Comparative analysis of cytomegalovirus retinitis and microvascular retinopathy in patients with acquired immunodeficiency syndrome

AIM：To compare the clinical manifestation of cytomegalovirus（CMV）retinitis and microvascular retinopathy（MVR）in patients with acquired immunodeficiency syndrome（AIDS）in China.METHODS：A total of 93 consecutive patients with AIDS,including 41 cases of CMV retinitis and 52 cases of MVR were retrospectively reviewed.Highly active antiretroviral therapy（HAART）status was recorded.HIV and CMV immunoassay were also tested.CD4＋T-lymphocyte count and blood CMV-DNA test were performed in all patients.Aqueous humor CMV-DNA test was completed in 39patients.Ophthalmological examinations including best corrected visual acuity（BCVA,by International Standard Vision Chart）,intraocular pressure（IOP）,slit-lamp biomicroscopy,indirect ophthalmoscopy were performed.RESULTS：In MVR group,the anterior segment examination was normal in all patients with a mean BCVA of 0.93±0.13.Blood CMV-DNA was 0（0,269 000）and 42 patients（80.77%）did not receive HAART.In CMV retinitis group,13 patients（31.71%）had anterior segment abnormality.The mean BCVA was 0.64±0.35 and blood CMV-DNA was 3470（0,1 450 000）.Nineteen patients（46.34%）had not received HAART.MVR group and CMV retinitis group the positive rates of aqueous CMV-DNA were 0 and 50%,respectively.Two patients with MVR progressed to CMV retinitis during the follow-up period.CONCLUSION：In comparison of CMV,patients with MVR have relatively mild visual function impairment.Careful ophthalmological examination and close follow-up are mandatory,especially for patients who have systemic complications,positive CMV-DNA test and without received HAART.

Drug-induced erythroderma in patients with acquired immunodeficiency syndrome

BACKGROUND: To explore the clinical manifestations, diagnosis, and treatment of patients with acquired immunodeficiency syndrome(AIDS) complicated with drug-induced erythroderma.METHODS: The clinical data of 12 AIDS patients with drug-induced erythroderma in our hospital were retrospectively analyzed. The general information, offending medications, complications, modified severity-of-illness score for toxic epidermal necrolysis(SCORTEN) scores, and disease outcome spectrums were analyzed.RESULTS: Drug-induced erythroderma was mostly caused by antiviral drugs, antituberculosis drugs, antibiotics, traditional Chinese medicine, and immune checkpoint inhibitors. The spectrum of sensitizing drugs was broad, the clinical situation was complex, and infections were common. The affected areas were greater than 40% body surface area in all patients. The modified SCOTERN score averaged 3.01±0.99. All patients were treated with glucocorticoids, and nine patients were treated with intravenous immunoglobulin(IVIG) pulse therapy at the same time. The average time to effectiveness was 7.08±2.23 days, and the average hospital stay was 17.92±8.46 days. Eleven patients were cured, and one patient died of secondary multiple infections, who had a modified SCORTEN score of 5 points. The mortality rate in this study was 8.3%.CONCLUSIONS: The clinical situation of AIDS patients with drug-induced erythroderma in hospitalized patients is complex and the co-infection rate is high. The use of modified SCORTEN score may objectively and accurately assess the conditions, and the use of glucocorticoid combined with IVIG therapy may improve the prognosis.

Epidemiological characterization and geographic distribution of human immunodeficiency virus/acquired immunodeficiency syndrome infection in North African countries

BACKGROUND Human immunodeficiency virus(HIV)infection is a major global public health concern.North African countries carry a disproportionate burden of HIV representing one of the highest rates in Africa.AIM To characterize the epidemiological and spatial trends of HIV infection in this region.METHODS A systematic review was carried out on all the published data regarding HIV/acquired immunodeficiency syndrome in North African countries over ten years(2008-2017)following the PRISMA guidelines.We performed a comprehensive literature search using Medline PubMed,Embase,regional and international databases,and country-level reports with no language restriction.The quality,quantity,and geographic coverage of the data were assessed at both the national and regional levels.We used random-effects methods,spatial variables,and stratified results by demographic factors.Only original data on the prevalence of HIV infection were included and independently evaluated by professional epidemiologists.RESULTS A total of 721 records were identified but only 41 that met the criteria were included in the meta-analysis.There was considerable variability in the prevalence estimates of HIV within the countries of the region.The overall prevalence of HIV ranged from 0.9%[95%confidence interval(CI)0.8-1.27]to 3.8%(95%CI 1.17-6.53).The highest prevalence was associated with vulnerable groups and particularly drug abusers and sexually promiscuous individuals.The dense HIV clustering noted varied from one country to another.At least 13 HIV subtypes and recombinant forms were prevalent in the region.Subtype B was the most common variant,followed by CRF02_AG.CONCLUSION This comprehensive review indicates that HIV infection in North African countries is an increasing threat.Effective national and regional strategies are needed to improve monitoring and control of HIV transmission,with particular emphasis on geographic variability and HIV clustering.

