Pub Date : 2024-05-03DOI: 10.1186/s12981-024-00610-x
Sara Bohnstedt Mørup, Preston Leung, Cavan Reilly, Brad T. Sherman, Weizhong Chang, Maja Milojevic, Ana Milinkovic, Angelike Liappis, Line Borgwardt, Kathy Petoumenos, Roger Paredes, Shweta S. Mistry, Cameron R. MacPherson, Jens Lundgren, Marie Helleberg, Joanne Reekie, Daniel D. Murray
Human genetic contribution to HIV progression remains inadequately explained. The type 1 interferon (IFN) pathway is important for host control of HIV and variation in type 1 IFN genes may contribute to disease progression. This study assessed the impact of variations at the gene and pathway level of type 1 IFN on HIV-1 viral load (VL). Two cohorts of antiretroviral (ART) naïve participants living with HIV (PLWH) with either early (START) or advanced infection (FIRST) were analysed separately. Type 1 IFN genes (n = 17) and receptor subunits (IFNAR1, IFNAR2) were examined for both cumulated type 1 IFN pathway analysis and individual gene analysis. SKAT-O was applied to detect associations between the genotype and HIV-1 study entry viral load (log10 transformed) as a proxy for set point VL; P-values were corrected using Bonferroni (P < 0.0025). The analyses among those with early infection included 2429 individuals from five continents. The median study entry HIV VL was 14,623 (IQR 3460–45100) copies/mL. Across 673 SNPs within 19 type 1 IFN genes, no significant association with study entry VL was detected. Conversely, examining individual genes in START showed a borderline significant association between IFNW1, and study entry VL (P = 0.0025). This significance remained after separate adjustments for age, CD4+ T-cell count, CD4+/CD8+ T-cell ratio and recent infection. When controlling for population structure using linear mixed effects models (LME), in addition to principal components used in the main model, this was no longer significant (p = 0.0244). In subgroup analyses stratified by geographical region, the association between IFNW1 and study entry VL was only observed among African participants, although, the association was not significant when controlling for population structure using LME. Of the 17 SNPs within the IFNW1 region, only rs79876898 (A > G) was associated with study entry VL (p = 0.0020, beta = 0.32; G associated with higher study entry VL than A) in single SNP association analyses. The findings were not reproduced in FIRST participants. Across 19 type 1 IFN genes, only IFNW1 was associated with HIV-1 study entry VL in a cohort of ART-naïve individuals in early stages of their infection, however, this was no longer significant in sensitivity analyses that controlled for population structures using LME.
{"title":"The association between single-nucleotide polymorphisms within type 1 interferon pathway genes and human immunodeficiency virus type 1 viral load in antiretroviral-naïve participants","authors":"Sara Bohnstedt Mørup, Preston Leung, Cavan Reilly, Brad T. Sherman, Weizhong Chang, Maja Milojevic, Ana Milinkovic, Angelike Liappis, Line Borgwardt, Kathy Petoumenos, Roger Paredes, Shweta S. Mistry, Cameron R. MacPherson, Jens Lundgren, Marie Helleberg, Joanne Reekie, Daniel D. Murray","doi":"10.1186/s12981-024-00610-x","DOIUrl":"https://doi.org/10.1186/s12981-024-00610-x","url":null,"abstract":"Human genetic contribution to HIV progression remains inadequately explained. The type 1 interferon (IFN) pathway is important for host control of HIV and variation in type 1 IFN genes may contribute to disease progression. This study assessed the impact of variations at the gene and pathway level of type 1 IFN on HIV-1 viral load (VL). Two cohorts of antiretroviral (ART) naïve participants living with HIV (PLWH) with either early (START) or advanced infection (FIRST) were analysed separately. Type 1 IFN genes (n = 17) and receptor subunits (IFNAR1, IFNAR2) were examined for both cumulated type 1 IFN pathway analysis and individual gene analysis. SKAT-O was applied to detect associations between the genotype and HIV-1 study entry viral load (log10 transformed) as a proxy for set point VL; P-values were corrected using Bonferroni (P < 0.0025). The analyses among those with early infection included 2429 individuals from five continents. The median study entry HIV VL was 14,623 (IQR 3460–45100) copies/mL. Across 673 SNPs within 19 type 1 IFN genes, no significant association with study entry VL was detected. Conversely, examining individual genes in START showed a borderline significant association between IFNW1, and study entry VL (P = 0.0025). This significance remained after separate adjustments for age, CD4+ T-cell count, CD4+/CD8+ T-cell ratio and recent infection. When controlling for population structure using linear mixed effects models (LME), in addition to principal components used in the main model, this was no longer significant (p = 0.0244). In subgroup analyses stratified by geographical region, the association between IFNW1 and study entry VL was only observed among African participants, although, the association was not significant when controlling for population structure using LME. Of the 17 SNPs within the IFNW1 region, only rs79876898 (A > G) was associated with study entry VL (p = 0.0020, beta = 0.32; G associated with higher study entry VL than A) in single SNP association analyses. The findings were not reproduced in FIRST participants. Across 19 type 1 IFN genes, only IFNW1 was associated with HIV-1 study entry VL in a cohort of ART-naïve individuals in early stages of their infection, however, this was no longer significant in sensitivity analyses that controlled for population structures using LME.","PeriodicalId":7503,"journal":{"name":"AIDS Research and Therapy","volume":"22 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140838781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><b>Correction to: AIDS Research and Therapy (2024) 21:18</b></p><p><b>https://doi.org/10.1186/s12981-024-00605-8</b>.</p><p>In this article [1], the statement in the Funding information section was incorrectly given as ‘The study was not funded’ and should have read ’ The secondary data analysis was not funded’.</p><ol data-track-component="outbound reference"><li data-counter="1."><p>Mapingure M, Chingombe I, Dzinamarira T, Moyo B, Samba C, Murigo D, Mugurungi O, Mbunge E, Makota RB, Murewanhema G, Musuka G. Presence of tuberculosis symptoms among HIV-positive men who have sex with men (MSM) in Zimbabwe. AIDS Res Ther. 2024;21(1):18.