Tuberculosis y otras causas de morbilidad y mortalidad hospitalaria en pacientes con VIH/sida / Tuberculosis and other causes of morbidity and mortality in hospitalized patients with HIV/AIDS

Introducción: A diferencia de lo descrito en países desarrollados, en los que se informan las enfermedades crónicas no transmisibles como causa de hospitalización en pacientes con VIH, en este estudio las principales causas de admisión hospitalaria y muerte fueron las infecciones oportunistas, particularmente la tuberculosis, algo similar a lo reportado en otros países de ingresos bajos en América y África Occidental, aun con la disponibilidad de la terapia antirretroviral. Objetivos: Se determinaron las causas más frecuentes de morbilidad y mortalidad hospitalaria en pacientes con VIH. Material y métodos: Se analizaron los datos demográficos, clínicos y de laboratorio de pacientes ingresados con diagnóstico de VIH durante un año, en un hospital de Guayaquil, Ecuador. Resultados: De 151 pacientes, el 76% era del sexo masculino, con 37 años en promedio. El 56.3% conocía el diagnóstico de infección por VIH. Las principales causas de hospitalización y muerte fueron las enfermedades definitorias de sida, entre las que las formas meníngeas, como criptococosis, toxoplasmosis, sífilis y leucoencefalopatía en conjunto, siguen a la tuberculosis; el 93.5% de los fallecidos tenía recuento de CD4 menor de 200 células/mm3 (p = 0.007). Conclusión: De manera similar a lo informado en pacientes adultos jóvenes con VIH en países de bajos ingresos económicos, las infecciones oportunistas fueron la principal causa de hospitalización y muerte, relacionada con inmunosupresión intensa, estadios avanzados de la enfermedad y falta de terapia antirretroviral. Los resultados refuerzan la importancia del diagnóstico precoz y el tratamiento de la infección por VIH, así como la profilaxis de las infecciones oportunistas prevenibles.

Introduction: Unlike what has been described in developed countries where chronic non-communicable diseases are reported as the cause of hospitalization in patients with HIV, in this study the main cause of hospital admission and death were opportunistic infections, particularly tuberculosis similar to what was reported in other low-income countries in the Americas and West Africa even with the availability of antiretroviral therapy. Aim: The most frequent causes of hospital morbidity and mortality in patients with HIV were determined. Material and methods: The demographic, clinical, and laboratory data of patients admitted with a diagnosis of HIV for one year in a Guayaquil General Hospital were analyzed. Results: Of 151 patients, 76% were male with an average age of 37 years old. 56.3% knew the diagnosis of HIV infection. The main cause of hospitalization and death were AIDS-defining diseases where the meningeal forms: cryptococcosis, toxoplasmosis, syphilis and leukoencephalopathy together follow tuberculosis, and 93.5% of the deceased had a CD4 count of fewer than 200 cells/ mm3 (p = 0.007). Conclusion: Similar to what was reported in young adult patients with HIV in low-income countries, opportunistic infections were the main cause of hospitalization and death, related to severe immunosuppression, advanced stages of the disease, and without antiretroviral therapy. The results reinforce the importance of early diagnosis and treatment of HIV infection and the prophylaxis of preventable opportunistic infections.

CCR5 Polymorphisms and its Relationship with HIV Susceptibility, Viral Load and CD4 Count in Early Antiretroviral Therapy among HIV Patients in Selangor and Terengganu

@#Introduction: Early studies have suggested the role of C-C chemokine receptor type 5 (CCR5) polymorphisms in influencing HIV pathogenesis and phenotypes, including the protection against HIV infection and delaying disease progression to AIDS. This study aimed to further determine the impact of CCR5 variants (CCR5-Δ32 and CCR5- R223Q) on HIV susceptibility, viral load suppression and CD4 recovery during highly active antiretroviral therapy (HAART) among Malaysian HIV patients. Methods: This cross-sectional study involved 182 HIV-infected who were recruited from three out-patient clinics, and 150 non-HIV subjects from Malay, Chinese and Indian ethnicities. CD4 count and viral load data at 4-6 months (t1) and 8-12 months (t2) after starting HAART were gathered from hospital records. Chi-square test was used to analyse the correlation between CCR5 variants with dependent variables. Results: Heterozygous CCR5-Δ32 and CCR5-R223Q occurred in a percentage of 0.5% (1/182) and 1.7% (3/182) among HIV patients respectively, while none of homozygous mutant for CCR5-Δ32 and CCR5-R223Q were found. CCR5-R223Q was found more frequently in non-HIV as compared to the HIV group (P=0.018). However, both polymorphisms were not found to be correlated with CD4 recovery to ≥500 cells/mm3 (P>0.05) and viral load suppression ≤50 copies/mL (P>0.05). Conclusion: CCR5-R223Q and CCR5-Δ32 alleles probably have no modifying effects on HIV susceptibility virological and immunological recoveries in the first 12 months of HAART, partially due to the low prevalence of these mutations in the studied population.

