Sexual behavioral characters of 321 HIV-positive MSM in Wuhan Jingyingtan Hospital / 公共卫生与预防医学

Objective To study the sexual behavioral characters of HIV-positive men who have sex with men(MSM) with different age group and different sexual orientation. Mehtods A total of 321 newly-diagnosed HIV-positive MSM were selected by convenience sampling from January 2016 to February 2019 in Wuhan Jingyingtan Hospital. All the interviews were performed by doctors one by one and face by face. Spss 23.0 software was used to analyse the difference of sexual behavioral characters in different age groups and sexual orientations. Results Among 321 MSM patients , 44.24% were ≤35 years, 33.02% were 36-59 years, 22.74% were ≥60 years. Homosexuality accounted for 44.86%, bisexuality 20.25%, heterosexuality were 24.30%, and other sexual orientation accounted for 10.59%. Internet was the main way for ≤35 years old group to look for fixed partners, while friends, colleagues and classmates were the main way for 36-59 years old group and ≥60 years old group. There was significant difference in the ways of looking for partners among different age groups（χ2=136.50，P=0.00）. The main way for ≤35 years old and 36-59 years old group to find temporary partners was internet, and the main way for ≥60 years old group to find temporary partners was from friends, colleagues and classmates, there was a significant difference in different age groups in the way to find temporary partners（χ2=69.66，P=0.00）. The age of first male sexual activity was the lowest in homosexual MSM cases, followed by bisexual MSM cases, and the highest in heterosexual MSM cases. The age of first male sexual activity was significantly different in different homosexual orientation MSM cases （F=32.52，P=0.00）. Conclusion When taking intervention measures, the sexual behavior difference in different age groups and different sexual orientations should be considered.

Pattern of hepatobiliary involvement in HIV/AIDS patients: study in a tertiary care centre

Background: Diseases of hepatobiliary system is a major problem in patients with HIV infection. It has been estimated that approximately one third of the death of patients with HIV infection are in some way related to liver disease. While this is predominantly a reflection of the problems encountered in the setting of co-infection Hepatitis B or C, it is also a reflection of the hepatic injury in the form of hepatic steatosis, that can be due to antiretroviral therapy. There had been little work done on liver function tests in HIV patients without pre-existing liver disease like viral hepatitis, or alcoholic hepatitis. So, this study was designed to assess the pattern of liver function test derangement in HIV patients. Aims and objective was to study the different pattern of hepatobiliary involvement in HIV positive patients, and to gauge the extent of liver damage.Methods: The study included 50 HIV positive patients coming to SMS hospital and Medical College, Jaipur, in medicine and HIV clinic of skin and VD department. Subjects having HIV test positive by ELISA, are included in this study. Other causes of liver function derangements were excluded from the study.Results: Maximum number of the patients were in the age group of 23-32 years. Out of 50 cases studied, 41 (82 %) cases had abnormal liver function tests, while 9 (18%) had normal liver function tests. Most of the cases had liver function abnormalities, and most common abnormality was raised SGOT/SGPT.Conclusions: Almost all types of liver function tests are found to be deranged in HIV patients. The pattern of hepatobiliary involvement varied from fatty liver, cholestasis to Toxic necrosis and granulomas.

A clinical study of neurological manifestations in HIV positive patients in a tertiary care hospital of Telangana, India

