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1.
Medicine (Baltimore) ; 99(9): e19273, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118737

RESUMEN

A subgroup of women who are co-infected with human immunodeficiency virus type 1 (HIV-1) and human papillomavirus (HPV), progress rapidly to cervical disease. We characterized HPV genotypes within cervical tumor biopsies, assessed the relationships of cervical disease stage with age, HIV-1 status, absolute CD4 count, and CD4 percentage, and identified the predictive power of these variables for cervical disease stage in a cohort of South African women.We recruited 181 women who were histologically diagnosed with cervical disease; 87 were HIV-1-positive and 94 were HIV-1-seronegative. Colposcopy-directed tumor biopsies were confirmed by histology and used for genomic DNA extraction. The Roche Linear Array HPV genotyping test was used for HPV genotyping. Peripheral whole blood was used for HIV-1 rapid testing. Fully automated FC500MPL/CellMek with PanLeucogate (PLG) was used to determine absolute CD4 count, CD4 percentage, and CD45 count. Chi-squared test, a logistic regression model, parametric Pearson correlation, and ROC curves were used for statistical analyses. We used the Benjamini-Horchberg test to control for false discovery rate (FDR, q-value). All tests were significant when both P and q were <.05.Age was a significant predictor for invasive cervical cancer (ICC) in both HIV-1-seronegative (P < .0001, q < 0.0001) and HIV-1-positive women (P = .0003, q = 0.0003). Sixty eight percent (59/87) of HIV-1-positive women with different stages of cervical disease presented with a CD4 percentage equal or less than 28%, and a median absolute CD4 count of 400 cells/µl (IQR 300-500 cells/µl). Of the HIV-1-positive women, 75% (30/40) with ICC, possessed ≤28% CD4 cells vs 25% (10/40) who possessed >28% CD4 cells (both P < .001, q < 0.001). Furthermore, 70% (28/40) of women with ICC possessed CD4 count >350 compared to 30% (12/40) who possessed CD4 count ≤ 350 (both P < .001, q < 0.001).Age is an independent predictor for ICC. In turn, development of ICC in HIV-1-positive women is independent of the host CD4 cells and associates with low CD4 percentage regardless of absolute CD4 count that falls within the normal range. Thus, using CD4 percentage may add a better prognostic indicator of cervical disease stage than absolute CD4 count alone.


Asunto(s)
Neoplasia Intraepitelial Cervical/epidemiología , Infecciones por VIH , VIH-1 , Infecciones por Papillomavirus/epidemiología , Neoplasias del Cuello Uterino/epidemiología , Adulto , Factores de Edad , Recuento de Linfocito CD4 , Neoplasia Intraepitelial Cervical/sangre , Neoplasia Intraepitelial Cervical/virología , Estudios de Cohortes , Femenino , Humanos , Estadificación de Neoplasias , Infecciones por Papillomavirus/sangre , Infecciones por Papillomavirus/virología , Factores de Riesgo , Sudáfrica/epidemiología , Neoplasias del Cuello Uterino/sangre , Neoplasias del Cuello Uterino/virología
2.
Rev Bras Epidemiol ; 23: e200020, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32159630

RESUMEN

INTRODUCTION: Linkage is a critical step in the ongoing care of human immunodeficiency virus (HIV/aids) infection and is essential for providing access to antiretroviral therapy, as well as comprehensive care. METHODOLOGY: Cross-sectional study on people living with HIV (PLHIV), aged ≥ 18 years old, linked between January and December 2015, in a referral service for outpatient and hospital care specialized in HIV/AIDS in Belo Horizonte, Minas Gerais. Linkage time was defined as the time from diagnosis to service linkage. Timely care linkage was considered when this time was ≤ 90 days. Data were collected through clinical records. A logistic regression analysis with a confidence interval of 95% (95%CI) was performed. RESULTS: Among 208 patients, most of them were males (77.8%) with a mean age of 39 years. About 45% presented AIDS-defining conditions at the moment of linkage. Linkage time presented a mean of 138 ± 397 days. And timely linkage occurred for 76.9% of the patients. The variables associated with timely care linkage were: age ≥ 48 years (odds ratio - OR = 8.50; 95%CI 1.53 - 47.28), currently working (OR = 3.69; 95%CI 1.33 - 10.25) at the time of linkage, and present CD4+ T lymphocyte count (CD4+ T) ≤ 200 cells/mm3 at the time of HIV diagnosis (OR = 4.84; 95%CI 1.54 - 15.18). There was an important proportion of timely care linkage among PLHIV, but with late diagnosis. CONCLUSION: Interventions should be targeted at younger people with higher CD4+ T lymphocyte counts, in order to better provide continuous HIV care.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Continuidad de la Atención al Paciente/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Adolescente , Adulto , Terapia Antirretroviral Altamente Activa , Brasil/epidemiología , Recuento de Linfocito CD4 , Estudios Transversales , Diagnóstico Tardío , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Adulto Joven
3.
N Engl J Med ; 382(12): 1124-1135, 2020 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-32130806

