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INTRODUCTION: People living with HIV (PLHIV) are at higher risk of cardiovascular disease (CVD), and dyslipidemia is a prevalent comorbidity that requires effective treatment. Limitations for the use of statins such as drug interactions and adverse effects highlight the need for alternative therapies. AREAS COVERED: This review evaluates the role of PCSK9 inhibitors in reducing cardiovascular risk in PLHIV with dyslipidemia. We analyzed studies available on PUBMED, using keywords HIV, dyslipidemia, PCSK9 inhibitors, and statin intolerance. We discuss the mechanisms underlying increased cardiovascular risk, limitations of statins, including a recent study using PCSK9 inhibitors. Evolocumab significantly reduced LDL-C levels by 56.9% in PLHIV, with 72.5% of patients achieving ≥50% LDL-C reduction. The trial confirmed the drug's safety. Additionally, PCSK9 inhibitors demonstrated reductions in lipoprotein(a) and inflammatory markers. EXPERT OPINION: PCSK9i present a promising option for lipid management in PLHIV, especially in statin-intolerant individuals or those with residual risk despite statin therapy. Additional non-statin therapies targeting adverse lipid profiles, including low HDL-C, high triglycerides, and lipoprotein(a), are under development. Combined with advancements in antisense oligonucleotides (ASOs) and siRNA technologies, they hold promise for transforming the treatment of dyslipidemia and cardiovascular disease in PLHIV.

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INTRODUCTION: The main objective of this study was to evaluate the association between the baseline level of Histoplasma capsulatum urinary antigen (AgU) and the severity of histoplasmosis in the context of HIV, as well as its utility for treatment monitoring. Secondary objectives included determining the appropriate cutoff point for AgU detection for the diagnosis of proven histoplasmosis. MATERIALS AND METHODS: The study was an analytical, retrospective cohort study in adults diagnosed with HIV, with at least one determination of AgU using ELISA. Sociodemographic, clinical, and laboratory variables were collected. Statistical analysis was performed using R-project® software. RESULTS: A total of 452 individuals with AgU were included from March 2018 to July 2022, with 42 (9.3%) positive results (25 proven histoplasmosis and 17 probable cases). An statistically significant correlation was found between the baseline concentration of AgU and positive cultures. However, the utility of AgU as a followup tool could not be evaluated. The optimal cutoff point for detecting proven histoplasmosis was an AgU value ≥2.2 ng/mL (specificity: 96.3% and sensitivity: 100%). DISCUSSION: Further studies are needed to evaluate the utility of AgU as a tool for monitoring antifungal treatment. A value of AgU ≥2.2 ng/mL could potentially correspond to a diagnosis of proven histoplasmosis.

Introducción: El objetivo principal del estudio fue evaluar la asociación entre el valor basal del antígeno urinario de Histoplasma capsulatum (AgU) y la gravedad del cuadro de histoplasmosis en contexto de HIV, así como su utilidad para seguimiento de tratamiento antifúngico. En los objetivos secundarios se incluyódeterminar el punto de corte adecuado en la detección del AgU para el diagnóstico de histoplasmosis probada. Materiales y métodos: Estudio de cohorte analítico, retrospectivo en adultos con diagnóstico de HIV con una determinación del AgU, mediante ELISA. Se recolectaron variables sociodemográficas, clínicas y de laboratorio. Se realizóel análisis estadístico mediante software Rproject®. Resultados: Se incluyeron 452 individuos con determinación de AgU desde marzo 2018 a julio 2022, con 42 (9.3%) resultados positivos (25 histoplasmosis probadas y 17 probables). Se hallóuna correlación estadísticamente significativa entre la concentración basal del AgU y los cultivos positivos. No pudo evaluarse la utilidad del AgU como herramienta de seguimiento. El mejor punto de corte para detectar histoplasmosis probada fue un valor de AgU ≥2.2 ng/mL (especificidad: 96.3% y sensibilidad: 100%). Discusión: Se requieren mayores estudios para evaluar la utilidad del AgU como herramienta para seguimiento del tratamiento antifúngico. Un valor de AgU ≥2.2 ng/mL, podría equivaler a un diagnóstico de histoplasmosis probada.

