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Background: Invasive cervical carcinoma (ICC) accounts for 23% of all cancer-related deaths in Zimbabwean women. Trials for a national program of genotype-specific HPV vaccines are underway to prevent cervical carcinoma, but the distribution of HPV types among women with ICC according to HIV status is unknown.Methods: To determine prevalence and distribution of high-risk HPV genotypes by HIV status in women with ICC, we performed a cross-sectional study on women referred for ICC testing at four urban referral hospitals in Zimbabwe from June 2014-December 2015. Cervical biopsies were obtained for histology and HPV genotyping. HIV serology testing was performed. HPV testing was performed using MY09/MY11 PCR followed by typing using dot blot hybridization.Results: Of 107 participants with histologically-proven, HIV prevalence was 49.5% (53/107). HIV-positive women tended to be younger (median age 44 years) than HIV-negative women (median age 59 years). HPV prevalence was 94% (101/107), ranging from 1-5 genotypes per participant. HPV 16 (81.5%), 18 (24%), 33 (13%), 35 (11%), 56 (9%) and 45(7.4%) were the most prevalent genotypes amongst HIV-negative participants; HPV 16 (67.9%), 18 (43.4%), 56 (18.9%), 45 (15.1%), 33 (11.3%), and 58 (9.4%) were most prevalent amongst HIV-positive participants. 83% of women were infected with either HPV-16 or HPV-18.Conclusion: Effective vaccination programs against HPV 16 and 18 could prevent up to 83% of cases of cervical cancer in Zimbabwe. HIV may influence distribution of some HPV genotypes given the significant increase in prevalence of HPV 18 amongst HIV positive participants.

Diarrhea is a debilitating condition in HIV infected individuals and with the finding that almost 1/4 cases of diarrhea in HIV are due to microsporidia, there is a dire need to institute measures for its detection on a regular basis. Keeping this in mind the study aims to determine the burden of intestinal microsporidiosis in HIV seropositive patients presenting with and without diarrhea and to compare the ability of microscopy and PCR in its detection.

Background. In view of the lack of evidence on the possibility of an economically viable, easy, and readily available biomarker to substitute the traditional role of CD4 counts in HIV disease progression, this study seeks to investigate the potential use of body mass index (BMI), haemoglobin (Hb), and total lymphocyte count (TLC) as surrogate biomarkers for monitoring the disease. Methods. This cross-sectional study was undertaken at the antiretroviral clinic (ART) of the Bomso Hospital, Kumasi, Ghana. We recruited 384 individuals who were 18 years or older and confirmed HIV seropositive patients. Blood samples were assayed for TLC and Hb. Weight and height were determined and BMI was calculated. Result. At a cut-off point of 12.15 g/dL, Hb had sensitivity and specificity of 73.9% and 56.8%, respectively, whereas BMI had 69.6% and 80.1% sensitivity and specificity, respectively. The sensitivity and specificity were also 100% among the studied participants at a cut-off point of 1200 mm−3 for TLC. There was a significant positive correlation between CD4 count and Hb (rho 0.262, p=0.0001), BMI (rho 0.301, p=0.0001), and TLC (rho 0.834, p=0.0001). Conclusion. The study demonstrates that TLC, Hb, and BMI may provide some useful prognostic information independent of that provided by CD4 count.

Estudo exploratório descritivo, com abordagem qualitativa, que objetivou investigar os motivos que levam mulheres soropositivas para o HIV e seus companheiros a decidirem engravidar, tendo em vista o risco da transmissão vertical e da contaminação ou reinfecção do parceiro. Participaram do estudo seis gestantes. A coleta de dados foi realizada por questionário semiestruturado, sendo os dados organizados no software NVivo 2.0 e interpretados por meio da análise de conteúdo do tipo temática. Da análise emergiram três temas: Planejamento da Gravidez; Conhecimento sobre Transmissão e Tratamento do HIV/AIDS; Vivendo no Contexto HIV/AIDS. A importância do estudo reside no fato de que, apesar do risco da transmissão vertical e da contaminação do parceiro ser conhecido pelo casal, isto não interfere no desejo de serem pais. The purpose of this qualitative, descriptive exploratory study is to investigate the reasons why HIV seropositive women and their partners make the decision of becoming pregnant despite the risk of vertical transmission, contamination or reinfection of the partner. The subjects of this study were six pregnant women. Data collection was done through a semi-structured questionnaire which was organized in the NVIVO 2.0 software and interpreted through theme-based content analysis. Through this analysis three themes emerged: Pregnancy planning; Knowledge of HIV/AIDS transmission and treatment; Living in the context of HIV/ AIDS. The relevance of this study resides on the fact that the desire of the couple in becoming parents remains, despite of the awareness regarding the risks of vertical transmission and contamination. Estudio exploratorio descriptivo con abordaje de tipo cualitativo, cuyo objetivo fue investigar las razones por qué las mujeres VIH positivas y sus parejas deciden por el embarazo dado el riesgo de transmisión vertical, infección o reinfección de la pareja. Los participantes fueron seis mujeres embarazadas. La recolección de datos se realizó mediante un cuestionario semiestructurado, con datos organizados en el software NVivo 2,0 y interpretados por intermedio del análisis de contenido temático. El análisis reveló tres temas: Planifi cación del embarazo; Conocimiento sobre la transmisión y tratamiento del VIH / SIDA; Vivir en el contexto del VIH/SIDA. La importancia del estudio radica en el hecho de que a pesar del riesgo de transmisión vertical y la contaminación de la pareja ser conocida por la pareja, esto no interfi era con el deseo de ser padres.

