Acute hepatitis C in a chronically HIV-infected patient:Evolution of different viral genomic regions

AIM: To analyze the molecular evolution of different viral genomic regions of HCV in an acute HCV infected patient chronically infected with HIV through a 42-month follow-up.METHODS: Serum samples of a chronically HIV infected patient that seroconverted to anti HCV antibodies were sequenced, from the event of superinfection through a period of 17 months and in a late sample (42nd month). Hypervariable genomic regions of HIV (V3 loop of the gp120) and HCV (HVR-1 on the E2 glycoprotein gene) were studied. In order to analyze genomic regions involved in different biological functions and with the cellular immune response, HCV core and NS5A were also chosen to be sequenced. Amplification of the different regions was done by RT-PCR and directly sequenced. Confirmation of sequences was done on reamplified material. Nucleotide sequences of the different time points were aligned with CLUSTAL W 1.5, and the corresponding amino acid ones were deduced.RESULTS: Hypervariable genomic regions of both viruses (HVR1 and gp120 V3 loop) presented several nonsynonymous changes but, while in the gp120 V3 loop mutations were detected in the sample obtained right after HCV superinfection and maintained throughout, they occurred following a sequential and cumulative pattern in the HVR1. In the NS5A region of HCV, two amino acid changes were detected during the follow-up period, whereas the core region presented several amino acid replacements, once the HCV chronic infection had been established.CONCLUSION: During the HIV-HCV superinfection, each genomic region analyzed shows a different evolutionary pattem.Most of the nucleotide substitutions observed are nonsynonymous and clustered in previously described epitopes,thus suggesting an immune-driven evolutionary process.

Clinical Observation on the Therapeutic Effects of Zhongyan-2 Recipe in Treating 29 HIV-Infected and AIDS Patients

Objective: To investigate the efficacy of Zhongyan-2 Recipe (ZY-2), a recipe consisting of Chinese herbal medicine. Methods: Twenty-nine HIV-infected patients were treated with ZY-2 for 3 months as one treatment course; and viral load, immune function and symptoms-signs were determined before and after treatment. Results: After treatment, the absolute values of CD4 were elevated in 8 cases, and lowered in 14 cases, 7 cases were not changed; the ratio of CD4/CD8 were elevated in 2 cases, lowered in 1 case, 16 of them were not changed obviously. The CD4 and CD4/CD8 ratio were elevated simultaneously in 2 cases. Neopterin lowered in 4 cases, elevated in 11 cases, and not changed in 1 case. Viral load (VL) was lowered in 6 cases, elevated in 8 cases and not changed in 2 cases. The total effective rate was 42.28% on the basis of comprehensive assessment of VL, immune function, body weight and symptoms-signs. Conclusion: ZY-2 is an effective Chinese recipe in treating HIV-infected patients.

Distribution of natural killer cell receptors in HIV infected individuals

Natural killer （NK） cells are bone marrow derived, large granular lymphocytes, comprising approximately 10% to 20% of the mononuclear cell fraction in normal peripheral blood. They form a part of the first line defense mechanism against tumoural and viral spreading^1-4 Unlike T and B cells, NK cells do not require gene rearrangement for assembly of their receptor genes; rather, NK cells discriminate potential target cells based on the levels of self major histocompatibility complex （MHC） class I expression on such cells^5.6 There are two kinds of NK cell receptors^2.7.8 Inhibitory receptors recognize MHC class I molecules and deliver a downregulatory signal that inactivates the lytic machinery of NK cells. Stimulatory receptors expressed by NK cells deliver an activation signal.

Evolution of the Immune Status in Children Infected with HIV/AIDS on Antiretroviral Treatment in Lubumbashi, Democratic Republic of Congo

The objective was to describe the immunological status among children infected with HIV （human immunodeficiency virus） at baseline and their change during the treatment. This longitudinal study conducted at the Center of Excellence in Lubumbashi from 2nd semester, 2011 to the 2nd semester, 2012, examined the records of children who had been receiving antiretroviral therapy for 48 weeks. A count of CD4 ＋ T lymphocytes was performed at the beginning, 24 weeks, and 48 weeks of treatment. The immunological status was defined by the 1996 CDC （centers for disease control） immunological categories. All the children were on zidovudine, lamivudine/nevirapine or Efavirens. At initiation of treatment, severe immunosuppression was found in 56%, moderative in 28% and lacked in 16% of cases. Furthermore, after 48 weeks of treatment, a change in the immunological status was observed in 42% of cases. In contrast, 58% of cases kept in their original status. In this cohort, the immune status has not undergone significant change.

