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1.
Artículo en Ruso | MEDLINE | ID: mdl-33580758

RESUMEN

OBJECTIVE: To evaluate social, demographic and clinical characteristics of women with schizophrenia and HIV. MATERIAL AND METHODS: Medical histories of patients who were in inpatient treatment during 2017 were retrospectively studied. A total of 174 medical histories were analyzed, but the final analysis included 40 HIV-infected patients (main groups) and 48 patients without HIV infection (comparison group). These groups included patients with a diagnosis of schizophrenia or acute polymorphic psychotic disorder. All patients with HIV infection were examined by a specialist and an immunological analysis was performed. Correlation analysis was performed between quantitative clinical indicators (duration of illness, number of hospitalizations, the number and duration of remissions, etc.) and immunological parameters. RESULTS AND CONCLUSION: Patients with schizophrenia and HIV infection are more often hospitalized and stay in the hospital longer than patients with schizophrenia without HIV infection, which may in part be determined by the social problems of this cohort of patients. There is a relationship between individual indicators of the immune status of the patients, the duration and some features of the course of mental illness. Regular treatment of HIV infection correlates with a lower frequency of hospitalizations in a psychiatric hospital due to an exacerbation of the mental state.


Asunto(s)
Infecciones por VIH , Trastornos Psicóticos , Esquizofrenia , Demografía , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Estudios Retrospectivos , Esquizofrenia/diagnóstico , Esquizofrenia/epidemiología , Esquizofrenia/terapia
3.
Curr Hypertens Rep ; 23(2): 9, 2021 02 11.
Artículo en Inglés | MEDLINE | ID: mdl-33570681

RESUMEN

PURPOSE OF REVIEW: The impact of the coronavirus disease 2019 (COVID-19) pandemic is profound, with distressing consequences on many individuals, especially those with co-morbidities. Pregnant women are one such group of individuals who are at in increased risk of contracting COVID-19, due to their immunocompromised state. In South Africa, HIV infection and pre-eclampsia are the leading causes of maternal morbidity and mortality, with South Africa being the HIV epicentre of the world. The relationship between COVID-19 superimposed on HIV infection and preeclampsia is complex and uncertain due to their different immune responses, and therefore requires further research. RECENT FINDINGS: Notably evidence suggests that pregnant women with chronic comorbidities (HIV and pre-eclampsia) may be at a greater risk of contracting or encountering complications from COVID-19. Maternal stress, during a pandemic, as well as home delivery have become potential options for pregnant woman. Nonetheless there is currently a paucity of information on the combined effect of COVID-19 in HIV-associated preeclampsia. Understanding the pathogenesis of COVID-19 could potentially aid in developing effective treatment strategies for COVID-19 in HIV associated preeclampsia. This review article presents a comprehensive analysis of the current data in relation to COVID-19 and its effect on pregnant women, including symptoms, pathogenesis and the possible risk of vertical transmission. This paper also reviews its' interactions and effects on preeclamptic and HIV positive pregnant women with suspected or confirmed COVID-19.


Asunto(s)
Infecciones por VIH , Hipertensión , Preeclampsia , Complicaciones Infecciosas del Embarazo , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Pandemias , Preeclampsia/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología
4.
Medicine (Baltimore) ; 100(6): e23626, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578511

RESUMEN

BACKGROUND: The number of adult patients affected by the human immunodeficiency virus (HIV) still remains high, mainly in the developing countries. However, only a few affected patients fail to experience oral lesions in the course of their experience with the virus. In particular, oral mucosa ulcers detected among HIV patients may be severe, which depictions may inhibit oral functioning and change patients' quality of life. Thus, it can result in considerable morbidity among this group of patients. To this end, the present study aims to examine the topical agent's clinical therapeutic efficacy among adult patients suffering from HIV-related oral mucosa ulcers. METHODS: For the investigation, only randomized controlled trials on any topical agent used to treat adult patients with HIV oral mucosa ulcers are to be explored from different databases: PubMed, the Cochrane Library, PsycINFO, EMBASE, SCOPUS, Web of Science, China Biomedical Literature Database, China National Knowledge Infrastructure, VIP, and WanFang databases. All databases will be searched from their inceptions to October 2020. Additionally, 2 independent authors will evaluate the possibly eligible studies to be included in the study. They will also perform data's trial extraction and risk of bias assessment. Accordingly, all data will be analysed by means of the RevMan 5.3 software. RESULTS: The present study seeks to evaluate the topical agents' clinical therapeutic efficacy to treat adult patients with HIV-related oral mucosa ulcers. CONCLUSION: The study can be applicable in providing evidence of any topical agents for treating adult patients with HIV-related oral mucosa ulcers for clinical practice. PROTOCOL REGISTRATION NUMBER: DOI 10.17605/OSF.IO/5CYR2 (https://osf.io/5cyr2/).


Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Infecciones por VIH/complicaciones , Mucosa Bucal/patología , Úlceras Bucales/tratamiento farmacológico , Adulto , Antiinfecciosos Locales/administración & dosificación , Estudios de Casos y Controles , VIH/efectos de los fármacos , Infecciones por VIH/epidemiología , Humanos , Mucosa Bucal/virología , Úlceras Bucales/psicología , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
5.
JAMA Netw Open ; 4(2): e2037069, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33533933

RESUMEN

Importance: New York State has been an epicenter for both the US coronavirus disease 2019 (COVID-19) and HIV/AIDS epidemics. Persons living with diagnosed HIV may be more prone to COVID-19 infection and severe outcomes, yet few studies have assessed this possibility at a population level. Objective: To evaluate the association between HIV diagnosis and COVID-19 diagnosis, hospitalization, and in-hospital death in New York State. Design, Setting, and Participants: This cohort study, conducted in New York State, including New York City, between March 1 and June 15, 2020, matched data from HIV surveillance, COVID-19 laboratory-confirmed diagnoses, and hospitalization databases to provide a full population-level comparison of COVID-19 outcomes between persons living with diagnosed HIV and persons living without diagnosed HIV. Exposures: Diagnosis of HIV infection through December 31, 2019. Main Outcomes and Measures: The main outcomes were COVID-19 diagnosis, hospitalization, and in-hospital death. COVID-19 diagnoses, hospitalizations, and in-hospital death rates comparing persons living with diagnosed HIV with persons living without dianosed HIV were computed, with unadjusted rate ratios and indirect standardized rate ratios (sRR), adjusting for sex, age, and region. Adjusted rate ratios (aRRs) for outcomes specific to persons living with diagnosed HIV were assessed by age, sex, region, race/ethnicity, transmission risk, and CD4+ T-cell count-defined HIV disease stage, using Poisson regression models. Results: A total of 2988 persons living with diagnosed HIV (2109 men [70.6%]; 2409 living in New York City [80.6%]; mean [SD] age, 54.0 [13.3] years) received a diagnosis of COVID-19. Of these persons living with diagnosed HIV, 896 were hospitalized and 207 died in the hospital through June 15, 2020. After standardization, persons living with diagnosed HIV and persons living without diagnosed HIV had similar diagnosis rates (sRR, 0.94 [95% CI, 0.91-0.97]), but persons living with diagnosed HIV were hospitalized more than persons living without diagnosed HIV, per population (sRR, 1.38 [95% CI, 1.29-1.47]) and among those diagnosed (sRR, 1.47 [95% CI, 1.37-1.56]). Elevated mortality among persons living with diagnosed HIV was observed per population (sRR, 1.23 [95% CI, 1.07-1.40]) and among those diagnosed (sRR, 1.30 [95% CI, 1.13-1.48]) but not among those hospitalized (sRR, 0.96 [95% CI, 0.83-1.09]). Among persons living with diagnosed HIV, non-Hispanic Black individuals (aRR, 1.59 [95% CI, 1.40-1.81]) and Hispanic individuals (aRR, 2.08 [95% CI, 1.83-2.37]) were more likely to receive a diagnosis of COVID-19 than White individuals, but they were not more likely to be hospitalized once they received a diagnosis or to die once hospitalized. Hospitalization risk increased with disease progression to HIV stage 2 (aRR, 1.29 [95% CI, 1.11-1.49]) and stage 3 (aRR, 1.69 [95% CI, 1.38-2.07]) relative to stage 1. Conclusions and Relevance: In this cohort study, persons living with diagnosed HIV experienced poorer COVID-related outcomes relative to persons living without diagnosed HIV; Previous HIV diagnosis was associated with higher rates of severe disease requiring hospitalization, and hospitalization risk increased with progression of HIV disease stage.


