HIV Sero-Positive Patients.

Abstract: Oral thrush is commonly associated with HIV infection. The causative agent is a yeast strain that is originally a commensal of the oral cavity. Most species of the genus Candida that causes oral candidasis in HIV patients if not properly identified and treated with the drug of choice could result in resistant to the drugs and make treatment very difficult. This study was carried out to establsish the species spectrum of the common yeast(Candida albicans) associated with oral candidiasis in HIV patients on antiretroviral treatment in Abakaliki. A total of 240 samples were collected from HIV sero-positive males(64) and females(176) at the two hospitals. 40 control samples from HIV sero-negative persons were also collected. The samples were cultured on Sabouraud dextrose agar and Candida species were isolated and characterized using germ tube test and sugar fermentation tests. Out of the 240 subjects(HIV sero-positive patients) examined for oral candidiasis, the carriage rate of oral candidiasis were 12.5%(30/240). Candida albicans accounted for 80.00% in HIV sero-postive patients, followed by Candida pseudotropicalis(10.0%). More women, 21(8.75) had oral candidiasis than men 9(3.75%). HIV patients whether or not on drugs were predisposed to oral candidiasis. C. albicans(76.19%) is the commonest species associated with HIV infected patients on ART(Active Retroviral Therapy) followed by Candida pseudotropicalis(14.29%), Candida tropicalis(4.76%) and Candida parapsilosis(4.76%). Among the patients not on ART Candida albicans(88.89%) was most prevalent, followed by Candida guilliermondii(11.11%). C. albicans still remains the leading cause of oropharyngeal candidiasis in HIV infected persons within the study population. Constant identification of isolates of yeasts infecting HIV infected persons and the immune compromised will further enhance the appropriate treatment and minimize the spread emergence of antifungal resistance.

Abstract: HIV worsens the nutritional status by increasing the body’s requirement for food and also leads to opportunistic infections, which in turn, increase body nutrition requirements. The objective was to assess nutrient intake, nutrient status and nutritional status and establish the infection pattern of HIV seropositive patients attending a Comprehensive Care Clinic. A prospective cohort design was adopted where 497 HIV and AIDS patients enrolled at the hospital were followed for six months. This comprised of 105 males and 392 females attending the AMPATH Comprehensive Care Clinic in Chulaimbo Sub-district hospital from February 2010 to July 2010. Analysis of nutrient intake using 24-hour recall, food frequency checklist, nutrient status using biochemical assessment indicators (haemoglobin, creatinine, serum glutamate pyruvate (SGPT) and mean corpuscular volume (MCV) and pattern of infections using a morbidity tool. There was inadequate nutrient intake reported in most of the patients although a slightly more than half (55.3%) had three meals per day. Malnutrition was observed in 20.3% of 497 HIV sero-positive patients were who had a mean BMI < 18.5kg/m 2 . The common co-infections/opportunistic infections were pneumonia (16.1%), tuberculosis (14.9%), dermatitis (8.7%), malaria (5.6%) and oral candidiasis (0.8%). Therefore, nutrition assessment of HIV and AIDS patients is important at all stages of the disease in order to identify those with signs of malnutrition. This will assist in preventing or detecting malnutrition from the early stages of HIV infection among HIV and AIDS patients.

Dermatologic, cardiovascular, musculoskeletal, neurologic, urologic, hepatobiliary or ocular complications can occur. Humoral and cellular Immunodeficiency states in HIV patients predispose than to serious disease with M pneumonia.These patients may suffer repeated bouts of M pneumonia and have difficulty in eliminating the organism from respiratory tract despite adequate therapy.These patients often have upper and lower respiratory tract symptoms with few or no infiltration observed on chest X-ray and have significant complications. Fulminant dessiminated infection with multi system involvement is rare. But it has been reported.

When the first case of HIV infection was reported in the early 1980’s, it was noted that infected persons presented with pertinent weight loss or mass wasting. This is perhaps the primary reason as to why HIV infection during this period was referred to as “wasting disease.” However, the advent of anti-retroviral medications utilized in treatment and care of HIV-infected patients has resulted in an immense improvement of the nutritional status of infected populations. In fact, some proportion of HIV-infected individuals on treatment and care are often overweight, whereas others are obese. This was evident by a research “Nutritional Status of HIV Sero-Positive patients in Niteroi, Rio de Janeiro, Brazil” carried out by Senna et al., (2014), which found out that 37.1% of the study patients had excess weight. While it is true that Senna et al., 2014 sentiments on the occurrence of overweight and obesity amongst HIV-infected persons, the study failed to consider certain factors such as food security status of households of HIV-infected persons, which are some of the core determinants of nutritional status.

