HIV (human immunodeficiency virus) infection is prevalent in many areas of sub-Saharan Africa. Seropositivity rates reach 10-15% in urban adults, 21% in critically ill adults and 30% in surgical inpatients aged 21-40 years. AIDS (acquired immune deficiency syndrome) is a multisystem disease which presents to the surgeon with a wide range of pathologies including Kaposi's sarcoma, lymphadenopathy and sepsis. The more common sites for sepsis are the female genital tract, anorectum, pleural cavity, soft tissues (necrotizing fasciitis) and bone and joints. To prevent iatrogenic HIV infection more use should be made of autologous blood. Occupational exposure to HIV infection can be minimized by double-gloving, protecting the eyes when operating and ensuring that theatre gowns are waterproof. The risk of HIV infection from a needlestick injury is 0.4%. Although contact with blood during a surgical procedure is common, the risk is lower than for a hollow needlestick injury. PIP: In Zambia, 10-15% of urban adults are reported HIV positive, as are over 80% of prostitutes. The HIV seroprevalence rate in a Lusaka hospital's intensive care unit was 21% (27% for surgical and 18% for trauma admissions). HIV-infected patients could be clinically recognized by risk factors or symptoms and signs: weight loss, chronic cough, chronic diarrhea, sepsis, septic arthritis, subacute hematogenous osteomyelitis, a history of sexually transmitted diseases (STDs), death of a spouse or of a child under age 2, recent pregnancy unable to go to term, poor quality or thin hair, appearance of aging beyond years, mental slowness, persistent or unexplained fever, lymphadenopathy, aggressive atypical Kaposi's sarcoma, oral thrush, hairy leukoplakia of the tongue, shingles scars, and scars of maculopapular dermatitis. Common sites for HIV-related sepsis are the female genital tract, anorectum, pleural cavity, soft tissues (e.g., necrotizing fascitis), and bone and joints. Autologous blood transfusion and use of donor blood screened for HIV antibodies, preferably limited to emergencies, would reduce the likelihood of iatrogenic HIV transmission. Surgeons should wear two pairs of gloves, a waterproof gown, and goggles to protect themselves from HIV transmission. If they have skin rashes, cuts, or abrasions on the hands or arms, they should not perform operations. Proper cleaning and disinfection of endoscopes are required. The risk of infection from a needle stick is small ( 0.4%).
AIDS-Related Opportunistic Infections - epidemiology, Adult, HIV Infections - epidemiology

The prevalence of asymptomatic cryptococcal antigenemia (ACA) in human immunodeficiency virus (HIV) infected individuals has been observed to be elevated. The prevalence of ACA ranges from 1.3% to 13%, with different rates of prevalence in various regions of the world. We reviewed studies conducted internationally, and also referred to two established expert consensus guideline documents published in China, and we have concluded that Chinese HIV-infected patients should undergo cryptococcal antigen screening when CD4 T-cell counts fall below 200 cells/μL and that the recommended treatment regimen for these patients follow current World Health Organization guidelines, although it is likely that this recommendation may change in the future. Early screening and optimized preemptive treatment for ACA is likely to help decrease the incidence of cryptococcosis, and is lifesaving. Further studies are warranted to explore issues related to the optimal management of ACA.
AIDS-Related Opportunistic Infections ; CD4 Lymphocyte Count ; China ; Cryptococcosis/epidemiology* ; Cryptococcus ; HIV Infections/complications* ; Humans ; Meningitis, Cryptococcal

