Leveraging interdisciplinary management in people with HIV and lymphoid neoplasms.

BACKGROUND: Drug-drug interactions between antiretroviral treatment (ART) and cytostatics may have a negative impact in the prognosis of people with HIV (PWH) and cancer. OBJECTIVE: The objective of this study is to evaluate the impact of the implementation of interdisciplinary management and the type of ART in PWH diagnosed with lymphoid neoplasms. METHODS: This is a multicentric, retrospective observational cohort study including PWH diagnosed with lymphoid neoplasm who started first-line chemotherapy between 2008 and 2020. Demographic, clinical and therapeutic variables were obtained from the electronic medical records and associated with 5-year progression-free survival (PFS) and overall survival (OS) using Cox proportional hazard models. RESULTS: A total of 118 individuals were included. Boosted ART was being used in 55 (46.6%) cases at the time of neoplasm diagnosis. The Infectious Diseases or the Pharmacy Department was consulted before starting chemotherapy in 79/118 (66.9%) cases. Interdisciplinary management resulted in fewer subjects taking boosted ART (17.7% versus 71.8%, P < 0.001) and more subjects using unboosted integrase strand transfer inhibitor-based ART (74.7% versus 7.7%, P < 0.001). The use of boosted ART with chemotherapy was associated with worse 5-year PFS (P = 0.003) and 5-year OS (P = 0.016). There was a trend towards better 5-year PFS and OS when interdisciplinary management was implemented, with significant differences for individuals receiving boosted ART at neoplasm diagnosis (P = 0.0246 and P = 0.0329, respectively). CONCLUSIONS: Our findings underscore the significant impact of the type of ART on the prognosis of PWH undergoing chemotherapy. Encouraging collaborative management between oncologists, pharmacists and HIV teams for these patients enhances PFS and OS rates.

Effectiveness, safety and discontinuation rates of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in people with HIV using real-world data: a systematic review and meta-analysis.

BACKGROUND: The use of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) is based on the results of robust clinical trials. OBJECTIVES: To assess the effectiveness and safety of BIC/FTC/TAF in treatment-naïve (TN) and treatment-experienced (TE) people with HIV using available real-world cohort studies. METHODS: Systematic review and meta-analysis of publications and communications identified via Boolean search in Medline, PubMed and Embase, and conference abstracts reporting retrospective real-world use of BIC/FTC/TAF, published until 31 January 2024. The primary endpoint was the proportion of TN and TE people with HIV with viral load (VL) < 50 copies/mL at 48 weeks while on treatment. RESULTS: Of the 38 identified publications and conference abstracts, for the present analysis we included 12 publications (comprising 792 TN and 6732 TE individuals). For the three publications including 507 TN participants reporting the primary outcome, VL suppression was 97% [95% confidence intervals (CI): 89-100]. For the nine publications including 4946 TE participants reporting the primary outcome, VL suppression was 95% (95% CI: 94-96), with suppression >93% in all studies. Total discontinuations at 48 weeks in TE individuals were 3% (95% CI: 2-5), 1% (95% CI: 0-2) due to side effects. A total of four publications with 151 TE individuals with previous presence of M184V substitution were identified, reporting a suppression rate at 48 weeks of 95% (95% CI: 88-100). CONCLUSIONS: Real-world studies demonstrate low discontinuation rates and high rates of virologic suppression in individuals treated with BIC/FTC/TAF, both TN and TE with and without previous detection of M184V substitution.

Rapid initiation of bictegravir/emtricitabine/tenofovir alafenamide as first-line therapy in HIV infection. A prospective study.

