Significant Increase In CD4 Counts Research Articles

Safety and Efficacy of Directly Acting Antivirals (Sofosbuvir & Daclatasvir) in Treatment of Chronic HCV

Abstract Background The introduction of direct-acting antiviral agents, has revolutionized the treatment for chronic HCV with higher cure rates, shorter duration of treatment and more tolerability have been achieved. Aim of the Work The aim of our study is to estimate the efficacy and safety of DAAs in treatment of chronic HCV in patients co-infected with HIV. Patients and Methods This study of previously untreated HCV infection in patients with HCV and HIV co-infection conducted at Abbasia Fever Hospital, from July 2019 to February 2020. Patients included are chronic HCV infection and were receiving antiretroviral therapy for the HIV with a CD4 T-lymphocyte count of 200 cells/mL or greater. Serial measurements of safety parameters, virologic and host immune correlates, and adherence were performed during treatment by combination of daclatasvir 90mg and sofosbuvir 400mg+/- ribavirin 800mg daily for 12 weeks. Results In this study, the rate of a sustained virologic response (SVR) at post-treatment week 12 (SVR 12) were high (29/30, 96.67%). The most common adverse events were fatigue (73.33%), headache (46.67%), and there was a high safety profile on using DAAs. No patient discontinued treatment because of adverse events. No serious adverse events or mortality were reported. In this study, AST & ALT were significantly decreased at end of treatment and 12 weeks after treatment, CD4 count was significantly increased. Otherwise there are no significant changes in both hematological and biochemical laboratory results. Conclusion Combination of daclatasvir and sofosbuvir have showed 96.67% sustained virologic response at 12 weeks after treatment (SVR 12) among HIV/HCV co-infected patients, with a very good safety profile. Moreover, the treated patients showed a significant increase in CD4 count. Accordingly, HIV/HCV co-infected patients should be treated with sofosbuvir and daclatesvir containing regimens.

A Longitudinal study on the Kinetic of T-cells and certain hematological parameters during the Initiation of antiretroviral therapy and after two years on treatment

Background: T- cell are key regulators of the immune system and their role in the initiating and follow –up of patients on antiretroviral therapy (ART) is primordial. In the present work, we compared T-cells and certain biological parameters after 2 months of ART with those obtained after one year and 2 years of ART. Method: In this prospective cohort study, 150 HIV patients on primo ART treatment and consenting were recruited. Five ml of blood were collected at initiation (M0), after 2 months (M2), after 1 year (M12), and after 2 years (M24) of ART. CD4 cells, CD8 cells, and other hematological parameters were measured according to standard operating procedures. Results: The 88 retained participants included 18 (20.6%) men and 70 (79.4%) women, with a mean age of 35.5 years. After 2 months, there was a significant increase in CD4 count, monocytes, and platelets with p-values of 0.001, 0.02, and 0.04, respectively, while hemoglobin and CD8 cells did not significantly change (p-values of 0.06 and 0.82, respectively). After one year and after two years of therapy, the increases in these parameters were not statistically significant compared to the values obtained at M2. Conclusion: CD4 lymphopenia, monopénia and thrombopenia induced by HIV infection are corrected maximally during the first months after the beginning of ART and tend to stabilize over time, while anemia can continue to persist.

SARS-CoV-2 mRNA vaccination and short-term changes in viral load and CD4/CD8 T-cell counts in people living with HIV

ObjectivesTo investigate whether SARS-CoV-2 messenger RNA (mRNA) vaccination has an impact on HIV-related viro-immunological parameters. MethodsPeople with HIV (PWH) in the VAXICONA-ORCHESTRA cohort who received one or more doses of SARS-CoV-2 mRNA vaccine and for whom paired measures of immuno-virological markers (viral load, clusters of differentiation [CD]4, and CD8 count 1 month before and after a vaccine dose [VD]) were available were included. Paired t-test and generalized estimating equation linear regression analyses were used to study changes over ± 1 month around the VD. Subgroup analyses were performed. ResultsA total of 510 PWH were enrolled: the median age was 55 years (interquartile range 46-60 years), the CD4 and CD8 count were 489 (287-719) and 790 (59-1104) cells/mm3, respectively, and 81% received three VDs. After a median of 28 (3-53) days from VD, CD4 count increased by +15 cells/mm3 (SD ± 129.7, P = 0.001) and CD8 by +12 (±250.5, P = 0.199) and the viral load decreased by −0.11 log10 (±0.88, P = 0.001). Similar results were observed after restricting the analysis to viro-suppressed PWH, with CD4 ≤200/mm3, more than 6 months of antiretroviral therapy before VD and after excluding previous COVID-19. ConclusionsA small significant increase in CD4 count and a negligible drop in HIV RNA were observed. Our findings are consistent with the hypothesis that SARS-CoV-2 mRNA vaccine can prime CD4 T spike-specific cells, even in the more immuno-compromised PWH.

