HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.
Methods: Descriptive case report. results: A 58-year-old man, diagnosed with HIV-1 in 1985 was subsequently diagnosed with VL in 1996 on gut biopsy; the latter was unmasked through HIV-associated immunodeficiency as leishmania was likely acquired during childhood years in Greece. Challenge 1: presumed L.infantum infection, as formal speciation was only possible in 2003 using an in-house PCR. Challenge 2: although the WHO “gold standard” for monitoring disease burden is splenic aspiration and culture, no unit would perform this due to understandable safety concerns – instead repeated bone marrow biopsies were used to “quantify” disease burden. Challenge 3: between 1996-2012 in accordance with various “guidelines” – based largely on HIV-negative experience, the patient received, in addition to combination antiretroviral therapy (cART ), successive “induction-maintenance” with pentavalent antimonials; miltefosine (imported from Germany); liposomal amphotericin and monthly pentamidine with azoles (posaconazole on compassionate access, later fluconazole). There was rapid clinical failure and ultimately clinical evidence of pan-resistance to all anti-parasitics. Progressive renal impairment, liver cirrhosis (Challenge 4) and increasing fraility meant that parenteral paromomycin was not a viable treatment option. Challenge 5 – immune failure ultimately leading to death from recurrent gram negative sepsis arising from ulcerated skin lesions infiltrated with leishmania.
Conclusion: Further data on induction-maintenance strategies using combination VL-therapeutics coupled with improved microbiological techniques for diagnosis and monitoring in the HIV setting are urgently needed. Moreover, these VL-therapeutics and cART need to be affordable and accessible in countries with endemic HIV-VL co-infection.
Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.
REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.
Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.
The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.
Early first sexual intercourse has been proposed as an important marker of later sexual and reproductive health. Discussions of what constitutes early sexual debut in this context, however, have been limited.
As part of the adult HIV and PPTCT (The Prevention of Parent to Child Transmission) services, Clinton Health Access Initiative, in collaboration with the Papua New Guinea Department of Health and Eastern Highlands Provincial Health Authority, implemented an HIV partner testing program in a public sector health center in Eastern Highlands Province in 2007. The program aimed to facilitate partner testing and disclosure in a safe environment, remove obstacles to care, involve partners in the promotion of infant HIV-free survival, increase early case detection and treatment among individuals at high-risk of HIV, and promote adherence antiretroviral treatment among PPTCT mothers.