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Introduction:highly active antiretroviral therapy (HAART) has contributed to a reduction in HIV-related oral lesions and improved quality of life among HIV seropositive patients. However, the therapy is not without its side effects. This study was aimed at assessing the self- reported orofacial manifestations due to long term use of HAART, as well as the pattern of oral lesions on examination. Methods:this was a cross-sectional study conducted among HIV seropositive adult patients in Ibadan, who had been on HAART for at least two years. Data were collected using an interviewer-administered questionnaire. Clinical diagnosis of HIV-related oral lesions was made according to the EC-Clearinghouse criteria. Data analysis was done using SPSS version 25. Results:the study participants comprised of 227 HIV seropositive patients who were HAART experienced, with 54 (24%) males and 173 (76%) females. Their mean age (±SD) was 44.7 (±9.4) years. The participants CD4 count ranged from 13-1338cells/mm³, with a median count of 341 cells/mm³. About half (45%) of the participants noted one or more orofacial changes since they commenced HAART. These oral changes included dryness of mouth, burning sensation, abnormal taste, melanotic hyperpigmentation, oral thrush, ulcers, and parotid swelling. Most of those who reported oral changes had been on HAART over 10 years (p=0.03), and the changes were more reported among those on the first-line regimen. Conclusion:melanotic hyperpigmentation was the most common oral lesion found and burning mouth syndrome was the most commonly reported complain among HIV-seropositive adults who are on long-term HAART.

Introduction: The association between HIV status and hypertension is not well described within sub-Saharan Africa. We examined prevalence and risk factors for hypertension among HIV positive and negative individuals living in a rural district of Uganda. Methods: We conducted a cross-sectional analysis in two concurrent cohorts of 600 HIV negative and 721 HIV seropositive individuals aged ≥35 years. Results: Of the 721 HIV positive participants, 59.8% were women and the median age was 44.3 years, while for HIV negative individuals, 55% were women and the median age was 47.8 years. Over 90% of HIV positive individuals were on antiretroviral treatment. The prevalence of hypertension (≥140/≥90 mmHg) was 33.5% in HIV negative individuals and 23.9% in HIV positive individuals. Age (adjusted OR = 1.05, 95% CI 1.03 to 1.06) and BMI (adjusted OR = 1.08, 95% CI 1.05 to 1.12) were associated with higher odds of hypertension. Having HIV was associated with lower odds of hypertension (adjusted OR = 0.66, 95% CI 0.50 to 0.88), lower systolic blood pressure (–5.1 mmHg, 95% CI: –7.4 to –2.4) and lower diastolic blood pressure (–4.0 mmHg, 95% CI: –5.6 to –2.5). We did not observe differences in the odds of hypertension by CD4 count, viral load or ART among HIV positive individuals in this sample. Conclusions: Hypertension was prevalent in one third of HIV negative individuals and in one fourth of HIV positive patients. While access to health information among individuals attending HIV clinics may explain observed differences, more research is needed to understand plausible biological and social mechanisms that could explain lower blood pressure among people living with HIV in Uganda.

Background: The incidence of Tuberculosis (TB) has seen a significant rise in association with HumanImmunodeficiency Virus (HIV) infection worldwide, in the recent years. It is evident that immunosuppressiondue to the HIV infection has resulted in modification of the clinical presentation of TB, thereby presentingwith atypical signs and symptoms, and also sometimes affecting extra-pulmonary sites.Objectives: To determine the pattern of presentation and prevalence of TB in HIV Seropositive patients andto study various socio-demographic factors associated with the same seen in the patients attending the AntiRetroviral Therapy (ART) Centre, Karnataka Institute of Medical Sciences (KIMS), Hubli.Methods: A cross-sectional study was conducted among 109 HIV Seropositive patients attending ARTCentre in KIMS, Hubli, for a period of 2 months. A pretested, semi-structured questionnaire was applied tocollect the data from the study participants after obtaining the verbal informed consent.Results: The prevalence of HIV-TB among the study participants was estimated to be around 34.9%.Although HIV infection was found to be more in females in the study, TB with HIV infection was seenmajorly in males. The commonly affected age group was 31-40 years, both in HIV infection alone and TBco-existing with HIV. Pulmonary TB was the commonest type of TB i.e., 92.1% among the HIV patients ofthe study. The prevalence of TB was found to be maximum in the cases with CD4 count of range less than250 cells/cu.mm.Conclusion: The prevalence of TB in HIV Seropositive patients was more than one third as per the studyand hence it is of utmost concern that HIV patients should be screened and treated for TB as early aspossible, and the prophylaxis of TB in HIV patients must be considered.

