Host immunity associated with spontaneous suppression of viremia in therapy-naïve young rhesus macaques following neonatal SHIV infection.

IMPORTANCE: Despite the advent of highly active anti-retroviral therapy, people are still dying from HIV-related causes, many of whom are children, and a protective vaccine or cure is needed to end the HIV pandemic. Understanding the nature and activation states of immune cell subsets during infection will provide insights into the immunologic milieu associated with viremia suppression that can be harnessed via therapeutic strategies to achieve a functional cure, but these are understudied in pediatric subjects. We evaluated humoral and adaptive host immunity associated with suppression of viremia in rhesus macaques infected soon after birth with a pathogenic SHIV. The results from our study provide insights into the immune cell subsets and functions associated with viremia control in young macaques that may translate to pediatric subjects for the design of future anti-viral strategies in HIV-1-infected infants and children and contribute to an understudied area of HIV-1 pathogenesis in pediatric subjects.

Angiomatosis bacilar y sarcoma de Kaposi en lesión cutánea de paciente VIH positivo / Bacillary angiomatosis and Kaposi's sarcoma in skin lesion of HIV positive patient

La angiomatosis bacilar (AB) es una enfermedad infec-ciosa poco frecuente, causada por bacterias del género Bartonella spp. transmitidas por vectores como pulgas, piojos y mosquitos. En el ser humano provoca diferentes síndromes clínicos. En pacientes con infección por el virus de inmunodeficiencia humana (VIH) con recuento de LT CD4 + <100 cél/µL se asocia a lesiones angiomatosas con neovascularización que comprometen la piel y, en menor medida, mucosas, hígado, bazo y huesos.El sarcoma de Kaposi (SK) es una neoplasia caracteriza-da por hiperplasia vascular multifocal de origen endotelial relacionada con el herpes virus humano 8. También puede afectar piel, mucosas y vísceras, siendo la variante epidé-mica una enfermedad marcadora de la infección avanzada por VIH. El principal diagnóstico diferencial clínico para las lesiones cutáneas y mucosas del SK es la AB.Presentamos un paciente con enfermedad VIH/sida que desarrolló AB y SK en forma concomitante en la misma lesión cutánea

Bacillary angiomatosis (BA) is a rare infectious disease, caused by bacteria of the genus Bartonella spp, transmitted by vectors such as fleas, lice and mosquitoes. It causes different clinical syndromes in humans. In patients with human immunodeficiency virus (HIV) infection with an LT CD4 + <100 cell/µL count, it is associated with the development of angiomatous lesions with neovascularization involving the skin and, with less frequency, mucous membranes, liver, spleen and bones. Kaposi's sarcoma (KS) is a neoplasm characterized by multifocal vascular hyperplasia of endothelial origin related to human herpes virus 8. It can also compromiso the skin, mucous membranes and viscera, with the epidemic variant being a marker disease of advanced HIV infection. The main clinical differential diagnosis for KS skin and mucosal lesions is the BA.Herein we present a patient with HIV/AIDS disease that developed BA and KS concomitantly in the same skin lesion

Impacto de la pandemia por SARS-CoV-2 en el testeo de VIH en un hospital público de la Ciudad Autónoma de Buenos Aires / Analysis on the effects of the SARS-CoV-2 Pandemic in relation to HIV testing at a Public Hospital in Buenos Aires City

La aparición del SARS-CoV-2 a fines de 2019 provocó difi-cultades en los sistemas sanitarios para cumplir con las metas propuestas por la OMS destinadas a erradicar el VIH, principalmente en países en vías de desarrollo. Con el fin de evaluar el impacto en nuestro medio, un hospital público de la Ciudad Autónoma de Buenos Aires relevó los testeos de VIH (asistenciales y voluntarios) y sus resultados en el periodo enero 2017-diciembre 2022 a partir de los registros del laboratorio central. Los test realizados en pandemia fueron el 62% de los históricos (38% menos) y las prevalen-cias de serologías reactivas del asistencial mostraron una disminución (3,13% vs. 2,56%), mientras que las del Cen-tro de Prevención, Asesoramiento y Diagnóstico (CEPAD) aumentaron (3,56% vs. 5,39%). Teniendo en cuenta que la ausencia de diagnóstico de VIH implica perpetuación del virus en la población, y que el aumento de prevalencias de serologías reactivas en un grupo poblacional es indicativo de rebrote de VIH, es necesario retomar en forma proactiva la lucha contra el VIH

