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1.
J Acquir Immune Defic Syndr ; 87(5): 1167-1172, 2021 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-34229329

RESUMO

BACKGROUND: Data on clinical characteristics and outcomes of people living with HIV (PLWH) hospitalized with coronavirus disease 2019 (COVID-19) who develop acute kidney injury (AKI) are limited. SETTING: Large tertiary health care system in the Bronx, NY. METHODS: We performed a retrospective cohort study of 83 PLWH and 4151 patients without HIV hospitalized with COVID-19 from March 10, 2020, to May 11, 2020. We compared the clinical characteristics and outcomes associated with AKI by HIV serostatus and evaluated HIV-related factors for AKI among PLWH. AKI was defined and staged using Kidney Disease Improving Global Outcomes criteria. RESULTS: The incidence of AKI in hospitalized patients with COVID-19 did not differ significantly by HIV serostatus (54.2% in PLWH vs 49.5% in patients without HIV, P = 0.6). Despite a higher incidence of stage 3 AKI (28.9% vs 17.1% P = 0.05) in PLWH compared with those without HIV, there was no significant difference in the need for renal replacement therapy (22.2% vs 13.4% P = 0.12), renal recovery (76.9% vs 82.5% P = 0.61), or dependence on renal replacement therapy (7.7% vs 3.8% P = 0.27). CD4 T-cell count, HIV-1 RNA viral suppression, and antiretroviral therapy use were not associated with AKI. AKI was associated with increased need for invasive ventilation and in-hospital death, but HIV was not an independent risk factor of in-hospital death after AKI [adjusted hazard ratio 1.01 (95% CI: 0.59 to 1.72), P = 0.98]. CONCLUSIONS: HIV-related factors were not associated with increased risk of AKI in PLWH hospitalized with COVID-19. PLWH hospitalized with COVID-19 had more stage 3 AKI, but outcomes after AKI were similar to those without HIV.


Assuntos
Injúria Renal Aguda/tratamento farmacológico , COVID-19/complicações , Infecções por HIV/tratamento farmacológico , Injúria Renal Aguda/complicações , Injúria Renal Aguda/epidemiologia , Idoso , Antirreumáticos/uso terapêutico , COVID-19/epidemiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
2.
Rev Soc Bras Med Trop ; 54: e00762021, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34231771

RESUMO

INTRODUCTION: Leptospirosis and brucellosis cause immunosuppression that worsens the clinical condition of people living with HIV/AIDS (PLWHA). We investigated the serological profile and risk factors of PLWHA. METHODS: Serum samples (n=238) were researched for Brucella spp. antibodies using Rose Bengal and tube agglutination tests and Leptospira spp. antibodies using the microscopic agglutination test. RESULTS: All samples were negative for Brucella spp. For leptospirosis, four samples (1.69%) were positive, and Andamana was the prevalent serovar. CONCLUSIONS: Low or no detection of these zoonoses does not reduce their importance in PLWHA. Vigilant, educational, and preventive measures should be adopted.


Assuntos
Brucelose , Infecções por HIV , Leptospira , Leptospirose , Testes de Aglutinação , Animais , Anticorpos Antibacterianos , Brasil/epidemiologia , Brucelose/complicações , Brucelose/epidemiologia , HIV , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Hospitais , Humanos , Leptospirose/complicações , Leptospirose/epidemiologia , Encaminhamento e Consulta , Fatores de Risco
3.
J Med Case Rep ; 15(1): 341, 2021 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-34243803

