Evaluación comparativa de medición de linfocitos CD4+ por dos técnicas: estándar nacional versus test rápido de ejecución local

Antecedentes: El recuento de linfocitos CD4+ (LTCD4) es una herramienta fundamental para la evaluación y seguimiento de los pacientes que viven con VIH. En Chile, la medición de LTCD4 estandarizada es por citometría de flujo. En el sistema público se realiza en forma centralizada en tres centros. Actualmente existen tecnologías de medición rápida de recuento de LTCD4 en el lugar de atención, permitiendo optimizar la atención de pacientes con infección por VIH. Objetivo: Comparar la precisión de un test rápido de ejecución local versus la técnica estándar. Metodología: Realización de ambas técnicas en un grupo de 102 pacientes durante su control regular de salud. Resultados: El rango de variación promedio de los resultados entre las dos técnicas fue de 10%, con una concordancia en los recuentos de LTCD4 de 97% para el rango de CD4 < 200 cél/uL, de 88% para los pacientes con recuento de LTCD4 entre 200 y 349 cél/uL y de 67% en los rangos superiores. Conclusión: La técnica por test rápido es un sistema fácil de aplicar, de bajo costo, con alta concordancia con la técnica estándar, lo que debería considerarse en la atención de los pacientes que viven con VIH.

Background: The CD4+ lymphocyte cell count is an instrumental tool for the assessment and follow-up in the therapeutic management of patients living with HIV. In Chile, the standardized CD4+ lymphocyte count technique is by flow cytometry. In the public health system, it is performed centralized in 3 sites. Currently, there are technologies that allow measuring the CD4 lymphocyte count at the point of care, allowing to optimize the care of HIV-infected patients. Aim: To compare the accuracy of a point of care rapid test versus the standard technique in patients under regular care at a single HIV center. Results: The average variation of the results between the two techniques was 10%, with a 97% concordance in CD4 range values for patients with CD4 below 200 cells/uL, 88% for CD4 counts between 200 and 349 cells/uL. and 67% above that range. Conclusion: This point of care test is an easy-to-operate, low-cost system with high correlation with the standard technique and should be considered in the care of patients living with HIV.

Recuento de linfocitos CD4, carga viral y colonización oral por Candida en personas viviendo con VIH/SIDA

Objetivos: determinar la correlación entre el recuento de CD4, carga viral y la colonización oral por Candida en personas viviendo con VIH/SIDA (PVVS) que reciben terapia antirretroviral (TAR). Métodos: se realizó un estudio transversal correlacional con 35 participantes que recibían tratamiento antirretroviral. Mediante citometría de flujo se determinó el recuento de CD4; la carga viral se determinó mediante RT-PCRq y la confirmación de colonización oral se realizó mediante aislamiento de Candida spp. Resultados: el recuento de CD4 se correlacionó significativamente de manera inversa con la carga viral (rho de Spearman = -0,457, p=0,006; Kendall Tau-b= -0,306, p=0,012) y con la colonización oral por Candida (rho de Spearman = -0,442, p=0,008; Kendall Tau-b= -0,366, p=0,010), no se encontró significancia estadística entre la carga viral y colonización (p>0,05). Conclusiones: En las PVVS que reciben TAR, los recuentos bajos de CD4 se relacionan con mayor colonización oral por Candida, no se encontró asociación de dicha colonización con la carga viral.

Objectives: to determine the correlation between CD4 count, viral load, and oral Candida colonization in people living with HIV/AIDS (PLWHA) receiving antiretroviral therapy (ART). Methods: a correlational cross-sectional study was conducted with 35 participants receiving antiretroviral treatment. Using flow cytometry, the CD4 count was determined; the viral load was determined by RT-PCRq and confirmation of oral colonization was made by isolating Candida spp. Results: CD4 count was significantly inversely correlated with viral load (Spearman's rho = -0.457, p=0.006; Kendall Tau-b= -0.306, p=0.012) and with oral Candida colonization (Spearman's rho = -0.442, p=0.008; Kendall Tau-b= -0.366, p=0,010), no statistical significance was found between viral load and colonization (p>0.05). Conclusions: in PLWHA receiving ART, low CD4 counts are associated with greater oral colonization by Candida; no association of said colonization with viral load was found.

Supervivencia en las personas que viven con VIH en el marco del sistema de salud colombiano 2011-2018 / Survival in people living with HIV in the framework the Colombian health system: 2011-2018

Resumen Objetivo: Describir la supervivencia a siete años y los principales factores asociados a esta, en las personas con VIH que fueron atendidas en el sistema de salud colombiano entre 2011 a 2018. Métodos: Análisis de supervivencia de una cohorte de 64 039 personas diagnosticadas con VIH en Colombia. Se aplicó el método de Kaplan-Meier para estimar la probabilidad de supervivencia a partir de la fecha del diagnóstico. Se ajustó un modelo de supervivencia paramétrico flexible de Royston Parmar. Resultados: La estimación de la supervivencia global a 7 años fue de 94,8% (IC 95%: 94,5-95,2). El mayor riesgo de muerte se presentó en los hombres (HR: 1,2; IC 95%: 1,1-1,4; p: 0,010); en personas ≥50 años de edad (HR: 3,1; IC 95%: 1,6-6,3; p: 0,002); en el régimen subsidiado (HR: 2,2; IC 95%: 1,9-2,5; p: <0,001); en la etapa sida (HR: 2,8; IC 95%: 2,1-3,7; p: <0,001); en quienes presentaron la última carga viral detectable (HR: 7,1; IC 95%: 6,0-8,3; p: <0,001); y en quienes mostraron conteo de linfocitos T CD4+ <350 células/μL (HR: 1,9; IC 95%: 1,4-2,4; p: <0,001). Conclusión: La probabilidad de la supervivencia de las personas que viven con VIH aumenta al ser diagnosticados en edades jóvenes, en quienes presenten un recuento de linfocitos T CD4+ ≥350 células/μL, una carga viral indetectable (< 50 copias/mL) y no se encuentren en etapa sida.

Summary Objective: to describe the seven-year survival and predictors of mortality among people with HIV who were treated in the Colombian health system between 2011 and 2018. Methods: 64 039 people diagnosed with HIV in Colombia were included. Kaplan-Meier analysis estimated the probability of survival from the date of diagnosis. A Royston Parmar flexible parametric survival model was fitted. Results: The overall survival at 7 years was 94.8% (95% CI: 94.5-95.2). Survival was related to sex (men, HR: 1.2; 95% CI: 1.1-1.4; p: 0.010); people ≥50 years of age (HR: 3.1; 95% CI: 1.6-6.3; p: 0.002); subsidized regime (HR: 2.2; 95% CI: 1.9-2.5; p: <0.001); AIDS stage (HR: 2.8; 95% CI: 2.1-3.7; p: <0.001); a detectable viral load (HR: 7.1; 95% CI: 6.0-8.3; p: <0.001); and a CD4+ Lymphocyte count <350 cells/μL (HR: 1.9; 95% CI: 1.4-2.4; p: <0.001). Conclusion: The probability of survival of people living with HIV increases when they are diagnosed at a young age, in those with a CD4+ T Lymphocyte count ≥350 cells/μL, an undetectable viral load (<50 copies/mL) and are not in the AIDS stage.

