Autoantibodies Neutralizing GM-CSF in HIV-Negative Colombian Patients Infected with Cryptococcus gattii and C. neoformans.

BACKGROUND: Cryptococcosis is a life-threatening disease caused by Cryptococcus neoformans or C. gattii. Neutralizing autoantibodies (auto-Abs) against granulocyte-macrophage colony-stimulating factor (GM-CSF) in otherwise healthy adults with cryptococcal meningitis have been described since 2013. We searched for neutralizing auto-Abs in sera collected from Colombian patients with non-HIV-associated cryptococcosis in a retrospective national cohort from 1997 to 2016. METHODS: We reviewed clinical and laboratory records and assessed the presence of neutralizing auto-Abs against GM-CSF in 30 HIV negative adults with cryptococcosis (13 caused by C. gattii and 17 caused by C. neoformans). RESULTS: We detected neutralizing auto-Abs against GM-CSF in the sera of 10 out of 13 (77%) patients infected with C. gattii and one out of 17 (6%) patients infected with C. neoformans. CONCLUSIONS: We report eleven Colombian patients diagnosed with cryptococcosis who had auto-Abs that neutralize GM-CSF. Among these patients, ten were infected with C. gattii and only one with C. neoformans.

Features of cryptococcosis among 652 HIV-seronegative individuals in France: a cross-sectional observational study (2005-2020).

OBJECTIVES: We aimed to describe features and outcomes of cryptococcosis among HIV-seronegative individuals in a large surveillance network for cryptococcosis in France. METHODS: We included incident cases of cryptococcosis in HIV-seronegative individuals from 2005 to 2020. We compared patient characteristics, disease presentations, cryptococcal antigen results, and induction antifungal treatments according to underlying disease. We examined factors associated with 90-day mortality. Among patients with disseminated infections, we investigated whether receipt of flucytosine and polyene combination was associated with lower mortality. RESULTS: Among 652 individuals, 209 (32.1%) had malignancy, 130 (19.9%) were solid-organ transplant recipients, 204 (31.3%) had other immunocompromising conditions, and 109 (16.7%) had no reported underlying factor. The commonest presentations were disseminated infections (63.3%, 413/652) and isolated pulmonary infections (25.3%, 165/652). Solid-organ transplant patients were most likely to have disseminated infections and a positive serum cryptococcal antigen result. Patients with malignancy were older and less likely to receive a flucytosine-containing regimen for disseminated infections than others (58.7%, 78/133 vs. 73.2%, 194/265; p 0.029). The crude 90-day case-fatality ratio was 27.2% (95% CI, 23.5%-31.1%). Age ≥60 years (aOR: 2.75 [1.78-4.26]; p < 0.001), meningitis/fungaemia (aOR: 4.79 [1.80-12.7]; p 0.002), and malignancy (aOR: 2.4 [1.14-5.07]; p 0.02) were associated with higher 90-day mortality. Receipt of flucytosine and polyene combination was associated with lower 90-day mortality (aOR: 0.40 [0.23-0.71]; p 0.002) in multivariable analysis and inverse probability of treatment weighted analysis (aOR: 0.45 [0.25-0.80]; p 0.006). DISCUSSION: HIV-seronegative individuals with cryptococcosis comprise a wide range of underlying conditions with different presentations and outcomes, requiring a tailored approach to diagnosis and management.

Disseminated Histoplasmosis Causing Temporally and Spatially Discrete Gastrointestinal Perforations in an HIV-Negative Patient.

Histoplasma capsulatum is a dimorphic fungi endemic to the Ohio and Mississippi River valleys. Immunocompetent persons who become infected are generally asymptomatic or present with mild symptoms. Symptomatic disease is seen primarily in immunocompromised patients with pulmonary manifestations being the most common presentation. We present a case of a young HIV-negative male who required 4 exploratory laparotomies over the course of 4 months during 2 hospitalizations due to discrete perforations of the ileum and jejunum caused by biopsy-proven gastrointestinal histoplasmosis despite maximal medical therapy as well as a gastric perforation.

HIV knowledge and its correlation with the Undetectable = Untransmittable slogan in Brazil

ABSTRACT Knowledge about HIV transmission and prevention is a necessary step for adopting preventive behaviors. We assessed HIV knowledge and its correlation with the perceived accuracy of the "Undetectable = Untransmittable" (U=U) slogan in an online sample with 401 adult Brazilians. Overall, 28% of participants showed high HIV knowledge level. The perceived accuracy of the U=U slogan significantly correlated with HIV knowledge. Younger participants, those reporting lower income or lower education, or who had never tested for HIV showed poorer HIV knowledge. Filling gaps of knowledge among specific populations is urgent in order to increase preventive behaviors and decrease HIV stigma.

