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This study aimed to review the varied 1–4 gastrointestinal (GI) system surgical outcomes among people living with Human Immunodeficiency Virus (PLWH) in the HAART-era. MEDLINE and EMBASE were searched for primary publications on GI surgery outcomes exclusively in HAART-treated HIV patients. NSQIP-reported complications (NRCs), all-cause complications (ACC) and HIV disease parameters were extracted. 12 studies met study inclusion criteria, examining bowel (4), bariatric (5), cholecystectomy (1), appendectomy (1), and other general abdominal operations (1). The NRC rate was 0%, ≥44.4% and 13.3% in bariatric, bowel and appendix surgeries, respectively. Over half of NRCs were infectious. HAART-treated patients had lower ACC, LOS, and sepsis versus untreated-HIV, and higher ACC, LOS and reoperation rates versus HIV-negative patients. HAART use is associated with markedly improved NRC outcomes post GI surgery among PLWH; however, these remained inferior to those documented among HIV uninfected individuals. •No NSQIP complications occurred in bariatric surgery HAART-treated HIV patients.•NSQIP complications in other GI surgery ranged from 19.7% to >80% in HAART patients.•HAART saw lower all-cause, stay length and sepsis complications vs untreated-HIV.•HAART saw higher all-cause complication, stay length, reoperation vs HIV-negative.•Preoperative HAART duration, CD4 and viral load characteristics varied widely.

The human immunodeficiency virus (HIV) is one of the most prevalent diseases globally. It is estimated that 37.7 million people are infected with HIV globally, and 8.2 million persons are infected with the virus in South Africa. The highly active antiretroviral therapy (HAART) involves combining various types of antiretroviral drugs that are dependent on the infected person’s viral load. HAART helps regulate the viral load and prevents its associated symptoms from progressing into acquired immune deficiency syndrome (AIDS). Despite its success in prolonging HIV-infected patients’ lifespans, the use of HAART promotes metabolic syndrome (MetS) through an inflammatory pathway, excess production of reactive oxygen species (ROS), and mitochondrial dysfunction. Interestingly, Spirulina platensis (SP), a blue-green microalgae commonly used as a traditional food by Mexican and African people, has been demonstrated to mitigate MetS by regulating oxidative and inflammatory pathways. SP is also a potent antioxidant that has been shown to exhibit immunological, anticancer, anti-inflammatory, anti-aging, antidiabetic, antibacterial, and antiviral properties. This review is aimed at highlighting the biochemical mechanism of SP with a focus on studies linking SP to the inhibition of HIV, inflammation, and oxidative stress. Further, we propose SP as a potential supplement for HIV-infected persons on lifelong HAART.

Background Although gut microbiota dysbiosis has been reported in HIV infected individuals recently, the relationship between the gut microbiota and immune activation in patients with different immune responses to highly active antiretroviral therapy (HAART) is still not well understood. Gut microbiota and immune activation were studied in 36 non-HIV-infected subjects (healthy controls) and 58 HIV-infected individuals, including 28 immunological responders (IR) and 30 immunological non-responders (INR) (≥500 and < 200 CD4+ T-cell counts/μl after 2 years of HIV-1 viral suppression respectively) without comorbidities. Results Metagenome sequencing revealed that HIV-infected immunological responders and immunological non-responders could not recover completely from the gut microbiota dysbiosis. At a 97% similarity level, the relative abundances of Fusobacterium, Ruminococcus gnavus and Megamonas were greater, whereas Faecalibacterium, Alistipes, Bifidobacterium, Eubacterium rectale and Roseburia were more depleted in the IR and INR groups than those in the healthy controls. Ruminococcaceae and Alistipes were positively correlated with nadir and current CD4+ T-cell counts, but negatively correlated with CD8 + CD57+ T-cell counts . Inflammation markers and translocation biomarkers (LPS) levels were positively correlated with the abundances of genera Ruminococcus and Fusobacterium but were negatively correlated with the genus Faecalibacterium . The relative abundances of Escherichia-Shigella and Blautia were significantly higher in the IR than those in the INR group. Escherichia-Shigella were negatively correlated with the CD4/CD8 ratio but positively correlated with the amount of C D8 + CD57+ T-cells. Roseburia and Blautia were negatively associated with nadir CD4+ T-cell and positively associated with CD8 + CD57+ T-cell counts. Conclusions Gut microbiota dysbiosis may be one of the factors contributing to different immune responses and treatment outcomes to HAART.

Longitudinal brain changes in treated and untreated individuals with primary HIV infection were examined. Before treatment, significant brain volume loss and cortical thinning were observed. After treatment, no further brain atrophy was found. This highlights the importance of early treatment. Abstract Background Human immunodeficiency virus (HIV) penetrates the brain in early infection. We used neuroimaging to longitudinally examine the impact of HIV and combination antiretroviral therapy (cART) on the brain in treated and untreated HIV-infected participants, starting in primary HIV infection (PHI). Methods Sixty-five participants, enrolled during PHI, underwent longitudinal magnetic resonance imaging, 30 of whom commenced cART during follow-up. Cross-sectional data from 16 patients with chronic HIV infection (CHI) and 19 HIV-uninfected participants were included for comparison. Brain volume and cortical thickness were estimated using tensor-based morphometry and cortical modeling, respectively. Mixed-effects models longitudinally mapped structural brain changes before and after cART. The relationship between brain morphometry estimates and blood and cerebrospinal fluid (CSF) biomarkers were also tested. Region-of-interest analyses were performed to compare brain morphometry estimates between the groups. Results Prior to cART, longer duration of untreated infection in PHI correlated with volume loss in the thalamus, caudate, and cerebellum, and with cortical thinning in the frontal and temporal lobes and cingulate cortex. After cART, no further volume loss was observed. However, small increases of cortical thickness in the frontal and temporal lobe correlated with longer cART duration. No correlations were observed with blood or CSF measures. The PHI group did not have different brain morphometric measures compared to the HIV-uninfected group, but had larger volumes in the thalamus, caudate, putamen, and cortical gray matter compared with CHI participants. Conclusions Subcortical atrophy and cortical thinning occur during untreated infection but may be arrested by cART. These findings emphasize the importance of early cART.

Background The AIDS Support Organization (TASO) Antiretroviral Program was rolled out in November 2004. The study aimed to assess adherence status of adult patients surviving for 60 months after HAART initiation in a resource poor setting. Methodology Retrospective cohort study of adult patients who initiated HAART 60 months prior to the date of data abstraction at TASO Soroti, Eastern Uganda. Participants included in the study were male and female adult (≥ 14 years) patients who initiated HAART at TASO Soroti (between 1st August 2005 to 31st March 2012). Since 2005 TASO Soroti has been providing HAART free of charge to patients either at World Health Organization (WHO) stage III or IV irrespective of CD4 cell count, or at any WHO stage with CD4 cell counts ≤ 350 cells/µl. Results Of the 4827 adults patients included in the analysis, 32.1% were male and the median age was 43 years. 67.9% were female and the median age was 41 years. 94.9% of patient were HAART naïve, 5.1% were transfer in. 3913(81.1%) of 4827 patients were still on HAART after 5 years of follow-up. 18.9% difference is attributed to lost to follow-up, patient transferred out and reported deaths. Among the patients with adherence assessment reported, 96.6% of patients had adherence level > 95%, 1.5% had adherence level of 85%–95% and 1% had adherence < 85%. 74.5% patients received their HAART refills at the CDDP, 23.8% received refills at the facility, and 1.4% received refills at their homes. Conclusions These positive results after 5 years of initiating HAART in patients with advanced HIV disease demonstrate efficacy of HAART in resource-limited settings. Additional support is required to ensure timely HAART among adults.

Background We measured the prevalence of hearing sensitivity among HIV+ and HIV- men and women and identified associated risks co-factors. Methods Audiometric testing was conducted among 262 men [median age 54.7 years; 117 (44.7% HIV+; median (25th, 75th): nadir CD4+: 296 (191, 400); viral load (VL): 40 (40.40))] from the Baltimore-DC site of the Multicenter AIDS Cohort Study and 134 women [median age 45.2 years; 105 (78.4% HIV+; median (25th, 75th): nadir CD4+: 249 (92, 367); VL: 80 (48,1270))] from the DC site of the Women’s Interagency HIV Study. Pure-tone hearing thresholds were obtained at 500, 1000, 2000, and 4000 Hz and HL was defined as a pure tone average (PTA) ≥ 20 dB hearing level in either ear. A linear mixed model with a random-subjects effect was used to account for two repeated measurements (one per ear) adjusted for age, gender, race, HIV status, and noise exposure. The HIV+ model included nadir CD4+, peak CD8+, VL, ever having AIDS, ever monotherapy (MT), ever combination therapy (CT) and ever HAART use. Results 84 (95.2% men, 4.8% women) HIV- and 90 (65.6% men, 34.4% women) HIV+ participants had HL in the poorer ear. Age was a statistically significant risk factor of HL, however HIV status and noise exposure were not. In the HIV+ model, nadir CD4+, peak CD8+, VL, ever having AIDS, and MT were not statistically significantly associated with HL. Although there was a higher PTA and a lower PTA with ever CT and HAART use neither was significantly associated with HL. Conclusions We found no impact of HIV status or treatment variables on HL. HIV-infected individuals who used HAART had a lower PTA, an indicator of better hearing sensitivity. However, due to cross-sectional design of this study, it is not known whether HAART use protects hearing sensitivity.