Mercy-Nkuba Nassali,1,2 Tadele Melese,1,2 Jamieson Modimowame,1,2 Badani Moreri-Ntshabele1,2 1Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana; 2Department of Obstetrics and Gynaecology, Princess Marina Hospital, Gaborone, BotswanaCorrespondence: Mercy-Nkuba NassaliDepartment of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Private Bag, 00713, Gaborone, BotswanaTel +267 76058947Fax +267 3105979Email nassalim2@gmail.comPurpose: To describe the timelines leading to presentation, diagnosis and definitive treatment among cervical cancer patients at a tertiary treatment center in Botswana.Patients and Methods: This was a retrospective study that evaluated timelines to diagnosis and linkage to definitive treatment among cervical cancer patients in Botswana. Medical records of 149 patients admitted at Princess Marina Hospital (PMH) from 2012 to 2014 were reviewed from August 2016 to February 2017. Data collected included socio-demographics, stage of disease at presentation, symptom duration at presentation, diagnosis to definitive treatment interval and treatment outcomes on discharge. STATA 12 was used for data analysis. Frequencies and percentages were used to analyse and present the data. This paper is limited to the analysis of records with documented duration of symptoms, histology turnaround time and the diagnosis to treatment interval.Results: The median duration of symptoms at presentation (N= 80) was 120 days (range 1– 1290). Women who were HIV seropositive, of secondary level education or higher, below 50 years and those with cervical cancer screening history reported shorter duration of symptoms at presentation. Median histopathology turnaround time (N=123) was 27 days (range 3– 274), median diagnosis to definitive chemoradiation interval (N=81) was 89 days (range 16– 305) while median waiting time for surgery (N=7) was 60 days (range 29– 279). Overall, the patients’ journey from the community to definitive treatment was about six months.Conclusion: Delayed cervical cancer diagnosis and treatment is multifactorial and entails a complex interplay between patient health-seeking behavioural patterns, robustness of the patient referral and follow-up mechanisms, availability of prompt histopathology services and relay of results, and timely linkage to definitive care. Prioritization of strategies to address hurdles in all these aspects will not only reduce waiting times but also ensure timely management and improved outcomes among patients with cervical cancer.Keywords: diagnosis, timelines, cervical cancer, Botswana

Background There is increasing prevalence of diseases associated with ageing such as hypertension, among people living with HIV (PLWHV). This study sought to assess: (1) knowledge related to HIV infection and hypertension, (2) adherence to prescribed medications and (3) clinical outcomes among HIV-positive persons with hypertension at a Nigerian hospital. Methods The Patient’s HIV Knowledge Questionnaire (PHKQ), Hypertension Knowledge-Level Scale (HK-LS) and Adherence to Refills and Medication Scale (ARMS) were administered to 220 eligible patients through the HIV clinic. Demographic and clinical data were also obtained. Results Participants were predominantly females (57.3%), with a median (IQR) age of 46 (38–58) years; majority were married (67.8%) and employed (60.8%). Participants reported a higher hypertension-related knowledge compared with HIV-related knowledge (63.6% versus 33.3%, Z = −10.263, P Conclusions Despite having a higher hypertension-related knowledge, adherence to antihypertensive medications and blood pressure control were poor. There is a need for increased attention to HIV education and comorbidities in PLWHV.

Malassezia is a genus of lipophilic yeasts residing on the skin of warm-blooded animals. The correlation between specific species and their involvement in skin diseases has been well researched. However, only very few studies have investigated the distribution of Malassezia spp. on the healthy skin of patients infected with human immunodeficiency virus (HIV). The purpose of this work was to analyze whether the composition of Malassezia spp. isolated from the skin of the HIV-infected patients differs from that of healthy individuals. The study included a total of 96 subjects, who were divided into two equally sized groups: HIV-seropositive and HIV-seronegative. The specimens were collected from the subjects by swabbing four anatomical sites (face, chest, back, and scalp). Species were identified using phenotype-based methods, and the identification of strains isolated from the HIV-seropositive patients was confirmed by PCR sequencing of the rDNA cluster. Malassezia spp. were isolated from 33 (69%) HIV-seropositive patients and 38 (79%) healthy volunteers. It was found that men were much more likely to have their heads colonized with Malassezia spp. than women. The most prevalent species on the skin of both HIV-seropositive and HIV-seronegative individuals were Malassezia sympodialis, M. globosa, and M. furfur, albeit at different proportions in the two populations. The diversity of Malassezia spp. was the highest on the face of the HIV-seropositive patients (Shannon–Weiner Index H = 1.35) and lowest on the back of the healthy volunteers (H = 0.16). The phenotype- and molecular-based identification methods were congruent at 94.9%. It was observed a tendency that the HIV-seropositive patients had higher CD4+ cell counts, indicating higher colonization with Malassezia spp.

