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1.
Medicine (Baltimore) ; 99(2): e18499, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914019

RESUMO

BACKGROUND: Previous studies have reported the association between Mycoplasma fermentans (M. fermentans) and the risk of human immunodeficiency virus 1 (HIV-1) infection, but the results were inconsistent. The present study aims to systematically review reported studies on M. fermentans and its association with HIV-1 infection, as well as to summarize the findings using a meta-analysis. METHODS: Studies meeting the inclusion criteria in the PubMed, Embase, China National Knowledge Infrastructure, WanFang Data, and Chongqing VIP databases up to March 2019 were identified. Cochran Q and I statistics were used to assess heterogeneity. Additionally, pooled odds ratio (OR) with 95% confidence intervals (CI) were calculated and displayed by Forest plots. Also, the funnel plot, Begg test, and Egger test were used to evaluate potential publication bias. In addition, the source of heterogeneity was investigated by subgroup and sensitivity analyses. RESULTS: A total of 11 studies comprising 1028 HIV-1-positive patients and 1298 controls were ultimately included in this meta-analysis. Our results indicated that M. fermentans could increase the risk of HIV-1 infection among humans (OR = 3.66, 95%CI 1.26-10.64). Subgroup analysis showed that the risk of HIV-1 infection associated with M. fermentans was, based on the geographical distribution, 1.19 (95%CI 0.33-4.33) in Europe, 2.83 (95%CI 0.94-8.52) in United States, 11.92 (95%CI 3.93-36.15) in Asia; based on the source of the sample, 2.97 (95%CI 0.89-9.95) in blood samples, 4.36 (95%CI 1.63-11.68) in urine samples; based on the detection method, 2.80 (95%CI 0.72-10.96) with the polymerase chain reaction method, 5.54 (95%CI 1.21-25.28) with other detection methods; based on the source of controls, 1.91 (95%CI 0.53-6.89) in sexually transmitted diseases individuals, and 8.25 (95%CI 2.16-31.60) in health individuals. CONCLUSION: Our study revealed evidence of the association between M. fermentans and HIV-1 infection. Considering the heterogeneity, further studies are warranted to understand the relationship between M. fermentans and HIV-1 infection.


Assuntos
Infecções por HIV/etiologia , Soropositividade para HIV/diagnóstico , Infecções por Mycoplasma/complicações , Mycoplasma fermentans/metabolismo , Ásia/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Infecções por HIV/diagnóstico , Soropositividade para HIV/complicações , Soropositividade para HIV/virologia , HIV-1/genética , HIV-1/isolamento & purificação , Humanos , Masculino , Infecções por Mycoplasma/microbiologia , Mycoplasma fermentans/isolamento & purificação , Fatores de Risco , Estados Unidos/epidemiologia
2.
BMC Womens Health ; 19(1): 123, 2019 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-31647013

RESUMO

BACKGROUND: Cervical cancer is the most common cancer in women in Ghana, but knowledge and experience of women who have had cervical screening is under-evaluated. This study examined knowledge and understanding of HPV and cervical cancer and evaluated experiences of screening in a cohort of women of mixed HIV status. METHODS: This was a mixed methods study using questionnaires and focus group discussions, with a knowledge score constructed from the questionnaire. HIV-positive and HIV-negative women were recruited from a larger cervical screening study in Ghana and were interviewed 6 months after receiving screening. Quantitative data was analyzed and triangulated with qualitative data following thematic analysis using the framework approach. RESULTS: A total of 131 women were included (HIV-positive, n = 60). Over 80% of participants had a knowledge score deemed adequate. There was no difference between HIV-status groups in overall knowledge scores (p = 0.1), but variation was seen in individual knowledge items. HIV-positive women were more likely to correctly identify HPV as being sexually-transmitted (p = 0.05), and HIV negative women to correctly identify the stages in developing cervical cancer (p = < 0.0001). HIV-positive women mostly described acquisition of HPV in stigmatising terms. The early asymptomatic phase of cervical cancer made it difficult for women to define "what" cancer was versus "what" HPV infection was. All women expressed that they found it difficult waiting for their screening results but that receiving information and counselling from health workers alleviated anxiety. CONCLUSIONS: Knowledge of women who had participated in a cervical screening study was good, but specific misconceptions existed. HIV-positive women had similar levels of knowledge to HIV-negative, but different misconceptions. Women expressed generally positive views about screening, but did experience distress. A standardized education tool explaining cervical screening and relevance specifically of HPV-DNA results in Ghana should be developed, taking into consideration the different needs of HIV-positive women.


