Considerations About Risk Factors for Peripheral Neuropathies in Romanian HIV-Infected Patients.

PURPOSE: The study aims at detecting risk factors for developing peripheral neuropathy in Romanian HIV infected subjects. MATERIAL/METHODS: retrospective study (january 1990-january 2009) who analyzed data from patients hospitalized in the Regional Center Craiova. We have compared 26 patients (group N) diagnosed with peripheral neuropathy  with 40 patients (group C) without neuropsychological sufferings, randomly selected. We have analysed: age, height, HIV mode of transmission, AIDS status, the average and nadir of CD4 lymphocytes, the mean viral load, the average duration of antiretroviral treatment (ART), use and duration of use of d-drugs, the presence of certain coinfection, diabetes or ethanol abuse. RESULTS: the following differences were statistically significant: age (31,54±14,64 vs 23,9±12,03 years, p=0.024), HIV mode of transmission  (parenteral/sexual: 13/13 vs 28/8, p = 0.044), the monitoring time duration (5,31±3,77 vs 7,75±5,4 years, p=0.043), median ART duration (37,2±9,66 vs 45,12±8,75 months, p=0.001). Close to the threshold of statistical significance are the CD4 nadir (97,33±65,6 vs 123,15±43,35 cells/mm3, p=0.058) and duration of use of d-drugs (22,5±31,94 vs 12,24±8,6 months, p=0.057). Odds ratio (OR) and relative risk (RR) increase with age. ROC analysis for the study group establishes a threshold difference of 29 years (sensitivity 50%, specificity 80%). CONCLUSIONS: higher age and advanced immunosupression are the most important risk factors for developing symptomatic peripheral neuropathy in Romanian HIV infected patients; taking into account the small number of cases studied, although not statistically significant, it should be noted the CD4 nadir and the length of d-drug use.

HBV influence on Response to Antiretroviral Therapy in Horizontally HIV-HBV Coinfected Patient during Early Childhood.

BACKGROUND: There are few studies on pediatric HIV-HBV coinfection, so evidences about relationships between the two viruses are scarce. OBJECTIVES: influence of HBV infection on virological and immunological response to antiretroviral therapy (ART) in antiretroviral-naïve horizontally HIV-HBV coinfected subjects during early childhood. MATERIAL AND METHODS: observational study on 826 HIV+ subjects in evidence of Craiova Regional Centre (CRC); we analyzed the immunological and virological response at 6-12 months after starting first antiretroviral regimens compared in 2 groups: horizontally HIV-HBV coinfected subjects during early childhood (CoS) versus horizontally HIV infected subjects during early childhood without HBV infection (non-CoS). RESULTS: Number of subjects: CoS-66 subjects, non-CoS-132 subjects. Demographic data: CoS-gender ratio F:M=0.886, the majority lived in rural area (57.58%), mean age on diagnosis-9.288±4.607 years, non-CoS-gender ratio F:M=0.859, the majority lived in urban area (53.79%), mean age on diagnosis-10.742±5.107 years. At baseline, HIV category was: CoS-A-1.52%, B-80.30%, C-18.18%, non-CoS-A-2.27%, B-70.45%, C-27.27% (p Chi(2)=0.332), the mean CD4+ cell count was: CoS-148.33±148.10 cells/ml, non-CoS-163.17±155.39 cells/ml (p Student=0.521) and the mean HIV viral load (HIV VL) was: CoS-5.06±0.80 lgcopies/ml (for 29 subjects), non-CoS-5.04±0.84 lgcopies/ml (for 61 subjects) (p Student=0.978). At the end of the studied period, the mean increase in CD4+ cell count was: CoS-177.068±141.676 cells/ml, non-CoS-176.015±191.751 cells/ml (p Student=0.969) and the mean decrease in HIV VL was: CoS-5.04±0.79 lgcopies/ml, non-COS-4.69±2.04 lgcopies/ml (p Student=0.911). CONCLUSIONS: The presence of HBV coinfection does not influence immunological or virological response to ART.

