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1.
West Afr J Med ; 37(1): 1-6, 2020.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-32030704

RESUMO

BACKGROUND: Pregnant women with asymptomatic bacteriuria are at increased risk of developing symptomatic urinary tract infections. HIV infection may modify the acquisition of bacteriuria in pregnancy. OBJECTIVE: To identify the determinants of asymptomatic bacteriuria in HIV-positive and HIV-negative pregnant women in Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. METHODS: A cross-sectional study involving 211 HIV-positive pregnant women and 422 HIV-negative pregnant women attending their first antenatal clinic between October 2017 and March 2018. Information on socio-demographic characteristics and risk factors for asymptomatic bacteriuria in study participants was recorded. Microbial culture was carried out on aseptically collected urine samples. RESULTS: Asymptomatic bacteriuria was found in 66(31.3%) and 118(28.0%) in HIV-positive and negative women respectively. Advanced maternal age, gestational age above 20 weeks, low socioeconomic status, history of urinary tract infections in previous pregnancies and low CD4 cell count had statistically significant association with increased prevalence of asymptomatic bacteriuria among HIV positive women. Binary logistic regression analysis showed that low socioeconomic status and history of urinary tract infections in previous pregnancies were strong determinants of asymptomatic bacteriuria among HIV positive women (AOR 4.1, CI 1.9-8.7, P < 0.001; AOR 5.8, CI 2.5-13.6, P < 0.001 respectively). In HIV negative women, gestational age above 20 weeks had statistically significant association with increased prevalence of asymptomatic bacteriuria (AOR= 2.34, CI 1.3-4.1, P= 0.002). CONCLUSION: Low socioeconomic status and previous history of urinary tract infections are determinants of asymptomatic bacteriuria in HIV positive women while gestational age above 20 weeks is a determinant in HIV negative women. These determinants could be used to identify women at high risk of asymptomatic bacteriuria for targeted screening.


Assuntos
Bactérias/isolamento & purificação , Bacteriúria/microbiologia , Bacteriúria/urina , Infecções por HIV/complicações , Soronegatividade para HIV , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/urina , Urina/microbiologia , Adulto , Bacteriúria/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/virologia , Humanos , Nigéria/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Prevalência , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Infecções Urinárias/urina
2.
BMC Infect Dis ; 20(1): 7, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900105

RESUMO

BACKGROUND: Mycoplasma sp. are well recognized as etiological agents of respiratory and sexually transmitted disease. Mycoplasma penetrans, a species of Mycoplasma sp., has been frequently detected in HIV-positive patients and associated with the progression of HIV-associated disease. To date, there is only a single case report describing M. penetrans as the causative agent of a severe respiratory tract infection in a HIV-negative patient. CASE PRESENTATION: In this report, we describe the case of M. penetrans bacteremia in a HIV-negative, 38-year-old, female, immunocompromised, solid organ transplant patient (combined kidney and pancreas transplantation in 2016), who was admitted to our hospital with anemic uterine bleeding and fever of 38.3 °C. Several hours before her admission at our university hospital, a latex bladder catheter was inserted into her uterus and she complained about fatigue, dizziness and ongoing vaginal bleeding. Laboratory examination showed severe anemia, but microbiological examination was inconspicuous (culture negative vaginal and cervical smears, negative urine culture). Bacterial blood cultures showed a growth signal after 4 h, but microscopic examination with Gram staining and subcultures on different agar media did not identify bacterial pathogens. To identify the bacterial cause of malignancy in the patient, metagenomic sequencing of the blood culture was performed that identified M. penetrans. CONCLUSION: Metagenomic sequencing identified M. penetrans in an immunosuppressed patient with culture-negative bacteremia. Clinicians should be aware of the opportunistic potential of M. penetrans that may cause severe infections in certain vulnerable patient populations and the limitations of culture and Gram staining for confirming the presence of fastidious bacterial pathogens like Mycoplasma spp.


Assuntos
Bacteriemia/diagnóstico , Hospedeiro Imunocomprometido , Metagenômica , Infecções por Mycoplasma/diagnóstico , Mycoplasma penetrans , Infecções Respiratórias/diagnóstico , Adulto , Bacteriemia/genética , Bacteriemia/microbiologia , Análise Mutacional de DNA/métodos , Diabetes Mellitus Tipo 1/imunologia , Diabetes Mellitus Tipo 1/terapia , Feminino , Soronegatividade para HIV , Humanos , Transplante de Rim , Metagenoma , Metagenômica/métodos , Infecções por Mycoplasma/genética , Infecções por Mycoplasma/microbiologia , Mycoplasma penetrans/genética , Mycoplasma penetrans/isolamento & purificação , Transplante de Pâncreas , Infecções Respiratórias/genética , Infecções Respiratórias/microbiologia , Análise de Sequência de DNA
3.
BMC Infect Dis ; 19(1): 1017, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791265

RESUMO

BACKGROUND: Early diagnosis and treatment of neurosyphilis is of great significance for regression. There is no gold standard for the diagnosis of neurosyphilis. We did this study to explore the factors associated with the clinical diagnosis of neurosyphilis and assess their accuracy for the diagnosis of neurosyphilis. METHODS: We retrospectively reviewed 100 cases of syphilis patients who underwent lumbar puncture at a major dermatology hospital in Guangzhou, China between April 2013 and November 2016. Fifty patients who were clinically diagnosed with neurosyphilis were selected as case group. Control group consisted of 50 general syphilis patients who were matched with age and gender. The records of patients were reviewed to collect data of socio-demographic information, clinical symptom, and laboratory indicators. Multivariable logistic regression was used to explore diagnostic indictors, and ROC analysis was used to assess diagnostic accuracy. RESULTS: Neurological symptoms (odds ratio (OR) = 59.281, 95% CI:5.215-662.910, P = 0.001), cerebrospinal fluid (CSF) Treponema pallidum particle agglutination (TPPA) titer (OR = 1.004, 95% CI:1.002-1.006, P < 0.001), CSF protein (OR = 1.005, 95% CI:1.000-1.009, P = 0.041), and CSF white blood cell (WBC) (OR = 1.120, 95% CI:1.017-1.233, P = 0.021) were found to be statistically associated with neurosyphilis. In ROC analysis, CSF TPPA titer had a sensitivity of 90%, a specificity of 84%, and an area under curve (AUC) of 0.941. CONCLUSION: CSF TPPA can potentially be considered as an alternative test for diagnosis of neurosyphilis. Combining with neurological symptoms, CSF protein, CSF WBC, the diagnosis would have a higher sensitivity.