Background: Human Immunodeficiency Virus (HIV) infection is a global pandemic, India has second largest burden of HIV illness. Nervous system is most frequent and serious target of HIV infection. Aim: The main aim of our study was to evaluate the occurrence of various neurological manifestations in HIV positive patients and to correlate them with CD4 count at the time of presentation. Materials and methods: This prospective study was carried out for a period of 2 years from January 2014 to December 2016 in the Department of Neurology, Gandhi Hospital, Hyderabad, India. Those patients, who satisfied the inclusion criteria (>18 year of age; HIV positive; any gender) were included in our study. Patients who were HIV positive but having non neurological medical conditions were excluded. Those with various neurological symptoms were subjected to thorough neurological examination, whenever indicated neuroimaging, CSF analysis, NCS, Toxoplasma serology were done. CD4 count was done in all patients. KameraSateesh Kumar, VeenaNarisetty, P. Chandra Shekar, Changala Praveen, AlluriNeeraja. A clinical study of neurological manifestations in HIV positive patients in a tertiary care hospital of Telangana, India. IAIM, 2018; 5(1): 42-49. Page 43 Results: Our study enrolled a total of 1011 HIV positive patients, out of them 354(35%) patients had neurological manifestations. Among them, 239 (67.51%) were male and115 (32.48%) were female. We analyzed patients presented with various neurological symptoms, 187(52%) patients presented with parasthesias. CD4 count was done to all patients. Out of 354 patients, 188 (39.4%) patients had low CD4 count (<200μL). NCS was abnormal in 182 (51.4%) patients. Axonal sensory neuropathy was the most common abnormality found in 82 (45.0%) patients. The most common neurological manifestation was peripheral neuropathy, seen in 166 (46.8%) patients. Conclusion: HIV infection can affect all levels of the neuronal axis. Neurological manifestations are common in 4th decade of life and males affect more than females. Peripheral neuropathy was the most common neurological manifestation and Tuberculosis was the prominent infectious etiology. Neurological manifestations are seen with low CD4 count and there is a significant correlation between them hence can be stated that, these are the manifestations of the late stage of the disease.

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.

Short Sleep Duration and Correlates among Sero-positive HIV Patients in Nigeria, West Africa.

Introduction: Short sleep duration is a salient issue because it is a major public health concern and has more wide-reaching problems among HIV/AIDS patients. Short sleep duration was said to be associated with lower CD4 count, higher viral load values, depression, high blood pressure, high body mass index and disease progression. It was also documented that patients receiving efavirenz had shorter duration of deep sleep. Incidentally there is paucity of data in Nigeria to support these claims hence the need to investigate. Methods: Four hundred HIV zero-positive patients were recruited at the HIV clinic of Kwara State Specialist Hospital, Sobi, Ilorin, after institutional ethical approval and informed consent was obtained. Blood pressure was measured. Classification of hypertension was made according to the seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure (JNC-7). Body Mass Index was calculated as (kg/m2). The Patient Health Questionnaire (PHQ-9) was administered to the respondents to screen for depressive symptoms. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep duration. The respondents were categorized into four groups viz, sleeping more than 7 hours, 6-7 hours, 5-6 hours and less than 5 hours. Subjects with <5hrs are poor sleepers while those with >7hrs were good sleepers. Results: Four hundred HIV-infected patients were recruited with a mean age of 39yrs (SD 9). Eighty four (21%) were male, while 316 (79%) were female. The mean body mass index was 22.0 (SD 4.6), mean present CD4 count was 339.0 (SD 180.6). One hundred and eighty three respondents (45.8%) slept less than 5 hours, while 58 (14.5%) sleep more than 7hours. Short sleep was commoner in the age group 31-40 73(39.9%), among the female 145(79.2%) and those that were married 103(56.7%), and those with non-formal education 84(45.9%). Traders 80(43.7%) had highest number than other occupation. Short sleepers of less than 5 hours were prone to high blood pressure; higher body mass index and depression. This was statistically significant. The lower the CD4 count, the more the short sleep duration observed among the respondents. Patients receiving HAART containing efavirenz had shorter duration of deep sleep. Conclusion: Almost half of the respondents were poor sleepers with associated high blood pressure and increased body mass index (BMI). Both effects of the virus and antiretroviral drugs may cause short sleep duration. Health providers managing HIV positive patients, need to take complaints of short sleep duration seriously, because they can indicate an increased risk for low CD4 counts, high viral load, depression, high blood pressure and increase body mass index. There is the need for targeting efforts to improve short sleep duration for the majority of adults living with HIV/AIDS and tailoring appropriate interventions.

