Identification of two potential aetiological agents of chronic diarrhoea in an immunocompromised patient in Cuba using conventional and molecular diagnostic techniques.

The aetiology of diarrhoea in a patient in Cuba with HIV was investigated. Although molecular diagnostics are still not used in many under-resourced settings, here traditional methods were supported by use of PCR. This approach enabled detection of a dual infection (Cystoisospora belli and Enterocytozoon bieneusi), the latter of which was not identified by microscopy with Didier's trichromic staining.

Pharmacogenetic Markers: A Path toward Individualized HIV Therapy.

INTRODUCTION Approximately 73% of persons with HIV who receive antiretroviral therapy in Cuba are in viral suppression. The non-response of the remaining 27% could be due to several factors including adverse drug reactions and HIV resistance to antiretroviral drugs, as well as social factors and idiosyncratic characteristics of each patient. Genetic information explains from 20% to 95% of a drug's effects and variations in response. Considering optimization of therapeutic efficacy in our country, genetic factors of the host should be identified. OBJECTIVE Identify polymorphisms affecting genetic variability of responses to antiretroviral drugs. EVIDENCE ACQUISITION A literature review was conducted (of original articles, published theses, clinical reports and bibliographic review studies, from 2000 to 2018, in Spanish and English listed in MEDLINE/PubMed, SciELO, LILACS, PharmGKB and Google Scholar) with the following key words: pharmacogenetics, human immunodeficiency virus, anti-retroviral agents, genetic polymorphism, genetic techniques, pharmacogenomic variants. DEVELOPMENT The review identified 77 relevant publications meeting specific quality criteria. A summary table was built with data collected on antiretroviral drugs, genes and proteins involved in polymorphic variations, their associated effects and relevant scientific references. Information was included on polymorphisms related to 12 antiretroviral drugs used in HIV therapy. Polymorphisms determine variations in proteins involved in drug transport and metabolism and in elements of immunity. Relevant pharmacogenetic biomarkers recognized by drug regulatory agencies were identified. CONCLUSIONS The study identified genetic variations (single-nucleotide polymorphisms) associated with 12 antiretroviral drugs. In most cases, no statistically significant causal association was found. Identifying polymorphic variations is a medium- and long-term objective that requires statistical support and adoption of strategies to optimize antiretroviral therapy. An approach combining plasma-level monitoring and pharmacogenetic analysis is recommended to optimize therapy for HIV patients. KEYWORDS Pharmacogenetics, HIV, anti-retroviral agents, antiretroviral therapy, genetic polymorphism, genetic techniques, pharmacogenomic variants.

Cuban Strategy and Medical Cooperation to Combat Ebola, 2014-2016.

The Ebola virus is a pathogen that causes high morbidity and mortality in epidemic events during which health personnel are frequently infected. Such an epidemic occurred in West Africa, prompting WHO to issue a call in 2014 for health personnel to be dispatched to affected countries. Cuba responded and signed an assistance agreement under which 265 Cuban health professionals, members of the Henry Reeve Emergency Medical Contingent, volunteered their services in the Republic of Guinea, Sierra Leone and Liberia. This article presents Cuba's strategy of medical aid and organization of the three medical teams formed; refers to the teams' contribution to epidemic control in treatment centers where they worked alongside other personnel; and describes measures taken in Cuba to prevent the virus from entering the country through returning volunteers or other means. In the centers where Cuban medical teams worked with other health professionals in West Africa, case fatality decreased from 80%-90% to 24%, contributing to control of the epidemic; no Ebola outbreaks occurred in Cuba. During the epidemic, two Cuban health professionals died of malaria and one physician fell ill with Ebola. This paper includes an overview of the treatment and evolution of the latter case, a doctor who contracted the disease in Sierra Leone and was treated in Geneva and Havana. KEYWORDS Ebola virus, treatment, strategy, followup, medical collaboration, Republic of Guinea, Sierra Leone, Liberia, Cuba.

Lupus eritematosos sistémico en la epidemia VIH/SIDA. Reporte inicial de casos en Cuba / Systemic lupus erythematous in the HIV / AIDS epidemic. Initial report of cases in Cuba

El lupus eritematoso sistémico clasifica como una compleja, multisistémica enfermedad autoinmune que evoluciona por brotes de actividad, con diferentes grados de severidad, determinante de daño crónico irreversible. Las infecciones constituyen un capitulo particular en pacientes con lupus eritematoso sistémico, y estos pacientes pueden asociar sus manifestaciones autoinmune-reumáticas a la infección por VIH/SIDA, aunque no existen muchos reportes a nivel mundial sobre esta asociación. Existen diferencias en cuanto a los mecanismos patogénicos que obran en ambas entidades, no obstante presentan homologías en el orden clínico las cuales en ocasiones hacen difícil establecer el diagnóstico diferencial entre estas entidades. Nuestro objetivo estuvo dirigido a reportar dos casos de féminas de 47 y 36 años de edad, con esta asociación en el marco de la epidemia cubana VIH-SIDA. Una de ellas desarrolló la infección varios años después del diagnóstico de lupus, y ha presentado luego del VIH brotes aislados de actividad; desarrollado daño renal y severas lesiones discoideas en cuero cabelludo todo ello aunado a infecciones urinarias. La segunda paciente desarrolló la infección VIH, y luego de varios años en tratamiento antirretroviral, tórpidamente presentó criterios clínicos e inmunológicos para lupus: debutó con un síndrome febril, toma del estado general, lesiones importantes vasculíticas de miembros inferiores complicadas con ulceraciones infectadas que remedaban pioderma gangrenosa así como serositis lúpica e infección respiratoria grave. Ambos casos contaban con tratamiento antirretroviral, y un buen conteo de células T CD4+, con carga viral indetectable. Se logró en ambos casos yugular los brotes de actividad e infecciones intercurrentes. Metodológicamente desarrollamos una amplia revisión por Medline, PubMed-Lilacs entre otros motores de búsqueda. No conocemos de otros estudios que establezcan una descripción clínica y analítica de este tipo de pacientes en Cuba(AU)

