MICROBES, VIRUSES AND PARASITES IN AIDS PROCESS Edited by Vladimír Zajac Microbes, Viruses and Parasites in AIDS Process Edited by Vladimír Zajac Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Alenka Urbancic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright RAJ CREATIONZS, 2011. Used under license from Shutterstock.com First published September, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Microbes, Viruses and Parasites in AIDS Process, Edited by Vladimír Zajac p. cm. ISBN 978-953-307-601-0 free online editions of InTech Books and Journals can be found at www.intechopen.com Contents Preface IX Chapter 1 Clinical Manifestations of HIV-Infection in the Era of Highly Active Antiretroviral Therapy 1 Sara Guillén, Luis Prieto, Marta Ruiz Jiménez and José T. Ramos Chapter 2 HIV-1 Super Infection 23 Maria Pernas and Cecilio López-Galindez Chapter 3 HIV/Aids Fact Sheet – Predisposing Factors the Nigeria Situation 35 Dibua Uju Chapter 4 Pearls and Pitfalls of HIV-1 Serologic Laboratory Testing 55 Jiasheng Shao, Yunzhi Zhang, Yi-Wei Tang and Hongzhou Lu Chapter 5 The Sub-Saharan African HIV Epidemic - “Successes and Challenges” 67 Roos E. Barth and Andy I.M. Hoepelman Chapter 6 AIDS and Opportunistic Infections 87 Aydin Çiledağ and Demet Karnak Chapter 7 Pneumocystis jirovecii Pneumonia in AIDS Patients 113 Jose M. Varela, Francisco J. Medrano, Eduardo Dei-Cas and Enrique J. Calderón Chapter 8 Bacterial and Parasitic Agents of Infectious Diarrhoea in the Era of HIV and AIDS - The Case of a Semi Rural Community in South Africa 143 Samie A., Bessong P.O., Obi C.L., Dillingham R. and Guerrant R.L. Chapter 9 Reducing Urogenital Infections Including HIV in Sub-Saharan Africa - Can Probiotics Be a Viable Paradigm? 183 Kingsley C. Anukam, Enya B. Bassey and Emmanuel O. Osazuwa VI Contents Chapter 10 Poverty, Parasitosis and HIV/AIDS - Major Health Concerns in Tanzania 207 Kennedy Daniel Mwambete and Mary Justin-Temu Chapter 11 Collaborative Approach to Prevent Leprosy and HIV Coinfection in Abia, Ebonyi and Oyo States of Nigeria - Best Practices for a Healthier Population 237 Ezinne E. Enwereji, Chukwunenye I. Okereke and Kelechi O. Enwereji Chapter 12 The Impact Water, Sanitation and Hygiene Infrastructures Have on People Living with HIV and AIDS in Zimbabwe 249 Natasha Potgieter,Tendayi B. Mpofu and Tobias G. Barnard Chapter 13 Mycotic Leukonychia in HIV Patients 267 Patricia Chang, Gabriela Moreno-Coutiño and Roberto Arenas Chapter 14 Cryptosporidiosis - From Epidemiology to Treatment 289 Anane Sonia Chapter 15 Toxoplasmosis in HIV/AIDS Patients - A Living Legacy 307 Veeranoot Nissapatorn Chapter 16 Use of Polymerase Chain Reaction for the Determination of About 2.5 kb fpvA and fpvB Gene Sequences in Pseudomonas aeruginosa Strains 353 Julie Osaretin Osayande Chapter 17 The Role of Bacteria and Yeasts in AIDS 375 Vladimír Zajac, Zuzana Adamcikova, Vladimir Holec, Katarina Hainova, Viola Stevurkova and Lenka Wachsmannova Preface A large number of diseases have appeared during the past half century, yet for many of them the reasons have so far remained unexplained. One of the most feared representatives is the acquired immune deficiency syndrome (AIDS). AIDS emerged suddenly, unexpectedly, and in the course of less than two decades it became one of the leading diseases in the world. The majority of scientists and clinicians, except Duesberg and some others, have accepted the data leading to the conclusion that HIV alone is the etiologic agent responsible for this disease, which has been identified as a global pandemic. Despite the unquestionable success in diagnosis and therapy, there are many unanswered questions which preclude a more successful treatment of the disease. The substantial argument of this predication is the fact that it is still not possible to stop the worldwide pervasion of AIDS, especially in Africa and Asia. The presented book is predominantly focused on opportunistic diseases of HIV positive patients. The majority of the chapters are from African authors, providing the reader with a fair overview on the prevalence of opportunistic infections of AIDS patients in several African countries. The overall picture of the AIDS situation in Africa is inconsolable, if not apocalyptic. Poverty, parasitosis and AIDS are closely