Características sociodemográficas y epidemiológicas de pacientes con inicio clínico de sida en Santiago de Cuba / Sociodemographic and epidemiological characteristics of patients with clinical onset of AIDS in Santiago de Cuba i: en

Introducción: Uno de los desafíos del milenio a nivel mundial es combatir el avance de la epidemia del virus de la inmunodeficiencia humana/sida. Objetivo: Caracterizar a la población de pacientes con inicio clínico de sida según variables sociodemográficas y epidemiológicas. Métodos: Se realizó un estudio observacional y descriptivo, desde el 2017 hasta el 2021, de 87 personas diagnosticadas con inicio clínico del sida en la provincia de Santiago de Cuba. En el análisis estadístico se emplearon medidas de tendencia central y de dispersión, así como la distribución de frecuencias absolutas y relativas; también, se computaron intervalos de confianza de 95 % para las proporciones de las variables seleccionadas. Resultados: La edad promedio en la serie fue de 42 años (79,3 %); asimismo, predominaron el sexo masculino (91,9 %), el estado civil soltero (91,9 %), la vinculación laboral (72,4 %), los colores de la piel mestizo (52,8 %) y negro (39,3 %) y la procedencia urbana (73,5 %). El coito anal fue la principal forma de contagio (84,0 %), en tanto la mayoría de los afectados de ambos sexos (65,2 % en el masculino y 66,7 % en el femenino) no usaban el preservativo y en los hombres primó la homosexualidad (55,0 %). Conclusiones: El inicio clínico del sida predominó en hombres jóvenes solteros, con vínculo laboral, entre los cuales fueron muy significativas las conductas sexuales de riesgo.

Introduction: One of the millennium challenges worldwide is to fight the advance of the human immunodeficiency virus/aids. Objective: To characterize the sick population with clinical onset of AIDS according to sociodemographic and epidemiologic variables. Methods: An observational and descriptive study was carried out, from 2017 to 2021, of 87 people diagnosed with clinical onset of AIDS in Santiago de Cuba province. In the statistical analysis, measures of central tendency and dispersion were used, as well as the distribution of absolute and relative frequencies; also, confidence intervals of 95% were computed for the proportions of selected variables. Results: The average age in the series was 42 years (79.3%), likewise, there was a prevalence of the male sex (91.9%), single as marital status (91.9%), working bond (72.4%), mixed race (52.8%) and black skin color (39.3%), and the urban origin (73.5%). The anal coitus was the main way of infection (84.0%), while the majority of the affected individuals of both sexes (65.2% in males and 66.7% in females) did not use condoms and homosexuality predominated among men (55.0%). Conclusions: The clinical onset of AIDS prevailed in young and single men, with working bond, among whom risky sexual behaviors were very significant.

Stigma kills

@#Stigma due to an HIV diagnosis is a well-known phenomenon and is a major barrier to accessing care.1 Over the last forty years, HIV has been transformed from a fatal disease to a manageable one, thanks to the remarkable success of antiretroviral (ARV) medication.2 When people living with HIV (PLHIV) start ARV treatment early, their life expectancy is almost completely restored. Moreover, a suppressed viral load means that PLHIV are no longer able to infect other people.3 They can have children naturally without risk to their seronegative partner or their child. PLHIV nowadays are more likely to die with HIV, not of HIV. While a cure remains elusive, the successful global rollout of ARVs means that there is no good reason for a PLHIV to die of AIDS and its complications due to lack of access to proper treatment. The Philippine AIDS Law Republic Act 8504 and its successor, Republic Act 11116 explicitly states that the State should “ensure access to HIV and AIDS-related services by eliminating the climate of stigma and discrimination that surrounds the country’s HIV and AIDS situation, and the people directly and indirectly affected by it.” Unfortunately, despite this admonition, stigma remains a significant cause of delayed HIV testing and of not seeking treatment in our country. In this issue of the journal, Dr. De Los Santos and her colleagues examine the effect of healthcare facility stigma on PLHIV accessing care in the Philippines.4 They report that 81% of their Filipino PLHIV respondents experienced stigma, which is an unacceptably high number. They identify which facilities are more likely to be correlated with stigma and make suggestions on how to address this problem. This study is very timely and comes at a time when the Department of Health is shifting first line antiretrovirals to dolutegravir-based regimens.5 Dolutegravir-based treatment is associated with fewer side effects than efavirenz-based regimens and is much more durable against resistance.6 With an HIV transmitted-drug resistance rate of 11.7%, it is imperative that PLHIV are started on more durable regimens which they are less likely to discontinue.7 Properly addressing stigma means that more people will access care. Better regimens will ensure that people stay in care. This will go a long way towards minimizing the impact of HIV and AIDS on Filipino PLHIV. Stigma among PLHIV is a complicated subject matter. Aside from the stigma associated with diagnosis, there is also stigma associated with the mode of acquisition of the disease. The most-at-risk populations are highly stigmatized. Men who have sex with men, people who inject drugs, and female sex workers experience additional stigma on top of the stigma from an HIV diagnosis.8 Aside from societal stigma, PLHIV are also prone to self-stigma.9 This phenomenon occurs when PLHIV believe they no longer deserve to live since they contracted the disease from deviant or sinful behavior. High rates of depression are found among these self-stigma sufferers. This significantly impacts the entire HIV healthcare cascade, starting from early diagnosis, to accessing treatment, and staying in care. The finding that Public Rural Health Units are the most stigmatizing healthcare facilities is very concerning since these are usually the only facilities available to PLHIV in far-flung areas. This needs to be addressed with better sensitivity training as well as concrete guidelines on avoiding stigma. It is very troubling that facilities that are supposed to cater to vulnerable populations inadvertently make it difficult for them to access care.10 Unfortunately, even facilities in urban areas are not immune to discrimination and stigmatizing behavior. I recall the experience of one of my early PLHIV patients who developed and eventually succumbed to a disseminated fungal infection.11 He told me that he had tried getting tested several years earlier but he had a traumatic experience in the government health facility that he accessed. He made a wrong turn and entered a different clinic in that hospital and when he asked for an HIV test, people recoiled from him in horror. Because of that terrible experience, he put off getting his HIV test for years until he started developing the fungal infection that eventually killed him. Had he been started on proper treatment earlier, he could have been saved. For me, it wasn’t just the fungus that killed him but it was the delay in diagnosis and care as a direct result of stigma. Addressing HIV-related stigma in our country entails a whole-of-society and a whole-of-nation approach. Mental health services to address self-stigma and depression should be standard of care not just among confirmed PLHIV but among the most-at-risk populations. Proactive education of all members of society, especially healthcare workers in facilities that diagnose and care for PLHIV is essential for ensuring sustained linkage to care. Ensuring that the majority of the PLHIV population are properly diagnosed, enrolled in treatment hubs, and have suppressed viral loads will ultimately lead to fewer transmissions and less AIDS-related deaths.

