Human Immunodeficiency Virus Stage Research Articles

Tuberculosis Co-infection among HIV/AIDS Cases Attending an Anti-retroviral Therapy Center: A Retrospective Cohort Study from Pakistan

Objective: The co-occurrence of tuberculosis (TB) and human immunodeficiency virus (HIV) results in heightened morbidity and mortality, placing an increased burden on healthcare systems. This study aims to assess the incidence and identify associated risk factors for TB/HIV co-infection, with the objective of enhancing the survival rates of co-infected patients in Pakistan. Methods: This retrospective cohort investigation took place at the Anti-Retroviral Treatment Center in Islamabad, Pakistan. Data spanning a decade (January 2006 to December 2016) were extracted from 2,542 people living with HIV using a pre-tested data extraction tool. Results: Following the exclusion of 156 ineligible participants, records of 2,386 individuals were analyzed over 4,433 person-years. The cumulative incidence and incidence rate of TB among HIV/AIDS patients were 446 (18.7%) and 0.001 cases/10,000 person-years, respectively. The majority (81%) of incident TB cases occurred within one year, predominantly manifesting as pulmonary TB. Of the TB-infected individuals, 98.6% received TB medication, with 0.7% prescribed Isoniazid prophylaxis. Significant associations with TB were identified in relation to work abroad history, patient age, and current HIV stage (P<0.05). Binary logistic regression indicated a 3.1 times higher likelihood of TB infection in the anemic group compared to the non-anemic group. HIV/AIDS infection emerged as a consistent TB risk factor irrespective of CD4 count and WHO HIV staging. Conclusion: This study highlights a substantial incidence of TB co-infection among HIV patients in Pakistan, emphasizing the need for comprehensive efforts by the National AIDS Control and National TB Control Programs to effectively manage co-infection.

Prevalence and determinants to COVID-19 vaccine hesitancy among people living with HIV in Bench Sheko zone, Southwest Ethiopia: A multi-center study

IntroductionIn 2019, the World Health Organization (WHO) identified coronavirus disease-2019 (COVID-19) as one of the top 10 threats to global health. Currently, vaccine hesitancy is the most common obstacle to reducing COVID-19 incidence and achieving herd immunity worldwide. Understanding the factors influencing vaccine hesitancy in this specific population is crucial for developing targeted interventions to improve vaccine uptake and protect vulnerable communities. Therefore, this study aimed to evaluate the prevalence and determinants of COVID-19 vaccine hesitancy among people living with human immunodeficiency virus (HIV) who receive care at public health facilities in Bench Sheko Zone, Southwest Ethiopia. MethodsA multi-center study was employed, involving multiple healthcare facilities within the Bench Sheko Zone from January 1 to 30 February 2023 to assess the prevalence and determinants of hesitancy to COVID-19 vaccination among people living with human deficiency virus (PLHIV). Data were collected by using pre-tested interviewer administered questionnaires and document review, and entered into Epi-data version 3.1 then exported to and analyzed by using SPSS version 24. Statistical significance was assessed by using multivariable logistic regression analysis by determining odds ratios and 95% confidence interval. Multi-Collinearity and model fitness were also checked. ResultsAccording to the study, the prevalence of COVID-19 vaccine hesitancy was found to be 47.9%, [95% CI, 43.8–52.0]. One significant finding was that younger individuals (age ≤25years) [AOR = 2.30, 95%CI, 1.15–4.57] exhibited a higher level of hesitancy compared to their older counterparts. Additionally, the study identified monthly income≤3000 birr [AOR = 0.57, 95%CI, 0.31–0.92], urban residence [AOR = 0.61, 95%CI, 0.42–0.91], HIV stage one [AOR = 0.44, 95%CI, 0.27–0.73] and human immunodeficiency virus (HIV) clinical stage two of HIV [AOR = 0.60, 95CI, 0.39–0.93] as determinants of vaccine hesitancy. ConclusionAccording to our study finding in southwest Ethiopia, individuals living with HIV were found to have a higher level of hesitancy towards receiving the COVID-19 vaccine as compared with center for disease control and prevention estimate of vaccine hesitancy. The study also identified several factors that contribute to vaccine hesitancy, including age, urban of residence, income level, and HIV clinical stage. Addressing the identified factors in this specific population could decrease the hesitancy. To ensure the success of vaccination campaigns in the region, policymakers and stakeholders should take steps to address these underlying factors and promote greater acceptance of the COVID-19 vaccine among the population.

