A multi-parameter diagnostic clinical decision tree for the rapid diagnosis of tuberculosis in HIV-positive patients presenting to an emergency centre

Background: Early diagnosis is essential to reduce the morbidity and mortality of HIV-associated tuberculosis. We developed a multi-parameter clinical decision tree to facilitate rapid diagnosis of tuberculosis using point-of-care diagnostic tests in HIV-positive patients presenting to an emergency centre. Methods: A cross-sectional study was performed in a district hospital emergency centre in a high-HIV-prevalence community in South Africa. Consecutive HIV-positive adults with ≥1 WHO tuberculosis symptoms were enrolled over a 16-month period. Point-of-care ultrasound (PoCUS) and urine lateral flow lipoarabinomannan (LF-LAM) assay were done according to standardized protocols. Participants also received a chest X-ray. Reference standard was the detection of Mycobacterium tuberculosis using Xpert MTB/RIF or culture. Logistic regressions models were used to investigate the independent association between prevalent microbiologically confirmed tuberculosis and clinical and biological variables of interest. A decision tree model to predict tuberculosis was developed using the classification and regression tree algorithm. Results: There were 414 participants enrolled: 171 male, median age 36 years, median CD4 cell count 86 cells/mm3. Tuberculosis prevalence was 42% (n=172). Significant variables used to build the classification tree included ≥2 WHO symptoms, antiretroviral therapy use, LF-LAM, PoCUS independent features (pericardial effusion, ascites, intra-abdominal lymphadenopathy) and chest X-ray. LF-LAM was positioned after WHO symptoms (75% true positive rate, representing 17% of study population). Chest X-ray should be performed next if LF-LAM is negative. The presence of ≤1 PoCUS independent feature in those with ‘possible or unlikely tuberculosis’ on chest x-ray represented 47% of non-tuberculosis participants (true negative rate 83%). In a prediction tree which only included true point-of-care tests, a negative LF-LAM and the presence of ≤2 independent PoCUS features had a 71% true negative rate (representing 53% of sample). Conclusions: LF-LAM should be performed in all adults with suspected HIV-associated tuberculosis (regardless of CD4 cell count) presenting to the emergency centre.

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Pattern of Pulmonary Tuberculosis in HIV Positive Patients

International Journal of Advanced and Integrated Medical Sciences ◽

10.5005/jp-journals-10050-10017 ◽

2016 ◽

Vol 1 (2) ◽

pp. 46-48

Author(s):

Sanjay Bansal ◽

Vijayesh K Tiwari ◽

Mohammed J Khan

Keyword(s):

Pulmonary Tuberculosis ◽

Opportunistic Infection ◽

Hiv Positive ◽

Hiv Patients ◽

Cd4 Cell Count ◽

Medical College ◽

Immunodeficiency Virus ◽

Common Opportunistic Infection ◽

Chest X Ray ◽

Cd4 Cell

ABSTRACT Tuberculosis is the most common opportunistic infection and cause of mortality in patients with human immunodeficiency virus (HIV). The main aim of this study was to find out the relation, clinical profile, and outcome of pulmonary tuberculosis (PTB) in HIV patients. A total of 35 patients with HIV-PTB coinfection who visited the Rohilkhand Medical College and Hospital for 1 year were enrolled in this study. The pattern of PTB in HIV patients was studied by the help of history, symptoms, chest X-ray, tuberculin skin test, CD4 cell count, and the presence of other opportunistic infection. How to cite this article Tiwari VK, Bansal S, Kumar A, Kumar A, Khan MJ. Pattern of Pulmonary Tuberculosis in HIV Positive Patients. Int J Adv Integ Med Sci 2016;1(2):46-48.

