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Epilepsia partialis continua (EPC) without intracranial abnormalities is a rare presentation in patients with human immunodeficiency virus (HIV) infection. In our case report, the patient presented with left-sided clonic-myoclonic seizures that were resistant to initial anti-seizure treatment. This condition is classified as EPC. Lesions that could be linked to episodes of EPC were not evident on magnetic resonance imaging. Electroencephalography showed right-sided centroparietal epileptiform activity. After blood testing, the patient was diagnosed with HIV. Dual antiseizure medications were administered, leading to seizure cessation after three days.

Epilepsia partialis continua (EPC) without intracranial abnormalities is a rare presentation in patients with human immunodeficiency virus (HIV) infection. In our case report, the patient presented with left-sided clonic-myoclonic seizures that were resistant to initial anti-seizure treatment. This condition is classified as EPC. Lesions that could be linked to episodes of EPC were not evident on magnetic resonance imaging. Electroencephalography showed right-sided centroparietal epileptiform activity. After blood testing, the patient was diagnosed with HIV. Dual antiseizure medications were administered, leading to seizure cessation after three days. [ABSTRACT FROM AUTHOR]

Bullous pemphigoid (BP) is the most common autoimmune blistering disease and results from autoantibodies against hemidesmosomal proteins of the basement membrane. Occurrence of BP in patients with human immunodeficiency virus (HIV) has already been described. We report an exuberant case of BP in a HIV carrier aiming to emphasize the difficulty of treating this entity in this population. [ABSTRACT FROM AUTHOR]

Introduction: Complex chest wall reconstruction after an oncological resection requires a multidisciplinary approach with the aim of curative resection. Aim: The complexity of such reconstruction is challenged by prior reconstructions that limit the options for free tissue transfer and recipient vessels for microsurgical anastomoses. Case study: We present a case of an immunocompromised patient with prior breast reconstruction for left breast carcinoma with a pedicled lattisimus dorsi flap who presents with a recurrence to the latissimus dorsi flap requiring a more extensive oncological resection. Results and discussion: This resulted in a large chest wall defect that is re-constructed with plating and an anterolateral thigh fasciocutaneous free flap for soft tissue coverage. Conclusions: The radical resection allows for excellent overall survival and better quality of life. [ABSTRACT FROM AUTHOR]

Epstein-Barr virus (EBV) disease of central nervous system (CNS) in human immunodeficiency virus (HIV) patients is mostly associated with primary CNS lymphoma (PCNSL). In patients who cannot undergo biopsy and have typical clinical and radiographic findings, detection of EBV deoxyribonucleic acid in CSF may provide enough evidence to start treatment for PCNSL. Here, we described a case of EBV encephalitis presenting with fever, memory, and psycho-motor deficits in a patient with HIV infection and severe immunosuppression who started antiretroviral therapy (ART) one month earlier. Brain magnetic resonance imaging showed periventricular lesions with nodular enhancing pattern and restricted diffusion, and CSF was positive for EBV. Brain biopsy revealed inflammatory lesions and lymphoid infiltrate without signs of malignancy. After three months of ART, patient improved significantly and MRI showed a marked reduction of lesions. Two years later, patient’s condition remains stable. PCNSL is the leading diagnosis in HIV patients with CNS mass lesions and positive CSF for EBV. In the case described, starting treatment for PCNSL could have been considered if the patient could not undergo biopsy, or if there was no improvement under ART. However, EBV encephalitis can be a differential diagnosis in patients with compatible histopathology and clinical course.

Background: Human immunodeficiency virus (HIV) management guidelines have evolved from initiating therapy at CD4 counts of < 200 cells/m3 to implementing universal test and treat (UTT). This study aimed to assess whether in clinical practice, patients are presenting with higher baseline CD4 counts, describe the incidence of opportunistic infections and the proportion that achieved viral suppression. Methods: A retrospective cohort design with convenience sampling was conducted. Cohort 1 included patients initiated on antiretroviral therapy (ART) between 01 January 2014 and 31 December 2014, when criteria were set at CD4 count ≤ 350 cells/mm³. Cohort 2 included patients initiated on ART between 01 January 2019 and 31 December 2019, during the UTT era. Results: At ART initiation, the median CD4 cell was 170 cells/mm³ (interquartile range [IQR]: 85.5-287) in Cohort 1 cells/mm³ and 243 cells/mm³ (IQR: 120-411) in Cohort 2. Tuberculosis was the predominant OI in the group with CD4 cell count ≤ 200 cells/m³ in both Cohort 1 (26.8%) and Cohort 2 (27.9%), p = 0.039. At 1 year, virological suppression was achieved in only 77.7% and 84.7% of Cohorts 1 and 2 patients. Conclusion: A notable portion of patients at King Edward VIII Hospital's HIV clinic commenced ART with CD4 counts significantly below the recommended guideline thresholds. Contribution: The research revealed a delay in initiating ART. A comprehensive reevaluation is essential to pinpoint the factors contributing to this delay and to devise customised interventions. [ABSTRACT FROM AUTHOR]

Background: Human immunodeficiency virus (HIV) management guidelines have evolved from initiating therapy at CD4 counts of ≤ 200 cells/m3 to implementing universal test and treat (UTT). This study aimed to assess whether in clinical practice, patients are presenting with higher baseline CD4 counts, describe the incidence of opportunistic infections and the proportion that achieved viral suppression. Methods: A retrospective cohort design with convenience sampling was conducted. Cohort 1 included patients initiated on antiretroviral therapy (ART) between 01 January 2014 and 31 December 2014, when criteria were set at CD4 count ≤ 350 cells/mm3. Cohort 2 included patients initiated on ART between 01 January 2019 and 31 December 2019, during the UTT era. Results: At ART initiation, the median CD4 cell was 170 cells/mm3 (interquartile range [IQR]: 85.5–287) in Cohort 1 cells/mm3 and 243 cells/mm3 (IQR: 120–411) in Cohort 2. Tuberculosis was the predominant OI in the group with CD4 cell count ≤ 200 cells/m3 in both Cohort 1 (26.8%) and Cohort 2 (27.9%), p = 0.039. At 1 year, virological suppression was achieved in only 77.7% and 84.7% of Cohorts 1 and 2 patients. Conclusion: A notable portion of patients at King Edward VIII Hospital’s HIV clinic commenced ART with CD4 counts significantly below the recommended guideline thresholds. Contribution: The research revealed a delay in initiating ART. A comprehensive reevaluation is essential to pinpoint the factors contributing to this delay and to devise customised interventions.