Lípidos anormales e inmunidad adquirida Síndrome de Deficiencia: Asociación de Suero Lípidos con estatus de VIH / Abnormal Lipids and Acquired Immune Deficiency Syndrome: Association of Serum Lipids with HIV Status

Context and Aim: Hematological abnormalities are amongst the most common complications of infection with HIV.There have been quite a few studies on the alterations in lipid profile, too, though the results have largely been inconclusive. The present study was carried-out to assess CD4 cell counts and lipid profile in the HIV infected and AIDS patients in the Indian population and correlates them with the sero-negative controls. Materials and Methods: The present study was designed as a cross-sectional, hospital-based study to assess CD4 cell counts and lipid profile in the HIV infected and AIDS patients in the Indian population and correlates them with the sero-negative controls. Evaluation of lipid profile was done using Erba EM 360, an automated analyzer powered by a diffraction grating photometer while CD4 cell counts were evaluated using Partec Cyflow Counter. Statistical analysis used: The data was analyzed using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA). Comparison of the said parameters was done using Analysis of Variance (ANOVA) and posthoc Games-Howell test. p-value of <0.05 was considered statistically significant. Results: The levels of total cholesterol and low-density lipoproteins (LDLs) were significantly decreased while triglycerides and very low density lipoproteins (VLDLs) were significantly increased in the HIV infected and AIDS patients when compared with the sero-negative controls. Conclusion: Total cholesterol, LDLs, triglycerides and VLDLs were significantly altered in the HIV infected and AIDS patients when compared with the sero-negative controls.

Kaposi sarcoma of th e penis in anHIV-negative patient / Sarcoma de Kaposi de pênis em paciente HIV negativo

ABSTRACT Kaposi sarcoma is an angioproliferative disorder that ranges from a single indolent skin lesion to respiratory and gastrointestinal/visceral involvement. Kaposi sarcoma is rare in non-immunosuppressed patients. Nineteen cases of penile Kaposi sarcoma in HIV-negative patients were reported in 2012. We present the case report of a 48-year-old male patient with no previous medical history, who came to our urology clinic presenting a purple-color papule on the penis glans. Lab tests revealed negative serology for HIV, but tissue PCR was positive for human herpesvirus 8. Histopathology examination after lesion excision was compatible with Kaposi sarcoma. No other cutaneous or mucosal lesions were present. Primary Kaposi sarcoma of the penis is rare, but may occur in non-immunosuppressed patients.

RESUMO O sarcoma de Kaposi é uma doença angioproliferativa que varia de uma lesão cutânea indolente isolada ao envolvimento visceral respiratório e gastrintestinal. É raro em pacientes não imunossuprimidos. Dezenove casos de sarcoma de Kaposi de pênis em pacientes HIV negativos foram relatados em 2012. Descrevemos o caso de um paciente do sexo masculino, 48 anos, sem história pregressa, que se apresentou em nossa clínica urológica com pápula violeta na glande. Os testes de laboratório revelaram sorologia negativa para HIV, mas o PCR em tecido foi positivo para o herpesvírus humano 8. A histopatologia após a excisão da lesão foi compatível com sarcoma de Kaposi. Não existia outra lesão cutânea ou de mucosa. O sarcoma de Kaposi primário de pênis é raro, mas pode ocorrer em pacientes não imunossuprimidos.

Effect of depressive symptoms and HIV exposure on the quality of life of HIV-seropositive and seronegative pregnant women

Introduction: Depression among human immunodeficiency virus (HIV)-seropositive individuals has been associated with reduced quality of life. The aim of the study was to evaluate the effect of depressive symptoms and HIV exposure on mean quality of life scores in HIV-seropositive and HIV-seronegative postpartum women. Methods: A cross-sectional study was conducted with two groups: 80 HIV-seropositive and 80 HIV-seronegative postpartum women. The Edinburgh Postnatal Depression Scale and the World Health Organization Quality of Life short-version scale were used to assess presence of depressive symptoms and quality of life scores. Two-way analysis of variance was used to compare the effects of depressive symptoms, HIV exposure and interaction between depressive symptoms and HIV exposure on mean quality of life scores, with p < 0.05 considered statistically significant. Results: Depressive symptoms were present in 35% (28) of HIV-seropositive and 17.5% (14) of HIV-seronegative participants (p = 0.02). The interaction between depressive symptoms and HIV exposure was not significant for any quality of life domain. The main effect of HIV exposure was also not significant. Depressive symptoms had a negative influence on quality of life scores in all domains (physical health, psychological health, social relationships and environment) (p < 0.001). Conclusions: The quality of life of pregnant women is negatively influenced by the presence of depressive symptoms. (AU)

Linfoma primario difuso de células B grandes de mucosa gingival, en paciente VIH y EBV negativos / Primary gingival diffuse large b-cell lymphoma in HIV/EBR negative patient abstract

El linfoma difuso de células B grandes (LDCBG) es el linfoma más frecuente. La presentación clínica puede ser nodal o extranodal y sus síntomas dependen de la localización tumoral; en la mayoría de los casos están asociados a algún tipo de inmunodeficiencia. Referiremos un caso de LDCBG de presentación atípica en una localización muy infrecuente. Es importante tener en cuenta estas situaciones, ya que pueden simular otros procesos patológicos, retrasando así su correcto diagnóstico y por lo tanto un adecuado tratamiento. (AU)

Diffuse large cell lymphoma B (LDCBG) is the most common type of lymphoma. It´s clinical presentation can be nodal or extranodal and it's symptoms depend where the tumor is located and whether is associated or not with an immunodeficiency disease. We present an atypical presentation of a LDCBG in a very unusual location. It´s important to consider these kind of appearance, as they can mimic other oral pathological processes, delaying their correct diagnosis and therefore an appropriate treatment. (AU)

