ABSTRACT
La Guía Colombiana de práctica clínica para la atención de la infección por VIH / Sida en adolescentes y adultos incluye como primera línea de tratamiento el uso de Inhibidores de integrasa; sin embargo, no incluye recomendaciones que soporten la decisión de tratar a los pacientes controladores elite (CE). La definición de controladores elite es confusa pues varía de un estudio a otro y se desconoce si las recomendaciones de tratamiento, se pueden aplicar a los controladores de forma similar; tampoco existen mecanismos apropiados para el seguimiento sistemático de los controladores elite cuando se inicia en ellos una terapia antirretroviral. Este artículo es una revisión bibliográfica de la información disponible sobre la definición de los pacientes controladores, y los controladores elite, su evolución clinica e inmunológica, el tratamiento y las terapias disponibles en Colombia.
The Colombian Guide to Clinical Practice for HIV / AIDS Care in Adolescents and Adults, includes as first line of treatment the use of integrase inhibitors; however, there is no information to support the decision to treat elite control patients (EC). The definition of elite controller is confusing, because of the changes in definitions between studies, and it is unknown whether these recommendations apply to these patients in a similar way; and how should be systematic follow-up of elite controllers when antiretroviral therapy is initiated. Present paper is a bibliographic review of the available information on the definition of the controllers, and elite controllers its clinical and immunological evolution, the treatment and therapies available in Colombia.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Acquired Immunodeficiency Syndrome , HIV , Practice Guideline , Integrase Inhibitors , Clinical Evolution , Review , Infection Control , Aftercare , Integrases , InfectionsABSTRACT
Background: Few reports suggest the association of killer immunoglobulin-like receptors of natural killer cells with human immunodeficiency virus infection. India with world's third largest population of human immunodeficiency virus / acquired immunodeficiency syndrome, offers scope to study such association. Objective: Current study (2010-2015) was designed to evaluate if killer immunoglobulin-like receptors gene polymorphisms are associated with HIV infection outcomes specifically, with long term non progressors. Methods: Killer immunoglobulin-like receptors genotyping was done using polymerase chain reaction - sequence-specific primer method. Viral load was measured by Cobas Taqman HIV-1 test. Estimation of CD4 counts was done using BD FACS CD4 count reagent. Results: The activating gene frequencies identified were 3DS1 (53.8%), 2DS3 (69.2%), 2DS4 (76.9%), 2DS5 (69.2%), 2DS1 (76.9%) and 2DS2 (92.3%). The inhibitory gene frequencies were 2DL2 (92.3%), 2DL5 (76.9%), 2DL3 (69.5%), 3DL1 (84.6%), 3DL2 (92.3%) and 2DL1 (100%). The results highlight high frequency of 3DS1/3DL1 heterozygote and killer immunoglobulin-like receptor 2DS1, among these long term non progressors indicating their possible association with slow progression. Genotype analysis shows total 13 genotypes, of which 8 genotypes were identified for the first time from India. Two genotypes were unique/novel, which were unreported. All genotypes observed in this study were considered to be Bx genotype (100 %). Limitations: A small sample size (n=13, due to a rare cohort) and the absence of control group were the limitations of this study. Conclusions: The present study highlights the distribution of killer immunoglobulin-like receptor genes in a very rare group of human immunodeficiency virus -1 infected individuals - long term non progressors. All the long term non progressors tested show the presence of Bx haplotype and each long term non progressors has a different killer immunoglobulin-like receptor genotype.
ABSTRACT
There are only scarce data on HIV progression in vertically infected children in developing countries. The aim of this study is to describe factors from neonatal period associated with long term non-progression (LTNP), in a Brazilian cohort. A cohort study, with data systematically collected from the "Peixe" Cohort (cohort study of children conducted at the main HIV Pediatric Center in Rio de Janeiro, from 1996 to 2005). The study included children who were vertically infected and started follow up at 5 years of age or younger. LTNP, defined as not reaching category C or severe immunosuppression before 5 years of age. Neonatal and demographic factors were studied. Variables with p-value<0.15 were included in a logistic regression model. 213 patients were included, of whom 42 percent (89/213) were classified as LTNP. Variables independently associated with LTNP were: baseline (at study entry) CD4+ cells (per percent) (OR= 1.06, 95 percentCI=1.01-1.12); age of initiating follow-up, per month (OR= 1.03, 95 percentCI=1.01-1.06); ZDV use duriing newborn period (OR= 3.31, 95 percentCI=0.86-12.71); use of antiretroviral (ART) before classification C or severe immunosuppression (OR= 5.89, 95 percentCI=2.03-17.10). Adjusting for age at the beginning of follow-up, antiretroviral that was unsuccessfully used to prevent maternal-to-child transmission (ZDV use in neonatal period) was associated with better prognosis. ARTs initiation before category C or severe immunosuppression was also associated with LTNP.