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1.
Clin Infect Dis ; 2018 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-29788075

RESUMO

Background: While nutritional interventions with prebiotics and probiotics seem to exert immunological effects, their clinical implications in HIV-infected subjects initiating ART at advanced HIV disease remain unclear. Methodology: Pilot multicenter randomized, placebo-controlled, double-blind study in which 78 HIV-infected, ART-naive subjects with <350 CD4 T-cells/µl or AIDS were randomized to either daily PMT25341 (a mixture of prebiotics, probiotics, oligonutrients, DHA, EPA, GLA, and aminoacids) or placebo for 48 weeks, each in combination with first-line ART. Primary endpoints were changes in CD4 T-cell counts and CD4/CD8 ratio from baseline to week 48 and safety. Secondary endpoints were changes in markers of T-cell activation, bacterial translocation, inflammation, and microbiota composition (Clinicaltrials.gov: NCT00870363). Results: Fifty-nine participants completed the follow-up with a mean CD4+ T-cell count of 221108/µl and mean CD4/CD8 ratio of 0.260.19. PMT25341 was well tolerated; without grade 3-4 adverse effects attributable to the intervention. While most of the assessed biomarkers improved during the follow-up in both arms, PMT25341-treated subjects did not experience any significant change, compared to placebo-treated subjects, in median CD4+ T-cell count change (226 cells/µl vs. 414, P=0.461) or CD4/CD8 ratio change (0.21 vs. 0.48, P=0.854). Similarly, we did not detect differences between treatment arms in the variations of %HLADR+CD38+ or %CD28- T-cells, sCD14, LTA, IL-6, CRP, TNF-⍺, sCD163, IP-10, IL-7, IL-10, or IL-17 or alpha and beta microbiota diversity. Conclusion: In HIV-infected patients initiating ART at advanced disease, the clear immunological benefits of ART were not enhanced by this nutritional intervention targeting the GALT and microbiota.

2.
AIDS ; 32(7): 913-920, 2018 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-29424785

RESUMO

OBJECIVE: Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is used to assess bone health in HIV patients. DXA measures the amount of mineral, but not other key aspects of bone strength such as bone microarchitecture or bone quality. Trabecular bone score (TBS) and in-vivo microindentation directly measure trabecular microarchitecture and bone tissue quality, respectively. The aim of this study is to measure bone strength properties using these techniques. RESULTS: Forty naive HIV patients who were going to start antiretroviral therapy (ART), a single pill treatment with elvitegravir/cobicistat, tenofovir disoproxil fumarate (TDF), emtricitavine (FTC) were included. A significant reduction in BMD at spine (-3.25%, P < 0.001) and in femoral neck (-3.82%, P = 0.016) between baseline and 48 weeks of treatment were found. Bone microarchitecture score at the spine, as measured by TBS, also significantly decreased from 1.357 (0.09) to 1.322 (0.09) (-2.5%, P = 0.011) between baseline to 48 weeks of treatment. Microindentation (BMSi) values were significantly higher than at baseline [89.04 (4.2) versus 86.07 (6.1); 3.49%, P < 0.001] after 48 weeks of TDF-based ART treatment, indicating improved bone material properties CONCLUSION:: A significant decrease in BMD and TBS were observed after 1 year of TDF therapy. However, tissue quality significantly improved after 1 year of treatment, suggesting a recovery of bone material properties following the control of the infection despite the significant reduction of BMD. These techniques provide additional and necessary information to DXA about bone health in treated HIV patients, and because of its convenience and feasibility they could be routinely apply to assess bone in clinical practice.