RESUMEN

BACKGROUND: Long-acting injectable regimens may simplify therapy for patients with human immunodeficiency virus type 1 (HIV-1) infection. METHODS: We conducted a phase 3, randomized, open-label trial in which adults with HIV-1 infection who had not previously received antiretroviral therapy were given 20 weeks of daily oral induction therapy with dolutegravir-abacavir-lamivudine. Participants who had an HIV-1 RNA level of less than 50 copies per milliliter after 16 weeks were randomly assigned (1:1) to continue the current oral therapy or switch to oral cabotegravir plus rilpivirine for 1 month followed by monthly injections of long-acting cabotegravir plus rilpivirine. The primary end point was the percentage of participants who had an HIV-1 RNA level of 50 copies per milliliter or higher at week 48 (Food and Drug Administration snapshot algorithm). RESULTS: At week 48, an HIV-1 RNA level of 50 copies per milliliter or higher was found in 6 of 283 participants (2.1%) who received long-acting therapy and in 7 of 283 (2.5%) who received oral therapy (adjusted difference, -0.4 percentage points; 95% confidence interval [CI], -2.8 to 2.1), a result that met the criterion for noninferiority for the primary end point (margin, 6 percentage points). An HIV-1 RNA level of less than 50 copies per milliliter at week 48 was found in 93.6% who received long-acting therapy and in 93.3% who received oral therapy (adjusted difference, 0.4 percentage points; 95% CI, -3.7 to 4.5), a result that met the criterion for noninferiority for this end point (margin, -10 percentage points). Of the participants who received long-acting therapy, 86% reported injection-site reactions (median duration, 3 days; mild or moderate severity, 99% of cases); 4 participants withdrew from the trial for injection-related reasons. Grade 3 or higher adverse events and events that met liver-related stopping criteria occurred in 11% and 2%, respectively, who received long-acting therapy and in 4% and 1% who received oral therapy. Treatment satisfaction increased after participants switched to long-acting therapy; 91% preferred long-acting therapy at week 48. CONCLUSIONS: Therapy with long-acting cabotegravir plus rilpivirine was noninferior to oral therapy with dolutegravir-abacavir-lamivudine with regard to maintaining HIV-1 suppression. Injection-site reactions were common. (Funded by ViiV Healthcare and Janssen; FLAIR ClinicalTrials.gov number, NCT02938520.).


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , VIH-1/aislamiento & purificación , Piridonas/administración & dosificación , Rilpivirina/administración & dosificación , Administración Oral , Adulto , Fármacos Anti-VIH/efectos adversos , Fármacos Anti-VIH/sangre , Antirretrovirales/uso terapéutico , Recuento de Linfocito CD4 , Farmacorresistencia Viral/genética , Quimioterapia Combinada , Femenino , VIH-1/genética , Humanos , Quimioterapia de Inducción , Inyecciones Intramusculares , Quimioterapia de Mantención , Masculino , Persona de Mediana Edad , Mutación , Medición de Resultados Informados por el Paciente , Piridonas/efectos adversos , Piridonas/sangre , ARN Viral/sangre , Rilpivirina/efectos adversos , Rilpivirina/sangre , Carga Viral
4.
N Engl J Med ; 382(12): 1112-1123, 2020 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-32130809

RESUMEN

BACKGROUND: Simplified regimens for the treatment of human immunodeficiency virus type 1 (HIV-1) infection may increase patient satisfaction and facilitate adherence. METHODS: In this phase 3, open-label, multicenter, noninferiority trial involving patients who had had plasma HIV-1 RNA levels of less than 50 copies per milliliter for at least 6 months while taking standard oral antiretroviral therapy, we randomly assigned participants (1:1) to either continue their oral therapy or switch to monthly intramuscular injections of long-acting cabotegravir, an HIV-1 integrase strand-transfer inhibitor, and long-acting rilpivirine, a nonnucleoside reverse-transcriptase inhibitor. The primary end point was the percentage of participants with an HIV-1 RNA level of 50 copies per milliliter or higher at week 48, determined with the use of the Food and Drug Administration snapshot algorithm. RESULTS: Treatment was initiated in 308 participants per group. At week 48, HIV-1 RNA levels of 50 copies per milliliter or higher were found in 5 participants (1.6%) receiving long-acting therapy and in 3 (1.0%) receiving oral therapy (adjusted difference, 0.6 percentage points; 95% confidence interval [CI], -1.2 to 2.5), a result that met the criterion for noninferiority for the primary end point (noninferiority margin, 6 percentage points). An HIV-1 RNA level of less than 50 copies per milliliter at week 48 was found in 92.5% of participants receiving long-acting therapy and in 95.5% of those receiving oral therapy (adjusted difference, -3.0 percentage points; 95% CI, -6.7 to 0.7), a result that met the criterion for noninferiority for this end point (noninferiority margin, -10 percentage points). Virologic failure was confirmed in 3 participants who received long-acting therapy and 4 participants who received oral therapy. Adverse events were more common in the long-acting-therapy group and included injection-site pain, which occurred in 231 recipients (75%) of long-acting therapy and was mild or moderate in most cases; 1% withdrew because of this event. Serious adverse events were reported in no more than 5% of participants in each group. CONCLUSIONS: Monthly injections of long-acting cabotegravir and rilpivirine were noninferior to standard oral therapy for maintaining HIV-1 suppression. Injection-related adverse events were common but only infrequently led to medication withdrawal. (Funded by ViiV Healthcare and Janssen; ATLAS ClinicalTrials.gov number, NCT02951052.).


