RESUMEN
PURPOSE: To study and compare the clinical characteristics and outcome of ocular syphilis between HIV positive and HIV negative patients. METHODS: Retrospective hospital-based case series from a tertiary eye care hospital in India. Patients with uveitis and positive syphilis serology were included. Demographics, clinical features, investigations, imaging and treatment modalities were noted. RESULTS: Hundred and five (105) eyes of 66 patients were analyzed. Males were predominantly affected (n = 57/66, 86.4%). Secondary syphilis was the most common stage of presentation (n = 48/66, 72.7%). Two groups were identified: HIV positive (HIVP) patients (n = 39/66, 59%) and HIV negative (HIVN) patients (n = 27/66, 41%). 12/39 (30.8%) patients were newly diagnosed with HIV at the time of ocular presentation. Panuveitis was the most common presenting feature in both groups (n = 66/105 eyes, 62.8%). Diffuse necrotizing retinitis was more common in HIV patients (HIVP - 15 Vs HIVN - 5 eyes). Ocular co-infections were more common in HIV patients, ocular tuberculosis, the commonest in both groups. Intravenous penicillin and titrated dose of systemic steroids were the mainstay of treatment. Improvement in mean logMAR was noted from 1.415 to 0.828 with p-value < 0.001. At final follow-up, 71.8% patients showed visual improvement. Complete resolution of ocular inflammation was noted in 95.5% patients. CONCLUSION: Ocular syphilis poses a diagnostic challenge considering the varied presentations and clinical course both in immunocompromised and immunocompetent groups. Clinical presentations are not always classical. High index of suspicion with supportive laboratory investigations and with characteristic OCT features helps diagnosis. All uveitis patients, especially with those suspected with infectious etiology, need to be tested for syphilis serology to prevent vision loss in this resurgent disease.
RESUMEN
While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I2 = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I2 = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I2 = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.
Asunto(s)
COVID-19 , Neoplasias , Humanos , COVID-19/epidemiología , Prueba de COVID-19 , Neoplasias/diagnóstico , Neoplasias/epidemiologíaRESUMEN
BACKGROUND: Some contacts of patients with tuberculosis remain negative on tests for tuberculosis infection, despite prolonged exposure, suggesting they might be resistant to Mycobacterium tuberculosis infection. The objective of this multinational study was to estimate the proportion of household contacts resistant to M. tuberculosis (resisters). METHODS: We conducted a longitudinal study enrolling index patients enrolled in treatment for pulmonary multidrug- or rifampin-resistant tuberculosis and their household contacts. Contacts were tested for tuberculosis infection with a tuberculin skin test (TST) and interferon-gamma release assay (IGRA) at baseline and after 1 year. Exposure was quantified based on index patients' infectiousness, index patient and household contact interaction, and age. We explored multiple definitions of resistance to tuberculosis infection by varying TST negativity cutoffs (0 vs <5 mm), classification of missing test results, and exposure level. RESULTS: In total, 1016 contacts were evaluated from 284 households; 572 contacts aged ≥5 years had TST and longitudinal IGRA results available. And 77 (13%) or 71 (12%) contacts were classified as resisters with a <5 mm or 0 mm TST threshold, respectively. Among 263 highly exposed contacts, 29 (11%) or 26 (10%) were classified as resisters using TST cutoffs of <5 mm and 0 mm, respectively. The prevalence of resisters did not differ substantially by sex, age, human immunodeficiency virus (HIV) coinfection, or comorbid conditions. CONCLUSIONS: At least 10% of household contacts can be classified as resistant to tuberculosis infection, depending on the definition used, including those with high exposure. Further studies to understand genetic or immunologic mechanisms underlying the resister phenotype may inform novel strategies for therapeutics and vaccines.
Asunto(s)
Tuberculosis Latente , Mycobacterium tuberculosis , Tuberculosis , Humanos , Ensayos de Liberación de Interferón gamma , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/epidemiología , Estudios Longitudinales , Prueba de TuberculinaRESUMEN
Ocular lesions in patients with human immunodeficiency virus (HIV) are commonly due to underlying opportunistic infections. With highly active antiretroviral therapy (HAART), infectious lesions have reduced and noninfectious ocular manifestations including drug-related side effects have been noted. While retinal toxicity has been noted with few other HAART drugs, there are not many on the same with Efavirenz usage. We report a series of five patients with possible efavirenz-related retinal toxicity, visual function abnormalities, and its management. Efavirenz was replaced with alternate anti-retroviral drug. Reversal of ocular side effects were noted subjectively in the form of symptom amelioration of the patients. Objectively, it could be documented with electroretinogram changes and other visual function tests reverting back to normal after change in HAART regime. Early identification of this uncommon side effect in select patients can prevent irreversible vision loss due to efavirenz-associated retinal toxicity.
