RESUMEN
The aims of this study were to investigate the frequency of HIV-1 RNA level discordance between the cerebrospinal fluid (CSF) and plasma and of CSF viral escape (CVE) in patients with HIV-1 subtype C on antiretroviral therapy, and evaluate the CSF white blood cell (WBC) performance characteristics in predicting CSF discordance in HIV+ group and the frequency of cognitive impairment in individuals with CSF HIV discordance or escape. HIV-1 RNA levels were assessed in plasma and CSF samples from 68 HIV+ participants without opportunistic infection. CSF discordance was found in 7.4% and CVE in 10%, with comparable frequencies between HIV-1B and C. Twenty samples (29%) showed increased CSF WBC counts. This group had higher CSF and plasma HIV-1 RNA levels than the group with normal WBC counts (p < 0.0001 and 0.006, respectively). The odds of CSF discordance were 18 times higher for a person with CSF WBC count of > 5 cells/mm3 than the group with normal CSF WBC count. CSF WBC counts (cut-off of 15 cells/mm3) showed high-performance characteristics as a predictive biomarker of CSF discordance (AUC the ROC curve 0.98). The frequency of cognitive impairment for CSF escape or discordance was 83% and 80%. The odds of cognitive impairment in these groups were 19 and 15 times higher than those for an HIV(-) person. Viral discordance or escape in the CNS occurs at a comparable frequency for HIV-1C and HIV-1B. The CSF WBC count was effective as a predictive biomarker of CSF and plasma discordance.
Asunto(s)
Infecciones por VIH , Leucocitosis/líquido cefalorraquídeo , ARN Viral/sangre , ARN Viral/líquido cefalorraquídeo , Adulto , Fármacos Anti-VIH/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , VIH-1 , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Major depressive disorder (MDD) is among the most prevalent neuropsychiatric disorders associated with HIV infection; however, its risks and neurobiologic correlates in diverse cultures are poorly understood. This study aimed to examine the frequency of MDD among HIV+ participants in southern Brazil. We hypothesized that the frequency and severity of MDD would be higher among individuals with HIV+ compared with HIV- and higher in HIV subtype B compared with C. Individuals with HIV (n = 39) as well as seronegative controls (n = 22) were enrolled in a cross-sectional, prospective, observational study. Current and lifetime history of MDD was diagnosed by MINI-Plus; symptom severity was assessed by Beck Depression Inventory-II (BDI-II). Current and past episodes of MDD were significantly more frequent in the HIV+ versus HIV- group: current MDD, 15 (38.5 %) vs. 0 (0 %), p = 0.0004; past MDD, 24 (61.5 %) vs. 3 (13.6 %), p = 0.0004. The median BDI-II score in the HIV+ group was significantly higher than that in the HIV- (13 (8-27.5) vs. 2.5 (1-5.5); p < 0.0001). Current suicide risk, defined as during the last month, was found in 18 % of participants in the HIV-positive and none in the HIV-negative group. Neither current MDD frequency (8 (57.1 %) vs. 6 (40 %), p = 0.47) nor BDI-II score differed across subtypes B and C. HIV+ group may be more likely to experience current MDD than HIV-. This was the first study to compare the frequency and severity of MDD in HIV subtypes B and C; we found no difference between HIV subtypes B and C.
Asunto(s)
Trastorno Depresivo Mayor/epidemiología , Infecciones por VIH/epidemiología , VIH-1/clasificación , Suicidio/estadística & datos numéricos , Adulto , Brasil/epidemiología , Estudios de Casos y Controles , Estudios Transversales , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/fisiopatología , Trastorno Depresivo Mayor/psicología , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/fisiopatología , Infecciones por VIH/psicología , VIH-1/genética , VIH-1/patogenicidad , Humanos , Masculino , Persona de Mediana Edad , Tipificación Molecular , Prevalencia , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Medición de Riesgo , Índice de Severidad de la Enfermedad , Suicidio/psicologíaRESUMEN
HIV-1 clade C isolates show reduced Tat protein chemoattractant activity compared with clade B. This might influence neuropathogenesis by altering trafficking of monocytes into the CNS. A previous study suggested low rates of HIV-associated dementia in clade C-infected individuals. The present study evaluated neurocognitive impairment rates in clade B- and C-infected individuals from the same local population. HIV+ and HIV- participants were recruited from the same geographic region in Southern Brazil. We evaluated neuropsychological (NP) impairment using a screening instrument (the International HIV Dementia Scale (IHDS)), as well as a Brazilian Portuguese adaptation of a comprehensive battery that has demonstrated sensitivity to HIV-associated neurocognitive disorders (HAND) internationally. NP performance in controls was used to generate T scores and impairment ratings by the global deficit score (GDS) method. Clade assignments were ascertained by sequencing pol and env. Blood and cerebrospinal fluid were collected from all HIV+ participants. HIV+ and HIV- participants were comparable on demographic characteristics. HIV+ participants overall were more likely to be impaired than HIV- by the IHDS and the GDS. Clade B- and C-infected individuals were demographically similar and did not differ significantly in rates of impairment. The prevalence of pleocytosis, a marker of intrathecal cellular chemotaxis, also did not differ between clade B and C infections. Clade B and C HIV-infected individuals from the same geographic region, when ascertained using comparable methods, did not differ in their rates of neurocognitive impairment, and there was no evidence of differences in CNS chemotaxis.
