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PLoS Negl Trop Dis ; 16(9): e0010712, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36067140


BACKGROUND: Human immunodeficiency virus (HIV) and enteric parasite co-infection not only aggravates the clinical symptoms of parasites but also accelerates acquired immunodeficiency syndrome (AIDS) progression. However, co-infection research on men who have sex with men (MSM), the predominant high-risk population of HIV/AIDS in China, is still limited. In this study, we investigated the epidemiology of enteric parasites, risk factors, and associations with clinical significance in an MSM HIV/AIDS population in Heilongjiang Province, northeast China. METHODS: We recruited 308 MSMs HIV/AIDS patients and 199 HIV-negative individuals in two designated AIDS hospitals in Heilongjiang between April 2016 and July 2017. Fresh stool samples were collected. DNA extraction, molecular identification, and genotyping of Cryptosporidium species, Entamoeba histolytica, Cyclospora cayetanensis, Enterocytozoon bieneusi, and Blastocystis hominis were performed. Fourteen diarrhea-related pathogens were examined to exclude the influence of other bacterial pathogens on diarrhea incidence. RESULTS: 31.5% of MSM HIV/AIDS participants were infected with at least one parasite species, a significantly higher proportion than that found in the HIV-negative individuals (2.5%). E. bieneusi presented the highest prevalence, followed by B. hominis, E. histolytica, Cryptosporidium spp., and C. cayetanensis. Warm seasons were the risk factor for parasitic infections in this population [odds ratio (OR) = 2.6, 95% CI: 1.47-4.57]. In addition, these individuals showed a higher proportion (35.8%) of present diarrhea (PD) compared with men who have sex with women (MSW) with HIV/AIDS (16.7%). The infection proportions of both Cryptosporidium spp. and E. histolytica were significantly higher in the PD. E. bieneusi infection was more prevalent in the historic diarrhea (HD) group. CD4+ T cell counts in the MSM patients with the above three parasites were significantly lower. New species and genotypes were found, and MSM patients had a wider range of species or genotypes. CONCLUSIONS: Enteric parasitic infection was prevalent in the MSM HIV/AIDS population, especially in patients with present diarrhea during warm seasons. E. histolytica and B. hominis should also be considered high-risk parasites for opportunistic infections in AIDS patients in addition to Cryptosporidium spp.

Síndrome de Imunodeficiência Adquirida , Coinfecção , Criptosporidiose , Cryptosporidium , Infecções por HIV , Parasitos , Doenças Parasitárias , Minorias Sexuais e de Gênero , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/epidemiologia , Animais , Coinfecção/complicações , Coinfecção/epidemiologia , Criptosporidiose/epidemiologia , Cryptosporidium/genética , Diarreia/parasitologia , Fezes/parasitologia , Feminino , HIV , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Prevalência
Zhongguo Dang Dai Er Ke Za Zhi ; 24(9): 967-972, 2022.
Artigo em Chinês | MEDLINE | ID: mdl-36111712


OBJECTIVES: To investigate the level of neuropsychological development in human immunodeficiency virus (HIV)-exposed uninfected (HEU) infants/young children and the influence of maternal HIV infection on the neuropsychological development of HEU infants/young children. METHODS: A total of 141 HEU infants/young children, aged 0-18 months and born to HIV-infected mothers, who were managed in four maternal and child health care hospitals in Yunnan Province of China from June 2019 to December 2020 and met the inclusion criteria were enrolled as the HEU group. A total of 141 HIV-unexposed uninfected (HUU) infants/young children who were born to healthy mothers and managed in the same hospitals, matched at a ratio of 1:1 based on sex, age, method of birth, birth weight, and gestational age, were enrolled as controls. Griffiths Development Scales-Chinese Edition was used to assess the development in the five domains of locomotion, personal-social, hearing and language, eye-hand co-ordination, and performance (visual perception and space integration ability). A questionnaire survey was performed to collect relevant information. The multivariate logistic regression analysis was used to assess the influence of maternal HIV infection on the neuropsychological development of HEU infants/young children. RESULTS: Compared with the HUU group, the HEU group had significantly higher detection rates of retardation in the domains of hearing and language and performance (P<0.05). The multivariate logistic regression analysis showed that maternal HIV infection increased the risk of retardation in the domains of hearing and language (OR=2.661, 95%CI: 1.171-6.047, P<0.05) and performance (OR=2.321, 95%CI: 1.156-4.658, P<0.05). CONCLUSIONS: Maternal HIV infection can negatively affect the development of hearing and language and performance in HEU infants/young children, and further studies are needed to clarify related mechanisms.