The emergence of SARS-COV-2 at the end of 2019 caused difficulties for the public health system to achieve the goals set by the WHO (World's Health Organization) focused on the eradication of HIV, mainly in developing countries. With the purpose of evaluating the impact in our field, a public hospital in Ciudad Autónoma de Buenos Aires provided the information about the tested tests (assistance and voluntary) and their results from the records of the central laboratory (January 2017-December 2022).The pandemic tests were 62% of histories (38%) and the prevalence of reactive serology the Healthcare serology decreased 3,13% vs 2,56%), while the Center for Prevention, Counseling and Diagnosis (CEPAD) serology increased (3,56% vs. 5,39%). Considering that the absence of an HIV diagnosis implies perpetuation of the virus in the population, and the increase in PSR% in a group is indicative of a possible regrowth of HIV, it is necessary to resume the fight against HIV proactively

Sífilis, VIH y hepatitis B en el binomio madre-hijo. Caracterización de casos atendidos en centros de tercer nivel del interior de Córdoba / Syphilis, HIV and hepatitis B in the Mother-Child binomial

ntroducción: Las infecciones perinatales pueden transmi-tirse al feto y al recién nacido. Sífilis, VIH y hepatitis B deben tamizarse durante la gestación.Objetivo: Conocer la incidencia, prevalencia y manejo de sífilis, VIH y hepatitis B en el binomio madre/hijo. Comparar resultados con estadísticas oficiales.Materiales y métodos: Estudio retrospectivo, descriptivo y analítico, mediante revisión de historias clínicas del Sana-torio de la Cañada y Hospital Pasteur, Villa María, Córdoba. Período 01/12/2020 al 31/07/2021. Resultados: Se estudiaron 870 embarazos, la incidencia de sífilis materna fue 52,87/1000 embarazos, 76,1% de las gestantes eran menores de 30 años y hubo 41% de diag-nósticos tardíos. La incidencia de sífilis congénita fue de 18,3/1000 RN vivos. La incidencia de VIH materno fue de 6,89/1000 embarazos, 66,7% tenían menos de 30 años y el 77,7% tuvo carga viral indetectable al parto. El 100% de los RN expuestos fueron estudiados, todos con carga viral indetectable al nacimien-to. No hubo casos de hepatitis B.Conclusión: 6,3% de las embarazadas presentaron al me-nos una serología reactiva y el mayor porcentaje diagnós-tico se centró en menores de 30 años. La incidencia de sífilis congénita superó la provincial y nacional (18,3 vs. 1,18 vs. 1,14). El porcentaje de positividad de VIH materno superó al provincial. No hubo transmisión vertical de VIH al nacimiento. La prevalencia de hepatitis B fue menor a las oficiales

Introduction: Perinatal infections can be transmitted to the fetus and new-born. Syphilis, HIV and Hepatitis B must be monitored during pregnancy.Objective: To know incidence, prevalence and management of syphilis, HIV and Hepatitis B in the mother/child binomial. To compare results with official statistics.Materials and methods: Retrospective, descriptive and analytical study, through the review of medical records from Sanatorio La Cañada and Hospital Pasteur in Villa Maria, Cordoba. Period 12/01/2020 to 07/31/2021.Results 870 pregnancies were studied, the incidence of maternal syphilis was 57.87/1000 pregnancies, 76.1% of pregnant women were under 30 years old, and there were 41% late diagnoses. The incidence of congenital syphilis was 18.3/1000 live newborns. The incidence of maternal HIV was 6.89/1000 pregnancies, 66.7% were women under 30 years old and 77.7% had undetectable viral load at birth. 100% of the exposed newborns were studied, all with undetectable viral load at birth. There were no cases of Hepatitis B.Conclusion: 6.3% of pregnant women presented at least one reactive serology and the highest diagnostic percentage was focused on those under 30 years old. The incidence of congenital syphilis exceeded the provincial and national data (18.3 vs 1.18 vs 1.14). The percentage of maternal HIV positivity was superior to the provincial one. There was no vertical transmission of HIV at birth. The prevalence of Hepatitis B was less than the official ones.