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , VIH-1/aislamiento & purificación , Piridonas/administración & dosificación , Rilpivirina/administración & dosificación , Administración Oral , Adulto , Fármacos Anti-VIH/efectos adversos , Fármacos Anti-VIH/sangre , Antirretrovirales/uso terapéutico , Recuento de Linfocito CD4 , Farmacorresistencia Viral/genética , Quimioterapia Combinada , Femenino , VIH-1/genética , Humanos , Inyecciones Intramusculares/efectos adversos , Quimioterapia de Mantención , Masculino , Persona de Mediana Edad , Mutación , Medición de Resultados Informados por el Paciente , Piridonas/efectos adversos , Piridonas/sangre , ARN Viral/sangre , Rilpivirina/efectos adversos , Rilpivirina/sangre , Carga Viral
6.
Mem Inst Oswaldo Cruz ; 114: e190350, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32022169

RESUMEN

BACKGROUND: Iron homeostasis contribute for the human immunodeficiency virus (HIV) pathogenesis. OBJECTIVES: We assessed the iron intake pattern in antiretroviral naïve Brazilian men living with HIV correlating with clinical and nutritional parameters. METHODS: The iron consumption mean was estimated according to a food frequency questionnaire (FFQ), and a 3-day food record (3dFR) submitted to the patients. HIV viral load, CD4+ T cell counts, serum iron, haematological and anthropometrics parameters were recorded. FINDINGS: Fifty-one HIV-infected adult men naïve for antiretroviral therapy (ART) were enrolled. The mean age of participants was 35 (SEM ± 1.28) years old, with mean time of HIV-1 infection of 1.78 (0-16.36, min-max) years. Majority (41.18%) had complete secondary, and 21.57% had tertiary educational level. The income was around 1x (54.90%) to 2x (41.18%) minimum wage. Fifty-four percent showed normal weight, while 40% were overweight. The patients showed normal mean values of haematological parameters, and mean serum iron was 14.40 µM (SEM ± 0.83). The FFQ showed moderate correlation with the 3dFR (ρ = 0.5436, p = 0.0009), and the mean values of iron intake were 10.55(± 0.92) mg/day, recorded by FFQ, and 15.75(± 1.51) mg/day, recorded by 3dFR. The iron intake, recorded by FFQ, negatively correlated with serum iron (ρ = -0.3448, p = 0.0132), and did not have influence in the CD4+ T cell counts [e.B 0.99 (0.97-1.01, 95% confidence interval (CI), p = 0.2]. However, the iron intake showed a positive effect in HIV viral load [e.B 1.12 (1.02-1.25, 95%CI), p < 0.01]. MAIN CONCLUSIONS: This study draws attention for the importance of iron intake nutritional counseling in people living with HIV. However, more studies are required to clarify the association between high iron intake and HIV infection and outcome.


Asunto(s)
Antirretrovirales/administración & dosificación , Infecciones por VIH/virología , Hierro en la Dieta/efectos adversos , Carga Viral/efectos de los fármacos , Adulto , Recuento de Linfocito CD4 , Estudios Transversales , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/tratamiento farmacológico , Homeostasis , Humanos , Hierro en la Dieta/análisis , Masculino , Estado Nutricional , Factores Socioeconómicos , Encuestas y Cuestionarios
7.
Biosci Trends ; 14(1): 9-15, 2020 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-32074547

RESUMEN

People living with HIV (PLWH) have an excess risk of cardiovascular diseases (CVD). Electrocardiographic (ECG) abnormalities are independently predictive of incident cardiovascular events in the general population. Our study aimed to evaluate the prevalence and correlates of ECG abnormalities among PLWH in Shanghai, China. We used a cross-sectional design to collect data from Shanghai Public Health Clinical Center, China. A total of 587 HIV-infected patients aged between 18 and 75 years were recruited between January 2015 and February 2016. The overall prevalence of any type of ECG abnormalities was 53.3%. The prevalence of sinus tachycardia, ST-T segment elevation and left ventricular hypertrophy was 23.0%, 18.1%, and 6.8%, respectively. Multivariable logistic regression analysis indicated that ST-T segment elevation was positively associated with higher baseline HIV viral load (≥ 4 log10 copies/mL), and sinus tachycardia was negatively associated with older age but positively associated with lower CD4 cell count, higher baseline HIV viral load (≥ 4 log10 copies/mL) and higher lactic dehydrogenase (LDH) level (≥133 mg/dL). Any coded ECG abnormality was positively associated with higher baseline HIV viral load (≥ 4 log10 copies/mL). ECG abnormalities including sinus tachycardia and ST-T segment elevation are prevalent among Chinese HIV patients, which are significantly associated with immunodeficiency and HIV viral load. Routine ECG screening may be an important part of HIV clinical care in China.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Electrocardiografía , Infecciones por VIH/complicaciones , Adolescente , Adulto , Anciano , Recuento de Linfocito CD4 , China/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Carga Viral , Adulto Joven
8.
Medicine (Baltimore) ; 99(8): e19289, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080144

RESUMEN

Achieving the Joint United Nations Program on human immunodeficiency virus (HIV)/AIDS Fast-Track targets requires additional strategies for mobile populations. We examined trends and socio-demographics of migrants (overseas-born) and Australian-born individuals presenting with late and advanced HIV diagnoses between 2008 and 2017 to help inform public health approaches for HIV testing coverage and linkage to care and treatment.We conducted a retrospective population-level observational study of individuals diagnosed with HIV in Australia and reported to the National HIV Registry. Annual proportional trends in late (CD4+ T-cell count <350 cells/µL) and advanced (CD4+ T-cell count <200 cells/µL). HIV diagnoses were determined using Poisson regression.Of 9926 new HIV diagnoses from 2008 to 2017, 84% (n = 8340) were included in analysis. Overall, 39% (n = 3267) of diagnoses were classified as late; 52% (n = 1688) of late diagnoses were advanced. Of 3317 diagnoses among migrants, 47% were late, versus 34% of Australian-born diagnoses (P < .001).The annual proportions of late (incidence rate ratio [IRR] 1.00; 95% confidence interval [CI] 0.99-1.01) and advanced HIV diagnoses (IRR 1.01; 95% CI 0.99-1.02) remained constant. Among migrants with late HIV diagnosis, the proportion reporting male-to-male sex exposure (IRR 1.05; 95% CI 1.03-1.08), non-English speaking (IRR 1.03; 95% CI 1.01-1.05), and individuals born in countries in low HIV-prevalence (IRR 1.02; 95% CI 1.00-1.04) increased. However, declines were noted among some migrants' categories such as females, heterosexual exposure, English speaking, and those born in high HIV-prevalence countries.Late HIV diagnosis remains a significant public health concern in Australia. Small declines in late diagnosis among some migrant categories are offset by increases among male-to-male exposures. Reaching the Fast-Track targets in Australia will require targeted testing and linkage to care strategies for all migrant populations, especially men who have sex with men.


