CLINICAL AND LABORATORY MARKERS OF DIGESTIVE SYSTEM DISEASES IN HIV-INFECTED PATIENTS FOR FAMILY MEDICINE PRACTICE

The aim: To identify clinical and laboratory signs of digestive system disease in HIV-infected patients for helping family physicians. Materials and methods: Research was conducted at five regional HIV / AIDS centers in Ukraine during 2017-2019. Randomly selected 342 adult HIV-infected patients were divided into two groups, with concomitant digestive system diseases and without concomitant digestive system disease. Statistical analysis was performed using the software package EZR 1.41 (Saitama Medical Center, Jichi Medical University, Japan). Results: The incidence of digestive system disease in patients with HIV clinical stages II, III and IV was significantly higher than in patients with HIV clinical stage I. Gastrointestinal disease was also significantly associated with the incidence of tuberculosis, candidiasis, kidney disease and HIV encephalopathy. Incidence of asthenic-vegetative and dyspeptic syndromes, weight loss, anemia and leukopenia, elevated liver enzymes, low CD4 counts and detectable viral load levels in patients on antiretroviral therapy were significantly more common in HIV-infected patients with gastrointestinal pathologies. HIV patients with digestive system disease significantly more often had changes to their therapy regiment, interruptions in treatment and more often experienced side effects. Conclusions: Digestive system disease becomes more common with the progression of HIV infection. Comorbidity of HIV infection and digestive system disease is characterized by changes in general clinical, biochemical and immunological blood parameters and patients with digestive system comorbidities more often have a poor virological response to antiretroviral therapy.

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Longitudinal analysis of sociodemographic, clinical and therapeutic factors of HIV-infected individuals in Kinshasa at antiretroviral therapy initiation during 2006-2017

PLoS ONE ◽

10.1371/journal.pone.0259073 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259073

Author(s):

Nadine Mayasi Ngongo ◽

Gilles Darcis ◽

Hippolyte Situakibanza Nanituna ◽

Marcel Mbula Mambimbi ◽

Nathalie Maes ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Early Detection ◽

Hiv Infection ◽

Median Time ◽

Clinical Stage ◽

Hiv Care ◽

Hiv Disease ◽

Art Initiation ◽

Time To Initiation ◽

Advanced Hiv Disease

Background The benefits of antiretroviral therapy (ART) underpin the recommendations for the early detection of HIV infection and ART initiation. Late initiation (LI) of antiretroviral therapy compromises the benefits of ART both individually and in the community. Indeed, it promotes the transmission of infection and higher HIV-related morbidity and mortality with complicated and costly clinical management. This study aims to analyze the evolutionary trends in the median CD4 count, the median time to initiation of ART, the proportion of patients with advanced HIV disease at the initiation of ART between 2006 and 2017 and their factors. Methods and findings HIV-positive adults (≥ 16 years old) who initiated ART between January 1, 2006 and December 31, 2017 in 25 HIV care facilities in Kinshasa, the capital of DRC, were eligible. The data were processed anonymously. LI is defined as CD4≤350 cells/μl and/or WHO clinical stage III or IV and advanced HIV disease (AHD), as CD4≤200 cells/μl and/or stage WHO clinic IV. Factors associated with advanced HIV disease at ART initiation were analyzed, irrespective of year of enrollment in HIV care, using logistic regression models. A total of 7278 patients (55% admitted after 2013) with an average age of 40.9 years were included. The majority were composed of women (71%), highly educated women (68%) and married or widowed women (61%). The median CD4 was 213 cells/μl, 76.7% of patients had CD4≤350 cells/μl, 46.1% had CD4≤200 cells/μl, and 59% of patients were at WHO clinical stages 3 or 4. Men had a more advanced clinical stage (p <0.046) and immunosuppression (p<0.0007) than women. Overall, 70% of patients started ART late, and 25% had AHD. Between 2006 and 2017, the median CD4 count increased from 190 cells/μl to 331 cells/μl (p<0.0001), and the proportions of patients with LI and AHD decreased from 76% to 47% (p< 0.0001) and from 18.7% to 8.9% (p<0.0001), respectively. The median time to initiation of ART after screening for HIV infection decreased from 40 to zero months (p<0.0001), and the proportion of time to initiation of ART in the month increased from 39 to 93.3% (p<0.0001) in the same period. The probability of LI of ART was higher in married couples (OR: 1.7; 95% CI: 1.3–2.3) (p<0.0007) and lower in patients with higher education (OR: 0.74; 95% CI: 0.64–0.86) (p<0.0001). Conclusion Despite increasingly rapid treatment, the proportions of LI and AHD remain high. New approaches to early detection, the first condition for early ART and a key to ending the HIV epidemic, such as home and work HIV testing, HIV self-testing and screening at the point of service, must be implemented.

