Dyslipidemia Secondary to the Use of HAART in Adults: A Systematic Review.

BACKGROUND: HIV infection affects millions of people globally. Currently, although several drugs have brought an improvement in the quality and life expectancy of these individuals, they are accompanied by several adverse effects. OBJECTIVE: To conduct a systematic review of studies examining the relationship between antiretroviral therapy (ART) uses and secondary dyslipidemia. METHODS: The review followed the criteria defined by PRISMA. Only articles that completely evaluated the lipid profile were included, which consisted of total cholesterol (TC), triglycerides (TG), and LDL cholesterol (LDL-c), HDL cholesterol (HDL-c). RESULTS: It was observed that the use of nucleoside and non-nucleoside reverse transcriptase inhibitor (NNRTI and NNRTI respectively) drugs and protease inhibitors are the most used in ART and are associated with changes in lipid profiles. The main changes observed were increases in TC, TG, and LDL-c in addition to a decrease in HDL-c. These patients had a higher risk of developing cardiovascular disease not only due to the use of therapy, but also due to the presence of other comorbidities evaluated in these studies, such as obesity, diabetes, and hypertension. The increase in age, the difference between genders, CD4 T-cell count, and viral load, were observed as risk factors for worsening dyslipidemia. CONCLUSION: According to the findings of this study, anti-HIV therapy is linked to dyslipidemia, which may or may not be the primary cause, and is frequently connected with a number of metabolic problems that can exacerbate the illness.

Stage II and stage III periodontitis clinical burdens of HIV-1 undergoing antiretroviral therapy.

OBJECTIVES: The aim of this retrospective cross-sectional study was to estimate the association of HIV-1 infection under highly active antiretroviral treatment (HAART) on the clinical parameters of periodontitis. MATERIALS AND METHODS: A total of 205 patients were divided in two groups: 74 HIV + and 131 HIV - . Periodontal probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), and visible supragingival biofilm (VSB) were recorded. The association of HIV-1 infection with the presence of at least 3 sites with PPD ≥ 5 mm and/or CAL ≥ 4 mm in non-adjacent teeth was estimated using binary logistic regression models. RESULTS: The variables HIV-1 infection (OR = 5.53, p < 0.0001, 95% CI: 2.45-13.64), age [range 35-50 years old (OR = 5.73, p < 0.0001, 95% CI: 2.49-13.20); > 50 years old (OR = 6.29, p = 0.002, 95% CI: 1.94-20.42)], and VSB (OR = 23.68, p < 0.0001, 95% CI: 8.07-69.53) showed a significant direct association with BOP outcome. CONCLUSIONS: HIV-1 infection under HAART did not have association with the presence of at least 3 sites with PPD ≥ 5 mm and/or CAL ≥ 4 mm. However, HIV patients on HAART had direct association of HIV-1 infection with BOP and an inverse association with PPD. CLINICAL RELEVANCE: These results support that monitoring gingival bleeding associated with oral prophylaxis would be beneficial in the prevention and management of periodontitis in HIV-1 patients on HAART.

Moringa oleifera restored semen quality, hormonal profile, and testicular morphology against Highly Active Antiretroviral Therapy-induced toxicity in adult male Wistar rats.

OBJECTIVE: Reproductive toxicity has been greatly linked with Highly Active Antiretroviral Therapy (HAART) use. This study investigated the effects of Moringa oleifera Leaf Extract (MOE) on HAART-induced testicular toxicity in adult male Wistar rats. METHODS: Twenty adult male Wistar rats (150-200 g) were assigned into four groups (n=5). Group A received distilled water; Group B received (orally) 200 mg/kg BW HAART only; Group C received (orally) 200 mg/kg BW HAART and 100 mg/kg BW MOE (low dose group) and Group D received (orally) 200 mg/kg BW HAART and 300 mg/kg BW MOE. At the end of the 28-day experiment, body and testicular weights were measured; serum and testis obtained were subjected to hormone profiling, biochemical and histological studies. RESULTS: HAART caused a significant decrease in body and testicular weight, testicular distortion and spermatogenic cell disorganization, altered semen quality and function, hormonal profiles, and oxidative stress markers (SOD, CAT, GSH) were significantly decreased with the concurrent increase in MDA level. However, treatment with MOE improved sperm parameters, testis morphology, antioxidants markers, and hormones assessments. CONCLUSIONS: The exposure to HAART produced marked testicular toxicity, ameliorated using Moringa oleifera leaf extract, thereby preserving testicular physiological function and morphology.

New world Leishmania spp. infection in people living with HIV: Concerns about relapses and secondary prophylaxis.

