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1.
Washington; Organización Panamericana de la Salud; Aug. 24, 2020.
Não convencional em Inglês, Espanhol | LILACS | ID: biblio-1118287

RESUMO

The Pan American Health Organization (PAHO), in collaboration with the Regional Inter-Agency Group of UNAIDS and co-sponsors, developed this information note. The note consolidates the most recent recommendations from WHO and UNAIDS and relevant references and available resources for HIV programs and other stakeholders of the HIV response.


La comunidad y la respuesta al VIH tienen mucho que ofrecer a la preparación y la resiliencia a la enfermedad por coronavirus del 2019 (COVID-19). Contar con organizaciones dirigidas por la comunidad, como las redes de personas que viven con el VIH, para que participen en las mesas de planificación y respuesta desde el principio es fundamental para fomentar la confianza, asegurar un intercambio productivo de información y sentar las bases para la adopción de medidas conjuntas de solución de problemas. Los gobiernos, las organizaciones y redes de la sociedad civil y las personas que viven con el VIH deberían adoptar las siguientes medidas clave para abordar las cuestiones que puedan surgir en la respuesta al VIH en medio del brote de COVID-19, a fin de garantizar que la respuesta se ajuste a los principios de los derechos humanos.


Assuntos
Pneumonia Viral/prevenção & controle , Pneumonia Viral/epidemiologia , HIV , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/epidemiologia , Pandemias/prevenção & controle , Betacoronavirus , Controle de Infecções/organização & administração , Planejamento
3.
Washington, D.C.; OPS; 2020-08-24. (OPS/CDE/HT/COVID-19/20-0028).
em Espanhol | PAHO-IRIS | ID: phr-52605

RESUMO

La comunidad y la respuesta al VIH tienen mucho que ofrecer a la preparación y la resiliencia a la enfermedad por coronavirus del 2019 (COVID-19). Contar con organizaciones dirigidas por la comunidad, como las redes de personas que viven con el VIH, para que participen en las mesas de planificación y respuesta desde el principio es fundamental para fomentar la confianza, asegurar un intercambio productivo de información y sentar las bases para la adopción de medidas conjuntas de solución de problemas. Los gobiernos, las organizaciones y redes de la sociedad civil y las personas que viven con el VIH deberían adoptar las siguientes medidas clave para abordar las cuestiones que puedan surgir en la respuesta al VIH en medio del brote de COVID-19, a fin de garantizar que la respuesta se ajuste a los principios de los derechos humanos.


Assuntos
Infecções por Coronavirus , Coronavirus , Pandemias , Controle de Infecções , HIV
4.
Artigo em Espanhol | PAHO-IRIS | ID: phr-52561

RESUMO

[RESUMEN]. Objetivo. Determinar los factores asociados con el tratamiento no exitoso en pacientes diagnosticados con tuberculosis (TB) sensible en Paraguay. Métodos. Estudio de cohorte retrospectivo, con datos recolectados del programa nacional entre enero de 2016 y marzo de 2017. Se definió tratamiento no exitoso como pacientes que se perdieron en el seguimiento, fracasaron en el tratamiento o fallecieron. Los factores asociados con tratamiento no exitoso se determinaron con regresión de Poisson; se estimó el riesgo relativo (RR) y el intervalo de confianza de 95% (IC95%) ajustados por región sanitaria. Resultados. Se estudiaron 3 034 casos: 2 189 (72,1%) tuvieron tratamiento exitoso (curados: 1 221 [40,2%], tratamiento completo: 968 [31,9%]) y 845 (27,9%) presentaron tratamiento no exitoso (fracaso: 40 [1,3%], pérdida de seguimiento: 466 [15,4%] y fallecidos: 339 [11,2%]). Los factores asociados a tratamiento no exitoso fueron hombres 1,28 (1,14- 1,42), indígenas 1,30 (1,09- 1,54), sin reporte de área de residencia 1,27 (1,02- 1,57), coinfección TB/VIH 1,97 (1,63- 2,38), adicción a drogas ilícitas 1,38 (1,16- 1,63), consumo de alcohol 1,25 (1,02- 1,52), ser previamente tratado 1,23 (1,10- 1,38) y sin datos de supervisión del tratamiento 4,92 (3,69- 6,56). Como factores protectores se consideran ser persona privada de libertad 0,65 (0,47- 0,89), así como la comorbilidad TB/diabetes 0,80 (0,67- 0,95). Conclusión. Paraguay presenta un alto porcentaje de tratamiento no exitoso en casi todo el país, sin alcanzar la meta propuesta por la Organización Mundial de la Salud. Los factores de riesgo asociados como infección por el virus de la inmunodeficiencia humana (VIH), consumo de drogas licitas e ilícitas y el ser indígena revela que es necesario revisar las estrategias dirigidas con abordaje interinstitucional.