Infecções por HIV , Criança , Pré-Escolar , China , Feminino , HIV , Humanos , Lactente , Mães
J Tradit Chin Med ; 42(5): 795-802, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36083488


OBJECTIVE: To evaluate the effects of the Wenshen Jianpi recipe (, WJR) on immune reconstruction and natural killer (NK) cells in immunological non-responders (INRs) of people living with human immunodeficiency virus (HIV) (PLWH) and propose new therapeutic strategies for HIV. METHODS: Based on Traditional Chinese Medicine treatment principle "invigorating and warming in the spleen and kidneys", WJR combined with antire-troviral therapy (ART) therapy was performed in a randomized, double-blind, placebo-controlled study of 60 patients with non-responders. The randomized process was executed by the Clinical Evaluation Center of China Academy of Chinese Medical Sciences. Sixty patients who met the inclusion criteria obtained random numbers (that is the drug number) was randomly divided into a treatment group and a placebo control group according to a 1∶1 ratio. CD4+T cell counts and natural killer (NK) cells counts were evaluated at baseline and 12-week, 24-week follow-ups. RESULTS: Four participants received random numbers and did not enter the group due to the patient's own reasons. A total of 56 patients were enrolled, including 28 in the treatment group and 28 in the control group. CD4+T cell counts in the treatment group were significantly increased at week 24 ( = 0.01 < 0.05), which were significantly higher than those in the control group (= 0.01 < 0.05). Although no significant differences were observed between two groups, the CD56briCD16- NK cell counts in the treatment group were significantly increased after duration. and CD56dimCD16+ NK cell counts in the treatment group were significantly higher than those in the control group after 24 weeks of treatment (= 0.025 < 0.05). As compared with the control group, the treatment group had significantly lower CD56negCD16+ NK cell counts after 24 weeks of treatment (= 0.023 < 0.05). CONCLUSIONS: WJR promotes the immune reconstruction of INRs and redistribution of NK cell subsets, notably decreasing CD56negCD16+ NK cell counts in INRs. However, the redistribution of NK cell subsets is not beneficial for immune reconstruction in INRs. Further large-scale RCTs are required to evaluate the effect of WJR on immune recovery in INRs and decipher the underlying mechanism.

Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Contagem de Linfócito CD4 , HIV , Infecções por HIV/tratamento farmacológico , Humanos , Células Matadoras Naturais
J Prim Care Community Health ; 13: 21501319221110411, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35972200


INTRODUCTION: Our study provides data on the prevalence of human papillomavirus (HPV) related disease and vaccination rates among users of pre-exposure prophylaxis (PrEP) in a primary care clinic. Results highlight an opportunity to partner HIV and HPV prevention efforts. METHODS: This is a retrospective chart review of PrEP patients in an urban Midwestern Family Medicine clinic. We conducted univariate analyses for HPV vaccination status and the prevalence of any HPV-related disease. We then examined bivariate relationships between vaccination status and insurance coverage, provider type, and age. RESULTS: Of all 78 PrEP patients identified, 21.8% (n = 17) were vaccinated. Of the 59 patients 45 years or younger, 28.8% (n = 17) were vaccinated. There was no association between insurance or provider type and vaccination status. Patients 26 years or younger were 3 times more likely to be vaccinated than those ages 27 to 45 (56.3% vs 18.6%, P = .0011). Three unvaccinated patients had HPV-related disease. CONCLUSIONS: Despite ongoing risk of HPV infection and frequent interaction with the medical system, this study found most PrEP users continue to be unvaccinated. This is a significant missed opportunity for HPV prevention. With the FDA approval of the HPV vaccine for individuals age 9 to 45, PrEP patients in this age range would benefit from clinicians partnering HPV vaccination with PrEP prescribing.