RESUMO

INTRODUCTION: Since its debut recognition in 1981, human immunodeficiency virus/acquired immunodeficiency syndrome has affected over 77 million people and has resulted in premature cessation of 35.4 million lives worldwide. Commonly, human immunodeficiency virus is transmitted by sexual contact across mucosal surfaces, by sharing of injecting equipment, through contaminated blood transfusions, and by maternal-infant exposure. Nevertheless, accidental transmission incidences involving family members are rare but possible. CASE PRESENTATION: A 78-year-old woman of African descent from Mtwara Region south of Tanzania was referred to us for further evaluation and treatment. She is 30 years postmenopausal and has a 35-year history of hypertension. Her last attendance to our institute was 11 months prior the index visit and she tested negative for human immunodeficiency virus. She came with complaints of weight loss, recurrent fevers, and cough. Her hematological tests revealed leukopenia with lymphocytosis, together with a normocytic normochromic anemia. Enzyme-linked immunosorbent assay for human immunodeficiency virus was positive, and she had a CD4 count of 177 cells/µL. We went back to history taking to identify the potential source of infection. We were informed that for the past 6 months, the 78-year-old lady has been living with her unwell 24-year-old granddaughter who has been divorced. The granddaughter had a history of recurrent fevers, significant weight loss, and a suppurative skin condition. As a way to show love and care, the old lady was puncturing the suppurative lesions with bare hands; then she would suck them to clear away the discharge. We requested to see the young lady, and she tested positive for human immunodeficiency virus. Both were started on tenofovir/lamivudine/dolutegravir combination plus cotrimoxazole 960 mg. The family was in total disarray following these findings. The patient was discharged through infectious diseases department and died of Pneumocystis jirovecii pneumonia 12 weeks later. CONCLUSIONS: Certain sociocultural norms that are believed to express love, care, and togetherness in developing rural communities, particularly Sub-Saharan Africa, have a potential of spreading human immunodeficiency virus, thus warranting prompt transformation.


Assuntos
Avós , Infecções por HIV , Adulto , Idoso , Contagem de Linfócito CD4 , Feminino , HIV , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Tanzânia , Adulto Jovem
4.
Blood Adv ; 5(13): 2701-2706, 2021 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-34196676

RESUMO

Betibeglogene autotemcel (beti-cel) gene therapy (GT) for patients with transfusion-dependent ß-thalassemia uses autologous CD34+ cells transduced with BB305 lentiviral vector (LVV), which encodes a modified ß-globin gene. BB305 LVV also contains select HIV sequences for viral packaging, reverse transcription, and integration. This case report describes a patient successfully treated with beti-cel in a phase 1/2 study (HGB-204; #NCT01745120) and subsequently diagnosed with wild-type (WT) HIV infection. From 3.5 to 21 months postinfusion, the patient stopped chronic red blood cell transfusions; total hemoglobin (Hb) and GT-derived HbAT87Q levels were 6.6 to 9.5 and 2.8 to 3.8 g/dL, respectively. At 21 months postinfusion, the patient resumed transfusions for anemia that coincided with an HIV-1 infection diagnosis. Quantitative polymerase chain reaction assays detected no replication-competent lentivirus. Next-generation sequencing confirmed WT HIV sequences. Six months after starting antiretroviral therapy, total Hb and HbAT87Q levels recovered to 8.6 and 3.6 g/dL, respectively, and 3.5 years postinfusion, 13.4 months had elapsed since the patient's last transfusion. To our knowledge, this is the first report of WT HIV infection in an LVV-based GT recipient and demonstrates persistent long-term hematopoiesis after treatment with beti-cel and the ability to differentiate between WT HIV and BB305-derived sequences.


Assuntos
Infecções por HIV , Talassemia beta , Terapia Genética , Vetores Genéticos/genética , Infecções por HIV/complicações , Infecções por HIV/terapia , Humanos , Lentivirus/genética , Talassemia beta/genética , Talassemia beta/terapia
5.
Front Cell Infect Microbiol ; 11: 701913, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34262882

RESUMO

Increasing attention has been directed to Talaromyces marneffei (T. marneffei) infection in HIV-negative patients due to its high mortality rate. However, nonspecific symptoms and biological characteristics similar to those of other common pathogenic fungi complicate the rapid and accurate diagnosis of T. marneffei infection. Sphingolipids (SPLs) are bioactive lipids involved in the regulation of various physiological and pathological processes and have been identified as serum biomarkers for several diseases. This study employed a sphingolipidomic approach established in our previous work to explore the use of serum SPLs in the diagnosis of HIV-negative patients with T. marneffei infection. Additional clinical cohorts of patients infected with other microorganisms were also recruited. We found that sphinganine (Sa) (d16:0) exhibited obvious depletion after infection; moreover, its level in patients with T. marneffei infection was significantly lower than that in patients infected with other microorganisms. Therefore, Sa (d16:0) was considered a specific diagnostic biomarker for T. marneffei infection, and 302.71 nM was selected as the optimal cutoff value with a diagnostic sensitivity of 87.5% and specificity of 100%. These results suggested that determination of serum Sa (d16:0) levels can be used as a new alternative tool for the rapid diagnosis of T. marneffei infection in HIV-negative patients.