Angiosarcoma in HIV-negative patients is not associated with HHV-8

Abstract: BACKGROUND: Angiosarcoma is an aggressive, malignant neoplasm of vascular or lymphatic origin. Herpes virus 8 (HHV-8) is a member of the herpes family with a tropism for endothelial cells and it has been proven to induce vascular neoplasms, such as Kaposi's sarcoma. The role of HHV-8 in the pathogenesis of angiosarcoma has not been well defined. OBJECTIVE: To investigate the relationship between the presence of HHV-8 and angiosarcoma. METHODS: In this study, the team investigated the relationship between the presence of HHV-8, as determined by polymerase chain reaction, and angiosarcoma, using samples from patients with epidemic Kaposi's sarcoma as controls. RESULTS: While all control cases with epidemic Kaposi's sarcoma were positive for HHV-8, none of the angiosarcoma cases was. CONCLUSION: These findings support most previous studies that found no association between HHV-8 and angiosarcoma.

Incidence of Cervical Human Papillomavirus and Cervical Intraepithelial Neoplasia in Women with Positive and Negative HIV Status / Incidência de infecção cervical pelo vírus papiloma humano e neoplasia intraepitelial cervical em mulheres com sorologia positiva e negativa para o HIV

Abstract Objectives To evaluate the incidence and factors associated with cervical intraepithelial neoplasia (CIN) and cervical infection by human papillomavirus (HPV) among HIV-positive and HIV-negative women. Methods A cohort of 103 HIV positive and 113 HIV negative women were monitored between October 2008 and February 2012, for at least one year. Procedures included cervical cytology, DNA/HPV detection by polymerase chain reaction, colposcopy with biopsy if necessary, followed by an interview for exposure characteristics data. CIN was based on the histopathological results. Results The incidence of CIN was of 8.8 and 4.6 cases/100 women-years in HIVpositive and HIV-negative women, respectively. HIV-positive women presented a hazard ratio (HR) of 2.8 for CIN and developed lesions earlier (0.86 year) than HIVnegative women (2 years) (p = 0.01). The risk of developing CIN decreased with age (HR = 0.9) and marital status (HR = 0.4). HPV patients presented a higher incidence of CIN when compared HIV-positive and HIV-negative women (p = 0.01). The incidence of HPV cervical infection was 18.1 and 11.4 cases/100 women-years in HIV-positive and HIV-negative women, respectively. Those HIV-positive presented earlier HPV infection (p = 0.002). The risk of developing HPV infection decreased with age and was higher among HIV-positive women. HPV 16 was the most common type in HIV-positive women, and also the type most closely associated with CIN in HIV-negative women. Conclusions HIV-positive women had a greater incidence of HPV and CIN, and in a shorter time interval. More rigorous and timely clinical control is required for this group.

Resumo Objetivos Avaliar a incidência e fatores associados com neoplasia intraepitelial cervical (NIC) e infecção cervical pelo Papiloma Vírus Humano (HPV) entre mulheres HIV positivas e negativas. Métodos Coorte de 103 mulheres positivas para o HIV e 113 negativas, que foram acompanhadas entre outubro de 2008 a fevereiro de 2012, com seguimento mínimo de um ano. Os procedimentos realizados foram coleta de material cervical para citologia oncótica e detecção do DNA/HPV pela reação em cadeia da polimerase, colposcopia seguida de biópsia, se necessário, e entrevista para obter dados e características de exposição. O diagnóstico de NIC foi baseado no resultado histopatológico das biópsias. Resultados A incidência pessoas-tempo de NIC foi de 8,8 e 4,6 casos/100 mulheresano para as mulheres HIV-positivas e HIV-negativas, respectivamente. As HIV-positivas apresentaram uma razão de risco (HR) de 2,8 para NIC e desenvolveram lesões mais precocemente (0,86 ano) do que as negativas (2 anos) (p = 0,01). O risco de desenvolver NIC diminuiu com a idade (HR = 0,9) e o estado civil (HR = 0,4). Pacientes com HPV apresentaram maior incidência de NIC, quando comparadas as mulheres HIVpositivas e as negativas (47,6 10,5%) (p = 0,01). A incidência de infecção cervical pelo HPV, por pessoa/tempo, foi de 18,1 e 11,4 casos/100 mulheres-ano, respectivamente para mulheres HIV-positivas e negativas. As HIV-positivas apresentaram HPV mais precocemente (p = 0,002). O risco de apresentar HPV diminuiu com a idade e foi maior entre as HIV-positivas. O HPV 16 foi o tipo mais comum entre as mulheres HIVpositivas. Conclusões As mulheres HIV-positivas tiveram maior incidência de HPV e NIC, e um menor intervalo de tempo. Controle clínico mais rigoroso e oportuno é requerido para este grupo.