Manifestaciones oculares asociadas a CD4+ en pacientes con virus de inmunodeficiencia humana / Ocular manifestations associated to CD4+ in patients with human immunodeficiency virus

Introducción: desde los primeros casos de virus de inmunodeficiencia humana (VIH), se conocen manifestaciones oculares secundarias a la infección y estas se han relacionado con el conteo de linfocitos CD4+. Objetivo: describir la correlación entre las manifestaciones oculares en pacientes con VIH y el conteo de linfocitos CD4+. Material y métodos: estudio transversal analítico de pacientes con VIH, en quienes se analizó la correlación entre conteo de CD4+ y manifestaciones oftalmológicas. Resultados: se incluyeron 21 pacientes entre 26 y 67 años de edad. Solo tres no se encontraban en terapia antirretroviral. El 67% presentó algún tipo de manifestación ocular, 42% presentó manifestaciones no relacionadas con la infección, 47% manifestaciones relacionadas y 24% ambas. La microangiopatía de la conjuntiva fue la manifestación ocular más frecuente (35.7%). Hubo una correlación estadísticamente significativa (r = 0.76, p = 0.0001) entre las manifestaciones oculares relacionadas con la infección y el conteo de linfocitos CD4+. Conclusiones: los pacientes con VIH presentan con frecuencia manifestaciones oculares, la mayoría asociadas a la infección. Existe correlación entre la presencia de estas con el conteo de CD4+; sin embargo, un número similar de manifestaciones no asociadas a la infección se presentaron sin correlación con el conteo, por lo que los pacientes con VIH deberían tener revisiones oftalmológicas periódicas, independientemente del conteo de CD4+.

Background: Since the first cases of human immunodeficiency virus (HIV), ocular manifestations secondary to infection have been known and these have been related to the CD4+ lymphocyte count. Objective: To describe the correlation between ocular manifestations in patients with HIV and the CD4+ lymphocyte count. Material and methods: Analytical cross-sectional study of patients with HIV whose CD4+ count was correlated with the presence of ophthalmological manifestations. Results: 21 patients between 26 and 67 years were studied. Only 3 patients were not on antiretroviral therapy. 67% of the patients presented some type of ocular manifestation, 42% presented non-infection related manifestations, 47% related manifestations and 24% both. Conjunctival microangiopathy was the most frequent ocular manifestation (35.7%). There was a statistically significant correlation (r = 0.76, p = 0.0001) between eye manifestations related to infection and CD4+ lymphocyte count. Conclusions: Patients with HIV frequently present ocular manifestations, the majority related to infection; there is a correlation between the presence of these with the CD4+ count. However, a similar number of manifestations not related to infection occurred without correlation with the count; therefore, HIV patients should have periodic ophthalmological examinations, independently of CD4+ count.

Immune recovery after antiretroviral therapy initiation: a challenge for people living with HIV in Brazil / Recuperação imunológica após o início da terapia antirretroviral: um desafio para pessoas vivendo com HIV no Brasil / Recuperación inmunológica tras el inicio de una terapia antirretroviral: un desafío para la gente que vive con VIH en Brasil

Immune recovery reflects health conditions. Our goal was to estimate the time it takes to achieve immune recovery and its associated factors, in people living with HIV (PLHIV), after antiretroviral therapy (ART) initiation. A historical cohort study was performed among PLHIV (> 18 years-old) in Minas Gerais State, Brazil, using data from healthcare databases. Patients initiating ART between 2009-2018, with T-CD4+ lymphocytes and viral load recorded before and after antiretroviral therapy were included. The outcome is achievement of immune recovery, defined as the first T-CD4+ > 500 cells/µL after ART initiation. Explanatory variables were age, gender, place of residence, year of ART initiation, baseline viral load and T-CD4+, viral load status, and adherence to ART at follow-up. Descriptive analysis, cumulative, and person-time incidences of immune recovery were estimated. Median-time to immune recovery was estimated using Kaplan-Meier method. Factors associated with immune recovery were assessed by Cox regression. Among 26,430 PLHIV, 8,014 (30%) were eligible. Most were male (67%), mean age 38.7 years, resided in non-central region, median-baseline T-CD4+ = 228 cells/µL (< 200 cells/µL = 43%) and viral load median-baseline = 4.7 log10 copies/mL (detectable viral load = 99%). Follow-up time = 15,872 person-years. Cumulative and incidence rate were 58% (95%CI: 57-58) (n = 4,678) and 29.47 cases/100 person-years, respectively. Median-time to immune recovery was of 22.8 months (95%CI: 21.9-24.0). Women living with HIV, younger than 38 years of age, with T-CD4+ baseline > 200 cells/µL, detectable viral load (baseline), antiretroviral therapy-adherence and undetectable viral load (follow-up) were independently associated with immune recovery. Time to immune recovery remains long and depends on early treatment and antiretroviral therapy-adherence.

A recuperação imunológica reflete condições de saúde. Nosso objetivo foi estimar o tempo até a recuperação imunológica e fatores associados em pessoas vivendo com HIV (PVHIV) após de iniciar a terapia antirretroviral (TARV). Foi conduzida uma coorte histórica de PVHIV (> 18 anos) no Estado de Minas Gerais, Brasil, usando bancos de serviços públicos de saúde. Foram incluídos pacientes que iniciaram a TARV entre 2009 e 2018, com linfócitos T-CD4+ e carga viral registrados antes e depois do início da TARV. O desfecho foi a recuperação imunológica, definida como a primeira contagem de T-CD4+ > 500 cel/µL após o início da TARV. As variáveis explanatórias foram idade, sexo, local de residência, ano de início de TARV, carga viral basal, T-CD4+ na linha de base e carga viral e adesão à TARV no seguimento. Foi realizada uma análise descritiva com estimativa de incidência acumulada e taxa de incidência (pessoa-ano). O tempo mediano até a recuperação imunológica foi estimado pelo método Kaplan-Meier. Fatores associados à recuperação imune foram avaliados por meio de regressão de Cox. Entre as 26.430 PVHIV, 8.014 (30%) foram elegíveis. A maioria era do sexo masculino (67%), com média de idade = 38,7 anos, residência em regiões fora da região metropolitana, mediana de T-CD4+ baseline = 228 células/µL (< 200 células/µL = 43%) e mediana de carga viral baseline = 4,7 log10 cópias/mL (carga viral detectável = 99%). Tempo de seguimento = 15.872 pessoas-ano. A incidência acumulativa e a taxa de incidência foram foram 58% (IC95%: 57-58) (n = 4.678) e 29,47 casos/100 pessoas-ano, respectivamente. Tempo mediano até recuperação imune = 22,8 meses (IC95%: 21,9-24,0). Os fatores independentemente associados com recuperação imunológica foram sexo feminino, idade < 38 anos, T-CD4+ basal > 200 células/µL, carga viral detectável (linha de base), adesão à TARV e carga viral indetectável (no seguimento). O tempo até a recuperação imunológica ainda é longo e impactado pelo tratamento precoce e da adesão à TARV.

