COVID-19 infection in patients with haematological disease - A tertiary centre experience from north India

This retrospective study was aimed to understand the clinical, laboratory, radiological parameters and the outcome of COVID-19 patients with underlying haematological disease. All patients with known haematological disease admitted with COVID-19-positive status from April to August 2020 in the COVID-19 facility of a tertiary care centre in north India, were included. Their medical records were analyzed for outcome and mortality risk factors. Fifty four patients, 37 males, were included in the study. Of these, 36 patients had haematological malignancy and 18 had benign disorder. Fever (95.5%), cough (59.2%) and dyspnoea (31.4%) were the most common symptoms. Nine patients had severe disease at diagnosis, mostly malignant disorders. Overall mortality rate was 37.0 per cent, with high mortality seen in patients with aplastic anaemia (50.0%), acute myeloid (46.7%) and lymphoblastic leukaemia (40.0%). On univariate analysis, Eastern Cooperative Oncology Group performance status >2 [odd ratio (OR) 11.6], COVID-19 severity (OR 8.2), dyspnoea (OR 5.7) and blood product transfusion (OR 6.4) were the predictors of mortality. However, the presence of moderate or severe COVID-19 (OR 16.6, confidence interval 3.8-72.8) was found significant on multivariate analysis. The results showed that patients with haematological malignancies and aplastic anaemia might be at increased risk of getting severe COVID-19 infection and mortality as compared to the general population

Genomic architecture of HIV-1 infection: Current status & challenges.

Studies on host genomics have revealed the existence of identifiable HIV-1 specific protective factors among infected individuals who remain naturally resistant viraemia controllers with little or no evidence of virus replication. These factors are broadly grouped into those that are immune associated (MHC, chemokines, cytokines, CTLs and others), linked to viral entry (chemokine co-receptors and ligands), act as post-entry restriction elements (TRIM5a, APOBEC3) and those associated with viral replication (cytokines and others). These features have been identified through multiple experimental approaches ranging from candidate gene approaches, genome wide association studies (GWAS), expression analysis in conjunction with functional assays in humans to primate based models. Several studies have highlighted the individual and population level gross differences both in the viral clade sequences as well as host determined genetic associations. This review collates current information on studies involving major histocompatibility complex (MHC) as well as non MHC genes in the context of HIV-1 infection and AIDS involving varied ethnic groups. Special focus of the review is on the genetic studies carried out on the Indian population. Further challenges with regard to therapeutic interventions based on current knowledge have been discussed along with discussion on documented cases of stem cell therapy and very early highly active antiretroviral therapy (HAART) interventions.

Defects in blood dendritic cell subsets in HIV-1 subtype C infected Indians.

Background & objective: DCs trigger both innate and adaptive immune responses to control HIV infection and represent a viral reservoir acting as target and HIV carriers for infection of permissive CD4+ T-cells. DCs thus form a very attractive study subject to further our existing knowledge of HIV induced immunopathogenesis due to its diverse and crucial role in HIV infection establishment, viral dissemination, immune evasion, viral persistence, etc. We aimed to characterize the effect of HIV infection on myeloid and plasmacytoid dendritic cell subsets in a group of HIV-1 subtype C infected treated or untreated Indian individuals. Methods: Blood DC subset numbers and immunophenotype were studied for 79 HIV infected subjects at various stages of disease and compared with 13 HIV-uninfected controls. Comparisons were also made between groups of subjects based on their CD4+ T cell counts and also experience of antiretrovirals. Results: Significant decreases were observed in blood DC counts and the two DC subsets in HIV infected individuals. Subjects with lowest CD4+ T cell counts also had a drastically reduced DC subset pool which correlated positively with plasma viraemia and negatively with CD4+ T cell counts. DC subsets from HIV infected subjects showed higher expression of co-stimulatory molecules CD40 and CD86, and HIV-1 co-receptors CXCR4 and CCR5 which correlated positively with HIV-1 plasma viraemia. The alterations in blood DCs were partly resolved in ART receiving study subjects. Interpretation & conclusions: Correlation between DC subset activation state and viraemia supports the role of DC activation on viral replication and CD4+ T cell depletion.

Multidimensional health status of HIV-infected outpatients at a tertiary care center in north India.

Background : Quality of life (QOL) scores inform researchers acquainted with such tools about patients' perception of various domains of their health. The scores provide a useful denominator for clinical trials, especially in chronic diseases with therapeutic side effects, such as HIV. However, in clinical settings, there is a felt need of description of problems commonly perceived by patients. Aim : This study describes the multidimensional health-related issues of HIV-positive patients. Settings and Design : Cross-sectional design with convenient sampling was used to recruit 138 HIV-positive patients at the outpatient section of the Department of Medicine of a tertiary care hospital in north India. Materials and Methods : A structured questionnaire was used to collect information about health-related problems. Identified problems were assessed using a Likert scale for severity. Results : Out of the 20 assessed problems, the patients reported positive for an average of 12.01 +/- 3.78 problems. The most prevalent problems were those related to emotions (98.6%), lack of energy (96.4%), and health perception (92.0%). The most distressing problems were 'feeling that health was not good' (77.5%) and 'health was bad' (75.4%). The number of problems reported was significantly related to weight loss ( P = 0.006) and clinical category ( P = 0.023). A significant correlation was observed between weight loss and problems in social activities ( P P P P = 0.002).Conclusion : Many patients have significant problems in dimensions other than physical. A physician's awareness about these problems is important for a holistic patient management.