Effect of Vitamin D3 2000 IU Tablets on Serum Vitamin D 25-OH Levels, Hemoglobin Levels, Body Mass Index and CD4/CD8 Ratio in Patients Infected with Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome Who Have Been Treated with Antiretrovira

Background: Human Immunodeficiency Virus (HIV) is a retrovirus subgroup of lentivirus family that has RNA genetic characteristics that attack the body's immune system, especially infecting Cluster Differential Four (CD4) lymphocytes and replicating according to the host's DNA. Vitamin D is important in stimulating innate immunity. Availability of vitamin D has an important role to improve the nutritional status of HIV/AIDS patients, improve the immune system, and improve prognosis. Research Objectives: To assess the effect of administration of vitamin D3 tablet therapy on serum vitamin D 25-OH levels, hemoglobin levels, body mass index (BMI), and CD4/CD8 ratio in HIV/AIDS infected patients who have been treated with antiretrovirals (ARV). Methods: This study was a cross-sectional study using 40 samples of HIV patients who were routinely controlled at the VCT polyclinic at Dr. Moewardi who received regular antiretrovirals. The inclusion and exclusion criteria are intended to obtain samples that are currently in HIV stages I and II so that it is expected to reduce other factors that cause bias levels of vitamin D apart from the chronic inflammatory process that occurs in HIV-infected patients. Patients who have come informed their consent to take blood samples during one of their visits to the VCT poly to check BMI, serum vitamin D (25-(OH)), and routine blood to determine the value of hemoglobin and the CD4/CD8 ratio. The statistical test uses an analysis of the difference in the average of the two groups. Results: The results of testing the mean difference between the two groups of serum levels of vitamin D 25-OH in the Vitamin D3 treatment and control groups showed a value of Z = -2.277 (p = 0.023). The results of the different test mean that the two groups of hemoglobin in the Vitamin D3 treatment group and the control showed a value of Z = -3.484 (p = 0.001). The results of different tests mean that the two BMI groups in the Vitamin D3 treatment group and the control group show a value of t = -5.098 (p = 0.001). The results of the mean difference test of the two CD4/CD8 ratio groups in the Vitamin D3 treatment group and the control group showed a value of t = -6.203 (p = 0.001). Conclusion: Administration of 2000 IU vitamin D3 tablets can increase serum vitamin D 25-OH levels, hemoglobin, BMI, and CD4/CD8 ratio in HIV/AIDS-infected patients treated with antiretroviral (ARV).

Analysis of the impact of treatments on HIV/AIDS and Tuberculosis co-infected population under random perturbations

In this work, we study the impact of treatments at different stages of Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) co-infection in a population under the influence of random perturbations. This is achieved by constructing a stochastic epidemic model describing the transmission and treatment of the diseases. The model is created with the assumption that transmission rates fluctuate rapidly compared to the evolution of the untreated diseases. The basic reproduction numbers corresponding to the population with HIV infection only (with n stages of infections and treatments), the population with tuberculosis infection only, and the overall population with co-infection (with n stages of infection/treatments) are derived in the presence and absence of noise perturbations. These are used to discuss the long term behavior of the population around a disease-free equilibrium and an endemic equilibrium, and to analyze the effect of noise and treatments on the system. We also showed conditions under which TB infected population dynamic undergoes backward bifurcation and give conditions for disease eradication in the entire population. Analysis shows that small perturbations to the disease-free equilibrium can initially grow under certain conditions, and the introduction of TB treatment is effective in eliminating the co-infection. Numerical simulations are presented for validation of our results using published parameters.

