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1.
J Assoc Nurses AIDS Care ; 35(2): 104-121, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38949906

RESUMEN

ABSTRACT: Speed of processing (SOP) cognitive training may improve indicators of the quality of life (QoL) in people living with HIV. In this 2-year, longitudinal, randomized, controlled trial, 216 participants ages 40 years and older with HIV-associated neurocognitive disorder or borderline HIV-associated neurocognitive disorder were assigned to one of three groups: (a) 10 hr of SOP training (n = 70); (b) 20 hr of SOP training (n = 73), or (c) 10 hr of internet navigation control training (a contact control group; n = 73). Participants completed several QoL measures at baseline, posttest, and Year 1 and Year 2 follow-ups. Using linear mixed-effect models, no strong pattern of training effects across QoL outcomes was apparent, with small-magnitude, nonsignificant, between-group differences in depression, locus of control, and Medical Outcomes Study-HIV scales. In conclusion, despite prior work showing some transfer of SOP cognitive training improving QoL, that was not observed. Implications for research and practice are posited.


Asunto(s)
Infecciones por VIH , Calidad de Vida , Humanos , Calidad de Vida/psicología , Masculino , Femenino , Persona de Mediana Edad , Infecciones por VIH/psicología , Infecciones por VIH/complicaciones , Adulto , Alabama , Estudios Longitudinales , Resultado del Tratamiento , Terapia Cognitivo-Conductual/métodos , Cognición , Depresión/psicología , Trastornos Neurocognitivos , Complejo SIDA Demencia/psicología , Complejo SIDA Demencia/terapia , Entrenamiento Cognitivo
2.
PLoS One ; 19(7): e0306245, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38950027

RESUMEN

INTRODUCTION: Toxoplasma gondii can cause symptomatic toxoplasmosis in immunodeficient hosts, including in people living with human immunodeficiency virus (PLWH), mainly because of the reactivation of latent infection. We assessed the prevalence of toxoplasmosis and its associated risk factors in PLWH in the Asia-Pacific region using data from the TREAT Asia Human Immunodeficiency Virus (HIV) Observational Database (TAHOD) of the International Epidemiology Databases to Evaluate AIDS (IeDEA) Asia-Pacific. METHODS: This study included both retrospective and prospective cases of toxoplasmosis reported between 1997 and 2020. A matched case-control method was employed, where PLWH diagnosed with toxoplasmosis (cases) were each matched to two PLWH without a toxoplasmosis diagnosis (controls) from the same site. Sites without toxoplasmosis were excluded. Risk factors for toxoplasmosis were analyzed using conditional logistic regression. RESULTS: A total of 269/9576 (2.8%) PLWH were diagnosed with toxoplasmosis in 19 TAHOD sites. Of these, 227 (84%) were reported retrospectively and 42 (16%) were prospective diagnoses after cohort enrollment. At the time of toxoplasmosis diagnosis, the median age was 33 years (interquartile range 28-38), and 80% participants were male, 75% were not on antiretroviral therapy (ART). Excluding 63 out of 269 people without CD4 values, 192 (93.2%) had CD4 ≤200 cells/µL and 162 (78.6%) had CD4 ≤100 cells/µL. By employing 538 matched controls, we found that factors associated with toxoplasmosis included abstaining from ART (odds ratio [OR] 3.62, 95% CI 1.81-7.24), in comparison to receiving nucleoside reverse transcriptase inhibitors plus non-nucleoside reverse transcriptase inhibitors, HIV exposure through injection drug use (OR 2.27, 95% CI 1.15-4.47) as opposed to engaging in heterosexual intercourse and testing positive for hepatitis B virus surface antigen (OR 3.19, 95% CI 1.41-7.21). Toxoplasmosis was less likely with increasing CD4 counts (51-100 cells/µL: OR 0.41, 95% CI 0.18-0.96; 101-200 cells/µL: OR 0.14, 95% CI 0.06-0.34; >200 cells/µL: OR 0.02, 95% CI 0.01-0.06), when compared to CD4 ≤50 cells/µL. Moreover, the use of prophylactic cotrimoxazole was not associated with toxoplasmosis. CONCLUSIONS: Symptomatic toxoplasmosis is rare but still occurs in PLWH in the Asia-Pacific region, especially in the context of delayed diagnosis, causing advanced HIV disease. Immune reconstitution through early diagnosis and ART administration remains a priority in Asian PLWH.


