scholarly journals Incidence and Predictors of Serological Treatment Response in Early and Late Syphilis Among People Living With HIV

2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Vincenzo Spagnuolo ◽  
Andrea Poli ◽  
Laura Galli ◽  
Silvia Nozza ◽  
Simona Bossolasco ◽  
...  
Keyword(s):  
Treatment Response ◽  
Recurrent Events ◽  
Secondary Syphilis ◽  
People Living With Hiv ◽  
Serological Response ◽  
Cd4 Cell Count ◽  
Early Syphilis ◽  
Living With Hiv ◽  
Cd4 Cell ◽  
Late Syphilis

Abstract Background Few studies have investigated predictors of serological response to syphilis treatment in people living with HIV (PLWH). Methods This was a retrospective, longitudinal study on PLWH who were diagnosed with and treated for syphilis who had an assessable serological response between January 2004 and June 2016. Serological treatment response (TR) was defined as a ≥4-fold decline in rapid plasma reagin (RPR) titers or a reversion to nonreactive (if RPR ≤1:4 at diagnosis) 12 months after treatment for early syphilis and 24 months after treatment for late syphilis. Factors associated with a TR were assessed with multivariate Cox proportional hazard models for recurrent events. Results A total of 829 episodes of syphilis (686 early, 143 late) in 564 patients were recorded. TR was observed in 732 (88%) syphilis episodes. The proportion of TR differed between early and late syphilis (89% vs 83%, respectively; P = .045). For early syphilis, TR was associated with a higher nadir CD4+ cell count (adjusted hazard ratio [AHR], 1.06; P = .029), an RPR titer >1:32 at diagnosis (AHR, 1.26; P = .009), secondary syphilis (AHR, 1.29; P = .008), and cases of syphilis diagnosed in more recent calendar years (AHR, 1.36; P < .0001). In late syphilis, TR was more likely to occur for first infections (AHR, 1.80; P = .027), for episodes that occurred in more recent years (AHR, 1.62; P = .007), and for RPR titers >1:32 at diagnosis (AHR, 2.04; P = .002). TR was not associated with the type of treatment regimen in early and late syphilis. Conclusions Higher RPR titers at diagnosis and a diagnosis of syphilis that was made in more recent years were associated with TR in early and late syphilis.

scholarly journals The THE SPECTRUM OF OPPORTUNISTIC INFECTIONS AND ASSOCIATED FACTORS AMONG PEOPLE LIVING WITH HIV/AIDS ON HIGHLY ACTIVE ANTI-RETROVIRAL THERAPY AT MERPATI CLINIC, BALI, INDONESIA: A RETROSPECTIVE STUDY

2020 ◽  
pp. 68-71
Author(s):  
NOVIANA JOENPUTRI ◽  
KETUT SURYANA
Keyword(s):  
Retrospective Study ◽  
Marital Status ◽  
Cell Count ◽  
Associated Factors ◽  
Opportunistic Infections ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Highly Active ◽  
Living With Hiv ◽  
Cd4 Cell

Objective: Infections contributed to higher morbidity and mortality in people living with HIV/AIDS (PLWHA) in both developed and developing countries. This study aimed to describe the spectrum of opportunistic infections (OIs) and associated factors among PLWHA on highly active antiretroviral therapy (HAART) at Merpati Clinic, Wangaya Regional General Hospital in Denpasar, Bali. Methods: This was a retrospective study. All of PLWHA, who still receiving HAART at Merpati Clinic from January 2018 to January 2020, who met inclusion and exclusion criteria, were included as subjects in this study. All data were collected through a review of the complete medical record of patients. Results: The prevalence of OIs in this study was 43.4%. Most PLWHA who experienced OIs were male (68.8%), age ≤40 y old with a median of age 36 y old, educational status senior high school (57.7%), married (62.1%), employed (89.7%), CD4 cell count ≥ 200 cells/µl (67.6%) and transmission route of HIV non-Intravenous (IV) drug user (99.2%). Sex, age, marital status, and CD4 cell count were significantly associated with OIs, p=0.000, p=0.005, p=0.005, and p=0.000, respectively. Conclusion: The commonest OI in this study was pulmonary tuberculosis. The presence of OIs was associated with sex, age of HIV diagnosis, marital status, and CD4 cell count. With the knowledge of OIs spectrum, clinicians are expected to be able to prevent, diagnose and treat OIs promptly to decrease the morbidity and mortality caused by OIs efficiently.

