Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.928
Filtrar
1.
BMC Infect Dis ; 21(1): 287, 2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743629

RESUMO

BACKGROUND: Talaromyces marneffei (T. marneffei) is an opportunistic pathogen that infects immunodeficient children. The aim of the study is to determine the clinical features and peripheral immune state of Talaromyces marneffei (T. marneffei) infections in children for early detection and diagnosis. METHODS: We retrospectively reviewed 21 pediatric patients who were diagnosed with T. marneffei infections and were followed up in the Guangzhou Women and Children's Medical Center from January 2010 to January 2020. For each patient, we collected and analyzed clinical characteristics, peripheral immunological results, genetic tests, complications and prognosis. RESULTS: Common clinical features of the patients included fever (20/21, 95.24%), cough (17/21, 80.95%) and hepatomegaly (17/21, 80.95%). Severe complications included septic shock (12/21, 57.14%), hemophagocytic lymphohistiocytosis (HLH) (11/21, 52.38%), acute respiratory distress syndrome (ARDS) (10/21, 47.62%), multiple organ dysfunction syndrome (MODS) (9/21, 42.86%), and disseminated intravascular coagulation (DIC) (7/21, 33.33%). Eleven children (11/21, 52.38%) eventually died of T. marneffei infections. All patients were HIV negative. Seven cases revealed reduced antibody levels, especially IgG. Higher levels of IgE were detected in 9 cases with an obvious increase in two patients. Ten patients showed decreased complement C3 levels, some of whom had low C4 levels. Three patients displayed decreased absolute T lymphocyte counts, including the CD 4+ and CD 8+ subsets. A reduction in NK cells was present in most patients. No patient had positive nitro blue tetrazolium (NBT) test results. Nine patients were screened for common genetic mutations. Of the cases, one case had no disease-specific gene mutation. Four children had confirmed hyperimmunoglobulin M syndrome (HIGM) with CD40LG variation, one case had severe combined immunodeficiency (SCID), and one case had hyper-IgE syndrome (HIES). One patient was identified as having a heterozygous mutation in STAT3 gene; however, he showed no typical clinical manifestations of HIES at his age. One patient had a mutated COPA gene with uncertain pathogenic potential. Another patient was diagnosed with HIES that depended on her clinical features and the National Institutes of Health (NIH) scoring system. CONCLUSIONS: T. marneffei infections in HIV-negative children induced severe systemic complications and poor prognosis. Children with T. marneffei infections commonly exhibited abnormal immunoglobulin levels in peripheral blood, particularly decreased IgG or increased IgE levels, further suggesting possible underlying PIDs in these patients.


Assuntos
Anticorpos Antifúngicos/sangue , Micoses/imunologia , Criança , China , Diagnóstico Precoce , Feminino , Soronegatividade para HIV , Humanos , Masculino , Micoses/diagnóstico , Estudos Retrospectivos , Talaromyces
2.
Medicine (Baltimore) ; 100(7): e24498, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607779

RESUMO

INTRODUCTION: No standard guideline has been established for the treatment of plasmablastic lymphoma (PBL) and prognosis remains extremely poor, given that patients relapse early after chemotherapy and show resistance to commonly used cytostatic drugs. PATIENT CONCERNS: We present the case of a 52-year-old HIV-negative man who presented with a mass at the left sternoclavicular joint. He had no significant comorbidities and no latent immunosuppression. DIAGNOSIS: The largest lymph node measured was 36 × 19 mm. An excisional biopsy showed diffuse proliferation of large lymphoid cells which were positive for CD38 and CD138, but negative for CD20. He was diagnosed with stage IV PBL with a low IPI. INTERVENTIONS: The patient was treated with four cycles of induction therapy with bortezomib, epirubicin and dexamethasone. He achieved complete remission. But 3 months after receiving consolidated autologous hematopoietic stem cell transplantation, he relapsed. Allogeneic hematopoietic stem cell transplantation was performed on the patient. OUTCOMES: The patient achieved remission again and there were no serious complications after allogeneic hematopoietic stem cell transplantation. This patient was followed up once every three months, and to date, he has been disease-free for more than 4 years. CONCLUSION: The survival of recurrent PBL after autologous hematopoietic stem cell transplantation is very poor. Salvage allogeneic hematopoietic stem cell transplantation may bring long-term survival opportunities for those patients. Further clinical studies are needed to explore the role of allogeneic hematopoietic stem cell transplantation in refractory and recurrent PBL.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Transplante de Células-Tronco Hematopoéticas/métodos , Linfoma Plasmablástico/terapia , Transplante Homólogo/métodos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Soronegatividade para HIV , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/terapia , Linfoma Plasmablástico/diagnóstico , Linfoma Plasmablástico/patologia , Indução de Remissão/métodos , Transplante Homólogo/efeitos adversos
3.
BMC Infect Dis ; 21(1): 224, 2021 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-33639846

