Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 19.557
Filtrar
1.
J Med Microbiol ; 68(11): 1622-1628, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31596198

RESUMO

Introduction. Nosocomial transmission of Mycobacterium tuberculosis is an important health issue and the detection of tuberculosis (TB) cases is the main tool for controlling this disease.Aim. We aimed to assess the possible occurrence of nosocomial transmission of M. tuberculosis in a reference hospital for HIV/AIDS patients and evaluate both the performance of the Xpert MTB/RIF (Xpert) platform and drug resistance profiles.Methodology. We evaluated the performance of the Xpert platform. Samples that tested positive on the BACTEC MGIT 320 (MGIT320) platform were submitted for genotyping and drug susceptibility testing.Results. In this study, pulmonary and extrapulmonary samples from 407 patients were evaluated, and among these, 15.5 % were diagnosed with TB by the MGIT320 platform, with a TB/HIV coinfection rate of 52.4 %. The Xpert platform gave positive results for TB for 11 samples with negative results on the MGIT320 platform. In the genotyping results, 53.3 % of the strains clustered; of these strains, half were in two of the four clusters formed, and the patients had visited the hospital on the same day. Drug resistance was observed in 11.7 % of the strains.Conclusion. Putative nosocomial transmission of M. tuberculosis was detected, showing that genotyping is a powerful approach for understanding the dynamics of M. tuberculosis transmission, especially in a high-burden TB and HIV landscape.


Assuntos
Infecções por HIV/complicações , Técnicas de Diagnóstico Molecular/métodos , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/microbiologia , Síndrome de Imunodeficiência Adquirida/complicações , Antibióticos Antituberculose/farmacologia , Técnicas de Laboratório Clínico , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/microbiologia , Estudos Transversais , Farmacorresistência Bacteriana , Humanos , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/classificação , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/genética , Filogenia , Tuberculose , Tuberculose Pulmonar/diagnóstico
2.
Pan Afr Med J ; 32: 215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31404285

RESUMO

Introduction: Kaposi's sarcoma (KS) is a kind of cancer that causes flat or raised lesions containing Human herpes virus 8 (HHV8). The KS lesions are common among immunosuppressed HIV patients. Highly Active Antiretroviral (HHART) treats and prevents the development of KS. The objective of this study was to determine the presence of K1 and K15 (predominant alleles) genes in Kaposi's sarcoma-associated herpes virus (KSHV) among immunosuppressed patients due to HIV-1. Methods: This was a cross-sectional descriptive study where consecutive sampling technique was adopted to pick archived tissue blocks from the Thematic Unit of Anatomic Pathology, Department of Human Pathology, College of Health Sciences, University of Nairobi and Department of Laboratory Medicine, Histology Section, Kenyatta National Hospital. Results: Upon staining 81 tissue blocks with H & E, 84% (68/81) were diagnosed as KS and 16% (13/81) as KS-like. The K1 and K15 (P) genes were both detected at 88.9% (72/81) in the tissue blocks, with 95.8% (69/72) detection from KS and 4.2% (3/72) from the KS-like. Conclusion: The K1 and K15 (P) genes of KSHV were present among the immunosuppressed patients with Human Immunodeficiency Virus (HIV)-1. It is important to carry out K1 and K15 (P) genes detection on tissues that are diagnosed as KS or KS-like by histology technique.


Assuntos
Infecções por HIV/complicações , Sarcoma de Kaposi/genética , Proteínas Virais/genética , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/genética , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade/métodos , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/genética , HIV-1/isolamento & purificação , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Sarcoma de Kaposi/epidemiologia , Sarcoma de Kaposi/etiologia , Adulto Jovem
3.
Medicine (Baltimore) ; 98(26): e16073, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261518

