A Retrospective Study of Culture-confirmed Mycobacterial Infection among Hospitalized HIV-infected Patients in Beijing, China

A retrospective analysis was performed in two major HIV/AIDS referral hospitals in Beijing to evaluate the prevalence of Mycobacterium tuberculosis（MTB） and non-tuberculous mycobacterial（NTM） infections in HIV-infected patients. A total of 627 patients＇ data were reviewed, and 102（16.3%） patients were diagnosed with culture-confirmed mycobacterial infection, including 84 with MTB, 16 with NTM, and 2 with both MTB and NTM. The most frequent clinical complication by mycobacterial infection was pulmonary infection（48/102, 47.1%）. The overall rates of multidrug-resistant TB（MDR-TB） and extensively drug-resistant TB（XDR-TB） were 11.9% and 3.4%, respectively. This study underlines the urgent need to intensify screening for mycobacteria coinfection with HIV and to prevent the spread of drug-resistant TB among HIV-infected patients.

HIV-infected Female Sex Workers High Risk Behavior and Attitude Changes in Kaiyuan City, Yunnan Province, China

Objective To investigate the attitude and sexual behavior status and change among HIV positive female workers in entertainment sites in Kaiyuan city, Yunnan province, China. The key information should be applied in the integrated intervention program in future. Methods A cohort survey among HIV positive female workers was conducted during 12 months, between 2010 and 2012. All the risk sexual behavior and attitude were collected for assessment for the potential secondary transmission to sexual partners. Results Of 99 HIV positive women who sell sex in Kaiyuan city, 99 participated in the survey at baseline, 80, 80, 75, and 75 at 3-, 6-, 9-, and 12-month follow-ups. The percentage of participants who reported consistently used condoms in the last one month ranged between 94.5% and 95.5%. The client volume in the last one month, income per sex and age group were significant related with non-insistent condom use with their clients. Conclusion It was suggested that integrated intervention program package should include 100 percent condom use promotion for the HIV positive FSW with all sexual partners, and also, include socially support involved.

An Assessment of the Level of Knowledge of HIV-Infected Patients about Highly Active Antireteroviral Therapy and Waiting Times and Their Influence on Antiretroviral Therapy Adherence at a Primary Healthcare Centre of South Africa

Objectives： The study assessed if the level of knowledge of HIV-infected about HAART and waiting-times in the PHC （primary healthcare） clinic have an influence on antiretroviral adherence. Methods： A descriptive-cross-sectional study was conducted in South Africa. Data collected uses a standardized-questionnaire and face-to-face-exit interviews. Pill-count technique was performed and a value of≥ 95% acceptable. Data were analysed using SPSS. Univariate-factors associated with poor-adherence to knowledge about HAART and waiting times were assessed using ANOVA and p ≤ 0.05 considered statistically significant. Key findings： Of 86 enrolled, 63（73.3%） were females and 23（26.7%） males, with mean-age （± SD） of 35.6（±9.6） years and on HAART for 35.5（± 31.8） months ranging from 1-137. Of these, 27（31.40%） and 25（29.07%） were on WHO stages 2 and 3 respectively. Adherence-rates computed from 32 patients, 23（71.9%） revealed poor adherence-rates. The level of knowledge about HAART in terms of names of tablets, correct-dose, frequency, adverse-effects had no influence on ARV-adherence （p _〉 0.05）. Of 23 non-compliant, 10 （40%） gave the reason of drugs-unavailability, 7（30%） adverse-effects, 5（20%） drugs＇ complexity, and 1（10%） too busy to take them. Waiting areas associated with poor ARV-adherence were reception （p = 0.028）, doctors （p = 0.027）, while nurse＇s station （p = 0.29） and pharmacy （p = 0.43） revealed acceptable ARV-adherence.

