Phototherapy effect on CD4 lymphocytes of Full Term Neonates with Jaundice

Background Neonatal jaundice is one of the most common problems that affect newborn infants, and phototherapy is usually used for treatment. Phototherapy is generally considered a very safe and well-tolerated treatment for hyperbilirubinaemia. However, clinical users should be aware of the unwanted effects of using phototherapy. Affection of neonatal immune system due to phototherapy has been reported. Objectives Evaluation of the effect of phototherapy on neonatal immune system through measuring the level of CD4+ lymphocytes. Methods A prospective cohort study was conducted on full term newborns assigned to three groups: group1 neonates with hyperbilirubinemia treated by conventional phototherapy, group2 neonates treated by LED phototherapy and healthy neonates as control group. The percentages and absolute counts ofCD4+ lymphocytes were measured by flow cytometry before phototherapy and 48 h after exposure. Results The study showed a significant decrease in CD4+ percentage in patients after 48 h of exposure to conventional phototherapy (P value < 0.05). There was a significant decrease in CD4+ absolute counts after 48 h of exposure to both types of phototherapy. Conclusion Conventional and LED phototherapy which is used in the treatment of neonatal hyperbilirubinemia, caused a decrease in CD4+ absolute count 48 hours after phototherapy. Also conventional phototherapy caused a decrease in CD4+% 48 hours after exposure.

Korelasi Antara Jumlah Cd4 Dengan Global Longitudinal Strain Ventrikel Kiri Pada Penderita Human Immunodeficiency Virus

Latar Belakang: Jumlah CD4 merupakan parameter penting pada penderita HIV dan berhubungan dengan peningkatan risiko disfungsi sistolik. Hingga saat ini, korelasi antara jumlah CD4 dengan parameter global longitudinal strain (GLS) sebagai indikator fungsi sistolik subklinis masih belum jelas. Metode: Penelitian ini merupakan studi observasional dengan metode belah lintang. GLS ventrikel kiri diperiksa menggunakan ekokardiografi dua dimensi. Jumlah CD4 baseline dan nadir diperoleh dari rekam medis sedangkan jumlah CD4 aktual dan CD4 percentage (CD4%) diperiksa menggunakan metode flow cytometry. Hasil: Total 37 pasien HIV asimptomatik mengikuti penelitian dengan rerata umur 31,95± 7,54 tahun dan median durasi penggunaan ARV adalah 34 bulan. Median CD4 baseline dan CD4 nadir adalah 272 sel/uL dan 223 sel/uL, sedangkan rerata CD4 aktual dan CD4% adalah 516,08±252,03 sel/uL dan 19,66±7,97 %. Semua subyek penelitian memiliki fungsi sistolik normal. Rerata GLS ventrikel kiri adalah 17,02±0,71. GLS ventrikel kiri berkorelasi positif dengan CD4 aktual (r=0,43; p=0,008) dan CD4% (r=0,349; p=0,034). Penderita HIV dengan jumlah CD4 aktual ?400 sel/uL memiliki GLS ventrikel kiri yang lebih baik dibandingkan dengan yang <400 sel/uL (p=0,022). Kesimpulan: Jumlah CD4, terutama CD4 aktual dan CD4 percentage berkorelasi dengan disfungsi sistolik subklinis yang diukur dengan global longitudinal strain pada penderita HIV asimtomatik. Hal ini mungkin dapat menjelaskan peran CD4 terhadap patogenesis gagal jantung pada penderita HIV.

Effectiveness and safety of first-line antiretroviral regimens in clinical practice: a multicentre cohort study

Objectives We compared 48 week effectiveness and safety of first-line antiretroviral regimens. Methods We analysed HIV treatment-naive adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) starting the most commonly used antiretroviral regimens from 2014 to 2018. We used multivariable regression models to assess the impact of initial regimen on: (i) viral suppression (VS) (viral load &lt;50 copies/mL); (ii) change in CD4 cell count; (iii) CD4/CD8 normalization (&gt;0.4 and &gt;1); (iv) CD4 percentage normalization (&gt;29%); (v) multiple T-cell marker recovery (MTMR: CD4 &gt; 500 cells/mm3 plus CD4 percentage &gt;29% plus CD4/CD8 &gt; 1); (vi) lipid, creatinine and transaminase changes; and (vii) discontinuations due to adverse events (AE). Results Among 3945 individuals analysed, the most frequently prescribed regimens were ABC/3TC/DTG (34.0%), TAF/FTC/EVG/CBT (17.2%), TDF/FTC + DTG (11.9%), TDF/FTC/EVG/CBT (11.7%), TDF/FTC/RPV (11.5%), TDF/FTC + bDRV (8.3%) and TDF/FTC + RAL (5.3%). At 48 weeks, 89.7% of individuals achieved VS with no significant differences by initial regimen. CD4 mean increase was 257.8 (249.3; 266.2) cells/mm3, and it was lower with TAF/FTC/EVG/CBT and TDF/FTC/RPV compared with ABC/3TC/DTG. CD4 percentage normalization was less likely with TAF/FTC/EVG/CBT, and MTMR was less likely with TAF/FTC/EVG/CBT and TDF/FTC + RAL. The proportion of discontinuations due to AE was higher with TDF/FTC + bDRV (9.7%), followed by TDF/FTC/EVG/CBT (9.5%) and TDF/FTC + DTG (7.9%). Compared with ABC/3TC/DTG, cholesterol and LDL mean increases were higher with TAF/FTC/EVG/CBT and lower with TDF/FTC + DTG, TDF/FTC/RPV and TDF/FTC + RAL. Higher mean increases in triglycerides were significantly associated with TAF/FTC/EVG/CBT. Regimens containing DTG showed higher creatinine increases. Conclusions The significantly greater immunological response and safety of some combinations may be useful for making decisions when initiating treatment.