Asunto(s)
Trastornos del Conocimiento/virología , Infecciones por VIH/virología , VIH-1/clasificación , VIH-1/patogenicidad , Productos del Gen env del Virus de la Inmunodeficiencia Humana/clasificación , Productos del Gen pol del Virus de la Inmunodeficiencia Humana/clasificación , Adulto , Brasil , Movimiento Celular , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/patología , Trastornos del Conocimiento/psicología , Estudios Transversales , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/psicología , VIH-1/genética , Humanos , Leucocitos/patología , Leucocitos/virología , Leucocitosis , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Análisis de Secuencia de ADN , Índice de Severidad de la Enfermedad , Productos del Gen env del Virus de la Inmunodeficiencia Humana/genética , Productos del Gen pol del Virus de la Inmunodeficiencia Humana/genéticaRESUMEN
OBJECTIVE: Compare the characteristics of AIDS patients and treatment outcomes under three different antiretroviral treatment regimens advocated by the Ministry of Health of Brazil. METHODS: Retrospective cohorts of patients who had survived up to five years after diagnosis were constructed. The data were obtained from medical records, medication dispensing forms, and death certificates of patients in Curitiba, in the Brazilian state of Paraná. Six hundred patients were selected from the first six months following the adoption of each of the treatment regimens (1992, 1997, and 2002). RESULTS: The ratio of men to women fell from 6.5:1 in 1992 to 1.4:1 in 2002. There was a proportionate rise in the number of people over 50, which increased from 1.4% in 1992 to 9.9% in 2002. The case fatality rate dropped from 81.9% to 33.9% in the period in question. An analysis of those who survived at least five years from the date of diagnosis showed that the percentage of patients treated increased from 46.2% in 1992 to 94.0% in 1997, finishing at 91.7% in 2002. Multivariate analysis yielded a positive and statistically significant association between survival up to five years after an AIDS diagnosis and years of schooling, age group, year of diagnosis, type of antiretroviral therapy, and treatment adherence (all with P < 0.001). CONCLUSIONS: Continuous improvement of the antiretroviral therapy recommended by the Ministry of Health had a positive impact on survival. There was an association between case fatality and fewer years of schooling, membership in an older age group, a diagnosis obtained in 1992, the type of antiretroviral therapy, and suboptimal adherence to antiretroviral treatment regimens.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Adulto , Factores de Edad , Fármacos Anti-VIH/administración & dosificación , Terapia Antirretroviral Altamente Activa , Brasil/epidemiología , Evaluación de Medicamentos , Quimioterapia Combinada , Escolaridad , Femenino , Humanos , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Estudios Retrospectivos , Conducta Sexual , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: Although the development of prevention and treatment strategies for sexually transmitted infections in key groups has improved over the years, they still remain a challenge for health systems worldwide. In this context, the objective of this study is to assess the seroprevalence in the tested population, with an emphasis on key populations, aiming at identifying the participants' profile and consequently the development of testing strategies. METHODS: The present study analyzed the seroprevalence of HIV, syphilis, and hepatitis B and C, and the epidemiological profiles of key and general populations tested at a reference public health facility for sexually transmitted infections testing and counseling in the city of Curitiba, Southern Brazil. A cross-sectional study was conducted to report data from 2010 to 2019. RESULTS: A total of 67,448 samples were analyzed, 9,086 of these tested positive, 3,633 (56%) for HIV, 4,978 (77%) for syphilis, 340 (5%) for hepatitis C virus (HCV), and 135 (2%) for hepatitis B virus (HBV). Overall, most of the participants were men (79 to 87%), and predominantly white. For HIV and syphilis, the predominant age groups were 21-30 years old (48 and 50%), HBV 21-40 years old (31%), and HCV 41-60 years old (25%). A high seroprevalence of HIV and syphilis was observed in the investigated key populations with a higher frequency in sex workers, men who have sex with men, and transgender. CONCLUSION: The progressive increase in syphilis cases emphasizes the need for effective interventions to enhance adherence to the use of condoms, and to expand diagnosis and treatment for these key populations.