La recuperación inmunológica refleja condiciones de salud. Nuestra meta fue estimar el tiempo y los factores asociados a la recuperación inmunológica en personas que viven con VIH (PVVIH), tras iniciar una terapia antirretroviral (TAR). Se realizó sobre una cohorte histórica entre PVVIH (> 18 años de edad) en Minas Gerais, Brasil, usando datos de las bases de datos del sistema de salud. Se incluyeron a pacientes que comenzaron una TAR entre 2009-2018, con T-CD4+ linfocitos y carga viral, registrada antes/después de TAR. El resultado fue el logro de recuperación inmunológica, definida como la primera T-CD4+ > 500 células/µL tras la iniciación TAR. Las variables explicatorias fueron: edad, género, lugar de residencia, año de iniciación TAR, base de referencia de carga viral, base de referencia de T-CD4+ y estatus de la carga viral y adherencia al TAR en el seguimiento. Se estimó: análisis descriptivo, acumulativo e incidencias persona-tiempo de recuperación inmunológica. La media de tiempo para la recuperación inmunológica se estimó usando el método Kaplan-Meier. Los factores asociados con la recuperación inmunológica se evaluaron mediante la regresión de Cox. Entre las 26.430 PVVIH, 8.014 (30%) fueron elegibles. La mayoría eran hombres (67%), media de edad = 38,7 años, residentes en una región no central, media de base de referencia T-CD4+ = 228 células/µL (< 200 células/µL = 43%) y carga viral media de base de referencia = 4,7 log10 copias/mL (carga viral detectable = 99%). El tiempo de seguimiento = 15.872 persona-años. La tasa acumulativa y de incidencia fue 58% (95%CI: 57-58) (n = 4.678) y 29,47 casos/100 persona-años, respectivamente. El tiempo de media para la recuperación inmunológica = 22,8 meses (95%CI: 21,9-24,0). Género femenino, PVVIH < 38 años de edad, T-CD4+ base de referencia > 200 células/µL, carga viral detectable (base de referencia), adherencia al TAR e carga viral indetectable (seguimiento) estuvieron independientemente asociadas con la recuperación inmunológica. El tiempo para la recuperación inmunológica sigue siendo largo y depende de un tratamiento temprano y de adherencia a la TAR.

Lípidos anormales e inmunidad adquirida Síndrome de Deficiencia: Asociación de Suero Lípidos con estatus de VIH / Abnormal Lipids and Acquired Immune Deficiency Syndrome: Association of Serum Lipids with HIV Status

Context and Aim: Hematological abnormalities are amongst the most common complications of infection with HIV.There have been quite a few studies on the alterations in lipid profile, too, though the results have largely been inconclusive. The present study was carried-out to assess CD4 cell counts and lipid profile in the HIV infected and AIDS patients in the Indian population and correlates them with the sero-negative controls. Materials and Methods: The present study was designed as a cross-sectional, hospital-based study to assess CD4 cell counts and lipid profile in the HIV infected and AIDS patients in the Indian population and correlates them with the sero-negative controls. Evaluation of lipid profile was done using Erba EM 360, an automated analyzer powered by a diffraction grating photometer while CD4 cell counts were evaluated using Partec Cyflow Counter. Statistical analysis used: The data was analyzed using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA). Comparison of the said parameters was done using Analysis of Variance (ANOVA) and posthoc Games-Howell test. p-value of <0.05 was considered statistically significant. Results: The levels of total cholesterol and low-density lipoproteins (LDLs) were significantly decreased while triglycerides and very low density lipoproteins (VLDLs) were significantly increased in the HIV infected and AIDS patients when compared with the sero-negative controls. Conclusion: Total cholesterol, LDLs, triglycerides and VLDLs were significantly altered in the HIV infected and AIDS patients when compared with the sero-negative controls.

Monitoring HIV infection in Minas Gerais state: 15-year assessment of adults living with HIV initiating Antiretroviral Therapy

Abstract INTRODUCTION The first Brazilian HIV treatment recommendation was put forward in 1996, resulting in 12 subsequent guidelines. Several changes were made regarding "when" and "how" to begin treatment. The latest guideline recommends immediate initiation of antiretroviral therapy (ART). This study aimed to describe the evolution of HIV treatment among people living with HIV (PLHIV) who initiated ART between 2004 and 2018 based on the national guideline recommendations concerning T-CD4+ and VL measurements. METHODS A cross-sectional analysis of data of PLHIV aged >18 years, in Minas Gerais who received ART between 2004 and 2018 was conducted. Clinical, therapeutic, and demographic information were obtained from national healthcare databases. The study was divided into four periods: 2004-2007, 2008-2012, 2013-2016, and 2017-2018. Descriptive analyses were performed. RESULTS A total of 60,618 PLHIV initiated ART (67% male and 48% aged 25-39 years), 36% of whom had CD4 counts at ART initiation and 51% documented VL after ART initiation. The median CD4 count ranged from 288 to 373 cells/µL. The median time to ART initiation decreased from 604 to 28 days and was lower among males (p <0.01). The median time from ART initiation to the first VL result decreased from 101 to 62 days over the study period, while the median VL after ART initiation ranged from 2.3 to 1.7 log10 copies/ml. CONCLUSIONS Although our results demonstrated that most recommendations were followed, there seemed to be little impact on CD4 counts and VL testing. This may result in an inadequate evaluation of ART effectiveness.

Perfil dos genótipos do HCV e subtipos de HIV em pacientes coinfectados no Sul do Brasil / Profile of hcv genotypes and hiv-subtypes among hiv-coinfected patients in southern brazil

ABSTRACT BACKGROUND: Hepatitis B and C virus (HBV and HCV) are the two most common infections among human immunodeficiency virus (HIV)-infected patients. OBJECTIVE: To identify the frequency of HIV subtypes and HCV genotypes in HIV-coinfected patients. METHODS: A cross-sectional and retrospective study was carried out into two reference centers in Southern Brazil between January 1, 2002 and June 30, 2016. The Abbott Real Time HCV Genotype II system was used for routine diagnostics to determine the HCV genotype based on dual-target real-time PCR. Proviral HIV-1 RNA was extracted from serum samples and fragments of the pol gene were generated by PCR. The HIV-1 PT and RT gene sequences were submitted to Maximum Likelihood Phylogenetic analysis by collecting reference sequences from the HIV-1 group M subtype of the Los Alamos database. RESULTS: During the study period, 3340 patients with HIV were diagnosed at both referral centers, of which 4.97% (166/3340) had HBV and/or HCV coinfection. Seroprevalence of HIV-HBV, HIV-HCV and HIV-HBV-HCV was 37.4%, 58.4%, and 4.2%, respectively. HIV-HCV-coinfected patients had a lower median nadir CD4+ T-cell count when compared to HIV-HBV-coinfected patients (P=0.01). Among those coinfected with HCV, HCV-1 (HCV-1) and HCV-3 (HCV-3) genotypes were the most prevalent, being detected in 73.8% and 21.4%, respectively. Among the HCV-1 coinfected patients, 79.3% and 20.1% had subtypes 1a and 1b, respectively. HIV subtype B was the most prevalent in HIV-coinfected patients. There was no significant difference regarding nadir CD4+ T-cell count and HIV viral load when compared to coinfected with HCV-1 with HCV-3, as well as those co-infected with HCV-1a with HCV-1b. CONCLUSION: In the present study, a higher frequency of subtype B of HIV and HCV-1 were found in HIV-coinfected patients. Further larger-scale and long-term studies are needed to better understand the effect of HCV genotypes in HIV-infected patients.

