scholarly journals Should We Screen HIV-Positive Migrants for Strongyloidiasis?

Pathogens ◽  
2020 ◽  
Vol 9 (5) ◽  
pp. 388
Author(s):  
Caroline Theunissen ◽  
Emmanuel Bottieau ◽  
Marjan Van Esbroeck ◽  
Achilleas Tsoumanis ◽  
Eric Florence
Keyword(s):  
Viral Load ◽  
Geographic Origin ◽  
Positive Likelihood Ratio ◽  
Strongyloides Stercoralis ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Hiv Viral Load ◽  
Tropical Regions ◽  
Eosinophil Cell ◽  
Medical Evaluation

Background: Strongyloides stercoralis, a nematode endemic in all (sub)tropical regions, can cause life-threatening disease, especially in immunosuppressed patients. Many countries with high HIV-prevalence rates are also highly S. stercoralis endemic, and co-infection may occur. Methods: Retrospective study based on serological testing for S. stercoralis in all HIV-infected migrants followed at the Institute of Tropical Medicine, Antwerp, Belgium. If untested, serologic testing was performed on stored samples, dating from the first HIV viral load determination. The epidemiological, clinical and laboratory features of patients with and without strongyloidiasis were retrieved from the electronic medical files. Results: Of the 2846 HIV patients in active follow-up, 723 (25.4%) had a migration background. Thirty-six patients (5.1%) were diagnosed with Strongyloides co-infection, including 29 during their medical evaluation and seven retrospectively. Patients had a median age of 35.3 years (IQR 30.3–44.4), 28 patients (78%) originated from Sub-Saharan Africa and median time in Belgium was 3.5 years (IQR 0.8–5.7). Symptoms compatible with strongyloidiasis were present in 17 (47%) patients, of whom two were diagnosed retrospectively. Eosinophilia (eosinophil cell count > 450/µL) was observed in 19 (53%) participants. Median CD4 level was 386 /µL (IQR 299–518) at diagnosis of co-infection. Of note, 8 (22%) patients with strongyloidiasis had no reported symptoms nor eosinophilia. None of the patients developed hyperinfection syndrome. There were no differences in age, gender, geographic origin, clinical presentation, CD4 level or viral load between patients with and without strongyloidiasis. Only eosinophilia was strongly correlated with the presence of Strongyloides in multivariate analysis (OR 10.74 (95% CI 5.19–22.25), p < 0.001); the positive likelihood ratio (LR+) of eosinophilia for strongyloidiasis was 5.38 (95% CI 3.66–7.91). Conclusion: Strongyloidiasis was diagnosed in 5.1% of HIV-infected migrants. Eosinophilia had good confirming power for the presence of the disease. However, a sizeable proportion (22%) of co-infected individuals were asymptomatic and had normal eosinophil count, supporting universal screening of all HIV-positive patients native to tropical countries.

scholarly journals Prevalence and predictors of persistent HIV viremia and viral rebound following universal test and treat: a population-based study

2021 ◽  
Author(s):  
M Kate Grabowski ◽  
Eshan U Patel ◽  
Gertrude Nakigozi ◽  
Victor Ssempijja ◽  
Robert Ssekubugu ◽  
...  
Keyword(s):  
Population Level ◽  
Population Based ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Viral Rebound ◽  
Hiv Viral Load ◽  
Test And Treat ◽  
Universal Test ◽  
Persistent Viremia ◽  
Universal Test And Treat