[ABSTRACT]. Objective. To determine the factors associated with the unsuccessful treatment of patients diagnosed with drug-sensitive tuberculosis (TB) in Paraguay. Methods. Retrospective cohort study, with data collected from the national program between January 2016 and March 2017. Unsuccessful treatment was defined as patients who were lost to follow-up, failed treatment, or died. Factors associated with unsuccessful treatment were determined using Poisson regression; the adjusted relative risk (RR) and 95% confidence interval (95% CI) were estimated by health region. Results. A total of 3 034 cases were studied: 2 189 (72.1%) were successfully treated (cured: 1 221 [40.2%], complete treatment: 968 [31.9%]) and 845 (27.9%) were unsuccessfully treated (treatment failure: 40 [1.3%], loss to follow-up: 466 [15.4%] and deaths: 339 [11.2%]). Factors associated with unsuccessful treatment were masculine sex 1.28 (1.14- 1.42), indigenous descent 1.3 (1.09- 1.54), lack of report of area of residence 1.27 (1.02- 1.57), TB/HIV coinfection 1.97 (1, 63- 2.38), illicit drug addiction 1.38 (1.16- 1.63), alcohol consumption 1.25 (1.02- 1.52), previous treatment 1.23 (1.10- 1.38) and lack of treatment monitoring data 4.92 (3.69- 6.56). Being deprived of liberty 0.65 (0.47- 0.89) and TB/diabetes comorbidity 0.80 (0.67- 0.95) were considered protective factors. Conclusion. Paraguay has a high percentage of unsuccessful treatment in almost the entire country, without reaching the target proposed by the World Health Organization. Associated risk factors such as HIV, consumption of legal and illicit drugs, and being indigenous highlight the need to revise the treatment strategies with an inter-institutional approach.


Assuntos
Fatores de Risco , Tuberculose , HIV , Grupos Populacionais , Paraguai , Fatores de Risco , HIV , Grupos Populacionais , Pesquisa Operacional
5.
Nat Commun ; 11(1): 3849, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32737300

RESUMO

Kaposi's sarcoma-associated herpesvirus (KSHV) and Epstein-Barr Virus (EBV) establish life-long infections and are associated with malignancies. Striking geographic variation in incidence and the fact that virus alone is insufficient to cause disease, suggests other co-factors are involved. Here we present epidemiological analysis and genome-wide association study (GWAS) in 4365 individuals from an African population cohort, to assess the influence of host genetic and non-genetic factors on virus antibody responses. EBV/KSHV co-infection (OR = 5.71(1.58-7.12)), HIV positivity (OR = 2.22(1.32-3.73)) and living in a more rural area (OR = 1.38(1.01-1.89)) are strongly associated with immunogenicity. GWAS reveals associations with KSHV antibody response in the HLA-B/C region (p = 6.64 × 10-09). For EBV, associations are identified for VCA (rs71542439, p = 1.15 × 10-12). Human leucocyte antigen (HLA) and trans-ancestry fine-mapping substantiate that distinct variants in HLA-DQA1 (p = 5.24 × 10-44) are driving associations for EBNA-1 in Africa. This study highlights complex interactions between KSHV and EBV, in addition to distinct genetic architectures resulting in important differences in pathogenesis and transmission.


Assuntos
Anticorpos Antivirais/biossíntese , Resistência à Doença/genética , Infecções por Vírus Epstein-Barr/genética , Infecções por Henipavirus/genética , Interações Hospedeiro-Patógeno/genética , Sarcoma de Kaposi/genética , Adolescente , Adulto , Antígenos Virais/genética , Antígenos Virais/imunologia , Proteínas do Capsídeo/genética , Proteínas do Capsídeo/imunologia , Coinfecção , Infecções por Vírus Epstein-Barr/epidemiologia , Infecções por Vírus Epstein-Barr/imunologia , Infecções por Vírus Epstein-Barr/virologia , Antígenos Nucleares do Vírus Epstein-Barr/genética , Antígenos Nucleares do Vírus Epstein-Barr/imunologia , Feminino , Expressão Gênica , Estudo de Associação Genômica Ampla , HIV/genética , HIV/imunologia , HIV/patogenicidade , Cadeias alfa de HLA-DQ/genética , Cadeias alfa de HLA-DQ/imunologia , Infecções por Henipavirus/epidemiologia , Infecções por Henipavirus/imunologia , Infecções por Henipavirus/virologia , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/imunologia , Herpesvirus Humano 4/patogenicidade , Herpesvirus Humano 8/genética , Herpesvirus Humano 8/imunologia , Herpesvirus Humano 8/patogenicidade , Interações Hospedeiro-Patógeno/imunologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , População Rural , Sarcoma de Kaposi/epidemiologia , Sarcoma de Kaposi/imunologia , Sarcoma de Kaposi/virologia , Uganda/epidemiologia , População Urbana
6.
Med Sci (Paris) ; 36(8-9): 783-796, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32773024

RESUMO

SARS-CoV-2 is a new human coronavirus (CoV), which emerged in People's Republic of China at the end of 2019 and is responsible for the global Covid-19 pandemic that caused more than 540 000 deaths in six months. Understanding the origin of this virus is an important issue and it is necessary to determine the mechanisms of its dissemination in order to be able to contain new epidemics. Based on phylogenetic inferences, sequence analysis and structure-function relationships of coronavirus proteins, informed by the knowledge currently available, we discuss the different scenarios evoked to account for the origin - natural or synthetic - of the virus. On the basis of currently available data, it is impossible to determine whether SARS-CoV-2 is the result of a natural zoonotic emergence or an accidental escape from experimental strains. Regardless of its origin, the study of the evolution of the molecular mechanisms involved in the emergence of this pandemic virus is essential to develop therapeutic and vaccine strategies.


