Status Of HIV-infected Patients Research Articles

Features of the immune status in HIV-infected patients with Kaposi’s sarcoma

Features of the immune status in HIV-infected patients with Kaposi’s sarcoma

Зміни імунологічного статусу у ВІЛ-інфікованих осіб із хронічною токсоплазмозною інвазією та токсоплазмозним енцефалітом

Актуальність. Інвазія Toxoplasma gondii у ВІЛ-інфікованих осіб може призвести до поглибленої імунопатології, що сприяє реактивації брадизоїтів та розвитку тяжких опортуністичних захворювань. Мета дослідження: вивчити особливості імунологічного статусу ВІЛ-інфікованих пацієнтів, які інвазовані токсоплазмами, та визначити предиктори розвитку токсоплазмозу мозку. Матеріали та методи. Обстежено 61 ВІЛ-інфіковану особу (33 особи серопозитивні на токсоплазмоз і 28 — серонегативні). Застосовували імуноферментний метод для визначення титрів специфічних протитоксоплазмозних IgG та IgМ; загальних IgM, IgA, IgG, а також IL-2, -4, -10, INF-γ, TNF-2α. Статистичну обробку здійснювали в статистичному пакеті програми Exсel з використанням t-критерію Стьюдента, а також z-критерію Фішера. Методом Байєса та послідовного статистичного аналізу А. Вальда визначали діагностичну цінність окремих лабораторних показників. Результати. У ВІЛ-інфікованих осіб виявлено дисбаланс цитокінів порівняно зі здоровими особами. У серонегативних на токсоплазмоз пацієнтів були підвищені рівні IL-4 (1,57 ± 0,30 пг/мл проти 0,81 ± 0,09 пг/мл, р < 0,001), IL-10 (9,81 ± 0,17 пг/мл проти 6,70 ± 0,13 пг/мл, р < 0,001), ТNF-2α (2,89 ± 0,08 пг/мл проти 1,90 ± 0,04 пг/мл, р < 0,001), INF-γ (9,30 ± 0,47 пг/мл проти 4,13 ± 0,12 пг/мл, р < 0,001), а також загальний IgG (20,63 ± 0,65 г/л проти 16,30 ± 0,94 г/л, р < 0,001). На відміну від серонегативних осіб у серопозитивних були вищими показники IL-10 (11,88 ± 0,50 пг/мл проти 9,81 ± 0,17 пг/мл, р < 0,05) та INF-γ (10,75 ± 0,44 пг/мл проти 9,30 ± 0,47 пг/мл, р < 0,05). Поєднання 2 ознак — INF-γ < 8,8 пг/мл та IL-4 < 0,77 пг/мл чи INF-γ < 8,8 пг/мл та IL-10 > 11,8 пг/мл або 3 ознак — IL-4 < 0,77 пг/мл, IL-10 > 11,8 пг/мл та IL-2 < 1,5 пг/мл є предиктором розвитку токсоплазмозного енцефаліту. Висновки. Установлено, що у ВІЛ-інфікованих осіб відмічаються підвищені рівні деяких прозапальних (TNF-α, INF-γ) та протизапальних (IL-4, -10) цитокінів, але порівняно із серонегативними в серопозитивних на токсоплазмоз осіб переважають показники INF-γ і IL-10. Проявом поглибленої імунопатології та предиктором розвитку токсоплазмозного енцефаліту є зниження рівня INF-γ, IL-4, -2 із підвищенням рівня IL-10 у контингенті серопозитивних на токсоплазмоз осіб.

Moderate to Intense Physical Activity Is Associated With Improved Clinical, CD4/CD8 Ratio, and Immune Activation Status in HIV-Infected Patients on ART.

