RESUMEN
OBJECTIVES: Pneumocystis jirovecii pneumonia (PCP) is an opportunistic fungal infection with high morbidity and mortality among people living with HIV. Upper respiratory tract (URT) swabs are routinely taken for testing viral and bacterial pathogens when patients present with respiratory symptoms in our hospital. We conducted a pilot service improvement project to explore the utility of URT swabs for PCP diagnosis using in-house real-time polymerase chain reaction (PCR). METHODS: Ten URT swab samples obtained from HIV-positive patients with PCP and a positive PCP PCR (AusDiagnostics) from lower respiratory tract (LRT) samples were retrospectively identified. Nine HIV-positive patients with a negative PCR for PCP from LRT samples were identified. Stored aliquots of DNA extracted from these samples were retrieved and tested by an in-house real-time PCR for the presence of PCP DNA. Among PCP-positive cases, URT swabs collected after PCP treatment initiation were excluded from the study. RESULTS: In all, 10 URT samples from PCP-positive patients and nine URT samples from PCP-negative patients were tested for PCP by real-time PCR. Eighteen out of 19 URT sample had a concordant result with the LRT samples. The sensitivity and specificity for URT sample PCR were 90% [confidence interval (CI): 55.50-99.75%] and 100% (CI: 66.37-100%). The positive predictive value was 100% and the negative predictive value was 90.9% (CI: 60.90-98.47%). CONCLUSIONS: Upper respiratory tract swab can reliably detect PCP DNA on real-time PCR among people living with HIV with PCP.
Asunto(s)
Infecciones por VIH , Pneumocystis carinii , Neumonía por Pneumocystis , Infecciones por VIH/complicaciones , Humanos , Pneumocystis carinii/genética , Neumonía por Pneumocystis/diagnóstico , Neumonía por Pneumocystis/microbiología , Reacción en Cadena en Tiempo Real de la Polimerasa , Sistema Respiratorio , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
OBJECTIVES: The aim of the study was to investigate the hypothesis of accelerated cognitive ageing in HIV-positive individuals using longitudinal assessment of cognitive performance and quantitative magnetic resonance imaging (MRI). METHODS: We assessed a broad cognitive battery and quantitative MRI metrics [voxel-based morphometry (VBM) and diffusion tensor imaging (DTI)] in asymptomatic HIV-positive men who have sex with men (15 aged 20-40 years and 15 aged ≥ 50 years), and HIV-seronegative matched controls (nine aged 20-40 years and 16 aged ≥ 50 years). RESULTS: Being HIV positive was associated with greater decreases in executive function and global cognition. Additionally, using DTI, we found that the HIV-positive group had a greater increase in mean diffusivity, but we did not find group differences in volume change using VBM. With respect to the HIV status by age group interaction, this was statistically significant for change in global cognition, with older HIV-positive individuals showing greater global cognitive decline, but there were no significant interaction effects on other measures. Lastly, change in cognitive performance was correlated with change in the DTI measures, and this effect was stronger for the HIV-positive participants. CONCLUSIONS: In the present study, we found some evidence for accelerated ageing in HIV-positive individuals, with a statistically significant HIV status by age group interaction in global cognition, although this interaction could not be explained by the imaging findings. Moreover, we also found that change in cognitive performance was correlated with change in the DTI measures, and this effect was stronger for the HIV-positive participants. This will need replication in larger studies using a similarly lengthy follow-up period.
Asunto(s)
Envejecimiento/patología , Disfunción Cognitiva/fisiopatología , Infecciones por VIH/fisiopatología , Infecciones por VIH/psicología , Imagen por Resonancia Magnética , Neuroimagen , Adulto , Envejecimiento/inmunología , Cognición , Disfunción Cognitiva/virología , Estudios de Seguimiento , Infecciones por VIH/inmunología , Homosexualidad Masculina , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Factores de Tiempo , Adulto JovenRESUMEN
A patient with a delayed diagnosis of vertically transmitted HIV presented with a rare form of severe warm and cold (mixed) autoimmune haemolytic anaemia, six months after starting antiretroviral therapy. The CD4 count had responded rapidly to introduction of antiretroviral therapy, rising from 5 cells/µL to 93 cells/µL over the course of six months. The haemolysis was resistant to immunoglobulin therapy, eventually responding to corticosteroids. On careful scrutiny of the case, we found the features to be in keeping with immune reconstitution inflammatory syndrome; thorough investigations revealed no other trigger for haemolysis in this case.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Anemia Hemolítica Autoinmune/inmunología , Terapia Antirretroviral Altamente Activa , Autoanticuerpos/sangre , Infecciones por VIH/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adolescente , Anemia Hemolítica Autoinmune/complicaciones , Antituberculosos/uso terapéutico , Recuento de Linfocito CD4 , Diagnóstico Tardío , Infecciones por VIH/inmunología , Humanos , Síndrome Inflamatorio de Reconstitución Inmune/inmunología , Transmisión Vertical de Enfermedad Infecciosa , Resultado del Tratamiento , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológicoRESUMEN
Immune reconstitution inflammatory syndrome has been described in Kaposi sarcoma, but does not usually manifest as acute hepatitis. We describe a case of rapid obstructive jaundice after initiation of antiretroviral therapy, in which the liver biopsy confirmed hepatic Kaposi sarcoma, and the clinical course was altered by the addition of montelukast.
