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1.
J Biomed Nanotechnol ; 17(5): 793-808, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-34082867

RESUMO

In recent years, the growing studies focused on the immunotherapy of hepatocellular carcinoma and proved the preclinical and clinical promises of host antitumor immune response. However, there were still various obstacles in meeting satisfactory clinic need, such as low response rate, primary resistance and secondary resistance to immunotherapy. Tackling these barriers required a deeper understanding of immune underpinnings and a broader understanding of advanced technology. This review described immune microenvironment of liver and HCC which naturally decided the complexity of immunotherapy, and summarized recent immunotherapy focusing on different points. The ever-growing clues indicated that the instant killing of tumor cell and the subsequent relive of immunosuppressive microenvironment were both indis- pensables. The nanotechnology applied in immunotherapy and the combination with intervention technology was also discussed.


Assuntos
Carcinoma Hepatocelular , Infecções por HIV , Neoplasias Hepáticas , Nanopartículas , HIV , Humanos , Simplexvirus , Microambiente Tumoral
2.
Rev Soc Bras Med Trop ; 54: e01572021, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34105629

RESUMO

Approximately one-third of patients with coronavirus disease 2019 (COVID-19) present with coagulation disorders and hematological changes. However, the clinical manifestations of COVID-19 and prognoses of people living with human immunodeficiency virus (HIV) remain controversial. This study reports the case of a 27-year-old HIV-infected man who regularly used antiretroviral medications, had no other comorbidities and was admitted for acute respiratory distress syndrome caused by COVID-19. Complementary examinations during hospitalization revealed a diagnosis of pulmonary thromboembolism in association with an intracavitary thrombus.


Assuntos
COVID-19 , Infecções por HIV , Embolia Pulmonar , Trombose , Adulto , HIV , Infecções por HIV/complicações , Humanos , Masculino , Embolia Pulmonar/etiologia , SARS-CoV-2
3.
Viruses ; 13(6)2021 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-34064066

RESUMO

Severe acute respiratory syndrome-related coronavirus (SARS-CoV-2), the causative agent of coronavirus disease 19 (COVID-19), enters cells through attachment to the human angiotensin converting enzyme 2 (hACE2) via the receptor-binding domain (RBD) in the surface/spike (S) protein. Several pseudotyped viruses expressing SARS-CoV-2 S proteins are available, but many of these can only infect hACE2-overexpressing cell lines. Here, we report the use of a simple, two-plasmid, pseudotyped virus system comprising a SARS-CoV-2 spike-expressing plasmid and an HIV vector with or without vpr to investigate the SARS-CoV-2 entry event in various cell lines. When an HIV vector without vpr was used, pseudotyped SARS-CoV-2 viruses produced in the presence of fetal bovine serum (FBS) were able to infect only engineered hACE2-overexpressing cell lines, whereas viruses produced under serum-free conditions were able to infect a broader range of cells, including cells without hACE2 overexpression. When an HIV vector containing vpr was used, pseudotyped viruses were able to infect a broad spectrum of cell types regardless of whether viruses were produced in the presence or absence of FBS. Infection sensitivities of various cell types did not correlate with mRNA abundance of hACE2, TMPRSS2, or TMPRSS4. Pseudotyped SARS-CoV-2 viruses and replication-competent SARS-CoV-2 virus were equally sensitive to neutralization by an anti-spike RBD antibody in cells with high abundance of hACE2. However, the anti-spike RBD antibody did not block pseudotyped viral entry into cell lines with low abundance of hACE2. We further found that CD147 was involved in viral entry in A549 cells with low abundance of hACE2. Thus, our assay is useful for drug and antibody screening as well as for investigating cellular receptors, including hACE2, CD147, and tyrosine-protein kinase receptor UFO (AXL), for the SARS-CoV-2 entry event in various cell lines.


Assuntos
HIV/genética , SARS-CoV-2/fisiologia , Glicoproteína da Espícula de Coronavírus/fisiologia , Internalização do Vírus , Células CACO-2 , Linhagem Celular , Vetores Genéticos , Células HEK293 , Humanos , Plasmídeos , SARS-CoV-2/genética , SARS-CoV-2/patogenicidade , Glicoproteína da Espícula de Coronavírus/genética , Transfecção , Produtos do Gene vpr do Vírus da Imunodeficiência Humana/metabolismo
4.
BMC Infect Dis ; 21(1): 469, 2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34022835