INTRODUCTION: Rapid initiation of ART after HIV diagnosis is recommended for individual and public health benefits. However, certain clinical and ART-related considerations hinder immediate initiation of therapy. METHODS: An open-label, single-arm, single-centre 48-week prospective clinical trial involving ART-naïve HIV-diagnosed adults who started bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) within a week from the first hospital visit, before the availability of baseline laboratory and genotype results. The primary aim was to determine the proportion of people with at least one condition that would hinder immediate initiation of any recommended ART regimen other than BIC/FTC/TAF. Clinicaltrials.gov: NCT04416906. RESULTS: We included 100 participants: 79% men, 64% from Latin America, median age 32 years. According to European AIDS Clinical Society (EACS) and US Department of Health and Human Services 2023 guidelines, 11% (95%CI 6; 19) of participants had at least one condition that made any ART different from BIC/FTC/TAF less appropriate for a rapid ART strategy. Seventy-nine percent of the people started BIC/FTC/TAF within the first 48 hours of their first hospital visit. There were 16 early discontinuations (11 lost to follow-up). By week 48, 92% (95%CI 86; 98) of the participants of the ITT population with observed data achieved viral suppression. Eight grade 3-4 adverse events (AEs), five serious AEs and six ART-related AEs were identified. Adherence remained high. CONCLUSIONS: BIC/FTC/TAF is an optimal treatment for rapid initiation of ART. However, additional strategies to improve retention in care must be implemented.

[Epidemiology, treatment and prognosis of HIV infection in 2024: A practical review]. / Epidemiología, tratamiento y pronóstico de la infección VIH en 2024: revisión práctica.

In recent years, the epidemiology and prognosis of HIV infection have undergone significant changes thanks to the recommendation of antiretroviral therapy (ART) for all infected persons, the development of more effective and better tolerated drugs, and preventive measures such as pre-exposure prophylaxis (PrEP). The evolution of ART, now with simple oral and injectable options, has also contributed to improvements in comprehensive HIV treatment and care. With early diagnosis and early initiation of ART, the life expectancy of people with HIV has reached the same as the general population. However, many people with HIV remain undiagnosed or are diagnosed late, and some population groups experience greater vulnerability, affecting individual and collective health. In this review we review the current epidemiology, treatment and prognosis of HIV infection.

Humoral immunogenicity of primary yellow fever vaccination in infants and children: a systematic review, meta-analysis and meta-regression.

BACKGROUND: Vaccination plays a critical role in mitigating the burden associated with yellow fever (YF). However, there is a lack of comprehensive evidence on the humoral response to primary vaccination in the paediatric population, with several questions debated, including the response when the vaccine is administered at early ages, the effect of co-administration with other vaccines, the duration of immunity and the use of fractional doses, among others. This study summarizes the existing evidence regarding the humoral response to primary YF vaccination in infants and children. METHODS: Studies on the humoral response to primary YF vaccination in children aged 12 years or younger were reviewed. The humoral vaccine response rate (VRR), i.e. the proportion of children who tested positive for vaccine-induced YF-specific neutralizing antibodies, was pooled through random-effects meta-analysis and categorized based on the time elapsed since vaccination. Subgroup, meta-regression and sensitivity analyses were performed. RESULTS: A total of 33 articles met the inclusion criteria, with all but one conducted in countries where YF is endemic. A total of 14 028 infants and children entered this systematic review. Within three months following vaccination, the pooled VRR was 91.9% (95% CI 89.8-93.9). A lower VRR was observed with the 17DD vaccine at the meta-regression analysis. No significant differences in immunogenicity outcomes were observed based on age, administration route, co-administration with other vaccines, or fractional dosing. Results also indicate a decline in VRR over time. CONCLUSIONS: Primary YF vaccination effectively provides humoral immunity in paediatric population. However, humoral response declines over time, and this decline is observable after the first 18 months following vaccination. A differential response according to the vaccine substrain was also observed. This research has valuable implications for stimulating further research on the primary YF vaccination in infants and children, as well as for informing future policies.

Outcomes of Drug Interactions Between Antiretrovirals and Co-Medications, Including Over-the-Counter Drugs: A Real-World Study.