</p></li></ol><p>Download references<svg aria-hidden="true" focusable="false" height="16" role="img" width="16"><use xlink:href="#icon-eds-i-download-medium" xmlns:xlink="http://www.w3.org/1999/xlink"></use></svg></p><h3>Authors and Affiliations</h3><ol><li><p>ICAP in Zimbabwe, Harare, Zimbabwe</p><p>Munyaradzi Mapingure, Innocent Chingombe & Tafadzwa Dzinamarira</p></li><li><p>AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe</p><p>Brian Moyo & Owen Mugurungi</p></li><li><p>GALZ, Harare, Zimbabwe</p><p>Chesterfield Samba & Delight Murigo</p></li><li><p>Department of Computer Science, Faculty of Science and Engineering, University of Eswatini, Kwaluseni, Eswatini</p><p>Elliot Mbunge</p></li><li><p>Department of Biological Sciences and Ecology, University of Zimbabwe, Harare, Zimbabwe</p><p>Rutendo Birri Makota</p></li><li><p>Unit of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe</p><p>Grant Murewanhema</p></li><li><p>International Initiative for Impact Evaluation, Harare, Zimbabwe</p><p>Godfrey Musuka</p></li></ol><span>Authors</span><ol><li><span>Munyaradzi Mapingure</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Innocent Chingombe</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Tafadzwa Dzinamarira</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Brian Moyo</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Chesterfield Samba</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Delight Murigo</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Owen Mugurungi</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Elliot Mbunge</span>View author publications<p>You can also search for this author in <span>PubMed<span
更正:AIDS Research and Therapy (2024) 21:18https://doi.org/10.1186/s12981-024-00605-8.In 这篇文章[1]中,资助信息部分的声明错误地表述为 "该研究未获得资助",应为 "二次数据分析未获得资助"。Mapingure M, Chingombe I, Dzinamarira T, Moyo B, Samba C, Murigo D, Mugurungi O, Mbunge E, Makota RB, Murewanhema G, Musuka G. 津巴布韦 HIV 阳性男男性行为者 (MSM) 中结核病症状的存在。AIDS Res Ther.2024;21(1):18.下载参考文献作者和单位津巴布韦国际艾滋病规划署,哈拉雷,津巴布韦Munyaradzi Mapingure, Innocent Chingombe & Tafadzwa Dzinamarira艾滋病和结核病计划,卫生和儿童保健部,哈拉雷,津巴布韦Brian Moyo & Owen MugurungiGALZ,哈拉雷,津巴布韦Chesterfield Samba &;Delight MurigoDepartment of Computer Science, Faculty of Science and Engineering, University of Eswatini, Kwaluseni, EswatiniElliot MbungeDepartment of Biological Sciences and Ecology, University of Zimbabwe, Harare, ZimbabweRutendo Birri MakotaUnit of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, ZimbabweGrant MurewanhemaInternational Initiative for Impact Evaluation, Harare、津巴布韦Godfrey Musuka作者Munyaradzi Mapingure查看作者发表的文章您也可以在PubMed谷歌学术中搜索该作者Innocent Chingombe查看作者发表的文章您也可以在PubMed谷歌学术中搜索该作者Tafadzwa Dzinamarira查看作者发表的文章您也可以在PubMed谷歌学术中搜索该作者您也可以在 PubMed Google Scholar中搜索这位作者Owen Mugurungi查看作者发表的作品您也可以在 PubMed Google Scholar中搜索这位作者Elliot Mbunge查看作者发表的作品您也可以在 PubMed Google Scholar中搜索这位作者Rutendo Birri Makota查看作者发表的作品您也可以在 PubMed Google Scholar中搜索这位作者您也可以在 PubMed Google Scholar 中搜索该作者Grant Murewanhema查看作者发表的作品您也可以在 PubMed Google Scholar 中搜索该作者Godfrey Musuka查看作者发表的作品您也可以在 PubMed Google Scholar 中搜索该作者通信作者:Godfrey Musuka。出版者注Springer Nature对已出版地图中的管辖权主张和机构隶属关系保持中立。原文的在线版本可在以下网址找到:https://doi.org/10.1186/s12981-024-00605-8.Open Access 本文采用知识共享署名 4.0 国际许可协议进行许可,该协议允许以任何媒介或格式使用、共享、改编、分发和复制,只要您适当注明原作者和来源,提供知识共享许可协议的链接,并说明是否进行了修改。本文中的图片或其他第三方材料均包含在文章的知识共享许可协议中,除非在材料的署名栏中另有说明。如果材料未包含在文章的知识共享许可协议中,且您打算使用的材料不符合法律规定或超出许可使用范围,则您需要直接从版权所有者处获得许可。要查看该许可的副本,请访问 http://creativecommons.org/licenses/by/4.0/。除非在数据的信用行中另有说明,否则知识共享公共领域专用免责声明(http://creativecommons.org/publicdomain/zero/1.0/)适用于本文提供的数据。转载与许可引用本文Mapingure, M., Chingombe, I., Dzinamarira, T. et al. Correction:津巴布韦 HIV 阳性男男性行为者(MSM)的结核病症状。AIDS Res Ther 21, 26 (2024). https://doi.org/10.1186/s12981-024-00617-4Download citationAccepted:12 April 2024Published: 29 April 2024DOI: https://doi.org/10.1186/s12981-024-00617-4Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative
{"title":"Correction: Presence of tuberculosis symptoms among HIV-positive men who have sex with men (MSM) in Zimbabwe","authors":"Munyaradzi Mapingure, Innocent Chingombe, Tafadzwa Dzinamarira, Brian Moyo, Chesterfield Samba, Delight Murigo, Owen Mugurungi, Elliot Mbunge, Rutendo Birri Makota, Grant Murewanhema, Godfrey Musuka","doi":"10.1186/s12981-024-00617-4","DOIUrl":"https://doi.org/10.1186/s12981-024-00617-4","url":null,"abstract":"<p><b>Correction to: AIDS Research and Therapy (2024) 21:18</b></p><p><b>https://doi.org/10.1186/s12981-024-00605-8</b>.</p><p>In this article [1], the statement in the Funding information section was incorrectly given as ‘The study was not funded’ and should have read ’ The secondary data analysis was not funded’.</p><ol data-track-component=\"outbound reference\"><li data-counter=\"1.\"><p>Mapingure M, Chingombe I, Dzinamarira T, Moyo B, Samba C, Murigo D, Mugurungi O, Mbunge E, Makota RB, Murewanhema G, Musuka G. Presence of tuberculosis symptoms among HIV-positive men who have sex with men (MSM) in Zimbabwe. AIDS Res Ther. 2024;21(1):18.</p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><h3>Authors and Affiliations</h3><ol><li><p>ICAP in Zimbabwe, Harare, Zimbabwe</p><p>Munyaradzi Mapingure, Innocent Chingombe & Tafadzwa Dzinamarira</p></li><li><p>AIDS and TB Programmes, Ministry of Health and Child Care, Harare, Zimbabwe</p><p>Brian Moyo & Owen Mugurungi</p></li><li><p>GALZ, Harare, Zimbabwe</p><p>Chesterfield Samba & Delight Murigo</p></li><li><p>Department of Computer Science, Faculty of Science and Engineering, University of Eswatini, Kwaluseni, Eswatini</p><p>Elliot Mbunge</p></li><li><p>Department of Biological Sciences and Ecology, University of Zimbabwe, Harare, Zimbabwe</p><p>Rutendo Birri Makota</p></li><li><p>Unit of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe</p><p>Grant Murewanhema</p></li><li><p>International Initiative for Impact Evaluation, Harare, Zimbabwe</p><p>Godfrey Musuka</p></li></ol><span>Authors</span><ol><li><span>Munyaradzi Mapingure</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Innocent Chingombe</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Tafadzwa Dzinamarira</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Brian Moyo</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Chesterfield Samba</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Delight Murigo</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Owen Mugurungi</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Elliot Mbunge</span>View author publications<p>You can also search for this author in <span>PubMed<span","PeriodicalId":7503,"journal":{"name":"AIDS Research and Therapy","volume":"22 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140838715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-27DOI: 10.1186/s12981-024-00614-7