RESUMO

The present study aims to measure the retinal thickness of the macular region of AIDS patients with normal ocular fundus, HIV-related microvascular retinopathy patients and cytomegalovirus retinitis (CMVR) patients by optical coherence tomography, and generalize the characteristics of retinal thickness of these 3 groups of patients.In this retrospective case series, the study object comprised of 111 AIDS patients who received diagnosis and treatment in the Ophthalmology Department of Beijing Youan Hospital. There are 33 patients in the AIDS normal ocular fundus group, 47 patients in the HIV-related microvascular retinopathy group, and 31 patients in the CMVR group. The retinal thickness of the macular region of these above patients was measured. The main indicators were retinal thickness of 9 macular partitions, best corrected visual acuity, CD4+ T lymphocyte count, and the start of highly active antiretroviral therapy.In the CMVR group, except for the nasal-outer and temporal-outer sectors, the thickness of the affected eye of the rest of the regions was greater than that of healthy eye (P < .05). Furthermore, there was a difference in thickness of the superior-outer and inferior-outer sectors between the AIDS normal ocular fundus group and HIV-related microvascular retinopathy group. The difference in thickness of the superior-inner sector between patients in the AIDS normal ocular fundus group and CMVR group was not statistically significant, while the difference in thickness of the rest of the regions was statistically significant. The difference in thickness of various regions between patients in the HIV-related microvascular retinopathy group and CMVR group was statistically significant.The retinal thickness of patients in the CMVR group generally increased, the retinal thickness of superior-outer and inferior-outer sections of patients in the HIV-related microvascular retinopathy group increased, when compared to the AIDS normal ocular fundus group. These optical coherence tomography (OCT) examination results present its own characteristics in different eye diseases in AIDS patients, and different stages of eye disease.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico por imagem , Síndrome de Imunodeficiência Adquirida/diagnóstico por imagem , Macula Lutea/diagnóstico por imagem , Doenças Retinianas/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/patologia , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/patologia , Adulto , Idoso , Contagem de Linfócito CD4 , Feminino , Fundo de Olho , Humanos , Macula Lutea/patologia , Masculino , Microvasos , Pessoa de Meia-Idade , Tamanho do Órgão , Doenças Retinianas/complicações , Doenças Retinianas/patologia , Vasos Retinianos , Estudos Retrospectivos , Tomografia de Coerência Óptica , Doenças Vasculares/complicações , Doenças Vasculares/patologia , Acuidade Visual , Adulto Jovem
4.
Rev Lat Am Enfermagem ; 27: e3155, 2019 Jul 18.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31340343

RESUMO

OBJECTIVE: to evaluate pain in people living with human immunodeficiency virus/acquired immunodeficiency syndrome and to relate it to sociodemographic and clinical factors, depressive symptoms and health-related quality of life. METHOD: descriptive, analytical, observational, cross-sectional and quantitative study. Three hundred and two (302) people assisted at a specialized care service participated in the study. Instruments were used to evaluate sociodemographic and clinical data, depressive symptoms, and health-related quality of life. Descriptive, bivariate analysis and multiple logistic regression were used. RESULTS: the incidence of pain of mild intensity was 59.27%, recurrent in the head, with interference in mood, mostly affecting females and individuals with no schooling/low schooling. Women were more likely to have moderate or severe pain. People aged 49 to 59 years had greater pain intensity than people aged 18 to 29 years. The variables depressive symptoms and pain were directly proportional. The higher the health-related quality of life and schooling, the lower was the possibility of presence of pain. CONCLUSION: presence of pain is of concern and has association with female sex, lack of schooling/low schooling, worse level of health-related quality of life and presence of depressive symptoms.


Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Depressão/complicações , Infecções por HIV/complicações , Medição da Dor/estatística & dados numéricos , Dor/etiologia , Qualidade de Vida , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Dor/psicologia , Prevalência , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
5.
BMC Infect Dis ; 19(1): 525, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200652