INTRODUCTION: The objective was to characterize real-world outcomes of drug-drug interactions (DDIs) between antiretrovirals (ARVs) and other drugs, including over-the-counter medications (OTC), and treatment outcomes in clinical practice. METHODS: www.clinicalcasesDDIs.com is an open-access website for healthcare providers to consult and briefly describe real-world clinical cases on DDI with ARVs. We reviewed all the clinical cases reported to the website between March 2019 and May 2023. RESULTS: A total of 139 cases were reported, mostly involving ritonavir or cobicistat (boosters; 74 cases), unboosted integrase inhibitors (InSTI; 29 cases), and non-nucleoside reverse transcriptase inhibitors (NNRTI; 23 cases). Central nervous system drugs (29 cases) and cardiovascular drugs (19 cases) were the most frequently described co-medications. Notably, OTC medications were implicated in 27 cases, including mineral supplements (11 cases), herbals (8 cases), weight loss drugs (4 cases), anabolic steroids (3 cases), and recreational drugs (1 case). OTC acted as the perpetrator drug in 21 cases, leading to loss of ARV efficacy in 17 instances (mineral supplements in 10 cases, weight loss drugs in 4 cases, herbals in 3 cases). Additionally, toxicity was reported in 4 out of 6 cases where OTC was considered the victim drug of the DDI (anabolic steroids in 3 cases, MDMA in 1 case). CONCLUSIONS: Frequent unwanted outcomes resulting from DDIs between ARVs and OTC medications underscore the importance of integrating non-prescription drugs into medication reconciliation. The real-world data available through www.clinicalcasesDDIs.com serves as a valuable resource for assessing the clinical relevance of DDIs.

Toxic-Induced Encephalopathy Following Chemsex in a Young HIV-Positive Male: A Complex Case of Acute Cognitive Impairment with Anterograde Amnesia and Behavioral Alterations.

BACKGROUND: A broadened clinical spectrum of concomitant complications emerges among the escalating incidence of substance use, particularly within the 'chemsex' context. This case exemplifies the profound neurotoxic repercussions and neurological risk of chemsex in a young HIV-positive male and addresses the multifaceted challenges of such evolving paradigms in substance utilization. CLINICAL FINDING: After consuming cannabis, poppers, methamphetamine, and cocaine, a 28-year-old HIV-positive male exhibited significant neurological and cognitive impairment. The initial presentation included dysarthria and profound anterograde amnesia. Laboratory findings showed leukocytosis with a PCR of 3 mg/dl - elevated cerebrospinal fluid protein levels with no cells. Urine toxicology returned positive for cannabis and amphetamines. A brain CT scan revealed bilateral and symmetrical hippocampi and pale globes hypodensity, indicative of toxic-metabolic encephalopathy. MRI further identified lesions in the globus pallidus, cerebellum, and hippocampi. Following the detection of toxic encephalopathy, Initial neuropsychological was performed screening using the Montreal Cognitive Assessment (MoCA), which highlighted immediate memory deficits. An in-depth neuropsychological assessment conducted 3 weeks later included the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), the Rey Auditory Verbal Learning Test (RAVLT), and tests for visuospatial skills, motor functions, and memory recall. The evaluations revealed pronounced anterograde amnesia, persistent long-term memory inconsistencies, and notable executive function challenges, detailed in Table 1. CONCLUSIONS: The detailed analysis of this case underpins the severe neurological consequences that can manifest from heavy substance use. Comprehensive diagnostic evaluations, including neuroimaging and neuropsychological assessments, are crucial in elucidating the full spectrum of substance-induced cognitive impairments. There is an urgent need for enhanced public awareness and preventative measures, especially in the context of chemsex, to bring forth multifaceted health, social, and government implications that modern society must adeptly navigate.

Consensus recommendations for use of long-acting antiretroviral medications in the treatment and prevention of HIV-1: Endorsed by the American Academy of HIV Medicine, American College of Clinical Pharmacy, Canadian HIV and Viral Hepatitis Pharmacists Network, European AIDS Clinical Society, and Society of Infectious Diseases Pharmacists: An executive summary.

Five long-acting (LA) antiretrovirals (ARVs) are currently available in a limited number of countries worldwide for HIV-1 prevention or treatment - cabotegravir, rilpivirine, lenacapavir, ibalizumab, and dapivirine. Implementing use of LA ARVs in routine clinical practice requires significant changes to the current framework of HIV-1 prevention, treatment, and service provision. Given the novelty, complexity, and interdisciplinary requirements of safe and optimal use of LA ARVs, consensus recommendations on the use of LA ARVs will assist clinicians in optimizing use of these agents. The purpose of these recommendations is to provide guidance for the clinical use of LA ARVs for HIV-1 treatment and prevention. In addition, future areas of research are identified and discussed.