Background HIV is a major public health issue, especially in developing countries. It is important to track and design successful intervention programs to explore the spatial pattern, distribution, and associated factors of HIV Seropositivity. This study therefore showed the spatial variation of HIV Seropositivity and related factors in Ethiopia. Methods A total sample of 25,774 individual data collected from the 2016 EDHS data were primarily HIV biomarkers, IR, MR, and GPS. Spatial heterogeneity analysis was used with methods such as Morans I, Interpolation, and Kulldorff ‘s scan statistic. Spatial analysis was conducted using open source tools (QGIS, GeoDa, SaTScan). Multilevel logistic regression analysis was performed using Stata14 to identify HIV-associated factors. Finally, the AOR with a 95% confidence interval was used to report the mixed-effect logistic regression result in the full model. Result The prevalence of HIV / AIDS at national level was 0.93%. The highest prevalence regions were Gambela, Addis Abeba, Harari and Diredawa, accounting for 4.79, 3.36, 2.65 and 2.6%, respectively. Higher HIV seropositive spatial clusters have been established in the Gambela and Addis Ababa regions. Multilevel analysis at the individual level being married [AOR = 2.19 95% CI: (1.11–4.31)] and previously married [AOR = 6.45, 95% CI: (3.06–13.59)], female [AOR = 1.8, 95% CI: (1.19–2.72)], first-sex at age ≤15 [AOR = 4.39, 95% CI: (1.70–11.34)], 18—19 [AOR = 2.67 95% CI: (1.05–6.8)], middle age group (25-34) [AOR = 6.53, 95% CI: (3.67–11.75)], older age group (>34) [AOR = 2.67 95% CI: (1.05–6.8)], primary school [AOR = 3.03, 95% CI: (1.92–4.79)], secondary school [AOR = 3.37, 95% CI: (1.92–5.92) were significantly associated with serropositivity. Regarding household level, place of residence [urban: AOR = 6.13 CI: (3.12, 12.06)], female-headed households (AOR = 2.24 95% CI: (1.57–3.73), media exposure [low exposure (AOR = 0.53 95% CI: (0.33–0.86), no exposure AOR = 0.39 95% CI: (0.23–0.65)] and increased household size [AOR = 0.72 95% CI: (0.65–0.8)] were associated with HIV Seropositivity. Conclusion High cluster HIV cases were found in Gambela, Addis Abeba, Harari, and Diredawa. Having a history of married, start sex at a younger age, female-headed household, urban residence, and lower household size is more affected by HIV/AIDS. So any concerned body work around this risk group and area can be effective in the reduction of transmission.

Introduction: Human Immunodeficiency Virus (HIV) causes severe public health problems. Despite the use of Highly Active Antiretroviral Therapy (HAART), opportunistic infections remain a serious problem in HIV infection. HIV seropositive women are at a higher risk of acquiring Vulvovaginal Infections (VVI), compared to their HIV seronegative counterparts. Also, the large untreated asymptomatic populations remain a source for transmitting agent. Aim: To identify the occurrence of vaginitis in symptomatic and asymptomatic HIV seropositive women. Materials and Methods: HIV seropositive female patients (60 symptomatic and 60 asymptomatic for vulvovaginitis) in the reproductive age group of 18-60 years were screened for their vaginal flora in a tertiary care hospital in East Delhi, India. Wet mount, Gram stain, and culture were performed to screen the samples for vaginitis. Asymptomatic samples were processed to check for asymptomatic VVI. Nugent and Amsel’s score were calculated for Bacterial Vaginitis (BV), and Donders classification was used for Aerobic Vaginitis (AV). Sabouraud’s Dextrose Agar (SDA) was used for fungal cultures, and Fluconazole and Voriconazole sensitivity was tested. The descriptive analysis of compiled data with Chi-square tests where applicable to compare differences between proportions was done. Results: As per the Nugent's score, 90% of symptomatic and 86.66% asymptomatic HIV reactive females had BV. Nugent scoring was found to be a better diagnostic criterion for BV. AV was observed in 33.33% asymptomatic patients. Candida albicans (C.albicans)was the most common agent isolated from 68.75% of Vulvovaginal Candidiasis (VVC) cases. Dual infection of BV and Candidiasis was reported to be 18.33% in symptomatic and 15% in asymptomatic HIV seropositive females. Conclusion: In the present study, despite Antiretroviral Therapy (ART), attendees manifested significantly with BV infection in both groups. VVC due to C. albicans was also predominant in both groups. Co-infection with BV and VVC was the highlight of this study as dual infections of BV and AV remain under-diagnosed as per Sexually Transmitted Infection (STI) syndromic management protocols. The clinicians need to identify AV as a separate entity as treatment modalities are essentially different.

