Virus-positive Individuals Research Articles

Diversity and Antifungal Drug Susceptibility of Cryptococcus Isolates in Thailand.

Yeasts of the Cryptococcus species complex are the causative agent of cryptococcosis, especially in human immunodeficiency virus (HIV) positive individuals. Cerebral or disseminated cryptococcosis has a very high mortality rate worldwide, including in Thailand. Additionally, an increasing rate of antifungal drug resistant cryptococcal isolates has been reported in several neighboring countries, complicating therapeutic approaches. To understand the situation of this infection in Thailand, we retrospectively investigated the molecular epidemiology and antifungal drug resistance in a collection of 74 clinical, 52 environmental and two veterinary isolates using the URA5-RFLP for typing and the EUCAST guideline for susceptibility testing. Where no EUCAST breakpoints (AMB and 5FC) were available, CLSI epidemiologic cutoff values were used for interpretation. Cryptococcal molecular type diversity showed most isolates were C. grubii, molecular type VNI. One clinical isolate was C. deuterogattii (mol. type VGII) and another C. grubii (mol. type VNII). One strain from environment was classified as C. grubii (mol. type VNII). No resistant strains were detected in this retrospective study for either of the antimycotics tested; however, monitoring of the epidemiology of Cryptococcus species in infected patients in Thailand needs to be continued to detect emergence of resistance.

Human immunodeficiency virus in institutionalized elderly people.

A search in the SciELO and PubMed databases showed few studies on human immunodeficiency virus (HIV) positive individuals in long-term care institutions (LTCIs), thus prompting the present study. The aim of this study was to ascertain whether there were any HIV-positive individuals in LTCIs for the elderly. Cross-sectional study in which the Hospital Infection Control Committee (HICC) of a 405-bed LTCI was consulted. The medical records of 405 individuals interned in the LTCI who had been tested for HIV infection were requested for analysis of the following variables: [1] age and gender; [2] length of stay at LTCI (months); [3] causes and diagnoses on admission to LTCI according to International Classification of Diseases, 10th edition; [4] date of HIV diagnosis; [5] seropositivity for syphilis and hepatitis B and C viruses; [6] medications used at last prescription in medical file; and [7] mean CD4 lymphocyte count based on: total lymphocyte count/6 and total lymphocyte count x 0.8 x 0.2 or 0.3. Four men were HIV-positive, with mean age 71.2 ± 8.6 years, LTCI stay 74.2 ± 38.1 months and length of HIV diagnosis 24.5 ± 17 months (confirmed by HICC standard screening). Three had stroke sequelae; one, dementia syndrome; two, seropositivity for syphilis; two, hepatitis B and one, hepatitis C. The main drugs used were lamivudine, zidovudine, lopinavir, ritonavir, levothyroxine, omeprazole, ranitidine, lactulose and risperidone. The estimated CD4 count was 341 ± 237/mm3. HIV-positive individuals are present in LTCIs, diagnosable through serological screening and treatable with antiretroviral drugs.

Clinical and pathological aspects of human immunodeficiency virus-associated plasmablastic lymphoma: analysis of 24 cases.

Plasmablastic lymphoma (PBL) is a rare AIDS-related malignancy with a poor prognosis. Little is known about this entity, and no standard treatment regimen has been defined. To establish an adequate treatment strategy, we investigated 24 cases of PBL arising in human immunodeficiency virus-positive individuals. Most of the patients were in the AIDS stage, with a median CD4 count of 67.5/µL. Lymph nodes (58%), gastrointestinal tract (42%), bone marrow (39%), oral cavity (38%), and CNS (18%) were the most commonly involved sites. Histology findings for the following were positive at varying rates, as follows: CD10 (56%); CD30 (39%); CD38 (87%); MUM-1 (91%); CD138 (79%); EBER (91%); and LMP-1 (18%). There was a marked increase in patients in 2011-12, and the cases found in that period appeared to be more aggressive, showing a higher rate of advanced-stage PBL. Fourteen cases were treated with CHOP, while the others were treated with more intensive regimens, including bortezomib and hematopoietic stem cell transplantation. The overall median survival time was 15months. A CD4 count of >100/µL at diagnosis and attaining complete remission in the first-line chemotherapy were associated with better outcomes (P=0.027 and 0.0016, respectively). Host immune status and chemosensitivity are associated with improved prognosis in PBL.