Incidence and Predictors of Tuberculosis among HIV/AIDS Infected Patients: A Five-Year Retrospective Follow-Up Study

Background: Despite increased deliverance of antiretroviral therapy (ART), morbidity and mortality from TB are still predominant among HIV/AIDS infected patients in Ethiopia. Thus, current study aimed to determine magnitude and predictors of tuberculosis among cohort of HIV infected patients at Arba Minch General Hospital, Ethiopia, 2015. Methods: Hospital based retrospective follow-up study was conducted among study population which was HIV/AIDS infected individuals registered from September 2007 to 2013. The data were collected using structured data abstraction form and four ART trained nurses were used to abstract the data. The data were checked for completeness, cleaned and entered into Epi Info 7.0 and analyzed using SPSS version (IBM-21). Results were summarized by using table of frequency, graph, and measure of central tendency. Statistical significance was inferred at P-value ≤ 0.05. Adjusted odd ratio (AOR) with 95% confidence interval (CI) was used to determine predictors. Result: Four hundred ninety six patient’s charts were abstracted. Cumulative and incidence density of tuberculosis were 21.4% (95% CI: 21.3, 21.44) and 5.36 per 100 person year respectively. Cigarette smokers (AOR: 2.82, 95% CI (1.27 - 6.27)), household with family size of 3 - 4 (AOR: 2.26, 95% CI (1.14 - 4.50)), baseline WHO clinical stage III (AOR: 20.26, 95% CI (7.09 - 57.6)) and IV (AOR: 22.9, 95% CI (6.91 - 76.4)) and heamoglobin level of <10 (AOR: 2.56, 95% CI (1.22 - 5.33)) were important predictors (risk factors) of tuberculosis among HIV infected patients. Conclusion and recommendation: Relatively high incident tuberculosis cases were established among HIV infected patients and history of cigarette smoking;family size;hemoglobin level and base line WHO clinical stage were responsible for this incidence. Therefore;early initiation of HAARTas per current guideline should get stressed, and the finding that smoking was important predictors for TB in Ethiopia had obvious TB control implication which required high attention focused on fighting against cigarette smoking among HIV infected cohort.

Anal Invasive Squamous Cell Cancer and Human Papillomavirus Distribution in HIV-Infected and Non-HIV-Infected Individuals

Invasive-squamous-cell-cancer (ISCC) of the anal canal is an uncommon disease. Human papillomavirus (HPV) is the etiological agent of most of types of ISCC. The incidence of ISCC has been increasing in HIV-infected individuals, even after the introduction of highly active antiretroviral therapy. The aim of this study was to analyze biopsy specimens from patients diagnosed with ISCC at a tertiary hospital from 1983 to 2012 in order to detect HPV-DNA. Methods: Formaldehyde-fixed, paraffin-embedded specimens from patients with ISCC underwent HPV-DNA genotyping using multiplex PCR assay. Results: A total of 31 cases were collected;10 were HIV-infected (9 men, 1 woman) and 21 non-HIV-infected (11 men, 10 women). HPV infection was detected in 87.5% (7/8) of the HIV-infected patients (DNA from 2 biopsies was degraded) and 76.2% (16/21) of non-HIV-infected individuals. Multiple-type infections were only found in 28.6% (2/7) of the HIV-infected patients (no multiple-type infections in non-HIV-infected individuals). The most prevalent type was HPV-16: 50% (4/8) in the HIV-infected group (57% [4/7] of the HPV-positive samples) and 66.7% (14/21) in the non-HIV-infected group (87.5% (14/16) of the HPV-positive samples). Remarkably, 37.5% (3/8) of the HIV-infected group had high-risk HPV types not included in the vaccines (HPV-33, 51, 52, and 66) compared with 4.8% in the non-HIV-infected group (1/21, HPV-52). All cases of anal ISCC in HIV-infected patients were recorded in the highly active antiretroviral therapy era. Conclusion: HIV-infected patients presented anal ISCC with a higher proportion of high-risk HPV types not covered by the conventional vaccines than non-HIV-infected individuals.

