Types Of Opportunistic Infections Research Articles

Incidence of Opportunistic Infections in HIV Patients at Anti-Retroviral Therapy (ART) Adherence Unit, Islamabad Pakistan

Background: Opportunistic infections (OIs) pose a considerable threat to HIV-infected individuals, especially in regions with varied environmental exposures and healthcare resources. The prevalence and severity of these infections are influenced by factors such as local pathogen profiles, host genetics, and the effectiveness of antiretroviral therapy (ART). Objective: This study aimed to determine the prevalence and types of opportunistic infections among male HIV-positive patients at an ART adherence unit in Islamabad, Pakistan, and to compare these with regional trends. Methods: An institution-based cross-sectional study design was utilized, encompassing a review of medical records from 533 male HIV-positive patients over a seven-month period. Data collection focused on demographic details, infection types, and treatment regimens. Exclusion criteria included incomplete files and unspecified OIs. The analysis was performed using SPSS version 25, with frequencies and percentages calculated to assess the prevalence of each infection type. Results: Out of 533 patients, 149 (27.95%) developed at least one opportunistic infection. Respiratory infections were most common, with tuberculosis (TB) found in 25 (16.77%) patients. Skin-related infections were observed in 37 (24.83%) patients, primarily associated with intravenous drug use. Oral thrush was present in 11 (7.38%) patients. Other infections included urinary tract infections in 5 (3.35%) patients and various less common OIs. Conclusion: The study revealed that OIs remain a significant health challenge for HIV-positive individuals, with a notable prevalence of respiratory and skin infections. Early and sustained ART, along with preventive healthcare measures, are crucial in managing and reducing OIs.

Diabetic Ketoacidosis (DKA), a Leading Risk Factor for Mucormycosis (Black Fungus), During the Era of Coronavirus Disease-2019 (COVID-19): An Overview.

Diabetes mellitus (DM) and steroid medication, coincided with coronavirus disease 2019 (COVID-19), results in a weakened immune system, allowing some commonly found pathogens to become more harmful. Mucormycosis (black fungus) is such a type of opportunistic infection caused by fungi belonging to the Mucorales family. DM is the most prominent risk factor for mucormycosis. Excessive blood sugar and decreased insulin levels lead to diabetic ketoacidosis (DKA), a devastating complication of DM that can be fatal if left untreated. Diabetic ketoacidosis is more common in type 1 diabetic patients, although it can also be fall in type 2 diabetic patients. DKA occurs when the body lacks enough insulin to allow blood sugar to enter the cells and is used for energy. Instead, the liver breaks down fat for fuel producing chemicals known as ketones in the process. When too many ketones are created too quickly, they can reach dangerously high levels in the body. Mucormycosis is a rare but serious infectious disease that requires medication or surgical removal. The confluence of diabetes and COVID-19 makes managing mucormycosis a serious and dead issue. Although the effectiveness of prophylactic antifungal therapy has yet to be demonstrated, hyperglycemia control appears to be the most important step in managing mucormycosis in DKA patients.

Role of demographic and clinical factors in survival of HIV patients on antiretroviral therapy.

Our retrospective cohort study assesses the survival probability and identifies the demographic and clinical predictors of mortality in HIV patients taking antiretroviral therapy using an antiretroviral therapy centre data in Western India. Secondary data on 7532 registered HIV-infected individuals between September 2006 and January 2013 were analysed. The probability of survival at 75months was 84.9%. Significant indicators of poor chances of survival were greater age, lower occupation class, lower CD4 count, poor functional status; higher stage of disease, lower weight, the presence and type of opportunistic infections, co-trimoxazole therapy and poor adherence to antiretroviral therapy. We thus find that, in addition to pre-ART, antiretroviral therapy clinical status and treatment adherence, socioeconomic status plays an important influence on ultimate survival of HIV patients on antiretroviral therapy.

