RESUMEN
La tuberculosis y otras micobacteriosis constituyen asociaciones o coinfecciones frecuentes en pacientes con sida y se asocian con una elevada mortalidad. En esta revisión se actualizan los tratamientos de las principales enfermedades micobacterianas asociadas al sida (tuberculosis y micobacteriosis por Mycobacterium avium), con especial énfasis en las interacciones farmacológicas entre antimicobacterianos, principalmente rifampicina y claritromicina, y fármacos antirretrovirales. Se analizan los esquemas de tratamiento, su duración, la quimioprofilaxis primaria y secundaria y el momento óptimo de iniciación del tratamiento antirretroviral. Finalmente se describe el síndrome inflamatorio de reconstitución inmune y su tratamiento. (AU)
Asunto(s)
Humanos , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Infecciones por Mycobacterium/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Antirretrovirales/uso terapéutico , Antibacterianos/uso terapéutico , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Infecciones por Mycobacterium/diagnóstico , Tuberculosis/tratamiento farmacológico , Tuberculosis/diagnóstico , Claritromicina/uso terapéutico , Rifampin/uso terapéutico , Interacciones FarmacológicasRESUMEN
Avascular osteonecrosis (AON) has increased in the last few years in patients infected with the human immunodeficiency virus type-1 (HIV-1). The most commonly affected bone is the femoral head and neck. Frequently these bilateral and clinical findings include moderate to severe pain and functional impotence of the affected joints. The etiology is multifactorial and highly active antiretroviral therapy (HAART) with protease inhibitors (PI) is probably related to its development. In the evolution, a total hip replacement may be needed. We present an hemophilic patient with AIDS, who developed a bilateral AON of the femoral head and neck during HAART.(AU)
La osteonecrosis avascular (ONA) es una complicación que se describe con frecuencia creciente en pacientes infectados por el virus de la inmunodeficiencia humana tipo-1 (HIV-1). En su localización más común compromete la cabeza y cuello del fémur con dolor e impotencia funcional, en una o ambas caderas. Su etiología es multifactorial y la terapia antirretroviral de alta eficacia (HAART) con inhibidoresde proteasa (IP) puede estar relacionada con la patogenia. En su evolución puede requerir el reemplazo total de la cadera con la colocación de una prótesis. Se presenta un paciente hemofílico, HIV-1 seropositivo, quedesarrolló una ONA bilateral de cabeza y cuello de fémur mientras se encontraba bajo HAART.(AU)
Asunto(s)
Adulto , Humanos , Masculino , Terapia Antirretroviral Altamente Activa/efectos adversos , Necrosis de la Cabeza Femoral/inducido químicamente , Seropositividad para VIH/tratamiento farmacológico , Recuento de Linfocito CD4RESUMEN
We conducted a retrospective evaluation to determine the clinical and microbiological characteristics of 61 episodes of infective endocarditis (IE) in intravenous drug abusers (IDA), HIV seropositive patients. Forty-nine males and 6 females between 15 and 42 years of age were included in the study. All the included patients presented 61 episodes of IE. Fever and cardiac murmur were present in all episodes; 43 (70.4
) presented cough (9 with hemoptysis); 25 (41
) had dyspnea, and 5 (8.2
) had jugular ingurgitation. Fundoscopy showed alterations in 3 patients (4.9
). Bacteriological confirmation was obtained in 41 episodes (67.2
); blood cultures revealed Staphylococcus aureus in 30 cases (73.1
), Streptococcus viridans in 8 (19.5
) patients, Staphylococcus epidermidis in 1 (2.4
), Staphylococcus hominis in 1 (2.4
) and Streptococcus pneumoniae in one case (2.4
). The tricuspid valve was involved in 51 episodes (83.6
), the aorta in 6 (9.8
), the mitral valve in 3 (4.9
) and the pulmonary valve in one (1.6
). There was evidence of right bivalvular involvement in 2 patients (3.2
) and tricuspid and mitral involvement in another (1.6
). Pericardial effusion was detected in 19 episodes (31.1
) died during the acute episode of IE.
RESUMEN
We conducted a retrospective evaluation to determine the clinical and microbiological characteristics of 61 episodes of infective endocarditis (IE) in intravenous drug abusers (IDA), HIV seropositive patients. Forty-nine males and 6 females between 15 and 42 years of age were included in the study. All the included patients presented 61 episodes of IE. Fever and cardiac murmur were present in all episodes; 43 (70.4
) had hepatomegaly; 29 (47.5
) had splenomegaly. Thirty-eight (62.3
) presented cough (9 with hemoptysis); 25 (41
) had dyspnea, and 5 (8.2
) had jugular ingurgitation. Fundoscopy showed alterations in 3 patients (4.9
). Bacteriological confirmation was obtained in 41 episodes (67.2
); blood cultures revealed Staphylococcus aureus in 30 cases (73.1
), Streptococcus viridans in 8 (19.5
) patients, Staphylococcus epidermidis in 1 (2.4
), Staphylococcus hominis in 1 (2.4
) and Streptococcus pneumoniae in one case (2.4
). The tricuspid valve was involved in 51 episodes (83.6
), the aorta in 6 (9.8
), the mitral valve in 3 (4.9
) and the pulmonary valve in one (1.6
). There was evidence of right bivalvular involvement in 2 patients (3.2
) and tricuspid and mitral involvement in another (1.6
). Pericardial effusion was detected in 19 episodes (31.1
). Six patients (10.9
) died during the acute episode of IE.