The Aim of this study was to investigate the correlation of oral lesions in HIV positive patients with their CD4, CD8 cell count and CD4/CD8 ratio. 150 HIV seropositive patients of any age and sex were evaluated. Then analyses of data obtained were revealed Pseudo membranous candidiasis (P-0.0043) was the most common variant, mostly seen when CD8 count was increased (>500 cells/mm 3 , P-0.05) and CD4/CD8 ratio was > 0.31(P-0.0034). Periodontal diseases (29%) mostly were seen in patients with CD4 count >400 cell/ mm 3 (P-0.045), CD8 count >500 CD8 cell/mm 3 (P-0.55) and CD4/CD8 ratio 500 cells/mm 3 and CD4/CD8 ratio is in between 0.31 - 0.6. Oral

Women seropositive for human immunodeficiency virus type 1 (HIV-1) are at an increased risk for a number of adverse perinatal outcomes. Although efforts to reduce mother-to-child transmission of HIV (MTCT) remain a priority in resource-limited countries, HIV testing and treatment have led to steep declines in MTCT in well-resourced countries. Even so, HIV seropositive pregnant women in the United States continue to deliver a disproportionately high number of preterm and low birth weight infants. In this mini-review, we address the role of the placenta in such HIV-related perinatal sequelae. We posit that adverse perinatal outcomes may result from two mutually non-exclusive routes: (1) HIV infection of the placenta proper, potentially leading to impaired maternal-fetal exchange; and (2) infection of the maternal decidual microenvironment, possibly disrupting normal placental implantation and development. Further research into the relationship between HIV-1 infection and placental pathology may lead to the development of novel strategies to improve birth outcomes among HIV-1 seropositive parturients.

Sputum microscopy, the most commonly practiced tuberculosis (TB) diagnostic test is less sensitive in immunocompromised patients due to low bacillary load.The study was carried out in a tertiary care general hospital during 2010-12 in Mysore, Karnataka, to diagnose smear negative TB in HIV patients by culture technique.Of416 HIV patients, 162 patients with features of pulmonary/extrapulmonary TB but smear negative were included in the study.Sputum, stool, blood and other relavent clinical samplese except blood were processed as per standard protocol. The blood collected with sodium citrate was processed by lysiscentrifugation .All samples were inoculated onto Lowstein Jensen slants and incubated at 37 0 c for 6 to 8 weeks.Of 162 HIV patients, 67(41%) were found to have TB. Extrapulmonary TB (25%) was more common than pulmonary TB (13%). Mycobacteria were recovered in 76 samples (26 sputum, 12 stool, 18 blood, 7 pleural fluid, 1 CSF, 9 FNAC, 1 ascitic fluid, 1pus ,1 ear discharge). M.tuberculosis (95%) was the predominant species isolated followed by M.avium complex (5%).Most HIV patients with TB are left undiagnosed for reasons of no advanced/high cost techniques in resource constrained settings. Thus culture could be used as a tool in diagnosing smear negative TB.

HIV status disclosure plays a crucial role in reducing risk behaviors of drug and sexual partners and thereby limiting HIV transmission. As people who inject drugs (PWID) bear a significant HIV burden and disclosure research among PWID is relatively few, we reviewed the literature to highlight what is known about disclosure among HIV-positive PWID. Searches of articles published from 2000 to 2015 yielded 17 studies addressing different aspects of disclosure, and results are presented by major themes. Our results suggest that despite the difficulties, most PWID (64-86%) disclose their HIV-positive status to trusted individuals (family members and intimate sexual partners) and to those who are known to be HIV-positive. Disclosure to non-intimate sexual partners and fellow drug users is relatively lower. Disclosure decision-making is primarily driven by the perceived positive and negative consequences of disclosure. Subsequent risk reduction practices following disclosure are influenced by the feeling of responsibility, as well as partners' willingness to accept risk. Cultural family values, ethnicity, and different localities were several contextual factors that affect patterns of disclosure and risk behaviors of PWID. Areas for future research are recommended.

Studies from sub-Saharan Africa where malaria is endemic have observed high incidences of malaria and HIV co-infection. It has long been accepted that malaria causes alterations in haemostatic parameters and that HIV is associated with a wide range of haematological changes. We assessed the effect of the overlap of these infections on routine haemostatic parameters.The study involved 337 subjects grouped according to their HIV and malaria status: Group 1 'Asymptomatic HIV seropositive, Plasmodium falciparum positive' (n = 61); Group 2 'Asymptomatic HIV seropositive, P. falciparum negative' (n = 73); Group 3 'Symptomatic HIV seropositive, P. falciparum positive' (n = 49); Group 4 'Symptomatic HIV positive P. falciparum negative' (n = 56); Group 5 'Control HIV negative, P. falciparum positive' (n = 52) and Group 6 'Control HIV negative, P. falciparum negative' (n = 46). Blood samples were taken for HIV testing, diagnosis of falciparum malaria and malaria parasite density counts. Citrated samples were used within one hour of collection for prothrombin time (PT) and activated partial thromboplastin time (APTT). CD4Our results demonstrate greater alterations in APTT, PT and platelet count with prolongation of APTT, PT and lower platelet counts in HIV and malaria co-infection. In spite of this, the co-infected subjects with mild to moderate parasitaemia did not show a bleeding tendency; however, the risk is higher in severe malaria.These results suggest that co-infected subjects with severe malaria have a higher risk of bleeding and would require greater monitoring.

No study has yet been conducted to estimate the burden of co-infection of HIV and HTLV-1/2 in inmates in sub-Saharan Africa. To investigate prevalence of co-infection in inmates in Mozambique, a total of 2140 inmates were screened for HIV, of which 515 were HIV seropositive. All HIV seropositive inmates were further screened for HTLV infection, and 8 (1.55%) were co-infected. Co-infection was higher in females [3.45% (2/58; CI: 0.42-11.91)] as compared to males [1.35% (6/445; CI: 0.55-3.06)]. Early screening of HTLV in prisons is urgently needed in Mozambique in order to improve the care provided to incarcerated individuals, including initiation of ART. This article is protected by copyright. All rights reserved

Two HIV seropostiive haemophilic patients with spontaneous infected soft tissue haematomas are described. In one patient the prepatellar bursa was infected, and in the other the posterior aspect of the shoulder. Treatmetn included evacuation of the suppurative focus, antibiotic therapy and prompt rehabilitation. The results were good in both cases and therefore operative management is recommended.

