Resistance to Prostaglandin E2 Promotes Monocyte Activation During Chronic HIV Infection.

BACKGROUND: Monocyte activation is a driver of inflammation in the course of chronic HIV infection. Prostaglandin E2 (PGE2) is known to mediate anti-inflammatory effects, notably the inhibition of tumor necrosis factor- (TNF-) production by monocytes. We aim to investigate the effects of PGE2 on activation of monocytes in chronic HIV infection and the mechanisms through which PGE2 modulates their inflammatory signature. METHODS: We recruited a group of people with HIV (PWH) and matched healthy uninfected persons. We compared plasma levels of PGE2, monocyte activation, and sensitivity of monocytes to the inhibitory actions mediated by PGE2. RESULTS: We found increased plasma levels of PGE2 in PWH, and an activated phenotype in circulating monocytes, compared with uninfected individuals. Monocytes from PWH showed a significant resistance to the inhibitory actions mediated by PGE2; the concentration of PGE2 able to inhibit 50 of the production of TNF- by lipopolysaccharide-stimulated monocytes was 10 times higher in PWH compared with uninfected controls. Furthermore, the expression of phosphodiesterase 4B, a negative regulator of PGE2 activity, was significantly increased in monocytes from PWH. CONCLUSIONS: Resistance to the inhibitory actions mediated by PGE2 could account, at least in part, for the inflammatory profile of circulating monocytes in PWH.

Utilización de prácticas clínicas para promover la cesación tabáquica en personas que viven con VIH en Argentina / Use of smoking cessation clinical practices among persons living with HIV in Argentina

INTRODUCCIÓN: El consumo de tabaco en las personas que viven con VIH (PVV) en Argentina está entre un 40 y un 60%. El consumo de tabaco se relaciona con la aparición de cáncer en la población general y con una disminución de la respuesta al tratamiento antirretroviral en las PVV. Los médicos que atienden a las PVV pueden tener un papel fundamental en ayudar a sus pacientes a dejar de fumar. Este estudio examinó los factores relacionados con la utilización de las prácticas clínicas de cesación tabáquica en una muestra de médicos infectólogos que atienden a PVV en Argentina. MÉTODOS: Se administró una encuesta en línea a miembros de la Sociedad Argentina de Infectología, quienes referían atender a PVV. Se realizaron análisis descriptivos y modelos lineales generalizados. RESULTADOS: Participaron 138 profesionales (20,4% de los convocados). La implementación de métodos para la cesación tabáquica por los infectólogos fue significativamente mayor en aquellos profesionales que habían recibido educación al respecto (RPa: 1,22; IC 95%: 1,10-1,35), y disminuía significativamente en quienes no habían recibido entrenamiento formal (RPa: 0,64; IC 95%: 0,44-0,94). DISCUSIÓN: Hay necesidad de incorporar el entrenamiento en cesación tabáquica en la capacitación profesional de médicos que atienden a PVV para aumentar sus destrezas en estas prácticas clínicas y disminuir el consumo de tabaco en esta población

Evaluación de la persistencia de síntomas luego de un episodio de infección por SARS-CoV-2 / Characterization of persistent symptoms after SARS-CoV-2 infection

Introducción: Es frecuente que, luego de un episodio de COVID-19, los pacientes persistan con síntomas, lo cual impacta negativamente en su calidad de vida. El objetivo primario de este estudio es determinar los síntomas prevalentes y su duración luego de un episodio de COVID-19 y la persistencia de estos al mes y a los tres meses del episodio. Los objetivos secundarios son describir el lapso entre el episodio de COVID-19, la reinserción laboral o académica y la reanudación de actividad física. Material y métodos: Estudio descriptivo, observacional, en adultos con antecedente de infección por SARS-CoV-2, realizado a través de una encuesta en línea. Se relacionaron variables demográficas y comorbilidades con síntomas durante la infección, al mes y al tercer mes del episodio.Resultados: Participaron 308 personas. Los síntomas más comunes en la fase aguda fueron dolor muscular y fiebre. Al mes, el 89% presentaba síntomas persistentes, siendo los más frecuentes: fatiga y mialgias. Luego de tres meses, 34,85% presentaba síntomas, siendo los más frecuentes: fatiga y anosmia. Solo el 45,7% de las personas logró la reinserción laboral/académica y el 17% de los individuos logró reiniciar actividad física al alta epidemiológica.Discusión: El porcentaje de personas con síntomas persistentes después de un episodio de COVID-19 es alto. La persistencia de los síntomas disminuye con el tiempo, lo cual es un dato alentador para todos aquellos pacientes que consultan por continuar sintomáticos.