Overall survival in Chilean patients with lymphoma and human immunodeficiency virus: A retrospective cohort study

ABSTRACT Introduction: People living with human immunodeficiency virus (PLWH) still face high morbidity and mortality resulting from lymphoma. Aim: To describe a population of PLWH and lymphoma in a Chilean public hospital and compare the overall survival (OS) with a previously reported cohort from the same institution. Methods: Retrospective single-center cohort study. All the patients diagnosed between 2010 and 2017 were included. Demographic and clinical variables were obtained from medical records. The overall survival (OS) was estimated in treated patients from diagnosis until death or October 2020. The OS was then compared with a cohort of patients diagnosed between 1992 and 2008. Main Results: Eighty-four patients were included. The most common histological types were Burkitt's lymphoma (BL), diffuse large B-cell lymphoma (DLBCL), Hodgkin's lymphoma (HL) and plasmablastic lymphoma (PBL) at 31%, 27%, 21% and 14%, respectively. The three-year OS for the whole cohort of BL, DLBCL, HL and PBL was 58.9%, 65.2%, 47.4%, 76.4% and 50%, respectively. Compared to the cohort of 1992 to 2008, a global increase in the OS was found after excluding HL and adjusting for age and clinical stage (HR 0.38, p = 0.002). However, when the main types were analyzed individually, the increase in the OS was statistically significant only in DLBCL (HR 0.29, p = 0.007). Most patients with DLBCL received CHOP chemotherapy, as in the previous cohort. Conclusion: The OS has improved in this population, despite no major changes in chemotherapy regimens, mainly due to the universal access to antiretroviral therapy.

Micosis diseminadas en pacientes con SIDA en un hospital de referencia

RESUMEN Introducción: las micosis diseminadas siguen aumentando su incidencia en pacientes inmunodeprimidos originando elevadas tasas de morbimortalidad. Los factores de riesgo más importantes asociados al desarrollo de infecciones oportunistas en pacientes infectados con el VIH son recuentos bajos de linfocitos T CD4+ y falta de adherencia al tratamiento con antirretrovirales. Objetivo: describir las características clínicas de las micosis diseminadas en pacientes con SIDA internados en el Departamento de Medicina Interna del Hospital Nacional, Itauguá, Paraguay, desde 2016 al 2018. Materiales y métodos: estudio observacional descriptivo prospectivo y retrospectivo de corte transverso. Se incluyeron a todos los varones y mujeres mayores de 18 años con SIDA diagnosticados con micosis diseminada. La investigación fue aprobada por el Comité de Ética de la Facultad de Medicina de la Universidad Nacional de Itapúa, Paraguay. Resultados: Se incluyeron 80 pacientes de los cuales 52 fueron varones con una edad media de 40 años ±10 años. La micosis más frecuente fue la candidiasis diseminada en 39 pacientes (49,5%), seguida por la criptococosis en 19 pacientes (23%). Del total de los pacientes, 69 (87%) tenían recuentos de CD4+ 100.000 copias y 41 sujetos (51%) habían abandonado el tratamiento antirretroviral. Los órganos más afectados fueron el tubo digestivo y aparato respiratorio. La mortalidad se observó en 17 casos (21%). Entre éstos, 11 (63%) sujetos presentaron falla renal y 9 (55%) estaban caquécticos. Conclusión: se encontró predominio de sexo masculino con una edad media de 40 años. La mayoría de los pacientes tenían carga viral elevada y recuento de CD4+ bajos. La micosis más frecuente fue la candidiasis. Uno de cada cuatro pacientes presentó criptococosis, con mayor frecuencia a nivel meníngeo. La mortalidad por micosis diseminada fue 21%.

ABSTRACT Introduction: Disseminated mycoses continue to increase their incidence in immunosuppressed patients, causing high rates of morbidity and mortality. The most important risk factors associated with the development of opportunistic infections in HIV-infected patients are low CD4+ T lymphocyte counts and lack of adherence to antiretroviral treatment. Objective: To describe the clinical characteristics of disseminated mycoses in patients with AIDS admitted to the Department of Internal Medicine of the Hospital Nacional of Itauguá, Paraguay from 2016 to 2018. Materials and methods: Prospective and retrospective descriptive cross-sectional observational study. All men and women older than 18 years with AIDS and diagnosed with disseminated mycosis were included. The research was approved by the Ethics Committee of the Faculty of Medicine of the National University of Itapúa, Paraguay. Results: Eighty patients were included, of which 52 were men with a mean age of 40 years ±10 years. The most frequent mycosis was disseminated candidiasis in 39 patients (49.5%), followed by cryptococcosis in 19 patients (23%). Of the total number of patients, 69 (87%) had CD4+ counts 100,000 copies, and 41 subjects (51%) had discontinued antiretroviral treatment. The most affected organs were the digestive tract and the respiratory system. Mortality was observed in 17 cases (21%) and among these, 11 (63%) subjects had renal failure and 9 (55%) were cachectic. Conclusion: Male predominance was found with a mean age of 40 years. Most of the patients had high viral load and low CD4+ counts. The most frequent mycosis was candidiasis. One in four patients presented cryptococcosis, most frequently at meningeal level. Mortality due to disseminated mycosis was 21%.