RESUMO

BACKGROUND: The clinical profiles and outcomes of cryptococcal meningitis have been shown to vary depending on the underlying condition. The aim of this study was to investigate clinical characteristics and outcomes in patients with and without type II diabetes mellitus. METHODS: A retrospective study was performed. Clinical data of HIV-negative cryptococcal meningitis patients with type II diabetes mellitus (n = 26) and without type II diabetes mellitus (n = 52) referring to the Jiangxi Chest Hospital between January 2012 to December 2018 were analyzed. The data were analyzed using chi square, none-parametric tests, and logistic regression. P-values < 0.05 were considered significant. RESULTS: In this study, cryptococcal meningitis patients suffering from type II diabetes mellitus had a higher mortality (23.08% vs. 7.69%; P = 0.055), and required longer hospitalization (59.58 vs. 42.88 days; P = 0.132). Moreover, cerebrospinal fluid examinations revealed that cryptococcal meningitis patients with type II diabetes mellitus had higher opening pressure (271.54 vs. 234.23 mmH2O; P = 0.125).The results of multivariate regression analysis revealed that cryptococcal meningitis patients with type II diabetes were more often presented with visual disorders (28.54% vs. 11.54%; [95% CI 0.056-0.705]; p = 0.012), and had higher cerebrospinal fluid protein levels (1027.62 ± 594.16 vs. 705.72 ± 373.88 mg/l; [95% CI 1.000-1.002]; p = 0.016). Among patients with type II diabetes mellitus, nausea and vomiting was more frequent at the initial visit in those died (100% vs. 50%; p = 0.027), and 66% of died type II diabetes mellitus patients were poorly controlled blood glucose level, compared with 30% in survival type II diabetes mellitus patients. CONCLUSION: This study suggests that cryptococcal meningitis patients with type II diabetes mellitus differ significantly from cryptococcal meningitis patients without type II diabetes mellitus with respect to clinical symptoms such as visual disorders and cerebrospinal fluid examination. The presence of nausea and vomiting among type II diabetes mellitus patients could have implication in mortality.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Meningite Criptocócica/diagnóstico , Meningite Criptocócica/epidemiologia , Adulto , Idoso , China/epidemiologia , Comorbidade , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/terapia , Feminino , Soronegatividade para HIV/fisiologia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Meningite Criptocócica/complicações , Meningite Criptocócica/terapia , Pessoa de Meia-Idade , Mortalidade , Prognóstico , Estudos Retrospectivos
4.
Lancet Infect Dis ; 21(3): 354-365, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33508224

RESUMO

BACKGROUND: Targeted preventive therapy for individuals at highest risk of incident tuberculosis might impact the epidemic by interrupting transmission. We tested performance of a transcriptomic signature of tuberculosis (RISK11) and efficacy of signature-guided preventive therapy in parallel, using a hybrid three-group study design. METHODS: Adult volunteers aged 18-59 years were recruited at five geographically distinct communities in South Africa. Whole blood was sampled for RISK11 by quantitative RT-PCR assay from eligible volunteers without HIV, recent previous tuberculosis (ie, <3 years before screening), or comorbidities at screening. RISK11-positive participants were block randomised (1:2; block size 15) to once-weekly, directly-observed, open-label isoniazid and rifapentine for 12 weeks (ie, RISK11 positive and 3HP positive), or no treatment (ie, RISK11 positive and 3HP negative). A subset of eligible RISK11-negative volunteers were randomly assigned to no treatment (ie, RISK11 negative and 3HP negative). Diagnostic discrimination of prevalent tuberculosis was tested in all participants at baseline. Thereafter, prognostic discrimination of incident tuberculosis was tested in the untreated RISK11-positive versus RISK11-negative groups, and treatment efficacy in the 3HP-treated versus untreated RISK11-positive groups, during active surveillance through 15 months. The primary endpoint was microbiologically confirmed pulmonary tuberculosis. The primary outcome measures were risk ratio [RR] for tuberculosis of RISK11-positive to RISK11-negative participants, and treatment efficacy. This trial is registered with ClinicalTrials.gov, NCT02735590. FINDINGS: 20 207 volunteers were screened, and 2923 participants were enrolled, including RISK11-positive participants randomly assigned to 3HP (n=375) or no 3HP (n=764), and 1784 RISK11-negative participants. Cumulative probability of prevalent or incident tuberculosis disease was 0·066 (95% CI 0·049 to 0·084) in RISK11-positive (3HP negative) participants and 0·018 (0·011 to 0·025) in RISK11-negative participants (RR 3·69, 95% CI 2·25-6·05) over 15 months. Tuberculosis prevalence was 47 (4·1%) of 1139 versus 14 (0·78%) of 1984 in RISK11-positive compared with RISK11-negative participants, respectively (diagnostic RR 5·13, 95% CI 2·93 to 9·43). Tuberculosis incidence over 15 months was 2·09 (95% CI 0·97 to 3·19) vs 0·80 (0·30 to 1·30) per 100 person years in RISK11-positive (3HP-negative) participants compared with RISK11-negative participants (cumulative incidence ratio 2·6, 95% CI 1·2 to 5·9). Serious adverse events related to 3HP included one hospitalisation for seizures (unintentional isoniazid overdose) and one death of unknown cause (possibly temporally related). Tuberculosis incidence over 15 months was 1·94 (95% CI 0·35 to 3·50) versus 2·09 (95% CI 0·97 to 3·19) per 100 person-years in 3HP-treated RISK11-positive participants compared with untreated RISK11-positive participants (efficacy 7·0%, 95% CI -145 to 65). INTERPRETATION: The RISK11 signature discriminated between individuals with prevalent tuberculosis, or progression to incident tuberculosis, and individuals who remained healthy, but provision of 3HP to signature-positive individuals after exclusion of baseline disease did not reduce progression to tuberculosis over 15 months. FUNDING: Bill and Melinda Gates Foundation, South African Medical Research Council.


