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The GB virus (GBV)/hepatitis G virus is a member of the Flaviviridae family and belongs to the hepatitis group of viruses transmitted parenterally, common among intravenous drug users. The strong association between GBV and HIV infection suggests that the two viruses may share similar epidemiological and transmission features. GBV infection is widely believed to prolong HIV disease progression as well as decreasing the HIV viral load and increasing the CD4(+) T-cell level. GBV-driven anti-E2 antibodies have been shown to inhibit HIV replication in vitro. Preliminary studies also suggest that GBV infection of peripheral blood mononuclear cells leads to increased production of beta-chemokines, which may explain the in vitro inhibitory effects and warrants further studies. With sufficient knowledge of resistance patterns studied in tropical south India, researchers are now keen to study the competitive interactions between GBV-induced chemokines and HIV ligands to bind CCR5.

SummaryObjectiveThe role of oxidative stress in disease progression has been shown to be more complicated in HIV-infected individuals receiving highly active antiretroviral therapy (HAART) compared to those who remain treatment-naïve. This study examined the changes in the antioxidant profile of HIV-infected subjects who remained HAART-naïve due to a high CD4 cell count and HIV-negative controls, over a 12-month follow-up period at YRG CARE, a tertiary HIV referral centre in southern India.MethodsWe prospectively studied 35 HIV-infected participants (18 on d4T+3TC+EFV (stavudine+lamivudine+efavirenz), eight on AZT+3TC+EFV (zidovudine+lamivudine+efavirenz), and nine who were antiretroviral therapy-naïve) and 20 HIV-negative controls. Antioxidant profile (total antioxidant status, glutathione reductase, glutathione peroxidase, uric acid, ceruloplasmin, zinc, and albumin), CD4 cell count, plasma viral load, dietary intake, and history of smoking and alcohol use were determined at baseline and at twelve months.ResultsAt 12 months, participants on HAART showed a significant increase in glutathione peroxidase (baseline: 1765 vs. 12 months: 2850U/l; p

Background We established the biochemical and hematological reference intervals among a south Indian healthy adult population attending an HIV referral centre in Chennai, southern India. Methods In a cross sectional study, 213 study subjects (129 male and 84 female) were studied between March and August 2005. All of the parameters were analyzed using standard hematological and biochemical techniques. Results Certain biochemical (viz. total bilirubin, alanine transaminase, albumin, creatinine, total protein, lipid profile, creatine phospokinase, uric acid and lactate) and hematological (mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration and lymphocyte levels) parameters presented higher upper limits. In addition, the upper limits of white blood cell count, platelet count, hematocrit, red blood cell count and hemoglobin level were low in comparison to the currently reported ranges. Conclusion Ethnic variation in reference intervals was observed in certain biochemical and hematological analytes in a south Indian adult population.

Studies have shown that the more iron in a given population, the more that population is vulnerable to intracellular opportunistic infections (OIs) in AIDS, mainly because these microbes make use of the intracellular iron to proliferate, and could render infections deadly. In contrast, macrophages that lack iron are effective in preventing an establishment of infection. We propose that reduction in total body iron could be a valuable treatment option for some intracellular infections, including OIs. We suggest two options to deprive pathogens of using intracellular iron (i) to practice regular blood-letting, an ancient treatment option, and (ii) to down-regulate hepcidin, the key hormone involved in the regulation of iron balance and recycling. This could also deprive transformed cells of metabolizing iron for survival. Whether or these methods serve to curb the onset of OIs/cancers to prolong HIV disease progression remains to be investigated.

BACKGROUND: The co-factors underlying abnormal lactate level remains to be determined in resource-limited settings. In a cross-sectional study conducted between January 2004 and July 2006 we determined the proportion of HIV-infected persons with abnormal lactate levels and correlated the association of certain co-factors of abnormal lactate levels at a tertiary HIV care centre in Chennai Southern India. METHODS: Lactate was estimated by the enzymatic method using an Olympus AU 400 autoanalyzer. Absolute CD4+T lymphocyte count was determined by the Guava personal cell analyser (Guava Technologies Inc. Hayward CA USA). Subjects were classified to have normal or abnormal values of lactate based on the reference interval (0.3-2.2 mmol/L). A p value 0.05 was considered statistically significant. RESULTS: A total of 225 HIV-infected individuals (HAART experienced 213 (95%) and HAART naive (5%)) were included in the analysis. Mean age was 34+/-8 and 36+/-9 years for the individuals with normal and abnormal lactate levels respectively. Of these 185 (82%) had normal (0.3-2.2 mmol/L) and 40 (18%) had abnormal (>2.2 mmol/L) lactate levels. Significant difference in relation to female gender was observed between the normal and abnormal groups (p=0.03). Among the abnormal group 39 (97.5%) subjects were HAART experienced compared to 174 (94.1%) normal group. Among the abnormal group 24 (60%) individuals had a CD4 count of