Characteristics and Opportunistic Infections of AIDS Patients in East Java Province in 2018

Background: Acquired immunodeficiency syndrome (AIDS) is a health problem in East Java. Opportunistic infections are one of the causes of morbidity and mortality in patients with human immunodeficiency virus (HIV) and AIDS in Indonesia. Purpose: This study aimed to describe the characteristics and opportunistic infections of AIDS patients in East Java Province, 2018. Methods: This study was conducted as observational descriptive research, and a survey was used as the research design. The research location was in East Java Provincial Health Office, and the study was carried out in August 2019. We used secondary data taken from the results of surveillance of AIDS patients in 2018. The sampling method of the study was total sampling, with 1,138 AIDS patients. The variables studied included the patients’ characteristics (sex, age, type of work, and risk factors) as well as the number and types of opportunistic infections. Results: The majority of the AIDS patients in East Java in this sample were male (70.74%), belonged to the adults (26–45 years old) group (62.65%), and worked as employees/laborers (46.08%). In terms of sexual orientation, the majority were heterosexuals (81.81%) or homosexuals (10.63%). The majority of patients experienced one type of opportunistic infection (46.08%), with histoplasmosis (48.77%) and tuberculosis (TB) (42.62%) as the most frequently experienced opportunistic infections. Conclusion: Characteristics that are risk factors for contracting AIDS in East Java include being male, being of adult age, working as an employee/laborer, and being heterosexual. There are also risks of opportunistic infections, particularly histoplasmosis and TB.

CSF biomarkers as potential screen of HIV-1 subtype C in post-HAART era

CSF biomarkers as potential screen of HIV-1 subtype C in post-HAART era - IJN- Print ISSN No: - 2581-8236 Online ISSN No:- 2581-916X Article DOI No:- 10.18231/j.ijn.2020.016, IP Indian Journal of Neurosciences-IP Indian J Neurosci

Incidence and Type of Opportunistic Infections during Ibrutinib Treatment at a Single Academic Center

