ABSTRACT
Neurosyphilis follows a more aggressive and different clinical course in HIV-infected patients compared to patients with normal immunity. Two historical series of patients with a diagnosis of neurosyphilis between 1995 and 2008 were compared: they included a group of 15 patients with y and 28 patients without HIV infection. Probability of neurosyphilis in patients with positive serum VDRL was increased in patients infected with HIV comparedto HIV negative patients (OR: 62.37 IC:95 percent (32.1-119.1) p value:< 0,001). Predominant clinical manifestations in neurosyphilis in the HIV negative group were ocular abnormality, vascular encephalic and spinal cord lesions. In the HIV positive group, they were fever, ocular abnormalities and headache. There were no differences in cerebrospinal fluid characteristics between both groups. Neurosyphilis was diagnosed even in patients with blood VDRL of < 1:32, that happened in 17.8 percent of the HIV positive patients with blood and in 60 percent of t he HIV negative patients. Penicillin sodium given at dose ¡Ý than 18.000.000 IU/day IV during 14 days was the most common treatment. In patients with clinical neurosyphilis, 93 percent of HIV negative group, and 54.2 percent of HIV positive group had persistent neurological after-effects. Three HIV positive patients died due to causes not related to neurosyphilis.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , AIDS-Related Opportunistic Infections/diagnosis , HIV Seronegativity , Neurosyphilis/diagnosis , AIDS-Related Opportunistic Infections/complications , AIDS-Related Opportunistic Infections/drug therapy , Anti-Bacterial Agents , Cohort Studies , Neurosyphilis/complications , Neurosyphilis/drug therapy , Penicillin G Benzathine/therapeutic use , Retrospective Studies , Syphilis Serodiagnosis , Young AdultABSTRACT
Background: Some infections share common modes of transmission with HIV and have the potential to change the course of the latter. Aim: To assess the prevalence of hepatitis B virus (HBV) hepatitis C virus (HCV), Treponema palladium and Toxoplasmosis gondii co-infections in HIV-1 infected patients followed at a university hospital. Material and methods: Clinical records of HIV-positive individuals were reviewed. The analysis included: demographical data, hepatitis B surface antigen (HBsAg), IgM and IgG anti-HBc, antibodies, anti-HCV antibodies, RPR or VDRL test and IgG anti Tgondii antibodies. Results: Three hundred ninety five patients (aged 16 to 89years, 359 males) were included in the review. Seventy nine percent had been tested for HBV status with HBsAg, and the global HIV-HBV co-infection prevalence was 6.1 percent. A subgroup of190 individuals were tested for HBV infection with HBsAg and IgM/IgG anti-HBc markers. Of these, 46 percent fulfilled co-infection criteria: eight with acute hepatitis B, 11 with chronic hepatitis B and 69 with inactive HBV infection. The frequency of HIV-HBV co-infection was 48 percent and 22 percent among men and women respectively (NS). HCV-HN co-infection was detected in 3 percent, syphilis-HIV co-infection in 21 percent and T gondii-HIV co-infection in 26 percent. Conclusions: In this cohort, HIV infection is accompanied by a high prevalence of other co-infections, particularly HBV among men.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , AIDS-Related Opportunistic Infections/epidemiology , Hepatitis B/epidemiology , Hepatitis C/epidemiology , Syphilis/epidemiology , Toxoplasmosis/epidemiology , AIDS-Related Opportunistic Infections/diagnosis , Chile/epidemiology , Cohort Studies , Hepatitis B/diagnosis , Hepatitis C/diagnosis , Prevalence , Retrospective Studies , Syphilis/diagnosis , Toxoplasmosis/diagnosis , Young AdultABSTRACT
Tuberculosis (TB) is worldwide one of the leading causes of death in HIV infected individuals. In Chile, TB rates have fallen dramatically in the general population and new cases are being progressively restricted to high risk groups, particularly immunosupressed individuals. In these patients diagnostic tests have decreased sensitivity and TB frequently evolves to disseminated and rapidly progressive forms. Besides, the concurrent treatment of HIV infection and TB adds further toxicities and the possibility of significant interactions. In this article we review the particularities and advances in diagnostic and therapeutic aspeets of TB in the HIV infected patient.
La tuberculosis (TBC) es una de las principales causas de muerte en el mundo en individuos con infección por VIH. En Chile, su incidencia en la población general se ha reducido significativamente y esta enfermedad se ha ido centrando en grupos de alto riesgo, en particular los inmuno suprimidos. En estos pacientes las pruebas diagnósticas tienen sensibilidad inferior y la enfermedad evoluciona con mayor frecuencia hacia formas diseminadas y rápidamente progresivas. El tratamiento simultáneo de la infección por VIH y la enfermedad tuberculosa aumenta la complejidad al sumar toxicidades e interacciones. En este artículo revisamos las particularidades y los avances que han surgido, tanto en el diagnóstico como el tratamiento de la TBC, en el paciente co-infectado con VIH.