Modelling the time to detection of urban tuberculosis in two big cities in Portugal: a spatial survival analysis

Portuguese National Tuberculosis Control Programme. To examine delays in tuberculosis (TB) diagnosis using a spatial component in two high-incidence cities, Lisbon and Oporto, in Portugal, a low-incidence country. A retrospective nationwide study was conducted based on official TB data between 2010 and 2013 to analyse diagnostic delays at the lowest administrative level (freguesias) using spatial survival analyses, taking into account individual level covariates. Median diagnostic delays in Lisbon (n = 2706 cases) and Oporto (n = 1883) were respectively 62 (range 1-359, mean 81.01) and 60 days (range 1-3544, mean 79.5). In both cities, case detection rates initially rose until 50 days, then stabilised, but rose again at about 200 days. Diagnostic delay was significantly shorter among males and human immunodeficiency virus positive individuals in both cities, but was significantly longer among migrants in Lisbon. There is evidence of spatial correlation between freguesias; different spatial patterns were observed in diagnostic delays and in likelihood of case detection. These results are concordant with existing literature. The two study areas present considerable spatial variations in diagnostic delay, highlighting the fact that large cities should not be treated as homogeneous entities. The potential of spatial survival methods in spatial epidemiology is highlighted.

A novel approach to estimation of the time to biomarker threshold: applications to HIV.

In longitudinal studies of biomarkers, an outcome of interest is the time at which a biomarker reaches a particular threshold. The CD4 count is a widely used marker of human immunodeficiency virus progression. Because of the inherent variability of this marker, a single CD4 count below a relevant threshold should be interpreted with caution. Several studies have applied persistence criteria, designating the outcome as the time to the occurrence of two consecutive measurements less than the threshold. In this paper, we propose a method to estimate the time to attainment of two consecutive CD4 counts less than a meaningful threshold, which takes into account the patient-specific trajectory and measurement error. An expression for the expected time to threshold is presented, which is a function of the fixed effects, random effects and residual variance. We present an application to human immunodeficiency virus-positive individuals from a seroprevalent cohort in Durban, South Africa. Two thresholds are examined, and 95% bootstrap confidence intervals are presented for the estimated time to threshold. Sensitivity analysis revealed that results are robust to truncation of the series and variation in the number of visits considered for most patients. Caution should be exercised when interpreting the estimated times for patients who exhibit very slow rates of decline and patients who have less than three measurements. We also discuss the relevance of the methodology to the study of other diseases and present such applications. We demonstrate that the method proposed is computationally efficient and offers more flexibility than existing frameworks. Copyright © 2016 John Wiley & Sons, Ltd.

Putting "sticky notes" on the electronic medical record to promote intra-hospital referral of hepatitis B and C virus-positive patients to hepatology specialists: an exploratory study.

BackgroundCurrently, no system for appropriate intra-hospital collaboration regarding hepatitis virus positive individuals exists, even in medical institutions with hepatologists among their staff. The main objective of this study was to explore a simple alert system to promote the referral of patients with hepatitis B surface antigen (HBsAg)- or anti-hepatitis C virus (HCV) antibodies positivity to hepatologists through electronic medical records.MethodsSince April 2014 at Osaka City Juso Hospital, “sticky notes” have been put on the electronic medical records of patients newly diagnosed with HBsAg- or anti-HCV- antibodies positivity to recommend intra-hospital referral of those patients to specialists. In this study, we investigated the number of referrals to hepatologists before vs. after the introduction of this system (that is, in fiscal years 2013 [Period 1] and 2014 [Period 2], respectively), and the subsequent clinical courses of the patients.ResultsThe proportions of patients with HBsAg and anti-HCV antibody positivity did not show statistically significant differences between Period 1 and Period 2 (1.6 % [43/2,757] vs. 1.3 % [39/2,891], p = 0.58; and 5.8 % [156/2,674] vs. 5.3 % [147/2,790], p = 0.39, respectively). However, the referral proportions for patients with HBsAg- and anti-HCV antibody positivity were significantly higher in Period 2 (73 % [11/15] and 65 % [41/63], respectively) than in Period 1 (28 % [5/18] and 17 % [9/54]) (p = 0.009 and p < 0.001, respectively). Among patients who were referred to hepatologists, 2 HBsAg-positive and 4 anti-HCV antibody positive patients initiated antiviral treatment.ConclusionOur simple electronic medical record based alert system effectively promoted intra-hospital referral of hepatitis virus-positive patients, who have been detected by screening tests, to hepatologists.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1765-y) contains supplementary material, which is available to authorized users.

