5^th World Congress on Control and Prevention of HIV/AIDS, STDs & STIs June 19-20, 2017 London, UK

Mohammad Akram Randhawa graduated from King Edward Medical College, Lahore, in 1973 and completed his Masters from the University of Punjab in 977. He did his Post-graduate training in Clinical Pharmacology at St Bartholomew’s Hospital, London, UK. Later he obtained PhD degree from the Quaid-i-Azam University, Islamabad. Currently, he is working as Professor and Head of the Department of Pharmacology, College of Medicine, Northern Border University. He has around 50 publications in the international scientific journals, which include his original contributions related to the transport of drugs across body membranes, gastroesophageal reflux disease and Nigella sativa (Black seed).

Religion may be defined as a cultural system of behaviors and practices, based on believes about supernatural being/s and sacred texts that help humanity to live peacefully in a community. About 84% of world's population is linked to one of five major religions: Christianity, Islam, Judaism, Hinduism and Buddhism. Besides others, one thing common in these religions is marriage, which is a life-long cultural and spiritual union between man and women, and serves important objectives: propagation of human race and provision of a companion of life for love and enjoyment. Religions give great emphasis to marriage and discourage immorality and adultery. In Holy Bible, it is narrated, "Then the Lord God said, it is not good that the man (Adam) should be alone; I will make him a helper fit for him" (Genesis: 2, 18). Moreover, it is mentioned, "Let marriage be held in honor among all, and let the marriage bed be undefiled, for God will judge the sexually immoral and adulterous" (Hebrews 13:4). Holy Qoran describes marriage as a divine favor from God Almighty, "Among his signs is that he created for you spouses from among yourselves, that you may live in peace with them, and spread love and compassion between you and them; surely, there are signs in that for those who reflect" (30; 21). In Judaism marriage is an important event and avoiding from it is considered as unnatural. In Vedic Hindu traditions and Buddhism also marriage is a sacred ceremony and lifelong commitment between wife and husband. Present article is aimed to project religions and marriage as significant factors in the prevention and control of sexually transmitted diseases, particularly Human Immune-deficiency Virus (HIV) infection, which is becoming epidemic worldwide and there is no effective vaccine or treatment for that so far.

 

Gabriela Gore-Gorszewska has her interest in human nature from both philosophical and psychological perspective (Master’s degree from Jagiellonian University, Poland, in 2010 and 2016, respectively). In recent years, her interests focus upon human sexuality as seen by the psychologist. She has done her education from Adam Mickiewicz University in Poznań, Poland, to achieve Diploma in Clinical Sexology. Her main area of expertise and research is sexual functioning of older adults. Her aim is to promote accurate and up-to-date knowledge about age-related changes in sexual life. She beliefs there is still not enough understanding and too much prejudice among healthcare professionals, experts and authorities, seniors themselves and general population, especially within the communities with strong sexual taboo and/or religious attitudes present.

Statement of the Problem: Preventing sexually transmitted infections from spreading is a complex process, based on theoretical findings, as well as thorough, interdisciplinary research, both of biological and psychological nature. Practical application is the crucial part of prevention; plying gathered knowledge in real-life scenarios, testing in practice and affecting actual people.

 

Methodology & Theoretical Orientation: First-person reports from international team of specialists were gathered. Issues regarding the application of existing knowledge in educating the public were analyzed. An internet search was conducted to obtain details regarding chosen implementation methods.

 

Findings: Certain deficit of STI prevention programs seems evident. Several social campaigns are cursory. Sexual awareness varies in EU from country to country, reflecting either progressiveness or conservativeness on the grounds of sexual education, and sexual education level itself. Examples of both exemplary and poor educational programs can be found. A selection of evidence-based, innovative and unique programs is presented; those included bring up important, yet controversial issues.

 

Conclusion & Significance: The core idea is to present already developed strategies that proved to be adequate and applicable in variety of contexts, and to draw from their experience while promoting sexual health and STI prevention.

Joan J Rugemalila is a Medical Specialist working at the Infectious Diseases Unit, Department of Internal Medicine at Muhimbili National Hospital. She has 6 years’ experience managing advanced HIV patients, adverse effects and treatment failure of antiretroviral therapy. She is also working with National Institute of Medical research, Tanzania and St George’s University of London to conduct research on major HIV co- infections, Cryptococcal meningitis and tuberculosis. She has a special interest in clinical research aiming at addressing challenges of HIV therapy. She attained her Doctor of Medicine and Master of Medicine degrees from Tumaini University, Tanzania and holds a Post-graduate Diploma of Tropical Medicine and Hygiene from London School of Hygiene and Tropical Medicine and Fellowship Training in Global Health Leadership. She also serves as a member of the technical working group and clinical subcommittee, care and treatment, National AIDS Control Program.