Asunto(s)
Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Migrantes/estadística & datos numéricos , Adolescente , Adulto , Australia/epidemiología , Recuento de Linfocito CD4 , Niño , Preescolar , Diagnóstico Tardío , Femenino , Homosexualidad Masculina , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Personas Transgénero/estadística & datos numéricos , Adulto Joven
9.
Arch Virol ; 165(3): 571-582, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32030535

RESUMEN

Torque teno virus (TTV), torque teno mini virus (TTMV) and torque teno midi virus (TTMDV) are members of the family Anelloviridae that are known to infect humans. Although no pathogenic roles have been associated with anelloviruses, their high prevalence and perceived ubiquitousness have provoked scientific interest in understanding their molecular and biological characteristics. We used nested PCR to determine the prevalence of anelloviruses among 130 human immunodeficiency virus (HIV)-infected patients and 130 healthy blood donors, and analyzed three near-full-length genome sequences of TTV isolates from HIV-infected and non-HIV infected Nigerians. Statistical analysis showed that the rate of TTV infection was significantly higher in the HIV-infected group (65%) than in the blood donor group (26%) (p < 0.05, χ2 = 40.3). TTMV and TTMDV infections were very high in both groups, ranging between 88 and 95%. No significant association was found between TTV infection and age, sex, CD4+ cell count, HIV viral load or alanine aminotransferase (ALT) level. Near-full-length genome sequences of TTV isolates FL100, FL08 and BD67 determined by next-generation sequencing were 3.6 kb, 3.2 kb and 2.9 kb, respectively, in size. Their GenBank accession numbers are MK820644, MK820645, MK820646, respectively. These isolates shared 59% sequence identity across the whole genome and clustered in two different phylogenetic groups. Our study established for the first time the circulation of TTV, TTMV and TTMDV in the Nigerian population, with a disproportionately higher prevalence of TTV in HIV-infected patients. The near-complete TTV genome sequences from Nigeria are similar to the sequences KT163879 and KT163916 (3748 and 3190 respectively), obtained from the plasma of HIV-infected subjects from the United States, and EU305675 (2919), identified in human plasma samples from France.


Asunto(s)
Infecciones por Virus ADN/complicaciones , Infecciones por Virus ADN/virología , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Torque teno virus/aislamiento & purificación , Secuencia de Aminoácidos , Recuento de Linfocito CD4 , Infecciones por Virus ADN/epidemiología , VIH-1 , Humanos , Nigeria/epidemiología , Filogenia , Torque teno virus/clasificación , Carga Viral , Proteínas Virales/química , Proteínas Virales/metabolismo
10.
J Assoc Physicians India ; 68(2): 35-38, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32009360

RESUMEN

Abstract: The interplay between Hepatitis C virus (HCV) and immune system, especially T lymphocytes play a major role in the clearance of virus and in development of liver cell injury resulting in replacement of healthy tissue with fibrous scar tissue. Objectives: To evaluate the association of CD4/CD8 ratio with viral load and genotype of HCV and to evaluate the correlation of CD4/CD8 ratio and CD4 and CD8 cell counts with liver function tests in HCV infected patients. Methods: Forty patients of Chronic Hepatitis C infection were enrolled for study. Immunophenotyping by flowcytometry for measurement of CD4 and CD8 T cell counts was used and the percentages of cells expressing CD4 and CD8 were estimated per lymphocyte population. HCV viral load quantitative was done by Roche Taqman Method. Results: The CD4/CD8 ratio was not found to have any significant correlation with HCV viral load. However, it showed a significant difference in the two HCV genotypes, the ratio being higher in genotype 3 than in genotype 1. It showed no significant correlation with liver function tests except serum albumin which had significant positive correlation with CD4/CD8 ratio. The ratio was also found to be significantly decreased in patients with cirrhosis of liver. Conclusion: Hepatitis C virus genotype but not viral load influences the immune response to HCV infection. The CD4/CD8 ratio significantly decreases in patients with liver cirrhosis than in normal and fatty liver.


Asunto(s)
Hepatitis C Crónica/epidemiología , Cirrosis Hepática/epidemiología , Recuento de Linfocito CD4 , Linfocitos T CD4-Positivos , Linfocitos T CD8-positivos , Genotipo , Hepatitis C , Hepatitis C Crónica/virología , Humanos , Carga Viral
11.
BMC Infect Dis ; 20(1): 27, 2020 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-31924186