Gender-Stratified Factors Associated with Stigma Toward HIV/ AIDS among Rural Communities in Sarawak, Malaysia

@#Introduction: Many factors hinder the effective responses to the HIV/AIDS epidemic. Stigma is one of the major barriers to effective responses to the HIV/AIDS epidemic. It is often considered the main reason for the low response to access proper services for prevention, treatment, and care for HIV/AIDS. In this context, we assessed the perceived level of stigmatisation towards people with HIV/AIDS among rural communities in Sarawak and determined its associated factors. Methods: This cross-sectional community-based study was conducted among the adult population aged 18 years and above among rural communities in Sarawak, Malaysia. A gender-stratified multistage cluster sampling technique was adopted to select the respondents. A total of 900 respondents were successfully interviewed using interviewer-guided questionnaires. Stepwise multiple linear regression with forward and backward selection method was used to determine the HIV/AIDS-related stigma. A p-value of ≤.05 was considered statistically significant. Results: Analysis revealed that females are more stigmatised than males (p<.05). Multivariate analysis showed that those who did not know someone had HIV and Chinese ethnicity were potential predictors in both male and female groups. Having no gainful job, and discussion of HIV/AIDS, household income less than MYR 500, history of HIV testing, knowledge on HIV transmission and exposure to HIV/AIDS information were factors that influenced HIV/ AIDS-related stigma among female respondents. On the other hand, age group 30 to 39, Bidayuh, Chinese ethnicity, and not knowing someone had HIV and media exposure on HIV were factors that influenced HIV/AIDS-related stigma among male respondents. Conclusion: HIV/AIDS-related stigma towards HIV/AIDS existed in rural communities. Enhanced health promotion related to HIV/AIDS activities in rural communities are needed to curb stigmatisation toward people with HIV/AIDS.

Prevalence and factors associated with late diagnosis of the HIV infection in a municipality of São Paulo / Prevalencia y factores asociados al diagnóstico tardío de la infección ocasionada por el VIH en un municipio de São Pauloo / Prevalência e fatores associados ao diagnóstico tardio da infecção pelo hiv em um município paulista

ABSTRACT Objective: to identify the prevalence and factors associated with late diagnosis of the infection by the Human Immunodeficiency Virus (HIV), in a municipality of São Paulo. Method: an epidemiological, analytical and retrospective study that analyzed the HIV and AIDS cases notified by the health services in the period from 2015 to 2017 using data from the notifications of the Information System for Notifiable Diseases (SINAN Net) corresponding to the users recently diagnosed with HIV/AIDS infection in the municipality of Ribeirão Preto/SP, Brazil. Data collection was in May 2018. The chi-square test was performed, as well as binary logistic regression, where the dependent variable was the AIDS criterion at the moment of notifying infection by HIV. A p-value<0.05 was considered for the association between the variables studied in relation to late diagnosis. Results: of the 829 (100%) new HIV cases, 290 (35.0%) were diagnosed in the condition of AIDS. Most of the population was male and aged between 15 and 34 years old. Oral candidiasis and weight loss greater than 10% were the main symptoms associated with AIDS. It was observed that people with lower schooling levels and older were more prone to late diagnoses. Conclusion: it is necessary to devise strategies that favor timely diagnosis in the municipality under study, particularly among the individuals aged over 45 years old and with lower schooling levels.

RESUMEN Objetivo: identificar la prevalencia y los factores asociados al diagnóstico tardío de la infección ocasionada por el Virus de Inmunodeficiencia Humana (HIV) en un municipio del interior de Brasil. Método: estudio epidemiológico, analítico y retrospectivo que analizó los casos de VIH y SIDA notificados por los servicios de salud entre 2015 y 2017 por medio de los datos de las notificaciones del Sistema de Información de Problemas de Salud pasibles de Notificación (SINAN Net) referentes a los usuarios recién diagnosticados con la infección ocasionada por el VIH/SIDA en el municipio de Ribeirão Preto/SP, Brasil. La recolección de datos fue en mayo de 2018. Se realizaron tanto una prueba de chi-cuadrado como un análisis de regresión logística binaria, en la cual la variable dependiente fue el criterio de SIDA al momento de notificar la infección ocasionada por el HIV. Se consideró un valor de p<0,05 para la asociación entre las variables estudiadas en relación con el diagnóstico tardío. Resultados: entre los 829 (100%) casos nuevos de HIV, 290 (35,0%) fueron diagnosticados en la condición de SIDA. La mayoría de la población era del sexo masculino y pertenecía al grupo etario de 15 a 34 años. Candidiasis oral y pérdida de peso superior al 10% fueron los principales síntomas asociados al SIDA. Se observó que las personas con niveles de educación más bajos y de mayor edad fueron más propensas a ser diagnosticadas tardíamente. Conclusión: es necesario elaborar estrategias que favorezcan el diagnóstico oportuno en el municipio estudiado, particularmente entre las personas de más de 45 años de edad y con niveles de educación más bajos.

