Audit of emergency obstetric referrals at a Tertiary Center in Kano

Introduction: Maternal and perinatal deaths could be prevented if functional referral systems are in place to allow pregnant women to get appropriate services when complications occur. Methodology: The study was a 1-year retrospective study of obstetric referrals in Aminu Kano Teaching hospital, from 1st January to 31st December 2019. Records of all emergency obstetrics patients referred to the hospital for 1 year were reviewed. A structured proforma was used to extract information such as sociodemographic characteristics of the patients, indications for referral, and pre-referral treatment. The care given at the receiving hospital was extracted from the patients' folders. An Audit standard was developed and the findings were compared with the standards in order to determine how the referral system in the study area perform in relation to the standard. Results: There were total of 180 referrals, the mean age of the women was 28.5 ± 6.3 years. Majority (52%) of the patients were referred from Secondary Centres and only 10% were transported with an ambulance. The most common diagnosis at the time of referral was severe preeclampsia. More than half of the patients (63%) had to wait for 30 to 60 minutes before they see a doctor. All the patients were offered high quality care and majority (70%) were delivered via caesarean section. Conclusion: There were lapses in the management of patients before referral; failure to identify high risk conditions, delay in referral, and lack of treatment during transit to the referral centre.

Prevalence and Types of Mucocutaneous Disorders, Their Correlation to CD4 Count and Their Impact on Quality of Life in Adults with HIV Infection

Background@#Data on prevalence and type of mucocutaneous diseases in HIV-positive patients and their impact on quality of life (QoL) are sparse. We aim to determine prevalence and type of mucocutaneous disorders, their correlation to CD4+ counts and impact on QoL for adults with HIV, using the Dermatology Life Quality Index (DLQI).@*Methods@#A cross-sectional study of HIV-infected adults seen in HIV and Dermatology Clinic.@*Results@#The majority (90%) of 174 participants recruited was male. Median age at diagnosis of HIV infection was 29 years (IQR 10). Mucocutaneous disorders were present in 90.2%, out of which 58.6% had two or more mucocutaneous disorders. Mean CD4+ count was significantly lower in patients with, compared to those without mucocutaneous disorders (363 vs 548 cells/µL; p=0.030). Infections accounted for 67.2% of all mucocutaneous disorders seen, followed by inflammatory dermatoses (51.7%), cutaneous adverse drug reactions (17.8%) and neoplasm (2.3%). The five most frequent manifestations were eczema (22.4%), anogenital warts (21.2%), candidiasis (16.7%), dermatophytosis (15.5%) and secondary syphilis (12.0%). Oral candidiasis, pruritic papular eruption, drug-induced maculopapular eruption and drug rash with eosinophilia and systemic symptoms were significantly more prevalent in patients with CD4+ counts <200 cells/µL but anogenital warts were more prevalent in patients with CD4+ counts ≥200 cells/µL. The mean DLQI score was 8.39 (SD ± 6.83). QoL was severely impaired (DLQI >10) in 34.4%.@*Conclusion@#Mucocutaneous disorders were common in HIV patients causing significant impairment in quality of life. Prevalence co-related with low CD4+ counts. Adequate management of HIV may reduce the prevalence of mucocutaneous disorders and improve QoL.

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.

VIH, dislipidemias y perspectivas de su evolución / HIV, dyslipidemias and perspectives of its evolution

Resumen Con el advenimiento de la terapia antirretroviral (ART), la infección por el virus de inmunodeficiencia humana (VIH) se ha convertido en una enfermedad crónica con complicaciones metabólicas importantes más acentuadas que en la población general. Mientras no se tenga una vacuna que erradique las tasas de infección y no exista una cura para esta pandemia, se debe ser más incisivo en el controlar las comorbilidades, entre las que destacan las alteraciones en el perfil de lípidos pues aumentan el riesgo cardiovascular.

Abstract With the advent of antiretroviral therapy (ART), infection with the human immunodeficiency virus (HIV) has become a chronic disease with major metabolic complications more pronounced than in the general population. While there is no vaccine to eradicate infection rates and there is no cure for this pandemic, it should be more incisive in controlling comorbidities, among which alterations in the lipid profile stand out as they increase cardiovascular risk.