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Efficacy of Helicobacter pylori eradication therapy among HIV positive and HIV negative individuals in Central Ethiopia and effects on CD4 cell count and haemoglobin levels

10.26226/morressier.5aeaf2d35800a00019098021 ◽

2018 ◽

Author(s):

Torsten Feldt ◽

Million Getachew Mesfun

Keyword(s):

Helicobacter Pylori ◽

Cell Count ◽

Eradication Therapy ◽

Hiv Positive ◽

Helicobacter Pylori Eradication ◽

Cd4 Cell Count ◽

Central Ethiopia ◽

Cd4 Cell ◽

Helicobacter Pylori Eradication Therapy ◽

Hiv Negative

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Homelessness among an inpatient HIV-positive cohort at a tertiary care hospital in central London

International Journal of STD & AIDS ◽

10.1177/0956462420918682 ◽

2020 ◽

Vol 31 (7) ◽

pp. 705-707

Author(s):

Venkateshwaran Sivaraj ◽

Rudiger Pittrof ◽

Olubanke Davies ◽

Ranjababu Kulasegaram

Keyword(s):

Bacterial Infections ◽

Substance Misuse ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Hiv Positive ◽

Care Hospital ◽

Hiv Viral Load ◽

Cd4 Cell Count ◽

Cell Counts ◽

Cd4 Cell

A cohort review was conducted at a central London tertiary care hospital trust on the prevalence of homelessness among human immunodeficiency virus (HIV)-positive inpatients over a year. Data were collected on the duration of inpatient stay, co-morbidities including acquired immune deficiency syndrome (AIDS)-defining illnesses, co-infections, initiation of antiretroviral therapy, CD4 cell count, HIV viral load and substance misuse. Homeless people were found to be at high risk for hepatitis C, mental health illness, substance misuse including injecting drug use, recurrent bacterial infections, AIDS-associated illnesses, lower CD4 cell counts and HIV viremia. They also had more missed HIV outpatient appointments. It was highlighted that a multidisciplinary approach in their care was necessary to address their needs and reduce the morbidity burden in this cohort.

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HIV-TUBERCULOSIS: A STUDY OF CHEST X-RAY PATTERNS IN RELATION TO CD4 COUNT

10.36106/ijsr/6300460 ◽

2021 ◽

pp. 10-12

Author(s):

Abdhesh Kumar ◽

Naveen Kumar ◽

Kumar Sourav

Keyword(s):

Pulmonary Tuberculosis ◽

Tertiary Hospital ◽

Hiv Positive ◽

Who Guidelines ◽

X Ray ◽

Ciency Virus ◽

Chest X Ray ◽

Radiological Patterns ◽

High Index Of Suspicion ◽

Ray Patterns

Background: Fight against human immunodeciency virus (HIV) is incomplete without addressing problems associated with difcult diagnosis of tuberculosis in HIV-Tuberculosis coinfected patients. Chest X-ray is a primary tool to evaluate tuberculosis in HIV. Aim: To assess and compare various radiological patterns of pulmonary tuberculosis in HIV patients and compare these patterns in relation to CD4 counts. Materials and Methods: Prospective cohort study was conducted in a tertiary hospital in J.L.N.M.C.H Bhagalpur from april 2019 to january 2021 with 200 HIV positive patients. WHO guidelines were used for diagnosis of HIV and tuberculosis. Results: 27% of the patients had sputum positive pulmonary tuberculosis, with higher incidence (33%) among CD4 less than 200 as compared to CD4 more than 200 (14%). Inltration (39%) followed by consolidation (30%), cavity (11%), and lymphadenopathy (9%) seen with CD4 less than 200. Inltration (37.5%) followed by cavity (25%) and miliary (25%) with CD4 above 200. Bilateral (68.5%) and mid and lower zones or all zone involvement more commonly seen. Conclusion: In patients with CD4 lower than 200 noncavitory inltration and consolidation predominated. Involvement of lungs was atypical; diffuse or mid and lower zone involvement was higher than classical upper lobe involvement. A high index of suspicion is necessary for the accurate and timely diagnosis of tuberculosis in HIVpositive patients.