BACKGROUNDIbrutinib is an irreversible inhibitor of Burton's tyrosine kinase (BTK) in the B-cell receptor (BCR) signaling cascade and is a practice changing treatment for chronic lymphocytic leukemia (CLL) and other B-cell malignancies. Ibrutinib also inhibits Interleukin-2 Inducible Kinase (ITK) in T-cells and has demonstrated immunomodulatory effects. Recently, cases of opportunistic infections (OI) have been reported during ibrutinib treatment including pneumocystis jirovecii pneumonia (PJP), cryptococcus, and fusarium. To date there are no reports on OI in large unselected cohorts of patients taking ibrutinib. We conducted a single-institution retrospective study to determine the incidence and type of OI during ibrutinib treatment as well as outcomes and characteristics associated with risk. METHODSWe reviewed medical records of all patients treated with ibrutinib at the Ohio State University between June 1st 2010 and March 31st 2016. Patients who received ibrutinib for graft versus host disease were excluded. All charts were initially reviewed by one of the investigators and patients with OI were independently reviewed by a second investigator. Baseline patient and disease characteristics were captured at time of starting ibrutinib. All OI occurring after the first dose of ibrutinib were recorded. Onset of OI was considered as the time of first presentation for a complaint related to OI. Time to OI was calculated from the date of starting ibrutinib until the onset of OI or censored at the last assessment date, discontinuation of ibrutinib, or death prior to OI as competing risks. The cumulative incidence of OI was estimated and the Fine and Gray regression models were used to examine the association between patient characteristics and risk of OI. Covariates with significance level of p<0.20 from univariable analyses were further evaluated in a multivariable analysis using a stepwise selection procedure, retaining those with p<0.05 in the final model. RESULTSThe cohort included 566 patients. Median age was 65 (range 23-89) and 70.1% (397/566) were men. The majority of patients had CLL (73.7%, 417/566). Other diagnoses included mantle cell lymphoma (9.9%, 56/566), indolent B-cell malignancies (8.1%, 46/566; 11 Waldenström's Macroglobulinemia, 13 Hairy Cell Leukemia, 15 Follicular Lymphoma, 6 Marginal Zone Lymphoma, and 1 Prolymphocytic Leukemia), and aggressive lymphoma (8.3%, 47/566; 35 diffuse large B-cell or transformed lymphoma and 12 Richter's syndrome). Median number of prior treatments was 3 (range 0-18) and 6.5% (37/566) of patients were treatment naïve. Ibrutinib was prescribed on clinical trial for 80.9% (458/566) of patients with the rest receiving it as standard of care. A second agent was given with ibrutinib in 30.9% (175/566) of cases and was most often a monoclonal antibody (81.7%, 143/175). Use of antiviral prophylaxis was common (78.6%, 445/566) with fewer patients receiving PJP (44.9%, 254/566) or fungal (11.5%, 65/566) prophylaxis. The most utilized prophylactic antifungal agent was fluconazole (70.8%, 46/65). Total ibrutinib exposure for the cohort was 1,225 person-years with a median exposure of 1.98 (range 0.008-6.40) years. Median duration of follow-up was 2.69 (range 0.03-6.40) years. Twenty-three of 566 (4.1%) patients developed an OI at a median of 0.39 (range 0.03-4.33) years after starting ibrutinib. The cumulative incidence of OI was 2.3% (95% CI: 1.3-3.8%) at 0.5 years and increased to 4.7% (95% CI: 3.0-7.0-%) at 5 years. Types of OI and outcomes are detailed in Table 1. Median survival of the entire cohort was not reached. Among 23 OI patients, the median survival after infection was 1.39 years. Univariable analysis revealed ≥3 prior treatments (HR 2.61), diabetes (HR 3.03), pulmonary disease (HR 2.81), chronic kidney disease (HR 2.56), and liver disease (HR 6.42) were associated with an increased risk for OI (p<0.05). In a multivariable analysis ≥3 prior treatments (HR 2.87, 95% CI: 1.12-7.35; p=0.028), diabetes (HR 3.63, 95% CI: 1.50-8.77; p=0.004), and liver disease (HR 7.53, 95% CI: 2.14-26.49; p=0.002) retained independent association with OI development. CONCLUSIONSThe cumulative incidence of OI during ibrutinib treatment was low (4.7% at 5 years) and the most common type was invasive fungal (61%) with no PJP cases. Three or greater prior treatments, diabetes, and liver disease were independently associated with risk for OI. [Display omitted] DisclosuresByrd:Janssen: Research Funding; The Ohio State University: Patents & Royalties: OSU-2S; Genentech: Research Funding; Acerta Pharma: Research Funding; Pharmacyclics: Research Funding.

PRM71 - Prediction Of Costs Associated With The Hospital Management Of Hiv Patients In France Using An Advanced Data Mining Approach On The French Medical Information System Database

The PMSI (medical information system database) is the French national administrative database containing medical information and patients’ features for millions of hospital stays. Most medical studies only use descriptive methods to analyze patient cohorts. The objective of this study is to assess the capability of an innovative Data Mining algorithm to discover hidden values in health data and to bring a better understanding of diseases. We applied the approach to predict the costs associated to HIV patients’ hospital management. We only selected hospital stays with an HIV code, HIV being the principal cause of hospitalization or not. Patients hospitalized with an HIV code in 2013 were extracted and followed up for one year. 10 groups of comorbidities and 5 types of opportunistic infections (OIs) linked to HIV were also identified, and their presence was tracked among these patients. Data were analyzed with an Enhanced Decision Tree technique, in order to explain HIV hospitalization costs depending on non-linear combinations of age, gender and the presence of comorbidities or OIs. 30,294 patients with 70,180 hospital stays were included, for a total cost of 180 million euros. Our Enhanced Decision Tree was able to determine 165 different patient profiles, created automatically to maximize the gathering of patients with similar features. The most discriminative variables for the cost of hospitalization were infections not associated to HIV, bacterial OI, cancer, fungal infections and endocrino-metabolic complications, whereas age, psychiatric or hepatic comorbidities were not discriminative. The annual average cost per patient profiles ranged from €1,680 to €42,650. This exploratory study shows that Enhanced Decision Trees are relevant to identify patient profiles from big databases and may have predictive capabilities. It could help identifying leverages to prevent hospitalizations costs. Further research should be done, adding therapeutic and biological parameters.

