Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 19.694
Filtrar
3.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 32(6): 577-583, 2020 Nov 23.
Artículo en Chino | MEDLINE | ID: mdl-33325191

RESUMEN

OBJECTIVE: To investigate the prevalence and risk factors of Blastocystis hominis infections among AIDS patients in Nanchang City. METHODS: A cross-sectional questionnaire survey was conducted among AIDS patients in Nanchang City during the period between May and September, 2016. B. hominis infection was detected in patients'stool samples using a PCR assay, and the CD4+ T cell count was measured in subjects'blood samples. In addition, the risk factors of B. hominis infection in AIDS patients were identified using univariate and multivariate logistic regression analyses. RESULTS: A survey was conducted in Nanchang City from May to September 2016. A total of 505 AIDS patients were investigated, and the prevalence of B. hominis infection was 4.16%. Univariate analysis revealed that B. hominis infection correlated with the occupation (χ2 = 8.595, P = 0.049), education level (χ2 = 14.494, P = 0.001), type of daily drinking water (χ2 = 10.750, P = 0.020), root of HIV infections (χ2 = 8.755, P = 0.026) and receiving anti-HIV therapy (χ2 = 23.083, P = 0.001) among AIDS patients, and multivariate logistic regression analysis identified daily direct drinking of tap water as a risk factor of B. hominis infections [odds ratio (OR) = 7.988, 95% confidential interval (CI): (1.160, 55.004)] and anti-HIV therapy as a protective factor of B. hominis infection [OR = 0.183, 95% CI: (0.049, 0.685)]. CONCLUSIONS: The prevalence of B. hominis is 4.16% among AIDS patients in Nanchang City. Daily direct drinking of tap water is a risk factor, and anti-HIV therapy is a protective factor of B. hominis infection among AIDS patients living in Nanchang City.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA , Síndrome de Inmunodeficiencia Adquirida , Infecciones por Blastocystis , Infecciones por VIH , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Infecciones por Blastocystis/epidemiología , Blastocystis hominis , China , Ciudades , Estudios Transversales , Heces/parasitología , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Prevalencia , Factores de Riesgo
4.
Int J Mol Sci ; 22(1)2020 Dec 22.
Artículo en Inglés | MEDLINE | ID: mdl-33375194

RESUMEN

Infectious diseases represent a relevant issue in lung cancer patients. Bacterial and viral infections might influence the patients' prognosis, both directly affecting the immune system and indirectly impairing the outcome of anticancer treatments, mainly immunotherapy. In this analysis, we aimed to review the current evidence in order to clarify the complex correlation between infections and lung cancer. In detail, we mainly explored the potential impact on immunotherapy outcome/safety of (1) bacterial infections, with a detailed focus on antibiotics; and (2) viral infections, discriminating among (a) human immune-deficiency virus (HIV), (b) hepatitis B/C virus (HBV-HCV), and (c) Sars-Cov-2. A series of studies suggested the prognostic impact of antibiotic therapy administration, timing, and exposure ratio in patients treated with immune checkpoint inhibitors, probably through an antibiotic-related microbiota dysbiosis. Although cancer patients with HIV, HBV, and HCV were usually excluded from clinical trials evaluating immunotherapy, some retrospective and prospective trials performed in these patient subgroups reported similar results compared to those described in not-infected patients, with a favorable safety profile. Moreover, patients with thoracic cancers are particularly at risk of COVID-19 severe outcomes and mortality. Few reports speculated about the prognostic implications of anticancer therapy, including immunotherapy, in lung cancer patients with concomitant Sars-Cov-2 infection, showing, to date, inconsistent results. The correlation between infectious diseases and immunotherapy remains to be further explored and clarified in the context of dedicated trials. In clinical practice, the accurate and prompt multidisciplinary management of lung cancer patients with infections should be encouraged in order to select the best treatment options for these patients, avoiding unexpected toxicities, while maintaining the anticancer effect.


Asunto(s)
Infecciones Bacterianas/complicaciones , Carcinoma de Pulmón de Células no Pequeñas/complicaciones , Carcinoma de Pulmón de Células no Pequeñas/terapia , Inmunoterapia , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/terapia , Virosis/complicaciones , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/inmunología , Síndrome de Inmunodeficiencia Adquirida/patología , Síndrome de Inmunodeficiencia Adquirida/terapia , Antibacterianos/administración & dosificación , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/patología , /patología , Carcinoma de Pulmón de Células no Pequeñas/microbiología , Carcinoma de Pulmón de Células no Pequeñas/virología , VIH/efectos de los fármacos , Hepatitis B/complicaciones , Hepatitis B/inmunología , Hepatitis B/patología , Hepatitis C/complicaciones , Hepatitis C/tratamiento farmacológico , Hepatitis C/patología , Humanos , Neoplasias Pulmonares/microbiología , Neoplasias Pulmonares/virología , Microbiota/efectos de los fármacos , Microbiota/inmunología
5.
An Acad Bras Cienc ; 92(4): e20200293, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33237145