Iron Status of a People Living with HIV in Sub-Saharan Africa Using a Multi-Criteria Approach Based on the Determination of Blood Ferritin, sTfR, CRP and sTfR-F Index

Background: The assessment of iron status using a single biomarker of iron metabolism is not enough sensitive and specific to reliably diagnose iron deficiency associated with multiple comorbidities. The objective of this study was to describe the iron status of people living with HIV in sub-Saharan Africa using a multi-criteria approach based on the determination of blood ferritin, sTfR, CRP and the calculation of sTfR-F index. Methods: This study was conducted using a retrospective panel of 933 sera/plasmas. We determined serum ferritin concentration, serum sTfR concentration, and C-reactive protein (CRP) by immunoturbidimetry for each subject. The sTfR-F index was determined by calculating the sTfR/log ferritin ratio. The statistical test used was Chi2. Results: Regardless of the inflammatory syndrome, we determined 3.80%, 30.29%, and 42.70% iron deficiency based on the separate interpretation of ferritin concentration, sTfR, and sTfR-F calculation, respectively. We used those biomarkers in addition to CRP in an algorithm for the diagnosis of iron deficiency. Subjects without inflammatory syndrome, had iron deficiency of 2.89% (n = 26). Taking into account the presence of an inflammatory syndrome, the frequency obtained was n = 88 (9.78%). Overall, iron deficiency was diagnosed in 114 (12.67%) patients when we used the diagnostic algorithm. Conclusion: The use of diagnostic algorithms combining several biomarkers of iron metabolism and taking into account the presence or absence of an inflammatory syndrome is a good approach to detect a large number of iron deficiencies in a population. Therefore, an assessment of the effectiveness of different diagnostic algorithms is necessary.

Prevention of Mother-to-Child Transmission of HIV: Experience of a Level 2 Health Center in Senegal

The elimination of vertical transmission of HIV from mother to child is a major global goal. In Senegal, the transmission rate was estimated at 3.2% in 2017. To reduce or even eliminate this transmission, Senegal has implemented various strategies and programs adopted and applied nationally. Thus access to services for the prevention of mother-to-child transmission of HIV has been extended to the level of the health post (the lowest level of the country’s health pyramid) with a delegation of tasks to paramedical staff (nurse, midwife) in the diagnosis and therapeutic management. Objectives: To describe the epidemiological profile of HIV (Human Immunodeficiency Virus)-positive mothers, to assess the care of children born to HIV-positive mothers, to determine the rate of HIV transmission from mother to child. Patients and Method: We carried out a retrospective, cross-sectional and descriptive study of all live newborns of HIV-positive mothers who gave birth at the Gaspard Kamara Health Center (a level 2 health center in Dakar, Senegal) between January 1, 2015 and December 31, 2018. The data were collected from prevention of mother-to-child transmission (PMTCT) prenatal follow-up registers and files, delivery files and registers, and neonatology and pediatric follow-up files, and exploited using the Epi info 7 software. Results: There were 98 children of seropositive mothers. The epidemiological profile of the HIV-positive woman was that of a young woman aged between 16 and 43 with an average of 31.31 years, pauciparous (>65% of cases) from Dakar center (>75% of cases), housewife with a low socio-economic level (63.1% of cases), married in almost all cases, with HIV profile (in almost all cases) and diagnosed before pregnancy (51.02%). The analysis of the children’s data revealed a predominance of girls (52.04%) with a good birth weight (2964g on average) and a pregnancy carried to term in more than 95% of cases. ARV prophylaxis was almost entirely respected with triple therapy (AZT + 3TC + NVP) in a fixed combination as protocol. Protected breastfeeding (80.21%), including 6 months of exclusive protected breastfeeding, was the rule for the mode of feeding. Three children were diagnosed positive with PCR1 as with serology (3.06%). Discussion and Conclusion: the initiatives and strategies put in place in Senegal have enabled a significant reduction in mother-to-child transmission of HIV and deserve to be supported by insisting on primary prevention, programming and good follow-up of pregnancies, and a good support for HIV-positive women.

