Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 31
Filtrar
1.
Eur J Clin Microbiol Infect Dis ; 40(9): 1863-1871, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33822285

RESUMO

To analyze the modifications of CD4 T cell, CD4/CD8 ratio, and serum levels of soluble CD14 (sCD14) in HIV/HCV-coinfected patients after treatment with direct anti-HCV antiviral agents. Consecutive cases of HIV/HCV-coinfected patients, attended at the University Hospital, who achieved sustained virological responses with interferon-free hepatitis C antiviral drugs, were analyzed. Thirty-five percent of patients (n = 39) had been diagnosed with liver cirrhosis. The evaluation criteria were changes in CD4 T-cell counts and percentages and inflammation (measured by serum sCD14 levels) or immune activation indexes (determined by CD4/CD8 ratio) from beginning anti-HCV therapy to 12 months later. One hundred twelve patients were included (87% male; median age, 54 years; median time from the infection diagnosis, 22 years; previous drug users, 87%). Significant increases in CD4 T cell count and percentage were detected only in individuals without liver cirrhosis. No significant differences in CD4/CD8 ratios or sCD14 levels were observed in patients with or without cirrhosis. The proportion of patients with less than 500 CD4 T cell/mm3 before therapy who achieved more than 500 CD4 T cell/mm3 after it increased only in the group without liver cirrhosis. The finding that CD4 T cell count and percentage were improved only in patients without liver cirrhosis supports the idea that treatment against HCV in HIV/HCV-coinfected patients is needed in the early phases of liver disease.


Assuntos
Antivirais/uso terapêutico , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , Coinfecção/imunologia , Coinfecção/virologia , Infecções por HIV/virologia , Hepacivirus/imunologia , Receptores de Lipopolissacarídeos/sangue , Cirrose Hepática/imunologia , Contagem de Linfócito CD4/estatística & dados numéricos , Coinfecção/tratamento farmacológico , Feminino , Hepacivirus/efeitos dos fármacos , Hepatite C/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Resposta Viral Sustentada
2.
Int J Med Sci ; 18(3): 846-851, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33437221

RESUMO

In the last 50 years we have experienced two big pandemics, the HIV pandemic and the pandemic caused by SARS-CoV-2. Both pandemics are caused by RNA viruses and have reached us from animals. These two viruses are different in the transmission mode and in the symptoms they generate. However, they have important similarities: the fear in the population, increase in proinflammatory cytokines that generate intestinal microbiota modifications or NETosis production by polymorphonuclear neutrophils, among others. They have been implicated in the clinical, prognostic and therapeutic attitudes.


Assuntos
COVID-19/epidemiologia , Infecções por HIV/epidemiologia , HIV-1/patogenicidade , Pandemias/história , SARS-CoV-2/patogenicidade , COVID-19/imunologia , COVID-19/psicologia , COVID-19/transmissão , Citocinas/sangue , Citocinas/imunologia , Armadilhas Extracelulares/imunologia , Armadilhas Extracelulares/metabolismo , Medo , Carga Global da Doença/estatística & dados numéricos , Infecções por HIV/imunologia , Infecções por HIV/psicologia , Infecções por HIV/transmissão , HIV-1/imunologia , HIV-1/isolamento & purificação , História do Século XX , História do Século XXI , Interações Hospedeiro-Patógeno/imunologia , Humanos , Mediadores da Inflamação/sangue , Mediadores da Inflamação/imunologia , Mortalidade , Neutrófilos/imunologia , Neutrófilos/metabolismo , Pandemias/estatística & dados numéricos , Prognóstico , SARS-CoV-2/imunologia , SARS-CoV-2/isolamento & purificação
3.
Eur J Clin Microbiol Infect Dis ; 39(8): 1503-1512, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32232689

RESUMO

Human immunodeficiency virus (HIV) antibodies have been proposed as a measure of the size of the HIV reservoir. The aim of our study is to quantify the anti-HIV antibodies level in a cohort of people living with HIV (PLWH), stratified based on the presence of continuous undetectable HIV viral load and the co-existence of hepatitis C virus infection. A sample of 229 HIV-monoinfected (n = 114) or HIV/HCV-coinfected [either with resolved HCV infection (n = 75) or active HCV coinfection (n = 40)] patients, followed up a median of 34 (IQR 20-44) months, was studied. Anti-HIV index was obtained as the 1:800 dilution of HIV antibodies. CD4+ T cell count, time with undetectable HIV viral load, annual increase of CD4+ T cell count, anti-HCV therapy, and diagnosis of cirrhosis were analyzed. Patients with a continued suppressed HIV viral load had significant lower anti-HIV index compared with those with virologic failure during the follow-up. Significant higher CD4+ T cell increase was observed in those with a lower anti-HIV index. HIV-monoinfected patients showed an anti-HIV index significantly lower than patients with HCV coinfection. Resolved HCV infection after interferon-based therapy, but not with direct acting antivirals, was associated with a lower anti-HIV index. HIV/HCV-coinfected patients showed higher HIV antibodies level when compared with HIV-monoinfected individuals. A decrease in anti-HIV index in HIV/HCV-coinfected patients was detected when a sustained virological HCV response was obtained after interferon-based therapy, in possible relation with the direct or indirect effect of interferon on PLWH CD4 T cells.