Profile of estimated glomerular filtration rate of children with Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome

Background: Kidney disease is more common in people of African descent in developed countries. Studies reporting estimate Glomerular Filtration Rate (eGFR) in African populations and people living with HIV have been carried more frequently on adults than children. The study aimed to assess eGFR by use of the SCHWARTZ formula in HIV infected children seen at tertiary hospital.Methods: A descriptive, prospective and cross sectional study of 221 children with HIV infection. Schwartz formula was used to determine eGFR. The main outcome measures were eGFR. The study population comprised HIV infected children attending Paediatric out-patients' clinic and those admitted into the Paediatric wards, aged between 6 months and 15 years. Data was analysed using SPSS version 20 and results presented in tables and figures. Results: The age range of the study subjects was 12 months to 15 years with the mean age and SD of 8.21'3.61 years. There were 129 (58.4%) male and 92 (41.6%) female children with male to female ratio 1: 0.7.' The mean age for males was 7.87'3.49 years while that for females was 8.70'3.71 years. The eGFR for the study as determined by Schwartz formula had a range of 49.21 to 463.67 ml/ min/ 1.73m2 with the mean of 159.56'59.04 ml/min. The mean eGFR for the males and females were 166.39'63.54ml/ min and 149.99'45.01 ml/ min respectively. Conclusion: The study, in comparison with other studies, observed a lower prevalence of CKD in HIV infected children. Detection of CKD in HIV infection children may be more optimal if combined methods are employed.

Awareness of HIV testing results before sex among men who have sex with men / 预防医学

Objective@#To understand the awareness of HIV testing results before having sex among men who have sex with men （MSM） .@*Methods@#The MSM from a gay bar in Zhejiang Province were recruited through convenience sampling method. A questionnaire survey was conducted to collect the information about demographic characteristics,sexual behaviors,awareness of HIV status between sexual partners and HIV testing results during August of the year 2016. The awareness of HIV testing results before having sex among MSM and the influencing factors were analyzed .@*Results@#A total of 124 MSM were recruited in this study,56.56% of whom aged from 25 to 39 years,and 61.29% were single,divorced or widowed. The number of sexual partners they had in the last year ranged from 1 to 40,with median of 8. The MSM who had casual sexual partners accounted for 70.97%. The MSM who had regular HIV testing accounted for 90.32%,yet who would like to share the HIV testing reports with partners only accounted for 18.55%. Whether asking about the HIV status before having sex or not was associated with age,marriage status,the number and characters of sexual partners（P<0.05）. The MSM who were informed of the HIV status of commercial partners,casual partners and regular partners accounted for 0,5.10% and 19.77%,respectively. The main reasons for MSM not knowing about the HIV status of their sexual partners were“condom use would prevent HIV infection”（78.38%）,“never thought about HIV infection”（53.15%）,and “there was no need to ask as the partner looked healthy”（36.94%） .@*Conclusion@#The proportion of MSM who were aware of HIV testing results before having sex was not high and was associated with age,marriage status,the number and characters of sexual partners. Lack of knowledge about HIV infection might contributed to this low proportion.

Fibrillary glomerulonephritis in a human immunodeficiency virus-positive, hepatitis C-negative Indian patient: Expanding the profile of renal involvement in human immunodeficiency virus infection

Highly active anti retroviral therapy (HAART) has dramatically improved life expectancy of human immunodeficiency virus (HIV) infected patients, converting HIV infection into a chronic illness with associated changes in its attendant renal complications. The past two decades have witnessed a decrease in the prevalence of HIV associated nephropathy (HIVAN), traditionally considered to be the hall mark of renal involvement in HIV infection. Simultaneously a host of other glomerular and tubulo-interstitial diseases have emerged, expanding the spectrum of HIV associated renal diseases, predominant among which is HIV associated immune complex mediated kidney diseases (HIVICK). Of the diverse glomerular diseases constituting HIVICK, fibrillary glomerulonephritis (FGN) remains a rarity, with only two existing reports to date, confined to patients co-infected with Hepatitis C virus (HCV). The pathogenetic role of HIV in these patients remains under a cloud because of previously well established association of HCV infection and FGN. We report a case of FGN in a HIV seropositive, HCV negative Indian patient, highlighting the diagnostic electron microscopy (EM) findings of FGN and strengthening the causal association of HIV with FGN. In view of increasing heterogeneity of renal complications in HIV infection, the diagnostic utility of a comprehensive renal biopsy evaluation inclusive of EM is emphasized for appropriate selection of treatment modalities.

