Cognitive impairment in patients with central nervous system tuberculosis

INTRODUCTION

Tuberculosis (TB) in Mexico remains an important cause of morbidity and mortality; in the past 4 years, 110,681 cases of pulmonary tuberculosis and 1571 cases of tuberculous meningitis were reported.

OBJECTIVE

To determine the neurocognitive sequelae, clinical presentation and neuroimaging alterations in patients with central nervous system tuberculosis.

METHODS

A retrospective, analytical, and cross-sectional study was carried out from 2010 to 2019. Patients with central nervous system tuberculosis, with and without HIV/AIDS coinfection, were included.

RESULTS

During the study period, 104 cases with a definitive or probable central nervous system tuberculosis diagnosis were included; 38% had HIV/AIDS coinfection, and 55%, various comorbidities (p = 0.0001); 49% had cognitive alterations, and 14% died.

CONCLUSIONS

Although HIV/AIDS infection can contribute to cognitive decline in patients with tuberculous meningitis, no differences were observed between patients with and without HIV/AIDS. Cognitive sequelae showed improvement during follow-up with adequate management and therapeutic control of the patients.

Factors related to quality of life of people living with HIV in Alicante, Spain

PURPOSE

To analyze the determinants that influence the health-related quality of life of people living with HIV in Alicante (Spain).

METHODS

A cross-sectional study was conducted, which recruited 214 Spanish-speaking participants over 18 years of age living with HIV from an outpatient consulting office of the infectious diseases in a hospital in Alicante between 2013 and 2014. A self-administration sociodemographic survey and the Short Form Health Survey (SF-36v2) was used to assess health-related quality of life. This questionnaire measures health on 8domains.

RESULTS

70% of the participants were male, 50% had CD4 cell count between 200-499 cells/mm³ and 20% were infected by the hepatitis C virus (HCV). For the 8SF-36v2 scales, the average scores were higher than 45. Men presented better scores than women; there were statistically significant differences in all the scales except for general health. Being co-infected with HCV and being unemployed or other situations other than having a job were significantly associated with a lower physical component summary, while being married or having a partner were significantly associated with a higher score in the mental component summary.

CONCLUSION

The socioeconomic level and the presence of clinical factors such as HCV influence the scales of quality of life of physical health among adults living with HIV.

[Ageing and HIV, the experience of HIV-positive women in French-speaking Switzerland]

Thanks to a burdensome lifelong treatment, it is now possible to lead an almost 'normal' life while being HIV-positive. The status of people living with the human immunodeficiency virus (HIV) is rarely questioned. The image of the 'dying contagious patient' has been replaced by that of the 'classic chronically ill patient'. However, their HIV-positive status still leads to discrimination. A sociological study based on the accounts of 30 HIV-positive women in French-speaking Switzerland reveals how they feel faced with the prospect of ageing with HIV.

[The contribution of the fight against AIDS to the health democracy]

There is a debate on the place and the role of users in the healthcare system. It is important to remember that the people concerned by AIDS and associations fighting against this pathology have initiated a new type of patient involvement in care and public policies. This could be taken as a model.

[Refusal of care by a HIV-positive adolescent: role of the cross-cultural approach]

The refusal of treatment is frequent in human immunodeficiency virus-positive adolescents. The clinical history of a teenage girl presenting severe immunodepression secondary to the virus, a depressive disorder and a refusal of treatment, illustrates the benefit of combined paediatric, child psychiatric and cross-cultural care as proposed by the Cochin-Paris Adolescent Centre. Working on the meaning of the refusal was a prerequisite for the construction of a care project forming part of a life project, as the psychopathological work could only begin once somatic care ensuring the patient's protection was in place.

[Living with HIV/AIDS today, impacts on mental health]

The human immunodeficiency virus (HIV)/AIDS, at one time fatal, has now become a chronic disease. Physically, patients are generally in good health. However, 35 years after the discovery of the virus, mental suffering is still very much present. Morbid representations, understandable given the history of the disease, are still active on an individual level as well as on a broader level within society. Adapted information campaigns are essential in order to change behaviour.

[Neuromeningeal cryptococcosis in patients infected with HIV at Agadir regional hospital, (Souss-Massa, Morocco)]

INTRODUCTION

Neuromeningeal cryptococcosis (NMC) is a severe and fatal opportunistic infection. Lethality is frequent in the absence of treatment, especially in the presence of HIV co-infection.

OBJECTIVE

To determine the prevalence, epidemiological, clinical, biological and therapeutic aspects as well as the evolution of NMC for patients infected with HIV.

PATIENTS AND METHODS

This is a retrospective study of 40 cases of neuromeningeal cryptococcosis diagnosed in HIV-infected patients. Data are collected for 7 years (from January 2010 to December 2016) in the registers of the parasitology laboratory and the infectious diseases department at the regional hospital center in Agadir.