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Human parvovirus B19 infection in HIV-positive patients

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822001000300002 ◽

2001 ◽

Vol 34 (3) ◽

pp. 239-242 ◽

Cited By ~ 6

Author(s):

Fábio S. Aguiar ◽

Daniella P. Lopes ◽

Anna Ricordi Bazin ◽

Sérgio Setúbal ◽

Bernard J. Cohen ◽

...

Keyword(s):

Neutralizing Antibodies ◽

Parvovirus B19 ◽

Blot Hybridization ◽

Epidemiological Studies ◽

Hiv Positive ◽

Dot Blot ◽

Cd4 Cell Count ◽

High Prevalence ◽

Parvovirus B19 Infection ◽

Cd4 Cell

Parvovirus B19 infects predominantly erythroid cells, leading to transient inhibition of erythropoiesis. Immunocompromised patients may be unable to produce neutralizing antibodies and may develop severe chronic anemia. Epidemiological studies done on Niterói population showed that B19 infection occurs periodically in late spring and summer. We report a study from 55 HIV infected patients attending an infectious diseases outpatient clinic in this city during a 5-month period in which B19 circulation was well documented. All patients were under anti-retroviral therapy. No anti-B19 IgM was found, but a high prevalence of IgG anti-B19 (91%) was observed. In six patients, B19 DNA was found by dot-blot hybridization techniques, but this was not confirmed by PCR. None of these 6 patients manifested anemia and only one had CD4 cell count below 200 x 10(7)/L. We conclude that persistent infection causing anemia is an infrequent finding in our HIV positive patients under drug therapy.

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Assessment of Markers of Depression and CD4 Cell Count among Adult HIV-Positive Patients on Anti-Retroviral at a Nigerian University Teaching Hospital

Research Journal of Health Sciences ◽

10.4314/rejhs.v8i4.8 ◽

2020 ◽

Vol 8 (4) ◽

pp. 283-290

Author(s):

A. Amoko ◽

P.O. Ajiboye ◽

F.A. Olagunju ◽

R.O. Shittu

Keyword(s):

Family Medicine ◽

Cell Count ◽

Teaching Hospital ◽

Cd4 Count ◽

Hiv Positive ◽

P Value ◽

People Living With Hiv ◽

Cd4 Cell Count ◽

Prevalence Of Depression ◽

Cd4 Cell

Objective: Depression is a common mental health problem among people living with HIV/AIDS (PLWHA); because low count of lymphocytes with cluster of differentiation 4 (CD4 cell count) is associated with severe symptoms of HIV infection, there are thoughts that low CD4 cells count can provoke depressive illness. This study was conducted to determine the relationship between CD4 count and depression among adult HIV positivepatients attending Family Medicine clinics at University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria.Method: A hospital based descriptive cross-sectional study was done over a period of 6 months among 350 systematically randomly selected adult HIV-positive patients. PHQ-9 was used to obtain information on depression and the CD4 count was determined using a flow-cytometric method. Data were obtained and analyzed using SPSS-17. Chi-square was used to determine degree of association between the depression and the level of CD4 count. P-value of < 0.05 was considered statistically significant.Results: The prevalence of depression among the respondents was 33.4%. The prevalence of depression was highest among respondents with low CD4 count (≤349cells/ul), 37.0%, and least among those with high CD4 count (≥500cells/ul), 28.3%. This relationship was however not statistically significant.Conclusion: The overall prevalence of depression was high among the respondents (33.4%) suggesting the need for routine depression screening among HIV positive patients. There was no statistically significant association between presence of depression and level of CD4 count (p-value=0.302). Keywords: Depression, CD4count, PLWHA, Family Medicine, UITH.

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LUNG ULTRASOUND DURING COVID-19 PANDEMICS: WHY, HOW AND WHEN?