“Oral Manifestations of HIV in Accordance with CD4 Count” – A Cross-Sectional Study

Aims and Objectives: Mouth acts as a mirror for most of the underlying systemic diseases. Very few studies were done in south Indian population to observe the oral manifestations of human immunodeficiency virus (HIV) in relation to the cluster of differentiation 4 (CD4) count, and this study mainly highlights the presenting complaint of HIV patients during their dental visit. The study was aimed to determine the chief complaints of patients along with oral manifestations of HIV and correlate them to CD4 count. Materials and Methods: One hundred consecutive HIV?positive patients were considered for the study. All the oral manifestations and the chief complaints along with the calculated CD4 counts were noted and the results were correlated. Spearman correlation was used for CD4 count and other oral manifestations. Results: The mean CD4 counts were 421 cells/mm3 with a standard deviation (SD) of 404.34 for the most common oral manifestation of burning mouth and 176.5 cells/mm3 for the least common manifestation of malignancies. The CD4 count ranged from 120 to 1100 cells/mm3. The mean age and CD4 count were 38 years and 398.86, respectively. There was a statistically significant correlation with candidiasis and gingivitis, and the rest of the conditions were insignificant. Conclusion: The study results suggest that the chief complaint of presentation of an HIV?positive patient is pain due to carious teeth/abscess followed by burning mouth, with candidiasis being the most common disease.

Hematological Parameters in HIV Patients: Association with CD4 Count

Background: Around 2.1 million people are currently living with human immunodeficiency virus (HIV) infection in India. Hematological parameters have been proposed as alternative markers of HIV infection in areas with limited resources. This study aimed to describe hematological parameters in patients with HIV infection and to determine their association with CD4 cell counts. Methods: This cross-sectional study assessed 100 HIV patients on antiretroviral therapy (ART). Their blood samples were collected to measure complete blood count (CBC) and CD4 count. Patients with known hematological disorders, critically ill patients, and those not willing to give informed consent were excluded. The Chi-square test was used to find the association between hematological parameters and CD4 counts. Results: Most patients with HIV infection had anemia (85%), followed by thrombocytopenia (42%) and neutropenia (36%). There was a statistically significant association between the number of patients having anemia and CD4 cell counts. Conclusion: Hematological changes are common in HIV patients. Hematological parameters should be routinely monitored and managed to reduce morbidity. Also, patients with unexplained low blood counts should be screened for underlying HIV infection.

Manifestaciones orales y recuento de linfocitos T CD4+ en pacientes adultos con infección por VIH atendidos en el Hospital San Juan de Dios. Santiago, Chile

Resumen Introducción: Las lesiones orales clasificadas como fuertemente asociadas a infección por VIH se presentan en casos de inmunosupresión profunda (recuento de linfocitos T CD4+ ≤ a 200 céls/mm3 de sangre). Objetivo: Asociar la presencia de lesiones orales fuertemente asociadas a infección por VIH con el recuento sérico de linfocitos T (LT) CD4+ al momento del diagnóstico. Métodos: Se realizó un estudio transversal en PVVIH atendidas en el Hospital San Juan de Dios entre 2013 y 2019. Las lesiones orales se diagnosticaron por el criterio de EC-Clearinghouse - OHARA, y la inmunosupresión fue determinada según el recuento de LT CD4+. Resultados: De los 240 pacientes reclutados, 35 pacientes presentaron lesiones fuertemente asociadas a infección por VIH y 26 de ellos presentaron inmunosupresión profunda. La probabilidad de ocurrencia de una lesión fuertemente asociada a infección por VIH fue 12,3 veces mayor en pacientes con inmunosupresión profunda. Conclusión: Existe una asociación estadísticamente significativa entre un estado de inmunosupresión profunda y la presencia de manifestaciones orales fuertemente asociadas a infección por VIH/SIDA, lo cual posee relevancia clínica pues se presenta como una herramienta clínica de diagnóstico inicial, progresión de la enfermedad y monitorización de la terapia antiretroviral.