RESUMO

BACKGROUND: As technology progresses, several highly sensitive human immunodeficiency virus (HIV) screening kits are being researched and developed to quickly and efficiently identify serum HIV antibodies within the non-window period. In individuals who are HIV-seronegative, HIV infections that are not within a window period are rare. In such cases, all antibody detection methods will fail, and misdiagnosing these patients will have catastrophic consequences. CASE PRESENTATION: A 22-year-old male Chinese patient with diffuse exudative lesions in both lungs and initial symptoms of cough and dyspnoea was diagnosed with Pneumocystis jirovecii pneumonia (PJP) by aetiological examination, and the patient's plasma CD4+ T-cell count was extremely low. In China, PJP is prevalent in HIV-infected individuals. Pneumocystis jirovecii (P. jirovecii) has a high colonisation rate in patients with HIV infections. This patient was naturally suspected of being an HIV patient; however, serum HIV antibody tests were negative using both an enzyme-linked immunosorbent assay (ELISA) and a latex agglutination assay, and HIV was not detected by western blotting. Subsequently, the plasma HIV viral load was found to be extremely high on two repeated plasma HIV RNA tests, thus confirming HIV-seronegative acquired immunodeficiency syndrome (AIDS) in this patient. With administration of effective anti-P. jirovecii treatment and highly active antiretroviral therapy (HAART) after diagnosis, the patient's disease condition was rapidly controlled. CONCLUSION: This is the second reported case in China of an HIV-seronegative AIDS patient. Such cases are also rare worldwide. Although HIV-seronegative HIV infections are rare, AIDS should be considered in immunodeficient patients with opportunistic infections, even if the test results are HIV-seronegative. Plasma HIV RNA testing is important for such patients.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/sangue , Síndrome de Imunodeficiência Adquirida/sangue , Pneumonia por Pneumocystis/complicações , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/patologia , Síndrome de Imunodeficiência Adquirida/virologia , Antibacterianos/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Humanos , Masculino , Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/sangue , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/patologia , RNA Viral/sangue , Resultado do Tratamento , Adulto Jovem
6.
Int J STD AIDS ; 30(6): 605-609, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31074359

RESUMO

Epstein-Barr virus-associated smooth muscle tumour (EBV-SMT) is a unique condition which affects immunocompromised patients. We describe the favourable outcome of a patient with acquired immune deficiency syndrome (AIDS)-related multi-centric EBV-SMT involving the posterior fossa and spine treated with surgery and adjuvant volumetric modulated arc therapy comprising 50 Gy in 25 fractions to four sites initially to the brain and lumbar spine followed by sixth to ninth thoracic vertebrae (T6-T9) and sacrum a year later. Reported literature suggests that AIDS-related EBV-SMTs are more sensitive to radiotherapy. However, compliance to the highly active anti-retroviral therapy is paramount in preventing future recurrence. This case also emphasises the importance of multidisciplinary management in ensuring the best possible outcome.


Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Encéfalo/diagnóstico por imagem , Neoplasias do Sistema Nervoso Central/patologia , Neoplasias do Sistema Nervoso Central/radioterapia , Neoplasias do Sistema Nervoso Central/cirurgia , Infecções por Vírus Epstein-Barr/complicações , Herpesvirus Humano 4/isolamento & purificação , Radioterapia Adjuvante , Tumor de Músculo Liso/patologia , Tumor de Músculo Liso/cirurgia , Tumor de Músculo Liso/virologia , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Terapia Antirretroviral de Alta Atividade , Encéfalo/patologia , Neoplasias do Sistema Nervoso Central/virologia , Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por Vírus Epstein-Barr/virologia , Humanos , Hospedeiro Imunocomprometido , Imagem por Ressonância Magnética , Masculino , Radioterapia Adjuvante/efeitos adversos , Tumor de Músculo Liso/radioterapia , Resultado do Tratamento , Carga Viral
7.
Microb Pathog ; 132: 282-292, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31082527

RESUMO

Cutaneous fungal infections include onychomycosis, an infection of the nail that affects both healthy and immunocompromised patients. This study investigated the in vitro hydrolytic enzymes production, adhesion and biofilm formation capacity of Candida parapsilosis complex species and Kodamaea ohmeri isolates from onychomycoses of HIV/AIDS patients and also established the antifungal sensitivity profiles of these isolates. Onychomycosis in HIV/AIDS patients showed a high prevalence of emerging yeasts, among which C. parapsilosis complex species and K. ohmeri were the most frequent. Three C. parapsilosis sensu stricto and two C. orthopsilosis isolates were resistant to amphotericin B and 83% of isolates were resistant to terbinafine. All three different species evaluated were proteinase and hemolysin producers. All isolates adhered to stainless steel and siliconized latex surfaces, and carbohydrates intensified adhesion of all isolates. Isolates adhered to keratinous nail and 50% formed biofilms with strong intensity. In multispecies or polymicrobial biofilms, C. albicans and Staphylococcus aureus regulated the biofilm formation of the analyzed species, decreasing the number of their cells in biofilms. The isolation of emerging yeast species from onychomycosis which are great producers of hydrolytic enzymes and with high adhesion and biofilm formation capacity is a result that should be considered relevant in clinical practice. In addition, half of the isolates was resistant to at least one of the tested antifungals. Taken together these data corroborate the infectious capacity and viability of these isolates under favorable conditions.


Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Candida parapsilosis/isolamento & purificação , Onicomicose/microbiologia , Saccharomycetales/isolamento & purificação , Adulto , Anfotericina B/farmacologia , Antifúngicos/farmacologia , Biofilmes/crescimento & desenvolvimento , Candida parapsilosis/efeitos dos fármacos , DNA Fúngico , Farmacorresistência Fúngica , Feminino , HIV , Humanos , Látex , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Onicomicose/epidemiologia , Saccharomycetales/efeitos dos fármacos , Aço Inoxidável , Terbinafina/farmacologia , Virulência , Adulto Jovem
8.
Rev Soc Bras Med Trop ; 52: e20180405, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31141050

RESUMO

INTRODUCTION: Low handgrip strength (HS) is associated with cardiometabolic alterations that have affected people with HIV/AIDS. METHODS: This was a cross-sectional study performed in adults receiving antiretroviral treatment. HS was evaluated using a dynamometer and divided by body weight to obtain the relative strength. The association between relative HS and overweight, increased waist circumference (WC), high body fat percentage, glycemia, and lipid ratios were assessed using logistic regression. RESULTS: Low relative HS was identified in 35% of participants and associated with increased WC (odds ratio = 9.7; 95% confidence interval = 2.8-33.0). CONCLUSIONS: The prevalence of low HS was high and associated with increased WC.


Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Biomarcadores/sangue , Doenças Cardiovasculares/etiologia , Força da Mão/fisiologia , Síndrome de Imunodeficiência Adquirida/sangue , Síndrome de Imunodeficiência Adquirida/fisiopatologia , Adulto , Índice de Massa Corporal , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/fisiopatologia , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de Risco , Circunferência da Cintura
9.
BMJ Case Rep ; 12(4)2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31015233

RESUMO

Haemophagocytic lymphohistiocytosis (HLH) is an immune dysregulation disorder with variable presentations and non-specific features making it extremely difficult to diagnose early in the clinical course. Here, we are presenting a case of a young man who presented in cardiogenic shock with findings of anterolateral wall ischaemia on ECG. Echocardiography findings were consistent with takotsubo cardiomyopathy (TCM). Cardiac catheterisation showed clean coronary arteries and pulmonary artery pressure measurements showed high output cardiac failure. After extensive workup, the patient was diagnosed with HLH. In spite of aggressive supportive and definitive therapy, he eventually died due to a complicated clinical course. We did a comprehensive literature review and found that this is the first reported case of HLH presenting as TCM as the initial clinical manifestation.


Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Linfo-Histiocitose Hemofagocítica/complicações , Cardiomiopatia de Takotsubo/etiologia , Adulto , Diagnóstico Diferencial , Ecocardiografia/métodos , Eletrocardiografia/métodos , Evolução Fatal , HIV/imunologia , Humanos , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/terapia , Masculino , Volume Sistólico , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/fisiopatologia , Cardiomiopatia de Takotsubo/terapia
10.
Autops. Case Rep ; 9(1): e2018063, Jan.-Mar. 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-986756

