High seroprevalence of Chlamydia trachomatis in newly diagnosed human immunodeficiency virus patients in georgia.

Due to the shared routes of transmission, co-infection with Human Immunodeficiency Virus (HIV) and other sexually transmitted infections (STIs) is common. There is strong evidence of bidirectional interactions between HIV and ulcerative STIs. Recent studies have also shown importance of non-ulcerative inflammatory STIs in the acquisition of HIV. The incidence of HIV and Chlamydia in Georgia has risen every year. We explored the extent of the problem of co-infection with C. trachomatis in HIV patients in the country. Study included 234 consecutive patients diagnosed with HIV from September 2008 through May 2009. Of them, approximately two-thirds were male 162 (69.23%), up to 44% (102) of patients had more than one lifetime sexual partner and one fifth of patients reported prior history of STIs. The seroprevalence of C. trachomatis in our study was 23.93% (95% CI: 18.61%-29.92%). In multivariate analysis the strongest predictors of C. trachomatis infection were history of STI (PR 1.94, 95% CI: 1.22-3.07) and female gender (PR 1.79, 95% CI: 1.11-2.87), while younger age and not being in marriage showed borderline significance. Findings of our study have important public health and clinical implications. Data suggest that STIs may play important role in increasing heterosexual transmission of HIV in Georgia. Efforts should be made to expand HIV screening programs. Further research is needed to better understand the role of inflammatory STIs in spreading HIV.

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.