[Prevalence of human immunodeficiency virus (HIV)-Trypanosoma cruzi co-infection and injectable-drugs abuse in a Buenos Aires health center]. / Prevalencia de la coinfección virus de la inmunodeficiencia humana (VIH)-Trypanosoma cruzi e impacto del abuso de drogas inyectables en un centro de salud de la ciudad de buenos aires.

The aim of this study was to evaluate the prevalence of human immunodeficiency virus (HIV)-Trypanosoma cruzi co-infection in a Buenos Aires health center. A retrospective analysis of the clinical charts of 602 HIV-infected patients was performed. Only 51.3% of the patients were evaluated against T. cruzi. The global co-infection prevalence was 4.2%, being more frequent among injectable drug users (IDU) (8.9% vs. 2.6%, < 0.05). The indication of T. cruzi testing should be stressed for HIV-infected patients, especially in those centers where IDU are assisted.

Prevalencia de la coinfección virus de la inmunodeficiencia humana (VIH)- Trypanosoma cruzi e impacto del abuso de drogas inyectables en un centro de salud de la ciudad de Buenos Aires / Prevalence of human immunodeficiency virus (HIV)- Trypanosoma cruzi co-infection and injectable-drugs abuse in a Buenos Aires health center

Se evaluó la prevalencia de coinfección virus de la inmunodeficiencia humana (VIH)- Trypanosoma cruzi ( T. cruzi) en pacientes atendidos en un centro asistencial de Buenos Aires, Argentina. Se realizó un análisis retrospectivo de las historias clínicas de 602 individuos VIH positivos. Sólo en el 51,3% de estos pacientes se había investigado la presencia de T. cruzi. La prevalencia global de coinfección fue del 4,2%, siendo más elevada en usuarios de drogas inyectables (UDI) (8,9% vs. 2,6%, p<0,05). Sobre la base de estos resultados, concluimos que debería enfatizarse el cumplimiento de la indicación de diagnóstico para la enfermedad de Chagas en pacientes VIH positivos, especialmente en UDI.

The aim of this study was to evaluate the prevalence of human immunodeficiency virus (HIV)- Trypanosoma cruzi co-infection in a Buenos Aires health center. A retrospective analysis of the clinical charts of 602 HIV-infected patients was performed. Only 51.3% of the patients were evaluated against T. cruzi. The global co-infection prevalence was 4.2%, being more frequent among injectable drug users (IDU) (8.9% vs. 2.6%, p<0.05). The indication of T. cruzi testing should be stressed for HIV-infected patients, especially in those centers where IDU are assisted.

Two simultaneous hepatitis B virus epidemics among injecting drug users and men who have sex with men in Buenos Aires, Argentina: characterization of the first D/A recombinant from the American continent.

Previous studies have revealed that hepatitis B virus (HBV)/D and HBV/F predominate among blood donors from Buenos Aires, Argentina. In the present study, blood samples from two high-risk groups were analysed: 160 corresponding to street- and hospital-recruited injecting drug users [81.2% showing the 'anti-hepatitis B core antigen (anti-HBc) only' serological pattern] and 20 to hepatitis B surface antigen (HBsAg)(+)/anti-HBc(+) men who have sex with men. HBV genotypes were assigned by polymerase chain reaction amplification followed by restriction fragment length polymorphism and confirmed by nucleotide sequencing of two different coding regions. HBV DNA was detected in 27 injecting drug users (16.9%, occult infection prevalence: 7.7%), and 14 men who have sex with men (70%). HBV/A prevailed among injecting drug users (81.8%) while HBV/F was predominant among men who have sex with men (57.1%). The high predominance of HBV/A among injecting drug users is in sharp contrast to its low prevalence among blood donors (P = 0.0006) and men who have sex with men (P = 0.0137). Interestingly, all HBV/A S gene sequences obtained from street-recruited injecting drug users encoded the rare serotype ayw1 and failed to cluster within any of the known A subgenotypes. Moreover, one of the HBV strains from a hospital-recruited injecting drug user was fully sequenced and found to be the first completely characterized D/A recombinant genome from the American continent. Data suggest that two simultaneous and independent HBV epidemics took place in Buenos Aires: one spreading among injecting drug users and another one sexually transmitted among the homosexual and heterosexual population.