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Prevalence of Cognitive Impairment and Its Predictors among HIV/AIDS Patients on Antiretroviral Therapy in Jimma University Medical Center, Southwest Ethiopia

Psychiatry Journal ◽

10.1155/2019/8306823 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Getachew Yideg Yitbarek ◽

Andualem Mossie Ayana ◽

Moyeta Bariso Gare ◽

Gashaw Garedew Woldeamanuel

Keyword(s):

Cognitive Impairment ◽

Antiretroviral Therapy ◽

Medical Center ◽

Clinical Stage ◽

Cross Sectional Study ◽

Hiv Positive ◽

Cross Sectional ◽

Face To Face ◽

Khat Chewing ◽

Jimma University

Background. Cognitive impairment among human immunodeficiency virus (HIV) infected patients can lead to treatment nonadherence, faster progression of the illness, disability, and bed ridden state if we fail to detect it early. However, there is scarcity of previous published studies in Ethiopia on the assessment of cognitive impairment among HIV-positive patients. Hence, this study aimed to determine the prevalence and associated factors of cognitive impairment among HIV-positive patients receiving antiretroviral therapy (ART) at Jimma University Medical Center, Ethiopia. Methods. Hospital-based cross-sectional study was conducted among 328 HIV-positive patients attending Jimma University Medical Center, Ethiopia. Data were collected from a face-to-face interview and review of medical records using semistructured questionnaire. Validated International HIV Dementia Scale (IHDS) was used to screen for cognitive impairment. Data was analyzed using SPSS version 20. Results. A total of 328 (191 females and 137 males) HIV-positive patients were included in the study with a response rate of 97.04%. The prevalence of cognitive impairment among HIV-positive patients was 35.7%. Factors significantly associated with cognitive impairment were age group of 41−64 years (adjusted odds ratio [AOR] = 3.1, 95% confidence interval [CI] (1.3, 7.4)], plasma HIV-1 RNA load between 1.7log10 and 3log10 copies/ml [AOR = 2.2, 95% CI (1.1,4.3)] and ≥ 3log10 copies/ml [AOR = 7.5, 95% CI (2.6, 21.5)], khat chewing [AOR = 4.4, 95% CI (2.3, 8.3)], and clinical stage III of the disease [AOR = 5.6, 95% CI (1.7, 19.2)]. Conclusion. Despite the use of ART, the burden of cognitive impairment among HIV patients was high. Older age, khat chewing, advanced stage of the disease, and higher viral load were the independent factors associated with cognitive impairment. Thus, continuous screening of cognitive impairment, identification of the possible risk factors, and proper management strategy should be designed.

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Analysis of the Prevalence of Digestive System Diseases in the Republic of Karakalpakstan

Bulletin of Science and Practice ◽

10.33619/2414-2948/42/11 ◽

2019 ◽

Vol 5 (5) ◽

pp. 83-88

Author(s):

S. Nurpolatova ◽

J. Jaibergenova ◽

G. Karimov

Keyword(s):

