What is AIDS in the Amazon and the Guianas in the 90-90-90 era?

IntroductionIn the past decade, new diagnostic methods and strategies have appeared, HIV testing efforts and the generalization of antiretroviral therapy may have influenced the number of opportunistic diagnoses and mortality of HIV-infected patients. To test this hypothesis we compiled data on the top opportunistic infections and causes of early death in the HIV cohort of French Guiana.MethodsHIV-infected persons followed in Cayenne, Kourou, and Saint Laurent du Maroni hospitals from 2010 to 2019 were studied. The annual incidence of different opportunistic infections and annual deaths were compiled. For patients with opportunistic infections we calculated the proportion of early deaths.ResultsAt the time of analysis, among 2 459 patients, (treated and untreated) 90% had a viral load <400 copies, 91% of the patients in the cohort were on antiretroviral treatment, and 94.2% of patients on treatment for over 6 months had undetectable viral loads. Only 9% of patients had CD4 counts under 200 per mm3. Disseminated histoplasmosis clearly remained the most frequent (128 cases) opportunistic infection among HIV-infected persons followed by cerebral toxoplasmosis (63 cases) and esophageal candidiasis (41 cases). Cryptococcal meningitis was ranked 5th most frequent opportunistic infection as was tuberculosis (31 cases). The trend for a sharp decline in early deaths continued (3.9% of patients).ConclusionsDespite the successes of antiretrovirals, patients presenting with advanced HIV are still common and they are still at risk of dying. Improved diagnosis, and notably systematic screening with appropriate tools are still important areas of potential progress.Author summaryIn the past decade, new diagnostic methods and strategies have appeared, HIV testing efforts and the generalization of antiretroviral therapy may have influenced the number of opportunistic diagnoses and mortality of HIV-infected patients. To test this hypothesis we compiled data on the top opportunistic infections and causes of early death in the HIV cohort of French Guiana. HIV-infected persons followed in Cayenne, Kourou, and Saint Laurent du Maroni hospitals from 2010 to 2019 were studied. The annual number of different opportunistic infections and annual deaths were compiled. For patients with opportunistic infections we calculated the proportion of early deaths. At the time of analysis, most patients were virologically controlled and had restored immunity. However, histoplasmosis clearly remained the most frequent (128 cases) opportunistic infection among HIV-infected persons followed by cerebral toxoplasmosis (63 cases) and esophageal candidiasis (41 cases). Cryptococcal meningitis was ranked 5th most frequent opportunistic infection as was tuberculosis (31 cases). The trend for a sharp decline in early deaths continued (3.9% of patients). Despite the successes of antiretroviral therapy, patients presenting with advanced HIV are still common and they are still at risk of dying. Improved diagnosis, and notably systematic screening with appropriate tools are still important areas of potential progress.

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The Broad Clinical Spectrum of Disseminated Histoplasmosis in HIV-Infected Patients: A 30 Years’ Experience in French Guiana

Journal of Fungi ◽

10.3390/jof5040115 ◽

2019 ◽

Vol 5 (4) ◽

pp. 115 ◽

Cited By ~ 1

Author(s):

Pierre Couppié ◽

Katarina Herceg ◽

Morgane Bourne-Watrin ◽

Vincent Thomas ◽

Denis Blanchet ◽

...

Keyword(s):

French Guiana ◽

Histoplasma Capsulatum ◽

Opportunistic Infections ◽

Clinical Findings ◽

Diagnostic Methods ◽

Medical Mycology ◽

Time To Initiation ◽

Level 3 ◽

Endemic Areas ◽

Biosafety Level

Histoplasmosis is a common but neglected AIDS-defining condition in endemic areas for Histoplasma capsulatum. At the advanced stage of HIV infection, the broad spectrum of clinical features may mimic other frequent opportunistic infections such as tuberculosis and makes it difficult for clinicians to diagnose histoplasmosis in a timely manner. Diagnosis of histoplasmosis is difficult and relies on a high index of clinical suspicion along with access to medical mycology facilities with the capacity to implement conventional diagnostic methods (direct examination and culture) in a biosafety level 3 laboratory as well as indirect diagnostic methods (molecular biology, antibody, and antigen detection tools in tissue and body fluids). Time to initiation of effective antifungals has an impact on the patient’s prognosis. The initiation of empirical antifungal treatment should be considered in endemic areas for Histoplasma capsulatum and HIV. Here, we report on 30 years of experience in managing HIV-associated histoplasmosis based on a synthesis of clinical findings in French Guiana with considerations regarding the difficulties in determining its differential diagnosis with other opportunistic infections.

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Nutritional Status of HIV Clients Receiving HAART: Its Implication on Occurrence of Opportunistic Infection

The Open Public Health Journal ◽

10.2174/1874944501710010208 ◽

2017 ◽

Vol 10 (1) ◽

pp. 208-214 ◽

Cited By ~ 3

Author(s):

Sadikalmahdi Hussen ◽

Tefera Belachew ◽

Nezif Hussein

Keyword(s):

Antiretroviral Therapy ◽

Nutritional Status ◽

Opportunistic Infection ◽

Opportunistic Infections ◽

Proportional Hazard ◽

Highly Active ◽

Medical Chart Review ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Specialized Hospital

Purposes:We aimed to assess the effects of nutritional status on occurrences of opportunistic infection in HIV/AIDS patients using antiretroviral therapy at Jimma University Specialized Hospital.Methods:We conducted a retrospective study on 340 adults who were taking antiretroviral therapy and the patients were followed for 2 years after they commence treatment. Medical Chart review was done from January 30 to February 28, 2014. SPSS for windows version 21 was used to analyze the data. The data was analyzed by SPSS for windows version 21.Time to occurrence of opportunistic infection was estimated by Kaplan-Meier analysis and Cox-proportional Hazard model was used to identify predictors of opportunistic infections.Results:Eighty three [24.4%] patients developed opportunistic infection after initiation of highly active anti-retroviral therapy. Fifty five [66.3%] patients were from malnourished group. Malnutrition, Stavudine based regimen, Zidovudine based regimen and taking isoniazid prophylaxis were associated with greater hazard of developing opportunistic infections.Conclusions:Malnutrition was significant predictor of opportunistic infections. Malnourished patients were associated with high risk and early development of opportunistic infections.

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Comparison of Disseminated Histoplasmosis with and without Cutaneo-Mucous Lesions in Persons Living with HIV in French Guiana

Journal of Fungi ◽

10.3390/jof6030133 ◽

2020 ◽

Vol 6 (3) ◽

pp. 133

Author(s):

Sophie Morote ◽

Mathieu Nacher ◽

Romain Blaizot ◽

Balthazar Ntab ◽

Denis Blanchet ◽

...

Keyword(s):

French Guiana ◽

Opportunistic Infections ◽

Significant Risk ◽

Early Death ◽

Fungal Culture ◽

Direct Examination ◽

Disseminated Histoplasmosis ◽

Persons Living With Hiv ◽

Living With Hiv ◽

Incident Cases

Introduction: Histoplasmosis is the main opportunistic infection and cause of death in HIV-infected persons living with HIV in French Guiana and probably in most of Latin America. The objective of the present study was to compare cutaneomucous histoplasmosis to non-cutaneomucous histoplasmosis in French Guiana. Methods: Between 1981 and 2014 AIDS-related disseminated histoplasmosis patients followed in the three hospitals of French Guiana were retrospectively studied. Only proven incident cases of histoplasmosis, either by pathology and/or mycological analysis, were considered. Mucocutaneous histoplasmosis was ascertained by a positive mucosal or cutaneous biopsy. Results: Thirty-one patients had mucocutaneous lesions, and 318 had no mucocutaneous lesions. Patients with cutaneomucous lesions were more likely to have had prior opportunistic infections (35.5%) than those who did not have cutaneomucous lesions (19.5%). They were more likely to be very severely immunocompromised (CD4 count < 50) (90.3% versus 62.8%) and less likely to have digestive signs (32.3% versus 74.1%) and superficial adenopathies (29% versus 50.2%) than those without cutaneomucous lesions. In terms of simple biological examinations, patients with cutaneomucous lesions had fewer signs of cholestasis. The diagnosis was significantly more likely to be performed by direct examination and pathology in those with cutaneomucous lesions than in those without such lesions. On the contrary, patients with cutaneomucous lesions were less likely to be diagnosed by fungal culture than those without cutaneomucous lesions. There was a greater but non-significant risk of early death in those with cutaneomucous lesions relative to those without (OR = 2.28 (95%CI = 0.83–5.7), p = 0.056. Conclusions: Mucocutaneous forms were associated with more profound immunosuppression and perhaps risk of early death. They are easily accessible for diagnosis.

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Immune Reconstitution Inflammatory Syndrome (IRIS)

Fundamentals of HIV Medicine 2019 ◽

10.1093/med/9780190942496.003.0048 ◽

2019 ◽

pp. 513-518

Author(s):

Dagan Coppock ◽

William R. Short

Keyword(s):

Antiretroviral Therapy ◽

Opportunistic Infection ◽

Immune Reconstitution Inflammatory Syndrome ◽

Immune Reconstitution ◽

Opportunistic Infections ◽

Infection Treatment ◽

Management Approaches ◽

Inflammatory Syndrome

Upon completion of this chapter, the reader should be able to • Understand the epidemiology of IRIS and its associated opportunistic infections. • Recognize the timing considerations regarding opportunistic infection treatment and antiretroviral therapy intiation as related to the risk for IRIS. • Understand the management approaches to IRIS, based upon its presentation and the underlying opportunistic infection....

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HPV-associated cervical diseases: screening, methods of examination, principles of treatment

GYNECOLOGY ◽

10.26442/20795696.2019.3.190595 ◽

2019 ◽

Vol 21 (3) ◽

pp. 6-8

Author(s):

Vera N Prilepskaya

Keyword(s):

Cervical Cancer ◽

Human Papillomavirus ◽

Cancer Prevention ◽

Mortality Rates ◽

Diagnostic Methods ◽

Screening Methods ◽

The Past ◽

Associated Diseases ◽

Principles Of Treatment ◽

Cervical Diseases

This article presents information about modern principles of diagnosis and treatment of HPV-associated diseases. Behind cervical cancer morbidity and mortality rates over the past 10 years increase significantly. Examination and observation of patients with human papillomavirus persistence of highly oncogenic types is important a link in cancer prevention. The article presents diagnostic methods, treatment of cervical diseases, as well as the possibility of pharmacotherapy in HPV-associated diseases.

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Dukungan sosial dan kualitas hidup orang dengan HIV/AIDS

Berita Kedokteran Masyarakat ◽

10.22146/bkm.12563 ◽

2017 ◽

Vol 33 (3) ◽

pp. 147

Author(s):

Mardia Mardia ◽

Riris Andono Ahmad ◽

Bambang Sigit Riyanto

Keyword(s):

Quality Of Life ◽

Social Support ◽

Antiretroviral Therapy ◽

Social Life ◽

Opportunistic Infections ◽

People Living With Hiv ◽

Hiv Diagnosis ◽

Criteria For Diagnosis ◽

Hiv Aids

Purpose: This study aimed to determine the quality of life among people living with HIV/AIDS based on the criteria for diagnosis and other factors.Methods: This study was conducted in the VCT clinic hospital of Dr. Moewardi. The population was HIV-positive patients with antiretroviral therapy. Data collection conducted through medical records and interview to patients. Results: Out of a total of 89 respondents, 66.29% were males and 71.91% were aged between 26-45 years. We found significant correlations for diagnosis of HIV/AIDS, opportunistic infections, time since HIV diagnosis, duration of ARV therapy, social support, modes of transport, sex, age, and marital status with the quality of life. Multivariate analysis obtained by each variable showed the strongest association with the quality of life was time since diagnosis, social support and duration of ARV therapy. Conclusion: The quality of life was better for those who have been diagnosed with HIV/AIDS ≥ 32 months, with social support, and who have been undergoing antiretroviral therapy ≥ 29 months. Improved counseling in the early days of ARV therapy is necessary to always maintain the treatment and provide support for their social life.

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Human immunodeficiency virus infection with multiple opportunistic infections: lessons learnt from a non-adherent patient

Oxford Medical Case Reports ◽

10.1093/omcr/omaa147 ◽

2021 ◽

Vol 2021 (3) ◽

Author(s):

Manish Soneja ◽

Anivita Aggarwal ◽

Parul Kodan ◽

Nitin Gupta

Keyword(s):

Human Immunodeficiency Virus ◽

Antiretroviral Therapy ◽

Virus Infection ◽

Human Immunodeficiency Virus Infection ◽

Cytomegalovirus Infection ◽

Opportunistic Infections ◽

Pneumocystis Carinii ◽

Adherent Patient ◽

Immunodeficiency Virus ◽

Adherence Counselling

Abstract We report a case of advanced human immunodeficiency virus (HIV) infection with multiple opportunistic infections (Pneumocystis carinii pneumonia, cryptosporidiosis, oesophagal candidiasis and cytomegalovirus infection). The patient was presumed to be adherent on antiretroviral therapy (ART) and was initiated on respective treatments for the opportunistic infections but continued to deteriorate. On further reviewing, he was found to be poorly adherent to ART and was advised enhanced adherence counselling after which his condition improved. We report this case to emphasize the importance of adherence to ART medications in the management of patients with HIV.

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