RESUMO Objetivo: identificar a prevalência e os fatores associados ao diagnóstico tardio da infecção pelo vírus da imunodeficiência humana (HIV), em um município do interior paulista. Método: estudo epidemiológico, analítico e retrospectivo que analisou os casos de HIV e AIDS notificados pelos serviços de saúde no período de 2015 a 2017 por meio dos dados das notificações do Sistema de Informação de Agravos de Notificação (Sinan Net) dos usuários recém-diagnosticados para a infecção pelo HIV/AIDS no município de Ribeirão Preto/SP, Brasil. A coleta de dados ocorreu em maio de 2018. Foi realizado o teste qui-quadrado e regressão logística binária, no qual a variável dependente foi o critério de AIDS no momento da notificação da infecção pelo HIV. Foi considerado o valor de p<0,05 para a associação entre as variáveis estudadas com relação ao diagnóstico tardio. Resultados: dentre os 829 (100%) casos novos de HIV, 290 (35,0%) foram diagnosticados na condição de AIDS. A maioria da população pertencia ao sexo masculino e na faixa etária dos 15 aos 34 anos. A candidose oral e a perda de peso acima de 10% foram os principais sintomas associados à AIDS. Observou-se que pessoas com menor escolaridade e com o aumento da idade eram mais propensas a serem diagnosticadas tardiamente. Conclusão: estratégias que favoreçam o diagnóstico oportuno no município estudado são necessárias, particularmente entre os indivíduos com idade acima de 45 anos e com menor escolaridade.

Prevalence of intestinal parasites in a cohort of HIV- infected patients from Antioquia, Colombia / Prevalencia de parásitos intestinales en una cohorte de pacientes positivos para HIV en Antioquia, Colombia

Abstract | Introduction: HIV infection is still a public health problem worldwide and co-infections with other infectious agents including intestinal parasites are of particular concern, mainly in developing countries like Colombia. Objective: To conduct a cross-sectional study in patients attending an HIV care program in Antioquia given that there have been few intestinal parasites prevalence studies among the HIV population in the country. Material and methods: We evaluated stool samples from 192 patients by direct wet mount and concentration, modified Ziehl Neelsen staining, and agar plate culture. Univariate and correlation analyses were done to explore the association between socio-demographic and clinical characteristics and parasitological data. Results: The overall prevalence of intestinal parasites in HIV-positive subjects was 29.2% (56/192; 95% CI: 22.8% - 35.6%). Entamoeba histolytica/dispar/moshkosvkii with 13.0% (25/192; 95% CI: 8.2% - 17.8%) and Blastocystis with 12.0% (23/192; 95% CI: 7.4% -16.6%) were the most frequent. Opportunistic parasites like Cryptosporidium spp. and Cystoisospora belli were less prevalent, each one with 0.5% of positive samples (1/192; 95% CI: 0.1% - 1.5%). Commensal protozoa were also detected with a prevalence of 18.8% (36/192; 95% CI: 13.3% - 24.3%). Most of the individuals in the study had a controlled viral load and an LTCD4 count greater than 200 cel/µL. A small percentage (9.3%) had diarrhea. Bivariate analysis and multivariate logistic regression showed that only age and having pets had a significant association with intestinal parasites in this cohort. Conclusions: Our results confirmed that the evaluated population is at high risk of intestinal parasite infection, which highlights the need for routine screening of gastrointestinal parasites to provide prompt treatment and reduce possible complications.

Resumen | Introducción. La infección por HIV y las coinfecciones con otros agentes infecciosos, incluidos los parásitos intestinales, son motivo de especial preocupación en países en desarrollo como Colombia. Objetivo. Hacer un estudio transversal en pacientes que asisten a un programa de atención de HIV en el departamento de Antioquia, dado que los estudios de prevalencia de parásitos intestinales en la población con HIV son escasos en el país. Materiales y métodos. Se evaluaron 192 muestras de materia fecal mediante examen coprológico directo y por concentración, tinción de Ziehl-Neelsen modificada, y aislamiento en agar. Se hicieron análisis univariados y de correlación, para explorar la asociación entre las características sociodemográficas y clínicas, y los datos parasitológicos. Resultados. La prevalencia global de parásitos intestinales en pacientes positivos para VIH fue del 29.2 % (56/192; IC95% 22.8-35.6 %), siendo Entamoeba histolytica/dispar/moshkosvkii, con 13.0 % (25/192; IC95% 8.2-17.8 %), y Blastocystis, con 12.0 % (23/192; IC95% 7.4-16.6 %), los mas frecuentes. Los parásitos oportunistas Cryptosporidium spp. Y Cystoisospora belli fueron menos prevalentes, cada uno con 0.5 % (1/192; IC95% 0.1-1.5 %) de muestras positivas. También, se detectaron protozoos comensales, con una prevalencia del 18,8 % (36/192; IC95% 13,3-24,3 %). La mayoría de los individuos tenía una carga viral controlada y un recuento de linfocitos T CD4 superior a 200 células/μl. Un pequeño porcentaje (9,3 %) presentó diarrea. La edad y el tener mascotas mostraron una asociación significativa con la presencia de parásitos intestinales. Conclusión. Se confirmó que la población evaluada tiene un alto riesgo de infección por parásitos intestinales, lo que resalta la necesidad de un protocolo de diagnóstico para el cribado de dichos agentes, con el fin de brindar un tratamiento rápido y reducir las posibles complicaciones.

Linfomas en pacientes con VIH: una asociación compleja y frecuente. Revisión narrativa de la literatura / HIV-related lymphomas: a complex and frequent association. A narrative review of the literature

En Colombia, la infección por el virus de la inmunodeficiencia humana (VIH) es una epidemia en aumento. Ante la mejoría de la supervivencia general con la terapia antirretroviral altamente efectiva, la aparición de neoplasias malignas ha ido desplazando las complicaciones infecciosas como principal problema en esta población. Los linfomas no Hodgkin son las neoplasias malignas definitorias de síndrome de inmunodeficiencia adquirida (SIDA) más frecuentes después del sarcoma de Kaposi, siendo el linfoma B difuso de células grandes y el linfoma de Burkitt las variantes más comunes; por otra parte, el riesgo de desarrollar linfoma de Hodgkin clásico es 5 a 20 veces mayor en pacientes positivos para VIH en comparación con la población general. Realizar un diagnóstico temprano es un reto, debido a infecciones oportunistas y a la presentación atípica de la enfermedad en este grupo de pacientes. El tratamiento de la enfermedad también supone un desafío debido a las comorbilidades y el estado funcional de los pacientes al momento del diagnóstico; sin embargo, en conjunto con esquemas combinados de quimioterapia y al uso concomitante de la terapia antirretroviral, se ha mejorado considerablemente el pronóstico, el cual actualmente se acerca al de los pacientes seronegativos. Por medio de esta revisión, se pretende describir las principales características de los linfomas asociados al VIH, de tal forma que permita a los trabajadores en salud, tener mayores elementos para el abordaje integral de esta población en nuestro país