Asunto(s)
Acetatos/uso terapéutico , Infecciones por VIH/complicaciones , Síndrome Inflamatorio de Reconstitución Inmune/complicaciones , Ictericia Obstructiva/etiología , Antagonistas de Leucotrieno/uso terapéutico , Quinolinas/uso terapéutico , Sarcoma de Kaposi/complicaciones , Sarcoma de Kaposi/patología , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/patología , Antirretrovirales/efectos adversos , Antirretrovirales/uso terapéutico , Antineoplásicos/uso terapéutico , Biopsia , Recuento de Linfocito CD4 , Ciclopropanos , Infecciones por VIH/tratamiento farmacológico , Humanos , Síndrome Inflamatorio de Reconstitución Inmune/tratamiento farmacológico , Ictericia Obstructiva/tratamiento farmacológico , Hígado/patología , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Sarcoma de Kaposi/tratamiento farmacológico , Sarcoma de Kaposi/virología , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/virología , Sulfuros , Resultado del Tratamiento , Carga ViralRESUMEN
HIV-2 is common in West Africa but rarely found in developed countries. It usually has a milder disease course than HIV-1 and clinical presentations of neurological syndromes in HIV-2 are extremely rare. We report a case of a HIV-2-infected, 46-year-old woman originally from Cote d'Ivoire who presented with possible intracerebral toxoplasmosis infection then developed progressive multifocal leukoencephalopathy.
Asunto(s)
Infecciones por VIH/complicaciones , Infecciones por VIH/virología , VIH-2/aislamiento & purificación , Leucoencefalopatía Multifocal Progresiva/diagnóstico , Côte d'Ivoire , Femenino , VIH-2/patogenicidad , Humanos , Leucoencefalopatía Multifocal Progresiva/complicaciones , Leucoencefalopatía Multifocal Progresiva/patología , Persona de Mediana Edad , Toxoplasmosis Cerebral/complicaciones , Toxoplasmosis Cerebral/diagnóstico , Toxoplasmosis Cerebral/patologíaRESUMEN
Bone involvement in secondary and tertiary syphilis is a well-documented but unusual phenomenon. We report the case of an atypical presentation of secondary syphilis in a 25-year-old HIV-positive man who has sex with men. He presented initially with headaches and an unusual calvarial swelling. The skull findings were consistent with osteitis and he later developed systemic symptoms. Treponema pallidum serology was positive and the lesions and systemic symptoms resolved completely after administration of appropriate antibiotic therapy.
Asunto(s)
Infecciones por VIH/complicaciones , Cráneo/patología , Sífilis/diagnóstico , Sífilis/patología , Treponema pallidum/aislamiento & purificación , Adulto , Antibacterianos/uso terapéutico , Homosexualidad Masculina , Humanos , Imagen por Resonancia Magnética , Masculino , Osteítis/patología , Radiografía , Cráneo/diagnóstico por imagen , Resultado del TratamientoRESUMEN
We present the updated British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis (PEPSE) to HIV. This document includes a review of the current data to support the use of PEPSE, considers how to calculate the risks of infection after a potential exposure, and provides recommendations on when PEPSE would and would not be considered. We review which agents to use for PEPSE including the potential for drug-drug interactions and make recommendations for monitoring individuals receiving PEPSE. Other areas included are the possible impact on sexual behaviour, cost-effectiveness and issues relating to service provision. Throughout the document, consideration is given to the place of PEPSE within the broader context of HIV prevention strategies and sexual health.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/prevención & control , Profilaxis Posexposición , Análisis Costo-Beneficio , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Exposición Profesional , Factores de Riesgo , Conducta Sexual , Reino UnidoRESUMEN
Practice related to hepatitis B vaccination of HIV outpatients in a London teaching hospital was audited against the British HIV Association (BHIVA) immunization guidelines 2004 and 2008, both before and after the implementation of a vaccination record sheet in the patients' notes. Adherence to the guidelines in the original audit was poor - only 67% of patients requiring vaccination for hepatitis B received a full course of vaccination. Following the introduction of the vaccination record sheet, this vaccination completion rate increased to 79% (BHIVA target 95%). Overall the percentage of patients managed according to BHIVA guidelines, including those who did not require vaccination, improved from 33% in the original audit to 61% in the re-audit. Introduction of a simple hepatitis B vaccination record sheet improved the quality of care for our HIV outpatients. Further modification of this system is warranted, perhaps by the introduction of a computerized reminder system.
