26
|
Pivetti-Pezzi P, Tamburi S, Accorinti M, Mezzaroma I, Vullo V, Sorice F, Aiuti F. Immunological and Viral Markers of Hiv Infection and Retinal Microangiopathy. Eur J Ophthalmol 2018; 3:138-42. [PMID: 8106027 DOI: 10.1177/112067219300300306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The relationship between retinal microangiopathy and some features of human immunodeficiency virus (HIV) infection such as HIV antigenemia, antibodies to the viral proteins, T lymphocyte subsets, were studied in 71 patients with acquired immunodeficiency syndrome (AIDS). The absence of antibodies to the HIV p24 protein was significantly related to retinal microangiopathy (p = 0.0051) and more closely to retinal cotton-wool spots (p = 0.0007); the combination of positive antigenemia with the absence of antibodies to p24, which is typical of the later phases of HIV infection, was found in a larger percentage of patients with cotton-wool spots (p = 0.0013) than in subjects with every sign of microangiopathy (p = 0.0546). T-helper (CD4+) cells count below 200 cells/mm3 was also detected in a higher percentage of patients with HIV-related retinal microangiopathy (p = 0.009). These findings suggest that retinal microangiopathy and especially retinal cotton-wool spots are related to the progression of immunodeficiency.
Collapse
|
27
|
Deng C, Li Y, Li Y. [Systemic review: the accuracy of lactic dehydrogenase in the diagnosis of pneumocystis pneumonia]. ZHONGHUA WEI ZHONG BING JI JIU YI XUE 2018; 30:322-326. [PMID: 29663992 DOI: 10.3760/cma.j.issn.2095-4352.2018.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To study the accuracy of lactic dehydrogenase (LDH) in the diagnosis of pneumocystis pneumonia (PCP). METHODS The data of this systemic review was retrieved from the PubMed, China Biology Medicine disc, Wanfang, Weipu and China National Knowledge Infrastructure (CNKI) databases from establishment till to October 31st, 2017. Case-control studies about the diagnosis of PCP were enrolled. Enrolled studies were required that patients in case group ware PCP and patients in control group were lung diseases other than PCP. The QUADAS tool was used to evaluate the quality of studies. The RevMan 5.3 software was used to draw a forest plot. The StataMP 14 software was used to make subgroup analyses by drawing receiver operator characteristic (SROC) curves for the whole group, the acquired immune deficiency syndrome (AIDS) group, and the not all-AIDS group, and calculating their diagnostic odds ratio (DOR) and 95% confidential interval (95%CI). RESULTS Thirteen studies, all in English, were included. There were 825 patients in the case group, in which 650 patients were AIDS. There were 1 341 patients in control group, in which 888 patients were AIDS and most of them were Pulmonary Kaposi Sarcoma, bacterial pneumonia, pulmonary tuberculosis etc. Although there were different positive values of LDH in different studies, from 200 U/L to 598 U/L, sensitivities were good, especially in AIDS patients all values were above 80% (80%-100%). The specificities had big fluctuations, from 6% to 85%, which made them poor. The DOR (95%CI) of LDH in PCP diagnosis of all patients, AIDS patients and not-all AIDS patients were 6.73 (3.19-14.21), 9.17 (3.79-22.18) and 5.07 (1.30-19.80) respectively. CONCLUSIONS The sensitivity of LDH in the diagnosis of PCP is high, especially in AIDS group. In practice if LDH is negative, there should be more evidences to support the treatment of PCP.
Collapse
|
28
|
Latini A, Zaccarelli M, Paglia MG, Donà MG, Giglio A, Moretto D, Vulcano A, Giuliani M, Colafigli M, Ambrifi M, Pimpinelli F, Cristaudo A. Inguinal and anorectal Lymphogranuloma Venereum: a case series from a sexually transmitted disease center in Rome, Italy. BMC Infect Dis 2017; 17:386. [PMID: 28577539 PMCID: PMC5455085 DOI: 10.1186/s12879-017-2484-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/22/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by L1, L2, L3 serovars of C. trachomatis (CT). Since 2003, LGV cases have been increasing in Europe. Aim of this report is to describe the LGV cases diagnosed in the largest STI center in Rome, Italy, from 2000 to 2016. This report shows that two clinically and epidemiologically different series of cases exist, and that, at present, the ano-rectal LGV represents the clinical variant occurring more frequently among men having sex with men (MSM), particularly those HIV-infected. CASE PRESENTATION Ten cases of LGV were observed. Three were diagnosed in 2009 in HIV-negative heterosexuals patients that presented the classical genito-ulcerative form with lymphadenopathy. Seven cases were observed in 2015-2016 in HIV-infected MSM, that presented the rectal variant and L2b serovar infection; 4 of these had been misclassified as a chronic bowel disease. Chlamydia infection was confirmed by CT-specific PCR (ompA gene nested PCR), followed by sequence analysis to identify the serovar. All the patients were treated with doxycycline for 3 weeks, obtaining a complete response with healing of both clinical symptoms and dermatological lesions. CONCLUSIONS Our findings suggest that, in case of persistent rectal symptoms in HIV-infected MSM, LGV should be taken into account and investigated through molecular analyses, in order to achieve a correct diagnosis and management of the patients.