The prevalence of parasitic infections was investigated in human immunodeficiency virus (HIV)-infected patients (n = 105) who visited Seoul National University Hospital, Seoul, Korea, during the period from 1995 to 2003. Fecal samples were collected from 67 patients for intestinal parasite examinations, and sputum or bronchoalveolar lavage samples from 60 patients for examination of Pneumocystis carinii. Both samples were obtained from 22 patients. Thirty-three (31.4%) of the 105 were found to have parasitic infections; Cryptosporidium parvum (10.5%; 7/67), Isospora belli (7.5%; 5/67), Clonorchis sinensis (3.0%; 2/67), Giardia lamblia (1.5%; 1/67), Gymnophalloides seoi (1.5%; 1/67), and Pneumocystis carinii (28.3%; 17/60). The hospital records of the 11 intestinal parasite-infected patients showed that all suffered from diarrhea. This study shows that parasitic infections are important clinical complications in HIV-infected patients in the Republic of Korea.
AIDS-Related Opportunistic Infections/*parasitology ; Adult ; Feces/parasitology ; Female ; HIV Infections/*complications ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Parasitic Diseases/*epidemiology ; Research Support, Non-U.S. Gov't

Objective: To understand the characteristics on major strain subtypes of hepatitis C virus among HIV/HCV co-infected patients, so as to explore the molecular transmission clusters and related risk factors of HCV strains. Methods: A total of 336 newly reported HIV-infected patients were diagnosed as HIV/HCV co-infection in Dehong Dai and Jingpo autonomous prefecture (Dehong) in 2016. We used Nested PCR to amplify CE1 and NS5B genes among 318 samples with plasma levels above 200 μl, before using the combining phylogenetic tree and constructing molecular propagation network method to analyze the related data. Results: A total of 267 HIV/HCV co-infection patients who had met the HCV genotyping requirements were screened the gene subtypes were diversified. Among these genotypes, proportions of 3b, 6n, 6u, 1a, 3a and other subtypes appeared as 32.6% (87/267), 18.4% (49/267), 15.7%(42/267), 13.1%(35/267), 11.2%(30/267) and 9.0%(24/267) respectively. Molecular transmission network of five major HCV genotypes was constructed with a clustering rate of 39.1% (95/243). The clustering rate of subtype 1a was the highest, as 71.4% (25/35). Results from the multivariate logistic regression showed that ethnic minorities other than the Yi and Jingpo (vs. the Han, OR=0.17, 95%CI: 0.04-0.71), the married spouses (vs. the unmarried, OR=0.42, 95%CI: 0.18-0.94), the 6n and 3a subtype (vs. the 3b subtype, OR=0.34, 95%CI: 0.12-0.95; OR=0.22, 95%CI: 0.05-0.93) were more difficult to form transmission clusters. However, the 6u and 1a subtype (vs. the 3b subtype, OR=3.10, 95%CI: 1.21-7.94; OR=4.00, 95%CI: 1.32-12.11) seemed more likely to form the transmission clusters. Conclusion: Ethnicity, marital status and genetic subtypes were factors significantly associated with the formation of transmission clusters related to the major HCV gene subtypes among newly reported HIV/HCV co-infection in Dehong.
AIDS-Related Opportunistic Infections/virology* ; Asian People ; China/epidemiology* ; Coinfection ; Genotype ; HIV Infections/virology* ; Hepacivirus/isolation & purification* ; Hepatitis C/virology* ; Humans ; Phylogeny ; Polymerase Chain Reaction

No abstract available.
AIDS-Related Opportunistic Infections/epidemiology* ; AIDS-Related Opportunistic Infections/diagnosis ; Acquired Immunodeficiency Syndrome/transmission ; Acquired Immunodeficiency Syndrome/epidemiology ; Acquired Immunodeficiency Syndrome/diagnosis ; Adolescence ; Adult ; Age Distribution ; Aged ; Child ; Child, Preschool ; Female ; HIV Infections/transmission* ; HIV Infections/epidemiology* ; HIV Infections/diagnosis ; Human ; Incidence ; Infant ; Infant, Newborn ; Korea/epidemiology ; Male ; Middle Age ; Risk Factors ; Sex Distribution ; Survival Analysis