RESUMEN

The present study assessed clinico-epidemiological and sociodemographic characteristics and risk factors for human immunodeficiency virus (HIV) in patients who were co-infected with T. gondii in the border region of Brazil. HIV-positive patients who were attended by the Expert Assistance Service in Foz do Iguaçu city were assessed using a questionnaire and medical records. Of the 332 patients with HIV/autoimmune deficiency syndrome (AIDS) who were evaluated, 111 had serology for toxoplasmosis, which could be attributed to the location of the city (i.e., border region) and tourism that encourages the intense flow of people. Toxoplasmosis infection was prevalent among patients who were 18-60 years old, had education up to the 4th grade of elementary school, ate raw vegetables from home, handled soil without gloves, drank untreated water, and allowed street cats to enter their homes. These findings contribute to assessments of the toxoplasmosis profile of HIV/AIDS patients who have a high rate of toxoplasmosis. The results may contribute to improving public health, especially in border regions with characteristics that are similar to this study. Effective measures need to be implemented to control morbidity and mortality that are associated with HIV/AIDS and toxoplasmosis in the evaluated population.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Coinfección , Infecciones por VIH , Toxoplasma , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Adolescente , Adulto , Animales , Anticuerpos Antiprotozoarios , Brasil/epidemiología , Gatos , Coinfección/epidemiología , VIH , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Persona de Mediana Edad , Factores de Riesgo , Estudios Seroepidemiológicos , Adulto Joven
6.
Medicine (Baltimore) ; 99(44): e22874, 2020 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-33126335

RESUMEN

BACKGROUND: Asymptomatic cryptococcal antigenemia is a state of cryptococcal infection commonly seen in immunocompromised HIV-infected persons. Without early intervention, a proportion of HIV-infected persons with cryptococcal antigenemia may go on to develop cryptococcosis, especially cryptococcal meningitis, which is associated with high mortality. The benefits of antifungal intervention and optimal therapeutic intervention regimens for HIV-infected persons with cryptococcal antigenemia remain controversial. We therefore designed the present study in order to investigate the necessity of, and the optimal regimens for antifungal intervention in the clinical management of cryptococcal antigenemia in HIV-infected populations. METHODS/DESIGN: This study will be an open-labeled, multi-center, prospective, randomized controlled trial, and 450 eligible participants will be randomized into a control arm and 2 intervention arms at a 1:1:1 ratio, with 150 subjects in each arm. Participants in the control arm will not receive antifungal treatment during the study period. Participants in intervention arm 1 will receive oral fluconazole 800 mg/day for 2 weeks, followed by 400 mg/day for 8 weeks and 200 mg/day for 42 weeks, and participants in intervention arm 2 will receive oral fluconazole 400 mg/day for 52 weeks. The primary outcome is the incidence of CM among the 3 groups during the study period. The secondary outcomes include the differences in all-cause mortality, proportion of patients reverting to blood CrAg negativity, change of CrAg titers, and adverse events among the 3 groups during the follow-up period. DISCUSSION: We envisage that the results of this study will reveal the necessity of, and the optimal therapeutic regimens for, antifungal intervention in clinical management of HIV-infected patients with cryptococcal antigenemia. TRIAL REGISTRATION: The study was registered as one of the 12 clinical trials under a general project at the Chinese Clinical Trial Registry on February 1, 2019, and the registration number of the general project is ChiCTR1900021195.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Protocolos Clínicos , Criptococosis/diagnóstico , Factores de Tiempo , Infecciones Oportunistas Relacionadas con el SIDA/etiología , Infecciones Oportunistas Relacionadas con el SIDA/fisiopatología , Síndrome de Inmunodeficiencia Adquirida/fisiopatología , Criptococosis/etiología , Criptococosis/fisiopatología , Femenino , Humanos , Masculino , Medicina de Precisión/métodos
7.
Medicine (Baltimore) ; 99(43): e22889, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120835