Asunto(s)
Infecciones por VIH , Hepatitis B , Hepatitis C , Minorías Sexuales y de Género , Enfermedades de Transmisión Sexual , Sífilis , Adulto , Brasil/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Hepatitis B/diagnóstico , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Hepatitis C/diagnóstico , Hepatitis C/epidemiología , Homosexualidad Masculina , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Seroepidemiológicos , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & control , Sífilis/epidemiología , Adulto JovenRESUMEN
Xpert® MTB/RIF has been widely used for tuberculosis (TB) diagnosis in Brazil, since 2014. This prospective observational study aimed to evaluate the performance of Xpert in different contexts during a two-year period: (i) laboratory and clinical/epidemiological diagnosis; (ii) HIV-positive and -negative populations; (iii) type of specimens: pulmonary and extrapulmonary. Overall, 924 specimens from 743 patients were evaluated. The performance of the assays was evaluated considering culture (Lowenstein Jensen or LJ medium) results and composite reference standard (CRS) classification as gold standard. According to CRS evaluation, 219 cases (29.5%) were classified as positive cases, 157 (21.1%) as 'possible TB', and 367 (49.3%) as 'not TB'. Based on culture, Xpert and AFB smear achieved a sensitivity of 96% and 62%, respectively, while based on CRS, the sensitivities of Xpert, AFB smear, and culture were 40.7%, 20%, and 25%, respectively. The pooled sensitivity and specificity of Xpert were 96% and 94%, respectively. Metric evaluations were similar between pulmonary and extrapulmonary samples against culture, whereas compared to CRS, the sensitivities were 44.6% and 29.3% for the pulmonary and extrapulmonary cases, respectively. The Xpert detected 42/69 (60.9%) patients with confirmed TB and negative culture on LJ medium, and 52/69 (75.4%) patients with negative AFB smear results. There was no significant difference in the diagnostic accuracy based on the types of specimens and population (positive- and negative-HIV). Molecular testing detected 13 cases of TB in culture-negative patients with severe immunosuppression. Resistance to rifampicin was detected in seven samples. Herein, Xpert showed improved detection of pulmonary and extrapulmonary TB cases, both among HIV-positive and -negative patients, even in cases with advanced immunosuppression, thereby performing better than multiple other diagnostic parameters.
Asunto(s)
Farmacorresistencia Bacteriana , Huésped Inmunocomprometido , Mycobacterium tuberculosis , Rifampin/farmacología , Tuberculosis Pulmonar , Adulto , Anciano , Brasil , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/crecimiento & desarrollo , Mycobacterium tuberculosis/aislamiento & purificación , Estudios Prospectivos , Sensibilidad y Especificidad , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/microbiologíaRESUMEN
Human immunodeficiency virus (HIV) clades B and C account for more than 60% of the HIV-1 infections worldwide. In this paper, we describe the profiles of patients infected with subtypes of HIV-1 from the state of Paraná, Southern Brazil, and correlate them with demographic and epidemiological findings. A retrospective analysis of HIV cases reported from 1999-2007 was also performed. Data from 293 patients were reviewed and 245 were older than 13 (58% female). The distribution of clades was as follows: B 140 (57%), C 67 (23%), F 24 (10%) and mosaic or unique recombinant forms (URFs) 24 (10%). Of the 48 patients younger than 13 years of age (62.5% male), vertical transmission occurred in 46 and the distribution of clades was as follows: B 14 (29%), C 24 (50%), F 7 (15%) and URFs 6 (13%). There was no significant difference in mortality between HIV-1 subtypes. In both groups, patients infected with clade C tended to have higher rates of injection drug use exposure risk.
Asunto(s)
Infecciones por VIH/epidemiología , VIH-1/genética , Adolescente , Adulto , Brasil/epidemiología , Estudios Transversales , Femenino , Genotipo , Infecciones por VIH/virología , VIH-1/clasificación , Humanos , Masculino , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Results from a cross-sectional observational study on candidemia conducted at Hospital de Clínicas, Federal University of Paraná, are presented. From January 2001 to December 2004, one hundred candidemia cases were evaluated. The incidence was 1.27 episodes per 1,000 hospitalizations and Candida was the eighth most frequently isolated agent from bloodstream infections. The patients ages ranged from five days to 89 years, with a mean of 32 years. Sixty percent of the cases occurred in adults (66% > 50 years old) and 40% in children (52% < one year old). Fifty-nine percent had been admitted to medical wards and 41% to the intensive care unit. Candida albicans was the most (59%) frequent species followed by Candida tropicalis (15%) and Candida parapsilosis (9%). The most (97%) prevalent coexisting conditions were the use of antibacterial drugs, central venous catheter (77%), H2 blockers (57%), total parenteral nutrition (49%) and admission to the intensive care unit (41%). Out of the 51 isolates tested, three of Candida glabrata presented dose-dependent susceptibility to fluconazole and resistance to itraconazole. One sample of Candida krusei presented dose-dependent susceptibility to fluconazole and one of Candida pelliculosa presented dose-dependent susceptibility to itraconazole. Among the study population, 68% received antifungal therapy, but the mortality was 56%.
Asunto(s)
Antifúngicos/farmacología , Candidiasis/epidemiología , Fungemia/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Candida/clasificación , Candida/efectos de los fármacos , Candidiasis/microbiología , Niño , Preescolar , Estudios Transversales , Femenino , Fungemia/microbiología , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Factores de Riesgo , Distribución por SexoRESUMEN
Acute communitarian bacterial meningitis and AIDS are prevalent infectious disease in Brazil. The objective of this study was to evaluate the frequency of acute communitarian bacterial meningitis in AIDS patients, the clinical and cerebrospinal fluid (CSF) characteristics. It was reviewed the Health Department data from city of Curitiba, Southern Brazil, from 1996 to 2002. During this period, 32 patients with AIDS fulfilled criteria for acute bacterial meningitis, representing 0.84% of the AIDS cases and 1.85% of the cases of bacterial meningitis. S. pneumoniae was the most frequent bacteria isolated. The number of white blood cells and the percentage of neutrophils were higher and CSF glucose was lower in the group with no HIV co-infection (p 0.12; 0.008; 0.04 respectively). Bacteria not so common causing meningitis can occur among HIV infected patients. The high mortality rate among pneumococcus meningitis patients makes pneumococcus vaccination important.