RESUMO

Progressive multifocal leukoencephalopathy (PML) is a feared entity that occurs most frequently in conditions of extreme immunodeficiency. The diagnosis is often made long after the onset of symptoms due to the physicians' unfamiliarity, and the unavailability of diagnostic tests in some medical centers. Although the incidence of PML is decreasing among HIV patients with the advent of highly active antiretroviral therapy (HAART), in Brazil this entity is the fourth highest neurological complication among these patients. The authors present the case of a middle-aged man who tested positive for HIV concomitantly with the presentation of hyposensitivity in the face and the right side of the body, accompanied by mild weakness in the left upper limb. The clinical features worsened rapidly within a couple of weeks. The diagnostic work-up pointed to the working diagnosis of PML after brain magnetic resonance imaging; however, the detection of the John Cunningham virus (JCV) in the cerebral spinal fluid was negative. HAART was started but the patient died after 7 weeks of hospitalization. The autopsy revealed extensive multifocal patchy areas of demyelination in the white matter where the microscopy depicted demyelination, oligodendrocytes alterations, bizarre atypical astrocytes, and perivascular lymphocytic infiltration. The immunohistochemistry was positive for anti-SV40, and the polymerase chain reaction of the brain paraffin-embedded tissue was positive for JCV. The authors highlight the challenges for diagnosing PML, as well as the devastating outcome of PML among HIV patients.


Assuntos
Humanos , Masculino , Adulto , Síndrome de Imunodeficiência Adquirida/complicações , Leucoencefalopatia Multifocal Progressiva/diagnóstico , Autopsia , Leucoencefalopatia Multifocal Progressiva/patologia , Evolução Fatal , Vírus JC
12.
J Emerg Med ; 56(4): e47-e49, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30803846

RESUMO

BACKGROUND: Methemoglobinemia is a rare dyshemoglobinemia that can be difficult to diagnose due to its nonspecific symptomatology and infrequent occurrence. A number of commonly used medications have been known to contribute to this disease process that results in acute hypoxemia. CASE REPORT: A 60-year-old man with history of acquired immunodeficiency syndrome presented to the Emergency Department (ED) with asymptomatic hypoxia. Supplemental oxygen proves to be ineffective in treating his low oxygen saturation. Numerous testing modalities are performed in the ED focused on an infectious versus pulmonary etiology prior to coming to the conclusion that the source is methemoglobinemia induced by dapsone therapy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This article discusses the basic pathophysiology of the disease and the expected clinical findings. Patient outcome is correlated with prompt identification and discontinuation of the offending agents leading to the excessive accumulation of methemoglobin in the circulatory system. This makes it crucial that emergency providers know the symptomatology of the disease to facilitate appropriate treatment therapy.


Assuntos
Dapsona/efeitos adversos , Neutropenia/etiologia , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Anti-Infecciosos/efeitos adversos , Anti-Infecciosos/uso terapêutico , Dapsona/uso terapêutico , Serviço Hospitalar de Emergência/organização & administração , Inibidores Enzimáticos/uso terapêutico , Humanos , Hipóxia/etiologia , Masculino , Metemoglobinemia/complicações , Metemoglobinemia/etiologia , Metemoglobinemia/fisiopatologia , Azul de Metileno/uso terapêutico , Pessoa de Meia-Idade , Pneumonia/tratamento farmacológico , Pneumonia/prevenção & controle
13.
BMC Pulm Med ; 19(1): 46, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30791902

RESUMO

BACKGROUND: Opportunistic infections, while well studied in the AIDS population, continue to have variable and surprising presentations. Here, we present a case of disseminated histoplasmosis with disseminated nontuberculous mycobacterial infection in a 50 year old man with long standing AIDS living in a non-endemic area. CASE PRESENTATION: Patient presented with a constellation of symptoms, and imaging of the chest showed a pulmonary mass with cavitation, multiple nodules, and ground glass opacities. Further investigations revealed granulomatous lung nodules and fungemia consistent with Histoplasma capsulatum, and coinfection with disseminated nontuberculous mycobateria in a nonendemic area. CONCLUSIONS: Immunocompromised patients risk co-inhabitation by multiple infectious organisms. Some of these organisms may preside in the host for years prior to reactivation. Clinicians in non endemic areas should therefore be careful to not overlook specific organisms based on a lack of a recent travel history. Physicians in nonendemic areas should become more familiar with the clinical findings and diagnostic approach of infectious such as Histoplasmosis, to ensure earlier recognition and treatment in immunocompromised individuals.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Síndrome de Imunodeficiência Adquirida/complicações , Bacteriemia/complicações , Fungemia/complicações , Histoplasmose/complicações , Infecções por Micobactéria não Tuberculosa/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Anfotericina B/uso terapêutico , Antibacterianos/uso terapêutico , Fármacos Anti-HIV/uso terapêutico , Antifúngicos/uso terapêutico , Antituberculosos/uso terapêutico , Azitromicina/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , California , Emtricitabina/uso terapêutico , Etambutol/uso terapêutico , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Histoplasmose/patologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/diagnóstico , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Infecções por Micobactéria não Tuberculosa/patologia , Rifabutina/uso terapêutico , Tenofovir/uso terapêutico , Tomografia Computadorizada por Raios X
14.
Zhonghua Nei Ke Za Zhi ; 58(3): 191-197, 2019 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-30803177

