African Australians living with HIV: a case series from Victoria

Sexual Health ◽  
2010 ◽  
Vol 7 (2) ◽  
pp. 142 ◽  
Author(s):  
Chris N. Lemoh ◽  
Samia Baho ◽  
Jeffrey Grierson ◽  
Margaret Hellard ◽  
Alan Street ◽  
...  
Keyword(s):  
Delayed Diagnosis ◽  
Case Series ◽  
Cd4 Count ◽  
Horn Of Africa ◽  
Hiv Diagnosis ◽  
Pneumocystis Jiroveci ◽  
Pneumocystis Jiroveci Pneumonia ◽  
Hiv Prevention Strategies ◽  
Industrialised Countries ◽  
Living With Hiv

Background: This research aimed to describe the characteristics of African-born Victorians living with HIV, identify associations with delayed HIV diagnosis and describe their response to combination antiretroviral therapy (cART). Methods: A case series of African-born adults living with HIV in Victoria was conducted. Data was collected in interviews and reviews of case notes. Associations with delayed HIV diagnosis (CD4 below 200 cells µL–1 at diagnosis and/or AIDS within 3 months of HIV diagnosis) were explored using univariate regression. AIDS-defining illnesses and response to cART were described. Results: Fourteen males and six females were included. Ten were born in the Horn of Africa (nine in Ethiopia). Sixteen had sexual exposure (12 heterosexual; four male-to-male sex). Seven reported acquiring HIV in Australia. Median CD4 count at diagnosis was 145 cells µL–1. Ten had delayed HIV diagnosis, of whom eight were born in the Horn of Africa. Delayed HIV diagnosis was associated with birth in the Horn of Africa (odds ratio: 11.56). Nine had a diagnosis of AIDS, including three cases of tuberculosis, three of Pneumocystis jiroveci pneumonia and two of cerebral toxoplasmosis. Eighteen had received cART, of which 16 achieved virological suppression and 15 achieved a CD4 count above 200 cells µL–1. Clinical failure and virological failure occurred in seven and five cases, respectively. Conclusions: HIV prevention strategies for Victoria’s African communities should address HIV exposure in Australia. Ethiopian-born Victorians with HIV appear to be at particular risk of delayed diagnosis. Response to cART in this series was comparable to that observed in other industrialised countries.

scholarly journals Assessment of Bronchiectasis in HIV Patients among an Urban Population

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Veena Dronamraju ◽  
Navneet Singh ◽  
Justin Poon ◽  
Sachi Shah ◽  
Joseph Gorga ◽  
...  
Keyword(s):  
Case Series ◽  
Cd4 Count ◽  
Wall Thickening ◽  
Hiv Patients ◽  
Pneumocystis Jiroveci ◽  
Computed Tomographic ◽  
Pneumocystis Jiroveci Pneumonia ◽  
History Of ◽  
Urban Institutions

Bronchiectasis is characterized by permanent destruction of the airways that presents with productive cough, as well as bronchial wall thickening and luminal dilatation on computed tomographic (CT) scan of the chest; it is associated with high mortality. Accumulating data suggests higher rates of bronchiectasis among the HIV-positive population. This case series involves 14 patients with bronchiectasis and HIV followed at two major urban institutions from 1999 to 2018. Demographics, clinical presentation, microbiology, radiographic imaging, and outcomes were collected and compiled. Mean age was 42 years (range 12-77 years). 36% had a CD4 count greater than 500 cells/mm3, 28% had a CD4 count between 200 and 500 cells/mm3, and 36% had AIDS. 43% were treated for Pneumocystis jiroveci pneumonia (PJP) and 50% for Mycobacterium avium complex (MAC) infection. 21% had COPD, 7% had asthma, and 7% had a history of pulmonary aspergillosis. Two patients were followed up by pulmonary services after diagnosis of bronchiectasis on CT. The timeline of the follow-up in these cases was within months and after three years respectively. It is posited that the prevalence of bronchiectasis in HIV patients may be underestimated. Improving recognition and management of bronchiectasis could help diminish rehospitalization rates.