Sustained heavy ethanol drinking affects CD4⁺cell counts in HIV-infected patients on stavudine (d4T), lamivudine (3TC) and nevirapine (NVP) treatment regimen during 9 months follow-up period

Sustained heavy ethanol drinking is a common problem globally and ethanol is one of the most abused drugs among individuals of different socio-economic status including the HIV-infected patients on antiretroviral drugs. Ethanol is reward drug and a CNS depressant especially at high doses. The study determined the effect of sustained heavy ethanol drinking by HIV-infected patients on d4T/3TC/NVP regimen on CD4+ cell counts in Uganda using WHO AUDIT tool and chronic alcohol-use biomarkers. A case control study using repeated measures design with serial measurements model was used. The patients on stavudine (d4T) 30 mg, lamivudine (3TC) 150 mg and nevirapine (NVP) 200 mg and chronic alcohol use were recruited. A total of 41 patients (20 in alcohol group and 21 in control group) were screened for chronic alcohol use by WHO AUDIT tool and chronic alcohol use biomarkers. They were followed up for 9 months with blood sampling done at 3 months intervals. CD4+ cell count was determined using Facscalibur Flow Cytometer system. Results were then sorted by alcohol-use biomarkers (GGT, MCV and AST/ ALT ratio). Data were analysed using SAS 2003 version 9.1 statistical package with repeated measures fixed model and the means were compared using student t-test. The mean CD4+ cell counts in all the groups were lower than the reference ranges at baseline and gradually increased at 3, 6 and 9 months of follow-up. The mean CD4+ cell counts were higher in the control group as compared to the chronic alcohol use group in both WHO AUDIT tool group and chronic alcohol-use biomarkers group though there was no significant difference (p > 0.05). Chronic alcohol use slightly lowers CD4+ cell count in HIV-infected patients on d4T/3TC/NVP treatment regimen.

Chronic Alcohol Consumption Affects Serum Enzymes Levels in the HIV-Infected Patients on Stavudine (d4T)/Lamivudine (3TC)/Nevirapine (NVP) Treatment Regimen

Chronic alcohol use is a common problem globally among the HIV-infected patients on ARV treatment regimens, leading to severe liver damage and increase in serum enzymes. The study determined effect of chronic alcohol intake on serum enzymes (alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyl transferase (GGT)) in HIV-infected patients on d4T/3TC/NVP treatment regimen in Uganda using the WHO alcohol use disorders’ identification test (AUDIT) tool and chronic alcohol use biomarkers (ALT, AST, GGT, AST/ALT ≥ 2.0 and mean corpuscular volume (MCV)). A case control study using repeated measure design with serial measurements model was used. Alcohol use biomarkers were used to standardize the gender differences in alcohol use. A total of 41 patients (21 alcohol group and 20 control group) were followed up for 9 months with blood sampling done at 3 month intervals. The serum enzymes’ levels were determined by using the Cobas Intergra 400 Plus analyzer system. The mean GGT levels were higher in chronic alcohol use group as compared to control group in both groups. The levels were above reference ranges during 6 month and three times higher during 9-month follow-up period for both chronic alcohol use self reporting WHO AUDIT tool and biomarkers’ groups. Generally, the mean AST, ALT and AST/ALT levels were slightly higher in alcohol use group as compared to control group and were slightly higher in both groups as compared to reference ranges during the 9 month follow-up period. Chronic alcohol consumption by HIV-infected patients on d4T/3TC/NVP drug regimen increased GGT and AST/ALT serum enzyme levels and hence was used as chronic alcohol use biomarkers.

Dermatophytes Species Isolated of HIV-Infected Patients Identified by ITS-RFLP and ITS Region Sequencing from Triangulo Mineiro, Minas Gerais State of Brazil

Dermatomycoses are a group of diseases worldwide distributed and affect skin, hair and nails. Several fungal species can be envolved and keratinophilic fungi belonging to the genera Trichophyton, Microsporum and Epidermophyton are very common. These infections are globally distributed and their incidence has progressively increased. Despite their high incidence, few studies have been carried out in HIV-infected patients, regarding frequency, clinical presentations, and species identification. This study aimed to evaluate some epidemiological and clinical aspects of dermatophytosis in HIV-infected patients and to attempt phenotypical and molecular characteristics of their agents. Of 398 patients included, 306 were HIV-infected. Clinical data and samples of skin, hair and nail lesions were simultaneously obtained. The dermatophytes yielded in culture were phenotypically identified and evaluated by ITS-RFLP and ITS (Internal Transcribed Space) sequencing. Dermatophytes frequency in HIV-infected patients with cutaneous lesions was 11.76% similar to the 15.22% observed in non-HIV individuals. Trichophyton rubrum was the most common isolated species in both groups. Throught ITS-RFLP, 29/32 (90.63%) of dermatophytes isolates were identified at the species level. From the 10 isolates randomly selected for ITS sequencing, seven confirmed the ITS-RFLP results while three Trichophyton sp. were not identified as dermatophytes. The identification of these species in HIV-infected patients is highly desirable in order to improve the knowledge of their frequency, geographical distribution and relation to clinical presentation.

