Pneumocystis jirovecii Pneumonia and Human Immunodeficiency Virus Co-Infection in Western Iran

2020 ◽  
Author(s):  
Arezoo BOZORGOMID ◽  
Yazdan HAMZAVI ◽  
Sahar HEIDARI KHAYAT ◽  
Behzad MAHDAVIAN ◽  
Homayoon BASHIRI
Keyword(s):  
Human Immunodeficiency Virus ◽  
Signs And Symptoms ◽  
Rapid Identification ◽  
Diagnostic Methods ◽  
Pneumocystis Jirovecii ◽  
Hiv Positive ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Cell Counts ◽  
Stage 4 ◽  
Immunodeficiency Virus

Background: The human immunodeficiency virus (HIV) is one of the greatest health challenges facing worldwide. The virus suppresses the immune system of the patient. The purpose of this study was to describe the epidemiology of Pneumocystis jirovecii colonization, rarely found in normal people, in patients with stage 4 HIV infection in Kermanshah, Iran, from Mar 1995 to Feb 2016. Methods: In this retrospective study, we surveyed medical records of stage 4 HIV-positive patients with Pneumocystis admitted to Behavioral Counseling Center of Kermanshah. Several parameters were analyzed including demographic characteristics, body mass index (BMI), treatment regimen, diagnostic methods, presenting signs and symptoms, presence of co-pathogens (bacteria, viruses, or fungi), and nadir of CD4 T-cell count before and after treatment. Results: During the study period, 114 HIV-positive patients were analyzed, of whom 93 were male and 21 were female, respectively. Of 114 cases, 26 (22.8%) patients had Pneumocystis. All 26 colonized patients had CD4 cell counts below 200 cells/mm3 (range 9–186). The median CD4 count increased from 91 cells/mm3 pretrimethoprim/sulfamethoxazole (TMP/SMX) to an estimated 263 cells/mm3 after starting (TMP/SMX). BMI was normal in the majority of the patients (85%) and coughs, sputum, and chest pain (19; 73%) followed by dyspnea, weakness, and lethargy (7; 27%) were the most common presentations of fungal pneumonia. Conclusion: HIV/AIDS-infected patients are an environmental reservoir of P. jirovecii infection that might transmit the infection from one person to another via the airborne route. In addition, rapid identification of such individuals may reduce the morbidity and mortality rate of this disease.

scholarly journals Tuberculin Skin Test Conversion and Reactivity Rates among Adults with and without Human Immunodeficiency Virus in Urban Settings in Ethiopia

2006 ◽  
Vol 13 (7) ◽  
pp. 784-789 ◽  
Author(s):  
Belete Tegbaru ◽  
Dawit Wolday ◽  
Tsehaynesh Messele ◽  
Mengistu Legesse ◽  
Yared Mekonnen ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
T Cell ◽  
Tuberculin Skin Test ◽  
Skin Test ◽  
Hiv Positive ◽  
Screening Methods ◽  
Lower Sensitivity ◽  
Urban Settings ◽  
Cell Counts ◽  
Immunodeficiency Virus

ABSTRACT To investigate whether low CD4+ T-cell counts in healthy and human immunodeficiency virus (HIV)-infected Ethiopians influence tuberculosis (TB) immunological memory, tuberculin skin test (TST) conversion and reactivity rates were investigated among adults with and without HIV infection in urban settings in Ethiopia. Reaction to the TST was analyzed with purified protein derivative by the Mantoux technique. A total of 1,286 individuals with TST results of ≥5-mm (n = 851) and ≤4-mm (n = 435) induration diameters were included. Individuals with ≤4-mm induration sizes were followed up for 21.4 ± 9.5 months (mean ± standard deviation) to observe skin test conversion. The overall TST reactivity (≥5-mm induration diameter) was 66.2% (n = 851). Reactivity was significantly lower among HIV-positive persons (40.5%) than among HIV-negative persons (68.7%) (P < 0.001). Of the above persons, 32 incident TB patients were checked for their TST status 13.05 ± 11.1 months before diagnosis and reactivity was found among 22 (68.7%) of them. Of the TST-negative persons with 0- to 4-mm indurations who were followed up for 3 years, the conversion rate to positivity was 17.9/100 person-years of observation (PYO) (14.4/100 PYO and 18.3/100 PYO in HIV-positive and -negative persons, respectively). Despite lower absolute CD4+ T-cell numbers in Ethiopians, higher TST conversion and reactivity rates show the presence of a higher rate of latent TB infection and/or transmission. The lower TST positivity rate before a diagnosis of TB disease showed the lower sensitivity of the test. This indicates the need for other sensitive and specific diagnostic and screening methods to detect TB infection, particularly among HIV-positive persons, so that they can be given prophylactic isoniazid therapy.

scholarly journals ECMO Support in HIV/AIDS with Pneumocystis Jirovecii Pneumonia: A Case Report and Short Review

