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Sample records for art-naive hiv-infected patients

  1. Regulation of Gag- and Env-Specific CD8+ T Cell Responses in ART-Naive HIV-Infected Patients: Potential Implications for Individualized Immunotherapy.

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    Christian Prebensen

    Full Text Available Strategies to develop a functional cure for HIV infection will likely require boosting of effector T cell responses to eliminate reactivated, latently infected cells. We have recently explored an assay for assessing antigen-specific regulation of T cell proliferation, which was related to clinical progression in untreated patients and to vaccine efficacy in two trials of therapeutic Gag-based vaccines. We here expand the same assay to further investigate regulation mediated by various inhibitory pathways. Peripheral blood mononuclear cells from 26 asymptomatic HIV-infected, antiretroviral therapy-naïve patients were stimulated with Gag and Env overlapping peptide panels for 5 days. Monoclonal antibodies (mAbs blocking inhibitory mediators interleukin (IL 10, transforming growth factor (TGF β, programmed death ligand (PD-L 1 and herpes virus entry mediator (HVEM were added to parallel cultures. Functional T cell regulation (FTR was defined as the difference in proliferation between stimulated cultures with and without blocking mAbs. FTR was detected in 54% of patients. Blockade of IL-10/PD-L1 and IL10/TGF-β detected all cases with Gag- and Env-associated FTR, respectively. In accordance with previous findings, isolated Env FTR was associated with higher plasma HIV RNA and lower CD4 counts, while patients with both Gag and Env FTR also had higher Gag- and Env-specific proliferative CD8+ T cell responses. There was no association between FTR and frequencies of activated regulatory T cells. In conclusion, we observed substantial heterogeneity in FTR between patients, inhibitory pathways and HIV antigens. FTR may help to individualize immunomodulation and warrants further assessment in clinical immunotherapy trials.

  2. Occult Hepatitis B Virus infection in ART-Naive HIV-Infected Patients seen at a Tertiary Care Centre in North India

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    Singh Sarman

    2010-03-01

    Full Text Available Abstract Background Co-infections of hepatitis B and C viruses are frequent with HIV due to shared routes of transmission. In most of the tertiary care health settings, HIV reactive patients are routinely tested for HBsAg and anti-HCV antibodies to rule out these co-infections. However, using the routine serological markers one can only detect active HBV infection while the occult HBV infection may be missed. There is insufficient data from India on HIV-HBV co-infection and even scarce on occult HBV infection in this group. Methods We estimated the burden of HBV infection in patients who were tested positive for HIV at a tertiary care centre in north India. We also attempted to determine the prevalence and clinical characteristics of occult HBV infection among these treatment-naïve patients and compare their demographic features with other HIV patients. During a period of 6 years between January 2002 to December 2007, 837 HIV positive patients (631 males and 206 females (M: F :: 3.06:1 were tested for serological markers of HBV (HBsAg and HCV (anti-HCV antibodies infections in our laboratory. For comparison 1000 apparently healthy, HIV-negative organ donors were also included in the study. Data on demographics, sexual behaviour, medical history, laboratory tests including the serum ALT and CD4 count of these patients were recorded. A sub-group of 53 HBsAg negative samples from HIV positive patients were assessed for anti-HBs, anti-HBc total (IgG+IgM and HBV-DNA using a highly sensitive qualitative PCR and analysed retrospectively. Results Overall, 7.28% of HIV positive patients showed presence of HBsAg as compared to 1.4% in the HIV negative control group. The prevalence of HBsAg was higher (8.55% in males than females (3.39%. The study revealed that occult HBV infection with detectable HBV-DNA was prevalent in 24.5% of patients positive for anti-HBc antibodies; being 45.5% in HBsAg negative patients. Most importantly the occult infection was

  3. Inflammation in HIV-Infected Patients

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    Langkilde, Anne; Petersen, Janne; Klausen, Henrik Hedegaard;

    2012-01-01

    To examine mechanisms underlying the increased inflammatory state of HIV-infected patients, by investigating the association of HIV-related factors, demography, lifestyle, and body composition with the inflammatory marker soluble urokinase plasminogen activator receptor (suPAR)....

  4. Brucella Infection in HIV Infected Patients

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    SeyedAhmad SeyedAlinaghi

    2011-12-01

    Full Text Available The purpose of this study was to assess the possible correlation between Brucella and HIV infections. Iran is a country where HIV infection is expanding and Brucellosis is prevalent. In the present study, 184 HIV infected patients were assigned and for all of them HIV infection was confirmed by western blot test. In order to identify the prevalence rate of Brucella infection and systemic brucellosis in these subjects, sera samples were obtained and Brucella specific serological tests were performed to reveal antibody titers. Detailed history was taken and physical examination was carried out for all of patients. 11 (6% subjects had high titers but only 3 of them were symptomatic. Most of these subjects were injection drug user (IDU men and one was a rural woman. Considering both prevalence rates of Brucella infection (3% and symptomatic brucellosis (0.1% in Iran, our HIV positive patients show higher rates of Brucella infection and systemic brucellosis. Preserved cellular immunity of participants and retention of granulocytes activity may explain this poor association; whereas other explanations such as immunological state difference and non-overlapping geographical distribution of the 2 pathogens have been mentioned by various authors.

  5. HIV DNA reservoir increases risk for cognitive disorders in cART-naive patients.

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    Victor G Valcour

    Full Text Available OBJECTIVES: Cognitive impairment remains frequent in HIV, despite combination antiretroviral therapy (cART. Leading theories implicate peripheral monocyte HIV DNA reservoirs as a mechanism for spread of the virus to the brain. These reservoirs remain present despite cART. The objective of this study was to determine if the level of HIV DNA in CD14(+ enriched monocytes predicted cognitive impairment and brain injury. METHODS: We enrolled 61 cART-naïve HIV-infected Thais in a prospective study and measured HIV DNA in CD14(+ enriched monocyte samples in a blinded fashion. We determined HAND diagnoses by consensus panel and all participants underwent magnetic resonance spectroscopy (MRS to measure markers of brain injury. Immune activation was measured via cytokines in cerebrospinal fluid (CSF. RESULTS: The mean (SD age was 35 (6.9 years, CD4 T-lymphocyte count was 236 (139 and log10 plasma HIV RNA was 4.8 (0.73. Twenty-eight of 61 met HAND criteria. The log10 CD14(+ HIV DNA was associated with HAND in unadjusted and adjusted models (p = 0.001. There was a 14.5 increased odds ratio for HAND per 1 log-value of HIV DNA (10-fold increase in copy number. Plasma CD14(+ HIV DNA was associated with plasma and CSF neopterin (p = 0.023 and with MRS markers of neuronal injury (lower N-acetyl aspartate and glial dysfunction (higher myoinositol in multiple brain regions. INTERPRETATION: Reservoir burden of HIV DNA in monocyte-enriched (CD14(+ peripheral blood cells increases risk for HAND in treatment-naïve HIV+ subjects and is directly associated with CSF immune activation and both brain injury and glial dysfunction by MRS.

  6. Bloodstream infections in HIV-infected patients.

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    Taramasso, Lucia; Tatarelli, Paola; Di Biagio, Antonio

    2016-04-02

    In the combined antiretroviral therapy era, HIV-infected patients remain a vulnerable population for the onset of bloodstream infections (BSI). Worldwide, nontyphoid salmonellae, Streptococcus pneumoniae, Escherichia coli, Staphylococcus aureus and coagulase negative staphylococci are the most important pathogens. Intravenous catheter associated infection, skin-soft tissue infection and endocarditis are associated with Gram-positive bacteremia. Among the Gram-negative, nontyphoidal Salmonella have been previously correlated to sepsis. Other causes of BSI in HIV-infected patients are mycobacteria and fungi. Mycobacteria constitute a major cause of BSI in limited resource countries. Fungal BSI are not frequent and among them Cryptococcus neoformans is the most common life-threatening infection. The degree of immunosuppression remains the key prognostic factor leading to the development of BSI.

  7. Virological efficacy of 24-week fozivudine-based regimen in ART-naive patients from Tanzania and Côte d’Ivoire

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    Kroidl, Arne; Ello, Frederic; Mgaya, Jimson; Lennemann, Tessa; Moh, Raoul; Maganga, Lucas; Eholie, Serge; Pruvost, Alain; Saathoff, Elmar; Girard, Pierre-Marie; Zuhse, Ralph; von Massow, Friedrich; Anglaret, Xavier; Hoelscher, Michael; Danel, Christine

    2017-01-01

    Objective: Use of zidovudine (ZDV) in antiretroviral therapy is limited by toxicity and twice daily (b.i.d.) dosing. Fozivudine (FZD) is a ZDV prodrug, which is activated intracellularly to ZDV-monophosphate especially in mononuclear cells but not in bone marrow cells. FZD promises improved myelotoxicity and once daily (o.d.) dosing. Design: Randomized clinical trial. Methods: We conducted an open-label, phase II, proof-of-concept trial investigating three different FZD doses (800 mg o.d., 600 mg b.i.d., 1200 mg o.d.) versus ZDV (300 mg b.i.d.) in combination with lamivudine and efavirenz in HIV-infected, ART-naive patients from Tanzania and Côte d’Ivoire. The primary objective was to demonstrate virological efficacy after 24 weeks in intent-to treat and per-protocol analysis. Secondary endpoints included safety and pharmacokinetic outcomes. Results: Of 119 participants included in the intent-to treat analysis, HIV RNA less than 50 copies/ml at 24 weeks was observed in 64 of 88 (73%) patients in the combined FZD arms versus 24 of 31 (77%) in the ZDV arm (RR 0.94, 95% confidence interval 0.75–1.18). In the per-protocol analysis, responses were 64 of 77 (87%) versus 23 of 29 (79%), respectively (RR 1.09, 95% confidence interval 0.89–1.34). Outcomes were similar between FZD arms. Overall, treatments were well tolerated. Severe or worse anaemia occurred in two cases (one related to FZD, one to ZDV), grade III/IV neutropenia was less frequent in FZD compared with ZDV arms (22 versus 42%, P = 0.035). Pharmacokinetic analysis supported o.d. administration of FZD. Conclusion: Virological 24-week efficacy was demonstrated in b.i.d. and o.d. administered FZD-based regimens. Reduced myelotoxicity of FZD needs to be confirmed in a larger trial. PMID:27941394

  8. Screening for neurocognitive impairment, depression, and anxiety in HIV-infected patients in Western Europe and Canada.

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    Robertson, Kevin; Bayon, Carmen; Molina, Jean-Michel; McNamara, Patricia; Resch, Christiane; Muñoz-Moreno, Jose A; Kulasegaram, Ranjababu; Schewe, Knud; Burgos-Ramirez, Angel; De Alvaro, Cristina; Cabrero, Esther; Guion, Matthew; Norton, Michael; van Wyk, Jean

    2014-01-01

    CRANIum, a cross-sectional epidemiology study in Western Europe and Canada, was conducted to describe and compare the prevalence of a positive screen for neurocognitive impairment (NCI), depressive symptoms, and anxiety in an HIV-positive population either receiving combination antiretroviral therapy (cART) or who were naive to antiretroviral therapy (ART). HIV-positive patients ≥18 years of age attending a routine medical follow-up visit and able to complete the designated screening tools were eligible for study inclusion. The Brief Neurocognitive Screen was used to assess NCI; depressive and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale. The evaluable patient population (N = 2863) included 1766 men (61.7%) and 1096 (38.3%) women. A total of 1969 patients were cART-experienced (68.8%), and 894 were ART-naive (31.2%). A positive screen for NCI was found in 41.5% of patients (cART-experienced, 42.5%; ART-naive, 39.4%; p = 0.12). A positive screen for depressive symptoms was found in 15.7% of patients (cART-experienced, 16.8%; ART-naive, 13.3%; p = 0.01), whereas 33.3% of patients screened positive for anxiety (cART-experienced, 33.5%; ART-naive, 32.8%; p = 0.71). A greater percentage of women compared with men screened positive for NCI (51.78% vs. 35.1%; p < 0.0001) and depressive symptoms (17.9% vs. 14.3%; p = 0.01). These data suggest that neurocognitive and mood disorders remain highly prevalent in HIV-infected patients. Regular mental health screening in this population is warranted.

  9. Legionellosis in patients with HIV infection

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    Bangsborg, Jette Marie; Jensen, B N; Friis-Møller, A

    1990-01-01

    During the five-year period 1984-1988 we received 192 specimens from 180 patients infected with the human immunodeficiency virus (HIV) for investigation of Legionella infection. The majority of specimens were bronchoalveolar lavage (BAL) fluids (84%), but tracheal suctions and lung tissue from...... specimens additionally for Pneumocystis carinii and mycobacteria. Legionellosis was not found to be common among HIV-infected patients, as only six specimens (3%) from six patients were found positive by DFA, and no specimens were culture-positive for Legionella species. Dual infection with Legionella and P...

  10. Predictors of mortality among HIV-infected patients initiating anti retroviral therapy at a tertiary care hospital in Eastern India

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    Ananya Bhowmik; Subhasis Bhandari; Rajyasree De; Subhasish Kamal Guha

    2012-01-01

    Objective: To assess early mortality and identify its predictors among the ART naive HIV-infected patients initiating anti retroviral therapy (ART) available free of cost at the ART Centres.Methods: A retrospective cohort analysis of routinely collected programme data was done for assessing mortality of all ART naive adult patients who received first-line ART at a government tertiary care hospital in eastern India during 1st March 2009 and 28th February 2010. Bivariate and multiple regression analyses of the baseline demographic, clinical and laboratory records using SPSS 15.0 were done to identify independent predictors of mortality. Results: The mortality rate at one year was estimated to be 7.66 (95% CI 5.84-9.83) deaths/100 patient-years and more than 50% of the deaths occurred during first three months of ART initiation with a median time interval of 73 days. Tuberculosis was the major cause of death. ART naive patients with baseline serum albumin <3.5 mg/dL were eight (OR 7.9; 95% CI: 3.8-16.5) at risk of death than those with higher serum albumin levels and patients with CD4 count <100 cells/μL were two times (OR 2.2;95% CI: 1.1-4.4) at risk of death compared to higher CD4 counts. Conclusions: Risk of mortality is increased when ART is initiated at advanced stages of immunosuppression denoted by low serum albumin levels and CD4 cell counts. This highlights the importance of early detection of HIV infection, early management of opportunistic infections including tuberculosis and timely initiation of the antiretroviral drugs in the resource-limited countries, now available free in the Indian national ART programme.

  11. [Kidney transplant in patients with HIV infection].

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    Bossini, Nicola; Sandrini, Silvio; Valerio, Francesca

    2012-01-01

    Until recently, human immunodeficiency virus (HIV) infection was an absolute contraindication to solid organ transplantation because it was feared that the anti-rejection therapy could result in accelerated HIV disease. At the end of the 1990s it became clear that HIV infection, once deemed a fatal disease, could be effectively turned into a chronic condition by the use of highly active antiretroviral therapy. Since then, the mortality rate from opportunistic infections has decreased dramatically, while liver and renal insufficiency have become the major causes of morbidity and mortality in these patients in the long term. A growing number of HIV patients develop end-stage renal disease secondary to immune-mediated glomerulonephritis, HIV-associated nephropathy, nephrotoxic effects induced by antiretroviral medication, or diabetic and vascular nephropathy, and therefore need maintenance dialysis. For this reason we have to reconsider kidney transplant as a possible treatment option. During the last decade, the results of many studies have shown that transplantation can be safe and effective as long as the HIV infection is effectively controlled by antiretroviral therapy. The short- and medium-term patient and graft survival rates in HIV-positive transplant recipients are comparable with those of the overall transplant population, but the incidence of acute rejection episodes is higher. The main clinical problem in the management of HIV-positive transplant recipients originates from the interference between immunosuppressive regimens and antiretroviral drugs. Thus, a close collaboration between infectious disease specialists and nephrologists is mandatory in order to optimize transplantation programs in these patients.

  12. Endocrine alterations in HIV-infected patients

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    Sujit Kumar Tripathy

    2015-01-01

    Full Text Available Aims and objectives: To study the frequency of thyroid, adrenal and gonadal dysfunction in newly diagnosed HIV-infected patients and to correlate them at different levels of CD4 cell counts. Materials and Methods: Forty-three HIV-positive cases were included in the study group. Cases were divided into three groups on the basis of CD4 cell count. Serum free T3, free T4, TSH, Cortisol, FSH, LH, testosterone and estradiol were estimated by the radioimmunoassay method. Hormone levels between cases were compared and their correlation with CD4 count was analyzed. Results: Prevalence of gonadal dysfunction (88.3% was the most common endocrine dysfunction followed by thyroid (60.4% and adrenal dysfunction (27.9%. Secondary hypogonadism (68.4% was more common than primary (31.6%. Low T3 syndrome, that is, isolated low free T3, was the most common (25.6% thyroid dysfunction followed by secondary hypothyroidism (16.2% and subclinical hypothyroidism (11.6%. Adrenal excess (16.3% was more common than adrenal insufficiency (11.6%. The difference in hormonal dysfunction between male and female was statistically insignificant (P > 0.05. 27.9% of patients had multiple hormone deficiency. There was negligible or no correlation between CD4 count and serum hormone level. Conclusion: In our study, endocrine dysfunction was quite common among HIV-infected patients but there was no correlation between hormone levels and CD4 count. Endocrine dysfunctions and role of hormone replacement therapy in HIV-infected patient needs to be substantiated by large longitudinal study, so that it will help to reduce morbidity, improve quality of life.

  13. Dialysis and renal transplantation in HIV-infected patients

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    Trullas, Joan Carles; Mocroft, Amanda; Cofan, Federico;

    2010-01-01

    To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients.......To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients....

  14. [Stroke in HIV-infected patients].

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    Lino, Ireneia; Sousa, António; Correia, José

    2007-01-01

    The spectrum of human immunodeficiency virus infection (HIV) is changing. New drug treatments have reduced morbidity and mortality of this disease, therefore it is necessary to start treating the HIV infection as a chronical disease. The association of the stroke with the HIV infection was inicially thought to be a result of other opportunistic infeccions and tumors. However, the vascular disease associated with HIV infection has been a subject of research and debate. New evidence shows that the vascular diseases could be a threat for the pacients doing highly active antirretroviral therapy (HAART). In this paper, we review the association between the HIV infection and stroke. Furthermore, we have done an analysis of the risk for the stroke on pacients with HIV infection considering the changes of the infection spectrum by the introduction of HAART.

  15. FEATURES OF PNEUMONIA IN HIV-INFECTED PATIENTS

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    M. T. Vatutin

    2016-01-01

    Full Text Available The article presents the clinical, diagnostic and treatment features of pneumocystis pneumonia in HIV-infected patients. The clinical case of diagnosis verification in a patient 58 years old with severe respiratory failure is described.

  16. Lung cancer in HIV-infected patients

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    R Palacios

    2012-11-01

    Full Text Available Purpose: Several studies have shown that HIV patients are at higher risk of lung cancer. Our aim is to analyse the prevalence and features of lung cancer in HIV-infected patients. Methods: The clinical charts of 4,721 HIV-infected patients seen in three hospitals of southeast Spain (study period 1992–2012 were reviewed, and all patients with a lung cancer were analysed. Results: There were 61 lung cancers, giving a prevalence of 1.2%. There was a predominance of men (82.0%, and smokers (96.6%; mean pack-years 35.2, with a median age of 48.0 (41.7–52.9 years, and their distribution according to risk group for HIV was: intravenous drug use 58.3%, homosexual 20.0%, and heterosexual 16.7%. Thirty-four (56.7% patients were Aids cases, and 29 (47.5% had prior pulmonar events: tuberculosis 16, bacterial pneumonia 9, and P. jiroveci pneumonia 4. The median nadir CD4 count was 149/mm3 (42–232, the median CD4 count at the time of diagnosis of the lung cancer was 237/mm3 (85–397, and 66.1%<350/mm3. 66.7% were on ART, and 70% of them had undetectable HIV viral load. The most common histological types of lung cancer were adenocarcinoma and epidermoid, with 24 (40.0% and 23 (38.3% cases, respectively. There were 49 (80.3% cases with advanced stages (III and IV at diagnosis. The distribution of treatments was: only palliative 23 (39.7%, chemotherapy 14 (24.1%, surgery and chemotherapy 8 (13.8%, radiotherapy 7 (12.1%, surgery 4 (6.9%, and other combined treatments 2 (3.4%. Forty-six (76.7% patients died, with a median survival time of 3 months. The Kaplan-Meier survival rate at 6 months was 42.7% (at 12 months 28.5%. Conclusions: The prevalence of lung cancer in this cohort of HIV-patients is high. People affected are mainly men, smokers, with transmission of HIV by intravenous drug use, and around half of them with prior opportunistic pulmonary events. Most patients had low nadir CD4 count, and were immunosuppressed at the time of diagnosis

  17. Dengue in HIV infected patients:clinical profiles

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    Beuy Joob; Viroj Wiwanitkit

    2014-01-01

    Dengue is an important tropical viral infection. It can present with acute febrile illness with possible hemorrhagic complication. Since it is a common infection in the tropical world, concomitance with other diseases can be expected. An important consideration is the co-presentation of dengue with HIV infection. In this specific report, the authors summarize the clinical profiles of dengue patients with HIV infection. Based on the present study, it can be seen that clinical profiles of dengue in any group of HIV infection is not different.

  18. Oral and airway microbiota in HIV-infected pneumonia patients

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    Iwai, S.; Fei, M; Huang, D.; Fong, S.; Subramanian, A.; Grieco, K; Lynch, SV; Huang, L

    2012-01-01

    Despite the increased frequency of recurrent pneumonia in HIV-infected patients and recent studies linking the airway bacterial community (microbiota) to acute and chronic respiratory infection, little is known of the oral and airway microbiota that exist in these individuals and their propensity to harbor pathogens despite antimicrobial treatment for acute pneumonia. This pilot study compared paired samples of the oral and airway microbiota from 15 hospitalized HIV-infected patients receivin...

  19. [Travel medicine for HIV-infected patients].

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    Rossi, M; Furrer, H

    2001-06-01

    Many HIV-infected persons travel from temperate zones to (sub)tropical destinations. HIV-specific immigration issues, medical resources abroad and problems regarding travelling with multiple medications have to be anticipated. When prescribing immunizations and specific chemoprophylaxis, the stage of immunodeficiency as well as drug interactions with antiretrovirals and medicaments against opportunistic infections have to be taken into account. Live vaccines may be contraindicated. Immunocompromised HIV-infected travellers have a higher risk for serious courses of diseases by enteropathogens. Therefore a good information about food hygiene is important and a prescription of an antibiotic to take in case of severe diarrhea may be indicated. A new antiretroviral combination therapy should not be started immediately before travelling to the tropics. The possibility to continue an established HIV treatment during travel has to be evaluated cautiously. With good pre-travel advice the risk of severe health problems is low for most HIV-infected travellers.

  20. Cryptic Leishmania infantum infection in Italian HIV infected patients

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    Rubino Raffaella

    2009-12-01

    Full Text Available Abstract Background Visceral leishmaniasis (VL is a protozoan diseases caused in Europe by Leishmania (L. infantum. Asymptomatic Leishmania infection is more frequent than clinically apparent disease. Among HIV infected patients the risk of clinical VL is increased due to immunosuppression, which can reactivate a latent infection. The aims of our study were to assess the prevalence of asymptomatic L. infantum infection in HIV infected patients and to study a possible correlation between Leishmania parasitemia and HIV infection markers. Methods One hundred and forty-five HIV infected patients were screened for the presence of anti-Leishmania antibodies and L. infantum DNA in peripheral blood. Statistical analysis was carried out by using a univariate regression analysis. Results Antibodies to L. infantum were detected in 1.4% of patients. L. infantum DNA was detected in 16.5% of patients. Significant association for PCR-Leishmania levels with plasma viral load was documented (p = 0.0001. Conclusion In our area a considerable proportion of HIV infected patients are asymptomatic carriers of L. infantum infection. A relationship between high HIV viral load and high parasitemic burden, possibly related to a higher risk of developing symptomatic disease, is suggested. PCR could be used for periodic screening of HIV patients to individuate those with higher risk of reactivation of L. infantum infection.

  1. [Organ transplants in HIV infected patients. Update and recommendations].

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    Barcan, Laura; Gadano, Adrian; Casetti, Isabel; Villamil, Federico

    2011-01-01

    Until few years ago, HIV infection was an absolute contraindication to consider organ transplants. Since HAART introduction, patient survival increased dramatically, but high mortality due to liver and kidney diseases became evident. For these reasons, this group of patients is now reconsidered for organ transplantation. In 2008, the Argentine Society of Transplants (SAT) and the Argentine Infectious Diseases Society (SADI), encouraged by the increasing published experience on kidney and liver transplants in this population, decided to form a Working Group, to prepare an update on this issue and elaborate practical recommendations for the better management of these patients. The first meeting was held on December 4th 2008. The most important conclusion was that HIV infection did not contraindicate a solid organ transplant. Later on, taking into account the accumulated experience and the available literature, the current document was prepared. HIV infected patients must fulfill certain clinical, immunological, virological and psychosocial criteria to be considered for solid organ transplants. HIV infected recipients of kidney and liver transplants currently show similar short and middle term survival to non HIV infected patients. There is not yet enough data on intrathoracic transplants in these patients in order to include them on a waiting list for these organs-transplants. Interactions between immunosupressors and antiretroviral drugs (specially protease inhibitors) are very important, and require a strict monitoring of immunosupressor levels.

  2. Care of Patients With HIV Infection: Antiretroviral Drug Regimens.

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    Bolduc, Philip; Roder, Navid; Colgate, Emily; Cheeseman, Sarah H

    2016-04-01

    The advent of combination antiretroviral drug regimens has transformed HIV infection from a fatal illness into a manageable chronic condition. All patients with HIV infection should be considered for antiretroviral therapy, regardless of CD4 count or HIV viral load, for individual benefit and to prevent HIV transmission. Antiretroviral drugs affect HIV in several ways: entry inhibitors block HIV entry into CD4 T cells; nucleotide and nucleoside reverse transcriptase inhibitors prevent reverse transcription from RNA to DNA via chain-terminating proteins; nonnucleoside reverse transcriptase inhibitors prevent reverse transcription through enzymatic inhibition; integrase strand transfer inhibitors block integration of viral DNA into cellular DNA; protease inhibitors block maturation and production of the virus. Current guidelines recommend six combination regimens for initial therapy. Five are based on tenofovir and emtricitabine; the other uses abacavir and lamivudine. Five include integrase strand transfer inhibitors. HIV specialists should assist with treating patients with complicated HIV infection, including patients with treatment-resistant HIV infection, coinfection with hepatitis B or C virus, pregnancy, childhood infections, severe opportunistic infections, complex drug interactions, significant drug toxicity, or comorbidities. Family physicians can treat most patients with HIV infection effectively by choosing appropriate treatment regimens, monitoring patients closely, and retaining patients in care.

  3. Pleurisy in tuberculosis and HIV-infected patients

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    A. K. Ivanov

    2014-01-01

    Full Text Available A clinical and epidemiological study for 14 years was conducted. Among TB patients, the percentage of persons with mixed infection (TB+HIV infection increased during the observation period from 10 up to 64%. About one third of them had a pleura reaction with an accumulation of fluid between pleura’s petals. Pleuritis in patients with mixed infection were characterized by special features: pleurisy complicated another form of tuberculosis more often, in one-third of patients (29,8% pleural liquid had hemorrhagic type, Mycobacterium tuberculosis in the pleural fluid was detected six times more often. The level of activity of adenosine deaminase and neopterin in the exudate of patients with tuberculosis and HIV infection remained significantly higher than in the control group of persons. These data can be useful in the diagnostics of specific diseases in HIV-infected patients.

  4. Psychopharmacology in HIV-infected patients.

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    Repetto, Martin J; Petitto, John M

    2008-06-01

    Neuropsychiatric disorders and syndromes may be underdiagnosed and inadequately treated in individuals infected with HIV. Depression in particular is among the most prevalent diagnoses, and data from controlled clinical studies have shown that antidepressant medications are efficacious and safe for treating depression in HIV-infected persons. A significant shortcoming of this literature is that most of the available data are from studies conducted before the advent of highly active antiretroviral therapy. In addition, apart from antidepressant medications, controlled studies systematically assessing efficacy and safety issues for other classes of psychotropic drugs (e.g., antipsychotic and anxiolytic medications) in HIV-infected persons are lacking. This review summarizes essential findings pertaining to the use of psychotropic medications to treat depression and other neuropsychiatric disorders in the context of HIV. It includes a discussion of clinically relevant treatment considerations (e.g., side effects, drug-drug interactions) derived from the existing literature as well as judgments that clinicians face in the absence of research data. Despite some shortcomings of the existing literature, overall there is compelling evidence that the appropriate use of psychotropic medications (coupled with behavioral therapy) can improve the quality of life of mentally ill HIV-infected individuals.

  5. Renal and urologic emergencies in the HIV-infected patient.

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    Liang, Stephen Y; Overton, E Turner

    2010-05-01

    Antiretroviral therapy has revolutionized the care of individuals infected with the human immunodeficiency virus (HIV) and has fundamentally altered the scope of the disease. Acute renal failure and chronic kidney disease from medication toxicity and comorbid noninfectious illnesses are just as likely today as end-organ injury from the virus itself. Chronic immunosuppression renders HIV-infected patients vulnerable to any of several unique urological infections not frequently seen in immunocompetent patients. A deeper understanding of renal and urological emergencies in the context of the HIV-infected patient will better prepare the emergency physician to render optimal care to this rapidly expanding and aging patient population.

  6. PPAR and Liver Injury in HIV-Infected Patients

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    Maud Lemoine

    2009-01-01

    Full Text Available Due to the introduction of active HIV antiretroviral treatment, AIDS-related morbidity and mortality have markedly decreased and liver diseases are now a major cause of morbidity and mortality in HIV-infected patients. Chronic liver injury encompasses a wide spectrum of diseases due to HCV and HBV coinfection, drug-related toxicity, and NASH. HIV-infected patients who are receiving treatment present with a high prevalence of metabolic complications and lipodystrophy. Those patients are at high risk of nonalcoholic fatty liver disease, the liver feature of the metabolic syndrome. This review will focus on (1 the liver injuries in HIV-infected patients; (2 both the current experimental and human data regarding PPAR and liver diseases; (3 the interactions between HIV and PPAR; (4 the potential use of PPAR agonists for the management of HIV-related liver diseases.

  7. Care of Patients With HIV Infection: Primary Care.

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    Bolduc, Philip; Roder, Navid; Colgate, Emily; Cheeseman, Sarah H

    2016-04-01

    With the advent of antiretroviral therapy and improved access to care, the average life expectancy of patients with HIV infection receiving optimal treatment approaches that of patients in the general population. AIDS-related opportunistic infections and malignancies are no longer the primary issues; instead, traditional age- and lifestyle-related conditions are a growing concern. Patients with HIV infection are at higher risk of cardiovascular disease, diabetes, hypertension, and some non-AIDS-related cancers than patients in the general population. Family physicians need to be knowledgeable about screening for and managing chronic comorbid conditions as this population ages. Health maintenance, including appropriate vaccinations, prophylaxis against opportunistic infections, and routine screening for sexually transmitted infections, remains an important part of care. As HIV infection becomes a chronic condition, emerging strategies in prevention, including preexposure prophylaxis, fall within the scope of practice of the family physician.

  8. Cardiovascular risk and dyslipidemia management in HIV-infected patients.

    Science.gov (United States)

    Stein, James H

    2012-01-01

    HIV infection and antiretroviral therapy each appear to increase cardiovascular disease risk. Increased risk may be attributable to the inflammatory effects of HIV infection and dyslipidemia associated with some antiretroviral agents. The prevalence of cardiovascular disease is increasing as patients live longer, age, and acquire traditional coronary heart disease (CHD) risk factors. In general, any additional cardiovascular risk posed by HIV infection or antiretroviral therapy is of potential concern for patients who are already at moderate or high risk for CHD. Long-term and well-designed studies are needed to more accurately ascertain to what degree HIV infection and antiretroviral therapy affect long-term cardiovascular disease risk. Management of dyslipidemia to reduce CHD risk in HIV-infected patients is much the same as in the general population, with the cornerstone consisting of statin therapy and lifestyle interventions. Smoking cessation is a major step in reducing CHD risk in those who smoke. This article summarizes a presentation by James H. Stein, MD, at the IAS-USA live continuing medical education activity held in New York City in March 2012.

  9. Oral and airway microbiota in HIV-infected pneumonia patients.

    Science.gov (United States)

    Iwai, Shoko; Fei, Matthew; Huang, Delphine; Fong, Serena; Subramanian, Anuradha; Grieco, Katherine; Lynch, Susan V; Huang, Laurence

    2012-09-01

    Despite the increased frequency of recurrent pneumonia in HIV-infected patients and recent studies linking the airway bacterial community (microbiota) to acute and chronic respiratory infection, little is known of the oral and airway microbiota that exist in these individuals and their propensity to harbor pathogens despite antimicrobial treatment for acute pneumonia. This pilot study compared paired samples of the oral and airway microbiota from 15 hospitalized HIV-infected patients receiving antimicrobial treatment for acute pneumonia. Total DNA was extracted, bacterial burden was assessed by quantitative PCR, and amplified 16S rRNA was profiled for microbiome composition using a phylogenetic microarray (16S rRNA PhyloChip). Though the bacterial burden of the airway was significantly lower than that of the oral cavity, microbiota in both niches were comparably diverse. However, oral and airway microbiota exhibited niche specificity. Oral microbiota were characterized by significantly increased relative abundance of multiple species associated with the mouth, including members of the Bacteroides, Firmicutes, and TM7 phyla, while airway microbiota were primarily characterized by a relative expansion of the Proteobacteria. Twenty-two taxa were detected in both niches, including Streptococcus bovis and Chryseobacterium species, pathogens associated with HIV-infected populations. In addition, we compared the airway microbiota of five of these patients to those of five non-HIV-infected pneumonia patients from a previous study. Compared to the control population, HIV-infected patients exhibited relative increased abundance of a large number of phylogenetically distinct taxa, which included several known or suspected pathogenic organisms, suggesting that recurrent pneumonia in HIV-infected populations may be related to the presence of these species.

  10. Vaccination scars in HIV infected patients – does vaccinia vaccination confer protection against HIV?

    DEFF Research Database (Denmark)

    Jespersen, Sanne; Hønge, Bo Langhoff; Medina, Candida;

    Vaccination scars in HIV infected patients – does vaccinia vaccination confer protection against HIV?......Vaccination scars in HIV infected patients – does vaccinia vaccination confer protection against HIV?...

  11. Interleukin-2 therapy in patients with HIV infection

    DEFF Research Database (Denmark)

    Abrams, D; Lévy, Y; Losso, M H;

    2009-01-01

    Interleukin-2 in HIV-Infected Patients with Low CD4+ Counts under Active Antiretroviral Therapy (SILCAAT) study and the Evaluation of Subcutaneous Proleukin in a Randomized International Trial (ESPRIT). In each, patients infected with the human immunodeficiency virus (HIV) who had CD4+ cell counts of either...

  12. Arterial hypertension and cardiovascular risk in HIV-infected patients.

    Science.gov (United States)

    Calò, Lorenzo A; Caielli, Paola; Maiolino, Giuseppe; Rossi, Gianpaolo

    2013-08-01

    The dramatic change of the natural history of HIV-infected patients by highly active antiretroviral therapy (HAART) has exposed these patients to cardiovascular risk, including cardiovascular disease and hypertension. In HIV-infected patients, the development of arterial hypertension, at least in the medium-long term is an established feature, although recognized predictors of its development have not been clearly identified. In addition, conflicting data regarding the influence of antiretroviral therapy (ART) are reported. The presence of a proinflammatory state and oxidative stress-mediated endothelial dysfunction seem, however, to play a pathophysiologic role. In this review, we examine and provide a comprehensive, literature based, consideration of the pathophysiologic aspects of hypertension in these patients. HIV-infected patients, independently of the presence of hypertension, remain at very high cardiovascular risk due to the presence of the same cardiovascular risk factors recognized for the general population with, in addition, the indirect influence of the ART, essentially via its effect on lipid metabolism. This review based on the evidence from the literature, concludes that the management of HIV-infected patients in terms of cardiovascular prevention emerges as a priority. The consideration of cardiovascular risk in these patients should receive the same emphasis given for the general population at high cardiovascular risk, including adequate blood pressure control according to international guidelines.

  13. Renal transplantation in HIV-infected patients: 2010 update.

    Science.gov (United States)

    Trullas, Joan C; Cofan, Federico; Tuset, Montse; Ricart, María J; Brunet, Mercedes; Cervera, Carlos; Manzardo, Christian; López-Dieguez, María; Oppenheimer, Federico; Moreno, Asuncion; Campistol, Josep M; Miro, Jose M

    2011-04-01

    The prognosis of human immunodeficiency virus (HIV) infection has improved in recent years with the introduction of antiretroviral treatment. While the frequency of AIDS-defining events has decreased as a cause of death, mortality from non-AIDS-related events including end-stage renal diseases has increased. The etiology of chronic kidney disease is multifactorial: immune-mediated glomerulonephritis, HIV-associated nephropathy, thrombotic microangiopathies, and so on. HIV infection is no longer a contraindication to transplantation and is becoming standard therapy in most developed countries. The HIV criteria used to select patients for renal transplantation are similar in Europe and North America. Current criteria state that prior opportunistic infections are not a strict exclusion criterion, but patients must have a CD4+ count above 200 cells/mm(3) and a HIV-1 RNA viral load suppressible with treatment. In recent years, more than 200 renal transplants have been performed in HIV-infected patients worldwide, and mid-term patient and graft survival rates have been similar to that of HIV-negative patients. The main issues in post-transplant period are pharmacokinetic interactions between antiretrovirals and immunosuppressants, a high rate of acute rejection, the management of hepatitis C virus coinfection, and the high cardiovascular risk after transplantation. More studies are needed to determine the most appropriate antiretroviral and immunosuppressive regimens and the long-term outcome of HIV infection and kidney graft.

  14. Coccidioides thyroiditis in an HIV-infected patient.

    Science.gov (United States)

    Jinno, Sadao; Chang, Shelley; Jacobs, Michael R

    2012-07-01

    We report a case of Coccidioides thyroiditis in an HIV-infected patient with a history of recent Coccidioides pneumonia but with negative Coccidioides serology determined by enzyme immunoassay at presentation. Diagnosis of Coccidioides thyroiditis was made based on histopathologic examination and culture of thyroid abscess material obtained by fine-needle aspiration biopsy.

  15. Determinants of survival among HIV-infected chronic dialysis patients.

    Science.gov (United States)

    Rodriguez, Rudolph A; Mendelson, Michael; O'Hare, Ann M; Hsu, Ling Chin; Schoenfeld, Patricia

    2003-05-01

    Over 100 HIV-infected patients have initiated chronic dialysis at San Francisco General Hospital (SFGH) since 1985. This study employed retrospective analysis to identify determinants of and trends in survival among HIV-infected patients who have initiated chronic dialysis at SFGH from January 1, 1985 to November 1, 2002 (n = 115). Cohort patient survival was compared with survival after an AIDS-opportunistic illness in all HIV-infected patients in San Francisco during the study period. Higher CD4 count (hazard ratio [HR], 0.86 per 50 cells/mm(3) increase; 95% confidence interval [CI], 0.80 to 0.93) and serum albumin (HR, 0.53 per 1 g/dl increase; CI, 0.36 to 0.78) at initiation of dialysis were strongly associated with lower mortality. Survival for those initiating dialysis during the era of highly active antiretroviral therapy (HAART) was 16.1 mo versus 9.4 mo for those initiating dialysis before this time, but this difference was not statistically significant. In adjusted analysis, only a non-statistically significant trend toward improved survival during the HAART era was noted (HR, 0.59; CI, 0.34 to 1.04). By comparison, survival for all HIV-infected patients after an AIDS-opportunistic illness in San Francisco increased from 16 mo in 1994 to 81 mo in 1996. The dramatic improvement in survival that has occurred since the mid-1990s for patients with HIV appears to be greatly attenuated in the sub-group undergoing dialysis. Although this may partly reflect confounding by race, injection drug use and HCV co-infection, future attempts to improve survival among HIV-infected dialysis patients should focus on barriers to the effective use of HAART in this group.

  16. Stroke in a patient with tuberculous meningitis and HIV infection

    Directory of Open Access Journals (Sweden)

    Maria Bruna Pasticci

    2013-02-01

    Full Text Available Abstract. Tuberculous meningitis (TBM is a devastating disease. TBM occurs more commonly in HIV infected patients. The influence of HIV co-infection on clinical manifestations and outcome of TBM is not well defined. Yet, some differences have been observed and stroke has been recorded to occur more frequently. This study reports on an HIV infected Caucasian female with lung, meningeal tuberculosis and stroke due to a cortical sub-cortical ischemic lesion.TBM was documented in the absence of neurologic symptoms. At the same time, miliary lung TB caused by multi-susceptible Mycobacterium tuberculosis was diagnosed. Anti-TB therapy consisting of a combination of four drugs was administered. The patient improved and was discharged five weeks later. In conclusion, TBM and multiple underling pathologies including HIV infection, as well as other risk factors can lead to a greater risk of stroke. Moreover, drug interactions and their side effects add levels of complexity. TBM must be included in the differential diagnosis of HIV infected patients with stroke and TBM treatment needs be started as soon as possible before the onset of vasculopathy.

  17. Tubuloreticular inclusions in skin biopsies from patients with HIV infection

    DEFF Research Database (Denmark)

    Pedersen, C; Horn, T; Junge, Jette;

    1989-01-01

    Skin biopsies obtained from apparently normal skin from 15 HIV infected patients and 6 anti-HIV negative patients were examined by electron microscopy. Tubuloreticular inclusions (TRI) were detected within the cytoplasm of capillary endothelial cells in 5/5 AIDS patients and in 2/5 patients...... with AIDS related conditions. Biopsies from 5 asymptomatic HIV positive patients and the 6 control subjects were without ultrastructural alterations. The occurrence of TRI was related to low numbers of CD 4+ lymphocytes. 5/7 patients with TRI had elevated serum interferon activity, and in all...... of the patients without TRI, interferon activity was below detection level. The occurrence of TRI was not dependent on the presence of free p24 antigen in serum. It is concluded that the occurrence of TRI in entothelial cells of skin capillaries is associated with late stages of HIV infection and this may...

  18. Hyperproinsulinaemia in normoglycaemic lipodystrophic HIV-infected patients

    DEFF Research Database (Denmark)

    Haugaard, Steen B; Andersen, Ove; Hales, CN;

    2006-01-01

    BACKGROUND: We aimed to investigate whether the insulin precursors, intact (IP) and 32-33 split proinsulin (SP), which are elevated in states of insulin resistance and predict type 2 diabetes, would be elevated in human immunodeficiency virus (HIV)-infected patients with lipodystrophy (LIPO......). MATERIALS AND METHODS: Forty-three normoglycaemic HIV-infected patients [18 LIPO and 18 without lipodystrophy (NONLIPO) receiving antiretroviral drugs, and seven patients naïve to antiretroviral drugs (NAIVE)] were examined. Insulin precursors were measured during fasting, during an intravenous glucose.......01), but did not differ between study groups. CONCLUSIONS: Proinsulin appeared to be increased in HIV-lipodystrophy, but no more than caused by the increased ISR. Nevertheless, the inverse correlations between SP/insulin ratio versus Si(RD) and incremental total proinsulin/insulin ratio versus DI may argue...

  19. Care of Patients With HIV Infection: Medical Complications and Comorbidities.

    Science.gov (United States)

    Bolduc, Philip; Roder, Navid; Colgate, Emily; Cheeseman, Sarah H

    2016-04-01

    Care of patients with HIV infection starts with diagnosis as soon as possible, preferably at or near the time of acute infection. Opportunistic infections, malignancies, and other conditions develop progressively over time, particularly in untreated patients. The AIDS-defining opportunistic infections most common in the United States include Pneumocystis jirovecii pneumonia, Candida esophagitis, toxoplasmic encephalitis, tuberculosis, disseminated Mycobacterium avium complex, cryptococcal meningitis, and cytomegalovirus retinitis. Specific prophylaxis regimens exist for several opportunistic infections, and effective antiretroviral therapy reduces the risk of most others. Other AIDS-defining conditions include wasting syndrome and HIV encephalopathy. AIDS-defining malignancies include Kaposi sarcoma, systemic non-Hodgkin lymphoma, primary central nervous system lymphoma, and invasive cervical cancer. Although not an AIDS-defining condition, anal cancer is common in patients with HIV infection. Other HIV-related conditions include thrombocytopenia, recurrent bacterial respiratory infections, HIV-associated nephropathy, and HIV-associated neurocognitive disorder.

  20. [Improvement of parodontitis therapy of patients with HIV-infection].

    Science.gov (United States)

    Soboleva, L A; Oseeva, A O; Shul'diakov, A A; Bulkina, N V

    2010-01-01

    For the purpose to determine the clinic-pathogenetic efficacy of cycloferon liniment in the combined therapy of periodontitis of patients with subclinical stage of HIV-infection medical examination and treatment of 40 patients was carried out. It was established that use of liniment cycloferon in the combined treatment of patients with subclinical stage of HIV-infection allowed to accelerate process of normalization of lipid peroxidation parameters and antioxidant potential of blood, to decrease infection load (herpes symplex virus I, Candida albicans, Staphylococcus aureus) in parodontal recess and evidence of local inflammation with reduction of activity of the tumours necrosis factor and interleukin 1beta, what provided acceleration of recuperation processes, lowering the frequency of parodontitis relapses.

  1. Coping With Stress Strategies in HIV-infected Iranian Patients.

    Science.gov (United States)

    Mahmoudi, Maryam; Dehdari, Tahereh; Shojaeezadeh, Davoud; Abbasian, Ladan

    2015-01-01

    Stress has significant adverse impacts on health outcomes of HIV-infected patients. Our study explored coping with stress strategies by HIV-infected Iranian patients. A qualitative content analysis study was conducted at the Consultation Clinic of HIV at the Imam Khomeini Hospital in Tehran, Iran in 2012. Twenty-six semi-structured in-depth interviews were done. Participants were asked about coping strategies for stress. After the first interview, continuous analysis of data was started and continued up to data saturation. Results showed that participants used two categories of strategies (emotion-based coping and problem-based coping) to cope with stress. Emotion-based coping had two sub-themes: adaptive and maladaptive. The problem-based coping category had three sub-themes: participation in education sessions, adherence to medication, and efforts to maintain a healthy lifestyle. Explanations of different strategies available to HIV-infected patients to cope with stress may help develop tailored interventions to improve the psychological conditions of people living with HIV.

  2. Tubuloreticular inclusions in skin biopsies from patients with HIV infection

    DEFF Research Database (Denmark)

    Pedersen, C; Horn, T; Junge, Jette;

    1989-01-01

    Skin biopsies obtained from apparently normal skin from 15 HIV infected patients and 6 anti-HIV negative patients were examined by electron microscopy. Tubuloreticular inclusions (TRI) were detected within the cytoplasm of capillary endothelial cells in 5/5 AIDS patients and in 2/5 patients...... with AIDS related conditions. Biopsies from 5 asymptomatic HIV positive patients and the 6 control subjects were without ultrastructural alterations. The occurrence of TRI was related to low numbers of CD 4+ lymphocytes. 5/7 patients with TRI had elevated serum interferon activity, and in all...

  3. Care of Patients With HIV Infection: Diagnosis and Monitoring.

    Science.gov (United States)

    Bolduc, Philip; Roder, Navid; Colgate, Emily; Cheeseman, Sarah H

    2016-04-01

    Appropriate screening for HIV infection is the cornerstone of HIV-related care. There have been several recent changes in testing technology and screening recommendations. The US Preventive Services Task Force recommends universal HIV screening at least once for adolescents and adults ages 15 to 65 years, and additional screening for patients at higher risk, although evidence is insufficient to determine optimum rescreening intervals. All pregnant women should be screened for HIV infection in the first trimester, and pregnant women at high risk should be screened again in the third trimester. The Centers for Disease Control and Prevention recommends use of an algorithm using fourth-generation tests for screening; this decreases the window period between infection and detection to as few as 14 days, thereby reducing the number of false-negative results. Home HIV testing kits, which require follow-up confirmatory testing, also are available. Clinicians should be aware of HIV-specific laws in their states, including those criminalizing HIV exposure and transmission. Thorough medical and laboratory evaluations are essential at initiation of care for patients with HIV infection, along with appropriate follow-up monitoring, as recommended in various guidelines.

  4. STD Clinic Patients' Awareness of Non-AIDS Complications of HIV Infection

    Science.gov (United States)

    Castro, José Guillermo; Granovsky, Inna; Jones, Deborah; Weiss, Stephen M.

    2016-01-01

    Participants were recruited from a sexually transmitted disease (STD) clinic in Florida and were assessed regarding the knowledge and awareness of non-AIDS conditions associated with HIV infection. Questionnaires were administered before and after a brief information session on non-AIDS conditions associated with HIV infection. Participants included men (n = 46) and women (n = 51). Prior to the information session, at baseline, only 34% of the participants were worried about HIV infection. Most participants (82%) agreed that HIV could be treated with antiretroviral therapy (ART), while only 38% were aware that HIV-associated conditions cannot be easily treated with ART. After the information session, almost all participants reported they were concerned regarding the risk of HIV infection. High-risk patients may have limited knowledge about the consequences of HIV infection beyond the traditional AIDS-associated conditions. Increased awareness of these less known consequences of HIV infection may decrease the potential for complacency regarding acquiring HIV infection. PMID:25331221

  5. Prevalence of lipodystrophy and dyslipidemia among patients with HIV infection on generic ART in rural South India.

    Science.gov (United States)

    Kalyanasundaram, Annie Phoebe; Jacob, Saramma Mini; Hemalatha, Ramachandran; Sivakumar, Mampakkam Rajappa

    2012-01-01

    As antiretroviral therapy (ART) becomes more available to the HIV-infected population, it is important to determine the prevalence of its long-term complications. In this cross-sectional study, 145 HIV-positive patients on ART, 146 HIV-positive patients not on ART, and 72 HIV-negative individuals visiting the Namakkal District Head Quarters Hospital, Tamil Nadu, India, were recruited from February 2007 to April 2009. Among the patients on ART, the prevalence of lipodystrophy was 60.7%; 22.7% with lipohypertrophy, 51.1% with lipoatrophy, and 22.7% with mixed pattern. The proportion of patients with dyslipidemia was significantly higher in the treatment group when compared to ART-naive and HIV-negative controls (P = .00). Total duration of ART was significantly associated with lipodystrophy (P = .04) and dyslipidemia (P = .01). Also, by logistic regression, abnormal metabolic levels were a risk factor in lipodystrophy (P = .02). This study highlights the need for development of inexpensive and accessible treatments for the reduction of lipodystrophy.

  6. CMV and HSV-2 myeloradiculitis in an HIV infected patient

    Directory of Open Access Journals (Sweden)

    Adriana Pinto

    2011-06-01

    Full Text Available While CMV myeloradiculitis is a known complication in AIDS patients with severe immunosuppression, HSV-2 necrotizing myeloradiculitis is rare and often associated with disabling a fatal outcome. We hereby describe a 46 year-old HIV infected patient with profound and sustained immunosuppression who presented with an acute ascending paraparesis and urinary retention. Lumbar spine MRI showed contrast enhancement at the conus medullaris and cauda equine, and both CMV and HSV-2 CSF PCR were positive. Despite treatment, the patient died 20 days later. We review the main diagnostic and therapeutic aspects of herpes virus associated myeloradiculitis and discuss the approach in similar cases.

  7. Assessment of nutritional status of HIV-infected patients at a tertiary centre in North India.

    Science.gov (United States)

    Malhotra, Sunita; Wanchu, Ajay; Khurana, Sudha

    2007-07-01

    Infection with HIV has an adverse effect on nutritional status, and can result in progressive involuntary weight loss. We assessed the nutritional status of our patients with HIV infection and found that HIV-infected patients had significantly low nutrient intake and body mass index as compared with controls. Involuntary weight loss, altered body composition and reduced nutritional status were present throughout the stages of HIV infection.

  8. Highly active antiretroviral therapy and changing spectrum of liver diseases in HIV infected patients

    OpenAIRE

    Kavita S. Joshi; Rohit R. Shriwastav

    2016-01-01

    Background: HIV is now considered as chronic disease than a fatal disease. HIV infected individual is having normal life expectancy post highly active antiretroviral therapy (HAART) era. Liver disease is the major cause of morbidity and mortality in HIV infected patients. The objective was to study the prevalence, clinical profile of various liver diseases in HIV infected individuals on HAART and also to study aetiologies of liver involvement in HIV patients. Methods: It was a cross secti...

  9. Stroke in a Patient With HIV Infection

    Directory of Open Access Journals (Sweden)

    Buse Rahime Hasırcı

    2015-08-01

    Full Text Available Stroke which is a common complication in Human immumodeficiency virus type 1 positive patients is seen between 1% and 5% in clinical series. Vasculopathy and atherogenesis in HIV are the main pathologic mechanisms of stroke. We report a 63 year old man with sudden onset of a right hemiplegia and who was diagnosed as HIV-related stroke.

  10. Cryptosporidiosis Among HIV-infected Patients with Diarrhea in Edo State, Midwesten Nigeria

    Directory of Open Access Journals (Sweden)

    Akinbo, F. O.

    2010-01-01

    Full Text Available To determine the prevalence of cryptosporidiosis among HIV infected and HIV non-infected patients with diarrhea in Edo State, Nigeria, as well as the effect of CD4+ lymphocyte count on the prevalence of cryptosporidial infection among the HIV patients. Stool samples were collected from 300 patients consisting of 200 HIV-infected and 100 HIV non-infected patients with diarrhea. Blood samples were collected from the HIV-infected patients. The stool samples were processed to detect Cryptosporidium species using a modified Ziehl-Neelsen stain, as well as other intestinal parasites using saline and iodine preparations. The blood samples were used to determine CD4+ lymphocyte count. The prevalence of intestinal parasites was higher in HIV-infected patients compared with their HIV non-infected counterparts (39% vs 24% respectively, p=0.0097. Cryptosporidiosis was diagnosed only among HIV-infected patients and was the only parasite whose prevalence was significantly different between HIV-infected and HIV non-infected patients. CD4+ lymphocyte count of <200 cells/µL among HIV-infected was a risk factor for acquiring cryptosporidial infection (OR=18.776, 95% CI=6.299, 55.964. A cryptosporidial infection prevalence of 18% among HIV-infected patients was observed and CD4+ count of <200 cells/µL was a risk factor for acquiring the disease. Routine examination of diarrhogenic stools of HIVinfected patients for cryptosporidiosis is advocated.

  11. Avascular necrosis of the femoral head in HIV infected patients

    Directory of Open Access Journals (Sweden)

    Marcos Almeida Matos

    2007-02-01

    Full Text Available Avascular necrosis (AVN of the femoral head is an emerging complication in HIV infected patients. It has been suggested that the increased incidence of AVN in this population may be caused by an increased prevalence of predisposing factors for osteonecrosis, including protease inhibitors, hyperlipidemia, corticosteroid use, alcohol and intravenous drug abuse. The aim of this study was to assess the risk factors for avascular necrosis developing in the femoral head of HIV infected individuals. This study consisted of meta-analysis of the secondary data extracted from current literature. The selected articles allowed two study groups to be drawn up for comparison. Group 1 comprised 324 individuals infected by the HIV virus, who did not present femoral head AVN. Group 2 comprised 32 HIV positive patients, who presented femoral head AVN. The parameters used for analysis were as follows: age, gender, sexual preference, use of intravenous drugs, time of diagnosis, CD4+ cell count, use of antiretroviral agents and duration, serum cholesterol and serum triglycerides. The present study found a statistically significant association between hypertriglyceridemia, hypercholesterolemia, sexual preference and intravenous drug abuse. The authors concluded that femoral head osteonecrosis is associated with hyperlipidemia (hypercholesterolemia and hypertriglyceridemia and intravenous drug abuse. This study supports the hypothesis that protease inhibitors play a role in the development of osteonecrosis through a tendency to cause hyperlipidemia.

  12. Rates of cardiovascular disease following smoking cessation in patients with HIV infection

    DEFF Research Database (Denmark)

    Petoumenos, K; Worm, S; Reiss, P;

    2011-01-01

    The aim of the study was to estimate the rates of cardiovascular disease (CVD) events after stopping smoking in patients with HIV infection.......The aim of the study was to estimate the rates of cardiovascular disease (CVD) events after stopping smoking in patients with HIV infection....

  13. The prevalence of metabolic syndrome in Danish patients with HIV infection: the effect of antiretroviral therapy

    DEFF Research Database (Denmark)

    Hansen, Birgitte Rønde; Petersen, J; Haugaard, S B;

    2009-01-01

    OBJECTIVES: The prevalence of metabolic syndrome (MS) in HIV-infected patients on highly active antiretroviral therapy (HAART) is a subject of debate. We investigated the prevalence of MS in a cohort of Danish HIV-infected patients and estimated the effect of the various classes of antiretroviral...

  14. Balamuthia mandrillaris and Acanthamoeba Amebic Encephalitis with Neurotoxoplasmosis Coinfection in a Patient with Advanced HIV Infection

    OpenAIRE

    Pietrucha-Dilanchian, Paula; Chan, Joseph C.; Castellano-Sanchez, Amilcar; Hirzel, Alicia; Laowansiri, Panthipa; Tuda, Claudio; Visvesvara, Govinda S.; Qvarnstrom, Yvonne; Ratzan, Kenneth R.

    2012-01-01

    We describe a patient with advanced HIV infection and Balamuthia mandrillaris and Acanthamoeba amebic encephalitis with Toxoplasma gondii coinfection. A multidisciplinary effort and state-of-the-art diagnostic techniques were required for diagnosis. Our patient is the first reported case of an HIV-infected person with dual Balamuthia mandrillaris and Acanthamoeba amebic encephalitis with neurotoxoplasmosis coinfection.

  15. Recurrent pneumococcal meningitis in a splenectomised HIV-infected patient

    Directory of Open Access Journals (Sweden)

    Quesne Gilles

    2003-11-01

    Full Text Available Abstract Background Streptococcus pneumoniae is a major cause of human disease, especially in pre-school children and elderly people, as well as in special risk groups such as asplenic, antibody deficient patients, or presenting disruption of natural barriers. The occurrence of pneumococcal disease has increased with the onset of the HIV epidemic and the emergence of drug-resistance. Case presentation We report the case of an HIV-1-infected patient who experienced three episodes of recurrent pneumococcal meningitis over a 4-year period, despite chemoprophylaxis and capsular vaccination. Conclusions Efficacy of anti-pneumococcal chemoprophylaxis and vaccination in HIV-infected patients are discussed in the light of this particular case.

  16. Clinical profile of HIV infected patients attending a HIV referral clinic in Pune, India

    Directory of Open Access Journals (Sweden)

    Megha Antwal

    2014-01-01

    Interpretation & conclusions: Signs and symptoms associated with HIV positivity observed in this study can be used by health care providers to detect HIV infection early. Moreover, similar to HIV testing in patients with tuberculosis, strategies can be developed for considering Herpes zoster as a predictor of HIV infection.

  17. The Spectrum of Pulmonary Disease in Patients with HIV Infection

    Directory of Open Access Journals (Sweden)

    Julio Sg Montaner

    1994-01-01

    bacterial pneumonia secondary to Streptococcus pneumoniae. Haemophilus influenzae or Staphylococcus aureus. Among the noninfectious causes of pulmonary disease. the most common are Kaposi's sarcoma. airways hyper-reactive disease (asthma and emphysema. Respiratory involvement in HIV-infected individuals is not always related to the HIV infection. These patients often present with pulmonary disorders that are common in the genernal population. Differential diagnosis of respiratory conditions is significantly facilitated by the prior knowledge of the degree of immunodeficiency present as measured by the CD4 count. In particular, most episodes of PCP occur in patients with absolute CD4 counts below 200 cells/mm3. On the other hand. bacterial pneumonias and tuberculosis tend to occur at any time during the natural history of HIV disease. History and physical examination can help in the differential diagnosis; however. they are rclatively nonspecific in this setting. The same can be said of radiographic findings as well as laboratory and physiological abnormalities. Of note, the lactate dehydrogenase (LDH serum level has proved to be extremely useful in ruling out PCP. Even mild PCP is usually accompanied by a significant elevation of LDH. Furthermore, the degree of LDH elevalion generally correlates wilh the severity of the PCP episode. Also, changes in LDH parallel the clinical course of the underlying PCP. Often LDH level has been useful in discriminating worsening PCP following the initiation of therapy from worsening respiratory symptoms due to superimposed disease. It must be emphasized, however. thal LDH level. although a very sensitive marker for PCP. is also nonspecific. Of note, hemolysis, lymphomas, pulmonary embolism, liver disease and dapsone therapy can be associated with elevated LDH in the context of HIV disease. Given the high frequency of respiratory involvement in this patient populalion. it is generally recommended thal preventive therapies be used

  18. HBV and neurological impairment in HIV-infected patients

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    L Manolescu

    2012-11-01

    Full Text Available Objective: HIV can affect CNS in early stages of disease and determine neurological impairment. HBV DNA was found in CSF of HIV co-infected patients, but little is known about the neurotropic character of this virus. Here we assessed the degree of association between HBV infection and neurological impairment in a large cohort of long-term survivors, HIV-infected patients that experienced multiple therapeutic schemes over time. Methods: A total of 462 HIV-1-infected patients were retrospectively followed up for 10 years for HBV infection and neurological impairment. The patients were tested for immune (flow cytometry and virological parameters of HIV infection (Roche Amplicor, version 1.5/ COBAS AmpliPrep/COBAS TaqMan HIV-1 test and for HBV infection markers (HBsAg, anti HBc: Murex Biotech ELISA tests. Many of these patients have experienced between one and six regimens such as: 2 NRTIs, 3 NRTIs, 2 NRTIs+1 NNRTI, 1 NRTI+1 NNRTI+1 PI, 2 NRTIs+2 PIs. Results: After 10 years 29.87% of the patients presented neurological impairment. Out of them 56.52% were HBV-infected. The prevalence of HIV encephalopathy (HE in our studied cohort was 22.7% and 50.4% of these patients were HBV-infected. The median HIV diagnosis age was 7 and the median age of HE diagnosis was 10. In order to establish a possible correlation between HBV infection and HE we first reviewed and excluded the main risk factors associated with HE at the moment of diagnosis: low weight, anemia, constitutional symptoms, low CD4+count, high plasma HIV-RNA load. No patient was infected with HCV. The groups of patients that presented HE and HBsAg and HE without HBsAg were balanced regarding sex, number of deceased patients, number of class C3 patients, but the patients in first group presented lower CD4 values at HE diagnosis vs patients from second group 2: 44.5 vs 95 cells/µL, p=0.3; lower nadir CD4 count: 38 vs 51 cell/µL, p=0.1; and slightly higher HIV viral load: 5.2 vs 5 log10 copies

  19. Nutritional status in patients with HIV infection and AIDS.

    Science.gov (United States)

    Stambullian, Marcela; Feliu, Susana; Slobodianik, Nora H

    2007-10-01

    The aim of this study was to evaluate the nutritional status of adults with HIV infection or with AIDS through the use of biochemical parameters. The study was performed on 43 patients (19 HIV+ and 24 AIDS patients), between 26 and 44 years of age, from low and medium socioeconomic status, with access to health care services; 35 patients were under highly active antiretroviral therapy (HAART) treatment. Body weight and height were determined, and the Body Mass Index calculated (kg/m2). Blood samples were collected from fasting patients. Plasma cholesterol (total, HDL and LDL), triacylglycerol, total protein, apolipoproteins A-I and B, albumin, transthyretin, retinol binding protein, and ceruloplasmin concentrations were determined. Plasma levels of zinc, copper, and selenium were determined in a haemolysis-free sample by flame atomic absorption spectrometry. Statistical analyses were performed with the Student's t-test. AIDS patients showed changes in biochemical parameters, particularly an increase in fibrinogen and a trend to decreased transthyretin levels. These findings stress the importance of the inclusion of functional biochemical parameters in the periodic evaluation of these patients. This would allow an early assessment of the need for appropriate nutritional support, implemented along with the specific retroviral treatment. This would aim at delaying the progression of the disease, and might improve the prospects of survival and quality of life.

  20. Occult hepatitis B virus infection in Moroccan HIV infected patients

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    Tahar Bajjou

    2015-03-01

    Full Text Available Background: The purpose of this study is to assess the prevalence of Occult hepatitis B virus Infection (OBI among antiretroviral treatment na and iuml;ve HIV-1 infected individuals in Morocco and to determine factors favouring its occurrence. Methods: The retrospective study was conducted in the Mohammed V military teaching hospital in Rabat between January 2010 and June 2011. It included patients with confirmed HIV infection, tested negative to serological detection of HBV surface antigen (HBsAg and did not received antiviral treatment or hepatitis B vaccine. All samples were tested for anti-HBc, anti-HBs and anti-HCV antibodies using enzyme immunoassay (ELISA. The detection of HBV DNA was performed by real-time PCR using two specific primers for a gene in the region C of the viral genome. The sensitivity of the technique was 20 copies/ml. Results: A total of 82 samples were analyzed, 19 (23 % were found to have isolated anti-HBc, 07 (8.5% with associated anti-HBc and Anti-HBs. No anti-HCV marker was detected on these screening samples. The HBV DNA was detected in 48 (58% samples, of which, males constituted 58% (28/48. The mean age of these patients was 38 +/- 8.2 (29-56, the median HIV-1 viral load and CD4 cell count HIV-1 infected patients were 127500 (54108-325325 copies/ml and 243 [80-385] cells/mm3 respectively and 27.1% (13/48 of these patients were found to have isolated anti-HBc. A significant correlations between DNA HBV and HIV viral load higher than 100000 copies/ml (P = 0.004, CD4 cell count lower than 400 cells/mm3 (P = 0.013, P = 0.006 and isolated anti-HBc samples (P <0.005 were founded. However there was no significant association with age, sex, transmission mode and clinical stage. Conclusion: The consequences of this high prevalence of OBI in Morocco need to be considered in laboratory diagnosis of HBV infection in HIV infected patients and the PCR seems to be inevitable for a better diagnosis and therapy. [Int J Res Med Sci

  1. Cryptococcal meningitis associated with tuberculosis in HIV infected patients.

    Science.gov (United States)

    Singh, Urvinderpal; Aditi; Aneja, Pooja; Kapoor, B K; Singh, S P; Purewal, Sukhpreet Singh

    2013-07-01

    Opportunistic infections are common complications of advanced immuno-deficiency in individuals with Human Immunodeficiency Virus (HIV) infection. Following involvement of the lung, the central nervous system (CNS) is the second most commonly affected organ. We report two cases of concurrent cryptococcal meningitis and tuberculosis (TB) in HIV infected persons. A high suspicion of multiple opportunistic infections should be kept in mind in HIV seropositive individuals.

  2. Care of HIV-infected patients in China

    Institute of Scientific and Technical Information of China (English)

    Yun; Zhen; CAO; Hong; Zhou; LU

    2005-01-01

    Compared with high infection areas of the world, the total HIV infection rate in China is relatively low. Nonetheless,because of China's vast territory and large population, the potential infection risk must be taken seriously. In the next few years, needle sharing among injection drug users will remain the most common route of transmission for the HIV/AIDS epidemic in China. Unprotected sex is gradually becoming a major route of transmission. China began to implement HAART in 1999 according to international standards. Prior to 2003, there were only about 150 HIV/AIDS patients were treated with HAART in some clinical trials and about 100 HIV/AIDS patients were treated by private sources.Results of those treatments are the scientific basis for development of the therapeutic strategies in China. In March of 2003, the Chinese government initiated China CARES program. In November of 2003, the Chinese Ministry of Health announced a national policy of free ARV treatment to all HIV+ Chinese citizens who were in poverty and required ARV therapy. There are total of 19,456 HIV/AIDS patients received free ARV drugs to date in 159 regions and 441 towns.Current challenges are how to follow-up and evaluate those patients in the clinical settings. The longer the therapy is postponed, the more side effects and the higher probability of drug resistance are going to occur. It remains unclear,therefore, when HAART regimen should be started in the HIV/AIDS population in China.

  3. Prevention and treatment of surgical site infection in HIV-infected patients

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    Zhang Lei

    2012-05-01

    Full Text Available Abstract Background Surgical site infection (SSI are the third most frequently reported nosocomial infection, and the most common on surgical wards. HIV-infected patients may increase the possibility of developing SSI after surgery. There are few reported date on incidence and the preventive measures of SSI in HIV-infected patients. This study was to determine the incidence and the associated risk factors for SSI in HIV-infected patients. And we also explored the preventive measures. Methods A retrospective study of SSI was conducted in 242 HIV-infected patients including 17 patients who combined with hemophilia from October 2008 to September 2011 in Shanghai Public Health Clinical Center. SSI were classified according to Centers for Disease Control and Prevention (CDC criteria and identified by bedside surveillance and post-discharge follow-up. Data were analyzed using SPSS 16.0 statistical software (SPSS Inc., Chicago, IL. Results The SSI incidence rate was 47.5% (115 of 242; 38.4% incisional SSIs, 5.4% deep incisional SSIs and 3.7% organ/space SSIs. The SSI incidence rate was 37.9% in HIV-infected patients undergoing abdominal operation. Patients undergoing abdominal surgery with lower preoperative CD4 counts were more likely to develop SSIs. The incidence increased from 2.6% in clean wounds to 100% in dirty wounds. In the HIV-infected patients combined with hemophilia, the mean preoperative albumin and postoperative hemoglobin were found significantly lower than those in no-SSIs group (P Conclusions SSI is frequent in HIV-infected patients. And suitable perioperative management may decrease the SSIs incidence rate of HIV-infected patients.

  4. Normal Myocardial Flow Reserve in HIV-Infected Patients on Stable Antiretroviral Therapy

    DEFF Research Database (Denmark)

    Knudsen, Andreas; Christensen, Thomas E; Ghotbi, Adam Ali

    2015-01-01

    Studies have found HIV-infected patients to be at increased risk of myocardial infarction, which may be caused by coronary microvascular dysfunction. For the first time among HIV-infected patients, we assessed the myocardial flow reserve (MFR) by Rubidium-82 (82Rb) positron emission tomography (PET......), which can quantify the coronary microvascular function. MFR has proved highly predictive of future coronary artery disease and cardiovascular events in the general population.In a prospective cross-sectional study, HIV-infected patients all receiving antiretroviral therapy (ART) with full viral...... suppression and HIV-uninfected controls were scanned using 82Rb PET/computed tomography at rest and adenosine-induced stress, thereby obtaining the MFR (stress flow/rest flow), stratified into low ≤1.5, borderline >1.5 to 2.0, or normal >2.0.Fifty-six HIV-infected patients and 25 controls were included...

  5. Intracellular pathogens within alveolar macrophages in a patient with HIV infection: diagnostic challenge

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    Takashi Shinha

    2015-03-01

    Full Text Available In HIV-infected individuals, macrophages, the key defense effector cells, manifest defective activity in their interactions with a wide variety of opportunistic pathogens, including fungi and protozoa. Understanding the morphological characteristics of intracellular opportunistic pathogens in addition to their pathogenesis is of critical importance to provide optimal therapy, thereby decreasing morbidity and mortality in HIV-infected patients. We herein present a case of disseminated histoplasmosis confused with disseminated visceral leishmaniasis in an HIV-infected individual from Guyana who developed intracellular organisms within alveolar macrophages

  6. Intestinal parasitic infections in Thai HIV-infected patients with different immunity status

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    Wiwanitkit Viroj

    2001-06-01

    Full Text Available Abstract Background One of the major health problems among HIV seropositive patients is superimposed infection due to the defect of immunity. Furthermore, intestinal parasite infection, which is also one of the basic health problems in tropical region, is common in these patients. In this study, a cross sectional study to document the prevalence of intestinal parasitic infection in Thai HIV-infected patients with different immune status was performed. Methods A study of stool samples from 60 Thai HIV-infected patients with different immune status was performed at King Chulalongkorn Memorial Hospital, Thailand. Each patient was examined for CD4 count and screened for diarrheal symptoms. Results The prevalence of intestinal parasitic infection among the HIV-infected patients in this study was 50 %. Non- opportunistic intestinal parasite infections such as hookworms, Opisthorchis viverrini and Ascaris lumbricoides were commonly found in HIV-infected people regardless of immune status with or without diarrheal symptoms. Opportunistic intestinal parasites such as Cryptosporidium, Isospora belli, Microsporidia and Strongyloides stercoralis infection were significantly more frequent in the low immunity group with diarrhea. Conclusion Therefore, opportunistic intestinal parasite infection should be suspected in any HIV infected patient with advanced disease presenting with diarrhea. The importance of tropical epidemic non-opportunistic intestinal parasite infections among HIV-infected patients should not be neglected.

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

    OpenAIRE

    Vassallo, Matteo; Moranne, Olivier; Ambrosetti, Damien; Jeandel, Pierre-Yves; Pomares, Christelle; Cassuto, Elisabeth; Boscagli, Annick; Giraud, Guillaume; Montagne, Nathalie; Dentone, Chiara; Demacina, Ilaria; Villaggio, Barbara; Secondo, Giovanni; Ferrea, Giuseppe; Passeron, Corinne

    2014-01-01

    Background We describe histological, clinical findings and outcomes of renal involvement during Leishmania infantum infection in four HIV-infected patients in South France and North Italy hospital settings. Cases presentation Four HIV-infected Caucasian patients (age 24-49) performed renal biopsy during episodes of visceral leishmaniasis. They presented severe immunosuppression, frequent relapses of visceral leishmaniasis during a follow-up period of several years and partial or complete reco...

  8. HLA-B*5701 frequency in Chilean HIV-infected patients and in general population

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    Helena Poggi

    2010-10-01

    Full Text Available It has been demonstrated that HLA-B*5701 screening reduces the risk for hypersensitivity reaction to abacavir in HIV-infected patients. Since B*5701 prevalence varies among different populations, it is important to determine the carrier frequency prior to its use for the screening of HIV-infected patients.The aim of this study was to determine HLA-B*5701 carrier frequency in Chilean general population and HIV-infected patients referred for B*5701 typing. For that purpose 300 blood bank donors and 492 abacavir-naïve HIV-infected patients from Chile were screened for B*5701 by a sequence specific primer PCR.We detected 14/300 (4.7% B*57-positive individuals in the Chilean general population, 11 (3.7% were B*5701 positive, and 3 (1% had another subtype.All were heterozygous,thus a B*5701 allele frequency of 2% was determined.Eleven of 492 (2.2 % HIV-patients carried a B*5701 allele. The difference between these frequencies is probably due to slow progression of HIV infection in HLA-B*5701 carriers, thus less patients would require antiretroviral therapy and B*5701 typing. Considering the usefulness of B*5701 screening, its prevalence in the Chilean general population,and the availability of a validated method,we conclude that HLA-B*5701 typing in Chilean HIV-infected patients about to initiate abacavir treatment is strongly recommended

  9. Clinicopathological study of itchy folliculitis in HIV-infected patients

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    Annam Vamseedhar

    2010-01-01

    Full Text Available Background: Itchy folliculitis are pruritic, folliculo-papular lesions seen in human immunodeficiency virus (HIV-infected patients. Previous studies have shown that it was impossible to clinically differentiate between eosinophilic folliculitis (EF and infective folliculitis (IF. Also, attempts to suppress the intense itch of EF were ineffective. Aims: The present study is aimed at correlating clinical, histopathological and immunological features of itchy folliculitis in HIV patients along with their treatment. Methods: The present prospective study lasted for 36 months (September, 2005 to August, 2008 after informed consent, data on skin disorders, HIV status and CD4 count were obtained by physical examination, histopathological examination and laboratory methods. Results: Of 51 HIV-positive patients with itchy folliculitis, the predominant lesion was EF in 23 (45.1% followed by bacterial folliculitis in 21 (41.2%, Pityrosporum folliculitis in five (9.8% and Demodex folliculitis in two (3.9% patients. The diagnosis was based on characteristic histopathological features and was also associated with microbiology confirmation wherever required. EF was associated with a lower mean CD4 count (180.58 ± 48.07 cells/mm 3 , P-value < 0.05, higher mean CD8 count (1675.42 ± 407.62 cells/mm3 and CD8/CD4 ratio of 9.27:1. There was significant reduction in lesions following specific treatment for the specific lesion identified. Conclusion: Clinically, it is impossible to differentiate itchy folliculitis and therefore it requires histopathological confirmation. Appropriate antimicrobial treatment for IF can be rapidly beneficial. The highly active antiretroviral therapy along with Isotretinoin therapy has shown marked reduction in the lesions of EF. Familiarity with these lesions may help in improving the quality of lives of the patients.