Asunto(s)
Adhesión a Directriz/estadística & datos numéricos , Infecciones por VIH/complicaciones , Vacunas contra Hepatitis B/administración & dosificación , Vacunas contra Hepatitis B/inmunología , Hepatitis B/prevención & control , Vacunación/estadística & datos numéricos , Hospitales de Enseñanza , Humanos , Londres , Servicio Ambulatorio en HospitalRESUMEN
AIMS: The aim of this study is to determine the cardiovascular disease (CVD) risk profile of a large UK HIV cohort and how highly active antiretroviral therapy (HAART) affects this. METHODS: It is a cross-sectional study within a large inner city hospital and neighbouring district hospital. A total of 1021 HIV positive outpatients representative of the complete cohort and 990 who had no previous CVD were included in CVD risk analysis. We recorded demographics, HAART history and CVD risk factors. CVD and coronary heart disease (CHD) risks were calculated using the Framingham (1991) algorithm adjusted for family history. RESULTS: The non-CVD cohort (n = 990) was 74% men, 51% Caucasian and 73.1% were on HAART. Mean age was 41 +/- 9 years, systolic blood pressure 120 +/- 14 mmHg, total cholesterol 4.70 +/- 1.05 mmol/l, high-density lipoprotein-C 1.32 +/- 0.48 mmol/l and 37% smoked. Median CVD risk was 4 (0-56) % in men and 1.4 (0-37) % in women; CHD risks were 3.5 (0-36) % and 0.6 (0-16) %. CVD risk was > 20% in 6% of men and 1% of women and > 10% in 12% of men and 4% of women. CVD risk was higher in Caucasians than other ethnicities; the risk factor contributing most was raised cholesterol. For patients on their first HAART, increased CHD risk (26.2% vs. 6.5%; odds ratio 4.03, p < 0.001) was strongly related to the duration of therapy. CONCLUSIONS: Modifiable risk factors, especially cholesterol, and also duration of HAART, were key determinants of CVD risk. DISCUSSION: Regular CHD and/or CVD risk assessment should be performed on patients with HIV, especially during HAART therapy. The effect of different HAART regimens on CHD risk should be considered when selecting therapy.
Asunto(s)
Terapia Antirretroviral Altamente Activa/efectos adversos , Enfermedades Cardiovasculares/inducido químicamente , Infecciones por VIH/tratamiento farmacológico , Adulto , Colesterol/sangre , Estudios de Cohortes , Enfermedad Coronaria/inducido químicamente , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Fumar/efectos adversosRESUMEN
The usefulness of genotypic resistance tests (GRT) among HIV-1 patients with low-level virological failure (LLVF) was evaluated. Up to 78% of samples with <1,000 copies/ml were sequenced successfully. For samples with 50 to 200 copies/ml, the success rate was as high as 69%. LLVF should not deter clinicians from requesting GRT.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , VIH-1/efectos de los fármacos , VIH-1/genética , Mutación Missense , ARN Viral/genética , Genotipo , VIH-1/aislamiento & purificación , Humanos , Pruebas de Sensibilidad Microbiana/métodos , Análisis de Secuencia de ADN , Carga ViralAsunto(s)
Antivirales/uso terapéutico , Infecciones por VIH , Hepatitis B Crónica , Hepatitis C Crónica , Adulto , Terapia Antirretroviral Altamente Activa , Antivirales/efectos adversos , Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/cirugía , Niño , Medicina Basada en la Evidencia , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/terapia , Hepatitis B Crónica/complicaciones , Hepatitis B Crónica/terapia , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/terapia , Hepatitis D/complicaciones , Hepatitis D/diagnóstico , Hepatitis D/epidemiología , Virus de Hepatitis/genética , Virus de Hepatitis/aislamiento & purificación , Humanos , Inmunoterapia Activa/métodos , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/epidemiología , Cirrosis Hepática/etiología , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/cirugía , Trasplante de Hígado , MasculinoAsunto(s)
Terapia Antirretroviral Altamente Activa , Sarcoma de Kaposi/diagnóstico por imagen , Sarcoma de Kaposi/tratamiento farmacológico , Vómitos/diagnóstico , Vómitos/tratamiento farmacológico , Adulto , Terapia Antirretroviral Altamente Activa/métodos , Neoplasias Duodenales/complicaciones , Neoplasias Duodenales/diagnóstico , Neoplasias Duodenales/tratamiento farmacológico , Humanos , Masculino , Sarcoma de Kaposi/complicaciones , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vómitos/etiologíaRESUMEN
An HIV-positive man with hepatitis B co-infection, naïve to highly active antiretroviral therapy, with a CD4 of 594 copies/mL and HIV-1 viral load of 140,070 copies, presented with right-sided facial weakness and hearing loss. He had been treated for secondary syphilis three months earlier when his rapid plasma reagin (RPR) result was 1:16, this had fallen to neat. At presentation, his RPR had risen to 1:16 again. A magnetic resonance imaging scan showed enhancement of the internal auditory canal and right cochlea. His cerebrospinal fluid examination was normal. He was treated with acyclovir and prednisolone before the syphilis serology was known. He was then treated for syphilis with doxycycline. He made an excellent recovery.
