The Prevalence of Overweight/Obesity and Related Comorbidities among HIV-Positive and HIV-Negative Patients Attending the Same Clinics in Gaborone, Botswana

Context: Antiretroviral therapy (ART) helps restore the health status of people living with HIV (PLHIV). Likewise, it increases the risk of overweight/obesity and related comorbidities among the recipients. In countries like Botswana where ±84% of PLHIV is on ART, the paucity of data comparing overweight/obesity between HIV-positive on ART and HIV-negative patients may impede clinical and policy decision-making. This study sought to estimate and compare: i) the prevalence of overweight/obesity between HIV-positive on ART and HIV-negative patients;ii) the prevalence of hypertension (HTN), diabetes mellitus (DM)/coronary heart disease (CHD) between HIV-positive patients on ART and HIV-negative patients attending same outpatient departments of general clinics in Gaborone, Botswana. Patients and Methods: Five hundred eighty-one (581) outpatients were recruited in four major clinics of Gaborone, Botswana, between June and July 2019;294 or 51% of them were HIV-negative and 287 or 49% were HIV-positive on ART. The prevalence of overweight/obesity and of HTN and DM/CHD were calculated and examined using stratified analysis. Subgroups were compared using Chi-square analysis with Yates correction or Fisher exact test and t-student test for continuous data. Results: Major findings after stratification of the study population by HIV status were: i) the prevalence of all categories of (BMI), including overweight/obesity, were comparable between HIV-negative-patients and HIV-positive. In fact, there were 24 (8.0%) cases of underweight among HIV-negative-Patients and 15(5%) cases among HIV-positive patients, p = 0.2;145 (49%) HIV-negative-patients and 128 (45%) HIV-positive, p = 0.07 cases of normal weight;72 (25%) HIV-negative-patients and 87 (30%) HIV-positive, p = 0.08, were overweight;53 (18%) HIV-negative-patients and 57 (20%) HIV-positive, p = 0.12, were obese;125 (43%) HIV-negative patients and 144 (50%) HIV-positive, p=0.06 were overweight/obese;ii) the prevalence of HTN and DM/CHD among HIV-positive-patients were significantly lower (p < 0.05) compared to HIV-negative patients: There were 32 (10.9%) cases of HTN among HIV-negative patients compared to 18 (6.3%) cases of HTN among HIV-positive patients, p = 0.001;32 (11%) cases of DM/CHD HIV-negative patients compared to 4 (1.4%) cases of DM/CHD among HIV-positive patients, p = 0.001. Conclusion: the prevalence of overweight/obesity observed between HIV-negative and HIV-positive patients may suggest that the two groups shared the same exposure factors. That HTN and DM/CHD prevalence was lower among HIV-positive compared to HIV-negative patients, is possibly due to interplay factors of ART, HIV or the host population. Further studies are, however, recommended for clarifications.

False Positive HIV “Combo” Screening Test in a Hemodialysis Patient in Saudi Arabia: A Case Report and Review of the Literature

Introduction: HIV screening tests are routinely conducted on dialysis patients as the constant exposure of their blood during the dialysis process makes them a reasonable risk for blood-borne infections. However, in low prevalence settings, where HIV rates are <0.1% of the population, false positive results are more likely. This results in apprehension in the dialysis unit as breaches in infectious disease protocols could be presumed. This is illustrated in the case report below. Case Summary: A 62-year-old male Saudi end-stage kidney disease patient secondary to DM nephropathy began dialysis a year before presentation in a hemodialysis center in Saudi Arabia. Routine screening tests done at the start of dialysis revealed negative Hepatitis C, HIV 1 and 2 screening but a positive Hepatitis B surface antigen screen. The patient went for holiday dialysis at another facility and had a routine fourth-generation HIV test done which was positive. A confirmatory HIV PCR test was negative. Conclusion: This case highlights the need for caution in interpreting highly sensitive and specific HIV screening tests in a low-prevalence setting. Routine screening beyond the national recommendation may not be necessary in low-prevalence areas.