Collapse
|
29
|
Cassim N, Schnippel K, Coetzee LM, Glencross DK. Establishing a cost-per-result of laboratory-based, reflex Cryptococcal antigenaemia screening (CrAg) in HIV+ patients with CD4 counts less than 100 cells/μl using a Lateral Flow Assay (LFA) at a typical busy CD4 laboratory in South Africa. PLoS One 2017; 12:e0171675. [PMID: 28166254 PMCID: PMC5293213 DOI: 10.1371/journal.pone.0171675] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 01/24/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Cryptococcal meningitis is a major cause of mortality and morbidity in countries with high HIV prevalence, primarily affecting patients whose CD4 are < = 100 cells/μl. Routine Cryptococcal Antigen (CrAg) screening is thus recommended in the South African HIV treatment guidelines for all patients with CD4 counts < = 100 cells/μl, followed by pre-emptive anti-fungal therapy where CrAg results are positive. A laboratory-based reflexed CrAg screening approach, using a Lateral Flow Assay (LFA) on remnant EDTA CD4 blood samples, was piloted at three CD4 laboratories. OBJECTIVES This study aimed to assess the cost-per-result of laboratory-based reflexed CrAg screening at one pilot CD4 referral laboratory. METHODS CD4 test volumes from 2014 were extracted to estimate percentage of CD4 < = 100 cells/μl. Daily average volumes were derived, assuming 12 months per/year and 21.73 working days per/month. Costing analyses were undertaken using Microsoft Excel and Stata with a provider prospective. The cost-per-result was estimated using a bottom-up method, inclusive of test kits and consumables (reagents), laboratory equipment and technical effort costs. The ZAR/$ exchange of 14.696/$1 was used, where applicable. One-way sensitivity analyses on the cost-per-result were conducted for possible error rates (3%- 8%, reductions or increases in reagent costs as well as test volumes (ranging from -60% to +60%). RESULTS The pilot CD4 laboratory performed 267000 CD4 tests in 2014; ~ 9.3% (27500) reported CD4< = 100 cells/μl, equivalent to 106 CrAg tests performed daily. A batch of 30-tests could be performed in 1.6 hours, including preparation and analysis time. A cost-per-result of $4.28 was reported, with reagents contributing $3.11 (72.8%), while technical effort and laboratory equipment overheads contributed $1.17 (27.2%) and $0.03 (<1%) respectively. One-way sensitivity analyses including increasing or decreasing test volumes by 60% revealed a cost-per-result range of $3.84 to $6.03. CONCLUSION A cost-per-result of $4.28 was established in a typical CD4 service laboratory to enable local budgetary cost projections and programmatic cost-effectiveness modelling. Varying reagent costs linked to currency exchange and varying test volumes in different levels of service can lead to varying cost-per-test and technical effort to manage workload, with an inverse relationship of higher costs expected at lower volumes of tests.
Collapse
|
30
|
Streltsova OS, Krupin VN, Yunusova KE, Mamonov MV. [Tuberculosis of the prostate]. UROLOGIIA (MOSCOW, RUSSIA : 1999) 2016:128-131. [PMID: 28248057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Genitourinary tract is the second most common site where extrapulmonary tuberculosis (TB) occurs. Genitourinary TB is notable for a latent clinical course and difficult diagnosis. The paper presents clinical observations of two patients treated in a urology department of a general public hospital. One of them was diagnosed with tuberculosis of the prostate, MTB+. In the other, TB of the prostate was suspected based on pathologic assessment of the surgical specimen after surgery for prostate cancer.