RESUMEN

BACKGROUND: Incidence of anal and oral infections with Human Papillomavirus (HPV) is increasing, particularly among Human Immunodeficiency Virus-positive (HIV+) men. HPV type 16 has exhibited the highest incidence and only limited data is available on other prevalent types, variants of HPV16, as well as associated factors. We were interested in identifying prevalent HPV types, variants of type 16, as well as factors associated with HPV16 infections in the oral cavity of HIV+ men who have sex with men (MSM). METHODS: A cross-sectional study of oral cavity samples from HIV+ MSM, that in a previous study were identified as positive for HPV16 in the anal canal. Cells from the oral cavity (102 samples, paired with 102 from the anal canal of same patient) were used to extract DNA and detect HPV infections using INNO-LiPA HPV Genotyping Extra II, and PCR. From these, 80 samples (paired, 40 anal and 40 oral) were used to identify variants of type 16 by sequencing. Statistical differences were estimated by the X2 test, and p values equal to or less than 0.05 were considered significant. SPSS ver. Twenty-four statistical software (IBM Corp) was used. RESULTS: We found a high prevalence of High-Risk HPV (HR-HPV) and Low-Risk HPV (LR-HPV). Patients were positive in the oral cavity for HR types; 16, 39 and 18 (80.4, 61.8 and 52.9% respectively) and LR types 11 and 6 (53.9 and 34.3% respectively). Surprisingly, only European variants of type 16 were found in the oral cavity, although American Asian (22.5%) and African (2.5%) variants were identified in the anal canal. The analysis showed that CD4 counts could be the most important risk factor associated with HR-HPV infections in the oral cavity, anal canal or both anatomical regions. The risk of infection of the oral cavity with type 18 increased in men diagnosed with HIV for more than 6 years. CONCLUSIONS: Prevalence of both HR and LR HPV's in the oral cavity of Mexican HIV+ MSM is very high. The fact that only European variants of HPV16 were found in the oral cavity suggest a possible tropism not previously described.


Asunto(s)
Enfermedades Asintomáticas/epidemiología , Infecciones por VIH/epidemiología , Homosexualidad Masculina , Papillomavirus Humano 16/genética , Enfermedades de la Boca/virología , Infecciones por Papillomavirus/epidemiología , Minorías Sexuales y de Género , Adulto , Canal Anal/virología , Recuento de Linfocito CD4 , Estudios Transversales , Técnicas de Genotipaje , Infecciones por VIH/virología , Humanos , Incidencia , Enfermedades Intestinales/virología , Masculino , México , Persona de Mediana Edad , Boca/virología , Infecciones por Papillomavirus/virología , Reacción en Cadena de la Polimerasa , Prevalencia , Factores de Riesgo , Adulto Joven
12.
Hu Li Za Zhi ; 67(1): 55-65, 2020 Feb.
Artículo en Chino | MEDLINE | ID: mdl-31960397

RESUMEN

BACKGROUND: Early antiretroviral therapy (ART) is recommended as an intervention for HIV by the World Health Organization. However, the association between the CD4 count at ART initiation and the risk of adverse drug reactions (ADRs) remains unclear. PURPOSE: This study aimed to describe the trends related to symptom number and intensity among patients newly diagnosed with HIV in three different CD4-count-based groups and then to investigate the ADR trends for these three groups at different points in time. METHODS: This multi-center cohort study recruited newly diagnosed HIV/AIDS patients who had not previously used ART from AIDS-designated hospitals in Taiwan from March 2015 to December 2016. Study measures were assessed at the time of case enrollment (T0) and during the 1st month (T1), 4-6th month (T2), and 7-9th month (T3) of ART treatment. Patients were stratified into three groups according to initial CD4 count: ≤ 350 cells/mm3, >350-500 cells/mm3 and >500 cells/mm3. Repeated measures ANOVA and generalized estimating equations were used to estimate the relationships between the level of initial CD4 count and ADRs. RESULTS: A total of 207 patients completed the study. Mean symptom numbers and symptom intensities decreased significantly over time in all three groups (p < .01). The largest mean reduction in both symptom number and intensity was achieved by the CD4 count >500 cells/mm3 group. Overall, at least one ADR was reported by 85.7% of the participants at the first month of ART use, and the incidence of ADR had decreased by an average of 22% at the 7-9th month assessment (p < .001). ARDs decreased significantly over time in the CD4 count > 500 cells/mm3 group, with the degrees of ADRs in systematic side effect most significantly decreased in this group (p = .03). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Number and intensity of symptoms significantly improved over time in all three CD4 count groups. The percentage of systematic side effects was most reduced in the CD4 count > 500 cells/mm3 group. The results of this study may be referenced by HIV care providers when discussing with patients the initiation of ART and the potential risks of experiencing ADRs.


Asunto(s)
Antirretrovirales/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/epidemiología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/inmunología , Recuento de Linfocito CD4/estadística & datos numéricos , Estudios de Cohortes , Infecciones por VIH/diagnóstico , Humanos , Taiwán/epidemiología , Factores de Tiempo
13.
BMC Infect Dis ; 20(1): 76, 2020 Jan 28.
Artículo en Inglés | MEDLINE | ID: mdl-31992216

RESUMEN

BACKGROUND: Following migration from Schistosoma and Strongyloides endemic to non-endemic regions, people remain at high risk for adverse sequelae from these chronic infections. HIV co-infected persons are particularly vulnerable to the serious and potentially fatal consequences of untreated helminth infection. While general screening guidelines exist for parasitic infection screening in immigrant populations, they remain silent on HIV positive populations. This study assessed the seroprevalence, epidemiology and laboratory characteristics of these two parasitic infections in a non-endemic setting in an immigrant/refugee HIV positive community. METHODS: Between February 2015 and 2018 individuals born outside of Canada receiving care at the centralized HIV clinic serving southern Alberta, Canada were screened by serology and direct stool analysis for schistosomiasis and strongyloidiasis. Canadian born persons with travel-based exposure risk factors were also screened. Epidemiologic and laboratory values were analyzed using bivariate logistic regression. We assessed the screening utility of serology, direct stool analysis, eosinophilia and hematuria. RESULTS: 253 HIV positive participants were screened. The prevalence of positive serology for Schistosoma and Strongyloides was 19.9 and 4.4%, respectively. Age between 40 and 50 years (OR 2.50, 95% CI 1.13-5.50), refugee status (3.55, 1.72-7.33), country of origin within Africa (6.15, 2.44-18.60), eosinophilia (3.56, 1.25-10.16) and CD4 count < 200 cells/mm3 (2.46, 1.02-5.92) were associated with positive Schistosoma serology. Eosinophilia (11.31, 2.03-58.94) was associated with positive Strongyloides serology. No Schistosoma or Strongyloides parasites were identified by direct stool microscopy. Eosinophilia had poor sensitivity for identification of positive serology. Hematuria was not associated with positive Schistosoma serology. CONCLUSION: Positive Schistosoma and Strongyloides serology was common in this migrant HIV positive population receiving HIV care in Southern Alberta. This supports the value of routine parasitic screening as part of standard HIV care in non-endemic areas. Given the high morbidity and mortality in this relatively immunosuppressed population, especially for Strongyloides infection, screening should include both serologic and direct parasitological tests. Eosinophilia and hematuria should not be used for Schistosoma and Strongyloides serologic screening in HIV positive migrants in non-endemic settings.


