Características clínico-epidemiológicas de pacientes coinfectados con el virus de inmunodeficiencia humana y leishmaniasis visceral que acuden al Instituto de Medicina Tropical, durante los años 2016 al 2020

RESUMEN La coinfección por leishmaniasis visceral y VIH es una preocupación mundial debido al ascenso progresivo en los últimos años, en varias regiones del mundo. La progresión de ambas enfermedades conducen al deterioro del sistema inmune, y como resultado, al fracaso terapéutico. El presunto estudio tiene como objetivo describir las características clínico-epidemiológicas de pacientes coinfectados con el virus de inmunodeficiencia humana y leishmaniasis visceral que acuden al Instituto de Medicina Tropical, en el periodo del 2016 al 2020. Es un estudio observacional, descriptivo, de corte transversal, utilizando registros médicos de pacientes con el diagnóstico de leishmaniasis visceral y VIH. Se incluyeron 51 pacientes coinfectados, entre 19 y 65 años, 42 del sexo masculino (82,3 %); 37 procedentes del área Central. Los hallazgos clínicos mas frecuentes fueron el decaimiento del estado general y la fiebre. La mayoría de los pacientes tuvieron un recuento bajo de linfocitos tCD4 y valores elevados de carga viral de VIH. Nuestro trabajo contribuye a conocer el perfil epidemiológico de pacientes coinfectados para mejorar el diagnóstico temprano y consecuentemente el tratamiento médico precoz.

ABSTRACT Co-infection by visceral leishmaniasis and HIV is a global concern due to the progressive rise in recent years, in various regions of the world. The progression of both diseases leads to the deterioration of the immune system, and as a result, to therapeutic failure. The presumed study aims to describe the clinical-epidemiological characteristics of patients co-infected with the human immunodeficiency virus and visceral leishmaniasis who attend the Institute of Tropical Medicine, in the period from 2016 to 2020. It is an observational, descriptive, cross-sectional study, using medical records of patients diagnosed with visceral leishmaniasis and HIV. 51 coinfected patients were included, between 19 and 65 years old, 42 male (82.3%); 37 from the Central area. The most frequent clinical findings were a weakness and fever. Most of the patients had a low tCD4 lymphocyte count and high HIV viral load values. Our study contributes to knowing the epidemiological profile of coinfected patients to improve early diagnosis and consequently early medical treatment.

Neurosyphilis with Ocular Involvement in a patient with newly diagnosed Human Immunodeficiency Virus (HIV) Infection: A case report

Introduction@#Syphilis is a chronic systemic infection caused by Treponema pallidum sub-species pallidum. Syphilis, by itself, already has a varied clinical presentation depending on the stage, earning its moniker as “the great imitator”. In a patient without HIV infection, untreated syphilis presents as a chronic infection with primary, secondary, latent, and tertiary stages. With the emergence of the AIDS pandemic, HIV co infection may significantly alter the clinical presentation of syphilis. This is a case of a patient with neurosyphilis with overlapping primary and secondary syphilis.@*Case Presentation@#This is a case of a 34-year-old Filipino male who came in due to blurring of vision. The patient’s illness started six months prior to admission, when he noted the appearance of a painless, non-pruritic, solitary ulcer with erosions on his penis. A month after, he started to have progressive blurring of vision. In the interim, erythematous, scaly plaques appeared on the dorsal aspect of both hands and feet, and on the tip of the nose, with associated thinning of hair on the scalp and eyebrows. The skin and penile lesions eventually increased in size and number. The examination of the pupils showed a 6 mm right pupil, non-reactive to light, and a 2 mm left pupil which was minimally reactive to light and constricts upon accommodation. The diagnosis of syphilis was confirmed by a reactive serum Rapid Plasma Reagin at 1:64 dilution, and a reactive serum Treponemal Enzyme Immunoassay. HIV screening was also reactive, with a CD4+ cell count of 15 cells/μL. Ophthalmologic findings were consistent with panuveitis. Skin punch biopsy revealed lichenoid and interstitial dermatitis with which syphilis was highly considered. Cranial CT imaging showed mild cerebral atrophy. Lumbar tap revealed a colorless, clear cerebrospinal fluid, with lymphocytic pleocytosis, normal protein, decreased glucose, and a reactive CSF RPR. The patient was given intravenous penicillin G 3 million units every 4 hours for 14 days, together with ophthalmic medications (prednisolone, levofloxacin, and atropine ophthalmic drops). He was also started on antiretroviral therapy. Prior to discharge, the patient was noted to have improved vision, skin lesions were significantly improved, and he was advised for close monitoring as outpatient.@*Conclusion@#Through this case, it was elaborated that with HIV co-infection, syphilis may present atypically—with multiple, persistent, primary lesions; with overlapping of the stages, and increased frequency of neurosyphilis presenting early into the infection.