interlinked and co-circulate in many populations. AIDS, parasitic infections and other opportunistic infections are by far the commonest causes of illness and death in the poorest countries of the world, that happen to be in the tropics and temperate countries in Africa, Asia, and South America. Parasitic infections remain an important cause of morbidity and mortality in developing countries, especially among HIV- infected persons. This alarming situation evokes the question whether opportunistic infections induced by microbes, viruses and parasites are not only the consequence of the immunodeficient condition of the patients, but play a rather more active role in AIDS than acknowledged so far. To date this question could not be answered and its elucidation requires further intensive and target-aimed research. Africa suffered very markedly from iatrogenic AIDS through dangerous medical interventions, including mass vaccination programs carried out by poorly trained individuals. Recent work by researchers from some laboratories has provided serious X Preface evidence that the heterosexual route for transmission of AIDS in Africa has been greatly overstressed and that iatrogenic factors have been very much underestimated. The book raises the basic question – what is the origin of HIV? The explanation that AIDS arose from a secluded area in Africa, where a virus was transmitted to man from another primate is unacceptable for some researchers. This concept is not able to answer the crucial questions: 1) Why would the immunodeficiency viruses stay put in simians for thousands of years and then suddenly, within a decade atack humans? 2) Was the virus, according to this concept, transferred by several accidental events from apes to humans, resulting in a world- wide pandemics? 3) The diversification of the ancestors of HIV into the HIV-1 and HIV-2 halves of the evolutionary tree would have occurred long before that, perhaps hundreds or even thousands of years ago, and not during the last three-four decades? In the book an original, for some readers maybe heretical idea, is presented, maintaining that HIV, similarly as other retroviruses, have been an integral part of a particular host organism since the beginning of their existence as species and were passed on from generation to generation. The hosts – including humans - inherited them from their ancestors. In accordance with this idea, it is assumed that transfer of the HIV from apes to humans in Africa, as a consequence of their accidental contact, is not the cause of AIDS pandemics. This hypothesis is confirmed by experimental results, which should be verified by other laboratories. New ideas in this health field are highly needed, as they may open new ways for research and therapy. Several studies have shown that probiotics could enhance the health and well-being of AIDS patients, but sadly the use of probiotics in Africa has not become popular for several reasons. First, pharmaceutical companies that manufacture probiotics would be forced to lower prices, which would adversely affect their revenues. Secondly, storage and distribution problems make the administration of probiotics difficult. The lack of any probiotic fermented, clinically proven products in Africa at present, with some exceptions, makes it hard to perform studies and provide benefits to the population. The fight against AIDS is challenging and should be realized in a more complex manner, overcoming all the taboos and dogmas surrounding the disease. As presented by a couple of book authors, it is necessary to consider other potential factors, not only HIV, which may be involved in this disease. They try to offer a new way ahead of our understanding of AIDS and the mechanisms underlying it, which may be very important to future development of research and treatment. Assoc. Prof. Vladimir Zajac, PhD. Cancer Research Institute, SAS, Bratislava, Slovakia [...]