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INTRODUCTION: People Living with Human Immunodeficiency Virus (PLHIV) appear to be at a higher risk of developing sarcopenia. Various factors seem to influence the risk of sarcopenia, and its prevalence may differ depending on the screening tool used. This study aimed to (i) Screen the risk of sarcopenia in PLHIV using the SARC-F and SARCCalf and identify associated factors; (ii) Analyze the agreement between the instruments in PLHIV. METHODS: Cross-sectional study including PLHIV taking antiretroviral therapy. The authors assessed sarcopenia risk using the SARC-F and SARCCalf tools with ≥4 and ≥11 cutoff points, respectively, and a wide spectrum of variables was analyzed. RESULTS: Participated 76 patients (44.9 ± 12.7 years). Sarcopenia risk, according to the SARC-F, was 27.6 % and was associated with socioeconomic status (p = 0.004), smoking (p = 0.001), disease status (p < 0.001), opportunistic infections (p = 0.001), CD4 T-cell count (p < 0.001), Handgrip Strength (HGS) (p < 0.001), and Gait Speed (GS) (p = 0,001). Using the SARCCalf, sarcopenia risk was 36.8 % and was associated with work activity (p = 0.029), socioeconomic status (p = 0.004), smoking (p = 0.009), disease status (p < 0.001), opportunistic infections (p = 0.015), CD4 T-cell count (p = 0.002), HGS (p = 0.001), Appendicular Skeletal Muscle Mass Index (ASMMI) (p = 0.009), and GS (p < 0.001). The agreement between tools was moderate (k = 0.49). CONCLUSION: Sarcopenia risk, as determined by both tools, was higher in low-income PLHIV with opportunistic infections, CD4 T-cell count ≤ 200 cells/mm3, low HGS, and low GS, and lower in asymptomatic and non-smoking individuals. The authors recommend investigating these factors in hospital and outpatient settings. The SARCCalf proved to be more appropriate for screening sarcopenia risk in PLHIV.

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Human Immunodeficiency Virus (HIV), Human T Lymphotropic Virus (HTLV), Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) coinfection may lead to disease progression or worsen its clinical presentation. Viral coinfections screening during blood donation is critical. To identify risk factors for coinfection among blood donors, we assessed the blood donations at the Fundação de Hematologia e Hemoterapia da Bahia, from 2008 to 2017. We compared serological/molecular evidence of single infection versus two or more viral blood-borne infections-BBI). A multivariable logistic regression model was performed to evaluate independent associations between characteristics of donors with single infection and multiple infection using "non-infection" category as reference. Among 777,446 collected blood donations, 27 358 (3.5%) were reactive, most (n = 26 677, 97.6%) for a single infection and 681 (2.4%) for coinfection. The most frequent coinfections were HBV-HIV (30.6%), HBV-HCV (30.4%), and HBV-HTLV (24.4%). Male sex, lower education, being single, and being a first-time donor were independently associated with both single and coinfections. Nevertheless, the adjusted odds for risk factors of coinfections were much higher than those for single infection. Donors with single and coinfection for BBI shared identical risks, but they were significantly higher for coinfection. Preventive strategies addressing the identified risks can decrease transmission of viral BBI by blood transfusion.

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OBJECTIVES: to compare the sociodemographic and clinical severity indicators of hospitalized people with HIV in relation to clinical outcomes and urgent hospital admission. METHODS: a retrospective cohort study was conducted with 102 medical records of HIV-infected individuals hospitalized in a hospital in southern Brazil. In addition to descriptive analysis, Fisher's exact test, Pearson's Chi-square, and logistic regression were used. RESULTS: the data showed a significant direct effect on severity indicators in the following variables: male sex (p=0.013), skin color (p=0.023), level of education (p=0.000), urgent admissions (p=0.000), late diagnosis (p=0.001), diabetes mellitus (p=0.001), hypertension (p=0.004), kidney disease (p=0.002), high viral load (p=0.006), CD4+ count below 200 (p=0.005), fever (p=0.016), weight loss (p=0.013), co-infection with hepatitis C (p=0.004), and mortality (p=0.007). CONCLUSIONS: three sociodemographic and thirteen clinical markers were identified as being associated with the risk of clinical deterioration in hospitalized people with HIV.