Introduction: Antiretroviral Therapy (ART) has changed the outlook of Human Immune-deficiency Virus (HIV)/Acquired Immuno Deficiency Syndrome (AIDS) patients worldwide. Aim: To analyse the trends in baseline CD4+ T cell counts and ART requirements in newly diagnosed HIV seropositive individuals in a Tertiary care hospital of Northern India. Materials and Methods: Out of 1263 HIV seropositive clients identified from January 2012 to June 2014, the baseline CD4+ T cell counts of only those 470 clients were analysed, who registered at the linked ART centre. Results: The mean baseline CD4+ count of the study group was 249.77±216.0cells/mm3 and that of male and female were 300.31±240.47cells/mm3 and 232.38±204.25cells/mm3 respectively. A total of 259 of 334 (77.54%) HIV reactive males, 83 of 130 (63.85%) HIV reactive females and overall 348 of 470 (74.04%) required antiretroviral treatment on enrolment. Conclusion: In the present study, about three-fourth of newly diagnosed HIV positive Indian patients required initiation of ART at registration. The relatively low baseline CD4+ T cell counts in this population highlights the need for timely baseline CD4+ counts testing of HIV positive patients and the urgency of initiating treatment in HIV reactive individuals in Indian health care settings.

The primary objective of this cross-sectional study is to correlate the presence of Cryptosporidium and other gastrointestinal parasites with the presence of diarrhoea in human immunodeficiency virus (HIV)-infected patients. Stool samples from 96 HIV-seropositive cases were examined for non-opportunistic parasites using the direct and formol-ether concentration methods, while the modified Ziehl-Neelsen technique was used to detect Cryptosporidium spp. The overall prevalence of Cryptosporidium spp. was 54.2%. Other intestinal parasites detected included Ascaris lumbricoides (59.4%), hookworm (5.2%), Entamoeba histolytica (3.1%), Strongyloides stercoralis (1%) and Taenia spp. (1%). Infection inmales was more common (68.2%) than in females (55.4%) but the difference was not statistically significant. Therewas a significant association between Cryptosporidium infection and CD4+ count (P=0.0001), with the highest parasite prevalence (90%) observed among patients who had the lowest CD4+ count (200 cells/mm3). Forty-five (86.5%) patients with Cryptosporidium infection presented with diarrhoea and the difference between those with and without diarrhoea was statistically significant (P=0.0001). There was a statistically significant difference (P=0.0001) among the age groups, with the 41-50 group showing the highest prevalence (84.6%) of infection. Co-infection was observed in 13.5% of the patients. As no drug is currently available for the treatment of cryptosporidiosis, emphasis should be placed on educating HIV-infected individuals about prevention.

Introduction: Human Immunodeficiency Virus (HIV) and Hepatitis B virus (HBV) share the routes of transmission as a consequences infection with Hepatitis B Virus are expected to occur in HIV infected patients. The co-infection of Hepatitis B Virus (HBV) with the Human Immunodeficiency Virus (HIV) have become a major health care catastrophe as it complicates the clinical course, management and therapy for HIV infection. Hence it is important to identify them as early as possible. Aim: The prevalence of HBV co-infection with HIV varies widely across different studies within India and outsides. This study is planned to evaluate the prevalence of HIV-HBV co-infection by HBsAg screening in HIV seropositive patients in our region. Material and Method: A total of 140 HIV seropositive patients were screened for the presence of Hepatitis B virus on the basis of the presence of HBsAg. Result: In patients infected with HIV the prevalence of HBsAg was 7.1% (10/140) wherease in control group it was 1% (5/500). Discussion: Our study documents fairly high rate of Hepatitis B co-infection among HIV seropositive patients suggesting that it should be mandatory to screen every HIV seropositive patient and their sexual partners for co infection with HBV and vice versa for early detection and a simultaneous treatment of hepatitis B co-infection beside HIV infection management to reduce the morbidity, delay mortality and improve quality of life in HIV-AIDS patients.

This study assessed the effects of highly active antiretroviral therapy on the cognitive performances of HIV seropositive patients with severe immune depression.It is a prospective longitudinal interventional study of 69 anti-retroviral naïve HIV-seropositive adult patients with CD4 levels ≤ 350/μl. The cognitive assessment was done at initiation and 12 months after anti-retroviral treatment using the Community Screening Instrument for Dementia (CSID) and the computer-assisted Iron Psychology (FePsy). The impact of therapy on CD4 levels and cognitive scores of the patients before and after therapy were compared and tested for statistical significance using Student t test and one-way ANOVA.The mean age of the patients was 36.6 ± 8.8 years. There was a significant increase in CD4 levels of the patients from 144.75 ± 88.92 at baseline to 295.91 ± 148.79 after 12 months of HAART (p0.0001). There were significant improvements in their cognitive scores (p0.05) in all cognitive domains tested but the finger tapping task (motor speed) did not show any improvement (p0.05). Combination ARV drugs with efavirenz did not significantly improve attention and choice reaction time.Highly active antiretroviral therapy significantly improved the CD4 levels and cognitive performances of treated HIV positive patients in all tested domains with the exception of motor speed.

