BACKGROUND Chronic diarrhoea in people living with human immunodeficiency virus(PLHIV)/acquired immunodeficiency syndrome presents a diagnostic challenge,often resulting from opportunistic infections(OIs),malignancies...BACKGROUND Chronic diarrhoea in people living with human immunodeficiency virus(PLHIV)/acquired immunodeficiency syndrome presents a diagnostic challenge,often resulting from opportunistic infections(OIs),malignancies,or disease progression itself.We present a case of an advanced human immunodeficiency virus(HIV)patient with chronic diarrhoea,significant weight loss,and antiretroviral therapy(ART)non-compliance,highlighting the diagnostic dilemma between HIV wasting syndrome,OIs,and malignancy.CASE SUMMARY A 36-year-old female,diagnosed with HIV five years ago on family screening,presented with three months of profuse watery diarrhoea,associated with crampy abdominal pain and weight loss(14 kg,30%in 3 months).She was non-compliant with ART.There was no history of recent travel,food contamination,or tuberculosis contact.Fever episodes were mild and transient.Physical examination revealed pallor and bilateral pedal oedema without lymphadenopathy or organomegaly.Genital examination was unremarkable.Routine investigations revealed severe anaemia and confirmed PLHIV status.CD4 count was<36 cells/μL.Empirical treatment with nitazoxanide was initiated for possible cryptosporidiosis.After ruling out OIs,ART was restarted.With treatment,her diarrhoea resolved,and she tolerated oral intake.Nutritional support was provided,and she was discharged in stable condition with ART,prophylactic antibiotics,and followup instructions for further evaluation.CONCLUSION In ART-noncompliant PLHIV with chronic diarrhoea,distinguishing between HIV wasting syndrome,OIs(Cryptosporidium,Mycobacterium avium complex,cytomegalovirus colitis)and malignancies(non-Hodgkin lymphoma and anal carcinoma)are critical.Gradual CD4 decline,systemic inflammation,and malnutrition favour progressive HIV/acquired immunodeficiency syndrome rather than an acute OI or malignancy.Early recognition and management,including ART reinitiation and nutritional support,are crucial for prognosis.展开更多
Increased microbial translocation and chronic immune activation are two critical problems for people living with HIV(PLWH)in the antiretroviral therapy(ART)era.Compared with numerous studies on bacterial microbiomic c...Increased microbial translocation and chronic immune activation are two critical problems for people living with HIV(PLWH)in the antiretroviral therapy(ART)era.Compared with numerous studies on bacterial microbiomic communities,there are only a limited number of studies focusing on fungal microbiomic composition and products in PLWH.This study protocol is used to evaluate the changes in bacterial and fungal microbiome populations induced by terbinafine treatment,which is an antifungal agent widely used amongst PLWH.Twenty-two PLWH on a stable ART regimen for more than six months,who require treatment for onychomycosis,will be recruited.The participants will be followed-up for a 12-week treatment period(oral terbinafine 250mg daily)and another 12-weeks of terbinafine discontinuation.Plasma and fecal samples will be collected before and after terbinafine treatment,and for 12weeks after the discontinuation of terbinafine.Plasma gut injury and microbial translocation biomarker assays,in addition to testing for gut microbiome composition,will be undertaken.With this pilot study,we will perform formal sample size calculations and test study feasibility for a possible full-scale study.展开更多
文摘BACKGROUND Chronic diarrhoea in people living with human immunodeficiency virus(PLHIV)/acquired immunodeficiency syndrome presents a diagnostic challenge,often resulting from opportunistic infections(OIs),malignancies,or disease progression itself.We present a case of an advanced human immunodeficiency virus(HIV)patient with chronic diarrhoea,significant weight loss,and antiretroviral therapy(ART)non-compliance,highlighting the diagnostic dilemma between HIV wasting syndrome,OIs,and malignancy.CASE SUMMARY A 36-year-old female,diagnosed with HIV five years ago on family screening,presented with three months of profuse watery diarrhoea,associated with crampy abdominal pain and weight loss(14 kg,30%in 3 months).She was non-compliant with ART.There was no history of recent travel,food contamination,or tuberculosis contact.Fever episodes were mild and transient.Physical examination revealed pallor and bilateral pedal oedema without lymphadenopathy or organomegaly.Genital examination was unremarkable.Routine investigations revealed severe anaemia and confirmed PLHIV status.CD4 count was<36 cells/μL.Empirical treatment with nitazoxanide was initiated for possible cryptosporidiosis.After ruling out OIs,ART was restarted.With treatment,her diarrhoea resolved,and she tolerated oral intake.Nutritional support was provided,and she was discharged in stable condition with ART,prophylactic antibiotics,and followup instructions for further evaluation.CONCLUSION In ART-noncompliant PLHIV with chronic diarrhoea,distinguishing between HIV wasting syndrome,OIs(Cryptosporidium,Mycobacterium avium complex,cytomegalovirus colitis)and malignancies(non-Hodgkin lymphoma and anal carcinoma)are critical.Gradual CD4 decline,systemic inflammation,and malnutrition favour progressive HIV/acquired immunodeficiency syndrome rather than an acute OI or malignancy.Early recognition and management,including ART reinitiation and nutritional support,are crucial for prognosis.
基金This work was supported by the Joint Medical Research Project(2020GDRC010)of Chongqing Science&Technology Bureau and Chongqing Health Commission,the Research Project of Chinese Federation of Public Health foundation(GWLM202024)the Youth Scientific Research and Innovation Fund Project of Chongqing Public Health Medical Center(2019QNKYXM02).
文摘Increased microbial translocation and chronic immune activation are two critical problems for people living with HIV(PLWH)in the antiretroviral therapy(ART)era.Compared with numerous studies on bacterial microbiomic communities,there are only a limited number of studies focusing on fungal microbiomic composition and products in PLWH.This study protocol is used to evaluate the changes in bacterial and fungal microbiome populations induced by terbinafine treatment,which is an antifungal agent widely used amongst PLWH.Twenty-two PLWH on a stable ART regimen for more than six months,who require treatment for onychomycosis,will be recruited.The participants will be followed-up for a 12-week treatment period(oral terbinafine 250mg daily)and another 12-weeks of terbinafine discontinuation.Plasma and fecal samples will be collected before and after terbinafine treatment,and for 12weeks after the discontinuation of terbinafine.Plasma gut injury and microbial translocation biomarker assays,in addition to testing for gut microbiome composition,will be undertaken.With this pilot study,we will perform formal sample size calculations and test study feasibility for a possible full-scale study.