Asunto(s)
Infecciones por VIH/microbiología , Meningitis Bacterianas/complicaciones , Enfermedad Aguda , Adulto , Brasil/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Femenino , Infecciones por VIH/epidemiología , Seronegatividad para VIH , Humanos , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/mortalidad , Meningitis Neumocócica/mortalidad , Vacunas Neumococicas/uso terapéutico , Estudios Retrospectivos , Factores de Riesgo , Estadísticas no Paramétricas , Streptococcus pneumoniae/aislamiento & purificaciónRESUMEN
ABSTRACT Objective: Although the development of prevention and treatment strategies for sexually transmitted infections in key groups has improved over the years, they still remain a challenge for health systems worldwide. In this context, the objective of this study is to assess the seroprevalence in the tested population, with an emphasis on key populations, aiming at identifying the participants' profile and consequently the development of testing strategies. Methods: The present study analyzed the seroprevalence of HIV, syphilis, and hepatitis B and C, and the epidemiological profiles of key and general populations tested at a reference public health facility for sexually transmitted infections testing and counseling in the city of Curitiba, Southern Brazil. A cross-sectional study was conducted to report data from 2010 to 2019. Results: A total of 67,448 samples were analyzed, 9,086 of these tested positive, 3,633 (56%) for HIV, 4,978 (77%) for syphilis, 340 (5%) for hepatitis C virus (HCV), and 135 (2%) for hepatitis B virus (HBV). Overall, most of the participants were men (79 to 87%), and predominantly white. For HIV and syphilis, the predominant age groups were 21-30 years old (48 and 50%), HBV 21-40 years old (31%), and HCV 41-60 years old (25%). A high seroprevalence of HIV and syphilis was observed in the investigated key populations with a higher frequency in sex workers, men who have sex with men, and transgender. Conclusion: The progressive increase in syphilis cases emphasizes the need for effective interventions to enhance adherence to the use of condoms, and to expand diagnosis and treatment for these key populations.
RESUMEN
INTRODUCTION:: HIV and viral hepatitis infections are major causes of chronic disease worldwide and have some similarities with regard to routes of transmission, epidemiology, front barriers faced during access of treatment, and strategies for a global public health response. The objective was to describe the HIV-1 subtypes, viral tropism and single-nucleotide polymorphisms (SNPs) of interleukin 28B (IL28B) from a case series of HIV/viral hepatitis coinfected patients from southern Brazil. METHODS:: Clinical and epidemiological data were evaluated by a review of medical records. Periodic blood draws were taken to determine the viral and host characteristics. RESULTS:: This study included 38 patients with HIV/HBV or HIV/HCV coinfection; the median age was 49 years. Thirty-seven (97.4%) were on antiretroviral therapy, 32 (84.2%) had an undetectable viral load, a median CD4+ T-cell count of 452 cells/mm3. HIV-1 subtyping showed 47.4 and 31.6% of patients with subtypes C and B, respectively. Analysis of viral co-receptor usage showed a predominance of the R5 variant (64.7%), with no significant difference between the subtypes. Twenty patients with HIV/HCV coinfection were eligible to receive HCV therapy with pegylated-interferon-alpha plus ribavirin, and 10/20 (50%) of them achieved sustained virological response. SNPs of IL28B were evaluated in 93.3% of patients with HIV/HCV coinfection, and 17 (60.7%) presented the CC genotype. CONCLUSIONS:: In the present case series, a higher frequency of HIV subtype C was found in coinfected patients. However such findings need to be prospectively evaluated with the inclusion of data from regional multicenter analyses.
Asunto(s)
Variación Genética , Infecciones por VIH/virología , Hepatitis B/complicaciones , Hepatitis C Crónica/complicaciones , Interleucinas/genética , Polimorfismo de Nucleótido Simple , Coinfección/virología , Estudios Transversales , Femenino , Infecciones por VIH/complicaciones , Humanos , Interferones , Masculino , Persona de Mediana Edad , Tropismo ViralRESUMEN
OBJECTIVE: To estimate HIV incidence in two Brazilian municipalities, Recife and Curitiba, in the year of 2013. METHODS: The method for estimating incidence was based on primary information, resulting from the Lag-Avidity laboratory test for detection of recent HIV infections, applied in a sample of the cases diagnosed in the two cities in 2013. For the estimation of the HIV incidence for the total population of the cities, the recent infections detected in the research were annualized and weighted by the inverse of the probability of HIV testing in 2013 among the infected and not diagnosed cases. After estimating HIV incidence for the total population, the incidence rates were estimated by sex, age group, and exposure category. RESULTS: In Recife, 902 individuals aged 13 years and older were diagnosed with HIV infection. From these, 528 were included in the study, and the estimated proportion of recent infections was 13.1%. In Curitiba, 1,013 people aged 13 years and older were diagnosed, 497 participated in the study, and the proportion of recent infections was 10.5%. In Recife, the estimated incidence rate was 53.1/100,000 inhabitants of 13 years and older, while in Curitiba, it was 41.1/100,000, with male-to-female ratio of 