Percina Machava, Winete Joaquim, Joseph Borrell, Shannon Richardson, Uneisse Cassia, Muhammad Sidat, Alice Maieca, Cláudia Massitela, Yara Quelhas, Cafrina Mucuila, Beatriz Elias, Massada da Rocha, H. Simon Schaaf, W. Chris Buck
Bacillus Calmette-Guérin (BCG) reactions are the most common cause of immune reconstitution inflammatory syndrome (IRIS) in HIV-positive infants who initiate antiretroviral therapy (ART). There is limited evidence regarding the incidence of BCG-IRIS; however, reports from outpatient cohorts have estimated that 6–9% of infants who initiated ART developed some form of BCG-IRIS within the first 6 months. Various treatment approaches for infants with BCG-IRIS have been reported, but there is currently no widely accepted standard-of-care. A 5-month-old male HIV-exposed infant BCG vaccinated at birth was admitted for refractory oral candidiasis, moderate anemia, and moderate acute malnutrition. He had a HIV DNA-PCR collected at one month of age, but the family never received the results. He was diagnosed with HIV during hospitalization with a point-of-care nucleic acid test and had severe immune suppression with a CD4 of 955 cells/µL (15%) with clinical stage III disease. During pre-ART counseling, the mother was educated on the signs and symptoms of BCG-IRIS and the importance of seeking follow-up care and remaining adherent to ART if symptoms arose. Three weeks after ART initiation, he was readmitted with intermittent subjective fevers, right axillary lymphadenopathy, and an ulcerated papule over the right deltoid region. He was subsequently discharged home with a diagnosis of local BCG-IRIS lymphadenitis. At six weeks post-ART initiation, he returned with suppurative lymphadenitis of the right axillary region that had completely eviscerated through the skin without signs of disseminated BCG disease. He was then started on an outpatient regimen of topical isoniazid, silver nitrate, and oral prednisolone. Throughout this time, the mother maintained good ART adherence despite this complication. After 2.5 months of ART and one month of specific treatment for the lymphadenitis, he had marked mass reduction, improved adenopathy, increased CD4 count, correction of anemia, and resolution of his acute malnutrition. He completely recovered and was symptom free two months after initial treatment without surgical intervention. This case details the successful management of severe suppurative BCG-IRIS with a non-surgical approach and underlines the importance of pre-ART counseling on BCG-IRIS for caregivers, particularly for infants who initiate ART with advanced HIV.
卡介苗(Bacillus Calmette-Guérin,BCG)反应是开始接受抗逆转录病毒疗法(ART)的 HIV 阳性婴儿出现免疫重建炎症综合征(IRIS)的最常见原因。有关卡介苗-IRIS 发生率的证据有限,但据门诊病人队列报告估计,6-9% 开始接受抗逆转录病毒疗法的婴儿在最初 6 个月内会出现某种形式的卡介苗-IRIS。针对卡介苗-IRIS 婴儿的各种治疗方法均有报道,但目前还没有被广泛接受的标准治疗方法。一名 5 个月大的男性艾滋病暴露婴儿在出生时接种了卡介苗,因难治性口腔念珠菌病、中度贫血和中度急性营养不良而入院。他在一个月大时进行了 HIV DNA-PCR 采集,但家人一直没有收到结果。住院期间,他通过床旁核酸检测被确诊感染了艾滋病毒,并出现了严重的免疫抑制,CD4 细胞数为 955 个/μL(15%),临床病程为 III 期。在接受抗逆转录病毒疗法前咨询时,母亲了解了卡介苗-IRIS 的症状和体征,以及出现症状时寻求后续治疗和坚持抗逆转录病毒疗法的重要性。开始抗逆转录病毒疗法三周后,他因间歇性主观发热、右腋窝淋巴结肿大和右三角肌区溃疡性丘疹再次入院。随后他出院回家,诊断为局部卡介苗-IRIS淋巴结炎。在开始接受抗逆转录病毒治疗六周后,他因右腋窝化脓性淋巴结炎复诊,淋巴结炎已完全穿透皮肤,但没有卡介苗播散的迹象。随后,他开始接受局部异烟肼、硝酸银和口服泼尼松龙的门诊治疗。在此期间,尽管出现了并发症,但母亲一直坚持接受抗逆转录病毒疗法。经过 2 个半月的抗逆转录病毒疗法和一个月的淋巴结炎特殊治疗后,他的肿块明显缩小,腺病得到改善,CD4 细胞计数增加,贫血得到纠正,急性营养不良症状得到缓解。初次治疗两个月后,他完全康复并无症状,无需手术治疗。本病例详细介绍了采用非手术方法成功治疗严重化脓性卡介苗-IRIS 的情况,并强调了为护理人员提供卡介苗-IRIS 抗逆转录病毒治疗前咨询的重要性,尤其是对于携带晚期艾滋病毒开始接受抗逆转录病毒治疗的婴儿。
{"title":"Severe BCG immune reconstitution inflammatory syndrome lymphadenitis successfully managed with pre-antiretroviral counseling and a non-surgical approach: a case report","authors":"Percina Machava, Winete Joaquim, Joseph Borrell, Shannon Richardson, Uneisse Cassia, Muhammad Sidat, Alice Maieca, Cláudia Massitela, Yara Quelhas, Cafrina Mucuila, Beatriz Elias, Massada da Rocha, H. Simon Schaaf, W. Chris Buck","doi":"10.1186/s12981-024-00614-7","DOIUrl":"https://doi.org/10.1186/s12981-024-00614-7","url":null,"abstract":"Bacillus Calmette-Guérin (BCG) reactions are the most common cause of immune reconstitution inflammatory syndrome (IRIS) in HIV-positive infants who initiate antiretroviral therapy (ART). There is limited evidence regarding the incidence of BCG-IRIS; however, reports from outpatient cohorts have estimated that 6–9% of infants who initiated ART developed some form of BCG-IRIS within the first 6 months. Various treatment approaches for infants with BCG-IRIS have been reported, but there is currently no widely accepted standard-of-care. A 5-month-old male HIV-exposed infant BCG vaccinated at birth was admitted for refractory oral candidiasis, moderate anemia, and moderate acute malnutrition. He had a HIV DNA-PCR collected at one month of age, but the family never received the results. He was diagnosed with HIV during hospitalization with a point-of-care nucleic acid test and had severe immune suppression with a CD4 of 955 cells/µL (15%) with clinical stage III disease. During pre-ART counseling, the mother was educated on the signs and symptoms of BCG-IRIS and the importance of seeking follow-up care and remaining adherent to ART if symptoms arose. Three weeks after ART initiation, he was readmitted with intermittent subjective fevers, right axillary lymphadenopathy, and an ulcerated papule over the right deltoid region. He was subsequently discharged home with a diagnosis of local BCG-IRIS lymphadenitis. At six weeks post-ART initiation, he returned with suppurative lymphadenitis of the right axillary region that had completely eviscerated through the skin without signs of disseminated BCG disease. He was then started on an outpatient regimen of topical isoniazid, silver nitrate, and oral prednisolone. Throughout this time, the mother maintained good ART adherence despite this complication. After 2.5 months of ART and one month of specific treatment for the lymphadenitis, he had marked mass reduction, improved adenopathy, increased CD4 count, correction of anemia, and resolution of his acute malnutrition. He completely recovered and was symptom free two months after initial treatment without surgical intervention. This case details the successful management of severe suppurative BCG-IRIS with a non-surgical approach and underlines the importance of pre-ART counseling on BCG-IRIS for caregivers, particularly for infants who initiate ART with advanced HIV.","PeriodicalId":7503,"journal":{"name":"AIDS Research and Therapy","volume":"22 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140799426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-18DOI: 10.1186/s12981-024-00607-6
