Mucocutaneous manifestations in newly diagnosed cases of HIV, correlation with CD4 counts and WHO staging at a tertiary care center

Background:Mucocutaneous infections have played an important role in initial diagnosis of HIV infection and in clinical staging of the disease. Mucocutaneous manifestations in HIV infected individuals are myriad and can serve as a main indicator of other problems. Health care personnel involved in HIV health care must therefore have a clear idea of type, pattern, and prevalence of skin diseases in their locality. The objective of the study was to determine the various mucocutaneous manifestations in newly diagnosed cases of HIV and to correlate them with CD4 cell counts. The manifestations and CD4 cell counts are correlated with WHO staging of the disease.Methods:Data was collected from all the newly diagnosed cases of HIV presenting to the Department of Dermatology. Thorough clinical examination was done and findings were noted. CD4 cell counts were performed by FACS counter and supportive laboratory tests were done for diagnosis of other skin manifestations.Results:250 cases were enrolled with males 148 and 102 females. Most common age group was middle age group and hetero sexual route was the most common route of transmission. Bacterial skin infections were more common and candidiasis was most common among fungal infections. Herpes zoster was most common in viral infections. Significant correlation was observed between CD4 cell counts and WHO clinical staging of disease. Majority of infections were more common at advanced stage of HIV.Conclusions:To conclude, HIV-related mucocutaneous manifestations are a good clinical clue in diagnosis of advanced stages of HIV. Most of these manifestations can serve as diagnostic and prognostic markers in HIV infection. Management of HIV related mucocutaneous manifestations should always be precluded with a screening of CD4 cell counts. A lowered CD4 cell counts will prolong the duration of treatment and may significantly alter the outcome of the disease.

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CD4 cell counts in adults with newly diagnosed HIV infection in Barbados

Revista Panamericana de Salud Pública ◽

10.1590/s1020-49892004001100002 ◽

2004 ◽

Vol 16 (5) ◽

Cited By ~ 9

Author(s):

Krishna R. Kilaru ◽

Alok Kumar ◽

Namrata Sippy

Keyword(s):

Hiv Infection ◽

Newly Diagnosed ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Cd4 Cell

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CD4 cell counts in adults with newly diagnosed HIV infection: results of surveillance in England and Wales, 1990–1998

AIDS ◽

10.1097/00002030-200005050-00012 ◽

2000 ◽

Vol 14 (7) ◽

pp. 853-861 ◽

Cited By ~ 33

Author(s):

Swati B. Gupta ◽

Ruth L. Gilbert ◽

Anthony R. Brady ◽

Shona J. Livingstone ◽

Barry G. Evans

Keyword(s):

Hiv Infection ◽

Newly Diagnosed ◽

England And Wales ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Cd4 Cell

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Factors associated with late presentation of HIV infection in Catalonia, Spain

International Journal of STD & AIDS ◽

10.1258/ijsa.2011.011280 ◽

2012 ◽

Vol 23 (7) ◽

pp. 475-480 ◽

Cited By ~ 19

Author(s):

N Vives ◽

D Carnicer-Pont ◽

P Garcia De Olalla ◽

N Camps ◽

A Esteve ◽

...

Keyword(s):

Hiv Infection ◽

Late Presentation ◽

Late Diagnosis ◽

Cd4 Cell Count ◽

Hiv Surveillance ◽

Factors Associated ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Populations At Risk ◽

Cd4 Cell

We sought to describe the prevalence, trends and factors associated with late diagnosis of HIV infection between 2001 and 2008 in Catalonia, Spain. Adults over 13 years of age with available CD4 cell counts, who were notified to the Catalonia Voluntary HIV Surveillance System between January 2001 and December 2008, were included in the study. Late presentation for HIV infection was defined as a CD4 cell count <350 cells/μL or with an AIDS-defining condition at presentation. Multivariable logistic regression was used to identify factors independently associated with late diagnosis of HIV. Of the 4651 newly diagnosed HIV-infected individuals with available CD4 counts, 2598 (55.9%) were diagnosed late. The proportion of people with a late diagnosis decreased from 60.4% in 2001 to 50% in 2008, a significant trend ( P < 0.001). Older age, male gender, foreign birth, heterosexuality and injecting drug use were independent risk factors for late diagnosis. Strategies to actively promote HIV testing to populations at risk of late diagnosis of HIV or those never attending health systems should be implemented.

