RESUMO
BACKGROUND: Hematologic manifestations of the human immunodeficiency virus (HIV) infection are a well-recognized complication of the disease and may be clinically important. Our objective was to determine the risk factors for anemia and its correlation with HIV treatment-naïve infected patients without co-infection or opportunistic diseases. FINDINGS: We performed a cross-sectional comparative study in which HIV treatment-naïve infected patients with anemia were compared with a control group of HIV patients without anemia. The interrelationship between risk factors and anemia was determined. Odds ratio and 95% confidence intervals were calculated, to adjust for the effects of potential confounders and we used a logistic regression model. Pearson's correlation coefficient was obtained to calculate the correlation between risk factors and hemoglobin.We enrolled 54 men and 9 women. Anemia was found in 13 patients; prevalence .20 (CI 95% 0.12-0.32). Severe anemia was found in only one patient (1.5%). Only CD4+ Cells Count <200 cells/mm3 was associated with increased risk of anemia in the multivariate analysis. There was a moderately strong, positive correlation between WBC and hemoglobin (r = 0.49, P < 0.001) and between CD4+ cell count and hemoglobin (r = 0.595, P < 0.001) and a moderately strong, negative correlation between HIV RNA viral load and hemoglobin (r = - 0.433, P < 0.001). CONCLUSIONS: Anemia is a common manifestation in the Mexican population without antiretroviral therapy. In HIV naïve patients a CD4+ Cell Count < 200 cells/mm3 was associated with an increased risk of anemia. There is a positive correlation between hemoglobin and CD4+ cell count.
RESUMO
AIM: To evaluate the aspartate aminotransferase (AST) to platelet ratio index (APRI) as a predictive factor of early viral response in chronic hepatitis C naive patients. METHODS: We performed an ambispective case-control study. We enrolled chronic hepatitis C naive patients who were evaluated to start therapy with PEGylated interferon alpha-2b (1.5 mug/kg per week) and ribavirin (> 75 kg: 1200 mg and < 75 kg: 1000 mg). Patients were allocated into two groups, group 1: Hepatitis C patients with early viral response (EVR), group 2: Patients without EVR. Odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the relationship between each risk factor and the EVR in both groups. RESULTS: During the study, 80 patients were analyzed, 45 retrospectively and 35 prospectively. The mean +/- SD age of our subjects was 42.9 +/- 12 years; weight 70 kg (+/- 11.19), AST 64.6 IU/mL (+/- 48.74), alanine aminotransferase (ALT) 76.3 IU/mL (+/- 63.08) and platelets 209 000 mill/mm(3) (+/- 84 429). Fifty-five (68.8%) were genotype 1 and 25 (31.3%) were genotype 2 or 3; the mean hepatitis C virus RNA viral load was 2 269 061 IU/mL (+/- 7 220 266). In the univariate analysis, APRI was not associated with EVR [OR 0.61 (95% CI 0.229-1.655, P = 0.33)], and the absence of EVR was only associated with genotype 1 [OR 0.28 (95% CI 0.08-0.94, P = 0.034)]. After adjustment in a logistic regression model, genotype 1 remains significant. CONCLUSION: APRI was not a predictor of EVR in chronic hepatitis C; Genotype 1 was the only predictive factor associated with the absence of EVR in our patients.
Assuntos
Antivirais/uso terapêutico , Aspartato Aminotransferases/sangue , Ensaios Enzimáticos Clínicos , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/uso terapêutico , Contagem de Plaquetas , Polietilenoglicóis/uso terapêutico , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Genótipo , Hepacivirus/genética , Hepatite C Crônica/sangue , Humanos , Interferon alfa-2 , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Estudos Prospectivos , RNA Viral/sangue , Proteínas Recombinantes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga Viral , Adulto JovemAssuntos
Síndrome da Imunodeficiência Adquirida/complicações , Doenças das Glândulas Suprarrenais/complicações , Doenças das Glândulas Suprarrenais/diagnóstico , Hormônio Adrenocorticotrópico/sangue , Adulto , Idoso , Técnicas de Laboratório Clínico , Feminino , Humanos , Avaliação de Estado de Karnofsky , Masculino , México , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/diagnóstico , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
La coccidioidomicosis es causada por Coccidioides immitis, hongo muy virulento cuyo hábitat natural se restringe a la región geográfica situada en el noroeste de la República Mexicana y el suroeste de Estados Unidos de América del Norte. La mayoría de las veces cursa en forma asintomática. El padecimiento suele presentarse en forma localizada (40 por ciento), limitado al aparato respiratorio. Raramente (0.5 por ciento) causa afección multiorgánica y se constituye en la forma diseminada. Aun en áreas endémicas, la enfermedad en su forma diseminada se presenta con igual prevalencia en pacientes con infección por el virus de la inmunodeficiencia humana (VIH), que en sujetos inmunocompetentes. Sin embargo, conforme aparece y avanza el deterioro de la inmunidad celular consecutivo a la infección por VIH se puede presentar la reactivación del hongo en pacientes que lo adquirieron previamente. En la coccidioidomicosis diseminada la afección de corazón, tiroides, hígado, bazo, intestino y encéfalo es poco común, incluso en pacientes con síndrome de inmunodeficiencia humana. Se informa de un paciente residente en un área no endémica, en el cual la coccidioidomicosis diseminada se presentó como reactivación de la infección y constituyó la manifestación inicial de sida.
