The first kidney transplant in HIV infected patient in Georgia.

Highly active antiretroviral therapy (HAART) has significantly improved the life expectancy of patients with HIV. As a result, kidney transplantation is considered an viable treatment option for HIV infected patients with end stage renal disease. The first living-related kidney transplant in Georgia has been performed between non-identical twin sisters in July 2013. In this paper we give the detailed case report and short overview of the existing literature. This is the first report of the successful kidney transplant in HIV infected patient in East Europe and former Soviet Union Countries including the Central Asia.

TB/HIV co infection in Georgia.

HIV and TB co-infection is a considerable problem worldwide. HIV significantly increases the morbidity and mortality from TB and often makes the diagnosis more challenging. In this study we attempted to evaluate the prevalence of TB among newly diagnosed HIV infected persons and determine the rate of HIV infection among active TB patients in Georgia. The prospective observational study has been conducted in Georgia since January 01, 2006. All newly diagnosed HIV positive persons were screened for active and latent TB infection and the prevalence of TB was identified. During the same time period HIV screening was performed in all identified active TB cases. Up to 22% (16.7 to 22%) of HIV positive individuals were found to have active TB, and 22.4 to 32.6% had LTBI. The prevalence of HIV among TB patents ranged from 1.7 to 2.2%. The study showed significant prevalence of TB (both active and latent TB) among HIV patients. Because of problems with TB diagnosis in HIV patients, the real prevalence may be underestimated. The alarming statistical data should force us towards meticulous and scrupulous screening for tuberculosis among HIV positive individuals. The prevalence of HIV among TB patents was not very high, ranging from 1.7 to 2.2%, but we recommend routine screening for HIV in all active TB patients.

Antiretroviral treatment in Georgia.

HIV infection is the major public health, social and economic problem in Georgia. The aim of this study is to evaluate effectiveness of ARV treatment system in Georgia. Study included 1052 people living with HIV/AIDS in Georgia registered at Infectious Disease, AIDS and Clinical Immunology Research Center since 2004. To ensure universal access to ARV therapy all HIV/AIDS individuals included in the study were investigated by special algorithm, all identified patients requiring ARV therapy were offered treatment and monitored during therapy on treatment effectiveness and side effects. Detection of HIV antibodies was performed by ELISA with further confirmation by Western Blot Assay. HIV-1 RNA in plasma was measured by quantitative Polymerase Chain Reaction. For determination of percentages and absolute count of T lymphocyte subpopulations single-platform immunophenotyping technique using the Becton-Dickinson FACSCalibur flow cytometer was applied. For resistance testing TRUGENE HIV-1 Genotyping Kit with the OpenGene DNA Sequencing System (Siemens) was used. Treatment was offered to 595 HIV/AIDS patients. 594 patients started treatment, 1 patient refused. Out of treated 594 HIV/AIDS patients 22 patients discontinued, 111 patients died and 461 patients are currently on ARV treatment. Out of treated patients 406 adults and 21 children are receiving first-line treatment, 31 adults and 2 children are on second-line treatment and 1 adult is receiving salvage regimen. Treatment failure was defined in 55 cases. Among them immunological failure was observed in 7 cases, clinical failure in 1 case and virologic failure in 47 cases. Prevalence of drug resistance among virologic failure cases accounted for 72% and inadequate adherence for 28% cases. Majority of death cases among ARV treated patients was due to non-AIDS related or incurable conditions, while deaths due to AIDS related conditions mainly were associated to the delayed referral of patients in already advanced stage of disease. It's worth to mention that highest number of death cases was due to liver failure in HIV/HCV and/or HBV co-infected patients.

Neurological complications in patients with HIV/AIDS.

The aim of the study was to determine the prevalence of HIV-related neurological disorders in HIV positive patients and its relationship to CD4 cell counts in Georgia. This study included 388 HIV/AIDS patients (302 men and 86 women), who have been admitted to the in-patient Department of Infectious Diseases, AIDS and Clinical Immunology Research Center (IDACIRC) of Georgia since 2006. Diagnosis of neurological disorders was made based on clinical symptoms and instrumental-laboratory investigations. CNS Neurological complications were detected in 76 patients; 13 patients had two or more neurological complications. Tuberculosis meningitis were the most common neurological disorders 26 (34%), followed by CNS toxoplasmosis 17 (22%), cryptococcal meningitis 11 (15%), presumed CMV encephalitis 5 (7%), PML 4 (5%), primary CNS lymphoma 4 (5%) and bacterial meningitis 3 (4%). AIDS related dementia was detected in 18 patients (24%). The median CD4+ T lymphocyte count was 47 cells/mm(3) (range: 2-183 cells/mm(3)) in HIV patients with neurological complications. There was correlation between the CD4 T lymphocyte count and type of neurological manifestation. Namely, in the patients with HIV related dementia median CD4 T lymphocyte count was 164 cells/mm(3), in the patients with CNS toxoplasmosis median CD4 count was 83 cells/mm(3), in the patients with cryptococcal meningitis median CD4 T lymphocyte count was 34 cells/mm(3) and in the patients with CMV encephalitis median CD4 T lymphocyte count was 26 cells/mm(3). Some neurological disorders such as TB meningitis and bacterial meningitis can occur at any CD4 level. PML and primary CNS lymphoma occurred when CD4 T lymphocyte count < 50 cells/mm(3). The most common clinical manifestations of neurological disorders in HIV infected patients were headache (91%), fever (75%), focal neurological deficits (61%), speech disturbances (42%), cognitive dysfunction (41%), visual disturbances (36%), impaired coordination (29%) and seizures (15%). The study provide convincing evidence that neurological disorders with HIV infection might serve as an indicator for advanced HIV infection, immunosuppression and decreased CD4 cell counts. Our data have shown correlation between the type of neurological manifestations of HIV infection and CD4 T lymphocyte count.