Effect of clinical efficacy of Yiaikang capsules on patients with human immunodeficiency virus infection and acquired immune deficiency syndrome / 中国中西医结合急救杂志

Objective To observe the effect of Yiaikang capsules on viral load, immunologic function and quality of life of patients with human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS). Methods A prospective randomized controlled clinical study was conducted, 118 patients with HIV/AIDS admitted to Department of Integrated Traditional Chinese and Western Medicine of Qinghai Fourth People's Hospital from July 2015 to February 2017 were enrolled, and they were divided into two groups by random digital table method, 59 cases in each group. The control group received highly active anti-retroviral therapy (HAART); while the treatment in combined Chinese and western medicine group was additionally given Yiaikang capsules on the basis of the therapy in control group, 5 capsules (0.5 g per grain,) once and 3 times a day for 12 months. The differences of World Health Organization HIV quality of life scale (WHOQOL HIV-BREF) score, CD4+, CD8+T-lymphocyte and viral load levels were compared between the two groups. Results After treatment for 12 months, the results of WHOQOL HIV-BREF scores in two groups were reduced significantly compared with those before treatment (P ＜ 0.05), and the degree of decrease of WHOQOL HIV-BREF score in combined Chinese and western medicine group was slower than that in control group (82.57±8.76 vs. 70.53±9.45, P ＜ 0.05). The CD4+, CD8+levels in control group after treatment were of no significant change compared with those before treatment (P ＞ 0.05), but the viral load level was decreased significantly after treatment compared with that before treatment (log/mL: 3.57±0.82 vs. 3.89±1.32, P ＜ 0.05); the CD4+in combined Chinese and western medicine group after treatment was obviously higher compared with that before treatment (number/μL: 413.67±187.39 vs. 376.65±206.51), the viral load level was markedly lowered compared with that before treatment (log/mL: 3.14±0.76 vs. 3.81±1.27) and the level of CD4+was significantly higher in combined Chinese and western medicine group than that in control group (413.67±187.39 vs. 382.72±194.82), viral load level in combined Chinese and western medicine group was siginificantly lower that in the control group (3.14±0.76 vs. 3.57±0.82, P ＜ 0.05), but the number of CD8+in two groups after treatment was of no significant change (P ＞ 0.05). Conclusion Yiaikang capsules possibly may elevate the number of CD4+T-lymphocytes and decrease the level of viral load to improve the quality of life in patients with HIV/AIDS.

Influence of Phosphatidylinositol-3-Kinase/Protein Kinase B-Mammalian Target of Rapamycin Signaling Pathway on the Neuropathic Pain Complicated by Nucleoside Reverse Transcriptase Inhibitors for the Treatment of HIV Infection / 中华医学杂志(英文版)

Background@#Nucleoside reverse transcriptase inhibitors (NRTIs) are the earliest and most commonly used anti-human immunodeficiency virus drugs and play an important role in high active antiretroviral therapy. However, NRTI drug therapy can cause peripheral neuropathic pain. In this study, we aimed to investigate the mechanisms of rapamycin on the pain sensitization of model mice by in vivo experiments to explore the effect of mammalian target of rapamycin (mTOR) in the pathogenesis of neuropathic pain caused by NRTIs.@*Methods@#Male Kun Ming (KM) mice weighing 20-22 g were divided into control, 2 mg/kg rapamycin, 12 mg/kg stavudine, and CMC-Na groups. Drugs were orally administered to mice for 42 consecutive days. The von Frey filament detection and thermal pain tests were conducted on day 7, 14, 21, 28, 35, and 42 after drug administration. After the last behavioral tests, immunohistochemistry and western blotting assay were used for the measurement of mTOR and other biomarkers. Multivariate analysis of variance was used.@*Results@#The beneficial effects of rapamycin on neuropathic pain were attributed to a reduction in mammalian target of rapamycin sensitive complex 1 (mTORC1)-positive cells (70.80 ± 2.41 vs. 112.30 ± 5.66, F = 34.36, P < 0.01) and mTORC1 activity in the mouse spinal cord. Mechanistic studies revealed that Protein Kinase B (Akt)/mTOR signaling pathway blockade with rapamycin prevented the phosphorylation of mTORC1 in stavudine-intoxicated mice (0.72 ± 0.04 vs. 0.86 ± 0.03, F = 4.24, P = 0.045), as well as decreased the expression of phospho-p70S6K (0.47 ± 0.01 vs. 0.68 ± 0.03, F = 6.01, P = 0.022) and phospho-4EBP1 (0.90 ± 0.04 vs. 0.94 ± 0.06, F = 0.28, P = 0.646).@*Conclusions@#Taken together, these results suggest that stavudine elevates the expression and activity of mTORC1 in the spinal cord through activating the Akt/mTOR signaling pathway. The data also provide evidence that rapamycin might be useful for the treatment of peripheral neuropathic pain.

