scholarly journals GENERALIZED ASPERGILLOSIS ASSOCIATED WITH CLINICAL STAGE IV OF HIV INFECTION

2018 ◽  
pp. 89-94
Author(s):  
E. I. Romanova ◽  
E. L. Krasavtsev ◽  
S. V. Tarasenko
Keyword(s):  
Hiv Infection ◽  
Clinical Case ◽  
Clinical Stage ◽  
Stage Iv

The article describes a clinical case of the asymptomatic course of generalized aspergillosis associated with HIV infection diagnosed at autopsy.

scholarly journals PREDICTORS OF HIV INFECTION PROGRESSION BEFORE PRESCRIPTION AND ON ART

2019 ◽  
Vol 19 (3) ◽  
pp. 57-62
Author(s):  
O. Marchenko ◽  
T. Koval ◽  
L. Sizova ◽  
N. Pryimenko
Keyword(s):  
T Lymphocytes ◽  
Hiv Infection ◽  
Hiv Transmission ◽  
Initial Level ◽  
Clinical Stage ◽  
Stage Iv ◽  
Hemoglobin Level ◽  
Hiv Progression ◽  
Parenteral Transmission ◽  
Tlr4 Gene

The search for predictors of the progression of HIV infection to the clinical stage IV in patients before prescription and on antiretroviral therapy (ART) is an urgent scientific and practical task. The study aimed to identify predictors of the progression of HIV infection to the clinical stage IV in patients before prescribing and on the background ART based on the determination of clinical and genetic markers. A retrospective cohort study of 181 HIV-infected patients was conducted. For statistical data processing, regression analysis was used. Independent predictors of the progression of HIV infection to clinical stage IV in HIV-infected patients prior to ART were: male (p = 0,037), parenteral HIV transmission (p = 0,004), conclusion experience (p = 0,020), body mass index (BMI) less than 18.5 kg / m2 (p = 0,040), initial viral load (HV) of HIV> 1.0 x 105 copies / ml (p = 0,034), initial level of CD4 + T-lymphocytes <350 cells / μl (p = 0,000), hemoglobin level below 100 g/l (p = 0,001), the presence of which increases the risk of HIV progression to the clinical stage IV prior to prescribing ART. Independent predictors of the progression of HIV infection to the clinical stage IV in HIV-infected patients receiving ART were: parenteral transmission of HIV infection (p = 0,053), previous incarceration (p = 0,043), low adherence to ART (p = 0,028) , the initial level of CD4 + T-lymphocytes <350 cells/μl (p = 0,020), hemoglobin level below 100 g/l (p = 0,015) and carriage of the 299 Gly allele of the TLR4 gene (p = 0,016).

scholarly journals HEMATOLOGICAL CHANGES OF ENDOGENIC INTOXICATION, NON-SPECIFIC REACTIVITY AND INFLAMMATION ACTIVITY INDICES IN HIV-INFECTED PATIENTS

2020 ◽  
Vol 73 (5) ◽  
pp. 983-987
Author(s):  
Mykola D. Chemych ◽  
Dmytro S. Sosnovenko ◽  
Oksana M. Chemych ◽  
Oleh B. Berest
Keyword(s):  
Hiv Infection ◽  
Clinical Laboratory ◽  
Hematological Parameters ◽  
Clinical Stage ◽  
Laboratory Data ◽  
Statistical Processing ◽  
Stage Iv ◽  
Inflammatory Reactions ◽  
Reactivity Indices ◽  
Specific Reactivity