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This study aims to investigate the possible association between neutrophil/lymphocyte and platelet/lymphocyte ratio in women with HIV, undergoing antiretroviral treatment, with HPV coinfection. This is a cross-sectional study with HIV positive women; their biological samples were collected for laboratory tests (complete blood count) and oncotic cytology for detection of HPV DNA, by PCR-Nested (PGMY and GP primers). Viral load and CD4 and CD8 T-cells counts were obtained from medical records. The data were analyzed, comparing the two groups: those with coinfection and those without it. From 82 HIV seropositive women, 50% exhibited HPV coinfection and 12.2% of coinfected patients had cervical cell alterations. Quantification of viral load, CD4 and CD8 T-cells count, CD4 / CD8 ratio and neutrophil/lymphocyte (NLR) and platelet/lymphocyte (PLR) ratio presented significant differences between groups (p<0.05). The predicting power of NLR and PLR in differentiating HIV/HPV coinfection which demonstrated differences between groups (AUC of 0.882 and 0.776 for NLR and PLR, respectively). There is a relation between the neutrophil/lymphocyte and platelet/lymphocyte ratio with HIV/HPV coinfection in women undergoing antiretroviral treatment, suggesting a state of greater and persistent systemic inflammation, reflecting as a biomarker for screening and monitoring these patients.

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Histoplasmosis poses a significant risk to HIV patients, particularly in regions with limited access to antiretroviral therapy. Antigen detection assays are crucial in these settings for timely diagnosis and treatment, which can reduce mortality. While commercial antigen detection kits have performed well in diagnosing histoplasmosis, their effectiveness in monitoring treatment remains unclear. This study aimed to evaluate the correlation between urine antigen levels and clinical response using the clarus Histoplasma Galactomannan (GM) enzyme immunoassays (EIA) kit. The study followed 27 HIV patients diagnosed with histoplasmosis over 24 weeks, measuring urinary Histoplasma antigen (Ag) levels and clinical outcomes. Patients received amphotericin B as induction therapy, followed by maintenance with itraconazole. Results showed a significant decrease in Ag levels over time, with clinical scores improving in correlation with the decline in Ag levels. Four patients exhibited atypical Ag patterns due to immune reconstitution inflammatory syndrome or issues with itraconazole bioavailability. Despite these challenges, all patients showed improvement by week 24. The findings suggest that the clarus Histoplasma GM EIA kit could be a valuable tool for monitoring and evaluating the response to antifungal therapy in histoplasmosis patients.

This study explored the use of the clarus Histoplasma Galactomannan EIA kit for monitoring histoplasmosis in HIV patients. Follow-up showed clinical improvement in patients receiving antifungal treatment, with a correlation between decreasing urine antigen concentrations and better outcomes. The findings suggest that the clarus Histoplasma GM EIA kit could be useful for treatment monitoring.

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OBJECTIVE: To describe the outcome indicators of implementing a cascade of care for latent Mycobacterium tuberculosis infection in people living with the human immunodeficiency virus. METHOD: Cross-sectional study, carried out with people living with HIV, from 2022 to 2024, in a reference service in Campo Grande, Mato Grosso do Sul. It occurred after the implementation of the following work process: Identification of people at risk for investigation of Latent Tuberculosis Infection (LTBI); Test for LTBI; Exclusion of active TB cases; Treatment for LTBI; Adherence to treatment; and Completion of treatment. Data were analyzed using descriptive statistics, Chi-square test and Fisher's exact test. RESULTS: 735 people were monitored, of which 29.6% were indicated to start treatment for latent infection, and 32.5% started it. Treatment completion was higher in those who used the shortened regimen (90.2% versus 71.8%; p-value < 0.05, 7.8% with isoniazid and 2% with rifampin). There was one (0.9%) serious adverse reaction. CONCLUSION: The implementation of the cascade of care demonstrated that 1/3 of participants had an indication for treatment and expanded access to recommended treatment. The conclusion was greater with the shortened scheme. Adverse reactions were infrequent.