Coinfection with the human immunodeficiency virus (HIV) and Leishmania impairs immune responses, increases treatment failure and relapse rates in patients with American tegumentary leishmaniasis (ATL), as well as visceral leishmaniasis (VL). There is insufficient data on the treatment, relapse, and secondary prophylaxis in patients coinfected with HIV/Leishmania in Brazil. This study investigated patients with HIV/ATL and HIV/VL to describe the outcome of leishmaniasis in patients assisted at a referral hospital of Brazilian midwestern region. Patients with HIV/ATL (n = 21) mainly presented cutaneous diseases (76.2%) with an overall relapse rate of 28.57% after treatment, whereas HIV/VL (n = 28) patients accounted for 17.5% of the cases. The counts of CD4+ T cells and CD8+ T cells and the CD4+/CD8+ cell ratios at diagnosis or relapses were not significantly different between relapsing and non-relapsing patients. Patients with HIV/ATL or HIV/VL showed high levels of activation markers in CD4+ and CD8+ T cells. The regular use of highly active antiretroviral therapy (HAART) and viral load at the time of diagnosis did not influence the relapse rates. Relapses occurred in 36.4% (4/11) of the patients with HIV/VL receiving secondary prophylaxis and in 5.9% (1/17) of the patients who did not receive secondary prophylaxis (p = 0.06). These data are relevant for the therapeutic management of the patients coinfected with HIV/Leishmania.

Linear and non-linear analysis of heart rate variability in HIV-positive patients on two different antiretroviral therapy regimens.

BACKGROUND: Cardiac autonomic dysfunction in HIV+ patients on different antiretroviral therapy (ART) regimens has been described. We aimed to characterize parameters of heart rate variability (HRV) and correlate with different classes of ART in HIV+ patients in three experimental conditions: rest, cold face, and tilt tests. METHODS: Cross-sectional study with three groups of age- and gender-matched individuals: group 1, 44 HIV+ patients undergoing combination therapy, with two nucleoside reverse transcriptase inhibitors (NRTI) and one non-nucleoside reverse transcriptase inhibitor (NNRTI); group 2, 42 HIV+ patients using two NRTI and protease inhibitors (PI's); and group 3, 35 healthy volunteers with negative HIV serology (control group). Autonomic function at rest and during cold face- and tilt-tests was assessed through computerized analysis of HRV, via quantification of time- and frequency domains by linear and non-linear parameters in the three groups. RESULTS: Anthropometric and clinical parameters were similar between both HIV groups, except CD4+ T lymphocytes, which were significantly lower in group 2 (p = 0.039). At baseline, time-domain linear HRV parameters, RMSSD and pNN50, and the correlation dimension, a non-linear HRV parameter (p < 0.001; p = 0.018; p = 0.019, respectively), as well as response of RMSSD to cold face test were also lower in the HIV+ group than in the control individuals (p < 0.001), while no differences among groups were detected in HRV parameters during the tilt test. CONCLUSIONS: Despite ART regimens, HIV+ patients presented lower cardiac vagal modulation than controls, whereas no difference was observed among the HIV groups, suggesting that higher cardiovascular risk linked to PIs may be associated with factors other than autonomic dysfunction.

Severe hyperkalaemia due to a potential drug-drug interaction between eplerenone and antiretrovirals in a HIV-positive patient after a myocardial infarction.

We present a case of a 48-year-old white HIV-1 positive man who presented an acute myocardial infarction. The patient was on ART for the last ten years with emtricitabine/tenofovir and ritonavir-boosted fosamprenavir. Eplerenone 25 mg/day was also initiated due to a left ventricular dysfunction. A week after discharge a routine laboratory examination revealed severe hyperkalaemia. Due to suspicion of a potential drug-drug interaction, both eplerenone and ARVs were interrupted. Despite daily treatment for hyperkalaemia, serum potassium levels normalized after two weeks. Eplerenone is metabolized by the hepatic P450 cytochrome isoenzyme CYP3A4; therefore, concomitant administration with CYP3A4 inhibitors, like ritonavir, may increase plasma levels of eplerenone and, therefore, the risk of side effects, mainly hyperkalaemia. Based on this case, it is important to alert the medical community of this possible life-threatening drug-drug interaction between eplerenone and ritonavir-boosted protease inhibitor.

Expression of Inflammatory Markers RANK, MMP-9 and PTHrP in Chronic Apical Periodontitis from People Living with HIV Undergoing Antiretroviral Therapy.

To compare the expression of the receptor activator of nuclear factor-kappa B (RANK), matrix metalloproteinase 9 (MMP-9) and parathyroid hormone-related protein (PTHrP) in primary chronic apical periodontitis lesions (CAPLs) between people living with HIV (PLWHIV) undergoing antiretroviral therapy (ART) and HIV- individuals, 32 CAPLs (16 lesions from each group) were submitted to histopathological and immunohistochemical analyses and compared between groups. The majority of the PLWHIV group had undetectable plasma viral loads (n = 13; 81.3%). The means of TCD4+ lymphocytes, exposure to HIV-1 and the time of the use of ART were 542.1 cells/mm3 (SD = 256.4), 6.3 years (SD = 2.9) and 5.0 years (SD = 2.5), respectively. Of all variables studied, only histopathological diagnosis showed a significant difference between groups (LWHIV: granuloma n = 11 (68.0%); cyst n = 5 (31.2%); HIV-: granuloma n = 15 (93.8%); cyst n = 1 (6.2%); p = 0.015). When comparing the expressions of the three inflammatory markers between the groups, no significant differences were seen. There was no difference in the expression of RANK, PTHrP and MMP-9 in primary chronic apical periodontitis lesions between PLWHIV under ART and HIV- individuals.