Knowledge of Cervical Cancer and Prevalence of the Screening Services among HIV-Infected Women in Blantyre, Malawi

HIV-infected women are at high risk of developing cervical cancer and are encouraged to undergo cervical cancer screening regularly. However, very little has been documented about the knowledge of cervical cancer and the utilization of the screening services by these women. This study aimed to investigate the knowledge of cervical cancer, prevalence of cervical cancer screening uptake and predictive factors that affect utilization of cervical cancer screening services among HIV-infected women. The study employed quantitative methods for data collection and analysis. It was conducted at Queen Elizabeth Central Hospital (QECH) from December 2017 to February 2018 where HIV-positive patients accessing QECH Antiretroviral Therapy (ART) clinic were recruited. Systematic random sampling was employed to select HIV-positive women for the survey. Data were collected using semi-structured questionnaires. STATA version 12 was used to analyze the data. Out of the 196 recruited women, the majority (98%;n = 192) indicated having heard of cervical cancer and of the 192 women, only 57% (n = 109) were able to know at least a single sign/symptom of cervical cancer, furthermore, only 47% (n = 91) indicated ever been screened, finally, getting information from health facilities and knowing at least a single sign/symptom of cervical cancer influenced HIV-infected women to go for cervical cancer screening services. The study revealed that knowledge of cervical cancer and the utilization of its screening services among HIV-infected women is low. Therefore, there is need to increase knowledge and strengthen cervical cancer screening services among HIV-infected women in the country.

Evidence of Renal Damage in HIV-Infected Patients with High CD4 Counts Following the Use of Traditional Medicine

Kidney dysfunction is one of the most serious complications resulting from the use of traditional medicine which is common in Africa accounting for about 35% of renal damage in HIV-infected patients. In this cross sectional study, 250 HIV-infected patients were groups as follows: ART GrpA (100), ART + traditional medicine use GrpB (100) and ART treatment naïve + traditional medicine GrpC (50). Tubular dysfunctions were defined when at least two or more of the following abnormalities were repeatedly present: Uricosuria ≥ 0.05 mg/dl, Phosphaturia ≥ 20.0 mg/dl, Glucosuria ≥ 0.1 mg/dl, Proteinuria = positive protein on dipstick urine. Renal dysfunctions were found to be significantly high (P = 0.001) in the group of patients treated with ART + traditional medicine. 27 (64.29%) patients followed by ART treatment naïve patients + traditional medicine;12 (28.57%) patients and only 4 (7.14%) patients developed renal toxicity in the ART treatment Grp. But strikingly CD4 counts were also significantly higher in Grp B (683 cell/ul) compared to group A (446 cell/ul) and C (206 cell/ul). Our results show that HIV-infected patients on ART combined with traditional medicine might develop renal abnormalities in the presence of high CD4 counts, in the course of incessant use of traditional medicine. Thus it is important that more research be conducted on its usage among the Black population with HIV infection.

Steps To ward HIV Cure Two more HIV-infected patients appear to be virus-free after bone-marrow transplants

THIS year＇s International AIDS Society Conference on HIV Pathogenesis, Treatment and Preven-／tion, held in Kuala Lumpur, Malaysia, made major headlines when Timothy Hendch, an American doctor, announced that two more cancer patients may have been cured of HIV after receiving bone-marrow transplants to treat lymphoma. Both patients had been taking retroviral medication, and continued to do so after the transplants as their viral levels sank until doctors were unable to find any traces of HIV in the patients＇ blood.