  10. Bilateral peripheral facial palsy in a patient with Human Immunodeficiency Virus (HIV) infection.

    Science.gov (United States)

    Kim, Min Su; Yoon, Hee Jung; Kim, Hai Jin; Nam, Ji Sun; Choi, Sung Ho; Kim, June Myung; Song, Young Goo

    2006-10-31

    Neurological complications are important causes of morbidity and mortality in patients with human immunodeficiency virus (HIV) infection. They can occur at any stage of the disease and can affect any level of the central or peripheral nervous systems. In the literature, several cases of HIV-associated facial paralysis have been reported; however, bilateral facial palsy is rarely reported. In this paper, we present the first case in Korea, of a bilateral facial palsy occurring as the first clinical manifestation of HIV infection.

  11. Fifteen-Year Trends in the Prevalence of Diabetes among Hospitalized HIV-Infected Patients in Spain (1997-2012)

    Science.gov (United States)

    Alvaro-Meca, Alejandro; Jimenez-Trujillo, Isabel; Hernandez-Barrera, Valentin; de Miguel-Diez, Javier

    2016-01-01

    Objective To describe trends in the prevalence of diabetes among hospitalized HIV-infected patients between 1997 and 2012 in Spain and compare them with those of age- and sex-matched non–HIV-infected patients. Methods The study was based on Spanish national hospital discharge data. We performed a retrospective study for the period 1997–2012. HIV infection (HIV-infected versus non–HIV-infected [control group])and calendar period in relation to widespread use of combination antiretroviral therapy (cART) (1997–1999; 2000–2003; 2004–2007 and 2008–2012), were the exposure variables The outcome variables were diagnosis of diabetes and in-hospital mortality (IHM). Results From 1997 to 2012, we identified 91,752 cases of diabetes: 15,398 in the HIV-infected group (403,277 hospital admissions) and 76,354 in the non–HIV-infected group (1,503,467 hospital admissions). Overall, HIV-infected patients had lower prevalence values for diabetes than non–HIV-infected patients throughout the follow-up (3.8% vs. 5.1%; p<0.001). The prevalence of diabetes increased 1.56-fold among non–HIV-infected patients and 4.2-fold among HIV-infected patients. The prevalence of diabetes in females was almost twice as high in HIV-infected patients as in non–HIV-infected patients during the last study period (4.72% vs. 2.88%; p<0.001). Diabetes showed a protective effect against IHM throughout the study period (aOR = 0.70; 95%CI, 0.65–0.75). Conclusions During the cART era, the prevalence of diabetes has increased sharply among HIV-infected hospitalized patients compared with matched non–HIV-infected subjects. The prevalence of diabetes is rising very fast among HIV-infected women. Diabetes has a protective effect on IHM among HIV-infected patients. Nevertheless, our study has several limitations. No information is available in the database used on important sociodemographic characteristics and relevant clinical variables including duration of the HIV infection, treatments

  12. M. tuberculosis genotypic diversity and drug susceptibility pattern in HIV- infected and non-HIV-infected patients in northern Tanzania

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    van Soolingen Dick

    2007-05-01

    Full Text Available Abstract Background Tuberculosis (TB is a major health problem and HIV is the major cause of the increase in TB. Sub-Saharan Africa is endemic for both TB and HIV infection. Determination of the prevalence of M. tuberculosis strains and their drug susceptibility is important for TB control. TB positive culture, BAL fluid or sputum samples from 130 patients were collected and genotyped. The spoligotypes were correlated with anti-tuberculous drug susceptibility in HIV-infected and non-HIV patients from Tanzania. Results One-third of patients were TB/HIV co-infected. Forty-seven spoligotypes were identified. Fourteen isolates (10.8% had new and unique spoligotypes while 116 isolates (89.2% belonged to 33 known spoligotypes. The major spoligotypes contained nine clusters: CAS1-Kili 30.0%, LAM11- ZWE 14.6%, ND 9.2%, EAI 6.2%, Beijing 5.4%, T-undefined 4.6%, CAS1-Delhi 3.8%, T1 3.8% and LAM9 3.8%. Twelve (10.8% of the 111 phenotypically tested strains were resistant to anti-TB drugs. Eight (7.2% were monoresistant strains: 7 to isoniazid (INH and one to streptomycin. Four strains (3.5% were resistant to multiple drugs: one (0.9% was resistant to INH and streptomycin and the other three (2.7% were MDR strains: one was resistant to INH, rifampicin and ethambutol and two were resistant to all four anti-TB drugs. Mutation in the katG gene codon 315 and the rpoB hotspot region showed a low and high sensitivity, respectively, as predictor of phenotypic drug resistance. Conclusion CAS1-Kili and LAM11-ZWE were the most common families. Strains of the Beijing family and CAS1-Kili were not or least often associated with resistance, respectively. HIV status was not associated with spoligotypes, resistance or previous TB treatment.

  13. Educational attainment and risk of HIV infection, response to antiretroviral treatment, and mortality in HIV-infected patients

    DEFF Research Database (Denmark)

    Legarth, Rebecca; Omland, Lars H; Kronborg, Gitte

    2014-01-01

    or intravenous drug abuse identified in the Danish HIV Cohort Study and 5108 individually matched population controls. METHODS: Data on educational attainment, categorized as low, medium, or high, were identified in The Danish Attainment Register. Logistic and Poisson regression were used to estimate odds ratios...... (ORs) and mortality rate ratios (MRRs). RESULTS: OR of HIV diagnosis was 1.7 (95% confidence interval, CI 1.3-2.3) among heterosexual individuals with low educational attainments, but no associations between educational attainment and time to HAART initiation, CD4 cell count, or viral suppression were...... with late/very late presentation of HIV, time to HAART initiation, or HAART response. However, low educational attainment substantially increased lifestyle-related mortality, which indicates that increased mortality in HIV-infected patients with low educational attainments stems from risk factors unrelated...

  14. [Guidelines for the management of patients with HIV infection. I. Adolescents and adults. Liege Working Group on HIV Infection].

    Science.gov (United States)

    Nkoghe, D; Moutschen, M; Demonty, J

    2000-05-01

    The management of HIV infected patient requires an approach that must put in balance profits expected from a tritherapy (suppression of viral replication, immune reconstitution) and problems related to treatment (difficulty of adherence, side effects, long-term toxicity, resistance). Controversies appear currently on the institution of a precocious treatment, on the use of protease inhibitors at initiation, in order to preserve choices when a modification is necessary. Many concepts, in investigation, are described in the management of a therapeutic failure. Resistance testings progressively find their place in the follow-up. Modes of prophylaxis-interruption of opportunistic infections are established, as well as is the management of professional postexposure. The question remains on how best to advise seropositive couples, about conception, and to elaborate recommendations after non-professional postexposure.

  15. A CASE OF RENAL DISEASE IN HIV INFECTED PATIENT

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    Ni Made Vina Septiani

    2013-11-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE MicrosoftInternetExplorer4 Kidney diseases in human immunodeficiency virus (HIV infected patients has been been fourth leading cause of death after sepsis, pneumonia, and liver disease. HIV-associated nephropathy (HIVAN is the most common. We report a case, a male patient, 48 years, who experienced shortness of breath, cough and intermittent fever and has been reported as HIV positive, without previous antiretroviral treatment and last CD4+ count is 89 cells/mm3. There are elevated BUN and SC from day to day during treatment and proteinuria +2 as a sign of kidney disease with normal blood pressure and there was no edema. Patients given an antibiotic and ACE inhibitors as antiproteinuria. Patients with suspicion of HIVAN in this case can progress very rapidly and causes progressive decline in renal function. Prognosis of patients with HIVAN if not handled properly will develop end stage renal disease (ESRD in 1-4 months and had a mortality rate 4.7 times higher than HIV patients without renal impairment. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  16. Prevalence of HIV Infection Among Tuberculosis Patients in Bali, Indonesia

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    Partha Muliawan

    2016-01-01

    Full Text Available Background: During 1998-2007, TB and HIV cases in Bali had shown a significant increase respectively. In general, both of these diseases are chronic diseases that need long term treatment, and together they could worsen the patients’ condition. To prevent the double burden of those patients, we need to know HIV infection prevalence among TB cases in Bali. Method: One thousands of TB cases diagnosed at TB health services unit (UPK at primary health centers (puskesmas and public hospitals in Bali, in September-November 2008, were given information and their blood samples were taken for HIV tests. Samples were chosen proportionally according to the number of TB cases registered in each UPK. Five milliliters of blood sample were taken from each eligible patient by laboratory staff or nurse at the UPK for HIV tests which were conducted at Bali Health Laboratory. HIV test used in this study were the two types of rapid test in accordance with WHO standard. Discussion: Thirty-nine out of 1,000 blood samples were found HIV positive. The highest HIV prevalence among TB cases was in the Buleleng District (11.5% and followed by Denpasar City (5.1%. This prevalence showed a different figure from the HIV/AIDS cases in VCT clinics registered at Bali Provincial Health Agency, where the highest prevalence found in Denpasar, followed by Buleleng and Badung. If we compare, the difference in figure between Badung and Buleleng, might be due to the difference in routes of HIV transmission. In Buleleng, most of the cases (90% were sexually transmitted, while in Badung 48% transmission were through injecting drug users. The IDUs seek health services at private health centers and rarely utilize public/government services such as puskesmas and hospitals. Conclusion: The HIV prevalence among TB patients in Bali was 3.9%. The characteristics of the patients showed that they are mostly male, aged between 31-40 years old, have junior high school-university education

  17. PATTERN OF MUCOCUTANEOUS MANIFESTATIONS OF HIV INFECTED PATIENTS: A RETROSPECTIVE STUDY

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    Murugan Swamiappan

    2016-07-01

    Full Text Available BACKGROUND Mucocutaneous manifestations occur in more than 90% of HIV infected patients. These manifestations are an early indicator of the presence of HIV infection and also aids in the clinical staging and prognosis as it reflects the underlying immune status. AIM To determine the prevalence and pattern of various mucocutaneous manifestations occurring in people living with HIV (PLHIV. MATERIALS AND METHODS A retrospective chart review of the data collected from the clinical records of all HIV seropositive patients, who had attended the Sexually Transmitted Infection (STI Clinic of Chengalpattu Medical College Hospital, Chengalpattu, Tamil Nadu, during the 3 years period from 2012 to 2015 was carried out. Demographic and clinical data were analysed. RESULTS The total number of HIV seropositive patients attended the STI Clinic were 176 during the study period of 3 years from 2012 to 2015. Among that males were 104 (59.1% and females were 72 (40.9%. The common age group was 35-49 (87 patients, 49.4%. Mucocutaneous manifestations were seen in 117 (66.4% patients. The most common manifestation seen was candidiasis among infections and seborrheic dermatitis among non-infectious dermatoses. CONCLUSION Mucocutaneous manifestations can arouse suspicion of HIV infection in otherwise healthy patients. They can serve as a dependable clinical marker of HIV infection. Awareness of the varied pattern of these manifestations would help in the early diagnosis and management of HIV infection, thereby decreasing the morbidity and improve the quality of life in them

  18. Treatment of Prolapsing Hemorrhoids in HIV-Infected Patients with Tissue-Selecting Technique

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    Zhe Fan

    2017-01-01

    Full Text Available The aim of this retrospective study was to evaluate the outcome of a tissue-selecting therapy stapler (TST for prolapsing hemorrhoids in HIV-infected patients. Sixty-two patients with stage III-IV hemorrhoidal prolapse were treated with TST by a single surgeon between June and November 2014. The TST group comprised 32 patients (4 females, and the TST + HIV group comprised 30 HIV-infected patients (3 females. Age, gender, and preoperative examination as well as intraoperative and postoperative features were assessed. There was no marked difference in hemorrhoidal prolapse between the TST and HIV + TST groups, except for patient satisfaction at 12 months. TST is an effective and safe technique for treatment of prolapsing hemorrhoids in HIV-infected patients.

  19. The use of biomarkers for assessing HAART-associated renal toxicity in HIV-infected patients.

    Science.gov (United States)

    del Palacio, María; Romero, Sara; Casado, Jose L

    2012-09-01

    Renal toxicity has become an important issue in HIV-infected patients receiving highly active antiretroviral therapy (HAART). Several biomarkers are available for monitoring renal function, although no consensus exists on how best to apply these tools in HIV infection. The best biomarker is the glomerular filtration rate (GFR), and several creatinine-based estimates equations of GFR are widely used in HIV infection, with clinical advantages for the equation developed by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Although serum cystatin C has been proposed as a more sensitive marker of renal dysfunction in HIV infection, it may be affected by ongoing inflammation. Tubular dysfunction can be simple or complex, depending on whether the tubular transport of one or more substances is affected. Multiple renal tubular dysfunction or Fanconi syndrome is characterized by alterations in the reabsorption of glucose, amino acids, phosphate and often also bicarbonate. Therefore, Fanconi syndrome would be the tip of the iceberg, and the most unusual and severe manifestation. In the last years, several low molecular weight proteins as markers of tubular alteration, including retinol-binding protein, b2-microglobulin, and neutrophil gelatinase associated lipocalin have become available. Different studies have shown differences in urine concentrations of these proteins in patients receiving tenofovir, but again, no consistent data have shown their clinical usefulness in predicting the clinical consequences of tubular alteration. Thus, we review findings from recent studies performed in this area to describe the performance of new biomarkers for renal damage in HIV-infected patients.

  20. Central Nervous System Strongyloidiasis and Cryptococcosis in an HIV-Infected Patient Starting Antiretroviral Therapy

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    Mónica Rodríguez

    2012-01-01

    Full Text Available We report a case of Strongyloides stercoralis hyperinfection syndrome with central nervous system involvement, in a patient with late human immunodeficiency virus (HIV infection starting antiretroviral therapy, in whom Strongyloides stercoralis larvae and Cryptococcus neoformans were isolated antemortem from cerebrospinal fluid. Our patient was not from an endemic region for the parasite, so strongyloidiasis was not originally suspected. For this reason, we conclude that Strongyloides stercoralis infection should be suspected in HIV-infected patients starting antiretroviral therapy in order to avoid potential fatal outcomes.

  1. Management of chronic diarrhea in HIV-infected patients: current treatment options, challenges and future directions

    Directory of Open Access Journals (Sweden)

    Lidia Elfstrand

    2010-11-01

    Full Text Available Lidia Elfstrand, Claes-Henrik FlorénDepartment of Medicine, Division of Clinical Sciences, Skåne University Hospital, Lund University, Lund, SwedenAbstract: Diarrhea is a common clinical manifestation of HIV infection regardless of whether the patients have AIDS. HIV and malnutrition tend to occur in the same populations, the underprivileged and resource-poor. Malnutrition increases severity and mortality of infection. Occurrence of chronic diarrhea in HIV-infected patients, gut status and pathogenic agents, nutritional status and the crucial role of nutrition are reviewed. Bovine colostrum-based food can be useful for managing chronic diarrhea in HIV-infected patients, enhancing both nutritional and immunological status.Keywords: HIV, diarrhea, nutrition, bovine colostrum, CD4+ 

  2. Skeletal muscle mitochondrial function and exercise capacity in HIV-infected patients with lipodystrophy and elevated p-lactate levels

    DEFF Research Database (Denmark)

    Røge, Birgit Thorup; Calbet, José A L; Møller, Kirsten;

    2002-01-01

    To investigate the skeletal muscle mitochondrial function in HIV-infected patients with lipodystrophy or elevated p-lactate levels.......To investigate the skeletal muscle mitochondrial function in HIV-infected patients with lipodystrophy or elevated p-lactate levels....

  3. Dialysis and Renal Transplantation in HIV-Infected Patients: a European Survey

    NARCIS (Netherlands)

    J.C. Trullas; A. Mocroft; F. Cofan; J. Tourret; A. Moreno; C.I. Bagnis; C.A. Fux; C. Katlama; P. Reiss; J. Lundgren; J.M. Gatell; O. Kirk; J.M. Miró

    2010-01-01

    Objectives: To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients. Methods: Cross-sectional multicenter survey of EuroSIDA clinics during 2008. Results: Prevalence of ESRD was 0.5%. Of 122 patient

  4. [Prevalence of HIV infection in dialysis patients: results of a national multicenter study].

    Science.gov (United States)

    Poignet, J L; Desassis, J F; Chanton, N; Litchinko, M B; Zins, B; Kolko, A; Patte, R; Sobel, A

    1999-01-01

    In order to determine the prevalence of HIV infection in french patients with end-stage renal disease (ESRD) on maintenance dialysis therapy, questionnaire forms were mailed out in february 1997 to the heads of the 260 dialysis facilities. We documented number of patients on maintenance dialysis therapy (hemo and peritoneal dialysis) and for HIV infected dialysis patients: age, gender, cause and duration of ESRD, known duration of HIV infection, risk factors for HIV infection, HBV and/or HCV infection, presence of clinical acquired immunodeficiency syndrome (AIDS), total CD4 count and treatment with antiretroviral agents. Questionnaire forms were returned from 98% of the dialysis facilities. As of february 1997 some 22,707 patients with ESRD were treated by renal replacement therapy, 19,947 by hemodialysis (HD) and 2760 by peritoneal dialysis (PD). 82 patients with ESRD and HIV infection were reported corresponding to 0.36% prevalence rate of all patients undergoing dialysis at the time specified. The 82 study subjects with ESRD and HIV infection received hemodialysis (79 patients) or peritoneal dialysis (3 patients) in 42 facilities. Forty seven patients were treated in Paris and suburbs and 9 in our own center. All 82 patients comprised 63% men and 47% women which included patients coming from Africa (37%), Caribbean and Oceania (28%), Europe (35%) of a mean age of 41.8 years. Modes of transmission were homobisexuals 15%, heterosexuals 31%, intravenous drug abusers 17%, blood transfusion 17% and unknown 20%. The mean duration of HIV infection was 96 months (range 12-168 months) and the mean duration of ESRD was 58 months (range 1-235 months). HIV associated nephropathy was established in 31%. AIDS was diagnosed in 25 patients. Seventy one percent of the patients were receiving an antiretroviral drug (tritherapy in 25% of cases). In conclusion HIV prevalence rate among French dialysis patients is low and focused in Paris and oversea. Sexual transmission is the

  5. Validation Protocol of Vitamin D Supplementation in Patients with HIV-Infection

    Science.gov (United States)

    Güerri-Fernández, Roberto; Villar García, Judit; González Mena, Alicia; Guelar Grinberg, Ana; Montero, María Milagro; Sorli, Luisa; Calzado, Sonia; Horcajada, Juan Pablo; Díez-Pérez, Adolfo; Knobel Freud, Hernando

    2016-01-01

    Hypovitaminosis D and secondary hyperparathyroidism are frequent among HIV-infected patients. As there are no data about the best supplementation therapy both in treatment and in maintenance, we conducted an observational study of 300 HIV-infected patients for whom vitamin D and parathormone (PTH) had been measured in order to validate a protocol of vitamin D supplementation in patients with HIV-infection. Patients with vitamin D deficiency (defined as 25(OH)D 65 pg/mL) were supplemented with cholecalciferol 16.000IU (0.266 mg) weekly (if deficiency) or fortnightly (if insufficiency or high PTH levels). Rates of normalization of 25(OH)D (levels above 20 ng/mL) and PTH levels (<65 pg/mL) were analyzed. Multivariate analysis of factors related to normalization was carried out. With a median follow-up of 2 years, 82.1% of patients with deficiency and 83.9% of cases with insufficiency reached levels above 20 ng/mL. However, only 67.2% of individuals with hyperparathyroidism at baseline reached target levels (<65 pg/mL). Independent factors for not achieving PTH objective were tenofovir (TDF) and protease inhibitors use. In HIV-infected patients with hypovitaminosis, the protocol of cholecalciferol supplementation normalized vitamin D levels regardless of antiretroviral regimen in a high proportion of patients but it was less effective to correct hyperparathyroidism. PMID:27699068

  6. Validation Protocol of Vitamin D Supplementation in Patients with HIV-Infection

    Directory of Open Access Journals (Sweden)

    Elisabet Lerma-Chippirraz

    2016-01-01

    Full Text Available Hypovitaminosis D and secondary hyperparathyroidism are frequent among HIV-infected patients. As there are no data about the best supplementation therapy both in treatment and in maintenance, we conducted an observational study of 300 HIV-infected patients for whom vitamin D and parathormone (PTH had been measured in order to validate a protocol of vitamin D supplementation in patients with HIV-infection. Patients with vitamin D deficiency (defined as 25(OHD 65 pg/mL were supplemented with cholecalciferol 16.000IU (0.266 mg weekly (if deficiency or fortnightly (if insufficiency or high PTH levels. Rates of normalization of 25(OHD (levels above 20 ng/mL and PTH levels (<65 pg/mL were analyzed. Multivariate analysis of factors related to normalization was carried out. With a median follow-up of 2 years, 82.1% of patients with deficiency and 83.9% of cases with insufficiency reached levels above 20 ng/mL. However, only 67.2% of individuals with hyperparathyroidism at baseline reached target levels (<65 pg/mL. Independent factors for not achieving PTH objective were tenofovir (TDF and protease inhibitors use. In HIV-infected patients with hypovitaminosis, the protocol of cholecalciferol supplementation normalized vitamin D levels regardless of antiretroviral regimen in a high proportion of patients but it was less effective to correct hyperparathyroidism.

  7. Indication for fiberoptic bronchoscopy in HIV-infected patients suspected for Pneumocystis carinii pneumonia

    DEFF Research Database (Denmark)

    Orholm, M; Lundgren, Jens Dilling; Nielsen, T L;

    1990-01-01

    During a six-month period, 40 consecutive fiberoptic bronchoscopic procedures including bronchoalveolar lavage, bronchial brushing and forceps biopsy were performed in local anaesthesia on 34 HIV-infected males presenting symptoms compatible with Pneumocystis carinii pneumonia. In 23 examinations...... did not differ with regard to history, clinical examination, immunology, serology or chest radiograph. We conclude that fiberoptic bronchoscopy should be performed on wide indications in HIV-infected patients with symptoms compatible with P. carinii pneumonia. The procedure is easily performed......, it is safe, and it is highly sensitive. The advantage of an early diagnosis compensates for a rather high frequency of negative examinations....

  8. Drug-Drug Interactions Between Antiretroviral and Immunosuppressive Agents in HIV-Infected Patients After Solid Organ Transplantation : A Review

    NARCIS (Netherlands)

    van Maarseveen, Erik M.; Rogers, Christin C.; Trofe-Clark, Jennifer; van Zuilen, Arjan D.; Mudrikova, Tania

    2012-01-01

    Since the introduction of combination antiretroviral therapy (cART) resulting in the prolonged survival of HIV-infected patients, HIV infection is no longer considered to be a contraindication for solid organ transplantation (SOT). The combined management of antiretroviral and immunosuppressive ther

  9. Depleted skeletal muscle mitochondrial DNA, hyperlactatemia, and decreased oxidative capacity in HIV-infected patients on highly active antiretroviral therapy

    DEFF Research Database (Denmark)

    Haugaard, Steen B; Andersen, Ove; Pedersen, Steen B;

    2005-01-01

    hyperlactatemia is associated with depletion of skeletal muscle (sm)-mtDNA and decreased oxidative capacity in HIV-infected patients on NRTI based highly active antiretroviral therapy (HAART) and whether HIV infection itself is associated with sm-mtDNA depletion. Sm-mtDNA was determined in 42 HIV...... in part could be mediated through an enhanced pro-inflammatory response....

  10. Evaluation of five conventional and molecular approaches for diagnosis of cryptococcal meningitis in non-HIV-infected patients

    NARCIS (Netherlands)

    Chen, Min; Zhou, Jie; Li, Juan; Li, Meng; Sun, Jun; Fang, Wen J; Al-Hatmi, Abdullah M S; Xu, Jianping; Boekhout, Teun; Liao, Wan Q; Pan, Wei H

    2016-01-01

    Cryptococcal meningitis (CM) is a life-threatening mycosis primarily occurring in HIV-infected individuals. Recently, non-HIV-infected hosts were increasingly reported to form a considerable proportion. However, the majority of the reported studies on the diagnosis of CM patients were performed on H

  11. Soluble urokinase plasminogen activator receptor is a marker of dysmetabolism in HIV-infected patients receiving highly active antiretroviral therapy

    DEFF Research Database (Denmark)

    Andersen, Ove; Eugen-Olsen, Jesper; Kofoed, Kristian;

    2008-01-01

    Circulating soluble urokinase plasminogen activator receptor (suPAR) reflects the immune and pro-inflammatory status of the HIV-infected patient. Highly active antiretroviral therapy (HAART) suppresses suPAR. Independent of the immune response to HAART, suPAR remains elevated in some HIV-infected...

  12. Hepatitis C prevalence among HIV-infected patients in Guinea-Bissau

    DEFF Research Database (Denmark)

    Hønge, Bo Langhoff; Jespersen, Sanne; Medina, Candida;

    2014-01-01

    Objectives: To estimate the prevalence and determine the clinical presentation of risk factors of hepatitis C virus (HCV) among HIV-infected patients in Bissau, Guinea-Bissau. Methods: In this cross-sectional study, we included individuals who had a routine blood analysis performed during...

  13. CRYPTOCOCCAL MENINGITIS AND PULMONARY CRYPTOCOCCOSIS IN A NON-HIV INFECTED PATIENT

    OpenAIRE

    2006-01-01

    Pulmonary cryptococcosis associated with cryptococcal meningitis in non-HIV infected patients is an uncommon finding. We report a case of polymyositis who developed pulmonary cryptococcosis and cryptococcal meningitis while she was on long term oral steroids, treated successfully. Key words: AIDS, Cryptococcus meningitis, HIV, immunosuppressive therapy

  14. Investigation of the Role of the Cytomegalovirus as a Respiratory Pathogen in HIV-Infected Patients

    Directory of Open Access Journals (Sweden)

    Rafael E de la Hoz

    1996-01-01

    Full Text Available OBJECTIVE: To investigate the occurrence of cytomegalovirus (CMV pneumonitis in the setting of human immunodeficiency virus (HIV infection and whether the presence of CMV as copathogen is associated with increased clinical severity or short term mortality in patients with Pneumocystis carinii pneumonia.

  15. Mechanisms by Which Interleukin-12 Corrects Defective NK Cell Anticryptococcal Activity in HIV-Infected Patients

    Directory of Open Access Journals (Sweden)

    Stephen K. Kyei

    2016-08-01

    Full Text Available Cryptococcus neoformans is a pathogenic yeast and a leading cause of life-threatening meningitis in AIDS patients. Natural killer (NK cells are important immune effector cells that directly recognize and kill C. neoformans via a perforin-dependent cytotoxic mechanism. We previously showed that NK cells from HIV-infected patients have aberrant anticryptococcal killing and that interleukin-12 (IL-12 restores the activity at least partially through restoration of NKp30. However, the mechanisms causing this defect or how IL-12 restores the function was unknown. By examining the sequential steps in NK cell killing of Cryptococcus, we found that NK cells from HIV-infected patients had defective binding of NK cells to C. neoformans. Moreover, those NK cells that bound to C. neoformans failed to polarize perforin-containing granules to the microbial synapse compared to healthy controls, suggesting that binding was insufficient to restore a defect in perforin polarization. We also identified lower expression of intracellular perforin and defective perforin release from NK cells of HIV-infected patients in response to C. neoformans. Importantly, treatment of NK cells from HIV-infected patients with IL-12 reversed the multiple defects in binding, granule polarization, perforin content, and perforin release and restored anticryptococcal activity. Thus, there are multiple defects in the cytolytic machinery of NK cells from HIV-infected patients, which cumulatively result in defective NK cell anticryptococcal activity, and each of these defects can be reversed with IL-12.

  16. Which equation should be used to measure energy expenditure in HIV-infected patients?

    Directory of Open Access Journals (Sweden)

    Helena Siqueira Vassimon

    2013-04-01

    Full Text Available OBJECTIVE: In view of the practical need to use equations for the evaluation of energy expenditure in HIV-infected patients, the objective of the present study was to determine the concordance between the energy expenditure values obtained by indirect calorimetry as the gold standard and those obtained by predictive equations elaborated from data for the healthy population: Harris-Benedict, Schofield and Cunningham, and by equations elaborated from data for HIV-infected patients: Melchior (1991-1993. METHODS: The study was conducted at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto on 32 HIV-infected men under treatment with highly active antiretroviral therapy. Resting energy expenditure was measured by indirect calorimetry and estimated on the basis of measurement of O2 consumption and CO2 production. RESULTS: Statistical analysis revealed weak concordance for the Harris-Benedict (0.38 and Cunningham (0.34 equations and satisfactory concordance for the Schofield equation (0.47. Only the two Melchior equations (1991 and 1993 showed strong concordance with the values obtained by indirect calorimetry (0.63 and 0.66, respectively and could be used in practice. CONCLUSION: The best equations seem to be population-specific, such as the Melchior equations elaborated for HIV-infected patients.

  17. Etiology of spontaneous pneumothorax in 105 HIV-infected patients without highly active antiretroviral therapy

    Energy Technology Data Exchange (ETDEWEB)

    Rivero, Antonio [Reina Sofia University Hospital, Cordoba (Spain)], E-mail: ariveror@saludalia.com; Perez-Camacho, Ines [Reina Sofia University Hospital, Cordoba (Spain); Lozano, Fernando [Virgen de Valme University Hospital, Sevilla (Spain); Santos, Jesus [Virgen de la Victoria University Hospital, Malaga (Spain); Camacho, Angela [Reina Sofia University Hospital, Cordoba (Spain); Serrano, Ascencion [Puerta del Mar University Hospital, Cadiz (Spain); Cordero, Elisa [Virgen del Rocio University Hospital, Sevilla (Spain); Jimenez, Francisco [Carlos Haya Hospital, Malaga (Spain); Torres-Tortosa, Manuel [Punta de Europa Hospital, Cadiz (Spain); Torre-Cisneros, Julian [Reina Sofia University Hospital, Cordoba (Spain)

    2009-08-15

    Introduction: Spontaneous pneumothorax (SP) is a frequent complication in non-treated HIV-infected patients as a complication of opportunistic infections and tumours. Objective: To analyse the aetiology of SP in non-treated HIV patients. Patients and methods: Observational study of SP cases observed in a cohort of 9831 of non-treated HIV-infected patients attended in seven Spanish hospitals. Results: 105 patients (1.06%) developed SP. The aetiological cause was identified in 89 patients. The major causes identified were: bacterial pneumonia (36 subjects, 34.3%); Pneumocystis jiroveci pneumonia (PJP) (31 patients, 29.5%); and pulmonary tuberculosis (17 cases, 15.2%). The most common cause of SP in drugs users was bacterial pneumonia (40%), whereas PJP was more common (65%) in sexual transmitted HIV-patients. The most common cause of bilateral SP was PJP (62.5%) whereas unilateral SP was most commonly associated with bacterial pneumonia (40.2%). The most common cause of SP in patients with a CD4+ lymphocyte count >200 cells/ml and in patients without AIDS criteria was bacterial pneumonia. PJP was the more common cause in patients with a CD4+ lymphocyte count <200 cells/ml or with AIDS. Conclusion: The incidence of SP in non-treated HIV-infected patients was 1.06%. The aetiology was related to the patients risk practices and to their degree of immunosuppression. Bacterial pneumonia was the most common cause of SP.

  18. Occurrence of occult HCV infection among Hiv infected patients in Georgia.

    Science.gov (United States)

    Gatserelia, L; Sharvadze, L; Karchava, M; Dolmazashvili, E; Tsertsvadze, T

    2014-01-01

    Occult hepatitis C (OCI) infection has been known as detectable HCV-RNA in the liver or peripheral blood mononuclear cells (PBMCs) in the absence of detectable serum or plasma HCV-RNA. OCI has been detected among different patients groups worldwide, it has been found not only in chronic hepatitis patients of unknown origin, but also among several groups at risk for HCV infection (hemodialysis patients or family members of patients with occult HCV). This occult infection has been reported also in healthy populations without evidence of liver disease. Prevalence of occult Hepatitis C virus has not been investigated in Georgian population, where a rate of HCV infection is highest (6.7%) among Eastern European Countries. The aim of this study was to investigate the occurrence of occult HCV infection among HIV infected individuals in Georgia. As a pilot study, we have selected three groups of HIV infected patients for analyses: Group 1- HIV infected patients without evidence of liver disease (n=98), group 2- HIV infected patients with cryptogenic liver disease (n=34) and group 3- HIV/HBV co infected patients (n=29). HCV RNA was tested in PBMCs samples by real-time polymerase chain reaction. HCV genotyping was performed by Line-probe assay based on reverse-hybridization technology. Liver fibrosis was evaluated by transient elastography (FibroScan®). HCV-RNA was detected in PBMCs specimens among 2 (2%) subjects from group 1, 4 (12%) subjects from group 2, and 9 (31%) subjects from group 3. HCV genotypes were determined for 14 of 15 OCI subjects resulting following genotype distribution: 6 (46%) - 1b, 3 (23%) - 2a/2c and 5 (38%) - 3a. One samples failed to be genotyped due to extremely low HCV viral load. Our data revealed the occurrence of occult HCV infection in HIV infected patients. No single HCV genotype was predominant in the present study. Liver fibrosis was found more frequently and the fibrosis score was significantly higher in OCI patients versus negative ones

  19. Risk factors for neurocognitive impairment in HIV-infected patients and comparison of different screening tools

    Directory of Open Access Journals (Sweden)

    Elisa Moreira de Souza

    Full Text Available HIV-associated neurocognitive disorder (HAND is relatively frequent among HIV-infected patients and is often underdiagnosed. Assessment of HAND in daily clinical practice is challenging and different tools have been proposed. Objective : To evaluate risk factors and compare different screening tools for neurocognitive impairment in HIV-infected patients. Methods : HIV-infected patients were evaluated using the International HIV-Dementia Scale (IHDS, Mini-Mental State Examination (MMSE and a neurocognitive self-perception questionnaire recommended by the European AIDS Clinical Society. Sociodemographic, clinical and laboratory data were obtained through chart review and patient interview. Results : Among the 63 patients included, low performance on the IHDS was observed in 54.0% and IHDS score was inversely associated with age (OR 0.13; 95%CI [0.02-0.67]. Regarding cognitive self-perception, 63.5% of patients reported no impairment on the three domains covered by the questionnaire. Among those patients self-reporting no problems, 42.1% had low performance on the IHDS. None of the patients scored below the education-adjusted cut-off on the MMSE. Conclusion : IHDS scores suggestive of HAND were observed in more than half of the patients and lower scores were found among older patients. There was low agreement between the different tools, suggesting that the MMSE may be inadequate for assessing HAND. The self-assessment questionnaire had low sensitivity and might not be useful as a screening tool.

  20. Risk of zidovudine-induced anemia on human immunodeficiency virus (HIV) infection patients with different CD4 cell counts

    OpenAIRE

    wedayani, anak agung ayu niti; Sholikhah, Eti Nurwening; Kristin, Erna; Triyono, Erwin Astha

    2017-01-01

    Anemia is the most common hematologic abnormality in patients with human immunodeficiency virus (HIV) infection. This abnormality is associated with HIV infection itself, HIV-related opportunities infections or drug use. Zidovudine (AZT) is the most common cause of anemia in HIV patients. Recent study showed anemia in HIV patients is also associated with CD4 cell counts. Aim of this study was to evaluate the risk of anemia on HIV patients with different CD4 cell counts after AZT-based antiret...

  1. Distribution of yeast species associated with oral lesions in HIV-infected patients in Southwest Uganda.

    LENUS (Irish Health Repository)

    Agwu, Ezera

    2012-04-01

    Oropharyngeal candidiasis remains a significant clinical problem in HIV-infected and AIDS patients in regions of Africa where anti-retroviral therapy isn\\'t readily available. In this study we identified the yeast populations associated with oral lesions in HIV-infected patients in Southwest Uganda who were receiving treatment with nystatin and topical clotrimazole. Samples were taken from 605 patients and 316 (52%) of these yielded yeast growth following incubation on Sabouraud dextrose agar. Samples were subsequently re-plated on CHROMagar Candida medium to facilitate identification of the yeast species present. The majority (56%) of culture-positive samples yielded a mix of two or more species. Candida albicans was present in 87% (274\\/316) of patient samples and accounted for 87% (120\\/138) of single species samples. Candida glabrata, Candida tropicalis and Candida norvegensis were also found in cultures that yielded a single species. No Candida dubliniensis isolates were identified in this population.

  2. Severe manifestation of psoriasis in a HIV infected patient: a case report

    Directory of Open Access Journals (Sweden)

    Alper Gunduz

    2015-12-01

    Full Text Available The human immunodeficiency virus (HIV epidemic in Turkey reveals a slow progression and at the end of November 2015, the total official number was reported to be 11,109 cases. Approximately 90% of HIV patients develop some type of skin disease. Especially patients with psoriasis and HIV infection often present with more severe and treatment-refractory cutaneous disease. Herein, we describe a case of a patient with previously known psoriasis worsened by HIV infection. A 37-year-old housewife was admitted to our clinic with previously known psoriasis worsened during the last two years with conversion to erythrodermic psoriasis which was not controlled even by PUVA, methotrexate and systemic cyclosporine. The patient had positive HIV antibody test. HIV RNA viral load was 120.000 copy/ml and CD4 count 88/ mm3 . She also had oral candidiasis and Pneumocystis jirovecii pneumonia. The patient received antiretroviral treatment including tenofovir/emtricitabine and lopinavir/ritonavir. Symptoms resolved gradually within one month with almost complete impovement of her erythrodermic psoriasis. . Four years later the patient was still on tenofovir/emtricitabine and lopinavir/ritonavir without concomitant spesific psoriasis treatment. Psoriasis manifestations can be severe in AIDS patients. Clinicians face diagnostic and therapeutic difficulties when psoriasis coexists with HIV infection. The HIV test should be considered in patients affected by severe erythrodermic psoriasis and resistant to conventional and biological treatments. [Dis Mol Med 2015; 3(4.000: 43-45

  3. Acute promyelocytic leukemia after whole brain irradiation of primary brain lymphomainan HIV-infected patient

    Directory of Open Access Journals (Sweden)

    Boban A

    2009-01-01

    Full Text Available Abstract The occurrence of acute promyelocytic leukemia (APL in HIV-infected patients has been reported in only five cases. Due to a very small number of reported HIV/APL patients who have been treated with different therapies with the variable outcome, the prognosis of APL in the setting of the HIV-infection is unclear. Here, we report a case of an HIV-patient who developed APL and upon treatment entered a complete remission. A 25-years old male patient was diagnosed with HIV-infection in 1996, but remained untreated. In 2004, the patient was diagnosed with primary central nervous system lymphoma. We treated the patient with antiretroviral therapy and whole-brain irradiation, resulting in complete remission of the lymphoma. In 2006, prompted by a sudden neutropenia, we carried out a set of diagnostic procedures, revealing APL. Induction therapy consisted of standard treatment with all-trans-retinoic-acid (ATRA and idarubicin. Subsequent cytological and molecular analysis of bone marrow demonstrated complete hematological and molecular remission. Due to the poor general condition, consolidation treatment with ATRA was given in March and April 2007. The last follow-up 14 months later, showed sustained molecular APL remission. In conclusion, we demonstrated that a complete molecular APL remission in an HIV-patient was achieved by using reduced-intensity treatment.

  4. Cerebral toxoplasmosis mimicking subacute meningitis in HIV-infected patients; a cohort study from Indonesia.

    Directory of Open Access Journals (Sweden)

    A Rizal Ganiem

    Full Text Available BACKGROUND: HIV-associated subacute meningitis is mostly caused by tuberculosis or cryptococcosis, but often no etiology can be established. In the absence of CT or MRI of the brain, toxoplasmosis is generally not considered as part of the differential diagnosis. METHODOLOGY/PRINCIPAL FINDINGS: We performed cerebrospinal fluid real time PCR and serological testing for Toxoplasma gondii in archived samples from a well-characterized cohort of 64 HIV-infected patients presenting with subacute meningitis in a referral hospital in Indonesia. Neuroradiology was only available for 6 patients. At time of presentation, patients mostly had newly diagnosed and advanced HIV infection (median CD4 count 22 cells/mL, with only 17.2% taking ART, and 9.4% PJP-prophylaxis. CSF PCR for T. Gondii was positive in 21 patients (32.8%. Circulating toxoplasma IgG was present in 77.2% of patients tested, including all in whom the PCR of CSF was positive for T. Gondii. Clinically, in the absence of neuroradiology, toxoplasmosis was difficult to distinguish from tuberculosis or cryptococcal meningitis, although CSF abnormalities were less pronounced. Mortality among patients with a positive CSF T. Gondii PCR was 81%, 2.16-fold higher (95% CI 1.04-4.47 compared to those with a negative PCR. CONCLUSIONS/SIGNIFICANCE: Toxoplasmosis should be considered in HIV-infected patients with clinically suspected subacute meningitis in settings where neuroradiology is not available.

  5. TTV viral load as a marker for immune reconstitution after initiation of HAART in HIV-infected patients

    DEFF Research Database (Denmark)

    Madsen, Chris; Eugen-Olsen, Jesper; Kirk, Ole;

    2002-01-01

    PURPOSE: To investigate whether TT virus (TTV) viral load may be used as a surrogate marker for functional immune reconstitution in HIV-infected patients receiving highly active antiretroviral therapy (HAART). METHOD: Fifteen protease inhibitor-naïve HIV-infected patients were included in a longi......PURPOSE: To investigate whether TT virus (TTV) viral load may be used as a surrogate marker for functional immune reconstitution in HIV-infected patients receiving highly active antiretroviral therapy (HAART). METHOD: Fifteen protease inhibitor-naïve HIV-infected patients were included...... in a longitudinal study. From each patient, three serum samples taken before HAART initiation and three samples taken during HAART were analyzed. TTV was detected by polymerase chain reaction (PCR) and was quantitated by competitive PCR. TTV viral heterogeneity was determined by restriction fragment length...

  6. Trends in Epidemiology of COPD in HIV-Infected Patients in Spain (1997–2012)

    Science.gov (United States)

    de Miguel-Díez, Javier; López-de-Andrés, Ana; Jiménez-García, Rodrigo; Puente-Maestu, Luis; Jiménez-Trujillo, Isabel; Hernández-Barrera, Valentín

    2016-01-01

    Purpose The aim of this study was to estimate trends of incidence of hospital admissions and in-hospital mortality (IHM) in HIV-infected patients with COPD in the combination antiretroviral therapy (cART) era in Spain (1997–2012). Methods A retrospective study with data from nationwide population-based COPD diagnoses in the Spanish Minimum Basic Data Set (MBDS) was performed. We established groups according to their HIV and HCV infections: 1) HIV-uninfected patients; 2) HIV-infected patients (with or without HCV coinfection). Results 1,580,207 patients discharge with a COPD diagnosis were included in the study, 8902 of them were HIV-infected patients (5000 HIV-monoinfected patients and 3902 HIV/HCV-coinfected patients). The HIV-infected patients had higher incidence rates of hospital admissions for COPD than the HIV-uninfected patients during the study period. The HIV-monoinfected patients had higher rates of hospitalizations for COPD than the HIV/HCV-coinfected patients in the early-period cART (1997–1999), but these rates decreased in the first group and increased in the second, being even similar in both groups in the late-period cART (2004–2011). On the other hand, the HIV-infected patients with COPD had higher IHM than the HIV-uninfected patients with COPD. The mortality rates were higher in the HIV-monoinfected patients with COPD than in the HIV/HCV-coinfected patients with COPD in the early-period cART; however, in the late-period cART, the mortality rates trends seems higher in the HIV/HCV group. The likelihood of death in HIV/HCV-coinfected patients with COPD was similar to than in HIV-monoinfected patients with COPD. Conclusions Incidence of hospital admissions for COPD and IHM have decreased among HIV-monoinfected individuals but have increased steadily among HIV/HCV-coinfected individuals in the cART era. PMID:27846297

  7. Dialysis and Renal Transplantation in HIV-Infected Patients: a European Survey

    DEFF Research Database (Denmark)

    Trullas, Joan Carles; Mocroft, Amanda; Cofan, Federico;

    2010-01-01

    OBJECTIVES:: To determine prevalence and characteristics of end-stage renal diseases (ESRD) [dialysis and renal transplantation (RT)] among European HIV-infected patients. METHODS:: Cross-sectional multicenter survey of EuroSIDA clinics during 2008. RESULTS:: Prevalence of ESRD was 0.5%. Of 122...... patients with ESRD 96 were on dialysis and 26 had received a RT. Median age was 47 years, 73% were males and 43% were black. Median duration of HIV infection was 11 years. Thirty-three percent had prior AIDS; 91% were receiving antiretrovirals; and 88% had undetectable viral load. Median CD4T-cell count...... was 341 cells per cubic millimetre; 20.5% had hepatitis C coinfection. Most frequent causes of ESRD were HIV-associated nephropathy (46%) and other glomerulonephritis (28%). Hemodialysis (93%) was the most common dialysis modality; 34% of patients were on the RT waiting list. A poor HIV control...

  8. [Comparative study of pneumococcal bacteremia in patients with and without HIV infection].

    Science.gov (United States)

    Roca, V; Pérez-Cecilia, E; Santillana, T; Romero, J; Picazo, J J

    1993-01-01

    A retrospective study of bacteriemias due to S. pneumoniae in adults is performed, from all the cases observed in our hospital during the 1989-1990 period. We compare the clinical characteristics of the disease depending if the affected patients were infected or not by the human immunodeficiency virus (HIV). In the considered period bacteriemia due to S. pneumoniae has been diagnosed in 12 patients with HIV infection and 29 without it. Ten of the twelve patients with HIV infection (83.3%) were in Stage IV (CDC) of the disease, staying the rest in a less developed phase of the disease. Age was significantly higher in non-HIV patients (p < 0.001) and a high percentage of patients in this group (75%) showed some disease considered as predisposing to bacteriemia due to S. pneumoniae. When a respiratory foci was present, VIH positive individuals showed more frequently bilateral radiologic infiltrates and less frequently pleural effusion. Leucocyte count when diagnosis was done were significantly higher in non-HIV group. Sensibility of isolated S. pneumoniae was similar in the two groups, being the immediate mortality related with bacteriemia due to S. pneumoniae higher in the non-HIV group. In our center 29.3% of bacteriemias due to S. pneumoniae are diagnosed in patients with HIV infection. This disease in itself could constitute an added risk factor in the development of bacteriemia due to S. pneumoniae.

  9. Coinfection of hepatitis B and hepatitis C virus in HIV-infected patients in South India

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To screen for the co-infection of hepatitis B (HBV)and hepatitis C virus (HCV) in human immunodeficiency virus (HIV) infected patients insouthern India.METHODS: Five hundred consecutive HIV infected patients were screened for Hepatitis B Virus (HBsAg and HBV-DNA) and Hepatitis C virus (anti-HCV and HCV-RNA)using commercially available ELISA kits; HBsAg, HBeAg/anti-HBe (Biorad laboratories, USA) and anti-HCV (Murex Diagnostics, UK). The HBV-DNA PCR was performed to detect the surface antigen region (pre S-S). HCV-RNA was detected by RT-PCR for the detection of the constant 5' putative non-coding region of HCV.RESULTS: HBV co-infection was detected in 45/500 (9%)patients and HCV co-infection in 11/500 (2.2%) subjects.Among the 45 co-infected patients only 40 patients could be studied, where the detection rates of HBe was 55%(22/40), antiHBe was 45% (18/40) and HBV-DNA was 56% (23/40). Among 11 HCV co-infected subjects, 6(54.5%) were anti-HCV and HCV RNA positive, while 3(27.2%) were positive for anti-HCV alone and 2 (18%)were positive for HCV RNA alone.CONCLUSION: Since the principal routes for HIV transmission are similar to that followed by the hepatotropic viruses, as a consequence, infections with HBV and HCV are expected in HIV infected patients.Therefore, it would be advisable to screen for these viruses in all the HIV infected individuals and their sexual partners at the earliest.

  10. Clinical prediction and diagnosis of neurosyphilis in HIV-infected patients with early Syphilis.

    Science.gov (United States)

    Dumaresq, Jeannot; Langevin, Stéphanie; Gagnon, Simon; Serhir, Bouchra; Deligne, Benoît; Tremblay, Cécile; Tsang, Raymond S W; Fortin, Claude; Coutlée, François; Roger, Michel

    2013-12-01

    The diagnosis of neurosyphilis (NS) is a challenge, especially in HIV-infected patients, and the criteria for deciding when to perform a lumbar puncture (LP) in HIV-infected patients with syphilis are controversial. We retrospectively reviewed demographic, clinical, and laboratory data from 122 cases of HIV-infected patients with documented early syphilis who underwent an LP to rule out NS, and we evaluated 3 laboratory-developed validated real-time PCR assays, the Treponema pallidum particle agglutination (TPPA) assay, the fluorescent treponemal antibody absorption (FTA-ABS) assay, and the line immunoassay INNO-LIA Syphilis, for the diagnosis of NS from cerebrospinal fluid (CSF) samples of these patients. NS was defined by a reactive CSF-VDRL test result and/or a CSF white blood cell (WBC) count of >20 cells/μl. Thirty of the 122 patients (24.6%) had early NS. Headache, visual symptoms, a CD4 cell count of HIV-1 RNA count of ≥50 copies/ml, were associated with NS in multivariate analysis (P = diagnosis of NS, the PCR, FTA-ABS, TPPA, and INNO-LIA assays had sensitivities of 58%, 100%, 68%, and 100%, specificities of 67%, 12%, 49%, and 13%, and negative predictive values of 85%, 100%, 84%, and 100%, respectively. Visual disturbances, headache, uncontrolled HIV-1 viremia, and a CD4 cell count of HIV-infected patients with early syphilis, while blood serum RPR titers were not; therefore, RPR titers should not be used as the sole criterion for deciding whether to perform an LP in early syphilis. When applied to CSF samples, the INNO-LIA Syphilis assay easily helped rule out NS.

  11. Immune Activation Response in Chronic HIV-Infected Patients: Influence of Hepatitis C Virus Coinfection

    Science.gov (United States)

    Márquez, Mercedes; Romero-Cores, Paula; Montes-Oca, Monserrat; Martín-Aspas, Andrés; Soto-Cárdenas, María-José; Guerrero, Francisca; Fernández-Gutiérrez, Clotilde; Girón-González, José-Antonio

    2015-01-01

    Objectives We have analyzed the parameters (bacterial translocation, immune activation and regulation, presence of HCV coinfection) which could be implicated in an inappropriate immune response from individuals with chronic HIV infection. The influence of them on the evolution of CD4+ T cell count has been investigated. Patients and methods Seventy HIV-infected patients [monoinfected by HIV (n = 20), HCV-coinfected (with (n = 25) and without (n = 25) liver cirrhosis)] and 25 healthy controls were included. Median duration of HIV infection was 20 years. HIV- and HCV-related parameters, as well as markers relative to bacterial translocation, monocyte and lymphocyte activation and regulation were considered as independent variables. Dependent variables were the increase of CD4+ T cell count during the follow-up (12 months). Results Increased values of bacterial translocation, measured by lipopolysaccharide-binding protein, monocyte and lymphocyte activation markers and T regulatory lymphocytes were detected in HIV-monoinfected and HIV/HCV coinfected patients. Serum sCD14 and IL-6 were increased in HIV/HCV-coinfected patients with liver cirrhosis in comparison with those with chronic hepatitis or HIV-monoinfected individuals. Time with undetectable HIV load was not related with these parameters. The presence of cirrhosis was negatively associated with a CD4+ T cell count increase. Conclusion In patients with a chronic HIV infection, a persistent increase of lipopolysaccharide-binding protein and monocyte and lymphocyte modifications are present. HCV-related cirrhosis is associated with more elevated serum concentrations of monocyte-derived markers. Cirrhosis influences the continued immune reconstitution of these patients. PMID:25775475

  12. The prevalence and clinical significance of intestinal parasites in HIV-infected patients in Denmark.

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    Stensvold, Christen Rune; Nielsen, Susanne Dam; Badsberg, Jens-Henrik; Engberg, Jørgen; Friis-Møller, Nina; Nielsen, Sanne Søgaard; Nielsen, Henrik Vedel; Friis-Møller, Alice

    2011-02-01

    To investigate the prevalence and clinical significance of intestinal parasites in human immunodeficiency virus (HIV)-infected patients, faecal specimens from 96 HIV-infected patients were submitted to microbiological analyses, including microscopy and polymerase chain reaction for protozoa and enteropathogenic bacteria. Results of microbiological analyses were compared with self-reported gastrointestinal complaints collected using a validated questionnaire. Thirty-two (33%) patients were positive for parasites. However, opportunistic parasites (Isospora and Cryptosporidium) were detected in only 2 instances. Entamoeba dispar was detected in 10 cases, 9 of which represented men who have sex with men (MSM). Despite generally low HIV RNA loads and high CD4+ T-cell counts, 42% of the 76 patients reporting symptoms complained of diarrhoea, 31% of whom were parasite-positive. The presence of diarrhoea was not associated with the presence or absence of parasites; neither was it associated with receiving highly active anti-retroviral therapy (HAART) in general, or protease inhibitors (PI) in particular. A CD4+ T-cell count parasitic infection or with diarrhoea. The data show that diarrhoea is a common symptom among HIV-infected patients in Denmark, but do not indicate that the diarrhoea is due to intestinal parasites.

  13. Pulmonary mucormycosis due to Lichtheimia ramosa in a patient with HIV infection.

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    Kutlu, Murat; Ergin, Cağrı; Bir, Ferda; Hilmioğlu-Polat, Süleyha; Gümral, Ramazan; Necan, Ceyda; Koçyiğit, Ali; Sayın-Kutlu, Selda

    2014-08-01

    Mucormycosis is increasingly common in patients with risk factors such as diabetes mellitus, neutropenia, and corticosteroid therapy. However, mucormycosis seems to be less common in patients with human immunodeficiency virus (HIV) infection compared to patients with other risk factors. Despite their lower virulence, Lichtheimia species should be regarded as emerging pathogens among Mucoralean fungi. We report a fatal case of pulmonary mucormycosis due to Lichtheimia ramosa in a 52-year-old man with an end-stage HIV infection. He had a cachectic appearance and his CD4 count was 8 cells/mm(3). The fungal infection was diagnosed based on a positive sputum culture with histopathologic confirmation. The fungus was resistant to caspofungin, anidulafungin, and voriconazole [minimum inhibitory concentration (MCI) >32 µg/ml], whereas the E test MIC values of itraconazole, posaconazole, and amphotericin B were 0.38, 0.38, and 0.5 µg/ml, respectively. Although intravenous drug use is the main risk factor for the development of mucormycosis in HIV-infected patients, it may also develop in patients with low CD4 count, opportunistic infections and/or additional diseases, such as Kaposi's sarcoma or severe immunodeficiency, as in our case.

  14. [Anti-neutrophil cytoplasmic antibodies (ANCA) in patients with symptomatic and asymptomatic HIV infection].

    Science.gov (United States)

    Habegger de Sorrentino, A; Motta, P; Iliovich, E; Sorrentino, A P

    1997-01-01

    The cytopathic effect of HIV on CD4 T cells, as well as the active autoimmune mechanism occurring during infection, have been documented. Of the cytokines involved in the pathogenesis of AIDS, the main one produced by the monocyte-macrophage series is tumor necrosis factor alfa (TNF alpha). This cytokine induces antigens such as proteinase 3 (Pr 3) or mieloperoxidase (MPO). Anti-neutrophil cytoplasmic antibodies (ANCA) are directed against this type of PMN antigens. In the present paper, the role of anti-neutrophil cytoplasmic antibodies (ANCA) in HIV infected patients as responsible for autoimmune phenomena in relation to opportunistic infections, was studied. A total of 88 serum samples belonging to 49 asymptomatic and 39 symptomatic HIV infected patients were tested for ANCA by an indirect immunofluorescence (IIF) test over a neutrophil substrate. ANCA were detected in 53.8% of symptomatic patients as compared to 4.1% in asymptomatic cases (p tuberculosis is a frequent finding in HIV infected patients from Northeastern Argentina. When the presence of ANCA in TB(+) HIV(+) and TB(+) HIV(-) patients was studied, it was seen that positive-ANCA significantly correlated with the first group (p pulmonar TB, could indicate that the virus may not be responsible for the induction of these antibodies.

  15. Immune activation response in chronic HIV-infected patients: influence of Hepatitis C virus coinfection.

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    Mercedes Márquez

    Full Text Available We have analyzed the parameters (bacterial translocation, immune activation and regulation, presence of HCV coinfection which could be implicated in an inappropriate immune response from individuals with chronic HIV infection. The influence of them on the evolution of CD4+ T cell count has been investigated.Seventy HIV-infected patients [monoinfected by HIV (n = 20, HCV-coinfected (with (n = 25 and without (n = 25 liver cirrhosis] and 25 healthy controls were included. Median duration of HIV infection was 20 years. HIV- and HCV-related parameters, as well as markers relative to bacterial translocation, monocyte and lymphocyte activation and regulation were considered as independent variables. Dependent variables were the increase of CD4+ T cell count during the follow-up (12 months.Increased values of bacterial translocation, measured by lipopolysaccharide-binding protein, monocyte and lymphocyte activation markers and T regulatory lymphocytes were detected in HIV-monoinfected and HIV/HCV coinfected patients. Serum sCD14 and IL-6 were increased in HIV/HCV-coinfected patients with liver cirrhosis in comparison with those with chronic hepatitis or HIV-monoinfected individuals. Time with undetectable HIV load was not related with these parameters. The presence of cirrhosis was negatively associated with a CD4+ T cell count increase.In patients with a chronic HIV infection, a persistent increase of lipopolysaccharide-binding protein and monocyte and lymphocyte modifications are present. HCV-related cirrhosis is associated with more elevated serum concentrations of monocyte-derived markers. Cirrhosis influences the continued immune reconstitution of these patients.

  16. Pharmacokinetic interactions of CEP-1347 and atazanavir in HIV-infected patients.

    Science.gov (United States)

    Ma, Qing; Gelbard, Harris A; Maggirwar, Sanjay B; Dewhurst, Stephen; Gendelman, Howard E; Peterson, Derick R; DiFrancesco, Robin; Hochreiter, Jill S; Morse, Gene D; Schifitto, Giovanni

    2013-06-01

    CEP-1347 is a potent inhibitor of mixed lineage kinase (MLK), which was investigated for ameliorating HIV-associated neurocognitive disorders. CEP-1347 and atazanavir pharmacokinetics were determined when CEP-1347 50 mg twice daily was administered to HIV-infected patients (n = 20) receiving combination antiretroviral therapy including atazanavir and ritonavir (ATV/RTV, 300/100 mg) once daily continuously. Co-administration of CEP-1347 and ATV/RTV resulted with significant changes in pharmacokinetics of ATV but not RTV. Specifically, an increase in ATV accumulation ratio of 15 % (p = 0.007) and a prolongation of T(½) from 12.7 to 15.9 h (p = 0.002) were observed. The results suggested that co-administration of CEP-1347 with ATV/RTV in HIV-infected patients might result in limited impact on ATV but not on RTV pharmacokinetics.

  17. [THE MOLECULAR TECHNIQUES OF DIAGNOSTIC OF GINGIVITIS AND PERIODONTITIS IN HIV-INFECTED PATIENTS].

    Science.gov (United States)

    Tsarev, V N; Nikolaeva, E N; Iagodina, E V; Trefilova, Yu A; Ippolitov, E V

    2016-01-01

    The examination was carried out in the Moscow clinical infectious hospital No 2 concerning 102 patients with verified diagnosis "AIDS-infection" and seropositive according results of detection of anti-HIV-antibodies in blood serum. The study was organized to analyze rate ofcolonization of gums with virulent anaerobic bacteria in HIV-infected (polymerase chain reaction) and antibodies to HIV in gingival fluid (enzyme-linked immunosorbent assay). It is established that in HIV-infected patients, in scrape from gingival sulcus dominate anaerobic bacteria P. gigngivalis and A. ctinomycetemcomitans and in case of periodontitis--P. gingivalis and T. forsythia. The received data permits recommending the test-system "Multident-5" for polymerase chain reaction diagnostic. The reagents kit "Calypte®HIV-1/2"--for enzyme-linked immunosorbent assay gingival fluid. The results of polymerase chain reaction and enzyme-linked immunosorbent assay have no impact of concomitant stomatological (periodontitis, gingivitis) and somatic pathology.

  18. Syphilis in HIV-infected patients: predictors for serological failure and serofast state

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    R Palacios

    2012-11-01

    Full Text Available Purpose: HIV-infected patients treated for syphilis may be at increased risk for serological failure and serofast state. Our aim was to analyse serological response to treatment in HIV-infected patients diagnosed with syphilis, and factors associated with serological cure and serofast state. Methods: Open-label, no controlled study of a series of HIV-patients diagnosed with syphilis during 2004–2011. Patients were categorized by rapid plasma reagin titer (RPR into success (4-fold decrease in RPR by 12 or 24 months after treatment of early or late syphilis, serofast (success with persistently stable reactive RPR, and failure/re-infection (failure to decrease 4-fold in RPR by 12 or 24 months after treatment or sustained 4-fold increase in RPR after treatment response. Results: 141 HIV-patients were diagnosed with syphilis during the study period (104 early syphilis, 36 late or indeterminate latent syphilis. The mean age was 36.3 years, 98.5% were male, and 87.2% homosexual men. In 46 (32.6% cases, HIV and syphilis infection diagnosis were coincident (mean CD4 457/mm3 and HIV-VL 4.72 log10. Among patients with prior known HIV infection, 65 were on antiretroviral therapy (ART at syphilis diagnosis (mean CD4 469/mm3, 76.9% undetectable HIV-VL. 116 patients satisfied criteria for serological response analysis (89 early, 24 late/indeterminate. At 12 months of early syphilis treatment (89.2% penicillin there were 16 (18% failures, and at 24 months of late/indeterminate syphilis (91.7% penicillin there were 5 (18.5% failures. Overall, 36 (31.0% patients presented serofast state. Treatment failure was related with lower CD4 count (295 vs 510/mL; p=0.045 only in patients with coincident diagnosis. Serofast state was related with older age (41 vs 36 years; p=0.024, and lower CD4 count (391 vs 513/mm3; p=0.026. Conclusions: In this series of HIV-infected patients, with many patients on ART and with good immunological and virological parameters, serological

  19. [Guidelines for the management of patients with HIV infection. II. Pregnant women and children. Liege Working Group on HIV Infection].

    Science.gov (United States)

    Schmitz, V; Nkoghe, D; Hoyoux, C; Dresse, M F

    2000-05-01

    The management of the HIV infected child is nearly identical to the adult. Nevertheless, there are many clinical, immunological and virological details. Difficulties evoked for the adult have an even bigger importance, in view of the foreseeable longevity of these children under treatment. The reduction of the mother to child transmission, thanks to the AZT-caesarean association, must be continued. The use of anti-retroviral drugs during pregnancy requires a sustained attention because of the potential risks and benefits for the foetus and mother. The long-term impact of these drugs, in children exposed during pregnancy, remains unknown. The follow-up of these children therefore remains important.

  20. Bilateral Peripheral Facial Palsy in a Patient with Human Immunodeficiency Virus (HIV) Infection

    OpenAIRE

    Kim, Min Su; Yoon, Hee Jung; Kim, Hai Jin; Nam, Ji Sun; Choi, Sung Ho; Kim, June Myung; Song, Young Goo

    2006-01-01

    Neurological complications are important causes of morbidity and mortality in patients with human immunodeficiency virus (HIV) infection. They can occur at any stage of the disease and can affect any level of the central or peripheral nervous systems. In the literature, several cases of HIV-associated facial paralysis have been reported; however, bilateral facial palsy is rarely reported. In this paper, we present the first case in Korea, of a bilateral facial palsy occurring as the first cli...

  1. Etiological study of lymphadenopathy in HIV-infected patients in a tertiary care hospital

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    Dipanwita Nag

    2016-01-01

    Full Text Available Introduction: Human immunodeficiency virus (HIV infection has become a global pandemic. Persistent generalized lymphadenopathy (PGL is very common manifestation of HIV infection. Moreover, different opportunistic infections such as tuberculosis (TB and malignancies may present with lymphadenopathy. Mycobacterium avium complex (MAC infection is most common with cluster of differentiation (CD4+ count ≤50 cells/μL. Fine-needle aspiration cytology (FNAC offers a simple and effective modality for obtaining a representative sample of the material from lymph nodes, permitting cytological evaluation and other investigations. Aims and Objectives: The aim of this study is to find out the different etiologies of lymphadenopathy in HIV-infected patients and to establish a possible correlation with CD4+ count. Materials and Methods: A total of 100 HIV-infected patients having significant (>1 cm extrainguinal lymphadenopathy were studied in 1 year at the Department of Pathology by FNAC and the stains used were Leishman-Giemsa, Ziehl-Neelsen (ZN, Papanicoloau, and Gram stains. For tubercular culture, Lφwenstein-Jensen (LJ medium was used. CD4+count was done by flow cytometer. Result: The present study revealed four types of cytomorphological variants in lymphadenopathy cases by FNAC, which include: Reactive hyperplasia and caseation necrosis; caseation necrosis and ill-formed granuloma; well-formed granuloma without any necrosis; and non-Hodgkin lymphoma (NHL. The highest acid-fast bacilli (AFB positivity was among the patients showing caseation necrosis. Tubercular culture in LJ media turned out as a more sensitive method for diagnosis than routine ZN staining. The 2 cases that showed well-formed epithelioid granuloma without any necrosis turned out to be histoplasmosis and cryptococcosis, respectively. In this study, we found 2 cases of NHL. The study also revealed that caseation necrosis and AFB positivity along with opportunistic infections increases

  2. Osteonecrosis en pacientes infectados por HIV Osteonecrosis in HIV-infected patients

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    Edgardo G. Bottaro

    2004-08-01

    Full Text Available Según la literatura, la osteonecrosis tiene una mayor incidencia en los pacientes infectados con HIV que en la población general. Ello sería resultado de la confluencia de factores de riesgo clásicos y de otros propios de esta población o más prevalentes en ella, como el tratamiento con inhibidores de proteasa, la dislipemia producto de su consumo, la presencia de anticuerpos anticardiolipina séricos, la hipercoagulabilidad, la restauración inmune y las vasculitis. Presentamos una serie de 13 pacientes infectados con HIV con osteonecrosis. El motivo de consulta fue dolor en grandes articulaciones. Cuatro eran alcoholistas, 8 tabaquistas y 9 tenían dislipemia. Once habían recibido esteroides en algún momento de la vida aunque sólo uno estaba recibiéndolos al momento del inicio del dolor. En 2 se detectaron anticuerpos anticardiolipina séricos. Doce tenían sida y recibían tratamiento antirretroviral de alta eficacia (11 con inhibidores de proteasa. Ellos lograron una adecuada recuperación inmunológica. Consideramos necesario incluir la osteonecrosis como diagnóstico diferencial de artralgia persistente en pacientes infectados con HIV e investigar infección por HIV en todo paciente con osteonecrosis sin claros factores predisponentes.Osteonecrosis, also known as avascular necrosis, is chiefly characterized by death of bone caused by vascular compromise. The true incidence of osteonecrosis in HIV-infected patients is not well known and the pathogenesis remains undefined. Hypothetical risk factors peculiar to HIV-infected individuals that might play a role in the pathogenesis of osteonecrosis include the introduction of protease inhibitors and resulting hyperlipidemia, the presence of anticardiolipin antibodies in serum leading to a hypercoagulable state, immune recovery and vasculitis. Hereby we present a series of 13 HIV-infected patients with osteonecrosis. The most common symptom upon presentation was arthralgia. The majority

  3. Risk of Coronary Heart Disease among HIV-Infected Patients: A Multicenter Study in Brazil

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    Sandra C. Fuchs

    2013-01-01

    Full Text Available Cardiovascular disease has emerged as a crescent problem among HIV-infected population. This study aimed to determine the 10-year risk of coronary heart disease using the Framingham risk score among HIV-infected patients from three regions of Brazil. This is a pooled analysis of three cohort studies, which enrolled 3,829 individuals, 59% were men, 66% had white skin color, and mean age 39.0 ± 9.9 years. Comparisons among regions showed that there were marked differences in demographic, socioeconomic, clinical, and HIV-related characteristics. Prevalence of Framingham score ≥10 was 4.5% in the Southern, 4.2% in the Midwest, and 3.9% in the Northeast of Brazil. The Framingham score ≥10 was similar between regions for males, patients aged ≥60 years, with obesity, central obesity, hypertension, and diabetes mellitus. Women were three times more likely to have coronary heart disease in 10 years than men. Hypertension and diabetes increased more than four times the risk of coronary heart disease, followed by central obesity, obesity, and prehypertension. The use of antiretroviral agents and time since HIV diagnosis were not risk factors for coronary artery disease in 10 years. In conclusion, hypertension and diabetes are the strongest independent predictors of 10-year risk of coronary heart disease among HIV-infected population.

  4. Vitamin D deficiency in a cohort of HIV-infected patients: clinical analysis

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    B Vandercam

    2012-11-01

    Full Text Available Purpose of the study: Observational studies have noted very high rates of low serum 25-hydroxyvitamin D [25(OHD3] levels in both general and HIV-infected populations. In HIV-infected patients, low 25(OHD3 levels are secondary to a combination of usual risk factors and HIV-specific risk factors, like antiretroviral therapy [1]. The objective of our study is to analyse the magnitude of vitamin D deficiency or insufficiency and the role of various factors such as age, sex, ethnicity, season, and antiretroviral medications in our cohort of HIV-infected patients. Methods: We prospectively collected data on 25-hydroxyvitamin D levels sampled between January 2009 and June 2011 from our cohort of 930 HIV-infected patients. Vitamin D dosage was performed using immunoassay (‘Diasorin’ - Saluggia, Italy. We divided vitamin D levels into 3 categories: 25-hydroxyvitamin D levels <20 mg/nl were considered deficient, insufficient between 20 and 29 ng/ml. Levels ≥30 ng/ml were defined as normal [2]. Data on demographic features (age, ethnicity, season, heterosexuality vs homosexuality, clinical features and laboratory findings (CD4 cell count, viral load, HAART, BMI were collected from patients’ medical records using our institutional database ‘Medical explorer v3r9, 2009’. Summary of results: Overall, 848 patients were included in our study (Table 1. Low levels of serum 25(OHD3 were seen in 89.3% of the study population, from which 69.5% were deficient and 19.8% were insufficient. On univariate analysis, female sex, high BMI, black African, heterosexuality, undetectable viral load and antiretroviral treatment were all predictors of vitamin D deficiency and insufficiency. Treatment with efavirenz and tenofovir were the most associated with low vitamin D levels. On multivariate analysis (multiple linear regression model only female sex (OR=1.14; 95% CI 0.84–0.96; p<0.001, dosage during winter months (OR=1.14; 95% CI 1–1.15; p<0.05 and HAART (OR=1

  5. Frequency of tuberculous and non-tuberculous mycobacteria in HIV infected patients from Bogota, Colombia

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    León Clara I

    2001-11-01

    Full Text Available Abstract Background The prevalence of infections by Mycobacterium tuberculosis and non-tuberculous Mycobacterium species in the HIV-infected patient population in Colombia was uncertain despite some pilot studies. We determined the frequency of isolation of Mycobacterium tuberculosis and of non-tuberculous Mycobacterium species in diverse body fluids of HIV-infected patients in Bogota, Colombia. Methods Patients who attended the three major HIV/AIDS healthcare centres in Bogota were prospectively studied over a six month period. A total of 286 patients were enrolled, 20% of them were hospitalized at some point during the study. Sixty four percent (64% were classified as stage C, 25% as stage B, and 11% as stage A (CDC staging system, 1993. A total of 1,622 clinical samples (mostly paired samples of blood, sputum, stool, and urine were processed for acid-fast bacilli (AFB stain and culture. Results Overall 43 of 1,622 cultures (2.6% were positive for mycobacteria. Twenty-two sputum samples were positive. Four patients were diagnosed with M. tuberculosis (1.4%. All isolates of M. tuberculosis were sensitive to common anti-tuberculous drugs. M. avium was isolated in thirteen patients (4.5%, but only in three of them the cultures originated from blood. The other isolates were obtained from stool, urine or sputum samples. In three cases, direct AFB smears of blood were positive. Two patients presented simultaneously with M. tuberculosis and M. avium. Conclusions Non-tuberculous Mycobacterium infections are frequent in HIV infected patients in Bogota. The diagnostic sensitivity for infection with tuberculous and non-tuberculous mycobacteria can be increased when diverse body fluids are processed from each patient.