RESUMEN

To determine the surgical outcomes and prognostic factors of cytomegalovirus (CMV) retinitis-related retinal detachment (RD) in acquired immune deficiency syndrome (AIDS) patients following vitrectomy.A retrospective charts review was carried out on AIDS patients who were diagnosed with CMV retinitis-related RD and treated with vitrectomy between 2002 and 2016. The main outcome measures were the rates of primary anatomical success and final visual acuity (VA) success defined as postoperative VA ≥20/200. Kaplan-Meier curves on the time to retinal redetachment were performed. Multivariate logistic regression models based on a directed acyclic graph were used to identify independent factors associated with achieving VA success.Forty five AIDS patients (52 eyes) were included. Over a mean follow-up period of 41.7 months, primary anatomical success was achieved in 44 eyes (84.6%) and VA success was achieved in 34 eyes (65.4%). Receiving highly active antiretroviral therapy (HAART) prior to RD (adjusted odds ratio [aOR]=4.9, P = .043), better preoperative VA (aOR = 4.3, P = .006), undergoing vitrectomy within 3 months (aOR=6.7, P = .008), absence of optic atrophy (aOR=58.1, P < .001), and absence of retinal redetachment (aOR=38.1, P = .007) increased the odds of achieving final VA success.Vitrectomy provided favorable anatomical reattachment in AIDS patients with CMV retinitis-related RD. Majority of patients was able to retain functional vision postoperatively. The use of HAART and early vitrectomy increased the probability of achieving both anatomical and VA success.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Retinitis por Citomegalovirus/complicaciones , Desprendimiento de Retina/etiología , Desprendimiento de Retina/cirugía , Vitrectomía/efectos adversos , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/virología , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/virología , Adulto , Terapia Antirretroviral Altamente Activa/métodos , Estudios de Casos y Controles , Citomegalovirus/genética , Retinitis por Citomegalovirus/diagnóstico , Retinitis por Citomegalovirus/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Tailandia/epidemiología , Resultado del Tratamiento , Agudeza Visual/fisiología , Vitrectomía/estadística & datos numéricos , Vitrectomía/tendencias
8.
PLoS One ; 15(9): e0238184, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32911508

RESUMEN

Pneumocystis pneumonia (PCP) is an opportunistic and potentially life-threatening infection of AIDS patients caused by the fungus Pneumocystis jirovecii (P. jirovecii). Trimethoprim-sulfamethoxazole (TMP-SMX) is the most commonly used drug combination in the treatment and prophylaxis of PCP. However, with long-term use of this combination, mutations in the dihydropteroate synthase (DHPS) gene of P. jirovecii bring about the development of resistance. Data on the prevalence of P. jirovecii and its DHPS mutants in China, especially in low endemic areas, are still limited. Thus, in the present study, we measured the P. jirovecii infection rate among HIV-positive and AIDS (HIV/AIDS) patients with suspected PCP and investigated the relationship between CD4+ T cell count and PCP occurrence. As well as the polymerase chain reaction (PCR) analysis and sequencing, the restriction fragment length polymorphism (RFLP) method was used to analyze DHPS point mutation in P. jirovecii strains. P. jirovecii was detected in 40.82% of cases. The clinical symptoms and signs of PCP were not typical; with decreasing CD4+ T cell counts, PCP infection in HIV/AIDS patients increased. In only one case (1.67%), the patients' DHPS gene could not be cut by the Acc I restriction enzyme. Furthermore, mutation at codon 171 was detected in 11 cases and no mutation was found at codon 57. Patients treated with sulfamethoxazole combined with Voriconazole or Caspofungin exhibited favorable results. After treatment, the symptoms of dyspnea were alleviated, and chest computed tomography findings showed the improvement of lung shadows. These indicated that the prevalence of DHPS mutations in P. jirovecii isolates in AIDS-PCP patients in the region was low. Thus, the contribution of gene mutations to treatment failure requires further research.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Dihidropteroato Sintasa/genética , Mutación , Pneumocystis carinii/genética , Pneumocystis carinii/fisiología , Neumonía por Pneumocystis/complicaciones , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Anciano , Secuencia de Bases , China/epidemiología , Enfermedades Endémicas/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pneumocystis carinii/enzimología , Prevalencia , Adulto Joven
9.
J Int AIDS Soc ; 23(8): e25587, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32767707

