Journal of AIDS & Clinical Research

Here we present the case of a man who was admitted to the hospital with an extremely low CD4 count and vague symptoms suggestive of an opportunistic infection, who subsequently developed a significant psychosis following standard treatment for Mycobacterium avium intracellulare. The patient was a 48 year old man who presented to the hospital with acute onset altered mental status, diarrhea, and generalized weakness. He had positive blood cultures for Mycobacterium avium intracellulare and was given clarithromycin, ethambutol, and rifabutin. The patient developed an acute change in mental status manifested by paranoid delusions, disorganized though processes, and perseverations which resolved after substitution of azithromycin for clarithromycin. Although the differential diagnosis of acute altered mental status in an AIDS patient is quite broad, we recommend that clinicians consider clarithromycin as a possible cause of psychosis and mania. Azithromycin should be considered as an alternative treatment in patients exhibiting such symptoms after initiation of clarithromycin.

The search for a HIV vaccine that can elicit potent, long lasting and broad immune responses to both prevent acquisition of infection and control viral replication has been going on for over two decades. The modest success of the RV144 vaccine efficacy trial and isolation of broadly neutralizing antibodies capable of neutralizing different HIV strains has reinvigorated research in antibody based vaccine design and development strategies. This review will discuss the efficacy trials conducted to date, lessons learned from the trials, challenges and current strategies being pursued in the HIV vaccine field.

South Africa has the highest number of individuals with HIV-1 infection worldwide with the epicentre of the epidemic in the province of KwaZulu-Natal (KZN). Currently South Africa has the largest antiretroviral treatment (ART) programme with KZN and Gauteng provinces accounting for 56% of all patients on ART. In order to understand transmission dynamics and temporal trends in drug resistance, we performed a comprehensive literature review of primary and acquired drug resistance in adults and children in KZN over a ten year period, 2003-2013. Transmitted drug resistance (TDR) to non-nucleoside reverse transcriptase inhibitors (NNRTIs) in adults is increasing to moderate levels (5-15%). Acquired drug resistance to first line drug regimens in adults was associated with at least one mutation to nucleoside reverse transcriptase inhibitors (NRTI) or NNRTIs or both, with M184V and K103N the most common mutations. Prevalence of thymidine analogues (TAMs) was low to moderate. There was no published data on acquired drug resistance to second line agents. Children failing first line drug regimens harboured drug resistance mutations to NRTI (M184V and TAMs), NNRTI (V106M and K103N) and protease inhibitors (PIs) (V82A). Concerns have been raised about the high levels of the K65R mutation associated with tenofovir regimens in adults and children. Continued vigilance is needed for ART failure in both adults and children, so as not to compromise second line treatment options. Drug resistance genotyping is now cost effective and should be considered for inclusion in regional surveillance studies and during routine care.

Background: The HIV epidemic has significantly altered the context within which women make decisions about how they will feed their infants. This study examined the antenatal infant feeding choices and actual infant feeding practices of HIV-positive mothers in order to assess adherence to the 2010 WHO national infant feeding guidelines in Nnewi, Nigeria.

Methods: The study was conducted between January 2012 and February 2013 at Nnamdi-Azikiwe University Teaching Hospital (NAUTH) in Nnewi-Anambra State, Nigeria. It was a prospective cohort study of HIV positive women attending the Prevention of Mother-To-Child Transmission (PMTCT) clinic in NAUTH. Women received HIV Counseling and Testing (HCT) from trained HIV positive women working in the hospital and from members of HIV support groups. The women made an informed decision on their infant feeding choice and received antiretroviral (ARV) treatment or prophylaxis (WHO option B) following WHO 2010 guidelines. Each mother-baby pair was followed up until the HIV sero-status of the baby was determined by DNA PCR (6-8weeks after cessation of breastfeeding).

