Impact Of Integrated Yoga Practice on Immune Parameters and Quality of Life of Adult People Living With HIV: Protocol for A Randomized Open-Label Trial in Chittoor, India

Background: Yoga therapy can be a promising adjunct to antiretroviral therapy. However, evidence on the ef-fectiveness of Yoga therapy is scanty. The proposed trial will estimate the effect of integrated yoga practice for six months on immune parameters (CD4 (cluster of differentiation 4), viral load) among adult people living with HIV (PLWH) and its cost-effectiveness from the healthcare system’s perspective. Methods: In this randomized open-label parallel-group trial, 110 PLWH in stage 2 HIV, between 18 and 49 years in the intervention arm and 220 PLWH in the same stage will be recruited by block randomization. Inte-grated yoga practice will be given for six months in the intervention arm, and health education on yoga prac-tice in the control arm, besides antiretroviral therapy. After six months, the difference in immune parameters, cardio-metabolic indicators and quality of life (QOL) will be assessed. Besides, an economic evaluation will be done with sensitivity analysis. If found useful, the intervention can be tested at large scale for further confir-mation of the outcomes. Irrespective of the study's outcome, the results will be disseminated through peer-reviewed journals.

A study to find the correlation between mucocutaneous manifestations and CD4 counts among the newly diagnosed HIV individuals

Introduction: Skin disorders are common manifestations of HIV disease. A study was conducted to find the correlation between the degree of immunosuppression and the incidence of specific skin disorders in patients with HIV infection. Materials and methods: Study was conducted in the department of dermatology, SCB Medical College and Hospital, Cuttack from October 2010 to September 2012. Random sampling was considered in this study. Referred patients, after pretest counseling at ICTC Centre, were included and individuals who are on antiretroviral treatment were excluded. Relevant diagnostic tests were performed like scraping and KOH examination for the diagnosis of dermatophytoses and candidiasis, Tzanck smear for herpes infection, Darkfield microscopy for diagnosis of a syphilitic ulcer, Biopsy is done wherever required. CD4 count was done as per the guidelines. Results: A total of 150 (100%) participants were included, the male-female ratio was 1.8. Age-wise, 57% (85) were included in 31–45 group and 15% were unmarried. Fungal infections constitute 17.9% of total mucocutaneous disorders followed by bacterial infections (10.5%), viral (8.09%) and parasitic (6.7%) infestations. Conclusion: Age group, 31–45 years is the commonest for HIV infection. Fungal infections (dermatoses) of the skin were most common followed by bacterial folliculitis, herpes zoster, and scabies. Except for viral infections, the mean CD4 counts were <200cells/cu mm.

Clinical presentation of vernal keratoconjunctivitis in an immunocompromised patient: a case report

Vernal keratoconjunctivitis(VKC)is a chronic bilateral inflammation of the conjunctiva, commonly associated with a personal or family history of atopy. It is characterized by severe itching, foreign body sensation, thick ropy discharge, photophobia and conjunctival injection. VKC has palpebral, limbal and mixed forms. The classical conjunctival sign in palpebral VKC is the presence of giant papillae, which are predominantly seen on the superior tarsal conjunctiva. The limbal form occurs in dark skinned individuals and the papillae tend to occur at the limbus and have a thick gelatinous appearance. Clinical findings and laboratory investigations support the presence of IgE mediated type1 hypersensitivity reaction. Involvement of CD4 T helper (Th2) driven type IV hypersensitivity has also been confirmed. There has been an increase in the prevalence of allergic disorders in recent years and exaggerated manifestations of these diseases have been recognized in patients living with Human immunodeficiency virus