Abstract Background The orthopoxvirus causes the rare disease monkeypox, and underlying immune deficiencies might lead to worse outcomes. In this report, we described a rare case of monkeypox with an underlying immune deficiency caused by human immunodeficiency virus infection which was combined with syphilis. This report discusses differences in the initial clinical presentation and clinical course compared to typical monkeypox cases. Case presentation We report the case of a 32-year-old man with human immunodeficiency virus infection who was admitted to a hospital in Southern Florida. The patient presented to the emergency department with shortness of breath, fever, cough and left-sided chest wall pain. Physical examination revealed a pustular skin rash, consisting of generalised exanthema with small white and red papules. Upon arrival, he was found to be in sepsis with lactic acidosis. Chest radiography showed left-sided pneumothorax and minimal atelectasis in the left mid-lung, with a small pleural effusion at the left lung base. An infectious disease specialist raised the possibility of monkeypox, and the lesion sample tested positive for monkeypox deoxyribonucleic acid. In this case, the possible diagnosis of skin lesions varied because the patient tested positive for syphilis and human immunodeficiency virus. For that reason, the differential diagnosis of monkeypox infection is prolonged owing to its initial atypical clinical features. Conclusions Patients with underlying immune deficiency who have human immunodeficiency virus infection and syphilis can present with atypical clinical features and delay proper diagnosis, which can increase the risk of spreading monkeypox in hospitals. Thus, patients with rash and risky sexual behaviour should be screened for monkeypox or other sexually transmitted diseases such as syphilis, and a readily available, rapid, and accurate test is necessary to stop the spread of the disease.

Background: With the availability of highly active anti-retroviral therapy and attendant increased lifespan of human immunodeficiency virus (HIV)-infected children, late complications of the disease, especially cardiovascular complications have become a growing problem for them. The cardiovascular complications of HIV infection start early in the course of the disease, although may remain asymptomatic until later in life, when they manifest with life-threatening symptoms. The electrocardiogram (ECG) is an invaluable tool in the early diagnosis of these abnormalities. Aim: This study assessed the prevalence and types of ECG abnormalities among HIV-infected children. Patients, Materials and Methods: It was a hospital-based, comparative, cross-sectional study involving randomly selected HIV-infected children (subjects) and age- and gender-matched HIV-uninfected children (controls). Relevant information was obtained through questionnaires, medical records, and physical examination. All participants underwent a 12-lead ECG assessment. Results: Electrocardiographic abnormalities were observed in 42.9% of subjects compared to 17.9% of controls (χ2 = 8.28; P = 0.004). The participants were about three times more likely to have ECG abnormalities than controls (odds ratio = 3.45, 95% confidence interval = 1.45–8.19). Left ventricular hypertrophy (LVH) was the most common abnormality in the subjects (14.3%), and compared to controls (1.8%), this was significant (χ2 = 0.032; P = 0.032). Other ECG abnormalities such as right ventricular hypertrophy, T-wave changes, and T-axis abnormalities were more prevalent among subjects (10.7%, 5.4%, and 10.7%, respectively) than controls (1.8%, 3.6%, and 14%, respectively), although not significant. Conclusion: Electrocardiographic abnormalities are quite prevalent among HIV-infected children, with LVH being predominant. It is recommended that routine ECG evaluations be done on HIV-infected children to enable the early detection and prompt management of these problems.

Epstein-Barr virus (EBV) disease of central nervous system (CNS) in human immunodeficiency virus (HIV) patients is mostly associated with primary CNS lymphoma (PCNSL). In patients who cannot undergo biopsy and have typical clinical and radiographic findings, detection of EBV deoxyribonucleic acid in CSF may provide enough evidence to start treatment for PCNSL. Here, we described a case of EBV encephalitis presenting with fever, memory, and psycho-motor deficits in a patient with HIV infection and severe immunosuppression who started antiretroviral therapy (ART) one month earlier. Brain magnetic resonance imaging showed periventricular lesions with nodular enhancing pattern and restricted diffusion, and CSF was positive for EBV. Brain biopsy revealed inflammatory lesions and lymphoid infiltrate without signs of malignancy. After three months of ART, patient improved significantly and MRI showed a marked reduction of lesions. Two years later, patient's condition remains stable. PCNSL is the leading diagnosis in HIV patients with CNS mass lesions and positive CSF for EBV. In the case described, starting treatment for PCNSL could have been considered if the patient could not undergo biopsy, or if there was no improvement under ART. However, EBV encephalitis can be a differential diagnosis in patients with compatible histopathology and clinical course. [ABSTRACT FROM AUTHOR]

Background: Since the recommendation of voluntary medical male circumcision (VMMC) to reduce the risk of heterosexually acquired HIV, a number of adolescent boys and men in 15 priority countries in Africa have been circumcised. Our primary goal was to identify the incidence of adverse events (AEs) associated with VMMC and to assess the safety profile among adolescent boys 10 – 14 years. Methods: We searched the databases MEDLINE and Embase, WHO, and conference abstracts from 2005 to 2019. The incidence of AEs was estimated by type of AE, size of study and age. Results: We retained 40 studies. Severe and moderate AEs overall were estimated at 0.30 per 100 VMMC clients with wide variability per study type. A higher rate was noted in small and moderate scale programmes and device method research studies compared with larger scale programmes. There was a limited number of studies reporting AEs among younger adolescent boys and they had higher infection-related AEs than those aged 20 years and older. Case studies noted rare AEs such as necrotizing fasciitis, tetanus, and glans injury. Conclusions: AE rates were comparable to those from the randomized controlled trials (RCTs) that led to recommendations and implementation of VMMC in high HIV burden countries, despite being implemented in low resource settings. Clients over time have increasingly included adolescents under the age of 15 years. Studies suggest potentially higher risks in this age group. As VMMC services are sustained, patient safety surveillance systems and promoting a patient safety culture are crucial to identify and mitigate potential harms from medical male circumcision.

