Sarcoma de Kaposi en personas que viven con VIH-SIDA en un hospital público de referencia en Perú / Kaposi's sarcoma in people living with HIV/aids in a public referral hospital in Peru

RESUMEN El sarcoma de Kaposi (SK) es el cáncer más frecuente en las personas que viven con VIH. Las investigaciones sobre esta condición son escasas en la región, por lo que, el objetivo de este artículo fue describir las características demográficas, clínicas y terapéuticas de los pacientes con VIH que desarrollaron SK en el Hospital Cayetano Heredia entre el 2000 y 2018. Se identificaron 129 casos de SK, con una mediana de edad de 33 años, con predominio en varones con el 92% (119/129), y en su mayoría hombres que tienen sexo con hombres (HSH). La mediana de tiempo desde el diagnóstico de VIH hasta el del SK fue de cinco meses, asociado con un recuento de linfocitos CD4 de 64 células/µL (RIC: 33-185) al momento del diagnóstico de SK. El compromiso cutáneo fue el más común; sin embargo, al menos la mitad de ellos también tuvo la forma visceral.

ABSTRACT Kaposi's sarcoma (KS) is the most frequent cancer in people living with HIV. Research on this condition is scarce in the region, therefore, this article aimed to describe the demographic, clinical and therapeutic characteristics of patients with HIV who developed KS at the Cayetano Heredia Hospital between 2000 and 2018. A total of 129 KS cases were identified, with a median age of 33 years, predominantly males with 92% (119/129), and mostly men who have sex with men (MSM). The median time from HIV diagnosis to KS diagnosis was five months, associated with a CD4 lymphocyte count of 64 cells/μL (IQR: 33-185) at KS diagnosis. Cutaneous involvement was the most common presentation; however, at least half also had the visceral form.

Enfermedad de Castleman multicéntrica en pacientes HIV positivos. Reporte de dos casos y revisión de la literatura / Multicentric Astleman disease in HIV positive patients. Two cases. Report and literature review

La enfermedad de Castleman (EC) es un proceso linfoproliferativo poco frecuente que se caracteriza por hiperplasia de los ganglios linfáticos. Existen dos variedades histológicas bien diferenciadas la hialino-vascular y la plasmocelular, que a su vez pueden ser localizadas o multicéntricas. La forma hialino-vascular suele ser asintomática y localizada en mediastino mientras que la plasmocelular se presenta frecuentemente con signo-sintomatología sistémica y suele ser difusa o multicéntrica. En el contexto de la enfermedad debida al virus de la inmunodeficiencia humana (VIH), la EC se asocia en su patogenia a la infección por el herpes virus humano tipo-8 (HHV-8). La mayoría de los casos corresponden a la variante hialino-vascular (80/90%) en tanto un pequeño porcentaje (10/20%) son de la variante plasmocelular. En algunos pacientes, el patrón histopatológico puede ser mixto. Se describen dos casos de enfermedad de Castleman multicéntrica HHV8- positiva en pacientes con enfermedad HIV/SIDA.

Castleman's disease (CD), is a rare hematological condition of uncertain etiology, involves a massive proliferation of lymphoid tissues and typically presents as mediastinal masses. This is considered as a distinct type of lymphoproliferative disorder associated with inflammatory symptoms. In the context of human immunodeficiency virus (HIV) infection, CD is associated with human herpesvirus-8 (HHV8) infection. Most cases of CD represent either the hyaline vascular variant (80­90% of cases) or the plasma cell variant (10­20%); a small percentage present with a mixed histologic appearance. Two cases of Castleman's disease associated with HHV-8 and HIV/AIDS infection are described

Proporción de infecciones oportunistas y factores de riesgo asociados a su aparición en pacientes con VIH / Proportion of opportunistic infections and risk factors associated with its appearance in patients with HIV

