Opportunistic infections (OIs) are the major cause of morbidity and mortality in HIV-infected patients. The incidences of many OIs are decreasing because of advances in HIV-related therapy. These decreases have been attributed to successful OI prophylaxis and the use of potent antiretroviral therapy (ART). ART has reduced the incidence of OIs and has extended the patients' life expectancy substantially. ART is the most effective approach to prevent OIs. However, HIV-infected patients continue to develop OIs. This occurs because many patients unaware of their HIV status until they present with an OI, and also because certain patients seek medical attention at a later stage during the course of disease. OIs also still occur after the patient has started ART, in the setting of treatment failure or immune reconstitution syndrome. Therefore, OIs will continue to cause substantial morbidity and mortality in patients with HIV infection, even among persons who are receiving ART. In this review, we focus on primary and secondary prophylaxis as well as the treatment of the most frequent OIs in HIV-infected patients.
HIV ; HIV Infections ; Humans ; Immune Reconstitution Inflammatory Syndrome ; Incidence ; Life Expectancy ; Mortality ; Opportunistic Infections* ; Treatment Failure

Highly active antiretroviral therapy for HIV infection has led to substantial reduction in AIDS associated morbidity and mortality. Systemic inflammatory reactions after the initiation of HAART (highly active antiretroviral therapy) have recently been described in HIV infected patients. The pathogenesis of systemic inflammatory reaction after HAART has not yet been clearly explained, but immune restoration after HAART may explain this phenomenon. We report two cases of systemic inflammatory reactions after starting HAART in HIV-infected patients. In each cases, 5 or 18 days after starting combination antiretroviral therapy, spiking fever and infiltration on chest Xray were developed. The etiology of fever such as opportunistic infection, drug reaction, noncompliance, or malabsorption were evaluated, but cause for clinical deterioration was not found. We concluded that this phenomenon was systemic inflammatory reaction after HAART and we overcame the clinical deterioration by steroid use.
Acquired Immunodeficiency Syndrome ; Antiretroviral Therapy, Highly Active* ; Fever ; HIV Infections ; HIV* ; Humans ; Mortality ; Opportunistic Infections ; Thorax ; Tuberculosis*

OBJECTIVETo understand the general feature of patients with Mycobacterium tuberculosis (MTB) and human immunodeficiency virus (HIV) co-infectious (TB/HIV) in Guangxi, from 2007 to 2012.

METHODSInformation regarding individuals that the contributory causes of death were due to MTB infection among HIV as the underlying cause of death from the Vital Registration System, together with bacterium smear or culture results, onset of TB, time that TB was diagnosed and entered an Internet base TB surveillance system was collected and checked. Data including information on time of death, age, occupation, the underlying cause of death among TB patients, bacterium distribution, average age of death, interval from onset to death, percentage of TB/HIV co-infection patients among all the patients etc, were all analysed.

RESULTS203 patients died from HIV associated with TB from the Guangxi Vital Registration System were identified between 2007 and 2012. The average percentage of TB/HIV co-infection cases accounted for 8.24% (ranging from 3.94% in 2007 to 13.27% in 2012) among all the deaths of HIV infection while it accounted for 9.90% (ranging from 2.56% to in 2007 to 26.88% in 2012) among patients with MTB infection in the same period. The average percentage of deaths from TB/HIV co-infection in 2010 and 2012 accounted for 10.66% (ranging from 8.83% to 13.27%)and 22.17% (ranging from 20.60% to 26.88%)among patients died of HIV and TB infection respectively. The male-female ratio was 4.21 for 1, with the average age of death as 44.65 (44.65 ± 15.52) years;median time from TB symptoms onset to diagnosis as 37 (mean 94.31, standard deviation 206.07) days, record as (94.31 ± 206.07); median time from diagnosis to death as 46 (165.22 ± 282.19) days, 54.68% TB/HIV patients died within two months of being diagnosed with TB and the median time from TB symptoms onset to death as 131 (257.68 ± 340.79) days. 16.26% of the TB/HIV cases were bacterium confirmed TB cases.

CONCLUSIONCompare to those TB patients without HIV, less bacterium evidence was found in TB/HIV patients. High burden caused by HIV disease was seen if they were co-infected with TB. An increasing proportion of deaths was noticed among patients co-infected with HIV and TB in the last three years, suggesting that the coverage of antiretroviral therapy be scaled up together with the strengthening of the capability on early TB case-finding among people live with HIV.

Adult ; China ; epidemiology ; Coinfection ; mortality ; Female ; HIV Infections ; microbiology ; mortality ; Humans ; Male ; Middle Aged ; Tuberculosis ; mortality ; virology ; Young Adult

Lead time bias might exist in observational study for clinical outcomes. This paper summarizes the concept of lead time bias, causes and control of lead time bias by using the studies of influences of screening diagnostic test on cancer patients'survival and highly active antiretroviral therapy on HIV/AIDS patients' survival as examples for the purpose of providing thinking and methods in the control of lead time bias for the accurate evaluation of the effects of interventions, such as test and treatment, on the diseases with multi courses or phases.
Antiretroviral Therapy, Highly Active ; Bias ; HIV Infections/mortality* ; Humans ; Mass Screening ; Outcome Assessment, Health Care

OBJECTIVETo investigate the risk factors attributable to tuberculosis-related deaths in areas with human immunodeficiency virus (HIV) infection epidemics.

