Psychosocial and Neurohormonal Predictors of HIV Disease Progression (CD4 Cells and Viral Load): A 4 Year Prospective Study.

Most studies of psychosocial predictors of disease progression in HIV have not considered norepinephrine (NE), a neurohormone related to emotion and stress, even though NE has been related to accelerated viral replication in vitro and impaired response to antiretroviral therapy (ART). We therefore examined NE, cortisol, depression, hopelessness, coping, and life event stress as predictors of HIV progression in a diverse sample. Participants (n = 177) completed psychological assessment, blood draws [CD4, viral load (VL)], and a 15 h urine sample (NE, cortisol) every 6 months over 4 years. Hierarchical linear modeling (HLM) was used to model slope in CD4 and VL controlling for ART at every time point, gender, age, race, SES, and initial disease status. NE (as well as depression, hopelessness, and avoidant coping) significantly predicted a greater rate of decrease in CD4 and increase in VL. Cortisol was not significantly related to CD4, but predicted VL increase. To our knowledge, this is the first study relating NE, in vivo, to accelerated disease progression over an extended time. It also extends our previous 2 year study by relating depressed mood and coping to accelerated disease progression over 4 years.

Should the first blood pressure reading be discarded?

We evaluated the consequences of excluding the first of three blood pressure (BP) readings in different settings: a random population sample (POS, n=1525), a general practice office (GPO, n=942) and a specialized hypertension center (SHC, n=462). Differences between systolic and diastolic BP (SBP and DBP) estimates obtained including and excluding the first reading were compared and their correlation with ambulatory BP monitoring (ABPM) was estimated. The samples were divided into quartiles according to the difference between the third and the first SBP (3-1ΔSBP). SBP decreased through sequential readings, 3-1ΔSBP was -5.5 ± 9.7 mm Hg (P<0.001), -5.1 ± 10.4 mm Hg (P<0.001) and -6.1 ± 9.3 mm Hg (P<0.001) for POS, GPO and SHC, respectively. However, individuals included in the top quartile of 3-1ΔSBP showed their highest values on the third reading. The mean SBP estimate was significantly higher excluding the first reading (P<0.001), but the differences among both approaches were small (1.5-1.6 mm g). Moreover, the correlation between SBP values including and excluding the first reading and daytime ABPM were comparable (r = 0.69 and 0.68, respectively). Similar results were observed for DBP. In conclusion, our study does not support the notion of discarding the first BP measurement and suggests that it should be measured repeatedly, regardless the first value.

Identifying cardiovascular disease risk and outcome: use of the plasma triglyceride/high-density lipoprotein cholesterol concentration ratio versus metabolic syndrome criteria.

BACKGROUND: Metabolic syndrome (MetS) has been shown to predict both risk and CVD events. We have identified sex-specific values for the triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio associated with an unfavourable cardio-metabolic risk profile, but it is not known whether it also predicts CVD outcome. METHODS: To quantify risk for CVD outcomes associated with a high TG/HDL-C ratio and to compare this risk with that predicted using MetS, a population longitudinal prospective observational study was performed in Rauch City, Buenos Aires, Argentina. In 2003 surveys were performed on a population random sample of 926 inhabitants. In 2012, 527 women and 269 men were surveyed again in search of new CVD events. The first CVD event was the primary endpoint. Relative risks for CVD events between individuals above and below the TG/HDL-C cut-points, and with or without MetS, were estimated using Cox proportional hazard. MAIN OUTCOME: The first CVD event was the primary endpoint. Relative risks for CVD events between individuals above and below the TG/HDL-C cut-points, and with or without MetS, were estimated using Cox proportional hazard. RESULTS: The number of subjects deemed at 'high' CVD risk on the basis of an elevated TG/HDL-C ratio (30%) or having the MetS (35%) was relatively comparable. The unadjusted hazard risk was significantly increased when comparing 'high' versus 'low' risk groups no matter which criteria was used, although it was somewhat higher in those with the MetS (HR = 3.17, 95% CI:1.79-5.60 vs. 2.16, 95% CI:1.24-3.75). However, this difference essentially disappeared when adjusted for sex and age (HR = 2.09, 95% CI:1.18-3.72 vs. 2.01, 95% CI:1.14-3.50 for MetS and TG/HDL-C respectively). CONCLUSIONS: An elevated TG/HDL-C ratio appears to be just as effective as the MetS diagnosis in predicting the development of CVD.