Antecedentes: Las infecciones oportunistas son la principal causa de morbilidad, discapaci- dad y mortalidad en pacientes con VIH, aumentando el número de hospitalizaciones y costos en la atención. Objetivo: Estimar la proporción de infecciones oportunistas e identificar los factores asociados a su aparición en pacientes con VIH atendidos en el Servicio de Atención Integral del Hospital Nacional Dr. Mario Catarino Rivas, San Pedro Sula, 2019-2020. Métodos: Estudio no experimental, analítico de casos (infección oportunista presente) y controles. Se evaluaron 40 casos y 120 controles, con un nivel de confianza de 95%, poder estadístico de 80%, con muestreo tipo aleatorio simple. Se utilizó la distribución de variables entre casos y controles para la obtención de Odds Ratio. Resultados: Las infecciones oportunistas incluyeron: 52.5% (21) tuberculosis, 15.0% (6) histoplasmosis, 12.5% (5) citomegalovirus, 10.0% (4) toxoplasmosis, 10.0% (4) candidiasis, 7.5% (3) criptococosis. El conteo de linfocitos T CD4 fue <200 cel/mm3 en 60.0% (24) de grupo casos y 10.8% (13) de grupo control. La carga viral ˃1000 copias/ml (OR 14.500 IC95% 6.109-34.415), el antecedente de abandono (OR 4.363 IC95% 1.928-9.872) y el no tomar tratamiento antirretroviral (OR 64.076 IC95% 8.063-509.165) se asociaron a infecciones oportunistas. La carga viral mayor de 1000 copias/mL predominó en el grupo de casos, y se encontró asociación de esta con la presencia de infecciones oportunistas con OR 14.500 (IC 95% 6.109-34.415, p=.0001). Conclusión: El no tomar ARV aumenta 64 veces más el riesgo de desarrollar infecciones oportunistas y el haber abandonado el tratamiento antirretroviral aumenta 4 veces más la probabilidad de desarrollar una infección oportunista. El tratamiento antirretroviral de gran actividad y el apego al mismo es la mejor estrategia para prevenir las infecciones oportunistas en pacientes infectados por el VIH...(AU)

Acompanhamento do comportamento do HIV através de exames laboratoriais em portadora do vírus: relato de caso / Monitoring of HIV behavior through laboratory tests in a virus carrier: case report

O vírus da imunodeficiência humana é o agente etiológico da AIDS, doença crônica que destrói o sistema imunológico e é caracterizada pela baixa contagem de células TCD4, alta contagem de partículas virais no sangue e manifestações clínicas da doença. O diagnóstico se dá com o aparecimento de infecções oportunistas, que levam a contagem de TCD4 a níveis menores que 200 céls/mm³. Os exames laboratoriais para o diagnóstico do HIV foram os principais avanços para o início do tratamento, reduzindo a transmissão. Detecção de anticorpos, detecção de antígenos e amplificação do genoma do vírus são alguns dos exames laboratoriais utilizados para diagnóstico. Os dois principais biomarcadores são os exames de contagem de células TCD4, que verifica o sistema imune, e a quantificação de carga viral, que informa a quantidade de partículas virais, mostrando a progressão da infecção. Quanto maior a carga viral, maior o dano ao sistema imune. Uma carga viral indetectável é inferior a 50 cópias/mL, mas valores menores ou iguais a 200 cópias/mL também impedem a transmissão. Uma declaração de consenso afirma que Indetectável é igual a Intransmissível. Portanto, quando indetectável, a transmissão inexiste. O presente estudo relata e discute o caso clínico de uma paciente diagnosticada com HIV/AIDS aos 28 anos, que sobreviveu, apesar do diagnóstico tardio, e sob presença de doença oportunista com um grave grau de diminuição de células TCD4 (22 cél/mm³). Por meio do diagnóstico, introdução e adesão correta da terapia antirretroviral e monitorização de exames laboratoriais, conseguiu evitar a morte e ter uma vida semelhante à de um HIV negativo. Ultrapassou a expectativa de vida que na descoberta era de 10 anos, com uma qualidade de vida considerável, não sendo transmissora do vírus, diminuindo assim o estigma e preconceito. O biomédico é peça fundamental nesse contexto, considerando que deve fornecer informações precisas e fidedignas, tão necessárias ao acompanhamento de pessoas vivendo com HIV, para que autoridades e profissionais de saúde adotem medidas adequadas, tanto na prevenção, quanto no diagnóstico e monitoramento da doença.