METHODSA prospective cohort study of newly registered patients in tuberculosis (TB) dispensaries in six representative Chinese provinces was conducted from September 1, 2009 to August 31, 2011. Risk factors for TB-associated death were identified through logistic regression analysis.

RESULTSOf 19,103 newly registered pulmonary TB patients, 925 (4.8%) were found to be HIV-positive. Miliary TB and acid-fast bacillus smear-negative TB were more common among these patients. Out of a total of 322 (1.7%) deaths that occurred during TB treatment, 85 (26%) of the patients were co-infected with HIV. Multivariate analysis revealed that HIV infection was the strongest predictor of death [adjusted odds ratio (aOR) 7.86]. Other significant mortality risk factors included presentation with miliary TB (aOR 4.10; 95% confidence interval: 2.14-7.88), ⋝35 years of age (aOR 3.04), non-Han ethnicity (aOR 1.67), and farming as an occupation (aOR 1.59). For patients with TB/HIV co-infection, miliary TB was the strongest risk factor for death (aOR 5.48). A low CD4 count (⋜200 cells/µL) (aOR 3.27) at the time of TB treatment initiation and a lack of antiretroviral therapy (ART) administration (aOR 3.78) were also correlated with an increased risk of death.

CONCLUSIONInfection with HIV was independently associated with increased mortality during TB treatment. Offering HIV testing at the time of diagnosis with TB, early TB diagnosis among HIV/acquired immunodeficiency syndrome patients, and the timely provision of ART were identified as the key approaches that could reduce the number of HIV-associated TB deaths.

Adult ; China ; epidemiology ; Cohort Studies ; Coinfection ; mortality ; therapy ; Female ; HIV Infections ; complications ; mortality ; Humans ; Male ; Middle Aged ; Risk Factors ; Tuberculosis, Pulmonary ; complications ; mortality ; therapy

BACKGROUND: Tuberculosis (TB) is the leading cause of mortality among human immunodeficiency virus (HIV) patients and the majority of them occur in developing countries. The aims of the present study were to determine the frequency of HIV/TB co-infection and other probable associated factors. METHODS: This 10 year retrospective study was conducted on 824 HIV patients in the south-west of Iran. HIV infection was diagnosed by the enzyme linked immunosorbent assay and confirmed by Western blot. TB diagnosis was based on consistency of the clinical manifestations, chest X-ray, and microscopic examination. Drug susceptibility testing was done by the proportional method on Lowenstein-Jensen media. RESULTS: Of 824 HIV patients, 59 (7.2%) were identified as TB co-infected and the majority (86.4%) of them were male. Of the overall TB infected patients, 6 cases (10.2%) showed multidrug-resistant with the mean CD4+ lymphocyte count of 163+/-166 cells/mm3. The main clinical forms of TB were pulmonary (73%). There was a significant (p<0.05) correlation between TB infection and CD4+ lymphocyte counts < or =200 cells/mm3, gender, prison history, addiction history, and highly active anti-retroviral therapy. CONCLUSION: We reported novel information on frequency of HIV/TB co-infection and multidrug resistant-TB outcome among co-infected patients that could facilitate better management of such infections on a global scale.
Blotting, Western ; Coinfection ; Developing Countries ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; HIV ; HIV Infections ; Humans ; Iran* ; Lymphocyte Count ; Male ; Methods ; Mortality ; Prisons ; Retrospective Studies ; Thorax ; Tuberculosis ; Tuberculosis, Multidrug-Resistant

We report on an abdominal pregnancy in human immunodeficiency virus-positive mother, currently on antiretroviral therapy, which was discovered incidentally while training the obstetric ultrasound capacity building program. Although abdominal pregnancy is a rare form of ectopic pregnancy, it may be more common in women with HIV infection because they tend to have a higher rate of sexually transmitted diseases than the general population. The positive diagnosis of abdominal pregnancy is difficult to establish and is usually missed during prenatal assessment particularly in settings that lack routine ultrasound examination as is the case in most developing countries. For the management of abdominal pregnancy, surgical intervention is recommended and removal of the placenta is a key controversy. Ultrasonography is considered the front-line and most effective imaging method and an awareness with a high index of suspicion of abdominal pregnancy is vital for reducing associated high maternal and even higher perinatal mortality.
Capacity Building ; Developing Countries ; Diagnosis ; Female ; HIV ; HIV Infections ; Humans* ; Methods ; Mothers ; Perinatal Mortality ; Placenta ; Pregnancy ; Pregnancy, Abdominal* ; Pregnancy, Ectopic ; Sexually Transmitted Diseases ; Ultrasonography

OBJECTIVETo examine the state of incubation period and survival time of former commercial plasma donors (FCPDs) infected with HIV.

