No role of herpes simplex virus type 2 [HSV-2] infection on HIV progression in naive HIV patients

Background: Herpes simplex virus type 2 [HSV-2] is a common infection in human immunodeficiency virus [HIV] patients and may accelerate HIV progression by rising HIV viral load and decreasing CD4 count. However, the available data regarding the influence of HSV-2 seropositivity on HIV progression in HIV individuals are inconclusive. Therefore, we aimed to determine HSV-2 seroprevalence in naive HIV patients and normal controls and also investigate the relation of HIV viral load and CD4 count with HSV-2 seropositivity. Subsequently, we investigated the association of HSV-2 serostatus with changing in CD4 count and HIV viral load in our subjects, after one year follow-up

Methods: In this study, 116 naive HIV patients and 85 healthy controls from Tehran, Iran were enrolled. HSV-2 IgG antibody was detected by ELISA. CD4 count was determined by flowcytometry, and serum HIV RNA copy numbers were determined using real-time PCR

Results: The prevalence of HSV-2 IgG was 18.1% in naive HIV patients and 0% in the control group [P = 0.000]. HSV-2 seroconversion was observed in 2.43% of HIV patients after one year. There was no significant difference regarding HSV-2 serostatus with CD4 count and HIV RNA viral load in our study cohort at baseline and after one year

Conclusion: Our results revealed that the prevalence and incidence of HSV-2 infection are low in our HIV cases, and it is negligible in the control group. However, it seems that HIV/HSV2 co-infection has no role on HIV infection acceleration

Preparation and evaluation of ribonuclease-resistant viral HIV RNA standards based on armored RNA technology

Background: The human immunodeficiency virus type 1 [HIV-1] is an infectious viral agent that gradually extinguishes the immune system, resulting in acquired immune deficiency syndrome [AIDS]. The aim of this study was to construct an RNA-positive control based on armored [AR] RNA technology, using HIV-1 RNA as a model

Methods: The MS2 maturase, a coat protein gene [at positions 1765 to 1787] and HIV-1 pol gene were cloned into pET-32a plasmid. The prepared plasmid was transformed into Escherichia coli strain BL2 [DE3], and the expression of the construct was induced by 1 mM of isopropyl-L-thio-D-galactopyranoside [IPTG] at 37 °C for 16 h to obtain the fabricated AR RNA. The AR RNA was precipitated and purified using polyethylene glycol and Sephacryl S-200 chromatography

Results: The stability of AR RNA was evaluated by treatment with DNase I and RNase A and confirmed by transmission electron microscopy and gel agarose electrophoresis. Tenfold serial dilution of AR RNA from 101 to 105 was prepared. Real-time PCR assays had a range of detection between 101 and 105. In addition, R2 value was 0.998, and the slope of the standard curve was -3.33

Conclusions: Prepared AR RNA, as a positive control, could be used as a basis for launching an in-house HIV-1 virus assay and other infectious agents. It can be readily available to laboratories and HIV research centers. The AR RNA is non-infectious and highly resistant to ribonuclease enzyme and can reduce the risk of infection in the clinical laboratory

Cloning, expression and library construction for HIV-1 Tat Protein

Background: Designing novel therapeutic agents has been a critical challenge for HIV disease

Materials and Methods: In current study a DNA sequence which was encoded the Tat protein was synthesized and inserted in pET 28 vector. Vector was cloned in BL21-DE3 E. coli and cultured in TB media. After protein expression, recombinant Tat protein was purified by NTA affinity chromatography. The Tat purified protein efficiency and confirmed by SDS-PAGE and Western blot, respectively. We were immunized the camel against HIV-1 Tat recombinant protein to made a camelid antibody library. Total RNA was extracted from camel lymphocytes and VHH fragments synthesized and amplified using RT-PCR and Nested- PCR methods by special primers

Results: The 350- 450 bp VHH gene fragment was produced by RT-PCR and Nested- PCR and extracted from agarose gel 1%. Then gel extraction was performed and pure fragments were inserted in HEN-4 vector by T4 DNA ligase

Conclusion: The library can be applied for biopanning and isolation of nanobody against HIV-1 Tat Protein. Nanobody small size may be a useful drug for treatment of HIV disease because give them the potency of the recognizing the cryptic epitopes of tat and neutralized the virus

