Symptomatic Human Immunodeficiency Virus Research Articles

Abstract 10613: Symptomatic Human Immunodeficiency Virus Infected Patients Receive Less Aggressive Revascularization Management After Acute Coronary Syndrome, a 5-year Nationwide Analysis.

Introduction: Cardiovascular disease is a leading cause of morbidity and mortality in human immunodeficiency virus (HIV) infected adults, and should be managed more aggressively.Prior studies highlighted treatment disparities for Acute Coronary Syndrome (ACS) among HIV patients. This study aims at examining these disparities with the latest large cohort data. Hypothesis: HIV patient with ACS are as likely to receive cardiac revascularization related procedures compared to control group. Methods: We reviewed the Nationwide Inpatient Sample from 2013 to 2016 to identify patients with diagnosis of ACS (ST-elevation and non ST-elevation myocardial infarction, and unstable angina) to compare rates of cardiac procedures (Catheterization, Percutaneous Coronary Intervention - PCI - and Coronary Artery Bypass Graft - CABG) among groups of population of interest (control, asymptomatic HIV, symptomatic HIV). Results: Overall, 515,016 patients with primary diagnosis of ACS where identified and among them 2066 (0.40%) of ACS patients had diagnosis of HIV (asymptomatic and symptomatic). Multivariate regression analysis showed statistically significant lower procedural rates for catheterization (OR: 0.62, 95% CI: [0.52, 0.73]), PCI (OR: 0.80, 95% CI: [0.67, 0.96]) and CABG (OR: 0.70, 95% CI: [0.52, 0.93]) in symptomatic HIV compared to control group. For asymptomatic HIV patient group, no significant change of procedural rates were found compared to control group for catheterization, PCI and CABG (respectively OR: 0.90, 95% CI: [0.78, 1.05], OR: 1.13, 95% CI: [1.00, 1.26] and OR: OR: 0.87, 95% CI: [0.72, 1.04]). Conclusions: Analysis shows a treatment disparity for ACS for symptomatic HIV patients only as symptomatic HIV affected patients received less aggressive catheterization and revascularization management after ACS, compared to control group. However, this effect was not present for the asymptomatic HIV patient group.

3039 Esophageal Ulcers: A Presenting Symptom of Acute HIV Infection

INTRODUCTION: Dysphagia and odynophagia are commonly encountered in patients who are immunocompromised from chronic Human Immunodeficiency Virus (HIV) infection. Acute HIV infection can also cause odynophagia due to abrupt onset of oropharyngeal mucosal disease. We describe the eventual diagnosis of acute HIV infection in a patient presenting with dysphagia and odynophagia following endoscopic finding of esophageal ulceration. CASE DESCRIPTION/METHODS: A 43-year-old man presented with one week of epigastric pain, dysphagia, and odynophagia in the setting of recent fever (TMax 102.8F) and chills. He had intermittently taken a PPI following an emergency room visit the previous week. Oropharyngeal exam was negative for ulcers or thrush and abdominal exam was benign. Initial labs were normal aside from mild leukopenia (WBC 3,100/uL) with a low absolute neutrophil count. He underwent EGD showing several deep distal esophageal ulcers. Pathology showed acute esophagitis with mild to severe neutrophilic infiltrate and neutrophilic microabscesses. Staining of the ulcer biopsy specimens was negative for cytomegalovirus (CMV), herpes simplex virus (HSV) and fungal elements. The unknown etiology of his esophageal ulcers prompted testing for HIV. HIV immunoassay was positive however antibody differentiation was indeterminate. A subsequent HIV viral load was positive indicating acute HIV-1 infection. He was placed on anti-retroviral therapy soon after. A repeat EGD was performed three months later, demonstrating complete resolution of the previously seen ulcers. DISCUSSION: Presenting signs and symptoms of acute symptomatic HIV infection are nonspecific and the diagnosis is often missed or delayed. Esophageal ulceration may be underrecognized as an acute manifestation of illness. In one study of 16 men presenting with odynophagia who were eventually found to have acute HIV infection (HIV serology negative at presentation), all 16 were found to have esophageal ulceration during index endoscopy. Identification of viral particles resembling HIV-1 within ulcer biopsies with electron microscopy and isolation of HIV-1 from an ulcer biopsy specimen raise the possibility of direct viral infection of esophageal cells. With this in mind, endoscopists and gastroenterology providers should have a high index of suspicion for acute HIV infection in patients with odynophagia secondary to esophageal ulcer of unknown etiology.