Assuntos
Soronegatividade para HIV , Neurossífilis/diagnóstico , Adulto , Estudos de Casos e Controles , China/epidemiologia , Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/normas , Feminino , Infecções por HIV/líquido cefalorraquidiano , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/líquido cefalorraquidiano , Neurossífilis/complicações , Neurossífilis/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Sífilis/líquido cefalorraquidiano , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/epidemiologia , Treponema pallidum
4.
N Engl J Med ; 381(25): 2429-2439, 2019 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-31661198

RESUMO

BACKGROUND: Results of an earlier analysis of a trial of the M72/AS01E candidate vaccine against Mycobacterium tuberculosis showed that in infected adults, the vaccine provided 54.0% protection against active pulmonary tuberculosis disease, without evident safety concerns. We now report the results of the 3-year final analysis of efficacy, safety, and immunogenicity. METHODS: From August 2014 through November 2015, we enrolled adults 18 to 50 years of age with M. tuberculosis infection (defined by positive results on interferon-γ release assay) without evidence of active tuberculosis disease at centers in Kenya, South Africa, and Zambia. Participants were randomly assigned in a 1:1 ratio to receive two doses of either M72/AS01E or placebo, administered 1 month apart. The primary objective was to evaluate the efficacy of M72/AS01E to prevent active pulmonary tuberculosis disease according to the first case definition (bacteriologically confirmed pulmonary tuberculosis not associated with human immunodeficiency virus infection). Participants were followed for 3 years after the second dose. Participants with clinical suspicion of tuberculosis provided sputum samples for polymerase-chain-reaction assay, mycobacterial culture, or both. Humoral and cell-mediated immune responses were evaluated until month 36 in a subgroup of 300 participants. Safety was assessed in all participants who received at least one dose of M72/AS01E or placebo. RESULTS: A total of 3575 participants underwent randomization, of whom 3573 received at least one dose of M72/AS01E or placebo, and 3330 received both planned doses. Among the 3289 participants in the according-to-protocol efficacy cohort, 13 of the 1626 participants in the M72/AS01E group, as compared with 26 of the 1663 participants in the placebo group, had cases of tuberculosis that met the first case definition (incidence, 0.3 vs. 0.6 cases per 100 person-years). The vaccine efficacy at month 36 was 49.7% (90% confidence interval [CI], 12.1 to 71.2; 95% CI, 2.1 to 74.2). Among participants in the M72/AS01E group, the concentrations of M72-specific antibodies and the frequencies of M72-specific CD4+ T cells increased after the first dose and were sustained throughout the follow-up period. Serious adverse events, potential immune-mediated diseases, and deaths occurred with similar frequencies in the two groups. CONCLUSIONS: Among adults infected with M. tuberculosis, vaccination with M72/AS01E elicited an immune response and provided protection against progression to pulmonary tuberculosis disease for at least 3 years. (Funded by GlaxoSmithKline Biologicals and Aeras; ClinicalTrials.gov number, NCT01755598.).


Assuntos
Imunogenicidade da Vacina , Tuberculose Latente/terapia , Mycobacterium tuberculosis/imunologia , Vacinas contra a Tuberculose/imunologia , Tuberculose Pulmonar/prevenção & controle , Adolescente , Adulto , África , Progressão da Doença , Método Duplo-Cego , Feminino , Seguimentos , Soronegatividade para HIV , Humanos , Tuberculose Latente/imunologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Adulto Jovem
5.
BMC Public Health ; 19(1): 1336, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640612

RESUMO

BACKGROUND: Perceived risk of HIV plays an important role in the adoption of protective behaviours and HIV testing. However, few studies have used multiple-item measures to assess this construct. The Perceived Risk of HIV Scale (PRHS) is an 8-item measure that assesses how people think and feel about their risk of HIV infection. This cross-sectional study aimed to assess the psychometric properties (reliability and validity) of the European Portuguese version of the PRHS, including the ability of this scale to discriminate between individuals from the general population and HIV-uninfected partners from sero-different couples on their perceived risk of HIV infection (known-groups validity). METHODS: This study included 917 individuals from the general population (sample 1) to assess the psychometric properties of the PRHS. To assess the known-groups validity, the sample comprised 445 participants from the general population who were in an intimate relationship (sub-set of sample 1) and 42 HIV-uninfected partners from sero-different couples (sample 2). All participants filled out a set of questionnaires, which included a self-reported questionnaire on sociodemographic information, sexual behaviours, HIV testing and the PRHS. Sample 1 also completed the HIV Knowledge Questionnaire - 18-item version. RESULTS: The original unidimensional structure was reproduced both in exploratory and confirmatory factor analyses, and the PRHS demonstrated good reliability (α = .78; composite reliability = .82). The differential item functioning analyses indicated that the items of the PRHS, in general, did not function differently for men and women or according to HIV testing. Significant associations with sexual risk behaviours and HIV testing provided evidence for criterion validity. The known-groups validity was supported. CONCLUSIONS: The PRHS is a suitable scale in the evaluation of the perceived risk of HIV, and its psychometric characteristics validate its use in the Portuguese population. Furthermore, the present study suggests that interventions improving individuals' HIV risk perceptions may be important since they were associated with different sexual behaviours and the likelihood of HIV testing.