Asunto(s)
/epidemiología , Comorbilidad , Infecciones por VIH/epidemiología , Mortalidad Hospitalaria , Hospitalización , Hospitales , Pandemias , Adulto , Afroamericanos , Anciano , Estudios de Cohortes , Epidemias , Grupo de Ascendencia Continental Europea , Femenino , Infecciones por VIH/complicaciones , Hispanoamericanos , Humanos , Masculino , Persona de Mediana Edad , New York/epidemiología , Ciudad de Nueva York/epidemiología
6.
PLoS Negl Trop Dis ; 15(2): e0009092, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33561159

RESUMEN

The World Health Organization (WHO) considers mycetoma, chromoblastomycosis, and paracoccidioidomycosis to be fungal neglected tropical diseases (FNTDs). Depending on climatic, cultural, and economic contexts, these diseases have a similar geographical distribution as many other diseases, particularly tuberculosis (TB) and malaria, but are often less targeted by the national and many international healthcare systems. Another subgroup of fungal infections, such as candidiasis, cryptococcosis, pneumocystosis, histoplasmosis, and to a lesser extent, aspergillosis, are known as AIDS-related mycoses. Although antiretroviral therapy (ART) has been able to decrease the mortality rate of these diseases, particularly cryptococcosis, the disproportionately low distribution of funds to their diagnosis and treatment remains an obstacle in saving and improving the lives of patients affected. A new wave of viral diseases dubbed the Coronavirus Disease 2019 (COVID-19) hit the world at the end of 2019. Due to progressive symptoms and high mortality rates of COVID-19 compared to fungal infections, particularly the FNTDs, funding is currently allocated predominantly for diagnostic and therapeutic research on COVID-19. As a result, advances in FNTDs and AIDS-related mycosis care are considerably reduced. This paper explores the association between COVID-19, FNTDs, and AIDS-related mycoses with a predictive perspective.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Micosis/epidemiología , Enfermedades Desatendidas/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos
7.
Eur J Med Res ; 26(1): 13, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33522960

RESUMEN

BACKGROUND: Here, we report an atypical HIV-vacuolar myelopathy and search the available medical literature about atypical presentations of human immunodeficiency virus associate vacuolar myelopathy (HIV-VM) and immunoglobulin therapy response. CASE: A 26-year-old lady who was 4 weeks postpartum presented to us with acute flaccid quadriparesis, with no sensory level. Extensive workup ruled out other causes of myelopathy. She developed a stage 3 acute kidney injury, and MRI showed diffuse cord atrophy involving the lower cervical and thoracic cord. The patient received IV-immunoglobulin, ARVs, and supportive therapy with inadequate response. Unfortunately, she developed nosocomial pneumonia and died. DISCUSSION: In HIV-VM, there is spinal cord atrophy, which mainly involves the thoracic cord. In our case, this pathological process also affected the spinal cord's cervical region, leading to flaccid tetraplegia, with high CD4 level, without response to the treatment, including intravenous immunoglobulin. KEYNOTES: Vacuolar myelopathy, HIV, Immunoglobulin therapy, flaccid tetraplegia, hypokalaemia. Renal failure.


Asunto(s)
Infecciones por VIH/complicaciones , Enfermedades de la Médula Espinal/patología , Enfermedades de la Médula Espinal/virología , Adulto , Femenino , Humanos
8.
Soins Gerontol ; 26(147): 38-39, 2021.
Artículo en Francés | MEDLINE | ID: mdl-33549240

RESUMEN

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infectious disease well described in patients living with HIV (PLHIV) but that can occur in other immunosuppressed patients. Currently, its incidence decreases in PLHIV but increases in non-HIV immunosuppressed patients, particularly in case of hematological diseases. Thus, in elderly, the diagnosis of PJP should be evoked in case of subacute pneumonia rapidly evolving to an acute respiratory distress, with or without interstitial pneumonia at chest radiography, and a context of immunosuppression.