Assuntos
Anticorpos Anti-HIV/sangue , Infecções por HIV/virologia , Hepatite C Crônica/virologia , Adulto , Biomarcadores/sangue , Estudos de Coortes , Coinfecção , Feminino , Infecções por HIV/sangue , Infecções por HIV/complicações , HIV-1/imunologia , Hepatite C Crônica/sangue , Hepatite C Crônica/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Estudos Prospectivos , Carga Viral
4.
Ann Hematol ; 98(8): 1953-1959, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31025161

RESUMO

The change in the incidence of lymphomas in function of the presence or absence of sustained virological response after anti-hepatitis C therapy in a cohort of human immunodeficiency (HIV)-hepatitis C (HCV) viruses coinfected patients was analyzed. A prospective cohort of 755 HIV-HCV coinfected patients who received their first anti-HCV therapy, based on interferon + ribavirin schemas, was evaluated. Incidence and histologic types of lymphomas were analyzed in two periods: (1) before administration of anti-HCV therapy and (2) after anti-HCV therapy. The association between lymphoma incidence and demographic, HIV- (minimum CD4+ cell count and CD4+ cell count at diagnosis of lymphoma, antiretroviral therapy, maximal HIV load and HIV load at diagnosis of lymphoma) and HCV-related variables (HCV load, genotype, sustained viral response to anti-HCV therapy) were analyzed. A total of 13 lymphomas [incidence rate (95% confidence interval), 0.72 (0.33-1.11) × 1000 person-years, time from HIV diagnosis to lymphoma diagnosis (median, interquartile range), 15 (11-19) years] were diagnosed. Nine of them were non-Hodgkin and four Hodgkin lymphomas. The median CD4+ T cell count at diagnosis of lymphoma was 457/mm3, with only two cases with values lower than 200/mm3. The incidence rate of non-Hodgkin lymphomas was similar pre- and post-anti HCV therapy [0.33 (0.00-0.65) vs 0.68 (0.08-1.26) × 1000 person-years, respectively, p > 0.05]. Patients with sustained virologic HCV response showed similar incidence rate of lymphomas than that of those without anti-HCV response. In conclusion, anti-HCV therapy does not modify the incidence rate of lymphomas in HIV-HCV coinfected patients.


Assuntos
Antivirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Doença de Hodgkin/tratamento farmacológico , Interferon alfa-2/uso terapêutico , Linfoma não Hodgkin/tratamento farmacológico , Ribavirina/uso terapêutico , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/efeitos dos fármacos , Linfócitos T CD4-Positivos/patologia , Linfócitos T CD4-Positivos/virologia , Coinfecção , Combinação de Medicamentos , HIV/efeitos dos fármacos , HIV/crescimento & desenvolvimento , Infecções por HIV/complicações , Infecções por HIV/patologia , Infecções por HIV/virologia , Hepacivirus/efeitos dos fármacos , Hepacivirus/crescimento & desenvolvimento , Hepatite C Crônica/complicações , Hepatite C Crônica/patologia , Hepatite C Crônica/virologia , Doença de Hodgkin/complicações , Doença de Hodgkin/patologia , Doença de Hodgkin/virologia , Humanos , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/virologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Carga Viral/efeitos dos fármacos
5.
Med Clin (Barc) ; 161(2): 65-77, 2023 07 21.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-37105842

RESUMO

The objective of the systematic review is to analyze the efficacy of direct-acting oral anticoagulants (DOAC) in the prophylaxis of thrombosis in antiphospholipid syndrome (APS). We searched for clinical trials, cohort studies and meta-analyses published from January 1, 2012 to September 30, 2022. Articles that analyzed the efficacy of DOAC in the prevention of thrombosis recurrence, with or without comparison with antivitamin K (VKA) drugs, were selected. DOACs, specifically rivaroxaban and apixaban, were significantly less effective than VKAs in preventing recurrence of thrombosis in patients with APS and prior arterial thrombosis or the concomitant presence of two or three different antiphospholipid antibodies. The proportion of patients with severe bleeding as side effect are similar in those treated with DOAC and with VKA. The results argue against the use of DOAC in the treatment of patients with thrombotic APS.