Relationship between hepatitis C virus (HCV) and insulin resistance, endothelial perturbation, and platelet activation in HIV-HCV-coinfected patients under highly active antiretroviral treatment.

Insulin resistance is associated with highly active antiretroviral therapy in HIV-infected patients, and the risk of developing insulin resistance is increased in hepatitis C virus (HCV)-infected patients. The aim of the present study was to determine whether hepatitis C virus infection constitutes an additional risk factor for insulin resistance or other prothrombotic conditions in HIV-HCV coinfected patients under highly active antiretroviral therapy. One hundred eighteen HIV-infected patients were studied: 50 who had no history of anti-HIV treatment and 68 who were receiving therapy with highly active antiretroviral treatment. The treatment-naive group consisted of 35 HCV-negative subjects and 15 HCV-positive ones. Within the treated group, 50 patients were HCV negative and 18 were HCV positive. For each patient, the lipid profile was determined and the following values measured: glucose, soluble P-selectin (as a marker of platelet activation), soluble thrombomodulin, von Willebrand factor and soluble vascular cell adhesion molecule-1 (as endothelial markers), and insulin resistance. No significant difference (p>0.05) for any variable was found among subjects with or without HCV coinfection in the treatment-naïve group. Among patients under highly active antiretroviral therapy, however, those with HCV coinfection showed higher values (p<0.05) for insulin resistance (homeostasis model assessment value: 2.65 vs. 1.79), glucose (93 vs. 86 mg/dl), endothelial markers (von Willebrand factor, 204 vs. 123%; soluble vascular cell adhesion molecule-1, 650 vs. 482 ng/ml), and platelet activation marker (soluble P-selectin, 78 vs. 51 ng/ml) in parallel with lower CD4+ cells counts (289 vs. 402 cells/mm3) and higher HIV-1 viral loads (305 vs. 50 copies/ml) compared to patients without HCV coinfection. Glucose, soluble P-selectin, and von Willebrand factor were independently related to HCV infection. The presence of HCV coinfection during HIV treatment was closely related to higher values of insulin resistance, to activated platelets, and to endothelial perturbation in parallel with lower CD4+ cell counts and higher HIV-1 viral loads compared to patients without HCV coinfection. On the basis of these results, it may be preferable to treat HCV infection prior to initiating treatment for HIV infection in HIV-HCV-coinfected patients.

Prospective evaluation of in-house polymerase chain reaction for diagnosis of mycobacterial diseases in patients with HIV infection and lung infiltrates.

SETTING: Rapid diagnosis of tuberculosis (TB) in AIDS is critical for optimal treatment to reduce mycobacterial dissemination, HIV-1 replication and mortality. The inadequate sensitivity of Ziehl-Neelsen staining and its inability to distinguish atypical mycobacteria delays accurate diagnosis. OBJECTIVE: To evaluate the polymerase chain reaction (PCR) for diagnosis of TB in bronchoalveolar lavage (BAL), blood and extra-pulmonary samples from patients with AIDS and pulmonary infiltrates. DESIGN: Specimens from 103 HIV-1-infected patients were prospectively analysed using bacteriological methods and IS6110-PCR. Smear-positive samples were also tested using 16S ribosomal-DNA-PCR to identify Mycobacterium avium complex (MAC) infections. Gold standard diagnosis relied on positive cultures or treatment outcome. RESULTS: Thirty-four patients exhibited TB, one TB and MAC and four MAC. The sensitivity of IS6110-PCR was 100% in smear-positive samples, 81.8% in smear-negative BAL, 66.7% in extra-pulmonary samples and 42.9% in blood. Its specificity was 97.1% in BAL and 100% in extra-pulmonary and blood specimens. The 16S rDNA-PCR identified M. avium from all smear-positive samples that grew MAC. CONCLUSIONS: IS6110-PCR proved useful in evaluating episodes with probable clinical diagnosis of pulmonary or mixed TB and negative smears, whereas 16S rDNA-PCR would be helpful for prompt differential diagnosis of MAC in smear-positive specimens.

