Cytomegalovirus retinitis in the highly active anti-retroviral therapy era

Cytomegalovirus(CMV)retinitis is an opportunistic infection that has traditionally affected those who have HIV/AIDS or immunosuppressed individuals.CMV retinitis previously infected one-third of AIDS patients in the pre-highly active antiretroviral therapy(HAART)era,but since HAART,Western countries have seen an 80%decrease in the incidence of the disease.More recently,CMV retinitis has been reported in patients who are immunosuppressed,often due to chemotherapy or immunomodulatory medications.The diagnosis of CMV retinitis is often suspected based on clinical findings,with polymerase chain reaction for confirmation of CMV,especially in atypical cases.Highly active antiretroviral therapy and anti-CMV medications(systemic or local)remain the mainstay of treatment.However,for those who are not responsive to HAART,CMV retinitis remains a challenge,and can still lead to significant vision loss.Moreover,a regimen of anti-CMV medications can sometimes lead to viral resistance or organ toxicity.Complications such as immune recovery retinitis and rhegmatogenous retinal detachments continue to threaten the vision of patients who develop CMV retinitis.These complications can arise following initiation of treatment or if patients show disease progression.Proper vision screening for CMV retinitis in immunosuppressed patients at-risk is necessary for early detection and treatment.

A Mother-to-Child Transmission Study in Nigeria:The Impact of Maternal HIV Infection and HAART on Plasma Immunoglobulins,Cytokine Profiles and Infant Outcome

Prevention of mother-to-child transmission(PMTCT)of HIV with highly active antiretroviral therapy(HARRT)allows the HIV^+pregnant mothers to have vaginal delivery and breastfeed.Here we investigated the maternal plasma immunoglobulin,cytokine secretion and the outcome of the exposed infants among the HIV^+HAART treated pregnan women in Nigeria.In this study,different plasma immunoglobulins and cytokines were measured in the HIV^+HAART treated pregnant mothers.Pooled culture supernatants of B and T lymphocytes showed lower levels of IFN-γ,IL-10 and IL-4.There were lower IFN-γand IL-10 secretions at 1st trimester;however,IL-10 continued to be lower throughout 2nd and 3rd trimesters.TNF-αsecretion significantly decreased as pregnancy progressed to term.There were high plasma IgG and low IgM in the HIV^+HAART treated pregnant women.Plasma IgG was high during 1st and 3rd trimesters.After one year of follow up,all the exposed children were seronegative for HIV-1 and HIV-2.Vaginal delivery and breastfeeding among HIV^+HAART treated mothers have shown to be safe.The use of HAART by the infected mothers and the use of septrin and niverapin by the exposed infants prevented mother to-child transmission of HIV.

Cutaneous Manifestations of HIV/AIDS in the Era of Highly Active Antiretroviral Therapy: Evidence from Bangladesh

Objective:Skin diseases are common and striking features of patients with human immunodeficiency virus/acquired immunodeficiency syndrome(HIV/AIDS)and may vary considerably by ethnic and geographic regions and by the influence of highly active antiretroviral therapy(HAART).However,little information exists regarding the cutaneous manifestations of patients with HIV/AIDS in Bangladesh.This study was performed to elucidate the spectrum of cutaneous disorders in patients with HIV/AIDS in the era of HAART.Materials:This descriptive cross-sectional study was carried out in Chittagong Medical College Hospital,Bangladesh from January 2017 and December 2020.Diagnosed case of HIV/AIDS for HAART therapy and all cases of HIV/AIDS who are already on HAART therapy were included in this study.Descriptive statistical analysis was carried out by using frequencies and percentages.Results:Of 40 patients with HIV/AIDS,22(55.0%)were male and 18(45.0%)were female.The patients ranged in age from 8 to 60 years,with a mean age of 38±0.966 years.Among all age groups,the highest 19(47.5%)patients were in the 31-to 40-year age group.Most of the patients were migrant workers[22/40(55.0%)]with low socioeconomic status[32/40(80.0%)],and the most common transmission mode was heterosexual activity[36/40(90.0%)].Most of the patients[32/40(80.0%)]had mucocutaneous disorders,30/40(75.0%)had infective dermatoses,and 21/40(52.5%)had non-infective inflammatory dermatoses.Eight of forty(20.0%)patients presented with three or more skin disorders.The most common infective dermatoses were fungal infections[15/40(37.5%)],followed by viral infections[8/40(20.0%)],bacterial infections[4/40(10.0%)],and scabies[3/40(7.5%)].The most common non-infective dermatosis was generalized pruritus[6/40(15.0%)],followed by prurigo simplex[4/40(10.0%)],psoriasis[4/40(10.0%)],eczema[3/40(7.5%)],pruritic papular eruption[1/40(2.5%)],seborrheic dermatitis[1/40(2.5%)],urticaria[1/40(2.5%)],and xerosis[1/40(2.5%)].Patients treated with HAART had decreased rates of oral candidiasis and herpes simplex but increased rates of drug reactions[19/40(47.5%)].The most common drug eruption following HAART was a morbilliform rash[11/40(27.5%)],and the most common offending agent was nevirapine.The prevalence of mucocutaneous disorders was higher in patients with a CD4 cell count of<200 cells/mm3.Conclusions:A wide range of mucocutaneous disorders is observed in Bangladeshi patients with HIV/AIDS,and HAART has an impact on the spectrum of HIV/AIDS-associated mucocutaneous disorders.Skin and mucocutaneous disorders are seen at every stage of HIV/AIDS and are the initial presentation in most patients in Bangladesh.There is a need for increased attention to the diagnosis and treatment of skin diseases affecting the quality of life of patients withHIV/AIDS.