Assuntos
Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Parceiros Sexuais/psicologia , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Soronegatividade para HIV , Soropositividade para HIV , Humanos , Masculino , Pessoa de Meia-Idade , Portugal , Psicometria , Reprodutibilidade dos Testes , Medição de Risco , Traduções , Adulto Jovem
6.
West Afr J Med ; 36(3): 199-204, 2019.
Artigo em Inglês, Francês | MEDLINE | ID: mdl-31622480

RESUMO

BACKGROUND: HIV infection in pregnant women is a known cause of low birth weight (LBW) and small for gestational age (SGA). This study compared the birth weight for gestational age (GA) of HIV exposed and non-exposed babies in Nnamdi Azikiwe University Teaching Hospital, (NAUTH) Nnewi, Nigeria. SUBJECTS AND METHODS: A retrospective comparative appraisal of birth weights for GA of babies born to HIV- positive and negative women, over a 7-year period (January 2009-December 2015), was conducted. Data were abstracted from PMTCT database, ANC and Labor ward registers of NAUTH. RESULTS: A total of 3459 babies (1782 males, 1677 females) were enrolled, out of which 1829 were HIV- exposed and 1630 were not. GA spanned from 26-42 weeks (mean 38.7 ± 2.2 weeks) and birth weights (BW) from 400-5300g (mean 3072.5 ± 630g). The mean BW of exposed babies was significantly lower than the unexposed babies (p=0.048). LBW occurred in 12.0% of exposed and 13.5% of non-exposed babies (p<0.001). Using either percentile or Z-score cut-offs, HIV-exposed babies had twice the proportion of SGA compared to their non-exposed counterparts. Using Z-score, maternal antiretroviral use for >5 years was significantly associated with the lowest proportion of SGA compared to shorter duration of use. CONCLUSION: Maternal HIV infection is associated with SGA. However, maternal ARV use in excess of 5 years is associated with better BW outcome. Targeted enhancement of maternal nutrition and strict adherence to ARV therapy prior to and during pregnancy will improve birth outcome.


Assuntos
Peso ao Nascer , Retardo do Crescimento Fetal/etiologia , Infecções por HIV/complicações , Soronegatividade para HIV , Transmissão Vertical de Doença Infecciosa , Complicações Infecciosas na Gravidez/epidemiologia , Adulto , Feminino , Retardo do Crescimento Fetal/epidemiologia , Idade Gestacional , Infecções por HIV/epidemiologia , Soropositividade para HIV , Humanos , Recém-Nascido , Masculino , Mães , Nigéria/epidemiologia , Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária
7.
BMC Infect Dis ; 19(Suppl 1): 789, 2019 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-31526366

RESUMO

BACKGROUND: Despite improved policies to prevent mother-to-child HIV transmission (MTCT), adherence to maternal antiretroviral therapy (ART) and infant Nevirapine prophylaxis (NVP) is low in South Africa. We describe ART adherence amongst a cohort of HIV-positive mothers and HIV-exposed but uninfected infants from 6 weeks until 18 months post-delivery and identify risk factors for nonadherence. METHODS: Data were collected in 2012-2014 through a nationally representative survey of PMTCT effectiveness. Mother-infant pairs were enrolled during the infant's first immunization visit at 6 weeks. Mothers and HIV-exposed infants (2811 pairs) were followed to 18 months at 3-month intervals. Mothers who self-reported being on ART at 6 weeks postpartum (N = 1572 (55.9%)) and infants on NVP at 6 weeks (N = 2370 (84.3%)) were eligible for this analysis and information about their adherence was captured at each interview they attended thereafter. We defined nonadherence within each 3-month interval as self-report of missing > 5% of daily ART/NVP doses, estimated adherence using a Cox survival curve with Andersen & Gill setup for recurring events, and identified risk factors for nonadherence with an extended Cox regression model (separately for mothers and infants) in Stata 13. Results are not nationally representative as this is a subgroup analysis of the follow-up cohort. RESULTS: Amongst mothers on ART at 6 weeks postpartum, cumulative adherence to maternal ART until 18 months was 63.4%. Among infants on NPV at 6 weeks postpartum, adherence to NVP was 74.5%.. Risk factors for nonadherence to maternal ART, controlling for other factors, included mother's age (16-24 years vs. ≥34 years, adjusted Hazard Ratio (aHR): 1.9, 95% CI: 1.4-2.5), nondisclosure of HIV status to anyone (nondisclosure vs. disclosure: aHR: 1.7, 95% CI: 1.3-2.1), and timing of ART initiation (initiated ART after delivery vs. initiated ART before delivery: aHR: 1.6, 95% CI: 1.3-2.0). Provincial variation was seen in nonadherence to infant NVP, controlling for other factors. CONCLUSION: Maintaining ART adherence until 18 months postpartum remains a crucial challenge, with maternal ART adherence among the six week maternal ART cohort below 65% and infant NVP adherence among breastfeeding infants in this cohort below 75%.This is gravely concerning, given the global policy shift to lifelong ART amongst pregnant and lactating women, and the need for extended infant prophylaxis amongst mothers who are not virally suppressed. Our findings suggest that young mothers and mothers who do not disclose their status should be targeted with messages to improve adherence, and that late maternal ART initiation (after delivery) increases the risk of maternal nonadherence.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , HIV/imunologia , Lactente , Mães , Nevirapina/uso terapêutico , Cooperação do Paciente/psicologia , Profilaxia Pós-Exposição , Adolescente , Adulto , Aleitamento Materno , Estudos Transversais , Feminino , Seguimentos , Soronegatividade para HIV , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Lactação , Cuidado Pós-Natal , Período Pós-Parto , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Fatores de Risco , Autorrelato , África do Sul , Adulto Jovem
8.
Respir Res ; 20(1): 213, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31554510