3.
PLoS One ; 12(4): e0173802, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28388647

RESUMO

Dysbalance in gut microbiota has been linked to increased microbial translocation, leading to chronic inflammation in HIV-patients, even under effective HAART. Moreover, microbial translocation is associated with insufficient reconstitution of CD4+T cells, and contributes to the pathogenesis of immunologic non-response. In a double-blind, randomised, placebo-controlled trial, we recently showed that, compared to placebo, 12 weeks treatment with probiotic Saccharomyces boulardii significantly reduced plasma levels of bacterial translocation (Lipopolysaccharide-binding protein or LBP) and systemic inflammation (IL-6) in 44 HIV virologically suppressed patients, half of whom (n = 22) had immunologic non-response to antiretroviral therapy (<270 CD4+Tcells/µL despite long-term suppressed viral load). The aim of the present study was to investigate if this beneficial effect of the probiotic Saccharomyces boulardii is due to modified gut microbiome composition, with a decrease of some species associated with higher systemic levels of microbial translocation and inflammation. In this study, we used 16S rDNA gene amplification and parallel sequencing to analyze the probiotic impact on the composition of the gut microbiome (faecal samples) in these 44 patients randomized to receive oral supplementation with probiotic or placebo for 12 weeks. Compared to the placebo group, in individuals treated with probiotic we observed lower concentrations of some gut species, such as those of the Clostridiaceae family, which were correlated with systemic levels of bacterial translocation and inflammation markers. In a sub-study of these patients, we observed significantly higher parameters of microbial translocation (LBP, soluble CD14) and systemic inflammation in immunologic non-responders than in immunologic responders, which was correlated with a relative abundance of specific gut bacterial groups (Lachnospiraceae genus and Proteobacteria). Thus, in this work, we propose a new therapeutic strategy using the probiotic yeast S. boulardii to modify gut microbiome composition. Identifying pro-inflammatory species in the gut microbiome could also be a useful new marker of poor immune response and a new therapeutic target.


Assuntos
Infecções por HIV/microbiologia , Intestinos/microbiologia , Microbiota , Probióticos , Saccharomyces boulardii , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placebos
4.
J Acquir Immune Defic Syndr ; 75(3): 322-327, 2017 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-28418990

RESUMO

OBJECTIVES: HIV infection has been associated with reduced bone mineral density (BMD). Antiretroviral therapy (ART) has a deleterious effect on BMD, but its effect on bone fragility is not clear. The objective of this study is to analyze the BMD, microarchitecture, and tissue quality of bone in patients receiving long-term tenofovir- or abacavir-based ART. DESIGN: We conducted a cross-sectional study in patients with HIV undergoing tenofovir or abacavir ART for more than 5 years. METHODS: We measured BMD using dual X-ray absorptiometry ,bone michroarchitecture using trabecular bone score (TBS), and bone tissue quality using microindentation. TBS is a dual X-ray absorptiometry-based software that is more highly correlated with bone fragility than BMD. Microindentation (BMSi) directly assesses bone quality at the tissue level. RESULTS: A total of 63 patients were included in this study, with 36 belonging to the TDF-FTC group and 27 to the ABC-3TC group. Patients receiving TDF-FTC treatment showed lower BMD values than those in the ABC-3TC group. We found no differences in TBS or microindentation between the 2 groups. However, after adjusting for sex, age, body mass index, and 25[OH]vitD we found lower BMSi and thus poorer bone properties in the TDF-FTC group than in the ABC-3TC group [beta coefficient -3.594 (confidence interval: 95% -0.12 to -7.61); P = 0.043]. CONCLUSIONS: Long-term treatment with TDF-FTC leads to impaired bone health, not only in terms of BMD but also in terms of bone quality, another determinant of overall bone strength. To complement BMD-based predictions, these other techniques may also be used to identify patients with excess fracture risk.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Densidade Óssea/efeitos dos fármacos , Didesoxinucleosídeos/efeitos adversos , Emtricitabina/efeitos adversos , Infecções por HIV/fisiopatologia , Lamivudina/efeitos adversos , Tenofovir/efeitos adversos , Absorciometria de Fóton , Fármacos Anti-HIV/administração & dosagem , Remodelação Óssea , Estudos Transversais , Didesoxinucleosídeos/administração & dosagem , Combinação de Medicamentos , Emtricitabina/administração & dosagem , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lamivudina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Espanha , Tenofovir/administração & dosagem
5.
Rev. esp. quimioter ; 30(1): 62-78, feb. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-159565