Influence of HIV Infection and Antiretroviral Therapy on Bone Homeostasis.

The human immunodeficiency virus type 1 (HIV)/AIDS pandemic represents the most significant global health challenge in modern history. This infection leads toward an inflammatory state associated with chronic immune dysregulation activation that tilts the immune-skeletal interface and its deep integration between cell types and cytokines with a strong influence on skeletal renewal and exacerbated bone loss. Hence, reduced bone mineral density is a complication among HIV-infected individuals that may progress to osteoporosis, thus increasing their prevalence of fractures. Highly active antiretroviral therapy (HAART) can effectively control HIV replication but the regimens, that include tenofovir disoproxil fumarate (TDF), may accelerate bone mass density loss. Molecular mechanisms of HIV-associated bone disease include the OPG/RANKL/RANK system dysregulation. Thereby, osteoclastogenesis and osteolytic activity are promoted after the osteoclast precursor infection, accompanied by a deleterious effect on osteoblast and its precursor cells, with exacerbated senescence of mesenchymal stem cells (MSCs). This review summarizes recent basic research data on HIV pathogenesis and its relation to bone quality. It also sheds light on HAART-related detrimental effects on bone metabolism, providing a better understanding of the molecular mechanisms involved in bone dysfunction and damage as well as how the HIV-associated imbalance on the gut microbiome may contribute to bone disease.

Plasma microRNA expression levels in HIV-1-positive patients receiving antiretroviral therapy.

MicroRNAs (miRNAs/miRs) may serve as therapeutic agents or targets in diseases in which the expression of proteins plays an important role. The aim of the present study was to compare the expression levels of specific miRNAs, as well as their correlation with markers of response to antiretroviral (ARV) therapy, in patients with human immunodeficiency virus type 1 (HIV-1) infection with and without resistance to highly active antiretroviral therapy (HAART). METHODS: miRNA assays were performed on plasma samples obtained from 20 HIV-1-positive patients. A total of ten patients were divided into two groups: HAART-responsive and HAART-resistant (n=5 per group). Commercial arrays were subsequently used to identify 84 miRNAs. A total of three differentially expressed miRNAs were selected and analyzed by quantitative PCR (qPCR). Five other patients were subsequently added to each group for a new relative expression analysis. The absolute expression level of the two miRNAs was obtained and compared using the Student's t test. Receiver operating characteristic (ROC) curves were used to identify patients with antiretroviral therapy (ART) resistance. RESULTS: The array analysis revealed that miR-15b-5p, miR-16-5p, miR-20a-5p, miR-26a-5p, miR-126-3p and miR-150-5p were down-regulated in patients with HAART-resistance comparing with HAART-responsive. The expression levels of miR-16-5p, miR-26a-5p and miR-150-5p were confirmed using qPCR. The area under the ROC curve was 1.0 for the three miRNAs. CONCLUSIONS: The lower expression levels of miR-16-5p and miR-26a-5p in patients with HAART-resistance suggested that these may serve as potential biomarkers for the identification of HAART-responsive patients.

Effects of a Combined Exercise Training Program on Health Indicators and Quality of Life of People Living with HIV: A Randomized Clinical Trial.

The aim of this study was to evaluate the effects of 16 weeks of combined exercise training (CET) on muscle strength, body composition, depression, anxiety and quality of life of people living with HIV (PLHIV). Twenty-three participants completed the study, 14 in trained group (TG) and 9 in control group (CG). TG consisted of resistance and aerobic training three times a week, while the CG was exposed to recreational activities twice a week. CET promoted increased muscle strength (25% in overall strength) and aerobic capacity (+ 20% in training speed and + 23% in VO2 during aerobic training; p < 0.05). In addition, TG had better quality of life and reduced depression rates (from 7 subjects with mild, moderate or severe depression to 1 post-training). In conclusion, this pilot data demonstrated that 16 weeks of CET increased muscle strength, and improved depression and quality of life indexes in a small sample of PLHIV.

Widespread use of anti-retroviral therapy elevated the prevalence of dyslipidemia in HIV-infected Chinese patients

With the widespread use of high-efficiency antiretroviral therapy (HAART), the life expectancy of HIV-infected patients has been significantly extended. However, the metabolic complications among HIV-infected patients treated with HAART have become the most common problem in the world. It is very important to explore the incidence of dyslipidaemia and studies on the role of potential risk factors in HIV-infected Chinese patients treated with HAART are sparse. Therefore, we designed current study, to investigate the effects of therapeutic intervention and continuous information support on the lifestyle of HIV/AIDS patients with dyslipidaemia. Three hundred and six HIV/AIDS patients admitted to the AIDS clinic in Beijing from January 2016 to January 2017 were recruited and assigned into two groups: the treatment group (n=64) and the control group (n=64). The median age of the participants was 38.8±11.0 years (range 20-75 years). The prevalence of dyslipidemia in control and treatment group was (59/64) 92.2% and (53/64) 82.8%, respectively. In this study, low HDL-cholesterol (HDLC) led to abnormalities 47/64 (73.3%) in the control group and 35/64 (54.7%) in HAART-treatment group. Additionally, HAART group showed higher triglyceride, total cholesterol, and low-density lipoprotein (246.1±171.8, 1.73±1.61 mmol/L, 4.46±1.1 mmol/L, 2.54±0.74 mmol/L). In multivariate analysis, gender, marital status, high BMI, dietary habits and physical activity were potential risk factors for dyslipidemia in HIV-infected Chinese patients. In this study, we reported high prevalence dyslipidemiain two HIV infected groups. We suggest that the appropriate diagnosis should be performed for analyzing the metabolic complications in HIV-infected Chinese patients. Further studies are very important to understand the role of potential risk factors in metabolic complications.

