Enterocytozoon schreckii n. sp. Infects the Enterocytes of Adult Chinook Salmon ( Oncorhynchus tshawytscha ) and May Be a Sentinel of Immunosenescence

In this work, we describe a new microsporidian species that infects the enterocytes of Chinook salmon. This novel pathogen is closely related to Enterocytozoon bieneusi , an opportunistic pathogen commonly found in AIDS patients and other severely immunocompromised humans.

Intestinal microsporidiosis among HIV/AIDS patients receiving antiretroviral therapy in Sana’a city, Yemen: first report on prevalence and predictors

Background Intestinal microsporidiosis is an opportunistic infection associated with persistent diarrhea among HIV/AIDS patients. In Yemen, however, its epidemiology is unknown. Therefore, this study determined its prevalence and predictors among HIV/AIDS patients receiving antiretroviral therapy (ART) in Sana’a city, the capital of Yemen. Methods This cross-sectional study included 402 patients receiving ART at Al-Jomhori Educational Hospital in Sana’a from November 2019 to December 2020. Data about demographics, clinical characteristics and risk factors were collected using a pre-designed questionnaire. Stool samples were collected and examined for microsporidian spores using the Gram-chromotrope Kinyoun staining. Blood samples were also collected and used for CD4 cell counting by flow cytometry. Univariate analysis was used to test the association of patients’ characteristics and risk factors with intestinal microsporidiosis. Multivariable logistic regression was then used to identify the independent predictors of infection. Statistical significance was considered at P-values < 0.05. Results Intestinal microsporidiosis was prevalent among 14.2% (57/402) of HIV/AIDS patients and was significantly associated with diarrhea (OR 3.4, 95% CI 1.7–6.6; P = 0.001). The significant independent predictors of infection were < 200 CD4 cells/µl (AOR 3.2, 95% CI 1.5–6.9; P = 0.003), not washing hands after contacting soil (AOR 2.5, 95% CI 1.1–5.4; P = 0.026) and before eating (AOR 3.1, 95% CI 1.5–6.4; P = 0.003), eating unwashed raw produce (AOR 2.5, 95% CI 1.2–5.3; P = 0.017) and absence of indoor latrines (AOR 6.2, 95% CI 1.5–25.9; P = 0.012). Conclusions The prevalence of intestinal microsporidiosis among HIV/AIDS patients in Sana'a is high and comparable to that reported from several other countries, being prevalent among approximately 14.0% of patients and significantly associated with diarrhea. It could be predicted among patients who have < 200 CD4 cells/µl, have poor hand hygiene after contacting soil and before eating, usually eat unwashed raw produce, or do not possess indoor latrines. Large-scale studies on its epidemiology and predictors among HIV/AIDS patients across the country are warranted.

Acceptance of COVID-19 Vaccination and its Related Factors Among HIV/AIDS Patients in Guangxi, China: A Cross-Sectional Survey.

