Abstract:Context: Non communicable diseases (NCDs)

Introduction India has third largest human immunodeficiency virus (HIV) population in the world. Average HIV prevalence was 0.22% (range, 0.16–0.30%) in 2017, and Manipur is one of the five states with the highest prevalence of HIV. Cryptococcal meningitis being one of the acquired immunodeficiency syndrome (AIDS)-defining illnesses is the second most common cause of opportunistic neuro-infection and usually occurs in advanced HIV disease when the cluster of differentiation 4 glycoprotein (CD4+) count is usually less than 100 cells/µL. Treatment includes amphotericin-B induction therapy for 2 weeks followed by fluconazole consolidation therapy for 8 weeks as per National AIDS Control Organisation guidelines. There is not much data on how much infection is cleared off after induction and consolidation treatment. So, this study was conducted to know the clearance of Cryptococci in cerebrospinal fluid (CSF) after induction and consolidation treatment in people living with HIV (PLHIV)-associated cryptococcal meningitis. Objective This work aimed to study the persistence of cryptococcal meningitis after amphotericin-based 2 weeks of induction therapy and 8 weeks of consolidation therapy with fluconazole and to evaluate the association between CD4 count and clearance rate of cryptococcal infection. Materials and Methods The study was conducted in Department of Medicine, Regional Institute of Medical Sciences, Imphal, from 2016 to 2018. Fifty-one patients above 18 years of age diagnosed as cryptococcal meningitis with HIV were included and treated with amphotericin for 2 weeks and fluconazole for 10 weeks. CSF analysis was done at 2nd and 10th weeks to study the clearance of infection. Results At 2nd week of induction therapy, out of 51 patients, 28 (54.9%) got cleared of infection, 18 (35.3%) had persistent infection, and 5 (9.2%) patients had either died or discontinued treatment. At 10th week of consolidation therapy, 36 (70.5%) patients got cleared of cryptococcal infection, 2 (4%) patients were having persistent infection, and 5 (9.8%) patients died, while 8 (15.7%) patients were lost in follow-up. However, after excluding mortality and lost in follow-up cases, from analysis in final outcome, 94% (34 out of 36) patients showed response to this regimen. Conclusion The present study showed that cryptococcal meningitis in PLHIV responded to amphotericin-based induction therapy with 60% clearance of infection followed by fluconazole-based consolidation therapy with 94% of clearance of infection. However, there is still need for good antifungal regimen that could clear infection in induction phase with less side effects.

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Context:Epicardial fat envelopes the coronary vessel adventitia without fascial separation, thus pathologic inflammation in the fat may promote the growth of atherosclerotic plaque in coronary arteries in an ‘outside-in’ fashion. Epicardial fat is quantitatively increased in HIV compared to un-infected people.Aims:1. To assess Epicardial Adipose tissue (EAT) by Computed tomography (CT) in PLHIV receiving first line ART (antiretroviral therapy) 2. To correlate EAT with metabolic risk parameters.Material and Methods:215 HIV-infected patients aged >18 years on first line ART were included in the cross sectional study. EAT thickness were measured by CT scan. Metabolic parameters were measured based on metabolic syndrome criteria.Statistical Analysis Used:Data analysis was done using IBM SPSS version ver. 21. Probability value of less than 0.5 was taken as significant.Ethical Issues:The study was carried out after obtaining approval from the Institutional Ethical Committee (IEC), Regional Institute of Medical Sciences, Imphal.Results:Half of the patients were found to have EAT thickness of 8.1-9 mm and 12.6% of cases had EAT of >9 mm. Mean epicardial thickness was 8.3 mm ± 0.7 mm for whole population. Triglyceride and high density lipoprotein (HDL) were also found to have positive correlation with EAT thickness (rp= 0.364, P = 0.04 and rp= 0.343, P = 0.05 respectively).Conclusion:Epicardial adipose tissue thickness is increased in PLHIV receiving highly active anti retroviral therapy (HAART) and positively co-related with parameters of metabolic syndrome such as waist circumference, HDL cholesterol and triglyceride level.

AbstrakHuman Immunodeficiency (HIV) infection is often associated with the development of malignancies. Of them Lymphoma and Kaposi's Sarcoma (KS) occur very frequently. However the pattern of malignancies have been found to be changing. Here we describe four such cases of non-lymphomatous malignancies. CASE REPORTSCase 1 : A 24 years old male patient with history of intravenous drug use (IVDU) for a period of 8 years developed bilateral upper cervical adenopathy. Nasopharynx showed an infiltrating mass involving the roof and posterior wall. The histopathological report of the mass was moderately differentiated squamous cell carcinoma. X-ray base of skull showed left petrous bone erosion. He was tested positive for HIV antibody, however he did not have any features of AIDS complex. He was incompletely treated by tele cobalt therapy upto a midline dose of 3000 cGy/15 exposures, he left the treatment. He has been resumed death.Case 2 : A 35 year old male developed a swelling over the right lower alveolus and floor of mouth for 1 year duration. He gives history of IVDU for 10 years and was tested positive for HIV antibody. Radiological survey of bones did not show any lytic lesion. The cytological report of the swelling was Plasmacytoma. He was treated by 3 cycles of VAD chemotherapy (vincristine 0.4 mg, adriamycin 15 mg and tab. dexamethasone 120 mg for 1-5 day given four weekly) with 50% regression anterior to External Radiation Therapy (RT). A midline dose of 5000 cGy/25 exposures by tele cobalt therapy was given to face and neck with complete regression. However he developed severe radiation induced mucositis of grade III. He received two more cycles of VAD chemotherapy with very poor tolerance to chemotherapy. Soon he developed features of AIDS complex and expired from it.Case 3 : A 25 year old male with history of IVDU 5 years back developed epistaxis and cervical adenopathy. Nasopharynx showed a friable mass over the roof and anterior wall of Nasopharynx. The pathological report was undifferentiated nasopharyngeal carcinoma. He was found positive of HIV antibody. He was given one cycle of anterior chemotherapy consisting of Inj. Carboplatin 450 mg and 5 F.U. -1000 mgm with poor tolerance to chemotherapy and with poor response. He was then given external RT to