HIV associated psychiatric comorbidity among attendees at a tertiary hospital, North-Eastern Nigeria

Background: There are a wide range of neuropsychiatric conditions associated with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). These mental disorders may be unrecognised yet their presence can significantly affect outcome.Aim: This study aimed to determine psychiatric comorbidity associated with HIV and AIDS.Setting: The HIV clinic of a tertiary hospital in North-Eastern Nigeria.Methods: A cross-sectional descriptive study consecutively recruiting 328 adult persons living with HIV. The Mini International Neuropsychiatric Interview and a sociodemographic questionnaire were administered to the participants.Results: Two-thirds of the respondents were females. The mean age (±s.d.) was 42 years (±11.24). Majority of the participants had World Health Organization stage 1 HIV disease. The prevalence of psychiatry comorbidity among our respondents was 82.9%. Social phobia was the leading disorder (69.8%). Others were mixed depression anxiety disorder (49.4%) and post-traumatic stress disorder (36.6%). Current psychosis was 27.7%, while major depressive disorder was 12.2%. Psychiatric comorbidity was significantly associated with male gender, religion, ethnicity, marital status and being unemployed with p 0.01. Human immunodeficiency virus stage was related to panic disorder with p 0.01, while viral load was significantly associated with depressive disorder with p = 0.001.Conclusion: Majority of our HIV patients attending the clinic have undetected psychiatric morbidity. Clinicians need to be aware of the features of major psychiatric disorders and refer appropriately for improved overall outcome.Contribution: This study contributes to the body of work on unrecognised psychiatric comorbidity in people living with HIV and AIDS, especially in North-Eastern Nigeria, identifying issues which are relevant to clinical practice and buttressing the need for integration of mental healthcare services into HIV treatment and prevention services.

In-hospital mortality of acute HIV-associated pulmonary morbidity among COVID-19 negative medical admissions to Dr. George Mukhari Academic Hospital

Objectives: Human immunodeficiency virus (HIV)-related complications remain a frequent cause of hospital admissions. Pulmonary complications are among the most frequent causes of morbidity and mortality in HIV-infected individuals. We aimed to describe the in-hospital mortality of medical admissions with an acute HIV-associated pulmonary pathology. Materials and Methods: This was an observational study undertaken at a tertiary care center over 12 months. Variables of interest were as follow: Diagnoses, diagnostic work-up, treatment, mortality rate, and impact of comorbidities and HIV-associated factors on mortality. Results: Two-hundred and seventy-two patients were studied. The mean age was 42.0 ± 10.8 years. Males constituted 62.4% of the cases. One hundred and thirty patients (47.8%) were anti-retroviral therapy (ART) naive. The median CD4 count was 76 cells/mm3. The most frequent pulmonary diagnosis was community-acquired pneumonia (CAP) (212; 78%). Gram-negative pathogens were isolated in the majority of patients admitted with infectious complications. Pulmonary tuberculosis (PTB) was confirmed in only 27 (0.9%) of the cases. Significantly more female patients were on ART compared to males (P = 0.0436). Survival rates were not significantly different between the two genders (P = 0.1670). Overall, in-hospital mortality was 25.7%. CD4 counts and comorbidities were not predictive of mortality. Conclusion: HIV-associated acute pulmonary disease is associated with significant mortality. A large number of patients are diagnosed at an advanced stage of HIV. Programs that encourage voluntary testing and treatment are likely to reduce the high number of late presentations and reduce the poor outcomes. Adherence to the South African thoracic society guideline recommended evaluation for PTB in HIV-infected patients diagnosed with CAP cannot be over-emphasized.

Ocular manifestations in HIV patients and its correlation with CD4 count before and after starting HAART

Background: Human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) are a global pandemic, with cases reported from practically every country. The majority of information and studies regarding ophthalmic manifestations in India reflects the pre-HAART (highly active anti-retroviral therapy) era. India may be going through an intermediate stage, where the spectrum of the ophthalmological manifestations may be changing significantly. Aims and Objectives: The aims of this study were to study the age and gender distribution in HIV patients presenting with various ocular manifestation and to correlate the cluster of differentiation 4 (CD4) count with various ocular manifestation of AIDS. Materials and Methods: Prospective cross-sectional study was conducted on 120 patients. Ocular manifestations and WHO clinical stage of HIV were noted and CD4 count was calculated. The participants were followed up for at least 6 months on monthly basis when they come to take ART tables or as required for any ophthalmic disorder presented by patient. Any manifestation during this months was included in post HAART group. CD4 count after 6 months was taken into account in post HAART group. Results: Males predominated females. The number of males in Pre HAART was 60.8% and post-HAART 59.4%. Mean CD4 count in pre-HAART was 140.63 and post-HAART was 221.93. Majority (34 patients) in pre-HAART had CD4 count between 100 and 150, while in post-HAART, majority had count more than 200 (57 patients). Conclusion: Mean CD4 count of pre-HAART group patients raised significantly. Mean CD4 count of pre-HAART group is 140.63 with SD of 63.4, while it increased in post-HAART group to 222 which is statistically highly significant.