Telangiectasia nevoide unilateral / Unilateral nevoid telangiectasia

La telangiectasia nevoide unilateral se define por la aparición progresiva de telangiectacias localizadas de manera blaschkoide o unilateral en un dermatoma cutáneo, habitualmente en la cabeza, el cuello y los miembros superiores. Las lesiones suelen comenzar en torno a la pubertad y son más habituales en pacientes de sexo femenino. Es una patología benigna con repercusiones meramente estéticas, pero en ocasiones puede asociarse a hepatopatía o a enfermedades autoinmunes, como el lupus eritematoso sistémico. El tratamiento consiste en láser colorante pulsado(AU)

Unilateral nevoid telangiectasia is a disorder characterized by a progressive occurrence of telangiectases on the skin. They are usually arranged in an unilateral or Blaschkoid pattern on the head, the neck or the upper limb. The disease appears around puberty and has a female predilection. Unilateral nevoid telangiectasia is a benign disorder but it has also been described in association with hepatopathy or with a connective tissue disease like lupus erythematosus. The pulsed dye laser is the treatment of choice(AU)

Piebaldismo / Piebaldism

El piebaldismo es una enfermedad infrecuente, autosómicadominante, que se caracteriza por la presencia desde el nacimientode poliosis y de máculas despigmentadas blanquecinaslocalizadas en la línea media frontal, el tórax, el abdomen y lasextremidades, donde no se encuentran melanocitos.Se ha relacionado con mutaciones inactivadoras o delecionesen el gen c-Kit, que provocan una disminución de la señaldel receptor tirosina-cinasa. Estas mutaciones impiden el correctodesarrollo de los melanoblastos y su posterior migracióndesde la cresta neural hacia su ubicación definitiva(AU)

Piebaldism is an autosomal dominant rare disease characterizedby the presence since birth of poliosis and congenitaldepigmentation white patches on the mid-forehead, chest, abdomenand extremities, where no melanocytes are found.It has been linked to inactivating mutations or deletions ofthe c-Kit gene. These mutations result in a decrease of the receptortyrosine kinase signalling. These mutations do not allowthe correct development of the melanoblast and the posteriormigration from the neural crest to a definitive site(AU)

Larva migratoria cutánea / Cutaneous larva migrans

La larva migratoria cutánea es una entidad caracterizada por la penetración de gusanos en la piel, sobre todo Ancylostomabraziliense y Ancylostoma caninum. La imagen clínica típica es la de una tracto eritematoso serpinginoso en la piel, que con frecuencia es pruriginoso y que normalmente afecta a los pies, las piernas y las nalgas. Es una enfermedad autolimitada, aunque un tratamiento antihelmíntico eficaz puede disminuir los síntomas y acortar su duración (AU)

Cutaneous larva migrans results from skin penetration of worms, most commonly Ancylostoma braziliense and Ancylostomacaninum. The typical clinical picture is a serpiginous erythematous tract on the skin, often pruritic, normally affecting the feet, legs and buttocks. It is a self-limited disease, though an effective treatment can diminish the symptoms and shorten the duration of the disease (AU)

Quistes vellosos eruptivos / Eruptive vellus hair cysts

Los quistes vellosos eruptivos se definen por la aparición de numerosas pápulas asintomáticas, que se localizan normalmente en la cara anterior del tórax, el abdomen y las axilas. Se trata de una entidad benigna, que puede aparecer de forma esporádica o heredarse de modo autosómico dominante. El tratamiento constituye todo un reto, con resultados decepcionantes en muchos casos (AU)

Eruptive vellus hair cysts are characterized by numerous symptomatic papules usually located on the anterior chest, abdomen and armpits. It is a benign condition, which may be inherited or acquired in a autosomal dominant manner. The treatment is often challenging with disappointing results manytimes (AU)

Enfermedad mano-pie-boca / Hand, foot and mouth disease

La enfermedad mano-pie-boca es una entidad nosológica de causa viral, que se caracteriza por la presencia de lesiones cutáneas en la mucosa oral y las regiones acrales. En la mayoría de las ocasiones el agente causal son los virus Coxsackie, miembros de la familia picornavirus. La infección se presenta habitualmente de forma esporádica, si bien pueden existir epidemias. El tratamiento es sintomático y el pronóstico es excelente, aunque se han descrito complicaciones neurológicas y casos mortales (AU)

Hand, foot and mouth disease is a nosological entity of viralorig in characterised by cutaneous lesions of the oral mucosa and acral regions. In most cases the causal agent is the Coxsackie virus, a member of the Picornavirus family. The infection usually occurs sporadically, even though epidemics may occur. Its treatment is symptomatic and the prognosis is excellent, although there have been reports of neurological complications and fatal cases (AU)