The human immunodeficiency virus is the etiological agent of AIDS, a chronic disease that destroys the immune system and is characterized by low TCD4 cell count, high viral particle count in blood and clinical manifestations of the disease. The diagnosis is due to the appearance of opportunistic infections, which lead to TCD4 counts below 200 cells / mm³. Laboratory tests for the diagnosis of HIV were the main advances in starting treatment, reducing transmission. Antibody detection, antigen detection and virus genome amplification are some of the laboratory tests used for diagnosis. The two main biomarkers are the TCD4 cell count tests, which checks the immune system, and viral load quantification, which reports the number of viral particles, showing the progression of infection. The higher the viral load, the greater the damage to the immune system. An undetectable viral load is less than 50 copies / mL, but values less than or equal to 200 copies / mL also prevent transmission. A consensus statement states that Undetectable equals Non-Transmissible. Therefore, when undetectable, transmission does not exist. The present study reports and discusses the clinical case of a patient diagnosed with HIV / AIDS at age 28, who survived despite late diagnosis and under the presence of opportunistic disease with a severe degree of TCD4 cell reduction (22 cells / mm³). Through the diagnosis, introduction and correct adherence of antiretroviral therapy and monitoring of laboratory tests, she was able to avoid death and have a life similar to that of an HIV negative. Exceeded the life expectancy that in the discovery was 10 years, with a considerable quality of life, not transmitting the virus, thus reducing the stigma and prejudice. The biomedical is a key player in this context, considering that he must provide accurate and reliable information, which is so necessary for the monitoring of people living with HIV, so that authorities and health professionals adopt appropriate measures, both in prevention, diagnosis and monitoring of the disease.

O conhecimento dos profissionais de saúde sobre vacinação de pessoas vivendo com HIV - uma revisão integrativa / El conocimiento de los profesionales de la salud sobre la vacunación de personas que viven con VIH - revisión integradora / Health professionals' knowledge about vaccination of people living with HIV - an integrative review

Resumo Objetivo Identificar evidências na literatura acerca do conhecimento dos profissionais de saúde sobre vacinação das pessoas vivendo com HIV. Método Trata-se de uma revisão integrativa. Para a busca, foram utilizados os descritores: pessoal de saúde (health personnel), conhecimento (knowledge), vacinação (vaccination), HIV e seus sinônimos, sem utilização de filtros, nas bases de dados Pubmed, Biblioteca Virtual em Saúde, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Science Direct e Cochrane. Foram incluídos apenas artigos primários analisados por meio do aplicativo RAYYAN. Resultados De 601 publicações iniciais, apenas cinco constituíram a amostra final, todas identificadas no Pubmed publicadas entre 2013 e 2018, sendo nenhum estudo brasileiro. A maioria das publicações estava relacionada a alguma vacina específica e não abordava todo o calendário vacinal. Conclusão e implicações para a prática O déficit de conhecimento dos profissionais de saúde, em relação às vacinas indicadas às pessoas vivendo com HIV, foi o principal aspecto identificado, resultando em insegurança dos profissionais. Há a necessidade de educação permanente das equipes multiprofissionais dos serviços especializados e da atenção primária visando diminuir as barreiras e aumentar a cobertura vacinal desta clientela.

Resumen Objetivo Identificar evidencias en la literatura acerca del conocimiento de los profesionales de la salud sobre la vacunación de personas que viven con VIH. Método Revisión integradora. Para la búsqueda, se utilizaron los descriptores: personal de salud (health personnel), conocimiento (knowledge), vacunación (vaccination), VIH y sus sinónimos, sin el uso de filtros, en las bases de datos Pubmed, Biblioteca Virtual en Salud, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Science Direct y Cochrane. Solo se incluyeron los artículos primarios analizados mediante la aplicación RAYYAN. Resultados De 601 publicaciones iniciales, solo cinco constituyeron la muestra final, todas identificadas en Pubmed y publicadas entre 2013 y 2018, sin ningún estudio brasileño. La mayoría de las publicaciones estaban relacionadas con una vacuna específica y no abordaban todo el calendario de vacunación. Conclusión e implicaciones para la práctica El desconocimiento de los profesionales de la salud en relación a las vacunas indicadas para personas que viven con VIH fue el principal aspecto identificado, lo que generó inseguridad entre los profesionales. Se advierte la necesidad de disponer la educación permanente de los equipos multiprofesionales de servicios especializados y de atención primaria para reducir barreras y aumentar las coberturas de vacunación de esta clientela.