Práticas de uma equipe multiprofissional para pessoas vivendo com HIV/AIDS: um estudo de caso em um município da Foz do Rio Itajaí-Açu, Santa Catarina ­ Brasil / Practices of a multiprofisional group for people living with HIV/AIDS: a case study in a city of Foz do Rio Itajaí-Açu, Santa Catarina state - Brazil

A incidência da Síndrome da Imunodeficiência Adquirida (AIDS) continua a aumentar em nosso país, mesmo com o avanço da Terapia antirretroviral (TARV) e a diminuição da mortalidade. Assim, aspectos relacionados ao cuidado destes pacientes tornam-se relevantes, especialmente quanto ao papel das equipes de saúde provedoras da atenção. O objetivo deste trabalho foi identificar particularidades relacionadas ao cuidado das pessoas com HIV/AIDS em um centro de referência de um município da Foz do Rio Itajaí-Açu, Santa Catarina ­ Brasil. Foi realizado um estudo qualitativo com coleta de dados por meio de grupo focal e utilizada a técnica de análise de conteúdo temático para avaliação e apresentação dos resultados. Identificaram-se duas grandes categorias, com suas respectivas subcategorias sendo: aspectos promotores de cuidado (acolhimento no serviço de saúde, trabalho em equipe, entendimento/aceitação da doença, presença de rede de apoio, existência de grupos nos serviços, atenção individual do profissional e tratamento medicamentoso) e aspectos dificultadores do cuidado (baixo número de profissionais; falta de ambiência/espaço físico adequado no serviço; sigilo/estigma do local e gestão dos serviços). Conclui-se que o cuidado do paciente com HIV/AIDS apresenta dimensões que extrapolam o conhecimento técnico sobre a doença, devendo considerar aspectos relacionados à vida da pessoa, na qual a organização do serviço de saúde apresenta papel determinante. Aspectos estruturais e de gestão também foram identificados como importantes na adesão ao tratamento e no cuidado desses pacientes.

The incidence of Acquired Immunodeficiency Syndrome (AIDS) continues to increase in our country in despite of theadvanceof antiretroviraltherapy (ART) anddecreasedmortality. Thus, related aspects to the care of these patients become relevant, especially about the role of health careproviders. The objective of this study was to identify aspects related to the care of people with HIV/AIDS, in a reference center of a city of Foz do Rio Itajaí-Açu, Santa Catarina - Brazil. A qualitative study was conducted with data collection with a focus group, and the thematic content analysis technique wasused for analysis and presentation of results. Two major categories related to the care of people with HIV/AIDS were identified, with their respective subcategories: care-promoting aspects (health service reception, teamwork, understanding / acceptance of the disease, presence of support network, existence of groups in this service, individual professional attention and drugtreatment) and aspects that hinder the care (low number of professionals; missing ambience/suitable physical space in the service; confidentiality / stigma of the placeand management of the services. It is concluded that the care of patients with HIV/AIDS hás dimensions which go beyond the technical knowledge about the disease, and aspects related to the person's life should be considered, which the organization of the health service plays a determining role. Structural and management aspects were also identified as important aspects that interfere in the patient adherence and care.

Alteración del metabolismo de glucosa y lípidos en los pacientes con virus de inmunodeficiencia humana

Introducción: El virus de inmunodeficiencia humana (VIH) es un retrovirus, de la subfamilia Lentiviridae, asociada con la dislipidemia y la resistencia a la insulina. Asimismo con el tratamiento antirretroviral de gran actividad (TARGA) se ha logrado una reducción de la morbimortalidad y como efecto secundario se ha presentado desbalance metabólico en cuanto a la glicemia y perfil lipídico. Objetivo: Relacionar los niveles de glucosa y lípidos en los pacientes con VIH con TARGA en la consulta de infectología del Servicio Autónomo del Hospital Central de Maracay (SAHCM) período mayo ­ julio 2016. Materiales y Métodos: Estudio clínico, diagnóstico, analítico, transversal, correlacional, no experimental. Se incluyeron pacientes con VIH mayores de 18 años que acudieron a la consulta de infectología en el SAHCM mayo ­ julio de 2016. Resultados: Se analizaron 30 pacientes con predominio de sexo masculino (66,7 %) y edad promedio de 41,13 años. El índice de masa corporal <25 Kg/m2 prevaleció (66,67 %), la circunferencia abdominal tuvo una media de 80,53 cm. Las personas con inhibidores de la transcriptasa reversa análogo de nucleósido más inhibidores de la transcriptasa reversa no análogo de nucleósido (ITRN/ITRNN) demostraron mayor proporción de sobrepeso (13 %). El 10 % presentaron hipercolesterolemia, la mayoría con ITRNN/ITRN; el 10 % tuvo hipertrigliceridemia y VLDL >100 mg/dL en tratamiento con ITRN/IP (Inhibidores de proteasa). El 63,3 % presentó LDL elevado asociado a ITRNN/ITRN; solo el 3,3 % presentó el HDL <50 mg/ dL y glicemias >100 mg/dL en 13,3 % de los pacientes. Conclusión: El VIH y los TARGA producen alteración metabólica.

