Coinfección por VIH/VHB: estrategias terapéuticas y control serológico / HIV/HBV coinfection: Serological control and therapeutic strategies

Objetivos. La evolución y pronóstico de los pacientes coinfectados por el virus de la inmunodeficiencia humana (VIH) y el de la hepatitis B (VHB) no es bien conocida. Este estudio describe el tratamiento y el control serológico, virológico, bioquímico y elastográfico de los pacientes coinfectados por VIH/VHB. Pacientes y métodos. Estudio descriptivo, retrospectivo, de la totalidad de pacientes coinfectados por VIH/VHB seguidos en una consulta monográfica de VIH entre el 1 de enero de 2007 y el 30 de noviembre de 2008. A los pacientes se les realizaron determinaciones virológicas y serológicas para el VHB y el VIH, así como linfocitos CD4 y transaminasas, antes de comenzar el tratamiento antirretroviral y en el momento del análisis. Resultados. Se identificaron 54 (5,4%) pacientes coinfectados por VIH/VHB. Las medianas de CD4 nadir y actual fueron de 179 y 437 células/μl, respectivamente. El 70% tenían RNA-VIH indetectable. Cincuenta y dos pacientes (96,3%) seguían terapia con fármacos activos frente al VHB. Un 68,8% presentaron negativización del antígeno «e» del VHB, con un 81,6% de respuesta virológica. El antígeno de superficie del VHB se negativizó en el 10,4%. La alanina aminotransferasa era normal en el75,5%. Se realizó FibroScan® a 30 (55,6%) pacientes, obteniéndose una mediana de 7.0 KPa. Conclusiones. Los resultados obtenidos sugieren un buen control serológico, virológico, bioquímico y elastográfico de los pacientes coinfectados por VIH/VHB con los tratamientos recomendados por las guías clínicas(AU)

Objectives. The evolution and prognosis of patients co-infected by human immunodeficiency virus (HIV) and hepatitis B (HBV) is not well know. This study describes the treatment and serological, virological and biochemical and elastographic responses of HIV and HBV-coinfected patients. Patients and methods. A descriptive, retrospective study of all the HIV/HBV-coinfected patients seen in a specialized HIV department between 1 January 2007 and 30 November 2008 was performed. Virological and serological determinations of HIV and HBV infections as well as CD4 lymphocytes and transaminases prior to antiretroviral treatment and at the time of analysis were obtained. Results. A total of 54 (5.4%) cases of HIV/HBV coinfection were identified. The median nadir and current CD4 were 179 and 437 cells/L, respectively. There was undetectable RNA-HIV in 70%. There were 52 patients (96.3%) who followed active drugs treatment against HBV. After treatment, 68.8% had HBeAg negative result, with 81.6% virologic response. The HBsAg became negative in 10.4%. ALT was normal in 75.5%. FibroScan® was performed in 30 (55.6%) patients, yielding a median of 7.0kPa. Conclusions. The results obtained suggest a good serological, virological and biochemical control of HIV/HBV-coinfected patients with treatments recommended by clinical guidelines(AU)

HIV/HBV coinfection: serological control and therapeutic strategies.

OBJECTIVES: The evolution and prognosis of patients co-infected by human immunodeficiency virus (HIV) and hepatitis B (HBV) is not well know. This study describes the treatment and serological, virological and biochemical and elastographic responses of HIV and HBV-coinfected patients. PATIENTS AND METHODS: A descriptive, retrospective study of all the HIV/HBV-coinfected patients seen in a specialized HIV department between 1 January 2007 and 30 November 2008 was performed. Virological and serological determinations of HIV and HBV infections as well as CD4 lymphocytes and transaminases prior to antiretroviral treatment and at the time of analysis were obtained. RESULTS: A total of 54 (5.4%) cases of HIV/HBV coinfection were identified. The median nadir and current CD4 were 179 and 437 cells/L, respectively. There was undetectable RNA-HIV in 70%. There were 52 patients (96.3%) who followed active drugs treatment against HBV. After treatment, 68.8% had HBeAg negative result, with 81.6% virologic response. The HBsAg became negative in 10.4%. ALT was normal in 75.5%. FibroScan(®) was performed in 30 (55.6%) patients, yielding a median of 7.0kPa. CONCLUSIONS: The results obtained suggest a good serological, virological and biochemical control of HIV/HBV-coinfected patients with treatments recommended by clinical guidelines.