The Socio-Demographics of HIV-Infected Persons with Psychological Morbidity in Zaria, Nigeria

Introduction: It is estimated that more than 330 million persons are living with HIV-infection globally and in Nigeria about 3.4 million persons are living with the infection, with an annual death rate of 180,000. Psychological morbidity often accompanies chronic illnesses and may be associated with substance abuse, poor health seeking behaviour and adherence to treatment program;it may worsen existing health problems and the overall quality of life. Until the burden is effectively identified, intervention cannot be planned. Until there is cure, the goal is to manage and cope effectively with HIV-infection. Little if any studies have been done in this area in the North West geopolitical zone of Nigeria, the study would help to identify high risk groups and prevent the progression and spread of the infection. Objectives: To identify HIV-infected persons with psychological morbidity, accessing HIV-clinic at Shika Hospital, Zaria, Kaduna State;and analyze their socio-demographic profile. Methodology: A cross sectional descriptive study was carried out to assess and analyze the socio-demographic characteristics of HIV-infected persons attending Shika hospital Zaria Nigeria, who screened positive for psychological morbidity. A total of 109 HIV-infected persons receiving HAART at Shika clinic, Zaria, Kaduna State, Nigeria, were administered questionnaires;the General Health Questionnaire (GHQ-12) measuring psychological morbidity and socio-demographic data. The participants ranged in age between 18 and 75 years. Results: Data were analyzed using SPSS software 15. Both descriptive and inferential Statistics were performed on the data. Results indicate a total prevalence rate of psychological morbidity of 78 percent among participants. Of this, about 16.2 percent were severely distressed, 25.1 percent moderately distressed and 36.7 percent were mildly distressed. The females were more likely to be distressed than men (65 percent vs. 35 percent of those with psychological morbidity, OR = 3.5 CI 95 percent). It was (57 percent) for patients whose HIV-infection was of relatively shorter duration (less than 4years) than (43 percent) those of longer duration (5 years and above;OR = 1.7, CI 95 percent = 1.1 - 3.5). The age group (18 - 40 years) was more likely to screen positive for psychological morbidity (58.3 percent vs. 41.7 percent, OR = 2.4, CI 95 percent), than the age group (41 - 75 years). On the other hand, Christians were more likely than Muslims (55 percent vs. 45 percent, OR = 1.5, CI 95 percent = 1.1 - 3) to be distressed. For married patients with partners it was 20 percent and for singles 30 percent;for the widowed (12 percent) and divorced (38 percent). At the level of tribal/ethnic groups, it was 13 percent for Ibos, 22 percent for Yorubas, 27 percent for Hausas and 38 percent for all the other minority tribes put together. Conclusion and recommendations: The study has been able to identify the presence of psychological morbidity among HIV-infected persons as high and analyze the socio-demographic factors associated with it as significant. Periodic screening of HIV-infected persons for psychological morbidity and psychosocial intervention was recommended.

Health related behaviors among HIV-infected people who are successfully linked to care:an institutional-based crosssectional study

Background:By the end of October 2019,there were 958 thousand people were reported living with HIV/AIDS in China.Unhealthy lifestyle factors,such as smoking,drinking alcohol,using illicit drugs and no physical activity have been found to mitigate the positive impact of antiretroviral therapy(ART)on viral load and HIV-related quality of life.Moreover,risky sexual behavior among HIV-positive persons places their partners at risk for HIV transmission and other sexually transmitted infections.The aim of the study is to determine the prevalence of unhealthy behavior of people living with HIV/AIDS and related influencing factors,particularly those that are closely connected with HIV infection and ART effects.Methods:An institutional based cross-sectional study design was used to collect data from people living with HIV/AIDS(PLWHA)in Beijing and Yunnan Province.The following information was included in the questionnaire survey:social-demographic characteristics,health behavior information,sexual risk behaviors.Binary logistic regression model was conducted to analyze the influencing factors of unhealthy general health behaviors and risky sexual behaviors.Results:In total,2575 PLWHA were included in the study and 78.3%(2017/2575)were male.For the general health behaviors,34.2%(987/2544)smoke;33.8%(870/2575)drank alcohol and 2.3%(49/2134)reported the use of illicit drugs in the previous 6 months.From the sexual behaviors perspective,59.0%(1519/2575)had sex in the previous 6 months.Among people who had sex,92.0%(1398/1519)had fixed sexual partners.Among those with no fixed sexual partner,38.0%(46/121)had more than three partners.Among men who had sex,34.7%(448/1292)reported having sex with men in the previous 6 months and 167%(75/448)of these had group sexual activity.Among participants,72.2%(1053/1458)used condoms every time they had sex while 6.4%(94/1458)of people never used condom.Male people living with HIV/AIDS were more likely to have sexual risk behaviors(adjusted odds ratio[OR]=2.208,95%confidence interval[CI]:1.147-4.252)and unhealthy general health behaviors(adjusted OR=2.029,95%CI:1.480-2.783).The odds of higher risk sexual behaviors was 1.546 times(95%CI:1.302-1.827,P=0.001)greater among participants who drank alcohol compared with their non-drinking counterparts.Conclusions:PLWHA is a group that is vulnerable to problematic health behaviors,especially for men who were more likely to drink alcohol,have more sexual partners,more sexual risk behaviors including group sexual activity,not using condoms and using drugs.Therefore,interventions focusing on gender-specific risk behaviors reduction for people living with HIV/AIDS are now necessary to control the spread of HIV infection and improve the efficacy of antiviral treatment.