Factors affecting adherence to antiretroviral therapy in Andhra Pradesh, India

Background: An important factor to effectiveness of ART is good adherence to treatment. This study aims to investigate the adherence levels to ART among people living with HIV (PLHIV) attending a Government ART centre in Anakapalli, Andhra Pradesh, India.Methods: A cross sectional study was done among 1000 adult PLHIV receiving ART. Out of nearly 4500 patients on ART we selected 1000 patients by simple random sampling technique. The average of adherence for a period of 2 years and socio demographic details were taken from the patients treatment card. Chi square test was performed to find out significant difference between the socio-demographic variables and adherence level < 95%.Results: Out of 1000 patients, 53.9% were male. 42.2% were in age group 31 to 40 years. 50.1 % had adherence >95%. Major factors influencing poor adherence were: decrease in weight (OR=18.65, p=0.000); decrease in CD4 counts (OR=20.12, p=0.000), presence of opportunistic infections (OR=12.67, p=0.000), WHO stage 3 and 4 illness (OR=6.50, p=0.000), travel distance to ART >50 kilometres (OR=1.94, p=0.000), smoker (OR=1.82, p=0.000),being illiterate (OR=1.72, p=0.000), and alcohol consumption (OR=1.58, p=0.001).Conclusions: Careful monitoring of weight, CD4 counts and opportunistic infections can help to identify poor adherence early.

Neopterin and Biochemical Parameters as Indicators of Predicting HIV Disease Progression and Treatment Response: A Cross-sectional Study in Ghana

Background: Surrogate markers have been identified to play significant role in the pathogenesis and prognosis of HIV infection. However, there is limited data on the utility of neopterin estimation in HIV infection. Therefore, the study sought to measure and ascertains the trends of serum neopterin and other biochemical parameters as indicators of predicting HIV disease progression and treatment response among HIV seropositive individuals Methods: A cross-sectional study with 298 HIV seropositive individuals consisting of 165 HIV on highly active antiretroviral treatment and 136 naïve highly active antiretroviral patients. Venous blood was drawn for the assay of neopterin and the other biochemical parameters.Results:Neopterin was significantly lower (P<0.0001) in patients in the highly active antiretroviral therapy than those in the naïve highly active antiretroviral therapy group. Serum neopterin increased as the disease progresses and decreased as the duration of the therapy treatment increased (p=0.0001). At a cut of point of 54.5nmol/L, neopterin gave a sensitivity of 97.5%, specificity of95.9% and an area under the curve of 0.99.Conclusion: Neopterin has shown to be to be good marker in predicting HIV disease progression especially in patients with CD4 counts less than 200mm-3and a useful indicator of patient’s response to therapy treatment.

High-Resolution Computed Tomography Lung Spectrum In Symptomatic Adult Hiv-Positive Patients In Correlation With Cd-4 Count

Context: Pulmonary disease accounts for 30–40% of the acute hospitalizations of HIV-positive patients. The CD4 count, anindicator of the severity of immune compromise, is of paramount importance for rendering an appropriate differential diagnosis.High-resolution computed tomography (HRCT) of lung provides detailed visualization of lung parenchyma and can characterizediseases according to pattern and distribution which can help in formulating a differential diagnosis.Aims: The aims of this study were as follows: (1) To identify the radiological appearance/pattern of HIV-associated infections.(2) To correlate the radiological findings with CD4 count.Settings and Design: This was a cross-sectional study using sample size of 100 HIV-infected patients conducted at theDepartment of Radiodiagnosis and Imaging, Gandhi Medical College and Hamidia Hospital, Bhopal.Materials and Methods: A total of 100 adult HIV-infected patients were scanned with HRCT chest and findings were documentedand correlated with their CD4+ counts.Statistical Analysis Used: Data analysis was done using SPSS 21.0. Two-tailed P < 0.05 was considered statistically significant.Results: TB (70%) was the most common infection followed by bacterial pneumonia (14%) and Pneumocystis jiroveci pneumonia(6%). Tuberculosis was found in 29% of advance CD4 count patients and 27% of severe CD4 count patients. Consolidation,airspace nodules, miliary nodules, diffuse ground-glass opacity, and pleural effusion showed significant correlation with CD4counts.Conclusions: Incidence of all these manifestations fairly correlates with the decline of CD4 counts. Early and proper diagnosisof these pulmonary complications in patients with HIV infection and lower CD4 counts will help clinicians to develop a focusedtherapeutic approach in their management.