Cost-effectiveness analysis of 'test and treat' policy for antiretroviral therapy among heterosexual HIV population in India.

The World Health Organisation recommended immediate initiation of antiretroviral therapy (ART) in all adult human immunodeficiency virus (HIV) patients regardless of their CD4 cell count. This study was undertaken to ascertain the cost-effectiveness of implementation of these guidelines in India. A Markov model was developed to assess the lifetime costs and health outcomes of three scenarios for initiation of ART treatment at varying CD4 cell count <350/mm[3], <500/mm[3] and test and treat using health system perspective using life-time horizon. A few input parameters for this model namely, transition probabilities from one stage to another stage of HIV and incidence rates of TB were calculated from the data of Centre of Excellence for HIV treatment and care, Chandigarh; whereas, other parameters were obtained from the published literature. Total HIV-related deaths averted, HIV infections averted and incremental cost-effectiveness ratio per quality adjusted life years (QALYs) gained were calculated. Test and treat intervention slowed down the progression of disease and averted 18,386 HIV-related deaths, over lifetime horizon. It also averted 16,105 new HIV infections and saved 343,172 QALYs as compared to the strategy of starting ART at CD4 cell count of 500/mm[3]. Incremental cost per QALY gained for the immediate initiation of ART as compared to ART at CD4 cell count of 500/mm[3] and 350/mm[3] was ₹ 46,599 and 80,050, respectively at reported rates of adherence to the therapy. Immediate ART (test and treat) is highly cost-effective strategy over the past criteria of delayed therapy in India. Cost-effectiveness of this policy is largely because of reduction in the transmission of HIV.

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.&#x0D; Aim. To conduct an epidemiological analysis of factors associated with late diagnosis of HIV infection.&#x0D; 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.&#x0D; 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).&#x0D; 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.

Prevalence and Determinants of Suicidal Ideation and Suicide Attempt in People With Human Immunodeficiency Virus in Africa: a Systematic Review

People with human immunodeficiency virus (HIV) are at higher risk of suicidal ideation and suicide attempts. We reviewed the literature for the prevalence and determinants of suicidal ideation and suicide attempt in people with HIV in Africa. The PubMed, Scopus, and Google scholar were searched for original studies published in peer-reviewed journals in English language between January 2015 to July 2020, using the key words: 'suicidal behavior', 'suicidal attempt', 'suicidal ideation', 'HIV/AIDS', and/or 'Africa'. The quality of included studies was assessed using the Newcastle-Ottawa scale. 12 cross-sectional studies published in the past 5 years in African countries were included. The quality of studies was high, with score ranging from 6 to 9. The prevalence of suicidal ideation ranged from 8.8% to 39%. The prevalence of suicide attempt ranged from 2.8% to 20.1%. The most common risk factors for suicidal behaviour were mental health-related problems. Other factors included high clinical stage of HIV, being unmarried, poor medication adherence, poorer quality of life, not taking highly active antiretroviral therapy, female sex, no education, substance use, low CD4 level, and opportunistic infection. Patients with HIV/AIDS have an increased risk of suicidal ideation and suicide attempts. Early screening, treatment, and referral of suicidal patients are necessary for HIV clinics.

Oral and maxillofacial manifestations of human immunodefficiency virus infection

Oral manifestations occur at all stages of human immunodeficiency virus (HIV) infection. Their clinical expressions and severity depend on the evolution of the infection and become critical at the stage of acquired immunodeficiency (AIDS). They are essentially infectious, tumoral, and, starting a few years ago, iatrogenic. Infections are mostly fungal (candidiasis), viral (herpes, zoster, human papillomavirus infections, etc.), and less frequently bacterial (streptococcemia). Cases of sexually transmitted diseases, particularly syphilis, are multiplying preoccupyingly. The most frequently observed tumors are Kaposi's sarcoma. Drug intolerance is common; the symptoms are mostly dermatological, but also oral (Stevens-Johnson syndrome and toxic epidermal necrolysis) when sulfonamides and certain antiretrovirals are used. The advent of prolonged Highly Active Anti-Retroviral Therapies (HAARTs) has led to a decline in the incidence of most opportunistic conditions, infections and tumors (except for multiple oral warts and zoster). HAARTs also provoke adverse reactions such as lipodystrophy syndromes (signs of peripheral atrophy and central hypertrophy, associated in varying degrees with metabolic syndromes). Extended survival and the new methods for prophylaxis of opportunistic infections have gradually modified diagnostic and therapeutic strategies for oral manifestations of HIV infections.