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BACKGROUND: Co-infections associated with Immune Reconstitution Inflammatory Syndrome (IRIS) have been described in literature, however they constitute an uncommon finding in the medical community. CASE PRESENTATION: Here we report a rare case of a 55-year-old woman from Cuba with prior medical history of HIV/AIDS adherent to her antiretroviral therapy (ART) regimen, who was hospitalized in Miami, Florida because of fluid dysphagia, odynophagia and right-sided cervical lymphadenopathy. A prior biopsy of the right cervical lymph node performed in an outside hospital found evidence of non-caseating granulomas with budding yeast, which was later confirmed to be disseminated histoplasmosis by a positive (1-3) -ß-glucan assay and histoplasmosis urine antigen in this admission. Furthermore, after multiple imaging testing due to her clinical condition, a brain MRI demonstrated findings concerning for cerebral toxoplasmosis, which was supported by serology findings. Treatment with liposomal amphotericin B and TMP-SMX led to clinical and radiological improvement of this patient's conditions, and she was discharged with an appointment for follow-up in the clinic. CONCLUSION: This case highlights the complexities and challenges in managing opportunistic infections (OIs) during immune recovery in HIV/AIDS patients on ART, and emphasizes the necessity of continuous, vigilant monitoring and having a broad differential diagnosis in this group of patients.

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The genus Prototheca (alga) comprises a unique group of achlorophyllic saprotrophic and mammalian pathogen species. Despite its rare occurrence in humans and animals, protothecosis is considered an emerging clinical entity with relevance in immunocompromised patients. In this study, the characterization of spherical structures with endospores recovered from a blood culture in an HIV patient was investigated using phenotypic and molecular methodologies. On 2% Sabouraud dextrose agar, the isolate displayed morphological and biochemical characteristics found on isolates identified as Prototheca wickerhamii. To validate these analyses, molecular phylogeny of the internal transcript space (ITS) partial gene confirmed the identity of the isolate as P. wickerhamii. This is the first case of systemic human protothecosis in Brazil. The present case of human Prototheca and those reported in the medical literature highlight the need for novel methodologies to identify pathogenic algae in the clinical laboratory, improving in this way the diagnosis and treatment of this group of neglected pathogens.

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Currently, COVID-19 and tuberculosis (TB) are the deadliest infectious diseases worldwide. Their synergy, form of presentation, morbidity, and mortality are data that have been scarcely explored. Thus, this study aimed to characterize the clinical, epidemiological, and laboratory factors of this co-infection and to analyze the factors associated with the active TB among COVID-19 cases. A case-control study was conducted with a retrospective survey of 21 laboratory-confirmed COVID-19/TB co-infected patients (case group) and 21 COVID-19 patients (control group). The study included participants from eight hospitals in Campo Grande city, capital of Mato Grosso do Sul State, Brazil, from March 2020 to March 2022. Association analysis and binomial logistic regression were employed with statistical significance set at p≤0.05. From the 21 identified cases of COVID-19/TB co-infection, we found a more frequent association with HIV infection than the control-group, without worsening the outcome. COVID-19/TB patients had less dyspnea and less need for mechanical ventilation compared to the cases with COVID-19 only. On the other hand, COVID-19/TB patients had higher levels of C-reactive protein and lower hemoglobin levels, the latter variable was independently associated with COVID-19/TB. Among the clinical differences presented among COVID-19/TB co-infected patients, despite the association with HIV and lower clinical repercussions, only lower hemoglobin levels were associated with COVID-19/TB.

