Spread Of Human Immunodeficiency Virus Infection Research Articles

Potential role of alveolar macrophages in HIV persistence and lung disease

While antiretroviral therapy (ART) has revolutionized the management of human immunodeficiency virus (HIV) and has enabled people living with HIV (PLWH) to achieve near-normal life expectancies, an HIV cure remains elusive due to the presence of HIV reservoirs. Furthermore, compared with individuals in the general population, PLWH support a higher burden of multimorbidity, including pulmonary diseases of both an infectious and non-infection nature, which may be a consequence of the formation of HIV reservoirs. Their gut, lymph nodes, brain, testes and lungs constitute important anatomic sites for the reservoirs. While CD4+ T-cells, and particularly memory CD4+ T-cells, are the best characterized cellular HIV reservoirs, tissue resident macrophages (TRM) and alveolar macrophages (AM) also harbor HIV infection. AM are the most abundant cells in bronchoalveolar (BAL) fluid in healthy conditions, and act as sentinels in the alveolar space by patrolling and clearing debris, microbes and surfactant recycling. Long-lived tissue-resident AM of embryonic origin have the capacity of self-renewal without replenishment from peripheral monocytes. As in other tissues, close cell-cell contacts in lungs also provide a milieu conducive for cell-to-cell spread of HIV infection and establishment of reservoirs. As lungs are in constant exposure to antigens from the external environment, this situation contributes to pro-inflammatory phenotype rendering pulmonary immune cells exhausted and senescent-an environment facilitating HIV persistence. Factors such as tobacco and e-cigarette smoking, lung microbiome dysbiosis and respiratory co-infections further drive antigenic stimulation and HIV replication. HIV replication, in turn, contributes to ongoing inflammation and clonal expansion. Herein, the potential role of AM in HIV persistence is discussed. Furthermore, their contribution towards pulmonary inflammation and immune dysregulation, which may in turn render PLWH susceptible to chronic lung disease, despite ART, is explored. Finally, strategies to eliminate HIV-infected AM are discussed.

Potential role of alveolar macrophages in HIV persistence and lung disease.

While antiretroviral therapy (ART) has revolutionized the management of human immunodeficiency virus (HIV) and has enabled people living with HIV (PLWH) to achieve near-normal life expectancies, an HIV cure remains elusive due to the presence of HIV reservoirs. Furthermore, compared with individuals in the general population, PLWH support a higher burden of multimorbidity, including pulmonary diseases of both an infectious and non-infection nature, which may be a consequence of the formation of HIV reservoirs. Their gut, lymph nodes, brain, testes and lungs constitute important anatomic sites for the reservoirs. While CD4+ T cells, and particularly memory CD4+ T cells, are the best characterized cellular HIV reservoirs, tissue resident macrophages (TRM) and alveolar macrophages (AM) also harbor HIV infection. AM are the most abundant cells in bronchoalveolar (BAL) fluid in healthy conditions, and act as sentinels in the alveolar space by patrolling and clearing debris, microbes and surfactant recycling. Long-lived tissue-resident AM of embryonic origin have the capacity of self-renewal without replenishment from peripheral monocytes. As in other tissues, close cell-cell contacts in lungs also provide a milieu conducive for cell-to-cell spread of HIV infection and establishment of reservoirs. As lungs are in constant exposure to antigens from the external environment, this situation contributes to pro-inflammatory phenotype rendering pulmonary immune cells exhausted and senescent-an environment facilitating HIV persistence. Factors such as tobacco and e-cigarette smoking, lung microbiome dysbiosis and respiratory coinfections further drive antigenic stimulation and HIV replication. HIV replication, in turn, contributes to ongoing inflammation and clonal expansion. Herein, the potential role of AM in HIV persistence is discussed. Furthermore, their contribution towards pulmonary inflammation and immune dysregulation, which may in turn render PLWH susceptible to chronic lung disease, despite ART, is explored. Finally, strategies to eliminate HIV-infected AM are discussed.

Human immunodeficiency virus transmission-Mechanisms underlying the cell-to-cell spread of human immunodeficiency virus.