Hipomelanosis macular progresiva / Progressive macular hypomelanosis

La hipomelanosis macular progresiva es una entidad poco conocida y, sin embargo, relativamente frecuente. Cursa con la aparición de máculas hipocrómicas asintomáticas en el tronco de adolescentes y adultos jóvenes, sin inflamación previa. La etiología de esta enfermedad es desconocida, pero se postula la posible intervención de cepas de Propionibacterium acnes. No tiene tratamiento eficaz, pero hay casos que responden a la fototerapia y la antibioterapia tópica (AU)

Progressive macular hypomelanosis is a little-known and yet relatively common condition. It presents with the appearance of asymptomatic hypochromic macules on the trunk of adolescents and young adults, without prior inflammation. This disease if of unknown a etiology, but is thought to involve the possible intervention of strains of Propionibacterium acnes. There is no efficient treatment for this disease, although certain cases respond to phototherapy and topical antibiotherapy (AU)

Nevo «spilus» congénito plantar / Foot congenital nevus spilus

El nevo spilus, también denominado nevo lentiginoso moteado, se define como una mácula café con leche, con presencia de máculas y pápulas hiperpigmentadas distribuidas de forma irregular en la superficie. Suele comenzar durante la primera infancia, y con menor probabilidad es congénito. Estas lesiones pueden malignizarse, por lo que se debe realizar un seguimiento. Presentamos el caso clínico de una niña de 4 años de edadc on un nevo spilus congénito en una localización inusual en el talón izquierdo (AU)

Nevus spilus, also known as speckled lentiginous nevus, is characterized by a café-au-lait macule, with the presence of hyper pigmented macules and papules irregularly distributed on the surface. It usually starts during the first childhood, and with less probability it is a congenital lesion. These lesions can turn malignant, so they have to be followed-up. We present a case report of 4-year-old child with a congenital nevus spilus on an unusual localization on the left heel (AU)

Nevo «spilus» congénito plantar / Congenital plantar nevus spilus

El nevo spilus, también denominado nevo lentiginoso moteado, se define como una mácula café con leche, con presencia de máculas y pápulas hiperpigmentadas, distribuidas de forma irregular en la superficie. Suele comenzar durante la primera infancia, y con menor probabilidad es congénito. Estas lesiones pueden malignizarse, por lo que se debe hacer un seguimiento de ellas. Presentamos el caso clínico de una niña de 4 años de edad con un nevo spilus congénito, en una localización inusual en el talón izquierdo (AU)

Nevus spilus, also known as speckled lentiginous nevus, is characterized as a café-au-lait macule, with the presence of hyper pigmented macules and papules irregularly distributed on the surface. It usually appears during the early child hood, and it is congenital with less probability. These lesions can become malignant, so these lesions must be followed-up. We present a case report of a 4-year-old girl with a congenital nevus spilus, in an unusual localization on the left heel (AU)

Angioqueratoma solitario / Solitary angiokeratoma

Los angioqueratomas son lesiones vasculares benignas que histopatológicamente están formadas por vasos capilares dilatados subepidérmicos, asociados a una reacción epidérmica con acantosis e hiperqueratosis. Clínicamente podemos encontrar lesiones solitarias o múltiples, en forma de pápulas o placas de pequeño tamaño de color rojo a negro, en variadas localizaciones y con una superficie hiperqueratósica. Presentamos el caso de un niño de 5 años con un angioqueratoma solitario localizado en el tronco que presenta una dermatoscopia característica (AU)

Angiokeratomas are benign vascular lesions that histopathologically consist of subepidermal dilated capillary vessels, associated to an epidermal reaction with acanthosis or hyperkeratosis. Clinically we can find solitary or multiple lesions, as small size red to black papules or plaques, in several locations with an hyperkeratosis surface. We present the case of a solitary angiokeratoma in a 5-years-old child, located on the trunk, with a characteristic dermatoscopy (AU)

Hemangiomatosis difusa neonatal / Diffuse neonatal hemangiomatosis

El hemangioma es el tumor benigno más frecuente de la infancia. La mayoría de las veces se manifiesta como un tumor solitario(o, a lo sumo, aparecen dos o tres lesiones), y remite de forma espontánea antes de los 10 años de vida. Cuando el número de hemangiomas es de cinco o más, el proceso de denomina hemangiomatosis cutánea múltiple. En estos casos pueden aparecer hemangiomas viscerales, sobre todo hepáticos; hablamos entonces de hemangiomatosis difusa neonatal, siendo necesario efectuar una monitorización estrecha para descartar posibles complicaciones (AU)

The hemangioma is the most common benign tumor in childhood. In most cases, it is a solitary tumor or, at most, there maybe two or three, which remits spontaneously before the childreaches the age of 10 years. When there are five or more hemangiomas, the process is referred to as multiple cutaneous hemangiomatosis. In these cases, visceral hemangiomas can develop, mainly in the liver, thus resulting in the disease referred to as diffuse neonatal hemangiomatosis. This process requires close monitoring in order to rule out possible complications (AU)