Central Nervous System Infections in HIV Patients: An Experience from a Tertiary Level Hospital in Mumbai.

Background: Opportunistic infections of the central nervous system (CNS) are common complications of advanced immunodeficiency in individuals with human immunodeficiency virus (HIV) infection. We aimed to study the clinical profile of CNS infections in HIV patients, effect of antiretroviral therapy (ART) on various patient variables and mortality outcomes associated with various patient characteristics. Methods: After approval of the ethics committee, we enrolled 100 patients from the Department of Medicine at Lokmanya Tilak Municipal General Hospital from January 2011. Patients who were diagnosed with HIV using ELISA and admitted with a CMS infection were consented and enrolled for the study. Various clinico-laboratory parameters like CD4 counts, ART, signs and symptoms were collected and analysed with approapriate statistical techniques. P vlaue less than 0.05 was taken as staistically significant. Results: Out of 100 patients, 71 were males, average age 35.24 years. Majority had headaches, CD4 counts between 101-200 cells/mm3and 57 were on ART. Tubercular mengitis was the most common CNS infection in our patient population. We found statistical signifiance in the occurance of CNS infections and ART among patients. Mortality outcomes were significantly associated with signs and symptoms of the patients (p < 0.05). Conclusion: Our results show that CNS infections can occur even with high CD4 counts. So strict monitoring and long term followup of HIV patients is needed. Areas of future research should focus on long term clinical outcomes of HIV patients and elucidating factors reponsible for it.

Demographic Profile and Clinical Features of Admitted HIV Positive Patients and their Correlation with CD4 Counts in a North India Tertiary Care Hospital.

Background: HIV Infections continues to be a burden globally and presents serious public health problems in the developing countries, especially in India. Aims and objectives: To study the demographic profile and clinical features of HIV positive admitted patients and to evaluate the correlation of clinical features with their CD4 counts. Methods: The present study was conducted to assess the socio-demographic profile and clinical features of 150 HIV+ve /AIDS patients admitted in various wards of Department of Medicine, Rajindra Hospital, Patiala from September 2013 to October 2015. For these patients a preformed questionnaire was prepared to enquire about socio-demographic characteristics such as age, sex, literacy status, marital status, occupation and socio-economic status. Thorough clinical examination was performed and correlation of clinical features with CD4 counts was evaluated using Pearson Coefficient of correlation. Results: The results of study showed that the most common age group affected was 26-45 years (56%). Male patients were 69.3% and females constituted 30.7%. Most common mode of transmission was heterosexual (73.3%), followed by intravenous drug abuse (6.7%), unsafe injections/needle stick injury (4.6%), blood transfusion (2.7%), 8% were both HS and IDU and transmission was unknown in 2.7%. The common presenting symptoms in admitted HIV patients were fever (71.3%), weight loss (50%), night sweats (39.3%), dry cough (36%), anaemia (32%), cough with expectoration (26%), lymphadenopathy (24%), shortness of breath (22%), chest pain (20.7%),diarrhoea (15.3%) and mouth ulcers (8.7%). Others were, headache (10.7%), haemoptysis (10%), icterus (6.7%), change of voice (4%), altered sensorium (14%) and neurological deficit (7.3%). 16 patients had pulmonary and 13 had extra pulmonary tuberculosis. It was also found that most patients (52%) had CD4 count in range of 200-500, with mean CD4 count of 282.61 + 14.31 cells/cmm at time of presentation. The frequency of these symptoms increased with fall in CD4 count indicating negative correlation. Conclusion: A thorough knowledge of the demographical & clinical profile of admitted patients will go a long way in managing resources and planning management of these patients. This will serve as a great step in achieving zero deaths as envisaged by NACO.