Despite the success of combined antiretroviral therapy in controlling viral load and reducing the risk of human immunodeficiency virus (HIV) transmission, an estimated 1.5 million new infections occurred worldwide in 2021. These new infections are mainly the result of sexual intercourse and thus involve cells present on the genital mucosa, such as dendritic cells (DCs), macrophages (Mø) and CD4+ T lymphocytes. Understanding the mechanisms by which HIV interacts with these cells and how HIV exploits these interactions to establish infection in a new human host is critical to the development of strategies to prevent and control HIV transmission. In this review, we explore how HIV has evolved to manipulate some of the physiological roles of these cells, thereby gaining access to strategic cellular niches that are critical for the spread and pathogenesis of HIV infection. The interaction of HIV with DCs, Mø and CD4+ T lymphocytes, and the role of the intercellular transfer of viral particles through the establishment of the infectious or virological synapses, but also through membrane protrusions such as filopodia and tunnelling nanotubes (TNTs), and cell fusion or cell engulfment processes are presented and discussed.

Building a model and assessing the level of morbidity during the epidemic

The article considers the effectiveness of methods of mathematical models and control over the spread of human immunodeficiency virus (HIV) in Kazakhstan. Data were obtained for a 10-year period of the incidence of HIV infection, a distribution schedule for the morbidity of the population was created and analyzed using the Statistica application software package. A model of HIV spread is considered taking into account the social adaptation of the population,a scheme of a probabilistic model is constructed and a system of probabilistic differential equations is used. The current direction of the strategy for combating HIV infection is largely determined by a scientifically based system for assessing the epidemiological state of HIV infection using mathematical models that can determine the patterns of the epidemiological process with great confidence and predict the expected level of morbidity. Currently, according to scientists, there are about 150 different forecasting methods, but in practice 15-20 types of these methods are most often used. One of the methods used in the majority are expert assessment, extrapolation, mathematical modeling, mixed forecasts. To date, the problem of HIV infection is one of the most important Kazakhstan consistently implements steps to curb the spread of HIV infection. The problems of combating HIV infection are included in the state program of healthcare development of the Republic of Kazakhstan for 2020-2025.

Epidemiological assessment of factors associated with late diagnosis of HIV infection

Background. Late diagnosis of human immunodeficiency virus (HIV) infection contributes to its spread and becomes an obstacle to achieving the goal of early treatment.
 Aim. To conduct an epidemiological analysis of factors associated with late diagnosis of HIV infection.
 Material and methods. The study included data from 348 patients over 18 years of age living in Kazan, who were diagnosed with HIV infection for the first time in 2019. The proportion of patients with late diagnosis of HIV infection was determined. The criteria for late diagnosis were the level of CD4+-lymphocytes less than 200 cells/mm3 and/or the presence of 4 HIV stage (stage of secondary diseases) at the time of diagnosis. The assessment of the influence of probable factors on the timeliness of diagnosis was carried out using binary logistic regression. The regression model included data from 307 people who managed to determine the timeliness of diagnosis. For each factor, odds ratios were calculated (unadjusted based on the results of univariate analysis, adjusted based on the results of multivariate analysis), as well as their 95% confidence intervals.
 Results. Late diagnosis of HIV infection was noted in 32.6% of cases. Examination for clinical indications was associated with late diagnosis in comparison with examination for preventive purposes (adjusted odds ratio 2.427, 95% confidence interval 1.1844.973). The age of 50 years and older was associated with late diagnosis compared with patients 3049 years of age (adjusted odds ratio 3.348, 95% confidence interval 1.5427.265).The chances of late diagnosis under the age of 30 years are 5 times lower than in the 3049 year old group (adjusted odds ratio 0.200, 95% confidence interval 0.0720.556). The odds of late diagnosis are significantly higher among people who become infected through parenteral transmission through injecting drug use compared to those who become infected through sexual (heterosexual) transmission (adjusted odds ratio 2.012, 95% confidence interval 1.0423.885).
 Conclusion. In order to control the spread of HIV infection in the population, it is necessary to increase the coverage of HIV screening testing for all population groups, especially the older age group and injecting drug users.