Assuntos
Betacoronavirus/genética , Doenças Transmissíveis Emergentes/virologia , Infecções por Coronavirus/virologia , Coronavirus/classificação , Evolução Molecular , Pandemias , Filogenia , Pneumonia Viral/virologia , RNA Viral/genética , Sequência de Aminoácidos , Animais , Betacoronavirus/classificação , Betacoronavirus/isolamento & purificação , Derramamento de Material Biológico , China/epidemiologia , Infecções por Coronaviridae/transmissão , Infecções por Coronaviridae/veterinária , Infecções por Coronaviridae/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Reservatórios de Doenças , Mutação com Ganho de Função , Genoma Viral , HIV/genética , Especificidade de Hospedeiro , Humanos , Mamíferos/virologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Vírus Reordenados/genética , Alinhamento de Sequência , Homologia de Sequência de Aminoácidos , Glicoproteína da Espícula de Coronavírus/química , Glicoproteína da Espícula de Coronavírus/genética , Glicoproteína da Espícula de Coronavírus/fisiologia , Zoonoses
7.
BMC Infect Dis ; 20(1): 613, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32811453

RESUMO

BACKGROUND: Strongyloidiasis is caused by the helminth Strongyloides stercoralis and is well-recognised amongst transplant recipients. Serious complications, including Strongyloides hyperinfection which is a syndrome of accelerated autoinfection, or disseminated disease, can occur post-transplantation, resulting in significant morbidity and mortality. Here we present the first published case we are aware of, describing post-transplant Strongyloides hyperinfection in an HIV-positive kidney transplant patient. We discuss the diagnostic challenges and the role of pre-transplant screening. CASE PRESENTATION: A 58-year-old African-American male, originally from the Caribbean, received a deceased donor kidney transplant for presumed focal segmental glomerulosclerosis. He was known to be HIV-positive, with a stable CD4 count, and an undetectable viral load. Five months post-transplant, he developed gastrointestinal symptoms and weight loss. He had a normal eosinophil count (0.1-0.2 × 109/L), negative serum cytomegalovirus DNA, and negative blood and stool cultures. His Strongyloides serology remained negative throughout. A diagnosis of Strongyloides hyperinfection was made by the histological examination of his duodenum and lung, which identified the parasites. He completed his course of treatment with Ivermectin but exhibited profound deconditioning and required a period of total parenteral nutrition. He was subsequently discharged after a prolonged hospital admission of 54 days. CONCLUSIONS: This case highlights the challenges in diagnosing Strongyloides infection and the need to maintain a high index of clinical suspicion. Non-invasive techniques for the diagnosis of Strongyloides may be insufficient. Routine pre-transplant serological strongyloidiasis screening is now performed at our centre.


Assuntos
Soropositividade para HIV/fisiopatologia , HIV/imunologia , Transplante de Rim/efeitos adversos , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Estrongiloidíase/etiologia , Transplantados , Afro-Americanos , Animais , Antiparasitários/uso terapêutico , Soropositividade para HIV/virologia , Humanos , Ivermectina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/parasitologia , Doadores de Tecidos , Resultado do Tratamento
8.
BMC Infect Dis ; 20(1): 634, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32847528

RESUMO

BACKGROUND: People who inject drugs (PWID) have increased risk of acquiring blood-transmitted chronic viral infections such as Hepatitis B (HBV), Hepatitis C (HCV) and Human Immunodeficiency Virus (HIV) as well as increased risk of acquiring bacterial infections. We aimed to identify and describe bacteraemic episodes, their recurrence rates, predictive and prognostic factors amongst hospitalised PWID. METHODS: In this retrospective cohort study, we included 257 hospitalised PWID during 2000-2006 with follow up at the Department of Infectious Diseases, Hvidovre Hospital, Denmark. Data collection included comorbidity (HBV-, HCV-, HIV-, and psychiatric comorbidities), social information (contact to an addiction treatment centre, homelessness), opioid substitution treatment (OST), treatment completion and microbiology findings. There was a 10-years follow-up regarding mortality. RESULTS: The study identified 257 patients classified as PWID. Of these, 58 (22.6%) had at least one episode of bacteraemia during their first hospital admission. Recurrence was found in 29 (50.0%) of the bacteraemia cases. Staphylococcus aureus was the dominant microorganism of both first and recurrent episodes with 24 (41.4%) and nine (31.4%) of cases, respectively. A psychiatric diagnose was significantly associated with a lower risk of bacteraemia in the multivariate analysis (OR: 0.29, [95%CI: 0.11-0.77], P = 0.01). Mortality was significantly higher in patients with bacteraemia (17.2% vs. 3.0%, P < 0.01, OR: 6.67 [95%CI: 2.33-20], P < 0.01). CONCLUSIONS: In hospitalised PWID, bacteraemia was found in 22.6% and was associated with at higher mortality. The most common microorganism of bacteraemia was S. aureus. Psychiatric comorbidity was significantly associated with a lower risk of bacteraemia.