The aim: To establish changes in hematological parameters of endogenous intoxication, nonspecific reactivity, activity of inflammation in HIV-infected persons, to improve verification of the clinical stage of the disease. Materials and methods: Anamnestic, clinical, laboratory data. The statistical processing was performed in the Microsoft Office Excel 2010 and IBM SPSS Statistic 23 computer software, variational statistics processing (Student’s t-criteria). Results: 51 HIV-infected were examined (main group) and 44 clinically anamnestic healthy blood donors (comparison group). The study included 46 patients (5 were withdrawn due to failure to meet criteria – severe septic condition). All patients were divided into three groups: A1 – all patients, 46 persons, men 76.0%, women – 24.0%; A2 – 11 people with I-III stages of HIV infection, men 72,7%, women – 27,3%; A3 – 35 HIV infected with stage IV disease, men 76.0%, women – 24.0%. All patients had an increase in intoxication indices and sex-dependent changes. Nonspecific reactivity indices in group A1 were above the norm, independent of gender except the index of neutrophils and lymphocyte (NLR). Below the norm is the immunoreactivity index (IR), the lymphocyte-monocyte ratio index (LMR), the lymphocyte index (Ilymph), the index of allergization (IA). Indices of nonspecific reactivity of A2 patients exceeded the norm and were independent of sex, with the exception of IR, Ilymph, IA, which were reduced. Non-specific reactivity indices are increased in HIV-infected group A3. Below the norm were IR, LMR, Ilymph, IA. Analyzing the activity indexes of inflammation, it became clear that the Krebs index (KI) was increased in all groups of patients; lymphocyte-granulocyte index (ILG) in groups A1 and A3 is less than normal, unlike patients in group A2, where it remained within the normal range. The leukocyte ratio and erythrocyte sedimentation rate (ILESR) in A1 and A3 have increased rates, unlike in A2, where the index is smaller. Conclusions: Men are predominantly HIV positive. The systemic immune response is more pronounced in women. There is a progressive impairment of immunological reactivity, indicating an immunodeficiency of the cell type with a decrease in nonspecific anti-infective protection. Patients with stage IV of HIV infection have moderate and severe inflammatory reactions, impaired reactivity, and are more pronounced in women.

Impact of HIV infection on overall survival among women with stage IV breast cancer in South Africa

2021 ◽  
Author(s):  
Yoanna S. Pumpalova ◽  
Oluwatosin A. Ayeni ◽  
Wenlong Carl Chen ◽  
Daniel S. O’Neil ◽  
Sarah Nietz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
South Africa ◽  
Overall Survival ◽  
Hiv Infection ◽  
Stage Iv ◽  
Stage Iv Breast Cancer

scholarly journals Impact of superselective intra-arterial and systemic chemoradiotherapy for gingival carcinoma; analysis of treatment outcomes and prognostic factors

2020 ◽  
Author(s):  
Yuki Mukai ◽  
Yuichiro Hayashi ◽  
Izumi Koike ◽  
Toshiyuki Koizumi ◽  
Madoka Sugiura ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Clinical Stage ◽  
Performance Status ◽  
Univariate Analysis ◽  
Stage Iv ◽  
Progression Free Survival ◽  
Late Toxicity ◽  
Free Survival

Abstract Background: We compared outcomes and toxicities between concurrent retrograde super-selective intra-arterial chemoradiotherapy (IACRT) and concurrent systemic chemoradiotherapy (SCRT) for gingival carcinoma (GC).　Methods: We included 84 consecutive patients who were treated for non-metastatic GC ≥ stage III, from 2006 to 2018, in this retrospective analysis (IACRT group: n=66; SCRT group: n=18).Results: The median follow-up time was 24 (range: 1–124) months. The median prescribed dose was 60 (6–70.2) Gy (IACRT: 60 Gy; SCRT: 69 Gy). There were significant differences between the two groups in terms of 3-year overall survival (OS; IACRT: 78.8%, 95% confidence interval [CI]: 66.0–87.6; SCRT: 50.4%, 95% CI: 27.6–73.0; P = 0.039), progression-free survival (PFS; IACRT: 75.6%, 95% CI: 62.7–85.2; SCRT: 42.0%, 95% CI: 17.7–70.9; P = 0.028) and local control rates (LC; IACRT: 77.2%, 95% CI: 64.2–86.4; SCRT: 42.0%, 95% CI: 17.7–70.9; P = 0.015). In univariate analysis, age ≥ 65 years, decreased performance status (PS) and SCRT were significantly associated with worse outcomes (P < 0.05). In multivariate analysis, age ≥ 65 years, clinical stage IV, and SCRT were significantly correlated with a poor OS rate (P < 0.05). Patients with poorer PS had a significantly worse PFS rate. Regarding acute toxicity, 22 IACRT patients had grade 4 lymphopenia, and osteoradionecrosis was the most common late toxicity in both groups.Conclusions: This is the first report to compare outcomes from IACRT and SCRT among patients with GC. ALL therapy related toxicities were manageable. IACRT is an effective and safe treatment for GC.