Impact of a Ryan White Clinic on Statewide New HIV Infections

Introduction The Ryan White (RW) program is a cohort of services for underinsured, uninsured, and low-income patients with human immunodeficiency virus (HIV) infection. Although the RW program is known to enhance patient engagement and continuity of care, there are no studies that have investigated the direct impact of a RW clinic on statewide HIV transmission. Methods A retrospective review of 372 patients was undertaken at an HIV clinical site receiving RW funds in West Virginia (WV) in 2009-2019. Demographics, comorbid conditions, and details regarding disease acquisition were noted. In-state transmission was measured as the proportion of patients with newly diagnosed HIV who self-reported HIV acquisition within WV. With high rates of viral suppression and patient retention in our clinic, our hypothesis was that this proportion should decrease over time. Results Despite maintaining a greater than 90% retention of care and viral suppression rate over the study period, our data did not show a significant decline in the ratio of patients newly infected with HIV within WV over time (54.2% at the beginning of the study period vs 58.6% at the end, p-value 0.199). Conclusion Our results show that maintenance of high retention of care and viral suppression rates in one RW clinical site did not significantly reduce in-state transmission of HIV. Additional studies are needed to determine if maintaining high engagement in clinical services and sustained viral suppression across all HIV providers can reduce spread of in-state HIV infection.

Stigma and Discrimination in Treatment of Patients with HIV Co-Infection - Tuberculosis in the Osh Region of Kyrgyz Republic

Despite the downward trend in the incidence rate, the situation in Kyrgyzstan is complicated by the spread of drug-resistant tuberculosis and tuberculosis (TB) combined with human immunodeficiency virus (HIV) infection. Stigma and discrimination are among the strongest negative factors affecting the lives of people affected by tuberculosis, leading to many patients not seeing doctors or dropping out of treatment. This article is devoted to an important issue, the study of the manifestation of stigma and discrimination in patients with HIV - infection combined with tuberculosis, which leads to a delay in diagnosis, early initiation of treatment, an increase in the reservoir of the source of tuberculosis infection, including drug-resistant tuberculosis among population. The publication contains a thorough and detailed analysis of the complex of social and medico-biological actions necessary to prevent the spread of HIV infection and tuberculosis. Keywords: Treatment, HIV, Stigma and Discrimination, Co-Infection, Tuberculosis

Effective Human Immunodeficiency Virus Molecular Surveillance Requires Identification of Incident Cases of Infection.

Ending the human immunodeficiency virus (HIV) epidemic requires knowledge of key drivers of spread of HIV infection. Between 1996 and 2018, 1119 newly and previously diagnosed, therapy-naive persons with HIV (PWH) from San Diego were followed. A genetic distance-based network was inferred using pol sequences, and genetic clusters grew over time through linkage of sequences from newly observed infections. Cox proportional hazards models were used to identify factors associated with the rate of growth. These results were used to predict the impact of a hypothetical intervention targeting PWH with incident infection. Comparison was made to the Centers for Disease Control and Prevention (CDC) Ending the HIV Epidemic (EHE) molecular surveillance strategy, which prioritizes clusters recently linked to all new HIV diagnoses and does not incorporate data on incident infections. Overall, 219 genetic linkages to incident infections were identified over a median follow-up of 8.8 years. Incident cluster growth was strongly associated with proportion of PWH in the cluster who themselves had incident infection (hazard ratio, 44.09 [95% confidence interval, 17.09-113.78]). The CDC EHE molecular surveillance strategy identified 11 linkages to incident infections a genetic distance threshold of 0.5%, and 24 linkages at 1.5%. Over the past 2 decades, incident infections drove incident HIV cluster growth in San Diego. The current CDC EHE molecular detection and response strategy would not have identified most transmission events arising from those with incident infection in San Diego. Molecular surveillance that includes detection of incident cases will provide a more effective strategy for EHE.

Trend of HIV Infection and Associated Risk Factors at Integrated Counselling and Testing Centre in a Tertiary Care Hospital in Bihar: A Retrospective Study

Introduction: Human Immunodeficiency Virus (HIV) infection became a major global health issue and a priority in many countries because it is the leading cause of morbidity and mortality throughout the world. In India, about 71% of total annual new HIV infections were reported from Telangana, Bihar, West Bengal, Uttar Pradesh, Andhra Pradesh, Maharashtra, Karnataka, Gujrat, Tamil Nadu and Delhi. The major cause of concern is that around 25% of the infected people are not aware that they are infected by HIV virus and is one of the major risk factor responsible for the spread of HIV infection. Aim: To evaluate the trends, pattern and associated risk factors responsible for the spread of Human Immunodeficiency Virus (HIV) infection in patients who attended Integrated Counselling and Testing Centre (ICTC) of a tertiary care centre of Bihar, India. Materials and Methods: A retrospective study was conducted on the available records of all the patients who attended ICTC of a tertiary care centre in Bihar, India, between January 2016 to December 2018. The data regarding the age, sex, marital status, educational status and behavioural pattern of the patients tested for HIV infection at the ICTC were assessed and analysed. Descriptive statistical analysis was done. Results: The total of 16333 and 15969 patients received counselling and testing services respectively during the study period. The prevalence of HIV infection was 3.70%, amongst whom 64.38% were males and 32.93% were females including 2.69% pregnant female patients. The ratio of seropositive male to seropositive female was 2.07:1. Maximum seroreactivity was found in 35-49 years age group (38.57%) followed by 25-34 years age group (28.42%). The major factor for the transmission and spread of HIV infection was unprotected sexual contact (88.33%) followed by mother to child transmission, infected blood and its products and infected needles and syringes. Illiteracy (45%) and unawareness was the major associated factor for spread of HIV infection. Conclusion: The high prevalence of HIV infection can be minimised by creating awareness, following safe sexual practices, promoting antenatal screening, procuring blood and its product from authorised blood banks where proper screening of Transfusion Transmitted Infections (TTI) is done.