Evaluation of the effects of Artemisia Annua L. and Moringa Oleifera Lam. on CD4 count and viral load among PLWH on ART at Mbarara Regional Referral Hospital: a double-blind randomized controlled clinical trial

BackgroundInitiation of ART among people living with HIV (PLWH) having a CD4 count ≤ 350cells/µl, produces poor immunological recovery, putting them at a high risk of opportunistic infections. To mitigate this, PLWH on ART in Uganda frequently use herbal remedies like Artemisia annua and Moringa oleifera, but their clinical benefits and potential antiretroviral (ARV) interactions remain unknown. This study examined the impact of A. annua and M. oleifera on CD4 count, viral load, and potential ARV interactions among PLWH on ART at an HIV clinic in Uganda.Methods282 HIV-positive participants on antiretroviral therapy (ART) with a CD4 count ≤ 350cells/µl were randomized in a double-blind clinical trial to receive daily, in addition to their routine standard of care either; 1) A. annua leaf powder, 2) A. annua plus M. oleifera, and 3) routine standard of care only. Change in the CD4 count at 12 months was our primary outcome. Secondary outcomes included changes in viral load, complete blood count, and ARV plasma levels. Participants were followed up for a year and outcomes were measured at baseline, 6 and 12 months.ResultsAt 12 months of patient follow-up, in addition to standard of care, administration of A. annua + M. oleifera resulted in an absolute mean CD4 increment of 105.06 cells/µl, (p < 0.001), while administration of A. annua plus routine standard of care registered an absolute mean CD4 increment of 60.84 cells/µl, (p = 0.001) compared to the control group. The A. annua plus M. oleifera treatment significantly reduced viral load (p = 0.022) and increased platelet count (p = 0.025) and white blood cell counts (p = 0.003) compared to standard care alone, with no significant difference in ARV plasma levels across the groups.ConclusionA combination of A. annua and M. oleifera leaf powders taken once a day together with the routine standard of care produced a significant increase in CD4 count, WBCs, platelets, and viral load suppression among individuals on ART. A. annua and M. oleifera have potential to offer an affordable alternative remedy for managing HIV infection, particularly in low-resource communities lacking ART access.Trial registrationClinicalTrials.gov NCT03366922.

A Real-world Evidence-based Management of HIV by Differential Duration HAART Treatment and its Association with Incidence of Oral Lesions.

BackgroundThe efficacy of highly active antiretroviral therapy (HAART) can be estimated by the immunological response and the incidence of opportunistic infections.ObjectiveThis study aimed at evaluating the effectiveness of different durations of HAART in terms of immunological response markers (CD4 count and CD4/CD8 ratio) along with disease progression markers (incidence of oral lesions) in Chinese patients with HIV.MethodsThis single-center, retrospective, and real-world study included patients with HIV, grouped into a treatment group and treatment-naïve group, of which the former was further divided into 6, 12, and 18 months based on the treatment duration. The CD4 and CD8 cell counts were analyzed by the FACSCalibur flow cytometry. Kruskal-Wallis test was applied to determine the outcome of different duration of HAART. Oral examination was carried out according to the WHO type IV examination.ResultsIn 246 patients with HIV, CD4 counts increased significantly post-HAART compared to pre-HAART in all three treatment groups (P<.001), while CD8 count decreased significantly (P<.05) in all three treated groups. A significant association of HAART with the CD4/CD8 ratio was observed (P<.001). A significant increase in CD4 count was observed between 12-months and 18-months treatment groups (P<.05). The occurrence of oral lesions reduced significantly in the treatment group.ConclusionWe observed a better response to the HAART regimen with 18-months of duration than 12-months and 6-months therapies and reduction in oral lesions.