Assuntos
Síndrome Antifosfolipídica , Trombose , Humanos , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Anticoagulantes/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Varfarina/uso terapêutico , Trombose/prevenção & controle , Trombose/complicações , Administração Oral
6.
Front Microbiol ; 14: 1136718, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36937285

RESUMO

Objective: To evaluate the serum expression of microRNAs (miRNAs) with ability to modulate the human immunodeficiency (HIV) replication or inflammatory status in people living with HIV (PLWH). Methods: Forty healthy controls and two groups of PLWH were evaluated: (a) Group 1 (n = 30), patients with detectable viral load at inclusion, analyzed before receiving antiretroviral therapy (ART) and 12 months after initiating it; (b) Group 2 (n = 55), PLWH with prolonged undetectable viral load. Intestinal barrier disruption (I-FABP) and bacterial translocation (16S rDNA) markers, inflammatory markers such as interleukin (IL)-6 and sCD163, immune activation and expression of specific miRNAs were evaluated. Results: Serum concentrations of I-FABP, 16S rDNA, IL-6, sCD163 and activated T lymphocytes were increased in PLWH. Serum miR-34a was overexpressed at inclusion and remained elevated after ART. The expression of the remaining miRNAs that modulate HIV infectivity (miR-7, mir-29a, miR-150, and miR-223) was similar in PLWH and controls. Related to miRNAs implicated in inflammation (miR-21, miR-155, and miR-210), significant overexpression were observed in miR-21 and miR-210 levels in untreated PLWH, but levels were restored in those patients treated for a long period. Conclusion: A sustained overexpression of miR-34a was detected even after prolonged HIV controlled replication. miR-21 and miR-210 can be considered new markers of inflammation with high sensitivity to its modifications.

7.
Enferm Infecc Microbiol Clin ; 30(9): 542-8, 2012 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-22365617

RESUMO

OBJECTIVE: The objective of this study was the analysis of the prevalence and type of primary resistance to antiretroviral drugs in patients diagnosed with HIV infection, and to determine the most appropriate empirical treatment to obtain a virological and immunological response. PATIENTS AND METHODS: An observational analysis of patients with a de novo diagnosis of HIV infection during the period 2008-2010. Clinical, immunological and virological characteristics, including genotype analysis of resistance to antiretrovirals, were considered as independent variables. The dependent variable was an undetectable HIV viral load after six months of treatment. Data are provided as median (interquartile range) and absolute number (percentage). RESULTS: Seventy-three patients with a de novo diagnosis of HIV infection were included [53 males (73%); 36 (30-46) years-old; prior use of intravenous drugs: 5 patients (7%); hepatitis C virus co-infection: 13 individuals (18%)]. Ten patients (14%) showed symptoms attributable to acute HIV infection. A CD4+ T cell count lower than 350 mm(3) was detected in a 37% (n=27) of all patients. The initiation of antiretroviral therapy followed the GESIDA recommendations (no therapy: 20 patients; tenofovir+emtricitabine+efavirenz: 28 patients; abacavir+lamivudine+efavirenz: 1 patient; tenofovir+emtricitabine+protease inhibitors: 5 patients; abacavir+lamivudine+protease inhibitors: 1 patient; 18 patients were lost in the follow-up). After starting antiretroviral therapy, the resistance analyses detected the existence of primary resistance to antiretrovirals in 12.7% (confidence interval 95%: 3-22) of the patients, distributed as follows: isolated resistance to, nucleosides was detected in 2% (M184V), to nevirapine/efavirenz in 9% (K103N), and combined resistance to nucleosides and non-nucleosides in 2%; there were no cases of resistance to protease inhibitors. Consequently, antiretroviral therapy was changed in 5 (14%) out of 35 patients, attaining an undetectable HIV viral load at 6 months in all of them. The primary resistance to antiretrovirals was not related with epidemiological, virological (including infection by non B subtype) or immunological variables. CONCLUSIONS: In the present study, a change in the epidemiological pattern of de novo diagnosis of HIV infection in our area has been observed. The existence of resistance mutations in more than 5% of the new cases is noteworthy. This finding must be considered in order to establish the rules of empirical treatment in our area.