Asunto(s)
Infecciones por VIH , Toxoplasmosis , Humanos , Masculino , Factores de Riesgo , Adulto , Femenino , Toxoplasmosis/epidemiología , Toxoplasmosis/complicaciones , Infecciones por VIH/epidemiología , Infecciones por VIH/complicaciones , Asia/epidemiología , Estudios Retrospectivos , Estudios de Casos y Controles , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Toxoplasma
3.
Dermatol Online J ; 30(2)2024 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-38959924

RESUMEN

There is growing evidence to support new modes of transmission for human monkeypox infection. As these methods are being explored, this report delineates the day-to-day clinical sequelae following the initial exposure in an HIV-positive man who had sexual intercourse with another man days preceding his infection. We describe atypical cutaneous manifestations involving widespread erythematous pustules with preceding anogenital ulcerations and concomitant bilateral inguinal lymphadenopathy. Clinicopathologic correlation is used to assist in the workup and establishing the diagnosis. Our case supports others reported in the literature that suggest sexual contact as a means of transmission. More research is needed that investigates the presence of infection in both men and women, including those who could act as carriers, to elucidate other pathways in this evolving yet evasive viral disease.


Asunto(s)
Mpox , Humanos , Masculino , Mpox/patología , Mpox/diagnóstico , Adulto , Linfadenopatía/patología , Infecciones por VIH/complicaciones
4.
BMC Endocr Disord ; 24(1): 102, 2024 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-38956584

RESUMEN

BACKGROUND: Lipodystrophy is characterized by progressive loss of adipose tissue and consequential metabolic abnormalities. With new treatments emerging for lipodystrophy, there is a growing need to understand the prevalence of specific comorbidities that may be commonly associated with lipodystrophy to contextualize the natural history of lipodystrophy without any disease modifying therapy. OBJECTIVE: To examine the risk of specific clinical characteristics in people living with lipodystrophy (LD) in 2018-2019 compared with the general US population, among the commercially insured US population. METHODS: A retrospective cohort study was conducted using the 2018-2019 Clinformatics® Data Mart database. An adult LD cohort (age ≥ 18 years) with at least ≥ 1 inpatient or ≥ 2 outpatient LD diagnoses was created. The LD cohort included non-HIV-associated LD (non-HIV-LD) and HIV-associated LD (HIV-LD) subgroups and compared against age- and sex-matched control groups with a 1:4 ratio from the general population with neither an LD or an HIV diagnosis using odds ratios (ORs) with 95% confidence intervals. RESULTS: We identified 546 individuals with non-HIV-LD (mean age, 60.3 ± 14.9 years; female, 67.6%) and 334 individuals with HIV-LD (mean age, 59.2 ± 8.3 years; female, 15.0%) in 2018-2019. Compared with the general population, individuals with non-HIV-LD had higher risks (odds ratio [95% confidence interval]) for hyperlipidemia (3.32 [2.71-4.09]), hypertension (3.58 [2.89-4.44]), diabetes mellitus (4.72 [3.85-5.79]), kidney disease (2.78 [2.19-3.53]), liver fibrosis or cirrhosis (4.06 [1.66-9.95]), cancer (2.20 [1.59-3.01]), and serious infections resulting in hospitalization (3.00 [2.19-4.10]). Compared with individuals with HIV, those with HIV-LD have higher odds of hypertension (1.47 [1.13-1.92]), hyperlipidemia (2.46 [1.86-3.28]), and diabetes (1.37 [1.04-1.79]). CONCLUSIONS: LD imposes a substantial burden on affected individuals due to a high prevalence of metabolic comorbidities and other complications as compared with the general non-LD population. Future longitudinal follow-up studies investigating the causality between LD and observed comorbidities are warranted.