Política terapéutica de la coinfección por M. tuberculosis y el VIH / Therapeutic policy of coinfection by M. tuberculosis and HIV

La tuberculosis (TB) es la infección oportunista más frecuente en pacientes infectados por el VIH, con impactos bidireccionales en el paciente: al aumentar la carga viral, la TB acelera la progresión de la infección por VIH a SIDA y, con ello, a la muerte. A su vez, El VIH dificulta el diagnóstico y tratamiento de la TB y favorece el desarrollo de diversas complicaciones clínicas. Al considerar que (1) sólo las dos terceras partes de la población seropositiva en el mundo tienen acceso a terapia antiretroviral; que (2) la tercera parte de fallecidos por SIDA en 2019 estaban también diagnosticados con TB; que (3) a nivel global el riesgo de morir por TB se duplica en el individuo con diagnóstivo de VIH positivo; y que (4) en las Américas, únicamente el 61% de las personas con TB-VIH reciben tratamiento antiretroviral, dejando tres veces más muertes y dos veces más pérdida en el seguimiento en los coinfectados, se evidencia una realidad preocupante sobre los resultados de las actuales políticas de tratamiento para la coinfección TB-VIH, haciendo necesario explorar sus bases, alcance, y metodologías en América y en Ecuador(AU)

Tuberculosis (TB) is the most frequent opportunistic infection in HIV-infected patients, with two-way impacts on the patient: by increasing the viral load, TB accelerates the progression from HIV infection to AIDS and, with it, to the death. In turn, HIV makes the diagnosis and treatment of TB difficult and favors the development of various clinical complications. Considering that (1) only two thirds of the HIV-positive population in the world have access to antiretroviral therapy; that (2) a third of those who died from AIDS in 2019 were also diagnosed with TB; that (3) globally, the risk of dying from TB is doubled in the individual with a positive HIV diagnosis; and that (4) in the Americas, only 61% of people with TB-HIV receive antiretroviral treatment, leaving three times more deaths and two times more loss to follow-up in those who are coinfected, there is a worrying reality about the results of current treatment policies for TB-HIV coinfection, making it necessary to explore its bases, scope, and methodologies in America and Ecuador(AU)

Multicenter study of Candida species in oral mucosa of different patients: analysis of 711 strains and literature review

This study aimed to identify Candida spp. collected from oral mucosa and maintained in culture collections, correlating the findings with the medical history of patients and comparing with data from the literature over the past five years. Seven hundred and eleven oral Candida spp. isolates, collected between 2013 and 2017, were selected and identified using traditional and molecular methods. In addition, a literature review was performed with the key words: "Oral", "Candida" and "Yeast". Seven species of the genus Candida: were identified C. albicans(73.3%); C. tropicalis (9.3%); C. parapsilosis (8.2%); C. glabrata (3.9%); C. guilliermondii(2.8%); C. krusei (1.7%) and C. lusitaniae (0.3%). The strains identified as C. albicans were submitted to molecular methods using specific primers and of these, 5.8% were identified as C. dubliniensis strains. The greatest diversity of strains was found in patients presenting no systemic diseases or HIV +, while the highest percentage of strains of Candidanon-albicanswere observed in cancer patients. This study reports a representative distribution of Candidaspecies among individuals exhibiting distinct clinical conditions, in order to contribute to the design of future research on details of aspects involved in the infections caused by these microorganisms. The correct identification of oral Candida strains contributes to a realistic epidemiological approach and future clinical protocols against these pathogens

Improving survival with tuberculosis & HIV treatment integration: A mini-review

Tuberculosis (TB) is a leading cause of morbidity and mortality among HIV-infected patients while HIV remains a key risk factor for the development of active TB infection. Treatment integration is a key in reducing mortality in patients with HIV-TB co-infection. However, this opportunity to improve outcomes of both infections is often missed or poorly implemented. Challenges in TB-HIV treatment integration range from complexities involving clinical management of co-infected patients to obstacles in health service-organization and prioritization. This is evident in high prevalence settings such as in sub-Saharan Africa where TB-HIV co-infection rates reach up to 80 per cent. This review discusses published literature on clinical trials and cohort studies of strategies for TB-HIV treatment integration aimed at reducing co-infection mortality. Studies published since 2009, when several treatment guidelines recommended treatment integration, were included. A total of 43 articles were identified, of which a total of 23 observational studies and nine clinical trials were informative on TB-HIV treatment integration. The data show that the survival benefit of AIDS therapy in patients infected with TB can be maximized among patients with advanced immunosuppression by starting antiretroviral therapy (ART) soon after TB treatment initiation, i.e. in patients with CD4+ cell counts <50 cells/?l. However, patients with greater CD4+ cell counts should defer initiation of ART to no less than eight weeks after initiation of TB treatment to reduce the occurrence and extent of immune reconstitution disease and subsequent hospitalization. Addressing operational challenges in integrating TB-HIV care can significantly improve patient outcomes, generate substantial public health impact by decreasing morbidity and death in settings with a high burden of HIV and TB.

Real-World Clinical Efficacy and Tolerability of Direct-Acting Antivirals in Hepatitis C Monoinfection Compared to Hepatitis C/Human Immunodeficiency Virus Coinfection in a Community Care Setting

BACKGROUND/AIMS: Limited data exist comparing the safety and efficacy of direct-acting antivirals (DAAs) in hepatitis C virus (HCV) monoinfected and HCV/human immunodeficiency virus (HIV) coinfected patients in the real-world clinic practice setting. METHODS: All HCV monoinfected and HCV/HIV coinfected patients treated with DAAs between January 2014 and October 2017 in community clinic settings were retrospectively analyzed. Pretreatment baseline patient characteristics, treatment efficacy, factors affecting sustained virologic response at 12 weeks (SVR12) after treatment, and adverse reactions were compared between the groups. RESULTS: A total of 327 patients were included in the study, of which 253 were HCV monoinfected, and 74 were HCV/HIV coinfected. There was a statistically significant difference observed in SVR12 when comparing HCV monoinfection and HCV/HIV coinfection (94% and 84%, respectively, p=0.005). However, there were no significant factors identified as a predictor of a reduced response. The most common adverse effect was fatigue (27%). No significant drug interaction was observed between DAA and antiretroviral therapy. None of the patients discontinued the treatment due to adverse events. CONCLUSIONS: In a real-world setting, DAA regimens have lower SVR12 in HCV/HIV coinfection than in HCV monoinfection. Further studies involving a higher number of HCV/HIV coinfected patients are needed to identify real predictors of a reduced response.

