[Comparative analysis of clinical characteristics, evolution and mortality of hospitalized patients with COVID-19 during the first and second wave of the pandemic (ECCOVID Study)]. / Análisis comparativo de las características clínicas, evolución y mortalidad de pacientes hospitalizados por COVID-19 durante la primera y segunda ola de la pandemia (Registro ECCOVID).

INTRODUCTION: Clinical features and outcomes of SARSCoV-2 infections may change between different waves of the pandemic. The objective of this study was to compare clinical characteristics and outcomes between two cohorts of patients hospitalized for COVID-19 during the first and second waves in Argentina. METHODS: Multicenter and prospective registry of patients =18 years old with a confirmed diagnosis of COVID-19 admitted to 18 hospitals in Argentina during the first wave (March to October 2020) and second wave (March to July 2021) of the pandemic. Demographics, clinical characteristics, and outcomes of these patients were compared. RESULTS: A total of 1691 patients were included (first wave n = 809, second wave n = 882). Hospitalized patients during the second wave were older (median 53 years vs. 61 years, p < 0.001), had more comorbidities (71% vs. 77%, p=0.007) and required more supplemental oxygen at admission (21% vs 62%, p < 0.001). During hospitalization, patients of the second wave required more supplemental oxygen (49% vs. 85%, p < 0.001), invasive ventilation (12% vs. 22%, p < 0.001) and had higher 30- day mortality (11% vs. 26%, p < 0.001). Comparing only patients who required supplemental oxygen during hospitalization, 30-day mortality was 20% and 30% p < 0.001 for the first and second wave, respectively. CONCLUSION: Compared to patients admitted during the first wave, patients admitted with SARS-CoV2 during the second wave in Argentina were more seriously ill and had a higher mortality.

Introducción: Las características clínicas y evolutivas de los pacientes con diagnóstico de COVID-19 pueden diferir entre las distintas olas de la pandemia. El objetivo de este estudio fue comparar las características clínicas, evolución y mortalidad de pacientes hospitalizados por COVID-19 durante la primera y segunda ola en Argentina. Métodos: Registro multicéntrico y prospectivo de pacientes = 18 años con diagnóstico confirmado de COVID-19 internados en 18 hospitales de Argentina durante la primera (marzo a octubre 2020) y la segunda ola (marzo a julio 2021) de la pandemia. Se compararon variables demográficas, características clínicas, y evolución a 30 días. Resultados: Se incluyeron un total de 1691 pacientes (primera ola n = 809, segunda ola n = 882). Los pacientes hospitalizados durante la segunda ola tenían mayor edad (mediana 53 años vs. 61 años, p < 0.001), comorbilidades (71% vs. 77%, p = 0.007) y requerimiento de oxígeno (21% vs. 62%, p < 0.001). Durante la hospitalización, los pacientes de la segunda ola requirieron más oxigenoterapia (49% vs. 85%, p < 0.001), asistencia mecánica respiratoria (12% vs. 22%, p < 0,001) y presentaron mayor mortalidad (11% vs. 26%, p < 0.001). Comparando únicamente a los que requirieron oxigenoterapia durante la hospitalización, la mortalidad a los 30 días fue de 20% y 30% p < 0.001 en la primera y segunda ola respectivamente. Conclusión: Comparados con los pacientes internados durante la primera ola, los internados durante la segunda ola de SARS-CoV-2 en Argentina presentaron mayor gravedad y mortalidad.