RESUMEN

INTRODUCTION: The COVID-19 pandemic reached the African continent in less than three months from when the first cases were reported from mainland China. As COVID-19 preparedness and response plans were rapidly instituted across sub-Saharan Africa, many governments and donor organizations braced themselves for the unknown impact the COVID-19 pandemic would have in under-resourced settings with high burdens of PLHIV. The potential negative impact of COVID-19 in these countries is uncertain, but is estimated to contribute both directly and indirectly to the morbidity and mortality of PLHIV, requiring countries to leverage existing HIV care systems to propel COVID-19 responses, while safeguarding PLHIV and HIV programme gains. In anticipation of COVID-19-related disruptions, PEPFAR promptly established guidance to rapidly adapt HIV programmes to maintain essential HIV services while protecting recipients of care and staff from COVID-19. This commentary reviews PEPFAR's COVID-19 technical guidance and provides country-specific examples of programme adaptions in sub-Saharan Africa. DISCUSSION: The COVID-19 pandemic may pose significant risks to the continuity of HIV services, especially in countries with high HIV prevalence and weak and over-burdened health systems. Although there is currently limited understanding of how COVID-19 affects PLHIV, it is imperative that public health systems and academic centres monitor the impact of COVID-19 on PLHIV. The general principles of the HIV programme adaptation guidance from PEPFAR prioritize protecting the gains in the HIV response while minimizing in-person home and facility visits and other direct contact when COVID-19 control measures are in effect. PEPFAR-supported clinical, laboratory, supply chain, community and data reporting systems can play an important role in mitigating the impact of COVID-19 in sub-Saharan Africa. CONCLUSIONS: As community transmission of COVID-19 continues and the number of country cases rise, fragile health systems may be strained. Utilizing the adaptive, data-driven programme approaches in facilities and communities established and supported by PEPFAR provides the opportunity to strengthen the COVID-19 response while protecting the immense gains spanning HIV prevention, testing and treatment reached thus far.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Prestación de Atención de Salud , Infecciones por VIH/complicaciones , Neumonía Viral/complicaciones , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/mortalidad , África del Sur del Sahara/epidemiología , China , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Costo de Enfermedad , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/normas , Prestación de Atención de Salud/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/mortalidad , Humanos , Cooperación Internacional , Pandemias , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/epidemiología , Prevalencia
10.
Oral Dis ; 26 Suppl 1: 3-8, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32862530

RESUMEN

The first World Workshop on Oral AIDS was held in San Diego in 1988, organized by John and Deborah Greenspan who saw the need and advantages of getting together all those health workers globally who were interested in oral aspects of HIV with a common purpose of advancing the field collectively and collaboratively. Since that time and over the following 30 years, World Workshops on oral HIV have been held every four years or so. The aims of the first and all subsequent Workshops were to bring together clinicians and non-clinical scientists who have an interest in the oral manifestations of HIV disease, to share worldwide perspectives, knowledge and understanding of oral health and disease in HIV infection, to agree on global definitions and classifications of oral diseases and to identify research needs taking account of the worldwide perspectives and opportunities. Thus, there have been clinical science, social science and basic science aspects of each World Workshop. The Workshops have achieved their aims and have had impact in all three fields, leading to robust research agendas, changes in national HIV policies and international collaborations. They have led to policy declarations of access to oral care as a basic human right for both HIV-positive and HIV-negative individuals and advancing the rights of all HIV-positive healthcare workers to perform clinical practice.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Infecciones por VIH , Enfermedades de la Boca , Salud Bucal , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Personal de Salud , Humanos , Enfermedades de la Boca/epidemiología
11.
S Afr Med J ; 110(4): 313-319, 2020 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-32657744

RESUMEN

BACKGROUND: The goal of antiretroviral therapy (ART) is to suppress viral replication to undetectable levels. These low viral load (VL) levels may not be attained in some patients, a situation representing potential virological failure during the course of treatment. OBJECTIVES: To present the results of a Markov model exploring how virological failure and active tuberculosis (TB) affect the progression of HIV in patients on ART. METHODS: A continuous-time non-homogeneous Markov model was used to model the progression of HIV/AIDS in patients on combination ART (cART). We define seven states in our model. The first five states are based on VL levels and the other two are absorbing states: death and withdrawal from the study. The effects of TB co-infection, baseline VL, lactic acidosis and treatment failure on transition intensities were assessed. RESULTS: The model shows that VL-based transition intensities do not follow a constant rate; rather, there are two different trends in HIV/AIDS progression. The first trend is an increase in the prevalence of state 1 (undetectable VL levels) in the first 0.5 years of treatment. The second trend follows thereafter and shows a slow decrease. Within the first 0.5 years of therapeutic intervention, the undetectable VL state is therefore attainable from any VL state. However, when virological failure occurs, there is an increased risk of death. Developing active TB while on cART increases the risk of viral rebound from undetectable levels to VLs between 50 and 10 000 copies/mL by ~1.03-fold. From a VL between 10 000 and 100 000 copies/mL, developing TB while on cART increases the rate of viral rebound by ~2.5-fold. However, if TB is detected and treated at enrolment, rates of viral rebound from undetectable levels are reduced. CONCLUSIONS: The model confirms that virological failure, coupled with developing active TB while on cART, increases mortality rates irrespective of patient CD4+ count status. It also suggests that while TB at the time of cART initiation does not increase the risk of viral rebound, development of active TB after cART initiation does increase this risk. These findings highlight the importance of strengthening VL monitoring, which should be performed every 2 months, especially in patients with TB, and addressing unsuppressed VLs appropriately if they are detected.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Antituberculosos/uso terapéutico , Coinfección , Infecciones por VIH/tratamiento farmacológico , Tuberculosis/tratamiento farmacológico , Acidosis Láctica/inducido químicamente , Síndrome de Inmunodeficiencia Adquirida/sangre , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Adolescente , Adulto , Anciano , Recuento de Linfocito CD4 , Progresión de la Enfermedad , Interacciones Farmacológicas , Farmacorresistencia Viral , Femenino , Infecciones por VIH/sangre , Infecciones por VIH/complicaciones , Humanos , Tuberculosis Latente/complicaciones , Masculino , Cadenas de Markov , Cumplimiento de la Medicación , Persona de Mediana Edad , Mortalidad , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Población Rural , Sudáfrica , Respuesta Virológica Sostenida , Insuficiencia del Tratamiento , Tuberculosis/complicaciones , Carga Viral , Adulto Joven
12.
BMC Infect Dis ; 20(1): 473, 2020 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-32620082

