Role of liver transplantation in human immunodeficiency virus positive patients

End-stage liver disease(ESLD) is a leading cause of morbidity and mortality amongst human immunodeficiency virus(HIV)-positive individuals. Chronic hepatitis B and hepatitis C virus(HCV) infection,drug-induced hepatotoxicity related to combined antiretro-viral therapy,alcohol related liver disease and non-alcohol related fatty liver disease appear to be the leading causes. It is therefore,anticipated that more HIV-positive patients with ESLD will present as potential transplant candidates. HIV infection is no longer a contraindication to liver transplantation. Key transplantation outcomes such as rejection and infection rates as well as medium term graft and patient survival match those seen in the non-HIV infected patients in the absence of co-existing HCV infection. HIV disease does not seem to be negatively impacted by transplantation. However,HIV-HCV coinfection transplant outcomes remain suboptimal due to recurrence. In this article,we review the key challenges faced by this patient cohort in the pre- and posttransplant period.

Screening of Fungi from Chinese Medical Plants for Anti-Human Immunodeficiency Virus Type 1 Activity

In order to Isolate anti-human Immunodeflclency virus （HIV） agents from natural products, 97 ethanollc extracts of 90 fungi were tested for their Inhibitory activity on HIV-1. Most of the extracts tested were relatively non-toxic to human lymphocytic MT-4 cells, but extracts of some fungi exhibited potent antl-HIV activity In an in vitro 3-（4, 5-dlmethyl-2 thlazoyl）-2,5-dlphenyl-2H-tetrazollum bromide assay with a selectivity Index greater than 3. Most fungi were Isolated from Dendrobium sp. and Taxus sp.

Co-infection of HIV and parasites in China: Results from an epidemiological survey in rural areas of Fuyang city, Anhui province, China

The aim of this study was to investigate epidemiological characteristics of co-infection of HIV and intestinal parasites in a HIV/AIDS highly endemic area in China.A cross-sectional survey was carried out in two villages where HIV/AIDS prevalence in residents was over 1%.Stool samples of all residents in the two targeted villages were examined for the presence of intestinal parasites.Blood examination was performed for the HIV infection detection and anemia test.A questionnaire survey was carried out in all residents participating in the study.A total of 769 individuals were enrolled in the investigation,720 of whom were involved in stool examination of intestinal parasites.The infection rates of parasites in the residents of the targeted villages were as follows:0.56%for Ascaris lumbricoides,4.03%for Hookworm,0.28%for Trichuris trichiura,0.42%for Clonorchis sinensis,21.39%for Blastocystis hominis,3.89%for Giardia lamblia,1.67%for Entamoeba spp.,4.44%for Cryptosporidium spp.,and no infection for Strongyloides stercoralis.The overall infection rate of intestinal worms was 4.72%,intestinal parasite infection rate was 24.31%,the anemia prevalence rate was 34.68%,the co-infection rate of HIV and intestinal helminthes 2.17%,the co-infection rate of HIV and intestinal protozoa 28.26%,of which the co-infection rates of HIV and Blastocystis hominis,and HIV and Cryptosporidium spp.were 19.57%and 13.04%,respectively.A significant difference of Cryptosporidium spp.infection rate was found between HIV-positive group(13.04%)and HIV-negative group(4.70%)(P<0.05).Higher prevalence of anemia(34.68%)occurred in the study villages,particularly in children(>50%)and women(>39%).It was concluded that the infection rate of intestinal protozoa in the residents was higher than that of intestinal helminthes in the local setting,and a same pattern appeared in the co-infection rate of HIV and parasites.An interestingfinding is that the infection rate of Cryptosporidium spp.among the HIV-positives was significantly higher than that in the HIV-negatives,and children and women had higher anemia prevalence.