Zero transmission of HIV: Till date’s only way leading towards its possible eradication.

Background: AIDS emerged as one of the most important public health issues of the late twentieth and early twenty-first centuries. The AIDS epidemic has prompted Wide-reaching changes in public health, clinical practice, and scientific research, and has had a great impact upon socities throughout the world. Aim: This article gave an insight into beak up of mode of transmission seen in our studied area of Gujarat, which highlighted in which area one should focus more at least to control the prevalence of HIV. Material and methods: In the present study 961 HIV sero-positive patients (T group) were screened with respiratory tract infections and more 300 HIV sero-positive patients but without respiratory tract infections (C2 group) had been inquired and collected their information about mode of transmission and other demographic characters like age, literacy, financial status, gender etc. Results: The highest patients had acquired HIV by hetro -sexual mode of transmission. In T group it was found to be in 773 (80.43%), while in C2 group it was seen among 257 (85.67%) HIV infected patients. But when both groups are merged which we consider TC2 group, this hetero-sexual mode of transmission was noted in 1030 (81.68%) HIV infected patients, followed by mother to child transmission (MTCT) which was found in 101 (10.51%) patients of T group while MTCT was seen in 29 (9.67%) HIV infected patients of C2 group. Conclusion: If anybody knows exact percentage of acquiring HIV in the particular area, one can work on this direction, to reduce that particularly mode mode of transmission seen in our studied area of Gujarat, which highlighted in which area one should focus more at least to control the prevalence of HIV. Material and methods: In the present study, 961 HIV sero-positive patients (T group) were screened with respiratory tract infections and more 300 HIV sero-positive patients but without respiratory tract infections (C2 group) had been inquired and collected their information about mode of transmission and other demographic like age, literacy, financial status, gender etc. Results: The highest patients had acquired HIV by hetero9-sexual mode of transmission. In T group it was found to be in 773 (80.43%), while in C2 group it was seen among 257 (85.67%) HIV infected patients. But when both groups are merged which we consider TC2 group, this hetero-sexual mode of transmission was noted in 1030 (81.68%) HIV infected patients, followed by mother to child transmission (MTCT) which was found in 101 (10.51%) patients of T group while MTCT was seen in 29 (9.67%) HIV infected patients of c2 group Conclusion: If anybody knows exact percentage of acquiring HIV in the particular area, one can work on this direction, to reduce that particular mode of transmission so that at least prevalence of HIV could certainly be decreased tremendously in that particular area, state, country and ultimately from globe. Minimum transmission of HIV can be achieved by widespread of ABC (Abstinence, behavioral change, condoms) policy and with additional maximum and quick implementation of TasP (Treatment as prevention), PrEP (Pre-exposure prophylaxis) and PEP (Post exposure prophylaxis) as and when required in the all ART Centres of our country.

Current scenario of Opportunistic and co-infections in HIV-infected individuals at a tertiary care hospital in Mumbai, India.

Purpose: An update on opportunistic infections/co-infections (OIs/CIs) is essential to understand the success of highly active antiretroviral therapy offered by the government agencies in reducing AIDS-related OIs/CIs. Hence, the present study aimed to evaluate the frequency of OIs/CIs in HIV-positive individuals at a tertiary care hospital in Mumbai. Its’ association with CD4 counts, anti-retroviral treatment and on HIV transmission was also determined. Materials and Methods: An observational study was designed to evaluate different OIs/CIs in individuals, who tested positive for HIV infection at the ICTC/Shakti Clinic of Seth G.S. Medical College and KEM Hospital, Mumbai. Data analysis was done with the use of SPSS software (version 19.0, SPSS, Chicago, IL, USA). P value was considered signifi cant if it is < 0.05. Results: Heterosexual contact was the major route of transmission among the enrolled 185 individuals. Ninety (48.06%) HIV-infected individuals were with OIs/CIs. Tuberculosis (TB) was the most common OI (68.8%). Other CIs noted were Herpes zoster, syphilis, hepatitis C and B, malaria, typhoid and dengue. The median CD4 count in HIV-positive individuals with TB was 337 ± 248 cells/μl, and 67.7% of individuals with OIs/CIs had low CD4 counts (<400 cells/μl). Individuals in 31-40 years of age group had signifi cantly (P = 0.01) more OIs/CIs. More (53.7%) spouse/children of HIV-positive individuals without OIs/CIs were HIV-1 positive. Low proportions of individuals with or without OIs/CIs were on ART. Conclusion: Nearly half of HIV-infected individuals were with OIs/ CIs. Initiation of free ART programme since 2004 possibly associated with the type and rate of OIs/CIs. Tuberculosis and multiple OIs/CIs were associated with low CD4 counts. Infection was high in 31-40 years age group. Most of the spouses of individuals without OIs/CIs were HIV positive, indirectly indicates lack of condom use or lack of awareness of condom use.