Two cases of immune reconstitution inflammatory syndrome in HIV patients treated with thalidomide

Immune reconstitution inflammatory syndrome (IRIS) is a clinical manifestation that accompanies paradoxical deterioration of symptoms in human immunodeficiency virus (HIV)-infected patients after commencement of antiretroviral treatment. This disease is caused by immune dysregulation, resulting in a cytokine storm and limited effector T-cell function. IRIS treatment involves supportive care and corticosteroid therapy to regulate the immune response. However, prolonged steroid therapy may increase the risk of opportunistic infections. Previous studies have highlighted the use of thalidomide to shorten the duration of steroid use. Herein, we report two cases of IRIS in HIV-infected patients whose symptoms were successfully controlled with thalidomide therapy. Both patients had opportunistic infections involving the central nervous system; one patient had cryptococcal meningitis and the other had progressive multifocal leukoencephalopathy.

Current Use and In-Hospital Outcomes of Mechanical Circulatory Support in HIV-Infected Patients: A Friend or a Foe?

Current Use and In-Hospital Outcomes of Mechanical Circulatory Support in HIV-Infected Patients: A Friend or a Foe?

Anti-HIV/AIDS Drugs: An Overview

Human Immunodeficiency Virus (HIV) is an enveloped virus, belonging to the viral family Retroviridae. It is a highly evolved virus which has grasped the attention of all researchers with its special features like morphology, genetics and also by its emerging nature3. The special feature of all retro viruses is the presence of an enzyme called Reverse transcriptase which plays major role in reverse transcription process4. HIV enters the host body, damages immune system and will cause life-threatening opportunistic infections finally leads to AIDS (Acquired Immunodeficiency Syndrome).Many advances have been made in the prevention of HIV transmission and management of HIV/AIDS since the virus was discovered in the early 1980s7. One of the most important discoveries has been antiretroviral treatment, which can halt the replication of HIV and ease symptoms, turning AIDS into a chronic condition instead of a rapidly terminal illness. Despite advances, HIV remains a major public health challenge. This article reviews the genus, life cycle, and transmission of HIV, as well as workplace issues surrounding the virus and the challenges of developing an HIV vaccine12. Keywords: Acquired Immunodeficiency Syndrome.

Symptomatic human immunodeficiency virus-infected patients have poorer outcomes following emergency general surgery: A study of the nationwide inpatient sample.

The impact of human immunodeficiency virus (HIV) infection on outcomes following common emergency general surgery procedures has not been evaluated since the widespread introduction of highly active antiretroviral therapy. A retrospective cohort study was conducted using the Nationwide Inpatient Sample. Records of patients who underwent laparoscopic or open appendectomy, cholecystectomy, or colon resection after emergency admission from 2004 to 2011 were obtained. Outcomes analyzed included in-hospital mortality, length of stay, total charges, and selected postoperative complications. Patients were divided among three groups, HIV-negative controls, asymptomatic HIV-positive patients, and symptomatic HIV/acquired immune deficiency syndrome (AIDS) patients. Data were analyzed using χ and multivariable regression with propensity score matching among the three groups, with p value less than 0.05 significant. There were 974,588 patients identified, of which 1,489 were HIV-positive and 1,633 were HIV/AIDS-positive. The HIV/AIDS patients were more likely to die during their hospital stay than HIV-negative patients (4.4% vs. 1.6%, adjusted odds ratio, 3.53; 95% confidence interval [CI], 2.67-4.07; p < 0.001). The HIV/AIDS patients had longer hospital stays (7 days vs. 3 days; adjusted difference, 3.66 days; 95% CI, 3.53-4.00; p < 0.001) and higher median total charges than HIV-negative patients (US $47,714 vs. US $28,405; adjusted difference, US $15,264; 95% CI, US $13,905-US $16,623; p < 0.001). The HIV/AIDS patients also had significantly increased odds of certain postoperative complications, including sepsis, septic shock, pneumonia, urinary tract infection, acute renal failure and need for transfusion (p < 0.05 for each). Differences persisted irrespective of case complexity and over the study period. Asymptomatic HIV-positive patients had outcomes similar to HIV-negative patients. The HIV/AIDS patients have a greater risk of death, infectious, and noninfectious complications after emergency surgery regardless of operative complexity and despite advanced highly active antiretroviral therapy. Patients who have not developed advanced disease, however, have similar outcomes to HIV-negative patients. Prognostic and epidemiologic study, level III.