Alphapapillomavirus , Infecções por HIV , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Profilaxia Pré-Exposição , Adolescente , Adulto , Criança , HIV , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Pessoa de Meia-Idade , Papillomaviridae , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/uso terapêutico , Prevalência , Estudos Retrospectivos , Vacinação , Adulto Jovem
Front Immunol ; 13: 942642, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35990692


Rheumatoid arthritis (RA) is a joint-disabling inflammatory disease associated with the pathology of synovitis. Some patients with RA are difficult to treat, using disease-modifying anti-rheumatic drugs (DMARDs). Biology and targeted synthetic DMARDs (b/tsDMARDs) are options for patients with RA. Acquired immunodeficiency syndrome (AIDS) is an infectious disease caused by the human immunodeficiency virus (HIV). Adalimumab is an anti-tumor necrosis factor therapy commonly used in patients with RA. However, there are no reports or related data on patients with RA-HIV/AIDS treated with adalimumab are available. In this report, we described the first successful case of a 60-year-old HIV-positive woman with difficult-to-treat RA treated with ADA after being screened for hepatitis virus, latent tuberculosis (LTBI), and other infections. She contracted HIV from sexual exposure while on adalimumab therapy. As the patient was resistant to first-line DMARDs, she continued adalimumab along with the initiation of highly active antiretroviral therapy (HAART). The patient was treated with adalimumab therapy for a year; her CD4+ lymphocyte count was normal, HIV-1 RNA decreased, and no new infections were triggered. The patient achieved clinical remission of RA. In conclusion, adalimumab is a safe option for patients with RA-HIV and may slow the progression of HIV infection. Furthermore, HAART has the potential to reduce joint pain and fatigue in patients with difficult-to-treat RA. Conclusions: Adalimumab is a safe option for patients with RA-HIV, and may slow down the progression of HIV infection. The HAART therapy has the potential to reduce joint pain and fatigue in patients with difficult-to-treat RA.

Síndrome de Imunodeficiência Adquirida , Antirreumáticos , Artrite Reumatoide , Infecções por HIV , Soropositividade para HIV , Síndrome de Imunodeficiência Adquirida/complicações , Adalimumab/efeitos adversos , Antirreumáticos/efeitos adversos , Artralgia , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Fadiga/complicações , Feminino , Seguimentos , HIV , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV/tratamento farmacológico , Humanos , Pessoa de Meia-Idade
Pediatr Clin North Am ; 69(4): 759-777, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35934498


HIV is now a chronic condition that can be managed. Adolescents and emerging adults represent a large proportion of new diagnoses, but struggle with many aspects of HIV-related self-management. Self-management of HIV is critical to maintaining health and involves retention in HIV care, medication adherence to achieve viral suppression, managing substance use, and sexual and general health-related behaviors. This article describes theoretic frameworks for HIV self-management as adapted for youth and reviews self-management interventions developed to improve health outcomes in youth living with HIV identified from a recent systematic review.

Infecções por HIV , Autogestão , Adolescente , Adulto , HIV , Infecções por HIV/tratamento farmacológico , Humanos , Adesão à Medicação , Comportamento Sexual
West Afr J Med ; 39(7): 670-677, 2022 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-35924817


BACKGROUND: Tuberculosis is the most common opportunistic infection affecting HIV-infected individuals and it remains the most common cause of death in patients with AIDS. Detection of latent tuberculosis and treatment largely prevents the development of active disease. OBJECTIVE: This study was to determine the prevalence and factors associated with latent TB in HIV-positive patients. METHODOLOGY: This is an analytical cross-sectional study which involved 160 consented patients. Active tuberculosis was excluded using signs, symptoms and laboratory tests. All participants were tested using Quantiferon TB Gold Plus test kits. Data analysed with SPSS version 25.0 included patient's demographics, clinical and laboratory features. P< 0.05 was considered significant. RESULTS: The mean age of HIV-infected patients was 42.69 ± 9.91 years and the mean age of the control was 41.29 ± 9.20 years with no significant statistical difference. The prevalence of latent tuberculosis among HIV-infected patients was found to be 22.50% while among controls was 10.0% which was statistically significant (p-0.001). CD4 cells count was observed to inversely predict latent tuberculosis (OR = 1.41; CI = 1.01-3.73) while viral load was found to directly predict latent tuberculosis (OR = 1.63; CI=1.04-4.25). CONCLUSION: The prevalence of latent tuberculosis infection is significantly higher among HIV-positive patients when compared with HIV-negative patients. Also, the prevalence of HIV infection was higher amongst the female and less educated population.