Addressing predictors of HIV related risk behaviors: demographic and psychosocial profile of Iranian patients

For effective implementation of HIV-related behavioral interventions, better understanding the demographic characteristics of infected patients in relation with high-risk behavior profiles, physical and mental health are essential. In a cross-sectional descriptive study, 400 HIV infected patients from December 2011 through January 2013 were evaluated regarding their demographic features, and four selected subscales [high-risk behaviors, self-efficacy, well-being, and social participation]. A validated questionnaire of 62 items was used for assessment. Almost 33% of all participants were women, 28% were younger than 30 years old, and 43% were never married; 50% had no permanent jobs. Women, widowed participants, patients <30 years, and those with higher educational levels had higher mean HIV risk behavior scores. In simple and multiple linear regression models, women >50 years and <30 years had the highest scores [beta = 2.714, p < 0.0001; beta = 2.00, p < 0.001]. Furthermore, male and illiterate patients had higher social participation scores while female and divorced participants had higher well-being and self-efficacy scores. We propose that demographic features play a critical role in increasing engagement in HIV-related high-risk behaviors; these characteristics also affect patients' social participation, well-being and self-efficacy. High-risk behaviors and social participation scores among women of different age groups and the youth highlight the need for future age and gender-specific educational and behavioral interventions among them

Health needs of people living with HIV/AIDS: from the perspective of policy makers, physicians and consultants, and people living with HIV/AIDS

HIV/AIDS has been concentrated among injecting drug users in the country. This study aimed to investigate and identify health and treatment needs of people living with HIV/AIDS in Iran. This qualitative study was conducted in 2012 in Iran. The study groups consisted of experts, practitioners, and consultants working with People Living with HIV/AIDS and their families. Data was collected through Focus Group Discussions and deep interviews. Data were analyzed using content analysis method. The findings of this study included the needs of people living with HIV/AIDS, which were classified in three main categories. The first category was prevention and counseling services with several sub-groups such as education and public and available consultation, distribution of condoms to vulnerable groups, increasing counseling centers in urban areas, providing appropriate psychological and supportive counseling, and family planning services. The second category included diagnostic and treatment services and had several sub-groups such as full retroviral treatment, Tuberculosis treatment and continuing care, providing care and treatment for patients with hepatitis, and providing dental services. The third category included rehabilitation services and had some sub-categories such as home care, social and psychological support, nutritional support, and empowering positive clubs. This study puts emphasis on making plans based on the priorities to meet the needs of people living with HIV/AIDS in Iran

Predictors of tuberculosis and human immunodeficiency virus co-infection: a case-control study / 한국역학회지

OBJECTIVES: The human immunodeficiency virus (HIV) and Mycobacterium tuberculosis co-infection is a major global challenge. It is not clear why some HIV-positive people are co-infected with tuberculosis (TB) while others are not. This study addressed that question. METHODS: This case-control study was conducted in Tehran, Iran in June 2004, enrolling 2,388 HIV-positive people. Cases were selected from those who were co-infected with TB and controls from those without TB. Multiple logistic regression analysis was performed to assess the association between M. tuberculosis/HIV co-infection and several predictors. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. RESULTS: In this study, 241 cases were compared with 2,147 controls. Sex, age, marital status, educational level, imprisonment, smoking, narcotic use, route of HIV transmission, previous TB infection, isoniazid preventive therapy (IPT), antiretroviral therapy (ART), and low CD4 count (<350 cells/mm3) were independently associated with M. tuberculosis/HIV co-infection (p<0.001). However, after adjusting for all other variables in the model, only the association between M. tuberculosis/HIV co-infection and the following predictors remained statistically significant: imprisonment (odds ratio [OR], 3.82; 95% confidence interval [CI], 2.11-6.90), previous TB infection (OR, 5.54; 95% CI, 1.99-15.39), IPT (OR, 0.13; 95% CI, 0.06-0.31), ART (OR, 1.81; 95% CI, 1.26-2.61), and CD4 count <350 cells/mm3 (OR, 2.34; 95% CI, 1.36-4.02). CONCLUSIONS: Several predictors are associated with M. tuberculosis/HIV co-infection, but only a few indicators were significantly associated with M. tuberculosis/HIV co-infection. It is estimated that a number of predictors of M. tuberculosis/HIV co-infection remain unknown and require further investigation.