Assuntos
Detecção Precoce de Câncer/psicologia , Soropositividade para HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Infecções por Papillomavirus/psicologia , Neoplasias do Colo do Útero/psicologia , Adulto , Estudos de Coortes , Aconselhamento , Detecção Precoce de Câncer/métodos , Feminino , Grupos Focais , Gana , Soropositividade para HIV/complicações , Humanos , Pessoa de Meia-Idade , Papillomaviridae , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/virologia , Inquéritos e Questionários , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/virologia
3.
Ned Tijdschr Geneeskd ; 1632019 10 02.
Artigo em Holandês | MEDLINE | ID: mdl-31580033

RESUMO

We report the case of a 79-year-old patient with pancytopenia and blue-purple cutaneous lesions on his legs, arms and in the oral cavity. These lesions had been present for several months. Based on a positive HIV test result we made a presumptive diagnosis of cutaneous Kaposi sarcoma. Histological examination confirmed the diagnosis of AIDS-related Kaposi sarcoma.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Soropositividade para HIV/diagnóstico , HIV , Pancitopenia/diagnóstico , Sarcoma de Kaposi/diagnóstico , Neoplasias Cutâneas/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/complicações , Idoso , Soropositividade para HIV/complicações , Humanos , Masculino , Pancitopenia/virologia , Sarcoma de Kaposi/complicações , Neoplasias Cutâneas/virologia
4.
BMC Infect Dis ; 19(1): 806, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521113

RESUMO

BACKGROUND: Non-typhoidal salmonellae (NTS) have been associated with invasive disease, notably meningitis, in immunocompromised individuals. Infections of this nature carry high rates of morbidity and mortality. Colistin resistance in salmonellae is a rare finding, more so in an invasive isolate such as cerebrospinal fluid (CSF). Colistin resistance has important infection control implications and failure to manage this phenomenon may lead to the loss of our last line of defence against multi-drug resistant Gram-negative organisms. To our knowledge, this is the first reported clinical case of colistin-resistant Salmonella Enteritidis meningitis in South Africa. CASE PRESENTATION: We report a case of a young male patient with advanced human immunodeficiency virus (HIV) infection who presented to hospital with symptoms of meningitis. Cerebrospinal fluid (CSF) cultured a Salmonella Enteritidis strain. Antimicrobial susceptibility testing (AST) of the isolate, revealed the strain to be colistin resistant. Despite early and aggressive antimicrobial therapy, the patient succumbed to the illness after a short stay in hospital. Subsequent genomic analysis of the isolate showed no presence of the mcr genes or resistance-conferring mutations in phoPQ, pmrAB, pmrHFIJKLME/arnBCADTEF, mgrB, and acrAB genes, suggesting the presence of a novel colistin resistance mechanism. CONCLUSION: Invasive non-typhoidal salmonellae infection should be suspected in patients with advanced immunosuppression who present with clinical features of meningitis. Despite early and appropriate empiric therapy, these infections are commonly associated with adverse outcomes to the patient. Combination therapy with two active anti-Salmonella agents may be a consideration in the future to overcome the high mortality associated with NTS meningitis. Colistin resistance in clinical Salmonella isolates, although a rare finding at present, has significant public health and infection control implications. The causative mechanism of resistance should be sought in all cases.


Assuntos
Antibacterianos/uso terapêutico , Colistina/uso terapêutico , Farmacorresistência Bacteriana , Soropositividade para HIV/complicações , Meningites Bacterianas/complicações , Meningites Bacterianas/tratamento farmacológico , Infecções por Salmonella/complicações , Infecções por Salmonella/tratamento farmacológico , Adulto , Antibacterianos/efeitos adversos , Colistina/efeitos adversos , Serviço Hospitalar de Emergência , Evolução Fatal , Escala de Coma de Glasgow , Humanos , Masculino , Salmonella enteritidis/isolamento & purificação , África do Sul , Centros de Atenção Terciária
5.
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
9.
Int J Infect Dis ; 85: 150-157, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31202910

RESUMO

BACKGROUND: Hepatitis B virus (HBV) infection is a major cause of morbidity and mortality; however, little is known about the prevalence and distribution of HBV in some populations and regions. METHODS: A total of 9791 participants, 15-49 years old, were enrolled in a household survey in KwaZulu-Natal, South Africa. Peripheral blood samples were tested for markers of HBV (hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), antibody to HBeAg (anti-HBe)) and analysed, accounting for multilevel sampling and weighted to represent the population. RESULTS: Overall HBsAg prevalence was 4.0% (95% confidence interval (CI) 3.4-4.5%): 4.8% (95% CI 3.8-5.8%) in men and 3.2% (95% CI 2.5-3.9%) in women (p=0.01). Among HBsAg-positive participants, 35.2% (95% CI 29.2-41.2%) were HBeAg-positive and 66.3% (95% CI 60.1-72.4%) were anti-HBe-positive. HBsAg prevalence was 6.4% (95% CI 5.3-7.5%) among HIV-positive participants compared to 2.6% (95% CI 1.9-3.2%) among HIV-negative participants (p<0.01), and was higher among HIV-positive men (8.7%, 95% CI 6.3-11.2%) than among HIV-positive women (5.0%, 95% CI 3.8-6.2%) (p<0.01). CONCLUSIONS: HBV infection among HIV-positive men remains an important public health problem in communities in KwaZulu-Natal, South Africa. The prevalence of HBsAg and HBeAg highlight the importance of surveillance and an important missed opportunity for the scale-up of programmes to achieve the goal of controlling HBV for public health benefit.


Assuntos
Anticorpos Anti-Hepatite B/sangue , Hepatite B/epidemiologia , Adolescente , Adulto , Coinfecção , Feminino , Soropositividade para HIV/complicações , Hepatite B/complicações , Antígenos de Superfície da Hepatite B/sangue , Antígenos E da Hepatite B/sangue , Antígenos E da Hepatite B/imunologia , Vírus da Hepatite B/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Soroepidemiológicos , África do Sul/epidemiologia , Inquéritos e Questionários , Adulto Jovem
10.
AIDS Behav ; 23(9): 2634-2639, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31236749

RESUMO

Among HIV-positive people who use illicit drugs (PWUD) in our setting, repeated periods of incarceration adversely affect ART adherence in a dose-dependent manner. However, the impact of non-custodial criminal justice involvement on HIV-related outcomes has not been previously investigated. Data were obtained from a longitudinal cohort of HIV-positive PWUD in a setting of universal no-cost ART and complete dispensation records. Multivariate generalized estimating equations were used to calculate the longitudinal odds of having a detectable HIV VL (VL) associated with custodial and non-custodial CJS exposure. Between 2005 and 2014, 716 HIV-positive ART-exposed PWUD were recruited. In multivariate analysis, both custodial [Adjusted odds ratio (AOR) 0.61, 95% CI 0.45-0.82] and noncustodial (AOR 0.78, 95% CI 0.62-0.99) involvement in the criminal justice system was associated with detectable HIV VL. Among HIV-positive PWUD, both custodial and non-custodial criminal justice involvement is associated with worse HIV treatment outcomes. Our findings highlight the need for increased ART adherence support across the full spectrum of the criminal justice system.


Assuntos
Direito Penal , Infecções por HIV/psicologia , Soropositividade para HIV/sangue , RNA Viral/sangue , Transtornos Relacionados ao Uso de Substâncias/complicações , Carga Viral , Adulto , Estudos de Coortes , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV/complicações , Soropositividade para HIV/tratamento farmacológico , Soropositividade para HIV/virologia , Humanos , Estudos Longitudinais , Masculino , Fatores de Risco , Testes Sorológicos
11.
Skinmed ; 17(2): 128-129, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31145067

RESUMO

A 34-year-old man presented with a painless lesion of the glans present for more than 4 years. The patient became HIV-positive in 2011, and he has been treated with tenofovir, emtricitabine, and efavirenz. A CD4 count performed 4 months prior was 570 cells/mL3; syphilis, hepatitis B, and hepatitis C serologies performed on the same date were non-reactive.