Shumani Charlotte Manenzhe, Razia Abdool Gafaar Khammissa, Sindisiwe Londiwe Shangase, Mia Michaela Beetge
Erythema multiforme (EM) is an immune-mediated mucocutaneous condition characterized by hypersensitivity reactions to antigenic stimuli from infectious agents and certain drugs. The most commonly implicated infectious agents associated with EM include herpes simplex virus (HSV) and Mycoplasma pneumoniae. Other infectious diseases reported to trigger EM include human immunodeficiency virus (HIV) infection and several opportunistic infections. However, studies focusing on EM and human immunodeficiency virus (HIV) infection are scarce. even though the incidence of EM among HIV-infected individuals have increased, the direct and indirect mechanisms that predispose HIV-infected individuals to EM are not well understood. In turn, this makes diagnosing and managing EM in HIV-infected individuals an overwhelming task. Individuals with HIV infection are prone to acquiring microorganisms known to trigger EM, such as HSV, Mycobacterium tuberculosis, Treponema pallidum, histoplasmosis, and many other infectious organisms. Although HIV is known to infect CD4 + T cells, it can also directly bind to the epithelial cells of the oral and genital mucosa, leading to a dysregulated response by CD8 + T cells against epithelial cells. HIV infection may also trigger EM directly when CD8 + T cells recognize viral particles on epithelial cells due to the hyperactivation of CD8 + T-cells. The hyperactivation of CD8 + T cells was similar to that observed in drug hypersensitivity reactions. Hence, the relationship between antiretroviral drugs and EM has been well established. This includes the administration of other drugs to HIV-infected individuals to manage opportunistic infections. Thus, multiple triggers may be present simultaneously in HIV-infected individuals. This article highlights the potential direct and indirect role that HIV infection may play in the development of EM and the clinical dilemma that arises in the management of HIV-infected patients with this condition. These patients may require additional medications to manage opportunistic infections, many of which can also trigger hypersensitivity reactions leading to EM.
多形性红斑(EM)是一种免疫介导的皮肤黏膜疾病,其特点是对传染源和某些药物的抗原刺激产生超敏反应。最常见的与多形性红斑有关的感染性病原体包括单纯疱疹病毒(HSV)和肺炎支原体。据报道,引发EM的其他传染病包括人类免疫缺陷病毒(HIV)感染和几种机会性感染。尽管艾滋病毒感染者的EM发病率有所上升,但人们对艾滋病毒感染者易患EM的直接和间接机制并不十分了解。反过来,这也使得诊断和管理艾滋病病毒感染者的EM成为一项艰巨的任务。艾滋病病毒感染者很容易感染已知可诱发EM的微生物,如HSV、结核分枝杆菌、苍白螺旋体、组织胞浆菌病和许多其他传染性病原体。虽然已知艾滋病病毒会感染 CD4 + T 细胞,但它也会直接与口腔和生殖器粘膜的上皮细胞结合,导致 CD8 + T 细胞对上皮细胞的反应失调。由于 CD8 + T 细胞的过度激活,当 CD8 + T 细胞识别到上皮细胞上的病毒颗粒时,艾滋病病毒感染也可能直接引发 EM。CD8 + T 细胞的超活化与药物超敏反应中观察到的情况类似。因此,抗逆转录病毒药物与EM之间的关系已得到充分证实。这包括对艾滋病毒感染者使用其他药物来控制机会性感染。因此,艾滋病病毒感染者可能同时存在多种诱发因素。本文重点阐述了艾滋病病毒感染在EM发病中可能扮演的直接和间接角色,以及在管理艾滋病病毒感染者时出现的临床困境。这些患者可能需要额外的药物来控制机会性感染,而许多机会性感染也可能诱发导致EM的超敏反应。
{"title":"Exploring the association between erythema multiforme and HIV infection: some mechanisms and implications","authors":"Shumani Charlotte Manenzhe, Razia Abdool Gafaar Khammissa, Sindisiwe Londiwe Shangase, Mia Michaela Beetge","doi":"10.1186/s12981-024-00607-6","DOIUrl":"https://doi.org/10.1186/s12981-024-00607-6","url":null,"abstract":"Erythema multiforme (EM) is an immune-mediated mucocutaneous condition characterized by hypersensitivity reactions to antigenic stimuli from infectious agents and certain drugs. The most commonly implicated infectious agents associated with EM include herpes simplex virus (HSV) and Mycoplasma pneumoniae. Other infectious diseases reported to trigger EM include human immunodeficiency virus (HIV) infection and several opportunistic infections. However, studies focusing on EM and human immunodeficiency virus (HIV) infection are scarce. even though the incidence of EM among HIV-infected individuals have increased, the direct and indirect mechanisms that predispose HIV-infected individuals to EM are not well understood. In turn, this makes diagnosing and managing EM in HIV-infected individuals an overwhelming task. Individuals with HIV infection are prone to acquiring microorganisms known to trigger EM, such as HSV, Mycobacterium tuberculosis, Treponema pallidum, histoplasmosis, and many other infectious organisms. Although HIV is known to infect CD4 + T cells, it can also directly bind to the epithelial cells of the oral and genital mucosa, leading to a dysregulated response by CD8 + T cells against epithelial cells. HIV infection may also trigger EM directly when CD8 + T cells recognize viral particles on epithelial cells due to the hyperactivation of CD8 + T-cells. The hyperactivation of CD8 + T cells was similar to that observed in drug hypersensitivity reactions. Hence, the relationship between antiretroviral drugs and EM has been well established. This includes the administration of other drugs to HIV-infected individuals to manage opportunistic infections. Thus, multiple triggers may be present simultaneously in HIV-infected individuals. This article highlights the potential direct and indirect role that HIV infection may play in the development of EM and the clinical dilemma that arises in the management of HIV-infected patients with this condition. These patients may require additional medications to manage opportunistic infections, many of which can also trigger hypersensitivity reactions leading to EM.","PeriodicalId":7503,"journal":{"name":"AIDS Research and Therapy","volume":"28 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140613325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-18DOI: 10.1186/s12981-024-00615-6
Irene Nakatudde, Elizabeth Katana, Eva Laker Agnes Odongpiny, Esther Alice Nalugga, Barbara Castelnuovo, Mary Glenn Fowler, Philippa Musoke