Hearing Loss, Congenital HIV, and Medulloblastoma: A Case Report

Hearing Loss, Congenital HIV, and Medulloblastoma: A Case Report

Hiv Stage 4 With Pulmonary Tuberculosis, Collitis Tuberculosis, Oral Candidiasis, Wasting Syndrome, And Sensorineural Deafness: A Case Report

Human immunodeficiency virus (HIV) is a retrovirus type virus that infects cells of the human immune system (especially CD4 positive T-cells and major components of the cellular immune system) and interferes with their function. This viral infection results in a continuous decline in the immune system, which will result in immune deficiency. People who are immune deficient/immunodeficiency become more susceptible to various types of infections. A 23 year male, a cafe employee, was admitted to hospital with complaints of weakness since 2 weeks before. He has productive cough for 3 weeks. He had decrease of food appetite, nauseas and vomiting. He had weight loss about 10 kg in the last 4 months. Patient had history of free sex, LGBT, since 2016 and history of hearing loss for 3 months. Laboratory finding showed rhonchi were found at the apex of the right and left lungs, Anti-HIV reactive and Absolute CD-4 count was 53 cell/uL, Gene Xpert MTB was detected, and Acid fast bacilli in stool is positive. Audiometry showed bilateral sensorineural deafness. Patient was diagnosed with HIV stage 4 with pulmonary tuberculosis, tuberculosis collitis, oral candidiasis, wasting syndrome, and sensorineural deafness.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Management of Psychiatric Disorders with HIV and Dermatological Disorders.

Disseminated Kaposi sarcoma with osseous metastases in patients with HIV infection. Case report

Background. Kaposi sarcoma is a low-grade vascular tumor affecting blood and lymphatic vessels associated with the human herpes virus type 8 (HHV-8). As a rule, the skin of the lower extremities is involved in the process first of all, and then other organs and lymph nodes are involved. There are 4 various types of the disease with different clinical picture: the classic, the endemic, the epidemic and immunosuppression subtype. The epidemic subtype is the most common and has the most aggressive course, with specific lesions of a multiple kind, including the skin, mucous membrane layers, the lymph nodes, the gastrointestinal tract, the lungs and the spleen. Osseous metastases are extremely rare.&#x0D; Aim. Show the case of Kaposi sarcoma with osseous metastases in patient with the human immunodeficiency virus (HIV) infection.&#x0D; Results. We observed a 43-year-old patient with HIV infection and stage 4b Kaposi sarcoma against the background of the irregular antiretroviral therapy in the progression stages. The duration of the anamnesis was 32 months. The clinical debut of the cancer process was noted with skin lesions on the shoulder. Histological and immunohistochemical analysis of skin biopsies showed the morphological picture of Kaposi sarcoma. HHV-8 was expressed in tumor cells. During the endoscopic examination the lesions of oral mucosa, stomach and proximal colon were confirmed morphologically, and spiral computed tomography of the chest revealed the lesions in the lungs. On this point, the patients received oxaliplatin-based chemotherapy and aetoposidum for 6 months and against the background of this treatment we observed the disease progression associated with the involvement of the retroperitoneal lymph nodes, the left adrenal gland and the penis. Circumcision was performed in the case associated with the involvement of the penis. The treatment was continued. The lytic left iliac bone lesion, the retroperitoneal lymph nodes, the iliac lymph node groups, as well as the left inguinal lymph nodes, the left adrenal gland and the lungs were characterized by a high F-18 FDG uptake after 3 months of the treatment, according to the results of Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography combined with computed tomography (PET/CT).&#x0D; Conclusion. Kaposi sarcoma in patients with HIV infection had an aggressively course with disseminated skin lesions and internal organ involvement, including bones as showed in this clinical case. In this case, the axial skeleton was more commonly involved. PET/CT is a diagnostic imaging method in the differential diagnosis and determination of the prevalence of the cancer process.