RESUMEN

BACKGROUND: People living with the Human Immunodeficiency Virus (PLHIV) have an increased susceptibility to develop non-communicable diseases such as cardiovascular disease (CVD). Infection with HIV contributes to the development of CVD independent of traditional risk factors, with endothelial dysfunction being the central physiological mechanism. While HIV-related mortality is declining due to antiretroviral treatment (ART), the number of deaths due to CVD is rising in South Africa - the country with the highest number of PLHIV and the world's largest ART programme. The EndoAfrica study was developed to determine whether HIV infection and ART are associated with cardiovascular risk markers and changes in vascular structure and function over 18 months in adults from different provinces of South Africa. This paper describes the rationale, methodology and baseline cohort profile of the EndoAfrica study conducted in the North West Province, South Africa. METHODS: In this case-control study, conducted between August 2017 and June 2018, 382 volunteers of African descent (276 women; 106 men), comprising of 278 HIV infected and 104 HIV free individuals were included. We measured health behaviours, a detailed cardiovascular profile, and performed biomarker analyses. We compared baseline characteristics, blood pressure, vascular function and biochemical markers between those infected and HIV free. RESULTS: At baseline, the HIV infected participants were older (43 vs 39 years), less were employed (21% vs 40%), less had a tertiary education (7% vs 16%) and their body mass index was lower (26 vs 29 kg/m2) than that of the HIV free participants. While the cardiovascular profile, flow-mediated dilation and pulse wave velocity did not differ, glycated haemoglobin was lower (p = 0.017) and total cholesterol, high density lipoprotein cholesterol, triglycerides, gamma-glutamyltransferase and tobacco use were higher (all p < 0.047) in PLHIV. CONCLUSION: Despite PLHIV being older, preliminary cross-sectional analysis suggests that PLHIV being treated with ART do not have poorer endothelial or vascular function compared to the HIV free participants. More detailed analyses on the baseline and follow-up data will provide further clarity regarding the cardiovascular profile of South Africans living with HIV.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/etiología , VIH , Síndrome de Inmunodeficiencia Adquirida/sangre , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Adulto , Antirretrovirales/uso terapéutico , Biomarcadores/sangre , Presión Sanguínea , Estudios de Casos y Controles , HDL-Colesterol/sangre , Estudios Transversales , Femenino , Hemoglobina A Glucada/análisis , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Enfermedades no Transmisibles , Análisis de la Onda del Pulso , Factores de Riesgo , Sudáfrica/epidemiología , Triglicéridos/sangre
15.
PLoS Negl Trop Dis ; 14(6): e0008383, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32542045