BackgroundPhysical activity has anti-inflammatory effects and reduces morbidity and mortality in the general population, but its role in the clinical, CD4/CD8 ratio, and immune activation status of HIV-infected patients has been poorly studied.MethodsA cross-sectional study was carried out in a cohort of 155 HIV-infected patients on stable antiretroviral therapy (ART) to compare clinical, biochemical, CD4/CD8 ratio, and immune activation status according to their physical activity in the last 2 years (sedentary/low vs moderate/intense) assessed by the iPAQ. A binary logistic regression and mixed analysis of variance were performed to evaluate the impact of levels of physical activity on CD4/CD8 ratio.ResultsIn our series, 77 (49.7%) out of 155 patients were sedentary, and 78 (50.3%) practiced moderate/intense physical activity. Moderate/intense physical activity was associated with better metabolic control (lower body mass index, P = .024; glucose, P = .024; and triglyceride, P = .002) and CDC HIV stage (P = .046), lower CD8+ (P = .018), CD4+CD8+ (P = .026), CD4+CD86+ (P = .045), CD4+HLA-DR+ (P = .011), CD8+HLA-DR+ (P = .048) T lymphocytes and CD16+HLA-DR+ natural killer cells (P = .026), and higher CD3+CD4+ T lymphocytes (P = .016) and CD4/CD8 ratio (P = .001). Sedentary lifestyle (odds ratio [OR], 2.12; P = .042), CD4 nadir (OR, 1.005; P < .001), and CD8+CD38+ T cells (OR, 1.27; P = .006) were independently associated with low CD4/CD8 ratio (<0.8). Earlier and more intense CD4/CD8 ratio recovery was observed in patients with higher physical activity in the 2-year follow-up with a significant interaction between these variables: F(2, 124) = 3.31; P = .049; partial η2 = 0.042.ConclusionsModerate to high physical activity is associated with beneficial health effects, improvement in metabolic profile, and reduction of chronic inflammation in patients with HIV. Although more studies and clinical trials are needed to confirm these findings, a healthy lifestyle including at least moderate physical activity should be recommended to HIV patients on stable ART.

Study of indicators of the immune status in HIV-infected patients with concurrent allergic pathology

Aim. To study the indicators of the immune status and manifestations of allergic diseases in HIV-infected patients in the Novgorod region. Methods. We studied the data of HIV-infected patients living in the Novgorod region for the years 20002021. A total of 1020 cases of HIV infection were studied, in which 121 (12%) patients were diagnosed with allergic reactions. In patients with allergic manifestations, the human immunodeficiency virus type 1 ribonucleic acid content was measured by the polymerase chain reaction method, and the indicators of the immune status (the content of lymphocytes, eosinophils, basophils, the levels of CD3+, CD3+CD4+, CD3+CD8+ cells, immunoregulatory index) were assessed. For statistical analysis, the Student's test (t) was used to assess the statistical significance of differences in immune status indicators, and the Pearson 2 test to assess the statistical significance of differences in allergic manifestations in patients with HIV. Results. The subjects of the study were divided into 2 groups based on the levels of HIV viral load. Analysis of these groups using the Pearson 2 test showed a statistically significant (p 0.012) correlation between high viral load and the development of drug hypersensitivity reaction in HIV-infected patients. The following etiology of allergic reactions was determined among the subjects: drug (59%), food (19%), pollen (5.7%), household (5.7%), chemical (1.9%), unspecified (6.7%). The study of the immune status in two groups did not reveal statistically significant differences (p 0.05). The study of the immune status indicators in HIV-infected patients with drug hypersensitivity reactions and different levels of viral load revealed a significantly higher level of CD3+ cells (p 0.003) in patients with drug hypersensitivity reactions and detectable viral load. Conclusion. The study revealed statistically significant differences in the immune status of HIV-infected patients with drug hypersensitivity reactions living in the Novgorod region compared with HIV-infected patients without drug allergies.

