Friday, January 27, 2023

Uti Treatment In Hiv Patients

How Hiv Affects The Body

Does hiv affect urine ?

HIV attacks the immune system. It specifically attacks the CD4 cells, a subtype of a T cell group. T cells help the body fight off infections.

Without treatment, HIV reduces the number of CD4 cells in the body, increasing a persons risk of getting infections.

If HIV progresses to stage 3, a person will have a higher chance of developing several complications, including an increased risk of developing certain cancers and opportunistic infections.

The Centers for Disease Control and Prevention provides information on where individuals can find their nearest HIV testing center.

Study Setting And Participants

Data were collected as part of the Antimicrobial Resistance in Gram-negative bacteria from Urinary Specimens study. This was a cross-sectional analysis of consecutively enrolled participants recruited from 10 PHCs in southwest Harare between 1 July 2019 and 24 July 2020. Adult HIV prevalence in Zimbabwe is estimated at 13%. According to national guidelines UTIs should be treated with either a fluoroquinolone or amoxicillin.

Eligibility criteria included age 18years or older, having at least two symptoms suggestive of UTI, onset of symptoms within the previous 2weeks, presence of symptoms within the last 24h, and provision of written informed consent. Those who were discharged from hospital in the previous 72h, who had a urinary catheter in situ or who were enrolled into the study on a previous occasion were excluded.

Interviewer-administered questionnaires determined potential risk factors for AMR and clinical history. Responses were entered in electronic form using the Open Data Kit . HIV status was ascertained by self-report and confirmed by patient-held records.

Inclusion And Exclusion Criteria

The study included all PLHIV aged 18 years and above without sign and symptoms of UTI who consented to the study. A total of 311 participants were approached and consented to the study, four of them were exposed to other antibiotics other than trimethoprim-sulfamethoxazole for the past 2 weeks before attending our clinic, one was suspected to be pregnant and six males were on medical treatment for benign prostatic enlargement and therefore they were excluded from the study. The remaining 300 participants were interviewed, their files were reviewed for extraction of some of the information necessary for the study and mid stream clean-catch urine was collected from them for analysis.

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Ethics Approval And Consent To Participate

Ethical clearance was obtained from the institutional review board of Hawassa University College of medicine and health science. Then support letter were obtained from the hospital administration. Written informed consents were obtained from each study participants. All methods were carried out in accordance with relevant guidelines and regulation as mentioned by Declaration of Helsinki.

Examples For Global Impact Of Antimicrobial Resistance Research And Interventions

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Examples of global research into antimicrobial resistance and its impact are given below :

Chinese Ministry of Health in 2011, reduced unnecessary prescription of antimicrobials by 1012%.

  • The Swedish Strategic Programme against Antibiotic Resistance : decrease in antibiotic use for outpatients from 15.7 to 12.6 daily doses per 1000 inhabitants and from 536 to 410 prescriptions per 1000 inhabitants per year from 1995 to 2004. The decrease was most evident for macrolides .

  • WHO essential medicines policies: reductions in antibiotic use of 20% in upper respiratory tract infections and 30% of reduction in the use of antibiotics in acute diarrheal illness.

  • Antimicrobial stewardship programme in 47 South African hospitals: reduction of antibiotic doses daily per 100 patient days from 101.4 to 83.04.

  • Antimicrobial Resistance Monitoring and Research Programme : Infections with carbapenem-resistant Enterobacteriaceae declined and there were no further reports of outbreaks of colistin-resistant Acinetobacter spp.

  • In the Netherlands, a decrease of CTX-M1-1-like ESBL genes in livestock was seen during 20102014 due to > 60% reduction in antibiotic use in livestock.

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    Factors Associated With Urinary Tract Infections Among Hiv

    • * E-mail:

      Affiliations Medical University of Warsaw, Department for Adult’s Infectious Diseases, Warsaw, Poland, Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland

    • Affiliation Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland

    • Agnieszka Bednarska,

      Roles Conceptualization

      Affiliations Medical University of Warsaw, Department for Adult’s Infectious Diseases, Warsaw, Poland, Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland

    • Roles Conceptualization

      Affiliations Medical University of Warsaw, Department for Adult’s Infectious Diseases, Warsaw, Poland, Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland

    • Affiliation Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland

    • Andrzej Horban,

      Roles Conceptualization

      Affiliations Medical University of Warsaw, Department for Adult’s Infectious Diseases, Warsaw, Poland, Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland

    • Justyna D. Kowalska

      Roles Formal analysis, Supervision

      Affiliations Medical University of Warsaw, Department for Adult’s Infectious Diseases, Warsaw, Poland, Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland

    Uncomplicated Cystitis: Antibiotic Selection And Duration

    Nitrofurantoin is the first line treatment recommendation for acute uncomplicated cystitis. Nitrofurantoin achieves good concentration in the urine, has low resistance rates for E. coli, and can be used in patients with CrCl > 30 mL/min/1.73 m2. Alternatives include TMP/SMX, cephalexin, and fosfomycin .