Asunto(s)
Pérdida Auditiva Sensorineural/etiología , Pérdida Auditiva Súbita/etiología , Sífilis/complicaciones , Adulto , Antibacterianos/uso terapéutico , Doxiciclina/uso terapéutico , Infecciones por VIH/complicaciones , VIH-1 , Pérdida Auditiva Sensorineural/diagnóstico por imagen , Pérdida Auditiva Sensorineural/tratamiento farmacológico , Pérdida Auditiva Súbita/diagnóstico por imagen , Pérdida Auditiva Súbita/tratamiento farmacológico , Hepatitis B/complicaciones , Humanos , Imagen por Resonancia Magnética , Masculino , Radiografía , Sífilis/tratamiento farmacológico , Resultado del TratamientoRESUMEN
An HIV-1/hepatitis C virus (HCV) co-infected patient with haemophilia received a 48-week course of pegylated interferon-alpha-2b and ribavirin therapy for genotype 5a HCV infection. Virological response was achieved at week 24. At the end of treatment, HCV RNA in serum was detected and identified to belong to genotype 2b, rather than genotype 5a. A sensitive method for identifying minority HCV genotypes in pre-treatment serum showed genotype 2b HCV carriage prior to treatment. Sequencing the interferon sensitivity-determining region of the HCV NS5A gene obtained from pre-, intra- and post-treatment sera revealed emergence of quasispecies bearing R-->K and M-->A/T mutations at codons 2222 and 2223, respectively. Occult presence of minority HCV subpopulations and their acquisition of mutations following therapy can result in poor treatment outcome.
Asunto(s)
Infecciones por VIH/complicaciones , VIH-1 , Hepacivirus/genética , Hepacivirus/aislamiento & purificación , Hepatitis C/virología , Adulto , Antivirales/uso terapéutico , Secuencia de Bases , Genotipo , Infecciones por VIH/virología , Hepacivirus/clasificación , Hepatitis C/complicaciones , Hepatitis C/tratamiento farmacológico , Humanos , Interferón alfa-2 , Interferón-alfa/uso terapéutico , Masculino , Datos de Secuencia Molecular , Polietilenglicoles , Proteínas Recombinantes , Ribavirina/uso terapéuticoRESUMEN
Highly active antiretroviral therapy (HAART) has markedly improved the prognosis of people with HIV infection. However, there are long-term side effects associated with HAART. Alterations in metabolic parameters are common and include hyperlipidaemia and insulin resistance (IR), either in isolation or as part of the lipodystrophy and metabolic syndromes. Insulin resistance is common in HIV-infected people, particularly among those being treated with protease inhibitor therapy. The prevalence of hyperglycaemia and diabetes mellitus is significantly higher in people with HIV infection being treated with antiretrovirals (ARVs), as compared with the general population. Hyperglycaemia is an important risk factor for the development of secondary pathology, including cardiovascular disease. It is therefore important to consider the effects of IR in HIV-infected individuals, and take measures to prevent or manage it appropriately. There is limited evidence for the benefit of pharmacological interventions for IR alone although the metabolic changes and body shape changes of lipodystrophy might benefit from the combined use of metformin with exercise. At present, therefore, it is best to concentrate on preventative measures, including lifestyle modification, the careful selection of ARV drugs, and changing drug combinations where appropriate.