Diferencias epidemiológicas y clínicas en pacientes VIH positivas antes y durante la pandemia covid-19 / Epidemiological and clinical differences in HIV positive patients before and during the Covid-19 Pandemic

Con la llegada de la pandemia por COVID-19 en el año 2020, múltiples diagnósticos y tratamientos de diversas enfermedades quedaron relegados por el impacto del síndrome respiratorio agudo causado por el nuevo coronavirus (SARS-CoV-2) en los sistemas de salud. Teniendo en cuenta la coexistencia de la pandemia por el virus de inmunodeficiencia humana (VIH) y la provocada por el virus SARS-Cov-2, el objetivo del presente trabajo fue recolectar información de un Hospital de Enfermedades Infecciosas de la Ciudad de Buenos Aires y analizar cómo repercutió la pandemia por SARS-CoV-2 en el diagnóstico de las enfermedades que afectan a la población VIH positiva y, a su vez, comparar el estado clínico al ingreso y egreso de las pacientes en el período pre pandemia y durante la misma. Para esto se analizaron 100 epicrisis correspondientes a la sala 16 de internación de mujeres con complicaciones de la enfermedad VIH/SIDA que fueron asistidas en el período entre Enero del 2020 y Julio del 2021, y 74 epicrisis de pacientes internadas en ese mismo sitio en los siete meses previos. Se tuvieron en cuenta múltiples variables como el motivo de ingreso, conocimiento o no del diagnóstico de VIH, indicación de tratamiento antirretroviral y cumplimiento del mismo, antecedentes patológicos de las pacientes, presencia de enfermedades marcadoras de SIDA e infecciones de transmisión sexual, entre otras. Al comparar los datos entre pre-pandemia y pandemia se evidencia que esta última afectó a la población VIH positiva, en aspectos que van desde el retraso en el diagnóstico de la infección por el retrovirus, el inicio o reinicio de los tratamientos antirretrovirales y diferencias en los múltiples diagnósticos de egreso, incrementándose las consultas por trastornos respiratorios y neurológicos. A todo esto se añadieron las dificultades del personal médico para brindar una buena atención dado por el colapso del sistema sanitario que se hizo presente en dicho contexto. Por otra parte, destacar la importancia de la confección correcta y completa de las historias clínicas para lograr una mejor calidad de atención médica

With the arrival of the COVID-19 pandemic in 2020, many diagnoses and treatments of various diseases were relegated due to the impact of the acute respiratory syndrome caused by the novel coronavirus (SARS-CoV-2) in health systems. Taking into account the coexistence of the human immunodeficiency virus (HIV) pandemic and that caused by the SARS-CoV-2 virus, the objective of this study was to collect information from an Infectious Disease Hospital in the City of Buenos Aires and analyze the impact of the SARS-CoV-2 pandemic on the diagnosis of diseases that affect the HIV-positive population. Also, was compared the clinical status at admission and discharge of patients in the pre-pandemic period and during the same. For this, 100 epicrisis (clinical summaries) corresponding to 16 women who were hospitalized in the period between January 2020 and July 2021 were analyzed, and 74 epicrisis from patients hospitalized during the seven previous months. Multiple variables were considered, such as the reason for admission, whether or not there was knowledge of the HIV diagnosis, the presence of antiretroviral treatment and compliance with it, the patient's clinical history, the presence of marker AIDS diseases and sexually transmitted infections. When comparing the data between both periods, it can be clearly observed that the pandemic generated by SARS-CoV-2 affected the population with HIV, in aspects ranging from the delay in the diagnosis of the retroviral infection, the start or restart of antiretroviral treatments and differences in the multiple discharge diagnoses, especially those involvement the respiratory and the central nervous systems, that added new difficulties to the medical staff due to the saturation of the health system. The importance of the correct and complete preparation of medical records is highlighted in order to achieve better clinical care

Esclerosis lateral amiotrífica asociada a sarcoma de kaposi, vih y serológica positiva para sífilis y el virus de epstein barr. A propósito de un caso / Amyotrophic lateral sclerosis associated with kaposi sarcoma, hiv and positive serological for syphilis and epstein barr virus. About a case

