Epidemiological characteristics and adherence of a cohort of elderly people with HIV/AIDS in the Public Health System

ABSTRACT Objective To characterize the epidemiological profile of patients aged 50 years or older diagnosed as HIV/AIDS, in a Specialized Service of the Public Health System. Methods A retrospective cohort study using secondary data from medical records in the period 2014 to 2018. Sociodemographic and clinical characteristics, and features related to treatment adherence were organized in a database. Quantitative variables were expressed as mean (or median) ± standard deviation (or interquartile range), and categorical variables expressed as number and percentage of patients. The Kaplan-Meier method was applied to assess the probability of overall specific survival. Results Of the 241 initially eligible patients, 149 patients were evaluated, registering 19 deaths in the studied period. There was a predominance of males aged 50-59 years, with severe immunodeficiency upon admission (29.7%), and with a CD4+ T lymphocyte count below 200 cells in 62 (46.3%) of patients. Elderly people aged 61 or over were more adherent. There was an increase in the CD4+ T lymphocyte count by an average of 139.63 in the first 6 months, and 50.51 from the first 6 months to 12 months of follow-up, with an average increase in the first 12 months of 157.63 cells. Specific overall survival in the period was 85%. Conclusion Patients older than 50 years had an immune response and no viral load detection in the 12-month period, deserving further studies to improve survival.

Linfoma não-Hodgkin de células T envolvendo a cavidade oral em paciente com o vírus da imunodeficiência humana positivo: relato de caso / T-cell Non-Hodgkin lymphoma of the oral cavity in human acquired virus-positive patient: case report

Linfoma não-Hodgkin (LNH) é uma das complicações oncológicas mais frequentes em portadores da síndrome da imunodeficiência adquirida (SIDA). O risco de desenvolvimento do Linfoma não-Hodgkin nos pacientes infectados pelo vírus da imunodeficiência humana (HIV) está diretamente relacionado à imunossupressão crônica,sendo particularmente mais frequentes nos paciente com baixa contagem de CD4. O objetivo deste estudo foi relatar o caso de Linfoma não-Hodgkin de células T em cavidade oral, em paciente com o vírus da imunodeficiência humana positivo, enfatizando a sua importância clínica e a necessidade do diagnóstico precoce especialmente em pacientes com SIDA. Paciente do sexo feminino, 38 anos, sabidamente HIV positivo, sem tratamento antirretroviral, apresentando tumoração extensa, vegetante, friável, de bordos irregulares, dolorosa em palato duro, acompanhada de linfoadenomegalia à direita. Realizada biópsia da lesão e estudo imuno-histoquímico com resultado de linfoma não-Hodgkin de células T. Foi iniciado tratamento específico para HIV e encaminhamento para centro onco-hematológico especializado. O caso relatado reflete rara manifestação de Linfoma não-Hodgkin em cavidade oral, em paciente com o vírus da imunodeficiência humana positivo, reforçando sua importância clínica e a necessidade do diagnóstico precoce, a fim de diminuir a morbimortalidade e melhorar seu reconhecimento clínico.

Non-Hodgkin lymphoma (NHL) is one of the most common cancer complications in patients with acquired immunodeficiency syndrome (AIDS). The risk of developing NHL in human immunodeficiency virus (HIV)-infected patients is directly related to chronic immunosuppression, and particularly more frequent in patients with low CD4 count. The aim of this study was to report the case of T-cell NHL in the oral cavity in HIV-infected patients, emphasizing its clinical importance and necessity of early diagnosis especially in patients with AIDS.Thirty-eight-year-old female patient, HIV-positive, without antiretroviral treatment, showing extensive, vegetative, friable, of ragged edges, painful tumor on hard palate, accompanied by lymphoadenomegaly on the right side. Biopsy of the lesion, and immunohistochemical study were performed with result of T-cell non-Hodgkin lymphoma. Treatment was started specifically for HIV, and patient was referred to a specialized oncohematological center. The related case reflects a rare manifestation of non-Hodgkin lymphoma in the oral cavity in HIV-positive patient, reinforcing its clinical importance and necessity of early diagnosis in order to decrease morbidity and mortality and improve its clinical recognition.

Paracoccidioidomicose subaguda abdominal em paciente adulto imunocompetente: relato de caso / Abdominal subacute paracoccidioidomycosis in an immunocompetent adult patient: case report

JUSTIFICATIVA E OBJETIVOS: A paracoccidioidomicose é uma doença fúngica, granulomatosa crônica, que acomete principalmente os pulmões, o sistema linfático e a pele. Pode ser dividida nas formas aguda e subaguda, que ocorre principalmente em crianças e acomete preferencialmente pele e sistema linfático e, crônica que ocorre principalmente em adultos, particularmente no pulmão. O objetivo deste estudo foi apresentar a manifestação da paracoccidioidomicose subaguda em adulto jovem imunocompetente.RELATO DO CASO: Paciente do sexo feminino, 29 anos, internada para investigação de dor abdominal, sendo diagnosticada paracoccidioidomicose subaguda. Apresentou colestase intra-hepática, devido à linfoadenomegalia intra-abdominal. Evoluiu sem complicações após tratamento instituído.CONCLUSÃO: O caso relatado reflete uma manifestação incomum,em adulto jovem, residente em zona urbana, das formas aguda e subaguda de paracoccidioidomicose, com acometimento linfonodal profundo intra-abdominal causando colestase intra-hepática, icterícia e anemia.

BACKGROUND AND OBJECTIVES: Paracoccidioidomycosis is a chronic, fungal, granulomatous disease, which mainly affects the lungs, lymphatic system and skin. It can be divided into acute and subacute, occurring primarily in children and affecting mainly the skin and lymphatic system, and chronic, occurring primarily in adults and affecting mainly the lungs. This report describes the manifestation of subacute paracoccidioidomycosis in an immunocompetent young adult.CASE REPORT: Female patient, 29 year-old, imunocompetent, hospitalized with abdominal pain, was diagnosed with subacute paracoccidioidomycosis. She showed intrahepatic cholestasis due to intra-abdominal lymphadenopathy. She presented uneventful recovery after treatment.CONCLUSION: This case reflects an unusual manifestation in young adults living in urban areas of the subacute/acute paracoccidioidomycosis, with deep intra-abdominal lymphadenopathy causing intrahepatic cholestasis, jaundice and anemia. There was improvement after treatment