RESULTS

A reduction in the prevalence of neuromeningeal cryptococcosis in HIV-infected patients was noted from 2010 to 2016 (3.66% to 0.83%). The overall prevalence of NMC was 1.53%. The mean age was 37±10 years old, with 90% of patients aged less than 45 years. The main clinical symptomatology was headache (75%). The main cytochemical abnormalities of cerebrospinal fluid analysis were hyperproteinorachy (60%), hypoglycorachy (63%) and lymphocytosis (50%). The mean CD4 cell count was 47/mm³. Patients were initially treated with amphotericin B, relayed with fluconazole. The overall lethality was 35%.

CONCLUSION

Neuromeningeal cryptococcosis is a serious opportunistic infection in patients HIV-infected, and the lethality rate remains unacceptable. Fighting NMC in HIV+ patients requires early diagnosis, increased access to antiretrovirals, rapid introduction of appropriate treatment and the prescription of effective systemic antifungals.

[Quantitative And Morphological Abnormalities Of Blood Cells Counts Among Customers Received VCT Unit Of The Central Laboratory Of The CHU Of Yopougon]

INTRODUCTION

The hematologic abnormalities constitute a reccuring problem in the general population. The HIV infection is a favourable situation for the potentiation of these various hematologic disorders. The aim of the study was to describe the quantitative and qualitative aspects of the three blood lines of our population of study.

MATERIAL AND METHOD

It was a prospective cross-sectional study of descriptive type having concerned the people received at the central laboratory of CHU de Yopougon for voluntary tracking from September 1st to September 30th, 2015.

RESULTS

We colliged 154 people among whom, a female prevalence was noted with a sex ratio M/F of 0.64. The age bracket from 18 to 29 years was represented (50%) with a 32.94 years median age ± 10 with the 18 and 75 years extremes represented by 50% of single people. The HIV infection prevalence was 20.37%. Anaemia was the most frequent hematologic abnormality (44.44%) its hypochromic microcitic form microcytic (50%) especially. The HIV positive patients had primarily a normochromic normocytic non regenerative anaemia (27.27%). Among HIV positive patients, 23 (65.22%) had a leuconeutropenia combined with lymphopenia at 23 (65.22%) and 12 had bicytopenia which consisted of thrombocytopenia and anaemia. A morphological abnormality of the three blood lines (red blood cells, white blood cells and platelets) was found in 57.41% of our subjects.

CONCLUSION

To be in apparent good health, does not exclude the hematologic abnormalities presence. But an HIV infection presence, even in the absence of specific treatment, increases the risk or the degree of severity of these different qualitative and quantitative abnormalities.

Trends in hospital admissions, re-admissions, and in-hospital mortality among HIV-infected patients between 1993 and 2013: Impact of hepatitis C co-infection

BACKGROUND

New patterns in epidemiological characteristics of people living with HIV infection (PLWH) and the introduction of Highly Active Antiretroviral Therapy (HAART) have changed the profile of hospital admissions in this population. The aim of this study was to evaluate trends in hospital admissions, re-admissions, and mortality rates in HIV patients and to analyze the role of HCV co-infection.

METHODS

A retrospective cohort study conducted on all hospital admissions of HIV patients between 1993 and 2013. The study time was divided in two periods (1993-2002 and 2003-2013) to be compared by conducting a comparative cross-sectional analysis.

RESULTS

A total of 22,901 patient-years were included in the analysis, with 6917 hospital admissions, corresponding to 1937 subjects (75% male, mean age 36±11 years, 37% HIV/HCV co-infected patients). The median length of hospital stay was 8 days (5-16), and the 30-day hospital re-admission rate was 20.1%. A significant decrease in hospital admissions related with infectious and psychiatric diseases was observed in the last period (2003-2013), but there was an increase in those related with malignancies, cardiovascular, gastrointestinal, and chronic respiratory diseases. In-hospital mortality remained high (6.8% in the first period vs. 6.3% in the second one), with a progressive increase of non-AIDS-defining illness deaths (37.9% vs. 68.3%, P<.001). The admission rate significantly dropped after 1996 (4.9% yearly), but it was less pronounced in HCV co-infected patients (1.7% yearly).

CONCLUSIONS

Hospital admissions due to infectious and psychiatric disorders have decreased, with a significant increase in non-AIDS-defining malignancies, cardiovascular, and chronic respiratory diseases. In-hospital mortality is currently still high, but mainly because of non-AIDS-defining illnesses. HCV co-infection increased the hospital stay and re-admissions during the study period.

[Retrospective study of neuromeningeal cryptococcosis in patients infected with HIV in the infectious diseases unit of university hospital of Casablanca, Morocco]

OBJECTIVE

To report the cases of neuromeningeal cryptococcosis and to describe the clinical, paraclinical, therapeutic and outcomes of patients.