Spectrum of Opportunistic Infections and Risk Factors for In-Hospital Mortality of Admitted AIDS Patients in Shanghai.

To investigate the frequency and the spectrum of major opportunistic infections (OIs), evaluate the major clinical factors associated with each specific OI, and identify the risk factors for in-hospital death among HIV patients in East China.A retrospective cohort study was made including all the HIV-infected patients who were admitted for the first time to the Shanghai Public Health Clinical Center during June 1, 2013 to June 1, 2015. The demographic and clinical data were collected. Comparison of continuous variables was analyzed by one-way ANOVA and rank sum test. Person χ test and Fisher exact test were applied to analyze the categorical variables. A Cox proportional hazards regression model was used to determine the risk for the occurrence of in-hospital death.In total, 920 patients were enrolled with age of 41.59 ± 13.36 years and 91% male. Median CD4 was 34 (IQR, 13-94) cells/μL. Among these patients, 94.7% acquired OIs while the rest developed malignancies. Pneumocystis pneumonia and bacterial coinfection (42.1%) was found to be the most common OIs, followed by tuberculosis (31.4%), CMV (20.9%), Cryptococcosis (9.0%), and MAC infection (5.2%). Of the above 5 major OIs, CMV-infected patients had the lowest median CD4 cell count 22.50 (IQR, 7.50-82.00) while the patients with tuberculosis infection had the highest count 61.00 (IQR, 27.00-176.00). In-hospital death rate was 4.2 per 100 person-years among these patients. Of note, admitted patients with 2 types of OIs (2.20, 95% CI 1.39-3.48) and those patients who were 40-year old or older (1.75, 95% CI 1.10-2.78) had a higher risk of such death.Pneumocystis pneumonia and tuberculosis were still the leading causes for the admission of HIV-infected patients in East China, and these patients tended to have very low CD4 cell counts. It is believed that expanding the HIV screening test and pushing the infected ones get ART earlier is required for generating a more successful HIV management strategy.

Biomarkers for Identifying Risk of Immune Reconstitution Inflammatory Syndrome

Biomarkers for Identifying Risk of Immune Reconstitution Inflammatory Syndrome

Disparities in the Magnitude of Human Immunodeficiency Virus-related Opportunistic Infections Between High and Low/Middle-income Countries: Is Highly Active Antiretroviral Therapy Changing the Trend?

Opportunistic infections (OIs) cause significant morbidity/mortality in human immunodeficiency virus (HIV)-infected individuals globally. Disparities between high-income countries (HICs) and low/middle-income countries (LMICs) in the magnitude of HIV-related OIs in pre-highly active antiretroviral therapy (HAART) populations was reviewed, and HAART-induced decline in OIs was further compared between the two settings. Studies published in English from onset of HIV epidemic up to December 2013 were searched in PubMed, Google, Google Scholar, and African Journal online. An article was included if (a) the study was conducted in HIC or LMIC, (b) the age of the participants was ≥12 years, (c) the HAART status of the participants was stated, and (d) various types of OIs were investigated. In predominantly pre-HAART populations, the incidence and prevalence of overall HIV-related OIs in HIC ranged from 5.5 to 50.0 per 100 person-years (PY) and 27.4-56.7%, respectively. In LMIC, the respective overall incidence and prevalence of OIs were 12.2-93.9 per 100 PY and 32.0-77.7%. Pneumocystis jirovecii pneumonia, candidiasis, Cytomegalovirus disease, Mycobacterium avium complex disease, and Kaposi's sarcoma were the most frequent OIs in HICs while tuberculosis, candidiasis, chronic diarrhea, and cryptococcosis were predominant in LMICs. The introduction of HAART led to substantial reduction in the incidence of OIs with more impressive percentage decline in HICs (43-97%) compared to 30-79% in LMICs. Disparities in the magnitude of HIV-related OIs between HICs and LMICs are evident both in the pre-HAART and post-HAART era. Efforts to optimize HAART-induced decline in HIV-related OIs should become a global health priority irrespective of prevailing socioeconomic circumstances.