RESUMO

Objective: To investigate the clinical features and T lymphocytes subsets in patients with acquired immune deficiency syndrome (AIDS) and cytomegalovirus (CMV) infection. Methods: A total of 48 hospitalized patients with human immunodeficiency virus (HIV)-1/AIDS and CMV infections were recruited at Peking Union Medical College Hospital from Jan 2010 to Aug 2017. Their clinical features and immune function were retrospectively analyzed. Patients with only HIV/AIDS in previous study were recruited as controls. Results: All 48 patients were at C3 stage, including 36 men and 12 women. Five of them were younger than 30 years old, 33 cases within 31-50 years old, and 10 cases older than 50 years old. Thirty-five patients had CD(4)(+)T lymphocytes ≤ 50 cells/µl, 7 cases with CD(4)(+)T cells 51-100/µl, 3 cases with 101-200 cells/µl, and 3 cases over 200 cells/µl. As to CMV infections, there were 31 cases of CMV viremia, 1 case of CMV encephalitis, 1 case of CMV enteritis, 5 cases of CMV pneumonia, and 9 cases of CMV retinitis. Other opportunistic infections were also common including 16 cases of pneumocystis pneumonia, 9 cases of tuberculosis, 5 cases of syphilis, 18 cases of digestive tract fungal infections, 8 cases of pulmonary fungal infections, 2 cases of EB virus infections, 2 cases of HIV encephalopathy/progressive multifocal leukoencephalopathy (PML), 3 cases of cryptococcal meningitis, 1 case of toxoplasma infection. In group of both CMV and HIV/AIDS infections, 100% patients had inverted CD(4)(+)/CD(8)(+) ratio. The immune activation marker CD(8)(+)CD(38)(+)/CD(8)(+) was higher (61.6%-98.8%) with a median value of 91.2% in 40 patients. HLA-DR(+)CD(8)(+)/CD(8)(+), another marker for T cell activation, was 25.5%-98.0% in 44 patients with a median value of 60.3%. Thirty-six patients had both immune activation markers positive. There was no significant difference in counts of B cells, natural killer cells, CD(4)(+) T cells, CD(8)(+) T cells and immune activation subsets stratified by gender and age (P>0.05). Meanwhile, neither serum HIV viral load nor serum CMV viral load was correlated with HLA-DR(+)CD(8)(+)/CD(8)(+), CD(8)(+)CD(38)(+)/CD(8)(+), CD(4)(+)T cell counts, and CD(4)(+)/CD(8)(+) ratio in the CMV and HIV/AIDS co-infection group (all P>0.05), while HIV viral load in HIV/AIDS only group was significantly correlated with HLA-DR(+)CD(8)(+)T/CD(8)(+), CD(38)(+)CD(8)(+)/CD(8)(+), CD(4)(+) T cell counts, CD(4)(+)/CD(8)(+) ratio (r=0.473, 0.575, -0.767 and -0.678, respectively, all P<0.05). Conclusions: CMV infections develop in HIV patients with advanced stage. CMV infection can cause life-threatening multiple organ lesions, especially in those with CD(4)(+) T cells less than 100 cells/µl. It is of great importance to screen CMV-IgM, pp65 antigen, CMV DNA to make early diagnosis and treatment.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Síndrome de Imunodeficiência Adquirida/complicações , Infecções por Citomegalovirus/complicações , Infecções por HIV/complicações , Subpopulações de Linfócitos T , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Síndrome de Imunodeficiência Adquirida/imunologia , Adulto , Idoso , Contagem de Linfócito CD4 , Citomegalovirus , Infecções por Citomegalovirus/imunologia , Feminino , Infecções por HIV/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Qual Life Res ; 28(5): 1265-1269, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30617704

