[Prevalence of HLA-B*57:01 allele in HIV-infected patients in a university hospital in Tehran]

Abacavir is an anti-retroviral medication used to treat HIV infected/AIDS patients and its efficacy has been proven in randomized clinical trials. The most significant adverse reaction associated with abacavir is the acute hypersensitivity phenomenon which manifests in many forms and in severe cases could result in death. Hypersensitivity reaction to abacavir has been closely linked to the presence of HLA-B*57:01 allele. Avoidance of abacavir initiation in allele-positive patients is the most effective strategy in preventing possible severe hypersensitivity reactions. Previous epidemiologic studies have made great strides toward delineating HLA-B*57:01 allele frequency in different regions of the World and the available results indicate significant discrepancy between geographical regions. Despite these efforts, no study to date has determined the allele frequency among Iranian HIV-positive patients. The aim of the present study was to determine the proportion of allele-positive patients among a group of Iranian HIV-infected patients. Between September 2012 and February 2013, 122 HIV-positive patients were selected among patients referred to Imam Khomeini Hospital's Consultation center for high risk behaviors using the convenience sampling method. Sampling scheme was designed in a manner to include equal number of infected patients with and without clinical Acquired Immunodeficiency Syndrome [AIDS]. Patient data was collected using available records and a blood sample for DNA analysis was also obtained. Presence of HLA-B*57:01 allele was determined using the Polymerase Chain Reaction- Sequence Specific Method [PCR-SSP]. Seventy three patients [59.8%] were male. Co-infection with hepatitis B and C was observed in 1.7% and 40.7% of the patients, respectively. History of addiction and anti-retroviral therapy was positive in 50.0% and 60.7% of the patients, respectively. Overall, three patients were allele-positive which corresponds to a frequency of 2.46% [95% CI: 0.005-7.30]. No association between presence of allele and investigated variables were identified. Frequency of HLA-B*57: 01 allele among a group of Iranian HIV-infected patients is estimated to be 2.5%. This rate is comparable to those reported in other Middle-Eastern countries, yet is relatively lower than reports generated from South-Eastern Asia, Europe, and the United States. Future studies with larger sample sizes are needed to corroborate these findings

[Outcome of TB in HIV patients treated with standard regimen]

HIV infection reduces the immune system and is the most significant factor in the spread of TB in recent years and one of the causes of death in HIV-seropositive patients. TB is the most commonly diagnosed opportunistic infection and the most frequent direct cause of death among HIV infected patients. The HIV infection can accelerate progression of TB infection to active TB disease. Among patients with active TB, those with HIV coinfection have the greatest risk for relapse. Regardless of increasing rate of TB and HIV in Iran, we decided to survey outcome of TB in HIV positive patients who treated with standard regimens in the years 2003-2012. This retrospective cohort study was conducted on HIV-positive patients with TB referred to Behavioral Diseases Consultation Center and Infectious Diseases Ward of Imam Khomeini Hospital from 2003 to 2012. Outcome was defined as failure, relapse and mortality. Moreover, the relationship between outcomes and number of CD4, co-trimoxazole and antiretroviral intake, type of TB and AIDS defining illness was studied. This study had 135 patients, 8 [5.9%] were females and 127 [94.1%] were males. The mean age of the patients was 40.14+10.02 and the most way to catch HIV in this study was intravenous drug user. There were 3 [2.22%] cases of failure, 15 [11.1%] relapse, and 21 [15.8%] deaths. Antiretroviral therapy, AIDS defining illness, type of TB and co-trimoxazole intake did not soley affect relapse. CD4 level was the most effective variables in relapse [Hazard ratio: 0.392 [0.11-1.4]; Relative Risk: 0.809 [0.593-1.103] [P=0.068]]. However, regard to CI95%, the impact of CD4 on relapse is not significant and antiretroviral intake was the most important and effective variable in increasing their survival. Hazard ratio: 0.137 [0.141-0.45]; Relative Risk: 0.686 [0.513-0.918] [P=0.001]. Overall, receiving antiretroviral was the most important factor influencing the outcome of patients

Antibody responses to trivalent influenza vaccine in Iranian adults infected with human immunodeficiency virus

The serious influenza-associated complications among immunodeficient individuals such as those who are infected with human immunodeficiency virus [HIV], highlights the importance of influenza vaccination in these people. Therefore, the current study aimed to investigate the antibody responses to influenza vaccine in this group. Two hundred subjects were recruited, during autumn 2010 and 2011, to receive, trivalent inactivated influenza vaccine consisting of A [H1N1], A [H3N2], and B strains. Hemagglutination inhibition assay was used to measure the antibody titer against all strains of the vaccine prior and one month post vaccination. Seroconversion rate for A [H1N1], A [H3N2], and B were found to be 58.5%, 67% and 64.5%, respectively. No correlation was found between antibody titer and demographics factors such as age and gender; however, we found a significant correlation between antibody titer and CD4 cell count. Checking the local and systemic reactions after vaccination, the pain on the injection site and myalgia were the most common local and systemic reactions with 20% and 6.5%, respectively. As vaccination with influenza mount considerable antibody responses in HIV-infected patients, annul influenza vaccination seems to be rational in order to prevent or reduce the severe clinical complications induced by influenza virus

[Evaluation of treatment effect of anti-tuberculosis drugs on the quality of life among tuberculosis patients admitted in Imam Khomeini hospital in Tehran]