RESUMO

Los datos sobre prevalencia de la eosinofilia importada entre viajeros e inmigrantes la sitúan entre un 8%-28,5%. El estudio etiológico es en ocasiones complejo, y en función de lo exhaustivo del estudio y de la población analizada, se ha podido identificar una causa parasitaria en el 17%-75,9% de los individuos. Entre las dificultades que se encuentran para comparar los estudios están la heterogeneidad de las poblaciones estudiadas, el tipo de recogida (prospectiva/retrospectiva) y distintos protocolos diagnósticos. En este documento se detallan las recomendaciones del grupo de expertos de la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI) para el diagnóstico y tratamiento de la eosinofilia importada (AU)


According to published data, prevalence of imported eosinophilia among travellers and immigrants is set between 8% and 28.5%. Etiological diagnosis is often troublesome, and depending on the depth of the study and on the population analyzed, a parasitic cause is identified in 17% to 75.9% of the individuals. Among the difficulties encountered to compare studies are the heterogeneity of the studied populations, the type of data collection (prospective/retrospective) and different diagnostic protocols. In this document the recommendations of the expert group of the Spanish Society of Tropical Medicine and International Health (SEMTSI) for the diagnosis and treatment of imported eosinophilia are detailed (AU)


Assuntos
Humanos , Masculino , Feminino , Eosinofilia/diagnóstico , Eosinofilia/terapia , Emigrantes e Imigrantes/estatística & dados numéricos , Conferências de Consenso como Assunto , Helmintíase/diagnóstico , Helmintos , Helmintos/isolamento & purificação , Imunoglobulina E/análise , Controle Sanitário de Viajantes , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Estudos Prospectivos , Saúde do Viajante , Helmintíase/epidemiologia , Estudos Retrospectivos , Eosinofilia/classificação , Ensaio de Imunoadsorção Enzimática/métodos , Western Blotting , Técnicas Imunoenzimáticas
6.
AIDS Res Treat ; 2016: 5120831, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27699068

RESUMO

Hypovitaminosis D and secondary hyperparathyroidism are frequent among HIV-infected patients. As there are no data about the best supplementation therapy both in treatment and in maintenance, we conducted an observational study of 300 HIV-infected patients for whom vitamin D and parathormone (PTH) had been measured in order to validate a protocol of vitamin D supplementation in patients with HIV-infection. Patients with vitamin D deficiency (defined as 25(OH)D < 10 ng/mL), insufficiency (defined as 25(OH)D < 20 ng/mL), or hyperparathyroidism (PTH > 65 pg/mL) were supplemented with cholecalciferol 16.000IU (0.266 mg) weekly (if deficiency) or fortnightly (if insufficiency or high PTH levels). Rates of normalization of 25(OH)D (levels above 20 ng/mL) and PTH levels (<65 pg/mL) were analyzed. Multivariate analysis of factors related to normalization was carried out. With a median follow-up of 2 years, 82.1% of patients with deficiency and 83.9% of cases with insufficiency reached levels above 20 ng/mL. However, only 67.2% of individuals with hyperparathyroidism at baseline reached target levels (<65 pg/mL). Independent factors for not achieving PTH objective were tenofovir (TDF) and protease inhibitors use. In HIV-infected patients with hypovitaminosis, the protocol of cholecalciferol supplementation normalized vitamin D levels regardless of antiretroviral regimen in a high proportion of patients but it was less effective to correct hyperparathyroidism.