Assuntos
Linfangioma/etiologia , Linfangite/complicações , Vasos Linfáticos/patologia , Neoplasias Penianas/etiologia , Adulto , Soropositividade para HIV/complicações , Soropositividade para HIV/tratamento farmacológico , Humanos , Masculino , Esclerose/complicações
13.
Cochrane Database Syst Rev ; 4: CD012915, 2019 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-31038197

RESUMO

BACKGROUND: Tuberculosis causes more deaths than any other infectious disease globally. Bacillus Calmette-Guérin (BCG) is the only available vaccine, but protection is incomplete and variable. The modified Vaccinia Ankara virus expressing antigen 85A (MVA85A) is a viral vector vaccine produced to prevent tuberculosis. OBJECTIVES: To assess and summarize the effects of the MVA85A vaccine boosting BCG in humans. SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register; Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); Embase (Ovid); and four other databases. We searched the WHO ICTRP and ClinicalTrials.gov. All searches were run up to 10 May 2018. SELECTION CRITERIA: We evaluated randomized controlled trials of MVA85A vaccine given with BCG in people regardless of age or HIV status. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the eligibility and risk of bias of trials, and extracted and analyzed data. The primary outcome was active tuberculosis disease. We summarized dichotomous outcomes using risk ratios (RR) and risk differences (RD), with 95% confidence intervals (CI). Where appropriate, we combined data in meta-analyses. Where meta-analysis was inappropriate, we summarized results narratively. MAIN RESULTS: The search identified six studies relating to four Phase 2 randomized controlled trials enrolling 3838 participants. Funding was by government bodies, charities, and philanthropic donors. Five studies included infants, one of them infants born to HIV-positive mothers. One study included adults living with HIV. All trials included authors from Oxford University who led the laboratory development of the vaccine. Participants received intradermal MVA85A after BCG in some studies, and before selective deferred BCG in HIV-exposed infants.The largest trial in 2797 African children was well conducted with low risk of bias for most parameters. Risk of bias was uncertain for selective reporting because there were no precise case definition endpoints for active tuberculosis published prior to the trial analysis.MVA85A added to BCG compared to BCG alone probably has no effect on the risk of developing microbiologically confirmed tuberculosis (RR 0.97, 95% CI 0.58 to 1.62; 3439 participants, 2 trials; moderate-certainty evidence), or the risk of starting on tuberculosis treatment (RR 1.10, 95% CI 0.92 to 1.33; 3687 participants, 3 trials; moderate-certainty evidence). MVA85A probably has no effect on the risk of developing latent tuberculosis (RR 1.01, 95% CI 0.85 to 1.21; 3831 participants, 4 trials; moderate-certainty evidence). Vaccinating people with MVA85A in addition to BCG did not cause life-threatening serious adverse effects (RD 0.00, 95% CI -0.00 to 0.00; 3692 participants, 3 trials; high-certainty evidence). Vaccination with MVA85A is probably associated with an increased risk of local skin adverse effects (3187 participants, 3 trials; moderate-certainty evidence), but not systemic adverse effect related to vaccination (144 participants, 1 trial; low-certainty evidence). This safety profile is consistent with Phase 1 studies which outlined a transient, superficial reaction local to the injection site and mild short-lived symptoms such as malaise and fever. AUTHORS' CONCLUSIONS: MVA85A delivered by intradermal injection in addition to BCG is safe but not effective in reducing the risk of developing tuberculosis.


Assuntos
Vacina BCG , Vacinas contra a Tuberculose , Tuberculose/prevenção & controle , Soropositividade para HIV/complicações , Soropositividade para HIV/imunologia , Humanos , Prevenção Primária , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
PLoS Med ; 16(4): e1002792, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-31039161

RESUMO

BACKGROUND: Current guidelines recommend the use of the lateral flow urine lipoarabinomannan assay (LAM) in HIV-positive, ambulatory patients with signs and symptoms of tuberculosis (TB) only if they are seriously ill or have CD4 count ≤ 100 cells/µl. We assessed the diagnostic yield of including LAM in TB diagnostic algorithms in HIV-positive, ambulatory patients with CD4 < 200 cells/µl, as well as the risk of mortality in LAM-positive patients who were not diagnosed using other diagnostic tools and not treated for TB. METHODS AND FINDINGS: We conducted a prospective observational study including HIV-positive adult patients with signs and symptoms of TB and CD4 < 200 cells/µl attending 6 health facilities in Malawi and Mozambique. Patients were included consecutively from 18 September 2015 to 27 October 2016 in Malawi and from 3 December 2014 to 22 August 2016 in Mozambique. All patients had a clinical exam and LAM, chest X-ray, sputum microscopy, and Xpert MTB/RIF assay (Xpert) requested. Culture in sputum was done for a subset of patients. The diagnostic yield was defined as the proportion of patients with a positive assay result among those with laboratory-confirmed TB. For the 456 patients included in the study, the median age was 36 years (IQR 31-43) and the median CD4 count was 50 cells/µl (IQR 21-108). Forty-five percent (205/456) of the patients had laboratory-confirmed TB. The diagnostic yields of LAM, microscopy, and Xpert were 82.4% (169/205), 33.7% (69/205), and 40.0% (84/205), respectively. In total, 50.2% (103/205) of the patients with laboratory-confirmed TB were diagnosed only through LAM. Overall, the use of LAM in diagnostic algorithms increased the yield of algorithms with microscopy and with Xpert by 38.0% (78/205) and 34.6% (71/205), respectively, and, specifically among patients with CD4 100-199 cells/µl, by 27.5% (14/51) and 29.4% (15/51), respectively. LAM-positive patients not diagnosed through other tools and not treated for TB had a significantly higher risk of mortality than LAM-positive patients who received treatment (adjusted risk ratio 2.57, 95% CI 1.27-5.19, p = 0.009). Although the TB diagnostic conditions in the study sites were similar to those in other resource-limited settings, the added value of LAM may depend on the availability of microscopy or Xpert results. CONCLUSIONS: LAM has diagnostic value for identifying TB in HIV-positive patients with signs and symptoms of TB and advanced immunodeficiency, including those with a CD4 count of 100-199 cells/µl. In this study, the use of LAM enabled the diagnosis of TB in half of the patients with confirmed TB disease; without LAM, these patients would have been missed. The rapid identification and treatment of TB enabled by LAM may decrease overall mortality risk for these patients.


Assuntos
Infecções por HIV/urina , Soropositividade para HIV/urina , Lipopolissacarídeos/urina , Tuberculose/diagnóstico , Adulto , Instituições de Assistência Ambulatorial , Contagem de Linfócito CD4 , Coinfecção/diagnóstico , Coinfecção/urina , Feminino , Infecções por HIV/sangue , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Soropositividade para HIV/sangue , Soropositividade para HIV/complicações , Recursos em Saúde , Humanos , Malaui , Masculino , Moçambique , Sistemas Automatizados de Assistência Junto ao Leito , Áreas de Pobreza , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Tuberculose/sangue , Tuberculose/complicações , Tuberculose/urina , Urinálise/economia , Urinálise/métodos
15.
Int J Infect Dis ; 84: 75-79, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31054966

RESUMO

OBJECTIVE: HIV positive individuals, particularly men having sex with men (MSM), are at increased risk of sexually transmitted infections (STIs) at genital and extra-genital sites. Data on anorectal Ureaplasma infections are lacking. The aim of our study was to characterize anal Ureaplasma positivity among a cohort of HIV positive MSM and evaluate possible association with papillomavirus infection at the same site. METHODS: Anal swab samples, collected as part of routine screening for Chlamydia trachomatis and Neisseria gonorrhea, were additionally tested for HPV genotypes as well as for Ureaplasma and Mycoplasma using nucleic acid amplification method. RESULTS: Out of a total of 222 study participants, 195 (89%, 95% CI (84.9-93.2)) were positive for HPV, approximately three quarter being high-risk genotypes. Forty three individuals (19.4%, 95% CI (14.4-24.3)) harbored Ureaplasma spp. Infection with high-risk HPV types was significantly associated with co-presence of Ureaplasma with an odds ratio (95% confidence-interval) of 2.59 (1.03-6.54), P = 0.04. CONCLUSION: Besides a high predominance of HPV infection, asymptomatic HIV positive MSM had a high prevalence of anal Ureaplasma positivity. Concomitant infections with high-risk HPV genotypes were common and statistically significant. The role of this co-existence as a potential risk factor for anal carcinogenesis needs further elucidation.