RESUMO CONTEXTO: Os vírus das hepatites B e C (VHB e VHC) são os causadores das duas infecções mais comuns entre os pacientes infectados pelo vírus da imunodeficiência humana (HIV). OBJETIVO: Identificar a frequência dos subtipos do HIV e genótipos de VHC em pacientes coinfectados com HIV. MÉTODOS: Estudo transversal e retrospectivo realizado em dois centros de referência do Sul do Brasil, entre 1º de janeiro de 2002 e 30 de junho de 2016. O sistema Abbott Real Time HCV Genótipo II foi utilizado para diagnósticos de rotina para determinar o genótipo do HCV com base na PCR em tempo real de duplo alvo. O RNA viral do HIV-1 foi extraído de amostras de soro e fragmentos do gene pol foram obtidos por PCR. As sequências do gene PT e RT do HIV-1 foram submetidas à análise filogenética por máxima verossimilhança através da coleta de sequências de referência do subtipo M do grupo HIV-1 da base de dados Los Alamos. RESULTADOS: Durante o período do estudo, 3340 pacientes foram diagnosticados com HIV em ambos os centros de referência, dos quais 4,97% (166/3340) possuíam coinfecção com HBV e/ou HCV. A soroprevalência de HIV-HBV, HIV-HCV e HIV-HBV-HCV foi de 37,4%, 58,4% e 4,2%, respectivamente. Pacientes HIV-VHC possuíam menor nadir de células T CD4+ quando comparados aos pacientes HIV-VHB (P=0,01). Entre os pacientes HIV-VHC, os genótipos VHC-1 e VHC-3 foram os mais prevalentes, sendo encontrados em 73,8% e 21,4%, respectivamente. Entre os coinfectados com VHC-1, 79,3% e 20,1% tinham subtipos 1a e 1b, respectivamente. O subtipo B do HIV foi o mais prevalente em pacientes coinfectados. Não houve diferença significativa em relação nadir de células T CD4+ e carga viral do HIV quando comparadas os coinfectados com o VHC-1 com o VHC-3, assim como, os coinfectados com HCV-1a quando comparados com o HCV-1b. CONCLUSÃO: No presente estudo, uma maior frequência do subtipo B do HIV e do VHC-1 foram encontrados em pacientes coinfectados com HIV. Outros estudos em larga escala e a longo prazo são necessários para entender melhor o efeito dos genótipos do HCV em pacientes infectados pelo HIV.

Características sociodemográficas y clínicas de pacientes con diagnóstico nuevo de VIH / Sociodemographic and clinical characteristics of patients with new HIV diagnosis

Objetivo: Caracterizar de forma sociodemográfica y clínica pacientes con diagnóstico nuevo de VIH, que fueron hospitalizados en una Clínica Universitaria de alta complejidad entre el año 2010 - 2016. Materiales y métodos: Se realizó un estudio observacional, descriptico, de corte transversal por medio de revisión de historias clínicas, que incluyo pacientes ≥14 años, a quienes se les diagnosticó VIH durante la hospitalización y tuvieran al menos un conteo de linfocitos CD4. Resultados: La mediana para la edad fue 41 años (RIC 31 - 51), el 85,1% eran hombres. Los principales síntomas al ingreso fueron generales/sistémicos (70,2%). 99 pacientes (61,5%) tenían infecciones oportunistas siendo tuberculosis la más frecuente (34,3%). La mediana para el conteo de CD4 fue 88 células/mm3 RIC (27 - 327) y el 77% se clasificó como SIDA. 29 pacientes murieron (18%) encontrando como posible factor de riesgo tener conteo de CD4 fue 88 células/mm3 RIC (27 - 327) y el 77% se clasificó como SIDA. 29 pacientes murieron (18%) encontrando como posible factor de riesgo tener conteo de CD4<200 células/mm3 , no pertenecer al régimen contributivo, ingresar con síntomas respiratorios, tener diagnóstico de neumonía, criterios de falla multiorgánica o necesidad de UCI/UCE. Conclusión: Para nuestro caso la mayoría de pacientes con diagnóstico nuevo de VIH se encontraban en estados avanzados de inmunosupresión con alta carga de enfermedades definitorias de SIDA. Es importante fortalecer las políticas de salud pública para diagnosticar más temprano la infección por VIH.

Purposes: To characterize sociodemographic and clinical aspects in newly diagnosed HIV patients that were hospitalized at a university health center between 2010 - 2016. Methods: We made an observational descriptive cross - sectional study reviewing clinical records, including patients older than 14 years old, who were diagnosed with HIV infection during hospitalization and at least a CD4 count. Results: Median age at diagnosis was 41 years old (IQR 31 - 51), 85% were men. The main symptoms were general/systemic (70.2%). 99 patients (61.5%) had opportunist infections, being tuberculosis the most frequent (34.3%). The median CD4 were 88 cells/mm3 (IQR 27 - 327) and 77% were classified as AIDS. 29 patients died (18%), finding as a risk factor for mortality don't having a good health care insurance, low CD4 count, having respiratory symptoms, pneumonia diagnosis, multiple organic failure's criteria and ICU admission. Conclusion: In our case, the majority of patients with a new diagnosis of HIV were in advanced stages of immunosuppression with a high burden of AIDS defining diseases. It is important to strengthen public health policies to diagnose HIV infection earlier.