RESUMO

PURPOSE: The Anal Cancer HSIL Outcomes Research (ANCHOR) trial aims to determine whether treating precancerous anal high-grade squamous intraepithelial lesions (HSIL), versus active surveillance, is effective in reducing anal cancer incidence in HIV-infected individuals. We evaluated the reliability (i.e., internal consistency, test-retest) and between-group stability of a 25-item ANCHOR Health-Related Symptom Index (A-HRSI). METHODS: ANCHOR participants at least 1-month post-randomization to treatment or active surveillance completed the A-HRSI via telephone. Participants were contacted 7-10 days later to complete the A-HRSI and a participant global impression of change (PGIC) item. RESULTS: Participants (n = 100) were enrolled (mean age = 51.4, 79% cisgender-male, 73% African American, 9% Hispanic) from five ANCHOR sites. Cronbach's α was good for the physical symptoms (0.82) domain and fair for the physical impacts (0.79) and psychological symptoms (0.73) domains. Intraclass correlation coefficients were good for each of respective domains (i.e., 0.80, 0.85, and 0.82). There were no significant differences in PGIC between the treatment (n = 56) and active surveillance (n = 44) groups (F(1,98) = 2.03, p = 0.16). CONCLUSIONS: The A-HRSI is able to reliably assess participant-reported symptoms and impacts of anal HSIL across a 7-10 days of timeframe. Future work will involve the establishment of construct and discriminant validity prior to inclusion in the full ANCHOR trial.


Assuntos
Neoplasias do Ânus/prevenção & controle , Qualidade de Vida/psicologia , Autorrelato , Lesões Intraepiteliais Escamosas Cervicais/psicologia , Lesões Intraepiteliais Escamosas Cervicais/terapia , Conduta Expectante/métodos , Síndrome de Imunodeficiência Adquirida/complicações , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Lesões Intraepiteliais Escamosas Cervicais/patologia , Inquéritos e Questionários , Resultado do Tratamento
18.
J Acquir Immune Defic Syndr ; 80(3): e53-e63, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30531297

RESUMO

BACKGROUND: HIV infection is associated with increased susceptibility to common pathogens, which may trigger chronic antigenic stimulation and hyperactivation of B cells, events known to precede the development of AIDS-associated non-Hodgkin lymphoma (AIDS-NHL). METHODS: To explore whether cumulative exposure to infectious agents contributes to AIDS-NHL risk, we tested sera from 199 AIDS-NHL patients (pre-NHL, average lead time 3.9 years) and 199 matched HIV-infected controls from the Multicenter AIDS Cohort Study, for anti-IgG responses to 18 pathogens using multiplex serology. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression models. RESULTS: We found no association between cumulative exposure to infectious agents and AIDS-NHL risk (OR 1.01, 95% CI: 0.91 to 1.12). However, seropositivity for trichodysplasia spinulosa polyomavirus (TSPyV), defined as presence of antibodies to TSPyV capsid protein VP1, was significantly associated with a 1.6-fold increase in AIDS-NHL risk (OR 1.62, 95% CI: 1.02 to 2.57). High Epstein-Barr virus (EBV) anti-VCA p18 antibody levels closer to the time of AIDS-NHL diagnosis (<4 years) were associated with a 2.6-fold increase in AIDS-NHL risk (OR 2.59, 95% CI: 1.17 to 5.74). In addition, high EBV anti-EBNA-1 and anti-ZEBRA antibody levels were associated with 2.1-fold (OR 0.47, 95% CI: 0.26 to 0.85) and 1.6-fold (OR 0.57, 95% CI: 0.35 to 0.93) decreased risk of AIDS-NHL, respectively. CONCLUSIONS: Our results do not support the hypothesis that cumulative exposure to infectious agents contributes to AIDS-NHL development. However, the observed associations with respect to TSPyV seropositivity and EBV antigen antibody levels offer additional insights into the pathogenesis of AIDS-NHL.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Síndrome de Imunodeficiência Adquirida/complicações , Doenças Transmissíveis/complicações , Linfoma não Hodgkin/etiologia , Humanos , Fatores de Risco
19.
Mycoses ; 62(3): 261-267, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30561870