Asunto(s)
Lipodistrofia , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Prevalencia , Adulto , Estados Unidos/epidemiología , Lipodistrofia/epidemiología , Bases de Datos Factuales , Anciano , Comorbilidad , Infecciones por VIH/epidemiología , Infecciones por VIH/complicaciones , Adulto Joven , Estudios de Seguimiento
5.
Afr Health Sci ; 24(1): 91-93, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38962355

RESUMEN

This case report describes a pregnant patient with recent diagnosis of Human Immuno-Deficiency Virus (HIV) infection initiated on Anti-Retroviral Therapy (ART) in the second trimester, as well as high dose acyclovir high for large infected genital warts. She had no other HIV related opportunistic infections, and no prior anti tuberculosis treatment or preventive medication. Despite little response to acyclovir, patient was continuing on acyclovir for over 4 months. She subsequently developed recurrent anemia requiring frequent transfusion (14 units in total) over a 6-week period. On stopping acyclovir, the anemia subsided, a few weeks later she had a normal delivery, followed by surgical removal of the warts. At a follow-up 8 months later, she was well, with a healthy baby, and reported no other episodes of blood transfusion.


Asunto(s)
Aciclovir , Anemia , Antivirales , Infecciones por VIH , Complicaciones Infecciosas del Embarazo , Recurrencia , Humanos , Femenino , Embarazo , Aciclovir/uso terapéutico , Aciclovir/efectos adversos , Aciclovir/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/complicaciones , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Antivirales/efectos adversos , Antivirales/uso terapéutico , Adulto , Uganda , Resultado del Tratamiento , Herpes Genital/tratamiento farmacológico , Transfusión Sanguínea
6.
Front Public Health ; 12: 1366795, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38962784

RESUMEN

Background: Antiretroviral therapy (ART) has been shown to reduce human immunodeficiency virus (HIV) viral replication and ultimately achieve viral suppression and eliminate HIV transmission. However, little is known about the impact of viral suppression on high-risk behaviors and sexually transmitted infections (STIs). Objective: This study aimed to assess the rates of current syphilis infection in virally suppressed people living with HIV (PLWH) and whether with the duration of ART can reduce the current syphilis infection in eastern China. Method: We conducted a cross-sectional survey of PLWH in Zhejiang Province, China, in 2022. PLWH who were on ART >6 months and were virally suppressed (viral load <50 copies/mL) were included in the study. Data were collected from the National Epidemiological Database of Zhejiang Province and all participants were tested for viral load and current syphilis. Multivariable logistic regression was used to identify risk factors associated with current syphilis infection. Result: A total of 30,744 participants were included in the analysis. 82.7% of participants were male, the mean age was 44.9 ± 14.1 years, 84.9% had received ART in a hospital setting, the mean time on ART was 5.9 ± 3.1 years and 5.6% of participants were infected with current syphilis. Multivariable logistic regression showed that being male [adjusted odds ratio (aOR): 2.12, 95% confidence interval (CI): 1.69-2.66], high level of education (aOR: 1.23, 95% CI: 1.02-1.49), homosexual route of HIV infection (aOR: 1.80, 95% CI: 1.60-2.04), non-local registered residence (aOR: 1.29, 95% CI: 1.11-1.51), had history of STIs before HIV diagnosis (aOR: 1.95, 95 % CI: 1.75-2.18) and treatment provided by a municipal hospital (aOR: 2.16, 95% CI: 1.31-3.55) were associated with increased risk of current syphilis infection. Being married (aOR: 0.67, 95% CI: 0.58-0.76) was associated with a decreased risk of current syphilis infection. Conclusion: Our findings revealed a high rate of current syphilis infection among virally suppressed PLWH in eastern China. Duration of ART did not reduce the prevalence of current syphilis infection. Targeted interventions to reduce current syphilis infection should be prioritized for subgroups at higher risk.


Asunto(s)
Infecciones por VIH , Sífilis , Carga Viral , Humanos , Sífilis/epidemiología , Estudios Transversales , Masculino , Adulto , Infecciones por VIH/epidemiología , Infecciones por VIH/complicaciones , Femenino , China/epidemiología , Persona de Mediana Edad , Factores de Riesgo
7.
Medicine (Baltimore) ; 103(27): e38558, 2024 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-38968505