Nieprawidłowo diagnozowana utrata masy ciała u pacjenta z późnym rozpoznaniem HIV – opis przypadku

2020 ◽  
Vol 11 (6) ◽  
pp. 307-310
Author(s):  
Błażej Rozpłochowski
Keyword(s):  
Elderly People ◽  
Male Patient ◽  
General Malaise ◽  
Hiv Diagnosis ◽  
Pneumocystis Jiroveci ◽  
Pneumocystis Jiroveci Pneumonia ◽  
Late Hiv Diagnosis ◽  
Loss Of Weight ◽  
Living With Hiv ◽  
Progressive Weakness

Late and very late HIV diagnosis are still a major challenge for caring for patients living with HIV. A 50-year-old male patient was followed up due to general malaise, progressive weakness and uncontrolled loss of weight through 9 months. He was diagnosed with HIV when presented cachexia, candidosis and Pneumocystis jiroveci pneumonia. There is a need for testing not only in MSM group with the highest prevalence of HIV but also in other groups such heterosexual or elderly people.

scholarly journals Clinical characteristics and outcomes of people living with HIV hospitalized with COVID-19: a nationwide experience

2021 ◽  
Vol 32 (5) ◽  
pp. 435-443
Author(s):  
Maria Elena Ceballos ◽  
Patricio Ross ◽  
Martin Lasso ◽  
Isabel Dominguez ◽  
Marcela Puente ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
General Population ◽  
Clinical Characteristics ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Hiv Diagnosis ◽  
Hiv Viral Load ◽  
Risk Of Death ◽  
Living With Hiv

In this prospective, multicentric, observational study, we describe the clinical characteristics and outcomes of people living with HIV (PLHIV) requiring hospitalization due to COVID-19 in Chile and compare them with Chilean general population admitted with SARS-CoV-2. Consecutive PLHIV admitted with COVID-19 in 23 hospitals, between 16 April and 23 June 2020, were included. Data of a temporally matched-hospitalized general population were used to compare demography, comorbidities, COVID-19 symptoms, and major outcomes. In total, 36 PLHIV subjects were enrolled; 92% were male and mean age was 44 years. Most patients (83%) were on antiretroviral therapy; mean CD4 count was 557 cells/mm3. Suppressed HIV viremia was found in 68% and 56% had, at least, one comorbidity. Severe COVID-19 occurred in 44.4%, intensive care was required in 22.2%, and five patients died (13.9%). No differences were seen between recovered and deceased patients in CD4 count, HIV viral load, or time since HIV diagnosis. Hypertension and cardiovascular disease were associated with a higher risk of death ( p = 0.02 and 0.006, respectively). Compared with general population, the HIV cohort had significantly more men (OR 0.15; IC 95% 0.07–0.31) and younger age (OR 8.68; IC 95% 2.66–28.31). In PLHIV, we found more intensive care unit admission (OR 2.31; IC 95% 1.05–5.07) but no differences in the need for mechanical ventilation or death. In this cohort of PLHIV hospitalized with COVID-19, hypertension and cardiovascular comorbidities, but not current HIV viro-immunologic status, were the most important risk factors for mortality. No differences were found between PLHIV and general population in the need for mechanical ventilation and death.

scholarly journals A study of clinical spectrum of opportunistic infections in HIV infected children and its correlation with CD4 count and anti-retroviral therapy

2017 ◽  
Vol 4 (4) ◽  
pp. 1485
Author(s):  
Vishal Manohar Jadhav ◽  
Yashwant Raghu Gabhale ◽  
Mamatha Murad Lala ◽  
Nikita Dilip Shah ◽  
Mamta Vijay Manglani
Keyword(s):  
Opportunistic Infections ◽  
Molluscum Contagiosum ◽  
Cd4 Count ◽  
Clinical Spectrum ◽  
Pneumocystis Jiroveci ◽  
Female Ratio ◽  
Cd4 Counts ◽  
Pneumocystis Jiroveci Pneumonia ◽  
High Index Of Suspicion ◽  
Male To Female