The incidence of specific intracranial parenchymal lesions of HIV-infected patients varies considerably between countries. In the Republic of Korea, the number of HIV-infected patients is increasing, but little is known regarding the spectrum of intracranial parenchymal lesions in these patients. The aim of the present study was to obtain this information. To identify HIV patients with intracranial parenchymal lesions, the electronic database of radiological reports for 1,167 HIV-infected patients, seen from 1999 to 2008 at the Seoul National University Hospital, were reviewed. Neuroradiologic studies were performed on 165 of these patients, and intracranial parenchymal lesions were detected in 40 (3.4%) of them. Thirty-seven were male, and median age was 41 yr (range, 26-61). At the time of the diagnosis of intracranial parenchymal lesions, median CD4+ lymphocyte count was 40 cells/microL (range 5-560) and in 33 (82.5%) patients, it was less than 200 cells/microL. Progressive multifocal leukoencephalopathy (12 patients) is the most frequent intracranial parenchymal lesions, followed by intracranial tuberculoma (7 patients), primary central nervous system lymphoma (7 patients), intracranial cryptococcoma (4 patients), Toxoplasma encephalitis (4 patients), and disseminated non-tuberculous mycobacterial infection (3 patients).
AIDS-Related Opportunistic Infections/epidemiology/*pathology/physiopathology/virology ; Adult ; Central Nervous System Diseases/epidemiology/*pathology/physiopathology/*virology ; Female ; HIV Infections/*pathology/physiopathology/virology ; Humans ; Male ; Middle Aged ; Republic of Korea/epidemiology

There have been profound changes in the pattern of cytomegalovirus (CMV) retinitis over the last two decades. The epidemiology and behaviour of CMV retinitis has been significantly altered by Acquired Immune Deficiency Syndrome (AIDS). It was uncommon prior to the AIDS epidemic, but soon became the most common retinal infection in AIDS patients. In the past several years, highly active anti-retroviral treatment (HAART) has achieved a dramatic improvement in the prognosis for patients infected with human immunodeficiency virus (HIV). As a result, HIV patients are living longer and have a reduced risk of CMV retinitis. Some patients with CMV retinitis who respond to HAART develop a transient symptomatic vitritis while others undergo no reactivation of their retinitis despite having no specific anti-CMV therapy. This pattern is likely to undergo further change as the treatment of HIV and CMV disease continues to improve.
AIDS-Related Opportunistic Infections ; drug therapy ; epidemiology ; Antiretroviral Therapy, Highly Active ; methods ; trends ; Antiviral Agents ; therapeutic use ; Cytomegalovirus Infections ; drug therapy ; epidemiology ; Disease Progression ; Humans ; Longevity ; Prognosis ; Remission Induction ; Risk Factors ; Treatment Outcome

OBJECTIVETo analyze Helicobacter pylori infection in the gastric mucosa of patients with HIV/AIDS in different clinical stages.

METHODSThis study involved 170 patients with HIV/AIDS and 34 HIV-negative patients. All the patients underwent upper endoscopy and antral gastric biopsy to determine the status of Helicobacter pylori infection using aniline red staining and rapid urease test. The patients with HIV/AIDS were stratified based on CD4(+)T lymphocyte counts and clinical setting into asymptomatic HIV infection (A1, A2) group, symptomatic HIV infection (B1, B2) group and AIDS (A3, B3, C1-3) group.

RESULTSThe prevalence of Helicobacter pylori infection in HIV/AIDS patients was 16.5% (28/170), and in the 3 groups classified, the infection rates were 23.4% (11/47), 14.0% (8/57), and 13.6% (9/66), respectively; the infection rate was 47.1% (16/34) in the control group. Helicobacter pylori infection rate in the gastric mucosa of the patients with HIV/AIDS in different clinical stages was significantly lower than that of the control group (P<0.05); the infection rates in symptomatic HIV-infected (B1, B2) group and AIDS (A3, B3, C1-3) group were significantly lower than that in asymptomatic HIV-infected (A1, A2) group (P<0.05).

