RESUMO
SETTING: In 2010, Médecins Sans Frontières set up decentralised community antiretroviral therapy (ART) refill centres ("poste de distribution communautaire", PODI) for the follow-up of stable human immunodeficiency virus (HIV) patients. OBJECTIVE: To assess retention in care and sustained viral suppression after transfer to three main PODI in Kinshasa, Democratic Republic of Congo (DRC) (PODI Barumbu/Central, PODI Binza Ozone/West and PODI Masina I/East). DESIGN: Retrospective cohort study using routine programme data for adult HIV patients transferred from Kabinda Hospital to PODIs between January 2015 and June 2017. RESULTS: A total of 337 patients were transferred to PODIs: 306 (91%) were on ART for at least 12 months; 118 (39%) had a routine "12-month" viral load (VL) done, 93% (n = 110) of whom had a suppressed VL <1000 copies/ml. Median time from enrolment into PODI to 12-month routine VL was 14.6 months (IQR 12.2-20.8). Kaplan-Meier estimates of retention in care at 6, 12 and 18 months after enrolment into PODIs were respectively 96%, 92% and 88%. CONCLUSION: Retention in care and viral suppression among patients in PODI with VL results were better than patients in clinic care and national outcomes.
RESUMO
Assuntos
Antituberculosos/administração & dosagem , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adolescente , Adulto , Idoso , Antituberculosos/efeitos adversos , Criança , Estudos de Coortes , Esquema de Medicação , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Níger , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Detection and quantification of different Pneumocystis carinii (PC) life cycle forms were performed by polymerase chain reaction (PCR) and by morphological stains on bronchoalveolar lavage fluids (BALF) from HIV-infected patients with P. carinii pneumonia (PCP). The number of PC trophozoites was higher in patients with PCP who were receiving prophylaxis than in those not receiving prophylaxis. Also the cyst: trophozoite ratio was lower in the first group. No difference was observed between patients receiving different prophylactic medications. The imbalance between PC forms in BALF from patients with PCP receiving anti-PC prophylaxis may hamper the sensitivity of cyst stains. Multiple stains or PCR examination should be performed on BALF from patients with clinically suspected PCP who are receiving prophylaxis.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Líquido da Lavagem Broncoalveolar/microbiologia , Pneumocystis/crescimento & desenvolvimento , Pneumonia por Pneumocystis/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Adulto , Anti-Infecciosos , Antifúngicos/uso terapêutico , DNA Fúngico/análise , Dapsona/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pentamidina/uso terapêutico , Pneumocystis/genética , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/prevenção & controle , Reação em Cadeia da Polimerase , Pirimetamina/uso terapêuticoRESUMO
Our aim was to evaluate if genetic diversity of Pneumocystis carinii could influence the detection by molecular techniques in bronchoalveolar lavage (BAL) fluids and in non-invasive specimens (induced sputum, oropharyngeal washing and serum/blood). P. carinii is morphologically similar in different hosts although several strains have been identified by biomolecular techniques. Variations of mt-LSU and ITSs sequences could determine a lack of hybridization of some clinical samples and could have diagnostic consequences with loss in sensitivity and specificity of available molecular tests, but at the moment no data support a significant impact of genetic diversity in these sequences on molecular detection of P. carinii for clinical purposes.
Assuntos
Variação Genética , Pneumocystis/isolamento & purificação , Primers do DNA , DNA Fúngico/isolamento & purificação , Humanos , Pneumocystis/genética , Reação em Cadeia da Polimerase , Sistema Respiratório/microbiologiaRESUMO
The purpose of this study was to determine whether dihydropteroate synthase gene (DHPS) mutations were associated with the failure of sulpha/sulphone drugs used as prophylaxis agents in HIV infected patients. Results suggested that DHPS mutations were significantly associated with failure of anti-Pneumocystis carinii sulphone prophylaxis (P=0.031). An increasing number of mutant P. carinii strains have been isolated from patients no longer having prophylaxis. There was no statistically significant difference in severity or outcome of the pneumonia caused by wild-type or mutant DHPS. Moreover, two of the three patients with mutant P. carinii pneumonia (PCP) were successfully treated with sulpha drugs. We think that P. carinii drug-resistance could be an emerging problem for immunocompromised patients including those with HIV infection.
