Primary chest wall Burkitt lymphoma in a case of HIV infection with immune reconstitution

Burkitt lymphoma (BL) develops at an increased frequency in patients with HIV irrespective of the CD4 count. Lymph nodes and gastrointestinal tract are common sites of involvement by BL; however, primary chest wall BL is rare. A 52-year-old man on highly active antiretroviral therapy (HAART) for HIV with a CD4 count of 0.204 x 109 cells/L presented with a 3-month history of enlarging chest wall mass. PET-CT scan imaging showed a bulky mass involving the musculoskeletal planes of left chest wall with the involvement of underlying pleura. Biopsy with immunohistochemistry confirmed BL. Patient received EPOCH-R (infusional etoposide, vincristine, and doxorubicin with prednisone, cyclophosphamide and rituximab) regime for six cycles along with HAART, attained complete remission (CR) and remains free of BL at 5 years. BL should be considered in the differential diagnosis of soft tissue masses in HIV-infected patients irrespective of their CD4 count.

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Pneumocystis jirovecii Pneumonia in a HIV-Infected Patient with a CD4 Count Greater Than 400 Cells/μL and Atovaquone Prophylaxis

Case Reports in Infectious Diseases ◽

10.1155/2020/8532780 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Abigayle Sullivan ◽

Theresa Lanham ◽

Ronald Krol ◽

Shilla Zachariah

Keyword(s):

Highly Active Antiretroviral Therapy ◽

Lung Biopsy ◽

Cd4 Count ◽

Pneumocystis Jirovecii ◽

Pneumocystis Jirovecii Pneumonia ◽

Silver Stain ◽

Highly Active ◽

History Of ◽

Methenamine Silver ◽

Methenamine Silver Stain

We describe a rare case of Pneumocystis jirovecii pneumonia (PCP) in a heterosexual man with a pertinent medical history of well-controlled human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) and PCP prophylaxis with atovaquone. The patient presented with recurrent shortness of breath, worsening malaise, and fever, following treatment for hypersensitivity pneumonitis one month prior, including a twenty-four-day course of 40 milligrams daily glucocorticoid with taper. However, transbronchial biopsies, lavage, and cytology from prior admission were inconclusive. The patient refused video-assisted thoracic surgery (VATS) at that time. Upon readmission, bronchoscopy with right VATS and lung biopsy were performed. Grocott’s methenamine silver stain of right lung biopsy was positive for Pneumocystis jirovecii. This case is a rare example of PCP in a patient with a normal CD4 count (>487 cells/μL) and a low viral load (<20 copies/mL) despite PCP prophylactic antibiotics in the setting of recent iatrogenic immunosuppression.

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Hematological Profile of HIV-Infected Patients on First-Line Highly Active Antiretroviral Therapy and Its Correlation With CD4 Count

International Journal of Recent Surgical and Medical Sciences ◽

10.1055/s-0041-1730257 ◽

2021 ◽

Author(s):

John Jospeh Diamond Princy ◽

Kshetrimayum Birendra Singh ◽

Ningthoujam Biplab ◽

Ningthoukhongjam Reema ◽

Rajesh Boini ◽

...

Keyword(s):

Platelet Count ◽

Antiretroviral Therapy ◽

Hiv Infection ◽

Highly Active Antiretroviral Therapy ◽

Cd4 Count ◽

Total Leukocyte Count ◽

Hiv Patients ◽

Positive Correlation ◽

Highly Active ◽

The Mean

Abstract Introduction Human immunodeficiency virus (HIV) infection is a state of profound immunodeficiency. Disorders of hematopoietic system are a common but often overlooked complication of HIV infection. This can manifest at any stage of the disease but more commonly in the advanced stage with low CD4 count. Anemia is the most common hematological abnormality in HIV patients and prevalence ranges from 1.3 to 95%. As HIV disease progresses, the prevalence and severity of anemia also increase. Hence, this study was undertaken to assess the hematological parameters of HIV-infected patients on highly active antiretroviral therapy (HAART) at different treatment durations with the hope to improve the HAART outcome in HIV patients and its correlation with CD4 count. Methods This prospective longitudinal study enrolled 134 HIV-infected patients admitted to or attending the OPD in the Department of Medicine or Antiretroviral Therapy (ART) Center (Center of Excellence), Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, from 2018 to 2020. Complete hemogram, CD4 count, and other related-blood investigations were studied. Results The mean age of the study population was 39.9 ± 11.04 years. Of the 134 patients, 75 (56%) were males and 59 (44%) were females. Twelve (9%) patients had a history of injecting drug use (IDU). TLE (tenofovir, lamivudine, efavirenz) regimen was started on 112 (83.6%) patients and the majority of them (69/134 [51.5%]) had a CD4 count of 200 to 499 cells/mm3, which increased significantly 6 months after HAART to 99 to 1,149 cells/mm3, with a mean of 445 ± 217 cells/mm3. There were significant improvements in hemoglobin (Hb) levels, total leukocyte count (TLC), absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) after HAART indicating a positive correlation with CD4 count (p < 0.05). Thrombocytopenia was observed higher after HAART when compared to baseline. There was a positive correlation between platelet count and CD4 count. However, the mean corpuscular volume (MCV) and erythrocyte sedimentation rate (ESR) had a negative correlation with CD4 count. Conclusion The study inferred a strong positive correlation between CD4 and Hb levels, TLC, ANC, ALC, and platelet count after HAART with improvement in these values as CD4 count increases. Specific treatment intervention based on the changes in the immunohematological profile trends can help prevent most of the adverse effects on HIV patients in our community.