Análisis comparativo de las características clínicas, evolución y mortalidad de pacientes hospitalizados por COVID-19 durante la primera y segunda ola de la pandemia (REGISTRO ECCOVID) / Comparative analysis of clinical characteristics, evolu tion and mortality of hospitalized patients with COVID-19 during the first and second wave of the pandemic (ECCOVID STUDY)

Resumen Introducción : Las características clínicas y evolutivas de los pacientes con diagnóstico de COVID-19 pueden diferir entre las distintas olas de la pandemia. El objetivo de este estudio fue comparar las características clínicas, evolución y mortalidad de pacientes hospitalizados por COVID-19 durante la primera y segunda ola en Argentina. Métodos : Registro multicéntrico y prospectivo de pacientes ≥ 18 años con diagnóstico confirmado de COVID-19 internados en 18 hospitales de Argentina durante la primera (marzo a octubre 2020) y la segunda ola (marzo a julio 2021) de la pandemia. Se compararon variables demográficas, características clínicas, y evolu ción a 30 días. Resultados : Se incluyeron un total de 1691 pacien tes (primera ola n = 809, segunda ola n = 882). Los pa cientes hospitalizados durante la segunda ola tenían mayor edad (mediana 53 años vs. 61 años, p < 0.001), comorbilidades (71% vs. 77%, p = 0.007) y requerimiento de oxígeno (21% vs. 62%, p < 0.001). Durante la hospi talización, los pacientes de la segunda ola requirieron más oxigenoterapia (49% vs. 85%, p < 0.001), asistencia mecánica respiratoria (12% vs. 22%, p <0,001) y presen taron mayor mortalidad (11% vs. 26%, p < 0.001). Compa rando únicamente a los que requirieron oxigenoterapia durante la hospitalización, la mortalidad a los 30 días fue de 20% y 30% p < 0.001 en la primera y segunda ola respectivamente. Conclusión : Comparados con los pacientes interna dos durante la primera ola, los internados durante la segunda ola de SARS-CoV-2 en Argentina presentaron mayor gravedad y mortalidad.

Abstract Introduction : Clinical features and outcomes of SARS-CoV-2 infections may change between different waves of the pandemic. The objective of this study was to compare clinical characteristics and outcomes between two cohorts of patients hospitalized for COVID-19 during the first and second waves in Argentina. Methods : Multicenter and prospective registry of patients ≥18 years old with a confirmed diagnosis of COVID-19 admitted to 18 hospitals in Argentina during the first wave (March to October 2020) and second wave (March to July 2021) of the pandemic. Demographics, clinical characteristics, and outcomes of these patients were compared. Results : A total of 1691 patients were included (first wave n = 809, second wave n = 882). Hospitalized pa tients during the second wave were older (median 53 years vs. 61 years, p < 0.001), had more comorbidities (71% vs. 77%, p=0.007) and required more supplemental oxygen at admission (21% vs 62%, p < 0.001). During hos pitalization, patients of the second wave required more supplemental oxygen (49% vs. 85%, p < 0.001), invasive ventilation (12% vs. 22%, p < 0.001) and had higher 30- day mortality (11% vs. 26%, p < 0.001). Comparing only patients who required supplemental oxygen during hos pitalization, 30-day mortality was 20% and 30% p < 0.001 for the first and second wave, respectively. Conclusion : Compared to patients admitted during the first wave, patients admitted with SARS-CoV2 dur ing the second wave in Argentina were more seriously ill and had a higher mortality.

Clinical characteristics and outcomes of hospitalized patients with SARS-CoV-2 infection in a Latin American country: Results from the ECCOVID multicenter prospective study.