Ulcerative Colitis ◽

Gastrointestinal Tract ◽

Digestive System ◽

Medical Center ◽

Development Stage ◽

Chronic Cholecystitis ◽

Initial Development ◽

Number Of Patients ◽

Digestive System Diseases ◽

The Republic

The analysis of the incidence rate associated with disorders in the gastrointestinal tract among the population of the Republic of Karakalpakstan for the period 2016–2017 is presented. Patients who received treatment in the Department of Gastroenterology of the Khalmuratov Republican Multidisciplinary Medical Center. Studies have shown an increase in the number of patients with a diagnosis of ulcerative colitis, chronic cholecystitis, chronic pancreatitis, chronic hepatitis, cirrhosis of the liver. In order to prevent diseases of the gastrointestinal tract, it is necessary to carry out measures for early diagnosis using the latest technologies and treatment of diseases at the initial development stage

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SOME ASPECTS OF MANAGEMENT OF HIV-INFECTED PATIENTS WITH PATHOLOGY OF DIGESTIVE SYSTEM IN CONTEXT OF FAMILY MEDICINE PRACTICE

Eastern Ukrainian Medical Journal ◽

10.21272/eumj.2020;8(1):72-83 ◽

2020 ◽

Vol 8 (1) ◽

pp. 72-83

Author(s):

O. A. Golubovska ◽

V. I. Vysotskyi

Keyword(s):

Antiretroviral Therapy ◽

Family Medicine ◽

Hiv Infection ◽

Digestive System ◽

Inflammatory Diseases ◽

Immunological Response ◽

Virologic Response ◽

Medical Surveillance ◽

Treatment Regimens ◽

Treatment Interruptions

Introduction. In the current situation of the HIV-infection epidemic, every 100-th citizen of Ukraine aged between 15 and 49 is infected with HIV. It is one of the highest rates among countries in the European Region. The issue of retaining HIV-positive patients in the medical surveillance system and support for adherence to ART treatment are becoming particularly relevant. At the same time, the comorbidity of HIV-infection with digestive system lesion is one of the main elements of pathological changes, both in the progression of HIV infection and in the occurrence of various complications leading to interruptions or failure to receive continuous antiretroviral therapy (ART). The purpose of the study is to examine the features of the digestive system lesions of HIV-infected patients and their impact on the effectiveness of antiretroviral therapy. Materials and methods. The study was conducted on randomly selected 215 HIV-infected patients in compliance with the bioethical and scientific standards, in accordance with industry standards and clinical guidelines approved by the Ministry of Health of Ukraine. Results and Discussion. Patients were divided into two comparison groups: the main group (MG) had 158 (73.5%) of HIV-infected persons with pathology of the digestive system, the controlled group (СG) had 57 (26.5%) of HIV-infected patients with no signs of gastric lesions of the gastrointestinal tract. Among the lesions of the digestive system in HIV-infected patients, hepatitis of viral and/or toxic genesis, chronic inflammatory diseases of the esophagus and gastroduodenal zone, chronic pancreatitis and cholecystitis were most often observed. In 61.4%, the pathology of the digestive tract was combined. When evaluating the efficacy of ART, no statistical difference was found between MG and CG in the frequency of the virologic response and the level of viral load at the beginning of the study and at 6 months of follow-up. However, MG patients had a worse immunologic response compared to CG, they were significantly more likely to switch the initial ART regimen, have breaks in treatment and development of adverse reactions. Patients treated for comorbid digestive system disorders had ART replacements less frequently and after 6 months of treatment they had an average level of CD4 + lymphocytes, which corresponded to the normal value. Conclusions. A significant majority of the examined patients with HIV-infection had digestive system lesions (73.5%). HIV-infected patients with digestive system pathology had more treatment interruptions, switch of ART regimens, and a worse immunological response, compared with the controlled group. Untreated diseases of the digestive system could be predictors of an increased break rate of ART, switch of treatment regimens, and decreased treatment efficacy. The introduction of an integrated, patient-oriented approach to the management of these nosologies in family medicine practice is proposed.