7.
Rev. esp. quimioter ; 29(3): 119-121, jun. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-153085

RESUMO

We report a quasi-experimental study of the implementation of an antimicrobial stewardship program in two surgical wards, with a pre-intervention period with just assessment of prescription and an intervention period with a prospective audit on antibiotic prescription model. There was a significant reduction of length of stay and the total days of antimicrobial administration. There were no differences in mortality between groups. The antimicrobial stewardship program led to the early detection of inappropriate empirical antibiotic treatment and was associated with a significant reduction in length of stay and the total duration of antimicrobial therapy (AU)


Presentamos un estudio cuasi-experimental de la aplicación de un programa de uso de terapia antimicrobiana en dos salas quirúrgicas, con un período de pre-intervención en que se realizó evaluación de la prescripción y un período de intervención con una auditoría prospectiva sobre la prescripción antibiótica siguiendo un modelo de recomendación. Hubo una reducción significativa de la estancia media y del total de días de tratamiento antibiótico. No hubo diferencias en la mortalidad entre los grupos. El programa de uso de terapia antimicrobiana condujo a la detección precoz de tratamiento antibiótico empírico inadecuado y se asoció con una reducción significativa de la estancia media y la duración total de la terapia antimicrobiana (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Salas Cirúrgicas , Antibacterianos/uso terapêutico , Estudos Prospectivos , Diagnóstico Precoce , Tempo de Internação/economia , Tempo de Internação/legislação & jurisprudência , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Cefotaxima/uso terapêutico , Ciprofloxacino/uso terapêutico , Piperacilina/uso terapêutico
8.
J Acquir Immune Defic Syndr ; 72(3): 314-8, 2016 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-26910501

RESUMO

Low bone mineral density (BMD) in HIV-infected individuals has been documented in an increasing number of studies. However, it is not clear whether it is the infection itself or the treatment that causes bone impairment. Microindentation measures bone material strength (Bone Material Strength index) directly. We recruited 85 patients, 50 infected with HIV and 35 controls. Median Bone Material Strength index was 84.5 (interquartile range 83-87) in HIV-infected patients and 90 (88.5-93) in controls (P < 0.001). No significant differences in BMD between cases and controls at any of the sites examined (total hip, femoral neck, and lumbar spine). HIV infection is associated with bone damage, independently of BMD.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Colo do Fêmur/patologia , Infecções por HIV/complicações , Vértebras Lombares/patologia , Osteoporose/patologia , Absorciometria de Fóton , Adulto , Fármacos Anti-HIV/efeitos adversos , Densidade Óssea , Estudos Transversais , Feminino , Colo do Fêmur/virologia , Infecções por HIV/patologia , Infecções por HIV/virologia , Humanos , Vértebras Lombares/virologia , Masculino , Pessoa de Meia-Idade , Osteoporose/virologia , Medição de Risco , Espanha
9.
Sex Transm Infect ; 92(1): 29-31, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26139207

RESUMO

OBJECTIVES: To describe the clinical characteristics and therapeutic outcomes from male patients diagnosed of Haemophilus spp urethritis. METHODS: A chart review of patients who presented to our hospital from January 2013 to December 2014 with symptoms of acute urethritis in which Haemophilus spp was isolated in their urethral samples was performed. RESULTS: Haemophilus spp was isolated in 52 out of 413 urethral samples (12.6%) received in our laboratory from patients with symptoms of acute urethritis during the study period. Seven cases corresponded to Haemophilus influenzae and 45 cases to Haemophilus parainfluenzae. The most common clinical presentation was mucopurulent urethral discharge (71%). Eight per cent were HIV-infected patients, and 60% were men who have sex with men. Haemophilus spp was isolated as a single pathogen in 6.8% (28 of 413) of cases. Seventeen per cent of Haemophilus spp were ß-lactamase producers. All patients reported having practiced unprotected insertive oral sex the month before consultation, and five of them denied having had another sexual contact apart from this exposure. In all cases in which follow-up was available, empirical treatment achieved a complete clinical resolution. CONCLUSIONS: Haemophilus spp was considered a pathogen in at least 6.8% of the patients from the evaluated area. It affected men regardless their sexual orientation or HIV status. Unprotected oral sex could play a role in its transmission. The limitations of the study (small sample size and lack of a representative control group) do not allow to prove the true pathogenic role of Haemophilus spp in acute urethritis.


