ABSTRACT
La infección por VIH está asociada con un elevado riesgo de malnutrición. Los mecanismos por los cuales un paciente con SIDA pierde peso, pueden llegar a ser disminución de ingreso alimentario por falta de apetito; pérdida de las capacidades cognoscitiva, visual, auditiva, olfatoria ó por pérdida del estado de consciencia; aversión a los alimentos por cambio de sabores; dificultad ó dolor al deglutir, por enfermedades del esófago; náuseas ó vómito por gastritis medicamentosa ó por efectos adversos de los medicamentos; pérdidas alimentarías anormales ó mayor consumo de energía y nutrimentos causado por la enfermedad ó sus complicaciones, sin olvidar factores económicos y el social. Diversos factores aquejan una ingesta anormal en el paciente con VIH/SIDA. El síndrome de malabsorción intestinal, aparece en el 31% de los niños infectados. Las infecciones oportunistas pueden ocasionar fiebre, provocando un estado hipermetabólico, con incremento de las necesidades energéticas del organismo así como las pérdidas de nitrógeno por orina. Los factores psicosociales también contribuyen de manera importante al crecimiento subóptimo de niños infectados con VIH.
The mechanisms by which an AIDS patient loses weight, may become reduced food intake due to lack of appetite, loss of cognitive skills, visual, auditory, olfactory or loss of the state of consciousness, aversion to food for change flavors, difficulty or pain on swallowing, esophageal diseases, gastritis, nausea or vomiting from medications or adverse drugs effects, los sor abnormal eating more energy and nutrients caused by the disease or its complications, not to mention economic factors and social. Several factors facing an abnormal intake in patients with HIV/AIDS. Intestinal malabsorption síndrome, occurs in 31% of infected children. Opporunistic infecions can cause fever, causing a hypermetabolic state with increased energy needs and body nitrogen losses in urine. Psychosocial factors also contribute significantly to suboptimal growth of children infected with HIV.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Child Nutrition , HIV Infections/classification , HIV Infections/complications , HIV Infections/diagnosis , HIV Infections/diet therapy , HIV Infections/metabolism , Malnutrition/classification , Malnutrition/complications , Malnutrition/diagnosisABSTRACT
En niños con infección por VIH/SIDA, existen diferentes métodos para estimar las necesidades de proteína y energía. Estos requerimientos pueden ser estimados, sustituyendo la ingesta diaria recomendada (IDR) por proteína, o incrementando la IDR de proteína entre 50%-100%. Los lípidos ayudan a aumentar el aporte energético. La restricción de carbohidratos simples, se hará en el caso de presentar resistencia periférica a la insulina, al igual que cuando se presente hipertrigliceridemia. Es necesario mantener una buena hidratación para asegurar el equilibrio hidroelectrolítico. El objetivo del soporte nutricional especial, tiene que estar encaminado a preservar la masa grasa y mantener los niveles adecuados de nutrimentos y minimizar los síntomas de malabsorción. De preferencia se deberá utilizar la vía oral ó enteral. Aunque muchos estudios reportan la transmisión del VIH a través de la leche materna, la proporción y la epidemiología no está completamente establecida.
