Efectividad del tratamiento antirretroviral con el primer esquema genérico cubano en pacientes con VIH/sida / Antirretroviral treatment with the first Cuban generic pattern in patients with HIV/aids

Introducción: Uno de los progresos más significativos en el enfrentamiento a la epidemia del VIH/sida ha sido el desarrollo de la terapia antirretroviral de gran actividad. Objetivo: Estimar las variaciones en la efectividad de la terapéutica empleada (zidovudina, lamivudina y nevirapina), en lo referente a parámetros clínicos y hematológicos seleccionados. Método: Se realizó un estudio observacional y descriptivo, de series de casos, en 45 pacientes con VIH/sida, quienes egresaron del Servicio de Medicina Interna del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, desde el 2015 hasta el 2017, para lo cual se emplearon variables clínicas y terapéuticas. Resultados: La terapia empleada modificó de manera beneficiosa los parámetros de estudio CD4 y carga viral. Asimismo, hubo una magnitud porcentual connotada en los afectados con buena evolución clínica (39 para 86,7 %) y la efectividad del esquema propuesto fue porcentualmente visible, al mostrar más de 80,0 % de los pacientes con respuesta favorable a dicha terapia. Conclusiones: El esquema terapéutico fue efectivo, pues se produjo un incremento marcado de los valores de linfocitos CD4 y la disminución relevante de la replicación viral, lo que trajo consigo un importante decremento de las enfermedades oportunistas.

Introduction: One of the most significant progresses in fighting the epidemic of HIV/aids has been the development of the antirretroviral therapy of great activity. Objective: To calculate variations in the effectiveness of the used therapeutic process (zidovudine, lamivudine y nevirapine), regarding selected clinical and hematological parameters. Method: An observational and descriptive series of cases study was carried out in 45 patients with HIV/aids who were discharged from the Internal Medicine Service in Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, from 2015 to 2017, for which clinical and therapeutic variables were used. Results: The implemented therapy modified in a beneficial way the study parameters CD4 and viral load. Also, there was a connoted magnitude percentage in those affected patients with good clinical course (39 representing 86.7 %) and the effectiveness of the proposed pattern was visible, when showing more than 80.0 % the patients with favorable response to this therapy. Conclusions: The therapeutic pattern was effective, because a marked increment of the CD4-lymphocytes count and the marked decrease of the viral replication, what caused an important decrease of the opportunist diseases.

Linfocitos TCD4+ y carga viral en pacientes con debut de sida que reciben tratamiento antirretroviral / CD4 + T lymphocytes and viral load in patients with AIDS debut receiving antiretroviral therapy

INTRODUCCIÓN: el debut de sida es una forma de presentación de la enfermedad causada por VIH que se caracteriza por alteración del estado general del paciente, síndrome de desgaste, aparición de graves infecciones oportunistas, neoplasias y alteraciones neurológicas. MÉTODOS: se estudió el comportamiento de los niveles de linfocitos T CD4+ y de carga viral en pacientes con debut de sida y terapia antirretroviral, al inicio y un año después del tratamiento. Se estudiaron 55 pacientes los cuales tuvieron al inicio del tratamiento conteos de linfocitos TCD4+ inferiores a 200cel/µL y carga viral elevada. RESULTADOS: después de un año de terapia, los valores de linfocitos T CD4+ aumentaron por encima de 200 cel/µL y la carga viral disminuyó a niveles no detectables en los pacientes estudiados. CONCLUSIONES: los resultados de esta investigación confirman los beneficios del tratamiento antirretroviral particularmente para los pacientes con debut de sida.

INTRODUCTION: the AIDS premiere is a form of presentation of the illness caused by HIV that is characterized by alteration of the patient's general state, waste syndrome, appearance of serious opportunists infections, neoplasia and neurological alterations. METHODS: the behavior of the CD4+ T lymphocytes levels were studied and of viral load in patient with AIDS premiere and antiretroviral therapy, to the beginning and one year after the treatment. 55 patients those were studied which had to the beginning of the treatment CD4+ T lymphocytes counts less to 200cel/µL and high viral load. RESULTS: after a year of therapy, the values of CD4+ T cells recovered and the viral load diminished at non detecting levels in the evaluated patients. CONCLUSIONS: the results of this study confirm the benefits of antiretroviral therapy, particularly for patient with AIDS premiere.

