Recent HIV infections: evaluation of a simple identification score for newly diagnosed patients

ABSTRACT OBJECTIVE Recognize incident infection to better characterize the groups that fuel HIV epidemic. We propose a simple score to identify recent infections among newly diagnosed patients as a HIV surveillance tool. METHODS Newly diagnosed patients were defined as recent infections when a negative serological test in the previous year was available. Laboratory tests, such as the avidity index (Bio-Rad, according to the CEPHIA protocol), chemiluminescent intensity (CMIA, architect, Abbott), and the nucleotide ambiguity index of partial pol sequences were used as proxies of recency. A simple score based on clinical symptoms of acute retroviral syndrome during the previous year, CD4+ T cell count, and viral load at admission was tested to assess the predictive power, using receiver operating characteristic (ROC) curves, to identify recent cases of infection. RESULTS We evaluated 204 recently diagnosed patients who were admitted to the Ambulatório de Referência em Moléstias Infecciosas de Santo André (Santo André Reference Infectious Diseases Outpatient Clinic), in the metropolitan region of São Paulo, Brazil, recruited between 2011 and 2018. An HIV-negative test in the year prior to enrollment was documented in 37% of participants. The proportion of cases classified as recent infections (less than one year), according to the laboratory proxies were: 37% (67/181) for an avidity index < 40%, 22% (30/137) for a CMIA < 200, and 68% (124/181) for an ambiguity index < 0.5%. Using different combinations of recency definitions, our score showed an area under the ROC curve from 0.66 to 0.87 to predict recency. CONCLUSIONS Using data from patients' interviews and routine laboratory tests at admission, a simple score may provide information on HIV recency and thus, a proxy for HIV incidence to guide public policies. This simple for the Brazilian public health system and other low- and middle-income countries.

Saliva, implicações orais e biossegurança em Odontologia: principais aspectos do COVID-19 / Saliva, oral implications and biosafety in Dentistry: main aspects in COVID-19

Objetivo: Diante da importância do fluido salivar no contexto da odontologia, este trabalho objetivou realizar uma revisão de literatura sobre a relação da saliva e a COVID-19, bem como as suas principais implicações na Odontologia. Métodos: Foi realizada a busca eletrônica de publicações nas bases de dados SciELO, PubMed, Scopus, EMBASE e Cochrane Central Register of Controlled Trials, utilizando os seguintes descritores: "Saliva", "oral cavity", "oral mucosa", "oral lesions", "Dentistry", e o operador booleano "AND" entre todas as palavras-chave citadas individualmente com o termo "COVID-19". Os estudos foram publicados no período de dezembro de 2019 a setembro de 2020. Resultados: Os estudos demonstraram que a saliva representa um importante meio de transmissão do SARS-CoV-2, o que torna necessário o cumprimento de medidas de biossegurança pelos cirurgiões-dentistas a fim de reduzir a possibilidade de infecção pelo SARS-CoV-2. Ao mesmo tempo, a alta carga viral encontrada na saliva possibilita que a mesma possa ser utilizada como um meio para diagnóstico da COVID-19. Pesquisas têm demonstrado eficácia similar da análise da saliva quando comparada a outras técnicas convencionais. Por sua vez, mais investigações precisam ser realizadas a fim de validar a metodologia aplicada nos estudos atuais. Conclusão: A detecção do SARS-CoV-2 através da saliva é bastante promissora e apresenta vantagens em comparação a outros fluidos biológicos, pois a coleta deste fluido não envolve uma intervenção invasiva, facilitando o manejo pelos profissionais e pacientes.

Aim: Due to the importance of the salivary fluid in dentistry, this study aimed to carry out a literature review on the relationship between saliva and COVID-19, as well as its main implications in Dentistry. Methods: An electronic search for publications was performed in the SciELO, PubMed, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials databases using the following descriptors: "Saliva", "oral cavity", "oral mucosa", "oral lesions ", and "Dentistry", using the Boolean operator "AND" between all keywords cited individually with the term "COVID-19". The studies were published from December 2019 to September 2020.Results: The studies have shown that saliva represents an important means of transmission of SARS-CoV-2, which makes it necessary for dentists to comply with biosafety measures in order to reduce the possibility of SARS-CoV-2 infection. Likewise, the high viral load found in saliva allows it to be used as a path to COVID-19 diagnosis. Investigations have shown similar effectiveness in the saliva analysis compared to other conventional techniques. In this regard, more investigations need to be carried out to validate the methodology applied in current studies. Conclusion: The detection of SARS-CoV-2 through saliva is very promising and has advantages in comparison to other biological fluids, as the collection of this fluid does not involve an invasive intervention, thus facilitating management by professionals and patients.