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CD4 cell counts used as surrogate test for HIV infection

BMJ ◽

10.1136/bmj.311.7003.513b ◽

1995 ◽

Vol 311 (7003) ◽

pp. 513-513 ◽

Cited By ~ 1

Author(s):

A S Jack ◽

S Richards

Keyword(s):

Hiv Infection ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Cd4 Cell

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The outcome predictors and therapeutic strategy of pneumocystis pneumonia in North China: a double-center retrospective study

10.21203/rs.2.9235/v1 ◽

2019 ◽

Author(s):

Wei Hua ◽

Yang Yang ◽

Zheng Zhang ◽

Wei Zhang ◽

Jing Zeng ◽

...

Keyword(s):

Hiv Infection ◽

Side Effect ◽

Therapeutic Strategy ◽

North China ◽

Pneumocystis Pneumonia ◽

Parameter Distribution ◽

Glucocorticoid Treatment ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Cd4 Cell

Abstract Background: Pneumocystis pneumonia (PCP) is common in HIV/AIDS patients with advanced immunosuppression. Trimethoprim/sulfamethoxazole (TMP/SMX) is recommended as the first-line anti-pneumocystis agent as soon as PCP is suspected based on its typical feature. However, the clinical characteristic and therapeutic strategy of Chinese PCP were not well-known. Methods: We retrospectively investigated 473 HIV associated PCPs in North China from double centers, Beijing You An Hospital during 2010 to 2017 and the Infectious Disease Hospital in Harbin during 2015 to 2017. HIV associated PCP were diagnosed as the guideline recommended by CDC, NIH and HIV Medicine Association of IDSA. Demographic and clinic data were collected and statistically analysed as the parameter distribution feature. Results: Among 473 HIV associated PCPs, we found that men were over-represented in PCP due to the high incidence of HIV infection among male homosexuality, and over one-third of them were aware of their HIV infection ago but did not maintain effective antiretroviral therapy. A history of smoking and multi-organism infection or system infection were common among them. In the multivariate analysis, we found lactate dehydrogenase (LDH) (OR 1.020, 95% CI 1.006-1.033, P=0.005), alveolar-arterial O2 difference ([A-a] DO2) and neutrophils counts (OR 1.051, 95% CI 1.005-1.099, P=0.030) were unfavourable predictors and CD4 cell counts (OR 0.900, 95% CI 0.813-0.996, P=0.041) were favourable predictor of PCP outcome. Trimethoprim/sulfamethozole (TMP/SMZ) but not TMP/SMX was used to anti-pneumocystis therapy in these patients with a low side-effect incidence which mainly forcused on epispasis, fever, liver injury and myelosuppression. Caspofungin was the only alternative medicine for those presented poor efficacy or could not tolerate the side-effects of TMP-SMZ and near 30 percent of moderate/severe PCP received glucocorticoid treatment. Conclusion: The present data suggest that high levels of serum-LDH, [A-a] DO2 and neutrophils counts and low CD4 cell counts predict poor outcome of PCP. TMP/SMZ can cure most PCPs with a low side-effect incidence and caspofungin is an effective alternation. A larger prospective study is needed to obtain better estimates of PCP in China.