RESUMO

BACKGROUND: Although great progress has been made in the prevention and treatment of AIDS, there are still a considerable number of new infections annually, especially in adolescents. With the advance of technology, game-based education has gradually become an important tool for changing healthy behaviors among youth. METHODS: A protocol for conducting a randomized controlled trial to evaluate the "AIDS Fighter · Health Defense", a game-based AIDS education project aimed at improving the ability of adolescents to prevent AIDS. During the four-week intervention, participants will receive: 1) A virus combat game; 2) Goal setting to eliminate HIV; 3) Questions to be answered to be resurrected in the game; 4) Points ranking; 5) Recognition and Rewards. The primary outcomes include changes in participants' knowledge, stigma attitude, and risk behaviors attitude related to AIDS after four weeks of intervention. The secondary outcomes are the participants' AIDS-related risk behaviors three and six months after the intervention. DISCUSSION: AIDS Fighter· Health Defense may be an innovative approach to help adolescents improve AIDS prevention capabilities, fill the gap in game-based AIDS prevention education in China, and gain experience of AIDS management. TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR2000040195 . Registered 25 November 2020.


Assuntos
Síndrome de Imunodeficiência Adquirida/prevenção & controle , Síndrome de Imunodeficiência Adquirida/psicologia , Atitude , Conscientização , HIV , Educação em Saúde/métodos , Jogos de Vídeo , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adolescente , China/epidemiologia , Feminino , Comportamentos de Risco à Saúde , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
5.
BMC Infect Dis ; 21(1): 466, 2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34022850

RESUMO

BACKGROUND: Pulmonary tuberculosis (TB) in people living with HIV (PLH) frequently presents as sputum smear-negative. However, clinical trials of TB in adults often use smear-positive individuals to ensure measurable bacterial responses following initiation of treatment, thereby excluding HIV-infected patients from trials. METHODS: In this prospective case cohort study, 118 HIV-seropositive TB patients were assessed prior to initiation of standard four-drug TB therapy and at several time points through 35 days. Sputum bacillary load, as a marker of treatment response, was determined serially by: smear microscopy, Xpert MTB/RIF, liquid culture, and colony counts on agar medium. RESULTS: By all four measures, patients who were baseline smear-positive had higher bacterial loads than those presenting as smear-negative, until day 35. However, most smear-negative PLH had significant bacillary load at enrolment and their mycobacteria were cleared more rapidly than smear-positive patients. Smear-negative patients' decline in bacillary load, determined by colony counts, was linear to day 7 suggesting measurable bactericidal activity. Moreover, the decrease in bacterial counts was comparable to smear-positive individuals. Increasing cycle threshold values (Ct) on the Xpert assay in smear-positive patients to day 14 implied decreasing bacterial load. CONCLUSION: Our data suggest that smear-negative PLH can be included in clinical trials of novel treatment regimens as they contain sufficient viable bacteria, but allowances for late exclusions would have to be made in sample size estimations. We also show that increases in Ct in smear-positive patients to day 14 reflect treatment responses and the Xpert MTB/RIF assay could be used as biomarker for early treatment response.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS , Antituberculosos/uso terapêutico , Carga Bacteriana/efeitos dos fármacos , Soropositividade para HIV , HIV/imunologia , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/isolamento & purificação , Escarro/microbiologia , Tuberculose Pulmonar/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Testes Diagnósticos de Rotina , Feminino , Seguimentos , Soropositividade para HIV/tratamento farmacológico , Soropositividade para HIV/virologia , Humanos , Masculino , Microscopia , Técnicas de Amplificação de Ácido Nucleico , Estudos Prospectivos , Resultado do Tratamento , Tuberculose Pulmonar/virologia
6.
J Pak Med Assoc ; 71(3): 897-899, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34057943

RESUMO

OBJECTIVE: To ascertain the frequency of markers of transfusion-transmitted infections among blood donors in a tertiary care setting. METHODS: The retrospective cross-sectional descriptive study, was conducted in the Blood Bank section of the Department of Pathology at the Dow University of Health Sciences, Karachi, and comprised data of blood donors from January 2013, to October 2018. All blood donors had been screened for hepatitis B, hepatitis C, human immunodeficiency virus I and II, syphilis through electrochemiluminescence and malaria using immunochromatography. Data was analyzed using SPSS 21. RESULTS: Of the 29,732 donors, 29,712(99.93%) were males and 20(0.06%) were females; 12(0.04%) were volunteers and 29,720(99.95%) were exchange donors. Overall, 2587(8.7%) donors were positive for an infectious disease; 908(3%) hepatitis C virus, 887(2.9%) hepatitis B, 620(2%) syphilis, 168(0.5%) human immunodeficiency virus and 4(0.02%) malaria. CONCLUSIONS: Hepatitis C and B were the most frequent infections, followed by syphilis in the sample.