Study on factors affecting TB/HIV co-infection in four counties of China

The factors affecting case detection of tuber-culosis(TB)/human immunodeficiency virus(HIV)co-infection cases were explored in order to provide evidence-based formulation of a TB/HIV co-infection control strategy in China.Four counties with different modes of HIV transmission and varying cooperation mechanisms between TB and HIV institutions were selected.HIV test among TB patients and TB examination among people living with HIV/acquired immunodeficiency syndrome(AIDS)were conducted.Patients also completed ques-tionnaires on potential factors affecting TB/HIV co-infection.The results showed that 19(1.7%)were HIV-positive among 1089 cases of people living with active TB who received HIV testing.Conversely,there were 126(10%)cases of active TB among 1255 cases of people living with HIV/AIDS.Among the newly discovered 145 cases of TB/HIV co-infection,AIDS institutions found 86.9%of these co-infections and 14.1%came from TB institutes.In different registration categories,there were 31(21.4%)cases of smear positive TB,104(71.7%)cases of smear negative TB,and extrapulmonary cases accounted for 10(6.9%).Gender,occupation,marital status,ethnic group,education,HIV transmission route,CD4 level,and type of TB susceptible symptoms had significant effects on whether HIV/AIDS patients were co-infected with TB disease(P<0.01).Sex,age,ethnic group,occupation,and type of tuberculosis had no significant influence on whether TB patients had HIV infection.AIDS institutions couldfind more TB/HIV co-infection patients in compar-ison with TB institutions,particularly in patients with smear negative pulmonary tuberculosis and extrapulmon-ary tuberculosis.Therefore,a cooperation mechanism should be built up between TB and HIV control systems,and routine TB checks should be conducted for HIV/AIDS patients.In areas where sex or drug use is the major transmission mode of HIV infection,antiretroviral therapy should be expanded,treatment adherence should be improved and patients’immunity level should be increased in order to decrease TB incidence.Cough and expectora-tion of more than two weeks,bloody sputum,and recurrent fevers could be revealing symptoms in TB screening of HIV/AIDS patients.

NRTIs’ effect on the sequence of mitochondrial DNA HV 2 in HIV infected patients

Potent combination antiretroviral therapy(cART)has significantly improved the life expectancy of people living with human immunodeficiency virus(HIV),but it has many side effects such as lipodystrophy(LD),hepatic steatosis,and lactic acidosis.Nucleoside reverse transcriptase inhibitors(NRTIs)could damage the mito-chondria by inhibiting the human DNA polymerase gamma,leading to mtDNA deletion.However,it remains uncertain whether NRTIs could induce the hypervariable region(HV)mutations of the D loop of mitochondria in Chinese HIV/AIDS patients,and whether that effect is different between individuals with and without LD.Hereby,30 Chinese AIDS patients who were receiving antiretroviral drugs were recruited,among which 16 had symptomatic LD and 14 did not.Blood samples were collected prior to and after 96 weeks of treatment.Total DNA was extracted from peripheral blood mononuclear cells(PBMCs).Fragments of 728 bp in length containing HV 2 were amplified by standard polymerase chain reaction(PCR).Direct DNA-sequencing analysis techni-ques were used to detect mitochondrial sequence variants between paired longitudinal samples.Alterations were compared with the revised Cambridge Reference Sequence(rCRS)to determine mutation or polymorphism.Results showed that two years after ART,totally seven cases exhibited sequence variations,five individuals showed 73 A!G revised variation(two with and three without LD),while two cases of LD were found to have other nucleotide alterations.There was no new alteration in individuals without LD.In conclusion,NRTIs could induce mutation of mtDNA HV 2,which might contribute to the development of LD.

Natural history of HIV infection in former plasma donors in rural China

Patients infected through commercial bloodselling practices(former plasma donors,FPDs)in China represent a unique patient population compared to individuals infected through sexual contact or intravenous drug use.FPDs all have an approximate time of human immunodeficiency virus(HIV)infection during the mid-1990s.Few studies about the natural history of HIV infection in these patients were performed.The current study focuses on characterizing the duration of asymptomatic infection as well as the time to disease and mortality of infected FPDs in China.A retrospective cohort study was conducted based on data collected from 5484 HIV-1 infected FPDs in Shangcai county,Henan province.Kaplan-Meier analysis was applied to estimate the asymptomatic duration from the time of infection to the onset of AIDS as well as the survival period from the onset of AIDS to the time of death.The estimated median asymptomatic phase was about 9.21 years,which is similar to that reported in other developing countries in Africa.The estimated median life span after the onset of symptoms was about 9.91 months,which is notably shorter than life spans reported elsewhere.This is the first large-scale retrospective study on the natural history of HIV infection in FPDs in rural China.The findings not only provide valuable insight into an understudied population,but should also serve as an important reference for patient management and care.