A preliminary analysis of the association between perceived stigma and HIV-related pain in South Africans living with HIV.

BackgroundStigma related to the human immunodeficiency virus (HIV) remains common and has been associated with severity of HIV-related symptoms. Associations between HIV stigma and HIV-related pain, one of the most common symptoms in HIV, have however not been investigated. Data from low back pain populations suggest that stigma is associated with worse pain intensity and so we hypothesised that the same would be the case in HIV.AimThe goal of this study was to assess the association between HIV stigma and pain intensity in people living with HIV (PLWH) with chronic pain whilst controlling for depression, a well-established correlate of pain.SettingThe study took place at an HIV clinic in Johannesburg, South Africa.MethodsMediation analysis was used to assess the effect of depression on the relationship between stigma and pain intensity in a cross-sectional cohort of 50 PLWH and chronic pain (pain most days of the week for > 3 months). All participants were assessed using the HIV/AIDS Stigma Instrument – PLWA, an 11-point numerical pain rating scale and the Beck Depression Inventory II.ResultsIn all, 88% (44/50) of participants reported experiencing some form of HIV stigma (HIV stigma scale score ≥ 1). Worst pain intensity and depressive symptoms individually correlated with total stigma score (Spearman’s r = 0.33, p = 0.02 for both). The mediation analysis highlighted that mediation of the relationship by depression was equivocal (b = -0.002, bootstrapped confidence interval -0.02 to 0.00).ConclusionWhilst these preliminary data are marginal, they do suggest that associations between HIV stigma and HIV-related pain warrant further investigation. Future study should also include potential mechanisms, which may include mediation through depression.

Managing Cases with Human Immunodeficiency Virus Infection: Knowing the Dynamics from Voluntary Counselling and Testing Clients in Bobo-Dioulasso for Better Planning in Burkina Faso (1996-2014)

Background: The Anonymous Screening and Information Centre (CADI) is the oldest screening centre of HIV from Burkina Faso. Since its opening, no analysis on the evolution of Human Immunodeficiency Virus (HIV) prevalence has been carried out. Objective: The study aimed to describe the dynamics of HIV infection when managing centres offering voluntary counselling and testing to client, such as the Screening and Counselling Centre (CADI), in Bobo Dioulasso, Burkina Faso. Patients and Methods: A cross-sectional study was performed including people screened at the CADI from May 1996 to June 2014. Pearson khi2 test and Cuzick trend test were used with a 5% significance level. Results: From 7.1% of the 11,451 cases analyzed, the average age of clients screened was 30 ± 10.83 year-old. There was a female predominance (sex ratio = 0.8). The 16.4% (15.7 - 17.1) of the cases from the 11,451 clients included in our study were tested HIV positive. The global prevalence rate of HIV in the centre has significantly decreased from 46.2% in 1996 to 1.5% in 2014 (p < 0.0001). In 1999, 2001, and 2006, the peaks of the HIV prevalence rates were noted: 22.9%, 34.1%, and 22.8% respectively. CADI’s customers’ profile has significantly changed. Therefore between 1996 and 2000, people with HIV symptoms were more common at the centre (42.7%). From 2001 to 2008, physician-prescribed screenings were best predominant (83.95%). From 2008 to 2014, a total of 72.7% people reported with reason for the screening a desire to know their serological status. Conclusion: The behaviour change could be a justification for the decline in HIV prevalence at the centre, hence the importance of sensitization campaigns.