2021 ◽  
Author(s):  
jianlei lv ◽  
yanfen Li ◽  
kang huang ◽  
ailian lv
Keyword(s):  
Human Immunodeficiency Virus ◽  
Case Report ◽  
Short Review ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Shortness Of Breath ◽  
Immunodeficiency Virus ◽  
Refractory Hypoxemia ◽  
Ecmo Therapy ◽  
Hiv Aids

Abstract Background We report a case of a patient with novel human immunodeficiency virus (HIV) and Pneumocystis jirovecii pneumonia (PJP) was successfully treated with veno-venous (V-V) ECMO owing to refractory hypoxemia and pneumomediastinum, and eventually discharged. In addition to the case report, several previous reports were reviewed for the discussion of some key therapies. Case report: A 30-year-old male patient was admitted to the our hospital presented with the shortness of breath. The patient showed a deteriorated oxygenation due to increasing pulmonary infiltrates and development of pneumomediastinum, necessitating ECMO. The diagnosis of ARDS, HIV, PJP was made. Trimethoprim/sulfamethoxazole (TMP/SMX) was provided for the treatment of PJP. After 7 days of ECMO therapy, the patient was successfully decannulated and eventually discharged. Conclusions ECMO may benefit adult patients with HIV/AIDS and refractory hypoxemia due to severe PCP. Post-ECMO antiretroviral therapy could improve outcomes.

scholarly journals Plasma Profiles of Inflammatory Markers Associated With Active Tuberculosis in Antiretroviral Therapy-Naive Human Immunodeficiency Virus-Positive Individuals

2019 ◽  
Vol 6 (2) ◽  
Author(s):  
Oskar Olsson ◽  
Per Björkman ◽  
Marianne Jansson ◽  
Taye Tolera Balcha ◽  
Daba Mulleta ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Cell Count ◽  
Inflammatory Markers ◽  
Area Under The Curve ◽  
Hiv Positive ◽  
Cd4 Cell Count ◽  
Cell Counts ◽  
Immunodeficiency Virus ◽  
Cd4 Cell ◽  
Rna Levels

Abstract Background Diagnosis of tuberculosis (TB) in human immunodeficiency virus (HIV)-coinfected individuals is challenging. We hypothesized that combinations of inflammatory markers could facilitate identification of active TB in HIV-positive individuals. Methods Participants were HIV-positive, treatment-naive adults systematically investigated for TB at Ethiopian health centers. Plasma samples from 130 subjects with TB (HIV+/TB+) and 130 subjects without TB (HIV+/TB−) were tested for concentration of the following markers: CCL5, C-reactive protein (CRP), interleukin (IL)-6, IL12-p70, IL-18, IL-27, interferon-γ-induced protein-10 (IP-10), procalcitonin (PCT), and soluble urokinase-type plasminogen activator receptor (suPAR). Analyzed markers were then assessed, either individually or in combination, with regard to infection status, CD4 cell count, and HIV ribonucleic acid (RNA) levels. Results The HIV+/TB+ subjects had higher levels of all markers, except IL12p70, compared with HIV+/TB− subjects. The CRP showed the best performance for TB identification (median 27.9 vs 1.8 mg/L for HIV+/TB+ and HIV+/TB−, respectively; area under the curve [AUC]: 0.80). Performance was increased when CRP was combined with suPAR analysis (AUC, 0.83 [0.93 for subjects with CD4 cell count &lt;200 cells/mm3]). Irrespective of TB status, IP-10 concentrations correlated with HIV RNA levels, and both IP-10 and IL-18 were inversely correlated to CD4 cell counts. Conclusions Although CRP showed the best single marker discriminatory potential, combining CRP and suPAR analyses increased performance for TB identification.

scholarly journals The Human papillomavirus among women living with Human Immunodeficiency Virus in Morocco A prospective cross-sectional study

2018 ◽  
Vol 12 (06) ◽  
pp. 477-484 ◽  
Author(s):  
Ahd Ouladlahsen ◽  
Naouar Fayssel ◽  
Rajaa Bensghir ◽  
Hanâ Baba ◽  
Hassan Lamdini ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Human Papillomavirus ◽  
High Risk ◽  
Hpv Infection ◽  
Hiv Positive ◽  
Cell Counts ◽  
Hiv Positive Women ◽  
Immunodeficiency Virus ◽  
High Prevalence ◽  
Hpv Types