Human immunodeficiency virus/acquired immunodeficiency syndrome prevalence,incidence,and mortality in China,1990 to 2017:a secondary analysis of the Global Burden of Disease Study 2017 data

Background:Despite almost two decades of well-funded and comprehensive response efforts by the Chinese Government,human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)remains a major problem in China.Yet,few studies have recently examined long-term trends in HIV/AIDS prevalence,incidence,and mortality at the national level.This study aimed to determine the prevalence,incidence,and mortality trends for HIV/AIDS over the past 28 years in China.Methods:We conducted a descriptive,epidemiological,secondary analysis of the Global Burden of Diseases,Injuries,and Risk Factors Study 2017 data.To evaluate trends in prevalence,incidence,and mortality over the study period from 1990 to 2017,we calculated values for annual percentage change(APC)and corresponding 95%confidence intervals(CIs)using joinpoint regression analysis.Results:A significant increase in HIV/AIDS prevalence was observed for 1990 to 2009(APC:10.7;95%CI:10.4,11.0;P<0.001),and then remained stable for 2009 to 2017(APC:0.7;95%CI:-0.3,1.7;P=0.1).A significant increase in HIV incidence was also observed for 1990 to 2005(APC:13.0;95%CI:12.6,13.4;P<0.001),and then a significant decrease was detected for 2005 to 2017(APC:-6.5;95%CI:-7.0,-6.1;P<0.001).A significant increase in AIDS-related mortality rate was detected for 1990 to 2004(APC:10.3;95%CI:9.3,11.3;P<0.001),followed by a period of stability for 2004 to 2013(APC:1.3;95%CI:-0.7,3.3;P=0.2),and then another significant increase for 2013 to 2017(APC:15.3;95%CI:8.7,22.2;P<0.001).Conclusions:Although prevalence has stabilized and incidence has declined,AIDS-related mortality has risen sharply in recent years.These findings suggest more must be done to bring people into treatment earlier,retain them in treatment more effectively,actively seek to reenter them in treatment if they dropout,and improve the quality of treatment and care regimens.

Effect of treatment course of comprehensive intervention with Traditional Chinese Medicine on mortality of acquired immunodeficiency syndrome patients treated with combined antiretroviral therapy

OBJECTIVE:To investigate the effect of a treatment course of comprehensive intervention with Traditional Chinese Medicine(TCM) on the mortality of patients with acquired immunodeficiency syndrome(AIDS) treated with combined antiretroviral therapy(c ART).METHODS:AIDS patients who had taken c ART in a national TCM human immunodeficiency virus treatment trial program(NTCMTP) before 2009 were enrolled in this study and followed for 36 months from November 2009.Patients enrolled in the NTCMTP in 2004 were taken as the first group,those enrolled in 2006 as the second group,and those enrolled in 2009 as the third group.Cumulative survival rates were calculated by the life table method.Survival curves for subgroups were compared by the log-rank test.Hazard ratios were calculated with a Cox proportional hazards model.RESULTS:A total of 1443 AIDS patients were followed for 3 years(4198 person-years).During this period,91(6.3%) patients died and 13(0.9%) were lost to follow-up.The total mortality rate was 2.17/100 person-years.The mortality rate of patients enrolled in the NTCMTP in 2004 was 1.49/100 person-years,which was lower than that of patients enrolled in 2006(2.23/100 person-years) and 2009(3.48/100 person-years).After adjusting for other factors,a shorter time of treatment with TCM,male sex,older age,lower CD4 + T-cell counts,and long-term treatment with c ART were risk factors of mortality.CONCLUSION:Long-term treatment with TCM decreased the mortality risk of AIDS patients.Factors such as being male,older age,CD4+ T-cell counts,and time of treatment with TCM and c ART were correlated with mortality.