RESUMO

BACKGROUND: Histoplasmosis is a frequent fungal infection in HIV/AIDS patients, with high morbimortality rates when diagnosis and treatment are delayed. Antibody detection, which is faster than the gold standard culture test, hastens the laboratory investigation. OBJECTIVES: To evaluate the role of WB for antibody detection in the diagnosis of histoplasmosis among HIV/AIDS patients. PATIENTS AND METHODS: Fifty patients with proven or probable histoplasmosis were included. Clinical, epidemiological and laboratory data were described in the same population after a review of their medical records. WB was performed using deglycosylated histoplasmin. RESULTS: About 82% of patients were adult males and the mean age was 39.3 years. CD4+ T lymphocyte count less than 150 cells/mm3 was observed in 62% patients. Antibodies against Histoplasma capsulatum M antigen were detected in 62% of patients, and against both M and H antigens in 28% of individuals. Sera from 10% of patients were nonreactive. Histoplasmosis was the first opportunistic infection in 38% of the cases. Disseminated and pulmonary histoplasmosis occurred in 84% and 16% of patients, respectively. The overall mortality was 16%. CONCLUSION: WB could be useful for the histoplasmosis diagnosis in HIV/AIDS patients because of its easefulness and good sensitivity in a population where antibody production is hampered.


Assuntos
Síndrome de Imunodeficiência Adquirida/complicações , Anticorpos Antifúngicos/sangue , Western Blotting/métodos , Testes Diagnósticos de Rotina/métodos , Histoplasma/imunologia , Histoplasmose/diagnóstico , Adulto , Distribuição por Idade , Antígenos de Fungos/imunologia , Brasil/epidemiologia , Contagem de Linfócito CD4 , Feminino , Histoplasmose/epidemiologia , Histoplasmose/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Sensibilidade e Especificidade , Distribuição por Sexo , Análise de Sobrevida
20.
Cancer Treat Res ; 177: 1-21, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30523619

RESUMO

Malignancies were one of the earliest recognized manifestations that led to the description of the acquired immune deficiency syndrome (AIDS). The majority of cancers in AIDS patients are associated with coinfection with oncogenic viruses, such as Epstein-Barr virus, human herpesvirus 8, and human papillomavirus, with resulting malignancies occurring secondary to diminished immune surveillance against viruses and virus-infected tumor cells. Over 50% of AIDS lymphomas are associated with Epstein-Barr virus (EBV) and/or HHV8 infection. HHV8-associated diseases include Kaposi sarcoma (KS), primary effusion lymphoma (PEL), and multicentric Castleman disease (MCD). EBV is associated with several malignancies, including Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Coinfection with HIV and HPV is associated with an increased risk of various squamous cell carcinomas of epithelial tissues. HAART has significantly impacted the incidence, management, and prognosis of AIDS-related malignancies. In addition to changing the natural history of HIV infection in regard to incidence and survival, HAART has dramatically decreased the incidence of certain virally mediated HIV-associated malignancies such as KS and primary CNS lymphoma. The beneficial effects of HAART on these tumors are attributed to drug-mediated HIV suppression and immune reconstitution. However, HAART has had a less favorable impact on EBV- and HPV-related malignancies. This chapter presents an overview of HIV-associated malignancies mediated by HHV-8, EBV, and HPV, and reviews the effect of HAART on the epidemiology, presentation, treatment, and outcomes of these cancers.


Assuntos
Síndrome de Imunodeficiência Adquirida/virologia , Terapia Antirretroviral de Alta Atividade , Infecções por Herpesviridae/tratamento farmacológico , Neoplasias , Infecções por Papillomavirus/tratamento farmacológico , Infecções Tumorais por Vírus/virologia , Síndrome de Imunodeficiência Adquirida/complicações , Coinfecção/virologia , Infecções por HIV/complicações , Infecções por HIV/virologia , Infecções por Herpesviridae/complicações , Herpesvirus Humano 4 , Herpesvirus Humano 8 , Humanos , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/terapia , Neoplasias/virologia , Vírus Oncogênicos , Papillomaviridae , Infecções por Papillomavirus/complicações , Sarcoma de Kaposi
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA