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1.
Medicine (Baltimore) ; 99(52): e23853, 2020 Dec 24.
Artículo en Inglés | MEDLINE | ID: mdl-33350777

RESUMEN

INTRODUCTION: The association of human immunodeficiency virus (HIV) infection with Burkitt lymphoma is related to the presence of Epstein Barr virus infection and the impact of the HIV antigen on the expansion of B-polyclonal cells. In Southeast Europe, the association is rare, and recognizing this is important in the therapeutic decision to increase patient survival rate. The association of HIV with Burkitt lymphoma and tuberculosis is even more rarely described in the literature. PATIENT CONCERNS: We present the case of a 40-year-old patient who presented with a 3-week history of fever (max. 38.7 °C), painful axillary swelling on the right side, lumbar pain, gait disorders, headache, and night sweats. Clinical manifestations included marked weight loss (about 30 kg in the last 2 months before his admission). DIAGNOSIS: A LyCD4 count of 38/µL and a HIV1 viral load of 384,000/mm3, classified the patient into a C3 stage. A biopsy of the right axillary lymph node was performed for suspected ganglionic tuberculosis due to immunodeficiency. Histopathological examination confirmed the diagnosis of Burkitt lymphoma. Cultures on Löwenstein-Jensen medium from sputum harvested at first admission were positive for Mycobacterium tuberculosis. INTERVENTIONS: Highly active antiretroviral therapy, chemotherapeutic agents for Burkitt lymphoma, anti-tuberculous drug therapy, neurosurgical intervention of spinal cord decompression, and antibiotic therapy of the associated bacterial infection. OUTCOME: Burkitt lymphoma disseminated rapidly, with central nervous system, spinal cord, osteomuscular, adrenal, and spleen involvement. The evolution under treatment was unfavorable, with patient death occurring 6 months after diagnosis. CONCLUSIONS: The association of HIV infection with Burkitt lymphoma and tuberculosis is rare in the highly active antiretroviral therapy (HAART) era, posing prompt and multidisciplinary therapeutic management issues. Similar cases of HIV-TB and Burkitt lymphoma association have been described, but none of the other cases showed the involvement of the central nervous system or of the bilateral adrenal glands.


Asunto(s)
Antineoplásicos/administración & dosificación , Terapia Antirretroviral Altamente Activa/métodos , Antituberculosos/administración & dosificación , Encéfalo , Linfoma de Burkitt , Infecciones por VIH , Médula Espinal , Tuberculosis Pulmonar , Adulto , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Linfoma de Burkitt/complicaciones , Linfoma de Burkitt/patología , Linfoma de Burkitt/fisiopatología , Linfoma de Burkitt/cirugía , Recuento de Linfocito CD4/métodos , Deterioro Clínico , Descompresión Quirúrgica/métodos , Resultado Fatal , Infecciones por VIH/sangre , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Procedimientos Neuroquirúrgicos/métodos , Médula Espinal/diagnóstico por imagen , Médula Espinal/patología , Médula Espinal/cirugía , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/fisiopatología , Tuberculosis Pulmonar/terapia , Carga Viral/métodos
2.
S Afr Med J ; 110(2): 126-131, 2020 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-32657683

RESUMEN

BACKGROUND: Point-of-care (POC) CD4+ technologies have the potential to increase patient access to treatment and care through rapid testing and result delivery at or close to where patients seek care. South African (SA) guidelines suggest the use of CD4+ testing to prioritise patients most in need of antiretroviral therapy (ART) and to support identification of patients with advanced HIV disease and opportunistic management of patients on ART. Understanding the patient impact of implementing POC CD4+ testing in the intended setting and operated by lower cadres of healthcare worker or non-professional healthcare facility staff will provide valuable insight into the appropriate use and placement of POC CD4+ technologies throughout SA. OBJECTIVES: To determine the patient impact (turnaround time of tests, loss to follow-up, and proportions of eligible patients proceeding to the next steps in the testing and treatment cascade) of implementing POC CD4+ testing technologies compared with conventional laboratory-based CD4+ testing. METHODS: This retrospective cohort study included all HIV-positive adults from 30 healthcare facilities in Free State Province, SA. Healthcare facilities were placed into two groups (POC and laboratory referral) using a stratified randomisation technique based on the presence of a POC CD4+ technology and minimal ART volumes. Patients who received a CD4+ test prior to ART initiation between September 2012 and September 2014 were included. Data were collected from patient charts and the POC devices. RESULTS: For new patients, the average time from HIV diagnosis and CD4+ testing was reduced from 7.6 days in the laboratory referral group to 4.5 days in the POC group, a decrease of almost 60%. Additionally, 59.6% of patients in the POC group received their HIV diagnosis and CD4+ test result on the same day, compared with 37.5% in the laboratory referral group (risk ratio (RR) 1.49; 95% confidence interval (CI) 1.01 - 2.18). Fewer patients were lost between HIV diagnosis and CD4+ testing (2.7% v. 8.6%) (RR 0.02; 95% CI 0.05 - 0.78) in the POC group. The average test error rate across the study time period was 8.4%; however, the error rate remained <5% for the final 5 months of the study. CONCLUSIONS: Introduction of the Alere Pima POC CD4+ technology in the Free State, operated by nurses and lay counsellors, was associated with positive patient outcomes across all parameters analysed. While this study highlighted an effective conventional laboratory network, a full costing and affordability analysis coupled with patient impact and access data from this study will provide further insight into the potential deployment strategies of POC CD4+ technologies in SA.