Assuntos
Antituberculosos/uso terapêutico , Biomarcadores/metabolismo , Isoniazida/uso terapêutico , Rifampina/análogos & derivados , Tuberculose/prevenção & controle , Adulto , Esquema de Medicação , Feminino , Soronegatividade para HIV , Humanos , Incidência , Masculino , Mycobacterium tuberculosis/genética , RNA Bacteriano/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Rifampina/uso terapêutico , África do Sul/epidemiologia , Resultado do Tratamento , Tuberculose/epidemiologia , Tuberculose/genética , Tuberculose/metabolismo , Adulto Jovem
5.
Zhonghua Jie He He Hu Xi Za Zhi ; 44(1): 14-27, 2021 Jan 12.
Artigo em Chinês | MEDLINE | ID: mdl-33412620

RESUMO

Objective: To investigate the current status of the diagnosis and treatment of pulmonary cryptococcosis in respiratory medicine and improve the understanding of the clinical characteristics of HIV-negative pulmonary cryptococcosis in China. Methods: A prospective multi-center open cohort study was designed to screen for pulmonary cryptococcosis in the general wards and intensive care units of the Department of Respiratory Diseases in 22 hospitals. The HIV-negative patients with positive cryptococcal etiological diagnosis based on smear culture, antigen detection and histopathology were enrolled in the study. The clinical data of enrolled patients were collected and analyzed. Results: A total of 457 cases of pulmonary cryptococcosis were enrolled, among which 3.28% (15/457) were disseminated infections. The case fatality rate was 0.88% (4/457). The majority of the cases were diagnosed by histopathological examinations (74.40%, 340/457) and cryptococcus antigen detection (37.64%, 172/457). Patients with pulmonary cryptococcosis accounted for 2.04‰ (457/223 748) of the total hospitalized patients in the Department of Respiratory Diseases during the same period, and the ratio was the highest in south and east China. Meanwhile, 70.24% (321/457) of the patients had no underlying diseases, while 87.75% (401/457) were found to have immunocompetent status. Cough and expectoration were the most common clinical symptoms in patients with pulmonary cryptococcosis. However, 25.16% (115/457) of the patients had no clinical symptom or physical signs. In terms of imaging features on pulmonary CT, multiple pulmonary lesions were more common than isolated lesions, and there were more subpleural lesions than perihilar or medial lesions. Morphologically, most of the lesions were middle-sized nodules (1-5 cm) or small-sized nodules (3 mm to 1 cm). The sensitivity of serum cryptococcus antigen test was 71.99% (203/282). Moreover, antigen-positive patients differed from antigen-negative patients in terms of basic immune status, clinical symptoms, imaging features and infection types. Meanwhile, immunocompromised patients differed from immunocompetent patients in terms of clinical symptoms, physical signs, infection-related inflammation indicator levels, imaging features, serum cryptococcus antigen positive rate and prognosis. Conclusions: The majority of cases of HIV-negative pulmonary cryptococcosis in China had no underlying disease or immunocompromised status, and the overrall prognosis was favorable. However, early diagnosis of HIV-negative pulmonary cryptococcosis remains challenging due to the complicated manifestations of the disease.


Assuntos
Criptococose/diagnóstico , Cryptococcus/isolamento & purificação , Soronegatividade para HIV , Antígenos de Fungos , China/epidemiologia , Estudos de Coortes , Tosse , Criptococose/epidemiologia , Humanos , Imunocompetência , Pulmão/diagnóstico por imagem , Estudos Prospectivos , Tomografia Computadorizada por Raios X
6.
Arterioscler Thromb Vasc Biol ; 41(1): 512-522, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33327750

RESUMO

OBJECTIVE: To determine the effects of HIV serostatus and disease severity on endothelial function in a large pooled cohort study of people living with HIV infection and HIV- controls. Approach and Results: We used participant-level data from 9 studies: 7 included people living with HIV (2 treatment-naïve) and 4 had HIV- controls. Brachial artery flow-mediated dilation (FMD) was measured using a standardized ultrasound imaging protocol with central reading. After data harmonization, multiple linear regression was used to examine the effects of HIV- serostatus, HIV disease severity measures, and cardiovascular disease risk factors on FMD. Of 2533 participants, 986 were people living with HIV (mean 44.4 [SD 11.8] years old) and 1547 were HIV- controls (42.9 [12.2] years old). The strongest and most consistent associates of FMD were brachial artery diameter, age, sex, and body mass index. The effect of HIV+ serostatus on FMD was strongly influenced by kidney function. In the highest tertile of creatinine (1.0 mg/dL), the effect of HIV+ serostatus was strong (ß=-1.59% [95% CI, -2.58% to -0.60%], P=0.002), even after covariate adjustment (ß=-1.36% [95% CI, -2.46% to -0.47%], P=0.003). In the lowest tertile (0.8 mg/dL), the effect of HIV+ serostatus was strong (ß=-1.90% [95% CI, -2.58% to -1.21%], P<0.001), but disappeared after covariate adjustment. HIV RNA viremia, CD4+ T-cell count, and use of antiretroviral therapy were not meaningfully associated with FMD. CONCLUSIONS: The significant effect of HIV+ serostatus on FMD suggests that people living with HIV are at increased cardiovascular disease risk, especially if they have kidney disease.