Department of Infectious Diseases,YRG Centre for AIDS Research and Education (YRG CARE),VHS Hospital Campus, IT Corridor, Taramani,Chennai 600 113, India.Tel.: +91 (44) 22542929E-mail: sundaram@yrgcare.orgDear Editor,Electrolyte disturbance can be associated with numerousmorbid conditions especially among HIV-infected individualsreceiving highly active antiretroviral therapy (HAART) (1- 4).Electrolyte imbalance is described to be the prime cause ofdeath due to myriad infectious ailments involving thegastrointestinal tract, exemplified by Asiatic cholera, rota virusinfection, shigellosis, salmonellosis, leptospirosis, malaria andparasitic diarrhoea. Unless restored, electrolyte imbalance canbe serious and might interfere with a patient’s immuneresponse. T erminal HIV disease is characterized by the onsetof numerous opportunistic infections (OI) and neoplasms andindividuals in terminal AIDS are vulnerable to numerousintracellular infections, where the corresponding aetiologicalagents reportedly use the intracellular elements (e.g. iron) andmetabolites to survive and replicate, which likely alters theevents related to cellular metabolism (5). This couldsubsequently lead to a plethora of functional sabotage eventsin cellular and immune functions (5). Maintenance of anoptimum amount of electrolyte (ionic homeostasis) in theintracellular as well as the extracellular compartment (blood,interstitial fluid etc.) is paramount to healthy living. Electrolyteimbalance could be attributed to numerous factors both fromthe host as well as from the parasite point of view andprincipally reflects a disturbance in the host’s cellular metabolicpathways possibly after establishment of an infection.In the post-HAART era, information of the prevalence ofelectrolyte imbalance is limited both in developed world aswell as in resource-limited settings and has never beenadequately investigated. One study has identified abnormallylow bicarbonate levels (1) and another documented HIV-associated nephropathy (2) among HAART-treated HIVpositive persons. Few others have documented that HIV-infected individual with underlying OIs treated with HAARTregimens developed biological abnormalities includinghyponatraemia, hyperkalaemia or hypokalaemia and acidosis(3, 4). Besides, sodium and potassium imbalances arebelieved to be associated with a plethora of chronic ailments,such as malnutrition, alcoholism, diabetes mellitus and otherinfectious causes especially in AIDS. A detailed literaturesurvey revealed the availability of very limited past data onthe prevalence of electrolyte imbalances in HIV infectedindividuals. Further, the underlying risk factors for biologicalabnormalities are poorly defined. Hence in a cross-sectionalstudy we investigated the proportion of HIV infected personswith abnormal serum electrolytes and identified the possibleco-factors of these biological abnormalities among personsattending YR Gaitonde Centre for AIDS Research andEducation (YRG CARE), a tertiary referral centre in SouthernIndia, between January 2004 and July 2006. Data werecollected with the approval of YRG CARE’s freestandinginstitutional review board.YRG CARE, since 1993, has provided medical andpsychosocial care and support to over 12,000 HIV-infectedpersons in the south of India. The study was approved by theInstitutional Review Board (IRB) of YRG CARE. Writteninformed consent was obtained from all the participants. Weinvestigated 464 HIV-infected persons who were either HAARTnaive or HAART experienced. Demographics, clinicalcharacteristics and co-factors (age, gender, hepatitis B and Cstatus and exposure to HAART) were included in the analysis.Laboratory investigations such as electrolytes (sodium,potassium, chloride and bicarbonate) and absolute CD

Estimation of CD4+ T-lymphocytes continues to be an important aspect for monitoring HIV disease progression and response to antiretroviral therapy. Most of the diagnostic laboratories often rely on western text books for CD4+ T-lymphocyte reference values, which could, often be unreliable for usage in local settings. Therefore, we attempted to establish the reference values for T-lymphocyte subsets among healthy adults in a cross-sectional study carried out at the YRG Centre for AIDS Research and Education (YRG CARE) in Chennai, south India, in 213 (84 female and 129 male) healthy, HIV-1/2 seronegative adults as volunteers. Whole blood specimens were processed for CD4+, CD8+ T-lymphocyte estimation and haematological parameters. The established range of CD4+ T-lymphocyte counts for men and women were 383-1347 cells/microl (mean 865 and median 845 cells/microl) and 448-1593 cells/microl (mean 1021 and median 954 cells/microl), respectively. Women had significantly higher absolute CD4+ Tlymphocyte counts (P0.001) and CD4+:CD8+ T-lymphocyte ratio as compared to men. The established normal range of CD4+ T-lymphocyte % was 21-59 (mean 40.2 and median 40.1). The influence of age was not observed in any of the parameters except CD4+/CD8+ T-lymphocyte ratio with the45 yr age group. Further studies with greater sample size may be required to define the staging of HIV disease in relation to the normal CD4 T-lymphocyte count in the general population.

Purpose of the Study South Indians are known to be genetically predisposed to diabetes mellitus and cardiovascular diseases. There are several reports of emerging insulin resistance and metabolic syndrome among HIV-infected persons from the Western population. This study reports insulin resistance and consequently metabolic syndrome among HIVinfected patients initiating HAART in South India and its outcomes.