3.5 and 2.4, respectively. We observed high rates of HIV incidence among men who have sex with men, of 1.47% in Recife and 0.92% in Curitiba. CONCLUSIONS: The results obtained in the two cities showed that the group of men who have sex with men are disproportionately subject to a greater risk of new infections, and indicate that strategies to control the spread of the epidemic in this population subgroup are essential and urgent. OBJETIVO: Estimar a incidência de HIV em dois municípios brasileiros, Recife e Curitiba, no ano de 2013. MÉTODOS: O método de estimação da incidência foi baseado em informações primárias, resultantes do ensaio laboratorial Lag-Avidity para detecção de infecções recentes do HIV, aplicado em uma amostra dos casos diagnosticados nas duas cidades em 2013. Para a estimação da incidência de HIV para a população total das cidades, as infecções recentes detectadas na pesquisa foram anualizadas e ponderadas pelo inverso da probabilidade de teste de HIV no ano de 2013 entre os casos infectados e não diagnosticados. Após a estimação da incidência de HIV para a população total, foram estimadas as taxas de incidência por sexo, faixa de idade e categoria de exposição. RESULTADOS: Em Recife, foram diagnosticados 902 indivíduos de 13 anos e mais com infecção de HIV. Desses, 528 foram incluídos no estudo, e a proporção estimada de infecções recentes foi de 13,1%. Em Curitiba, foram diagnosticadas 1.013 pessoas de 13 anos e mais, 497 participaram do estudo, e a proporção de infecções recentes foi de 10,5%. Em Recife, a taxa de incidência estimada foi de 53,1 por 100 mil habitantes de 13 anos e mais, enquanto em Curitiba, de 41,1 por 100 mil, com razão do sexo masculino para o feminino de 3,5 e 2,4, respectivamente. Foram evidenciadas elevadas taxas de incidência de HIV entre homens que fazem sexo com homens, de 1,47% em Recife e 0,92% em Curitiba. CONCLUSÕES: Os resultados obtidos nas duas cidades mostraram que o grupo dos homens que fazem sexo com homens está desproporcionalmente sujeito ao maior risco de novas infecções, e indicam que estratégias para controle da disseminação da epidemia nesse subgrupo populacional são essenciais e urgentes.
Asunto(s)
Ciudades/epidemiología , Infecciones por VIH/epidemiología , Adolescente , Adulto , Brasil/epidemiología , Femenino , Infecciones por VIH/diagnóstico , Homosexualidad Masculina , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores Sexuales , Adulto JovenRESUMEN
Blood plasma specimens are the clinical standard for HIV-1 pol gene genotyping from viral populations; however, it is not always successful, often from low viral loads or the presence of polymerase chain reaction (PCR) inhibitors. Objective To describe the successful of HIV-1 genotyping in two samples of cerebrospinal fluid (CSF), after genotype procedures failed from blood. Method Two HIV-infected patients enrolled in a neurocognitive research study were evaluated when standard HIV-1 genotyping failed from blood plasma samples. Genotyping was performed using the commercial system TRUGENE HIV-1 Genotyping Kit and the OpenGene DNA Sequencing System (Siemens Healthcare Diagnostics, Tarrytown, NY, USA). Results CSF genotyping was performed via the same commercial platform and was successful in both cases. Conclusion This report demonstrates that CSF could be used as an alternate clinical specimen for HIV-1 genotyping when it fails from blood.
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Técnicas de Genotipaje/métodos , Infecciones por VIH/líquido cefalorraquídeo , VIH-1/genética , Adulto , Secuencia de Bases , Infecciones por VIH/sangre , VIH-1/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , ARN Viral/aislamiento & purificación , Reproducibilidad de los Resultados , Carga ViralRESUMEN
BACKGROUND: Brazil accounts for the largest number of HIV+ persons in Latin America, and this epidemic poses a significant public health burden in this country. Little is known about the neuropsychiatric and functional consequences of HIV infection in this population. METHODS: Participants were 43 HIV+ and 29 HIV- individuals who underwent a neuropsychological, psychiatric and neurological evaluation that included self-report measures of mood (Beck Depression Inventory-II; BDI-II), neurocognitive complaints (Patient's Assessment of Own Functioning Inventory) and declines in instrumental activities of daily living (Activities of Daily Living questionnaire). The MINI-Plus generated major depressive disorder (MDD) diagnoses. Apathy, defined as social withdrawal, decision-making difficulty, loss of interest and pleasure, was measured using items from the BDI-II and the neurological evaluation. RESULTS: When compared with seronegative participants, HIV+ individuals endorsed higher levels of apathy spectrum symptoms. After adjusting for mood and other covariates, apathy significantly predicted worse everyday functioning. LIMITATIONS: The small sample size, along with the self-report measures used to evaluate apathy and functional difficulties limit the inferences that may be drawn from our findings. CONCLUSIONS: Our Brazilian HIV+ cohort endorsed apathy and depression as well as significant functional complaints. Although correlated with depression, apathy was uniquely associated with functional difficulties. Clinical attention to apathy and depression in HIV-infected Brazilians may help identify patients at risk for functional difficulties who may benefit from additional support to maintain independence.
