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1.
Int J STD AIDS ; 31(12): 1222-1224, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32903133

RESUMO

Limited information is available concerning the coexistence of COVID-19 and opportunistic infections in people living with HIV. The possible association of COVID-19 with AIDS-related respiratory diseases should be considered, particularly in patients with advance immunosuppression. We report the case of a male patient with AIDS-related disseminated histoplasmosis associated with COVID-19.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções por HIV/complicações , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Adulto , Contagem de Linfócito CD4 , Infecções por HIV/tratamento farmacológico , Histoplasmose/complicações , Histoplasmose/virologia , Humanos , Imunossupressão , Masculino
2.
Malawi Med J ; 32(1): 3-7, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32733652

RESUMO

Introduction: Cryptococcal meningitis (CM) is the most common systemic fungal infection in patients with HIV infection. Rapid diagnosis and timely initiation of antifungal therapy are key to reducing mortality rate associated with CM. This study aims to evaluate the ability of four different diagnostic tests (Gram stain, India ink, and two types of commercial lateral flow assay [LFA]) to identify CM-positive patients and to compare the sensitivity and specificity of these tests. Methods: This was a prospective cross-sectional study on diagnostic tests accuracy conducted in Northern Malawi. The target population was HIV-infected adult patients presenting with features of meningitis. Four types of diagnostic tests were conducted: India ink, Gram stain, and two types of commercial lateral flow assay (LFA) (Immy, Inc., OK, USA and Dynamiker Biotechnology (Tianjin) Co., Ltd), Singapore). Culture was conducted as the reference standard. Results: A total of 265 samples were collected. The rate of positive CM detection ranged from 6.4% (using India ink) to 14.3% (using LFA). India ink exhibited the lowest sensitivity of 54.8% (95% confidence interval [CI]: 36.0%-72.7%), followed by Gram stain (61.3%; 95% CI: 42.2%-78.2%). The Dynamiker LFA exhibited the highest sensitivity of 100.0% (95% CI: 90.0%-100.0%) but a lower specificity (97.0%; 93.9%-98.8%) compared to the Immy LFA (98.3%; 95% CI: 95.7%-99.5%). Conclusion: LFA diagnostic methods have the potential to double the detection rate of CM-positive patients in resource-limited countries such as Malawi. As such, LFAs should be considered to become the main diagnostic tests used for CM diagnostics in these countries. Our data indicate that LFAs may be the best method for diagnosing CM and exhibits the highest diagnostic accuracy as it has shown that it outperforms cell culture, the current gold standard.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Antifúngicos/uso terapêutico , Antígenos de Fungos/sangue , Cryptococcus/isolamento & purificação , Infecções por HIV/complicações , Meningite Criptocócica/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/sangue , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Adulto , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Estudos Transversais , Cryptococcus/imunologia , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Malaui/epidemiologia , Masculino , Meningite Criptocócica/sangue , Meningite Criptocócica/tratamento farmacológico , Sistemas Automatizados de Assistência Junto ao Leito , Estudos Prospectivos , Sensibilidade e Especificidade
3.
Medicine (Baltimore) ; 99(29): e21141, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702867

RESUMO

BACKGROUND: Toxoplasma encephalitis (TE) is one of the main opportunistic infections in acquired immunodeficiency syndrome (AIDS) patients, and represents a social burden due to its high prevalence and morbidity. Concomitant antiretroviral therapy (ART), together with effective anti- toxoplasma combination therapy, is an effective strategy to treat AIDS-associated TE (AIDS/TE) patients. However, the timing for the initiation of ART after diagnosis of TE remains controversial. We therefore designed the present study to determine the optimal timing for ART initiation in AIDS/TE patients. METHODS/DESIGN: This trial is a 17-center, randomized, prospective clinical study with 2 parallel arms. A total of 200 participants will be randomized at a 1:1 ratio into the 2 arms: the early ART initiation (≤14 days after TE diagnosis) arm and the deferred ART (>14 days after TE diagnosis) arm. The primary outcome will be the difference of mortality between the 2 arms at 48 weeks. The secondary outcomes will be the differences between the 2 arms in the changes of CD4+ counts from baseline to week 48, the rate of virologic suppression (HIV ribonucleic acid <50 copies/mL) from baseline to week 48, the incidence of TE-associated immune reconstitution inflammatory syndrome during the study period, and the incidence of adverse effects during the study period. DISCUSSION: This present trial aims to evaluate the optimal timing for ART initiation in AIDS/TE patients, and will provide strong evidence for AIDS/TE treatment should it be successful. TRIAL REGISTRATION: This trial was registered as one of the 12 trials under the name of a general project at the chictr.gov (http://www.chictr.org.cn/showproj.aspx?proj=35362) on February 1, 2019, and the registration number of the general project is ChiCTR1900021195.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Antirretrovirais/uso terapêutico , Protocolos Clínicos , Fatores de Tempo , Toxoplasmose Cerebral/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/fisiopatologia , Adulto , Infecções por HIV/complicações , Infecções por HIV/fisiopatologia , Humanos , Medicina de Precisão/métodos , Estudos Prospectivos , Toxoplasmose Cerebral/fisiopatologia
4.
BMC Infect Dis ; 20(1): 407, 2020 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-32527231