The proof of vertical transmission of the nucleopolyhedrovirus in many generations of the gypsy moth &lt;i&gt;Lymantria dispar&lt;/i&gt; L

Introduction. Insect viruses can play an important role in population dynamics of their hosts. That is why the problem of permanent viral infection support among virus-positive insects is associated with one of the intriguing problems of general biology and virology.Materials and methods. Under laboratory conditions, the modeling of the vertical transmission of the nucleopolyhedrovirus (NPV) gypsy moth was implemented at relatively high level of mortality among insects of parental generation (60%). The diagnostics of the occult virus was executed by the PCR method among insects before their infection under laboratory conditions, as well as among insects that survived after inoculation. results. The NPV-caused mortality among insects that survived after infection in generations F1, F2, and F3 was 14 ± 4%, 10 ± 4%, and 5 ± 0.5%, respectively. In the following three generations NPV-induced mortality was not noticed.Discussion. The level of the virus-positive individuals among the gypsy moth embryos in all occasions was higher than the NPV-induced mortality of insects. Thus, the given results show that the presence of virus among insect does not mean inevitable mortality of their hosts. Perhaps, the viral DNA can completely or partly lose its infectivity but may exist in the analyzed insect samples.Conclusions. The viral infection can be formed among progeny surviving after inoculation of insects. It can be actuated during three generations of the gypsy moth. The level of the virus-positive individuals among the gypsy moth embryos determined by the PCR method in daughter generations was higher than the NPV-induced mortality of insects.

Seroepidemiological study of Herpes simplex virus 2 in human immuno deficiency virus-positive individuals attending a tertiary care hospital of South India

Background: Herpes Simplex Virus-2 (HSV-2) infection is widely studied and associated disease in human immuno deficiency virus-positive (HIV-positive) individuals. The diagnosis of HSV is difficult as the presentations are atypical. Studies have confirmed that HSV-2 infection increases the risk of HIV acquisition by 2-3 folds. The aim of the study was to estimate the seroprevalence of HSV-2 and its association with age, sex and behavioral characters among HIV-infected individuals attending a tertiary care hospital.Methods: Serum samples from 150 HIV positive patients were collected and screened for HSV-2 Ig G antibodies by indirect ELISA. The cut off index (COI) of each serum sample was determined by dividing the OD which was obtained for that serum sample, by the average OD of the cutoff serum. A COI below or equal to 1 was considered as negative and that above 1.1 was considered as positive.Results: The overall seroprevalence of HSV-2 in the study was 44% (95% CI: 36-52%) with more in men than women. Out of 92 men, 42 (45.65%) were HSV positive and 24 (41.38%) of 58 female were positive. Statistical significance was observed in participants who had past history of sexually transmitted disease and who had multiple sexual partners (≥11) making as risk factors for HSV-2 seropositivity. Genital herpes was reported in 41 of 150 participants and seropositivity was 51.22% indicating the lack of awareness and most of the infections are asymptomatic.Conclusions: Our study demonstrated a clear increase in seroprevalence of HSV-2 in HIV-infected individuals. Findings of our study have relevant public implications and strongly suggest the implementation of interventions in sexually transmitted infections to reduce the prevalence of HSV-2 and associated HIV transmission. As most of the infections of HSV are asymptomatic a continuous program for the screening of HSV in all cases of STD’s must be made to reduce the chances of acquisition of HIV and others.

Hepatitis C and Oral Lichen Planus: Evaluation of their Correlation and Risk Factors in a Longitudinal Clinical Study.