Systemic lupus erythematous classifies as a complex, multisystemic autoimmune disease that evolves through outbreaks of activity, with different degrees of severity, determining irreversible chronic damage. Infections are a particular chapter in patients with systemic lupus erythematous, and these patients can associate their autoimmune-rheumatic manifestations with HIV / AIDS infection, although there are not many worldwide reports on this association. There are differences in the pathogenic mechanisms that work in both entities, however they present homologies in the clinical order which sometimes make it difficult to establish the differential diagnosis between these entities. Our objective was to report two cases of females aged 47 and 36 years old, with the association within the framework of the Cuban HIV-AIDS epidemic. One of them developed the infection several years after the diagnosis of lupus, has presented isolated HIV activity outbreaks and developed kidney damage and severe discoid lesions on the scalp and urinary tract infections. The second patient developed HIV infection, and after several years on antiretroviral treatment, she presented clinical and immunological criteria for lupus: She debuted with a febrile syndrome, taking the general condition, important vasculitic lesions of the lower limbs complicated by infected ulcerations mimicking pioderma, gangrenous as well as lupus serositis and severe respiratory infection. Both cases had ARV treatment, and a good CD4 + T cell count, with undetectable viral load. In both cases, the outbreaks of activity and intercurrent infections were achieved. Methodologically, we developed an extensive review by Med-Line, Pubmed-Lilacs among other search engines using the keywords lupus and VIH infections: We do not know of other studies that establish a clinical and analytical description of this type of patients in Cuba.We conclude with the presentation of two patients differents form of presentation, both with systemic lupus in asociation with VIH-aids infection, and hgih level of disease activity . The were safe with a good control of the diseases and the treatment wih antirretroviral drugs, antibiotics, an especific drugs like antimalarials, corticosteroids and others with satisfactory clinical evolutions(AU)

US and Cuban Scientists Forge Collaboration on Arbovirus Research.

After December 17, 2014, when the US and Cuban governments announced their intent to restore relations, the two countries participated in various exchange activities in an effort to encourage cooperation in public health, health research and biomedical sciences. The conference entitled Exploring Opportunities for Arbovirus Research Collaboration, hosted at Havana's Hotel Nacional, was part of these efforts and was the first major US-Cuban scientific conference in over 50 years. Its purpose was to share information about current arbovirus research and recent findings, and to explore opportunities for future joint research. The nearly 100 participants included leading arbovirus and vector transmission experts from ten US academic institutions, NIH, CDC, FDA and the US Department of Defense. Cuban participants included researchers, clinicians and students from Cuba's Ministry of Public Health, Pedro Kourí Tropical Medicine Institute, Center for Genetic Engineering and Biotechnology, Center for State Control of Medicines and Medical Devices and other health research and regulatory organizations. Topics highlighted at the three-day meeting included surveillance, research and epidemiology; pathogenesis, immunology and virology; treatment and diagnosis; vector biology and control; vaccine development and clinical trials; and regulatory matters. Concurrent breakout discussions focused on novel vector control, nonvector transmission, community engagement, Zika in pregnancy, and workforce development. Following the conference, the Pedro Kourí Tropical Medicine Institute and the US National Institute of Allergic and Infectious Diseases have continued to explore ways to encourage and support scientists in Cuba and the USA who wish to pursue arbovirus research cooperation to advance scientific discovery to improve disease prevention and control. KEYWORDS Arboviruses, flavivirus, Zika virus, chikungunya virus, dengue virus, research, disease vectors, Cuba, USA.

HIV-1 Antiretroviral Resistance in Cuba, 2009-2014.

INTRODUCTION By the end of 2017, there were more than 28,000 individuals living with HIV in Cuba, over 80% receiving antiretroviral therapy, which dramatically reduces viral replication, improves immune status and decreases risk of transmission. These results could be jeopardized by emergence of HIV-1 drug resistance. In 2009, a test for HIV-1 genotypic resistance was introduced in routine clinical practice in Cuba. OBJECTIVE Investigate antiretroviral resistance and its relation to subtype distribution in HIV-1 treatment-naïve and previously treated patients in Cuba. METHODS Resistance and HIV-1 subtype distribution were determined in 342 antiretroviral treatment-naïve patients and 584 previously treated for HIV-1 whose blood specimens were sent to the Pedro Kourí Tropical Medicine Institute during 2009-2014. Transmitted drug resistance was determined using the Calibrated Population Resistance Tool v.6. Drug resistance analysis was conducted using the algorithm Rega v9.1.0. RESULTS Prevalence of transmitted drug resistance was 11.4%, and 41% of mutated viruses exhibited dual-class resistance to nucleoside reverse transcriptase inhibitor and non-nucleoside reverse transcriptase inhibitor. Overall, 84.9% of patients had ≥1 resistance mutation, 80% had ≥1 nucleoside reverse transcriptase inhibitor mutation, 71.4% had ≥1 non-nucleoside reverse transcriptase inhibitor mutation and 31.7% had ≥1 protease inhibitor mutation. K65R and K101E mutations were significantly more frequent in subtype C, L210W in CRF19_cpx, and M47V/I in CRF BGs (20, 23, 24). Full class resistance to nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, protease inhibitors and multidrug resistance were detected in 21.2%, 32.4%, 8% and 4.1% of patients, respectively. Average percentage resistance to nucleoside reverse transcriptase inhibitor, protease inhibitor, full class resistance to nucleoside reverse transcriptase inhibitor, protease inhibitor and multidrug resistance increased in patients failing two or more regimens. Nevertheless, after 2011, a declining trend was observed in the frequency of multidrug resistance and full class resistance to nucleoside reverse transcriptase inhibitors and protease inhibitors. CONCLUSIONS Detected levels of transmitted drug resistance highlight the need for a national surveillance study in treatment-naïve patients. Resistance prevalence is high in previously treated patients but appears to be decreasing over time. The frequency of resistance mutations in recombinant forms of HIV in Cuba needs further study. KEYWORDS Antiretroviral therapy, highly active antiretroviral therapy, HIV, anti-HIV agents, drug resistance, multiple drug resistance, Cuba.