Asunto(s)
Esquistosomiasis/epidemiología , Estrongiloidiasis/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adulto , Alberta/epidemiología , Recuento de Linfocito CD4 , Estudios Transversales , Emigrantes e Inmigrantes/estadística & datos numéricos , Eosinofilia/parasitología , Heces/parasitología , Femenino , Infecciones por VIH/parasitología , Humanos , Huésped Inmunocomprometido , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Prevalencia , Refugiados/estadística & datos numéricos , Estudios Seroepidemiológicos , Viaje
14.
Scand J Immunol ; 91(3): e12838, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31630413

RESUMEN

To evaluate the levels of recent thymic emigrant (RTE) CD4+ T cells in HIV-infected children and to explore the associations among their frequency, antiretroviral treatment (ART) adherence, and CD4+ T cell restoration. The group evaluated comprised 85 HIV-infected patients classified as subjects with moderate or severe immunosuppression or as those with no evidence of immunosuppression. To evaluate the association between the frequency of RTE CD4+ T cells and ART adherence, 23 of the 85 patients were evaluated at two different time points during a one-year follow-up period. Children with severe immunosuppression had lower frequencies of RTE CD4+ T cells compared with children without evidence of immunosuppression (P < .001). The frequency of RTE CD4+ T cells in children with a high rate of adherence was significantly higher (P < .05) than that observed among those with suboptimal adherence. The latter group presented with infectious intercurrences on admission that decreased after initiation of treatment along with improved CD4+ and RTE naïve CD4+ T cells counts. The adequate ART adherence is essential for immune reconstitution, which might be reflected by the levels of RTE CD4+ T cells.


Asunto(s)
Recuento de Linfocito CD4 , Linfocitos T CD4-Positivos/inmunología , Infecciones por VIH/inmunología , VIH-1/inmunología , Timocitos/inmunología , Adolescente , Terapia Antirretroviral Altamente Activa , Biomarcadores , Linfocitos T CD4-Positivos/metabolismo , Movimiento Celular , Niño , Preescolar , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Inmunofenotipificación , Lactante , Masculino , Cumplimiento de la Medicación , Timocitos/metabolismo , Resultado del Tratamiento , Carga Viral
15.
Int J Cancer ; 146(3): 601-609, 2020 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-31215037

RESUMEN

We compared invasive cervical cancer (ICC) incidence rates in Europe, South Africa, Latin and North America among women living with HIV who initiated antiretroviral therapy (ART) between 1996 and 2014. We analyzed cohort data from the International Epidemiology Databases to Evaluate AIDS (IeDEA) and the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) in EuroCoord. We used flexible parametric survival models to determine regional ICC rates and risk factors for incident ICC. We included 64,231 women from 45 countries. During 320,141 person-years (pys), 356 incident ICC cases were diagnosed (Europe 164, South Africa 156, North America 19 and Latin America 17). Raw ICC incidence rates per 100,000 pys were 447 in South Africa (95% confidence interval [CI]: 382-523), 136 in Latin America (95% CI: 85-219), 76 in North America (95% CI: 48-119) and 66 in Europe (95% CI: 57-77). Compared to European women ICC rates at 5 years after ART initiation were more than double in Latin America (adjusted hazard ratio [aHR]: 2.43, 95% CI: 1.27-4.68) and 11 times higher in South Africa (aHR: 10.66, 95% CI: 6.73-16.88), but similar in North America (aHR: 0.79, 95% CI: 0.37-1.71). Overall, ICC rates increased with age (>50 years vs. 16-30 years, aHR: 1.57, 95% CI: 1.03-2.40) and lower CD4 cell counts at ART initiation (per 100 cell/µl decrease, aHR: 1.25, 95% CI: 1.15-1.36). Improving access to early ART initiation and effective cervical cancer screening in women living with HIV should be key parts of global efforts to reduce cancer-related health inequities.


Asunto(s)
Infecciones por VIH/complicaciones , Disparidades en el Estado de Salud , Neoplasias del Cuello Uterino/epidemiología , Adolescente , Adulto , Factores de Edad , Antirretrovirales/uso terapéutico , Recuento de Linfocito CD4 , Comparación Transcultural , Detección Precóz del Cáncer , Europa (Continente)/epidemiología , Femenino , Estudios de Seguimiento , Infecciones por VIH/sangre , Infecciones por VIH/tratamiento farmacológico , Humanos , Incidencia , América Latina/epidemiología , Persona de Mediana Edad , América del Norte/epidemiología , Factores de Riesgo , Sudáfrica/epidemiología , Neoplasias del Cuello Uterino/complicaciones , Neoplasias del Cuello Uterino/prevención & control , Adulto Joven
16.
BMC Infect Dis ; 19(1): 1024, 2019 Dec 03.
Artículo en Inglés | MEDLINE | ID: mdl-31795955