BK virus salivary shedding and viremia in renal transplant recipients

Abstract Objectives: This study aimed to verify the presence of polyomavirus BK (BKPyV) in the saliva of kidney transplant recipients and to correlate it with blood viremia. Material and Methods: We have conducted a cross-sectional study with a sample involving 126 renal transplant recipients. 126 samples of saliva and 52 samples of blood were collected from these patients. Detection and quantification of BKPyV were performed using a real-time PCR. To compare the presence of BKPyV in blood and saliva, the binomial proportion test was used. To verify associations between salivary shedding BKPyV and post-transplant periods (in months), the Mann-Whitney test was used. Spearman's correlation was used to correlate the viral load in the saliva with blood of kidney transplant recipients. Results: The mean age of the study group was 51.11±12.45 years old, and 69 participants (54.8%) were female, with a mean post-transplantation time of 4.80±6.04 months. BKPyV was quantified in several samples of saliva and blood, with medians of 1,108 cp/mL and 1,255 cp/mL, respectively. Only 16/52 (30.8%) participants presented BKPyV in blood, and 59/126 (46.8%) excreted the virus in saliva (p=0.004). BKPyV shedding was found in patients at a shorter post-transplantation period (3.86±5.25, p=0.100). A weak correlation was observed between viral quantification in saliva and blood (Spearman's correlation coefficient=0.193). Conclusion: The results of this study suggested that, although saliva excretes more BKPyV than blood, there is no reliable correlation between salivary shedding and blood viremia, showing two independent compartments of viral replication.

Associação entre a carga viral plasmática e a carga viral subgengival no biofilme em pacientes infectados pelo HIV-1 / Association between plasmatic viral load and subgingival viral load in biofilm in HIV-1 infected patients

Objetivo: Investigar a associação entre carga viral no biofilme subgengival (CVS) e carga viral plasmática (CVP) do HIV-1 e os parâmetros clínicos periodontais em indivíduos infectados pelo HIV. Metodologia: Quarenta e um pacientes com sorologia positiva para HIV-1 foram distribuídos em dois grupos: 20 com CVP detectável e 21 com CVP indetectável (< 50 cópias/mL). Amostras do biofilme subgengival foram coletadas de 12 sítios de cada paciente com periodontite, sendo 6 sítios com as maiores PBS, preferencialmente não adjacentes, e 6 sítios com periodonto sadio. Nos pacientes com saúde periodontal, foram coletadas 6 amostras de sítios periodontais sadios aleatórios. Das 6 amostras dos sítios com maiores PBS dos pacientes com periodontite, foram realizados 3 pools, com 2 amostras cada, de sítios com parâmetros clínicos semelhantes. O mesmo foi feito para as 6 amostras de periodontos sadios (tanto para os pacientes com periodontite como para aqueles com saúde periodontal), resultando em 3 pools. A detecção e quantificação da CVS foram realizadas através do PCR em Tempo Real. Os níveis de linfócitos T CD4+, T CD8+, neutrófilos e CVP foram obtidos dos resultados desses exames presentes nos prontuários médicos de cada paciente. Diferenças significativas entre os grupos para todos os parâmetros estudados foram avaliadas pelos testes Qui-quadrado, exato de Fisher e Mann-Whitney. O modelo de regressão utilizado foi a Equação de Estimação Generalizada (GEE) para testar a associação entre as co-variáveis e a CVS. Resultados: A maioria dos indivíduos era composta por homens (51,2%), não usuários de drogas (85,4%), não tabagistas (63,4%) e não consumidores diários de álcool (87,8%). Os dados laboratoriais demonstraram diferenças significantes entre os dois grupos estudados somente para os níveis de linfócitos T CD4+ (p = 0,038), porém não houve diferença estatisticamente significante entre os grupos em relação aos parâmetros clínicos periodontais. Não houve associação estatisticamente significante entre CV plasmática e CV subgengival, sendo a contagem de linfócitos TCD4+ a única co-variável que apresentou efeito estatisticamente significante sobre o desfecho CV subgengival indetectável (p = 0,017). A interpretação dos resultados demonstrou que indivíduos com níveis mais altos de linfócitos T CD4+ (> 500 células/mm3 ) tem uma chance muito maior de apresentar CV subgengival indetectável em relação aos indivíduos com níveis de linfócito T CD4+ < 200 células/mm3 . Conclusão: Não há associação entre a carga viral no biofilme subgengival e a carga viral plasmática do HIV-1 e os parâmetros clínicos periodontais em pacientes infectados pelo HIV.(AU)