  6. Evaluation of immunological indices in HIV-infected patients with chronic hepatitis C in Kazakhstan

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    Sarsekeyeva N

    2016-05-01

    Full Text Available Nazgul Sarsekeyeva,1,2 Bakhyt Kosherova3 1Department of Infectious Diseases and Dermatovenerology, Karaganda State Medical University, 2Karaganda Regional Center for the AIDS Prevention and Control, 3Rectorate of Karaganda State Medical University, Karaganda, Kazakhstan Aim: To evaluate immunological indices in HIV-infected patients with chronic hepatitis C (CHC who are injecting drug users. Materials and methods: The study examined 38 patients coinfected with HIV and CHC who were injecting drug users and 36 patients with HIV/CHC who were not injecting drug users. In the study of immune status, the relative and absolute numbers of CD3+, CD4+, CD8+, CD16+, and CD20+ cells were determined by means of flow cytofluorometry of “FACSCount” using monoclonal antibodies of the company Becton Dickinson. The level of circulating immune complexes in blood serum was determined by means of precipitation in polyethylene glycol solution. Results: It was found that T-cell immunodeficiency was developing in patients coinfected with HIV and CHC. T-cell immunodeficiency was characterized by a decrease in the number of T-helpers, mainly for injecting drug users. At the same time, patients coinfected with HIV and CHC experienced markedly elevated levels of circulating immune complexes, mainly among injecting drug users. The evaluation of immunogram indices in injecting drug users coinfected with HIV and CHC, depending on the stage of HIV infection, revealed a greater degree of immune-suppression of T-helper cells in clinical stage III. Conclusion: Our comprehensive immunological study of patients coinfected with HIV and CHC revealed a pronounced dysfunction of the immune system. The comparison of the immune system indices in patients with HIV/CHC showed a more pronounced T-cell suppression in injecting drug users than in patients with HIV/CHC but who were not injecting drug users. Keywords: HIV infection, chronic hepatitis C, immunological indices, injecting drug

  7. Spectrum of Clinical Presentations in Human Immunodeficiency Virus (HIV) Infected Patients with Renal Disease.

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    Okafor, U H; Unuigbe, E I; Wokoma, F S

    2011-01-01

    HIV infection is a multiorgan disease with the kidney not spared. A variety of renal syndromes with varying clinical presentations has been reported amongst HIV infected patients. This study aims to highlight the spectrum of clinical presentations in HIV infected patients with renal disease. HIV infected patients presenting at University of Benin Teaching Hospital (UBTH) Benin City were the study population. A total of 383 patients were studied. Their biodata, clinical presentations and laboratory investigations including serum urea, creatinine and albumin, urine protein and creatinine were assessed. Their glomerular filtration rate (GFR) and protein urine excretion were calculated using six equations of modification of diet in renal disease (MDRD) and protein: creatinine ratio respectively. Patients were stratified according to their renal functions into normal, mild, moderate and severe renal function impairment. The data was analysed using statistical software program SPSS Vs 15.0. 53.3% of 383 patients screened had renal function impairment, 40.2% mild, 37.7% moderate and 22.2% severe impairment. Mean age was 35.6±8.3, 36.0±9.9 and 36.3±8.3 years for mild, moderate and severe renal function impairment (RFI) respectively. Easy fatigability was the commonest symptoms occurring in 47.5%, 30.0%, 37.5% and 22.5% of control, mild RFI, moderate RFI and severe RFI subjects respectively (p = 0.568). Oliguria, facial and body swelling occurred more in patients with RFI especially in patients with severe renal impairment. The difference is statistically significant (p = 0.046, 0.041, and 0.033 respectively). Pallor was the commonest clinical sign occurring in 32.5%, 50.0%, 35.0% and 62.5% of control and patients with mild, moderate, and severe RFI respectively; the difference was not statistically significant (p = 0.459). Ascites, facial puffiness and pedal oedema were commoner in patients with RFI especially those with severe RFI. The differences were statistically

  8. Particularities of tuberculosis in HIV-infected patients: 10-year experience of a Portuguese hospital

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    S Nunes

    2012-11-01

    Full Text Available The incidence of tuberculosis (TB has dramatically increased since the advent of the human immunodeficiency virus (HIV pandemic. In Portugal, tuberculosis is still common in HIV-negative patients, despite earlier diagnosis and countrywide directly observed therapy strategies. With the purpose of comparing some demographic and clinical aspects of TB in HIV-infected and uninfected patients, the authors reviewed the files of patients admitted with a diagnosis of tuberculosis between January 2002 and December 2011. During this time period, there were 234 cases of tuberculosis, 43 (18% of which occurred in HIV-infected patients. In this group, 74% of patients were male, with a mean age of 38±11 years and the majority (51% acquired HIV from heterosexual risk behavior. The most common site of infection was the lung, in both groups, but cases of extrapulmonary TB were significantly higher in the HIV-infected group (67% versus 39%, p<0.01. Disseminated TB was the most common extrapulmonary diagnosis in the former group (28% and lymph node TB (8% in the latter. The duration of hospitalization was not statistically different between the two groups (mean of 26±16 days in HIV-infected patients and 21±15 days in the HIV-negative group, p=0.21. The mean CD4 count at TB diagnosis was 180±177/mm3. In 11 (26% of the patients, HIV was diagnosed during the TB episode and in 5 cases, the diagnosis of tuberculosis occurred with immune reconstitution syndrome. In the majority of patients (60%, TB was the first AIDS-defining condition. In 26 (60% of patients there was microbiologic confirmation of TB, mainly by direct observation (69%, positive culture (46% and molecular diagnostic technics (27%. While most patients were treated with the 4-drug standard regimen, 16 (37% of cases received alternative treatment. The mean duration of treatment was 8.5±4.8 months and the majority of patients (58% were considered cured. About one-third of patients were lost to follow

  9. Anemia and iron homeostasis in a cohort of HIV-infected patients in Indonesia

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    Jusuf Hadi

    2011-08-01

    Full Text Available Abstract Background Anemia is a common clinical finding in HIV-infected patients and iron deficiency or redistribution may contribute to the development of low hemoglobin levels. Iron overload is associated with a poor prognosis in HIV and Hepatitis C virus infections. Iron redistribution may be caused by inflammation but possibly also by hepatitis C co-infection. We examined the prevalence of anemia and its relation to mortality in a cohort of HIV patients in a setting where injecting drug use (IDU is a main mode of HIV transmission, and measured serum ferritin and sTfR, in relation to anemia, inflammation, stage of HIV disease, ART and HCV infection. Methods Patient characteristics, ART history and iron parameters were recorded from adult HIV patients presenting between September 2007 and August 2009 in the referral hospital for West Java, Indonesia. Kaplan-Meier estimates and Cox's regression were used to assess factors affecting survival. Logistic regression was used to identity parameters associated with high ferritin concentrations. Results Anemia was found in 49.6% of 611 ART-naïve patients, with mild (Hb 10.5 - 12.99 g/dL for men; and 10.5 - 11.99 g/dL for women anemia in 62.0%, and moderate to severe anemia (Hb Conclusion HIV-associated anemia is common among HIV-infected patients in Indonesia and strongly related to mortality. High ferritin with low sTfR levels suggest that iron redistribution and low erythropoietic activity, rather than iron deficiency, contribute to anemia. Serum ferritin and sTfR should be used cautiously to assess iron status in patients with advanced HIV infection.

  10. Etiologic Characteristics of Enterocolitis in Hospitalized HIV-Infected Patients for 3-Year Period (2013-2015

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    Yancheva N.

    2016-03-01

    Full Text Available Diarrhea is the most common gastrointestinal symptom in HIV-infected patients. The incidence and severity of diarrhea increase with progression of the immune defi ciency. In the literature, 30-60% of the patients with diarrhea among HIV-infected individuals remain without specified etiological agent. The aim of this article is to present the incidence of enterocolitis among hospitalized HIV-infected patients over a 3-year period and the degree of etiological clarifi cation of the cause. The results of our analyses showed that 63% of the hospitalized HIV-infected patients for this period were with enterocolitis. Only in 30% of these patients etiological agent was isolated. The reasons for this are mainly financial constraints and, therefore, virological investigations and further endoscopic and histopathological examination of the patients with negative for bacteria and parasites stool samples, were not performed. In the cases with isolated pathogen, an etiological treatment was carried out in parallel with highly active antiretroviral therapy, while in unsubstantiated cases an empirical treatment was carried out. Advanced immune defi ciency was associated with more severe course and worse prognosis of the enterocolitis. The treatment with highly active antiretroviral therapy, which leads to improvement of the immune status of the patients, is essential for the output of enterocolitis in HIV-infected patients.

  11. Prevalence of metabolic syndrome among HIV-infected patients in Ghana: A cross-sectional study

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    Christian Obirikorang

    2016-01-01

    Full Text Available Background: Prevalence of metabolic syndrome (MetS in HIV-infected patients is very limited in the Ghanaian setting and may vary across the globe by the different study populations and criteria used. Aim: We investigated the prevalence of MetS among HIV-infected patients receiving highly active antiretroviral therapy (HAART at the St. Dominic Hospital, Akwatia, Ghana. Patients and Methods: This cross-sectional study recruited 433 HIV-infected patients (294 on HAART and 139 HAART-naÏve from the period of February 2013 to December 2013. Information on the demographic, clinical, anthropometric characteristics were obtained and lipid profile for each patient was assessed. MetS was assessed based on the National Cholesterol Education Program (NCEP Adult Treatment Panel III (ATP III, World Health Organization (WHO and International Diabetes Federation (IDF criteria. Results: The prevalence of MetS was 24.5% according to WHO criteria, 48.3% by NCEP-ATP III criteria, and 42.3% by IDF criteria. In general, participants on HAART were significantly associated with higher prevalence of MetS compared to those without HAART (P < 0.05 irrespective of the criteria used. Prevalence of clustering components of MetS was significantly higher among those on HAART when risk scores of 2 and above were used compared with those not on HAART (P < 0.05. Conclusion: HAART recipient developed MetS as indicated by dyslipidemia, high blood pressure, and abnormal body fat. It is incumbent on health giver to incorporate MetS assessment as a part of treatment and management plan in patients receiving HAART.

  12. Unexpected spontaneous remission of HCV in a patient with chronic HIV infection

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    Roberto Manfredi

    2010-03-01

    Full Text Available We report an exceptional case of resolution of HCV infection in a HIV-infected patient. The patient, a 49-year-old male with history of drugs addiction, suffered from an evolutive liver disease never treated with specific anti-HCV compounds during two decades. The case report highlights a rare phenomenon, seldom reported in medical literature (a PubMed search retrieved only 8 similar cases, and underlines the importance of a deeper investigation of all the virologic, immunological, pathogenetic, and therapeutic implications.

  13. HIV INFECTION STAGE, ANTIRETROVIRAL THERAPY SCHEME AND PATIENT IMMUNE STATUS INFLUENCE ON HIV/TB CO-INFECTION OUTCOME

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    A. V. Mordyk

    2016-01-01

    Full Text Available Retrospective research of 381 clinical records is conducted to study HIV infection influence on stationary stage of tuberculosis treatment outcome in HIV-TB co-infected patients. All cases were divided depending on a hospitalization outcome on favorable and adverse. At most of patients tuberculosis of respiratory organs met. Immunological researches were conducted, the stage of HIV infection was registered and the issue of purpose of anti-retroviral therapy was resolved. Besides, as indirect signs of an immunodeficiency at the patients with a combination of tuberculosis and HIV infection who were on hospitalization the indicators received when carrying out clinical laboratory trials were analyzed: absolute and relative quantity of lymphocytes according to the general blood test, the contents the globulin fractions and circulating immune complexes concentration according to the clinical chemistry blood test. At an assessment of results in both groups of research more than at a half of patients existence of HIV infection at late stages that speaks about late identification and neglect of an immunodeficiency was revealed. At patients with tuberculosis of lungs in combination with HIV infection at a failure statistically significant decrease in an immunoregulatory index is revealed. It is interesting that the level of CD4 lymphocytes and a stage of HIV infection had no impact on the co-infection’s outcome. However, existence of virus loa ding more than 100 000 copies/ml reduced probability favorable an outcome of treatment of tuberculosis at the patient with HIV infection. Timely purpose of anti-retroviral therapy at patients with co-infection increased chances of treatment of tuberculosis at patients with an immunodeficiency. Frequency of adverse side effect of antiviral therapy met equally often at patients in both groups. Thus, patients at any stages of HIV infection with any forms of tuberculosis, including generalized, had a

  14. Oxidative Stress Predicts All-Cause Mortality in HIV-Infected Patients.

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    Mar Masiá

    Full Text Available We aimed to assess whether oxidative stress is a predictor of mortality in HIV-infected patients.We conducted a nested case-control study in CoRIS, a contemporary, multicentre cohort of HIV-infected patients, antiretroviral-naïve at entry, launched in 2004. Cases were patients who died with available stored plasma samples collected. Two age and sex-matched controls for each case were selected. We measured F2-isoprostanes (F2-IsoPs and malondialdehyde (MDA plasma levels in the first blood sample obtained after cohort engagement.54 cases and 93 controls were included. Median F2-IsoPs and MDA levels were significantly higher in cases than in controls. When adjustment was performed for age, HIV-transmission category, CD4 cell count and HIV viral load at cohort entry, and subclinical inflammation measured with highly-sensitive C-reactive protein (hsCRP, the association of F2-IsoPs with mortality remained significant (adjusted OR per 1 log10 increase, 2.34 [1.23-4.47], P = 0.009. The association of MDA with mortality was attenuated after adjustment: adjusted OR (95% CI per 1 log10 increase, 2.05 [0.91-4.59], P = 0.080. Median hsCRP was also higher in cases, and it also proved to be an independent predictor of mortality in the adjusted analysis: OR (95% CI per 1 log10 increase, 1.39 (1.01-1.91, P = 0.043; and OR (95% CI per 1 log10 increase, 1.46 (1.07-1.99, P = 0.014, respectively, when adjustment included F2-IsoPs and MDA.Oxidative stress is a predictor of all-cause mortality in HIV-infected patients. For plasma F2-IsoPs, this association is independent of HIV-related factors and subclinical inflammation.

  15. High Incidence of Zidovudine Induced Anaemia in HIV Infected Patients in Southern Odisha.

    Science.gov (United States)

    Dash, Kaibalya Ranjan; Meher, Lalit Kumar; Hui, P K; Behera, S K; Nayak, S N

    2015-06-01

    Zidovudine (AZT), a nucleoside reverse transcriptase inhibitor was the first breakthrough in AIDS therapy in 1990.This study was conducted with an aim to determine prevalence of AZT induced anaemia in HIV infected patients initiated on AZT containing anti retroviral therapy(ART) regimen and also to find out any risk factor for causing AZT induced anaemia. Study was carried out in ART centre, M.K.C.G, MCH, Berhampur between Jan 2009 and Dec 2011. HIV infected patients registered at ART centre were treated according to National AIDS Control Organisation (NACO) guidelines. Patients (n = 1221) with Hb >8 gm/dl were prescribed AZT based ART regimen. Patients having anaemia (<8 gm/dl) were excluded from the study. Correlation of baseline characteristics (age, sex, weight, Hb level, CD4 count, World Health Organization (WHO) clinical stage) with risk of developing anaemia was also calculated. 178 (14.6 %) patients on AZT regimen developed anaemia. Patients with low CD4 count were more prone to develop severe anaemia. Age, sex, weight, WHO clinical stage had no relation with development of anaemia. Incidence of AZT induced anaemia was very high and patients having low CD4 count were more susceptible to develop anaemia.

  16. Meningitis due to Rhodotorula glutinis in an HIV infected patient

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    Shinde R

    2008-01-01

    Full Text Available Rhodotorula spp, though considered a common saprophyte, recently has been reported as causative agent of opportunistic mycoses. We present a case of meningitis in an immunocompromised human immunodeficiency virus infected patient who presented with longstanding fever. He was diagnosed as a case of chronic meningitis. Diagnosis was confirmed by cell cytology, India ink preparation, Gram staining and culture of cerebrospinal fluid (CSF sample. CSF culture grew Rhodotorula glutinis . Therapy with amphotericin B was successful in eliminating the yeast from CSF and the patient was discharged after recovery.

  17. Epidemiology of tuberculosis in HIV-infected patients in Denmark

    DEFF Research Database (Denmark)

    Dragsted, Ulrik Bak; Bauer, J; Poulsen, S;

    1999-01-01

    increased in the younger age groups, indicating more newly infected persons. This study was performed in order to assess the impact of the HIV epidemic and immigration on TB incidence among native Danes. The study was also designed to reveal transmission patterns of TB among HIV-positive patients. Data from......Denmark is an area of low incidence of HIV and tuberculosis (TB). The number of newly reported cases of HIV has been stable during the 1990s, whereas the number of TB cases has doubled in Denmark in the past decade, mainly due to immigration. However, among native Danes the incidence of TB has...... in the nationwide Danish RFLP database (approximately 1,700 patients). Sixty-seven co-infected patients were identified, 26 Danes and 41 immigrants, representing only 4% of all TB cases during the study period. Danish co-infected patients were part of a cluster, i.e. they had a RFLP-pattern identical to a pattern...

  18. Malignant syphilis (Leus maligna in a HIV infected patient

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    Prasad P

    2001-01-01

    Full Text Available A 40-year-old promiscuous man presented with nodulo ulcerative lesions all over the body and a healing genital ulcer. Blood VDRL was reactive in 64 dilutions and HIV (Elisa was positive. Patient was diagnosed to have malignant syphilis (leas inaligna and was given appropriate treatment. Lesions healed with hypopigmented macules suggestive of ′Icukoderma colli′.

  19. The advent of Cytomegalovirus infection in HIV infected patients: A review

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    Sundar Isaac Kirubakaran

    2004-03-01

    Full Text Available Cytomegalovirus is considered as one among the long list of latent infections in humans that although normally controlled by the cellular immune response, gets activated after HIV infection takes its role on infecting the T4 lymphocytes. Clinical disease due to Cytomegalovirus has been recognized in up to 40% of patients with advanced HIV disease. The clinical syndromes most commonly associated include chorioretinitis, esophagitis, colitis, pneumonitis, adrenalitis and neurological disorders. Cytomegalovirus infections are usually diagnosed clinically and by serological tests for CMV immunoglobulin. Chemotherapy using systemic agents, including ganciclovir, intravenous foscarnet and intravenous cidofovir is effective. New agents, as for example an anti-sense agent against cytomegalovirus, appear promising.

  20. Removal of Dolutegravir by Hemodialysis in HIV-Infected Patients with End-Stage Renal Disease.

    Science.gov (United States)

    Moltó, José; Graterol, Fredzzia; Miranda, Cristina; Khoo, Saye; Bancu, Ioana; Amara, Alieu; Bonjoch, Anna; Clotet, Bonaventura

    2016-04-01

    Data on dolutegravir removal by hemodialysis are lacking. To study this, we measured dolutegravir plasma concentrations in samples of blood entering and leaving the dialyzer and of the resulting dialysate from 5 HIV-infected patients with end-stage renal disease. The median dolutegravir hemodialysis extraction ratio was 7%. The dolutegravir concentrations after the dialysis session remained far above the protein-binding-adjusted inhibitory concentration. Our results show minimal dolutegravir removal by hemodialysis, with no specific dolutegravir dosage adjustments required in this setting. (This study is registered at ClinicalTrials.gov under registration number NCT02487706.).

  1. Nevirapine induced Stevens-Johnson syndrome in an HIV infected patient

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    Harminder Singh

    2011-01-01

    Full Text Available Nevirapine, a non-nucleoside reverse transcriptase inhibitor (NNRTI, is widely prescribed as a part of the combination therapy of human immunodeficiency virus (HIV infection because of its efficacy and good tolerability. Here, we report a case of Stevens-Johnson syndrome (SJS secondary to nevirapine. The patient had a diffuse, exfoliating exanthema with generalized bullous eruptions that involved the face, trunk and both extremities with elevated hepatic alanine aminotransferase and aspartate aminotransferase enzyme activities. The condition improved with stoppage of nevirapine-based highly active antiretroviral therapy (HAART regimen, so we attributed this adverse event to nevirapine. A strict vigilance of adverse drug reaction is required in HAART.

  2. Factors associated with adherence to antiretroviral therapy in HIV-infected patients in Kathmandu District, Nepal

    OpenAIRE

    Shigdel R; Klouman E; Bhandari A; Ahmed LA

    2014-01-01

    Rajesh Shigdel,1 Elise Klouman,2 Anita Bhandari,2 Luai A Ahmed11Department of Health and Care Sciences, 2Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, NorwayPurpose: There are a high number of HIV-infected patients receiving antiretroviral therapy (ART) in the Kathmandu District of Nepal, but information on adherence and factors influencing it are scarce in this population. The present study aimed to estimate ART adherence am...

  3. [Management of HIV infected patients. Experience of the Liege University Hospital Center].

    Science.gov (United States)

    Nkoghe, D; Léonard, P; Nnegue, S; Moutschen, M; Demonty, J

    2002-08-01

    We present data from 112 patients followed in the Infectious Diseases Unit of the Liege University Hospital (CHU Sart-Tilman). The primary goal of this study was to evaluate the efficiency of highly active antiretroviral therapy (HAART) on surrogate immunological and virological parameters. The study also aimed at determining the prevalence of opportunistic infections and iatrogenic metabolical abnormalities in the era of HAART. Data from HIV infected patients under combined treatment were collected from March 1996 till July 1999. The follow-up focused on the variation of the CD4 cell counts and viral load, and the occurrence of opportunistic infections. The average age was 39 +/- 10 years and the sex ratio (M/F) was 2.3. At baseline, the CD4 count was 352 +/- 244/mm3 and the viral load was 4.1 +/- 1.2 log. After 12 months, the CD4 cells were at 540 +/- 374 and the viral load at 2.5 +/- 1.5 log. This favourable outcome was observed in 70% of patients (naive and experienced). Clinically, patients in therapeutic success presented few opportunistic infections, but many drugs related toxicity. Our data demonstrate the efficiency of combined treatment in the management of HIV infected patients. However, the apparition of toxicity problems could limit the benefit brought by these drugs.

  4. Physical and psychosocial nursing care for patients with HIV infection.

    Science.gov (United States)

    O'Brien, M E; Pheifer, W G

    1993-06-01

    As suggested earlier we have chosen in this article to discuss only a small group of key physical and psychosocial concerns and needs associated with HIV and AIDS. These were the issues most frequently discussed by a study group of people living with HIV. We recognize, however, that holistic nursing intervention considers the totality of the individual living with HIV: body, mind, and spirit. It is to that end that the discussed nursing diagnoses and interventions are directed. Ultimately, the successful identification of and intervention in HIV related problems rests in the unique relationship between nurse and patient sharing as collaborators in the healing experience. The body of contemporary nursing and behavioral science research in the area of HIV/AIDS continues to grow. Presently the National Center for Nursing Research is supporting studies focusing on such areas as the use of designated versus general care settings for HIV patient care, quality of nursing care in HIV/AIDS, the effects of nurse-managed home care for AIDS patients, stress and coping in caregivers of AIDS children, the testing of interventions for black women with AIDS, and prevention studies (National Center for Nursing Research, personal communication, 1992). Nevertheless, as the HIV pandemic continues to grow and expand its demographic parameters, more research, particularly with such populations as women and children, is urgently needed. Studies exploring prevention issues and symptom management also are most important. Some suggestions for future study include examination of cultural variables associated with coping with HIV and AIDS; longitudinal research on surviving HIV over time; intervention studies to test specific nursing therapeutics in various settings such as hospital, home, and clinic; and finally, research describing the impact of HIV and AIDS on family functioning and adaptation. It is only through continued study of the impact of HIV, on both the individual living with HIV

  5. Executive summary of the consensus document on metabolic disorders and cardiovascular risk in patients with HIV infection.

    Science.gov (United States)

    Polo Rodríguez, Rosa; Galindo Puerto, María José; Dueñas, Carlos; Gómez Candela, Carmen; Estrada, Vicente; Villar, Noemí G P; Locutura, Jaime; Mariño, Ana; Pascua, Javier; Palacios, Rosario; Von Wichmman, Miguel Ángel; Álvarez, Julia; Asensi, Victor; Lopez Aldeguer, José; Lozano, Fernando; Negredo, Eugenia; Ortega, Enrique; Pedrol, Enric; Gutiérrez, Félix; Sanz Sanz, Jesús; Martínez Chamorro, Esteban

    2015-01-01

    The importance of the metabolic disorders and their impact on patients with HIV infection requires an individualized study and continuous updating. HIV patients have the same cardiovascular risk factors as the general population. The HIV infection per se increases the cardiovascular risk, and metabolic disorders caused by some antiretroviral drugs are added risk factors. For this reason, the choice of drugs with a good metabolic profile is essential. The most common metabolic disorders of HIV infected-patients (insulin resistance, diabetes, hyperlipidemia or osteopenia), as well as other factors of cardiovascular risk, such as hypertension, should also be dealt with according to guidelines similar to the general population, as well as insisting on steps to healthier lifestyles. The aim of this document is to provide a query tool for all professionals who treat HIV-patients and who may present or display any metabolic disorders listed in this document.

  6. Acute diarrhea in HIV infected patient receiving antiretroviral therapy:is there any role of microscopic stool examination at present?

    Institute of Scientific and Technical Information of China (English)

    Beuy Joob; Viroj Wiwanitkit

    2014-01-01

    Objective:To reassess the usefulness of microscopic stool examination for theHIV infected patients with acute diarrhea.Methods:Overall100HIV-infected patients receiving standard antiretroviral therapy who visited to a primary care center(for privacy reason, the name is hereby blinded) with compliant of acute diarrhea were reviewed.In all patients, the standard microscopic stool examination was performed.Results:Of interest, from overall100 indexed cases, there is no case with determined parasite in stool samples.Conclusions:Based on our setting, it seems that there is diagnostic role of using microscopic stool examination for determining possible parasitic infestation inHIV infected patients receiving standard antiretroviral therapy who present with acute diarrhea.

  7. Comorbidities of HIV infection and health care seeking behavior among HIV infected patients attending public sector healthcare facilities in KwaZulu-Natal: A cross sectional study

    Science.gov (United States)

    Nlooto, Manimbulu

    2017-01-01

    Background HIV-infected people may present with co-infections, comorbidities, and side effects associated with antiretroviral therapy. This study explored the prevalence of comorbid health problems and determined the extent of the use of traditional medicine for treatment of co-infections, comorbidities of HIV infection and side effects. Methods A cross sectional study, using researcher-administered questionnaires, was carried out among HIV-infected patients in eight public sector healthcare facilities in KwaZulu-Natal between April and October 1024. Self-reports of comorbidities, co-infections and side effects were analyzed with respect to factors such as age, gender, race, and health care seeking behavior including the use of traditional medicine. Cross-tabulations were conducted to test the association between factors and the use of traditional medicine, using Pearson chi-squared (χ2) test. Simple and multiple logistic regression models tested the association of the use of traditional medicine with age, gender, race, side effects and comorbidities. Odds ratios with 95% confidence intervals were estimated. Missing values were handled, defined and treated as missing values in the final analysis. Results Overall, 29.5% (n = 516) of the survey participants reported having other comorbidities and or co-infections besides their HIV condition. Same participants reported two or more comorbidities. Almost forty percent of participants (208/531, 39.17%) reported having hypertension as the most noninfectious comorbidity while 21.65% of participants (115/531) had tuberculosis accounting for the most infectious comorbidity. Almost eight percent of participants (142/1748, 8.12%) reported using traditional medicine after starting with cART. Sixty out of 142 participants (60/142, 42.25%) on cART resorted to the use of traditional medicine for the management of comorbidities and or co-infections of their HIV infection. Overall, 311 out of 1748 participants (17.80%) complained

  8. Intellectual Impairment in Patients with Newly Diagnosed HIV Infection in Southwestern Nigeria

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    Taofiki A. Sunmonu

    2015-01-01

    Full Text Available Neurocognitive impairment is a detrimental complication of HIV infection. Here, we characterized the intellectual performance of patients with newly diagnosed HIV infection in southwestern Nigeria. We conducted a prospective study at Owo Federal Medical Center by using the adapted Wechsler Adult Intelligence Scale (WAIS. The raw scores were converted to standardized scores (z-scores and correlated with clinical and laboratory findings. Fifty-eight HIV positive patients were recruited; 72% were in WHO stages 3 and 4. We detected a high rate of intellectual impairment in HIV positive patients and controls (63.8% and 10%, resp.; P<0.001. HIV positive patients performed worse throughout the subtests of both verbal and performance intelligence quotients. Presence of opportunistic infections was associated with worse performance in the similarities and digit symbol tests and performance and full scale scores. Lower body weight correlated with poor performance in different WAIS subtests. The high rate of advanced disease stage warrants measures aimed at earlier diagnosis and treatment. Assessment of neurocognitive performance at diagnosis may offer the opportunity to improve functioning in daily life and counteract disease progression.

  9. High acceptability of cognitive screening in HIV-infected patients: a pilot study

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    D Fasel

    2012-11-01

    Full Text Available With combined antiretroviral therapy (cART life expectancy of HIV-infected persons is close to the one of non-infected persons. Identifying neurocognitive deficits in ageing HIV-infected individuals is important. This study aimed to evaluate the acceptability of screening neurocognitive deficits in HIV-infected patients. Thirty patients (26 men, 4 women from the HIV clinic were examined with a new screening test and an in-depth neuropsychological examination. The screening tests consisted of questions and examinations on cognition in everyday situations, mood and selected cognitive functions (word list memory, grooved pegboard, psychomotor speed, trail-making test, psychomotor speed and executive functions, digit symbol test. Also, patients received a questionnaire to evaluate test acceptance. The mean age of the patients was 52.5 (30–74 years, mean education 12.5 (8–18 years. Seven patients had HIV-stage CDC A, 12 B and 11 CDC stage C. The mean CD4 count was 657 cells/µl, the mean HIV viral load<20 cop./µl. All patients were treated with cART (7 with efavirenz. The screening test was done assisted by a nurse and lasted 26 minutes (mean. The screening indicated pathological signs of neurocognitive function in 11 (42% patients. The in-depth neuropsychological assessment revealed pathological conditions in 25 (83% of patients; i.e. 16 (53% patients had ANI (asymptomatic neurocognitive impairment, 8 (27% had MND (mild neurocognitive disorder and 1 (3% had HAD (HIV-associated dementia. Most patients (43.3% judged the test as not too difficult and 56.6% as partly difficult. 96.6% of patients viewed the instructions of nurses as clear, 3.3% as unclear. 93.3% felt the test has not affected privacy and 83.3% estimated the screening as valuable and not worriesome. 83.4% of all patients were interested in their results and for none of the patients the test was too long. The test acceptability by the study nurses was also good. Only in 3.4% of tested

  10. Vitamin D deficiency in HIV-infected patients: a systematic review

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    Giusti A

    2011-11-01

    Full Text Available Andrea Giusti1, Giovanni Penco2, Giulio Pioli31Bone Clinic, Department of Gerontology and Musculoskeletal Sciences, Galliera Hospital, Genoa, Italy; 2Department of Infectious Diseases, Galliera Hospital, Genoa, Italy; 3Department of Geriatrics, ASMN Hospital, Reggio Emilia, ItalyAbstract: Advances in the diagnosis and management of human immunodeficiency virus (HIV have resulted in a dramatic decrease in mortality in HIV-infected individuals (HIV+. The subsequent increase in life expectancy of HIV+ has led to the need to consider the long-term complications of the disease and its treatment. Abnormalities in vitamin D status and metabolism are increasingly recognized as a major concern in HIV infection. In the last 5 years a number of cross-sectional and prospective studies have suggested a high prevalence of vitamin D deficiency in HIV+. Although few case-control studies have been published, it has been suggested that the prevalence of hypovitaminosis D in HIV+ is higher than in the general population, and at least in part, is related to the course of the disease and/or the antiretroviral drugs used to treat the disease. An adequate vitamin D status is important not only for bone tissue, but also for the global health status of HIV+ individuals, since a growing body of evidence has demonstrated the detrimental effects of vitamin D deficiency on multiple health outcomes. Therefore, definition of the size of the problem and identification of effective protocols for the prevention and management of vitamin D deficiency in HIV+ patients represent important steps in improving health status and reducing long-term chronic complications in individuals with HIV. Due to its immunomodulatory effects, vitamin D may also have implications in the progression of HIV infection. This systematic review was designed to determine the prevalence of vitamin D deficiency in HIV+ patients; to identify risk factors (related to the HIV infection or not potentially

  11. Impaired proinsulin secretion before and during oral glucose stimulation in HIV-infected patients who display fat redistribution

    DEFF Research Database (Denmark)

    Haugaard, Steen B; Andersen, Ove; Halsall, Ian;

    2007-01-01

    The beta-cell function of HIV-infected patients on highly active antiretroviral therapy who display lipodystrophy may be impaired. An early defect in beta-cell function may be characterized by an increase in secretion of 32-33 split proinsulin (SP) and intact proinsulin (IP). To address this issue......, the secretion patterns of SP and IP of 16 HIV-infected men with lipodystrophy (LIPO) and 15 HIV-infected men without lipodystrophy (NONLIPO) were studied during an oral glucose tolerance test (OGTT). All patients received highly active antiretroviral therapy. Insulin secretion rates were determined...... with lipodystrophy display major perturbations of proinsulin secretion in the fasting state and during an OGTT, which is compatible with the notion of a beta-cell dysfunction of such patients. Udgivelsesdato: 2007-Jul...

  12. Insulin resistance and diabetes mellitus associated with antiretroviral use in HIV-infected patients: pathogenesis, prevention, and treatment options.

    Science.gov (United States)

    Tebas, Pablo

    2008-09-01

    The contribution of current antiretroviral treatment regimens to the long-term survival of HIV-infected individuals is accompanied by increased risk of glucose metabolism abnormalities in this patient population. The risk of insulin resistance and diabetes in HIV-infected patients receiving antiretroviral treatment stems from 2 sources: exposure to the same environmental factors that have led to an increased incidence of these conditions in the general population and the negative effects on glucose metabolism inherent to components of antiretroviral treatment regimens. This article reviews the pathogenesis and diagnosis of insulin resistance and diabetes and the contribution of components of antiretroviral therapy regimens to increased risk for these conditions. Optimization of antiretroviral treatment regimens for HIV-infected patients with or at increased risk for development of abnormalities in glucose metabolism is discussed.

  13. Seroprevalence of anti-HCV and hepatitis B surface antigen in HIV infected patients

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    Tankhiwale S

    2003-01-01

    Full Text Available Human immunodeficiency virus (HIV is known to influence the natural history of infections with certain hepatitis viruses and interactions between HIV and hepatitis viruses may potentiate HIV replication. There is high degree of epidemiological similarity between hepatitis B virus and HIV as regard to high-risk group and route of transmission. Transmission of hepatitis C virus (HCV through blood transfusion and intravenous drug abuse is well documented. Present study deals with the study of concurrent infection of HBV and HCV with HIV infection. In the study of 110 HIV seropositive patients, 34(30.4% were positive for HBV and 8(7.27% for HCV. The difference of concomitant infection was highly significant compared to controls. (p value < 0.0001. Heterosexual high risk behaviour was observed in 89(80.91% of 110 HIV positive patients, out of which 23(25.8% and 5(5.62% were HBsAg and anti-HCV positive respectively. History of transmission was unclear in remaining patients. Concomitant infection of HIV and HBV was found to be significantly more in the symptomatic group (40.68% compared to asymptomatic group (19.6%. As HIV infection is known to affect the natural history of both HBV and HCV infection, screening of their concurrent association is necessary.

  14. Transfusion-Associated HIV Infection in Pediatric Leukemia Patients(Two Case Reports

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    Xuejun Chen

    2012-09-01

    Full Text Available Background: Leukemia is the second most malignant tumor in children. The chemotherapy induced anemia(CIA and hemorrhage are the most popular side-effects due to the myelosuppression of chemotherapy. So far,multitransfusion is still the timely and effective measure in curing these complications. The acquisition of HIV infection and subsequent development of AIDS by component transfusion from donors at risk is well known,and prognosis of HIV infection is particularly severe in patients with leukemia.Case Presentation: We report two leukemic cases that were infected with HIV through transfusion. The first patient was totally transfused with 16 U RBC, 20 U platelets and 820 ml fresh frozen plasma, and later test showed that his first used FFP carried the HIV. For the second 2 U RBC, 5 U platelets and 1500 ml fresh frozenplasma were transfused to her. Late test of her used blood products showed that the fourth RBC carried the HIV. Both results were confirmed by the local Center for Disease Control (CDC. They were not transfused before the diagnosis of leukemia. Their parents were healthy with negative HIV-Ab Conclusion: Since the two leukemic patients suffered transfusion-associated HIV with poor prognosis, we must take more efforts to utilize blood products judiciously, manage blood donors, test blood samples etiologically, shorten HIV testing "window periods" and develop preventive vaccination against HIV to reduce the incidence as low as possible.

  15. Reduction in circulating markers of endothelial dysfunction in HIV-infected patients during antiretroviral therapy

    DEFF Research Database (Denmark)

    Kjær, Andreas; Kristoffersen, U S; Kofoed, K;

    2009-01-01

    OBJECTIVES: Antiretroviral therapy (ART) in HIV-infected patients is associated with increased cardiovascular risk. Circulating markers of endothelial dysfunction may be used to study early atherogenesis. The aim of our study was to investigate changes in such markers during initiation of ART....... METHODS: In 115 HIV-positive treatment-naïve patients, plasma lipids, E-selectin, soluble intercellular adhesion molecule 1 (sICAM-1), soluble vascular cell adhesion molecule 1 (sVCAM-1), tissue-type plasminogen activator inhibitor 1 (tPAI-1) and high-sensitivity C-reactive protein (hsCRP) were measured...... before and after 2 and 14 months of ART. A control group of 30 healthy subjects was included. Values are mean+/-standard error of the mean. RESULTS: Prior to treatment, HIV-infected patients had elevated levels of sICAM-1 (296+/-24 vs. 144+/-12 ng/mL), tPAI-1 (18 473+/-1399 vs. 5490+/-576 pg/mL) and hs...

  16. COPD in HIV-Infected Patients: CD4 Cell Count Highly Correlated

    Science.gov (United States)

    Guillouet-de-Salvador, Francine; Valerio, Laure; Puglièse, Pascal; Naqvi, Alissa; Durant, Jacques; Demonchy, Elisa; Perbost, Isabelle; Cua, Eric; Marquette, Charles-Hugo; Roger, Pierre-Marie

    2017-01-01

    Background COPD is a frequent and significant cause of respiratory morbidity in HIV-infected patients despite the control of HIV. We aimed to analyze the factors correlated with COPD in this population to evaluate the existence of specific indicators of vulnerability in this population. Methods and Findings 623 HIV-infected outpatients were enrolled during one year. This population was characterised by a dedicated questionnaire and electronic patient records. COPD screening was performed according to recommended spirometric criteria. The prevalence of COPD was 9.0%. Age and smoking were independently correlated with COPD (OR, 1.61 per 10 years increase, P = 0.007; OR, 1.28 per 10 pack-year increase, P = 0.003, respectively). Body mass index (BMI) and CD4 cell-count were independently and negatively correlated with COPD (OR, 0.78, P tobacco-smoking and respiratory complaints with a particular concern toward patients with a profound CD4 cell count defect. PMID:28056048

  17. Prevalence and incidence of diabetes in HIV-infected minority patients on protease inhibitors.

    Science.gov (United States)

    Salehian, Behrouz; Bilas, Josephine; Bazargan, Mohsen; Abbasian, Mohammad

    2005-01-01

    In HIV-infected patients, the use of protease inhibitors (PIs) is associated with a constellation of abdominal obesity; buffalo hump; decreased facial and subcutaneous fat; hyperlipidemia and type-2 diabetes mellitus, a so-called HAART-associated dysmetabolic syndrome. The incidence and prevalence of one of its components, the type-2 diabetes mellitus, among minority population is unknown. In August and September 1999, we reviewed 101 charts of HIV-infected patients who visited an inner-city HIV outpatient clinic. The age, gender, ethnicity, BMI, fasting plasma glucose, random serum glucose, triglycerides, CD4 counts, and the type and duration of antiretroviral drugs were recorded. Three years later (2002), the same patient charts were reviewed for evidence of new-onset diabetes. Ten percent of the subjects were identified as diabetic at baseline. The prevalence of diabetes was 12% among those who were taking PIs, compared to 0% among those who were not taking PIs. The incidence of newly diagnosed diabetes during this three-year period was 7.2%. Diabetes occurred only in the group taking PIs. Diabetic subjects were older than their nondiabetic counterparts. All were African Americans. Our study suggests that PIs increase the likelihood of diabetes developing with increasing age in African Americans infected with HIV. PMID:16173323

  18. Prevalence of antibodies to Hepatitis C virus among Nigerian patients with HIV infection

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    Petrus Uchenna Inyama

    2005-08-01

    Full Text Available Nigeria belongs to the group of countries highly endemic for viral hepatitis; unfortunately information on the prevalence of hepatitis C amongst patients with HIV in Nigeria is very scarce. This hospital-based investigation was conducted at two major hospitals in Jos, Nigeria from June 2002 through May 2003. Serum samples from 490 confirmed HIV infected patients were assayed for the presence of antibodies to HCV, using a third generation enzyme linked immunosorbent assay. Twenty eight (5.7%; 95% CI 3.66-7.76% of the patients had antibodies to HCV. The prevalence of HCV antibodies was higher among the males (7.5%; 95% CI 3.83-11.09% than the females (4.5%; 95% CI 2.10-6.88%. Statistical analysis showed no significant difference (x2 = 1.917, df =1, p=0.05. Individuals of the age group 41-50 years had the highest prevalence of HCV antibodies (15.4%; 95% CI. 7.37-23.29%, followed by those of age group 31-40 years (7.4%; 95%, CI 3.70-11.20%. A significant difference was observed in the association between age and prevalence of HCV antibodies (x2 = 24.151, df = 4, p =0.05. Early diagnosis of HCV in people with HIV infection is advocated to reduce risk of HCV related advanced liver disease.

  19. QTc interval prolongation in HIV-infected patients: a case–control study by 24-hour Holter ECG recording

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    Fiorentini Alessandra

    2012-12-01

    Full Text Available Abstract Background Aim of the study was to assess QTc interval by a 24-hour ECG recording in a group of HIV-infected individuals with a basal prolonged QTc. The risk factors associated with QTc prolongation and the indices of cardiovascular autonomic control were also evaluated. Methods A case–control study was performed using as cases 32 HIV-infected patients with prolonged (>440 msec QTc interval as assessed by Holter ECG, and as controls 64 HIV-infected subjects with normal QTc interval. Autonomic function was evaluated by heart rate variability analysis during 24-hour recording. Results Duration of HIV disease was significantly longer among cases than among controls (p=0.04. Waist/hip ratio was also higher among cases than among controls (p=0.05. Frequency domain analysis showed the absence of physiologic decrease of low frequency (LF in the night period in both cases and controls. The LF night in cases showed a statistically significant reduction when compared with controls (p=0.007. Conclusions In our study group, QTc interval prolongation was associated with a longer duration of HIV infection and with a greater waist/hip ratio. HIV patients with QTc interval prolongation and with a longer duration of HIV infection were more likely to have an impairment of parasympathetic and sympathetic cardiac component.

  20. CARDIOVASCULAR ABNORMALITIES IN PATIENTS WITH HIV INFECTION: A BOLT IN BLUE

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    Anita

    2015-12-01

    Full Text Available One of the consistent findings among various studies on HIV has been simultaneous multiorgan dysfunction. Cardiovascular disorders are now most common cause of mortality worldwide. With more effective and widespread treatment of HIV in resource-rich settings, morbidity and mortality from non-AIDS-related events have surpassed those from AIDS-related events with cardiovascular diseases emerging as an important cause of death in HIV-infected patients relative to the decreasing incidence of opportunistic disease. Various studies have reported a 1.5-fold increase in the rate of cardiovascular events in HIV-infected individuals compared to control populations. MATERIAL AND METHODS The aim of the study was to the find the prevalence and types of different cardiovascular abnormalities in HIV positive patients and assess their association with CD4 counts. Consecutive 82 patients, HIV positive patients fulfilling the inclusion criteria and giving informed consent were included in the study. All patients were subjected to history taking and a detailed physical examination. Blood counts, renal function tests, lipid profile and CD4 counts were estimated and patients were subjected to 12-lead ECG, chest X-ray and 2D/Colour Doppler Echocardiogram. RESULTS Of the 82 patients studied 47.46% had evidence of cardiovascular involvement, out of which 12% had clinical features of heart failure while electrocardiographic changes were seen in 35% of patients in the form of sinus tachycardia (27%, QTc prolongation (10% and left sided chamber enlargements (6%. Echocardiographic abnormalities were noted in 39 patients (47.56% including fractional shortening associated with systolic dysfunction (26.8%. The mean CD4 count in patients with echocardiographic abnormalities was found to be 58.87±29.80, whereas in patients without echocardiographic abnormalities it was 136.53±38.80 (p<0.0001. CONCLUSION High frequencies of cardiac abnormalities, both symptomatic and

  1. KIR-HLA genotypes in HIV-infected patients lacking immunological recovery despite effective antiretroviral therapy.

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    Alessandro Soria

    Full Text Available BACKGROUND: In HIV-infected individuals, mechanisms underlying unsatisfactory immune recovery during effective combination antiretroviral therapy (cART have yet to be fully understood. We investigated whether polymorphism of genes encoding immune-regulating molecules, such as killer immunoglobulin-like receptors (KIR and their ligands class I human leukocyte antigen (HLA, could influence immunological response to cART. METHODS: KIR and HLA frequencies were analyzed in 154 HIV-infected and cART-treated patients with undetectable viral load divided into two groups: 'immunological non responders' (INR, N = 50, CD4(+ T-cell count 350/mm(3. Molecular KIR were typed using polymerase chain reaction-based genotyping. Comparisons were adjusted for baseline patient characteristics. RESULTS: The frequency of KIR2DL3 allele was significantly higher in FR than in INR (83.7% vs. 62%, P = 0.005. The functional compound genotype HLA-C1(+/KIR2DL3(+, even at multivariable analysis, when adjusted for nadir CD4(+ T-cell count, was associated with reduced risk of INR status: odds ratio (95% Confidence Intervals 0.34 (0.13-0.88, P = 0.03. CONCLUSIONS: Reduced presence of the inhibitory KIR2DL3 genotype detected in INR might provoke an imbalance in NK function, possibly leading to increased immune activation, impaired killing of latently infected cells, and higher proviral burden. These factors would hinder full immune recovery during therapy.

  2. Cerebral infarction in an HIV-infected patient with combined protein S and C deficiency and a patent foramen ovale.

    Science.gov (United States)

    Tomomasa, Ran; Yamashiro, Kazuo; Tanaka, Ryota; Hattori, Nobutaka

    2013-11-01

    A 41-year-old male with a history of human immunodeficiency virus (HIV) infection developed motor aphasia, dysarthria, and right hemiparesis. A magnetic resonance imaging scan of the brain revealed a cerebral infarction in the territory of the left middle cerebral artery. The laboratory data showed decreased levels of protein S and protein C. Transesophageal contrast-enhanced echocardiography revealed a patent foramen ovale (PFO). Prothrombotic states, such as protein S and C deficiency, have been reported in HIV-infected patients. In addition, previous studies have reported prothrombotic states to be risk factors for PFO-related cerebral infarction. An association between combined protein S and C deficiency caused by HIV infection and PFO-related cerebral infarction was suggested in our patient.

  3. Hypertriglyceridemia, Metabolic Syndrome, and Cardiovascular Disease in HIV-Infected Patients: Effects of Antiretroviral Therapy and Adipose Tissue Distribution

    Science.gov (United States)

    van Wijk, Jeroen P. H.; Cabezas, Manuel Castro

    2012-01-01

    The use of combination antiretroviral therapy (CART) in HIV-infected patients has resulted in a dramatic decline in AIDS-related mortality. However, mortality due to non-AIDS conditions, particularly cardiovascular disease (CVD) seems to increase in this population. CART has been associated with several metabolic risk factors, including insulin resistance, low HDL-cholesterol, hypertriglyceridemia and postprandial hyperlipidemia. In addition, HIV itself, as well as specific antiretroviral agents, may further increase cardiovascular risk by interfering with endothelial function. As the HIV population is aging, CVD may become an increasingly growing health problem in the future. Therefore, early diagnosis and treatment of cardiovascular risk factors is warranted in this population. This paper reviews the contribution of both, HIV infection and CART, to insulin resistance, postprandial hyperlipidemia and cardiovascular risk in HIV-infected patients. Strategies to reduce cardiovascular risk are also discussed. PMID:21876813

  4. Impact of injecting drug use on mortality in Danish HIV-infected patients: a nation-wide population-based cohort study

    DEFF Research Database (Denmark)

    Larsen, Mette V; Omland, Lars Haukali Hvass; Gerstoft, Jan

    2010-01-01

    To estimate the impact of injecting drug use (IDU) on mortality in HIV-infected patients in the highly active antiretroviral therapy (HAART) era.......To estimate the impact of injecting drug use (IDU) on mortality in HIV-infected patients in the highly active antiretroviral therapy (HAART) era....

  5. Species distribution and in vitro antifungal susceptibility of oral yeast isolates from Tanzanian HIV-infected patients with primary and recurrent oropharyngeal candidiasis.

    NARCIS (Netherlands)

    Hamza, O.J.; Matee, M.I.N.; Moshi, M.J.; Simon, E.N.; Mugusi, F.; Mikx, F.H.M.; Palenstein Helderman, W.H. van; Rijs, A.J.M.M.; Ven, A.J.A.M. van der; Verweij, P.E.

    2008-01-01

    BACKGROUND: In Tanzania, little is known on the species distribution and antifungal susceptibility profiles of yeast isolates from HIV-infected patients with primary and recurrent oropharyngeal candidiasis. METHODS: A total of 296 clinical oral yeasts were isolated from 292 HIV-infected patients wit

  6. Paraquat Poisoning in Patients With HIV Infection: A Case Report and Literature Review.

    Science.gov (United States)

    Tsai, Jun-Li; Chen, Cheng-Hsu; Wu, Ming-Ju; Tsai, Shang-Feng

    2016-04-01

    Paraquat poisoning is very severe. Most victims, including those who have ingested a small amount, will die from Paraquat poisoning. The cause of death in the majority of such cases is lung fibrosis. Paraquat poisoning in patients with positive human immunodeficiency virus (HIV) infection status has seldom been reported. Herein, we report a case of an HIV patient with Paraquat poisoning who had an excellent outcome even without standard treatment. Currently, only 3 such cases have been reported in the literature and in each case there was a good outcome, which was not expected according to predictive models. A possible mechanism may involve the relative lack of functional macrophages in HIV patients, which would tend to result in much less severe lung injury. None of the available predictive models of Paraquat poisoning appear to be appropriate for HIV patients.Paraquat poisoning in HIV patients may have better survival due to less lung injury.

  7. Prevailing HCV genotypes and subtypes among hiv infected patients in Georgia.

    Science.gov (United States)

    Karchava, M; Sharvadze, L; Gatserelia, L; Badridze, N; Tsertsvadze, T

    2009-12-01

    Recent analysis of antiretroviral treatment (ART) program data in Georgia showed that end-stage liver disease was a leading cause of death among HIV/HCV co infected patients in 2005. The objective of this retrospective study was to study prevailing genotypes and subtypes of HCV virus in a cohort of HIV infected patients. The investigation revealed that of 1490 patients, 879 (59%) were hepatitis C antibody positive. Detectable HCV RNA was found among 91% of patients. Median liver HCV RNA level was higher than among mono-infected patients. The most prevalent genotypes were genotype 1 (41.6%), followed by genotype 3 (34.7%) and genotype 2 (17.6%), inter (mix) genotype recombinants were found among 5.8 % of patients. The genotype distribution in our study is slightly different from what was seen in Georgia in 2000. The differences of prevailing HCV genotypes among general population and HIV co infected group was probably attributed to the different methods for sample selection used within our study or possible influence of diverse transmission networks among HIV infected group. Another explanation can be the possible shift from predominance of genotype 1 to non 1 genotypes. The higher number intergenotype recombinant forms might be the result of continues parenteral exposure to different HCV genotypes during drug injection paraphernalia. Our study demonstrated high prevalence of HCV infection among HIV-infected patients and revealed 1b as predominant genotype. IDUs were less likely to spontaneously clear the virus than homosexual man and heterosexually infected woman. A greater HCV RNA levels were associated with a greater chance to be infected with HCV genotypes 1. Possible shift from predominance of genotype 1 to non 1 genotypes can be of option. This shift may have a major and beneficial impact on treatment schedules and costs. The higher number intergenotype recombinant forms might be the results of continues parenteral exposure to different HCV genotypes during

  8. Steady-state pharmacokinetics of zidovudine in Chinese HIV-infected patients

    Institute of Scientific and Technical Information of China (English)

    LIU Li-feng; WANG Lu; FU Qiang; ZHU Zhu; XIE Jing; HAN Yang; LIU Zheng-yin; YE Min; LI Tai-sheng

    2012-01-01

    Background The pharmacokinetics of zidovudine (AZT) are possibly influenced by weight,age,sex,liver and renal functions,severity of disease,and ethnicity.Currently,little information is available on the steady-state pharmacokinetics of AZT in Chinese HIV-infected patients.The current study aimed to characterize the steady-state pharmacokinetics of AZT in a Chinese set-up.Methods Eleven Chinese HIV-infected patients were involved in the steady-state pharmacokinetic study.In total,300 mg of AZT,as a part of combination therapy,was given to patients,and serial blood samples were collected for 12 hours.The samples were measured by a high-performance liquid chromatography (HPLC) assay,and the results were analyzed by both the non-compartment model and the one-compartment model.Results The Cmax of AZT in Chinese patients was higher than that in non-Asian patients.The half-life of AZT,analyzed by the non-compartment model (P=0.02),in male patients ((1.02±0.22) hours) was shorter than that of AZT in female patients ((1.55±0.29) hours).The AZT clearance,analyzed by the one-compartment model (P=0.045),in male patients ((262.60±28.13) L/h) was higher than that in female patients ((195.85±60.51 ) L/h).Conclusion The present study provides valuable information for the clinical practice of AZT-based highly active antiretroviral therapy in a Chinese set-up.

  9. Proliferation and telomere length in acutely mobilized blood mononuclear cells in HIV infected patients

    DEFF Research Database (Denmark)

    Søndergaard, S R; Essen, M V; Schjerling, P

    2002-01-01

    The aim of the study was to investigate the mobilization of T cells in response to a stressful challenge (adrenalin stimulation), and to access T cells resided in the peripheral lymphoid organs in HIV infected patients. Seventeen patients and eight HIV seronegative controls received an adrenalin...... infusion for 1 h. Blood was sampled before, during and 1 h after adrenalin infusion. Proliferation and mean telomere restriction fragment length (telomeres) of blood mononuclear cells (BMNC) and purified CD8+ and CD4+ cells were investigated at all time points. In patients, the proliferation to pokeweed...... mitogens (PWM) was lower and decreased more during adrenalin infusion. After adrenalin infusion the proliferation to PWM was restored only in the controls. In all subjects telomeres in CD4+ cells declined during adrenalin infusion. Additionally, the patients had shortened telomeres in their CD8+ cells...

  10. Spectrum of clinical disease in a series of 135 hospitalised HIV-infected patients from north India

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    Sharma SK

    2004-11-01

    Full Text Available Abstract Background Literature on the spectrum of opportunistic disease in human immunodeficiency virus (HIV-infected patients from developing countries is sparse. The objective of this study was to document the spectrum and determine the frequency of various opportunistic infections (OIs and non-infectious opportunistic diseases, in hospitalised HIV-infected patients from north India. Methods One hundred and thirty five consecutive, HIV-infected patients (age 34 ± 10 years, females 17% admitted to a tertiary care hospital in north India, for the evaluation and management of an OI or HIV-related disorder between January 2000 and July 2003, were studied. Results Fever (71% and weight loss (65% were the commonest presenting symptoms. Heterosexual transmission was the commonest mode of HIV-acquisition. Tuberculosis (TB was the commonest OI (71% followed by candidiasis (39.3%, Pneumocystis jiroveci pneumonia (PCP (7.4%, cryptococcal meningitis and cerebral toxoplasmosis (3.7% each. Most of the cases of TB were disseminated (64%. Apart from other well-recognised OIs, two patients had visceral leishmaniasis. Two cases of HIV-associated lymphoma were encountered. CD4+ cell counts were done in 109 patients. Majority of the patients (82.6% had CD4+ counts Conclusions A wide spectrum of disease, including both OIs and non-infectious opportunistic diseases, is seen in hospitalised HIV-infected patients from north India. Tuberculosis remains the most common OI and is the commonest cause of death in these patients.

  11. suPAR associates to glucose metabolic aberration during glucose stimulation in HIV-infected patients on HAART

    DEFF Research Database (Denmark)

    Andersen, Ove; Eugen-Olsen, Jesper; Kofoed, Kristian;

    2008-01-01

    OBJECTIVE: We have recently shown that the level of soluble urokinase plasminogen activator receptor (suPAR), which is associated with the immune status of HIV-infected patients undergoing highly active antiretroviral therapy (HAART), correlates with the insulin action of such patients. Here we e...

  12. Intestinal parasitic infections in HIV-infected patients, Lao People's Democratic Republic.

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    Phimpha Paboriboune

    Full Text Available BACKGROUND: HIV infection is an emerging problem in Laos. We conducted the first prospective study on intestinal parasites, including opportunistic protozoa, in newly diagnosed HIV infected patients, with or without diarrhea. The aims were to describe the spectrum of infections, to determine their prevalence and to assess their associations with diarrhea, CD4 cell count, place of residence and living conditions. METHODOLOGY: One to three stool samples over consecutive days were obtained from 137 patients. The Kato thick smear method, formalin-ethyl concentration and specific stains for coccidia and microsporidia diagnosis were performed on 260 stool samples. Baseline characteristics regarding relevant demographics, place of residence and living conditions, clinical features including diarrhea, were collected using a standardized questionnaire. PRINCIPAL FINDINGS: The 137 patients were young (median age: 36 years and severely immunocompromised (83.9% at WHO stage 3 or 4, median CD4 cell count: 41/mm3. Diarrhea was present in 43.0% of patients. Parasite infection was found in 78.8% of patients, infection with at least two species in 49.6%. Prevalence rates of protozoan and helminth infections were similar (54.7% and 58.4% respectively. Blastocystis sp. was the most frequent protozoa (26.3%. Cryptosporidium sp., Cytoisospora belli and microsporidia, found at low prevalence rates (6.6%, 4.4%, 2.9%, respectively, were described for the first time in Laos. Cryptosporidium sp. was associated with persistent diarrhea. Strongyloides stercoralis was the most prevalent helminth following Opisthorchis viverrini (20.4% and 47.5% respectively. The most immunocompromised patients, as assessed by a CD4 count ≤ 50 cells/mm3, were more likely to be infected with intestinal parasites. CONCLUSIONS/SIGNIFICANCE: HIV infection was mainly diagnosed at an advanced stage of immunosuppression in Lao patients. Intestinal parasite infections were highly prevalent

  13. Factors associated with adherence to antiretroviral therapy in HIV-infected patients in Kathmandu District, Nepal

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    Shigdel R

    2014-06-01

    Full Text Available Rajesh Shigdel,1 Elise Klouman,2 Anita Bhandari,2 Luai A Ahmed11Department of Health and Care Sciences, 2Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, NorwayPurpose: There are a high number of HIV-infected patients receiving antiretroviral therapy (ART in the Kathmandu District of Nepal, but information on adherence and factors influencing it are scarce in this population. The present study aimed to estimate ART adherence among HIV-infected patients in the Kathmandu District of Nepal, and to determine the factors associated with ART adherence.Patients and methods: This study included 316 HIV-infected patients attending three ART centers in the Kathmandu District. Information on sociodemographic characteristics, socioeconomic status, and ART use for the previous 7 days was collected via interview. Participants were considered adherent if they reported taking ≥95% of their ART as prescribed. The association between explanatory variables and ART adherence was measured using logistic regression and reported as odds ratios (OR with 95% confidence intervals (CI.Results: Male participants accounted for 64.6% (n=204. Overall ART adherence was 86.7%. ART adherence in men and women were 84.3% and 91.1%, respectively. Age (OR 1.04; 95% CI 1.00–1.09, travel time to ART centers (OR 1.38; 95% CI 1.12–1.71, history of illegal drug use (OR 3.98; 95% CI 1.71–9.24, and adverse effects (OR 4.88; 95% CI 1.09–21.8, were all independently and negatively associated with ART adherence. Use of reminder tools (OR 3.45; 95% CI 1.33–8.91 was independently and positively associated with ART adherence.Conclusion: The observed ART adherence in this study is encouraging. Travel time to ART centers, self-reported adverse effects, illegal drug use, and not using reminder tools were the major determinants of ART adherence. Interventions that take these factors into account could further improve ART

  14. Do the epidemiology, physiological mechanisms and characteristics of hepatocellular carcinoma in HIV-infected patients justify specific screening policies?

    Science.gov (United States)

    Gelu-Simeon, Moana; Sobesky, Rodolphe; Haïm-Boukobza, Stéphanie; Ostos, Marita; Teicher, Elina; Fontaine, Hélène; Salmon-Ceron, Dominique; Meyer, Laurence; Trinchet, Jean-Claude; Paule, Bernard; Samuel, Didier; Lewin, Maïté; Duclos-Vallée, Jean-Charles

    2014-06-19

    Reducing the incidence of hepatocellular carcinoma (HCC) in HIV-infected patients has become a serious problem when managing these patients. There are many explanations for this disease evolution, which notably include their longer survival under effective antiviral therapy and also the more rapid evolution of chronic liver disease. Despite recent advances in the management of hepatitis B (HBV) and hepatitis C (HCV) viral diseases, which will probably increase the number of patients achieving a virological response, HIV-infected patients with cirrhosis are still at risk of the onset of HCC. This evolution to HCC is also correlated to other comorbidities such as excessive alcohol consumption and nonalcoholic steatohepatitis (NASH). HCC thus remains a public health issue in this population. The poor prognosis and aggressiveness of HCC have been fully demonstrated, but the mechanisms underlying this aggressiveness are not yet well defined. As well as underlying mechanisms that contribute to accelerating hepatocarcinogenesis in HIV-infected patients, there are other reasons why HIV-infected patients should be considered a higher risk population. This review discusses the principal epidemiological determinants; the mechanisms of pathogenesis; and the treatment of HCC in HIV/HBV and HIV/HCV coinfected patients. It also discusses the probable need to develop a specific screening policy for HCC in this population in order to prevent the rapid development and to make them more amenable to a curative treatment.

  15. Tuberculosis and hepatic steatosis are prevalent liver pathology findings among HIV-infected patients in South Africa.

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    Christopher J Hoffmann

    Full Text Available Liver disease epidemiology in sub-Saharan Africa has shifted as a result of HIV and the increased use of antiretroviral therapy leading to a need for updated data on common causes of liver disease. We retrospectively reviewed records from all hospitalized patients who had liver biopsy at a single hospital in South Africa from 2001 to 2009 and compared diagnosis by HIV status. During the period of study 262 patients had liver biopsy, 108 (41% were HIV-infected, 25 (10% were HIV-sero-negative, and 129 (49% had unknown or unrecorded HIV status. Overall 81% of biopsies provided additional diagnostic data. Malignancy was the most common finding reported on 56 (21% biopsies followed by granuloma or TB, hepatic steatosis, and fibrosis or cirrhosis. HIV-infected patients were more likely to have granulomas and steatosis. Half of patients with granulomas were already on TB treatment, suggesting paradoxical reactions or drug induced liver injury may have been important causes of liver inflammation among these patients. We note that TB, paradoxical reactions during TB treatment, possible drug induced liver injury, and hepatic steatosis are important causes of liver pathology among HIV-infected hospitalized patients with unclear etiology of liver disease after initial assessment. Among HIV sero-negative patients, malignancy was the major cause of liver disease. Our findings re-enforce the importance of TB as a diagnosis among HIV-infected individuals.

  16. Predictive factors of herpes zoster HIV-infected patients: another adverse effect of crack cocaine.

    Science.gov (United States)

    Nacher, Mathieu; Basurko, Celia; Adenis, Antoine; Gaubert-Marechal, Emilie; Mosnier, Emilie; Edouard, Sophie; Vantilcke, Vincent; Sivapregassam, Sindou; Tressières, Benoit; Cabié, André; Couppié, Pierre

    2013-01-01

    A retrospective cohort study was conducted on 1541 HIV-infected patients to determine variables associated with the incidence of herpes zoster. A single failure Cox model showed that herpes zoster incidence increased following the first 6 months of antiretroviral treatment adjusted hazard ratio (AHR)=5 (95%CI=2.6-9.2), P60 years age group AHR=2 (95%CI=1-4), P=0.04; in patients in the top CD8 quartile AHR=2.1 (95%CI=1.3-3.6), PHerpes zoster incidence increased in patients with CD4 countsherpes zoster incidence. The present study is the first to suggest that crack cocaine is associated with an increased incidence of herpes zoster. The neurological or immunological effects of crack are discussed.

  17. ANALYSIS OF POLYMORPHIC VARIANTS OF CYTOKINE GENES IN PATIENTS WITH HIV INFECTION

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    N. A. Sukhalentseva

    2011-01-01

    Full Text Available Abstract. A distribution mode for allelic variants of cytokine genes was evaluated in 184 patients with slow viral infections, including 97 patients with chronic herpetic infection and 87 HIV-infected patients. Using modern methods of immunogenetics, we have found that relative risks of recurrent course and poor outcome of infection are positively associated with AA promoter region genotype and AA promoter genotype of +874 A/T polymorphism in the IFNG gene. Immunogenetic factors associated with protective effect in slow virus infections, include G allele of TNFA gene (G-308A SNP, and T allele/TT genotype of promoter region in  the IFNG gene (+874 A/T SNP. (Med. Immunol., 2011, vol. 13, N 1, pp 79-82

  18. A comparative study of CIDP in a cohort of HIV-infected and HIV-uninfected patients

    Science.gov (United States)

    Bill, Pierre L.A.

    2016-01-01

    Objective: To investigate differences in clinical presentation, electrodiagnostic measures, CSF changes, and treatment outcome measures in HIV-infected and HIV-uninfected patients with chronic inflammatory demyelinating polyneuropathy (CIDP). Methods: A retrospective analysis of medical records of all patients meeting the European Federation of Neurology diagnostic criteria for idiopathic CIDP was performed in 2 neuromuscular units in Kwa-Zulu Natal between 2003 and 2015. Results: Eighty-four patients were included in the study; 39 were HIV-infected and 45 were HIV-uninfected. Among the HIV-infected patients, the majority were younger, were female, and had a monophasic progressive illness. Eighty-six percent (86%) were corticosteroid-responsive and 76% were in remission within 6–12 months requiring no further treatment. Among the HIV- uninfected patients, the majority were older, were male, and had a relapsing-remitting course. Twenty-seven percent (27%) were corticosteroid-responsive, 95% required combination therapy, and 33% were not in remission by 18 months on therapy. Conclusion: This study shows that HIV-infected patients with CIDP were younger, were more often female, displayed a monophasic progressive course, were highly steroid-responsive, and went into remission within 12 months of corticosteroid initiation. PMID:28054000

  19. Monocyte activation, but not microbial translocation, is independently associated with markers of endovascular dysfunction in HIV-infected patients receiving cART

    DEFF Research Database (Denmark)

    Pedersen, Karin K; Manner, Ingjerd W; Seljeflot, Ingebjørg;

    2014-01-01

    BACKGROUND: Microbial translocation has been suggested as a driver of cardiovascular disease in HIV infection. We hypothesized that microbial translocation and the resulting monocyte activation would be associated with markers of endovascular dysfunction. METHODS: In 60 HIV-infected patients on c...

  20. Lamivudine plus darunavir boosted with ritonavir as simplification dual regimen in HIV-infected patients

    Directory of Open Access Journals (Sweden)

    Jose Luis Casado

    2014-11-01

    Full Text Available Introduction: The combination of lamivudine plus a protease inhibitor boosted with ritonavir (PI/r has become an alternative as simplification strategy in HIV-infected patients with toxicity/intolerance to other nucleoside analogues (NA. Lamivudine plus darunavir/r (DRV/r could be an adequate once daily option. Materials and Methods: Prospective cohort study of 48 HIV-infected patients on suppressive triple therapy-based HAART, HBV negative, who switched to lamivudine 300 mg plus DRV/r 800/100 mg once daily. Results: Mean age was 50 yrs (35–74, and 65% were male. Thirty patients (63% had HCV co-infection (fibrosis 4 in 7 cases, 23%. Median time of HIV infection was 19.1 years, and CD4+ count nadir was 220 cells/µL (2–604. They had received a mean of three regimens before (2–20, and 20 (42% had a previous AIDS diagnosis. In eight cases, a previous resistance test showed two to seven secondary mutations in the protease gene, without resistance to DRV/r (one patient with the I84V mutation. At baseline, patients had viral suppression (<50 copies/mL for a median time of 1263 days (341–1884, and they were receiving predominantly a PI based regimen (ATV in four, FPV in four, LPV in three, DRV in six or an efavirenz-based regimen (seven. The main reason to switching to this dual therapy was toxicity (35 patients, 75%, mainly renal toxicity attributed to tenofovir (24 cases. During 104.3 patients-year of follow-up (median 912 days, only two patients (4% failed at 27 and 505 days, due to non-adherence and lost to follow up, respectively. Total cholesterol and triglycerides increased significantly during the first six months after initiation (TC, from 185 to 269 mg/dL; p=0.01, TG from 118 to 185 mg/dL; p=0.03, TC/HDL ratio, from 4.09 to 4.66 and decreased after. Median estimated glomerular filtration rate (eGFR improved during follow up (from 86 to 96.1 mL/min; p=0.13. In patients with renal toxicity as cause of switch there was a mild, no

  1. Spectrums of opportunistic infections and malignancies in HIV-infected patients in tertiary care hospital, China.

    Directory of Open Access Journals (Sweden)

    Jiang Xiao

    Full Text Available BACKGROUND: HIV-related opportunistic infections (OIs and malignancies continued to cause morbidity and mortality in Chinese HIV-infected individuals. The objective for this study is to elucidate the prevalence and spectrums of OIs and malignancies in HIV-infected patients in the Beijing Ditan Hospital. METHODS: The evaluation of the prevalence and spectrums of OIs and malignancies was conducted by using the clinical data of 834 HIV-infected patients admitted in the Beijing Ditan hospital from January 1, 2009, to November 30, 2012. RESULTS: The prevalence and spectrums of OIs and malignancies varied contingent on geographic region, transmission routes, and CD4 levels. We found that tuberculosis was most common OI and prevalence was 32.5%, followed by candidiasis(29.3%, Pneumocystis pneumonia(PCP(22.4%, cytomegalovirus(CMV infection(21.7%, other fungal infections(16.2%, mycobacterium avium complex(MAC(11.3%, cryptococcosis(8.0%, progressive multifocal leukoencephalopathy(PML(4.4%, Cerebral Toxoplasmosis(3.5% and Penicillium marneffei infection(1.4%; while Lymphoma(2.9%, Kaposi's sarcoma(0.8% and cervix carcinoma(0.3% were emerged as common AIDS-defining malignancies. Pulmonary OI infections were the most prevalent morbidity and mortality in patients in the AIDS stage including pulmonary tuberculosis (26.6% and PCP (22.4%. CMV infection(21.7% was most common viral infection; Fungal OIs were one of most prevalent morbidity in patients in the AIDS stage, including oral candidiasis (29.3%, other fungal infection (16.2%, Cryptococcosis (8.0% and Penicillium marneffei infection (1.4%. We found the low prevalence of AIDS-defining illnesses in central neural system in this study, including progressive multifocal leukoencephalopathy (4.4%, cerebral toxoplasmosis (3.5%, tuberculosis meningitis (3.2%, cryptococcal meningitis (2.4% and CMV encephalitis (1.1%. In-hospital mortality rate was 4.3 per 100 person-years due to severe OIs, malignancies, and medical

  2. Pregnancy and HIV infection

    Directory of Open Access Journals (Sweden)

    Mete Sucu

    2016-12-01

    Full Text Available The management of Human Immunodeficiency Virus (HIV infection is progressing rapidly. In developed countries, the perinatal transmission rates have decreased from 20-30% to 1-2% with the use of antiretroviral therapy and cesarean section. Interventions for the prevention of prenatal transmission has made the prenatal care of pregnant patients with HIV infection more complex. Rapid development of standard care and continuing increase in the distribution of HIV infection has required clinicians taking care of pregnants to have current information. Therefore, in our review we aimed to summarize the prenatal course, treatment and preventive methods for perinatal transmission of HIV. [Archives Medical Review Journal 2016; 25(4.000: 522-535

  3. Providers' lack of knowledge about herpes zoster in HIV-infected patients is among barriers to herpes zoster vaccination.

    Science.gov (United States)

    Aziz, M; Kessler, H; Huhn, G

    2013-06-01

    Identification of perceptions about herpes zoster (HZ) disease, vaccine effectiveness and safety, and vaccine recommendations may impact immunization practices of physicians for HIV-infected patients. A survey was used to quantify knowledge of HZ as well as determine physician immunization perceptions and practices. There were 272/1700 respondents (16%). Correct answers for the incidence of varicella zoster virus (VZV) infection in adults and incidence of HZ in HIV-infected patients were recorded by 14% and 10% of providers, respectively. Providers reported poor knowledge of the incidence of disease recurrence in HIV-infected patients (41% correct), potency of HZ vaccine (47.5% correct) and mechanism of protection against reactivation of VZV (66% correct). Most (88%) agreed that HZ was a serious disease, and 73% believed that the burden of disease made vaccination important. A majority (75%) did not vaccinate HIV patients with HZ vaccine regardless of antiretroviral therapy status. Barriers to administration included safety concerns, concern that vaccine would not prevent HZ, risk of HZ dissemination, reimbursement issues and lack of Infectious Diseases Society of America (IDSA) guidelines. Only 38% of providers agreed that CDC guidelines were clear and 50% believed that clinical trials were needed prior to use of HZ vaccine in HIV-infected patients. Education about HZ is needed among HIV providers. Providers perceived vaccination as important, but data on vaccine safety and clear guidance from the CDC on this issue are lacking.

  4. Treatment of rheumatic diseases in patients with HCV and HIV infection.

    Science.gov (United States)

    Galeazzi, Mauro; Giannitti, Chiara; Manganelli, Stefania; Benucci, Maurizio; Scarpato, Salvatore; Bazzani, Chiara; Caporali, Roberto; Sebastiani, Gian Domenico

    2008-12-01

    A wide variety of rheumatic diseases has been documented in the presence of hepatitis C virus (HCV) infection and in human immunodeficiency virus (HIV) infection. In this conditions, physicians are refrained from using corticosteroids and/or immunosuppressants agents because of the risk of favouring viral replication and the progression of the underlying viral disease. In the present review we have focused our attention on the possible role of cyclosporine A (CsA), anti-Tumour Necrosis Factor (TNF) alpha agents in the treatment of HIV or HCV infected autoimmune patients. The results drown from the literature and from our personal experience confirm the safety of CsA and anti-TNF alpha agents, in terms of viral load and liver toxicity. A limited experience also suggest that both therapies can be given in combination in rheumatoid arthritis patients without increasing the risk of adverse events.

  5. THE CHANGES OF LARGE INTESTINE CAVITY’S MICROBIOTA IN PATIENTS WITH HIV INFECTION

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    Savinova O.M.

    2015-12-01

    Full Text Available Introduction. Infections of the gastrointestinal tract are caused by a wide range of fungi, viruses and bacteria. The great value has the ratio of microorganisms. There are certain regularities in microecological system of intestinal microflora. Thus, bifidous bacteria should be more than lactobacterium; enterobacteria – more than enterococcus; E.faecalis more than E.faecium. However, these differences should be at least one or two orders of magnitude. An important indicator is the ratio of enterobacteria and enterococcus. Material & methods. In the paper were used following materials and methods: bacteriological and statistical. The conditions of intestinal microbiocenosis were evaluated according to the methodical instructions about researches of fecal masses on dysbiosis and modern methods of correction of intestinal dysbiosis that included identifying of anaerobic and facultative anaerobic microorganisms, staphylococci, enterococci, opportunistic enterobacteria, Proteus spp., Klebsiella spp., P.aeruginosa, C.albicans. Bacterial cultures were identified by standard techniques. Statistical analysis of the results was performed by the standard method of determining the average value and its standard deviation (M + m and Student's t-test. The reliability of the difference was evaluated at the level of probability p 104 CFU/grams in 11,8 + 5,53%, S.epidermidis in amount of > 105 CFU/grams in 32,4 + 8,03%, C.albicans in amount of > 104 CFU/grams in 11,1 + 6,59% and 1 patient had Clostridium in amount > 103 CFU/grams, which was 3 + 2,93%. These data show that patients with HIV infection is detected at the same time reducing number of anaerobic microflora (bifidus bacteria and lactobacilli and aerobic microflora, a leading representative of which is intestinal E.coli irrespective of the clinical stage of the disease. Association of these microorganisms is 56%. To this attach indicators of reduction E.faecalis and E.faecium. Taking into account the

  6. Clinically significant drug interactions among HIV-infected patients receiving antiretroviral therapy.

    Science.gov (United States)

    So-Ngern, Apichot; Montakantikul, Preecha; Manosuthi, Weerawat

    2014-09-01

    We conducted a cross sectional study of the outpatient medical records of 1000 HIV-infected patients receiving antiretroviral therapy (ART) in 2011 to determine the incidence of clinically significant drug interactions (CSDI). The severities of the CSDI were graded following the Micromedex" 2.0 database and the Department of Health and Human Services (DHHS) 2012 HIV treatment guidelines. Three hundred thirty-five patients (34%) had 554 episodes of CSDI. Of which 337 episodes (61%), 163 episodes (29%) and 54 episodes (10%) had grades 2, 3 and 4 severity CSDI, respectively. The CSDI were caused by protease inhibitor (PI)-based drug regimens in 79%, by efavirenz-based regimens in 34% and by nevirapine-based regimens in 10% (p5 items prescribed at a time (OR 1.80; 95% CI: 1.23-2.63), seeing a doctor >4 times a year (OR 1.72; 95% CI: 1.20-2.46), having hypertension (OR 0.60; 95% CI: 0.37-0.98), having a duration of receiving ART of >5 years (OR 0.46; 95% CI: 0.28-0.77) and having a CD4 count of >200 cells/mm3 (OR 0.46; 95%CI: 0.26-0.84). CSDI were common among HIV-infected patients receiving ARV in our outpatient clinic. Patients having a low CD, count, having dyslipidemia, receiving PI-based ART, having a frequent number of visits per year and having a large number of items prescribed at each visit had a greater chance of a CSDI.