scholarly journals Validity of hemoglobin A1c for diagnosing diabetes among people with and without HIV in Uganda

2019 ◽  
Vol 30 (5) ◽  
pp. 479-485
Author(s):  
James Muchira ◽  
Eileen Stuart-Shor ◽  
Jen Manne-Goehler ◽  
Janet Lo ◽  
Alexander C Tsai ◽  
...  
Keyword(s):  
Hemoglobin A1c ◽  
Fasting Blood Glucose ◽  
High Specificity ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Sub Saharan ◽  
And Gender ◽  
Living With Hiv ◽  
Cd4 Cell

Sub-Saharan Africa (SSA) is facing a growing co-epidemic of chronic HIV infection and diabetes. Hemoglobin A1c (A1c) may underestimate glycemia among people living with HIV (PLWH). We estimated the validity of A1c to diagnose diabetes among PLWH and HIV-uninfected persons in rural Uganda. Data were derived from a cohort of PLWH and age- and gender-matched HIV-uninfected comparators. We compared A1c to fasting blood glucose (FBG) using Pearson correlations, regression models, and estimated the sensitivity and specificity of A1c for detecting diabetes with FBG ≥126 mg/dL as reference standard. Approximately half (48%) of the 212 participants were female, mean age of 51.7 years (SD = 7.0) at enrollment. All PLWH (n = 118) were on antiretroviral therapy for a median of 7.5 years with mean CD4 cell count of 442 cells/µL. Mean FBG (89.7 mg/dL) and A1c (5.6%) were not different between PLWH and HIV-uninfected ( P > 0.50) groups, but the HIV-uninfected group had a higher prevalence of A1c >5.7% (33% vs. 20%, P = 0.024). We found a relatively strong correlation between A1c and FBG (r = 0.67). An A1c ≥6.5% had a poor sensitivity (46%, 95% CI 26–67%) but high specificity (98%, 95% CI 96–99%) for detecting diabetes. More work is needed to define an optimal A1c for screening diabetes in SSA.

scholarly journals CD4+ cell count stratification to guide tuberculosis preventive therapy for people living with HIV

AIDS ◽  
2020 ◽  
Vol 34 (1) ◽  
pp. 139-147 ◽  
Author(s):  
Lelia H. Chaisson ◽  
Valeria Saraceni ◽  
Silvia Cohn ◽  
Dena Seabrook ◽  
Solange C. Cavalcante ◽  
...  
Keyword(s):  
Cell Count ◽  
Preventive Therapy ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Living With Hiv ◽  
Cd4 Cell

scholarly journals Human cytomegalovirus infection, viraemia and retinitis among people living with HIV/AIDS in Kano, North-Western Nigeria

2021 ◽  
Vol 9 (8) ◽  
pp. 2191
Author(s):  
Chinagozi P. Edwin ◽  
Sadiq Hassan ◽  
Philips I. Ebisike ◽  
Saudat G. Habib ◽  
Taiwo G. Amole ◽  
...  
Keyword(s):  
Human Cytomegalovirus ◽  
Hcmv Infection ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
People Living With Hiv ◽  
Cd4 Cells ◽  
Cross Sectional ◽  
Cd4 Cell Count ◽  
Living With Hiv ◽  
Cd4 Cell

Background: Human cytomegalovirus (HCMV) is a leading cause of opportunistic infection in HIV-infected patients. HCMV viraemia is an active infection marker and prelude to end-organ diseases (EODs), such as retinitis. The aim of the study was to assess the burden and associated factors of HCMV infection, viraemia and retinitis among HIV-infected patients in Nigeria.Methods: Comparative cross-sectional study of 160 HIV-infected adults, comprising 80 participants in each of <100/mm3 and ≥100 cells/mm3 CD4+ cell count groups, who attended HIV clinic at a tertiary hospital located in a major Nigerian city.  A questionnaire was used to collect data from eligible consenting participants and their case files. Sera from all participants were tested for anti-HCMV IgG using ELISA method, and plasma of seropositive participants were subjected to PCR for HCMV viraemia. Participants whose samples were HCMV viraemic were examined for HCMV retinitis using indirect ophthalmoscopy. Data was analyzed using Minitab vs 14.1.1PP.Results: All 160 participants tested positive for anti-HCMV IgG. HCMV viraemia was 14.4% (23 of 160) generally, but comparatively more among <100 CD4 cells/mm3 group (18.8%; 15 of 80) than in ≥100 cells/mm3 patient group (10%; 8 of 80). Only HCMV viraemic patients in <100 CD4 cells/mm3 group (20%; 3 of 15) were diagnosed with HCMV retinitis. WHO stage was associated with HCMV viraemia (χ2= 7.79, p=0.05) and HCMV retinitis (χ2= 4.60, p=0.03). The only predictor of HCMV retinitis was WHO staging I and II [aOR = 0.04, 95%CI (0.01- 0.52)].  Conclusions: Evidence of previous and active HCMV infection is prevalent among PLWHA in Nigeria with WHO staging being associated and a predictor of HCMV viraemia and retinitis, respectively.

