RESUMO
BACKGROUND: HIV subjects have several kidney pathologies, like HIV-associated nephropathy or antiretroviral therapy injury, among others. The global prevalence of Chronic Kidney Disease (CKD) is 8-16%; however, in HIV subjects, the prevalence varies between geographic regions (2-38%). The aim was to determine the prevalence of CKD and identify the associated risk factors. METHODS: A longitudinal descriptive study was carried out at the 'Hospital Civil de Guadalajara' Feb'18 - Jan'19. Basal clinical, demographic, opportunistic infections (OI), and laboratory data were obtained at months 0 and 3; inclusion criteria were ≥ 18 years old, naïve HIV + , urine albumin/creatinine ratio, serum creatinine & urine test, and signed informed consent. Descriptive and multiple logistic regression statistical analyses were made. RESULTS: One hundred twenty subjects were included; 92.5% were male, 33 ± 9.5 years, 60% consumed tobacco, 73% alcohol, and 59% some type of drug. The CKD prevalence was 15.8%. CKD patients had a higher risk of hepatitis C virus coinfection, Relative Risk (RR):5.9; HCV infection, RR:4.3; ≥ 30 years old, RR:3.9; C clinical-stage, RR:3.5; CD4+ T cells count < 200 cells/µL, RR: 2.4; and HIV-1 viral load ≥ 100,000 cop/mL, RR: 2.7. CONCLUSIONS: Our study showed a higher CKD prevalence in patients with HIV; higher CKD development with coinfections as Hepatitis C Virus and Mycobacterium tuberculosis. The identification and prompt management of CKD and coinfections should be considered to avoid the progression and to delay renal replacement therapy as long as possible.
Assuntos
Nefropatia Associada a AIDS/epidemiologia , HIV-1 , Insuficiência Renal Crônica/epidemiologia , Adulto , Contagem de Linfócito CD4 , Relação CD4-CD8 , Coinfecção , Feminino , Soropositividade para HIV/complicações , Soropositividade para HIV/virologia , Humanos , Masculino , México/epidemiologia , Prevalência , Insuficiência Renal Crônica/etiologia , Fatores de Risco , Carga ViralRESUMO
ABSTRACT: To examine potential risk factors associated with biochemical alterations in renal function in a population diagnosed with HIV/AIDS undergoing antiretroviral treatment.This is an observational, transversal, and relational design study that included 179 HIV-seropositive subjects. Glucose serum, cholesterol, triglycerides, total proteins, albumin, creatine, urea, blood urea nitrogen (BUN), and electrolytes levels were determined for each individual. Renal function was evaluated through the glomerular filtration rate (GFR), using the CKD-EPI equation. Chronic kidney disease (CKD) was defined as estimated glomerular filtration rate â<â60âmL/min/1.73âm2. Univariate model significant variables, with a 95% confidence interval (CI), were included in a multivariate logistic regression analysis.CKD prevalence in patients was 7.3%, with comorbidities of 7.8% for type 2 diabetes mellitus, 7.3% for arterial hypertension, and 35.2% for dyslipidemia. Additionally, both hypernatremia and hypophosphatemia were detected in 57% (nâ=â102) of the patients. Multivariate logistic regression suggested that CD4+ T cell countâ<â200 (Pâ=â.02; OR 0.2; CI 95% 0.08-0.8) was associated to hyponatremia; similarly, detectable viral load was associated to hypokalemia (Pâ=â.02; OR 5.1; CI 95% 1.2-21.3), hypocalcemia (Pâ=â.01; OR 4.1; CI 95% 1.3-12.3), and hypermagnesemia (OR 3.9; CI 95% 1.1-13.6). Patient age was associated to both hypophosphatemia (Pâ=â.01; OR 2.4; CI 95% 1.1-5.0) and hypermagnesemia (Pâ=â.01; OR 2.8; IC 95% 1.1-7.0), and high creatinine levels were associated to nucleoside reverse transcriptase inhibitor treatment (Pâ=â.001; OR 42.5; CI 95% 2.2-806.9). Lastly, high BUN levels were associated to age (Pâ=â.03; OR 3.8; CI 95% 1.0-14.4), while GFR 60 to 89âmL/min/1.73âm2 was associated to dyslipidemia (Pâ=â.02; OR 2.2; CI 95% 1.1-4.5).CD4+ T cell and viral load were the main factors associated with renal biochemical alterations.