Introduction: Human Immunodeficiency Virus (HIV) is a retrovirus, Lentiviridae subfamily, associated with dyslipidemia and insulin resistance. Antiretroviral therapy (HAART) has achieved a reduction in morbidity and mortality as a result, it has been presented metabolic imbalance related to glycemia and lipid profile. Objetive: Relate glucose and lipid levels in HIV patients on HAART in infectology's consultation the Autonomous Service of the Central Hospital of Maracay (SAHCM) period from May to July 2016. Materials and Methods: Clinical, diagnostic, analytical, transversal, co-relational, not experimental study. HIV patients over 18 years old, attended in the Infectology's consultation in May SAHCM, were included Results: 30 patients predominantly male (66.7 %) and average age of 41.13 years were analyzed. The body mass index <25 kg / m2 prevailed (66.67 %), abdominal circumference had an average of 80,53 cm. People treated with nucleotide reverse transcriptase inhibitor plus non nucleotide reverse transcriptase inhibitor (NRTIS/ ITRNA) showed higher proportion of overweight (13 %). Hypercholesterolemia was founded in 10 %, almost patients with ITRNN / ITRN; 10 % had hypertriglyceridemia and VLDL> 100 mg/dL treated with NRTIS /ITRNN / PI (protease inhibitors) with P = 0.00. The 63.3 % had elevated LDL associated with ITRNN / ITRN; only 3.3 % had HDL <50 mg/dL; the blood glucose> 100 mg/dL (13.3 %) was evident in most of HAART. Conclusion: HIV and HAART produce metabolic disorder.

Candida spp. Determination and Th1/Th2 Mixed Cytokine Profile in Oral Samples From HIV+ Patients With Chronic Periodontitis.

Background: Chronic periodontitis (CP), caused by bacteria and fungi, appears in up to 66% of HIV-patients. The impact and association of HIV-treatment (HAART) and Candida itself has not been properly evaluated in the development and progression of CP. The immunopathogenesis is characterized by CD4+ T-cells activation and the balance between the T-helper 1 (Th1) and T-helper 2 (Th2) or a mixed cytokine profile. Currently, the associated causes of an immune response in HIV-patients with CP is controversial. Our aims were the determination of Candida spp. and cytokine profile in oral samples from HIV-positive patients with CP, considering the CD4+ T cells levels and HAART use. Methods: From 500 HIV-positive patients evaluated, 228 patients were enrolled. Patients were separated in groups: (A) n = 53 (≤200 CD4+ T-cells on HAART); (B) n = 57 (≤200 CD4+ T-cells without HAART); (C) n = 50 (>200 CD4+ T-cells without HAART); (D) n = 68 (>200 CD4+ T-cells on HAART). Candida spp. were isolated from the oral biofilm and crevicular fluid in CHROMagar and confirmed by endpoint PCR. Cytokine levels were measured by beads-based immunoassay in saliva by flow cytometry. Results: 147 patients (64.5%) were positive to Candida spp. and 204 strains were isolated; 138 (67.6%) were C. albicans and the remaining C. non-albicans species (C. glabrata>C. tropicalis>C. krusei>C. dubliniensis). In this study, CHROMagar showed good sensitivity (95%) but poor specificity (68%); since of the 152 samples identified as C. albicans, only 131 were confirmed by PCR; from the 10 samples identified as C. glabrata, only six were confirmed. Finally, of the 42 samples detected as C. tropicalis, only five were confirmed. When evaluating Candida spp. presence, group A and D had higher isolation, while group B had the highest species diversity. Whereas, group C had a significant reduction of Candida spp. Despite the presence of Candida and HAART, we found a Th1/Th2 hybrid profile in the saliva of patients with low CD4+ T-cell count (group A). Conclusion: Abundance and diversity of the Candida spp. detected in HIV-patients with CP could be related to HAART and low CD4+ T-cells levels. Also, the immunosuppression might promote a local Th1/Th2 hybrid cytokine profile.