Progressive phasing out of baseline CD4 cell count testing for people living with HIV in Kinshasa, DRC

AIDS ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Nadine Mayasi Ngongo ◽  
Hippolyte Situakibanza Nani-Tuma ◽  
Marcel Mbula Mambimbi ◽  
Murielle Longokolo Mashi ◽  
Ben Bepouka Izizag ◽  
...  
Keyword(s):  
Cell Count ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Living With Hiv ◽  
Cd4 Cell

The effect of probiotics on CD4 counts among people living with HIV: a systematic review

2016 ◽  
Vol 7 (3) ◽  
pp. 345-351 ◽  
Author(s):  
H. Miller ◽  
R. Ferris ◽  
B.R. Phelps
Keyword(s):  
Health Benefit ◽  
Cd4 Count ◽  
People Living With Hiv ◽  
Daily Consumption ◽  
Ongoing Research ◽  
Cd4 Cell Count ◽  
Search Terms ◽  
Immunodeficiency Virus ◽  
Living With Hiv ◽  
Cd4 Cell

Probiotics are defined by the WHO as ‘live microorganisms which when administered in adequate amounts confer a health benefit on the host’. Ongoing research has shown probiotics provide benefits to humans, including protection and restoration of the gastrointestinal and other mucosal tracts. As human immunodeficiency virus (HIV) activates gut-associated lymphoid tissue (GALT), several studies have investigated the effect of probiotics on CD4 cell count and related outcomes among those living with HIV. These studies are summarised here. Manuscripts were identified using the search terms ‘probiotics’, ‘synbiotics’, ‘HIV’, and ‘CD4’, and were reviewed for relevance and inclusion of CD4 count as an immunologic endpoint. Bibliographies of relevant manuscripts were also reviewed for additional studies matching inclusion and exclusion criteria. The search yielded 91 results; 13 included relevant outcomes. Seven of these studies produced beneficial CD4 outcomes, while the remaining 6 reported on insignificant beneficial or negative CD4 outcomes. The studies summarised here collectively suggest that daily consumption of probiotics over a prolonged period of time may improve CD4 count in people living with HIV.

scholarly journals A comparative study: long and short term effect of a nutrition sensitive approach to delay the progression of HIV to AIDS among people living with HIV (PLWH) in Nigeria

2016 ◽  
Vol 6 (2) ◽  
pp. 79
Author(s):  
Abraham Mainaji Amlogu ◽  
Sundus Tewfik ◽  
Charles Wambebe ◽  
Ihab Tewfik
Keyword(s):  
Cell Count ◽  
Negative Impact ◽  
Scale Up ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Biochemical Indices ◽  
Nutrition Sensitive ◽  
Living With Hiv ◽  
Cd4 Cell