English

Dual voices of women with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) show the experiences of the HIV positive women who are ignored by the society at large. The study aims to showcase the voices of women living with HIV and AIDS at a micro-level to approach the disease in a more holistic way. Qualitative study was employed to explore and describe the experiences of women living with HIV and AIDS. The study area is a clinic in Gauteng Province of South Africa. A non-probability purposive sampling technique was used to select the study participants (n=12). In-depth, individual semi-structured interviews were conducted and thematic content approach was used for data analysis. Five themes were used to describe the women’s five experiences from being diagnosed with HIV: disclosing HIV positive status, signs and symptoms of HIV and AIDS, stigmatization, emotions and services being rendered. HIV and AIDS have negative effects on the women. They are looking for ways to cope with the disease. Women should be given enough support and health care. This can be done by providing enough consultation rooms, adequate waiting time, pre-counseling before given antiretroviral treatment (ART), engagement of male partners and relatives and addressing peer support and confidentiality. Key words: Acquired immune deficiency syndrome (AIDS), experiences, human immunodeficiency virus (HIV), women.

Measles Seroprevalence and Vaccine Responses in Human Immunodeficiency Virus-infected Adolescents and Adults: A Systematic Review.

The World Health Organization (WHO) recommends an additional dose of measles-containing vaccine (MCV) for human immunodeficiency virus (HIV)-infected children receiving highly active antiretroviral therapy following immune reconstitution. We conducted a systematic review to synthesize available evidence regarding measles seroprevalence and measles vaccine immunogenicity, efficacy, and safety in HIV-infected adolescents and adults to provide the evidence base for recommendations on the need for measles vaccination. We conducted searches of 8 databases through 26 September 2017. Identified studies were screened independently by 2 reviewers. The search identified 30 studies meeting inclusion criteria. Across studies, measles seroprevalence among HIV-infected adolescents and adults was high (median, 92%; 27 studies), with no significant difference compared to HIV-uninfected participants (10 studies). In 6 studies that evaluated the immunogenicity of MCVs among seronegative HIV-infected adults, measles seropositivity at end of follow-up ranged from 0% to 56% (median, 39%). No severe adverse events were reported following measles vaccination in HIV-infected patients. Based on similar measles seroprevalence between HIV-infected and HIV-uninfected adolescents and adults, and the low response to vaccination, these studies do not support the need for an additional dose of MCV in HIV-infected adolescents and adults. These findings support WHO guidelines that measles vaccine be administered to potentially susceptible, asymptomatic HIV-infected adults, and may be considered for those with symptomatic HIV infection if not severely immunosuppressed. Measles-susceptible adolescents and adults, regardless of HIV status, may require targeted vaccination efforts to reach critical vaccination thresholds and achieve regional elimination goals.

181 Clinical Knowledge of Human Immunodeficiency Virus Among Emergency Providers at Two Level 1 Trauma Centers in Cleveland, Ohio