Introduction: Human immunodeficiency virus (HIV) virus, causative agent in acquired immunodeficiency syndrome, is fast becoming a major threat in the Indian subcontinent, with an estimated 3.7 million persons being infected with HIV. HIV infection is complicated by various opportunistic infections (OIs) such as tuberculosis (TB), candidiasis, herpes zoster, Pneumocystis, cytomegalovirus (CMV) etc. This study carried out to know the clinical profile opportunistic infections in HIV seropositive patients. The aim of this study to determine the opportunistic infections in adult AIDS patients. Material and methods: A total of 200 patients were tested for opportunistic infections in HIV patients. All the specimens were processed as per standard procedures to detect opportunistic infections. Results: 200 cases that satisfied the inclusion criteria were considered for the study. Of the 200 individuals analyzed, 133 (66.5%) were males and 67 (33.5%) were females. The maximum number of patients who had opportunistic infections fell in the age group of 25-35yrs, 94 (47%), followed by the age group below 25 yrs, 53 (26.5%) and most of the occupants, who harboured opportunistic infections were labourer (49.5%), n=49, followed by driver 17.5% and then housewives 13%. The tuberculosis is the most frequent opportunistic infections accounting for 52.5% of all opportunistic infections, followed by candidiasis in 50.5% of cases and followed by pneumocystosis in 17%, cryptosporidiosis in 10.5%. Conclusions: Respiratory system was the most common system involved by OIs. Early diagnosis and prompt treatment of opportunistic infections is important before development of severe immunodeficiency to prevent serious and fatal outcome. Keywords: HIV/AIDS, Opportunistic Infections, Tuberculosis, Candidiasis

BACKGROUND Contraceptive use among HIV positive women plays a crucial role in meeting their reproductive health needs. This is a study with the primary aim to estimate the magnitude of unmet need for family planning among HIV seropositive women of reproductive age in central India and to identify the various socio-demographic factors and reasons associated with unmet need for family planning. MATERIALS AND METHODS The study is an institutional cross- sectional study. The unmet need of 400 women with HIV positive status in reproductive age group (15-49 years) attending Anti-Retroviral Therapy (ART) clinic in a tertiary care center in central India was evaluated on the basis of their age, living region, type & size of family, education, duration of marriage, occupation, religion and by Modified BG Prasad sociodemographic class. The use of contraceptives and the reasons for not using any temporary or permanent method of family planning was evaluated. RESULTS The prevalence of unmet need of contraception in study population was found to be 28%. There is a significant association between age, education, socioeconomic status, type of family, duration of marriage, parity and HIV status of partner, duration of antiretroviral treatment with met and unmet needs of contraception. Little perceived risk of pregnancy was the most common reason for not willing to use contraception. Opposition from partner or family members, cultural & religious opposition (13%) also constitutes the major causes of not using contraception. Lack of awareness (1.8%) was the least common cause for reasons for not using contraception. CONCLUSION Efforts to integrate the family planning services and HIV care services, strengthening the traditional family programmes and expanding the access of contraception are prerequisites to reduce unmet needs.

BACKGROUND:The long-term effects of marijuana on cognition, particularly in the context of HIV is not clear, as extant research shows mixed findings. OBJECTIVE:To determine associations between current and cumulative exposure to marijuana and changes in cognitive processing speed and flexibility in 788 HIV-seropositive (HIV+) and 1,132 HIV-seronegative (HIV-) men followed for up to 17 years in the Multicenter AIDS Cohort Study. RESULTS:Among HIV+ men only, current daily marijuana use compared to none-use, was significantly associated with a greater annual percentage decline in cognitive processing speed assessed with the Trail Making Test A (TMTA) (β=-0.41, 95% confidence interval (CI): -0.88, -0.03, p=0.03)] and Symbol Digit Modalities Test (SDMT) (β= -0.14, 95% CI: -0.28, -0.01, p=0.04). Further, monthly marijuana use was associated with greater annual percentage decline in cognitive flexibility assessed with the Trail Making Test B (TMTB) (β= -0.70, 95% CI: -1.34, -0.05; p=0.03] and cognitive processing speed (SDMT) (β= -0.21, 95% CI: -0.40, -0.01, p=0.03). Among the HIV- men only, each 5-marijuana use-years (equivalent to 5-years of daily marijuana use) was significantly associated with a 0.17 annual percentage decline in cognitive processing speed only (TMTA) (β= -0.18, 95% CI: -0.36, -0.01; p=0.04). CONCLUSIONS:Our findings suggest that marijuana use, particularly current use, may be associated with worse cognitive processing speed, but the magnitude of the estimates was not clinically meaningful.

Five-year clinico-laboratory data from 99 (one HIV seropositive) adults (mean age = 41.3 ± 20.4 years) who underwent bone marrow examination for fever persisting for ≥ 1 week were analysed and correlated with microbiological characteristics. Infections, reactive marrow changes and haematolymphoid malignancies were most commonly associated with fever. A high concordance rate of 71% was noted between aspiration and trephine biopsies. Bone marrow granulomas (BMG) were seen exclusively on sections and were most commonly of tubercular and typhoidal in origin (two Salmonella Typhi, one Salmonella Paratyphi A). The common aetiologies associated with fever and cytopenia(s) were BMG, acute leukaemia and haemophagocytic lymphohistiocytosis (HLH; n = 3). The yield from bone marrow culture was inferior compared to other body fluids. In conclusion, bone marrow histology is superior to smears in the evaluation of prolonged fever. Marrow culture may not be useful in immunocompetent individuals other than if Salmonellosis is suspected.