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American trypanosomiasis or Chagas disease is a vector-borne infection caused by the protozoan parasite Trypanosoma cruzi, characterized by acute and chronic phases; reactivations due to immunosuppression can occur. In this case report, we confirm the presence of trypomastigotes of T. cruzi in a patient with neurologic manifestations. For this purpose, a battery of techniques, including direct examination of cerebrospinal fluid, Giemsa stains, sample cultures, serology and molecular techniques were employed. The patient was treated with nifurtimox for 6 months and started antiretroviral therapy as the concomitant diagnosis of HIV was also performed, showing no sequelae nor adverse effects. A follow-up of the patient´s health status was performed for 42 months.

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Direct-acting antivirals (DAA) are effective in patients with hepatitis C virus (HCV) infection, but there is little information about real-world effectiveness in people living with human immunodeficiency virus (PLH). The aim of this study was to determinate the effectiveness of DAA to achieve sustained virologic response at week 12 post-treatment (SVR12) in PLH with HCV coinfection and in people with HCV-monoinfection. We conducted a prospective cohort. The full analysis set (FAS) included all subjects enrolled in the study; the modified analysis set (MAS) excluded cases with missing data to evaluate SVR12. A total of 278 people were included, 130 (46.7%) with HCV/HIV-coinfection and 148 (53.2%) with HCV-monoinfection. In the HCV/HIV-coinfection group, 82 (63%) received GLE/PIB for 8 weeks, 45 (34.6%) received SOF/VEL for 12 weeks, and 3 (2.3%) were treated with SOF/VEL + RBV for 12 weeks. In the HCV-monoinfection group, 62 (41.8%) received GLE/PIB for 8 weeks, 28 (18.9%) received SOF/VEL for 12 weeks, and 58 (39.1%) participants were treated with SOF/VEL + RBV for 12 weeks. In the FAS analysis, SVR12 was 81.6% in the HCV/HIV-coinfection group and 86.4% in the HCV-monoinfection group (p = 0.128). In the MAS analysis, both groups achieved 100% of SVR12. In this cohort, the effectiveness of DAA to achieve SVR12 was similar between HCV/HIV-coinfection and HCV-monoinfection cases, regardless of advanced liver disease with no differences between treatment regimens.

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The rapid diagnosis of opportunistic infections (OIs) is critical for improving the health outcomes of people living with HIV/AIDS (PLWHA). This study aimed to describe the feasibility of implementing a package for the rapid diagnosis of tuberculosis, histoplasmosis, and cryptococcosis in patients with advanced HIV/AIDS disease in Porto Alegre, Brazil. The research involved two focus groups with health professionals, four in-depth interviews with healthcare managers, and twelve interviews with PLWHA. The corpus was analyzed using Descending Hierarchical Classification (DHC). The study found that the rapid test diagnosis intervention was generally well-received by patients and health professionals, improving diagnosis and treatment outcomes. However, it also identified several areas for improvement, including the need for expanded psychosocial support and enhanced coordination between health services. The findings have important implications for the development and implementation of policies and programs aimed at enhancing the diagnosis and treatment of OIs among PLWHA with advanced diseases. Further research should explore social determinants of HIV/AIDS mortality to offer valuable insights into improving prevention and treatment strategies. By prioritizing patient-centered care and improving coordination between health services, policymakers and health professionals can improve the health outcomes of PLWHA with advanced disease in Porto Alegre and other similar settings.

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BACKGROUND: Age and HIV are synergistic risk factors for conditions such as HIV-associated neurocognitive disorders (HAND). Yet, it is unclear whether older persons with HIV (OPWH) display different cognitive profiles for HAND. OBJECTIVE: To describe the cognitive patterns of OPWH treated with combined antiretroviral therapy (cART). METHODS: Cross-sectional study that included 330 participants with HIV, aged 50 years or older, cared for at a tertiary care hospital in Mexico City. A short neuropsychological test battery was used to assess a wide spectrum of cognitive functions. The optimal number of cognitive clusters was determined by the silhouette method and a minimization of the Bayesian information criterion. RESULTS: Participants' mean age was 58.8 years (standard deviation = 6.6), and 12.1% were women. A 3-cluster solution yielded stable Jaccard coefficients (p > 0.70). Cluster 1 showed more significant impairment in visual and verbal memory domains, whereas participants in cluster 3 showed significant impairment in language, and abstraction. Cluster 2 showed no predominance of any domain for alterations. CONCLUSIONS: There are different cognitive profiles among OAWH with HAND. These differences may be due to individual patterns of HIV-related and non-HIV-related factors.