Assuntos
Exsudatos e Transudatos/microbiologia , Infecções por Haemophilus/microbiologia , Haemophilus influenzae/isolamento & purificação , Haemophilus parainfluenzae/isolamento & purificação , Sexo sem Proteção/estatística & dados numéricos , Uretra/patologia , Uretrite/microbiologia , Adulto , Antibacterianos , Técnicas de Tipagem Bacteriana , Infecções por Haemophilus/tratamento farmacológico , Infecções por Haemophilus/patologia , Humanos , Masculino , Uretra/microbiologia , Uretrite/tratamento farmacológico , Uretrite/etiologia
10.
J Dermatol ; 42(12): 1176-8, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26074211

RESUMO

Hypertrophic herpes simplex genitalis is an atypical presentation of genital herpes described in the context of immunosuppression, particularly HIV-positive patients. This situation can become a diagnostic and therapeutic challenge. For this reason, alternative therapies are currently being discussed in the literature. We report a case of hypertrophic genital herpes in a HIV-positive patient who was successfully treated with topical 5% imiquimod after treatment failures with oral and i.v. antivirals.


Assuntos
Aminoquinolinas/administração & dosagem , Infecções por HIV/complicações , Herpes Genital/complicações , Herpes Genital/tratamento farmacológico , Adjuvantes Imunológicos/administração & dosagem , Administração Tópica , Herpes Genital/patologia , Humanos , Hipertrofia , Imiquimode , Masculino , Pessoa de Meia-Idade
11.
J Acquir Immune Defic Syndr ; 68(3): 256-63, 2015 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-25469528

RESUMO

BACKGROUND: Microbial translocation has been associated with an increase in immune activation and inflammation in HIV infection despite effective highly active antiretroviral therapy. It has been shown that some probiotics have a beneficial effect by reducing intestinal permeability and, consequently, microbial translocation. OBJECTIVES: To assess changes in microbial translocation and inflammation after treatment with probiotics (Saccharomyces boulardii) in HIV-1-infected patients with virologic suppression. METHODS: A double-blind, randomized, placebo-controlled trial was conducted in 44 nonconsecutive HIV-1-infected patients with viral load of <20 copies per milliliter for at least 2 years. Patients were randomized to oral supplementation with probiotics or placebo during 12 weeks. Markers of microbial translocation (lipopolysaccharide-binding protein [LBP] and soluble CD14), inflammation (interleukin 6 [IL-6], tumor necrosis factor alpha, interferon gamma, high-sensitivity C-reactive protein), and immunological and clinical data were determined before and after the intervention and 3 months after treatment discontinuation. Quantitative variables were compared using the Mann-Whitney U test, and categorical variables were compared using the Fisher exact test. RESULTS: After 12 weeks of treatment, differences between the probiotic arm and the placebo arm were observed in LBP values (-0.30 vs +0.70 pg/mL) and IL-6 (-0.60 vs +0.78 pg/mL). These differences were also noted at 3 months after treatment withdrawal. Qualitative analysis was performed, defining a variable as "decreased" or "increased" from baseline LBP. A significant decrease of LBP at 12 weeks of treatment was observed (57.9% patients in the probiotic group vs 6.2% in the placebo group, P = 0.002). CONCLUSIONS: Treatment with S. boulardii decreases microbial translocation (LBP) and inflammation parameters (IL-6) in HIV-1-infected patients with long-term virologic suppression.