Dynamic study of oral Candida infection and immune status in HIV infected patients during HAART

ObjectiveTo dynamically monitor oral Candida infection, CD4+ T lymphocyte counts, CD8+ T lymphocyte counts and CD4/CD8 ratios in HIV/AIDS patients during their first year of HAART and to preliminarily explore the relationships between them. DesignForty-six patients with HIV/AIDS receiving HAART at the Infection Department of Chongqing Red Cross Hospital were followed for one year. At baseline and 3, 6, and 12 months after HAART initiation, oral rinses were collected and cultured to identify Candida species. Further, blood samples were collected to detect CD4+ T lymphocyte counts, CD8+ T lymphocyte counts and CD4/CD8 ratios. ResultsThe prevalence of OC decreased after HAART initiation (P ＜ 0.05), and Candida albicans was the dominant species isolated from the oral cavity (66/93). At 3, 6 and 12 months after HAART initiation, CD4+ T lymphocyte counts were 327.91 ± 138.82, 329.65 ± 142.66 and 319.98 ± 97.90 cells/mm3, respectively, which were significantly higher than the level at baseline (263.39 ± 126.01 cells/mm3) (P = 0.016, P = 0.014, and P = 0.035, respectively). During the first year of HAART, CD4/CD8 ratios increased gradually, and CD8+ T lymphocyte counts decreased continually. OC was associated with low CD4+ T lymphocyte counts and a low CD4/CD8 ratio. CD4+ T lymphocyte counts <200 cells/mm3 and Candida load ≥300 CFU/mL were risk factors for OC (P ＜ 0.05), and oral Candida load was negatively correlated with CD4+ T lymphocyte counts and the CD4/CD8 ratio. ConclusionOC might be a useful marker for the evaluation of immune status in patients with HIV/AIDS.

Prediction of CD4 T-Lymphocyte Count Using WHO Clinical Staging among ART-Naïve HIV-Infected Adolescents and Adults in Northern Ethiopia: A Retrospective Study.

Background WHO clinical staging has long been used to assess the immunological status of HIV-infected patients at initiation of antiretroviral therapy and during treatment follow-up. In setups where CD4 count determination is not readily available, WHO clinical staging is a viable option. However, correlation between CD4 count and WHO clinical staging is not known in an Ethiopian setting, and hence, the main aim of this study was to assess predictability of CD4 T-lymphocyte count using WHO clinical staging among ART-naïve HIV-infected adolescents and adults in northern Ethiopia. Methods A retrospective cross-sectional study was done in the Tigray Region, Ethiopia, from April 2015 to January 2019 from a secondary database of 19525 HIV-infected patients on antiretroviral treatment. Analysis was done using STATA-14.0 to estimate the frequencies, mean, and median of CD4 T-cell count in each WHO stages. Sensitivity, specificity, positive predictive value, negative predictive value, kappa test, and correlations were calculated to show the relationships between WHO stages and CD T-cell count. Results The sensitivity of WHO clinical staging to predict CD4 T-cell counts of <200 cells/μl was 94.17% with a specificity of 3.62%. The PPV was 49.03%, and the NPV was 3.62%. The sensitivity of WHO clinical staging to predict CD4 T-cell counts of <350 cells/μl was 94.75% with a specificity of 3.00%. The PPV was 75.81%, and the NPV was 15.09%. Similarly, the sensitivity of WHO clinical staging to predict CD4 T-cell counts of <500 cells/μl was 95.03% with a specificity of 2.73% and the PPV and NPV were 88.32% and 6.62%, respectively. The kappa agreement of WHO clinical stages was also insignificant when compared with the disaggregated CD4 counts in different categories. The correlation of WHO clinical staging was inversely associated with the CD4 count, and the magnitude of the correlation was 5.22%. Conclusions The WHO clinical staging had high sensitivity but low specificity in predicting patients with CD4 count <200 cells/μl, <350 cells/μl, and <500 cells/μl. There was poor correlation and agreement between CD4 T-lymphocyte count and WHO clinical staging. Therefore, WHO clinical staging alone may not provide accurate information on the immunological status of patients, and hence, it is better to use the CDC definition rather than the WHO clinical definition.