BACKGROUND: Clinical features and outcomes of SARS-CoV-2 infections diverge in different countries. The aim of this study was to describe clinical characteristics and outcomes in a cohort of patients hospitalized with SARS-CoV-2 in Argentina. METHODS: Multicenter prospective cohort study of ≥18 years-old patients with confirmed SARS-CoV-2 infection consecutively admitted to 19 hospitals in Argentina. Multivariable logistic regression models were used to identify variables associated with 30-day mortality and admission to intensive care unit (ICU). RESULTS: A total of 809 patients were analyzed. Median age was 53 years, 56% were males and 71% had at least one comorbidity. The most common comorbidities were hypertension (32%), obesity (23%) and diabetes (17%). Disease severity at admission was classified as mild 25%, moderate 51%, severe 17%, and critical 7%. Almost half of patients (49%) required supplemental oxygen, 18% ICU, and 12% invasive ventilation. Overall, 30-day mortality was 11%. Factors independently associated with ICU admission were male gender (OR 1.81; 95%CI 1.16-2.81), hypertension (OR 3.21; 95%CI 2.08-4.95), obesity (OR 2.38; 95%CI 1.51-3.7), oxygen saturation ≤93% (OR 6.45; 95%CI 4.20-9.92) and lymphopenia (OR 3.21; 95%CI 2.08-4.95). Factors independently associated with 30-day mortality included age ≥60 years-old (OR 2.68; 95% CI 1.63-4.43), oxygen saturation ≤93% (OR 3.19; 95%CI 1.97-5.16) and lymphopenia (OR 2.65; 95%CI 1.64-4.27). CONCLUSIONS: This cohort validates crucial clinical data on patients hospitalized with SARS-CoV-2 in Argentina.

Programa de acompañamiento por pares para personas con diagnóstico reciente de infección por VIH: Experiencia PPP / Peer support program for people with recently diagnosed HIV-infection: PPP experience

Introducción: Para mejorar la retención en el sistema de salud de las personas que viven con VIH (PVVIH) con diagnóstico reciente y promover su adherencia se implementó el programa de acompañamiento de pares "Positivos para Positivos" (PPP).Material y métodos: Se entrenó a PVVIH con excelente adherencia y se les ofreció integrar PPP. Entre 06/2014 y 08/2018 cada individuo con diagnóstico reciente de infección VIH fue invitado a contactar con PPP. Se evaluó prospectivamente la evolución de los pacientes durante un año y se analizaron variables vinculadas a adherencia. Se compararon sus resultados con lo observado entre PVVIH con diagnóstico reciente sin apoyo de pares. Se analizó mediante tablas de 2x2 y la prueba exacta de Fisher (EpiInfo7.2.2.6).Resultados: Se incluyeron 158 PVVIH (40 grupo intervención y 118 grupo control). En el grupo intervención hubo más pacientes que iniciaron TARGA [100% vs 87,3%; RR 1,15 (IC95 1,07-1,23); p=0,024]. Tras excluir a los derivados y fallecidos tempranamente quedaron 37 y 112 pacientes respectivamente. En el grupo intervención se observó mejor control clínico [94,6% vs 75,9%; RR 4,2 (IC95 1,08-16,6); p=0,015] y menos abandono de seguimiento [8,1% vs 25,9%; RR 0,3 (IC95 0,11-0,98); p=0,02]. Entre quienes iniciaron TARGA y tuvieron al menos una consulta con el servicio de Infectología (37 grupo intervención y 97 grupo control) se registraron más pacientes con alta tasa de retiro de TARGA de farmacia [51,4% vs 18,6%; RR 2,77 (IC95 1,64­4,66); p=0,0003]; mayor alcance de CV <50 [100% vs 85,1%; RR 1,18 (IC95 1,06­1,30); p=0,06]; y menos interrupciones RESUMENARTÍCULO ORIGINALISSN 2314-3193. Actualizaciones en sida e infectología. Buenos Aires. noviembre 2020. volumen 28. número 103: 80-92no estructuradas del TARGA [10,8% vs 36,1%; RR 0,3 (IC95 0,11­0,78); p=0,008]. Conclusión: El acompañamiento de pares impactó positivamente en la adherencia de las PVVIH con diagnóstico reciente en el primer año de seguimiento