Perfil de ativação dos linfócitos T de pacientes com mielopatia associada ao vírus linfotrópico das células T humanas do tipo 1 (HTLV-1) / paraparesia tropical espástica (HAM/TSP) possível, provável e definido / Activation profile of T lymphocytes of patients with myelopathy associated with human T-lymphotropic virus type 1 cells (HTLV-1) tropical spastic paraparesis (HAM / TSP) possible, probable and definite

O vírus linfotrópico das células T humanas do tipo 1 (HTLV-1) é o agente etiológico da mielopatia associada ao HTLV / paraparesia espástica tropical (HAM / TSP ), que ocorre em menos de 5 % dos indivíduos infectados. A resposta imune controla parcialmente a infecção, porém pode estar ligada a patogênese da doença. O objetivo deste estudo foi caracterizar fenotipicamente as subpopulações de linfócitos T, em pacientes assintomáticos e com diagnóstico de HAM/TSP. Foram avaliados 103 pacientes acompanhados no Centro de HTLV da Escola Bahiana de Medicina e Saúde Pública (EBMSP) e 19 controles não infectados. Os pacientes foram categorizados de acordo com o grau de certeza do diagnóstico de HAM/TSP: possível (Ps), provável (Pb) e definido (D), além de pacientes assintomáticos (ASS). O perfil fenotípico (CD25, CD45RA, CD45RO, HLA-DR, CD25, CCR-7, CD62L)...

The human T-cell lymphotropic vírus type 1(HTLV-1) is the etiological agent of HTLV- associated myelopathy/ Tropical spastic paraparesis(HAM/TSP), wich occurs in less then 5% of the infected individuals. The immune response partially controls the infection, but may be linked to the pathogenesis of disease. The aim of this study was to characterize phenotipically T lymphocyte subpopulations in asymptomatic and in patients diagnosed with HAM/TSP. We evaluated 103 patients treated at the center for HTLV of Bahia School of Medicine and Public Health (EBMSP) and 19 uninfected controls. Patients were categorized as asymptomatic and according to the degree of certainty of the diagnosis of HAM/TSP: Possible(Ps), Probable(Pb) and Definite(D). The phenotypic profile (CD25, CD45RA, CD45RO, HLA-DR, CCR-7, CD62L)...

Causas de cambio de tratamiento en un grupo de pacientes VIH/SIDA cubanos / Causes of change in treatment in a group of HIV/AIDS Cuban patients

La infección por virus de inmunodeficiencia humana (VIH) es uno de los mayores problemas de salud actuales, se estima que más de 40 millones de personas están infectadas en el mundo. Se realizó un estudio descriptivo de corte transversal en 40 pacientes VIH/SIDA pertenecientes al servicio de Medicina del IPK con el propósito de caracterizar las causas del cambio de tratamiento antirretroviral y los tipos de reacciones adversas presentadas con este tratamiento en un grupo de pacientes VIH/SIDA..Los pacientes recibieron diferentes esquemas de antirretrovirales entre los que predominaron los siguientes: 3TC, d4T e Indinavir (57,5 por ciento), seguido de 3TC, AZT e Indinavir (22,5 por ciento). Las causas más frecuentes de cambio de tratamiento fueron las reacciones adversas y la mala adherencia al tratamiento. Entre las personas que están recibiendo terapia contra el VIH, existe una tendencia cada vez más frecuente de abandonar o cambiar la terapia. Las causas de estos cambios y del abandono de las terapias suelen estar relacionadas con los efectos secundarios, la fatiga del tratamiento, la fase de la infección por VIH en que se encuentra el paciente, y factores relativos a su estilo de vida. Las causas más frecuentes de cambio de tratamiento fueron las reacciones adversas, seguidas de la mala adherencia al tratamiento antirretroviral. Las reacciones adversas más frecuentes en el grupo de estudio fueron los vómitos y los trastornos digestivos respectivamente