The CALVIH Study: How to Handle Renal Stones in Persons Living with HIV1?

Background: Renal stone (RS) is a highly prevalent disease in our societies and is mostly secondary to lifestyle habits. HIV1 patients often experience RS, although specific risk factors are not known. Despite other priorities, comprehensive work-up should be offered to avoid recurrences (50% risk in 5 years). Purpose and Methods: The aim of the study is to describe how to handle RS in persons living with HIV1 and to suggest how the understanding of mechanisms involved in stone composition helps customize therapy and prevent recurrences. We prospectively performed a complete work-up in a cohort of 23 prevalent HIV1 patients referred to our highly-specialized center by HIV physicians. Results: Inclusion was secondary to a colic episode with spontaneous elimination of the stone (74%), bilateral (67%), not obstructive (67%);53% underwent urologic interventions. Mean age was 34 ± 16 years old and BMI was 22.5 ± 3 (one-third with metabolic syndrome). History of RS showed only one episode (22%), >one (74%) or >4 (4%). Estimated GFR was 78 ± 24 ml/min/1.73m2 (mean Cr 101 ± 24 μmol/L), and 5 were classified CKD stage 3. Stone analysis was only available for 7 patients and in 6/7 patients, and calcium metabolism was fully explored (2 absorptive hypercalciuria, 4 renal primitive hypercalciuria). Retained mechanism for RS was uric acid dependent for one, oxalic acid dependent for three and calcium dependent for three. Very few patients were exposed to known environmental risk factors for RS, 3 were/had been exposed to darunavir and 3 to atazanavir, 1 to efavirenz, 1 to acetazolamide, 2 to allopurinol. Conclusion: RS in HIV1 patients is mostly not related to ARV. Understanding of renal stone composition is critical to prevent recurrences by offering specific dietetic counselling and therapy. The role of HIV physicians is important due to the high prevalence of RS in the context of HIV disease.

Future Long-Term Care Setting Preferences and Related Factors among Japanese Middle-Aged and Older People Living with HIV

Since the introduction of antiretroviral therapy, the life expectancy of people living with human immunodeficiency virus (PLWH) has extended. This extension has led to an increase in the aging population in Japan and globally. Providing appropriate long-term care (LTC) for PLWH has thus become increasingly critical. Our study aimed to describe LTC setting preferences and related factors among middle-aged and older Japanese people living with HIV. A cross-sectional survey was conducted at two hospitals in Tokyo. One hundred seventy-five outpatients aged 40 years and above participated in this study. Participants completed an anonymous self-administered questionnaire to assess where they wanted to live once they could no longer care for themselves. Approximately 52.0% preferred a designated facility for older adults or LTC, while 30.3% preferred their home or living with family, a partner, or a friend (“familiar housing”). Bivariate analyses revealed that LTC setting preference was significantly associated with marital status, whether or not the participant had at least one child, and household composition. Furthermore, logistic regression analysis revealed that participants living with non-kin were less likely to prefer living in designated housing facilities for older adults or LTC (adjusted odds ratio = 0.17, 95% confidence interval: 0.05 - 0.63). The study findings suggest that family make-up and composition of cohabiters are critical indicators for LTC setting preference in this population. These findings can be the foundation for future care planning and delivery to meet the unique LTC needs and expectations of the aging population with HIV in Japan and similar global settings.

Investigation and Analysis of HIV Infection among Unpaid Blood Donors in Wuzhou City