Assuntos
Infecções por HIV , Talaromyces , Adulto , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Humanos , Micoses , Esfingolipídeos
6.
Viruses ; 13(7)2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34209711

RESUMO

In stark contrast to the rapid development of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an effective human immunodeficiency virus (HIV) vaccine is still lacking. Furthermore, despite virologic suppression and CD4 T-cell count normalization with antiretroviral therapy (ART), people living with HIV (PLWH) still exhibit increased morbidity and mortality compared to the general population. Such differences in health outcomes are related to higher risk behaviors, but also to HIV-related immune activation and viral coinfections. Among these coinfections, cytomegalovirus (CMV) latent infection is a well-known inducer of long-term immune dysregulation. Cytomegalovirus contributes to the persistent immune activation in PLWH receiving ART by directly skewing immune response toward itself, and by increasing immune activation through modification of the gut microbiota and microbial translocation. In addition, through induction of immunosenescence, CMV has been associated with a decreased response to infections and vaccines. This review provides a comprehensive overview of the influence of CMV on the immune system, the mechanisms underlying a reduced response to vaccines, and discuss new therapeutic advances targeting CMV that could be used to improve vaccine response in PLWH.


Assuntos
Coinfecção/virologia , Infecções por Citomegalovirus/virologia , Citomegalovirus/imunologia , Infecções por HIV/virologia , Vacinas/imunologia , Animais , Fármacos Anti-HIV/uso terapêutico , Ensaios Clínicos como Assunto , Citomegalovirus/patogenicidade , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/imunologia , Trato Gastrointestinal/imunologia , Trato Gastrointestinal/patologia , Trato Gastrointestinal/virologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Humanos , Imunossenescência , Inflamação , Infecção Latente/imunologia , Infecção Latente/virologia , Camundongos , Vacinas/administração & dosagem
7.
Georgian Med News ; (314): 56-63, 2021 May.
Artigo em Russo | MEDLINE | ID: mdl-34248028

RESUMO

Oral manifestations of HIV infection are diverse and not still not completely studied. HIV-associated diseases can occur as the first symptoms of infection, these are characterized by high frequency, clinical polymorphism and pronounced course. Periodontal aspects are also neglected in the literature. No papers on the condition of different areas of the oral mucosa, tongue and periodontium where they were studied simultaneously and according to various criteria have been found in the available literature. The objective of the research is to evaluate the condition of periodontium and the oral mucosa in different parts of the oral cavity in HIV-positive patients. Total number of the HIV-positive patients observed was 90, among them 81 males and 9 females between the age range of 24-62. An average age of the patients was 45.2±8.34, with male patients prevailing (p<0.001). HIV infection was diagnosed by Western-blot reaction. Clinical examination as well as probing and determination of the pocket depth by means of the periodontal probe was carried out to assess the health status of the oral cavity. Periodontal indices were also determined. It has been found that immunocompromised condition due to HIV infection contributes to the oral mucosa lesions. Namely, coated tongue was observed in 100% of cases, the oral mucosa relief impairment was seen in 75.6% of cases, lip cracks of different location and bright red color of the mucous membrane were observed in 73.3% and 82.2%, respectively (р<0.001). Examination of the tongue revealed the symptoms which were not found in the control group, such as tongue coating - in 100% (90 patients observed), epithelial desquamation foci - in 54.4% (49) (p<0.001). Inflammatory diseases of periodontium, particularly catarrhal and hypertrophic gingivitis and periodontitis of moderate severity were also revealed.