  7. Chronic Hepatitis B and C Virus Infection and Risk for Non-Hodgkin Lymphoma in HIV-Infected Patients

    DEFF Research Database (Denmark)

    Wang, Qing; De Luca, Andrea; Smith, Colette

    2017-01-01

    Background: Non-Hodgkin lymphoma (NHL) is the most common AIDS-defining condition in the era of antiretroviral therapy (ART). Whether chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection promote NHL in HIV-infected patients is unclear. Objective: To investigate whether chronic HB...

  8. Glomerular lesions in HIV-infected patients: a Yale University Department of Medicine Residency Peer-Teaching Conference.

    OpenAIRE

    1997-01-01

    HIV-associated nephropathy (HIVAN) is a clinicopathologic entity characterized by heavy proteinuria, absence of edema and an irreversible decline in renal function. Findings on renal biopsy include: collapsed glomerular capillaries; visceral glomerular epitheliosis; microcystic tubules; mesangial prominence; and endothelial tubuloreticular inclusions. Early in the AIDS epidemic, HIVAN was the predominant glomerular lesion observed in HIV-infected patients. It is being increasingly recognized,...

  9. Association between diarrhea and quality of life in HIV-infected patients receiving highly active antiretroviral therapy

    NARCIS (Netherlands)

    Tramarin, A; Parise, N; Campostrini, S; Yin, DD; Postma, MJ; Lyu, R; Grisetti, R; Capetti, A; Cattelan, AM; Di Toro, MT; Mastroianni, A; Pignattari, E; Mondardini, [No Value; Calleri, G; Raise, E; Starace, F

    2004-01-01

    Diarrhea is a common symptom that many HIV patients experience either as a consequence of HIV infection or of highly active antiretroviral therapy (HAART). A multicenter, prospective observational study was conducted in 11 AIDS clinics in Italy to determine the effect of diarrhea on health-related q

  10. Autoimmune diseases and HIV infection

    Science.gov (United States)

    Virot, Emilie; Duclos, Antoine; Adelaide, Leopold; Miailhes, Patrick; Hot, Arnaud; Ferry, Tristan; Seve, Pascal

    2017-01-01

    Abstract To describe the clinical manifestations, treatments, prognosis, and prevalence of autoimmune diseases (ADs) in human immunodeficiency virus (HIV)-infected patients. All HIV-infected patients managed in the Infectious Diseases Department of the Lyon University Hospitals, France, between January 2003 and December 2013 and presenting an AD were retrospectively included. Thirty-six ADs were found among 5186 HIV-infected patients which represents a prevalence of 0.69% including immune thrombocytopenic purpura (n = 15), inflammatory myositis (IM) (n = 4), sarcoidosis (n = 4), Guillain–Barré syndrome (GBS) (n = 4), myasthenia gravis (n = 2), Graves’ disease (n = 2), and 1 case of each following conditions: systemic lupus erythematosus, rheumatoid arthritis, autoimmune hepatitis, Hashimoto thyroiditis and autoimmune hemolytic anemia. One patient presented 2 ADs. Thirty patients were known to be HIV-infected when they developed an AD. The AD preceded HIV infection in 2 patients. GBS and HIV infection were diagnosed simultaneously in 3 cases. At AD diagnosis, CD4 T lymphocytes count were higher than 350/mm3 in 63% of patients, between 200 and 350/mm3 in 19% and less than 200/mm3 in 19%. Twenty patients benefited from immunosuppressant treatments, with a good tolerance. ADs during HIV infection are uncommon in this large French cohort. Immune thrombocytopenic purpura, sarcoidosis, IM, and GBS appear to be more frequent than in the general population. Immunosuppressant treatments seem to be effective and well tolerated. PMID:28121924

  11. Approach to dyslipidemia, lipodystrophy, and cardiovascular risk in patients with HIV infection.

    Science.gov (United States)

    Troll, J Gregory

    2011-02-01

    There is a significant prevalence (20%-80% depending on the population and the study) of lipid disorders and other cardiovascular risk factors in people living with HIV infection. This review focuses on HIV and HIV treatment-associated metabolic and cardiovascular concerns, including dyslipidemias, lipodystrophy syndromes, endothelial dysfunctions, and associated metabolic events such as insulin resistance. Emerging hypotheses of the underlying pathophysiology of these issues, with impact on selection of specific antiretroviral treatment (ART) strategies, therapy, and preventive approaches to decreasing cardiovascular risk and other problems associated with these syndromes are discussed. Screening for cardiovascular risk as part of the decision of starting antiretroviral therapy, and during care of patients with HIV regardless of ART therapy status, is suggested with particular areas of focus. Statins, other hyperlipidemic therapies, treatment for specific problems arising due to lipodystrophy, and implications on ART selection to avoid drug interactions and adverse effects are also discussed.

  12. Low-dose growth hormone therapy reduces inflammation in HIV-infected patients

    DEFF Research Database (Denmark)

    Lindboe, Johanne Bjerre; Langkilde, Anne; Eugen-Olsen, Jesper

    2016-01-01

    ). Recombinant human growth hormone (rhGH) has been tested as treatment of HALS. Low-dose rhGH therapy improves thymopoiesis and fat distribution in HIV-infected patients and appears to be well tolerated. However, since high-dose rhGH is associated with adverse events related to inflammation, we wanted.......06) decreased in the rhGH group compared to placebo; however, only CRP decreased significantly. The effect of rhGH on inflammation was not mediated through rhGH-induced changes in insulin-like growth factor 1, body composition, or immune parameters. CONCLUSION: Daily 0.7 mg rhGH treatment for 40 weeks......, administered at nadir endogenous GH secretion, significantly reduced CRP. The effect does not appear to be mediated by other factors. Our findings suggest that low-dose rhGH treatment may minimize long-term risks associated with high-dose rhGH therapy....

  13. Will adoption of the 2010 WHO ART guidelines for HIV-infected TB patients increase the demand for ART services in India?

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    Ajay M V Kumar

    Full Text Available BACKGROUND: In 2010, WHO expanded previously-recommended indications for anti-retroviral treatment to include all HIV-infected TB patients irrespective of CD4 count. India, however, still limits ART to those TB patients with CD4 counts <350/mm(3 or with extrapulmonary TB manifestations. We sought to evaluate the additional number of patients that would be initiated on ART if India adopted the current 2010 WHO ART guidelines for HIV-infected TB patients. METHODS: We evaluated all TB patients recorded in treatment registers of the Revised National TB Control Programme in June 2010 in the high-HIV prevalence state of Karnataka, and cross-matched HIV-infected TB patients with ART programme records. RESULTS: Of 6182 TB patients registered, HIV status was ascertained for 5761(93% and 710(12% were HIV-infected. 146(21% HIV-infected TB patients were on ART prior to TB diagnosis. Of the remaining 564, 497(88% were assessed for ART eligibility; of these, 436(88% were eligible for ART according to 2006 WHO ART guidelines. Altogether, 487(69% HIV-infected TB patients received ART during TB treatment. About 80% started ART within 8 weeks of TB treatment and 95% received an efavirenz based regimen. CONCLUSION: In Karnataka, India, about nine out of ten HIV-infected TB patients were eligible for ART according to 2006 WHO ART guidelines. The efficiency of HIV case finding, ART evaluation, and ART initiation was relatively high, with 78% of eligible HIV-infected patients actually initiated on ART, and 80% within 8 weeks of diagnosis. ART could be extended to all HIV-infected TB patients irrespective of CD4 count with relatively little additional burden on the national ART programme.

  14. Herb-Drug Interaction between Echinacea purpurea and Etravirine in HIV-Infected Patients

    Science.gov (United States)

    Valle, Marta; Miranda, Cristina; Cedeño, Samandhy; Negredo, Eugenia; Clotet, Bonaventura

    2012-01-01

    The aim of this open-label, fixed-sequence study was to investigate the potential of the botanical supplement Echinacea purpurea to interact with etravirine, a nonnucleoside reverse transcriptase inhibitor of HIV. Fifteen HIV-infected patients receiving antiretroviral therapy with etravirine (400 mg once daily) for at least 4 weeks were included. E. purpurea root/extract-containing capsules were added to the antiretroviral treatment (500 mg every 8 h) for 14 days. Etravirine concentrations in plasma were determined by high-performance liquid chromatography immediately before and 1, 2, 4, 6, 8, 10, 12, and 24 h after a morning dose of etravirine on day 0 and etravirine plus E. purpurea on day 14. Individual etravirine pharmacokinetic parameters were calculated by noncompartmental analysis and compared between days 0 and 14 by means of the geometric mean ratio (GMR) and its 90% confidence interval (CI). The median age was 46 years (interquartile range, 41 to 50), and the median body weight was 76 kg (interquartile range, 68 to 92). Echinacea was well tolerated, and all participants completed the study. The GMR for etravirine coadministered with E. purpurea relative to etravirine alone was 1.07 (90% CI, 0.81 to 1.42) for the maximum concentration, 1.04 (90% CI, 0.79 to 1.38) for the area under the concentration-time curve from 0 to 24 h, and 1.04 (90% CI, 0.74 to 1.44) for the concentration at the end of the dosing interval. In conclusion, the coadministration of E. purpurea with etravirine was safe and well tolerated in HIV-infected patients; our data suggest that no dose adjustment for etravirine is necessary. PMID:22869560

  15. Trends in the Treatment of Anemia Using Recombinant Human Erythropoietin in Patients with HIV Infection

    Science.gov (United States)

    Sullivan, Patrick S; Hanson, Debra L; Richardson, James T; Brooks, John T

    2011-01-01

    Background: Treating anemia with erythropoietin (EPO) to hemoglobin (Hb) endpoints >11 g/dL may increase risk of serious adverse cardiovascular events. Methods: We used medical records data (1996-2003 from the Adolescent Spectrum of HIV Disease Project [ASD] and 1996-2006 from the HIV Outpatient Study [HOPS]) to describe EPO prescription patterns for mildly, moderately, or severely anemic HIV-infected patients. We calculated proportions prescribed EPO and treated to Hb>12 g/dL, and tested for trends over time. We calculated median hemoglobin at first EPO prescription, and described temporal changes using linear regression. Results: Among 37,395 patients in ASD and 7,005 patients in HOPS, EPO prescription increased over time for moderately anemic patients; for patients with severe anemia, EPO prescription increased only among ASD patients. Hb at EPO prescription decreased over time in ASD patients (median=8.5 g/dL), but not in HOPS patients (median 9.5 g/dL). Percentage of EPO-treated patients with post-treatment Hb>12 g/dL was 18.3% in ASD and stable, and was 56.7% in HOPS and increased over time (p = 0.03). Conclusions: Through 2006, EPO prescription increased over time for patients with moderate or severe anemia. Many patients treated with EPO had post-treatment Hb>12 g/dL. Based on 2011 FDA recommendations, changes in previous prescription practices will be needed. PMID:22253666

  16. Immunotherapy of HIV-infected patients with Gc protein-derived macrophage activating factor (GcMAF).

    Science.gov (United States)

    Yamamoto, Nobuto; Ushijima, Naofumi; Koga, Yoshihiko

    2009-01-01

    Serum Gc protein (known as vitamin D3-binding protein) is the precursor for the principal macrophage activating factor (MAF). The MAF precursor activity of serum Gc protein of HIV-infected patients was lost or reduced because Gc protein is deglycosylated by alpha-N-acetylgalactosaminidase (Nagalase) secreted from HIV-infected cells. Therefore, macrophages of HIV-infected patients having deglycosylated Gc protein cannot be activated, leading to immunosuppression. Since Nagalase is the intrinsic component of the envelope protein gp120, serum Nagalase activity is the sum of enzyme activities carried by both HIV virions and envelope proteins. These Nagalase carriers were already complexed with anti-HIV immunoglobulin G (IgG) but retained Nagalase activity that is required for infectivity. Stepwise treatment of purified Gc protein with immobilized beta-galactosidase and sialidase generated the most potent macrophage activating factor (termed GcMAF), which produces no side effects in humans. Macrophages activated by administration of 100 ng GcMAF develop a large amount of Fc-receptors as well as an enormous variation of receptors that recognize IgG-bound and unbound HIV virions. Since latently HIV-infected cells are unstable and constantly release HIV virions, the activated macrophages rapidly intercept the released HIV virions to prevent reinfection resulting in exhaustion of infected cells. After less than 18 weekly administrations of 100 ng GcMAF for nonanemic patients, they exhibited low serum Nagalase activities equivalent to healthy controls, indicating eradication of HIV-infection, which was also confirmed by no infectious center formation by provirus inducing agent-treated patient PBMCs. No recurrence occurred and their healthy CD + cell counts were maintained for 7 years.

  17. Comparison of the therapeutic dose of warfarin in HIV-infected and HIV-uninfected patients: a study of clinical practice

    Science.gov (United States)

    Jackson, B S; Mokoena, T

    2017-01-01

    Background People infected with HIV are prone to venous thrombosis. Treatment of thrombosis is primarily with warfarin. No studies have addressed the effects of HIV infection on warfarin dose. The aims of this study were to determine whether the therapeutic dose of warfarin and induction time to therapeutic dose in HIV-infected patients differ from that in HIV-uninfected patients. Methods A prospective and retrospective descriptive study of induction time to therapeutic warfarin dose, as well as of ambulant therapeutic warfarin dose, was performed. HIV-infected and HIV-uninfected patients being treated after deep venous thrombosis with or without pulmonary embolism were compared. Sex and use of antiretroviral drugs (ARVs) were also compared in the groups. Results 234 patients were entered into the study. Induction time to therapeutic warfarin dose did not differ between the 2 groups. The mean therapeutic dose of warfarin was higher in the HIV-infected than the HIV-uninfected group: 6.06 vs 5.72 mg/day, but this was not statistically significant (p=0.29). There was no difference in therapeutic warfarin dose between ARV-naïve groups—HIV-uninfected and HIV-infected patients not on ARVs. Conclusions There appears to be little effect of HIV infection on warfarin dosing. Warfarin therapy should be administered conventionally in HIV-infected patients. PMID:28179414

  18. Predictors of mortality among HIV infected patients taking antiretroviral treatment in Ethiopia: a retrospective cohort study

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    Biadgilign Sibhatu

    2012-05-01

    Full Text Available Abstract Background Studies indicate that there is high early mortality among patients starting antiretroviral treatment in sub-Saharan Africa. However, there is paucity of evidence on long term survival of patients on anti-retroviral treatment in the region. The objective of this study is to examine mortality and its predictors among a cohort of HIV infected patients on anti-retroviral treatment retrospectively followed for five years. Methods A retrospective cohort study was conducted among HIV infected patients on ART in eastern Ethiopia. Cox regression and Kaplan-Meier analyses were performed to investigate factors that influence time to death and survival over time. Result A total of 1540 study participants were included in the study. From the registered patients in the cohort, the outcome of patients as active, deceased, lost to follow up and transfer out was 1005 (67.2%, 86 (5.9%, 210 (14.0% and 192 (12.8% respectively. The overall mortality rate provides an incidence density of 2.03 deaths per 100 person years (95% CI 1.64 - 2.50. Out of a total of 86 deaths over 60 month period; 63 (73.3% died during the first 12 months, 10 (11.6% during the second year, and 10 (11.6% in the third year of follow up. In multivariate analysis, the independent predictors for mortality were loss of more 10% weight loss, bedridden functional status at baseline, ≤ 200 CD4 cell count/ml, and advanced WHO stage patients. Conclusion A lower level of mortality was detected among the cohort of patients on antiretroviral treatment in eastern Ethiopia. Previous history of weight loss, bedridden functional status at baseline, low CD4 cell count and advanced WHO status patients had a higher risk of death. Early initiation of ART, provision of nutritional support and strengthening of the food by prescription initiative, and counseling of patients for early presentation to treatment is recommended.

  19. Clinical value of determination HIV viral load in the cerebrospinal fluid of HIV-infected patients

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    V. B. Musatov

    2015-01-01

    Full Text Available Aim. To analyze the concentration of HIV RNA in the cerebrospinal fluid and to evaluate its significance in the pathology of the central nervous system among HIV infected persons.Materials: We examined 36 patients with HIV infection with signs of pathology of the central nervous system. All patients was done completed a standard investigation of cerebrospinal fluid, cytological examination and detection viral load of HIV in the cerebrospinal fluid and serum.Results. A different of opportunistic and HIV-related disease was diagnosed in 29 patients. The most frequent pathology of the nervous system (12 cases is a diffuse HIV-associated brain damage occurring in 7 patients in the form of aseptic non purulent meningitis and in 5 patients in the form of encephalitis. The average value of the absolute and relative count of CD4-lymphocytes in patients amounted 147,0 cells/μl (40,0; 408,75 and 10.0% (4,00; 18,50. Pathological changes in cellular composition and protein concentration of cerebrospinal fluid detected in 19 cases. Replication of HIV in the cerebrospinal fluid are detected in 31 of 32 patients not receiving antiretroviral therapy, including 17 patients with normal values of cerebrospinal fluid. The average HIV viral load in the cerebrospinal fluid was 15 133,0 copies/ml (2501,0; 30624,0 or 4,18 (3,35; 4,48 lg HIV RNA, average HIV viral load in serum – 62 784,0 copies/ml (6027,5; 173869,0 or 4,80 4,80 (3,7; 5,2 lg HIV RNA. The concentration of HIV in the cerebrospinal fluid was significantly lower than in serum (4,18 and 4,80 lg HIV RNA, p=0.027. 4 patients with severe, multietiology damage of the central nervous system viral, microbial and fungal etiology, there was an inverse relationship between the concentration of HIV in the cerebrospinal fluid and in serum, the concentrations of HIV was higher in the cerebrospinal fluid.Conclusion: Among the majority of HIV-infected patients with signs of the central

  20. Predicting the risk of cardiovascular disease in HIV-infected patients: the data collection on adverse effects of anti-HIV drugs study

    DEFF Research Database (Denmark)

    Friis-Møller, Nina; Thiébaut, Rodolphe; Reiss, Peter;

    2010-01-01

    aimed to develop cardiovascular risk-assessment models tailored to HIV-infected patients. METHODS AND RESULTS: Prospective multinational cohort study. The data set included 22 625 HIV-infected patients from 20 countries in Europe and Australia who were free of CVD at entry into the Data collection.......670-0.818) for coronary heart disease and 0.769 (0.695-0.824) for CVD. The models estimated more accurately the outcomes in the subgroups than the Framingham score. CONCLUSION: Risk equations developed from a population of HIV-infected patients, incorporating routinely collected cardiovascular risk parameters...

  1. Rituximab plus liposomal doxorubicin in HIV-infected patients with KSHV-associated multicentric Castleman disease

    Science.gov (United States)

    Polizzotto, Mark N.; Aleman, Karen; Wyvill, Kathleen M.; Marshall, Vickie; Whitby, Denise; Wang, Victoria; Pittaluga, Stefania; O’Mahony, Deirdre; Steinberg, Seth M.; Little, Richard F.; Yarchoan, Robert

    2014-01-01

    Kaposi sarcoma (KS) herpesvirus–associated multicentric Castleman disease (KSHV-MCD) is a lymphoproliferative disorder, most commonly seen in HIV-infected patients, that has a high mortality if untreated. Concurrent KS is common. Although rituximab has reported activity in KSHV-MCD, its use is often associated with KS progression. Within a natural history study of KSHV-MCD, we prospectively evaluated rituximab 375 mg/m2 combined with liposomal doxorubicin 20 mg/m2 (R-Dox) every 3 weeks in 17 patients. Patients received a median of 4 cycles (range 3-9). All received antiretroviral therapy, 11 received consolidation interferon-α, and 6 received consolidation high-dose zidovudine with valganciclovir. Using NCI KSHV-MCD response criteria, major clinical and biochemical responses were attained in 94% and 88% of patients, respectively. With a median 58 months’ potential follow-up, 3-year event-free survival was 69% and 3-year overall survival was 81%. During R-Dox therapy, cutaneous KS developed in 1 patient, whereas 5 of 6 patients with it had clinical improvement. R-Dox was associated with significant improvement in anemia and hypoalbuminemia. KSHV viral load, KSHV viral interleukin-6, C-reactive protein, human interleukin-6, and serum immunoglobulin free light chains decreased with therapy. R-Dox is effective in symptomatic KSHV-MCD and may be useful in patients with concurrent KS. This trial was registered at www.clinicaltrials.gov as #NCT00092222. PMID:25331113

  2. Barriers and successful strategies to antiretroviral adherence among HIV-infected monolingual Spanish-speaking patients.

    Science.gov (United States)

    Murphy, D A; Roberts, K Johnston; Hoffman, D; Molina, A; Lu, M C

    2003-04-01

    Focus groups were conducted with HIV-infected, monolingual Spanish-speaking patients (N = 81) taking antiretrovirals in order to: (1) determine what barriers impede medication adherence; (2) determine what strategies facilitate adherence; and (3) investigate the health care provider-patient relationship and whether it impacts adherence. Both quantitative and qualitative information was gathered. Participants were prescribed an average of 11 pills per day (M = 11.4, SD = 7.0, range = 1-30). Only 32% of participants were consistently adherent when self-report of medication taking (yesterday, the day before yesterday, and last Saturday) was compared to prescribed regimen. The most frequently reported strategies were: learning more about the medications (77%), accepting the need to take them (75%) and refilling prescriptions early or on time (70%). Barriers most often reported were: feeling depressed or overwhelmed (21%), simply forgetting (19%) and sleeping through a dose (17%). From the qualitative data, four main issues emerged: patient characteristics, the health care professional-patient relationship, language and cultural barriers within the health care system, and the medication regimen. Among this Latino sample, having someone to live for was extremely important in terms of patient adherence. Language barriers were reported, and the use of translators was not always seen as a sufficient remedy. Differences between monolingual Spanish-speaking patients' and English-speaking patients' strategies and barriers are discussed.

  3. Latent and subclinical tuberculosis in HIV infected patients: a cross-sectional study

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    Kall Meaghan M

    2012-05-01

    Full Text Available Abstract Background HIV and tuberculosis (TB are commonly associated. Identifying latent and asymptomatic tuberculosis infection in HIV-positive patients is important in preventing death and morbidity associated with active TB. Methods Cross-sectional study of one time use of an interferon-gamma release assay (T-SPOT.TB - immunospot to detect tuberculosis infection in patients in a UK inner city HIV clinic with a large sub-Saharan population. Results 542 patient samples from 520 patients who disclosed their symptoms of TB were tested. Median follow-up was 35 months (range 27-69. More than half (55% originated from countries with medium or high tuberculosis burden and 57% were women. Antiretroviral therapy was used by 67%; median CD4 count at test was 458 cells/μl. A negative test was found in 452 samples and an indeterminate results in 40 (7.4% but neither were associated with a low CD4 count. A positive test was found in 10% (50/502 individuals. All patients with positive tests were referred to the TB specialist, 47 (94% had a chest radiograph and 46 (92% attended the TB clinic. Two had culture-positive TB and a third individual with features of active TB was treated. 40 started and 38 completed preventive treatment. One patient who completed preventive treatment with isoniazid monotherapy subsequently developed isoniazid-resistant pulmonary tuberculosis. No patient with a negative test has developed TB. Conclusions We found an overall prevalence of latent TB infection of 10% through screening for TB in those with HIV infection and without symptoms, and a further 1% with active disease, a yield greater than typically found in contact tracing. Acceptability of preventive treatment was high with 85% of those with latent TB infection eventually completing their TB chemotherapy regimens. IGRA-based TB screening among HIV-infected individuals was feasible in the clinical setting and assisted with appropriate management (including preventive

  4. Destructive spondyloarthropathy in a haemodialysis patient with HIV infection: case report and literature review.

    Science.gov (United States)

    Agarwal, V; Gandhi, V

    2013-01-01

    This case describes the presentation, diagnosis and treatment of a 59-year-old man with medical history of HIV/AIDS and hepatitis C on haemodialysis for end stage renal disease who presented with debilitating neck pain radiating down to the left arm with associated weakness of left upper and lower extremities. He had received a prolonged course of intravenous antibiotics for similar complaints. His initial presentation, coupled with the history of recent antibiotics, triggered a non-infectious work-up and the patient was diagnosed with destructive spondyloarthropathy, a rare but under-diagnosed complication of patients on long-term haemodialysis. This was confirmed on imaging studies. The patient refused surgical intervention, and was treated conservatively. With improved survival of patients with HIV infection, other significant co-morbidities like end stage renal disease and their potential complications in these patients have become an increasing focus of attention. Destructive spondyloarthropathy is a severely debilitating condition and can be potentially fatal. The aetiopathogenesis, management and ethical and legal implications of HIV patients with destructive spondyloarthropathy secondary to long-term haemodialysis are discussed.

  5. Assessing the immunological response to hepatitis B vaccination in HIV-infected patients in clinical practice.

    Science.gov (United States)

    Mena, Guillermo; Llupià, Anna; García-Basteiro, Alberto L; Díez, Consolación; León, Agathe; García, Felipe; Bayas, José M

    2012-05-21

    Hepatitis B vaccination is recommended in HIV-infected patients. Achieving seroprotection rates (anti-HBs ≥ 10I U/L) comparable to the general population remains a challenge. The aim of this study was to analyze the proportion of responders among patients infected with HIV receiving primary HBV vaccination and identify factors associated with seroprotection rates. We analyzed the response to vaccination (antiHBs titers) in 474 HIV-infected patients receiving ≥ 1 doses of vaccine between 1994 and 2009. Factors associated with response to vaccination were analyzed using a logistic regression model. Considering the first vaccine courses administered, a response rate of 60.3% (286/474) was obtained. Eighty-seven patients began a second course, responding in 58.6% of cases. Regardless of the number of doses, schedules, and whether or not they completed the course, the response rates were 71.1% (337/474). After adjustment for year of reception of the first dose, responders were less likely to have a higher baseline HIV 1-RNA viral load (OR: 0.78 95% CI: 0.68-0.91) and more likely to have a CD4 count ≥ 350 cells/μL (OR: 1.64, 95% CI: 1.03-3.62). Patients receiving less than three doses of vaccine (OR: 0.31 95% CI 0.15-0.61) or three doses of the rapidly accelerated schedule (OR: 0.35 95% CI 0.15-0.81) had a lower probability of response in comparison with those receiving three doses of an accelerated schedule. In patients diagnosed with HIV, HBV vaccination before evolution to greater immunosuppression (CD4 < 350 cells/μL) or delaying vaccination until the CD4 count is higher could provide better seroprotection rates. The rapidly accelerated vaccination schedule should be used with caution, due to its lower effectiveness. If seroprotection is not achieved after the first course, revaccination seems to be effective in increasing the proportion of responders.

  6. Factors associated with the continuum of care of HIV-infected patients in Belgium

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    Dominique Van Beckhoven

    2014-11-01

    Full Text Available Introduction: We studied factors associated with the continuum of HIV care in Belgium. Methods: Data of the national registration of new HIV diagnosis and of the national cohort of HIV-infected patients in care were combined to obtain estimates of and factors related with proportions of HIV-infected patients in each step of the continuum of care from diagnosis to suppressed viral load (VL. Factors associated with ignorance of HIV seropositivity were analyzed among patients co-infected with HIV and STI in the Belgian STI sentinel surveillance network. Associated factors were identified by multivariate logistic regression. Results: Among 4038 individuals diagnosed with HIV between 2007 and 2010, 90.3% were linked to care. Of 11684 patients in care in 2010, 90.8% were retained in care up to the following year, 88.3% of those were on ART, of whom 95.3% had suppressed VL (<500 cp/ml (Figure 1. In multivariate analyses, factors associated with ignoring HIV+ status were being younger (p<0.001, being heterosexual compared to MSM, and of a region of origin other than Belgium, Sub-Saharan Africa and Europe. Non-Belgian regions of origin were associated with lower entry and retention in care (p<0.001 for both. Preoperative HIV testing was associated with lower entry in care (p=0.003. MSM had a higher retention in care (p<0.001, whilst IDU had lower retention (p=0.004. Low CD4 at first clinical contact and clinical reasons for HIV testing were independently associated with being on ART (p<0.001 for both; whilst prenatal HIV diagnosis was associated with lower proportion on ART (p=0.016 and lower proportion with suppressed VL among those on ART (p=0.005. Older age was associated with both being on ART and having suppressed VL among those on ART (p=0.007 and p<0.001 respectively, independently of time since HIV diagnosis (Table 1. Conclusions: Regions of origin and risk groups (MSM/heterosexual/IDU are the main factors associated with ignorance of HIV

  7. Plasma Mitochondrial DNA Levels as a Biomarker of Lipodystrophy Among HIV-infected Patients Treated with Highly Active Antiretroviral Therapy (HAART).

    Science.gov (United States)

    Dai, Z; Cai, W; Hu, F; Lan, Y; Li, L; Chung, C; Caughey, B; Zhang, K; Tang, X

    2015-01-01

    Lipodystrophy is a common complication in HIV-infected patients taking highly active antiretroviral therapy. Its early diagnosis is crucial for timely modification of antiretroviral therapy. We hypothesize that mitochondrial DNA in plasma may be a potential marker of LD in HIV-infected individuals. In this study, we compared plasma mitochondrial DNA levels in HIV-infected individuals and non-HIV-infected individuals to investigate its potential diagnostic value. Total plasma DNA was extracted from 67 HIV-infected patients at baseline and 12, 24 and 30 months after initiating antiretroviral therapy. Real-time quantitative PCR was used to determine the mitochondrial DNA levels in plasma. Lipodystrophy was defined by the physician-assessed presence of lipoatrophy or lipohypertrophy in one or more body regions. The mitochondrial DNA levels in plasma were significantly higher at baseline in HIV-infected individuals than in non-HIV-infected individuals (pmitochondrial DNA levels in lipodystrophy patients were significantly higher compared to those without lipodystrophy at month 24 (pmitochondrial DNA level (with cut-off value mitochondrial DNA levels may help to guide therapy selection with regards to HIV lipodystrophy risk.

  8. CHAGASIC MENINGOENCEPHALITIS IN AN HIV INFECTED PATIENT WITH MODERATE IMMUNOSUPPRESSION: PROLONGED SURVIVAL AND CHALLENGES IN THE HAART ERA

    Science.gov (United States)

    BUCCHERI, Renata; KASSAB, Maria José; de FREITAS, Vera Lucia Teixeira; da SILVA, Sheila Cristina Vicente; BEZERRA, Rita C.; KHOURY, Zarifa; SHIKANAI-YASUDA, Maria Aparecida; VIDAL, José E.

    2015-01-01

    The reactivation of Chagas disease in HIV infected patients presents high mortality and morbidity. We present the case of a female patient with confirmed Chagasic meningoencephalitis as AIDS-defining illness. Interestingly, her TCD4+ lymphocyte cell count was 318 cells/mm3. After two months of induction therapy, one year of maintenance with benznidazol, and early introduction of highly active antiretroviral therapy (HAART), the patient had good clinical, parasitological and radiological evolution. We used a qualitative polymerase chain reaction for the monitoring of T. cruzi parasitemia during and after the treatment. We emphasize the potential value of molecular techniques along with clinical and radiological parameters in the follow-up of patients with Chagas disease and HIV infection. Early introduction of HAART, prolonged induction and maintenance of antiparasitic therapy, and its discontinuation are feasible, in the current management of reactivation of Chagas disease. PMID:27049711

  9. Trans-abdominal ultrasonic findings correlated with CD4+ counts in adult HIV-infected patients in Benin, Nigeria

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    B O-E Igbinedion

    2009-06-01

    Full Text Available Objective: The objective of this study is to document the abdominal ultrasound findings in HIV infected patients and compare it with their CD4+ count. Patients and method: 300 confirmed HIV positive patients had abdominal ultrasonography done at the University of Benin Teaching Hospital from November 2007 to January 2008. Each patient’s sonographic findings were correlated with their CD4+ category using the WHO’s HIV classification index. Result: Splenomegaly, hepatomegaly, renomegaly, hyperechoic splenic parenchyma, increased renal echogenicity and lymphadenopathy are among the common sonographic findings. However, few of these findings correlated statistically with the CD4+ count. Conclusion: The versatile diagnostic tool, ultrasound, should continue to be an important imaging equipment in several impoverished communities. In the evaluation of HIV infected patients, its use is invaluable and should be promoted.

  10. Long-term high-physiological-dose growth hormone reduces intra-abdominal fat in HIV-infected patients with a neutral effect on glucose metabolism

    DEFF Research Database (Denmark)

    Hansen, Birgitte Rønde; Haugaard, S B; Jensen, Frank Krieger;

    2010-01-01

    OBJECTIVES: The aim of the study was to investigate the effect of long-term high-physiological-dose recombinant human growth hormone (rhGH) therapy on fat distribution and glucose metabolism in HIV-infected patients. METHODS: Forty-six HIV-infected Caucasian men on highly active antiretroviral......, glucose tolerance, and total plasma cholesterol and triglycerides did not significantly change during intervention. CONCLUSIONS: Daily 0.7 mg rhGH treatment for 40 weeks reduced abdominal visceral fat and trunk fat mass in HIV-infected patients. This treatment appeared to be safe with respect to glucose...

  11. FDG-PET imaging in HIV-infected subjects: relation with therapy and immunovirological variables

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    Lucignani, Giovanni; Orunesu, Eva [Neurological Institute Milan, Laboratory of Cellular Neurophysiology, IRCCS Foundation, Milan (Italy); Cesari, Miriam [Univ. of Milan (Italy). Dept. of Clinical Science; Marzo, Katia; Chiti, Arturo [IRCCS Humanitas, Milan (Italy). Dept. of Nuclear Medicine; Pacei, Michela [Milan Univ. (Italy). Lab. of Immunology; Bechi, Giulia [IRCCS Foundation, Milan (Italy). Lab. of Cellular Neurophysiology; Gori, Andrea [Univ. of Milan Biococca, Monza (Italy). Inst. of Infectious Disseases; Gaito, Sabrina [Milan Univ. (Italy). Dept. of Computer Science; Clerici, Mario [Milan Univ. (Italy). Dept. of Biomedical Sciences and Technologies

    2009-04-15

    To characterise tissue sites of immune activation and HIV replication we performed FDG-PET in ART-treated and ART-naive HIV-infected individuals. Specific aims were to establish whether HIV-infected patients can be differentiated on the basis of the detection of specific locations of viral replication, even in the presence of an apparently optimal immunovirological response to ART, and whether these FDG-PET findings can be related to immunovirological variables and AIDS history status. Patients were divided into five groups as follows: subgroup A1 (full responders, n=8): current ART treatment, CD4+ T lymphocytes >500/mL, viral load <50 copies/mL; subgroup A2 (full responders, n=5): same criteria as A-1, but with a previous history of AIDS; subgroup A3 (immunological non responders, n=5): current ART treatment, viral load <50 copies/mL, low CD4+ T lymphocytes (<200/mL); group B (virological non responders, n = 2): current ART treatment, CD4+ T lymphocytes around 500/mL, viral load >50,000 copies/mL; group C (ART-naive, n=5): no current or previous ART treatment, increased viral load. PET images revealed different patterns of FDG uptake. All ART-treated patients with either suppressed (<50 copies/mL; Group A) or high viremia (group B) showed a normal pattern of FDG uptake. On the contrary, the ART-naive subjects with high viraemia (group C) displayed multiple foci of increased glucose metabolism in the lymph nodes. In the ART-naive subjects, FDG uptake, apparently related to viraemia level, was observed in the upper torso mainly in the axillary nodes bilaterally in patients with viraemia below 100,000 copies/mL; in those with viraemia higher than 100,000 copies/mL, FDG uptake was also observed in the inguinal lymph nodes. The emergence, in our study, of a correlation between the percentage of CD8+/CD38+/RO+ T cells (well established markers of progression to AIDS independently of CD4+ T lymphocytes) and positive FDG-PET in ART-naive patients is a novel finding that

  12. Antiretroviral Therapy – Changes of Basic Laboratory Parameters in Hiv-Infected Bulgarian Patients

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    Stojanova Yancheva Nina

    2015-11-01

    Full Text Available HIV-1 infection keeps on being a global problem because of its pandemic character and the impossibility for eradication. The combined antiretroviral therapy (АRТ remains the only treatment which has proven its effectiveness for maintaining the life of HIV positive patients. Because of long term (life time duration of this therapy, it is necessary to monitor patients for possible drug toxicity. The aim of our research is to evaluate the changes of basic laboratory examinations while conducting a long-term АRТ. We analyzed basic laboratory studies of 145 HIV-infected Bulgarian patients in the current research. The patients were separated into four groups according to their treatment regimen. They were on dispensary monitoring and were being treated in the Department for Patients with Acquired Immune Deficiency in the Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases “Prof. Ivan Kirov” - Sofia. Our results showed that combined ART led to changes in blood count, alanin-aminotransferase (ALT, glucose and total cholesterol. Some of these changes are significant for some of the drugs administered. The current ART does not lead to severe toxicity and life-threatening conditions such as those which were observed in the first few years of ART introduction.

  13. Impaired proinsulin secretion before and during oral glucose stimulation in HIV-infected patients who display fat redistribution

    DEFF Research Database (Denmark)

    Haugaard, Steen B; Andersen, Ove; Halsall, Ian;

    2007-01-01

    The beta-cell function of HIV-infected patients on highly active antiretroviral therapy who display lipodystrophy may be impaired. An early defect in beta-cell function may be characterized by an increase in secretion of 32-33 split proinsulin (SP) and intact proinsulin (IP). To address this issue...... of SP and IP during the early phase (0, 10, and 20 minutes) and during the late phase (45, 75, and 105 minutes) of the OGTT compared with NONLIPO patients (Ps

  14. Electron microscopy identification of microsporidia (enterocytozoon bieneusi and cyclospora cayetanensis from stool samples of HIV infected patients

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    Satheeshkumar S

    2004-01-01

    Full Text Available Microsporidia (Enterocytozoon bieneusi and Cyclospora cayetanensis have been reported worldwide causing diarrhoea in AIDS patients. Stool samples from HIV infected patients were subjected to routine examination for parasites, followed by special staining techniques to detect microsporidia and Cyclospora cayetanensis. Confirmed positive cases of these parasites were further processed for electron microscopy identity of the parasites and characteristic details. Scanning and transmission electron microscopy showed better morphological and structural details of the parasites.

  15. Cardiovascular markers of inflammation and serum lipid levels in HIV-infected patients with undetectable viraemia

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    Klaudija Viskovic

    2014-11-01

    Full Text Available Introduction: Successfully treated HIV-infected patients may still have an increased risk for cardiovascular morbidity and mortality, which might be related not only to traditional risks, but also to inflammation and dyslipidemia induced by HIV and/or antiretroviral therapy [1, 2]. We examined the relationship of serum lipid levels with plasma biomarkers of inflammation using a composite inflammatory burden score (IBS from the following seven markers of inflammation: CD40L, tPA, MCP-1, IL-8, IL-6, hCRP and P-selectin. Materials and Methods: Subjects were selected among consecutive HIV-infected males ≥18 years of age with an undetectable viral load (75th percentile were considered elevated and an IBS was constructed as the presence of zero, one, two, or three or more elevated biomarkers. Correlations between the IBS and lipid parameters were examined using Spearman's Rho and by ordered logistic regression proportional odds model to estimate the odds of more elevated (>75th percentile biomarkers. Results: 181 male patients were included into the study, the median age was 46.7 (Q1–Q3, 39.9–55.0 years and the median current CD4 cell count was 553.0 (Q1–Q3, 389–729 per microliter. The patients were mainly treated with two nucleoside reverse transcriptase inhibitor (NRTI plus one non-NRTI (NNRTI (N=100, 60.8% or two NRTI plus lopinavir (N=50, 27.6%. There was a significant correlation between the IBS and serum cholesterol (Rho=0.23, 95% CI, 0.09–0.37, triglycerides (Rho=0.30, 95% CI, 0.16–0.42 and cholesterol/HDL-cholesterol ratio (Rho=0.25, 95% CI 0.11–0.38. In the multivariable model a one unit increase in cholesterol/HDL-cholesterol ratio was associated with a 1.72-fold (95% CI, 1.27–2.33 increased odds of having a greater IBS. One unit increase (mmol/L of cholesterol and triglycerides was associated with a 1.41-fold (95% CI, 1.13–1.76 and 1.37-fold (95% CI, 1.18–1.60 increased odds of having a greater IBS, respectively

  16. Update on current management of chronic kidney disease in patients with HIV infection

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    Diana NE

    2016-09-01

    disease by screening of HIV-positive individuals for the presence of kidney disease is critical for the optimal management of these patients. Screening for the presence of kidney disease upon detection of HIV infection and annually thereafter in high-risk populations is recommended. Keywords: chronic kidney disease, HIV infection, current management

  17. HIV-infected patients show functionally defective high-density lipoprotein (HDL paralleled with changes in HDL-associated proteins

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    V Estrada

    2012-11-01

    Full Text Available Purpose of the study Epidemiological studies have consistently demonstrated an inverse association between plasma HDL concentrations and cardiovascular risk. Although this cardioprotective role has been mainly attributed to its role in promoting cellular cholesterol efflux, there is an emerging interest in the anti-inflammatory and antioxidant properties of HDL. The aim of the study is to investigate the anti-inflammatory properties of HDL isolated from HIV-infected patients. Methods Cross-sectional study of 113 HIV-infected patients and 70 non-infected control subjects without evident CVD. From each subject, HDL was isolated by ultracentrifugation and its anti-inflammatory status was tested as its ability to inhibit MCP-1-induced migration of the monocytic cell line THP-1 using transwell cell culture chamber inserts with micropore filters of 5 microns pore size. HDL-associated proteins were measured by commercial ELISAs. Results Twenty-three HIV-infected patients were ART-naïve (32±15 years, 66.7% male and ninety were currently on ART (46±11 years, 78.9 % male. Most patients on ART (91.1% had undetectable viral load (<50 copies/mL. When compared to healthy subjects, both naïve and treated HIV-infected patients had lower plasma HDL-cholesterol levels (naïve: 45±12, ART: 50±10, controls: 55±10 mg/dL, p<0.05. HDL isolated from HIV naïve patients showed a significantly reduced anti-inflammatory activity (THP-1 monocyte migration capacity was 203% times higher in HIV patients than in control subjects. The anti-inflammatory activity of HDL from ART-treated HIV-infected patients was significantly improved when compared to naïve patients, although it remained significantly lower than controls (130% THP-1 monocyte migration vs controls. HDL from HIV-infected patients had a decreased concentration of the anti-inflammatory proteins Apo A1 (controls: 2.1±0.3, naïve: 1.4±0.2, ART: 1.6±0.1 mg/ml and LCAT (controls: 0.53±0.09, naïve: 0.34±0

  18. The impact of HIV infection on blood leukocyte responsiveness to bacterial stimulation in asymptomatic patients and patients with bloodstream infection

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    Michaëla A M Huson

    2016-05-01

    Full Text Available Introduction: HIV-induced changes in cytokine responses to bacteria may influence susceptibility to bacterial infections and the consequent inflammatory response. Methods: We examined the impact of HIV on whole blood responsiveness to bacterial stimulation in asymptomatic subjects and patients with bacterial bloodstream infection (BSI. Whole blood was stimulated ex vivo with two bacterial Toll-like receptor agonists (lipopolysaccharide and lipoteichoic acid and two pathogens (Streptococcus pneumoniae and non-typhoidal Salmonella, which are relevant in HIV-positive patients. Production of interferon-γ, tumour necrosis factor-α, interleukin-1β and interleukin-6 was used as a read-out. Results: In asymptomatic subjects, HIV infection was associated with reduced interferon-γ, release after stimulation and priming of the pro-inflammatory cytokine response to non-typhoidal Salmonella. In patients with BSI, we found no such priming effect, nor was there evidence for more profound sepsis-induced immunosuppression in BSI patients with HIV co-infection. Conclusions: These results suggest a complex effect of HIV on leukocyte responses to bacteria. However, in patients with sepsis, leukocyte responses were equally blunted in patients with and without HIV infection.

  19. Electrocardiographic spatial QRS-T angle and incident cardiovascular disease in HIV-infected patients (from the Strategies for the Management of Antiretroviral Therapy [SMART] study)

    DEFF Research Database (Denmark)

    Dawood, Farah Z; Khan, Faraaz; Roediger, Mollie P;

    2013-01-01

    the baseline resting 12-lead electrocardiogram of 4,453 HIV-infected patients aged 43.5 ± 9.3 years from the Strategies for Management of Antiretroviral Therapy (SMART) trial. CVD events were identified during a median follow-up of 28.7 months. Quartiles of the spatial QRS-T angle was calculated for men...... was independently predictive of CVD events in HIV-infected patients receiving antiretroviral therapy. This highlights the potential role of routine electrocardiography as a simple noninvasive CVD risk-screening tool in HIV-infected patients.......Widening of the electrocardiographic (ECG) spatial QRS-T angle has been predictive of cardiovascular disease (CVD) events in the general population. However, its prognostic significance in human immunodeficiency virus (HIV)-infected patients remains unknown. The spatial QRS-T angle was derived from...

  20. Single-dose fluconazole versus standard 2-week therapy for oropharyngeal candidiasis in HIV-infected patients: a randomized, double-blind, double-dummy trial.

    NARCIS (Netherlands)

    Hamza, O.J.; Matee, M.I.N.; Bruggemann, R.J.M.; Moshi, M.J.; Simon, E.N.; Mugusi, F.; Mikx, F.H.M.; Lee, H.A.L. van der; Verweij, P.E.; Ven, A.J.A.M. van der

    2008-01-01

    BACKGROUND: Oropharyngeal candidiasis is the most common opportunistic infection affecting patients with human immunodeficiency virus (HIV) infection. Because of convenience, cost, and reluctance to complicate antiretroviral treatment regimens, single-dose fluconazole may be a favorable regimen for

  1. High seroprevalence of human herpes virus 8 (HHV-8 antibodies among vertically HIV-infected pediatric patients living in Germany

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    C Feiterna-Sperling

    2012-11-01

    Full Text Available Background: Human herpes virus 8 (HHV-8, a gamma herpes virus, is the etiological agent for Kaposi sarcoma (KS. HIV-infected adults with advanced immunodeficiency are at risk. Prevalence data of HHV-8 infection in HIV-infected children living in non-endemic areas are limited. Serologic studies indicate low seroprevalence rates of 3–4% for healthy children living in United States and Germany [1]. Purpose of the study: The aim of the study was to determine the seroprevalence of HHV-8 antibodies among vertically HIV-infected pediatric patients in Germany and to evaluate their association with age, gender, ethnicity, and other demographic factors. Methods: In 2012, a multi-center cross-sectional study was conducted in four University Hospitals in Germany. Stored frozen serum specimens obtained from vertically HIV-infected children and adolescents were tested for antibodies against lytic and latent HHV-8 antigens. Data on patients' demographic characteristics and medical history were recorded. Results: A total of 214 HIV-infected children and adolescents (105 males, 109 females were included. The median age was 10.2 years (range 1 months–22.6 years. A high proportion of these children (62% was born in Western Europe, whereas 65% (139/214 of their mothers were born in countries outside Western Europe. The majoritiy (91% of the children had been treated with highly active antiretroviral therapy and 55.2% (116/210 had a HIV-viral load<50 copies/mL. The median CD4 cell count was 1000/L (range 3–4400. The overall seroprevalence of HHV-8 antibodies was 23.8% (51/214. Seroprevalence rates did not show significant differences between age or gender. In the group of young children aged 1 month to 35 months, 19.4% (46/31 had HHV-8 antibodies, compared to 25% (25/100 in children aged 36 months to 11 years, and 24.1% (20/83 children 12 years and older. In the study group, seroprevalence rates were significantly lower in children who were born in Western

  2. Risk factors for disseminated histoplasmosis in a cohort of HIV-infected patients in French Guiana.

    Science.gov (United States)

    Nacher, Mathieu; Adenis, Antoine; Blanchet, Denis; Vantilcke, Vincent; Demar, Magalie; Basurko, Célia; Gaubert-Maréchal, Emilie; Dufour, Julie; Aznar, Christine; Carme, Bernard; Couppié, Pierre

    2014-01-01

    Disseminated histoplasmosis is the first AIDS-defining infection in French Guiana. A retrospective cohort study studied predictive factors of disseminated histoplasmosis in HIV-infected patients between 1996 and 2008. Cox proportional hazards models were used. The variables studied were age, sex, last CD4/CD8 count, CD4 nadir, herpes or pneumocystosis, cotrimoxazole and fluconazole use, antiretroviral treatment and the notion of recent initiation of HAART. A total of 1404 patients were followed for 6833 person-years. The variables independently associated with increased incidence of disseminated histoplasmosis were CD4 counthistoplasmosis were antiretroviral treatment for more than 6 months, fluconazole treatment, and pneumocystosis. There were 13.5% of deaths at 1 month, 17.5% at 3 months, and 22.5% at 6 months after the date of diagnosis of histoplasmosis. The most important predictive factors for death within 6 months of diagnosis were CD4 counts and antiretroviral treatment. The present study did not study environmental/occupational factors but provides predictive factors for disseminated histoplasmosis and its outcome in HIV patients in an Amazonian environment during the HAART era.

  3. Risk factors for disseminated histoplasmosis in a cohort of HIV-infected patients in French Guiana.

    Directory of Open Access Journals (Sweden)

    Mathieu Nacher

    Full Text Available Disseminated histoplasmosis is the first AIDS-defining infection in French Guiana. A retrospective cohort study studied predictive factors of disseminated histoplasmosis in HIV-infected patients between 1996 and 2008. Cox proportional hazards models were used. The variables studied were age, sex, last CD4/CD8 count, CD4 nadir, herpes or pneumocystosis, cotrimoxazole and fluconazole use, antiretroviral treatment and the notion of recent initiation of HAART. A total of 1404 patients were followed for 6833 person-years. The variables independently associated with increased incidence of disseminated histoplasmosis were CD4 count<50 per mm3, CD4 count between 50 and 200 per mm3, a CD4 nadir <50 per mm3, CD8 count in the lowest quartile, herpes infection, and recent antiretroviral treatment initiation (less than 6 months. The variables associated with decreased incidence of histoplasmosis were antiretroviral treatment for more than 6 months, fluconazole treatment, and pneumocystosis. There were 13.5% of deaths at 1 month, 17.5% at 3 months, and 22.5% at 6 months after the date of diagnosis of histoplasmosis. The most important predictive factors for death within 6 months of diagnosis were CD4 counts and antiretroviral treatment. The present study did not study environmental/occupational factors but provides predictive factors for disseminated histoplasmosis and its outcome in HIV patients in an Amazonian environment during the HAART era.

  4. Low prevalence of peripheral arterial disease in a cross-sectional study of Danish HIV-infected patients

    DEFF Research Database (Denmark)

    Knudsen, Andreas; Malmberg, Catarina Anna Evelina; Kjær, Andreas

    2015-01-01

    . However, controversies exist on the prevalence of PAD among HIV-infected patients. In this study we aimed to measure the prevalence of PAD among HIV-infected patients and compare the ABI with carotid intima-media thickness (cIMT) and other known CVD risk predictors. METHODS: We prospectively included HIV...... patients included (mean age 52 years, 75% male, 94% receiving antiretroviral therapy (ART), 33% active smokers), 1 had a pre-exercise ABI ≤ 0.9 and in addition 3 patients had a post-exercise ABI ≤ 0.9. We found a poor correlation between ABI and traditional CVD risk factors other than body mass index....... In contrast, a strong correlation was found between cIMT and traditional risk factors. Values of post-exercise ABI and cIMT were not correlated. The current ART did not influence ABI values. CONCLUSIONS: We found a low prevalence of PAD in HIV-infected patients. ABI did not correlate with CVD risk factors...

  5. Low acute toxicity of radiotherapy and radiochemotherapy in patients with cancer of the anal canal and HIV-infection

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    Hoecht, S.; Wiegel, T.; Hinkelbein, W. [Abt. Strahlentherapie, Universitaetsklinikum Benjamin Franklin der Freien Univ. Berlin (Germany); Kroesen, A.J.; Runkel, N. [Abt. Allgemein- Thorax- und Gefaesschirurgie, Universitaetsklinikum Benjamin Franklin der Freien Univ. Berlin (Germany); Berdel, W.E. [Abt. Innere Medizin mit Schwerpunkt Haematologie und Onkologie, Universitaetsklinikum Benjamin Franklin der Freien Univ. Berlin (Germany)

    1997-12-31

    Although not an AIDS-defining malignancy, anal cancer is an evolving problem in HIV-infected patients. Treatment-tolerance to radiotherapy as well as to chemotherapy is supposed to be reduced in patients with HIV-infection. From January 1995 to January 1997, four patients with epidermoid cancer of the anal canal and a long history of HIV-infection but without symptoms of AIDS or repeated severe infections were treated with radiotherapy (n=1) or radiochemotherapy (n=3). External beam radiotherapy with 45 Gy to the tumor and pelvic as well as inguinal lymphatic drainage was administered. In tumors larger than T2 N0 lesions an additional boost of 9 Gy was given. Chemotherapy consisted of 5-fluorouracil 1000 mg/m{sup 2}/24 h, d 1-4 two cycles and Mitomycin C either 1 x 15 mg/m{sup 2}, d 1 in the first, or 2 x 10 mg/m{sup 2}, d 1, in the first and fifth week of radiotherapy. Acute reactions were mild to moderate in all patients and all but one treatment could be given as scheduled (1 patient with a delay of 4 days). No excessive acute reactions were seen. Because of the short follow-up, late reactions and local control are not yet evaluable. (orig.).

  6. Increased mitochondrial DNA content in peripheral blood lymphocytes from HIV-infected patients with lipodystrophy.

    Science.gov (United States)

    Cossarizza, Andrea; Riva, Agostino; Pinti, Marcello; Ammannato, Silvia; Fedeli, Paolo; Mussini, Cristina; Esposito, Roberto; Galli, Massimo

    2003-08-01

    We have evaluated mitochondrial (mt) DNA content in CD4 and CD8 peripheral blood lymphocytes (PBLs) from HIV-infected patients taking highly active antiretroviral therapy (HAART) who display different types of adipose tissue alterations. A cross-sectional study was performed in a total of 23 patients with lipodystrophy (LD): nine patients with fat accumulation, six patients with fat loss, eight patients with combined form, who were compared to 11 individuals infected by HIV without LD (HIV-positive) and 10 seronegative controls (CTRL). PBLs were obtained by standard methods, that is, gradient density centrifugation on Ficoll, and CD4 or CD8 cells were positively isolated by magnetic sorting to eliminate the contamination of platelets. mtDNA content was then measured by an original assay based upon real-time PCR. mtDNA content was significantly increased in CD4 T cells from patients with LD, while no differences were present between CD4 and CD8 cells from HIV-positive and CTRL individuals. Nor were any differences found when comparing LD or HIV-positive patients treated with stavudine or zidovudine, or taking D-drugs or non D-drugs. Patients with fat accumulation had significantly higher mtDNA content compared to HIV-positive and CTRL, this phenomenon regarding both CD4 and CD8 PBLs. Considering all HIV-positive patients (including LD), mtDNA content showed a significant, positive correlation with cholesterolaemia but not with triglyceridaemia and glycaemia. Relatively high mtDNA content in LD patients, as well as the correlation between mtDNA content and cholesterol in all HIV-positive subjects, suggest the involvement of mitochondria in such a pathology. However, further studies are needed to confirm these initial observations and ascertain whether the quantification of mtDNA in PBL is a useful and reliable marker to investigate and monitor HAART-related changes in fat distribution.

  7. Correlation analysis on total lymphocyte count and CD4 count in HIV-infected patients: a retrospective evaluation.

    Science.gov (United States)

    Wang, Yuming; Liang, Shuying; Yu, Erman; Guo, Jinling; Li, Zizhao; Wang, Zhe; Du, Yukai

    2011-10-01

    CD4 count is the standard method for determining eligibility for highly active antiretroviral therapy (HAART) and monitoring HIV/AIDS disease progression, but it is not widely available in resource-limited settings. This study examined the correlation between total lymphocyte count (TLC) and CD4 count of HIV-infected patients before and after HAART, and assessed the thresholds of TLC for making decisions about the initiation and for monitoring HAART. A retrospective study was performed, and 665 HIV-infected patients with TLC and CD4 count from four counties (Shangcai, Queshan, Shenqiu and Weishi) were included in the study. Pearson correlation and receiver operating characteristic (ROC) were used. TLC and CD4 count after HAART was significantly increased as compared with pre-HAART (PHIV-infected individuals for making decisions about the initiation and for monitoring HAART in resource-limited settings.

  8. Inflammation in HIV-infected patients: impact of HIV, lifestyle, body composition, and demography - a cross sectional cohort study.

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    Anne Langkilde

    Full Text Available To examine mechanisms underlying the increased inflammatory state of HIV-infected patients, by investigating the association of HIV-related factors, demography, lifestyle, and body composition with the inflammatory marker soluble urokinase plasminogen activator receptor (suPAR.suPAR was measured in EDTA-plasma and associated with HIV-related factors (HIV-duration, combination antiretroviral treatment (cART, nadir CD4+ cell count, CD4+ cell count, and HIV RNA; demography; lifestyle; and body composition determined by Dual energy X-ray Absorptiometry (DXA scan, in multiple linear regression analyses adjusted for biological relevant covariates, in a cross-sectional study of 1142 HIV-infected patients.Increased suPAR levels were significantly associated with age, female sex, daily smoking, metabolic syndrome and waist circumference. cART was associated with 17% lower suPAR levels. In cART-treated patients 10-fold higher HIV RNA was associated with 15% higher suPAR, whereas there was no association in untreated patients. Patients with CD4+ cell count <350 cells/µL had higher suPAR levels than patients with CD4+ cell count ≥350 cells/µL , though not significantly. We found no association with nadir CD4+ cell count or with duration of HIV-infection [corrected]. Finally, suPAR was not associated with adipose tissue distribution, but strongly associated with low leg muscle mass [corrected].In patients infected through intravenous drug use (IDU, CD4+ cell counts ≥350 cells/µL were associated with 27% lower suPAR (p = 0.03, andsuPAR was 4% lower pr. year during treatment (p = 0.05; however, there was no association with HIV RNA, duration of HIV-infection, nor cART [corrected].We found elevated suPAR levels in untreated patients compared to patients on cART. Moreover, we observed a significant positive association between suPAR and HIV RNA levels in cART-treated patients. Age, HIV-transmission through IDU, metabolic syndrome, smoking, and low leg

  9. Nutritional status, symptoms experienced and general state of health in HIV-infected patients.

    Science.gov (United States)

    Karlsson, A; Nordström, G

    2001-09-01

    The aim of the study was to describe HIV-infected patients with respect to nutritional status, symptoms experienced, general state of health, and relevant medical and laboratory data. An additional aim was to study the relationships between some of these variables. On admission to an acute care hospital in Sweden, 25 HIV-positive men were consecutively included in the study. Medical data, anthropometric variables such as weight, height, body mass index (BMI) and percentage weight loss were studied. The following instruments were used: the subjective global assessment (SGA) was used to determine nutritional status; the oral assessment guide (OAG) was used for subjective assessment of the oral cavity; and the numeric rating scale (NRS) was used to assess the symptoms experienced. The Health Index (HI) was used to evaluate general state of health. The results showed that more than half of the patients had suspected/severe malnutrition; between 48% and 72% complained of moderate to severe symptoms of various kinds. Two thirds felt their general state of health was rather poor or very poor. Correlations showed that the lower the BMI, the worse the nutritional status (SGA); the greater the weight loss in percent, the worse the nutritional status (SGA); and the worse the general state of health (HI), the worse the nutritional status (SGA). In conclusion, it is important that nurses have good knowledge concerning nutritional problems in order to be able to detect these conditions at an early stage and/or to endeavour to prevent them.

  10. Proteomic profiling of pretreatment serum from HIV-infected patients identifies candidate markers predictive of lymphoma development

    DEFF Research Database (Denmark)

    Vase, Maja Ølholm; Ludvigsen, Maja; Bendix, Knud;

    2016-01-01

    Objective: HIV-infected individuals have an increased risk of developing lymphoma. We sought to identify markers predictive of lymphoma development by comparing protein expression patterns in serum obtained at the time of HIV diagnosis from patients who later developed malignant lymphoma or benign...... protein spots were detected. Using principal components analysis, spots containing immunoglobulin J chain, apolipoprotein A-I, procollagen C-endopeptidase enhancer-1 and complement C4-A were associated with lymphoma development (P...

  11. Dermatological manifestations in HIV-infected patients at a tertiary care hospital in a tribal (Bastar region of Chhattisgarh, India

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    Singh Harminder

    2009-01-01

    Full Text Available Background: Cutaneous disorders during HIV infection are numerous and skin is often the first and only organ affected during most of the course of HIV disease. Some Cutaneous disorders reflect the progression of HIV disease; though the relation is still controversial. Aims : The objective of this study, conducted at a tertiary care centre in Bastar, Jagdalpur, is to estimate the status of cutaneous manifestation in HIV-infected patients and its relationship with CD4 cell counts. Methods: We enrolled 137 HIV positive subjects. Demographic information such as age, gender, weight, height, socioeconomic status, and educational status were recorded. Laboratory parameter (CD4 counts and treatment regimen were noted. Patients were examined for skin disorders by a dermatologist. Data were analyzed using chi-square test for categorical variables. Results: Majority of the patients were from rural area (65.69% and belonged to a low socioeconomic and educational status. 30.65% of the patients were housewives, 23.35% drivers, and 16.78% labourers. Predominant mode of transmission was heterosexual contact (94.16%. Most common HIV-related dermatological manifestations were seborrheic dermatitis (74.16%, xerosis (52.5%, generalized skin hyperpigmentation 56 (46.67%, onychomycosis 53 (44.16%, pruritic papular eruption 27 (22.5%, oral candidiasis 21 (17.5%, photo dermatitis 21 (17.5%, and scabies 4 (3.33%. Significant correlation with low CD4+ cell counts was found for oral candidiasis (P < 0.0001 and Kaposi′s sarcoma ( P = 0.03, while other disorders such as seborrheic dermatitis ( P = 0.22, xerosis ( P = 0.25, and onychomycosis (P = 0.08 were not statistically significant. Conclusion : This study showed high prevalence of dermatological manifestations in HIV-infected subjects, and they occur more frequently with progression of HIV and decline in immune functions. Therefore, early diagnosis and management of skin disorders can improve the quality of life of

  12. Prevalence of HLA-B*57:01 allele in HIV-infected patients in a university hospital in Tehran

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    Mahboobeh Haji-Abdolbaghi

    2014-04-01

    Conclusion: Frequency of HLA-B*57:01 allele among a group of Iranian HIV-infected patients is estimated to be 2.5%. This rate is comparable to those reported in other Middle-Eastern countries, yet is relatively lower than reports generated from South-Eastern Asia, Europe, and the United States. Future studies with larger sample sizes are needed to corroborate these findings.

  13. Glucose production, oxidation and disposal correlate with plasma lactate levels in HIV-infected patients on HAART

    DEFF Research Database (Denmark)

    Haugaard, S.B.; Andersen, Ove; Madsbad, Sten

    2007-01-01

    .g. glucose turnover may contribute to hyperlactatemia. METHODS: HIV-infected patients receiving HAART who had lipodystrophy (LIPO, n=18) or were without lipodystrophy (NONLIPO, n=18) were investigated. Insulin sensitivity (M-value), glucose oxidation rate (GOX) and fasting endogenous glucose production (EGP...... inversely with M-value (P0.5) during clamp. Incremental (clamp minus fasting value) GOX (P....01) was decreased and incremental insulin (P

  14. Analysis of causes of death among HIV-infected patients of Kiev Regional AIDS Center during 2013

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    Tetiana Stepchenkova

    2014-11-01

    Full Text Available Ukraine is a leader in Europe in the prevalence of HIV infection. There are up to 270 thousand people, who are living with HIV. Since 1987, in Ukraine, 33,149 HIV-infected people died. During the first six months of 2013, of all the dead, who were suffering from HIV and in need of antiretroviral treatment (ART at the time of death, 41% received treatment and only 5.7% received ART for more than one year. Specialists of Kiev Regional AIDS Center analyzed mortality among the patients of the centre, in order to determine the most frequent cause of death, set the group most at risk and to develop effective measures to reduce mortality among HIV-infected patients. In Kiev AIDS Center, 10,000 people are under medical observation and 4004 of them are taking ART. During 2013, 305 persons died: 217 were women and 88 were men which included 3 children under 14 years. Most of the dead – 272 (89% were aged 25–49. Among the total number of the dead, 125 people (41% were receiving ART, 53 of them (17% were receiving ART for at least one year and 39 of them (13% were receiving ART for less than one month. Hundred and fifty-eight people (52% required ART and 22 (7% did not need therapy. Hundred and ninety-two patients (63% were in four clinical stage of HIV infection. Hundred and ten of them had HIV+TB co-infection. Twenty patients died due to TB and 12 patients died due to hepatitis b virus/hepatitis c virus (HBV/HCV. Among these patients, 87 people (39% were taking ART and 136 persons (61% were in need of ART, but did not get it. Nineteen patients were diagnosed with cancer. Sixteen patients, who were co-infected HIV+TB had a CD4 cell count of more than 300. Based on this analysis, we can conclude that the main causes of high mortality among HIV-infected patients in 2013 were late diagnosis of HIV, besides a large number (52% of patients, who were in need of ART did not take it. A large number (40% among those who died were patients co-infected with HIV

  15. Comparison of oral manifestations with CD4 count in HIV-infected patients

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    Subodh Arun Sontakke

    2011-01-01

    Full Text Available Aim and Objective: This study was carried out with the primary aim of correlating oral changes and general changes of HIV-infected patients with their CD4 count. Materials and Methods: 124 patients were selected, and after taking their informed consent, they were subjected to detailed history taking and thorough clinical examination. Specific oral lesions and general physical changes were recorded. Every patient was subjected to laboratory investigation for CD4 count. All these findings were tabulated. The clinical observation and laboratory findings were subjected to critical analysis and correlated. Statistical test, i.e. Student′s " t" test, was applied and objective conclusions were drawn. Result: Out of 124 patients, 40 had oral candidiasis, 6 had oral hairy leukoplakia, 12 had periodontal disease, 20 had xerostomia, 30 had melanin pigmentation, while 4 had HSV2, and atypical ulceration. Out of 40 patients with oral candidiasis, 28 patients had CD4 count 500 cell/mm 3 . Oral hairy leukoplakia occurred in equal proportions in group A and B. These periodontal diseases were more commonly in group B; xerostomia and melanin pigmentation was equally seen in group A and B. Conclusion: Oral candidiasis, oral hairy leukoplakia, linear gingival erythema, necrotizing ulcerative gingivitis, and necrotizing ulcerative periodontitis are specific oral indicators which will definitely suggest to the dental surgeon that the disease is running a rapid downhill course and due to this the oral physician is in a position to raise a suspicion and alert the general physician regarding the declining immune status of patient.

  16. [Adherence as a result of a "particular relationship". HIV-infected patients about their physician-patient relationship].

    Science.gov (United States)

    Engelbach, Ute; Dannecker, Martin; Kaufhold, Johannes; Lenz, Cynthia; Grabhorn, Ralph

    2008-06-01

    This qualitative study examines the relationship between doctors and HIV-infected patients with regard to problems of adherence. Objective hermeneutics was used to analyze the scene of a doctor-patient conversation produced through psychodrama. Specific traits shared by the patients in question were a confused regulation of closeness and distance as well as a non-maintenance of the traditional asymmetry within the doctor-patient relation. The patients faced the doctors on a level of diffuse social relations and showed the tendency to involve the doctor into their community. The conclusion for a model explaining patients' adherence may be: it exist an individual level of the need for being accepted by the doctor as somebody particular. If this level is reached, i. e. individual claims are met and personal desires are satisfied, the patient will follow the physician's advice. Authors discuss whether the model is compatible with the conflict of self-esteem.

  17. [Prevalence of microsporidia and other intestinal parasites in patients with HIV infection, Bogota, 2001].

    Science.gov (United States)

    Flórez, Astrid Carolina; García, Dabeiba Adriana; Moncada, Ligia; Beltrán, Mauricio

    2003-09-01

    Opportunistic intestinal parasites are a common cause of diarrhea in HIV-infected patients. To determine the prevalence of microsporidia and other opportunistic parasites infecting HIV patients in Bogotá, Colombia, 115 patients were examined for these infections during the year 2001. The institution and the sample percent from each are as follows: Santa Clara Hospital, 33.0%; San Pedro Claver, 20.0%; Simón Bolívar Hospital, 14.8%; San José Hospital, 13.9%; Central de la Policía Hospital, 6.1%; Compensar, 5.2%; Colombian League against AIDS, 2.6%; San Ignacio Hospital, 2.6%, and the Military Hospital, 1.7%. The average patient age was 36 years, with a range from 18 to 71 years. Patients with complaint of gastrointestinal symptoms were asked to provide two consecutive stool samples. The samples were concentrated in formalin-ether and examined microscopically for intestinal coccidian parasites by direct wet slide mounts. The prevalence of intestinal opportunistic parasites was 10.4% for Cryptosporidium sp. Initially, 29% of the samples were found to be positive for microsporidian spores using a modified Ziehl Neelsen chromotrope stain, but only 3.5% of them were confirmed as positive when a calcofluor/Gram chromotrope stain was used. The general prevalence of intestinal parasites was 59.1%. The most frequently found pathogens were Blastocystis hominis, 25.2%, and Entamoeba histolytica, 13%. In other studies with HIV patients in Colombia, lower prevalences of Cryptosporidium sp. infection were observed.

  18. [Profile of HIV infected patients among blood donors in Abidjan, Côte d'Ivoire (1992-1999)].

    Science.gov (United States)

    Minga, A K; Huët, C; Coulibaly, I; Abo, Y; Dohoun, L; Bonard, D; Gourvellec, G; Coulibaly, Y; Konaté, S; Dabis, F; Bondurand, A; Salamon, R

    2005-06-01

    The FonSIDA is a private clinic created in 1992 within the premises of the National Blood Transfusion Center of Abidjan (CNTS), the largest city in Côte d'Ivoire. It provides medical and psychological follow-up for blood donors which are diagnosed as HIV-infected. This Centre provides blood for transfusions in Abidjan and the surrounding area, which from 1992 to 1999 collected 263,398 blood units. In this period, 5574 subjects were detected HIV-positive. Among those, 1766 (32%) HIV infected blood donors came back to be tested for confirmation of HIV diagnosis. Since then, only 9% of the 5574 donors have been seen at least twice a year for medical and psychological follow-up. Women were more compliant than men in the FonSIDA Clinic: they constituted 62% of the 409 patients who were followed-up (p < 0.001). 53% of men had sex with prostitutes the year before HIV diagnosis. 67% of women stated voluntary abortion at least once. In the same period the systematic use of condoms was reported by only 7% of women and 5% of men. 22% of women and 28% of men reported having two or more sexual partners in the year before HIV diagnosis. The main aim of every blood center is to improve blood safety, particularly in developing countries. The appropriate counseling towards blood donors and especially those detected HIV positive can contribute to reduce new HIV infections in high HIV prevalence cities. Rate of compliance of HIV-infected patients to follow-up has risen to 11% in 1992-1994 to 60% in 1997-1999 and will contribute to reach this aim.

  19. Antiretroviral Treatment-Associated Tuberculosis in a Prospective Cohort of HIV-Infected Patients Starting ART

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    William Worodria

    2011-01-01

    Full Text Available Commencement of antiretroviral treatment (ART in severely immunosuppressed HIV-infected persons is associated with unmasking of subclinical disease. The subset of patients that are diagnosed with tuberculosis (TB disease while on ART have been classified as ART-associated TB. Few studies have reported the incidence of ART-associated TB and unmasking TB-IRIS according to the International Network for the Study of HIV-Associated IRIS (INSHI consensus definition. To determine the incidence and predictors of ART-associated TB, we screened 219 patients commencing ART at the Infectious Diseases Clinic in Kampala, Uganda for TB by symptoms, sputum microscopy, and chest X-rays and followed them for one year. Fourteen (6.4% patients were diagnosed with TB during followup. Eight (3.8% patients had ART-associated TB (incidence rate of 4.3 per 100 person years; of these, three patients fulfilled INSHI criteria for unmasking TB-associated IRIS (incidence rate of 1.6 per 100 person years. A body mass index of less than 18.5 kg/m2 BMI (HR 5.85 95% CI 1.24–27.46, P=.025 and a C-reactive protein greater than 5 mg/L (HR 8.23 95% CI 1.36–38.33, P=.020 were risk factors for ART-associated TB at multivariate analysis. In conclusion, with systematic TB screening (including culture and chest X-ray, the incidence of ART-associated TB is relatively low in settings with high HIV and TB prevalence.

  20. Antiretroviral treatment-associated tuberculosis in a prospective cohort of HIV-infected patients starting ART.

    Science.gov (United States)

    Worodria, William; Massinga-Loembe, Marguerite; Mayanja-Kizza, Harriet; Namaganda, Jane; Kambugu, Andrew; Manabe, Yukari C; Kestens, Luc; Colebunders, Robert

    2011-01-01

    Commencement of antiretroviral treatment (ART) in severely immunosuppressed HIV-infected persons is associated with unmasking of subclinical disease. The subset of patients that are diagnosed with tuberculosis (TB) disease while on ART have been classified as ART-associated TB. Few studies have reported the incidence of ART-associated TB and unmasking TB-IRIS according to the International Network for the Study of HIV-Associated IRIS (INSHI) consensus definition. To determine the incidence and predictors of ART-associated TB, we screened 219 patients commencing ART at the Infectious Diseases Clinic in Kampala, Uganda for TB by symptoms, sputum microscopy, and chest X-rays and followed them for one year. Fourteen (6.4%) patients were diagnosed with TB during followup. Eight (3.8%) patients had ART-associated TB (incidence rate of 4.3 per 100 person years); of these, three patients fulfilled INSHI criteria for unmasking TB-associated IRIS (incidence rate of 1.6 per 100 person years). A body mass index of less than 18.5 kg/m(2) BMI (HR 5.85 95% CI 1.24-27.46, P = .025) and a C-reactive protein greater than 5 mg/L (HR 8.23 95% CI 1.36-38.33, P = .020) were risk factors for ART-associated TB at multivariate analysis. In conclusion, with systematic TB screening (including culture and chest X-ray), the incidence of ART-associated TB is relatively low in settings with high HIV and TB prevalence.

  1. Metabolic syndrome in HIV-infected patients receiving antiretroviral therapy in Latin America

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    C Alvarez

    2010-06-01

    Full Text Available OBJECTIVE: To evaluate the prevalence of and the associated factors for metabolic syndrome (MS among Latin American HIV-infected patients receiving antiretroviral therapy (ART using baseline data from the RAPID II study. METHODS: A longitudinal study to evaluate the metabolic profile, cardiovascular disease (CVD risk and associated treatment practices to reduce this risk has been conducted in seven Latin American countries (the RAPID II study. Adult HIV patients with at least six months of RT were enrolled. MS was defined following ATP-III criteria. Demographic and anthropometric data, serum biochemical and clinical parameters were compared in patients with and without MS using bivariate and multivariate analysis. RESULTS: A total of 4,010 patients were enrolled, 2,963 (74% were males. Mean age (SD was 41.9 (10.0 years. The prevalence of MS was 20.2%. Females had higher prevalence of MS than males (22.7% vs. 19.4%, p = 0.02. MS was driven by high triglycerides, low HDL-cholesterol and high blood pressure (HBP. Patients with MS had higher 10year CVD risk: 22.2% vs. 7.4%, p < 0.001. Age (OR: 1.05 per year, female gender (OR: 1.29, family history of CVD (OR: 1.28, CD4 cell count (OR: 1.09 per 100 cell increase, and protease inhibitor based-ART (OR: 1.33 correlated with MS in the multivariate analysis. CONCLUSIONS: Prevalence of MS in this setting was similar to that reported from developed countries. MS was driven by high triglycerides, low-HDL and HBP, and it was associated with higher risk of CVD. Traditional risk factors, female gender, immune reconstitution, and protease inhibitor based-ART correlated with MS.