Objective: To take the unpaid blood donors in Wuzhou City as the research object, analyze the characteristics and prevalence of HIV infection, further explore its epidemiological characteristics, and lay a solid foundation for the recruitment of unpaid blood donors and the safety of blood transfusion, so as to reduce the risk of HIV transmission through blood transfusion. Methods: This paper collected the anti-HIV test results of unpaid blood donors and the confirmation results of reactive samples from 2015 to 2020, and carried out statistical analysis on the relevant information of positive samples. Result: From 2015 to 2020, a total of 233,242 unpaid blood donors were tested, and the positive rate of anti-HIV initial screening was 0.057% (132/233,242), and the positive rate of anti-HIV confirmed was 0.022% (51/233,242);the comparison of positive rates in each year was P < 0.05. Among the total number of infections, 76.47% (39/51) of confirmed positive persons were infected with HIV alone, followed by combined TP infection, accounting for 15.69% (8/51);for the people between 46 and 55 years old, the infection rate was the highest, reaching 37.3%;and more men (90.2%) were infected than women. In terms of education background, junior high school and below were the majority, accounting for 58.83% of the total;in terms of marital status, the number of unmarried people was 27, accounting for 52.9%. In terms of occupation, there were two main groups: farmers and workers, accounting for 66.7% of the total number of infections, and students accounting for 15.7%. Among the confirmed positives, the proportion of first-time blood donors and whole blood donors was higher than that of those who donated blood again or donated component blood. Conclusion: The situation of HIV infection among unpaid blood donors in Wuzhou City was relatively stable from 2015 to 2020, with no significant change in the absolute number of infected people compared to the previous period (the HIV infection rate from 2010 to 2013 was 0.03%), and most of them were males, unmarried people and those with low education. Therefore, attention must be paid to the consultation and recruitment of blood donors before blood donation, as well as the HIV screening in the laboratory after blood donation, so as to ensure the safety of clinical blood use.

Computation, Modeling, and Simulation of HIV-AIDS Epidemics with Vaccination

The principles of the HIV-AIDS epidemics are established based on the subpopulation 1) Susceptible;2) HIV-infected;3) AIDS-infected;4) Immunized. The immunized subset of the population in this paper is the total individuals who were infected and cured or immunized by vaccination. The immunized group can be identified by removing individuals from the susceptible group. A general mathematical model is developed for HIV-AIDS epidemics with Vaccination to understand the spread of the virus throughout the population. Particularly we use numerical simulation with some values of parameters to predict the number of infected individuals during a certain period in a population and the effect of vaccine to reduce infected group and increase the number of immunized individuals. Further, we expand the research to special cases with no vaccinations. A special case is when the removal subset of the population is empty, or there is no recovery in this epidemic. We also can consider the total infected number is equal to the sum of the HIV infected and the number of AIDS infected. As a result, one can reduce four-stage HIV-AIDS investigation to a three-stage of SIR. With this introduction and modification, the numerical simulation can be developed the Monte Carlo simulation method in SIR case to verify the Validity of the HIV-AIDS model.

Hepatitis C and HIV co-infection:a review

Co-infection with hepatitis C virus and humanimmunodeficiency virus is common in certainpopulations. Among HCV(+) persons, 10 % are alsoHIV (+), and among HIV (+) persons, 25 % are alsoHCV(+). Many studies have shown that in intravenousdrug users, co-infection prevalence can be as high as90-95 %. There is increasing evidence supporting theconcept that people infected with HIV have a muchmore rapid course of their hepatitis C infection.Treatment of co-infection is often challenging becausehighly active anti-retroviral therapy (HAART) therapyis frequently hepatotoxic, especially in the presence ofHCV. The purpose of this review is to describe theeffects that HIV has on hepatitis C, the effects thathepatitis C has on HIV, and the treatment options inthis challenging population.