In Colombia, human immunodeficiency virus (HIV) infection is a growing epidemic. Given the improvement in overall survival with highly effective antiretroviral therapy, cancer has been displacing infectious complications in this population. Non-Hodgkin's lymphoma is the most common AIDS defining malignancy after Kaposi's sarcoma. Diffuse large B-cell lymphoma and Burkitt's lymphoma are the most common variants; meanwhile, the risk of developing classical Hodgkin lymphoma is 5 to 20-fold higher compared to HIV-negative individuals. Making an early diagnosis is a challenge, due to opportunistic infections and the atypical presentation of the disease in this group of patients. Treatment of the disease is also a challenge given the comorbidities and patient condition at diagnosis; however, in conjunction with combined chemotherapy regimens and the concomitant use of antiretroviral therapy, the outcome of patients with AIDS-related lymphomas has significantly improved, currently approaching that of seronegative patients. The aim of this review article is to describe the main characteristics of the disease, in such a way that it allows health workers to have more elements for a comprehensive approach in patients with AIDS-related lymphomas in our country

Effectiveness of GeneXpert® in the diagnosis of tuberculosis in people living with HIV/AIDS / Efetividade do GeneXpert® no diagnóstico da tuberculose em pessoas que vivem com HIV/aids

ABSTRACT OBJECTIVE To identify and synthesize the scientific knowledge produced regarding the effectiveness of the GeneXpert test in the diagnosis of pulmonary tuberculosis (TB) in people living with HIV/AIDS. METHODS Integrative literature review, which was searched on Embase, Scopus, PubMed, Cinahl, Academic Search Premier, Socindex, and LILACS platforms, in December 2019. The studies surveyed went through two stages of selection: reading of titles and abstracts by two reviewers independently; using the Rayyan platform and reading. Nineteen primary studies in English, Portuguese, and Spanish that answered the study's guiding question were included: How effective is the GeneXpert test in the diagnosis of pulmonary TB in people living with HIV/AIDS? RESULTS The use of GeneXpert substantially increased the detection of TB cases among the population co-infected with HIV/AIDS, with sensitivity ranging from 68% to 100%, superior to sputum smear microscopy. Specificity ranged from 91.7% to 100%; the positive predictive value from 79.2% to 96.1%; and the negative predictive value from 84.6% to 99.3%. These values were considered similar to sputum smear microscopy by most studies. We also compared these results with different ways of performing culture and other molecular tests, being considered inferior only to the Xpert Ultra. CONCLUSION It is possible to affirm that places with a high incidence of HIV/AIDS would benefit from the implementation of the GeneXpert test, entailing effectiveness in diagnosing pulmonary TB in this population when compared to sputum smear microscopy, a widely used test for detection of cases.

RESUMO OBJETIVO Identificar e sintetizar o conhecimento científico produzido a respeito da efetividade do teste GeneXpert no diagnóstico da tuberculose (TB) pulmonar em pessoas vivendo com HIV/aids. MÉTODOS Revisão integrativa da literatura, cuja busca foi feita nas plataformas Embase, Scopus, PubMed, Cinahl, Academic Search Premier, Socindex e Lilacs, em dezembro de 2019. Os estudos levantados passaram por duas etapas de seleção: leitura dos títulos e resumos por dois revisores de forma independente, utilizando a plataforma Rayyan e leitura integral dos mesmos. Foram incluídos 19 estudos primários em inglês, português e espanhol que respondiam à pergunta norteadora do estudo: Qual é a efetividade do teste GeneXpert no diagnóstico da TB pulmonar em pessoas que vivem com HIV/aids? RESULTADOS A utilização do GeneXpert aumentou substancialmente a detecção de casos de TB entre a população coinfectada com HIV, com sensibilidade que variou de 68% a 100%, sendo superior à baciloscopia. A especificidade variou de 91,7% a 100%; o valor preditivo positivo, de 79,2% a 96,1%; e o valor preditivo negativo, de 84,6% a 99,3%, valores considerados semelhantes à baciloscopia pela maioria dos estudos. O teste também foi comparado com as diferentes formas de realização da cultura e outros testes moleculares, sendo considerado inferior apenas ao Xpert Ultra. CONCLUSÃO É possível afirmar que locais com alta incidência de HIV se beneficiariam com a implantação do teste GeneXpert, uma vez que sua efetividade no diagnóstico da TB pulmonar nessa população é expressiva quando comparada à baciloscopia, teste que foi por muito tempo amplamente utilizado para a detecção dos casos.

Isolation of Malassezia spp. in HIV-positive patients with and without seborrheic dermatitis

Abstract Background Malassezia, a skin saprophyte, is frequently isolated from patients with seborrheic dermatitis, which is one of the most common dermatoses in HIV-infected patients. Its role in pathophysiology has not been defined. Objective To determine whether patients living with HIV and seborrheic dermatitis have more Malassezia than those without seborrheic dermatitis. Method This is an descriptive, observational, prospective cross-sectional study to which all adult patients living with HIV that attend the infectious disease outpatient clinic at the Dr. Manuel Gea González General Hospital were invited. Patients presenting with scale and erythema were included in Group 1, while patients without erythema were included in Group 2. Samples were taken from all patients for smear and culture. Results Thirty patients were included in each group. All patients with seborrheic dermatitis had a positive smear, with varying amounts of yeasts. In the control group, 36.7% of patients had a negative smear. The results are statistically significant, as well as the number of colonies in the cultures.Study limitations The study used a small sample size and the subspecies were not identified. Conclusions Patients with clinical manifestations of seborrheic dermatitis have larger amounts of Malassezia. Further studies need to be performed to analyze if the greater amount is related to imbalances in the microbiota of the skin.