Advantages of Chinese Medicine for Patients with Acquired Immunodeficiency Syndrome in Rural Central China

Objective： To analyze the effect of Chinese medicine （CM） on mortality and quality of life （QOL） of acquired immunodeficiency syndrome （AIDS） patients treated with combined antiretroviral therapy （cART）. Methods： A random sample of AIDS patients enrolled in the National Chinese Medicine Treatment Trial Program （NCMTP） that met the inclusion criteria was included in this study. NCMTP patients were included as the CM＋cART group, and those not in the NCMTP were included as the cART group. Survival from September 2004 to September 2012 was analyzed by retrospective cohort study. QOL was analyzed by cross-sectional study. Results： The retrospective cohort study included 528 AIDS patients, 322 in the CM＋cART group and 206 in the cART group. After 8 years, the mortality in the CM＋cART group was 3.3/100 person-years, which was lower than the cART group of 5.3/100 person-years （P〈0.05）. The hazard ratio （HR） for mortality in the cART group was 1.6 times that of the CM＋cART group by Cox proportional hazard model analysis. After controlling for gender, age, marital status, education, and CD4＋ T-cell count, the HR was 1.9 times higher in the cART group compared with the CM＋cART group （P〈0.05）. The cross-sectional study investigated 275 AIDS patients. The mean scores of all QOL domains except spirituality/personal beliefs were higher in the CM＋cART group than in the cART group （P〈0.05）. Conclusions： For AIDS patients, CM could help to prolong life, decrease mortality, and improve QOL. However, there were limitations in the study, so prospective studies should be carded out to confirm our primary results.

Efficacy of integrated Traditional Chinese Medicine and anti-retroviral therapy on immunological nonresponse in patients with human immunodeficiency virus/acquired immunodeficiency syndrome: a Meta-analysis of randomized controlled trials

OBJECTIVE:To explore the efficacy of integrating Traditional Chinese Medicine(TCM)and anti-retroviral therapy(ART),a customized combination of different classes of medications which was also called cock-tail treatment,on the immunological nonresponse(INR)in people living with human immunodeficiency virus(HIV)(PLWH).METHODS:Relevant literature in databases such as China National Knowledge Infrastructure Database(CNKI),Wanfang Digital Journal,Chinese Medical Journal Database(CMJD),Chinese Biomedical Literature Database(CBM),Pub Med,Cochrane,and Embase was reviewed by two independent investigators.Data were extracted from the studies according to the eligible criteria and analyzed using Review Manager 5.3.RESULTS:Nine randomized controlled trials(RCTs)with 1078 patients were analyzed.Our analyses showed that CD4 T cell counts in the treatment group improved compared with that in the control group[mean difference(MD)=13.51,95%confidence interval(CI):7.42-19.60,P<0.0001].There was no significant difference between the treated and control groups after 3 months(MD=25.31,95%CI:-2.78 to 53.41,P=0.08).However,after 6 and 12 months,the response of the treatment group was superior to the control group(MD=27.45,95%CI:7.09-47.81,P=0.008 and MD=27.34,95%CI:6.31–48.37,P=0.01,respectively).The clinical efficacy of the treatment group was also higher than that of the control group(RR=1.75,95%CI:1.16-2.65,P=0.007).However,CD45 RO and CD45 RA T cell counts did not differ significantly between the two groups(MD=12.37,95%CI:-6.71 to 31.45,P=0.20 and MD=5.67,95%CI:-3.00 to14.35,P=0.20,respectively).CONCLUSION:The combined treatment strategy of integrated TCM and Western Medicine promotes long-term reconstitution of the immune system and thus,is beneficial and has potential use for improving INR in PLWH.However,large-scale RCTs are required to provide evidence for optimal intervention strategies.

Herbal compatibility of Traditional Chinese Medical formulas for acquired immunodeficiency syndrome