Duration of Human Immunodef iciency Virus Infection at Diagnosis among New Human Immunodef iciency Virus Cases in Dehong, Yunnan, China, 2008-2015 / 中华医学杂志(英文版)

Background@#On diagnosis of human immunodeficiency virus (HIV) infection, a person may have been infected already for many years. This study aimed to estimate the duration of HIV infection at the time of diagnosis.@*Methods@#Newly diagnosed HIV cases in Dehong, China, from 2008 to 2015 were studied. Duration of infection at the time of diagnosis was calculated using the first CD4 cell count result after diagnosis and a CD4 depletion model of disease progression. Multiple linear regression analysis was used to investigate the associated risk factors.@*Results@#A.@*@#total of 5867 new HIV cases were enrolled. Overall, mean duration of infection was 6.3 years (95% confidence interval [CI]: 6.2, 6.5). After adjusting for confounding, significantly shorter durations of infection were observed among participants who were female (beta: -0.37, 95% CI: -0.64, -0.09), Dai ethnicity (beta: -0.28, 95% CI: -0.57, 0.01), and infected through injecting drug use (beta: -1.82, 95% CI: -2.25, -1.39). Compared to the hospital setting, durations were shorter for those diagnosed in any other settings, and compared to 2008, durations were shorter for those diagnosed all years after 2010.@*Conclusion@#Although the reduction in duration of infection at the time of diagnosis observed in Dehong was significant, it may not have had a meaningful impact.

Linfoma plasmablastico oral en un paciente pediatrico con virus de inmunodeficiencia humana/sindrome de inmunodeficiencia adquirida: a proposito de un caso / Oral plasmablastic lymphoma in a human immunodeficiency virus positive child: a case report

El linfoma plasmablástico es un subtipo raro y agresivo de linfoma no Hodgkin de células grandes B, descrito inicialmente en la cavidad oral de adultos varones con enfermedad por virus de inmunodeficiencia humana/síndrome de inmunodeficiencia adquirida. Se compone de una proliferación de células neoplásicas que se asemejan a los inmunoblastos, pero presentan inmunofenotipo característico de célula plasmática e infección latente por el virus de Epstein-Barr. En la población pediátrica, es una entidad excepcional. Presentamos el caso de una niña de 5 años de edad, con enfermedad por virus de inmunodeficiencia humana / síndrome de inmunodeficiencia adquirida de transmisión vertical con linfoma plasmablástico de cavidad oral.

Plasmablastic lymphoma is a rare and aggressive subtype of diffuse large B cell non-Hodgkin lymphoma, originally described in the oral cavity of male adults with acquired immune deficiency syndrome. It is composed of neoplastic ceils which resemble immunoblasts but present immunophenotype distinctive of plasma cell and Epstein-Barr virus latent infection. In children, it is an even rarer disease. We present a case of oral plasmablastic lymphoma in a vertically transmitted human immunodeficiency virus-positive five-year-old child.

Microangiopatía trombótica en una paciente con infección por el virus de la inmunodeficiencia humana / Thrombotic microangiopathy in a patient with human inmunodeficiency virus infection

Notificamos un caso de microangiopatía trombótica, caracterizado por un proceso de agregación plaquetaria amenazante para la vida, que presentó afectación multisistémica y rápida evolución en una paciente con infección por el VIH. En este caso exponemos ampliamente los síntomas, la evolución y, finalmente, la necropsia clínica. Esta enfermedad es ahora infrecuente tras la llegada de los antirretrovirales de gran actividad, no obstante, se presenta con síntomas inespecíficos y evoluciona rápidamente a la afectación multisistémica y muerte. En consecuencia, un diagnóstico precoz con base en criterios clínicos y analíticos es fundamental para instaurar el tratamiento adecuado y mejorar la supervivencia.