Abstract Background There are limited data on individual HIV viral load (VL) trajectories at the population-level following the introduction of universal test and treat (UTT) in sub-Saharan Africa. Methods HIV VLs were assessed among HIV-positive participants at three population-based surveys in four Ugandan fishing communities surveyed between November 2011 and August 2017. The unit of analysis was a visit-pair (two consecutive person-visits), which were categorized as exhibiting durable VL suppression, new/renewed suppression, viral rebound, or persistent viremia. Adjusted relative risks (adjRRs) and 95%CIs of persistent viremia were estimated using multivariate Poisson regression. Results There were 1,346 HIV-positive participants (n=1,883 visit-pairs). The population-level prevalence of durable VL suppression increased from 29.7% to 67.9% during UTT rollout, viral rebound declined from 4.4% to 2.7%, and persistent viremia declined from 20.7% to 13.3%. Younger age (15-29 vs. 40-49 years, adjRR=1.80 [95%CI=1.19-2.71]), male sex (adjRR=2.09 [95%CI=1.47-2.95]), never being married (vs. currently married; adjRR=1.88 [95%CI=1.34-2.62]), and recent migration to the community (vs. long-term resident; adjRR=1.91 [95%CI=1.34-2.73]) were factors associated with persistent viremia. Conclusions Despite increases in durable VL suppression during roll-out of UTT in hyperendemic communities, a substantial fraction of the population, whose risk profile tended to be younger, male, and mobile, remained persistently viremic.

scholarly journals Intakes of Vitamin a and Zinc and Markers of Oxidative Stress in Newly Diagnosed HIV-positive Participants in the MASH Cohort in Miami (P24-016-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Priscilla Clayton ◽  
Adriana Campa ◽  
Qingyun Liu ◽  
Sabrina Martinez ◽  
Leslie Seminario ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Mitochondrial Dna ◽  
Viral Load ◽  
Vitamin A ◽  
Hiv Positive ◽  
Oxidized Glutathione ◽  
Newly Diagnosed ◽  
Hiv Viral Load ◽  
Cross Sectional ◽  
Mitochondrial Dna Damage

Abstract Objectives HIV infection is characterized by increased oxidative stress. We examined the association of antioxidant intake with measures of oxidative stress and HIV disease progression in newly diagnosed HIV-infected participants. Methods Cross-sectional study of 52 newly-diagnosed HIV-positive participants in the MASH cohort. Blood was drawn for parameters of oxidative stress (oxidized glutathione % and oxidative mitochondrial DNA damage [8-oxo-dG]) and disease stage (CD4- cell counts; HIV-viral load). Questionnaires on demographics and 24-hour dietary recalls and Alcohol Use Disorders Identification Test (AUDIT) were administered. AUDIT scores ≥ 8 was considered hazardous drinking. Dietary intakes of vitamin A and Zinc were calculated. SPSS was used for analyses and Linear Regression Models were estimated. Results Participants were 74% male, 75% Black Non-Hispanic, and 21% Hispanics. Mean age was 42.3 ± SD10.2 years, CD4 count was 506.7 ± SD733.4 cells/µLA cross-sectional and HIV viral load was 3.63 ± SD1.23log10 copies/mL. Dietary intake of vitamin A (β = −0.001, SE = 0.0002, P = 0.044) and zinc (β = −0.0004, SE = 0.0002, P = 0.044) were inversely related with mitochondrial DNA damage (8-oxo-dG), after adjusting for education, race, age, gender, and excessive alcohol use. Oxidized glutathione percentage was directly associated with HIV-viral load (β = 0.81, SE = 0.4, P = 0.037) adjusting for age, gender, AUDIT ≥ 8 and BMI in linear regressions. Conclusions Lower intake of vitamin A and Zinc were associated with higher oxidative stress and higher HIV viral load. These findings suggest that antioxidant supplementation may be beneficial immediately after receiving a diagnosis of HIV infection as well as during antiretroviral treatment. Funding Sources Funded by the National Institute on Drug Abuse and the National Institute of Health.

scholarly journals Opportunistic Cryptococcal Antigenemia in the HAART Era at HIV Epidemic Settings of Northwest Ethiopia

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Markos Negash ◽  
Tadelo Wondmagegn ◽  
Fitsumbrhan Tajebe
Keyword(s):  
Viral Load ◽  
Opportunistic Infection ◽  
Demographic Data ◽  
Oral Candidiasis ◽  
Northwest Ethiopia ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Hiv Rna ◽  
Cell Counts ◽  
Th Cell