Background: There is limited evidence of kidney disease and risk factors among people with HIV/AIDS in East Africa. The aim of this study was to determine the risk factors associated with moderate to severe chronic kidney disease (CKD) among HIV patients in Dar es Salaam, Tanzania.

 

Methods: A cross-sectional analysis of the baseline clinical data for 30,822 HIV-infected adult patients presented at HIV/AIDS care and treatment centers (CTC) in Dar es Salam, Tanzania was done. CKD was defined as presence of estimated glomerular filtration rate (eGFR<60 mL/min). Log binomial regression models were used to estimate relative risks and predictors of CKD.

 

Results: The overall prevalence of CKD was 11%. In multivariate adjusted analysis, CKD at the time of enrollment into care was significantly associated with age <30 years (RR 0.71, 95% CI 0.63-0.80) and age ≥50 years (RR: 1.93, 95% CI 1.76-2.15), compared with age 30≤40 years. Patients with clinical stage IV (RR 1.32, 95% CI 1.21-1.44) and alanine aminotransferase (ALT)>200 U/L (RR 1.80, 95% CI 1.13-2.86) were also at higher risk. Hemoglobin <7 g/dl (RR 1.67, 95% CI 1.52-1.83) and CD4<100 cells/mm3 (RR 1.18, 95% CI 1.04-1.34) were also associated with prevalence of CKD.

 

Conclusion: CKD was prevalent at the time of enrollment into care. Advancing age, ALT levels and advanced WHO clinical stage were major risk factors for CKD among HIV patients enrolling for care.

Ketty Vera Acuna Elizabeth, author of the titling work Prevalence of Latent Tuberculosis determined by the Interferon Gamma (IGRA) in patients from the Luis Vernaza hospital in the period between August of 2015 and March of the 2016. Previous to the obtaining of the title of physician at the Catholic University of Santiago de Guayaquil.

Background: The leading global epidemic Human Immunodeficiency Virus (HIV) infection has been well-documented. It is transmitted from an infected person to an uninfected one by two ways: horizontal and vertical transmission (VT), which is mother-to-child transmission (MTCT) and is acquired at one or more of the following stages: transplacentally in the uterus during pregnancy, perinatally during the process of labor and delivery and postnatally during breastfeeding. The reason of this study is to demonstrate that adequate management at each of these three moments reduces the MTCT.

 

Methods: A observational-retrospective study was carried out at Maternidad Matilde Hidalgo de Procel in Guayaquil, Ecuador to detect the prevalence of serorevertors newborns of VIH who received prophylactic antiretroviral treatment at birth, formula milk and whose mothers got administered antiretroviral therapy (ART) during pregnancy or partum according to the established schemes. These vertically exposed infants were followed up by an accredited pediatrician by the National Program of HIV-AIDS to receive special care during at least the first 18 months.

 

Results: One hundred pregnant women were enrolled. ART was started between the 14th and 28th pregnancy week in a 41%, after the 28th week in 24% and during labor or delivery in 35%. 100% of pregnant women received ART intra-partum. 100% of the newborns received antirretroviral prophylaxis from 6 to 8 hours old for 4-6 weeks according to the applied scheme. In both, mothers and children, the most frequently administered regimen was the C with 48% based on zidovudine. 100% of the newborns were fed by formula milk and 100% was serorevertor of HIV.

 

Conclusions: This study shows that MTCT was 0% due to the seroreversion in children at ≥18 months which represents that the treatments and properly applied procedures reduce the MTCT to zero and place Ecuador at the level of developed countries where the VT has been decreased at 1-2%.

Chloe Chan is doing his Major in Psychology with a Minor in Child and Adolescent Mental Health Studies from New York University, USA. She is currently a Program Coordinator at Health Leads and a Research Assistant at Bellevue Hospital Center. Her research interests lie in health disparities and sexual decision making.