High-risk Sexual Behavior among HIV-positive Former Commercial Blood Donors in Rural Eastern and Central China

Objective： To investigate high-risk sexual behavior among HIV-positive former commercial blood donors in rural central and eastern China. Methods： From December 2003 to May 2004, a crosssectional study was conducted to investigate demographic characteristics, sexual behaviors, condom use, and knownHIV status among HIV-positive commercial blood donors.A total of 796 subjects were recruited for the study. Results： Of the 796 study subjects, 53.0% （258/487） did not use condoms, 10.9% （53/487） inconsistently usedcondoms, and 36.1% （176/487） consistently used condoms with a steady sex partner in the past threemonths. Age （OR, 0.57; 95% CI： 0.39, 0.82）, years of education （OR, 1.90; 95% Ch 1.27, 2.84） and known HIVstatus （OR, 1.66; 95% CI： 1.12, 2.45） were independently and positively associated with condom use with a steady sex partner. Of those subjects without a steady sexual partner in the past year, 63.6% （14/22） did not use condoms, 9.1% （2/22） inconsistently used condoms, and 27.3% （6/22） consistently used condoms. Conclusion： HIV counseling and education should be focused on HIV-positive blood donors to prevent a secondary spread of HIV through unsafe sexual practices.

The relative frequency of Mycobacterium tuberculosis and Mycobacterium avium infections in HIV positive patients,Ahvaz,Iran

Objective:To estimate the prevalence of Mycobacterium tuberculosis(M.tuberculosis) and Mycobacterium avium(M.avium) infections in HIV -positive patients suspected to have puimonar) and extrapulmonary mycobacterial co-infection using PCR technique.Methods: Totally 50 samples comprising sputum,pleural fluid and CSF taken from HIV positive patients suspected to have mycobacterial infection,were processed.The demographic information and results of acid fast staining and culture were recorded for each patient.The PCR for detecting of M.tuberculosis comprised of specific primers targeting IS6110 gene sequence.For detecting of M.avium,PCR with primers that amplifies the mig gene were used.Results:From 50 samples processed,45 were sputum(90%),3 pleural fluid(6%) and 2 CSK(4%).In total.8(16%) were culture positive,7 had positive acid fast staining 114%) and 13 samples(26%)were positive using PCR technique.All the positive samples were sputum and belonged to patients with pulmonary infection.01 these.9 were positive for M.tuberculosis(69.2%) and 4 were identified as 1/.avium (30.8%).which 2 out of 13 positive samples showed mixed infections by both mycobacteria. Conclusions:The PCR shows the highest detection rate(26%) of mycobacteria compared with culture and acid last staining.The majority of infections were with M.tuberculosis(18%) and this shows the importance of this mycobacterial co-infection in HIV positive patients in the region of study.

Prevalence survey of infection with Treponema pallidum among HIV-positive patients in Tehran

Objective:To identify the frequency of syphilis among Iranian HIV-positive patients.Methods:A cross-sectional study on the prevalence of syphilis and HIV co-infection among 450 patients diagnosed with HIV infection was conducted between 2004 and 2008 at Imam Khomeini hospital,Tehran,Iran.The lab tests including CD4 cell count,cerebrospinal fluid,veneral disease research laboratory(VDRL),fluorescent treponema antibody-absorption(FTA-Abs)and viral load were performed for all the patients.Data regarding medical history and their demographics were also collected.Results:Of all 450 HIV-positive patients,24(5.3%)had a positive VDRL test and only two men had a FTA-Abs positive test which means 0.45%of them had a definite co-infection of syphilis.65.3%of the HIV-positive patients were injection drug users that the co-infection prevalence of them was 0.7%.We did not find any patient with neurosyphilis.Conclusions:Considering the increasing prevalence of HIV and also extensive use of highly active antiretroviral therapy in developing nations,the diagnosis of syphilis should be timely established using screening tests among such patients.