Background. Cryptococcus neoformans is a frequent opportunistic infection in patients with the acquired immunodeficiency syndrome. While the advent of ART reduces the occurrence of cryptococcal meningitis in HIV patients, cryptococcal disease remains a leading cause of morbidity and mortality in the developing world especially in sub-Saharan Africa which is the epicenter of HIV. This study aimed to assess the cryptococcal antigenemia, CD4+ Th cell counts, HIV RNA viral load, and clinical presentations among HIV-positive patients in Northwest Ethiopia. Method. A total of two hundred (200) HIV-positive patients were recruited for this study. Cryptococcus antigenemia prevalence in plasma samples of HIV‐positive patients was determined by using Antigen lateral flow assay (CrAg‐LFA) also, and CD4+ Th cell counts and HIV‐RNA levels were quantified from blood specimen. Patients’ demographic data, clinical manifestation, and concurrent opportunistic infection were recorded. Result. The sex distributions of study participants were 105(52.5%) male and 94(47.5%) female with an age range of 15–65 (mean 39.42 ± 9) years. All patients had a CD4+ T-cell count <100 cells/µl with the median 54 cells/μl and median HIV-RNA viral load 2.16 × 105 RNA copies/ml (50–3.66 × 105 RNA copies/ml); the prevalence of cryptococcal antigenemia was found to be 4% in HIV-positive patients. More than half and two third of CrAg‐positive patients had a CD4 count <25 cells/μl and HIV viral load >10,000 copies/ml, respectively, as well; Tuberculosis, Candidiasis, and herpes zoster are the most often observed concurrent infections while cryptococcal antigenemia is significantly associated with oral candidiasis (p<0.001). Conclusion. Although the advent of ART, early diagnosis of cryptococcosis, and application of antifungal interventions, HIV-induced cryptococcal antigenemia positivity in HIV infected individuals is still the countries’ big challenge. Thus, stringent follow-up and case management should be considered.

scholarly journals Increasing syphilis rates among men who have sex with men and screening to detect asymptomatic infection

Sexual Health ◽  
2017 ◽  
Vol 14 (4) ◽  
pp. 301 ◽  
Author(s):  
Marcus Chen ◽  
Rebecca Guy
Keyword(s):  
Viral Load ◽  
Hiv Testing ◽  
Asymptomatic Infection ◽  
Hiv Positive ◽  
Load Testing ◽  
Serological Testing ◽  
Hiv Viral Load ◽  
Ocular Syphilis ◽  
Syphilis Screening ◽  
Sex With Men

With reports of increasing syphilis rates among men who have sex with men in various countries and complications such as ocular syphilis and neurosyphilis, greater efforts for promoting frequent syphilis screening of higher risk men are required. This should include serological testing for syphilis every time HIV testing is undertaken and each time HIV viral load testing is performed in HIV-positive men who have sex with men. Systems-based approaches tailored to particular contexts should be explored, evaluated and, if shown to be effective, implemented.

HIV-positive Kaposi sarcoma and immune checkpoint blockade.

2018 ◽  
Vol 36 (5_suppl) ◽  
pp. 63-63 ◽  
Author(s):  
Natalie Galanina ◽  
Aaron Goodman ◽  
Philip R Cohen ◽  
Razelle Kurzrock
Keyword(s):  
Viral Load ◽  
Immune Checkpoint ◽  
Kaposi Sarcoma ◽  
Immune Checkpoint Blockade ◽  
Cd4 Count ◽  
Checkpoint Blockade ◽  
Hiv Positive ◽  
Hiv Viral Load ◽  
Gastrointestinal Discomfort ◽  
Count Table