Asunto(s)
Recuento de Linfocito CD4/métodos , Infecciones por VIH/diagnóstico , Sistemas de Atención de Punto , Pruebas en el Punto de Atención , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , Sudáfrica
3.
Sci Rep ; 10(1): 9474, 2020 06 11.
Artículo en Inglés | MEDLINE | ID: mdl-32528044

RESUMEN

BACKGROUND: Incidental findings are a well-known complication of imaging studies done for both diagnostic and research purposes. Little is known about the rates and types of incidental findings found on brain MRI in patients with HIV infection, who may be at risk for HIV-Associated Neurocognitive Disorders (HAND). METHODS: The parent study included 108 adults with HIV infection and 125 demographically-matched uninfected controls who completed MRI and neuropsychological testing. Incidental findings were classified by the study team as vascular, neoplastic, congenital, other neurologic, or non-neurologic. Categorical measures were compared using Pearson chi-square tests; continuous measures were compared using t-tests. RESULTS: Among participants with HIV infection, 36/108 (33%) had incidental findings compared to 33/125 (26%) controls (p = 0.248). Rates of incidental findings were significantly correlated with increasing age in both participants with HIV infection (p = 0.013) and controls (p = 0.022). We found no correlation between presence of incidental findings and sex or race/ethnicity among either cohort, and no correlation with CD4 count or HAND status for the HIV-infected cohort. CONCLUSIONS: Incidental findings were common in both participants with HIV infection and controls, at higher rates than previously reported in healthy populations. There was no significant difference in prevalence between the groups.


Asunto(s)
Encéfalo/patología , Infecciones por VIH/complicaciones , Infecciones por VIH/patología , Adulto , Anciano , Encéfalo/virología , Recuento de Linfocito CD4/métodos , Estudios de Cohortes , Femenino , Infecciones por VIH/virología , Humanos , Hallazgos Incidentales , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Adulto Joven
4.
BMC Public Health ; 20(1): 528, 2020 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-32306930

RESUMEN

BACKGROUND: Mobile HIV testing services (HTS) are effective at reaching undiagnosed people living with HIV. However, linkage to HIV care from mobile HTS is often poor, ranging from 10 to 60%. Point-of-care (POC) CD4 testing has shown to increase retention in health facilities, but little evidence exists about their use in mobile HTS. This study assessed the feasibility of POC CD4 test implementation and investigated linkage to HIV care among clients accepting a POC test at community-based mobile HTS. METHODS: This retrospective study used routinely collected data from clients who utilized community-based mobile HTS in the City of Cape Town Metropolitan district, South Africa between December 2014 and September 2016. A POC CD4 test was offered to all clients with an HIV positive diagnosis during this period, and a CD4 cell count was provided to clients accepting a POC CD4 test. Random effects logistic regression was used to assess factors associated with POC CD4 test uptake and self-reported linkage to care among clients accepting a POC test. Models were adjusted for sex, age, previous HIV test done, tuberculosis status and year of HIV diagnosis. RESULTS: One thousand three hundred twenty-five of Thirty-nine thousand seven hundred ninety clients utilizing mobile HTS tested HIV positive (3%). 51% (679/1325) accepted a POC test. The age group with the highest proportion accepting a POC test was 50+ years (60%). Females were less likely to accept a POC test than males (odds ratio = 0.7, 95%CI = 0.6-0.8). Median CD4 count was 429 cells/µl (interquartile range = 290-584). Among 679 clients who accepted a POC CD4 test, 491 (72%) linked to HIV care. CD4 cell count was not associated with linkage to care. CONCLUSION: Our findings suggest that mobile HTS can identify early HIV infection, and show that a high proportion of clients with a POC test result linked to care. Future research should assess factors associated with POC test acceptance and assess the impact of POC CD4 testing in comparison to alternative strategies to engage HIV positive people in care.


Asunto(s)
Recuento de Linfocito CD4/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Sistemas de Atención de Punto/estadística & datos numéricos , Adulto , Recuento de Linfocito CD4/métodos , Femenino , VIH , Humanos , Modelos Logísticos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Unidades Móviles de Salud , Estudios Retrospectivos , Sudáfrica
5.
PLoS One ; 15(4): e0230453, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32243435

RESUMEN

BACKGROUND: In sub-Saharan Africa, a third of people starting antiretroviral therapy and majority of patients returning to HIV-care after disengagement, present with advanced HIV disease (ADH), and are at high risk of mortality. Simplified and more affordable point-of-care (POC) diagnostics are required to increase access to prompt CD4 cell count screening for ambulatory and asymptomatic patients. The Visitect CD4 Lateral Flow Assay (LFA) is a disposable POC test, providing a visually interpreted result of above or below 200 CD4cells/mm3. This study evaluated the diagnostic performance of this index test. METHODS: Consenting patients above 18years of age and eligible for CD4 testing were enrolled in Nsanje district hospital (Malawi), Gutu mission hospital (Zimbabwe) and Centre hopitalier de Kabinda (DRC). A total of 708 venous blood samples were tested in the index test and in the BD FACSCount assay (reference test method) in the laboratories (Phase 1) to determine diagnostic accuracy. A total of 433 finger-prick (FP) samples were tested on the index test at POC by clinicians (Phase 2) and a self-completed questionnaire was administered to all testers to explore usability of the index test. RESULTS: Among 708 patients, 67.2% were female and median CD4 was 297cells/mm3. The sensitivity of the Visitect CD4 LFA using venous blood in the laboratory was 95.0% [95% CI: 91.3-97.5] and specificity was 81.9% [95% CI: 78.2-85.2%]. Using FP samples, the sensitivity of the Visitect CD4 LFA was 98.3% [95% CI: 95.0-99.6] and specificity was 77.2% [95% CI: 71.6-82.2%]. Usability of the Visitect CD4 LFA was high across the study sites with 97% successfully completed tests. Due to the required specific multiple incubation and procedural steps during the Visitect CD4 LFA testing, few health workers (7/26) were not confident to manage testing whilst multi-tasking in their clinical work. CONCLUSIONS: Visitect CD4 LFA is a promising test for decentralized CD4 screening in resource-limited settings, without access to CD4 testing and and it can trigger prompt management of patients with AHD. Lay health cadres should be considered to conduct Visitect CD4 LFA testing in PHCs as well as coordinating all other POC quality assurance.