Asunto(s)
Disnea , Infecciones Oportunistas , Pneumocystis carinii , Neumonía por Pneumocystis , Anciano , Disnea/diagnóstico , Disnea/etiología , Infecciones por VIH/complicaciones , Humanos , Huésped Inmunocomprometido , Neumonía por Pneumocystis/complicaciones , Neumonía por Pneumocystis/diagnóstico
10.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artículo en Inglés | MEDLINE | ID: mdl-33462006

RESUMEN

Individuals with HIV may present to the emergency department with HIV-related or HIV-unrelated conditions, toxicity associated with antiretroviral therapy or primary HIV infection (seroconversion). In individuals with HIV infection, central nervous system toxoplasmosis occurs from reactivation of disease, especially when the CD4+ count is <100 cells/µL, whereas in those taking immunosuppressive therapy, this can be either due to newly acquired or reactivated latent infection. It is a rare occurrence in immune-competent patients. Vertical transmission during pregnancy can manifest as congenital toxoplasmosis in the neonate and is often asymptomatic until the second or third decade of life when ocular lesions develop. Toxoplasmosis is an infection caused by the intracellular protozoan parasite Toxoplasma gondii and causes zoonotic infection. It can cause focal or disseminated brain lesions leading to neurological deficit, coma and death. Typical radiological findings are multiple ring-enhancing lesions. Histopathological examination demonstrating tachyzoites of T. gondii and the presence of nucleic material in the spinal cerebrospinal fluid (CSF) confirms the diagnosis. The authors present the case of a 52-year-old male UK resident, born in sub-Saharan Africa, with a 3-week history of visual hallucinations. He attended the emergency department on three occasions. Laboratory investigations and a CT head were unremarkable. He was referred to psychological medicine for further evaluation. On his third presentation, 2 months later, a CT head showed widespread lesions suggestive of cerebral metastasis. Dexamethasone was initiated and he developed rigours. An MRI head showed multiple ring-enhancing lesions disseminated throughout his brain parenchyma. CSF analysis and serology confirmed the diagnosis of HIV and toxoplasmosis, respectively. His CD4 count was 10 and his viral load (VL) was 1 245 003. He was then initiated on Biktarvy 50 mg/200 mg/25 mg, one tablet daily, which contains 50 mg of bictegravir, 200 mg of emtricitabine and tenofovir alafenamide fumarate equivalent to 25 mg of tenofovir alafenamide. After 3 months of antiretroviral therapy, his HIV VL reduced to 42. However, his abbreviated mental test remained at 2/10. Despite presenting with neurocognitive impairment and being born in a HIV prevalent region, an HIV test was not offered. This case highlights missed opportunities to request HIV serology and raises awareness that cerebral toxoplasmosis can occur as the first manifestation of HIV. Prompt diagnosis and early initiation of antiretroviral therapy reduces morbidity and mortality in this patient cohort.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones por VIH/diagnóstico , Toxoplasmosis Cerebral/etiología , Infecciones por VIH/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Toxoplasmosis Cerebral/diagnóstico
11.
Dtsch Med Wochenschr ; 146(3): 162-166, 2021 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-33513649

RESUMEN

Corticosteroids have been found as useful adjunctive therapy in patients with various infections and hyperinflammation-associated disease. They are recommended in practice guidelines for patients with tuberculous and pneumococcal meningitis and patients with immune reconstitution syndrome associated with antiretroviral therapy. A new indication is severe COVID-19. Evidence from clinical trials is insufficient to allow the routine use of steroids among patients with septic shock, community-acquired pneumonia or tuberculous pericarditis.


Asunto(s)
Corticoesteroides/uso terapéutico , Infecciones por VIH/complicaciones , Síndrome Inflamatorio de Reconstitución Inmune/tratamiento farmacológico , Meningitis Neumocócica/tratamiento farmacológico , Tuberculosis Meníngea/tratamiento farmacológico , Absceso Encefálico/tratamiento farmacológico , Quimioterapia Adyuvante , Infecciones por VIH/tratamiento farmacológico , Humanos , Sepsis/tratamiento farmacológico , Índice de Severidad de la Enfermedad , Choque Séptico/tratamiento farmacológico , Infecciones por Spirochaetales/tratamiento farmacológico , Tuberculosis/tratamiento farmacológico
12.
J Acquir Immune Defic Syndr ; 86(2): 224-230, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33433966