Decreased CD4+CD8low T cells in early HIV infection are associated with rapid disease progression

BackgroundHIV rapid progressors (RPs) present with a rapid decline of CD4+ T cells within a few years of infection. Determining the underlying mechanisms throughout this decline is important to identify prognostic biomarkers and intervention strategies. Determining the numbers of CD4+ and CD8+ T cells is essential for monitoring the immune status of HIV infected patients. There are additional kinds of cell subtypes in T cells, but their relationship to the rapid progression of HIV disease is not well defined. MethodsNineteen RPs and twenty-one chronic progressors (CPs) were enrolled in this study. Based on the intensity of CD4 and CD8 expression, different T cell subtypes were identified, including CD4+CD8+T cells, CD4−CD8− T cells, CD4+CD8low T cells and CD4−CD8low T cells. Alterations in these T cell subtypes in early HIV infection (within 120 days of infection) between RPs and CPs were measured, and the relationships between these subtypes and HIV disease progression were investigated. In addition, expression of IFN-γ in T cell subtypes after PMA stimulation was analyzed by flow cytometry. ResultsWe found that during early HIV infection, CD4+CD8low T cells both significantly decreased in numbers and percentages in RPs compared to CPs. Furthermore, baseline CD4+CD8low T cells positively correlated not only with baseline CD4+T cells but also with CD4+T cells 12 months after infection. Moreover, survival analysis indicated that low levels of baseline CD4+CD8low T cells significantly accelerated the decline in CD4+ T cells as well as increased viral loads. CD4+CD8low T cells secreted significantly more IFN-γ after PMA stimulation compared to CD4+CD8−T cells and CD4−CD8+T cells, which may be beneficial for the prevention of disease progression. ConclusionsOur results identified that in early stage HIV-1 infection, a subtype of T cells, CD4+CD8low, are associated with subsequent disease progression.

IMMUNE STATUS IN HIV-INFECTED PATIENTS COINFECTED WITH HEPАTITIS C VIRUS (HCV)

The most common co-infection associated with HIV infection is viral hepatitis C. More than half of HIV-infected patients is coinfected with HCV in Russia. Both infections can have a reciprocal negative effect, what is reflected in an increase in the morbidity and mortality of co-infected patients compared with mono-infected patients. The negative role of HIV infection in the development of hepatitis C is manifested by the acceleration of the process of fibrosis and the formation of cirrhosis of the liver, as well as the frequent occurrence of hepatocellular carcinoma. The effects of HCV infection on the course of HIV infection have been less studied. It is known that hepatitis can slow down the immune reconstitution while receiving antiretroviral therapy. In addition, a violation of the hepatic barrier for products supplying from the intestine, apparently, can lead to additional activation of the immune system, aggravatted immunodeficiency, increased systemic inflammation and the development of AIDS-non-associated diseases, primarily cardiovascular diseases. Most researchers see the solution of the problem in the early start of antiretroviral therapy, as well as in the transition from interferon therapy to the appointment of drugs of direct action in the treatment of HCV infection.

LEVELS OF PLASMA SOLUBLE CD14 IN HIV-INFECTED OPIATE USERS

Chronic immune activation is one of the main causes of HIV disease progression. Bacterial components passed to the bloodstream from the gut as a result of microbial translocation, are known to induce immune activation. Component of Gram-negative bacteria’s cell walls, the lipopolysaccharide (LPS), is considered to be the major marker of microbial translocation. Through the activation of myeloid cells (predominantly monocytes) LPS causes the secretion of soluble CD14, thus making it a marker of LPS bioactivity. Besides sCD14 was shown to correlate with immune status in HIVinfected patients and to be an independent predictor of disease progression. Hypothesis: opiates increase microbial translocation from the gut in HIV-infected patients that is manifested by a higher concentration of sCD14 in plasma. Aim: to estimate the influence of opiate use on the level of sCD14 in plasma of HIV-infected patients. Materials and methods. Longitudinal study of 351 HIV positive individuals. Concentration of sCD14, was evaluated at 3 time points: baseline, after 12 and 24 months. Following groups were studied: 1) current opiate users – opiate use within past 30 days; 2) opiate users, who denied consumption of opiates within past 30 days; 3) people claiming to never have used opiates. Results. In dynamic assessment sCD14 mean was significantly higher in current opiate users (2222,46±39,02 ng/ml) against patients who denied opiates within past 30 days (1930±597 ng/ml) and those, claiming to never have used opiates (1915±577 ng/ml) (p<0,001). Conclusion. Opiate use in the course of HIV disease leads to increase in LPS induced monocyte activation which therefore signifies more intensive microbial translocation.