RESUMO

BACKGROUND: The prevalence of pneumocystis pneumonia (PCP) and associated hypoxic respiratory failure is increasing in human immunodeficiency virus (HIV)-negative patients. However, no prior studies have evaluated the effect of early anti-PCP treatment on clinical outcomes in HIV-negative patient with severe PCP. Therefore, this study investigated the association between the time to anti-PCP treatment and the clinical outcomes in HIV-negative patients with PCP who presented with hypoxemic respiratory failure. METHODS: A retrospective observational study was performed involving 51 HIV-negative patients with PCP who presented in respiratory failure and were admitted to the intensive care unit between October 2005 and July 2018. A logistic regression model was used to adjust for potential confounding factors in the association between the time to anti-PCP treatment and in-hospital mortality. RESULTS: All patients were treated with appropriate anti-PCP treatment, primarily involving trimethoprim/sulfamethoxazole. The median time to anti-PCP treatment was 58.0 (28.0-97.8) hours. Thirty-one (60.8%) patients were treated empirically prior to confirmation of the microbiological diagnosis. However, the hospital mortality rates were not associated with increasing quartiles of time until anti-PCP treatment (P = 0.818, test for trend). In addition, hospital mortality of patients received early empiric treatment was not better than those of patients received definitive treatment after microbiologic diagnosis (48.4% vs. 40.0%, P = 0.765). In a multiple logistic regression model, the time to anti-PCP treatment was not associated with increased mortality. However, age (adjusted OR 1.07, 95% CI 1.01-1.14) and failure to initial treatment (adjusted OR 13.03, 95% CI 2.34-72.65) were independently associated with increased mortality. CONCLUSIONS: There was no association between the time to anti-PCP treatment and treatment outcomes in HIV-negative patients with PCP who presented in hypoxemic respiratory failure.


Assuntos
Soronegatividade para HIV , Pneumonia por Pneumocystis/terapia , Insuficiência Respiratória/fisiopatologia , Adulto , Fatores Etários , Idoso , Antibacterianos/uso terapêutico , Cuidados Críticos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/complicações , Pneumonia por Pneumocystis/mortalidade , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Tempo para o Tratamento , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
9.
Medicine (Baltimore) ; 98(36): e16887, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490372

RESUMO

RATIONALE: Multiple syphilitic gummas involving both the brain and spinal cord are quite rare. Central nervous system (CNS) syphilitic gummas are commonly misdiagnosed as CNS tumors, and clinical suspicion and diagnosis of a syphilitic gumma by physicians are vital to avoiding unnecessary surgeries. Our case emphasizes the importance of routine serologic syphilis tests and standard therapy with penicillin in patients with a CNS mass. PATIENT CONCERNS: A 22-year-old previously healthy man presented with a 9-day history of progressive right lower limb weakness. DIAGNOSIS: The diagnosis of gummatous neurosyphilis was based on positive serological, cerebrospinal fluid tests for syphilis and magnetic resonance imaging (MRI) findings, which revealed the presence of multiple dural-based enhancing masses with marked edema. INTERVENTIONS: Therapy consisting of intravenous penicillin G at 24 million units daily divided into 6 doses were given for a total of 21 days, along with 3 weekly intramuscular injections of benzathine penicillin G (2.4 million units) to ensure that the syphilitic lesions in the CNS were adequately treated. OUTCOMES: Complete resolution of the lesions was observed on MRI over a 3-month period. LESSONS: The importance of routine serologic syphilis tests and standard therapy with penicillin in patients with central CNS mass lesions is noted to avoiding unnecessary surgeries.


Assuntos
Neurossífilis/diagnóstico , Antibacterianos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Diagnóstico Diferencial , Soronegatividade para HIV , Humanos , Imagem por Ressonância Magnética , Masculino , Neurossífilis/diagnóstico por imagem , Neurossífilis/tratamento farmacológico , Penicilina G/uso terapêutico , Medula Espinal/diagnóstico por imagem , Medula Espinal/patologia , Adulto Jovem
10.
S Afr J Surg ; 57(3): 38-43, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31392863

RESUMO

BACKGROUND: The influence of HIV-infection on surgical site infection (SSI) after surgery for penetrating abdominal trauma is not investigated and therefore not as yet elucidated. This prospective study was performed with the aim to compare the SSI rate in human immunodeficiency virus (HIV)-seropositive and HIV-negative patients and to identify other risk factors for this abdominal wound complication. METHOD: 98 patients who underwent small or large bowel resection and subsequent anastomosis due to penetrating abdominal trauma were included in the study. Injury related factors as well as demographical and physiological parameters, including HIV-status were analysed and superficial and deep SSI incidence rates were evaluated. RESULTS: Of the 98 patients, 23 patients (23%) were HIV-seropositive. The overall superficial SSI rate was 45% and the deep SSI rate was 15%. No significant difference in SSI (superficial or deep) in the HIV-seropositive and -negative group was demonstrated (superficial SSI HIV-pos vs HIV-neg: 61% vs 40%; p=0.172, deep SSI 22% vs 13%, p=0.276). Multivariate analysis identified five independent risk factors for SSI: postoperative CD4 count < 250 cells/µl, postoperative albumin < 30 g/L, relook operation, anastomotic leak and colonic anastomosis. CONCLUSION: HIV-infection is not an independent risk factor for developing SSI after penetrating abdominal trauma. Low postoperative CD4 count, irrespective of HIV status, low postoperative albumin, relook operation, anastomotic leak and colonic anastomosis are predictors for SSI irrespective of the HIV-serostatus. These factors should be considered in unison during the decision-making process of abdominal wound closure; planned secondary wound treatment or immediate application of negative pressure dressings in patients with a high-risk profile may decrease the hospital stay and the financial burden on the health care system.