With the rise of social media and smartphones, millennials increasingly report meeting their romantic partners through mobile dating apps. Yet there is concern that this may also be the reason behind the increase in sexually transmitted infection (STI) rates among young adults. This study examines whether contextual factors affect young adults’ perceived STI risk and engagement in sexual risk behaviors. In addition, we compare sexual histories among app users and non-users. We recruited our sample from 111 college Facebook groups over a 10-week period. Depending on their sexual orientation, participants were presented with 1 of 32 scenarios varying in levels of perceived risk. They answered questions pertaining to their sexual decision making, relationship status, dating app and sexual experience, condom usage, and STI testing experience. A total of 4,429 eligible participants between the ages of 18-24 completed the survey. Participants were more likely to believe that their partner had a greater number of sexual partners and engaged in casual sex if the scenario involved a male partner, perceived high-risk location, or one-night stand. They were more likely to enforce condom usage if their partner was male. Lastly, they were more likely to ask about their partner’s STI status if the scenario involved a male partner or one-month dating. Among sexually active participants, dating app usage was associated with sexual experience and having casual relationships,more sexual partners, higher perceived STI risk, and STI testing. While over half of the sexually active participants had inconsistent condom usage and had not been tested for STIs, they generally reported low perceived STI risk. Dating app users are more likely to engage in sexual risk behaviors and to have had STI testing. Thus, dating apps can be a useful platform for increasing STI knowledge and reducing the incidence of STIs among their users.

 

Patricia Garcia de Olalla is a Medical Doctor, Specialist in Preventive Medicine and Public Health. She is an Associate Professor of Public Health, University Pompeu Fabra. Since 1993, she works as an Epidemiologist at the Epidemiology Department of the Public Health Agency of Barcelona. Since 1995, she is Incharge of surveillance, prevention and control of HIV/AIDS and others sexually transmitted infections in Barcelona. She coordinates the Program Saunas-based

testing to detect HIV infection in Barcelona.

Background & Aim: Early diagnosis of HIV infection and its treatment improves health of patients and is essential to prevent HIV transmission. The aim of this study was to determine the prevalence, describe the trend and identify the factors associated with late presentation (LP) of HIV-infection in Barcelona during the period 2013-2015.

 

Methods: We analyzed the cases included in the register of HIV-infection. LP were defined as persons presenting for care with a CD4 count below 350 cells/μl or with an AIDS-defining event at the time of HIV diagnosis or within 6 months of the positive test, regardless of the CD4 cell count. Multivariate logistic regression was used to identify predictors of LP.

 

Results: Of the 1,115 cases studied, 479 (43.0%, 95% confidence interval (CI): 40.1%-45.9%) were LP. The prevalence of LP was 42.4% in 2013, 42.5% in 2014, 44.0% in 2015 (p=0.65). 39.6% (341 cases) of men who has sex with men (MSM) were LP, 60.2% (65 cases) of the heterosexual men (HTM) and 61% (22 cases) of the injecting drug users (IDU). After adjusting for place of birth and year of diagnosis, LP was more frequent in those older than 29 years (between 30 and 49 years old Odds ratio (OR): 1.4; CI: 1.1-1.8; older than 49 years old; OR: 2.5; CI: 1.2-5.38), in HTM and IDU when compared to MSM (OR: 2.5; CI: 1.2-5.38, and OR : 1.9, CI: 1.3-2.9, respectively), and in those reported from hospitals (OR: 2.1; CI: 1.3-3.2) when compared with those from units of sexually transmitted infections.

 

Conclusion: LP in 2015 remains at levels of previous years and continues to be very high in all transmission groups despite initiatives to increase access to HIV testing in our city. It is necessary to improve and develop new interventions that are more efficient for an early diagnosis of HIV.

Lamin Ceesay works at the Santa Yalla Support Society since January 1999. He started advocating for universal access to treatment care and support for people

living with HIV since December 2000.

As a person living with HIV (PLHIV) the author speaks frequently in public about the challenges faced by PLHIV. PLHIVs, especially women and girls face serious problems of stigma and discrimination. We need to address stigma and discrimination by developing a stigma reduction strategy, demystify ignorance and the fear of AIDS. The author also believe that we PLHIV are best placed to stop the further spread of the virus by disclosing our status and create more awareness among individuals and communities of the need for behavior change. We need to promote correct and consistent use of condoms to prevent the spread of the virus. Santa Yalla organizes training workshops on HIV for the members to create awareness about positive living for PLHIV. People want to know if the author still having sex and if yes, with whom. They want to know whether his children know his HIV status. We also conduct community HIV sensitizations meetings. We invite five villages in one forum. We meet with the village chiefs and elders and explain our mission and agreed with the chiefs that each village should come with two elderly men, two elderly women, three boys and three girls, and they will all assemble in the bigger village in that surrounding, and if the village chiefs agreed we select and agreed on a date for the meeting, and they should announce it to every-body in their communities. After all these we do a follow up to see if the announcement have reached everyone to attend the meeting, and we invite the Imam and the Pastor to do the opening prayers to bless the occasion. After the opening prayers, the introduction is done by the program manager, followed by presentation by a PLHIV during which we cover: HIV/AIDS and STIs, HIV counseling and testing, importance of PMTCT, HIV stigma and discrimination, care and support for PLHIV. We provide counseling and testing with partners. We do the counseling and our partner provides testing services. Taking this approach, we have made a lot of progress; a high number of people now know their HIV status. Follow up after testing is also conducted to those who tested positive to support them enrolls into care and into the HIV support groups. It can be concluded that, for effective response to the HIV and AIDS epidemic, concerted efforts are required and PLHIVs actively participate in

