Prevalence and correlates of current cigarette smoking among transgender women in Argentina.

Objective: To assess the prevalence of current cigarette smoking among transgender women in Argentina, and to examine the unique associations of current cigarette smoking with demographic and psychosocial factors. Methods: This study is a secondary data analysis of the TransCITAR - a prospective cohort study of transgender individuals living in Buenos Aires, Argentina - baseline data. The baseline survey collected information on sociodemographic characteristics, perceived health status, depressive symptoms, suicide attempts, current cigarette smoking, alcohol use disorder, and substance use. Participants were also asked about lifetime experiences of physical and sexual violence perpetrated by partners, clients and/or the police, and experiences of gender identity stigma in the past year from healthcare workers and the police. Lastly, participants were asked if they had ever been arrested. Fisher's exact test was used to compare proportions in categorical variables and student t-test was used for continuous variables. Significant associations with current cigarette smoking were tested in a logistic regression model adjusted for all significant associations. Results: A total of 41.7% of participants (n = 393) reported current cigarette smoking. Compared to their non-smoking counterparts, participants who reported current cigarette smoking (1) had completed less education, (2) were more likely to be born in Argentina, (3) more likely to had migrated to Buenos Aires from other parts of the country, (4) more likely to report a history of sex work, (5) more likely to perceive their health as excellent, (6) more likely to screen positive for hazardous alcohol drinking, (7) more likely to report any substance and cocaine use in the past year, (8) more likely to experience gender identity stigma from the police in the past year, and (9) more likely to being arrested in their lifetime (all p's < 0.05). After controlling for all significant associations, education level of less than high school (AOR = 1.79, 95% CI 1.02-2.12), hazardous drinking (AOR = 2.65, 95% CI 1.30-5.37), and any substance use in the last year (AOR = 2.14, 95% CI 1.16-3.94) were positively and independently associated with current cigarette smoking. Conclusion: Among transgender women in Argentina, current cigarette smoking was more than double the rate for cisgender women. Current cigarette smoking was associated with education, hazardous drinking, and any drug use. These results will inform future smoking cessation interventions among transgender women in Argentina.

Validation of a Lateral Flow Assay for Rapid Diagnosis of Histoplasmosis in Advanced HIV Disease, Buenos Aires, Argentina.

Histoplasmosis is a major cause of mortality in individuals with advanced human immunodeficiency virus (HIV) disease (AHD). We evaluated in patients with AHD a lateral flow assay (LFA) developed by MiraVista® Diagnostics (MVD LFA). Histoplasmosis was defined based on the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) case definitions. We also compared the results of this LFA with those obtained using a commercial enzyme immunoassay (EIA) developed by IMMY, Clarus Histoplasma GM EIA, IMMY (HGM EIA). A retrospective observational study was conducted at Hospital Juan A. Fernández, located in Buenos Aires, Argentina. The study included 48 urine specimens from patients aged >18 years with AHD. Urine specimens included 17 patients with disseminated histoplasmosis and 31 specimens from patients without evidence of histoplasmosis. Specimens were tested using the MVD LFA and the HGM EIA. The MVD LFA and the HGM EIA had similar analytical performance, with a sensitivity of 94%, specificity of 100%, positive predictive value of 100%, negative predictive value of 97%, and an accuracy of 98%. Comparison of the MVD LFA with the HGM EIA demonstrated a Kappa agreement index of 0.906. The LFA evaluated in this study had high analytical performance; it provided rapid diagnosis of histoplasmosis with minimal requirements for laboratory training, equipment, and laboratory infrastructure.

