[Sexually transmitted coinfections. HIV coinfections]

MECHANISMS OF INTERACTION OF VIRAL CAUSATIVE AGENTS IN PATIENTS CO-INFECTED WITH HUMAN IMMUNODEFICIENCY AND HEPATITIS C VIRUSES

In patients infected with human immunodeficiency virus (HIV) in 20 - 30% of cases co-infection with hepatitis C virus (HCV) is observed, that is associated with common routes of transmission for these causative agents. The main cause of lethal outcome for co-infected patients is liver damage. Thus, analysis of mechanisms of mutual influence of HIV and HCV under the conditions of co-infection gains special attention, that can be examined from both standpoints of direct inter-molecular interaction of 2 viral causative agents, as well as from the position of their immune-mediated effect. Negative effect of HIV on the course of fibrosis process in liver during HCVinfection is associated with the feature of this virus to cause deep alteration in the immune system by direct damage of CD4+ cells, disruption of mechanisms of immunological memory, suppression of functions of liver fraction of NK and NKT, as well as its ability of co-receptor interaction with hepatocytes and stellate cells, enhancing progress of fibrosis alterations and HCV replication in liver. HCV is also established to effect replication of HIV, stimulate infection of macrophages with this virus. All these events facilitate the rise in lethality during HIV and HCV co-infection.

Sexually Transmitted Infections Among Hospitalized Patients With Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS) in Zahedan, Southeastern Iran

Background

Studies show that nearly 40 million people are living with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) around the world and since the beginning of the epidemic, about 35 million have died from AIDS. Heterosexual intercourse is the most common route for transmission of HIV infection (85%). People with a sexually transmitted infection (STI), such as syphilis, genital herpes, chancroid, or bacterial vaginosis, are more likely to obtain HIV infection during sex. On the other hand, a patient with HIV can acquire other infections such as hepatitis C virus (HCV) and hepatitis B virus (HBV) and also STIs. Co-infections and co-morbidities can affect the treatment route of patients with HIV/AIDs. Sometimes, physicians should treat these infections before treating the HIV infection. Therefore, it is important to identify co-infection or comorbidity in patients with HIV/AIDS.

Objectives

This study was conducted in order to understand the prevalence of HIV/AIDS/STI co-infection.

Patients and Methods

In this cross-sectional study, we evaluated all HIV/AIDS patients who were admitted to the infectious wards of Boo-Ali hospital (Southeastern Iran) between March 2000 and January 2015. All HIV/AIDS patients were studied for sexually transmitted infections (STI) such as syphilis, gonorrhea, hepatitis B virus (HBV) and genital herpes. A questionnaire including data on age, sex, job, history of vaccination against HBV, hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc), hepatitis B surface antigen (anti-HBs), HCV-Ab, venereal disease research laboratory (VDRL) test, fluorescent treponemal antibody absorption (FTA-Abs) test, and urine culture was designed. Data was analyzed by the Chi square test and P values of < 0.05 were considered significant.

Results

Among the 41 patients with HIV/AIDS (11 females and 30 males; with age range of 18 to 69 years) five cases (12.1%) had a positive test (1:8 or more) for VDRL. The FTA-Abs was positive for all patients who were positive for VDRL. Gonorrhea was found in seven patients (17%) and three cases had genital herpes in clinical examinations. All patients who had positive test results for these STIs were male. Eleven patients (26.8%) had HBV infection (three females and eight males). hepatitis C virus (HCV) was found in 13 cases (31%). Eighty percent of patients were unemployed. Seventy-eight percent of patients with HIV/STI were aged between 18 and 38 years. There was a significant difference between sex and becoming infected with HIV and also STI (P < 0.05).

Conclusions

Patients with HIV/AIDS are more likely to acquire other STIs, because the same behaviors that increase the risk of becoming HIV infected can also increase the risk of acquiring STIs. Having a sore on the skin due to an STI can make the transmission of HIV to the sex partner more likely than people who don’t have such sore in their genital area.

The physical and psychological effects of HIV infection and its treatment on perinatally HIV-infected children

INTRODUCTION

As highly active antiretroviral therapy (HAART) transforms human immunodeficiency virus (HIV) into a manageable chronic disease, new challenges are emerging in treating children born with HIV, including a number of risks to their physical and psychological health due to HIV infection and its lifelong treatment.

METHODS

We conducted a literature review to evaluate the evidence on the physical and psychological effects of perinatal HIV (PHIV+) infection and its treatment in the era of HAART, including major chronic comorbidities.

RESULTS AND DISCUSSION

Perinatally infected children face concerning levels of treatment failure and drug resistance, which may hamper their long-term treatment and result in more significant comorbidities. Physical complications from PHIV+ infection and treatment potentially affect all major organ systems. Although treatment with antiretroviral (ARV) therapy has reduced incidence of severe neurocognitive diseases like HIV encephalopathy, perinatally infected children may experience less severe neurocognitive complications related to HIV disease and ARV neurotoxicity. Major metabolic complications include dyslipidaemia and insulin resistance, complications that are associated with both HIV infection and several ARV agents and may significantly affect cardiovascular disease risk with age. Bone abnormalities, particularly amongst children treated with tenofovir, are a concern for perinatally infected children who may be at higher risk for bone fractures and osteoporosis. In many studies, rates of anaemia are significantly higher for HIV-infected children. Renal failure is a significant complication and cause of death amongst perinatally infected children, while new data on sexual and reproductive health suggest that sexually transmitted infections and birth complications may be additional concerns for perinatally infected children in adolescence. Finally, perinatally infected children may face psychological challenges, including higher rates of mental health and behavioural disorders. Existing studies have significant methodological limitations, including small sample sizes, inappropriate control groups and heterogeneous definitions, to name a few.

CONCLUSIONS

Success in treating perinatally HIV-infected children and better understanding of the physical and psychological implications of lifelong HIV infection require that we address a new set of challenges for children. A better understanding of these challenges will guide care providers, researchers and policymakers towards more effective HIV care management for perinatally infected children and their transition to adulthood.