CMV and HIV Coinfection in Women from a Region in Eastern Europe.

(1) Background: Human cytomegalovirus (CMV) infection is one of the most frequent opportunistic infections in immunosuppressed patients. Romania has one of the highest incidences of patients living with human immunodeficiency virus (HIV) which determines an immunosuppressive state. The aim of this study was to establish the prevalence of CMV infection among women living with HIV in Southeastern Romania and also to evaluate and correlate antiretroviral therapy (ART) with CD4 level and CMV disease evolution. (2) Methods: Seventy women living with HIV from Southeastern Romania were screened for CMV infection using antigen quantification. Of these, 50 were included in the study. First, the patients filled out a questionnaire regarding social conditions and other associated diseases. Then, we explored the statistical correlations between the data and HIV status, CD4+ cell counts, viral load, and antiretroviral therapy (ART). (3) Results: Median age of the patients was 33 years. Twenty-nine cases were diagnosed with HIV after sexual life beginning and 21 before. Most of the patients had a CD4 level over 200 cells/µL. ART duration in the CD4 under 200 cells/µL group was a bit longer than that in the CD4 over 200 cells/µL group. Forty-one patients had undetectable viremia. CD4 average value in the lot of patients with undetectable viremia was 704.71 cells/µL and in the lot with detectable viremia was 452.44 cells/µL. Viremia values correlated negatively with CD4 level. A positive correlation between IgG CMV values and ART therapy length was identified. A negative significant correlation between values of IgG CMV and values of CD4 was identified. CD4 value correlated negatively with IgG CMV values and with CMV avidity. (4) Conclusions: IgG CMV values had a weak positive correlation with ART therapy length, and a negative statistically significant correlation with values of CD4. CMV avidity has a negative correlation with CD4 value.

HPV and HIV Coinfection in Women from a Southeast Region of Romania-PICOPIV Study.

Background and Objectives: Romania faces one of the highest cervical cancer burdens in Europe though it is a preventable cancer through population screening by cytology and human papillomavirus (HPV) detection. Also, it has one of the highest incidences of human immunodeficiency virus (HIV) infection. HPV and HIV coinfection are frequently encountered. The aim of study was to establish the prevalence of HPV infection among HIV-positive women in Southeast Region of Romania, to genotype high risk HPV types -and to correlate the results with clinical data and cytological cervical lesions. Materials and Methods: 40 HIV-positive women were screened for HPV types and for cytological cervical lesions. The findings were evaluated in correlation with CD4 cell counts, HIV viral load, age at first sexual intercourse, number of sexual partners, vaginal candidiasis, and Gardnerella using statistical methods. Results: 19/40 (47.5%) women were positive for HPV types, 63.15% infected with single HPV type and 36.85% with multiple HPV types. The most frequent types were type: 31 (42.1%), 56 (31.57%), 53 (15.78%). On cytology, 34 (85%) women were found with NILM of which 38.23% were HPV-positive. Fifteen percent of women had abnormal cytology (three ASC-US, three LSIL), and all of them were HPV-positive. Through analyzing the value of CD4 count, women with CD4 count ≤ 200 cells/µL were found to be significantly more likely to be infected with HPV; meanwhile there was no correlation between the detection of HPV types and HIV viral load. Candida or Gardnerella were more often associated with HIV-positive women with HPV, than in women without HPV. Conclusions: Infection with HPV types is common among HIV-positive women in the Southeast Region of Romania and it is associated with age at the beginning of sexual life, number of sexual partners, CD4 value, vaginal candidiasis, and Gardnerella infection.

Pulmonary inflammatory myofibroblastic tumor in an AIDS patient.

BACKGROUND: Pulmonary inflammatory myofibroblastic tumor (PIMT) is a rare disease that occurs more frequently in younger patients. Its etiopathogeny remains debated whether this is an inflammatory lesion characterized by uncontrolled cell growth or a true neoplasm. AIM: To present a case of PIMT in a young men, HIV-positive since childhood. Patient, Methods and Results: We report the case of an HIV-positive patient, aged 21 years, with collapsed immunity (CD4=23 cells/mm3), which in the second half of 2009 was clinically and radiologically diagnosed with recurrent right pneumonia. Serological tests were negative for Mycoplasma, Epstein-Barr and HHV-8 and positive for cytomegalovirus (CMV). Further monitoring of this episode raises imaging suspicion of the tumor in right upper pulmonary lobe. A lung wedge biopsy by thoracotomy was performed. The result of histopathological examination was suggestive for Kaposi sarcoma but required an immunohistochemical examination (vimentin, smooth muscle actin, CD34, anaplastic lymphoma kinase, CK7, L26/CD20, CD38, CD68), which established diagnosis of PIMT. In our case, we noticed a favorable evolution under antiretroviral treatment (by increasing CD4 count - immunity slowly improved), broad-spectrum antibiotics, and steroidal anti-inflammatory treatment, with regression of PIMT over eight months. CONCLUSIONS: Although inflammatory myofibroblastic tumor (IMT) is rare, it should be considered in the differential diagnosis of pulmonary tumoral lesions in young adults. This is the first PIMT case in an HIV-positive patient described in Romania. Even good response in such cases was noticed after surgical treatment, in our case we achieved complete remission of the disease with anti-inflammatory steroidal therapy and combined antiretroviral therapy (cART). As other infectious etiologies, CMV also could represent a trigger for developing a pulmonary inflammatory myofibroblastic tumor.

Simultaneous occurrence of two rare diseases: actinomycosis and melanoma of the rectum.

The simultaneous occurrence of two rare conditions in a single patient is uncommon. We report the case of a patient with rectal actinomycosis covering an anorectal melanoma (both infrequent conditions), the last one being later recognized, only after surgical excision. We underline here the role of thinking "outside the box" when an unusual situation is experienced.

Disseminated tuberculosis in HIV-infected patients from the Regional HIV/AIDS Center Constanta, Romania.

INTRODUCTION: The purpose of our study was to evaluate clinical and pathological characteristics as well as treatment outcomes in HIV-infected patients with disseminated tuberculosis from the Regional HIV/AIDS Center Constanta, Romania, and to determine associated risk factors. METHODS: We analyzed HIV-infected adults diagnosed with disseminated tuberculosis (TB) over the past two years, monitored in the Regional HIV/AIDS Center Constanta. RESULTS: Out of a total number of 956 HIV-infected patients, 42 had been diagnosed with tuberculosis over the past two years (2011-2013) (4.39%) and 16 of them developed disseminated TB (38%). At the time of diagnosis, we recorded abnormal chest X-rays in 8 (50%), and positive sputum cultures in 4 (25%) of them. The median CD4 count was 40 cells/µL with a range of 5-85 cells/µL; HIV-RNA was detectable in all cases. Multidrug-resistant tuberculosis (MDR-TB) was identified in 6 cases. The outcome was unfavorable in 15 patients. CONCLUSION: In our study, disseminated tuberculosis appeared to be a common pattern of evolution of HIV-TB co-infection (38%). Sputum smear positivity was low and chest X-ray images did not follow a typical pattern. HIV-TB co-infected patients with CD4 lymphocyte cell count <50 cells/µL were more likely to have disseminated TB. The severity of cases, proved by a high mortality rate, requires consideration of this diagnosis early in patients with advanced AIDS, even if laboratory investigations are not suggestive.