The HIV virus infection is one of the major current problems of health estimating that more than 40 millions of persons are infected at world level. A cross-sectional and descriptive study was conducted in 40 HIV/AIDS patients from the Tropical Medicine Institute service to characterize the causes of the change in antiretroviruses treatment and the types of adverse reactions related to this treatment in a group of HIV/AIDS patients. Patients received different antiretroviruses schemes with predominance of 3TC, d4T and Indinarir (57,5 percent), followed by 3TC, AZT and Indinavir (22,5 percent). The more frequent causes of change of this treatment were the adverse reactions and a poor adherence to it. Among the persons with therapy HIV there is a more and more frequent trend to give up or to change of therapy. The causes of these changes and the leaving the therapy are related to side effects, treatment fatigue, and the HIV infection phase in patient and relative factors related to the lifestyle. The more frequent causes of the change of treatment were the adverse reactions followed by a poor adherence to antiretroviruses treatment. The more frequent adverse reactions were vomiting and digestive disorders, respectively

Infección por virus Epstein Barr en niños VIH positivos: Relación con carga viral del VIH y contaje de linfocitos T CD4+ / Epstein Barr virus infection in HIV positive children: relationship with viral load and T CD4+ lymphocyte count

El objetivo de este trabajo fue estudiar la infección por Epstein Barr en niños VIH+ menores de 12 años, de ambos sexos, con TARAE y su relación con carga viral del VIH y contaje de linfocitos T CD4+. La detección de IgM/IgG anti CVA y anti EBNA1 se realizó por ELISA, la cuantificación de EBV en sangre periférica por PCR y el inmunofenotipaje por citometría de flujo. Estudio estadístico mediante el análisis de correlación de Spearman y la prueba de t de Student. Se evaluaron 21 niños con edades comprendidas entre 3 a 12 años, 18 de los cuales (85,7%) presentaron carga viral detectable para EBV. Dos de ellos tuvieron infección aguda temprana (IgM CVA e IgM EBNA1 +), 5 infección aguda tardía (IgM CVA - IgM EBNA +) con carga viral para EBV de 573 copias/ml, y 14 con infección pasada (IgG CVA e IgG EBNA positivos), 11 de los cuales tenían carga viral para EBV de 646 copias/ml (crónicos activos). No hubo diferencias estadísticamente significativas al comparar los promedios de las cargas virales de EBV en infecciones agudas y pasadas, ni entre esas cargas y las de VIH, pero si con los contajes de linfocitos T CD4+: cifras menores se correlacionaron con niveles altos de carga viral de EBV (p<0,05). Debe realizarse detección de los anticuerpos anti CVA y EBNA1 así como cuantificación de EBV por pruebas moleculares a todo niño VIH positivo, ya que a menor contaje de linfocitos T CD4+ mayor carga viral de EBV.

The purpose of this work was to study Epstein Barr infection in HIV+ children less than 12 years old of both sexes, with TARAE and its relationship with the HIV viral load and T CD4+ lymphocyte count. The detection of anti CVA and anti EBNA1 IgM/IgG was done by ELISA, the EBV quantification in peripheral blood by PCR, and the immunophenotype by flow cytometry. The statistical study was done through Spearman’s correlation analysis and Student’s t test. The evaluation included 21 children with ages between 3 and 12 years, 18 of which (85.7%) presented a detectable EBV viral load. Two of them had an acute early infection (IgM CVA and IgM EBNA1 +), 5 an acute late infection (IgM CVA - IgM EBNA+) with a EBV viral load equal to 573 copies/ml, and 14 with past infections ( IgG CVA and IgG EBNA positive), 11 of which had an EBV viral load equal to 646 copies/ml (active chronics). There were no statistical significant differences when comparing the mean EBV viral load in acute and past infections, nor between those loads and the HIV loads, but there were differences in the T CD4+ loads; lower numbers were correlated with high EBV viral loads (p<0.05). Detection of anti CVA and EBNA1 antibodies, as well as EBV quantification through molecular tests, should be done to all HIV positive children, since a lower T CD4+ lymphocyte count means a higher EBV viral load.