Dinámica de adquisición de VIH: definiciones desde seropositivos cubanos / Dynamics of HIV acquisition: definitions by Cuban seropositives

Introducción: la exposición a la infección por el VIH, con participación consciente del individuo vulnerable, es un problema complejo que se ha extendido rápidamente, especialmente entre los hombres que tienen sexo con otros hombres. Objetivo: definir cómo se produce la infección teniendo en cuenta la contribución individual a la exposición y los elementos que caracterizan dicha contribución. Métodos: un estudio cualitativo con grupos de discusión se llevó a cabo para explorar los criterios y percepciones de las personas con VIH /sida sobre los modos de exposición a la infección. Se seleccionó una muestra intencional de grupos homogéneos. Las respuestas y comentarios de los grupos de discusión fueron ponderados para darles un orden jerárquico. Resultados: se realizaron 6 grupos de discusión. Los principales conceptos construidos fueron: infección no evitada e infección intencionada, esta última referida a la exposición consciente o participativa del individuo. Además, el riesgo general de contraer la infección para toda la población cubana, independientemente de su grado de participación (en base a la tasa de prevalencia del VIH en Cuba) se definió como infección accidental. Para cada concepto se generaron diferentes categorías que describen la manera y el propósito de la exposición a la infección por VIH. Conclusiones: los diferentes perfiles de comportamiento individuales están condicionados por factores complejos que conducen a no evitar exponerse y en muchos casos incluso intencionalmente buscar la infección con el VIH. Estrategias de intervención adecuadas podrían contribuir a identificar a tiempo y controlar estos patrones en la población con mayor riesgo(AU)

Introduction: Exposure to HIV infection, with conscious participation of the vulnerable individual, is a complex problem that has spread rapidly, especially among men who have sex with men. Objective: To define how the infection occurs taking into account the individual's contribution to the exposure and the elements that characterize such contribution. Methods: A qualitative study with discussion groups was conducted to explore the criteria and perceptions of people with HIV/AIDS about the ways of exposure to infection. An intentional sample of homogeneous groups was selected. The answers and comments of the discussion groups were weighted to give them a hierarchical order. Results: Six discussion groups were held. The main concepts were unavoided infection and intentional infection, the latter referred to the conscious or participatory exposure of the individual. In addition, the overall risk of infection for the entire Cuban population, regardless of their degree of participation (based on the HIV prevalence rate in Cuba) was defined as accidental infection. Different categories were generated for each concept describing the manner and purpose of exposure to HIV infection. Conclusions: Different individual behavioral profiles are conditioned by complex factors that lead not to avoid exposure and, in many cases, even intentionally seek HIV infection. Appropriate intervention strategies could help timely identify and control these patterns in the population at greater risk(AU)

Dinámica de adquisición de VIH: definiciones desde seropositivos cubanos / Dynamics of HIV acquisition: definitions by Cuban seropositives

Introducción: la exposición a la infección por el VIH, con participación consciente del individuo vulnerable, es un problema complejo que se ha extendido rápidamente, especialmente entre los hombres que tienen sexo con otros hombres. Objetivo: definir cómo se produce la infección teniendo en cuenta la contribución individual a la exposición y los elementos que caracterizan dicha contribución. Métodos: un estudio cualitativo con grupos de discusión se llevó a cabo para explorar los criterios y percepciones de las personas con VIH /sida sobre los modos de exposición a la infección. Se seleccionó una muestra intencional de grupos homogéneos. Las respuestas y comentarios de los grupos de discusión fueron ponderados para darles un orden jerárquico. Resultados: se realizaron 6 grupos de discusión. Los principales conceptos construidos fueron: infección no evitada e infección intencionada, esta última referida a la exposición consciente o participativa del individuo. Además, el riesgo general de contraer la infección para toda la población cubana, independientemente de su grado de participación (en base a la tasa de prevalencia del VIH en Cuba) se definió como infección accidental. Para cada concepto se generaron diferentes categorías que describen la manera y el propósito de la exposición a la infección por VIH. Conclusiones: los diferentes perfiles de comportamiento individuales están condicionados por factores complejos que conducen a no evitar exponerse y en muchos casos incluso intencionalmente buscar la infección con el VIH. Estrategias de intervención adecuadas podrían contribuir a identificar a tiempo y controlar estos patrones en la población con mayor riesgo(AU)

Introduction: Exposure to HIV infection, with conscious participation of the vulnerable individual, is a complex problem that has spread rapidly, especially among men who have sex with men. Objective: To define how the infection occurs taking into account the individual's contribution to the exposure and the elements that characterize such contribution. Methods: A qualitative study with discussion groups was conducted to explore the criteria and perceptions of people with HIV/AIDS about the ways of exposure to infection. An intentional sample of homogeneous groups was selected. The answers and comments of the discussion groups were weighted to give them a hierarchical order. Results: Six discussion groups were held. The main concepts were unavoided infection and intentional infection, the latter referred to the conscious or participatory exposure of the individual. In addition, the overall risk of infection for the entire Cuban population, regardless of their degree of participation (based on the HIV prevalence rate in Cuba) was defined as accidental infection. Different categories were generated for each concept describing the manner and purpose of exposure to HIV infection. Conclusions: Different individual behavioral profiles are conditioned by complex factors that lead not to avoid exposure and, in many cases, even intentionally seek HIV infection. Appropriate intervention strategies could help timely identify and control these patterns in the population at greater risk(AU)

Enfermedades oportunistas en pacientes VIH/sida con debut de sida que reciben tratamiento antirretroviral / Opportunistic diseases observed in HIV/aids patients with onset of aids and antiretroviral treatment

