Severity Of Immune Deficiency Research Articles

Echocardiographic and electrocardiographic abnormalities in adults living with human immunodeficiency virus: a cross-sectional study in the Yaoundé Central Hospital, Cameroon.

Cardiac involvement is frequent in the course of human immunodeficiency virus (HIV) infection disease. This work aimed at studying the profile of echocardiographic and electrocardiography (ECG) abnormalities in adults living with HIV (PLHIV), compared to those not infected with HIV at the treatment unit of the Yaoundé Central Hospital. We carried out a case-control study over three months at the HIV treatment unit. We included adults of both sexes, aged ≥21 years, HIV-infected (cases), and age and sex matched controls. Those with a history of heart disease were excluded. We collected sociodemographic, clinical, ECG, and echocardiographic data. We included 59 PLHIV and 59 age-sex matched controls without HIV infection. The prevalence of echocardiographic abnormalities was 28.8% in cases, and 8.5% in the control group (P=0.005). The prevalence of ECG abnormalities was 28.8% in the cases, and 18.6% in the control group (P=0.195). The main echocardiographic abnormalities (cases versus controls) were aortic regurgitation (10.2% versus 3.4%, P=0.144), right atrial dilation (6.8% versus 1.7%, P=0.178), diastolic dysfunction (5.1% versus 1.7%, P=0.310), and Left ventricular hypertrophy (5.1% versus 0%, P=0.080). The main ECG abnormalities (cases versus controls) were abnormal repolarization (11.9% versus 5.1%, P=0.187), sinus tachycardia (10.2% versus 6.8%, P=0.510), and atrial fibrillation (5.1% versus 0%, P=0.080). HIV infection was significantly associated with echocardiographic abnormalities and not with ECG abnormalities. The degree of immune deficiency was independently associated with the occurrence of echocardiographic and ECG abnormalities. HIV infected adults have more echocardiographic and ECG abnormalities compared to non-infected adults. The ECG and echocardiographic anomalies varied, and depends on the severity of immune deficiency.

Challenges in Managing Hospitalized HIV Infected Persons with Low Absolute CD4 and Preserved CD4 Percentage

Background: HIV infected persons are at risk for opportunistic illnesses based upon severity of immune deficiency. Management is generally based upon the most recent absolute CD4 count. We hypothesized there is a group of patients with a low absolute CD4 count and preserved CD4 percentage that are at low risk of AIDS-related opportunistic illnesses (OI). Methods: A retrospective review of medical records in HIV-infected persons hospitalized from 2004-2006. Individuals without CD4 counts available within 180 days of admission and during hospitalization were excluded. Patients with a decrease in the absolute CD4 count during hospitalization and stable CD4 percentage were compared to the rest of the cohort. Appropriate management was defined using DHHS guidelines for the prevention and treatment of opportunistic illnesses in HIV infection. Results: 464 patients had 978 hospitalizations. In 221 hospitalizations (N = 161 patients) inpatient and outpatient CD4 counts were available. In 35 hospitalizations (N = 25 patients) the absolute CD4 count declined with stable CD4 percent (cases). Cases had an average decline in CD4 of –197 cells/mm3 compared to –5 cells/mm3 in the comparator group. 30% of comparators had AIDS defining OI's compared to none in the case group (p = 0.01). Management outside of DHHS guidelines was more common in cases compared to the comparator group (49% vs 30%, p = 0.048). The median length of stay was prolonged in cases with management outside guidelines compared to appropriately managed persons in the comparator group (7 days vs 3.5 days, p = 0.03). Conclusion: In persons on potent antiretroviral therapy, abrupt declines in absolute CD4 counts without an accompanying change in CD4 percentage are associated with a low risk of AIDS related opportunistic infection, a higher rate of in-patient management outside DHHS guidelines, and a more prolonged length of stay.

Antiretroviral-therapy-associated lipoatrophy: current status and future directions

Lipoatrophy is perhaps the most visibly recognisable component of antiretroviral-therapy-associated lipodystrophy due to the rarity of this form of body composition change in the general population. In this respect, it is apparent that lipoatrophy represents a form of drug toxicity specifically involving the subcutaneous fat tissue, resulting in pathological fat loss that preferentially affects the limbs and face. It is now clear that the choice and duration of nucleoside analogue reverse transcriptase inhibitor (NRTI) therapy (stavudine > zidovudine) is the dominant risk factor for clinical lipoatrophy, as well as for the pathological changes to adipose tissue that underlie the clinical syndrome. Host factors have also emerged as important modulators of lipoatrophy severity in patients receiving these NRTI drugs, including age, racial origin, and severity of immune deficiency. On the other hand, the use of selected HIV protease inhibitor drugs is more closely associated with metabolic complications such as dyslipidemia and insulin resistance and has not been convincingly linked to lipoatrophy. This review examines the clinical and pathological manifestations of lipoatrophy, and also presents information regarding the safety profile of alternative NRTI drugs, such as tenofovir and abacavir, that have not been associated with lipoatrophy risk. With increasing knowledge of lipoatrophy pathogenesis, it is likely that moderate and severe forms of this complication can now be considered a preventable complication of HIV treatment. However, it is also important to recognise that there is an ongoing burden of disease in patients who have been affected by lipoatrophy over the past six years, and that therapeutic management of established lipoatrophy will remain a challenge into the future.

No relationship between gastric pH, small bowel bacterial colonisation, and diarrhoea in HIV-1 infected patients

Background/AimsConclusive studies of small bowel bacterial overgrowth in patients with HIV-1 infection are limited. The relation was therefore determined between the quantity and species of bacteria in the proximal small...