Dolutegravir (DTG)-based antiretroviral therapy (ART) is currently the preferred first-line treatment for persons living with HIV (PLHIV) including children and adolescents in many low- and middle-income countries including Uganda. However, there are concerns about excessive weight gain associated with DTG especially in adults. There remains paucity of current information on weight-related outcomes among adolescents on DTG. We determined the prevalence of excessive weight gain and associated factors among adolescents living with HIV (ALHIV) receiving DTG-based ART in Kampala, Uganda. Cross-sectional study involving ALHIV aged 10–19 years on DTG-based ART for at least one year were recruited from public health facilities in Kampala between February and May 2022. Excessive weight gain was defined as becoming overweight or obese per body mass index (BMI) norms while on DTG-based ART for at least one year. Demographic, clinical and laboratory data were collected using interviewer-administered questionnaires and data extracted from medical records. At enrolment, blood pressure and anthropometry were measured and blood was drawn for blood glucose and lipid profile. Data was summarised using descriptive statistics and logistic regression was performed to determine the associated factors. We enrolled 165 ALHIV with a median age of 14 years (IQR 12–16). Eighty (48.5%) were female. The median duration on ART and DTG was 8 years (IQR 7–11) and 2 years (IQR 1–3) respectively. At DTG initiation, the majority of participants (152/165, 92.1%) were ART-experienced, and had normal BMI (160/165, 97%). Overall, 12/165 (7.3%) adolescents (95% CI: 4.2–12.4) had excessive weight gain. No factors were significantly associated with excessive weight gain after DTG start in ALHIV. However, all ALHIV with excessive weight gain were females. Our study found a prevalence of 7.3% of overweight and obesity in ALHIV after initiating DTG. We did not find any factor significantly associated with excessive weight gain in ALHIV on DTG. Nonetheless, we recommend ongoing routine monitoring of anthropometry and metabolic markers in ALHIV as DTG use increases globally, to determine the exact magnitude of excessive weight gain and to identify those at risk of becoming overweight or obese while taking the medication.
{"title":"Prevalence of overweight and obesity among adolescents living with HIV after dolutegravir - based antiretroviral therapy start in Kampala, Uganda","authors":"Irene Nakatudde, Elizabeth Katana, Eva Laker Agnes Odongpiny, Esther Alice Nalugga, Barbara Castelnuovo, Mary Glenn Fowler, Philippa Musoke","doi":"10.1186/s12981-024-00615-6","DOIUrl":"https://doi.org/10.1186/s12981-024-00615-6","url":null,"abstract":"Dolutegravir (DTG)-based antiretroviral therapy (ART) is currently the preferred first-line treatment for persons living with HIV (PLHIV) including children and adolescents in many low- and middle-income countries including Uganda. However, there are concerns about excessive weight gain associated with DTG especially in adults. There remains paucity of current information on weight-related outcomes among adolescents on DTG. We determined the prevalence of excessive weight gain and associated factors among adolescents living with HIV (ALHIV) receiving DTG-based ART in Kampala, Uganda. Cross-sectional study involving ALHIV aged 10–19 years on DTG-based ART for at least one year were recruited from public health facilities in Kampala between February and May 2022. Excessive weight gain was defined as becoming overweight or obese per body mass index (BMI) norms while on DTG-based ART for at least one year. Demographic, clinical and laboratory data were collected using interviewer-administered questionnaires and data extracted from medical records. At enrolment, blood pressure and anthropometry were measured and blood was drawn for blood glucose and lipid profile. Data was summarised using descriptive statistics and logistic regression was performed to determine the associated factors. We enrolled 165 ALHIV with a median age of 14 years (IQR 12–16). Eighty (48.5%) were female. The median duration on ART and DTG was 8 years (IQR 7–11) and 2 years (IQR 1–3) respectively. At DTG initiation, the majority of participants (152/165, 92.1%) were ART-experienced, and had normal BMI (160/165, 97%). Overall, 12/165 (7.3%) adolescents (95% CI: 4.2–12.4) had excessive weight gain. No factors were significantly associated with excessive weight gain after DTG start in ALHIV. However, all ALHIV with excessive weight gain were females. Our study found a prevalence of 7.3% of overweight and obesity in ALHIV after initiating DTG. We did not find any factor significantly associated with excessive weight gain in ALHIV on DTG. Nonetheless, we recommend ongoing routine monitoring of anthropometry and metabolic markers in ALHIV as DTG use increases globally, to determine the exact magnitude of excessive weight gain and to identify those at risk of becoming overweight or obese while taking the medication.","PeriodicalId":7503,"journal":{"name":"AIDS Research and Therapy","volume":"38 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140613445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-16DOI: 10.1186/s12981-024-00609-4
Silvano S. Twinomujuni, Esther C Atukunda, Jackson K. Mukonzo, Musinguzi Nicholas, Felicitas Roelofsen, Patrick E. Ogwang
Initiation of ART among people living with HIV (PLWH) having a CD4 count ≤ 350cells/µl, produces poor immunological recovery, putting them at a high risk of opportunistic infections. To mitigate this, PLWH on ART in Uganda frequently use herbal remedies like Artemisia annua and Moringa oleifera, but their clinical benefits and potential antiretroviral (ARV) interactions remain unknown. This study examined the impact of A. annua and M. oleifera on CD4 count, viral load, and potential ARV interactions among PLWH on ART at an HIV clinic in Uganda. 282 HIV-positive participants on antiretroviral therapy (ART) with a CD4 count ≤ 350cells/µl were randomized in a double-blind clinical trial to receive daily, in addition to their routine standard of care either; 1) A. annua leaf powder, 2) A. annua plus M. oleifera, and 3) routine standard of care only. Change in the CD4 count at 12 months was our primary outcome. Secondary outcomes included changes in viral load, complete blood count, and ARV plasma levels. Participants were followed up for a year and outcomes were measured at baseline, 6 and 12 months. At 12 months of patient follow-up, in addition to standard of care, administration of A. annua + M. oleifera resulted in an absolute mean CD4 increment of 105.06 cells/µl, (p < 0.001), while administration of A. annua plus routine standard of care registered an absolute mean CD4 increment of 60.84 cells/µl, (p = 0.001) compared to the control group. The A. annua plus M. oleifera treatment significantly reduced viral load (p = 0.022) and increased platelet count (p = 0.025) and white blood cell counts (p = 0.003) compared to standard care alone, with no significant difference in ARV plasma levels across the groups. A combination of A. annua and M. oleifera leaf powders taken once a day together with the routine standard of care produced a significant increase in CD4 count, WBCs, platelets, and viral load suppression among individuals on ART. A. annua and M. oleifera have potential to offer an affordable alternative remedy for managing HIV infection, particularly in low-resource communities lacking ART access. ClinicalTrials.gov NCT03366922.