Background Opportunistic infections (OI) of gastrointestinal (GI) and hepatobilliary system (HB) are common in HIV infected patients. Despite highly active antiretroviral therapy (HAART) GI OI have been reported in HIV infected patients. There is paucity of data from south Asia describing occurrence of GI and HB OI in AIDS with use of HAART. Method Study population included 74 HIV infected patients (Male = 57, Female = 17) in the age group of 17 to 63 years admitted to a tertiary care referral centre in North India from January 2011 through December 2012. Only subjects who presented with GI and HB system manifestations were enrolled in the study. 74 study subjects were stratified into HAART naïve (36) and HAART experienced (38) groups according to their HAART status on admission. HIV infection was confirmed by western blot test. Gastrointestinal and hepatobilliary pathologies including OI were diagnosed and defined as per standard protocols. Results In HAART experienced group 33% and in HAART naïve group 52% patients were diagnosed with OI. Esophageal candidiasis was present in 10% patients in HAART experienced group and in 7% patients in HAART naïve group (p value > 0.05). Abdominal Tuberculosis was present in 24% patients in HAART experienced group and in 33% patients in HAART naïve group (p value > 0.05). Drug induced liver injury was present in 10 patients in HAART experienced group and in 5 patients in HAART naïve group. Conclusion In our study we conclude that Gastrointestinal and Hepatobiliary OI are equally common in patients taking HAART; especially esophageal candidiasis and abdominal tuberculosis, reasons for this include HAART resistance, drug noncompliance, immune restoration inflammatory syndrome (IRIS) and high prevalence of tuberculosis in this region.

[This corrects the article DOI: 10.3389/fmed.2022.1071431.].

Background Cytokines play an important role in controlling the homeostasis of the immune system and infection with Human Immunodeficiency virus (HIV) leads to deregulated production of both pro- and anti-inflammatory cytokines. This study was designed to determine the effects of HIV and Highly Active Antiretroviral Therapy (HAART) on the levels of pro-and anti-inflammatory cytokines in HIV infected subjects. Method A total of 50 HIV infected and 50 HIV seronegative control participants were recruited for the study. The HIV infected subjects were recruited before commencement of antiretroviral therapy and were followed up for 12 months. Blood samples were collected at 3 different points: before initiation of therapy, 6 months into therapy and 12 months into therapy. Serum cytokines were analyzed using ELISA method while CD4+ T cells and viral load counts were measured using standard laboratory methods. Result The results showed that pro-inflammatory cytokines: Tumour necrosis factor-alpha (TNF-α), Interleukin-6 (IL-6) and anti-inflammatory cytokines Interleukin-4 (IL-4), Interleukin-10 (IL-10) and Transforming growth factor-beta (TGF-β) were significantly elevated in HIV infected subjects before commencement of therapy compared to 6 months and 12 months into therapy ( P  < 0.01) and compared to control participants ( P  < 0.01). TNF-α, TGF-beta remained significantly elevated even after 12 months of therapy compared to control participants ( P  < 0.01), while IL-4, IL-6, and IL-10 showed no significant difference compared to control participants after 12 months of therapy ( P  > 0.05). INF-γ was significantly reduced before commencement of therapy and after 12 months of therapy compared to control participants ( P  < 0.05) respectively. Conclusion TNF-α and TGF-β remained significantly elevated even after 12 months of therapy, while IFN-γ remained significantly reduced after 12 months of therapy. Regulating these cytokines which were unresponsive to therapy could serve as a potential measure of therapy for HIV infected subjects. The positive effect of 12 months therapy on IL-4, IL-6 and IL-10 levels can be used to monitor disease prognosis during therapy especially in resource poor setting where regular viral load monitoring is unavailable.

Human immunodeficiency virus (HIV) infection remains an important global public health problem. About 40 million people are infected with HIV, and this infection caused about 630,000 deaths in 2022. The hallmark of HIV infection is the depletion of CD4+ T helper lymphocytes (Th cells). There are at least seven different Th subtypes, and not all are the main targets of HIV. Moreover, the effect of the virus in a specific subtype can be completely different from that of the others. Although the most compromised Th subtype in HIV infection is Th17, HIV can induce important dysregulations in other subtypes, such as follicular Th (Tfh) cells and regulatory Th cells (Treg cells or Tregs). Several studies have shown that HIV can induce an increase in the immunosuppressive activity of Tregs without causing a significant reduction in their numbers, at least in the early phase of infection. The increased activity of this Th subtype seems to play an important role in determining the immunodeficiency status of HIV-infected patients, and Tregs may represent a new target for innovative anti-HIV therapies, including the so-called “Kick and Kill” therapeutic method whose goal is the complete elimination of the virus and the healing of HIV infection. In this review, we report the most important findings on the effects of HIV on different CD4+ T cell subtypes, the molecular mechanisms by which the virus impairs the functions of these cells, and the implications for new anti-HIV therapeutic strategies.