Human herpesvirus 8 can be transmitted through blood in drug addicts.

Human Herpes virus type-8 (HHV-8) seroprevalence was studied in a population of HIV positive intravenous drug users (IVDUs) from Argentina. Analysis of this population also indirectly made it possible to study HHV-8 blood transmission, because these individuals frequently engage in needle sharing behavior and are capable of acquiring a broad array of blood borne pathogens, including Hepatitis B/C virus. The seroprevalence of HHV-8 in IVDUs was compared to a group of non-IVDUs and HIV negative individuals. Of the 223 individuals tested, 13.45% were HHV-8 positive, 16.99% in the IVDUs group, and 5.71% in the non-IVDUs. Among HIV positive IVDUs, 25/144 (17.36%) were also HHV-8 seropositive. The seropositivity rate of HHV-8 in HIV negative IVDUs was 11.1%. In contrast, HHV-8 seroprevalence in HIV negative heterosexual individuals without drug usage behavior was even lower (5.71%). The rate of HHV-8 infection in HIV positive IVDUs was three times as high compared to the non IVDU HIV negative individuals, suggesting that IVDU is a risk for HHV-8 infection. Furthermore, it was found that IVDUs showed a very high rate of Hepatitis B/C (52.77%), which also correlate with HHV-8 infection in this population (23.68%). All Hepatitis B/C positive individuals were also HIV positive. Our data confirm other studies showing that individuals who share needles are at risk for acquiring Hepatitis B/C and HIV infections. In addition, our results suggest that they are also at risk to acquiring HHV-8 infection by the same route.

Human herpesvirus 8 can be transmitted through blood in drug addicts.

Human Herpes virus type-8 (HHV-8) seroprevalence was studied in a population of HIV positive intravenous drug users (IVDUs) from Argentina. Analysis of this population also indirectly made it possible to study HHV-8 blood transmission, because these individuals frequently engage in needle sharing behavior and are capable of acquiring a broad array of blood borne pathogens, including Hepatitis B/C virus. The seroprevalence of HHV-8 in IVDUs was compared to a group of non-IVDUs and HIV negative individuals. Of the 223 individuals tested, 13.45

were HHV-8 positive, 16.99

in the IVDUs group, and 5.71

in the non-IVDUs. Among HIV positive IVDUs, 25/144 (17.36

) were also HHV-8 seropositive. The seropositivity rate of HHV-8 in HIV negative IVDUs was 11.1

. In contrast, HHV-8 seroprevalence in HIV negative heterosexual individuals without drug usage behavior was even lower (5.71

). The rate of HHV-8 infection in HIV positive IVDUs was three times as high compared to the non IVDU HIV negative individuals, suggesting that IVDU is a risk for HHV-8 infection. Furthermore, it was found that IVDUs showed a very high rate of Hepatitis B/C (52.77

), which also correlate with HHV-8 infection in this population (23.68

). All Hepatitis B/C positive individuals were also HIV positive. Our data confirm other studies showing that individuals who share needles are at risk for acquiring Hepatitis B/C and HIV infections. In addition, our results suggest that they are also at risk to acquiring HHV-8 infection by the same route.

A randomized, controlled, phase II trial comparing escalating doses of subcutaneous interleukin-2 plus antiretrovirals versus antiretrovirals alone in human immunodeficiency virus-infected patients with CD4+ cell counts >/=350/mm3.