    The rate of resistance to TMP/SMX is > 30% in some areas. In contrast, nitrofurantoin resistance remains < 5%. The 2010 resistance rates to TMP/SMX for E. coli in the US were 28%, which led to TMP/SMX no longer being recommended as first line therapy for uncomplicated cystitis. However, it remains a reasonable alternative. Since TMP/SMX is concentrated in the urine, in vitro resistance does not necessarily translate into therapeutic failures. Reported TMP/SMX resistance rates may be misleadingly high as they represent patients receiving urine cultures, whereas most acute uncomplicated cystitis is not assessed with a urine culture.

    When beta-lactam therapy, such as cephalexin, is chosen due to allergies or other factors, little evidence guides treatment duration for cystitis. Three to 7 days are recommended, depending on symptom severity.

    Single-dose cystitis treatment regimens are less efficient than 3-5 day regimens at eradicating bacteriuria . A 2018 randomized controlled trial demonstrated decreased efficacy of a single dose of fosfomycin compared to 5 days of nitrofurantoin.

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    What Should I Tell My Health Care Provider Before Taking Sulfamethoxazole/trimethoprim

    Before taking sulfamethoxazole/trimethoprim, tell your health care provider:

    • If you are allergic to sulfamethoxazole, sulfonamides , trimethoprim, or any other medicines.
    • About any medical conditions you have or have had, including:
    • Kidney or liver problems
    • Folate deficiency
    • Severe allergies or asthma
    • Inherited blood disorders: porphyria or glucose-6-phosphate dehydrogenase deficiency
    • Thyroid problems
  • About anything that could affect your ability to take medicines, such as difficulty swallowing pills, difficulty remembering to take pills, or any health conditions that may prevent your use of intravenous medicines.
  • If you are pregnant or plan to become pregnant. Sulfamethoxazole/trimethoprim should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Talk to your health care provider about the risks and benefits of taking sulfamethoxazole/trimethoprim during pregnancy. The Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV may include other recommendations on the use of sulfamethoxazole/trimethoprim during pregnancy. Please refer to these guidelines for additional information.
  • If you are breastfeeding or plan to breastfeed. For women with HIV in the United States, the Guideline does not recommend breastfeeding. Before your baby is born, or if you are already breastfeeding, talk to your health care provider to discuss alternative options for feeding your baby.
  • What Is Sulfamethoxazole/trimethoprim

    Topic 36: Sexually Transmitted Infections (STI) and Urinary Tract Infections (UTI)

    Sulfamethoxazole/trimethoprim is an antibacterial prescription medicine approved by the U.S. Food and Drug Administration for the treatment of certain infections, such as:

    Sulfamethoxazole/trimethoprim is also FDA-approved to prevent PCP in people who are immunosuppressed and are at risk of developing PCP.

    Certain bacterial infections and PCP can be opportunistic infections of HIV. An OI is an infection that occurs more frequently or is more severe in people with weakened immune systemssuch as people with HIVthan in people with healthy immune systems. To learn more about OIs, read the HIVinfo What is an Opportunistic Infection? fact sheet.

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    Urine Culture And Biochemical Test

    Using a calibrated loop 0.001 ml of well-mixed un-centrifuged urine was inoculated on blood and MacConkey agar. The inoculated media were incubated at 3537 °C for 24 h and examined for the growth of bacteria. For identification of Gram negative bacteria, bacterial colony was sub-cultured onto nutrient broth. Then, the nutrient broth was inoculated on biochemical test culture medias such as Triple sugar iron agar, Simmons citrate agar, Lysine iron agar, Urea, Motility tests, and Indol. Identification of species was done by their characteristics in the respective culture media as per the standard. Species identification for Gram positive bacteria was carried out using catalase and coagulase test.

    Enhancing Healthcare Team Outcomes

    The management of asymptomatic bacteriuria is not simple and requires clinical acumen. When encountering such patients, an interprofessional approach with an infectious disease expert, emergency department physician, nurse practitioner, internist, pharmacist, and a nurse is recommended.