BACKGROUND Monitoring of transfusion-transmissible infections in the blood supply is essential for blood safety, as the donor population is not static, and changes in policy, donor behavior, or other factors could increase the risk of recipient infection. We assessed patterns of recently acquired HIV infection in US blood donors, including before and after the implementation of the 12-month deferral for men who have sex with men (MSM). STUDY DESIGN AND METHODS A large convenience sample of donations from donors testing HIV-1 nucleic acid testing (NAT) and serology-reactive were further tested with the Sedia HIV-1 Limiting Antigen enzyme immunoassay. Samples were analyzed across available demographic and donation data to provide an assessment of recently acquired HIV infection in US blood donors from 2010 to 2018. RESULTS Overall, 317 of 1154 (27.5%; 95% confidence interval, 24.9%-30.1%) donations from HIV NAT and serology-reactive donors had recently acquired HIV infection. There was no evidence of change in the percentages of recent HIV infection by year over the study period, either in all donors or in male donors, including after the MSM policy change. In multivariable logistic regression analysis, donors aged 24 years or younger were over 2.7 times more likely and repeat donors 2.2 times more likely to have recently acquired HIV infection compared to donors aged 55 years or older and first-time donors, respectively. CONCLUSION Patterns of recently acquired HIV infection varied by demographics but not over time. These findings suggest no impact of the MSM policy change on recently acquired HIV infection in US blood donors.

ObjectivesWe examined data collected as part of the fifth round of integrated biological and behavioural surveillance to determine the prevalence and factors associated with HIV infection among female sex workers (FSWs) in Pakistan.MethodsFSWs were defined as ‘all females, age 13 years and above, who receive money or goods in exchange for sexual services, regardless of the site of operation’. Data were collected between October 2016 and January 2017 in 18 cities using multistage sampling techniques to randomly select FSWs from spots facilitated by peers. Behavioural data were collected by interviewers using structured questionnaires, which was followed by obtaining finger prick blood samples tested for HIV using two rapid tests. Multivariate logistic regression analysis was done to assess independent associations of potential correlates using HIV status as dependent variable.ResultsWe invited 5728 FSWs to participate, of which 68 refused to participate (refusal rate=1.2%). Of the 5660 FSWs who participated, 121 were HIV seropositive (weighted HIV prevalence 2.3%; 95% CI 1.9% to 2.7%) mostly concentrated within cities in Sindh. Multivariate analysis showed being uneducated/illiterate (adjusted OR (aOR) 2.1; 95% CI 1.4 to 3.4), directly dealing with clients without a pimp (aOR 1.8; 95% CI 1.1 to 2.8), non-use of condom with clients (aOR 1.8; 95% CI 1.1 to 2.8), having sexual contact with people who inject drugs (PWID) (aOR 2.2; 95% CI 1.3 to 3.7) and non-participation in HIV programmes (aOR 1.7; 95% CI 1.0 to 3.1) as factors independently associated with HIV seropositivity.ConclusionsWe found a weighted national HIV prevalence of 2.3% and identified factors independently associated with HIV in FSWs. The country needs to scale up HIV prevention programmes to improve coverage, prioritising FSWs who are illiterate, work independently and have PWID as sex partners. Emphasis should be laid on strategies to improve condom use with both regular and non-regular partners.

BACKGROUND As per UNAIDS data, India ranks third in the HIV epidemic in the world, with 2.1 million people living with HIV with 88000 new infections and 0.2% adult HIV prevalence (15-49 yrs. age group).1 Sexually transmitted infections are biological factors for both acquisition and transmission of HIV infection.2 STI are markers for high risk behaviour for HIV infections. There is compelling evidence that management of STIs has brought down the transmission of HIV. The aim of the study is to study the prevalence and epidemiological aspects of STI in HIV positive patients attending STD OPD in Govt. Vellore Medical College, Vellore. MATERIALS AND METHODS Retrospective observational study of pts. who are registered at STD clinic, Government Vellore Medical College between January 2016 and Dec 2017. Inclusion Criteria- All newly diagnosed HIV pts. Attending our OPD were included and new STIs were included. Exclusion Criteria- Previously diagnosed HIV/STI were excluded. RESULTS 138 pts were identified to be HIV seropositive with coexistent STI. 66% rural and 34% were of urban origin. Predominant age grp 20 to 40 yrs. 4 males and 20 females had mixed STD and HIV. Vaginal discharge and Pelvic Inflammatory Disease seem to be predominant STI in female pts. CONCLUSION There is a high prevalence of STIs among HIV positive patients which is a very important factor for HIV transmission in society. Genital herpes and vaginal discharge were found to be the most common STIs among HIV positive individuals.

Background: Dietary intake of HIV-seropositive persons remains a major concern across various settings around the globe. Inadequate dietary intake, infections and stage of disease progression elici...