RESUMO

BACKGROUND: Cryptococcosis is an opportunistic fungal infection that primarily affects people with advanced HIV/AIDS and is an important cause of morbidity and mortality around the globe. By far the most common presentation of the disease is cryptococcal meningitis (CM), which leads to an estimated 15-20% of all HIV related deaths worldwide, 75% of which are in sub-Saharan Africa. However, to the best of our knowledge there is quite limited reviewed data on the epidemiology of cryptococcal antigenemia in a large HIV-infected population in resource limited settings. METHODS: Articles published in English irrespective of the time of publication were systematically searched using comprehensive search strings from PubMed/Medline and SCOPUS. In addition, Google Scholar and Google databases were searched manually for grey literature. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. The pooled prevalence of cryptococcal antigenemia was determined with 95% confidence interval (CI). RESULTS: Among 2941 potential citations, we have included 22 studies with a total of 8338 HIV positive individuals. The studies were reported in ten different countries during the year (2007-2018). Most of the articles reported the mean CD4 count of the participants below 100 cells/µl. The pooled prevalence of cryptococcal antigenemia at different CD4 count and ART status was at 8% (95%CI: 6-10%) (ranged between 1.7 and 33%). Body mass index (BMI) < 18.5 kg/m2, CD4 count < 100 cells, patients presenting with headache and male gender were reported by two or more articles as an important predictors of cryptococcal antigenemia. CONCLUSIONS: Implementing a targeted screening of HIV patients with low BMI, CD4 count < 100 cells, having headache and males; and treatment for asymptomatic cryptococcal disease should be considered. Additional data is needed to better define the epidemiology of cryptococcal antigenemia and its predictors in resource limited settings in order to optimize the prevention, diagnosis, and treatment strategies.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Alocação de Recursos para a Atenção à Saúde , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , África ao Sul do Saara/epidemiologia , Humanos , Meningite Criptocócica/tratamento farmacológico , Prevalência , Fatores de Risco
5.
BMC Infect Dis ; 20(1): 410, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32532212

RESUMO

BACKGROUND: Current WHO guidelines (2018) recommend screening for cryptococcal antigen (CrAg) in HIV-infected persons with CD4+ T cell counts< 100 cells/µL, followed by pre-emptive antifungal therapy among CrAg positive (CrAg+) persons, to prevent cryptococcal meningitis related deaths. This strategy may also be considered for those persons with a CD4+ T cell count of < 200 cells/uL according the WHO guidelines. However, there is sparse evidence in the literature supporting CrAg screening and pre-emptive antifungal therapy in those HIV-infected persons with this CD4+ T cell counts< 200 cells/µL. METHOD: We conducted a meta-analysis using data extracted from randomized controlled studies (RCTs) and cohort studies found in a search of Pubmed, Web of Science, the Cochrane Library and the EMBASE/MEDLINE database. RESULTS: The pooled prevalence of CrAg positivity in HIV-infected persons with CD4+ T cell counts< 200 cells/µL was 5% (95%CI: 2-7). The incidence of CM in CrAg+ persons was 3% (95%CI: 1-6). Among those CrAg+ persons who did not receive pre-emptive treatment, or those who received placebo, the incidence of CM was 5% (95%CI: 2-9), whereas the incidence of CM among those who received pre-emptive antifungal therapy was 3% (95%CI: 1-6), which is a statistically significant reduction in incidence of 40% (RR: 7.64, 95%CI: 2.96-19.73, p < 0.00001). As for persons with CD4+ T cell counts between 101 ~ 200 cells/µL, the risk ratio for the incidence of CM among those receiving placebo or no intervention was 1.15, compared to those receiving antifungal treatment (95%CI: 0.16-8.13). CONCLUSIONS: In our meta-analysis the incidence of CM was significantly reduced by pre-emptive antifungal therapy in CrAg+ HIV-infected persons with CD4 <  200 cells/µL. However, more specific observational data in persons with CD4+ T cell counts between 101 ~ 200 cells/µL are required in order to emphasize specific benefit of CrAg screening and pre-emptive antifungal treating in CrAg+ persons with CD4+ T cell counts < 200 cells/µL.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Antifúngicos/uso terapêutico , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/prevenção & controle , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Antígenos de Fungos/sangue , Contagem de Linfócito CD4 , Cryptococcus/imunologia , Cryptococcus/isolamento & purificação , Humanos , Incidência , Programas de Rastreamento , Meningite Criptocócica/imunologia , Meningite Criptocócica/microbiologia , Prevalência
6.
N Engl J Med ; 382(25): 2397-2410, 2020 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-32558469