OBJECTIVE:Because herbal compatibility is one of the most important reasons why Traditional Chinese Medcine(TCM) formulas are effective for acquired immunodeficiency syndrome(AIDS),our study aimed to determine the compatibility of herbs based on published AIDS clinical research in Chinese periodicals.To achieve this aim,we designed a new data-mining algorithm according to TCM data characteristics.METHODS:We found 25 clinical AIDS studies,all using Chinese herbs for treatment,in the Traditional Chinese Medicine Database System,and information on diagnosis and treatment was extracted.To find out herbal compatibility,especially the formulae for herbal combinations,we proposed an improved association rule algorithm based on the frequency of combinations.In this algorithm,all the compatibility relationships were displayed in a tree structure,by which the relationship between formulas and their derivation could be clearly inferred.RESULTS:Data analysis showed that approximately 100 herbs have been used for treating AIDS.Based on the whole herb compatibility tree,we calculated a basic formula for AIDS:Huang Qi combined with Ren Shen,Fu Ling,Bai Zhu,Bai Zhu,Dang Gui,and Bai Shao.This formula,deriving from most of clinical prescriptions,and was chosed by most of clinicians for AIDS treatment.From data mining we found that Qi replenishment and detoxification were the main treatment principles,which coincided with the AIDS pathological mechanism in which immune function is destroyed by human immunodeficiency virus(HIV).CONCLUSIONS:Our data-mining results suggest that the core TCM treatment of AIDS is replenishing Qi and detoxification,by which AIDS patients' immune system may be enhanced.Compatibility of Huang Qi with some frequently-used herbs have shown real efficacy in clinical practice,which warrants pharmacological research in the future.

Fighting against Acquired Immunodeficiency Syndrome with Chinese Medicine:A Perspective from China

Continuing expansion of the human immunodeficiency virus （HIV）/ acquired immunodeficiency syndrome （AIDS） pandemic has been recognized as an exceptional challenge to global health. Taking highly active antiretroviral treatment （HAART）, a confirmed effective treatment, has its limitations. While a much cheaper and potential treatment--the Chinese medicine （CM） has not been paid enough attention from the worldwide. We explained the CM viewpoints about pathology and etiology to answer some questions about whether and how CM can treat AIDS. Some herbal formulae and their targeted patterns and common symptoms were also introduced. Chinese government has realized the important role of CM as an independent therapy for early management, bolstering immune-system functions depressed by HIV, and has funded large randomized double-blind controlled clinical trials to more accurately assess the benefits, and valued the fundamental research to establish a quantitative standardization of pattern diagnosis. Researchers of CM are looking for cooperation with all the world＇s top experts in the areas of AIDS and immunity to strive for victories in the fight against AIDS.

Cytomegalovirus retinitis associated with acquired immunodeficiency syndrome

Background Cytomegalovirus （CMV） retinitis is the most severe intraocular complication that results in total retinal destruction and loss of visual acuity in patients with acquired immunodeficiency syndrome （AIDS）. This study aimed to investigate the fundus characteristics, systemic manifestations and therapeutic outcomes of CMV retinitis associated with AIDS.Methods It was a retrospective case series. CMV retinitis was present in 39 eyes （25 patients）. Best corrected visual acuities, anterior segment, fundus features, fundus fluorescence angiography （FFA） and CD4＋ T-lymphocyte counts of the patients with CMV retinitis associated with AIDS were analyzed. Intravitreal injections of ganciclovir （400 μg） were performed in 4 eyes （2 patients）.Results Retinal vasculitis, dense, full-thickness, yellow-white lesions along vascular distribution with irregular granules at the border, and hemorrhage on the retinal surface were present in 28 eyes. The vitreous was clear or mildly opaque.Late stage of the retinopathy was demonstrated in 8 eyes characterized as atrophic retina, sclerotic and attenuated vessels, retinal pigment epithelium （RPE） atrophy, and optic nerve atrophy. Retinal detachment was found in 3 eyes. The average CD4＋ T-lymphocyte count in peripheral blood of the patients with CMV retinitis was （30.6±25.3） ×106/L （range,（0-85） × 106/L）. After intravitreal injections of ganciclovir, visual acuity was improved and fundus lesions regressed.Conclusions CMV retinitis is the most severe and the most common intraocular complication in patients with AIDS. For the patients with yellow-white retinal lesions, hemorrhage and retinal vasculitis without clear cause, human immunodeficiency virus （HIV） serology should be performed. Routine eye examination is also indicated in HIV positive patients.

Acquired immunodeficiency syndrome associated disseminated Penicillium Marneffei infection: report of 8 cases

Penicillinosis Marneffei （PSM） is a rare fungal disease caused by systemic infection of Penicillium Mameffei （PM）. Disseminated PSM is one of the most common opportunistic infections in patients with acquired immunodeficiency syndrome （AIDS） living in Southeastern region during the endstage of disease. Sporadic and individual cases have been reported recently in China and there appeared a tendency of increase of PM infections because of the increase of AIDS cases. To improve our understanding of this disease, we report here 8 cases of AIDS associated PSM.

