Human Polyomavirus-Associated Cerebral Disorders in the Post-HAART Era

Human polyomavirus JC is the causative agent of a deadly form of sudden onset dementia, progressive multifocal leukocoencephalopathy (PML). PML is highly prevalent in immunodeficient populations, specially those undergoing chemotherapy, immunosuppressive treatments for autoimmune conditions, and HIV-1/AIDS patients. In fact, before the highly active antiretroviral therapy (HAART) regimens became available, PML was a leading cause of death in HIV-1 seropositive individuals. However, patients under HAART show increased survival times with better prognoses. In this report we described the main differences between PML before and after the HAART era; highlighting the new patterns of presentation, the neurotropism of other human polyomaviruses, and the increased prevalence of immune reconstitution inflammatory syndrome (IRIS), as a complication of PML in patients under HAART. Lastly, we propose a revised classification of human poliomavirus-associated cerebral disorders that may reflect more accurately what clinicians encounter in their everyday practice.

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Measuring Recent Thymic Emigrants in Blood of Normal and HIV-1–Infected Individuals before and after Effective Therapy

Journal of Experimental Medicine ◽

10.1084/jem.190.5.725 ◽

1999 ◽

Vol 190 (5) ◽

pp. 725-732 ◽

Cited By ~ 264

Author(s):

Linqi Zhang ◽

Sharon R. Lewin ◽

Martin Markowitz ◽

Hsi-Hsun Lin ◽

Eva Skulsky ◽

...

Keyword(s):

Highly Active Antiretroviral Therapy ◽

Cell Receptor ◽

Appreciable Effect ◽

Recent Thymic Emigrants ◽

Sharp Drop ◽

Highly Active ◽

Normal Individuals ◽

Before And After ◽

Cd4 Lymphocyte ◽

Hiv 1

The role of the thymus in HIV-1 pathogenesis remains unclear. We developed an assay to quantify the number of recent thymic emigrants in blood based on the detection of a major excisional DNA byproduct (termed α1 circle) of T cell receptor rearrangement. By studying 532 normal individuals, we found that α1 circle numbers in blood remain high for the first 10–15 yr of life, a sharp drop is seen in the late teen years, and a gradual decline occurs thereafter. Compared with age-matched uninfected control individuals, α1 circle numbers in HIV-1–infected adults were significantly reduced; however, there were many individuals with normal α1 circle numbers. In 74 individuals receiving highly active antiretroviral therapy, we found no appreciable effect on α1 circle numbers in those whose baseline values were already within the normal range, but significant increases were observed in those with a preexisting impairment. The increases in α1 circle numbers were, however, numerically insufficient to account for the rise in levels of naive T lymphocytes. Overall, it is difficult to invoke thymic regenerative failure as a generalized mechanism for CD4 lymphocyte depletion in HIV-1 infection, as α1 circle numbers are normal in a substantial subset of HIV-1–infected individuals.

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Hematological parameters abnormalities and associated factors in HIV-positive adults before and after highly active antiretroviral treatment in Goba Referral Hospital, southeast Ethiopia: A cross-sectional study

SAGE Open Medicine ◽

10.1177/20503121211020175 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110201

Author(s):

Negesso Duguma ◽

Girum Tesfaye Kiya ◽

Wondimagegn Adissu Maleko ◽

Lealem Gedefaw Bimerew

Keyword(s):

Antiretroviral Therapy ◽

Highly Active Antiretroviral Therapy ◽

Hematological Parameters ◽

Referral Hospital ◽

Hiv Positive ◽

Highly Active ◽

Before And After ◽

Hiv Positive Adults ◽

Hematological Abnormalities ◽

Hiv 1

Objectives: Hematological abnormalities of the major blood cell lines are frequently reported in patients with HIV-1 infection, in patients without antiretroviral therapy, and during the advanced stages of the disease. Chronic immune activation and inflammation results in the progressive depletion of CD4+ T-cells play a significant role in the clinical progression and pathogenesis of this infection. This study was aimed at assessing the prevalence of hematological abnormalities and their associated factors before and after the initiation of antiretroviral therapy in adults with HIV-1 infection in a referral hospital. Methods: The study was conducted from 1 April to 30 June 2018, at Goba Referral Hospital. A total of 308 HIV-positive adults on treatment were enrolled during the study period. Socio-demographic and clinical data were collected using a structured questionnaire, with pre-highly active antiretroviral therapy data were extracted from medical records while post-treatment immuno-hematological measurements were done on blood samples collected at the time of enrollment. Results: The prevalence of anemia, leukopenia, and thrombocytopenia before initiation of antiretroviral treatment was higher, although anemia and thrombocytopenia decreased correspondingly after initiation of treatment leukopenia increased by 4%. Mean values of immuno-hematological parameters before and after treatment initiation were significant ( p < 0.05). CD4+ T-cell count <200 cells/µL was the only independent risk factor for anemia and leukopenia before highly active antiretroviral therapy, while stage IV disease, female sex, zidovudine, lamivudine, and nevirapine treatment, and intestinal parasite infection were predictors of anemia after treatment initiation. Conclusion: The study revealed that hematological abnormalities are common in HIV infection, while the occurrence of abnormalities after highly active antiretroviral therapy initiation. Different risk factors are associated with hematological abnormalities at pre- and post-highly active antiretroviral therapy with regular monitoring of risk factors, adherence to the early initiation of highly active antiretroviral therapy, and conduct of further longitudinal studies are recommended.

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Chylous ascites in disseminated Kaposi sarcoma: an unusual manifestation as immune reconstitution inflammatory syndrome

BMJ Case Reports ◽

10.1136/bcr-2018-228406 ◽

2019 ◽

Vol 12 (3) ◽

pp. e228406 ◽

Cited By ~ 2

Author(s):

Patrícia Cipriano ◽

Inês Nabais ◽

Nuno Melo ◽

Ana Rafaela Alves

Keyword(s):

Immune Reconstitution Inflammatory Syndrome ◽

Highly Active Antiretroviral Therapy ◽

Immune Reconstitution ◽

Kaposi Sarcoma ◽

Chylous Ascites ◽

Gastrointestinal Involvement ◽

Unusual Manifestation ◽

Highly Active ◽

Inflammatory Syndrome ◽

Hiv 1

A 29-year-old man with diarrhoea, fever, abdominal pain and multiple purple papular lesions, neither pruriginous nor painful, was diagnosed with HIV-1 infection and disseminated Kaposi sarcoma (KS) with gastrointestinal involvement. He was started on highly active antiretroviral therapy immediately, as well as doxorubicin. Three weeks later, the patient developed bilateral moderate pleural effusion and large-volume ascites compatible with chylothorax and chylous ascites. An immune reconstitution inflammatory syndrome (IRIS) reaction was assumed. KS flare was associated with lymphatic obstruction and infiltration of thoracic duct by the tumour itself with leakage of chylous into pleural and peritoneal cavities. KS is the most common tumour in HIV patients and the existence of related effusions is not uncommon. KS-related chylothorax is an unusual manifestation of KS; there are only four cases described in the literature of chylous ascites related to KS–HIV. Overall survival is improving in KS but explosive and debilitating IRIS reactions can explain cases with poor prognosis.

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