RESUMO

BACKGROUND: In regions with high burdens of tuberculosis and human immunodeficiency virus (HIV), many HIV-infected adults begin antiretroviral therapy (ART) when they are already severely immunocompromised. Mortality after ART initiation is high in these patients, and tuberculosis and invasive bacterial diseases are common causes of death. METHODS: We conducted a 48-week trial of empirical treatment for tuberculosis as compared with treatment guided by testing in HIV-infected adults who had not previously received ART and had CD4+ T-cell counts below 100 cells per cubic millimeter. Patients recruited in Ivory Coast, Uganda, Cambodia, and Vietnam were randomly assigned in a 1:1 ratio to undergo screening (Xpert MTB/RIF test, urinary lipoarabinomannan test, and chest radiography) to determine whether treatment for tuberculosis should be started or to receive systematic empirical treatment with rifampin, isoniazid, ethambutol, and pyrazinamide daily for 2 months, followed by rifampin and isoniazid daily for 4 months. The primary end point was a composite of death from any cause or invasive bacterial disease within 24 weeks (primary analysis) or within 48 weeks after randomization. RESULTS: A total of 522 patients in the systematic-treatment group and 525 in the guided-treatment group were included in the analyses. At week 24, the rate of death from any cause or invasive bacterial disease (calculated as the number of first events per 100 patient-years) was 19.4 with systematic treatment and 20.3 with guided treatment (adjusted hazard ratio, 0.95; 95% confidence interval [CI], 0.63 to 1.44). At week 48, the corresponding rates were 12.8 and 13.3 (adjusted hazard ratio, 0.97 [95% CI, 0.67 to 1.40]). At week 24, the probability of tuberculosis was lower with systematic treatment than with guided treatment (3.0% vs. 17.9%; adjusted hazard ratio, 0.15; 95% CI, 0.09 to 0.26), but the probability of grade 3 or 4 drug-related adverse events was higher with systematic treatment (17.4% vs. 7.2%; adjusted hazard ratio 2.57; 95% CI, 1.75 to 3.78). Serious adverse events were more common with systematic treatment. CONCLUSIONS: Among severely immunosuppressed adults with HIV infection who had not previously received ART, systematic treatment for tuberculosis was not superior to test-guided treatment in reducing the rate of death or invasive bacterial disease over 24 or 48 weeks and was associated with more grade 3 or 4 adverse events. (Funded by the Agence Nationale de Recherches sur le Sida et les Hépatites Virales; STATIS ANRS 12290 ClinicalTrials.gov number, NCT02057796.).


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antirretrovirais/uso terapêutico , Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Hospedeiro Imunocomprometido , Tuberculose/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Adulto , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Contagem de Linfócito CD4 , Feminino , HIV , Infecções por HIV/complicações , Infecções por HIV/mortalidade , Humanos , Masculino , Tuberculose/complicações , Tuberculose/diagnóstico , Tuberculose/mortalidade , Carga Viral
7.
Lancet HIV ; 7(7): e514-e520, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32473102

RESUMO

Patients with advanced HIV disease have a high risk of mortality, mainly from tuberculosis and cryptococcal meningitis. The advanced HIV disease management package recommended by WHO, which includes diagnostics, therapeutics, and patient psychosocial support, is barely implemented in many different countries. Here, we present a framework for the implementation of advanced HIV disease diagnostics. Laboratory and point-of-care-based reflex testing, coupled with provider-initiated requested testing, for cryptococcal antigen and urinary Mycobacterium tuberculosis lipoarabinomannan antigen, should be done for all patients with CD4+ cell counts of 200 cells per µL or less. Implementation of the advanced HIV disease package should be encouraged within primary health-care facilities and task shifting of testing to lay cadres could facilitate access to rapid results. Implementation of differentiated antiretroviral therapy delivery models can allow clinicians enough time to focus on the management of patients with advanced HIV disease. Efficient up-referral and post-discharge systems, including the development of patient-centric advanced HIV disease literacy, are also crucial. Implementation of the advanced HIV disease package is feasible at all health-care levels, and it should be part of the core of the global response towards ending AIDS as a public health threat.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Antirretrovirais/uso terapêutico , Antígenos de Fungos/imunologia , Infecções por HIV/diagnóstico , Implementação de Plano de Saúde , Tuberculose/diagnóstico , África ao Sul do Saara/epidemiologia , Assistência ao Convalescente , Instituições de Assistência Ambulatorial , Contagem de Linfócito CD4 , Infecções por HIV/complicações , Infecções por HIV/mortalidade , Humanos , Alta do Paciente , Testes Imediatos
9.
Rev. iberoam. micol ; 37(1): 28-33, ene.-mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193843