Assuntos
Canal Anal/microbiologia , Soropositividade para HIV/complicações , Homossexualidade Masculina , Infecções por Papillomavirus/etiologia , Ureaplasma/isolamento & purificação , Adulto , Soropositividade para HIV/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade
17.
Niger J Clin Pract ; 22(5): 591-597, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31089011

RESUMO

Objective: We analyzed the maternal and perinatal outcomes in early onset preeclampsia (EOPE) and late onset preeclampsia (LOPE) pregnant women who had scheduled caesarean deliveries. We sub-analyzed the two categories into HIV positive and HIV negative. Patients and Methods: This prospective study was conducted at a regional hospital in Durban, South Africa during 14 months. A total of 14304 deliveries were registered. Out of the 1759 preeclampsia, 351 (19.9%) were EOPE and 1408 (80.1%) were LOPE. Hundred and twenty preeclamptics (n = 120) scheduled for caesarean delivery were selected and divided into two categories namely EOPE (n = 60) and LOPE (n = 60). Each preeclampsia category was then further stratified into HIV positive (n = 30) and HIV negative (n = 30) groups. Maternal demographic, clinical details for preeclampsia, blood laboratory tests, maternal, and perinatal outcomes were recorded. Results: Women with EOPE were older compared to those with LOPE (P = 0.0001). Also the HIV positive women were older compared to the HIV negative groups in both EOPE and LOPE categories (P = 0.03). However, multiparous and primiparous were predominant in EOPE and LOPE categories, respectively (P = 0.00 and P = 0.00). The severity of hypertension and the HIV status did not differentiate the 2 groups. Overall, maternal complications (eclampsia, persistent postpartum hypertension, HELLP syndrome, maternal death) and poor fetal outcomes occurred predominately in EOPE. Conclusion: This study confirms the heterogeneity of preeclampsia and shows that the timing of onset of this pregnancy disorder is important to disease severity. Further HIV status influences maternal and neonatal outcome.


Assuntos
Cesárea , Soronegatividade para HIV , Soropositividade para HIV/complicações , Pré-Eclâmpsia , Adolescente , Adulto , Fatores Etários , Índice de Apgar , Peso ao Nascer , Cesárea/efeitos adversos , Eclampsia/etiologia , Feminino , Retardo do Crescimento Fetal/etiologia , Idade Gestacional , Síndrome HELLP/etiologia , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Masculino , Paridade , Pré-Eclâmpsia/etiologia , Gravidez , Estudos Prospectivos , África do Sul , Adulto Jovem
18.
Int J STD AIDS ; 30(5): 472-478, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30999829

