scholarly journals CD4 Count and anti Retroviral Therapy for HIV Positive Patients with Cancer in Nigeria -A Pilot Study

2010 ◽  
Vol 4 ◽  
pp. CMO.S5028 ◽  
Author(s):  
Atara I. Ntekim ◽  
Ayo M. Folasire
Keyword(s):  
Performance Status ◽  
Cd4 Count ◽  
Hiv Positive ◽  
Ecog Performance Status ◽  
College Hospital ◽  
Cd4 Counts ◽  
Patients With Cancer ◽  
Highly Active ◽  
History Of ◽  
Oncology Treatment

Background Highly Active Anti Retroviral Treatment (HAART) improves the outcome of HIV positive patients treated for cancer. In our center HAART is only commenced in HIV positive patients with malignancy if the CD4 T lymphocyte count is less than 200 cells/ul. Presently, the outcome of treatment in these patients is poor. Objective To evaluate the influence of CD4 T- cell count and HAART on treatment outcome of HIV positive patients with cancer managed at the oncology service of The University College Hospital, Ibadan- South West Nigeria. Patients and Methods Twenty two adult HIV positive patients with malignancies who presented for treatment at our hospital from 2007 to 2009 were closely monitored by the investigators. Relevant clinical data collected included age, sex, HIV status, type of malignancy, CD4 counts, history of ART, ECOG performance status, prescribed oncology treatment with regularity of treatment and to follow up conditions. Results Twenty two patients aged between 26 and 67 years were evaluated. The performance status of all patients was at least ECOG 2. Three ART naive patients with initial CD4 counts 450 cells/ul and above were able to complete oncology treatment without HAART with good malignant disease control. Five other patients on HAART before the diagnosis of malignancy with CD4 counts 350 cells/ul and above were also able to complete their treatments on schedule with good outcome. Eight HAART naive patients with initial CD4 counts less than 370 cells/ul had inconsistent treatments with poor outcome. Conclusion Based on these observations, we propose that HAART should be commenced on all HIV positive patients diagnosed with malignancy with an initial CD4 count less than 450 cells/ul in our environment. Further studies in low resource settings with appropriate sample sizes are however needed to validate these findings.

Cervical cancer in patients infected with human immunodeficiency virus (HIV)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5544-5544
Author(s):  
M. M. Leitao ◽  
P. White ◽  
B. M. Cracchiolo
Keyword(s):  
Cervical Cancer ◽  
Highly Active Antiretroviral Therapy ◽  
Invasive Cervical Cancer ◽  
Cd4 Count ◽  
University Hospital ◽  
Smoking History ◽  
Hiv Positive ◽  
Hiv Viral Load ◽  
Cd4 Counts ◽  
Highly Active

5544 Background: The objective of this study was to compare the HIV viral load (VL), and CD4 counts (CD4) in patients infected with HIV with and without cervical cancer. We hypothesize that HIV positive women with inadequate HIV control, as reflected by the degree of immune suppression, will be at the highest risk of developing cervical cancer. Methods: We performed a case-control study of all patients seen at University Hospital from 1/1/95 - 4/30/06. All patients were HIV positive and were identified using an institutional electronic patient database and University Hospital Cancer Registry using ICD-9 codes. Cases were patients diagnosed with invasive cervical cancer and controls were patients without invasive cervical cancer. Patients were used as a control if there was documentation of a normal gynecologic exam without clinical or histopathologic evidence of cervical cancer. CD4 counts and viral loads were then abstracted from the electronic medical chart. Patients were kept as cases or controls if they had a CD4 count <6 months before or <1 month after the diagnosis of invasive cervical cancer (cases) or from the last gynecologic exam (controls). Controls were matched to cases on a 4:1 ratio according to current smoking history. Patients were considered immunocompetent if they had both CD4 counts >200 and VL <10,000. SPSS version 12.0 statistical software was used to analyze our data. Results: A total of 15 cases and 60 controls were identified. The majority (67 [89%]) of patients were African-American. The median CD4 count for the cases was 208 (range 18 - 1102) compared to 445 (range 20 - 1201) for the controls (p=0.03). The median VL was 16,918 (range 50 - 214,915) for the cases compared to 1,430 (range 50 - 571,000) for the controls (p=0.15). Only one (7.1%) of 14 cases was immunocompetent compared to 35 (63.6%) of 55 controls (OR 0.04 [95% CI: 0, 0.37; p<0.001]). This significance was maintained after adjusting for current highly active antiretroviral therapy (HAART) use, number of years known to be HIV infected, and patient age (p=0.002). Conclusions: Patients with HIV who are diagnosed with invasive cervical cancer appear to have a much greater degree of immunosuppression than women with HIV without invasive cervical cancer. No significant financial relationships to disclose.