The aim of this study is to evaluate the correlation between hepatitis C virus (HCV) infection and oral lichen planus (OLP), and further examine the relationship between age, sex, systemic diseases and drugs with the presence of HCV infection or OLP. A longitudinal clinical study was carried out from March 2010 to December 2013 with 51 individuals, of whom 33 had been presented with HCV (HCV-positive group) and 18 had OLP (OLP-positive group), in Passo Fundo, RS, Brazil. Hepatitis C virus-positive individuals who presented lesions compatible with OLP were subjected to an intraoral biopsy for histopathological diagnosis, while OLP-positive individuals underwent anti-HCV serological test for diagnosis of HCV infection. Data on age, sex, systemic diseases and drugs used were recorded for later analysis. The data were analyzed using descriptive statistics of frequency and by Pearson's Chi-square test, with a 5% significance level (p < 0.05). Out of the 33 HCV-positive individuals, only one was clinically and pathologically positive for OLP, demonstrating a significant relationship between the presence of HCV infection and the manifestation of OLP (Chi-square test -46.852, p = 7.65 × 10(-12)). None of the individuals in OLP-positive group had HCV infection. The most common systemic diseases were hypertension and diabetes, and the most commonly used drugs were antihypertensives. However, there was no significant relationship between these factors and the presence of OLP or HCV infection (p > 0.05). There was a significant relationship between HCV infection and manifestation of OLP. Age, sex, systemic diseases and drugs were not identified as risk factors for the development of these diseases. The OLP could serve as an indicative of HCV infection in asymptomatic patients, thus enabling early diagnosis and treatment of hepatitis and hence, a better prognosis.

Therapy and Health System-Related Factors Influencing Adherence to ART Treatment among HIV/AIDS Patients in Embu Teaching and Referral Hospital Comprehensive Care Clinic

Adherence to antiretroviral therapy is a major predictor of the survival of individuals living with HIV/AIDS. Appropriate use of antiretroviral (ARV’s) has improved the health of many human immunodeficiency virus (HIV) positive individuals. The effectiveness of HIV treatment depends on sustenance of high levels of adherence to ARV; however, ARV regimens are often complicated and can be affected by varying dosing schedules, failing to have proper dietary requirements and patients developing adverse effects. The objective of this study was to determine therapy and health system related factors influencing adherence to Anti-retroviral drugs among adult HIV/ AIDS patients in Embu County Teaching and Referral Hospital Comprehensive Care Clinic. The study applied cross sectional descriptive design with stratified random sampling used to obtain relative proportion of male and female adult respondents in the sample population. 332 HIV positive patients were chosen from a total of 1694 patients who were active in ART for more than one year. A semi-structured interview schedules was used to obtain patients view on various dimension or ART services at the facility. ART adherence was at 48.2%. There was significant association between adherence to ART treatment and the type of drug a respondent was in with AZT, ddl, NFV having the highest proportion of sub-optimal adherence to treatment while respondents on D4T, 3TC, NVP had the lowest proportion of sub-optimal adherence to treatment. Convenience of the facilities for people with chronic ailments and waiting time at the facilities were reported to be good (73.0%) and excellent (75.3%) respectively.

Assessment of Blood CD4 Count and Antibiogram Profile of Bacteria Isolated from HIV Patients

In this study, the blood CD4 count and the bacterial profile in the stool of Human Immunodeficiency Virus (HIV) positive individuals attending Antiretroviral therapy (ART) clinic in a tertiary health institution in Ekiti State, Nigeria was investigated. In addition, the antibiogram of the bacterial isolates was also investigated. A total of 150 HIV patients was recruited for the study. Samples of their blood and stool were collected for the investigation. Their blood was used to determine their CD4 count using cytometry method while their stools were cultured on microbiological media and pure isolates were identified using standard microbiological techniques. The antibiogram of the isolates was determined using disk diffusion method. HIV negative individuals were used as control. The results showed that the CD4 count of HIV patients ranged from 5 to 1278 cells/mm3, while the most frequently encountered bacteria in their stool are Pseudomonas aeruginosa, Morganella morganii, Aeromonas sp, Enterococcus sp. and Lactobacillus sp. All these bacterial spp however are absent from the stool of the control subjects. Pathogenic bacteria such as Salmonella typhi [6 (40% and 4 (26%)], Shigella species [7 (41%) and 5 (28%)], Pseudomonas aeruginosa [3(37.5%) and 4(50%)] were prevalent among patients with CD4 count level 200-350 cellmm3 and 200 cell/mm3 respectively but are statistically insignificant (p>0.05). The isolated bacterial spp., were resistant to most of the conventional antibiotics tested and the resistance was plasmid mediated in 95.2% of the isolates. This study shows the importance of investigating associated bacterial pathogens in HIV patients and evaluating the antibiogram profile of such pathogens before prescribing antibiotics to such patients in order to checkmate bacterial infections that may complicate the infection.

Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals.

BackgroundThe prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population.ObjectivesTo assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls.MethodsEighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant.ResultsAn IMT > P75 or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17]).ConclusionIn HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects.

Diagnostic accuracy of nucleic acid amplification tests in urine for pulmonary tuberculosis: a meta-analysis.

To determine the diagnostic accuracy of tuberculosis (TB) nucleic acid amplification tests (NAATs) in urine samples for individuals with active pulmonary tuberculosis (PTB). Systematic review and meta-analysis. Electronic databases and reference lists were searched without age or setting restrictions up to May 2015. Eligible articles examined Mycobacterium tuberculosis NAATs in urine samples for PTB diagnosis in patients with sputum culture as the reference standard, and reported sufficient data to separately calculate sensitivity or specificity. Eight studies, including 1212 participants from seven countries with a mean age ranging from 28 to 48 years, were included. Polymerase chain reaction (PCR) with insertion sequence (IS) 6110, rpoB or cfp32/hf6 as gene targets was used for NAATs. The pooled sensitivity and specificity was respectively 0.55 (95%CI 0.36-0.72) and 0.94 (95%CI 0.78-0.99), with slightly higher sensitivity in human immunodeficiency virus positive individuals, at 0.59 (95%CI 0.20-0.89). Sensitivity was higher in sputum microscopy-positive than -negative individuals. Storage temperatures below -70°C, centrifuge speed <5000 rpm and IS6110 increased sensitivity on meta-regression. Urine M. tuberculosis PCR for active PTB diagnosis had high specificity but modest sensitivity (55%). Optimizing specimen handling, gene targets or PCR techniques may improve diagnostic accuracy. Reproducibility data are needed.

English

Nigeria has an estimated 3.5 million human immunodeficiency virus (HIV) positive individuals, ranking third worldwide. This study analyzes the determinants of HIV infection to enable improvements in HIV programming in Nigeria and other developing countries. The methodology used is a literature review of grey and electronic databases of reviewed journals, analyzed in terms of an adapted version of Dahlgren and Whitehead’s (1991) determinants of health model. A total of 43 publications (14 reports and 29 articles) were reviewed. Political, work environment, healthcare service, social network, lifestyle, and gender determinants are predominant over others. The level of political commitment to HIV control is extremely low: over 90% of funding is from foreign sources. Stigmatization leads to delayed and inadequate treatment; and economic and social hardships for HIV-positive individuals. New infections are emerging at increasing rates among individuals engaging in sexual relationships such as men having sex with men (MSM) and female sex workers (FSW). HIV control in Nigeria is financially over-dependent on foreign intervention. Political action is required to formulate and implement a human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) policy that provides legal, social, and economic support for people infected and affected by HIV/AIDS. Measures are required to inform about scientific safeguards against infection, and to reduce HIV stigma among the general population and healthcare workers in particular. Most-at-risk populations require education, legal and economic support, and access to effective health care without negative repercussions, in order to minimize new infections. Key words: HIV, infection, determinant of health, Dahlgren and whitehead, Nigeria, synthesis, stigma.

Lipodystrophy among HIV-infected patients: a cross-sectional study on impact on quality of life and mental health disorders.