Correlation analysis of compromised immune function with perioperative sepsis in HIV-positive patient

Objective: To investigate the relationship between immune function and perioperative sepsis in HIV-positive patients. Methods: Retrospective analysis of 144 HIV-positive patients surgically treated from Oct 2008 to Dec 2010 in Shanghai Public Health Clinical Center. The patients were divided into four groups based on their CD4+ T cells counts in preoperative period: group A (0 – 99 cell/ul), group B (100 – 199 cell/ul),group C (200 – 349 cell/ul),group D (≥350 cell/ul). All patients had received standardized surgical procedures, careful surgical routines were applied. To reduce operational damage, conventional antibi-otics, anti-TB, anti-fugal, antiretroviral therapies were used to prevent infection and promptly treatment of complications. Results among 144 HIV-positive patients (male 133 and female 11, aged 42.6 ± 12.5), 80 patients got perioperative sepsis (14 cases in preoperative period and 66 cases in postoperative period). 64 cases did not get sepsis. The average CD4+ T cell count was 276.97 ± 137.91 in preoperative period of patients without sepsis, which was significant higher than the patients with preoperative sepsis (151.29 ± 110.64) and patients with postope- rative sepsis(161.14 ± 128.45) (F = 13.91, P χ2 = 23.680, P +T cells (r = –0.987, P = 0.013). Conclusions With the decrease of preoperative CD4+T cells, the risk of perioperative sepsis had notable increase. Complete evaluation of surgical risk and suitable perioperative treatments may obtain better effect for the patients infected HIV.

Hepatitis E Virus Infection in HIV Positive ART Naive and Experienced Individuals in Nigeria

Background: Studies have shown Hepatitis E Virus to be a causative agent of acute and chronic hepatitis in severely immunocompromised patients such as organ transplant recipients and person with HIV infection. This study was designed to determine the burden of HEV infection among HIV positive individuals in Nigeria and the effect of HIV treatment on the burden of HEV infection among this group of patients. Methods: Aliquot of plasma samples collected for laboratory investigations such as CD4 enumeration, blood chemistry (AST, ALT, Creatine, Urea) were used to determine the presence of HEV IgG and IgM antibodies using commercially available ELISA. Samples analysed in the study were collected from 180 HIV positive individuals (90 ART naive and 90 ART experienced) attending the ART clinic at the University College Hospital, Ibadan, Nigeria. Results: Twenty two of the 180 (12.2%) samples were positive for either HEV IgG (20/180) or IgM (2/180). The rate of HEV IgG was higher among ART naive individuals and the two IgM positive persons were ART naive. There was no significant difference in the mean CD4 count and mean ALT between HEV seronegative and seropositive individuals (P = 0.8 and 0.2 respectively). Conclusions: The results of this study suggest the need to test for HEV infection in HIV positive individuals for the early diagnosis and proper management since HEV is known to be fulminant in the presence of underlying liver disease that is common among HIV infected persons. In addition, the use of ART may reduce the incidence of HEV infection in HIV positive persons.

Optimizing the Dosage Regimen of Micafungin against <i>Candida spp</i>in HIV Positive Patients with EC Based on Mote Carlo Simulation

The objective of our study was to explore the possibility of the antifungal efficacy of various micafungin dosage regimens against Candida spp in HIV positive patients with EC. According to pharmacokinetic/pharmacodynamics parameters of micafungin in HIV positive patients and MICs distribution of micafungin against Candida spp. in published studies, the dosage regimens of micafungin were 50, 100 and 150 mg QD iv. Monte Carlo Simulation analysed the probability of target attainment and cumulative fraction of response. The results showed that micafungin has good antifungal effect in treating HIV positive patients with EC when pathomycetes are Candida albicans, Candida glabrata or Candida tropicalis, in dosage at 100 mg QD and 150 mg QD.

Streptomycin-Induced Steven-Johnson Syndrome in a HIV Sero-Positive Patient with Tuberculosis: A Case Report

Severe cutaneous hypersensitivity reactions to anti-tuberculosis medication are rare and have been attributed mainly to thiacetazone. A case of streptomycin-induced Steven-Johnson Syndrome in a patient with TB-HIV co-infection which ended in death is reported.

Intracranial Cryptococcal Infection in HIV Positive Patient

Cryptococcus neoformans is the most common fungal infection of the CNS. The majority of patients with cryptococcosis have preexisting immunodeficiency such as acquired immunodeficiency syndrome (AIDS). CT and/or MRI of the brain only occasionally detects abnormalities specifically related to this infection. We report a case of MR appearance of central nervous system cryptococcosis in a 33-year-old HIV positive man.