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Apatía , Trastorno Depresivo Mayor/etiología , Infecciones por VIH/psicología , Actividades Humanas/psicología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/psicología , Adulto , Afecto , Atención , Brasil , Trastorno Depresivo Mayor/psicología , Femenino , Infecciones por VIH/complicaciones , Seropositividad para VIH/complicaciones , Seropositividad para VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Inventario de Personalidad , Escalas de Valoración Psiquiátrica , Autoinforme , Encuestas y CuestionariosRESUMEN
Abstract INTRODUCTION: HIV and viral hepatitis infections are major causes of chronic disease worldwide and have some similarities with regard to routes of transmission, epidemiology, front barriers faced during access of treatment, and strategies for a global public health response. The objective was to describe the HIV-1 subtypes, viral tropism and single-nucleotide polymorphisms (SNPs) of interleukin 28B (IL28B) from a case series of HIV/viral hepatitis coinfected patients from southern Brazil. METHODS: Clinical and epidemiological data were evaluated by a review of medical records. Periodic blood draws were taken to determine the viral and host characteristics. RESULTS: This study included 38 patients with HIV/HBV or HIV/HCV coinfection; the median age was 49 years. Thirty-seven (97.4%) were on antiretroviral therapy, 32 (84.2%) had an undetectable viral load, a median CD4+ T-cell count of 452 cells/mm3. HIV-1 subtyping showed 47.4 and 31.6% of patients with subtypes C and B, respectively. Analysis of viral co-receptor usage showed a predominance of the R5 variant (64.7%), with no significant difference between the subtypes. Twenty patients with HIV/HCV coinfection were eligible to receive HCV therapy with pegylated-interferon-alpha plus ribavirin, and 10/20 (50%) of them achieved sustained virological response. SNPs of IL28B were evaluated in 93.3% of patients with HIV/HCV coinfection, and 17 (60.7%) presented the CC genotype. CONCLUSIONS: In the present case series, a higher frequency of HIV subtype C was found in coinfected patients. However such findings need to be prospectively evaluated with the inclusion of data from regional multicenter analyses.
Asunto(s)
Humanos , Masculino , Femenino , Variación Genética , Infecciones por VIH/virología , Interleucinas/genética , Hepatitis C Crónica/complicaciones , Polimorfismo de Nucleótido Simple , Hepatitis B/complicaciones , Infecciones por VIH/complicaciones , Estudios Transversales , Interferones , Tropismo Viral , Coinfección/virología , Persona de Mediana EdadRESUMEN
ABSTRACT OBJECTIVE To estimate HIV incidence in two Brazilian municipalities, Recife and Curitiba, in the year of 2013. METHODS The method for estimating incidence was based on primary information, resulting from the Lag-Avidity laboratory test for detection of recent HIV infections, applied in a sample of the cases diagnosed in the two cities in 2013. For the estimation of the HIV incidence for the total population of the cities, the recent infections detected in the research were annualized and weighted by the inverse of the probability of HIV testing in 2013 among the infected and not diagnosed cases. After estimating HIV incidence for the total population, the incidence rates were estimated by sex, age group, and exposure category. RESULTS In Recife, 902 individuals aged 13 years and older were diagnosed with HIV infection. From these, 528 were included in the study, and the estimated proportion of recent infections was 13.1%. In Curitiba, 1,013 people aged 13 years and older were diagnosed, 497 participated in the study, and the proportion of recent infections was 10.5%. In Recife, the estimated incidence rate was 53.1/100,000 inhabitants of 13 years and older, while in Curitiba, it was 41.1/100,000, with male-to-female ratio of 3.5 and 2.4, respectively. We observed high rates of HIV incidence among men who have sex with men, of 1.47% in Recife and 0.92% in Curitiba. CONCLUSIONS The results obtained in the two cities showed that the group of men who have sex with men are disproportionately subject to a greater risk of new infections, and indicate that strategies to control the spread of the epidemic in this population subgroup are essential and urgent.
RESUMO OBJETIVO Estimar a incidência de HIV em dois municípios brasileiros, Recife e Curitiba, no ano de 2013. MÉTODOS O método de estimação da incidência foi baseado em informações primárias, resultantes do ensaio laboratorial Lag-Avidity para detecção de infecções recentes do HIV, aplicado em uma amostra dos casos diagnosticados nas duas cidades em 2013. Para a estimação da incidência de HIV para a população total das cidades, as infecções recentes detectadas na pesquisa foram anualizadas e ponderadas pelo inverso da probabilidade de teste de HIV no ano de 2013 entre os casos infectados e não diagnosticados. Após a estimação da incidência de HIV para a população total, foram estimadas as taxas de incidência por sexo, faixa de idade e categoria de exposição. RESULTADOS Em Recife, foram diagnosticados 902 indivíduos de 13 anos e mais com infecção de HIV. Desses, 528 foram incluídos no estudo, e a proporção estimada de infecções recentes foi de 13,1%. Em Curitiba, foram diagnosticadas 1.013 pessoas de 13 anos e mais, 497 participaram do estudo, e a proporção de infecções recentes foi de 10,5%. Em Recife, a taxa de incidência estimada foi de 53,1 por 100 mil habitantes de 13 anos e mais, enquanto em Curitiba, de 41,1 por 100 mil, com razão do sexo masculino para o feminino de 3,5 e 2,4, respectivamente. Foram evidenciadas elevadas taxas de incidência de HIV entre homens que fazem sexo com homens, de 1,47% em Recife e 0,92% em Curitiba. CONCLUSÕES Os resultados obtidos nas duas cidades mostraram que o grupo dos homens que fazem sexo com homens está desproporcionalmente sujeito ao maior risco de novas infecções, e indicam que estratégias para controle da disseminação da epidemia nesse subgrupo populacional são essenciais e urgentes.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Adulto Joven , Infecciones por VIH/epidemiología , Ciudades/epidemiología , Brasil/epidemiología , Infecciones por VIH/diagnóstico , Factores Sexuales , Incidencia , Factores de Riesgo , Homosexualidad Masculina , Persona de Mediana EdadRESUMEN
Objetivou-se conhecer aspectos da violência sexual e adesão das vítimas ao seguimento ambulatorial. Estudo transversal, com coleta retrospectiva de dados em um serviço de referência no estado do Paraná. A coleta foi realizada de fevereiro a maio de 2014 mediante fichas de notificação de 2009 a 2013. Foram atendidos 1272 agredidos sexualmente, sendo 53,46% deles com idade entre 12 e 18 anos e 94,65%, mulheres. Em mais da metade dos casos, o agressor era desconhecido (53,38%), a agressão ocorreu nas residências (39,30%) e vias públicas (35%), à noite (50,33%) e, em 96,67% dos casos, houve penetração vaginal. A indicação da Profilaxia Pós-Exposição às vítimas ocorreu em 76,4% e a contracepção de emergência foi administrada em 64,77% das mulheres. Apenas 19,54% completaram o seguimento ambulatorial. As evidências indicam a necessidade de estratégias de atendimento que motivem a vítima de violência sexual a finalizar o tratamento (AU).