CONTEXTE: La tuberculose est l'infection opportuniste la plus courante chez les personnes infectées par le VIHet reste la cause la plus fréquente de décès chez les patients atteints du SIDA. La détection de la tuberculose latente et le traitement empêchent largement le développement de la maladie active. OBJECTIF: Cette étude visait à déterminer la prévalence et les facteurs associés à la tuberculose latente chez les personnes séropositives. MÉTHODOLOGIE: Il s'agit d'une étude transversale analytique qui a porté sur 160 patients consentants. La tuberculose active a été exclue à l'aide de signes, de symptômes et de tests de laboratoire. Tous les participants participants ont été testés à l'aide de kits de test Quantiferon TB Gold Plus. de Quantiferon TB Gold Plus. Les données analysées avec SPSS version 25.0 comprenaient les caractéristiques démographiques, cliniques et de laboratoire des patients. P< 0,05 a été a été considéré comme significatif. RÉSULTATS: L'âge moyen des patients infectés par le VIH était de 42,69 ± 9,91 ans et l'âge moyen du groupe témoin était de 41,29 ± 9,20 ans., sans différence statistic significative. La prevalence de tuberculose latente chez les patients infectés par le VIH était de 22,50 % alors qu'elle était de 10,0 % chez les témoins, ce qui était statistiquement significative (p-0,001). On a observé que le nombre de cellules CD4 de prédire de façon inverse la tuberculose latente (OR = 1,41; IC = 1,01- 3,73), tandis que la charge virale prédit directement la tuberculose latente (OR = 1,63 ; IC = 1,04-4,25). CONCLUSION: la prévalence de l'infection tuberculeuse latente est significativement plus élevée chez les patients séropositifs par rapport aux patients séronégatifs. De même, la prévalence de l'infection par le VIH était plus élevée chez les femmes et les personnes peu moins éduquée. Mots clés: Bacilles acido-alcoolo-résistants, indice de masse corporelle, extrapulmonaire, virus de l'immunodéficience humaine, interféron gamma, immunodéficience, tuberculose latente, ZiehlNeelsen.

Infecções por HIV , Soropositividade para HIV , Tuberculose Latente , Tuberculose , Adulto , Estudos Transversais , Feminino , HIV , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Tuberculose Latente/diagnóstico , Tuberculose Latente/epidemiologia , Pessoa de Meia-Idade , Prevalência , Teste Tuberculínico
Washington, D.C.; OPS; 2022-08-19. (OPS/CDE/HT/22-0008).
em Espanhol | PAHO-IRIS | ID: phr-56299


La infección por el virus linfotrópico humano de células T (HTLV, por su sigla en inglés) afecta principalmente a los grupos de población vulnerables, a saber, las personas que viven en la pobreza en zonas donde el índice de desarrollo humano es muy bajo, los trabajadores sexuales, los hombres que tienen relaciones sexuales con hombres, los consumidores de drogas inyectables y los grupos de población cerrados y semicerrados desde el punto de vista epidemiológico, incluidos los grupos tradicionales e indígenas. El HTLV y sus consecuencias han sido desatendidos durante decenios, a pesar de la elevada carga de morbilidad y mortalidad causada por la infección por este virus. Hay pocas políticas de salud pública sobre el HTLV de tipo 1 y el HTLV de tipo 2 en la Región de las Américas y generalmente se limitan al tamizaje de los donantes de sangre. Se debe priorizar la ampliación de las pruebas del HTLV-1/2, así como el asesoramiento de las personas con infección por el HTLV‑1, que ofrece la posibilidad de prevenir la transmisión. Otra prioridad es realizar pruebas a las embarazadas y evitar o limitar la lactancia materna, y también deben sopesarse las ventajas y desventajas de realizar pruebas a las personas con alto riesgo de infección. Dado que la falta de conciencia sobre el HTLV plantea un desafío importante, la intervención de la OPS es decisiva para superar este obstáculo. Se determinó que la inclusión de la infección por el HTLV en los programas vigentes, como los de prevención y control de las ITS, salud materna y eliminación de las enfermedades infecciosas y las infecciones desatendidas, ofrece la posibilidad de agilizar la ejecución de políticas de salud sobre el HTLV 1 y 2 en la Región. Es necesario invertir en investigación encaminada a subsanar las lagunas en el conocimiento y formular políticas e instrumentos costoeficaces que apoyen el fomento de respuestas de salud pública eficaces, como las pruebas de bajo costo en el lugar de consulta para diagnosticar la infección por el HTLV-1/2. La infeccion por el HTLV-1 también tiene efectos negativos en los desenlaces clínicos de coinfecciones frecuentes en la Región, incluidas la tuberculosis, la estrongiloidiasis, las ITS y las micosis. Es posible que los aspectos genéticos, ambientales y socioculturales influyan en los conglomerados de casos de infección por el HTLV-1 o en los desenlaces de la enfermedad en la Región. La agregación familiar también es importante y debe tenerse en cuenta al evaluarse las consecuencias de la infección por el HTLV-1 y formularse las políticas contra este virus. El virus linfotrópico humano de células T de tipo 2 (HTLV-2) es el que predomina entre los indígenas de la Región de las Américas. Las políticas eficaces para controlar esta infección deben basarse en una estrategia combinada que permita superar los obstáculos lingüísticos, culturales y geográficos. En este informe se destacan algunas de las principales intervenciones disponibles para la prevención y el control de la infección por el virus linfotrópico humano de células T (HTLV, por su sigla en inglés) y sus consecuencias. También se resumen las experiencias, los debates, los logros y los desafíos a nivel nacional e institucional en relación con la ejecución de políticas de salud pública orientadas a eliminar esta infección. Estos temas se presentaron en el seminario web “Día Mundial de Lucha contra el HTLV 2021: Foro internacional de políticas de salud para la eliminación del HTLV. Promoción de las políticas de salud sobre el HTLV en todo el mundo”.