63 Title: HIV-Positive Kaposi Sarcoma and Immune Checkpoint Blockade Background: Kaposi sarcoma (KS) is an incurable, virally mediated malignancy arising in HIV-positive patients. We report the first observations on the safety and efficacy of checkpoint blockade in these patients. Methods: We identified eight evaluable patients with HIV-related Kaposi sarcoma who received ≥1 dose of checkpoint blockade. Data on demographics, treatment efficacy, and the effects on immune function (HIV and HHV8 viral load, CD4 count) and toxicity were curated. Results: Median age was 45.5 years (range, 38-63); all men; median, one prior regimen; all were treated with nivolumab 3mg/kg IV days 1 and 14 of each 28-day cycle. PD-L1 expression was assessed retrospectively and was low in 3 out of 4 patients with available data. All patients were receiving anti-retroviral therapy. The majority (75%) had preserved CD4 count and undetectable HIV viral load (Table). The response rate (RR) was 62.5% (5 of 8 patients) with 1 complete remission and 4 partial remissions; the remaining 3 patients have stable disease. Median follow up to date is 3.5 months and no patients has discontinued therapy. No grade >2 toxicities were noted. Most common side effects included fatigue, gastrointestinal discomfort, pruritis, and onycholysis. There was an overall increase in CD4 counts. Conclusions: Preliminary observations suggest that checkpoint blockade with nivolumab has low toxicity and high anti-tumor activity in KS. Additionally, patients experienced improvement in CD4 count. [Table: see text]

scholarly journals Higher Risk Myelodysplastic Syndromes in Patients with Well-Controlled HIV Infection: Clinical Features, Treatment, and Outcome

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Bradley T. Williamson ◽  
Heather A. Leitch
Keyword(s):  
Bone Marrow ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Myelodysplastic Syndromes ◽  
Hiv Positive ◽  
Combination Antiretroviral Therapy ◽  
Hiv Viral Load ◽  
Hiv Patients ◽  
Age Of Diagnosis ◽  
Hiv Negative

Introduction. In advanced HIV prior to combination antiretroviral therapy (ART), dysplastic marrow changes occurred and resolved with ART. Few reports of myelodysplastic syndromes (MDS) in well-controlled HIV exist and management is undefined.Methods. Patients with well-controlled HIV and higher risk MDS were identified; characteristics, treatment, and outcomes were reviewed.Results. Of 292 MDS patients since 1996, 1 (0.3%) was HIV-positive. A 56-year-old woman presented with cytopenias. CD4 was 1310 cells/mL and HIV viral load <40 copies/mL. Bone marrow biopsy showed RCMD and karyotype included del(5q) and del(7q); IPSS was intermediate-2 risk. She received azacitidine at 75% dose. Cycle 2, at full dose, was complicated by marrow aplasia and possible AML; she elected palliation. Three additional HIV patients with higher risk MDS, aged 56–64, were identified from the literature. All had deletions involving chromosomes 5 and 7. MDS treatment of 2 was not reported and one received palliation; all died of AML.Conclusion. Four higher risk MDS in well-controlled HIV were below the median age of diagnosis for HIV-negative patients; all had adverse karyotype. This is the first report of an HIV patient receiving MDS treatment with azacitidine. Cytopenias were profound and dosing in HIV patients should be considered with caution.

Effects of Antioxidants on CD4 and Viral Load in HIV-Infected Women in Sub-Saharan Africa - Dietary Supplements vs. Local Diet

2012 ◽  
Vol 82 (1) ◽  
pp. 63-72 ◽  
Author(s):  
N. Nkengfack ◽  
N. Torimiro ◽  
Englert
Keyword(s):  
Oxidative Stress ◽  
Viral Load ◽  
Immune System ◽  
Dietary Supplements ◽  
Micronutrient Deficiency ◽  
The Body ◽  
Sub Saharan Africa ◽  
Hiv Positive ◽  
Natural Food ◽  
Nutritional Education

In sub-Sahara Africa, micronutrient deficiency, especially of antioxidant micronutrients including vitamins A, C, and E, beta-carotene, selenium, zinc, and polyphenols is very common in HIV-positive patients. Amongst adults, women are the most vulnerable. Antioxidants are known to play a vital role in the immune system, reducing oxidative stress. Oxidative stress is induced by excess production of reactive oxygen species (ROS), due to the HIV infection. Such damage may be prevented or moderated through adequate oral intake of antioxidants, scavenging ROS, as well as protecting cells and tissues against oxidative stress. Antioxidants can be provided to the body through locally available antioxidant rich-diets such as fruit-and-vegetable-based diets and/or dietary supplements. Provision of antioxidants through local diets or dietary supplements exercise beneficial effects on biological markers of the immune system (CD4 and viral load). However, while dietary supplements represent a costly and short-term strategy to limiting antioxidant deficiency, local diets, combined with adequate nutritional education, can provide a low-cost and long-term strategy to reduce oxidative stress, prevent micronutrient deficiency, and slow down HIV disease progression. The former can be applicable in countries around the West, Central, and South coast of Africa, which are rich in natural food resources. In contrast with significant evidence that dietary supplements confer benefits in HIV patients, fewer data are available relating to the benefits of local diets. Thus the need to do more research in this area arises. This review compares available data on effects of antioxidants on CD4 and viral load in HIV-positive women noneligible for antiretroviral therapy. Intake of antioxidants though dietary supplements and local diet, associated with nutritional education, is compared. Studies conducted in sub-Sahara Africa are considered.