Influence of hepatitis B virus co-infection on virological and immunological response to antiretroviral treatment among HIV patients attending comprehensive care clinics in Makueni County, Kenya.

Introductionthe effect of hepatitis B virus (HBV) infection on the natural history of human immunodeficiency virus (HIV) disease remains uncertain. Therefore, this study was conducted to determine the association of HBV co-infections with CD4 count and viral load levels in response to antiretroviral treatment among HIV patients attending comprehensive care clinics in Makueni County (Kenya).Methodsthis was a prospective case-control study among patients seeking HIV services in three hospitals of Makueni County (Kenya). Newly diagnosed HIV mono-infected patients (controls) and HIV/HBV co-infected (cases), 18 years and above who had not started antiretrovirals (ARVs) participated. A total of 258 patients gave informed consent and participated. HIV mono-infected (controls) produced 129 while HIV/HBV (cases) gave 129 participants. P-values ≤ 0.05 were considered significant.Resultsthe majority (164, 63%) of the study participants were females for both arms of the study. The mean age of the participants was 31±0.402 years and majority of them were between the age of 26-30years old. At the beginning and end of the study the mean viral load for HIV/HBV co-infected individuals was (30169 and 1731) copies/ml while that of CD4 count was (327 and 459) cells/ul, and that of HIV mono-infected was (21860 and 1689) copies/ml and CD4 count of (421 and 437) cells/ul respectively. After enrolling them into antiretroviral therapy (ART) treatment and after six months of follow-up there was significant drop in viral load and significant increase in CD4 count for both groups at p<0.001 using logistic regression.ConclusionHIV patients co-infected with hepatitis B virus had high viral load and low CD4 count compared to HIV monoinfected patients however with introduction of ARVs there was improvement in both groups with the highest noticed among the HIV/HBV co-infected patients.

The Effect of Probiotics, Prebiotics, and Synbiotics on CD4 Counts in HIV-Infected Patients: A Systematic Review and Meta-Analysis.

Background Probiotics as a potential adjuvant therapy may improve the restoration of the intestinal CD4+ T-cell population in HIV-infected patients, whereas findings from clinical trials are inconsistent. This systematic review and meta-analysis of randomized controlled trials (RCTs) was performed to quantify the effects of probiotic, prebiotic, and synbiotic supplementation on CD4 counts in HIV-infected patients. Methods We searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials for relevant articles published up to March 20, 2020. Two authors independently performed the study selection, data extraction, and risk of bias assessment. Data were pooled by using the random effects model, and weighted mean difference (WMD) was considered the summary effect size. Publication bias was evaluated by a funnel plot and Egger's test. Results The search strategy identified 1712 citations. After screening, a total of 16 RCTs with 19 trials were included in the meta-analysis. Pooling of the extracted data indicated no significant difference between the probiotics/prebiotics/synbiotics and placebo groups on CD4 counts (WMD = 3.86, 95% confidence interval (CI) -24.72 to 32.45, P = 0.791). In subgroup analysis, a significant increase in CD4 counts was found in the study with high risk of bias (WMD = 188, 95% CI 108.74 to 227.26, P ≤ 0.001). Egger's test showed no evidence of significant publication bias (P = 0.936). Conclusions In summary, the evidence for the efficacy of probiotics, prebiotics, and synbiotics in improving HIV-infected patients' CD4 counts as presented in currently published RCTs is insufficient. Therefore, further comprehensive studies are needed to reveal the exact effect of probiotics, prebiotics, and synbiotics on CD4+ cell counts.

Treatment outcome of different antiretroviral drug regimens in HIV-positive pregnant women.