Abstract Objective to identify evidence in the literature about the health professionals' knowledge concerning vaccination of people living with HIV. Method This is an integrative review. In this research, the descriptors used were the following: health personnel, knowledge, vaccination, HIV and its synonyms, without the use of filters, in the Pubmed, Virtual Health Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Science Direct and Cochrane databases. Only primary articles analyzed using the RAYYAN application were included. Results Out of 601 initial publications, only five comprised the final sample, all identified in Pubmed and published between 2013 and 2018, with no Brazilian studies. Most of the publications were related to a specific vaccine and did not address the entire vaccination schedule. Conclusion and implications for the practice The health professionals' lack of knowledge in relation to vaccines indicated to people living with HIV was the main aspect identified, resulting in insecurity among the professionals. There is a need for permanent education of the multidisciplinary teams of specialized services and primary care in order to reduce barriers and to increase vaccination coverage for this clientele.

Prevalence and factors associated with late diagnosis of the HIV infection in a municipality of São Paulo / Prevalencia y factores asociados al diagnóstico tardío de la infección ocasionada por el VIH en un municipio de São Pauloo / Prevalência e fatores associados ao diagnóstico tardio da infecção pelo hiv em um município paulista

ABSTRACT Objective: to identify the prevalence and factors associated with late diagnosis of the infection by the Human Immunodeficiency Virus (HIV), in a municipality of São Paulo. Method: an epidemiological, analytical and retrospective study that analyzed the HIV and AIDS cases notified by the health services in the period from 2015 to 2017 using data from the notifications of the Information System for Notifiable Diseases (SINAN Net) corresponding to the users recently diagnosed with HIV/AIDS infection in the municipality of Ribeirão Preto/SP, Brazil. Data collection was in May 2018. The chi-square test was performed, as well as binary logistic regression, where the dependent variable was the AIDS criterion at the moment of notifying infection by HIV. A p-value<0.05 was considered for the association between the variables studied in relation to late diagnosis. Results: of the 829 (100%) new HIV cases, 290 (35.0%) were diagnosed in the condition of AIDS. Most of the population was male and aged between 15 and 34 years old. Oral candidiasis and weight loss greater than 10% were the main symptoms associated with AIDS. It was observed that people with lower schooling levels and older were more prone to late diagnoses. Conclusion: it is necessary to devise strategies that favor timely diagnosis in the municipality under study, particularly among the individuals aged over 45 years old and with lower schooling levels.

RESUMEN Objetivo: identificar la prevalencia y los factores asociados al diagnóstico tardío de la infección ocasionada por el Virus de Inmunodeficiencia Humana (HIV) en un municipio del interior de Brasil. Método: estudio epidemiológico, analítico y retrospectivo que analizó los casos de VIH y SIDA notificados por los servicios de salud entre 2015 y 2017 por medio de los datos de las notificaciones del Sistema de Información de Problemas de Salud pasibles de Notificación (SINAN Net) referentes a los usuarios recién diagnosticados con la infección ocasionada por el VIH/SIDA en el municipio de Ribeirão Preto/SP, Brasil. La recolección de datos fue en mayo de 2018. Se realizaron tanto una prueba de chi-cuadrado como un análisis de regresión logística binaria, en la cual la variable dependiente fue el criterio de SIDA al momento de notificar la infección ocasionada por el HIV. Se consideró un valor de p<0,05 para la asociación entre las variables estudiadas en relación con el diagnóstico tardío. Resultados: entre los 829 (100%) casos nuevos de HIV, 290 (35,0%) fueron diagnosticados en la condición de SIDA. La mayoría de la población era del sexo masculino y pertenecía al grupo etario de 15 a 34 años. Candidiasis oral y pérdida de peso superior al 10% fueron los principales síntomas asociados al SIDA. Se observó que las personas con niveles de educación más bajos y de mayor edad fueron más propensas a ser diagnosticadas tardíamente. Conclusión: es necesario elaborar estrategias que favorezcan el diagnóstico oportuno en el municipio estudiado, particularmente entre las personas de más de 45 años de edad y con niveles de educación más bajos.