INTRODUCCIÓN: el debut del sida es una forma de presentación de la enfermedad caracterizada por alteración del estado general, síndrome de desgaste, graves infecciones oportunistas, neoplasias y alteraciones neurológicas. El tratamiento con antirretrovirales ha aumentado la esperanza de vida de estos pacientes. OBJETIVOS: identificar las enfermedades oportunistas, asociadas a la condición clínica de los pacientes bajo estudio, y su relación con el conteo de linfocitos T CD4+ y la carga viral así como, evaluar la mortalidad en el grupo de pacientes estudiados y su relación con las enfermedades oportunistas. MÉTODOS: se realizó un estudio observacional prospectivo de corte transversal. El tamaño de la muestra estuvo condicionado al universo total de pacientes VIH/sida del servicio de Medicina del Instituto de Medicina Tropical "Pedro Kourí". La muestra (55 pacientes) se seleccionó, se tuvo en cuenta los sujetos que fueron diagnosticados con debut de sida y presentaron enfermedades oportunistas durante un año. RESULTADOS: las enfermedades oportunistas infecciosas como neurotoxoplasmosis 21,8 % y neumonía por Pneumocystis jirovecii 12,7 % fueron los eventos definitorios de sida predominantes. No hubo asociación estadística significativa, con el conteo bajo de linfocitos T CD4+ bajos y carga viral elevada. En los pacientes mayores de 50 años con más de una enfermedad oportunista el riesgo de morir fue 4,72 veces mayor que para el resto. CONCLUSIONES: las enfermedades oportunistas infecciosas como neurotoxoplasmosis y Pneumocystis jirovecii,fueron los eventos definitorios de sida predominantes. La mortalidad asociada a sida en los pacientes mayores de 50 años aumentó en los individuos que presentaron más de una enfermedad oportunista. Estos resultados son útiles para el diseño de estrategias de tratamiento que disminuyan la aparición de las enfermedades oportunistas y mejoren aun más, la supervivencia de los pacientes VIH/sida.

INTRODUCTION: onset of aids is a form of presentation of the disease that is characterized by altered general condition, wornout syndrome, serious opportunistic infections, neoplasias and neurological alterations. The antiretroviral treatment has increased the life expectancy of these patients. OBJECTIVES: to identify the opportunistic diseases associated to the clinical condition under study and their linking to the CD4+ T lymphocyte count and the viral load as well as to evaluate the mortality in the studied group and its relationship with opportunistic diseases. METHODS: prospective, observational and cross-sectional study of a sample of 55 patients. The size of the sample depended on the total universe of HIV/aids patients in the medicine service of "Pedro Kouri" Tropical Medicine Institute. The study took into account those subjects who were diagnosed with onset of aids and presented with opportunistic diseases during one year. RESULTS: infectious opportunistic diseases such as neurotoxoplasmosis (21.8 %) and pneumonia caused by Pneumocystis jirovecii (12.7 %) were the predominant defining events of aids. There was no statistically significant association with low CD4+ T lymphocyte count and high viral load. In patients over 50 years of age with more than one opportunistic disease, the risk of dying was 4.72 times higher than in the rest of the group. CONCLUSIONS: infectious opportunistic diseases as neurotoxoplasmosis and Pneumocystis jirovecii were the prevailing defining events of aids. Aids-associated mortality in patients aged over 50 years increased in individuals who presented more than one opportunistic disease. These results are useful for the design of treatment strategies that reduce the occurrence of opportunistic diseases and improve even more the survival of HIV/aids patients.

Enfermedades oportunistas en pacientes VIH/sida con debut de sida que reciben tratamiento antirretroviral / Opportunistic diseases observed in HIV/aids patients with onset of aids and antiretroviral treatment

Introducción: el debut del sida es una forma de presentación de la enfermedad caracterizada por alteración del estado general, síndrome de desgaste, graves infecciones oportunistas, neoplasias y alteraciones neurológicas. El tratamiento con antirretrovirales ha aumentado la esperanza de vida de estos pacientes. Objetivos: identificar las enfermedades oportunistas, asociadas a la condición clínica de los pacientes bajo estudio, y su relación con el conteo de linfocitos T CD4+ y la carga viral así como, evaluar la mortalidad en el grupo de pacientes estudiados y su relación con las enfermedades oportunistas. Métodos: se realizó un estudio observacional prospectivo de corte transversal. El tamaño de la muestra estuvo condicionado al universo total de pacientes VIH/sida del servicio de Medicina del Instituto de Medicina Tropical Pedro Kourí. La muestra (55 pacientes) se seleccionó, se tuvo en cuenta los sujetos que fueron diagnosticados con debut de sida y presentaron enfermedades oportunistas durante un año. Resultados: las enfermedades oportunistas infecciosas como neurotoxoplasmosis 21,8 por ciento y neumonía por Pneumocystis jirovecii 12,7 por ciento fueron los eventos definitorios de sida predominantes. No hubo asociación estadística significativa, con el conteo bajo de linfocitos T CD4+ bajos y carga viral elevada. En los pacientes mayores de 50 años con más de una enfermedad oportunista el riesgo de morir fue 4,72 veces mayor que para el resto. Conclusiones: las enfermedades oportunistas infecciosas como neurotoxoplasmosis y Pneumocystis jirovecii, fueron los eventos definitorios de sida predominantes. La mortalidad asociada a sida en los pacientes mayores de 50 años aumentó en los individuos que presentaron más de una enfermedad oportunista. Estos resultados son útiles para el diseño de estrategias de tratamiento que disminuyan la aparición de las enfermedades oportunistas y mejoren aun más, la supervivencia de los pacientes VIH/sida(AU)