The human papillomavirus (HPV) is the major etiologic agent in the development of cervical cancer [1] with known risk factors such an early age at first intercourse, history of multiple sexual partners, oral contraceptive use, high parity, lower socioeconomic status, and immuno- suppression. In immunocompetent subjects, HPV infec- tions normally clear in six to twenty-four months in 70% of females [2]. The natural history of HPV infection is altered in persons infected with the human immunodefi- ciency virus (HIV) and there is an increased likelihood of persistent HPV infections in this population [3]. This per- sistent infection increases their risk of having cervical dys- plasia and cervical intraepithelial neoplasms (CIN) [3,4]. HIV-positive women especially those with severe immu- nosuppression are five times more likely than HIV sero- negative women to have lower genital tract neoplasias [4,7]. High HPV load in HIV-positive women is associated with a 10-fold increase risk of CIN in severe immunosup- pression [5]. Recent studies indicate that plasma HIV RNA levels and CD4+ cell counts are strong determinants of the ability to detect HPV suggesting that as the immune sys- tem weakens, it facilitates reactivation of the HPV thus helping to explain the increase rates of HPV infection in women with HIV [6,7]. Additionally, Highly Active Anti- Retroviral Therapy (HAART) does not seem to impact this increased rate or persistent of HPV infections in this pop- ulation [8]. For many years the focus of care for HIV sero- positive patients in the Bahamas was on immune system reconstitution using HAART. Patients receiving HAART die less frequently from opportunistic infections but more now face morbidity from chronic medical diseases and other illnesses including malignancies. One such prevent- able disease is cervical cancer. There is no available data from the Bahamas or the Caribbean that documents the prevalence of cervical dysplasia or HPV infections in HIV sero-positive females.

However hematological complication such as anemia and leucopenia are common health complications and cause of mortality and morbidity in HIV infected patient if the trend is not checked and managed with potent antiviral therapeutic agent (Kirchoff and Silverstri 2008). This calls for better and improved management of the scourge especially in remote areas of Niger Delta. CD4 cell count is an important immunological marker which is useful in the understanding and evaluation of disease progression in Human Immuno deficiency Virus sero-positive patients. This should be regularly monitored at all time since it is one of the specialized cells that are very active in body defensive mechanism. The Virus attacks these cells and uses them to make more copies of itself, in doing so the Human Immune deficiency Virus weakens the immune system, making it unable to protect the body from illness and other form of opportunistic infections that are highly associated with HIV infection. Early in the stage of the disease, the body makes more CD4 cells to replace the ones that have been damaged by the virus. Eventually, the system might no longer keep up with the health challenge associated with this trend as the number of active T-cells continues to decrease downward leaving the body more vulnerable for attack. As more and more CD4 cells become damaged, the immune system becomes more and more weakened (Imade et al., 2005). It is strongly believed that the higher the number of CD4 in the system, the active and more robust is the immunological responses of the system. People without HIV infection have about 500 to 1000 CD4 cells in a drop of blood (Mermine et al., 2006). People living with HIV infection are considered to have “normal” CD4 counts, if the number is above 500 CD4 cells in a drop of blood. This can be as a result of the nutrition taken. It is strongly advised that food taken by HIV sero-positive patients should be nutritious as this will help the immune system to be stronger and makes the CD4 count higher as longer duration of Human Immune deficiency Virus infection suppresses the immune system and leads to lower CD4 cell numbers (Froebel et al., 2004).