RESUMEN
In the context of HIV infection, cryptococcal meningitis is the most common mycosis threatening the patients life. We conducted a retrospective evaluation to determine the epidemiological, microbiological, immunological and clinical characteristics of disseminated cryptococcosis in 51 hospitalised HIV seropositive patients. All the individuals (n = 51) presented reactive serology for HIV (ELISA and/or Western blot) and none fulfilled strict HAART treatment, previous to the opportunistic infection. CD4+ lymphocyte T counts showed levels between 361 and 0 cells/microliter (mean = 45). All patients but one had counts lower than 100 cells/microliter. Cryptococcosis presented as unique episode in 35 patients (68.6) and in 16 as relapse (31.3). In all of them we detected central nervous system involvement. The induction treatment was carried out with amphotericin B (AMB), continued with maintenance therapy with fluconazole. Lethality rate was 36.7, slightly superior among patients in relapse (40) compared to those who presented a first episode of the mycosis (35.2). In those individuals for whom data were available, 65.2 of blood cultures, 94.1 of CSF cultures and 79.06 of microscopic CSF examination with India ink were positive. Titers of Cryptococcus neoformans capsular antigen in CSF > or = 1/1000 were found in 36.1 and > or = 1/1000 in 73.6 of serum samples. In conclusion, manifestations and severity of disseminated cryptococcosis continue maintaining the characteristics of half a decade behind, in those patients who are not treated with HAART. Neurological involvement existed in all patients of this cohort. Treatment is not able to modify the parameters of mortality seen in previous communications. Diagnostic methods applied in this study are in accordance with those in the bibliography.(AU)
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Criptococosis/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Enfermedad Aguda , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Antígenos Fúngicos/sangre , Antígenos Fúngicos/líquido cefalorraquídeo , Terapia Antirretroviral Altamente Activa , Argentina/epidemiología , Recuento de Linfocito CD4 , Criptococosis/tratamiento farmacológico , Criptococosis/inmunología , Criptococosis/microbiología , Cryptococcus neoformans/inmunología , Cryptococcus neoformans/aislamiento & purificación , Fluconazol/uso terapéutico , Anticuerpos Anti-VIH/sangre , VIH-1 , Pacientes Internos , Meningitis Criptocócica/líquido cefalorraquídeo , Meningitis Criptocócica/tratamiento farmacológico , Meningitis Criptocócica/epidemiología , Meningitis Criptocócica/inmunología , Meningitis Criptocócica/microbiología , Recurrencia , Estudios RetrospectivosRESUMEN
As HIV seropositive patients with undetectable CSF viral load have a lower likelihood of developing neurologic disease, the determination of CSF viral load levels may be useful to evaluate the efficacy of HAART. We compared plasma viral load levels with HIV-1 RNA CSF levels in 18 hemophilic patients without neurocognitive involvement under HAART. We detected a significant correlation between plasma viral load levels and CSF viral load levels. Fourteen patients with undetectable plasma viral load had undetectable RNA HIV-1 CSF levels as well. Four patients with detectable plasma viral load had detectable HIV-RNA in CSF, but the latter were significantly lower. Viral load is usually lower in non-blood fluids and HAART decreases the viral load in CSF as well as in blood.
RESUMEN
In the context of HIV infection, cryptococcal meningitis is the most common mycosis threatening the patients life. We conducted a retrospective evaluation to determine the epidemiological, microbiological, immunological and clinical characteristics of disseminated cryptococcosis in 51 hospitalised HIV seropositive patients. All the individuals (n = 51) presented reactive serology for HIV (ELISA and/or Western blot) and none fulfilled strict HAART treatment, previous to the opportunistic infection. CD4+ lymphocyte T counts showed levels between 361 and 0 cells/microliter (mean = 45). All patients but one had counts lower than 100 cells/microliter. Cryptococcosis presented as unique episode in 35 patients (68.6
) and in 16 as relapse (31.3
). In all of them we detected central nervous system involvement. The induction treatment was carried out with amphotericin B (AMB), continued with maintenance therapy with fluconazole. Lethality rate was 36.7
, slightly superior among patients in relapse (40
) compared to those who presented a first episode of the mycosis (35.2
). In those individuals for whom data were available, 65.2
of blood cultures, 94.1
of CSF cultures and 79.06
of microscopic CSF examination with India ink were positive. Titers of Cryptococcus neoformans capsular antigen in CSF > or = 1/1000 were found in 36.1
and > or = 1/1000 in 73.6
of serum samples. In conclusion, manifestations and severity of disseminated cryptococcosis continue maintaining the characteristics of half a decade behind, in those patients who are not treated with HAART. Neurological involvement existed in all patients of this cohort. Treatment is not able to modify the parameters of mortality seen in previous communications. Diagnostic methods applied in this study are in accordance with those in the bibliography.