Objective: Initiation of anti retroviral therapy (ART) is routinely based on the algorithms that combine CD4, HIV load and clinical illness. But their high cost and unavailability at resource poor settings are one of its major limitations. An attempt has been made to find a correlation between CD4 count and Absolute lymphocyte count (ALC) so that timely initiation of ART could be done in peripheral areas of developing countries where automation and established technologies have not been reached. Methods: This cross sectional study included 200 patients between 18-60 year of ages who are HIV seropositive with and without clinical evidence of oral candidiasis (100 case; 100 control). ALC was calculated as per the percentage of lymphocyte in total leukocyte count as seen in peripheral smear. CD4 cell count estimation was done by flow cytometry method. Results: A good correlation was found between CD4 count and ALC in both cases (R=0.656) and controls (R=0.642). There was an increase in sensitivity (St) and decrease in specificity (Sp) of predicting CD4 count

An increasing number of serodiscordant couples are utilizing advanced reproductive technologies to address their reproductive needs. Recent literature has demonstrated that it is not only technically possible but also safe to utilize sperm-washing techniques to allow for the creation of embryos, thereby preventing both horizontal and vertical transmission of HIV. This article addresses the strengths and weakness of various reproductive techniques and discusses our experience at Columbia University (NY, USA), the location of the largest HIV-focused fertility program in the USA.

Cardiovascular diseases have been associated with deaths among HIV seropositive persons in low income countries. This was a cross-sectional study of cardiovascular risk among 100 HIV seropositive persons and 100 age and sex matched seropositive but HAART-naive controls in Rivers state, Nigeria. The study subjects underwent clinical examinations to determine their blood pressure and anthropometric parameters. Blood samples were taken to assess fasting blood glucose and lipid profile. Risk assessment was done using the WHO/ISH cardiovascular risk score chart. Among the subjects, 76 (76%) were on a non-PI based HAART compared with 24 (24%) on a PI-based HAART. The mean BMI and CD4 count were significantly higher among the cases than the controls (p =.0.048 and p < 0.0001 respectively). There was a statistically significant difference in the mean SBP (131.90 ± 14.33mmHg versus 127.48 ± 12.03mmHg) and DBP (83.88 ± 6.59mmHg versus 80.63 ± 6.74mmHg) between the cases and controls (p = 0.019 and 0.023 respectively). Dyslipidaemia was higher among the cases than the controls (low HDL-c was 36% vs 33%; increased TC 20% vs 7%; increased LDL-c 13% vs 4% and triglycerides 7% vs 5%. The prevalence of hypercholesterolemia and increased LDL-c was significantly higher among the cases than the controls (p = 0.007 and 0.022 respectively). The prevalence of intermediate to high CV risk score was higher among the HAART experienced HIV seropositive subjects compared to control subjects.

Aims In the present study, the flow rate and few specific components of saliva from HIV positive patients on HAART and not on HAART therapy has been examined. Setting and design: This study was conducted on the HIV +ve patients attending the specialty clinics of the Oral Medicine Clinics at Guy′s and King College Hospital, London, in 2004 Materials and methods: Two group of patients (nine HIV +ve patients on HAART and nine not on HAART) were selected by random sampling. From each patient, whole mouth unstimulated saliva and stimulated parotid saliva was collected. Markers used were (1) Salivary flow rate indicator of acinar cell fluid secretion, (2) lactoferrin-indicator of salivary gland inflammation and innate immunity, (3) immunoglobulin A indicator of mucosal immunity and (4) total protein-indicator of overall salivary protein secretion Total salivary protein contraction was assayed by measuring absorbance at 215 nm by a spectrophotometer (Ultrospec 4050) and salivary IgA concentration by ELISA. Statistical analysis used: Student′s unpaired t-test and Mann-Whitney parametric test. P-values < 0-05 were regarded as statistically significant. Results: No significant difference was observed between the two groups. Mean IgA of the HAART group patients was found to be nonsignificantly higher. Conclusions: This preliminary study suggests that HAART does not significantly after the composition of saliva. Further, larger studies are required to study the effect of HAART on salivary gland function.

Objective: A panorama of mucocutaneous manifestations is seen at every stage of HIV. This study was done to study the sex prevalence in HIV/AIDS patients with mucocutaneous disorders. Methods: A total of 1 000 HIV seropositive patients attending Skin-STD clinic, Govt. Medical College, Amritsar, for any dermatologic complaints were studied in respect to the sex group preponderance. Results: Males constituted the majority as 75.6% while females were 24.4%. Conclusions: Women, in most of the cases, get infected from their spouses, who have acquired infection through extramarital sexual contact. HIV infection in female patients increases the risk of HIV transmission to neonates and infants, thus further spreading the HIV in a community. So it is very crucial to initiate early preventive measures to reduce HIV burden.

The occupation of healthcare workers in their care for patients and exposure to blood and biological fluids brings the risk of contracting HIV/AIDS and other blood infections. The risk of contamination in the hospital environment is reciprocal, from patient to staff and vice versa. Aim: The aim of this article is to explore the stigma and discrimination against people living with HIV in the process of their healthcare. Materials and Methods : Anonymous poll examined 330 individuals - copper workers, students and HIV seropositive. The results were statistically processed with SPSS v. 20.0, using descriptive, variational and comparative analysis. Results: The results of the analysis show that slightly over half of the surveyed medical specialists are not afraid to provide care to an HIV positive patient (about 60%), with a significant part supporting the periodic HIV/AIDS tests of medical staff. On the other hand, 74% of HIV seropositive respondents report that they report their HIV status while visiting a doctor, and only 36.00% say their physician is aware of the fact that they are HIV positive. The main reason for hiding information about the HIV status is the fear of stigma and discrimination. In the group of medical students surveyed, only 44% of the respondents are ready to provide care to an HIV seropositive patients. Conclusion : Although healthcare workers and medical students in training are well aware of the mechanisms of transmission of HIV infection, there is still fear of working with HIV seropositive patients. This also determines the choice of these patients to keep their HIV status secret when visiting a medical professional.