Fuzhengpaidu granule regulates immune activation molecules CD38 and human leukocyte antigen-D related on CD4+ and CD8+ T cells in patients with acquired immunodeficiency syndrome/human immunodeficiency virus

OBJECTIVE: To evaluate the effect of Fuzhengpaidu granule (FZPDG) on immune activation molecules CD38 and human leukocyte antigen-D related (HLA-DR) on CD4+ and CD8+ cells in HIV/AIDS patients, and to explore the underlying mechanism of this therapy. METHODS: Plasma changes in CD3+, CD4+, CD8+, CD3+CD4+CD38+, CD3+CD4+HLA-DR+, CD3+ CD8+CD38+, and CD3+CD8+HLA-DR+levels in HIV/ AIDS patients treated with FZPDG for six months were examined by flow cytometry and compared with levels in healthy controls. RESULTS: The clinical trial included 34 outpatients with HIV/AIDS. Before treatment, plasma levels of CD38+ and HLA-DR+ on CD4/CD8 cells were higherthan those in 28 health controls (P<0.05). There were no significant changes in serum levels of CD3+, CD4+, and CD8+ T cells between pretreatment baseline versus after treatment, which were 82.85% ± 5.41% , 14.57% ± 10.31% and 54.55% ± 11.43% before treatment and 79.15% ± 8.21% , 19.96% ± 9.58% and 56.36% ± 11.67% after treatment, respectively (P>0.05). Plasma levels of CD3+ CD4+CD38+and CD3+CD4+HLA-DR+were 2.3%± 2.2% and 7.8%±5.5% before treatment and 1.2%± 0.8% and 2.6%±1.0% after treatment, respectively. Plasma levels of CD3+CD8+CD38+ and CD3+CD8+ HLA-DR+ were 41.4%±13.4% and 17.8%±11.3% beforetreatment,whichchangedto27.1%±10.2%and 3.8%±2.4%aftertreatment,respectively(P<0.05). CONCLUSION: HIV/AIDS patients exhibited an immune activation profile following FZPDG treatment. A potential mechanism of action for FZPDG appears to lie in its ability to up-regulate CD38 and HLA-DR levels on CD4+ T cells, and down-regulate them on CD8+ cells, thereby modulating immune activation of CD4+and CD8+T cells.

Reliability and validity of dermatology life quality index: assessment of quality of life in human immunodeficiency virus/acquired immunodeficiency syndrome patients with pruritic papular eruption

OBJECTIVE: To test the reliability and validity of dermatology life quality index(DLQI) in simplified Chinese language by assessing the quality of life(QoL) in HIV(human immunodeficiency virus)/AIDS(Acquired immunodeficiency syndrome) patients with pruritic papular eruption(PPE). METHODS: A study of simplified-Chinese-versiond from10 questions with the principal component analysis and the contribution rate of the 3 common factors was 59.95%. CONCLUSION: The simplified-Chinese-version DIQL is an acceptable and valid scale for HIV/AIDS patients with PPE. It can be used to evaluate the QoL of HIV/AIDS patients with PPE in China.

Immune Reconstitution——the Footing of Chinese Medicine Treatment for Acquired Immunodeficiency Syndrome

Acquired immuno- deficiency syndrome （AIDS） is caused by human immunodeficiency virus （HIV）. It has spread all over in the world, seriously jeopardizing people＇s physical and mental health and their life since the first case was announced by the U.S. Center for Disease Control and Prevention in 1981.

Disseminated Penicillium marneffei infection in acquired immunodeficiency syndrome: a case report

P enicillium marneffei ( P. marneffei ) is a facultative intracellular pathogen and the only thermally dimorphic fungus. This fungal infection is commonly found in Southeast Asian, Hong Kong, south China, and especially in acquired immunodeficiency syndrome (AIDS) patients. 1-4 We reported a patient with AIDS in whom infection due to P. marneffei was demonstrated. CASE REPORT A 34-year-old man with human immunodeficiency virus (HIV) infection (diagnosed before 6 months), living in Guangzhou of south China, was admitted to the hospital because of prolonged fever, cough, and weight loss. Initial examination revealed permanent high-grade fever (39-40℃) with chill and cough. Laboratory findings revealed haemoglobin concentration at 80 g/L, CD 4 lymphocyte count at 7×10 6/L, and viral load at 1.3×10 5 copies/ml. Blood and urine culture revealed no bacterial growth. Sputum culture was negative for mycobacterium. Chest X-ray film revealed left upper lobe ill-defined parenchymal opacities and widening of the superior mediastinum with left lung hilum prominence (Fig. 1). Abdominal B ultrasound showed hepatoplenomegaly and coeliac enlarged lymph nodes. On physical examination, the patient was found to have facial papula, cervical and superclavicular multiple lymph nodes.