Aim: To investigate the association between subgingival viral load in biofilm and plasmatic viral load and clinical periodontal parameters in HIV-1 infected patients. Methods: Fortyone HIV-positive patients were divided into two groups: detectable and undetectable plasmatic viral load (< 50 copies/mL). Subgingival biofilm samples were collected from 12 sites in each patient with periodontitis, 6 sites with the deepest PBS, preferably not adjacent, and 6 sites with healthy periodontium. In patients with periodontal health, 6 samples were collected from random healthy periodontal sites. Of the six samples of periodontal lesions were performed 3 pools, with 2 samples from each site with similar clinical parameters. The same was done with the 6 samples from healthy periodontium, resulting in three pools. Detection and quantification of subgingival viral load were determined by Real Time PCR. The levels of CD4, CD8, neutrophils and plasmatic viral load were obtained from the medical records of each patient. Significant differences between groups for all parameters were evaluated by Chi-square, Fisher's exact test and Mann-Whitney. The utilized regression model consisted of a test called Generalized Estimation Equation (GEE) to test the association between the co-variables and the subgingival viral load. Results: The majority of the patients were male (51,2%), non-drug users (85,4%), non-smokers (63,4%) and nonalcohol users (87,8%). The laboratory data demonstrated significant differences between groups only for levels of TCD4+ cells (p=0,038), however there was no significant difference between groups for clinical periodontal parameters. There was no statistically significant association between plasmatic viral load and subgingival viral load, and only the levels of TCD4+ cells demonstrated significant effect on the undetectable subgingival viral load (p=0,017). The interpretation of the results demonstrated that patients with higher levels of TCD4+ cells (> 500 cells/mm3 ) have a much higher chance of presenting undetectable subgingival viral load compared to patients with levels of TCD4+ cells < 200 cells/mm3. Conclusion: There is no association between subgingival viral load in biofilm and plasmatic viral load and clinical periodontal parameters in HIV-1 infected patients(AU)

Análise quantitativa das células CD4 e sua importância no diagnóstico de lesões orais em pacientes HIV positivos / Quantitative analysis of the cells CD4 and its importance in the diagnosis of verbal injuries in positive patients HIV

As manifestações bucais da infecção pelo HIV são, muitas vezes, os primeiros sinais clínicos da doença. Estas lesões também podem funcionar como sinalizadores e sentinelas do curso e progressão da infecção pelo HIV e AIDS. O objetivo desse trabalho foi avaliar a prevalência das lesões orais em pacientes HIV positivos, relacionando-as com a contagem de células CD4+ e a carga viral em pacientes do Hospital de Doenças Infectocontagiosas Gizelda Trigueiro em Natal-RN. Foram avaliados 121 pacientes, onde após exame clínico da cavidade oral, estes eram conduzidos à coleta de sangue periférico para contagem dos linfócitos CD4+. Observamos uma prevalência de 25,6%, de lesões orais, totalizando 31 casos. A candidíase foi a lesão mais comum, seguida da leucoplasia pilosa, eritema gengival linear, herpes labial, periodontite ulcero-necrosante e gengivite ulcero-necrosante. A contagem média das células CD4+ dos pacientes portadores de lesão foi de 250 células/mm3. Não observamos relação entre a presença de lesões e a carga viral dos indivíduos (AU).

The oral manifestations due to HIV infection are, a lot of times, the first clinical signs of the disease. These injuries may also function as beepers and sentries of the curse and progression of the HIV infection and AIDS. The objective of this work was to evaluate the prevalence of the oral injuries in HIV positive patients, relating them with the CD4+ cells counting and the viral load in patients from the Hospital of Infected contagious Gizelda Trigueiro in Natal-RN. One hundred and one patients were evaluated, where after the clinical exam of the oral cavity, these ones were conducted to the peripheral blood collection for the counting of CD4+ lymphocytes. We observed a prevalence of 25,6%, that is, 31 cases. The Oral Candidiasis was the most commum injure, followed by Oral Hairy Leukoplakia, linear gingival erytema, lips herpes, gingivitis and periodontitis - HIV. The average counting of cells CD4+ of the injury carrying patients was of 250 cells/mm3. We did not observe relation between the presence of injuries and the viral load of the individuals (AU).

Manifestaçöes estomatológicas, contagem de linfócitos T-CD4+ e carga viral de crianças brasileiras e norte-americanas infectadas pelo HIV / Oral manifestations, counts of CD4+ T lymphocytes and viral load in Brazilian and American HIV-infected children

A prevalência de manifestaçöes estomatológicas associadas à infecçäo pelo HIV foi avaliada em 184 crianças de ambos os sexos, da faixa etária de zero a 13 anos de idade, atendidas nos Ambulatórios de AIDS Pediátrica do Hospital Säo Lucas (HSL) da PUCRS, e do Hospital de Clínicas de Porto Alegre (HCPA) da UFRGS, ambos em Porto Alegre, RS, Brasil e no Centro Pediátrico para Doenças Infecciosas do Hospital Universitário e Departamento de Odontopediatria da Faculdade de Odontologia da Universidade Estadual de Nova Iorque (SUNY) em Stony Brrok, Nova Iorque, EUA, no período de janeiro de 1999 a maio de 2000. Freqüência de crianças brasileiras (72,73 por cento) e norte-americanas (53,66 por cento) com manifestaçöes estomatológicas associadas à infecçäo pelo HIV foi estatisticamente significativa, com destaque para linfadenopatia cérvico-facial, aumento de volume das parótidas, candidíase eritematosa, petéquias, gengivite, xerostomia e queilite angular. As crianças com manifestaçöes estomatológicas apresentaram contagens médias de linfócitos T-CD4+ próximas à normalidade e carga viral alta