Assuntos
Hepatite B , Hepatite C , Malária , Sífilis , Bancos de Sangue , Doadores de Sangue , Estudos Transversais , Feminino , HIV , Hepacivirus , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Humanos , Malária/epidemiologia , Masculino , Estudos Retrospectivos , Estudos Soroepidemiológicos , Sífilis/epidemiologia , Centros de Atenção Terciária , Atenção Terciária à Saúde
7.
J Int Med Res ; 49(5): 3000605211016197, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34038196

RESUMO

Cryptococcus neoformans is an environmental fungal pathogen that causes opportunistic infections and severe disseminated meningoencephalitis, mainly in immunocompromised patients such as those with acquired immunodeficiency syndrome (AIDS). In this study, the clinical characteristics, treatment protocols, and outcomes of 70 patients with AIDS and Cryptococcus neoformans infection at Beijing Ditan Hospital were retrospectively analyzed. We performed antimicrobial sensitivity tests and multilocus sequence typing (MLST) on C. neoformans isolates from these patients. The most common symptoms were headache (58.6%), fever (54.3%), and high cerebrospinal fluid pressure (≥200 mm H2O) (71.4%). All patients were positive for C. neoformans antigen in blood or cerebrospinal fluid. The CD4 cell counts of 92.8% (65/70) of patients were <100 cells/µL. In total, 74 C. neoformans isolates were obtained from the 70 patients. The 65 isolates that could be typed fell into 12 sequence types (STs) by MLST: ST5, ST31, ST63, ST202, ST237, ST289, ST295, ST296, ST298, ST324, ST337, and ST359. ST5 was the major type, accounting for 78.5% of isolates (51/65). This study comprehensively assessed the clinical and molecular epidemiology of C. neoformans in patients with AIDS and may inform the development of targeted prevention and treatment strategies for immunocompromised patients with C. neoformans infection.


Assuntos
Criptococose , Cryptococcus neoformans , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Pequim/epidemiologia , China/epidemiologia , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Criptococose/epidemiologia , Cryptococcus neoformans/genética , Genótipo , HIV , Humanos , Tipagem de Sequências Multilocus , Técnicas de Tipagem Micológica , Estudos Retrospectivos
8.
Am J Case Rep ; 22: e931376, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-33986239

RESUMO

BACKGROUND Convexal subarachnoid hemorrhage (cSAH), a rare form of non-aneurysmal subarachnoid hemorrhage, is confined to cerebral convexities without extension into basal cisterns or ventricles. Typical presentation includes thunderclap/progressive headache or transient focal neurological symptoms; rare manifestations include seizures, intractable vomiting, or altered mental status. Here, we report the first case of convexal subarachnoid hemorrhage and multifocal ischemic lesions caused by infective endocarditis (IE) in a treatment-naïve advanced HIV patient. CASE REPORT A 52-year-old HAART-naïve, HIV-positive, African American man presented with altered mental status, shortness of breath, nonproductive cough, and generalized weakness. His past medical history was significant for congestive heart failure, chronic obstructive pulmonary disease, and end-stage renal disease (noncompliant with hemodialysis). Head computed tomography (CT) showed an isolated sulcal hemorrhage in the mid-left frontal lobe. Fluid-attenuated inversion recovery/gradient recalled echo sequences confirmed a hemorrhage in the left-mid-frontal sulcus, and diffusion-weighted imaging revealed multifocal bilateral ischemic lesions. Transesophageal echocardiography exhibited mitral valve vegetations. Multifocal ischemic lesions and cSAH caused by infectious endocarditis were confirmed. Initiation of intravenous vancomycin and piperacillin-tazobactam allowed the patient to have resolution of his altered mental status. A head CT 5 days later revealed the resolution of cSAH. CONCLUSIONS Infective endocarditis should be considered as an underlying etiology of cSAH, especially when present with multifocal ischemic lesions. Risk factors contributing to the development of cSAH in the IE patient population should be explored in future studies. HIV has not been previously reported in this subgroup and its prevalence should be considered. The prognosis for cSAH in relation to IE is generally favorable.