We report on a case of thrombotic microangiopathy, defined as an extensive and dangerous intravascular platelet aggregation disorder, which progressed to multisystem involvement in a patient with HIV infection. For this clinical case, we detail the symptoms, evolution and, ultimately, the clinical autopsy. This disease is now uncommon due to the arrival of highactivity antiretroviral drugs; however, it can appear with nonspecific symptoms and rapidly progress to multisystem involvement and death. An accurate diagnosis on the basis of clinical and analytical criteria is essential to starting treatment and improving survival.

Left Ventricular Noncompaction: A Rare Cause of Heart Failure in a HIV Patient.

Background: Heart failure in patients with human immunodeficiency virus (HIV) is often from dilated cardiomyopathy as a result of HIV itself, drug myotoxicity, secondary infections, or druginduced atherosclerosis. Left ventricular noncompaction (LVNC) is a rare cardiac congenital abnormality which occurs due to early arrest of endomyocardial morphogenesis. Case: A 47- year-old female patient with HIV presented with sudden onset shortness of breath and symptoms of congestive heart failure. Echocardiography showed noncompacted endocardium with reduced left ventricular function. She was subsequently diagnosed with LVNC. Discussion: Multiple etiologies have been implicated in cardiomyopathy among HIV patients. LVNC is a rare cause of left ventricular failure, particularly in this population. Echocardiography plays a pivotal role in the diagnosis. Conclusion: It is often challenging to identify the underlying cause of cardiomyopathy in a patient with HIV. While LVNC is a rare cause of left ventricular failure, typical findings on echocardiography can obviate the need for a more complex evaluative strategy.

The risk factors for mortality in non-human immunodeficiency virus infected children with pneumocys-tis carinii pneumonia / 中国小儿急救医学

Objective To analyze the epidemiologic characteristics and risk factors for mortality in non-(human immunodeficiency virus,HIV) infected children with pneumocystis carinii pneumonia(PCP). Methods The data of non-HIV infected children with PCP diagnosed in Beijing Children′s Hospital from January 1,2006 to December 31,2012 were collected. They were divided into survival and non-survival group according to the prognosis. The epidemiologic characteristics and risk factors for mortality were analyzed. Results Sixteen patients were enrolled in this study. Ten of them survived and 6 of them were non-survived. The basic diseases included malignant tumor in 5 patients and non-malignancy diseases in 11 of them. Com-pared with the survival group,the non-survival group had a higher average age [(12. 00 ± 2. 00) years vs. (6. 65 ± 4. 32)years,P=0. 01],higher ratio to need mechanical ventilation (6/6 vs. 4/10,P=0. 04),lower PaO2/FiO2[(73. 88 ±26. 95) mmHg vs. (167. 50 ± 97. 17) mmHg,1 mmHg=0. 133 kPa,P=0. 01] and lower pediatric critical illness score(75. 67 ± 5. 72 vs. 86. 40 ± 8. 88,P=0. 02). There were no differences on sex ratio,kinds of basic diseases,whether with co-infections,the time of immunosuppressant administration, the time from onset to diagnosis,the time from onset to beginning trimethoprim-sulfamethoxazole therapy, PaCO2 ,white blood cell counts,lymphocyte counts,CD4+ cell counts,C-reactive protein,and hemoglobin con-centrations between the survival and non-survival group. Conclusion A higher age, need for mechanical ventilation,lower PaO2/FiO2 and lower pediatric critical illness score were risk factors for mortality in non-HIV infected children with PCP.

Investigation of the hospitalized patients with human immunodeficiency virus infection in Shanxi Cancer Hospital / 肿瘤研究与临床

Objective To investigate the epidemiological characteristics of the hospitalized patients with human immunodeficiency virus (HIV) infection in Shanxi Cancer Hospital.Methods 70 patients with HIV positive were detected in Shanxi Cancer Hospital from January 2004 to December 2014.55 patients with HIV infection combined with malignant tumors were diagnosed by histopathology,however,15 patients were HIV infection alone.Results 55 cases of HIV infection combined with malignant tumors were 7-80 years old,and 46-55 years old was a high incidence of disease age,15 patients with simple HIV infection were 35 years old (7-55 years old).During 15 kinds of malignant tumors complicated with HIV infection,lung cancer was the most [11 cases (20 ％)],followed by hepatocellular carcinoma in 5 cases (9 ％),gastric cancer in 5 cases (9 ％),and non-Hodgkin lymphoma in 5 cases (9 ％).In 70 patients with HIV infection,farmers accounted for 43 ％ (30 cases),they were significantly higher than other occupations.Conclusions The age of HIV infected patients with malignant tumors is higher than that of patients with single HIV infection,which may because of immunocompromised patients have higher incidence of secondary opportunistic infections or malignant tumors.This study shows that with the extension of the survival of patients with the HIV infection,the incidence of malignant tumor is increasing.