Association of opportunistic infections with HIV-RNA and CD4 cell count in pre arv and arv failure at the care support treatment clinic of sanglah hospital, Bali

An examination for HIV RNA (viral load) prior to Antiretroviral (ARV) administration is necessary to assess the level of virus inthe serum, which has an impact on how rapidly the disease will progress. HIV RNA measurements are also important to detectearly therapy failure. To date, HIV RNA examination has not been performed for both pre-ARV and ARV failure patients inIndonesia. Therefore, we performed a study to assess the level of HIV RNA in pre-ARV and ARV failure patients, and evaluatedthe association between HIV RNA level, CD4 count, and the types of opportunistic infections. This is a cross sectional study of40 pre-ARV and 35 ARV failure patients. In these pre-ARV and ARV failure patients, the mean level of HIV RNA were 389,394 ( SD 287,913) and 163,705 ( SD 218,681) copies/ml, while the CD4 counts were 73 ( SD 97) and 50 ( SD 94) cells/mm 3 respectively. In pre-ARV patients, the mean CD4 count in subject with TB and without TB was significantly different (14 [ SD 12] vs. 92 [ SD 105] cells/mm 3 ). The HIV RNA level in pre-ARV patients with wasting syndrome is higher than that of patients without wastingsyndrome (556 [ SD 286] vs . 340 [ SD 274] copies/mm 3 ), while in the ARV failure patients, HIV RNA level is higher in subjectwith toxoplasma infections than those without wasting syndrome (525 [ SD 255] vs. 129 [ SD 185] copies/mm 3 ). There was anassociation between few opportunistic infections and HIV-RNA level and CD4 cell count in patients at the clinic of SanglahHospital, Bali.

Clinical &amp; epidemiological profile of malignancy in HIV a retrospective study

Background: HIV is the etiologic agent of AIDS. HIV infection is associated with various types of opportunistic infections and malignancies. The incidence of malignancies among Human Immunodeficiency Virus (HIV) infected patients is known to be higher than in the general population. The study was aimed to know the profile of malignancy in HIV infected individuals. Methodology: Study was a Retrospective study & data was collected from medical records department using semi structured proforma. 40 HIV subjects diagnosed with malignancy was obtained. Stastical analysis of data was done using Chi square test and Fisher’s exact test. Results: Out of 40 HIV subjects diagnosed with malignancy in our study 62%, were males and 38% were females, 95% were receiving ART, Predominantly the patients were in STAGE 4 and NHL was the most common malignancy in our study. CD4 count has no correlation with the incidence of malignancy. Conclusion: Age and Gender distribution does not affect the type of malignancy. Non AIDS defining malignancies are more prevalent than AIDS defining malignancies. NHL is the commonest type of AIDS defining malignancy. CD4 count and HIV stage does not predict the type of malignancy, immunodeficiency can be a trigger for development of malignancy.