Assuntos
Artéria Braquial/fisiopatologia , Doenças Cardiovasculares/etiologia , Endotélio Vascular/fisiopatologia , Infecções por HIV/complicações , Vasodilatação , Sorodiagnóstico da AIDS , Nefropatia Associada a AIDS/complicações , Adolescente , Adulto , Idoso , Artéria Braquial/diagnóstico por imagem , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/fisiopatologia , Estudos de Casos e Controles , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/virologia , Soronegatividade para HIV , Soropositividade para HIV , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Índice de Gravidade de Doença , Adulto Jovem
7.
PLoS Pathog ; 16(12): e1009103, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33315937

RESUMO

The antibody molecule comprises a variable domain conferring antigen specificity and affinity distinct from the heavy chain constant (CH) domains dictating effector functions. We here interrogate this paradigm by evaluating the unique influence of the CH1α domain on epitope specificity and functions using two mucosal gp41-specific Fab-IgAs (FabA) derived from HIV-1 highly-exposed but persistently seronegative individuals (HESN). These HESN develop selectively affinity-matured HIV-1-specific mucosal IgA that target the gp41 viral envelope and might provide protection although by unclear mechanisms. Isotype-switching FabAs into Fab-IgGs (FabGs) results in a >10-fold loss in affinity for HIV-1 clade A, B, and C gp41, together with reduced neutralization of HIV-1 cross-clade. The FabA conformational epitopes map selectively on gp41 in 6-Helix bundle and pre-fusion conformations cross-clade, unlike FabGs. Finally, we designed in silico, a 12 amino-acid peptide recapitulating one FabA conformational epitope that inhibits the FabA binding to gp41 cross-clade and its neutralizing activity. Altogether, our results reveal that the CH1α domain shapes the antibody paratope through an allosteric effect, thereby strengthening the antibody specificity and functional activities. Further, they clarify the mechanisms by which these HESN IgAs might confer protection against HIV-1-sexual acquisition. The IgA-specific epitope we characterized by reverse vaccinology could help designing a mucosal HIV-1 vaccine.


Assuntos
Especificidade de Anticorpos/imunologia , Sítios de Ligação de Anticorpos/imunologia , Anticorpos Anti-HIV/imunologia , Infecções por HIV/imunologia , HIV-1/imunologia , Imunoglobulina A/imunologia , Epitopos de Linfócito B/química , Epitopos de Linfócito B/imunologia , Proteína gp41 do Envelope de HIV/imunologia , Soronegatividade para HIV/imunologia , Humanos , Imunoglobulina A/química , Imunoglobulina G/imunologia , Domínios Proteicos/imunologia
8.
BMC Psychol ; 8(1): 116, 2020 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-33143747

RESUMO

BACKGROUND: Choosing the most useful and versatile way to solve one's personal and social problems is one of the most important choices in individual life. The aim of this study was to compare the coping styles of people living with Human immunodeficiency virus positive and negative. METHODS: This is a Cross-sectional study that accomplished in Shiraz Behavioural Disease Counselling Centre in 2019 and 2020. For this purpose, in the first phase, 40 HIV+ and 40 HIV- patients were randomly selected to answer the questionnaire of dealing with the stressful conditions of Andler and Parker. In the second phase, the same questionnaire was filled out along with a reality distortion questionnaire from similar individuals (40 HIV+ and 40 HIV-). RESULTS: 92% of the HIV population in this study was between 15 and 55 years and 8% was upper than 55 years. 90% of them had no university degree. Among all, 47.5% of them were, 48.5% were self-employed and 49% of them were infected sexually. The results showed that in the first stage there was a significant relationship between marital status and the chances of getting the disease in people, and after controlling the demographic factors, coping styles did not show a significant effect on the disease. In the second stage, the factors of age, sex, education, and marital status had significant effects on people living with HIV, but the effect of coping styles on people with HIV was not significant (P < 0.05). CONCLUSION: Therefore, it can be concluded that demographic factors more than coping styles can affect the chances of high-risk behaviours; so, what is identified and measured as a coping style in people in the process that leads to the manifestation of high-risk behaviours or healthy behaviour does not matter much. It should be noted that the reason for rejecting the hypotheses of this study could be the effect of cultural and social factors of Iranian society.


