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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 1  |  Page : 7-10

Clinical profile of people living with human immunodeficiency virus


Department of Medicine, Dr V. M. Govt. Medical College, Solapur, Maharashtra, India

Date of Submission23-Apr-2019
Date of Decision20-Jan-2020
Date of Acceptance20-Jan-2020
Date of Web Publication2-Jun-2020

Correspondence Address:
Shubhangi Vithal Dhadke
Associate Professor, Department of Medicine, Dr V. M. Government Medical College, Solapur 413 003, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCSR.JCSR_59_19

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  Abstract 


Background: Clinical manifestations in people living with human immunodeficiency virus infection (PLHIV) can be protean.
Methods: We studied the clinical profile, neurological, cardiac manifestations and opportunistic infections (OIs) at the time of diagnosis in PLHIV at our medical college tertiary care teaching hospital in Solapur, Maharashtra, India.
Results: Majority of patients (36%) were observed in the age group of 31-40 years. The mmost common presenting complaint was fever (65%), followed by anorexia (34%), weight loss (33%), cough (22%) and fatigue (21%). Diarrhoea and headache were seen in 15% and 13% of the patients, respectively. Most of the patients had weight between 31 and 40 kg and 41 and 50 kg (48% in each). On general physical examination pallor (63%), oral thrush (30.4%) were commonly seen. Genital lesions and icterus were seen in 4.3% and 2.1% of the patients, respectively. Majority (31%) of patients had CD4+ counts (/mm3) in the range 151 and 200. Most of the of patients (30%) had respiratory system involvement. Central nervous system (CNS) and gastrointestinal system manifestations were seen in 21% and 15% of the patients, respectively. Among infections tuberculosis (TB) was most common (46%) followed by Candidiasis (18%), Pneumocystis carinii pneumonia (PCP) (9.2%) and cryptococcosis (8.7%). Other infections seen were herpes (5.2%), Cryptosporidium parvum (3.9%), Isospora belli (2.6%), toxoplasmosis (2.6%), cytomegalovirus (CMV) (1.3%), hepatitis B (1.3%) and Epstein–Barr virus (1.3%).
Conclusions: TB is a common cause of morbidity in PLHIV. They further merit careful evaluation for assessing involvement of various organ systems, OIs.

Keywords: Human immunodeficiency virus, meningitis, tuberculosis


How to cite this article:
Dhadke VN, Jadhav M, Dhadke SV. Clinical profile of people living with human immunodeficiency virus. J Clin Sci Res 2020;9:7-10

How to cite this URL:
Dhadke VN, Jadhav M, Dhadke SV. Clinical profile of people living with human immunodeficiency virus. J Clin Sci Res [serial online] 2020 [cited 2020 Jul 11];9:7-10. Available from: http://www.jcsr.co.in/text.asp?2020/9/1/7/285716




  Introduction Top


Human immunodeficiency virus (HIV) infection is a global pandemic. Acquired immunodeficiency syndrome (AIDS) continues to be a major global health priority. HIV causes progressive impairment of the body's cellular immune system leading to increased susceptibility to tumours, and the fatal conditions know as AIDS.[1] The present study was designed to study the clinical profile of HIV-infected patients admitted in this hospital and to study the neurological, cardiac manifestations and opportunistic infections (OIs) in HIV patients.


  Material and Methods Top


The present study was conducted at our medical college teaching hospital. One hundred cases with HIV/AIDS admitted to our wards, aged above 12 years, were included in the study. Patients over 18 years of age and having other immunosuppressive conditions were excluded. Written consent was obtained. Patients were examined thoroughly with history and clinical examination and relevant investigations.

The laboratory investigations that were done included rapid spot test by enzyme linked immunosorbent assay (ELISA), complete haemogram, erythrocyte sedimentation rate, serum biochemistry including liver and kidney function tests, abdominal ultrasonography,, serological testing for hepatitis B surface antigen (HbsAg), and hepatitis C virus (HCV),, sputum (Gram stain, acid-fast bacillus and culture), urinalysis, stool microscopy, chest X-ray, high-resolution computed tomography of thorax, computed tomography head (plain/contrast), cerebrospinal fluid

studies, CD4+ T-lymphocyte count and other relevant investigations. as the clinical condition warranted. These details were noted in case proforma.

Statistical analysis

Continuous variables are summarised as mean ± standard deviation and median (range); categorical measurements are presented in number and percentages.