Nutritional and metabolic status of HIV-positive patients with lipodystrophy during one year of follow-up

OBJECTIVES: The aim of this prospective study was to compare changes in lipid metabolism and nutritional status after either 6 and 12 months of follow-up in subjects with lipodystrophy syndrome after traditional lifestyle therapy with or without fibric acid analogue intervention (bezafibrate and clofibrate). METHODS: Food intake, alterations in body composition and metabolic abnormalities were assessed in subjects with lipodystrophy syndrome at the beginning of the study. The nutritional status and metabolic alterations of the subjects were monitored, and the subjects received nutritional counseling each time they were seen. The subjects were monitored either two times over a period no longer than six months (Group A; n = 18) or three times over a period of at least 12 months (Group B; n = 35). All of the subjects underwent nutrition counseling that was based on behavior modification. The fibric acid analogue was only given to patients with serum triglyceride levels above 400 mg/dL. RESULTS: After six months of follow-up, Group A showed no alterations in the experimental parameters. After twelve months, there was a decrease in serum triglyceride levels (410.4 ± 235.5 vs. 307.7 ± 150.5 mg/dL, p< 0.05) and an increase in both HDLc levels (37.9±36.6 vs. 44.9 ±27.9 mg/dL, p,0.05) and lean mass (79.9 ± 7.8 vs. 80.3 ± 9.9 percent, p< 0.05) in Group B. CONCLUSION: After one year of follow-up (three sessions of nutritional and medical counseling), the metabolic parameters of the subjects with lipodystrophy improved after traditional lifestyle therapy with or without fibric acid analogue intervention.

Aspectos micológicos e suscetibilidade in vitro de leveduras do gênero Candida em pacientes HIV-positivos provenientes do Estado de Mato Grosso / Mycological aspects and susceptibility in vitro the yeast of the genus Candida from HIV-positive patients in the State of Mato Grosso

INTRODUÇÃO: A candidíase é uma das infecções fúngicas mais frequentes entre os pacientes infectados pelo vírus da imunodeficiência humana. O presente estudo objetivou a caracterização das leveduras do gênero Candida de distintas amostras clínicas, provenientes de pacientes HIV - positivos, assim como a determinação do perfil de suscetibilidade in vitro a cinco drogas antifúngicas. MÉTODOS: A caracterização dos isolados de Candida sp foi realizada através da metodologia clássica, testes bioquímicos (zimograma e auxanograma) e morfológicos (prova do tubo germinativo e microcultivo em lâmina). Também, foram realizadas a técnica genotípica (PCR) e identificação pelo método comercial API 20C AUX (BioMeriéux). Para a determinação do perfil de suscetibilidade in vitro, foram utilizadas cinco drogas antifúngicas (cetoconazol, fluconazol, itraconazol, voriconazol e anfotericina B), através do método comercialmente disponível - Etest. RESULTADOS: Foram identificados 105 isolados de leveduras do gênero Candida provenientes de 102 pacientes infectados pelo vírus HIV. Destes, foram caracterizadas 82 (78,1 por cento) Candida albicans, 8 (7,6 por cento) Candida parapsilosis, 8 (7,6 por cento) Candida tropicalis, 4 (3,8 por cento) Candida krusei, 2 (1,9 por cento) Candida glabrata e 1 (1 por cento) Candida guilliermondii. CONCLUSÕES: Considerando o perfil geral de sensibilidade, 60 por cento dos isolados foram suscetíveis a todos os antifúngicos testados, porém as espécies C. tropicalis e C. krusei demonstraram uma tendência a valores mais elevados de CIMs para os azóis do que os encontrados paraC. albicans, sugerindo resistência.