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Biochemical Modifications in HIV-Infected Children and Adolescents Under Antiretroviral Therapy

Revista de Chimie ◽

10.37358/rc.17.11.5932 ◽

2017 ◽

Vol 68 (11) ◽

pp. 2578-2581

Author(s):

Gheorghita Jugulete ◽

Simona Iacob ◽

Madalina Merisescu ◽

Monica Luminos

Keyword(s):

Retrospective Study ◽

Antiretroviral Therapy ◽

Hiv Infection ◽

Children And Adolescents ◽

Protease Inhibitors ◽

Liver Enzymes ◽

Serum Glucose ◽

Elevated Liver Enzymes ◽

Hiv Seropositive

In this paper we propose to present the biochemical modifications in children and adolescents with HIV infection/AIDS undergoing antiretroviral therapy (ART). We have carried out a retrospective study on 200 HIV-seropositive children registered in our department, without any prior workup modifications, in which antiretroviral therapy was initiated. In all patients we have monitored serum glucose, amylasemia, natremia, and liver enzymes. Most of the biochemical modifications were mild and moderate and did not necessitate cessation of therapy. In only 2 cases, modifications were severe enough to impose a temporary interruption of the ART: one case with elevated triglycerides and one case with elevated liver enzymes. After 24 months of ART, approximately 11.5% (23/200) of the monitored patients had biochemical modifications: 3.5 % elevated triglycerides, 5% elevated liver enzymes, 2.5 % hyperamylasemia, and 0.5 % hypernatremia. Biochemical modifications were more significant in patients who received prior antiretroviral therapy, particularly those who received protease inhibitors (PIs) in comparison to patients naive to ART.

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Leukocytoclastic vasculitis associated with nontyphoidal Salmonella in a patient infected with human immunodeficiency virus

International Journal of STD & AIDS ◽

10.1177/0956462419900847 ◽

2020 ◽

Vol 31 (4) ◽

pp. 383-386

Author(s):

Gonzalo Cornejo-Venegas ◽

Juan José Montenegro-Idrogo ◽

Cristhian Resurrección-Delgado ◽

Carolina Mendez-Guerra ◽

Andres Quevedo-Ramirez ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Antiretroviral Therapy ◽

Hiv Infection ◽

Leukocytoclastic Vasculitis ◽

Clinical Stage ◽

Corticosteroid Treatment ◽

Skin Lesions ◽

Meningococcal Infection ◽

Immunodeficiency Virus ◽

History Of

A 27-year-old Peruvian woman living with human immunodeficiency virus (HIV) in clinical stage B3 and not on antiretroviral therapy presented with a ten-day history of fever, chills, night sweats and a two-day history of skin lesions. On physical examination, several erythematous-purplish lesions were found on the face and legs. Meningococcal infection was suspected and ceftriaxone was started. Blood culture grew nontyphoidal Salmonella enterica. A biopsy of the skin lesions showed leukocytoclastic vasculitis (LCV); therefore, corticosteroids were added. After two weeks of antibiotic and corticosteroid treatment, the lesions had resolved, but they recurred two days after treatment with prednisone was stopped. Corticosteroids and combination antiretroviral therapy were started simultaneously and the lesions resolved without recurrence. HIV infection has been associated with higher rates of skin lesions in salmonellosis. LCV has been described both in the setting of HIV infection and salmonellosis. However, our review of the literature found no previous cases of LCV in concurrent HIV and salmonellosis.

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Investigation of Disease Spectrum and Analysis of Risk Factor for Digestive System Diseases of Chinese Army During a Field Training on The Midland of China

10.21203/rs.3.rs-706793/v1 ◽

2021 ◽

Author(s):

Guanjun Zhang ◽

Mingyang Li ◽

Fan Lin ◽

Yizhe Zhang ◽

Haohui Li ◽

...