Calcium and Total Bilirubin Levels in Patients Co-Infected with HIV and Hepatitis C Viruses in Lautech Teaching Hospital, Osogbo, South West Nigeria.

Aim: One third of HIV patients are co- infected with HCV. As HIV patients live longer this coinfection and its complications such as liver cirrhosis, hepatic carcinoma, metabolic syndrome are emerging as major manifestations of the disease that need to be dealt with promptly in order to avoid a reduction of the positive effects of highly active antiretroviral therapy (HAART) on HIV/AIDS introduced in 1996. Another system that could be affected by co-infection is the skeletal system. It has been shown that HIV itself and in combination with HCV could lead to a reduction in bone mineral density (BMD) predisposing to pathological fractures. It is thus important to determine the state of calcium metabolism among our HIV/HCV patients in order to forestall negative impacts on our patients who have been stable on HAART for several years. The majority of our patients are on combination therapy of Zidovudine, Lamivudine and Nevirapine. The hepatic complications of HIV/HCV co-infection have been well established. In our previous studies signs of hepatic inflammation have been demonstrated by raised aspartate transaminase (AST) and alanine transaminase (ALT) levels. However in this study we wish to also demonstrate liver damage through estimation of bilirubin levels. Methodology: Antibodies to HIV were determines using Unigold and determine. immunochromatographic device was used to detect anti-HCV. Total bilirubin and calcium were analyzed using vitros DT-60 card reader. Results: The majority of our patients were female. In group I up to %80. There was a statistically significant elevation of total bilirubin levels in HIV/HCV co-infected patients when compared to HIV mono-infected patients. There were statistically significant changes in calcium levels between the groups Conclusion: Information on HIV/HCV co-infection and its effects on calcium metabolism in this clinical instance appears to be scarce. Intensification of research is required to firmly establish the role of HIV/HCV co-infection on calcium metabolism in our clinical instance.

The Effect of Co-infection with Hepatitis C Virus on Incidence of Anaemia, Liver Transaminases and Immunological Markers among HIV Patients on HAART in South West (Osun State) Nigeria.

Introduction: It is becoming clear that a major complication of HIV patients on HAART is coinfection with hepatitis C and its attendant sequalae such as liver cirrhosis and carcinoma. The aim is to determine the prevalence of anaemia, transaminitis in these co-infected patients. Materials and Methods: Three groups of patients were studied. There were a total of 44 male and 106 females included in the study. No children were among. Those co-infected with both HIV and HCV (group I), HIV only (group II) and negative for both viruses (Group III). Each group consists of 50 patients each. HIV status was determined utilizing determine and Unigold to detect HIV antibodies. HCV was determined by detecting the anti-HCV antibody (IgG) using third generation ELISA kit from DIA.PRO, Italy. The haematological indices were determined using the Sysmex haematology analyser. Liver transaminases were determined from the sera of the participants using Randox kits and absolute CD4 positive lymphocyte cells were determined using Partec cyflow (SL Green). The results were statistically analysed. Results: No case of anaemia was detected. CD4 counts in group I patients (HIV /HCV positive) and group II patients were clearly reduced. The CD 4 counts were markedly reduced when compared to the controls (group III) P<0.005. The liver enzymes were markedly raised in coinfected patients. Conclusion: The major observations in our group of co-infected patients was marked transaminitis and reduced CD 4 counts in co-infected patients. It is necessary to determine HCV genotypes to explain why our patients have not presented with increased cirrhosis and hepatic carcinoma.