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

PLoS ONE ◽  
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.

scholarly journals Malignant Extracranial Germ Cell Tumours: A First Report by the South African Children’s Cancer Study Group

2021 ◽  
Author(s):  
Marc Hendricks ◽  
Annibale Cois ◽  
Jennifer Geel ◽  
Jan du Plessis ◽  
Mairi Bassingthwaighte ◽  
...  
Keyword(s):  
Germ Cell ◽  
South African ◽  
Economic Status ◽  
Clinical Stage ◽  
Elevated Serum ◽  
Treatment Protocol ◽  
Stage Iv ◽  
Germ Cell Tumours ◽  
Advanced Clinical Stage ◽  
Risk Of Death

OBJECTIVE  To determine the overall survival (OS) and prognostic factors influencing outcomes in children and adolescents with malignant extracranial germ cell tumours (MEGCTs) in preparation for the development of a harmonised national treatment protocol.METHODS A retrospective folder review was undertaken at nine South African paediatric oncology units to document patient profiles, tumour and treatment-related data and outcomes for all children with biopsy proven MEGCTs from birth up to and including 16 years of age. RESULTS Between 1 January 2000 and 31 December 2015, 218 patients were diagnosed with MEGCTs. Female sex (HR 0.284 p=0.037) and higher socio-economic status (SES) (HR 0.071; p=0.039) were associated with a significantly lower risk of death. Advanced clinical stage at diagnosis significantly affected 5-year OS: stage I -96%; stage II - 94.3%; stage III -75.5%; (p=0.017) and stage IV (60.1%; p<0.001). There was a significant association between earlier stage at presentation and higher SES (p=0.03). Patients with a serum AFP level of more than 33,000 ng/ml at diagnosis had significantly poorer outcomes (p=0.002). The use of chemotherapy significantly improved survival, irrespective of the regimen used (p<0.001). CONCLUSIONS The cohort demonstrated a 5-year OS of 80.3% with an EFS of 75.3%. Stage, the use of chemotherapy and an elevated serum AFP level of more than 33,000ng/ml were independently predictive of outcome. The relationship between SES and outcome is important as the implementation of the new national protocol hopes to standardise care across the socio-economic divide.

scholarly journals Human Immunodeficiency Virus Antibody Testing by Enzyme-Linked Fluorescent and Western Blot Assays Using Serum, Gingival-Crevicular Transudate, and Urine Samples

1999 ◽  
Vol 37 (4) ◽  
pp. 1100-1106 ◽  
Author(s):  
Prudencio Martínez Martínez ◽  
Antonio Rodríguez Torres ◽  
Raul Ortiz de Lejarazu ◽  
Ana Montoya ◽  
José Francisco Martín ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Western Blot ◽  
Stage Iv ◽  
Urine Samples ◽  
World Health ◽  
Antibody Detection ◽  
Lower Sensitivity ◽  
Antibody Testing ◽  
Immunodeficiency Virus

The aim of the present study was to evaluate the possible utilization of saliva and urine as alternative samples to serum for the diagnosis of human immunodeficiency virus (HIV) infection. A total of 302 individuals participated in the study: 187 HIV-infected individuals (106 had Centers for Disease Control and Prevention [CDC] stage II infection, 19 had CDC stage III infection, and 62 had CDC stage IV infection) and 115 noninfected persons (46 of the noninfected persons were blood donors and 69 belonged to a group at high risk of HIV infection). Paired saliva and urine samples were taken from each of the participants in the study. The presence of HIV-specific antibodies was detected by an enzyme-linked fluorescent assay (ELFA), and the result was confirmed by Western blot analysis (WB). The ELFA with saliva gave maximum sensitivity and specificity values, while ELFA had lower sensitivity (95.2%) and specificity (97.4%) values for detection of HIV antibody in urine samples. WB with all saliva samples fulfilled the World Health Organization criterion for positivity, while only 96.8% of the urine samples were confirmed to be positive by WB. Among the four reactivity patterns found by WB of these alternative samples, the most frequent included bands against three groups of HIV structural proteins (was ENV, POL, and GAG). The reactivity bands most frequently observed were those for the proteins gp160 and gp120. The least common reactivity band was the band for protein p17. The detection of HIV antibodies in saliva samples by means of ELFA with the possibility of later confirmation by WB makes saliva an alternative to serum for possible use in the diagnosis of infection. In contrast, HIV antibody detection in urine samples by the same methodology (ELFA) could be taken into consideration for use in epidemiological studies.