CLINICAL, AMNESTIC AND IMMUNOLOGICAL PARAMETERS IN HIV-INFECTED PATIENTS WITH GASTROENTEROLOGICAL DISEASES

Nowadays the relevance of questions of comorbidity of different pathologies, including HIV infection diseases of the digestive system. Structural and functional changes in HIV infection can occur in various organs of the digestive system: mouth, esophagus, stomach, liver and in the intestine. The aim of the study was to examine features of the social, epidemiologic, somatic and immune status in HIV infected patients with gastroenterological diseases. Materials and methods. The study involved 500 HIV infected patients consisting on the dispensary account in the Center for the prevention and control of AIDS of the Tyumen region. Results. Sex-age structure and epidemiological history among HIV infected patients with gastrointestinal pathology did not differ (p>0,05) of the total cohort of HIV infected Tyumen region — predominance of males, middle-aged with intravenous by HIV infection in the non-medical use of psychoactive substances. The most common gastrointestinal abnormalities in HIV infection are diseases of the gastroduodenal zone (68,2%) and diseases of the bile ducts (31,8 per cent). Indicators CD4, CD8, and LN of HIV infected to determine the diversity and severity of clinical symptoms resulting from lesions of the digestive tract. The prevalence of gastrointestinal disease in HIV infected patients had inverse correlation of medium strength with immunoregulatory index CD4/CD8 (r=-0,537; p<0,05). Conclusion. Pathogenetic defeat of the digestive system in HIV infection may be caused by direct impact of the virus on the gastrointestinal tract and opportunistic infections, and the indirect influence during chronic systemic inflammatory response and immunodeficiency condition, and also result from prolonged administration of drugs.

Nutritional status of HIV-infected patients in Fars Province, Southern Iran

ABSTRACTMalnutrition among HIV-infected people is a notable problem that can affect both the therapeutic response and severity of this illness. The aim of this study is to assess the nutritional status based on the body mass index of HIV-infected patients in Fars Province, Iran. This cross-sectional study enrolled 485 HIV-positive individuals. Anthropometric indices and demographic and socioeconomic information were identified. Among HIV-positive individuals, 14.9% had evidence of malnutrition, while 26.7% were either overweight or obese. The authors observed a significant difference between body mass index and different socioeconomic classes, as well as body mass index and gender. Since undernutrition is more prevalent among HIV-infected patients who belong to a low socioeconomic class, it is substantially important to pay specific attention to this group of underprivileged patients.

Cerebrospinal fluid metabolomics implicate bioenergetic adaptation as a neural mechanism regulating shifts in cognitive states of HIV-infected patients.

To identify prognostic surrogate markers for change in cognitive states of HIV-infected patients. Longitudinal cerebrospinal fluid (CSF) samples were collected from 98 HIV-infected patients identified by temporal change in cognitive states classified as normal, stably impaired, improving and worsening. The metabolic composition of CSF was analysed using H nuclear magnetic resonance (H NMR) spectroscopy that focused on energy metabolites. Metabolic biomarkers for cognitive states were identified using multivariate partial least squares regression modelling of the acquired spectra, combined with nonparametric analyses of metabolites with clinical features. Multivariate modelling and cross-validated recursive partitioning identified several energy metabolites that, when combined with clinical variables, classified patients based on change in neurocognitive states. Prognostic identification for worsening was achieved with four features that included no change in a detectable plasma viral load, elevated citrate and acetate; decreased creatine, to produce a model with a predictive accuracy of 92%, sensitivity of 88% and 96% specificity. Prognosis for improvement contained seven features that included first visit age less than 47 years, new or continued use of antiretrovirals, elevated glutamine and glucose; decreased myo-inositol, β-glucose and creatinine to generate a model with a predictive accuracy of 92%, sensitivity of 100% and specificity of 84%. These CSF metabolic results suggest that worsening cognitive status in HIV-infected patients is associated with increased aerobic glycolysis, and improvements in cognitive status are associated with a shift to anaerobic glycolysis. Dietary, lifestyle and pharmacologic interventions that promote anaerobic glycolysis could protect the brain in setting of HIV infection with combined antiretroviral therapy.