RESUMO Objetivo: identificar a prevalência e os fatores associados ao diagnóstico tardio da infecção pelo vírus da imunodeficiência humana (HIV), em um município do interior paulista. Método: estudo epidemiológico, analítico e retrospectivo que analisou os casos de HIV e AIDS notificados pelos serviços de saúde no período de 2015 a 2017 por meio dos dados das notificações do Sistema de Informação de Agravos de Notificação (Sinan Net) dos usuários recém-diagnosticados para a infecção pelo HIV/AIDS no município de Ribeirão Preto/SP, Brasil. A coleta de dados ocorreu em maio de 2018. Foi realizado o teste qui-quadrado e regressão logística binária, no qual a variável dependente foi o critério de AIDS no momento da notificação da infecção pelo HIV. Foi considerado o valor de p<0,05 para a associação entre as variáveis estudadas com relação ao diagnóstico tardio. Resultados: dentre os 829 (100%) casos novos de HIV, 290 (35,0%) foram diagnosticados na condição de AIDS. A maioria da população pertencia ao sexo masculino e na faixa etária dos 15 aos 34 anos. A candidose oral e a perda de peso acima de 10% foram os principais sintomas associados à AIDS. Observou-se que pessoas com menor escolaridade e com o aumento da idade eram mais propensas a serem diagnosticadas tardiamente. Conclusão: estratégias que favoreçam o diagnóstico oportuno no município estudado são necessárias, particularmente entre os indivíduos com idade acima de 45 anos e com menor escolaridade.

Actualités au cours de l'évolution de l'infection à VIH sida dans un centre de référence: à propos de 327 cas colligés dans le service de médecine interne du CHU de Bouake, Côte d'Ivoire / News during the evolution of HIV/AIDS infection in a reference center about 327 cases collected in the internal medicine department of the Bouake teaching hospital, Ivory Coast

Introduction : Les maladies opportunistes surviennent chez les personnes vivant avec le VIH (PvVIH) dans les situations de prise en charge tardive. En absence de traitements efficace, la multiplication du virus est inévitable et les personnes concernées sont confrontées à une baisse de leur immunité [1]. C'est dans cette situation que des infections opportunistes se déclarent. Objectif: contribuer à une meilleure connaissance des affections opportunistes liées au VIH Méthode : L'étude s'est déroulée dans le service de Médecine Interne du CHU de Bouaké du 1er janvier 2017 au 31 décembre 2020. C'était une étude rétrospective et transversale qui a concerné les dossiers de patients infectés par le VIH hospitalisés dans ledit service. Résultats : L'analyse a noté 327 cas de dossiers complets sur 3815. La prévalence hospitalière était de 8,5%. L'âge moyen était de 36,2 ans et le sex ratio de 0,83. 65,3% des patients n'ont découvert leur statut sérologique que pendant l'hospitalisation dont les motifs étaient dominés par l'altération de l'état général (36,8%) suivi du coma (19,2%). 84,5% des patients avaient le VIH1. Le taux moyen de CD4 était de 50,5% cellules/mm3 . Les affections opportunistes étaient dominées par la tuberculose (41,8% des cas) et la plus létale était la maladie de Kaposi digestif dans 100% des cas. Conclusion: les patients étaient hospitalisés au stade d'altération de l'état général et de coma d'où la forte létalité. La tuberculose était la principale affection opportuniste. Ces résultats montrent avec beaucoup d'intérêt l'importance de la sensibilisation de la population sur le VIH et la nécessité du dépistage précoce.

Introduction: Opportunistic diseases occur in people living with HIV (PvHIV) in situations of late treatment. In the absence of effective treatments, the multiplication of the virus is inevitable and the people concerned are confronted with a drop in their immune defenses [1, 2]. It is in this situation that opportunistic infections occur Objective: to contribute to a better understanding of opportunistic infections linked to HIV. Method: The study took place in the Internal Medicine department of the Bouake University Hospital from January 1, 2017 to December 31, 2020. It was a retrospective and cross-sectional study which concerned the files of patients infected with HIV hospitalized in the said department. Results: The analysis noted 327 cases of complete records out of 3815. The hospital prevalence of 8.5%. The mean age was 36 years and the sex ratio 0.83. 65.3% of patients only discovered their serological status during hospitalization, the reasons for which were dominated by deterioration in general condition (36%) followed by coma (19.2%). 84.5% of patients had HIV1. The average CD4 count was 50.5% cell/mm3. Opportunistic diseases were dominated by tuberculosis (38% of cases) and the most lethal was digestive Kaposi in 100% of cases. Conclusion: Most of our patients were without social security and did not know their HIV status. These patients were hospitalized at the stage of impaired general condition and coma, hence the high lethality observed. The main opportunistic infections were tuberculosis, cerebral toxoplasmosis and digestive mycoses. These results show with great interest the importance of sensitizing the general population on HIV AIDS and the need for early detection of these opportunistic diseases.