Envío de mensajes de texto para mejorar la adherencia de pacientes en targa: ensayo aleatorizado controlado / Text messaging to improve patient adherence in haart: randomized controlled trial

RESUMEN Objetivos . Evaluar la eficacia de una estrategia de envío de mensajes de texto (SMS) en la mejora de la asistencia a citas, adherencia al tratamiento y marcadores biológicos (carga viral y CD4) en pacientes continuadores con tratamiento antirretroviral de gran actividad (TARGA) que asistieron a destiempo a su última cita programada. Materiales y métodos. Se realizó un ensayo aleatorizado controlado implementado en Vía Libre, una organización no gubernamental (ONG) que brinda servicios a personas viviendo con el virus de la inmunodeficiencia humana (VIH) en Lima. Se aleatorizaron 166 pacientes continuadores: 82 participantes recibieron SMS por seis meses y 84 participantes la atención estándar. Resultados. Los pacientes en el grupo de intervención, un 93,9% fueron hombres y tenían una mediana de 5,1 años en TARGA; en cambio en el grupo control, un 94,1% fueron hombres y una mediana de 5,3 años en TARGA. En el grupo de intervención, los pacientes asistieron con más frecuencia que aquellos en el grupo control a sus citas médicas programadas (RR=1,89; IC 95%: 1,21-2,97) en los seis meses de intervención. Al comparar el nivel de carga viral y el nivel de CD4 no se encontraron diferencias (p=0,930 y p=0,905, respectivamente). La adherencia al tratamiento medida por autorreporte fue mayor en el grupo de intervención (p<0,001). Conclusiones. Los resultados en este estudio sugieren que el envío de SMS por seis meses puede mejorar la asistencia a citas y la adherencia al tratamiento en pacientes continuadores en TARGA.

ABSTRACT Objectives. To assess the efficacy of a text messaging (SMS) strategy to improve appointment attendance, treatment adherence, and biological markers (viral load and CD4) in continuous patients with high activity antiretroviral therapy (HAART) who were late to their last scheduled appointment. Materials and Methods. A randomized controlled trial implemented in Via Libre, a non-governmental organization (NGO) that provides services to people living with human immunodeficiency virus (HIV) in Lima, Peru, was conducted, where 166 follow-up patients were randomized: 82 participants received SMS for six months and 84 participants received standard care. Results. Patients in the intervention group: 93.9% were men and had a median of 5.1 years in HAART; in the control group: 94.1% were men and a median of 5.3 years in HAART. In the intervention group, patients attended their scheduled medical appointments more frequently than those in the control group (RR=1.89, 95% CI 1.21-2.97) during the six months of intervention. Comparing the viral load level and CD4 level, no differences were found (p=0.930 and p=0.905, respectively). Adherence to treatment measured by self-report was higher in the intervention group (p<0.001). Conclusions. The results of this study suggest that sending SMS for six months may improve appointment attendance and adherence to treatment in continuing patients on HAART.

Factores asociados a respuesta inadecuada a la vacuna de hepatitis B en pacientes con VIH

Objetivo: Establecer la asociación entre la edad, sexo, Índice de masa corporal, consumo de bebidas alcohólicas y consumo de cigarrillos con la respuesta inadecuada a la vacuna contra la Hepatitis B, en los pacientes con infección por VIH que fueron atendidos en la Unidad Clínica de Enfermedades Infecciosas y Tropicales del Hospital Regional Docente de Trujillo - Perú, entre 2014-2016. Materiales y métodos: Se realizó un estudio observacional, retrospectivo, de corte transversal, tipo casos y controles. Resultados: De los pacientes vacunados se encontró que la edad ≥ 50 años; con OR=3,4 y el CD4<200, con OR=35,0, son los factores de riesgo para la respuesta inadecuada a la vacuna contra hepatitis B. Conclusiones: Existe asociación entre el recuento de células CD4 <200 y la edad mayor de 50 años con una respuesta Inadecuada a la vacunación contra hepatitis B en pacientes infectados por VIH en el Hospital Regional Docente de Trujillo.

Objective: To establish the relationship among age, sex, body mass index, consumption of alcoholic beverages and cigarettes with the inadequate response to the vaccine against Hepatitis B in patients with HIV infection who were treated in the Clinical Unit of Infectious and Tropical Diseases of the Regional Hospital of Trujillo - Peru, from 2014 to 2015. Materials and methods: The study was observational, retrospective, cross-sectional, type cases and controls. Results: In the vaccinated patients, it was found that the age ≥ 50 years old; with OR = 3.4 and CD4 <200, with OR = 35.0, are the risk factors to get the inadequate response to the vaccine against Hepatitis B. Conclusions: There is a relationship between the re-count of cells CD4 <200 and the age over 50 years old with an Inadequate response to the vaccination against hepatitis B in HIV-infected patients in the Regional Hospital of Trujillo.

Characteristics and abnormal rate of electrocardiogram in patients with human immunodeficiency virus/acquired immunodeficiency syndrome / 中华传染病杂志

Objective@#To analyze the characteristics and abnormalities of electrocardiograms (ECG) in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and to provide evidences for the prevention and treatment of cardiovascular diseases in HIV/AIDS patients.@*Methods@#The ECG results of 1 131 HIV/AIDS patients and 5 622 non-HIV/AIDS subjects from Shanghai Public Health Clinical Center were involved. The abnormality rates and characteristics of ECG were compared between the two groups. CD4+ T lymphocyte counts, CD8+ T lymphocyte counts and CD4/CD8 ratios were measured in HIV/AIDS patients. The comparison between two groups was conducted by chi-square test. Logistic regression model was used to explore the factors associated with ECG abnormalities in HIV/AIDS patients.@*Results@#There were 611 cases (54.02%) out of 1 131 HIV/AIDS patients with abnormal ECG. The common abnormal ECG types were sinus tachycardia 239 cases (39.12%), sinus rhythm with ST-T changes 115 cases (18.82%) and sinus bradycardia 55 cases (9.00%). There were 1 958 cases (34.83%) out of 5 622 cases of non-HIV/AIDS subjects with abnormal ECG. The common ECG abnormality types were sinus bradycardia 633 cases (32.33%), sinus rhythm with ST-T changes 463 cases (23.65%) and sinus arrhythmia 256 cases (13.07%). The abnormal rate of ECG in HIV/AIDS patients was significantly higher than that in non-HIV/AIDS subjects (χ2=140.39, P<0.01). The abnormal rates of ECG in HIV/AIDS patients <50 years old and ≥50 years old were both higher than those of non-HIV/AIDS subjects in the corresponding age group, and the differences were statistically significant (χ2=111.92 and 52.12, respectively, both P<0.01). Logistic regression analysis showed an increased risk of abnormal ECG in HIV-infected individuals compared with non-HIV/AIDS individuals (odds ratio (OR)=2.27, 95% confidence interval (CI) 2.00-2.60, P<0.01). The risk of ECG abnormality increased in patients aged ≥50 years(OR=1.60, 95%CI 1.45-1.77, P<0.01). The ECG abnormal distribution patterns were significantly different between different levels of CD4+ T lymphocyte counts, CD8+ T lymphocyte counts and CD4/CD8 ratios in HIV/AIDS patients (χ2= 12.92, 10.99 and 16.48, respectively, all P<0.05 ). The risk of ECG abnormality increased in HIV/AIDS patients aged ≥50 years (OR=1.50, 95%CI 1.15-1.96, P<0.01). When CD8+ T lymphocyte counts ≥500/μL, the risk of ECG abnormalities reduced (OR=0.75, 95%CI 0.58-0.96, P<0.01).@*Conclusions@#The abnormal rate of ECG in patients with HIV/AIDS is high. The sinus tachycardia and sinus rhythm with ST-T segment changes are common. The risk of ECG abnormality increases in HIV/AIDS patients aged ≥50 years old and reduces when the CD8+ T lymphocyte counts ≥500/μL. Type distribution of ECG abnormalities is associated with cellular immune status of patients.