Assessment of two POC technologies for CD4 count in Morocco

Background : In the era of “test and treat strategy”, CD4 testing remains an important tool for monitoring HIV-infected individuals. Since conventional methods of CD4 count measurement are costly and cumbersome, POC CD4 counting technique are more affordable and practical for countries with limited resources. Before introducing such methods in Morocco, we decided to assess their reliability. Methods : in this study 92 blood samples from HIV-infected patients, were tested by PIMA to generate absolute CD4 count and by FACSPresto to derive percentage and absolute CD4 count. Flow cytometry using FacsCalibur, was used as reference method for CD4 count comparison. Linear regression, Bland and Altman analysis were performed to assess correlation and agreement between POC methods and the reference method. In addition, sensibility and specificity, positive predictive value (PPV), negative predictive value (NPV) at 350 CD4 count threshold were also determined. Finally, because FACSPresto can also measure hemoglobin (Hb) concentration, 52 samples were used to compare FACSPresto against an automated hematology analyzer. Results : With PIMA technology, the coefficient of determination R 2 was 0.93. Regarding FACSPresto, R 2 was 0.93 and 0.96for absolute CD4 count and percentage CD4 count, respectively. Bland and Altman analysis displayed a mean bias of -32.3 cells/µl with a limit of agreement (LOA): -181.3 to116.8, for Pima. The mean bias for FACSPresto was -8.1 cells/µl with LOA:-158.2 to 142.0for absolute CD4 count and 0.2 with LOA:-3.8 to 4.3, for CD4 percentage. Moreover, with a threshold of 350 CD4 count, sensibility, specificity, PPV, NPV, were 98%, 87%, 89%, 86%, and 88%, 96%,93% and 92% for PIMA and FACSPresto, respectively. Finally, the hemoglobin measurement evaluation displayed an R 2 of 0.80 and a mean bias of-0.12 with a LOA between -1.75 and 1.51. Conclusion : When compared to the reference method, PIMA and FACSPresto have shown good performance, for CD4 counting. The introduction of such POC technology will speed up the uptake of patients in the continuum of HIV care, in our country.

HIV RNA, CD4+ Percentage, and Risk of Hepatocellular Carcinoma by Cirrhosis Status

Background Despite increasing incidence of hepatocellular carcinoma (HCC) among HIV-infected patients, it remains unclear if HIV-related factors contribute to development of HCC. We examined if higher or prolonged HIV viremia and lower CD4+ cell percentage were associated with HCC. Methods We conducted a cohort study of HIV-infected individuals who had HIV RNA, CD4+, and CD8+ cell counts and percentages assessed in the Veterans Aging Cohort Study (1999–2015). HCC was ascertained using Veterans Health Administration cancer registries and electronic records. Cox regression was used to determine hazard ratios (HR, 95% confidence interval [CI]) of HCC associated with higher current HIV RNA, longer duration of detectable HIV viremia (≥500 copies/mL), and current CD4+ cell percentage less than 14%, adjusting for traditional HCC risk factors. Analyses were stratified by previously validated diagnoses of cirrhosis prior to start of follow-up. Results Among 35 659 HIV-infected patients, 302 (0.8%) developed HCC over 281 441 person-years (incidence rate = 107.3 per 100 000 person-years). Among patients without baseline cirrhosis, higher HIV RNA (HR = 1.25, 95% CI = 1.12 to 1.40, per 1.0 log10 copies/mL) and 12 or more months of detectable HIV (HR = 1.47, 95% CI = 1.02 to 2.11) were independently associated with higher risk of HCC. CD4+ percentage less than 14% was not associated with HCC in any model. Hepatitis C coinfection was a statistically significant predictor of HCC regardless of baseline cirrhosis status. Conclusion Among HIV-infected patients without baseline cirrhosis, higher HIV RNA and longer duration of HIV viremia increased risk of HCC, independent of traditional HCC risk factors. This is the strongest evidence to date that HIV viremia contributes to risk of HCC in this group.