Assuntos
Bacteriemia/epidemiologia , Infecções por HIV/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Transtornos Mentais/epidemiologia , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/isolamento & purificação , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Comorbidade , Dinamarca/epidemiologia , Feminino , Seguimentos , HIV/imunologia , Hepacivirus/imunologia , Vírus da Hepatite B/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Recidiva , Estudos Retrospectivos , Abuso de Substâncias por Via Intravenosa/mortalidade
9.
Monoclon Antib Immunodiagn Immunother ; 39(4): 107-111, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32762609

RESUMO

In this hypothesis, we address the biological/immunological pathway leading to severe disease or death after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The underlying immune response is described with "original antigenic sin" (OAS) whereby previous infections influence the response to future virus encounters. We cite evidence for OAS-induced immunopathology in HIV-1 disease. We hypothesize that similar immune abnormalities can occur after infection with SARS-CoV-2. This hypothesis is supported by recent analysis of the antibodies in infected patients demonstrating serological and B cell abnormalities. The concept of symmetrical clonal regulation developed earlier for the immune network illustrates the pathway suggested by our hypothesis and may be helpful to develop strategies avoiding severe coronavirus disease 2019.


Assuntos
Anticorpos Antivirais/imunologia , Linfócitos B/imunologia , Betacoronavirus/imunologia , Infecções por Coronavirus/imunologia , Evasão da Resposta Imune/imunologia , Pneumonia Viral/imunologia , Anticorpos Monoclonais/imunologia , Infecções por Coronavirus/patologia , Reações Cruzadas/imunologia , Síndrome da Liberação de Citocina/imunologia , HIV/imunologia , HIV-1/imunologia , Humanos , Imunoglobulina G/imunologia , Imunoglobulina M/imunologia , Memória Imunológica/imunologia , Pandemias , Pneumonia Viral/patologia
10.
Phys Rev Lett ; 125(7): 078003, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32857587

RESUMO

Determining the positions of lattice defects on bounded elastic surfaces with Gaussian curvature is a nontrivial task of mechanical energy optimization. We introduce a simple way to predict the onset of disclination disorder from the shape of the surface. The criterion fixes the value of a weighted integral Gaussian curvature to a universal constant and proves accurate across a great variety of shapes. It provides improved understanding of the limitations to crystalline order in many natural and engineering contexts, such as the assembly of viral capsids.


Assuntos
Capsídeo/química , Modelos Teóricos , RNA/química , Animais , Proteínas do Capsídeo/química , Drosophila , Elasticidade , HIV/química , Vírus da SARS/química , Propriedades de Superfície , Termodinâmica , Thermoproteus
11.
BMC Infect Dis ; 20(1): 571, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32758162

RESUMO

BACKGROUND: The incidence of cryptococcal meningitis (CM) has gradually increased in recent years. Cerebrospinal fluid (CSF) cytology and cell count are very important for CM on etiology diagnosis and assessment of disease status and therapeutic response. However, the clinical significance of CSF white cell count (WCC) in CM patients is not fully understood. Using longitudinal data of CSF WCC and its relationship with clinical outcomes in CM patients, we aimed to elucidate the clinical significance of this test. METHODS: We retrospectively analyzed the medical records of 150 CM patients admitted to our hospital between January 2008 and December 2018. RESULTS: CM patients with lower baseline CSF WCC, CSF protein concentration or CD4/CD8 ratio, and those with altered mentation or HIV coinfection were more likely to have poor clinical outcome (P<0.05). CM patients with triple therapy during the induction period presented with a better clinical outcome (P<0.05). Baseline CSF WCC had a moderate positive correlation with peripheral CD4+ T lymphocyte count (r = 0.738, P < 0.001) and CD4+ T lymphocyte percentage (r = 0.616, P < 0.001). The best cut-off value to predict a poor clinical outcome was 40 cells/µL during baseline CSF WCC. The predictive model incorporating longitudinal data of CSF WCC had better sensitivity, specificity, and accuracy than a model incorporating only baseline CSF WCC data. CONCLUSIONS: Our results indicated that baseline CSF WCC and changes in CSF WCC over time could be used to assess the prognosis of CM patients.