ntroduction: To improve retention in the health system of recently diagnosed people living with HIV (PLHIV) and promote their adherence, the "Positive for Positive" peer support program (PPP) was implemented.Materials and methods: PLHIV with excellent adherence were trained and offered to integrate PPP. Between June/2014 and August/2018 each individual with a recent diagnosis of HIV infection was invited to contact PPP. Patients were prospectively evaluated for one year and variables linked to adherence were analyzed. Their results were compared with those observed among recently diagnosed PLHIV without peer support. It was analyzed using 2x2 tables and Fisher's exact test (EpiInfo7.2.2.6).Results: 158 PLHIV were included (40 intervention group and 118 control group). In the intervention group more patients started HAART [100% vs 87.3%; RR 1.15 (IC95 1.07-1.23); p=0.024]. After excluding referrals and early deaths, remained 37 and 112 patients, respectively. In the intervention group there was better clinical control [94.6% vs 75.9%; RR 4.2 (IC95 1.08-16.6); p=0.015] and less dropout from follow-up [8.1% vs 25.9%; RR 0.3 (IC95 0.11-0.98); p=0.02]. Among those who initiated HAART and had at least one visit to the Infectious Disease Outpatient Clinic (37 intervention group and 97 control group), more patients showed a high refill rate (51.4% vs. 18.6%); RR 2.77 (IC95 1.64-4.66); p=0.0003]; greater achievement of undetectable viral load [100% vs 85.1%; RR 1.18 (IC95 1.06-1.30); p=0.06]; fewer unstructured HAART interruptions [10.8% vs 36.1%; RR 0.3 (IC95 0.11-0.78); p=0.008].Conclusion: Peer support had a positive impact on adherence among recently diagnosed PLHIV in the first year of follow-up

[Aerobic etiology of acute appendicitis in adults. Multicenter study of abdominal sepsis in Argentina]. / Etiología aerobia de apendicitis aguda en adultos. Estudio multicéntrico de la sepsis abdominal en Argentina.

Antibiotic treatment for acute appendicitis is empirically chosen, based on epidemiological information. Resistance rates are different between regions and there are limited data on the situation in Argentina. As a part of a multicenter, observational study of abdominal infections, we performed the analysis of adult patients diagnosed with appendicitis, enrolled in 16 centers of 5 provinces, between Jan/01/2014 and Jun/30/2015. The aim was to analyze the prevalent aerobic pathogens, their resistance rates and the antimicrobial prescription pattern. On a total of 131 appendicitis cases analyzed, we found 184 aerobic pathogens (1.4 bacteria/episode): Escherichia coli 106 (57.6%), Klebsiella spp 16 (8.7%), Pseudomonas aeruginosa 19 (10.3%), Enterobacter spp. 2 (1%), other Gram negative bacilli 5 (2.7%); Enterococcus spp. 16 (8.7%) and other Gram positive cocci 20 (10.9%). The resistance rate of E. coli and enterobacteria to ampicillin/sulbactam was greater than 34% and greater than 31% to ciprofloxacin. However, the resistance of enterobacteria to piperacillin/tazobactam was 4.8%, to ceftriaxone 9.5%, to amikacin 3.6% and 8.2% to gentamicin. No resistance to carbapenems was found. The choice of quinolones or ampicillin/sulbactam for the treatment of appendicitis should be discouraged in our context, due to the high rates of resistance found in this prevalent etiology. Aminoglycoside-based treatments should be considered, given the findings of high antibiotic susceptibility and their low impact on the induction of resistance.

Etiología aerobia de apendicitis aguda en adultos: Estudio multicéntrico de la sepsis abdominal en Argentina / Aerobic etiology of acute appendicitis in adults. Multicenter study of abdominal sepsis in Argentina