RESUMO

ANTECEDENTES: La histoplasmosis diseminada (HD) es una infección fúngica oportunista en pacientes con infección por VIH gravemente inmunocomprometidos. El síndrome hemofagocítico (SHF), que puede presentarse en estos pacientes coinfectados cuando la respuesta inmunitaria está significativamente alterada, suele estar asociado a una elevada mortalidad. OBJETIVOS: Describir las características epidemiológicas, clínicas, analíticas y microbiológicas, así como evaluar la presencia de SHF, en pacientes con HD-VIH. MÉTODOS: Estudio retrospectivo de serie de casos, consistente en la revisión de registros clínicos de pacientes con diagnóstico de HD e infección VIH, durante los años 2014 y 2015. RESULTADOS: El 1,3% (8/597) de los pacientes VIH presentaron HD. El 100% se hallaban en estadio C3 y el 75% (6/8) no se encontraban en terapia antirretroviral combinada (TARVc). Los dos pacientes restantes habían comenzado recientemente el tratamiento con TARVc (posible síndrome de reconstitución inmunológica). El 62,5% (5/8) cumplieron con criterios diagnósticos de SHF. Las manifestaciones clínicas más frecuentes fueron el síndrome linfoproliferativo y consuntivo, el compromiso respiratorio y la citopenia. En el 75% (6/8) de los pacientes se aisló Histoplasma en ganglios, en el 25% (2/8) en muestras hemáticas y en uno adicionalmente en tejido intestinal. La terapia antifúngica fue anfotericina B desoxicolato; no se emplearon adyuvantes. La mortalidad global fue del 50%. CONCLUSIONES: En nuestra serie la coinfección HD-VIH progresó en la mayoría de los casos a SHF con elevada mortalidad. El cuadro clínico puede asemejarse al de otras enfermedades sistémicas, como la tuberculosis, o presentarse simultáneamente a ellas. Con el fin de obtener un diagnóstico precoz y poder prescribir la terapia específica oportuna es importante poseer un adecuado índice de sospecha en pacientes con síndrome linfoproliferativo y consuntivo asociado a citopenia grave


BACKGROUND: Disseminated histoplasmosis (DH) is an opportunistic fungal infection in severely immunocompromised patients with HIV infection. Haemophagocytic syndrome (HFS), which can occur in these co-infected patients when the immune response is significantly altered, is often associated with high mortality. AIMS: To describe the epidemiological, clinical, analytical and microbiological characteristics, along with studying the presence of HFS, in patients with DH-HIV. METHODS: A retrospective study was conducted on a case series using data from the clinical records of patients diagnosed with DH and HIV infection during the years 2014 and 2015. RESULTS: DH was diagnosed in 8 (1.3%) of 597 HIV patients. All patients were in stage C3, and 75% (6/8) were not receiving combined antiretroviral therapy (CART). The remaining two patients had recently begun CART (possible immune reconstitution syndrome). Five (62.5%) of the 8 patients met criteria for HFS. The most frequent clinical symptoms were lymphoproliferative and consumptive syndrome, respiratory compromise, and cytopenia. Histoplasma was isolated in lymph nodes of 75% (6/8) of the patients, in blood samples in 25% (2/8), and also in intestinal tissue in one patient. The antifungal therapy was amphotericin B deoxycholate, without adjuvants. The overall mortality was 50%. CONCLUSIONS: In this case series, DH-HIV co-infection frequently progressed to HFS with high mortality. The clinical picture may resemble that of other systemic opportunistic infections, such as tuberculosis, or can take place simultaneously with other infections. Clinical suspicion is important in patients with severe cytopenia and lymphoproliferative and consumptive syndrome in order to establish an early diagnosis and prescribing a timely specific therapy


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Histoplasmose/diagnóstico , Linfo-Histiocitose Hemofagocítica/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Estudos Retrospectivos , Peru
10.
BMC Infect Dis ; 20(1): 141, 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32059703