Accelerated decline in anti-HCV antibody levels in spontaneous HCV seroconverters with HIV co-in-fection / 中华微生物学和免疫学杂志

Objective To investigate the influence on anti-HCV antibody levels in spontaneous HCV seroconverters co-infected with HIV. Methods A retrospective study was conducted on people with a history of blood donation in Wangying Village,Shangcai County,Henan Province in 2009 and 2017. Accord-ing to the infection status in 2009,patients who were positive for anti-HCV antibody were divided into four groups:HIV-negative chronic HCV infection group (HCVc),HIV-negative spontaneous HCV clearance group (HCVr),HIV-positive chronic HCV infection group (HIV+HCVc),HIV-positive spontaneous HCV clear-ance group ( HIV+HCVr). All patients were followed up in 2017 and those who were lost to follow-up, received HCV treatment or were reinfected with HCV (only for those of HCV seroconverters) were excluded from this study. Altogether 167 patients met the inclusion criteria (HCVc:n=65;HCVr:n=34;HIV+HCVc:n=44;HIV+HCVr:n=24). A horizontal comparison of anti-HCV antibody levels among the above four groups in 2009 and a longitudinal comparison of changes in anti-HCV antibody in each group from 2009 to 2017 were respectively conducted. Results The horizontal comparison indicated that the levels of anti-HCV antibody were higher in chronic HCV-infected patients than in HCV seroconverters no matter whether they were co-infected with HIV or not (both P<0. 000 1). After comparison of anti-HCV antibody titers in 2017 and 2009,no significant changes were found in HCVc or HIV+HCVc group. The levels of anti-HCV antibody in HCVr and HIV+HCVr groups decreased significantly from 2009 to 2017 ( both P<0. 000 1). HIV+HCVr group showed a faster decline in anti-HCV antibody level than HCVr group (P=0. 003 9). Significant nega-tive correlations between the decline speed in anti-HCV antibody sample/cut-off ( S/CO) values and the initial anti-HCV antibody S/CO values (in 2009) were found in both HCVr (r=-0. 517 7, P=0. 001 7) and HIV+HCVr groups (r=-0. 753 2, P<0. 000 1). The decline speed in anti-HCV antibody in HIV+HCVr patients was found to be negatively correlated with their CD4+T cell counts in 2009 ( r=-0. 563 8, P=0. 004 1). Moreover,the seroreversion rate of anti-HCV antibody in patients of the HIV+HCVr group was higher than that of HCVr group (P=0. 027 5). Conclusion HIV co-infection can accelerate the decline of anti-HCV antibody in spontaneous HCV seroconverters. This study indicates that in a large-scale retrospective epidemiological investigation especially for HIV-infected populations, the prevalence of anti-HCV antibody may be underestimated.

Mortalidade por tuberculose e tuberculose-HIV, sua relação espacial com os determinantes sociais e tendência temporal: uma abordagem multimétodo em Foz do Iguaçu, PR / Mortality due to tuberculosis and HIV-tuberculosis, its spatial relationship with social determinants and temporal trend: a multi-method approach in Foz do Iguaçu, PR

A tuberculose (TB) é um grave problema de saúde pública, acometendo milhares de pessoas, principalmente em populações ou grupos menos favorecidos. A região de fronteira, devido ao aumento do fluxo de pessoas, constitui um desafio para o controle da TB. Nesse contexto, o objetivo geral do trabalho foi "Analisar a relação espacial de determinantes sociais da saúde com a mortalidade por TB e por TB-HIV e tendência temporal desses eventos em Foz do Iguaçu, PR". Como abordagem teórica, foi utilizado o marco conceitual dos Determinantes Sociais da Saúde. Trata-se de um estudo ecológico com aplicação de múltiplos métodos de análise. A população consistiu de casos de óbitos por TB como causa básica e TB associado com HIV (coinfecção TB-HIV) residentes em Foz do Iguaçu, no período de 2004 a 2015 e as unidades de análise foram os setores censitários urbanos. Os dados referentes aos óbitos foram coletados no Sistema de Informação de Mortalidade (SIM). As variáveis originais que representaram os determinantes sociais foram coletadas do Censo Demográfico 2010 do Instituto Brasileiro de Geografia e Estatística (IBGE). Quanto aos métodos de análises, foram realizadas análise descritiva dos óbitos, Estimador de densidade Kernel, estatística de varredura, distribuição e análise estatística das taxas de mortalidade, análise de dependência espacial (I Moran), Associação espacial (Índice Local de Associação Espacial - LISA e Gi*), Regressão Geograficamente Ponderada [RGP, em inglês - Geographically Weighted Regression (GWR)] e análise de tendência temporal (regressão temporal Prais-Wistein). Os resultados da análise descritiva demonstraram que dos 130 casos de óbitos no período, 74 ocorreram por TB como causa básica e 56 pela coinfecção TB-HIV. Para os dois grupos estudados a maioria era homens [TB = 53 (71,6%); TB-HIV = 43 (76,8%)], de raça/cor de pele branca [TB = 51 (68,9%); TB-HIV = 43 (76,8)], solteiros [TB = 36 (48,6%); TB-HIV = 35 (62,5%)], com ensino fundamental [TB = 34 (45,9%); TB-HIV = 25 (44,6%)] e com TB pulmonar [TB = 67 (90,5%); TB-HIV = 48 (85,7%)]. Os óbitos pela coinfecção TBHIV foram mais jovem em relação aos óbitos por TB. A técnica de estimador de densidade Kernel demonstrou pontos quentes para os óbitos por TB nas regiões Leste e Sul, enquanto que para os óbitos de TB-HIV foram as regiões Norte, Nordeste, Leste e Sul. A estatística de varredura apontou um cluster de risco relativo espacial aumentado 5,07 (IC95% 1,79 - 14,30) na região leste. As taxas de mortalidade foram 2,2/100mil hab. para TB e 1,8/100mil hab. para TB-HIV. A partir da técnica Gi*, observou-se que a taxa de mortalidade por TB apresentou áreas quentes na região Sul, Leste e Central, enquanto que a taxa de mortalidade por TB-HIV apresentou nas regiões Norte, Nordeste e Leste. A associação bivariada (LISA) demonstrou que o padrão predominante foi a associação das altas taxas de uma mortalidade com a baixa taxa da outra, ou seja, alto-baixo (High-Low) e baixo-alto (Low-High). Ocorreu ainda associação do padrão alto-alto (High-High), não sendo observado a associação baixobaixo. A associação local (LISA) entre os determinantes sociais e a mortalidade por TB apontou a renda, cor de pele e densidade de moradores por domicílio como fatores associados. Já em relação a taxa de mortalidade por TB-HIV, a técnica GWR, os determinantes indicados foram renda, raça/cor de pele parda e esgoto a céu aberto. Em relação à tendência temporal, observou-se um crescimento da mortalidade de TB em pessoas de raça/cor de pele parda. Os resultados contribuem para reflexão sobre a relevância da adoção de estratégias intersetoriais para a redução das desigualdades sociais afim de evitar as mortes por TB e TB-HIV em territórcios com grande vulnerabilidade