The aim was to investigate aspects of sexual violence and the victims' adherence to outpatient follow-up. This transversal study involved retrospective data collection in a specialized service in the Brazilian state of Paraná. The collection was undertaken between February and May 2014 from the notification files of 2009 2013. A total of 1,272 persons who had been the victims of sexual assault was attended; 53.46% of them were aged between 12 and 18 years old, and 94.65% were female. In more than half of the cases, the aggressor was unknown (53.38%), the aggression took place in homes (39.30%) and on public highways (35%), at night (50.33%) and, in 96.67% of cases, there was vaginal penetration. Indication of Post-Exposure Prophylaxis to the victims took place in 76.4% of cases and emergency contraception was administered to 64.77% of the women. Only 19.54% completed the outpatient follow-up. The evidence indicates the need for attendance strategies which motivate the victim of sexual violence to complete treatment (AU).
El objetivo del estudio fue conocer aspectos de la violencia sexual y adhesión de las víctimas al procedimiento ambulatorial. Estudio transversal cuyos datos fueron obtenidos de modo retrospectivo en un servicio de referencia en el estado de Paraná. Los datos fueron recogidos de febrero a mayo de 2014 por medio de fichas de notificación de 2009 a 2013. Fueron atendidos 1272 agredidos sexualmente, siendo la edad de 53,46% de ellos entre 12 y 18 años y 94,65%, mujeres. En más de la mitad de los casos, el agresor era desconocido (53,38%), la agresión ocurrió en las residencias (39,30%) y locales públicos (35%), por la noche (50,33%) y, en 96,67% de los casos, hubo penetración vaginal. La indicación de la Profilaxia Pos Exposicón a las víctimas ocurrió en 76,4% y la contracepción de emergencia fue administrada en 64,77% de las mujeres. Solamente 19,54% completaron el procedimiento ambulatorial. Las evidencias apuntan la necesidad de estrategias de atendimiento que ayuden la víctima de violencia sexual a finalizar el tratamiento (AU).
Asunto(s)
Femenino , Delitos Sexuales , Enfermería , Violencia contra la MujerRESUMEN
Blood plasma specimens are the clinical standard for HIV-1 pol gene genotyping from viral populations; however, it is not always successful, often from low viral loads or the presence of polymerase chain reaction (PCR) inhibitors. Objective To describe the successful of HIV-1 genotyping in two samples of cerebrospinal fluid (CSF), after genotype procedures failed from blood. Method Two HIV-infected patients enrolled in a neurocognitive research study were evaluated when standard HIV-1 genotyping failed from blood plasma samples. Genotyping was performed using the commercial system TRUGENE® HIV-1 Genotyping Kit and the OpenGene® DNA Sequencing System (Siemens Healthcare Diagnostics, Tarrytown, NY, USA). Results CSF genotyping was performed via the same commercial platform and was successful in both cases. Conclusion This report demonstrates that CSF could be used as an alternate clinical specimen for HIV-1 genotyping when it fails from blood. .
O plasma é a amostra clínica padrão utilizada para a genotipagem da região pol do HIV-1; entretanto, a genotipagem pode nem sempre ser bem sucedida, geralmente devido a baixas cargas virais ou à presença de inibidores da reação em cadeia da polimerase (PCR). Objetivo: Descrever o sucesso da genotipagem do HIV-1 em duas amostras de líquido cefalorraquidiano (LCR) após a falha do mesmo método em amostras de plasma dos mesmos pacientes. Método: Dois pacientes HIV+ envolvidos em um estudo neurocognitivo foram avaliados após a falha da genotipagem do HIV-1 no plasma. A genotipagem foi realizada com o sistema comercial TRUGENE® HIV-1 Genotyping e o OpenGene® DNA Sequencing (Siemens Healthcare Diagnostics, Tarrytown, NY, USA). Resultados: A genotipagem no LCR foi realizada pelo mesmo método utilizado no plasma, sendo bem sucedida para ambos os pacientes. Conclusão: Este artigo demonstra que o LCR pode ser usado como uma amostra clínica alternativa para a genotipagem do HIV-1 quando esta falha no plasma. .