El tratamiento antibiótico de las apendicitis agudas se decide empíricamente basándose en la información epidemiológica. Las resistencias son variables entre regiones y los datos de Argentina son escasos. En el contexto de un estudio multicéntrico, observacional, de infecciones abdominales, se efectuó el análisis de los pacientes adultos con diagnóstico de apendicitis, incorporados al estudio entre enero 2014 y junio 2015, en 16 centros de 5 provincias argentinas. El objetivo fue analizar los gérmenes aeróbicos prevalentes, su resistencia a antibióticos y el patrón de prescripción antimicrobiana. Se estudiaron 131 apendicitis. Se aislaron 184 bacterias aerobias (1.4 bacterias/episodio): Escherichia coli 106 (57.6%), Klebsiella spp 16 (8.7%), Pseudomonas aeruginosa 19 (10.3%), Enterobacter spp. 2 (1%), otros bacilos Gram negativos 5 (2.7%). Enterococcus spp. 16 (8.7%) y otros cocos Gram positivos 20 (10.9%). La resistencia de E. coli y enterobacterias a ampicilina/sulbactam fue mayor a 34% y a ciprofloxacina mayor a 31%. En cambio, la resistencia de enterobacterias a piperacilina/tazobactam fue 4.8%, a ceftriaxona 9.5% y no se halló resistencia a carbapenemes. Respecto a amikacina fue 3.6% y a gentamicina 8.2%. En función de los resultados, el uso de quinolonas o de ampicilina/sulbactam para el tratamiento de las apendicitis debiera ser desaconsejado. Los esquemas basados en aminoglucósidos debieran ser jerarquizados en función de la sensibilidad hallada y su bajo impacto en la inducción de resistencias.

Antibiotic treatment for acute appendicitis is empirically chosen, based on epidemiological information. Resistance rates are different between regions and there are limited data on the situation in Argentina. As a part of a multicenter, observational study of abdominal infections, we performed the analysis of adult patients diagnosed with appendicitis, enrolled in 16 centers of 5 provinces, between Jan/01/2014 and Jun/30/2015. The aim was to analyze the prevalent aerobic pathogens, their resistance rates and the antimicrobial prescription pattern. On a total of 131 appendicitis cases analyzed, we found 184 aerobic pathogens (1.4 bacteria/episode): Escherichia coli 106 (57.6%), Klebsiella spp 16 (8.7%), Pseudomonas aeruginosa 19 (10.3%), Enterobacter spp. 2 (1%), other Gram negative bacilli 5 (2.7%); Enterococcus spp. 16 (8.7%) and other Gram positive cocci 20 (10.9%). The resistance rate of E. coli and enterobacteria to ampicillin/sulbactam was greater than 34% and greater than 31% to ciprofloxacin. However, the resistance of enterobacteria to piperacillin/tazobactam was 4.8%, to ceftriaxone 9.5%, to amikacin 3.6% and 8.2% to gentamicin. No resistance to carbapenems was found. The choice of quinolones or ampicillin/sulbactam for the treatment of appendicitis should be discouraged in our context, due to the high rates of resistance found in this prevalent etiology. Aminoglycoside-based treatments should be considered, given the findings of high antibiotic susceptibility and their low impact on the induction of resistance.

Candidemia en un paciente que recibió tratamiento para infección por Clostridium difficile: relación directa o casualidad? / Candidemia subsequent to Clostridium difficile infection: direct relationship or coincidence?

No disponible

Brucellosis complicating chronic non-infectious disorders: diagnostic and therapeutic dilemmas.

There is little information in the literature on the clinical progress of brucellosis in patients affected by other non-infectious diseases; however, the infection can often trigger an exacerbation of existing underlying conditions in certain target organs. In this report we present four cases of brucellosis complicating previous diseases, and the difficulties in relation to their diagnosis and treatment. The study involved four patients with the following disorders: polycythaemia vera, pulmonary fibrosis, cirrhosis of the liver and arthritis of the knee. Brucellosis was diagnosed by classical serological and bacteriological methods. The strains involved could be isolated only in three of the four patients: two strains were Brucella abortus biovar 1 and one was Brucella suis biovar 1. Two patients relapsed 10 and 7 months after admission, another presented chronic brucellosis and received various therapy schemes, and one died. Since the best selection of antibiotics and the optimal duration of therapy remain unknown for patients having brucellosis complicated by previous pathologies, these remain at the discretion of the attending physician. Management of our patients was controversial in terms of the selection of antibiotics, duration of treatment and decision regarding surgery.