Consensus recommendations for use of long-acting antiretroviral medications in the treatment and prevention of HIV-1: Endorsed by the American Academy of HIV Medicine, American College of Clinical Pharmacy, Canadian HIV and Viral Hepatitis Pharmacists Network, European AIDS Clinical Society, and Society of Infectious Diseases Pharmacists.

Five long-acting (LA) antiretrovirals (ARVs) are currently available in a limited number of countries worldwide for HIV-1 prevention or treatment-cabotegravir, rilpivirine, lenacapavir, ibalizumab, and dapivirine. Implementing use of LA ARVs into routine clinical practice requires significant changes to the current framework of HIV-1 prevention, treatment, and service provision. Given the novelty, complexity, and interdisciplinary requirements needed to safely and optimally utilize LA ARVs, consensus recommendations on the use of LA ARVs will assist clinicians in optimizing use of these agents. The purpose of these recommendations is to provide guidance for the clinical use of LA ARVs for HIV-1 treatment and prevention. In addition, future areas of research are also identified and discussed.

Comparative Analysis of Primary and Monovalent Booster SARS-CoV-2 Vaccination Coverage in Adults with and without HIV in Catalonia, Spain.

People with HIV (PWH) may be more susceptible to SARS-CoV-2 infection and worse clinical outcomes. We investigated the disparity in SARS-CoV-2 vaccination coverage between PWH and those without HIV (PWoH) in Catalonia, Spain, assessing primary and monovalent booster vaccination coverage from December 2021 to July 2022. The vaccines administered were BNT162, ChAdOx1-S, mRNA-127, and Ad26.COV2.S. Using a 1:10 ratio of PWH to PWoH based on sex, age, and socioeconomic deprivation, the analysis included 201,630 individuals (183,300 PWoH and 18,330 PWH). Despite a higher prevalence of comorbidities, PWH exhibited lower rates of complete primary vaccination (78.2% vs. 81.8%, p < 0.001) but surpassed PWoH in booster coverage (68.5% vs. 63.1%, p < 0.001). Notably, complete vaccination rates were lower among PWH with CD4 <200 cells/µL, detectable HIV viremia, and migrants compared to PWoH (p < 0.001, all). However, PWH with CD4 < 200 cells/µL received more boosters (p < 0.001). In multivariable logistic regression analysis of the overall population, a prior SARS-CoV-2 diagnosis, HIV status, migrants, and mild-to-severe socioeconomic deprivation were associated with lower primary vaccination coverage, reflecting barriers to healthcare and vaccine access. However, booster vaccination was higher among PWH. Targeted interventions are needed to improve vaccine coverage and address hesitancy in vulnerable populations.

Reevaluación del diagnóstico y el tratamiento de las infecciones de dispositivos de electroestimulación cardiaca mediante [18F]FDG-PET/TC / Reappraisal of [18F]FDG-PET/CT for diagnosis and management of cardiac implantable electronic device infections

Introducción y objetivos: El papel de la tomografía por emisión de positrones/tomografía computarizada con 18F-fluorodesoxiglucosa ([18F]FDG-PET/CT) en las infecciones de los dispositivos de electroestimulación cardiaca (DEC) requiere una evaluación más precisa. El objetivo del trabajo es determinar su rendimiento en cada región topográfica del DEC, su capacidad en la diferenciación de infecciones locales aisladas y sistémicas, la utilidad de la captación de bazo y médula ósea (MO) para diferenciar entre infecciones locales y sistémicas y su potencial utilidad en el seguimiento de las infecciones de los DEC. Métodos: Estudio retrospectivo unicéntrico de 54 casos de infección de DEC y 54 controles durante 2014-2021. Se estudió el rendimiento diagnóstico en cada región topográfica del DEC. Se evaluó la combinación de la [18F]FDG-PET/CT con el ecocardiograma transesofágico (ETE) para diagnosticar infecciones sistémicas, el papel de la actividad en MO y bazo y su posible utilidad para guiar la duración de la antibioterapia crónica cuando no se retira el DEC. Resultados: Se incluyeron 13 (24%) infecciones locales aisladas y 41 (76%) infecciones sistémicas. En general, la [18F]FDG-PET/CT mostró un 100% de especificidad y el 85% de sensibilidad, que fue del 79% en el bolsillo, el 57% en el cable subcutáneo, el 22% en el cable endovascular y del 10% en el cable intracardiaco. En las infecciones sistémicas, la [18F]FDG-PET/CT en combinación con ETE aumentó el diagnóstico definitivo del 34 al 56% (p=0,04). Los casos con bacteriemia mostraron hipermetabolismo del bazo (p=0,05) y la MO (p=0,04). Se obtuvo una [18F]FDG-PET/CT de seguimiento de 13 pacientes sin extracción del DEC. No hubo recaídas al suspender la antibioterapia crónica en 6 casos con [18F]FDG-PET/CT negativa. Conclusiones: La sensibilidad de la [18F]FDG-PET/CT para evaluar infecciones locales es mayor que en infecciones sistémicas y aumenta en las sistémicas en combinación con ETE...(AU)