Neuroparacoccidioidomicosis: para tener presente / Neuroparacoccidiodomycosis to keep in mind:

La paracoccidioidomicosis (PCM) es una micosis endémica de zonas tropicales y subtropicales, con mayor prevalencia en América Latina, producida por especies del género Para-coccidioides. Es una micosis profunda sistémica que en su forma crónica afecta principalmente a varones adultos. La afectación del sistema nervioso central (SNC) está descrita en un 10-27%. Nosotros presentamos dos casos con mani-festación neurológica al ingreso

Paracoccidioidomycosis (PCM) is an endemic mycosis, from tropical and subtropical zones, with a higher prevalence in Latin America, produced by species of the genus Paracoccidioides. It is a deep chronic systemic my-cosis, which mainly affects adult males. The involvement of the central nervous system (CNS) is described in 10-27%. We present two cases with neurological manifestation upon admission.

Factores contextuales, sociales e individuales como barreras y facilitadores para el acceso a la salud de mujeres trans: desde la perspectiva de la comunidad / Contextual, social and individual factors as barriers and facilitators for healthcare access of trans women: a community perspective

Introducción: Las mujeres transgénero (MT) son vulnerables a diversos problemas de salud, incluyendo el virus de la inmunodeficiencia humana (VIH) y otras infecciones de transmisión sexual (ITS), que reducen significativamente su expectativa de vida. Consecuentemente, existe la necesidad de entender los factores que afectan su acceso a la salud.Métodos: Se realizó una investigación cualitativa en MT que viven en alojamientos comunitarios (HT, hoteles trans) en Buenos Aires. El objetivo del estudio fue explorar las barreras y facilitadores contextuales, sociales e individuales para el acceso a la salud, particularmente los servicios de VIH, y la aceptabilidad de diferentes intervenciones. Se realizaron dos grupos focales y cinco entrevistas en tres hoteles trans.Resultados: Las barreras contextuales descriptas fueron los turnos limitados y las largas horas de espera. Los obstáculos sociales incluyeron el estigma y la discriminación por parte del personal y la culpabilización de las MT de sus problemas de salud, así como el estigma por VIH dentro de los grupos de MT. El facilitador más importante fueron los servicios inclusivos. Las barreras individuales incluyeron la auto-exclusión y el estigma anticipado, resultando en altos índices de automedicación e inyección de siliconas. Las pares juegan un rol importante acompañando a otras MT a los servicios. Aun reportando problemas similares, las MT recomendaron intervenciones diferentes según su perfil de hotel. Conclusiones: Dado que el estigma y la discriminación son la principal barrera, es imprescindible sensibilizar a todo el personal de salud. Se necesita implementar una amplia gama de estrategias en los establecimientos de salud y evaluar la aceptación de intervenciones domiciliarias para responder a las diferentes demandas de las MT

Background: Transgender women (TGW) are vulnerable to several health problems, including HIV and other STDs, which significantly reduces their life expectancy. Therefore, there is an urgent need to understand factors affecting access to healthcare.Methods: A qualitative study was conducted among TGW living in rooming houses (TRH) in Buenos Aires. The objective of the study was to explore contextual, social and individual barriers and facilitators to access healthcare, particularly HIV services, and the acceptability of interventions. Two focus groups and five interviews were conducted in three TRH.Results: Contextual barriers described were the limited number of appointments and long waiting hours. Social obstacles included health workers' stigma and discrimination and blaming of TGW for their health burdens, as well as HIV stigma within TGW groups. Most important facilitator were inclusive services. Individual barriers were self-exclusion and anticipated stigma, resulting in high rates of self-medication and industrial silicone injection. Peers play an important role by accompanying others TGW to healthcare. While reporting similar problems, TGW recommended different interventions according to their THR profile. Conclusions: As the stigma and discrimination is the most important barrier, it is imperative to ensure awareness of transgender issues for all personnel of healthcare services. It is necessary to implement a wide range of strategies in health facilities, and evaluate the community acceptance of domiciliary interventions, in order to respond to the different demands of this population

Prevalence of cryptococcal infection among advanced HIV patients in Argentina using lateral flow immunoassay.