Background: To determine the clinical spectrum and prevalence of opportunistic infections (OIs) in HIV infected children and correlate the occurrence of opportunistic infections with their CD4 count and Anti-retroviral treatment (ART).Methods: A total of 100 HIV infected children diagnosed with opportunistic infections were included in the study. Demographic details, clinical examination and relevant investigations were done for all the children. Clinical spectrum of OIs and HIV staging was recorded. CD4 counts were done at baseline and were repeated at 6 monthly intervals.Results: Mean age of the patients was 7.08±3.48 years (ranging from 6 months to 15 years) at enrollment with male to female ratio of 1.2:1. Fever (91%) was a common presenting symptom followed by weight loss (74%), cough (37%), abdominal pain (29%) and breathlessness (16%). CD4 count was significantly associated with presence of opportunistic infection in the study group. Tuberculosis - pulmonary (32%) and extra-pulmonary (29%) was the most common oppurtunistic infections, followed by oral thrush (13%), Herpes zoster (10%), Molluscum Contagiosum (9%), Pneumocystis jiroveci pneumonia (3%), Parvovirus infection (3%) and Pruritic Papular Eruptions (2%). 70% children were on ART as per clinical and immunological staging of HIV.Conclusions: Low CD4 count is significantly associated with severe opportunistic infections, therefore drop in CD4 count should serve as an alarming signal for the treating physician. High index of suspicion is required to detect opportunistic infections and therefore CD4 counts should be done more frequently to predict occurrence of OIs. 

scholarly journals Delayed Treatment for People Living with HIV in China, 2004–2016: An Analysis of An Observational Cohort

2020 ◽  
Vol 17 (5) ◽  
pp. 1809
Author(s):  
Junfang Xu ◽  
Anders Sönnerborg ◽  
Liangmin Gao ◽  
Peicheng Wang ◽  
Jennifer Z.H. Bouey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Universal Access ◽  
Binary Logistic Regression ◽  
Lag Time ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Hiv Diagnosis ◽  
Delayed Initiation ◽  
Living With Hiv ◽  
Late Testing

Early universal access to antiretroviral treatment (ART) is critical in the control of the HIV epidemic. However, prompt initiation of ART remains problematic in China. This study analyzed the late testing and lag time between HIV diagnosis and initiation of ART from 2004 to 2016 and identified the risk factors for delayed initiation of ART. Data from 16,957 people living with HIV were abstracted from a hospital electronic health record database and a case report database for AIDS prevention and control in Yunnan province. Reasons for delayed initiation of ART were categorized into late testing, defined as CD4 count of < 350 cells/μL at baseline HIV diagnosis, and delayed access, defined as a lag time of > 1 month between the diagnosis and initiation of ART. Binary logistic regression models were used to identify risk factors for late testing and delayed access. The CD4 counts at diagnosis increased from 201 ± 147 cells/μL (mean ± SD) in 2004 to 324 ± 238 cells/μL in 2016 (p = 0.024). The CD4 count was higher for persons < 45 years, unmarried, and men who have sex with men (MSM) (356, 357, and 409 cells/μL, respectively) compared to their peers in 2016 (p < 0.05). The lag time from diagnosis to initiation of ART was significantly reduced from 59.2 months in 2004 to 0.9 months in 2016 (p < 0.05). The shorter lag time over the years was consistent when analysis was stratified by sex, age, marital status, and transmission routes, even though the lag time for people using drugs was longest in 2016 (> 2 months versus 0.82 and 0.72 month of heterosexuals and MSM, respectively). Compared to their peers, married persons (AOR = 0.63, 95%CI: 0.57, 0.69) were less likely to have delayed access to ART, and drugs-using patients (AOR = 3.58, 95%CI: 2.95,4.33) were more likely to have delayed access to ART. Late testing rather than delayed access to ART after a diagnosis remains problematic in China, although improvements have been seen for both parameters from 2004 to 2016. Our data highlight the importance of continued efforts to promote early diagnosis of HIV to prevent transmission, morbidity, and early mortality in HIV infection.