Clinical analysis of neurological system complications in AIDS and HIV positive patients

Objective：To report the clinical manifestations of AIDS with nervous system complications. Methods：We collected the clinical material of AIDS and HIV positive patients who were admitted to our hospital from January 1998 to July 2006, and retrospectively analyzed the 39 cases having nervous system complications, among 146 cases in total. Results：Among 39 cases, there were 3 cases of HIV dementia, 1 case of vacuolar myelopathy, 3 cases of Gullain-barre syndrome, 3 cases of myopathy and 26 cases of secondary opportunistic infection of CNS,including 9 cases of tuberculosis, 6 cases of cryptococcus, 5 cases of toxoplasma, 3 cases of herpes zoster virus, 2 cases of herpes simples virus, 1 case of cytomegalovirus, 1 case of progressive multifocal leukoencencephalitis. 2 cases with central nervous system lymphoma.Among them 12 patients gave up treatment, other patients received anti-HIV treatment and antimicroorganism treatment. 5 patients died of respiratory failure, 2 patients died of multiple organs failure. Conclusion：Up to now, AIDS still has not very good management. So prevention is very important.

Assessment of Liver Fibrosis in HBsAg-Negative and Anti HBc Positive Patients

Background: Surface antigen (HBsAg) is the mean marker of hepatitis B virus infection. During the course of the infection, some patients lose the HBsAg and only the presence of anti-HBc antibody indicates previous contact with the virus. Among these patients, some have detectable viral load (occult infection) but most without viral replication. There is no guideline regarding these patients. The aim of this study was to assess hepatic fibrosis in patients with only the hepatitis B virus contact marker “total anti-HBc”. Patients and methods: it was a descriptive and analytical cross-sectional study, conducted in three private hospitals from January to August 2022. Were included HBsAg-negative and HBc-positive patients, consulting in Gastroenterology departments. Noninvasive methods (APRI, FIB-4 and FIBROSCAN) were used to evaluate liver stiffness because of their easy accessibility and low-cost. The hepatic fibrosis was considered significant when the score determined by APRI, FIB-4 and FIBROSCAN® tests was respectively greater than 1.5;2.67 and 8 kPa corresponding to fibrosis level 2 (F2). Results: A total of 63 HBsAg-negative/total HBcAg-positive patients were included. The mean age was 49.9 ± 13.4 years. The male/female sex ratio was 1.78. Of the 63 patients, 19 had significant liver fibrosis (30.1%) among which 9 patients had HCC. The FIB-4 score outperformed the APRI score in assessing liver fibrosis, with a sensitivity of 84.2%, a specificity of 100% and a negative predictive value of 93.6%. In univariate analysis, there was a significant association between the occurrence of significant liver fibrosis and age over 40 years, dyslipidaemia, obesity, alcohol consumption, smoking, herbal medicine, negative anti-HBs immunological status and detectable viral load. Conclusion: Our study revealed a high prevalence of significant to severe hepatic fibrosis in anti-HBc positive patients. In most of the cases, the fibrosis was severe. Progression to HCC has also been possible. There is no consensus on the follow-up strategy for those patients. However, screening for hepatic fibrosis using noninvasive methods should be recommended for patients aged over 40 years, alcohol or herbal medicine users, patients with metabolic syndrome or occult hepatitis B. In HBsAg-negative/anti-HBc-positive patients, liver stiffness should be evaluated and if it is greater than F2, HCC screening should be started.

Embedding Perovskite in Polymer Matrix Achieved Positive Temperature Response with Inversed Temperature Crystallization

Organic perovskites are promising semiconductor materials for advanced photoelectric applications.Their fluorescence typically shows a negative temperature coefficient due to bandgap change and structural instability.In this study,a novel perovskite-based composite with positive sensitivity to temperature was designed and obtained based on its inverse temperature crystallization,demonstrating good flexibility and solution processability.The supercritical drying method was used to address the limitations of annealing drying in preparing high-performance perovskite.Optimizing the precursor composition proved to be an effective approach for achieving high fluorescence and structural integrity in the perovskite material.This perovskite-based composite exhibited a positive temperature sensitivity of 28.563%℃^(-1)for intensity change and excellent temperature cycling reversibility in the range of 25-40℃in an ambient environment.This made it suitable for use as a smart window with rapid response.Furthermore,the perovskite composite was found to offer temperature-sensing photoluminescence and flexible processability due to its components of perovskite-based compounds and polyethylene oxide.The organic precursor solvent could be a promising candidate for use as ink to print or write on various substrates for optoelectronic devices responding to temperature.