Factors influencing HIV infection in men who have sex with men in China

To identify risk factors for HIV infection among men who have sex with men （MSM） and to provide a theoretical basis for prevention interventions. Between December 2011 and August 2012, a case-control study was conducted among MSM who underwent voluntary counselling and testing for HIV. Confirmed HIV-positive MSM were included in the case group, and HIV-negative MSM were included in the control group. Information on possible risk factors was collected by a survey questionnaire and a qualitative interview. The results of a conditional logistic regression showed that the following were influencing factors for HIV infection： average monthly income between 2001 and 3000 Yuan （odds ratio （0R）=6.341, 95% Ch 1.714-12.544）, only sometimes using condoms when having anal sex with men in the last 6 months （0R=7.601, 95% Ch 1.359-23.083）, having HIV-positive sex partners （0R=5.273, 95% Ch 1.572- 17.691）, rectal trauma with bleeding in the last 6 months （0R=2.947, 95% Ch 1.308-6.638）, not using condoms at last sexual encounter （OR-- 1.278, 95% Ch 1.012-5.595）, engaging in commercial sex （0R=5.925, 95% Ch 1.923-13.890） and having more than 16 sex partners in the last 6 months （0R=1.175, 95% Ch 1.021-1.353）. These seven factors were the risk factors of HIV infection （OR〉l）. However, having anal sex less than 10 times in the previous 1 month （OR=O.O02, 95% CI： 0.000-0.287） was a protective factor against HIV infection among MSM （OR〈l）, and insertive （0R=0.116, 95% Ch 0.000-0.236） （OR〈l） anal intercourse influenced HIV infection. Interventions should be targeted at MSM whose average monthly income is between 2001 and 3000 Yuan, and who engage in commercial sex. In addition, the importance of using condoms at every sexual encounter should be emphasised in health education, as should the treatment of rectal trauma with bleeding. Finally, MSM should decrease the number of sex partners and frequency of anal sex to decrease the rate of HIV infection.

Candida esophagitis:Risk factors in non-HIV population in Pakistan

AIM:Candida esophagitis is a frequent infection in immunocompromised patients. This study was designed to determine its characteristics in non- human immune deficiency virus (HIV) infected patients attending a teaching hospital.METHODS: Clinical records of all patients coded by international classification of diseases 9th revision with clinical modifications'(ICD-9-CM), with candida esophagitis diagnosed by esophagogastroduodenoscopy (EGD) and histopathology over a period of 5 years were studied.RESULTS: Fifty-one patients (27 males, 24 females, range 21-77 years old and mean age 52.9 years) fulfilled the criteria (0.34% of the EGD). The common predisposing factors were carcinoma (OR 3.87, CI 1.00-14.99) and diabetes mellitus (OR 4.39, CI 1.34-14.42). The frequent clinical symptoms were retrosternal discomfort, dysphagia and epigastric abdominal pain with endoscopic appearance of scattered mucosal plaques. Another endoscopic lesion was associated with candida esophagitis in 15% patients.CONCLUSION: Carcinomas, diabetes mellitus, corticosteroid and antibiotic therapy are major risk factors for candida esophagitis in Pakistan. It is an easily managed complication that responds to treatment with nystatin.

A survey of HIV infection and related high-risk factors among men who have sex with men in Suzhou,Jiangsu,China

A cross-sectional study using the snowball sampling method was conducted in May 2008 to investigate human immunodeficiency virus （HIV） infection status and related high risk factors among men who have sex with men （MSM） in Suzhou city of Jiangsu province. The researchers carried out a face-to-face questionnaire interview among MSM, and collected their blood samples to test for HIV and other sexually transmitted diseases （STDs）. Among the 280 respondents, 91.1% had homosexual acts in the past 6 months and 87.5% had multiple homosex- ual partners; 46.4% had heterosexual sex in the past 6 months and 33.1% had multiple heterosexual partners. The rate of continued condom use was 44.3% in homosexual sex in the past 6 months, while the rate in heterosexual sex was 33.9%. Laboratory test results showed that the prevalences of HIV and syphilis were 7.1% （20/280） and 15.0% （42/280）, respectively, but no HCV-positive person was found. In the multivariate logistic regression model, subjects with a monthly income of more than RMB $ 1,000 （OR=4.83,95% CI=1.44-16.22）, subjects who often went to bars for sexual partners （OR=2.25, 95%CI=1.21-4.20）, and subjects who had more than one sexual partner in the past 6 months （OR=0.49, 95%CI=0.25-0.97） and had sex with fixed sexual partners in the past 6 months （OR=0.42, 95%CI=0.25-0.75） were significantly associated with the rate of continued condom use in homosexual sex in the past 6 months. Unprotected sex and multiple sexual partners were more common among MSM in Suzhou city; furthermore, the prevalences of HIV infection and syphilis were relatively high. HIV preventive measures should be designed to address these risk factors and control the spread of HIV among MSM.