A multi-institutional, cross-sectional study on disclosure of HIV status to sexual partner(s) and associated factors among people living with HIV/AIDS attending selected hospitals in Kigali, Rwanda

Background: In Sub-Saharan Africa, human immunodeficiency virus (HIV) remains a public health problem. There is need for evidence-based interventions to curb new infections. HIV status disclosure, especially to sexual partner(s) remains a critical step towards reducing viral transmission across sexual partners.Methods: A hospital-based cross-sectional study, conducted at HIV clinics of three selected hospitals. Systematic random sampling was employed to sample 384 people living with HIV/AIDS (PLWH). A pre-tested self-administered questionnaire was used to collect data.Results: Of the participants, 66% of the participants reported HIV positive status disclosure, with only 46% of these having disclosed to their sexual partner. Logistic regression analysis identified age (p value 0.035; AOR 0.94), being satisfied with counselling (p value 0.017; AOR 0.24), gender (p value 0.030; AOR 5.51) and education (p value 0.041; AOR 2.14) as factors associated with having disclosed HIV status. Being younger, satisfaction with counselling, being female and having attained at least secondary education were all associated with higher odds of HIV status disclosure.Conclusions: Based on the findings of the current study, it can be concluded that there is need to improve rates of HIV status disclosure among PLWH in Kigali, Rwanda. The current study findings have provided baseline information for the local health authorities, health care providers, policy makers and other scholars working in HIV epidemic control. The local health authorities can use this as a guide to develop a programme aimed to address the issue of non-disclosure of HIV status in Kigali City and hence help control the incessant spread of HIV infection.

Prevalence of HIV and Associated Risk Factors Among Adults in Negele Borena Hospital, Guji zone, Oromia Region, Ethiopia

Background:- The peak incidence of Human Immunodeficiency Virus (HIV) infection occurs among adults who are at the most productive age of the population. They are vulnerable to HIV because of their age, living arrangement, and cultural influences. Objective:- The aim of this study is to determine the prevalence of HIV infection and its risk factors among adults in Negele Borena Hospital. Method:- A cross-sectional study was conducted on 384 adults in Nagele Borena Hospital from April to September, 2017. Self-administered questionnaire was used to collect data on socio-demographic variables, knowledge of HIV/STIs and behavioral factors. In collaboration with the hospital work, whole blood samples were tested for the presence of antibody to HIV infection using National HIV rapid diagnostic tests algorithm. Chi-square test was conducted to identify risk factors, and finally, regression analysis was computed to identify the independent risk factors that influence the incidence of HIV/AIDS. Results:- The sero-prevalence of HIV was 11(2.86%) where 4(2.03%) and 7(3.74%) were males and females respectively. Alcohol drinking (AOR=5.2(1.1-25) and khat chewing (AOR=5.8, 95%CI 5.8 (1.3-27) discuss about sexual issues openly with their family AOR=13, 95%CI 13(1.6-102), peer pressure AOR=22.9, 95%CI22.9 (3.9-131) and multiple sexual partner (AOR=5.2, 95%CI 5.2(0.9-29) were the risk factors for HIV infection and HIV/AIDS transmission determinants. Conclusion and recommendation:- The prevalence of HIV infection among adults of Negele Borena Hospital is high. New infection among young people suggested that the disease is not under control yet in the country. Therefore, planning strategy to prevent the spread of HIV infection in town is critical. Keywords: Behavior, HIV/AIDS, prevalence, risk factor, transmission DOI : 10.7176/JHMN/68-03 Publication date: November 30 th 2019