Results: The overall HIV MTCT rate was 19 of 583 (3.3%; 95% confidence interval (CI): 2.0 - 5.0). Only 94 (16.1%; 95% CI: 13.2 - 19.4) mothers complied with the WHO 2010 recommendation of exclusive breastfeeding (EBF) and ARV treatment or prophylaxis. Overall, 431 (73.9%) mother-baby pairs received prophylactic ARV intervention; in 88 (15.1%) pairs, the baby or the mother received ARV; while in 64 (11.0%) pairs, neither mother nor baby received ARV. When the mother-baby pair received ARV, MTCT was 0.8%, 1.7% and 5.9% for Exclusive Formular Feeding (EFF), EBF and Mixed Feeding (MF), respectively. When either mother or baby received intervention, MTCT rates increased to 3.3%, 4.8% and 7.7% for EFF, EBF and MF, respectively. The rate of MTCT was further increased to 5.1%, 6.7% and 23.5% when neither mother nor baby received intervention for EFF, EBF and MF respectively.

Conclusion: EFF is still the infant feeding option preferred and practiced by majority of our HIV positive mothers despite the promotion of the safety of EBF with ARV interventions according to WHO 2010 guideline. It will take some time to change existing belief in EFF for us to achieve the required shift to EBF in our practice area. We also demonstrated that ARV treatment/chemoprophylaxis for both mother and baby is an important measure for achieving the reduction of MTCT of HIV in breastfeeding setting mixed feeding practice is associated with an increased rate of MTCT and should be strongly discouraged. Increasing the uptake of ARV treatment/ chemoprophylaxis and ensuring appropriate counseling about infant feeding practices have the potential to markedly decrease the rate of MTCT of HIV in developing countries.

Introduction: Opportunistic infections (OIs) are infections that are more frequent or more severe because of immune-suppression in HIV-infected persons, and they are the major clinical manifestation of HIV patients. They indirectly affect the natural history of HIV disease. Many studies concentrated on drug adherence, survival and other aspects of the diseases but limited studies are evident on OIs after Anti-Retroviral Therapy (ART) initiated. So this study was conducted to assess the prevalence of opportunistic infections and associated factors among HIV positive patients taking (ART) in DebreMarkos referral hospital, Northwest Ethiopia.

Methods:A cross sectional study design was conducted among HIV patients taking ART from 5 to 7years. The study was conducted in DebreMarkos referral hospital among 423 patients. The data was entered in EPI data version 3.1 and analysis with done by using Statistical Package for Social Sciences (SPSS) version 16.0. Bivariate and multivariate analysis was performed to determine the association of each independent variable with occurrence of OIs. 95% CI and p-value less than 0.05 were considered as significant association.

Result: Majority, 241(57%) of the study participants were female patients. The mean age of the study participants was 35.17, with standard deviation of +/- 9.481 years. A total of 181 OIs were observed from the study participants during the study period. The commonest type of OIs were oral candidiasis 50(11.8%), followed by chronic diarrhea for greater than 1 month, 42(9.9%) and tuberculosis, 41(9.7%). The factors associated with OIs were; Age less than 40 years old was protective (AOR=0.47, 95%CI=0.25, 0.90); baseline WHO stages of III&IV was risk for development of OI by five times(AOR=4.759, 95%CI=2.163, 10.469); those who used to chew khat was at risk of developing OI almost five times more likely than those who did not chew (AOR=4.733, 95%CI=1.185, 18.915); patients with good ART adherence were less likely to develop OI compare to their counter parts (AOR=0.163, 95%CI=0.051, 0.522); current hemoglobin level of ≥ 10 g/dl was protective (AOR=0.313, 95%CI=0.162, 0.605); and recent weight of <60 kg (AOR=3.658, 95%CI=1.656, 8.078).