ANTECEDENTES: La edad y el VIH constituyen factores de riesgo sinérgicos de afecciones como los trastornos neurocognitivos asociados al VIH (TNAV). No se ha esclarecido si las personas mayores con VIH presentan perfiles cognitivos diferentes en caso de padecer TNAV. OBJETIVO: Describir los patrones cognitivos de personas mayores con VIH tratados con terapia antirretroviral combinada (TARc). MÉTODOS: Estudio transversal que incluyó a 330 participantes con VIH, de 50 años o más, atendidos en un centro hospitalario de tercer nivel en la Ciudad de México. Se utilizó una batería neuropsicológica corta estandarizada a fin de evaluar un amplio espectro de funciones cognitivas. Se determinó el número óptimo de grupos de dominios cognitivos a partir del método de la silueta y minimización del criterio de información bayesiano. RESULTADOS: La edad promedio de los participantes fue de 58.8 años; las mujeres constituyeron 12.1 %. Una solución de tres grupos produjo coeficientes de Jaccard estables (p > 0.70). El grupo 1 mostró deterioro más significativo en la memoria visual y verbal, en tanto que el grupo 3 mostró deterioro significativo en el lenguaje y la abstracción. En el grupo 2 no se registró predominio de ningún dominio en cuanto a alteraciones. CONCLUSIONES: Existen perfiles cognitivos diferentes entre las personas mayores con VIH y TNAV. Estas diferencias pueden deberse a patrones individuales de factores relacionados o no con el VIH.

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BACKGROUND: Paediatric tuberculosis leads to more than 200 000 deaths annually. We aimed to investigate the incidence of Mycobacterium tuberculosis infection and tuberculosis disease in the first decade of life in the Drakenstein Child Health Study (DCHS), a South African cohort in a community with high tuberculosis and HIV incidence. METHODS: In this prospective birth cohort study, we enrolled pregnant women aged 18 years or older who were between 20 and 28 weeks' of gestation in a peri-urban setting outside of Cape Town, South Africa. We followed up their children for tuberculosis until age 10 years. To measure M tuberculosis infection tuberculin skin tests were administered to children at age 6 months, 12 months, and then annually in children with a negative test, and at the time of a lower respiratory tract infection. Tuberculin skin test conversion was defined by an induration reaction of 10 mm or more. To measure tuberculosis disease, active surveillance was done throughout follow-up. Each episode of presumed tuberculosis disease was investigated using sputum induction, tested with Xpert MTB/RIF and liquid culture for M tuberculosis. Survival analyses were performed and multivariable Cox regression was used to measure factors associated with M tuberculosis infection or disease. FINDINGS: Between March 5, 2012, and March 31, 2015, 1137 women and their 1143 children (248 [21·7%] of 1143 children were HIV-exposed, two [0·2%] children with HIV) were included in the analysis. Children were followed up for 8870 person-years (median follow-up 9·1 years [IQR 8·2-10·2]). The annual risk of tuberculin conversion during follow-up was 6·6 infections per 100 person-years (95% CI 5·8-7·3) but ranged from 4-9 infections per 100 person-years over the follow-up period. 98 children developed tuberculosis (1105 cases per 100 000 person-years; 95% CI 906-1347). The cumulative hazard of tuberculin conversion was 36% (95% CI 32-41) at age 8 years and the cumulative hazard of tuberculosis disease was 10% (8-12) at age 10 years. Preventive treatment was associated with a reduction in tuberculosis disease among children who had tuberculin conversion (adjusted hazard ratio 0·23 [95% CI 0·12-0·47]). Most cases of tuberculosis disease (78 [79%; 95% CI 69-86] of 98 children) occurred among children who had tuberculin skin test conversion but were not administered preventive treatment. INTERPRETATION: In this prospective South African birth cohort, M tuberculosis transmission was consistently high throughout the first decade of life leading to approximately 10% of children developing tuberculosis disease. A multipronged approach to decrease paediatric tuberculosis is needed that combines preventive treatment for children at risk, reducing community M tuberculosis transmission, and active case finding. FUNDING: Bill & Melinda Gates Foundation, Medical Research Council South Africa, and National Research Foundation South Africa.