Asunto(s)
Recuento de Linfocito CD4/métodos , Infecciones por VIH/diagnóstico , Tamizaje Masivo , Adulto , Femenino , Infecciones por VIH/epidemiología , Humanos , Malaui/epidemiología , Persona de Mediana Edad , Pruebas en el Punto de Atención , Pruebas Serológicas , Zimbabwe/epidemiología
6.
PLoS One ; 15(4): e0230772, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32267847

RESUMEN

In 31 participants who started first-line antiretroviral therapy in the NEAT 001/ANRS 143 clinical trial, we found after 96 weeks a statistically significant increase in blood telomere length (TL) of 0.04 (T/S Ratio) (p = 0.03). This increase was positively correlated with both the change in the percentage of CD4+ T-cells and with the decrease of CD38+ molecules on Central Memory CD8+ and negatively correlated with the change in the percentage of CD4+ Effector Memory cells. Increase in TL could be an expression of immune reconstitution and the associated decrease in immune activation. We acknowledge for the low statistical power due to the small sample size and the potential for false positive results due to multiple testing. Hence, further studies are needed to confirm these observations.


Asunto(s)
Antirretrovirales/inmunología , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Infecciones por VIH/inmunología , Subgrupos de Linfocitos T/inmunología , Telómero/inmunología , ADP-Ribosil Ciclasa 1/inmunología , Adulto , Antirretrovirales/uso terapéutico , Terapia Antirretroviral Altamente Activa/métodos , Recuento de Linfocito CD4/métodos , Femenino , Infecciones por VIH/tratamiento farmacológico , Seropositividad para VIH/inmunología , VIH-1/efectos de los fármacos , VIH-1/inmunología , Humanos , Memoria Inmunológica/inmunología , Inmunofenotipificación/métodos , Activación de Linfocitos/inmunología , Masculino , Persona de Mediana Edad , Carga Viral/inmunología
7.
J Acquir Immune Defic Syndr ; 83(5): 522-529, 2020 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-31917752

RESUMEN

BACKGROUND: Interventions aiming for an HIV cure would benefit from rapid elimination of virus after the onset of antiretroviral therapy (ART), by keeping the latent HIV reservoir small. SETTING: We investigated HIV suppression in 312 perinatally infected infants starting ART within 6 months after birth from the EPPICC (European Pregnancy and Paediatric HIV Cohort Collaboration). METHODS: To better understand kinetic differences in HIV suppression among infants, we investigated their individual viral load (VL) decay dynamics. We identified VL decay patterns and determined times to viral suppression (TTS). For infants with strictly declining VLs (n = 188), we used parameter fitting methods to estimate baseline VLs, decay rates, and TTS. We subsequently identified the parameters determining TTS by linear modeling. RESULTS: The majority of infants suppress HIV VL after the onset of ART. Some children experienced a long TTS due to an "erratic" VL decay pattern. We cannot exclude that this is partly due to treatment complications and subsequent treatment changes, but these children were characterized by significantly lower CD4 percentages (CD4%) at start of treatment compared with those with a "clean" VL decline. Focusing on this "clean" subset, the TTS could be predicted by mathematical modeling, and we identified baseline VL and CD4% as the major factors determining the TTS. CONCLUSIONS: As VL steeply increases and CD4% constantly decreases in untreated HIV-infected infants, the progression of an HIV infection is largely determined by these 2 factors. To prevent a further disease progression, treatment should be initiated early after contracting HIV, which consequently shortens TTS.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Recuento de Linfocito CD4/métodos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Carga Viral/efectos de los fármacos , Linfocitos T CD4-Positivos , Estudios de Cohortes , Femenino , VIH-1 , Humanos , Lactante , Recién Nacido , Masculino , Modelos Teóricos , Embarazo , Latencia del Virus
8.
Med Decis Making ; 40(1): 3-16, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31865849

RESUMEN

Background. Heterogeneity in HIV microepidemics across US cities necessitates locally oriented, combination implementation strategies to prioritize resources. We calibrated and validated a dynamic, compartmental HIV transmission model to establish a status quo treatment scenario, holding constant current levels of care for 6 US cities. Methods. Built off a comprehensive evidence synthesis, we adapted and extended a previously published model to replicate the transmission, progression, and clinical care for each microepidemic. We identified a common set of 17 calibration targets between 2012 and 2015 and used the Morris method to select the most influential parameters for calibration. We then applied the Nelder-Mead algorithm to iteratively calibrate the model to generate 2000 best-fitting parameter sets. Finally, model projections were internally validated with a series of robustness checks and externally validated against published estimates of HIV incidence, while the face validity of 25-year projections was assessed by a Scientific Advisory Committee (SAC). Results. We documented our process for model development, calibration, and validation to maximize its transparency and reproducibility. The projected outcomes demonstrated a good fit to calibration targets, with a mean goodness-of-fit ranging from 0.0174 (New York City [NYC]) to 0.0861 (Atlanta). Most of the incidence predictions were within the uncertainty range for 5 of the 6 cities (ranging from 21% [Miami] to 100% [NYC]), demonstrating good external validity. The face validity of the long-term projections was confirmed by our SAC, showing that the incidence would decrease or remain stable in Atlanta, Los Angeles, NYC, and Seattle while increasing in Baltimore and Miami. Discussion. This exercise provides a basis for assessing the incremental value of further investments in HIV combination implementation strategies tailored to urban HIV microepidemics.