RESUMEN

BACKGROUND: Urogenital schistosomiasis and HIV/AIDS infections are widespread in sub-Saharan Africa (SSA) leading to substantial morbidity and mortality. The co-occurrence of both diseases has led to the possible hypothesis that urogenital schistosomiasis leads to increased risk of acquiring HIV infection. However, the available evidence concerning this association is inconsistent. The aim of this study was to systematically review and quantitatively synthesize studies that investigated the association between urogenital schistosomiasis and HIV/AIDS infection. METHODS: A systematic review basing on PRISMA guidelines was conducted. It is registered with PROSPERO, number CRD42018116648. We searched four databases, MEDLINE, EMBASE, Global Health and Global Index Medicus for studies investigating the association between urogenital schistosomiasis and HIV infection. Only studies published in English were considered. Results of the association were summarised by gender. A meta-analysis was performed for studies on females using random-effects model and a pooled OR with 95% confidence interval was reported. RESULTS: Of the 993 studies screened, only eight observational studies met the inclusion criteria. Across all studies, the reported unadjusted OR ranged from 0.78 to 3.76. The pooled estimate of unadjusted OR among females was 1.31 (95% CI: 0.87-1.99). Only four of the eight studies reported an adjusted OR. A separate meta-analysis done in the three studies among females that reported an adjusted OR showed that the pooled estimate was 1.85 (95% CI: 1.17-2.92). There were insufficient data to pool results for association between urogenital schistosomiasis and HIV infection in the males. CONCLUSION: Our investigation supports the hypothesis of an association between urogenital schistosomiasis with HIV/AIDS infection in females. Due to insufficient evidence, no conclusion could be drawn in males with urogenital schistosomiasis. Large-scale prospective studies are needed in future.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Esquistosomiasis Urinaria/complicaciones , África del Sur del Sahara , Bases de Datos Factuales , Femenino , Salud Global , Humanos , Masculino
16.
Rev. méd. Chile ; 148(6): 778-786, jun. 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1139371

RESUMEN

ABSTRACT Background: Cytomegalovirus (CMV) is an opportunistic infection (OI) in immunosuppressed patients. However, there are no clear cut-off values available for quantitative plasmatic CMV measures (viral load [VL]) to discriminate those with CMV illness from those infected suffering a transient viral reactivation. Aim: To estimate a CMV VL cut-off point that discriminates infected patients and those with CMV related diseases, and to clinically characterize AIDS patients with this OI. Patients and Methods: Retrospective analysis of AIDS patients admitted by any reason between years 2017 and 2019 and who had a positive plasma CMV VL at any titer. Cases were categorized with illness or infected using accepted criteria and the cut-off value was obtained by receiver operating characteristic curve (ROC) analysis. Results: Twelve patients were identified as having a CMV-associated illness and seven with CMV infection. A CMV VL of 3,800 copies/mL had a sensitivity of 91.6% and 100% specificity to discriminate both states. Of the 12 patients with CMV illness, all were in AIDS stage and only five were receiving HIV therapy. Predominant clinical presentations were gastrointestinal (50%), followed by liver involvement (25%) and CMV disease (25%). All patients were treated with ganciclovir or valganciclovir. Ten patients had a favorable response (83.3%), one patient only had a laboratory improvement (8.3%) and one died during treatment (8.3%). Drug toxicity was recorded in nine patients but in only three cases, a dose adjustment was necessary. Conclusions: The predominant clinical manifestation in our series was gastrointestinal. A CMV VL cutoff level of CMV VL of 3,800 copies / mL is useful to discriminate infected patients from those with CMV related disease.


Antecedentes: Citomegalovirus (CMV) es una infección oportunista (IO) en pacientes inmunosuprimidos. Sin embargo, se requieren puntos de corte de carga viral (CV) para discriminar a aquellos con enfermedad por CMV de aquellos infectados que sufren una reactivación viral transitoria. Objetivos: Estimar un punto de corte de la CV de CMV que discrimine a los enfermos de los infectados y, además, caracterizar clínicamente a los pacientes con sida que presentan esta IO. Pacientes y Métodos: Análisis retrospectivo de pacientes con sida hospitalizados por cualquier motivo entre los años 2017 y 2019, y que presentaron un CV de CMV plasmática positiva a cualquier título. Los casos se clasificaron como enfermos utilizando criterios aceptados y el valor de corte se obtuvo mediante análisis de una curva ROC. Resultados: Durante el período de estudio, 12 pacientes fueron identificados con enfermedad asociada al CMV y siete con infección. Una CV de 3.800 copias/ml logró una sensibilidad de 91,6% y una especificidad de 100% para discriminar ambos estados. De los 12 pacientes enfermos, todos estaban en etapa de sida y solo 5 recibían terapia contra el VIH. La presentación clínica predominante fue gastrointestinal (50%) seguida del compromiso hepático (25%) y de la enfermedad por CMV (25%). Todos los pacientes fueron tratados con ganciclovir o valganciclovir. Diez pacientes tuvieron una respuesta favorable (83,3%), uno solo tuvo mejoría de laboratorio (8,3%) y otro paciente falleció durante el tratamiento (8,3%). Nueve pacientes evolucionaron con toxicidad farmacológica, pero en solo 3 casos fue necesario ajustar las dosis. Conclusiones: La forma predominante de presentación de la enfermedad fue gastrointestinal. Un punto de corte de 3.800 copias/ml discrimina pacientes infectados de aquellos con la enfermedad.