RESUMO

BACKGROUND: The global annual estimate for cryptococcal disease-related deaths exceeds 180,000, with three fourth occurring in sub-Saharan Africa. The World Health Organization (WHO) recommends cryptococcal antigen (CrAg) screening in all HIV patients with CD4 count < 100/µl. As there is no previous published study on the burden and impact of cryptococcal disease in Sierra Leone, research is needed to inform public health policies. We aimed to establish the seroprevalence and mortality of cryptococcal disease in adults with advanced HIV attending an urban tertiary hospital in Sierra Leone. METHODS: A prospective cohort study design was used to screen consecutive adult (18 years or older) HIV patients at Connaught Hospital in Freetown, Sierra Leone with CD4 count below 100 cells/mm3 from January to April 2018. Participants received a blood CrAg lateral flow assay (IMMY, Oklahoma, USA). All participants with a positive serum CrAg had lumbar puncture and cerebrospinal fluid (CSF) CrAg assay, and those with cryptococcal diseases had fluconazole monotherapy with 8 weeks followed up. Data were entered into Excel and analysed in Stata version 13.0. Proportions, median and interquartile ranges were used to summarise the data. Fisher's exact test was used to compare categorical variables. RESULTS: A total of 170 patients, with median age of 36 (IQR 30-43) and median CD4 count of 45 cells/mm3 (IQR 23-63) were screened. At the time of enrolment, 54% were inpatients, 51% were newly diagnosed with HIV, and 56% were either ART-naïve or newly initiated (≤ 30 days). Eight participants had a positive blood CrAg, giving a prevalence of 4.7% (95% CI: 2.4-9.2%). Of those with a positive CrAg, CSF CrAg was positive in five (62.5%). Five (62.5%) CrAg-positive participants died within the first month, while the remaining three were alive and established on ART at 8 weeks. CONCLUSION: A substantial prevalence of cryptococcal antigenaemia and poor outcome of cryptococcal disease were demonstrated in our study. The high mortality suggests a need for the HIV programme to formulate and implement policies on screening and pre-emptive fluconazole therapy for all adults with advanced HIV in Sierra Leone, and advocate for affordable access to effective antifungal therapies.


Assuntos
Antígenos de Fungos/sangue , Criptococose/epidemiologia , Infecções por HIV/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Adulto , Antifúngicos/uso terapêutico , Estudos Transversais , Criptococose/diagnóstico , Criptococose/tratamento farmacológico , Criptococose/mortalidade , Cryptococcus , Feminino , Fluconazol/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/tratamento farmacológico , Meningite Criptocócica/epidemiologia , Prevalência , Estudos Prospectivos , Estudos Soroepidemiológicos , Serra Leoa/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos
13.
BMC Oral Health ; 20(1): 13, 2020 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-31937291

RESUMO

BACKGROUND: The aim of this study was to evaluate the dentists' knowledge and practice regarding HIV positive individuals' oral care in Rio de Janeiro State. METHODS: Dentists from Rio de Janeiro State (n = 242) answered an electronic questionnaire on biosafety procedures, oral manifestations of AIDS, and knowledge of HIV infection. Collected information was stratified by gender, and data were analyzed using Chi-square and t tests. RESULTS: From the 14 oral manifestations investigated, oral candidiasis, necrotizing ulcerative gingivitis, and hairy leucoplakia were more associated with HIV, with no differences between the responses from men and women. Above 85% of the participants would be concerned about becoming infected with HIV after a needle/ sharp object injury and more than 80% of them were willing to be tested for HIV. However, significantly more women (98.8%), compared to men (91.3%), said they knew that HIV/ AIDS patients can contaminate dental care professionals, p = 0.007. There was a significant difference in the answers for the questions: "Are there special dental clinics for treatment of HIV/AIDS patients in Brazil?" (p = 0.044), and "Do the negative HIV tests surely indicate that the persons are free of viruses?" (p = 0.005). Significant differences between men and women were also observed regarding use of disposable mask (p = 0.01), and cap (p < 0.0001). CONCLUSION: Most dentists who participated in the study presented a good knowledge on the care of HIV/ AIDS individuals, including biosafety protocols and in terms of the oral manifestations commonly associated to AIDS.


Assuntos
Relações Dentista-Paciente , Odontólogos/psicologia , Infecções por HIV/complicações , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Saúde Bucal , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Adulto , Idoso , Brasil , Criança , Assistência Odontológica para Doentes Crônicos , Feminino , Infecções por HIV/transmissão , Humanos , Controle de Infecções Dentárias , Masculino , Doenças da Boca/diagnóstico , Doenças da Boca/etiologia , Prática Profissional , Inquéritos e Questionários , Precauções Universais
14.
Vasc Endovascular Surg ; 54(2): 191-194, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31578128