BackgroundLipodystrophy (LD) is a frequent adverse event of combination antiretroviral therapy (ART) and occurs mainly in patients exposed to first-generation antiretroviral drugs. The aim of this study was to explore and measure the interaction between LD, mental health, and quality of life of human immunodeficiency virus (HIV) positive individuals seen in a metabolic clinic.MethodsWe conducted a single-site cross-sectional study including all HIV-infected patients attending the LIPO group and metabolism day clinic at the University Hospitals of Geneva, Switzerland between January 31, 2008 and November 28, 2013. Data on LD were prospectively collected using the HIV Outpatient Study (HOPS) score, the Lipodystrophy Case Definition (LDCD), ART regimens, anthropometric measures, imaging, and standardized questionnaires. Quality of life was evaluated using a visual analog scale of 0–100. Depression and anxiety were assessed using the Beck Depression Inventory and the State Trait Anxiety Inventory scales, respectively.ResultsOne hundred ninety-four patients (54.6% male; 45.4% female; median age, 50 years) on successful ART (median CD4 cell count, 569.0 cells/mm3; median viral load, 20 copies/mL) were evaluated. Among these, 62.7, 63.5 and 35.5% of patients reported at least one body site affected by fat hypertrophy, atrophy or both, respectively. Using the LDCD score conservative definition, including imaging and biological values, 57.8% were diagnosed with LD. Of these, 39.7% suffered from severe/very severe LD. Depression was reported by 35.6% of individuals; 51.9% had anxiety symptoms and 49.5% reported poor quality of life (defined as being inferior to 50% on a scale from 0 to 100%). LD (odds ratio (OR = 5.22, 95% confidence interval (CI) 1.07–25.37, p-value: 0.040), depression (OR = 4.67, 95% CI 1.08–20.31, p-value 0.040), and anxiety (OR = 7.83, 95% CI 1.91–32.03, p-value 0.004) all affected significantly the quality of life.ConclusionsLD, depression and anxiety were frequent features among HIV-infected individuals seen in the metabolic clinic and significantly impacted on their quality of life.Electronic supplementary materialThe online version of this article (doi:10.1186/s12981-015-0061-z) contains supplementary material, which is available to authorized users.

International travel in the immunocompromised patient: a cross-sectional survey of travel advice in 254 consecutive patients.

Our primary aim was to determine the rate of overseas travel in immunocompromised individuals attending appropriate clinics at an Australian tertiary care hospital. We also aimed to characterise health-seeking behaviour prior to travel and investigated sources of pre-travel advice, compared travel patterns and activities between three specific immunosuppressed groups, and examined pre-immunosuppression patient serology. We implemented a cross-sectional survey of patients between February and August 2012. This survey was implemented among three outpatient populations at Monash Medical Centre, an Australian tertiary care hospital. We recruited 254 immunosuppressed adults from three patient populations: human immunodeficiency virus-positive individuals, renal transplant patients and rheumatology patients requiring immunosuppressive therapy. No clinical intervention was performed. In the 10 years preceding the survey, 153 (60.2%) participants reported international travel. Of these, 105 (68.6%) were immunosuppressed at the time of travel. These patients were 47.6% male and 60% Australian born. Forty per cent were visiting friends and relatives as part of their travel. Fifty-four per cent of those immunocompromised at the time of travel were going to high-risk destinations. Pathology files indicated that serological screening was frequently not performed prior to immunosuppression in the renal transplant and rheumatology groups. Immunocompromised patients often travel to high-risk destinations with limited or inadequate pre-travel preparations. Doctors caring for the immunocompromised should be aware of travel risks, suitable vaccination protocols and when to refer to specialist travel clinics.

Prevalence of hepatitis B and C and relationship to liver damage in HIV infected patients attending Joint Clinical Research Centre Clinic (JCRC), Kampala, Uganda.

