Anal cytology screening in men who have sex with men with HIV at a university hospital in Bogotá, Colombia.

BACKGROUND: Risk of anal squamous cell carcinoma (anal cancer) is greater among men who have sex with men (MSM) living with human immunodeficiency virus (HIV). We describe the frequency of and factors associated with abnormal anal cytology results in Colombian MSM living with HIV. METHODS: This retrospective observational cohort study included MSM ≥18 years old living with HIV screened with anal cytology at Hospital Universitario San Ignacio in Bogotá, Colombia between January 2019 and February 2020. A multivariable log-binomial regression model estimated associations with abnormal anal cytology. RESULTS: A total of 211 patients were included. Mean age was 35.6 years. Sixty-eight (32.3%) had an abnormal anal cytology result: ASC-US 33.8% (n = 23); LSIL 60.3% (n = 41); and HSIL 5.9% (n = 4). MSM with an STI diagnosis in the previous 12 months (RR 1.48, [95% CI 1.03-2.12], p = 0.032) or with a CD4+ T cell count <200 (RR 2.08 [95% CI 1.16-3.73], p = 0.014) were significantly more likely to have abnormal anal cytology. CONCLUSIONS: These data provide crucial information to guide scale up of anal cancer screening at select centers in Colombia. Our results also suggest STI prevention efforts and improved virological control among MSM living with HIV may have the secondary benefit of reducing the risk of anal cancer.

Screening with Anal Cytology in Colombia: Initial Experience and Need for High-Resolution Anoscopy.

BACKGROUND: Men who have sex with men (MSM) living with human immunodeficiency virus (HIV) are at increased risk of anal cancer. Anal cytology can be used to screen for dysplasia, with high-resolution anoscopy (HRA) required for diagnostic confirmation. We describe the impact lack of HRA had on management of abnormal screening results in Bogotá, Colombia. MATERIAL AND METHODS: This retrospective cohort study includes MSM with HIV who underwent anal cytology screening between January 2019February 2020, with colorectal surgery (CRS) follow-up through July 2020. Cytology results included atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), and high-grade squamous intraepithelial lesion (HSIL). Categorical and continuous variables were compared via Fisher's exact test and Wilcoxon rank-sum, respectively. RESULTS: Of 211 MSM screened, 68 had abnormal cytology: ASC-US (n = 23), LSIL (n = 41), HSIL (n = 4). Sixty (88.2%) were referred to CRS, and 51 (75.0%) attended ≥ 1 appointment. At initial assessment, 17 were referred for anal exam under anesthesia (EUA) for tissue resection, and 21 for rectosigmoidoscopy. Having perianal condyloma was associated with recommendation for EUA (P < 0.001), while cytology grade of dysplasia was not (P = 0.308). Eleven (16.2%) underwent EUA for condyloma resection. CONCLUSIONS: Few studies have described anal cancer screening in settings without HRA. We found lack of HRA limited management of abnormal cytology in Colombia. Those with condyloma underwent resection, but HRA remains necessary to localize and treat microscopic disease. Next steps include implementation of HRA in order to further develop the anal cancer screening program for MSM with HIV in Bogotá.

Inhibidores de Transferencia de la Cadena de Integrasa: Bases para su uso en la práctica clínica / Integrase Strand Transfer Inhibitors: Bases for its use in the clinical practice

Los inhibidores de transferencia de la cadena de integrasa (INSTI) son medicamentos cuyo mecanismo de acción consiste en bloquear el proceso de integración del ADN proviral al ADN del hospedero mediante la unión al sitio catalítico de la integrasa viral y de esta manera evitar su replicación. Actualmente se cuenta con la aprobación INSTI de primera y segunda generación, presentan similitud en su mecanismo de acción, cambios en su estructura que modifican su barrera genética, pero mantienen su perfil de seguridad y efectividad. Desde su aprobación en el año 2007, se han llevado a cabo múltiples estudios clínicos cuyos resultados han permitido avanzar en el conocimiento de su efectividad en diferentes escenarios clínicos; (pacientes naive, experimentados, esquemas de simplificación y profilaxis, así, como en el conocimiento de su perfil de mutaciones de resistencia). En el presente artículo se hizo una revisión de los miembros de esta familia de antirretrovirales (ARV).

Integrase strand transfer inhibitors (INSTI) are drugs whose mechanism of action consists of blocking the integration process of the proviral DNA to the host DNA by binding to the catalytic site of the viral integration and thus preventing its replication. Currently it has the approval of INSTI of first generation, two of second generation and in process of approval of a third of second generation. The two generations has similitude in its mechanisms of action, changes in its structures that modify its genetic barrier, but keeping his security and effectiveness profile. Since the approval of INSTI´s in 2007 to date, multiple clinical studies have been carried out, whose results have allowed us to advance in the knowledge of their effectiveness in different clinical scenarios; (naive patients, experienced patients, simplification and prophylaxis schemes, as well as in the knowledge of their profile of resistance mutations). In the present article, we made a review of the members of this family of antiretrovirals (ARV).

Coriorretinitis por toxoplasma gondii en contexto de un síndrome de reconstitución inmunológica inflamatorio en un paciente con síndrome de inmunodeficiencia adquirida SIDA / Chorioretinitis by toxoplasma gondii in context of immune reconstitution inflammatory syndrome in an AIDS patient

El síndrome de reconstitución inmunológica inflamatorio (SRII) en pacientes con infección por el virus de inmunodeficiencia humana (VIH), es una entidad clínica rara caracterizada por un aumento de linfocitos T CD4+(CLTCD4+) y disminución de la carga viral servirá del VIH, que aparece corto tiempo después de iniciar terapia antirretroviral de gran actividad (TARGA). Usualmente se manifiesta con un deterioro paradójico del estado del paciente secundario a una reactivación de procesos infecciosos oportunistas.Caso clínico: hombre con diagnóstico de toxoplasmosis cerebral en el curso de infección por VIH, quien posterioral inicio de la TARGA desarrollo coriorretinitis. El paciente experimento mejoría poco tiempo después de haber suspendido la TARGA y de administrar esteroides.Conclusión: La incidencia del SRII ha aumentado en los pacientes VIH que cursan con alta carga antigénica yCLTCD4+ bajo. Su patofisiología genera incertidumbre debido a que los biomarcadores diagnósticos y pronósticos no se conocen del todo. El tratamiento propuesto lo constituye en algunos casos la suspensión temporal de la TARGA con administración de esteroides, no obstante es necesaria la realización de más estudios.

Immune reconstitution inflammatory syndrome (IRIS) in context of severe immunosupression secondary to humanimmunodeficiency virus (HIV), is characterized by a dramatic rise of T lymphocyte CD4+ count in addition to aHIV viral load drop in, typically it is manifested by a paradoxical clinical impairment due to reactivation opportunistic of infectious processes previously under immune surveillance. A 36 years old male with cerebral toxoplasmosis in context of HIV infection developed chorioretinitis 8 weeks after commencing HAART. Workup laboratories only showed a marked T Lymphocyte CD4+ count increase with a HIV viral load lower than 40 copies/ml and other possible causes of chorioretinitis were excluded. After cessation of HAART and establishing corticosteroid therapy clinical improvement of this condition was documented. IRIS incidence has increased among AIDS patients especially with high antigenic burden and very low CD4 + T lymphocytecount. However its mechanism is still unclear due to biomarkers for diagnosis and prognosis are not completely known at all. In order to validate and refine diagnostic criteria and therapeutic approaches of IRIS more studies are needed.

Manifestaciones neurológicas atípicas del síndrome de reconstitución inmunológico por infección con el virus de inmunodeficiencia humana, reporte de los casos / Atypical neurological manifestations of immunologic reconstitution syndrome in the context of HIV infection, a report of two case studies

El síndrome inflamatorio de reconstitución inmunológica en caso de infección por el virus de inmunodeficiencia humana (VIH) es una entidad clínica rara, que se manifiesta con la activación de procesos infecciosos oportunistas que se encontraban estables. Presentamos dos casos de este síndrome con compromiso del sistema nervioso central: síndrome de movimientos anormales y periférico, y síndrome de Guillain Barré...

Immune reconstitution inflammatory syndrome in the context of severe immunosupression secondary to human immunodeficiency virus (HIV) is a clinical entity manifested by a paradoxical clinical impairment due to an activation of infectious opportunistic processes previously under immune surveillance. We illustrate two case reports of immune reconstitution inflammatory syndrome with atypical central nervous system involvement (choreoathetosis) and acute inflammatory demyelinating polineuropathy (Guillain-Barré syndrome)...

Polineuropatia desmielinizante aguda en SIDA: presentación de dos casos / Atypical acute inflammatory demyelinating polyneuropathy in the setting of HIV infection: Report of two cases

La polineuropatia desmielinizante aguda (AIDP) es un desorden inmune que afecta el nervio periférico produciendolesión axonal o mielínica. las infecciones respiratorias altas, gastrointestinales o los cuadros febriles inespecíficosusualmente preceden este caudro clínico caracterizado por debilidad progresiva y disminución de reflejos miotendinosos.En el paciente con infección VIH la AIDP usulamnete aparece en el periodo de seroconversión cuandoel conteo de CD4 es mayor a 500 células/uL. Se presume origen infecciosos a pesar de no existir un anticuerpoespecífico. reportamos dos casos de paciente con VIH y ADPI con presentación atípica. El primero con un conteode CD4 menos a 100 células/uL, el segundo en el contexto de síndrome de reconstitución inmunológica (IRIS).Ambos pacientes tuvieron recuperación satisfactoria luego de tratamiento con inmunoglobulina intravenosa ysuspensión temporal del tratamiento antiretroviral respectivamente.