Osteomielitis por Klebsiella pneumoniae BLEE. Reporte de un caso y revisión de la literatura. / OSTEOMYELITIS DUE TO KLEBSIELLA PNEUMONIAE ESBL. REPORT OF A CASE AND LITERATURE REVIEW

Las betalactamasas de espectro extendido (BLEE) son enzimas producidas por bacilos gram negativos capaces de hidrolizar las cefalosporinas de amplio espectro y los monobactámicos. La mayoría pertenece a la familia de Enterobacteriae, tales como Klebsiella pneumoniae y Escherichia coli: Sin embargo, se asocian también con otras bacterias como Proteus, Serratia, Salmonella, Pseudomonas aeruginosa y Acinetobacter. Las enterobacterias productoras de carbapenemasas no sólo han sido aisladas en el ambiente hospitalario, sino que también provienen de la comunidad. Se presenta una paciente de sexo femenino con antecedentes de sida y osteomielitis secundaria a artritis séptica producida por una Klebsiella pneumoniae BLEE de la comunidad. Un tratamiento oportuno y eficaz puede evitar la opción quirúrgica, disminuyendo la morbimortalidad asociada con esta afección

Extended-spectrum beta-lactamases (ESBL) are enzymes produced by gram-negative rods capable of hydrolyzing broad-spectrum cephalosporins and monobactams. Most belong to the Enterobacteriae family, such as Klebsiella pneumoniae and Escherichia coli. However, they are also associated with other bacteria such as Proteus, Serratia, Salmonella, Pseudomonas aeruginosa and Acinetobacter. Carbapenemase-producing Enterobacteriaceae have not only been isolated from the hospital environment, but also from the community. We present a female patient with a history of AIDS and secondary osteomyelitis to septic arthritis caused by a community Klebsiella pneumoniae ESBL. It is concluded that a timely and effective treatment can avoids the surgical option, reducing the morbidity and mortality of this condition.

Prevalence of intestinal parasites in a cohort of HIV- infected patients from Antioquia, Colombia / Prevalencia de parásitos intestinales en una cohorte de pacientes positivos para HIV en Antioquia, Colombia

Abstract | Introduction: HIV infection is still a public health problem worldwide and co-infections with other infectious agents including intestinal parasites are of particular concern, mainly in developing countries like Colombia. Objective: To conduct a cross-sectional study in patients attending an HIV care program in Antioquia given that there have been few intestinal parasites prevalence studies among the HIV population in the country. Material and methods: We evaluated stool samples from 192 patients by direct wet mount and concentration, modified Ziehl Neelsen staining, and agar plate culture. Univariate and correlation analyses were done to explore the association between socio-demographic and clinical characteristics and parasitological data. Results: The overall prevalence of intestinal parasites in HIV-positive subjects was 29.2% (56/192; 95% CI: 22.8% - 35.6%). Entamoeba histolytica/dispar/moshkosvkii with 13.0% (25/192; 95% CI: 8.2% - 17.8%) and Blastocystis with 12.0% (23/192; 95% CI: 7.4% -16.6%) were the most frequent. Opportunistic parasites like Cryptosporidium spp. and Cystoisospora belli were less prevalent, each one with 0.5% of positive samples (1/192; 95% CI: 0.1% - 1.5%). Commensal protozoa were also detected with a prevalence of 18.8% (36/192; 95% CI: 13.3% - 24.3%). Most of the individuals in the study had a controlled viral load and an LTCD4 count greater than 200 cel/µL. A small percentage (9.3%) had diarrhea. Bivariate analysis and multivariate logistic regression showed that only age and having pets had a significant association with intestinal parasites in this cohort. Conclusions: Our results confirmed that the evaluated population is at high risk of intestinal parasite infection, which highlights the need for routine screening of gastrointestinal parasites to provide prompt treatment and reduce possible complications.