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Natural History of Hyperlactataemia in Human Immunodeficiency Virus-1-infected Patients During Highly Active Antiretroviral Therapy

Scandinavian Journal of Infectious Diseases ◽

10.1080/0036554021000026992 ◽

2003 ◽

Vol 35 (1) ◽

pp. 62-66 ◽

Cited By ~ 10

Author(s):

TUAN K. HUYNH ◽

HANS R. LÜTTICHAU ◽

BIRGIT T. ROGE ◽

JAN GERSTOFT

Keyword(s):

Human Immunodeficiency Virus ◽

Antiretroviral Therapy ◽

Natural History ◽

Highly Active Antiretroviral Therapy ◽

Highly Active ◽

Immunodeficiency Virus ◽

History Of ◽

Human Immunodeficiency Virus 1

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Acquired localised lipoatrophy secondary to transgluteal drainage

BMJ Case Reports ◽

10.1136/bcr-2021-242964 ◽

2021 ◽

Vol 14 (7) ◽

pp. e242964

Author(s):

Austin Hamp ◽

Jarett Anderson ◽

Arjun Bal ◽

Nate Hansen

Keyword(s):

Highly Active Antiretroviral Therapy ◽

Subcutaneous Fat ◽

Pelvic Abscess ◽

Previous Surgery ◽

Abscess Drainage ◽

Potential Side Effect ◽

Highly Active ◽

History Of ◽

Focal Fat ◽

Made In

Acquired localised lipoatrophy is a focal loss of subcutaneous fat, which is commonly secondary to trauma, injections of medications such as antibiotics or corticosteroids, pressure, previous surgery or panniculitis. We present a case of a patient who experienced focal fat loss in the left gluteal region from a previous left transgluteal drainage of a suspected abscess. There was no medical history of corticosteroid, antibiotic injection or use of highly active antiretroviral therapy. Lipoatrophy occurring as a consequence of a deep pelvic abscess drainage has not been reported in the literature; however, based on the lack of other aetiologies, the diagnosis of acquired localised lipoatrophy secondary to a transgluteal drainage was made in this patient. The aim of this report was to present this rare cause of lipoatrophy that has not previously been described and to acknowledge lipoatrophy as a potential side effect of a deep abscess drainage.

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EFFECT OF ANTIRETROVIRAL TREATMENT REGIMENS ON LIVER ENZYMES IN HUMAN IMMUNODEFICIENCY VIRUS PATIENTS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i8.24885 ◽

2018 ◽

Vol 11 (8) ◽

pp. 95

Author(s):

Adiga Sachidananda Mn ◽

Adiga Usha S

Keyword(s):

Human Immunodeficiency Virus ◽

Highly Active Antiretroviral Therapy ◽

Liver Enzymes ◽

Cd4 Count ◽

Treatment Regimens ◽

Highly Active ◽

Significant Difference ◽

Immunodeficiency Virus ◽

Slight Elevation ◽

The Difference

Objective: Treatment of human immunodeficiency virus (HIV) with highly active antiretroviral therapy is complicated due to its effect on liver enzymes along with associated risk of opportunistic infection and its treatment. The objective of the study was to compare the effect of two zidovudine and lamivudine-based regimens on liver enzymes and to correlate them with age and CD4 count in HIV patients.Methods: In this retrospective study, patients who have received zidovudine+lamivudine+nevirapine (ZLN) or zidovudine+lamivudine+efavirenz (ZLE) at least for 1 year were included. Baseline, 6-month, and 1-year values of aspartate amino transferase (AST), alanine amino transferase (ALT), and CD4 count were collected. One-way analysis of variance and unpaired t-test were used to compare the difference in AST, ALT, and CD4 count value within basal, 6 months, and 1 year of two group and between the groups, respectively. Pearson’s correlation was used for correlation study.Results: Elevation of AST levels in patients who had received ZLN regimen at different interval was significant statistically. There was a statistically significant elevation of ALT level at 6 months. There was no significant change in AST and ALT values in patients who had received ZLE regimen. Between the two regimens, there was statistically significant difference in AST and ALT values at 6 months and 1 year. There was no correlation between age and CD4 count with liver enzymes.Conclusion: We conclude from the study that nevirapine containing zidovudine regimen showed a slight elevation in AST. The efavirenz regimen did not show a change in AST and ALT.