O vivido da reprodução do casal heterossexual sorodiscordante para o HIV: possibilidades para o cuidado em enfermagem e na saúde reprodutiva

As questões reprodutivas das pessoas que vivem com HIV/aids representam uma das demandasinerentes ao caráter de doença crônica atribuído à aids. Neste contexto, a infecção pelo vírus se mostracomo fator que agrega risco às relações afetivo sexuais, refletindo na crítica a estas pessoas quanto aoexercício dos seus direitos sexuais e reprodutivos. Dentre estas, os casais heterossexuaissorodiscordantes para o HIV estão submetidos aos desafios impostos pelas especificidades queenvolvem a reprodução na situação de sorodiscordância e, diante disso, desvela-se a necessidade decompreender o impacto do HIV nas escolhas reprodutivas destes casais. Esta investigação teve comoobjetivo desvelar o sentido do casal heterossexual sorodiscordante para o HIV no vivido da reprodução.Trata-se de uma investigação qualitativa que tem como referencial teórico, filosófico e metodológico afenomenologia de Martin Heidegger. Desenvolvida no período de agosto de 2013 a abril de 2014 tendocomo cenário um Hospital Universitário no interior do Rio Grande do Sul. Participaram do estudo 11casais heterossexuais sorodiscordantes para o HIV que vivenciaram a gestação nesta situação. Foipossível desvelar que o ser-casal se mantém permanentemente em fuga do seu poder-ser mais próprio –que é ser um casal sorodiscordante para o HIV e que se reproduz. O ser-casal se mostra no movimentode ser impropriamente-si-mesmo dominado pelo impessoal do mundo público em que todos falam queele não pode ter filho. Diante disso, ao se deparar com a facticidade da gestação teme pela infecção dofilho, se ocupa com o tratamento, silencia sua situação sorológica e decai no mundo empenhado naconvivência para parecer como todos que não convivem com o HIV na situação de sorodiscordância ena exposição do filho à infecção pelo vírus. Assim, o ser-casal se mantém num constante movimento deinautenticidade e de in-visibilidade...

Reproductive issues of people who live with HIV/AIDS represent one of the chronic illness reachedepidemiologically inherent demands. In this context, vivurs infection shows itself as a factor thatagregates risk to sexual affective relations, reflecting on criticism to these people when they exercisetheir sexual and reproductive rights. Among these, HIV serodiscordant heterossexual couples aresubmissed to challenged imposed by specificities that involve reproduction in this situation, thus, aneed to comprehend these couples’ reproductive choices unveils itself. This investigation aimed tounveil the HIV serodiscordant heterossexual couple’s meaning on lived experience with reproduction.It is a qualitative research which has Martin Heidegger’s phenomenology as theoretical, andmethodological framework. Developed from August 2013 to April 2014 having as scenery was aUniversity Hospital in Rio Grande do Sul’s countryside and 11 HIV serodiscordant heterossexualcouples participated who experienced gestation in this situation participated in the study. It waspossible to unveil that being-couple maintain itself on the run from their proper could-be – which is tobe an HIV serodiscordant couple that reproduces – permately. Being-couple shows itself on themovement of being onself-inapropriately dominated by public world’s impersonal in which everyonesays one can not have a child. Before that, on facing gestation’s factuality fears the child’s infecction,occupies onself with treatment, silent one’s serological situation and decays on the world comitted onliving together to seem like others who don’t live with HIV in a serodiscordant situation ando nexposing one’s child to vírus infecction. Therefore, being a couple maintains onself in constantinautencity and in-visibility movement...

Mal de Pott en un indígena colombiano / Pott´s disease in a Colombian indigenous man

Cada año mueren alrededor de dos millones de personas a causa de la tuberculosis y se estima que un tercio de la población mundial está infectada con el bacilo que la causa, pero solo entre 5 y 10 % desarrolla la enfermedad. El riesgo de que la enfermedad progrese al estado activo depende de factores endógenos y exógenos. Las comunidades indígenas son un grupo con un alto riesgo de infectarse y enfermar de tuberculosis; además de factores como el aislamiento geográfico, el abandono social y cultural y la desnutrición, se han identificado en ellos polimorfismos genéticos que los hacen más propensos a la infección. La tuberculosis vertebral es la forma más destructiva de la enfermedad y representa cerca de la mitad de los casos de tuberculosis esquelética. Se presenta el caso de un paciente indígena colombiano con tuberculosis vertebral y resultado negativo para HIV. El diagnóstico se basó en los hallazgos clínicos y en los estudios de imaginología, y se confirmó mediante la prueba molecular rápida Genotype MTBDR plus ® y de la reacción en cadena de la polimerasa PCR IS6110; el cultivo fue negativo a las 16 semanas de incubación. Se discuten brevemente la patogénesis, el diagnóstico y el tratamiento, y se comentan algunos aspectos relacionados con la situación de la tuberculosis en las comunidades indígenas colombianas.

Approximately 2 million people die each year from tuberculosis. One third of the world´s population is estimated to be infected with the tuberculosis bacillus, although only 5-10% will develop the disease in their lifetime. The disease progression risk depends on endogenous and exogenous factors. Indigenous communities are a high-risk group for infection and development of tuberculosis. In addition to factors such as geographical isolation, social and cultural neglect and malnutrition, susceptibility to genetic polymorphisms has been identified in them. Spinal tuberculosis is the most destructive form of the disease, which represents approximately half of all cases of skeletal tuberculosis. The case of an HIV negative, indigenous Colombian man is presented. His diagnosis was done based on clinical and image findings, and it was confirmed with the rapid molecular assay Genotype MTBDRplus ® and IS6110 PCR.The culture in solid media was negative after 16 weeks. We briefly discuss the pathogenesis, diagnosis and treatment. Finally, we comment on some aspects of the situation of tuberculosis among indigenous Colombian communities.