Hepatitis B and C viruses cause death due to liver disease worldwide among Human Immunodeficiency Virus (HIV) positive individuals. Hepatitis B (HBV) and HIV have similar routes of transmission primarily; sexual, intravenous injections and prenatal while hepatitis C (HCV) is transmitted mainly through blood transfusion. Human immunodeficiency virus increases the pathological effect of hepatitis viruses and potentiates re-activation of latent hepatitis infections as a result of reduced immunity. The increase in use of antiretroviral (ARVs) drugs has led to longer period for patient survival and apparent increase in liver disease among HIV positive individuals. This study aimed at determining the prevalence of HBV, HCV, their co-infection with HIV and their effect on liver cell function. This was a cross sectional study conducted at the Joint Clinical Research Centre (JCRC) among HIV positive individuals attending the clinic. Patients were enrolled after obtaining a signed informed consent or assent for children below 17 years. Serum samples were collected for detection of Hepatitis B surface antigen (HBsAg), HCV specific antibodies and alanine aminotransferase (ALT) liver enzyme. Of the 89 patients enrolled, 20 (22.5%) had at least one hepatitis virus, 15 tested positive for HBsAg (16.9%) and 5 for HCV (5.6%), one had both viruses. Hepatitis B was more prevalent among women (13 out of 57, 22.8%) than men, (2 out of 32, 6.2%), while HCV was higher among men (4 out of 32, 12.5%) than women (1 out of 57, 1.8%). Seven of 89 patients (7.9%) had elevated ALT, indicative of liver cell injury. Of these with liver cell injury, one individual tested positive for HBsAg and another one individual tested positive for HCV specific antibodies. The prevalence of HBV is high in HIV positive individuals with more women commonly infected. The Prevalence of HCV is lower than that of HBV with more men commonly infected. Co-infection of Hepatitis B and C viruses was uncommon. This study reveals a high prevalence of liver cell injury among HIV positive individuals although the injury due to HBV or HCV infection was lower than that which has been documented. From this study, the high prevalence of HBV and HCV among HIV positive individuals point to a need for screening of HIV positive individuals for the hepatitis viruses.

Detection of bacteriuria among human immunodeficiency virus seropositive individuals in Osogbo, south-western Nigeria.

Human immunodeficiency virus-positive individuals are at increased risk of both asymptomatic and symptomatic urinary tract infections. The aim of this study was to determine the prevalence of asymptomatic bacteriuria (ASB) in HIV-positive individuals, its associated factors including any correlation with the CD4 count of the patient, and the antibiotic susceptibility pattern of the isolated organisms. Midstream urine and blood samples were collected from 242 consenting HIV-positive patients who were attending routine follow-up clinic during the six-month period of the study. Microscopy, culture, and antibiotic susceptibility testing of the samples were carried out following standard protocols, and CD4 counts were also determined. Fifty one (21.1%) of the 242 individuals had significant bacteriuria. The predominant organism was Klebsiella spp. (35%) followed by Escherichia coli (31%). Prevalence of bacteriuria was higher in the women. Low CD4 counts and young age were significantly associated with the presence of bacteriuria. ASB prevalence is high in this population and related to the CD4 count level.

Seroprevalence of Syphilis among Human Immunodeficiency Virus Positive Individuals Attending Immune Suppressed Syndrome Clinic at International Hospital Kampala, Uganda

Seroprevalence of Syphilis among Human Immunodeficiency Virus Positive Individuals Attending Immune Suppressed Syndrome Clinic at International Hospital Kampala, Uganda

A Study of Sero-Prevalence of Cytomegalo Virus

Background : CMV seroprevalence varies considerably in differe nt population groups throughout the world. Sero- conversion results from close contact with virus po sitive individuals. It need to stop its transmissio n & save the population from CMV infection by adapting safety measures like safe sex, safe blood transfusion, scree ning ante- natal mothers for CMV & health education. Methodology : The study cohort consisted of 105 patients which included 60 males and 45 females. Seroprevalence of CMV IgG antibodies in HIV and non-HIV patients are done by ELISA. Results : The high seroprevalence CMV was reported in HIV positive patients sexually active age group of 16 to 49 yrs females than in males. Employee, lo wer educated, Heterosexual with single sex partner s CMV was highly prevalent. In the HIV negative group the hig h seroprevalance of CMV was reported in patients wi th age group of 16 to59 years, males, laborers and low une ducated patients.It was more common in heterosexuals and in patients exposed to multiple partners. Conclusion : This study showed varying influences of demographic and social factors on the prevalence of CMV. The sexual factor s and STD conditions showed common influence on seroprevalence of CMV.