Update on Opportunistic Infections in the Era of Effective Antiretroviral Therapy

Zanoni, Brian C.; Gandhi, Rajesh T.

doi:10.1016/j.idc.2014.05.002

Cited by 34 publications

(26 citation statements)

References 91 publications

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“…Moreover, at any given location modification of the composition of the microbiota may occur caused, for example, by antibiotic treatments [Crielaard, 2013]. Once the balance of the immune system is re-established, the oral microbiota remains stable and opportunistic infections/dysbiosis can be prevented [Zanoni and Gandhi, 2014]. The term "dysbiosis" is sometimes used to refer to the changes in the composition of the microbiota in particular niches (for example, those found in deep periodontal pockets), but such changes are more likely an adaptation of the normal microbiome to a modified microenvironment rather than strictly a dysbiosis, a term that normally refers to microbial imbalance or maladaptation within the microbiome.…”

Section: The Human Oral Microbiomementioning

confidence: 99%

Caries and Periodontitis: Contesting the Conventional Wisdom on Their Aetiology

Manji¹,

Dahlén

Fejerskov

2018

Caries Res

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We review the literature on the oral microbiome and the role of the microbiota in the development of dental caries and periodontitis. While most research has been focused on identifying one or more specific determinants of these diseases, the results have provided limited predictive value and have not been able to explain the variation in the distribution of these diseases observed in epidemiological or clinical studies. Drawing on existing knowledge about the nature of the oral microbiota, we suggest that a stochastic model based on the Weiner process provides simple and parsimonious explanations for the pathogenesis of both caries and periodontitis, making few assumptions, and providing explanations for phenomena that have hitherto proved difficult, or have required complex arguments, to explain. These diseases occur as the result of the dental hard tissues and periodontal tissues integrating the random “noise” caused by normal metabolic activities of commensal microorganisms in the dental biofilm. The processes that result in the progression and regression of caries and periodontitis may be considered as “natural,” rather than pathological, even if, when left unchecked over long periods of time, they can result in the development of pathologies. The likelihood of progression or regression can be influenced by other determinants, but these processes will nevertheless occur in the absence of such influences. The distributional characteristics of the model approximate the findings of epidemiological studies indicating that, for both caries and periodontitis, there will be few sites affected in the early period after the eruption of the permanent dentition, but in those older there is an almost linear relationship with increasing age; furthermore, the longer a site survives without being affected, the less likely that it will be affected. We discuss the clinical and public health importance of these findings.

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Section: The Human Oral Microbiomementioning

confidence: 99%

Caries and Periodontitis: Contesting the Conventional Wisdom on Their Aetiology

Manji¹,

Dahlén

Fejerskov

2018

Caries Res

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“…Chronic HIV infection more than any other infectious disease is a disease of co-infections, as the HIV virus cripples the immune system and allows reactivation of dormant pathogens or increases susceptibility to exogenous pathogen[1]. These co-infections fuel further the immune activation that characterizes HIV infection, even after initiation of anti-retroviral therapy (ART).…”

Section: Introductionmentioning

confidence: 99%

HIV infection and immune activation

Boulougoura

Sereti

2016

Current Opinion in HIV and AIDS

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Purpose of review To explore new data from recent studies addressing the role of co-infections in immune activation in HIV-1 infected patients, with a focus on Immune Reconstitution Inflammatory Syndrome (IRIS), an aberrant inflammatory response occurring shortly after antiretroviral therapy (ART) initiation. Recent findings Chronic HIV infection is associated with a number of co-infections that contribute to immune activation in various settings including early after ART initiation in the most noticeable form of IRIS and also in chronic treated infection, with chronic viral infections like CMV and HCV or HBV contributing to immune activation and also morbidity and mortality. Expanding on older studies, the role of T cells in IRIS has been further elucidated with evidence of more pronounced effector activity in IRIS patients that may be leading to excessive tissue pathology. Newer studies are also continuing to shed light on the role of myeloid cells in IRIS as well as the contribution of antigen load in the syndrome. In addition, preliminary data are beginning to suggest a possible role of inflammasome formation in IRIS. In cryptococcal IRIS, the role of activated immune cells (T cell and myeloid) and biomarkers were evaluated in more detail at the site of infection (CSF). Finally, important differences of patients developing IRIS versus those who die from TB despite ART initiation were reported, a distinction that may have important implications for participant selection in studies aiming to prevent IRIS with immunosuppressive agents. Summary Better understanding of the role of opportunistic infections at ART initiation and IRIS pathogenesis will assist in improved strategies for prevention and treatment. The long-term consequences of IRIS remain unclear. Chronic viral coinfections with herpesviruses and HCV are important factors in persistent immune activation in chronic treated HIV.

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“…Owing to a weakened immune system, the infected person is placed at an increased risk of a wide variety of opportunistic infections [ 4 , 5 ]. A number of protozoa, fungi, viruses, and bacteria are responsible for such infections [ 6 , 7 ]. Fungal opportunistic infections in patients infected with HIV are a major cause of morbidity and mortality [ 8 ] and compromise the quality of life of such individuals.…”

Section: Introductionmentioning

confidence: 99%

CandidaSpecies Prevalence Profile in HIV Seropositive Patients from a Major Tertiary Care Hospital in New Delhi, India

Maheshwari¹,

Kaur

Chadha

2016

Journal of Pathogens

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Candida is a common opportunistic pathogen during the course of human immunodeficiency virus (HIV) disease progression. Changes in the clinical severity of candidiasis and the Candida species prevalence profile may be a reflection of immunological changes in HIV positive patients. The aim of this study was to document the changing pattern of Candida species prevalence profile in HIV seropositive patients from a tertiary care hospital in North India. One hundred and twenty HIV seropositive subjects were recruited for Candida microbial screening. Clinical specimens including blood, oral swabs, expectorated or induced sputum/bronchoalveolar lavage specimens, and urine were collected depending on the patient's symptoms. A total of 128 Candida isolates were obtained from 88 cases and 7 different Candida species were identified. C. albicans (50%) was the most common species isolated followed by C. glabrata (17%) and C. dubliniensis (12.5%). Other species isolated were C. parapsilosis (7.8%), C. krusei, C. tropicalis (4.6% each), and C. kefyr (3%). Strong clinical suspicion along with optimal sampling of an accurate diagnosis of Candida species involved would go a long way in decreasing the morbidity associated with non-albicans Candida species.

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Update on Opportunistic Infections in the Era of Effective Antiretroviral Therapy

Cited by 34 publications

References 91 publications

Caries and Periodontitis: Contesting the Conventional Wisdom on Their Aetiology

Caries and Periodontitis: Contesting the Conventional Wisdom on Their Aetiology

HIV infection and immune activation

CandidaSpecies Prevalence Profile in HIV Seropositive Patients from a Major Tertiary Care Hospital in New Delhi, India

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