BACKGROUND: Globally, Latin America ranks third among regions with most cases of AIDS related cryptococcal meningitis. In 2009, a lateral flow immunoassay (LFA) for the detection of cryptococcal antigen (CrAg) was developed as a potential point-of-care test for diagnosis of cryptococcal infection. In 2011 World Health Organizations recommended on CrAg screening for HIV positive persons with CD4 below 100 cells/µL, followed by preemptive fluconazole treatment. However, in Argentina no formal recommendations for CrAg screening have been issued. METHODS: HIV positive patients > = 18 years with advanced immunosuppression (CD4 counts ≤100 cells/µL within 3 months or WHO stage III/IV), who visited the hospital between April 1, 2014 and January 31, 2015, were included. The LFA was performed according to the manufacturer's instructions on all serum samples. When CrAg detection was positive, a lumbar puncture was performed to rule out cryptococcal meningitis. Patients without evidence of meningeal involvement were treated with preemptive oral fluconazole in ambulatory care. RESULTS: We included 123 patients. Prevalence of CrAg-positivity was 8.1%. Among the 10 CrAg-positive patients, 6 had meningeal involvement detected through the CSF analysis (CSF India-ink testing, CSF CrAg and culture). The remaining 4 patients with positive CrAg received targeted preemptive treatment with oral fluconazole and were free of cryptococcal disease during the follow-up period. None of the 113 patients with a negative CrAg test result developed cryptococcal disease. CONCLUSIONS: This is the first study in Argentina, to our knowledge, describing the prevalence of cryptococcosis and usefulness of CrAg screening. LFA provided early diagnosis to determine a high prevalence of CrAg in our hospital, and that screening for subclinical infection with preemptive antifungal treatment, prevented a substantial proportion of meningeal disease.

Manejo de criptococosis meníngea refractaria: a propósito de un caso / Management of refractory cryptococcal meningitis: report of a case

La criptococosis es una de las infecciones oportunistas más frecuentes en pacientes con infección por HIV. La toxicidad de la anfotericina B y el aislamiento de un número creciente de cepas resistentes a fluconazol determinan la necesidad de tratamientos alternativos y estrategias novedosas. Este artículo presenta un paciente HIV positivo con criptococosis meníngea sin negativización de los aislamientos de Cryptococcus neoformans con el tratamiento convencional de inducción con anfotericina B más fluconazol, y respuesta favorable al sustituir este último antifúngico por voriconazol...

Cryptococcosis is one of the most common opportunistic infections in patientes with HIV infection. The toxicity of amphotericin B and isolation of an increasing number of strains resistant to fluconazole dictate the need for alternative treatments and novel strategies. This paper presents an HIV positive patient with cryptococcal meningitis without negativisation Cryptococcus neoformans isolates with conventional induction therapy with amphotericin B plus fluconazole, and favorable to the latter replaced by voriconazole antifungal response...

Manejo de criptococosis meníngea refractaria: a propósito de un caso / Management of refractory cryptococcal meningitis: report of a case

La criptococosis es una de las infecciones oportunistas más frecuentes en pacientes con infección por HIV. La toxicidad de la anfotericina B y el aislamiento de un número creciente de cepas re-sistentes a fluconazol determinan la necesidad de tratamientos alter-nativos y estrategias novedosas. Este artículo presenta un pacien-te HIV positivo con criptococosis meníngea sin negativización de los aislamientos de Cryptococcus neoformans con el tratamiento con-vencional de inducción con anfotericina B más fluconazol, y respues-ta favorable al sustituir éste último antifúngico por voriconazol

Cryptococcosis is one of the most common opportunistic infections in patients with HIV infection. The toxicity of amphotericin B and isolation of an increasing number of strains resistant to fluconazole dictate the need for alternative treatments and novel strategies. This paper presents an HIV positive patient with cryptococcal meningitis without negativisation Cryptococcus neoformans isolates with conventional induction therapy with amphotericin B plus fluconazole, and favorable to the latter replaced by voriconazole antifungal response

Impacto de la histoplasmosis diseminada en pacientes HIV positivos / Impact of disseminated histoplasmosis in HIV positive patients