Assuntos
Gengivite , Infecções por HIV , Periodontite , Feminino , Gengivite/complicações , Gengivite/epidemiologia , Infecções por HIV/complicações , Humanos , Masculino , Saúde Bucal , Periodonto
8.
Artigo em Inglês | MEDLINE | ID: mdl-34231822

RESUMO

Cryptococcal infection is a frequent cause of mortality in Brazilian HIV-infected patients. The present study aimed to evaluate the cost-effectiveness and budgetary impact of four cryptococcosis screening strategies in HIV-infected patients with CD4+ ≤ 200 cells/mm3, in Brazil. A Monte Carlo microsimulation was used to compare the following diagnostic tests: a systematic serum cryptococcal antigen (CRAG) screening with latex agglutination (CRAG-LA), a lateral flow immunochromatographic test (CRAG-LFA), India ink staining and no intervention. The rationale was that of the Unified Health System (SUS), and the time horizon was of one year for the intervention and of five years for the budgetary impact analysis (BIA). The effectiveness outcomes were years of life and years of life adjusted for quality (QALY). The cost-effectiveness analysis showed that the two cryptococcal antigen tests were cost-effective, presenting with superior results in comparison with India ink and no screening. CRAG-LFA, compared to CRAG-LA, has an incremental cost of US$0.25 and an incremental cost-effectiveness ratio of US$73.36 (considering the US dollar equal to 5 reais, the Brazilian current money). The probabilistic sensitivity analysis between CRAG-LFA and CRAG-LA, despite showing a high agreement between the two tests, indicated the superiority of CRAG-LFA. The BIA estimated that the incorporation of CRAG-LFA would have an additional cost of approximately U$S 10.4 million dollars in five years. These findings suggest that, for the group of studied patients, the adoption of CRAG-LFA and CRAG-LA are cost-effective, while the India ink test and no intervention are less effective strategies. The BIA showed that using the CRAG-LFA test for people living with HIV (PLHIV) with CD4+ ≤ 200 cells/mm3 could reduce costs for the Brazilian Unified Health System (SUS).


Assuntos
Infecções Oportunistas Relacionadas com a AIDS , Criptococose , Cryptococcus , Infecções por HIV , Meningite Criptocócica , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Antígenos de Fungos , Brasil , Contagem de Linfócito CD4 , Análise Custo-Benefício , Criptococose/diagnóstico , Infecções por HIV/complicações , Humanos
9.
BMC Infect Dis ; 21(1): 675, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34247583

RESUMO

BACKGROUND: Oral human papillomavirus (HPV) infection has been causally linked to a subset of oropharyngeal cancers in Western populations, and both oropharyngeal cancer and oral HPV infection are increased among HIV-positive individuals. India has high incidences of oral and oropharyngeal cancers, and Indian HIV-positive men who have sex with men (MSM) may be at increased risk of developing oropharyngeal cancers. However, there is little information available on the prevalence of oral HPV in this population. METHODS: We tested 302 HIV-positive Indian MSM for oral HPV infection using L1 HPV DNA PCR with probes specific for 29 types and a mixture of 10 additional types. CD4+ level and plasma HIV viral load (VL) were measured. Participants completed an interviewer-administered questionnaire including a sexual history. RESULTS: The prevalence of oral HPV was 23.7% (95% CI: 19-29%) and 2.4% of participants had oncogenic HPV types. No participants had oral HPV type 16 (HPV-16) and the prevalence of other anogenital HPV types was low. Participants with higher CD4+ levels had reduced odds of having any oral HPV infection (OR: 3.1 [1.4-6.9]) in multivariable analyses. CONCLUSIONS: This is the first report of oral HPV among Indian HIV-positive MSM. Our results show a high prevalence of oral HPV infection consistent with studies from Western populations. However, oncogenic anogenital HPV types were relatively uncommon in our study population. It is unknown what the impact of this distribution of oral HPV will be on oropharyngeal cancers. HIV-positive MSM in India should be monitored closely for oral and oropharyngeal pre-cancer and cancer.