Assuntos
Endocardite , Infecções por HIV , Hemorragia Subaracnóidea , Endocardite/complicações , HIV , Infecções por HIV/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/etiologia
9.
Artigo em Inglês | PAHO-IRIS | ID: phr-53970

RESUMO

[ABSTRACT]. Objective. To appraise the presence and magnitude of inter- and intra-country health inequalities related to HIV in Latin America and the Caribbean (LAC) among young females. Methods. We analyzed household surveys in twenty LAC countries, that included data from female adolescents and young women (ages 15-24) between 2008 and 2018, measuring inequality with the concentration index of 4 indicators: 1) whether individuals have heard of HIV or not, 2) a composite variable of correct knowledge, 3) reported condom use with the last partner, and 4) whether individuals were ever tested for HIV. Results. Participants from households in countries with higher socioeconomic status are more likely to have heard of HIV, have correct knowledge of HIV transmission, and have used condoms during their last sexual intercourse. The inter-country concentration index for those indicators were 0.352, 0.302 and 0.110, respectively. Conclusions. Economically disadvantaged female adolescents and young women in LAC face an increased risk for HIV, as they are less aware of HIV and its actual transmission mechanism and are less likely to use condoms with their sexual partners. There is an urgent need to tailor prevention strategies of sexually transmitted infections and HIV for adolescents and young women that are sensitive to their socioeconomic context.


[RESUMEN]. Objetivo. Evaluar la presencia y la magnitud de las desigualdades en la salud entre los países y dentro de cada país en relación con la infección por el VIH en las mujeres jóvenes en América Latina y el Caribe. Métodos. Analizamos encuestas de hogares en veinte países de América Latina y el Caribe con datos sobre las adolescentes y las mujeres jóvenes (de edades entre 15 y 24 años) entre el 2008 y el 2018. En estas encuestas se medía la desigualdad con un índice de concentración de cuatro indicadores: 1) si sabían lo que era el VIH o no, 2) una variable compuesta con respecto a los conocimientos correctos, 3) si habían usado preservativo con su pareja más reciente, y 4) si se habían hecho alguna vez la prueba del VIH. Resultados. Las participantes de los hogares en países con una situación socioeconómica más alta tienen mayores probabilidades de saber acerca del VIH, de tener los conocimientos correctos con respecto a la transmisión del VIH y de haber usado preservativo en su relación sexual más reciente. El índice de concentración entre países para esos indicadores fue de 0,352, 0,302 y 0,110, respectivamente. Conclusiones. Las adolescentes y las mujeres jóvenes económicamente desfavorecidas en América Latina y el Caribe se enfrentan a un riesgo mayor de contraer el VIH, ya que saben menos sobre este virus y su mecanismo real de transmisión, y es menos probable que usen preservativo con sus parejas sexuales. Hay una necesidad urgente de adaptar las estrategias de prevención de las infecciones de transmisión sexual y de la infección por el VIH para las adolescentes y las mujeres jóvenes que son susceptibles a su contexto socioeconómico.


[RESUMO]. Objetivo. Avaliar a presença e a dimensão das desigualdades em saúde relacionadas ao HIV entre os países e dentro de cada país em adolescentes e mulheres jovens da América Latina e Caribe. Métodos. Analisamos pesquisas domiciliares realizadas em 20 países da América Latina e Caribe contendo dados de adolescentes do sexo feminino e mulheres jovens (15 a 24 anos) para o período entre 2008 e 2018, mensurando a desigualdade pelo índice de concentração segundo 4 indicadores: 1) ter ouvido falar de HIV, 2) uma variável composta de conhecimento correto, 3) uso de preservativo com o último parceiro (autorrelatado) e 4) ter feito o teste de HIV. Resultados. As participantes domiciliadas em países com nível socioeconômico mais alto têm uma chance maior de ter ouvido falar de HIV, de ter conhecimento correto da transmissão do vírus e de ter feito uso de preservativos na última relação sexual. Os índices de concentração entre os países para estes indicadores foram 0,352, 0,302 e 0,110, respectivamente. Conclusões. As adolescentes e mulheres jovens da América Latina e Caribe em situação econômica menos favorecida têm um risco maior de se infectar pelo HIV porque sabem menos sobre o vírus e seu real mecanismo de transmissão, e é menos provável que façam uso de preservativos com seus parceiros sexuais. As estratégias de prevenção de infecções sexualmente transmissíveis e do HIV precisam urgentemente ser adaptadas ao contexto socioeconômico em que se inserem as adolescentes e mulheres jovens da Região.