RESUMEN

Antiretroviral regimens for human immunodeficiency virus (HIV) infection have continuously evolved; however, antiretrovirals can cause severe adverse reactions. Two-drug regimen therapy can decrease lifetime cumulative drug exposure and long-term toxicities associated with multiple antiretrovirals. The preferred 2-drug regimen constitutes dolutegravir (DTG) and lamivudine (3TC). This study determined the rate of virological suppression and incidence of adverse events at week 48 in treatment-naïve people living with HIV initiated on DTG + 3TC. This was a single-center, retrospective, observational study. Treatment-naïve people aged ≥18 years who received at least 1 DTG + 3TC dose between May 2020 and May 2022 were included. Eighty-nine people living with HIV were enrolled. Twenty-five (28.1%) patients with a DTG + 3TC regimen at baseline were analyzed because of comorbidities, and 48% because of concomitant tuberculosis (TB). Viral suppression at 48 weeks was achieved in 91.67% of patients, and TB was well controlled. At week 48, 84 (94.38%) patients had viral loads < 50 copies/mL, and 21 (91.31%) of the 23 participants with a baseline HIV-1-RNA level ≥ 1 × 105 copies/mL achieved virological success. Fifteen (88.23%) of the 17 participants with a baseline CD4 + cell count of <200 cells/µL achieved virological suppression. The median CD4 + cell count change from baseline was 539.5 cells/µL. No significant changes in triglycerides, low-density lipoprotein cholesterol, weight, or creatinine were observed from baseline to 48 weeks. One patient had severe insomnia at 4 weeks. Our findings support the real-world effectiveness and low metabolic impact of DTG + 3TC. Using DTG + 3TC in patients coinfected with TB and HIV has favorable therapeutic outcomes.


Asunto(s)
Fármacos Anti-VIH , Quimioterapia Combinada , Infecciones por VIH , Compuestos Heterocíclicos con 3 Anillos , Lamivudine , Oxazinas , Piperazinas , Piridonas , Tuberculosis , Humanos , Piridonas/administración & dosificación , Piridonas/uso terapéutico , Piridonas/efectos adversos , Lamivudine/uso terapéutico , Lamivudine/administración & dosificación , Lamivudine/efectos adversos , Compuestos Heterocíclicos con 3 Anillos/uso terapéutico , Compuestos Heterocíclicos con 3 Anillos/efectos adversos , Compuestos Heterocíclicos con 3 Anillos/administración & dosificación , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/complicaciones , Masculino , Estudios Retrospectivos , Adulto , Piperazinas/uso terapéutico , Piperazinas/administración & dosificación , Piperazinas/efectos adversos , China , Persona de Mediana Edad , Tuberculosis/tratamiento farmacológico , Tuberculosis/complicaciones , Fármacos Anti-VIH/uso terapéutico , Fármacos Anti-VIH/efectos adversos , Fármacos Anti-VIH/administración & dosificación , Carga Viral/efectos de los fármacos , Coinfección/tratamiento farmacológico , Resultado del Tratamiento , Recuento de Linfocito CD4
8.
BMJ Open ; 14(7): e087218, 2024 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-38969385

RESUMEN

OBJECTIVES: Despite the implementation of a short-term direct observation treatment programme, HIV coinfection is one of the main determinants of tuberculosis (TB) treatment success. This meta-analysis was conducted to report the impact of HIV on TB treatment outcomes using inconsistent and variable study findings. DESIGN: Systematic review and meta-analysis was performed. DATA SOURCES: The PubMed/Medline, Web of Science and Google Scholar databases were used to access the articles. The Joanna Briggs Institute (JBI) Meta-Analysis of Statistics Assessment and Review Instrument was used for the critical appraisal. ELIGIBILITY CRITERIA: All observational studies conducted in Ethiopia and reporting TB treatment outcomes in relation to HIV coinfection were included in the final analysis. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted the data using a standardised data extraction format. The JBI critical appraisal tool was used to assess the quality of primary studies. Stata V.14 was used for the data analysis. Cochran's Q statistic with inverse variance (I2) and funnel plot are used to assess the presence of heterogeneity (I2=94.4%, p<0.001) and publication bias, respectively. A random effect model was used to estimate TB treatment outcomes with a 95% CI. RESULTS: The overall success rate of TB treatment was 69.9% (95% CI 64% to 75%). The cure rate of TB among patients living with HIV was 19.3%. Furthermore, the odds of unsuccessful treatment among TB-HIV coinfected patients were 2.6 times greater than those among HIV nonreactive patients (OR 2.65; 95% CI 2.1 to 3.3). CONCLUSION: The success of TB treatment among patients living with HIV in Ethiopia was lower than the WHO standard threshold (85%). HIV coinfection hurts TB treatment success. Therefore, collaborative measurements and management, such as early treatment initiation, follow-up and the management of complications, are important.