    Most patients with asymptomatic bacteriuria will not develop symptomatic urinary tract infections and will have no adverse consequences from asymptomatic bacteriuria. Specifically, children, patients with diabetes, older patients, patients with spinal cord injuries, and patients with indwelling urinary catheters do not benefit from treatment with antibiotics for asymptomatic bacteriuria. Treatment in these patients does not decrease the incidence of symptomatic urinary tract infections or improve survival. However, it does increase the likelihood of adverse effects of antibiotics and the development of antibiotic-resistant bacteria.

    In contrast, treatment of pregnant women with asymptomatic bacteriuria has been shown to be beneficial. There is evidence that treatment of asymptomatic bacteriuria in these patients decreases the risk of symptomatic urinary tract infection.

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    Study Setting And Period

    An institution-based cross-sectional study was conducted from 1st January to 30th May, 2021, at the ART clinic of Arba Minch General Hospital. Arba Minch is the administrative center of the Gamo zone, which is 454 kilometers from Ethiopia’s capital, Addis Ababa. More than 2 million individuals from the Gamo zone and other neighboring zones receive preventive, curative, and rehabilitative care at the hospital. The hospital also offers adults optional counseling testing and antiretroviral therapy to more than 1860 HIV-positive patients.

    Hiv And Amr In E Coli

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    Amoxicillin resistance was present in 67 E. coli isolates from participants with HIV and in 117 from individuals without HIV infection while ciprofloxacin resistance was detected in 24 and 27 , respectively . The prevalence of co-trimoxazole resistance was 91.5% among individuals with HIV and 86.9% in those without HIV infection. In participants with HIV who were taking co-trimoxazole prophylaxis the prevalence of co-trimoxazole resistance was 97.8%. Infections with ESBL-producing organisms were more common among participants with HIV than in participants without HIV infection . Participants with HIV had a 2.43 higher odds of infection with ESBL-producing E. coli than individuals without HIV, and the association persisted after adjusting for age and sex 2.13 95% CI 1.054.32, Tables S5 and S6, Figure S1).

    AMR among E. coli isolates in individuals with HIV and individuals without HIV infection . AMP, ampicillin AMC, amoxicillin/clavulanic acid CHL, chloramphenicol CIP, ciprofloxacin CRO, ceftriaxone FOS, fosfomycin GEN, gentamicin NIT, nitrofurantoin SXT, co-trimoxazole. None of the isolates had imipenem resistance.

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    Sample Collection And Processing

    The structured data questionnaire was used to collect the required data for the study. The questionnaire was pre-tested on five patients and errors noticed were corrected prior to the commencement of the study. These five patients were not included in this study. Social demography together with other variables were obtained from patients files and recorded on the questionnaire.

    Two mid-stream clean-catch urine samples from all eligible study participants were collected using two wide mouth screw-capped leak proof sterile containers by taking all precautions to avoid contamination. The two samples were taken to KCMC clinical laboratory within 30 minutes of collection. One specimen in each patient was cultured on blood agar and cysteine lactose electrolyte deficient agar . One-microliter disposable loop was used for nucleation on culture media plates then the plates were incubated at 37 °C for 24 hours. In case of delay in processing the sample, the samples were kept at 28 °C in a well-monitored refrigerator and cultured within 6 hours.

    Antimicrobial susceptibility tests were done for commonly prescribed antibiotics in our set up and zones of inhibition were interpreted using Clinical Laboratory Standard Institute guideline of year 2020 .14 However, owing to the challenges in the availability of antibiotic discs, we did not conduct even number of drug sensitivity tests.

    Symptomatic Cystitis In Pregnancy

    Recommendation.

    The diagnosis of cystitis in pregnancy is made based on the presence of lower urinary tract symptoms and laboratory testing. Unlike in nonpregnant patients, urine culture should be routinely obtained to confirm the diagnosis and guide treatment.

    Treat cystitis during pregnancy with nitrofurantoin for 7 days or cephalexin for 7 days. Avoid use of nitrofurantoin after 37 weeks gestation because it may increase neonatal jaundice.

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    Treatment Of Uti In Men

    Recommendations.

    Antibiotic Selection and Duration. Before prescribing, review any prior urine culture results and consider if the patient is at risk for a drug-resistant infection. Send a urine culture to guide treatment.