Herpes zoster in Crohn’s disease during treatment with infliximab

Infliximab is widely used in both inducing and maintaining remission of patients with Crohn's disease (CD). The efficacy of infliximab has been undoubtedly proven; however, various opportunistic infections have emerged. Herpes virus infections (being a type of opportunistic infection) in CD patients treated with infliximab alone with no other concomitant medications are, however, rare and have not aroused enough attention. Gastroenterologists have limited knowledge of the immunization status of patients with CD, and rarely do they take an adequate immunization history before immunosuppressive therapy. Here we report two herpes zoster (HZ) events in CD patients while using infliximab alone: in the first case, HZ occurred during the patient's 12th infusion for maintance therapy, and in the second case, HZ occurred during the patient's first course of infliximab after surgery for therapy of inducing remission. We hope to increase the gastroenterologists' awareness of this potential infection in CD patients during treatment with infliximab.

Re: Spectrum of AIDS Defining Opportunistic Infections in a Series of 77 Hospitalised HIV-Infected Omani Patients

Sir, The recent report on the spectrum of AIDS-defining opportunistic infections (OIs) in HIV-infected patients is very interesting.1 Balkhair et al. concluded that “a wide spectrum of OIs are seen in hospitalised HIV-infected patients in Oman.”1 Indeed, OIs are common in HIV and can be seen elsewhere around the world. The concern with the present cohort study is the diagnostic approach. Certainly, to identify the clinical spectrum, good, systematic and highly accurate tests must be implemented. Some OIs require special tests for detection. Focusing on the present report, an interesting point is the low prevalence of intestinal OIs. This might be due to these types of OIs having been overlooked. In our experience, several intestinal parasites including OIs are common and must be screened for in HIV-infected patients.2–3

Pathogenic escherichia coli – an update

Escherichia coli is a leading cause of primary intestinal infections and many different types of opportunistic infections of humans, thus making it the most versatile of all pathogens. Sequence analysis of several hundred individual E. coli isolates has revealed a pan-genome comprising more than 15 000 genes, around 5000 of which are present in any one E. coli strain, and around 2500 of which are present in every E. coli strain. Some non-essential genes of pathogenic strains of E. coli include virulence genes, many of which will have been introduced into the pathogen by bacterio-phages. Those genes which become integrated into the E. coli genome typically can be genetically regulated. Over time, this genetic regulation becomes fine-tuned such that the virulence genes are activated in response to host-specific signals. Escherichia coli also acts as a major reservoir of plasmid-borne genes for antibiotic resistance. The genetic malleability of E. coli and its medical importance is well illustrated by the Shiga-toxin-producing strain responsible for a major food-poisoning outbreak in Germany during 2011. Improved understanding of the molecular biology of E. coli has significant implications for the diagnosis, treatment, epi-demiological tracing and prevention of infections caused by this remarkable pathogen.

089 Delayed primary CNS post-transplant lymphoproliferative disorder (PTLD)

Primary central nervous system (PCNS) PTLD is a very rare complication that occurs as a result of immunosuppression in the setting of solid organ transplantation. The median time from transplantation...

Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia

The survival benefits of highly active antiretroviral therapy (HAART) in HIV infected patients have been studied well in the developed world. In resource poor settings like Ethiopia such treatment was started only in 2003. As a result, the existing treatment guidelines and recommendations are based on data from the developed world. The objective of this study was to determine the immunological and clinical progress in HIV/AIDS patients in one year data review of patients' card who initiated on HAART in Ethiopia. A retrospective cohort study was done based on past medical records of HIV/AIDS patients, using a structured data collection format. All patient cards of one year data with patients who initiated HAART from October 1, 2006 to November 30, 2007 were included in the study. The data collected was analyzed using SPSS for window version 16.0. The majority of the study population (383, 64.2%) were prescribed zidovudine/lamivudine/neverapine (ZDV/3TC/NVP) regimen initially. Overall functional status change showed that ability to work was increased by 31.5%, being ambulatory decreased by 93.4% and bedridden status decreased by 80%. A total of 240 (46.9%) patients have showed functional status improvement. Average mean weight change of 5.9 kg (increment by 11.9%) was seen during a one year follow-up. The patients showed immunological change from 132.883 mean CD4/mm3 count to 335.87 mean CD4/mm3. About 492 (82.4%) patients present with different type of opportunistic infections (OIs) at start of therapy which dramatically dropped to only 40 (6.7%) patient after one year of receiving HAART. HAART initiation has decreased progression of the diseases and improved the patients' quality of life. Most patients have showed a significant increment in their CD4 count. The restoration of CD4 in turn has improved the clinical status of most patients. Despite the significant progression of health of patients, greater immunological and clinical success should be attained by encouraging patients for effective use of those lifesaving drugs with maximal adherence.