METHODSAll objects infected with HIV were from Hebei province and found from general investigation for FCPDs in 1995. The infector cohort by 142 cases was used to estimate incubation period. In the infector cohort, the time which infectors entered the cohort was their infection time, which was the middle value of the origin date, which was January 1, 1995. The onset of AIDS was defined as an outcome event. End point of observation was Dec 31, 2010. There were 192 months in all from beginning to end. The AIDS cohort by 57 cases was used to estimate the survival of the patients. In the patient cohort, the time of AIDS onset was defined as the time entering the cohort, and death of AIDS was defined as an outcome event. The cumulative incidence ratio, cumulative mortality, illness intensity and mortality intensity were analyzed through Kaplan-Meier.

RESULTSDuring the observation period, 123 cases of 142 infectors developed into AIDS, the cumulative incidence was 86.42% (123/142) and the intensity was 8.53/100 person-years and the median time of incubation period was 112.0 months (95%CI: 108.8 - 115.2). The death dates of 57 patients were from 1 to 24 months after onset. The cumulative mortality was 100%, and the intensity was 250.66/100 person-years and the median survival time was 3.0 months (95%CI: 1.8 - 4.2). It was estimated that the median time was 115.0 months (9.6 years) from infection to death.

CONCLUSIONThe median times of incubation and median survival time were 112.0 and 3.0 months, respectively.

Adult ; Blood Donors ; Cohort Studies ; Female ; HIV ; physiology ; HIV Infections ; epidemiology ; mortality ; virology ; Humans ; Incidence ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Virus Latency ; Young Adult

Human immune deficiency virus (HIV) is a leading cause of death. It attacks the immune system, thereby rendering the infected host susceptible to many HIV-associated infections, malignancies and neurocognitive disorders. The altered immune system affects the way the human host responds to disease, resulting in atypical presentation of these disorders. This presents a diagnostic challenge and the clinician must use all diagnostic avenues available to diagnose and manage these conditions. The advent of highly active antiretroviral therapy (HAART) has markedly reduced the mortality associated with HIVinfection but has also brought in its wake problems associated with adverse effects or drug interaction and may even modulate some of the HIV-associated disorders to the detriment of the infected human host. Nuclear medicine techniques allow non-invasive visualisation of tissues in the body. By using this principle, pathophysiology in the body can be targeted and the treatment of diseases can be monitored. Being a functional imaging modality, it is able to detect diseases at the molecular level, and thus it has increased our understanding of the immunological changes in the infected host at different stages of the HIV infection. It also detects pathological changes much earlier than conventional imaging based on anatomical changes. This is important in the immunocompromised host as in some of the associated disorders a delay in diagnosis may have dire consequences. Nuclear medicine has played a huge role in the management of many HIV-associated disorders in the past and continues to help in the diagnosis, prognosis, staging, monitoring and assessing the response to treatment of many HIV-associated disorders. As our understanding of the molecular basis of disease increases nuclear medicine is poised to play an even greater role. In this review we highlight the functional basis of the clinicopathological correlation of HIV from a metabolic view and discuss how the use of nuclear medicine techniques, with particular emphasis of F-18 fluorodeoxyglucose, may have impact in the setting of HIV. We also provide an overview of the role of nuclear medicine techniques in the management of HIV-associated disorders.
Antiretroviral Therapy, Highly Active ; Cause of Death ; Diagnosis ; Drug Interactions ; HIV ; HIV Infections ; Humans ; Immune System ; Immunocompromised Host ; Mortality ; Neurocognitive Disorders ; Nuclear Medicine ; Prognosis

HIV) co-infection in the intensive phase of treatment.METHODS: Fifty-four patients with TB/TM and HIV co-infection were enrolled for this study. Group 1 comprised of 23 patients treated with E and H intravenously, while rifampicin and pyrazinamide were prescribed orally. Group 2 consisted of 31 patients treated with the first-line anti-TB drugs orally. The concentrations of H and E in blood serum were detected using a chromatographic method.RESULTS: A significant improvement in the clinical symptoms and X-ray signs in patients treated intravenously with H and E was observed and compared to group 2. The sputum Mycobacterium tuberculosis positivity was observed during the second month of the treatment in 25.0% of patients from group 1 and 76.1% of the patients from the control group (p=0.003). In addition, nine patients (39.1%) died up to 6 months when H and E were prescribed intravenously compared with 22 (70.9%) in group 2 (p=0.023).CONCLUSION: In TB/TM with HIV, the intravenous H and E treatment was more effective than oral H and E treatment at 2 months of intensive treatment in sputum conversion as well as in clinical improvement, accompanied by significantly higher mean serum concentrations. In addition, the mortality rate was lower in intravenous H and E treatment compared to oral treatment.]]>
Coinfection ; Ethambutol ; HIV Infections ; HIV ; Humans ; Isoniazid ; Meningoencephalitis ; Methods ; Mortality ; Mycobacterium tuberculosis ; Pyrazinamide ; Rifampin ; Serum ; Sputum ; Tuberculosis ; Tuberculosis, Meningeal ; Tuberculosis, Pulmonary