Despite the possibility of curing TB with medical therapy, it has a sizable impact on the lives of afflicted patients. This study aimed to evaluate of treatment effect of anti-tuberculosis drugs on the quality of life on tuberculosis patients admitted in Imam Khomeini hospital in Tehran. The investigation was a before and after study. It was done in 2006-2007 by fill in Persian translated questionnaire of WHOQOL- BREF on 46 pulmonary or extra pulmonary TB infected patients. Paired samples T-test was performed to find out the differences. After 8 weeks of treatment, mean score elevation was significant in physical [15.76 +/- 23.89, p<0.001], psychological [7.84 +/- 17.57, p=0.004], and social [6.83 +/- 19.48, p=0.02] domains. It was not significant in environmental domain [2.15 +/- 8.48, p=0.09]. Mean score elevation at the discharge time in physical, psychological, social and environmental domains were: [5.65 +/- 16.56, p=0.09], [11.69 +/- 19.22, p=0.001], [1.04 +/- 8.60, p=0.41], and [4.37 +/- 17.77, p=0.1], respectively. In our study, after treatment of tuberculosis, patient's physical, psychological and social -not environmental- domains of quality of life were elevated, but at the discharge, there was a significant elevation in physical and psychological domains. These results emphasize the importance of patient's treatment at the first days of admission, with special attention to social and environmental domains

FNA diagnostic value in patients with neck masses in two teaching hospitals in Iran

The FNA [fine needle aspiration] procedure is simple, inexpensive, available and a safe method for the diagnosis of a neck mass. FNA has numerous advantages over open surgical biopsies as an initial diagnostic tool; therefore we decided to compare the accuracy of this method with open biopsy. This Retrospective as well as Descriptive study comparing preoperative FNA results with existing data in the Pathology Department in Bu-Ali and Amir Alam Hospitals. Our study included 100 patients with neck masses of which 22 were thyroid masses, 31 were salivary gland masses, and 47 were other masses. Age ranged from 3 years to 80 years with the mean age of 42.6 years. There were 59 men and 41 women. The Sensitivity was 72%, Specificity 87%, PPV 85%, NPV 75% and diagnostic Accuracy 79%. In this study we had also 26% false negative and 15% false positive. FNA is a valuable diagnostic tool in the management of neck masses; also it has been used for staging and planning of treatment for the wide and metastatic malignancy. This technique reduces the need for more invasive and costly procedures. According to the high sensitivity and high accuracy in this study, FNA can be used as the first step of diagnoses test in neck masses

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

Incidence of isolation of Mycobacterium tuberculosis from blood samples in tuberculosis patients in Imam Khomeini hospital, Tehran, Iran

It is estimated that one third of the world's population is latently infected with tuberculosis [TB]. The HIV epidemic fuels the TB epidemic by increasing the risk of reactivation of latent TB infection and by facilitating a more rapid progression of TB disease. Although the incidence of TB is constant or decreasing in many regions of the world, rates remain high in developing countries as a consequence of the HIV epidemic. This study was conducted as a collaboration of the Infectious Diseases department of Imam Khomeini Hospital with the Microbiology department of Tehran University of Medical Sciences. The hospital dataset of 94 patients admitted with TB during 2003-2005 was reviewed. We aimed to study factors correlating with positive blood culture including age, sex, immune deficiency status, HIV serology and SIRS [Systemic Inflammatory Response Syndrome] status. In this study, we found that positive blood cultures are more frequent in patients less than 45 years old. Positive blood cultures were also more frequent in HIV infected patients and there was a significant correlation between blood culture and SIRS status. Therefore, we recommend that we obtain blood cultures from these high-risk groups in order to increase early detection of TB

Application of SYBR-Green Real Time RT-PCR for quantification of human immunodeficiency virus type-1 [HIV-1] and comparison with COBAS AMPLICOR test

In this study, a SYBR Green real-time RT-PCR assay for quantification of HIV-1 viral RNA was developed. This assay was performed based on amplification of the pol region of HIV-1 and product analysis by an ABI 7500 system. We quantified HIV-1 viral load in 26_seropositive patients by this system and the data were subsequently compared with results obtained with a reference technique represented by COBAS AMPLICOR HIB-1 Monitor test. The results demonstrated that this technique could detect up to 500 HIV-1 RNA copies/ml of plasma. The linearity of this approach was conserved over a wide range of HIV-1 copy numbers [5x10[2]- 5x10[9]]. Since no positive signal was observed in seronegative volunteers, the specificity of the test was calculated as 100%. Comparison of the results with those obtained by the reference quantification method, revealed a significant correlation between the results [R[2] =0.95]. On the basis of the most recent recorded cases for HIV-1 infection and AIDS in Iran, the prevalence of this disease is rising rapidly and the situation has been called to be alarming by national health representatives. Determination of HIV-1 viral load in plasma has been considered as the most effective single prediction tool for monitoring HIV-1 patients treated with antiviral drugs. In this study, we have developed a SYBR-Green Real Time RT-PCR assay for quantitative analysis of HIV-1 in infected patients. Since a synthetic RNA standard was used in this assay, the upper limit of detection was detected to be higher than the standard test [5x10[9] versus 7.5x10[5]]. This can be important in patients with acute high viral load infections. Reproducibility was assessed by Intra assay and Inter assay analysis, Coefficient of variations Ct, in reproducibility tests for Intra assay and Inter assay variability were less than 3% and 4.5% accordingly. The above results, indicates that the new developed test can be a used in substitution of the commercial assay for quantitative analysis of HIV-1