Introduction and objectives: The role of [18F]FDG-PET/CT in cardiac implantable electronic device (CIED) infections requires better evaluation, especially in the diagnosis of systemic infections. We aimed to determine the following: a) the diagnostic accuracy of [18F]FDG-PET/CT in each CIED topographical region, b) the added value of [18F]FDG-PET/CT over transesophageal echocardiography (TEE) in diagnosing systemic infections, c) spleen and bone marrow uptake in differentiating isolated local infections from systemic infections, and d) the potential application of [18F]FDG-PET/CT in follow-up. Methods: Retrospective single-center study including 54 cases and 54 controls from 2014 to 2021. The Primary endpoint was the diagnostic yield of [18F]FDG-PET/CT in each topographical CIED region. Secondary analyses described the performance of [18F]FDG-PET/CT compared with that of TEE in systemic infections, bone marrow and spleen uptake in systemic and isolated local infections, and the potential application of [18F]FDG-PET/CT in guiding cessation of chronic antibiotic suppression when completed device removal is not performed. Results: We analyzed 13 (24%) isolated local infections and 41 (76%) systemic infections. Overall, the specificity of [18F]FDG-PET/CT was 100% and sensitivity 85% (79% pocket, 57% subcutaneous lead, 22% endovascular lead, 10% intracardiac lead). When combined with TEE, [18F]FDG-PET/CT increased definite diagnosis o fsystemic infections from 34% to 56% (P=.04). Systemic infections with bacteremia showed higher spleen (P=.05) and bone marrow metabolism (P=.04) than local infections. Thirteen patients without complete device removal underwent a follow-up [18F]FDG-PET/CT, with no relapses after discontinuation of chronic antibiotic suppression in 6 cases with negative follow-up [18F]FDG-PET/CT. Conclusions: The sensitivity of [18F]FDG-PET/CT for evaluating CIED infections was high in local infections but much lower in systemic infections...(AU)

Prevalence and risk factors of mild chronic renal failure in HIV-infected patients: influence of female gender and antiretroviral therapy

ABSTRACT Background In people living with HIV, much is known about chronic kidney disease, defined as a glomerular filtration rate under 60 mL/min. However, there is scarce data about prevalence and risk factors for milder impairment (60-89 mL/min). Objective The present study aims to assess the influence of sex, antiretroviral therapy, and classical risk factors on the occurrence of mild decreased renal function in a large Spanish cohort of HIV-infected patients. Methods Cross-sectional, single center study, including all adult HIV-1-infected patients under antiretroviral treatment with at least two serum creatinine measures during 2014, describing the occurrence of and the risk factors for mildly decreased renal function (eGFR by CKD-EPI creatinine equation of 60-89 mL/min). Results Among the 4337 patients included, the prevalence rate of mildly reduced renal function was 25%. Independent risk factors for this outcome were age older than 50 years (OR 3.03, 95% CI 2.58-3.55), female sex (OR 1.23, 95% CI 1.02-1.48), baseline hypertension (OR 1.57, 95% CI 1.25-1.97) or dyslipidemia (OR 1.48, 95% CI 1.17-1.87), virologic suppression (OR 1.88, 95% CI 1.39-2.53), and exposure to tenofovir disoproxil-fumarate (OR 1.67, 95% CI 1.33-2.08) or ritonavir-boosted protease-inhibitors (OR 1.19, 95% CI 1.03-1.39). Conclusions Females and patients over 50 seem to be more vulnerable to renal impairment. Potentially modifiable risk factors and exposure to tenofovir disoproxil-fumarate or ritonavir-boosted protease-inhibitors are present even in earlier stages of chronic kidney dysfunction. It remains to be determined whether early interventions including antiretroviral therapy changes (tenofovir alafenamide, cobicistat) or improving comorbidities management will improve the course of chronic kidney disease.