HPV perianal en pacientes HIV positivos: anoscopía magnificada y determinación de serotipos por biología molecular / Perianal HPV in HIV patients: high resolution anoscopy and virus type determination by molecular biology

Introducción: La incidencia de cáncer anal se ha incrementado notablemente en los últimos años. La asociación de esta patología con la presencia de infección anal por el virus HPV permite identificar una población de riesgo, principalmente en pacientes con serología positiva para HIV y con prácticas homosexuales. Objetivo: Determinar la incidencia de lesiones perianales clínicas y subclínicas vinculables a la infección por HPV (virus del papiloma humano) en una población de individuos infectados por HIV (virus de la inmunodeficiencia humana). Material y Método: Entre el 1 de Noviembre de 2006 y 31 de Junio de 2007 se analizaron prospectivamente 33 pacientes con diagnóstico de HIV, 60 por ciento sexo femenino, edad media de 40 años (r = 19-62). Las variables en estudio fueron edad, sexo, recuento de CD4, nadir de CD4, carga viral, antecedentes de HPV previo, hábito sexual, tratamiento antirretroviral, HIV status, antecedentes de ETS (Enfermedades de transmisión sexual), inspección y anoscopía, anoscopía magnificada, citología, biopsia, serotipo de riesgo, tratamiento. Resultados: Los resultados genéticos confirmaron 54.5 por ciento (18) casos de infección; correspondiendo 77.7 por ciento a cepas de bajo riesgo y 22.2 por ciento a cepas de alto riesgo. La inspección y anoscopía simple mostró lesión sospechosa de HPV en 30 por ciento de los pacientes y la anoscopía magnificada en el 45 por ciento de los pacientes. La citología mostró lesión sugestiva de HPV en 36.3 por ciento y atipía citológica en 27.2 por ciento. Las biopsias revelaron 27.2 por ciento de lesiones típicas de condiloma, 18.2 por ciento de lesiones AIN (neoplasia intraepitelial anal) y 3 por ciento de hiperparaqueratosis. La sensibilidad y especificidad para la inspección, anoscopía magnificada y cepillado fue de 44.4 por ciento, 72 por ciento y 77 por ciento; y de 86 por ciento, y 53.3 por ciento respectivamente...

Background: The incidence of anal cancer has increased in the last years. The association between anal cancer and HPV anal infection let us identify a risk population, principally HIV patients with men sexual men practices. Aim: To asses the incidence of anal and perianal lesions associated with HPV (human papillomavirus) infection in HIV (human immunodeficiency virus) positive patients. Material and Methods: Between 1 November 2006, to 31 June 2007, 33 patients with positive serology for HIV infection were prospectively analyzed, 60 per cent females, median age 40 years (r = 19-62). The variables included in the study were age, gender, CD4 recount, CD4 nadir, viral charge, HPV previous history, sexual habits, type of retroviral treatment, HIV status, sexually transmitted disease history, simple anoscopy, high resolution anoscopy, pap cytology, pathology results, viral HPV type, treatment. Results: Genetic reports informed 54,5 per cent (18) of positive HPV patients, 77,7 per cent low risk viral type and 22 per cent of high risk. Inspection and conventional anoscopy showed 30 per cent of suspicious HPV lesions and high resolution anoscopy 45 per cent of them. Citology report informed 36,3 per cent of cellular changes associated with HPV infections and 27,2 per cent of atypia. The pathology report confirmed 27,2 per cent of typical HPV warms, 18,2 per cent of AIN (anal intraepithelial neoplasia) and 3 per cent of ASCUS (anal squamous cells of uncertain significance). Inspection and conventional anoscopy, high resolution anoscopy and citology by anal brushing showed sensibility and specificity of 44,4 per cent, 72 per cent and 77 per cent and 86 per cent, 86 per cent, 53,3 per cent respectively. Conclusions: HPV anal and perianal infection in HIV patients is frequent independently of sexual habits. High resolution Anoscopy and molecular diagnostic with viral type determination allow us to find sub clinical lesions of risk.