Jejunal epithelial barrier disruption triggered by reactive oxygen species in early SIV infected rhesus macaques

Intestinal epithelial barrier destruction occurs earlier than mucosal immune dysfunction in the acute stage of human immunodeficiency virus (HIV) and simian immunodeficiency virus (SIV) infections. At present, however, the cause of compromised gastrointestinal integrity in early SIV infection remains unknown. In the current study, we investigated the effects of SIV infection on epithelial barrier integrity and explored oxidative stress-mediated DNA damage and apoptosis in epithelial cells from early acute SIVmac239-infected Chinese rhesus macaques (Macaca mulatta). Results showed that the sensitive molecular marker of small intestinal barrier dysfunction, i.e., intestinal fatty acid-binding protein (IFABP), was significantly increased in plasma at 14 days post-SIV infection. SIV infection induced a profound decrease in the expression of tight junction proteins, including claudin-1, claudin-3, and zonula occludens (ZO)-1, as well as a significant increase in the active form of caspase-3 level in epithelial cells. RNA sequencing (RNA-seq) analysis suggested that differentially expressed genes between pre- and post-SIV-infected jejuna were enriched in pathways involved in cell redox homeostasis, oxidoreductase activity, and mitochondria. Indeed, a SIV-mediated increase in reactive oxygen species (ROS) in the epithelium and macrophages, as well as an increase in hydrogen peroxide (H2O2) and decrease in glutathione (GSH)/glutathione disulfide (GSSG) antioxidant defense, were observed in SIV-infected jejuna. In addition, the accumulation of mitochondrial dysfunction and DNA oxidative damage led to an increase in senescence-associated β-galactosidase (SA-β-gal) and early apoptosis in intestinal epithelial cells. Furthermore, HIV-1 Tat protein-induced epithelial monolayer disruption in HT-29 cells was rescued by antioxidant N-acetylcysteine (NAC). These results indicate that mitochondrial dysfunction and oxidative stress in jejunal epithelial cells are primary contributors to gut epithelial barrier disruption in early SIV-infected rhesus macaques.

Human Immunodeficiency Virus (HIV) and Menopause Are Independently Associated With Lower Bone Mineral Density: Results From the Women's Interagency HIV Study.

We previously reported lower bone mineral density (BMD) among premenopausal women with HIV (WWH) compared to women without HIV (HIV-). Rate of bone loss may be even greater for WWH during the menopausal transition. Pre-, peri- and postmenopausal women in the Women\'s Interagency HIV Study (WIHS) underwent whole body DXA and central quantitative computed tomography to measure areal BMD (aBMD) and volumetric BMD (vBMD), respectively. Multivariable regression models with covariates associated with low aBMD (T score < -1.0) in univariate analyses (P≤.05) and known risk factors for low BMD assessed contributions of HIV and menopausal stage to the prediction of aBMD. Compared to HIV- women, in unadjusted analyses, WWH had 5-9% lower aBMD at the lumbar spine (P=.001), femoral neck (P=.04), total hip (P=.003) and the ultradistal radius (P=.004), and higher osteoporosis prevalence (T score<-2.5) at the ultradistal radius only (13.5% vs 0%, P=.0003). WWH also had lower vBMD at the spine and hip. In fully adjusted models, HIV independently predicted reduced aBMD at the lumbar spine, total hip, femoral neck, and ultradistal radius; menopausal stage remained a significant predictor of lumbar spine and ultradistal radius aBMD. HIV infection and menopausal stage were independent predictors of lower BMD, and had an additive effect on lumbar spine and total hip BMD. Additional research is needed to better understand underlying mechanisms by which HIV impacts BMD as women age and transition through menopause, and develop strategies to mitigate osteoporosis and fracture risk in this growing population.