Asunto(s)
Infecciones por VIH/transmisión , Recuento de Linfocito CD4/métodos , Recuento de Linfocito CD4/estadística & datos numéricos , Calibración/normas , Ciudades/estadística & datos numéricos , Simulación por Computador , Epidemias/prevención & control , Epidemias/estadística & datos numéricos , Infecciones por VIH/epidemiología , Infecciones por VIH/mortalidad , Humanos , Incidencia , Mortalidad/tendencias , Vigilancia de la Población/métodos , Reproducibilidad de los Resultados , Factores de Riesgo , Factores Sexuales , Sexualidad/estadística & datos numéricos , Estados Unidos/epidemiología
9.
Sci Rep ; 9(1): 19946, 2019 12 27.
Artículo en Inglés | MEDLINE | ID: mdl-31882580

RESUMEN

Persons infected with HIV are particularly vulnerable to a variety of oral microbial diseases. Although various study designs and detection approaches have been used to compare the oral microbiota of HIV-negative and HIV-positive persons, both with and without highly active antiretroviral therapy (HAART), methods have varied, and results have not been consistent or conclusive. The purpose of the present study was to compare the oral bacterial community composition in HIV-positive persons under HAART to an HIV-negative group using 16S rRNA gene sequence analysis. Extensive clinical data was collected, and efforts were made to balance the groups on clinical variables to minimize confounding. Multivariate analysis was used to assess the independent contribution of HIV status. Eighty-nine HIV-negative participants and 252 HIV-positive participants under HAART were sampled. The independent effect of HIV under HAART on the oral microbiome was statistically significant, but smaller than the effect of gingivitis, periodontal disease, smoking, caries, and other clinical variables. In conclusion, a multivariate comparison of a large sample of persons with HIV under HAART to an HIV-negative control group showed a complex set of clinical features that influenced oral bacterial community composition, including the presence of HIV under HAART.


Asunto(s)
Caries Dental/microbiología , Infecciones por VIH/microbiología , Microbiota/efectos de los fármacos , Adulto , Antirretrovirales/farmacología , Terapia Antirretroviral Altamente Activa/métodos , Recuento de Linfocito CD4/métodos , Femenino , Infecciones por VIH/tratamiento farmacológico , VIH-1/efectos de los fármacos , VIH-1/patogenicidad , Humanos , Masculino , Metagenómica/métodos , Análisis Multivariante , ARN Ribosómico 16S/genética
10.
Cent Eur J Public Health ; 27(3): 217-222, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31580557

RESUMEN

OBJECTIVES: Individuals with HIV infection are at an increased risk for a number of infectious diseases, some of which are preventable by vaccination. Unfortunately, little is known about the attitudes of this population group to vaccination, therefore, we decided to find out vaccination coverage against 5 infections among newly diagnosed HIV-infected patients in the Czech Republic. METHODS: This cross-sectional study was conducted on newly diagnosed patients who started their follow-up care at the HIV Clinic of Na Bulovce Hospital during the two following years. Vaccination history data and results of serological tests were collected from all participants. RESULTS: Enrolled were 269 HIV-positive subjects (94.1% males) with a mean age of 34.4 years, 64 subjects (23.8%) had tertiary education, 229 (85.1%) were men having sex with men, 32 (11.9%) were heterosexual, and 8 (3.0%) were injection drug users. The mean CD4+ T-lymphocyte count was 556.2/µL, with 149 persons (55.4%) who had a CD4+ T-lymphocyte count > 500/µL, and 68 (25.3%) individuals were late presenters with CD4+ T-lymphocyte count < 350/µL. A vaccination against tetanus was reported by 262 subjects (97.4%), against influenza by 18 subjects (6.7%), against tick-borne encephalitis by 18 subjects (6.7%), against viral hepatitis A by 78 persons (29.0%), and against hepatitis B by 104 subjects (38.7%). For influenza, tick-borne encephalitis and hepatitis A, a significant positive impact of tertiary education was found (p-values < 0.001-0.044). Vaccination coverage against both types of hepatitis was significantly lower in late presenters (p = 0.044 and p = 0.004, respectively). CONCLUSIONS: Vaccination rates found in our cohort were except tetanus and hepatitis B in young people low, especially for influenza and tick-borne encephalitis. Higher level of education and less advanced HIV infection were associated with higher vaccination rates. To improve this unsatisfactory situation, more attention should be paid to vaccination.