Opportunistic Infections in HIV Infection

An infection is defined as opportunistic when it affects those with severe immunosuppression, i.e. takes a n opportunity to cause disease in a host with a weakened immune system. In people living with HIV it mainly affects those with a CD4 count < 200 although it is not impossible in those with CD4 count > 200. The CD4 percentage is also important as those with a CD4% < 14 are also more likely to have an OI. The lower the CD4 count the higher the risk of OIs, and some OIs are seen much more commonly with very low CD4 counts, e.g. cryptococcal meningitis in those with CD4 count of < 100. Before the introduction of antiretroviral therapy OIs were much more common than they are now, with previously up to 80% of those with AIDS having pneumocystis pneumonia (PCP). Since the introduction of antiretrovirals (ARVs) the rates of OIs has reduced greatly but unfortunately there are people who are still diagnosed late with an OI at diagnosis. Those with poor adherence or difficulty accessing ARVs are also more likely to be affected. In the UK in 2014, 40% of people diagnosed with HIV had a CD4 count of <350 which is defined as a late diagnosis (and 22% had a CD4 count of <200 which is defined as a very late diagnosis). In comparison to someone diagnosed with HIV early, those who are diagnosed late have a 10 times higher risk of dying in the year after they are diagnosed. This highlights the need for routine HIV testing so that people are diagnosed early to reduce the incidence of OIs further. The most common OIs seen in the UK are pneumocystis pneumonia (PCP), central nervous system (CNS) toxoplasmosis, cryptococcal meningitis, cytomegalovirus (CMV) retinitis, Mycobacterium avium intracellulare (MAI) infection and candidiasis. All those with HIV and a CD4 count ≤ 200, or with a CD4% < 14 should be given prophylaxis against PCP. Prophylaxis should also be recommended for those with oral candidiasis or a previous AIDs – defining illness. The options are co-trimoxazole 480mg od or 960mg 3x/week (960mg once daily can be given although does not confer any greater protection and has increased risk of side effects), dapsone 50mg once daily, or pentamidine nebulisers 300mg once every 4 weeks.

Sleep Profile and Self-Reported Neuropsychiatric Symptoms in Vertically HIV-Infected Adolescents on cART

Background Sleep quality (SQ) data in human immunodeficiency virus (HIV) pediatric population are scarce. Our main objective was to assess SQ in our cohort and to determine the impact of antiretroviral therapy (ART) on sleep in a cohort of HIV-infected adolescents on cART. Materials and Methods The SQ was assessed through the Pittsburgh Sleep Quality Index (PSQI). Neuropsychiatric symptoms (NS) were recorded using an auto-administered questionnaire. To determine the antiretroviral (ARV) impact of efavirenz (EFV) on SQ, patients on EFV versus protease inhibitors-based regimens were compared. Results Forty-six patients were evaluated (median age: 16 years, interquartile range [IQR]: 10.8, 17)). Age at the start of ART: 1.3 years (0.4, 5.2); 23.9% showed acquired immunodeficiency syndrome (AIDS) category. Median CD4 at baseline was 656 (550, 808) cells/mm3; 91.3% had viral load <50 copies/mL. Median time on cART was 11.3 years (7.5, 15.2). Fifty-two percent of the patients were on EFV-based regimen. No differences were found in clinical and immunovirological variables although patients on EFV were older and were exposed for a longer time to ARV. Poor SQ was found in 26.1% of patients. Most frequent complaints were: sleep disturbances (76.1%), sleep latency (63%), and daytime dysfunction (54.3%). Similarly, there were no significant differences in NS between both treatment groups according to patients' reports but were significantly more common in bad sleepers. Patients on EFV-based regimen were more likely to repeat one or more school grades after the adjustment for age at evaluation and nadir CD4 percentage (odds ratio [OR]: 14.421, confidence interval [CI] 95%: 1.207–172.249, p = 0.035). Conclusions Sleep complaints and NS are common among our cohort of HIV adolescents on long-term cART and interestingly, not only in those who were receiving EFV.

Seroprevalence of HCMV among Pregnant Women and Its relation to CD4 and CRP

The HCMV is a widespread viral pathogen characterized by strict host specificity and is limited to humans. It has been described as an important etiological agent of intrauterine infection in during the pregnancy, which may lead to some serious results such as miscarriage, cerebellar malformation stillbirth, and fetus developmental retardation. The study carried out in Kirkuk governorate from the December 2017 to May 2018 for study the relation of CD4 percentage and CRP with HCMV seropositive pregnant women. The number of pregnant women under study was two hundred women attending to some private medical laboratories in Kirkuk. The pregnant women were examined for the seroprevalence of HCMV IgM and IgG antibodies by using VIDAS technique. The results were (81 %), (9%) and (6%) for HCMV-IgG, HCMV-IgM and for both IgG & IgM at the same time respectively. The highest rates (41.66%) of decreased CD4 percentage were within seropositive pregnant women for both IgG & IgM at same time, while the highest rates (16.66%)of CRP positive were found within HCMV-IgM seropositive group.