Wiadomości Lekarskie ◽

10.36740/wlek202108101 ◽

2021 ◽

Vol 74 (8) ◽

pp. 1783-1788

Author(s):

Khrystyna O. Pronyuk ◽

Liudmyla O. Kondratiuk ◽

Andrii D. Vysotskyi ◽

Olga A. Golubovska ◽

Iryna M. Nikitina

Keyword(s):

Hospital Stay ◽

Clinical Decision Making ◽

Lung Ultrasound ◽

Limited Resource ◽

Clinical Decision ◽

Lung Damage ◽

Dynamic Monitoring ◽

Initial Assessment ◽

X Ray ◽

Chest X Ray

The aim: To optimize diagnostic of pathological processes in lungs affected by COVID-19, dynamic monitoring and clinical decision making using lung ultrasound in limited resources settings. Materials and methods: Between the onset of pandemics and January 2021, approximately 9000 patients have been treated for confirmed COVID-19 in the Olexandrivska Clinical Hospital. Assessment of all hospitalized patients included hematology, chemistries and proinflammatory cytokines – IL-6, CRP, procalcitonin, ferritin. Diagnosis was confirmed by PCR for SARS-CoV-2 RNA. Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. Lung ultrasound was proactively utilized to assess the type and extent of lung damage and to monitor the progress of disease in patients hospitalized into the ICU and Infection Unit (n=135). Ultrasound findings were recorded numerically based on scales. Results: In the setting of СOVID-19, bedside lung ultrasound has been promptly recognized as a tool to diagnose and monitor the nature and extent of lung injury. Lung ultrasound is a real time assessment, which helps determine the nature of a pathologic process affecting lungs. In this paper the accuracy of bedside LUS, chest X-ray and computer tomography are compared based on clinical cases, typical for COVID-19 lung ultrasound appearance is evaluated. Described in article data is collected in one of the biggest facility that deals with COVID-19. Chest X-ray was performed in all hospitalized cases, while CT was available approximately in 30% of cases during hospital stay. The cases presented in the paper indicate potential advantages to the use of ultrasound in limited resource healthcare settings, especially when the risk of transportation to CT outweighs the value of information obtained. Conclusions: Grading of ultrasonographic findings in the lungs was sufficient for both initial assessment with identification of high risk patients, and routine daily monitoring. Hence, lung ultrsound may be used to predict deterioration, stratify risks and make clinical decisions.

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The correlation of tuberculosis smear results and immuno-suppression with CD4+ counts as a surrogate marker among HIV infected patients.

10.21203/rs.3.rs-1060928/v1 ◽

2021 ◽

Author(s):

Kingsley Kamvuma ◽

Yusuf ademola ◽

Warren Chanda ◽

Christopher Newton Phiri ◽

Sam Bezza Phiri ◽

...

Keyword(s):

Cell Count ◽

Surrogate Marker ◽

Hiv Positive ◽

Sputum Smear ◽

Cd4 Cell Count ◽

Cd4 Counts ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Study Participants ◽

Cd4 Cell

Abstract Background: Human immunodeficiency virus (HIV) and M.tuberculosis are two intracellular pathogens that interact at the cellular, clinical and population levels. Since the recognition of AIDS in 1981, the number of reported cases of TB in the has increased substantially, especially in regions with high incidence of AIDS. The main aim of this study was to establish weather there is a relationship between sputum smear positives and low CD4 cell counts among HIV infected patients.Materials and methods: This was a retrospective study involving 473 participants. The patients recruited in this study were those who tested HIV positive and smear positive for TB. Their HIV status was determined by performing an HIV blood test, if they were HIV positive their CD4 cell count were then made.Results: This study examined the relation between smear positivity and low CD4 (below 200cells/µl) together with CD8 and CD3 markers as a measure of immune function among patients infected with HIV. The study participants’ constituted males 67% and females 33%. The overall mean age was 33.2 (SD 6.9) with the youngest and oldest participants being 18 and 60 respectively. It was found that smear positive results negatively (r=-0.13; p=0.021) correlated with CD4+ below 200 cells/µl. No correlation was observed between smear positives and CD8+ or CD3+ since the calculated correlation coefficient was not significant 0.007 (p=0.9) and 0.03 (p=0.6) respectively. There are more 3+ smear results below 200 cells/µl than the others while above 200 cells/µl 1+ was the most commonly reported smear result. The scanty smear positives were the least commonly reported result in the low and high CD4 counts. Conclusion: The smear positive result negatively correlated with a low CD4+ (r=-0.13; p=0.021) but no correlation with low CD+8 and CD+3 results was observed. The long held theory that low bacillary counts in patients with low CD4+ counts needs to be revisited. The reduction of CD4+ cell count parallels' that of the total lymphocyte count and is more marked in patients with high bacillary counts. Further, studies are required to confirm these findings