Tuberculosis (TB) is a serious public health problem, affecting thousands of people, especially in disadvantaged populations or groups. Border regions constitute a challenge for the control of TB, due to the constant increase in the flow of people. In this context, the general objective of this study was to "Analyze the spatial relationship of social determinants of health with mortality from TB and HIV-TB and its temporal tendency in Foz do Iguassu, PR". As a theoretical approach, the study opted for the conceptual framework of the Social Determinants of Health. It is an ecological study with application of multiple methods of analysis. The population of this study consisted of cases of deaths due to TB as a basic cause and TB associated with HIV (TB-HIV co-infection) residing in Foz do Iguassu, from 2004 to 2015, and the analysis units were the urban census tracts. Data on deaths were collected in the Mortality Information System (SIM). The original variables that represented the social determinants were collected from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE). As for the methods of analysis, this study focused on descriptive analysis of deaths, Kernel Density Estimator, Scan Statistics, Distribution and statistical analysis of mortality rates, spatial dependence (I Moran), Spatial Association (Local Spatial Association Index - LISA and Gi *), Geographically Weighted Regression (GWR) and temporal trend analysis (Prais-Wistein temporal regression). The results of the descriptive analysis showed that of the 130 cases of death in the period, 74 occurred because of TB as the basic cause and 56 because of TB-HIV co-infection. For the two groups studied the majority were men [TB = 53 (71,6%); TB-HIV = 43 (76,8%)], of race/color of white skin [TB = 51 (68,9%); TB-HIV = 43 (76,8)], single [TB = 36 (48,6%); TB-HIV = 35 (62,5%)], with elementary education (TB = 34 (45,9%); TB-HIV = 25 (44,6%)) and with pulmonary TB [TB = 67 (90,5%); TBHIV = 48 (85,7%)]. Deaths from TB-HIV coinfection were younger in relation to TB deaths. The Kernel intensity estimator technique demonstrated hot spots for TB deaths in the eastern and southern regions, while for the deaths of HIV-TB were the north, northeast, east and south. The scan statistic pointed to a cluster of spatial relative risk increased by 5.07 (95% CI 1.79 - 14.30) in the eastern region. Mortality rates were 2.2/100mil for TB and 1.8 / 100 thousand inhabitants for HIV-TB. From the Gi * technique, it was observed that the TB mortality rate presented hot areas in the south, east and central regions, while the mortality rate due to TB-HIV presented in the north, northeast and east regions. The bivariate association (LISA) showed that the predominant pattern was the association of the high rates of one mortality with the low rate of the other, that is, high-low and low-high. There was also association of the highhigh pattern, and the low-low association was not observed. The local association (LISA) between the social determinants and the mortality by TB indicated the income, skin color and density of residents per household as associated factors. Regarding the mortality rate due to HIV-TB, the GWR technique, the determinants indicated were income, race / color of brown skin and open sewage. Regarding the temporal trend, there was an increase in the mortality of TB in people of race / color of brown skin. The bivariate association (LISA) showed that the predominant pattern was the association of the high rates of one mortality with the low rate of the other, that is, high-low and low-high. There was also association of the high-high pattern, and the low-low association was not observed. The local association (LISA) between the social determinants and the mortality by TB indicated the income, skin color and density of residents per household as associated factors. Regarding the mortality rate due to HIVTB, the GWR technique, the determinants indicated were income, race / color of brown skin and open sewage. Regarding the temporal trend, there was an increase in the mortality of TB in people of race / color of brown skin. Regarding the temporal trend, there was an increase in the mortality of TB in people of race / color of brown skin. The results contribute to a reflection on the relevance of adopting intersectoral strategies to reduce social inequalities in order to avoid deaths due to TB and HIV-TB in highly vulnerable territories

Identification of novel Mycobacterium tuberculosis peptides as diagnostic reagents for tuberculosis among human immunodeficiency virus infected population / 中华传染病杂志