RESUMEN

BACKGROUND: In 2018 in Ethiopia, magnitude of human immunodeficiency virus Acquired Immunodeficiency Syndrome treatment failure was 15.9% and currently the number of patient receiving second line antiretroviral therapy (ART) is more increasing than those taking first line ART. Little is known about the predictors of treatment failure in the study area. Therefore; more factors that can be risk for first line ART failure have to identified to make the patients stay on first line ART for long times. Consequently, the aim of this study was to identify determinants of first line ART treatment failure among patients on ART at St. Luke referral hospital and Tulubolo General Hospital, 2019. METHODS: A 1:2 un-matched case-control study was conducted among adult patients on active follow up. One new group variables was formed as group 1 for cases and group 0 for controls and then data was entered in to Epi data version 3 and exported to STATA SE version 14 for analysis. From binary logistic regression variables with p value ≤0.25 were a candidate for multiple logistic regression. At the end variables with a p-value ≤0.05 were considered as statistically significant. RESULT: A total of 350 (117 cases and 233 controls) patients were participated in the study. Starting ART after 2 years of being confirmed HIV positive (AOR = 3.82 95% CI 1.37,10.6), nevirapine (NVP) based initial ART (AOR = 2.77,95%CI 1.22,6.28) having history of lost to follow up (AOR 3.66,95%CI 1.44,9.27) and base line opportunistic infection (AOR = 1.97,95%CI 1.06,3.63), staying on first line ART for greater than 5 years (AOR = 3.42,95%CI 1.63,7.19) and CD4 less than100cell/ul (AOR = 2.72,95%CI 1.46,5.07) were independent determinants of first line ART treatment failure. CONCLUSION: Lost to follow up, staying on first line ART for greater than 5 years, presence of opportunistic infections, NVP based NNRT, late initiation of ART are determinant factors for first line ART treatment failure. The concerned bodies have to focus and act on those identified factors to maintain the patient on first line ART.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Antirretrovirales/uso terapéutico , Nevirapina/uso terapéutico , Adulto , Recuento de Linfocito CD4 , Estudios de Casos y Controles , Etiopía , Femenino , Estudios de Seguimiento , Seropositividad para VIH/tratamiento farmacológico , Hospitales Generales , Humanos , Modelos Logísticos , Perdida de Seguimiento , Masculino , Persona de Mediana Edad , Análisis Multivariante , Infecciones Oportunistas/tratamiento farmacológico , Centros de Atención Secundaria , Insuficiencia del Tratamiento , Adulto Joven
17.
Anticancer Res ; 39(12): 6887-6893, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31810958

RESUMEN

BACKGROUND/AIM: Little information is available about the association between peripheral T-lymphocyte expression of programmed cell death protein 1 (PD1) and the efficacy of immune checkpoint inhibitor therapy in patients with non-small cell lung cancer (NSCLC). We analyzed the PD1 and cytotoxic T-lymphocyte associated protein 4 (CTLA4) expression in peripheral blood T-lymphocytes of patients with NSCLC receiving immune checkpoint inhibitor therapy. PATIENTS AND METHODS: Patients with NSCLC who were scheduled to receive treatment with immune checkpoint inhibitors were prospectively enrolled in this study between November 2017 and November 2018. Peripheral blood samples were obtained within 1 week before or after the initiation of treatment with an immune checkpoint inhibitor. RESULTS: Flow cytometry was conducted in 19 patients. Patients were treated with nivolumab, pembrolizumab, or atezolizumab. The group with a high percentage of PD1+CD4+ T-lymphocytes relative to the total CD4+ T-lymphocyte count had a longer progression-free survival [median=6.0 (95% confidence intervaI=0.5-not estimated) months] than the group with a low percentage of PD1+CD4+ T-lymphocytes [median=1.1 (95% confidence intervaI=0.4-5.0) months; p=0.034, log-rank test]. However, no significant associations were detected with the percentages of CTLA4+CD4+, PD1+CD8+ or CTLA4+CD8+ T-lymphocytes in the peripheral blood. CONCLUSION: A high percentage of peripheral CD4+PD1+ T-lymphocytes was associated with a longer progression-free survival in patients receiving treatment with an immune checkpoint inhibitor. The systemic immune system may have an influence on the efficacy of immune checkpoint inhibitor therapy in patients with NSCLC.


Asunto(s)
Antineoplásicos Inmunológicos/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Receptor de Muerte Celular Programada 1/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales Humanizados/uso terapéutico , Recuento de Linfocito CD4 , Carcinoma de Pulmón de Células no Pequeñas/inmunología , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Pulmonares/inmunología , Masculino , Persona de Mediana Edad , Nivolumab/uso terapéutico , Pronóstico , Estudios Prospectivos , Resultado del Tratamiento
18.
S Afr Med J ; 109(12): 919-926, 2019 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-31865953