Clinical characteristics of abnormal savda syndrome type in human immunodeficiency virus infection and acquired immune deficiency syndrome patients: A cross-sectional investigation in Xinjiang, China / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the distribution of abnormal hilit syndromes in traditional Uighur medicine (TUM) among human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) patients, and to find out the clinical characteristics of abnormal savda syndrome type HIV/AIDS patients.</p><p><b>METHODS</b>Between June and July in 2012, 307 eligible HIV/AIDS patients from in-patient department and out-patient clinics of Xinjiang Uighur Autonomous Region the Sixth People's Hospital in Urumqi were investigated. TUM syndrome differentiation was performed by a senior TUM physician. Each participant completed a Sign and Symptom Check-List for Persons Living with HIV/AIDS (SSC-HIV) questionnaire. Depression was evaluated by using Hamilton Rating Scale for Depression Questionnaire. Blood specimen was collected from each participant to test the levels of blood chemicals.</p><p><b>RESULTS</b>Of 307 HIV/AIDS patients, 189 (61.6%) were abnormal savda syndrome type, 118 (38.4%) were non-abnormal-savda syndrome type. Mean CD4 counts of abnormal savda syndrome type patients was (227.61±192.93) cells/µL, and the prevalence of anemia, thrombocytopenia, and elevated cystatin C were 49.7%, 28.6%, and 44.7%, which were significantly higher than those in the non-abnormal-savda syndrome type patients (26.3%, 16.0% and 25.0%,P<0.05). In addition, depression (79.9%) and HIV/AIDS-related symptoms such as fatigue (42.3%), back aches (40.7%), lack of appetite (33.9%), night sweats (31.7%) were more common among abnormal savda syndrome patients (P<0.05).</p><p><b>CONCLUSION</b>Abnormal savda syndrome is the dominant syndrome among HIV/AIDS patients, and they present a more sever clinical manifestation.</p>

A Review of the Epidemiology of Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STI) - Globally and in Singapore

In recent years HIV infections have declined in many parts of the world, however, there are still 35 million persons living with HIV infection and 2.1 million new infections occurred in 2011 worldwide. In many areas HIV continues to affect certain at risk communities viz. men who have sex with men, sex workers, clients of sex workers and injecting drug users. In Singapore the number of newly diagnosed HIV infections appears to have stabilised, however the current trend is that infected individuals are presenting at a late stage of infection and more HIV infections are being diagnosed among MSM and fewer in heterosexuals. The trend for other sexually-transmitted infections is generally stable, with gonorrhea, Chlamydia trachomatis infection and anogenital herpes showing decreases, whilst the incidence of syphilis showed an increase in 2012. Interviews with patients attending the DSC Clinic indicate that most STIs are contracted locally from casual partners. Unregulated sex workers are more frequently cited as primary contacts than are local regulated sex workers, who continue to have very low levels of STIs, underlining the benefits of the programme of routine screening, treatment and condom negotiation skills training provided by the Department of STI Control (DSC) Clinic in Singapore.

Respuesta a la terapia antirretroviral altamente activa en pacientes de 50 años de edad o más viviendo con infección VIH/SIDA / Highly actve antirretroviral therapy responce in patients over 50 years old living with HIV/AIDS infection