RESUMEN

BACKGROUND: Limited data exist about clinical outcomes and levels of inflammatory and immune markers among people hospitalized with COVID-19 by HIV serostatus and by HIV viral suppression. SETTING: Large tertiary care health system in the Bronx, NY, USA. METHODS: We conducted a retrospective cohort study of 4613 SARS-CoV-2 PCR-positive patients admitted between March 10, 2020, and May 11, 2020. We examined in-hospital intubation, acute kidney injury (AKI), hospitalization length, and in-hospital mortality by HIV serostatus, and by HIV-viral suppression and CD4 counts among people living with HIV (PLWH) using adjusted competing risks regression. We also compared immune and inflammatory marker levels by HIV serostatus and viral suppression. RESULTS: Most patients were either non-Hispanic Black (36%) or Hispanic (37%); 100/4613 (2.2%) were PLWH, among whom 15 had detectable HIV viral load. PLWH compared to patients without HIV had increased intubation rates (adjusted hazard ratio 1.73 [95% CI: 1.12 to 2.67], P = 0.01). Both groups had similar rates of AKI, length of hospitalization, and death. No (0%) virally unsuppressed PLWH were intubated or died, versus 21/81 (26%, P = 0.04) and 22/81 (27%, P = 0.02) of virally suppressed PLWH, respectively. Among PLWH, higher CD4 T-cell counts were associated with increased intubation rates. C-reactive protein, IL-6, neutrophil counts, and ferritin levels were similar between virally suppressed PLWH and patients without HIV, but significantly lower for unsuppressed PLWH (all P < 0.05). CONCLUSIONS: PLWH had increased risk of intubation but similarly frequent rates of AKI and in-hospital death as those without HIV. Findings of no intubations or deaths among PLWH with unsuppressed HIV viral load warrant further investigation.


Asunto(s)
Biomarcadores/sangre , Infecciones por VIH/inmunología , Anciano , Recuento de Linfocito CD4 , /mortalidad , Estudios de Cohortes , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/mortalidad , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Carga Viral
13.
Lancet HIV ; 8(1): e33-e41, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33387477

RESUMEN

BACKGROUND: Dolutegravir has been widely available in Brazil since 2017. Following the signal that infants born to women with dolutegravir exposure at conception in Botswana had a higher risk of neural tube defects (NTDs), public health leaders initiated a national investigation to evaluate periconception dolutegravir exposure among all pregnant Brazilian women with HIV and its potential association with risk of NTDs, stillbirth, or miscarriage before 22 weeks (also called spontaneous abortion). METHODS: In this retrospective, observational, national, cohort study, we identified all women with pregnancies and possible dolutegravir exposure within 8 weeks of estimated date of conception between Jan 1, 2017, and May 31, 2018, and approximately 3:1 matched pregnant women exposed to efavirenz between Jan 1, 2015, and May 31, 2018, using the Brazilian antiretroviral therapy database. We did detailed chart reviews for identified women. The primary outcomes were NTD and a composite measure of NTD, stillbirth, or miscarriage. NTD incidences were calculated with 95% CI. The composite outcome was examined with logistic regression using propensity score matching weights to balance confounders. FINDINGS: Of 1427 included women, 382 were exposed to dolutegravir within 8 weeks of estimated date of conception. During pregnancy, 183 (48%) of 382 dolutegravir-exposed and 465 (44%) of 1045 efavirenz-exposed women received folic acid supplementation. There were 1452 birth outcomes. There were no NTDs in either dolutegravir-exposed (0, 95% CI 0-0·0010) or efavirenz-exposed groups (0, 95% CI 0-0·0036). There were 23 (6%) stillbirths or miscarriages in 384 dolutegravir-exposed fetuses and 28 (3%) in the 1068 efavirenz-exposed fetuses (p=0·0037). Logistic regression models did not consistently indicate an association between dolutegravir exposure and risk of stillbirths or miscarriages. After study closure, two confirmed NTD outcomes in fetuses with periconception dolutegravir exposure were reported to public health officials. An updated estimate of NTD incidence incorporating these cases and the estimated number of additional dolutegravir-exposed pregnancies between Jan 1, 2015 and Feb 28, 2019, is 0·0018 (95% CI 0·0005-0·0067). INTERPRETATION: Neither dolutegravir nor efavirenz exposure was associated with NTDs in our national cohort; incidence of NTDs is probably well under 1% in dolutegravir-exposed HIV-positive women but still slightly above HIV-uninfected women (0·06%) in Brazil. FUNDING: The Brazilian Ministry of Health and the United States' National Institutes of Health.