{"title":"Evaluation of the effects of Artemisia Annua L. and Moringa Oleifera Lam. on CD4 count and viral load among PLWH on ART at Mbarara Regional Referral Hospital: a double-blind randomized controlled clinical trial","authors":"Silvano S. Twinomujuni, Esther C Atukunda, Jackson K. Mukonzo, Musinguzi Nicholas, Felicitas Roelofsen, Patrick E. Ogwang","doi":"10.1186/s12981-024-00609-4","DOIUrl":"https://doi.org/10.1186/s12981-024-00609-4","url":null,"abstract":"Initiation of ART among people living with HIV (PLWH) having a CD4 count ≤ 350cells/µl, produces poor immunological recovery, putting them at a high risk of opportunistic infections. To mitigate this, PLWH on ART in Uganda frequently use herbal remedies like Artemisia annua and Moringa oleifera, but their clinical benefits and potential antiretroviral (ARV) interactions remain unknown. This study examined the impact of A. annua and M. oleifera on CD4 count, viral load, and potential ARV interactions among PLWH on ART at an HIV clinic in Uganda. 282 HIV-positive participants on antiretroviral therapy (ART) with a CD4 count ≤ 350cells/µl were randomized in a double-blind clinical trial to receive daily, in addition to their routine standard of care either; 1) A. annua leaf powder, 2) A. annua plus M. oleifera, and 3) routine standard of care only. Change in the CD4 count at 12 months was our primary outcome. Secondary outcomes included changes in viral load, complete blood count, and ARV plasma levels. Participants were followed up for a year and outcomes were measured at baseline, 6 and 12 months. At 12 months of patient follow-up, in addition to standard of care, administration of A. annua + M. oleifera resulted in an absolute mean CD4 increment of 105.06 cells/µl, (p < 0.001), while administration of A. annua plus routine standard of care registered an absolute mean CD4 increment of 60.84 cells/µl, (p = 0.001) compared to the control group. The A. annua plus M. oleifera treatment significantly reduced viral load (p = 0.022) and increased platelet count (p = 0.025) and white blood cell counts (p = 0.003) compared to standard care alone, with no significant difference in ARV plasma levels across the groups. A combination of A. annua and M. oleifera leaf powders taken once a day together with the routine standard of care produced a significant increase in CD4 count, WBCs, platelets, and viral load suppression among individuals on ART. A. annua and M. oleifera have potential to offer an affordable alternative remedy for managing HIV infection, particularly in low-resource communities lacking ART access. ClinicalTrials.gov NCT03366922.","PeriodicalId":7503,"journal":{"name":"AIDS Research and Therapy","volume":"240 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.1186/s12981-024-00608-5
L. V. Bonadonna, E. Guerrero, T. McClendon, S. Union, D. Kabbani, D. Wittmann, J. Cohn, J. Veltman
Maintaining people living with HIV (PLWHIV) in clinical care is a global priority. In the Metro Detroit area of Michigan, approximately 30% of PLWHIV are out of care. To re-engage lost-to-follow-up patients, Wayne Health Infectious Disease clinic launched an innovative Homecare program in 2017. In addition to home healthcare delivery, the program included links to community resources and quarterly community meetings. We aimed to evaluate Homecare’s impact on participants’ ability to stay engaged in HIV care and reach viral suppression. We included data from PLWHIV and their healthcare workers. We used a convergent mixed-methods design, including first year program record review, semi-structured interviews, and a validated Likert scale questionnaire rating illness perception before and after Homecare. Interview data were collected from 15 PLWHIV in Metro Detroit and two healthcare workers responsible for program delivery. Semi-structured interviews focused on obstacles to clinic-based care, support networks, and illness perceptions. Interview data were transcribed and analyzed using a thematic approach. A fully coded analysis was used to create a conceptual framework of factors contributing to Homecare’s success. Means in eight categories of the Brief Illness Perception (IPQ) were compared using paired T-tests. In the first year of Homecare, 28 of 34 participants (82%) became virally suppressed at least once. The program offered (1) social support and stigma reduction through strong relationships with healthcare workers, (2) removal of physical and resource barriers such as transportation, and (3) positive changes in illness perceptions. PLWHIV worked towards functional coping strategies, including improvements in emotional regulation, acceptance of their diagnosis, and more positive perspectives of control. Brief-IPQ showed significant changes in six domains before and after Homecare. Homecare offers an innovative system for successfully re-engaging and maintaining lost-to-follow-up PLWHIV in care. These findings have implications for HIV control efforts and could inform the development of future programs for difficult to reach populations.