Comparison of HIV-Infected Patients' Characteristics and Clinical Outcomes Between Cohort-Dependent and Independent Patients: Korean HIV Cohort Study

Comparison of HIV-Infected Patients' Characteristics and Clinical Outcomes Between Cohort-Dependent and Independent Patients: Korean HIV Cohort Study

Coinfection by HTLV-I/II is associated with an increased risk of strongyloidiasis and delay in starting antiretroviral therapy for AIDS patients

ObjectiveTo compare the clinical characteristics and outcomes of HIV-1-HTLV-1 coinfected patients, in Bahia, Brazil. MethodsRetrospective, comparative study. ResultsAmong a total of 123 consecutive HIV infected patients, 20 men (20.6%) and 6 women (23.1%) had detectable antibodies against HTLV-I/II. The major risk factor associated with coinfection by HTLV was intravenous drug use (57.7% of coinfected patient versus 9.2% of HTLV seronegative patients, p < 0.0001). Coinfected patients had higher absolute lymphocyte counts (1,921 + 762 versus 1,587 + 951, p = 0.03). Both groups of patients had similar means of CD4+ and CD8+ cell counts. However, among patients with AIDS CD4+ cell counts were significantly higher among those coinfected with HTLV-I/II (292 ± 92 cells/mm3, versus 140 ± 177cells/mm3, p = 0.36). The frequency and type of opportunistic infections were similar for both groups, but strongyloidiasis and encephalopathy were more frequently diagnosed in coinfected patients (p < 0.05). On the other hand, patients coinfected with HTLV-I/II received significantly less antiretroviral therapy than singly infected by HIV-1 ConclusionCoinfection by HTLV-I/II is associated with an increased risk of strongyloidiasis for HIV patients. Higher CD4 count may lead to underestimation of immunodeficiency, and delay to initiate antiretroviral therapy.

Identificación morfológica de Ehrlichia sp. en las plaquetas de pacientes con infección por virus de la inmunodeficiencia humana, en Venezuela

To determine the frequency of infection by bacteria of the genus Ehrlichia in a population of patients infected with the human immunodeficiency virus (HIV). As is widely recognized, HIV infection is usually followed by the acquired immunodeficiency syndrome (AIDS) after a variable period during which the individual can develop different types of opportunistic infections whose severity depends on his/her immune status. Human ehrlichiosis is a newly-recognized tick-borne infectious disease caused by Ehrlichia spp., which are obligate intracellular, Gram-negative bacteria showing tropism for blood cells (leukocytes and platelets). In Venezuela, the disease was first recognized in humans in 1994, when intra-cytoplasmic microcolonies (morula) were found in human platelets. We collected peripheral blood samples from 87 HIV-positive persons that were received at the Immunology Laboratory of the Oncology and Hematology Institute in Caracas, Venezuela, one of the country's referral centers for cases of HIV infection. Slides prepared from buffy coat that had been stained with Wright's solution and sealed with resin for preservation were examined retrospectively under the light microscope. Ehrlichia spp. were found in the platelets of 12 of the 87 (13.8%) patients whose slides were examined. The presence of Ehrlichia sp. in the platelets of HIV-positive patients suggests that ehrlichiosis should be among the differential diagnoses of opportunistic infection in this group of patients.