DOI: 10.4236/ojepi.2018.82004 45 Open Journal of Epidemiology have knowledge of their sexual partner HIV sero status [9]. In Ethiopia, different level of sero status disclosure was documented. The study done at Axum health facility showed 41.8% level of sero status disclosure to sexual partner. The main reasons for non-disclosure were fear of stigma and rejection, fear of breach of confidentiality, fear of divorce and fear of accusation of infidelity. Marital status of the respondents, knowledge of partner’s HIV status and being a member of Anti-HIV/AIDS association were identified as significant determinants of sero status disclosure [10]. The studies done at Jimma University Specialized Hospi- tal, kemisse health center, Hawassa Referral Hospital and Woldia hospital rev- elead 90.2%, 93.1%, 92.2% and 76.6% level of HIV sero status disclosure to sex- ual partner respectively [10] [11] [12] [13]. Pre-test discussion about the benefit of sero status disclosure and knowing their partner’s HIV sero status were sig- nificantly associated with HIV sero status disclosure to sexual partners [12] [13] [14]. A cross sectional study done at Mekelle Hospital among patients attending antiretroviral treatment clinic follow up revelead overall HIV status disclosure to sexual partner of 57.4%. The study showed that there was significant association between knowing HIV status of sexual partner ,duration of HIV related care fol- low up and discussion before HIV testing with HIV positive status disclosure to sexual partner [15]. This study tried to assess HIV sero status disclosure to sex- ual partners and identify context based influencing factor for sero status disclo- sure to sexual partner. So that, finding of this study have a great role in contrib- uting valuable information about HIV positive status disclosure to sexual part- ner and it provides scientific evidence regarding the factors which influence a person’s decision to disclose his/her HIV sero status to sexual partner which help policy makers, health planners and health workers to devise effective strat- egy for improving HIV sero status disclosure so as to benefit from it as vital protocol for HIV prevention and control strategies.

Prevalence of tuberculosis (TB) is higher among HIV sero-positive persons than among HIV sero-negative persons. The ages between 15 and 50 years are most affected, of which males are more in number. Also, areas such as the Port Harcourt town area that is highly populated and harbours the poor people of the society, show higher prevalence rates compared to other parts of Port Harcourt due to poverty, and the crowded nature of the area. Infection with human immunodeficiency virus (HIV) has been reported as an important risk factor for tuberculosis. [12-14] Tuberculosis continues to occur and is the most common AIDS-associated opportunistic infection. [15] In recent times, a lot of people who suffer from tuberculosis are also HIV sero-positive, it is therefore necessary that patients diagnosed to be HIV sero-positive should also be tested for Mycobacterium tuberculosis infection and be given preventive chemotherapy to prevent the development of active tuberculosis (TB). The youths and young adults should be educated adequately on how to prevent the HIV and tuberculosis infections. The urban areas of Port Harcourt should be decongested of the activities that attract people to the cities. More jobs should be provided for the youths in the rural areas as this will prevent rural – urban migration. This would reduce the transmission of tuberculosis due to congestion of people and would also improve the quality of life of the inhabitants of Port Harcourt metropolis and of the inhabitants of the rural areas.

medication [10]. The first United States National Health and Nutrition Examination Survey (NHANES-1) reported that short sleep duration was associated with a 60% increased risk of hypertension [11]. Cross sectional studies from USA [12-15], France [16], Japan [17], Canada [18,19], Spain [20], Germany [21], and the United Kingdom [22] found significant association between short sleep and obesity. Short sleep was also found to be associated with lower CD4+ T-cell counts and higher viral load [23]. Our aim was to determine the prevalence of short sleep duration among HIV patient on HAART and to evaluate the associated factors.

The treatment of anal cancer is not straight forward. Histologic classification and staging are important. Anal SCC spreads mostly by the lymphatic route. Pa- tient should be fit or optimized for whatever treatment modality in use. The treatment of the various grades of precancerous lesions holds the key to pre- venting advancement while screening and vaccination of those with risky be- haviour has been advocated. This appears feasible since the same approach has reduced the incidence of cervical cancer in women and both anal and cervical cancer share the same aetiological agent in HPV types 16 and 18. Patients with RVD in addition to anal cancer have a peculiar challenge. They usually succumb to Retro-Viral Disease (RVD) rather than anal cancer, from effects of HIV and very low CD4 + count < 200 [7] [9]. This further suggests that HIV positive pa-