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Background: Kaposi's sarcoma (KS) is the most frequent cancer in HIV-positive people in developing countries, affecting their quality of life. Objective: To analyze the clinical, histopathological and epidemiological features of KS in patients living with HIV, as well as to evaluate the impact of antiretroviral treatment on the incidence and progression of the disease. Material and methods: Observational, descriptive, retrospective and cohort study. During October 2022 to August 2023. Twenty-eight HIV-positive male patients were included and were diagnosed with KS in our institution. Clinical variables, CD4+ cell counts, viral load and treatments received were evaluated, in addition to histopathological and immunohistochemical analysis of the lesions. Results: Most patients had low CD4+ cell counts and high viral load at diagnosis. The most common lesions were erythematous-violaceous papules, nodules and and plaques, in multiple areas of the body. HHV8 was identified in most cases. Antiretroviral therapy showed a long-term protective effect on the incidence of KS. Opportunistic infections were frequent in these patients, the most common one was tuberculosis. Conclusions: Our study highlights the need for an early and multidisciplinary approach in the management of KS in HIV-positive patients, underlining the importance of antiretroviral treatment to prevent disease progression. Furthermore, it stresses its complexity and the significant prevalence of opportunistic infections, advocating for comprehensive strategies addressing sarcoma as well as concomitant infections.

Introducción: el sarcoma de Kaposi (SK) es el cáncer más frecuente en personas que viven con VIH en países en desarrollo, afectando su calidad de vida. Objetivo: analizar las características clínicas, histopatológicas y epidemiológicas del SK en una muestra de pacientes que viven con VIH, así como evaluar el impacto del tratamiento antirretroviral en la incidencia y progresión de la enfermedad. Material y métodos: estudio observacional, descriptivo, retrospectivo y de cohorte, realizado durante octubre de 2022 a agosto de 2023. Se incluyeron 28 pacientes hombres VIH positivos que fueron diagnosticados con SK en nuestra institución. Se evaluaron variables clínicas, recuentos de células CD4+, carga viral y tratamientos recibidos, además se llevaron a cabo análisis histopatológicos e inmunohistoquímicos de las lesiones. Resultados: la mayoría de los pacientes presentaban recuentos bajos de células CD4+ y alta carga viral al diagnóstico. Las lesiones más comunes fueron placas eritematovioláceas y nodulares en múltiples áreas del cuerpo. Se identificó HHV8 en la mayoría de los casos. El tratamiento antirretroviral mostró un efecto protector a largo plazo en la incidencia del SK. Las infecciones oportunistas fueron frecuentes en estos pacientes, siendo la tuberculosis la más frecuente. Conclusiones: nuestro estudio resalta la necesidad de un enfoque temprano y multidisciplinario en la gestión del SK en pacientes que viven con VIH, subrayando la importancia del tratamiento antirretroviral para prevenir la progresión de la enfermedad.