Introduction: onset of aids is a form of presentation of the disease that is characterized by altered general condition, wornout syndrome, serious opportunistic infections, neoplasias and neurological alterations. The antiretroviral treatment has increased the life expectancy of these patients. Objectives: to identify the opportunistic diseases associated to the clinical condition under study and their linking to the CD4+ T lymphocyte count and the viral load as well as to evaluate the mortality in the studied group and its relationship with opportunistic diseases. Methods: prospective, observational and cross-sectional study of a sample of 55 patients. The size of the sample depended on the total universe of HIV/aids patients in the medicine service of Pedro Kouri Tropical Medicine Institute. The study took into account those subjects who were diagnosed with onset of aids and presented with opportunistic diseases during one year. Results: infectious opportunistic diseases such as neurotoxoplasmosis (21.8 percent) and pneumonia caused by Pneumocystis jirovecii (12.7 percent) were the predominant defining events of aids. There was no statistically significant association with low CD4+ T lymphocyte count and high viral load. In patients over 50 years of age with more than one opportunistic disease, the risk of dying was 4.72 times higher than in the rest of the group. Conclusions: infectious opportunistic diseases as neurotoxoplasmosis and Pneumocystis jirovecii were the prevailing defining events of aids. Aids-associated mortality in patients aged over 50 years increased in individuals who presented more than one opportunistic disease. These results are useful for the design of treatment strategies that reduce the occurrence of opportunistic diseases and improve even more the survival of HIV/aids patients(AU)

Características microbiológicas y epidemiológicas de la infección del torrente sanguíneo en pacientes HIV/SIDA / Microbiological and epidemiological characteristics of bloodstream infection in HIV / AIDS patients

Introducción: los individuos seropositivos al virus de la inmunodeficiencia humana, tienen un alto riesgo para desarrollar una infección del torrente sanguíneo. Objetivo: identificar los agentes etiológicos y los factores de riesgo asociados a esta entidad. Métodos: se realizó un estudio observacional prospectivo desde febrero hasta diciembre de 2012. El universo estuvo conformado por 118 pacientes. La identificación microbiana se realizó mediante el sistema automatizado VITEK 2 Compact. Para determinar la asociación entre las variables se calculó la razón de prevalencia. Resultados: Predominaron los pacientes del sexo masculino, con edades entre 41-50 años, severamente inmunodeprimido y con terapia antirretroviral. La mayoría de los aislamientos correspondieron a las enterobacterias, con predominio de Klebsiella pneumoniae. Staphylococcus aureus constituyó la principal bacteria grampositiva aislada. Las variables que se asociaron con el desarrollo de enfermedad invasiva fueron: el empleo de catéter venoso central, el tratamiento con hemodiálisis y la estadía hospitalaria mayor de 7 días. Conclusiones: se ratifica a las bacterias gramnegativas como importantes agentes causales de bacteriemia en los pacientes VIH/sida. Los procederes invasivos constituyen los principales factores de riesgo para el desarrollo de bacteriemia en pacientes VIH positivos(AU)

Introduction: human immunodeficiency virus seropositive individuals are at high risk for developing a bloodstream infection. Objective: to identify the etiologic agents and risk factors associated with this entity. Methods: a prospective observational study was conducted from February to December 2012. The study group consisted of 118 patients. Microbial identification was performed by the VITEK 2 Compact automated system. Variables were calculated to determine the association between the prevalence ratio. Results: predominance of male patients, aged 41-50 years, severely immune-compromised and undergoing antiretroviral therapy was observed. Enterobacter Staphylococcus aureus was the main isolated Gram-positive bacterium. Conclusions: gram-negative bacteria are ratified as important causative agents of bacteremia in HIV / AIDS patients. The invasive procedures are major risk factors for the development of bacteremia in HIV positive patients(AU)

Características microbiológicas y epidemiológicas de la infección del torrente sanguíneo en pacientes HIV/SIDA / Microbiological and epidemiological characteristics of bloodstream infection in HIV / AIDS patients

INTRODUCCIÓN: los individuos seropositivos al virus de la inmunodeficiencia humana, tienen un alto riesgo para desarrollar una infección del torrente sanguíneo. OBJETIVO: identificar los agentes etiológicos y los factores de riesgo asociados a esta entidad. MÉTODOS: se realizó un estudio observacional prospectivo desde febrero hasta diciembre de 2012. El universo estuvo conformado por 118 pacientes. La identificación microbiana se realizó mediante el sistema automatizado VITEK 2 Compact. Para determinar la asociación entre las variables se calculó la razón de prevalencia. RESULTADOS: Predominaron los pacientes del sexo masculino, con edades entre 41-50 años, severamente inmunodeprimido y con terapia antirretroviral. La mayoría de los aislamientos correspondieron a las enterobacterias, con predominio de Klebsiella pneumoniae. Staphylococcus aureus constituyó la principal bacteria grampositiva aislada. Las variables que se asociaron con el desarrollo de enfermedad invasiva fueron: el empleo de catéter venoso central, el tratamiento con hemodiálisis y la estadía hospitalaria mayor de 7 días. CONCLUSIONES: se ratifica a las bacterias gramnegativas como importantes agentes causales de bacteriemia en los pacientes VIH/sida. Los procederes invasivos constituyen los principales factores de riesgo para el desarrollo de bacteriemia en pacientes VIH positivos.

INTRODUCTION: human immunodeficiency virus seropositive individuals are at high risk for developing a bloodstream infection. OBJECTIVE: to identify the etiologic agents and risk factors associated with this entity. METHODS: a prospective observational study was conducted from February to December 2012. The study group consisted of 118 patients. Microbial identification was performed by the VITEK 2 Compact automated system. Variables were calculated to determine the association between the prevalence ratio. RESULTS: predominance of male patients, aged 41-50 years, severely immunecompromised and undergoing antiretroviral therapy was observed. Enterobacter Staphylococcus aureus was the main isolated Gram-positive bacterium. CONCLUSIONS: gram-negative bacteria are ratified as important causative agents of bacteremia in HIV / AIDS patients. The invasive procedures are major risk factors for the development of bacteremia in HIV positive patients

Linfocitos TCD4+ y carga viral en pacientes con debut de sida que reciben tratamiento antirretroviral / CD4 + T lymphocytes and viral load in patients with AIDS debut receiving antiretroviral therapy