Assuntos
Eletrólitos/sangue , Taxa de Filtração Glomerular/fisiologia , Soropositividade para HIV/sangue , Soropositividade para HIV/complicações , Insuficiência Renal Crônica/epidemiologia , Adulto , Idoso , Antirretrovirais/uso terapêutico , Feminino , Soropositividade para HIV/tratamento farmacológico , Humanos , Masculino , México , Pessoa de Meia-Idade , Prevalência , Insuficiência Renal Crônica/diagnóstico , Fatores de Risco , Adulto JovemRESUMO
RESUMEN Se presentó el caso clínico de un paciente seropositivo, en fase sintomática avanzada. Fue atendido en el Servicio de Medicina Interna del Hospital Clínico Quirúrgico Docente "León Cuervo Rubio", de la ciudad de Pinar del Río, por presentar disnea, astenia, anorexia y pérdida de peso. Al examen oral se constató lesión tumoral de la lengua que dificultaba la masticación y deglución. La biopsia mostró sarcoma de Kaposi asociado al VIH/sida. La evolución tórpida y el estadio tan avanzado de la enfermedad, propiciaron el deceso del paciente (AU).
ABSTRACT The authors presented the clinical case of a seropositive patient, in advanced symptomatic phase. The patient attended the Internal Medicine Service of the Teaching Clinical Surgical Hospital Leon Cuervo Rubio of Pinar del Rio, presenting dyspnea, asthenia, anorexia and weight loss. On the oral examination, a tumor lesion was found making difficult to chew and swallow. A biopsy showed Kaposi sarcoma associated to HIV/AIDS. The torpid evolution and disease's advanced stage propitiated the patient's death (AU).
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Sarcoma de Kaposi/complicações , Soropositividade para HIV/complicações , Sarcoma de Kaposi/etiologia , Sarcoma de Kaposi/mortalidade , Sarcoma de Kaposi/tratamento farmacológico , Sarcoma de Kaposi/epidemiologia , Condiloma Acuminado/diagnóstico , Soropositividade para HIV/mortalidade , Unidades de Terapia IntensivaRESUMO
OBJECTIVE: Determine the impact of HIV-1 seroconversion on inflammatory cytokines in the rectal mucosa. SETTING: Secondary analysis of data from men who have sex with men and transgender women who participated in a HIV prevention trial Lima, Peru. METHODS: From July to December 2017, 605 men who have sex with men and transgender women were screened for rectal gonorrhea/chlamydia (GC/CT). Fifty GC/CT-positive cases were randomly selected and matched with 52 GC/CT-negative controls by age and number of receptive anal intercourse partners in the last month. All participants were HIV-negative at baseline and those with GC/CT at baseline and/or follow-up received appropriate antibiotic therapy. Participants underwent sponge collection of rectal secretions for the measurement of inflammatory cytokines (IL-1ß, IL-6, IL-8, and TNF-α) and were screened for rectal GC/CT and HIV at baseline, 3 months, and 6 months. Wilcoxon rank-sum tests compared inflammatory cytokine levels between participants diagnosed with HIV during follow-up and persons who remained HIV-negative. RESULTS: Eight participants were diagnosed with HIV at the 3-month (n = 6) or 6-month (n = 2) visit. The median number of receptive anal intercourse partners in the month before HIV diagnosis was the same for those who acquired HIV and those who did not. There were no significant differences in inflammatory cytokine levels in rectal mucosa between participants who did and did not experience HIV seroconversion at any time point. CONCLUSIONS: Despite a surge in viral replication during acute infection, findings from this study suggest that there is no prolonged effect of HIV-1 seroconversion on inflammatory cytokine levels in the rectal mucosa.