the planning, implementation and monitoring of the HIV program.

Gesesew Hailay has his expertise in Epidemiology. His multi-method approach assessing in each cascades of HIV care continuum will establish a significant contribution for the AIDS ending goal. He has been publishing a lot of peer reviewed articles on the area of HIV care in reputable journals. His publications produced from his PhD will improve the HIV care in developing countries especially Ethiopia. He has been serving as a Clinician, Academician and Researcher.

Background: How Ethiopia’s UNAIDS 90-90-90 targets is progressing was not assessed. We assessed HIV care continuum outcomes as surrogate markers for the 90-90-90 targets.

 

Methodology: Data were collected from a 12 years retrospective cohort from anti-retroviral therapy (ART) clinic in Southwest Ethiopia. For measuring the UNAIDS diagnosis target, prevalence rate of delayed HIV diagnosis was considered as a surrogate marker. For the treatment target, number of people on ART, number of people who discontinued from ART or transferred out, and number of people who had fair or poor adherence were used as surrogate markers. For the viral suppression target, number of CD4 counts and/or WHO clinical stages were used to assess immunological, clinical and treatment successes and further show the viral suppression. Summary statistics, trends and estimated survival time were reported.

 

Findings: 8172 patients were enrolled for HIV cares in 2003-2015. For the diagnosis target, 34.5% patients knew their status early (43% children and 33% adults). For the treatment target, 65% patients received ART, 1154 (21.9%) patients discontinued from ART, 1015 (19.3%) patients on ART transferred out to other sites, 916 (17%) of patients on ART had fair or good adherence. For the virological suppression target, 80.7, 80.3 and 65.8% of patients had immunological, clinical and treatment success displaying an estimated 66% of patients achieved the target.

 

Conclusions: The finding reflects that an estimated 35% of patients knew their status timely, 65% of diagnosed patients received treatment and 66% of patients on ART achieved viral suppression. This is very far from the UNAIDS 90-90-90 targets underscoring the need for concreted efforts such as use of unmanned aerial systems (or drones) for transporting laboratory specimens, immediate or same day ART initiation, community distribution of ART, runaway packs during conflict, and use of GenXpert for HIV viral load testing would help to hit the target.

Nagesh Wadgera is a MBBS student at the Bangalore Medical College and Research Institute. His research interest focuses on HIV and related topics. As a part of Short Term Studentship Program of ICMR, he has done a project under the guidance of Dr. Kala Yadhav.

Opportunistic infections account for the majority of death in untreated patients with AIDS. CRP is a highly sensitive marker of infection and inflammation and its level increase with infection. The present study was undertaken among 100 HIV+ patients, at ART Center Victoria Hospital, Bangalore. With the informed consent of the patient, a generalized pro forma was filled up consisting of patient’s clinical presentation and diagnosis. Their CRP level and CD4 count were measured. 56 HIV+ patients were asymptomatic and acted as control giving a negative test for CRP (<6 mg/l), showing no base line rise in CRP. Patients with infectious diagnosis showed a positive test for CRP, while patients on treatment were negative. Among the infectious cases, bacterial infection showed high level of CRP (mean 32 mg/l) compared to viral/fungal infection (mean 9 mg/l). Combinations of opportunistic infections produced a high level of CRP (mean 45 mg/l). A graph of CRP along x-axis and CD4 count along Y-axis were plotted which showed a negative correlation (r=-0.2324, p<0.01 and lzl=2.40). From the graph, the CRP level at which ART can be started is >92.413 mg/l [taking <200 (cells/μl) as the CD4 count at which ART is started]. Patients showing negative test for CRP need not be started with ART, as their CD4 count is found to be approximately 329 cells/μl. CRP level in HIV patients has a prognostic significance and can be used as an early marker of Opportunistic infections.