Objective:The objective of the study was to compare the maternal and fetal outcomes of currently preferred tenofovir-based regimen with previous zidovudine-based regimen and also to determine whether the time of starting antiretroviral therapy (ART), whether it can affect the pregnancy and fetal outcome.Materials and Methods:Pregnant patients prescribed any of the above regimens were followed up every month till delivery and newborns for initial 6 months. Maternal endpoints were body weight, hemoglobin, and CD4 count, whereas fetal endpoints were birth weight, Apgar score, body weight, and HIV status at 6 months. Data were analyzed using ANOVA and unpaired t-test. P <0.05 was considered statistically significant.Results:A significant increase in CD4 count was observed in patients treated with both the regimens at 12 months as compared to baseline (P < 0.001 and 0.05). Moreover, a significant increase in CD4 count was observed at 12 months as compared to baseline, whether treatment was started before or after the diagnosis of pregnancy (P < 0.05 and 0.001). A significant difference in mean body weight at the end of 9 months was observed in patients wherein ART was started before or after the diagnosis of pregnancy (P < 0.005). Majority of patients had a favorable maternal outcome, while fetal birth weight, Apgar score, body weight, and HIV status were comparable at 6 months irrespective of treatment and time of starting ART.Conclusion:All ART regimens are equally effective in terms of increase in CD4 count, gestational gain in body weight, and pregnancy and fetal outcome. Furthermore, there is no significant difference in efficacy, pregnancy, and fetal outcome in women who were already on ART when diagnosed pregnancy or who were started ART later in antenatal period.

356. HIV-HCV Coinfection: An Investigation of CD4 T-Cell Reconstitution after HCV Direct-Acting Antiviral Treatment

BackgroundBoth human immunodeficiency virus (HIV) and hepatitis C virus (HCV) can adversely affect CD4 cell count. Among patients with HIV-HCV coinfection, treatment with HCV direct-acting antivirals (DAAs) may be an opportunity to restore/reconstitute CD4 count. The primary objective of this study was to determine whether DAA treatment results in improved CD4 cell counts in HIV-HCV coinfected patients.MethodsA retrospective multicenter cohort study was performed among 4 sites between 11/1/2013–4/12/2018. Patients were included if they were age ≥18 years, infected with both HIV and HCV, and received all-oral DAA therapy. Trained reviewers extracted demographics, comorbidities, receipt of antiretroviral therapy (ART), DAA treatment regimen/duration and HIV/HCV-related lab values, which included CD4, HIV RNA, and HCV RNA. Labs were restricted to the closest values before/after DAA treatment. The primary endpoint was changed in pre-DAA/post-DAA CD4 count. Descriptive statistic and Wilcoxan Signed Rank were used.ResultsThere were 88 patients included. Most (78.4%) identified as male. Mean ± standard deviation (SD) age was 57.1 ± 9.6 years. The proportion of patients with undetectable pretreatment HIV RNA was 78.4%. Among the 97.7% of patients on ART, regimens included the following classes of ART: integrase strand transfer inhibitor (75.6%), non-nucleoside reverse transcriptase inhibitors (23.3%) and protease inhibitors (19.8%). Of the 87 patients who completed DAA therapy and had post-DAA labs drawn, sustained virologic response (SVR) was achieved in 96.6%. The median (interquartile range, IQR) CD4 counts before/after DAA treatment did not significantly differ [515 (349–704) vs. 554 (374–693), P = 0.80]. In the subset of patients with pre-DAA CD4 counts < 350 cells/mm3 (n = 23), CD4 count significantly improved before/after DAA treatment [235 (202–311) vs. 309 (189–392), P = 0.01].ConclusionThe use of DAA therapy in HIV-HCV co-infected patients resulted in a significant increase in CD4 count in patients with pre-DAA CD4 < 350 cells/mm3. This may represent a high priority population for DAA treatment.Disclosures All authors: No reported disclosures.

Comparison of efficacy of stavudine and zidovudine on CD4 counts in triple drug therapy regimen in patients with HIV infection - a retrospective study.