ABSTRACTBackground: Malnutrition has a negative impact on optimal immune function, thus increasing susceptibility to morbidity and mortality among HIV positive patients. Evidence indicates that the prevalence of macro and micronutrient deficiencies (particularly magnesium, selenium, zinc, and vitamin C) has a negative impact on optimal immune function, through the progressive depletion of CD4 T-lymphocyte cells, which thereby increases susceptibility to morbidity and mortality among PLWH. Objective: To assess the effectiveness of a nutrition sensitive intervention to delay the progression of human immune-deficiency virus (HIV) to AIDS among people living with HIV in Abuja, Nigeria.Methods: A randomised control trial was carried out on 400 PLWH (adult, male and female of different religious background) in Abuja, Nigeria between January and December, 2012. Out of these 400 participants, 100 were randomly selected for the six months pilot study (January to June, 2012). The participants in the pilot study overlapped to form part of the scale-up participants (n 400) monitored from June to December, 2012. The comparative effect of daily consumed 354.92 kcal/d optimised meal for six and twelve months was ascertained through the nutritional status and biochemical indices of the study participants (n 100 pilot and n 400 scale-up interventions) who were/were not taking the intervention meal. The meal consisted of: Glycine max 50g; Pennisetum americanum 20g; Moringa oleifera 15g; Daucus carota spp.sativa 15g.Results: At the end of six months of the scale-up intervention, mean CD4 cell count (cell/mm3) for Pre-ART and ART Test groups increased by 6.31% and 12.12% respectively. Mean mid upper arm circumference (MUAC) for Pre-ART and ART Test groups increased by 2.72% and 2.52% within the same period (n 400). Comparatively, participants who overlapped from pilot to scale-up intervention (Long term use, n 100) were assessed for 12 months. Mean CD4 cell count (cell/mm3) for Pre-ART and ART Test groups increased by 2.21% and 12.14%. Mean MUAC for Pre-ART and ART Test groups increased by 2.08% and 3.95% respectively. Moreover, Student’s t-test analysis suggests a strong association between the intervention meal,  MUAC and CD4 count on long term use of optimised meal in the group of participants on antiretroviral therapy (ART) (P<0.05). Conclusion: Although the achieved results take the form of specific technology, it suggests that a prolong consumption of the intervention meal will be suitable to sustain the gained improvements in the anthropometric and biochemical indices of PLWHIV in Nigeria. Keywords: HIV; AIDS; Nutrition-sensitive approach; CD4 cell count; Macro and Micronutrients; ART; Tailored Functional Recipe - TFR.

scholarly journals Antiretroviral treatment, prevention of transmission, and modeling the HIV epidemic: why the ART efficacy and effectiveness parameter matters

2017 ◽  
Author(s):  
Reuben Granich ◽  
Somya Gupta ◽  
Matt Wollmers ◽  
Brian Williams
Keyword(s):  
Viral Suppression ◽  
Hiv Infections ◽  
Population Based ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Art Initiation ◽  
Effectiveness Model ◽  
Prevention Interventions ◽  
Living With Hiv ◽  
Cd4 Cell

AbstractIntroductionHIV remains a major public health threat with over 75 million deaths, 2 million annual infections and over 1 million HIV-associated TB cases a year. Population-based studies suggest a marked decline in incidence, prevalence and deaths, mostly likely due to treatment expansion, in countries in East and Southern Africa. This calls into question the ART efficacy, effectiveness and coverage parameters used by many modelers to project HIV incidence and prevalence.MethodsFor 2015 and 2016 we reviewed global and national mathematical modeling studies regarding ART impact (with or without other HIV prevention interventions) and/or 90-90-90 on either new HIV infections or investment or both. We reviewed these HIV epidemiologic and costing models for their structure and parameterization around ART; we directly compared two models to illustrate differences in outcome.ResultsThe nine models published in 2015 or 2016 included parameters for ART effectiveness ranging from 20% to 86% for ART effectiveness. Model 1 limits eligibility for ART initiation to 80% coverage of people living with HIV and with a CD4+ cell count below 350 cells/μL, 70% retention, and ART reduces transmission by 80%, with a derived ART effectiveness of 20%. Model 2 assumes 90-90-90 by 2020 (i.e., 73% viral suppression of estimated PLHIV), ART reduces transmission by 96% in those on ART and virally suppressed, and by 88% in those on ART but not virally suppressed with a derived effectiveness of 86% and consequent decline towards ending AIDS and HIV elimination. ART parameter selection and assumptions dominate and low ART effectiveness translates into lower impact.DiscussionUsing more realistic parameters for ART effectiveness suggests that through expanding access and supporting sustainable viral suppression it will be possible to significantly reduce transmission and eliminate HIV in many settings.

scholarly journals Diagnostic Issues of Asymptomatic Neurosyphilis in HIV-Positive Patients: A Retrospective Study

2019 ◽  
Vol 9 (10) ◽  
pp. 278 ◽  
Author(s):  
Giancarlo Ceccarelli ◽  
Cristian Borrazzo ◽  
Alessandro Lazzaro ◽  
Giuseppe Pietro Innocenti ◽  
Luigi Celani ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Medical Center ◽  
Venereal Disease ◽  
Laboratory Data ◽  
Simultaneous Occurrence ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
European Guidelines ◽  
Cd4 Cell ◽  
Late Syphilis