{"title":"Evaluation of an HIV homecare program for lost-to-follow-up populations: a mixed methods study in Detroit, Michigan","authors":"L. V. Bonadonna, E. Guerrero, T. McClendon, S. Union, D. Kabbani, D. Wittmann, J. Cohn, J. Veltman","doi":"10.1186/s12981-024-00608-5","DOIUrl":"https://doi.org/10.1186/s12981-024-00608-5","url":null,"abstract":"Maintaining people living with HIV (PLWHIV) in clinical care is a global priority. In the Metro Detroit area of Michigan, approximately 30% of PLWHIV are out of care. To re-engage lost-to-follow-up patients, Wayne Health Infectious Disease clinic launched an innovative Homecare program in 2017. In addition to home healthcare delivery, the program included links to community resources and quarterly community meetings. We aimed to evaluate Homecare’s impact on participants’ ability to stay engaged in HIV care and reach viral suppression. We included data from PLWHIV and their healthcare workers. We used a convergent mixed-methods design, including first year program record review, semi-structured interviews, and a validated Likert scale questionnaire rating illness perception before and after Homecare. Interview data were collected from 15 PLWHIV in Metro Detroit and two healthcare workers responsible for program delivery. Semi-structured interviews focused on obstacles to clinic-based care, support networks, and illness perceptions. Interview data were transcribed and analyzed using a thematic approach. A fully coded analysis was used to create a conceptual framework of factors contributing to Homecare’s success. Means in eight categories of the Brief Illness Perception (IPQ) were compared using paired T-tests. In the first year of Homecare, 28 of 34 participants (82%) became virally suppressed at least once. The program offered (1) social support and stigma reduction through strong relationships with healthcare workers, (2) removal of physical and resource barriers such as transportation, and (3) positive changes in illness perceptions. PLWHIV worked towards functional coping strategies, including improvements in emotional regulation, acceptance of their diagnosis, and more positive perspectives of control. Brief-IPQ showed significant changes in six domains before and after Homecare. Homecare offers an innovative system for successfully re-engaging and maintaining lost-to-follow-up PLWHIV in care. These findings have implications for HIV control efforts and could inform the development of future programs for difficult to reach populations.","PeriodicalId":7503,"journal":{"name":"AIDS Research and Therapy","volume":"13 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-05DOI: 10.1186/s12981-024-00606-7
Lina Martina Würfel, Anja Potthoff, Sandeep Nambiar, Adriane Skaletz-Rorowski
HIV testing remains an important tool in identifying people living with HIV/AIDS (PLWHA). An early diagnosis of HIV can lead to a prolonged life expectancy if treatment is initiated promptly. Indicator conditions can be the first sign of an HIV infection and should therefore be recognised and consequently a HIV test should be carried out. Testing should occur in all individuals as sexuality can be experienced by everyone, and stigma can lead to the exclusion of vulnerable groups, leading to a gap in diagnosis and treatment [1, 2]. A 63-year-old man, who identifies as bisexual and has had an intellectual disability since birth, presented at our health care centre for HIV testing. A decade ago, the patient was diagnosed with Stage III Diffuse Large B-cell Non-Hodgkin Lymphoma, an AIDS defining cancer. The patient presented at a Haematology and Oncology department 3 months prior, due to a weight loss of 10 kg over the past 5 months. Oral thrush, an HIV-indicator condition, had been diagnosed by the otolaryngologists shortly before. During this medical evaluation, pancytopenia was identified. Despite the presence of indicator conditions, the patient was never tested for HIV in the past. Staff members from the care facility for intellectually disabled suggested conducting a HIV test in our clinic through the public health department, where HIV positivity was revealed. The AIDS-defining diagnosis, along with a CD4 + cell count of 41/µl, suggests a prolonged period of HIV positivity. Due to the presence of existing indicator conditions, an earlier HIV diagnosis was possible. We contend that most of the recent illnesses could have been prevented if earlier testing had been carried out. Therefore, patients presenting with AIDS indicator conditions, including those with mental disabilities, should be given the opportunity to be tested for HIV. HIV/AIDS trainings should be made available to health care professionals as well as to personnel interacting with vulnerable groups.
艾滋病毒检测仍然是识别艾滋病毒/艾滋病感染者(PLWHA)的重要工具。如果能及时开始治疗,艾滋病毒的早期诊断可延长预期寿命。征兆性症状可能是艾滋病毒感染的最初征兆,因此应加以识别,并进行艾滋病毒检测。所有人都应进行检测,因为每个人都可能经历过性行为,而污名化会导致弱势群体被排除在外,从而造成诊断和治疗上的差距[1, 2]。一名 63 岁的男子来到我们的医疗中心进行 HIV 检测,他自称是双性恋者,从出生起就患有智力障碍。十年前,患者被诊断出患有弥漫性大 B 细胞非霍奇金淋巴瘤 III 期,这是一种艾滋病定义的癌症。3 个月前,患者因过去 5 个月体重下降 10 公斤而到血液肿瘤科就诊。不久前,耳鼻喉科医生诊断出患者患有口腔鹅口疮,这是一种艾滋病病毒感染性疾病。在这次医疗评估中,发现了全血细胞减少症。尽管存在这些指标性病症,但患者过去从未接受过艾滋病毒检测。智障人士护理机构的工作人员建议通过公共卫生部门在本诊所进行 HIV 检测,结果显示 HIV 阳性。艾滋病定义诊断以及 CD4 + 细胞计数为 41/µl,表明该患者长期处于 HIV 阳性状态。由于现有指标条件的存在,可以更早地诊断出艾滋病毒。我们认为,如果能更早地进行检测,近期的大多数疾病都是可以避免的。因此,应为出现艾滋病指标情况的病人,包括智障病人,提供接受艾滋病毒检测的机会。应向保健专业人员以及与弱势群体打交道的人员提供艾滋病毒/艾滋病培训。
{"title":"Missed opportunities for HIV testing and sexual health-related challenges in an individual with intellectual disability: a case report","authors":"Lina Martina Würfel, Anja Potthoff, Sandeep Nambiar, Adriane Skaletz-Rorowski","doi":"10.1186/s12981-024-00606-7","DOIUrl":"https://doi.org/10.1186/s12981-024-00606-7","url":null,"abstract":"HIV testing remains an important tool in identifying people living with HIV/AIDS (PLWHA). An early diagnosis of HIV can lead to a prolonged life expectancy if treatment is initiated promptly. Indicator conditions can be the first sign of an HIV infection and should therefore be recognised and consequently a HIV test should be carried out. Testing should occur in all individuals as sexuality can be experienced by everyone, and stigma can lead to the exclusion of vulnerable groups, leading to a gap in diagnosis and treatment [1, 2]. A 63-year-old man, who identifies as bisexual and has had an intellectual disability since birth, presented at our health care centre for HIV testing. A decade ago, the patient was diagnosed with Stage III Diffuse Large B-cell Non-Hodgkin Lymphoma, an AIDS defining cancer. The patient presented at a Haematology and Oncology department 3 months prior, due to a weight loss of 10 kg over the past 5 months. Oral thrush, an HIV-indicator condition, had been diagnosed by the otolaryngologists shortly before. During this medical evaluation, pancytopenia was identified. Despite the presence of indicator conditions, the patient was never tested for HIV in the past. Staff members from the care facility for intellectually disabled suggested conducting a HIV test in our clinic through the public health department, where HIV positivity was revealed. The AIDS-defining diagnosis, along with a CD4 + cell count of 41/µl, suggests a prolonged period of HIV positivity. Due to the presence of existing indicator conditions, an earlier HIV diagnosis was possible. We contend that most of the recent illnesses could have been prevented if earlier testing had been carried out. Therefore, patients presenting with AIDS indicator conditions, including those with mental disabilities, should be given the opportunity to be tested for HIV. HIV/AIDS trainings should be made available to health care professionals as well as to personnel interacting with vulnerable groups.","PeriodicalId":7503,"journal":{"name":"AIDS Research and Therapy","volume":"87 1","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140572523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Syphilis is an infection caused by the bacteria Treponema pallidum. It is mainly transmitted through oral, vaginal and anal sex, in pregnancy and through blood transfusion. Syphilis develops in primary, secondary, latent and tertiary stages and presents with different clinical features at each stage. Infected patients can remain asymptomatic for several years and, without treatment, can, in extreme cases, manifest as damage in several organs and tissues, including the brain, nervous tissue, eyes, ear and soft tissues. In countries with a high human immunodeficiency virus (HIV) burden, syphilis increases the risk of HIV infections. We report the case of a young HIV-positive black woman who presented with alopecia and hypopigmentation as features of secondary syphilis.