HIV , Populações Vulneráveis , Doenças Transmissíveis , Infecções Sexualmente Transmissíveis , Infecções por HTLV-II , Infecções por HTLV-I
Washington, D.C.; OPS; 2022-08-04.
em Espanhol | PAHO-IRIS | ID: phr-56219


Esta tercera edición del documento sobre validación mundial de la eliminación de la transmisión maternoinfantil (ETMI) proporciona procesos estandarizados y criterios elaborados por consenso para validar la ETMI del VIH, la sífilis y el VHB, y para reconocer a los países con carga alta por estas enfermedades que han logrado avances significativos en el camino hacia la eliminación. Se hace especial hincapié en la rendición de cuentas dirigida por los países, el análisis riguroso, la evaluación intensiva de los programas y la colaboración a múltiples niveles, incluida la participación de las comunidades de mujeres con VIH o con VHB. Asimismo, se fomenta un enfoque armonizado para la triple eliminación, pero, dependiendo de su disposición operativa, los países pueden optar por centrarse en obtener la validación de ETMI única, doble o triple. Por último, en esta edición se actualizan los instrumentos y las listas de verificación en los ámbitos de la evaluación de los datos y los sistemas de vigilancia; los servicios de laboratorio; el programa, y los derechos humanos, la igualdad de género y la participación de la comunidad, que están disponibles en línea.

HIV , Vírus da Hepatite B , Sífilis , HIV , Vírus da Hepatite B , Transmissão Vertical de Doenças Infecciosas , Transmissão Vertical de Doenças Infecciosas
Actual. SIDA. infectol ; 30(109): 38-47, 20220000. tab, fig
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1392519


La criptococosis es una micosis grave que se manifiesta, en el 90% de los casos, como una meningoencefalitis, especialmente en las personas con VIH. El objetivo de este estudio es describir los casos de criptococosis extrameníngea en personas viviendo con VIH y conocer cuántas de estas padecen compromiso meníngeo concomitante. Además, determinar la relación con el título de antígeno polisacárido capsular de Cryptococcus en suero. Se realizó un estudio retrospectivo, observacional y analítico. Se incluyeron personas viviendo con VIH cuyo diagnóstico inicial de criptococosis se había realizado a partir de muestras extrameníngeas en el período comprendido entre 2012 y 2019. Los pacientes se dividieron en dos grupos. Grupo 1, pacientes sin compromiso meníngeo; Grupo 2, aquellos que finalmente tenían compromiso del SNC. De un total de 531 criptococosis registradas en ese período, se incluyeron 113 pacientes (21%), de los cuales en 58 se comprobó el compromiso meníngeo. No se observaron diferencias significativas en cuanto a la mortalidad entre ambos grupos.Ninguno de los pacientes con antigenemia por LFA (antígeno capsular en suero por inmunocromatografía) positiva, pero con antigenemia por aglutinación de partículas de látex (AL) negativa, tuvo compromiso meníngeo. Se observó que títulos de antígeno para Cryptococcus en suero por AL mayor o igual a 1/100 se correlacionaron con un aumento de 30 veces en la posibilidad de padecer meningitis. En todos los casos se debe descartar el compromiso del SNC. La AL sigue siendo una prueba útil y complementaria, debido a que en los casos con AL negativa no se observó compromiso meníngeo