A total of 73 patients with baseline CD4+ cell counts >/=350 cells/mm3 who were receiving combination antiretroviral therapy (ART) were randomized to receive subcutaneous interleukin-2 (IL-2; n=36) in addition to ART or to continue ART alone (n=37). Subcutaneous IL-2 was delivered at 1 of 3 doses (1.5 million international units ¿MIU, 4.5 MIU, and 7.5 MIU per dose) by twice-daily injection for 5 consecutive days every 8 weeks. After 24 weeks, the time-weighted mean change from baseline CD4+ cell count was 210 cells/mm3 for recipients of subcutaneous IL-2, compared with 29 cells/mm3 for recipients of ART alone (P<.001). There were no significant differences between treatment groups for measures of plasma human immunodeficiency virus RNA (P=.851). Subcutaneous IL-2 delivered at doses of 4.5 MIU and 7.5 MIU resulted in significant increases in CD4+ cell count (P=.006 and P<.001, respectively), compared with that seen in control patients. These changes were not significant in the 1.5 MIU dose group compared with that in the control patients (P=.105). Side effects that occurred from subcutaneous IL-2 administration were generally low grade, of short duration, and readily managed in an outpatient environment.

[Detection of the viral load and its use as a virological marker in the follow-up of HIV-1-positive patients]. / Detección de la carga viral y su uso como marcador virológico en el seguimiento de pacientes HIV-1 positivos.

The evaluation of viral load as virological marker and its clinical and immunological correlation are presented. The first viral load studies were performed during 1996 at the National Reference Center for AIDS in Argentina in HIV-1 positive patients derived from different Hospitals in Buenos Aires. The study included 216 HIV-1 positive patients, 49 females and 167 males. Plasma was used for evaluating viral load and a second sample was obtained in 25 of the 216 patients for their monitoring. Viral load was performed using bDNA technique (Quantiplex HIV RNA assay 2.0, Chiron Corporation, USA). Other parameters such as CD4 count determined by flow cytometry and clinical stages according to CDC classification were obtained in order to correlate clinical and immunological status of the patients. When CD4 count was compared with viral load, the results showed a trend of viral RNA increase in plasma along with a decrease in CD4+ lymphocytes. This trend was also observed to correlate with the progression to AIDS disease. In all groups of patients, considering either CD4 counts or clinical status, ranges of viral load values were broad. Thus, as shown by percentiles 25 and 75, patients with CD4 counts < 200/ml, presented viral load values between 18,395 c/ml to 215,425 c/ml and patients with > 200/ml viral RNA showed values from < 10,000 to 35,180 c/ml. Patients with CDC's A and B stages presented values from < 10,000 to 45,160 c/ml and 87,000 c/ml respectively, while patients classified as C had 10,582 to 215,000 c/ml. Results of two consecutive samples in the 25 patients showed the usefulness of this technique for monitoring antiretroviral therapy. Nevertheless, despite the tendency of viral load to increase along with the progression of the disease, the broad range of values suggested the importance of using both virological and immunological parameters for the management of HIV infected patients.

Detección de la carga viral y su uso como marcador virológico en el seguimiento de pacientes HIV-1 positivos / Viral load detection and its role as virological marker for the monitoring of HIV-1 positive patients

Se realizaron los primeros estudios de carga viral en pacientes HIV-1 positivos provenientes de diferentes instituciones asistenciales de la Ciudad de Buenos Aires. Se evaluó la carga viral como marcador virológico y su correlación con la clínica y el recuento de los linfocitos CD4+ para 216 pacientes HIV-1 positivos. La técnica utilizada fue bDNA (Quantiplex HIV RNA 2.0 assay, Chiron Corporation). Se observó una tendencia al aumento de la carga viral en los pacientes con menor cantidad de linfocitos CD4+ y en los estadíos clínicos con sintomatología. En pacientes que no recibieron ninguna terapia antirretroviral se encontraron valores desde < 10000 copias de ARN viral/ml de plasma hasta 48995 c/ml. En aquéllos que recibieron terapia antirretroviral se observó mayor variación en los valores de la carga viral como lo mostró un rango de < 10000 c/ml hasta 96605 c/ml. Se obtuvieron muestras consecutivas en 25 pacientes y se observaron diferencias entre ambas muestras que permitieron corroborar la utilidad de la técnica en el seguimiento de los pacientes infectados con HIV