Asunto(s)
Infecciones por VIH/complicaciones , Inhibidores de Integrasa VIH/efectos adversos , Compuestos Heterocíclicos con 3 Anillos/efectos adversos , Defectos del Tubo Neural/etiología , Oxazinas/efectos adversos , Piperazinas/efectos adversos , Piridonas/efectos adversos , Aborto Espontáneo/epidemiología , Aborto Espontáneo/etiología , Adulto , Terapia Antirretroviral Altamente Activa/efectos adversos , Brasil/epidemiología , Comorbilidad , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Inhibidores de Integrasa VIH/administración & dosificación , Inhibidores de Integrasa VIH/uso terapéutico , Compuestos Heterocíclicos con 3 Anillos/administración & dosificación , Compuestos Heterocíclicos con 3 Anillos/uso terapéutico , Humanos , Defectos del Tubo Neural/diagnóstico , Defectos del Tubo Neural/epidemiología , Oxazinas/administración & dosificación , Oxazinas/uso terapéutico , Piperazinas/administración & dosificación , Piperazinas/uso terapéutico , Embarazo , Resultado del Embarazo , Piridonas/administración & dosificación , Piridonas/uso terapéutico , Estudios Retrospectivos , Mortinato , Adulto Joven
14.
Ugeskr Laeger ; 183(4)2021 01 25.
Artículo en Danés | MEDLINE | ID: mdl-33491631

RESUMEN

Pneumocystis pneumonia (PCP) in undiagnosed HIV-positive individuals and COVID-19 patients share many of the same clinical features. This case report describes two patients admitted to hospital during the COVID-19 pandemic. Both suffered from dyspnoea, dry cough and fever, showed signs of underlying illness and had severe hypoxia, elevated lactate dehydrogenase levels and lymfocytopenia. COVID-19 was suspected despite several negative tests. Both patients tested positive for PCP and HIV. In cases with unexplained interstitial pneumonia, PCP and underlying immunodeficiency should be suspected, and an HIV-test should be performed.


Asunto(s)
Infecciones por VIH , Neumonía por Pneumocystis , Tos , Disnea , Fiebre , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Humanos , Hipoxia , L-Lactato Deshidrogenasa/sangre , Linfopenia , Neumonía por Pneumocystis/diagnóstico
15.
Eur J Endocrinol ; 184(1): 107-122, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33112262

RESUMEN

Objective: Hypogonadism is common in HIV-infected men. The relationship between health status, sex steroids and body composition is poorly known in HIV. The aim was to investigate the association between health status (comorbidities/frailty), body composition, and gonadal function in young-to-middle-aged HIV-infected men. Design: Prospective, cross-sectional, observational study. Methods: HIV-infected men aged <50 years and ongoing Highly Active Antiretroviral Therapy were enrolled. Serum total testosterone (TT), estradiol (E2), estrone (E1) were measured by liquid chromatography-tandem mass spectrometry, LH and FSH by immunoassay. Free testosterone (cFT) was calculated by Vermeulen equation. Body composition was assessed by dual-energy X-ray absorptiometry and abdominal CT scan. Multimorbidity (MM) and frailty were defined as ≥3 comorbidities and by a 37-item index, respectively. Results: A total of 316 HIV-infected men aged 45.3 ± 5.3 years were enrolled. Body fat parameters were inversely related to cFT and TT, and directly related to E1 and E2/testosterone (TS) ratio. Patients with MM had lower cFT (P < 0.0001) and TT (P = 0.036), and higher E1 (P < 0.0001) and E2/TS ratio (P = 0.002). Frailty was inversely related to cFT (R2 = 0.057, P < 0.0001) and TT (R2 = 0.013, P = 0.043), and directly related to E1 (R2 = 0.171, P < 0.0001), E2 (R2 = 0.041, P = 0.004) and E2/TS ratio (R2 = 0.104, P < 0.0001). Conclusions: Lower TT and cFT, higher E1, E2/TS ratio and visceral fat were independently associated to poor health status and frailty, being possible hallmarks of unhealthy conditions in adult HIV-infected men. Overall, MM, frailty and body fat mass are strictly associated to each other and to sex steroids, concurring together to functional male hypogonadism in HIV.