Sixty-four males with haemophilia were assessed with a series of neuropsychological tests and a structured interview for psychiatric symptoms. Thirty-one had been infected with human immunodeficiency virus (HIV) before the age of 18 and were in various stages of the disease at the time of testing and 33 were HIV negative. Sixteen male control subjects were recruited to match in age with the haemophilia group. The HIV-seropositive group were older than the HIV-negative group due to the cohort effect of the time of infection. Contrary to predictions from the known effects of HIV on the central nervous system the HIV-seropositive group performed better on many of the tests than the HIV-seronegative group. In some but not all of the tests this may have been an age effect. There was very little psychiatric morbidity, consistent with the view that high levels of psychological support provided by the haemophilia units can alleviate the effects of the illness on emotions and behaviour. These findings form a baseline for a 2-year follow-up study which is in progress.

Background: HIV infection is defined by sero-conversion and the detection of HIV-specific antibodies. Emergence and pandemic spread of acquired immunodeficiency syndrome is due to the exposure to human immunodeficiency virus (HIV). A decrease in CD4 count is at least partially responsible for the profound immunodeficiency that leads to various OIs in HIV- infected persons. When the CD4 count falls below 200cells/µL, there is irreversible breakdown of immune defence mechanism and patient become prey to a variety of human opportunistic pathogens.HIV positive patients must receive infections screening and access medical care before onset of advanced immunosuppression.Methods: In this study, total 230 HIV positive patients were selected during 18 months of study period. CD4 counts were estimated of all HIV positive cases. Positive HIV patients were investigated further to detect mycobacterial and fungal opportunistic infections. They were subjected to routine microscopy such as KOH mount, India ink, Gram’s staining for suspected fungal infection and ZN staining method for suspected mycobacterial infection. For fungal infection, samples were inoculated in two Sabouraud Dextrose Agar followed by different biochemical test and LPCB mount; for mycobacterial infection, samples were cultured on LJ medium followed by biochemical test.Results: In our study, maximum patients presented with complain of fever (90.43%), weight loss (73.91%) followed by loss of appetite (35.65%), breathlessness (33.91%), coughing (28.69%) and chest pain (22.17%). Overall prevalence of OIs (Mycobacterium and fungal) was 93 (40.43%) among 230 HIV positive patients. Among OIs 63(27.39%) patients were detected as having Mycobacterial infection and 41(17.82%) as had opportunistic fungal infections. Maximum OIs were related to patients with CD4 count 0-200 cells/µL followed by 201-400 Cells/µL. Most common OIs, among mycobacterial and opportunistic fungal infection were M. tuberculosis (50 isolates) and Candida spp. (26 isolates) respectively.Conclusions: This study provides important information about the risks of OIs at lower CD4 counts among HIV positive patients. These results highlight the need for early screening of HIV infected patients for opportunistic infections. There is also need to increase awareness in healthcare providers in order to improve decisions regarding prophylaxis for prevention of OIs and appropriate therapeutic intervention.

Background and Aims: Skin and mucocutaneous disorders are common in HIV infection and may be the earliest manifestation of the disease. The spectrum of these disorders is wide and may vary in different regions due to varying prevalence of various microbial agents. Therefore, we studied the seroprevalence of HIV infection in patients presenting with skin and mucocutaneous disorders and clinical and regional epidemiological profile of seropositive patients. Methods: Eleven hundred and seventy patients having any type of skin or mucocutaneous disorders were screened for HIV infection (NACO guidelines) after recording their clinical and epidemiological profile. Results: Of the 1170 patients screened, 38 (3.24%) were found to be positive for HIV 1 and none for HIV 2 antibodies. Seropositive patients belonged to the age group of 9 to 48 years, with a male:female ratio of 0.9:1. Heterosexuality was the most common mode of transmission (86.8%). A wide range of infectious and noninfectious lesions were observed and herpes zoster was the most common infectious disease (31.5%) followed by mucocutaneous candidiasis (26.3%). The most common noninfectious manifestation was seborrhoeic dermatitis (18.4%) followed by pruritic papular eruptions (7.9%). Conclusion: High prevalence and wide variety of skin and mucocutaneous disorders in HIV-positive patients highlight the importance of better vigilance and early suspicion of HIV infection in such patients.

Oral lesions associated with human immunodeficiency virus (HIV) are often the first overt clinical features of HIV infection. Reports of HIV-associated herpes zoster infection with alveolar bone necrosis and spontaneous tooth exfoliation are extremely rare, with only four cases reported in the literature. The exact mechanism of osteonecrosis induced by herpes zoster infection remains uncertain. An altered oral environment, decreased host immunity, or immune reconstitution inflammatory syndrome (IRIS) could further compromise the viable periodontal status, leading to alveolar bone necrosis and tooth exfoliation. We report a case of herpes zoster infection involving two divisions of the trigeminal nerve in an HIV-seropositive patient who further manifested with mandibular and maxillary osteonecrosis and spontaneous mandibular and maxillary tooth exfoliation. The occurrence of such infection in immunosuppressed individuals, its etiopathogenesis, and associated clinical features are briefly reviewed and discussed.

As tuberculosis generates a highly heterogeneous antibody repertoire, its diagnosis requires tests based on cocktails of antigens. We describe a new, rapid method called rapid immunochromatographic assay (RICA) for cocktail-based diagnosis, which can detect Mycobacterial antigens in sputum specimens. Six antigenic fractions of pathogenic Mycobacterium tuberculosis were used in combination as the capture antigens in the control line of the flow-through assay. Antigen detection of 200 sputum samples from HIV seropositive patients by RICA assay gave a sensitivity of 97.9%, specificity of 99.0%, positive predictive value of 98.9%, negative predictive value of 98.0%, false positive rate of 0.9%, false negative rate of 2.0%, prevalence rate of 49%, likelihood ratio for positive results 97 and likelihood ratio for negative results 0.02. The combination of RICA and AFB staining gave a sensitivity of 100%, specificity of 100%, positive predictive value of 100%, negative predictive value of 100%, false positive rate of 0%, false negative rate of 0%, likelihood ratio for negative results 0. The assay was simple, rapid and economical for the detection of M. tuberculosis infection and suitable for large scale screening of samples in endemic areas without any sophisticated equipment. The results of the assay proved to be superior to conventional methods and combined with clinical data, could form the basis for starting an earlier course of treatment.