Frecuencia y etiología de la enteroparasitosis en pacientes con virus inmunodeficiencia humana en un hospital de Lambayeque, Perú / Frequency and etiology of enteroparasitosis in patients with human immunodeficiency virus at a hospital of Lambayeque, Peru

RESUMEN Introducción: A pesar de terapia antiretroviral aún es común encontrar la presencia de infecciones oportunistas, tales como enteroparásitos que causan un gran impacto en salud y economía de los pacientes. Objetivos: Determinar la frecuencia, etiología y factores asociados a las enteroparasitosis en pacientes con VIH, en un hospital referencial de Lambayeque, Perú. Material y Métodos: Se realizó un estudio prospectivo tipo observacional en pacientes diarreicos con infección por VIH de un hospital de Lambayeque desde enero a junio del 2016. Tanto la recolección y transporte, como el análisis de las muestras siguieron las recomendaciones del Manual de procedimientos para el diagnóstico de las parasitosis humanas del Instituto Nacional de Salud. Resultados: La mediana de edad fue 28 años, predominó el sexo masculino y el porcentaje de parasitismo fue de 73,08%. Pacientes con carga viral > 1000 fueron 69,2% y pacientes en TARGA fueron 55,8%. Blastocystis hominis fue el parásito más frecuente (30,77%), seguida de Cryptosporidium spp. y Cystoisospora belli con el 21,2% y 11,5% respectivamente. El análisis bivariado entre carga viral y TARGA con parasitismo, demostró asociación con el parasitismo. Conclusiones: La enteroparasitosis es frecuente en pacientes con VIH y diarrea, predominando las infecciones oportunistas por encima de las no oportunistas.

ABSTRACT Introduction: Despite antiretroviral therapy, it is still common to find the presence of opportunistic infections such as enteroparasites, which cause a big impact on the health and economy of patients. Objetive: To determine the frequency, etiology and factors associated with enteroparasitosis in patients with HIV at a reference hospital in Lambayeque, Peru. Material and Methods: A prospective observational study was conducted in diarrheic patients with HIV infection in a hospital in Lambayeque from January to June, 2016. The study was a census. Both the collection and transport as well as the analysis of the samples followed the recommendations of the Manual of procedures for the diagnosis of human parasitosis of the National Institute of Health. Results: The meadian age was 28 years, the male sex predominated, and the percentage of parasitism was 73.08%. Patients with viral load >1000 were 69.2% and patients with HAART were 55.8%. Blastocystis hominis was the most frequent parasite (30.77%), followed by Cryptosporidium spp. and Cystoisospora belli with 21.2% and 11.5%, respectively. The bivariate analysis between viral load and HAART with parasitism, demonstrated an association with parasitism. Conclusions: Enteroparasitosis is frequent in patients with HIV and diarrhea, predominating opportunistic infections over non opportunistic ones.

El acceso universal al tratamiento antirretroviral no ha modificado las causas de internación y muerte en infectados por HIV en Buenos Aires / The universal high active antiretroviral treatment (HAART) did not chance the causes of admiission and death of HIV infected patients in Buenos Aires

Introducción: El tratamiento antirretroviral de alta eficacia (TARGA) ha desplazado a las infecciones oportunistas como principal causa de hospitalización en infectados por el HIV. Sin embargo, algunos autores hallaron que las causas de internación por HIV en Buenos Aires no cambiaron a pesar del acceso universal al TARGA desde 1996. Pacientes y Métodos. Para confirmar estos resultados revisamos todos los ingresos hospitalarios ocurridos durante tres años en un hospital general de la ciudad de Buenos Aires. Resultados: 57 pacientes (34 hombres) tuvieron 79 hospitalizaciones: 43 ingresaron sólo una vez y los 14 restantes tuvieron dos o más ingresos hasta totalizar 36 internaciones. La edad fue de 44.46 ± 11.55 años (promedio ± desvío estándard), 43 pacientes (75.45%) se sabían HIV + y 28 de ellos (65.12%) recibían TARGA al ingreso, 31 hospitalizaciones (39.24%) fueron causadas por enfermedades marcadoras de SIDA; 35 (44.30%) por infecciones no marcadoras de SIDA (INMS) y 13 (13.46%) por enfermedades no infecciosas. Tuberculosis fue el diagnóstico más frecuente (11 casos, 13.92%), seguida por meningitis a Cryptococcus neoformans en 9 (11.39%) y toxoplasmosis cerebral en 6 (7.59%). Entre las INMS, la neumonía fue la principal causa de hospitalización (13 pacientes, 16.46%). Discusión: Estos resultados confirman resultados previos comunicando que las causas de hospitalización en infectados por el HIV no cambiaron en respuesta al TARGA en Buenos Aires, lo que puede estar reflejando problemas de detección o adherencia, o puede estar relacionado con resistencia viral, razones sociales o cualquier combinación de estos factores (AU)

Introduction. High Active Antiretroviral Treatment (HAART) displaced opportunistic infections as the main cause of hospitalization in HIV infected patients. However, some authors found that causes for hospitalization in HiV infected patients did not changed at Buenos Aires although this country offers universal access to HAART since 1996. Patients and Methods. We analyzed all the HIV related admissions recorded during three years at a general hospital. Results. 57 patients (34 men) were hospitalized 79 times. 43 out of them were hospitalized only one time. The reaining 14 were hospitalized 36 times. Age was 44.46 ± 11.55 years (mean ± standard deviation). 43 patients (75.45%) had a previous diagnosis of HIV infection. 28 of them (65.12%) received HAART. 31 hospitalizations (39.24%) were caused by AIDS defining events. 35 (44.30%) related to non-AIDS-defining infections diseases (NADID), and 13 (13.46%) to non-infections diseases. Tuberculosis was the prevalent illness (11 cases, 13.92%), followed by cryptoccal meningitis in 9 (11.39%) and cerebral toxoplasmosis in 6 (7.59%). Among NADID, pneumonia was the main cause of admission (13 patientes, 16,46%). Discussion: These results confirm previous reports showing that causes of HIV related hospitalization remain unchanged in spite of HAART at Buenos Aires, which may be reflecting problems of detection and adherence, or may be related to local viral resistance, social reasons, or any combination of these factors (AU)

Moderate prevalence of HIV-1 transmitted drug resistance mutations in southern Brazil.