Occurrence of intestinal parasitic infections in HIV-positive patients

Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are among the leading causes of infectious disease morbidity and mortality worldwide. Diarrhea is one of the most common AIDS-related illnesses causing a significant morbidity and mortality in HIV infected patients. The opportunistic enteric parasites most commonly implicated in HIV-positive patients are Cryptosporidium parvum, Isospora belli, Cyclospora, Microsporidium spp, Giardia intestinalis, Entamoeba histolytica and Strongyloides stercoralis. Despite the spread of HIV infection in India, and the high prevalence of diarrheal disease, there is little information available on the epidemiology of diarrheal disease among people with HIV infection. The present study was aimed to determine the prevalence of intestinal parasites in HIV infected patients. HIV infection was prevalent in the age group 36 40 years, followed by age group of 31 -35 years, with males outnumbering females. Cryptosporidium parvum followed by Isospora belli and Giardia intestinalis were the most common intestinal parasites isolated. Our study highlights the importance of early diagnosis and treatment of intestinal parasites, so as to reduce morbidity and mortality in HIV/AIDS patients due to diarrhea. K e y w o r d s Cryptosporidium parvum, Giardia intestinalis, Isospora belli, Human Immunodeficiency Virus, Intestinal parasites, Diarrhea

Effectiveness of structured teaching programme on transmission and prevention of human immunodeficiency virus/acquired immune deficiency syndrome among adolescent girls in Lowry Memorial High School, Bengaluru.

Background:Adolescence is a critical stage in human development. Most young people become sexually active during adolescence and are more likely to have multipartner and unprotected sex with high-risk behavior that predisposes them to sexually transmitted infections such as human immunodeficiency virus (HIV).Objectives:The objective of the study was to evaluate the effectiveness of a structured teaching programme on transmission and prevention of HIV/acquired immune deficiency syndrome (HIV/AIDS) among adolescent girls.Methods:An evaluative research approach was adopted, in which a preexperimental, one group pre- and post-test research design was used to evaluate the effectiveness of the structured teaching programme on transmission and prevention of HIV/AIDS among adolescent girls studying at Lowry Memorial High School, Bengaluru. A self-administered structured questionnaire was used for data collection. Data were presented in frequency tables and statistical graphs (bar charts) and analyzed using descriptive statistics (mean, standard deviation) and inferential statistical methods (Chi-square and paired “t”-tests) using SPSS version 21.Results:The findings of the study revealed that the mean percentage difference in the pre- and post-test knowledge scores was statistically significant at 5% level (P < 0.05). The overall mean post-test knowledge score of adolescent girls on transmission and prevention of HIV/AIDS was 88.83%. It is apparently higher compared to the pretest knowledge score, which was 67.67% with enhancement of 21.16%. This implies that the structured teaching programme was effective in gaining knowledge of adolescent girls regarding transmission and prevention of HIV/AIDS.Conclusion:Our study suggests that structured teaching programme enhanced the knowledge of the adolescent girls on transmission and prevention of HIV/AIDS. We, therefore, recommend that structured teaching programmes on transmission and prevention of HIV/AIDS should be encouraged among adolescents and youths to reduce the spread of HIV infection.

Preventing HIV transmission through blockade of CCR5: rationale, progress and perspectives.

Of the two million people estimated to be newly infected with human immunodeficiency virus (HIV) every year, 95% live in poorer regions of the world where effective HIV treatment is not universally available. Strategies to reduce the spread of HIV infection, which predominantly occurs via sexual contact, are urgently required. In the absence of an effective vaccine, a number of approaches to prevent HIV infection have been developed. These include using potent anti-HIV drugs prophylactically, either through systemic administration or topical application to the mucosal tissues that HIV initially encounters during sexual transmission. Genetic deficiency of the chemokine receptor CCR5 provides individuals with a remarkable degree of protection from HIV acquisition. This is because CCR5 is the major coreceptor used by HIV to infect new target cells. Since CCR5 deficiency does not appear to carry any health disadvantages, targeting the receptor is a promising strategy for both therapy and prevention of HIV. In this review we first describe the advantages and limitations of the currently available strategies for HIV prevention, then we focus on strategies targeting CCR5, covering the progress that has been made in developing different classes of CCR5 inhibitors for prophylaxis, and the perspectives for their future development as new weapons in the global fight against HIV/AIDS.