Assuntos
Relação CD4-CD8/métodos , Cryptococcus neoformans , Meningite Criptocócica/líquido cefalorraquidiano , Meningite Criptocócica/diagnóstico , Adulto , Antirretrovirais/uso terapêutico , Antifúngicos/uso terapêutico , China , Confiabilidade dos Dados , Feminino , Previsões/métodos , HIV , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Estudos Longitudinais , Masculino , Meningite Criptocócica/tratamento farmacológico , Meningite Criptocócica/microbiologia , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
12.
BMC Infect Dis ; 20(1): 576, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32758169

RESUMO

BACKGROUND: China ranks second in the world in terms of numbers of tuberculosis (TB) cases and is one of the top three countries with the largest number of multidrug-resistant and rifampicin-resistant TB (MDR/RR-TB). It also has high mortality and low cure rates of human immunodeficiency virus (HIV)-positive TB patients. This study aimed to analyse, under the integrated TB control model, the characteristics of TB patients seeking healthcare in the largest designated TB hospital in Chongqing. METHODS: This was a retrospective study of TB registers in a health facility. Record data of 1827 TB patients who had attended the Chongqing Public Health Medical Center (CPHMC) from 1 January to 31 December 2018 were included. The Statistical Package for Social Science (SPSS 18.0; IBM Corporation, Armonk, NY, USA) was used to analyse the data. Counting data were compared using the chi-square test or Fisher' s exact test. Among the results of the univariate analysis, the variables with statistical significance were included in the binomial stepwise logistic regression, with odds ratio and 95% confidence interval calculated. A two-tailed probability level of P < 0.05 was considered statistically significant. RESULTS: The majority of registered patients were men (1197), of Han ethnicity (1670), aged 21-60 years (1331), farmer/unemployed (1075), and living in county/district (1207). Approximately 24.9% of patients (455/1827) contracted DR-TB, 6% (110/1827) were co-infected with HIV, and 41.0% (749/1827) had drug-related hepatotoxicity. Among those patients, DR-TB was more likely to develop among farmers who received retreatment and had drug-related hepatotoxicity (P < 0.05). Women who received retreatment and lived in county/district were less likely to be HIV positive (P < 0.05). Compared with farmers, patients who were unemployed were more likely to be HIV positive, and those aged 21-60 years had a higher risk of being tested as HIV positive (P < 0.05). CONCLUSION: Farmers who received retreatment and had drug-related hepatotoxicity are more susceptible to DR-TB; young unemployed men have a higher risk of contracting HIV-positive TB. The demographic and clinical characteristics of TB patients should be taken into consideration in DR-TB and HIV-positive TB screening in the future.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Coinfecção/epidemiologia , HIV , Mycobacterium tuberculosis/efeitos dos fármacos , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adulto , Antituberculosos/efeitos adversos , Antituberculosos/uso terapêutico , China/epidemiologia , Coinfecção/tratamento farmacológico , Coinfecção/virologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Fazendeiros , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Desemprego , Adulto Jovem
13.
BMC Infect Dis ; 20(1): 593, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787798

RESUMO

BACKGROUND: Tuberculosis is a serious health risk, for people living with human immune deficiency virus worldwide, and the burden of TB/HIV infection is still high in Ethiopia in particular. Therefore, the aim of this study was to determine the predictors of tuberculosis infection among adults visiting anti-retroviral treatment center in East and West Gojjam, northwest, Ethiopia. METHODS: Institution based unmatched case-control study was employed to determine the predictors of tuberculosis infection among adults visiting anti-retroviral treatment center in east and west Gojjam, Northwest, Ethiopia from March 7-April 15, 2017. Just about 552 participants were participated in the study (139 Cases and 413 controls). Cases were confirmed with active TB and infected with HIV, and controls were HIV positive adults with non-TB. All cases in each health facility who confirmed by acid-fast bacilli, culture and gene expert were considered as TB positive. However, controls were selected by using simple random sampling technique through the above diagnostic criteria and the data were collected with Face to face interview as well as patient medical record were utilized, and the quality of the data were assured, checked, coded, cleaned and entered in EPI-Data version 3.1 and exported to SPSS version 20 for the analysis. RESULT: Of the total sample (556), just about 552(99.2%) were participated in the study. 47.5% were females and 58.9% were rural dweller. Behavioral and modifiable biological risk factors: alcohol users (AOR = 2.33; 95%CI:1.34,4.07), BMI < 18.5 kg/m2 (AOR = 3.03;95%CI:1.79,5.14), CD4 count ≤200 cells/µl (AOR = 2.34;95%CI:1.89,2.79) and between 201 and 499 cells/µl (AOR = 2.63; 95%CI: 1.01,6.84), bedridden and ambulatory (AOR = 3.3;95%CI:1.70,6.29 and AOR = 8.2;95%CI:4.34,15.64), respectively. TB history in the family (AOR = 3.00; 95%CI: 1.57, 5.74) were predictors for TB infection. Taking CPT (AOR = 0.36; 95%CI: 0.21, 0.62) and having early WHO clinical stage I or II (AOR = 0.34; 95%CI: 0.20, 0.56) had protective effect against TB infection. CONCLUSION: From this study, it has been concluded that alcohol users, BMI < 18.5 kg/m2, CD4 count < 499 cells/µl, bedridden and ambulatory and TB history were predictors for TB-HIV co-infected adults. Strengthen screening more frequently, CPT Prophlaxysis and treated promptly important to reduce TB co-morbidity.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antirretrovirais/uso terapêutico , Coinfecção/epidemiologia , HIV , Mycobacterium tuberculosis/genética , Tuberculose Pulmonar/epidemiologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas , Índice de Massa Corporal , Contagem de Linfócito CD4 , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Prognóstico , População Rural , Adulto Jovem
14.
Lancet Haematol ; 7(8): e594-e600, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32735838