  Results Top


Age distribution is shown in [Table 1]. In the present study, it was observed that majority of patients were observed in the age group of 31–40 years, i.e. 36%. Fewest patients belonged to the age group of 12–20 years, i.e., 1%. Majority of patients (59%) were males.
Table 1: Age distribution

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Clinical presentation is shown in [Table 2]. In the present study, it was observed that the most common presenting complaint was fever (65%), followed by anorexia (34%), weight loss (33%), cough (22%) and fatigue (21%). Diarrhoea and headache were seen in 15% and 13% of the patients, respectively. Other presenting complaints were altered behaviour (11%), dyspnoea (9%), chest pain (6%), convulsions (5%), abdominal pain (5%), dysphagia (3%), vomiting (2%), haemoptysis (1%) and paraplegia (1%). Body weight distribution is shown in [Table 3]. Most of the patients had weight between 31 and 40 kg and 41 and 50 kg with 48% of the patients in each. On general physical examination [Table 4], most of the patients had pallor (63%). Oral thrush was seen in 30.4% of the patients. Genital lesions and icterus were seen in 4.3% and 2.1% of the patients, respectively.
Table 2: Symptoms at presentation

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Table 3: Weight distribution

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Table 4: General physical examination

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Majority (31%) of patients had CD4+ counts (/mm3) in the range 151 and 200 [Table 5] and [Table 6]. Moreover, minimum number of patients, i.e., 2%, had CD4+ counts (/mm3) below 50. Among patients with tuberculosis (TB), and those with candidiasis, majority (57.1% each) of patients had CD4+ counts (/mm3) 151-250 [Table 7].
Table 5: CD4+ count distribution

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Table 6: CD4+ counts in patients with tuberculosis

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Table 7: CD4+ counts in patients with candidiasis

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System involvement is shown in [Table 8]. Most of the of patients (30%) had respiratory system involvement. Central nervous system (CNS) and gastrointestinal system manifestations were seen in 21% and 15% of the patients, respectively. Anaemia was seen in 12% of the patients. Least common systems involved were hepatobiliary system (2%), genitourinary system (1%) and cardiovascular system (1%). Other patients had candidiasis (14%), oral hairy leukoplakia (1%) and herpes lesion (3%). Among infections ([Table 9]), TB was most commonly seen in 46% of the patients. Candidiasis, Pneumocystis carinii pneumonia (PCP) and cryptococcosis were seen in 18%, 9.2% and 8.7% of the patients, respectively. Other infections seen were herpes (5.2%), Cryptosporidium parvum (3.9%), Isospora belli (2.6%), toxoplasmosis (2.6%), cytomegalovirus (CMV) (1.3%), hepatitis B (1.3%) and Epstein–Barr virus (1.3%).
Table 8: System distribution

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Table 9: Opportunistic infections

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Among CNS manifestations, TB meningitis (TBM) was most commonly seen in 47.6% of the patients. Other manifestations were cryptococcal meningitis (28.6%), toxoplasmosis (9.5%), CMV retinitis (4.7%), post-herpetic neuralgia (4.7%) and PMLE (4.7%). Among respiratory manifestations, pulmonary TB was most commonly seen in 43.3% of the patients. Other respiratory manifestations were TB pleural effusion (20%), PCP (23.3%) and bacterial pneumonia (13.3%).


  Discussion Top


In the present study, it was observed that majority of the patients (36%) belonged to the age group of 31–40 years. Another study[1] reported that 86%–90.6% of the patients belonged to the age group of 15–49 years. In the present study, it was observed that majority of the patients were males (59%). Similar observations were reported in another study,[2] where 61% were men.

In the present study, the most common presenting complaint was fever (65%), followed by anorexia (34%), weight loss (33%), cough (22%) and fatigue (21%). Diarrhoea and headache were seen in 15% and 13% of the patients, respectively. Other presenting complaints were altered behaviour (11%), dyspnoea (9%), chest pain (6%), convulsions (5%), abdominal pain (5%), dysphagia (3%), vomiting (2%), haemoptysis (1%) and paraplegia (1%). In another study,[3] the most common symptoms at presentation were fever (78%), loss of appetite (76%), weight loss (74%) and cough (58%), whereas diarrhoea was seen in only 18% of the cases. These differences could be due to variations in the level of immunosuppression in these patients.

In the present study, on general physical examination, maximum number of patients had pallor (63%). Oral thrush was seen in 30.4% of the patients. Genital lesions and icterus were seen in 4.3% and 2.1% of the patients, respectively. In another study,[3] the most common finding on general physical examination was pallor (76%), oral thrush was seen in 45% of the patients, genital lesions in 10% of the patients, icterus was seen in 3% of the patients.