Prediction of the changes of immunological status and psychopathological data in HIV-infected schizophrenia patients

To predict the immunological status in HIV-infected patients with schizophrenia based on a set of clinical and psychopathological characteristics of the endogenous process. The study included 28 patients with confirmed diagnosis of schizophrenia and HIV status. Authors used psychopathological method, along with psychometric scales (PANSS), in patients with schizophrenia and an immunological method for the determination of HIV-associated status and viral load. Affective syndromes with severe depressive symptoms, volitional impairment, high impulsivity and social features of autism can be prognostically favorable factors for the immune status of HIV-infected patients with schizophrenia that obviously indicates an acute psychotic state. Negative (deficit) symptoms were prognostically unfavorable for the immune status of HIV-infected patients with schizophrenia and for psychosis course. Favorable immune status corresponds to acute psychosis whereas the forms with severe deficit are associated with immunosuppression in HIV-infected patients.

Visceral leishmaniasis due to Leishmania infantum with renal involvement in HIV-infected patients.

BackgroundWe describe histological, clinical findings and outcomes of renal involvement during Leishmania infantum infection in four HIV-infected patients in South France and North Italy hospital settings.Cases presentationFour HIV-infected Caucasian patients (age 24-49) performed renal biopsy during episodes of visceral leishmaniasis. They presented severe immunosuppression, frequent relapses of visceral leishmaniasis during a follow-up period of several years and partial or complete recovery of renal function after anti-parasitic treatment. Main clinical presentations were nephrotic or nephritic syndrome and/or acute renal failure secondary to membranoproliferative type III glomerulonephritis or acute interstitial nephritis. Clinical outcome was poor, probably as a consequence of insufficient immuno-virological control of the HIV infection.ConclusionsOur findings suggest that the main histological findings in case of renal involvement due to Leishmania infantum infection in HIV-infected patients are type III MPGN and acute interstitial nephritis, with a histological specificity similar to that observed in canine leishmaniasis. Poor immune status in HIV-infected patients, altering the capacity for parasite clearance, and prolonged course of chronic active VL in this population may lead to the development of specific renal lesions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0561-9) contains supplementary material, which is available to authorized users.

Identification of putative biomarkers for HIV-associated neurocognitive impairment in the CSF of HIV-infected patients under cART therapy determined by mass spectrometry.

We identified and measured proteins in the cerebral spinal fluid (CSF) involved in HIV-associated neurological disorders. Protein levels were determined by mass spectrometry (MS) in pooled CSF taken from three patient groups (human immunodeficiency virus (HIV)-1-infected patients that developed HIV-associated neurocognitive disorders (HANDs), HIV-1-infected patients without HAND, and healthy controls). Pools were generated from 10 patients each per group. CSF from individual patient groups were digested with trypsin and separately labeled using with isobaric tags for relative and absolute quantitation (iTRAQ). After combining all samples in one, peptides were extensively fractionated by offline two-dimensional separation and identified by tandem MS. One hundred and ninety three proteins were deemed to be interpretable for quantitation based on permutation tests with a 95 % confidence interval with a p value ≤ 0.05. Using a cutoff of 1.5-fold for upregulation and 0.6 for downregulation, 16 proteins were differentially expressed in HIV + HAND (reporter p value ≤0.05) with seven of them previously described as HIV-interacting proteins: endoplasmin, mitochondrial damage mediator-BH3-interacting domanin death agonist, orosomucoid, apolipoprotein E, metalloproteinase inhibitor 2, peroxiredoxin-2, and the nuclear protein, ruvB-like 2. Several previously unidentified proteins with possible neurological implication in HIV patients include forming-binding protein 1, C-reactive protein, leukocyte-associated immunoglobulin receptor 1, renin receptor, mediator of RNA polymerase II transcription subunit 14, multimerin-2, alpha-N-acetylglucosaminidase, caldesmon, and cadherin EGF LAG G-type receptor. Our results suggest that not only a few but possibly a combination of biomarkers that are highly correlated can predict neurocognitive status in HIV-infected patients and might be involved in monocyte or macrophage activation.