A 4-year follow-up study on sexual orientation, sexual behavior and AIDS related knowledge of undergraduate students in a medical university / 中华疾病控制杂志

Objective To explore the characteristics of medical sexual orientation, sexual behavior and acquired immunodeficiency syndrome(AIDS) related knowledge changing with grade. Methods A group of 876 undergraduate students of 2015 in a medical university were selected to conduct an anonymous survey once a year and a total of four times using self-compiled questionnaires on AIDS-related knowledge, sexual orientation and behavior of college students. Descriptive epidemiological methods were adopted for statistical description. Results The distribution of sexual orientation among medical students with different survey batches was statistically significant ( 2=26.223, P=0.036). The proportion of openly gay people in the total number of homosexuals showed an increasing trend ( 2trend=4.150, P=0.042). Follow-up study of Chinese medicine students on AIDS related knowledge of the overall rate of increased ( 2trend=23.462, P<0.001). The incidence of general sexual behavior and male homosexual sex among medical students in the past six months showed an increasing trend with grade growth ( 2trend=4.450, P=0.035; 2trend=6.738，P=0.009). At the second and third follow-ups, the proportion of men who used condoms occasionally and never used condoms increased, and the difference was statistically significant ( 2=7.935, P=0.047). Conclusions Due to the weak awareness of medical sexual safety protection, the school should continue to strengthen the AIDS publicity and prevention education of medical students in all grades, and improve the school sexual health education mechanism.

Epidemiological characteristics of HIV infected Korean: Korea HIV/AIDS Cohort Study / 한국역학회지

OBJECTIVES: To manage evidence-based diseases, it is important to identify the characteristics of patients in each country.METHODS: The Korea HIV/AIDS Cohort Study seeks to identify the epidemiological characteristics of 1,442 Korean individuals with human immunodeficiency virus (HIV) infection (12% of Korean individuals with HIV infection in 2017) who visited 21 university hospitals nationwide. The descriptive statistics were presented using the Korea HIV/AIDS cohort data (2006-2016).RESULTS: Men accounted for 93.3% of the total number of respondents, and approximately 55.8% of respondents reported having an acute infection symptom. According to the transmission route, infection caused by sexual contact accounted for 94.4%, of which 60.4% were caused by sexual contact with the same sex or both males and females. Participants repeatedly answered the survey to decrease depression and anxiety scores. Of the total participants, 89.1% received antiretroviral therapy (ART). In the initial ART, 95.3% of patients were treated based on the recommendation. The median CD4 T-cell count at the time of diagnosis was 229.5 and improved to 331 after the initial ART. Of the patients, 16.6% and 9.4% had tuberculosis and syphilis, respectively, and 26.7% had pneumocystis pneumonia. In the medical history, sexually transmitted infectious diseases showed the highest prevalence, followed by endocrine diseases. The main reasons for termination were loss to follow-up (29.9%) and withdrawal of consent (18.7%).CONCLUSIONS: Early diagnosis and ART should be performed at an appropriate time to prevent the development of new infection.

Clinicopathological features of intestinal mucosal lesions in AIDS patients and their relation with CD4+ T lymphocytes / 中华病理学杂志

Objective@#To observe the histopathological features of different opportunistic infections and tumors of the intestinal mucosa in AIDS patients, and to explore the correlation between different lesions and CD4+ T lymphocyte levels.@*Methods@#Colonic mucosal biopsy specimens of 263 patients with clinically diagnosed AIDS and abdominal pain, diarrhea, blood in the stool and other gastrointestinal symptoms were collected from Beijing Ditan Hospital from 2010 to 2018. There were 232 males and 31 females, with age range 10-81 (mean 40±13) years. HE staining, histochemical special staining, immunohistochemical staining, and in-situ hybridization were used to detect the expression of different opportunistic infection pathogens, tumors and CD4+ T lymphocytes. Peripheral blood was also taken for CD4+ T lymphocytes, CD8+ T lymphocytes, HIV viral load and routine indicators.@*Results@#The cohort included 263 intestinal mucosal biopsy specimens. There were 175 cases (66.5%) of non-specific inflammation, and pathogens were detected in 41 cases (15.6%), including 20 cases(7.6%) of cytomegalovirus (CMV) infection, 12 cases (4.6%) of mycobacterial infection, eight cases (3.0%) of amoeba infestation, and one case (0.3%) of talaromycesmarneffei infection; there were also 41 (15.6%) neoplastic lesions including 25 cases (9.5%) of intraepithelial neoplasia, 10 cases (3.8%) of adenocarcinoma and squamous cell carcinoma, six cases (2.3%) of lymphoma; and six cases (2.3%) of ulcerative colitis. The peripheral blood CD4+T lymphocyte levels of patients with CMV, mycobacteria and talaromycesmarneffei were less than 200/μL; the peripheral blood CD4+ T lymphocyte level (P<0.01) and intestinal mucosa CD4+T lymphocytes (P<0.01) were all significantly lower than those in patients with non-specific inflammation. The peripheral red blood cells and hemoglobin levels of patients with CMV and mycobacterial infection (P<0.01), adenocarcinoma and squamous cell carcinoma (P<0.05) were significantly lower than those of non-specific inflammation patients.@*Conclusions@#Pathologic examination of intestinal mucosa can identify specific infections and neoplastic lesions in AIDS patients; the most common lesions are non-specific inflammation, and CMV infection is the most common opportunistic infections; CMV, mycobacteria and talaromycesmarneffei infections are associated with decreased levels of CD4+ T lymphocytes in peripheral blood and intestinal mucosa; entamoeba histolytica infestation and non-HIV-related neoplastic lesions such as intraepithelial neoplasia, adenocarcinoma and squamous cell carcinoma are not associated with changes in AIDS immune function.