Cure for Acquired Immunodeficiency Syndrome——A Global Battle

Acquired immu- nodeficiency syndrome （AIDS） is caused by the human immunodeficiency virus （HIV）. It has ravaged everywhere in the world and has seriously ieopardized people＇s physical and mental health and their lives since the first case was announced by the US Center for Disease Control in 1981.

An Experimental Model for Screening Anti-AIDS Drugs with Bovine Immunodeficiency Virus

The assays for bovine immunodeficiency virus (BIV) induced syncytium formation and BIV long terminal repeat (LTR) directed luciferase (Luc) gene expression were applied to screen and evaluate anti AIDS drugs. Frequency of the syncytium formation and BIV LTR directed Luc activity were in proportion to the number of input BIV infected cells. AZT inhibited the syncytium formation and the BIV LTR directed Luc gene expression level. Its inhibitory effects were dosedependent with the IC 50 being 0.24 and 0.052 mmol / L, respectively.

Treatment of Pneumocystis jirovecii pneumonia in non-human immunodeficiency virus-infected patients using a combination of trimethoprim-sulfamethoxazole and caspofungin

BACKGROUND Pneumocystis jirovecii pneumonia(PJP)is an infectious disease common in immunocompromised hosts.However,the currently,the clinical characteristics of non-HIV patients with PJP infection have not been fully elucidated.AIM To explore efficacy of trimethoprim–sulfamethoxazole(TMP-SMX)and caspofungin for treatment of non-human immunodeficiency virus(HIV)-infected PJP patients.METHODS A retrospective study enrolled 22 patients with non-HIV-infected PJP treated with TMP-SMX and caspofungin from 2019 to 2021.Clinical manifestations,treatment and prognosis of the patients were analyzed.RESULTS Five patients presented with comorbidity of autoimmune diseases,seven with lung cancer,four with lymphoma,two with organ transplantation and four with membranous nephropathy associated with use of immunosuppressive agents.The main clinical manifestations of patients were fever,dry cough,and progressive dyspnea.All patients presented with acute onset and respiratory failure.The most common imaging manifestation was ground glass opacity around the hilar,mainly in the upper lobe.All patients were diagnosed using next-generation sequencing,and were treated with a combination of TMP-SMX and caspofungin.Among them,17 patients received short-term adjuvant glucocorticoid therapy.All patients recovered well and were discharged from hospital.CONCLUSION Non-HIV-infected PJP have rapid disease progression,high risk of respiratory failure,and high mortality.Combination of TMP-SMX and caspofungin can effectively treat severe non-HIVinfected PJP patients with respiratory failure.

Human Immunodeficiency Virus Infection-Associated Mortality during Pulmonary Tuberculosis Treatment in Six Provinces of China

Objective To investigate the risk factors attributable to tuberculosis-related deaths in areas with human immunodeficiency virus（HIV） infection epidemics. Methods A 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. Results Of 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（aO R） 7.86]. Other significant mortality risk factors included presentation with miliary TB（aO R 4.10; 95% confidence interval： 2.14-7.88）, ≥35 years of age（aO R 3.04）, non-Han ethnicity（aO R 1.67）, and farming as an occupation（aO R 1.59）. For patients with TB/HIV co-infection, miliary TB was the strongest risk factor for death（aO R 5.48）. A low CD4 count（≤ 200 cells/μL）（aO R 3.27） at the time of TB treatment initiation and a lack of antiretroviral therapy（ART） administration（aO R 3.78） were also correlated with an increased risk of death. Conclusion Infection 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.

Hitting the bull’s eye of ending tuberculosis goal: The challenge of addressing tuberculosis in human immunodeficiency virus positive population in India

Eradicating tuberculosis in human immunodeficiency virus is all the more important to realise India’s ambitious goal of tuberculosis free India by 2025.Although,continuous efforts are being made to address tuberculosis in human immunodeficiency virus co-infection,it is imperative to closely monitor the implemented strategies,encourage and validate disease notification system in the country,and bring about societal change to view this disease as an ailment only and not as a stigma.