RESUMO
Rhodococcus equi infection is increasing in regions with high HIV prevalence worldwide. The microbiological features and clinical mimicry of tuberculosis infection pose diagnostic challenges in high-tuberculosis-incidence settings. We present two HIV-associated cases of R. equi infection from Vietnam and discuss the unique diagnostic challenges in such settings.
Assuntos
Infecções por Actinomycetales/diagnóstico , Rhodococcus equi , Tuberculose Pulmonar/diagnóstico , Infecções por Actinomycetales/complicações , Infecções por Actinomycetales/epidemiologia , Infecções por Actinomycetales/microbiologia , Adulto , Antibacterianos/uso terapêutico , Fármacos Anti-HIV/uso terapêutico , Ácido Ascórbico , Colecalciferol , Desidroepiandrosterona/análogos & derivados , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Ácidos Nicotínicos , Extratos Vegetais , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/epidemiologia , Vietnã/epidemiologiaRESUMO
BACKGROUND: The use of tenofovir has been rapidly increasing in Vietnam. Several studies identified low body weight as a risk factor for tenofovir-induced nephrotoxicity. However, little is known about the impact of tenofovir on renal function in HIV-infected Vietnamese with generally low weight. METHODS: An observational single-center cohort of adult HIV-infected patients on antiretroviral therapy at National Hospital of Tropical Diseases, Hanoi. Patients on tenofovir or with creatinine clearance ≤60 ml/min at baseline were excluded. The incidence of renal dysfunction was compared between patients who switched to tenofovir and those who did not. Renal dysfunction was defined as 25% decline of creatinine clearance from baseline. Time to renal dysfunction was analyzed by the Kaplan-Meier method between the two groups. The Cox hazard model was used to determine risk factors for renal dysfunction in uni- and multivariate analyses. RESULTS: Of 556 patients enrolled in this study, 403 were non-tenofovir group while 153 were the tenofovir-switched group. Renal dysfunction occurred at a higher rate in the tenofovir-switched group (92.5 per 1000 person-years) than the non-tenofovir group (47.8 per 1000 person-years)(p = 0.023, Log-rank test). Multivariate analysis confirmed that tenofovir use, low body weight and glucosuria were significant risk factors for renal dysfunction (hazard ratio = 1.980; 95% confidential interval, 1.094-3.582, HR = 1.057; 95%CI, 1.016-1.098, HR = 5.202; 95%CI, 1.245-21.738, respectively). CONCLUSIONS: Tenofovir use, low body weight and glucosuria were significant risk factors for renal dysfunction. We suggest close monitoring of renal function in patients with these risk factors even in resource-limited setting.
Assuntos
Infecções por HIV/tratamento farmacológico , Infecções por HIV/fisiopatologia , Nefropatias/fisiopatologia , Nefropatias/virologia , Magreza/fisiopatologia , Adulto , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Estudos Prospectivos , Fatores de Risco , Magreza/virologia , VietnãRESUMO
BACKGROUND: The role of adaptive immunity in severe influenza is poorly understood. The occurrence of influenza A/H5N1 in a patient with HIV provided a rare opportunity to investigate this. CASE PRESENTATION: A 30-year-old male was admitted on day 4 of influenza-like-illness with tachycardia, tachypnea, hypoxemia and bilateral pulmonary infiltrates. Influenza A/H5N1 and HIV tests were positive and the patient was treated with Oseltamivir and broad-spectrum antibiotics. Initially his condition improved coinciding with virus clearance by day 6. He clinically deteriorated as of day 10 with fever recrudescence and increasing neutrophil counts and died on day 16. His admission CD4 count was 100/microl and decreased until virus was cleared. CD8 T cells shifted to a CD27+CD28- phenotype. Plasma chemokine and cytokine levels were similar to those found previously in fatal H5N1. CONCLUSIONS: The course of H5N1 infection was not notably different from other cases. Virus was cleared despite profound CD4 T cell depletion and aberrant CD8 T cell activation but this may have increased susceptibility to a fatal secondary infection.
Assuntos
Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Virus da Influenza A Subtipo H5N1/isolamento & purificação , Influenza Humana/complicações , Influenza Humana/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Antígenos CD28/análise , Contagem de Linfócito CD4 , Linfócitos T CD8-Positivos/química , Citocinas/sangue , Evolução Fatal , Anticorpos Anti-HIV/sangue , Infecções por HIV/patologia , Humanos , Influenza Humana/patologia , Influenza Humana/virologia , Masculino , Oseltamivir/uso terapêutico , Membro 7 da Superfamília de Receptores de Fatores de Necrose Tumoral/análiseRESUMO
OBJECTIVE: The 2010 WHO antiretroviral therapy (ART) guidelines have resulted in increased tenofovir use. Little is known about tenofovir-induced chronic kidney disease (CKD) in HIV-infected Vietnamese with mean body weight of 55 kg. We evaluated the prevalence and risk factors of CKD in this country. DESIGN: Cross-sectional study was performed. METHODS: Clinical data on HIV-infected Vietnamese cohort were collected twice a year. To evaluate the prevalence of CKD, serum creatinine was measured in 771 patients in October 2011 and April 2012. CKD was defined as creatinine clearance less than 60 ml/min at both time points. Multivariate logistic regression was used to determine the factors associated with CKD. RESULTS: Tenofovir use increased in Vietnam from 11.9% in April 2011 to 40.3% in April 2012. CKD was diagnosed in 7.3%, of which 7% was considered moderate and 0.3% was severe. Multivariate analysis of October-2011 data identified age per year-increase (OR: 1.229, 95%CI, 1.170-1.291), body weight per 1 kg-decrement (1.286, 1.193-1.386), and tenofovir use (2.715, 1.028-7.168) as risk factors for CKD. CONCLUSIONS: Older age, low body weight and tenofovir use were independent risk factors for CKD in Vietnam. Further longitudinal study is required to evaluate the impact of TDF on renal function in Vietnam and other countries with small-body weight patients.