Collapse
|
31
|
Boivin MJ, Ruisenor-Escudero H, Familiar-Lopez I. CNS Impact of Perinatal HIV Infection and Early Treatment: the Need for Behavioral Rehabilitative Interventions Along with Medical Treatment and Care. Curr HIV/AIDS Rep 2016; 13:318-327. [PMID: 27783207 PMCID: PMC5107125 DOI: 10.1007/s11904-016-0342-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
There is growing concern that although the more severe forms of HIV-associated neurologic deficits are reduced following highly active anti-retroviral therapy (HAART), mild to moderate cognitive disorders may persist for years after HAART initiation and this may occur despite complete plasma viral suppression. According to the UNAIDS 2014 report, there were 3.2 million children living with HIV around the world at the end of 2013 and 91 % of these resided in sub-Saharan Africa. In the same year, only 24 % of children who needed antiretroviral treatment (ART) received it and 190,000 children died of AIDS-related illnesses. We propose that behavioral interventions are needed in combination with medical treatment and care in order to fully address the needs of children and adolescents in Africa living with HIV. In early childhood, caregiver training programs to enhance the developmental milieu of the child with HIV can enhance their cognitive and social development and that such interventions are both feasible and well-accepted by the local population. For school-age children, computerized cognitive rehabilitation training can be an entertaining and engaging way to improve attention, working memory, and problem solving skills for children with HIV. Further dissemination and implementation science work is needed for arriving at cost-effective strategies for scaling up such behavioral interventions in African resource-constrained settings, given that the vast majority of HIV-affected children and youth worldwide presently live in sub-Saharan Africa.
Collapse
|
32
|
Dara M. TB and HIV co-infection in children: do we know enough? Int J Tuberc Lung Dis 2016; 20:1422. [PMID: 27776579 DOI: 10.5588/ijtld.16.0681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
33
|
Günthard HF, Saag MS, Benson CA, del Rio C, Eron JJ, Gallant JE, Hoy JF, Mugavero MJ, Sax PE, Thompson MA, Gandhi RT, Landovitz RJ, Smith DM, Jacobsen DM, Volberding PA. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society-USA Panel. JAMA 2016; 316:191-210. [PMID: 27404187 PMCID: PMC5012643 DOI: 10.1001/jama.2016.8900] [Citation(s) in RCA: 477] [Impact Index Per Article: 59.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE New data and therapeutic options warrant updated recommendations for the use of antiretroviral drugs (ARVs) to treat or to prevent HIV infection in adults. OBJECTIVE To provide updated recommendations for the use of antiretroviral therapy in adults (aged ≥18 years) with established HIV infection, including when to start treatment, initial regimens, and changing regimens, along with recommendations for using ARVs for preventing HIV among those at risk, including preexposure and postexposure prophylaxis. EVIDENCE REVIEW A panel of experts in HIV research and patient care convened by the International Antiviral Society-USA reviewed data published in peer-reviewed journals, presented by regulatory agencies, or presented as conference abstracts at peer-reviewed scientific conferences since the 2014 report, for new data or evidence that would change previous recommendations or their ratings. Comprehensive literature searches were conducted in the PubMed and EMBASE databases through April 2016. Recommendations were by consensus, and each recommendation was rated by strength and quality of the evidence. FINDINGS Newer data support the widely accepted recommendation that antiretroviral therapy should be started in all individuals with HIV infection with detectable viremia regardless of CD4 cell count. Recommended optimal initial regimens for most patients are 2 nucleoside reverse transcriptase inhibitors (NRTIs) plus an integrase strand transfer inhibitor (InSTI). Other effective regimens include nonnucleoside reverse transcriptase inhibitors or boosted protease inhibitors with 2 NRTIs. Recommendations for special populations and in the settings of opportunistic infections and concomitant conditions are provided. Reasons for switching therapy include convenience, tolerability, simplification, anticipation of potential new drug interactions, pregnancy or plans for pregnancy, elimination of food restrictions, virologic failure, or drug toxicities. Laboratory assessments are recommended before treatment, and monitoring during treatment is recommended to assess response, adverse effects, and adherence. Approaches are recommended to improve linkage to and retention in care are provided. Daily tenofovir disoproxil fumarate/emtricitabine is recommended for use as preexposure prophylaxis to prevent HIV infection in persons at high risk. When indicated, postexposure prophylaxis should be started as soon as possible after exposure. CONCLUSIONS AND RELEVANCE Antiretroviral agents remain the cornerstone of HIV treatment and prevention. All HIV-infected individuals with detectable plasma virus should receive treatment with recommended initial regimens consisting of an InSTI plus 2 NRTIs. Preexposure prophylaxis should be considered as part of an HIV prevention strategy for at-risk individuals. When used effectively, currently available ARVs can sustain HIV suppression and can prevent new HIV infection. With these treatment regimens, survival rates among HIV-infected adults who are retained in care can approach those of uninfected adults.
Collapse
|
34
|
Bolduc P, Roder N, Colgate E, Cheeseman SH. Care of Patients With HIV Infection: Medical Complications and Comorbidities. FP ESSENTIALS 2016; 443:16-22. [PMID: 27092563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
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.