Asunto(s)
Infecciones por VIH , Cobertura de Vacunación , Adolescente , Adulto , Recuento de Linfocito CD4/métodos , Estudios Transversales , República Checa , Infecciones por VIH/diagnóstico , Humanos , Masculino
11.
Cent Eur J Public Health ; 27(3): 229-234, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31580559

RESUMEN

OBJECTIVE: Late presentation of the patients with human immunodeficiency virus (HIV) infection is associated with less favourable treatment responses, more accelerated clinical progression, and a higher mortality risk. Although HIV prevalence is low in Turkey, it is steadily increasing and the information about late presentation among HIV-positives is limited. We aimed to analyze the status of late presentation among HIV-positive patients in Turkey. METHODS: All newly diagnosed HIV/AIDS patients from 2003 to 2016 were enrolled in this study by five dedicated centres in Istanbul, Turkey. Demographic data, CD4+ counts, and HIV RNA were collected from medical records and were transferred to a HIV database system. Late pre- sentation was defined as presentation for care with a CD4 count < 350 cells/mm3 or presentation with an AIDS-defining event, regardless of the CD4 cell count. A medical literature search was done for the analysis of late presentation in Turkey. RESULTS: The cohort included 1,673 patients (1,440 males, median age 35 years). Among them, 847 (50.6%) had an early diagnosis, with a CD count of more than 350 cells/mm3. The remaining 826 were late presenters. Among late presenters, 427 (25.5% of all, 51.7% of late presenters) presented with advanced HIV disease. Late presenters were more elderly and less educated. The gender seemed comparable between groups. Late presentation was more likely among married patients. Early presenters were more likely among homosexuals, those diagnosed in screening studies, and in lower HIV-RNA viral load category. There has been a decreasing trend among late presenters in 2011-2016 when compared to 2003-2011 period. CONCLUSION: Current data suggest that half of HIV-infected patients present late in Turkey. In our cohort, those presented late were more elderly, less educated, married and had heterosexual intercourse. On admission, late presenters had more HIV-related diseases and were more likely in higher HIV-RNA category. In the cohort, men having sex with men were less likely late presenters. Efforts to reduce the proportion of late presentation are essential for almost every country. The countries should identify the risk factors of late presentation and should improve early diagnosis and presentation for HIV care.


Asunto(s)
Diagnóstico Tardío , Infecciones por VIH , Adulto , Anciano , Recuento de Linfocito CD4/métodos , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Heterosexualidad/estadística & datos numéricos , Humanos , Masculino , Factores de Riesgo , Turquia
12.
PLoS One ; 14(10): e0224510, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31661533

RESUMEN

INTRODUCTION: Previous studies have reported that the rate of FEV1 decline over time is increased in HIV patients but the mechanisms underlying this observation are unclear. Since current HIV treatment with Highly Active Antiretroviral Therapy (HAART) results in very good immune-viral control, we hypothesized that HAART should normalize the elevated rate of FEV1 decline previously reported in HIV patients if it was somehow related to the immune alterations caused by HIV, particularly in never smokers or quitters, since smoking is a well established risk factor for accelerated FEV1 decline in the general population. METHODS: We explored this hypothesis in a prospectively recruited cohort of 188 HIV (smoker and non-smoker) patients treated with HAART in Palma de Mallorca (Spain) and followed-up for 6 years. The cross-sectional characteristics of this cohort have been published elsewhere. RESULTS: We found that: (1) HAART resulted in good immune-viral control; (2) the rate of FEV1 decline remained abnormally elevated, even in non-smokers and quitters; and, (3) alcohol abuse during follow-up was related to FEV1 decline in these patients. DISCUSSION: Despite adequate immune-viral control by HAART, lung function decline remains increased in most HIV patients, even in non-smokers and quitters. Alcohol abuse is a preventable risk factor to decrease the accelerated FEV1 decline in this population.


Asunto(s)
Proteínas de Unión al ADN/metabolismo , Infecciones por VIH/metabolismo , Factores de Transcripción/metabolismo , Carga Viral/efectos de los fármacos , Adulto , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/métodos , Recuento de Linfocito CD4/métodos , Estudios de Cohortes , Estudios Transversales , Proteínas de Unión al ADN/genética , Femenino , Estudios de Seguimiento , Infecciones por VIH/tratamiento farmacológico , VIH-1/patogenicidad , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Fumar , España , Factores de Transcripción/genética , Resultado del Tratamiento
13.
Rev. bras. enferm ; 72(5): 1235-1242, Sep.-Oct. 2019. tab, graf
Artículo en Inglés | LILACS, BDENF - Enfermería | ID: biblio-1042151

RESUMEN

ABSTRACT Aim: To develop a clinical risk stratification score for people living with AIDS and to analyze its association with clinical and sociodemographic aspects. Method: Cross-sectional study involving 150 adults with AIDS, in outpatient follow-up. A structured instrument was applied and, sequentially, inferential statistical techniques on the developed score. Results: 45.3% of the participants were classified as in high clinical risk. TL-CD4+ <500cel/mm3 count, detectable viral load, presence of opportunistic diseases, chronic diseases and clinical manifestations were associated with high clinical risk. There was a significant difference in the mean risk between the categories of variables employment status (p = 0.003) and economic class (p = 0.035). There was a higher risk for brown people (OR = 5.55), unemployed status (OR = 16,51) and belonging to classes C (OR = 20.07) and D (OR = 53,32), and a lower risk for individuals with higher schooling (OR = 0.02). Conclusion: The proposed score quantifies clinical situations and points out sociodemographic aspects that predispose to instability and aggravation of AIDS, supporting the qualification of care.