Neurological complications associated with the acquired immunodeficiency syndrome, in particular, HIV-associated dementia, continue to plague those infected. We report our finding that the concentration of brain Glu is reduced in the frontal white matter region in this condition. In addition, our data appear to absolve highly active retroviral therapy (HAART) from blame, as drug-naive patients were equally affected. Our findings suggest that Glu neurotransmission is abnormal and may be a key target for early interventions to reduce the later incidence of neurocognitive impairment and dementia among HIV-seropositive patients. Copyright © 2008 John Wiley & Sons, Ltd.

Lipoatrophy of the face in HIV seropositives are not susceptible to satisfactory correction by using single cosmetic surgery. The limitation of the available filler products to augment and to correct the facial defects in facial lipoatrophy is mainly inherent in the amount of substance that can be implanted for the correction of lipoatrophy. Using Bio-Alcamid, which is an injectable, biocompatible, nontoxic, nonallergenic soft tissue filler designed to correct tissue deficits of various volume by intratissue administration, 9 nonrelated HIV seropositive patients with facial lipoatrophy (7 males and 2 females, age 43 +/- 6 years) underwent cheek augmentation. From 7 mL to 16 mL of substance was injected each on both cheeks per application up to a maximum total of 25 mL. with a mean amount of 12 mL +/- 4 mL. The median follow up time was 2 years. The results revealed that the corrections have remained essentially unchanged throughout the period of follow up. Bio-Alcamid maintained the form and blend with the surrounding tissues. The surgical outcome was evaluated according to the analysis of photographs obtained before and after surgery, the analysis of pre- and postoperative measurements, and patients' self-judgment. The level of satisfaction was significantly high: in 63% of the cases, the result was judged to be excellent and in 32%, good. Only in 5% of the cases the result was considered poor. The present study strongly suggests that Bio-Alcamid is suitable for the correction of remarkable defects of facial atrophy, otherwise treatable only by surgery with myofascial free flaps. In addition, it permits a simplification of facial reconstruction and rejuvenation.

Made available in DSpace on 2019-09-12T16:57:00Z (GMT). No. of bitstreams: 0 Previous issue date: 2008 Objective: Invasive pneumococcal disease (IPD) primarily affects children less than 5 years old, the elderly and certain at-risk groups; especially people infected by the human immunodeficiency virus (HIV). The objective of this study was to analyze invasive pneumococcal diseases (IPD) in children and adolescents infected by the human immunodeficiency virus (HIV), with relation to morbidity, the case fatality ratio, pneumococcus serotypes, susceptibility to penicillin and ceftriaxone and to the proportion of susceptible and resistant Streptococcus pneumoniae (Sp) included in the 7-valent pneumococcal conjugate vaccine that has already been licensed. Methods: A total of 19 cases of IPD were identified among HIV seropositive patients aged from 1 month to 20 years and hospitalized between 1993 and 2000. Data were recorded on standardized charts containing information on age, clinical diagnosis and progression, serotypes and the susceptibility to penicillin and ceftriaxone of the Sp strains identified in cultures. When the minimum inhibitory concentration was < 0.1 mcg/mL, Sp were defined as susceptible to penicillin (SpSPn), and all other strains were defined as not susceptible (SpNSPn). Results: Of the 19 HIV seropositive cases with IPD, 16 (84%) had pneumonia and three (16%), had meningitis; 13 (68%) cases were children less than 2 years old and 16 (84%) were less than 5 years old. The case fatality ratio was 10%. Seven (54%) of the 13 cases less than 2 years old were SpNSPn and 10 (77%) were caused by serotypes covered by the 7-valent pneumococcal conjugate vaccine. From the 10 isolated serotypes the most frequent were 14, 6B and 23F, all them susceptible to ceftriaxone. From the three patients with meningitis, two were caused by SpNSPn. Conclusion: In this study most of the IPD occurred in children less than 2 years old; 77% of the strains and 86% of the serotypes of SpNSPn were covered by the 7-valent pneumococcal conjugate vaccine. [Mattei, Sonia M.] Universidade de Taubaté (Unitau), Fac Med Taubate, Disciplina Molestias Infecciosas [Falleiros-Carvalho, Luiza Helena] Univ Fed Sao Paulo, Sao Paulo, Brazil [Falleiros-Carvalho, Luiza Helena] FAMEMA, Disciplina Molestias Infecciosas, Marilia, SP, Brazil [Falleiros-Carvalho, Luiza Helena] Univ Metropolitana Santos, Santos, SP, Brazil [Cavalcante, Nilton J. F.] Inst Infectol Emilio Ribas, Programa Posgrad Infectol Saude Publ, Sao Paulo, Brazil [Cavalcante, Nilton J. F.] Univ Sao Paulo, Sao Paulo, Brazil [Cavalcante, Nilton J. F.] Secretaria Saude Sao Paulo, Sao Paulo, Brazil

Recently, modified directly observed therapy (MDOT) has emerged as a promising intervention to address nonadherence for hard-to-reach populations infected with HIV. To date, there are no existing data on MDOT focusing exclusively on African Americans. The present study sought to determine the feasibility of MDOT among 31 HIV-seropositive African American substance users in the South. An outreach worker observed the participants' medication intake 5 days per week (once per day) for a period of 3 months (intensive phase). This phase was followed by a transition phase of 3 months during which the frequency of MDOT was gradually tapered from 5 days to once weekly. Assessments to gather demographic information, HIV risk behaviors, substance use, depression, and medication adherence were conducted at baseline, 3 months, and 6 months. Results indicated that more participants adhered to their medication regimen and had viral loads of less than 400 copies per milliliter at 3 and 6 months compared to baseline. Participants reported significantly less depressive symptoms at the 6-month assessment compared to baseline and 3 months. With regard to acceptability, 95% of participants indicated they liked having the outreach visits, 100% reported MDOT helped them take their medications, and only 5% felt MDOT was a violation of privacy. These results suggest MDOT is feasible among African American substance users in the South and a larger controlled study of MDOT with this population is warranted.