RESUMO

Invasive pneumococcal diseases (IPDs) remain a significant cause of morbidity and mortality in human immunodeficiency virus (HIV)-positive individuals despite the widespread use of highly active antiretroviral therapy (HAART) and availability of pneumococcal vaccines. The aim of this study was to measure temporal trends in incidence and risk factors for IPD (defined as culture of Streptococcus pneumoniae from blood, cerebrospinal fluid or both) in a cohort of HIV-positive patients attending an ambulatory HIV care centre in Dublin, Ireland over a 10-year period 2006-2015. Incidence of IPD was determined as events per 100,000 person-years' follow-up. Poisson regression was used to assess linear trend in incidence over time. A nested case-control study (four controls per case) was undertaken to assess risk factors for IPD. Forty-seven episodes of IPD were identified in 42 HIV-positive individuals (median [IQR] age 38 years [33-43], 69% male, 86% injecting drug users (IDUs), median CD4 T-cell count 213 cells/mm3) over 16,008 person-years' follow-up (overall incidence rate 293/100,000 person-years). Three patients had two episodes and one patient had three episodes of IPD during the study period. The overall case fatality rate was 15% (95% confidence interval [CI] 4-24%). The incidence of IPD per 100,000 person-years decreased from 728 (95% CI, 455-1002), to 242 (95% CI, 120-365) to 82 (95% CI, 40-154) in calendar periods 2006-2008, 2009-2012 and 2013-2015, respectively (p < 0.01 for linear trend). Older age (p = 0.02), male gender (p = 0.05), detectable HIV viral load (p < 0.01) and non-receipt of pneumococcal vaccine (p = 0.03) were associated with IPD while IDU as risk of acquisition of HIV was of borderline significance (p = 0.06). HIV-positive individuals remain at greater risk of IPD compared to the general population. Pneumococcal vaccine should be seen as a priority to ensure optimal protection for HIV-positive patients.


Assuntos
Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV/complicações , Infecções Pneumocócicas/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Terapia Antirretroviral de Alta Atividade/métodos , Estudos de Casos e Controles , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Incidência , Irlanda/epidemiologia , Masculino , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/diagnóstico , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/imunologia , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/epidemiologia
19.
Int J STD AIDS ; 30(5): 509-511, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30999832

RESUMO

The presentation of syphilis as a manifestation of immune reconstitution inflammatory syndrome in patients with human immunodeficiency virus (HIV) infection is rare and can be associated with the varied clinical expression of unusual syphilitic manifestations. We report a case of immune reconstitution syndrome with dermatologic, ophthalmologic and neurologic compromise of secondary syphilis in a patient with HIV infection.


Assuntos
Infecções por HIV/complicações , Síndrome Inflamatória da Reconstituição Imune/diagnóstico , Sífilis/diagnóstico , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Alopecia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Soropositividade para HIV/complicações , Humanos , Síndrome Inflamatória da Reconstituição Imune/complicações , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/imunologia , Masculino , Pan-Uveíte , Penicilinas/administração & dosagem , Penicilinas/uso terapêutico , Sífilis/complicações , Sífilis/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem
20.
Neuropsychology ; 33(3): 370-378, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30816783

RESUMO

OBJECTIVES: Despite treatment-related improvements in morbidity and mortality, HIV-1-infected (HIV+) individuals continue to face a wide range of HIV-associated medical and HIV-associated neurocognitive disorders. Little is known about the impact of cognitive impairment on patients' health-related quality of life (HRQoL). To address this, the current study examined the longitudinal relationship between cognitive functioning and HRQoL among HIV+ individuals. METHOD: The sample consisted of 1,306 HIV+ men enrolled in the Multicenter AIDS Cohort Study. Participants received biannual assessments of cognitive functioning (including tests of processing speed, executive functioning, attention/working memory, motor functioning, learning, and memory) and completed questionnaires assessing HRQoL and depression. Multilevel models were used to examine the longitudinal and cross-lagged relationship between HRQoL and cognition, independent of depression and HIV disease severity. RESULTS: There was a significant relationship between HRQoL and cognitive functioning both between and within subjects. Specifically, individuals who reported better HRQoL reported better cognitive functioning, and longitudinal change in cognition was positively related to change in HRQoL. There was a significant unidirectional-lagged relationship; cognition predicted HRQoL at subsequent visits, but HRQoL did not predict cognitive functioning at subsequent visits. Furthermore, analyses of severity of neurocognitive impairment revealed that transition to a more severe stage of cognitive impairment was associated with a decline in HRQoL. CONCLUSIONS: Overall, the current study suggests that changes in HRQoL are partially driven by changes in cognitive functioning. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Cognição/fisiologia , Disfunção Cognitiva/diagnóstico , Soropositividade para HIV/psicologia , Qualidade de Vida/psicologia , Adulto , Atenção/fisiologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Função Executiva/fisiologia , Soropositividade para HIV/complicações , Humanos , Masculino , Memória/fisiologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Inquéritos e Questionários
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