scholarly journals A Case Report of Mycobacterium Avium Complex Peritonitis in an AIDS Patient

2013 ◽  
Vol 2013 ◽  
pp. 1-2 ◽  
Author(s):  
Yihenew Negatu ◽  
Eyasu Mekonen
Keyword(s):  
Mycobacterium Avium ◽  
Highly Active Antiretroviral Therapy ◽  
Mycobacterium Avium Complex ◽  
Cd4 Count ◽  
Mesenteric Lymph Nodes ◽  
Pneumocystis Jiroveci ◽  
Pneumocystis Jiroveci Pneumonia ◽  
Highly Active ◽  
Abdominal Symptoms ◽  
Mesenteric Lymph

Peritonitis due to Mycobacterium avium complex (MAC) infection is uncommon. The risk for MAC in AIDS patients is greatest in those with severely depressed CD4 count. The organs most commonly involved in disseminated MAC infection include spleen, mesenteric lymph nodes, liver, and intestines. The involvement of peritoneum by MAC infection is rare. This is a case of MAC peritonitis in a 26-year-old female AIDS patient who is noncompliant to highly active antiretroviral therapy (HAART). This patient presented with abdominal pain and distension, anorexia, diarrhea, and cough. She was treated with rifabutin, clarithromycin, and ethambutol along with atovaquone for Pneumocystis jiroveci pneumonia prophylaxis and so the patient’s condition improved. MAC peritonitis should be considered in a patient presenting with nonspecific abdominal symptoms in the setting of AIDS and low CD4 count.

scholarly journals Prevalence and Correlates of Neurocognitive Disorders among HIV Patients on Antiretroviral Therapy at a Kenyan Hospital

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
A. G. Mugendi ◽  
M. N. Kubo ◽  
D. G. Nyamu ◽  
L. M. Mwaniki ◽  
S. K. Wahome ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Clinical Care ◽  
Neurocognitive Impairment ◽  
Neurocognitive Disorders ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Hiv Diagnosis ◽  
Cross Sectional ◽  
Asymptomatic Neurocognitive Impairment ◽  
Living With Hiv

Background. HIV-associated neurocognitive disorders (HAND) represent a spectrum of cognitive abnormalities affecting attention, concentration, learning, memory, executive function, psychomotor speed, and/or dexterity. Our objectives in this analysis are to determine the prevalence of HAND and the covariates in a Kenyan population. Methods. We conducted a cross-sectional study in a convenient sample of people living with HIV on antiretroviral therapy (ART) attending routine care visits at the Kenyatta National Hospital HIV clinic between July and August 2015. Baseline demographics were obtained using interviewer-administered questionnaires; clinical data were abstracted from patient records. Trained research clinicians determined the neurocognitive status by administration of the International HIV Dementia Scale (IHDS), the Montreal Cognitive Assessment (MOCA) scale, and the Lawton Instrumental Activities of Daily Living (IADL) scale. Cognitive impairment was defined as a score of ≤26 on the MOCA and ≤10 on the IHDS. Descriptive analysis and logistic regression to determine predictors of screening positive for HAND were done with the significance value set at <0.05. Results. We enrolled 345 participants (202 men; 143 women). The mean age of the study population was 42 years (±standard deviation (SD) 9.5). Mean duration since HIV diagnosis and mean duration on ART were 6.3 (±SD 3.7) and 5.6 years (±SD 3.4), respectively. Median CD4 count at interview was 446 cells/mm3 (interquartile range (IQR) 278–596). Eighty-eight percent of participants screened positive for HAND, of whom 87% had asymptomatic neurocognitive impairment (ANI) and minor neurocognitive disorders (MND) grouped together while 1% had HIV-associated dementia (HAD). Patients on AZT/3TC/EFV were 3.7 times more likely to have HAND (OR = 3.7, p=0.03) compared to other HAART regimens. In the adjusted analysis, women were more likely to suffer any form of HAND than men (aOR = 2.17, 95% CI: 1.02, 4.71; p=0.045), whereas more years in school and a higher CD4 count (aOR = 0.58, 95% CI: 0.38, 0.88; p=0.012), (aOR = 0.998, 95% CI 0.997, 0.999; p=0.013) conferred a lowered risk. Conclusion. Asymptomatic and mild neurocognitive impairment is prevalent among people living with HIV on treatment. Clinical care for HIV-positive patients should involve regular screening for neurocognitive disorders while prioritizing women and those with low education and/or low CD4 counts.