Case presentation: A virologically suppressed 29-year-old woman on Anti-retroviral Therapy (ART) presented with a short history of generalized hair loss associated with a non-itchy maculopapular rash and skin depigmentation on the feet. Limited laboratory testing confirmed a diagnosis of secondary syphilis. She was treated with Benzathine Penicillin 2.4MU. After receiving three doses of the recommended treatment, the presenting features cleared, and the patient recovered fully.
Conclusion: This case demonstrates the importance of a high index of clinical suspicion and testing for syphilis in patients presenting with atypical clinical features of secondary syphilis, such as hair loss and hypopigmentation. It also highlights the challenges in diagnosing and clinically managing syphilis in a resource-limited setting.
背景:梅毒是由苍白螺旋体引起的一种感染。梅毒主要通过口交、阴道性交、肛交、妊娠和输血传播。梅毒分为原发期、继发期、潜伏期和三期,每个阶段都有不同的临床特征。受感染的患者可数年无症状,如不治疗,在极端情况下,可表现为多个器官和组织受损,包括大脑、神经组织、眼睛、耳朵和软组织。在人类免疫缺陷病毒(HIV)感染率较高的国家,梅毒会增加感染 HIV 的风险。我们报告了一例年轻的 HIV 阳性黑人妇女的病例,她出现了脱发和色素沉着,这是继发性梅毒的特征:一名正在接受抗逆转录病毒疗法(Anti-retroviral Therapy,ART)的 29 岁女性,因全身脱发伴有非瘙痒性斑丘疹和足部皮肤色素沉着而就诊。有限的实验室检查确诊为继发性梅毒。她接受了苄星青霉素 2.4MU 的治疗。在接受了三剂建议的治疗后,症状消失,患者完全康复:本病例表明,对于出现脱发和色素沉着等非典型二期梅毒临床特征的患者,临床高度怀疑梅毒并进行梅毒检测非常重要。该病例还凸显了在资源有限的环境中诊断和临床治疗梅毒所面临的挑战。
{"title":"Secondary syphilis presenting with alopecia and leukoderma in a stable HIV-positive patient in a resource-limited setting: a case report.","authors":"Sukoluhle Khumalo, Yves Mafulu, Victor Williams, Normusa Musarapasi, Samson Haumba, Nkululeko Dube","doi":"10.1186/s12981-024-00603-w","DOIUrl":"10.1186/s12981-024-00603-w","url":null,"abstract":"<p><strong>Background: </strong>Syphilis is an infection caused by the bacteria Treponema pallidum. It is mainly transmitted through oral, vaginal and anal sex, in pregnancy and through blood transfusion. Syphilis develops in primary, secondary, latent and tertiary stages and presents with different clinical features at each stage. Infected patients can remain asymptomatic for several years and, without treatment, can, in extreme cases, manifest as damage in several organs and tissues, including the brain, nervous tissue, eyes, ear and soft tissues. In countries with a high human immunodeficiency virus (HIV) burden, syphilis increases the risk of HIV infections. We report the case of a young HIV-positive black woman who presented with alopecia and hypopigmentation as features of secondary syphilis.</p><p><strong>Case presentation: </strong>A virologically suppressed 29-year-old woman on Anti-retroviral Therapy (ART) presented with a short history of generalized hair loss associated with a non-itchy maculopapular rash and skin depigmentation on the feet. Limited laboratory testing confirmed a diagnosis of secondary syphilis. She was treated with Benzathine Penicillin 2.4MU. After receiving three doses of the recommended treatment, the presenting features cleared, and the patient recovered fully.</p><p><strong>Conclusion: </strong>This case demonstrates the importance of a high index of clinical suspicion and testing for syphilis in patients presenting with atypical clinical features of secondary syphilis, such as hair loss and hypopigmentation. It also highlights the challenges in diagnosing and clinically managing syphilis in a resource-limited setting.</p>","PeriodicalId":7503,"journal":{"name":"AIDS Research and Therapy","volume":"21 1","pages":"19"},"PeriodicalIF":2.1,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10986119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140334343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We conducted secondary data analysis using a biobehavioral survey dataset of 1538 MSM from Zimbabwe. Survey participants were screened for the four symptoms suggestive of tuberculosis infection using the WHO TB screening algorithm. Results: All participants experienced at least one symptom suggestive of tuberculosis. 40% of HIV-positive MSM reported having had a cough in the last month and 13% of them experienced unexpected weight loss. The prevalence of experiencing any of the four TB symptoms amongst HIV-positive MSM was 23%. Contribution There is an urgent need for active TB case finding and treatment amongst HIV-positive MSM in Zimbabwe. Clinicians will need to ensure that MSM who need TB testing receive it timeously.
{"title":"Presence of tuberculosis symptoms among HIV-positive men who have sex with men (MSM) in Zimbabwe.","authors":"Munyaradzi Mapingure, Innocent Chingombe, Tafadzwa Dzinamarira, Brian Moyo, Chesterfield Samba, Delight Murigo, Owen Mugurungi, Elliot Mbunge, Rutendo Birri Makota, Grant Murewanhema, Godfrey Musuka","doi":"10.1186/s12981-024-00605-8","DOIUrl":"10.1186/s12981-024-00605-8","url":null,"abstract":"<p><p>We conducted secondary data analysis using a biobehavioral survey dataset of 1538 MSM from Zimbabwe. Survey participants were screened for the four symptoms suggestive of tuberculosis infection using the WHO TB screening algorithm. Results: All participants experienced at least one symptom suggestive of tuberculosis. 40% of HIV-positive MSM reported having had a cough in the last month and 13% of them experienced unexpected weight loss. The prevalence of experiencing any of the four TB symptoms amongst HIV-positive MSM was 23%. Contribution There is an urgent need for active TB case finding and treatment amongst HIV-positive MSM in Zimbabwe. Clinicians will need to ensure that MSM who need TB testing receive it timeously.</p>","PeriodicalId":7503,"journal":{"name":"AIDS Research and Therapy","volume":"21 1","pages":"18"},"PeriodicalIF":2.1,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10979552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140317559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}