Non-opportunistic intestinal parasitic infections among HIV-infected individuals at Wolaita Sodo Hospital, South Ethiopia

Objective:To determine the prevalence of non-opportunistic intestinal helminthic and protozoal infections among HIV-infected individuals and to determine socio-demographic determinants of intestinal parasitosis.Methods:A cross-sectional study was conducted on HIV-infected individuals attending antiretroviral therapy clinic of Wolaita Sodo Hospital.Stool in wet mount preparation and formalether concentration technique were used to diagnose intestinal parasitic infection.Sociodemographic variables were collected by using questionnaire.Chi-square test was used to test the associations between intestinal parasitosis and socio-demographic variables.Results:The overall prevalence of non-opportunistic intestinal parasitic infection was 32.4%out of which 11.0%was protozoal infection and 21.4%was helminthic infection.The most common intestinal parasite detected was Ascaris lumbricoides with 12.7%prevalence followed by Giardia lamblia with 7.5%prevalence.The prevalence of Strongyloides stercoralis,hookworm species,Entamoeba histolytica/Entamoeba dispar,Schistosoma mansoni and Taenia species was 2.9%,1.2%,3.5%,1.7%and 2.3%respectively.There was no significant difference in prevalence of intestinal parasite infection with regard to age,sex,residence area,job type and religion of participants but there was a significant association between the educational status and intestinal parasitic infection.The prevalence of intestinal parasitic infection was higher among illiterate participants.Conclusions:Ascaris lumbricoides was the most common intestinal parasite detected in HIV-infected individuals.Giardia lamblia was the most common protozoal parasite observed.Prevalence of intestinal helminthic infection was higher than protozoal infection.Intestinal parasitosis was significantly associated with an educational status of individuals.

HIV-Infection Reduction-Rates in Patients, on Antiretroviral Efficacy-Trial of a Nigerian Broad-Spectrum Antiviral Medicine (Antivirt^®)

In verifying antiretroviral efficacy of a Nigerian broad spectrum antiviral medicine (Antivirt®), the Nigerian Institute of Medical Research certified it safe by toxicological test on laboratory animals, before commencing treatment of three HIV/AIDS patients whose viral loads varied widely (millions, hundreds of thousands and thousands). To overcome errors associated with such wide differences in subject-classes, percentages of viral load-reductions were calculated instead of comparing their viral loads. After first month of the Antivirt®-treatment, means of ranked viral loads of the patients significantly (P ≤ 0.05) increased from 10.00 ± 7.21 to 11.30 ± 5.51 (-41.03% infection-reduction rate) instead of reducing. From second month of the trial, their viral loads started to reduce, continuously, so that their infection-reduction rates have been increasing from that -41.03%, to -38.22% in the second month;23.98% in the third month;31.76% in the fourth month and 64.12% after the fifth month.