OBJECTIVE: To evaluate and summarize the evidence quality of efficacy and safety of systematic review and Meta-analysis of traditional Chinese medicine (TCM) in the treatment of human immunodeficiency virus (HIV) infection / acquired immunodeficiency syndrome ( AIDS). METHODS: A number of Chinese and English databases were retrieved to collect systematic review / Meta-analysis of the treatment of HIV infection / AIDS with TCM (intervention of study group was TCM alone or TCM combined with western medicine; intervention of control group was blank, placebo, mimic, western medicine treatment, or western medicine treatment combined with placebo and mimic). The retrieval time was from the establishment of the database to Aug. 2022. The literature was screened and the data were extracted according to the inclusion and exclusion criteria. AMSTAR2 scale was used to evaluate the methodological quality of the included studies, and the GRADE tool was used to grade the evidence quality of the outcome indicators. RESULTS: A total of 11 studies were included, all of which showed that the efficacy of TCM in the treatment of HIV infection / AIDS was better than that of the control group. AMSTAR2 scale showed that the methodological quality of 5 studies was low, and that of 6 studies was very low. GRADE evaluation showed that among the 38 outcome indicators, 2 outcome indicators were moderate, 24 outcome indicators were low and 12 outcome indicators were very low. Moderate quality evidence showed that the improvement rate of clinical symptoms and CD4 cell count in HIV infection / AIDS patients treated with TCM combined with antiviral therapy was better than that of antiviral therapy alone. CONCLUSIONS: Current evidence shows that TCM has certain advantages and high safety in the treatment of HIV infection / AIDS. However, the methodological quality and evidence quality level of most of the studies are low, further verification is required. [ABSTRACT FROM AUTHOR]

Context: Newborns' low birth weight (LBW) has been linked to early infant morbidity and mortality. However, our understanding of the determinants and outcomes of LBW in this population is still poor. Aim: This study aimed to assess determinants and outcomes of LBW among newborns at a tertiary hospital. Settings and Design: Retrospective cohort study at Women and Newborn Hospital in Lusaka Zambia. Subjects and Methods: We reviewed delivery case records and neonatal files between January 1, 2018, and September 30, 2019, for newborns admitted to the neonatal intensive care unit. Statistical Analysis Used: Logistic regression models were used to establish determinants of LBW and describe the outcomes. Results: Women living with human immunodeficiency virus infection were more likely to deliver LBW infants (adjusted odds ratio [AOR] = 1.46; 95% confidence interval [CI]: 1.16-1.86). Other maternal determinants of LBW were; increased parity (AOR = 1.22; 95% CI: 1.05-1.43), preeclampsia (AOR = 6.91; 95% CI: 1.48-32.36), and gestational age <37 weeks compared to 37 weeks or more (AOR = 24.83; 95% CI: 13.27-46.44). LBW neonates were at higher odds of early mortality (AOR = 2.16; 95% CI: 1.85-2.52), developing respiratory distress syndrome (AOR = 2.96; 95% CI: 2.53-3.47), and necrotizing enterocolitis (AOR = 1.66; 95% CI: 1.16-2.38) than neonates with a birth weight of 2500 g or more. Conclusions: These findings underscore the importance of effective maternal and neonatal interventions to reduce the risk of morbidity and mortality for neonates with LBW in Zambia and other similar settings. [ABSTRACT FROM AUTHOR]

Background: The orthopoxvirus causes the rare disease monkeypox, and underlying immune deficiencies might lead to worse outcomes. In this report, we described a rare case of monkeypox with an underlying immune deficiency caused by human immunodeficiency virus infection which was combined with syphilis. This report discusses differences in the initial clinical presentation and clinical course compared to typical monkeypox cases. Case presentation: We report the case of a 32-year-old man with human immunodeficiency virus infection who was admitted to a hospital in Southern Florida. The patient presented to the emergency department with shortness of breath, fever, cough and left-sided chest wall pain. Physical examination revealed a pustular skin rash, consisting of generalised exanthema with small white and red papules. Upon arrival, he was found to be in sepsis with lactic acidosis. Chest radiography showed left-sided pneumothorax and minimal atelectasis in the left mid-lung, with a small pleural effusion at the left lung base. An infectious disease specialist raised the possibility of monkeypox, and the lesion sample tested positive for monkeypox deoxyribonucleic acid. In this case, the possible diagnosis of skin lesions varied because the patient tested positive for syphilis and human immunodeficiency virus. For that reason, the differential diagnosis of monkeypox infection is prolonged owing to its initial atypical clinical features. Conclusions: Patients with underlying immune deficiency who have human immunodeficiency virus infection and syphilis can present with atypical clinical features and delay proper diagnosis, which can increase the risk of spreading monkeypox in hospitals. Thus, patients with rash and risky sexual behaviour should be screened for monkeypox or other sexually transmitted diseases such as syphilis, and a readily available, rapid, and accurate test is necessary to stop the spread of the disease. [ABSTRACT FROM AUTHOR]

A 56-year-old male with a poorly controlled human immunodeficiency virus infection presents to the emergency room due to anorexia and weight loss. The patient was emaciated, hypertensive and his laboratory tests showed thrombocytopenia, anaemia, an elevated lactate dehydrogenase and an acute kidney injury. The patient was admitted to the Infecciology ward and by the fourth day, as the kidney function did not improve, a Nephrology consultation was requested. We collected a full auto-immune and serological panel and a urinalysis to rule out glomerular pathologies. Two days later, the patient developed a hypertensive emergency associated with an acute respiratory distress, responsive to furosemide and anti-hypertensive medications. The complementary study showed a high LDH, unmeasurable haptoglobin, thrombocytopenia and schizocytes on peripheral blood smear. These findings suggested a thrombotic microangiopathy associated with human immunodeficiency virus infection and so, he restarted antiretroviral therapy. The kidney function deteriorated and, despite starting haemodialysis, the patient died shortly after.