RESUMO

Burkitt lymphoma is a rare and aggressive non-Hodgkin lymphoma with three classifications: endemic, sporadic, and immunodeficiency-related. High-intensity chemotherapeutic regimens have considerably improved overall survival for patients with Burkitt lymphoma. In this Review of HIV-associated Burkitt lymphoma, we summarise expert opinion and provide general recommendations for the treatment of Burkitt lymphoma in patients with HIV on the basis of retrospective and prospective studies, taking into consideration immune status, CD4 cell counts, the presence of systemic disease, and the risk of CNS involvement or relapse. We also discuss the role of rituximab and antiretroviral therapy. We highlight the reasons behind the possible different mechanisms of lymphomagenesis in HIV-associated Burkitt lymphoma and endemic Burkitt lymphoma, which indicate that HIV might have either a direct or indirect oncogenic role in Burkitt lymphoma. We discuss the possible mechanisms by which HIV and HIV proteins could directly contribute to lymphomagenesis. Identifying these mechanisms might lead to the development of therapies that have fewer toxic effects than high-intensity chemotherapeutic regimens.


Assuntos
Linfoma de Burkitt/patologia , Infecções por HIV/complicações , HIV/patogenicidade , Linfoma de Burkitt/epidemiologia , Linfoma de Burkitt/etiologia , Infecções por HIV/virologia , Humanos , Incidência
15.
J Assoc Physicians India ; 68(9): 23-26, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32798341

RESUMO

Introduction: HIV/AIDS is a chronic multisystem disease and about 70% develop neurologic complications (including distal symmetric polyneuropathy (DSPN) any time during their life. DSPN is also a very common toxicity of drugs used to treat HIV infection. Little is known about the impact of HIV per se or other factors (apart from drugs) on the occurrence of DSPN in these patients. Methods: It was a cross sectional, observational study, done at the department of Medicine, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, India. Ninety consecutive 18-40 years old HIV infected but treatment naïve (ART naïve) cases and 30 age and sex matched healthy controls were recruited for this study. Results: Out of 90 cases, 12 (13.4%) had DSPN (8 males and 4 females). The mean CD4 counts of these cases with and without DSPN was 294.73/µl and 370.84/µl respectively. Only 3 out of these 12 cases were symptomatic on presentation and rest nine were diagnosed on NCV study. No control had abnormal NCV. Presence of DSPN was found to be directly associated with infection with HIV per se (p<0.001) along with duration of HIV infection (p<0.01) and level of immunodeficiency (p<0.001). Conclusion: This study demonstrates that DSPN is already present in 13.4% of treatment naive patients with HIV/AIDS and even with milder immunodeficiency and at early stages of disease. Not only HAART but HIV by itself is a major causative risk factor for DSPN in these patients.


Assuntos
Infecções por HIV , Polineuropatias , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Estudos Transversais , Feminino , HIV , Infecções por HIV/terapia , Humanos , Índia , Masculino , Prevalência , Adulto Jovem
16.
Arch. med ; 20(2): 269-281, 20200703.
Artigo em Espanhol | LILACS | ID: biblio-1118575

RESUMO

Objetivo: determinar el efecto del cambio en la terapia antirretroviral sobre el control virológico en una cohorte de pacientes VIH positivos de una institución prestadora de servicios de salud en Medellín, Antioquia (Colombia) en el año 2017. Materiales y métodos: estudio observacional analítico transversal, comparativo entre pacientes que cambiaron y no cambiaron el esquema inicial de terapia antirretroviral. Se realizó en una cohorte de 1245 pacientes que conviven con el VIH. Resultados: un total de 322 pacientes fueron evaluados. El principal motivo de cambio fue la presencia de efectos adversos a la terapia antirretroviral, seguido de la falla virológica sin genotipo e intolerancia a la terapia antirretroviral. La falla virológica, RP 1,4 IC95% (1,2-1,6, p0,00), el tener genotipo, RP 1,2 IC95% (1,1-1,3, p 0,00) y el padecer una infección oportunista, RP 1,3 IC95% (1,0-1,6, p 0,03), se asociaron a mayor número de cambios a la TAR. La adherencia a la terapia antirretroviral, RP 0,18 IC95% (0,1-0,3, p 0,00) y la toma de otros medicamentos no relacionados al VIH (RP 0,6, IC95% 0,4-0,8, p 0,005) se asociaron a menor frecuencia de cambio de la terapia antirretroviral. El cambio de la terapia antirretroviral (OR ajustado 3,4, IC 95% (2,0-5,8), continúa siendo el factor pronóstico más importante para falla virológica. Conclusión: el cambio de la terapia antirretroviral, definida en este estudio como la principal variable de exposición, representa el principal factor de riesgo para falla virológica, incluso cuando fue ajustado por otras variables..Au