Objective This study examined the effects of HIV infection, methamphetamine dependence and their interaction on cortical thickness, area and volume, as well as the potential interactive effects on cortical morphometry of HIV and methamphetamine with age. Method T1-weighted structural images were obtained on a 3.0T General Electric MR750 scanner. Freesurfer v5.3.0 was used to derive cortical thickness, area and volume measures in thirty-four regions based on Desikan-Killiany atlas labels. Results Following correction for multiple statistical tests, HIV diagnosis was not significantly related to cortical thickness or area in any ROI, although smaller global cortical area and volume were seen in those with lower nadir CD4 count. HIV diagnosis, nevertheless, was associated with smaller mean cortical volumes in rostral middle frontal gyrus and in the inferior and superior parietal lobes. Methamphetamine dependence was significantly associated with thinner cortex especially in posterior cingulate gyrus, but was not associated with cortical area or volume following correction for multiple statistical tests. We found little evidence that methamphetamine dependence moderated differences in cortical area, volume or thickness for any ROI in the HIV seropositive group. Interactions with age revealed that HIV diagnosis attenuated the degree of age-related cortical thinning seen in non-infected individuals; intercepts indicated that young HIV seropositive individuals had thinner cortex than non-infected peers. Conclusions Methamphetamine dependence does not appear to potentiate a reduction of cortical area, volume or thickness in HIV seropositive individuals. The finding of thinner cortex in young HIV seropositive individuals and the association between CD4 nadir and global cortical area and volume argue for prioritizing early antiretroviral treatment., Highlights • HIV was associated with smaller cortical volumes in frontal and parietal regions. • Nadir (but not current) CD4 was associated with smaller global cortical area in HIV. • Methamphetamine-dependent subjects had thinner cortex in posterior cingulate. • Methamphetamine dependence did not exacerbate the cortical effect of HIV infection. • Young HIV adults showed cortical thinning similar to middle-aged uninfected adults.

Enzymes intricate by organisms are used to inactivate and destroy antibiotics. This study determined some virulence factors elaborated by the bacterial isolates cultured from urine samples of HIV seropositive pregnant women that attended antenatal clinic of the Ondo State Specialist Hospital, Akure. Screening for extracellular enzymes and extended spectrum beta lactamase (ESBL) of the isolate was carried out using standard method and disk approximation method respectively. The extracellular enzymes such as lipase, protease and DNase were detected in the three bacterial genera used. ESBL was found inS. aureusandE. coli.The study concluded that most of the bacterial isolates cultured from urine samples of HIV seropositive pregnant women in the study area were found to have these virulence factors.

Neighborhood social and physical factors shape sexual network characteristics in HIV-seronegative adults in the United States. This multilevel analysis evaluated whether these relationships also exist in a predominantly HIV-seropositive cohort of women. This cross-sectional multilevel analysis included dm 734 women enrolled in the Women's Interagency HIV Study's sites in the U S South. Center track-level contextual data captured socioeconomic disadvantage (e.g., tract poverty), number of alcohol outlets, and number of nonprofits in the census tracts where women lived; participant-level data, including perceived neighborhood cohesion, were gathered via survey. We used hierarchical generalized linear models to evaluate relationships between tract characteristics and two outcomes: perceived main sex partner risk level (e.g., partner substance use) and perceived main sex partner non-monogamy. We tested whether these relationships varied by women's HIV. Greater tract-level socioeconomic disadvantage was associated with greater sex partner risk (OR = 1.29, 95 % CI = 1.06-1.58) among HIV-seropositive women and less partner non-monogamy among HIV-seronegative women (OR = 0.69, 95 % CI = 0.51-0.92). Perceived neighborhood trust and cohesion was associated with lower partner risk (OR = 0.83, 95 % CI = 0.69-1.00) for HIV-seropositive and HIV-seronegative women. The tract-level number of alcohol outlets and non-profits were not associated with partner risk characteristics. Neighborhood characteristics are associated with perceived sex partner risk and non-monogamy among women in the South; these relationships vary by HIV status. Future studies should examine causal relationships and explore the pathways through which neighborhoods influence partner selection and risk characteristics.

Meningitis is a serious infection of the nervous system associated with high mortality in Human Immunodeficiency Virus (HIV) seropositive individuals. Asian clinical studies describing meningitis in people living with HIV are scarce. We describe the clinical features of meningitis in 116 HIV seropositive patients from a tertiary hospital in India as a cross-sectional observational study. The mean age of the patients in our study was 35±9 years with 70.6% of them being men. Eighty-five percent of the patients had an altered sensorium during the illness. Tuberculous meningitis [82.6%] was the most common cause. Clinical features varied by aetiology. Cranial nerve deficits [40%] were common in Cryptococcal meningitis. Hydrocephalus [3%], infarcts [15.9%] and IntraCranial Space Occupying Lesions (ICSOLs) [39.1%] were common in tuberculous meningitis.

