Assuntos
Terapia Antirretroviral de Alta Atividade , Surtos de Doenças/prevenção & controle , Infecções por HIV/tratamento farmacológico , HIV-1/efeitos dos fármacos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Contagem de Linfócito CD4 , Guiana Francesa/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Risco , Fatores Socioeconômicos , Carga ViralRESUMO
Risk factors for death in an HIV-infected cohort in French Guiana were studied in 1374 patients between 1996 and 2005. Of these patients, 48.5% were male and 76% were immigrants. Covariates were measured at the time of consultation. There were 223 deaths. Addictions [adjusted hazard ratio (HR)=13; 95% confidence interval (CI) 5.5-30.6; P<0.001], age>60 years (HR=1.5; 95% CI 0.9-2.5; P=0.13), male gender (HR=1.5; 95% CI 1.03-2.5; P=0.03) and CD4 count<50 cells/microL (HR=9.1; 95% CI 5.1-16.3; P<0.001) were independently associated with death. These results suggest that strategies promoting early diagnosis and better follow-up of addicted patients would have a significant impact on mortality.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Infecções por HIV/mortalidade , HIV , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Distribuição por Idade , Causas de Morte , Transmissão de Doença Infecciosa , Feminino , Seguimentos , Guiana Francesa/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Distribuição por Sexo , MigrantesRESUMO
Immune reconstitution syndrome (IRIS) is an unusual inflammatory reaction to an opportunistic infection in an HIV-positive patient. This syndrome occurs when immunity is restored in the first months of an effective highly active antiretroviral treatment (HAART). First, we described all patients with a cutaneous form of IRIS. Then, between 1992 and 2004 we conducted a retrospective cohort study comparing Herpes Zoster and Herpes Simplex infections among untreated patients, patients treated by HAART for < or = six months, and patients treated for > six months. We observed three cases of atypical leprosy and three original observations: two of these were fistulisation of lymph node histoplasmosis and tuberculosis, the third one reports the recurrence of a treated cutaneous leishmaniasis. Multivariate analysis showed that, after controlling for age, sex and CD4 counts, patients receiving HAART for < or = six months were more likely to develop Herpes Zoster or herpes simplex infections (p < 0.005). Herpes Simplex and Herpes Zoster infections are the two most frequent dermatological manifestations in our tropical setting. Although mycobacterial infections are more rarely observed than in visceral IRIS, the increased incidence of leprosy may be quite significant when the availability of HAART spreads to developing countries.
Assuntos
Terapia Antirretroviral de Alta Atividade , Dermatite/etiologia , Infecções por HIV/tratamento farmacológico , Hanseníase/complicações , Dermatopatias Infecciosas/etiologia , Abscesso/etiologia , Adulto , Estudos de Coortes , Fístula Cutânea/etiologia , Dermatite/imunologia , Suscetibilidade a Doenças , Feminino , Fístula/etiologia , Guiana Francesa/epidemiologia , Infecções por HIV/complicações , Herpes Simples/etiologia , Herpes Simples/imunologia , Herpes Zoster/etiologia , Herpes Zoster/imunologia , Histoplasmose/complicações , Histoplasmose/imunologia , Humanos , Hospedeiro Imunocomprometido , Memória Imunológica , Leishmaniose Cutânea/complicações , Leishmaniose Cutânea/imunologia , Hanseníase/imunologia , Doenças Linfáticas/etiologia , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Dermatopatias Infecciosas/imunologia , Tuberculose dos Linfonodos/complicações , Tuberculose dos Linfonodos/imunologiaRESUMO
A case of balantidial dysentery is reported in a patient infected with the HIV in French Guiana. This case is the first described in medical literature. The patient presented also a disseminated histoplasmosis. Immunosuppression probably favoured the evolution of asymptomatic carriage to clinical dysentery. This clinical case did not present any complications. Treatment with doxycycline had to be carried out for 20 days in order to obtain a clinical and parasitological cure.