The main objective of the study is 1. To compare the effect of triple drug therapy with stavudine + lamivudine + nevirapine on CD4 counts 6months and 12 months after therapy. 2. To compare the effect of triple drug therapy with zidovudine + lamivudine + nevirapine on CD4 counts 6months and 12 months after therapy. 3. To compare the efficacy of the above two mentioned regimens. Methods: In this retrospective study, data was collected from the antiretroviral therapy (ART) Centre where 46 subjects infected with HIV received stavudine + lamivudine + nevirapine and 54 subjects infected with HIV received zidovudine + lamivudine + nevirapine. Baseline CD4 counts were recorded and compared with CD4 counts after 6 months and 12 months after therapy in each regimen. Changes in CD4 counts in both the regimen were also compared. Statistical analysis was done using ANOVA followed by Tukey test for group wise comparison. Results: Statistical analysis showed that there was no significant change in CD4 count after 6 months of treatment in stavudine group whereas there was significant increase in CD4 counts after 12 months after therapy with stavudine + lamivudine + nevirapine. But there was a significant increase in CD4 counts after both 6 months and 12 months of treatment with zidovudine + lamivudine + nevirapine. But when efficacy of both the regimen was compared with each other there was no significant change in the CD4 counts. Conclusion: This nevirapine and zidovudine + lamivudine + nevirapine are equally efficacious but improvement of CD4 counts after initial 6 months of therapy is better with zidovudine + lamivudine + nevirapine treated group than compared with stavudine + lamivudine + nevirapine treated group. // //

Peripheral T Cell Subpopulation in Patients with Hepatocellular Carcinoma: Relation to Ablation Therapy

Background: Ablation therapy with advances in its techniques becomes widely used in patients with hepatocellular carcinoma. Ablative techniques can induce tumor cell death and stimulate many immunological responses. These responses can be evaluated through assessment of peripheral immune cells changes in systemic circulation. Aims: To investigate changes in the peripheral immune cells presented in CD4, CD8 and CD4/CD8 ratio after HCC ablation by different procedures and their relations to ablation result. Subjects and Methods: This study investigated 73 HCC patients admitted to Department of Tropical Medicine, Mansoura University Hospital, Egypt. The patients were stratified into three groups according to ablative technique used. Radiofrequency ablation was performed for 24 cases, microwave ablation for 24 and transarterial chemoembolization for 25 cases. After history taking, clinical examination, basic investigations, triphasic abdominal computerized tomography before and 4 weeks after the treatment, HCC patients were selected according to EASL guideline. Lymphocyte subset assay using flow cytometry 1 day before, and 4 weeks post ablation was done. The patients subdivided into successful and unsuccessful subgroup according to the result of ablation by CT. Results: In patients treated with Radiofrequency ablation, significant increase in CD4 count and CD4/CD8 ratio after treatment (P<0.001), while CD8+ cells count significantly decreased (P<0.002). In HCC patients treated with microwave ablation, CD4+ count and CD4/CD8 ratio significantly increased after treatment (P<0.001,<0.007), without significant differences in CD8+ cells count. After transarterial chemoembolization, CD4+ cells count and CD4/CD8 ratio significantly decreased (P<0.001) with significant increase of CD8+ cells (P<0.001). Changes in CD4, CD8, and CD4/CD8 ratio remained comparable to that occurred in both successfully ablated and cases with residual tumor. Conclusion: Various ablation procedures of HCC are associated with significant changes in peripheral T cell subpopulation. These changes mostly were due to the ablation of tumor cells but these changes cannot predict the success of ablation or recurrence of previously ablated one.

Effect of Integrated Yoga (IY) on psychological states and CD4 counts of HIV-1 infected patients: A randomized controlled pilot study.

Background:Human immunodeficiency virus (HIV) infected individuals frequently suffer from anxiety and depression. Depression has been associated with rapid decline in CD4 counts and worsened treatment outcomes in HIV-infected patients. Yoga has been used to reduce psychopathology and improve immunity.Aim:To study the effect of 1-month integrated yoga (IY) intervention on anxiety, depression, and CD4 counts in patients suffering from HIV-1 infection.Methods:Forty four HIV-1 infected individuals from two HIV rehabilitation centers of Manipur State of India were randomized into two groups: Yoga (n = 22; 12 males) and control (n = 22; 14 males). Yoga group received IY intervention, which included physical postures (asanas), breathing practices (pranayama), relaxation techniques, and meditation. IY sessions were given 60 min/day, 6 days a week for 1 month. Control group followed daily routine during this period. All patients were on anti-retroviral therapy (ART) and dosages were kept stable during the study. There was no significant difference in age, gender, education, CD4 counts, and ART status between the two groups. Hospital anxiety and depression scale was used to assess anxiety and depression, CD4 counts were measured by flow cytometry before and after intervention. Analysis of variance – repeated measures was applied to analyze the data using SPSS version 10.Results:Within group comparison showed a significant reduction in depression scores (F [1, 21] =4.19, P < 0.05) and non-significant reduction in anxiety scores along with non significant increment in CD4 counts in the yoga group. In the control group, there was a non-significant increase in anxiety and depression scores and reduction in CD4 counts. Between-group comparison revealed a significant reduction in depression scores (F [1, 21] =5.64, P < 0.05) and significant increase in CD4 counts (F [1, 21] =5.35, P < 0.05) in the yoga group as compared to the control.Conclusion:One month practice of IY may reduce depression and improve immunity in HIV-1 infected adults.