Assuntos
Di-Hidropteroato Sintase/genética , Farmacorresistência Bacteriana/genética , Infecções por HIV/complicações , Pneumocystis/genética , Pneumonia por Pneumocystis/microbiologia , Adulto , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Pneumocystis/enzimologia , Pneumonia por Pneumocystis/prevenção & controle , Sulfonas/uso terapêutico , Falha de TratamentoAssuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , DNA Ribossômico/genética , Técnicas de Tipagem Micológica , Pneumocystis/classificação , Pneumonia por Pneumocystis/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Antifúngicos/uso terapêutico , DNA Fúngico/genética , Variação Genética , Humanos , Itália/epidemiologia , Masculino , Pneumocystis/genética , Pneumocystis/isolamento & purificação , Pneumonia por Pneumocystis/epidemiologia , RecidivaRESUMO
The Immune reconstitution inflammatory syndrome (IRIS) after starting antiretroviral therapy for HIV is well known. We describe an HIV seropositive woman, presenting 2 IRIS episodes associated with Mycobacterium tuberculosis. Exceptional was that the last episode occurred 4 years after initiating antiretroviral treatment, when her CD4+ lymphocyte count had been around 300 cells/mm3 for one year.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antirretrovirais/imunologia , Inflamação/etiologia , Tuberculose/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Antirretrovirais/efeitos adversos , Feminino , Humanos , Síndrome , Fatores de Tempo , Tuberculose/complicações , Tuberculose/imunologiaRESUMO
By using a recently developed PCR-solution hybridization enzyme-linked assay (PCR-SHELA), we investigated Pneumocystis carinii in bronchoalveolar lavage fluid samples and induced sputa of patients with pneumocystosis. In detecting P. carinii, PCR-SHELA proved more sensitive than immunofluorescence staining or a single PCR and significantly more diagnostically specific than a nested PCR. Our data suggest that PCR-SHELA could be used to detect P. carinii organisms in respiratory samples, particularly in patients with uncertain diagnoses.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Ensaio de Imunoadsorção Enzimática/métodos , Pneumocystis/isolamento & purificação , Pneumonia por Pneumocystis/microbiologia , Reação em Cadeia da Polimerase/métodos , Adulto , Líquido da Lavagem Broncoalveolar/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hibridização de Ácido Nucleico , Pneumocystis/genética , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Escarro/microbiologiaRESUMO
A nested PCR which amplified a portion of the mitochondrial large-subunit rRNA gene of Pneumocystis carinii was used to detect P. carinii DNA in blood from patients with P. carinii pneumonia. P. carinii DNA was not detected in serum and was detected at low levels of blood cells.
Assuntos
DNA Fúngico/sangue , DNA Fúngico/genética , Pneumocystis/genética , Pneumocystis/isolamento & purificação , Pneumonia por Pneumocystis/diagnóstico , Reação em Cadeia da Polimerase/métodos , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Sequência de Bases , Primers do DNA/genética , Reações Falso-Negativas , Humanos , Leucócitos Mononucleares/microbiologia , Neutrófilos/microbiologia , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/microbiologiaRESUMO
Oropharyngeal washings (Ophs) from 27 HIV infected patients (18 with P. carinii pneumonia, PCP, and 9 without PCP) were examined for P. carinii using morphological staining and DNA amplification with PCR-SHELA and nested PCR methods. The comparison of these techniques shows that 1. the amplification of P. carinii DNA is more sensitive than (and as specific as) morphological staining; 2. PCR-SHELA is less sensitive than (and as specific as) nested PCR.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Orofaringe/microbiologia , Pneumocystis/isolamento & purificação , Pneumonia por Pneumocystis/diagnóstico , Reação em Cadeia da Polimerase/métodos , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Técnicas de Sonda Molecular , Líquido da Lavagem Nasal/microbiologia , Pneumonia por Pneumocystis/microbiologia , Sensibilidade e EspecificidadeRESUMO
To understand the way of reinfection of Pneumocystis carinii we have analyzed the genetic variation at the internal transcribed spacer (ITS) in DNA samples from bronchoalveolar lavage fluid of Italian HIV patients who had multiple episodes of P.carinii pneumonia. The presence of the same and/or a new type in both episodes suggest the possible occurrence of both reactivation of a previously acquired infection and reinfection from an exogenous source. Furthermore the occurrence of two different types in the same episode indicate that a mixed infection is common.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , DNA Fúngico/genética , DNA Ribossômico/genética , Técnicas de Tipagem Micológica , Pneumocystis/genética , Pneumonia por Pneumocystis/microbiologia , Líquido da Lavagem Broncoalveolar/microbiologia , Variação Genética/genética , Humanos , Recidiva , Análise de Sequência de DNARESUMO
The aim of this study was to determine the kinetics, the dissemination of the infection and the immunological response to Pneumocystis carinii primary infection in a non-immunosuppressed rabbit model. For this purpose, we developed a nested PCR that amplified a portion of the mitochondrial large-subunit rRNA gene of rabbit-derived P. carinii. The PCR detected P. carinii DNA in lung and bronchoalveolar lavage fluids from 14- to 45-day-old rabbits but not in their serum. No P. carinii DNA was detected in extrapulmonary organs from 28-day-old rabbits with P. carinii pneumonia. ELISA and immunoblotting analysis showed that 5-day-old pups had elevated specific IgG. The IgG concentration sharply decreased, reaching a trough on day 21, and from then onwards progressively increased as the infection cleared. Conversely, the specific IgM concentration increased during the infection and peaked on day 28. IgG mainly recognized a 50-kDa subunit of P. carinii organisms; IgM recognized first a 45-kDa subunit on day 21, whereas from day 28 onwards it also recognized the 50-kDa subunit. A P. carinii-specific splenocyte proliferative response was observed on day 45. These findings suggest that P. carinii primary infection is a time-limited and a lung-limited event and contribute new information on the relationship between the kinetics of primary P. carinii infection and the immunological response in a model that mimics the primary infections in humans.