Effects of a symptom management intervention based on group sessions combined with a mobile health application for persons living with HIV in China:A randomized controlled trial

Objective:This study aims to evaluate the effects of a symptom management intervention(SMI)based on symptom management group sessions combined with a mobile health(mHealth)application(app)on the knowledge of symptom management,the certainty of symptom self-management,symptom severity,symptom distress,medication adherence,social support,and quality of life among persons living with HIV(PLWH)in China.Methods:A parallel randomized controlled trial with 61 PLWH was conducted in Shanghai,China.The participants in the control group(n¼30)downloaded the Symptom Management(SM)app according to their needs and preferences,and received routine follow-ups.The participants in the intervention group(n¼31)were guided to download and use the SM app,and received four tailored weekly group sessions at routine follow-ups.Each group session lasted for approximately 2 h and targeted one of the major modules of the SM app.All the outcomes were assessed at baseline and post-intervention.The study was registered with the Chinese Clinical Trial Registry(ChiCTR1900024821).Results:The symptom management knowledge and certainty of symptom self-management were significantly improved after the intervention(all P<0.01).Compared with the control group,the scores of symptoms reasons knowledge score improved 11.47 points(95%CI:3.41,19.53)and scores of symptoms self-management knowledge score improved 12.80 points(95%CI:4.55,21.05)in the intervention group after controlling for covariates.However,other outcomes did not show statistically significant differences between the intervention group and the control group(P>0.05).Conclusion:The SMI could improve PLWH’s symptom management knowledge and certainty of symptom self-management.Multi-center studies with larger sample sizes and longer follow-ups are needed to further understand the effects of SM app on ameliorating symptom severity and symptom distress.More innovative strategies are also needed to promote and maintain the sustainability of the SM app.

Frequency and Absolute Number of FoxP3^+ Regulatory T Cells Correlate with Disease Progression of Chronic HIV-1 Infection

CD4^＋CD25^＋ Regulatory T cells （Treg） have been found to down-regulate immune activation in HIV-1 infection. However, whether the depletion of Treg benefits to the disease status of HIV infection remains undefined. To address this issue, we enumerated the Treg absolute counts and frequency in 75 antiviral-naive HIV-1-infected individuals in this study. It was found that HIV-infected patients displayed a significant decline in Treg absolute counts but a significant increase in Treg frequency. In addition, with disease progression indicated by CD4 T-cell absolute counts, circulating Treg frequency gradually increased; while Treg absolute counts were gradually decreased, suggesting that the alteration of Treg number closely correlated with disease progression in HIV infection Functional analysis further showed that Treg efficiently inhibit both CD4 and CD8 T cell proliferation in vitro. Thus, our findings indicates that Treg actively participate in pathogenesis of chronic HIV infection, influencing the disease progression.

Utility of Pooled HIV RNA RT-PCR Assay in Diagnosing Acute HIV Infections

The P24 antigen test, HIV RNA PCR test, HIV isolation/culture and fourth-generation HIV uniform Ag/Ab assay are being utilized in diagnosing acute HIV infection in different labs. Many factors limit the use of screening for acute HIV in high-risk populations, in blood donors and during voluntary HIV testing, including, cost, technique, sensitivity and specificity. In this review we explore a new NAAT method which involves HIV RNA RT-PCR on pooled samples. This technique is able to screen for acute infections in a large testing volume and may be used as a screening method in high-risk populations and blood donors.

Intestinal Kaposi's sarcoma may mimic gastrointestinal stromal tumor in HIV infection

Diffuse intestinal Kaposi＇s sarcoma shares macroscopic and histopathologic features with gastrointestinal stromal tumors. Correct diagnosis may pose a clinical challenge. We describe the case of a young HIV-1-infected African lady without advanced immunodeficiency, who presented with a diffuse spindle cell tumor of the gut. Initial diagnosis was of a gastrointestinal stromal tumor, based on endoscopy and histopathology. Further evaluation revealed evidence for human herpesvirus 8 （HHV8） and the diagnosis had to be changed to diffuse intestinal Kaposi＇s sarcoma. Antiretroviral triple therapy together with chemotherapy was commenced, and has led to the rapid remission of intestinal lesions. With a background of HIV infection, the presence of HHV8 as the causative agent of Kaposi＇s sarcoma should be determined, as distinct treatment is indicated.