Asunto(s)
Humanos , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Infecciones por Citomegalovirus/complicaciones , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/tratamiento farmacológico , Antivirales/uso terapéutico , Ganciclovir/uso terapéutico , Estudios Retrospectivos , Carga Viral , Citomegalovirus
17.
Medicine (Baltimore) ; 99(18): e19930, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32358363

RESUMEN

INTRODUCTION: Epstein-Barr virus (EBV) associated smooth muscle tumors (SMTs) usually present under the condition of immunosuppression, including congenital immunodeficiency syndrome-SMT, post-transplantation-SMT and HIV-SMT. HIV-SMTs are most likely to invade the central nervous system, followed by the liver, lungs, and other locations. Many laboratory techniques, including serological techniques, polymerase chain reaction and immunohistochemistry (IHC), are employed to determine the aetiologies of these tumours. With respect to therapy, surgical resection is the main treatment. In patients with immunodeficiency, improving immune status is significant for defending against other viruses. We describe a case of the primary focus of SMT in the liver of HIV-positive patient without any metastasis. PATIENT CONCERNS: A young male HIV-positive patient complained of fever and abdominal pain for 2 months. DIAGNOSIS: IHC of liver tissue confirmed the finding: EBV-related smooth muscle tumor. INTERVENTIONS: Given the patient's general condition, he was not a suitable candidate for surgical resection. He was given antibiotics, antifungal agents and EBV-directed agents to control infection as well as highly active antiretroviral therapy to enhance the immunity. OUTCOMES: The patient's symptoms improved. He was discharged. CONCLUSIONS: In conclusion, EBV-related HIV-SMTs is a rare neoplasm found in the liver among immunodeficient patients. This case highlights that a variety of examinations such as IHC for smooth muscle markers (smooth muscle actin and desmin) and EBER, as well as polymerase chain reaction for EBV DNA should be done when diagnoses are ambiguous.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Infecciones por Virus de Epstein-Barr/complicaciones , Hígado/patología , Tumor de Músculo Liso/complicaciones , Tumor de Músculo Liso/diagnóstico , Adulto , Humanos , Masculino
18.
BMC Infect Dis ; 20(1): 360, 2020 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-32434484

RESUMEN

BACKGROUND: To date, very little information is available concerning the relationship between acanthosis nigricans (AN) and infection with human immunodeficiency virus type 1 (HIV-1). CASE PRESENTATION: Herein, we report the case of a middle-aged man admitted for fever and progressively worsening dyspnea in the context of an opportunistic pneumonia and firstly diagnosed with acquired immunodeficiency syndrome (AIDS). At the time of diagnosis, physical examination revealed the presence of a palpable, hyperpigmented skin lesion on the left areola with surface desquamation and velvety texture consistent with AN. Of note, the most common primary etiologies related to AN were excluded and the complete regression of the skin lesion was observed once antiretroviral therapy was started. CONCLUSION: This is the second report of AN found in patients with AIDS and apparently responsive to prolonged antiretroviral treatment. Possible explanations of this association are still not completely understood, probably related to virus-induced changes in lipid metabolism. Our experience suggests that HIV testing should always be considered in the setting of apparently idiopathic AN.


Asunto(s)
Acantosis Nigricans/etiología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Acantosis Nigricans/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , VIH-1/fisiología , Humanos , Masculino , Persona de Mediana Edad , Activación Viral
19.
PLoS Med ; 17(5): e1003125, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32463815