Asunto(s)
Alquinos/toxicidad , Benzoxazinas/toxicidad , Ciclopropanos/toxicidad , Ceguera Nocturna/inducido químicamente , Retina/efectos de los fármacos , Enfermedades de la Retina/inducido químicamente , Inhibidores de la Transcriptasa Inversa/toxicidad , Adulto , Terapia Antirretroviral Altamente Activa , Visión de Colores/fisiología , Electrorretinografía , Potenciales Evocados Visuales , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Ceguera Nocturna/diagnóstico por imagen , Ceguera Nocturna/fisiopatología , Oftalmoscopía , Retina/fisiopatología , Enfermedades de la Retina/diagnóstico por imagen , Enfermedades de la Retina/fisiopatología , Microscopía con Lámpara de Hendidura , Tomografía de Coherencia Óptica , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: Re-emergent ocular syphilis in patients with Human immunodeficiency virus (HIV) co-infection has both diagnostic and management difficulties because of the overlapping risk factors. The clinical manifestations described in non-HIV may not be the same in patients with HIV coinfection. Immune recovery uveitis (IRU) may also alter the course of the disease causing recurrences. We studied the clinical features in correlation with CD4 counts, systemic immune status, sexual preferences and management outcomes in HIV/AIDS patients with ocular syphilis in the highly active antiretroviral treatment (HAART) era from a high endemic HIV population like India. METHODS: Retrospective analysis of all patients with ocular syphilis and HIV/AIDS seen between 2016 and 2019 was done. RESULTS: A total of 33 patients (56 eyes) with a CD4 count range of 42-612 cells/cu.mm were included. Ocular syphilis was found to be higher in individuals with high risk behavior such as men who have sex with men (MSMs) (45%). Panuveitis was the commonest manifestation (53.57%) and was even the presenting feature of HIV and syphilis in many patients. Significant vitritis, usually uncommon in HIV/AIDS immunocompromised patients was noted even with low CD4 counts in patients with ocular syphilis. Significant correlation was noted between ocular presentation and CD4 counts (P < 0.05). CONCLUSION: Ocular syphilis presents differently in patients with HIV/AIDS. Diffuse retinitis is seen commonly in low counts (<100 cells/cu.mm). Classical placoid chorioretinitis lesions usually described in non-HIV individuals is uncommon in HIV patients and is seen in higher CD4 counts ( >400 cells/cu.mm). Ocular manifestations can be an indicator of the immune status of the patient. Not all patients with ocular manifestations have associated features of systemic syphilis. Ocular manifestations can be the first presentation of HIV/AIDS. Although, there is good response to systemic penicillin and HAART, recurrences and immune recovery uveitis (IRU) can also occur.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Minorías Sexuales y de Género , Sífilis , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , VIH , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Homosexualidad Masculina , Humanos , India , Masculino , Estudios Retrospectivos , Sífilis/complicaciones , Sífilis/diagnóstico , Sífilis/tratamiento farmacológicoRESUMEN
A 31-year-old male patient presented with sudden onset loss of vision in the left eye. Ocular examination revealed significant vitritis with chorioretinitis lesion in the posterior pole. Subsequent investigations revealed positive human immunodeficiency virus (HIV) and syphilis serology; chest imaging revealed active pulmonary tuberculosis. Polymerase chain reaction from aqueous aspirate was positive for Mycobacterium tuberculosis. There was complete resolution of the lesions following antisyphilitic medications, antitubercular therapy along with highly active antiretroviral therapy. Syphilis and tuberculosis coinfection in a previously unknown HIV patient is rare but can occur. It is worthwhile to look for multiple coinfections in HIV patients.
Asunto(s)
Coriorretinitis , Infecciones por VIH , Sífilis , Tuberculosis , Adulto , Coriorretinitis/complicaciones , Coriorretinitis/diagnóstico , Coriorretinitis/tratamiento farmacológico , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Sífilis/complicaciones , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Agudeza VisualAsunto(s)
Carcinoma de Células Escamosas/complicaciones , Retinitis por Citomegalovirus/complicaciones , Infecciones Virales del Ojo/complicaciones , Neoplasias del Ojo/complicaciones , Seropositividad para VIH/complicaciones , VIH , Neoplasias de la Retina/complicaciones , Adulto , Recuento de Linfocito CD4 , Carcinoma de Células Escamosas/diagnóstico , Córnea/patología , Retinitis por Citomegalovirus/diagnóstico , Infecciones Virales del Ojo/diagnóstico , Neoplasias del Ojo/diagnóstico , Humanos , Masculino , Neoplasias de la Retina/diagnósticoRESUMEN
Intraocular (IO) inflammation in patients with Human immune deficiency virus (HIV) infection can be due to opportunistic infections, immune recovery uveitis, drugs used in the management or a primary manifestation of HIV itself. We studied the role of RT-PCR for HIV RNA in confirming the diagnosis of HIV induced uveitis and its useful in the management and follow-up of these patients.
Asunto(s)
Humor Acuoso/virología , ADN Viral/análisis , Infecciones Virales del Ojo/diagnóstico , Infecciones por VIH/diagnóstico , VIH/genética , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Uveítis/diagnóstico , Adulto , Manejo de la Enfermedad , Infecciones Virales del Ojo/virología , Infecciones por VIH/virología , Humanos , Masculino , Uveítis/genética , Adulto JovenRESUMEN
The validity of a comprehensive international neuropsychological (NP) test battery for detection of HIV-associated neurocognitive disorders (HAND) in a Tamil speaking southern Indian cohort (69 HIV+ and 67 HIV-) was explored. The prevalence of HAND was significantly higher in the HIV+ vs. HIV- group (33 vs.13%; p < 0.01). Impairment rates were highest in the motor and speed of information processing domains. An NP battery translated into Tamil appears to be a valid tool for assessing HAND because the prevalence it found of HAND in southern India is similar to that found elsewhere.
Asunto(s)
Complejo SIDA Demencia/diagnóstico , Complejo SIDA Demencia/epidemiología , Pruebas Neuropsicológicas , Adulto , Femenino , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Adulto JovenRESUMEN
We have analyzed reverse transcriptase (RT) region of HIV-1 pol gene from 97 HIV-infected children who were identified as failing first-line therapy that included first-generation non-nucleoside RT inhibitors (Nevirapine and Efavirenz) for at least 6 months. We found that 54% and 65% of the children had genotypically predicted resistance to second-generation non-nucleoside RT inhibitors drugs Etravirine (ETR) and Rilpivirine, respectively. These cross-resistance mutations may compromise future NNRTI-based regimens, especially in resource-limited settings. To complement these investigations, we also analyzed the sequences in Stanford database, Monogram weighted score, and DUET weighted score algorithms for ETR susceptibility and found almost perfect agreement between the three algorithms in predicting ETR susceptibility from genotypic data.
Asunto(s)
Fármacos Anti-VIH/farmacología , Farmacorresistencia Viral , Infecciones por VIH/virología , VIH-1/efectos de los fármacos , Piridazinas/farmacología , Rilpivirina/farmacología , Adolescente , Fármacos Anti-VIH/uso terapéutico , Niño , Preescolar , Femenino , Genotipo , Transcriptasa Inversa del VIH/genética , VIH-1/clasificación , VIH-1/genética , Humanos , India , Masculino , Mutación Missense , Nitrilos , Piridazinas/uso terapéutico , Pirimidinas , Estudios Retrospectivos , Rilpivirina/uso terapéutico , Análisis de Secuencia de ADN , Insuficiencia del TratamientoRESUMEN
In this study HIV-1 subtype C-infected adults demonstrated higher purifying selection on their viral populations in reverse transcriptase (RT) than infected children. This difference is likely explained by more mature cytotoxic T-lymphocyte responses in adults, which may have implications for the development of drug resistance in the RT region.
Asunto(s)
Evolución Molecular , Variación Genética , Transcriptasa Inversa del VIH/genética , VIH-1/enzimología , VIH-1/inmunología , Linfocitos T Citotóxicos/inmunología , Adulto , Niño , Femenino , Genotipo , VIH-1/clasificación , VIH-1/genética , Humanos , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Selección Genética , Análisis de Secuencia de ADNRESUMEN
BACKGROUND: This is a case report of cortical blindness in a HIV-positive patient with progressive multifocal leukoencephalopathy (PML) without any other associated neurological dysfunction. FINDINGS: Young HIV-positive patient presented to us with sudden profound visual loss. On examination and further investigation, we have diagnosed cortical blindness without any other focal neurological deficit due to PML. CONCLUSION: Our case highlights the fact that PML needs to be suspected in patients with HIV, presenting with cortical blindness even without any other focal neurological defect.