[Surgical management of clinical problems in children with HIV infection]. / Elemente de patologie chirurgicala la copilul infectat HIV.

HIV infection is a very actual disease widespread all over the world (40 million people), including up to 10 thousand Romanian, are infected with HIV; there are 950 HIV-infected patients in Oltenia, 450 of them are in our county (Dolj area), 80% of the HIV-infected persons are children. The authors are studying a group of 17 cases of HIV-infected children with surgical problems (Acute appendicitis, acute cholecystitis, pulmonary and kidney abscess, lymphadenophlegmons, abdominal tumours), which have been transferred to our department from the Infectious Diseases Clinic, between 1995-2004. The medical records of all patients were reviewed: strategies of management, particularity of antiretroviral therapy of children, and also strategies of prevention the perioperative HIV transmission. The most frequent cases were the lymphadenophleg mons (40%) and chronic abdominal pain (25%). The acute abdominal pathology consisted in 2 cases of acute appendicitis and 1 case of acute cholecystitis, which were successfully treated. The HIV infection remains in actuality, because there is not an efficient antiretroviral therapy. Surgeons planning treatment must consider the risks of the patient against the potential benefits of surgery.

Genetic evidence of multiple transmissions of HIV type 1 subtype F within Romania from adult blood donors to children.

We studied the phylogeny of HIV-1 subtype F viruses from children and adults in Romania in order to (1) clarify whether the Romanian subtype F epidemic was caused by one or several virus introductions and (2) gain insight into the route of spread of the HIV-1 subtype F virus among children and adults in Romania. env (V3), gag (p17/half p24), and pol (prot/half RT) sequences were obtained from three districts in Romania: Tirgu Mures (n = 9, children), Craiova (n = 15, children), and Bucharest (n = 13, adults). Of 37 HIV V3 sequences from Romania, 35 belonged to the genetic subtype F in the neighbor-joining tree, whereas 2 sequences from adults clustered with subtypes A and C. Within the subtype F cluster, no bootstrap-supported subclusters were observed according to geographic area in Romania. Two of the adult V3 sequences that clustered with the children were obtained from individuals who tested HIV seropositive in 1989 and 1990, showing that the subtype F virus was present among adults when the HIV epidemic began among children in Romania. The HIV-1 subtype F viruses obtained from children showed a mean pairwise V3 nucleotide distance of 7.9% and maximum distances of between 18 and 19%; both are higher than previously described. The mean V3 distances (overall, synonymous, and nonsynonymous) were significantly higher for adults than for children. One V3 sequence from the Democratic Republic of Congo clustered within the Romanian sequences, suggesting that the subtype F virus in Romania may originate from this area. Our data also suggest that HIV-1 subtype F was present among Romanian adults before it appeared in 1989 among institutionalized children. The juvenile population was most likely infected with the HIV-1 subtype F virus on more than one occasion, presumably through HIV-contaminated blood (products) obtained from adults.

Some seroepidemiological data on HIV-antibody and HBs-antigen prevalence in children and infants of Craiova (Romania).

By testing 2362 children and infants from Craiova (Romania), for both HIV-antibody and HBs-antigen presence in the blood, a high rate of positivity was noticed in orphanages and in dystrophia units. A rate of "signal" (i.e. about 4% for HIV-antibodies, and 2.5% for HIV-antibody/HBs antigen), in hospitalized patients (pediatric service), was found as well. Four reasons support the horizontal way of virus transmission as the main route: most of seropositive subjects belong to 1-to-3-year age range, suggesting a virtual contamination before introduction of disposable syringes in Romania care units and hospitals; many HIV-seropositive cases have received frequent parenteral treatments, during repeated hospitalizations for acute respiratory disease; only few of the mothers of seropositive infants exhibited HIV-antibody presence; a relatively high rate of "double" seropositivity, i.e. HIV-antibody/HBs antigen, within tested serum samples was noticed.