[Clinical, epidemiological and immunological study of patients coinfected with HIV and HTLV-1]. / Estudio epidemiológico, clinico e inmunológico de pacientes coinfectados con HIV y HTLV-1.

We studied the prevalence of antibodies against HTLV-1 among every HIV-infected outpatients assisted in our hospital between January 1st 2000 and June 30th 2003. We reviewed the epidemiological data, clinical findings, viral load and CD4 cells-count, comparing coinfected with non HTLV-1 coinfected. We found a prevalence of HTLV-1 infection of 8.1% (23/282); 8.5% (12/141) in men and 7.8% (11/141) in women [[OR=0.91 (0.36

[Osteonecrosis in HIV-infected patients]. / Osteonecrosis en pacientes infectados por HIV.

Osteonecrosis, also known as avascular necrosis, is chiefly characterized by death of bone caused by vascular compromise. The true incidence of osteonecrosis in HIV-infected patients is not well known and the pathogenesis remains undefined. Hypothetical risk factors peculiar to HIV-infected individuals that might play a role in the pathogenesis of osteonecrosis include the introduction of protease inhibitors and resulting hyperlipidemia, the presence of anticardiolipin antibodies in serum leading to a hypercoagulable state, immune recovery and vasculitis. Hereby we present a series of 13 HIV-infected patients with osteonecrosis. The most common symptom upon presentation was arthralgia. The majority of the patients had received steroids, 9 had developed hyperlipidemia after the introduction of HAART, 8 were smokers and 4 patients were alcoholics. In 2 patients, seric anticardiolipin antibodies were detected. Twelve patients had AIDS and were on HAART (11 were on protease inhibitors). We believe that osteonecrosis should be included as differential diagnosis of every HIV-infected patient who complains of pain of weight bearing joints. Likewise, it seems prudent to rule out HIV infection in subjects with osteonecrosis.

Osteonecrosis en pacientes infectados por HIV. / [Osteonecrosis in HIV-infected patients]

Osteonecrosis, also known as avascular necrosis, is chiefly characterized by death of bone caused by vascular compromise. The true incidence of osteonecrosis in HIV-infected patients is not well known and the pathogenesis remains undefined. Hypothetical risk factors peculiar to HIV-infected individuals that might play a role in the pathogenesis of osteonecrosis include the introduction of protease inhibitors and resulting hyperlipidemia, the presence of anticardiolipin antibodies in serum leading to a hypercoagulable state, immune recovery and vasculitis. Hereby we present a series of 13 HIV-infected patients with osteonecrosis. The most common symptom upon presentation was arthralgia. The majority of the patients had received steroids, 9 had developed hyperlipidemia after the introduction of HAART, 8 were smokers and 4 patients were alcoholics. In 2 patients, seric anticardiolipin antibodies were detected. Twelve patients had AIDS and were on HAART (11 were on protease inhibitors). We believe that osteonecrosis should be included as differential diagnosis of every HIV-infected patient who complains of pain of weight bearing joints. Likewise, it seems prudent to rule out HIV infection in subjects with osteonecrosis.