Assuntos
Colo/cirurgia , Soronegatividade para HIV , Soropositividade para HIV/complicações , Infecção da Ferida Cirúrgica/etiologia , Ferimentos Penetrantes/cirurgia , Traumatismos Abdominais/cirurgia , Adulto , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/etiologia , Contagem de Linfócito CD4 , Colo/lesões , Feminino , Humanos , Intestino Delgado/lesões , Intestino Delgado/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Cirurgia de Second-Look , Albumina Sérica/metabolismo , Adulto Jovem
11.
BMC Infect Dis ; 19(1): 725, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31420019

RESUMO

BACKGROUND: Female sex workers (FSWs) at substantial risk of HIV are potentially a suitable group for HIV prevention trials including vaccine trials. Few HIV vaccine preparatory studies have been conducted among FSWs in Sub-Saharan Africa (SSA); data are therefore limited on acceptability of vaccine trial procedures. We determined vaccination completion and one-year retention among FSWs in Kampala, Uganda. METHODS: We conducted a prospective study that simulated a vaccine efficacy trial among HIV negative FSWs (18-49 years). Hepatitis B vaccine (Engerix B) was used to mimic an HIV vaccine product. Volunteers received 1 ml intramuscular injection at 0, 1 and 6 months, and made additional visits (3 days post-vaccination and months 3, 9 and 12). They were censored at that visit if diagnosed as HIV positive or pregnant. We collected socio-demographic, behavioral and clinical data at baseline, 6 and 12 months and fitted Poisson regression models with robust standard error to find factors associated with vaccination completion and retention. RESULTS: We enrolled 290 volunteers (median age 27 years) of whom 230 reached a study end-point as follows: 7 became HIV infected, 11 became pregnant and 212 completed both the vaccination schedule and 12-month visit giving a retention of 77.9% (212/272). Vaccination completion was 82.4%. Non-retention at 1 year was more likely among those reporting symptoms of genital ulcer disease (GUD) in the past 3 months (IRR 1.90; 95% CI 1.09-3.32) and those < 35 years; (IRR 6.59; 95% CI 2.11-20.57). Non-completion of the vaccination schedule was associated with being < 35 years (IRR 13.10; 95% CI 1.89-90.92, reporting GUD symptoms (IRR 3.02; 95% CI 1.71-5.33) and reporting consistent condom use with new sexual partners (IRR 2.57; 95% CI 1.10-6.07). CONCLUSIONS: FSWs are at substantial risk of HIV infection and yet willing to participate in HIV vaccine and prevention research; young FSWs should be empowered, and those reporting GUD symptoms need close follow up to improve participation in future HIV vaccine trials.


Assuntos
Vacinas contra Hepatite B/uso terapêutico , Vacinação , Vacinas contra a AIDS , Adolescente , Adulto , Feminino , Infecções por HIV/prevenção & controle , Soronegatividade para HIV , Humanos , Estudos Prospectivos , Sexo Seguro , Profissionais do Sexo , Parceiros Sexuais , Uganda , Vacinação/métodos , Vacinação/estatística & dados numéricos
12.
Intern Med ; 58(21): 3077-3082, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31243232

RESUMO

Objective Cryptococcal meningoencephalitis (CM) causes significant morbidity and mortality in human immunodeficiency virus (HIV)-negative and HIV-positive populations. White matter lesions (WMLs) have been reported in both populations of CM patients; however, the mechanisms underlying WML formation remain unknown. We herein report the relationship between the intrathecal immune response and the development of WMLs in HIV-negative patients with CM. Methods Eleven consecutive HIV-negative patients with CM who presented at one of three emergency hospitals in Japan from April 2001 to March 2018 were enrolled. For all patients, we retrospectively assessed the relationships between clinical and laboratory information and the presence of WMLs. Results At presentation, 6 patients had WMLs on magnetic resonance imaging (MRI). The cerebrospinal fluid immunoglobulin G (CSF IgG) index was significantly higher in the patients with WMLs than in those without WMLs (mean, 1.34 vs. 0.70, p=0.017). The time from the symptom onset to initial neuroimaging was also significantly longer in the patients with WMLs than in those without WMLs (median, 31.5 vs. 7.0 days; p=0.008). The clinical outcome was comparable among the patients with and without WMLs. Conclusion In HIV-negative patients with CM, a persistent, aberrant immune response to Cryptococcus, such as intrathecal IgG synthesis, may induce WML formation.


Assuntos
Soronegatividade para HIV , Imunoglobulina G/metabolismo , Meningite Criptocócica/imunologia , Substância Branca/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Cryptococcus/imunologia , Feminino , Humanos , Imunoglobulina G/líquido cefalorraquidiano , Imagem por Ressonância Magnética , Masculino , Meningite Criptocócica/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
AIDS Behav ; 23(9): 2486-2489, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31254191

RESUMO

To address gaps in the cost literature by estimating the cost of delivering an evidence-based HIV risk reduction intervention for HIV-serodiscordant, heterosexual, African American couples (Eban II) and calculating the cost-effective thresholds at three participating sites. The cost, cost-saving, and cost-effectiveness thresholds for Eban II were calculated using standard methods. The analytic time period was from July 1 to September 31, 2014. Total costs for 3 months of program implementation were from $13,747 to $25,937, with societal costs ranging from $5632 to $17,008 and program costs ranging from $8115 to $14,122. The costs per participant were from $1621 to $2160; the cost per session (per participant) ranged from $147 to $196. Sites had achievable cost-saving thresholds, which were all less than one for the 3-month costing timeframe.