Quantitative Computerized Tomography (QCT) versus Dual X-Ray Absorptiometry (DXA) in the Assessment of Bone Mineral Density of HIV-1 Infected Children

Bone studies of HIV-infected children using dual X-ray absorptiometry (DXA) suggest bone mineral density (BMD) abnormalities. Pediatric studies are often performed using DXA instead of computed tomography (CT), which accounts for 3-dimensional differences in bone size of growing children. We evaluated whether CT would match DXA measurements in this population. For this purpose, the BMD of 16 perinatally HIV-infected patients, ages 6 to 22 was assessed. Subjects were matched by age, gender, and race to controls. BMD was assessed via DXA and QCT. Clinical anthropometric data, body mass index, immunologic and virologic parameters and laboratory markers for osteoblastic and osteoclastic activity were performed. No statistically significant differences in age and anthropometric parameters between subjects and controls were found. Individual CT and DXA z-scores were significantly different when subjects were evaluated as a group (p = 0.0002) or when males and females were analyzed independently (p = 0.001 and 0.03). DXA z-scores were below 1 SD, while CT z-scores were above the mean. 31% of subjects were identified as having poor bone mineralization by DXA while none had osteopenia/osteoporosis by CT. There was no correlation between immunologic/virologic parameters and BMD by either method. Increased osteoclastic activity was noted in 10 patients receiving tenofovir. In summary, decreased BMD diagnosed by DXA in pediatric HIV-infected subjects was not confirmed by CT. Increased bone turnover in patients on tenofovir was suggested by laboratory markers. Prospective studies using CT as the imaging standard are needed for evaluation of bone mineral changes in HIV-infected children.

Prevalence of Asymptomatic Bacteriuria in HIV Infected Patients in a Tertiary Hospital in Lagos, Nigeria

Background: People living with Human Immunodeficiency Virus (HIV) are more predisposed to urinary tract infections due to suppression of their immunity by the virus. Asymptomatic bacteriuria is associated with an increased risk of symptomatic urinary tract infection and the latter being an important contributor to development of chronic renal failure, hypertension and toxaemia of pregnancy. The aim of this study was to determine the prevalence of asymptomatic bacteriuria in HIV-infected patients and proffer a recommendation on the need or otherwise to screen. Methods: This was a cross sectional study of treatment-naive HIV-infected patients attending the HIV clinics of Lagos State University Teaching Hospital (LASUTH), Ikeja. A single voided aseptically collected mid-stream urine (MSU) was obtained from each patient and all samples processed immediately, were sent for urinalysis and culture. Isolates were considered significant if there were ≥105 colony forming unit/mL (CFU/mL) with 2 or less isolates, doubtful significance if 5 CFU/mL. Significant isolates were selected for identification. Data were analyzed using SPSS version 16.0 (Statistical Package for Social Sciences, Inc., Chicago, Ill). Results: A total of 156 consenting participants were recruited into the study. The mean age was 36.45 ± 8.65 years. There were 60 of 156 (38.4%) males and 96 of 156 (61.56%) females. Only 33 of 156 (21.2%) had significant bacteriuria, out of the 33 participants, 19 (57.8%) were asymptomatic, while 14 of 33 (42.4%) had significant growth but were symptomatic or on antibiotics. E. coli was isolated in 9 of 19 (47.3%), followed by Staph aureus 4 of 19 (21.05%). Conclusion: More than half of participants who had significant growth had asymptomatic bacteriuria, while one-fifth of all patients had significant growth. Considering this statistics, screening for or treatment of asymptomatic bacteriuria may be recommended in all HIV-infected patients.

Acute Malnutrition and Infection with the Human Immuno-Deficiency Virus (HIV) in Children Followed up at the Pediatrics University Hospital Charles de Gaulle: Evolution of Anthropometric Parameters on Antiretroviral Treatment