 

John A Schetz is a Professor of Pharmacology, Neuroscience and Medical Education with a penchant for advancing knowledge and addressing societal needs by solving problems and answering questions of relevance to medicine. His translational research efforts are focused on elucidating mechanisms of drug action and the discovery and development of innovative agents for preventing or treating neurological and psychiatric conditions. He serves on national and international grant review panels and his research has been published in reputed journals and featured in print, radio and televised media reports. His collaborative team pioneered an understanding of the molecular mechanistic underpinnings of adverse neuropsychiatric events associated with the HIV-1 antiretroviral medication efavirenz when taken as prescribed, and its attractiveness as a recreational drug when smoked.

Anti-HIV pharmacotherapies currently remain centralized around HAART. Since its introduction in 1998, efavirenz has been a mainstay of HAART, because it efficaciously suppresses HIV-1, and while it was recently downgraded by DHHS from a first line to an alternative treatment for naïve patients due to neuropsychiatric adverse events (NPAE), both WHO and South African guidelines continue to recommend efavirenz as the preferred NNRTI for HAART in adults and its popularity is likely to continue now that generic forms are becoming available. Only recently, however, has significant progress been made toward a molecular mechanistic appreciation of efavirenz-mediated NPAEs and its attractiveness as a recreational drug. Contributing factors for efavirenz are its ability to rapidly accumulate in brain and a narrow therapeutic window. Our receptor pharmacology studies indicate that within a concentration range relevant to its brain exposure, efavirenz is able to disrupt multiple monoamine neurotransmitter systems, including dopaminergic, serotoninergic, cholinergic, and GABAergic systems, hence its combined effects on these systems is likely to be responsible for some of efavirenz’s NPAEs, such as sleep disturbances, depression, anxiety, hallucinations, dizziness, headaches and memory impairments. Within a concentration range relevant to its brain exposure, a number of CNS off-target interactions for efavirenz were identified, including with the 5-HT2A, 5-HT2C, 5-HT3, 5-HT6, M1, M3 and GABAA receptors, DAT, SERT, and VMAT2 transporters, and MAO-A. In rats trained to discriminate LSD from saline, efavirenz partially substitutes for LSD and this substitution is blocked by pre-treatment with a 5-HT2A receptor selective antagonist. Efavirenz also apparently competes for the same binding site at the 5-HT2A receptor as LSD, and prolonged chronic treatment with efavirenz leads to a pronounced reduction in 5-HT2A receptor levels. Finding from our receptor pharmacology studies with those in animals and humans correlate primarily with behavioral effects related to depressive, anxiogenic, hallucinogenic, and sleep disturbances.

 

 

 

Al-Jaroudi D is an Assistant Professor, King Saud Bin Abdulaziz University for Health Sciences. He is a Chairperson of Reproductive Endocrinology and Infertility department and Medical Forms Subcommittee, Reproductive Endocrinology and Infertility Medicine department, King Fahad Medical City.

Objectives: In infertile couples receiving assisted reproduction, hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV may pose a risk to patients, health care providers and fetuses through cross contamination of biological material. This study aimed at determining the prevalence of HBV, HCV and HIV in a group of infertile couples attending a tertiary care facility in Saudi

Arabia.

 

Materials & Methods: A retrospective cross-sectional observational study was performed by reviewing medical records of 500 couples i.e. 1000 individual patients enrolled between 2006 and 2008. 38 records had incomplete data and were excluded from the study leaving a total of 462 couples. All patients were screened for HBV markers (HBsAg, AntiHBs, AntiHBc and AntiHBe), anti-HCV, anti-HIV type I and II using ELISA technique. Main Outcome Measures: Prevalence of HBV, HCV, and HIV in infertile Saudi couples.

 

Results: The overall prevalence of HBV in the population studied was 1.8% (17/924). For females HBV prevalence was 1.5% (7/462), and for males it was 2.1% (10/462). Overall HCV prevalence in this group was 0.5%. All females were negative for HCV while males had a prevalence of 1.1% (5/462). All males and females were negative for HIV.

 

Conclusion: This study reports a high prevalence for HBV and HCV in a group of Saudi infertile population. HIV prevalence was found to be 0%. Due to the risks of cross sectional and vertical transmission of these infections and despite the low incidence of HIV infection and the cost implications it is important to screen all Saudi infertile couples for these infections prior to embarking on fertility treatments.