PREVALENCE OF CLINICAL FORMS OF CHRONIC SINUSITIS IN HIV INFECTED PATIENTS

2021 ◽  
pp. 60-64
Author(s):  
М.S. Zagurskaya ◽  
Keyword(s):  
Hiv Infection ◽  
Chronic Inflammation ◽  
Paranasal Sinuses ◽  
Who Classification ◽  
Chronic Sinusitis ◽  
Clinical Stage ◽  
Clinical Forms ◽  
Cd4 Lymphocyte ◽  
Immunological Deficiency ◽  
Cd4 Lymphocytes

Purpose: to identify patterns in the prevalence of various clinical forms of chronic sinusitis (exudative, proliferative, alterative) depending on the clinical and immunological stages of HIV infection. The study involved 108 HIV-infected patients who were diagnosed with chronic sinusitis. The prevalence of each of the clinical forms of chronic inflammation of the paranasal sinuses (exudative, proliferative, alterative) at different immunological and clinical stages of HIV infection was determined. The majority of HIV-infected persons with chronic sinusitis were diagnosed with a proliferative form of inflammation of the paranasal sinuses (61.1 ± 4.7). As the clinical stage of HIV infection progressed (WHO classification), a decrease in the prevalence of exudative forms of chronic sinusitis (from 84.8 ± 6.2 at the first stage to 4.0 ± 3.9 at the fourth) and, accordingly, an increase in proliferative forms (with 15.2 ± 6.2 at the first stage to 92.0 ± 5.4 at the fourth). As the number of CD4-lymphocytes in the blood of HIV-infected patients decreased, a significant decrease in the frequency of detection of exudative forms of chronic sinusitis was observed (from 85.0 ± 8.0 with a CD4-lymphocyte level of more than 500 uL-1 to 12.9 ± 4.3 with the level of CD4 lymphocytes is less than 200 uL-1) and, accordingly, an increase in the prevalence of proliferative forms of chronic inflammation of the paranasal sinuses (from 15.0 ± 8.0 to 83.9 ± 4.7, respectively). As immunological deficiency progresses in HIV-infected patients, the prevalence of proliferative forms of chronic inflammation of the paranasal sinuses increases, which is a factor determining the tactics of treating chronic sinusitis in this group of patients.

scholarly journals Clinicopathologic Features Predictive of Distant Metastasis in Patients Diagnosed With Invasive Breast Cancer

2020 ◽  
pp. 1346-1351
Author(s):  
Basim Ali ◽  
Fatima Mubarik ◽  
Nida Zahid ◽  
Abida K. Sattar
Keyword(s):  
Breast Cancer ◽  
Metastatic Disease ◽  
Invasive Breast Cancer ◽  
Distant Metastasis ◽  
Tumor Size ◽  
Clinical Stage ◽  
Stage Iv ◽  
Clinicopathologic Features ◽  
Pathologic Staging ◽  
Stage Iv Disease

PURPOSE National Comprehensive Cancer Network and European Society for Medical Oncology guidelines suggest screening for distant metastasis (M1) in symptomatic patients or those with locally advanced breast cancer. These guidelines are based on studies that often used pathologic staging for analysis. Physician variability in screening for M1 has also resulted in overuse of diagnostic tests. We sought to identify clinicopathologic features at diagnosis that could guide testing for metastatic disease. METHODS Patients diagnosed with invasive breast cancer between January 2014 and December 2015 were identified from our institutional database. Demographic and clinical variables were collected, including receptor profiles and clinical TNM staging. Rates of upstaging for each clinical stage and rates of concordance of pathologic and clinical staging were analyzed. Univariate analysis and multivariate regression analysis ( P < .05) identified predictors of upstaging to stage IV disease. RESULTS A total of 370 patients met the inclusion criteria. Seventy patients (18.9%) had metastatic disease at diagnosis. The rate of upstaging for stages I, IIA, IIB, and III were 0%, 5.6%, 18.8%, and 36.6%, respectively. Advancing clinical stage, tumor size, and nodal status resulted in a significantly higher rate ( P < .001) of upstaging to M1 disease. Age and hormone receptor status were not associated with upstaging to stage IV disease. Clinical stages I-III were concordant with pathologic staging in 65(42.8%) of 152 patients (kappa’s index, 0.197; P < .000). CONCLUSION Advancing clinical stage, tumor size, and nodal status at diagnosis were predictive of upstaging to M1 disease in patients with breast cancer. Distant metastatic workup should be considered in patients with clinical stage IIB disease or higher.

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