An increasing proportion of HIV infections is occurring in older adults as members of this age group are the least likely to practice safe sex and changes in the reproductive tract and immune system may enhance suscepti- bility to HIV acquisition in seniors. HIV infection can be diagnosed after age of 50 years and it may present with atypical clinical picture. Our study demands attention of policy makers as well as social workers to addressing the emerging issue of HIV at the doorstep of geriatrics and considering wider awareness program and more lib- eral HIV testing among elderly men and women. Physicians also need to be wiser in considering and ordering HIV testing among elderly persons with risk factors and signs of premature ageing. The strength of the study being, it deals with an unexplored element of gender inequality in demographical and clinical profile among HIV infected elderly. The limitations are that it is a cross-sectional hospital based study consisting of heteroge- neous study group with small number of cases. Moreover since the history regarding the possible exposure to HIV among the elderly sero-positive patients could not be retrieved due, expected duration of HIV infection could not assessed and thus severity of infection could not be correlated with the duration of disease. This study also points the need for larger multi-centric population based study involving elderly HIV infected persons in India.

It’s estimated that by the year 2030 approximately a million people will be dying from cancer related causes on the African continent [7]. Head and neck cancers being among the top ten cancers worldwide are important enough to look at in the context of HIV AIDS. Additionally developing countries especially those in Sub Saharan Africa not only bare the blunt of HIV/AIDS, but also increasingly have a high incidence of cancers [8], [9], [10], [11]. A study from Uganda showed nasopharyngeal carcinoma (a head and neck cancer) as one of the non AIDS associated cancers with increased incidence presenting at late stages after diagnosis [6]. Head and neck cancers have been reported to have increased incidence among people living with HIV/AIDS and are thought to be associated with viral infections such as HPV and EBV [12]. Since demonstration of increased HPV sero prevalence has been reported among HIV+ patients [13], [14], Its plausible that head and neck cancers associated with HPV and other viruses would increase and maybe behave differently among people living with HIV hence our interest in seeing differences and similarities at presentation of HIV positive head and neck cancer patients compared to the negative ones.

detect Sero prevalence of HIV infection among known tuberculosis patients In Khartoum state , and to detect relation between certain factors such as gender, age, residence, occupation, treatment and duration of TB. It was descriptive cross-sectional study conducted from April to June 2015. A total of 89 known Tuberculosis patients who attended hospitals (67 males and 22 females) were enrolled. Serum specimens were tested by ELISA for anti HIV 0, 1, 2. Data were analyze chi squared test in SPSS software. sero positive of HIV antibodies 0,1,2 was detected in 2(2.2%) of cases and negative was 87(97.8%).

This study was a subset of a parent case-case study con- ducted on toxoplasmosis among HIV infected individ- uals from May to August 2015. The participants were recruited from three hospitals in the Central Region. The hospitals were the Cape Coast Teaching Hospital (CCTH) which is the referral and teaching hospital in the Central Region, Cape Coast Metropolitan Hospital (CCMH) both located in Cape Coast Metropolis and Saltpond Municipal Hospital (SMH) located in the Mfantseman District. All these hospitals provide services to HIV infected individuals within and beyond the Central Region. CCTH and SMH receive the highest number of infected individuals. CCTH is a tertiary facil- ity with about 400 beds. The HIV/STIs clinic in the facility was the first to be established in the region in 2006 and has registered over 4000 HIV positive patients since. SMH has 112 beds and provides service to 517 HIV infected patients while CCMH has 120 beds with an estimated 365 HIV population.

There was a high sero-discordance rate among the mar- ried patients. Being a female, having education at college/ university level and living in an area with late initiation of VCT were predictors of higher HIV sero-concordance, whereas being male, having a history of IDU and TB and living in an area with earlier VCT initiation were predic- tors of the HIV sero-discordance of the partner. To con- tain the increasing HIV prevalence among women and prevent transmission among sero-discordant couples, measures should be taken to reduce the HIV viral load and exposure. These include providing increased infor- mation, as well as condoms and ART to the HIV-positive partner, regardless of their immune status. Pre-Expo- sure Prophylaxis (PrEP) might in some cases also be an option to reduce transmission. Viral load monitoring is important to assess the effect of treatment, early detec- tion treatment failure or poor adherence, as well as of increased risk for HIV transmission, especially among sero-discordant couples.