Asunto(s)
Antituberculosos , Coinfección , Infecciones por VIH , Tuberculosis , Humanos , Etiopía/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Antituberculosos/uso terapéutico , Tuberculosis/complicaciones , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Resultado del Tratamiento
9.
Front Cell Infect Microbiol ; 14: 1412753, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38979508

RESUMEN

Background: Monkeypox virus (MPXV) is spreading globally and nearly half of the infected people were human immunodeficiency virus (HIV) positive. Therefore, an in-depth understanding of the effects of HIV infection on the outcomes of MPXV infection is urgently needed. This study aimed to explore the clinical features, viral dynamics, and antibody response to MPXV infections in men who had sex with men (MSM) with and without HIV co-infection. Design or methods: MPXV-infected patients diagnosed by PCR were recruited in this study and were divided into MPXV and MPXV + HIV groups based on whether they were co-infected with HIV. Clinical data and samples were collected during of the hospital stay and follow up interviews. The symptoms and signs, laboratory examinations, viral shedding in various body fluids or swabs, antibody dynamics were tracked and compared between the two groups. Results: A total of 41 MPXV patients were recruited through June 2023 to September 2023 in Guangzhou. The MPXV group and MPXV + HIV group comprised 20 and 21 MSM, respectively. Patients in the two groups exhibited similar clinical characteristics except for pruritus and eschar, both were significantly fewer in MPXV + HIV group than in MPXV only group. Among the 355 clinical samples collected, MPXV DNA was detected in 100% of scabs, 97.4% of skin swabs, and 92.3% of exudate swabs from lesions, while the positive rate was 87.5% from oropharyngeal swabs, 59% from saliva, 51.3% from anal swabs, 50% from feces, 30.6% from urine samples, 37.5% of semen, and 28.2% from sera. Dynamics analysis revealed that viral DNA was undetectable in most patients 20 days after symptom onset. IgM and IgG antibodies to MPXV were detected in all patients with 3-5 days earlier in the MPXV group than in the MPXV + HIV group. Conclusion: This cohort analysis based on a large outbreak among MSM in Guangzhou indicated no obvious differences in clinical symptoms, viral DNA data, but antibody responses were 3-5 days later in mpox patients with HIV infection.


Asunto(s)
Anticuerpos Antivirales , Coinfección , Infecciones por VIH , Homosexualidad Masculina , Monkeypox virus , Mpox , Humanos , Masculino , Infecciones por VIH/complicaciones , Infecciones por VIH/inmunología , Infecciones por VIH/epidemiología , China/epidemiología , Adulto , Anticuerpos Antivirales/sangre , Coinfección/virología , Coinfección/epidemiología , Mpox/epidemiología , Mpox/inmunología , Monkeypox virus/inmunología , Monkeypox virus/genética , Esparcimiento de Virus , Persona de Mediana Edad , Formación de Anticuerpos , Carga Viral , Adulto Joven
10.
Front Cell Infect Microbiol ; 14: 1408388, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38988810

RESUMEN

Background: Surgical site infection (SSI) is a common complication in HIV-positive fracture patients undergoing surgery, leading to increased morbidity, mortality, and healthcare costs. Accurate prediction of SSI risk can help guide clinical decision-making and improve patient outcomes. However, there is a lack of user-friendly, Web-based calculator for predicting SSI risk in this patient population. Objective: This study aimed to develop and validate a novel web-based risk calculator for predicting SSI in HIV-positive fracture patients undergoing surgery in China. Method: A multicenter retrospective cohort study was conducted using data from HIV-positive fracture patients who underwent surgery in three tertiary hospitals in China between May 2011 and September 2023. We used patients from Beijing Ditan Hospital as the training cohort and patients from Chengdu Public Health and Changsha First Hospital as the external validation cohort. Univariate, multivariate logistic regression analyses and SVM-RFE were performed to identify independent risk factors for SSIs. A web-based calculator was developed using the identified risk factors and validated using an external validation cohort. The performance of the nomogram was evaluated using the area under the receiver operating characteristic (AUC) curves, calibration plots, and decision curve analysis (DCA). Results: A total of 338 HIV-positive patients were included in the study, with 216 patients in the training cohort and 122 patients in the validation cohort. The overall SSI incidence was 10.7%. The web-based risk calculator (https://sydtliubo.shinyapps.io/DynNom_for_SSI/) incorporated six risk factors: HBV/HCV co-infection, HIV RNA load, CD4+ T-cell count, Neu and Lym level. The nomogram demonstrated good discrimination, with an AUC of 0.890 in the training cohort and 0.853 in the validation cohort. The calibration plot showed good agreement between predicted and observed SSI probabilities. The DCA indicated that the nomogram had clinical utility across a wide range of threshold probabilities. Conclusion: Our study developed and validated a novel web-based risk calculator for predicting SSI risk in HIV-positive fracture patients undergoing surgery in China. The nomogram demonstrated good discrimination, calibration, and clinical utility, and can serve as a valuable tool for risk stratification and clinical decision-making in this patient population. Future studies should focus on integrating this nomogram into hospital information systems for real-time risk assessment and management.