CD4 count evaluation in HIV-TB co infection before and after anti-tubercular treatment.

Background: The global impact of Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) co-infection is one of the major public health challenge. India has a very high burden of TB according to the WHO. A decrease in CD4 counts in HIV-TB co-infection leads to an increase in morbidity and mortality. Methods: Information regarding the duration of HIV, type of TB, CD4 counts before and after ATT and any associated Opportunistic Infections (OIs) were collected from the records of 100 patients with HIV-TB co-infection who attended ART centre for a period of one year. The collected data was statistically analyzed. Results: In the study group, 35 had Pulmonary Tuberculosis (PTB) and 65 had Extra Pulmonary Tuberculosis (EPTB), 40 had OIs. Mean CD4 count prior to ATT in PTB was 197 (7-940), EPTB 192 (13-683) and with OIs 129 (7-288). After completion in PTB was 300, EPTB 302 and 252 in OIs. Least CD4 count of 121 was observed in patients above 50yrs and after completion it was 133. Incidence of both EPTB and PTB was higher in males 66.2% and 62.9%, and in the age group of 31-50 yrs 50.8% and 60% (Cell counts expressed in cells/μl.). Conclusion: In our study, we found that there was significant recovery of CD4 cells following ATT. Difference in CD4 counts among patients with PTB and EPTB was not significant. There was remarkable reduction of CD4 counts in patients who had other OIs and the recovery after ATT was also marginal.

Pulmonary Manifestations in HIV Seropositive Patients and Their Correlation with CD4 Counts in a Tertiary Care Centre of North India.

The prolonged course of human immunodeficiency virus (HIV) infection is marked by a decrease in the number of circulating CD4+ T helper cells and persistent viral replication, resulting in immunologic decline and death from opportunistic infections. The study was conducted in HIV Seropositive Patients admitted in our hospital. Demographic profile of the patient was recorded along with history, examination, investigations and evaluated for pulmonary manifestations and correlated with the CD4 counts. Age of HIV positive cases ranged from 21 to 74 years, male: female ratio was 3:1. Commonest mode of transmission was heterosexual sex (77%) followed by IV drug abusers (13.3%). Commonest X- ray finding was Infiltrates (33.3%) followed by pleural effusion (8%) and miliary mottling (5.3%). Commonest pulmonary diagnosis was pulmonary tuberculosis in 22.6% cases, followed by pyogenic pneumonia in 14.67% and pneumocystis carinii pneumonia (PCP) in 5.3% cases. Extrapulmonary tuberculosis was present in 16% of the cases. Pulmonary tuberculosis and pyogenic pneumonia was present in over wide range of CD4 count but their incidence has increased as the CD4 count declined. The knowledge of the CD4 count level in HIV patients is extremely useful in making differential diagnosis and suggesting a diagnostic and therapeutic plan.

Use of first line antiretroviral therapy from a free ART programme clinic in Pune, India - A preliminary report.