Trend of CD4+ Cell Counts at Diagnosis and Initiation of Highly Active Antiretroviral Therapy (HAART): Korea HIV/AIDS Cohort Study, 1992-2015.

BackgroundCD4+ cell counts reflect immunologic status of human immunodeficiency virus (HIV) patients. Recommended CD4+ cell counts for the initiation of highly active antiretroviral therapy (HAART) has increased over the past several years in various HIV treatment guidelines. We investigated the trend of CD4+ cell counts at diagnosis and treatment start using data from the Korea HIV/acquired immune deficiency syndrome (AIDS) Cohort Study.Materials and MethodsThe Korea HIV/AIDS Cohort Study started in 2006 and enrolled HIV patients from 21 tertiary and secondary hospitals in South Korea. The data for CD4+ cell counts at diagnosis and HAART initiation from these HIV patients were analyzed by three-year time intervals and presented by number of CD4+ cells (≤100, 101-200, 201-350, 351-500 and >500 cells/mm3). The HIV-RNA titer at diagnosis and HAART initiation were presented by 3-year intervals by groups ≤50,000, 50,001-100,000, 100,001-200,000, 200,001-1,000,000, and >1,000,000 copies/mL.ResultsMedian values of CD4+ cell count and HIV-RNA titer at initial HIV diagnosis were 247 cells/mm3 and 394,955 copies/mL, respectively. At time of initiating HAART, median values of CD4+ cell count and HIV-RNA were 181 cells/mm3 and 83,500 copies/mL, respectively. Patients with low CD4+ cell count (CD4+ cell count ≤200 cells/mm3) at diagnosis (31-51%) and initiation of HAART accounted for the largest proportion (30-65%) over the three-year time intervals. This proportion increased until 2010-2012.ConclusionCD4+ cell count at initiation of HAART was found to be very low, and the increase in late initiation of HAART in recent years is of concern. We think that this increase is primarily due to an increasing proportion of late presenters. We recommend early detection of HIV patients and earlier start of HAART in order to treat and prevent spread of HIV infection.

HIV prevention advice for people with serious mental illness.

People with serious mental illness have rates of Human Immuno-deficiency Virus (HIV) infection higher than expected in the general population for the same demographic area. Despite this elevated prevalence, UK national strategies around sexual health and HIV prevention do not state that people with serious mental illness are a high risk group. However, a significant proportion in this group are sexually active and engage in HIV-risk behaviours including having multiple sexual partners, infrequent use of condoms and trading sex for money or drugs. Therefore we propose the provision of HIV prevention advice could enhance the physical and social well being of this population. To assess the effects of HIV prevention advice in reducing morbidity, mortality and preserving the quality of life in people with serious mental illness. We searched the Cochrane Schizophrenia Group's Trials Register (24 January 2012; 4 July 2016). We planned to include all randomised controlled trials focusing on HIV prevention advice versus standard care or comparing HIV prevention advice with other more focused methods of delivering care or information for people with serious mental illness. Review authors (NW, AC, AA, GT) independently screened search results and did not identify any studies that fulfilled the review's criteria. We did not identify any randomised studies that evaluated advice regarding HIV for people with serious mental illness. The excluded studies illustrate that randomisation of packages of care relevant to both people with serious mental illness and HIV risk are possible. Policy makers, clinicians, researchers and service users need to collaborate to produce guidance on how best to provide advice for people with serious mental illness in preventing the spread of HIV infection. It is entirely feasible that this could be within the context of a well-designed simple large randomised study.

Dynamics of HIV infection in lymphoid tissue network.

Human immunodeficiency virus (HIV) is a fast replicating ribonucleic acid virus, which can easily mutate in order to escape the effects of drug administration. Hence, understanding the basic mechanisms underlying HIV persistence in the body is essential in the development of new therapies that could eradicate HIV infection. Lymphoid tissues are the primary sites of HIV infection. Despite the recent progress in real-time monitoring technology, HIV infection dynamics in a whole body is unknown. Mathematical modeling and simulations provide speculations on global behavior of HIV infection in the lymphatic system. We propose a new mathematical model that describes the spread of HIV infection throughout the lymphoid tissue network. In order to represent the volume difference between lymphoid tissues, we propose the proportionality of several kinetic parameters to the lymphoid tissues' volume distribution. Under this assumption, we perform extensive numerical computations in order to simulate the spread of HIV infection in the lymphoid tissue network. Numerical computations simulate single drug treatments of an HIV infection. One of the important biological speculations derived from this study is a drug saturation effect generated by lymphoid network connection. This implies that a portion of reservoir lymphoid tissues to which drug is not sufficiently delivered would inhibit HIV eradication despite of extensive drug injection.