Detección de la carga viral y su uso como marcador virológico en el seguimiento de pacientes HIV-1 positivos / Viral load detection and its role as virological marker for the monitoring of HIV-1 positive patients

Se realizaron los primeros estudios de carga viral en pacientes HIV-1 positivos provenientes de diferentes instituciones asistenciales de la Ciudad de Buenos Aires. Se evaluó la carga viral como marcador virológico y su correlación con la clínica y el recuento de los linfocitos CD4+ para 216 pacientes HIV-1 positivos. La técnica utilizada fue bDNA (Quantiplex HIV RNA 2.0 assay, Chiron Corporation). Se observó una tendencia al aumento de la carga viral en los pacientes con menor cantidad de linfocitos CD4+ y en los estadíos clínicos con sintomatología. En pacientes que no recibieron ninguna terapia antirretroviral se encontraron valores desde < 10000 copias de ARN viral/ml de plasma hasta 48995 c/ml. En aquéllos que recibieron terapia antirretroviral se observó mayor variación en los valores de la carga viral como lo mostró un rango de < 10000 c/ml hasta 96605 c/ml. Se obtuvieron muestras consecutivas en 25 pacientes y se observaron diferencias entre ambas muestras que permitieron corroborar la utilidad de la técnica en el seguimiento de los pacientes infectados con HIV (AU)

Influencia del tratamiento con zidovudina (AZT) sobre los niveles de antígeno polisacárido capsular de Cryptococcus neoformans en los fluídos biológicos / Influence of zidovudine (AZT) on levels of capsular antigen of Cryptococcus neoformans in body fluids

Fueron investigados los títulos de antígeno polisacárido capsular de Cryptococcus neoformans en el momento del diagnóstico en 25 pacientes con criptococosis asociada al SIDA. Siete pacientes recibirían en el momento del diagnóstico de la micosis 500-600 mg/día de zidovudina (AZT) y otros 18 no recobirían ninguna medicación antirretroviral. Todos ellos recibieron tratamiento antifúngico específico inmediatamente después de realizado el diagnóstico micológico. Los títulos de los pacientes tratados con AZT fueron más bajos que aquellos no tratados con ningún esquema antirretroviral, aunque la diferencia observada careció de significación estadística (p>0,05). El promedio del tiempo de sobrevida (tomando desde el momento del diagnóstico de la micosis hasta la muerte) fue significativamente más largo (504,43 ñ 160 días) (p = 0,002). Tampoco se observaron diferencias significativas entre los recuentos de linfocitos CD4+ y la prevalencia de diferentes infecciones intercurrentes en ambos grupos. Las diferencias observadas entre ambas poblaciones estudiadas puede demostrar indirectamente la eficacia de la terapéutica antirretroviral para retardar el daño inmunológico provocado por el VIH sobre el sistema inmune de los pacientes (AU)

Influencia del tratamiento con zidovudina (AZT) sobre los niveles de antígeno polisacárido capsular de Cryptococcus neoformans en los fluídos biológicos / Influence of zidovudine (AZT) on levels of capsular antigen of Cryptococcus neoformans in body fluids