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We identified factors associated with depressive symptoms according to age group. We used data from a city-wide, cross-sectional survey conducted by the Seoul Metropolitan Government in 2014. Multivariable logistic regression analyses were performed to explore factors related to depressive symptoms. Depressive symptoms were assessed using a single item from the Korea National Health and Nutrition Examination Survey. Of the 370 subjects, 37.3% had depressive symptoms during the past 12 months. Compared to an age of ≥50 years, being 20–39 (adjusted odds ratio, 2.45; 95% confidence interval, 1.26–4.75) or 40–49 years (2.58; 1.32–5.06) of age was positively associated with depressive symptoms. In addition, a history of acquired immune deficiency syndrome-defining opportunistic disease (3.29; 1.09–9.92) and perceived discrimination (1.93; 1.16–3.20) in subjects aged 20–39 years, and poor subjective health (4.97; 1.42–17.32) in subjects aged 40–49 years, were associated with depressive symptoms, but no factor exhibited a significant association in subjects aged ≥ 50 years. In conclusion, a screening program that considers the factors identified in this study to prioritize patients with depression should be implemented. [ABSTRACT FROM AUTHOR]

Background: Human immunodeficiency virus (HIV) has been reported to be associated with several adverse pregnancy outcomes. There are limited data on the extent by which HIV-positive pregnant women in this part of the world are affected. Aim: The aim of this study was to assess the pregnancy outcome of HIV-positive pregnant women who attended the antenatal clinic. Materials and Methods: A retrospective analysis of the case notes of HIV-positive women that enrolled in the prevention of mother-to-child (PMTCT) clinic from January 1, 2020, to December 31, 2020. All data collected were entered and analyzed using the IBM SPSS version 25.0 software. Results: A total of 1817 women attended the antenatal clinic and 127 (6.9%) were HIV positive and enrolled in the PMTCT program. Out of the 127 HIV-positive women, only 102 (85.0%) utilized the delivery service. HIV was found to be more common among women within the age group of 30–39 years. Majority 105 (82.6%) of the women were aware of their HIV status before index pregnancy and were on treatment, 62 (60.78%) of the women had a vaginal delivery, whereas 34 (33.3%) had a caesarean delivery. A total of 6 (4.7%) women had a miscarriage. There was no maternal death. Of these pregnancies, 7 (5.5%) were stillbirths, 18 (18.8%) were preterm deliveries, and 10 (11.2%) had a low birthweight. Conclusion: Despite antiretroviral therapy, HIV-positive pregnant women had adverse pregnancy outcomes; therefore, they should be managed with a multidisciplinary approach to ensure good maternal and fetal outcomes.

Background: Since the recommendation of voluntary medical male circumcision (VMMC) to reduce the risk of heterosexually acquired HIV, a number of adolescent boys and men in 15 priority countries in Africa have been circumcised. Our primary goal was to identify the incidence of adverse events (AEs) associated with VMMC and to assess the safety profile among adolescent boys 10 – 14 years. Methods: We searched the databases MEDLINE and Embase, WHO, and conference abstracts from 2005 to 2019. The incidence of AEs was estimated by type of AE, size of study and age. Results: We retained 40 studies. Severe and moderate AEs overall were estimated at 0.30 per 100 VMMC clients with wide variability per study type. A higher rate was noted in small and moderate scale programmes and device method research studies compared with larger scale programmes. There was a limited number of studies reporting AEs among younger adolescent boys and they had higher infection-related AEs than those aged 20 years and older. Case studies noted rare AEs such as necrotizing fasciitis, tetanus, and glans injury. Conclusions: AE rates were comparable to those from the randomized controlled trials (RCTs) that led to recommendations and implementation of VMMC in high HIV burden countries, despite being implemented in low resource settings. Clients over time have increasingly included adolescents under the age of 15 years. Studies suggest potentially higher risks in this age group. As VMMC services are sustained, patient safety surveillance systems and promoting a patient safety culture are crucial to identify and mitigate potential harms from medical male circumcision.

This study aimed to determine the capacity of HIV in the blood and cerebrospinal fluid of patients, depending on the reception of antiretroviral therapy (ART). Paired blood and cerebrospinal fluid samples were examined in 116 HIV-infected patients to determine the level of viral load in both biological fluids and the number of blood CD4+ lymphocytes. In patients receiving ART, the difference between the load of HIV in blood and cerebrospinal fluid (CSF) was significantly smaller than in untreated patients. Taking ART reduces the amount of HIV in the blood and CSF, but the dynamics of virus suppression in these biological fluids differ. The analysis revealed a statistically significant inverse relationship between the load of HIV in the blood and the number of CD4+ lymphocytes in untreated patients. There is a clear moderate positive correlation between the level of viremia and the clinical stage of HIV infection, as well as the duration of the disease. The number of CD4+ lymphocytes was expected to be inversely weakly correlated with the clinical stage of HIV infection and its duration. Accordingly, a direct correlation of mean strength was found between the levels of viral load in the blood and cerebrospinal fluid. There was a significant increase in the difference between the levels of HIV load in the blood and CSF compared with the average value in 25.6% of patients. [ABSTRACT FROM AUTHOR]

Gingival enlargement may be a result of multifactorial etiology which includes local factors such as calculus, food lodgement, overhanging restorations, and overextended dentures as well as systemic conditions such as hormonal disturbances and blood dyscrasias. Acquired immune deficiency is a manifestation of immune disorder caused by a retrovirus Human Immunodeficiency Virus (HIV). The association of Acquired Immunodeficiency Syndrome or HIV with oral and periodontal lesions is highly significant. Seropositive patients usually present with periodontal diseases and atypical periodontal lesions. These clinical findings may prove to be a link for probing patients' systemic health. This case report describes one such case of a patient, unaware of HIV infection with localized gingival overgrowth, wherein detailed probing and investigation led to the diagnosis of underlying systemic condition as acquired immunodeficiency. Subsequently, antiretroviral therapy was started, and nonsurgical periodontal therapy was performed to resolve the gingival overgrowth. [ABSTRACT FROM AUTHOR]

BACKGROUND: The incidence of anal cancer in human immunodeficiency virus (HIV)-positive individuals is increasing, and how co-infection affects outcomes is not fully understood. This study sought to describe the current outcome disparities between anal cancer patients with and without HIV undergoing abdominoperineal resection (APR). METHODS: A retrospective review of all US patients diagnosed with anal squamous cell carcinoma, undergoing an APR, was performed. Cases were identified using a weighted derivative of the Healthcare Utilization Projects National Inpatient Sample (2000-2011). Patients greater than 60 years old were excluded after finding a skewed population distribution between those with and without HIV infection. Multivariable logistic regression and generalized linear modeling analysis examined factors associated with postoperative outcomes and cost. Perioperative complications, in-hospital mortality, length of hospital stay, and hospital costs were compared for those undergoing APR with and without HIV infection. RESULTS: A total of 1725 patients diagnosed with anal squamous cell cancer undergoing APR were identified, of whom 308 (17.9 %) were HIV-positive. HIV-positive patients were younger than HIV-negative patients undergoing APR for anal cancer (median age 47 years old versus 51 years old, p