RESUMO

Aortic graft infections are uncommon complications after endovascular aortic surgery. In the majority of cases, gram-positive and then gram-negative organisms are the causative agents leading to this condition. Atypical organisms are traditionally not responsible for graft infection unless the patient is immunocompromised. We are reporting a case of culture-confirmed mycobacterium avium complex infection of an aortic graft in a well-controlled patient with HIV who had an undetected viral load and a CD4 count of 324 while on highly active antiretroviral therapy.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Infecções por HIV/tratamento farmacológico , Complexo Mycobacterium avium/patogenicidade , Infecção por Mycobacterium avium-intracellulare/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/terapia , Adulto , Antibacterianos/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Implante de Prótese Vascular/instrumentação , Remoção de Dispositivo , Infecções por HIV/diagnóstico , Infecções por HIV/imunologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Complexo Mycobacterium avium/imunologia , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Infecção por Mycobacterium avium-intracellulare/imunologia , Infecção por Mycobacterium avium-intracellulare/terapia , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/imunologia , Infecções Relacionadas à Prótese/terapia , Resultado do Tratamento
15.
J Mycol Med ; 30(1): 100916, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31843296

RESUMO

Here, we describe an invasive infection due to Trichosporon coremiiforme in an HIV positive patient with neutropenia. The strain was first erroneously identified as Trichosporon asahii by conventional methods, but correctly identified by mass spectrometry using matrix-assisted laser desorption/ionization time-of-flight technology (MALDI-TOF MS) and ribosomal DNA sequencing. The infection was successfully resolved after antifungal treatment with amphotericin B and fluconazole. This case report is a contribution to the study of T. coremiiforme infections and reinforces its relevance as a species capable of causing invasive human infection in immunocompromised patients and also contributes to the study of its susceptibility profile against antifungal drugs.


Assuntos
Infecções Relacionadas a Cateter/diagnóstico , Infecções por HIV/complicações , Neutropenia/complicações , Tricosporonose/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/sangue , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Anfotericina B/administração & dosagem , Antituberculosos/administração & dosagem , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/complicações , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/microbiologia , Cateteres Venosos Centrais/efeitos adversos , Cateteres Venosos Centrais/microbiologia , Quimioterapia Combinada , Feminino , Fluconazol/administração & dosagem , HIV , Infecções por HIV/diagnóstico , Infecções por HIV/microbiologia , Humanos , Hospedeiro Imunocomprometido , Pessoa de Meia-Idade , Neutropenia/diagnóstico , Neutropenia/microbiologia , Neutropenia/virologia , Trichosporon/isolamento & purificação , Tricosporonose/tratamento farmacológico , Tricosporonose/etiologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/microbiologia
16.
Artigo em Inglês | LILACS, Sec. Est. Saúde SP, SESSP-IALPROD, Sec. Est. Saúde SP | ID: biblio-1121320

RESUMO

Difficulties in confirming and discriminating human T-cell lymphotropic virus type 1 (HTLV-1) and HTLV-2 infections by serological Western blot (WB) assays (HTLV Blot 2.4; MP Biomedicals) have been reported in Brazil, mainly in HIV/AIDS patients, with a large number of WB-indeterminate and WB-positive but HTLV-untypeable results. Nonetheless, a line immunoassay (LIA) (INNO-LIA HTLV-I/II; Fujirebio) provided enhanced specificity and sensitivity for confirming HTLV-1/2 infections. To add information concerning the improved ability of the LIA in relation to WB when applied to samples of individuals from different risk groups from Brazil, we performed the present study. Three groups were analyzed group 1 (G1), with 62 samples from HIV/AIDS patients from São Paulo, SP (48 WB indeterminate and 14 HTLV untypeable); group 2 (G2), with 24 samples from patients with hepatitis B or hepatitis C from São Paulo (21 WB indeterminate and 3 HTLV untypeable; 17 HIV seropositive); and group 3 (G3), with 25 samples from an HTLV outpatient clinic in Salvador, Bahia (16 WB indeterminate and 9 HTLV untypeable; all HIV seronegative). Overall, the LIA confirmed HTLV-1/2 infection (HTLV-1, HTLV-2, or HTLV) in 66.1% (G1), 83.3% (G2), and 76.0% (G3) of samples. Interestingly, the majority of WB-indeterminate results were confirmed by the LIA as being HTLV-2 positive in G1 and G2 but not in G3, in which the samples were defined as being HTLV-1 or HTLV positive. These results agree with the virus types that circulate in such patients of different regions in Brazil and emphasize that the LIA is the bes


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Infecções por HTLV-I/diagnóstico , Infecções por HTLV-II/diagnóstico , Hepatite C , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Hepatite B , Imunoensaio , Western Blotting , Sensibilidade e Especificidade , Coinfecção
17.
BMC Infect Dis ; 19(1): 1051, 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31830905