This is Letter to the Editor

Introduction: Diarrhea is one of the most common complaintspeople living with HIV(PLHIV), occurring in almost 90% of them. Intestinal parasites are one of the main causes of diarrhea in developing countries. Objective: The present study was undertaken to detect enteric parasites in PLHIV with different levels of immune status (CD 4+ Counts). Materials and Methods: The study included a total of 209 HIV seropositive subjects. Stool samples from each subject was examined microscopically for the presence of ova and cysts using wet mount preparations and stained smears (modified ZN stain). Results: Enteric pathogens were detected in 57 (27.27%) of the 209 patients. The parasites identified were Cryptosporidium (25), Isospora belli (3), Strongoloides larvae (2), Ascaris ova (1).In our study it was observed that the prevalence of cryptosporidium in HIV sero-positive subjects was 49.01%, 33.33%, 17.6% in those having CD4 500 cells/μl respectively. Conclusion: Intestinal opportunistic parasitic infections were detected in 27.27 % among HIV-seropositive patients. Cryptosporidiumis an important emerging pathogen in HIV-seropositive individuals with or without symptoms.Early detection of opportunistic intestinal parasitic infections using simple techniques like wet mount and modified ZN staining will help in the timely management and will improve the quality of life of HIV infected individuals.

Background & objectives: Hepatitis B and hepatitis C virus (HBV and HCV) cause acute and chronic hepatitis, and infections with HBV and HCV are common in HIV-infected patients. The present study was conducted to determine the co-infection of hepatitis B and C virus in stored serum samples of HIV-positive/negative individuals attending an Integrated Counselling and Testing Centre (ICTC) in north India and their association with certain risk factors. Methods: This study included a total of 840 serum samples, of which 440 were from HIV seropositive individuals and 400 were from control individuals seeking voluntary check-up of HIV status at ICTC. Serum samples were used for the detection of HBV and HCV infection. Results: HBV infection (11%) was found to be less in contrast to HCV (13%) amongst the HIV seropositive. In controls, HBV and HCV infection was two and three per cent, respectively. Co-infection of HBV and HCV was found in 15 of 109, and in controls, it was 2 of 15. Age group between 21 and 40 was significantly associated with HBV and HCV infection. Heterosexual contact was the leading mode of acquiring HBV and HCV infection. Interpretation & conclusions: HBV and HCV co-infection was found to be significantly higher in HIV-positive individuals in comparison to normal population. Hepatitis virus infection leads to rapid progression of liver cirrhosis in HIV-infected patients. Routine check-up of HIV seropositive patients for hepatitis virus may be required to monitor clinical outcome.

Purpose To describe the case of a born HIV seropositive woman who developed outer retinal alterations secondary to vascular abnormalities in the perimacular region and in the periphery of both eyes. Methods Case report. Results A 21-year-old woman born HIV seropositive was referred for a routinary visit. Her best-corrected visual acuity was 20/20 in both eyes, and during the visit, only mild superotemporal metamorphopsia in the left eye was reported. Multimodal imaging disclosed findings consistent with acute macular neuroretinopathy such as reddish-brown lesions at fundus examination and disruption of ellipsoid zone at spectral domain optical coherence tomography. Peripheral vascular alterations were also noted at fluorescein angiography. Conclusion Several associations or risk factors have been identified in patients with acute macular neuroretinopathy, including oral contraceptives, epinephrine/ephedrine, or systemic shock. To the best of our knowledge, this is the first case describing peripheral vascular alterations and acute macular neuroretinopathy in association with HIV seropositivity at birth.

Human immunodeficiency virus (HIV)-infected individuals have been shown to have a high prevalence of sleep disturbances. Both the effects of the virus and the antiretroviral drugs may cause sleep disturbances. We sought to determine the prevalence and predictors of sleep disorders among HIV seropositive adult subjects presenting at an outpatient hospital setting. One hundred and fifty six subjects were recruited for the study by using a sleep disorder screening questionnaire. The mean ages of the participants were 38.7 ± 9.23 and 39.5 ± 9.23 for those with and those without sleep disorder, respectively. The prevalence rate of sleep disorders was 46.2%. Elevated systolic blood pressure, lower CD4 count levels, and being on the highly active antiretroviral therapy combination TDF/3TC/ATZ/lpvr were associated with sleep disorders. The high prevalence rate observed necessitates routine screening for sleep disorders among HIV/AIDs patients.

Introduction: Pediatric HIV is a major world health problem, which is progressing at an alarming rate. Few studies have been done about variable clinical manifestation of pediatric HIV infection in children. This study intends to know the clinical profile of HIV infection in children of Chhattisgarh, evaluate the seroconversion rates of babies born to HIV seropositive women, possible maternal, obstetrical, and feeding factors influencing them, patient’s adherence to ART and opportunistic infections in affected children. Methods: All pediatric HIV cases from 1½ year to 14 year registered in A.R.T. centres of Chhattisgarh. Data were analysed using SPSS system version 21. Result: A total of 414 children were evaluated from different A.R.T. centres in Chhattisgarh for final analysis. Male to female ratio is 1.38:1. Most common mode of transmission is from mother to child. Tuberculosis, Recurrent and Persistent Diarrhoea, Recurrent Pneumonia and Oral Candidiasis are common infection in most of the children. Conclusion: Average age of diagnosis of pediatric HIV is around 7.5 ± 2.1years. Majority of children are diagnosed in stage 3. Adherence therapy to A.R.T. is good. Vertical transmission is most common mode of transmission.