Changes in acquired immunodeficiency syndrome–related lymphoma since the introduction of highly active antiretroviral therapy

Blood ◽  
2000 ◽  
Vol 96 (8) ◽  
pp. 2730-2734 ◽  
Author(s):  
Gail V. Matthews ◽  
Mark Bower ◽  
Sundhiya Mandalia ◽  
Tom Powles ◽  
Mark R. Nelson ◽  
...  
Keyword(s):  
Statistical Models ◽  
Highly Active Antiretroviral Therapy ◽  
Performance Status ◽  
Cd4 Count ◽  
Survival Duration ◽  
Hiv Positive ◽  
Highly Active ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome

Clinical data on 7840 HIV-positive patients, representing 43 745 patient-years of follow-up, has been collected. All patients with ARL since 1986 (n = 150) were assessed at presentation for prognostic factors and outcomes recorded. Comparisons are made between cases in the pre-HAART era (1988-1995), and the HAART era (1996-1999). Statistical models are used to calculate the incidence of ARL and factors predicting its development. The incidence of ARL has not changed over time (3 to 7 of 1000 patients per year,P = .933), but contributes to a greater percentage of first AIDS-defining illnesses (ADI) in the HAART era (P ≤ .0001). Older age, nadir CD4 count, and no prior HAART use, predict the development of ARL. There has been no change in stage at presentation, presence of B symptoms, performance status, or marrow involvement between the 2 time cohorts or between patients with or without prior HAART exposure. Similarly, there is no difference in survival duration between the pre-HAART and HAART era (log rankP = .15) or specifically in patients treated with HAART before ARL diagnosis (log rank P = .12). The use of HAART has not yet been shown to influence the incidence or survival of ARL. However, because nadir CD4 count and use of HAART are independent predictors of ARL development, this may translate into a future fall in new cases.

Changes in acquired immunodeficiency syndrome–related lymphoma since the introduction of highly active antiretroviral therapy

Blood ◽  
2000 ◽  
Vol 96 (8) ◽  
pp. 2730-2734 ◽  
Author(s):  
Gail V. Matthews ◽  
Mark Bower ◽  
Sundhiya Mandalia ◽  
Tom Powles ◽  
Mark R. Nelson ◽  
...  
Keyword(s):  
Statistical Models ◽  
Highly Active Antiretroviral Therapy ◽  
Performance Status ◽  
Cd4 Count ◽  
Survival Duration ◽  
Hiv Positive ◽  
Highly Active ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome

Abstract Clinical data on 7840 HIV-positive patients, representing 43 745 patient-years of follow-up, has been collected. All patients with ARL since 1986 (n = 150) were assessed at presentation for prognostic factors and outcomes recorded. Comparisons are made between cases in the pre-HAART era (1988-1995), and the HAART era (1996-1999). Statistical models are used to calculate the incidence of ARL and factors predicting its development. The incidence of ARL has not changed over time (3 to 7 of 1000 patients per year,P = .933), but contributes to a greater percentage of first AIDS-defining illnesses (ADI) in the HAART era (P ≤ .0001). Older age, nadir CD4 count, and no prior HAART use, predict the development of ARL. There has been no change in stage at presentation, presence of B symptoms, performance status, or marrow involvement between the 2 time cohorts or between patients with or without prior HAART exposure. Similarly, there is no difference in survival duration between the pre-HAART and HAART era (log rankP = .15) or specifically in patients treated with HAART before ARL diagnosis (log rank P = .12). The use of HAART has not yet been shown to influence the incidence or survival of ARL. However, because nadir CD4 count and use of HAART are independent predictors of ARL development, this may translate into a future fall in new cases.

scholarly journals THE ROLE OF HIV IN THE PATHOGENESIS OF ADULT-ONSET VERNAL KERATOCONJUNCTIVITIS: A DEMOGRAPHIC AND EPIDEMIOLOGICAL STUDY

2019 ◽  
Author(s):  
Anine Kritzinger ◽  
Anthony Grant Zaborowski ◽  
Wilbert Sibanda ◽  
Linda Visser
Keyword(s):  
Cd4 Count ◽  
Vernal Keratoconjunctivitis ◽  
Hiv Positive ◽  
P Value ◽  
Adult Onset ◽  
Atopic Diseases ◽  
Hiv Status ◽  
Chi Squared ◽  
History Of ◽  
New Onset