Background Vaccination is the most effective approach against the coronavirus disease 2019 (COVID-2019) pandemic. This study aimed to investigate acceptance and the predominant influential factors of COVID-19 vaccination among people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Methods A cross-sectional survey was carried out in five cities in Guangxi from 7 May to 1 June 2021. Questionnaires on the acceptance of COVID-19 vaccination and the influential factors were conducted among HIV/AIDS patients recruited by random cluster sampling. We performed univariate and multivariate logistic regression analysis to identify factors associated with acceptance of COVID-19 vaccination among HIV/AIDS patients. Results Of all the participants (n = 903), 72.9% (n = 658) were willing to accept the COVID-19 vaccine and there was no statistically significant difference between CD4+T cell count and willingness to vaccinate using stratified analysis (P > 0.05). The main reason for willingness to accept the COVID-19 vaccine was fear of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (76.0%), whereas patients who were reluctant to receive the vaccine were mainly concerned about the safety of the vaccine (54.7%) and whether it would impact anti-retroviral therapy(ART) efficacy (50.6%). The most significant factors influencing vaccination were concerns that the vaccine was unsafe in HIV patients (OR=0.082, 95%CI = 0.024–0.282) and that it would be less effective in preventing SARS-CoV-2 infection in HIV patients (OR = 0.093, 95%CI = 0.030–0.287). Other factors associated with acceptance of the COVID-19 vaccine included Zhuang ethnicity (OR=1.653, 95%CI=1.109–2.465), the highest education level of middle school and high school or above (OR=1.747, 95%CI=1.170–2.608; OR=2.492, 95%CI=1.326–4.682), unknown vaccination type (OR=0.487, 95%CI=0.305–0.776) and little vaccine influence on ART efficacy (OR=2.889, 95%CI=1.378-6.059). Conclusions Acceptance of the COVID-19 vaccination is high among HIV/AIDS patients, although some patients refused vaccination because of vaccine safety and influence on ART efficacy. More research is needed to investigate the impact of the COVID-19 vaccine on the efficacy of ART and to evaluate its effectiveness in preventing SARS-CoV-2 infection in HIV patients so that concerns about COVID-19 vaccination issues can be addressed in HIV patients.

Incidence and predictors of reoccurrence of opportunistic infection among adult HIV/AIDS patients attending ART clinic at public health facilities in Arba Minch town, southern Ethiopia: A retrospective cohort study

Background Human immunodeficiency virus (HIV) infected individuals are prone to opportunistic infections (OIs) due to HIV mediated immune suppression. When opportunistic infections occur in the form of relapse or reinfection, it is said to be reoccurrence. This study was aimed to assess Incidence and predictors of reoccurrence of opportunistic infections among adult people living with HIV (PLHIV) attending ART clinics in Arba Minch Town, Southern Ethiopia Methods This retrospective cohort study was conducted on 450 HIV/AIDS patients attending anti-retro viral therapy (ART) clinics in Arba Minch town, southern Ethiopia. Simple random sampling technique was used. Kaplan-Meier graph and log rank test were used for group wise comparison. Bivariate and multivariable Cox Proportional Hazard Regression model were used to identify independent predictors of reoccurrence of opportunistic infection. Result One hundred nineteen HIV/AIDS patient had reoccurrence of opportunistic infection. The incidence rate was 11.5 per 1000 person months. The mean time of reoccurrence was 56 months. One of the most reoccurred OIs was pulmonary tuberculosis (PTB). Predictors that were associated significantly were recent cell differentiation 4 (CD4) count, recent body mass index (BMI), recent functional status, and duration on anti-retroviral therapy (ART). Conclusion Though the incidence rate of OIs decreased from previous findings, attention should be given to HIV patients with low CD4 count, low BMI and for those bedridden patients.

Bayesian Parametric Modeling of Time to Tuberculosis Co-Infection of HIV/AIDS Patients Under Antiretroviral Therapy Treatment at Jimma University Medical Center, Ethiopia

Background: Tuberculosis is the most common opportunistic infection among HIV/AIDS patients, including those following Antiretroviral Therapy treatment. The risk of Tuberculosis infection is higher in people living with HIV/AIDS than in people who are free from HIV/AIDS. Many studies focused on prevalence and determinants of Tuberculosis in HIV/AIDS patients without taking into account the censoring aspects of the time to event data. Therefore, this study was undertaken with aim to model time to Tuberculosis co-infection of HIV/AIDS patients following Antiretroviral Therapy treatment using Bayesian parametric survival models.Methods: A data of a retrospective cohort of HIV/AIDS patients under Antiretroviral Therapy treatment follow-up from January 2016 to December 2020 until Tuberculosis was clinically diagnosed or until the end of the study was collected from Antiretroviral Therapy treatment center of Jimma University Medical Center, Ethiopia. In order to identify the risk factors which have association with Tuberculosis co-infection survival time, Bayesian parametric Accelerated failure time survival models were fitted to the data using Integrated Nested Laplace Approximation methodology.Results: About 26.37% of the study subjects had been co-infected with tuberculosis during the study period. Among the parametric Accelerated failure time models, the Bayesian log-logistic Accelerated failure time model was found to be the best fitting model for the data.Conclusions: Tuberculosis co-infection survival time was significantly associated with place of residence, smoking, drinking alcohol, family size, WHO clinical stages, functional status, CD4 count, BMI and hemoglobin level. The finding of this study provide timely information on the risk factors associated with TB co-infection survival time for healthy policy makers and planners.