HIV/HBV coinfection: Serological control and therapeutic strategies. / Coinfección por VIH/VHB: estrategias terapéuticas y control serológico.

OBJECTIVES: The evolution and prognosis of patients co-infected by human immunodeficiency virus (HIV) and hepatitis B (HBV) is not well know. This study describes the treatment and serological, virological and biochemical and elastographic responses of HIV and HBV-coinfected patients. PATIENTS AND METHODS: A descriptive, retrospective study of all the HIV/HBV-coinfected patients seen in a specialized HIV department between 1 January 2007 and 30 November 2008 was performed. Virological and serological determinations of HIV and HBV infections as well as CD4 lymphocytes and transaminases prior to antiretroviral treatment and at the time of analysis were obtained. RESULTS: A total of 54 (5.4%) cases of HIV/HBV coinfection were identified. The median nadir and current CD4 were 179 and 437 cells/L, respectively. There was undetectable RNA-HIV in 70%. There were 52 patients (96.3%) who followed active drugs treatment against HBV. After treatment, 68.8% had HBeAg negative result, with 81.6% virologic response. The HBsAg became negative in 10.4%. ALT was normal in 75.5%. FibroScan(®) was performed in 30 (55.6%) patients, yielding a median of 7.0kPa. CONCLUSIONS: The results obtained suggest a good serological, virological and biochemical control of HIV/HBV-coinfected patients with treatments recommended by clinical guidelines.

[Report of a case: non-Hodgkin's lymphoma of the hypopharynx in a patient with HIV infection. Remission without lymphoma-specific treatment]. / A propósito de un caso: linfoma no Hodgkin de hipofaringe en paciente con infección por VIH. Remisión sin tratamiento específico para el linfoma.

Non-Hodgkin's lymphomas (NHL) are common in HIV patients, although it is rare for primary lymphomas to develop in the larynx or hypopharynx. We present the case of a patient that was diagnosed of a high degree NHL, following a biopsy of the piriform sinus' lesion, taker by direct laryngoscopy. Simultaneously he was diagnosed as HIV. The interest of this paper is the total remission of the lymphoma seen after specific HIV treatment only.

[Unifocal Langerhans cell granulomatosis in a young woman]. / Granulomatosis de células de Langerhans unifocal en una mujer joven.

We report a 24-years-old woman who presented with thoracic pain after coughing. Physical exam revealed no abnormalities except pain after pressing under blade-bone area. A rib radiography and CT of the thorax showed a lonely osteolytic lesion inside eleventh left costal arch without affecting others tissues. There were no more osteolytic lesions at other levels and the histopathological study of a resection-biopsy of the lesion was diagnosed as Langerhans' cell granulomatosis. This is an uncommon disease which diagnosis can only be made through histopathological study of suspected lesions.

Granulomatosis de células de Langerhans unifocal en una mujer joven / Langerhans´ cell granulomatosis in young woman

Mujer de 24 años de edad sin antecedentes personales de interés, que consultó por un dolor en región subescapular tras un acceso de tos. En la exploración física no había hallazgos, excepto el dolor a la palpación en la región subescapular. La radiografía de la parrilla costal objetivó una lesión lítica en el undécimo arco costal izquierdo que se confirmó en una TAC de tórax, en la que no había afectación de partes blandas. En el estudio general no se objetivaron otras lesiones líticas a otros niveles ni causa de la lesión, por lo que se realizó una biopsia-excisión, cuyo estudio anatomopatológico fue de Granulomatosis de células de Langerhans unifocal. Es ésta una enfermedad infrecuente, en la que sólo tras el estudio anatomopatológico puede establecerse el diagnóstico (AU)