Keyword(s):

Risk Factors ◽

Military Service ◽

Digestive System ◽

Treatment Strategies ◽

Training Time ◽

Field Training ◽

System Disease ◽

Disease Spectrum ◽

Digestive Diseases ◽

Digestive System Diseases

Abstract Objective To investigate the digestive disease spectrum of Chinese army servicemen during a field training on the midland and to analyze risk factors of diseases in order to discuss the relative prevention and treatment strategies.Methods Seven troops during a field training on the midland of China were randomly selected by using stratified cluster random sampling methods, all soldiers in that received a questionnaire survey, and then we collected all questionnaires and summarized the soldiers’ digestive system disease spectrum, and discussed risk factors for diseases.Results 3055 valid questionnaires were finally collected,896 soldiers had digestive symptoms, and of all symptoms diarrhea was the most common,whose ratio was 29.3%; 507 soldiers suffered from digestive system diseases, including gastritis, enteritis,digestive ulcer, functional bowel disease, which were more common. By the logistic regression analysis, length of military service time, identity of army officer,length of a field training time,training pressure, chilled abdomen, and defiled food were possible risk factors for digestive diseases.Conclusions During a field training, a healthy and regular diet, the thermal outfit, appropriate decompression of negative emotions and reasonable training time may effectively decrease the risk of digestive diseases, so that to reduce attrition.

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Justification of the integrated approach to management of hiv-infected patients with comorbid pathology of the digestive system

Psychosomatic Medicine and General Practice ◽

10.26766/pmgp.v5i2.259 ◽

2020 ◽

Vol 5 (2) ◽

Author(s):

Olga Holubovska ◽

Volodymyr Vysotskyi

Keyword(s):

Antiretroviral Therapy ◽

Early Diagnosis ◽

Hiv Infection ◽

Digestive System ◽

Integrated Management ◽

Family Physicians ◽

Infected People ◽

Gastrointestinal Pathology ◽

Hiv Aids

Introduction. Among the main strategic and operational goals of the State Strategy for Combating HIV / AIDS, Tuberculosis and Viral Hepatitis by 2030 in Ukraine is to ensure comprehensive access to HIV treatment, increase the effectiveness of monitoring and support of treatment of both opportunistic infections and other somatic conditions in HIV-infected patients. The key role of family physicians in the detection and treatment of many chronic gastrointestinal complications in HIV-infected patients is recognized. Purpose of the study. To increase the efficiency of early diagnosis and tactics of integrated management of HIV-infected patients of family physicians (FP) by clarifying the peculiarities of HIV infection in the presence of comorbid pathology of the digestive system (DS) and creating an algorithm for providing medical care to these patients. Material and methods. The research was conducted on the basis of five regional HIV / AIDS centers of Ukraine during 2017-2019. Randomly selected 342 adult HIV-infected patients were divided into two groups - with concomitant lesions and without concomitant gastrointestinal lesions. The following research methods were used: general clinical and laboratory biochemical, molecular genetic, immunological, enzyme-linked immunosorbent, instrumental (FGDS, chest radiography, abdominal ultrasound, computed tomography of the chest and / or abdominal cavity), analysis of primary medical records, consultations related specialists according to the indications, questionnaires, statistical methods. Results and discussion. It was found that the incidence of gastrointestinal pathology in patients with II, III and IV clinical stages of HIV infection was significantly higher than in patients with stage I, significantly more often associated with tuberculosis, candidiasis, kidney disease and HIV encephalopathy and was combined. Manifestations of asthenovegetative and dyspeptic syndromes, weight loss, anemia and leukopenia, increased activity of liver enzymes, low levels of CD4 + lymphocytes and preservation of viral load on antiretroviral therapy were significantly more common in HIV-infected patients with gastrointestinal pathology. In the presence of pathology of the digestive system, replacements, breaks and side effects of antiretroviral therapy were significantly more frequent. The results of physicians survey analysis showed the role of family physicians in the current examination and management of HIV-infected people with comorbid pathology of the digestive system. Conclusions. To detect diseases of the organs of the DS in HIV-infected people, it is necessary to conduct a comprehensive laboratory and instrumental examination, taking into account the possibility of combined pathology. The proposed algorithm of integrated management of HIV-infected patients with comorbid pathology of DS by FPs, taking into account the most informative clinical and laboratory criteria, allows to increase the effectiveness of early diagnosis and tactics of integrated management of HIV-infected by FPs.

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