scholarly journals Access to HIV Viral Load Testing and Antiretroviral Therapy Switch Practices: A Multicountry Prospective Cohort Study in Sub-Saharan Africa

2020 ◽  
Vol 36 (11) ◽  
pp. 918-926
Author(s):  
Pascale Ondoa ◽  
Andrea A. Kim ◽  
T. Sonia Boender ◽  
Guoqing Zhang ◽  
Stefanie Kroeze ◽  
...  
Keyword(s):  
Cohort Study ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Sub Saharan Africa ◽  
Load Testing ◽  
Hiv Viral Load ◽  
Sub Saharan ◽  
Therapy Switch

scholarly journals High Prevalence of Human Papillomavirus Infection among Brazilian Pregnant Women with and without Human Immunodeficiency Virus Type 1

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Emilia Moreira Jalil ◽  
Geraldo Duarte ◽  
Patrícia El Beitune ◽  
Renata Toscano Simões ◽  
Patrícia Pereira dos Santos Melli ◽  
...  
Keyword(s):  
Viral Load ◽  
Pregnant Women ◽  
Prevalence Ratio ◽  
Hpv Infection ◽  
Cross Sectional Study ◽  
Hiv Positive ◽  
Hiv Viral Load ◽  
Cross Sectional ◽  
Hpv Dna ◽  
Hiv Negative

Objective. To estimate HPV prevalence among pregnant women from Ribeirão Preto, Brazil, and the possible influence of HIV-1 infection on this prevalence.Methods. A cross-sectional study with 44 HIV-positive and 53 HIV-negative pregnant women was conducted. Cervicovaginal specimens were obtained from all women during gynecologic exam. HPV DNA, low and high risk HPV types, was detected using conventional PCR. Statistical analysis used Student'st-test, Mann-Whitney test, Fischer's Exact test, and prevalence ratios with 95% confidence interval.Results. HIV-positive pregnant women had higher proportion of HPV infection than HIV-negative pregnant women (79.5% versus 58.5%;P<.05). HPV positivity prevalence ratio for HIV-positive women was 1.36 (95% CI 1.04–1.8;P=.03). There was significant association between HIV viral load levels and HPV positivity (P<.05).Conclusions. Our results demonstrate higher HPV positivity in HIV-infected pregnant women. Higher values of HIV viral load were associated with HPV positivity.

An unexpected undetectable viral load in a vulnerable woman

2012 ◽  
Vol 23 (7) ◽  
pp. 531-532
Author(s):  
G Fraser ◽  
F Fargie
Keyword(s):  
Viral Load ◽  
Undetectable Viral Load ◽  
Significant Rise ◽  
African Woman ◽  
Hiv Positive ◽  
Treatment Level ◽  
Elite Controllers ◽  
Hiv Viral Load ◽  
Recommended Treatment ◽  
History Of

We present a case of a vulnerable HIV-positive African woman who on initial visits to the clinic had an undetectable HIV viral load without giving a history of being on antiretroviral therapy (ART) who then had an abrupt and significant rise in viral load and fall in CD4 count to below the recommended treatment level of 350 cells/μL. She gave a history of having been given a ‘white tablet’ from the man who had trafficked her. As genuine ‘elite controllers’ are rare and do not usually follow this pattern, we suspect that this woman was unknowingly on ART.

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