Objective: to determine the effect of the change in antiretroviral therapy on virological control in a cohort of HIV positive patients corresponding to a healthcare institution in Medellín, Antioquia (Colombia) in 2017. Materials and methods: cross-sectional,comparative analytical observational study. It was performed in a cohort of 1245 patients living with HIV. Results: a total of 322 patients were evaluated. The main reason for change was the presence of adverse effects to antiretroviral therapy, followed by virological failure without genotype and antiretroviral therapy intolerance. Virological failure, PR 1.4 95% CI (1.2-1.6, p 0,00), having genotype, PR 1.2 95% CI (1.1-1.3, p0,00 ) and suffering from an opportunistic infection, PR 1.3 95% CI (1.0-1.6, p 0,03),were associated with a greater number of changes to antiretroviral therapy. Adherence to antiretroviral therapy, PR 0.18 95% CI (0.1-0.3, p 0,00) and taking other non-HIVrelated medications (PR 0.6, 95% CI 0.4-0 , 8, p 0,005) were associated with a lower frequency of change of antiretroviral therapy. The change in antiretroviral therapy (adjusted OR 3.4, 95% CI (2.0-5.8)) remains the most important prognostic factor for virological failure. Conclusion: the change in antirretroviral therapy, defined in this study as the main exposure variable, represents the main risk factor for virological failure, even when was adjusted for other variables..Au


Assuntos
HIV , Terapia Antirretroviral de Alta Atividade
17.
Medicine (Baltimore) ; 99(28): e21132, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664143

RESUMO

Among human immunodeficiency virus (HIV)-infected individuals, syphilis is an important sexually transmitted infection (STI), and repeat infections are common. Identifying risk factors for delineating the trends in repeat syphilis are essential for STI and HIV prevention.This study is to investigate the dynamic of the syphilis epidemic among HIV-infected patients and to identify the risk factors associated with repeat syphilis.A population-based cohort design was used to analyze claim data between January 2000 and December 2010 using the Taiwan National Health Insurance Research Database. The Poisson regression test was used to identify risk factors for repeat syphilis.Of 13,239 HIV-infected patients, annual syphilis screen tests have been performed in 4,907 (37.1%) of these patients. Syphilis has been diagnosed in 956 (19.5%) patients, and 524 (10.7%) had repeat syphilis. The annual trend in repeat syphilis showed a significant increase in the study period (ß = 0.23, P < .001). Younger age (adjusted incidence rate ratio [aIRR] 1.43; 95% CI 1.11-1.86), male gender (aIRR 11.14, 95% CI 4.16-29.79), a history of STIs (aIRR 1.39, 95% CI 1.21-1.59) were independently associated with repeat syphilis. The retention in HIV care and adherence to antiretroviral therapy ≥85% ([aIRR] 0.77, 95% CI 0.61-0.98; P < .001) were associated with a reduced risk of repeat syphilis.The incidence of repeat syphilis increased during 11 years of follow-up. The screening of syphilis for early diagnosis and retention in HIV care with medication adherence should be encouraged to minimize the risk of repeat syphilis in the targeted population.


Assuntos
Previsões , Infecções por HIV/epidemiologia , HIV , Vigilância da População/métodos , Sífilis/epidemiologia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Risco , Taiwan/epidemiologia , Adulto Jovem
18.
PLoS One ; 15(7): e0233877, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645021

RESUMO

BACKGROUND: The impact of nutritional supplements on weight gain in HIV-infected children on antiretroviral treatment (ART) remains uncertain. Starting supplements depends upon current weight-for-age or other acute malnutrition indicators, producing time-dependent confounding. However, weight-for-age at ART initiation may affect subsequent weight gain, independent of supplement use. Implications for marginal structural models (MSMs) with inverse probability of treatment weights (IPTW) are unclear. METHODS: In the ARROW trial, non-randomised supplement use and weight-for-age were recorded monthly from ART initiation. The effect of supplements on weight-for-age over the first year was estimated using generalised estimating equation MSMs with IPTW, both with and without interaction terms between baseline weight-for-age and time. Separately, data were simulated assuming no supplement effect, with use depending on current weight-for-age, and weight-for-age trajectory depending on baseline weight-for-age to investigate potential bias associated with different MSM specifications. RESULTS: In simulations, despite correctly specifying IPTW, omitting an interaction in the MSM between baseline weight-for-age and time produced increasingly biased estimates as associations between baseline weight-for-age and subsequent weight trajectory increased. Estimates were unbiased when the interaction between baseline weight-for-age and time was included, even if the data were simulated with no such interaction. In ARROW, without an interaction the estimated effect was +0.09 (95%CI +0.02,+0.16) greater weight-for-age gain per month's supplement use; this reduced to +0.03 (-0.04,+0.10) including the interaction. DISCUSSION: This study highlights a specific situation in which MSM model misspecification can occur and impact the resulting estimate. Since an interaction in the MSM (outcome) model does not bias the estimate of effect if the interaction does not exist, it may be advisable to include such a term when fitting MSMs for repeated measures.