Occurrence of pneumocystis pneumonia in hiv-infected patients and the interference of the highly active antiretroviral therapy

From the beginning of the AIDS epidemic, pneumocystis pneumonia (PCP) has been distinguished as one of the most frequent opportunistic diseases with high morbid-mortality. As from 1996, the advent of the highly active antiretroviral therapy (HAART) has changed the characteristics of such epidemic by reducing its related diseases and, as a result, AIDS-related mortality. With the purpose to estimate PCP occurrence and HAART interference, 376 HIV-infected or AIDS patients were studied from January 1992 to December 2002. Among them, 58 (15.5 percent) PCP cases were found. There was a higher occurrence of PCP in the group of patients in which HAART was not used, with 40 (69.0 percent) of the episodes. As regards the studied period, a tendency to a linear reduction in annual PCP incidence was observed. The mean of T CD4+ lymphocytes in the patients with PCP (117 cells/mm³) was significantly lower when compared to that of the other individuals (325 cells/mm³). Therefore, this study suggests a temporal reduction in PCP occurrence related to HAART use with higher T CD4+ lymphocyte counts. Nevertheless, this opportunistic infection still shows significant incidence in AIDS patients. (NCT00516581).

Portal cd4+ and cd8+ t lymphocyte correlate to intensity of interface hepatitis in chronic hepatitis C

BACKGROUND: The pathogenesis of chronic hepatitis C is still a matter of debate. CD4+ and CD8+ T lymphocytes (TL) are typically observed within the portal and periportal spaces of affected livers, but their functional role in hepatitis C progression has not been fully elucidated. METHODS: CD4+ and CD8+ TL were quantified by immunohistochemistry in portal and periportal spaces of 39 liver biopsies from patients with chronic hepatitis C. They were associated to demographic data, histological parameters, laboratory findings of patients and hepatitis C genotypes. RESULTS: There was high numbers of CD4+ and CD8+ TL from which the density of CD4+ T was higher than CD8+ TL in portal and periportal spaces. CD4+ and CD8+ TL were directly correlated to intensity of interface hepatitis. CD8+ TL correlated to serum enzyme levels. CONCLUSION: The high numbers of CD4+ and CD8+ TL in portal and periportal spaces and their correlation to interface hepatitis suggest that hepatitis C evolution depends on the action of intrahepatic T lymphocytes, lending support to the notion of an immune-mediated mechanism in the pathogenesis of chronic hepatitis C.

INTRODUÇÃO: A patogênese da hepatite C crônica ainda está em discussão. Sabe-se que linfócitos T (LT) CD4+ e CD8+ são tipicamente observados no espaço portal e peri-portal de pacientes com hepatite C crônica, mas o conhecimento exato de suas ações no fígado, bem como sua influência na progressão da doença hepática ainda estão em discussão. MÉTODOS: Os LT CD4+ e T CD8+ foram quantificados por imunohistoquímica nos espaços porta e peri-portais em 39 biópsias hepáticas de pacientes cronicamente infectados pelo vírus da hepatite C. Esses dados foram associados com os dados demográficos, as alterações histológicas, os achados laboratoriais dos pacientes com hepatite C e com os genótipos do vírus da hepatite C. RESULTADOS: Houve grande quantidade tanto de LT CD4+ como de CD8+, sendo que houve maior densidade de LTCD4+ do que CD8+ nos espaços portal e peri-portal. Tanto o número de linfócitos T CD4+ como de CD8+ foram diretamente relacionados com a intensidade da hepatite de interface. Os linfócitos T CD8+ foram estatisticamente relacionados às enzimas hepáticas. CONCLUSÃO: O encontro de numerosos linfócitos T CD4+ e linfócitos T CD8+ no espaço-portal e peri-portal e sua correlação com a hepatite de interface sugerem que a evolução da hepatite C dependa da ação dos linfócitos T intra-hepáticos, ou seja, há um mecanismo imuno-mediado na patogênese da hepatite C crônica.

Increased mRNA Encoding for Transforming Growth Factor-beta in Peripheral CD4+ Lymphocytes Stimulated with Mitogen from Patients with IgA Nephropathy / 대한신장학회잡지

NO abstract available.