Assuntos
Adaptação Psicológica , Infecções por HIV/psicologia , Soronegatividade para HIV , Soropositividade para HIV , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
9.
PLoS One ; 15(10): e0237409, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002002

RESUMO

INTRODUCTION: Population-based HIV-free survival at 18-24 months of age among HIV-exposed infants in high prevalence settings in the era of treatment for all is largely unknown. We conducted a community-based survey to determine outcomes of HIV-exposed infants at 18-24 months in Lesotho. METHODS: Between November 2015 and December 2016, we conducted a survey among households with a child born 18-24 months prior to data collection. Catchment areas from 25 health facilities in Butha-Buthe, Maseru, Mohale's Hoek and Thaba-Tseka districts were randomly selected using probability proportional to size sampling. Consecutive households were visited and eligible consenting caregivers and children were enrolled. Rapid HIV antibody testing was performed on mothers of unknown HIV status (never tested or tested HIV-negative >3 months prior) and their children, and to children born to known HIV-positive mothers. Information on demographics, health-seeking behavior, HIV, and mortality were captured for mothers and children, including those who died. The difference in survival between subgroups was determined using the log-rank test. RESULTS: Of the 1,852 mothers/caregivers enrolled, 570 mothers were HIV-positive. The mother-to-child HIV transmission rate was 5.7% [95% CI: 4.0-8.0]. The mortality rate was 2.6% [95% CI: 1.6-4.2] among HIV-exposed children compared to 1.4% (95% CI: 0.9-2.3) among HIV-unexposed children. HIV-free survival was 91.8% [95% CI: 89.2-93.8] among HIV-exposed infants. Disclosure of mother's HIV status (aOR = 4.9, 95% CI: 1.3-18.2) and initiation of cotrimoxazole prophylaxis in the child (aOR = 3.9, 95% CI: 1.2-12.6) were independently associated with increased HIV-free survival while child growth problems (aOR = 0.2, 95% CI: 0.09-0.5) were independently associated with reduced HIV-free survival. CONCLUSION: Even in the context of lifelong antiretroviral therapy among pregnant and breastfeeding women, HIV has a significant effect on survival among HIV-exposed children compared to unexposed children. Lesotho has not reached elimination of HIV transmission from mother to child.


Assuntos
Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Adulto , Fármacos Anti-HIV/uso terapêutico , Aleitamento Materno , Estudos Transversais , Intervalo Livre de Doença , Feminino , Infecções por HIV/complicações , Soronegatividade para HIV , Soropositividade para HIV/epidemiologia , Humanos , Lactente , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Lesoto/epidemiologia , Masculino , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Inquéritos e Questionários , Adulto Jovem
10.
Medicine (Baltimore) ; 99(42): e22546, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080688

RESUMO

There are still no unified guidelines of surgical treatment and timing for human immunodeficiency virus (HIV)-negative patients with cryptococcal meningitis (CM).The clinical data and follow-up data were collected from HIV-negative CM patients in Xiangya Hospital of Central South University from January 2009 to November 2018, and 42 patients who were treated with surgical intervention were enrolled in the present study. These 42 patients were divided into ventriculoatrial (VA) group, ventriculoperitoneal group, external ventricle drainage (EVD) group, hydrocephalus (HYC) group, non-HYC group, EVD group, and non-EVD group (VA/ ventriculoperitoneal) according to different surgical procedures. Statistical analyses were conducted using SPSS (version 19.0, Chicago, IL).Signs of headache, fever, and loss of consciousness in the VA group were significantly improved compared with the EVD group at 1 week after operation (P < .05). The mortality rate of the VA group was significantly lower than that of the EVD group (P < .05). Moreover, male patients were more prone to have HYC (P < .05). Younger patients tended to develop HYC (P < .05). Cerebrospinal fluid sugar in the non-HYC group was significantly lower compared with the HYC group (P < .05). Time of CM-to-operation in the non-HYC group was markedly shorter compared with the HYC group (P < .01).VA procedure could be one of the first choices for the treatment of uncontrollable intracranial hypertension caused by CM. Severe uncontrollable headache, loss of consciousness, and cerebral hernia were indications of emergency surgery. Repeated headache, hearing impairment, and especially progressive loss of vision were indications of early surgery to avoid permanent damage to nerve functions of HIV-negative CM patients.


Assuntos
Soronegatividade para HIV , Meningite Criptocócica/cirurgia , Duração da Cirurgia , Adolescente , Adulto , Idoso , Criança , China , Feminino , Humanos , Masculino , Meningite Criptocócica/diagnóstico por imagem , Meningite Criptocócica/mortalidade , Pessoa de Meia-Idade
11.
AIDS Patient Care STDS ; 34(9): 380-391, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32931316

RESUMO

Prior research found low acceptability of HIV treatment as prevention (TasP; or Undetectable = Untransmittable) among HIV-negative men who have sex with men (MSM). This study reports on qualitative data regarding TasP adoption in a sample of 170 self-reported HIV-negative MSM who had engaged in exchange sex (received money, drugs, or other things in exchange for sex). We classified participants along five stages of TasP adoption: 1-unaware of TasP (11.2%); 2-aware, but perceived ineffective (17.1%); 3-perceived effective, but unwilling to use (35.3%); 4-willing to rely on TasP, but had never done so (24.1%); and 5-had relied on TasP (12.4%). Obstacles to TasP adoption included the following: not believing that it could completely prevent HIV transmission; deeply ingrained fears of HIV/AIDS; concerns about viral load fluctuation; and reluctance to trust a partner's claimed undetectable status. TasP promotion efforts, which can decrease barriers to HIV testing and HIV stigma, will be more effective if tailored to the obstacles specific to each stage of TasP adoption.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Soronegatividade para HIV/efeitos dos fármacos , Homossexualidade Masculina/psicologia , Profilaxia Pré-Exposição/métodos , Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/epidemiologia , Humanos , Masculino , Parceiros Sexuais , Minorias Sexuais e de Gênero/psicologia , Carga Viral
12.
PLoS One ; 15(9): e0239042, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915907

RESUMO

OBJECTIVE: Pneumocystis jirovecii pneumonia (PJP) was reported among immunosuppressed patients with deficits in cell-mediated immunity and in patients treated with immunomodulatory drugs. The aim of this study was to identify risk-factors for PJP in noninfected HIV patients. METHODS: This retrospective, test negative, case-control study was conducted in six hospitals in Israel, 2006-2016. Cases were hospitalized HIV-negative patients with pneumonia diagnosed as PJP by bronchoalveolar lavage. Controls were similar patients negative for PJP. RESULTS: Seventy-six cases and 159 controls were identified. Median age was 63.7 years, 65% males, 34% had hematological malignancies, 11% inflammatory diseases, 47% used steroids and 9% received antilymphocyte monoclonal antibodies. PJP was independently associated with antilymphocyte monoclonal antibodies (OR 11.47, CI 1.50-87.74), high-dose steroid treatment (OR 4.39, CI 1.52-12.63), lymphopenia (OR 8.13, CI 2.48-26.60), low albumin (OR 0.15, CI 0.40-0.54) and low BMI (OR 0.80, CI 0.68-0.93). CONCLUSION: In conclusion, rituximab, which is prescribed for a wide variety of malignant and inflammatory disorders, was found to be significant risk-factor for PJP. Increased awareness of possible PJP infection in this patient population is warranted.


Assuntos
Pneumocystis carinii , Pneumonia por Pneumocystis/etiologia , Rituximab/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Soro Antilinfocitário/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Estudos de Casos e Controles , Feminino , Soronegatividade para HIV , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/tratamento farmacológico , Neoplasias Hematológicas/imunologia , Humanos , Fatores Imunológicos/efeitos adversos , Israel , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Esteroides/efeitos adversos
13.
PLoS One ; 15(8): e0238234, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32841266

RESUMO

INTRODUCTION: We performed a cross-sectional study of HIV-uninfected men and women who inject drugs from the ALIVE cohort to examine if black men and women who inject drugs have higher levels of CD4+ T cells expressing the integrin heterodimer α4ß7 compared to white men and women. MATERIALS AND METHODS: Flow cytometry was used to examine expression of α4ß7 and other markers associated with different functional CD4+ T cell subsets in both men and women who inject drugs. RESULTS: Higher levels of α4ß7, CCR5, and CCR6 were observed on CD4+ T cells from black participants compared with white participants. In a multivariable model, α4ß7 expression differed by race, but not sex, age, or other factors. DISCUSSION: Black men and women express higher percentages of α4ß7 expressing CD4+ T cells, which may play a role in HIV disease.


Assuntos
Linfócitos T CD4-Positivos/imunologia , Soronegatividade para HIV/imunologia , Integrinas/sangue , Abuso de Substâncias por Via Intravenosa/imunologia , Adulto , Afro-Americanos , Baltimore , Estudos de Coortes , Estudos Transversais , Grupo com Ancestrais do Continente Europeu , Feminino , Citometria de Fluxo , Humanos , Masculino , Pessoa de Meia-Idade , Abuso de Substâncias por Via Intravenosa/sangue
14.
Dermatol Online J ; 26(4)2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32621687

RESUMO

Kaposi sarcoma typically presents as violaceous macules and papules in immunocompromised, specifically HIV-positive, patients. Its distinct clinical features often facilitate rapid diagnosis. In this article, we report a case of Kaposi sarcoma presenting as a concerning yet nondescript lesion in an HIV-negative woman. Although Kaposi sarcoma is frequently part of the differential diagnosis for skin lesions affecting HIV-positive patients, it is less frequently considered in HIV-negative individuals. Additionally, this case differs from the classic clinical presentation of Kaposi sarcoma by resembling a squamous cell carcinoma or superficial basal cell carcinoma. Therefore, it illustrates the importance of suspicious lesion biopsies to ensure accurate diagnosis and appropriate treatment.


Assuntos
Carcinoma de Células Escamosas/patologia , Soronegatividade para HIV , Sarcoma de Kaposi/patologia , Idoso , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Sarcoma de Kaposi/diagnóstico
15.
New Microbiol ; 43(2): 99-102, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32510160

RESUMO

Cryptococcus species is still a very common opportunistic infection in AIDS patients. However, it is increasingly responsible for disease in otherwise immunocompromised individuals, such as transplant recipients and the heterogeneous group of patients with underlying immunologic diseases, hematologic disorders and organ failure syndromes. Clinical presentation, prognosis, and outcomes are difficult to define given these varied host groups, and tailoring treatments to fit the necessities of each patient is likewise challenging. Our patient was on treatment with steroids and direct-acting antiviral agents (DAAs) for a chronic HCV-related hepatitis, worsened by cryoglobulinemia, membranoproliferative glomerulonephritis and a lowgrade B cells lymphoma. We report a case of systemic cryptococcal infection in an immunosenescent, HIV-negative patient.


Assuntos
Criptococose/diagnóstico , Hepatite C Crônica/complicações , Imunossenescência , Antivirais , Criptococose/virologia , Soronegatividade para HIV , Hepatite/virologia , Hepatite C Crônica/microbiologia , Humanos
16.
BMC Infect Dis ; 20(1): 431, 2020 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-32563248

RESUMO

BACKGROUND: Good's syndrome (GS) is characterized by immunodeficiency, and can lead to severe infection, which is the most significant complication. Although Mycobacterium rarely causes infection in patients with GS, disseminated nontuberculous mycobacterial (NTM) infection frequently occurs in GS patients that are also positive for the human immunodeficiency virus (HIV) or anti-interferon (IFN)-γ autoantibodies. Here, we report a rare case of GS with NTM without HIV or IFN-γ autoantibodies. CASE PRESENTATION: A 57-year-old Japanese male with GS and myasthenia gravis (treated with prednisolone and tacrolimus) was diagnosed with disseminated NTM infection caused by Mycobacterium abscessus subsp. massiliense. He presented with fever and back pain. Blood, lumbar tissue, urine, stool, and sputum cultures tested positive for M. abscessus. Bacteremia, spondylitis, intestinal lumber abscess, and lung infection were confirmed by bacteriological examination and diagnostic imaging; urinary and intestinal tract infections were suspected by bacteriological examination but not confirmed by imaging. Despite multidrug combination therapy, including azithromycin, imipenem/cilastatin, levofloxacin, minocycline, linezolid, and sitafloxacin, the patient ultimately died of the infection. The patient tested negative for HIV and anti-IFN-γ autoantibodies. CONCLUSIONS: Since myasthenia gravis symptoms interfere with therapy, patients with GS and their physicians should carefully consider the antibacterial treatment options against disseminated NTM.


Assuntos
Pneumopatias/microbiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium abscessus , Doenças da Imunodeficiência Primária/complicações , Antibacterianos/uso terapêutico , Autoanticorpos/sangue , Quimioterapia Combinada , Evolução Fatal , Fluoroquinolonas/uso terapêutico , Soronegatividade para HIV , Humanos , Interferon gama/imunologia , Pneumopatias/complicações , Pneumopatias/imunologia , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/complicações , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/imunologia , Síndrome
17.
AIDS Patient Care STDS ; 34(5): 205-212, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32396476

RESUMO

There is effectively no risk of transmission of HIV from an HIV-positive person with consistent undetectable viral load (UDVL) to an HIV-negative person during sex. This has been publicly disseminated by an international health campaign called "undetectable = untransmittable" (U = U). This study extends previous research by examining confidence in the U = U message and potential covariates of confidence in U = U, as well as by assessing the perceived personal risk and sexual outcomes in a sample of people living with HIV (PLWH) in Australia. Between October 2017 and June 2018, 139 adult PLWH were recruited through clinics or community-based strategies. They completed an online questionnaire assessing participant characteristics, general agreement with the U = U message, confidence in U = U as an effective HIV prevention strategy, perceived personal risk of onward transmission, and sexual outcomes. While the majority of participants (70.5%) agreed with the general U = U message, only 48.2% were confident in U = U as an effective HIV transmission prevention strategy across sexual situations. Lack of confidence in U = U was more pronounced in the community subsample, minority group participants, and lower educated participants. A minority of PLWH with self-reported UDVL thought they could pass on HIV and indicated poor sexual outcomes, including sexual inactivity, reduced frequency of sex, and reduced sexual satisfaction. General agreement with the U = U message among PLWH may mask lack of confidence in U = U. Community-based information and education tailored to culturally diverse groups and people with low health literacy are required to promote accurate perception of risk of transmission of HIV with consistent UDVL.


Assuntos
Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Soronegatividade para HIV , Doenças Sexualmente Transmissíveis/prevenção & controle , Carga Viral , Adulto , Austrália , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Autorrelato , Comportamento Sexual , Inquéritos e Questionários
18.
PLoS One ; 15(5): e0232977, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469981

RESUMO

INTRODUCTION: Antiretroviral therapy has improved the health of people living with HIV (PLW-HIV), though less is known about how this impacts on acute respiratory illness. These illnesses are a common cause of ill health in the general population and any increase in their frequency or severity in PLW-HIV might have significant implications for health-related quality of life and the development of chronic respiratory disease. METHODS: In a prospective observational cohort study following PLW-HIV and HIV negative participants for 12 months with weekly documentation of any acute respiratory illness, we compared the frequency, severity and healthcare use associated with acute respiratory illnesses to determine whether PLW-HIV continue to have a greater frequency or severity of such illnesses despite antiretroviral therapy. RESULTS: We followed-up 136 HIV positive and 73 HIV negative participants for 12 months with weekly documentation of any new respiratory symptoms. We found that HIV status did not affect the frequency of acute respiratory illness: unadjusted incidence rates per person year of follow-up were 2.08 illnesses (95% CI 1.81-2.38) and 2.30 illnesses (1.94-2.70) in HIV positive and negative participants respectively, IRR 0.87 (0.70-1.07) p = 0.18. However, when acute respiratory illnesses occurred, PLW-HIV reported more severe symptoms (relative fold-change in symptom score 1.61 (1.28-2.02), p <0.001) and were more likely to seek healthcare advice (42% vs 18% of illnesses, odds ratio 3.32 (1.48-7.39), p = 0.003). After adjustment for differences in baseline characteristics, PLW-HIV still had higher symptom scores when unwell. CONCLUSIONS: HIV suppression with antiretroviral therapy reduces the frequency of acute respiratory illness to background levels, however when these occur, they are associated with more severe self-reported symptoms and greater healthcare utilisation. Exploration of the reasons for this greater severity of acute respiratory illness may allow targeted interventions to improve the health of people living with HIV. TRIAL REGISTRATION: ISRCTN registry (ISRCTN38386321).


Assuntos
Infecções por HIV/complicações , Infecções Respiratórias/complicações , Adulto , Fármacos Anti-HIV/uso terapêutico , Estudos de Coortes , Feminino , Infecções por HIV/tratamento farmacológico , Soronegatividade para HIV , Soropositividade para HIV/complicações , Humanos , Incidência , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Prospectivos , Qualidade de Vida , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Índice de Gravidade de Doença
19.
AIDS Behav ; 24(11): 3071-3082, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32274672

RESUMO

This study evaluated whether a history of lifetime methamphetamine (MA) use disorder increases risk for poor sleep quality in people with or without HIV infection (HIV+/HIV-). Participants (n = 313) were stratified into four groups based on HIV status and lifetime MA use disorder diagnosis [HIV+/MA+ (n = 84); HIV+/MA- (n = 141); HIV-/MA+ (n = 16); and HIV-/MA- (n = 72)] and compared on global sleep outcomes using the Pittsburgh Sleep Quality Index (PSQI). Significant differences on global sleep were observed between HIV+/MA+ and HIV+/MA- groups, but not between the HIV- groups. Follow-up multiple regression analyses within the HIV+ subgroups examined global sleep scores as a function of MA status and clinical covariates, including those related to HIV disease and demographics. HIV+ individuals with a history of MA use disorder evidenced significantly poorer sleep quality and were more likely to be classified as problematic sleepers than those without a lifetime disorder. This was independent of depressed mood, body mass index, and viral suppression while on treatment. Poorer reported sleep quality among HIV+/MA+ was associated also with multiple adverse functional outcomes, including greater objective cognitive impairment, unemployment, clinical ratings of functional impairment, and self-reported cognitive difficulties, decreased independence in activities of daily living, and poorer overall life quality. Interventions to avoid or curtail MA use in HIV+ individuals may help protect sleep quality and improve functioning.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/complicações , Infecções por HIV/complicações , Infecções por HIV/psicologia , Metanfetamina/efeitos adversos , Transtornos do Sono-Vigília/psicologia , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/psicologia , Fármacos Anti-HIV/uso terapêutico , Disfunção Cognitiva/complicações , Feminino , Infecções por HIV/tratamento farmacológico , Soronegatividade para HIV , Humanos , Masculino , Metanfetamina/administração & dosagem , Pessoa de Meia-Idade , Testes Neuropsicológicos , Autorrelato , Sono , Transtornos do Sono-Vigília/complicações
20.
AIDS Patient Care STDS ; 34(4): 184-192, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32324483

RESUMO

Knowledge of HIV status is a necessary pre-condition for most HIV interventions, including treatment as well as biomedical and behavioral prevention interventions. We used data from a female sex worker (FSW) cohort in three Zambian transit towns to understand the effect that knowledge of HIV status has on FSWs' HIV risk-related sexual behaviors with clients. The cohort was formed from an HIV self-testing trial that followed participants for 4 months. Participants completed three rounds of data collection at baseline, 1 month, and 4 months where they reported their perceived knowledge of HIV status, number of clients on an average working night, and consistent condom use with clients. We measured the effect of knowledge of HIV status on participants' sexual behaviors by using linear regression models with individual fixed effects. The majority of the 965 participants tested for HIV at least once during the observation period (96%) and changed their knowledge of HIV status (79%). Knowledge of HIV status did not affect participants' number of clients, but it did affect their consistency of condom use. Compared with unknown HIV status, knowledge of HIV-negative status significantly increased participants' consistent condom use by 8.1% points [95% confidence interval (CI): 2.7-13.4, p = 0.003] and knowledge of HIV-positive status increased participants' consistent condom use by 6.1% points (95% CI: -0.1 to 12.9, p = 0.08); however, this latter effect was not statistically significant. FSWs in Zambia engaged in safer sex with clients when they learned their HIV status. The expansion of HIV testing programs may serve as a behavioral HIV prevention measure among FSWs.


Assuntos
Preservativos/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Soronegatividade para HIV , Conhecimentos, Atitudes e Prática em Saúde , Profissionais do Sexo/psicologia , Comportamento Sexual/psicologia , Adulto , Cidades , Estudos de Coortes , Feminino , Humanos , Programas de Rastreamento , Sexo Seguro/estatística & dados numéricos , Profissionais do Sexo/estatística & dados numéricos , Populações Vulneráveis , Zâmbia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...