Burkina Faso, a country with very scarce resources, undertook to fight against HIV infection. In 2013, according to UNAIDS, 110,000 persons were living in this country with HIV infection. 18,000 children among these persons were under 15. We conducted a retrospective study from January 2003 to December 2012 at the Pediatrics University Hospital Charles De Gaulle, Ouagadougou (CHUP CDG), Burkina Faso. The study aimed at assessing the children’s ponderal growth when under antiretroviral treatment. The children who were under 15 and who had been on antiretroviral treatment for at least 5 years were included in the study. Acute malnutrition concerned children whose height/weight ratio (H/W) was lower at -2 width type (or Z score) of the median of reference regarding age according to WHO. Two categories of malnutrition were outstanding in our study: moderate acute malnutrition, (-3 Z-score ≤ H/W -2 Z-score) and severe acute malnutrition (W/H -3 Z-score). The clinical and paraclinical data recorded during previous consultations were extracted from the ESOPE (Monitoring and follow-up of patients) data basis and exported to the ENA software and SPSS for their analysis. In total, 210 out of 529 children’s cases were considered. These children’s average age was 6.9 years. There were 55.7% of male and 44.3% of female children. HIV1 was found in 97.6% of the children against 2.4% for HIV2. In a 5 year follow-up, 46 among the children, namely 20.4% were on a second line protocol of antiretroviral treatment and 164 among them were still on a first line protocol of antiretroviral treatment. When they were admitted at hospital, 38% of the children showed characteristics of acute malnutrition. 17.8% of these children presented characteristics of severe form of acute malnutrition. During this 5-year follow-up, the average of the W/H index of the children gradually rised from -1.62 Z-score when being admitted to -0.18 Z-score at after a 60-month antiretroviral treatment. Our study showed an effective ponderal catch-up with an average of the W/H index at -1.02 Z-score after a 12-month antiretroviral treatment. This study completed by the search for nutritious factors is likely to influence the infected children’s ponderal growth.

Epidemiological Patterns of AIDS in a Reference Center from Catanduva,Sao Paulo State,Brazil

Objective: Hereby we present the epidemiological and clinical profile of HIV-infected population before and during the highly active antiretroviral therapy (HAART) era from a tertiary care hospital in the Southeastern region of Brazil. Methods: A retrospective, cross-sectional and descriptive study was carried out, this involved the analysis of the medi-cal records of patients diagnosed with HIV-1/AIDS admitted to Hospital Escola Emílio Carlos, located in the munici-pality of Catanduva, State of S?o Paulo, Brazil. Results: In both pre-HAART and HAART periods, HIV-1 infection was more prevalent in men. Heterosexuality and secondary education were associated with AIDS in the HAART period. Statistically significant association was only observed for co-infection with HIV-1/Hepatitis C in the pre-HAART era and the number of patients with opportunistic infection (OI) was lower in the HAART period. Among all OI it is worth mentioning pulmonary pneumocystosis, which despite being common in two periods, its occurrence was considerably greater in the pre-HAART era. Concerning the distribution of OIs according to the HIV-1 viral load and serial count of T CD4+ lymphocytes, a significant association was observed. The association between the number of deaths by OIs and death in the 1st year of diagnosis in the HAART treatment was significant. Conclusions: The clinical and epidemiological profile of a specialized HIV-1/AIDS center in Catanduva, Southeastern Brazilian region, is consistent with the epidemiology of AIDS in the country.

High frequency of regulatory T cells among HIV type 1-infected men who have sex with men correlates with disease progression

Background Regulatory T cells （Tregs） may play an important role in immunopathology during HIV-1 infection. Transcription factor forkhead box P3 （FoxP3） orchestrates the development of Tregs and is a useful marker to identify this population. Using a FoxP3 phenotype to define Tregs, we investigated the level and phenotype of peripheral blood natural CD4~Tregs and assessed the relationship between the frequencies and absolute numbers of CD4＋Tregs and disease progression among untreated HIV-infected men who have sex with men （HIV^MSM） in China. Methods Fifty-two untreated HIV^＋MSM with CD4^＋T-cell counts of 〈350 cells/μl or 〉350 cells/μl were compared in a cross- sectional study. Twelve age-matched HIV-uninfected MSM and nine patients receiving antiretroviral therapy for at least 1 year were also included. Expression of CD25, CD127, CD45RA, CCR7 and CTLA-4 was assessed on CD4^＋Tregs using polychromatic flow cytometry. Results The percentage of CD4^＋Tregs was increased significantly, whereas CD4^＋Tregs expressed less CTLA-4 in HIV＊MSM compared with controls. CD4^＋Tregs displayed predominantly an effector memory phenotype （CD45RA-CCR7-）, phenotypically distinct from conventional CD4^＋T cells. Moreover, the expansive frequencies of CD4^＋Tregs coincided with lower CD4＋T-cell counts and higher viral loads whereas the absolute numbers of CD4^＋Tregs were associated with higher CD4^＋T-cell counts and lower viral loads. The expansion of Tregs was also associated with CD8^＋T-cell activation. Conclusion Increased proportions and decreased numbers of CD4^＋Tregs are associated with HIV progression, and their functions may impair with the progression of HIV infection.