Background & objectives: The treatment outcomes under national antiretroviral therapy (ART) programme are being evaluated in some ART centres in the country. We carried out this study to analyze the impact of first line antiretroviral therapy in HIV infected patients attending a free ART roll out national programme clinic in Pune, India. Methods: Antiretroviral naive HIV infected patients attending the clinic between December 2005 and April 2008 and followed up till March 31, 2011 were included in the analysis. The enrolment and follow up of these patients were done as per the national guidelines. Viral load estimations were done in a subset of patients. Results: One hundred and forty two patients with median CD4 count of 109 cells/μl (IQR: 60-160) were initiated on treatment. The median follow up was 44 months (IQR: 37-53.3 months). Survival analysis showed that the probability of being alive at the end of 5 years was 85 per cent. Overall increase in the median CD4 count was statistically significant (P<0.001). It was significant in patients with >95 per cent adherence (P<0.001). In 14 per cent patients, the absolute CD4 count did not increase by 100 or more cells/μl at the end of 12 months. Viral load estimation in a subset of 68 patients showed undetectable levels in 61 (89.7%) patients after a median duration of 46 months (IQR: 38.3-54.8). Interpretation & conclusions: The first line treatment was effective in patients attending the programme clinic. The adherence level influenced immunological and virological outcomes of patients.

Absolute lymphocyte count as a surrogate marker for CD4 counts after six months of HAART initiation in a resource-limited setting in India.

Background & objectives: Owing to the ever-expanding access to HAART (highly active anti-retroviral therapy) in resource-limited settings, there is a need to evaluate alternate markers like absolute lymphocyte count (ALC) as a surrogate for CD4 counts. This study was done to assess the usefulness of ALC as a surrogate marker for CD4 counts in monitoring HIV-infected patients after HAART initiation. Methods: In this study, 108 HIV-positive adult patients of both sexes fulfilling the inclusion criteria were included. CD4 and ALC were recorded at baseline. After initiation on HAART, these patients were followed up at three month intervals. Results: ALC and CD4 counts were positively correlated (Spearman correlation coefficient= 0.553). After six months of HAART, the sensitivity of an ALC increase as a marker for CD4 count increase at six months was 82 per cent, specificity was 100 per cent, PPV was 100 per cent and NPV was 31 per cent. Area under the corresponding ROC curve for CD4 increase of >100 cells/μl was 0. 825 ± 0.053. Interpretation & conclusions: ALC may be a useful surrogate marker in predicting an increase in CD4 counts as a response to HAART, but of questionable value in predicting a decrease in CD4 counts.

HIV serodiscordant relationships in India: Translating science to practice.

Over the past 30 years, several interventions have been identified to prevent HIV transmission from HIV-infected persons to uninfected persons in discordant relationships. Yet, transmissions continue to occur. Interventions such as voluntary counselling and testing, condom promotion and risk reduction counselling are very effective in preventing transmission among serodiscordant couples but are underutilized in India despite their widespread availability. New interventions such as pre-risk exposure prophylaxis and universal antiretroviral therapy (irrespective of CD4 count) have been newly identified but face several challenges that impede their widespread implementation in India. Discordant couples in India also face certain unique socio-cultural issues such as marital and fertility pressure. We briefly review the various interventions (existing and novel) available for persons in discordant relationships in India and socio-cultural issues faced by these individuals and make recommendations to maximize their implementation.

Postpartum changes in plasma viral load and CD4 percentage among HIV-infected women from Latin American and Caribbean countries: the NISDI Perinatal Study

The goal of this study was to evaluate changes in plasma human immunodeficiency virus (HIV) RNA concentration [viral load (VL)] and CD4+ percentage (CD4 percent) during 6-12 weeks postpartum (PP) among HIV-infected women and to assess differences according to the reason for receipt of antiretrovirals (ARVs) during pregnancy [prophylaxis (PR) vs. treatment (TR)]. Data from a prospective cohort of HIV-infected pregnant women (National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study) were analyzed. Women experiencing their first pregnancy who received ARVs for PR (started during pregnancy, stopped PP) or for TR (initiated prior to pregnancy and/or continued PP) were included and were followed PP. Increases in plasma VL (> 0.5 log10) and decreases in CD4 percent (> 20 percent relative decrease in CD4 percent) between hospital discharge (HD) and PP were assessed. Of the 1,229 women enrolled, 1,119 met the inclusion criteria (PR: 601; TR: 518). At enrollment, 87 percent were asymptomatic. The median CD4 percent values were: HD [34 percent (PR); 25 percent (TR)] and PP [29 percent (PR); 24 percent (TR)]. The VL increases were 60 percent (PR) and 19 percent (TR) (p < 0.0001). The CD4 percent decreases were 36 percent (PR) and 18 percent (TR) (p < 0.0001). Women receiving PR were more likely to exhibit an increase in VL [adjusted odds ratio (AOR) 7.7 (95 percent CI: 5.5-10.9) and a CD4 percent decrease (AOR 2.3; 95 percent CI: 1.6-3.2). Women receiving PR are more likely to have VL increases and CD4 percent decreases compared to those receiving TR. The clinical implications of these VL and CD4 percent changes remain to be explored.