Introducción: el debut de sida es una forma de presentación de la enfermedad causada por VIH que se caracteriza por alteración del estado general del paciente, síndrome de desgaste, aparición de graves infecciones oportunistas, neoplasias y alteraciones neurológicas. Métodos: se estudió el comportamiento de los niveles de linfocitos T CD4+ y de carga viral en pacientes con debut de sida y terapia antirretroviral, al inicio y un año después del tratamiento. Se estudiaron 55 pacientes los cuales tuvieron al inicio del tratamiento conteos de linfocitos TCD4+ inferiores a 200cel/µL y carga viral elevada. Resultados: después de un año de terapia, los valores de linfocitos T CD4+ aumentaron por encima de 200 cel/µL y la carga viral disminuyó a niveles no detectables en los pacientes estudiados. Conclusiones: los resultados de esta investigación confirman los beneficios del tratamiento antirretroviral particularmente para los pacientes con debut de sida.(AU)

Introduction: the AIDS premiere is a form of presentation of the illness caused by HIV that is characterized by alteration of the patient's general state, waste syndrome, appearance of serious opportunists infections, neoplasia and neurological alterations. Methods: the behavior of the CD4+ T lymphocytes levels were studied and of viral load in patient with AIDS premiere and antiretroviral therapy, to the beginning and one year after the treatment. 55 patients those were studied which had to the beginning of the treatment CD4+ T lymphocytes counts less to 200cel/µL and high viral load. Results: after a year of therapy, the values of CD4+ T cells recovered and the viral load diminished at non detecting levels in the evaluated patients. Conclusions: the results of this study confirm the benefits of antiretroviral therapy, particularly for patient with AIDS premiere(AU)

Linfocitos TCD4+ y carga viral en pacientes con debut de sida que reciben tratamiento antirretroviral / CD4 + T lymphocytes and viral load in patients with AIDS debut receiving antiretroviral therapy

INTRODUCCIÓN: el debut de sida es una forma de presentación de la enfermedad causada por VIH que se caracteriza por alteración del estado general del paciente, síndrome de desgaste, aparición de graves infecciones oportunistas, neoplasias y alteraciones neurológicas. MÉTODOS: se estudió el comportamiento de los niveles de linfocitos T CD4+ y de carga viral en pacientes con debut de sida y terapia antirretroviral, al inicio y un año después del tratamiento. Se estudiaron 55 pacientes los cuales tuvieron al inicio del tratamiento conteos de linfocitos TCD4+ inferiores a 200cel/µL y carga viral elevada. RESULTADOS: después de un año de terapia, los valores de linfocitos T CD4+ aumentaron por encima de 200 cel/µL y la carga viral disminuyó a niveles no detectables en los pacientes estudiados. CONCLUSIONES: los resultados de esta investigación confirman los beneficios del tratamiento antirretroviral particularmente para los pacientes con debut de sida.

INTRODUCTION: the AIDS premiere is a form of presentation of the illness caused by HIV that is characterized by alteration of the patient's general state, waste syndrome, appearance of serious opportunists infections, neoplasia and neurological alterations. METHODS: the behavior of the CD4+ T lymphocytes levels were studied and of viral load in patient with AIDS premiere and antiretroviral therapy, to the beginning and one year after the treatment. 55 patients those were studied which had to the beginning of the treatment CD4+ T lymphocytes counts less to 200cel/µL and high viral load. RESULTS: after a year of therapy, the values of CD4+ T cells recovered and the viral load diminished at non detecting levels in the evaluated patients. CONCLUSIONS: the results of this study confirm the benefits of antiretroviral therapy, particularly for patient with AIDS premiere.

Estados afectivos, autorregulación psíquica y conductas frente a la enfermedad en pacientes con inicio de sida / Affective states, psychic self-regulation and behavioral response to the disease among patients with clinical onset of AIDS

Introducción: se reporta la relación entre VIH/sida y enfermedad mental, pero en Cuba no se han estudiado alteraciones de la vida psíquica en pacientes con comienzo de sida. Métodos: población de estudio: pacientes con diagnóstico de aparición de sida a menos de un año del diagnóstico, de ambos sexos; se empleó el sistema de registro SIDATRAT listándose y localizándose los casos. Se propuso conocer el comportamiento de variables de la vida psíquica en pacientes con aparición de sida y su asociación con inmunocompetencia. Resultados: se estimaron estados afectivos, autorregulación psíquica, conductas frente a la enfermedad, linfocitos CD4+ y carga viral en 42 pacientes con inicio de sida con y sin síntomas psicopatológicos. Se emplearon estadísticas descriptivas y ANOVA de comparación de medias para relacionar variables y pruebas robustas confirmatorias. Los estados afectivos negativos no fueron buenos indicadores de alteración psíquica, con medias homogéneas entre grupos. En pacientes sintomáticos predominó la toma de decisiones reflexivas-responsabilidad, con medias superiores para descontrol e inferiores en autocontrol indicadoras de peor afrontamiento. Puntajes altos para autocontrol se asociaron con baja carga viral, pero no con conteos de LT CD4+; no se relacionaron variables psíquicas con inmunocompetencia(AU)

Introduction: the relationship between HIV/AIDS and mental illness has been reported, but no studies have been conducted in Cuba about psychic alterations in patients at clinical onset of AIDS. Methods: study population: patients of both sexes with a diagnosis of AIDS onset within a year after diagnosis. The record system SIDATRAT was used to list and locate the cases. The purpose was to learn about the behavior of psychic variables in patients at clinical onset of AIDS and their association with immunocompetence. Results: estimation was made of affective states, psychic self-regulation, behavioral response to the disease, CD4+ lymphocytes and viral load in 42 patients at clinical onset of AIDS with and without psychopathological symptoms. Descriptive statistics analysis, ANOVA mean comparison, was performed to relate variables and robust confirmatory tests. Negative affective states were not good indicators of psychic alteration, with homogeneous means between the groups. Reflexive decision making responsibility predominated among symptomatic patients, with upper means for discontrol and lower means for self-control, indicative of worst coping. High self-control scores were associated with a low viral load, but not with TL CD4+ counts. No psychic variable was related to immunocompetence(AU)