In 2013, the prevalence and incidence rates of HIV/AIDS infection in Nigeria were 3,229,757 and 220,394 respectively. Despite the fact that the influence of alcohol consumption on unsafe sexual behaviours and HIV risk in Nigeria has been documented, gaps still exist in knowledge on the roles of drinking places. This paper examines the roles of drinking places in enhancing illicit, risky sexual behaviours (irregular condom use and having sex while drunk) and the spread of HIV. A sample of 1,621 (864 women; 757 men; 815 HIV seropositive; 806 HIV seronegative) respondents who participated in survey and in-depth interviews were selected from 2 clinics and 2 other locations using multi-stage and purposive sampling methods. SPSS (version 21) software was used for quantitative data analysis. Drinking places are meeting points for lovers, alcohol consumption, verbal pornography and negotiations for illicit sexual activities with high risk of HIV infection. Understanding, and then addressing the impact of drinking places on risky sexual behaviours would assist in reducing the spread of HIV/AIDS amongst the Tiv people. Consequently, there likely would be an improvement in the sexual wellbeing of individuals and the public in Nigeria more generally.

Background: Despite the rampant human immunodeficiency (HIV) epidemic in Africa, there is a paucity of published data of HIV-related Epstein-Barr virus-associated smooth muscle tumours (EBV-SMT) from Africa.Methods: We embarked on retrospective documentation of the clinicopathological features of confirmed HIV-related EBV-SMT over a 5-year time frame at the largest hospital in Africa. All haematoxylin and eosin stained tissue sections, immunohistochemistry and EBV in situ hybridisation (ISH) investigations were reviewed in conjunction with clinical data.Results: Fourteen (n = 14) EBV-SMT were confirmed in 13 patients (age range: 10–53 years). Five paediatric patients and a predominance of females (70%) were evident in this series. All patients were HIV seropositive and CD4 counts ranged from 1 to 1331 cells/ul (median 355 cells/ul; mean 442 cells/ul). Tumour-associated pain was a common symptom in the paediatric age group, while neurological symptoms were frequent in the adults due to paraspinal c...

This study explored the disclosure narratives of women living with HIV (WLWH) to establish how they make sense of the stigmatized identity associated with HIV and decisions to conceal or reveal knowledge of their seropositive status to others. Forty-eight WLWH participated in seven focus group discussions (with 42 participants) and six in-depth interviews about their experiences with living with HIV and disclosure of their HIV seropositive status. The results suggest three key themes highlighting: (1) how HIV disrupted the identities of some of the participants, (2) how disclosure tested the strength of identities and relationships, and (3) how WLWH coped with HIV and disclosure. The findings help to reveal experiences that typically remain implicit or unrecognized as WLWH unite their past, with the present and a future identity, where HIV is moved from the foreground into the background.

BACKGROUND The global impact of the converging dual epidemics of TB and HIV is one of the major public health challenges. The increasing rate of HIV infection in many countries has had an impact on TB epidemiology. As the prevalence of pulmonary tuberculosis is increasing among HIV seropositive patients with a wide range of immune status and clinical presentations, the present study was undertaken to assess the clinical and laboratory profile of sputum positive pulmonary tuberculosis among HIV seropositive and HIV seronegative patients. MATERIALS AND METHODS The present one year cross-sectional study was conducted in the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum on 104 patients with sputum positive pulmonary tuberculosis patients during the period of January 2009 to December 2009. Routine investigations such as blood group, haemogram that is haemoglobin, total count, differential count, erythrocyte sedimentation rate, sputum smears for AFB and chest x-ray were done. RESULTS Seroprevalence of HIV among pulmonary tuberculosis patients was 23.08%. On examination anaemia, undernourishment, lymphadenopathy and the presence of opportunistic infections like oral candidiasis, herpes zoster stain and genital lesions were more predominant among HIV seropositives compared to HIV seronegatives. Mean Hb and TLC were significantly low among HIV seropositives compared to HIV seronegatives. Chest x-ray showed varied presentation. Upper zone infiltration, cavitation and fibrosis were more commonly involved among HIV seronegatives compared to HIV seropositives. CONCLUSION HIV seropositive PTB patients commonly present with fever, weight loss and loss of appetite, while cough with expectoration, haemoptysis, breathlessness were more common with HIV seronegative patients. Cavitation, fibrosis and fibrocavitary lesions were predominantly seen among HIV seronegatives, while infiltration and miliary mottling was present in HIV seropositives.