Conclusion and recommendation: The prevalence of OIs among HIV patients on ART is still high namely oral candidiasis, pathogens that cause chronic diarrhea and tuberculosis. Education on adherence of medications, and use of prophylactic medications for OIs should be given for HIV patients taking ART. Similar studies should be conducted to identify the relation between substance abuse and OIs in HIV patients taking ART

Th17 and Th22 cells are thought to function as innate regulators of mucosal antimicrobial responses, tissue inflammation and mucosal integrity, yet their role in persistent SIV infection is still unclear. Here we compared Th17 and Th22 cells in their phenotype, effector/cytokine function, and frequency in blood and intestinal mucosal tissues, and correlate levels with mucosal damage in SIV-infected rhesus macaques. We found that Th17/Th22 cells share similar features in that both highly produce TNF-α and IL-2 and express CCR5 in intestinal tissues; yet very few show cytotoxic functions, as evidenced by lack of IFN-γ and granzyme B production. Further, Th17/Th22 cells display distinct tissue-specific distributions. Both Th17 and Th22 cells and cytokine secretion were significantly depleted in both blood and intestine in chronically SIV-infected macaques. The frequency of Th17 and Th22 cells in the intestine positively correlated with percentages of intestinal CD4+ T cells and negatively with damage to intestinal mucosa, and plasma viral loads in SIV infection. These findings indicate Th17 and Th22 cells share considerable functions, and may coordinate in innate mucosal immune responses, and their regional loss in the intestine may be associated with local mucosal immune dysfunction in persistent HIV/SIV infection.

Objective: Few studies have examined psychiatric comorbidity among HIV positive injection drug users (IDUs) in resource-limiting settings. We sought to identify key factors associated with symptoms of depression among IDUs receiving antiretroviral (ARV) treatment in Jakarta and Denpasar, Indonesia.

Methods: The cross-sectional study was conducted at five ARV delivery sites in Indonesia. Former IDUs aged 18 years or older having received ARV treatment for at least three months (n=117) were recruited and interviewed faceto- face. A 9-item version of the Center for Epidemiologic Studies Depression Scale was used to measure symptoms of depression. A structured questionnaire measured participants’ demographic characteristics, social support and services received, current substance use, and treatment for drug dependency and HIV. Multiple logistic regression was used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI).

Results: Of the 117 participants, 33% (39) exhibited symptoms of depression, 24% (28) reported using an illicit substance in the past month, and 29% (34) were in methadone treatment. Depressive symptoms were significantly associated with recent substance use in the last 30 days (AOR, 95% CI: 5.3, 1.9 to 15.4) and being on methadone (3.5, 1.2 to 10). Older age (per year 0.9, 0.8 to 1), full-time employment (0.2, 0.1 to 0.7), and living with parents (0.2, 0.1 to 0.6) appeared to be protective.

Conclusion: The results suggest that depression is common among Indonesian IDUs, even among patients enrolled in methadone treatment. HIV clinics and drug treatment programs need to recognize the risk/protective factors and also provide services to address this common comorbidity.

Although the use of highly active antiretroviral therapy (HAART) hampers HIV-1 replication, it is not yet a cure. The main obstacle to HAART-mediated HIV eradication is the latent reservoir of virally infected cells, which is the source of fast viral rebound in patients that stopped therapy. Patients must therefore have lifelong HAART, which is expensive and in long term the many side effects undermine successful treatment. Attempts to eradicate latent reservoir have focused on reactivating latent proviruses. However, killing the infected cells after virus reactivation, which is pivotal for elimination of the reservoir, has not been addressed. In this paper, we proposed a novel complementary approach, which we have called the “Nanomagnet-Based Detoxifying Machine (NBDM)” and, is able to eliminate the virus load in the bloodstream of the patients. In this regard, our proposed nanomagnets (Fe3O4-PLGA-PEG-gp120 Ab\aptamer\ MIP) will be able to bind to any gp120 markers in the blood circulation. The nanomagnets will trap the virus particles in a dialysis column during the hemodialysis and under a strong electromagnetic field. Therefore, each nanomagnets will serve as a hook to capture millions of virus particles out of the patient’s body. In the present research, we suggested the application of the Molecularly Imprinted Polymers (MIPs), because they could simply be synthesized through selfassembling approaches without any need for highly expensive Ab/aptamers. The synthesized MIPs have the potential to mimic the behavior of an antibody/aptamer raised against one of the main antigenic determinants of the virus, such as gp120. NBDM provides a simple but very beneficial system to detoxify the blood from both the viruses and nanoparticles. In conclusion, we think that it could be used as complementary therapy beside the HAART to improve the CD4+ count and disease prognosis without any concern for side effects. This is a simple, cost effectiveness, easy to handle, convenient for the patients, non-invasive, and effective approach that could be extended for a large spectrum of human diseases other than HIV.