Effects of adherence to antiretroviral therapy on body mass index, immunological and virological status of Nigerians living with HIV/AIDS

ObjectiveThis study determined the effect of adherence to highly active antiretroviral therapy (HAART) on body mass index (BMI) and immunological and virological parameters of people living with HIV/AIDS (PLWHA) attending University College Hospital, Ibadan. MethodologyProspective cohort of consenting PLWHA was followed up for a minimum of 3months, had their drug adherence determined using pharmacy records and self-reporting. The sociodemographic data, weight, height, plasma viral load and CD4 count were recorded at baseline and 3months. These data were entered into the computer and analyzed. ResultsA total of 318 PLWHA with a median age of 38±9.6years participated. Fifty-four percent were female. Sixty-three percent were 95% adherent to HAART. Most (99.4%) were on non-nucleoside reverse transcriptase inhibitor-based therapy. There was a remarkable fall in viral load to non-detectable levels among adherent compared with non-adherent PLWHA. Furthermore, there was a significant increase in CD4 count among adherent compared with non-adherent PLWHA. Adherent clients showed marked improvement in BMI and immunological and virological status. ConclusionAdherence to HAART reduced viral load to an undetectable level and increased CD4 count among adherent PLWHA on HAART.

Role of multivitamins, micronutrients and probiotics supplementation in management of HIV infected children.

To assess the immuno-clinical response of micronutrients supplementation in human immunodeficiency virus (HIV) infected children (both on and without antiretroviral therapy) and to assess the role of probiotics in improvement of CD4 counts in HIV infected children not on antiretroviral therapy. This was an open labeled randomized control study, conducted in Department of Pediatrics and Antiretrovial Therapy (ART) Center, S.N. Medical College, Agra. One hundred and twenty seven HIV infected children aged ≤ 15 y were included in the study. Enrolled children were randomized to receive micronutrients for 6 mo or probiotics for 3 mo. Children who did not receive supplements served as control. Change in WHO clinical stage, immunological stage, CD4 counts and body mass index (BMI) status were taken at the end of 6 mo. In probiotic group, mean CD4 count were taken as outcome measure. A detailed history, examination and WHO clinical staging were recorded for all the patients. In micronutrient supplemented group (not on ART), significant improvement was seen in WHO clinical staging (p = 0.049) when compared to controls after 6 mo. Probiotic supplemented group showed significant increase in CD4 counts compared to control group (p = 0.0022) in children >5 y. Control group showed significant decline in CD4 count in children ≤5 y (-65.3 cells/mm(3), p=0.005) and in children >5 y (-87.9 cells/mm(3), p=0.05) after 12 wk of supplementation. Probiotics supplementation has shown significant improvement in CD4 counts. Micronutrients supplementation has shown significant delay in the progression towards advance stage of disease.

Treatment of HIV-associated facial lipoatrophy: impact on infection progression assessed by viral load and CD4 count

BACKGROUND HIV/AIDS-Associated Lipodystrophy Syndrome includes changes in body fat distribution, with or without metabolic changes. The loss of fat from the face, called facial lipoatrophy, is one of the most stigmatizing signs of the syndrome. OBJECTIVESTo evaluate the effect of FL treatment using polymethylmethacrylate (PMMA) implants on disease progression, assessed by viral load and CD4 cell count. METHODS This was a prospective study of 44 patients treated from July 2009 to December 2010. Male and female patients, aged over 18 years, with clinically detectable FL and who had never been treated were included in the study. PMMA implantation was done to fill atrophic areas. Laboratory tests were conducted to measure viral load and CD4 count before and after treatment. RESULTS Of the 44 patients, 72.72% were male and 27.27% female, mean age of 44.38 years. Before treatment, 82% of patients had undetectable viral load, which increased to 88.6% after treatment, but without statistical significance (p = 0.67). CD4 count before treatment ranged from 209 to 1293, averaging 493.97. After treatment, the average increased to 548.61. The increase in CD4 count after treatment was statistically significant with p = 0.02. CONCLUSION The treatment of FL with PMMA implants showed a statistically significant increase in CD4 count after treatment, revealing the impact of FL treatment on disease progression. Viral load before and after treatment did not vary significantly.