Cryptococcosis is a serious mycosis that manifests itself, in 90% of cases, as meningoencephalitis, especially in AIDS patients. The objective of this study is to describe the extra-meningeal cases of cryptococcosis in people living with HIV and to know how many of them suffer from concomitant meningeal involvement. Also, to determine its relationship with the Cryptococcus capsular polysaccharide antigen titer in serum.A retrospective, observational and analytical study was carried out. HIV-positive patients whose initial diagnosis had been made from extrameningeal samples in the period between 2012 and 2019 were included. The patients were divided into 2 groups. Group 1: patients without meningeal involvement; group 2: those who finally had CNS involvement.Of a total of 531 cryptococcosis registered in this period, 113 patients (21%) were included, of whom meningeal involvement was confirmed in 58. No significant differences were observed in terms of mortality in both groups.None of the patients with positive LFA antigenemia (Capsular antigen detection by lateral Flow assay) but negative latex particle agglutination (LA) antigenemia had meningeal involvement. LFA was found to be highly sensitive and allows early diagnosis, but it does not replace other diagnostic procedures.Serum Cryptococcus antigen titers for by LA greater than or equal to 1/100 were found to correlate with a 30-fold increase in the likelihood of meningitis.In all cases, CNS involvement must be ruled out. LA continues to be a useful and complementary test, because in cases with negative LA, no meningeal involvement was observed

Humanos , Punção Espinal , Sintomas Concomitantes , Estudos Retrospectivos , Cromatografia de Afinidade/estatística & dados numéricos , HIV/imunologia , Criptococose/diagnóstico , Criptococose/terapia , Testes Imediatos
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 40(7): 388-395, Ago - Sep 2022. tab, graf
Artigo em Inglês | IBECS | ID: ibc-207364


Objective:Calculate the efficiency of the EmERGE Pathway of Care for medically stable people living with HIV at the Hospital Clínic-IDIBAPS, Barcelona, Spain. Methods: 546 study participants were followed between 1st July 2016 and 30th October 2019 across three HIV outpatient clinics, but the virtual clinic was closed during the second year. Unit costs were calculated, linked to mean use outpatient services per patient year, one-year before and after the implementation of EmERGE. Costs were combined with primary and secondary outcomes. Results:Annual costs across HIV-outpatient services increased by 8%: €1073 (95%CI €999–€1157) to €1158 (95%CI €1084–€1238). Annual cost of ARVs was €7,557; total annual costs increased by 1% from €8430 (95%CI €8356–8514) to €8515 (95%CI €8441–8595). Annual cost for 433 participants managed in face-to-face (F2F) clinics decreased by 5% from €958 (95%CI 905–1018) to €904 (95%CI 863–945); participants transferred from virtual to F2F outpatient clinics (V2F) increased their annual cost by a factor of 2.2, from €115 (95%CI 94–139) to €251 (95%CI 219–290). No substantive changes were observed in primary and secondary outcomes. Conclusion: EmERGE Pathway is an efficient and acceptable intervention. Increases in costs were caused by internal structural changes. The cost reduction observed in F2F clinics were off-set by the transfer of participants from the virtual to the F2F clinics due to the closure of the virtual clinic during the second year of the Study. Greater efficiencies are likely to be achieved by extending the use of the Pathway to other PLHIV.(AU)