Clinical Profile of 24 AIDS Patients with Cryptococcal Meningitis in the HAART Era: A Report from an Infectious Diseases Tertiary Hospital in Western Romania

Management of cryptococcal infections among patients suffering from acquired immunodeficiency syndrome (AIDS) represents a medical challenge. This retrospective study aims to describe the disease management and outcomes among 24 AIDS patients who suffered from Cryptococcus neoformans meningitis. The parameters evaluated from our patients’ database records include epidemiological data, clinical manifestations, biochemical and microbiological analysis of patients’ cerebrospinal fluid (CSF), treatment profiles, and disease outcomes. All patients included in the study had a lymphocyte count of less than 200 CD4/mm3. Of the 24 patients included in this study, five had been diagnosed with HIV infection since childhood, after receiving HIV-infected blood transfusions. The most prominent symptom was fatigue in 62.5% of patients, followed by nausea/vomiting and headache. Seven patients had liver cirrhosis due to hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, while Kaposi sarcoma and cerebral toxoplasmosis were found in two patients. Six out of 24 patients died due to bacterial sepsis and acute respiratory distress syndrome (ARDS). High intracranial pressure was the strongest predictive factor for mortality (OR = 2.9), followed by ARDS (OR = 1.8), seizures at disease onset (OR = 1.4), and diabetes mellitus (OR = 1.2). Interestingly, patients younger than 40 years old had a significantly lower survival rate than that of the older patients. Before developing Cryptococcal meningitis, all patients had low adherence to the early ART treatment scheme and skipped the follow-up visits. All patients received a combination of amphotericin B and flucytosine as induction therapy, adding fluconazole for maintenance. Simultaneously, AIDS HAART was initiated at diagnosis of the cryptococcal infection. A combined regimen of antifungals and highly active antiretroviral therapy showed improved patient recovery with minor side effects.

HIV/AIDS Patients’ Survival Rate between One Co-infection and More Than One Opportunistic Co-infection at Haji Adam Malik General Hospital Medan in 2015-2017

Background: AIDS is a collection of disease symptoms caused by HIV that damages the human immune system. Decreased immunity causes the patient to be very susceptible to various, often fatal, infectious diseases (opportunistic infections). Aim: To determine the difference in HIV/AIDS patients' survival rate between one co-infection and more than one opportunistic co-infection at Haji Adam Malik Hospital Medan in 2015-2017. Methods: This is a retrospective cohort analytic study using secondary data from medical records of HIV patients from January 2015-December 2017. The samples were 34 HIV/AIDS patients who met the inclusion and exclusion criteria, selected by consecutive technique sampling. Descriptive statistical analysis was used for demographic data. Kaplan Meier's statistical analysis was used for endurance or survival tests. The difference was considered statistically significant if p<0.05. Results: The most opportunistic infections found were diarrhea in 265 subjects (55.67%), followed by toxoplasmosis in 159 subjects (33.40%), oral candidiasis 141 subjects (29.62%), CMV 78 subjects (16.39%), pneumonia 63 subjects (13.24%), sepsis 62 subjects (13.03%), PCP 45 subjects (9.45%), hepatitis B 38 subjects (7.98%), chlamydia 24 subjects (5.04%), hepatitis C 14 subjects (2, 94%), Herpes zoster 11 subjects (2.31%), lymphadenopathy 4 subjects (0.84%), and the least common were NHL 1 subject (0.21%) and Penicilosis 1 subject (0.21%). Conclusion: The HIV patients’ survival rates are different based on the number of opportunistic infections. According to the order, the most common opportunistic infections were diarrhea, toxoplasmosis, and oral candidiasis. Keywords: HIV/AIDS, opportunistic infections, oral candidiasis, toxoplasmosis, diarrhea.