English

Aim: The prevalence of pulmonary tuberculosis (PTB) in Human immunodeficiency virus (HIV)/Acquired immunodeficiency syndrome (AIDS) patients is a dual epidemic problem of major concern worldwide especially in Africa where there is upsurge of the disease. This study is set to determine the prevalence of PTB among HIV patients. Methods: A total of 489 patients were recruited into the study, 173(35.4%) were males, while 316 (64.6%) were females between January 2012 and December 2013. HIV status and Mycobacterium tuberculosis were determined using WHO systems two and Ziehl Neelsen (ZN) staining technique respectively. Results: Prevalence of 10.6%, 79.6% and 9.8% was obtained for HIV/PTB co infection, HIV and PTB respectively. A prevalence of 5.1% recorded for HIV/PTB co infection is highest among age group 31-45years, followed by 2.7% and 1.6% in the age groups 16-30 and 46-60years respectively. The lowest prevalence of 0.2% each was observed in the age groups 61-75 and 76-90 years. Conclusion: There is need for more advocacy and proper monitoring of infected patients to check the spread of HIV infections especially in a depressed economy like Nigeria in order to further reduce cases of PTB. Keywords: Pulmonary tuberculosis, HIV, Prevalence, Delta State.

Retrospective study on cost distribution of antiretroviral therapy in a tertiary care hospital

Background: Acquired immunodeficiency syndrome (AIDS) is caused by human immunodeficiency virus (HIV), which is an RNA virus. The first case of AIDS in human beings was reported in 1981, and now spread of HIV infection is alarmingly high with around 20 million deaths. The objective of the study was to determine the cost distribution of antiretroviral therapy among autoimmune deficiency syndrome (AIDS) patient attending the anti-retroviral therapy (ART) center of the tertiary care center.Methods: The objective of the study was to determine the cost distribution of antiretroviral therapy among AIDS patient attending the ART center of the tertiary care center. The study was retrospective, 20 patients included in different age groups and categories the cost incurred toward patients were divided under different heads: medication, laboratory diagnosis, transport, and miscellaneous costs.Results: It was found that major part of the cost is spent on drugs. The cost of transport and lab diagnosis varied based on age and stage of the disease. Miscellaneous costs were also high and were proportional to other costs.Conclusion: HIV infected population is more likely to have a lower socioeconomic status which has varied effect on the effectiveness of highly active ART. Some of the problems faced by them are access to health care, transport, economic instability, etc. all these factors have an impact on outcome of treatment. Overall it can be found that preventive measure than treating has better impact on quality of life.

Herpes simplex virus 2 infection in HIV-seropositive individuals in Tamil Nadu, India

Background: Viral infection with Herpes Simplex Virus (HSV) is one of the most common opportunistic infections in seropositive patients of Human Immunodeficiency Virus (HIV). Studies have confirmed that genital herpes caused by HSV-2 has been associated with two- to threefold increased risk of HIV acquisition. Objective: To determine the seroprevalence of HSV-2 in HIV-positive patients. Materials and Methods: A prospective, cross-sectional study was conducted from July 2012 to January 2013 and HIV-positive patients were enrolled into the study after obtaining written informed consent. Demographic characteristics were recorded and serology test was performed using HSV-2 IgG ELISA test kit (Calbiotech, USA). Results were analyzed using X2-test. Results: Among 273 HIV-positive patients, 67% were men, 33% were women, and 1 transgender with an average age of 38.8 years. Overall, 50% of HIV-positive patients had HSV-2 IgG antibodies. Seroprevalence of HSV-2 among HIV-positive men and women was 47% and 57%, respectively. The highest HSV-2 seropositivity was detected in the age group of 36–45 years. X2-Analysis showed a statistically significant association between HSV-2 and HIV infection (X2 = 55.900, p = 0.0076). The median CD4 counts estimated in 100 patients were 563.50 cells/mm3. No significant difference was observed in the CD4 counts of those with or without HSV-2. Conclusion: HSV-2 prevalence was higher in HIV-positive women than in men. The implementation of continuous interventions for sexually transmitted infections and HIV will bring down the prevalence and spread of both HSV-2 and HIV infection.