Las enfermedades de la neurona motora no se asocian frecuentemente al Virus de Inmunodeficiencia Humana. Según algunos autores, existe evidencia de que los retrovirus podrían participar de alguna manera en la fisiopatología de la Esclerosis Lateral Amiotrófica (ELA). Según teorías no probadas, la activación de antiguos genes virales incrustados en el genoma humano conduciría a la degeneración de las neuronas motoras. Básicamente, esta enfermedad comienza con una desmielinización, seguida de una degeneración axonal, y termina en una esclerosis glial (estado terminal) de la vía motora central. Sin embargo, es difícil entender cómo se produce la desintegración de la mielina, ¿podría deberse a una alteración en el metabolismo lipídico? Es lamentable que no se haya realizado una evaluación anatomopatológica completa en los casos estudiados y en los que nos ocupan, ya que no podemos considerar al sistema nervioso como completamente independiente de otros sistemas. Se presenta un hombre con enfermedad de la neurona motora VIH positiva (ELA) asociada con sarcoma de Kaposi. Se describe una infección por un parásito

Motor neuron diseases are not frequently associated to Human Immunodeficiency Virus According to some authors, there is evidence that retroviruses could participate in some way in the pathophysiology of Amyotrophic Lateral Sclerosis (ALS). According to unproven theories, activation of ancient viral genes embedded in the human genome would lead to degeneration of motor neurons. Basically, this disease starts as demyelination, followed by axonal degeneration, and ends up in glial sclerosis (terminal state) of the motor central pathway. However, it is difficult to understand how the disintegration of myelin occurs, could it be due to an alteration in lipid metabolism? It is unfortunate that a complete anatomopathological evaluation has not been carried out in the cases studied and in those that concern us, since we cannot consider the nervous system as completely independent of other systems. A man individual with HIV-positive motor neuron disease ALS) associated with Kaposi's sarcoma is presented. An infection with a parasite is described

Infección por VIH: carga viral plasmática intratratamiento en la era del "Indetectable = Intransmisible" / HIV infection: Plasma viral load intratratization in the era of the "undetectable = non transmissible"

Se acepta que los individuos infectados por el virus de la inmunodeficiencia humana (HIV) son incapaces de transmitir la infección por vía sexual mientras sus niveles de carga viral plasmática se mantengan indetectables. Con el propósito de estudiar qué porcentaje de infectados por el HIV cumple esa condición estudiamos una población de pacientes asistidos regularmente en un hospital general de agudos de la ciudad de Buenos Aires. Se incluyeron 298 individuos, 162 de ellos de sexo masculino (54.36%) con una edad (promedio ± desvío estándar) de 47.83 ± 11.69 años y un recuento de células CD4+ de 693.93 ± 363.87 x 106 células / mL de sangre periférica. La carga viral plasmática fue indetectable en 230 de los individuos estudiados (77.81%). Los 68 restantes (22.82%) mostraron en promedio 9856.67 ± 70922.11 copias / mL, siendo estos niveles mayores en hombres que en mujeres (17379.39 ± 95521.51 copias / mL vs 895.78 ± 5952.99 copias / mL, respectivamente; p=0.015, Student t test), lo que explicaría los recuentos de linfocitos CD4+ significativamente menores hallados en hombres.187 de 231 individuos que recibían su primer tratamiento antiretroviral (TARV) mostraron cargas virales indetectables (80,95%) versus 42 de 67 pacientes que habían recibido dos o más esquemas de tratamiento antirretroviral (61,69%; p= 0.002, prueba de 2 ). Estos resultados muestran que un porcentaje importante de infectados por el HIV continúan presentando cargas virales plasmáticas detectables a pesar del TARV, siendo capaces de transmitir la infección por vía sexual a sus parejas