RESUMO

BACKGROUND: Cryptococcal prostatitis is a rare clinical disease and has never been reported in China. CASE PRESENTATION: We report on a male HIV-infected patient with pulmonary and prostate cryptococcosis that was misdiagnosed (as tuberculosis) and delayed diagnosed. Although the patients accepted anti-fungal treatment and anti-retroviral treatment finally, the physician's mistakes reflect the rarity of this condition in China. CONCLUSION: Cryptococcal prostatitis is a rare disease that unusually presents in immunodeficient patients. Physicians should have a heightened awareness of this particular infection in the immunodeficient population.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Criptococose/diagnóstico , Cryptococcus neoformans/isolamento & purificação , Pneumonia por Pneumocystis/diagnóstico , Prostatite/diagnóstico , Retenção Urinária/diagnóstico , Retenção Urinária/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , China , Criptococose/complicações , Criptococose/tratamento farmacológico , Diagnóstico Tardio , Erros de Diagnóstico , Fluconazol/administração & dosagem , Fluconazol/uso terapêutico , Flucitosina/administração & dosagem , Flucitosina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/microbiologia , Prostatite/tratamento farmacológico , Prostatite/microbiologia , Resultado do Tratamento , Voriconazol/administração & dosagem , Voriconazol/uso terapêutico
18.
J Immunol Res ; 2019: 8105075, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886310

RESUMO

Background and Objectives: Pneumocystis pneumonia (PCP) is a common opportunistic infection in acquired immune deficiency syndrome (AIDS) patients that continues to result in a high mortality rate. To develop a better treatment strategy and improve PCP prognosis, a cohort study was conducted to evaluate the therapeutic potential of echinocandin treatment for AIDS patients with PCP (AIDS-PCP). Methods: The AIDS-PCP patients were analyzed in our retrospective cohort study that were hospitalized in The First Affiliated Hospital of Zhejiang University during 2013-2018. The antifungal effects of echinocandins were evaluated in two subgroups that were classified by oxygenation as a proxy for the disease state: PaO2/FiO2 > 200 mmHg and PaO2/FiO2 ≤ 200 mmHg. Intergroup comparisons and survival curves were used to evaluate the effectiveness of the two AIDS-PCP treatment regimens. Results: During the follow-up, 182 AIDS-PCP patients were diagnosed and analyzed in the study. After excluding 55 patients with other superinfections and five patients that were treated with HAART, the remaining 122 patients were enrolled in the study. The group treated with echinocandins combined with trimethoprim-sulfamethoxazole (TMP-SMZ) and clindamycin exhibited a lower mortality rate (9.62%, 5/52) than did the group with TMP-SMZ and clindamycin treatment (20%, 14/70). For AIDS-PCP patients in the PaO2/FiO2 > 200 mmHg subgroup, treatment with echinocandins combined with TMP-SMZ and clindamycin significantly reduced their mortality rate (4.44% (2/45) vs. 18.18% (10/55), P = 0.035). Conclusion: The results of this study indicate that treatment with echinocandins in combination with the standard TMP-SMZ and clindamycin regimen can improve the prognosis and reduce the mortality rate in patients with mild to moderate AIDS-PCP disease.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Clindamicina/uso terapêutico , Equinocandinas/uso terapêutico , Pneumonia por Pneumocystis/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Adulto , Antifúngicos/uso terapêutico , Clindamicina/administração & dosagem , Clindamicina/efeitos adversos , Quimioterapia Combinada , Equinocandinas/administração & dosagem , Equinocandinas/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/etiologia , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos
19.
S Afr Med J ; 110(1): 10-15, 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31865936