Amplifying colorectal cancer progression: impact of a PDIA4/SP1 positive feedback loop by circPDIA4 sponging miR-9-5p

Objective:Colorectal cancer(CRC)is a prevalent malignant tumor with a high fatality rate.CircPDIA4 has been shown to have a vital role in cancer development by acting as a facilitator.Nevertheless,the impact of the circPDIA4/miR-9-5p/SP1 axis on development of CRC has not been studied.Methods:Western blot,immunohistochemistry,and reverse transcription-quantitative polymerase chain reaction assays were used to analyze gene expression.The CCK-8 assay was used to assess cell growth.The Transwell assay was used to detect invasion and migration of cells.The luciferase reporter and RNA immunoprecipitation tests were used to determine if miR-9-5p and circPDIA4(or SP1)bind to one another.An in vivo assay was used to measure tumor growth.Results:It was shown that circPDIA4 expression was greater in CRC cell lines and tissues than healthy cell lines and tissues.CircPDIA4 knockdown prevented the invasion,migration,and proliferation of cells in CRC.Additionally,the combination of circPDIA4 and miR-9-5p was confirmed,as well as miR-9-5p binding to SP1.Rescue experiments also showed that the circPDIA4/miR-9-5p/SP1 axis accelerated the development of CRC.In addition,SP1 combined with the promoter region of circPDIA4 and induced circPDIA4 transcription.CircPDIA4 was shown to facilitate tumor growth in an in vivo assay.Conclusions:The circPDIA4/miR-9-5p/SP1 feedback loop was shown to aggravate CRC progression.This finding suggests that the ceRNA axis may be a promising biomarker for CRC patient treatment.

Prevention of Maternal-to-Child Transmission of HIV: Knowledge, Attitude and Factors Influencing Active Participation among HIV-Positive Men in a Military Health Facility in Lagos, South Western Nigeria

Introduction: Traditionally, Prevention of Maternal-to-Child Transmission (PMTCT) of HIV involves women and excludes men despite their important roles. There is a need for more data on factors influencing male participation in PMTCT programs. Design: This was a cross-sectional, descriptive study of married HIV-positive men receiving care at the adult ART clinic, 68 Nigerian Army Reference Hospital Yaba. Data were collected from March 15 to April 30, 2018. Result: Out of the 366 respondents, 333 (91%) were aware that HIV can be transmitted from mother to child. However, only 43.2% correctly identified that it can be transmitted during pregnancy, while 30.2% stated during labour. Almost all of the respondents (96.4%) would also accept that their positive partners take antiretroviral treatment to protect her unborn baby, 86.9% would support non breastfeeding option after delivery, and 95.6% indicated readiness to buy formula milk for the baby. Similarly, majority believed that a pregnant woman can be tested for HIV without the permission of her partner (Mean = 1.47 ± 0.893), and that men should accompany their spouse to ANC/PMTCT clinics (Mean = 1.86 ± 0.921). Conclusion: This study revealed that despite low knowledge of PMTCT among men, there is a good level of attitude and involvement among them. We recommend further study to fully explore the impact of education on men’s participation.

Disclosure of Parental HIV Positive Status: What, Why, When, and How Parents Tell Their Children in the Era of HAART in South Africa

The aim of the study was to explore the decision to and the process of disclosure of parental HIV status to children. Focus group interviews were conducted with 21 parents of 39 children aged 7 - 18 years. Participants were recruited from a highly active antiretroviral treatment (HAART) program of an academic hospital in South Africa. Parents disclosed more to older children than to younger children in the same family, and the breadth and depth of the information shared was depended on the age of the child. Communication with adolescent children included topics on HIV prevention and unsafe sexual practices. For parents with a long history of sickness, disclosure occurred soon after the diagnosis was made, when they had not commenced with antiretroviral treatment (ART). They disclosed to prepare their children for HIV related emergencies and imminent death. Parents also expected support from their older children after disclosure. Some parents were forced to disclose because children suspected their HIV status, and parents could not continue to hide symptoms like severe weight loss. In addition, parents disclosed to educate children on how to protect themselves from HIV infection. For most parents, disclosure was unplanned, emotive, and burdened with anxiety and fear of rejection by their children. However, when the decision to disclose was made, parents were honest and open and informed their children that they were HIV positive. Parents may benefit from disclosure support services, and health care providers can assist parents in deciding when and how to disclose.