Assuntos
Saúde do Adolescente , Saúde Sexual e Reprodutiva , Monitoramento das Desigualdades em Saúde , HIV , Doenças Sexualmente Transmissíveis , América Latina , Região do Caribe , Saúde do Adolescente , Saúde Sexual e Reprodutiva , Monitoramento das Desigualdades em Saúde , HIV , Doenças Sexualmente Transmissíveis , América Latina , Região do Caribe , Saúde do Adolescente , Saúde Sexual e Reprodutiva , Monitoramento das Desigualdades em Saúde , Doenças Sexualmente Transmissíveis , Região do Caribe
10.
Washington, D.C.; PAHO; 2021-05-10. (PAHO/CDE/HT/21-0006).
Não convencional em Inglês | PAHO-IRIS | ID: phr-53919

RESUMO

Control of syphilis is a key component of Peru’s national strategy and activities to control human immunodeficiency virus (HIV) and sexually transmitted infections (STIs). Compared to other countries in the Region of the Americas, Peru has a relatively low prevalence of syphilis in pregnant women, and this fell from 2012 to 2016 – whereas the prevalence in the Region increased. Syphilis Interventions Towards Transmission (SITE) is a new tool developed by Avenir Health with support from the Pan American Health Organization. SITE simulates adult syphilis transmission in a country and can be used to look at the impact and cost-effectiveness of different STI control programs and interventions, guiding countries toward syphilis elimination targets. The model has been piloted in Peru to identify opportunities for optimizing the country’s STI and syphilis control strategy, plan, targets, and cost estimates. This report presents a compilation of syphilis epidemiological and programmatic data, the model calibration based on those, and projection results for several program scenarios suggested as relevant by the national HIV/STI program. It discusses results in terms of the health and transmission impact, service levels, and cost of alternative and combined packages of prevention, screening, and treatment interventions.


Assuntos
Doenças Transmissíveis , Sífilis , Doenças Virais Sexualmente Transmissíveis , HIV , Peru
11.
J Med Case Rep ; 15(1): 267, 2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980269

RESUMO

BACKGROUND: Frosted branch angiitis (FBA) is an uncommon ocular sign with multiple causes. With the recent outbreak of coronavirus disease 2019 (COVID-19), many cases of ocular manifestation in association with this disease have been reported. However, as yet we have no complete understanding of this condition. We report here the first case of FBA in a human immunodeficiency virus-infected patient with coexisting cytomegalovirus (CMV) and COVID-19 infection. CASE PRESENTATION: A 33-year-old Malay man with underlying acquired immunodeficiency syndrome receiving highly active antiretroviral therapy was referred to the Opthalmology Department with complaints of blurry vision for the past 2 months. He had tested positive for and been diagnosed with COVID-19 1 month previously. Clinical examination of the fundus revealed extensive perivascular sheathing of both the artery and vein suggestive of FBA in the right eye. Laboratory testing of nasal swabs for COVID-19 polymerase chain reaction (PCR) and serum CMV antibody were positive. The patient was then admitted to the COVID-19 ward and treated with intravenous ganciclovir. CONCLUSION: Clinicians should be aware of and take the necessary standard precautions for possible coexistence of COVID-19 in an immunocompromised patient presenting with blurred vision, eye redness, dry eye and foreign body sensation despite the absence of clinical features suggestive of COVID-19. Whether FBA is one of the ocular signs of co-infection of COVID-19 and CMV remains unknown. Further studies are needed to provide more information on ocular signs presented in patients with concurrent COVID-19 and CMV infections.


Assuntos
COVID-19 , Vasculite Retiniana , Adulto , Fundo de Olho , HIV , Humanos , Masculino , SARS-CoV-2
12.
Int J Mol Sci ; 22(7)2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33918134

RESUMO

The persistence of latent HIV provirus pools in different resting CD4+ cell subsets remains the greatest obstacle in the current efforts to treat and cure HIV infection. Recent efforts to purge out latently infected memory CD4+ T-cells using latency-reversing agents have failed in clinical trials. This review discusses the epigenetic and non-epigenetic mechanisms of HIV latency control, major limitations of the current approaches of using latency-reversing agents to reactivate HIV latency in resting CD4+ T-cells, and potential solutions to these limitations.


Assuntos
Linfócitos T CD4-Positivos/virologia , Epigênese Genética/imunologia , HIV/fisiologia , Interações Hospedeiro-Patógeno/imunologia , Latência Viral , Humanos , Memória Imunológica , NF-kappa B/fisiologia , Fator B de Elongação Transcricional Positiva/fisiologia , Reinfecção
13.
BMC Infect Dis ; 21(1): 390, 2021 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-33906638