Objective To screen and validate the major histocompatibility complex class-Ⅰ(MHC-Ⅰ) restricted tuberculosis peptides as potential diagnostic reagents in tuberculosis interferon-gamma release assay (IGRA) used among human immunodeficiency (HIV)-infected population.Methods Candidate peptides were encoded by Mycobacterium tuberculosis (TB) RD (Region of difference).Computer software was used to predict and select CD8+ T cell epitopes restricted by MHC-Ⅰ molecules with high frequency and high affinity among HIV-infected people.Then peptides containing CD8+ T cell epitope were synthesized and screened in vitro.The sensitivity and specificity of IGRA using the above mixed peptides as stimulants were compared with those of IGRA using early secretory antigen target-6 (ESAT-6,molecular weight of 6 000) and culture filtrate protein-10 (CFP-10,molecular weight of 10 000) as stimulants among HIV-infected population.Results Eight overlapping peptides,including Rv0222176-191,Rv1980c122-138,Rv1985c105-120,Rv3425141-165,Rv3873133-151,Rv3873158-166,Rv387878-86,Rv3879c673-690,were obtained finally,which were able to stimulate the production of interferon-gamma from peripheral CD8+ T cells of tuberculosis patients,but not from peripheral blood mononuclear cells (PBMC) of healthy controls.Among the 25 patients with HIV/TB co-infection,the sensitivities of IGRA using the combination peptides (CP) and that using rESAT-6/CFP-10 (CE) were low (68％ vs 48％,x2 =2.052,P=0.152).However,the sensitivity increased to 92％ by using the combination of CP and CE,which was significantly higher than that using rESAT-6/CFP-10 alone (x2 =11.523,P ＜ 0.01),and the specificity was not affected.Conclusion These RD peptides with CD8+ T cell epitopes can increase the sensitivity of IGRA in detecting HIV/TB co-infection,which may improve the detection rate of tuberculosis in HIV infected population.

Leishmaniasis in a patient with HIV co‑infection: Diagnosis on fine needle aspiration cytology.

Leishmaniasis is a vector borne parasitic disease caused by obligate intracellular protozoa Leishmania and is transmitted by the bite of sand fly. The disease typically presents in visceral, cutaneous and mucocutaneous forms and is endemic in some states of India. Cases with atypical presentation are seen when patient has co- infection with HIV. We report a case of Leishmaniasis occurring in a HIV seropositive expectant mother diagnosed initially on fine needle aspiration cytology. The patient was resident of non endemic area and had presented with isolated cervical lymphadenopathy and fever without spleenomegaly. Characteristic morphological features of Leishmania seen in the fine needle aspiration smears from the neck nodes were identified and definitive diagnosis of Leishmaniasis could be given. Cytological features were not suggestive of any other disease. Timely diagnosis of the disease facilitated proper management in our patient.

Aspectos da coinfecção leishmaniose visceral e HIV no nordeste do Brasil / Aspectos de la leishmaniasis visceral y la coinfección por VIH en el noreste de Brasil / Aspects of visceral leishmaniasis and HIV co-infection in northeastern Brazil

O objetivo deste estudo foi descrever o perfil epidemiológico, clínico e laboratorial dos casos de Leishmaniose Visceral (LV) coinfectados com o Vírus da Imunodeficiência Humana (HIV) no Nordeste do Brasil, de 2007 a 2011. Estudo descritivo dos casos de LV coinfectados com HIV (LV-HIV) registrados no Sistema de Informação de Agravos de Notificação (SINAN). Dos 9.615 casos de LV: 5,08% eram coinfectados com HIV; o Estado da Paraíba apresentou os maiores percentuais de coinfecção; o sexo masculino representou 81,3% desses casos; os pardos (84,2%) e a faixa etária 20 a 39 anos (56%) foram os mais acometidos; a taxa de letalidade foi de 10,6%; e o percentual de cura foi de 62%. É notória a magnitude da coinfecção LV-HIV no Nordeste do Brasil, pois, embora o perfil dos pacientes coinfectados por LV-HIV não seja diferente daqueles com LV clássica, a maior letalidade aponta para a necessidade de estruturação dos serviços de assistência ao paciente e de vigilância em saúde.

The aim of this study was to describe the epidemiological, clinical and laboratory cases of Visceral Leishmaniasis (VL) coinfected with Human Immunodeficiency Virus (HIV) in Northeastern Brazil from 2007 to 2011. A descriptive study of cases of VL coinfected with HIV registered in the Information System for Notifiable Diseases (SINAN). Out of 9615 cases of VL: 5.08% were coinfected with HIV; the State of Paraíba had the highest percentage of coinfection; males represented 81.3% of these cases; the browns (84.2%) and age 20 to 39 years (56%) were the most affected; the fatality rate was 10.6%; and the cure rate was 62%. These findings emphasize the magnitude of HIV-coinfection LV in Northeastern Brazil, for although the profile of patients coinfected with HIV-LV is not different from those with classic LV, the greater lethality points to the need for the structuring of patient care services and health surveillance.

El objetivo de este estudio fue describir el perfil epidemiológico, clínico y de laboratorio de la Leishmaniasis Visceral (LV) coinfectados con el Virus de la Inmunodeficiencia Humana (VIH) en el Noreste de Brasil desde 2007 a 2011. Se realizó un estudio descriptivo de los casos de LV coinfectados con el VIH (LV-VIH) registrados en el Sistema de Información de Agravios de Notificación (SINAN). De los 9.615 casos de LV: 5,08% estaban coinfectados por el VIH, el Estado de Paraíba presentó el mayor porcentaje de coinfección; el sexo masculino representó el 81,3% de esos casos; los pardos (84,2%) y la edad entre 20 a 39 años (56%) fueron los más afectados; la tasa de letalidad fue de 10,6%, y la tasa de curación fue de 62%. Estos hallazgos ponen de relieve la magnitud de la coinfección VIH-LV en el noreste de Brasil, pues si bien el perfil de los pacientes coinfectados por el VIH-LV no es diferente de las personas con LV clásico, la mayor letalidad señala la necesidad de estructuración de los servicios de atención al paciente y de vigilancia de la salud.