In children with HIV/AIDS infection, there are different methods for estimating protein and energy needs. These requirements can be estimated by replacing the recommended daily intake (RDI) for protein, or increasing the RDA of protein between 50%-100%. Lipids help to increase energy intake. The restriction of simple carbohydrates, will be presented in the case of peripheral insulin resistance, like when presented hypertriglyceridemia. Must be maintained to ensure good hydration and electrolyte balance. The purpose of the special nutritional support, must be designed to preserve body fat and maintain proper levels of nutrients and minimize symptoms of malabsorption. Preferably it should use the oral or enteral. Although many studies report HIV transmission through breast milk, the proportion and epidemiology is not fully established.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , HIV Infections/classification , HIV Infections/diagnosis , HIV Infections/metabolism , Child Nutrition , Carbohydrates/classification , Lipids/analysis , Lipids/classification , Minerals , Nutritional Requirements , Vitamins/classification , VitaminsSubject(s)
AIDS-Related Opportunistic Infections/drug therapy , Adolescent , Adult , Algorithms , Anti-HIV Agents/adverse effects , CD4 Lymphocyte Count , Developing Countries , Drug Resistance, Viral , Drug Therapy, Combination , Evidence-Based Medicine , Female , HIV Infections/classification , HIV-1/drug effects , Humans , India , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Male , Pregnancy , Reverse Transcriptase Inhibitors/adverse effects , Treatment Refusal , Viral LoadABSTRACT
BACKGROUND: The study describes a cohort of HIV-infected Jamaican children receiving antiretroviral therapy (ART) and reports the outcome. METHOD: An observational prospective study was conducted on HIV-infected Jamaican children receiving anti retroviral drug therapy (ART). The outcome measures, weight, height, hospital admissions and length of stay were compared at initiation and within six months of commencing ART. RESULTS: There were 37 (33.6) of 110 HIV-infected children receiving ART during 2001 to 2003. The median age at commencement was six years (age range 1-16 years) with 54.1 (20) males and 48 AIDS orphans. Care was home-based for 68 of all cases with the University Hospital of the West Indies managing 27 (73) and the Bustamante Hospital for Children 10 (27). The distribution by Centers for Disease Control and Prevention (CDC) clinical class was C (severely symptomatic), 22 (59.5); B (moderately symptomatic), 8 (21.6); A (mildly symptomatic), 6 (16.2) and N (asymptomatic), one (2.7). Among 14 (36) children with CD4 counts, 8 (57) were CDC immune class 2 (moderate immunodeficiency) and 6 (43) were class 3 (severe immunodeficiency). After commencing ART the mean difference in admissions was--1.5+/-2.55 admissions (95 CI -2.3, -0.6; p < 0.001) and in length of stay was -12.9+/-21 day (95 CI -19.9, -0.5.9; p < 0.001). Antiretroviral therapy resulted in a mean weight gain of 2.8 kg+/-4.9 kg (95 CI 1.0, 4.5; p < 0.003) and a mean gain in height of 1.7 cm+/-2.6 cm (95 CI 0.6, 2.8; p < 0.003). Five children required second line therapy. CONCLUSION: The introduction of antiretroviral therapy has resulted in improved outcomes and is being initiated in older children cared for mainly at home. Limitations in accessing affordable second line agents underscore the need for compliance with first line therapy
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Antiretroviral Therapy, Highly Active , Anti-Retroviral Agents , HIV Infections/drug therapy , Treatment Outcome , Child Health Services , Prospective Studies , HIV Infections/classification , HIV Infections/physiopathology , Jamaica , Severity of Illness IndexABSTRACT
Analises do comportamento da viremia plasmatica apos a introducao de esquemas terapeuticos contendo associacoes de drogas potentes tem sido alvo de estudos, os quais conduziram a importantes informacoes sobre o comportamento do HIV-1 quando exposto a estas drogas. Nesta pesquisa, foram avaliados dez pacientes infectados pelo subtipo B brasileiro, nunca expostos a drogas anti-retrovirais, com o objetivo de avaliar possiveis diferencas na resposta virologica dos mesmos em comparacao aos estudos publicados anteriormente, os quais avaliaram o subtipo B americano. Usou-se o esquema terapeutico mais potente disponivel no momento do estudo, baseados em dados mais recentes de avaliacao da supressao viral, tendo como resultado curvas de decaimento estremamente semelhantes aos resultados de estudos previamente publicados, com queda importante destas particulas virais nas primeiras duas semanas de tratamento, correspondendo a eliminacao de particulas virus livres e a perda de celulas produtivamente infectadas, com valor medio de decaimento de 2,51logs na maioria dos pacientes estudados, seguidos por um declinio mais lento, correspondendo a manutencao da eliminacao de virions pelos reservatorios virais. Conclui-se com este estudo, o ja comprovado anteriormente, que esquemas mais potentes causam declinios mais rapidos da viremia plasmatica devido a acao destes nos compartimentos infectados pelo HIV-1.