Pregnancy Outcomes in Women with Advanced HIV Infection in Italy

Pregnancy has been associated with a low risk of HIV disease progression. Most pregnancies with HIV currently involve women who have not experienced AIDS-defining events, and are clinically classified as Centers for Disease Control and Prevention (CDC) groups A or B. We evaluated the main maternal outcomes among pregnant women with more advanced HIV disease, defined by CDC-C disease stage. Data from the Italian National Program on Surveillance on Antiretroviral Treatment in Pregnancy were used. A total of 566 HIV-infected mothers, 515 in stage A or B (CDC-AB group) and 51 in stage C (CDC-C group) were evaluated. The two groups had similar baseline characteristics. No differences were found in the main maternal and neonatal outcomes. Most of the women achieved viral suppression at end of pregnancy (>1000 copies per milliliter: CDC-C: 17.2%; CDC-AB: 13.7%). One year after delivery, HIV replication (HIV-RNA >1000 copies per milliliter) was present in 11.5% of CDC-AB women and 30.0% CDC-C women. Despite lower initial CD4 counts (300 versus 481 cells per microliter), CDC-C women maintained stable CD4 levels during pregnancy, and 1 year after delivery, a significant increase in CD4 count from preconception values was observed in both groups (CDC-C: +72 cells per microliter, p=0.031; CDC-AB: +43 cells per microliter, p<0.001). Only one AIDS event occurred in a woman with a previous diagnosis of AIDS. In CDC-C women, pregnancy is not associated with an increased rate of adverse maternal or neonatal outcomes, and a good immunovirologic response can be expected. During postpartum care, women with more advanced HIV infection should receive particular care to prevent loss of virologic suppression.

Evaluation of CD4+ T cells in HIV patients presenting with malaria at the University of Ilorin Teaching Hospital Nigeria.

CD4 count is an important immunological marker of disease progression in HIV seropositive patients. This study was carried out to determine the effect of malaria or fever of unknown origin on the population of CD4+ T lymphocytes of HIV seropositive patients attending the highly active antiretroviral therapy (HAART) clinic of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. 36 subjects were selected for this study. Ongoing history of fever was used as a case definition for malaria and malaria was confirmed from microscopic examination of thick and thin film of blood sample obtained from the patients during presentation with fever. The CD4 count was evaluated during presentation of fever and post-fever using flow cytometry. There was significant decrease in CD4 count of the patients. However, upon classifying the patients into 2 groups - those that returned to the clinic after a week and those that returned after a month; a significant increase in CD4 count was noticed in the group that returned after a week, while a significant decrease was noticed in the group that returned after a month (at p value of 95 %). Further classification of the patients based on presence of malaria parasite, and body temperature resulted in varying effects on CD4 count post-fever (in the general group, 27 were positive for malaria parasites). Of these 27, there was an increase in CD4 count in 9 (33.3 %). However in the group that returned after a week, all 6 (100 %) that were positive for malaria parasites showed increase in CD4 count. Five (26.3 %) of the 19 patients that had body temperature within the range of 35.5-37.4 °C showed an increase in CD4 count, while 7 (41.2 %) of the 17 patients that had body temperature of 37.5 °C and above showed an increase in CD4 count. The results led to the conclusion that while some components of the immune response to malaria could strengthen the immune system of HIV seropositive patients by increasing their CD4 count, other components will suppress their immunity by decreasing their CD4 count, accelerating the progression to AIDS.