Asunto(s)
Terapia Antirretroviral Altamente Activa/efectos adversos , Diabetes Mellitus Tipo 2/prevención & control , Infecciones por VIH/tratamiento farmacológico , Hiperglucemia/prevención & control , Resistencia a la Insulina/fisiología , Infecciones por VIH/fisiopatología , Humanos , Factores de RiesgoRESUMEN
Highly active antiretroviral therapy (HAART) is an important part of the treatment of Kaposi's sarcoma (KS) in HIV-infected patients. We describe two cases of KS, which worsened on HAART.
Asunto(s)
Terapia Antirretroviral Altamente Activa/métodos , Doxorrubicina/administración & dosificación , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , VIH , Sarcoma de Kaposi/tratamiento farmacológico , Sarcoma de Kaposi/virología , Adulto , Antibióticos Antineoplásicos/administración & dosificación , Esquema de Medicación , Femenino , Humanos , Masculino , Sarcoma de Kaposi/radioterapiaRESUMEN
OBJECTIVES: To retrospectively audit the management of post-exposure HIV prophylaxis following sexual exposure (PEPSE) against the British Association for Sexual Health and HIV 2004 draft guidance. METHODS: A retrospective review of case notes from January 2000 to November 2004. The draft guidelines were not adopted into clinical practice during the study period. RESULTS: 76 patients received PEPSE. 79% (95% CI 68.08 to 87.46) of PEPSE prescriptions were given for exposures that were in accordance with the guidelines' recommended indications (target 90%). 87% (95% CI 77.13 to 93.51) of PEPSE was prescribed within 72 hours of risk exposure (target 90%). 91% (95% CI 81.94 to 96.22) of recipients received a recommended antiretroviral combination. 53% (95% CI 40.84 to 64.21) of recipients completed the PEPSE course (target 75%). 45% of patients attended for the 3 month follow up HIV test but only 12% (95% CI 5.56 to 21.29) attended for both the 3 month and 6 month HIV test (target 75%). CONCLUSION: PEPSE is predominantly being prescribed for recommended indications and is dispensed within 72 hours of risk exposure. PEPSE completion rates and attendance for 3 months and 6 months post-exposure HIV testing need improving, perhaps by introducing a PEPSE clinic.
Asunto(s)
Infecciones por VIH/prevención & control , Sexo Inseguro/estadística & datos numéricos , Adulto , Femenino , Infecciones por VIH/transmisión , Humanos , Masculino , Auditoría Médica , Guías de Práctica Clínica como Asunto , Estudios RetrospectivosRESUMEN
Since the discovery of hepatitis C virus (HCV) in 1989, there has been much debate regarding its potential modes of transmission particularly as only about half of the reported cases of acute HCV have a defined parenteral exposure. It has been clearly established that blood-blood contact is important in its transmission, but the question of sexual transmission has caused more controversy with studies producing conflicting evidence. The objective of this review was to examine the current evidence on all reported routes of transmission of hepatitis C with particular attention to sexual transmission in men having sex with men (MSM) and HIV-positive individuals. We conducted PubMed searches using keywords hepatitis C, transmission, sexual, HIV, MSM, mother to child, haemophilia, intravenous drug use, tattooing and skin piercing. The bibliographies in articles identified were also searched.
Asunto(s)
Transmisión de Enfermedad Infecciosa , Hepatitis C/transmisión , Transmisión Vertical de Enfermedad Infecciosa , Intercambio Materno-Fetal , Enfermedades Virales de Transmisión Sexual/transmisión , Femenino , Hepatitis C/epidemiología , Humanos , Embarazo , Factores de Riesgo , Parejas Sexuales , Enfermedades Virales de Transmisión Sexual/epidemiologíaRESUMEN
Multicentric Castleman's disease (MCD) was originally described in non-HIV patients. It is a rare lymphoproliferative disorder, which is more commonly seen in HIV-positive patients and is associated with human herpes virus-8 (HHV-8). We describe a patient with advanced HIV who responded well to conventional highly active antiretroviral treatment. She was diagnosed with MCD soon after her diagnosis of HIV. She presented with multiple flares of her MCD. The case illustrates the difficulty of differentiating between episodes of septicaemia and a flare of MCD. The patient was treated with various chemotherapy regimens, which included several cycles of liposomal doxyrubicin and etoposide. There is currently no consensus on the treatment of MCD and various therapies are described in the literature, which include chemotherapy. Chemotherapy must be chosen with the immunosuppressive effects of the treatment being considered with caution. Both doxyrubicin and etoposide are well tolerated and successfully controlled the symptoms of MCD in our patient.