... opportunistic infection and IRIS Opportunistic infections can occur in HIV-infected children experiencing virologic and immunologic failure on HAART If symptoms appeared within the 12 weeks after initiation HAART, it may indicate ¨unmasking IRIS¨, so HAART must be continued and opportunistic infection treatment 16 Microbes, Viruses and Parasites in AIDS Process initiated If symptoms occurred after 12 weeks and. .. Smooth-muscle tumors are reported in the gastrointestinal tract, liver, spleen and lung In HIV-infected children these tumors are strongly associated to EpsteinBarr virus In a study of malignancy in HIV-infected children no significant differences were found in the overall rates of soft tissue cancer between HIV-infected children and uninfected 6 Microbes, Viruses and Parasites in AIDS Process children Leiomyosarcoma... opportunistic infections, medications and malnutrition Generalized lymphadenopathy is another common clinical finding in HIV-infected children, but a differential diagnosis must be done with other viral infections, opportunistic and mycobacterial infections, and malignancy 4 Microbes, Viruses and Parasites in AIDS Process Clinical stage 1 Asymptomatic Persistent generalized lymphadenoapathy Clinical stage... decreased in HIV-infected children who have access to HAART Frequent causes of hospitalization like 2 Microbes, Viruses and Parasites in AIDS Process bacterial infections and opportunistic infections have diminished after introduction of HAART (Puthanakit et al., 2007) Many children died of Pneumocystis carinii pneumonia whereas others succumbed to a variety of opportunistic infections, including disseminated... Varicella vaccine is indicated in two dose schedule in HIV-infected children more than 12 moths of age, in CDC clinical class N, A or B with CD4 threshold as stated for MMR vaccination and without evidence of varicella immunity Live-attenuated human rotavirus vaccine have been studied in HIV infected infants, in clinical stages I and II according to WHO classification, in a three dose schedule starting on... recommendations for early administration of HAART among infants 18 Microbes, Viruses and Parasites in AIDS Process It is currently recommended to start vaccination of HIV-infected children in infancy with some modifications of the routine immunization schedule: - Hepatitis B virus (HBV) immunization in a four-dose-schedule starting soon after birth is recommended Standard doses are advised as the infant should not... HIV-infected when vaccinated with bacille Calmette-Guérin (BCG) at birth, and who later developed AIDS, were at increased risk of developing disseminated BCG disease Among HIV-infected infants, the benefits of potentially preventing severe tuberculosis therefore appear to be outweighed by the risks associated with the use of BCG vaccine In 2007, HIV infection in infants was considered a full contraindication... Reconstitution Inflammatory Syndrome (IRIS) Curr Opin HIV AIDS, Vol 3 No 4, (July 2008), pp 461-467 Bretlinger, PE, (2006) Challenges in the concurrent management of malaria and HIV in pregnancy in sub-Saharan Africa Lancet infect Dis, Vol 6, No 2, (February 2006), pp 100-111 20 Microbes, Viruses and Parasites in AIDS Process CDC (1994) Revised classification system for human immunodeficiency virus infection in. .. antiretroviral agents in pediatric HIV infection (August 2010) Available from: http://aidsinfo.nih.gov/contentfiles/PediatricGuidelines.pdf Chiapinni, E et al (2007) Changing patterns of clinical events in perinatally HIV-1-infected children during the era of HAART AIDS, Vol 21, No.12, (2007), pp 1607-1615 Chintu, C et al (2004) Co-trimoxazole as prophylaxis against opportunistic infections in HIV-infected Zambian... antiretroviral treatment in vertically infected children are of major importance The recommendation to start HAART in children has shifted towards an earlier initiation, to include infants less than 2 years in WHO guidelines in developing countries and in less than one year old in American and European guidelines, independently of immunological stage (WHO, 2010; CDC, 2010; PENTA, 2009) Primary and secondary prophylaxis . MICROBES, VIRUSES AND PARASITES IN AIDS PROCESS Edited by Vladimír Zajac Microbes, Viruses and Parasites in AIDS Process Edited by Vladimír. parasitosis and AIDS are closely interlinked and co-circulate in many populations. AIDS, parasitic infections and other opportunistic infections are by far the commonest causes of illness and death in. causes of hospitalization like Microbes, Viruses and Parasites in AIDS Process 2 bacterial infections and opportunistic infections have diminished after introduction of HAART (Puthanakit