RESUMO

BACKGROUND: Late-diagnosis of HIV is a major challenge for the control and prevention of AIDS in the world. The present study aimed to specify factors associated with the late diagnosis of HIV in Iran from 1987 to 2016. METHODS: In this retrospective cohort study, data for 4402 diagnosed HIV/AIDS patients were extracted from 158 behavioral disease counseling centers of 31 Iranian provinces. We defined late diagnosis as having a CD4 count less than 350 within 3 months after diagnosis. Multiple logistic regression analysis was used to determine the factors influencing late diagnosis. Moreover, we used multivariate Cox regression to assess the association of these factors with the patients' survival. RESULTS: In this study, the prevalence of late diagnosis among the patients was 58.2%. People aged 50 years and over (adjusted OR = 3.55), transmission through blood transfusion (adjusted OR = 2.89), co-infection with tuberculosis (adjusted OR = 2.06), and male gender (adjusted OR = 1.38) were the strongest predictors for late diagnosis of HIV. On the other hand, baseline CD4 (adjusted HR = 2.21), people aged 50 and over (adjusted HR = 1.81), male gender (adjusted HR = 1.76), being a widow (adjusted HR = 1.68), people with unknown transmission way (adjusted HR = 18.24), people who inject drugs (adjusted HR = 1.87), diagnosis at previous years (adjusted HR = 2.45) and co-infection with tuberculosis (adjusted OR = 1.77) significantly associated with the survival of patients. CONCLUSION: The prevalence of late diagnosis is high among Iranian HIV/AIDS. The risk factors of late diagnoses include being males and aged 50 years and over, transmission through blood transfusion, and co-infection with tuberculosis. Therefore, implementation of screening programs for early diagnosis of HIV these high risk groups is recommended to Iranian health providers and policymakers.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Diagnóstico Tardio/efeitos adversos , HIV , Mycobacterium tuberculosis , Tuberculose/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Adulto , Contagem de Linfócito CD4 , Comorbidade , Aconselhamento , Feminino , Seguimentos , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida , Adulto Jovem
14.
BMC Infect Dis ; 21(1): 375, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882845

RESUMO

BACKGROUND: Cryptococcal meningitis (CM) is a common HIV-associated opportunistic-infection worldwide. Existing literature focusses on hospital-based outcomes of induction treatment. This paper reviews outpatient management in integrated primary care clinics in Yangon. METHOD: This retrospective case note review analyses a Myanmar HIV-positive patient cohort managed using ambulatory induction-phase treatment with intravenous amphotericin-B-deoxycholate (0.7-1.0 mg/kg) and oral fluconazole (800 mg orally/day). RESULTS: Seventy-six patients were diagnosed between 2010 and 2017. The median age of patients diagnosed was 35 years, 63% were male and 33 (45%) were on concurrent treatment for tuberculosis. The median CD4 count was 60 at the time of diagnosis. Amphotericin-B-deoxycholate infusions precipitated 56 episodes of toxicity, namely hypokalaemia, nephrotoxicity, anaemia, febrile reactions, phlebitis, observed in 44 patients (58%). One-year survival (86%) was higher than existing hospital-based treatment studies. CONCLUSION: Ambulation of patients in this cohort saved 1029 hospital bed days and had better survival outcomes when compared to hospital-based studies in other resource constrained settings.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Cryptococcus neoformans/imunologia , Ácido Desoxicólico/administração & dosagem , Fluconazol/administração & dosagem , HIV , Meningite Criptocócica/complicações , Meningite Criptocócica/tratamento farmacológico , Atenção Primária à Saúde , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Administração Intravenosa , Administração Oral , Adolescente , Adulto , Anfotericina B/efeitos adversos , Antifúngicos/efeitos adversos , Cryptococcus neoformans/isolamento & purificação , Ácido Desoxicólico/efeitos adversos , Combinação de Medicamentos , Quimioterapia Combinada , Feminino , Fluconazol/efeitos adversos , Humanos , Masculino , Meningite Criptocócica/epidemiologia , Meningite Criptocócica/microbiologia , Pessoa de Meia-Idade , Mianmar/epidemiologia , Flebite/induzido quimicamente , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
BMC Infect Dis ; 21(1): 376, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33882850

RESUMO

BACKGROUND: The manifestation of Talaromyces marneffei infection in some HIV-infected patients may be atypical. Cases with gastrointestinal involvement have rarely been reported. It is hard to make a diagnosis when patients are lacking the characteristic rash and positive blood culture. CASE PRESENTATION: Here, we described a patient living with HIV who complained of fever and abdominal pain, and was rapidly diagnosed with Talaromyces marneffei infection by metagenomic next-generation sequencing (mNGS) using formalin-fixation and paraffin-embedded (FFPE) samples of omentum majus tissue. We also reviewed reported related cases. CONCLUSIONS: Talaromyces marneffei is an unusual cause of clinical presentations involving obvious abdominal pain and lower gastrointestinal bleeding, but can be included in the differential diagnosis. As an important diagnostic tool, the significance of mNGS using FFPE samples of lesions provides a more targeted diagnosis.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Hemorragia Gastrointestinal/microbiologia , HIV/genética , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Metagenômica/métodos , Micoses/complicações , Micoses/fisiopatologia , Talaromyces/genética , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Antifúngicos/uso terapêutico , China , Diagnóstico Diferencial , Seguimentos , Humanos , Masculino , Micoses/tratamento farmacológico , Micoses/microbiologia , RNA Viral/sangue , Resultado do Tratamento
16.
AIDS Patient Care STDS ; 35(4): 103-109, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33835849