Estados afectivos, autorregulación psíquica y conductas frente a la enfermedad en pacientes con inicio de sida / Affective states, psychic self-regulation and behavioral response to the disease among patients with clinical onset of AIDS

Introducción: se reporta la relación entre VIH/sida y enfermedad mental, pero en Cuba no se han estudiado alteraciones de la vida psíquica en pacientes con comienzo de sida. Métodos: población de estudio: pacientes con diagnóstico de aparición de sida a menos de un año del diagnóstico, de ambos sexos; se empleó el sistema de registro SIDATRAT listándose y localizándose los casos. Se propuso conocer el comportamiento de variables de la vida psíquica en pacientes con aparición de sida y su asociación con inmunocompetencia. Resultados: se estimaron estados afectivos, autorregulación psíquica, conductas frente a la enfermedad, linfocitos CD4+ y carga viral en 42 pacientes con inicio de sida con y sin síntomas psicopatológicos. Se emplearon estadísticas descriptivas y ANOVA de comparación de medias para relacionar variables y pruebas robustas confirmatorias. Los estados afectivos negativos no fueron buenos indicadores de alteración psíquica, con medias homogéneas entre grupos. En pacientes sintomáticos predominó la toma de decisiones reflexivas-responsabilidad, con medias superiores para descontrol e inferiores en autocontrol indicadoras de peor afrontamiento. Puntajes altos para autocontrol se asociaron con baja carga viral, pero no con conteos de LT CD4+; no se relacionaron variables psíquicas con inmunocompetencia

Introduction: the relationship between HIV/AIDS and mental illness has been reported, but no studies have been conducted in Cuba about psychic alterations in patients at clinical onset of AIDS. Methods: study population: patients of both sexes with a diagnosis of AIDS onset within a year after diagnosis. The record system SIDATRAT was used to list and locate the cases. The purpose was to learn about the behavior of psychic variables in patients at clinical onset of AIDS and their association with immunocompetence. Results: estimation was made of affective states, psychic self-regulation, behavioral response to the disease, CD4+ lymphocytes and viral load in 42 patients at clinical onset of AIDS with and without psychopathological symptoms. Descriptive statistics analysis, ANOVA mean comparison, was performed to relate variables and robust confirmatory tests. Negative affective states were not good indicators of psychic alteration, with homogeneous means between the groups. Reflexive decision making responsibility predominated among symptomatic patients, with upper means for discontrol and lower means for self-control, indicative of worst coping. High self-control scores were associated with a low viral load, but not with TL CD4+ counts. No psychic variable was related to immunocompetence

Quality of life of people with HIV/AIDS receiving antiretroviral therapy in Cuba: a cross-sectional study of the national population.

OBJECTIVES: We studied the effect of antiretroviral therapy (ART) on the quality of life (QOL) of Cubans with HIV/AIDS. METHODS: We conducted a cross-sectional study including administration of the Medical Outcomes Study-HIV Health Survey Questionnaire to a representative sample of the 1592 Cubans receiving ART in 2004. For univariate analyses, we compared mean HIV scale scores. We used logistic regression models to estimate the association between role function and year of diagnosis, between pain and sex, and between health transition and region of diagnosis, with adjustment for demographics, ART regimen, and clinical status. RESULTS: There were 354 participants (73 women, 281 men). Scores for all functional activities showed means higher than 80 out of 100. Pain interfered more in women than in men (73.2 vs 81.9; P = .01). When HIV diagnosis occurred after 2001, the probability of experiencing difficulties performing work (odds ratio [OR] = 4.42; 95% CI = 1.83, 10.73) and pain (OR = 1.70; 95% CI = 1.01, 2.88) increased compared with earlier diagnosis. People treated with indinavir showed a greater perception of general health (58.9 vs 52.4; P = .045) and greater health improvement (78.6 vs 67.8; P = .002). CONCLUSIONS: Although Cubans receiving ART are maintaining a high QOL, we observed significant differences by sex and time of diagnosis. QOL assessment can serve as a health outcome and may allow identification of QOL reductions potentially related to ART side effects.

Identificación y sensibilidad antimicrobiana de bacterias gramnegativas causantes de neumonía en pacientes VIH/sida / Identification and antimicrobial sensitivity of gramnegative bacteria causing pneumonia in HIV/AIDS patients

Las bacterias gramnegativas se consideran como causa frecuente de neumonía en pacientes VIH/sida. La emergente y elevada proporción de microorganismos resistentes obliga a utilizar el antibiograma como un método que definirá la terapéutica de estos pacientes. Objetivos: identificar las bacterias gramnegativas que causan neumonía en pacientes VIH/sida y determinar la sensibilidad antimicrobiana de los microorganismos aislados. Métodos: se realizó un estudio descriptivo prospectivo en el Instituto Pedro Kourí de 85 pacientes con VIH/sida y diagnóstico presuntivo de neumonía bacteriana por criterios clínicos y radiológicos. Se recogieron muestras de esputo y sangre para cultivo. Las bacterias aisladas y la sensibilidad antimicrobiana se determinaron por el sistema semiautomatizado miniApi (bioMérieux). Resultados: se aislaron 74 bacterias potencialmente patógenas de las que 32 (43,2 porciento) se clasificaron como gramnegativas. Predominaron Klebsiella pneumoniae (11 cepas: 34,3 porciento), Pseudomonas spp. (8 cepas: 25 porciento) y Escherichia coli (4 cepas: 12,5 porciento). Escherichia coli mostró el mayor porcentaje de resistencia y el 75 porciento de las cepas fue sensible frente a la amikacina. No se encontró resistencia al meropenem y más del 50 porciento de las enterobacterias identificadas con excepción de E.coli fueron sensibles a las cefalosporinas de tercera generación, ciprofloxacina, amikacina y cotrimoxazol. Pseudomonas spp. presentó resistencia al cotrimoxazol (87 porciento) y ticarcilina (75 porciento). Conclusiones: las bacterias gramnegativas causan en un porcentaje no despreciable neumonía en pacientes con VIH/sida. Aunque persisten cepas resistentes frente a diversos antimicrobianos, las cefalosporinas, quinolonas y los carbapenémicos muestran una adecuada actividad frente a estas bacterias

