scholarly journals Challenges in the Management of Disseminated Progressive Histoplasmosis in Human Immunodeficiency Virus-Infected Patients in Resource-Limited Settings

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Richard A. Murphy ◽  
Lilishia Gounder ◽  
Thandekile C. Manzini ◽  
Pratistadevi K. Ramdial ◽  
Carmen Castilla ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Therapeutic Drug Monitoring ◽  
Liposomal Amphotericin ◽  
Treatment Options ◽  
Diagnostic Tools ◽  
Therapeutic Drug ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Immunodeficiency Virus ◽  
African Context

Abstract The diagnosis of histoplasmosis in patients with human immunodeficiency virus in southern Africa is complicated by the nonspecific presentation of the disease in this patient group and the unavailability of sensitive diagnostics including antigen assays. Treatment options are also limited due to the unavailability of liposomal amphotericin and itraconazole, and the inability to perform therapeutic drug monitoring further confounds management. We present 3 clinical cases to illustrate the limits of diagnosis and management in the southern African context, and we highlight the need for additional diagnostic tools and treatment options in resource-limited settings.

scholarly journals Human Immunodeficiency Virus-associated Neurocognitive Impairment in Diverse Resource-limited Settings

2018 ◽  
Author(s):  
Kevin R Robertson ◽  
Hongyu Jiang ◽  
Johnstone Kumwenda ◽  
Khuanchai Supparatpinyo ◽  
Christina M Marra ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Neurocognitive Impairment ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Immunodeficiency Virus

scholarly journals Calcaneal Quantitative Ultrasonography and Urinary Retinol-Binding Protein in Antiretroviral-Treated Patients With Human Immunodeficiency Virus in Uganda: A Pilot Study

2020 ◽  
Vol 222 (2) ◽  
pp. 263-272
Author(s):  
Cecilia Costa ◽  
Silvia Scabini ◽  
Arvind Kaimal ◽  
William Kasozi ◽  
Jessica Cusato ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Binding Protein ◽  
Retinol Binding Protein ◽  
Tubular Dysfunction ◽  
Mineral Density ◽  
Resource Limited Settings ◽  
Quantitative Ultrasonography ◽  
Resource Limited ◽  
Immunodeficiency Virus

Abstract Background Data on bone health and renal impairment in people with human immunodeficiency virus (HIV) in resource-limited settings are limited. The primary aim of this study was to investigate the potential role of calcaneal quantitative ultrasonography (QUS) in predicting bone mineral density (BMD) reduction in a population of Ugandan HIV-infected  individuals receiving long-term antiretroviral therapy; the secondary end point was to assess the prevalence of proximal tubular dysfunction and the correlation between elevated urinary retinol-binding protein–urinary creatinine ratio (uRBP/uCr) and reduced BMD. Methods We conducted a cross-sectional study at the Infectious Diseases Institute, Kampala, Uganda. We included 101 HIV-infected adults who had been receiving continuous antiretroviral therapy for ≥10 years and had undergone dual-energy x-ray absorptiometry (DXA) during the previous 12 months. All patients underwent calcaneal QUS evaluation and urine sample collection. Results DXA BMD measurements were significantly associated (P < .01) with calcaneal speed of sound, broadband ultrasound attenuation, and QUS index. Forty-seven individuals (47%) had abnormal uRBP/uCr values. A significant inverse correlation was observed between uRBP/uCr and DXA T scores (lumbar [P = .03], femoral neck [P < .001], and total hip [P = .002]). Conclusions Calcaneal QUS results showed a moderate correlation with DXA outputs. The identified high prevalence of subclinical tubular impairment also highlights the importance of expanding access to tenofovir disoproxil fumarate–sparing regimens in resource-limited settings.

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