Assuntos
Infecções por HIV/complicações , Doenças da Boca/epidemiologia , Infecções por Papillomavirus/epidemiologia , Minorias Sexuais e de Gênero , Estudos Transversais , Soropositividade para HIV/epidemiologia , Homossexualidade Masculina , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças da Boca/etiologia , Infecções por Papillomavirus/complicações , Prevalência , Fatores de Risco
10.
J Coll Physicians Surg Pak ; 30(7): 759-764, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34271772

RESUMO

BACKGROUND:  To evaluate the role of the traditional risk scoring system (TRSS) in detecting subclinical atherosclerosis in HIV (+) patients. STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Infectious Diseases Clinic, Izmir Katip Çelebi University, Atatürk Training and Research Hospital, from March 2017 to January 2018. METHODOLOGY: The patient group was formed with 52 HIV (+) patients, aged 18-60 years, and a control group was formed with 52 HIV (-) healthy volunteers. For all groups, there was no comorbid diseases or family history. Diabetes mellitus, hypertension, chronic kidney disease and cardiovascular disease were excluded from the two groups. Carotid intima-media thickness (CIMT) measurements were performed with high resolution B mode Doppler USG and patients with subclinical atherosclerosis were identified by the presence of atheroma plaque. RESULTS: The median right CIMT measurement was 0.91 (0.73-0.97) mm and the median left CIMT was 0.90 (0.73-0.98) mm in HIV (+) patients. The median values of CIMT on right and left sides in the control group were 0.77 (0.67-0.81) mm and 0.76 (0.70-0.81) mm. Atheroma plaque was detected in 13.5% of the HIV (+) patients and in none of the control group. Subclinical atherosclerosis was found in 51.9% of HIV (+) patients and this rate was 7.7% in the HIV (-) group (p<0.001). There was a weak correlation between CIMT and TRSS. CONCLUSION: In this study, the scoring systems (Framingham, ACC/AHA CVHRS) that determine the risk of cardiovascular disease recommended in current practice and the results of CIMT measurements were not found to be compatible. The development of new scoring systems including CIMT testing for the determination of this risk will open important new horizons. Key Words: AIDS, Cardiovascular disease, Subclinical atherosclerosis, CIMT.


Assuntos
Aterosclerose , Infecções por HIV , Aterosclerose/diagnóstico por imagem , Aterosclerose/epidemiologia , Espessura Intima-Media Carotídea , Estudos de Coortes , Infecções por HIV/complicações , Humanos , Fatores de Risco
11.
Vnitr Lek ; 67(E-4): 26-28, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34275316

RESUMO

The authors present a case report of 59-years-old woman examined for pancytopenia recently diagnosed during hospitalization for bilateral interstitial pneumonia without any confirmed etiological agents. Concomitantly, some systemic symptoms like lack of appetite and weight loss were present. Primary hematological disease was ruled out. Positivity of serological screening for HIV-1,2 was rather surprising. Absolute count of CD4+ lymphocytes was 8/μl. Thus, HIV infection was already in stage of AIDS and retrospectively, the interstitial pneumonia has to be judged as AIDS-indicative illness.


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Pancitopenia , Síndrome de Imunodeficiência Adquirida/complicações , Linfócitos T CD4-Positivos , Feminino , Infecções por HIV/complicações , Humanos , Pessoa de Meia-Idade , Pancitopenia/etiologia , Estudos Retrospectivos
12.
Medicina (Kaunas) ; 57(6)2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34200527

RESUMO

The pathophysiology of accelerated atherosclerosis in people living with Human Immunofediciency virus (HIV) is complex. Coronary artery disease (CAD) has become an important cause of mortality in these patients. They often have atypical symptoms, leading to frequently missed diagnoses. We report a case of a 51-year-old male undergoing antiretroviral therapy who was admitted for acute coronary syndrome. He had severe coronary artery disease that involved difficult management.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Infecções por HIV , Ponte de Artéria Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento
13.
BMC Infect Dis ; 21(1): 521, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078297