Collapse
|
35
|
Chapagain RH, Adhikari K, Kamar SB, Singh DR. Retrospective study of HIV infection in Anti Retroviral Treatment center of Mahendranagar, Nepal. Kathmandu Univ Med J (KUMJ) 2016; 14:54-57. [PMID: 27892442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Background Being the most backward region, The Far Western Development Region has high illiteracy rate, low socioeconomic status and high migration rate contributing the progression of epidemiological status of Human Immunodeficiency Virus (HIV) towards generalized form. Objective To study the demographic profile of the HIV positive patients, along with their CD4 status and tuberculosis during diagnosis. Method A retrospective descriptive study carried out from May 2006 to July 2012 in 271 HIV patients registered in HIV clinic of Mahakali Zonal Hospital, Mahendranagar. Result Among 271 patients enrolled, 48.30% (131) were male and 51.7% (140) were females. Thirty seven (13.7%) were less than 15 years and 76.3% (207) were of age 16-45 years. 38.7% were household workers by occupation and 34.50% were involved in agriculture and 3.70%were migrant labour. At the time of presentation, 22.4% (60) were stage I according to WHO staging and 18.5% (50), 58.5 (158) and 0.7% (2) were of stage II, III and IV respectively. Similarly, 33.0% (89) had more than 350 CD4 count at the time of presentation. 20.8% (56) of patients were infected with tuberculosis. Among 236 families, 2 or more members were found to be affected in 24 families. In most of the cases, female were diagnosed first followed by male in the families, where both the couple were infected. Conclusion Most of the HIV infected patients were of productive age group. Majority of patients were uneducated and Tuberculosis was found to be common opportunistic infections associated with HIV infection.
Collapse
|
36
|
Zhu X, Tao X, Wang G, Hao L, Kang D. [Analysis of antiviral therapy HIV/AIDS children from Shandong province]. ZHONGHUA YU FANG YI XUE ZA ZHI [CHINESE JOURNAL OF PREVENTIVE MEDICINE] 2014; 48:959-963. [PMID: 25582365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To analyze the outcome among HIV-infected children following antiretroviral treatment in Shandong province. METHODS From the national AIDS antiviral treatment database during April 2009 and December 2013, 50 children who were according to antiviral treatment in Shandong province were classified as the cases. Regular follow-up observation and test were conducted among children under antiretroviral therapy before treatment,0.5(th), 1(th), 2(th), 3(th), 6(th), 9(th), 12(th) months after treatment, and then one time after every 3 months follow-up after one year. The height and weight of the children under antiretroviral therapy and normal children (2010 national student physical health survey results)were compared during different times. And the height and weight of the follow-up period of situation, the CD4(+)T cell count and viral load, regular physical examination results, the incidence of opportunistic infections were compared with baseline data. RESULTS Among the 50 children under antiviral therapy, male accounted for 54.0% (27/50) , female 46.0% (23/50) , the youngest was 2 years of age, the oldest was 15 years old, and all of them were transmitted by the mother-to-child route and none received mother-to-child prevention. The shortest treatment time lasted five months, the longest 61 months, with a median 25 months. The height of the baseline, 12(th), 24(th), 36(th) months after antiviral treatment were ( 111.9 ± 23.4), (118.1 ± 20.9), (127.1 ± 13.9), (135.4 ± 10.2)cm, and weigh were ( 20.6 ± 8.7), (23.8 ± 6.3), (27.8 ± 7.2), (30.7 ± 5.5) kg, respectively. The height and weight of the treated children were higher than those in the baseline (P < 0.05), but lower than those among the children without HIV infection. The CD4(+)T lymphocytes level of the baseline, 3(th), 6(th), 12(th), 24(th), 36(th) months after antiviral treatment were 224.0, 279.5, 465.0, 581.0, 640.0, 728.0/µl, the CD4(+)T lymphocytes level after antiviral treatment were higher than the baseline (P < 0.05). Hemoglobin and AST were significantly different between children received treatment after 24 months and those in the baseline (P < 0.05), baseline and 24(th) months after treatment the hemoglobin value were (106.6 ± 22.2), (125.2 ± 5.8), and the AST measurements were (42.1 ± 23.1), (23.4 ± 15.6). Baseline and 12(th), 24(th) months after treatment, the median of viral load were 10 000.0, 105.0,0.0 copies/ml , and the ratio of viral load ≤ 400 copies/ml were 50% (4/8) , 65% (22/34) , 88% (14/16) , respectively, the results of viral load had significant difference among 12(th), 24(th) months after antiviral treatment and baseline (P < 0.05). The incidence of opportunistic infections was 62% (31/50) before treatment, and 12% (6/50) after the antiviral therapy. CONCLUSION Antiviral therapy can effectively improve the immunity and reduce the incidence of opportunistic infections which is helpful to improve the quality of life among HIV-infected children following antiretroviral treatment in Shandong province.
Collapse
|
37
|
Ziuzia IR, Zimina VN, Al'vares Figeroa MV, Parkhomenko IG, Dolgova EA. [The morphological characteristics of HIV-associated tuberculosis in relation to blood CD4+ lymphocyte counts]. Arkh Patol 2014; 76:33-37. [PMID: 25543406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the morphological features of HIV-associated tuberculosis with different peripheral blood CD4 lymphocyte counts. MATERIAL AND METHODS Intraoperative and biopsy specimens from 148 patients with HIV-associated tuberculosis were examined. Group 1 included 16 (10.8%) patients having a CD4+ lymphocyte count above 350 cells/μl; Group 2 comprised 38 (25.7%) patients having 200 to 349 cells/μl; Group 3 consisted of 94 (63.5%) patients with a CD4+ lymphocyte count below 200 cells/μl. Histological and immunohistochemical studies and a polymerase chain reaction assay were used. RESULTS According to the predominant inflammatory phase, all analyzed cases were divided into 4 patterns of tissue responses: 1) typical productive granulomatous tuberculous inflammation; 2) obscure productive granulomatous inflammation; 3) a predominant alterative phase with the formation of pyonecrotic foci; 4) a predominant exudative tissue response with the development of amorphofunctional pattern typical of nonspecific inflammation. A relationship was found between the count of CD4+ lymphocytes and the predominant pattern of a tissue inflammatory response. A productive component of inflammation prevailed in Group 1; a mild productive response with the significantly obscure features of a granulomatous process was dominant in Group 2; alterative phenomena were noted in Group 3. Most patients (n=132, 89.2%) were stated to have an obscure granulomatous response (n=61, 41.2%), and a preponderance of an alternative (n=48, 32.4%) and vascular (n=23, 15.6%) components of inflammation. CONCLUSION The magnitude of alterative and exudative components in the foci of tuberculous inflammation suggested that there was a change-over from a delayed hypersensitivity reaction that was typical of tuberculosis to an immediate hypersensitivity reaction and reflected severe immune system dysfunction.
Collapse
|
38
|
Cao W, Song X, Li Y, Qiu Z, Xie J, Han Y, Lyu W, Wang H, Fan H, Zhou B, Liu Z, Liu X, Li T. [Clinical characteristics of 297 newly diagnosed Chinese HIV/AIDS patients]. ZHONGHUA NEI KE ZA ZHI 2014; 53:537-541. [PMID: 25264008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the clinical characteristics of HIV infected patients in China in order to improve early recognition and diagnosis of AIDS. METHODS A total of 297 newly diagnosed HIV/AIDS patients were enrolled in Peking Union Medical College Hospital (PUMCH) from January 2001 to December 2012, including 19 patients of primary phase, 115 of asymptomatic phase and 163 of AIDS phase. Clinical characteristics of these patients were retrospectively analyzed. RESULTS Two hundred and nineteen out of 297 patients reported clinical symptoms with variety. The main systemic symptoms included fever (100 cases, 33.7%), weight loss (50 cases, 16.8%) and fatigue (38 cases, 12.8%). Organ involvement included mucocutaneous (67 cases, 22.6%), respiratory (62 cases, 20.9%), gastrointestinal (40 cases, 13.5%) systems. Patients in AIDS phase were more symptomatic. Seventy-three out of 173 (42.2%)patients have been referred by 2 healthcare providers at least before the diagnosis of HIV infection was confirmed. Initial diagnoses were made in Departments of Infectious Diseases (36.9%), Gastroenterology (16.4%), and Emergency (13.7%). Opportunistic infections accounted for most AIDS defining conditions (ADC), including pneumocystis jiroveci pneumonia (PCP) (36 cases, 22.1%), cytomegalovirus infection (25 cases, 15.3%) and tuberculosis (22 cases, 13.5%). Median peripheral CD(+)4 T lymphocyte count in patients with ADC were 36 cells/µl. CONCLUSIONS Common clinical presentations of HIV/AIDS included fever, weight loss, diarrhea, short of breath and mucocutaneous lesions. Opportunistic infections mainly affected respiratory and gastrointestinal system, with PCP the most common one. The diagnosis of HIV infection was delayed in most cases, suggesting that more efforts are required especially in universal education of clinicians and accurate viral detection.
Collapse
|
39
|
Basu S, Kumar A. Giant molluscum contagiosum - a clue to the diagnosis of human immunodeficiency virus infection. J Epidemiol Glob Health 2013; 3:289-91. [PMID: 24206800 PMCID: PMC7320409 DOI: 10.1016/j.jegh.2013.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 06/03/2013] [Accepted: 06/05/2013] [Indexed: 11/29/2022] Open
Abstract
Molluscum contagiosum (MC) is a benign cutaneous viral infection, affecting mainly children and young adults. Though the disease is self-limiting in immunocompetent individuals, a severe and prolonged course is associated with Human Immunodeficiency Virus (HIV) infection. The following reports an apparently healthy 2-year-old boy with extensive MC without any systemic illness. His parents died of tuberculosis. Investigations revealed him to be a case of HIV infection with severe immunosuppression. The fact that awareness of this condition as being the first sign of HIV infection should prompt diagnostic investigation, especially in India where access to healthcare facilities is limited.
Collapse
|
40
|
Abstract
The field of HIV medicine has changed rapidly in the last two decades since effective and tolerable antiretroviral treatment became available. As a result, although classical opportunistic infections of the brain have become less common, clinicians need to be aware of a wider range of acute and chronic complications of HIV and its treatment. In this article, we summarise major opportunistic infections, immune reconstitution inflammatory syndrome, HIV-associated neurocognitive disorders, and cerebrovascular disease in HIV positive patients. We also emphasise the preventability and reversibility of most of the central nervous system complications of HIV, and hence the importance of early diagnosis of HIV and involvement of clinicians with special expertise in HIV medicine.
Collapse
|
41
|
Chow MB. CNS toxoplasmosis induced hydrocephalus revisited and a brief review of AIDS dementia complex. THE MEDICAL JOURNAL OF MALAYSIA 2013; 68:278. [PMID: 23749026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
42
|
Ye JJ. [Think highly of the diagnose and therapy of ocular pathological changes in the HIV infected and AIDS patients]. [ZHONGHUA YAN KE ZA ZHI] CHINESE JOURNAL OF OPHTHALMOLOGY 2013; 49:196-198. [PMID: 23866697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Acquired immune deficiency syndrome (AIDS) is a kind of fatal disease which involve multiple organs and the public health of global intention. The incidence rate in China is escalating obviously. Currently there is lack of large samples and long-term systematic observations of ocular pathological changes in the human immunodeficiency virus (HIV) infected and AIDS patients. Diagnostic errors and missed diagnosis still exist in hospitals, even in some advanced hospitals. They delay the therapy of patients, also easily result in hospital acquired infections. It is notable that there is insufficient attention to preoperative test of anti-HIV in some hospitals, especially in outpatient surgeries. Therefore potential iatrogenic infection risks are hidden. Some clinical doctors are afraid of AIDS patients, therefore they are lack of subjective initiative to comprehensively examination and treatment the patients. For the past few years, highly active antiretroviral therapy is widely used, AIDS related morbidity and mortality is significantly reduced, and the prevalence rate of ocular complications decreased from 55% to 95%. But due to the HIV/AIDS patient volume increased year by year, and the survival rate raised, prolonged survival, results in the increase of the absolute number of patients with ocular complications. Therefore it is critical to pay attention to the HIV/AIDS ocular lesions in the diagnosis and treatment of iatrogenic infection.
Collapse
|
43
|
Mulu A, Kassu A, Anagaw B, Moges B, Gelaw A, Alemayehu M, Belyhun Y, Biadglegne F, Hurissa Z, Moges F, Isogai E. Frequent detection of 'azole' resistant Candida species among late presenting AIDS patients in northwest Ethiopia. BMC Infect Dis 2013; 13:82. [PMID: 23398783 PMCID: PMC3577436 DOI: 10.1186/1471-2334-13-82] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 02/06/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The chronic use of antifungal agents in the treatment of fungal infection in general and oropharyngeal candidiasis mainly in AIDS patient's leads to the selection of strain resistant to these therapies and a shift in the spectrum of Candida species. This study determines the species diversity and in vitro susceptibility of Candida isolates from late presenting AIDS patients in northwest Ethiopia. METHODS Two hundred and twenty one HIV/AIDS patients were assessed with a standardized evaluation form at enrolment. Oral rinses were cultured on CHROMagar plates at 37°C for 48 hours and Candida species identification were made following standard microbiological techniques. In vitro drug susceptibility tests were made using broth microdilution method. RESULTS The colonization rate of Candida species was found to be 82.3% (177/215). C. albicans was the predominant species isolated from 139 (81%) patients but there was a diversity of other species. C. glabrata was the most frequent non-albicans species isolated in 22.5% (40/177) of the patients followed by C. tropicalis 14.1% (27/177), C. krusei 5.6% (10) and other unidentifiable Candida species 4% (7/177). Recurrent episodes of oropharyngeal candidiasis and previous exposure to antifungal drugs were found to be predisposing factors for colonization by non-albicans species. Irrespective of the Candida species identified 12.2% (11/90), 7.7% (7/90) and 4.7% (4) of the isolates were resistant to fluconazole, ketoconazole and itraconazole, respectively. In contrast, resistance to micafungin, amphotericin B and 5-Fluorocytosine was infrequent. CONCLUSION HIV/AIDS patients are orally colonized by single or multiple albicans and non- albicans Candida species that are frequently resistant to azoles and occasionally to amphotericin B, 5-Fluorocytosine and micafungin. These highlight the need for national surveillance for examining Candida epidemiology and resistance to antifungal drugs.