Los accidentes laborales en la era del VIH. Soluciones a un problema creciente / Work accidents in the HIV era. Solutions to a growing problem

HIV/AIDS has changed the way the medical profession cares for patients. Uninformed doctors still turn away suspected and confirmed cases of HIV/AIDS for fear of contracting the disease themselves, especially in the developing world. Increasing awareness of universal precautions and the modes of spread of HIV has resulted in better care for such patients. Health care workers (HCWs) are getting increasingly exposed to patients with HIV/AIDS, a large number of whom are clinically silent. Data from developing countries is lacking, and exposure rate is high in the absence of access to resources needed for universal precautions. In the absence of an effective vaccine, universal precautions and post-exposure prophylaxis remain the mainstay of tackling this occupational hazard. The risk of seroconversion after a needlestick injury may be reduced by knowledge of body fluids that are high risk and awareness of postexposure prophylaxis after possible HIV-contaminated needlestick injury. The lack of awareness of risk involved and the measures to be taken in case of accidental exposure to contaminated body fluids is alarming. In most hospitals, work-practice controls for exposure prevention are either inadequate or underutilized. It is high time we tackled this issue of immense immediate concern to health care professionals, with a larger bearing on handling this plague of modern times

El VIH/sida cambió la forma en que la profesión médica trata a los pacientes. Algunos médicos desinformados todavía le dan la espalda a casos sospechados o confirmados de VIH/sida por temor a contraer la enfermedad ellos mismos, especialmente en el mundo en vías de desarrollo. Aumentar el conocimiento de las medidas de prevención universal y las formas de contagio del VIH resultó en tratamientos mejores para estos pacientes. Los trabajadores de la salud se exponen cada vez más a pacientes con VIH/sida, de los cuales un gran número es clínicamente asintomático. Hay pocos datos de los países en vías de desarrollo y la tasa de exposición es alta ante la falta de acceso a recursos necesarios para medidas de prevención universal. Al no contar con una vacuna efectiva, las medidas precautorias universales y la profilaxis posexposición siguen siendo el pilar para abordar este riesgo ocupacional. El riesgo de seroconversión luego de una herida penetrante con aguja puede ser reducido por la noción de que los fluidos corporales que son más riesgosos y por el conocimiento de la existencia de la profilaxis posexposición luego de la lesión con una aguja posiblemente contaminada con el VIH. La falta de conocimiento del riesgo que implica y las medidas a implementar en el caso de una exposición accidental a fluidos corporales contaminados es alarmante. En la mayoría de los hospitales, los controles laborales para la prevención de la exposición son inadecuados o poco utilizados. Ya es tiempo de que abordemos este tema de enorme e inmediata preocupación para los trabajadores de la salud, con una mayor orientación en el manejo de esta «peste¼ de los tiempos modernos

The impact of HIV/AIDS on the quality of life: a cross sectional study in north India.

OBJECTIVE: To determine the impact of Human Deficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) on the quality of life (QOL) on such patients in North India. DESIGN: A cross sectional study. SETTING: Outpatient setting and wards, Department of Medicine at a premier tertiary health care center, North India. PARTICIPANTS: Sixty-eight consecutive HIV/AIDS patients attending Medicine out patient department and/or admitted to the wards of All India Institute of Medical Sciences were administered a structured questionnaire by the HIV nurse coordinator. QOL was evaluated using the WHOQOL-Bref (Hindi) instrument. ANALYSIS: One way Analysis of Variance (ANOVA) was performed to find out significant difference between the clinical categories and socio-demographic variables on QOL domains. RESULTS: The overall QOL mean score on a scale of 0-100 was found to be 25.8. Similarly, on the scale of 0-100 the mean scores in the four domains of QOL in descending order were social (80.9); psychological (27.5); physical (17.7) and environmental domain (11.65). There was a significant difference of quality of life in the physical domain between asymptomatic patients (14.6) and patients with AIDS (10.43) defining illnesses (p< 0.001) and asymptomatic and early symptomatic (12) patients (p=0.014). QOL in the psychological domain was significantly poorer in early symptomatic (12.1) (p< 0.05) and AIDS patients (12.4) (p< 0.006) as compared to asymptomatic individuals (14.2). A significant difference in QOL scores in the psychological domain was observed with respect to the educational status (p< 0.037) and income of patients (p< 0.048). Significantly better QOL scores in the physical (p< 0.040) and environmental domain (p< 0.017) were present with respect to the occupation of the patients. Patients with family support had better QOL scores in environmental domain. CONCLUSIONS: In our study, QOL is associated with education, income, occupation, family support and clinical categories of the patients.