Emergency departments (ED) are targeted areas for prevention and diagnosis of early human immunodeficiency virus (HIV) and sexually transmitted infections (STI) given increased prevalence in this setting. Clinical knowledge and recognition of these diseases is required for identifying those at risk. Previous studies show that STI knowledge is sup-optimal among general practitioners, and acute HIV infection is frequently misdiagnosed in the ED. The purpose of this study was to assess the correlation between self-reported STI knowledge and HIV test ordering practices among emergency medicine providers in a survey study of simulated scenarios. We modified 2 surveys previously published in the literature that assess knowledge of acute HIV infection and STIs. The survey was divided into 2 sections: a 29-point score for STIs and a 10-point score for HIV. This modified survey was administered to all emergency physicians, residents, and advanced practice providers affiliated with 2 level 1 trauma centers in Cleveland, Ohio. The primary outcome of ordering an HIV test was analyzed using Spearman’s correlation coefficient (SC) to assess strength of correlation with STI knowledge. Subgroup analyses were conducted using SC and ANOVA. This study was powered to estimate the SC using an effect size of 0.3 at an alpha of 0.05 for 90% power requiring a sample size of 90 respondents. A total of 75 providers (31.3%) completed the survey. Respondents were primarily physicians (54.6%), male (56%), white (83.7%), with a median of 8 years in practice (IQR: 2,16). The majority of respondents (57%) report formal HIV training as part of their professional education. Spearman’s correlation of HIV and STIs showed a monotonic relationship with a weak positive correlation (r = 0.3513, p = 0.002). A similar analysis comparing length of time as an emergency medicine provider with HIV and STI scores was monotonic with a weak negative correlation that was not statistically significant. There was no association between HIV scores and provider type (p=0.67) or provider sex (p=0.89); however, those with formal HIV training scored higher than those without formal HIV training (p=0.003). There was no association between STI scores and provider type (p=0.10) or provider sex (p=0.79). The movement in emergency medicine to screen patients at risk of undiagnosed HIV focuses on universal or targeted screening. The results of our study reveal that when presented with a patient at high-risk for undiagnosed HIV or with undiagnosed symptomatic HIV infection, most providers either do not screen or do not have HIV in the differential diagnosis. Similarly, knowledge of STIs is only weakly correlated with knowledge of HIV risk factors and symptomatic HIV infection. Further research and screening efforts may benefit by focusing on HIV education among EM providers.

Effect of Rational Emotive Health Therapy on Alcohol Use Among Community-dwelling, HIV-positive Patients.

Patients who have tested positive for the human immunodeficiency virus (HIV) and who also experience alcohol use disorder (AUD) symptoms have worse clinical outcomes when compared with those who do not have AUD symptoms. The objective of the present study was to determine the effect of rational emotive health therapy (REHT) on AUD among community-dwelling, HIV-positive patients in the Southeastern region of Nigeria. The research design included a pretest/post-test control group with a total of 124 community-dwelling, HIV-positive patients with AUD symptoms participating in the study. The measures employed for data collection included Alcohol-related Irrational Beliefs Scale (AIBS) and Alcohol Use Disorder Scale (AUDS). Repeated measures analysis of variance was used for statistical analysis. The result obtained at the initial assessment indicated that AUD was severe. Furthermore, REHT intervention led to a significant reduction in AUD symptoms, as shown by a reduction in AUDS and AIBS scores with time in the treatment group compared to those in the waitlist control group after the intervention. Also, the effect of REHT was positively maintained in the treatment group participants at follow-up assessment. The presence of HIV symptoms alone does not cause HIV-positive patients to be dependent on alcohol; rather, irrational beliefs about the infection may contribute to unhealthy feelings and abuse of alcohol. Rational emotive health therapy is an effective approach that can be employed by therapists and health counselors in helping HIV-positive patients to think rationally about themselves and work to be able to overcome HIV-related, as well as alcohol-related, irrational beliefs.

Effects of Household Air Pollution in Malawi and Human Immunodeficiency Virus Status on Respiratory Symptoms and Inflammation, Injury, and Repair Markers