Asunto(s)
Infecciones por VIH , Internet , Infección de la Herida Quirúrgica , Humanos , Masculino , China/epidemiología , Femenino , Persona de Mediana Edad , Infecciones por VIH/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/epidemiología , Adulto , Medición de Riesgo/métodos , Curva ROC , Nomogramas
13.
Int J Mol Sci ; 25(13)2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-39000373

RESUMEN

Atherosclerotic vascular disease disproportionately affects persons living with HIV (PLWH) compared to those without. The reasons for the excess risk include dysregulated immune response and inflammation related to HIV infection itself, comorbid conditions, and co-infections. Here, we review an updated understanding of immune and inflammatory pathways underlying atherosclerosis in PLWH, including effects of viral products, soluble mediators and chemokines, innate and adaptive immune cells, and important co-infections. We also present potential therapeutic targets which may reduce cardiovascular risk in PLWH.


Asunto(s)
Aterosclerosis , Infecciones por VIH , Inflamación , Humanos , Infecciones por VIH/inmunología , Infecciones por VIH/complicaciones , Aterosclerosis/inmunología , Inflamación/inmunología , Enfermedades Cardiovasculares/inmunología , Enfermedades Cardiovasculares/etiología , Animales , Inmunidad Innata
14.
Mycoses ; 67(7): e13767, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-39004801

RESUMEN

BACKGROUND: The radiological manifestations of central nervous system (CNS) cryptococcosis are diverse and often subtle. There is heterogeneity on how different neuroimaging patterns impact prognosis. This study aims to assess the association between the neuroimaging and clinical outcomes of CNS cryptococcosis. METHODS: All patients with CNS cryptococcosis between July 2017 and April 2023 who underwent brain magnetic resonance imaging (MRI) were included. The primary outcome was mortality during hospitalisation. Secondary outcomes were readmission, ventricular shunting, duration of hospitalisation and time to the first negative cerebrospinal fluid culture. We compared the outcomes for each of the five main radiological findings on the brain MRI scan. RESULTS: We included 46 proven CNS cryptococcosis cases. The two main comorbidity groups were HIV infection (20, 43%) and solid organ transplantation (10, 22%), respectively. Thirty-nine patients exhibited at least one radiological abnormality (85%), with the most common being meningeal enhancement (34, 74%). The mortality rates occurred at 11% (5/46) during hospitalisation. We found no significant disparities in mortality related to distinct radiological patterns. The presence of pseudocysts was significantly associated with the need for readmission (p = .027). The ventricular shunting was significantly associated with the presence of pseudocysts (p = .005) and hydrocephalus (p = .044). CONCLUSION: In this study, there is no association between brain MRI findings and mortality. Larger studies are needed to evaluate this important issue.


Asunto(s)
Criptococosis , Imagen por Resonancia Magnética , Neuroimagen , Humanos , Masculino , Femenino , Persona de Mediana Edad , Neuroimagen/métodos , Criptococosis/diagnóstico por imagen , Criptococosis/mortalidad , Criptococosis/microbiología , Adulto , Anciano , Estudios Retrospectivos , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Infecciones Fúngicas del Sistema Nervioso Central/diagnóstico por imagen , Infecciones Fúngicas del Sistema Nervioso Central/mortalidad , Infecciones Fúngicas del Sistema Nervioso Central/microbiología , Pronóstico , Hidrocefalia/diagnóstico por imagen , Hidrocefalia/mortalidad , Hospitalización , Infecciones por VIH/complicaciones
16.
BMJ Case Rep ; 17(7)2024 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-39025797