RESUMEN Objetivo: Elaborar una puntuación para estratificación de riesgo clínico de personas viviendo con sida y analizar su asociación con aspectos clínicos y sociodemográficos. Método: Estudio transversal que involucra a 150 adultos con sida, en seguimiento de ambulatorio. Se aplicó instrumento estructurado y, secuencialmente, técnicas estadísticas que interfieren en la puntuación elaborada. Resultados: El 45,3% de los participantes fueron clasificados en el riesgo clínico alto. La cuenta de LT−CD4+<500cel/mm3, la carga viral detectable, la presencia de enfermedades oportunistas, las enfermedades crónicas y manifestaciones clínicas se asociaron al riesgo clínico elevado. Se verificó una diferencia significativa en el riesgo medio entre las categorías de variables de empleo (p=0,003) y la clase económica (p=0,035). Se constató un mayor riesgo para las personas pardas (OR=5,55), alejadas del empleo (OR=16,51) y pertenecientes a las clases C (OR=20,07) y D (OR=53,32), y menor riesgo entre los individuos con mayor escolaridad (OR=0,02). Conclusión: La puntuación propuesta cuantifica situaciones clínicas y apunta aspectos sociodemográficos que predisponen a la inestabilidad y agudización del sida, subsidiando la calificación del cuidado.


RESUMO Objetivo: Elaborar um escore para estratificação de risco clínico de pessoas vivendo co.m Aids e analisar sua associação com aspectos clínicos e sociodemográficos. Método: Estudo transversal envolvendo 150 adultos com aids, em acompanhamento ambulatorial. Aplicou-se instrumento estruturado e, sequencialmente, técnicas estatísticas inferenciais sobre o escore elaborado. Resultados: 45,3% dos participantes foram classificados no risco clínico alto. A contagem de LT-CD4+<500cel/mm3, carga viral detectável, presença de doenças oportunistas, doenças crônicas e manifestações clínicas associaram-se ao risco clínico elevado. Verificou-se diferença significativa no risco médio entre as categorias das variáveis situação empregatícia (p = 0,003) e classe econômica (p = 0,035). Constatou-se maior risco para pessoas pardas (OR = 5,55), afastadas do emprego (OR = 16,51) e pertencentes às classes C (OR = 20,07) e D (OR = 53,32), e menor risco entre os indivíduos com maior escolaridade (OR = 0,02). Conclusão: O escore proposto quantifica situações clínicas e aponta aspectos sociodemográficos que predispõem a instabilidade e agudização da aids, subsidiando a qualificação do cuidado.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Anciano , Riesgo , Síndrome de Inmunodeficiencia Adquirida/clasificación , Prestación de Atención de Salud/métodos , Estudios Transversales , Síndrome de Inmunodeficiencia Adquirida/sangre , Recuento de Linfocito CD4/métodos , Prestación de Atención de Salud/normas , Prestación de Atención de Salud/estadística & datos numéricos , Persona de Mediana Edad
14.
BMJ Open ; 9(9): e033393, 2019 09 24.
Artículo en Inglés | MEDLINE | ID: mdl-31551394

RESUMEN

OBJECTIVES: This study aimed to assess the evolution of body mass index (BMI) of HIV-positive adults on second-line antiretroviral therapy (ART) over time and factors affecting it in north-west Ethiopia. DESIGN: An institution-based retrospective follow-up study was conducted using data extracted from 1016 patient cards from February 2008 to February 2016. SETTING: Eight referral hospitals from Amhara region, Ethiopia were included. PARTICIPANTS: HIV patients who started second-line ART. OUTCOME MEASURES: Change in BMI since starting second-line ART. RESULTS: Five hundred and thirty-eight (52.95%) participants were males and the median age of the participants was 33 years (IQR: 28; 39). The median follow-up time was 18 months (IQR: 5.2; 32.2). The average change of BMI showed linear increase over time. The amount of BMI increment or decrement according to each variable was shown as ß coefficients. Treatment duration (ß=0.013, 95% CI 0.004 to 0.022), isoniazid prophylaxis (ß=0.87, 95% CI 0.32 to 1.42), cotrimoxazole prophylaxis (ß=0.63, 95% CI 0.08 to 1.19), ambulatory functional status (ß=-1.16, 95% CI -1.95 to 1.31), bedridden functional status (ß=-1.83, 95% CI -2.47 to 1.21), WHO stage III (ß=-0.42, 95% CI -0.65 to 0.20), WHO stage IV (ß=-0.62, 95% CI -1.02 to 0.22), CD4 count (ß=0.001, 95% CI 0.0008 to 0.0015), and time interaction of variables like tertiary educational status (ß=0.02, 95% CI 0.01 to 0.04), ambulatory functional status (ß=0.03, 95% CI 0.01 to 0.05) and WHO stages III (ß=0.01, 95% CI 0.007 to 0.02) were found to be significant predictors. CONCLUSION: The BMI of patients has shown linear increment over the treatment time. Factors affecting it have been identified but its effect on cardiovascular disease needs further study.


Asunto(s)
Fármacos Anti-VIH , Índice de Masa Corporal , Coinfección/prevención & control , Infecciones por VIH , Isoniazida , Combinación Trimetoprim y Sulfametoxazol , Aumento de Peso/efectos de los fármacos , Adulto , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/efectos adversos , Antiinfecciosos/administración & dosificación , Antiinfecciosos/efectos adversos , Terapia Antirretroviral Altamente Activa/métodos , Recuento de Linfocito CD4/métodos , Coinfección/epidemiología , Etiopía/epidemiología , Femenino , Estudios de Seguimiento , Infecciones por VIH/sangre , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Isoniazida/administración & dosificación , Isoniazida/efectos adversos , Masculino , Persona de Mediana Edad , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Combinación Trimetoprim y Sulfametoxazol/efectos adversos
15.
Rev Bras Enferm ; 72(5): 1235-1242, 2019 Sep 16.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31531646