Pneumocystis jiroveci pneumonia during first and second-line chemotherapy for solid tumours.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18330-e18330
Author(s):  
Emma Shaughnessy ◽  
Kevin Armstrong ◽  
Madeline Rogers-Seeley ◽  
Adarsh Das ◽  
Domenic Higgs ◽  
...  
Keyword(s):  
Reference Range ◽  
Cd4 Count ◽  
Solid Tumours ◽  
High Dose ◽  
Second Line ◽  
First Line ◽  
Pneumocystis Jiroveci ◽  
Second Line Chemotherapy ◽  
Pneumocystis Jiroveci Pneumonia ◽  
Line Chemotherapy

e18330 Background: Pneumocystis jiroveci pneumonia (PJP) is an opportunistic fungal infection, historically associated with individuals with advanced immunodeficiency, sustained temozolamide chemotherapy and in those who have undergone multiple lines of chemotherapy. PJP is now increasingly being recognised in patients undergoing first-line chemotherapy. This is a retrospective study of ten cases of PJP at our institution amongst patients undergoing first or second-line chemotherapy for solid tumours. Methods: An electronic database search was conducted, looking at cases of PJP diagnosed in our institution over a five year period. Ten patients with a history of PJP were identified. These patients’ pharmacy records, pathology, imaging and laboratory results were examined. Results: All identified patients developed PJP whilst undergoing first-line (70%) or second-line (30%) chemotherapy for solid tumours. These included metastatic cancers such as: pancreatic adenocarcinoma (50%), lung cancer (20%), prostate adenocarcinoma (10%), gastric adenocarcinoma (10%); and colon adenocarcinoma (10%). Eight of ten patients were lymphopenic, with lymphocytes counts of 0.1 - 0.5 (reference range 1.0 - 4.0 x 109/L). One patient had a recorded CD4 count of 114 (reference range 500-1500). On the basis of clinical context, ground-glass changes on CT and/or a positive sputum PCR for PJP, each patient was treated with intravenous high-dose trimethoprim/sulfamethoxazole until they were clinically stable. Patients were then switched on to a life-long prophylactic dose. Four patients required intensive care for management of respiratory failure. Nine out of ten patients recovered well without any long-term sequelae and one patient died. Conclusions: PJP is being diagnosed more frequently than previously thought in those receiving first and second-line chemotherapy. Limited research has been conducted into the potential benefit of prescribing trimethoprim/sulfamethoxazole prophylaxis to patients commencing chemotherapy. Monitoring of CD4 count prior to each chemotherapy cycle could provide guidance to oncologists regarding when to commence prophylactic treatment as a means to reducing patients diagnosed with PJP.

scholarly journals Pneumocystis jiroveci pneumonia in giant cell arteritis: A case series

2011 ◽  
Vol 63 (5) ◽  
pp. 761-765 ◽  
Author(s):  
Tanaz A. Kermani ◽  
Steven R. Ytterberg ◽  
Kenneth J. Warrington
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Case Series ◽  
Pneumocystis Jiroveci ◽  
Pneumocystis Jiroveci Pneumonia
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