Abstract Background: Oral lesions classified as strongly associated with HIV infection occur in cases of severe immunosuppression (CD4+ T lymphocyte count ≤ 200 cells/mm3 of blood). Aim: To associate the presence of oral lesions strongly associated with HIV infection with CD4+ T lymphocytes count at the time of diagnosis. Methods: A cross-sectional study was carried out in PLHIV treated at the San Juan de Dios Hospital between 2013 and 2019. Oral lesions were diagnosed by the EC-Clearinghouse - OHARA criteria and immunosuppression was determined according to the CD4+ T lymphocyte count. Results: Of the 240 recruited patients, 35 had lesions strongly associated with HIV infection and 26 of them had severe immunosuppression. The probability of occurrence of a lesion strongly associated with HIV infection is 12.3 times higher in patients with severe immunosuppression. Conclusion: There is a statistically significant association between a severe immunosuppression and the presence of oral manifestations strongly associated with HIV/ AIDS infection, which has clinical relevance since it is presented as a clinical tool for initial diagnosis, disease progression and monitoring of antiretroviral therapy.

Dermatoses in Human Immunodeficiency Virus Infected Patients with A Focus on Infections: A 12-month Cross-sectional Study in Hospital Sungai Buloh

Background@#Cutaneous disorders are common clinical manifestations of the Human Immunodeficiency Virus (HIV). In the era of antiretroviral therapy (ART), the spectrum of cutaneous disorders in HIV-infected patients has changed. We assessed the types of dermatoses, including cutaneous infections in HIVpositive patients and the association between the peripheral CD4 cell count and the severity of skin infection.@*Methods@#All HIV-positive patients referred to the Dermatology Department of Hospital Sungai Buloh from January 2021 – December 2021 were enrolled in a prospective cross-sectional study. Patients were subjected to a complete medical and physical examination and appropriate investigation to confirm the diagnosis. @*Results@#A total of 112 (92.6%) male and 9 (7.4%) female patients with a mean age of 38.76 ± SD years participated. The majority of patients were Malay (56.2%), with MSM (54.5%) being the commonest mode of transmission. 65.2% of patients had CD4≥350 cells/ mm3 and 86.7% of patients were on ART. Infections (56.1%) were the most common group of mucocutaneous manifestations, with 45.6% of these due to viral infections. There was no statistically significant correlation between the CD4 count and the severity of skin involvement in bacterial (p=0.302), viral (p=0.145) and fungal (p=0.533) infections.@*Conclusion@#Viral infection were the commonest cutaneous manifestations in HIV- positive patients. The frequency and severity of the cutaneous infections were much more common in patients with more advanced immunosuppression.

Características clínico-epidemiológicas de mujeres con Virus de Inmunodeficiencia Humana. Boyeros. 1986-2016 / Clinical and epidemiological characteristics of women with Human Immunodeficiency Virus. Boyeros. 1986-2016

Introducción: En los últimos años las mujeres constituyen uno de los grupos más vulnerables y afectados por el VIH. Objetivo: Determinar características clínico-epidemiológicas de mujeres con VIH, residentes en el municipio Boyeros. Material y métodos: investigación descriptiva, retrospectiva de pacientes femeninas con VIH, diagnosticadas y residentes en el municipio Boyeros, desde 1986 hasta el 31 de diciembre del 2016. Se incluyeron solo las pacientes mayores de 14 años, vivas, diagnosticadas y residentes en el municipio. La muestra estuvo constituida por 99 casos. La fuente de información se obtuvo de las historias clínicas de la Consulta Municipal especializada para la atención a pacientes con VIH/sida del municipio Boyeros. Resultados: Las tasas de incidencia muestran tendencia ascendente. El 49,5 por ciento se diagnostican con edades entre 15 y 29 años. Predominan las mujeres blancas en 40 por ciento, con nivel de escolaridad secundaria básica (43 por ciento). Un 19 por ciento se hizo el diagnostico como gestante y más de 50 por ciento no declararon vínculo laboral estable. El diagnóstico tardío se presentó en 43 por ciento y a edades mayores. El último conteo de T-CD4 fue mayor de 350 células/mm3 en más de 50 por ciento. El 92,9 por ciento de los casos tienen indicado TARV. Conclusiones: La población femenina con VIH del municipio Boyeros es predominantemente joven, con nivel de escolaridad básica y sin vínculo laboral. Se mantienen casos de diagnóstico tardío y las cifras de T-CD4 muestran valores adecuados en la mayoría de los casos(AU)

Introduction: Women are one of the most vulnerable groups affected by HIV during the last years. Objective: To determine the clinical and epidemiological characteristics of women with HIV in Boyeros municipality. Material and Methods: A descriptive retrospective research was conducted in female HIV patients in Boyeros municipality from 1986 to December 31, 2016. Only alive women older than 14 years living in the aforementioned municipality who were previously diagnosed with HIV were included in the study. The sample was composed of 99 cases. The information was obtained from the clinical records of the Municipal Consultation where specialized care is given to patients with HIV/AIDS. Results: The incidence rates of HIV infection in women showed a rising trend. Also, 49,5 percent of women infected with HIV were between 15 and 29 years of age. There was a prevalence of whites (40 percent) as well as women with secondary levels of education (43 percent). The diagnosis was also made in pregnant women, representing the 19 percent. More than 50 percent of them declared not to have steady jobs. Late diagnosis was identified in 43 percent of women in older ages. The latest T-CD4 count was higher than 350 cells/mm3 in more than 50 percent of them. ART was indicated in 92,9 percent of the cases. Conclusions: The female population infected with HIV in Boyeros municipality is mainly young; a lot of them have basic educational levels and do not have an employment contract. Late diagnosis of HIV infection continues to be identified. T-CD4 cell counts show adequate values in most of the cases(AU)