PATIENTS AND METHODS

Retrospective study of 43 patients infected with HIV admitted from January first 2010 to June 30th 2015 in the infectious disease unit of UHC Ibn Rochd, for neuromeningeal cryptococcus.

RESULTS

The mean frequency of neuromeningeal cryptococcosis in patients infected with HIV was 1.4%. The mean age was 39 years and a sex ratio of 1.38. The mean CD4 count was 70 cells/mm³. The diagnosis of HIV was revealed by neuromeningeal cryptococcus in 77% of cases. Fifteen days interval was reported between the first symptom and hospital admission. Headache (77%) was the most represented clinical sign. The cerebrospinal fluid analysis showed hypoglycorachy (67%), hyperproteinorachy (65%) and lymphocytosis (63%). Chinese ink direct examination for Cryptococcus neoformans in CSF was positive in 86% of cases and all cases were positive after culture on Sabouraud's medium. Patients were treated with monotherapy amphotericin B (42%) or fluconazole (28%) and bitherapy amphotéricine B/fluconazole (28%). Fatal evolution was observed in 60% of cases.

CONCLUSION

Neuromeningeal cryptococcosis remains a severe opportunistic infection in HIV patients with a heavy mortality rate.

The convergence of HIV/AIDS and customary tenure on women's access to land in rural Malawi

This paper examines the convergence of HIV/AIDS and the social processes through which women access customary land in rural Malawi. Data were collected from focus group discussions with women in patrilineal and matrilineal communities. Women's land tenure is primarily determined through kinship group membership, customary inheritance practices and location of residence. In patrilineal communities, land is inherited through the male lineage and women access land through relationships with male members who are the rightful heirs. Conversely in matrilineal matrilocal communities, women as daughters directly inherit the land. This research found that in patrilineal communities, HIV/AIDS, gendered inequalities embedded in customary inheritance practices and resource shortages combine to affect women's access to land. HIV/AIDS may cause the termination of a woman's relationship with the access individual due to stigma or the individual's death. Termination of such relationships increases tenure insecurity for women accessing land in a community where they do not have inheritance rights. In contrast to the patrilineal patrilocal experience, research on matrilineal matrilocal communities demonstrates that where women are the inheritors of the land and have robust land tenure rights, they are not at risk of losing their access to land due to HIV/AIDS.

[Epidemiological aspects of cutaneous mycosis of HIV-infected patients in the National Referral Center of Burkina Faso, West Africa]

AIM

Our study aimed to analyze the epidemiological aspects of cutaneous mycosis in people living with human immunodeficiency virus (PLHIV).

MATERIALS AND METHODS

This is a descriptive study of 382 patients living with HIV. Following an investigation into the risk factors, mycological samples have been performed. Each sample underwent direct examination and cultivation for the identification of fungal species. The Blastese test is used for the identification of Candida albicans.

RESULTS

One hundred and six (106) of the 382 people living with human immunodeficiency virus undergo a mycological collection of which 76 gave a positive result. The overall prevalence of cutaneous mycosis was 19.9 %. It was significantly higher in women and in patients who had a CD4 count ≤500/mm3. C. albicans and Trichophyton rubrum were the most isolated species with 22.4 and 19.8 % of all fungal species isolated, respectively.

CONCLUSION

Cutaneous mycoses are common among people living with human immunodeficiency virus and whose CD4 count ≤ 500/mm(3).

Family physicians and HIV infection

OBJECTIVE

We aimed to describe the current and desired involvement of family physicians (FPs) in the treatment of HIV patients (screening practices, potential training and patient follow-up) to reduce the duration and frequency of their hospital treatment.

MATERIAL AND METHODS

We conducted a descriptive cross-sectional survey between 2011 and 2012 with the support of COREVIH (Regional Coordinating Committee on HIV). We sent a self-assessment questionnaire to all FPs of the Pays de la Loire region to enquire about their HIV screening practices and expectations for the management of HIV patients.

RESULTS

A total of 871 FPs completed the questionnaire (response rate: 30.4%). A total of 54.2% said to provide care to HIV patients; the mean number of HIV patients per FP was estimated at 1.4. With regard to HIV screening, 12.2% systematically suggest an HIV serology to their patients and 72.7% always suggest it to pregnant women. About 45.4% of responding FPs said to be willing to manage HIV patients (clinical and biological monitoring, compliance checks and prescription renewal). FPs mainly reported the lack of training and the low number of HIV patients as a barrier to their further involvement in the management of HIV patients.

CONCLUSION

The responding FPs provide care to very few HIV patients. They are, however, willing to be more involved in the routine care of these patients. Medical training provided by COREVIH would help improve HIV screening. The management of HIV patients could thus be handed over to willing FPs.