RESUMO

BACKGROUND: The clinical manifestations of recent syphilis can be variable, with typical and atypical patterns. Several conditions may cause atypical clinical aspects, including human immunodeficiency virus (HIV) co-infection. Besides the clinical features, co-infections may completely alter syphilis serological tests, causing interpretative difficulties and diagnostic delays. Aim of the work is to describe the difficulties encountered during the diagnostic evaluation of atypical skin manifestations and of the serology for syphilis of an HIV-infected patient who had contracted it several times. CASE PRESENTATION: In 2020, a 52-year old HIV-positive bisexual male patient was admitted to our department with a 4-month history of moderately itchy cutaneous lesions localized at his neck, trunk and arms. In 2013, the patient presented with a classic syphilitic roseola of the trunk and a secondary syphilis was diagnosed, with increased levels of rapid plasma reagin (RPR), Treponema pallidum hemagglutination assay (TPHA), anti-Treponema pallidum IgM and IgG Index. A second episode occurred in 2018, as a primary syphilis with multiple ulcerative lesions of the penis, and increased levels of RPR, IgG and IgM. In 2019, a further episode of secondary syphilis was treated with Doxycycline. In 2020, erythematous and papular lesions with vesicular components and urticarial erythema multiforme (EM)-like lesions were present at the neck, trunk and arms. Serological tests and Nucleic Acid Amplification Test (NAAT) for Treponema Pallidum were performed, as well as a cutaneous biopsy with histological and immunohistochemical evaluation of one lesion. NAAT was negative for T. pallidum. Serological test results were discordant with a new syphilis infection, showing only increased levels of RPR and anti-Treponema IgG. The cutaneous biopsy revealed a non specific histological pattern, while the immunohistochemical evaluation with anti-spirochetal antibodies was mandatory for the diagnosis of recent syphilis, showing clusters of rod-shaped elements, some of which with spiral form, focally present at the epidermis and adnexal structures. CONCLUSIONS: Nowadays, syphilis may present with atypical clinical and serological features. Physicians should be aware of these possible alterations and consider syphilis even in case of uncommon clinical aspect and unclear serological tests. Cutaneous biopsy and immunohistochemical exam may be mandatory for the diagnosis.


Assuntos
Sífilis/diagnóstico , Treponema pallidum/isolamento & purificação , Anticorpos Antibacterianos/sangue , Biópsia , Infecções por HIV/complicações , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Recidiva , Minorias Sexuais e de Gênero , Sífilis/patologia , Sorodiagnóstico da Sífilis , Treponema pallidum/imunologia
15.
Medicine (Baltimore) ; 100(26): e26507, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190180

RESUMO

ABSTRACT: We investigated the temporal trends of short-term mortality (death within 1 year of diagnosis) and cause-specific deaths in human immunodeficiency virus (HIV)-infected persons by stage of HIV infection at diagnosis. We also assessed the impact of late diagnosis (LD) on short-term mortality.Epidemiological records of HIV-infected Singapore residents from the National HIV Registry were linked to death records from the Registry of Births and Deaths for observational analyses. Newly-diagnosed HIV cases with available cluster of differentiation 4 count at time of diagnosis in a 5-year period from 2012 to 2016 were included in the study. Hazard ratios (HRs) and 95% confidence interval (CI) of LD for all deaths excluding suicides and self-inflicted or accidental injuries, and HIV/ acquired immunodeficiency syndrome (AIDS)-related deaths occurring within 1 year post-diagnosis were calculated using Cox proportional hazards regression models with adjustment for age at HIV/AIDS diagnosis. Population attributable risk proportions (PARPs) were then calculated using the adjusted HRs.Of the 1990 newly-diagnosed HIV cases included in the study, 7.2% had died by end of 2017, giving an overall mortality rate of 2.16 per 100 person-years (PY) (95% CI 1.82-2.54). The mortality rate was 3.81 per 100 PY (95% CI 3.15-4.56) in HIV cases with LD, compared with 0.71 (95% CI 0.46-1.05) in non-LD (nLD) cases. Short-term mortality was significantly higher in LD (9.1%) than nLD cases (1.1%). Of the 143 deaths reported between 2012 and 2017, 58.0% were HIV/AIDS-related (nLD 28.0% vs LD 64.4%). HIV/AIDS-related causes represented 70.4% of all deaths which occurred during the first year of diagnosis (nLD 36.4% vs LD 74.7%). The PARP of short-term mortality due to LD was 77.8% for all deaths by natural causes, and 87.8% for HIV/AIDS-related deaths.The mortality rate of HIV-infected persons with LD was higher than nLD, especially within 1 year of diagnosis, and HIV/AIDS-related causes constituted majority of these deaths. To reduce short-term mortality, persons at high risk of late-stage HIV infection should be targeted in outreach efforts to promote health screening and remove barriers to HIV testing and treatment.