Xiaoling Yu, Wenqian Jiang Department of Infectious Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People’s Republic of ChinaCorrespondence: Xiaoling YuDepartment of Infectious Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, Fujian, People’s Republic of ChinaTel/Fax +86 591 88116019Email xiaolingyu82@163.comAbstract: Non-tuberculous mycobacteria are conditional pathogens that can cause many diseases, among which pulmonary infections are the most common (65– 90%). Mycobacterium avium and Mycobacterium abscessus are non-tuberculous mycobacteria most often associated with lung diseases. Mass spectrometry diagnostic techniques were not effective in Mycobacterium avium complex infection. We report a case of Mycobacterium colombiense and Mycobacterium avium complex causing severe pneumonia in an adult with HIV. Our group developed a novel molecular-based method to identify Mycobacterium species. Novel techniques such as molecular cloning which we have described here can make up for the inability of matrix-assisted laser desorption ionization-time of flight mass spectrometry to distinguish the multiple microorganisms present, and may add to the diagnostic toolkit and increase the accuracy and rapidity of diagnosis in the future.Keywords: non-tuberculous mycobacteria, Mycobacterium avium complex, Mycobacterium colombiense, human immunodeficiency virus infection, pneumonia

Godfrey Mutashambara Rwegerera,1,2 Dorothea HP Shailemo,3 Yordanka Pina Rivera,4 Kathryn O Mokgosi,5 Portia Bale,6 Taibat Aderonke Oyewo,2,7 Bruno Diaz Luis,2 Dereje Habte,8 Brian Godman9– 11 1Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana; 2Department of Medicine, Princess Marina Hospital, Gaborone, Botswana; 3Department of Pharmacology and Therapeutics, School of Pharmacy, University of Namibia, Windhoek, Namibia; 4Department of Medicine, Sidilega Private Hospital, Gaborone, Botswana; 5Department of Obstetrics and Gynaecology, Nyangabgwe Referral Hospital, Francistown, Botswana; 6Otse Outpatient Clinic, District Health Management Team, Lobatse, Botswana; 7Department of Family Medicine, University of Botswana, Gaborone, Botswana; 8Consultant Public Health Specialist, Addis Ababa, Ethiopia; 9School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa; 10Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK; 11Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, SwedenCorrespondence: Godfrey Mutashambara RwegereraDepartment of Internal Medicine, Faculty of Medicine, University of Botswana, Corner of Notwane and Mobuto Road, Plot 4775, Gaborone, BotswanaTel +26775753207Email grwege@yahoo.comPurpose: We primarily aimed at determining the prevalence of metabolic syndrome and abnormal individual metabolic control variables in HIV-infected participants as compared to HIV-uninfected participants given current concerns. Our secondary objective was to determine the predictors of metabolic syndrome and individual metabolic control variables among the study participants to guide future management.Patients and Methods: A descriptive, case-matched cross-sectional study for four months from 15th June 2019 to 15th October 2019 at Block 6 Diabetes Reference Clinic in Gaborone, Botswana. We compared the proportions of metabolic syndrome and individual metabolic control variables based on gender and HIV status by means of bivariate analysis (Chi-squared test or Fisher’s exact test) to determine factors associated with metabolic control. A p-value of less than 0.05 was considered statistically significant.Results: Overall, 86% of the study participants were found to have metabolic syndrome by International Diabetes Federation (IDF) criteria with 79.8% among HIV-infected and 89.1% among HIV-negative participants (p-value = 0.018). Older age was significantly associated with metabolic syndrome (p-value = 0.008). Female gender was significantly associated with metabolic syndrome as compared to male gender (P-value < 0.001), and with a statistically significant higher proportion of low HDL-C compared to males (P-value < 0.001). Female participants were significantly more likely to be obese as compared to males (P-value < 0.001). High triglycerides were more common in HIV-infected compared to HIV-negative participants (P-value = 0.004). HIV-negative participants were more likely to be obese as compared to HIV-infected participants (P-value = 0.003).Conclusion: Metabolic syndrome is an appreciable problem in this tertiary clinic in Botswana for both HIV-infected and HIV-negative participants. Future prospective studies are warranted in our setting and similar sub-Saharan settings to enhance understanding of the role played by HAART in causing the metabolic syndrome, and the implications for future patient management.Keywords: human immunodeficiency virus infection, HIV, diabetes mellitus, metabolic syndrome, sub-Saharan Africa, Botswana

Objective: Antimicrobial-resistant Neisseria gonorrhoeae is a public health concern. This study determined antimicrobial resistance (AMR) patterns in vaginal swabs testing positive for N. gonorrhoeae. Methods: In total, 385 pregnant women were enrolled in this study. Vaginal swabs were collected from consenting women and used for the detection of N. gonorrhoeae using the TaqMan assay. Genes containing known mutations associated with resistance to azithromycin, spectinomycin, ciprofloxacin and extended-spectrum cephalosporins (ESCs) in N. gonorrhoeae were investigated using a quantitative polymerase chain reaction (PCR) assay. To validate the PCR assay, N. gonorrhoeae cultured isolates with known antimicrobial profiles were used as controls in the mutation detection assays. Results: The prevalence of N. gonorrhoeae in the study population was 4.1% (16/385). The validation assays showed a positive correlation between phenotypic and genotypic data for ESCs, ciprofloxacin and spectinomycin resistance profiles only. Of the 16 N. gonorrhoeae-positive clinical samples, the Ser91Phe mutation carried on the gryA gene was detected in 6/16 samples (37.5%). The penA gene carrying the Gly545Ser mutation was shown to be present in 1/16 samples (6.25%). Within the same gene, the Asp345del mutation, which also confers decreased susceptibility or resistance to ESCs, was not detected. Approximately 6.25% of the samples carried the C1192T mutation in the 16S rRNA gene associated with spectinomycin resistance. Conclusion: Molecular-based assays for tracking resistance patterns may serve as an attractive alternative for antimicrobial surveillance. [ABSTRACT FROM AUTHOR]

We previously characterized a human betaretrovirus and linked infection with the development of primary biliary cholangitis (PBC). There are in vitro and in vivo data demonstrating that antiretroviral therapy used to treat human immunodeficiency virus (HIV) can be repurposed to treat betaretroviruses. As such, PBC patients have been treated with nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), alone and in combination with a boosted protease inhibitor or an integrase strand transfer inhibitor in case studies and clinical trials. However, a randomized controlled trial using combination antiretroviral therapy with lopinavir was terminated early because 70% of PBC patients discontinued therapy because of gastrointestinal side effects. In the open-label extension, patients tolerating combination therapy underwent a significant reduction in serum liver parameters, whereas those on NRTIs alone rebounded to baseline. Herein, we compare clinical experience in the experimental use of antiretroviral agents in patients with PBC with the broader experience of using these agents in people living with HIV infection. While the incidence of gastrointestinal side effects in the PBC population appears somewhat increased compared to those with HIV infection, the clinical improvement observed in patients with PBC suggests that further studies using the newer and better tolerated antiretroviral agents are warranted. [ABSTRACT FROM AUTHOR]

Abstract Asymptomatic pulmonary sarcoidosis can develop after starting antiretroviral therapy. The decision on whether to treat sarcoidosis with corticosteroids should be based on the disease severity.