Characteristics and abnormal rate of electrocardiogram in patients with human immunodeficiency virus/acquired immunodeficiency syndrome / 中华传染病杂志

Objective To analyze the characteristics and abnormalities of electrocardiograms (ECG) in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS),and to provide evidences for the prevention and treatment of cardiovascular diseases in HIV/AIDS patients.Methods The ECG results of 1 131 HIV/AIDS patients and 5 622 non-HIV/AIDS subjects from Shanghai Public Health Clinical Center were involved.The abnormality rates and characteristics of ECG were compared between the two groups.CD4 + T lymphocyte counts,CD8+ T lymphocyte counts and CD4/CD8 ratios were measured in HIV/ AIDS patients.The comparison between two groups was conducted by chi-square test.Logistic regression model was used to explore the factors associated with ECG abnormalities in HIV/AIDS patients.Results There were 611 cases (54.02％) out of 1 131 HIV/AIDS patients with abnormal ECG.The common abnormal ECG types were sinus tachycardia 239 cases (39.12％),sinus rhythm with ST-T changes 115 cases (18.82％) and sinus bradycardia 55 cases (9.00％).There were 1 958 cases (34.83％) out of 5 622 cases of non-HIV/AIDS subjects with abnormal ECG.The common ECG abnormality types were sinus bradycardia 633 cases (32.33％),sinus rhythm with ST-T changes 463 cases (23.65％) and sinus arrhythmia 256 cases (13.07％).The abnormal rate of ECG in HIV/AIDS patients was significantly higher than that in non-HIV/ AIDS subjects (x2 =140.39,P ＜ 0.01).The abnormal rates of ECG in HIV/AIDS patients ＜ 50 years old and ≥50 years old were both higher than those of non-HIV/AIDS subjects in the corresponding age group,and the differences were statistically significant (x2 =111.92 and 52.12,respectively,both P ＜ 0.01).Logistic regression analysis showed an increased risk of abnormal ECG in HIV-infected individuals compared with nonHIV/AIDS individuals (odds ratio (OR) =2.27,95％ confidence interval (CI) 2.00-2.60,P ＜ 0.01).The risk of ECG abnormality increased in patients aged ≥ 50 years (OR =1.60,95％ CI 1.45-1.77,P ＜ 0.01).The ECG abnormal distribution patterns were significantly different between different levels of CD4+ T lymphocyte counts,CD8+ T lymphocyte counts and CD4/CD8 ratios in HIV/AIDS patients (x2 =12.92,10.99 and 16.48,respectively,all P ＜0.05).The risk of ECG abnormality increased in HIV/AIDS patients aged ≥50 years (OR =1.50,95％ CI 1.15-1.96,P ＜ 0.01).When C D8+ T lymphocyte counts ≥ 500/pL,the risk of ECG abnormalities reduced (OR =0.75,95％ CI 0.58-0.96,P ＜ 0.01).Conclusions The abnormal rate of ECG in patients with HIV/AIDS is high.The sinus tachycardia and sinus rhythm with ST-T segment changes are common.The risk of ECG abnormality increases in HIV/AIDS patients aged ≥50 years old and reduces when the CD8+ T lymphocyte counts ≥ 500/μL.Type distribution of ECG abnormalities is associated with cellular immune status of patients.

Safety of monitoring antiretroviral therapy response in HIV-1 infection using CD4+ T cell count at long-term intervals / Segurança do monitoramento da resposta à terapia antirretroviral em pacientes com infecção pelo HIV-1 através da contagem de linfócitos T CD4+ a intervalos mais longos / Seguridad en la monitorización de la respuesta a la terapia antirretroviral ante el VIH-1, usando el recuento celular CD4+ T en intervalos a largo plazo

Abstract: The latest Brazilian guideline recommended the reduction of routine CD4+ T cell counts for the monitoring of patients with human immunodeficiency virus type 1 (HIV-1) under combination antiretroviral therapy (cART). The aim of this study was to evaluate the safety of monitoring response to cART in HIV-1 infection using routine viral load at shorter intervals and CD4+ T cell count at longer intervals. CD4+ T cell counts and HIV-1 viral load were evaluated in 1,906 HIV-1-infected patients under cART during a three-year follow-up. Patients were stratified as sustained, non-sustained and non-responders. The proportion of patients who showed a CD4+ T > 350cells/µL at study entry among those with sustained, non-sustained and non-responders to cART and who remained with values above this threshold during follow-up was 94.1%, 81.8% and 71.9%, respectively. HIV-1-infected patients who are sustained virologic responders and have initial CD4+ T cell counts > 350cells/µL showed a higher chance of maintaining the counts of these cells above this threshold during follow-up than those presenting CD4+ T ≤ 350cells/µL (OR = 39.9; 95%CI: 26.5-60.2; p < 0.001). This study showed that HIV-1-infected patients who had sustained virologic response and initial CD4+ T > 350cells/µL were more likely to maintain CD4+ T cell counts above this threshold during the next three-year follow-up. This result underscores that the evaluation of CD4+ T cell counts in longer intervals does not impair the safety of monitoring cART response when routine viral load assessment is performed in HIV-1-infected patients with sustained virologic response.

Resumo: O último consenso brasileiro recomenda reduzir a rotina de contagem de linfócitos T CD4+ para monitorar os pacientes com HIV-1 sob terapia antirretroviral combinada (TARV). O estudo teve como objetivo avaliar a segurança do monitoramento à TARV na infecção pelo HIV-1, realizando a carga viral a intervalos mais curtos e a contagem de linfócitos T CD4+ a intervalos mais longos. Foram avaliadas a contagem de linfócitos T CD4+ e a carga viral do HIV-1 em 1.906 pacientes com HIV-1 em uso de TARV durante um seguimento de três anos. Os pacientes foram estratificados em: resposta sustentada, não sustentada e não respondedores. As proporções de pacientes com linfócitos T CD4+ > 350células/µL na linha de base do estudo entre de resposta sustentada, não sustentada e não respondedores à TARV e que permaneceram com valores acima desse limiar ao longo do seguimento foram 94,1%, 81,8% e 71,9%, respectivamente. Os pacientes com resposta virológica sustentada e que tinham contagem de T CD4+ > 350células/µL mostraram maior probabilidade de manter a contagem acima desse limiar durante o seguimento, quando comparados àqueles com T CD4+ ≤ 350células/µL (OR = 39,9; 95%CI: 26,5-60,2; p < 0,001). O estudo mostrou que pacientes HIV-1+ com resposta virológica sustentada e contagem de linfócitos T CD4+ > 350células/µL tinham maior probabilidade de manter a contagem de células T CD4+ acima desse limiar durante o seguimento de três anos subsequentes. O resultado corrobora que a contagem de linfócitos T CD4+ com intervalos mais longos não compromete a segurança do monitoramento da resposta à TARV quando a avaliação da carga viral é feita de rotina em pacientes HIV-1+ com resposta virológica sustentada.