Assuntos
Infecções por HIV/prevenção & controle , HIV-1/imunologia , Inflamação/imunologia , Soroconversão , Adulto , Infecções por Chlamydia/diagnóstico , Citocinas/metabolismo , Feminino , Gonorreia/diagnóstico , Soropositividade para HIV/complicações , Homossexualidade Masculina , Humanos , Inflamação/complicações , Masculino , Peru , Doenças Retais/complicações , Comportamento Sexual , Minorias Sexuais e de Gênero , Sífilis/diagnóstico , Pessoas Transgênero , Adulto JovemRESUMO
BACKGROUND: Saliva is a complex secretion produced daily by the salivary glands. Saliva consists mainly of water, enzymes, ions and amino acids and performs several important functions in oral health. OBJECTIVE: The aim of this study was to investigate the flow rate and concentrations of amylase and total proteins in the saliva of hospitalized patients due to AIDS complications. METHODS: Ninety-three men and women (20-64 years of age) were divided into two groups (46 HIV-infected patients and 47 controls) and had salivary flow rate and levels of amylase enzyme and total proteins evaluated. RESULT: The mean salivary flow rate was lower in individuals with HIV when compared to controls (P < 0.05). No significant difference between amylase enzyme levels and total proteins were observed in the saliva of patients with HIV infection when compared to controls. CONCLUSION: Individuals with HIV / AIDS infection (in hospital treatment) suffer no interference in levels of amylase and total salivary proteins, but they have significantly reduced salivary flow.
Assuntos
Infecções por HIV/complicações , Soropositividade para HIV/complicações , Saliva/metabolismo , Proteínas e Peptídeos Salivares/metabolismo , Salivação/fisiologia , Xerostomia/complicações , alfa-Amilases/metabolismo , Adolescente , Adulto , Idoso , Amilases/análise , Amilases/metabolismo , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Estudos de Casos e Controles , Feminino , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Glândulas Salivares/metabolismo , Proteínas e Peptídeos Salivares/análise , Taxa Secretória/efeitos dos fármacos , Taxa Secretória/fisiologia , Xerostomia/etiologia , Adulto Jovem , alfa-Amilases/análiseAssuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Encéfalo/diagnóstico por imagem , Soropositividade para HIV/complicações , Meningite/complicações , Toxoplasma/isolamento & purificação , Toxoplasmose Cerebral/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Anti-Infecciosos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Dexametasona/uso terapêutico , Eosinófilos , Cefaleia/etiologia , Humanos , Meningite/diagnóstico , Meningite/tratamento farmacológico , Náusea/etiologia , Paresia/etiologia , Reação em Cadeia da Polimerase , Sulfametoxazol/uso terapêutico , Tomografia Computadorizada por Raios X , Toxoplasma/genética , Toxoplasmose Cerebral/líquido cefalorraquidiano , Toxoplasmose Cerebral/complicações , Toxoplasmose Cerebral/tratamento farmacológico , Resultado do Tratamento , Vômito/etiologiaRESUMO
BACKGROUND: Human papillomaviruses (HPVs) have been divided into mucosal and cutaneous types according to their primary epithelial tissue tropism. However, recent studies showed the presence of several cutaneous types in mucosal lesions and healthy mucosa from different anatomical sites. METHODS: Here, the HPV prevalence and type-specific distribution were assessed in a variety of mucosal samples from 435 individuals using a combination of two established broad-spectrum primer systems: Gamma-PV PCR and CUT PCR. RESULTS: Overall HPV prevalence in anal canal swabs, cervical cancer biopsies, genital warts and oral swabs was 85, 47, 62 and 4%, respectively. In anal canal swabs, Alpha-PVs were most frequently found (59%), followed by Gamma- (37%) and Beta-PVs (4%). The prevalence and persistence of HPV infection in the anal canal of 226 individuals were further explored. Overall HPV, Gamma-PVs and multiple HPV infections were significantly higher in men vs. women (p = 0.034, p = 0.027 and p = 0.003, respectively); multiple HPV infections were more common in individuals ≤40 years (p = 0.05), and significantly higher prevalence of Gamma-PVs and multiple HPV infections was observed in HIV-1-positive vs. HIV-1-negative individuals (p = 0.003 and p = 0.04, respectively). Out of 21 patients with follow-up anal swabs, only one persistent infection with the same type (HPV58) was detected. CONCLUSIONS: Our findings suggest that Gamma-PVs (except species Gamma-6) are ubiquitous viruses with dual muco-cutaneous tissue tropism. Anal canal Gamma-PV infections may be associated with sexual behavior and the host immune status. This study expands the knowledge on Gamma-PVs' tissue tropism, providing valuable data on the characteristics of HPV infection in the anal canal.