    When treating acute uncomplicated cystitis in men, use the recommended antibiotics per , with nitrofurantoin being the first-line choice. When concerned about prostatitis, choose an antibiotic that penetrates the prostate, such as TMP/SMX, ciprofloxacin, or levofloxacin. Beta lactam antibiotics such as penicillins and cephalosporins can be used when indicated by culture results, but tend to be less effective in men due to poor prostate penetration. Because nitrofurantoin achieves therapeutic concentrations only in the bladder, it is not effective for pyelonephritis or prostatitis.

    For presumed acute bacterial prostatitis, the duration of antibiotic treatment is traditionally 4-6 weeks based on limited observational studies, but 2 weeks may be adequate., Acute prostatitis following a urologic procedure, such as transrectal biopsy of the prostate or cystoscopy, should prompt urologic consult.

    Chronic bacterial prostatitis may be difficult to eradicate. TMP/SMX or a fluoroquinolone is the treatment of choice due to better penetration of prostate tissue. A 4-6 week course of treatment resolves chronic bacterial prostatitis in about 6080% of patients with E. coli and other Enterobacteriaceae infections.

    Prevalence And Risk Factors Of Uti

    Can your urine tell if you have HIV ?

    The overall prevalence of bacteriuria was 37 . The magnitude was high among females compared to males , and in those who had a CD4 count of < 200 cell/mm3, 2, positive leucocytes 5 and four positive nitrites 4 compared to their counterparts. The presence of nitrites in urine was 21 times higher among people with ABU compared to their counterparts with no ABU . The risk of ABU was more than doubled among females and those having leucocytes in urine, however, such association did not reach a statistically significant level .

    Table 2 Prevalence and Risk Factors for UTI Among 300 Patients Living with HIV Attending CTC Clinic at KCMC from July to September 2020

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    What Is A Urinary Tract Infection

    A urinary tract infection, or UTI, is an infection in any part of your urinary system, which includes your kidneys, bladder, ureters, and urethra.

    If you’re a woman, your chance of getting a urinary tract infection is high. Some experts rank your lifetime risk of getting one as high as 1 in 2, with many women having repeat infections, sometimes for years. About 1 in 10 men will get a UTI in their lifetime.

    Here’s how to handle UTIs and how to make it less likely you’ll get one in the first place.

    Progressing To Stage 3 Hiv

    If a person with HIV does not receive treatment, the condition may eventually progress to stage 3 HIV. Thanks to modern medical advances, current HIV infections rarely reach stage 3 in the U.S.

    Stage 3 HIV is not a specific disease but a syndrome with a wide range of identifiable symptoms. The symptoms can also stem from other illnesses because opportunistic infections take advantage of the bodys reduced immune activity.

    Symptoms include:

    Treatment will depend on the individual and their complications. A person can consult a healthcare team to develop a suitable plan.

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    How Is Sulfamethoxazole/trimethoprim Used In People With Hiv

    The Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV include recommendations on the uses of sulfamethoxazole/trimethoprim in people with HIV to:

    • PCP from occurring the first time and from recurring
    • Bacterial enteric infections from occurring the first time
    • Toxoplasmosis from occurring the first time and from recurring
    • Cystoisosporiasis from recurring

    The recommended uses may not always be consistent with FDA-approved uses of sulfamethoxazole/trimethoprim. See the Guidelines for complete information on recommended uses of sulfamethoxazole/trimethoprim in adults and adolescents with HIV. Sulfamethoxazole/trimethoprim may have other recommended uses not listed above.

    Tackle Of Antimicrobial Resistance

    Human Immunodeficiency Virus (HIV) Infection/AIDS

    WHO developed a global priority of pathogens list of antibiotic-resistant bacteria to help in prioritizing the research and development of new and effective antibiotic treatments. Drug-resistant bacteria were categorized into critical priority, high priority and medium priority pathogens .

    Type of priority

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    How Should Sulfamethoxazole/trimethoprim Be Stored

    • Store sulfamethoxazole/trimethoprim oral suspension at room temperature, 68°F to 77°F . Protect the oral suspension from light.
    • Store sulfamethoxazole/trimethoprim tablets at room temperature, 68°F to 77°F .
    • Store sulfamethoxazole/trimethoprim injection solution at room temperature, 68°F to 77°F . Do not refrigerate the injection solution.
    • Do not use sulfamethoxazole/trimethoprim if the original seal of the container is broken or missing.
    • Throw away sulfamethoxazole/trimethoprim that is no longer needed or expired . Follow FDA guidelines on how to safely dispose of unused medicine.
    • Keep sulfamethoxazole/trimethoprim and all medicines out of reach of children.

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