  2. Acute tubular nephropathy in a patient with acute HIV infection: review of the literature.

    Science.gov (United States)

    Ananworanich, Jintanat; Datta, Anandita A; Fletcher, James Lk; Townamchai, Natavudh; Chomchey, Nitiya; Kroon, Eugene; Sereti, Irini; Valcour, Victor; Kim, Jerome H

    2014-01-01

    We report a 57-year old man with diabetes mellitus and hypertension who presented with acute HIV infection. Routine blood tests showed an elevated blood urea nitrogen and creatinine. Renal biopsy showed acute tubular nephropathy, which has not been reported to occur during acute HIV infection, in the absence of rhabdomyolysis or multiple organ system failure. Antiretroviral therapy was initiated. His renal failure gradually resolved without further intervention. At one year of follow-up his HIV RNA was undetectable, and his renal function was normal. The case illustrates a rare manifestation of acute HIV infection - acute renal failure - in an older man with diabetes and hypertension. In this setting acute kidney injury might mistakenly have been attributed to his chronic comorbidities, and this case supports early HIV-1 testing in the setting of a high index of suspicion.

  3. Nutritional and metabolic correlates of cardiovascular and bone disease in HIV-infected patients.

    Science.gov (United States)

    Fitch, Kathleen; Grinspoon, Steven

    2011-12-01

    The treatment of HIV infection has dramatically reduced the incidence of AIDS-related illnesses. At the same time, non-AIDS-related illnesses such as cardiovascular and bone disease are becoming more prevalent in this population. The mechanisms of these illnesses are complex and are related in part to the HIV virus, antiretroviral medications prescribed for HIV infection, traditional risk factors exacerbated by HIV, and lifestyle and nutritional factors. Further prospective research is needed to clarify the mechanisms by which HIV, antiretroviral medications, and nutritional abnormalities contribute to bone and cardiovascular disease in the HIV population. Increasingly, it is being recognized that optimizing the treatment of HIV infection to improve immune function and reduce viral load may also benefit the development of non-AIDS-related illnesses such as cardiovascular and bone disease.

  4. Transplante renal em pacientes infectados pelo HIV Kidney transplantation in HIV infected patients

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    Carina Nilsen Moreno

    2011-02-01

    HIV-positive patients with end stage chronic kidney disease requiring dialysis is progressively growing. Kidney transplantation, previously considered as absolute contraindication for HIV-infected patients is currently, in the HAART era, considered a possible treatment alternative. Concerns for the effects of immunosuppressive drugs in these patients and the possible effects on progression of HIV disease, in addition to the risk of opportunistic infections and cancer development are widely discussed. Clinical experience in the HAART era shows that use of immunosuppressive drugs does not adversely affect HIV-seropositive patients. Furthermore, several transplant centers have reported improved patient and graft outcomes for kidney transplant recipients infected with HIV. In summary, results obtained so far are encouraging, supporting that renal transplantation, following specific selection criteria, can be considered an alternative of renal replacement therapy in HIV-infected patients.

  5. FATAL DISSEMINATED CRYPTOCOCCOSIS WITH RENAL INVOLVEMENT IN AN HIV-INFECTED PATIENT

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    Elizabeth De Francesco DAHER

    2015-08-01

    Full Text Available SUMMARY Introduction: We present a fatal case of disseminated cryptococcosis in a young man whose diagnosis of HIV infection was made at the time of admission to the emergency room. Case report: The patient was a twenty-three-year-old man, with a history of daily fever during one month associated with diarrhea, weight loss, headache, vomiting and generalized seizures. He also had a history of diabetes mellitus, alcoholism and drug addiction. Upon physical examination the patient was pale, disoriented and had periods of agitation. White blood cells count was 3,440/mm3 (5% lymphocytes, hemoglobin was 10g/dL, platelets were 83,000/ mm3. Creatinine was 0.7 mg/dL; urea 19 mg/dL; Na, K, and liver enzymes were within normal limits. Lactic dehydrogenase was 494 IU/L. Cerebrospinal fluid (CSF analysis revealed 10 white blood cells/mm3 (58% neutrophils, 31% lymphocytes, 11% monocytes and 2 red blood cells/mm3. India ink test revealed six Cryptococcus yeasts/mm3. CSF glucose was 122 mg/dL and protein was 36 mg/ dL. VDRL test was negative and anti-HIV test was positive. Intravenous hydration, insulin, phenytoin, fluconazole, pyrimethamine, sulfadiazine, folinic acid, and amphotericin B were started. The patient did not improve and became obtunded and hypotensive. He was intubated and put on mechanical respiration. He received vasoactive drugs and died less than 24 hours after admission. A postmortem examination was performed and revealed disseminated cryptococcosis, with severe involvement of the kidneys. Conclusion: Cryptococcosis, as a rule, is a systemic disease that affects mostly immunocompromised individuals, especially patients with AIDS. When diagnosed late in its course it has a very high mortality.

  6. Clinical characteristics and outcome of Penicillium marneffei infection among HIV-infected patients in northern Vietnam

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    Larsson Mattias

    2012-08-01

    Full Text Available Abstract Objective This study reports the clinical characteristics and outcome of HIV-associated Penicilliummarneffei infection in northern Vietnam. Methods We conducted a retrospective chart review of all patients with laboratory confirmed Penicilliummarneffei infection admitted to the National Hospital for Tropical Diseases in Hanoi, Vietnam, between July 2006 and September 2009. Results 127 patients with P. marneffei infection were identified. All were HIV-infected; median CD4+ T-cell count was 24 cells/μl (IQR:12-48; 76% were men. Common clinical features were fever (92.9%, skin lesions (82.6%, hepatomegaly (61.4%, lymphadenopathy (40.2%, weight loss (59.1% and cough (49.6%. Concurrent opportunistic infections were present in 22.0%; half of those had tuberculosis. Initial treatment regimens were: itraconazole or ketoconazole capsule (77.2%, amphotericin B (20.5%, and fluconazole (1.6%. In-hospital mortality was 12.6% and showed no significant difference in patients treated with itraconazole (or ketoconazole and amphotericin B (p = 0.43. Dyspnea, ascites, and increased LDH level were independent predictors of mortality. No seasonality was observed. Conclusion The clinical features, treatments and outcomes of HIV-associated P. marneffei infection in northern Vietnam are similar to those reported in other endemic regions. Dyspnea was an important predictor of mortality. More patients were treated with itraconazole than amphotericin B and no significant difference in treatment outcome was observed. It would be of clinical value to compare the efficacy of oral itraconazole and amphotericin B in a clinical trial.

  7. Difficulties reported by hiv-infected patients using antiretroviral therapy in brazil

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    Mark Drew Crosland Guimarães

    2008-01-01

    Full Text Available OBJECTIVE: To describe the degree of difficulty that HIV-infected patients have with therapy treatment. INTRODUCTION: Patients’ perceptions about their treatment are a determinant factor for improved adherence and a better quality of life. METHODS: Two cross-sectional analyses were conducted in public AIDS referral centers in Brazil among patients initiating treatment. Patients interviewed at baseline, after one month, and after seven months following the beginning of treatment were asked to classify and justify the degree of difficulty with treatment. Logistic regression was used for analysis. RESULTS: Among 406 patients initiating treatment, 350 (86.2% and 209 (51.5% returned for their first and third visits, respectively. Treatment perceptions ranged from medium to very difficult for 51.4% and 37.3% on the first and third visits, respectively. The main difficulties reported were adverse reactions to the medication and scheduling. A separate logistic regression indicated that the HIV-seropositive status disclosure, symptoms of anxiety, absence of psychotherapy, higher CD4+ cell count (> 200/mm³ and high (> 4 adverse reaction count reported were independently associated with the degree of difficulty in the first visit, while CDC clinical category A, pill burden (> 7 pills, use of other medications, high (> 4 adverse reaction count reported and low understanding of medical orientation showed independent association for the third visit. CONCLUSIONS: A significant level of difficulty was observed with treatment. Our analyses suggest the need for early assessment of difficulties with treatment, highlighting the importance of modifiable factors that may contribute to better adherence to the treatment protocol.

  8. The beta-chemokines MIP-1alpha and RANTES and lipoprotein metabolism in HIV-infected brazilian patients

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    Angela Yumico Mikawa

    2005-08-01

    Full Text Available HIV patients are predisposed to the development of hypertriglyceridemia and hypercholesterolemia as a result of both viral infection and HIV infection therapy, especially the protease inhibitors. Chemokines and cytokines are present at sites of inflammation and can influence the nature of the inflammatory response in atherosclerosis. We investigated the correlation between biochemical variables and beta-chemokines (MIP-1alpha and RANTES and the apolipoprotein E genotype in HIV-infected individuals. The apolipoproteins were measured by nephelometry. Triglycerides and total cholesterol were determined by standard enzymatic procedures. The beta-chemokines were detected by ELISA. The genetic category of CCR5 and apolipoprotein E were determined by PCR amplification and restriction enzymes. Immunological and virological profiles were assessed by TCD4+ and TCD8+ lymphocyte counts and viral load quantification. Positive correlations were found between apo E and CD8+ (p = 0.035, apo E and viral load (p = 0.018, MIP-1alpha and triglycerides (p = 0.039 and MIP-1a and VLDL (p = 0.040. Negative correlations were found between viral load and CD4+ (p = 0.05 and RANTES and CD4+ (p = 0.029. The beta-chemokine levels may influence lipid metabolism in HIV-infected individuals.

  9. Evaluation of cardiovascular biomarkers In HIV-infected patients switching to abacavir or tenofovir based therapy

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    Langdahl Bente L

    2011-10-01

    Full Text Available Abstract Background Our objective was to evaluate and compare the effect of abacavir on levels of biomarkers associated with cardiovascular risk. Methods In an open-label randomized trial, HIV-infected patients were randomized 1:1 to switch from zidovudine/lamivudine to abacavir/lamivudine or tenofovir/emtricitabine. In the present analysis, we measured levels of interleukin-6 (IL-6, high-sensitivity C-reactive protein (hs-CRP, soluble intercellular adhesion molecule-1 (sICAM-1, soluble vascular adhesion molecule-1 (sVCAM-1, E-selectin, and myeloperoxidase (MPO at baseline and 4, 12, and 48 weeks after randomization. D-dimer and fasting lipids were measured at baseline and weeks 12 and 48. Levels of biomarkers at all time points and changes from baseline were compared across study arms using Wilcoxon rank sum test. Results Of 40 included patients, 35 completed 48 weeks of randomized therapy and follow up. Levels of E-selectin (P = 0.004 and sVCAM-1 (P = 0.041 increased transiently from baseline to week 4 in the abacavir arm compared with the tenofovir arm, but no long-term increases were detected. We found no significant differences between study arms in the levels or changes in the levels of sICAM-1, MPO, d-dimer, IL-6, or hs-CRP. Levels of total cholesterol and high density lipoprotein (HDL increased in the abacavir arm relative to the tenofovir arm, but no difference was found in total cholesterol/HDL ratio. Conclusion In patients randomized to abacavir-based HIV-treatment transient increases were seen in the plasma levels of E-selectin and sVCAM-1 compared with treatment with tenofovir, but no difference between study arms was found in other biomarkers associated with endothelial dysfunction, inflammation, or coagulation. The clinical significance of these findings is uncertain. Trial Regestration Clinicaltrials.gov identifier: NCT00647244.

  10. Compromiso renal en pacientes HIV+ Renal abnormalities in HIV infected patients

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    María Marta Pernasetti

    2010-06-01

    agents and/or drugs. Little is known about the prevalence of renal diseases that may occur as a complication of or related to HIV infection in asymptomatic patients. This is a single center cross-sectional study of asymptomatic HIV+ patients referred to a nefrology care service at an Argentine hospital to look for the presence of renal abnormalities. Fifty two consecutive patients were studied between April and November 2008. Patients underwent plasma and urine analysis, ultrasound, and kidney biopsy as needed. Mean age was 39.9 ± 10.6 years, 88% were male, time from HIV diagnosis 53.2 ± 41.2 months (2-127; 71% had HIV-disease and 77% were on antiretroviral therapy. Mean plasma HIV-RNA copies number was 7.043 ± 3.322 and CD4+ cell count: 484 ± 39. Pathologic findings in urine analysis were present in 30.7% of patients: albuminuria 16.6%, microscopic hematuria 11.5%, hypercalciuria 10.8% and crystalluria 6%. Mean glomerular filtration rate was 102.2 ± 22.95 ml/min (34-149 and 41% of patients could be classified in stages 1 to 3 of chronic kidney disease. Renal abnormalities prevaled in older patients without relationship with presence of HIV-disease. Two patients were biopsied and the findings included: tubulointerstitial nephritis with presence of crystal deposition in one and IgA nephropathy in the other. No HIV-associated nephropathy was detected. The broad spectrum and the high prevalence of lesions found in this series suggest that asymptomatic HIV-infected patients should routinely undergo renal evaluation.

  11. Drug-resistant tuberculosis in HIV-infected patients in a national referral hospital, Phnom Penh, Cambodia

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    Genevieve Walls

    2015-01-01

    Full Text Available Background and objective: There are no recent data on the prevalence of drug-resistant tuberculosis (DR TB in Cambodia. We aim to describe TB drug resistance amongst adults with pulmonary and extra-pulmonary TB and human immunodeficiency virus (HIV co-infection in a national referral hospital in Phnom Penh, Cambodia. Design: Between 22 November 2007 and 30 November 2009, clinical specimens from HIV-infected patients suspected of having TB underwent routine microscopy, Mycobacterium tuberculosis culture, and drug susceptibility testing. Laboratory and clinical data were collected for patients with positive M. tuberculosis cultures. Results: M. tuberculosis was cultured from 236 HIV-infected patients. Resistance to any first-line TB drug occurred in 34.7% of patients; 8.1% had multidrug resistant tuberculosis (MDR TB. The proportion of MDR TB amongst new patients and previously treated patients was 3.7 and 28.9%, respectively (p<0.001. The diagnosis of MDR TB was made after death in 15.8% of patients; in total 26.3% of patients with MDR TB died. The diagnosis of TB was established by culture of extra-pulmonary specimens in 23.6% of cases. Conclusions: There is significant resistance to first-line TB drugs amongst new and previously treated TB–HIV co-infected patients in Phnom Penh. These data suggest that the prevalence of DR TB in Cambodia may be higher than previously recognised, particularly amongst HIV-infected patients. Additional prevalence studies are needed. This study also illustrates the feasibility and utility of analysis of non-respiratory specimens in the diagnosis of TB, even in low-resource settings, and suggests that extra-pulmonary specimens should be included in TB diagnostic algorithms.

  12. Neurocognitive function in HIV-infected patients: comparison of two methods to define impairment.

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    Alejandro Arenas-Pinto

    Full Text Available To compare two definitions of neurocognitive impairment (NCI in a large clinical trial of effectively-treated HIV-infected adults at baseline.Hopkins Verbal Learning test-Revised (HVLT-R, Colour Trail (CTT and Grooved Pegboard (GPT tests were applied exploring five cognitive domains. Raw scores were transformed into Z-scores and NCI defined as summary NPZ-5 score one standard deviation below the mean of the normative dataset (i.e. <-1SD or Z-scores <-1SD in at least two individual domains (categorical scale. Principal component analysis (PCA was performed to explore the contribution of individual tests to the total variance.Mean NPZ-5 score was -0.72 (SD 0.98 and 178/548 (32% participants had NPZ-5 scores <-1SD. When impairment was defined as <-1SD in at least two individual tests, 283 (52% patients were impaired. Strong correlations between the two components of the HVLT-R test (learning/recall (r = 0.73, and the CTT and (attention/executive functioning (r = 0.66 were observed. PCA showed a clustering with three components accounting for 88% of the total variance. When patients who scored <-1SD only in two correlated tests were considered as not impaired, prevalence of NCI was 43%. When correlated test scores were averaged, 36% of participants had NPZ-3 scores <-1SD and 32% underperformed in at least two individual tests.Controlling for differential contribution of individual test-scores on the overall performance and the level of correlation between components of the test battery used appear to be important when testing cognitive function. These two factors are likely to affect both summary scores and categorical scales in defining cognitive impairment.EUDRACT: 2007-006448-23 and ISRCTN04857074.

  13. Neurocognitive Function in HIV-Infected Patients: Comparison of Two Methods to Define Impairment

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    Arenas-Pinto, Alejandro; Winston, Alan; Stöhr, Wolfgang; Day, John; Wiggins, Rebecca; Quah, Say Pheng; Ainsworth, Jonathan; Fleck, Sue; Dunn, David; Accoroni, Alex; Paton, Nicholas I.

    2014-01-01

    Objective To compare two definitions of neurocognitive impairment (NCI) in a large clinical trial of effectively-treated HIV-infected adults at baseline. Methods Hopkins Verbal Learning test-Revised (HVLT-R), Colour Trail (CTT) and Grooved Pegboard (GPT) tests were applied exploring five cognitive domains. Raw scores were transformed into Z-scores and NCI defined as summary NPZ-5 score one standard deviation below the mean of the normative dataset (i.e. <−1SD) or Z-scores <−1SD in at least two individual domains (categorical scale). Principal component analysis (PCA) was performed to explore the contribution of individual tests to the total variance. Results Mean NPZ-5 score was −0.72 (SD 0.98) and 178/548 (32%) participants had NPZ-5 scores <−1SD. When impairment was defined as <−1SD in at least two individual tests, 283 (52%) patients were impaired. Strong correlations between the two components of the HVLT-R test (learning/recall) (r = 0.73), and the CTT and (attention/executive functioning) (r = 0.66) were observed. PCA showed a clustering with three components accounting for 88% of the total variance. When patients who scored <−1SD only in two correlated tests were considered as not impaired, prevalence of NCI was 43%. When correlated test scores were averaged, 36% of participants had NPZ-3 scores <−1SD and 32% underperformed in at least two individual tests. Conclusion Controlling for differential contribution of individual test-scores on the overall performance and the level of correlation between components of the test battery used appear to be important when testing cognitive function. These two factors are likely to affect both summary scores and categorical scales in defining cognitive impairment. Trial registration EUDRACT: 2007-006448-23 and ISRCTN04857074. PMID:25078406

  14. Acute hepatitis C in a chronically HIV-infected patient: Evolution of different viral genomic regions

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    Diego Flichman; Veronica Kott; Silvia Sookoian; Rodolfo Campos

    2003-01-01

    AIM: To analyze the molecular evolution of different viral genomic regions of HCV in an acute HCV infected patient chronically infected with HIV through a 42-month follow-up.METHODS: Serum samples of a chronically HIV infected patient that seroconverted to anti HCV antibodies were sequenced, from the event of superinfection through a period of 17 months and in a late sample (42nd month). Hypervariable genomic regions of HIV (V3 loop of the gp120) and HCV (HVR-1 on the E2 glycoprotein gene) were studied. In order to analyze genomic regions involved in different biological functions and with the cellular immune response, HCV core and NS5A were also chosen to be sequenced. Amplification of the different regions was done by RT-PCR and directly sequenced. Confirmation of sequences was done on reamplified material. Nucleotide sequences of the different time points were aligned with CLUSTAL W 1.5, and the corresponding amino acid ones were deduced.RESULTS: Hypervariable genomic regions of both viruses (HVR1 and gp120 V3 loop) presented several nonsynonymous changes but, while in the gp120 V3 loop mutations were detected in the sample obtained right after HCV superinfection and maintained throughout, they occurred following a sequential and cumulative pattern in the HVR1. In the NS5A region of HCV, two amino acid changes were detected during the follow-up period, whereas the core region presented several amino acid replacements, once the HCV chronic infection had been established.CONCLUSION: During the HIV-HCV superinfection, each genomic region analyzed shows a different evolutionary pattem.Most of the nucleotide substitutions observed are nonsynonymous and clustered in previously described epitopes,thus suggesting an immune-driven evolutionary process.

  15. Impact of Early Initiation of Antiretroviral Therapy in Patients with Acute HIV Infection in Vienna, Austria.

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    Sandra Herout

    Full Text Available It is unclear whether antiretroviral therapy (ART should be initiated during acute HIV infection. Most recent data provides evidence of benefits of early ART.We retrospectively compared the clinical and immunological course of individuals with acute HIV infection, who received ART within 3 months (group A or not (group B after diagnosis.Among the 84 individuals with acute HIV infection, 57 (68% received ART within 3 months (A whereas 27 (32% did not receive ART within 3 months (B, respectively. Clinical progression to CDC stadium B or C within 5 years after the diagnosis of HIV was less common in (A when compared to (B (P = 0.002. After twelve months, both the mean increase in CD4+ T cell count and the mean decrease in viral load was more pronounced in (A, when compared to (B (225 vs. 87 cells/μl; P = 0.002 and -4.19 vs. -1.14 log10 copies/mL; P<0.001. Twenty-four months after diagnosis the mean increase from baseline of CD4+ T cells was still higher in group A compared to group B (251 vs. 67 cells/μl, P = 0.004.Initiation of ART during acute HIV infection is associated with a lower probability of clinical progression to more advanced CDC stages and significant immunological benefits.

  16. Diabetic ketoacidosis in an HIV-infected patient undergoing antiretroviral therapy

    DEFF Research Database (Denmark)

    Holm, MR; Hansen, Birgitte Rønde; Røder, ME

    2006-01-01

    inhibitors (PI), in particular, has been associated with insulin resistance and hyperglycaemia, but only infrequently with diabetic ketoacidosis. We report a case of diabetic ketoacidosis in an HIV-infected woman after 1(1/2) years of a PI-containing regimen, demonstrating reduced beta cell function...... and insulin resistance....

  17. Hepatitis A vaccination and immunological parameters in HIV-infected patients.

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    Kourkounti, Sofia; Papaizos, Vassilios; Leuow, Kirsten; Kordosis, Theodoros; Antoniou, Christina

    2013-10-01

    Vaccination against hepatitis A is an important intervention to prevent disease in HIV-patients. There are insufficient data on the association of the response to hepatitis A vaccine with immunological parameters, including subpopulations of T-cells. We studied HIV-infected adults with CD4 T-cells>200 cells/mm(3) who received two doses of hepatitis A vaccine (Havrix or Vaqta). The counts of CD3, CD4, CD8, CD4+T-cells, NK, NK CD8+, NK CD8 - cells, and HIV RNA were measured at the time of first dose administration and one month after the end of the vaccination period. The geometric mean titer of antibodies to hepatitis A virus (anti-HAV) and factors affecting response were evaluated. 113 patients (50 antiretroviral treatment-naïve and 63 treatment-experienced) were enrolled in the study. There was no change in the immunological parameters and in the HIV-RNA post-vaccination, except for a decrease in CD8 and in double positive CD4+CD8+t-cell count. The immune response and geometric mean titer of anti-HAV were similar among treated and naïve patients (78% vs. 76% and 237 mIU/mL vs. 158 mIU/mL). Vaccine response was achieved in 71% of patients with CD4=200-499 cells/mm(3) compared with 80% of participants with CD4 ≥500 cells/mm(3) (p>0.05). Logistic regression revealed that immunological cells tested do not affect response differently in treatment-naïve vs. experienced patients. The only factor affecting response is the CD4 T-cell count at vaccination (OR 1.320; 95% CI 1.052-1.656; p=0.016). Patients with CD4 T-cell count ≥500 cells/mm(3) were 4.3 times more likely to respond to the vaccine than patients with CD4 T-cell count 200-499 cells/mm(3) (p=0.005). In conclusion, successful vaccination is associated with CD4 T-cells. The count of other immune cells or the administration of antiretroviral therapy does not predict response to hepatitis A vaccine in HIV patient with baseline CD4 T-cell>200 cells/mm(3).

  18. Acceptability and confidence in antiretroviral generics of physicians and HIV-infected patients in France

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    Clotilde Allavena

    2014-11-01

    Full Text Available Introduction: Switching brand name medications to generics is recommended in France in the interest of cost effectiveness but patients and physicians are sometimes not convinced that switching is appropriate. Some antiretroviral (ARV generics (ZDV, 3TC, NVP have been marketed in France since 2013. Materials and Methods: A multicentric cross-sectional survey was performed in September 2013 to evaluate the perception of generics overall and ARV generics in physicians and HIV-infected patients and factors associated to their acceptability. Adult HIV outpatients were asked to complete a self-questionnaire on their perception of generics. Physicians completed a questionnaire on the acceptability of generics and ARV generics. Socio-demographic data, medical history and HIV history were collected. Results: 116 physicians in 33 clinics (68% in University Hospital included 556 patients (France-native 77%, active employment 59%, covered by social Insurance 100%, homosexual/bisexual contamination 47%, median HIV duration 13 years, hepatitis coinfection 16%, on ARV therapy 95%. Overall, patients accepted and had confidence in generics in 76% and 55% of the cases, respectively. Switching ARVs for generics was accepted by 44% of the patients but only by 17% if the pill burden was going to increase. 75% of the physicians would prescribe generics, but this decreased to only 26% if the combo had to be broken. The main reasons for non-prescription of generics were previous brand name ARV-induced side effects (35%, refusal of generics overall (37%, lack of understanding of generics (26%, risk of non-observance of treatment (44%, anxiety (47% and depressive symptoms (25%. In multivariate analysis, factors associated with the acceptability of ARV generics in patients were the use of generics overall (p<0.001 and in physicians, the absence of concern regarding the drug efficacy (p<0.001 and being aware that the patient would accept generics overall (p=0.03 and ARV

  19. Low retention of HIV-infected patients on antiretroviral therapy in 11 clinical centers

    Science.gov (United States)

    Ekouevi, Didier K.; Balestre, Eric; Ba-Gomis, Franck-Olivier; Eholie, Serge Paul; Maiga, Moussa; Amani-Bosse, Clarisse; Minga, Albert; Messou, Eugène; Sow, Papa Salif; Lewden, Charlotte; Traoré, Hamar Allassane; Bissagnene, Emmanuel; Dabis, François

    2010-01-01

    Summary Objective To study factors associated with the probability of retention in antiretroviral therapy (ART) programs in West Africa. Methods The International epidemiologic Databases to Evaluate AIDS (IeDEA) in West Africa is a prospective, operational, observational cohort study based on collaboration between 11 cohorts of HIV-infected adult patients in Benin, Côte d'Ivoire, Gambia, Mali and Senegal. All patients aged 16 and older at ART initiation, with documented gender and date of ART initiation, were included. For those with at least one day of follow-up, Kaplan-Meier method and Weibull regression model were used to estimate the 12-month probability of retention in care and the associated factors. Results 14,352 patients (61% female) on ART were included in this data merger. Median age was 37 years (IQR: 31-44 years) and median CD4 count at baseline was 131 cells/mm3 (IQR: 48-221 cells/mm3). The first line regimen was NNRTI-based for 78% of patients, protease-inhibitor based for 17%, and three NRTIs for 3%. The probability of retention was 0.90 (95% confidence interval [CI]: 0.89-0.90) at 3 months, 0.84 (95%CI: 0.83-0.85) at 6 months and 0.76 (95%CI: 0.75-0.77) at 12 months. The probability of retention in care was lower in patients with baseline CD4 count 200 cells/mm3, in men (aHR=1.17; 95%CI: 1.10-1.24; p=0.0002), in younger patients (<30 years) (aHR=1.10; 95%CI: 1.03-1.19; p=0.01) and in patients with low hemoglobinemia <8g/dL (aHR=1.33; 95%CI: 1.21-1.45; p<0.0001). Availability of funds for systematic tracing was associated with better retention (aHR=0.29; 95%CI: 0.16-0.55; p=0.001). Conclusions Close follow-up, promoting early access to care and ART and a decentralized system of care may improve the retention in care of HIV-patients on ART. PMID:20586958

  20. Cerebral metabolism in HIV infected patients with non-cognitive disorder using single voxel magnetic resonance spectroscopy

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    Shi Qi

    2015-09-01

    Conclusion: HIV infection induces inflammation in basal ganglia region, frontal lobe and parietal lobe before non-cognitive disorder occurs after HIV infection. However, the basal ganga region sees more neurons loss.

  1. Drug-resistant tuberculosis among HIV-infected patients starting antiretroviral therapy in Durban, South Africa.

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    Jeffrey K Hom

    Full Text Available OBJECTIVE: To estimate the prevalence of drug-resistant tuberculosis (TB and describe the resistance patterns in patients commencing antiretroviral therapy (ART in an HIV clinic in Durban, South Africa. DESIGN: Cross-sectional cohort study. METHODS: Consecutive HIV-infected adults (≥ 18y/o initiating HIV care were enrolled from May 2007-May 2008, regardless of signs or symptoms of active TB. Prior TB history and current TB treatment status were self-reported. Subjects expectorated sputum for culture (MGIT liquid and 7H11 solid medium. Positive cultures were tested for susceptibility to first- and second-line anti-tuberculous drugs. The prevalence of drug-resistant TB, stratified by prior TB history and current TB treatment status, was assessed. RESULTS: 1,035 subjects had complete culture results. Median CD4 count was 92/µl (IQR 42-150/µl. 267 subjects (26% reported a prior history of TB and 210 (20% were receiving TB treatment at enrollment; 191 (18% subjects had positive sputum cultures, among whom the estimated prevalence of resistance to any antituberculous drug was 7.4% (95% CI 4.0-12.4. Among those with prior TB, the prevalence of resistance was 15.4% (95% CI 5.9-30.5 compared to 5.2% (95% CI 2.1-8.9 among those with no prior TB. 5.1% (95% CI 2.4-9.5 had rifampin or rifampin plus INH resistance. CONCLUSIONS: The prevalence of TB resistance to at least one drug was 7.4% among adults with positive TB cultures initiating ART in Durban, South Africa, with 5.1% having rifampin or rifampin plus INH resistance. Improved tools for diagnosing TB and drug resistance are urgently needed in areas of high HIV/TB prevalence.

  2. MRI signal changes of the bone marrow in HIV-infected patients with lipodystrophy: correlation with clinical parameters

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    Garcia, Ana I.; Tomas, Xavier; Pomes, Jaume; Amo, Montserrat del [Hospital Clinic, Department of Radiology, Barcelona (Spain); Milinkovic, Ana; Perez, Inaki; Mallolas, Josep [IDIBAPS-Hospital Clinic, Department of Infectious Diseases, Barcelona (Spain); Rios, Jose [Hospital Clinic, Department of Biostatistics, Barcelona (Spain); Vidal-Sicart, Sergi [Hospital Clinic, Department of Nuclear Medicine, Barcelona (Spain)

    2011-10-15

    To assess the prevalence, imaging appearance, and clinical significance, of bone marrow MR signal changes in a group of human immunodeficiency virus (HIV)-infected patients with lipodystrophy syndrome. Twenty-eight HIV-infected patients with lipodystrophy syndrome treated with highly active antiretroviral therapy, and 12 HIV-negative controls underwent MRI of the legs. Whole-body MRI, SPECT/CT, and a complete radiographic skeletal survey were obtained in subjects with signal changes in bone marrow. MRI and clinical evaluations were reviewed 6 months after baseline to determine changes after switching from thymidine analogs (TA) to tenofovir-DF (TDF). MRI results correlated with clinical parameters. We observed foci of a serous-like pattern (low signal and no enhancement on T1-weighted, high signal on T2-weighted images) in 4 out of 28 patients (14.3%) and an intermediate signal on T1-weighted images in 4 out of 28 patients (14.3%). Serous-like lesions were located in the lower limbs and scattered in the talus, calcaneus, femurs, and humeral bones; they showed slight uptake on SPECT bone scans and were normal on CT and radiographs. Patients with serous-like lesions had significantly lower peripheral and total fat at baseline than other groups (P < 0.05). No changes at 6 months were observed on MRI, and the serous-like lesion group showed good peripheral fat recovery after changing drug treatment. A serous-like MRI pattern is observed in the peripheral skeletons of HIV-infected patients with lipodystrophy, which correlates with peripheral lipoatrophy, and should not be misdiagnosed as malignant or infectious diseases. Although the MR lesions did not improve after switching the treatment, there was evidence of lipoatrophy recovery. (orig.)

  3. HIV infection in the elderly

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    Nancy Nguyen

    2008-09-01

    Full Text Available Nancy Nguyen1, Mark Holodniy21University of the Pacific School of Pharmacy and Health Sciences, Stockton, CA, USA; 2VA Palo Alto Health Care System, Palo Alto, CA, USAAbstract: In the US, an estimated 1 million people are infected with HIV, although one-third of this population are unaware of their diagnosis. While HIV infection is commonly thought to affect younger adults, there are an increasing number of patients over 50 years of age living with the condition. UNAIDS and WHO estimate that of the 40 million people living with HIV/AIDS in the world, approximately 2.8 million are 50 years and older. With the introduction of highly active antiretroviral therapy (HAART in the mid-1990s, survival following HIV diagnosis has risen dramatically and HIV infection has evolved from an acute disease process to being managed as a chronic medical condition. As treated HIV-infected patients live longer and the number of new HIV diagnoses in older patients rise, clinicians need to be aware of these trends and become familiar with the management of HIV infection in the older patient. This article is intended for the general clinician, including geriatricians, and will review epidemiologic data and HIV treatment as well as provide a discussion on medical management issues affecting the older HIV-infected patient.Keywords: HIV, epidemiology, treatment, aging, review

  4. Novel antiretroviral combinations in treatment-experienced patients with HIV infection: rationale and results.

    Science.gov (United States)

    Taiwo, Babafemi; Murphy, Robert L; Katlama, Christine

    2010-09-10

    Novel antiretroviral drugs offer different degrees of improvement in activity against drug-resistant HIV, short- and long-term tolerability, and dosing convenience compared with earlier drugs. Those drugs approved more recently and commonly used in treatment-experienced patients include the entry inhibitor enfuvirtide, protease inhibitors (PIs) [darunavir and tipranavir], a C-C chemokine receptor (CCR) type 5 antagonist (maraviroc), an integrase inhibitor (raltegravir) and etravirine, a non-nucleoside reverse transcriptase inhibitor (NNRTI). Novel agents in earlier stages of development include a CCR5 monoclonal antibody (PRO 140) administered subcutaneously once weekly, once-daily integrase inhibitors (elvitegravir and S/GSK1349572), and several nucleoside (nucleotide) reverse transcriptase inhibitors and NNRTIs. Bevirimat, a maturation inhibitor, has compromised activity in the presence of relatively common Gag polymorphisms. Viral suppression is necessary to control the evolution of drug resistance, reduce chronic immune activation that probably underlies the excess morbidity and mortality in HIV-infected patients, and reduce viral transmission, including transmitted drug resistance. In general, the proportion of viraemic patients who achieve suppression increases with the number of active pharmacokinetically compatible antiretroviral drugs in the regimen. In the ANRS139-TRIO trial, 86% of highly treatment-experienced patients treated with darunavir-ritonavir, etravirine and raltegravir had HIV RNA suppression, novel agents may be used to simplify the dosing schedule, lower costs (such as by switching to boosted PI monotherapy), reduce adverse events or preserve antiretroviral drug options, especially since the absence of an HIV eradication strategy implies the need for life-long combination antiretroviral therapy. Switching enfuvirtide to raltegravir eliminated painful injection-site reactions without compromising virological suppression. Two studies found

  5. Maraviroc Failed to Control Progressive Multifocal Leukoencephalopathy-Associated IRIS in a Patient with Advanced HIV Infection

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    Mónica Rodríguez

    2014-01-01

    Full Text Available Due to the lack of therapeutic options for patients with progressive multifocal leukoencephalopathy-associated immune reconstitution inflammatory syndrome (PML-associated IRIS, maraviroc has generated expectations among the medical community. However, we report a patient with advanced HIV infection, who developed PML-associated IRIS and had a fatal outcome despite the addition of maraviroc to suppressive ART. Future studies are required to define the therapeutic role of maraviroc in PML-associated IRIS and differentiate individuals who may benefit from maraviroc from those who may develop neurological deterioration.

  6. Evaluation of improvement of onychomycosis in HIV-infected patients after initiation of combined antiretroviral therapy without antifungal treatment.

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    Ruíz-López, Patricia; Moreno-Coutiño, Gabriela; Fernández-Martínez, Ramón; Espinoza-Hernández, Jessica; Rodríguez-Zulueta, Patricia; Reyes-Terán, Gustavo

    2015-09-01

    Onychomycosis in HIV-infected patients has a prevalence of 20-44% and is more frequently seen with CD4(+) T cell counts ≤450 cel μl(-1). There are case reports of improvement in onychomycosis after initiation of combined antiretroviral therapy (cART), but there are no prospective studies that prove the existence and frequency of this phenomenon. The aim of this study was to evaluate if HIV-infected patients with onychomycosis who begin cART improve and/or cure without antifungal treatment. We included HIV-infected patients with onychomycosis who had not started cART and nor received antifungal therapy during 6 months prior to the study. We evaluated affected the nails with the Onychomycosis Severity Index (OSI); nail scrapings were collected and direct microscopy with potassium hydroxide (KOH) as well as mycological culture were performed. We repeated these procedures at 3 and 6 months to assess changes. CD4 T cell counts and HIV viral load were obtained. A total of 16 patients were included, with male gender predominance (68.7%); distal and lateral subungual onychomycosis (DLSO) was the most common form (31.3%). Trichophyton rubrum was the most frequently isolated microorganism. OSI decreased 21.5% at 3 months and 40% at 6 months after initiation of antiretrovirals (P = 0.05). We found a non-significant tendency towards improvement with higher CD4(+) T cell counts and with viral loads <100 000 copies ml(-1). This could be due to the increase in CD4(+) T cells, decreased percentage of Treg (CD4(+)CD25(+)) among CD4(+) Tcells and/or a decreased viral load; further studies are necessary to prove these hypothesis.

  7. Association between polymorphisms in genes involved in lipid metabolism and immunological status in chronically HIV-infected patients.

    Science.gov (United States)

    Echeverria, Patricia; Guardiola, Montse; González, Marta; Vallvé, Joan Carles; Bonjoch, Anna; Puig, Jordi; Clotet, Bonaventura; Ribalta, Josep; Negredo, Eugènia

    2015-02-01

    Several studies have reported associations between lipid parameters and clinical progression of HIV infection. We performed a cross-sectional study including 468 antiretroviral-treated HIV-infected patients to investigate the impact of 13 polymorphisms of 9 genes affecting lipid metabolism and CD4 and CD8-T cell levels. Polymorphisms were identified in genes selected for their role in the development of atherogenic dyslipidemia, defined as triglycerides ⩾1.7mmol/L and high-density lipoprotein cholesterol (HDLc) <1.02 in women or 1.28mmol/L in men. Lipid and lipoprotein parameters were determined in all participants, as well as CD4 and CD8 T-cell counts. ANOVA was performed to compare the mean values of lipid and CD4 and CD8 T-cell count data. A Bonferroni correction for multiple comparisons was applied. 468 patients were included, 148 of them had a diagnosis of atherogenic dyslipidemia. The polymorphism rs3135506 in APOA5 was associated with a 9% increase in triglycerides (p=0.002), 10% and 21% decrease in HDLc (p=0.005), and CD4 T-cell count (p=0.024), respectively. APOA5 rs662799, was associated with a 19% increase in CD8 T-cell count (p=0.002). Carriers of LPL rs328 in the dyslipidemic group presented 11% higher levels of HDLc (p=0.015) and 14% higher levels of CD4 cells (p=0.038). In conclusion, polymorphisms in genes associated to the development of atherogenic dyslipidemia, especially variants in APOA5 gene (rs3135506 and rs662799), can influence the circulating CD4 T-cell levels in chronically HIV-infected patients. These data support previous reports on the effect of lipid metabolism on immunologic parameters in HIV+ individuals on antiretroviral therapy.

  8. Acute kidney injury in HIV-infected children: comparison of patients according to the use of highly active antiretroviral therapy

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    Douglas de Sousa Soares

    Full Text Available Abstract Objective: To assess clinical and laboratory data, and acute kidney injury (AKI in HIV-infected children using and not using highly active antiretroviral therapy (HAART prior to admission. Methods: A retrospective study was conducted with HIV-infected pediatric patients (<16 years. Children who were using and not using HAART prior to admission were compared. Results: Sixty-three patients were included. Mean age was 5.3 ± 4.27 years; 55.6% were females. AKI was observed in 33 (52.3% children. Patients on HAART presented lower levels of potassium (3.9 ± 0.8 vs. 4.5 ± 0.7 mEq/L, p = 0.019 and bicarbonate (19.1 ± 4.9 vs. 23.5 ± 2.2 mEq/L, p = 0.013 and had a higher estimated glomerular filtration rate (102.2 ± 36.7 vs. 77.0 ± 32.8 mL/min/1.73 m2, p = 0.011 than those not on HAART. In the multivariate analysis, the use of HAART prior to the admission was a protective factor for AKI (p = 0.036; OR = 0.30; 95% CI = 0.097-0.926. Conclusion: AKI is a common complication of pediatric HIV infection. Use of HAART prior to the admission preserved glomerular filtration and was a protective factor for AKI, but increased medication side effects, such as hypokalemia and renal metabolic acidosis.

  9. From Space to the Patient: A New Cytokine Release Assay to Monitor the Immune Status of HIV Infected Patients and Sepsis Patients

    Science.gov (United States)

    Kaufmann, I.; Draenert, R.; Gruber, M.; Feuerecker, M.; Crucian, B. E.; Mehta, S. L.; Roider, J.; Pierson, D. L.; Briegel, J. M.; Schelling, G.; Sams, C. F.; Chouker, A.

    2013-01-01

    Monitoring of humans either in the healthy men under extreme environmental stress like space flight, in human immunodeficiency virus (HIV) infected patients or in sepsis is of critical importance with regard to the timing of adequate therapeutic (counter-)measures. The in vivo skin delayed-type hypersensitivity test (DTH) served for many years as a tool to evaluate cell mediated immunity. However, this standardised in vivo test was removed from the market in 2002 due to the risk of antigen stabilization. To the best of our knowledge an alternative test as monitoring tool to determine cell mediated immunity is not available so far. For this purpose we tested a new alternative assay using elements of the skin DTH which is based on an ex vivo cytokine release from whole blood and asked if it is suitable and applicable to monitor immune changes in HIV infected patients and in patients with septic shock.

  10. Environmental Factors Related to Pulmonary Tuberculosis in HIV-Infected Patients in the Combined Antiretroviral Therapy (cART) Era

    Science.gov (United States)

    Álvaro-Meca, Alejandro; Díaz, Asuncion; de Miguel Díez, Javier; Resino, Rosa

    2016-01-01

    The aim of our study was to evaluate the seasonal variations and whether short-term exposure to environmental risk factors, such as climate and air pollution, is associated with PTB-related hospital admissions in human immunodeficiency virus (HIV)-infected patients in Spain during the era of combined antiretroviral therapy (cART). A retrospective study was carried out using data from the Minimum Basic Data Set (MBDS) and the State Meteorological Agency (AEMET) of Spain. The primary outcome variable was hospital admissions with PTB diagnosis. The environmental risk factors evaluated were season, temperature, humidity, NO2, SO2, O3, PM10, and CO. Overall, HIV-infected patients had a lower frequency of PTB-related hospital admissions in summer (22.8%) and autumn (22.4%), but higher values in winter (26.6%) and spring (28.2%). Using a Bayesian temporal model, PTB-related hospital admissions were less frequent in summer-autumn and more abundant in winter-spring during the first years of follow-up. During the later years of follow-up, the seasonal trends continued resulting in the lowest values in autumn and the highest in spring. When considering short-term exposure to environmental risk factors, lower temperatures at 1 week (odds ratio (OR) = 1.03; p = 0.008), 1.5 weeks (OR = 1.03; p<0.001), 2 weeks (OR = 1.04; p<0.001), and 3 weeks (OR = 1.03; p<0.001) prior to PTB admission. In addition, higher concentration of NO2 at the time of admission were significantly associated with higher likelihoods of PTB-related hospital admission in HIV-infected patients when 1.5 weeks (OR = 1.1; p = 0.044) and 2 weeks (OR = 1.21; p<0.001) were used as controls. Finally, higher concentration of SO2 at 1.5 weeks prior to PTB admission was significantly associated with a higher likelihood of PTB-related hospital admissions (OR = 0.92; p = 0.029). In conclusion, our data suggest an apparent seasonal variation in hospital admissions of HIV-infected patients with a PTB diagnosis (summer

  11. Mitochondrial toxicity in HIV-infected patients both off and on antiretroviral treatment: a continuum or distinct underlying mechanisms?

    Science.gov (United States)

    Maagaard, Anne; Kvale, Dag

    2009-11-01

    Mitochondrial toxicity contributes to serious adverse effects observed in HIV-infected individuals treated with nucleoside reverse transcriptase inhibitors (NRTIs). However, similar mitochondrial abnormalities have recently been found even in treatment-naive patients, suggesting that chronic HIV per se could contribute to the toxicity observed in NRTI-exposed individuals. This review gives a current status of the field, with particular focus on recent observations suggesting that distinct mechanisms might cause such toxicity in both NRTI-exposed individuals and those naive to antiretroviral treatment.

  12. Pharmacokinetic interaction between rifampin and the combination of indinavir and low-dose ritonavir in HIV-infected patients

    DEFF Research Database (Denmark)

    Justesen, U S; Andersen, A B; Klitgaard, N A;

    2004-01-01

    of indinavir (800 mg) and ritonavir (100 mg) twice a day was performed to evaluate whether the inducing effect of rifampin on the drug-metabolizing enzyme cytochrome P450 (CYP) 3A4 could be overcome by the inhibitory effect of ritonavir. Pharmacokinetic evaluations of steady-state concentrations of indinavir......Rifampin is an important drug in the treatment of tuberculosis, but administration of rifampin in combination with protease inhibitors is complicated because of drug-drug interactions. A prospective, controlled, multiple-dose study involving 6 HIV-infected patients receiving a combination...

  13. Genetic polymorphisms in the CD14 gene are associated with monocyte activation and carotid intima-media thickness in HIV-infected patients on antiretroviral therapy.

    Science.gov (United States)

    Yong, Yean K; Shankar, Esaki M; Westhorpe, Clare L V; Maisa, Anna; Spelman, Tim; Kamarulzaman, Adeeba; Crowe, Suzanne M; Lewin, Sharon R

    2016-08-01

    HIV-infected individuals on antiretroviral therapy (ART) are at increased risk of cardiovascular disease (CVD). Given the relationship between innate immune activation and CVD, we investigated the association of single-nucleotide polymorphisms (SNPs) in TLR4 and CD14 and carotid intima-media thickness (cIMT), a surrogate measurement for CVD, in HIV-infected individuals on ART and HIV-uninfected controls as a cross-sectional, case-control study. We quantified the frequency of monocyte subsets (CD14, CD16), markers of monocyte activation (CD38, HLA-DR), and endothelial adhesion (CCR2, CX3CR1, CD11b) by flow cytometry. Plasma levels of lipopolysaccharide, sCD163, sCD14, sCX3CL1, and sCCL2, were measured by ELISA. Genotyping of TLR4 and CD14 SNPs was also performed. The TT genotype for CD14/-260SNP but not the CC/CT genotype was associated with elevated plasma sCD14, and increased frequency of CD11b+CD14+ monocytes in HIV-infected individuals. The TT genotype was associated with lower cIMT in HIV-infected patients (n = 47) but not in HIV-uninfected controls (n = 37). The AG genotype for TLR4/+896 was associated with increased CX3CR1 expression on total monocytes among HIV-infected individuals and increased sCCL2 and fibrinogen levels in HIV-uninfected controls. SNPs in CD14/-260 and TLR4/+896 were significantly associated with different markers of systemic and monocyte activation and cIMT that differed between HIV-infected participants on ART and HIV-uninfected controls. Further investigation on the relationship of these SNPs with a clinical endpoint of CVD is warranted in HIV-infected patients on ART.

  14. Prevalence and predictors of anaemia in patients with HIV infection at the initiation of combined antiretroviral therapy in Xinjiang, China.

    Science.gov (United States)

    Mijiti, Peierdun; Yuexin, Zhang; Min, Liu; Wubuli, Maimaitili; Kejun, Pan; Upur, Halmurat

    2015-03-01

    We retrospectively analysed routinely collected baseline data of 2252 patients with HIV infection registered in the National Free Antiretroviral Treatment Program in Xinjiang province, China, from 2006 to 2011 to estimate the prevalence and predictors of anaemia at the initiation of combined antiretroviral therapy. Anaemia was diagnosed using the criteria set forth by the World Health Organisation, and univariate and multivariate logistic regression analyses were performed to determine its predictors. The prevalences of mild, moderate, and severe anaemia at the initiation of combined antiretroviral therapy were 19.2%, 17.1%, and 2.6%, respectively. Overall, 38.9% of the patients were anaemic at the initiation of combined antiretroviral therapy. The multivariate logistic regression analysis indicated that Uyghur ethnicity, female gender, lower CD4 count, lower body mass index value, self-reported tuberculosis infection, and oral candidiasis were associated with a higher prevalence of anaemia, whereas higher serum alanine aminotransferase level was associated with a lower prevalence of anaemia. The results suggest that the overall prevalence of anaemia at the initiation of combined antiretroviral therapy in patients with HIV infection is high in Xinjiang, China, but severe anaemia is uncommon. Patients in China should be routinely checked for anaemia prior to combined antiretroviral therapy initiation, and healthcare providers should carefully select the appropriate first-line combined antiretroviral therapy regimens for anaemic patients.

  15. Executive summary of the consensus document on the management of renal disease in HIV-infected patients.

    Science.gov (United States)

    Górriz, José Luis; Gutiérrez, Félix; Trullas, Joan Carles; Arazo, Piedad; Arribas, Jose Ramón; Barril, Guillermina; Cervero, Miguel; Cofan, Frederic; Domingo, Pere; Estrada, Vicente; Fulladosa, Xavier; Galindo, Maria José; Gracia, Silvia; Iribarren, Jose Antonio; Knobel, Hernando; Lopez-Aldeguer, Jose; Lozano, Fernando; Martínez-Castelao, Alberto; Martinez, Esteban; Mazuecos, Maria A; Miralles, Celia; Montañes, Rosario; Negredo, Eugenia; Palacios, Rosario; Pérez-Elías, María Jesús; Portilla, Joaquin; Praga, Manuel; Quereda, Carlos; Rivero, Antonio; Santamaria, Juan M; Sanz, Jose; Sanz, Jesús; Miró, José María

    2014-11-17

    The aim of this article is to update the 2010 recommendations on the evaluation and management of renal disease in HIV-infected patients. Renal function should be monitored in all HIV-infected patients. The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glucosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document provides indications for renal biopsy and advises on the optimal time for referral of a patient to the nephrologist. The indications for and evaluation and management of dialysis and renal transplantation are also addressed.

  16. Drug fever induced by piperacillin/tazobactam in an elderly patient with underlying human immunodeficiency virus (HIV) infection.

    Science.gov (United States)

    Swe, Thein; Ali, Mir; Naing, Akari Thein

    2016-07-20

    Our search of the literature revealed no detailed case reports about drug fever induced by piperacillin/tazobactam in a patient with HIV infection although there were a few case reports about drug fever due to piperacillin/tazobactam with other comorbidities. A 63-year-old male patient with HIV positive was admitted for acute cholecystitis. He was started on piperacillin/tazobactam. For the next 8 days, he had intermittent fever up to 103°F (39.4°C) with relative bradycardia although he showed clinical improvement. There was no laboratory or imaging findings suggestive of another infectious source and drug fever was suspected. The antibiotics were stopped and after 48 hours no fever was observed until the day of discharge. Piperacillin/tazobactam can induce fever in patients with cystic fibrosis and in patients with other conditions. Drug fever may be more prevalent in patients with HIV infection. It has no characteristic pattern and may not be associated with eosinophilia.

  17. Risk of discontinuation of nevirapine due to toxicities in antiretroviral-naive and -experienced HIV-infected patients with high and low CD4+ T-cell counts

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Staszewski, Schlomo; Weber, Rainer;

    2007-01-01

    It is unknown whether the increased risk of toxicities in antiretroviral-naive HIV-infected patients initiating nevirapine-based (NVPc) combination antiretroviral therapy (cART) with high CD4+ T-cell counts is also observed when NVPc is initiated in cARTexperienced patients.......It is unknown whether the increased risk of toxicities in antiretroviral-naive HIV-infected patients initiating nevirapine-based (NVPc) combination antiretroviral therapy (cART) with high CD4+ T-cell counts is also observed when NVPc is initiated in cARTexperienced patients....

  18. Dyslipidaemia in HIV-infected women on antiretroviral therapy. Analysis of 922 patients from the Spanish VACH cohort

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    Estrada Vicente

    2011-08-01

    Full Text Available Abstract Background Information concerning lipid disturbances in HIV-infected women on antiretroviral therapy (ART is scarce. The objective of the study is to describe the lipid profile in a large cohort of HIV-infected women on contemporary ART and analyse differences between regimes and patient's characteristics. Methods Observational, multicentre, cross-sectional study from the Spanish VACH Cohort. 922 women on stable ART without lipid-lowering treatment were included. Results Median age was 42 years, median CD4 lymphocyte count was 544 cells/mm3, and 85.6% presented undetectable HIV-1 viral load. Median total cholesterol (TC was 189 mg/dL (interquartile range, IQR, 165-221, HDL cholesterol 53 mg/dL (IQR, 44-64, LDL cholesterol 108 mg/dL (IQR, 86-134, and triglycerides 116 mg/dL (IQR, 85-163. Mean accumulated time on ART was 116 months; 47.4% were on NNRTI-based regimes, 44.7% on PI, and 6.7% on only-NRTI therapy. 43.8% were also hepatitis C (HCV coinfected. Patients on PI treatment presented higher TC/HDL ratio than those on NNRTI (p Conclusions In HIV-infected women, the NNRTI-based ART is associated with a better lipid profile than the PI-based. Factors unrelated to ART selection may also exert an independent, significant influence on lipids; in particular, age, and triglyceride levels are associated with an increased TC/HDL ratio while HCV co-infection is associated with a reduced TC/HDL ratio.

  19. Lower Self-Reported Quality of Life in HIV-Infected Patients on cART and With Low Comorbidity Compared With Healthy Controls

    DEFF Research Database (Denmark)

    Pedersen, Karin K; Eiersted, Morten R; Gaardbo, Julie C

    2015-01-01

    BACKGROUND: Self-reported quality of life (QoL) has previously been found to be impaired in patients living with HIV and associated with viral replication, degree of immunodeficiency, and comorbidity. We aimed at investigating QoL in a group of HIV-infected patients with suppressed viral...... replication and with low comorbidity, compared with healthy controls. We furthermore aimed to identify factors associated with QoL. DESIGN AND METHODS: Cross-sectional study of 52 HIV-infected patients and 23 healthy controls matched on age, gender, education, and comorbidity. HIV-infected patients...... and healthy controls had previously been examined regarding cognitive, physical, metabolic, and immunological parameters. QoL was investigated using the Medical Outcomes Study HIV Health Survey (MOS-HIV). Linear multiple regression models were created to find factors associated with mental health summary...

  20. Atypical Presentation of PKDL due to Leishmania infantum in an HIV-Infected Patient with Relapsing Visceral Leishmaniasis

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    Benedetto Maurizio Celesia

    2014-01-01

    Full Text Available We describe the case of an Italian patient with HIV infection who developed an atypical rash resembling post-kala-azar dermal leishmaniasis (PKDL when receiving liposomal Amphotericin B (L-AMB for secondary prophylaxis of visceral leishmaniasis (VL. At the time of PKDL appearance, the patient was virologically suppressed but had failed to restore an adequate CD4+ T-cell count. Histology of skin lesions revealed the presence of a granulomatous infiltrate, with lymphocytes, plasma cells, and macrophages, most of which contained Leishmania amastigotes. Restriction fragment length polymorphism-polymerase chain reaction was positive for Leishmania infantum. Paradoxically, cutaneous lesions markedly improved when a new relapse of VL occurred. The patient received meglumine antimoniate, with a rapid clinical response and complete disappearance of cutaneous rash. Unfortunately, the patient had several relapses of VL over the following years, though the interval between them has become wider after restarting maintenance therapy with L-AMB 4 mg/kg/day once a month. Even if rare, PKDL due to Leishmania infantum may occur in Western countries and represents a diagnostic and therapeutic challenge for physicians. The therapeutic management of both PKDL and VL in HIV infection is challenging, because relapses are frequent and evidence is often limited to small case series and case reports.

  1. Bone disease and HIV infection.

    Science.gov (United States)

    Amorosa, Valerianna; Tebas, Pablo

    2006-01-01

    The high prevalence of bone demineralization among human immunodeficiency virus (HIV)-infected patients in the current therapeutic era has been described in multiple studies, sounding the alarm that we may expect an epidemic of fragility fractures in the future. However, despite noting high overall prevalences of osteopenia and osteoporosis, recent longitudinal studies that we review here have generally not observed accelerated bone loss during antiretroviral therapy beyond the initial period after treatment initiation. We discuss the continued progress toward understanding the mechanisms of HIV-associated bone loss, particularly the effects of HIV infection, antiretroviral therapy, and host immune factors on bone turnover. We summarize results of clinical trials published in the past year that studied the safety and efficacy of treatment of bone loss in HIV-infected patients and provide provisional opinions about who should be considered for bone disease screening and treatment.

  2. CD4 lymphocyte counts and serum p24 antigen of no diagnostic value in monitoring HIV-infected patients with pulmonary symptoms

    DEFF Research Database (Denmark)

    Orholm, M; Nielsen, T L; Nielsen, Jens Ole;

    1990-01-01

    The diagnostic value of the CD4 cell counts and the HIV p24 antigen were evaluated in a consecutive series of 105 HIV-infected patients experiencing 128 episodes of pulmonary symptoms which required bronchoscopy. One-third of patients with opportunistic infection (OI) had CD4 counts greater than 0....... In conclusion, the CD4 cell counts and the presence of p24 antigen in serum had a very limited predictive value for the presence of OI in HIV-infected patients with pulmonary symptoms....

  3. Combined use of waist and hip circumference to identify abdominally obese HIV-infected patients at increased health risk.

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    Trevor O'Neill

    Full Text Available OBJECTIVES: To determine whether for a given waist circumference (WC, a larger hip circumference (HC was associated with a reduced risk of insulin resistance, type 2 diabetes (T2D, hypertension and cardiovascular disease (CVD in HIV-infected patients. A second objective was to determine whether, for a given WC, the addition of HC improved upon estimates of abdominal adiposity, in particular visceral adipose tissue (VAT, compared to those obtained by WC alone. METHODS: HIV-infected men (N = 1481 and women (N = 841 were recruited between 2005 and 2009. WC and HC were obtained using standard techniques and abdominal adiposity was measured using computed tomography. RESULTS: After control for WC and covariates, HC was negatively associated with risk of insulin resistance (p<0.05 and T2D [Men: OR = 0.91 (95% CI: 0.86-0.96; Women: OR = 0.91 (95% CI: 0.84-0.98]. For a given WC, HC was also negatively associated with a lower risk of hypertension (p<0.05 and CVD [OR = 0.94 (95% CI: 0.88-0.99] in men, but not women. Although HC was negatively associated with VAT in men and women after control for WC (p<0.05, the addition of HC did not substantially improve upon the prediction of VAT compared to WC alone. CONCLUSIONS: The identification of HIV-infected individuals at increased health risk by WC alone is substantially improved by the addition of HC. Estimates of visceral adipose tissue by WC are not substantially improved by the addition of HC and thus variation in visceral adiposity may not be the conduit by which HC identifies increased health risk.

  4. Prevalence and Predictors of Thyroid Dysfunction in Patients with HIV Infection and Acquired Immunodeficiency Syndrome: An Indian Perspective

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    Neera Sharma

    2015-01-01

    Full Text Available Background. Predictors of thyroid dysfunction in HIV are not well determined. This study aimed to determine the prevalence and predictors of thyroid dysfunction in HIV infected Indians. Methods. Consecutive HIV patients, 18–70 years of age, without any severe comorbid state, having at least 1-year follow-up at the antiretroviral therapy clinic, underwent clinical assessment and hormone assays. Results. From initially screened 527 patients, 359 patients (61.44±39.42 months’ disease duration, having good immune function [CD4 count >200 cell/mm3: 90.25%; highly active antiretroviral therapy (HAART: 88.58%], were analyzed. Subclinical hypothyroidism (ScH was the commonest thyroid dysfunction (14.76% followed by sick euthyroid syndrome (SES (5.29% and isolated low TSH (3.1%. Anti-TPO antibody (TPOAb was positive in 3.90%. Baseline CD4 count had inverse correlation with TPOAb after adjusting for age and body mass index. Stepwise linear regression revealed baseline CD4 count, TPOAb, and tuberculosis to be best predictors of ScH after adjusting for age, weight, duration of HIV, and history of opportunistic fungal and viral infections. Conclusion. Burden of thyroid dysfunction in chronic HIV infection with stable immune function is lower compared to pre-HAART era. Thyroid dysfunction is primarily of nonautoimmune origin, predominantly ScH. Severe immunodeficiency at disease onset, TPOAb positivity, and tuberculosis were best predictors of ScH.

  5. Reliability and validity of the Ethiopian version of the hospital anxiety and depression scale (HADS in HIV infected patients.

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    Ayalu Aklilu Reda

    Full Text Available BACKGROUND: The hospital anxiety and depression scale (HADS is a widely used instrument for evaluating psychological distress from anxiety and depression. HADS has not yet been validated in Ethiopia. The aim of this study was to evaluate the reliability and validity of the Amharic (Ethiopian language version of HADs among HIV infected patients. METHODS: The translated scale was administered to 302 HIV/AIDS patients on follow up for and taking anti-retroviral treatment. Consistency assessment was conducted using Cronbach's alpha, test-retest reliability using intra-class correlation coefficients (ICC. Construct validity was examined using principal components analysis (PCA. Parallel analysis, Kaiser's criterion and the scree test were used for factor extraction. RESULTS: The internal consistency was 0.78 for the anxiety, 0.76 for depression subscales and 0.87 for the full scale of HADS. The intra-class correlation coefficient (ICC was 80%, 86%, and 84% for the anxiety and depression subscales, and total score respectively. PCA revealed a one dimensional scale. CONCLUSION: This preliminary validation study of the Ethiopian version of the HADs indicates that it has promising acceptability, reliability and validity. The adopted scale has a single underlying dimension as indicated by Razavi's model. The HADS can be used to examine psychological distress in HIV infected patients. Findings are discussed and recommendations made.

  6. Bone turnover markers in HIV-infected patients before starting antiretroviral therapy

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    R Martín-Morales

    2012-11-01

    , and one with hypovitaminosis D. Elevated BTM were related with no clinical, analytical, immunovirological parameters nor with serum levels of 25OHD nor PTH. Conclusions: The prevalence of elevated BTM was high in this series of HIV-patients, mostly young men, with short time of HIV infection and with no immunovirologic control. BTM were related with no clinical nor analytical data.

  7. A web-based intervention trial for depressive symptoms and subjective well-being in patients with chronic HIV infection.

    Science.gov (United States)

    Drozd, Filip; Skeie, Linda Gail; Kraft, Pål; Kvale, Dag

    2014-01-01

    The current study examined the efficacy of a web-based intervention (WBI; Avanti) on symptoms of depression and well-being for patients diagnosed with HIV. A two-armed randomized trial recruited patients on antiretroviral therapy (ART) at an outpatient clinic. Thirty-six patients were allocated to Avanti and 31 patients to a control group. Primary outcomes were symptoms of depression and subjective well-being (SWB), and secondary outcomes included life satisfaction and affect balance. Paired tests showed that only patients following Avanti had significant improvements in SWB by 3 months as well as affect balance. No significant differences between groups were detected in any of the outcome parameters at baseline after 3 months, as expected from group size and variability in the parameters. However, time since HIV diagnosis and ART initiation moderated the effects of Avanti. In conclusion, our data show that patients with HIV infection may benefit from a WBI in adjunct to medical treatment.

  8. Immune reconstitution inflammatory syndrome in HIV-infected patients with mycobacterial infections starting highly active anti-retroviral therapy

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    Buckingham, S.J.; Haddow, L.J.; Shaw, P.J.; Miller, R.F. E-mail: rmiller@gum.ucl.ac.uk

    2004-06-01

    AIM: To describe the radiological appearances of immune reconstitution inflammatory syndrome (IRIS) in human immunodeficiency virus (HIV)-infected patients with mycobacterial infections starting highly active anti-retroviral therapy (HAART). MATERIALS AND METHODS: Five consecutive HIV infected patients with IRIS due to mycobacterial infection were studied. Intercurrent infection and poor drug compliance were excluded as causes of presentation. The chest radiological appearances at the time of starting HAART and at the time of diagnosis of IRIS were compared. RESULTS: In these five patients there was clinical and radiological deterioration, occurring between 10 days and 7 months after starting HAART, leading to unmasking of previously undiagnosed mycobacterial infection or to worsening of mycobacterial disease. All five patients had HAART-induced increases in CD4+ T lymphocyte counts and reductions in peripheral blood HIV 'viral load'. Chest radiographic abnormalities due to IRIS included marked mediastinal lymphadenopathy in three patients--severe enough to produce tracheal compression in two patients (one of whom had stridor)--and was associated with new pulmonary infiltrates in two patients. The other two patients had new infiltrates, which in one patient was associated with a pleural effusion. CONCLUSION: These cases illustrate the diverse chest radiographic appearances of IRIS occurring after HAART in patients with mycobacterial and HIV co-infection. Marked mediastinal lymphadenopathy occurred in three of these five patients (with associated tracheal narrowing in two patients); four patients developed pulmonary infiltrates and one had an effusion. The cases further highlight that the onset of IRIS may be delayed for several months after HAART is started.

  9. Mortality of HIV-infected patients starting antiretroviral therapy in sub-Saharan Africa: comparison with HIV-unrelated mortality.

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    Martin W G Brinkhof

    2009-04-01

    Full Text Available BACKGROUND: Mortality in HIV-infected patients who have access to highly active antiretroviral therapy (ART has declined in sub-Saharan Africa, but it is unclear how mortality compares to the non-HIV-infected population. We compared mortality rates observed in HIV-1-infected patients starting ART with non-HIV-related background mortality in four countries in sub-Saharan Africa. METHODS AND FINDINGS: Patients enrolled in antiretroviral treatment programmes in Côte d'Ivoire, Malawi, South Africa, and Zimbabwe were included. We calculated excess mortality rates and standardised mortality ratios (SMRs with 95% confidence intervals (CIs. Expected numbers of deaths were obtained using estimates of age-, sex-, and country-specific, HIV-unrelated, mortality rates from the Global Burden of Disease project. Among 13,249 eligible patients 1,177 deaths were recorded during 14,695 person-years of follow-up. The median age was 34 y, 8,831 (67% patients were female, and 10,811 of 12,720 patients (85% with information on clinical stage had advanced disease when starting ART. The excess mortality rate was 17.5 (95% CI 14.5-21.1 per 100 person-years SMR in patients who started ART with a CD4 cell count of less than 25 cells/microl and World Health Organization (WHO stage III/IV, compared to 1.00 (0.55-1.81 per 100 person-years in patients who started with 200 cells/microl or above with WHO stage I/II. The corresponding SMRs were 47.1 (39.1-56.6 and 3.44 (1.91-6.17. Among patients who started ART with 200 cells/microl or above in WHO stage I/II and survived the first year of ART, the excess mortality rate was 0.27 (0.08-0.94 per 100 person-years and the SMR was 1.14 (0.47-2.77. CONCLUSIONS: Mortality of HIV-infected patients treated with combination ART in sub-Saharan Africa continues to be higher than in the general population, but for some patients excess mortality is moderate and reaches that of the general population in the second year of ART. Much of the

  10. WHO antiretroviral therapy guidelines 2010 and impact of tenofovir on chronic kidney disease in Vietnamese HIV-infected patients.

    Directory of Open Access Journals (Sweden)

    Daisuke Mizushima

    Full Text Available OBJECTIVE: The 2010 WHO antiretroviral therapy (ART guidelines have resulted in increased tenofovir use. Little is known about tenofovir-induced chronic kidney disease (CKD in HIV-infected Vietnamese with mean body weight of 55 kg. We evaluated the prevalence and risk factors of CKD in this country. DESIGN: Cross-sectional study was performed. METHODS: Clinical data on HIV-infected Vietnamese cohort were collected twice a year. To evaluate the prevalence of CKD, serum creatinine was measured in 771 patients in October 2011 and April 2012. CKD was defined as creatinine clearance less than 60 ml/min at both time points. Multivariate logistic regression was used to determine the factors associated with CKD. RESULTS: Tenofovir use increased in Vietnam from 11.9% in April 2011 to 40.3% in April 2012. CKD was diagnosed in 7.3%, of which 7% was considered moderate and 0.3% was severe. Multivariate analysis of October-2011 data identified age per year-increase (OR: 1.229, 95%CI, 1.170-1.291, body weight per 1 kg-decrement (1.286, 1.193-1.386, and tenofovir use (2.715, 1.028-7.168 as risk factors for CKD. CONCLUSIONS: Older age, low body weight and tenofovir use were independent risk factors for CKD in Vietnam. Further longitudinal study is required to evaluate the impact of TDF on renal function in Vietnam and other countries with small-body weight patients.

  11. Posterior Reversible Encephalopathy Syndrome in a Patient with Newly Diagnosed HIV Infection and End Stage Renal Disease.

    Science.gov (United States)

    Kurukumbi, Mohankumar; Castellanos, Maria I; Crawford, Amanda K; Gowdar, Shreyas D; Jayam-Trouth, Annapurni

    2013-01-01

    Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome in which patients present with an acute or subacute clinical presentation of seizures, visual disturbances, headache, and altered mental status. The pathophysiology of PRES may be explained by endothelial dysfunction that leads to transudation of fluids and protein, resulting in vasogenic cerebral edema. PRES is typically associated with many conditions such as hypertension, uremia, immunosuppressive drugs, and sepsis. This is a case report of a 39-year-old woman with untreated HIV infection and end-stage renal disease (ESRD) who developed PRES with a normal blood pressure and no other known causes of PRES. Untreated HIV is associated with known endothelial dysfunction and we believe that this, in combination with her untreated end-stage renal disease, contributed to her unique presentation of PRES. Although uncommon in HIV-infected patients and challenging to diagnose, prompt recognition of PRES is critical to provide appropriate care and ensure reversibility of the vasogenic edema seen in PRES.

  12. Posterior Reversible Encephalopathy Syndrome in a Patient with Newly Diagnosed HIV Infection and End Stage Renal Disease

    Directory of Open Access Journals (Sweden)

    Mohankumar Kurukumbi

    2013-01-01

    Full Text Available Posterior reversible encephalopathy syndrome (PRES is a clinicoradiological syndrome in which patients present with an acute or subacute clinical presentation of seizures, visual disturbances, headache, and altered mental status. The pathophysiology of PRES may be explained by endothelial dysfunction that leads to transudation of fluids and protein, resulting in vasogenic cerebral edema. PRES is typically associated with many conditions such as hypertension, uremia, immunosuppressive drugs, and sepsis. This is a case report of a 39-year-old woman with untreated HIV infection and end-stage renal disease (ESRD who developed PRES with a normal blood pressure and no other known causes of PRES. Untreated HIV is associated with known endothelial dysfunction and we believe that this, in combination with her untreated end-stage renal disease, contributed to her unique presentation of PRES. Although uncommon in HIV-infected patients and challenging to diagnose, prompt recognition of PRES is critical to provide appropriate care and ensure reversibility of the vasogenic edema seen in PRES.

  13. [Microbiological diagnosis of HIV infection].

    Science.gov (United States)

    López-Bernaldo de Quirós, Juan Carlos; Delgado, Rafael; García, Federico; Eiros, José M; Ortiz de Lejarazu, Raúl

    2007-12-01

    Currently, there are around 150,000 HIV-infected patients in Spain. This number, together with the fact that this disease is now a chronic condition since the introduction of antiretroviral therapy, has generated an increasing demand on the clinical microbiology laboratories in our hospitals. This increase has occurred not only in the diagnosis and treatment of opportunistic diseases, but also in tests related to the diagnosis and therapeutic management of HIV infection. To meet this demand, the Sociedad de Enfermedades Infecciosas y Microbiología Clinica (Spanish Society of Infectious Diseases and Clinical Microbiology) has updated its standard Procedure for the microbiological diagnosis of HIV infection. The main advances related to serological diagnosis, plasma viral load, and detection of resistance to antiretroviral drugs are reviewed in this version of the Procedure.

  14. Different growth hormone sensitivity of target tissues and growth hormone response to glucose in HIV-infected patients with and without lipodystrophy

    DEFF Research Database (Denmark)

    Andersen, Ove; Haugaard, Steen B; Hansen, Birgitte R;

    2004-01-01

    Growth hormone (GH)-secretion in HIV-lipodystrophy is impaired; however, GH-sensitivity of GH-target tissues remains to be evaluated. We measured overnight fasting concentrations of GH-sensitive insulin-like growth-factor-I (IGF-I) and IGF binding protein-3 (IGFBP-3) including GH binding protein...... (GHBP), a marker of GH-receptor sensitivity, in antiretroviral treated HIV-infected patients with (LIPO) and without lipodystrophy (NONLIPO) and antiretroviral naive HIV-infected patients (NAIVE). Three h GH-suppression tests using oral glucose were undertaken to determine dynamics of GH-secretion. IGF...... glucose in LIPO compared with NONLIPO and NAIVE (p lipodystrophy....

  15. Pleural tuberculosis in patients with early HIV infection is associated with increased TNF-alpha expression and necrosis in granulomas.

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    Juanita Bezuidenhout

    Full Text Available Although granulomas may be an essential host response against persistent antigens, they are also associated with immunopathology. We investigated whether HIV co-infection affects histopathological appearance and cytokine profiles of pleural granulomas in patients with active pleural tuberculosis (TB. Granulomas were investigated in pleural biopsies from HIV positive and negative TB pleuritis patients. Granulomas were characterised as necrotic or non-necrotic, graded histologically and investigated for the mRNA expression of IL-12, IFN-gamma, TNF-alpha and IL-4 by in situ hybridisation. In all TB patients a mixed Th1/Th2 profile was noted. Necrotic granulomas were more evident in HIV positive patients with a clear association between TNF-alpha and necrosis. This study demonstrates immune dysregulation which may include TNF-alpha-mediated immunopathology at the site of disease in HIV infected pleural TB patients.

  16. Tuberculosis en pacientes infectados por el VIH Tuberculosis in patients with HIV infection

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    J. Úriz

    2007-01-01

    tuberculosis infection and accelerates progression after infection or reinfection; on the other hand, TB aggravates the prognosis of patients infected with HIV. This article sets out the differential aspects in the clinical manifestations of TB amongst populations with and without HIV infection; we also comment on some special characteristics in the treatment of tuberculosis in HIV patients. With the exception of primary cutaneous infections produced by accidental inoculation and infantile lymphadenitis, the majority of the cases of disease due to non-tuberculosis mycobacteria (NTM affect patients with certain predisposing factors. In the case of patients with AIDS, the deep immunological disorder provoked by HIV brings a particular susceptibility to suffering invasive disease due to certain NTM, principally M. avium complex and M. kansasii.