Introduction: Asymptomatic neurosyphilis (ANS) is a disease that is difficult to diagnose in people living with HIV (PLWH). The European Guidelines on the management of syphilis suggest that ANS should be suspected and thus the lumbar puncture (LP) should be performed in cases of (1) late syphilis (acquired >2 years previously), (2) CD4+ cells ≤ 350/mm3 and/or a serum Venereal Disease Research Laboratory/Rapid Plasma Reagin (VDRL/RPR) title > 1:32, (3) “serological failure” after syphilis therapy, and (4) the use of alternative treatment for syphilis. In the present study, we aimed to verify the accuracy of the guideline’s criteria for the indication of LP in the suspicion of ANS in a cohort of PLWH. Methods: This retrospective study was carried out in a cohort of PLWH referred at a single medical center of a large academic hospital in Italy. Clinical and laboratory data of patients diagnosed with late syphilis were extracted from the cohort and analyzed. The European Guidelines of syphilis were adopted for patient management. Results: Out of a cohort of 713 PLWH, only 51 (7%) had a diagnosis of late syphilis and were therefore included in the study. Thirty-one subjects (61%) met one or more diagnostic criteria to perform LP: 39% (12/31) of patients undergoing LP had a diagnosis of ANS. The accuracy of predictive criteria for ANS, suggested by the guidelines, was 62% for RPR > 1:32 and 74% for CD4+ ≤ 350 cc/µL. The simultaneous occurrence of both criteria (RPR > 1:32 plus CD4+ ≤ 350 cc/µL) achieved a diagnostic accuracy of 59%. Interestingly, only 17% of patients who underwent LP for serological failure were eventually diagnosed positive for ANS. Conclusion: Asymptomatic neurosyphilis represents a challenging, but not uncommon, diagnosis. Therefore, it requires a careful investigation. Low CD4+ cell count and RPR > 1:32 remain excellent predictors of neurosyphilis, but have become the only acceptable predictors of ANS in PLWH. “Serologic failure” should be regarded with caution as a criterion to perform LP in order to investigate possible ANS in HIV-syphilis coinfected patients asymptomatic for neurological disorders. The retrospective nature of this single-site study may represent a limit to the interpretation of the data. Thus, larger clinical studies on the topic are warranted.

scholarly journals The HIV treatment cascade in people living with HIV in Iran in 2014: Mixed-method study to measure losses and reasons

2019 ◽  
Vol 30 (13) ◽  
pp. 1257-1264 ◽  
Author(s):  
Nima Ghalehkhani ◽  
Behnam Farhoudi ◽  
Mohammad Mehdi Gouya ◽  
Hamid Sharifi ◽  
SeyedAhmad SeyedAlinaghi ◽  
...  
Keyword(s):  
Cell Count ◽  
Hiv Treatment ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Treatment Cascade ◽  
Cascade Analysis ◽  
Hiv Treatment Cascade ◽  
Living With Hiv ◽  
Cd4 Cell

The study assessed the HIV treatment cascade of people living with HIV (PLWH) in Iran and the reasons for gaps in HIV services in 2014. We did the cascade analysis using the WHO HIV test–treat–retain cascade analysis tool (2014). To measure the gaps, we checked the records for all PLWH reported to the national HIV surveillance till September 2014 to define how many were alive, linked to HIV care, assessed for CD4 cell count, started antiretroviral therapy (ART), and reported to be alive up to five years after ART. To assess the reasons for gaps in the cascade, we ran desk review, four focus group discussions and 51 in-depth interviews with key informants including PLWH. Spectrum model estimated 75,700 PLWH in Iran, of whom only 22,647 people (%30) were diagnosed. Of those who were diagnosed with HIV, 16,266 people (%72) had enrolled in HIV care. About 13% of all PLWH were retained in HIV care and only 9% (6745 people) had ever been tested for CD4 cell count. Only 8% (6018 people) of all PLWH had received ART by September 2014. We found the biggest gap in the HIV treatment cascade to be HIV diagnosis as only 30% of PLWH have been diagnosed. Innovative strategies to improve HIV testing, particularly those that work best for key populations, are critical to reach the 90–90-90 targets.

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