RESUMO

Adolescents (13-24 years of age) account for more than one-fifth of new HIV diagnoses yearly, and the United States has one of the highest rates of adolescent pregnancy among high resource countries. However, there is limited information on the characteristics and outcomes of adolescents living with HIV (ALWHIV) during pregnancy and differences with pregnancy in adults living with HIV. We performed a retrospective cohort study to compare demographic characteristics, HIV viral suppression, and pregnancy outcomes in adolescents (n = 90) as compared with adults (n = 250) in an urban HIV pregnancy clinic from 2003 to 2015. Seventy-one women overall were diagnosed with HIV during pregnancy (adolescents, 25/90; adults, 46/250). One-fifth of adolescents acquired HIV perinatally. Adolescents were more likely than adults to have unintended pregnancy (83.6% vs. 68.7%, p = 0.016) and were less likely to be virally suppressed at delivery (50.0% vs. 69.7% overall, p = 0.001; 48.0% vs. 78.2% in postuniversal antiretroviral therapy era, p = 0.007%). Over one-third of adolescents reported a history of any illicit substance use, and adolescents were more likely than adults to use marijuana during pregnancy (29.2% vs. 16.9%, p = 0.013). Adolescents were less likely to experience preterm labor (11.0% vs. 24.1%, p = 0.012) or preterm premature rupture of membranes (3.7% vs. 16.7%, p = 0.003). There was one case of maternal-fetal transmission, which occurred in an adult pregnancy. Despite the high rate of unintended pregnancy, one-third of adolescents were discharged without an identified contraception plan. We identify several opportunities for intervention to improve reproductive health outcomes in ALWHIV.


Assuntos
Infecções por HIV , Gravidez na Adolescência , Adolescente , Adulto , Estudos de Coortes , Feminino , HIV , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Recém-Nascido , Gravidez , Estudos Retrospectivos , Estados Unidos/epidemiologia
17.
AIDS Patient Care STDS ; 35(4): 126-133, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33835850

RESUMO

Gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by mental health problems and human immunodeficiency virus (HIV). Health navigation has the potential to improve both HIV and mental health outcomes; however, few studies have measured the impact of navigation on mental health among people living with HIV. We analyzed longitudinal data from a sociobehavioral survey and navigation monitoring system with GBMSM living with HIV in Guatemala (n = 346) that participated in a 12-month differentiated care intervention. We examined relationships between navigation characteristics (frequency, duration, mode of interactions, and level of emotional, instrumental, and informational navigation support) and anxiety and depression using fixed-effects regression. We also examined if these relationships were moderated by baseline social support. We found that as navigation interactions increased, anxiety significantly improved [B = -0.03, standard error (SE) = 0.01 p = 0.05]. Participants who received high levels of informational navigator support also experienced a significant improvement in anxiety compared with those receiving low levels of informational support (B = -0.81, SE = 0.40, p = 0.04). Unexpectedly, we found that as the proportion of in-person navigation interactions increased, anxiety worsened (B = 1.12, SE = 0.54, p = 0.04). No aspects of navigation were significantly associated with depression and baseline social support did not moderate the relationship between navigation and anxiety and depression. To improve the mental health of key populations affected by HIV, health navigation programs should prioritize frequent interaction and informational navigation support for clients with anxiety while considering other strategies that specifically target reducing depressive symptoms, including other cost-effective modalities, such as mobile apps.


Assuntos
Infecções por HIV , Minorias Sexuais e de Gênero , Guatemala/epidemiologia , HIV , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Saúde Mental
18.
Rev Soc Bras Med Trop ; 54: e0795, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33886819