  17. Forty-eight-week efficacy and safety and early CNS tolerability of doravirine (MK-1439, a novel NNRTI, with TDF/FTC in ART-naive HIV-positive patients

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    Josep M Gatell

    2014-11-01

    Full Text Available Introduction: Doravirine (DOR is an investigational NNRTI (aka MK-1439 that retains activity against common NNRTI-resistant mutants. We have previously reported the Part 1 results from a two-part, randomized, double-blind, Phase IIb study in ART-naïve HIV-1-positive patients (1. At doses of 25, 50, 100 and 200 mg qd, DOR plus open-label tenofovir/emtricitabine (TDF/FTC demonstrated potent antiretroviral activity comparable to EFV 600 mg qhs plus TDF/FTC and was generally well tolerated at week 24. DOR 100 mg was selected for use in patients continuing in Part 1 and those newly enrolled in Part 2. Methods: Patients receiving DOR 25, 50 or 200 mg in Part 1 were switched to 100 mg after dose selection. In Part 2, 132 additional patients were randomized 1:1 to DOR 100 mg qd or EFV 600 mg qhs (each with TDF/FTC. We present week 48 efficacy and safety results for all patients in Part 1, and early (week 8 CNS tolerability only for patients randomized to DOR 100 mg or to EFV in Parts 1 and 2 combined. The primary safety endpoint is the % of patients with pre-specified CNS events (all causality by week 8 for DOR 100 mg qd vs EFV (Parts 1 + 2 combined. Results: Part 1 week 48 efficacy and safety results are shown below. The most common DR clinical AEs in the DOR and EFV groups, respectively, were abnormal dreams (10.2%; 9.5%, nausea (7.8%; 2.4%, fatigue (7.2%; 4.8%, diarrhoea (4.8%; 9.5% and dizziness (3.0%; 23.8%, and were generally mild to moderate. Part 1 + 2 Week 8 CNS Event Analysis: One hundred thirty-two patients were randomized in Part 2, 66 to DOR 100 mg and 66 to EFV. Combining Part 1 and 2, a total of 108 patients received DOR 100 mg and 108 received EFV. By week 8, at least one CNS AE was reported in 22.2% of the DOR group and 43.5% of the EFV group (p<0.001. The most common CNS AEs were dizziness (DOR 9.3%; EFV 27.8%, insomnia (6.5%; 2.8%, abnormal dreams (5.6%; 16.7% and nightmares (5.6%; 8.3%. Conclusions: In ART-naïve, HIV-1-positive

  18. CD4 lymphocyte counts and serum p24 antigen of no diagnostic value in monitoring HIV-infected patients with pulmonary symptoms

    DEFF Research Database (Denmark)

    Orholm, M; Nielsen, T L; Nielsen, Jens Ole

    1990-01-01

    The diagnostic value of the CD4 cell counts and the HIV p24 antigen were evaluated in a consecutive series of 105 HIV-infected patients experiencing 128 episodes of pulmonary symptoms which required bronchoscopy. One-third of patients with opportunistic infection (OI) had CD4 counts greater than ...

  19. Assessment of the effect of antiretroviral therapy on renal and liver functions among HIV-infected patients: a retrospective study

    Science.gov (United States)

    Wondifraw Baynes, Habtamu; Tegene, Birhanemeskel; Gebremichael, Mikiyas; Birhane, Gebrehawaria; Kedir, Wabe; Biadgo, Belete

    2017-01-01

    Background The emergence of highly active antiretroviral therapy (HAART) has dramatically improved quality of life in prolonging survival of human immunodeficiency virus (HIV)-infected patients on treatment in developed as well as developing countries. However, the main shortcoming of HAART in long-term use is its potential to cause liver and kidney derangements that may be life threatening. The drugs are actively accumulated in the proximal renal tubule resulting in functional disturbance with mitochondrial injury being one of the most important targets recognized. Therefore, the aim of this study was to assess the adverse effects of HAART on kidney and liver functions among HIV-infected patients presenting to the University of Gondar Hospital, Ethiopia. Materials and methods An institution-based retrospective study was conducted from 2010 to 2015 on a subset of HIV-infected patients. Data were collected from the registration book of the University of Gondar Hospital antiretroviral clinic laboratory after checking the completeness of age, gender, creatinine, blood urea nitrogen, and alanine aminotransferase level. Data were entered and analyzed using SPSS version 20. Descriptive statistics, chi-square test, one-way analysis of variance, and logistic regression were done to determine associations. A P-value <0.05 was considered statistically significant. Results A total of 275 study subjects were included in the study. Of these, 62.2% were females, and the overall prevalence of chronic kidney disease (CKD) before and after treatment was 3.6% and 11.7%, respectively. A majority of the CKD patients were in stage 3 for patients after treatment. The overall prevalence of hepatotoxicity was 6.5% and 16.7% before and after treatment, respectively. A majority of the patients developed Grade 2 hepatotoxicity 66.7% and 65.2% before and after treatment, respectively. Binary and multiple logistic regression analysis indicated that the female gender was a risk factor for CKD

  20. Assessment of the effect of antiretroviral therapy on renal and liver functions among HIV-infected patients: a retrospective study

    Directory of Open Access Journals (Sweden)

    Wondifraw Baynes H

    2016-12-01

    Full Text Available Habtamu Wondifraw Baynes,1 Birhanemeskel Tegene,2 Mikiyas Gebremichael,3 Gebrehawaria Birhane,3 Wabe Kedir,3 Belete Biadgo1 1Department of Clinical Chemistry, 2Department of Medical Microbiology, 3Department of Medical Laboratory Science, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Background: The emergence of highly active antiretroviral therapy (HAART has dramatically improved quality of life in prolonging survival of human immunodeficiency virus (HIV-infected patients on treatment in developed as well as developing countries. However, the main shortcoming of HAART in long-term use is its potential to cause liver and kidney derangements that may be life threatening. The drugs are actively accumulated in the proximal renal tubule resulting in functional disturbance with mitochondrial injury being one of the most important targets recognized. Therefore, the aim of this study was to assess the adverse effects of HAART on kidney and liver functions among HIV-infected patients presenting to the University of Gondar Hospital, Ethiopia. Materials and methods: An institution-based retrospective study was conducted from 2010 to 2015 on a subset of HIV-infected patients. Data were collected from the registration book of the University of Gondar Hospital antiretroviral clinic laboratory after checking the completeness of age, gender, creatinine, blood urea nitrogen, and alanine aminotransferase level. Data were entered and analyzed using SPSS version 20. Descriptive statistics, chi-square test, one-way analysis of variance, and logistic regression were done to determine associations. A P-value <0.05 was considered statistically significant. Results: A total of 275 study subjects were included in the study. Of these, 62.2% were females, and the overall prevalence of chronic kidney disease (CKD before and after treatment was 3.6% and 11.7%, respectively. A majority of the CKD

  1. Risk of zidovudine-induced anemia on human immunodeficiency virus (HIV infection patients with different CD4 cell counts

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    anak agung ayu niti wedayani

    2017-02-01

    Full Text Available Anemia is the most common hematologic abnormality in patients with human immunodeficiency virus (HIV infection. This abnormality is associated with HIV infection itself, HIV-related opportunities infections or drug use. Zidovudine (AZT is the most common cause of anemia in HIV patients. Recent study showed anemia in HIV patients is also associated with CD4 cell counts. Aim of this study was to evaluate the risk of anemia on HIV patients with different CD4 cell counts after AZT-based antiretroviral therapy (ART.This retrospective cohort study was conducted using medical record of HIV patients in Dr. Soetomo General Hospital, Surabaya. Subjects who fulfilled the inclusion and exclusion criteria were divided into two group i.e. HIV patients with CD4 cell counts 200-350 cell/mm3 and those with CD4cell counts ≥350 cell/mm3. All available demographics, clinical and laboratory data of subjects before and after AZT-based ART were then recorded and evaluated. Ninety-seven HIV patients (50 male and 47 female were involved in this study. The result showed that the anemia incidence significantly increased after AZT-based ART (p0.05. Gender, age, weight and clinical stage were not associated with anemia incidence (p>0.05. In contrast, anemia incidence is associated with Hb level before AZT therapy (p<0.05. In conclusion, the anemia incidence in HIV patients after AZT based ART is not associated with the level of CD4 cell counts, however it is associated with Hb levels before AZT therapy.

  2. Immunosenescence of the CD8(+) T cell compartment is associated with HIV-infection, but only weakly reflects age-related processes of adipose tissue, metabolism, and muscle in antiretroviral therapy-treated HIV-infected patients and controls

    DEFF Research Database (Denmark)

    Tavenier, Juliette; Langkilde, Anne; Haupt, Thomas Huneck

    2015-01-01

    -related processes of inflammation, metabolism, adipose tissue, and muscle. T cell immunosenescence and exhaustion were assessed by flow cytometry analysis of CD8 (+) cells from 43 ART-treated HIV-infected patients (HIV(+)) and ten Controls using markers of differentiation: CD27/CD28; maturation: CD27/CD45RA...... differentiated and mature CD8 (+) T cell phenotypes. PD-1 and KLRG1 expression did not differ between HIV(+) and Controls, but depended on differentiation and maturation stages of the cells. CD8 (+) T cell maturation was associated with age. KLRG1 expression was associated with age, metabolic syndrome, visceral...

  3. Mycetoma in an HIV-infected patient Mycetoma em paciente HIV positivo

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    Luiz G. M. Castro

    1999-10-01

    Full Text Available Although oportunistic fungal infections occur commonly in immunocompromised hosts, mycetoma has never been reported in association with HIV infection. The authors present a case that to their knowledge is the first reported case of mycetoma associated with HIV infection. Diagnosis was confirmed by direct examination of grains and histologic examination. Precise identification of the agent, an actinomycete, was not possible. The unusual site of infection may probably be related to the use of contaminated needless and sirynges for HIV drug injection.Os autores relatam um caso de actinomicetoma em pacientes HIV positivo. Apesar das infecções fúngicas oportunistas serem freqüentemente observadas em pacientes infectados pelo HIV, a associação com micetoma nunca foi descrita. O diagnóstico foi confirmado pelo exame micolígico direto de grãos obtidos da secreção e de exame anátomo-patológico. Não foi possível identificar o agente, mas as características sugerem tratar-se de actinomiceto. Os autores acreditam que a localização no membro superior possa estar relacionada com o uso de seringas e agulhas contaminadas para injeção de drogas EV.

  4. Renal and urologic disorders in antiretroviral-treated patients with HIV infection or AIDS: spectrum of cross-sectional imaging findings.

    Science.gov (United States)

    Tonolini, Massimo; Villa, Federica; Villa, Chiara; Ippolito, Sonia; Bianco, Roberto

    2013-01-01

    In the aging human immunodeficiency virus (HIV)-infected population with improved immune function under antiretroviral treatment, many different opportunistic disorders may be encountered, along with rare presentations or complicated forms of common diseases. Renal and urologic abnormalities observed in the setting of HIV infection or acquired immunodeficiency syndrome are reviewed with their imaging appearances, including renal dysfunction, urolithiasis, urinary tract infections and related complications, genitourinary tuberculosis, vascular lesions, urogenital tumors, and bladder abnormalities, with emphasis on characterization. In HIV-positive patients, early cross-sectional imaging is warranted to detect uncommon disorders and complications, with the aim to preserve renal function.

  5. Early diagnosis and retention in care of HIV-infected patients through rapid salivary testing: a test-and-treat fast track pilot study.

    Science.gov (United States)

    Parisi, Maria Rita; Soldini, Laura; Negri, Silvia; Vidoni, Gian Marino; Gianotti, Nicola; Nozza, Silvia; Schlusnus, Karin; Dorigatti, Fernanda; Lazzarin, Adriano

    2016-01-01

    Aim of this study was to evaluate the efficacy and the retention-in-care of individuals diagnosed during six years of salivary HIV testing (EASY-test project). Among those linked-to-care at the Infectious Diseases Department of San Raffaele Hospital (Milan, Italy), the proportion of patients engaged, retained in care and virologically suppressed after the antiretroviral treatment was 96%, 100% and 95.2%, respectively. Results from our study suggest that salivary HIV testing may help bring to light cases of HIV infection otherwise undiagnosed, and thus favour a more rapid and wider reduction of the HIV infection burden at the population level.

  6. Durability of response to vaccination against viral hepatitis A in HIV-infected patients: a 5-year observation.

    Science.gov (United States)

    Jabłonowska, E; Kuydowicz, J

    2014-09-01

    The aim of this study was to estimate the prevalence of total antibodies to hepatitis A virus (anti-HAV-T) in the group of HIV-positive adults in Lodz region of Poland, and to evaluate the response and long-term immunity after vaccination against hepatitis A virus. In the group of 234 HIV-infected patients, 72 persons (30.8%) were anti-HAV-T positive (>20 IU/L). In multivariate analysis, two independent factors associated with the presence of anti-HAV-T were identified: the age of patients (OR = 1.07) and the presence of antibodies to hepatitis C virus (OR = 2.87). Vaccination was completed in 83 patients. Good response (anti-HAV-T >20 IU/L one month after the booster dose) was obtained in 79.5% of patients. In patients with CD4 >200 cells/µL in multivariate analysis only presence of antibodies to hepatitis C virus was a prognostic factor for the response to vaccination (OR = 0.13). Among responders available for the follow-up, 82% (50 out of 61) had detectable anti-HAV-T at 1 year and 75.5% (37 out of 49) at 5 years. Our results demonstrate that most of the studied HIV-positive patients were susceptible to hepatitis A virus infection. Most HIV-infected adults with high CD4 counts had a durable response even up to 5 years after vaccination. Patients with a HIV/hepatitis C virus coinfection displayed a worse response to vaccination.

  7. Tricuspid Valve Replacement in an HIV-Infected Patient with Severe Tricuspid Regurgitation Secondary to Remote Endocarditis.

    Science.gov (United States)

    Myerson, Merle; Armstrong, Ehrin J; Poltavskiy, Eduard; Fefer, Jose; Bang, Heejung

    2016-12-01

    Surgical intervention for severe tricuspid regurgitation secondary to remote infective endocarditis has been infrequent, especially in patients also infected with the human immunodeficiency virus (HIV). We describe the case of a 62-year-old HIV-positive man, with a 24-year history of endocarditis caused by intravenous heroin use, who presented with severe tricuspid regurgitation. The patient was initially asymptomatic, was taking antiretroviral medications, and had a satisfactory CD4 count and an undetectable viral load, so we decided to manage the regurgitation conservatively. Two years later, he presented with biventricular heart failure and dyspnea. After surgical tricuspid valve replacement, his condition improved substantially. This case illustrates that HIV-infected patients with complex medical conditions can successfully undergo cardiac surgery.

  8. CD3zeta down-modulation may explain Vgamma9Vdelta2 T lymphocyte anergy in HIV-infected patients.

    Science.gov (United States)

    Sacchi, Alessandra; Tempestilli, Massimo; Turchi, Federica; Agrati, Chiara; Casetti, Rita; Cimini, Eleonora; Gioia, Cristiana; Martini, Federico

    2009-02-01

    The aim of the present study was to explain the observed anergy of Vgamma9Vdelta2 T cells from human immunodeficiency virus (HIV)-positive patients. CD3zeta expression and interferon (IFN)-gamma production by Vgamma9Vdelta2 T cells from HIV-positive and HIV-negative subjects were analyzed. We demonstrated that Vgamma9Vdelta2 T cells from HIV-infected patients expressed a lower level of CD3zeta than did Vgamma9Vdelta2 T cells from healthy donors. A direct correlation was found between CD3zeta expression and IFN-gamma production capability by Vgamma9Vdelta2 T cells. However, activation of protein kinase C by phorbol myristate acetate is able to restore CD3zeta expression and IFN-gamma production. Our findings may contribute to clarification of the molecular mechanisms of Vgamma9Vdelta2 T cell anergy found in HIV-positive patients.

  9. Immune reconstitution inflammatory syndrome in HIV-infected patients receiving antiretroviral therapy : pathogenesis, clinical manifestations and management

    DEFF Research Database (Denmark)

    Dhasmana, Devesh J; Dheda, Keertan; Ravn, Pernille;

    2008-01-01

    The use of antiretroviral therapy (ART) to treat HIV infection, by restoring CD4+ cell count and immune function, is associated with significant reductions in morbidity and mortality. Soon after ART initiation, there is a rapid phase of restoration of pathogen-specific immunity. In certain patients...... to a heterogeneous range of clinical manifestations. The commonest forms of IRIS are associated with mycobacterial infections, fungi and herpes viruses. In most patients, ART should be continued and treatment for the associated condition optimized, and there is anecdotal evidence for the use of corticosteroids...... in patients who are severely affected. In this review, we discuss research relating to pathogenesis, the range of clinical manifestations, treatment options and prevention issues....

  10. Effect of medroxyprogesterone acetate on the efficiency of an oral protein-rich nutritional support in HIV-infected patients.

    Science.gov (United States)

    Rochon, Cécile; Prod'homme, Magali; Laurichesse, Henri; Tauveron, Igor; Balage, Michèle; Gourdon, Florence; Baud, Olivier; Jacomet, Christine; Jouvency, Sylvie; Bayle, Gérard; Champredon, Claude; Thieblot, Philippe; Beytout, Jean; Grizard, Jean

    2003-01-01

    We have examined the effect of a medroxyprogesterone therapy in HIV-infected patients under appropriate nutrition for anabolism. The experiments were performed on 12 men (mean age 40 y), HIV seropositive but free of any clinically active opportunistic infection for at least one month. The patients underwent a 2-week baseline diet period (1.2 g protein x kg(-1) body weight (BW) x d(-1)) and then a 5-week experimental period with again the baseline diet in conjunction with supplements including Tonexis HP (0.7 g protein x kg(-1) BW) x d(-1)), L-threonine (0.018 g x kg(-1) BW x d(-1)) and L-methionine (0.013 g x kg(-1) BW x d(-1)). Indeed HIV-infected patients showed deficiencies in these amino acids. They were randomly divided into groups I and II under double-blinded condition. Group II was given medroxyprogesterone acetate (0.4 g x d(-1)) during the last 3 weeks whereas group I received a placebo. All the patients significantly increased their body weight (P < 0.05) during the experimental periods. Those under medroxyprogesterone tended to show a higher but not significant weight gain (+3.1 +/- 1.0 kg in group II and +1.9 +/- 0.3 kg in group I). Blood free amino acids were used as rough indicators of amino acid utilization and were analyzed prior and during acute 150 min intravenous infusion of a complete glucose-amino acid mixture. This test was done before and at the end of the experimental periods. Basal essential blood free amino acids were similar in the two groups and did not change during the experimental period. Most essential amino acids increased following glucose-amino acid infusions. The incremental increase was of less magnitude after the experimental period than before when medroxyprogesterone was present (P < 0.05 for valine, leucine, lysine, threonine and methionine). This was not the case in the absence of the hormone. We concluded that medroxyprogesterone might improve the efficacy of an oral protein-rich nutritional support in HIV-infected

  11. Raltegravir and Abacavir/Lamivudine in Japanese Treatment-Naïve and Treatment-Experienced Patients with HIV Infection: a 48-Week Retrospective Pilot Analysis.

    Science.gov (United States)

    Suzuki, Akihito; Uehara, Yuki; Saita, Mizue; Inui, Akihiro; Isonuma, Hiroshi; Naito, Toshio

    2016-01-01

    Abacavir/lamivudine (ABC/3TC) is a nucleoside reverse transcriptase inhibitor used for treating human immunodeficiency viral (HIV) infections. Hypersensitivity reactions such as skin eruptions caused by ABC are well-known, but rarely occur in Asians. Raltegravir (RAL) is an integrase strand transfer inhibitor, that is now increasingly, used for treating HIV infections because it has few adverse effects. This retrospective analysis assessed the efficacy and safety of combined ABC/3TC and RAL in both treatment-naïve and -experienced Japanese patients with HIV infections. In all 11 treatment-naïve patients (100%), virological suppression to undetectable level was achieved. Liver transaminases, renal function, and serum lipid profiles showed no exacerbations up to 48 weeks of treatment. In 12 patients who were switched from previous regimens to ABC/3TC and RAL, HIV viral load was undetectable in 11 patients (91.6%), but remained detectable in 1 patient with poor adherence. Major reasons for switching regimens to ABC/3TC and RAL were hyperlipidemia and nausea. After switching, these adverse effects improved, and no new adverse effects were observed. Despite the small number of participants in this study, the results support the combination of ABC/3TC and RAL as a possible treatment choice in Japanese individuals with HIV-infection.

  12. Cryptoccocal meningitis in Yaoundé (Cameroon) HIV infected patients: Diagnosis, frequency and Cryptococcus neoformans isolates susceptibility study to fluconazole.

    Science.gov (United States)

    Kammalac Ngouana, T; Dongtsa, J; Kouanfack, C; Tonfack, C; Fomena, S; Mallié, M; Delaporte, E; Boyom, F-Fekam; Bertout, S

    2015-03-01

    Cryptococcal meningitis is a mycosis encountered especially in patients with Acquired Immunodeficiency Syndrome and is fatal in the absence of treatment. Information on epidemiology, diagnosis and susceptibility profile to antifungal drugs, are scarce in Cameroon. Authors evaluated the diagnosis possibilities of the cryptococcal meningitis in Cameroon, and studied the antifungal susceptibility of isolated strains to fluconazole, used as first line treatment of the disease in Cameroon. Between December 2009 and July 2011, 146 cerebrospinal fluids obtained from HIV patients with suspicion of meningitis were analysed. The diagnosis procedure involved macroscopic and cyto-chemical analysis, India ink test, culture on Sabouraud chloramphenicol medium and antigen latex agglutination test. Antifungal susceptibility testing of isolated strains to fluconazole was done by the E-test(®) method. The diagnosis of cryptococcal meningitis gave 28.08% positive cases. Among these patients, 80% were at stages III and IV and 20% at stage I of the HIV infection, according to the WHO previous classification. Cyto-chemical analysis showed current findings in the case of cryptococcal meningitis. India ink test and latex agglutination test exhibited very high sensitivity and specificity (>94%). Fluconazole antifungal susceptibility testing gave MICs lower than 32μg/mL to 92.7% of isolated strains and MICs greater than this value to 7.3% of isolates. These results showed that cryptococcal meningitis remains a real problem among HIV infected patients in Yaoundé. The emergence of fluconazole reduced susceptibility strains is worrying. Nevertheless, efficacy of rapid detection tests is interesting because this will help in rapid diagnosis and treatment of patients.

  13. Clinical Correlates and Drug Resistance in HIV-Infected and -Uninfected Pulmonary Tuberculosis Patients in South India

    Science.gov (United States)

    Sara, Chandy; Elsa, Heylen; Baijayanti, Mishra; Lennartsdotter, Ekstrand Maria

    2016-01-01

    Objectives To examine demographics, clinical correlates, sputum AFB (acid fast bacilli) smear grading DOTS (Directly Observed Therapy Short Course) uptake, and drug resistance in a cohort of newly-diagnosed, smear positive pulmonary tuberculosis (TB) patients with respect to HIV status at baseline, and compare smear conversion rates, side effects and mortality after two months. Design A prospective study among 54 HIV positive and 41 HIV negative pulmonary TB patients. Data were collected via face-to-face interviews, review of medical records, and lab tests. Results HIVTB co-infected patients, though more symptomatic at baseline, showed more improvement in their symptoms compared to HIV-uninfected TB patients at follow-up. The HIV co-infected group had more prevalent perceived side effects, and sputum smear positivity was marginally higher compared to the HIV negative group at follow-up. Mortality was higher among the HIV-infected group. Both groups had high rates of resistance to first-line anti-tubercular drugs, particularly isoniazid. There was no significant difference in the drug resistance patterns between the groups. Conclusions Prompt initiation and provision of daily regimens of ATT (Anti-Tubercular treatment) along with ART (Anti-Retroviral treatment) via ART centers is urgently needed in India. As resistance to ART and/or ATT is directly linked to medication non-adherence, the use of counseling, regular reinforcement, early detection and appropriate intervention strategies to tackle this complex issue could help prevent premature mortality and development of resistance in HIV-TB co-infected patients. The high rate of isoniazid resistance might preclude its use in India as prophylaxis for latent TB in HIV infected persons as per the World Health Organization (WHO) guideline. PMID:27708985

  14. Attitude of patients with HIV infection towards organ transplant between HIV patients. A cross-sectional questionnaire survey.

    Science.gov (United States)

    Taha, Huda; Newby, Katie; Das, Archik; Das, Satyajit

    2016-01-01

    This study examined the HIV patients' attitudes towards the practice of organ transplant between HIV patients using a cross-sectional survey design. In total, 206 patients participated with a mean age of 42 (±8.8) years. The majority (70%) were black African and women (54%), and 83% described themselves as heterosexual. Most participants (n = 171, 83%) were on treatment, and 159 (93%) had viral load less than 40 copies/ml. Mean duration of illness and mean duration of treatment were 77 (±42.7) and 68 (±41) months, respectively. Of all participants, 128 (62%) reported that they would consider donating either any organ or a specific organ/s to an HIV patient, 33 (16%) would not consider it and 45 (22%) were unsure about donating their organs. Furthermore, 113 (55%) participants would consider receiving an organ from an HIV patient, 37 (18%) would not consider it, and 56 (27%) were unsure. Ninety-eight participants (42%) reported that they would consider both donating and receiving an organ. Multinomial logistic regression analysis found that significantly more Black African than Caucasian participants were unsure about organ donation (p = 0.011, OR = 3.887). Participants with longer duration of infection were significantly less likely to consider receiving an organ from an HIV patient (p = 0.036, OR = 1.297). Overall, the study findings indicated that the majority of participants were in favour of organ transplant between HIV patients. Use of HIV-infected donors could potentially reduce current organ waiting list among HIV patients.

  15. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: patients with HIV infection or AIDS.

    Science.gov (United States)

    Lortholary, O; Petrikkos, G; Akova, M; Arendrup, M C; Arikan-Akdagli, S; Bassetti, M; Bille, J; Calandra, T; Castagnola, E; Cornely, O A; Cuenca-Estrella, M; Donnelly, J P; Garbino, J; Groll, A H; Herbrecht, R; Hope, W W; Jensen, H E; Kullberg, B J; Lass-Flörl, C; Meersseman, W; Richardson, M D; Roilides, E; Verweij, P E; Viscoli, C; Ullmann, A J

    2012-12-01

    Mucosal candidiasis is frequent in immunocompromised HIV-infected highly active antiretroviral (HAART) naive patients or those who have failed therapy. Mucosal candidiasis is a marker of progressive immune deficiency. Because of the frequently marked and prompt immune reconstitution induced by HAART, there is no recommendation for primary antifungal prophylaxis of mucosal candidiasis in the HIV setting in Europe, although it has been evidenced as effective in the pre-HAART era. Fluconazole remains the first line of therapy for both oropharyngeal candidiasis and oesophageal candidiasis and should be preferred to itraconazole oral solution (or capsules when not available) due to fewer side effects. For patients who still present with fluconazole-refractory mucosal candidiasis, oral treatment with any other azole should be preferred based on precise Candida species identification and susceptibility testing results in addition to the optimization of HAART when feasible. For vaginal candidiasis, topical therapy is preferred.

  16. Coinfection with human herpesvirus 8 is associated with persistent inflammation and immune activation in virologically suppressed HIV-infected patients.

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    Mar Masiá

    Full Text Available Infection with co-pathogens is one of the postulated factors contributing to persistent inflammation and non-AIDS events in virologically-suppressed HIV-infected patients. We aimed to investigate the relationship of human herpesvirus-8 (HHV-8, a vasculotropic virus implicated in the pathogenesis of Kaposi's sarcoma, with inflammation and subclinical atherosclerosis in HIV-infected patients.Prospective study including virologically suppressed HIV-infected patients. Several blood biomarkers (highly-sensitive C-reactive protein [hsCRP], tumour necrosis factor-α, interleukin-6, monocyte chemoattractant protein-1, vascular cell adhesion molecule-1, intercellular cell adhesion molecule-1, malondialdehyde, plasminogen activator inhibitor [PAI-1], D-dimer, sCD14, sCD163, CD4/CD38/HLA-DR, and CD8/CD38/HLA-DR, serological tests for HHV-8 and the majority of herpesviruses, carotid intima-media thickness, and endothelial function through flow-mediated dilatation of the brachial artery were measured.A total of 136 patients were included, 34.6% of them infected with HHV-8. HHV-8-infected patients were more frequently co-infected with herpes simplex virus type 2 (HSV-2 (P<0.001, and less frequently with hepatitis C virus (HCV (P = 0.045, and tended to be older (P = 0.086. HHV-8-infected patients had higher levels of hsCRP (median [interquartile range], 3.63 [1.32-7.54] vs. 2.08 [0.89-4.11] mg/L, P = 0.009, CD4/CD38/HLA-DR (7.67% [4.10-11.86]% vs. 3.86% [2.51-7.42]%, P = 0.035 and CD8/CD38/HLA-DR (8.02% [4.98-14.09]% vs. 5.02% [3.66-6.96]%, P = 0.018. After adjustment for the traditional cardiovascular risk factors, HCV and HSV-2 infection, the associations remained significant: adjusted difference between HHV-8 positive and negative patients (95% confidence interval for hsCRP, 74.19% (16.65-160.13%; for CD4/CD38/HLA-DR, 89.65% (14.34-214.87%; and for CD8/CD38/HLA-DR, 58.41% (12.30-123.22%. Flow-mediated dilatation and total carotid intima

  17. Tobacco use and its determinants in HIV-infected patients on antiretroviral therapy in West African countries

    Science.gov (United States)

    Jaquet, Antoine; Ekouevi, Didier-Koumavi; Aboubakrine, Maiga; Bashi, Jules; Messou, Eugène; Maiga, Moussa; Traore, Hamar-Alassane; Zannou, Marcel; Guehi, Calixte; Ba-Gomis, Franck-Olivier; Minga, Albert; Allou, Gérard; Eholie, Serge-Paul; Dabis, Francois; Bissagnene, Emmanuel; Sasco, Annie-Jeanne

    2009-01-01

    INTRODUCTION Tobacco smoking is common in HIV-infected patients from industrialized countries. In West Africa, few data exist concerning tobacco consumption. METHODS A cross-sectional survey was conducted within the International epidemiological Database to Evaluate AIDS (IeDEA) network in West Africa. Health workers administered to patients receiving antiretroviral treatment a questionnaire assessing tobacco and cannabis consumption. Regular smokers were defined as present smokers who smoked >1 cigarette per day for ≥1 year. RESULTS Overall, 2920 patients were enrolled in three countries. The prevalence of ever smokers and present smokers were 46.2% (95% CI 42.8–49.5) and 15.6% (95% CI 13.2–18.0) in men and 3.7% (95% CI 2.9–4.5) and 0.6% (95% CI 0.3–0.9) in women, respectively. Regular smoking was associated being from Côte d’Ivoire or Mali compared to Benin (OR 4.6; 95% CI 2.9–7.3 and 7.7; 95% CI 4.4–13.6), a severely impaired immunological status at HAART initiation (OR 1.5; 95% CI 1.1–2.2) and a history of tuberculosis (OR 1.8; 95% CI 1.1–3.0). CONCLUSION Marked differences of smoking prevalence exist between these West African countries. This survey approach also provides evidences concerning the association between cigarette smoking and tuberculosis in HIV-infected patients, a major public health issue in this part of the world. PMID:19861019

  18. Tumor necrosis factor alpha is associated with insulin-mediated suppression of free fatty acids and net lipid oxidation in HIV-infected patients with lipodystrophy

    DEFF Research Database (Denmark)

    Haugaard, Steen B; Andersen, Ove; Pedersen, SB;

    2006-01-01

    Tumor necrosis factor alpha (TNF-alpha) stimulates lipolysis in man. We examined whether plasma TNF-alpha is associated with the degree by which insulin suppresses markers of lipolysis, for example, plasma free fatty acid (FFA) and net lipid oxidation (LIPOX) rate in HIV-infected patients...

  19. Response to 2009 pandemic influenza a (H1N1) vaccine in HIV-infected patients and the influence of prior seasonal influenza vaccination

    NARCIS (Netherlands)

    D. Soonawala (Darius); G.F. Rimmelzwaan (Guus); L.B.S. Gelinck (Luc); L.G. Visser; F.P. Kroon (Frank)

    2011-01-01

    textabstractBackground: The immunogenicity of 2009 pandemic influenza A(H1N1) (pH1N1) vaccines and the effect of previous influenza vaccination is a matter of current interest and debate. We measured the immune response to pH1N1 vaccine in HIV-infected patients and in healthy controls. In addition w

  20. High-dose vitamin D(3) supplementation is a requisite for modulation of skin-homing markers on regulatory T cells in HIV-infected patients

    NARCIS (Netherlands)

    Khoo, A.L.; Koenen, H.J.P.M.; Michels, M.; Ooms, S.J.; Bosch, M.; Netea, M.G.; Joosten, I.; Ven, A.J.A.M. van der

    2013-01-01

    Vitamin D(3) is known to have an effect on the immune function. We investigated the immunomodulatory capability of vitamin D(3) in HIV-infected patients and studied the expression of chemokine receptors on regulatory T cells (Treg). Vitamin D(3)-deficient HIV-1-seropositive subjects were treated wit

  1. Cost-effectiveness of tipranavir versus comparator protease inhibitor regimens in HIV infected patients previously exposed to antiretroviral therapy in the Netherlands

    NARCIS (Netherlands)

    Hubben, Gijs A A; Bos, Jasper M; Veltman-Starkenburg, Christa A; Stegmeijer, Simon; Finnern, Henrik W; Kappelhoff, Bregt S; Simpson, Kit N; Tramarin, Andrea; Postma, Maarten J

    2007-01-01

    BACKGROUND: This study compares the costs and effects of a regimen with ritonavir-boosted tipranavir (TPV/r) to a physician-selected genotypically-defined standard-of-care comparator protease inhibitor regimen boosted with ritonavir (CPI/r) in HIV infected patients that were previously exposed to an

  2. Persisting Inflammation and Chronic Immune Activation but Intact Cognitive Function in HIV-Infected Patients After Long-Term Treatment With Combination Antiretroviral Therapy

    DEFF Research Database (Denmark)

    Pedersen, Karin K; Pedersen, Maria; Gaardbo, Julie C;

    2013-01-01

    Impaired cognitive function in HIV-infected patients has been suggested. Treatment with combination antiretroviral therapy (cART) restores CD4⁺ cell counts and suppresses viral replication, but immune activation and inflammation may persist. The aim of the study was to examine if cognitive function...

  3. HIV-Associated Neuroretinal Disorder in Patients With Well-Suppressed HIV-Infection : A Comparative Cohort Study

    NARCIS (Netherlands)

    Demirkaya, Nazli; Wit, Ferdinand W N M; van Den Berg, Thomas J T P; Kooij, Katherine W; Prins, Maria; Schlingemann, Reinier O; Abramoff, Michael D; Reiss, Peter; Verbraak, Frank D

    2016-01-01

    PURPOSE: Loss of neuroretinal structure and function, ascribed to a 'HIV-associated Neuroretinal Disorder' (HIV-NRD), in the absence of ocular opportunistic infections, has been reported in HIV-infected individuals treated with combination antiretroviral therapy (cART). Whether HIV-infected individu

  4. Frequency of human immunodeficiency virus type-2 in hiv infected patients in Maputo City, Mozambique

    Directory of Open Access Journals (Sweden)

    Bhatt Nilesh

    2011-08-01

    Full Text Available Abstract The HIV/AIDS pandemic is primarily caused by HIV-1. Another virus type, HIV-2, is found mainly in West African countries. We hypothesized that population migration and mobility in Africa may have facilitated the introduction and spreading of HIV-2 in Mozambique. The presence of HIV-2 has important implications for diagnosis and choice of treatment of HIV infection. Hence, the aim of this study was to estimate the prevalence of HIV-2 infection and its genotype in Maputo, Mozambique. HIV-infected individuals (N = 1,200 were consecutively enrolled and screened for IgG antibodies against HIV-1 gp41 and HIV-2 gp36 using peptide-based enzyme immunoassays (pepEIA. Specimens showing reactivity on the HIV-2 pepEIA were further tested using the INNO-LIA immunoblot assay and HIV-2 PCR targeting RT and PR genes. Subtype analysis of HIV-2 was based on the protease gene. After screening with HIV-2 pepEIA 1,168 were non-reactive and 32 were reactive to HIV-2 gp36 peptide. Of this total, 30 specimens were simultaneously reactive to gp41 and gp36 pepEIA while two samples reacted solely to gp36 peptide. Only three specimens containing antibodies against gp36 and gp105 on the INNO-LIA immunoblot assay were found to be positive by PCR to HIV-2 subtype A. The proportion of HIV-2 in Maputo City was 0.25% (90%CI 0.01-0.49. The HIV epidemic in Southern Mozambique is driven by HIV-1, with HIV-2 also circulating at a marginal rate. Surveillance program need to improve HIV-2 diagnosis and consider periodical survey aiming to monitor HIV-2 prevalence in the country.

  5. The Effect of Spirulina platensis versus Soybean on Insulin Resistance in HIV-Infected Patients: A Randomized Pilot Study

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    Jeanne Ngogang

    2011-07-01

    Full Text Available HIV-infected patients develop abnormalities of glucose metabolism due to the virus and antiretroviral drugs. Spirulina and soybean are nutritional supplements that are cheap, accessible in our community and affect glucose metabolism. We carried out a randomized study to assess the effect of Spirulina platensis versus soybean as a food supplement on HIV/HAART-associated insulin resistance (IR in 33 insulin-resistant HIV-infected patients. The study lasted for two months at the National Obesity Centre of Cameroon. Insulin resistance was measured using the short insulin tolerance test. Physical activity and diet did not change over the study duration. On-treatment analysis was used to analyze data. The Mann-Whitney U test, the Students T test and the Chi square test were used as appropriate. Curve gradients were analyzed using ANCOVA. Seventeen subjects were randomized to spirulina and 16 to soybean. Each received 19 g of supplement daily. The follow up rate was 65% vs. 100% for spirulina and soybean groups, respectively, and both groups were comparable at baseline. After eight weeks, insulin sensitivity (IS increased by 224.7% vs. 60% in the spirulina and soybean groups respectively (p < 0.001. One hundred per cent vs. 69% of subjects on spirulina versus soybean, respectively, improved their IS (p = 0.049 with a 1.45 (1.05–2.02 chance of improving insulin sensitivity on spirulina. This pilot study suggests that insulin sensitivity in HIV patients improves more when spirulina rather than soybean is used as a nutritional supplement. Trial registration: ClinicalTrials.gov identifier NCT01141777.

  6. The Effect of Spirulina platensis versus Soybean on Insulin Resistance in HIV-Infected Patients: A Randomized Pilot Study

    Science.gov (United States)

    Marcel, Azabji-Kenfack; Ekali, Loni G.; Eugene, Sobngwi; Arnold, Onana E.; Sandrine, Edie D.; von der Weid, Denis; Gbaguidi, Emmanuel; Ngogang, Jeanne; Mbanya, Jean C.

    2011-01-01

    HIV-infected patients develop abnormalities of glucose metabolism due to the virus and antiretroviral drugs. Spirulina and soybean are nutritional supplements that are cheap, accessible in our community and affect glucose metabolism. We carried out a randomized study to assess the effect of Spirulina platensis versus soybean as a food supplement on HIV/HAART-associated insulin resistance (IR) in 33 insulin-resistant HIV-infected patients. The study lasted for two months at the National Obesity Centre of Cameroon. Insulin resistance was measured using the short insulin tolerance test. Physical activity and diet did not change over the study duration. On-treatment analysis was used to analyze data. The Mann-Whitney U test, the Students T test and the Chi square test were used as appropriate. Curve gradients were analyzed using ANCOVA. Seventeen subjects were randomized to spirulina and 16 to soybean. Each received 19 g of supplement daily. The follow up rate was 65% vs. 100% for spirulina and soybean groups, respectively, and both groups were comparable at baseline. After eight weeks, insulin sensitivity (IS) increased by 224.7% vs. 60% in the spirulina and soybean groups respectively (p < 0.001). One hundred per cent vs. 69% of subjects on spirulina versus soybean, respectively, improved their IS (p = 0.049) with a 1.45 (1.05–2.02) chance of improving insulin sensitivity on spirulina. This pilot study suggests that insulin sensitivity in HIV patients improves more when spirulina rather than soybean is used as a nutritional supplement. Trial registration: ClinicalTrials.gov identifier NCT01141777. PMID:22254118

  7. Effects of recombinant human growth hormone on hepatic lipid and carbohydrate metabolism in HIV-infected patients with fat accumulation.

    Science.gov (United States)

    Schwarz, Jean-Marc; Mulligan, Kathleen; Lee, Jeongae; Lo, Joan C; Wen, Michael; Noor, Mustafa A; Grunfeld, Carl; Schambelan, Morris

    2002-02-01

    We recently reported that treatment with a pharmacologic dose of recombinant human growth hormone (GH) resulted in a significant loss of body fat and gain in lean tissue in HIV-infected patients with syndromes of fat accumulation. However, insulin-mediated glucose disposal decreased transiently after one month of GH therapy. The present paper focuses on the changes of hepatic carbohydrate and fat metabolism associated with GH treatment in the same subjects. We assessed hepatic insulin sensitivity under both fasting and hyperinsulinemic-euglycemic clamp conditions prior to and after one and six months of GH treatment (3 mg/day) in five patients using stable isotope tracer techniques. Indirect calorimetry, and measurements of lipid concentrations. Fasting endogenous glucose production (EGP) increased significantly at one month (12.0 +/- 0.7 to 14.9 +/- 0.9 micromol/kg/min, P glucogenesis (GNG) (3.5 +/- 0.9 to 5.2 +/- 0.9 and 5.8 +/-1.2 micromol/kg/min, n = 4, P < 0.01 and P < 0.01 at one and six months, respectively); small changes in hepatic glycogenolysis also contributed. Sustained increases in lipolysis and progressive decreases in hepatic fractional de novo lipogenesis (DNL) and triglyceride concentrations occurred with GH treatment. These changes were accompanied by an improved lipid profile with a significant increase in HDL cholesterol and significant decreases in total and LDL cholesterol and triglyceride levels, the latter consistent with the decrease in hepatic DNL. During a hyperinsulinemic-euglycemic glucose clamp, EGP and GNG were markedly suppressed compared to the corresponding time points under fasting conditions, albeit less so when measured after one month of GH treatment. Thus, in HIV-infected patients with abnormal fat distribution, pharmacologic doses of GH improved the overall lipid profile, but worsened glucose homeostasis under both fasting and hyperinsulinemic conditions. The combined implications of these positive and negative metabolic

  8. Relapse of visceral leishmaniasis in an HIV-infected patient successfully treated with a combination of miltefosine and amphotericin B.

    Science.gov (United States)

    McQuarrie, Shauna; Kasper, Ken; Moffatt, Dana C; Marko, Daniel; Keynan, Yoav

    2015-01-01

    The present report documents a 49-year-old HIV-infected man receiving antiretroviral therapy with a suboptimal immune response and a CD4 count of 95 cells/mm(3), despite virological suppression. Investigation of bone marrow was conducted and yielded a diagnosis of visceral leishmaniasis. The clinical course was complicated by gastrointestinal involvment and relapse occurred after amphotericin B therapy. With the addition of miltefosine, the patient no longer presented with bone marrow amastigotes, and displayed an increased CD4 count and negative Leishmania polymerase chain reaction results. The present case highlights atypical presentation of visceral leishmaniasis, including poor immune reconstitution and gastrointestinal involvement. The high likelihood of relapse and response to combination therapy are illustrated.

  9. Relapse of Visceral Leishmaniasis in an HIV-Infected Patient Successfully Treated with a Combination of Miltefosine and Amphotericin B

    Directory of Open Access Journals (Sweden)

    Shauna McQuarrie

    2015-01-01

    Full Text Available The present report documents a 49-year-old HIV-infected man receiving antiretroviral therapy with a suboptimal immune response and a CD4 count of 95 cells/mm3, despite virological suppression. Investigation of bone marrow was conducted and yielded a diagnosis of visceral leishmaniasis. The clinical course was complicated by gastrointestinal involvment and relapse occurred after amphotericin B therapy. With the addition of miltefosine, the patient no longer presented with bone marrow amastigotes, and displayed an increased CD4 count and negative Leishmania polymerase chain reaction results. The present case highlights atypical presentation of visceral leishmaniasis, including poor immune reconstitution and gastrointestinal involvement. The high likelihood of relapse and response to combination therapy are illustrated.

  10. Activation of HIV transcription with short-course vorinostat in HIV-infected patients on suppressive antiretroviral therapy.

    Directory of Open Access Journals (Sweden)

    Julian H Elliott

    2014-10-01

    Full Text Available Human immunodeficiency virus (HIV persistence in latently infected resting memory CD4+ T-cells is the major barrier to HIV cure. Cellular histone deacetylases (HDACs are important in maintaining HIV latency and histone deacetylase inhibitors (HDACi may reverse latency by activating HIV transcription from latently infected CD4+ T-cells. We performed a single arm, open label, proof-of-concept study in which vorinostat, a pan-HDACi, was administered 400 mg orally once daily for 14 days to 20 HIV-infected individuals on suppressive antiretroviral therapy (ART. The primary endpoint was change in cell associated unspliced (CA-US HIV RNA in total CD4+ T-cells from blood at day 14. The study is registered at ClinicalTrials.gov (NCT01365065. Vorinostat was safe and well tolerated and there were no dose modifications or study drug discontinuations. CA-US HIV RNA in blood increased significantly in 18/20 patients (90% with a median fold change from baseline to peak value of 7.4 (IQR 3.4, 9.1. CA-US RNA was significantly elevated 8 hours post drug and remained elevated 70 days after last dose. Significant early changes in expression of genes associated with chromatin remodeling and activation of HIV transcription correlated with the magnitude of increased CA-US HIV RNA. There were no statistically significant changes in plasma HIV RNA, concentration of HIV DNA, integrated DNA, inducible virus in CD4+ T-cells or markers of T-cell activation. Vorinostat induced a significant and sustained increase in HIV transcription from latency in the majority of HIV-infected patients. However, additional interventions will be needed to efficiently induce virus production and ultimately eliminate latently infected cells.ClinicalTrials.gov NCT01365065.

  11. Assessment of intima-media complex in carotid, femoral and right subclavian arteries for early investigation of atherosclerosis in HIV-infected patients

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    Emmanuelle Tenorio Albuquerque Madruga Godoi

    2013-12-01

    Full Text Available Objective To compare automatic and manual measurements of intima-media complex (IMC in common carotid, common femoral and right subclavian arteries of HIV-infected patients in relation to a control group, taking into consideration the classical risk factors for atherosclerosis. Materials and Methods The study sample comprised 70 HIV-infected patients and 70 non-HIV-infected controls paired according sex and age. Automatic (gold standard and manual measurements of IMC were performed in the carotid arteries. Manual measurements were also performed in common femoral and right subclavian arteries. Bland-Altman graphs were utilized in the comparison and the adopted level significance was 5%. Results Intima-media complex alterations were not observed in any of the individuals as the mean automatic measurement in the right common carotid (RCC artery was considered as the gold standard. As the gold standard was compared with the manual measurements (mean, maximum and minimum, no clinically significant alteration was observed. As the gold standard was compared with other sites, the difference was statistically and clinically significant at the origin of right subclavian artery (RCC: 0.51 mm vs. 0.91 mm (p < 0.001. Conclusion HIV-infected individuals are not at higher risk for atherosclerosis than the control population.

  12. Effects of Combined Aerobic and Resistance Exercise on Exercise Capacity, Muscle Strength and Quality of Life in HIV-Infected Patients: A Systematic Review and Meta-Analysis.

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    Mansueto Gomes Neto

    Full Text Available Many HIV-infected patients demonstrate disability and lower aerobic capacity. The inclusion of resistance training combined with aerobic exercise in a single program is known as combined aerobic and resistance exercise (CARE and seems to be an effective strategy to improve muscle weakness, as well as aerobic capacity in HIV-infected patients. We performed a meta-analysis to investigate the effects of CARE in HIV-infected patients.We searched MEDLINE, Cochrane Controlled Trials Register, EMBASE, CINAHL (from the earliest date available to august 2014 for controlled trials that evaluated the effects of CARE in HIV-infected patients. Weighted mean differences (WMD and 95% confidence intervals (CIs were calculated, and heterogeneity was assessed using the I2 test.Seven studies met the study criteria. CARE resulted in improvement in Peak VO2 WMD (4.48 mL·kg-1·min-1 95% CI: 2.95 to 6.0, muscle strength of the knee extensors WMD (25.06 Kg 95% CI: 10.46 to 39.66 and elbow flexors WMD (4.44 Kg 95% CI: 1.22 to 7.67 compared with no exercise group. The meta-analyses also showed significant improvement in Health status, Energy/Vitality and physical function domains of quality of life for participants in the CARE group compared with no exercise group. A nonsignificant improvement in social function domain of quality of life was found for participants in the CARE group compared with no exercise group.Combined aerobic and resistance exercise may improve peak VO2, muscle strength and health status, energy and physical function domains of quality of life and should be considered as a component of care of HIV-infected individuals.

  13. Interferon-gamma release assays for the diagnosis of active tuberculosis in HIV-infected patients: a systematic review and meta-analysis.

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    Jun Chen

    Full Text Available BACKGROUND: Interferon-gamma release assays (IGRAs have provided a new method for the diagnosis of Mycobacterium tuberculosis infection. However, the role of IGRAs for the diagnosis of active tuberculosis (TB, especially in HIV-infected patients remains unclear. METHODS: We searched PubMed, EMBASE and Cochrane databases to identify studies published in January 2001-July 2011 that evaluated the evidence of using QuantiFERON-TB Gold in-tube (QFT-GIT and T-SPOT.TB (T-SPOT on blood for the diagnosis of active TB in HIV-infected patients. RESULTS: The search identified 16 eligible studies that included 2801 HIV-infected individuals (637 culture confirmed TB cases. The pooled sensitivity for the diagnosis of active TB was 76.7% (95%CI, 71.6-80.5% and 77.4% (95%CI, 71.4-82.6% for QFT-GIT and T-SPOT, respectively, while the specificity was 76.1% (95%CI, 74.0-78.0% and 63.1% (95%CI, 57.6-68.3% after excluding the indeterminate results. Studies conducted in low/middle income countries showed slightly lower sensitivity and specificity when compared to that in high-income countries. The proportion of indeterminate results was as high as 10% (95%CI, 8.8-11.3% and 13.2% (95%CI, 10.6-16.0% for QFT-GIT and T-SPOT, respectively. CONCLUSION: IGRAs in their current formulations have limited accuracy in diagnosing active TB in HIV-infected patients, and should not be used alone to rule out or rule in active TB cases in HIV-infected patients. Further modification is needed to improve their accuracy.

  14. Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome following HAART Initiation in an HIV-infected Patient Being Treated for Severe Pneumonia: Case Report and Literature Review

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    Dong Won Park

    2016-05-01

    Full Text Available Pnuemocystis jirovecii pneumonia (PJP is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV, and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.

  15. Survey of HIV infection in 74 tumor patients%肿瘤患者HIV74例感染情况分析

    Institute of Scientific and Technical Information of China (English)

    王红羚; 张天勇

    2012-01-01

    目的 通过对近年在重庆市肿瘤研究所就医的肿瘤患者人类免疫缺陷病毒(HIV)感染状况的统计,了解感染HIV的肿瘤患者的相关肿瘤的发生情况.方法 对该院2003年1月至2011年9月,HIV抗体检测结果为阳性的肿瘤患者共计74例,进行统计分析.结果 2003~2011年该院确认的HIV抗体阳性的肿瘤患者呈逐年递增趋势,其中男性患者HIV感染率和增长速度明显高于女性患者.HIV抗体阳性的肿瘤患者以颈部肿瘤、淋巴瘤、脑瘤、宫颈癌发病率较高.结论 应对肿瘤患者进行HIV感染的筛查和长期监测.%Objective To investigate the prevalence of HIV infection in tumor patients and the patterns of tumor in those patients with HIV-infection in our hospital. Methods 74 tumor patients with positive HIV-antibody results during January 2003 to September 2009 in our hospital have been collected and analyzed. Results During Jan. 2003 to Sep. 2011,74 tumor patients with positive HIV-antibody results were identified in our hospital. The HIV-infected tumor patients increased progressively year by year. Furthermore, the rate of HIV infection in male patients was higher and increased significantly faster than that in female patients. The frequent types of tumor occurring in HIV-infected tumor patients included neck tumors,lymphoma,brain cancer and cervical cancer. Conclusion Screening and long-time monitoring of HIV infection should be conducted in tumor patients.

  16. Management of Pneumocystis Jirovecii pneumonia in HIV infected patients: current options, challenges and future directions

    Directory of Open Access Journals (Sweden)

    Jose G Castro

    2010-06-01

    Full Text Available Jose G Castro1, Maya Morrison-Bryant21Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA; 2Jackson Memorial Hospital/University of Miami Infectious Diseases Fellowship Program, Miami, Florida, USAAbstract: The discovery of the Human Immunodeficiency Virus (HIV was led by the merge of clustered cases of Pneumocystis jirovecii Pneumonia (PCP in otherwise healthy people in the early 80’s.1,2 In the face of sophisticated treatment now available for HIV infection, life expectancy approaches normal limits. It has dramatically changed the natural course of HIV from a nearly fatal infection to a chronic disease.3–5 However, PCP still remains a relatively common presentation of uncontrolled HIV. Despite the knowledge and advances gained in the prevention and management of PCP infection, it continues to have high morbidity and mortality rates. Trimethoprim-sulfamethoxazole (TMP-SMZ remains as the recommended first-line treatment. Alternatives include pentamidine, dapsone plus trimethoprim, clindamycin administered with primaquine, and atovaquone. For optimal management, clinicians need to be familiar with the advantages and disadvantages of the available drugs. The parameters used to classify severity of infection are also important, as it is well known that the adjunctive use of steroids in moderate to severe cases have been shown to significantly improve outcome. Evolving management practices, such as the successful institution of early antiretroviral therapy, may further enhance overall survival rates.Keywords: HIV, Pneumocystis Jirovecii, PCP, TMP-SMZ

  17. The Rates of Serious Infections in HIV-infected Patients Who Received Tumor Necrosis Factor (TNF)-α Inhibitor Therapy for Concomitant Autoimmune Diseases

    Science.gov (United States)

    Wangsiricharoen, Sintawat; Ligon, Colin; Gedmintas, Lydia; Dehrab, Admad; Tungsiripat, Marisa; Bingham, Clifton; Lozada, Carlos; Calabrese, Leonard

    2016-01-01

    Objectives To estimate the incidence of serious infections in patients with HIV infection and autoimmune disease who were treated with tumor necrosis factor (TNF) -α inhibitor therapy, and to compare these rates among stratified viral load levels. Methods Using a unified search strategy, four centers identified HIV-infected patients exposed to TNF-α inhibitors. Patient characteristics and infection data were assessed via chart review in all patients who were ≥18 years old and received TNF-α inhibitor therapy after HIV diagnosis between January 1999 and March 2015. Results Twenty-three patients with 26 uses of TNF-α inhibitor therapy provided 86.7 person-years of follow-up. Two (8.7%) experienced at least 1 serious infection episode, an overall incidence rate of 2.55 per 100 patient-years (95% CI 0.28–9.23). The incidence rate per 100 patient-years was 3.28 (95% CI 0.04–18.26) among patients with viral load > 500 copies/mL at therapy initiation and 2.09 (0.03–11.65) among patients with viral load ≤ 500 copies/mL. Conclusion This study suggests that TNF-α inhibitors may have a comparable rate of serious infections to the range of those observed in registry databases when used in patients with HIV infection under active care. PMID:27332039

  18. Alcohol use and subsequent sex among HIV-infected patients in an ethnic minority area of Yunnan Province, China.

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    Xiaofeng Luo

    Full Text Available OBJECTIVE: To examine alcohol use and subsequent HIV risky behaviors among a sample of predominately ethnic minority people living with HIV/AIDS (PLWHA in a rural community in Yunnan Province, China. METHOD: A cross-sectional study with a face-to-face questionnaire interview was conducted among eligible participants. RESULTS: In total, 455 (94.4% out of 482 eligible HIV patients participated in the study. Of them, 82.6% were ethnic minorities; 15.4% were never married; 96.5% were sexually experienced; 55.4% had used drugs, 67% were receiving antiretroviral therapy (ART. Over 65% were ever drinkers; of whom 61.5% were current drinkers. Among current drinkers, 32.4% drank daily and 41.2% were hazardous drinkers. Chinese white wine was the preferred choice. Higher level of alcohol use among drinkers in the preceding month was positively associated with being males (OR = 2.76, 95%CI: 1.03-7.43, ethnic minorities (OR Jingpo = 2.21, 95%CI: 1.06-4.59; OR other minorities = 3.20, 95%CI: 1.34-7.62, higher education (OR1-6 = 1.98, 95%CI: 0.99-3.96; OR≥7 = 2.35, 95%CI: 1.09-5.06 and being ART-naive (OR = 2.69, 95%CI: 1.67-4.32. About 39% of ever drinkers reported having engaged in sex after drinking since HIV diagnosis. Those who were younger than 46 years (OR16-25 = 7.77, 95%CI: 1.22-49.60, OR26-35 = 2.79, 95%CI: 1.06-7.35, OR36-45 = 2.96, 95%CI: 1.57-7.58, hazardous drinkers (OR = 1.99, 95%CI: 1.00-3.97 and drug users (OR = 3.01, 95%CI: 1.19-7.58 were more likely to have had sex after drinking. Approximately 56% of drug users had used drugs after drinking. CONCLUSIONS: High prevalence of alcohol use and subsequent risky behaviors including sexual engagement and drug use among HIV patients in rural Yunnan require tremendous and integrated efforts for prevention and control of alcohol and drug abuse and HIV spreading.

  19. Factors associated with negative direct sputum examination in Asian and African HIV-infected patients with tuberculosis (ANRS 1260.

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    Loïc Chartier

    Full Text Available OBJECTIVE: To identify factors associated with negative direct sputum examination among African and Cambodian patients co-infected by Mycobacterium tuberculosis and HIV. DESIGN: Prospective multicenter study (ANRS1260 conducted in Cambodia, Senegal and Central African Republic. METHODS: Univariate and multivariate analyses (logistic regression were used to identify clinical and radiological features associated with negative direct sputum examination in HIV-infected patients with positive M. tuberculosis culture on Lowenstein-Jensen medium. RESULTS: Between September 2002 and December 2005, 175 co-infected patients were hospitalized with at least one respiratory symptom and pulmonary radiographic anomaly. Acid-fast bacillus (AFB examination was positive in sputum samples from 110 subjects (63% and negative in 65 patients (37%. Most patients were at an advanced stage of HIV disease (92% at stage III or IV of the WHO classification with a median CD4 cell count of 36/mm³. In this context, we found that sputum AFB negativity was more frequent in co-infected subjects with associated respiratory tract infections (OR = 2.8 [95%CI:1.1-7.0], dyspnea (OR = 2.5 [95%CI:1.1-5.6], and localized interstitial opacities (OR = 3.1 [95%CI:1.3-7.6], but was less frequent with CD4 ≤ 50/mm³ (OR = 0.4 [95%CI:0.2-0.90, adenopathies (OR = 0.4 [95%CI:0.2-0.93] and cavitation (OR = 0.1 [95%CI:0.03-0.6]. CONCLUSIONS: One novel finding of this study is the association between concomitant respiratory tract infection and negative sputum AFB, particularly in Cambodia. This finding suggests that repeating AFB testing in AFB-negative patients should be conducted when broad spectrum antibiotic treatment does not lead to complete recovery from respiratory symptoms. In HIV-infected patients with a CD4 cell count below 50/mm3 without an identified cause of pneumonia, systematic AFB direct sputum examination is justified because of atypical clinical

  20. Ritonavir-boosted darunavir is rarely associated with nephrolithiasis compared with ritonavir-boosted atazanavir in HIV-infected patients.

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    Takeshi Nishijima

    Full Text Available BACKGROUND: Although ritonavir-boosted atazanavir (ATV/r is known to be associated with nephrolithiasis, little is known about the incidence of nephrolithiasis in patients treated with ritonavir-boosted Darunavir (DRV/r, the other preferred protease inhibitor. METHODS: In a single-center cohort, the incidence of nephrolithiasis was compared between HIV-infected patients who commenced DRV/r-containing antiretroviral therapy and those on ATV/r. The effects of ATV/r use over DRV/r were estimated by univariate and multivariate Cox hazards models. RESULTS: Renal stones were diagnosed in only one patient (0.86 per 1000 person-years of the DRV/r group (n=540 and 37 (20.2 per 1000 person-years of the ATV/r group (n=517. The median [interquartile (IQR] observation period in the DRV/r group was 27.1 months (IQR 18.1-38.4 months, and 40.6 months (IQR 17.5-42.7 for the ATV/r group. The total observation period was 1,163.6 person-years and 1,829.6 person-years for the DRV/r group and for the ATV/r group, respectively. In the 37 patients on ATV/r who developed nephrolithiasis, the median time from commencement of ATV/r to diagnosis was 28.1 months (IQR 18.4-42.7, whereas nephrolithiasis in the single patient of the DRV/r group occurred 11.2 month after the introduction of DRV/r. ATV/r use over DRV/r was significantly associated with nephrolithiasis by uni- and multivariate analyses (HR=26.01; 95% CI, 3.541-191.0; p=0.001 (adjusted HR=21.47; 95% CI, 2.879-160.2; p=0.003. CONCLUSION: The incidence of nephrolithiasis was substantially lower in patients on DRV/r than those on ATV/r. The results suggest that DRV/r should be selected for treatment of HIV-infected patients at risk of chronic kidney disease.

  1. 9G4 autoreactivity is increased in HIV-infected patients and correlates with HIV broadly neutralizing serum activity.

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    James J Kobie

    Full Text Available The induction of a broadly neutralizing antibody (BNAb response against HIV-1 would be a desirable feature of a protective vaccine. Vaccine strategies thus far have failed to elicit broadly neutralizing antibody responses; however a minority of HIV-infected patients do develop circulating BNAbs, from which several potent broadly neutralizing monoclonal antibodies (mAbs have been isolated. The findings that several BNmAbs exhibit autoreactivity and that autoreactive serum antibodies are observed in some HIV patients have advanced the possibility that enforcement of self-tolerance may contribute to the rarity of BNAbs. To examine the possible breakdown of tolerance in HIV patients, we utilized the 9G4 anti-idiotype antibody system, enabling resolution of both autoreactive VH4-34 gene-expressing B cells and serum antibodies. Compared with healthy controls, HIV patients had significantly elevated 9G4+ serum IgG antibody concentrations and frequencies of 9G4+ B cells, a finding characteristic of systemic lupus erythematosus (SLE patients, both of which positively correlated with HIV viral load. Compared to the global 9G4-IgD--memory B cell population, the 9G4+IgD--memory fraction in HIV patients was dominated by isotype switched IgG+ B cells, but had a more prominent bias toward "IgM only" memory. HIV envelope reactivity was observed both in the 9G4+ serum antibody and 9G4+ B cell population. 9G4+ IgG serum antibody levels positively correlated (r = 0.403, p = 0.0019 with the serum HIV BNAbs. Interestingly, other serum autoantibodies commonly found in SLE (anti-dsDNA, ANA, anti-CL did not correlate with serum HIV BNAbs. 9G4-associated autoreactivity is preferentially expanded in chronic HIV infection as compared to other SLE autoreactivities. Therefore, the 9G4 system provides an effective tool to examine autoreactivity in HIV patients. Our results suggest that the development of HIV BNAbs is not merely a consequence of a general breakdown in

  2. Neurocognitive Impairment in HIV-Infected Naïve Patients with Advanced Disease: The Role of Virus and Intrathecal Immune Activation

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    Monica Airoldi

    2012-01-01

    Full Text Available Objective. To investigate intrathecal immune activation parameters and HIV-RNA in HIV-associated neurocognitive disorders (HAND of advanced naïve HIV-infected patients and to evaluate their dynamics before and after initiation of antiretroviral therapy (ART. Methods. Cross-sectional and longitudinal analysis of HIV RNA, proinflammatory cytokines (IL-6, IL-10, INF-γ, TNF-α, TGF-β1, and TGF-β2 and chemokines (MIP-1α, MIP-1β, and MCP-1 in plasma and cerebrospinal fluid (CSF of HIV-infected patients with CD4 <200/μL. Results. HAND was diagnosed at baseline in 6/12 patients. Baseline CSF HIV-RNA was comparable in patients with or without HAND, whereas CSF concentration of IL-6 and MIP-1β, proinflammatory cytokines, was increased in HAND patients. CSF evaluation at 12 weeks was available in 10/12 cases. ART greatly reduced HIV-RNA in all patients. Nevertheless, IL-6 and MIP-1β remained elevated after 12 weeks of therapy in HAND patients, in whom CSF HIV RNA decay was slower than the plasmatic one as well. Conclusion. Immune activation, as indicated by inflammatory cytokines, but not higher levels of HIV-RNA is observed in advanced naïve HIV-infected patients with HAND. In HAND patients, ART introduction resulted in a less rapid clearance of CSF viremia compared to plasma and no modifications of intratechal immune activation.

  3. Low prevalence of Pneumocystis jirovecii lung colonization in Ugandan HIV-infected patients hospitalized with non-Pneumocystis pneumonia

    Science.gov (United States)

    Taylor, Steve M; Meshnick, Steven R; Worodria, William; Andama, Alfred; Davis, J. Lucian; Cattamanchi, Adithya; Boon, Saskia den; Yoo, Samuel D; Goodman, Carol D.; Huang, Laurence

    2011-01-01

    Pneumocystis jirovecii is an important opportunistic infection in HIV-infected patients. In the developed world, P. jirovecii epidemiology is marked by frequent colonization in immunosuppressed patients, but data on the prevalence of colonization is very limited in sub-Saharan Africa, where the majority of persons living with HIV reside. Our objective was to describe the epidemiology of P. jirovecii colonization among HIV-positive patients in a cross-sectional, hospital-based study of patients admitted with suspected pneumonia in Kampala, Uganda. P. jirovecii was detectable in bronchoalveolar lavage fluid from 7 of 124 (6%) consecutive patients with non-Pneumocystis pneumonia. Colonization was not associated with patient demographic or clinical information. This prevalence is substantially lower than in published studies in the developed world, and suggests that there is a limited reservoir of organisms for clinical infections in this Ugandan population. These findings may partially explain the low incidence of Pneumocystis pneumonia in Uganda and other sub-Saharan African countries. PMID:22153850

  4. Secondary hyperparathyroidism in HIV-infected patients: relationship with bone remodeling and response to vitamin D supplementation

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    S Bañon

    2012-11-01

    Full Text Available Purpose of the study: Secondary hyperparathyroidism (SH is frequent in HIV-infected patients. However, the causes and consequences are not well established. The aim of our study was to determine the relationship between parathyroid hormone (PTH, vitamin D and bone mineral density (BMD in HIV-infected patients, and the effect of vitamin D replacement on PTH levels. Methods: Prospective study of 506 patients with at least two sequential serum determinations of PTH and 25-hydroxyvitamin D levels. In all cases, a bone dual X-ray absorptiometry (DEXA was performed at inclusion. Hyperparathyroidism was defined as a PTH level above 65 pg/ml. Summary of results: Mean age was 44 yrs (24–78, and 75% were male. Mean BMI was 23.7 (17.97–33.11, and only 3% were of black race. Median nadir CD4+ was 200 cells/µL (9–499, and median time of HIV infection was 15.3 yrs (1.7–25.2. At inclusion, 488 patients (86% were on HAART (31% TDF+PI, 44% TDF+NNRTI, 25% non-TDF based regimen for a median of 929.5 days (154–1969, and 40% were HCV-coinfected. Median eGFR was 97.9 ml/min (62.14–134.08. Overall, mean serum PTH was 56.3 pg/mL (27.2–95.07. SH was observed in 27% of cases, with a marked influence of seasonality (from 44% in January to 10% in August. Mean levels of vitamin D were 17.45 ng/mL (7.6–40.78, with 16% below 10 ng/ml, 59%<20 ng/ml (deficiency, 85%<30 ng/ml (insufficiency. SH was related to vitamin D deficiency (relative risk, RR, 2.44, age (RR 1.04 per year, and a higher decrease in eGFR (RR 1.03 per ml/min, after adjustment by season, antiretroviral therapy, GFR at baseline, and HCV coinfection. DEXA scan showed 18% osteoporosis and 54% osteopenia, and there was an inverse correlation between PTH levels and T and Z score in femoral neck (r=−0.14, p<0.01, higher in those patients below 40 yrs. Vitamin D supplementation in 181 patients produced a significant decrease in serum PTH (57.2 if not treated vs 50.5 pg/ml, p=0.02, 23% continues with

  5. Immunodiagnosis in cerebrospinal fluid of cerebral toxoplasmosis and HIV-infected patients using Toxoplasma gondii excreted/secreted antigens.

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    Meira, Cristina S; Vidal, José E; Costa-Silva, Thaís A; Frazatti-Gallina, Neuza; Pereira-Chioccola, Vera L

    2011-11-01

    Cerebral toxoplasmosis is the most common neurologic opportunistic infection in HIV-infected patients. Excretory-secretory antigens (ESA) are the majority of the circulating antigens in sera from hosts with acute toxoplasmosis, and their usefulness as antigens has been shown. This study considered whether it could find anti-ESA antibodies in cerebrospinal fluid (CSF) and whether these antibodies can be markers of active infection. Samples of CSF from 270 HIV-infected patients were analyzed and divided into 3 groups according to the presence or absence of active toxoplasmosis. Group I: 99 patients with cerebral toxoplasmosis; group II: 112 patients with other opportunistic neurologic diseases and seropositive for toxoplasmosis; and group III: 59 patients with other opportunistic neurologic diseases and seronegative for toxoplasmosis. Toxoplasma gondii ESA and a crude tachyzoite antigen were used as antigens using ELISA and immunoblotting. The statistical analysis was done using the F test and unpaired Student's t test. Crude tachyzoite antigen: mean ELISA-relative values ± standard error for CSF of groups I and II were 7.0 ± 0.27 and 3.9 ± 0.19, respectively. Variance analysis revealed that results of both groups of patients were statistically different (1.80, P = 0.0025). The difference between the mean results was 3.0 ± 0.3, and the Student's t test value was 9.41 (P = 0.0001). Samples from groups I and II were reactive by immunoblotting, with similar intensities. In ESA-ELISA, the mean for group I was 9.0 ± 0.39. Group II showed a mean value of 2.7 ± 0.12. Both groups were statistically different (9.16, P test value was 16.04 (P ELISA-relative value of the control group (group III) was 0.5 ± 0.09 for the first antigen and 0.4 ± 0.22 for the second. ESA-ELISA and/or immunoblotting of CSF samples can be used for diagnosis of cerebral toxoplasmosis in association with clinical, serologic, and radiological information, thus providing a simple straightforward

  6. Antiretroviral therapy in HIV-infected patients: a proposal to assess the economic value of the single-tablet regimen

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    Colombo GL

    2013-02-01

    Full Text Available Giorgio L Colombo,1,2 Sergio Di Matteo,2 Franco Maggiolo31University of Pavia, Department of Drug Sciences, School of Pharmacy, Pavia, Italy, 2Studi Analisi Valutazioni Economiche, Milan, Italy, 3Division of Infectious Diseases, Ospedali Riuniti, Bergamo, ItalyBackground: The aim of this study was to assess the economic value of a reduced number of pills in patients infected with the immunodeficiency virus (HIV and on highly active antiretroviral therapy by a cost-effectiveness model.Methods: An incremental cost-effectiveness analysis of efavirenz, tenofovir, and emtricitabine (TDF-FTC-EFV as a single-tablet regimen versus a multipill regimen, with reference to untreated HIV-infected patients, was carried out from the perspective of the Italian National Health Service. The comparisons were performed with the help of a Markov decision model over a 10-year time horizon. Based on the ADONE (ADherence to ONE pill study, it was then possible to identify the utility score increment in patients switching from a multipill regimen of TDF-FTC + EFV therapy to a single-tablet regimen.Results: The single-tablet regimen (0.755 quality-adjusted life-years [QALYs]/year resulted in better patient quality of life, with a higher number of QALYs than for the TDF-FTC + EFV multipill regimen (0.716 QALYs/year. The single-tablet regimen was the most cost-effective treatment strategy, with an incremental cost-effectiveness ratio of €22,017.00 versus €26,558.00 for the multipill regimen. A 24% decrease in cost of the multipill regimen determined equivalence with the single-tablet regimen in terms of the incremental cost-effectiveness ratio. Univariate sensitivity and probabilistic analysis carried out on the main variables did not highlight significant variations with respect to the base case scenario.Conclusion: The single-tablet regimen resulted in better adherence, and therefore better quality of life as perceived by patients, corresponding to a €4541.00 lower

  7. Tuberculosis in HIV-negative and HIV-infected patients in a low-incidence country: clinical characteristics and treatment outcomes.

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    Lukas Fenner

    Full Text Available BACKGROUND: In Switzerland and other developed countries, the number of tuberculosis (TB cases has been decreasing for decades, but HIV-infected patients and migrants remain risk groups. The aim of this study was to compare characteristics of TB in HIV-negative and HIV-infected patients diagnosed in Switzerland, and between coinfected patients enrolled and not enrolled in the national Swiss HIV Cohort Study (SHCS. METHODS AND FINDINGS: All patients diagnosed with culture-confirmed TB in the SHCS and a random sample of culture-confirmed cases reported to the national TB registry 2000-2008 were included. Outcomes were assessed in HIV-infected patients and considered successful in case of cure or treatment completion. Ninety-three SHCS patients and 288 patients selected randomly from 4221 registered patients were analyzed. The registry sample included 10 (3.5% coinfected patients not enrolled in the SHCS: the estimated number of HIV-infected patients not enrolled in the SHCS but reported to the registry 2000-2008 was 146 (95% CI 122-173. Coinfected patients were more likely to be from sub-Saharan Africa (51.5% versus 15.8%, P<0.0001 and to present disseminated disease (23.9% vs. 3.4%, P<0.0001 than HIV-negative patients. Coinfected patients not enrolled in the SHCS were asylum seekers or migrant workers, with lower CD4 cell counts at TB diagnosis (median CD4 count 79 cells/µL compared to 149 cells/µL among SHCS patients, P = 0.07. There were 6 patients (60.0% with successful outcomes compared to 82 (88.2% patients in the SHCS (P = 0.023. CONCLUSIONS: The clinical presentation of coinfected patients differed from HIV-negative TB patients. The number of HIV-infected patients diagnosed with TB outside the SHCS is similar to the number diagnosed within the cohort but outcomes are poorer in patients not followed up in the national cohort. Special efforts are required to address the needs of this vulnerable population.

  8. Current oral manifestations of HIV infection.

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    Navazesh, M

    2001-02-01

    The oral manifestations of human immunodeficiency virus infection have changed drastically since the introduction of the highly active anti-retroviral therapy (HAART) in developed countries. Recent studies have documented significant reductions in morbidity and mortality rates among HIV-infected patients on HAART. This article focuses on the latest information about the oral manifestations of HIV infection and will discuss the impact of HAART.

  9. Defective HIV-1 proviruses produce novel protein-coding RNA species in HIV-infected patients on combination antiretroviral therapy.

    Science.gov (United States)

    Imamichi, Hiromi; Dewar, Robin L; Adelsberger, Joseph W; Rehm, Catherine A; O'Doherty, Una; Paxinos, Ellen E; Fauci, Anthony S; Lane, H Clifford

    2016-08-02

    Despite years of plasma HIV-RNA levels <40 copies per milliliter during combination antiretroviral therapy (cART), the majority of HIV-infected patients exhibit persistent seropositivity to HIV-1 and evidence of immune activation. These patients also show persistence of proviruses of HIV-1 in circulating peripheral blood mononuclear cells. Many of these proviruses have been characterized as defective and thus thought to contribute little to HIV-1 pathogenesis. By combining 5'LTR-to-3'LTR single-genome amplification and direct amplicon sequencing, we have identified the presence of "defective" proviruses capable of transcribing novel unspliced HIV-RNA (usHIV-RNA) species in patients at all stages of HIV-1 infection. Although these novel usHIV-RNA transcripts had exon structures that were different from those of the known spliced HIV-RNA variants, they maintained translationally competent ORFs, involving elements of gag, pol, env, rev, and nef to encode a series of novel HIV-1 chimeric proteins. These novel usHIV-RNAs were detected in five of five patients, including four of four patients with prolonged viral suppression of HIV-RNA levels <40 copies per milliliter for more than 6 y. Our findings suggest that the persistent defective proviruses of HIV-1 are not "silent," but rather may contribute to HIV-1 pathogenesis by stimulating host-defense pathways that target foreign nucleic acids and proteins.

