Journal of AIDS & Clinical Research

This case involves a 26-year-old, HIV-infected woman who presented with recurrent ischemic strokes as the first manifestation of HIV infection. The patient reported a history of three episodes of stroke in the previous 10 years. Recent admission presentation was of left hemiparesis and pseudobulbar palsy. She underwent an extensive workup during her first stroke episode for the risk factors associated with stroke in a very young woman, but no cause found other than positive HIV-1 antibodies. Contrast CT scan of the brain revealed vasculitic changes, but again only HIV found. This case illustrates the possibility of HIV manifesting first as recurrent stroke

Introduction: The use of many anti-retroviral drugs has been associated with a myriad of adverse drug reactions (ADRs) which could limit successful treatment outcome with respect to patient compliance and quality of life. An additional consideration is the high incidence of HIV infection with tuberculosis (TB) in Southern Africa, including Zimbabwe, and the use of co-treatment regimens.

Methods: The study is a cross sectional, case-control study of 433 out-patients conducted at two hospitals in Zimbabwe. The patients were profiled for adverse reactions namely central nervous system side-effects (CNS), lipodystrophy (LD), skin hypersensitivity (SH), and peripheral neuropathy (PN). Assignment of the case and the control status of a patient was done based on occurrence of these adverse drug reactions in each of the HIV/AIDS only, TB only and HIV/TB co-infection patient groups.

Results: Among the HIV/AIDS only treatment group (n= 240), the incidences of major ADRs were PN (63%), LD (38%), CNS (29%) and SH (21%). In the TB only treatment group (n=92), the major ADRs were PN (49%), CNS (29%), and SH (14%). In the HIV-TB co-treatment group (n=98), the major ADRs were PN (64%), CNS (39%), LD (6%) and SH (18%). A significant number of females were on alternate first line treatment that has no stavudine as compared to males (OR=1.98, CI (1.1, 3.59); p=0.03). Occurrence of CNS adverse drug reactions were more associated with patients on efavirenz than other HIV-drug combinations (43% vs. 17%, p<0.00001).

Conclusion: The use of anti-retroviral drugs and anti-TB drugs is associated with very high incidences of adverse drug reactions. There is therefore need to understand the pharmacokinetic and pharmacodynamic mechanisms of these ADRs so as to identify patients at risk and to provide guidelines for the choice of drug and dosage to ensure safe and efficacious treatment outcomes

Background: The objective of the present study was to evaluate the impact of progressive resistance training on the body composition of HIV/AIDS-seropositive patients with lipodystrophy.

Methods: The sample consisted of ten individuals with lipodystrophy submitted to a training program. Lean mass and fat mass levels were determined by double energy X-ray absorptiometry (DXA) before and after 36 sessions (12 weeks) of training divided into a preparatory phase (six sessions with three series of 15 repetitions), a transitory phase (six sessions with three series of 15 repetitions with 40 to 50% of maximum muscle strength), and a specific phase (24 sessions with three series of eight repetitions with 70 to 80% of maximum muscle strength). Data were analyzed statistically by the paired sample test.

Results: The results showed a significant increase in total lean mass (P=0.039) in the upper limbs (P=0.004) and in the trunk (P=0.019).

Conclusions: On this basis, we conclude that progressive resistance training promotes an increase in lean mass and can be useful for the complementary treatment of lipodystrophy by improving the body harmony and quality of life of patients with HIV/AIDS.

Therapy initiation at confirmation of HIV-infection is now medically preferred, which implies that, with adequate financial support, the diagnostic use of T-helper lymphocyte parameters will shift from ART enrollment to tracking therapeutic response. Of the two main therapy tracking parameters, CD4% and the CD4 count, the CD4% parameter is less prone to non-HIV influences. For example, normal CD4% values do not change at all during 17 years of healthy childhood maturation while the CD4 count falls by approximately a factor of three. In mature, HIV-stable persons the CD4 count randomly fluctuates by approximately 12% from day to day in health and by 30% in severe HIV-infection; while CD4% fluctuates by one-third of these amounts respectively. Despite indications such as these that CD4% is the best cell proxy for HIV-related immune status, CD4% is not delineated in adult therapy guidelines and not universally measured by smaller commercial cytometers in resource challenged areas. With only the CD4 count available how might one determine whether a result was subject to factors that would call for a repeat count at a later time? We showed in two populations (African and American) that the normality of the total lymphocyte count was an indicator of the utility of a given CD4 count. High or low lymphocyte counts were strongly related to a high or low CD4 count, which means that factors such as stress and microbial infection that are known to temporarily affect the total lymphocyte count will affect the CD4 count. During HIV therapy the total lymphocyte count should be inclined to normal values and a lymphocyte count that is high or low relative to a patient’s history would call for a repeat CD4 measurement at a later time and, more importantly, qualify the repeat measurement.

Background of study: The visual status and causes of visual impairment among HIV/AIDS patients in Yenagoa is not yet determined. In order to optimize the gain of an effective HIV/AIDS control programme, this information is vital. Aim/Objectives: To determine the visual status and causes of visual impairment among HIV/AIDS patients in Yenagoa, Bayelsa state, Nigeria.

Method: A prospective cross sectional study was carried out on new consecutive HIV positive patients presenting to the “heart to heart” clinic of the Niger Delta University Teaching Hospital, Okolobiri over a period of 16 months. Relevant history was obtained from the patients and their base line data such as age, sex and CD4 count was recorded. The patients underwent a full ophthalmic examination including visual acuity assessment and an anterior and a posterior segment examination.

Result: One hundred and thirty nine patients (139), was evaluated consisting of 91 males and 48 females (M/F ratio of 1:1.9). 15(10.8%) had visual impairment while 124(89.2%) had normal vision. Eighty (80 %) of patients with visual impairment was found to be blind while 20% had low vision. Eighty percent (80%) of patients with visual impairment has CD4 counts of 300 cells/μl or less. Retrobulbar optic neuritis was the commonest cause of blindness (33.4%) followed by cataract (24.9%) and maculopathy (16.7%). Cytomegalovirus retinitis, herpes zoster ophthalmicus and toxoplasmosis were each responsible for 8.3% of blindness.

Conclusion: The visual status of this population was generally good. For a few with visual impairment, it was largely due to retrobulbar optic neuritis and cataract. Improvement of the visual status of this population must pay priority attention to these diseases.

Background: HIV-1 uses different co-receptors (CCR5/CXCR4) at different stages of disease to enter target cells. Any information in understanding this mechanism has important implication on both, the rate of disease progression and our understanding of the immunopathogenesis of this disease.

Methods: This cross-sectional study involved 67 treatment-naïve HIV-1 infected individuals. The expression of CCR5 and CXCR4 on T-cell subsets was evaluated in the peripheral blood of patients at different stages of HIV disease, active pulmonary tuberculosis (PTB), HIV/PTB co-infection and healthy controls, to assess their possible role or association with change in Treg frequency during the disease progression. Furthermore, we investigated the impact of Rac1 expression in relation to functionally active CXCR4 and NF-κB expression.

Results: Significantly higher CCR5 expression on CD4+CD25high Treg cells in HIV-1 subjects in early stage of the disease correlated well with initial decrease in Treg frequency. On the contrary, higher CXCR4 expression on CD4+CD25low/negative T-cells (non-Treg cells) in advanced stage of disease explained the shift to X4 type with faster progression to AIDS. This shift is further supported by initial significant decrease in Rac1 expression in early disease followed by returning to normal expression with disease progression. Interestingly, PTB co-infection correlated significantly with increase in CCR5 expression on Treg population only, at the same time favoring increase in CXCR4 expression on CD4+CD25low/negative subset.

Conclusion: The study indicates novel inter-relationships of co-receptor expression and their regulatory genes in therapy naïve individuals and how the virus manipulates the host machinery to its advantage. The Rac-1 seems to regulate not only the functional conformation of CXCR4, but also the expression of both FoxP3 and NF-κB genes there by affecting the disease progression in HIV subjects. These findings need further attention to look at their clinical implication and disease outcome in a larger study.

Objective: HIV-infected persons frequently experience lipodystrophy and are at higher risk of cardiovascular disease, but the impact of adipose-related hormones, such as adiponectin, on Coronary Artery Disease (CAD) remains unclear. We evaluated the association of plasma adiponectin levels and the presence of CAD.

Design: A cross-sectional study among HIV-infected men in a large HIV clinic. Methods: HIV-infected participants underwent CT scan imaging to determine CAD as measured by Coronary Artery Calcium (CAC) scores categorized as no detectable disease (0), minimum disease (1-100), and significant disease (>100). Factors associated with CAD, including adiponectin levels, were evaluated using multivariate logistic regression modeling.

Results: 213 HIV-infected men were evaluated with a median age of 43 years, median CD4 count of 583 cells/ mm3, and 69% had HIV RNA<50 copies/mL. Forty-nine percent had lipohypertrophy, 30% had hypertension, and 21% had a moderate/high Framingham risk score (FRS). Thirty-three percent (n=71) had positive CAC scores. Seventy percent (n=149) had a low adiponectin level (<4.0 μg/ml), including 66% with CAC=0, 76% with CAC of 1-100, and 81% with CAC>100 (p=0.09). Adiponectin levels were inversely correlated with lipohypertrophy, hypertension, and triglyceride levels (p<0.05), while FRS was marginally correlated (X2=3.1, p=0.08). In the final multivariate model, increasing age (OR 3.8 per 10 year increase, 95% CI 2.56-5.71, p<0.001) was significantly associated with CAC, and adiponectin approached significance (OR 0.8 per 1 μg/ml increase, 95% CI 0.69-1.00, p=0.05).

Conclusions: Low adiponectin levels are common among HIV-infected persons. Adiponectin is correlated with lipohypertrophy and lower levels approached significance with CAD. Understanding the role of adiponectin in the pathogenesis of CAD may allow for targeted treatment and prevention strategies among HIV-infected persons.

Background: Physical activity and cardiovascular fitness are beneficial for HIV-infected individuals; however effects over a one year period are unknown. This study aimed to document habitual physical activity and cardiovascular fitness over a 12 month period in stable, HAART-treated individuals with HIV, explore relationships to body composition, body image and cardiovascular disease (CVD) risk and evaluate physical activity determinants.

Methods: Eighty adults participated. Physical activity was reported using the International Physical Activity Questionnaire and cardiovascular fitness assessed using the Kasch Pulse Recovery Test.

Results: 19-37% participants reported suboptimal physical activity levels at each study visit, while physical activity and cardiovascular fitness were largely stable over the study period. Higher cardiovascular fitness was associated with better body composition and this association persisted over time (p<0.03 for all). Greater total energy expenditure was associated with improved body image (r=-0.325, p=0.027) but not CVD risk. Being in a permanent relationship was independently associated with higher levels of physical activity.

Conclusions: This study found benefits for both physical activity and cardiovascular fitness performed over a one year period for chronic HIV-infection. Future endeavours, including larger cohorts and longer follow up are needed to further explore factors that influence physical activity and cardiovascular fitness in HIV.