RESUMEN

AIM: To develop a clinical risk stratification score for people living with AIDS and to analyze its association with clinical and sociodemographic aspects. METHOD: Cross-sectional study involving 150 adults with AIDS, in outpatient follow-up. A structured instrument was applied and, sequentially, inferential statistical techniques on the developed score. RESULTS: 45.3% of the participants were classified as in high clinical risk. TL-CD4+ <500cel/mm3 count, detectable viral load, presence of opportunistic diseases, chronic diseases and clinical manifestations were associated with high clinical risk. There was a significant difference in the mean risk between the categories of variables employment status (p = 0.003) and economic class (p = 0.035). There was a higher risk for brown people (OR = 5.55), unemployed status (OR = 16,51) and belonging to classes C (OR = 20.07) and D (OR = 53,32), and a lower risk for individuals with higher schooling (OR = 0.02). CONCLUSION: The proposed score quantifies clinical situations and points out sociodemographic aspects that predispose to instability and aggravation of AIDS, supporting the qualification of care.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/clasificación , Prestación de Atención de Salud/métodos , Riesgo , Síndrome de Inmunodeficiencia Adquirida/sangre , Adulto , Anciano , Recuento de Linfocito CD4/métodos , Estudios Transversales , Prestación de Atención de Salud/normas , Prestación de Atención de Salud/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad
16.
J Clin Hypertens (Greenwich) ; 21(10): 1558-1566, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31448551

RESUMEN

HIV infection is associated with increased risk and progression of cardiovascular disease (CVD), yet little is known about the prevalence of CVD risk factors among long-term AIDS survivors in resource-limited settings. Using routinely collected data, we conducted a retrospective study to describe the prevalence of CVD risk factors among a cohort of HIV-infected patients followed for over 10 years in Port-au Prince, Haiti. This cohort includes 910 adults who initiated antiretroviral therapy (ART) between 2003 and 2004 and remained in care between 2014 and 2016 when routine screening for CVD risk factors was implemented at a large clinic in Haiti. A total of 397 remained in care ≥10 years and received screening. At ART initiation, 59% were female, median age was 38 years (IQR 33-44), and median CD4 count was 117 cells/mm3 (IQR 34-201). Median follow-up time from ART initiation was 12.1 years (IQR 11.7-12.7). At screening, median CD4 count was 574 cells/mm3 (IQR 378-771), and 84% (282 of 336 screened) had HIV-1 RNA < 1000 copies/mL. Seventy-four percent of patients had at least 1 risk factor including 58% (224/385) with hypertension, 8% (24/297) diabetes, 43% (119/275) hypercholesterolemia, 8% (20/248) active smoking, and 10% (25/245) obesity. Factors associated with hypertension were age (adjusted OR 1.06, P < .001) and weight at screening (adjusted OR 1.02, P = .019). Long-term AIDS survivors have a high prevalence of CVD risk factors, primarily hypertension. Integration of cardiovascular screening and management into routine HIV care is needed to maximize health outcomes among aging HIV patients in resource-limited settings.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Enfermedades Cardiovasculares/epidemiología , Infecciones por VIH/complicaciones , Hipertensión/epidemiología , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/inmunología , Síndrome de Inmunodeficiencia Adquirida/virología , Adulto , Antirretrovirales/uso terapéutico , Recuento de Linfocito CD4/métodos , Recuento de Linfocito CD4/estadística & datos numéricos , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/etiología , Diabetes Mellitus/epidemiología , Programas de Detección Diagnóstica/normas , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/inmunología , Infecciones por VIH/virología , VIH-1/genética , Haití/epidemiología , Humanos , Hipercolesterolemia/epidemiología , Hipertensión/diagnóstico , Hipertensión/etiología , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Fumar/epidemiología , Sobrevivientes/estadística & datos numéricos
17.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artículo en Inglés | MEDLINE | ID: mdl-31451457

RESUMEN

Kaposi sarcoma (KS) is an angioproliferative disorder that is commonly associated with human herpes virus 8 as well as the HIV. In fact, KS is one of the most common AIDS-defining illnesses. KS typically presents with diffuse, violaceous cutaneous nodules, and may have concomitant visceral involvement. However, visceral involvement rarely occurs without skin manifestations. A rare case of localised bronchopulmonary KS without skin involvement is described in a patient with previously undiagnosed HIV. This atypical presentation represents a challenge for modern-day physicians in developed countries where the prevalence of AIDS-related diseases is decreasing.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Neoplasias Pulmonares , Oseltamivir/administración & dosificación , Sarcoma de Kaposi , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Síndrome de Inmunodeficiencia Adquirida/etiología , Antivirales/administración & dosificación , Lavado Broncoalveolar/métodos , Recuento de Linfocito CD4/métodos , Deterioro Clínico , Confusión/diagnóstico , Confusión/etiología , Deshidratación/complicaciones , Deshidratación/diagnóstico , Deshidratación/terapia , Diagnóstico Diferencial , Resultado Fatal , Fluidoterapia/métodos , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Infecciones por VIH/fisiopatología , Infecciones por VIH/terapia , Humanos , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/fisiopatología , Masculino , Sarcoma de Kaposi/patología , Sarcoma de Kaposi/fisiopatología , Tomografía Computarizada por Rayos X/métodos , Carga Viral/métodos
18.
Medicine (Baltimore) ; 98(29): e16376, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31335686