Introducción: la histoplasmosis constituye la segunda micosis sistémica en orden de frecuencia en Argentina, después de criptococosis, en pacientes HIV positivos. En éstos, la forma clínica diseminada progresiva es marcadora de sida. La coinfección HIV-Histoplasmosis diseminada (HD) en nuestro país ha sido reportada entre 5,3 y 6 %. Métodos: estudio descriptivo, retrospectivo, realizado en un hospital de agudos de CABA, que incluyó pacientes HIV positivos con HD, en el período 2000-2011. Resultados: n:80. Edad, media (desvío estándar, DE): 37 años (8,1). Varones: 81,2%. CD4, mediana (rango intercuartil, RIC): 19,5 cél/µL (7-54). HD como primera marcadora de sida: 70%; serología HIV previa desconocida: 38,7 %. El 11,8% recibía terapia antirretroviral (TARV) al diagnóstico de HD. Otra infección oportunista concomitante al diagnóstico: 29,4%. Clínica 84,7% fiebre, 75% síndrome de impregnación, 72,2% síntomas respiratorios, 56,9% lesiones cutáneo-mucosas, 30,5% hepatosplenomegalia. Laboratorio: 76,2% anemia, 60,3% leucopenia, 42,1% plaquetopenia. Aislamientos: hemocultivos: 81,8%; muestras positivas: piel y mucosas: 39 pacientes, respiratorias: 16 pacientes, médula ósea: 6 pacientes. Radiografía de tórax patológica: 77,6%. Tratamiento: anfotericina B: 58,5%; itraconazol: 91%. Recaída: 21,2%. Mortalidad global: 20,2%, atribuible a HD: 5,9%. Conclusión: HD fue la primera marcadora en el 70% de los pacientes, alrededor de un 40% desconocían su serología y sólo 1 de cada 10 recibía TARV, lo que refleja un retraso en el diagnóstico de HIV en nuestra población. Las principales manifestaciones clínicas semejan otras infecciones oportunistas siendo importante la sospecha diagnóstica para el tratamiento temprano.

Introduction: Histoplasmosis is the second most frequente fungal infection in Argentina, after cryptococcosis in HIV positive patients. In these patients the disseminated clinical presentation is an AIDS-defining condition. Disseminated histoplasmosis (DH) and HIV coinfection has been reported between 5.3 and 6 % in Argentina. Methods: Retrospective, descriptive study, performed in an acute care hospital of Buenos Aires city, including HIV positive patients with DH, between 2000-2011. Results: n: 80. Mean age (standard deviation, SD): 37 years (8.1). Male: 81.2%. Median CD4 (interquartile range, IQR): 19.5 cells/uL (7-54). DH as the first AIDS defining condition: 70%; unknown prior HIV test: 38.7%. ONly 11.8% were receiving antiretroviral treatment at the time of diagnosis of DH. Other concomitant oportunistic infections: 29.4 %. Clinical manifestations: fever 84.7%, constitutinal symptoms 75%, respiratory symptoms 72.2 %, mucocutaneous lesions 56.9%, liver and/or spleen enlargement 30.5%. Laboratory abnormalities: anemia 76.2 %, leucopenia 60.3%, thrombocytopenia 42.1% Microbiological isolates: blood culture 81.8%; others positive samples: 39 of skin and mucosa, 16 of respiratory specimens, 6 of bone marrow. X-ray chest abnormalities: 77.6%. Treatment: amphotericin B: 58.5%; itraconazole: 91%. Relapse: 21.2%. Global mortality: 20.2%, DH atributable mortality: 5.9%. Conclusion: DH was the first AIDS defining condition in 70% of our patients, about 40% were unaware of their serostatus and only one in ten received antiretroviral treatment, reflecting a delay in diagnosis of HIV in our population. The main clinical manifestations resemble other oportunistic infections, so diagnostic of DH should be for considered in order to provide timely treatment.