HIV-1 primary infection and acute hepatitis A: Beware of co-infection / Primoinfección por VIH-1 y hepatitis A aguda: cuidado con la co-infección

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Triquinosis: aspectos epidemiológicos, clínicos y de laboratorio. Estudio retrospectivo a 10 años (1994-2003) / Trichinellosis: epidemiological, clinical and laboratory aspects. A retrospective study (1994-2003)

Antecedentes. La triquinosis es una zoonosis parasitaria que se adquiere por consumo de carne infectada con quistes de Trichinella spp. Objetivos. Analizar las características epidemiológicas, clínicas y de laboratorio de los pacientes asistidos en nuestro centro y comparar los resultados con otras series publicadas. Analizar la relación entre variables de laboratorio y clínicas. Materiales y métodos. Análisis retrospectivo que incluyó 127 pacientes durante el período 1994-2003. Resultados. Epidemiológicos: sexo masculino 61%, edad promedio de 32 años; 95% con casos acompañantes. El alimento implicado fue siempre la carne porcina. Clínicos: el 45% presentó síntomas gastrointestinales y el 98%, síntomas extragastrointestinales. En total de 3 pacientes requirieron asistencia en unidad de terapia intensiva y uno falleció. El 53% recibió asociación de tratamiento antiparasitario y antiinflamatorio. Laboratorio: presentó leucocitosis el 59% y eosinofilia absoluta el 72%. Presentó elevación de creatinfosfocinasa el 62%, de lactato deshidrogenasa el 56%, y de transaminasa glutamicooxalacética el 30%. De 52 pacientes, el 65% presentó serología positiva; el examen microscópico de la fuente alimentaria fue positivo en 3 brotes. La población estudiada presentó un promedio de 5 signos y/o síntomas. El grupo de pacientes con más de 5 signos y/o síntomas presentó valores más elevados de transaminasa glutamicooxalacética y leucocitos (p < 0,05). Conclusiones. Los resultados obtenidos fueron comparables a los de otras series; sin embargo, hubo un bajo porcentaje de complicaciones. Los pacientes plurisintomáticos tuvieron valores más elevados de transaminasa glutamicooxalacética y leucocitos, por lo que hay que analizar su significado en estudios futuros. Las distintas modalidades terapéuticas indicadas reflejan la falta de consenso sobre el tratamiento óptimo (AU)

Background. Trichinellosis is a parasitic zoonosis caused by ingestion of infected meat containing cysts of Trichinella spp. Objectives. To analyze the epidemiological, clinical and laboratory findings of trichinellosis patients in our center and compare the results with those from published series. To analyze the relationship between the clinical symptoms and laboratory findings. Materials and methods. The clinical records of 127 patients were retrospectively analyzed. Results. Epidemiological: 61% were male and mean age was 32 years; 95% were associated with other cases. The food implicated was always pork. Clinical: 45% presented gastrointestinal symptoms and 98% systemic symptoms. Three patients required intensive care unit hospitalization and one died. In 53%, treatment consisted of associated antiparasitic and anti-inflammatory drugs. Laboratory: 59% presented leukocytosis and 72% absolute eosinophilia. Creatine phosphokinase was elevated in 62%, lactic dehydrogenase in 56% and glutamic-oxaloacetic transaminase (GOT) in 30%. Among 52 patients, 65% had positive serology; trichinoscopy of food samples was positive in three outbreaks. The population studied had a mean of 5 signs and/or symptoms. The patient group with more than 5 signs and/or symptoms presented higher white blood cell counts and GOT levels (p < 0.05). Conclusions. Our results were comparable to those of other series; however, there was a low rate of complications. An association was found between a larger number of signs and symptoms and higher leukocyte counts and GOT levels. The relevance of these findings should be assessed in future studies. There is no agreement as to the best therapeutic option, a fact reflected in the various treatment modalities seen in our study (AU)