Objetivo: Calcular la eficiencia de la vía asistencial EmERGE para personas clínicamente estables que viven con VIH en el Hospital Clínic-IDIBAPS, en Barcelona, España. Métodos: Se realizó un seguimiento a 546 participantes del estudio, entre el 1 de julio de 2016 y el 30 de octubre de 2019, en tres clínicas ambulatorias de VIH, pero la clínica virtual se cerró durante el segundo año. Se calcularon los costes unitarios, vinculados al uso medio de los servicios ambulatorios por paciente al año, un año antes y después de la implementación de EmERGE. Los costes se combinaron con criterios de valoración principales y secundarios. Resultados: Los costes anuales en los servicios ambulatorios para el VIH aumentaron un 8%: 1.073 € (IC 95%: 999-1.157 €) a 1.158 € (IC 95%: 1.084-1.238 €). El coste anual de los fármacos antirretrovirales (ARV) fue de 7.557 €; los costes anuales totales aumentaron en un 1%, de 8.430 € (IC 95%: 8.356-8.514 €) a 8.515 € (IC 95%: 8.441-8.595 €).El coste anual para 433 participantes que recibieron tratamiento en clínicas presenciales (face to face, F2F) disminuyó en un 5%, de 958 € (IC 95%: 905-1.018 €) a 904 € (IC 95%: 863-945 €); los participantes transferidos de clínicas ambulatorias virtuales (V2F) a F2F aumentaron su coste anual en un factor de 2,2, de 115 € (IC 95%: 94-139 €) a 251 € (IC 95%: 219-290 €). No se observaron cambios sustanciales en los criterios de valoración principales y secundarios. Conclusión: La vía EmERGE es un tratamiento eficaz y aceptable. Los aumentos de los costes fueron el resultado de cambios estructurales internos. La reducción de costes observada en las clínicas F2F se compensó con la transferencia de participantes de las clínicas virtuales a las F2F debido al cierre de la clínica virtual durante el segundo año del estudio. Es probable que se logre una mayor eficiencia si se amplía el uso de la vía a otras personas que viven con VIH (PVVIH).(AU)

Humanos , Masculino , Feminino , HIV , Análise Custo-Eficiência , Espanha , Instituições de Assistência Ambulatorial , Assistência Ambulatorial , Continuidade da Assistência ao Paciente , Infecções por HIV/terapia , Microbiologia , Doenças Transmissíveis
Rev. esp. quimioter ; 35(4): 378-381, ag. - sept. 2022. tab
Artigo em Inglês | IBECS | ID: ibc-205384


Objetivo. Analizar la eficacia y tolerabilidad de la estrategia de cambio desde regímenes basados en rilpivirina (RPV)a bictegravir/emtricitabina/tenofovir alafenamida (B/F/TAF) enla vida real.Métodos. Estudio unicéntrico, observacional y retrospectivo. Se seleccionaron pacientes que cambiaron de un régimencon RPV a B/F/TAF antes de febrero del 2020 analizándose losresultados después de 24 y 48 semanas. Se determinó el porcentaje que permanecía con carga viral indetectable, así comolos cambios en linfocitos CD4+, parámetros metabólicos y función renal.Resultados. Se incluyeron en el estudio 42 pacientes. 32de los 35 (91,4%) que completaron las 48 semanas de seguimiento tenían carga viral indetectable. El recuento de linfocitos CD4+ permaneció estable a las 24 y a las 48 semanas. Eltipo de análogos recibidos previamente no influyó en la respuestaConclusión. El cambio desde una triple terapia con RPV aB/F/TAF es una estrategia segura y eficaz en la vida real. (AU)

Objective. To analyze the efficacy and tolerability of thestrategy to change from rilpivirine (RPV) based regimens tobictegravir / emtricitabine / tenofovir alafenamide (B/F/TAF).Methods. Single-center, observational and retrospectivestudy. Patients who made the change to B/F/TAF before February 2020 were selected, analyzing the results after 24 and48 weeks. The percentage that remained with an undetectableviral load was determined, as well as the changes in CD4 +lymphocytes, metabolic parameters and renal function.Results. A total of 42 patients were included. Thirty-twoof the 35 patients (91.4%) who completed the 48 weeks offollow-up had an undetectable viral load. The CD4 + lymphocyte count remained stable at 24 and 48 weeks. The responseto B/F/TAF was not influenced by the two analogs previouslyreceived.Conclusion. Switching from triple therapy with RPV toB/F/TAF is a safe and effective strategy in real life. (AU)

Humanos , Adulto , Pessoa de Meia-Idade , Rilpivirina/farmacocinética , Rilpivirina/análise , Estudos Retrospectivos , HIV
PLoS Genet ; 18(8): e1010337, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36007015