Assuntos
Antirretrovirais/farmacologia , Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , HIV/efeitos dos fármacos , Adulto , Combinação de Medicamentos , Farmacorresistência Viral , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
Biomedicines ; 10(10)2022 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-36289900

RESUMO

Peripheral blood polymorphonuclear neutrophils (PMNs) forming extracellular traps (NETs), as well as endothelial- and platelet-derived parameters, have been analyzed in patients with SARS-CoV-2 pneumonia, and their prognostic role has been evaluated. Eighty-seven consecutive patients hospitalized with SARS-CoV-2 pneumonia were prospectively selected. A sample of 30 healthy individuals served as the control group. Clinical and oxygenation (oxygen saturation to fraction of inspired oxygen ratio-SpO2/FiO2) characteristics and PMNs forming NETs, serum levels of myeloperoxidase, E-selectin, vascular cell adhesion molecule 1-VCAM1-vascular endothelial growth factor, P-selectin, platelet factor 4 and plasma concentrations of D-dimer were evaluated at hospital admission, at discharge and 14 days after discharge. Intensive care unit admission or death was the primary composite endpoint. Patients showed a higher number of PMNs forming NETs than healthy controls. The absolute number of PMNs forming NETs was inversely correlated with oxygen status (SpO2/FiO2) and positively with inflammatory (C-reactive protein, ferritin) markers and VCAM1. A decrease in, but not a normalization of NETs and endothelial-derived parameters was observed in patients who survived. In conclusion, the formation of NETs runs parallel to that of other inflammatory and endothelial activation markers, and is inverse to the oxygenation parameters, supporting a pathogenic role for PMNs in this entity.

9.
World J Hepatol ; 14(1): 62-79, 2022 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-35126840

RESUMO

Loss of follow-up or reinfections hinder the expectations of hepatitis C eradication despite the existence of highly effective treatments. Moreover, the elimination of the infection does not imply the reversion of those chronic alterations derived from the previous infection by hepatitis C virus (HCV). This review analyzes the risk factors associated with loss to follow-up in diagnosis or treatment, and the possibility of reinfection. Likewise, it assesses the residual alterations induced by chronic HCV infection considering the liver alterations (inflammation, fibrosis, risk of decompensation, hepatocellular carcinoma, liver transplantation) and, on the other hand, the comorbidities and extrahepatic manifestations (cryoglobulinemia, non-Hodgkin lymphoma, peripheral insulin resistance, and lipid, bone and cognitive alterations). Peculiarities present in subjects coinfected with human immunodeficiency virus are analyzed in each section.

10.
Sci Rep ; 11(1): 9824, 2021 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-33972651

RESUMO

The objective of this work was to identify predictive factors of fibrosis regression after direct antiviral agents (DAAs) in HCV-monoinfected and HIV/HCV-coinfected patients. This was a prospective study of HCV-monoinfected (n = 20), HIV/HCV-co-infected (n = 66) patients and healthy controls (n = 15). Patients had started DAAs and achieved sustained virological response. Liver stiffness (LS) and serum concentrations of profibrotic transforming growth factor (TGF)-ß1 and CXC chemokine ligand 4 (CXCL4) and antifibrotic HGF hepatocyte growth factor (HGF) were analyzed at baseline (M0) and 12 months after starting DAAs (M12). A M12 LS achievement of ≤ 9.5 kPa was considered the cutoff point to discharge from a liver clinic. The LS decrease from M0 to M12 was 34%. No significant differences were observed in LS decline between HCV- and HIV/HCV-infected individuals. Changes of serum CXCL4, TGF-ß1 and HGF levels did not correlate with LS improvement. 16 out from 56 patients (28%) with a baseline LS > 9.5 achieved a M12 LS ≤ 9.5. HCV-monoinfected and HIV/HCV coinfected patients experienced a significant reduction of LS after sustained virological response. This improvement did not correlate with changes in serum profibrotic or antifibrotic markers. A 29% of those with a baseline LS > 9.5 achieved a LS under this cutoff point.


Assuntos
Antivirais/administração & dosagem , Coinfecção/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Hepatite C Crônica/tratamento farmacológico , Cirrose Hepática/diagnóstico , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Coinfecção/sangue , Coinfecção/patologia , Coinfecção/virologia , Técnicas de Imagem por Elasticidade , Feminino , Seguimentos , Infecções por HIV/patologia , Infecções por HIV/virologia , Voluntários Saudáveis , Hepatite C Crônica/patologia , Hepatite C Crônica/virologia , Fator de Crescimento de Hepatócito/sangue , Humanos , Fígado/diagnóstico por imagem , Fígado/efeitos dos fármacos , Fígado/patologia , Cirrose Hepática/sangue , Cirrose Hepática/tratamento farmacológico , Cirrose Hepática/virologia , Masculino , Pessoa de Meia-Idade , Fator Plaquetário 4/sangue , Estudos Prospectivos , Valores de Referência , Resposta Viral Sustentada , Fator de Crescimento Transformador beta1/sangue
11.
Front Immunol ; 12: 670966, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34975826