Prevalência de infecção cervical por papilomavírus humano e neoplasia intraepitelial cervical em mulheres HIV-positivas e negativas / Prevalence of cervical infection by human papillomavirus and cervical intraepithelial neoplasia in HIV-positive and negative women

OBJETIVO: Realizar estudo comparativo entre mulheres positivas e negativas para o vírus da imunodeficiência humana (HIV), analisando: prevalência de neoplasia intraepitelial cervical (NIC) e infecção cervical pelo papilomavírus humano (HPV); risco viral e relação com desenvolvimento de NIC; parâmetros sociodemográficos e de comportamento que influenciaram na presença de infecção cervical por HPV e NIC. MÉTODOS: Estudo comparativo entre mulheres positivas e negativas para o HIV, sendo analisadas, respectivamente, 202 e 171 mulheres para avaliar a prevalência de NIC e 164 e 100 mulheres para avaliar a prevalência de infecção cervical pelo HPV. Em todas as consultas foram realizados: coleta de amostras cervicais para realização de citologia oncótica e reação em cadeia da polimerase (PCR) para detecção do DNA-HPV; colposcopia; questionário padronizado para coleta de dados demográficos/comportamentais; biópsia de todas as alterações colposcópicas. O exame histopatológico foi o padrão-ouro para o diagnóstico de NIC. RESULTADOS: A prevalência de NIC foi de 2,4 e 15,3% (p<0,001) e de infecção cervical pelo HPV foi de 37,1 e 55,5% (p=0,002), respectivamente, nas negativas e positivas para o HIV. As soropositivas tiveram mais infecção por HPV de alto risco (35,7 e 23,6%; p=0,02) e por múltiplos tipos (6,2 e 0%). O HPV 16 foi o tipo prevalente, ocorrendo em 11,3 e 10,2% das positivas e negativas para o HIV e também nas mulheres que tiveram NIC nos dois grupos. Os fatores associados ao desenvolvimento de NIC foram: infecção pelo HIV (HT=4,64; IC95% 2,23-9,65), idade (HT=0,95; IC95% 0,93-0,98 para cada ano de vida) e estado civil (HT=0,49; IC95% 0,30-0,80). Os fatores associados à infecção pelo HPV foram: presença do HIV (HT=2,72; IC95% 1,77-4,17), maior número de parceiros sexuais (HT=1,87; IC95% 1,23-2,84), idade (HT=0,97; IC95% 0,95-0,99 para cada ano de vida) e estado civil (HT=0,65: IC95% 0,42-1,0 para união estável/viúvas). CONCLUSÃO: A ...

PURPOSE: To conduct a comparative study between two groups of women (HIV positive and negative) analyzing: the prevalence of cervical intraepithelial neoplasia (CIN) and cervical HPV infection; viral risk and relationship with development of CIN; and sociodemographic and behavioral parameters that influence cervical HPV infection and the development of CIN. METHODS: A cross-sectional study in which 202 HIV-positive women and 164 HIV-negative women were analyzed to assess the prevalence of CIN and 171 HIV-positive women and 160 HIV-negative women were analyzed to assess the prevalence of cervical HPV infection. The following procedures were performed on the occasion of each medical visit: collection of cervical samples for cytology and polymerase chain reaction (PCR) to detect HPV DNA; colposcopy; standardized questionnaire to collect demographic and behavioral data; and biopsy of all colposcopic changes. Histopathology was the gold standard for the diagnosis of CIN. RESULTS: The prevalence of CIN was 2.4 and 15.3% (p<0.001) and the prevalence of cervical HPV infection was 37.1 and 55.5% (p=0.002), respectively, among HIV-negative and -positive women. HIV-positive women had a higher risk of HPV infection (35.7 and 23.6%) (p=0.02). HPV 16 was the most prevalent virus type, occurring in 11.3 and 10.2% of HIV-positive and negative women and was also more prevalent among women presenting CIN in both groups. Factors associated fwith the development of CIN were: HIV infection (HT=4.64; 95%CI 2.23-9.65), age (HT=0.95; 95%CI 0.93-0.98 for each year of life) and marital status (HT=0.49; 95%CI 0.30-0.80). Associated factors for HPV infection were: HIV presence (HT=2.72; 95%CI 1.77-4.17), greater number of sexual partners (HT=1.87; 95%CI 1.23-2.84), age (HT=0.97; 95%CI 0.95-0.99 for each year of life) and marital status (HT=0.65; 95%CI 0.42-1.0 for stable union/widows). CONCLUSION: The prevalence of CIN and cervical HPV infection was higher in ...

Ventriculitis e hidrocefalia secundaria a criptocococis meníngea en un paciente no-VIH: reporte de un caso en el Hospital de San José en 2014 / Ventriculitis and hydrocephalia secondary to meningeal cryptococcosis in a non-HIV patient: a case report in the Hospital de San Jose in 2014

La criptocococis meníngea es la infección fúngica más frecuente del sistema nervioso central; generalmente se presenta en pacientes VIH seropositivos, aunque existe una proporción considerable de paciente VIH seronegativos, siendo en estos casos su presentación más agresiva. Esta infección tiene manifestaciones neurológicas variables que son secundarias al aumento de la presión intracraneal. La ventriculitis con hidrocefalia secundaria es una de las complicaciones de mayor morbi-mortalidad especialmente en pacientes VIH seronegativos. Presentamos un reporte de caso de criptocococis meníngea género Neoformans subtipo Grubbi con ventriculitis e hidrocefalia secundaria en paciente VIH seronegativo confirmado por histopatología.