Abstract Background HIV/AIDS has attracted considerable research attention since the 1980s. In the current context of globalization and the predominance of cooperative work, it is crucial to analyze the participation of the countries and regions where the infection is most prevalent. This study assesses the participation of African countries in publications on the topic, as well as the degree of equity or influence existing in North-South relations. Methods We identified all articles and reviews of HIV/AIDS indexed in the Web of Science Core Collection. We analyzed the scientific production, collaboration, and contributions from African and Middle Eastern countries to scientific activity in the region. The concept of leadership, measured through the participation as the first author of documents in collaboration was used to determine the equity in research produced through international collaboration. Results A total of 68,808 documents published from 2010 to 2017 were analyzed. Researchers from North America and Europe participated in 82.14% of the global scientific production on HIV/AIDS, compared to just 21.61% from Africa and the Middle East. Furthermore, the publications that did come out of these regions was concentrated in a small number of countries, led by South Africa (41% of the documents). Other features associated with HIV/AIDS publications from Africa include the importance of international collaboration from the USA, the UK, and other European countries (75–93% of the documents) and the limited participation as first authors that is evident (30 to 36% of the documents). Finally, the publications to which African countries contributed had a notably different disciplinary orientation, with a predominance of research on public health, epidemiology, and drug therapy. Conclusions It is essential to foster more balance in research output, avoid the concentration of resources that reproduces the global North-South model on the African continent, and focus the research agenda on local priorities. To accomplish this, the global North should strengthen the transfer of research skills and seek equity in cooperative ties, favoring the empowerment of African countries. These efforts should be concentrated in countries with low scientific activity and high incidence and prevalence of the disease. It is also essential to foster intraregional collaborations between African countries.

Due to antiretroviral therapy, human immunodeficiency virus (HIV) patients and non-HIV patients have a similar life expectancy. The leading cause of death among HIV patients is lung cancer. However, clinical toxicities with immune checkpoint inhibitors, including durvalumab, in HIV-positive patients with non-small cell lung cancer (NSCLC) remain unknown. We report a 45-year-old Japanese HIV patient, who was safely treated with durvalumab consolidation therapy after concurrent chemoradiotherapy (CCRT) for locally advanced NSCLC without significant toxicities until his disease progressed. This case demonstrates the safety of durvalu­mab consolidation therapy for HIV-positive patients after CCRT for locally advanced NSCLC.

Gastrointestinal disorder is one of the main elements in a number of pathological changes characteristic of human immunodeficiency virus (HIV) infection in children. Such lesion can be caused by direct impact of the virus on the gastrointestinal tract, opportunistic infections, prolonged use of drugs (antibiotics, antivirals, antifungals).With the progression of HIV-infection, the risk of pathology of the digestive system increases. Among opportunistic diseases, a special attention should be paid to cytomegalovirus (CMV) infection, in which all the organs and systems of the child are involved in the pathological process, including the gastrointestinal tract. Esophagitis is the second most common gastrointestinal disorder after colitis in such patients. With CMV esophagitis in HIV-infected children, the clinical symptoms are nonspecific. Endoscopic examination is quite informative. Available literature contains descriptions of esophagitis in children with HIV-infection, but the focus was made on damage to the esophagus caused by fungi. The presented clinical case demonstrates the development of CMV esophagitis in an adolescent with HIV-infection. Poor patient’s adherence to therapy allowed the disease to develop naturally, with a progressive decline in the immune status, the occurrence of an opportunistic CMV infection with a predominant lesion of the esophagus and severe CMV esophagitis. The development of this complication did not make it possible to correct antiretroviral therapy. This clinical case illustrates the progressive course of HIV-infection with the development of severe CMV esophagitis in an adolescent against the background of poor adherence to antiretroviral therapy.

The article presents clinical cases of human immunodeficiency virus (HIV) infection diagnosed in elderly patients: a man aged 70 years and a woman aged 68 years, living together for a long time. Despite approximately the same age of patients at the time of diagnosis, female patient had a more advanced clinical stage 3 of HIV infection, a more pronounced immunodeficiency (CD4+ T-lymphocytes — 285 cells/μl) compared with male patient, who had clinical stage 1 of HIV infection when diagnosing a disease with moderate immunodeficiency (CD4+ T-lymphocytes — 375 cells/μl). However, against the background of antiretroviral therapy, woman had an increase in CD4+ T-lymphocytes, she is currently in a satisfactory condition, and the life expectancy after HIV infection has been diagnosed is 7 years so far. In man, the disease was more aggressive, as the patient refused to take antiretroviral therapy, which led to the rapid progression of HIV infection, the development of acquired immune deficiency syndrome-associated tumor — Kaposi’s sarcoma, which resulted in death. Life expectancy in male patient after diagnosing HIV infection was 4 years.