It is widely accepted that HIV-infected subjects are incapable to transmit sexually the infection while their plasmatic viral load remains undetectable. In order to assess the percentage of HIV infected patients showing undetectable viral loads during their antiviral treatment we studied a population of patients regularly assisted at a general hospital. A total of 298 patients (162 men; 54.36%) were admitted to the study. The mean age was (mean ± standard deviation) 47.83 ± 11.69 years, and the mean CD4+ cell count was 693.93 ± 363.87 x 106 cells / mL. These variables did not showed statistically significative differences between men and women. Plasmatic viral load was undetectable in 230 patients (77.81%). The remaining 68 patients (22.82%) showed a mean of 9856.67 ± 70922 copies / mL. These values were higher in men than in women (17379.39 ± 95521.51 copies / mL vs 895.78 ± 5952.99 copies / mL, respectively; p=0.015, Student t test). In line with these findings, CD4+ cell count was significantly lower in men (575.10 ± 345.14 cells / L vs. 707.04 ± 373.46 cells / L, respectively; p=0.0019, Student t test). 187 out of 231 patients receiving their first antiretroviral treatment showed undetectable viral loads (80,95%), while only 42 out of 67 patients having previously received other antiretroviral schemes had undetectable levels of plasmatic viral load (61,69%; p= 0.002, 2 ). These findings show that an important number of patients may keep detectable levels of plasmatic viral load during antiretroviral treatment, being therefore capable to sexually transmit the infection to their couples.

Angiomatosis bacilar y micobacteriosis atípica en paciente con diagnóstico reciente de infección por el virus de la inmunodeficiencia humana / Bacillary Angiomatosis and Atypical Mycobacteriosis in a patient recently diagnosed with Human Immunodeficiency Virus infection

Múltiples infecciones oportunistas pueden manifestarse simultáneamente cuando la inmunosupresión es grave en pacientes infectados por el virus de la inmunodeficiencia humana. Se presenta un caso de coinfección de VIH, Bartonella spp y Mycobacterium kansasii, siendo escasos los reportes a la fecha de dicha asociación y aun más en pacientes que desconocen su condición de VIH

Multiple opportunistic infections can manifest simultaneously when immunosuppression is severe in patients infected with the human immunodeficiency virus. A case of co-infection with HIV, Bartonella spp and Mycobacterium kansasii is presented, with few reports to date of this association and even more so in patients who are unaware of their HIV status.

Sarcoma de Kaposi del tracto gastrointestinal. Reporte de presentación en colon / Kaposi's sarcoma of the gastrointestinal tract. Report of presentation in colon

El sarcoma de Kaposi (SK) es una neoplasia maligna angioproliferativa de bajo grado, causada por la infección por virus herpes humano tipo 8 (HHV-8). El tracto gastrointestinal está involucrado en el 40% de los casos y constituye la neoplasia maligna gastrointestinal más común en pacientes con sida. Se presenta el caso de un paciente 32 años con antecedente de VIH de larga data, sin tratamiento, que relató episodios de proctorragia intermitente y pérdida de peso en los últimos dos meses. Presentaba lesiones cutáneas elevadas en forma de placas violáceas que predominaban en tronco y miembros superiores. Se realizó videocolonoscopía, la que evidenció en el área próxima a la válvula ileocecal y en el colon ascendente, lesiones sobreelevadas, eritematosas, friables y sangrantes, las cuales se biopsiaron. El estudio anatomopatológico reportó un perfil inmunohistoquímico compatible con SK. Al momento de la escritura de este artículo el paciente se encontraba bajo tratamiento quimioterápico (doxorrubicina liposomal, seis ciclos) e iniciando tratamiento antirretroviral (lamivudina ­ tenofovir ­ dolutegravir). Se presenta el siguiente caso para destacar la importancia del enfoque multidisciplinario del paciente con VIH/sida y fundamentalmente el rol de la endoscopía digestiva tanto alta como baja en pacientes con dolor abdominal, sangrado digestivo u otros síntomas abdominales, con el fin de descartar patologías del tracto gastrointestinal y, particularmente, el SK