The aim of this study was to establish and apply a real-time quantitative reverse transcription polymerase chain reaction (RT-PCR) for human immunodeficiency virus (HIV) RNA quantification in patients on antiretroviral treatment (ART) in Ghana, where recombinant strains including CRF02_AG are prevalent. The primers and TaqMan probe concentrations as well as reaction temperatures were optimized to establish an efficient in-house quantitative assay system for HIV RNA, a tool for HIV viral load measurement in patients. Then an already established HIV-specific PCR amplicon (HIV-1 NL4-3) was used as an external standard to estimate the linearity, amplification efficiency, analytical sensitivity and reproducibility of the in-house real time quantitative assay. Finally, the assay was applied to quantify the viral load in clinical samples of HIV patients on ART. The real time quantitative assay was shown to have good linearity (R2=1.0), high amplification efficiency (E=1.91), high sensitivity (180 copies/ml), and high reproducibility (variation coefficient range, from 1.25% to 3.58%). Analytical specificity and sensitivity of the assay in clinical samples was 96.7% and 95.0%, respectively. The established tool is reliable and covers all relevant genotypes including rare and recombinant forms that circulate in the sub-region. It could therefore allow general monitoring of antiretroviral therapy in patients living in resource-limited settings due to its simplicity, rapidity and less-labour intensiveness.

Introduction: “AIDS was the major epidemic of the 20th century, and remains the epidemic of the 21st century as well” thinks Prof. Jean-François Delfraissy, the director of the National Agency for Research on AIDS (ANRS). In the early 90’s, over 50% of HIV-positive European children were living in Romania. Even today, most HIV/AIDS-positive people live in Romania – more than 7000 being children and adolescents. The purpose of my study is the correlation of the female mucocutaneous genital lesions with the clinical picture and the laboratory data, and the data correlation in pregnant women.

Matter and methods: The methodological support of the paper is represented by various materials obtained from official sources and personal research. The epidemiological analysis of the HIV infection cases was made based on data with sanitary-epidemiological indicators selected from annual records, in the time period from 2005 to 2010. To determine the eligibility criteria for developing the epidemic process, in the study were used classical methods of retrospective statistical analysis of the annual and multiannual cases. I have used a series of blood tests, of which the best known and most used are the ELISA and the Western-Blot tests. The reaction of Western-Blot is very much used in present to confirm or disprove the result of the ELISA test regarding HIV (test for specific antibodies), which sometimes can be false positive.

Results and discussions: It is interesting to note that the infected mother’s antibodies can be transmitted to the fetus and it may persist in the fetus’s blood up to 18 months. A test performed during this period is positive, meaning it would indicate the presence of the infection although it is possible that the fetus was not infected (46 cases). Therefore, a positive HIV test is not significant, only after the age of 18 months. Of the total of 47 pregnant women under observation 32 of them had undergone caesarean section (the other ones quitted our service). The age of the pregnant women was between 21 and 36 years. Gestational age was, except for 2 cases (39 weeks), between 34-36 weeks. Female newborns weighed between 2100 g – 3300 g, AI (Apgar Index) 8 or 9. We also detected injuries caused by syphilis in 8 of our cases.

Conclusions: The genital chancre (genital ulceration) caused by syphilis makes a person more vulnerable to sexually transmitting or acquiring the HIV infection. The existence of syphilis increases the risk of acquiring HIV by 2 to 5 times.