Central and eastern chimpanzees are infected with Simian Immunodeficiency Virus (SIV) in the wild, typically without developing acute immunodeficiency. Yet the recent zoonotic transmission of chimpanzee SIV to humans, which were naïve to the virus, gave rise to the Human Immunodeficiency Virus (HIV), which causes AIDS and is responsible for one of the deadliest pandemics in human history. Chimpanzees have likely been infected with SIV for tens of thousands of years and have likely evolved to reduce its pathogenicity, becoming semi-natural hosts that largely tolerate the virus. In support of this view, central and eastern chimpanzees show evidence of positive selection in genes involved in SIV/HIV cell entry and immune response to SIV, respectively. We hypothesise that the population first infected by SIV would have experienced the strongest selective pressure to control the lethal potential of zoonotic SIV, and that population genetics will reveal those first critical adaptations. With that aim we used population genetics to investigate signatures of positive selection in the common ancestor of central-eastern chimpanzees. The genes with signatures of positive selection in the ancestral population are significantly enriched in SIV-related genes, especially those involved in the immune response to SIV and those encoding for host genes that physically interact with SIV/HIV (VIPs). This supports a scenario where SIV first infected the central-eastern ancestor and where this population was under strong pressure to adapt to zoonotic SIV. Interestingly, integrating these genes with candidates of positive selection in the two infected subspecies reveals novel patterns of adaptation to SIV. Specifically, we observe evidence of positive selection in numerous steps of the biological pathway responsible for T-helper cell differentiation, including CD4 and multiple genes that SIV/HIV use to infect and control host cells. This pathway is active only in CD4+ cells which SIV/HIV infects, and it plays a crucial role in shaping the immune response so it can efficiently control the virus. Our results confirm the importance of SIV as a selective factor, identify specific genetic changes that may have allowed our closest living relatives to reduce SIV's pathogenicity, and demonstrate the potential of population genomics to reveal the evolutionary mechanisms used by naïve hosts to reduce the pathogenicity of zoonotic pathogens.

Infecções por HIV , Síndrome de Imunodeficiência Adquirida dos Símios , Vírus da Imunodeficiência Símia , Animais , HIV/genética , Humanos , Pan troglodytes/genética , Síndrome de Imunodeficiência Adquirida dos Símios/genética , Vírus da Imunodeficiência Símia/genética
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde, LIS-bvsms | ID: lis-49033


Informações sobre Casas de apoio para pessoas vivendo com HIV/Aids

HIV , Síndrome de Imunodeficiência Adquirida , Apoio Social
Prev Med ; 162: 107157, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35810936


As the US moves increasingly towards using human papillomavirus (HPV) testing with or without concurrent cytology for cervical cancer screening, it is unknown what the corresponding risks are following a screening result for women living with HIV (WLWH), which will dictate the optimal clinical follow-up. Therefore, using medical records data from Kaiser Permanente Northern California, which introduced triennial HPV and cytology co-testing in women aged 30-64 years in 2003, we compared risks of cervical intraepithelial neoplasia grade 2 (CIN2) or more severe diagnoses (CIN2+) in women not known to have HIV (HIV[-] women) (n = 67,488) frequency matched 111:1 on age and year of the first co-test to the 608 WLWH (n = 608). WLWH were more likely to test HPV positive (20.2% vs. 6.5%, p < 0.001) and have non-normal cytology (14.1% vs. 4.1%, p < 0.001) than HIV[-] women. Five-year CIN2+ risks for all WLWH and HIV[-] women were 3.5% (95%CI = 2.0-5.0%) and 1.6% (95%CI = 1.5-1.8%) (p = 0.01), respectively. Five-year CIN2+ risks for WLWH with positive HPV and non-normal cytology, positive HPV and normal cytology, negative HPV and non-normal cytology, and negative HPV and normal cytology were 24.9% (95%CI = 13.4-36.4%), 3.0% (95%CI = 0.0-7.4%), 3.6 (95%CI = 0.0-9.8%) and 0.3% (95%CI = 0.0-0.8%), respectively. Corresponding 5-year CIN2+ risks for HIV[-] women were 26.6% (95%CI = 24.6-28.7%), 8.5% (95%CI = 7.2-9.9%), 1.9% (95%CI = 1.0-2.8%), and 0.5% (95%CI = 0.4-0.6%), respectively. Thus, in this healthcare setting, the main cause in overall CIN2+ risk differences between WLWH and HIV[-] women was the former was more likely to screen positive and once the screening result is known, it may be reasonable to manage both populations similarly.

Alphapapillomavirus , Neoplasia Intraepitelial Cervical , Infecções por HIV , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Detecção Precoce de Câncer , Feminino , HIV , Humanos , Programas de Rastreamento , Papillomaviridae , Infecções por Papillomavirus/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal