Tuberculosis situation in the program area of a general acute care hospital in Buenos Aires City, 2017-2019 / Tuberculosis situation in the program area of a general acute care hospital in Buenos Aires City, 2017-2019

INTRODUCCIÓN: La tuberculosis (TB) genera una gran carga de enfermedad a nivel global. Su elevada presencia en grandes ciudades se explica porque ellas son escenarios de urbanización acelerada, fuertes inequidades sociales y concentración de circunstancias de vulnerabilidad. El objetivo fue analizar la situación epidemiológica de la TB en un área programática (AP) de la Ciudad de Buenos Aires entre 2017 y 2019. MÉTODOS: Se realizó un estudio descriptivo de corte transversal. La población de estudio fueron los casos notificados de TB en residentes en el AP del Hospital Fernández (HF). La fuente de datos principal fue el Sistema Nacional de Vigilancia de Salud. RESULTADOS: Se registraron 375 casos. En 2017 se presentó la tasa de notificación de TB más alta del AP (29,2). Los casos se concentraron en el barrio de Retiro y alcanzaron su mayor tasa en 2018 (134,5). Los barrios populares presentaron 12 veces la tasa del AP (305,1). De todos los casos, 213 fueron de género masculino (56,8%), con 29 años como mediana de edad. Mayormente fueron notificados por la red de efectores del AP del HF. Respecto a la evolución, en 169 casos fue satisfactoria (45,1%), y 138 no registraron datos de evolución (36,8%). DISCUSIÓN: El análisis epidemiológico desagregado reveló la gran complejidad del territorio respecto a este padecimiento de salud. Las redes de abordaje interdisciplinarias e intersectoriales resultan claves para garantizar la accesibilidad al cuidado y tratamiento en esta población.

Immune variations throughout the course of tuberculosis treatment and its relationship with adrenal hormone changes in HIV-1 patients co-infected with Mycobacterium tuberculosis.

HIV infection is a major risk factor predisposing for Mycobacterium tuberculosis infection and progression to active tuberculosis (TB). As host immune response defines the course of infection, we aimed to identify immuno-endocrine changes over six-months of anti-TB chemotherapy in HIV+ people. Plasma levels of cortisol, DHEA and DHEA-S, percentages of CD4+ regulatory T cell subsets and number of IFN-γ-secreting cells were determined. Several cytokines, chemokines and C-reactive protein levels were measured. Results were correlated with clinical parameters as predictors of infection resolution and compared to similar data from HIV+ individuals, HIV-infected persons with latent TB infection and healthy donors. Throughout the course of anti-TB/HIV treatment, DHEA and DHEA-S plasma levels raised while cortisol diminished, which correlated to predictive factors of infection resolution. Furthermore, the balance between cortisol and DHEA, together with clinical assessment, may be considered as an indicator of clinical outcome after anti-TB treatment in HIV+ individuals. Clinical improvement was associated with reduced frequency of unconventional Tregs, increment in IFN-γ-secreting cells, diminution of systemic inflammation and changes of circulating cytokines and chemokines. This study suggests that the combined anti-HIV/TB therapies result in partial restoration of both, immune function and adrenal hormone plasma levels.

Determination of dehydroepiandrosterone and its biologically active oxygenated metabolites in human plasma evinces a hormonal imbalance during HIV-TB coinfection.

An estimated one third of the world's population is affected by latent tuberculosis (TB), which once active represents a leading cause of death among infectious diseases. Human immunodeficiency virus (HIV) infection is a main predisposing factor to TB reactivation. Individuals HIV-TB co-infected develop a chronic state of inflammation associated with hypothalamic-pituitary-adrenal (HPA) axis dysregulation. This results in a hormonal imbalance, disturbing the physiological levels of cortisol and dehydroepiandrosterone (DHEA). DHEA and its oxygenated metabolites androstenediol (AED), androstenetriol (AET) and 7-oxo-DHEA are immunomodulatory compounds that may regulate physiopathology in HIV-TB co-infection. In order to study possible changes in plasma levels of these hormones, we developed an approach based on high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). To our knowledge, this represents the first report of their simultaneous measurement in HIV-TB individuals and the comparison with healthy donors, obtaining statistically higher plasma levels of DHEA, AET and 7-oxo-DHEA in patients. Moreover, we found that concentrations of 7-oxo-DHEA positively correlated with absolute CD4+ T cell counts, nadir CD4+ T cell values and with individuals who presented TB restricted to the lungs. This research contributes to understanding the role of these hormones in HIV-TB and emphasizes the importance of deepening their study in this context.

Expansion of CD25-Negative Forkhead Box P3-Positive T Cells during HIV and Mycobacterium tuberculosis Infection.

Tuberculosis (TB) and HIV alter the immune system, and coinfected (HIV-TB) individuals usually present deregulations of T-lymphocytic immune response. We previously observed an increased frequency of "unconventional" CD4+CD25-FoxP3+ Treg (uTreg) population during HIV-TB disease. Therefore, we aimed to explore the phenotype and function of uTreg and conventional CD4+CD25+FoxP3+ Treg subsets (cTreg) in this context. We evaluated the expression of CD39, programmed cell death protein 1 (PD1), glucocorticoid-induced tumor necrosis factor receptor (GITR), and the effector/memory distribution by flow cytometry in cTreg and uTreg. Also, IL-10, TGF-ß, IFN-γ production, and the suppressor capacity of uTregs were analyzed in cocultures with effector lymphocytes and compared with the effect of regulatory T cells (Tregs). We found diminished expression of CD39 and higher levels of PD1 on uTreg compared to cTreg in both HIV-TB and healthy donors (HD). In addition, uTreg and cTreg showed differences in maturation status in both HIV-TB and HD groups, due to the expansion of effector memory uTregs. Interestingly, both HIV-TB and HD showed a pronounced production of IFN-γ in uTreg population, though no significant differences were observed for IL-10 and TGF-ß production between uTreg and cTreg. Moreover, IFN-γ+ cells were restricted to the CD39- uTreg population. Finally, when the suppressor capacity was evaluated, both uTreg and cTreg inhibited polyclonal T cell-proliferation and IFN-γ production in a similar extent. These findings suggest that uTregs, which are expanded during HIV-TB coinfection, exert regulatory functions in a similar way to cTregs despite an altered surface expression of Treg characteristic markers and differences in cytokine production.

Anemia grave en un paciente con infección por el virus de inmunodeficiencia humana / Severe anemia in a patient with human immunodeficiency virus infection

La anemia es relativamente frecuente en pacientes con infección avanzada por VIH. La aplasia pura de la serie roja (APSR) asociada a la infección por Parvovirus B19 (PVB19) se caracteriza por la ausencia de precursores eritroides en la médula ósea que produce anemia grave normocítica, normocrómica, con un bajo recuento de reticulocitos. Este artículo describe un paciente con infección por VIH con inmunosupresión grave y en fracaso virológico que desarrolló APSR asociada a PV B19.

Severe anemia is quite frequently seen in HIV infected patient with advanced disease. Pure red cell aplasia associated to Parvovirus B19 (PVB 19) infection is characterized by the absence of erythroid precursors in the bone marrow resulting in severe normocytic-normochromic anemia with a low reticulocyte count. This article reports a patient with advanced HIV and virological failure, who developed pure red cell aplasia associated to PVB19.

Reactivación de tuberculosis pulmonar asociada a seroconversión al virus de inmunodeficiencia humana / Reactivation of Pulmonary Tuberculosis associated with Human Immunodeficiency Virus (HIV) seroconversion

Entre un 40-90% de los pacientes que adquieren la infección por HIV presentan un conjunto de síntomas durante el periodo de la seroconversión, habitualmente denominado "Síndrome Retroviral Agudo" (SRA)...

It is estimated that between 40 and 90% of HIV infected patients experience some sympotoms during HIV seroconversion, attributable to an acute retroviral syndrome (ARS)...

Tuberculosis and HIV: a partnership against the most vulnerable.

Tuberculosis (TB) is a major cause of morbidity and mortality worldwide. Each year, there are eight million new Mycobacterium tuberculosis complex (MTB) infections and three million TB-related deaths. The catastrophic effects of TB are borne disproportionately among the most vulnerable. The HIV pandemic has further increased the burden so that the risk of TB reactivation from latency is 5 to 15 percent in HIV/TB coinfection. Tuberculosis reactivation fuels further primary infections, creating a vicious cycle of increasing infection, disease, and deaths. In addition, drug-resistant TB exacerbates this increasingly common problem. The clinical presentations of TB in relation to HIV and HIV-associated immune deficiency are discussed from the perspective of clinical diagnosis and treatment in patient care. Tuberculosis prophylaxis, concurrent drug treatment of TB and HIV, drug interactions, and overlapping toxicities are detailed for the practitioner. Immune reconstitution inflammatory reactions are now a common phenomenon in HIV treatment, where similar reactions have been less commonly described in TB treatment in the past. Global distributive injustices in wealth, the burden of disease, and the provision of healthcare are obvious in TB, and clearly show us that the needs of the most vulnerable populations must be met in order to address the problems.