  10. Response to 2009 pandemic influenza A (H1N1 vaccine in HIV-infected patients and the influence of prior seasonal influenza vaccination.

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    Darius Soonawala

    Full Text Available BACKGROUND: The immunogenicity of 2009 pandemic influenza A(H1N1 (pH1N1 vaccines and the effect of previous influenza vaccination is a matter of current interest and debate. We measured the immune response to pH1N1 vaccine in HIV-infected patients and in healthy controls. In addition we tested whether recent vaccination with seasonal trivalent inactivated vaccine (TIV induced cross-reactive antibodies to pH1N1. (clinicaltrials.gov Identifier:NCT01066169. METHODS AND FINDINGS: In this single-center prospective cohort study MF59-adjuvanted pH1N1 vaccine (Focetria®, Novartis was administered twice to 58 adult HIV-infected patients and 44 healthy controls in November 2009 (day 0 and day 21. Antibody responses were measured at baseline, day 21 and day 56 with hemagglutination-inhibition (HI assay. The seroprotection rate (defined as HI titers ≥ 1 : 40 for HIV-infected patients was 88% after the first and 91% after the second vaccination. These rates were comparable to those in healthy controls. Post-vaccination GMT, a sensitive marker of the immune competence of a group, was lower in HIV-infected patients. We found a high seroprotection rate at baseline (31%. Seroprotective titers at baseline were much more common in those who had received 2009-2010 seasonal TIV three weeks prior to the first dose of pH1N1 vaccine. Using stored serum samples of 51 HIV-infected participants we measured the pH1N1 specific response to 2009-2010 seasonal TIV. The seroprotection rate to pH1N1 increased from 22% to 49% after vaccination with 2009-2010 seasonal TIV. Seasonal TIV induced higher levels of antibodies to pH1N1 in older than in younger subjects. CONCLUSION: In HIV-infected patients on combination antiretroviral therapy, with a median CD4+ T-lymphocyte count above 500 cells/mm(3, one dose of MF59-adjuvanted pH1N1 vaccine induced a high seroprotection rate comparable to that in healthy controls. A second dose had a modest additional effect. Furthermore

  11. Is it safe to discontinue primary Pneumocystis jiroveci pneumonia prophylaxis in patients with virologically suppressed HIV infection and a CD4 cell count

    DEFF Research Database (Denmark)

    Mocroft, Amanda; Reiss, Peter; Kirk, Ole;

    2010-01-01

    Current guidelines suggest that primary prophylaxis for Pneumocystis jiroveci pneumonia (PcP) can be safely stopped in human immunodeficiency virus (HIV)-infected patients who are receiving combined antiretroviral therapy (cART) and who have a CD4 cell count >200 cells/microL. There are few data ...... regarding the incidence of PcP or safety of stopping prophylaxis in virologically suppressed patients with CD4 cell counts of 101-200 cells/microL....

  12. Efficacy, Safety and Pharmacokinetics of Once-Daily Saquinavir Soft-Gelatin Capsule/Ritonavir in Antiretroviral-Naive, HIV-Infected Patients

    OpenAIRE

    Julio, Montaner SG; Schutz, Malte; Schwartz, Robert; Jayaweera, Dushyantha T; Burnside, Alfred F; Walmsley, Sharon; Saag, Michael S.

    2006-01-01

    Context Once-daily HIV treatment regimens are being used in clinical practice with the objective of improving patient acceptance and adherence. Objective To evaluate the efficacy and safety of saquinavir-soft-gelatin capsule (SGC)/ritonavir combination (1600 mg/100 mg) vs efavirenz (600 mg) both once daily and combined with 2 nucleoside analogs twice daily. Setting Twenty-six centers in the United States, Canada, and Puerto Rico. Patients A total of 171 antiretroviral naive HIV-infected indiv...

  13. A nonparametric procedure for defining a new humoral immunologic profile in a pilot study on HIV infected patients.

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    Chiara Brombin

    Full Text Available This work aims at identifying a set of humoral immunologic parameters that improve prediction of the activation process in HIV patients. Starting from the well-known impact of humoral immunity in HIV infection, there is still a lack of knowledge in defining the role of the modulation of functional activity and titers of serum antibodies from early stage of infection to the development of AIDS. We propose an integrated approach that combines humoral and clinical parameters in defining the host immunity, implementing algorithms associated with virus control. A number of humoral parameters were simultaneously evaluated in a whole range of serum samples from HIV-positive patients. This issue has been afforded accounting for estimation problems typically related to "feasibility" studies where small sample size in each group and large number of parameters are jointly estimated. We used nonparametric statistical procedures to identify biomarkers in our study which included 42 subjects stratified on five different stages of HIV infection, i.e., Elite Controllers (EC, Long Term Non Progressors (LTNP, HAART, AIDS and Acute Infection (AI. The main goal of the paper is to illustrate a novel profiling method for helping to design a further confirmatory study. A set of seventeen different HIV-specific blood humoral factors were analyzed in all subjects, i.e. IgG and IgA to gp120IIIB, to gp120Bal, to whole gp41, to P1 and T20 gp41 epitopes of the MPER-HR2 region, to QARILAV gp41 epitope of the HR1 region and to CCR5; neutralization activity against five different virus strains and ADCC were also evaluated. Patients were selected on the basis of CD4 cell counts, HIV/RNA and clinical status. The Classification and Regression Trees (CART approach has been used to uncover specific patterns of humoral parameters in different stages of HIV disease. Virus neutralization of primary virus strains and antibodies to gp41 were required to classify patients, suggesting

  14. Psychological factors, including alexithymia, in the prediction of cardiovascular risk in HIV infected patients: results of a cohort study.

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    Giustino Parruti

    Full Text Available BACKGROUND: Psychological factors are known predictors of cardiovascular disease in many clinical settings, but data are lacking for HIV infection. We carried out a prospective cohort study to evaluate potential psychological predictors of preclinical and clinical vascular disease in HIV patients. METHODOLOGY/PRINCIPAL FINDINGS: HIV patients were consecutively enrolled. Demographics, viral and immune parameters and traditional cardiovascular predictors were considered; Intima-Media Thickness (c-IMT, continuous measure and Carotid Plaques (CPs, focal thickening ≥1.5 mm were investigated by B-mode ultrasonography; depressive symptoms by the Beck Depression Inventory (BDI-II, Type D personality (Distressed Personality or Type D by the DS14, alexithymia by the Toronto Alexithymia Scale (TAS-20. Vascular outcomes included transient ischemic attacks or stroke, acute coronary syndrome, myocardial or other organ infarction. We enrolled 232 HIV subjects, 73.9% males, aged 44.5±9.9 y, 38.2% with AIDS diagnosis, 18.3% untreated. Mean Nadir CD4 T-cell counts were 237.5±186.2/mmc. Of them, 224 (96.5% attended IMT measurements; 201 (86.6% attended both IMT assessment and psychological profiling. Mean follow-up was 782±308 days. Fifty-nine patients (29.4% had CPs at baseline. Nineteen patients (9.5% had ≥1 vascular event; 12 (6.0% died due to such events (n = 4 or any cause. At baseline cross-sectional multivariate analysis, increasing age, total cholesterol, current smoking and Alexithymia score≥50 were significantly associated with both increased cIMT (linear regression and CPs (logistic regression. At follow-up analysis, log-rank tests and Cox's regression revealed that only older age (p = 0.001, current smoking (p = 0.019 and alexithymia score≥50 (p = 0.013 were independently associated with vascular events. CONCLUSIONS/SIGNIFICANCE: In HIV-infected subjects, the Alexithymic trait emerges as a strong predictor of increased IMT, presence of CPs

  15. Effects of highly active antiretroviral therapy on the survival of HIV-infected adult patients in urban slums of Kenya.

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    Muhula, Samuel Opondo; Peter, Memiah; Sibhatu, Biadgilign; Meshack, Ndirangu; Lennie, Kyomuhangi

    2015-01-01

    Recent improvements in access to Anti-Retroviral Therapy (ART) have radically reduced hospitalizations and deaths associated with HIV infection in both developed countries and sub-Saharan Africa. Not much is known about survival of patients on ART in slums. The objective of this study was to identify factors associated with mortality among adult patients on ART in resource poor, urban, sub-Saharan African setting. A prospective open cohort study was conducted with adult patients on ART at a clinic in Kibera slums, Nairobi, Kenya. The patients' enrollment to care was between March 2005 and November 2011. Descriptive statistics were computed and Kaplan-Meier (KM) methods used to estimate survival time while Cox's proportional hazards (CPH) model fitted to determine mortality predictors. A total of 2,011 adult patients were studied, 69% being female. Female gender (p=0.0016), zidovudine-based regimen patients (p351 patients (p<0.0001), WHO stage I patients (p<0.0001) and "Working" functional status patients recorded better survival probability on ART. In CPH analysis, the hazard of dying was higher in patients on Stavudine-based regimen(hazard ratio (HR)=.8; 95% CI, 1.5-2.2; p<0.0001),CD4 count<50 cells/µl (HR=1.6; 95% CI, 1.5-1.7;p<0.0001), WHO Stage IV at ART initiation (HR=1.3; 95% CI, 1.1-1.6; p=0.016) and bedridden patients (HR=2.7; 95% CI, 1.7-4.4;p<0.0001). There was increased mortality among the males, those with advanced Immunosuppression, late WHO stage and bedridden patients. The findings further justify the need to switch patients on Stavudine-based regimen as per the WHO recommendations.

  16. The Use of the Framingham Equation to Predict Myocardial Infarctions in HIV-infected Patients: Comparison with Observed Events in the D:A:D Study

    DEFF Research Database (Denmark)

    Law, MG; Friis-Møller, Nina; El-Sadr, WM;

    2006-01-01

    BACKGROUND: The D:A:D (Data Collection on Adverse Events of Anti-HIV Drugs) Study, a prospective observational study on a cohort of 23 468 patients with HIV infection, indicated that the incidence of myocardial infarction (MI) increased by 26% per year of exposure to combination antiretroviral...... treatment (CART). However, it remains unclear whether the observed increase in the rate of MI in this population can be attributed to changes in conventional cardiovascular risk factors. OBJECTIVE: To compare the number of MIs observed among participants in the D:A:D Study with the number predicted...... by assuming that conventional cardiovascular risk equations apply to patients with HIV infection. METHODS: The Framingham equation, a conventional cardiovascular risk algorithm, was applied to individual patient data in the D:A:D Study to predict rates of MI by duration of CART. A series of sensitivity...

  17. The impact of tenofovir disoproxil fumarate on kidney function: four-year data from the HIV-infected outpatient cohort

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    Nadine Monteiro

    2014-11-01

    Full Text Available Introduction: With improvements in survival and disease progression in the era of combined antiretroviral therapy, complications such as kidney disease are becoming increasingly prevalent in HIV-infected patients. Tenofovir disoproxil fumarate (TDF has been associated with nephrotoxicity, including decline in glomerular filtration rate, proximal tubular damage and acute kidney injury. Objective: Characterize kidney safety of TDF-containing antiretroviral treatment (ART regimens in HIV-infected patients. Methods: Non-controlled, observational, retrospective study was based on the clinical files registry of HIV patients who started TDF between January and December 2008. We assessed outpatients followed at a single Portuguese center. Demographic, clinical, virological and immunological data at baseline were collected. Serum creatinine, estimated glomerular filtration rate (eGFR and creatinine clearance (CrCL were assessed at baseline, after six months and every year up to four years. CrCL and eGFR were calculated by Cockroft–Gault and Modification of Diet in Renal Disease equations, respectively. Results: A total of 176 patients (71.6% males with a mean age of 43 years were enrolled. Ninety-six (52% were ART-naive patients at TDF initiation. At baseline 12.5% had hypertension, 4% diabetes, 25% chronic hepatitis C and 9% chronic hepatitis B infections; 58% had normal renal function (eGFR ≥90 ml/min/1.73 m2, 36% had mild (eGFR 60-89 ml/min/1.73 m2 renal dysfunction and 2.3% had moderate (eGFR 30-59 ml/min/1.73 m2 renal dysfunction at initiation of TDF. Eighty-three (47% patients were on protease inhibitors and the remaining on NNRTIs containing regimens. During 48 months follow-up, 5% experienced moderate renal dysfunction and 1.7% severe renal dysfunction. Twenty-one (12% patients met the definition criteria of rapid decline of renal function (annual decline of eGFR ≥3 ml/min/1.73 m2 in two consecutive years. The development of kidney events

  18. Traditional medicine for HIV infected patients in antiretroviral therapy in a tertiary hospital in Kano, Northwest Nigeria

    Institute of Scientific and Technical Information of China (English)

    Igbiks Tamuno

    2011-01-01

    Objective:To investigate the prevalence of use of traditional medicines amongst patients with HIV infection receiving therapies of antiretroviral(ARV) drugs at the Aminu Kano Teaching Hospital(AKTH), Kano, Northwest Nigeria, and to assess the attitude of these patients to theirARV therapy.Methods: A cross sectional prospective study using pretested structured questionnaires administered on430 patients with antiretroviral therapy attending the AKTH between April and June2009. Data was collected on socio-demographic characteristics, use of traditional medicine and attitude to antiretroviral therapy.Results: A mean age of(33.6±8.4)years old was found with67.2% females and32.8% males. A total of29% had no formal education while 10.5% had postgraduate education;12% earned above 35 000 naira (230 USD) per month;63.8% were married;39.8% had at least2 sexual partners; 27.5% used traditional medicine before commencement of antiretroviral therapy (ART), but only4.25% of patients used ARV and traditional medicine concurrently. There was no significant difference in most of the socio-demographic indices between the concurrent users and other patients (P>0.05). A total of 28.8% HIV patients,14.6% patients used traditional medicine beforeART and29.4% concurrent users had missed at least a dose of theirARVs since commencement of therapy. 148 (37%) of the patients had their drug regimen changed at least once while23 (20.90%) patients receiving traditional medicine beforeARTand5 (29.41%) patients having two treatments had their drug regimen changed.Conclusions: A total of4.25% patients used ARV and traditional medicine concurrently. In conclusion, the widespread use of traditional medicine by patients living with HIV/AIDSshould be of concern to clinicians and policy makers.

  19. Nevirapine-Based Antiretroviral Therapy Impacts Artesunate and Dihydroartemisinin Disposition in HIV-Infected Nigerian Adults

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    Fatai A. Fehintola

    2012-01-01

    Full Text Available Background. Nevirapine- (NVP- based antiretroviral therapy (ART and artesunate-amodiaquine are frequently coprescribed in areas of HIV and malaria endemicity. We explored the impact of this practice on artesunate and dihydroartemisinin pharmacokinetics. Methods. We conducted a parallel-group pharmacokinetic comparison between HIV-infected patients receiving NVP-based ART (n=10 and ART-naive controls (n=11. Artesunate-amodiaquine 200/600 mg was given daily for three days. Measurement of drug concentrations occurred between 0 and 96 hours after the final dose. Pharmacokinetic parameters were determined using noncompartmental analysis. Results. Comparing the NVP group to controls, clearance of artesunate was reduced 50% (1950 versus 2995 L/h; P=0.03, resulting in a 45% increase in the AUC0-96 (105 versus 69 ug∗hr/L; P=0.02. The half-life of dihydroartemisinin was shorter in the NVP group (1.6 versuss 3.2 h; P=0.004, but other dihydroartemisinin pharmacokinetic parameters were unchanged. A lower conversion of artesunate to dihydroartemisinin was observed in the NVP group (dihydroartemisinin: artesunate AUC0-96=5.6 versuss 8.5 in NVP and control groups, respectively, P=0.008. Conclusion. Although NVP-containing ART impacted some pharmacokinetic parameters of artesunate and dihydroartemisinin, overall exposure was similar or better in the NVP group.

  20. Differential clinical outcome of dengue infection among patients with and without HIV infection: a matched case-control study.

    Science.gov (United States)

    Pang, Junxiong; Thein, Tun-Linn; Lye, David C; Leo, Yee-Sin

    2015-06-01

    Clinical characteristics and outcome among dengue patients with and without human immunodeficiency virus (HIV) infection remain elusive. A total of 10 dengue virus (DENV)-HIV Chinese patients were compared with 40 Chinese dengue patients without HIV, who were matched for age, gender, type of care received, methods, and year of dengue diagnosis from 2005 to 2008. Univariate and multivariate conditional logistics regression were applied. DENV-HIV patients were significantly associated with the World Health Organization (WHO) 2009 severe dengue (conditional odds ratio [COR] = 5.72; 95% confidence interval [CI] = 1.01-32.64) but not with the WHO 1997 dengue hemorrhagic fever/dengue shock syndrome (COR = 0.40; 95% CI = 0.09-1.71). This is mainly due to severe plasma leakage and the lack of hemorrhagic manifestations. Hospitalization duration was longer for DENV-HIV patients (10.5 days; interquartile range [IQR] = 5.5-26.3 days) compared with dengue patients (5 days; IQR = 4-6 days). There were no significant differences in presentation of clinical warning signs and symptoms at admission and during hospitalization, except for rash (adjusted COR [ACOR] = 0.06; 95% CI = 0.03-0.92). DENV-HIV patients were associated with higher pulse rate (ACOR = 1.13; 95% CI = 1.02-1.25), eosinophils proportion (ACOR = 3.07; 95% CI = 1.12-8.41) and lower hematocrit level (ACOR = 0.79; 95% CI = 0.64-0.98) compared with dengue patients. Even though DENV-HIV patients may present similarly to dengue patients, they may be more likely to have severe dengue outcome. Hence, close monitoring of DENV-HIV patients is highly recommended as part of dengue clinical care and management.

  1. Short-Course Induction Treatment with Intrathecal Amphotericin B Lipid Emulsion for HIV Infected Patients with Cryptococcal Meningitis

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    Gerardo Alvarez-Uria

    2015-01-01

    Full Text Available Cryptococcal meningitis (CM is a common cause of death among HIV infected patients in developing countries, especially in sub-Saharan Africa. In this observational HIV cohort study in a resource-limited setting in India, we compared the standard two-week intravenous amphotericin B deoxycholate (AmBd (Regimen I with one week of intravenous AmBd along with daily therapeutic lumbar punctures and intrathecal AmB lipid emulsion (Regimen II during the intensive phase of CM treatment. 78 patients received Regimen I and 45 patients received Regimen II. After adjustment for baseline characteristics (gender, age, altered mental status or seizures at presentation, CD4 cell count, white blood cells, cerebrospinal fluid white cells, and haemoglobin, the use of Regimen II was associated with a significant relative risk reduction in mortality (adjusted hazard ratio 0.4, 95% confidence interval, 0.22–0.76 and 26.7% absolute risk reduction (95% confidence interval, 9.9–43.5 at 12 weeks. The use of Regimen II resulted in lower costs of drugs and hospital admission days. Since the study is observational in nature, we should be cautious about our results. However, the good tolerability of intrathecal administration of AmB lipid emulsion and the clinically important mortality reduction observed with the short-course induction treatment warrant further research, ideally through a randomized clinical trial.

  2. Opportunistic diseases in HIV-infected patients in Gabon following the administration of highly active antiretroviral therapy: a retrospective study.

    Science.gov (United States)

    Okome-Nkoumou, Madeleine; Guiyedi, Vincent; Ondounda, Magloire; Efire, Nora; Clevenbergh, Philippe; Dibo, Mireille; Dzeing-Ella, Arnaud

    2014-02-01

    Opportunistic diseases cause substantial morbidity and mortality to human immunodeficiency virus (HIV)-infected patients. Highly active antiretroviral therapy (HAART) leading to immune reconstitution is the most effective treatment of preventing opportunistic diseases. This retrospective study established an epidemiologic profile of opportunistic diseases 10 years after the introduction of HAART. The HIV antiretroviral therapy-naive patients matching inclusion criteria were included. The primary outcome was the prevalence of opportunistic diseases. From January 1, 2002 to September 30, 2010, 654 opportunistic diseases were identified in 458 patients. Pulmonary tuberculosis, herpes zoster, cerebral toxoplasmosis, oral candidiasis, and severe pneumonia accounted for 22.05%, 15.94%, 14.19%, 14.19%, and 9.39%, respectively. Cryptococcal meningitis and pneumocystosis accounted for 0.44% and 0.21%, respectively. The prevalence of opportunistic diseases in Gabon remains high. New guidelines emphasize the importance of initiating antiretroviral therapy early to reconstitute the immune system, and reduce disease risk, and treat the primary opportunistic infection of pulmonary tuberculosis.

  3. Kaposi Sarcoma among HIV Infected Patients in Lagos University Teaching Hospital, Nigeria: A 14-Year Retrospective Clinicopathological Study

    Science.gov (United States)

    Akinde, Olakanmi; Adeyemo, Titilope; Omoseebi, Oladipo; Ikeri, Nzechukwu; Okonkwo, Ikechukwu; Afolayan, Olatunji

    2016-01-01

    Background. Despite the increased incidence of Kaposi sarcoma (KS) resulting from the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) pandemic, there is still significant underreporting of KS in this environment. Objectives. This study was aimed at determining the incidence and clinicopathologic patterns of KS among HIV infected patients in Lagos University Teaching Hospital (LUTH), Nigeria, over a 14-year period: January 2000 to December 2013. Methodology. The materials for this study included patients' hospital clinical files, duplicate copies of histopathologic reports, and tissue blocks and corresponding archival slides in the Anatomic and Molecular Pathology Department and the HIV/AIDS unit of the Department of Haematology. Results. Within the study period, 182 cases of KS were diagnosed, accounting for 1.2% of all patients managed for HIV/AIDS and 2.99% of solid malignant tumours. The male-to-female ratio and modal age group were 1 : 1.3 and 5th decade, respectively. Most cases (90%) had purely mucocutaneous involvement with the lower limb being the commonest site (65.8%). The majority of lesions were plaques (65.8%). Vascular formation was the predominant histologic type seen (43.5%). Conclusion. KS in Lagos followed the same epidemiologic trend as other centers in Nigeria, with an increasing incidence in this era of HIV/AIDS. PMID:27034839

  4. Gender and age differences in quality of life and the impact of psychopathological symptoms among HIV-infected patients.

    Science.gov (United States)

    Pereira, Marco; Canavarro, Maria Cristina

    2011-11-01

    The purpose of this study was to determine gender and age differences and interaction effects on the quality of life (QoL) domains in a sample of Portuguese HIV-positive patients, and to examine to what degree psychopathological symptoms are associated with QoL in addition to sociodemographic and clinical variables. The sample consisted of 1191 HIV-positive patients, and measures included the WHOQOL-HIV-Bref and the Brief Symptom Inventory. Controlling for clinical status, there was a significant effect of gender on QoL. Women reported lower scores of Psychological and Spirituality QoL. Younger patients reported higher scores on Physical and Level of Independence domains. Age by gender interactions emerged on all domains of QoL except on the Level of Independence domain. Overall, women over 45 years old showed lower QoL scores. Psychopathological symptoms contributed significantly to the variance of all QoL domains. Gender differences in the association of HIV infection with QoL and psychopathological symptoms seemed to be modulated by age. Understanding gender and age differences (and their interaction) may provide potentially useful information for planning interventions to improve QoL and mental health among people infected with HIV/AIDS, especially among older women.

  5. Willingness to participate in HIV therapeutic vaccine trials among HIV-infected patients on ART in China.

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    Yuan Dong

    Full Text Available BACKGROUND: More and more HIV therapeutic vaccines will enter clinical trials; however, little is known about the willingness to participate (WTP in HIV therapeutic vaccine trials among HIV-positive individuals. OBJECTIVE: To investigate the WTP in HIV therapeutic vaccine trials among Chinese HIV-infected patients. METHODS: We conducted a cross-sectional survey on HIV-positive inpatients and outpatients at Shanghai Public Health Center. A total of 447 participants were recruited into this study. Following an introduction with general information on HIV therapeutic vaccine and its potential effectiveness and side effects, each participant completed a questionnaire in a self-administered form. The questionnaires covered demographics, high-risk behaviors, clinical characteristics and willingness to participate in HIV therapeutic vaccine trial. RESULTS: The overall willingness to participate in HIV therapeutic vaccine trials was 91.5%. Interestingly, multivariate logistic regression analyses demonstrated that the willingness was higher for those sexually infected by HIV (odds ratio [OR]: 4.36; 95% confidence interval [CI]: 1.53-12.41, diagnosed as HIV-1 infection for greater than 5 years (OR: 7.12, 95% CI: 1.83-27.76, and with the presence of infectious complications (OR: 2.75; 95% CI: 1.02-7.45. The primary reason for participation was to delay or reduce antiretroviral treatment (ART and to avoid ART side effects (76.6%, and then followed by delaying disease progression (74.9%, increasing immune response to suppress opportunistic infections (57.7% and preventing the development of drug resistance (37.1%. Reasons for unwillingness to participate mainly included concern for safety (37.0%, lack of knowledge on therapeutic vaccine (33.3%, and satisfaction with ART effectiveness (22.2%. CONCLUSIONS: The WTP in HIV therapeutic vaccine trials was high among HIV-infected Chinese patients. HIV+ subjects who acquired infection through sexual contact and who

  6. Prevalence of intestinal parasites in relation to CD4 counts and anaemia among HIV-infected patients in Benin City, Edo State, Nigeria.

    Science.gov (United States)

    Akinbo, Frederick O; Okaka, Christopher E; Omoregie, Richard

    2011-01-01

    Parasitic infections continue to take their toll on HIV positive patients by influencing the blood qualitatively and quantitatively. The objective of this study was to determine the prevalence of intestinal parasitic infections in relation to anaemia and CD4 counts among HIV-infected patients in Benin City, Nigeria. Using a serial sampling method, a total of 2000 HIV-infected patients were recruited on their first visit prior to highly active anti-retroviral therapy (HAART) at the University of Benin Teaching Hospital from August 2007 to August 2009. Stool and blood samples were collected from each patient. The stool samples were processed using the modified Ziehl-Neelsen staining technique to microscopically identify the oocysts of Cryptosporidium species, Isospora belli, Cyclospora species and spores of Microsporidium species while saline and iodine preparations were used for identifying the ova, cysts and parasites of Ascaris lumbricoides, hookworm, Taenia spp and other parasites. The blood specimens were equally analyzed using the flow cytometry for CD4+ T-lymphocyte count and autoanalyzer - sysmex kx - 21 for haemoglobin concentration. The overall prevalence of anaemia was 93.3% while 18% had parasitic infections. There was a significant relationship between CD4 count <200cells/microL and anaemia (P<0.0001). Cryptosporidium species (P= 0.005), A. lumbricoides (P=0.035), hookworm and Taenia species (P=0.014) were associated with anaemia. Anaemia was associated with CD4 count while Cryptosporidium species, Ascaris lumbricoides, hookworm and Taenia species were the intestinal parasitic agents associated with anaemia. In conclusion the prevalence of anaemia in HIV-infected patients is high low CD4 count is a significant risk factor of acquiring anaemia. Except for isosporiasis, cryptosporidiosis, A. lumbricoides, hookworm and Taenia species in HIV infected individuals are parasitic agents associated with anaemia. Routine screening for intestinal parasites and

  7. Prevalence and prognostic significance of ECG abnormalities in HIV-infected patients: results from the Strategies for Management of Antiretroviral Therapy study

    DEFF Research Database (Denmark)

    Soliman, Elsayed Z; Prineas, Ronald J; Roediger, Mollie P

    2011-01-01

    BACKGROUND: It remains debated whether to include resting electrocardiogram (ECG) in the routine care of human immunodeficiency virus (HIV)-infected patients. METHODS: This analysis included 4518 HIV-infected patients (28% women and 29% blacks) from the Strategies for Management of Antiretroviral...... Therapy study, a clinical trial aimed to compare 2 HIV treatment strategies. ECG abnormalities were classified using the Minnesota Code. Cox proportional hazards analysis was used to examine the association between baseline ECG abnormalities and incident cardiovascular disease (CVD). RESULTS: More than...... half of the participants (n = 2325, or 51.5%) had either minor or major ECG abnormalities. Minor ECG abnormalities (48.6%) were more common than major ECG abnormalities (7.7%). During a median follow-up of 28.7 months, 155 participants (3.4%) developed incident CVD. After adjusting for the study...

  8. Intestinal parasitic infections in HIV infected and non-infected patients in a low HIV prevalence region, West-Cameroon.

    Science.gov (United States)

    Nkenfou, Céline Nguefeu; Nana, Christelle Tafou; Payne, Vincent Khan

    2013-01-01

    The magnitude of intestinal parasitic infection in acquired immunodeficiency syndrome patients requires careful consideration in the developing world where poor nutrition is associated with poor hygiene and several tropical diseases. However, there have been very few studies addressing this issue in Cameroon. This study was conducted to determine the prevalence of intestinal parasitosis in HIV/AIDS patients in Dschang -Cameroon. Stool and blood specimens from HIV/AIDS patients and control group were screened respectively for intestinal parasites and for HIV antibodies. Intestinal parasites were identified using direct microscopy, formalin-ether concentration and Ziehl Neelsen methods. Out of 396 participants recruited among patients consulting at hospital, 42 (10.6%) were HIV positive, thirty of them treatment naïve. The overall prevalence of intestinal parasites was 14.64%. Out of 42 HIV/AIDS patients, 59.5% (25/42) were infected with intestinal parasites, while only 9.32% (33/354) of the HIV negative patients were infected with intestinal parasites. The parasites detected in our study population included Crystosporidium parvum (2.53%), Entamoeba histolytica (7.52%), Entamoeba coli (4.04%), Giardia lamblia (0.25%), Trichuris trichura (0.25%), Strongyloides stercoralis (0.25%) and Taenia spp. (0.25%). In the HIV infected group, Crystosporidium parvum (19.04%), Entamoeba histolytica (19.04%), Entamoeba coli (21.42%), Giardia lamblia (2.38%), Strongyloides stercoralis (0.25%) and Taenia spp. (0.25%) were found. Crystosporidium parvum was found to be significantly higher in HIV/AIDS patients than in controls (Pintestinal parasitosis. Routine examinations of stool samples for parasites would significantly benefit the HIV patients by contributing in reducing morbidity and improving the efficiency of antiretroviral treatment. Even after the introduction of free anti-retroviral drugs, opportunistic intestinal infections are still a threat. HIV patients should be screened

  9. Kaposi Sarcoma among HIV Infected Patients in Lagos University Teaching Hospital, Nigeria: A 14-Year Retrospective Clinicopathological Study

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    Olakanmi Akinde

    2016-01-01

    Full Text Available Background. Despite the increased incidence of Kaposi sarcoma (KS resulting from the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS pandemic, there is still significant underreporting of KS in this environment. Objectives. This study was aimed at determining the incidence and clinicopathologic patterns of KS among HIV infected patients in Lagos University Teaching Hospital (LUTH, Nigeria, over a 14-year period: January 2000 to December 2013. Methodology. The materials for this study included patients’ hospital clinical files, duplicate copies of histopathologic reports, and tissue blocks and corresponding archival slides in the Anatomic and Molecular Pathology Department and the HIV/AIDS unit of the Department of Haematology. Results. Within the study period, 182 cases of KS were diagnosed, accounting for 1.2% of all patients managed for HIV/AIDS and 2.99% of solid malignant tumours. The male-to-female ratio and modal age group were 1 : 1.3 and 5th decade, respectively. Most cases (90% had purely mucocutaneous involvement with the lower limb being the commonest site (65.8%. The majority of lesions were plaques (65.8%. Vascular formation was the predominant histologic type seen (43.5%. Conclusion. KS in Lagos followed the same epidemiologic trend as other centers in Nigeria, with an increasing incidence in this era of HIV/AIDS.

  10. Candida and candidiasis in HIV-infected patients: where commensalism, opportunistic behavior and frank pathogenicity lose their borders.

    Science.gov (United States)

    Cassone, Antonio; Cauda, Roberto

    2012-07-31

    In this era of efficacious antiretroviral therapy and consequent immune reconstitution, oropharyngeal and esophageal candidiasis (OPC and OEC) still remain two clinically relevant presentations in the global HIV setting. Both diseases are predominantly caused by Candida albicans, a polymorphic fungus which is a commensal microbe in the healthy individual but can become an aggressive pathogen in a debilitated host. Actually, C. albicans commensalism is not the result of a benign behavior of one of the many components of human microbiota, but rather the result of host's potent innate and adaptive immune responses that restrict the growth of a potentially dangerous microrganism on the epithelia. An important asset guarding against the fungus is the Th17 functional subset of T helper cells. The selective loss of these cells with the progression of HIV infection causes the decay of fungal containment on the oral epithelium and allows C. albicans to express its pathogenic potential. An important part of this potential is represented by mechanisms to evade host immunity and enhance inflammation and immunoactivation. In C. albicans, these mechanisms are mostly incorporated into and expressed by characteristic morphogenic transitions such as the yeast-to-hyphal growth and the white-to-opaque switch. In addition, HIV infection generates an 'environment' selecting for overexpression of the virulence potential by the fungus, particularly concerning the secreted aspartyl proteinases (Saps). These enzymes can degrade critical host defense components such as complement and epithelial defensive proteins such as histatin-5 and E-cadherin. It appears that part of this enhanced Candida virulence could be induced by the binding of the fungus to HIV and/or induced by HIV proteins such as GP160 and tat. Both OPC and OEC can be controlled by old and new antimycotics, but in the absence of host collaboration, anticandidal therapy may become ineffective in the long run. For these reasons

  11. Seroprevalence of Toxoplasma gondii IgG antibody in HIV-infected patients at the Lagos University Teaching Hospital

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    Osunkalu VO

    2011-09-01

    -IgG antibodies was lowest among the educated subjects (19% of the respondents with tertiary education and among females in both study groups. A higher proportion of the subjects with neurological complications had CD4 cell count <100 cells/µL compared with respondents without neurological defects (39% vs 22.7%; P = 0.000, but the seroprevalence of Toxo-IgG antibodies was higher in subjects without neurological complications (45% vs 31.3%; P = 0.000.Conclusion: Toxoplasmosis, though an important opportunistic infection in our environment, may not account for the majority of neurological complications observed in patients with HIV infection in our center.Keywords: Toxoplasma gondii antibody (Toxo-IgG, seroprevalence, neurological complication 

  12. Bone marrow CD34+ progenitor cells from HIV infected patients show an impaired T cell differentiation potential related to pro-inflammatory cytokines.

    Science.gov (United States)

    Bordoni, Veronica; Bibas, Michele; Viola, Domenico; Sacchi, Alessandra; Cimini, Eleonora; Tumino, Nicola; Casetti, Rita; Amendola, Alessandra; Ammassari, Adriana; Agrati, Chiara; Martini, Federico

    2017-01-26

    The impact of HIV infection on the frequency and differentiation capability of CD34+ Bone Marrow Hematopoietic Progenitor Cells (BM-HPCs) is still debated, having a possible primary role in antiretroviral-induced immunoreconstitution. We investigated the influence of HIV replication or pro-inflammatory cytokines on lymphopoietic capability of BM-HPCs from 7 viremic (VR) and 5 non-viremic (NVR) HIV infected patients. We found that BM-HPCs from VR patients were unable to differentiate in vitro toward T cells, and produced pro-inflammatory cytokines in the absence of viral replication. In contrast, the lymphoid differentiation potential of BM-HPCs was partially restored after successful antiretroviral therapy. We also showed that TLR8 triggering induced BM-HPCs from healthy donors to release pro-inflammatory cytokines affecting T cells differentiation. These data suggest that in HIV infected patients the lymphopoiesis capability of BM-HPCs may be modulated by a virus-driven autocrine mechanism involving pro-inflammatory cytokines.

  13. Clinical significance of the UGT1A1*28 allele detection in HIV-infected patients

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    Veronika Kanestri

    2014-11-01

    Full Text Available Introduction: The UGT1A1*28 (rs8175347 polymorphism is associated with hyperbilirubinemia. The presence of 6 TA-repeats in the UGT1A1 gene promoter region corresponds to normal UGT1TA1 activity. A detection of 7 TA-repeats in hetero- or homozygous individuals [(TA6/(TA7 and (TA7/(TA7] is associated with lower UGT1TA1 activity, which may eventually result in the development of Gilbert syndrome and/or modified individual response to drugs metabolized by this enzyme. ATV contributes to the decreased levels of UGT1A1, which may lead to elevations of indirect bilirubin, jaundice and even to therapy discontinuation. We evaluated the prevalence of the UGT1A1*28 among HIV-infected patients and the dependence of the frequency and severity of AE during ATV treatment on individual genetic characteristics. Materials and Methods: 47 HIV-infected patients was screen for UGT1A1 genotype and the presence of UGT1A1*28. All patients received ATV in the HAART regimen for 48 weeks. Changes in the total, direct and indirect bilirubin, ALT, AST, GGT and jaundice were evaluated. Statistical analysis was performed using Microsoft Office Excel for Windows XP Professional 2007 and Biostat. Results: All patients were followed up in the AIDS Center (males 72.3%, median age 33 years, median CD4+ count-282 cells/µl (19.5%. HBV/HCV was in 36.2% patients. Ten patients had risk factors that could affect bilirubin turnover (chronic cholecystitis, biliary dyskinesia, etc.. Genotype (TA6/(TA6 was found in 42.6% patients, (TA6/(TA7-42.6% and (TA7/(TA7-14.9%. Overall prevalence of UGT1A1*28 was 57.4%, and homozygous allele frequency was 14.9%. G3/4 of indirect bilirubin were detected in 36.2% patients [(TA6/(TA6 in 10–20%, (TA6/(TA7-25-40%, (TA7/(TA7-72-86%], and significant jaundice in 10.6% [80% with (TA7/(TA7]. The OR for hyperbilirubinemia>40 µmol/L in patients with heterozygous UGT1A1*28 was increased 3 times over patients without this allele (OR 3.07, 95% CI 1.54–4.6 and

  14. Highly aggressive squamous cell carcinoma in an HIV-infected patient Carcinoma de células escamosas altamente agressivo em um paciente HIV-positivo

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    Rogerio Neves-Motta

    2004-12-01

    Full Text Available Unusually aggressive forms of cutaneous squamous cell carcinoma are being increasingly recognized as a complication of HIV infection. We report the case of a 59-year-old male patient with advanced HIV infection who presented with a highly aggressive SCC lesion over the scalp area with destruction of the underlying parietal bone and fulminant clinical progression.Formas altamente agressivas de carcinoma cutâneo de células escamosas vêm sendo reconhecidas como uma importante complicação da infecção pelo HIV. Descrevemos o caso de um paciente do sexo masculino, de 59 anos, que se apresentou com uma lesão altamente agressiva de SCC na região do couro cabeludo, com destruição do osso parietal subjacente e curso clínico fulminante.

  15. Analysis of hepatitis non-treatment causes in a cohort of HCV and HCV/HIV infected patients

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    Karen Pereira

    2014-11-01

    Full Text Available Introduction: The decision to start hepatitis C virus (HCV treatment and its timing remains controversial. As new treatment regimens are approved, it is essential to identify patients eligible for each regimen in a timed and tailored approach. This study aims to identify the reasons to defer treatment of chronic hepatitis C infection in both HCV and HCV/HIV infected patients. Materials and Methods: Retrospective observational study of a cohort of HCV chronically infected patients with or without HIV infection, followed in an infectious disease clinic in Lisbon. Demographic, epidemiological, clinical, immunologic and virologic data were collected. Statistical analysis was performed with Microsoft Office®- Excel 2012. Kolmogorov-Smirnov, t-test, Chi-square and correlation analysis were performed for a significant p value<0.05. Results: The study included 669 patients, 225 patients infected with HCV (group A and 444 patients co-infected with HCV/HIV (group B. The comparative analysis of those groups (A vs. B showed: mean age was 49.4 years versus 46.9 (p<0.01, mean time since HCV diagnosis was 9.5 versus 14.6 years (p=0.558 both groups shared a male predominance and HCV acquisition due to intravenous drug use. Regarding genotype characterization, the predominant was 1a in both groups (p<0.01. Evaluation of IL28B polymorphism revealed CC 15.5% (A versus 9.45% (B (p<0.01. Group B mean TCD4 count was 585 cells/µL (mean percentage 27.1%. There was spontaneous viral clearance in 10.7% (A versus 4.1% (B (p<0.01. There were treated 52.0% (A versus 32.2% (B patients (p<0.01. For the untreated ones (107 – group A vs 270 – group B, no reason was identified for treatment deferral in 32.5% (A versus 48.0% (B patients. The most frequent reasons for deferring treatment were: withdrawal to follow-up (33.7%, active staging of disease (7.2%, alcohol abuse (6.0% and advanced age (6.0% in group A versus low TCD4 cell count (17.1%, loss to follow-up (7.5%, poor

  16. Lamivudine plus a boosted-protease inhibitor as simplification strategy in HIV-infected patients with toxicity to nucleoside analogues

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    J Casado

    2012-11-01

    Full Text Available Purpose of the study: Dual therapy with lamivudine plus a PI boosted with ritonavir (PI/r could be an alternative to standard triple therapy or PI/r monotherapy as a simplification strategy in patients with toxicity to nucleoside analogues (NA. Methods: Retrospective cohort study of 44 HIV-infected patients on suppressive HAART, with no chronic HBV, who simplified to this dual therapy since 2008. Virological and immunological outcome, lipids and renal changes were evaluated. Summary of results: Mean age was 50 years (38-70, 66% were male, and the median time of HIV infection was 18.6 years. The median nadir CD4+ count was 150 cells/ml (2–407. At inclusion, patients were receiving therapy with lamivudine plus atazanavir/r in 5 cases, lopinavir/r in 12, and darunavir/r in 27, and they had an HIV RNA level<50 copies/ml for a median time of 794 days (129–2344, 90% >6 months. The NA discontinued was tenofovir (27, didanosine (12, AZT (3, and d4T (2. The reasons for changing were toxicity in 76% of cases, especially renal impairment. They had received a mean of 8 regimens before (2–20, and 55% were in CDC-stage C. In 11 cases, history of resistance was available (to NA in 7 cases, including the 210W mutation in four. The mutations 184V was not observed, but four patients (9% had a previous failure to therapy including 3tC. Mutations in the protease gene were observed in 8 patients (2 to 7 mutations, the most frequent 77I and 93L, without resistance to the current PI/r. During 62.8 patient-years of follow-up (median, 802 days, only 2 patients failed (4.5%, due to incomplete adherence, at 27 and 141 days. Of note, these two patients had no previous failed with 3tC or PI. Overall, CD4+ count increased for 55 cells/ml. No new adverse events were observed, but total cholesterol (from 180 to 246 mg/dl, p=0.007 and triglycerides (from 166 to 195, p=0.01 increased during the first 24 weeks with improvement at 48 weeks. On the other hand, estimated

  17. CD4/CD8 Ratio and KT Ratio Predict Yellow Fever Vaccine Immunogenicity in HIV-Infected Patients

    Science.gov (United States)

    Hunt, Peter W.; Huang, Yong; Simoes, Marisol; Lima, Sheila B.; Freire, Marcos S.; Caiaffa-Filho, Helio H.; Hong, Marisa A.; Costa, Dayane Alves; Dias, Juliana Zanatta C.; Cerqueira, Natalia B.; Nishiya, Anna Shoko; Sabino, Ester Cerdeira; Sartori, Ana M.; Kallas, Esper G.

    2016-01-01

    Background HIV-infected individuals have deficient responses to Yellow Fever vaccine (YFV) and may be at higher risk for adverse events (AE). Chronic immune activation–characterized by low CD4/CD8 ratio or high indoleamine 2,3-dioxygenase-1 (IDO) activity—may influence vaccine response in this population. Methods We prospectively assessed AE, viremia by the YFV virus and YF-specific neutralizing antibodies (NAb) in HIV-infected (CD4>350) and -uninfected adults through 1 year after vaccination. The effect of HIV status on initial antibody response to YFV was measured during the first 3 months following vaccination, while the effect on persistence of antibody response was measured one year following vaccination. We explored CD4/CD8 ratio, IDO activity (plasma kynurenine/tryptophan [KT] ratio) and viremia by Human Pegivirus as potential predictors of NAb response to YFV among HIV-infected participants with linear mixed models. Results 12 HIV-infected and 45-uninfected participants were included in the final analysis. HIV was not significantly associated with AE, YFV viremia or NAb titers through the first 3 months following vaccination. However, HIV–infected participants had 0.32 times the NAb titers observed for HIV-uninfected participants at 1 year following YFV (95% CI 0.13 to 0.83, p = 0.021), independent of sex, age and prior vaccination. In HIV-infected participants, each 10% increase in CD4/CD8 ratio predicted a mean 21% higher post-baseline YFV Nab titer (p = 0.024). Similarly, each 10% increase in KT ratio predicted a mean 21% lower post-baseline YFV Nab titer (p = 0.009). Viremia by Human Pegivirus was not significantly associated with NAb titers. Conclusions HIV infection appears to decrease the durability of NAb responses to YFV, an effect that may be predicted by lower CD4/CD8 ratio or higher KT ratio. PMID:27941965

  18. Haemolytic anaemia in an HIV-infected patient with severe falciparum malaria after treatment with oral artemether-lumefantrine

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    Corpolongo Angela

    2012-03-01

    Full Text Available Abstract Intravenous (i.v. artesunate is now the recommended first-line treatment of severe falciparum malaria in adults and children by WHO guidelines. Nevertheless, several cases of haemolytic anaemia due to i.v. artesunate treatment have been reported. This paper describes the case of an HIV-infected patient with severe falciparum malaria who was diagnosed with haemolytic anaemia after treatment with oral artemether-lumefantrine. The patient presented with fever, headache, and arthromyalgia after returning from Central African Republic where he had been working. The blood examination revealed acute renal failure, thrombocytopaenia and hypoxia. Blood for malaria parasites indicated hyperparasitaemia (6% and Plasmodium falciparum infection was confirmed by nested-PCR. Severe malaria according to the laboratory WHO criteria was diagnosed. A treatment with quinine and doxycycline for the first 12 hours was initially administered, followed by arthemeter/lumefantrine (Riamet® for a further three days. At day 10, a diagnosis of severe haemolytic anaemia was made (Hb 6.9 g/dl, LDH 2071 U/l. Hereditary and autoimmune disorders and other infections were excluded through bone marrow aspiration, total body TC scan and a wide panel of molecular and serologic assays. The patient was treated by transfusion of six units of packed blood red cell. He was discharged after complete remission at day 25. At present, the patient is in a good clinical condition and there is no evidence of haemolytic anaemia recurrence. This is the first report of haemolytic anaemia probably associated with oral artemether/lumefantrine. Further research is warranted to better define the adverse events occurring during combination therapy with artemisinin derivatives.

  19. Forecast model for the evaluation of economic resources employed in the health care of patients with HIV infection

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    Sacchi P

    2012-05-01

    Full Text Available Paolo Sacchi1, Savino FA Patruno1, Raffaele Bruno1, Serena Maria Benedetta Cima1, Pietro Previtali2, Alessia Franchini2, Luca Nicolini3, Carla Rognoni4, Lucia Sacchi5, Riccardo Bellazzi4, Gaetano Filice11Divisione di Malattie Infettive e Tropicali - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; 2Università degli Studi di Pavia – Facoltà di Economia, Pavia, Italy; 3Controllo di Gestione Fondazione IRCCS Policlinico San Matteo di Pavia, Pavia, Italy; 4Dipartimento di Informatica e Sistemistica, Universita' degli Studi di Pavia, Pavia, Italy; 5Department of Information Systems and Computing, Brunel University, London, UKBackground and aims: The total health care cost for human immunodeficiency virus (HIV patients has constantly grown in recent years. To date, there is no information about how this trend will behave over the next few years. The aim of the present study is to define a pharmacoeconomic model for the forecast of the costs of a group of chronically treated patients followed over the period 2004–2009.Methods: A pharmacoeconomics model was built to describe the probability of transition among different health states and to modify the therapy over time. A Markov model was applied to evaluate the temporal evolution of the average cost. The health care resources exploited during hospitalization were analyzed by using an “activity-based costing” method.Results: The Markov model showed that the mean total cost, after an initial increase, tended to remain stable. A total of 20 clinical records were examined. The average daily cost for each patient was EUR 484.42, with a cost for admission of EUR 6781.88.Conclusion: The treatment of HIV infection in compliance with the guidelines is also effective from the payer perspective, as it allows a good health condition to be maintained and reduces the need and the costs of hospitalizations.Keywords: health care cost, HIV, Markov model, activity-based costing

  20. Improvement of endothelial function after switching previously treated HIV-infected patients to an NRTI-sparing bitherapy with maraviroc

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    Enrique Bernal

    2014-11-01

    Full Text Available Introduction: Nucleoside reverse transcriptase inhibitor (NRTI is associated with endothelial dysfunction and proinflammatory effects. Maraviroc (MVC is an antagonist of CCR5 receptor. CCR5 is the receptor of RANTES (Regulated on Activation, Normal T Cell Expressed and Secreted, a mediator of chronic inflammation and endothelial function. Our aim was to evaluate the maintenance of viral suppression and improvement of endothelial function in virologically suppressed HIV-infected patients switched to an NRTI-sparing combined antiretroviral therapy (cART with MVC. Materials and Methods: This observational, non-interventional, multicenter study was performed at the Infectious Diseases Service of Santa Lucia, Morales Meseguer, Virgen de la Arrixaca and Reina Sofía University Hospital (Murcia, Spain. The selection criteria were to be asymptomatic on a regimen with undetectable viral load (<50 HIV-RNA copies/mL for at least six months, no previous treatment with R5 antagonists, no evidence of previous protease inhibitor (PI failure and available R5 tropism test. Twenty-one HIV-infected patients were selected after the treatment regimen was changed to Maraviroc 150 mg/once daily plus ritonavir-boosted PI therapy. Endothelial function was prospectively evaluated through flow-mediated dilatation (FMD of the brachial artery at baseline and at weeks 24. Results: We included 21 patients on treatment with PI in combination with 2 NRTI. The mean cART exposition was 133±68.9 months. Fourteen (66.6% were males, aged 49±9 years, 15 (71.4% smokers, 4 (19.04% family history of coronary heart disease, 1 (5.76% type 2 diabetes and 3 (14.28% hypertensive, mean total cholesterol was 185.5±35 mg/dL, c-LDL 100.2±37 mg/dL, tryglicerides 170.42±92.03 mg/dL, cHDL 52.6±15.5 mg/dL, CD4 779,5±383.28 cells/mL, nadir CD4 187,96±96 cells/mL. After 24 weeks of follow-up of a switch to an NRTI-sparing regimen, 95.2% of HIV-patients on viral suppressive cART maintained

  1. Regional differences in use of antiretroviral agents and primary prophylaxis in 3122 European HIV-infected patients. EuroSIDA Study Group

    DEFF Research Database (Denmark)

    Lundgren, Jens Dilling; Phillips, A N; Vella, S;

    1997-01-01

    differences. In patients without esophageal candidiasis or other invasive fungal infections, antifungal drugs were far less frequently used in patients from southern and central Europe compared with patients from northern Europe (10%, 10%, and 25%, respectively, p ...Little is known about how widely HIV-related drugs are used outside controlled clinical trials. We therefore assessed factors associated with use of antiretroviral (ARV) therapy and primary prophylactic regimens to prevent HIV-associated opportunistic infections. Baseline data from a prospective...... study from May to August 1994, on 3122 consecutive HIV infected patients with a CD4 count

  2. Primary cutaneous plasmablastic lymphoma revealing clinically unsuspected HIV infection*

    Science.gov (United States)

    Marques, Silvio Alencar; Abbade, Luciana P. Fernandes; Guiotoku, Marcelo Massaki; Marques, Mariangela Esther Alencar

    2016-01-01

    Plasmablastic lymphoma is a rare subtype of diffuse large B-cell lymphoma more frequently diagnosed in immunosuppressed patients, mainly HIV-infected. Primary cutaneous plasmablastic lymphoma is extremely rare, and in this patient it was the first clinical manifestation of unsuspected HIV-infection. PMID:27579749

  3. Combination of anti-retroviral drugs and radioimmunotherapy specifically kills infected cells from HIV infected individuals

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    Dina Tsukrov

    2016-09-01

    Full Text Available Eliminating virally infected cells is an essential component of any HIV eradication strategy. Radioimmunotherapy (RIT, a clinically established method for killing cells using radiolabeled antibodies, was recently applied to target HIV-1 gp41 antigen expressed on the surface of infect-ed cells. Since gp41 expression by infected cells is likely down-regulated in patients on an-tiretroviral therapy (ART, we evaluated the ability of RIT to kill ART-treated infected cells us-ing both in vitro models and lymphocytes isolated from HIV-infected subjects. Human peripheral blood mononuclear cells (PBMCs were infected with HIV and cultured in the presence of two clinically relevant ART combinations. Scatchard analysis of the 2556 human monoclonal anti-body to HIV gp41 binding to the infected and ART-treated cells demonstrated sufficient residual expression of gp41 on the cell surface to warrant subsequent RIT. This is the first time the quantification of gp41 post-ART is being reported. Cells were then treated with Bismuth-213-labeled 2556 antibody. conjugated to the human monoclonal antibody 2556, which binds to HIV gp41. Cell survival was quantified by Trypan blue and residual viremia by p24 ELISA. Cell surface gp41 expression was assessed by Scatchard analysis. The experiments were repeated using PBMCs isolated from blood specimens obtained from 15 HIV-infected individuals: ten on ART and five ART-naive. We found that 213Bi-2556 killed ART-treated infected PBMCs and reduced viral production to undetectable levels. ART and RIT co-treatment was more effective at reducing viral load in vitro than either therapy alone, indicating that gp41 expression under ART was sufficient to allow 213Bi-2556 to deliver cytocidal doses of radiation to infected cells. This study provides proof of concept that 213Bi-2556 may represent an innovative and effective targeting method for killing HIV-infected cells treated with ART, and supports continued development of 213Bi

  4. High attrition among HIV-infected patients with advanced disease treated in an intermediary referral center in Maputo, Mozambique

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    Lucas Molfino

    2014-04-01

    Full Text Available Background: In Mozambique, antiretroviral therapy (ART scale-up has been successfully implemented. However, attrition in care remains a major programmatic challenge. In 2009, an intermediary-level HIV referral center was created in Maputo to ensure access to specialized care for HIV-infected patients with complications (advanced clinical-immunological stage, Kaposi sarcoma, or suspected ART failure. Objective: To determine the attrition from care and to identify risk factors that lead to high attrition among patients referred to an intermediary-level HIV referral center. Design: This was a retrospective cohort study from 2009 to 2011. Results: A total of 1,657 patients were enrolled, 847 (51% were men, the mean age was 36 years (standard deviation: 11, the mean CD4 count was 27 cells/µl (interquartile range: 11–44, and one-third were severely malnourished. The main reasons for referral were advanced clinical stages (WHO stages 3 and 4, and CD4 count <50 cells/µl in 70% of the cases, and 19% had Kaposi sarcoma. The overall attrition rate was 28.7 per 100 person-years (PYs – the mortality rate was 5.0 (95% confidence interval [CI]: 4.2–5.9 per 100 PYs, and the loss-to-follow-up rate was 23.7 (95% CI: 21.9–25.6 per 100 PYs. There were 793 attritions – 137 deaths and 656 lost to follow-up (LTFU; 77% of all attrition happened within the first year. The factors independently associated with attrition were male sex (adjusted hazard ratio [aHR]: 1.15, 95% CI: 1.0–1.3, low body mass index (aHR: 1.51, 95% CI: 1.2–1.8, WHO clinical stage 3 or 4 (aHR: 1.30, 95% CI: 1.0–1.6; and aHR: 1.91, 95% CI: 1.4–2.5, later year of enrollment (aHR 1.61, 95% CI 1.3–1.9, and ‘being already on ART’ at enrollment (aHR 13.71, 95% CI 11.4–16.4. Conclusions: Attrition rates among HIV-infected patients enrolled in an intermediary referral center were high, mainly related to advanced stage of clinical disease. Measures are required to address this

  5. In vitro activity of inexpensive topical alternatives against Candida spp. isolated from the oral cavity of HIV-infected patients.

    Science.gov (United States)

    Traboulsi, Rana S; Mukherjee, Pranab K; Ghannoum, Mahmoud A

    2008-03-01

    The use of inexpensive topical alternatives, e.g. oil of melaleuca (tea tree oil (TTO)), chlorhexidine (CHX), povidone iodine (PI) and gentian violet (GV), to treat oral candidiasis in human immunodeficiency virus (HIV)-infected patients has been proposed in resource-poor countries. However, pre-clinical studies comparing the antifungal activity of these agents are lacking. This study compared the minimal inhibitory concentrations (MICs) of TTO, GV, PI, CHX and fluconazole (FLZ) against 91 clinical Candida strains using Clinical and Laboratory Standard Institute (CLSI) methodology. Isolates were obtained from the oral cavity of acquired immune deficiency syndrome (AIDS) patients. Among the topical agents examined, GV showed the most potent activity against all Candida isolates tested (MIC range, MIC for 50% of the organisms (MIC(50)) and MIC for 90% of the organisms (MIC(90)) of 0.03-0.25 microg/mL, 0.06 microg/mL and 0.1 2microg/mL, respectively). CHX was 64 times less active than GV (MIC range, MIC(50) and MIC(90) of 0.5-16 microg/mL, 4 microg/mL and 8 microg/mL, respectively). The lowest antifungal activity was seen for PI (MIC(90)=0.25%). Moreover, GV, unlike the other topical agents tested, was fungicidal (minimum fungicidal concentration=1 microg/mL) against Candida albicans isolates (n=83). In addition, GV showed activity against FLZ-resistant C. albicans (n=3). The combination of GV and FLZ was not antagonistic and there was no interaction between the two compounds. GV possesses potent antifungal activity against FLZ-susceptible and -resistant Candida strains and is not antagonistic when used in combination with FLZ. In vivo evaluation is warranted.

  6. Tenofovir-induced acute kidney injury in HIV-infected patients in western India: a resource limited setting perspective

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    A Sadre

    2012-11-01

    Full Text Available Background and objective Tenofovir use in HIV positive patients is associated with 0.5–2.5% risk of acute kidney injury (AKI. Data on AKI due to tenofovir use in resource limited settings like India is sparse. Objective of this study is to determine incidence, risk factors and outcome of tenofovir-induced acute kidney injury (serum creatinine>2 mg/dl or creatinine clearance decrease by 50% compared to baseline in HIV infected patients attending tertiary level HIV clinic in Western India. Methods All patients enrolled at the clinic from 2009 to 2012 who were initiated on tenofovir-based ART and had regular follow up creatinine clearance values available were included in this retrospective observational cohort analysis. Patients already on tenofovir-based ART during enrollment were also included. Summary of results 512 patients were enrolled in the study with 70% being males. Average age of the cohort was 41 years, average body weight 56 kilograms and median baseline CD4 count 164 cells/mm3. Mean baseline creatinine clearance was 90 ml/min. Median duration of follow up was 26 months. Tenofovir-induced AKI developed in 25 patients (incidence 4.88 %. Median time to developing AKI was 6 months. On stopping tenofovir, 15 patients had complete recovery of renal function, 5 had partial recovery while 5 patients died. Hemodialysis as a treatment option was used in 3 patients. Age>50 yrs (p=0.001, baseline creatinine clearance<50 ml/min (p=0.0001, diabetes mellitus (p=0.0001, use of tenofovir with protease inhibitors (p=0.001, presence of renal calculus disease (p =0.0001 and use of concomitant nephrotoxic medications (p=0.001 were significantly associated with risk of tenofovir AKI on applying Pearson's Chi square test. Conclusions Incidence of tenofovir-induced AKI in our cohort is higher than previously reported and could be attributed to lower body weight, lower baseline creatinine clearance, higher incidence of advanced HIV disease and higher

  7. Immune reconstitution inflammatory syndrome in HIV-infected patients receiving antiretroviral therapy : pathogenesis, clinical manifestations and management

    DEFF Research Database (Denmark)

    Dhasmana, Devesh J; Dheda, Keertan; Ravn, Pernille;

    2008-01-01

    The use of antiretroviral therapy (ART) to treat HIV infection, by restoring CD4+ cell count and immune function, is associated with significant reductions in morbidity and mortality. Soon after ART initiation, there is a rapid phase of restoration of pathogen-specific immunity. In certain patien...

  8. INCIDENCE OF LYMPHOMAS AND OTHER CANCERS IN HIV-INFECTED AND HIV-UNINFECTED PATIENTS WITH HEMOPHILIA

    NARCIS (Netherlands)

    RABKIN, CS; HILGARTNER, MW; HEDBERG, KW; ALEDORT, LM; HATZAKIS, A; EICHINGER, S; EYSTER, ME; WHITE, GC; KESSLER, CM; LEDERMAN, MM; DEMOERLOOSE, P; BRAY, GL; COHEN, AR; ANDES, WA; MANCOJOHNSON, M; SCHRAMM, W; KRONER, BL; BLATTNER, WA; GOEDERT, JJ

    1992-01-01

    Objective. - To determine the types and rates of cancers occurring in excess in the presence of infection with the human immunodeficiency virus type 1 (HIV-1). Design. - Cohort analytic study of HIV-infected and HIV-uninfected subjects followed for up to 12 years. Setting. - Fifteen hemophilia treat

  9. Use of Pentamidine As Secondary Prophylaxis to Prevent Visceral Leishmaniasis Relapse in HIV Infected Patients, the First Twelve Months of a Prospective Cohort Study.

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    Ermias Diro

    Full Text Available Visceral leishmaniasis (VL has become an important opportunistic infection in persons with HIV-infection in VL-endemic areas. The co-infection leads to profound immunosuppression and high rate of annual VL recurrence. This study assessed the effectiveness, safety and feasibility of monthly pentamidine infusions to prevent recurrence of VL in HIV co-infected patients.A single-arm, open-label trial was conducted at two leishmaniasis treatment centers in northwest Ethiopia. HIV-infected patients with a VL episode were included after parasitological cure. Monthly infusions of 4 mg/kg pentamidine-isethionate diluted in normal-saline were started for 12 months. All received antiretroviral therapy (ART. Time-to-relapse or death was the primary end point.Seventy-four patients were included. The probability of relapse-free survival at 6 months and at 12 months was 79% and 71% respectively. Renal failure, a possible drug-related serious adverse event, occurred in two patients with severe pneumonia. Forty-one patients completed the regimen taking at least 11 of the 12 doses. Main reasons to discontinue were: 15 relapsed, five died and seven became lost to follow-up. More patients failed among those with a CD4+cell count ≤ 50 cells/μl, 5/7 (71.4% than those with counts above 200 cells/μl, 2/12 (16.7%, (p = 0.005.Pentamidine secondary prophylaxis led to a 29% failure rate within one year, much lower than reported in historical controls (50%-100%. Patients with low CD4+cell counts are at increased risk of relapse despite effective initial VL treatment, ART and secondary prophylaxis. VL should be detected and treated early enough in patients with HIV infection before profound immune deficiency installs.

  10. Intestinal parasitic infections in HIV infected and non-infected patients in a low HIV prevalence region, West-Cameroon.

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    Céline Nguefeu Nkenfou

    Full Text Available The magnitude of intestinal parasitic infection in acquired immunodeficiency syndrome patients requires careful consideration in the developing world where poor nutrition is associated with poor hygiene and several tropical diseases. However, there have been very few studies addressing this issue in Cameroon. This study was conducted to determine the prevalence of intestinal parasitosis in HIV/AIDS patients in Dschang -Cameroon. Stool and blood specimens from HIV/AIDS patients and control group were screened respectively for intestinal parasites and for HIV antibodies. Intestinal parasites were identified using direct microscopy, formalin-ether concentration and Ziehl Neelsen methods. Out of 396 participants recruited among patients consulting at hospital, 42 (10.6% were HIV positive, thirty of them treatment naïve. The overall prevalence of intestinal parasites was 14.64%. Out of 42 HIV/AIDS patients, 59.5% (25/42 were infected with intestinal parasites, while only 9.32% (33/354 of the HIV negative patients were infected with intestinal parasites. The parasites detected in our study population included Crystosporidium parvum (2.53%, Entamoeba histolytica (7.52%, Entamoeba coli (4.04%, Giardia lamblia (0.25%, Trichuris trichura (0.25%, Strongyloides stercoralis (0.25% and Taenia spp. (0.25%. In the HIV infected group, Crystosporidium parvum (19.04%, Entamoeba histolytica (19.04%, Entamoeba coli (21.42%, Giardia lamblia (2.38%, Strongyloides stercoralis (0.25% and Taenia spp. (0.25% were found. Crystosporidium parvum was found to be significantly higher in HIV/AIDS patients than in controls (P<0.05. Multivariate analysis showed that the HIV status and the quality of water were the major risk factors for intestinal parasitosis. Routine examinations of stool samples for parasites would significantly benefit the HIV patients by contributing in reducing morbidity and improving the efficiency of antiretroviral treatment. Even after the introduction

  11. Epidemiology and clinical characteristics of HIV-infected patients in Kuala Lumpur.

    Science.gov (United States)

    Cheong, I; Lim, A; Lee, C; Ibrahim, Z; Sarvanathan, K

    1997-12-01

    Between 1987 to 1995, a total of 334 patients infected with HIV were treated at the Hospital Kuala Lumpur. There were 159 Malays, 108 Chinese, 64 Indians, and 3 from other ethnic groups. Three hundred and twenty-one (96.1%) of these individuals were males and 262 (65.9%) were between the ages of 26-45 years. Intravenous drug users made up 77% (256) of the attributable risk behaviour from the group although many of them also had added risk behaviours like heterosexual activity with multiple partners (50 patients), tattoos (7 patients), homosexual practice (4 patients) and previous transfusions (3 patients). The others acquired their infection through heterosexual promiscuity (59 patients), homo/bisexual activity (7 patients), previous transfusion (5 patients) and tattoos (1 patient). Sixty-six patients (all males) had since progressed to full blown AIDS and 10 have died. The two commonest AIDS-defining events were tuberculosis infection and Pneumocystic carinii pneumonia occurring in 37 (56%) and 15 (22.7%) of patients respectively. Forty-one patients with AIDS presented for the first time with their AIDS-defining infections. The mean CD4 count of the patients when they progressed to AIDS was 130/mm3. The mean time for progression from "known" seropositivity to AIDS was 2.42 years. These results suggest that Malaysians infected with HIV are not coming forward for treatment until they are in the advanced stage of the disease.

  12. Pseudo-outbreak of pseudomonas aeruginosa in HIV-infected patients undergoing fiberoptic bronchoscopy

    DEFF Research Database (Denmark)

    Kolmos, H J; Lerche, A; Kristoffersen, Kirsten Lydia;

    1994-01-01

    Pseudomonas aeruginosa was isolated from bronchoalveolar lavage fluid from 8 consecutive patients undergoing bronchoscopy at an infectious diseases unit. None of the patients developed signs of respiratory tract infection that could be ascribed to the organism. The source of contamination...

  13. Bone marrow aspiration, biopsy, and culture in the evaluation of HIV-infected patients for invasive mycobacteria and histoplasma infections.

    Science.gov (United States)

    Akpek, G; Lee, S M; Gagnon, D R; Cooley, T P; Wright, D G

    2001-06-01

    Bone marrow (BM) aspiration and biopsy are used commonly in clinical practice to diagnose invasive tissue infections caused by Mycobacterium avium intracellulare (MAC), Mycobacterium tuberculosis (TB), and Histoplasma capsulatum (HC) in patients with human immunodeficiency virus-1 (HIV) infection. However, the value of these invasive procedures relative to other diagnostic approaches has not been clearly defined. To determine the value of BM culture and BM histology in the diagnosis of opportunistic MAC/TB and HC infections in immunosuppressed patients with HIV, we retrospectively reviewed the records of 56 adult patients with HIV who underwent a single BM aspiration, biopsy, and culture because of unexplained fever and/or other clinical features suggestive of MAC/TB or HC infection. Thirty-two patients (57%) were ultimately diagnosed with MAC/TB or HC infection by positive cultures of BM, blood, sputum, or bronchoalveolar lavage fluid or by the histologic detection of organisms in biopsies of BM or other tissues. The diagnostic sensitivity of BM cultures was equal to that of blood cultures (20/32, or 63%). Granuloma and/or histologically apparent organisms were seen in BM biopsy specimens in 11 of 32 individuals (34%) ultimately diagnosed with MAC/TB or HC infections. Among these 11 cases, both granuloma and acid-fast staining organisms were found in the BM biopsy specimens of 2 individuals for whom both BM and blood cultures were negative. Certain clinical symptoms and signs at the time of BM examination were found by logistic regression analysis to be significantly associated with a subsequent diagnosis of MAC/TB or HC infections; these included high fever, long duration of febrile days prior to BM examination, and elevated direct bilirubin. In conclusion, while the diagnostic sensitivity of BM cultures was found to be no greater than that of blood cultures in detecting MAC/TB or HC infections in immunosuppressed HIV+ patients, histopathologic examination of BM

  14. Relationship between T-SPOT.TB responses and numbers of circulating CD4+ T-cells in HIV infected patients with active tuberculosis.

    Science.gov (United States)

    Cai, Rentian; Chen, Jun; Guan, Liqian; Sun, Meiyan; Sun, Yang; Shen, Yinzhong; Zhang, Renfang; Liu, Li; Lu, Hongzhou

    2014-06-01

    This study sought to evaluate the performance of the T-SPOT.TB assay for the diagnosis of active tuberculosis (TB) in human immunodeficiency virus (HIV) infected patients. One hundred confirmed HIV-infected patients with active TB and known T-SPOT.TB and CD4+ T-cell counts were enrolled in this clinical retrospective study. We found that patients with lower CD4+ T-cell counts (11-50 cells/μL) had the lowest T-SPOT.TB positive rates (50%), and patients with higher CD4+ T-cell counts (50-100 cells/μL) had the highest T-SPOT.TB positive rates (75%). However, there were no significant differences between the T-SPOT.TB positive rates of patients with different CD4+ T-cell counts ( 100 cells/μL) (χ(2) = 3.7747, p = 0.287). The patients with positive TB culture results had significantly higher T-SPOT.TB positive rates (78.9%) than patients that were culture-negative (44.3%) (χ(2) = 12.8303, p SPOT.TB positive rates. The number of spot-forming cells (SFCs) reactive with ESAT-6, CFP-10 and ESAT-6/CFP-10-specific T cells detected by T-SPOT.TB were positively is strongly related to the degree of immunodeficiency, while the T-SPOT.TB positive rates are less dependent on the level of CD4+ T-cell depletion in HIV infection and active TB.

  15. Administration of a Toll-like receptor 9 agonist decreases the proviral reservoir in virologically suppressed HIV-infected patients.

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    Anni A Winckelmann

    Full Text Available Toll-like receptor (TLR agonists can reactivate HIV from latently infected cells in vitro. We aimed to investigate the TLR-9 agonist, CPG 7909's in vivo effect on the proviral HIV reservoir and HIV-specific immunity. This was a post-hoc analysis of a double-blind randomized controlled vaccine trial. HIV-infected adults were randomized 1:1 to receive pneumococcal vaccines with or without 1 mg CPG 7909 as adjuvant at 0, 3 and 9 months. In patients on suppressive antiretroviral therapy we quantified proviral DNA at 0, 3, 4, 9, and 10 months (31 subjects in the CPG group and 37 in the placebo-adjuvant group. Furthermore, we measured HIV-specific antibodies, characterized T cell phenotypes and HIV-specific T cell immunity. We observed a mean reduction in proviral DNA in the CPG group of 12.6% (95% CI: -23.6-0.0 following each immunization whereas proviral DNA in the placebo-adjuvant group remained largely unchanged (6.7% increase; 95% CI: -4.2-19.0 after each immunization, p = 0.02. Among participants with additional cryo-preserved PBMCs, HIV-specific CD8+ T cell immunity as indicated by increased expression of degranulation marker CD107a and macrophage inflammatory protein 1β (MIP1β tended to be up-regulated following immunization with CPG 7909 compared with placebo as adjuvant. Further, increasing proportion of HIV-specific CD107a and MIP1β-expressing CD8+ T cells were strongly correlated with decreasing proviral load. No changes were observed in T cell phenotype distribution, HIV-specific CD4+ T cell immunity, or HIV-specific antibodies. TLR9-adjuvanted pneumococcal vaccination decreased proviral load. Reductions in proviral load correlated with increasing levels of HIV specific CD8+ T cells. Further investigation into the potential effect of TLR9 agonists on HIV latency is warranted.

  16. Administration of a Toll-like receptor 9 agonist decreases the proviral reservoir in virologically suppressed HIV-infected patients.

    Science.gov (United States)

    Winckelmann, Anni A; Munk-Petersen, Lærke V; Rasmussen, Thomas A; Melchjorsen, Jesper; Hjelholt, Thomas J; Montefiori, David; Østergaard, Lars; Søgaard, Ole S; Tolstrup, Martin

    2013-01-01

    Toll-like receptor (TLR) agonists can reactivate HIV from latently infected cells in vitro. We aimed to investigate the TLR-9 agonist, CPG 7909's in vivo effect on the proviral HIV reservoir and HIV-specific immunity. This was a post-hoc analysis of a double-blind randomized controlled vaccine trial. HIV-infected adults were randomized 1:1 to receive pneumococcal vaccines with or without 1 mg CPG 7909 as adjuvant at 0, 3 and 9 months. In patients on suppressive antiretroviral therapy we quantified proviral DNA at 0, 3, 4, 9, and 10 months (31 subjects in the CPG group and 37 in the placebo-adjuvant group). Furthermore, we measured HIV-specific antibodies, characterized T cell phenotypes and HIV-specific T cell immunity. We observed a mean reduction in proviral DNA in the CPG group of 12.6% (95% CI: -23.6-0.0) following each immunization whereas proviral DNA in the placebo-adjuvant group remained largely unchanged (6.7% increase; 95% CI: -4.2-19.0 after each immunization, p = 0.02). Among participants with additional cryo-preserved PBMCs, HIV-specific CD8+ T cell immunity as indicated by increased expression of degranulation marker CD107a and macrophage inflammatory protein 1β (MIP1β) tended to be up-regulated following immunization with CPG 7909 compared with placebo as adjuvant. Further, increasing proportion of HIV-specific CD107a and MIP1β-expressing CD8+ T cells were strongly correlated with decreasing proviral load. No changes were observed in T cell phenotype distribution, HIV-specific CD4+ T cell immunity, or HIV-specific antibodies. TLR9-adjuvanted pneumococcal vaccination decreased proviral load. Reductions in proviral load correlated with increasing levels of HIV specific CD8+ T cells. Further investigation into the potential effect of TLR9 agonists on HIV latency is warranted.

  17. Immunological function restoration with lopinavir/ritonavir versus efavirenz containing regimens in HIV-infected patients: a randomized clinical trial.

    Science.gov (United States)

    Torres, Berta; Rallón, Norma I; Loncá, Montserrat; Díaz, Alba; Alós, Llucia; Martínez, Esteban; Cruceta, Anna; Arnaiz, Joan Albert; Leal, Lorna; Lucero, Constanza; León, Agathe; Sánchez, Marcelo; Negredo, Eugenia; Clotet, Bonaventura; Gatell, José M; Benito, José M; Garcia, Felipe

    2014-05-01

    CD4(+) count increase has been reported to be different with lopinavir/r (LPV/r) and efavirenz (EFV)-containing regimens. The different effect of these two regimens on other immune function parameters and the relationship with the gain of CD4(+) count have not been assessed in a randomized clinical trial. Fifty antiretroviral treatment (cART) naïve HIV-infected individuals were randomized to receive LPV/r or EFV both with tenofovir/emtricitabine for 48 weeks. A substudy of immunological function restoration was performed in 22 patients (LPV/r n=10 and EFV n=12). Activation, thymic function, apoptosis, senescence, exhaustion, Treg cells, interleukin (IL)-7-receptor/IL-7 system, thymic volume, and lymphoid tissue fibrosis were evaluated at baseline and at week 48. Both groups experienced a CD4(+) count increase that was higher in the EFV group (ΔCD4(+) 88 vs. 315 cells/μl LPV/r vs. EFV, respectively, p<0.001). Despite this difference in CD4(+) gain, the change in other immune function parameters was similar in both treatment groups. Most of parameters evaluated tended to normalize after 48 weeks of cART. A significant decrease in levels of activation, senescence, exhaustion, and apoptosis on CD4(+) and CD8(+) T cells (p<0.001 for all) and a significant increase in markers of thymic function, IL-7 receptor, and in the levels of central memory CD4(+) T cells and naive subsets of CD8(+) T cells (p<0.001 for all) with respect to baseline values were observed without any difference between groups. These data indicate that the differences in CD4(+) gain with different cART regimens are not immunologically meaningful and might explain the similar clinical efficacy of these regimens.

