Search

Introduction. Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) are two major causes of death worldwide. These two viruses share routes of transmission, and therefore, HIV–HBV coinfection is common and is associated with low plasma levels of CD4 T lymphocytes and accelerated liver disease progression. Maternal HIV and HBV infections have been individually associated with preterm birth and low birth weight. Case presentation. We describe the case of a 28-year-old patient, 14 weeks pregnant, asymptomatic, who performed Elisa-HIV 1,2 test within prenatal screening, with a positive result, in 2018. From the medical history, we mention that the patient is known for about 5 years with HBV-hepatitis D virus coinfection, for which she underwent interferon treatment for a year. ART was initiated after one month with lamivudine / zidovudine + lopinavir / ritonavir. The patient was adherent to ART (adherence ≥ 95%) during pregnancy. Before birth, the immunovirological evaluation revealed the suppression of maternal HIV viral load, a moderate degree of immunosuppression and undetectable HBV-DNA. The patient gave birth by caesarean section to a female child, with a gestational age of 36 weeks, birth weight of 1730 g, lenght = 43 cm, head circumference = 30 cm, APGAR score = 8 points. The child received antiretroviral prophylaxis with retrovir+epivir, human hepatitis B immunoglobulin and was vaccinated against hepatitis B. The newborn was not vertically infected with HIV and HBV. Conclusions. Good adherence to ART during pregnancy has been associated with HIV viral load and HBV-DNA suppression and it led to the birth of a child who has not been infected with HIV or HBV. Maternal HIV-HBV coinfection was a significant risk factor for preterm birth and low birth weight.

Introduction. Kaposi's sarcoma (KS) is a multicentric vascular neoplasia typically occurring in the context of immunodeficiency. Although the incidence of HIV-related KS has dramatically decreased and the prognosis improved due to the combined antiretroviral therapy (cART), KS remains an important cause of morbidity and mortality among people living with HIV. Case presentation. We describe the case of a-34-year-old patient from an urban area, who is admitted in the Dermatology Clinic from Emergency Clinical County Hospital Craiova reporting a 3-years history of painful infiltrated plaques on the left hand, in the groin area and on the left lower limb. Among the biological investigations ELISA test-HIV1,2 is performed, with a positive result so the patient is transferred to the HIV/ AIDS Department - „Victor Babes“ Clinical Hospital of Infectious Diseases and Pneumoftiziology Craiova. The patient underwent treatment with: antiretrovirals, antibiotics, antifungals, anticoagulants, vasodilators and symptomatic drugs. During hospitalization, the patient also developed violaceous lesions in the oral cavity, on the right foot and on the left ear lobe. Skin biopsy was performed and the histopathological examination confirmed the clinical suspicion of KS. The oncological treatment was initiated after about 2 months and the evolution of the patient has been favorable, with remission of mucocutaneous lesions more than 50%. Conclusions. Persistent skin lesions in a young patient can be an indicator marker for AIDS and the delayed HIV diagnosis may influence the prognosis.

Objectives. To assess the level of adherence to combined antiretroviral therapy (cART) among pregnant women infected with HIV-1 in early childhood, registered in Craiova Regional Center for Monitoring and Evaluation of HIV / AIDS within „Victor Babes” Clinical Hospital of Infectious Diseases and Pneumoftiziology of Craiova (CRC) and to identify the main factors associated with non-adherence. Material and method. Retrospective study, during January 1st 2014 and December 31st 2019, with the analysis of the data mentioned in the medical records for the HIV-positive pregnant women registered within CRC. The level of adherence was assessed after applying an adherence questionnaire: 18-22 points (adherence ≥ 80%) and under 18 points (non-adherence < 80%). Results. The studied group included 71 patients and it was divided into two batches, depending on the route of HIV transmission: group A which included 48 pregnant women parenterally infected with HIV in early childhood and 23 pregnant women sexually infected with HIV. We found that the proportion of non-adherent patients was higher in sexually infected mothers (77.7%) compared to those parenterally infected, in early childhood (14.8%), with statistically significant differences (p = 0.001). The HIV viral load level was correlated with the level of adherence to cART (p = 0.005). Conclusions. Pregnant women infected with HIV-1 in early childhood had a higher level of adherence to cART compared to those sexually infected, directly correlated with HIV viremia.

The immune reconstitution inflammatory syndrome (IRIS) is a paradoxical inflammatory response that can occur in patients infected with the human immunodeficiency virus (HIV) in the first weeks after initiating antiretroviral therapy (ART). It can be manifested either by exposing an underlying infection, or by aggravating the symptoms of an opportunistic infection already diagnosed and under treatment. We present the case of a 24-year-old patient, diagnosed in September 2019 with HIV infection category C3. Extrapulmonary tuberculosis with lymph node and probably splenic metastases. Bacteremia with Staphylococcus aureus. Normocytic hypochromic anaemia – medium form. Antibacillary therapy and ART were initiated (10 days after treatment for tuberculosis). After about 2 weeks from the initiation of ART, the patient complained of intense lumbar pain with irradiation in the lower limbs. IRIS (bone tuberculosis) or a bone adverse reaction to ART was suspected, but the imaging examination (MRI-lumbar spine) reveals a lumbosacral disc herniation, the patient continuing ART, antibacillary treatment, adding neurological treatment. Conclusions. IRIS should be considered in patients diagnosed with HIV in late stages, in which the introduction of ART may be followed by the aggravation or occurrence of an opportunistic infection posing a problem of treatment and differential diagnosis.

HIV infection is still associated with high maternal, feto-neonatal and infant morbidity. Early detection of HIV infection during pregnancy and early initiation of antiretroviral therapy are correlated with obtaining an HIV viral load of less than 50 copies/ml, in which case the risk of maternal-fetal transmission of the infection is less than 0.5%. Objectives. To establish the maternal-fetal transmission rate of HIV infection among HIV-positive pregnant women registered in Craiova Regional Center for Monitoring and Evaluation of HIV/AIDS within „Victor Babeş” Clinical Hospital of Infectious Diseases and Pneumoftiziology of Craiova (CRC) and to identify some correlations between it and certain risk factors. Material and method. Retrospective study, during January 1st, 2014-December 31st, 2019, on 73 HIV-positive pregnant women, registered by Craiova Regional Center (CRC). For the patients included in the study group we analysed: demographic data, epidemiological data, clinical data, biological data, data provided by gynaecological and obstetrical examination, data on antiretroviral treatment (ART). The children were biologically evaluated until the age of 18 months. Results. We found a maternal-fetal transmission rate of 6.3%. For patients with complete prophylaxis measures, the maternal-fetal transmission rate was 3%. The application of complete prophylaxis measures was correlated with a low risk of vertical transmission of HIV infection (p = 0.006). The low adherence to ART was correlated with a high risk of maternal-fetal transmission of HIV infection (p = 0.02), detectable viral-HIV load (VL-HIV) (p = 0.0004) and advanced immunosuppression (p = 0.02). The disease stage of HIV-positive pregnant women was not correlated with the risk of vertical transmission of the infection (p = 1). The level of HIV viral load of mothers who gave birth to HIV-positive children was higher than in the general group and correlated with the maternal-fetal transmission (p = 0.04). Conclusions. The maternal-fetal transmission rate in the studied period was relatively high (6.3%), due to the incomplete application of prevention measures, 12 of the pregnant women being diagnosed during pregnancy or childbirth. The vertical transmission of HIV infection was correlated with detectable HIV viremia and low ART adherence in pregnant women.