CD3+T, CD4+T, CD8+T, and CD4+T/CD8+T Ratio and Quantity of γδT Cells in Peripheral Blood of HIV-Infected/AIDS Patients and Its Clinical Significance

Objective. To investigate the quantity of CD4+T, CD4+T, CD8+T, and γδT cells in peripheral blood of HIV-infected/AIDS patients as well as to explore the possible role of CD4/CD8 ratio and γδT cells in the progression of HIV/AIDS, aimed at providing evidence for the diagnosis and treatment of AIDS. Methods. The quantity levels of CD3+T cells, CD4+T cells, CD8+T cells, and γδT cells in peripheral blood of 46 HIV-infected/AIDS patients and 30 healthy controls were detected by using flow cytometry. Results. The count of CD3+T, CD4+T, CD8+T, and γδT cells ( x ¯ ± s , A/μl) in the peripheral blood was 1183.64 ± 132.58 , 278.39 ± 122.38 , 863.13 ± 82.38 , and 22.53 ± 1.74 in the experimental group as well as 1456.46 ± 124.37 , 788.74 ± 189.67 , 569.61 ± 46.49 , and 10.96 ± 0.28 in the control group, respectively. The p values of the two groups were <0.005 after the t -test, revealing a statistically significant difference. The proportion of CD3+T, CD4+T, CD8+T, and γδT cells in total lymphocytes in the two groups ( x ¯ ± s , %) was 71.83 ± 5.37 , 13.39 ± 2.23 , 62.93 ± 5.81 , and 3.67 ± 0.87 in the experimental group, respectively. In the control group, the values were expressed as 66.72 ± 5.48 , 42.77 ± 3.38 , 31.41 ± 3.62 , and 1.73 ± 0.36 , respectively. After performing the t -test, p values in the two groups were <0.005 except CD3+T, with statistically significant differences. Besides, CD4/CD8 was 0.33 ± 0.11 in the experimental group and 1.48 ± 0.29 in the control group, t = 26.528 , p < 0.001 , exhibiting a significant statistical difference. Conclusion. HIV infection induces the activation and proliferation of CD8+T and γδT cells, contributing to the decrease of CD4+T cells, while CD8+T and γδT cells are involved in the immune response and tissue damage after HIV infection.

Multilocus Genotyping of Pneumocystis jirovecii from Deceased Cuban AIDS Patients Using Formalin-Fixed and Paraffin-Embedded Tissues

The results of the genotypic characterization of Pneumocystis jirovecii are described in lung tissue samples from 41 Cubans who died of AIDS with pneumocystosis between 1995 and 2008. Histological sections of the lung preserved as formalin-fixed and paraffin-embedded tissue were examined. PCR amplification and nucleotide sequencing of the two mitochondrial genes (large and small) of the pathogen allowed verification of a predominance of genotype 3 (85T/248C) of the large mitochondrial gene and genotype 3 (160A/196T) of the small mitochondrial gene over a period of 14 years (1995–2008). These results suggest that the 85T/248C//160A/196T genotype circulates with the highest frequency (81.3%) among AIDS patients in Cuba. Multilocus analysis indicates a limited circulation of pathogen genotypes on the island with the existence of a clonal genotype with an epidemic structure. Furthermore, it appears that circulating strains of P. jirovecii have not developed mutations related to sulfonamide resistance. Taken together, the data in this study revealed important elements about pneumocystosis in Cuban patients dying of AIDS and the usefulness of formalin-fixed and paraffin-embedded samples to carry out molecular epidemiology studies of P. jirovecii.