Evaluation of CD4+ T Cells in HIV Patients Presenting with Malaria at the University of Ilorin Teaching Hospital Nigeria

AbstractCD4 count is an important immunological marker of disease progression in HIV seropositive patients. This study was carried out to determine the effect of malaria or fever of unknown origin on the population of CD4+ T lymphocytes of HIV seropositive patients attending the highly active antiretroviral therapy (HAART) clinic of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. 36 subjects were selected for this study. Ongoing history of fever was used as a case definition for malaria and malaria was confirmed from microscopic examination of thick and thin film of blood sample obtained from the patients during presentation with fever. The CD4 count was evaluated during presentation of fever and post-fever using flow cytometry. There was significant decrease in CD4 count of the patients. However, upon classifying the patients into 2 groups - those that returned to the clinic after a week and those that returned after a month - a significant increase in CD4 count was noticed in the group that returned after a week, while a significant decrease was noticed in the group that returned after a month (at p value of 95%). Further classification of the patients based on presence of malaria parasite, and body temperature resulted in varying effects on CD4 count post-fever (in the general group, 27 were positive for malaria parasites. Of these 27, there was an increase in CD4 count in 9 (33.3%). However in the group that returned after a week, all 6 (100%) that were positive for malaria parasites showed increase in CD4 count. Five (26.3%) of the 19 patients that had body temperature within the range of 35.5-37.4^o^C showed an increase in CD4 count, while 7 (41.2%) the 17 patients that had body temperature of 37.5^o^C and above showed an increase in CD4 count. The results led to the conclusion that while some components of the immune response to malaria could strengthen the immune system of HIV seropositive patients by increasing their CD4 count, other components will suppress their immunity by decreasing their CD4 count, accelerating the progression to AIDS.

Safety, efficacy, and tolerability of nelfinavir-containing antiretroviral therapy for patients coinfected with HIV and hepatitis C undergoing methadone maintenance

The safety, efficacy, and tolerability of nelfinavir (NFV)-containing antiretroviral therapy were evaluated in patients coinfected with HIV and hepatitis C undergoing methadone maintenance at an urban outpatient opioid treatment program serving a minority adult population. Eligibility covered methadone-maintained patients coinfected with HIV and hepatitis C who had received or were currently receiving NFV. The yield was 51 case patients. Parameters examined looked into safety, efficacy, and tolerability. Nelfinavir was discontinued in 2 patients for liver function abnormalities but resumed in 1 patient. One patient developed laboratory abnormalities during NFV therapy that were not present before NFV therapy; in 12 case patients, pre-NFV therapy liver function abnormalities resolved completely during NFV therapy. There was a statistically significant increase in CD4 count during NFV therapy. Viral load decreased or was unchanged in 10 case patients and increased in 8, of whom 5 had a CD4 count increase during NFV therapy. Three patients had diarrhea and 4 patients had constipation. Nelfinavir was not discontinued—neither was dose adjusted—in any of these patients. Patients who had received NFV ≥36 months had a smaller increase in mean methadone dose as compared with patients who had received NFV <36 months. The results show that NFV is safe, efficacious, and well tolerated.

Potential Utility of Mycobacterium w Vaccine in Control of Tuberculosis

Mycobacterium w is a non-pathogenic, saprophytic, atypical mycobacterium with the ability to produce macrophage activating factors from lymphocytes of human patients. Prior immunization with heat-killed suspension of Mycobacterium w shows protection against sub-lethal infection with Mycobacterium tuberculosis H37Rv in mice. Heatkilled Mycobacterium w vaccine is manufactured by M/s Cadila Pharmaceuticals, Ahmedabad, India. Combined heatkilled M. w vaccine and multidrug treatment (MDT) revealed clinical, histological and bacteriological improvements in highly bacillated untreated anergic lepromatous cases of leprosy. In healthy contacts of leprosy patients, M. w vaccine has shown lepromin conversion and protection against leprosy. Only a few clinical studies have been carried out using antituberculous treatment with and without M. w vaccine in pulmonary tuberculosis, in which faster sputum conversion and higher cure rate have been observed in M. w group. M. w vaccine has shown potential of Tuberculin conversion in HIV positive subjects. In a study, five monthly doses of M. w vaccine have shown highly significant increase in CD4 count in HIV positive human beings. More clinical trials are needed to confirm beneficial role of M. w vaccine as an immunomodulator in therapy and prevention of tuberculosis, particularly so in multidrug resistant tuberculosis and those with HIV infection. Keywords: Mycobacterium w, immunomodulator, tuberculosis, leprosy, immunoprophylaxis, immunotherapy