Abstract Background: Very few studies in the literature describe adult-onset vernal keratoconjunctivitis (VKC). HIV has many associated ocular pathologies and an association with VKC has not been described yet. The aim is to identify and describe patients who present with new-onset VKC after puberty, with no prior history of atopic diseases or allergies. Methods: The study consisted of two parts: the first part was a prospective observational descriptive study of patients with adult-onset VKC, detailing the epidemiological and demographic characteristics of these patients, including their HIV status. The second was a case-control study to determine the relationship of a CD4 count with adult-onset VKC in the setting of HIV. Patients were recruited between January 2016 and November 2017 from McCord Provincial Eye hospital, one of two large referral hospitals for the province of KwaZulu-Natal, South Africa. Patients presenting to the Eye clinic were screened at the Primary Eye Care Unit. Inclusion criteria were age 15 years and older with signs and symptoms of new-onset VKC. Exclusion criteria were a history of childhood atopic diseases, atopic keratoconjunctivitis and patients who refused HIV testing. Data collected included HIV status, CD4 count where appropriate, anti-nuclear antibodies and total serum immunoglobulin E. Results: 33 patients were included in this study; females n=16, males n=17. The mean age at presentation was 32.45±9.93 years, 95% CI=28.94-35.97. All of the patients were black Africans. One patient tested ANA positive. 51.5% of patients had a raised IgE level. A total of 13 of 25 HIV positive patients (52%) had a raised IgE. The proportion of HIV positive patients was statistically different from the HIV negative group, with Chi-squared = 21.866, p-value <0.0001. 72% of the HIV positive patients were grouped as immunodeficient according to their CD4 counts. An association was proven between severely immunodeficient patients and the risk of having VKC (chi-squared=4.992, p-value=0.0255). Conclusion: In this cohort a statistically significant association was found between adult-onset vernal keratoconjunctivitis and an HIV positive status. This association calls for more research on the subject, but could imply that patients presenting with adult-onset VKC should be offered an HIV test. Key words: Vernal keratoconjunctivitis, New-onset VKC Adult-onset VKC Ocular manifestations of HIV Allergy Immunocompromised.

scholarly journals Beneficial Treatment Management with Trifluridine/Tipiracil in a Patient with Metastatic Colorectal Cancer and Pronounced Hematological Event History during Previous Treatments

2018 ◽  
Vol 11 (1) ◽  
pp. 43-48 ◽  
Author(s):  
Volker Kaechele ◽  
Jürgen Hess ◽  
Wolfgang Schneider-Kappus
Keyword(s):  
Colorectal Cancer ◽  
Metastatic Colorectal Cancer ◽  
Dose Reduction ◽  
Performance Status ◽  
Recommended Dose ◽  
Hematological Toxicity ◽  
Ecog Performance Status ◽  
History Of ◽  
Grade 3

Trifluridine/tipiracil (FTD/TPI) significantly improves overall survival in patients with metastatic colorectal cancer (mCRC). The most common treatment-related event (grade ≥3) was hematological toxicity. We here report long-term disease-stabilizing FTD/TPI treatment of an mCRC patient (KRAS wild-type, ECOG performance status 1 at baseline and at the end of FTD/TPI therapy) with multifocal synchronous metastases and a longstanding history of extensive hematological events during previous treatments. Finally, this 62-year-old male patient was treated for 10 months with FTD/TPI by consecutive alteration of treatment parameters: (i) initial daily dose reduction to 80 mg (72% of the recommended dose), (ii) 20 days dose delay, (iii) a second and later third dose reduction to 70 mg and 60 mg (about 64% and 55%, respectively, of the recommended dose), and (iv) 30 µg per day of granulocyte colony-stimulating factor administration first for 3 days, and later for 5 days, for each treatment cycle.

scholarly journals Pneumocystis jirovecii Pneumonia in a HIV-Infected Patient with a CD4 Count Greater Than 400 Cells/μL and Atovaquone Prophylaxis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Abigayle Sullivan ◽  
Theresa Lanham ◽  
Ronald Krol ◽  
Shilla Zachariah
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Lung Biopsy ◽  
Cd4 Count ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Silver Stain ◽  
Highly Active ◽  
History Of ◽  
Methenamine Silver ◽  
Methenamine Silver Stain