Collapse
|
44
|
Haddow LJ, Moosa MYS, Mosam A, Moodley P, Parboosing R, Easterbrook PJ. Incidence, clinical spectrum, risk factors and impact of HIV-associated immune reconstitution inflammatory syndrome in South Africa. PLoS One 2012; 7:e40623. [PMID: 23152745 PMCID: PMC3495974 DOI: 10.1371/journal.pone.0040623] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 10/03/2012] [Indexed: 11/18/2022] Open
Abstract
Background Immune reconstitution inflammatory syndrome (IRIS) is a widely recognised complication of antiretroviral therapy (ART), but there are still limited data from resource-limited settings. Our objective was to characterize the incidence, clinical spectrum, risk factors and contribution to mortality of IRIS in two urban ART clinics in South Africa. Methods and Findings 498 adults initiating ART in Durban, South Africa were followed prospectively for 24 weeks. IRIS diagnosis was based on consensus expert opinion, and classified by mode of presentation (paradoxical worsening of known opportunistic infection [OI] or unmasking of subclinical disease). 114 patients (22.9%) developed IRIS (36% paradoxical, 64% unmasking). Mucocutaneous conditions accounted for 68% of IRIS events, mainly folliculitis, warts, genital ulcers and herpes zoster. Tuberculosis (TB) accounted for 25% of IRIS events. 18/135 (13.3%) patients with major pre-ART OIs (e.g. TB, cryptococcosis) developed paradoxical IRIS related to the same OI. Risk factors for this type of IRIS were baseline viral load >5.5 vs. <4.5 log10 (adjusted hazard ratio 7.23; 95% confidence interval 1.35–38.76) and ≤30 vs. >30 days of OI treatment prior to ART (2.66; 1.16–6.09). Unmasking IRIS related to major OIs occurred in 25/498 patients (5.0%), and risk factors for this type of IRIS were baseline C-reactive protein ≥25 vs. <25 mg/L (2.77; 1.31–5.85), haemoglobin <10 vs. >12 g/dL (3.36; 1.32–8.52), ≥10% vs. <10% weight loss prior to ART (2.31; 1.05–5.11) and mediastinal lymphadenopathy on pre-ART chest x-ray (9.15; 4.10–20.42). IRIS accounted for 6/25 (24%) deaths, 13/65 (20%) hospitalizations and 10/35 (29%) ART interruptions or discontinuations. Conclusion IRIS occurred in almost one quarter of patients initiating ART, and accounted for one quarter of deaths in the first 6 months. Priority strategies to reduce IRIS-associated morbidity and mortality in ART programmes include earlier ART initiation before onset of advanced immunodeficiency, improved pre-ART screening for TB and cryptococcal infection, optimization of OI therapy prior to ART initiation, more intensive clinical monitoring in initial weeks of ART, and education of health care workers and patients about IRIS.
Collapse
|
45
|
Thompson MA, Aberg JA, Hoy JF, Telenti A, Benson C, Cahn P, Eron JJ, Günthard HF, Hammer SM, Reiss P, Richman DD, Rizzardini G, Thomas DL, Jacobsen DM, Volberding PA. Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society-USA panel. JAMA 2012; 308:387-402. [PMID: 22820792 DOI: 10.1001/jama.2012.7961] [Citation(s) in RCA: 621] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CONTEXT New trial data and drug regimens that have become available in the last 2 years warrant an update to guidelines for antiretroviral therapy (ART) in human immunodeficiency virus (HIV)-infected adults in resource-rich settings. OBJECTIVE To provide current recommendations for the treatment of adult HIV infection with ART and use of laboratory-monitoring tools. Guidelines include when to start therapy and with what drugs, monitoring for response and toxic effects, special considerations in therapy, and managing antiretroviral failure. DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION Data that had been published or presented in abstract form at scientific conferences in the past 2 years were systematically searched and reviewed by an International Antiviral Society-USA panel. The panel reviewed available evidence and formed recommendations by full panel consensus. DATA SYNTHESIS Treatment is recommended for all adults with HIV infection; the strength of the recommendation and the quality of the evidence increase with decreasing CD4 cell count and the presence of certain concurrent conditions. Recommended initial regimens include 2 nucleoside reverse transcriptase inhibitors (tenofovir/emtricitabine or abacavir/lamivudine) plus a nonnucleoside reverse transcriptase inhibitor (efavirenz), a ritonavir-boosted protease inhibitor (atazanavir or darunavir), or an integrase strand transfer inhibitor (raltegravir). Alternatives in each class are recommended for patients with or at risk of certain concurrent conditions. CD4 cell count and HIV-1 RNA level should be monitored, as should engagement in care, ART adherence, HIV drug resistance, and quality-of-care indicators. Reasons for regimen switching include virologic, immunologic, or clinical failure and drug toxicity or intolerance. Confirmed treatment failure should be addressed promptly and multiple factors considered. CONCLUSION New recommendations for HIV patient care include offering ART to all patients regardless of CD4 cell count, changes in therapeutic options, and modifications in the timing and choice of ART in the setting of opportunistic illnesses such as cryptococcal disease and tuberculosis.