Immunophenotyping of circulating T cells in a mucosal leishmaniasis patient coinfected with HIV / Immunofenotipagem de células T circulantes em um paciente com leishmaniose mucosa co-infectado com HIV

HIV coinfection modifies the clinical course of leishmaniasis by promoting a Th2 pattern of cytokine production. However, little information is available regarding the lymphocytic response in untreated coinfected patients. This work presents the immunophenotyping of Leishmania-stimulated T cells from a treatment-naÏve HIV+ patient with ML. Leishmania braziliensis antigens induced CD69 expression on CD3+CD4+ and CD3+CD8+ cells. It also increased IL-4 intracellular staining on CD3+CD4+GATA3- population and decreased the percentage of CD3+CD4+IL-17+ cells. This suggests that modulations in the IL-4R/STAT6 pathway and the Th17 population may serve as parasitic evasion mechanisms in HIV/ML. Further studies are required to confirm these results.

A co-infecção por HIV modifica o curso clínico da leishmaniose ao promover aumento no perfil Th2 de produção de citocinas. No entanto, há pouca informação a respeito da resposta linfocitária em pacientes co-infectados sem tratamento. Neste trabalho, foi realizada a imunofenotipagem de células T estimuladas com antígenos de Leishmania braziliensis em paciente não tratado HIV+ e com leishmaniose mucosa. Os resultados mostraram aumento na expressão de CD69 em células CD3+CD4+ e CD3+CD8+. Além disso, foi observado aumento de IL-4 na população de linfócitos CD3+CD4+GATA3- e diminuição no percentual de células CD3+CD4+IL-17+. Estes resultados sugerem que a modulação da via IL-4R/STAT6 e da população de células Th17 funcione como mecanismo de evasão parasitária em HIV/LM. Estudos futuros são necessários para confirmar estes resultados.

Presentation of tuberculosis in TB-HIV co-infection patients and the treatment outcome with directly observed short course therapy

Objective:To investigate different presentations of tuberculosis in HIV positive patients and their treatment outcome with directly observed short course therapy (DOTS). Methods: All patients having tuberculosis-HIV (TB-HIV) co-infection were taken. Different manifestations of tuberculosis in HIV positive patients were analyzed. Outcome of the treatment was observed in 14 patients. The rest of the patients were either transferred to other districts or still continuing their DOTS therapy according to the revised national tuberculosis control programme (RNTCP). Results:A total of 901 patients were diagnosed as tuberculosis. Out of these, 227 had positive pulmonary tuberculosis smear, 212 had negative smear and 462 had extra pulmonary tuberculosis. A total of 65 patients suffered from TB-HIV co-infection (7%). Result showed that the incidence of TB-HIV coinfection was the highest in productive age group of 16-45 years old (75%). Treatment completion rate was only 57%and the rate was higher in extra pulmonary tuberculosis patients (83%). Out of 4 sputum positive cases, 3 were declared cured (75%). Conclusions:TB-HIV co-infection in wardha (Cental India) is around 7%. Pattern of tuberculosis in HIV positive patient is the same as in HIV negative patient. Pattern of extra-pulmonary tuberculosis in HIV positive patients is mainly in form of tubercular lymphadenitis and pleural effusion. DOTS is the best modality of treatment of tuberculosis.

Estudo clínico-molecular na leishmaniose mucocutânea: diagnóstico e rastreamento de subpopulações de leishmania (Viannia) braziliensis nos níveis inter e intrapacientes / Clinical and molecular study in mucocutaneous leishmaniasis: Diagnoses and screening of subpopulation of leishmania (Viannia) braziliensis in the inter and intrapatient levels

O presente estudo teve como principal objetivo avaliar a diversidade genética de Leishmania (Viannia) braziliensis nos níveis inter e intrapacientes, diretamente em lesões cutâneas e mucosas de indivíduos com leishmanioses mucocutânea (LMC), disseminada (LD) e mucosa (LM), incluindo indivíduos coinfectados pelo vírus da imunodeficiência humana (HIV). Um total de 61 amostras procedentes de 38 pacientes foi analisado pelas técnicas da reação em cadeia da polimerase (PCR), da reação em cadeia da polimerase com primer único em condições de baixa estringência (LSSP-PCR) e da análise fenética, tendo como alvo molecular a região variável do minicírculo do DNA do cinetoplasto (kDNA). Neste estudo, predominaram indivíduos do sexo masculino e com acometimento mucoso nasal. A presença de DNA do parasita foi evidenciada pela banda diagnóstica de 750 pb, em todas as amostras analisadas, possibilitando o diagnóstico específico. Na investigação do perfil genotípico de subpopulações de L. (V.) braziliensis, através da LSSP-PCR, foi revelado o polimorfismo genético intrafragmento traduzido como uma assinatura do kDNA do parasito para cada amostra. Assinaturas de kDNAs similares em amostras de paciente coletadas ao mesmo tempo (mucosa oral e nasal), e a divergência nos perfis genéticos em amostras coletadas em tempos diferentes na mesma localização (mucosa nasal) sugerem a clonalidade do inóculo inicial, como consequência da estrutura populacional clonal de Leishmania. No estudo da variabilidade genética de L. (V.) braziliensis nos níveis inter e intrapacientes foram evidenciadas similaridades genotípicas entre as amostras de lesões cutânea e mucosa intrapacientes. As análises fenética e estatística possibilitaram afirmar que a diversidade genética no nível intrapacientes é menor do que a observada entre os pacientes...

The present study has as its main objective to evaluate the genetic diversity of Leishmania(Viannia) braziliensis in the inter and intrapatient levels, directly from cutaneous and mucosallesions of individuals with mucocutaneous (MCL), disseminated (DL) and mucosal (ML)leishmaniasis, including individuals with the human immunodeficiency virus (HIV) infection.A total of 61 samples recovered from 38 patients was analyzed by the techniques ofpolymerase chain reaction (PCR), low-stringency single-specific-primer PCR (LSSP-PCR)and phenetic analysis, directed to the variable region of the kinetoplast DNA (kDNA)minicircles. In this study, male individuals with nasal mucosa involvement predominated. Thepresence of the parasite’s DNA was revealed by the diagnosis band of 750 bp, in all analyzedsamples, making the specific diagnosis possible. In the investigation of the genotypic profileof the subpopulations of L. (V.) braziliensis, through LSSP-PCR, it was revealed theintrafragment genetic polymorphism translated as a kDNA signature for each sample. SimilarkDNAs signatures in patient’s samples collected simultaneously (oral and nasal mucosa), andthe divergence in the genetic profiles in samples collected at different times on the samelocation (nasal mucosa) suggest the clonality of the initial inoculum, as a consequence of theclonal population structure of Leishmania. In the study of the genetic variability of L. (V.)braziliensis in the inter and intrapatient levels, genotypic similarities were observed amongthe cutaneous and mucosal lesions intrapatients...

Primeira descrição epidemiológica da leishmaniose visceral em Campo Grande, Estado de Mato Grosso do Sul / First epidemiological description of visceral leishmaniasis in Campo Grande, State of Mato Grosso do Sul

Foi realizado estudo epidemiológico sobre casos de leishmaniose visceral notificados em Campo Grande de 2001 a 2006, utilizando-se dados do Sistema de Informação de Agravos de Notificação. Foram registradas 577 notificações com incidência de 1,47 casos/100.000hab em 2001, chegando a 20,98 casos /100.000hab em 2006, com notificações todos os meses a partir de 2002. Crianças até nove anos contribuíram com 40 por cento dos casos. O sexo masculino contribuiu com 64 por cento das notificações e o sexo feminino com 36 por cento. A letalidade variou de 5 por cento a 11 por cento, com média de 8 por cento. Dos 44 óbitos, 33 (75 por cento) ocorreram no sexo masculino e 11 (25 por cento) no sexo feminino. Embora os idosos tenham contribuído com 9 por cento dos casos, a mortalidade entre eles alcançou 39 por cento. Foram 27 casos de co-infecção Leishmania/HIV (5 por cento) com letalidade de 15 por cento, a maioria em homens dos 20 aos 49 anos. Constatou-se processo de endemização da doença com elevada incidência.

An epidemiological study was conducted on cases of visceral leishmaniasis that were notified in Campo Grande between 2001 and 2006, using data from the Brazilian information system for notifiable diseases (Sistema de Informação de Agravos de Notificação, SINAN). In 2001, 577 cases were notified, giving an incidence of 1.47 cases/100,000. This rose to 20.98 cases/100,000 in 2006. From 2002 onwards, new cases were notified every month. Children up to nine years of age accounted for 40 percent of the cases. Males accounted for 64 percent of the cases and females, 36 percent. The death rate ranged from 5 to 11 percent, with a mean of 8 percent. Among the 44 deaths, 33 (75 percent) were male cases and 11 (25 percent) were female cases. Although elderly people accounted for 9 percent of the cases, mortality among them reached 39 percent. There were 27 cases of Leishmania /HIV coinfection (5 percent), with a mortality rate of 15 percent, mostly among men aged 20 to 49 years. A process of disease endemization with a high rate of incidence was observed.

Malaria infection in HIV/AIDS patients and its correlation with packed cell volume (PCV).

Background & objectives: The study was designed: (i) to determine the prevalence of malaria parasites; (ii) to determine the relationship between parasitaemia and age/sex; (iii) to correlate the PCV levels with parasitaemia; and (iv) to determine the influence of protection against natural transmission on the prevalence of malaria. Methods: Participants were recruited at the Plateau State Human Virology Research Laboratory (PLASVIREC), Robert Gallo House at the Plateau State Specialist Hospital, Jos and grouped into: (i) Malaria and HIV co-infection group (n = 64); and (ii) HIV infected group without concurrent malaria infection (n = 136). Standard laboratory procedures were used for the HIV and Plasmodium parasites screening, malaria parasite density, and packed cell volume. Results: The results showed a significant difference (p <0.05) among the sexes and age groups. About 64 (32%) of the individuals had Plasmodium infection (30% Plasmodium falciparum, 0.5% P. malariae, and 1.5% mixed infections of P. falciparum and P. malariae). Malaria parasites were more common among the rural dwellers and in the age group of 21–30 yr. Regression analysis showed a negative association of malaria parasitaemia and PCV among the malaria–HIV positive and malaria-HIV negative (r2 = 0.529; p <0.001). Interpretation & conclusion: In the present study, PCV might be of useful indicator and if not monitored could lead to AIDS establishment especially where high malaria parasitaemia is noted. The findings further suggest that the defined stage of HIV infection in the study, malaria coinfection may moderate the impact of HIV infection on PCV.