INTRODUCTION: Candidiasis is one of the most common fungal infections among patients infected by human immunodeficiency virus. The present study aimed to characterize yeasts of the genus Candida from distinct clinical samples from HIV-positive patients and determine the in vitro susceptibility profile to five antifungal drugs. METHODS: Characterization of Candida sp was achieved using the classic methodology: biochemical (zymogram and auxanogram) and micromorphology (germinative tube growth test and slide microculture) tests. Genotypic technique (PCR) and identification by the commercial method API 20C AUX (Biomeriéux) were also performed. To determine the in vitro susceptibility profile, five antifungal drugs were used (ketoconazole, fluconazole, itraconazole, voriconazole and amphotericin-B) following a commercially available method, the Etest. RESULTS: The procedure isolated 105 yeasts of the genus Candida from 102 HIV-infected patients. Of these, 82 (78.1 percent) were characterized as Candida albicans, 8 (7.6 percent) as C. parapsilosi s, 8 (7.6 percent) C. tropicalis, 4 (3.8 percent) C. krusei, 2 (1.9 percent) C. glabrata, and 1 (1 percent) as C. guiilliermondii. CONCLUSIONS: Considering the general profile of sensitivity, 60 percent of isolates were susceptible to all the antifungal drugs tested; however, the species C. tropicalis and C. krusei showed a tendency toward higher MICs to azoles than those obtained for C. albicans, suggesting resistance.

A serological study of cysticercosis in patients with HIV / Estudo sorológico da cisticercose em pacientes com HIV

Neurocysticercosis (NCC) has attained the importance of one of the most common cause of focal brain lesions in patients infected with HIV (human immunodeficiency virus). Adequate data regarding the rate of this co-infection is lacking. Therefore, the present study was carried out to determine the prevalence of cysticercosis among HIV patients residing in Puducherry or its neighboring districts of Tamil Nadu State, India. A total of one hundred blood samples were collected from HIV seropositive cases visiting JIPMER hospital, Puducherry, between June 2007 and May 2008. Enzyme immunotransfer blot (EITB) and enzyme linked immunosorbent assay (ELISA) were used to demonstrate anti- T. solium larval stage antibodies and Co-agglutination (Co-A) test was used to detect T. solium larval stage antigens in sera. Two HIV seropositive cases were found positive for anti-T. solium larval stage antibody by EITB and four were positive by ELISA. Only one sample was positive by both EITB and ELISA. No serum sample was found positive for T. solium larval stage antigen by Co-A test. The overall seropositivity detected by all the methods was 5 percent in this study group. The accurate clinical diagnosis of NCC in HIV is difficult due to deranged immunological parameters in the HIV infected patients. The results of this study provides important data on the prevalence of cysticercosis in HIV positive patients in Puducherry and neighboring areas which was previously unknown. This study will also increase awareness among physicians and public health agencies about T. solium cysticercosis in the selected group.

Neurocisticercose (NCC) tem alcançado a importância de uma das mais comuns causas de lesões focais no cérebro em pacientes infectados pelo HIV (vírus da imunodeficiência adquirida). Dados adequados relativos à frequencia desta co-infecção estão faltando. Portanto, o presente estudo foi realizado para determinar a prevalência da cisticercose entre pacientes com HIV residindo em Puducherry ou distritos vizinhos do Estado de Tamil Nadu, India. Um total de cem amostras foram coletadas de casos soropositivos do Hospital JIPMER, Puducherry, entre junho de 2007 e maio de 2008. "Enzyme immunotransfer blot" (EITB) e ELISA foram utilizados para demonstrar anticorpos contra a fase larval do T. solium. Testes de co-aglutinação (Co-a) foram usados para demonstrar antígenos da fase larval do T. solium no soro. Dois casos HIV soropositivos foram positivos para anticorpos contra a fase larval do T. solium por EITB e quatro foram positivos por ELISA. Somente uma amostra foi positiva por ambos EITB e ELISA. Nenhuma amostra de soro foi positiva para antígeno da fase larval do T. solium pelo teste Co-a. A soropositividade total detectada por todos os métodos foi 5 por cento neste grupo de estudo. O diagnóstico clínico exato de NCC em HIV é difícil devido aos desordenados parâmetros imunológicos nos pacientes infectados pelo HIV. Os resultados deste estudo fornecem dados importantes sobre a prevalência da cisticercose em pacientes HIV positivos em Puducherry e áreas vizinhas que eram previamente desconhecidos. Este estudo também aumentará a atenção dos médicos e agências de saúde pública sobre a cisticercose por T. solium em grupo selecionado.