Objective: Candidiasis is the most common fungal infection in human immunodeficiency virus (HIV) - infected individuals. As there is sparse data on the oral Candida species in HIV- infected individuals in India, we characterized Candida species from the oral cavity in two cohorts - with and without HIV infection and with presence or absence of clinical oral candidiasis, in Chennai, South India.Methods: Saliva samples were collected from 147 consecutive study participants by the oral rinse technique. Candidal species were isolated by culturing specimens on Sabouraud‘s dextrose agar. The pure cultures so derived were speciated using the commercially available ID32C system, and the results were interpreted using APILAB plus software.Results: In the HIV seropositive group, the most commonly isolated candida species was C.albicans (86%) followed by C.tropicalis (23%), C.guilliermondi (6%), C.krusei (5%) and others (4%). In the healthy cohort without clinical candidiasis, C.tropicalis was the most commonly isolated species.Conclusion: There appears to be a marked variation in oral Candida species found in HIV-seropositive and seronegative individuals in India. To our knowledge, this is the first attempt to identify oral Candida species in a South Indian population.

Emmanuel Ademola Anígilájé,1 Bem Ruben Ageda,2 Nnamdi Okechukwu Nweke1 1Department of Paediatrics, 2Department of Obstetrics and Gynaecology, Federal Medical Centre, Makurdi, Nigeria Background: Perinatal transmission of human immunodeficiency virus (HIV) continues in Nigeria because of the poor use of prevention of mother-to-child transmission of HIV (PMTCT) services. This study reports on the barriers preventing mothers of vertically infected HIV-seropositive infants to use the PMTCT services at the Federal Medical Centre, Makurdi, Nigeria.Methods: This is a descriptive study conducted between January and April, 2014. A quantitative survey was applied to detect barriers along the PMTCT services cascade among 52mothers of vertically infected HIV-seropositive infants. This includes 22 women who attended antenatal care at the Federal Medical Centre (designated as Group A mothers) and 30 women who did not receive any form of PMTCT service (Group B mothers). The study was supplemented with a focused group discussion involving 12 discussants from the two groups.Results: In the quantitative assessment: among the Group A mothers, falling asleep was the most common reason (n=22, 100%) for missing therapeutic/prophylactic antiretroviral medicine; financial constraint (n=22, 100%) was the most common reason for antenatal care visit defaults; and a lot of the mothers (n=11, 50.0%) did not give nevirapine to their newborns because they delivered at home. Among Group B mothers, unawareness of HIV-seropositive status was the most common reason (n=28, 93.3%) given for not accessing PMTCT services. In the qualitative study: noninvolvement of male partners, stigma and discrimination experienced by HIV-seropositive mothers, financial constraints in couples, involvement of traditional birth attendants in antenatal care and delivery of HIV-infected women, unawareness of HIV-seropositive status by pregnant women, poor health system, and the lack of funding for PMTCT services at private and rural health facilities were the major barriers preventing the use of PMTCT services.Conclusion: In order to reduce the missed opportunities for PMTCT interventions in Makurdi and by extension the Benue State it represents in Nigeria, strong political and financial commitments are needed to overcome the identified barriers. Keywords: obstacles, PMTCT services, Makurdi, Nigeria

This study was aimed at evaluating the effect of HIV infection on hemostatic parameters, determination of the influence and duration of antiretroviral therapy (ART) on these parameters. It was carried out at the Nnamdi Azikiwe University Teaching Hospital, Nnewi. One hundred and eighty two subjects were recruited consisting; Sixty one (31 males and 30 females) HIV positive subjects on antiretroviral therapy (ART) with an ART duration of 6 months - 2 years ≤5 years, ≤10 years; Sixty one (28 males and 33 females) HIV positive subjects ART naive and Sixty (30 males and 30 females) seronegative (HIV negative control) subjects. The prothrombin time (PT) was determined using Quick One Stage method, activated partial thromboplastin time (APTT) was determined by Modified Kaolin method, thrombin time (TT) was done by Two stage method, HIV status was determined using Immunochromatographic method and Platelet count was determined using Direct current detection method. Student t-Test and ANOVA were used to analyze significance of differences in mean values between groups and among groups, respectively. PT and APTT for ART and Non-ART subjects were significantly increased compared with control (P 0.05 in each case). The TT was significantly higher in HIV-positive on ART compared to control (P 0.05 in each case). Platelet count was significantly lower in HIV-positive subjects (ART and Non-ART) compared to the values obtained in HIV negative subjects (P 0.05 in each case). The reason for the increase in PT and APTT in HIV disease may be as a result of endothelial activation and liver derangement and decreased platelet count is due to cytopenias seen in HIV disease.