Gramnegative bacteria are considered to be a common cause of pneumonia in HIV/AIDS patients. The emergence of a large number of resistant microorganisms has made it necessary to use antibiograms to decide what treatment will be applied to these patients. Objectives: identify gramnegative bacteria causing pneumonia in HIV/AIDS patients and determine the antimicrobial sensitivity of the microorganisms isolated. Methods: a prospective descriptive study of 85 patients with HIV/AIDS and presumed diagnosis of bacterial pneumonia was carried out at Pedro Kourí Institute applying clinical and radiological criteria. Sputum and blood samples were collected to be cultured. The bacteria isolated and their antimicrobial sensitivity were determined using the mini-Api (bioMÚrieux) semiautomated system. Results: seventy-four potentially pathogenic bacteria were isolated, of which 32 (43.2 percent) were classified as gramnegative. The prevailing ones were Klebsiella pneumoniae (11 strains: 34.3 percent), Pseudomonas spp. (8 strains: 25 percent) and Escherichia coli (4 strains: 12,5 percent). Escherichia coli exhibited the highest resistance percentage. 75 percent of the strains were sensitive to amikacin. No resistance was found to meropenem, and more than 50 percent of the enterobacteria identified, with the exception of E. coli, were sensitive to third-generation cephalosporins, ciprofloxacin, amikacin and cotrimoxazol. Pseudomonas spp. showed resistance to cotrimoxazol (87 percent) and ticarcillin (75 percent). Conclusions: gramnegative bacteria cause pneumonia in HIV/AIDS patients to a considerable extent. There continue to be strains which are resistant to various antimicrobial drugs. However, cephalosporins, quinolones and carbapenemics exhibit adequate activity against these bacteria

Identificación y sensibilidad antimicrobiana de bacterias gramnegativas causantes de neumonía en pacientes VIH/sida / Identification and antimicrobial sensitivity of gramnegative bacteria causing pneumonia in HIV/AIDS patients

Las bacterias gramnegativas se consideran como causa frecuente de neumonía en pacientes VIH/sida. La emergente y elevada proporción de microorganismos resistentes obliga a utilizar el antibiograma como un método que definirá la terapéutica de estos pacientes. Objetivos: identificar las bacterias gramnegativas que causan neumonía en pacientes VIH/sida y determinar la sensibilidad antimicrobiana de los microorganismos aislados. Métodos: se realizó un estudio descriptivo prospectivo en el Instituto Pedro Kourí de 85 pacientes con VIH/sida y diagnóstico presuntivo de neumonía bacteriana por criterios clínicos y radiológicos. Se recogieron muestras de esputo y sangre para cultivo. Las bacterias aisladas y la sensibilidad antimicrobiana se determinaron por el sistema semiautomatizado miniApi (bioMérieux). Resultados: se aislaron 74 bacterias potencialmente patógenas de las que 32 (43,2 porciento) se clasificaron como gramnegativas. Predominaron Klebsiella pneumoniae (11 cepas: 34,3 porciento), Pseudomonas spp. (8 cepas: 25 porciento) y Escherichia coli (4 cepas: 12,5 porciento). Escherichia coli mostró el mayor porcentaje de resistencia y el 75 porciento de las cepas fue sensible frente a la amikacina. No se encontró resistencia al meropenem y más del 50 porciento de las enterobacterias identificadas con excepción de E.coli fueron sensibles a las cefalosporinas de tercera generación, ciprofloxacina, amikacina y cotrimoxazol. Pseudomonas spp. presentó resistencia al cotrimoxazol (87 porciento) y ticarcilina (75 porciento). Conclusiones: las bacterias gramnegativas causan en un porcentaje no despreciable neumonía en pacientes con VIH/sida. Aunque persisten cepas resistentes frente a diversos antimicrobianos, las cefalosporinas, quinolonas y los carbapenémicos muestran una adecuada actividad frente a estas bacterias(AU)

Gramnegative bacteria are considered to be a common cause of pneumonia in HIV/AIDS patients. The emergence of a large number of resistant microorganisms has made it necessary to use antibiograms to decide what treatment will be applied to these patients. Objectives: identify gramnegative bacteria causing pneumonia in HIV/AIDS patients and determine the antimicrobial sensitivity of the microorganisms isolated. Methods: a prospective descriptive study of 85 patients with HIV/AIDS and presumed diagnosis of bacterial pneumonia was carried out at Pedro Kourí Institute applying clinical and radiological criteria. Sputum and blood samples were collected to be cultured. The bacteria isolated and their antimicrobial sensitivity were determined using the mini-Api (bioMÚrieux) semiautomated system. Results: seventy-four potentially pathogenic bacteria were isolated, of which 32 (43.2 percent) were classified as gramnegative. The prevailing ones were Klebsiella pneumoniae (11 strains: 34.3 percent), Pseudomonas spp. (8 strains: 25 percent) and Escherichia coli (4 strains: 12,5 percent). Escherichia coli exhibited the highest resistance percentage. 75 percent of the strains were sensitive to amikacin. No resistance was found to meropenem, and more than 50 percent of the enterobacteria identified, with the exception of E. coli, were sensitive to third-generation cephalosporins, ciprofloxacin, amikacin and cotrimoxazol. Pseudomonas spp. showed resistance to cotrimoxazol (87 percent) and ticarcillin (75 percent). Conclusions: gramnegative bacteria cause pneumonia in HIV/AIDS patients to a considerable extent. There continue to be strains which are resistant to various antimicrobial drugs. However, cephalosporins, quinolones and carbapenemics exhibit adequate activity against these bacteria(AU)