Para el 2015 >50% de la población con infección por el virus de inmunodeficiencia humana será >50 años, proponiéndose diversos retos en su atención. En el presente estudio se planteó como objetivo evaluar la respuesta a la terapia antirretroviral altamente activa, características epidemiológicas y clínicas en pacientes con infección del virus de inmunodeficiencia humana/síndrome de inmunodeficiencia adquiridad >50 años. Se realizó estudio descriptivo, retrospectivo, observacional, no experimental, con diseño de casos y controles (pacientes >50 años, casos; y <50 años, controles), comparando sus evaluaciones basales, a los 6 y a los 12 meses, entre enero 2005 y junio 2009. Se incluyeron 311 pacientes, 99 casos (>50 años) y 121 controles (<50 años), representado el género femenino un tercio de la población. Más del 65% consultaron en etapas avanzadas de la enfermedad, 47% correspondieron con síndrome de inmunodeficiencia adquirida estadio C3. La medida del lapso entre diagnóstico e inicio de la terapia antirretroviral altamente activa fue >1 año, en los grupos. Los regímenes de terapia antirretroviral altamente activa más usados fueron AZT/3TC/EFV y AZT/3TC+LOP/RIT. No se encontraron diferencias significativas en la respuesta inmunológica ni virológica a la terapia antirretroviral altamente activa a los 6 y 12 meses entre los grupos; valores promedio de carga viral a los 6 meses: 58221,08 copias de ARN/mm³ (2,21 log) y 6081,92 copias de ARN/mm³ (2,28 log) para adultos mayores y jóvenes, respectivamente. En adultos mayores , el incremeto de valores promedio de linfocitos TCD4+pos-terapia antirretroviral altamente activa fue significativa (P<0,05) comparando niveles basales y a los 12 meses; en los jóvenes dicha significancia se alcanzó a los 6 meses. Más del 85% de los pacientes tuvieron carga viral indetectable por 12 meses. En los pacientes >50 años se observó buena respuesta inmunológica y virológica similar a los jóvenes, a los 6 y 12 meses de la terapia....

For the year 2015 >50% of the population living with the human immunodeficiency virus infection will be >50 years old, facing it diverse challenges in their attention. In the current study the objetive to assess the response to the highly active antiretroviral therapy (HAART), epidemiological and clinical characteristics in patients with human immnodeficiency virus infection/acquired immunodeficiency syndrome >50 years old, was proposed. A descriptive, retrospective, observational, non-experimental, cases and control desing study (patients >50 years old, cases; and <50 years old, controls), comparing their basal, at 6 months and t 12 months evalutions, between january 2005 and june 2009, was done. A total 311 patients, 99 cases (>50 years old) and 212 controls (<50 years old) were included. Females represented a third of the population. More than 65% of the patients consulted in advanced stages of diseases, 47% corresponded with acquired immnodeficiency syndrome stage C3. Mean time between diagnosis and beginning of highly active antiretroviral therapy was >1 year, in both groups. Most used highly active antiretroviral therapy schemes were AZT/3TC/EFV and AZT/3TC+LOP/RIT. No significant differences between immunological and virological responce to highly active antiretroviral therapy at 6 and 12 months between both groups were found; mean values of viral load at 6 months: 5,821.08 RNA copies/mm³ (2.21 log) and 6,081.92 RNA copies/mm³ (2.28 log) for mayor adults and young patients, respectively. In mayor adults, increase in mean values of TCD4 + lymphocyte counts post-highly active antiretroviral therapy were significant (P<0.05) when compared basal with 12 months moments. In young patients that significant change was reached at 6 months. More than 85% of the patients had undetectable viral at 12 months. In patients >50 years old a good immunological and virological responce was observed, being similar to that seen in young patients, at 6 and 12 months.....

Comportamiento de la epidemia de VIH en Cuba / Behavior of the HIV epidemics in Cuba