Profil clinique, immunologique et virologique des personnes vivant avec le VIH suivies au CHUD Oueme-Plateau / NA

Introduction : L'infection par le virus de l'immunodéficience humaine au (VIH) est une infection chronique caractérisée par la destruction progressive du système immunitaire par le virus. L'objectif de cette étude était de décrire le profil clinique, immunologique et virologique des personnes vivant avec le VIH et suivies au CHU Départemental Ouémé-Plateau de Porto-Novo. Méthodes : Il s'agissait d'une étude transversale et descriptive couvrant la période du 1er février 2016 au 1er mai 2016. Il a été procédé à un recrutement exhaustif de toutes les personnes vivant avec le VIH suivies en ambulatoire ou hospitalisées dans le Service de Médecine Interne du CHUD-OP, âgées d'au moins 15 ans et ayant donné leur consentement éclairé. Résultats : Au total 301 patients ont été inclus. L'âge moyen était de 42 ans ± 10,3 ans, avec des extrêmes de 19 ans et 74 ans. Les tranches d'âge les plus représentées étaient celle des 35 à 45 ans (118 patients soit 39,2%) et celle des 25 à 35 ans (72 patients soit 23,9%). Cette population était majoritairement féminine (73,1 %), soit une sex-ratio de 0,37. Les enquêtés, dans 79,4 %, étaient en couple. Le stade clinique 3 de l'OMS était prédominant (47,8%). Parmi les pathologies associées, l'hypertension artérielle était la plus fréquente (18.6%). Parmi ces patients, 300 (99,7 %) étaient porteurs de VIH 1. La charge virale a été réalisée chez 177 (58,8 %) patients et s'est révélée indétectable chez 117 patients soit 66,1 % des cas. La numération des CD4 a été réalisée chez 298 (99 %). Le nombre médian des CD4 était de 350 (Q1=206 ; Q3=504). Parmi les 301 PVVIH, 291 (96,68 %) étaient sous traitement antirétroviral. Conclusion : Cette population de personnes vivant avec le VIH est jeune et consulte tardivement

Introduction : Human immunodeficiency virus (HIV) infection is a chronic infection characterized by the progressive destruction of the immune system by the virus. The objective of this study was to describe the clinical, immunological and virological profile of people living with HIV and monitored at the Ouémé-Plateau Departmental University Hospital in Porto-Novo. Methods: This was a cross-sectional and descriptive study covering the period from February 1, 2016 to May 1, 2016. An exhaustive recruitment was carried out of all people living with HIV followed on an outpatient basis or hospitalized in the Service of Internal Medicine of the CHUD-OP, at least 15 years old and having given their informed consent. Results: A total of 301 patients were included. The mean age was 42 ± 10.3 years, with extremes of 19 and 74 years. The most represented age groups were that of 35 to 45 years (118 patients or 39.2%) and that of 25 to 35 years (72 patients or 23.9%). This population was predominantly female (73.1%), i.e. a sex ratio of 0.37. The respondents, in 79.4%, were in a relationship. WHO clinical stage 3 was predominant (47.8%). Among the associated pathologies, arterial hypertension was the most common (18.6%). Of these patients, 300 (99.7%) were carriers of HIV 1. Viral load was achieved in 177 (58.8%) patients and was undetectable in 117 patients, or 66.1% of cases. CD4 counts were performed in 298 (99%). The median CD4 count was 350 (Q1 = 206; Q3 = 504). Among the 301 PLHIV, 291 (96.68%) were on antiretroviral therapy. Conclusion: This population of people living with HIV is young and consults late.

Evaluation of Depression and Anxiety and Its Association with CD4 Count among HIV Patients Taking Antiretroviral Therapy.