Identificação microbiológica e sensibilidade in vitro de Candida isoladas da cavidade oral de indivíduos HIV positivos / Microbiological identification and in vitro sensitivity of Candida isolates from the oral cavity of HIV-positive individuals

A candidíase orofaríngea é a infecção fúngica mais comum entre os pacientes infectados pelo vírus da imunodeficiência humana e seu tratamento é realizado com antifúngicos tópicos ou sistêmicos, que são indicados empiricamente com base em dados clínicos. O objetivo deste estudo foi determinar a freqüência de leveduras em lavados bucais de indivíduos HIV positivos, comparando os resultados entre pacientes com diferentes condições de imunodeficiência e verificar o perfil de susceptibilidade das espécies isoladas frente aos antifúngicos visando avaliar se as opções de tratamento utilizadas na prática clínica atingem a maioria das espécies identificadas. Leveduras foram isoladas em 58 por cento das amostras de lavado bucal coletadas e Candida albicans foi a espécie mais (93 por cento) freqüente. Resistência ou susceptibilidade dose dependente, frente aos antifúngicos testados foi registrada em aproximadamente 17 por cento das amostras. A importante variabilidade de resposta sugere limitações quanto à eficácia das terapias instituídas empiricamente.

Oropharyngeal candidiasis is the most common fungal infection among patients infected with the human immunodeficiency virus. It can be treated with either systemic or topical antifungal agents, which are indicated empirically on the basis of clinical data. The objective of this study was to determine the frequency of yeast in mouthwashes from HIV-positive patients, compare the results between patients presenting different states of immunodeficiency, and investigate the susceptibility profile of the species isolated in relation to antifungal agents, with the aim of evaluating whether the treatments used in clinical practice are able to reach the majority of the species identified. Yeasts were isolated from 58 percent of the mouthwash samples collected. Candida albicans was the most (93 percent) frequent species. Resistance or dose-dependent susceptibility in relation to the antifungal agent tested was registered in approximately 17 percent of the samples. The significant variability of responses suggests that there are limitations regarding the effectiveness of the empirical therapies instituted.

Psychosocial Variables in HIV-Positive Patients / 신경정신의학

OBJECTIVE: With rapid increase of HIV infection worldwide, researchers have been naturally concerned about their psychosocial adjustment and problems to living with AIDS. This study examined coping and psychosocial variables, and their interrelationship to evaluate the psychosocial adjustment and problems of HIV-positive patients. METHOD: A total of 27 HIV-positive patients were interviewed and they completed self administered scales of the ways of coping, HADS, perceived stress, family support, and SF-36. Also, the control subjects included two samples of 27 hematopoietic cell transplantation patients, and 30 healthy persons. The data were analyzed using analysis of variance and scheffe's multiple range test to check for significant differences among the mean scores in three samples. RESULTS: 1) As for the coping styles, there were no significant differences among the three groups. 2) The mean scores of perceived stress in HIV-positive patients were significantly higher than those in normal controls. 3) The mean scores of family support scale were significantly lower in HIV-positive patients than those in normal controls. 4) The mean scores of depression and anxiety on HADS were significantly higher in HIV-positive patients than those in normal controls. 5) There were no significant associations between active or passive coping styles and depressive/anxiety or perceived stress in HIV-positive patients. 6) The mean scores of health status(SF-36) were significantly lower in HIV-positive patients than those in normal controls. CONCLUSION: Although coping styles had no significant influence on depression/anxiety, HIV-positive patients showed higher scores on depression/anxiety, and perceived stress compared with normal controls. They received lower family support than hematopoietic stem cell transplantation patients and normal controls. HIV-positive patients rated their general health status as worse than normal controls. These findings might point to the need for more attention to some psychosocial variables in HIV-positive patients.