RESUMO

Objective: Evaluate the expression of B and T cell immunomodulatory molecules in polymorphonuclear neutrophils (PMN) in HIV-infected patients. Methods: HIV load, bacterial translocation and neutrophils' expression of T [programmed death ligand, interleukin-10+, arginase 1+] and B [BAFF, APRIL] molecules were analyzed in different cohorts and time points: a control group of 25 healthy individuals and two groups of HIV-infected patients. Group 1 of patients included 35 untreated patients, studied at baseline and after antiretroviral therapy (ART). Group 2 was composed of 25 patients with undetectable viral load after a median of 101 months of ART prior to inclusion in the study. Results: Compared with the control group, group 1 patients showed increased bacterial translocation and their PMN had a significantly higher expression of T and B-cell immunomodulatory molecules, both at baseline and after 12 months of ART. Group 2 patients showed reduced bacterial translocation levels when compared with group 1 patients after 12 months of treatment. PMN expression of B-cell modulators was similar between group 2 patients and healthy controls, although the expression of T-cell modulators remained increased. Conclusion: In HIV-infected patients, the expression of B-cell stimulatory and T-cell suppressive molecules by neutrophils was increased at baseline and after a limited time of therapy. After a prolonged period of ART, only PMNs expression of T-cell immunosuppressive molecules remained elevated.


Assuntos
Arginase/biossíntese , Fator Ativador de Células B/biossíntese , Antígeno B7-H1/biossíntese , Infecções por HIV/imunologia , HIV-1 , Interleucina-10/biossíntese , Neutrófilos/metabolismo , Membro 13 da Superfamília de Ligantes de Fatores de Necrose Tumoral/biossíntese , Adulto , Fármacos Anti-HIV/uso terapêutico , Linfócitos B/imunologia , Translocação Bacteriana , Feminino , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Infecções por HIV/microbiologia , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Linfócitos T/imunologia , Carga Viral
12.
Enferm Infecc Microbiol Clin ; 28(5): 294-6, 2010 May.
Artigo em Espanhol | MEDLINE | ID: mdl-19716207

RESUMO

OBJECTIVE: To analyze differences in neuropsychological test results of former intravenous drug abusers, who were divided into 2 groups based on the presence or absence of HIV-1 infection. METHODS: Higher-level cognitive functions were assessed with neuropsychological tests in 40 former drug abusers (20 with and 20 without HIV-1 infection). RESULTS: As compared to individuals without infection, patients with HIV-1 infection showed significantly poorer performance in areas related to attention, learning, working memory, verbal fluency, information processing, problem solving, and flexibility. CONCLUSION: Independently of the effect of drug addiction, HIV infection was associated with cognitive alterations in all the areas examined.


Assuntos
Infecções por HIV/fisiopatologia , Infecções por HIV/psicologia , Adulto , Feminino , Infecções por HIV/etiologia , Humanos , Masculino , Testes Neuropsicológicos , Isolamento Social , Abuso de Substâncias por Via Intravenosa/complicações
13.
J Neuroimmune Pharmacol ; 14(3): 413-422, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30649665

RESUMO

Analysis of gut barrier status, monocyte and lymphocyte activation and T regulatory (Treg) cells at diagnosis before and after therapy, in patients with multiple sclerosis (MS). Analysis of differential effects of interferon beta (IFN-ß), glatiramer acetate (GA) and natalizumab. Thirty-five patients with untreated MS were included. Gut barrier status (serum concentrations of intestinal fatty acid binding protein), monocyte (serum levels of soluble CD14, soluble CD163 and interleukin 6) and T lymphocyte activation (CD4 + DR+ and CD8 + DR+) and Treg (CD4 + CD25highFoxP3+) cells were analyzed. Patients with clinical isolated syndrome and relapsing-remitting forms were treated with IFN-ß or GA, and immune characteristics were reevaluated following up after 6 months. A sample of 56 stable RR MS patients, in treatment with IFN-ß, GA or natalizumab, and 50 healthy individuals were included as controls. Gut barrier status was similar in MS patients and healthy controls. Untreated patients with relapsing-remitting and primary progressive patterns of MS showed increased serum levels of soluble CD14. At baseline, significant increases in activated T lymphocytes and Treg were detected in patients. A significant decrease of CD4 + DR+, CD8 + DR+, and Treg percentages after 6 months of therapy was observed. In previously treated patients, IFN-ß, GA, or natalizumab therapies were associated with a comparable cell proportion of activated lymphocytes and Treg. MS patients have a baseline state characterized by monocyte and lymphocyte activation, not related with gut barrier lesion. An increase in Treg number, correlated with activated T CD8+ lymphocytes, was detected. Treatment with IFN-ß, GA or natalizumab was associated with a comparable decrease in activated lymphocytes and Treg. Graphical Abstract ᅟ.