Depression and anxiety are the most common mental disorder affecting individuals with human immunodeficiency virus (HIV) infection. Anxiety is highly prevalent in HIV infected individuals in clinical studies. Early identification and treatment of depression and anxiety in patients may improve better outcome of ART Therapy. We wanted to evaluate the prevalence of depression and anxiety among HIV patients taking antiretroviral therapy and examine the predicting effect of depression and anxiety with demographics on CD4 count. MethodsThis study was conducted in the ART Plus center in Department of Medicine, PT JNM Medical college, Raipur, Chhattisgarh and Dr. Bhim Rao Ambedkar Memorial Hospital between July 2018 and June 2019. A total of 300 patients who were enrolled in the ART plus center, gave consent to participate in study. Participants were selected in systematic random sampling method irrespective of their age, gender, ethnicity, socio-economic status, occupation, education, and present CD4 count. Starting CD4 count was assessed on enrolment to ART center and present CD4 count repeated at the time of recruitment to our study. Depression was evaluated using Hamilton Depression Rating Scale and anxiety was measured by Hamilton Anxiety Rating Scale by a Psychiatrist. ResultsThe first model showed 8.8% of total variance (R= .297, R2=.088; F (5, 298) = 5.683; p<0.01) for starting CD4 count and second model showed 6.7% of total variance (R=.259, R2=.067; F (5, 298) = 4.221; p<0.01) for present CD4 count with five predictor variables (depression, treatment year, gender, age, anxiety). Depression of the patients was negatively associated with starting CD4 count (-.085, p<0.01) before starting ART Regimen. Treatment year of the patients was positively associated with present CD4 count (-.085, p<0.01). ConclusionsThe study demonstrates high prevalence of anxiety and depression among HIV positive patients taking antiretroviral therapy (ART) and strong correlation of depression and anxiety and its associated factors among HIV positive patients taking ART. High depression reported lower level of CD4 count before starting ART regimen.

Feto-maternal outcome in human immunodeficiency virus seropositive mothers in co-relation with CD4 count

Background: To study the effect of human immunodeficiency virus (HIV) infection on pregnancy outcomes and new born as mother to child transmission of HIV is a major route on new infections in children and compare it with HIV uninfected pregnancies.Methods: Prospective comparative study conducted on 40 HIV seropositive and 40 HIV seronegative pregnant women attending ANC and delivering in the department of obstetrics and gynecology, S. M. S. Medical College, Jaipur, Rajasthan, India.Results: CD4 count had no effect on birth weight of baby or term of delivery. HIV seropositive pregnancies were more prone to IUD, still birth and preterm birth (p=0.029). Mother to child transmission was 2.7%.Conclusions: HIV infection increases the risk of adverse foetal outcome in terms of intrauterine demise, still birth and preterm labour.

A prospective study of postoperative outcome following splenectomy in immunocompromised thalassemia patient with special reference to CD4 count

Background: Thalassemia are inherited blood disorders that can result in the abnormal formation of hemoglobin. Splenectomy is indicated in the transfusion-dependent patient when hypersplenism increases blood transfusion requirement and prevents adequate control of body iron with chelation therapy. Ninety percent of recipients transfused with HIV antibody-positive blood are found to be HIV infected at follow-up. Prevailing literature on effects of splenectomy on CD4 count suggests that splenectomy causes an abrupt and prolonged increase in CD4 cell count. The aims and objectives this is an Institution based prospective observational study with the aim to observe postoperative outcome in immunocompromised thalassemic patients following splenectomy, postoperative outcome following splenectomy in a patient with low CD4 count and to analyze the effect of CD 4 count if any on different patients in terms of wound infection, chest infection , urinary tract infection or infection at any other site.Methods: The study included twenty immunocompromised thalassemia Patients attending in Pediatric Surgery OPD and admitted to Paediatric Surgery department of Medical college and hospital Kolkata with splenomegaly and HIV infection for splenectomy, between January 2015 to December 2016.Simple comparative analysis of gathered data was used to evaluate postoperative outcome m and the preop and the post op CD4 count levels of splenectomised thalassaemic patients.Results: Most patients in this study were in the (3-8) years age group and all are HIV positive patients with thalassemia. In this study author found there was increased CD4 count after splenectomy and postoperative period one patient developed postoperative oral candidiasis.Conclusions: HIV-infected thalassaemic patients on ART can now safely undergo major splenectomy surgery with encouraging results and in patients with a low CD4 count, there is no relation of CD4 count and splenectomy outcome.

Study of Serum Albumin Level in Subjects with HIV Infection, in Relation to CD 4 Count, as a Marker of Immune Suppression

Introduction: HIV/AIDS Infection is one of the commonlyencountered illness in our setup. It causes morbidity andmortality worldwide, and the number of HIV-infected patientshas increased dramatically in the past decade. Current studyaimed to record serum albumin level in patients suffering fromHIV infection.Material and methods: A total of 175 subjects were studiedover a period of 3 months. History and examination weredone according to the proforma after taking written informedconsent. Routine investigations included CD 4 Count andLFT. All data were entered in the master chart and analysedusing SPSS Version 20 softwareResults: Out of 175 subjects majority were in age group of 41to 50 years (30.4%) with mean age around 42 years and 101subjects were males (57.7%). Low serum albumin was foundin 67.2% of subjects. 12% of the subjects had CD 4 Count ofless than 100 and among subjects with CD 4 Count of lessthan 100, 76% of the subjects had low serum albumin whichwas statistically significant with p value of 0.003.Conclusion: From the study can conclude that in HIV /AIDSpatients serum albumin levels correlate with CD 4 counts andcan be used as a marker of immune suppression.