Assuntos
Afro-Americanos , Medicina Baseada em Evidências/economia , Infecções por HIV/prevenção & controle , Soronegatividade para HIV , Avaliação de Programas e Projetos de Saúde , Comportamento de Redução do Risco , Parceiros Sexuais , Adulto , Preservativos/estatística & dados numéricos , Análise Custo-Benefício , Custos e Análise de Custo , Feminino , Infecções por HIV/economia , Infecções por HIV/etnologia , Heterossexualidade , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde/economia , Sexo Seguro/etnologia , Sexo Seguro/estatística & dados numéricos
14.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(5): 493-498, 2019 May 10.
Artigo em Chinês | MEDLINE | ID: mdl-31177726

RESUMO

Objective: To understand the prevalence of alcohol use and related factors in HIV positive and HIV negative males. Methods: Baseline data were from the prospective cohort study of comparative HIV and aging research in Taizhou of Zhejiang province from January to December, 2017. The information about alcohol use in the last month was collected through a face-to-face questionnaire interview. Participants were categorized into non-current drinkers, light/moderate drinkers and heavy drinkers according to the US National Institute on Alcoholism and Alcohol Abuse (NIAAA) standard. Results: A total of 1 367 HIV positive males and 2 418 HIV negative males were included. Current alcohol use rate (35.2%, 481/1 367) and heavy alcohol use rate (5.0%, 24/481) were significantly lower in HIV positive males than in HIV negative males (48.0%, 1 161/2 418; 23.5%, 273/1 161), but the proportion of drinking wine and yellow rice wine were significantly higher (21.8%, 105/481; 9.1%, 44/481) in HIV positive males than in HIV negative males (13.5%, 157/1 161; 5.8%, 67/1 161). The multivariate multinomial logistic regression analysis results showed that larger waist circumference, current smoking and regular physical exercise were associated with heavy alcohol use behavior in HIV positive males, and age ≥30 years, current smoking, regular physical exercise, higher score of depressive symptoms, heterosexual transmission route and baseline CD(4)(+)T cells counts of 200-499 cells/µl were significantly associated with mild/moderate alcohol use behavior in HIV positive males. Conclusions: The alcohol use rate was significantly lower in HIV positive males than in HIV negative males in Taizhou. It is important to strengthen intervention on alcohol drinking behavior and chronic disease risk factors, such as larger waist circumference, smoking and so on.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/psicologia , Infecções por HIV/psicologia , Soronegatividade para HIV , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , China/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Entrevistas como Assunto , Masculino , Prevalência , Estudos Prospectivos , Inquéritos e Questionários
15.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(5): 499-504, 2019 May 10.
Artigo em Chinês | MEDLINE | ID: mdl-31177727

RESUMO

Objective: To understand the characteristics of sleep disorder in HIV positive and negative individuals, and compare the distributions and epidemiologic characteristic of different subtypes of sleep disorder between two groups. Methods: Baseline data were from the prospective cohort study of comparative HIV and aging research in Taizhou of Zhejiang province from January to December, 2017. A total of 459 HIV positive patients and 798 HIV negative controls with sleep disorders (Pittsburg Sleep Quality Index >5 or at least one question with answers of "most nights" or "every night" for Jenkins Sleep Scale) were included in the analysis. Cluster analysis was conducted to identify the different subtypes of sleep disorder based on 15 sleep-related questions. Results: A total of 1 257 participants were divided into three groups (clusters), i.e. difficulty falling asleep and sleep keeping group (cluster 1), the mild symptoms group (cluster 2), and restless night and daytime dysfunction group (cluster 3), accounting for 19.4% (89/459), 63.8% (293/459) and 16.8% (77/459) in HIV positive group and 13.8% (110/798), 60.5% (483/798) and 25.7% (205/798) in HIV negative group (χ(2)=16.62, P<0.001). In HIV positive group, the patients in cluster 1 and 3 were older and had higher frailty score, the patients in cluster 1 had highest level of depression, and the more patients in cluster 3 had low body weight or overweight (χ(2)=13.29, P=0.039; χ(2)=23.33, P<0.001; χ(2)=25.71, P<0.001; χ(2)=15.37, P=0.004). In HIV-negative group, similar findings were found for age, depressive symptoms and frailty score. In addition, the proportion of those who were illiteracy or with primary school education level was significantly high in cluster 1, and the proportion of abnormal waist-to-hip ratio was significantly higher in cluster 1 and 3 (χ(2)=30.59, P<0.001; χ(2)=11.61, P=0.003). Conclusions: The proportion of every subtype of sleep disorder in HIV positive individuals were different to those in HIV negative individuals. Mental and physical health status were the main factors affecting the prevalence of sleep disorder. It is necessary to conduct targeted interventions to improve sleep quality.


Assuntos
Infecções por HIV/complicações , Soronegatividade para HIV , Distúrbios do Início e da Manutenção do Sono/complicações , Transtornos do Sono-Vigília/complicações , Sono/fisiologia , Análise por Conglomerados , Infecções por HIV/epidemiologia , Nível de Saúde , Humanos , Estudos Prospectivos , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Transtornos do Sono-Vigília/epidemiologia
16.
AIDS Patient Care STDS ; 33(7): 299-307, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31188016

