Prevalence of hepatitis-B surface antigen among blood donors and human immunodeficiency virus-infected patients in Jos, Nigeria

Information is very scarce on the prevalence of hepatitis-B virus (HBV) infection among blood donors and patients with human immunodeficiency virus (HIV) infection in Nigeria. Hepatitis-B surface antigen (HBsAg) ELISA was used to determined the prevalence of HBsAg among 175 blood donors (aged 20-40 years) and 490 HIV-infected patients (aged 17-60 years) in Jos, Nigeria. Twenty-five (14.3%) of the blood donors and 127 (25.9%) of the HIV-infected individuals were HBsAg seropositive, indicating a higher HBV infection among HIV-infected persons than among healthy blood donors. A slightly higher HBsAg seroprevalence was recorded in the males (14.6%) than females (12.9%) of the blood donors. Among the HIV-infected patients, the males had considerably higher HBsAg seroprevalence than the females (31.8 vs 22.1%) with the highest prevalence of HBsAg occurring in the 51-60 years age group (44%), followed by those of 31-40 years (28.2%). Results confirmed the high endemicity of HBV infection in Jos, Nigeria and the significantly greater prevalence of HBV infection among HIV-infected patients than among blood donors.     

Secondary diseases in HIV-infected patients

During the period of 1980-1996 the dispensary observation of 50 HIV-infected patients was carried out. The clinical forms of the infection were distributed among these patients as follows: asymptomatic forms in 18 patients, persisting generalized lymphadenopathy in 8 patients, pre-AIDS in 14 patients, AIDS in 10 patients. Secondary infections were registered at the pre-AIDS stage. Dermatoses, oropharyngeal candidiasis occurred most frequently: in 52% of the HIV-infected patients. Herpes virus infection was registered in 46% of the patients. At the stage of AIDS during the generalized herpes virus and cytomegalovirus infections were registered in 5 and 7 patients respectively. Generalized forms of combined infections (herpes virus + fungi) prevailed, which caused the death of 7 patients at the terminal stage of AIDS.     

HIV infection in Russia in 1998

The statistic information about the distribution of HIV-infected persons in 1998 in different regions of Russian Federation was presented 3169 new cases of HIV-infected persons of Russia registered by 11.5 months in 1998. This are only 82.2% cases in comparison of cases (3856) which registered in 1997. The total number HIV-infected persons registered by 1st of January 1987-16th of November 1998 was 10,193, among them 431 children. 112 children were infected during period of mother's pregnancy and parturitions.     

Emergency measures to control the spread of diseases caused by the human immunodeficiency virus

Since the middle of 1996 the growth of HIV-infected persons and AIDS morbidity are registered in Russia. In 1997 4,300 new cases of HIV infection were registered, which exceeded 1.6 times the total number of cases for the period of 1987-1996. The highest morbidity rate was observed in the cities of the European part of Russia: Kaliningrad (west), Krasnodar and Rostov-on-Don (south), Nizhny Novgorod and Moscow (center). AIDS patients and HIV-infected persons were registered in 73 out of 89 regions of the country. 90% of HIV-infected persons were drug users in 1997. In 1992-1997 the number of drug addicts increased 3.5 fold and young women in 1987-1997, 6.5 fold. 71 HIV-infected children were registered were born from HIV-infected mothers at present time. The article deals with the main provisions of the federal laws aimed at the prevention of the spread of HIV infection in Russia and characterizes scientific research on AIDS. Evidence is presented that the early detection of HIV-infected persons, as well as rendering timely medical and social assistance to such persons, makes it possible to increase their mean survival time and check the spread of human immunodeficiency virus.     

Children, adolescents and HIV infection

The analysis of the occurrence of HIV infection in adults, children and adolescents under 18 years of age on the basis of statistical data by February 1, 1997, is presented. The total number HIV-infected persons registered by this date was 6,232; among them 902 (14.5%) were children and adolescents. 267 children were infected in the hospital focus of HIV infection; of these, 80 children (30%) died of AIDS during the period of 1989-1997. In 1992 only 16 adolescents, HIV infected were registered, while in 1995 the number of HIV-infected adolescents was 34, in 1996 their number rose to 144 and in 1997, to 435. The main cause of adolescent infections (80%) was the intravenous injection of narcotic drugs.     