Background: It is frequent that patients complain of persistent symptoms after an episode of COVID-19 infection, that worsened their quality of lifeAim: the aim of this study is to describe the main symptoms during a COVID-19 infection and persistent symptoms a month and three months after the episode. Our secondary objective is to describe the period between the COVID-19 episode and resuming work/ studies and exercise routine. Methods: this is a descriptive, observational study that included adults who underwent an episode of SARS-CoV-2 infection. Participants responded to an online survey. We include demographic and comorbidity data and symptoms during infection, and one and three months after infection. Results: 308 people responded to the survey, frequent symptoms during the episode included myalgia and fever. A month after the episode, 89% complained of persistent symptoms, most frequently myalgia and fatigue. Three months after the episode 38.85% complained of persistent symptoms , most frequently fatigue and anosmia. Only 45.7% could resume work/ studies 10 days after the diagnosis, and 17% could resume exercise routine 10 days after the diagnosis. Conclusions: there is a high percentage of people who persisted with symptoms after a COVID-19 infection. We noticed symptoms improved over time, this finding could be encouraged for patients who persist symptomatic after the episode.

Strongyloidiasis Outside Endemic Areas: Long-term Parasitological and Clinical Follow-up After Ivermectin Treatment.

Background: Strongyloides stercoralis affects 30-100 million people worldwide. The first-line therapy is ivermectin. Cure is defined as the absence of larvae by parasitological methods 1 year after treatment. To date, no longitudinal parasitological studies for longer periods of time have been conducted to confirm its cure. Here, we evaluated treatment response in long-term follow-up patients with chronic infection using parasitological and molecular methods for larvae or DNA detection. Methods: A prospective, descriptive, observational study was conducted between January 2009 and September 2015 in Buenos Aires, Argentina. Twenty-one patients with S. stercoralis diagnosis were evaluated 30, 60, and 90 days as well as 1, 2, 3, and/or 4 years after treatment by conventional methods (fresh stool, Ritchie method, agar plate culture), S. stercoralis-specific polymerase chain reaction (PCR) in stool DNA, and eosinophil values. Results: During follow-up, larvae were detected by conventional methods in 14 of 21 patients. This parasitological reactivation was observed starting 30 days posttreatment (dpt) and then at different times since 90 dpt. Eosinophil values decreased (P = .001) 30 days after treatment, but their levels were neither associated with nor predicted these reactivations. However, S. stercoralis DNA was detected by PCR in all patients, both in their first and subsequent stool samples, thus reflecting the poor efficacy of ivermectin at eradicating parasite from host tissues. Asymptomatic eosinophilia was the most frequent clinical form among chronically infected patients. Conclusions: These results suggest that the parasitological cure is unlikely. Strongyloidiasis must be considered a chronic infection and ivermectin administration schedules should be reevaluated.

Vitamin D levels and their impact on mineral metabolism in HIV infected patients: an exploratory study.

Vitamin D has immunomodulating properties. The nuclear receptor for vitamin D is expressed in several immune cells, which convert 25-hydroxyvitamin D (25OHD) to the active form 1,25 hydroxyvitamin D [1,25(OH)2 D]. Under conditions of infection, 1,25(OH)2 D promotes production of cathelicidin (an antimicrobial peptide) in monocytes and activated macrophages. In vitro studies have shown the ability of cathelicidin to inhibit replication of human immunodeficiency virus (HIV-1) in T CD4 lymphocytes and macrophages. OBJECTIVE: To evaluate vitamin D levels and their impact on mineral metabolism in HIV infected patients. MATERIALS AND METHODS: Seventy-four clinical records of HIV/AIDS patients seen at the outpatients clinic were reviewed. The following data were collected: age, sex, time since diagnosis of HIV, HIV-1 viral load, CD4 counts (absolute value and percentage), and mineral metabolism determinations: 25OHD, intact parathormone (iPTH); serum calcium (sCa); serum phosphorus (sP) and serum crosslaps (sCTX). Vitamin D levels were stratified as follows: optimal: ≥30ng/ml; insufficient: 21-29ng/ml; moderately deficient: 20≥ -25OHD- >10 ng/ml and severely deficient ≤10 ng/ml. RESULTS: Fifty-five clinical records were included; 82% of patients had 25OHD levels below 30ng/ml (insufficient: 23.6%, moderately deficient: 36.4%; and severely deficient: 21.8%). A significantly higher serum PTH levels in the moderately and severely deficient groups than in the optimal and insufficient groups was observed (p<0.05 and p<0.03 respectively). A weak negative correlation was observed between serum 25OHD and PTH levels (r=-0.268; p<0.004). CONCLUSION: Sub-optimal vitamin D levels are frequently observed in HIV/AIDS patients on antiretroviral therapy (ART). Systematic assessment of mineral metabolism is considered necessary in HIV/AIDS positive patients.