RISK FACTORS FOR AIDS ASSOCIATED NON-HODGKIN'S LYMPHOMA: A CASE-CONTROL STUDY.

S6 Background: Although non-Hodgkin's lymphoma (NHL) occurs in more than 5% of people with AIDS, little is known of risk factors for this malignancy. The one clear risk factor is severity of immune deficiency. Our study was designed to identify other risk factors for NHL, including demographic, clinical and laboratory factors. Methods: 219 people with AIDS-NHL diagnosed in Sydney prior to 1995 were compared to 219 HIV positive controls matched for degree of immune deficiency as indicated by CD4 lymphocyte count. Data on risk factors were abstracted by medical record review. Results: AIDS and cancer register linkage confirmed that all registered cases of AIDS-NHL in the study area were included. The CD4 counts of cases and controls did not differ significantly (p = 0.66). NHL risk was associated with indices of prolonged immune deficiency including longer time since seroconversion (median of 6.5 and 5.0 years in cases and controls for whom this was known, p = 0.001), lower CD4 count one year prior to diagnosis (p trend 0.003) and a prior diagnosis of mycobacterium avium complex disease (OR 3.2, 95% CI 1.2-10). Markers of immune stimulation, including raised serum globulin (p trend 0.015), IgG (p trend 0.026), and HIV p24 antigen positivity (OR 2.0, 95% CI 1.3-3.3) were also associated with risk of NHL. Indices of lytic EBV infection, including a prior diagnosis of oral hairy leukoplakia and receipt of anti-herpesvirus therapy, were not associated with risk, although receipt of ganciclovir prior to diagnosis was non-significantly protective (OR 0.51, 95% CI 0.20-1.25). Total dose of AZT received was not related to risk of NHL, and the highest dose level of ddC was associated with a decreased risk of NHL (OR 0.38, 95% CI 0.17-0.82). Conclusion: These data indicate that prolonged immune deficiency and immune stimulation are risk factors for NHL in people with HIV. This study does not support a role of anti-EBV therapy in NHL prophylaxis. Our results suggest that effective anti-HIV therapy may decrease the risk of NHL by decreasing immune stimulation.

Spectrum of disease in Africans with AIDS in London.

To compare the spectrum of disease, severity of immune deficiency and chemoprophylaxis prescribed in HIV-infected African and non-African patients in London. Retrospective review of case notes of all HIV-infected Africans and a comparison group of non-Africans attending 11 specialist HIV/AIDS Units in London. Comparison of demographic information, first and subsequent AIDS-defining conditions, levels of immune deficiency, and chemoprophylactic practices between the African and non-African groups. A total of 1056 Africans (313 developing AIDS) and 992 non-Africans (314 developing AIDS) were studied. Africans presented later than non-Africans (median CD4+ lymphocyte counts at diagnosis 238 and 371 x 10(6)/l, respectively). Tuberculosis accounted for 27% of initial episodes of AIDS in Africans and 5% in non-Africans; Pneumocystis carinii pneumonia (PCP) was the initial AIDS-defining condition in 34% of non-Africans and 17% of Africans. The incidence of tuberculosis in Africans with another AIDS-indicator disease was 16 per 100 person-years. PCP prophylaxis was prescribed for 40% Africans and 32% non-Africans; only 8% of Africans received tuberculosis preventive therapy. HIV-infected African patients presented at lower levels of CD4+ lymphocyte count, at a more advanced clinical stage, and with different AIDS-indicator diseases as compared with non-Africans. Prophylaxis against tuberculosis should be considered for all HIV-infected African patients in industrialized countries. The high incidence of diseases that are indicative of advanced immunodeficiency (e.g., cytomegalovirus disease) in African patients contrasts with data from Africa, suggesting better survival chances in the UK.

Response to treatment, mortality, and CD4 lymphocyte counts in HIV-infected persons with tuberculosis in Abidjan, Côte d'Ivoire

We examined the severity of immune deficiency in patients with HIV-associated tuberculosis in Côte d'lvoire and assessed its effect on mortality and response to treatment. Consecutive patients attending a tuberculosis treatment centre in Abidjan with smear-positive pulmonary or clinically diagnosed extrapulmonary tuberculosis were tested for HIV-1 and HIV-2 infections and had CD4 lymphocyte counts measured. Patients received standard short-course chemotherapy. Analysis of outcome (restricted to smear-positive tuberculosis patients) was done at 6 months. The 247 HIV-positive patients were significantly more likely than the 312 HIV-negative patients to have CD4 lymphocyte counts of less than 200/μL (43% vs 1%; odds ratio 56·9; [95% Cl 19·7-185·3]) and 200-499/μL (39% vs 14%, odds ratio 3·8; [2·5-5·9]). Among HIV-positive patients, median CD4 lymphocyte counts in those with extrapulmonary tuberculosis (198/μL; n=67) was lower, but not significantly so, than among those with pulmonary tuberculosis (257/μL; n=180). Among 460 patients with pulmonary tuberculosis, the overall mortality rate was significantly higher in HIV-positive than HIV-negative persons (6% vs 0·4%; relative risk 17·1 [2·2-131·4]), and increased with the severity of immune deficiency; mortality rates in HIV-positive patients with CD4 counts of <200/μL and 200-499/μL were 10% and 4%, relative risk 27·6 (3·5-220·8); and 11·5 (1·2-109), respectively, compared to HIV-negatives. Among patients completing treatment, cure rates were similar in HIV-positive patients (93%) and HIV-negative patients (92%), and were not related to CD4 counts. Severity of immune deficiency was the major determinant of mortality in HIV-associated tuberculosis. Among people completing treatment, microbiological response was satisfactory irrespective of serological or immune status.