RESUMEN

Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by an invasive form of Chlamydia trachomatis, typically affecting the anogenital area with regional lymphatic involvement. Extragenital manifestations are rare but can occur, particularly if the bacterium is inoculated out of the genital tract. To our knowledge, only 13 cases of symptomatic neck LGV have been published so far in the medical literature. We describe a case of a young man living with HIV with bilateral, rapid-growing and painful neck swelling, whose definite diagnosis was challenging. The patient underwent extensive investigation, including repeated ultrasound-guided fine-needle aspirations, microbiological exams and histological characterisation. Genotyping revealed C. trachomatis L2 serovar, confirming LGV as a final diagnosis, affecting neck lymph nodes. Treatment with doxycycline combined with surgical drainage led to clinical resolution. This case emphasises the importance of a comprehensive testing strategy to identify LGV, especially in individuals reporting unprotected oral sex, with unexplained neck lymphadenitis.


Asunto(s)
Chlamydia trachomatis , Doxiciclina , Infecciones por VIH , Linfogranuloma Venéreo , Cuello , Humanos , Masculino , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/complicaciones , Linfogranuloma Venéreo/tratamiento farmacológico , Cuello/patología , Infecciones por VIH/complicaciones , Doxiciclina/uso terapéutico , Chlamydia trachomatis/aislamiento & purificación , Adulto , Antibacterianos/uso terapéutico , Drenaje , Ganglios Linfáticos/patología
17.
Sci Rep ; 14(1): 16955, 2024 Jul 23.
Artículo en Inglés | MEDLINE | ID: mdl-39043922

RESUMEN

Good-quality sleep is defined by its ability to minimize disturbances, provide adequate duration, and maintain a balanced progression through sleep stages. Sleep disturbance is a common complaint in people living with HIV/AIDS. Despite the influence of sleep disturbance on treatment adherence, quality of life, work productivity, risk of chronic illness. Studies have reported sleep disturbances among HIV/AIDS patients in sub-Saharan African countries (SSA), yielding varied results at the country level. Therefore, conducting a systematic review and meta-analysis is essential. This systematic review and meta-analysis aimed to evaluate the prevalence of poor sleep quality and identify associated factors among HIV/AIDS patients in sub-Saharan African countries. We systematically searched across various databases, including PubMed, African Journals Online, Scopus, Cochrane Library, HINARI, and Science Direct. Additionally, we conducted searches using Google and Google Scholar search engines. Microsoft Excel was used for data extraction, and the data were analysed using STAT version 17.0. We assessed heterogeneity using Cochran's Q test and I2 test and checked for small study effects using funnel plot symmetry and Egger's test. Pooled prevalence and associated factors were estimated using a random-effects model at a 95% confidence interval (CI) and significance level of p < 0.05. To identify factors associated with poor sleep quality among individuals living with HIV/AIDS, odds ratios (ORs) and their corresponding 95% CI were calculated. This analysis combined data from 15 separate studies involving a total sample size of 5176 participants. The pooled prevalence of poor sleep quality among HIV/AIDS patients in SSA countries was 49.32% (95% CI 41.32-56.8%). Factors significantly associated with poor sleep quality included depression (OR 2.78; 95% CI 1.21-6.40) and CD4 count < 200 cells/mm3 (AOR 3.15; 95% CI 2.41-4.15). In this study the prevalence of poor sleep quality among HIV/AIDS patients in SSA was higher and differs across the countries, ranging from 21.7 to 73.7%. The findings underscore the urgent necessity for programs aimed at improving sleep quality, particularly in addressing factors such as participant income and depression that are linked to poor sleep quality in HIV/AIDS patients.Systematic review registration: PROSPERO CRD42024517229.


