Characteristics, immunological response & treatment outcomes of HIV-2 compared with HIV-1 & dual infections (HIV 1/ 2) in Mumbai.

Background & objectives: Information available on HIV-2 and dual infection (HIV-1/2) is limited. This study was carried out among HIV positive individuals in an urban referral clinic in Khar, Mumbai, India, to report on relative proportions of HIV-1, HIV-2 and HIV-1/2 and baseline characteristics, response to and outcomes on antiretroviral treatment (ART). Methods: Retrospective analysis of programme data (May 2006-May 2009) at Khar HIV/AIDS clinic at Mumbai, India was done. Three test algorithm was used to diagnose HIV-1 and -2 infection. Standard ART was given to infected individuals. Information was collected on standardized forms. Results: A total of 524 individuals (male=51%; median age=37 yr) were included in the analysis over a 3 year period (2006-2009) - 489 (93%) with HIV-1, 28 (6%) with HIV-2 and 7(1%) with dual HIV-1/2 infection. HIV-2 individuals were significantly older than HIV-1 individuals (P<0.001). A significantly higher proportion of HIV-2 patients and those with dual infections had CD4 counts <200 cells/µl compared to HIV-1. HIV-2 individuals were more likely to present in WHO Clinical Stage 4. Of the 443 patients who were started on ART, 358 (81%) were still alive and on ART, 38 (8.5%) died and 3 were transferred out. CD4 count recovery at 6 and 12 months was satisfactory for HIV-1 and HIV-2 patients on protease inhibitor based regimens while this was significantly lower in HIV-2 individuals receiving 3 nucleoside reverse transcriptase inhibitors. Interpretation & conclusions: In an urban HIV clinic in Mumbai, India, HIV-2 and dual infections are not uncommon. Adaptation of the current national diagnostic and management protocols to include discriminatory testing for HIV types and providing access to appropriate and effective ART regimens will prevent the development of viral resistance and preserve future therapeutic options.

Health seeking behaviour of tuberculosis patients--role of the private practitioner.

India accounts for nearly 30% of the global tuberculosis burden. The goal of the Revised National TB Control Programme (RNTCP) is to cure at least 85% of new smear positive cases of TB and detect at least 75% of such patients. There are many reasons for patient delaying seeking healthcare. A Private Practitioner plays a major role in combating the disease but unfortunately the doctor-delay is more than patient-delay. Still patients seem to prefer Private Practitioners and they are often the first point of contact for a significant number of patients with TB.

Linfoma "T" de ileo terminal levando a abdome agudo obstrutivo por intussuscepçao ileocecal / Lymphoma \"T\" of terminal ileum leading to acute obstructive abdomen by ileocecal intussusception

Os autores relatam o caso de um paciente de 30 anos, branco, sexo masculino, que desenvolveu abdome agudo obstrutivo, cujo diagnostico, apos laparotomia, revelou a presença de uma intussuscepçao ileocecal, a qual, desfeita manualmente, evidenciou massa tumoral esferica de 5 cm de diametro em ileo terminal, tendo a biopsia de congelaçao revelado neoplasia maligna pouco diferenciada. Foi realizada hemicolectomia a direita e ressecçao de segmento de ileo terminal com ileo transverso-anastomose termino-lateral em dois planos, com evoluçao pos-operatoria sem intercorrencias. O exame histologico anatomopatologico, bem como posterior estudo imunohistoquimico, mostraram tratar-se de linfoma tipo "T" primario de ileo. A investigaçao posterior ao ato cirurgico, mostrou ausencia de acometimento neoplasico em linfonodos, medula ossea e outros sitios. O paciente foi encaminhado para tratamento complementar quimioterapico, com boa evoluçao. Os autores enfatizam a baixa frequencia dessa patologia como primaria de ileo terminal 1,2,3, bem como a surpreendente evoluçao do paciente, que ate o presente momento nao apresentou outra manifestaçao da doença em outros locais, embora tenha completado um ano de evoluçao