BACKGROUND: Despite the advances in therapy, the occurrence of drug-resistant human immunodeficiency virus type 1 (HIV-1) is a major obstacle to successful treatment. This study aimed to characterize the genetic diversity and to determine the prevalence of transmitted drug resistance mutations (TDRM) between individuals recently or chronically diagnosed with HIV-1 from Paraná, Brazil. METHODS: A total of 260 HIV-1 positive antiretroviral therapy-naïve patients were recruited to participate on the study, of which 39 were recently diagnosed. HIV-1 genotyping was performed using sequencing reaction followed by phylogenetic analyses to determine the HIV-1 subtype. TDRM were defined using the Calibrated Population Resistance Tool program. RESULTS: The HIV-1 subtypes frequency found in the studied population were 54.0% of subtype B, 26.7% subtype C, 6.7% subtype F1 and 12.7% recombinant forms. The overall prevalence of TDRM was 6.7%, including 13.3% for recently diagnosed subjects and 5.9% for the chronic group. CONCLUSIONS: The prevalence of resistance mutations found in this study is considered moderate, thus to perform genotyping tests before the initiation of antiretroviral therapy may be important to define the first line therapy and contribute for the improvement of regional prevention strategies for epidemic control.

Factores asociados a la adherencia al targa, en pacientes con vih/sida en el hospital central de las fuerzas policiales / Factors Associated With Adherence To Haart, In Patients With Hiv / Aids In At The Central Hospital Of The Police Forces

Objetivo: Determinar los factores asociados y el grado de adherencia al TARGA en los pacientes con VIH/SIDA en el hospital Central PNP "Luis N. Sáenz" en los meses de octubre a diciembre del 2015. Métodos: Estudio observacional, transversal, analítico y descriptivo donde se evaluó a 123 pacientes con un cuestionario CEAT-VIH. Se realizó la recolección de datos en el programa Microsoft Excel y el análisis estadístico mediante el programa SPSS v.22. Resultados: Donde encontramos que la edad promedio de los todos los pacientes evaluados es 40.11 años. El tiempo de infección de los pacientes evaluados fue un promedio un año y 7 meses. El tiempo de tratamiento con el TARGA consto de un promedio de 20 meses. El 52 % (64 pacientes) de la población estudiada fue algún familiar del titular, ya sea esposa (o), hijo (a) o padres. El género que prevalece en la muestra es masculino con el 63.4 % (78 pacientes). Y la carga viral, el 77.2 % es indetectable (< 400 copias/ml). El grado encontrado fue una adecuada adherencia al TARGA, con una puntuación de 82.51 y al relacionar el grado de adherencia con las características socio-demográficas no son significativas. Pero si se encontró relación el grado de adherencia con la carga viral. Conclusión: La población estudiada tiene una adecuada adherencia al tratamiento antirretroviral y los 5 factores que mide el cuestionario: cumplimento del tratamiento, antecedentes de la falta de adherencia, interacción médico-paciente, creencias del paciente y estrategia para la toma de medicamentos, tienen muy buena influencia en la adherencia al TARGA.

Objective: To determine the associated factors and the degree of adherence to HAART in patients with HIV / AIDS at the PNP Central hospital "Luis N. Saenz" from October to December 2015. Methods: Observational, cross- sectional, analytical and descriptive study where 123 patients with a CEAT-HIV questionnaire were evaluated. Data collection was performed in the Microsoft Excel program and statistical analysis using the SPSS v.22 program. Results: Where we found that the average age of all patients evaluated was 40.11 years. The infection time of the evaluated patients was an average of one year and 7 months. Treatment time with HAART averaged 20 months. Fifty-two percent (64 patients) of the study population were any family members of the holder, either wife (s), child (ren) or parents. The gender that prevails in the sample is male with 63.4% (78 patients). And viral load, 77.2% is undetectable (<400 copies / ml). The grade found was adequate adherence to HAART, with a score of 82.51. And relating the degree of adherence to socio-demographic characteristics are not significant. But if the degree of adherence to viral load was found to be related. Conclusion: In the study population has adequate adherence to antiretroviral treatment and the 5 factors measured by the questionnaire: adherence to treatment, history of lack of adherence, physician-patient interaction, patient's beliefs and strategy for taking medications, have a very good influence on adherence to HAART.