The research of inflammatory cytokines and T cell activation in peripheral blood of opportunistic infections and death in HIV / 中国医师杂志

Objective The plasma levels of interleukin 6 (IL-6),high sensitive C reactive protein (hs-CRP) and the level of T cell activation were detected in the peripheral blood inflammatory factors of acquired immunodeficiency syndrome (AIDS) patients,and the relationship with opportunistic infection and prognosis was analyzed.Methods 79 human immunodeficiency virus (HIV)-positive/aids cases from May 2014 to January 2015 in first hospital of Changsha were enrolled in the study.They were divided into three groups:HIV-infected without opportunistic infections group (n =20),HIV-infected with infections group (n =43,including HIV-infected with tuberculosis group,HIV-infected with merge fungus group.HIV combined hepatitis C),death group (n =16).Serum IL-6 and the concentration of hs-CRP were detected by enzyme-linked immunosorbent assay (ELISA).Flow cytometry was used to test the CD3 + CD4 + cell count,the percentage of CD4 + CD38 + cell and CD8 + CD38 + cell in peripheral blood mononuclear cell (PBMC).Compare the differences among the three groups.Results The results showed that:the concentration of hsCRP and IL-6 in peripheral blood of HIV death group was significantly higher than that in other three groups (P ＜ 0.05).The concentration of hs-CRP and IL-6 in the peripheral blood of the HIV-infected with tuberculosis group and HIV-infected with merge fungus group were significantly higher than that in the HIV-infected without opportunistic infections group (P ＜ 0.05),and the hs-CRP in the peripheral blood of the HIV combined with the hepatitis C group was higher than that in the HIV-infected without opportunistic infections group (P ＜ 0.05).The number of CD3,CD4T lymph nodes in the death group and the combined opportunistic infection group was significantly lower than that in the HIV-infected without opportunistic infections group (P ＜ 0.05).The HIV-RNA expression in peripheral blood of the death group and the combined opportunistic infection group was significantly lower than that in the HIV-infected without opportunistic infections group (P ＜ 0.05).The expression of CD8+CD38+ on PBMC in the HIV-infected without opportunistic infections group was significantly lower than that in the death group,the tuberculosis group,the fungus group and the hepatitis C group (P ＜ 0.05).The expression of CD4+ CD38 + on PBMC in the HIV-infected without opportunistic infections group was higher than that in the death group (P ＜ 0,05).Conclusions The concentration of inflammatory cytokines (IL-6,hs-CRP) and the expression level of T cell surface CD8 + CD38 + related to immune activation were associated with opportunistic infection and prognosis of AIDS.

Diagnosis and treatment progress of acquired immunologic deficiency syndrome-related lymphoma / 白血病·淋巴瘤

Malignancy is one of the most important complications of acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV) infection and destruction of host CD4-positive T lymphocytes. Lymphoma ranks first in AIDS-related malignancies. The clinical features of lymphoma patients infected with HIV are different from non-HIV infected patients. The host immune condition in anti-lymphoma chemotherapy also needs to be considered. This paper reviews the clinical characteristics of AIDS-related lymphoma and the attention in anti-lymphoma therapy according to the latest international research findings and related guidelines.

Analysis of AIDS epidemic and clinical features in some part regions of Henan province during 2006-2015 / 中国基层医药

Objective To discuss the epidemiology and clinical characteristics of AIDS in some part of Henan regions.Methods Retrospective analysis was conducted based on the clinical and epidemic information collected from AIDS patients who were treated in the Sixth People's Hospital of Zhengzhou between 2006 and 2015 in He'nan province.Results Between 2006 and 2015,the number of hospitalization increased every year.The average growth rate was 20.31％.The average age of patients was (43.91 ± 13.56) years old.The patients from 40 to 60 years old group occupied 54.06％ of total patients,and 71.12％ of patients were farmers.During 2006 to 2015,the propagation path changed a lot.Before 2008,blood transmission was the major propagation path (72.72％),but after 2013,the major propagation path was sexual activity (59.69％).40.41％ of patients were infected by two or more opportunistic infections.The top five opportunistic infections were bacterial pneumonia (32.68％),tuberculosis (19.29％),fungal infection (18.65％),pneumocystis carinii pneumonia (12.96％),extra pulmonary tuberculosis (7.45％).The death rate was 5.79％.The number of CD4 cells in peripheral blood was closely related to the severity of illness.Conclusion Early anti-virus treatment and opportunistic infection control are key factors to relieve the severity of illness and reduce the death rate.

Chylous ascites secondary to Hodgkin's lymphoma in a HIV/aids patient: case report and literature review

Study design: case report. Case report: Man, 42 years old, diagnosed with aids two years ago, had developed enlarging in abdominal volume six months from admission. Computed tomography imaging showed free liquid in peritoneal cavity and increased retroperitoneal and mesenteric lymph nodes, besides splenomegaly. Ascitic fluid had milky appearance and high triglycerides levels. Hodgkin's lymphoma (mixed cellularity) was confirmed by histopathological analysis of a video-laparoscopic lymph node biopsy, Ann Arbor IIIS staging. Chemotherapy and continuation of highly active antiretroviral therapy resulted in weight gain and reduction of abdominal volume. Chylous ascites is a rare condition, which has a vast differential diagnosis. Discussion: In our review, the majority (15/18, 83%) of chylous ascites in HIV/aids-patients are due to infectious causes (mainly Mycobacterium avium complex and tuberculosis infection), in highly immunocompromised patients (mean TCD4=87cell/mL). To the best of our knowledge, this is the first case of chylous ascites secondary to Hodgkin's lymphoma in a patient with aids. (AU)