Development and validation of a computer-based algorithm to identify foreign-born patients with HIV infection from the electronic medical record.

To develop and validate an efficient and accurate method to identify foreign-born patients from a large patient data registry in order to facilitate population-based health outcomes research. We developed a three-stage algorithm for classifying foreign-born status in HIV-infected patients receiving care in a large US healthcare system (January 1, 2001-March 31, 2012) (n = 9,114). In stage 1, we classified those coded as non-English language speaking as foreign-born. In stage 2, we searched free text electronic medical record (EMR) notes of remaining patients for keywords associated with place of birth and language spoken. Patients without keywords were classified as US-born. In stage 3, we retrieved and reviewed a 50-character text window around the keyword (i.e. token) for the remaining patients. To validate the algorithm, we performed a chart review and asked all HIV physicians (n = 37) to classify their patients (n = 957).We calculated algorithm sensitivity and specificity. We excluded 160/957 because physicians indicated the patient was not HIV-infected (n = 54), "not my patient" (n = 103), or had unknown place of birth (n = 3), leaving 797 for analysis. In stage 1, providers agreed that 71/95 foreign language speakers were foreign-born. Most disagreements (23/24) involved patients born in Puerto Rico. In stage 2, 49/50 patients without keywords were classified as US-born by chart review. In stage 3, token review correctly classified 55/60 patients (92%), with 93% (CI: 84.4, 100%) sensitivity and 90% (CI: 74.3, 100%) specificity compared with full chart review. After application of the three-stage algorithm, 2,102/9,114 (23%) patients were classified as foreign-born. When compared against physician response, estimated sensitivity of the algorithm was 94% (CI: 90.9, 97.2%) and specificity 92% (CI: 89.7, 94.1%), with 92% correctly classified. A computer-based algorithm classified foreign-born status in a large HIV-infected cohort efficiently and accurately. This approach can be used to improve EMR-based outcomes research.

Adherence to Antiretroviral Therapy and Its Effect on Survival of HIV-Infected Individuals in Jharkhand, India

IntroductionResearch in India has extensively examined the factors associated with non-adherence to antiretroviral therapy (ART) with limited focus on examining the relationship between adherence to ART regimen and survival status of HIV infected patients. This study examines the effect of optimal adherence to ART on survival status of HIV infected patients attending ART centers in Jharkhand, India.Materials and MethodsData from a cohort of 239 HIV infected individuals who were initiated ART in 2007 were compiled from medical records retrospectively for 36 months. Socio-demographic characteristics, CD4 T cell count, presence of opportunistic infections at the time of ART initiation and ART regimen intake and survival status was collected periodically. Optimal adherence was assessed using pill count methods; patients who took <95% of the specified regimens were identified as non-adherent. Cox-proportional hazard model was used to determine the relative hazards of mortality.ResultsMore than three-fourths of the patients were male, on an average 34 year old and median CD4 T cell count was 118 cells/cmm at the time of ART registration. About 57% of the patients registered for ART were found to be adherent to ART. A total of 104 patients died in 358.5 patient-years of observation resulting in a mortality rate of 29 per 100 patient-years (95% confidence interval (CI): 23.9–35.2) and median survival time of 6.5 months (CI: 2.7–10.9). The mortality rate was higher among patients who were non-adherent to ART (64.5, CI: 50.5–82.4) than who were adherent (15.4, CI: 11.3–21.0). The risk of mortality was fourfold higher among individuals who were non-adherent to ART than who were adherent (Adjusted hazard ratio: 3.9, CI: 2.6–6.0).ConclusionAdherence to ART is associated with a higher chance of survival of HIV infected patients, ascertaining the need for interventions to improve the ART adherence and early initiation of ART.