Introduction: Women infected with human immunodeficiency virus (HIV) have a higher risk of contracting human papillomavirus (HPV) infections and are more prone to develop cervical cancer. The objective of this study was to determine the prevalence of HPV and its association with risk factors among Moroccan women living with HIV/AIDS. Methodology: We enrolled 251 HIV-infected non-pregnant women in Morocco from February 2013 to September 2016. Sociodemographic, lifestyles, behavioral and clinical data were collected. Polymerase chain reaction followed by sequencing were performed for molecular detection and HPV genotyping in cervical samples, respectively. Results: Abnormal cervical smears were found in 34/246 patients (13.82%). The overall prevalence of HPV was 74.50%. HPV 58 was the most prevalent (39.29%) followed by HPV 18 (10.71%), HPV 70 (8.93%), HPV 33 (7.14%), HPV 6 (6.25%) and other genotypes (< 3%). Overall, high-risk HPV (HR-HPV) types were present in 75% (84/112) of patients and the prevalence of HR-HPV types in samples with abnormal Pap was higher than in normal Pap (55/83, 66.27% vs. 28/83, 33.33%, p < 0.0001). Univariate analyses showed that none of the socio-demographic and behaviors factors was associated with HPV infection. Moreover, Pap results were not affected by HPV status (p = 0.532). Whereas, CD4 T-cell counts above 200/mm3 at enrolment were apparently not protective to HPV infection. We found a high prevalence of HPV infection and HR-HPV types among HIV-positive women that significantly associated with abnormal Pap. Conclusion: Our findings suggest a high prevalence of HPV infection with high-risk types was observed among HIV-positive women warrant to implement a regular screening by Pap smear.

scholarly journals Pneumonia por Pneumocystis em 107 Doentes com Infecção por VIH Internados no Serviço de Doenças Infecciosas, Hospital de Santa Maria, Lisboa (2002 - 2013)

2016 ◽  
Vol 29 (10) ◽  
pp. 639 ◽  
Author(s):  
Vilma Grilo ◽  
Aida Pereira
Keyword(s):  
Human Immunodeficiency Virus ◽  
Virus Infection ◽  
Human Immunodeficiency Virus Infection ◽  
Injection Drug Users ◽  
Drug Users ◽  
Injection Drug ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Immunodeficiency Virus ◽  
Santa Maria

Introduction: Pneumocystis jirovecii pneumonia remains one of the most common opportunistic illnesses in patients infected with the human immunodeficiency virus. It is currently the most reported AIDS-defining infection in Portugal. The aims of this study were to analyze the features of a human immunodeficiency virus /Pneumocystis jirovecii pneumonia coinfected population, to compare it with the current literature, and to evaluate comparatively subpopulations of patients based on the previous knowledge of the human immunodeficiency virus infection, Pneumocystis jirovecii pneumonia diagnostic method and discharge results.Material and Methods: A retrospective, observational, non-controlled study was conducted. The 107 patients admitted to the Department of Infectious Diseases at Santa Maria Hospital, in Lisbon, between the 1st of January 2002 and the 31st of December 2013, that presented the simultaneous diagnosis of human immunodeficiency virus infection and Pneumocystis jirovecii pneumonia were included. We studied epidemiologic and clinical data collected from the patient files, including immunity status, human immunodeficiency virus viral load and treatment options. The variables were analyzed using the Chi-Squared and Mann-Whitney tests.Results: Data from this population evidenced male predominance (81.3%), patient age between 20 - 39 years old in 59.2% and heterossexual human immunodeficiency virus transmission in 48.6%; 24.3% were immigrants. Human immunodeficiency virus infection was previously known in 62.6% patients, but 76.2% were not engaged in medical care. A TCD4+ cell count ≤ 200 cells/mm3, high viralload and oropharyngeal candidiasis (72%) were prevalent risk factors associated with the Pneumocystis jirovecii pneumonia infection; hypoxaemia (78.5%) and LDH (82.2%), which are markers of Pneumocystis jirovecii pneumonia severity, did not translate into a worseprognosis. Pneumocystis jirovecii was only identified in 55.1% patients, pointing out the hardship involved in achieving a definite diagnosis. The inicial drug of choice was TMP-SMX (91.6%), and corticosteroid adjuvant therapy was added in 75.7%. The in-hospital mortality was 13.1%.Discussion: The comparative analysis between groups of patients showed that injection drug users knew more frequently their human immunodeficiency virus seropositivity before the current hospitalization, which could be explained by the presence of specific programs aiming the early human immunodeficiency virus diagnosis in this population. However, there is lack of adhesion to the treatment andfollow up consultations, putting them at a higher risk of Pneumocystis jirovecii pneumonia infection and other AIDS related diseases. Besides showing the classic Pneumocystis jirovecii pneumonia presentation, healthcare seeking was delayed, especially amongst patients with newly diagnosed human immunodeficiency virus infection. Moreover, the Pneumocystis jirovecii pneumonia diagnosis was difficult to obtain, mainly because of the current limitations of Pneumocystis jirovecii pneumonia diagnostic techniques, the simultaneous presence of other respiratory diseases, and the need of a high degree of clinical suspicion.Conclusion: This population of human immunodeficiency virus and Pneumocystis jirovecii pneumonia coinfected patients shows similarities with the data from previous studies, particularly considering Portuguese epidemiological data. The main differences found were the Pneumocystis jirovecii pneumonia diagnostic frequence in injection drug users, the importance of previous/recurrent episodes of Pneumocystis jirovecii pneumonia as a risk factor and the frequency of concurrent pulmonary diseases. The deceased patients showed less imagiologic features suggestive of Pneumocystis jirovecii pneumonia, and advanced age was found to be an indicative of worst prognosis.

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