RESUMO

INTRODUCTION: The association of visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) infection is a concern worldwide, and this co-infection is linked to increased lethality. The Northeast is the region that mostly reports cases of VL in Brazil. The knowledge of risk factors associated with VL/HIV co-infection and its impact on lethality is extremely important. METHODS: The present study analyzed the epidemiologic features of cases with VL/HIV co-infection in the state of Pernambuco, Northeast of Brazil, from 2014 to 2018. RESULTS: There were 858 and 11,514 reported cases of VL and HIV infection, respectively. The average incidences of VL and HIV infection were 1.82 and 24.4/100,000 inhabitants, respectively. Of all reported cases of VL, 4.9% (42/858) also had HIV infection. There was an inverse spatial association between VL and HIV infection incidences. The lethality rates of VL, HIV infection, and co-infection were 9.9%, 26.1%, and 16.6%, respectively. Most of the patients were males and lived in urban areas. The cases of VL mostly occurred in children aged below 10 years, whereas the cases of HIV infection and VL/HIV co-infection were primarily observed in adults between 20 years and 39 years old. CONCLUSIONS: We defined the profile and areas with most cases of co-infection and found that the lethality of VL with co-infection increased in the current period. These findings contribute to applying efforts with a greater focus in these identified populations to prevent future deaths.


Assuntos
Coinfecção , Infecções por HIV , Leishmaniose Visceral , Adulto , Brasil/epidemiologia , Criança , Coinfecção/epidemiologia , Feminino , HIV , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Leishmaniose Visceral/epidemiologia , Masculino
19.
Medicine (Baltimore) ; 100(16): e25428, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879673

RESUMO

ABSTRACT: The objective of this paper is to determine the temporal trend of the association of 66 comorbidities with human immunodeficiency virus (HIV) infection status among Medicare beneficiaries from 2000 through 2016.We harvested patient level encounter claims from a 17-year long 100% sample of Medicare records. We used the chronic conditions warehouse comorbidity flags to determine HIV infection status and presence of comorbidities. We prepared 1 data set per year for analysis. Our 17 study data sets are retrospective annualized patient level case histories where the comorbidity status reflects if the patient has ever met the comorbidity case definition from the start of the study to the analysis year.We implemented one logistic binary regression model per study year to discover the maximum likelihood estimate (MLE) of a comorbidity belonging to our binary classes of HIV+ or HIV- study populations. We report MLE and odds ratios by comorbidity and year.Of the 66 assessed comorbidities, 35 remained associated with HIV- across all model years, 19 remained associated with HIV+ across all model years. Three comorbidities changed association from HIV+ to HIV- and 9 comorbidities changed association from HIV- to HIV+.The prevalence of comorbidities associated with HIV infection changed over time due to clinical, social, and epidemiological reasons. Comorbidity surveillance can provide important insights into the understanding and management of HIV infection and its consequences.


Assuntos
Doença Crônica/epidemiologia , Infecções por HIV/epidemiologia , HIV , Medicare/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Funções Verossimilhança , Estudos Longitudinais , Masculino , Razão de Chances , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologia
20.
Medicine (Baltimore) ; 100(17): e25510, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907100

RESUMO

ABSTRACT: While pediatric human immunodeficiency virus (HIV) testing has been more focused on children below 18 months through prevention of mother to child transmission of HIV (PMTCT), the yield of this approach remains unclear comparatively to testing children above 18 months through routine provider-initiated testing and counselling (PITC). This study aimed at assessing and comparing the HIV case detection and antiretroviral therapy (ART) enrolment among children below and above 18 months of age in Cameroon. This information is required to guide the investments in HIV testing among children and adolescents.We conducted a cross-sectional study where we invited parents visiting or receiving HIV care in 3 hospitals to have their children tested for HIV. HIV testing was done using polymerase chain reaction (PCR) and antibody rapid tests for children <18 months and those ≥18 months, respectively. We compared HIV case detection and ART initiation between the 2 subgroups of children and this using Chi-square test at 5% significant level.A total of 4079 children aged 6 weeks to 15 years were included in the analysis. Compared with children <18 months, children group ≥18 months was 4-fold higher among those who enrolled in the study (80.3% vs 19.7%, P < .001); 3.5-fold higher among those who tested for HIV (77.6% vs 22.4%, P < .001); 6-fold higher among those who tested HIV+ (85.7% vs 14.3%, P = .24), and 11-fold higher among those who enrolled on ART (91.7% vs 8.3%, P = .02).Our results show that 4 out of 5 children who tested HIV+ and over 90% of ART enrolled cases were children ≥18 months. Thus, while rolling out PCR HIV testing technology for neonates and infants, committing adequate and proportionate resources in antibody rapid testing for older children is a sine quo none condition to achieve an acquired immunodeficiency syndrome (AIDS)-free generation.


Assuntos
Sorodiagnóstico da AIDS/estatística & dados numéricos , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Programas de Rastreamento/estatística & dados numéricos , Adolescente , Fatores Etários , Camarões/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Feminino , HIV/imunologia , Infecções por HIV/epidemiologia , Humanos , Lactente , Masculino , Programas de Rastreamento/métodos
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