RESUMO

BACKGROUND: Effective combination antiretroviral therapy (cART) has tremendously reduced HIV-associated morbidity, mortality and mother-to-child transmission. However, the benefits of cART are threatened by comorbidities, adverse drug reactions and virus resistance to existing treatment regimens. One of the most occurring comorbidities is cytomegalovirus (CMV) infection. OBJECTIVES: To investigate the effects of cART on the occurrence of CMV infection among pregnant women. METHODS: Using a cross-sectional study design, 175 HIV-infected pregnant women were recruited, and data were obtained from their clinical records. Blood samples were collected for host DNA, CMV DNA and plasma efavirenz (EFV) measurement. CMV DNA was measured using real-time polymerase chain reaction (PCR). CYP2B6 c.516G>T and CYP2B6 c.983T>C single nucleotide polymorphisms were characterised using PCR/restriction fragment length polymorphism and TaqMan assays, respectively. Plasma EFV concentrations were determined using high-performance liquid chromatography. RESULTS: There was an inverse association between plasma EFV concentration and CMV DNA. Participants with lower plasma EFV concentrations were significantly (p<0.001) more likely to be CMV DNA positive than those with higher plasma concentrations. This result is also supported by the observation that carriers of CYP2B6 poor-metaboliser genotypes (CYP2B6 c.516T/T and CYP2B6 c.983T/C) were less likely to be positive for CMV DNA. Furthermore, poor metabolism as denoted by CYP2B6 c.516T/T and CYP2B6 c.983T/C genotypes was significantly associated with lower CMV viral load. CONCLUSIONS: HIV treatment disrupts the balance between host and co-infecting microbes. Reduced or subtherapeutic levels of antiretroviral drugs, which could be exacerbated by genetic polymorphisms in drug metabolism genes and non-adherence, predispose infected individuals to an increased risk of CMV infection in pregnancy.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/etiologia , Benzoxazinas/farmacocinética , Coinfecção/etiologia , Infecções por Citomegalovirus/etiologia , Complicações Infecciosas na Gravidez/etiologia , Inibidores da Transcriptase Reversa/farmacocinética , Infecções Oportunistas Relacionadas com a AIDS/sangue , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Adulto , Benzoxazinas/sangue , Benzoxazinas/uso terapêutico , Coinfecção/sangue , Coinfecção/diagnóstico , Coinfecção/prevenção & controle , Estudos Transversais , Infecções por Citomegalovirus/sangue , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/prevenção & controle , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/prevenção & controle , Inibidores da Transcriptase Reversa/sangue , Inibidores da Transcriptase Reversa/uso terapêutico , Fatores de Risco
20.
Fontilles, Rev. leprol ; 32(3): 163-168, sept.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-189963

RESUMO

El síndrome de inmunodeficiencia humana conocido por las siglas SIDA, y la lepra son enfermedades estigmatizadas por la sociedad lo que se debe, fundamentalmente al impacto social producido por dichas entidades. La lepra ha afligido a la humanidad desde tiempos inmemorables. Se trata de un paciente blanco, masculino, de 24 años de edad, con antecedentes de ser VIH positivo, que marcó SIDA, desde hace aproximadamente cinco años, que acude a consulta por presentar lesiones nodulares de diferentes tamaños, localizadas en miembros superiores y en cara principalmente en la frente, pabellones auriculares y cejas, las cuales no pican ni duelen, algunas se encuentran exulceradas y tienen una evolución de aproximadamente un año. Al examen dermatológico se constata cuadro cutáneo diseminado, caracterizado por la presencia de nódulos eritematosos, con trastornos de la sensibilidad, en número y tamaños variables a nivel en miembros superiores y en cara principalmente en la frente, pabellones auriculares y cejas, algunos de los cuales presentan exulceraciones centrales y en otras costras hemáticas. Se constata además infiltración del rostro a nivel de los salientes, atrofia de la región tenar e hipotenar, nervios cubitales engrosados, no dolorosos, de forma simétrica y bilateral. Esta forma clínica suele presentarse en forma de placas, máculas, pápulas, nódulos, variables en número, de distribución simétrica y bilateral que pueden o no acompañarse de áreas con anestesia. Pueden afectarse numerosos nervios y la baciloscopía suele ser positiva. La infección por VIH/SIDA afecta la inmunidad celular mediada por linfocitos T CD4+. Los pacientes portadores de VIH/SIDA, al cual se le diagnostica lepra, pueden presentar síndrome inflamatorio de reconstitución inmunitaria tras iniciar el tratamiento


The human immunodeficiency syndrome known by the acronym AIDS, and leprosy are diseases stigmatized by society, which is mainly due to the social impact produced by these entities. Leprosy has afflicted humanity since time immemorial. We report a case of a white male patient, 24 years old, with a history of being HIV positive, and diagnosed of AIDS approximately five years ago who attended the clinic for presenting nodular lesions of different sizes. They were located in upper limbs and in face mainly on the forehead, ear pavilions and eyebrows. They do not itch or hurt; some are ulcerated and have an evolution of approximately one year. The dermatological examination shows disseminated cutaneous symptoms, characterized by the presence of erythematous nodules, with variable sensitivity disorders of the upper limbs and in the face mainly on the forehead, ear pavilions and eyebrows, some of which have central ulcerations and blood scabs. He also presented infiltration on the face, atrophy of the tenar and hypothenar region, thickened symmetrically and bilaterally but not painful ulnar nerves. This clinical type usually occurs in the form of plaques, macules, papules, nodules, variable in number with symmetrical and bilateral distribution that may or may not be accompanied by areas with anesthesia. Several nerves can be affected and the skin smear is usually positive. HIV/AIDS infection affects cell immunity mediated by CD4 + T cells. Patients with HIV/AIDS, who are diagnosed with leprosy, may present immune reconstitution inflammatory syndrome after starting treatment


Assuntos
Humanos , Masculino , Adulto Jovem , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Hanseníase/diagnóstico
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