Tipo de estudo: relato de caso. Relato de caso: Homem, 42 anos, diagnosticado com aids há dois anos, desenvolveu aumento de volume abdominal há seis meses da admissão. Tomografia computadorizada mostrou líquido livre na cavidade peritoneal, além de linfonodos mesentéricos e esplenomegalia. O líquido ascítico tinha aspecto leitoso e alto nível de triglicerídeos. Após amplo diagnóstico diferencial, diagnosticamos linfoma de Hodgkin tipo celularidade mista por biópsia linfonodal via videolaparoscópica, Ann Arbor IIIS. Quimioterapia e continuação da terapia antirretroviral de alta potência resultaram em ganho de peso e redução do volume abdominal. Ascite quilosa é uma entidade rara, que possui vários diagnósticos diferenciais. Discussão: Em nossa revisão, a maioria (15/18, 83%) dos casos de ascite quilosa em paciente com HIV/aids deveu-se a causa infecciosa (especialmente pelo Mycobacterium avium complex e tuberculose), em pacientes gravemente imunocomprometidos (linfócitos T-CD4 médio=84células/mm3). Até onde sabemos, este é o primeiro caso de ascite quilosa secundária a linfoma de Hodgkin em paciente com aids. (AU)

Sarcoma de Kaposi en el recto, reporte de un caso / Kaposi´s sarcoma in the rectum: case report

En 1872, el dermatólogo austro-húngaro Moritz Kaposi describió -por primera vez- esta enfermedad clínica y la llamó Sarcoma Múltiple Pigmentado Idiopático, que afecta a varones judíos y de áreas mediterráneas. En 1956 describieron una variedad endémica en África ecuatorial. En la década de los 60 se describió una tercera variedad en pacientes sometidos a trasplante renal e inmunodeprimidos. En la década de los 80 se comunicaron los primeros casos asociados al Virus de la Inmunodeficiencia Humana. Caso clínico: Se presentó el caso de un paciente portador del Virus de la Inmunodeficiencia Humana que fue atendido en el Hospital Carlos Andrade Marín de la ciudad de Quito, por presentar lesiones exofíticas distribuidas en la región inguinal, genital y ano-perineal, con secreción amarillenta de mal olor, edema de la bolsa escrotal y del muslo derecho. El diagnosticó fue Sarcoma de Kaposi asociada al virus de Inmunodeficiencia Humana. La evolución desfavorable y el estadio avanzado de la enfermedad provocaron la muerte del paciente. Discusión: El Sarcoma de Kaposi (SK) es una neoplasia maligna vascular, más frecuente en pacientes inmunocomprometidos, conlleva una alta morbilidad y mortalidad. El diagnóstico requiere una confirmación histológica de la celularidad neoplásica y la presencia del VHH-8.

In 1872 the Austro Hungarian dermatologist Moritz Kaposi described this clinical entity for the first time and called Idiopathic Pigmented Multiple Sarcoma that affected male Jews from Mediterranean areas. In 1956 an endemic variety in equatorial Africa was reported. In the 1960s, a third variety was described in patients undergoing renal transplantation and receiving immunosuppression. In the 80s appeared in patients infected with the Human Immunodeficiency Virus. Case report: The case of a patient previously diagnosed as a carrier of human immunodeficiency virus treated at Carlos Andrade Marín Hospital, Quito Ecuador, for having exophytic lesions distributed in the inguinal, genital and ano-perineal regions, with a fetid yellowish discharge, scrotal and right thigh edema. A diagnosis of Kaposi's sarcoma associated to acquired immunodeficiency virus was made. After an unsatisfactory evolution and due to the advanced stage of the disease, the patient died. Discussion: Kaposi's Sarcoma (KS) is a malignant vascular neoplasm, more frequent in immunocompromised patients. It has a high morbidity and mortality. The diagnosis requires histological confirmation of neoplastic cellularity and the presence of HHV-8.

Investigation on AIDS cognition and sexual behavior among patients with HIV/AIDS in shenzhen in 2016 / 中华实验和临床病毒学杂志

Objective@#To investigate the situations of AIDS related knowledge, sexual behavior with various partners among HIV positive patients in Shenzhen before highly active anti-retroviral therapy, and to provide evidences for health education intervention.@*Methods@#Questionnaire survey and information collection were carried out among HIV positive patients, under the informed consent, during the first physical examination before highly active anti-retroviral therapy.@*Results@#The overall awareness rate of AIDS knowledge was 91%, 94.46% and 80.95% respectively for homosexual and heterosexual populations, with significant difference between the two groups (χ2=21.254, P<0.001). In addition, there were significant differences in the factors related to education, income, route of infection, marital status, residence and other related factors (P<0.05). In HIV positive MSM, primary sexual behavior occurred mainly at the age of less than 30 (96.8%) and in university or earlier stage (58.3%), college students as the first sexual partner accounted for 44.9%, and once used Rush accounted for 42.7%. There were significant differences in the number of temporary sexual partners and condom use frequency between homosexual and heterosexual subjects (P<0.05).@*Conclusions@#Individuals infected with HIV via different routes are variant on AIDS cognition. Health education on AIDS related knowledge and sexual security before and after antiviral treatment can not only improve the awareness rate of HIV/AIDS infection, but also can reduce the risk of the spread of HIV/AIDS.

Noninvasive intracranial pressure monitoring for HIV-associated cryptococcal meningitis

Mortality and adverse neurologic sequelae from HIV-associated cryptococcal meningitis (HIV-CM) remains high due to raised intracranial pressure (ICP) complications. Cerebrospinal fluid (CSF) high opening pressure occurs in more than 50% of HIV-CM patients. Repeated lumbar puncture with CSF drainage and external lumbar drainage might be required in the management of these patients. Usually, there is a high grade of uncertainty and the basis for clinical decisions regarding ICP hypertension tends to be from clinical findings (headache, nausea and vomiting), a low Glasgow coma scale score, and/or fundoscopic papilledema. Significant neurological decline can occur if elevated CSF pressures are inadequately managed. Various treatment strategies to address intracranial hypertension in this setting have been described, including: medical management, serial lumbar punctures, external lumbar and ventricular drain placement, and either ventricular or lumbar shunting. This study aims to evaluate the role of a non-invasive intracranial pressure (ICP-NI) monitoring in a critically ill HIV-CM patient.