Collapse
|
46
|
Letang E, Naniche D, Bower M, Miro JM. Kaposi sarcoma-associated immune reconstitution inflammatory syndrome: in need of a specific case definition. Clin Infect Dis 2012; 55:157-8; author reply 158-9. [PMID: 22491336 DOI: 10.1093/cid/cis308] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
47
|
Lewis DM. Oral hairy leukoplakia. JOURNAL - OKLAHOMA DENTAL ASSOCIATION 2011; 102:38-39. [PMID: 22128498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
48
|
Abstract
PURPOSE OF REVIEW HIV-associated multicentric Castleman disease (HIV MCD) is a rare lymphoproliferative disorder, the incidence of which appears to be increasing in the highly active antiretroviral therapy era. Current knowledge of the disease is limited and this review will discuss what is known about the pathophysiology, diagnosis, management, and prognosis of HIV MCD. RECENT FINDINGS HIV MCD has been shown to be associated with infection with human herpesvirus-8. Vascular endothelial growth factor and the cytokine interleukin-6 (IL-6) are also thought to play a role in the pathogenesis of MCD. Currently, rituximab is often used alone or in combination with chemotherapy for treatment of MCD. Novel monoclonal antibodies targeting IL-6 and the IL-6 receptor are also being studied for the management of this disease. SUMMARY Because HIV MCD is an uncommon diagnosis, comprehensive clinical studies have not been done, and understanding of the disease is incomplete. Further studies are needed to make definitive conclusions regarding optimal treatment of HIV MCD.
Collapse
|
49
|
Fang GL, Sun HY, Lun WH. [AIDS-related Kaposi's sarcoma, a case report of external nose]. ZHONGHUA ER BI YAN HOU TOU JING WAI KE ZA ZHI = CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY 2011; 46:772. [PMID: 22177052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
50
|
Sisay Z, Berhe N, Petros B, Tegbaru B, Messele T, Hailu A, Wolday D. Serum chemokine profiles in visceral leishmaniasis, HIV and HIV/ visceral leishmaniasis co-infected Ethiopian patients. ETHIOPIAN MEDICAL JOURNAL 2011; 49:179-186. [PMID: 21991751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND The search for a correlation between chemokine levels in plasma or serum and protection from HIV infection or progression to AIDS has been attempted by a number of workers. Chemokines are also suggested to play a role in immunity to Leishmania and Leishmania co-infection with HIV. OBJECTIVE To assess plasma level of alpha chemokine (CXCL12, formerly known as SDF-1alpha) and beta chemokines (CCL3, CCL4 and CCL5, formerly known as MIP-1alpha, MIP-1beta and RANTES, respectively) in HIV Visceral Leishmaniasis (VL) and HIV/VL coinfection. METHODS Frozen serum samples from a cross sectional study were used. The samples (n = 80) were comprised of healthy controls (n = 20), HIV patients (n = 20); Visceral Leishmaniasis (VL) patients (n = 22), and HIV/VL coinfected patients (n = 18). Chemokine levels of MIP-1alpha, MIP-1beta, RANTES, and SDF-1alpha of the serum samples were determined using ELISA. RESULTS MIP-1alpha and MIP-1beta expression were significantly elevated in Leishmania infected (p < 0.001) and in HIV/ VL co-infected individuals (p < 0.001) as compared to the control groups, while no significant difference was seen between HIV infected patients p > 0.05, implying that VL alone might modulate the production of these two chemokines in the case of co-infection In RANTES, however, its expression was significantly higher in HIV patients compared to controls (p = 0.002). Further assessment of serum RANTES concentration in HIV patients has shown a tendency of negative association with viral load. Higher amount of the alpha chemokine, SDF-1alpha, was detected in the HIV patients (p = 0.001) than the control group. Also a trend of positive association between SDF-1alpha and CD4 count was observed CONCLUSION From our data we can speculate that RANTES and SDF-1alpha might be involved in the regulation of HIV; and MIP-1alpha and MIP-1beta in VL. Therefore, enhancing or suppressing the production of these chemokines might help in therapeutic intervention of VL or HIV.
Collapse
|