We describe a rare case of Pneumocystis jirovecii pneumonia (PCP) in a heterosexual man with a pertinent medical history of well-controlled human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) and PCP prophylaxis with atovaquone. The patient presented with recurrent shortness of breath, worsening malaise, and fever, following treatment for hypersensitivity pneumonitis one month prior, including a twenty-four-day course of 40 milligrams daily glucocorticoid with taper. However, transbronchial biopsies, lavage, and cytology from prior admission were inconclusive. The patient refused video-assisted thoracic surgery (VATS) at that time. Upon readmission, bronchoscopy with right VATS and lung biopsy were performed. Grocott’s methenamine silver stain of right lung biopsy was positive for Pneumocystis jirovecii. This case is a rare example of PCP in a patient with a normal CD4 count (>487 cells/μL) and a low viral load (<20 copies/mL) despite PCP prophylactic antibiotics in the setting of recent iatrogenic immunosuppression.

scholarly journals Trans-abdominal ultrasonic findings correlated with CD4+ counts in adult HIV-infected patients in Benin, Nigeria

2009 ◽  
Vol 13 (2) ◽  
pp. 34 ◽  
Author(s):  
B O-E Igbinedion ◽  
T T Marchie ◽  
E Ogbeide
Keyword(s):  
Abdominal Ultrasound ◽  
Cd4 Count ◽  
Hiv Positive ◽  
Abdominal Ultrasonography ◽  
Cd4 Counts ◽  
Splenic Parenchyma ◽  
Ultrasound Findings ◽  
The Common ◽  
Classification Index ◽  
The University

Objective: The objective of this study is to document the abdominal ultrasound findings in HIV infected patients and compare it with their CD4+ count. Patients and method: 300 confirmed HIV positive patients had abdominal ultrasonography done at the University of Benin Teaching Hospital from November 2007 to January 2008. Each patient’s sonographic findings were correlated with their CD4+ category using the WHO’s HIV classification index. Result: Splenomegaly, hepatomegaly, renomegaly, hyperechoic splenic parenchyma, increased renal echogenicity and lymphadenopathy are among the common sonographic findings. However, few of these findings correlated statistically with the CD4+ count. Conclusion: The versatile diagnostic tool, ultrasound, should continue to be an important imaging equipment in several impoverished communities. In the evaluation of HIV infected patients, its use is invaluable and should be promoted.

A phase II study of capecitabine and oxaliplatin (CAPOX) in metastatic adenocarcinoma of the small bowel (SBA) or ampulla of Vater

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14025-14025
Author(s):  
M. J. Overman ◽  
S. Chedid ◽  
J. Morris ◽  
S. Waldrum ◽  
R. A. Wolff
Keyword(s):  
Small Bowel ◽  
Performance Status ◽  
Complete Response ◽  
Ampulla Of Vater ◽  
Ecog Performance Status ◽  
Ampullary Adenocarcinoma ◽  
Highly Active ◽  
Common Grade ◽  
Grade 3 ◽  
Tumor Types

14025 Background: Metastatic SBA and ampullary adenocarcinoma (AAC) are incurable, aggressive malignancies. Limited data exists regarding the role of systemic chemotherapy in these diseases. Given the marked activity of CAPOX in other cancers of the gastrointestinal tract, we have investigated the activity of this combination in these two tumor types. Methods: Patients (pts) with either metastatic or unresectable SBA and AAC who had adequate organ function, ECOG performance status (PS) ≤2 and measurable disease per modified RECIST criteria were enrolled. Prior use of 5-FU or capecitabine as adjuvant therapy, neoadjuvant therapy, or with radiation was allowed. CAPOX was administered as a 21 day cycle with oxaliplatin 130mg/m2 IV on day 1 and capecitabine 750mg/m2 PO BID days 1–14. Up to 30 pts will be enrolled. The primary endpoint is overall response rate (ORR). Results: Eleven pts have been enrolled from 11/04 to 12/05 (6 with AAC and 5 with SBA). Ten pts have received ≥2 cycles and are evaluable for response. All pts had metastatic disease and none had received prior chemotherapy. Patient (pt) characteristics: median age 59 (49–76); M/F (4/7); 91% PS 0–1. Grade 3/4 toxicities included fatigue (5), neuropathy (1), anorexia (1), thrombocytopenia (1), hypokalemia (1), hyponatremia (1), and musculoskeletal (1). Common grade 1/2 toxicities included neuropathy (8), nausea (8), diarrhea (6), and fatigue (5). Four pts required dose reduction and 1 pt discontinued due to toxicity (grade 3 fatigue). Six pts, 3 AAC and 3 SBA, responded with an ORR of 60% (95% CI 31 to 83%). Five responses have been confirmed and 1 AAC pt obtained a complete response after 5 cycles of treatment. Median time to progression was 6.8m (95% CI 4.4 to 9.3+m). Conclusions: The combination of CAPOX is both well-tolerated and highly active. The ORR of 60% is one of the highest yet reported in the literature for the treatment of adenocarcinoma of the small bowel and ampulla of Vater. Enrollment continues on this trial. (Supported by a research grant from Sanofi-Aventis). [Table: see text]

scholarly journals ASSOCIATION BETWEEN CLUSTER OF DIFFERENTIATION 4 COUNT AND THE CLINICAL OUTCOMES OF CEREBRAL TOXOPLASMOSIS IN POSITIVE HIV PATIENTS

