Antiretroviral therapy and arterial elasticity in HIV-infected patients.

Cardiovascular risk is increased in HIV-infected patients and has become a leading cause of morbi-mortality in this population. The purpose of this study is to compare HIV-infected patients on antiretroviral therapy (ART) and ART-naïve HIV-infected patients regarding arterial elasticity. From September 2010 to September 2015, 105 HIV-infected subjects were enrolled, 41 ART-naïve and 64 on ART with stable viral suppression. Elasticity of large and small arteries (LAE and SAE) was assessed by analysis of radial pulse waveforms using a calibrated device. A single set of measurements was performed. Multivariate linear regression models were constructed to estimate independent correlates of arterial elasticity. On-ART and ART-naïve patients were similar with respect to gender, age, body mass index, Framingham cardiovascular risk score, smoking habits, and CD4+ counts. Median time on treatment was 60 months and 79% of patients were on regimens based on non-nucleoside reverse-transcriptase inhibitors. No significant differences in LAE and SAE assessments were found between groups. However, time on ART and cholesterol levels were independently associated with LAE impairment. No association between arterial elasticity and CD4+ counts was found. We conclude that cumulative exposure to ART may play a role on LAE impairment and deserves further investigation.

Late diagnosis of HIV infection in asymptomatic patients.

Recent findings from the START Trial provided evidence that early initiation of antiretroviral treatment should be implemented as the global standard of care. However, a large proportion of patients are still being diagnosed in late stages. Our objective was to evaluate the temporal trend in the CD4+ cell count at diagnosis during a 13 year period and the factors associated with late HIV diagnosis in asymptomatic individuals tested in the Centre for Prevention, Counselling and Diagnosis of our hospital. It was a retrospective study including all asymptomatic patients with new diagnosis of HIV infection. Very late presenters (VLP) were defined as those with CD4+ counts < 200 and late presenters (LP) with CD4+ < 350 cell/mm3. We also evaluated the proportion of patients diagnosed with CD4+ cell counts below 500 cell/mm3. Between January 2002 and December 2014, 20 263 patients were tested for HIV, 1104 with a positive result of whom 995 asymptomatic individuals were included. Overall, median CD4+ count was 372 cells/mm3 and HIV-RNA 31 145 copies/ml. There was no evidence that the CD4+ count at diagnosis progressively increased over time, nor that the proportion of VLP and LP decreased. In a multivariate model older age, heterosexual transmission and intravenous drug use remained as independent factors associated with LP. In conclusion, late diagnosis of HIV infection remains prevalent among asymptomatic patients, highlighting the need to continue implementing strategies towards early diagnosis.

[Monkeypox: description of two cases under follow-up in Buenos Aires]. / Viruela símica: descripción de dos casos en seguimiento en Buenos Aires.

Monkeypox is an endemic disease in several African countries. In May 2022, an outbreak was reported in dozens of non-endemic countries. On July 23, 2022, the WHO Director-General declared this multinational outbreak a public health emergency of international concern. We report two cases of patients under follow-up in Buenos Aires, Argentina, between June and July 2022. Both were men who have sex with men, with the appearance of lesions in the genital area without a prodromal period. In both cases, treatment was carried out in the first instance with suspicion of sexually transmitted infections. We highlight the importance of considering this pathology as a differential diagnosis, taking into account the current epidemiological context.

La viruela símica es una enfermedad endémica en varios países de áfrica. En mayo de 2022 varios países donde la viruela símica no es endémica notificaron casos, incluyendo algunos países de las Américas. El 23 de julio de 2022, el Director General de la OMS declaró que este brote multinacional constituye una emergencia de salud pública de importancia internacional. Comunicamos dos casos de pacientes en seguimiento en la Ciudad de Buenos Aires, Argentina, entre junio y julio de 2022. Ambos eran hombres que tienen sexo con hombres, con aparición de lesiones en zona genital sin período prodrómico. En los dos casos se realizó tratamiento en primera instancia con sospecha de infecciones de transmisión sexual. Señalamos la importancia de considerar esta enfermedad como diagnóstico diferencial teniendo en cuenta el contexto epidemiológico actual.

Viruela símica: descripción de dos casos en seguimiento en Buenos Aires / Monkeypox: description of two cases under follow-up in Buenos Aires

Resumen La viruela símica es una enfermedad endémica en varios países de África. En mayo de 2022 varios países donde la viruela símica no es endémica notificaron casos, incluyendo algunos países de las Américas. El 23 de julio de 2022, el Director General de la OMS declaró que este brote multinacional constituye una emergencia de salud pública de importancia internacional. Comunicamos dos casos de pacientes en segui miento en la Ciudad de Buenos Aires, Argentina, entre junio y julio de 2022. Ambos eran hombres que tienen sexo con hombres, con aparición de lesiones en zona genital sin período prodrómico. En los dos casos se realizó tratamiento en primera instancia con sospecha de infecciones de transmisión sexual. Señalamos la importancia de considerar esta enfermedad como diagnóstico diferencial teniendo en cuenta el contexto epidemiológico actual.

Abstract Monkeypox is an endemic disease in several African countries. In May 2022, an outbreak was repor ted in dozens of non-endemic countries. On July 23, 2022, the WHO Director-General declared this multinational outbreak a public health emergency of international concern. We report two cases of patients under follow-up in Buenos Aires, Argentina, between June and July 2022. Both were men who have sex with men, with the appea rance of lesions in the genital area without a prodromal period. In both cases, treatment was carried out in the first instance with suspicion of sexually transmitted infections. We highlight the importance of considering this pathology as a differential diagnosis, taking into account the current epidemiological context.

Antiretroviral therapy and arterial elasticity in HIV-infected patients

Cardiovascular risk is increased in HIV-infected patients and has become a leading cause of morbimortality in this population. The purpose of this study is to compare HIV-infected patients on antiretroviral therapy (ART) and ART-naïve HIV-infected patients regarding arterial elasticity. From September 2010 to September 2015, 105 HIV-infected subjects were enrolled, 41 ART-naïve and 64 on ART with stable viral suppression. Elasticity of large and small arteries (LAE and SAE) was assessed by analysis of radial pulse waveforms using a calibrated device. A single set of measurements was performed. Multivariate linear regression models were constructed to estimate independent correlates of arterial elasticity. On-ART and ART-naïve patients were similar with respect to gender, age, body mass index, Framingham cardiovascular risk score, smoking habits, and CD4+ counts. Median time on treatment was 60 months and 79% of patients were on regimens based on non-nucleoside reverse-transcriptase inhibitors. No significant differences in LAE and SAE assessments were found between groups. However, time on ART and cholesterol levels were independently associated with LAE impairment. No association between arterial elasticity and CD4+ counts was found. We conclude that cumulative exposure to ART may play a role on LAE impairment and deserves further investigation.

El riesgo cardiovascular está incrementado en los pacientes HIV seropositivos y se ha convertido en una de las principales causas de morbimortalidad en esta población. El objetivo de este estudio fue comparar la elasticidad de grandes y pequeñas arterias (LAE y SAE) en pacientes infectados por HIV con y sin terapia antirretroviral. De septiembre de 2010 a septiembre de 2015 se enrolaron 105 pacientes con infección por HIV, 41 vírgenes de antirretrovirales y 64 con tratamiento estable en supresión viral. LAE y SAE fueron evaluados mediante análisis de la onda de pulso radial. Se construyeron modelos de regresión lineal múltiple para evaluar los predictores independientes de la elasticidad arterial. Los grupos en tratamiento y naïve fueron similares con respecto al sexo, edad, índice de masa corporal, índice de Framingham, tabaquismo y recuento de CD4+. La mediana de tiempo en tratamiento antirretroviral fue 60 meses y el 79% de los pacientes recibieron inhibidores no nucleosídicos. No hubo diferencias significativas entre los grupos en los valores de LAE y SAE. Sin embargo, el tiempo en tratamiento y el nivel de colesterol plasmático se asociaron independientemente con deterioro de LAE. No observamos asociaciones entre la elasticidad arterial y los recuentos de CD4+. Concluimos que la exposición acumulada al tratamiento antirretroviral podría contribuir al deterioro de la LAE. Este hallazgo merece ulterior investigación.

Late diagnosis of HIV infection in asymptomatic patients

Recent findings from the START Trial provided evidence that early initiation of antiretroviral treatment should be implemented as the global standard of care. However, a large proportion of patients are still being diagnosed in late stages. Our objective was to evaluate the temporal trend in the CD4+ cell count at diagnosis during a 13 year period and the factors associated with late HIV diagnosis in asymptomatic individuals tested in the Centre for Prevention, Counselling and Diagnosis of our hospital. It was a retrospective study including all asymptomatic patients with new diagnosis of HIV infection. Very late presenters (VLP) were defined as those with CD4+ counts < 200 and late presenters (LP) with CD4+ < 350 cell/mm³. We also evaluated the proportion of patients diagnosed with CD4+ cell counts below 500 cell/mm3. Between January 2002 and December 2014, 20 263 patients were tested for HIV, 1104 with a positive result of whom 995 asymptomatic individuals were included. Overall, median CD4+ count was 372 cells/mm3 and HIV-RNA 31 145 copies/ml. There was no evidence that the CD4+ count at diagnosis progressively increased over time, nor that the proportion of VLP and LP decreased. In a multivariate model older age, heterosexual transmission and intravenous drug use remained as independent factors associated with LP. In conclusion, late diagnosis of HIV infection remains prevalent among asymptomatic patients, highlighting the need to continue implementing strategies towards early diagnosis.

Los resultados del estudio START han evidenciado que la iniciación temprana del tratamiento antirretroviral debe ser un estándar global. No obstante, una gran proporción de pacientes aún se diagnostican en etapas tardías. Nuestro objetivo fue evaluar la tendencia en el recuento de CD4+ al diagnóstico de infección por HIV, la proporción de presentadores tardíos entre 2002 y 2014, y los factores asociados con el diagnóstico tardío en pacientes asintomáticos en el Centro de Prevención, Asesoramiento y Diagnóstico de nuestro hospital. Se incluyeron en un estudio retrospectivo todos los sujetos asintomáticos con un diagnóstico de HIV. Se consideraron presentadores muy tardíos (PMT) a aquellos pacientes con CD4+ < 200 y presentadores tardíos (PT) con cifras de CD4+ < 350 células/mm³. Adicionalmente evaluamos la proporción de pacientes diagnosticados con recuentos de CD4+ inferiores a 500 células/mm³. Desde enero 2002 a diciembre de 2014 se testearon para HIV 20 263 pacientes, 1104 con resultado positivo, de los cuales 995 eran asintomáticos. Globalmente, la mediana de CD4+ fue 372 células/mm3 y la de HIV-ARN de 31 145 copias/ml. No hubo evidencia de que el recuento de CD4+ al diagnóstico haya aumentado en el tiempo, ni de disminución de la proporción de PT o PMT. En un modelo multivariado, la mayor edad, la transmisión heterosexual y el uso de drogas intravenosas se asociaron independientemente con PT. En conclusión, el diagnóstico tardío de infección por HIV se mantiene prevalente en pacientes asintomáticos, resaltando la necesidad de continuar implementando estrategias orientadas a favorecer el diagnóstico temprano.