RESUMEN

BACKGROUND: World Health Organization guidelines recommend that HIV patients who do not achieve viral suppression on efavirenz-based first-line antiretroviral therapy (ART) should be changed to a protease inhibitor (PI)-based regimen. In South Africa (SA), ~200 000 people are on second-line treatment, but little is known about these patients. OBJECTIVES: To describe second-line black African patients in a large urban area. METHODS: A quantitative retrospective study of 825 second-line patients in central Johannesburg, SA (subdistrict F), was performed with data extracted from government databases. Demographic characteristics, treatment status and laboratory information were gathered, then analysed with CD4+ cell count, viral load (VL) and retention-in-care data as outcome variables. RESULTS: The average recorded time to VL measurement after the switch to a PI-based ART regimen was 20 months, and 83.1% (570/686) of patients with a recent VL achieved viral suppression while on second-line treatment. The most recent median CD4+ cell count for the cohort was 286 cells/µL (interquartile range 160 - 478), which represented a 177 cells/µL increase from the baseline count at the start of first-line ART. Slightly less than three-quarters (72.4%) of the population remained active in care in the study clinics from initiation on first-line ART. Demographic characteristics such as being <25 years of age, male sex and geographical transfer (started initial treatment in a different region) independently predicted low CD4+ cell counts and virological failure on second-line treatment. Patients with virological failure were most likely (odds ratio (OR) 3.13, 95% confidence interval (CI) 1.50 - 6.56) to be lost to follow-up after the switch, while patients from Hillbrow Community Health Centre (OR 0.27, 95% CI 0.16 - 0.44), South Rand Hospital (OR 0.24, 95% CI 0.12 - 0.47) and Jeppe Clinic (OR 0.38, 95% CI 0.16 - 0.88), three larger sites, were most likely to remain active in care. CONCLUSIONS: VL suppression was high in patients on second-line treatment, but one-fifth of patients were lost to follow-up. Younger age, male sex and transfer from other treatment sites predicted poor treatment outcomes, highlighting opportunities for prioritisation of adherence interventions.


Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , Carga Viral , Adulto , Factores de Edad , Recuento de Linfocito CD4 , Bases de Datos Factuales , Quimioterapia Combinada , Femenino , Infecciones por VIH/inmunología , Humanos , Lamivudine/uso terapéutico , Lopinavir/uso terapéutico , Perdida de Seguimiento , Masculino , Persona de Mediana Edad , Retratamiento , Estudios Retrospectivos , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Ritonavir/uso terapéutico , Factores Sexuales , Tenofovir/uso terapéutico , Insuficiencia del Tratamiento , Organización Mundial de la Salud , Zidovudina/uso terapéutico
19.
PLoS One ; 14(12): e0225415, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31869342

RESUMEN

A significant proportion of HIV-infected patients experiencing a late diagnosis highlights the need to define immunological protocols able to help the clinicians in identifying patients at higher risk for immunological failure. The aim of the study was to evaluate the feasibility of easy cytometric tests in defining the effect of antiretroviral treatment (cART) on immunological homeostasis and in identifying predictive markers of early immune recovery. Chronic HIV infected patients (n = 202) were enrolled in a prospective multicentric study, and their immunological profile was studied before (w0) and after 24 weeks (w24) of antiretroviral treatment (cART) using a standardized flow cytometric panel. Based on CD4 T cell count before treatment, patients were divided in late (LP: CD4 <350/mmc), intermediate (IP: 350/mmc500/mmc) presenters. In all groups, cART introduction increased CD4 and CD4/CD8 T cell ratio, naïve T cell (CD4 and CD8) and CD127-expressing CD4 T cells. In parallel, cART significantly reduced effector memory T cells (CD4 and CD8) and T cell activation (CD38+CD8 and CD95+CD4 T cells). Moreover, the frequency of Naïve and Effector CD4 T cells before treatment correlated with several immune parameters key associated with the pathogenesis of HIV, thus mirroring the health of immune system. Interestingly, we identified the Naïve/Effector CD4 T cell ratio (N/EM) at w0 as a marker able to predict early immune recovery. Specifically, in LP, N/EM ratio was significantly higher in immunological responder patients (CD4>500/mmc at w24) when compared to immunological non responder (CD4 T cells <500/mmc at w24). Finally, a multivariate analysis indicates that after 24w patients with N/EM ratio higher than 1.86 at w0 recovered 96 CD4 T cells more than those with N/EM ratio lower than 0.46. Altogether, our data define an easy protocol able to define reliable immunological markers useful for the characterization of immune profile in viremic HIV patients and identify the naïve/effector CD4 T cell ratio as a new tool able to predict an early immune reconstitution potential.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Linfocitos T CD4-Positivos/inmunología , Infecciones por VIH/inmunología , Reconstitución Inmune , Adulto , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento
20.
Rev Chilena Infectol ; 36(4): 469-474, 2019 Aug.
Artículo en Español | MEDLINE | ID: mdl-31859771

RESUMEN

BACKGROUND: HIV (+) patients have a higher risk of oral infections with high oncogenic risk HPV (HPV-HR). AIM: To determine the HPV genotypes in oral papillomatous lesions in HIV (+) patients and describe the associated factors. METHODS: Eight adults HIV (+) subjects with papillomatous HPV lesions were studied. The lesions DNA was extracted and HPV genome and genotypes were detected by PCR and the commercial kit HPV 3.5 LCD-Array Kit (Chipron®) and associated factors were described. RESULTS: 63% of patients exhibited more than one HPV genotype and 75% of them exhibited at least 1 HPV-HR genotype. The most frequent genotype was HPV 52 (27%), followed by HPV 16 and 56 (18%). The mean CD4 T lymphocyte count in patients with at least one HPV-HR genotype was 330.6 cells/mm3. CONCLUSIONS: A higher frequency of multiple HPV infections was detected, including at least one high-risk genotype. The genotype HPV-AR 52 was the most frequent. The mean CD4 T lymphocyte count in patients with at least one HPV-HR genotype indicates moderate immunosuppression. It is required to increase the number of patients.


Asunto(s)
Infecciones por VIH/virología , Neoplasias de la Boca/virología , Papiloma/virología , Papillomaviridae/genética , Infecciones por Papillomavirus/virología , Adulto , Recuento de Linfocito CD4 , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Papillomaviridae/aislamiento & purificación , Carga Viral , Adulto Joven
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