Asunto(s)
Tejido Adiposo , Estrona/sangre , Infecciones por VIH/fisiopatología , Hipogonadismo/fisiopatología , Testosterona/sangre , Absorciometría de Fotón , Adulto , Terapia Antirretroviral Altamente Activa , Composición Corporal , Estudios Transversales , Fragilidad/fisiopatología , Fragilidad/virología , VIH , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Estado de Salud , Indicadores de Salud , Humanos , Hipogonadismo/virología , Masculino , Persona de Mediana Edad , Multimorbilidad , Estudios Prospectivos
17.
Arterioscler Thromb Vasc Biol ; 41(1): 512-522, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33327750

RESUMEN

OBJECTIVE: To determine the effects of HIV serostatus and disease severity on endothelial function in a large pooled cohort study of people living with HIV infection and HIV- controls. Approach and Results: We used participant-level data from 9 studies: 7 included people living with HIV (2 treatment-naïve) and 4 had HIV- controls. Brachial artery flow-mediated dilation (FMD) was measured using a standardized ultrasound imaging protocol with central reading. After data harmonization, multiple linear regression was used to examine the effects of HIV- serostatus, HIV disease severity measures, and cardiovascular disease risk factors on FMD. Of 2533 participants, 986 were people living with HIV (mean 44.4 [SD 11.8] years old) and 1547 were HIV- controls (42.9 [12.2] years old). The strongest and most consistent associates of FMD were brachial artery diameter, age, sex, and body mass index. The effect of HIV+ serostatus on FMD was strongly influenced by kidney function. In the highest tertile of creatinine (1.0 mg/dL), the effect of HIV+ serostatus was strong (ß=-1.59% [95% CI, -2.58% to -0.60%], P=0.002), even after covariate adjustment (ß=-1.36% [95% CI, -2.46% to -0.47%], P=0.003). In the lowest tertile (0.8 mg/dL), the effect of HIV+ serostatus was strong (ß=-1.90% [95% CI, -2.58% to -1.21%], P<0.001), but disappeared after covariate adjustment. HIV RNA viremia, CD4+ T-cell count, and use of antiretroviral therapy were not meaningfully associated with FMD. CONCLUSIONS: The significant effect of HIV+ serostatus on FMD suggests that people living with HIV are at increased cardiovascular disease risk, especially if they have kidney disease.


Asunto(s)
Arteria Braquial/fisiopatología , Enfermedades Cardiovasculares/etiología , Endotelio Vascular/fisiopatología , Infecciones por VIH/complicaciones , Vasodilatación , Serodiagnóstico del SIDA , Nefropatía Asociada a SIDA/complicaciones , Adolescente , Adulto , Anciano , Arteria Braquial/diagnóstico por imagen , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/fisiopatología , Estudios de Casos y Controles , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/virología , Seronegatividad para VIH , Seropositividad para VIH , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Medición de Riesgo , Índice de Severidad de la Enfermedad , Adulto Joven
19.
Transl Res ; 227: 89-99, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32693031

RESUMEN

The risk of venous thromboembolism (VTE) and of recurrent VTE remain elevated in people living with HIV compared to controls still with contemporary antiretroviral therapy (ART). The pathophysiology of VTE in HIV is multi factorial and includes an interplay among traditional risk factors, HIV-specific factors, behavioral factors, exposure to ART and other therapies, coinfections, and co-morbidities.


Asunto(s)
Infecciones por VIH/complicaciones , Tromboembolia Venosa/complicaciones , Adulto , Fármacos Anti-VIH/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad
20.
AJR Am J Roentgenol ; 216(2): 526-533, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33325733

RESUMEN

OBJECTIVE. The purpose of this article is to review important imaging and clinical features to help elucidate causes of lymphadenopathy in patients with HIV infection. CONCLUSION. HIV lymphadenopathy has various causes generally categorized as inflammatory or reactive, such as immune reconstitution syndrome; infectious, such as tuberculous and nontuberculous mycobacterial infections and HIV infection itself; and neoplastic, such as lymphoma, Kaposi sarcoma, and Castleman disease. It is important to consider patients' demographic characteristics, clinical presentations, CD4 lymphocyte counts, and radiologic features to identify likely causes of lymphadenopathy.


Asunto(s)
Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico por imagen , Linfadenopatía/diagnóstico por imagen , Linfadenopatía/virología , Diagnóstico Diferencial , Humanos , Tomografía Computarizada por Rayos X
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