Assuntos
Síndrome de Imunodeficiência Adquirida , Terapia Antirretroviral de Alta Atividade , Diagnóstico Tardio , Infecções por HIV , Mortalidade/tendências , Síndrome de Imunodeficiência Adquirida/diagnóstico , Síndrome de Imunodeficiência Adquirida/etiologia , Síndrome de Imunodeficiência Adquirida/mortalidade , Adulto , Terapia Antirretroviral de Alta Atividade/métodos , Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , Causas de Morte , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/mortalidade , Diagnóstico Tardio/prevenção & controle , Demografia , Feminino , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Humanos , Masculino , Risco Ajustado/métodos , Fatores de Risco , Singapura/epidemiologia , Fatores Socioeconômicos , Tempo para o Tratamento/estatística & dados numéricos
16.
Top Antivir Med ; 29(2): 328-333, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34107202

RESUMO

Comorbid conditions have a major impact on the health, quality of life, and survival in people with HIV, particularly as they age. The 2021 Conference on Retroviruses and Opportunistic Infections featured excellent science related to specific comorbidities as well as multimorbidity. A number of presentations related to comorbidities in women with HIV reflected a new wave of research aimed at understanding how the epidemiology and pathogenesis of comorbidities may differ by sex. Weight gain related to antiretroviral therapy was also a major theme of the comorbidity abstracts presented at the meeting. Several presentations demonstrated the importance of comorbid conditions in COVID-19 outcomes in people with HIV and described persistent symptoms after acute SARS-CoV-2 infection has resolved, a nascent topic that will expand over time. This review focuses on research presented at the conference in these areas, highlighting those with the most clinical impact.


Assuntos
COVID-19/complicações , Doenças Cardiovasculares , Comorbidade , Infecções por HIV/complicações , Antivirais/efeitos adversos , Antivirais/uso terapêutico , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/etiologia , Infecções por HIV/tratamento farmacológico , Humanos , Fatores Sexuais , Ganho de Peso
17.
Top Antivir Med ; 29(2): 334-343, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34107203

RESUMO

The 2021 Conference on Retroviruses and Opportunistic Infections (CROI) featured a timely review of the neurologic complications of COVID-19 as well as new research findings on mechanisms by which SARS-CoV-2 may affect the brain. CROI included new and important findings about the neurologic complications of HIV-1, human polyomavirus 2 (also known as JC Virus), and cryptococcus. New long-term analyses of cognition in people with HIV-1 identified that cognitive decline over time is associated with multimorbidity, particularly diabetes, chronic lung disease, and vascular disease risk conditions. These conditions are associated with aging, and the question of whether people with HIV are at risk for premature aging was addressed by several reports. New findings from large analyses of resting state networks also provided valuable information on the structural and functional networks that are affected by HIV-1 infection and cognitive impairment. Several reports addressed changes after initiating or switching antiretroviral therapy (ART). Findings that will improve understanding of the biologic mechanisms of brain injury in people with HIV were also presented and included evidence that host (eg, myeloid activation, inflammation, and endothelial activation) and viral (eg, transcriptional activity and compartmentalization) factors adversely affect brain health. Other research focused on adjunctive therapies to treat HIV-1 and its complications in the central nervous system. This summary will review these and other findings in greater detail and identify key gaps and opportunities for researchers and clinicians.