CONCLUSIONThe low Helicobacter pylori infection rate in HIV/AIDS patients may result from severe immunodeficiency in the gastric mucosa.

AIDS-Related Opportunistic Infections ; microbiology ; pathology ; Acquired Immunodeficiency Syndrome ; microbiology ; pathology ; Adult ; Female ; Gastric Mucosa ; microbiology ; Gastroscopy ; HIV Infections ; microbiology ; pathology ; Helicobacter Infections ; epidemiology ; pathology ; Helicobacter pylori ; Humans ; Male ; Middle Aged

BACKGROUNDPulmonary fungal infection is one type of the common opportunistic infections in AIDS patients. The disease is hard to diagnose because of its complicated imaging features. The objective of this study was to investigate the imaging performance characteristics of pulmonary fungal infection in AIDS patients.

METHODSFifty-one patients with AIDS complicated with pulmonary fungal infection and 56 patients of non-AIDS with pulmonary fungal infection were examined by CT scans and high-resolution CT scans. The contrast enhanced scans were performed in patients with the mass or suspected enlarged mediastinal lymph nodes. Results were compared between the two groups.

RESULTSThe most common fungal infection in the two groups of patients was Candida albicans. The infection rates were 54.8% (28 cases) in the group (AIDS patients with pulmonary fungal infection) and 58.3% (32 cases) in another group (non-AIDS patients with pulmonary fungal infection). In the two groups, the difference in diffuse distribution and the difference in incidence of affected upper and lower lobes in the bilateral lung fields were statistically significant. The differences in patchy or large consolidation shadow, cavitas, enlarged lymph nodes in mediastinum and pleural effusion were also significant when comparing the two groups.

CONCLUSIONSThe lesion in most of AIDS patients with pulmonary fungal infection tends to exhibit diffuse distribution, patchy or large consolidation shadow covering a more extensive region. The differences between AIDS with pulmonary fungal infection and non-AIDS with pulmonary fungal infection are statistically significant in lesion location and complicated imaging features. The most common fungal infection in AIDS patients is Candida albicans.

AIDS-Related Opportunistic Infections ; diagnostic imaging ; epidemiology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Candidiasis ; diagnostic imaging ; Child ; Female ; Humans ; Incidence ; Lung Diseases, Fungal ; diagnostic imaging ; epidemiology ; etiology ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods

A retrospective analysis was performed in two major HIV/AIDS referral hospitals in Beijing to evaluate the prevalence of Mycobacterium tuberculosis (MTB) and non-tuberculous mycobacterial (NTM) infections in HIV-infected patients. A total of 627 patients' data were reviewed, and 102 (16.3%) patients were diagnosed with culture-confirmed mycobacterial infection, including 84 with MTB, 16 with NTM, and 2 with both MTB and NTM. The most frequent clinical complication by mycobacterial infection was pulmonary infection (48/102, 47.1%). The overall rates of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) were 11.9% and 3.4%, respectively. This study underlines the urgent need to intensify screening for mycobacteria coinfection with HIV and to prevent the spread of drug-resistant TB among HIV-infected patients.
AIDS-Related Opportunistic Infections ; epidemiology ; microbiology ; Adult ; Beijing ; Coinfection ; Extensively Drug-Resistant Tuberculosis ; epidemiology ; microbiology ; Female ; HIV Infections ; epidemiology ; microbiology ; Hospitals, Urban ; Humans ; Male ; Mycobacterium Infections, Nontuberculous ; epidemiology ; microbiology ; Mycobacterium tuberculosis ; isolation & purification ; Nontuberculous Mycobacteria ; isolation & purification ; Prevalence ; Retrospective Studies ; Sputum ; microbiology ; Tuberculosis, Multidrug-Resistant ; epidemiology ; microbiology ; Tuberculosis, Pulmonary ; epidemiology ; microbiology