Kaposi's sarcoma (KS) is a low-grade angioproliferative malignancy caused by infection with human herpes virus -8. The gastrointestinal tract is involved in 40% of cases, being the most common gastrointestinal malignancy in patients with AIDS. We present the case of a 32-year-old patient with a long-standing history of HIV without treatment, who reported episodes of intermittent proctorrhagia and weight loss in the last two months. He presented raised skin lesions in the form of violaceous plaques that predominate on the trunk and upper limbs. A videocolonoscopy was performed, revealing raised, erythematous, friable, bleeding lesions near the ileocecal valve and in the ascending colon, which were biopsied. The anatomopathological study shows an immunohistochemical profile compatible with KS. At the time of writing this article, the patient was under chemotherapy treatment (liposomal doxorubicin, 6 cycles) and starting antiretroviral treatment (lamivudine - tenofovir - dolutegravir). The following case is presented to highlight the importance of the multidisciplinary approach of the patient with HIV / AIDS and fundamentally the role of both upper and lower digestive endoscopy in those cases that present with abdominal pain, digestive bleeding and other abdominal symptoms, in order to rule out gastrointestinal tract pathologies and particularly KS

Presentación cutánea atípica de histoplasmosis diseminada en paciente con VIH/sida / Atypical cutaneous presentation of disseminated

La histoplasmosis diseminada es una infección oportunista frecuente en los pacientes VIH/sida. Frecuentemente se encuentra compromiso cutáneo, siendo las formas clínicas más comunes el aspecto moluscoide, variceliforme y papulonecrótico.Se presenta el caso de una paciente con una forma cutánea atípica de histoplasmosis diseminada similar a pioderma gangrenoso cuyo diagnóstico fue realizado mediante escarificación.Es importante mantener la sospecha clínica en estas presentaciones atípicas y reforzar la utilidad de la escarificación de lesiones cutáneas como método rápido y efectivo para su diagnóstico.

Disseminated histoplasmosis is a frequent opportunistic infection in HIV/AIDS patients. Cutaneous manifestations are common, the most frequent are molluscum contagio-sum-like lesions, varicelliform eruption and papulo-necro-tic lesions.We present a case of an atypical disseminated cutaneous histoplasmosis with pyoderma gangrenosum-like ulcers, diagnosed by direct examination of tissue smear.It is important to have a high clinical suspicion of this atypical presentation and to emphasize the usefulness of skin smear as a simple and effective test to establish its diagnosis

Linfogranuloma venéreo / Venereal lymphogranuloma

El Linfogranuloma venéreo (LGV) es una infección de transmisión sexual (ITS) ulcerativa poco frecuente causada por la bacteria Chlamydia trachomatis (CT), serotipos L1, L2 y L3, originada por el contacto no protegido genital, anal y/u oral. Se asocia con co-infecciones de otras ITS, entre ellas las ocasionadas por el virus de la inmunodeficiencia humana (VIH) y la sífilis. Endémico en áreas tropicales y subtropicales de África, Sudeste Asiático, Latinoamérica y el Caribe, a partir del 2003 se han registrado nuevos brotes en Europa, América del Norte y Australia, en especial entre la población de hombres que tienen sexo con hombres (HsH) y en pacientes VIH positivos. Si bien lo más frecuente de observar en HsH es la proctitis con escasa repercusión ganglionar regional, se debe sospechar LGV ante toda úlcera ano-genital transitoria y linfadenopatías inguinales en esta población. Se presenta un caso de LGV en un paciente HsH no VIH cuya forma de inicio genital permitió el diagnóstico y el tratamiento adecuado.

Lymphogranuloma venereum (LGV) is a rare ulcerative sexually transmitted infection (STI) caused by the bacterium Chlamydia trachomatis (CT), serotypes L1, L2 and L3, caused by unprotected genital, anal and/or oral contact. It is associated with co-infections with other STIs, including those caused by the human immunodeficiency virus (HIV) and syphilis. Endemic in tropical and subtropical areas of Africa, Southeast Asia, Latin America and the Caribbean, since 2003 there have been new outbreaks in Europe, North America and Australia, especially among the population of men who have sex with men (MSM) and in HIV positive patients. Although the most common sign to observe in MSM is proctitis with little regional lymph node repercussion, LGV should be suspected in the presence of any transient anogenital ulcer and inguinal lymphadenopathy in this population. We present a case of LGV in a non-HIV MSM patient whose form of genital onset led to diagnosis and treatment.