Assuntos
COVID-19/complicações , Infecções por HIV/complicações , HIV-1 , Doenças do Sistema Nervoso , Neuroimagem , Infecções por Retroviridae , Envelhecimento/fisiologia , Antirretrovirais/uso terapêutico , Encéfalo/fisiopatologia , Disfunção Cognitiva/fisiopatologia , Cryptococcus/isolamento & purificação , Infecções por HIV/tratamento farmacológico , Humanos , Vírus JC/isolamento & purificação , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/patologia , Estados Unidos
18.
BMJ Case Rep ; 14(6)2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112632

RESUMO

Molluscum contagiosum (MC) is a viral skin infection seen in children, sexually active adults and immunocompromised populations. It is usually a self-limiting illness that typically spontaneously resolves without therapeutic intervention. However, when the papules are extensive or refractory causing complications or aesthetic issues, multiple treatment modalities exist to relieve symptoms, limit spread and decrease the social stigma associated with visible lesions. Treatment is especially important in HIV/AIDS infected populations, where prevalence is estimated between 5% and 18% and susceptibility to larger, widespread and recalcitrant lesions involving atypical distributions is more common. We evaluated a 38-year-old woman with a history of AIDS (CD4+ T cell count <25 cells/µL) and poor adherence with antiretroviral therapy who presented with a 9-month history of persistent, progressively worsening facial and truncal umbilicated papules consistent with recalcitrant MC refractory to cidofovir injections. She was successfully treated with paclitaxel with complete resolution of the lesions after four cycles without adverse effects.


Assuntos
Infecções por HIV , Molusco Contagioso , Adulto , Criança , Cidofovir , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Molusco Contagioso/tratamento farmacológico , Paclitaxel
19.
Viruses ; 13(5)2021 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-34067925

RESUMO

By the middle of 2021, we are still immersed in the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The concurrence of this new pandemic in regions where human immunodeficiency virus (HIV) and tuberculosis (TB) infections possess the same epidemiological consideration, has arisen concerns about the prognosis, clinical management, symptomatology, and treatment of patients with triple infection. At the same time, healthcare services previously devoted to diagnosis and treatment of TB and HIV are being jeopardized by the urgent need of resources and attention for COVID-19 patients. The aim of this review was to collect any article considering the three conditions (HIV, TB, and SARS-CoV-2), included in PubMed/Medline and published in the English language since the beginning of the COVID-19 pandemic. We focused on detailed descriptions of the unusual cases describing the three co-infections. Eighty-four out of 184 publications retrieved met our inclusion criteria, but only three of them reported cases (five in total) with the three concomitant infections. The clinical evolution, management, and therapy of all of them were not different from mild/severe cases with exclusive COVID-19; the outcome was not worse either, with recovery for the five patients. Cases of patients with COVID-19 besides HIV and TB infections are scarce in literature, but studies deliberately embracing the triple infection as a priori inclusion criterion should be carried out in order to provide a complete understanding of joint influence.


Assuntos
COVID-19/complicações , Coinfecção/epidemiologia , COVID-19/epidemiologia , Testes Diagnósticos de Rotina , HIV/patogenicidade , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Mycobacterium tuberculosis/patogenicidade , Pandemias , SARS-CoV-2/patogenicidade , Tuberculose/complicações , Tuberculose/epidemiologia
20.
BMJ Case Rep ; 14(6)2021 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187795

RESUMO

A 52-year-old woman with HIV and recent antiretroviral therapy non-adherence presented with a 5-day history of widespread painful vesicular skin lesions. Direct fluorescent antibody testing of the skin lesions was positive for varicella zoster virus (VZV). On day 3, she developed profound right upper extremity weakness. MRI of the brain and cervical spine was suggestive of VZV myelitis. Lumbar puncture was positive for VZV PCR in the cerebrospinal fluid (CSF) and CSF HIV viral load was detected at 1030 copies/mL, indicating 'secondary' HIV CSF escape. She was treated with intravenous acyclovir for 4 weeks and subsequent oral therapy with famciclovir then valacyclovir for 6 weeks. She also received dexamethasone. The patient had an almost full recovery at 6 months. Myelitis is a rare complication of reactivated VZV infection that can have atypical presentation in immunocompromised patients. Such 'secondary' HIV CSF escape should be considered in immunosuppressed patients with concomitant central nervous system infection.


Assuntos
Infecções do Sistema Nervoso Central , Infecções por HIV , Herpes Zoster , Mielite , Aciclovir/uso terapêutico , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Herpesvirus Humano 3 , Humanos , Pessoa de Meia-Idade , Mielite/diagnóstico , Mielite/tratamento farmacológico , Mielite/etiologia
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