Synbiotic therapy decreases microbial translocation and inflammation and improves immunological status in HIV-infected patients: a double-blind randomized controlled pilot trial

BackgroundHIV-infection results in damage and dysfunction of the gastrointestinal system. HIV enteropathy includes pronounced CD4+ T-cell loss, increased intestinal permeability, and microbial translocation that promotes systemic immune activation, which is implicated in disease progression. A synbiotic is the combination of probiotics and prebiotics that could improve gut barrier function. Our study goal was to determine whether the use of a synbiotic, probiotics or a prebiotic can recover immunological parameters in HIV-infected subjects through of a reduction of microbial translocation and pro-inflammatory cytokine production.MethodsA randomized, double-blind controlled study was performed; twenty Antiretroviral treatment-naïve HIV-infected subjects were subgrouped and assigned to receive a synbiotic, probiotics, a prebiotic, or a placebo throughout 16 weeks.ResultsWe had no reports of serious adverse-events. From baseline to week 16, the synbiotic group showed a reduction in bacterial DNA concentrations in plasma (p = 0.048). Moreover, the probiotic and synbiotic groups demonstrated a decrease in total bacterial load in feces (p = 0.05). The probiotic group exhibited a significant increment of beneficial bacteria load (such as Bifidobacterium; p = 0.05) and a decrease in harmful bacteria load (such as Clostridium; p = 0.063). In the synbiotic group, the CD4+ T-cells count increased (median: +102 cells/μL; p = 0.05) and the level of Interleukin 6 cytokine decreased significantly (p = 0.016).ConclusionsOur study showed a significant increase in CD4+ T lymphocyte levels in the synbiotic group, which could delay the initiation of antiretroviral therapy and decrease costs in countries with limited resources.

Periodontal status of HIV infected patients with special reference to CD4 cell count in West Bengal, India

ObjectiveTo evaluate the periodontal status of HIV seropositive patients and to find out if any correlation exists between the severity of periodontal disease and the CD4 cell count in HIV patients. MethodsOne hundred and thirty patients attending the Viral Diseases OPD, Calcutta School of Tropical Medicine, Kolkata were examined. They were grouped according to the CD4 cell count as Group A – Subjects with CD4 Cell count < 200/μL and Group B – Subjects with CD4 Cell count≥200/μL. Their community periodontal index of treatment needs (CPITN) score were recorded. ResultsIt was found that most of the patients in each group were having score ‘2’ (i.e. presence of supra or subgingival calculus), as their highest score. A statistically significant association was found between immune status as depicted by CD4 cell count and periodontal status as shown by highest CPITN score in the present study. ConclusionsThe present study confirms the effect of immunosuppression on periodontal diseases in HIV infected patients.

Vitamin D Status in HIV-Infected Patients With and Without Tuberculosis

Tuberculosis (TB) is a leading cause of death in human immunodeficiency virus (HIV)-infected individuals. Efforts to reduce the burden of TB include isoniazid prophylactic therapy (IPT) for latent TB infection (LTBI).1 However, IPT confers a risk of hepatotoxicity and requires at least six months of therapy.2 Therefore, additional strategies to reduce the burden of active TB are needed. Vitamin D supplementation may decrease the progression of LTBI to active TB. Primarily, in vitro studies demonstrate that 1,25-dihydroxyvitamin D (1,25[OH]2D) enhances macrophage function, thereby augmenting immunologic control of mycobacteria.3 The benefit of vitamin D supplementation is suggested by the observation of increased rates of clearance of TB from sputum in HIV-uninfected individuals.4 Vitamin D, however, may have detrimental effects in HIV-infected patients. In vitro, vitamin D depresses cell mediated immune function, 5 which could hasten progression of LTBI to active disease. This may limit vitamin D supplementation as an adjunct for TB control. Given vitamin D’s conflicting mechanisms of action on the immune system, we conducted a study in Botswana, an area of high TB and HIV prevalence,6 to determine if there was evidence for differences in 25-hydroxyvitamin D (25-OHD) levels in HIV-infected individuals with and without active TB. We hypothesized that 25-OHD levels would be significantly lower in HIV-infected individuals with active TB as compared to those without active TB.