Five-year overall survival following chemoradiation therapy for locally advanced cervical carcinoma in women living with and without HIV infection in Botswana

PurposeTo compare updated prospective 5-year survival outcomes of cervical cancer patients living with and without human immunodeficiency virus (HIV) infection who initiated curative chemoradiation therapy (CRT) in a resource-limited setting.Methods & MaterialsWomen in Botswana with locally advanced cervical cancer were enrolled in a prospective, observational, cohort study from July 2013 through January 2015. Survival outcomes were analyzed after 5 years of follow-up.ResultsThis cohort included 143 women initiating curative CRT. Sixty-seven percent (n = 96) of cohort were women living with HIV (WLWH), all of whom were receiving antiretroviral therapy (ART) at the time of treatment initiation and boasted a median CD4 count of 481 cells/μL (IQR, 351-579 μL). The 5-year overall survival (OS) rates were 56.8% (95% CI, 40.0–70.5%) for patients without HIV infection and 55.1% (95% CI, 44.2–64.7%) for WLWH (p = 0.732). Factors associated with superior 5-year OS on multivariate analyses included baseline hemoglobin > 10 g/dL (hazard ratio (HR) 0.90, 95% CI, 0.83–0.98, p = 0.015), lower stage at diagnosis (stage I and II vs. III and IV) (HR 1.39, 95% CI 1.09–1.76, p = 0.007), and higher EQD2 (HR 0.98, 95% CI 0.97–0.99, p = 0.001).ConclusionsFive-year OS was not impacted by HIV status in this population of WLWH with well-managed infection who initiated curative treatment for cervical cancer in Botswana. Regardless of HIV status, hemoglobin levels and stage at diagnosis were associated with survival. These findings suggest that treatment for cervical cancer in WLWH with well-controlled infection need not be altered solely due to HIV status.

Monocytic-Myeloid Derived Suppressor Cells of HIV-Infected Individuals With Viral Suppression Exhibit Suppressed Innate Immunity to Mycobacterium tuberculosis.

Tuberculosis can occur during any stage of Human Immunodeficiency virus 1 (HIV) -infection including times when CD4+ T cell numbers have reconstituted and viral replication suppressed. We have previously shown that CD11b+CD33+CD14+HLA-DR-/lo monocytic myeloid-derived suppressor cells (MDSC) persist in HIV-infected individuals on combined anti-retroviral therapy (cART) and with virologic suppression. The response of MDSC to Mycobacterium tuberculosis (Mtb) is not known. In this study, we compared the anti-mycobacterial activity of MDSC isolated from HIV –infected individuals on cART with virologic suppression (HIV MDSC) and HIV-uninfected healthy controls (HIV (-) MDSC). Compared to HIV (-) MDSC, HIV MDSC produced significantly less quantities of anti-mycobacterial cytokines IL-12p70 and TNFα, and reactive oxygen species when cultured with infectious Mtb or Mtb antigens. Furthermore, HIV MDSC showed changes in the Toll-like receptor and IL-27 signaling, including reduced expression of MyD88 and higher levels of IL-27. Neutralizing IL-27 and overexpression of MyD88 synergistically controlled intracellular replication of Mtb in HIV MDSC. These results demonstrate that MDSC in fully suppressed HIV-infected individuals are permissive to Mtb and exhibit downregulated anti-mycobacterial innate immune activity through mechanisms involving IL-27 and TLR signaling. Our findings suggest MDSC as novel mediators of tuberculosis in HIV-Mtb co-infected individuals with virologic suppression.

Switching from Multiplex to Multimodal Colorimetric Lateral Flow Immunosensor.

Multiplex lateral flow immunoassay (LFIA) is largely used for point-of-care testing to detect different pathogens or biomarkers in a single device. The increasing demand for multitargeting diagnostics requires multi-informative single tests. In this study, we demonstrated three strategies to upgrade standard multiplex LFIA to multimodal capacity. As a proof-of-concept, we applied the strategies to the differential diagnosis of Human Immunodeficiency Virus (HIV) infection, a widespread pathogen, for which conventional multiplex LFIA testing is well-established. In the new two-parameter LFIA (x2LFIA), we exploited color encoding, in which the binding of multiple targets occurs in one reactive band and the color of the probe reveals which one is present in the sample. By combining the sequential alignment of several reactive zones along the membrane of the LFIA strip and gold nanoparticles and gold nanostars for the differential visualization, in this demonstration, the x2LFIA can furnish information on HIV serotype and stage of infection in a single device. Three immunosensors were designed. The use of bioreagents as the capturing ligand anchored onto the membrane or as the detection ligand labelled with gold nanomaterials affected the performance of the x2LFIA. Higher detectability was achieved by the format involving the HIV-specific antigens as capturing agent and labelled secondary bioligands (anti-human immunoglobulins M and protein G) as the probes.