Virus de la inmunodeficiencia humana en la era TARGA. Experiencia en un hospital de referencia / Human immunodeficiency virus in the intensive care unit in the targa era. Experience in a referral hospital

INTRODUCTION: The cause of ICU admission of HIV patients has changed during the HAART era. OBJECTIVE: To analyze HIV + patients admitted in the ICU of a tertiary university hospital, reference in HIV patients, during the HAART era. To describe the epidemiology of the disease in the ICU, cause of admission and comorbidities. Material and METHODS: Descriptive, retrospective study. HIV + patients admitted to the ICU from May 2013 to November 2017. Collected data: HIV diagnosis, HIV related previous illnesses, previous admissions, HBV coinfection, HCV, lymphocytes, CD4, adherence to treatment, cause of admission, microbiological isolation, severity scores (SOFA, SAPS II, APACHE II), mechanical ventilation, vasoactive drugs, albumin, intra ICU mortality). RESULTS: 1,511 patients were analyzed, 27 had previous diagnosis of HIV +, 5 (18.9%) were not adherent to treatment. Cause of admission: 13 patients altered level of consciousness. 7 patients acute respiratory failure. Seven patients shock. DISCUSSION: Patients who were not adherent to treatment or coinfected with HCV-HBV had lower average of CD4, lymphocyte, albumin and hemoglobin values which were associated with higher mortality and need for vasoactive drugs. (p < 0.005). Non treatment adherent HIV patients admitted to the ICU with infection have higher mortality percentages than those who comply with treatment (p < 0.005).

INTRODUCCIÓN: La causa en ingreso en UCI de los pacientes VIH ha cambiado durante la era TARGA. OBJETIVO: Analizar los pacientes VIH+ que ingresan en UCI de un hospital terciario universitario, referencia de pacientes VIH, durante la era TARGA. Describir la epidemiología de la enfermedad en UCI, motivos de ingreso, comorbilidades. MATERIAL Y MÉTODOS: Estudio descriptivo, retrospectivo. Pacientes VIH+ que ingresan en UCI desde mayo de 2013 hasta noviembre de 2017. Se recoge: diagnóstico VIH, enfermedades previas relacionada, ingresos previos, coinfección VHB, VHC, linfocitos, CD4, cumplimiento de tratamiento, causa de ingreso, aislamiento microbiológico, scores de gravedad (SOFA, SAPS II, APACHE II) ventilación mecánica, fármacos vasoactivos, albúmina, mortalidad intra UCI). RESULTADOS: Se analizan 1.511 pacientes, 27 presentan diagnóstico previo VIH+, 5 (18,9%) no eran cumplidores de tratamiento. Causa de ingreso: 13 pacientes con alteración del nivel de conciencia. Siete pacientes con insuficiencia respiratoria aguda. Siete pacientes shock. DISCUSIÓN: Los pacientes no cumplidores o coinfectados con VHC-VHB, presentan valores medios de CD4, linfocitos, albúmina y hemoglobina menores que se asocian a mayor mortalidad y necesidad de fármacos vasoactivos (p < 0,005). Los pacientes VIH no cumplidores que ingresan en UCI con infección, presentan porcentajes de mortalidad mayores que los cumplidores de tratamiento (p < 0,005).

A Low Frequency of IL-17-Producing CD8+ T-Cells Is Associated With Persistent Immune Activation in People Living With HIV Despite HAART-Induced Viral Suppression.

Immune activation is the hallmark of HIV infection, even in patients with highly active anti-retroviral therapy (HAART)-induced viral suppression. A major cause of immune activation during HIV infection is the intestinal microbial translocation as a consequence, among other factors, of the decrease and/or dysfunction of interleukin (IL)-17-producing T-cells, due to their role promoting the integrity of the intestinal barrier. A population of IL-17-producing CD8+ T-cells (Tc17 cells), characterized by the expression of CD161, has been described, but its relation with the persistent immune activation in non-viremic people living with HIV (PLWH) on HAART is unclear. By flow cytometry, we characterized the activation phenotype (evaluated by the expression of HLA-DR and CD38) of circulating CD161-expressing CD8+ T-cells; in addition, we explored the functionality of polyclonally-stimulated Tc17 cells in PLWH under HAART-induced viral suppression, and in healthy individuals. Finally, we determined the association of Tc17 cells with the expression of cellular and soluble activation markers. Circulating CD161-expressing CD8+ T-cells were decreased in PLWH compared with healthy individuals, despite their similar basal activation state. After polyclonal stimulation, IL-17 production was higher in CD8+ T-cells co-expressing HLA-DR and CD38 in healthy individuals. In contrast, although PLWH had a higher frequency of HLA-DR+ CD38+ CD8+ T-cells after stimulation, they had a lower production of IL-17. Interferon (IFN)-γ-producing CD8+ T-cells (Tc1 cells) were increased in PLWH. The low Tc17 cells response was associated with a high expression of CD38 and programmed death 1 protein, high levels of soluble CD14 and the treatment duration. Finally, to explore potential immunomodulatory strategies, the in vitro effect of the anti-inflammatory agent sulfasalazine was assessed on Tc17 cells. Interestingly, a decreased inflammatory environment, death of activated CD8+ T-cells, and an increased frequency of Tc17 cells were observed with sulfasalazine treatment. Thus, our findings suggest that activated CD8+ T-cells have a marked capacity to produce IL-17 in healthy individuals, but not in PLWH, despite HAART. This dysfunction of Tc17 cells is associated with the persistent immune activation observed in these patients, and can be partially restored by anti-inflammatory agents.