Talón negro (hematoma subcórneo) / Black heel (subcorneal hematoma)

El talón negro es un proceso relativamente frecuente, caracterizado por la aparición de una lesión negra en la zona de apoyo del talón, que aparece en jóvenes deportistas. Está provocado por pequeños traumatismos que pueden dar lugar a hemorragias superficiales. Su interés patológico radica en la posible confusión con lesiones pigmentarias de estirpe melanocítica, lo que puede originar cierto grado de alarma. El diagnóstico es fácil de realizar y puede llevarse a cabo por el simple raspado de la lesión o mediante el examen con dermatoscopio(AU)

Black heel, or talon noir, is a relatively common condition, especially in young athletes, that is characterized by the development of a black lesion on the part of the heel that is subjected to pressure. It is caused by the rupture of tiny blood vessels and can lead to bruising. It is of interest because of the possible confusion with pigmented melanocytic lesions, a circumstance that can give rise to a certain degree of alarm. The diagnosis is easy to perform and can consist of simple scraping of the lesion or a dermoscopic examination(AU)

Dermatitis palmar juvenil de las piscinas / Juvenile palmar dermatitis acquired at swimming pools

La dermatitis palmar de las piscinas es un proceso benigno relativamente frecuente, debido al incremento de las actividades deportivas en las piscinas. Las lesiones se localizan en las zonas de roce y apoyo de las regiones palmares, y se producen por la fricción continuada con las superficies rugosas del borde de las piscinas, a lo que contribuye la fragilidad cutánea consecutiva al contacto continuado con el agua. El descanso de las actividades en la piscina durante unos días da lugar a la remisión del proceso(AU)

Palmar dermatitis acquired at swimming pools is a benign process that is relatively frequent due to the increase in sports activities in swimming pools. The lesions are located on the friction and support areas of the palmar regions and are caused by the continuous friction with the rough surfaces of the edges of swimming pools, made easier by the fragility of the skin following the continuous contact with the water. A break from the swimming pool activities for a few days heals the process(AU)

Relative preservation of natural killer cell cytotoxicity and number in healthy AIDS patients with low CD4 cell counts.

OBJECTIVE: This study examines whether there may be an immune component that protects a relatively rare group of HIV-infected people with very low CD4 cell counts (< or = 50 x 10(6)/l) who have prolonged asymptomatic periods. DESIGN/METHODS: Three groups were recruited in Miami: (i) healthy low CD4 cell count patients (HLC; n = 30) who, for 9 months had < 50 x 10(6) CD4 cells/l, were asymptomatic and were not on protease inhibitors during that time; (ii) HIV comparison group (Comp; n = 60) who had CD4 cell counts predominantly 150 x 10(6) to 400 x 10(6)/l and never had AIDS Category C symptoms; this group was also followed for CD4 cell count and viral load change over 6 months; and (iii) healthy community controls (n = 33). The study was replicated at the University of California at Los Angeles (UCLA) with HLC (n = 31) versus HIV-negative laboratory controls (n = 28). RESULTS: The HLC patients were significantly higher than the Comp group on natural killer cell cytotoxicity (NKCC) and natural killer cell number (NK#) despite their lower CD4 cell numbers and higher viral loads. In fact, there was no difference between the HLC group and the healthy community control group in NK# or NKCC. The NK findings were replicated at UCLA. A retrospective analysis showing that higher NKCC was related to fewer prior symptoms in the HLC group, and prospective analysis in the Comp group showing that NK# predicted a lower increase in viral load over 6 months further supported the importance of NK# and NKCC. CONCLUSIONS: Non-specific cellular immunity may be a factor protecting the health of HIV sero-positive individuals with very low CD4 cell counts.

Stress and coping: the psychoneuroimmunology of HIV/AIDS.

A considerable body of evidence, reviewed in this chapter, suggests that psychosocial factors play an important role in progression of HIV infection, its morbidity and mortality. Psychosocial influences relating to faster disease progression include life-event stress, sustained depression, denial/avoidance coping, concealment of gay identity (unless one is rejection-sensitive), and negative expectancies. Conversely, protective psychosocial factors include active coping, finding new meaning, and stress management. In studying long survivors of HIV/AIDS, our group has found protective effects on health of life involvement, collaborative relationship with doctor, emotional expression, depression (conversely), and perceived stress (conversely). Reviewed and discussed are psychoneuroimmunological pathways by which immune and neuroendocrine mechanisms might link psychosocial factors with health and long survival. Finally, biological factors are also a major determinant of disease progression and include genetics and age of the host, viral strain and virulence, medication and several immune response factors on which psychosocial influences could impact.