Introducción: La infección por el VIH/sida es considerada un problema de la salud pública a nivel mundial. Los primeros diagnósticos ocurrieron en 1981 y desde entonces el número de infectados se ha incrementado. Cuba no está ajena a este fenómeno y se continúa trabajando para detener el avance de la epidemia en el país. Objetivo: Caracterizar el comportamiento de la epidemia de VIH en Cuba y elaborar un modelo pronóstico para los próximos años. Métodos: El universo estuvo constituido por todos los diagnósticos de personas de nacionalidad cubana infectadas por el VIH desde 1986 hasta 2010. La información fue obtenida de la base de datos de VIH/sida del Ministerio de Salud Pública de Cuba. Se analizó la epidemia tomando en cuenta los componentes de la serie cronológica. Para la modelación del pronóstico se empleó el alisamiento exponencial con dos parámetros. Para el procesamiento y análisis se utilizaron los paquetes estadísticos SPSS versión 11.5, Statistic versión 6.0, Econometric Views versión 4.0 y el programa MapInfo Profesional versión 7.5. Resultados: Se consideró que no existió aleatoriedad en la serie cronológica, pero sí que existía un patrón cíclico. La tasa de incidencia de VIH presentó una tendencia ascendente, aumentando un 90,70 % con respecto a los años extremos de la serie. La relación hombre/mujer se presentó como una mujer diagnosticada por cada 4 hombres. El 56,87 % de los diagnosticados eran homobisexuales, la mayoría del sexo masculino. El grupo de edades más afectado fue el de 20-24 años. La capital del país reportó la mayor tasa de incidencia de casos. Los municipios más afectados son urbanos y de alta densidad poblacional. Conclusiones: La incidencia del diagnóstico de personas VIH positivas mantiene una tendencia ascendente a expensas de los hombres que tienen sexo con otros hombres. El grupo de edades con mayor incidencia corresponden al de 20 a 24 años. La mayor cantidad de casos generalmente provenía de regiones urbanas y densamente pobladas.

Introduction: The HIV/AIDS infection is considered a public health problem around the world. The firsts diagnostics were made in 1981, and since that the number of infected persons has increased. Cuba is not free from to this phenomenon and we continue working to stop the advance of the epidemics in the country. Objective: Characterizing the behavior of the HIV epidemics in Cuba and making a prognostic model for the following years. Methods: The universe was formed by all the diagnoses of Cuban people infected with the HIV between 1986 and 2010. Data were obtained from the HIV/AIDS data base of the Public health Ministry of Cuba. We analyzed the epidemics taking into account the components of the chronologic series. For making the model of the prognostic we used the exponential smoothening with two parameters. For processing and analyzing data we used the statistic packages SPSS version 11.5, Statistic version 6.0, Econometric Views version 4.0 and the program MapInfo Professional Version 7.5. Results: We considered that there was not any randomization in the chronologic series, but there it was a cyclic pattern. The HIV incidence rate showed a growing tendency, increasing 90,70 % with respect of the extreme years of the series. The relation man/woman was one woman diagnosed per four men. The 56,87 % of the diagnosed people were homo-bisexual ones, most of them male. The most affected age group was the 20-24 years-old group. The capital of the country reported the biggest incidence rate of cases. The most affected municipalities were urban and had a high population density. Conclusions: The incidence of the HIV positive people's diagnosis maintains an increasing tendency due to the men having sex with other men. The age group with higher incidence is the 20-24 years-old one. The bigger quantity of the cases stems from urban and densely populated regions.

Characteristics of DC subsets in chronic HIV-1 infected patients during antiretroviral therapy / 中华微生物学和免疫学杂志

Objective To understand the dynamics of DC subsets in chronic HIV-infected patients during antiretroviral therapy (ART).Methods Seventeen treatment-naive chronic HIV-infected patients were enrolled in our study,and blood was collected at week 0,4,12,24,48 and 60 of ART.Additional 15 HIV-uninfected age-matched healthy adults and 15 long term non-progressors(LTNP) were recruited as controls.CD4+T cell counts and viral loads were examined routinely.The counts of DC subsets were measured by flow cytometry and IFN-α plasma levels were measured by ELISA.Data analysis was performed using SPSS version 16.0.Results ( 1 ) Before ART,mDC ( percentage and absolute count) in ⅢⅤ-infected group were significantly lower than those in healthy group and LTNP group,P＜0.001 in both groups.After 60 weeks of ART,mDC in HIV-infeeted group were significantly increased,and there were no significant differences compared with healthy controls and LTNP group.(2) pDC and IFN-α plasma levels remained relatively stable during ART,and similar to those in healthy controls and LTNP group.(3)Significant associations were found for DC subsets and CD4+ T cell counts before ART.mDC subsets at week 12,24,60 post ART were positively correlated with CD4+ T cell counts,and negntively correlated with virus load.Changes in mDC at week 8 post ART positively correlated with the changes in CD4+T cells at week 60 post ART,and negatively correlated with the changes in virus load at week 60 post ART.Conclusion The counts of mDC significantly reduced in HIV-infected patients,increased after ART,and positively correlated with CD4+ T cell counts.The findings suggest that mDC may play an important role in controlling HIV infection,mDC may serve as an early predictor for immune reconstitution in the initiation of ART.