Objectives: Depressive disorders are a significant public health issue. They are prevalent, disabling, and often chronic, with a high economic burden to the society. Depressive illness is the most common psychiatric disorder in HIV/AIDS with prevalence 2 to 4 times higher than the general population. It’s still questionable whether HIV related depression is clinically different from sero-positive patients without depression. Studies comparing the clinical features of depressed and non-depressed People Living with HIV/AIDs are limited, hence the need for this study. Methods: This was a hospital based, cross sectional, descriptive study of three hundred adult HIV/AIDS patients attending the HIV clinic of Kwara State specialist hospital, Sobi, Ilorin. The PHQ-9 was ad- ministered to the respondents to screen for depression. A pre-tested PHQ-9 questionnaire was used to collect data. Subject who scored one and more were assessed clinically for depression. The three keys of social determi- nants of depression (SDS) were assessed and the association with depression sought. Results: One hundred and seventy (56.7%) satisfied the criteria for a depressive disorder using the PHQ-9 score. Compared to non-de- pressed sero-positive patients, depressed HIV patients were more likely to be female, single, unemployed, with below average year of schooling, low social economic status, low social cohesion and more stressful life events. They are more prone to hopelessness, thought of taking life and plan to commit suicide. Conclusion: These find- ings, show that the clinical and associated features of depression differ between depressed and non-depressed sero-positive subjects, thus requiring different management.

With regard to the absence of data about prevalence of HSV-1 in the Iranian HIV positive patients, studies on non-infected HIV cases in Gorgan (22), northern Iran (23) and Anzali city (24)were Surprisingly similar to our finding (44.3%,58.4%,65.5%) respectively. Although prevalence of the EBV and HSV-1 are high in other studies like in Africa Report 2014, seroprevalence of EBV (100%) and HSV-1 (98%)(25), the Chinese survey HSV-1 (91.5%)(4),and in Tan et alʼstudy HSV- 1(73.8%)(26) but these high rates of prevalence are significantly reported higher than EBV and especially HSV-1 prevalence in Iran.

with examination of growth every 3 days for two weeks. Identification of isolates was done using Gram staining methods, chromogenic media and slide culture. Results: 46(34.8%) of the test subjects (132) were co-infected with TB while 94(71.2%) tested positive for fungi infection; 36(60.0%) for HIV-sero positive subjects on ART and 58(80.6%) for those not on ART (P<0.05). The prevalence of fungi isolates from test subjects shows that Candida albicans has the highest frequency of 25(26.6%), followed by Penicillum marneiffei with 18(21.6%), with the least prevalent being Aspergillus flavus and Phialemonium curvatum at 2(2.1%) respectively. In HIV-sero negative indivuals, Candida albicans was of the highest prevalence with 7(53.9%), followed by Candida tropicalis with 3(23.1%) and Aspergillus fumigatus and A. flavus with the least prevalence of 1(7.7%) respectively. Furthermore, there was a positive significant correlation between TB and fungi infection in HIV-sero positive subjects (P<0.05). Conclusion: The high prevalence of fungi infection amongst TB co-infected HIV-sero positive individuals suggests a high degree of drug resistance in said patients thus, could be the mitigating factor behind the increasing morbidity and mortality among TB co-infected HIV positive subjects.

STUDY SUBJECTS: HIV seropositive pediatric patients from Government TB sanatorium, Tambaram, Government Institute of Children Health, Egmore, YRG Care VHS, Taramani and Ragas Dental Collage and Hospital, Uthandi, constituted the study group.150 patients between 6 months to 15 years of age who were confirmed HIV seropositive either by ELISA / Western blot / Tridot, tests were included. Informed verbal consent was taken from the patient / guardian for clinical examination, photography and for collecting salivary samples. All the clinical details were noted in a preformatted case sheet. Systemic lesions were diagnosed based on the clinical diagnosis given by the pediatrician of the respective hospital. All oral lesions were diagnosed based on the diagnostic criteria formulated by EC Clearing House (Annexure III)

The data of HIV testing results and demographic profiles of subjects was retrieved from records maintained at ICTC and department of Microbiology of our Institute. Records of both outdoor patients (OP) and admitted Indoor Patients (IP) who attended ICTC, have undergone pre-test and post-test counseling and gave their consent for undergoing screening for Antibody to HIV by rapid kit 1 (Comb-Aids) during the study period were included in the study.