Positive health:An integrated quantitative approach in patients with chronic gastrointestinal and hepato-pancreatico-biliary disorders

BACKGROUND The concept of positive health(PH)supports an integrated approach for patients by taking into account six dimensions of health.This approach is especially relevant for patients with chronic disorders.Chronic gastrointestinal and hepatopancreatico-biliary(GI-HPB)disorders are among the top-6 of the most prevalent chronically affected organ systems.The impact of chronic GI-HPB disorders on individuals may be disproportionally high because:(1)The affected organ system frequently contributes to a malnourished state;and(2)persons with chronic GIHPB disorders are often younger than persons with chronic diseases in other organ systems.AIM To describe and quantify the dimensions of PH in patients with chronic GI-HPB disorders.METHODS Prospective,observational questionnaire study performed between 2019 and 2021 in 235 patients with a chronic GIHPB disorder attending the Outpatient Department of the Maastricht University Medical Center.Validated questionnaires and data from patient files were used to quantify the six dimensions of PH.Internal consistency was tested with McDonald’s Omega.Zero-order Pearson correlations and t-tests were used to assess associations and differences.A P value<0.05 was considered significant.RESULTS The GI-HPB patients scored significantly worse in all dimensions of PH compared to control data or norm scores from the general population.Regarding quality of life,participation and daily functioning,GI-HPB patients scored in the same range as patients with chronic disorders in other organ systems,but depressive symptoms(in 35%)and malnutrition(in 45%)were more frequent in patients with chronic GI-HPB disorders.Intercorrelation scores between the six dimensions were only very weak to weak,forcing us to quantify each domain separately.CONCLUSION All six dimensions of PH are impaired in the GI-HPB patients.Malnutrition and depressive symptoms are more prevalent compared to patients with chronic disorders in other organ systems.

Predictive value of positive lymph node ratio in patients with locally advanced gastric remnant cancer

BACKGROUND Traditional lymph node stage(N stage)has limitations in advanced gastric remnant cancer(GRC)patients;therefore,establishing a new predictive stage is necessary.AIM To explore the predictive value of positive lymph node ratio(LNR)according to clinicopathological characteristics and prognosis of locally advanced GRC.METHODS Seventy-four patients who underwent radical gastrectomy and lymphadenectomy for locally advanced GRC were retrospectively reviewed.The relationship between LNR and clinicopathological characteristics was analyzed.The survival analysis was performed using Kaplan-Meier survival curves and Cox regression model.RESULTS Number of metastatic LNs,tumor diameter,depth of tumor invasion,Borrmann type,serum tumor biomarkers,and tumor-node-metastasis(TNM)stage were correlated with LNR stage and N stage.Univariate analysis revealed that the factors affecting survival included tumor diameter,anemia,serum tumor biomarkers,vascular or neural invasion,combined resection,LNR stage,N stage,and TNM stage(all P<0.05).The median survival time for those with LNR0,LNR1,LNR2 and LNR3 stage were 61,31,23 and 17 mo,respectively,and the differences were significant(P=0.000).Anemia,tumor biomarkers and LNR stage were independent prognostic factors for survival in multivariable analysis(all P<0.05).CONCLUSION The new LNR stage is uniquely based on number of metastatic LNs,with significant prognostic value for locally advanced GRC,and could better differentiate overall survival,compared with N stage.

Synthetic Characteristics Associated with HIV Diagnosis through Voluntary HIV Testing among HIV-positive People with Non-marital and Non-commercial Heterosexual Transmission in China

The Joint United Nations program on HIV/AIDS reported that 53% of new infections globally in 2017 were beyond key populations and their sexual partners.In this report, although only 16% in Asia and the Pacific were people living with HIV (PLHIV) who did not report any HIV-risk behaviors (mainly including injective drug use, men who have sex with men, sexual workers, and their dients), increasing diag no sed cases who reported their own transmission as non-marital and non-commercial heterosexual con tact (non-M&C sex, defi ned as those heterosexuals who have unpaid sex with any other sexual partners whom they have never married) in China have indicated that the HIV epidemic is spreading to the general population by the bridge of key populations.