  18. Anal carcinoma in HIV-infected patients in the period 1995-2009

    DEFF Research Database (Denmark)

    Legarth, Rebecca Asbjørn; Helleberg, Marie; Kronborg, Gitte;

    2013-01-01

    Abstract Background: Several studies have demonstrated an increased risk of non-AIDS cancers in HIV patients and, for some cancers, also in relatives of HIV patients. We aimed to estimate (1) the risk of anal carcinoma among HIV patients and their parents, and (2) the mortality after a diagnosis...... 1995-2009, and (2) parents of HIV patients compared with parents of controls for the period 1978-2009. Cancer diagnoses were identified from The Danish Cancer Registry. We further estimated the mortality rate ratios (MRR) of HIV patients compared with controls after the diagnosis of anal carcinoma...... risk of anal carcinoma (IRR 7.4, 95% CI 1.4-38.3) compared to fathers of population controls. Mortality after diagnosis of anal carcinoma was increased in male HIV patients compared with the male control cohort (MRR 3.2, 95% CI 1.1-9.2). Conclusions: Danish HIV patients, especially MSM, have...

  19. Fever in hospitalized HIV-infected patients in Western French Guiana: first think histoplasmosis.

    Science.gov (United States)

    Vantilcke, Vincent; Boukhari, Rachida; Jolivet, Anne; Vautrin, Cyrille; Misslin, Caroline; Adenis, Antoine; Nacher, Mathieu

    2014-08-01

    In Western French Guiana, there was a dramatic increase in HIV prevalence between 1990 and 2000. The present study describes the causes of fever among HIV patients hospitalized in the medical ward of the only hospital in the western part of French Guiana. A retrospective descriptive study was conducted between 1 January 2008 and 30 June 2010 in the department of medicine of Saint Laurent du Maroni Hospital. The main characteristics of 67 patients having presented with fever in the first 48 hours of hospitalization were described. Among patients with CD4 histoplasmosis (41.1%). Among patients with CD4 counts histoplasmosis. Three patients died and all had disseminated histoplasmosis. Disseminated histoplasmosis is the most common febrile opportunistic infection in western French Guiana. Primary prophylaxis with itraconazole among immunocompromised patients seems warranted.

  20. Acceptance and tolerability of an adjuvanted nH1N1 vaccine in HIV-infected patients in the cologne-bonn cohort

    Directory of Open Access Journals (Sweden)

    Steffens B

    2011-07-01

    Full Text Available Abstract Objective To evaluate the acceptance and tolerability of the nH1N1 2009 vaccine in HIV-positive individuals. Method 758 patients were included in this prospective study. Different study populations were formed: The Tolerability Study Group consists of HIV-infected patients who visited three outpatient clinics (Cologne, Bonn, Freiburg during a predefined time period. Patients were offered nH1N1 vaccination. Those accepting were administered a standard dose AS03 adjuvant nH1N1 vaccine. Questionnaires to report side effects occurring within 7 days after immunization were handed out. In a substudy conducted during the same time period, acceptance towards immunization was recorded. This Acceptance Study Group consists of all HIV-infected patients visiting the Cologne clinic. They were offered vaccination. In case of refusal, motivation was recorded. Results In the Tolerability Study Group, a total of 475 patient diaries returned in the three study centres could be evaluated, 119 of those (25% reported no side effects. Distribution of symptoms was as follows: Pain 285/475 patients (60%, swelling 96 (20%, redness 54 (11%, fever 48/475 (10%, muscle/joint ache 173 (36%, headache 127 (27%, and fatigue 210 (44%. Association of side effects with clinical data was calculated for patients in Cologne and Bonn. Incidence of side effects was significantly associated with CDC stages A, B compared to C, and with a detectable viral load (> 50 copies/mL. No correlation was noted for CD4 cell count, age, gender or ethnicity. In the Acceptance Study Group, 538 HIV-infected patients were offered vaccination, 402 (75% accepted, while 136 (25% rejected. Main reasons for rejection were: Negative media coverage (35%, indecisiveness with preference to wait until a later date (23%, influenza not seen as personal threat (19% and scepticism towards immunization in general (10%. Conclusion A total of 622 HIV-infected patients were vaccinated against nH1N1-influenza in

  1. Clinical evolution of chronic renal patients with HIV infection in replacement therapy.

    Science.gov (United States)

    Saracho, Ramón; Martín Escobar, Eduardo; Comas Farnés, Jordi; Arcos, Emma; Mazuecos Blanca, Auxiliadora; Gentil Govantes, Miguel Ángel; Castro de la Nuez, Pablo; Zurriaga, Óscar; Ferrer Alamar, Manuel; Bouzas Caamaño, Encarnación; García Falcón, Teresa; Portolés Pérez, José; Herrero Calvo, José A; Chamorro Jambrina, Carlos; Moina Eguren, Íñigo; Rodrigo de Tomás, María Teresa; Abad Díez, José María; Sánchez Miret, José I; Alvarez Lipe, Rafael; Díaz Tejeiro, Rafael; Moreno Alía, Inmaculada; Torres Guinea, Marta; Huarte Loza, Enma; Artamendi Larrañaga, Marta; Fernández Renedo, Carlos; González Fernández, Raquel; Sánchez Álvarez, Emilio; Alonso de la Torre, Ramón

    2015-01-01

    Patients on renal replacement therapy (RRT) infected with the human immunodeficiency virus (HIV) are a special group with growing interest. In order to study the epidemiological data of HIV+ patients on RRT in Spain, we collected individual information from 2004-2011 (period of use of highly active antiretroviral therapy [HAART] in the Autonomous Communities of Andalusia, Aragon, Asturias, Catalonia, Valencia, Castilla la Mancha, Castilla León, Galicia, Madrid, La Rioja and the Basque Country, comprising 85% of the Spanish population. A total of 271 incident and 209 prevalent patients were analysed. They were compared with the remaining patients on RRT during the same period. The annual incidence was 0.8 patients per one million inhabitants, with a significant increase during the follow-up period. The proportion of prevalent HIV+ patients was 5.1 per 1,000 patients on RRT (95% confidence interval [CI] 4.4-5.8. Although glomerular diseases constituted the majority of cases (42%), diabetic nephropathy was the cause in 14% of patients. The nation-wide totals for these percentages were 13 and 25%, respectively. Compared to the total of patients in treatment, the risk of death was significantly higher in the HIV+ group: hazard ratio (HR) adjusted for age, sex and diabetes was 2.26 (95% CI 1.74 - 2.91). Hepatitis C coinfection increased the risk of death in the HIV+ group (HR 1.77; 95% CI 1.10 - 2.85). The probability of kidney transplantation in HIV+ was only 17% after 7 years, comparing with total RTT patients (HR 0.15; 95% CI: 0.10-0.24). Despite the use of HAART, the incidence of HIV+ patients on dialysis has increased; their mortality still exceeds non-HIV patients, and they have a very low rate of transplantation. It is necessary to further our knowledge of this disease in order to improve results.

  2. Multidrug-Resistant Tuberculosis: Long Term Follow-Up of 40 Non-HIV-Infected Patients

    Directory of Open Access Journals (Sweden)

    Monica Avendaño

    2000-01-01

    Full Text Available BACKGROUND: There has been a steady increase in referrals of patients with multidrug-resistant tuberculosis (MDR-TB who are human immunodeficiency virus (HIV negative. Between 1986 and 1999, 40 patients were admitted to the authors' institution, eight of whom were admitted between January and June 1999. The management of such individuals is difficult. Although they are a clinically and epidemiologically important group of patients, few reports detail their management.

  3. Evolution of cytokine profile during the treatment of cerebral toxoplasmosis in HIV-infected patients.

    Science.gov (United States)

    Meira, Cristina da Silva; Pereira-Chioccola, Vera Lucia; Vidal, José Ernesto; Motoie, Gabriela; Costa-Silva, Thaís Alves da; Gava, Ricardo

    2015-11-01

    This study was to follow IFN-γ, TNF-α and IL-10 modulation of peripheral blood mononuclear cells (PBMC) from HIV/cerebral toxoplasmosis patients (CT) during specific treatment. The results were compared with two other groups: HIV patients that had CT at least one year before (P/CT) and individuals with chronic toxoplasmosis (CHR). Blood samples (63) collected from three groups were analyzed. CT, 15 patients (3 blood samples collected one day before Toxoplasma gondii treatment; 7 and 15days during the treatment). P/CT, 5 patients (one blood sample collected at least, one year after the treatment). CHR, 13 individuals with chronic toxoplasmosis (one blood sample). Cytokine levels were assessed by ELISA after PBMC stimulation with T. gondii antigen. CT patients had low IFN-γ; discrete increase at 7th and 15th days; and the levels were recovered in cured patients (P/CT). CT patients had high TNF-α in the beginning of the treatment. TNF-α levels decrease during the treatment (7th and 15th) and in those patients who were treated (P/CT). IL-10 levels were almost similar in CT and P/CT groups but low when compared with CHR individuals. The evolution of the infection was correlated to restoration of IFN-γ response and a decrease of the inflammation. The evaluation of the immune response can provide valuable information and better monitoring of patients during specific treatment.

  4. The preliminary efficacy of interferon-α and ribavirin combination treatment of chronic hepatitis C in HIV-infected patients

    Institute of Scientific and Technical Information of China (English)

    ZHENG Yu-huang; ZHANG Chun-ying; HE Yan; ZHOU Hua-ying; ZOU Wen; DING Pei-pei; HUANG Li; LI Hui

    2005-01-01

    Background It is internationally accepted that in drug-nave individuals with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) co-infection, chronic hepatitis C should be treated first if the CD4 cell count does not require the initiation of anti-retroviral therapy. Present paper evaluated the clinical effect and side-effect of interferon-α (IFN-α) and ribavirin (RBV) combination therapy for Chinese patients with HCV-HIV co-infection, and compared with them for HIV infection alone. Methods Ten patients with HCV-HIV and 17 patients with HCV received 5 million unit IFNα-2b every other day intramuscularly, and 300 mg RBV triple daily by oral. Dynamic observations were made for HCV RNA and HIV RNA loads, CD4+ and CD8+ T lymphocyte counts, liver function and blood cell measurement, and the medicine side-effects. Results After 12-week and 24-week treatments of IFN-α and RBV combination therapy, mean HCV RNA levels reduced 1.14 logs and 1.56 logs from the baseline at week 0 in HCV-HIV co-infection, and reduced 1.48 logs and 1.75 logs in HCV infection, respectively. The HIV RNA levels decreased 1.22 logs and 1.32 logs from the base line; however, there were no obvious different changes at T lymphocyte counts of HCV-HIV and HCV patients through 24-week treatments. Whole 27 patients showed satisfactory biochemical response to therapy. There were some mild or mediate influence-like symptoms, intestinal uncomfortable and depressed blood cell counts in early stage of the treatments. No neuropsychiatric and auto-immune disorders were found. Conclusions IFN-α and RBV combination therapy had similar anti-HCV effects during 24-week treatment for HCV-HIV and HCV infected Chinese patients, and some anti-HIV effect. There were no obvious different biochemical responses and side-effects between two groups above.

  5. An update on clinical utility of rilpivirine in the management of HIV infection in treatment-naïve patients

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    Putcharoen O

    2013-09-01

    mutations that confer cross-resistance to other NNRTIs, including etravirine. Rilpivirine is currently available as a fixed-dose combination that allows for once-daily administration as a single pill, and is approved for use in treatment-naïve patients. This drug is contraindicated when co-administered with rifamycins or proton-pump inhibitors. Keywords: rilpivirine, HIV infection, treatment-naïve

  6. A randomized controlled trial of a web-based psychological intervention for patients under treatment for chronic HIV infection

    Directory of Open Access Journals (Sweden)

    L Skeie

    2012-11-01

    Full Text Available Purpose of the study: One of the most prevalent mental conditions in people with HIV is depression as uniquely characterized by low positive affect. This study examined the effect of a web-based intervention (Avanti on overall mood and depressive symptoms among patients with HIV infection. Methods: Patients treated with effective antiretroviral treatment were included in a two-armed trial with substance abuse as an exclusion criterion and randomized to Avanti (n=36 or control (n=31. Patients were surveyed at baseline, as well as 1 and 3 months after the initiation of a 5-week intervention period. Outcomes were Center for Epidemiological Studies-Depression scale and the Positive and Negative Affect Schedule which was combined into an overall mood index. Changes within groups were tested by Wilcoxon matched pairs test and baseline differences between groups by chi-square and Mann-Whitney independent samples test. Summary of results: Baseline scores for both groups were similar. However, patients in the intervention group had an improvement in median (M overall mood from baseline (M=67.6 to 1 month (M=71, p=0.02 which was also maintained from 1 to 3 months (M=71.9. Moreover, these patients had a favorable reduction in negative affect from 1 (M=24 to 3 months (M=22, p=0.01 and a transient improvement in positive affect from baseline (M=31.7 to 1 month after intervention onset (M=35, p<0.01 which almost returned to baseline levels at month 3 (M=32, p=0.01. In contrast, no significant changes were observed within the control group, except for a reduction in negative affect from 1 (M=23 to 3 months (M=21.6, p=0.05. Notably, symptoms of depression at baseline were low in both the Avanti (M=13 and control (M=12 groups, possibly explaining why no further reduction in depression was observed from baseline to 3 months in either of the two groups. Conclusions: The results of this study lend support to the promise of a web-based psychological intervention

  7. Species distribution and in vitro antifungal susceptibility of oral yeast isolates from Tanzanian HIV-infected patients with primary and recurrent oropharyngeal candidiasis

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    Rijs Antonius JMM

    2008-08-01

    Full Text Available Abstract Background In Tanzania, little is known on the species distribution and antifungal susceptibility profiles of yeast isolates from HIV-infected patients with primary and recurrent oropharyngeal candidiasis. Methods A total of 296 clinical oral yeasts were isolated from 292 HIV-infected patients with oropharyngeal candidiasis at the Muhimbili National Hospital, Dar es Salaam, Tanzania. Identification of the yeasts was performed using standard phenotypic methods. Antifungal susceptibility to fluconazole, itraconazole, miconazole, clotrimazole, amphotericin B and nystatin was assessed using a broth microdilution format according to the guidelines of the Clinical and Laboratory Standard Institute (CLSI; M27-A2. Results Candida albicans was the most frequently isolated species from 250 (84.5% patients followed by C. glabrata from 20 (6.8% patients, and C. krusei from 10 (3.4% patients. There was no observed significant difference in species distribution between patients with primary and recurrent oropharyngeal candidiasis, but isolates cultured from patients previously treated were significantly less susceptible to the azole compounds compared to those cultured from antifungal naïve patients. Conclusion C. albicans was the most frequently isolated species from patients with oropharyngeal candidiasis. Oral yeast isolates from Tanzania had high level susceptibility to the antifungal agents tested. Recurrent oropharyngeal candidiasis and previous antifungal therapy significantly correlated with reduced susceptibility to azoles antifungal agents.

  8. Computerized Information and Support for Patients with Breast Cancer or HIV Infection.

    Science.gov (United States)

    Rolnick, Sharon J.; Owens, Betta; Botta, Renee; Sathe, Laurie; Hawkins, Robert; Cooper, Leah; Kelley, Mary; Gustafson, David

    1999-01-01

    Use of the Comprehensive Health Enhancement Support System, a computerized information system, by patients with breast cancer or HIV was compared. Groups differed in the frequency of access and use of certain aspects (e.g., discussion groups). Identification of patient concerns provided useful information for system improvements. (SK)

  9. Non-typhoidal Salmonella group D bacteremia and urosepsis in a patient diagnosed with HIV Infection

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    Said Abuhasna

    2012-01-01

    Full Text Available Urinary tract infections caused by non-typhoid Salmonella are rare and usually develops in patients with predisposing factors such as immune deficiency or occult urologic problems. This report describes a case where Salmonella Group D was isolated from the blood and urine of a patient with documented human acquired immunodeficiency syndrome who developed urosepsis and was successfully treated with antibiotics.

  10. Non-typhoidal Salmonella group D bacteremia and urosepsis in a patient diagnosed with HIV Infection.

    Science.gov (United States)

    Abuhasna, Said; Al Jundi, Amer; Rahman, Masood Ur; Said, Walaa

    2012-10-01

    Urinary tract infections caused by non-typhoid Salmonella are rare and usually develops in patients with predisposing factors such as immune deficiency or occult urologic problems. This report describes a case where Salmonella Group D was isolated from the blood and urine of a patient with documented human acquired immunodeficiency syndrome who developed urosepsis and was successfully treated with antibiotics.

  11. ECIL guidelines for treatment of Pneumocystis jirovecii pneumonia in non-HIV-infected haematology patients

    DEFF Research Database (Denmark)

    Maschmeyer, Georg; Helweg-Larsen, Jannik; Pagano, Livio

    2016-01-01

    The initiation of systemic antimicrobial treatment of Pneumocystis jirovecii pneumonia (PCP) is triggered by clinical signs and symptoms, typical radiological and occasionally laboratory findings in patients at risk of this infection. Diagnostic proof by bronchoalveolar lavage should not delay...... and secondary anti-PCP prophylaxis is indicated in all patients thereafter. In patients with critical respiratory failure, non-invasive ventilation is not significantly superior to intubation and mechanical ventilation. The administration of glucocorticoids must be decided on a case-by-case basis....... the start of treatment. Most patients with haematological malignancies present with a severe PCP; therefore, antimicrobial therapy should be started intravenously. High-dose trimethoprim/sulfamethoxazole is the treatment of choice. In patients with documented intolerance to this regimen, the preferred...

  12. Assessing factors for loss to follow-up of HIV infected patients in Guinea-Bissau

    DEFF Research Database (Denmark)

    Nordentoft, Pernille Bejer; Engell-Sørensen, Thomas; Jespersen, Sanne

    2016-01-01

    to face or by phone by a field assistant and patients were asked why they had not shown up for the scheduled appointment. Patients were included by date of HIV testing and risk factors for LTFU were assessed using Cox proportional hazard model. Results: Among 561 patients (69.5 % HIV-1, 18.0 % HIV-2......Purpose: The objective of this study was to ascertain vital status of patients considered lost to follow-up at an HIV clinic in Guinea-Bissau, and describe reasons for loss to follow-up (LTFU). Methods: This study was a cross-sectional sample of a prospective cohort, carried out between May 15......, 2013, and January 31, 2014. Patients lost to follow-up, who lived within the area of the Bandim Health Project, a demographic surveillance site (DSS), were eligible for inclusion. Active follow-up was attempted by telephone and tracing by a field assistant. Semi-structured interviews were done face...

  13. Enhanced glucagon-like peptide-1 (GLP-1) response to oral glucose in glucose-intolerant HIV-infected patients on antiretroviral therapy

    DEFF Research Database (Denmark)

    Andersen, O; Haugaard, S B; Holst, Jens Juul;

    2005-01-01

    concentrations of GLP-1 and GIP were determined frequently during a 3-h, 75-g glucose tolerance test. Insulin secretion rates (ISRs) were calculated by deconvolution of C-peptide concentrations. RESULTS: The incremental area under the curve (incrAUC) for GLP-1 was increased by 250% in IGT patients compared...... with NGT patients (1455+/-422 vs. 409+/-254 pmol/L/180 min, respectively; PISR incr......, which may represent a compensatory mechanism rather than explain the IGT; (2) that the GIP response may be associated with ISR independently of plasma glucose in nondiabetic HIV-infected males on HAART....

  14. Epstein-Barr virus and human immunodeficiency virus serological responses and viral burdens in HIV-infected patients treated with HAART

    Science.gov (United States)

    O'Sullivan, Cathal E.; Peng, RongSheng; Cole, Kelly Stefano; Montelaro, Ronald C.; Sturgeon, Timothy; Jenson, Hal B.; Ling, Paul D.; Butel, J. S. (Principal Investigator)

    2002-01-01

    Epstein-Barr virus (EBV) associated non-Hodgkin lymphoma is recognized as a complication of human immunodeficiency virus (HIV) infection. Little is known regarding the influence of highly active antiretroviral therapy (HAART) on the biology of EBV in this population. To characterize the EBV- and HIV-specific serological responses together with EBV DNA levels in a cohort of HIV-infected adults treated with HAART, a study was conducted to compare EBV and HIV serologies and EBV DNA copy number (DNAemia) over a 12-month period after the commencement of HAART. All patients were seropositive for EBV at baseline. Approximately 50% of patients had detectable EBV DNA at baseline, and 27/30 had detectable EBV DNA at some point over the follow-up period of 1 year. Changes in EBV DNA copy number over time for any individual were unpredictable. Significant increases in the levels of Epstein-Barr nuclear antigen (EBNA) and Epstein-Barr early antigen (EA) antibodies were demonstrated in the 17 patients who had a good response to HAART. Of 29 patients with paired samples tested, four-fold or greater increases in titers were detected for EA in 12/29 (41%), for EBNA in 7/29 (24%), for VCA-IgG in 4/29 (14%); four-fold decreases in titers were detected in 2/29 (7%) for EA and 12/29 (41%) for EBNA. A significant decline in the titer of anti-HIV antibodies was also demonstrated. It was concluded that patients with advanced HIV infection who respond to HAART have an increase in their EBV specific antibodies and a decrease in their HIV-specific antibodies. For the cohort overall, there was a transient increase in EBV DNA levels that had declined by 12 months. Copyright 2002 Wiley-Liss, Inc.

  15. The prevalence and clinical significance of intestinal parasites in HIV-infected patients in Denmark

    DEFF Research Database (Denmark)

    Stensvold, Christen Rune; Nielsen, Susanne Dam; Badsberg, Jens Henrik;

    2011-01-01

    and enteropathogenic bacteria. Results of microbiological analyses were compared with self-reported gastrointestinal complaints collected using a validated questionnaire. Thirty-two (33%) patients were positive for parasites. However, opportunistic parasites (Isospora and Cryptosporidium) were detected in only 2...

  16. Highly active antiretroviral therapy and changing spectrum of liver diseases in HIV infected patients

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    Kavita S. Joshi

    2016-08-01

    Conclusions: Although hepatitis B and alcoholic liver disease are major causes of liver diseases in HIV patients in India, incidence of drug related hepato toxicities are increasing. [Int J Res Med Sci 2016; 4(8.000: 3125-3129

  17. Alterations of growth and nutritional status in HIV-infected pediatric patients

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    Lizbeth López-Mejía

    2014-08-01

    Conclusions: This study demonstrates the importance of nutritional intervention in patients with HIV. The HIV Clinic of Instituto Nacional de Pediatría should consider including a nutritionist as part of the multidisciplinary team.

  18. Adherence and Risk Behaviour in Patients with HIV Infection Receiving Antiretroviral Therapy in Bangkok.

    Science.gov (United States)

    Clarke, Amanda; Kerr, Stephen; Honeybrook, Adam; Cooper, David A; Avihingsanon, Anchalee; Duncombe, Chris; Phanuphak, Praphan; Ruxrungtham, Kiat; Ananworanich, Jintanat; Kaldor, John

    2012-01-01

    It could be postulated that due to lifestyle factors, patients with poor antiretroviral therapy (ART) adherence may also have risky sexual behaviour potentially leading to HIV transmission. There are limited data regarding unprotected sex risk and ART adherence in resource limited settings and our study set out to investigate these in an HIV clinic in Bangkok. Patients completed an anonymous questionnaire regarding their relationship details, ART adherence, sexual behaviour, alcohol and drug use and HIV transmission beliefs. Laboratory findings and medical history were also collected. Unprotected sex risk (USR) was defined as inconsistent condom use with a partner of negative or unknown HIV status. Five hundred and twelve patients completed the questionnaire. Fifty seven per cent of patients reported having taken ARV >95% of the time in the last month and 58% had been sexually active in the previous 30 days. Only 27 patients (5%) were classified as having USR in our cohort. Multivariate analysis showed USR was associated with female gender (OR 2.9, 95% CI 1.2-7.0, p0.02) but not with adherence, age, type or number of partners, recreational drug or alcohol use nor beliefs about HIV transmission whilst taking ART. Levels of USR in this resource limited setting were reassuringly low and not associated with poor ART adherence; as all USR patients had undetectable viral loads onward HIV transmission risk is likely to be low but not negligible. Nonetheless condom negotiation techniques, particularly in women, may be useful in this group.

  19. Risk factors for discordant immune response among HIV-infected patients initiating antiretroviral therapy: A retrospective cohort study

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    B P Muzah

    2012-11-01

    Full Text Available Background. The therapeutic goal of antiretroviral therapy (ART is sustained immune recovery and viral suppression. However, some patients experience poor CD4 cell count responses despite achieving viral suppression. Such discordant immune responses have been associated with poor clinical outcomes. Objective. We aimed to determine the prevalence of discordant immune response and explore associated factors in a retrospective cohort of patients attending 2 large public sector clinics, during the 6 months following ART initiation. Methods. Data were analysed from 810 HIV-infected adults initiated on first-line ART at 2 clinics in Johannesburg, between 1 November 2008 and 31 December 2009. Multivariate logistic regression models were used to estimate adjusted odds ratios (AORs to determine associations between discordant immune response and clinical and demographic factors. Results. At ART initiation, 65% (n=592 of participants were female, with a mean age of 38.5 years. Median baseline CD4 cell count was 155 cells/mm3, 70% (n=645 of patients had a haemoglobin level >11 g/dl and 88% (n=803 were initiated on stavudine-lamivudine-efavirenz/nevirapine (D4T-3TC-EFV/NVP. Six months after ART initiation, 24% (n=220 of patients had a discordant immune response and 7% (n=67 a discordant virological response. On multivariate analysis, baseline CD cell count ≥200 cells/mm3 (AOR 3.02; 95% confidence interval (CI 2.08 - 4.38; p<0.001 and moderate anaemia (8.0 - 9.4 g/dl at baseline (AOR 2.30; 95% CI 1.25 - 4.59; p=0.007 were independently associated with the development of discordant immune response, after adjustment for education level, World Health Organization (WHO clinical stage and ART regimen. Conclusions. Discordant immune response following ART initiation was common and associated with baseline anaemia and CD4 cell count in our cohort. Intensive monitoring of at-risk individuals may improve clinical outcomes.

  20. Anti-hepatitis B virus efficacy of tenofovir disoproxil fumarate in HIV-infected patients.

    Science.gov (United States)

    Benhamou, Yves; Fleury, Herve; Trimoulet, Pascale; Pellegrin, Isabelle; Urbinelli, Renaud; Katlama, Christine; Rozenbaum, Willy; Le Teuff, Gwenael; Trylesinski, Aldo; Piketty, Christophe

    2006-03-01

    Tenofovir disoproxil fumarate (TDF) has shown in vitro activity against both HIV and hepatitis B virus (HBV). We retrospectively evaluated the efficacy of TDF (300 mg/d), administered as a part of anti-retroviral therapy, in a large cohort of HIV/HBV-coinfected patients. Sixty-five HIV/HBV-coinfected patients who received TDF for at least 6 months with serum HBV DNA levels above 2.3 log10 copies/mL at TDF initiation and who had stored serum samples before and during TDF therapy were included. Serum HBV DNA was measured on stored samples. The median follow-up period was 12 (Q1-Q3: 8-17) months. Serum hepatitis B e antigen (HBeAg) was positive in 54 patients (83.1%). Fifty-two patients (80.0%) were receiving lamivudine (LAM) (150 mg twice a day), and 68.8% had documented LAM resistance at baseline. Among HBeAg-positive patients, the median reduction from baseline (8.17; Q1-Q3 = 7.30-8.30 log10 copies/mL) of serum HBV DNA was 4.56 log10 copies/mL (Q1-Q3 = 3.33-5.55) (P < .0001). In HBeAg-negative patients, serum HBV DNA decline from baseline (4.83; Q1-Q3 = 2.69-6.40 log10 copies/mL) was 2.53 log10 copies/mL (Q1-Q3 = 0.39-4.10). At the end of the study, HBV DNA became undetectable in 29.6% and 81.6% of the HBeAg-positive and HBeAg-negative patients, respectively. Serum HBeAg became negative in 4 patients, 2 of whom acquired serum hepatitis B e antibody. In conclusion, this retrospective analysis demonstrates the efficacy of TDF against wild-type, presumed precore mutants and LAM-resistant HBV when used as a part of anti-retroviral therapy in HIV-coinfected patients.

  1. [Tuberculosis and HIV infection in the Kaliningrad Region].

    Science.gov (United States)

    Kuz'min, O A; Turkin, E N; Nikitina, T N; Sergeeva, E G

    2005-01-01

    The first cases of tuberculosis in the HIV infected were notified in the Kaliningrad Region in 1997. A total of 254 HIV-infected persons fell ill with tuberculosis in 1997-2003. In the HIV infected, the number of new cases of tuberculosis increased by 9.9 times in 2003 as compared with 1997; their proportion among the first detected patients with tuberculosis was 8%. In 2003, the incidence of tuberculosis in the HIV infected was 20.7 times greater than that in the general population. In this year, the rates of death in the HIV infected from tuberculosis were 34.6 times higher than those in the general population. The course and outcomes of tuberculoses were followed up in 165 patients with HIV infection. The diagnostic features of tuberculosis are shown in end-stage HIV infection. The findings showed the low efficiency of treatment for tuberculosis in patients with comorbidity. The early detection and treatment of tuberculosis are of priority in antituberculous work among the HIV-infected persons.

  2. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients

    DEFF Research Database (Denmark)

    Lundgren, Jens

    2008-01-01

    BACKGROUND: Two nucleos(t)ide reverse transcriptase inhibitors (NRTIs)--abacavir and didanosine--may each be associated with excess risk of myocardial infarction. The reproducibility of this finding in an independent dataset was explored and plausible biological mechanisms were sought. METHODS......: Biomarkers, ischemic changes on the electrocardiogram, and rates of various predefined types of cardiovascular disease (CVD) events according to NRTIs used were explored in the Strategies for Management of Anti-Retroviral Therapy (SMART) study. Patients receiving abacavir and not didanosine were compared...... with those receiving didanosine, and to those receiving NRTIs other than abacavir or didanosine (other NRTIs). Patients randomly assigned to the continuous antiretroviral therapy arm of SMART were included in all analyses (N = 2752); for the study of biomarkers, patients from the antiretroviral therapy...

  3. Mayaro fever in an HIV-infected patient suspected of having Chikungunya fever.

    Science.gov (United States)

    Estofolete, Cássia Fernanda; Mota, Mânlio Tasso Oliveira; Vedovello, Danila; Góngora, Delzi Vinha Nunes de; Maia, Irineu Luiz; Nogueira, Maurício Lacerda

    2016-01-01

    Arboviruses impose a serious threat to public health services. We report a case of a patient returning from a work trip to the Amazon basin with myalgia, arthralgia, fever, and headache. During this travel, the patient visited riverside communities. Both dengue and Chikungunya fevers were first suspected, tested for, and excluded. Mayaro fever was then confirmed by reverse transcription polymerase chain reaction followed by next-generation sequencing and phylogenetic reconstruction. The increased awareness of physicians and consequent detection of Mayaro virus in this case was only possible due a previous surveillance program with specific health personnel training about these neglected arboviruses.

  4. Diagnostic Clues and Development of Immunodeficiency in Patients with HIV Infection in Nagano Prefecture

    OpenAIRE

    四本, 美保子; 北野, 喜良; 斎藤, 博

    2006-01-01

    Nagano ranks third in Japan in terms of the percentage of HIV-positive people in its population. We analysed the number of CD4+ T cells, the ratio of AIDS in HIV-positive people, diagnostic clues and the past histories in 125 patients who visited the AIDS base hospitals in Nagano from January 2001 to August 2005. 58.4% of patients had developed to AIDS when they were diagnosed as HIV positive.CD4+ T cells were below 200/μl in 64.8% and severe immunosupression (CD4+ T cells below 50/μl)was obs...

  5. Mayaro fever in an HIV-infected patient suspected of having Chikungunya fever

    Directory of Open Access Journals (Sweden)

    Cássia Fernanda Estofolete

    Full Text Available Abstract Arboviruses impose a serious threat to public health services. We report a case of a patient returning from a work trip to the Amazon basin with myalgia, arthralgia, fever, and headache. During this travel, the patient visited riverside communities. Both dengue and Chikungunya fevers were first suspected, tested for, and excluded. Mayaro fever was then confirmed by reverse transcription polymerase chain reaction followed by next-generation sequencing and phylogenetic reconstruction. The increased awareness of physicians and consequent detection of Mayaro virus in this case was only possible due a previous surveillance program with specific health personnel training about these neglected arboviruses.

  6. Oral and constitutional manifestations of HIV-infected hospital patients in Northern Vietnam

    DEFF Research Database (Denmark)

    Jensen, Tomas O; Tam, Vu V; Mai, Nguyen T

    2005-01-01

    This study reports clinical features, with emphasis on oral lesions and constitutional signs, of 170 patients in a regional hospital in northern Vietnam, of whom 56 were HIV positive. The purpose of the study was to investigate the relationship of oral hairy leukoplakia (OHL) and oropharyngeal...

  7. High prevalence of the metabolic syndrome in HIV-infected patients

    DEFF Research Database (Denmark)

    Worm, Signe Westring; Friis-Møller, Nina; Bruyand, Mathias

    2010-01-01

    This study describes the characteristics of the metabolic syndrome in HIV-positive patients in the Data Collection on Adverse Events of Anti-HIV Drugs study and discusses the impact of different methodological approaches on estimates of the prevalence of metabolic syndrome over time....

  8. Syphilis on the rise: A prolonged syphilis outbreak among HIV-infected patients in Northern Greece

    Science.gov (United States)

    Tsachouridou, Olga; Skoura, Lemonia; Christaki, Eirini; Kollaras, Panagiotis; Sidiropoulou, Eleni; Zebekakis, Pantelis; Vakirlis, Efstratios; Margariti, Apostolia; Metallidis, Symeon

    2016-01-01

    Introduction Sexually transmitted diseases (STDs) are a major public health issue in Europe. Numerous outbreaks of syphilis have been described recently and an increased prevalence of high-risk sexual practices has raised concern about the transmission of HIV and other STDs. Similarly, an increase in sexually transmitted infections has been recorded in Northern Greece. Methods This report describes a recent outbreak of syphilis in people living with HIV. The demographic, clinical, and serologic data of HIV patients diagnosed with syphilis were recorded and analyzed. Data on syphilis incidence from the general population was also compared to HIV patients’ data. Results Fifty-eight HIV-patients of the Infectious Diseases Unit of a tertiary hospital (5.2%) were diagnosed with syphilis during a three-year period (2008-2010). Highly active antiretroviral therapy (HAART) and coexistence of other STDs were independent predictors of syphilis (OR: 2.4, 95CI%: 1.26, 4.63, p=0.008; OR: 9.4, 95%CI: 4.49, 19.64, phomosexual contact (p=0.003), were separate risk factors for syphilis in the general population in the same area. Conclusion Diagnosis of a sexually transmitted disease in an HIV patient is a crucial clinical event that should trigger the clinician’s suspicion for high-risk sexual behavior. Sexual health assessments should be a routine process for HIV patients. PMID:27622160

  9. Intestinal parasitic infection in HIV infected patients with diarrhoea in Chennai

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    Kumar S

    2002-01-01

    Full Text Available PURPOSE: To determine the prevalence of intestinal parasites in HIV patients with and without diarrhoea in Chennai. METHODS: A total of 150 stool samples, 41 - acute diarrhoea, 59 - chronic diarrhoea and 50 control samples without diarrhoea were collected and examined for enteric parasites by microscopy. RESULTS: Enteric parasites were detected in 39% patients with diarrhoea compared to 14% in patients without diarrhoea. Isospora belli was found in 18.6% (11/59 of chronic diarrhoea and 7.3% (3/41 in acute diarrhoea (P > 0.2. Cryptosporidium was detected in 7 cases each in acute and chronic diarrhoea, which was statistically insignificant as compared to the control group (P >0.05. Microsporidia and Cyclospora cayetanensis associated diarrhoea were detected in only one chronic case each 1/59 (1.69 %. CONCLUSIONS: Isospora belli appeared to be a predominant parasite associated with diarrhoea among HIV patients. Detection rate of Microsporidia and Cyclospora was found to be very low.

  10. T Cell Subsets in HIV Infected Patients after Successful Combination Antiretroviral Therapy

    DEFF Research Database (Denmark)

    Rönsholt, Frederikke F; Ostrowski, Sisse Rye; Katzenstein, Terese Lea;

    2012-01-01

    Immune activation is decreased by combination antiretroviral therapy (cART) in patients infected with human immunodeficiency virus (HIV), but residual activation remains and has been proposed as a cause of premature aging and death, but data are lacking. We analyzed the relationship between T...

  11. Silent Ischemic Heart Disease and Pericardial Fat Volume in HIV-Infected Patients

    DEFF Research Database (Denmark)

    Kristoffersen, Ulrik S; Lebech, Anne-Mette; Wiinberg, Niels;

    2013-01-01

    to determine the prevalence of asymptomatic ischemic heart disease (IHD) in HIV patients by myocardial perfusion scintigraphy (MPS) and to determine the value of coronary artery calcium score (CACS), carotid intima-media thickness (cIMT) and pericardial fat volume as screening tools for detection...

  12. Lung fibrosis in deceased HIV-infected patients with Pneumocystis pneumonia

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    Erica J Shaddock

    2012-06-01

    Full Text Available Background. Pneumocystis pneumonia (PcP is one of the most common opportunistic infections found in patients with HIV. The prognosis if ventilation is required is poor, with mortality of 36 - 80%. Although more recent studies have shown improved survival, our experience has been that close to 100% of such patients die, and we therefore decided to investigate further. Methods. All patients with confirmed or suspected PcP who died owing to respiratory failure were eligible for the study. Where consent was obtained, trucut lung biopsies were performed post mortem, stored in formalin and sent for histopathological assessment. Results. Twelve adequate lung biopsies were obtained from 1 July 2008 to 28 February 2011 – 3 from men and 9 from women. The mean age was 34.7 years (range 24 - 46, and the mean admission CD4 count was 20.8 (range 1 - 68 cells/μl and median 18.5 cells/μl. All specimens demonstrated typical PcP histopathology; in addition, 9 showed significant interstitial fibrosis. Three had co-infection with cytomegalovirus (CMV, two of which had fibrosis present. There was no evidence of TB or other fungal infections. Conclusion. The high mortality seen in this cohort of PcP patients was due to intractable respiratory failure from interstitial lung fibrosis. whereas the differential includes ventilator induced lung injury, drug resistance or co-infections, we suggest that this is part of the disease progression in certain individuals. Further studies are required to identify interventions that could modify this process and improve outcomes in patients with PcP who require mechanical ventilation. S Afr J HIV Med 2012;13(2:64-67.

  13. In Vitro Antifungal Susceptibility of Oral Candida Species from Iranian HIV Infected Patients

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    A A Khaksar

    2012-05-01

    Full Text Available Background: Oropharyngeal candidiasis and antifungal drug resistance are major problems in HIV positive patients. The increased reports of antifungal resistance and expanding therapeutic options prompted the determination of antifungal susceptibility profile of Candida species isolates in Iranian patients living with HIV/AIDS (PLWHA in the present study. Methods: One hundred fifty oral samples from Iranian HIV positive patients were obtained and cultured on CHROMagar and Sabourauds dextrose agar. All isolates were identified according to assimilation profile, germ tube, colony color and other conventional methods. Disk diffusion testing and Broth Microdilution of six antifungal agents were performed according to the methods described in CLSI. Results: Candida albicans (50.2% was the most frequent isolated yeast, followed by C. glabrata (22%. Non-Candida albicans species were isolated from 71 (61% positive cultures. 25.7% of Candida albicans isolates were resistant to fluconazole (MIC≥64 µg/ml as were 21.9% and 16.4% to ketoconazole and clotrimazole (MIC>0.125 µg/ml, respectively. Resistance to polyene antifungals including amphotericin B and nystatin, and caspofungin were scarce. 57.7% of candida glabrata isolates were resistant to fluconazole, 31% to ketoconazole and 35% to clotrimazole. Conclusion: Screening for antifungal resistant candida isolates by disk diffusion or broth dilution methods in clinical laboratories is an ideal surveillance measure in the management of oral thrush in patients with HIV/AIDS. Although nystatin is widely used in clinical practice for HIV positive patients, there was no evidence of enhanced resistance to it. Regarding no resistance to caspofungin, its administration is suggested.

  14. The analysis of PCP in renal transplantation recipients and HIV-infected patients%HIV阳性PCP及肾移植术后PCP患者诊治分析

    Institute of Scientific and Technical Information of China (English)

    焦洋; 董宇超; 黄怡; 李强; 周道银

    2012-01-01

    目的 探讨HIV阳性PCP及肾移植术后PCP患者的临床特点.方法 对我院呼吸科收治的4例HIV阳性PCP及4例肾移植术后PCP患者的临床症状、影像学、治疗经过进行总结分析.结果 7例患者为男性,1例为女性,发热、无痰性咳嗽及气促是常见的临床表现.影像学主要表现为两肺弥漫性磨玻璃影.肾移植术后PCP患者的确诊时间小于HIV阳性PCP患者(P<0.05)、CRP及CD+4T淋巴细胞绝对值均高于HIV阳性PCP患者(P>0.05).结论 肾移植患者在术后半年内容易发生PCP.早期诊断,及时TMP-SMZ治疗,对疾病的预防和控制有重要作用.%Objective To investigate the clinical characteristics of pneumocystis carinii pneumonia ( PCP ) alter HIV-infected and renal transplantation patients. Methods The clinical data of four HIV-infected PCP and four renal transplantal PCP were analyzed, inclu ding the clinical profiles, immunological status, and chest radiological characteristics. Results Seven of the patients were men, and one was women. The most common clinical symptoms were level', cough without sputum and breathless, and the typical imaging finding was bi lateral diffuse ground glass opacities distributing in perihilar regions. Compared with HIV-infected patients, the number of white blood cell, neumophila and CD4+ T cell were higher in renal tiansplantal patients than that of HIV-infected ones with significant difference. Con clusion More and more PCP happens in HIV-negative patients because of the use of glucocorticoid and immunosuppressive agents. Early diagnosis and timely treatment of TMP-SMZ are important in treating the disease.

  15. Generalized psychological distress among HIV-infected patients enrolled in antiretroviral treatment in Dilla University Hospital, Gedeo zone, Ethiopia

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    Solomon H. Tesfaye

    2014-05-01

    Full Text Available Background: Psychological disorders like depression and anxiety are potentially dangerous conditions. In the context of HIV/AIDS, this can influence health-seeking behavior or uptake of diagnosis and treatment for HIV/AIDS, add to the burden of disease for HIV patients, create difficulty in adherence to treatment, and increase the risk of mortality and morbidity. The objective of this study was to assess the prevalence and correlates of generalized psychological distress among HIV-infected subjects on antiretroviral treatment (ART. Design: An institution-based cross-sectional study was conducted. Interviews were conducted with 500 patients initiating ART at Dilla Referral Hospital. Generalized psychological distress was measured using the Hospital Anxiety and Depression Scale (HADS. A cutoff score ≥19 was used to identify possible cases of patients with generalized psychological distress. Multivariable logistic regression analysis using SPSS Version 20 was performed to identify factors associated with psychological distress. Results: The prevalence of generalized psychological distress among the population of this study was 11.2% (HADS≥19. Factors independently associated with generalized psychological distress were moderate stress (OR=6.87, 95% CI 2.27–20.81, low social support (OR=10.17, 95% CI 2.85–36.29, number of negative life events of six and above (OR=3.99, 95% CI 1.77–8.99, not disclosing HIV status (OR=5.24, 95% CI 1.33–20.62, and CD4 cell count of <200 cells/mm3 (OR=1.98, 95% CI 0.45–0.83 and 200–499 cells/mm3 (OR=3.53, 95% CI 1.62–7.73. Conclusions: This study provides prevalence of psychological distress lower than the prevalence of common mental disorders in Ethiopia and comparable to some other studies in sub-Saharan Africa. The findings are important in terms of their relevance to identifying high-risk groups for generalized psychological distress and preventing distress through integrating mental health

  16. High-dose vitamin D3 supplementation is a requisite for modulation of skin-homing markers on regulatory T cells in HIV-infected patients.

    Science.gov (United States)

    Khoo, Ai-Leng; Koenen, Hans J P M; Michels, Meta; Ooms, Sharon; Bosch, Marjolein; Netea, Mihai G; Joosten, Irma; van der Ven, André J A M

    2013-02-01

    Vitamin D(3) is known to have an effect on the immune function. We investigated the immunomodulatory capability of vitamin D(3) in HIV-infected patients and studied the expression of chemokine receptors on regulatory T cells (Treg). Vitamin D(3)-deficient HIV-1-seropositive subjects were treated with cholecalciferol (vitamin D(3)) at a dose of 800 IU daily for 3 months (n=9) or 25,000 IU weekly for 2 months (n=7). Peripheral blood mononuclear cells (PBMCs) were isolated and analyzed for skin-homing (CCR4 and CCR10) and gut-homing (CCR9 and integrin α(4)β(7)) marker expression on Treg, by flow cytometry, before and after supplementation. Serum 25(OH)D(3) and parathyroid hormone (PTH) levels were determined at baseline and after the treatment period. Weekly doses of 25,000 IU cholecalciferol effectively achieved the optimal target serum 25(OH)D(3) concentration of >75 nmol/liter (30 ng/ml) in HIV-infected patients. High-dose cholecalciferol supplementation differentially influenced skin-homing markers on Treg with an increased level of CCR10 expression and while a reduction in CCR4 expression level was observed together with a lower percentage of Treg expressing CCR4. For both dosing regimens, there were no significant differences in the expression of gut-homing markers, CCR9, and integrin α(4)β(7). High-dose vitamin D(3) supplementation is needed to reverse vitamin D(3) deficiency in HIV-infected individuals and this results in modulation of skin-homing markers but not gut-homing markers expression on Treg. At a standard dose of 800 IU/day, vitamin D(3) is not effective in achieving an optimal 25(OH)D(3) concentration in patients with an underlying T cell dysfunction and is unable to exert any immunomodulatory effects.

  17. Immunovirological Efficacy of Once-Daily Maraviroc Plus Ritonavir-Boosted Atazanavir After 48 Weeks in Naive HIV-Infected Patients.

    Science.gov (United States)

    Pulido, Ildefonso; Genebat, Miguel; Alvarez-Rios, Ana I; De Pablo-Bernal, Rebeca S; Rafii-El-Idrissi Benhnia, Mohammed; Pacheco, Yolanda M; Ruiz-Mateos, Ezequiel; Leal, Manuel

    2016-10-01

    Toxicities related to the use of nucleoside analogues have increased the interest in developing nucleoside-sparing regimens, mainly combining protease inhibitors with raltegravir. However, data regarding the use of CCR5-antagonists in this setting and in the naive scenario are scarce. The main objective was to analyze the immunovirological efficacy and tolerability of a low-dose, once-daily, maraviroc (MVC)-containing, nucleoside reverse transcriptase inhibitor-sparing dual therapy compared with standard triple therapy after 48 weeks for naive HIV-infected patients in the routine clinical practice setting. All naive HIV-infected patients with stable clinical condition that started antiretroviral treatment since February 1, 2008 to May 30,h 2012 were included. MVC clinical test was used to select candidate subjects to MVC therapy. Thirty-two subjects with MVC + atazanavir/ritonavir (ATV/r) and 66 with standard triple therapy were analyzed. A comparable virological efficacy between groups was found after 48 weeks (87.5% vs. 80.3% of HIV undetectability, p = 0.37, MVC + ATV/r and triple therapy groups, respectively). The CD4 recovery after 48 weeks was similar and more than 200 cells/mm(3) in both groups. No need of therapy changes or treatment discontinuations was observed in the MVC + ATV/r group. Effect on lipid profile, high-sensitivity C reactive protein, and β2-microglobulin was similar for both groups. Noteworthy, a significant increase of erythrocyte mean corpuscular volume was observed only in the triple therapy group. A nucleoside-sparing MVC-containing dual therapy showed similar immunovirological efficacy and tolerability than standard triple therapy in naive HIV-infected patients.

  18. Microscopic observation drug susceptibility assay for the diagnosis of TB and MDR-TB in HIV-infected patients: a systematic review and meta-analysis.

    Science.gov (United States)

    Wikman-Jorgensen, Philip; Llenas-García, Jara; Hobbins, Michael; Ehmer, Jochen; Abellana, Rosa; Gonçalves, Alessandra Queiroga; Pérez-Porcuna, Tomàs Maria; Ascaso, Carlos

    2014-10-01

    The objective of the present study was to assess the diagnostic accuracy of the microscopic observation drug susceptibility (MODS) assay for tuberculosis (TB) diagnosis in HIV-infected patients. MEDLINE, EMBASE, LILACS, the Cochrane Central Register of Controlled Trials, African Index Medicus, ResearchGate, SciELO, and the abstracts of the main conferences on infectious diseases and tropical medicine were searched, and other sources investigated. Only studies including HIV-infected patients evaluating MODS for the diagnosis of TB and using culture-based diagnostic tests as a gold standard were analysed. Summary sensitivity and specificity were calculated with a bivariate model. 3259 citations were found, 29 were selected for full-text review and 10 studies including 3075 samples were finally analysed. Overall diagnostic accuracy of MODS for the diagnosis of TB was a sensitivity of 88.3% (95% CI 86.18-90.2%) and specificity 98.2% (95% CI 97.75-98.55%). For multidrug-resistant (MDR)-TB, sensitivity was 89% (95% CI 66.07-97%) and specificity was 100% (95 CI 94.81-100%). For smear-negative pulmonary TB, a sensitivity of 88.2% (95% CI 86.1-89.9%) and specificity of 98.2% (95% CI 96.8-98.9%) were found. Costs varied between USD 0.72 and 7.31 per sample. Mean time to positivity was 8.24 days. MODS was found to have a good accuracy for the diagnosis of TB and MDR-TB in HIV-infected patients with low cost and fast results.

  19. New and emerging agents in the management of lipodystrophy in HIV-infected patients

    Directory of Open Access Journals (Sweden)

    Eric Bonnet

    2010-09-01

    Full Text Available Eric BonnetService des Maladies Infectieuses, Hôpital Purpan, Toulouse, FranceAbstract: Lipodystrophy remains a major long-term complication in human immunodeficiency virus-infected patients under antiretroviral (ARV therapy. Patients may present with lipoatrophy or lipohypertrophy or both. The choice of treatments to improve fat redistribution depends on the form of lipodystrophy and its duration. Measures known to improve lipoatrophy are switches in ARV therapy (stavudine or zidovudine to abacavir or tenofovir and filling interventions. Pioglitazone may be added to these measures, although any benefits appear small. Uridine and leptin were found to be disappointing so far. Regarding lipohypertrophy, diet and exercise, recombinant human growth hormone, and metformin may reduce visceral fat, but may worsen subcutaneous lipoatrophy. Surgical therapy may be required. Attractive pharmacologic treatments include growth hormone-releasing factor and leptin. Adiponectin and adiponectin receptors are promising therapeutic targets to explore.Keywords: lipoatrophy, lipohypertrophy, lipodystrophy, treatment, HIV, AIDS

  20. Schistosomiasis-induced squamous cell bladder carcinoma in an HIV-infected patient

    DEFF Research Database (Denmark)

    Marbjerg, Lis Høy; Øvrehus, Anne Lindebo Holm; Johansen, Isik Somuncu

    2015-01-01

    The burden of Schistosoma haematobium-associated bladder cancer is very high in Africa; nevertheless the disease can pose considerable diagnostic challenges in low prevalence countries. We present the case of a 40-year-old HIV co-infected woman, originally from Mozambique, who had persisting...... haematuria for more than a year. Investigations revealed invasive S. haematobium-associated squamous cell bladder cancer. If her origin had been taken into account, the diagnosis might have been made earlier. Awareness of the disease prevalence among HIV co-infected patients from endemic areas and timely...... screening of such patients is important for the early diagnosis of schistosomiasis and related complications, such as S. haematobium-associated squamous cell bladder cancer....

  1. Clinical outcome among HIV-infected patients starting saquinavir hard gel compared to ritonavir or indinavir

    DEFF Research Database (Denmark)

    Kirk, O; Mocroft, A; Pradier, C;

    2001-01-01

    OBJECTIVE: To compare the clinical response among patients who initiate protease inhibitor therapies with different virological potency. DESIGN: We analysed patients who started indinavir, ritonavir or saquinavir hard gel capsule (hgc) as part of at least triple therapy during prospective follow.......62--1.11); P = 0.20. CONCLUSIONS: Saquinavir hgc was associated with an inferior long-term clinical response relative to indinavir, which was consistent with the observed differences in virological and immunological responses.......-up within the EuroSIDA study. METHODS: Changes in plasma viral load (pVL) and CD4 cell count from baseline were compared between treatment groups. Time to new AIDS-defining events and death were compared in Kaplan--Meier models, and Cox models were established to further assess differences in clinical...

  2. Granulomatous hypophysitis by Mycobacterium gordonae in a non HIV-infected patient

    Directory of Open Access Journals (Sweden)

    José Luis Ruiz-Sandoval

    2009-12-01

    Full Text Available Lymphocytic or granulomatous hypophysitis is a rare entity with a difficult diagnosis. Our objective was to report a patient with non-tuberculous granulomatous hypophysitis. An HIV-negative 45-year old man with confusional state, subacute ophthalmoplegia, and clinical and laboratory findings of panhypopituitarism was seen in the emergency unit. A cranial MRI showed a sellar mass suggestive of hypophysitis. After an unsuccessful attempt with steroids and antituberculous drugs the patient died. Post-mortem histopathology revealed granulomatous lesions and restriction fragment length polymorphism analysis confirmed the presence of Mycobacterium gordonae’s DNA. In conclusion, we should consider granulomatous hypophysitis in the differential diagnosis of non-secreting hypophyseal tumors. The etiology of a pituitary granuloma by a non-tuberculous mycobacteria is best reached by histopathological techniques and molecular assays. The optimal therapy is yet to be established.

  3. Prevalence and correlates of alcohol dependence disorder among TB and HIV infected patients in Zambia.

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    Rebecca O'Connell

    Full Text Available To determine the prevalence and correlates of alcohol dependence disorders in persons receiving treatment for HIV and Tuberculosis (TB at 16 Primary Health Care centres (PHC across Zambia.649 adult patients receiving treatment for HIV and/or TB at PHCs in Zambia (363 males, 286 females were recruited between 1st December 2009 and 31st January 2010. Data on socio-demographic variables, clinical disease features (TB and HIV, and psychopathological status were collected. The Mini International Neuropsychiatric Interview (MINI was used to diagnose alcohol dependence disorder. Correlates of alcohol dependence were analyzed for men only, due to low prevalence in women. Univariable and multivariable logistic regression models were used to estimate odds ratios (OR and 95% confidence intervals (CI, using general estimating equations to allow for within-PHC clustering.The prevalence of alcohol dependence was 27.2% (95%CI: 17.7-39.5% for men and 3.9% (95%CI: 1.4-0.1% for women. Factors associated with alcohol dependence disorder in men included being single, divorced or widowed compared with married (adjusted OR = 1.47, 95%CI: 1.00-2.14 and being unemployed (adjusted OR=1.30, 95%CI: 1.01-1.67. The highest prevalence of alcohol dependence was among HIV-test unknown TB patients (34.7%, and lowest was among HIV positive patients on treatment but without TB (14.1%, although the difference was not statistically significant (p=0.38.Male TB/HIV patients in this population have high prevalence of alcohol dependence disorder, and prevalence differs by HIV/TB status. Further work is needed to explore interventions to reduce harmful drinking in this population.

  4. Prevalence and Factors Associated with Renal Dysfunction Among HIV-Infected Patients

    Science.gov (United States)

    2010-01-01

    diseased uring the pre-HAART period was largely a result of HIV-associated nephropathy (HIV AN), which was associated with African American ethnicity...Hypertension was defined as a blood pressure greater than 140/90mm Hg on at least two of any three prior clinic visits, by a physician diagnosis , or...by early 1-DV diagnosis and treabnent, may be important components of preventing future kidney disease among HIV patients; further studies are

  5. Successful Treatment of Uncomplicated Gonococcal Urethritis in HIV-Infected Patients with Single-Dose Oral Cefpodoxime

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    George Psevdos

    2010-01-01

    Full Text Available Fluoroquinolones are no longer recommended for the treatment of gonococcal infections in the United States. Cephalosporins – ceftriaxone and cefixime – are the treatment of choice, as suggested by the Centers for Disease Control and Prevention (USA. There are limited data on the efficacy of cefpodoxime for the treatment of uncomplicated gonococcal infections. Two cases of HIV-infected homosexual men who were successfully treated with cefpodoxime for urethritis caused by Neisseria gonorrhoeae are described in the present study.

  6. Insulin secretion in lipodystrophic HIV-infected patients is associated with high levels of nonglucose secretagogues and insulin resistance of beta-cells

    DEFF Research Database (Denmark)

    Haugaard, Steen B; Andersen, Ove; Storgaard, Heidi

    2004-01-01

    We examined whether plasma concentrations of nonglucose insulin secretagogues are associated with prehepatic insulin secretion rates (ISR) in nondiabetic, insulin-resistant, human immunodeficiency virus (HIV)-infected, lipodystrophic patients (LIPO). Additionally, the negative feedback of insulin...... of insulin on beta-cells and an increased stimulation of ISR by FFA, alanine, triglyceride, and glucagon.......%), and clamp insulin (32%), all P alanine, and glucagon (all r > 0.65, P ..., and glucose (all r > 0.41, P alanine. In LIPO, ISRclamp correlated significantly with clamp free fatty acids (FFA), alanine, triglyceride, and glucagon (all r > 0.51, P

  7. Schistosomiasis-induced squamous cell bladder carcinoma in an HIV-infected patient

    DEFF Research Database (Denmark)

    Marbjerg, Lis Høy; Øvrehus, Anne Lindebo Holm; Johansen, Isik Somuncu

    2015-01-01

    The burden of Schistosoma haematobium-associated bladder cancer is very high in Africa; nevertheless the disease can pose considerable diagnostic challenges in low prevalence countries. We present the case of a 40-year-old HIV co-infected woman, originally from Mozambique, who had persisting...... haematuria for more than a year. Investigations revealed invasive S. haematobium-associated squamous cell bladder cancer. If her origin had been taken into account, the diagnosis might have been made earlier. Awareness of the disease prevalence among HIV co-infected patients from endemic areas and timely...

  8. The palliative care needs of patients with stage 3 and 4 HIV infection

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    C Jameson

    2008-01-01

    Conclusions : Medical problems with poor symptom control were the commonest problems, followed by socioeconomic issues related to no income, poor living conditions and fears for the future of their children. Spiritual and psychological issues were surprisingly less of a problem possibly because the immediacy and severity of the demands of day-to-day survival. As a result of the needs identified among these patients, it became apparent that a palliative care ward catering to these needs was needed. The guiding principles in the development of this ward were the need for privacy, for a teamwork approach and for meticulous medical care, all of which underpin good palliative care.

  9. Plasma and Intracellular Antiretroviral Concentrations in HIV-Infected Patients under Short Cycles of Antiretroviral Therapy

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    Laura Zehnacker

    2014-01-01

    Full Text Available Study of plasma and intracellular concentrations of atazanavir, lopinavir, nevirapine, and efavirenz was conducted on 48 patients under short cycles of antiretroviral therapy. Intracellular concentrations (IC were still measurable for all drugs after 85 h or 110 h drug intake despite the absence of drug in plasma for atazanavir and lopinavir. A linear relationship between plasma and intracellular efavirenz was observed. Further studies to fully understand the impact of IC in the intermittent antiviral treatment are required.

  10. [Opportunistic diseases in HIV-infected patients at the Jeanne Ebori Foundation in Libreville, Gabon].

    Science.gov (United States)

    Okome-Nkoumou, M; Boguikouma, J B; Kombila, M

    2006-04-01

    The purpose of this study was to determine the frequencies of opportunistic diseases among AIDS patients at the Jeanne Ebori Foundation (JEF) in Libreville, Gabon. A total 6313 file of patients treated in the internal medicine unit between 1994 and 1998 were analyzed. Findings showed that the main diseases related to AIDS classified according to seroprevalence were as follows: purigo (100%), cerebral toxoplasmosis (100%), oral candidiaisis (88%), bacteremia (87.8%), shingles (84.6%), minor salmonelosis (72%), and tuberclosis. The main diagnoses unrelated to AIDS at the JEF according to seroprevalene were typhoid (9.4%), common pneumonia (28%), bacterial meningitis (26.3%, hepatitis B (20.0%), and malaria (14%). In addition to these diseases there were nine cases of Kaposi's sarcoma, four cases of isosporosis, two cases of cryptococcosis, two cases of herpes Varicella, one case of cryptosporidiosis, and one case of isosporosis. The incidence of opportunistic disease was high in our study and must be taken in drug procurement.

  11. Vanishing Lung Syndrome in a Patient with HIV Infection and Heavy Marijuana Use

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    Basheer Tashtoush

    2014-01-01

    Full Text Available Vanishing lung syndrome (VLS is a rare and distinct clinical syndrome that usually affects young men. VLS leads to severe progressive dyspnea and is characterized by extensive, asymmetric, peripheral, and predominantly upper lobe giant lung bullae. Case reports have suggested an additive role of marijuana use in the development of this disease in young male tobacco smokers. We herein report a case of a 65-year-old Hispanic male previously diagnosed with severe emphysema and acquired immune deficiency syndrome (AIDS, with a history of intravenous heroin use and active marijuana smoking who presents to the emergency department with severe progressive shortness of breath he was found to have multiple large subpleural bullae occupying more than one-third of the hemithorax on chest computerized tomography (CT, characteristic of vanishing lung syndrome. The patient was mechanically ventilated and later developed a pneumothorax requiring chest tube placement and referral for surgical bullectomy. Surgical bullectomy has shown high success rates in alleviating the debilitating symptoms and preventing the life threatening complications of this rare syndrome. This case further emphasizes the importance of recognizing VLS in patients with severe emphysema and heavy marijuana smoking.

  12. Bladder cancer in HIV-infected adults: an emerging concern?

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    Sylvain Chawki

    2014-11-01

    Full Text Available Introduction: As HIV-infected patients get older more non-AIDS-related malignancies are to be seen. Cancer now represents almost one third of all causes of deaths among HIV-infected patients (1. Albeit bladder cancer is one of the most common malignancy worldwide (2, only 13 cases of bladder cancer in HIV-infected patients have been reported in the literature so far (3. Materials and Methods: We conducted a monocentric study in our hospital. We selected all patients who were previously admitted (from 1998 to 2013 in our hospital with diagnoses of HIV and bladder cancer. The objective was to assess the prevalence and characteristics of bladder cancers in HIV-infected patients in our hospital. Results: Based on our administrative HIV database (6353 patients, we found 15 patients (0.2% with a bladder cancer. Patients’ characteristics are presented in Table 1. Patients were mostly men and heavy smokers. Their median nadir CD4 cell count was below 200 and most had a diagnosis of AIDS. A median time of 14 years was observed in those patients, between the diagnosis of HIV-infection and the occurrence of bladder cancer, although in patients much younger (median age 56 than those developing bladder cancer without HIV infection (71.1 years (4. Haematuria was the most frequent diagnosis circumstance in HIV-infected patients who had relatively preserved immune function on highly active antiretroviral therapy (HAART. Histopathology showed relatively advanced cancers at diagnosis with a high percentage of non transitional cell carcinoma (TCC tumor and of TCC with squamous differentiation, suggesting a potential role for human papilloma virus (HPV co-infection. Death rate was high in this population. Conclusions: Bladder cancers in HIV-infected patients remain rare but occur in relatively young HIV-infected patients with a low CD4 nadir, presenting with haematuria, most of them being smokers, and have aggressive pathological features that are associated with

  13. Relationship of long-term highly active antiretroviral therapy on salivary flow rate and CD4 Count among HIV-infected patients

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    J Vijay Kumar

    2015-01-01

    Full Text Available Objectives: To determine if long-term highly active antiretroviral therapy (HAART therapy alters salivary flow rate and also to compare its relation of CD4 count with unstimulated and stimulated whole saliva. Materials and Methods: A cross-sectional study was performed on 150 individuals divided into three groups. Group I (50 human immunodeficiency virus (HIV seropositive patients, but not on HAART therapy, Group II (50 HIV-infected subjects and on HAART for less than 3 years called short-term HAART, Group III (50 HIV-infected subjects and on HAART for more than or equal to 3 years called long-term HAART. Spitting method proposed by Navazesh and Kumar was used for the measurement of unstimulated and stimulated salivary flow rate. Chi-square test and analysis of variance (ANOVA were used for statistical analysis. Results: The mean CD4 count was 424.78 ΁ 187.03, 497.82 ΁ 206.11 and 537.6 ΁ 264.00 in the respective groups. Majority of the patients in all the groups had a CD4 count between 401 and 600. Both unstimulated and stimulated whole salivary (UWS and SWS flow rates in Group I was found to be significantly higher than in Group II (P < 0.05. Unstimulated salivary flow rate between Group II and III subjects were also found to be statistically significant (P < 0.05. ANOVA performed between CD4 count and unstimulated and stimulated whole saliva in each group demonstrated a statistically significant relationship in Group II (P < 0.05. There were no significant results found between CD4 count and stimulated whole saliva in each groups. Conclusion:The reduction in CD4 cell counts were significantly associated with salivary flow rates of HIV-infected individuals who are on long-term HAART.

  14. Size controlled biogenic silver nanoparticles as antibacterial agent against isolates from HIV infected patients

    Science.gov (United States)

    Suganya, K. S. Uma; Govindaraju, K.; Kumar, V. Ganesh; Dhas, T. Stalin; Karthick, V.; Singaravelu, G.; Elanchezhiyan, M.

    2015-06-01

    Silver nanoparticles (AgNPs) are synthesized using biological sources due to its high specificity in biomedical applications. Herein, we report the size and shape controlled synthesis of AgNPs using the aqueous extract of blue green alga, Spirulina platensis. Size, shape and elemental composition of AgNPs were characterized using UV-vis spectroscopy, Fluorescence spectroscopy, FT-IR (Fourier Transform-Infrared Spectroscopy), FT-RS (Fourier Transform-Raman Spectroscopy), SEM-EDAX (Scanning Electron Microscopy-Energy Dispersive X-ray analysis) and HR-TEM (High Resolution Transmission Electron Microscopy). AgNPs were stable, well defined and monodispersed (spherical) with an average size of 6 nm. The synthesized AgNPs were tested for its antibacterial potency against isolates obtained from HIV patients.

  15. Acute myocardial infarction associated with anabolic steroids in a young HIV-infected patient.

    Science.gov (United States)

    Varriale, P; Mirzai-tehrane, M; Sedighi, A

    1999-07-01

    The use and abuse of anabolic-androgenic steroids have increased over the past decade and pose a medical and public health problem. In addition to their use by athletes to increase muscle mass and improve performance, people with wasting and malignant diseases are finding that the agents improve both their physical appearance and strength. Unfortunately, anabolic steroids are associated with a number of adverse effects, not the least of which is acute myocardial infarction, which occurred in a 39-year-old man with human immunodeficiency virus infection. It is important for clinicians to be aware of the association and to counsel patients carefully about this and other untoward effects that may occur with the agents.

  16. Focal Epithelial Hyperplasia in Adult Patients With HIV Infection: Clearance With Topical Imiquimod.

    Science.gov (United States)

    Méndez-Flores, Silvia; Esquivel-Pedraza, Lilly; Hernández-Salazar, Amparo; Charli-Joseph, Yann; Saeb-Lima, Marcela

    2016-01-01

    Case 1 A 41-year-old man with human immunodeficiency virus (HIV) 1 diagnosed 16 years prior to his consultation was referred for an 8-month history of multiple painless lumps in his mouth. He had A2 status (CD4 cell count of 273 cells/mm(3) and viral load of 43,000 copies/L) and was taking treatment with lamivudine/zidovudine (combivir) and efavirenz. Physical examination showed multiple small mucosal-colored and lobulated papulonodules located in the palate and lower gingiva and a whitish verrucous plaque on the lower labial mucosa (Figure 1a). The lesions were diagnosed clinically as focal epithelial hyperplasia (FEH) and further confirmed by classical histopathological findings (Figure 1b). He had previously received unspecified treatment; thus, topical 5% imiquimod cream was initiated every night. Mild erosion and ulceration developed in the upper labial mucosa, which were managed with lubrication (petrolatum ointment). After 2 weeks, all of the small lesions disappeared and the largest plaque resolved 1 week later (Figure 1c). A small residual mass in the area of biopsy, suggesting a scar, remained on the lower lip. The area was removed surgically and corresponded to fibrosis histologically, with no evidence of human papillomavirus (HPV) infection. CD4 cell count (694 cells/mm(3)) and viral load (<40 copies/L) did not show remarkable changes after imiquimod administration. No serious side effects were observed and the patient has remained free of disease after 1 year of follow-up.

  17. Immunologic treatment failure among HIV-infected adult patients in Jiangsu province, China

    Science.gov (United States)

    Qiu, Tao; Ding, Ping; Fu, Gengfeng; Huan, Xiping; Xu, Xiaoqin; Zhang, Zhi; Liu, Xiaoyan; Yang, Haitao; Mandel, Jeff; Wei, Chongyi; McFarland, Willi; Yan, Hongjing

    2017-01-01

    The National Free Antiretroviral Treatment Program was implemented in Jiangsu Province, China in 2005. We conducted a retrospective, open cohort study to determine treatment failure rates and associated risk factors. Data were obtained from the national web-based antiretroviral treatment database. WHO criteria were used to define immunologic treatment failure. Kaplan-Meier methods were used to determine treatment failure rates and Cox proportional hazards modeling was used to identify risk factors. A total of 5,083 (87.8%) having at least one CD4 cell count measure were included from 2005 to 2013. Overall, 30.4% had immunologic treatment failure with cumulative treatment failure rates increasing to 50.5% at month 60 and 64.1% at month 90. Factors predicting treatment failure included being treated in the Centers for Disease Control and Prevention system (HR 1.69, 95% CI 1.14–2.50, p = 0.009) or jail hospital (HR 1.20, 95% CI 1.08–1.34, p = 0.001), and having a baseline CD4 count >350 cells/uL (HR 2.37, 95% CI 1.94–2.89. p HIV patients. Providing second-line regimens and shifting treatment providers to professional hospitals should be considered to consolidate gains in averting morbidity and mortality. PMID:28220792

  18. STUDY OF VAGINAL INFECTIONS, CERVICAL CYTOLOGY AND PREVALENCE OF MENSTRUAL PROBLEMS IN HIV INFECTED PATIENTS

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    Balvin Kaur

    2015-07-01

    Full Text Available OBJECTIVE: To study vaginal infections, cervical cytology and prevalence of menstrual problems in HIV seropositive patients. METHODS: Study D esign: hospital based non - randomized prospective observational study. Study Type: case control study. SAMPLE SIZE: 130 cases & 100 contols. INCLUSION CRITERIA: All married women in the age group of 20 - 55 yrs. Cases were taken from the seropositive women register ed at the ART C entre willing to participate. Controls were HIV seronegative women attending gynaecology OPD. RESULTS: Out of the 130 cases, 78.4% were on ART & 21.5% were not on ART. In the present study, 87.09% of cases had abnormal Pap smear results comp ared to 29.09% of controls. 20% of cases had SILs compared to 8.18% of controls. Low grade intraepithelial lesions were 4.56 times more prevalent in cases. In the present study, it was found that 44.4% of SILs were found in cases with CD4 cell count <200/μ l. When studied for lower reproductive tract infections, 54.6% of cases had LRTIs compared to 30% of controls. The most common infection was candidiasis, found in 20% cases vs . 10% controls. CONCLUSION: The present study has shown that the prevalence of Pa p smear abnormalities & LRTIs is higher in HIV seropositive women. Hence, periodic gynaecological testing, Pap smear examination & vaginal swab testing should be done in HIV seropositive women to provide timely treatment & early identification of risk fact ors of malignancy.

  19. CD8 T-cells from most HIV-infected patients lack ex vivo HIV-suppressive capacity during acute and early infection.

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    Camille Lécuroux

    Full Text Available The strong CD8+ T-cell-mediated HIV-1-suppressive capacity found in a minority of HIV-infected patients in chronic infection is associated with spontaneous control of viremia. However, it is still unclear whether such capacities were also present earlier in the CD8+ T cells from non controller patients and then lost as a consequence of uncontrolled viral replication. We studied 50 patients with primary HIV-1-infection to determine whether strong CD8+ T-cell-mediated HIV suppression is more often observed at that time. Despite high frequencies of polyfunctional HIV-specific CD8+ T-cells and a strong CD4+ T-helper response, CD8+ T-cells from 48 patients lacked strong HIV-suppressive capacities ex vivo. This indicates that the superior HIV-suppressive capacity of CD8+ T-cells from HIV controllers is not a general characteristic of the HIV-specific CD8+ T cell response in primary HIV infection.

  20. High prevalence of the simultaneous excretion of polyomaviruses JC and BK in the urine of HIV-infected patients without neurological symptoms in São Paulo, Brazil

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    Luiz Henrique da Silva Nali

    2012-08-01

    Full Text Available OBJECTIVE: To evaluate the prevalence of the urinary excretion of BKV and JCV in HIV-infected patients without neurological symptoms. METHODS: Urine samples from HIV-infected patients without neurological symptoms were tested for JC virus and BK virus by PCR. Samples were screened for the presence of polyomavirus with sets of primers complementary to the early region of JCV and BKV genome (AgT. The presence of JC virus or BK virus were confirmed by two other PCR assays using sets of primers complementary to the VP1 gene of each virus. Analysis of the data was performed by the Kruskal-Wallis test for numerical data and Pearson or Yates for categorical variables. RESULTS: A total of 75 patients were included in the study. The overall prevalence of polyomavirus DNA urinary shedding was 67/75 (89.3%. Only BKV DNA was detected in 14/75 (18.7% urine samples, and only JCV DNA was detected in 11/75 (14.7% samples. Both BKV and JCV DNA were present in 42/75 (56.0% samples. CONCLUSION: In this study we found high rates of excretion of JCV, BKV, and simultaneous excretion in HIV+ patients. Also these results differ from the others available on the literature.

  1. Adequacy of the Oral Environment Through the Atraumatic Restoration Treatment in HIV Infected Pediatric Patients

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    Pierangelo Ruffier PAGANI

    2007-03-01

    Full Text Available Objective: To describe the procedures done in children infected with the HIV and to assess the effectiveness of care of the oral cavity by comparison of the levels of Streptococcus mutans and Lactobacillus. Method: Consisted of the sealing of cavities, instructing oral hygiene, supervising and improving the brushing techniques already in use, nutritional counseling for children and their caretakers, and fluoride therapy. Outpatient children from de immunology department of the University Hospital Gafrée e Guinle (UNI-RIO were selected for this study. Children had different levels of immunosupression categorized as severe (50.0%, moderate (33.0% and none (17.0%. Results: The results demonstrated that all children had salivary flow below 0,7ml/min. As for the counting of S. mutans and Lactobacillus, 33.0% kept the same numbers found in the first colonies/ml count. This was due to the presence of radicular remains which constitute an ideal medium for the proliferation of such organisms. There was a decrease in the number of colonies/ml in 67.0% of the children when the second count was made. Conclusion: The procedures carried out were effective in diminishing the number of colonies/ml of S. Mutans and Lactobacilli in the mouths of the target population, thus improving their health. This research intends to present with a protocol description in the odontological care of pediatric patients infected with the HIV and suggests that new studies with a larger population in order to confirm the findings.