Características clínicas, métodos diagnósticos y evolución de la criptococosis extrameníngea en personas viviendo con VIH / Clinical features, diagnosis methods and evolution in non meningeal cryptococcosis in people living with VIH

La criptococosis es una micosis grave que se manifiesta, en el 90% de los casos, como una meningoencefalitis, especialmente en las personas con VIH. El objetivo de este estudio es describir los casos de criptococosis extrameníngea en personas viviendo con VIH y conocer cuántas de estas padecen compromiso meníngeo concomitante. Además, determinar la relación con el título de antígeno polisacárido capsular de Cryptococcus en suero. Se realizó un estudio retrospectivo, observacional y analítico. Se incluyeron personas viviendo con VIH cuyo diagnóstico inicial de criptococosis se había realizado a partir de muestras extrameníngeas en el período comprendido entre 2012 y 2019. Los pacientes se dividieron en dos grupos. Grupo 1, pacientes sin compromiso meníngeo; Grupo 2, aquellos que finalmente tenían compromiso del SNC. De un total de 531 criptococosis registradas en ese período, se incluyeron 113 pacientes (21%), de los cuales en 58 se comprobó el compromiso meníngeo. No se observaron diferencias significativas en cuanto a la mortalidad entre ambos grupos.Ninguno de los pacientes con antigenemia por LFA (antígeno capsular en suero por inmunocromatografía) positiva, pero con antigenemia por aglutinación de partículas de látex (AL) negativa, tuvo compromiso meníngeo. Se observó que títulos de antígeno para Cryptococcus en suero por AL mayor o igual a 1/100 se correlacionaron con un aumento de 30 veces en la posibilidad de padecer meningitis. En todos los casos se debe descartar el compromiso del SNC. La AL sigue siendo una prueba útil y complementaria, debido a que en los casos con AL negativa no se observó compromiso meníngeo

Cryptococcosis is a serious mycosis that manifests itself, in 90% of cases, as meningoencephalitis, especially in AIDS patients. The objective of this study is to describe the extra-meningeal cases of cryptococcosis in people living with HIV and to know how many of them suffer from concomitant meningeal involvement. Also, to determine its relationship with the Cryptococcus capsular polysaccharide antigen titer in serum.A retrospective, observational and analytical study was carried out. HIV-positive patients whose initial diagnosis had been made from extrameningeal samples in the period between 2012 and 2019 were included. The patients were divided into 2 groups. Group 1: patients without meningeal involvement; group 2: those who finally had CNS involvement.Of a total of 531 cryptococcosis registered in this period, 113 patients (21%) were included, of whom meningeal involvement was confirmed in 58. No significant differences were observed in terms of mortality in both groups.None of the patients with positive LFA antigenemia (Capsular antigen detection by lateral Flow assay) but negative latex particle agglutination (LA) antigenemia had meningeal involvement. LFA was found to be highly sensitive and allows early diagnosis, but it does not replace other diagnostic procedures.Serum Cryptococcus antigen titers for by LA greater than or equal to 1/100 were found to correlate with a 30-fold increase in the likelihood of meningitis.In all cases, CNS involvement must be ruled out. LA continues to be a useful and complementary test, because in cases with negative LA, no meningeal involvement was observed

Mapping where HIV hides suggests cure strategy.

Long-term antiretrovirals may corner viral genomes in inactive regions of DNA.

A simple algorithm for selecting cases to investigate acute and early HIV infections in low- and middle-income countries.

We documented the outcome of an over 10-year (2011-2021) effort to diagnose acute and early HIV infections (AEHI) in an Infectious Diseases Outpatient Clinic with limited resources. Of a total of 132, 119 HIV-RNA tests were performed from 2017 to 2020, 12 cases were identified, using a simple algorithm: risk exposure of 6 weeks or less before the visit and/or symptoms compatible with acute retroviral syndrome 7-30 days after exposure and/or undetermined 3rd generation rapid diagnostic test or serology. AEHI diagnoses varied from 2.4% among asymptomatic to 25% for undetermined serology cases using this simple screening applicable to different settings.

Attenuated Negative Feedback in Monocyte-Derived Macrophages From Persons Living With HIV: A Role for IKAROS.

Persons living with HIV (PLWH) are at higher risk of developing secondary illnesses than their uninfected counterparts, suggestive of a dysfunctional immune system in these individuals. Upon exposure to pathogens, monocytes undergo epigenetic remodeling that results in either a trained or a tolerant phenotype, characterized by hyper-responsiveness or hypo-responsiveness to secondary stimuli, respectively. We utilized CD14+ monocytes from virally suppressed PLWH and healthy controls for in vitro analysis following polarization of these cells toward a pro-inflammatory monocyte-derived macrophage (MDM) phenotype. We found that in PLWH-derived MDMs, pro-inflammatory signals (TNFA, IL6, IL1B, miR-155-5p, and IDO1) dominate over negative feedback signals (NCOR2, GSN, MSC, BIN1, and miR-146a-5p), favoring an abnormally trained phenotype. The mechanism of this reduction in negative feedback involves the attenuated expression of IKZF1, a transcription factor required for de novo synthesis of RELA during LPS-induced inflammatory responses. Furthermore, restoring IKZF1 expression in PLWH-MDMs partially reinstated expression of negative regulators of inflammation and lowered the expression of pro-inflammatory cytokines. Overall, this mechanism may provide a link between dysfunctional immune responses and susceptibility to co-morbidities in PLWH with low or undetectable viral load.

Cross-Reactivity to Mutated Viral Immune Targets Can Influence CD8+ T Cell Functionality: An Alternative Viral Adaptation Strategy.

Loss of T cell immunogenicity due to mutations in virally encoded epitopes is a well-described adaptation strategy to limit host anti-viral immunity. Another described, but less understood, adaptation strategy involves the selection of mutations within epitopes that retain immune recognition, suggesting a benefit for the virus despite continued immune pressure (termed non-classical adaptation). To understand this adaptation strategy, we utilized a single cell transcriptomic approach to identify features of the HIV-specific CD8+ T cell responses targeting non-adapted (NAE) and adapted (AE) forms of epitopes containing a non-classical adaptation. T cell receptor (TCR) repertoire and transcriptome were obtained from antigen-specific CD8+ T cells of chronic (n=7) and acute (n=4) HIV-infected subjects identified by either HLA class I tetramers or upregulation of activation markers following peptide stimulation. CD8+ T cells were predominantly dual tetramer+, confirming a large proportion of cross-reactive TCR clonotypes capable of recognizing the NAE and AE form. However, single-reactive CD8+ T cells were identified in acute HIV-infected subjects only, providing the potential for the selection of T cell clones over time. The transcriptomic profile of CD8+ T cells was dependent on the autologous virus: subjects whose virus encoded the NAE form of the epitope (and who transitioned to the AE form at a later timepoint) exhibited an 'effective' immune response, as indicated by expression of transcripts associated with polyfunctionality, cytotoxicity and apoptosis (largely driven by the genes GZMB, IFNÉ£, CCL3, CCL4 and CCL5). These data suggest that viral adaptation at a single amino acid residue can provide an alternative strategy for viral survival by modulating the transcriptome of CD8+ T cells and potentially selecting for less effective T cell clones from the acute to chronic phase.

Myeloid-derived suppressor cells and the pathogenesis of human immunodeficiency virus infection.

There are several mechanisms by which human immunodeficiency virus (HIV) can mediate immune dysfunction and exhaustion during the course of infection. Chronic immune activation, after HIV infection, seems to be a key driving force of such unwanted consequences, which in turn worsens the pathological status. In such cases, the immune system is programmed to initiate responses that counteract unwanted immune activation, for example through the expansion of myeloid-derived suppressor cells (MDSCs). Although the expansion of immune suppressor cells in the setting of systemic chronic immune activation, in theory, is expected to contain immune activation, HIV infection is still associated with a remarkably high level of biomarkers of immune activation. Paradoxically, the expansion of immune suppressor cells during HIV infection can suppress potent anti-viral immune responses, which in turn contribute to viral persistence and disease progression. This indicates that HIV hijacks not only immune activation but also the immune regulatory responses to its advantage. In this work, we aim to pave the way to comprehend how such unwanted expansion of MDSCs could participate in the pathology of acute/primary and chronic HIV infection in humans, as well as simian immunodeficiency virus infection in rhesus macaques, according to the available literature.