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Perioperative outcomes in human immunodeficiency virus-infected patients – the PRO HIV study

International Journal of STD & AIDS ◽

10.1177/0956462418764485 ◽

2018 ◽

Vol 29 (10) ◽

pp. 968-973 ◽

Cited By ~ 2

Author(s):

Divyashree Shanthamurthy ◽

Abi Manesh ◽

Naveena GP Zacchaeus ◽

Lisa R Roy ◽

Priscilla Rupali

Keyword(s):

Surgical Procedures ◽

Median Duration ◽

Surgical Outcomes ◽

Surgical Outcome ◽

Tertiary Care ◽

Perioperative Outcomes ◽

Care Hospital ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Cd4 Cell

It is estimated that a quarter of patients with HIV/AIDS undergo at least one surgical procedure in their life time. Surgical outcomes in these patients from developing countries are poorly characterized and surgeons are often concerned about poor surgical outcomes, especially when their CD4 cell counts are less than 200 cells/µl. This study evaluated the surgical outcomes of HIV-infected patients undergoing various surgical procedures over a six-year period in a large tertiary care hospital from South India. Two hundred and ninety-three patients underwent 374 surgical procedures during the study period. The median duration of HIV prior to surgery was 1.9 years (range 0–18.8 years). Two-thirds (58%) were on highly active antiretroviral therapy (HAART) at the time of surgery with the median duration of this treatment being 38 months (n = 194). About one-third (35%) of surgical procedures were performed as an emergency. Abdomino-pelvic surgeries were the most common (225, 60%). Adverse surgical outcome defined as death or post-operative infection was seen in 25 (6.6%). The post-operative infection rate was 5% (20/374). The most common of these was surgical site infection observed in nine (60%) followed by pneumonia in five patients (33%) and urinary tract infection in one patient. Day 30 mortality was 2% (n = 8) and a quarter of these were reported to be related to post-operative infectious complications. On multivariate analysis, only preoperative haemoglobin of less than 10 g/dl was significantly associated with a poor surgical outcome. HIV-related parameters such as CD4 cell counts, duration of HIV infection and HAART regimen did not seem to contribute towards an adverse surgical outcome.

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Identification of an HIV-1 and Neurosyphilis Cluster in Vermont

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1834 ◽

2020 ◽

Author(s):

Devika Singh ◽

William M Switzer ◽

Roy Belcher ◽

Daniel Daltry ◽

Jennifer S Read

Keyword(s):

Newly Diagnosed ◽

Viral Loads ◽

Network Analyses ◽

Intervention Specialists ◽

Cell Counts ◽

Cd4 Cell Counts ◽

Sex With Men ◽

Cd4 Cell ◽

Hiv 1 ◽

Sexual Networking

Abstract Background Rates of syphilis in the U.S. have more than doubled over the last several decades, largely among men who have sex with men (MSM). Our study characterizes a cluster of neurosyphilis cases among HIV-1-infected individuals in Vermont in 2017-2018. Methods Vermont Department of Health disease intervention specialists conduct interviews with all newly diagnosed HIV-1 cases and pursued sexual networking analyses. Phylogenetic and network analyses of available Vermont HIV-1 polymerase (pol) sequences identified clusters of infection. Fishers-exact and independent t-tests were used to compare HIV-1-infected individuals within or outside an identified cluster. Results Between January 1, 2017 and December 31, 2018, 38 Vermont residents were newly diagnosed with HIV-1 infection. The mean age was 35.5 years, 79% were male and 82% were white. Risk factors for HIV-1 acquisition included MSM status (79%) and methamphetamine use (21%). Eighteen cases (49%) had HIV-1 viral loads (VLs) >100,000 copies/mL and 47% had CD4 cell counts <200/mm 3. Eleven of the 38 (29%) cases had positive syphilis serology, including four (36%) with neurosyphilis. Sexual networking analysis revealed a ten-person cluster with higher VLs at diagnosis (90% with VLs > 100,000 copies/mL vs. 33%, p=0.015). Phylogenetic analysis of pol sequences showed a cluster of 14 cases with sequences that shared 98-100% HIV-1 nucleotide identity. Conclusions This investigation of newly infected HIV-1 cases in Vermont led to identification of a cluster that appeared more likely to have advanced HIV-1 disease and neurosyphilis. Identification of a cluster was strongly supported by both phylogenetic and network analyses of HIV-1 pol sequences.

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