Asunto(s)
Adulto , Humanos , Masculino , Persona de Mediana Edad , Técnicas de Genotipaje/métodos , Infecciones por VIH/líquido cefalorraquídeo , VIH-1 , Secuencia de Bases , Infecciones por VIH/sangre , VIH-1 , Reacción en Cadena de la Polimerasa , Reproducibilidad de los Resultados , ARN Viral/aislamiento & purificación , Carga ViralRESUMEN
Objetivo. Comparar as características dos pacientes com Aids e os resultados dos tratamentos na vigência de três diferentes consensos de terapia antirretroviral preconizados pelo Ministério da Saúde do Brasil. Métodos. Foram construídas coortes retrospectivas de pacientes com sobrevida de até 5 anos após diagnóstico. Os dados foram obtidos de prontuários, formulários de dispensação de medicamentos e declarações de óbitos dos pacientes residentes no município de Curitiba (PR), Brasil. Foram elegíveis 600 pacientes referentes aos 6 primeiros meses dos anos seguintes à implantação dos consensos (1992, 1997 e 2002). Resultados. A razão de masculinidade passou de 6,5:1 em 1992 para 1,4:1 em 2002. Ocorreu um aumento proporcional na população com mais de 50 anos, que passou de 1,4% em 1992 para 9,9% em 2002. A letalidade diminuiu de 81,9% para 33,9% no período estudado. A análise dos que sobreviveram até pelo menos 5 anos após diagnóstico mostrou que a frequência de pacientes tratados aumentou, sendo 46,2, 94,0 e 91,7%, respectivamente, para os anos de 1992, 1997 e 2002. A análise multivariada mostrou associação positiva e estatisticamente significante entre sobrevida até 5 anos após o diagnóstico de Aids e anos de estudo, faixa etária, ano de diagnóstico, tipo de terapia antirretroviral e adesão ao tratamento (todos com P < 0,001). Conclusões. O aprimoramento da terapia antirretroviral preconizada pelo Ministério da Saúde teve impacto positivo na sobrevida. Houve associação entre letalidade e menor escolaridade, maior faixa etária, diagnóstico obtido em 1992, tipo de terapia antirretroviral e adesão incompleta ao tratamento antirretroviral.
Objective. Compare the characteristics of AIDS patients and treatment outcomes under three different antiretroviral treatment regimens advocated by the Ministry of Health of Brazil. Methods. Retrospective cohorts of patients who had survived up to five years after diagnosis were constructed. The data were obtained from medical records, medication dispensing forms, and death certificates of patients in Curitiba, in the Brazilian state of Paraná. Six hundred patients were selected from the first six months following the adoption of each of the treatment regimens (1992, 1997, and 2002). Results. The ratio of men to women fell from 6.5:1 in 1992 to 1.4:1 in 2002. There was a proportionate rise in the number of people over 50, which increased from 1.4% in 1992 to 9.9% in 2002. The case fatality rate dropped from 81.9% to 33.9% in the period in question. An analysis of those who survived at least five years from the date of diagnosis showed that the percentage of patients treated increased from 46.2% in 1992 to 94.0% in 1997, finishing at 91.7% in 2002. Multivariate analysis yielded a positive and statistically significant association between survival up to five years after an AIDS diagnosis and years of schooling, age group, year of diagnosis, type of antiretroviral therapy, and treatment adherence (all with P < 0.001). Conclusions. Continuous improvement of the antiretroviral therapy recommended by the Ministry of Health had a positive impact on survival. There was an association between case fatality and fewer years of schooling, membership in an older age group, a diagnosis obtained in 1992, the type of antiretroviral therapy, and suboptimal adherence to antiretroviral treatment regimens
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Adulto Joven , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Factores de Edad , Fármacos Anti-VIH/administración & dosificación , Terapia Antirretroviral Altamente Activa , Brasil/epidemiología , Evaluación de Medicamentos , Quimioterapia Combinada , Escolaridad , Cumplimiento de la Medicación , Estudios Retrospectivos , Conducta Sexual , Resultado del TratamientoRESUMEN
Human immunodeficiency virus (HIV) clades B and C account for more than 60 percent of the HIV-1 infections worldwide. In this paper, we describe the profiles of patients infected with subtypes of HIV-1 from the state of Paraná, Southern Brazil, and correlate them with demographic and epidemiological findings. A retrospective analysis of HIV cases reported from 1999-2007 was also performed. Data from 293 patients were reviewed and 245 were older than 13 (58 percent female). The distribution of clades was as follows: B 140 (57 percent), C 67 (23 percent), F 24 (10 percent) and mosaic or unique recombinant forms (URFs) 24 (10 percent). Of the 48 patients younger than 13 years of age (62.5 percent male), vertical transmission occurred in 46 and the distribution of clades was as follows: B 14 (29 percent), C 24 (50 percent), F 7 (15 percent) and URFs 6 (13 percent). There was no significant difference in mortality between HIV-1 subtypes. In both groups, patients infected with clade C tended to have higher rates of injection drug use exposure risk.