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Objective: To evaluate the role of being human immunodeficiency virus (HIV) positive for predicting the risk of recurrence in women with a cervical high grade squamous intraepithelial lesion (HSIL) diagnosis. Methods: Retrospective observational case-control study, comprising HIV positive (case) and HIV negative (control) women in a 1:4 ratio. Women assisted by the Erasto Gaertner Hospital, between 2009-2018, with cervical HSIL diagnosis, submitted to treatment by Loop electrosurgical excision procedure (LEEP), and with a minimum follow-up of 18 months, were included. The immunological status, number and time to recurrence were analyzed, with p<0.05 considered significant. In a second analysis, only patients with free margins were evaluated. Results: The sample consisted of 320 women (64 cases and 256 controls). Presence of HIV, CD4 levels <200 and detectable viral load (CV) were associated with high risk of recurrence, with odds ratio (OR) of 5.4 (p<0.001/95CI:2.8-10); 3.6 (p<0.001 /IC95:0.6-21.1) and 1.8 (p=0.039 /IC95:0.3-9.3), respectively. In the sample with free margins (n=271), this risk was also higher among seropositive patients, with OR 4.18 (p=0.001/95CI:1.8-9.2). Conclusion: HIV is an independent risk factor for cervical HSIL recurrence and reduced disease-free survival time. Glandular involvement, compromised margins, undetectable CV and CD4<200 also increase the risk of relapse.

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Immune reconstitution inflammatory syndrome is a common manifestation in human immunodeficiency virus (HIV)-positive patients infected with tuberculosis (TB). One of the unusual complications of this condition is the development of psoas abscess. We describe a case of immune reconstitution inflammatory syndrome (IRIS) in a patient with disseminated TB under treatment, HIV-positive with a low CD4 cell count, complicated by bilateral psoas abscess. Our patient presented with fever, abdominal pain, and lymphadenopathy, typical symptoms of TB-IRIS. Diagnosis was confirmed by surgical drainage of the abscess of the right iliac psoas muscle with detection of acid-fast bacteria on Ziehl-Neelsen staining and negative culture of purulent discharge. Treatment with prednisone was started in addition to continuation of antituberculosis therapy and antiretroviral therapy.

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Visceral leishmaniasis (VL) poses a serious health threat, particularly when untreated, necessitating accurate diagnosis. While the gold-standard method involves identifying amastigotes in bone marrow aspirate (BMA), this procedure is invasive and occasionally contraindicated. Additionally, when VL is associated with HIV infection the serologies accuracies could be affected. This study aims to evaluate and compare diagnostic methods for VL in patients with and without HIV coinfection. We enrolled prospectively 127 consecutive adult VL patients, 48 (37.8%) of whom had HIV coinfection, in Brazil's Midwestern region, where VL is endemic. Parasitological examination served as the reference standard for accuracy analysis, with index tests including immunofluorescent antibody test (IFAT), immunochromatographic test with rK39 protein (rK39-ICT), and blood polymerase chain reaction (PCR). Specificity assessment involved 430 healthy blood donors from the same endemic area. Ninety-two patients had parasitologically confirmed VL. Among HIV-uninfected patients, rK39-ICT exhibited sensitivity comparable to PCR (93.6%; 95% CI: 83.6-100 vs. 97.8%; 95% CI: 93.6-99.2, respectively) and superior to IFAT (71.1%; 95% CI: 57.9-84.3). However, in HIV-infected patients, rK39-ICT sensitivity was notably lower than PCR (40.0%; 95% CI: 22.5-57.5 vs. 97.4%; 95% CI: 92.5-98.9) and similar to IFAT (67.5%; 95% CI: 52.9-82.0). Combining two serological tests in parallel identified 82.1% of parasitologically confirmed VL cases, with a negative likelihood ratio significantly lower than either test alone. No test achieved a specificity of 90%, and there were no significant differences in specificity observed among the index tests. The positivity rate of parasitological examination in the 127 VL patients was higher in HIV-infected compared to HIV-uninfected patients, 91.3% (95% CI: 83.2-99.4) versus 67.6% (95% CI: 56.9-78.3), respectively. These findings underscore the necessity of accounting for HIV infection when choosing VL diagnostic methods. Although rK39-ICT provides reliable results in HIV-uninfected patients, BMA examination remains crucial for accurate diagnosis in individuals with HIV/AIDS. In cases where bone marrow aspiration is contraindicated, employing IFAT and rK39-ICT in parallel could be considered, as the occurrence of both positive results is uncommon in healthy individuals from endemic areas.