Ssenfuma Ronnie is a PhD Research Student at Makerere University School of Public Health. His area of research is HIV/AIDs and has done his PhD research entitled as “Demand creation for couples’ HIV counseling and testing among married or cohabiting individuals in Rakai, Uganda: Trends, Motivations, barriers and intervention outcomes”. He also works as an Assistant Lecturer/Research Associate at Makerere University.

Uptake of couples’ HIV counseling and testing (couples’ HCT) services remains largely low in most settings. We report the effect of a demand-creation intervention trial on couples’ HCT uptake among married or cohabiting individuals who had never received couples’ HCT. This was a cluster-randomized intervention trial implemented in three study regions with differing

HIV prevalence levels (range: 9-43%) in Rakai district, Southwestern Uganda, between February 2014 and September 2014. We randomly assigned six clusters (1:1) to receive the intervention or serve as the comparison arm using computer-generated random numbers. In the intervention clusters, individuals attended small group, couple and male-focused interactive sessions, reinforced with testimonies from ‘expert couples’, and received invitation coupons to test together with their partners at designated health facilities. In the comparison clusters, participants attended general adult health education sessions but received no invitation coupons. The primary outcome was couples’ HCT uptake, measured 12 months post-baseline. Baseline data were collected between November 2013 and February 2014 while follow-up data were collected between March and April 2015. We conducted intention-to-treat analysis using a mixed effects Poisson regression model to assess for differences in couples’ HCT uptake between the intervention and comparison clusters. Data analysis was conducted using STATA statistical software, version 14.1. Of 2135 married or cohabiting individuals interviewed at baseline, 42% (n=846) had ever received couples’ HCT. Of those who had never received couples’ HCT (n=1,174), 697 were interviewed in the intervention clusters while 477 were interviewed in the comparison clusters. 73.6 % (n=513) of those interviewed in the intervention and 82.6% (n=394) of those interviewed in the comparison cluster were interviewed at follow-up. Of those interviewed, 72.3% (n=371) in the intervention and 65.2% (n=257) in the comparison clusters received HCT. Couples’ HCT uptake was higher in the intervention than in the comparison clusters (20.3% versus 13.7%; adjusted prevalence ratio (aPR)=1.43, 95% CI: 1.02, 2.01, P=0.04). Our findings show that a small group, couple and male-focused, demand-creation intervention reinforced with testimonies from ‘expert couples’, improved uptake of couples’ HCT in this rural setting.

Background: Typhoid fever remains to be an important cause of life threatening illness in the developing world. Neuropsychiatric manifestations of Salmonella infection have been described in case reports and case series. Infection with the HIV is a rising epidemic worldwide. Its presence can lead to altered clinical presentation of disease among patients.

 

Case presentation: We report a case of a 32 year-old Filipino male who developed acute onset febrile illness, with temperatures ranging from 38-39ºC associated with acute psychosis. He was admitted to our hospital on June 25, 2015 on his fourth day of illness. The patient was received awake, disoriented to person, place and time. He had a BP of 110/70 mmHg, regular pulse rate

of 112 and temperature of 38.6ºC. The physical examination only showed oral thrush, seborrheic dermatitis on the face and scalp. There were no abdominal tenderness, hepatomegaly generalized rash and focal neurologic deficit. The patient had supple neck. The initial assessment was bacterial and viral meningitis and septic encephalopathy. Laboratory investigations showed

anemia with a normal leukocyte count, elevated creatinine at 141 mol/L. The chest X-ray and urinalysis showed no infection. Cranial CT scan and cerebrospinal fluid studies were normal. The patient tested positive in the HIV confirmatory test. He was empirically treated with ceftriaxone 2 gm IV 12 hourly and acyclovir 700 mg IV 8 hourly. On the fourth hospital day, the blood

culture revealed Salmonella typhi sensitive to ceftriaxone. Acyclovir was discontinued and the ceftriaxone was reduced to nonmeningitis dose. The patient defervesced on day four of ceftriaxone and had improved sensorium on day six of antibiotics. The patient was discharged improved.

 

Discussion: We present a case of typhoid fever presenting as acute psychosis in a HIV patient. Salmonella infection remains a common the developing world. The mechanism by which it causes neuropsychiatric disorder is not yet known. In the time of HIV epidemic, diseases may have an altered spectrum of presentation. Physicians should keep in mind the full spectrum of disease manifestations and a high index of suspicion in order to arrive at the proper diagnosis and management.