Assuntos
Infecções por HIV/dietoterapia , Apoio Nutricional/métodos , Ganho de Peso/efeitos dos fármacos , Antirretrovirais/uso terapêutico , Peso Corporal/efeitos dos fármacos , Peso Corporal/fisiologia , Pré-Escolar , Suplementos Nutricionais/análise , Feminino , HIV/patogenicidade , Infecções por HIV/metabolismo , Humanos , Lactente , Masculino , Modelos Estatísticos , Modelagem Computacional Específica para o Paciente , Projetos de Pesquisa
19.
BMC Infect Dis ; 20(1): 473, 2020 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-32620082

RESUMO

BACKGROUND: People living with the Human Immunodeficiency Virus (PLHIV) have an increased susceptibility to develop non-communicable diseases such as cardiovascular disease (CVD). Infection with HIV contributes to the development of CVD independent of traditional risk factors, with endothelial dysfunction being the central physiological mechanism. While HIV-related mortality is declining due to antiretroviral treatment (ART), the number of deaths due to CVD is rising in South Africa - the country with the highest number of PLHIV and the world's largest ART programme. The EndoAfrica study was developed to determine whether HIV infection and ART are associated with cardiovascular risk markers and changes in vascular structure and function over 18 months in adults from different provinces of South Africa. This paper describes the rationale, methodology and baseline cohort profile of the EndoAfrica study conducted in the North West Province, South Africa. METHODS: In this case-control study, conducted between August 2017 and June 2018, 382 volunteers of African descent (276 women; 106 men), comprising of 278 HIV infected and 104 HIV free individuals were included. We measured health behaviours, a detailed cardiovascular profile, and performed biomarker analyses. We compared baseline characteristics, blood pressure, vascular function and biochemical markers between those infected and HIV free. RESULTS: At baseline, the HIV infected participants were older (43 vs 39 years), less were employed (21% vs 40%), less had a tertiary education (7% vs 16%) and their body mass index was lower (26 vs 29 kg/m2) than that of the HIV free participants. While the cardiovascular profile, flow-mediated dilation and pulse wave velocity did not differ, glycated haemoglobin was lower (p = 0.017) and total cholesterol, high density lipoprotein cholesterol, triglycerides, gamma-glutamyltransferase and tobacco use were higher (all p < 0.047) in PLHIV. CONCLUSION: Despite PLHIV being older, preliminary cross-sectional analysis suggests that PLHIV being treated with ART do not have poorer endothelial or vascular function compared to the HIV free participants. More detailed analyses on the baseline and follow-up data will provide further clarity regarding the cardiovascular profile of South Africans living with HIV.


Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/epidemiologia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/etiologia , HIV , Síndrome de Imunodeficiência Adquirida/sangue , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Antirretrovirais/uso terapêutico , Biomarcadores/sangue , Pressão Sanguínea , Estudos de Casos e Controles , HDL-Colesterol/sangue , Estudos Transversais , Feminino , Hemoglobina A Glicada/análise , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis , Análise de Onda de Pulso , Fatores de Risco , África do Sul/epidemiologia , Triglicerídeos/sangue
20.
BMC Infect Dis ; 20(1): 460, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32611405

RESUMO

BACKGROUND: Although the United Nations program on HIV/AIDS 90-90-90-targets recommends achieving 90% of viral suppression for patients on first-line antiretroviral therapy by 2020, virological failure is still high and it remains a global public health problem. Therefore, assessing the incidence and predictors of virological failure among adult HIV patients on first-line ART in Amhara regional referral hospitals, Ethiopia is vital to design appropriate prevention strategies for treatment failure and preventing the unnecessary switching to second-line regimens. METHOD: An institution-based retrospective follow-up study was conducted on 490 adult HIV patients. The simple random sampling technique was used, and data were entered into Epi data Version 4.2.0.0 and was exported to Stata version 14 for analysis. The proportional hazard assumption was checked, and the Weibull regression was fitted. Cox-Snell residual was used to test the goodness of fit, and the appropriate model was selected by AIC/BIC. Finally, an adjusted hazard ratio with a 95% CI was computed, and variables with P-value < 0.05 in the multivariable analysis were taken as significant predictors of virological failure. RESULTS: The overall incidence rate of virological failure was 4.9 events per 1000 person-month observations (95%CI: 3.86-6.38). Users of CPT (AHR = 0.55, 95%CI: 0.31-0.97), poor adherence (AHR = 5.46, 95%CI: 3.07-9.74), CD4 Count <=200 cells/mm3 (AHR = 3.9, 95%CI: 1.07-13.9) and 201-350 cells/mm3 (AHR 4.1, 95%CI: 1.12-15) respectively, and NVP based first line drug regimen (AHR = 3.53, 95%CI: 1.73-7.21) were significantly associated with virological failure. CONCLUSION: The incidence rate of virological failure was high. CPT, poor adherence, low baseline CD4 count and NVP based first-line drug regimen were independent risk factors associated with virological failure. Therefore, strengthening HIV care intervention and addressing these significant predictors is highly recommended in the study setting.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Antirretrovirais/efeitos adversos , Antirretrovirais/uso terapêutico , HIV/efeitos dos fármacos , Adolescente , Adulto , Contagem de Linfócito CD4 , Etiópia/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Adulto Jovem
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