Caracterização da tuberculose em portadores de HIV/AIDS em um serviço de referência de Mato Grosso do Sul / Characterization of tuberculosis among HIV/AIDS patients at a referral center in Mato Grosso do Sul

Investigou-se a tuberculose quanto à apresentação clínica, desfecho de tratamento e perfil sociodemográfico dos infectados pelo vírus da imunodeficiência humana atendidos em 2003-2005 em um serviço de referência sulmatogrossense. Analisaram-se 66 prontuários de pacientes maiores de 14 anos e informações do Sistema de Informação Nacional de Agravos de Notificação para Tuberculose e do Sistema de Informações de Mortalidade. Predominaram indivíduos do sexo masculino, cor branca, pouca escolaridade e procedência do meio urbano. Identificou-se incremento da apresentação clínica extrapulmonar e sua relação com o comprometimento imunológico. Sobressaíram-se como formas de encerramento da tuberculose a cura (alcançada com acompanhamento mais longo que o previsto) e o óbito (de seis pacientes no início do tratamento da tuberculose). Observaram-se lacunas de preenchimento nas notificações de tuberculose e nos prontuários. Detectou-se a necessidade de diagnosticar precocemente a tuberculose em soropositivos para HIV, de aperfeiçoar os registros nos prontuários e de acompanhar os casos além do período recomendado, por alteração da evolução clínica da tuberculose em co-morbidade com a infecção pelo vírus da imunodeficiência adquirida.

Tuberculosis was investigated regarding its clinical presentation, treatment outcome and sociodemographic profile among HIV patients attended at a referral center in Mato Grosso do Sul, in 2003-2005. Sixty-six medical files on patients over 14 years of age and data from the Brazilian National Information System for Notifiable Diseases relating to tuberculosis and from the Mortality Information System were analyzed. Most of the patients were male, white, of low schooling level and from urban areas. Increased extrapulmonary clinical presentation was found and it correlated with the degree of immunological competence. The main reasons for ceasing treatment were cure (reached after longer-than-expected follow-up) and death (of six patients at the beginning of the tuberculosis treatment). Information gaps were found in the tuberculosis notification records and medical files. The study revealed the need for early diagnosis of tuberculosis among HIV-positive patients, improvements in medical records and follow-up beyond the recommended duration, because of changes to the clinical evolution of tuberculosis in cases of comorbidity with HIV.

Associação entre a hepatite crônica pelo vírus da hepatite C (VHC) e diabete melito em pacientes monoinfectados pelo VHC e co-infectados com o vírus da imunodeficiência humana / Association between the chronic infection by hepatitis C virus (HCV) and diabetes mellitus in patients monoinfected with the HCV and coinfected with the human immunodeficiency virus

O objetivo deste estudo é estimar a prevalência de diabete melito (DM) em pacientes portadores de hepatite crônica pelo vírus da hepatite C (VHC) e naqueles co-infectados por VHC/HIV. Foram avaliados dois grupos: um com pacientes monoinfectados por VHC e outro com pacientes co-infectados por VHC/HIV. Foram avaliados idade, gênero e cor da pele. Nos monoinfectados foi calculado o índice de massa corporal (IMC). Foram realizados aminotransferases, albumina, bilirrubina total, tempo de protrombina e genotipagem do VHC. A biópsia hepática foi realizada em todos os pacientes. Foram avaliados 135 pacientes monoinfectados, dos quais 30 (22,2%) apresentavam DM, e 117 pacientes co-infectados, sendo 35 (29,9%) com DM (p=0,164). A média geral de idade nos monoinfectados foi de 48,28 ± 9,68 anos, superior ao grupo de co-infectados (40,83 ± 9,01 anos). Na avaliação dos dois grupos houve predomínio do gênero masculino. A maioria dos pacientes apresentava pele de cor branca. Avaliando-se o IMC, observou-se distribuição uniforme, com predomínio de IMC acima de 25 kg/m2, independente da presença de DM. Quando avaliados os exames laboratoriais, observou-se que as aminotransferases foram significativamente mais alteradas naqueles pacientes sem DM. Os demais exames não demonstraram diferenças significativas entre os grupos. Houve maior prevalência de genótipo 2 ou 3, sendo que dentre aqueles co-infectados observou-se correlação entre estes e a presença de DM. Quanto à fibrose, houve predomínio de F3/F4 naqueles com DM. Em conclusão, a prevalência de DM nos pacientes monoinfectados pelo VHC e nos co-infectados por VHC/HIV é alta (AU)

The aim of this study was to estimate the prevalence of Diabeters Mellitus (DM) in chronically HCV infected patients and in those coinfected by HCV/HIV. Two groups were evaluated: one infected with HCV virus and the other with co-infection HCV/HIV. The patients in both groups were evaluated for age, gender and skin color. In the monoinfected group the body mass index (BMI) was calculated. Aminotransferases, albumin, total bilirrubin, protrombin time and HCV genotyping were performed. Liver biopsy was performed in all patients. Thirty (22.2%) of 135 monoinfected patients had DM. DM was observed in 35 (29.9%) of 117 co-infected patients (p=0,164). The age in the monoinfected group was 48.28 ± 9.68 years. It was higher than the co-infected group (40.83 ± 9.01 years). In both groups there was a predominance of males and most patients were white. Regarding BMI it was an uniform distribution and BMI higher than 25 Kg/m2 was more frequent. The aminotransferases were significantly higher in those patients without DM. The other exams did not show significant differences between the groups.There was a higher prevalence of genotype 2 or 3. Among the co-infected a correlation was observed between these genotypes and the presence of DM. Liver biopsy showed a predominance of F3/F4 in those with DM. In conclusion, the prevalence of DM in the HCV monoinfected patients and in those co-infected HCV/HIV is high (AU)