Subject(s)
HIV-1 , Anti-HIV Agents , HIV Infections/classificationABSTRACT
Factors associated with undetectable viral load (<80 copies/ml) were investigated among non-pregnant adults in antiretroviral treatment in a specialized service for HIV/AIDS in Southern Brazil. Use of antiretrovirals was investigated in two interviews (one month interval). Clinical data were collected from the clinical records; viral load previous to adherence measurement was defined the viral load previous to the first interview; the final viral load, the viral load subsequent to the second interview (interval between measures approximately 6 months). Undetectable final viral load occurred in 48 of the patients and was positively associated with levels of treatment adherence (p<0.001), being 19 for less than 60 of adherence and about 60 for adherence greater than 80. In the multivariate model, the odds of undetectable final viral load was four times greater for 80-94 and > or =95 of adherence (CI 95 1,80-13,28; CI 95 1,73-9,53), compared with less than 60 adherence; it was greater for less than 6 months in treatment (OR = 3.37; CI 95 1.09-10.46); and smaller for viral load previous to adherence measurement 5.2 log10 (OR = 0.19; CI95 0.06-0.58), adjusted for these variables and sex, age, clinical status, current immune status, group of drugs and interval between the two measurements of viral load. The crude odds were lower for age 16-24 years and use of Nucleoside Analog Reverse Transcriptase Inhibitors only, but these effects were not significant in the multivariate model. There was no evidence of effect of sex, clinical status, current immune status, and changes in treatment regimen. Treatment adherence gave the largest effect. Motivational interventions directed at adherence may improve treatment effectiveness.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Anti-HIV Agents , HIV , HIV Infections/drug therapy , HIV Infections/virology , Viral Load , Brazil , Drug Therapy, Combination , HIV , HIV Protease Inhibitors , HIV Infections/classification , HIV Infections/immunology , Patient Compliance , Odds Ratio , Reverse Transcriptase Inhibitors , Risk Factors , Socioeconomic FactorsABSTRACT
O objetivo do presente estudo foi determinar a prevalência de cárie em crianças infectadas pelo HIV (HIV+) comparando com um grupo controle de crianças sem sinais de imunodeficiência e observar suas correlaçöes com níveis salivares s Streptococcus mutans, Streptococcus sobrinus e Lactobacillus acidophilus e níveis de anticorpos salivares (IgA total e IgA específica pasa S. mutans, S. sobrinus e L. acidophilus). Correlaçöes entre estes parâmetros e a classificaçäo clínica e imunológica das crianças HIV+ também foram investigadas. A cárie foi quantificada pelos índices ceo e ceo-s e após coleta de saliva estimulada, os níveis das bactérias cariogênicas determinados pela técnica do "Checkerboard DNA-DNA hybridization", e os anticorpos medidos através de "enzyme linked immunosorbant assays". A prevalência de cárie foi maior para as crianças HIV+ (p<0,05) e a quantidade de microorganismos cariogênicos e anticorpos salivares semelhantes nos dois grupos, com exceçäo da IgA total que apresentou níveis mais elevados no grupo HIV+ (p<0,05). Embora näo estatisticamente significante, a prevalência de cárie e a quantidade de S. mutans nas crianças HIV+ foram maiores nas mais comprometidas clínica e imunologicamente. Os níveis de IgA (total e específica) também cresceram com a piora do quadro clínico das cianças HIV+, porém reduziram no estágio mais grave (AIDS). Quando observado somente os indivíduos mais imunologicamente comprometidos, as crianças mais infectadas pelo S. mutans e com maior prevalência de cárie apresentram níveis menores de imunoglobulinas. Os resultados indicam que a resposta do sistema imune mucoso a bactérias cariogênicas permanece intacta nas crianças HIV+, até que a AIDS se instale
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Dental Caries/epidemiology , Dental Caries/etiology , Immunoglobulin A, Secretory , Immunosuppression Therapy , HIV Infections/classification , HIV Infections/complications , HIV Infections/epidemiology , Prevalence , SalivaSubject(s)
Anti-HIV Agents/administration & dosage , CD4 Lymphocyte Count , Chemoprevention/methods , Child , Child, Preschool , Female , HIV Infections/classification , Humans , Infant , Infant, Newborn , Infectious Disease Transmission, Vertical/prevention & control , Practice Guidelines as Topic , Pregnancy , Severity of Illness IndexSubject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Disease Management , Acquired Immunodeficiency Syndrome , Antiviral Agents , Skin Diseases , Clinical Laboratory Techniques , Fever , Heart Diseases , Kidney Diseases , Ambulatory Care , Heart Defects, Congenital , Digestive System Diseases , Nervous System Diseases , Hematologic Diseases , Musculoskeletal Diseases , Respiratory Tract Diseases , Rheumatic Diseases , Immunization , Eye Infections , HIV Infections/classification , HIV Infections/diagnosis , Home Care Services , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/etiologyABSTRACT
Uma série de 332 pacientes ambulatoriais com sorologia positiva para o HIV ou de risco para a infecçäo, subdivididos em classes (AIDS, ARC, LGP, soropositivos assintomáticos e soronegativos), foram examinados para determinar a frequência das manifestaçöes oftalmológicas. As alteraçöes oculares foram observadas em 26,5 por cento dos pacientes e houve um aumento significativo destas quando o paciente se encontrava naas fases de ARC (13,6 por cento) e AIDS (73,8 por cento) (p<0,05). A microangiopatia retiniana foi a alteraçäo ocular mais frequente (42,0 por cento), seguida pela retinite por citomegalovírus (18,2 por cento), retinocoroidite toxoplásmica (7,9 por cento) e a coroidite tuberculosa (4,5 por cento). A proporçäo das alteraçöes oftalmológicas foi 7 vezes maior nos pacientes imunodeficientes que nos imunocompetentes (p=0)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Eye Manifestations , HIV Infections/classificationABSTRACT
Estudio dermatológico e histopatológico en 46 pacientes con infección VIH/SIDA. Se hizo clasificación clínica y de su subpoblaciones de linfocitos de acuerdo con los criterios del CDC, pero no se encontró relación estadísticamente significativa. Las dermatosis se presentaron en 77 por ciento de los casos y las más frecuentes fueron: sarcoma de Kaposi (18.9 por ciento), molusco contagioso (16.8 por ciento), dermatitis seborreica (12.6 por ciento), herpes zoster (10.5 por ciento), reacciones a fármacos (10.5 por ciento) y candidosis oral (8.4 por ciento)
Subject(s)
Adult , Humans , Male , Female , CD4-Positive T-Lymphocytes/immunology , Herpes Zoster/diagnosis , Herpes Zoster/immunology , HIV Infections/classification , HIV Infections/physiopathology , Molluscum Contagiosum/diagnosis , Molluscum Contagiosum/immunology , Sarcoma, Kaposi/diagnosis , Sarcoma, Kaposi/etiology , Acquired Immunodeficiency Syndrome/classification , Acquired Immunodeficiency Syndrome/physiopathologyABSTRACT
A infecçao pelo HIV rapidamente ganhou importância no meio médico. Entretanto, ainda há desinformaçao sobre as manifestaçoes clínicas e a classificaçao dos pacientes. Os autores abordam os aspectos clínicos e epidemiológicos, com a nova classificaçao proposta pelo Center for Disease Control (CDC), em 1992, para o melhor manuseio da infecçao pelo HIV.