Estudio epidemiológico, clinico e inmunológico de pacientes coinfectados con HIV y HTLV-1. / [Clinical, epidemiological and immunological study of patients coinfected with HIV and HTLV-1]

We studied the prevalence of antibodies against HTLV-1 among every HIV-infected outpatients assisted in our hospital between January 1st 2000 and June 30th 2003. We reviewed the epidemiological data, clinical findings, viral load and CD4 cells-count, comparing coinfected with non HTLV-1 coinfected. We found a prevalence of HTLV-1 infection of 8.1

(23/282); 8.5

(12/141) in men and 7.8

(11/141) in women [[OR=0.91 (0.36

(16/129) among patients users of illicit drugs and 4.6

(7/152) among non-users [OR=2.93 (1.09

(16/77) in injecting drugs users (IDU) and 3.4

(7/205) in non-IDU patients [p=0.000006 OR=7.42 (2.71

Estudio epidemiologico, clinico e inmunologico de pacientes coinfectados con HIV y HTLV-1 / Clinical, epidemiological and immunological study of patients coinfected with HIV and HTLV-1

Se efectuó un estudio prospectivo parcial de seroprevalencia de HTLV-1 en todos los pacientes infectados con HIV seguidos en el consultorio externo de infectología de nuestro hospital entre el 1 de enero de 2000 y el 30 de junio de 2003. Se analizaron retrospectivamente las características clínicas, carga viral de HIV (CV) y recuento de células CD4, comparando a la población de pacientes coinfectados y no coinfectados. Hallamos una seroprevalencia de HTLV-1 de 8.1% (23/282); 8.5% (12/141) entre hombres y 7.8% (11/141) entre mujeres [OR=0.91 (0.36 < OR < 2.3) p=0.8]; 12.4% (16/129) entre consumidores de drogas y 4.6% (7/152) entre quienes no consumían drogas [OR=2.93 (1.09 < OR < 8.17) p=0.03]; 20.8% (16/77) entre adictos a drogas intravenosas (DIV) y 3.4% (7/205) entre los no-DIV [OR=7.42 (2.71 < OR < 20.9) p=0.000006]. Noventa y seis pacientes (96/282) habían tenido enfermedad marcadora (EM) de SIDA, el tipo de EM no difirió entre los coinfectados y no coinfectados. Ningún paciente desarrolló enfermedad vinculable con HTLV-1. El CD4 promedio en los pacientes portadores de HTLV-1 con antecedentes de EM y vírgenes de antirretrovirales (n=7) fue 211 células/ml, y 87.9 células/ml entre los no coinfectados (n=55) [test-t=2.82; p=0.006]. La CV de los pacientes coinfectados fue similar a la de los no coinfectados. Hallamos una alta prevalencia de infección por HTLV-1 entre los pacientes portadores de HIV (mayor aún entre los usuarios de drogas). El recuento de CD4 en los pacientes que presentaron EM fue superior en los coinfectados con HTLV-1 que en los no coinfectados, lo cual podría evidenciar algún grado de disfunción de dichas células. (AU)

Osteonecrosis en pacientes infectados por HIV / Osteonecrosis in HIV-infected patients

Según la literatura, la osteonecrosis tiene una mayor incidencia en los pacientes infectados con HIV que en la población general. Ello sería resultado de la confluencia de factores de riesgo clásicos y de otros propios de esta población o más prevalentes en ella, como el tratamiento con inhibidores de proteasa, la dislepemia producto de su consumo, la presencia de anticuerpos anticardiolipina séricos, la hipercoagulabilidad, la restauración inmune y las vasculitis. Presentamos una serie de 13 pacientes infectados con HIV con osteonecrosis. El motivo de consulta fue dolor en grandes articulaciones. Cuatro eran alcoholistas, 8 tabaquistas y 9 tenían dislipemia. Once habían recibido esteroides en algún momento de la vida aunque sólo uno estaba reciciéndolos al momento de inicio del dolor. En 2 se detectaron anticuerpos anticardiolipina séricos. Doce tenían sida y recebían tratamiento antirretroviral de alta eficacia (11 con inhibidores de proteasa). Ellos lograron una adecuada recuperacíon inmunológica. Consideramos necesario incluir la osteonecrosis como diagnóstico diferencial de artralgia persistente en pacientes infectados con HIV e investigar infección por HIV en todo paciente con osteonecrosis sin claros factores predisponentes. (AU)