In the present study, majority of the patients (31%) had CD4+ counts between 151 and 200/mm3 In another study,[4] most of the patients (31%) presented with CD4+ counts of 51–200 cells/μL; 26% had CD4+ counts of above 350 cells/μL.

In the present study, majority of the patients (30%) had respiratory system involvement. CNS and gastrointestinal system manifestations were seen in 21% and 15% of the patients, respectively. Anaemia was seen in 12% of the patients. Least commonly involved systems were hepatobiliary system (2%), genitourinary system (1%) and cardiovascular system (1%). Other patients had candidiasis (14%), oral hairy leukoplakia (1%) and herpes lesion (3%). In another study[5] among patients with OIs, the respiratory system was more commonly affected (56%), followed by nervous system (26%), skin (15%) and genital system (10%).

In the present study, among infections, TB was most commonly seen in 46% of the patients. Candidiasis, PCP and cryptococcosis were seen in 18%, 9.2% and 8.7% of the patients, respectively. Other infections seen were herpes (5.2%), C. parvum (3.9%), I. belli (2.6%), toxoplasmosis (2.6%), CMV (1.3%), hepatitis B (1.3%) and Epstein–Barr virus (1.3%). In a study,[6] various OIs noted were oropharyngeal candidiasis (41.9%), pulmonary and extrapulmonary TB (25.8%), recurrent pyogenic infections (12.9%), PCP (12.9%), AIDS dementia complex (9.7%) and recurrent herpes zoster (9.7%). In another study,[7] the predominant OIs were TB (47%), followed by parasitic diarrhoea (43.5%) and oral candidiasis (25.2%).

In the present study, among CNS manifestations, TBM was most commonly seen in 47.6% of the patients. Other manifestations were cryptococcal meningitis (28.6%), toxoplasmosis (9.5%), CMV retinitis (4.7%), post-herpetic neuralgia (4.7%) and PMLE (4.7%). Similar observations were reported in other studies.[6],[7],[8],[9]

In the present study, among respiratory manifestations, pulmonary TB was most commonly seen in 43.3% of the patients. Other respiratory manifestations were TB pleural effusion (20%), PCP (23.3%) and bacterial pneumonia (13.3%). In a study,[9] TB (49%) was the most common pulmonary manifestation. Cardiac manifestations were seen in one patient (TB pericardial effusion). Similar observations were reported in other studies.[6],[7],[8],[9]



Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Vyas N, Hooja S, Sinha P, Mathur A, Singhal A, Vyas L. Prevalence of HIV and prediction of future trends in North-West region of India. Indian J Community Med 2009;25:384-8.  Back to cited text no. 1
    
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Pandey A, Damodar S, Bakkali T. Estimate of HIV prevalence and no. of people living with HIV in India. BMJ Open 2012;2:1-4.  Back to cited text no. 2
    
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Kamble KB. Descriptive study on clinical profile of patients with HIV in a tertiary care hospital. Int J Curr Res Rev 2014;2:137-43.  Back to cited text no. 3
    
4.
Matin N, Shahrin L, Pervez MM, Banu S, Ahmed D, Khatun M, et al. Clinical profile of HIV/AIDS-infected patients admitted to a new specialist unit in Dhaka, Bangladesh – A low-prevalence country for HIV. J Health Popul Nutr 2011;29:14-9.  Back to cited text no. 4
    
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Ramesh K, Gandhi S, Rao V. Clinical profile of human immunodeficiency virus patients with opportunistic infections: A descriptive case series study. Int J Appl Basic Med Res 2015;5:119-23.  Back to cited text no. 5
    
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Patel AK, Sheth JT, Vasa CV, Patel RK, Saxena DM. HIV disease: Clinical spectrum in state of Gujarat, India (Abstract No. PB0028). Int Conf AIDS 1994 Aug 7-12;10(1):150.   Back to cited text no. 6
    
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Vajpayee M, Kanswal S, Seth P, Wig N. Spectrum of opportunistic infections and profile of CD4+ counts among AIDS patients in North India. Infection 2003;31:336-40.  Back to cited text no. 7
    
8.
Satishchandra P, Nalini A, Gourie-Devi M, Khanna N, Santosh V, Ravi V, et al. Profile of neurologic disorders associated with HIV/AIDS from Bangalore, south India (1989-96). Indian J Med Res 2000;111:14-23.  Back to cited text no. 8
    
9.
Singh RP, Kashyap AK, Puri S, Whig J. Pulmonary manifestations in HIV seropositive patients and their correlation with cd4 counts in a tertiary care centre of North India. JK Sci J Med Edu Res 2013;15:140-4.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]



 

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