Objective: Here we report the prevalence and predictors of genital CMV infection among HIV infected women in Mwanza, Tanzania. Methods: A total of 255 HIV seropositive women were investigated between August and October, 2014. Demographic and clinical data were collected using standardized data collection tool. Exfoliated cells from endocervix were obtained and detection of CMV DNA was done using real-time polymerase chain reaction (RTPCR). Results: A total number of 255 HIV infected women were enrolled with the mean age of 39.2 ± 9.1.The overall prevalence of genital CMV among HIV infected women was 43(16.7%, 95% CI: 12-21). Inflammatory changes and dysplasia did not show any association with genital CMV infection (p>0.05). Only good socio-economic status (OR=2.36, 95% CI; 1.1-5.02, p=.0.027), young age at first sexual intercourse (OR=2.18, 95% CI; 1.04-4.62, p=0.04) and lower CD4+ counts (OR=2.07, 95% CI; 1.23-3.48, p=.0.027) were found to be independent predictors of genital CMV infection among HIV infected women. Conclusion: A significant proportion of HIV infected women are genitally infected with CMV in the genital tract. More studies to ascertain the clinical role of this virus in the female genital tract are recommended especially in HIV infected women.

Candidais a common opportunistic pathogen during the course of human immunodeficiency virus (HIV) disease progression. Changes in the clinical severity of candidiasis and theCandidaspecies prevalence profile may be a reflection of immunological changes in HIV positive patients. The aim of this study was to document the changing pattern ofCandidaspecies prevalence profile in HIV seropositive patients from a tertiary care hospital in North India. One hundred and twenty HIV seropositive subjects were recruited forCandidamicrobial screening. Clinical specimens including blood, oral swabs, expectorated or induced sputum/bronchoalveolar lavage specimens, and urine were collected depending on the patient’s symptoms. A total of 128Candidaisolates were obtained from 88 cases and 7 differentCandidaspecies were identified.C. albicans(50%) was the most common species isolated followed byC. glabrata(17%) andC. dubliniensis(12.5%). Other species isolated wereC. parapsilosis(7.8%),C. krusei,C. tropicalis(4.6% each), andC. kefyr(3%). Strong clinical suspicion along with optimal sampling of an accurate diagnosis ofCandidaspecies involved would go a long way in decreasing the morbidity associated with non-albicans Candidaspecies.

Introduction: Human Immunodeficiency Virus (HIV) infects and cripples the immune system of the body. The two important marker CD4+T cells and Plasma viral load are crucial not only in understanding the disease progression but also in starting the antiretroviral therapy. A lot of research is going on in understanding the dynamic nature of HIV. Aim: To find the correlation between CD4+ count and Plasma Viral Load (PVL) measured by two different technologies; with the help of correlation technique in conjunction with the three dimensional HIV model with a purpose of establishing a mathematical model between the CD4+ cells and PVL using a sinusoidal function as well as Radial Basis Function (RBF) neural network. Materials and Methods: Plasma Viral Load were determined by two different methods viz Exavir CavidiTM and Abbott Real time HIV-1 assay and then they were correlated with the CD4+ count with the help of computational intelligence in predicting viral load. Results: It was found that there exists a positive correlation between the CD4+ cells and viral loads. A correlation value of 0.4082 and 0.3652 was observed between CD4+ cells and viral measured using Exavir CavidiTM and Abbott Real time HIV-1 assay respectively. Conclusion: The existence of positive correlation had helped us to understand the nature and dynamic of the existence of HIV and how the CD4 + and PVL act.

Toxoplasmosis caused by an obligate intracellular Protozoan, Toxoplasma gondii has emerged as an important cause of opportunistic infection in HIV/AI DS resulting in severe morbidity and significant mortality. HIV infected pregnant women are prone to infection by T. gondii due to immune suppression and may lead to severe complications and congenital abnormalities. However, data on this subject matter are scarce in this environment. The study was aimed to determine the seroprevalence of T. gondii infection among HIV infected pregnant women and associated risk factors in Kano, northern Nigeria. A total of 273 HIV seropositive pregnant women attending Aminu Kano Teaching Hospital (AKTH), Kano were screened for T. gondii antibodies (IgG/IgM) by serology including determination of CD4 cell level in the patients by standard proced ures. Socio-demographic information and risk factors variables of Toxoplasmosis including patient histor y were obtained via a questionnaire. Data were analyzed statistically.

This study investigated some factors predisposing people to stigmatize and discriminate against HIV seropositive people in the workplace. The study sample was 183 employees randomly drawn from 5 di...

The aims of this research are: i) to evaluate the prevalence of HHV-8, HBV and HIV among pregnant women, ii) to determine the percentage of these co-infections and iii) to estimate the frequency of the mother-to-child transmission of HIV among HBV and HHV-8 positive mothers. Thus, 379 pregnant women attending ante-natal consultation in Saint Camille Medical Centre were subject to HIV, HHV-8 antibodies and the viral marker Hepatitis B Surface Antigen (HBsAg) detection. We observed 48/379 (12.66%) HIV seropositive subjects. Among them, HIV-1 type infection was predominant (95.83%), only 2/48 (4.17%) subjects had a dual HIV-1 type and HIV-2 type infection, no single HIV-2 type infection was detected. 38/379 (10.02%) subjects were infected by HHV-8 and 30/379 (7.91%) were HBsAg positive. HHV-8 and HIV Co-infections rates were high within HBV positive patients and we had respectively 20.00 and 16.67%. 10.42% HIV positive women were coinfected by HBV while 12.50% were infected by HHV-8. Then, 15.79% subjects HHV-8 positive were co-infected by HBV or HIV. In spite of the PMTCT protocol application, five (10.42%) HIV positive women transmitted the virus to their children. Two HIV positive mothers were co-infected by HHV-8 and one by HBV. Among the 5 HIV infected, one mother (20.0%) was HBV positive and two (40.0%) HHV-8 positive. Although we did not have a large sample which would show large prélalences of the infections, we could put forward that the Co-infection of the HIV with one of these viruses (HBV or HHV-8) could favorite the mother-to-child transmission.