Global prevalence and associated risk factors of diarrheagenic Giardia duodenalis in HIV/AIDS patients: A systematic review and meta-analysis.

Early diagnosis of cryptococcal meningitis among people living with HIV (PLHIV) is crucial for its therapeutic success. The objective of this study was to diagnose cryptococcal meningitis in PLHIV cases using the available laboratory techniques for its confirmation in resource limited setting. This cross‐sectional prospective study was conducted among 72 PLHIV with clinical suspicion of meningitis. Each cerebrospinal fluid (CSF) sample received at the National Public Health Laboratory, Kathmandu was processed for India ink staining, cryptococcal antigen lateral flow assay, and fungal culture following standard protocols. The laboratory‐confirmed cryptococcal meningitis cases were between 24 and 69 years of age (median age 39 years) with 87.5% (12/14) of cases being male. Cryptococcus was detected in 22.22% (16/72) by any of the three tests, 19.44% (14/72) by cryptococcal antigen lateral flow assay, 16.66% (12/72) by India ink staining, and 8.33% (6/72) by culture. High percentage of cryptococcal meningitis among PLHIV warrants early microbiological diagnosis for better case management. Cryptococcal antigen detection immunoassay should be the priority test for laboratory diagnosis of cryptococcal meningitis in PLHIV. Alternatively, very simple and economic India ink staining of CSF specimens could be used in resource limited settings.

Cryptococcal meningitis in people living with human immunodeficiency virus in Nepal: Perspectives from resource limited setting

Introduction: Prevention of Human Immunodeficiency Virus infection is a high priority for the government of Nepal, so the government has been scaling up Anti Retroviral Therapy centers throughout the country. The objective of our study was to find out the prevalence of people living with Human Immunodeficiency Virus infection on Anti Retroviral Therapy service.
Methods: This descriptive cross-sectional study was done in Lamjung district hospital, from May 2017 till August 2017 after taking ethical clearance from the institutional review committee. The study was done in 96 patients and convenience sampling was done. The data collected was entered in Microsoft Excel and analyzed in Statistical Packages for Social Sciences version 17.0, point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.
Results: Out of the total 109 patients enrolled at the hospital, 85 (78%) were on ongoing Anti Retroviral Therapy. The predominant age group among patients using Anti Retroviral Therapy was 25-34 years 27 (31.7%) and the five most common clinical manifestation/opportunistic infections were fever 40 (47.1%), diarrhea 34 (40%), fatigue/generalized weakness 32 (37.6%), loss of appetite 25 (29.4%) and headache 18 (21.2%) among them. Out of total patients, 14 (12.8%) of our patients were under 14 years of age. We found 71 (83.6%) of the patients continued the original first-line regimen and in 14 (16.5%) one or two drugs were substituted in the original regimen. 
Conclusions: Our study showed a similar prevalence of people living with Human Immunodeficiency Virus infection on Anti Retroviral Therapy service with the other studies done within Nepal.

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Prevalence of Antiretroviral Therapy Use among HIV/AIDS Patients in a District Hospital.

There is a wide spread availability of highly active antiretroviral treatment but opportunistic illnesses still occur and result in an increased risk of mortality among persons with HIV/AIDS. The spectrum of illness that one observes, changes as the CD4+ cell count declines. The close relationship between clinical manifestation and CD4+ cell count has made measurement of the latter a routine part of evaluation of the progress of HIV infection in individuals: The objective of this study was to reveal the clinical spectrum and explore the different types of opportunistic infections in HIV/AIDS patients. A total of 234 patients with HIV/AIDS from three ART centers of Eastern Nepal were purposively selected for this cross sectional study conducted from May 2009 to April 2010. Statistical analysis was done using SPSS version 11.5. Chi-squared test and Student's t test were applied to find the association between the variables. A p-value less than 0.05 was considered to be significant. Out of the 234 patient, 85% were found to be symptomatic. Most common presenting symptoms were weight loss (74.4%) followed by fever (59.4%). Around 64% of HIV/AIDS patients had a CD4+ cell count below 200 cells/mm3. Most common opportunistic infections were tuberculosis (51.1%) followed by oral candidiasis (21.7%). A significant relationship (p < 0.001) between decrease in CD4+ cell count and occurrence of opportunistic infections in HIV/AIDS patients was seen.

V K Khanal

Papers

Opportunistic infections and clinical profile of HIV/AIDS patients: A study from eastern region of Nepal.