Comparison of the ACC/AHA and Framingham algorithms to assess cardiovascular risk in HIV-infected patients

ABSTRACT The aim of this study was to compare the predictions of Framingham cardiovascular (CV) risk score (FRS) and the American College of Cardiology/American Heart Association (ACC/AHA) risk score in an HIV outpatient clinic in the city of Vitoria, Espirito Santo, Brazil. In a cross-sectional study 341 HIV infected patients over 40 years old consecutively recruited were interviewed. Cohen's kappa coefficient was used to assess agreement between the two algorithms. 61.3% were stratified as low risk by Framingham score, compared with 54% by ACC/AHA score (Spearman correlation 0.845; p < 0.000). Only 26.1% were classified as cardiovascular high risk by Framingham compared to 46% by ACC/AHA score (Kappa = 0.745; p < 0.039). Only one out of eight patients had cardiovascular high risk by Framingham at the time of a myocardial infarction event registered up to five years before the study period. Both cardiovascular risk scores but especially Framingham underestimated high-risk patients in this HIV-infected population.

Spectrum of AIDS defining & non-AIDS defining malignancies in north India.

Background & objectives: There is scarcity of data on the frequency of malignancies in HIV infected individuals from India. The objective of this study was to determine the type and frequency of malignancies in HIV infected individuals attending a tertiary care hospital in north India. Methods: The study design included retrospective analysis of data of all HIV infected individuals registered in the Immunodeficiency clinic from December 2009 to December 2011 and a prospective analysis of HIV infected individuals registered from January 2012 to April 2013. The clinical details and treatment outcomes of all individuals diagnosed to have AIDS defining and non-AIDS defining malignancies were recorded. Results: Records of 2880 HIV infected individuals were reviewed. Thirty one (19 males, 12 females) individuals were diagnosed to have malignancy. AIDS defining malignancy was found in the form of non-Hodgkin’s lymphoma in 12 individuals and cervical cancer in six women. Non-AIDS defining malignancies included Hodgkin’s lymphoma (n=2); and chronic myelogenous leukaemia, carcinoma base of tongue, carcinoma larynx, carcinoma bronchus, sinonasal carcinoma, ovarian carcinoma, anal carcinoma, carcinoma urinary bladder, pleomorphic sarcoma, parathyroid adenoma, and renal cell carcinoma in one individual each. Mean CD4+cell count prior to ART initiation was 250 ± 195.6 (median: 187; range, 22-805) cells/μl and at the time of diagnosis of malignancy was 272 ± 202 (median: 202; range, 15-959) cells/μl. The mean CD4+ count of individuals with AIDS defining malignancy was significantly lower when compared with non-AIDS defining malignancy (P<0.001). Fourteen individuals were alive and on regular follow up, 15 had died and two cases were lost to follow up. Interpretation & conclusions: The frequency of malignancies in HIV infected patients at our centre was 1 per cent, with non-Hodgkin’s lymphoma being the commonest. Further studies need to be done to document similar data from different parts of the country.

Anorectal and gastric peripheral T-cell lymphoma, unspecified in a non-AIDS patient

Anorectum is a rare location for malignant lymphoma. Involvement of is rare even for the lymphoma associated with acquired immune deficiency syndrome (AIDS), and AIDS has a relatively increased frequency of anorectal lymphoma. Most lymphomas in AIDS patients are of a B-cell origin, and T-cell lymphoma of the gastrointestinal tract is extremely rare. We report here on a case of anorectal and gastric peripheral T-cell lymphoma, unspecified (PTCLu) in a non-AIDS patient. A previously healthy 29-year-old man presented with hematochezia and tenesmus that he had suffered with for the previous 2 months. Sigmoidoscopy showed anal and rectal submucosal tumor. Multiple round-shaped, flat and elevated lesions were noted on the gastric antrum and body as well. He underwent excisional biopsy for the anal mass and the diagnosis was PTCLu. Biopsies of the gastric lesions gave the same diagnosis. There was no lymphoma involved in the bone marrow. At admission, no antibodies against human immunodeficiency virus were detected. He underwent systemic chemotherapy and upfront autologous stem cell transplantation.

Criptococose não associada à AIDS no Rio Grande do sul: relato de oito casos e revisão da literatura sul-RioGrandense / Cryptococcosis not related to AIDS in Rio Grande do Sul: a report of 8 cases and a review of the literature

Relatam-se oito casos de criptococose não associada à AIDS diagnosticados em Santa Maria, RS, no período 1961-1995. É revisada a literatura sul-riograndense sobre a micose e comentada a prevalência da infecção pela var. neoformans em pacientes sem doença predisponente nas regiões subtropicais.

We report eight cases of cryptococcosis in non-AIDS patients diagnosed in Santa Maria, RS, during 1961-1995. A review of the literature is performed and the prevalence of the infection caused by var neoformans in patients without underlying disease in subtropical regions is commented.

The comparative study of CSF findings in AIDS and non-AIDS patients with cryptococcal meningitis.

The ceredrospinal fluid of patients with AIDS and Cryptococcus neoformans infection (n = 62) and those of non-AIDS with Cryptococcus neoformans infection (n = 31) were analysed for white cell count, protein and CSF sugar/blood sugar levels. The mean value of white cell count (39.43/cumm VS 160.83/cumm) and protein (77.91 mg/dl Vs 118.2 mg/dl) in patient with AIDS and cryptococcal infection were statistically significant lower than non-AIDS patients with cryptococcal infection (p < 0.005 and p < 0.01), whereas there were no difference in CSF sugar/levels. Two-thirds of the patients with AIDS and cryptococcal infection had the white cell count less than 10 cell/cumm. These data shows that AIDS aptients have lower immune response to cryptococcus neoformans than non-AIDS patients. Thus it is advisable that Indian ink preparation of CSF is always necessary for AIDS patients in spite of normal white cell count in the CSF.