Assuntos
Translocação Bacteriana , Infecções por HIV/complicações , Inflamação/prevenção & controle , Probióticos/uso terapêutico , Saccharomyces/fisiologia , Proteínas da Fase Aguda , Administração Oral , Proteína C-Reativa/análise , Proteínas de Transporte/sangue , Citocinas/sangue , Método Duplo-Cego , Feminino , Infecções por HIV/terapia , Humanos , Receptores de Lipopolissacarídeos/sangue , Masculino , Glicoproteínas de Membrana/sangue , Placebos/administração & dosagem , Saccharomyces/crescimento & desenvolvimento , Resultado do Tratamento
12.
Arq Bras Endocrinol Metabol ; 58(5): 478-83, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25166038

RESUMO

With the advent of high active antiretroviral therapy there was a significant improvement on HIV subjects survival. Thus, bone changes related to HIV became an important aspect of these individuals. HIV affects bone remodeling causing bone fragility. In addition, antiretroviral therapy may also negatively affect bone metabolism. Several studies describe an increased incidence of fractures in these patients when compared with controls without the disease. The European Society of AIDS (EACS), and other societies, have included guidance on management of osteoporosis in HIV-infected patients emphasizing the identification of patients with low bone mass. Supplementation of calcium and vitamin D and the use of alendronate in these individuals should be recommended on a case base.


Assuntos
Envelhecimento/metabolismo , Osso e Ossos/metabolismo , Osso e Ossos/virologia , Fraturas Ósseas , Infecções por HIV , Osteoporose/complicações , Antirretrovirais/efeitos adversos , Densidade Óssea , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/virologia , Infecções por HIV/complicações , Infecções por HIV/metabolismo , Humanos , Masculino , Fraturas por Osteoporose/prevenção & controle , Fatores de Risco
13.
Arq. bras. endocrinol. metab ; 58(5): 478-483, 07/2014. graf
Artigo em Inglês | LILACS | ID: lil-719193

RESUMO

With the advent of high active antiretroviral therapy there was a significant improvement on HIV subjects survival. Thus, bone changes related to HIV became an important aspect of these individuals. HIV affects bone remodeling causing bone fragility. In addition, antiretroviral therapy may also negatively affect bone metabolism. Several studies describe an increased incidence of fractures in these patients when compared with controls without the disease. The European Society of AIDS (EACS), and other societies, have included guidance on management of osteoporosis in HIV-infected patients emphasizing the identification of patients with low bone mass. Supplementation of calcium and vitamin D and the use of alendronate in these individuals should be recommended on a case base.


Com o advento da terapia antirretroviral, houve uma melhora considerável na sobrevida dos indivíduos portadores do vírus HIV. Dessa forma, as alterações ósseas referentes ao HIV se tornaram um fator importante no cuidado desses indivíduos. O HIV altera o remodelamento ósseo causando fragilidade óssea. As alterações causadas por esse vírus nos linfócitos T afetam a produção de RANKL e de citocinas pró-inflamatórias levando à osteoclastogênese. Ademais, a terapia antirretroviral também pode afetar negativamente o metabolismo ósseo. Vários estudos descrevem aumento da incidência de fraturas nesses indivíduos quando comparados a controles sem a doença. Diretrizes da Sociedade Europeia de SIDA (EACS) têm orientado o manejo da osteoporose nesses sujeitos, enfatizando a identificação de pacientes com baixa massa óssea. A suplementação de cálcio e vitamina D e o uso de alendronato nesses indivíduos devem ser recomendados caso a caso.


Assuntos
Feminino , Humanos , Masculino , Envelhecimento/metabolismo , Osso e Ossos/metabolismo , Osso e Ossos/virologia , Fraturas Ósseas , Infecções por HIV , Osteoporose/complicações , Antirretrovirais/efeitos adversos , Densidade Óssea , Fraturas Ósseas/etiologia , Fraturas Ósseas/virologia , Infecções por HIV/complicações , Infecções por HIV/metabolismo , Fraturas por Osteoporose/prevenção & controle , Fatores de Risco
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