RESUMO

We conducted a cross-sectional study of 148 HIV+ on HIV antiretroviral therapy and 149 HIV- adults in Mbarara, Uganda, to estimate the association between HIV infection and homeostasis model assessment of insulin resistance (HOMA-IR) using multivariable regression analysis. In addition, we evaluated whether intestinal fatty acid-binding protein (I-FABP), monocyte activation markers soluble (s)CD14 and sCD163, and proinflammatory cytokine interleukin 6 (IL-6) mediated this association. HOMA-IR was greater among HIV+ than HIV- adults [median (interquartile range): 1.3 (0.7-2.5) vs. 0.9 (0.5-2.4); p = 0.008]. In models adjusted for sociodemographic variables, diet, hypertension, and smoking history, HIV infection was associated with 37% [95% confidence intervals (95% CIs): 5-77] greater HOMA-IR compared with HIV- participants. The magnitude of association was greater when I-FABP was included as a covariate although the additive effect was modest (40% CI: 8-82). By contrast adding sCD14 to the model was associated with greater HOMA-IR (59%; 95% CI: 21-109) among HIV+ participants compared with HIV- participants. Among HIV+ participants, greater CD4 nadir was non-significantly associated with greater HOMA-IR (22%; 95% CI: -2 to 52). Each 5-unit increase in body mass index (BMI; 49% greater HOMA-IR; 95% CI: 18-87) and female sex (71%; 95% CI: 17-150) remained associated in adjusted models. In this study of mainly normal-weight Ugandan adults, HIV infection, female sex, and greater BMI were all associated with greater insulin resistance (IR). This association was strengthened modestly after adjustment for sCD14, suggesting possible distinct immune pathways to IR that are independent of HIV or related to inflammatory changes occurring on HIV treatment.


Assuntos
Biomarcadores/sangue , Proteínas de Ligação a Ácido Graxo , Infecções por HIV/complicações , Infecções por HIV/metabolismo , Inflamação/metabolismo , Resistência à Insulina/fisiologia , Adulto , Antirretrovirais/uso terapêutico , Biomarcadores/metabolismo , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Feminino , Intolerância à Glucose/sangue , Intolerância à Glucose/metabolismo , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Soronegatividade para HIV , Humanos , Inflamação/sangue , Masculino , Pessoa de Meia-Idade , Uganda
17.
AIDS Patient Care STDS ; 33(7): 323-335, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31194573

RESUMO

The systemic framework of resilience and dyadic perspective of couple coping suggests that HIV-discordant couples may show heterogeneous profiles of dyadic adjustment, shaped by contextual risks and resources. This study aimed to identify heterogeneous profiles of dyadic adjustment and thus investigate the expression of resilience among 159 heterosexual HIV-discordant couples in rural China. We hypothesized that the couples could be grouped into distinct profiles: both members showing poor well-being, both members showing good well-being, and discrepant well-being across the two members. A latent profile analysis classified the couples into three subgroups based on well-being, which was measured using the World Health Organization Well-Being Index. As expected, one subgroup, labeled Maladapted Couples (n = 58, 36.5%), reported poor well-being in both people living with HIV/AIDS (PLWHA) and the seronegative spouse. The second subgroup, labeled Resilient Couples (n = 50, 31.4%), was characterized by relatively good well-being in both partners. In the third subgroup, labeled Maladapted PLWHA and Resilient Spouses (n = 51, 32.1%), the PLWHA showed poor well-being, while the seronegative spouses demonstrated good well-being. The identified subgroups were validated against external well-being measures, including depression and self-rated health measures. Exploratory analyses identified distinct patterns of contextual risks (including HIV stigma and financial difficulties) and resource factors (including individual resources and relational resources) across the subgroups. These findings underscore the heterogeneity of adjustment among heterosexual HIV-discordant couples in rural China and suggest the potential usefulness of services tailored to specific subgroups.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Infecções por HIV/psicologia , Soronegatividade para HIV , Heterossexualidade , Resiliência Psicológica , Parceiros Sexuais/psicologia , Cônjuges/psicologia , Estresse Psicológico/psicologia , Adaptação Psicológica , Adulto , China/epidemiologia , Feminino , Infecções por HIV/etnologia , Humanos , Masculino , População Rural , Estigma Social
18.
PLoS Pathog ; 15(6): e1007840, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31173604

RESUMO

BLyS/BAFF is recognized for its role in B-cell ontogenesis, as well as cell fate decision towards the first-line/innate marginal zone (MZ) B-cell pool. Excess BLyS/BAFF is associated with hyperglobulinemia and increased frequencies of activated precursor-like MZ B-cells. Herein, we show that HIV highly-exposed seronegative (HESN) commercial sex workers (CSWs) had lower soluble BLyS/BAFF levels and relative frequencies of BLyS/BAFF expressing cells in their genital mucosa when compared to those from HIV-infected CSWs and HIV-uninfected non-CSWs. Furthermore, we identified genital innate and/or marginal zone (MZ)-like CD1c+ B-cells that naturally bind to fully glycosylated gp120, which frequencies were lower in HESNs when compared to HIV-infected CSWs and HIV-uninfected non-CSWs. Although genital levels of total IgA were similar between groups, HESNs had lower levels of total IgG1 and IgG3. Interestingly, HIV-gp41 reactive IgG1 were found in some HESNs. Low genital levels of BLyS/BAFF observed in HESNs may allow for controlled first-line responses, contributing to natural immunity to HIV.


Assuntos
Antígenos CD1/imunologia , Fator Ativador de Células B/imunologia , Linfócitos B/imunologia , Genitália Feminina/imunologia , Glicoproteínas/imunologia , Soronegatividade para HIV/imunologia , HIV-1/imunologia , Imunidade Inata , Profissionais do Sexo , Adulto , Linfócitos B/patologia , Feminino , Anticorpos Anti-HIV/imunologia , Humanos , Imunoglobulina G/imunologia , Pessoa de Meia-Idade
19.
Infez Med ; 27(2): 168-174, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205040

RESUMO

Opportunistic parasites are still important agents causing morbidity and mortality in immunocompromised patients, particularly those living with HIV/AIDS. Few studies in Mexico have attempted to determine the prevalence of opportunistic intestinal parasites causing diarrhea in immunocompromised patients. A study was conducted to determine the intestinal parasites in HIV-positive and HIV-negative immunocompromised patients with diarrhea admitted to a tertiary care hospital in Monterrey, Mexico, from 2014 to 2015. Stool samples were examined for trophozoites, cysts, and eggs using the EGRoPe sedimentation-concentration technique and special techniques (modified Ziehl-Neelsen stain, modified trichrome stain). A total of 56 patients were included. The overall prevalence of intestinal parasitism was 64% (36/56); 22/36 patients were HIV-positive. Prevalence of opportunistic parasites was 69% in HIV-infected patients compared to 44% in HIV-negative patients (P = 0.06). Microsporidia were the most frequently identified parasites (24/36, 67%), followed by Cryptosporidium sp. (6/36, 17%), Sarcocystis sp. (4/36, 11%), Cystoisospora belli (3/36, 8%), and Cyclospora cayetanensis (1/36, 3%). Overall prevalence rates of microsporidiosis and cryptosporidiosis were 43% and 11%, respectively. Among HIV-infected patients, prevalence rates of microsporidiosis and cryptosporidiosis were 48% and 14%, respectively. We also report the first cases of intestinal sarcocystosis in Mexico, all in HIV-infected patients. In conclusion, microsporidia and coccidia are major parasitic agents causing diarrhea in immunocompromised patients, particularly HIV-infected patients.


Assuntos
Hospedeiro Imunocomprometido , Enteropatias Parasitárias/epidemiologia , Infecções Oportunistas/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Adolescente , Adulto , Idoso , Coccidiose/epidemiologia , Criptosporidiose/epidemiologia , Fezes/parasitologia , Feminino , Soronegatividade para HIV , Soropositividade para HIV/epidemiologia , Soropositividade para HIV/parasitologia , Humanos , Enteropatias Parasitárias/parasitologia , Masculino , México , Microsporidiose/epidemiologia , Pessoa de Meia-Idade , Infecções Oportunistas/parasitologia , Estudos Prospectivos , Sarcocistose/epidemiologia , Centros de Atenção Terciária , Adulto Jovem
20.
Rev. iberoam. micol ; 36(2): 55-60, abr.-jun. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-185476

RESUMO

Background: The number of fungal infections has increased in recent years in Rio Grande do Sul (RS), Brazil. Epidemiological studies are important for proper control of infections. Aims: To evaluate the etiology of fungal infections in patients in RS, from 2003 to 2015. Methods: This is a retrospective and longitudinal study carried out at Mycology Department of Central Laboratory of RS; 13,707 samples were evaluated. The variables sex, age, site of infection, and etiologic agent were analyzed. Susceptibility of Candida to fluconazole was tested in isolates from samples collected in 2015 from 51 outpatients. Results: Of the 13,707 samples, 840 cases (6.12%) of fungal infections were found and included in the analyses; female gender accounted for the 55.9% of the cases. The main fungus was Candida albicans (450 cases, 53.38%; p < 0.001). Onychomycosis was the most frequent infection in superficial mycoses. Systemic mycoses accounted for 54.05% of the cases, from which 68.8% occurred in males, mainly HIV-positive (33.11%), and the main etiologic agent in these cases was Cryptococcus neoformans (73.13%). Among 51 samples tested for susceptibility to fluconazole, 78.43% of Candida isolates were susceptible; 5.88% were susceptible in a dose-dependent manner, and 15.69% were resistant. Conclusions: C. albicans is a common cause of fungal infections in RS, accounting for half of the cases; resistance to antifungals was found in non-hospitalized patients. In addition, women seem to be more susceptible to fungal infections than men, however men show more systemic mycoses than women. The nails are the most common site of infection


Antecedentes: El número de casos de infecciones fúngicas ha aumentado en los últimos años en Rio Grande do Sul (RS), Brasil. Los estudios epidemiológicos son importantes para el control de estas infecciones. Objetivos: Evaluar la etiología de las infecciones fúngicas en pacientes de RS desde 2003 hasta 2015. Métodos: Este es un estudio retrospectivo y longitudinal realizado en el Departamento de Micología del Laboratorio Central de RS; se evaluaron 13.707 casos de infecciones. Se analizaron las variables sexo, edad, lugar de infección y agente etiológico. La sensibilidad de Candida al fluconazol se analizó en 51 aislamientos de muestras recogidas en el año 2015. Resultados: De las 13.707 muestras, 840 casos (6,12%) de infecciones fúngicas se incluyeron en el análisis; el 55,9% correspondieron a mujeres. El hongo predominante fue Candida albicans (450 casos, 53,38%; p < 0,001). La onicomicosis fue la infección más frecuente de las micosis superficiales. Las micosis sistémicas representaron el 54,05% de los casos; de estos, el 68,8% tuvieron lugar en hombres, principalmente VIH-positivos (33,11%), y el principal agente etiológico en estos casos fue Cryptococcus neoformans (73,13%). Entre las 51 muestras analizadas para determinar la sensibilidad al fluconazol, el 78,43% de los aislamientos de Candida fueron sensibles; el 5,88% fueron sensibles de forma dosis-dependiente y el 15,69% fueron resistentes. Conclusiones: C. albicans es una causa común de infecciones fúngicas en RS, pues representa la mitad de los casos; su resistencia a los antifúngicos se encontró entre pacientes ambulatorios. Además, parece que las mujeres son más susceptibles a las infecciones fúngicas que los hombres, mientras que los hombres presentan más micosis sistémicas que las mujeres; las uñas son el lugar más frecuente de infección


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Micoses/epidemiologia , Antifúngicos/uso terapêutico , Brasil/epidemiologia , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candida albicans/isolamento & purificação , Candidíase/epidemiologia , Candidíase/microbiologia , Criptococose/epidemiologia , Criptococose/microbiologia , Cryptococcus neoformans/isolamento & purificação , Fluconazol/uso terapêutico , Soronegatividade para HIV , Soropositividade para HIV/epidemiologia , Estudos Longitudinais , Testes de Sensibilidade Microbiana , Micoses/microbiologia , Onicomicose/epidemiologia , Onicomicose/microbiologia , Prevalência
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