2020 ◽  
Vol 7 (8) ◽  
pp. 45-50
Keyword(s):  
Clinical Outcomes ◽  
Significant Relationship ◽  
Performance Status ◽  
Cd4 Count ◽  
Hiv Positive ◽  
Karnofsky Performance Scale ◽  
Karnofsky Performance Score ◽  
Cerebral Toxoplasmosis ◽  
Research Subjects ◽  
Hiv Patients

Background: About 30% to 40% of HIV patients ultimately will develop cerebral toxoplasmosis. Objectives: To determine the relationship between CD4 count and clinical outcomes of cerebral toxoplasmosis in HIV positive patients. Methods: This study uses a cross-sectional design. Sampling was conducted at the Integrated Inpatient Room at H. Adam Malik Hospital Medan. The study sample was taken as many as 31 consecutive subjects. CD4 count and KPS (Karnofsky performance score) examinations were performed. CD4 is calculated using the flow cytometry method. The Karnofsky scale is measured to determine the patient's performance status. Data analysis using fisher's exact test. Results: The demographic characteristics of the research subjects were male (93,5%), age range 34,38 ± 7,67 years, marital status (64,5%), high school education level (74,2%), and entrepreneurial work (64,5%). CD4 count < 100 were obtained in 67.7% of subjects with a median value of 25 (2-480). As many as 77.4 % of subjects had a karnofsky scale value of 70 with a median value of 50 (0-80). There is a significant relationship between CD4 count and clinical outcomes of cerebral toxoplasmosis in HIV positive patients, while CD4 <100 cells / µL can increase clinical risk with a Karnofsky Performance Scale (KPS) score 70 to 1.8 times greater (p = 0.02 and PR = 1.8 and Confidence Interval 95% = 0,95-3,41). Conclusions: There is a significant relationship between CD4 count and clinical outcomes of cerebral toxoplasmosis in HIV positive patients.

scholarly journals Prevalence of opportunistic infections in HIV-positive patients in Bahrain: a four-year review (2009-2013)

2015 ◽  
Vol 9 (01) ◽  
pp. 060-069 ◽  
Author(s):  
Nermin Kamal Saeed ◽  
Eman Farid ◽  
Afaf E Jamsheer
Keyword(s):  
Bacterial Infections ◽  
Opportunistic Infections ◽  
Arab World ◽  
Cd4 Count ◽  
Hiv Positive ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Cd4 Counts ◽  
Significant Difference ◽  
Streptococcus Milleri ◽  
Mycobacteria Other Than Tuberculosis

Introduction: This study aimed to examine the prevalence of opportunistic infections in HIV-infected patients in Bahrain and its relation to absolute CD4 count, CD4%, and CD4/CD8 ratio. Methodology: This retrospective cohort study used laboratory records (January 2009 - May 2013) from a major hospital in Bahrain. Opportunistic infections (OIs); absolute CD4 counts, CD4%, and CD4/CD8 ratio were recorded. Results: CD4% and absolute CD4 count in HIV patients with associated infections (157 ± 295) was significantly lower than in those without associated infections (471 ± 285) (p < 0.001). There was no significant difference in CD4/CD8 ratio between the two groups. Infection with Staphylococcus aureus was the commonest infection, present in 9.8% of total HIV-infected patients and 28.7% of members of the AIDS patient group with OIs, followed by yeast infections (9.2% and 27.2%, respectively). Mycobacterium tuberculosis was present in 3.6% of total HIV-infected patients and 10.6% of the group with OIs, while mycobacteria other than tuberculosis (MOTT) was present in 2.5% and 7.5%, respectively. Pneumocystis jirovecii pneumonia (PCP) was observed in 5.1% and 15.1%, respectively. Herpes simplex II (HSV-II) was observed in 3% and 9%, respectively, while Cytomegalovirus antigenemia was only present in 2% and 6%, respectively. Streptococcus pneumoniae, Streptococcus milleri, Stenotrophomonas maltophilia, and Citrobacter species were bacterial infections observed least frequently. Conclusions: Studying the pattern of OIs in HIV-infected patients in Bahrain is of paramount importance due to the scarcity of data in the Arab world. This will help to improve physicians’ awareness to improve care of HIV-infected patients.

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