Association of Candida albicans fungi with some opportunistic microorganisms in intestinal dysbiosis in patients of different age groups

The occurrence of C. albicans in association with opportunistic microorganisms (Staphylococcus aureus and Klebsiella) in intestinal dysbiosis in patents of different age groups (from 6 days to 31 years) was analyzed. The data on the comparative evaluation of the results of the bacteriological examination of patients with intestinal dysbiosis, carried out during the periods of 2000-2001 and 2001-2002 (388 and 467 patients respectively), are presented. During the period of 2000-2001 the detection rate of C. albicans in monoculture was 6-33% of cases (in the examined group). A higher detection rate was registered with respect to the association of C. albicans with staphylococci (42-65% of cases). The associations of C. albicans with staphylococci and Klebsiella were observed in 13-46% of cases. Similar results were registered during the period of 2001-2002, but during this period a reliable decrease in the detection rate of the association of C. albicans with staphylococci (practically by 20% in the group of infants) and the 1 1/2-fold increase of the detection rate of C. albicans in monooulture (in all age groups) were observed.     

Development of HIV infection epidemic among intravenous drug users in the Sverdlovsky region

The Sverdlovsky region takes the fourth place among the 89 subjects of the Russian Federation by the number of registered cases of HIV infection. Drug addiction has reached an excessive scale in this region: according to the data of express evaluation carried out by the Regional Narcological Hospital and the Regional AIDS Center, not less than 7-8% of persons aged 15-30 years constantly use injection drugs. The large-scale epidemic of injection drug addiction has led to the rapid spread of HIV among addicts. The first penetration of HIV into this population took place in 1996 and, starting from the year 2000, rapid, development of the epidemic began, taking the character of an avalanche. The peak of new cases of HIV infection fell on 2001 (9,230 cases were registered). The concentrated stage of the epidemic development is observed in the region at present, the prevalence of HIV infection among drug addicts being 13.8%. Children born from HIV-infected drug addicted mothers now represent a new risk group due to great difficulties in the prophylaxis of the vertical virus transmission.     

Tuberculosis and Hepatic Steatosis Are Prevalent Liver Pathology Findings among HIV-Infected Patients in South Africa

Liver disease epidemiology in sub-Saharan Africa has shifted as a result of HIV and the increased use of antiretroviral therapy leading to a need for updated data on common causes of liver disease. We retrospectively reviewed records from all hospitalized patients who had liver biopsy at a single hospital in South Africa from 2001 to 2009 and compared diagnosis by HIV status. During the period of study 262 patients had liver biopsy, 108 (41%) were HIV-infected, 25 (10%) were HIV-sero-negative, and 129 (49%) had unknown or unrecorded HIV status. Overall 81% of biopsies provided additional diagnostic data. Malignancy was the most common finding reported on 56 (21%) biopsies followed by granuloma or TB, hepatic steatosis, and fibrosis or cirrhosis. HIV-infected patients were more likely to have granulomas and steatosis. Half of patients with granulomas were already on TB treatment, suggesting paradoxical reactions or drug induced liver injury may have been important causes of liver inflammation among these patients. We note that TB, paradoxical reactions during TB treatment, possible drug induced liver injury, and hepatic steatosis are important causes of liver pathology among HIV-infected hospitalized patients with unclear etiology of liver disease after initial assessment. Among HIV sero-negative patients, malignancy was the major cause of liver disease. Our findings re-enforce the importance of TB as a diagnosis among HIV-infected individuals.     

Seroprevalence of herpes simplex virus type 2 in adult HIV-infected patients and blood donors in Croatia

The present study estimates herpes simplex virus type 2 (HSV-2) seroprevalence and evaluates its association with age, sex, human herpesvirus type 8 (HHV-8) and human immunodeficiency virus (HIV) among adults in Croatia. A cross-sectional survey included 166 HIV-infected patients and 219 blood donors. Antibodies against HSV-2 were determined by enzyme immunoassays based on gG2 recombinant glycoprotein. HSV-2 seroprevalence was 45.8% in HIV-infected patients and 8.7% in blood donors (p < 0.0001; OR 8.8; 95% CI 5.05-15.49). Independent predictors of HSV-2 seropositivity were HIV infection (OR 11.0; 95% CI 5.93-20.41), female gender (OR 2.28; 95% CI 1.22-4.26), older age (OR 3.93; 95% CI 2.74-7.11), and HHV-8 seropositivity (OR 2.72; 95% CI 1.09-6.75). Understanding the epidemiology of HSV-2 is a critical first step in designing interventions to decrease HSV-2 and HIV transmission. The association of HSV-2 with HIV infection and HHV-8 antibodies suggests a similar transmission route.     

HIV infection in children perinatally infected

During the period from 1987 to the middle of 1996 only 20 children were born of HIV-infected women, while during the following 1.5 years the number of such children were 59, the maximum number of seropositive children being registered in Kaliningrad and the Kaliningrad region, in the Krasnodar Territory, Stavropol and Nizhny Novgorod (altogether 46 children). Out of 79 children born of HIV-infected mothers during the whole period of the epidemic, 8 children died. Out of the children born before 1995 who remained alive, 9 children were struck off the register after 3 years of observation due to the absence of HIV infection. By the end of 1997 63 children were registered, the majority of them born in 1996-1997.     

The organization of the work to determine antibodies to the human immunodeficiency virus in the Republic of Byelarus

The study revealed that the method of mass screening for the detection of antibodies to HIV antigen, carried out in the Republic till 1993, proved to be economically and diagnostically unjustified. Starting from 1993, the work on the step-by-step reduction of groups to be tested for the presence of antibodies to HIV began. At the same time from 1997 the proportion of tested donors of blood, organs and tissues, as well as persons belonging to high risk groups, increased in comparison with 1993 (from 23.3% to 40% and from 5.3% to 21% respectively). Voluntary and anonymous testing for the presence of HIV infection was organized and legally introduced. In comparison with 1991, in 1997 the number of persons who voluntarily underwent testing increased 3.7 times. The period of transition from mass screening to selective one was noted to have no effect on the detection of HIV-infected persons. Since 1995 the method of "patrol" epidemiological surveillance was also used. 2,118 persons underwent testing, the results of screening were negative. During the period of 3 years the testing of 12,547 young people called up for military service revealed 28 seropositive persons in the region where an outbreak of HIV infection had been registered among addicts using drugs intravenously.     

Content of ceruloplasmin and immunoglobulins of the main classes in the blood sera of patients with herpes virus infection

In 35 patients with herpes virus infection (males and females aged 25 to 45 years) the content of ceruloplasmin and immunoglobulins of the main classes in the blood sera and the content of IgA in saliva at the stages of exacerbation and remission were evaluated. For control, a group of 35 healthy donors of the same ages were used. In patients with relapsing herpes virus infection even at the period of remission reliably higher levels of ceruloplasmin and immunoglobulins of the main classes were registered in comparison with those in the group of healthy donors. This was indicative of the fact that constant antigenic load caused by virus persistence and, in our opinion, could be regarded as a sign of unfavorable prognosis. At the periods of exacerbation a reliable increased level of secretory IgA was registered in a group of patients with rare relapses of herpes virus infection in comparison with a group of patients with frequent relapses, which showed that patients with rare relapses had a better immune response.     

Diphtheria morbidity in Russia today

The data on diphtheria morbidity and the occurrence of carrier state for its causative agent at the period of 2001-2002 were analyzed. The rates of morbidity and detected carrier state for these years were 0.63-0.55 and 0.65-0.64 respectively. Nevertheless, in spite of the relatively low morbidity rates the presence of the toxic forms of diphtheria (400 patients for two years) and lethal cases (with lethality rate reaching 5.4%) indicated that the epidemic situation in diphtheria remained tense. The most unfavorable situation was observed in the North-Western and Central regions of Russia. In urban areas morbidity rates were still 2- to 3-fold higher in than in rural ones, but the latter showed a higher percentage of severe cases (46.6% in 2001 and 39.7% in 2002) and lethal outcomes (13.6% and 19.2%). The latter was indicative of drawbacks in the immunoprophylaxis, diagnostics and treatment of diphtheria in rural areas. In the total structure of diphtheria patients adults prevailed: 75%. The highest morbidity rates were registered among children aged 3-6 years, among adults in the age groups of 18-19 years and 50-59 years. The epidemic process developed mainly among the immunized population, which was indicated by a high proportion of vaccinated persons among those affected by this infection (62.8-66.6%) and a mild course of the disease in the majority of them. The present epidemiological situation in diphtheria was determined by patients not vaccinated against this infection. The proportion of severe cases among nonvaccinated children was 42.4-51.6% and lethal outcomes, 12.9-15.1%. Among nonimmunized adults these figures were equal to 43.1% and 9.3% respectively. The highest percentage of children, not vaccinated during the first years of their life, was registered among those in the asocial families, refugees and homeless persons. Among adults these were persons above 50 years old, as well as jobless persons of working age, pensioners and invalids, who had limited possibilities of undergoing vaccination due to their social position. It was these social and age groups that should be regarded as risk groups with respect to the severity of the course of diphtheria and lethality. To stabilize diphtheria morbidity, the full complex of prophylactic and antiepidemic measures, and primarily the immunization of the population, should be systematically carried out.     

Epidemiological pattern of scarlet fever in recent years

During the period of 1953-2001 scarlet fever morbidity level fluctuated from 670.3 to 65.9 per 100,000 of the population in Moscow and from 531.9 to 35.0 per 100,000 of the population of the Russian Federation. In recent years an increased morbidity was more pronounced in Moscow than in the Russian Federation as a whole. Children formed the greater part of scarlet fever patients, the cases of scarlet fever among children in Moscow occurring more often than, on the average, in Russia. As before, annual morbidity among children attending children's institutions was higher 3- to 4-fold than among children brought up at home. This difference was most sharply pronounced among young children during the first two years of their life. In contrast to morbidity observed during previous 20-30 years, a drop in morbidity among children during the first two years of their life was registered, while morbidity level among children aged 3-6 years and 7-14 years increased. Scarlet fever morbidity had a pronounced seasonal (autumn-winter) pattern. In a group of children aged 3-5 years who attended organized groups, on the average, 78.6% of scarlet fever cases fell on seasonal morbidity, the most prolonged one.     

Analysis of structure and causes of mortality of HIV-infected in Volga Federal District in 2005 - 2010

Among with morbidity and affection, mortality is an objective indicator of HIV-infection epidemic process intensity. Dynamics of mortality of HIV-infected in Volga Federal District (VFD) in 2005 - 2010, distribution of deceased by disease stage, period of start and coverage by antiretroviral therapy were studied based on approved statistical forms and additional collected data, the leading causes of death were revealed, comparative analysis with population of HIV-infected in penitentiary system institutions was performed. All-cause mortality was established to have dynamics of growth in HIV-infected population in VFD in 2005 - 2010, at the same time HIV-infection mortality has a certain tendency of stabilization after 2007 with subsequent decline in 2010, that apparently is related to wide use of combined antiretroviral therapy. HIV-infection mortality among HIV-infected in penitentiary system of the district is significantly higher than mortality in the general population of HIV-infected in VFD. The leading cause of death in HIV-infection is tuberculosis.     

Leishmania-HIV Co-infection: Clinical Presentation and Outcomes in an Urban Area in Brazil

BackgroundVisceral leishmaniasis (VL) is an emerging condition affecting HIV-infected patients living in Latin America, particularly in Brazil. Leishmania-HIV coinfection represents a challenging diagnosis because the clinical picture of VL is similar to that of other disseminated opportunistic diseases. Additionally, coinfection is related to treatment failure, relapse and high mortality.ObjectiveTo assess the clinical-laboratory profile and outcomes of VL-HIV-coinfected patients using a group of non HIV-infected patients diagnosed with VL during the same period as a comparator.MethodsThe study was conducted at a reference center for infectious diseases in Brazil. All patients with suspected VL were evaluated in an ongoing cohort study. Confirmed cases were divided into two groups: with and without HIV coinfection. Patients were treated according to the current guidelines of the Ministry of Health of Brazil, which considers antimony as the first-choice therapy for non HIV-infected patients and recommends amphotericin B for HIV-infected patients. After treatment, all patients with CD4 counts below 350 cells/mm³ received secondary prophylaxis with amphotericin B.ResultsBetween 2011 and 2013, 168 patients with suspected VL were evaluated, of whom 90 were confirmed to have VL. In total, 51% were HIV coinfected patients (46 patients). HIV-infected patients had a lower rate of fever and splenomegaly compared with immunocompetent patients. The VL relapse rate in 6 months was 37% among HIV-infected patients, despite receiving secondary prophylaxis. The overall case-fatality rate was 6.6% (4 deaths in the HIV-infected group versus 2 deaths in the non HIV-infected group). The main risk factors for a poor outcome at 6 months after the end of treatment were HIV infection, bleeding and a previous VL episode.ConclusionAlthough VL mortality rates among HIV-infected individuals are close to those observed among immunocompetent patients treated with amphotericin B, HIV coinfection is related to a low clinical response and high relapse rates within 6 months.     

Characteristics of clinical isolates of Mycobacterium tuberculosis using molecular biological methods

A total of 230 clinically drug-resistant and 3 drug-sensitive isolates of M. tuberculosis obtained from patients in Tula and Tula region in 1998-2001 were studied. The RFLP-IS6110 genotyping showed that 52 (30.2%) of isolates had unique patterns, and 120 (69.8%) of them were grouped to form 16 clusters. 95 (55.2%) and 53 (30.8%) of isolates were attributed to groups A1 and W (Beijing), respectively. Double mycobacterium cultures were detected in 4.1% of isolates. 2 to 4 clinical isolates were obtained from each of 55 patients during 1.5 years. A replacement of mycobacterium isolates was registered in the course of treatment in 12 (21.8%) patients. No replacement of clinical isolates occurred in 43 (78.2%) patients during the whole follow-up period. Repeatedly obtained isolates acquired the determinants of drug-resistance in 5 (11.6%) patients. Changes in the quantity of IS6110 elements were registered only in 1.05% of isolates during a 3-year follow-up.     

The detection of viral hepatitis markers in HIV-infected patients

The determination of markers of virus hepatitides B, C and D in 63 registered HIV-infected persons was made. The use of Russian and foreign EIA systems permitted the detection of markers of virus hepatitides 30.1% of HIV-infected persons, including 26.3% of children. Markers of hepatitis B virus were found to occur in children and adults with the same frequency. Out of 65 persons registered in the Center, 3 persons (4.6%) were drug addicts; of these, 2 were found to have antibodies to antigens of hepatitis viruses. Such persons constituted 3.8% of the total number of HIV-infected persons. Among 8 newly detected and registered HIV-infected adults, 2 were found to have antibodies to hepatitis B virus (of these, 1 used drugs intravenously).     

T cell recognition of HIV synthetic peptides in a natural infection

Because T cell responses are critical for defense against viral infections, a series of synthetic peptides derived from the predicted sequence for HIV-1 proteins gp41, pg120, gag, and viral polymerase were used to test the T cell proliferative response of HIV-1 seropositive individuals. Of HIV-1-infected donors from various clinical categories 90% (27/30) had sensitized cells that proliferated in response to at least one of 21 HIV peptides tested. Cells from HIV seronegative controls did not proliferate (0/9) in response to these HIV peptides. Individuals with fewer clinical manifestations of HIV-1 disease responded to a greater number of peptides (average for asymptomatic seropositives = 8.1 peptides; AIDS patients averaged 2.0). The number of peptides recognized also correlated with absolute number of CD4+ cells, but not with delayed cutaneous hypersensitivity to a (non-HIV) battery of Ag. However, clinical stage at no time correlated with the response to any particular peptide. Response patterns differed considerably among individuals, and some peptides stimulated proliferation in many (48%) HIV-infected donors (peptides gp41-2 and pol-3), whereas another peptide elicited no T cell response in any donor tested (peptide gp120-8). We have also begun to investigate the basis for individual heterogeneity of T lymphocyte proliferative responses of HIV-infected donors to the 21 HIV synthetic peptides. Peptide structure and HLA class II determinants both influenced patterns of lymphocyte responses. Reactivity correlated with peptide size, the presence of alpha and beta secondary structure and lack of reverse turn potential. Hydropathy and charge had no predictive value. Peptides derived from HIV sequences that vary highly among strains tended to be recognized less frequently. HIV-infected lymphocyte donors were HLA typed to examine the influence of the MHC on T lymphocyte proliferation. Analysis of the frequencies of individuals reacting to specific peptides, when compared to the allele frequencies in the population at large, indicated association of some responses to DR alleles. More DR association was observed with peptides that showed "moderate" reactivity than with those that were "highly" reactive. We suggest that highly reactive peptides are capable of forming a structure closer to an "ideal" T cell epitope that can associate with many DR alleles. In contrast, "moderately" reactive determinants have less favorable structures for interaction, are more limited in their ability to interact and therefore show more restriction to specific class II alleles.