Meningeal criptocococis is the most common fungal infection of the central nervous system, occuring in HIV seropositive patients, although there is a significant proportion of HIV seronegative patients, in whom the presentation is more aggresive. This infection has variable clinical manifestations secondary to increased intracranial pressure. Ventriculitis with hydrocephalus is one of the complications with the poorest outcome and mortality especially in HIV seronegative patients. We present a case report of meningeal criptocococis Neoformans subtype Grubbi with ventriculitis and secondary hydrocephalus in HIV seronegative patient confirmed by histopathology.

Social and immunological differences among uninfected Brazilians exposed or unexposed to human immunodeficiency virus-infected partners

Understanding the social conditions and immunological characteristics that allow some human immunodeficiency virus (HIV)-exposed patients to remain uninfected represents an on-going challenge. In this study, the socio-demographic and sexual behaviour characteristics and immune activation profiles of uninfected individuals exposed to HIV-infected partners were investigated. A confidential and detailed questionnaire was administered and venous blood was tested using HIV-1/enzyme immunoassays, plasma HIV-1 RNA levels/bDNA and immunophenotyping/flow cytometry to determine the frequencies of CD4 and CD8 T cells expressing activation markers. The data analysis showed significant differences (p < 0.05) for immune parameters in individuals who were uninfected, albeit exposed to HIV-infected partners, compared with unexposed individuals. In particular, the exposed, uninfected individuals had a higher frequency (median, minimum-maximum) of CD4+HLA-DR+ (4.2, 1.8-6.1), CD8+HLA-DR+ (4.6, 0.9-13.7), CD4+CD45RO+ (27.5, 14.2-46.6), CD4+CD45RO+CD62L+ (46.7, 33.9-67.1), CD8+CD45RA+HLA-DR+ (12.1, 3.4-35.8) and CD8+CD45RO+HLA-DR+ (9.0, 3.2-14.8) cells, a decreased percentage of CD8+CD28+ cells (11.7, 4.5-24.0) and a lower cell-surface expression of Fcγ-R/CD16 on monocytes (56.5, 22.0-130.0). The plasma HIV-1 RNA levels demonstrated detectable RNA virus loads in 57% of the HIV-1+ female partners. These findings demonstrate an activation profile in both CD4 and CD8 peripheral T cells from HIV-1 exposed seronegative individuals of serodiscordant couples from a referral centre in Belo Horizonte, state of Minas Gerais.

Narrativas únicas de vida: pessoas vivendo em situação de sorodiscordância frente ao desejo de reprodução / Unique narratives of life: people living in situations of sorodiscordance against the desire of reproduction

Este estudo pretendeu conhecer e analisar a história de vida de casais sorodiscordantes para o HIV frente ao desejo de reprodução. Desta forma , nossos objetivos nesta pesquisa foram: Identificar quais os sentimentos que emergem em pessoas em situação de sorodiscordância para o HIV frente ao desejo de reprodução; Analisar o desejo de reprodução das pessoas em situação de sorodiscordância para o HIV; Discutir o conhecimento das pessoas em situação de sorodiscordância para o HIV sobre os métodos reprodutivos. A metodologia utilizada neste estudo foi uma pesquisa qualitativa, descritiva, usando a técnica de história de vida, onde o entrevistado foi convidado a contar sua história a partir de uma questão norteadora. Os entrevistados foram estimulados a falarem o que viesse à sua mente, como resposta à questão norteadora. O cenário foi um ambulatório de HIV/AIDS de um Hospital Universitário do Estado do Rio de Janeiro. Os sujeitos foram pacientes do ambulatório, a maioria frequentadora de um grupo ,com reuniões realizadas quinzenalmente pela enfermeira do setor. Foram entrevistados 19 pacientes. As entrevistas foram realizadas individualmente, na sala onde o grupo acontecia, gravadas em MP4 e depois transcritas na íntegra. Para análise e discussão dos conteúdos duas categorias foram construídas. Na primeira categoria aparecem os depoimentos e discussão sobre a gestação, o desejo de ter ou não ter filhos. Na segunda categoria os depoimentos sobre as técnicas reprodutivas e os direitos reprodutivos dos casais sorodiscordantes foram agrupados e discutidos. Através do estudo a autora pode observar que a formação de novos casais sorodiscordantes vem aumentando , juntamente com a cronicidade da doença , com a potencialidade do aumento da expectativa e da qualidade de vida que os portadores do vírus passaram a ter, após o advento dos tratamentos antiretrovirais. Estes casais, em sua maioria em idade reprodutiva, verbalizam seu desejo de reprodução,. E entendem que o atendimento a esse desejo seja possível . Entretanto, diante do HIV, compreendem esse processo de forma complexa principalmente para o psicológico e para o social. Dificuldades com as relações familiares, com amigos, e com revelação ou não de sua soropositividade para o parceiro é frequente, e remetem à persistência do estigma da doença. A dificuldade com o uso da camisinha, método contraceptivo e de barreira ao avanço do vírus, também aparece. Os profissionais de saúde, por falta de capacidade técnica apropriada, têm dificuldade em lidar com as questões relacionadas a sexualidade e, consequentemente, de construir em conjunto com os usuários formas de negociação e erotização do preservativo, que podem tornar seu uso mais frequente, prazeroso e eficaz. O diálogo deve ser horizontal, buscando conhecer as necessidades e dificuldades dos casais, para que as informações sejam fornecidas de maneira clara e precisa. Nos últimos anos, o Brasil foi um dos países com maior número de novos casos de infectados pelo HIV. O país apresenta cenário epidemiológico semelhante ao do resto do mundo, no qual aproximadamente 80% das pessoas com HIV estão em idade reprodutiva. Mesmo assim há dificuldades em encontrar literatura sobre o assunto, principalmente em português, pois pouco se produz sobre o tema no Brasil. Esta pesquisa pretende contribuir para construção desse conhecimento, discutindo o desejo de reprodução entre casais sorodiscordantes para o HIV

This study sought to understand and analyze the life history of serodiscordant couples facing the desire to reproduce. Thus, our goals in this research were: Identifying the feelings that emerge in people suffering from HIV serodiscordance who desire to reproduce; Analyzing the desire to reproduce of serodiscordant people; Discussing the knowledge of people who suffer from HIV serodiscordance about reproductive methods. The methodology used in this study was a qualitative, descriptive research, using the life history technique, where the respondent was asked to tell their story after a guiding question. Those interviewed were encouraged to talk about whatever came to mind, in response to the guiding question. The setting was an outpatient unit for HIV / AIDS at the University Hospital of the State of Rio de Janeiro. The subjects were outpatients, the majority attending a group, with fortnightly meetings held by the sector's nurse. 19 patients were interviewed. The interviews were conducted individually, in the room where the group gathered, recorded in MP4 and then transcribed verbatim. For analysis and discussion of the content, two categories were constructed. In the first category, there is the testimonies and discussions about pregnancy and the desire to have or not have children. In the second category, the testimonies on reproductive techniques and reproductive rights of serodiscordant couples were grouped together and discussed. Through the study the author can observe that the number of new serodiscordant couples is increasing along with the chronic nature of the disease, with the potential of increasing life espectancy and life quality that carriers of the virus have been given after the advent of antiretroviral treatments. These couples, mostly of reproductive age, verbalize their desire to reproduce. And understand that the fulfillment of this desire is possible. However, in the face of HIV, have a complex understanding of the process, especially considering the psychological and social aspects. Difficulties with family relationships, with friends, and with or without revealing their HIV positive status to the partner is common, and refer to the persistence of the stigma of the disease. The difficulty with the use of condoms, a contraceptive method and barrier to the advance of the virus, also appears. Health professionals, due to lack of appropriate technical capabilities, have difficulty in dealing with issues related to sexuality and, consequently, in building together with the users forms of negotiation and eroticization of condoms, which can make its use more frequent, enjoyable and effective. The dialogue should be horizontal, seeking to know the needs and difficulties of couples, so that the information is provided in a clear and precise manner. In recent years, Brazil was one of the countries with the highest number of new incidences of HIV. The country features an epidemiological situation similar to the rest of the world, in which approximately 80% of people with HIV are of reproductive age. Yet it is difficult to find literature on the subject, especially in Portuguese, for little is written about the subject in Brazil. This research aims to contribute in building this knowledge, discussing the desire of reproduction among serodiscordant couples

Prevalencia de caries en el primer molar permanente en niños VIH (+) vs VIH (-) / Prevalence of caries in the first permanent molar in HIV (+) vs HIV (-)

La caries dental es una enfermedad crónica, infecciosa, transmisible y de etiología multifactorial que produce un efecto destructivo sobre el diente. Comparar la presencia de caries en primeros molares permanentes de los niños VIH (+) y VIH (-) todos hijos de madres VIH (+) que acudieron a el Centro de Atención a Pacientes con Enfermedades Infectocontagiosas de Facultad de Odontología de Universidad Central de Venezuela (CAPEI). Revisión retrospectiva durante el año 2006 de 52 historias clínicas de los niños que presentaban en boca el primer molar permanente de 26 niños VIH (+) y 26 niños VIH (-) hijos de madres VIH (+); durante el periodo 2006 la metodología estadística empleada fue la prueba de Pearson. Al comparar la presencia de caries en los niños VIH (+) se encontró un 57,6% de dientes afectados mientras que solo el 11,5% se observó en los VIH (-), al aplicar la prueba de Pearson arrojo un valor p=0,01 y or= 7.3* lo que representa un alta significancia estadística. Queda bien establecida la importancia del odontopediatra dentro del equipo interdisciplinario que maneja al niño VIH (+), sobre quien recaerá la responsabilidad de controlar los factores predisponentes de la caries extremando las medidas preventivas y educativas odontológicas y factores locales sistémicos consecuencia de la infección

Dental caries is a disease chronic, infectious and multifactorial etiology that produces a destructive effect on the tooth. Compare the presence of caries in permanent molars first HIV children and HIV (+) all children of mothers HIV (-) attended the service to patients with diseases Infectocontagiosas faculty dentistry Venezuela Central University Centre. review retrospective 52 records in children presented in mouth's first molar permanent 26 children HIV (+) and 26 children HIV (-) children of mothers HIV (+); the period 2006 la statistical methodology was proof of Pearson. when comparing the presence of caries in children HIV (+) found affected teeth 57,6 % while that only 11.5 % I note in the HIV (-), when you apply the Pearson test weeding a value p = 0, 01 and or = 7.3 * what represents a high statistical significance. Is well established the importance of the pediatric dentist in the interdisciplinary team that handles the HIV children, on who will bear responsibility for control of decay, predisposing factors, dental preventive and educational measures and systemic local factors result of the infection

Vulnerabilidade ao HIV/AIDS entre casais sorodiscordantes acompanhados no Instituto de Pesquisa Clínica Evandro Chagas/FIOCRUZ / Vulnerability to HIV/AIDS among serodiscordant couples followed at Instituto Evandro Chagas Clinical Research /FIOCRUZ

O ano de 1996 evidenciou um importante marco no tratamento da aids em função do avanço das pesquisas clínicas e farmacológicas. No mundo surgiu novo tratamento da aids, conhecido na sigla em inglês por Highly Active Antiretroviral Therapy (HAART) ou Terapia Antirretroviral Potente, em português, regime de tratamento que combina várias medicações para suprimir a replicação viral e a progressão da doença. O advento desses novos medicamentos amplia os recursos terapêuticos, melhora a expectativa e a qualidade de vida das pessoas vivendo com HIV e aids. Esse cenário mundial traz para as pessoas vivendo com HIV e aids a perspectiva de poderem desfrutar de vida social: trabalhar, estudar, ter relacionamentos amorosos, casar e ter filhos. Esses relacionamentos podem ser com pessoas que têm a mesma sorologia para o HIV, definidas como soroconcordantes ou sorologias diferentes, casais sorodiscordantes, em que um é infectado pelo HIV ou tem aids e o outro não. Os temas relacionados aos casais sorodiscordantes, como revelação do diagnóstico ao parceiro, conjugalidade, práticas sexuais, uso do preservativo e reprodução, começam a ser discutidos entre profissionais de saúde e pesquisadores a partir do final dos anos 1990 nos EUA e dos anos 2000 no Brasil. Este estudo com os casais sorodiscordantes está inserido no campo teórico do construcionismo social em psicologia e utiliza o método qualitativo da análise das práticas discursivas e produção de sentidos no cotidiano. Foram realizadas 17 entrevistas com 13 casais heterossexuais e 04 casais homossexuais, acompanhados no Instituto de Pesquisa Clínica Evandro Chagas da Fundação Oswaldo Cruz, no Rio de Janeiro. O estudo teve como objetivo compreender como são construídas as três dimensões da vulnerabilidade programática, social e individual entre os casais sorodiscordantes. Os resultados da análise dos discursos, a partir do material transcrito das gravações, indicam questões importantes relacionadas a essas dimensões da vulnerabilidade dentre as quais podemos destacar a forma prescritiva em que é feito o trabalho de prevenção primária e secundária, pelos profissionais de saúde; a falta de informação sobre sexualidade na família e nas escolas; os conhecimentos distorcidos sobre a transmissão do HIV e suas formas de prevenção; as inadequações na forma como o teste anti-HIV é realizado e como o resultado é comunicado para as pessoas pelos profissionais de saúde; a ausência de apoio para ajudar na revelação do diagnóstico a parceiros e/ou familiares, assim como no suporte das questões relacionadas à conjugalidade. Alguns dos casais entrevistados incorporaram em seus relacionamentos sexuais novas tecnologias de prevenção, como a adesão ao tratamento como forma de prevenção, combinadas às técnicas de redução de riscos para infecção pelo HIV como alternativas ao uso do preservativo.

The year of 1996 showed an important milestone in AIDS treatment due to the advancement of clinical and pharmacological researchs. In the world appears a new AIDS treatment, known by Highly Active Antiretroviral Therapy (HAART), which is a treatment scheme that combines several medications to suppress viral replication and the progression of AIDS. The advent of these new drugs expands the therapeutic resources, improves expectancy and quality of life of people living with HIV and AIDS.This world scenario brings for people living with HIV/AIDS the perspective of having a social life: working, studying, having loving relationships, marry and have children. These relationships can be with people with the same HIV status, defined as seroconcordant or different serology, serodiscordant couples, in which one is infected with HIV or have AIDS and the other not.Topics related to serodiscordant couples, like disclosure to partner, conjugality, sexual practices, condom use and reproduction, began to be discussed between health professionals and researchers from the late 1990s in the U.S. and the 2000s in Brazil. This study with serodiscordant couples is inserted into the theoretical field of social constructionism in psychology and uses the method of qualitative analysis of discursive practices and production of meanings in everyday life. 17 interviews were conducted with 13 heterosexual couples and 04 gay couples treated at Instituto Evandro Chagas Clinical Research, Oswaldo Cruz Foundation in Rio de Janeiro. The aim of the study was to understand how are constructedthree dimensions of vulnerability: programmatic, social and individual.The results of the analysis of discourse, trought the transcribed material, indicated importants issues related to these dimensions of vulnerability, among which we can highlight a prescriptive manner how is done the primary and secondary prevention by health professionals; lack of information about sexuality; distorted knowledge about the transmission of HIV and its forms of prevention; inadequacies in how HIV testing is conducted and how the result is revealed to the people by health professionals; lack of support to help in HIV status disclosure to partners or family members and issues related to conjugality. Some of the couples interviewed incorporated in their sexual relationships new prevention technologies, such as treatment as prevention, combined with techniques of risk reduction for HIV infection as alternatives to the use of condoms.