Background: HPV-related vulvar cancer is increasing in prevalence, especially in women living with HIV. Treatment of vulva cancer is based on evidence from HPV-independent cancers, which affect older women. The impact of HIV on vulvar cancer characteristics and treatment outcomes needs to be elucidated., Patients and Methods: A retrospective observational study compared the clinical characteristics, treatment, and outcomes of 92 HIV-positive and 131 HIV-negative women with vulvar cancer at our institution. Using descriptive statistics, HIV-positive and negative patients were compared and Cox regression models were tested for differences in mortality and recurrence., Results: HIV-positive patients were 20 years younger than HIV-negative patients ( p < 0.001). More than 50% of patients presented with advanced stage cancer, however this was independent of HIV-status. Although HIV infection was associated with poorer survival ( p = 0.022); rates of cure ( p = 0.933) and recurrence rates ( p = 0.8) were similar in HIV-positive and negative women., Conclusions: Vulvar cancer occurs at a much younger age in women living with HIV. Awareness among HIV-positive women and health care providers would lead to diagnosis of vulvar cancer at an earlier stage. Treatment protocols for HPV-related vulvar cancer should not be altered due to HIV status and should take into consideration the young age of the patients., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Reported cases of upper airway obstruction (UAO) due to obstructive adenotonsillar Kaposi sarcoma (KS) are rare in our environment. We report a 29-year-old human immunodeficiency virus (HIV)-positive female Nigerian who had defaulted treatment for 6 years but represented with disseminated KS and features of severe UAO that necessitated emergency tracheostomy and adenotonsillectomy. She had remarkable improvement in her breathing, feeding, and speech while being in a stable and satisfactory clinical state postoperatively until 3 days later. She suddenly deteriorated and died. Histology report of the adenoid and tonsillar tissues revealed features in keeping with KS (nodular stage). Lack of compliance with antiretroviral therapy and default from care could have facilitated the development of an aggressive KS and the rare presentation. Adherence to the management protocol of HIV infection would bring about early detection of KS, which can be promptly managed with a possible favorable outcome, thereby preventing or reducing dissemination. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to assess the risk of venous thromboembolism (VTE) and the potential need for thromboprophylaxis in patients with tuberculosis (TB). Methods: A total of 103 patients who underwent treatment for TB at the King Khalid University Hospital in Riyadh between February 2015 to May 2018, the percentage of patients diagnosed with TB who developed VTE was assessed. This was a retrospective cohort study conducted at King Khalid University Hospital in Riyadh. Fisher's exact test was used to analyze the categorical variables.P < 0.05 was considered statistically significant. Results: Our data showed the prevalence of VTE in TB patients to be 2.93% (3/103). VTE occurred irrespective of the type of TB (pulmonary and/or extrapulmonary). All TB patients with VTE showed no significant association with factors such as human immunodeficiency virus coinfection, malignancy, and multidrug-resistant TB. Conclusion: Our study showed that TB patients in Saudi Arabia may be at a higher risk for developing VTE and should be carefully monitored as potential candidates for additional thromboprophylaxis; further studies are recommended to establish more reliable assessment and recommendations.

Abstract Background Pegylated liposomal doxorubicin plays an important role in the treatment of patients with severe refractory human immunodeficiency virus (HIV)-associated Kaposi sarcoma (KS). High cumulative doses of conventional doxorubicin exceeding 500 mg/m2 are known to cause cardiac toxicity. However, the safe cumulative dose of pegylated liposomal doxorubicin is unclear. Case presentation A 40-year-old Japanese man with HIV infection presented with pain, edema, and multiple skin nodules on both legs which worsened over several months. He was diagnosed with HIV-associated KS. He received long-term pegylated liposomal doxorubicin combined with antiretroviral therapy for advanced, progressive KS. The cumulative dose of pegylated liposomal doxorubicin reached 980 mg/m2. The patient’s left ventricular ejection fraction remained unchanged from baseline during treatment. After he died as a result of cachexia and wasting, caused by recurrent sepsis and advanced KS, an autopsy specimen of his heart revealed little or no evidence of histological cardiac damage. We also conducted a literature review focusing on histological changes of the myocardium in patients treated with a cumulative dose of pegylated liposomal doxorubicin exceeding 500 mg/m2. Conclusions This case report and literature review suggest that high (> 500 mg/m2) cumulative doses of pegylated liposomal doxorubicin may be used without significant histological/clinical cardiac toxicity in patients with HIV-associated KS.

Background: Viral hepatitis is a major global health problem. There is a paucity of data from Botswana on the seroprevalence of markers of hepatitis. The objective of the study was to determine the seroprevalence and risk factors of hepatitis B virus (HBV), hepatitis D virus (HDV) and hepatitis C virus (HCV) infections in patients with clinical features of hepatitis and/or altered liver function tests. Method: This cross-sectional study was done at Princess Marina Hospital (PMH) in Gaborone, Botswana, from February 2015 to July 2016. It involved 328 adult patients with any of the following: jaundice, history of liver disease and/or increased serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and serum bilirubin of 2 times the upper limit of normal (ULN). Results: Active or chronic active hepatitis (hepatitis B surface antigen [HBsAg] positive) was identified in 46.7% of patients. Antibodies to HDV infection were detected in 4.6% of the HBsAg-positive patients and antibodies to HCV infection in 4.3% of the study patients. Immunity against HBV infection was noted in 34.5% of patients. Human immunodeficiency virus (HIV) co-infection was self-reported by 42.7% of HBsAg-positive patients with known HIV status. Conclusion: High prevalence rate of HBV, HCV, HDV infection and HIV co-infection was observed in patients with liver disease attending PMH.

It is a known fact that antiretroviral treatment (ART) is highly efficacious in reducing the sexual transmission of human immunodeficiency virus (HIV). In addition, it is clear now that those infected and living with HIV and having an undetectable viral load below 200 copies per mL, measured 4 to 6 monthwise, do not transmit it sexually to their partners. Therefore, U = U (Undetectable = Untransmittable; where symbol = means similar to) campaign is the message of a new UNAIDS explainer. The authors herein report the blood donation made by an HIV-I positive Indian male under the existing policy of confidential unit exclusion at their blood center. It was alarming because he was driven by an incorrect belief that being in a state of sexual nontransmissibility, due to the regular intake of ART, his donated blood was safe and suitable for blood transfusion too. He firmly believed that the ART he was receiving was highly efficacious in reducing the transmission of HIV through sexual intercourse and misconstrued the same for blood transfusion. After a thorough consultation and discussion with the transfusion medicine specialist, the individual could understand that U = U certainly, does not ascribe to the blood transfusion-related transmission due to a bigger inoculum and the intravenous route of administration.

This is the case of a 66-year-old male with a medical history of HIV infection on combination antiretroviral therapy (cART) who presented to the hospital with gradually worsening chronic right-sided chest and abdominal pain over the past three months. Computed tomography (CT) with contrast showed new mass-like pleural thickening in the right lower lobe posteriorly with an associated small loculated right pleural effusion. A core needle pleural biopsy was performed, and the results were consistent with primary pleural malignant lymphoma. Histopathological and immunohistochemical examinations revealed CD10-positive, low-grade B-cell lymphoma. This case is considered a rare occurrence of primary malignant lymphoma developing in the pleura., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Katkov et al.)

ObjectiveTo assess the ability of Medicare claims to identify US hospitals with high rates of surgical site infection (SSI) after hip arthroplasty.DesignRetrospective cohort study.SettingAcute care US hospitals.ParticipantsFee-for-service Medicare patients 65 years of age and older who underwent hip arthroplasty in US hospitals from 2005 through 2007.MethodsHospital rankings were derived from claims codes suggestive of SSI, adjusted for age, sex, and comorbidities, while using generalized linear mixed models to account for hospital volume. Medical records were obtained for validation of infection on a random sample of patients from hospitals ranked in the best and worst deciles of performance. We then calculated the risk-adjusted odds of developing a chart-confirmed SSI after hip arthroplasty in hospitals ranked by claims into worst- versus best-performing deciles.ResultsAmong 524,892 eligible Medicare patients who underwent hip arthroplasty at 3,296 US hospitals, a patient who underwent surgery in a hospital ranked in the worst-performing decile based on claims-based evidence of SSI had 2.9-fold higher odds of developing a chart-confirmed SSI relative to a patient with the same age, sex, and comorbidities in a hospital ranked in the best-performing decile (95% confidence interval, 2.2-3.7).ConclusionsMedicare claims successfully distinguished between hospitals with high and low SSI rates following hip arthroplasty. These claims can identify potential outlier hospitals that merit further evaluation. This strategy can also be used to validate the completeness of public reporting of SSI.

We previously characterized a human betaretrovirus and linked infection with the development of primary biliary cholangitis (PBC). There are in vitro and in vivo data demonstrating that antiretroviral therapy used to treat human immunodeficiency virus (HIV) can be repurposed to treat betaretroviruses. As such, PBC patients have been treated with nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), alone and in combination with a boosted protease inhibitor or an integrase strand transfer inhibitor in case studies and clinical trials. However, a randomized controlled trial using combination antiretroviral therapy with lopinavir was terminated early because 70% of PBC patients discontinued therapy because of gastrointestinal side effects. In the open-label extension, patients tolerating combination therapy underwent a significant reduction in serum liver parameters, whereas those on NRTIs alone rebounded to baseline. Herein, we compare clinical experience in the experimental use of antiretroviral agents in patients with PBC with the broader experience of using these agents in people living with HIV infection. While the incidence of gastrointestinal side effects in the PBC population appears somewhat increased compared to those with HIV infection, the clinical improvement observed in patients with PBC suggests that further studies using the newer and better tolerated antiretroviral agents are warranted.

Abstract Background Sub Saharan African (SSA) prisons have seen a substantial increase in women prisoners in recent years. Despite this increase, women prisoners constitute a minority in male dominated prison environments, and their special health needs are often neglected. Research activity on prison health remains scant in SSA, with gathering of strategic information generally restricted to infectious diseases (human immunodeficiency virus infection HIV/tuberculosis TB), and particularly focused on male prisoners. Health care provisions for women (and pregnant women) in SSA prisons are anecdotally reported to fall far short of the equivalence care standards mandated by human rights and international recommendations, and the recent agreements set out in the Southern African Development Community (SADC) Minimum Standards for HIV in Prisons. Methods A scoping review mapped what is currently known about women prisoners’ health experiences, unique prison health care needs and health care outcomes in SSA. A systematic search collected and reviewed all available and relevant published and grey literature (2000–2017). Following removal of duplicates and application of exclusion measures, 46 records remained, which represented 18 of the 49 SSA countries. These records were subsequently charted and thematically analysed. Results Three themes were generated; ‘The Prison Regime’; ‘Navigating inside the Prison Health Infrastructure’ and ‘Accessing the outside Community and Primary Care Health Services’. Women in SSA prisons experience the same substandard nutrition, overcrowding and unhygienic conditions which exacerbate poor health and infectious disease transmission as males. Human rights abuses, substandard prison conditions and poor access to prison based and community clinical care, along with the invisible nature of women and that of their unique health needs are deplorable. Conclusions The review has highlighted the dearth of gender specific strategic information on women prisoners in the region, appalling environmental conditions and prison health care provision, and violation of human rights for those incarcerated. Enhanced donor support, resource allocation, prison health and population health policy reform, health systems surveillance and gender sensitive prison health service provision is warranted. This will help address women prisoners’ conditions and their specific health needs in SSA prisons, and ultimately bridge the gap between prison and population health in the region.

Anaemia remains a common global health issue with approximately a quarter of the worlds’ population affected despite universal initiatives to address the disorder. Iron deficiency anaemia and anaemia of chronic disease remain the two top ranking causes of anaemia globally and when these conditions co-exist, diagnosis is often challenging. In South Africa, high-risk groups include children, pregnant women and human immunodeficiency virus infected individuals. The morbidity and mortality associated with anaemia mandates the correct identification of the underlying cause, thus ensuring early, appropriate management. This review proposes morphological assessment with the appropriate baseline biochemical testing as the initial approach to unexplained anaemia in a primary health care setting in South Africa, in order to expedite diagnosis and ensure appropriate management.

Objective: To describe peripheral blood monocyte to lymphocyte (ML) ratio in tuberculous meningitis (TBM) patients with human immunodeficiency virus (HIV) infection in Dr. Hasan Sadikin General Hospital Bandung as a tertiary hospital in West Java Province, Indonesia. Methods: A cross-sectional study with retrospective data approach was done in Dr. Hasan Sadikin General Hospital, Bandung. Data were collected from TBM patients who were hospitalized in Dr. Hasan Sadikin General Hospital, Bandung in the period of 2014–2016. The sample size was determined using total sampling method. General data, clinical manifestation data, and laboratory finding data were collected. The ML ratio was collected and presented into three groups of percentile (25th, 25–75th and 75th) based on the pre-defined cut-off. Results: Six subjects (40%) had an ML ratio of ≤0.47 and 3 subjects had an ML ratio of ≥1.22 in TBM with HIV population. Among TBM with HIV-negative population, there were 16 subjects had ML ratio ≤0.47, and 19 subjects had ML ratio ≥1.22. Conclusions: The ML ratio in TBM with HIV infection has become additional tool for detecting the development of TBM with HIV-infected, as well as TBM with non-HIV-infected. Therefore, it could help directing the patients with clinical suspicious of TBM into the diagnosis algorithm and treatment of TBM, to have better outcome.