Rationale: Household air pollution (HAP) and human immunodeficiency virus (HIV) are associated with increased risk for chronic obstructive pulmonary disease. Both HAP and HIV are widespread in Sub-Saharan Africa, including Malawi, where HIV has 10.6% prevalence in patients 15–49 years old. Objectives: We hypothesized that HIV infection (HIV+) and habitual exposure to HAP (HAP+) synergize to cause systemic inflammation and vascular injury, which may herald early onset of chronic respiratory diseases. Methods: In this pilot study, 50 subjects from Malawi with known HIV status were administered surveys recording demographics, HAP exposure, and respiratory symptoms/diagnoses. Peripheral blood was collected, and Meso Scale Discovery V-Plex assay was used to measure the levels of 41 serum markers. Results: Almost all subjects (96%) reported HAP+, 30 were HIV+, 20 were HIV−, with a mean age of 22 years in both groups. More females (73%) were HIV+, whereas 65% of those who were HIV− were males. The vast majority were never-smokers (70% of HIV− and 83% of HIV+ subjects, respectively). Forty-six percent of all subjects (57% of HIV+HAP+ and 33% of HIV−HAP+) reported respiratory diagnoses and/or respiratory symptoms, with breathlessness and cough being most common. Although HIV+HAP+ individuals had a trend to increased proinflammatory cytokines and vascular injury markers, and decreases in proangiogenic factors compared with HIV−HAP+, only the decrease in serum interleukin-16 (by 44%) was statistically significant (P = 0.03). Also, compared with other subjects, serum interleukin-2 levels were significantly decreased (by 31%; P = 0.02) in HIV+ subjects with persistent respiratory symptoms. Conclusions: This study suggests a high prevalence of respiratory symptoms in HIV+ individuals exposed to HAP. The significant decrease in interleukin-2 and interleukin-16, cytokines associated with HIV clearance, may contribute to viral persistence, and because their low levels were found to correlate with chronic obstructive pulmonary disease severity, they may serve as biomarkers for risk of chronic obstructive pulmonary disease in this vulnerable population.

Clinico-mycological analysis and antifungal resistance pattern in human immunodeficiency virus-associated candidiasis: An Indian perspective.

Objectives:Candidiasis is a common human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome-associated opportunistic mycoses. The present study ascertained the species spectrum of Candida strains recovered from different clinical samples from symptomatic HIV-positive individuals and determined the antifungal susceptibility profile of the isolates.Materials and Methods:A variety of specimens were collected from 234 symptomatic HIV seropositive individuals depending on their clinical manifestations and subjected to direct microscopic examination. Blood samples were inoculated in biphasic blood culture medium and all other specimens on Sabouraud dextrose agar with chloramphenicol and incubated at 35°C–37°C. Species identification of the recovered Candida isolates was attempted on the basis of germ tube production, micromorphology on corn meal agar, color and morphology on HiCrome Candida Differential agar, and carbohydrate fermentation and assimilation tests. Susceptibility testing of the isolates was performed employing the VITEK 2 system.Results:A total of 167 Candida isolates were obtained; Candida albicans (136), Candida tropicalis (13), Candida krusei (8), Candida parapsilosis (5), Candida glabrata (4), and Candida kefyr (1). Fluconazole resistance was more frequent among nonalbicans species, and significantly higher 5-fluorocytosine resistance compared to C. albicans was also observed. Eight Candida strains (six C. krusei, one C. kefyr, and one C. albicans) were multidrug resistant.Conclusion:Although C. albicans continues to be the leading etiological agent of candidiasis, the incidence of nonalbicans species among HIV-positive Indian individuals is rising. Antifungal resistance was higher among nonalbicans Candida species. Another issue of therapeutic concern is the possible emergence of multidrug-resistant Candida strains among these patients.

Human Immunodeficiency Virus in the Brain-Culprit or Facilitator?

Introduction:Human immunodeficiency virus (HIV) enters the brain early, where it can persist, evolve, and become compartmentalized. Central nervous system (CNS) disease can be attributed to HIV alone or to the complex interplay between the virus and other neurotropic pathogens.Aim:The current review aims to describe the direct impact of HIV on the brain as well as its relationship with other pathogens from a practitioner’s perspective, to provide a general clinical overview, brief workup, and, whenever possible, treatment guidance.Methods:A review of PubMed was conducted to identify studies on neuropathogenesis of HIV in relation to host responses. Furthermore, the interaction between the CNS pathogens and the host damage responses were revised in the setting of advanced and also well-controlled HIV infection.Results:Similar to other pathogens, HIV leads to CNS immune activation, inflammation, and viral persistence. Therefore, almost half of the infected individuals present with neurocognitive disorders, albeit mild. Compartmentalized HIV in the CNS can be responsible in a minority of cases for the dramatic presentation of symptomatic HIV escape. Disruption of the immune system secondary to HIV may reactivate latent infections or allow new pathogens to enter the CNS. Opportunistic infections with an inflammatory component are associated with elevated HIV loads in the cerebrospinal fluid and also with greater cognitive impairment. The inflammatory immune reconstitution syndrome associated with CNS opportunistic infections can be a life-threatening condition, which needs to be recognized and managed by efficiently controlling the pathogen burden and timely balanced combination antiretroviral therapy. Latent neurotropic pathogens can reactivate in the brain and mimic HIV-associated severe neurological diseases or contribute to neurocognitive impairment in the setting of stable HIV infection.Conclusions:As HIV can be responsible for considerable brain damage directly or by facilitating other pathogens, more effort is needed to recognize and manage HIV-associated CNS disorders and to eventually target HIV eradication from the brain.