RESUMEN

The HIV subtype B is the most frequent in Brazil. The HIV subtype B' codes the amino acids glicine-tryptophan-glicine (GWG) instead of glicine-proline-glicine on the tip of gp120 V3 loop. This variant was associated to a slower HIV progression in mono-infected patients; however, there is no information in coinfected patients. This study evaluated the infection progression of HIV variant B' on the hepatitis C virus presence. RNA isolated from plasma of the 601 infected patients were used to human immunodeficiency virus (HIV) subtyping and to classify the virus according their syncytium-inducing ability. The HIV infection progression was evaluated by clinical and laboratorial data. The results showed a significant association between HIV B' variant and CD4 count and time of AIDS in HIV mono-infected patients. Notwithstanding the fact that we did not find a direct association between GWG variant and AIDS and in HIV coinfected patients no mitigating effect due to GWG presence was found. We did observe that the association between GWG variant and CD4 counts is lost in coinfected patients. This is first work showing influence of the HIV GWG variant in coinfected patients. Nevertheless, the presence of the GWG variant can indicate a better prognostic in the mono-infected patients.


Asunto(s)
Proteína gp120 de Envoltorio del VIH/genética , Infecciones por VIH , VIH-1/genética , Hepatitis C , Adulto , Brasil/epidemiología , Recuento de Linfocito CD4/métodos , Coinfección/epidemiología , Coinfección/virología , Progresión de la Enfermedad , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/inmunología , Infecciones por VIH/virología , Hepacivirus/aislamiento & purificación , Hepatitis C/epidemiología , Hepatitis C/virología , Humanos , Masculino , Pronóstico , ARN Viral/análisis
19.
Biomed Res Int ; 2019: 8048670, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31309117

RESUMEN

Human pegivirus type 1 (HPgV-1) infection has been associated with a beneficial effect on the prognosis of human immunodeficiency virus type 1 (HIV-1)-coinfected individuals. However, the mechanisms involved in this protection are not yet fully elucidated. To date, circulating HPgV-1 genotypes in HIV-1-infected individuals have not yet been identified in the extreme south of Brazil. The present study aimed to determine the genotypic circulation of HPgV-1 and the influence of HPgV-1 status and persistence time on the evolution of HIV-1 infection. A retrospective cohort of 110 coinfected individuals was analyzed. Samples were subjected to viral RNA extraction, cDNA synthesis, nested PCR, and genotyping. Genotypes 1 (2.8%), 2 (47.9% of subtype 2a and 42.3% of subtype 2b), and 3 (7%) were identified. In antiretroviral treatment-naïve subjects HPgV-1 subtype 2b was associated with lower HIV-1 viral load (VL) rates (p = 0.04) and higher CD4+ T-cell counts (p = 0.03) than was subtype 2a, and the positivity for HPgV-1 was associated with higher CD4+ T-cell counts (p = 0.02). However, there was no significant difference in HIV-1 VL between HPgV-1-positive and HPgV-1-negative subjects (p = 0.08). There was no significant association between the different groups in HPgV-1 persistence and median HIV-1 VL (p = 0.66) or CD4+ T-cell counts (p = 0.15). HPgV-1 subtype 2b is associated with better prognosis of HIV-1 infection. Although HPgV-1 infection is persistent, our data suggest that the time of infection does not influence HIV-1 VL or CD4+ T-cell counts in coinfected subjects.


Asunto(s)
Coinfección/virología , Virus GB-C/genética , Infecciones por VIH/virología , VIH-1/genética , Adulto , Brasil , Recuento de Linfocito CD4/métodos , Femenino , Genotipo , Humanos , Masculino , Proyectos Piloto , ARN Viral/genética , Estudios Retrospectivos , Carga Viral/genética
20.
Biosens Bioelectron ; 142: 111490, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31302394

RESUMEN

The development of cost-effective and rapid assays for the accurate counting of CD4 cells has remained prime focus for disease management. The lack of such assays has severely affected people living in resource-limited disease prevalent areas. CD4 count information plays a vital role in the effective management of HIV disease. There is an unmet need to develop rapid, cost-effective, portable and user-friendly point-of-care (POC) disease diagnostic platform technology for CD4+ T cell counting. Here, we have developed a flow-free magnetic actuation platform that uses antibody-coated magnetic beads to efficiently capture CD4+ T cells from a 30 µL drop of whole blood. On-chip cell lysate electrical impedance spectroscopy has been utilized to quantify the isolated CD4 cells. The developed assay has a limit of detection of 25 cells per µL and provides accurate CD4 counts in the range of 25-800 cells per µL. The whole immunoassay along with the enumeration process is very rapid and provides CD4 quantification results within 5 min time frame. The assay does not require off-chip sample preparation steps and minimizes human involvement to a greater extent. The developed impedance-based immunoassay has potential to significantly improve the CD4 enumeration process especially for POC settings.


Asunto(s)
Técnicas Biosensibles/instrumentación , Recuento de Linfocito CD4/instrumentación , Inmunoensayo/instrumentación , Sistemas de Atención de Punto , Anticuerpos Inmovilizados/química , Técnicas Biosensibles/economía , Técnicas Biosensibles/métodos , Recuento de Linfocito CD4/economía , Recuento de Linfocito CD4/métodos , Espectroscopía Dieléctrica/economía , Espectroscopía Dieléctrica/instrumentación , Diseño de Equipo , Humanos , Inmunoensayo/economía , Inmunoensayo/métodos , Dispositivos Laboratorio en un Chip/economía , Sistemas de Atención de Punto/economía , Factores de Tiempo
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