Tuberculosis-HIV Coinfection: The Relationship Between Manifestation Of Tuberculosis And The Degree Of Immunosuppression (CD4 Counts)

The incidence of tuberculosis (TB) is currently increasing. HIV induced immuno-suppression modifies the clinical presentation of TB. Our aim is to determine the differences in clinical presentation of HIV-TB co-infection based on their CD4 counts. This retrospective study looked at cases of adult active TB and HIV-1 co-infection treated in Penang Hospital from January 2004 to December 2005. Of the 820 patients treated for active TB, HIV-1 seropositivity rate was 12.6% (103 patients). Majority of HIV-1 co-infected patients presented with prolonged insidious and non-specific symptoms like weight loss, fever and night sweats. The clinical presentation of TB depended on the stage of HIV-1 infection and associated degree of immunodeficiency. Compared to the less immuno-compromised HIV-1 and TB co-infected population (CD4 > 200/mm3), patients with CD4 counts ² 200 are more likely to have atypical chest radiographs (P = 0.009). During active TB, the Mantoux test was positive in 12 (14.5%) HIV-1 infected patients with a CD4 counts ² 200/mm3 and in 16 (80%) of those with CD4 counts > 200/mm3 (P = 0.0001). In our series, the AFB smear / AFB culture and type of TB did not show obvious correlation with CD4 counts. Therefore to diagnose TB in severely immuno-compromised HIV patients, we need to have a high index of suspicion.

Evaluating total lymphocyte counts as a substitute for CD4 counts in the follow up of AIDS patients

This study evaluated total lymphocyte count (TLC) as a substitute marker for CD4+ cell counts to identify patients who need prophylaxis against opportunistic infection (CD4 < 200 cells/mm³) and patients with CD4 < 350 cells/mm³ (Brazilian threshold value of CD4 count to define AIDS). We evaluated TLC and CD4+ cells count of 1,174 HIV-infected patients, in Salvador, Brazil, from May 2003 to September 2004. CD4+ cell counts were performed by flow cytometry, and TLC was measured with an automated hematological counter. The mean CD4 count was 430 cells/mm³ (range: 4 to 2,531 cells/mm³). Mean TLC was 1,900 cells/mm³ (range: 300 to 6,200 cells/mm³). Using a threshold value of 1,000 cells/mm³ for TLC, the positive predictive value (PPV) was 77 percent for CD4 < 200 cells/mm³, but the sensitivity was only 29 percent, while the negative predictive value (NPV) was 88 percent, with 98 percent specificity. Similar findings were observed for CD4 count < 350. Using the same threshold value of 1,000 cells/mm³ for TLC, sensitivity was 14 percent, and specificity 99 percent (PPV= 94 percent; NPV=62 percent). In 70/1,510 (5 percent) of the samples the sum of CD4 and CD8 cell counts was greater than the TLC and in 27 percent (419/1,510) this sum was below 65 percent of the TLC. TLC has a high specificity to identify patients for prophylaxis, but a quite low sensitivity. It is not useful as an alternative to CD4+ T-cell counts as a marker in HIV-infected patients.