Fueron investigados los títulos de antígeno polisacárido capsular de Cryptococcus neoformans en el momento del diagnóstico en 25 pacientes con criptococosis asociada al SIDA. Siete pacientes recibirían en el momento del diagnóstico de la micosis 500-600 mg/día de zidovudina (AZT) y otros 18 no recobirían ninguna medicación antirretroviral. Todos ellos recibieron tratamiento antifúngico específico inmediatamente después de realizado el diagnóstico micológico. Los títulos de los pacientes tratados con AZT fueron más bajos que aquellos no tratados con ningún esquema antirretroviral, aunque la diferencia observada careció de significación estadística (p>0,05). El promedio del tiempo de sobrevida (tomando desde el momento del diagnóstico de la micosis hasta la muerte) fue significativamente más largo (504,43 ñ 160 días) (p = 0,002). Tampoco se observaron diferencias significativas entre los recuentos de linfocitos CD4+ y la prevalencia de diferentes infecciones intercurrentes en ambos grupos. Las diferencias observadas entre ambas poblaciones estudiadas puede demostrar indirectamente la eficacia de la terapéutica antirretroviral para retardar el daño inmunológico provocado por el VIH sobre el sistema inmune de los pacientes

[Morphological study of Enterocytozoon bineousi in patients with AIDS and chronic diarrhea]. / Estudio morfólogico de Enterocytozoon bieneusi en pacientes con SIDA y diarrhea crónica.

Microsporidia are protozoan parasites responsible for significant gastrointestinal disease in patients infected with the human immunodeficiency virus. We report the clinical features of three patients with chronic diarrhea and intestinal microsporidiosis caused by Enterocytozoon bieneusi. The average value for CD4 in these patients was < or = 50 cells/mm3. The spores were detected in smears from stool samples and duodenal aspirates stained with trichrome blue in all patients. Light microscopy of semi-thin plastic sections revealed parasites and spores in the enterocytes and were associated with villous atrophy (2 out of 3). Thin section-electron microscopy showed a variety of developmental stages of the microsporidio. Patients treated with Albendazole had an unsatisfactory clinical response to therapy. Enterocytozoon bieneusi infection may be an important cause of diarrhea in patients with AIDS in our country.

Estudio morfologico de Enterocytozoon bieneusi en pacientes con SIDA y diarrhea cronica / Morphological study of Enterocytozoon bineousi in patients with AIDS and chronic diarrhea

Microsporidia are protozoan parasites responsible for significant gastrointestinal disease in patients infected with the human inmunodeficiency virus. We reporte the clinical features of three patients with chronic diarrhea and intestinal microsporidiosis caused by Enterocytozoon bieneusi. The average value for CD4 in these patients was ó 50 cells/mm3. The spores were detected in smears from stool samples and duodenal aspirates stained with trichrome blue in all patiens. Light microscopy of semithin plastic sections revealed parasites and spores in the enterocytes and were associated with villous atrophy (2 out of 3). Thin section-electron microscopy showed a variety of developmental stages of the microsporidio. Patients treated with Albendazole had an unsatisfactory clinical response to therapy. Enterocytozzon bieneusi infection may be an important cause of diarrhea in patiens with AIDS in our country.

Estudio morfologico de Enterocytozoon bieneusi en pacientes con SIDA y diarrhea cronica / Morphological study of Enterocytozoon bineousi in patients with AIDS and chronic diarrhea

Microsporidia are protozoan parasites responsible for significant gastrointestinal disease in patients infected with the human inmunodeficiency virus. We reporte the clinical features of three patients with chronic diarrhea and intestinal microsporidiosis caused by Enterocytozoon bieneusi. The average value for CD4 in these patients was ó 50 cells/mm3. The spores were detected in smears from stool samples and duodenal aspirates stained with trichrome blue in all patiens. Light microscopy of semithin plastic sections revealed parasites and spores in the enterocytes and were associated with villous atrophy (2 out of 3). Thin section-electron microscopy showed a variety of developmental stages of the microsporidio. Patients treated with Albendazole had an unsatisfactory clinical response to therapy. Enterocytozzon bieneusi infection may be an important cause of diarrhea in patiens with AIDS in our country. (AU)