Assuntos
Doenças do Ânus/complicações , Gammapapillomavirus/genética , Soropositividade para HIV/complicações , HIV-1/imunologia , Mucosa Bucal/virologia , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/epidemiologia , Reação em Cadeia da Polimerase/métodos , Adolescente , Adulto , Idoso , Doenças do Ânus/virologia , Sequência de Bases/genética , Condiloma Acuminado/virologia , Epitélio/virologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Papillomavirus/virologia , Prevalência , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia , Adulto JovemRESUMO
BACKGROUND: Weight change may inform tuberculosis treatment response, but its predictive power may be confounded by human immunodeficiency virus (HIV). METHODS: We prospectively followed up adults with culture-confirmed, drug-susceptible, pulmonary tuberculosis receiving standard 4-drug therapy (isoniazid, rifampin, pyrazinamide, and ethambutol) in Brazil. We examined median weight change 2 months after treatment initiation by HIV status, using quantile regression, and unsuccessful tuberculosis treatment outcome (treatment failure, tuberculosis recurrence, or death) by HIV and weight change status, using Cox regression. RESULTS: Among 547 participants, 102 (19%) were HIV positive, and 35 (6%) had an unsuccessful outcome. After adjustment for confounders, persons living with HIV (PLWH) gained a median of 1.3 kg (95% confidence interval [CI], -2.8 to .1) less than HIV-negative individuals during the first 2 months of tuberculosis treatment. PLWH were at increased risk of an unsuccessful outcome (adjusted hazard ratio, 4.8; 95% CI, 2.1-10.9). Weight change was independently associated with outcome, with risk of unsuccessful outcome decreasing by 12% (95% CI, .81%-.95%) per 1-kg increase. CONCLUSIONS: PLWH gained less weight during the first 2 months of tuberculosis treatment, and lack of weight gain and HIV independently predicted unsuccessful tuberculosis treatment outcomes. Weight, an easily collected biomarker, may identify patients who would benefit from alternative treatment strategies.
Assuntos
Antituberculosos/uso terapêutico , Soropositividade para HIV/complicações , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/tratamento farmacológico , Aumento de Peso , Adulto , Brasil , Etambutol/uso terapêutico , Feminino , Humanos , Isoniazida/uso terapêutico , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Pirazinamida/uso terapêutico , Rifampina/uso terapêutico , Fatores de Tempo , Resultado do TratamentoAssuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/patologia , Encéfalo/diagnóstico por imagem , Soropositividade para HIV/diagnóstico , HIV-1/isolamento & purificação , Hemorragias Intracranianas/patologia , Toxoplasmose Cerebral/complicações , Toxoplasmose Cerebral/patologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico por imagem , Adulto , Encéfalo/patologia , Soropositividade para HIV/complicações , HIV-1/genética , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X , Toxoplasmose Cerebral/diagnóstico , Toxoplasmose Cerebral/diagnóstico por imagemRESUMO
Tuberculosis (TB) of the esophagus is an extremely rare condition, even in immunocompromised patients. We report the case of a 24-year-old man with a past history of HIV and pulmonary tuberculosis who presented with dysphagia and a 2cm submucosal mass in the proximal esophagus. The biopsy was diagnosed as a spindle cell neoplasm in another center. Sections displayed a submucosal lesion formed by spindle and epithelioid cells, surrounded by chronic inflammation. The spindle cells were positive for S100 and CD68, but negative for cytokeratin, desmin, smooth muscle actin, ALK, CD34 and CD117. Ziehl-Neelsen stain was performed and showed many intracellular acid-fast bacilli, confirming the diagnosis of esophageal TB. This case is a reminder that esophageal TB may become manifest as a submucosal lesion and the histiocytic-granulomatous reaction may mimic a spindle cell tumor.