Vaccine-related poliovirus shedding in trivalent polio vaccine and human immunodeficiency virus status: analysis from under five children

BackgroundPoliomyelitis is an acute viral infection caused by poliovirus and transmitted via the fecal–oral route. The causative agent is one of the three serotypes of poliovirus (serotypes 1, 2, 3) that differ slightly in capsid protein. Prolonged vaccine-related poliovirus shedding in human immunodeficiency virus (HIV) positive individuals has been linked to possible reservoir for reintroduction of polioviruses after eradication. The study therefore aimed at estimating the duration for vaccine-related poliovirus shedding among potentially and HIV-infected persons.MethodsPoliovirus excretion was studied following vaccination of children aged ≤ 59 month per human immunodeficiency virus status after national immunization days. Their medical records were reviewed to identify the child’s HIV status, demographic and immunization data. Sequential stool samples were collected at site 2nd, 4th and 8th week after trivalent oral poliovirus vaccine (tOPV) was administered. To isolate suspected polioviruses and non-polio enteroviruses, characterize poliovirus subtypes by intratypic differentiation and Sabin vaccine derived poliovirus, real time polymerase chain reaction was applied. Shedding for ≥ 24 weeks was defined as long-term persistence.ResultsThe mean age of the study population was 28.6 months, while the median age was 24 months. Of the children recruited, majority were in the 25–48 months (n = 12; 46.2%) age category. All the HIV-positive children (n = 10) had mild symptomatic HIV status and did shed vaccine-related polioviruses between weeks 2 and 4 respectively. No participant shed polioviruses for ≥ 6 weeks.ConclusionsIt was evident mildly symptomatic HIV+ children sustain the capacity to clear vaccine-related poliovirus. The oral poliovirus vaccine-2 (Sabin like) that was detected in one HIV-infected child’s stool 6 weeks after the national immunization days was predominantly non revertant. There was no evident prolonged poliovirus shedding among the participants enlisted in the present study. High powered studies are desired to further corroborate these findings.

Neurological manifestations of HIV-AIDS at a tertiary care institute in North Eastern India.

The nervous system is among the most frequent and serious targets of human immunodeficiency virus (HIV) infection. The infection usually occurs in patients with profound immunosuppression. In 10 - 20% of the patients, the presence of a neurological disease is the first manifestation of symptomatic HIV infection. Despite the wide prevalence of neurological manifestations in HIV, there is no study examining the clinical manifestations of this disease in the resource- limited communities from north-eastern parts of India. To characterize the neurological involvement in patients with HIV infection at a tertiary care institute in northeast India, we studied various neurological presentations of HIV. This was a retrospective observational study done at a tertiary care institute in northeast India over a period of 6 years from August 2008 to September 2014. A total of 91 HIV seropositive patients of both genders, aged >18 years, showing clinical evidence of central nervous system (CNS) involvement, and admitted in a tertiary care institute were included. Their clinical manifestations, laboratory investigations, and imaging were studied. Tuberculous meningitis was the most common presentation as secondary CNS illness (43.9%), followed by cryptococcal meningitis (14.2%) and cerebrovascular accidents (5.49%). Furthermore, 6.59% had neurosyphilis, 6.59% had acquired immune deficiency syndrome (AIDS) - associated dementia, and peripheral neuropathy occurred in 16.4% of the patients. Headache was the most common neurological symptom seen in 25% of the patients. Seizures were noted in 25% of the pateints. CD4 was significantly low in most of the patients with progressive multifocal leukoencephalopathy, HIV associated encephalopathy (HAD) and cryptococcal meningitis compared with other neurological manifestations. CD4 counts in tuberculous meningitis and HAD were 110.3/μl and 95/μl, respectively. CNS tuberculosis was the most common secondary infection seen in HIV patients followed by cryptococcal meningitis. A high index of clinical suspicion of neurological involvement in HIV patients helps in the early diagnosis and early institution of specific treatment, which in turn decreases the morbidity and mortality considerably.

Death Anxiety among Asymptomatic Acute HIV Condition, Clinically Symptomatic Condition and Aids Indicator Condition Groups

There is much interest in, whether death anxiety may explain the wide variability in the disease course of patients infected with Human Immunodeficiency Virus (HIV). This paper examines whether death anxiety varies across Asymptomatic Acute HIV condition, Clinically Symptomatic Condition and AIDS Indicator Condition. A cross sectional research design is employed and participants were grouped as having asymptomatic, clinically symptomatic and AIDS according to case definitions established by the Centers for Disease Control and Prevention. The data is obtained from 480 participants on the level of death anxiety and it is analysed with reference of their disease progression from HIV to AIDS. A one way ANOVA statistics indicated that Asymptomatic acute HIV condition, Clinically symptomatic HIV condition and AIDS indicator groups were significantly differ in the level of death anxiety. A Tukey’s HSD post-hoc test indicated that clinically symptomatic acute HIV condition group had exhibited higher level of death anxiety than asymptomatic acute HIV condition group and lower level of death anxiety compared to AIDS indicator group. By knowing the varied level of death anxiety across disease progression the tailor made interventions can be planned.

Higher HIV RNA Viral Load in Recent Patients with Symptomatic Acute HIV Infection in Lyon University Hospitals.

IntroductionIncreased human immunodeficiency virus (HIV) virulence at infection has been suggested by a meta-analysis based on viral load and CD4 T lymphocytes (CD4) count during acute infection. This result was obtained after secondary analyses of large databases, facilitating the detection of differences. Similar finding in cohorts of more modest sample size would indicate that the effect could be more substantial.MethodsChange from initial CD4 count and HIV viral load after acute HIV infection by calendar year was explored in patients treated at Lyon University hospitals. All patients admitted to our hospitals with acute HIV infection between 1996 and 2013 were included in our study. Initial CD4 count and viral load before the start of anti-retroviral treatment were analyzed. Trends over time were assessed in linear models.ResultsInitial CD4 count remained similar over time. However, in 2006–2013, initial viral load rose significantly (+1.12 log10/ml/year, p = 0.01).ConclusionOur data, obtained from a single hospital cohort, confirmed findings from a large meta-analysis, showed increased initial viremia at acute HIV infection since 2006 and suggesting potentially higher HIV virulence in recent years.

The Potential of Sub-Saharan African Plants in the Management of Human Immunodeficiency Virus Infections: A Review.

Acquired immunodeficiency syndrome, caused by human immunodeficiency virus (HIV), is a leading cause of mortality and morbidity in Sub-Saharan Africa, particularly in Southern Africa. Phytomedicines are an integral part of African health care. The Southern African flora is composed of at least 23 400 taxa. Despite this richness, only a handful of botanical products have been assessed for activities against HIV. This study aimed to summarize the potential of Sub-Saharan African plants, based on their composition and the established bioactivities, as sources of agents to manage HIV symptoms and as retroviral therapy. At least 109 plant species from 42 families and 94 genera that are found in Southern Africa were shown to have potential or actual activities against HIV. Only 12 of these plant species from 6 families and 10 genera were shown to harbour anti-HIV properties. Phytochemicals that include β-sitosterols, terpenoids, glycosides, saponins, flavonoids, triterpenoids, tannins and alkaloids, which harbour anti-HIV properties, were found to have a near cosmopolitan presence across the plant families in the region. Bioactivities of multiple phytochemicals are comparable to those for standard allopathic antiretroviral drugs. Research to determine the anti-HIV activities of the identified and other plants, including clinical trials, is long overdue.