Prevalence of tuberculosis in newly diagnosed HIV patients and its relationship with CD4 count in a tertiary care hospital

Background: Tuberculosis (TB) is the commonest opportunistic infection among Human Immunodeficiency Virus (HIV) positive patients in India and HIV/TB co-infection poses a major public health challenge in developing countries. It is estimated that 60-70% of HIV positive patients will develop tuberculosis in their lifetime. The aim of the present study is to record the clinical, radiological profile of pulmonary and Extrapulmonary Tuberculosis (EPTB) in HIV positive patients.Methods: This was a prospective study conducted in the department of Pulmonary medicine, Kempegowda institute of medical sciences. All newly diagnosed HIV patients during the study period were included and screened for tuberculosis irrespective of whether they had signs and symptoms.Results: Among 44(15.94%) patients among 276 HIV positive patients were diagnosed to have tuberculosis. Males (72.72%) were affected more than females (27.27%). Most common affected age group was 31-40 years with a mean age of 38.08 years. Unprotected heterosexual contact was the most common mode of HIV transmission. Fever, weight loss and cough were the commonest symptoms at presentation. Pulmonary TB was diagnosed in 10(22.7%) patients, EPTB in 30(68.3%) and disseminated TB in 4(9%) patients. All the pulmonary TB patients had CD4 count below 250, EPTB below 150 and disseminated TB patients below 50.6(13.63%) patients had pleural effusion, 5(11.36%) had abdominal TB, 5(11.36%) had tubercular meningitis, 4(9%) had intra thoracic lymphadenopathy and one (2.27%) patient had pericardial effusion. Low CD4 count (<150) had statically significant association with HIV/TB co-infection.Conclusions: The prevalence of HIV-TB co-infection was high. Moreover, HIV positive patients need early diagnosis and treatment of active TB. The study has shown clear correlation between clinical data and the laboratory parameter of immunodeficiency (CD4 count) and the temporal development of TB.

Enteric parasitosis and its correlation with CD4 count in human immunodeficiency virus infected patients

Background: The gastrointestinal tract of the HIV/AIDS patient (s) is harboured by a number of luminal extracellular and intracellular parasites. These parasites are responsible for deteriorating and worsening the general health condition(s) of these immunocompromised groups of patients. Moreover, these parasitic infections are often correlated with the CD4 counts of the individuals. Therefore, with a view to assess the relationship between the presence of parasitic infection and that of the CD4 count, the present work is being undertaken.Methods: The study was conducted in the Parasitology section of the department of Life Sciences, Manipur University and CD4 count unit of Microbiology Department, RIMS hospital Imphal from 34 HIV positive Antiretroviral treatment (ART) naive patients, aged between 19 to 50 years. The samples were taken from the patients only after obtaining a signed consent form . Techniques like normal saline method, iodine wet preparation method, formol ethyl acetate concentration technique, Baermann modified funnel technique, modified Ziehl Neelsen staining technique and adhesive cellophane tape method were employed for the present investigation.Results: The present study reveals that patients with CD4 count <200 cells/μl were harbouring only two parasites (Cryptosporidium sp and G. lamblia) whereas individuals with CD4 count within the range of 200-500 cells/μl were observed to have harboured G. lamblia, Cryptosporidium sp, E.histolytica, hookworm, S. stercoralis and A. lumbricoides. On the other hand, enteric parasites associated with CD4 count >500 cells/μl included G. lamblia, hookworm, E. vermicularis and S. stercoralis.Conclusions: The present study shows that occurrence of intestinal parasitism is independent of CD4 count in HIV infected patients. Therefore, based on the present findings, it may be suggested that irrespective of CD4 count(s) and whether the patient experiences diarrhoea or not, regular monitoring of the HIV patient(s) for the presence of enteric parasitosis by adopting standard laboratory protocols should be encouraged for maintaining a healthy life of the people living with HIV/AIDS.

A study on clinical profile of tuberculosis in HIV children

Background: Children born to Human immunodeficiency virus (HIV) positive parents who are not infected with tuberculosis (TB) themselves, are also at higher risk of acquiring TB because of exposure. The source of transmission of TB to a child is usually an adult with sputum-smear positive PTB. To evaluate the clinical, bacteriological and radiological pattern of TB in HIV seropositive children in correlation with CD4 count.Methods: This study was conducted over a period of 12 months from May 2008- April 2009 at GMKMCH Salem. 100 children screened positive for HIV at voluntary counselling and testing centers (VCTC) in Antiretroviral therapy (ART) center and diagnosed to have TB infection as per Revised national tuberculosis control programme (RNTCP) guidelines.Results: Out of the 100 children with HIV and TB infection 62 were males and 38 were females. The ratio was 1.63:1. The sputum positivity in our study shows that only 9% of the children are sputum positive. Sputum culture for M. Tuberculosis remains the gold standard for the diagnosis of Pulmonary TB. In resource-poor countries, the diagnosis is heavily dependent on the sputum AFB smear. In our study CD4 cell count, less than 300 was observed in 33 children. In these children the predominant X-ray lesions were Hilar adenopathy, lower lobe infiltrations, diffuse infiltrates and miliary mottling. Upper lobe infiltrates was common with higher CD4 count mean 350.Conclusions: With the conventional sputum positivity and Tuberculin test not providing an adequate diagnostic help, familiarity with clinical radiological spectrum of TB and HIV co-infection will help in early diagnosis and improve survival among HIV seropositive children.

Correlation between CD4 Count and HIV-1 Viral Load among ART Naive Patients Attending ICTC, SMS Medical College, Jaipur

Objectives: To study the correlation between CD4 count &HIV-1 viral load among ART Naive patients attending ICTCSMS Medical College, Jaipur.Material and Methods: This study was conducted on 250 HIVserologically confirmed, ART Naive cases from ICTC, SMSJaipur. RNA extraction was done from plasma samples byQiagen Viral RNA Mini Kit then HIV-1 Viral load wasdetermined by Qiagen HIV-1 viral load kit on ABI 7500 Fast dxReal Time PCR, while CD4 count was done on FACSCALIBUR flowcytometer (BD Biosciences). SPSS ver. 21.0was used to determine correlation between CD4 count & HIV-1viral load.Results: Out of 250, 216 (86.4%) cases were found in whichviral RNA was detected. These samples were correlated withtheir CD4 Count. The mean of viral load was 194746.2791 ±550442.61805 IU/ml while CD4 count was 282.7674 ±217.56456 cells/ul. Females were having Avg. Viral load228506.7273 & CD4 count 337.21 and males were found tohave Avg. Viral load 179791.9866 & CD4 count 258.65Conclusion: This study concluded a negativecorrelation between HIV-1 RNA viral load and CD4 count inHIV-seropositive ART naïve patients of this part of the country.Our study confirmed that HIV-1 RNA viral load levels aresignificantly higher in women than in men, but no suchsignificant gender difference in the CD4 count was found.

A prevalence study of ocular manifestations in HIV positive patients on highly active anti-retroviral therapy

Background: Among 40 million cases worldwide, 50-75% of patients have at least one ocular manifestation in their lifetime. Many of ocular infections are treatable with therapeutic agents. Ocular manifestations invariably reflect systemic disease and can be the initial manifestations of HIV in many cases. Understanding of ocular sequel of HIV infection can lead to the early diagnosis and effective treatment. This study emphasizes on the need of developing a specific ophthalmic examination for the management of ocular manifestations in HIV infected patients.Methods: Cross sectional and observational study of 100 HIV positive participants on HAART were done irrespective of presence or absence of ocular symptoms. Participants were examined for complete ocular examination. Prevalence find out using chi-square test, find p values and ensuring statistical significance.Results: In our study, prevalence of ocular manifestation in HIV positive patients receiving HAART was 39%. Out of them, 20% adnexal involvement, 28% anterior segment involvement, 33% posterior segment involvement, 11% neuro-ophthalmic abnormality, 4% orbital involvement were present. 76% patients belonged to WHO clinical stage 2 and 3. 51% had CD4+ T cell counts <200 cells/µl.Conclusions: Posterior segment followed by anterior segment are the most commonly encountered ocular manifestations of HIV infection. Low CD4 count is good predictor for ocular manifestations in HIV positive patients. Higher WHO stage is also directly related with the severity of the ocular symptoms. Routine baseline ophthalmic screening to all HIV positive patients are necessary to prevent ocular morbidity.

Clinical and immunological responses of zidovudine lamivudine-nevirapine versus tenofovir lamivudine-efavirenz antiretroviral treatment among HIV-1 infected adults: Gandhi Hospital, Telangana, India

Background: HAART (Highly active antiretroviral therapy) is the cornerstone of management of patients with HIV infection. Antiretroviral therapy was started in the year 1986 with the first drug Zidovudine (ZDV). Later on, other antiretroviral drugs (NRTIs, NNRTIs and Pls) were introduced. Dual and mono therapies were used initially but the problem of resistance emerged. Currently, 3 or more ARV drugs are recommended globally for the treatment of people with HIV infection.Methods: A cross-sectional descriptive study conducted at a tertiary care Hospital over 200 patients, two commonly used medications are ZLN (Zidovudine+Lamivudine+Nevirapine) and TLE (Tenofovir+Lamivudine+Efavirenz ). The factors considered to affect the clinical and immunologic outcomes in both groups were assessed using baseline CD4 count, WHO clinical staging, presence of chronic diarrhea, anemia, and baseline weight, occurrence of TB, and switching of ART regimen.Results: A total of 200 patients were included in the study. ART documents of 100 patients are on Zidovudine+Lamivudine+Nevirapine) and 100 patients are on TLE (Tenofovir+Lamivudine+Efavirenz) regimen. Out of 200 patients, 97 were males and 103 were females. Maximum number of subjects were in the age of 15-45 years (82.5%) followed by 45 and above (17.5%). Mean age was 34.5±2.5 (years) with range 15 to 65 years. The baseline CD4 count of the patients, 94 were <350 and 6 were ≥350 on ZLN, in case of TLE 82 were <350 and 18 were ≥350. CD4 count after 6 months in 200 patients as follows, 60 were <350 and 40 were ≥350 in case of TLE 53 were <350 and 47 were ≥350.Conclusions: This research finding concluded that there is no critical difference between the two medications in regards to serious adverse events but did find that TDF is superior to AZT in terms of immunologic response and adherence and more frequent emergence of resistance.

Association of CD4 count with anthropometric parameters and metabolic alterations in treatment naive human immunodeficiency virus infected patients

Background: Body fat abnormalities and metabolic derangements are well known to occur in human immunodeficiency virus (HIV) infection. The objective of present study was to evaluate the anthropometric parameters, fasting lipid profile and fasting blood sugar in treatment naïve HIV patients and to assess any relation with CD4 count.Methods: Anthropometric measurements, latest CD4 count were recorded from HIV patients. Blood was collected from patients for lipid profile and sugar measurements.Results: Anthropometric parameters showed a gradual increase in waist circumference (WC), increase in waist hip ratio (WHR) and decrease in body mass index (BMI) as CD4 count declined. Fasting lipid profile showed a gradual decrease in total cholesterol, low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) and increase in triglycerides (TG) and very low density lipoprotein cholesterol (VLDL-C) as CD4 count declined which were statistically highly significant (P<0.001). Compared to higher CD4 group (350-500/ mm3), the lower CD4 group (<50/mm3) showed a decrease in mean total cholesterol by 60 mg/dL, LDL-C by 76 mg/dL and HDL-C by 13 mg/dL. The increase in mean TG and VLDL-C were 154 mg/dL and 30 mg/dL respectively. Comparison of fating blood sugar (FBS) between CD4 groups showed a gradual rise in FBS as CD4 count declined.Conclusions: As CD4 count declines, metabolic alterations occur in treatment-naïve HIV patients with substantial decrease in serum total cholesterol, HDL-C, LDL-C and an increase in TG and VLDL-C and increased incidence of impaired FBS. Morphological alteration in advanced HIV is evidenced by increased WC, WHR and decreased BMI.

Incidence of Seropositive But HIV-1 Viral RNA Not Detected Naive Cases In Rajasthan

Objectives: To identify cause of HIV seropositive but ViralRNA undetected naive cases in Rajasthan.Materials and Methods: This study included 250 HIV seropositive cases from ICTC Centre, SMS Jaipur .HIV Viral loadwas done by Qiagen HIV-1 viral load kit on ABI 7500 Fast dxReal Time PCR, while CD4 count was done on FACSCALIBUR flowcytometer (BD Biosciences).Results: A total of 250 HIV Serological confirmed positivesamples were tested for HIV-1 RNA viral load & CD Count inthe period of 2014-19. Out of 250, 26 (10.4%) cases werefound in which viral RNA were undetected. out of 26seropositive but HIV RNA undetected case, 16(61.5%) wereMale while 10 (38.5%) were females. Mean of CD4 in Femalewas 565 while 650 in males.Conclusion: HIV‑1 seropositive patients but undetected viralload is not uncommon in society. HIV sero-positive but viralRNA undetected males CD4 count were higher than females. Itwas also observed that all the cases of seropositive withundetected viral load had higher CD4 count comparative withseropositive with viral RNA detected patients. It is concludedthat RNA viral load test is a prognosis test, although suchpatients who had seropositive but viral load undetected needfurther investigations after 3-4 weeks to monitor the status ofthe disease