Assuntos
Acetato de Glatiramer/farmacologia , Interferon beta/farmacologia , Ativação Linfocitária/efeitos dos fármacos , Monócitos/efeitos dos fármacos , Esclerose Múltipla Crônica Progressiva/tratamento farmacológico , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Natalizumab/farmacologia , Subpopulações de Linfócitos T/efeitos dos fármacos , Adulto , Estudos de Casos e Controles , Proteínas de Ligação a Ácido Graxo/sangue , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Acetato de Glatiramer/uso terapêutico , Humanos , Interferon beta/uso terapêutico , Masculino , Pessoa de Meia-Idade , Monócitos/imunologia , Monócitos/metabolismo , Esclerose Múltipla/tratamento farmacológico , Esclerose Múltipla Crônica Progressiva/imunologia , Esclerose Múltipla Recidivante-Remitente/imunologia , NF-kappa B/metabolismo , Natalizumab/uso terapêutico , Proteínas do Tecido Nervoso/biossíntese , Proteínas do Tecido Nervoso/genética , Estudos Prospectivos , Transdução de Sinais/efeitos dos fármacos , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/metabolismo
14.
Oncotarget ; 9(27): 18908-18915, 2018 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-29721171

RESUMO

The differential prognostic accuracy of the Palliative Prognostic Index (PPI) in hospitalized oncologic patients treated by a palliative care team according to the presence or absence of acute concomitant diseases was analyzed. All patients (n = 322) hospitalized in a palliative unit of a university hospital were included in a 2-year prospective study. PPI was determined at the time of hospital admission and discharge. Patients were grouped into two categories according to the causes of hospitalization (presence and absence of acute concomitant diseases). Metastases, PPI punctuation, refractory symptoms, and the presence of acute concomitant diseases were analyzed as survival-related factors. The absence of acute concomitant diseases and a PPI calculated at admission >4 or >6 were related with survival at 3 and 6 weeks, respectively. After hospital discharge, the accuracy of PPI was lower, decreasing the positive predictive value from 84% (PPI calculated at the time of hospital admission) to 67% (PPI calculated at the time of discharge) for survival <6 weeks. In conclusion, the impact of acute concomitant diseases on survival should be considered in prediction models for patients receiving palliative care.

15.
Infect Drug Resist ; 11: 861-872, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29922077

RESUMO

OBJECTIVES: The objectives of this study were to detect those characteristics that were specifically associated with infection or colonization by Acinetobacter baumannii, describe the clinical manifestations of those patients in whom the infection was detected in intensive care unit (ICU) or non-ICU wards, and analyze the prognosis-associated factors in patients from whom A. baumannii was isolated. PATIENTS AND METHODS: A sample of 122 patients from whom A. baumannii was recovered during an endemic period in a teaching hospital was included. Only those cases in which A. baumannii was recovered as the unique microbe were considered. Demographic data; ward of admission; intrinsic and extrinsic risk factors for infection or colonization; chronic underlying condition severity, as evaluated by the McCabe classification or Charlson index and Acute Physiology and Chronic Health Evaluation (APACHE) II score; and clinical manifestations were analyzed to differentiate specific characteristics of colonized or infected patients. Factors independently associated with the mortality at 30 days were also analyzed by Cox regression. RESULTS: A total of 73 (60%) patients were colonized and 49 (40%) individuals were infected with A. baumannii. A non-fatal McCabe class (when compared to ultimately and rapidly fatal), days of hospitalization prior to isolation of A. baumannii, and present ICU admission were associated with the diagnosis of infection. The more frequent clinical picture was respiratory infection (tracheobronchitis, 16 [33%] cases; pneumonia, 27 [55%] cases). Mortality at 30 days was 24% (n=29). A non-fatal McCabe class (Exp[B] 2.44, 95% confidence interval [CI] 1.05-5.66, p=0.039) and the absence of infection (Exp[B] 2.75, 95% CI 1.18-6.38, p=0.019) were independently associated with survival. CONCLUSION: Parameters associated with infection by A. baumannii in an endemic situation are the admission at ICU and the number of days of hospitalization. Mortality of patients from whom A. baumannii was isolated was independently influenced by the chronic underlying basal state and the presence of infection by A. baumannii.

16.
J Infect ; 77(6): 503-508, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30171877

RESUMO

INTRODUCTION: The objective of this study was to evaluate the impact of an intervention based on unsolicited consultations by an infectious diseases specialist (IDS) on the adequacy of antimicrobial treatment and mortality in patients with BSI. METHODS: A prospective cohort study was performed in a 410-bed hospital. An intervention based on unsolicited consultation by an IDS for patients with BSI was performed only on days when an IDS was available. Outcomes were the percentage of days on optimal antimicrobial treatment (PDOAT) and mortality. Analyses were performed by linear regression and multivariate logistic regression. RESULTS: Of 400 episodes of BSI included, 292 received the intervention. The median (interquartile range) PDOAT among those with and without the intervention was 93 (6-100) and 0 (0-53), respectively. The intervention was independently associated with a higher PDOAT (r = 0.5; p < 0.001) but not with mortality. The IDS recommendations were followed in full in 183 episodes, and not in 109. Mortality was 10.4% and 27.6%, respectively. Adherence to recommendations was associated with lower mortality (adjusted OR = 0.3; 95% CI: 0.1-0.5). CONCLUSIONS: An intervention based on unsolicited IDS consultation for BSI episodes was associated with improved use of antibiotics and, when the recommendations were fully followed, with lower mortality.