Asunto(s)
Infecciones por VIH , Calidad del Sueño , Humanos , África del Sur del Sahara/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Trastornos del Sueño-Vigilia/epidemiología , Calidad de Vida , Prevalencia , Factores de Riesgo , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Femenino , Masculino
18.
BMC Microbiol ; 24(1): 274, 2024 Jul 24.
Artículo en Inglés | MEDLINE | ID: mdl-39044127

RESUMEN

BACKGROUND: Person with human immunodeficiency virus type-1 (PWH) are prone to chronic inflammation due to residual viral production, even with antiretroviral therapy (ART), which increases the risk of age-related diseases. There is also limited information on changes in the intestinal environment of PWH during ART. In this longitudinal study, we investigated changes in the gut microbiota, persistence of chronic inflammation, interactions between the gut environment and inflammation, and metabolic changes in PWH using long-term ART. RESULTS: We analyzed changes in clinical parameters and gut microbiota in 46 PWH over a mean period of 4 years to understand the influence of gut dysbiosis on inflammation. Overall, changes in the gut microbiota included a decrease in some bacteria, mainly involved in short-chain fatty acid (SCFA) production, and an increase in certain opportunistic bacteria. Throughout the study period, an increase in bacterial-specific metabolic activity was observed in the intestinal environment. Continued decline in certain bacteria belonging to the Clostridia class and metabolic changes in gut bacteria involved in glucose metabolism. Additionally, patients with a low abundance of Parabacteroides exhibited low bacterial alpha diversity and a significant increase in body mass index (BMI) during the study period. Monocyte chemoattractant protein 1, a marker of macrophage activation in the plasma, continued to increase from baseline (first stool collection timepoint) to follow-up (second stool collection timepoint), demonstrating a mild correlation with BMI. Elevated BMI was mild to moderately correlated with elevated levels of plasma interleukin 16 and chemokine ligand 13, both of which may play a role in intestinal inflammation and bacterial translocation within the gut microbiota. The rate of BMI increase correlated with the rate of decrease in certain SCFA-producing bacteria, such as Anaerostipes and Coprococcus 3. CONCLUSION: Our data suggest that despite effective ART, PWH with chronic inflammation exhibit persistent dysbiosis associated with gut inflammation, resulting in a transition to an intestinal environment with metabolic consequences. Moreover, the loss of certain bacteria such as Parabacteroides in PWH correlates with weight gain and may contribute to the development of metabolic diseases.


Asunto(s)
Disbiosis , Microbioma Gastrointestinal , Infecciones por VIH , Inflamación , Aumento de Peso , Humanos , Disbiosis/microbiología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/microbiología , Infecciones por VIH/complicaciones , Microbioma Gastrointestinal/efectos de los fármacos , Masculino , Femenino , Estudios Longitudinales , Persona de Mediana Edad , Adulto , Aumento de Peso/efectos de los fármacos , Bacterias/clasificación , Bacterias/aislamiento & purificación , VIH-1 , Índice de Masa Corporal , Intestinos/microbiología , Antirretrovirales/uso terapéutico
19.
Sci Rep ; 14(1): 16858, 2024 Jul 23.
Artículo en Inglés | MEDLINE | ID: mdl-39039244

RESUMEN

We performed a systematic review and meta-analysis of hypertension in people living with human immunodeficiency virus (HIV) in sub-Saharan Africa (SSA). We searched the PubMed, Google Scholar, African Index Medicus, and Embase databases to identify studies published from January 1, 2010, to December 31, 2021. We used a random-effects model to estimate the pooled prevalence of hypertension and mean SBP/DBP level on a sex-specific basis. We included 48 studies reporting data on a pooled sample of 193,843 people living with HIV (PLW-HIV) in SSA. The pooled mean SBP/DBP level was 120 (95% CI 113-128)/77 (95%CI 72-82) mmHg, while the overall pooled prevalence of hypertension was 21.9% (95% CI 19.9-23.9%). Further meta-regression analyses suggested that the prevalence of hypertension was 1.33 times greater in males, 1.23 times greater in individuals receiving antiretroviral therapy (ART) and 1.45 times greater in those individuals with a CD4-count ≥ 200. This meta-analysis of the contemporary pattern of BP levels among PLW-HIV in SSA, suggests that around one in five of such individuals also have hypertension. Given the further context of greater access to ART and subsequently greater longevity, study findings support calls to integrate cardiovascular management into routine HIV care.


Asunto(s)
Infecciones por VIH , Hipertensión , Humanos , África del Sur del Sahara/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Infecciones por VIH/tratamiento farmacológico , Hipertensión/epidemiología , Hipertensión/complicaciones , Prevalencia , Masculino , Femenino , Recuento de Linfocito CD4
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