Respiratory complications in Iranian hospitalized patients with HIV/AIDS

The respiratory tract has been the most commonly affected site of illness in HIV-infected patients. The current study was done to identify the frequency of respiratory complications in a consecutive case series of HIV-positive patients in Iran. This study was a retrospective analysis at the national academic reference medical center of Imam-Khomeini Hospital, in Tehran, Iran. The study included 199 new admissions for 177 HIV-infected patients between 2000 and 2005. Demographic characteristics, risk factors for HIV infection, respiratory complications, and CD4+ lymphocyte counts were evaluated in these patients. All patients were males. The mean age was 35 years [age range: 15 to 63 years]. Among 34 cases with available CD4+ lymphocyte count results, 70.6% had results <200 cells/mm[3]. Nearly half the patients [47.7%] had respiratory symptoms. The most common pulmonary complications were cough [86.3%], sputum [71.6%], dyspnea [54.7%], and hemoptysis [10.5%]. The most common diagnosis was pulmonary tuberculosis [27.1%], followed by other bacterial pneumonias [16.6%] and pneumocystis carinii pneumonia [4.5%]. Intravenous drug users who had history of incarceration had the highest risk factors for Mycobacterium tuberculosis infection [59%], and other bacterial pneumonias [52%].Our study demonstrates that respiratory complications are highly frequent in HIV patients in Iran and that pulmonary tuberculosis is still a common complication in HIV infected patients, despite the availability of effective treatment. Results suggest the need for more effective preventive and prophylactic measures, wider use of antiretroviral treatment and effective chemotherapy for Iranian patients with HIV/AIDS

Seroprevalence of toxoplasmosis in HIV+/AIDS patients in Iran

Toxoplasma gondii has arisen as an important opportunistic agent especially in the central nervous system and in advanced HIV disease can cause significant morbidity and mortality. This study was carried out to determine the seroprevalence of toxoplasmosis among HIV-positive patients in Iran. Blood samples were collected from 201 HIV-positive patients and anti-toxoplasma antibodies were detected by using conventional ELISA. An antibody titer of >3 IU/ml was considered positive. The majority of studied patients were male [male to female ratio: 5 to 1] with the mean age of 36 +/- 1 yrs. The seroprevalence of toxoplasmosis in HIV-positive patients was 49.75%. The mean CD4 count in HIV patients with positive toxoplasma serology was 332.5 +/- 22.4 cells/micro l. Only 1% of the patients had IgM anti-toxoplasma antibodies and 10% of the patients had clinical toxoplasma encephalitis. The mean CD4 count in this group was 66.4 +/- 15.5 cells/micro l and there was a significant association between CD4 count and rate of toxoplasma encephalitis [P<0.001]. Previous reports suggested that toxoplasma encephalitis could be prevented by appropriate chemoprophylaxis. In view of the relatively high prevalence of toxoplasma infection found among the HIV-infected patients in our study, we suggest that routine screening for toxoplasma should be undertaken for all HIV-infected patients in Iran

Hepatitis-C and hepatitis-B co-infections in patients with human immunodeficiency virus in Tehran, Iran

We carried out a study to determine the seroprevalence of HBV and HCV infections in HIV positive patients at a main referral center for HIV/AIDS in Iran. Serum samples from 201 HIV positive patients referring to a referral center for HIV/AIDS were analyzed for the presence of some hepatitis B [HBsAg, anti-HBc, anti-HBs] and Hepatitis C [anti-HCV] markers, during 2004- 2005. HBsAg was positive in 27 patients [13.4%], anti-HBc was positive in 60 patients [29.8%] and anti-HBs in 23 patients [11.4%]. Anti-HCV Ab was positive in 135 of 201 [67.2%]. HBV and HCV coinfection was observed in 73 of 201 [36.3%]. The maximum prevalence of HBV-HIV and HCV-HIV coinfections were seen in intravenous drug users; 61.2% and 85.1%, respectively [P<0.0001]. The minimum prevalence of HBV-HIV and HCV-HIV were seen in HIV patients wife [HIV+ patients who were infected by monogamous sexual contact with their HIV positive husband] both of them were 8% [P<0.0001]. This study showed that HBV-HIV and HCV-HIV coinfections are significant in patients with HIV/AIDS in Iran. A greater relevance was observed in the association between HCV and HIV. This study suggests that it is necessary to investigate risk factors and risk groups for these infections in Iran

Wart lesion in a patient associated with HIV infection and treatment under IMOD therapy

We report a 27-year-old hemophilic male who was HIV positive and under Highly Active Antiretroviral Therapy [HAART] along with wart lesions. When IMOD therapy started concurrently with HAART, the skin lesions disappeared

Evaluation of bone mineral density in Iranian HIV/AIDS patients

Bone disorders have emerged as a worrisome complication in HIV-infected patients in recent years. It is not clear that HIV infection itself or antiretroviral treatment or both are causes of bone loss. However, most studies have found a high prevalence of osteopenia and osteoporosis in HIV/AIDS patients. The objectives of this study were to determine the prevalence of osteopenia and osteoporosis in HIV-infected patients either untreated or receiving Highly Active Antiretroviral Therapy as compared with HIV negative persons. We also assessed the factors associated with these conditions. Bone Mineral Density was assessed by Dual Energy X-Ray Absorptiometry scans at the hip and lumbar spine in 36 AIDS patients receiving antiretroviral therapy and 44 HIV infected patients not receiving antiretroviral therapy [na‹ve patients] and 40 HIV negative individuals as control. Factors that affect BMD were also determined. Prevalence of osteopenia or osteoporosis in different regions was significantly higher in HIV/AIDS patients compared with HIV negative subjects [77.3% in HIV positive na‹ve patients, 86.1% in HAART-treated patients and 60% in the control group, P=0.002]. Mean serum alkaline phosphatase was higher in HIV/AIDS patients than the control group [P=0.003]. Osteopenia and osteoporosis in HIV-infected patients were associated with duration of HIV infection [P<0.0001] and antiretroviral treatment [P=0.012]. Prevalence of osteopenia and osteoporosis in HIV/AIDS patients was higher than HIV negative individuals. Osteopenia and osteoporosis in HIV/AIDS patients was associated with duration of HIV infection and antiretroviral treatment

Assessing the prevalence of HIV among Afghan immigrants in Iran through rapid HIV testing in the field

Throughout the world, many migrant and mobile populations are at elevated risk for HIV. Iran has a large immigrant population from neighboring Afghanistan; however, few data exist on the prevalence of HIV in this community. In 2008, we conducted a study to assess the presence of HIV infection among 477 immigrants in a town to the northeast of Tehran using a rapid test in the field. HIV prevalence was 0.2% [95% CI 0.005-1.2] with one person HIV-positive. We recommend periodic HIV sero-surveillance with detailed behavioral measures for this population in the future

Cytomegalovirus co-infection in patients with human immunodeficiency virus in Iran

Serum samples from 201 HIV positive patients were collected to determine the seroprevalence of CMV infection in Iranian HIV infected patients during March 2004 until March 2005 using conventional ELISA kits. An antibody level of>1.1 Iu/ml was considered positive. The seroprevalence of CMV infection was 94%.The maximum prevalence of CMV antibody was seen in patients with unsafe sex and IDUs. Prevalence of CMV was much higher in patients with low socioeconomic status and low level of education. 83% of patients with CD4<100 were CMV seropositive. Our study showed that a significantly high prevalence of CMV in HIV positive patients in Iran. By increasing the level of education and socioeconomic status the prevalence of CMV infection decreased

Characterization of immune responses induced by combined clade-A HIV-1 recombinant adenovectors in mice

Numerous evidences indicate that in some HIV-1 positive patients, the humoral and cellular immune responses are induced against HIV-1 proteins and this is inversely related to the progress of infection. The aim of this study was the evaluation of the Adenovectors containing HIV genes in induction of immune responses in mice. The HIV-1 genes including gag p24, rev, nef and exon-1 of tat were amplified from HIV-1 RNA [clade-A]. The cDNA of each gene was cloned into a transfer vector. The transfer vector was then co-transformed into E. coli strain BJ5183 together with pAdenovector ?E1/E3. The recombinant adenoviral construct was transfected into QBI-293A cells. Recombinant viruses were purified and titrated on 293 cell plates. Expression of transgenes was evaluated using western blotting. Then 1012 viral particles were injected into 15 groups of 5 mice and all patterns of combination of these 4 HIV-1 genes were evaluated. After 2 weeks, humoral and cellular immune responses were evaluated using ELISA, cell proliferation and ELISpot [IL-2, IL-4 and IFN- gamma] assays, consecutively. It was demonstrated that each gene was expressed. The response targets were mostly toward Th1, though several Th2 responses were also observed. Single injection in our study induced a good cellular response but the humoral responses were not as strong as the cellular ones. Considering and comparing all results and evaluating the various possible interactions revealed that simultaneous injection of tat and gag has enhanced the humoral and cellular responses

cross-sectional study of anemia in human immunodeficiency virus-infected patients in Iran

Anemia is a frequent complication of infection with human immunodeficiency virus [HIV]. The causes of HIV-related anemia are multifactorial. This study was conducted to evaluate the factors associated with anemia in HIV-infected patients. A total of 642 patients with HIV/AIDS attending the HIV Clinic at Imam Khomeini Hospital in Tehran, Iran enrolled in this study. A detailed history and physical examination was done for all the patients. Investigations included CD4+ count, hemoglobin concentration, and red blood cells morphology. Among HIV-infected patients, 87% were males. The mean duration of antiretroviral therapy was 17.9 +/- 9.2 months. The mean [ +/- SD] hemoglobin level was 12.9 +/- 2.31 mg/dL. Evaluation of red blood cell morphology showed macrocytosis in 11%, normocytosis plus normochromia in 41.1%, and microcytosis plus hypochromia in 47.9% of the patients. The prevalence of anemia [defined as hemoglobin<10 mg/dL] was 10.3%. Anemia was positively associated with female sex [OR = 3.01], CD4 level [CD4 count of <200] [OR=3.49], and antituberculous drug administration [OR=4.57]. Female sex, stage of HIV infection, and antituberculous drug use were the most important factors associated with anemia in HIV-infected patients in our study

Frequency of positive purified proterin derivative test in those infected with human immunodeficiency virus

The objective of this study was to determine the frequency of positive purified protein derivative [PPD] skin test in those infected with human immunodeficiency virus [HIV] and to investigate its association with CD4-positive T cell count, demographic factors, and possible routes of transmission in Iran. Fifty-one [36 males and 15 females] patients from an HIV clinic were selected and tested by a 5-tuberculin unit PPD. The mean +/- SD age of patients was 32.2 +/- 7.9 years. The probable route of HIV transmission was intravenous drug using in 21 [41%, CI95%: 28 - 54%] and sexual transmission in 17 [33%, CI95%: 20 - 46%] patients. Thirteen [26%, CI95%: 14 - 38%] patients had other risk factors. There were 13 [25%; 10 males and 3 females] PPD-positive patients among HIV-infected patients when a cut-off value of 5 mm was used; there were 15 [29%; 11 males and 4 females] when a cut-off point of 2 mm was employed. In addition, there was no significant correlation between the PPD test using both cut-off values of 5 and 2 mm, and none of the three probable routes of HIV transmission including intravenous drug using, sexual, and others. The mean +/- SD CD4[+] T cell count was 674 +/- 487/mm[3] in men and 573 +/- 327/mm[3] in women [P > 0.05]. No significant correlation could be demonstrated between the patient's PPD positivity rate and CD4[+] T cell count. Considering the high rate of tuberculin reactivity, more attention should be paid to the importance of PPD test and isoniazid preventive therapy against tuberculosis in HIV-infected patients

Recurrent non-typhoidal salmonella bacteremia in a patient with interleukin -12p40 deficiency

The South eastern region of Iran is an endemic area for salmonellosis. Sometimes bacteremia due to nontyphoidal salmonella occurs but certain patients are at increased risk for recurrent bacteremia. The risk of invasive salmonellosis and recurrent bacteremia is increased in the patients with immunosuppression, especially impaired cell-mediated immunity, lymphoproliferative diseases and in patients with IL-12 deficiency. In recent years, a series of inherited disorders of IL-12-IFN-gamma axis have been described that predispose affected individuals to disseminated disease caused by environmental mycobacteria and non-typhoidal salmonella. We report here the first such patient originating from and living in Iran. The patient was a 26-year-old man, suffering from IL-12p40 deficiency and presented with recurrent episodes of systemic salmonellosis. This report indicates that there are patients with inherited defects of the IL-12-IFN-gamma circuit in Iran. We recommended to consider this group of disorders in all patients with recurrent non-typhoidal salmonella bacteremia, wherever they are found