Assuntos
Bacteriemia/tratamento farmacológico , Doenças Transmissíveis/tratamento farmacológico , Medicina , Encaminhamento e Consulta , Idoso , Bacteriemia/mortalidade , Intervenção Médica Precoce/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos , Estudos Prospectivos , Espanha
17.
PLoS One ; 12(4): e0175254, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28380034

RESUMO

BACKGROUND: The objective of this study was to explore the diagnostic and prognostic value of soluble triggering receptor expressed on myeloid cell 1 (sTREM-1), soluble cluster of differentiation 14 (sCD14), soluble cluster of differentiation 163 (sCD163), interleukin-6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) serum levels for patients with severe sepsis and septic shock in an intensive care unit (ICU). METHODS: Fifty patients admitted at the ICU with the diagnosis of severe sepsis or septic shock were studied. SOFA and APACHE II scores as well as serum biomarkers were measured at days 0, 2 and 5. The influence of these variables on 28-day mortality was analyzed. Twenty healthy individuals served as controls. RESULTS: Baseline serum concentrations of sTREM-1, sCD163, IL-6 and PCT correlated with SOFA score. Only sTREM-1 levels correlated with APACHE II score. The 28-day mortality rate for all patients was 42%. The absence of risk factors for infection, presence of septic shock, baseline values of sCD14 and decrease of PCT and IL-6 from baseline to day 5 were variables associated to mortality in the univariate analysis. The unique independent factor associated to mortality in the multivariate analysis was a decrease of PCT higher than 50% from days 0 to 5. CONCLUSIONS: Serum levels of sTREM-1 are correlated with the severity of sepsis. A 50% decrease of PCT was the unique variable associated with survival in the multivariate analysis.


Assuntos
Antígenos CD/sangue , Antígenos de Diferenciação Mielomonocítica/sangue , Proteína C-Reativa/análise , Calcitonina/sangue , Interleucina-6/sangue , Receptores de Lipopolissacarídeos/sangue , Glicoproteínas de Membrana/sangue , Receptores de Superfície Celular/sangue , Receptores Imunológicos/sangue , Sepse/diagnóstico , Choque Séptico/diagnóstico , APACHE , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Sepse/sangue , Sepse/mortalidade , Choque Séptico/sangue , Choque Séptico/mortalidade , Receptor Gatilho 1 Expresso em Células Mieloides
18.
World J Gastroenterol ; 22(4): 1433-48, 2016 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-26819512

RESUMO

Even in cases where viral replication has been controlled by antiretroviral therapy for long periods of time, human immunodeficiency virus (HIV)-infected patients have several non-acquired immunodeficiency syndrome (AIDS) related co-morbidities, including liver disease, cardiovascular disease and neurocognitive decline, which have a clear impact on survival. It has been considered that persistent innate and acquired immune activation contributes to the pathogenesis of these non-AIDS related diseases. Immune activation has been related with several conditions, remarkably with the bacterial translocation related with the intestinal barrier damage by the HIV or by hepatitis C virus (HCV)-related liver cirrhosis. Consequently, increased morbidity and mortality must be expected in HIV-HCV coinfected patients. Disrupted gut barrier lead to an increased passage of microbial products and to an activation of the mucosal immune system and secretion of inflammatory mediators, which in turn might increase barrier dysfunction. In the present review, the intestinal barrier structure, measures of intestinal barrier dysfunction and the modifications of them in HIV monoinfection and in HIV-HCV coinfection will be considered. Both pathogenesis and the consequences for the progression of liver disease secondary to gut microbial fragment leakage and immune activation will be assessed.


Assuntos
Imunidade Adaptativa , Coinfecção , Infecções por HIV/imunologia , HIV/imunologia , Hepacivirus/imunologia , Hepatite C/imunologia , Imunidade Inata , Imunidade nas Mucosas , Mucosa Intestinal/imunologia , Animais , Translocação Bacteriana , Microbioma Gastrointestinal , Infecções por HIV/diagnóstico , Infecções por HIV/microbiologia , Infecções por HIV/virologia , Hepatite C/diagnóstico , Hepatite C/microbiologia , Hepatite C/virologia , Interações Hospedeiro-Patógeno , Humanos , Mucosa Intestinal/microbiologia , Mucosa Intestinal/virologia , Permeabilidade , Prognóstico
19.
PLoS One ; 10(3): e0119568, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25775475