RESUMEN

BACKGROUND: In the United States, approximately one-fifth of transgender women are living with HIV-nearly one-half of Black/African American (Black) transgender women are living with HIV. Limited data are available on HIV-related clinical indicators among transgender women. This is because of a lack of robust transgender data collection and research, especially within demographic subgroups. The objective of this study was to examine retention in care and viral suppression among transgender women accessing the Health Resources and Services Administration's (HRSA) Ryan White HIV/AIDS Program (RWHAP)-supported HIV care, compared with cisgender women and cisgender men. METHODS AND FINDINGS: We assessed the association between gender (cisgender or transgender) and (1) retention in care and (2) viral suppression using 2016 client-level RWHAP Services Report data. Multivariable modified Poisson regression models adjusting for confounding by age, race, health care coverage, housing, and poverty level, overall and stratified by race/ethnicity, were used to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). In 2016, the RWHAP served 6,534 transgender women (79.8% retained in care, 79.0% virally suppressed), 143,173 cisgender women (83.7% retained in care, 84.0% virally suppressed), and 382,591 cisgender men (81.0% retained in care, 85.9% virally suppressed). Black transgender women were less likely to be retained in care than Black cisgender women (aPR: 0.95, 95% CI: 0.92-0.97, p < 0.001). Black transgender women were also less likely to reach viral suppression than Black cisgender women (aPR: 0.55, 95%I CI: 0.41-0.73, p < 0.001) and Black cisgender men (aPR: 0.55, 95% CI: 0.42-0.73, p < 0.001). A limitation of the study is that RWHAP data are collected for administrative, not research, purposes, and clinical outcome measures, including retention and viral suppression, are only reported to the RWHAP for the approximately 60% of RWHAP clients engaged in RWHAP-supported outpatient medical care. CONCLUSIONS: In this study, we observed disparities in HIV clinical outcomes among Black transgender women. These results fill an important gap in national HIV data about transgender people with HIV. Reducing barriers to HIV medical care for transgender women is critical to decrease disparities among this population.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/fisiopatología , Infecciones por VIH/epidemiología , Personas Transgénero/estadística & datos numéricos , United States Health Resources and Services Administration/estadística & datos numéricos , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Afroamericanos , Prestación de Atención de Salud/organización & administración , Femenino , VIH/patogenicidad , Infecciones por VIH/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estados Unidos
20.
Zhonghua Yan Ke Za Zhi ; 56(4): 258-265, 2020 Apr 11.
Artículo en Chino | MEDLINE | ID: mdl-32306617

RESUMEN

Objective: To investigate the characteristics of retinal nerve fiber layer (RNFL) thickness in AIDS patients with normal fundus, HIV-related microvascular retinopathy (MVR), and cytomegalovirus retinitis (CMVR). Methods: In this cross-sectional study, 111 patients were diagnosed with AIDS from 2012 to 2017 by infectious disease physicians in Beijing You'an Hospital. There were 105 males and 6 females, aged 20-65 years. According to the results of ophthalmic examination, the patients were divided into three groups: 31 patients in the active-stage CMVR group, 47 patients in the MVR group, and 33 patients with normal fundus in the control group. RNFL thickness was measured by optical coherence tomography in all patients. At the same time, visual acuity, intraocular pressure, and fundus were examined, and AIDS-related systemic examination (CD4(+) T lymphocyte count, HAART treatment status, and blood cytomegalovirus DNA level) was performed. The measurement data were compared by t-test, variance analysis or rank sum test. The counting data were compared by chi square test or Fisher exact probability method. Results: In the control group, the thickness of RNFL in the superior quadrant in the left and right eyes was 145 (79, 231) µm and 142 (46, 179) µm, respectively; the difference was statistically significant (Z=-2.481, P=0.013). The RNFL thickness of the diseased and healthy eyes in the MVR group was 116 (91, 138) µm and 122 (82, 192) µm, respectively, with no significant difference (Z=-0.861, P=0.389); the best corrected visual acuity was 0.0 (0.0, 0.2) and 0.0 (0.0, 0.2), respectively, with no significant difference (Z=-0.378, P=0.705). In the CMVR group, the best corrected visual acuity of the diseased and healthy eyes was (0.23±0.48) and (0.02±0.82), respectively, and the difference was statistically significant (t=-2.944, P=0.003); the RNFL thickness was 133 (61, 219) µm and 121 (69, 146), respectively, in the whole optic disc, with statistically significant difference (Z=-2.385, P=0.017), 104 (41, 374) µm and 82 (55, 121) µm, respectively, in the nasal quadrant, and 99 (14, 173) µm and 72 (36, 111) µm, respectively, in the temporal quadrant, with statistically significant difference (Z=-2.045, -2.543; P=0.041, 0.011). The RNFL thickness in the CMVR group, the MVR group, and the control group was 149 (61, 350) µm, 126 (71, 304) µm, and 113 (87, 149) µm, respectively, with statistically significant difference (H=20.908, P=0.000). Conclusions: The fundus of AIDS patients had different characteristics on optical coherence tomography. In active CMVR patients, the thickness of RNFL was generally thickened. In MVR patients, the average thickness of RNFL was thicker than that in the normal control group.(Chin J Ophthalmol, 2020, 56:258-265).


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Retinitis por Citomegalovirus/patología , Fibras Nerviosas/patología , Disco Óptico , Enfermedades de la Retina/patología , Adulto , Anciano , Estudios Transversales , Retinitis por Citomegalovirus/complicaciones , Femenino , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Retina/complicaciones , Tomografía de Coherencia Óptica , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...