Nocardiosis en pacientes infectados por el VIH / Nocardiosis in patients with human immunodeficiency virus infection

Antecedentes. La nocardiosis es una enfermedad bacteriana asociada con estados de inmunodeficiencia, incluyendo la infección por el virus de la inmunodeficiencia humana (VIH). Métodos. Se analizaron en forma retrospectiva las historias clínicas de 27 pacientes con nocardiosis e infección por VIH asistidos entre los años 1993 y 2004. Se evaluaron las características epidemiológicas, clínicas, inmunológicas, microbiológicas y terapéuticas. Resultados. Eran hombres el 81% con una mediana de edad de 30 años. Un elevado porcentaje de pacientes (89%) tenían antecedentes de enolismo, tabaquismo (80%) y uso de drogas intravenosas (82%). El 85% tenía diagnóstico previo de infección por el VIH. La mediana de linfocitos T CD4+ (n = 17) al momento del diagnóstico de nocardiosis fue de 15 cél./μl. Predominaron las formas clínicas pulmonar (70%), cutánea (11%) y diseminada (11%). Los materiales más frecuentes para el diagnóstico incluyeron muestras de esputo (52%), punción-aspiración de piel y partes blandas (22%) y lavado broncoalveolar (19%). El patrón radiológico pulmonar predominante fue alveolar: 74%, seguido de cavidades pulmonares en el 32%. La especie se pudo identificar en 13 pacientes (48%); la más frecuente fue el complejo Nocardia asteroides en el 84% (n = 11). Los antimicrobianos más utilizados fueron cotrimoxazol (78%), amikacina (59%) y ciprofloxacino (33%). En el 78% de los casos el tratamiento fue combinado y la asociación más frecuente fue cotrimoxazol-amikacina. La mortalidad global fue del 37%. Conclusiones. La nocardiosis es una enfermedad poco frecuente en pacientes infectados por el VIH. Su diagnóstico debería considerarse en sujetos con inmunodepresión grave (linfocitos T CD4+ < 50 cél./μl) y compromiso pulmonar o pericárdico (AU)

Background. Nocardiosis is a bacterial disease that occurs in immunocompromised patients, including those infected by the human immunodeficiency virus (HIV). Methods. We retrospectively analyzed the clinical records of 27 HIV-positive patients with nocardiosis seen during the period of 1993 to 2004. Clinical presentations, diagnostic methods, predominant species, antimicrobial therapy and outcome were analyzed. Results. Among the total, 81% were males and the median age was 30 years. There was an elevated percentage of alcoholism (89%), smoking (80%) and intravenous drug use (82%). A previous positive serology for HIV infection was present in 85% of the patients. Plasma CD4+ T cell count at the time of diagnosis in 15 of 17 patients (88%) was below 50 cells/ml (median 15 cells/μl). The most frequent clinical onset was pulmonary in 70%, followed by cutaneous in 11% and disseminated in 11%. The main specimens for diagnostic bacterial isolation were sputum (54%), skin and soft tissues (22%) and bronchoalveolar lavage (19%). The predominant pulmonary radiological pattern was alveolar infiltration (74%), followed by cavitations (32%). The species was identified in 13 patients (48%); Nocardia asteroides was isolated in 84% (n = 11). The main antimicrobial drugs prescribed were cotrimoxazole (78%), amikacin (59%) and ciprofloxacin (33%). Dual therapy was used in 78% of the cases, with cotrimoxazole-amikacin being the most frequent. Overall mortality was 37%. Conclusions. Nocardiosis is an unusual infection among HIV-infected patients. The diagnosis should be considered in patients with CD4+ T cell counts below 50/μL and lung or pericardial involvement (AU)