RESUMO

OBJECTIVES: We have analyzed the parameters (bacterial translocation, immune activation and regulation, presence of HCV coinfection) which could be implicated in an inappropriate immune response from individuals with chronic HIV infection. The influence of them on the evolution of CD4+ T cell count has been investigated. PATIENTS AND METHODS: Seventy HIV-infected patients [monoinfected by HIV (n = 20), HCV-coinfected (with (n = 25) and without (n = 25) liver cirrhosis)] and 25 healthy controls were included. Median duration of HIV infection was 20 years. HIV- and HCV-related parameters, as well as markers relative to bacterial translocation, monocyte and lymphocyte activation and regulation were considered as independent variables. Dependent variables were the increase of CD4+ T cell count during the follow-up (12 months). RESULTS: Increased values of bacterial translocation, measured by lipopolysaccharide-binding protein, monocyte and lymphocyte activation markers and T regulatory lymphocytes were detected in HIV-monoinfected and HIV/HCV coinfected patients. Serum sCD14 and IL-6 were increased in HIV/HCV-coinfected patients with liver cirrhosis in comparison with those with chronic hepatitis or HIV-monoinfected individuals. Time with undetectable HIV load was not related with these parameters. The presence of cirrhosis was negatively associated with a CD4+ T cell count increase. CONCLUSION: In patients with a chronic HIV infection, a persistent increase of lipopolysaccharide-binding protein and monocyte and lymphocyte modifications are present. HCV-related cirrhosis is associated with more elevated serum concentrations of monocyte-derived markers. Cirrhosis influences the continued immune reconstitution of these patients.


Assuntos
Coinfecção/imunologia , Infecções por HIV/imunologia , Hepatite C/imunologia , Cirrose Hepática/imunologia , Adulto , Translocação Bacteriana , Contagem de Linfócito CD4 , Coinfecção/virologia , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/microbiologia , Hepatite C/complicações , Humanos , Imunidade Ativa , Cirrose Hepática/virologia , Ativação Linfocitária , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
20.
PLoS One ; 9(7): e101760, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25013899

RESUMO

OBJECTIVE: To establish the role of liver fibrosis as a predictive tool of response to pegylated interferon alpha (Peg-IFN) and ribavirin (RBV) treatment in human immunodeficiency (HIV)/hepatitis C virus (HCV) coinfected patients, in addition to recognized predictive factors (HCV load, HCV genotype, IL-28B polymorphism). PATIENTS AND METHODS: A sample of 267 HIV/HCV coinfected patients was treated with Peg-IFN and RBV. Predictive factors of rapid (RVR) and sustained (SVR) virological response were analyzed. Independent variables were age, sex, IL28B, -238 TNF-α and -592 IL-10 polymorphisms, HCV genotype, HCV-RNA levels, significant fibrosis or cirrhosis and CD4+ T cell count. RESULTS: Patients infected by HCV genotype 1 (n = 187) showed RVR and SVR in 12% and 39% of cases, respectively. The parameters associated with RVR were IL28B genotype CC and plasma HCV-RNA levels <600,000 IU/ml. Advanced liver fibrosis was negatively associated with SVR in patients without RVR. A SVR was obtained in 42% of subjects with HCV genotype 4, and the independent factors associated with SVR were IL28B genotype CC and an HCV-RNA <600,000 IU/ml. A SVR was obtained in 66% of patients with HCV genotypes 2/3; in this case, the independent parameter associated with SVR was the absence of significant liver fibrosis. TNF-α and IL-10 polymorphisms were not associated with SVR, although a significantly higher percentage of -238 TNF-α genotype GG was detected in patients with significant liver fibrosis. CONCLUSIONS: In HIV/HCV coinfected patients with HCV genotypes 1 or 4, RVR, mainly influenced by genotype IL28B and HCV-RNA levels, reliably predicted SVR after 4 weeks of therapy with Peg-IFN plus RBV. In patients infected by HCV genotype 3, an elevated relapse rate compromised the influence of RVR on SVR. Relapses were related to the presence of advanced liver fibrosis. Liver cirrhosis was associated with a -238 TNF-α polymorphism in these patients.


Assuntos
Coinfecção/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Hepacivirus/patogenicidade , Hepatite C Crônica/tratamento farmacológico , Cirrose Hepática/tratamento farmacológico , Adulto , Idoso , Linfócitos T CD4-Positivos/metabolismo , Coinfecção/genética , Feminino , Genótipo , Infecções por HIV/genética , Hepatite C Crônica/genética , Humanos , Interferon-alfa/uso terapêutico , Cirrose Hepática/genética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Ribavirina/uso terapêutico , Fator de Necrose Tumoral alfa/genética , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
Detalhe da pesquisa