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Overt Lower Gastrointestinal Bleeding and Pseudotumor: A Rare Presentation of Cytomegalovirus Infection

Case Reports in Medicine ◽

10.1155/2017/9732967 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Akanksha Agrawal ◽

Deepanshu Jain ◽

Sameer Siddique

Keyword(s):

Highly Active Antiretroviral Therapy ◽

The Body ◽

Cmv Infection ◽

Rare Presentation ◽

Multiple Organs ◽

Highly Active ◽

History Of ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome

Cytomegalovirus (CMV) is a ubiquitous organism which can infect multiple organs of the body. In an immunocompromised patient, it can have a myriad of gastrointestinal manifestations. We report a case of recurrent hematochezia and concomitant pseudotumor in an AIDS (acquired immunodeficiency syndrome) patient attributable to CMV infection. A 62-year-old man with a history of AIDS, noncompliant with highly active antiretroviral therapy (HAART), presented with bright red blood per rectum. Index colonoscopy showed presence of multiple ulcers, colonic stenosis, and mass-like appearing lesion. Biopsy confirmed CMV infection and ruled out malignancy. Cessation of dual antiplatelet therapy and compliance with HAART lead to clinical cessation of bleeding and endoscopic healing of ulcers with complete resolution of colon mass on follow-up colonoscopy.

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Acute gouty arthritis as a manifestation of immune reconstitution inflammatory syndrome after initiation of antiretroviral therapy

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652012000400009 ◽

2012 ◽

Vol 54 (4) ◽

pp. 231-233 ◽

Cited By ~ 3

Author(s):

Walter de Araujo Eyer-Silva ◽

Maria Cecília da Fonseca Salgado ◽

Jorge Francisco da Cunha Pinto ◽

Fernando Raphael de Almeida Ferry ◽

Rogério Neves-Motta ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Immune Reconstitution Inflammatory Syndrome ◽

Highly Active Antiretroviral Therapy ◽

Immune Reconstitution ◽

Gouty Arthritis ◽

Infected Male ◽

Acute Gouty Arthritis ◽

Highly Active ◽

History Of ◽

Inflammatory Syndrome

Immune reconstitution inflammatory syndrome (IRIS) in HIV-infected subjects initiating antiretroviral therapy most commonly involves new or worsening manifestations of previously subclinical or overt infectious diseases. Reports of non-infectious IRIS are much less common but represent important diagnostic and treatment challenges. We report on a 34-year-old HIV-infected male patient with no history of gout who developed acute gouty arthritis in a single joint one month after initiating highly active antiretroviral therapy.

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Depression and suicidal ideation among HIV seropositive patients attending the special treatment clinic of the University of Calabar Teaching Hospital, Calabar, Nigeria

Calabar Journal of Health Sciences ◽

10.25259/cjhs_27_2020 ◽

2021 ◽

Vol 4 ◽

pp. 64-70

Author(s):

Elvis Mbu Bisong ◽

Chidi John Okafor ◽

Agam Ebaji Ayuk ◽

Udeme Essien Asibong ◽

Henry Ohem Okpa

Keyword(s):

Viral Load ◽

Suicidal Ideation ◽

Highly Active Antiretroviral Therapy ◽

Cd4 Count ◽

Special Treatment ◽

Prevalence Rates ◽

Highly Active ◽

Study Participants ◽

Hiv Seropositive ◽

Hiv Aids

Objectives: The introduction of highly active antiretroviral therapy and innovations in healthcare has contributed in improving the lives of persons living with human immunodeficiency virus (HIV)/AID. Patients infected with HIV are more susceptible to develop psychiatric illnesses. Depression is common among patients suffering from chronic illness such as HIV/AIDS and can exacerbate these illnesses. Depression has been observed to be twice as common in HIV seropositive individuals than in the general population. Undiagnosed and untreated depression in patients suffering from HIV/AIDS could lead to poor adherence to medications and lower quality of life. Depression is associated with rapid HIV disease progression. The diagnosis of HIV infection may be associated with feelings of anger, denial, sadness, guilt feelings, loss of self-esteem among others. These negative feelings could lead to suicidal ideation and attempted suicide or suicide. We sought to determine the prevalence rates, sociodemographics and predictors, of depression and suicidal ideation among study participants. Material and methods: Two hundred and two adult participants who met the inclusion criteria were recruited into the study. Mini International Neuropsychiatric Interview English version 6.0.0 was employed to diagnose depression and suicidal ideation. Data were analyzed using Statistical Package for the Social Sciences version 20.0. Significant levels were set at P < 0.05. Results: This study revealed prevalence rates of 11.4% for depression and 7.9% for suicidal ideation among study participants. Majority of the participants were females in the young age group category of 30–40 years (45%) with mostly secondary education (47.8%), most had a higher CD4 count greater than 200 cells/µL (82.6%) and were mainly on zidovudine/lamivudine/nevirapine combination therapy (56.5%). Mean age, CD4 count, and viral load levels were lower in HIV patients with depression but were not statistically significant (P > 0.05). CD4 count and viral load were not significantly associated with suicidal ideation. Lower age (30–40 years) was significantly associated with suicidal ideation (P < 0.05). Suicidal ideation is a predictor of depression in the same way depression is a predictor of suicidal ideation (P < 0.05). Conclusion: Routine screening for depression and suicidal ideation especially among younger HIV/AIDS patients is recommended in the clinic setting.

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