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A STUDY OF CARDIAC MANIFESTATIONS IN PATIENTS WITH HIV/AIDS

International Journal of Advanced Research ◽

10.21474/ijar01/13560 ◽

2021 ◽

Vol 9 (10) ◽

pp. 411-422

Author(s):

Ajay Bang ◽

◽

Deepti Deshmukh ◽

Sanjay Raut ◽

◽

...

Keyword(s):

Cardiovascular Disease ◽

Left Ventricular Diastolic Dysfunction ◽

Left Ventricular ◽

Cd4 Count ◽

Hiv Positive ◽

X Ray ◽

Cardiac Abnormalities ◽

Ventricular Diastolic Dysfunction ◽

Chest X Ray ◽

Cardiac Manifestations

Introduction:HIV/AIDS pandemic is evolving as a major public concern. Cardiovascular diseases are common in HIV-positive patients. Many patients without any symptoms or signs were found to have a cardiovascular disease on autopsy.It is expected that the risk of cardiovascular disease willrise in the following years due to the cardiovascular risk profile andincreased life expectancy of infected patients. Therefore,diagnosis andtherapy of HIV-associated cardiovascular diseases should be part of the evaluation and management of the HIV-positive patient. Objectives: To find out the frequency of cardiac manifestations on clinical examination, electrocardiography, chest X-ray, and echocardiographic examination. To assess the association of Cardiac abnormality with CD4 Count in patients with HIV/AIDS. Toevaluate the association between cardiac abnormalities with types and duration of antiretroviral therapy regimen (ART). Method:A total of 100 consecutive patients visiting ART OPD and admitted to our institute were examined for signs and symptoms of cardiovascular disease. All patients were evaluated with electrocardiography, chest X-ray, and 2 D echocardiography. CD4 count was measured for all patients using flowcytometry using a BD FACS Count system. Results:Out of 100 patients, 53% were male and 47% were female. Patients were divided into subgroups with CD4 count <200, 200-349, 350-499, and â‰¥500. The mean CD4 count was 403.62 Â± 284.98. Prevalence of the cardiovascular abnormality on ECG, chest X-ray, and echocardiography were 74%, 10%, and 51% respectively. The left ventricular systolic dysfunction was the most common finding in our study with fractional shortening â‰¤25% in 34% of patients and LVEF <50% in 27% of patients followed by left ventricular diastolic function (26%), dilated cardiomyopathy (6%), pulmonary hypertension (4%), and regional wall motion abnormality (2%).Reduced LV ejection fraction (<50%) and left ventricular diastolic dysfunction were statistically significant in patients with CD4 count less than 200/mm3. Conclusion: In present study electrocardiographic, chest X-ray and echocardiographic abnormalities were present in 74%, 10% and 51% patients respectively. Cardiac abnormalities such as QTc prolongation, LBBB, reduced left ventricular ejection fraction, and left ventricular diastolic dysfunction were more significantly higher in patients with CD4 count less than 200/mm3. We could not find any statistically significant difference in cardiac abnormalities in patients on different ART regimens. Further studies are required with a higher sample size.

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