Resumen: Las últimas directrices brasileñas recomendaron la reducción de la rutina en el recuento celular CD4+ T para pacientes con el virus de inmunodeficiencia humano tipo 1 (VIH-1), con terapia de combinación antirretroviral (cART por sus siglas en inglês). El objetivo de este estudio fue evaluar la seguridad de la monitorización de la respuesta a la cART en una infección por VIH-1, usando rutinas de carga viral en intervalos más cortos y recuento celular CD4+ T en intervalos más largos. Se evaluaron el recuento celular CD4+ T y la carga viral VIH-1 en 1.906 pacientes infectados con VIH-1 y con cART durante un seguimiento que duró tres años. Los pacientes fueron estratificados como constantes, inconstantes y sin respuesta. La proporción de pacientes que mostraron CD4+ T > 350células/µL en el estudio entran dentro del grupo de los constantes, inconstantes y sin respuesta al cART, y quienes permanecieron con valores por encima de este umbral durante los seguimientos fueron 94,1%, 81,8% y 71,9%, respectivamente. Los pacientes infectados por VIH-1 que cuentan con la respuesta virológica constante y tienen un recuento inicial CD4+ T > 350células/µL mostraron una oportunidad más alta de mantener el recuento de estas células por encima del umbral durante los seguimientos, respecto a quienes presentaban CD4+ T células ≤ 350células/µL (OR = 39,9; IC95%: 26,5-60,2; p < 0,001). Este estudio expuso que los pacientes infectados por VIH-1, que habían tenido una respuesta virológica constante e inicial CD4+ T > 350células/µL, eran más propensos a mantener el recuento de células CD4+ T por encima de este umbral durante los tres años posteriores de seguimiento. Este resultado destaca que la evaluación del cómputo de células CD4+ T en intervalos más largos no obstaculiza la seguridad al realizar una monitorización en la respuesta a cART, cuando la evaluación de la carga viral rutinaria se realiza en pacientes infectados por VIH-1 con una respuesta virológica constante.

Correlation between blood routine indicators and CD4+ T cell count in AIDS patients without antiviral therapy / 中国基层医药

Objective@#To study the correlation between the blood routine indicators and CD4+ T, CD8+ T lymphocytes in AIDS patients without antiviral treatment, and to find a simple, cheap and effective monitoring indicator.@*Methods@#A study of 333 AIDS patients without antiviral treatment was performed.The methods of regression analysis and other statistical methods were applied to research the correlation between WBC, W-SCC and CD4+ T, CD8+ T cell count among HIV/AIDS.@*Results@#The rate of routine blood abnormalities among 333 HIV/AIDS patients was very high, the main test indicators within the reference range only accounted for 30.63%.The proportion of late diagnosis infected with HIV among women was higher than that of males.Significant correlations were observed between CD4+ Tcell count and WBC, W-SCC, W-LCC, RBC, HGB, PLT(r=0.408, 0.541, 0.157, 0.337, 0.338, 0.166). The equation between W-SCC (x) and CD4+ cell count (y) was y=120.913x+ 90.339.@*Conclusion@#There is a strong correlation between CD4+ T lymphocyte count and lymphocyte count in AIDS patients without antiviral treatment.It can be used as an important indicator of immune status in patients with AIDS.At the same time, we should strengthen the propaganda of AIDS prevention, promote AIDS early detection, early treatment, and improve the quality of life of AIDS patients.

Survival analysis of HIV/AIDS patients receiving antiretroviral therapy in Hangzhou from 2004 to 2014 / 中华临床感染病杂志

Objective To analyze the survival rate of HIV /AIDS patients receiving highly active antiretroviral therapy(HAART)since the implementation of the national Four Free and One Carepolicy against HIV in Hangzhou.Methods Clinical data of 2370 AIDS patients were collected from National AIDS Comprehensive Treatment Information System Treatment Library from 2004 to 2014.The data, including basic information,viral load,CD4 +T lymphocyte counts,starting time of treatment,WHO clinical stage,infection pathways and follow-up were respectively analyzed.Kaplan-Meier and Cox proportional hazards models were used to analyze the survival rate and the factors affecting survival.Results The total follow-up time was 3968.14 person years and 57 patients died in 2370 patients with a mortality rate of 1 .44 /100 person years (57 /3968.14).Kaplan-Meier method showed that the cumulative survival rates of the first,third and fifth year were 98.08%,96.20% and 95.24%,respectively.The overall mortality rate fell from 6.06 /100 person years in 2006 to 1 .44 /100 person years in 2014.The mortality rate of AIDS-related disease declined from 1 .10 /100 person years in 2009 to 0.90 /100 person years in 2014.Multivariate Cox regression analysis showed that the risk of death for patients with CD4 +T 200-349 cells/μL was 0.466 times(95%CI 0.246-0.882)as that for patients with CD4 +T cells <200 /μL.The risk of death was 3.408 times(95%CI 1 .365-8.506)in patients aged≥ 50 years,3.788 times(95%CI 1 .645-8.718)in patients aged 40 to <50 years,and 2.593 times(95%CI 1 .139-5.905)in patients aged 30 to 40 years as that in patients aged <30 years.The mortality risk for patients with baseline WHO stage Ⅲ and Ⅳ was 1 .960 times as patients with WHO stage Ⅰ and Ⅱ (95% CI 1 .117-3.439 ).Conclusions Patients with increased age,low CD4 +T counts and baseline WHO stage Ⅲ or Ⅳ are main risk factors affecting survival rate of HIV /AIDS patients,early antiviral therapy is the key for improving the survival rate of patients.

Trend of CD4+ Cell Counts at Diagnosis and Initiation of Highly Active Antiretroviral Therapy (HAART): Korea HIV/AIDS Cohort Study, 1992-2015

BACKGROUND: CD4+ cell counts reflect immunologic status of human immunodeficiency virus (HIV) patients. Recommended CD4+ cell counts for the initiation of highly active antiretroviral therapy (HAART) has increased over the past several years in various HIV treatment guidelines. We investigated the trend of CD4+ cell counts at diagnosis and treatment start using data from the Korea HIV/acquired immune deficiency syndrome (AIDS) Cohort Study. MATERIALS AND METHODS: The Korea HIV/AIDS Cohort Study started in 2006 and enrolled HIV patients from 21 tertiary and secondary hospitals in South Korea. The data for CD4+ cell counts at diagnosis and HAART initiation from these HIV patients were analyzed by three-year time intervals and presented by number of CD4+ cells (≤100, 101-200, 201-350, 351-500 and >500 cells/mm³). The HIV-RNA titer at diagnosis and HAART initiation were presented by 3-year intervals by groups ≤50,000, 50,001-100,000, 100,001-200,000, 200,001-1,000,000, and >1,000,000 copies/mL. RESULTS: Median values of CD4+ cell count and HIV-RNA titer at initial HIV diagnosis were 247 cells/mm³ and 394,955 copies/mL, respectively. At time of initiating HAART, median values of CD4+ cell count and HIV-RNA were 181 cells/mm³ and 83,500 copies/mL, respectively. Patients with low CD4+ cell count (CD4+ cell count ≤200 cells/mm³) at diagnosis (31-51%) and initiation of HAART accounted for the largest proportion (30-65%) over the three-year time intervals. This proportion increased until 2010-2012. CONCLUSION: CD4+ cell count at initiation of HAART was found to be very low, and the increase in late initiation of HAART in recent years is of concern. We think that this increase is primarily due to an increasing proportion of late presenters. We recommend early detection of HIV patients and earlier start of HAART in order to treat and prevent spread of HIV infection.

Manifestaciones Orales en pacientes VIH/SIDA del Hospital Base de Valdivia en Chile / Oral manifestations in HIV / AIDS patients at Valdivia Base Hospital in Chile

Introducción: Las manifestaciones orales en pacientes que viven con el Virus de la inmunodeficiencia humana (VIH) pueden ser el primer signo de la enfermedad, y hablar del deterioro del sistema inmune. Objetivo: Determinar la frecuencia de manifestaciones orales en personas que viven con VIH (PVVIH), estableciendo la asociación con el conteo de linfocitos TCD4 y la carga Viral. Materiales y métodos: Se estudiaron 177 pacientes que viven con VIH en control y/o tratamiento del Hospital Base de Valdivia en Chile, a los cuales se les realizó un examen clínico bucal y se recolectaron los valores del último conteo de linfocitos TCD4 y carga viral. Resultados: La muestra estaba formada por un 78,5% de varones; la edad promedio fue de 40,1±12,02 años y el 92,7% estaba bajo terapia antirretroviral. Las lesiones bucales se presentaron en el 93,8% de los pacientes, de las cuales el 39,2% pertenecían a manifestaciones orales de la Clasificación CEE. Se observó que los pacientes con manifestaciones bucales tenían valores de linfocitos TCD4 más bajos (427,40 ± 224,51) que los que no las presentaron (530,8 ± 222,7); encontrando que ambos valores son independiente de la carga viral. Conclusión: Las lesiones orales en PVVIH están asociadas mayormente a un conteo de linfocitos TCD4 bajo, independientemente de la terapia antirretroviral que reciben y la carga viral que presenten al momento del examen bucal.

Introduction: Oral Manifestations in patients living with Human Immunodeficiency Virus (HIV) may be the first sign of the disease, and talk about the deterioration of the immune system. Objective: Determine the frequency of oral manifestations in people living with HIV (PLHIV), establishing the association with CD4 lymphocyte count and viral load. Materials and methods: 177 patients living with HIV in control and / or treatment of the Base Hospital of Valdivia in Chile, where he underwent an oral examination and values of the last count of CD4 lymphocytes and viral load were collected were studied. Results: The sample consisted of 78.5% males; the average age was 40.1±12.02 years, and 92.7% were on antiretroviral therapy. The oral lesions occurred in 93.8% of patients, of which 39.2% belonged to oral manifestations of the EEC Classification. It was observed that patients with oral manifestations had values lower CD4 lymphocytes (427.40 ± 224.51) than those who did not submit (530.8 ± 222.7); finding that both values are independent of viral load. Conclusion: Oral lesions in people living with HIV are mostly associated with a low CD4 lymphocyte count, regardless of receiving antiretroviral therapy and viral load at the time of presenting oral exam.

Regulation of saw palmetto extract on immune function in GL261 glioma / 中国免疫学杂志

Objective:To investigate the effect of saw palmetto extract ( SR ) on GL261 glioma in rats and immune system.Methods:The 40 rats were divided into 4 groups randomly,one was the control group without tumor( the blank group) ( n=10) ,the other 30 rats were given subcutaneous inoculation of tumor cells and then divided into 3 groups:the tumor-bearing group( n=10) ,low dose SR group( n=10) ,and high dose SR group( n=10).After 1 week fed,the rats of SR groups were given the saw palmetto extract,low dose group 50 mg/kg once a day every other day and 300 mg/kg of high dose group every other day.The tumor-bearing groups received the same dose of distilled water.After 4 weeks fed, we measured the tumor weight and the inhibition rate was calculated.The tumor cell apoptosis was detected by TUNEL staining.The activity of splenic macrophages was detected by macrophage phagocytosis of chicken erythrocytes and CD4+lymphocytes by flow cytometry.Results:①The SR groups compared with tumor group, the tumor weight was significantly reduced(F=62.678,P=0.000).The tumor inhibition rate was significantly higher in high dose group.②The apoptosis of tumor cells in tumor-bearing group was significantly less than SR groups and the apoptosis was significantly increased after treatment with SR ,especially in high dose SR group(F=1.287,P=0.000).③Compared with the blank group,the macrophage activity decreased remarkablely.SR enhanced the macrophage activity obviously, positively related to doses of SR ( F=141.205,P=0.000;F=126.903,P=0.000).④In the tumor-bearing group,the CD4+lymphocyte count decreased significantly.After SR treatment,the CD4+lymphocyte increased and were positively related to the dose of SR.Conclusion: Saw palmetto extract can strengthen the immune system.

Effects of Antiretroviral Therapy on the Survival of Human Immunodeficiency Virus-positive Adult Patients in Andhra Pradesh, India: A Retrospective Cohort Study, 2007-2013 / 예방의학회지

OBJECTIVES: The survival outcomes of antiretroviral treatment (ART) programs have not been systematically evaluated at the state level in India. This retrospective study assessed the survival rates and factors associated with survival among adult human immunodeficiency virus (HIV)-infected patients in Andhra Pradesh, India. METHODS: The present study used data from 139 679 HIV patients aged ≥15 years on ART who were registered from 2007 to 2011 and were followed up through December 2013. The primary end point was death of the patient. Mortality densities (per 1000 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore the factors associated with survival. RESULTS: The overall median follow-up time was 16.0 months (2.0 months for the deceased and 14.0 months for those lost to follow-up). Approximately 13.2% of those newly initiated on ART died during follow-up. Of those deaths, 56% occurred in the first three months. The crude mortality rate was 80.9 per 1000 person-years at risk. The CD4 count (adjusted hazard ratio [aHR],4.88; 95% confidence interval [CI], 4.36 to 5.46 for 350 cells/mm³), functional status (aHR, 3.05; 95% CI, 2.82 to 3.30 for bedridden vs. normal), and body weight (aHR, 3.69; 95% CI, 3.42 to 3.97 for 60 kg) were strongly associated with the survival of HIV patients. CONCLUSIONS: The study findings revealed that high mortality was observed within the first three months of ART initiation. Patients with poor baseline clinical characteristics had a higher risk of mortality. Expanded testing and counseling should be encouraged, with the goal of ensuring early enrollment into the program followed by the initiation of ART in HIV-infected patients.