Resumen | Introducción. La infección por HIV y las coinfecciones con otros agentes infecciosos, incluidos los parásitos intestinales, son motivo de especial preocupación en países en desarrollo como Colombia. Objetivo. Hacer un estudio transversal en pacientes que asisten a un programa de atención de HIV en el departamento de Antioquia, dado que los estudios de prevalencia de parásitos intestinales en la población con HIV son escasos en el país. Materiales y métodos. Se evaluaron 192 muestras de materia fecal mediante examen coprológico directo y por concentración, tinción de Ziehl-Neelsen modificada, y aislamiento en agar. Se hicieron análisis univariados y de correlación, para explorar la asociación entre las características sociodemográficas y clínicas, y los datos parasitológicos. Resultados. La prevalencia global de parásitos intestinales en pacientes positivos para VIH fue del 29.2 % (56/192; IC95% 22.8-35.6 %), siendo Entamoeba histolytica/dispar/moshkosvkii, con 13.0 % (25/192; IC95% 8.2-17.8 %), y Blastocystis, con 12.0 % (23/192; IC95% 7.4-16.6 %), los mas frecuentes. Los parásitos oportunistas Cryptosporidium spp. Y Cystoisospora belli fueron menos prevalentes, cada uno con 0.5 % (1/192; IC95% 0.1-1.5 %) de muestras positivas. También, se detectaron protozoos comensales, con una prevalencia del 18,8 % (36/192; IC95% 13,3-24,3 %). La mayoría de los individuos tenía una carga viral controlada y un recuento de linfocitos T CD4 superior a 200 células/μl. Un pequeño porcentaje (9,3 %) presentó diarrea. La edad y el tener mascotas mostraron una asociación significativa con la presencia de parásitos intestinales. Conclusión. Se confirmó que la población evaluada tiene un alto riesgo de infección por parásitos intestinales, lo que resalta la necesidad de un protocolo de diagnóstico para el cribado de dichos agentes, con el fin de brindar un tratamiento rápido y reducir las posibles complicaciones.

Sarcoma de Kaposi en pacientes que viven con el VIH en Guinea Ecuatorial / Kaposi sarcoma in patients living with HIV in Equatorial Guinea

Introducción: El sarcoma de Kaposi es una neoplasia oportunista asociada a la inmunodepresión causada por VIH, que se relaciona con la infección por VHH tipo 8. Objetivo: Describir la presentación del sarcoma de Kaposi en personas que viven con VIH en Guinea Ecuatorial. Métodos: Se realizó un estudio descriptivo de carácter retrospectivo para identificar la prevalencia y las características epidemiológicas y clínicas del sarcoma de Kaposi en las personas que viven con VIH que acuden a las unidades de referencia para el manejo de casos en Guinea Ecuatorial. Se revisaron las historias clínicas de una muestra aleatoria y representativa de 338 pacientes del grupo que ha recibido tratamiento en las unidades de referencia para enfermedades infecciosas de Bata, desde enero de 2007 a febrero de 2012. Resultados: Se identificaron 40 pacientes diagnosticados de sarcoma de Kaposi (prevalencia del 11, 83 por ciento). La mediana de la edad al diagnóstico de sarcoma de Kaposi fue de 43 años, siendo la ratio del sexo de 1/1. La media de linfocitos CD4 al diagnóstico fue de 166 (rango 21-375) y la frecuencia de afectación oral fue de 45 por ciento. En la mayoría de los pacientes (94,6 por ciento) la observación del sarcoma de Kaposi fue anterior al inicio del tratamiento antirretroviral. Las cifras de linfocitos T CD4/mm3 inferiores a 100 aparecían sobre todo en pacientes menores de 30 años, y esto era especialmente frecuente en el grupo de mujeres (OR 11, p <0,04, Ic 95 por ciento 0,8-148). Conclusiones: El sarcoma de Kaposi es una neoplasia prevalente en personas que viven con VIH seguidas en las unidades de referencia en Guinea Ecuatorial. En mujeres menores de 30 años podría existir un diagnóstico tardío(AU)

Introduction: Kaposi sarcoma is an opportunistic neoplasm associated to the immunosuppression caused by HIV and related to infection by HHV-8. Objective: Describe the presentation of Kaposi sarcoma in people living with HIV in Equatorial Guinea. Methods: A retrospective descriptive study was conducted to identify the prevalence and the clinical and epidemiological characteristics of Kaposi sarcoma in people living with HIV attending reference units for the management of cases in Equatorial Guinea. A review was carried out of the medical records of a random sample representative of 338 patients from the group receiving treatment at Bata reference unit for infectious diseases from January 2007 to February 2012. Results: A total 40 patients diagnosed with Kaposi sarcoma were identified (prevalence of 11,83 percent). Mean age at Kaposi sarcoma diagnosis was 43 years, with a 1/1 sex ratio. The mean CD4 lymphocyte count at diagnosis was 166 (range 21-375), whereas the frequency of oral damage was 45 percent. In most patients (94.6 percent) detection of Kaposi sarcoma was prior to the start of antiretroviral therapy. CD4 T lymphocyte levels / mm3 below 100 were mainly found in patients aged under 30 years, a fact particularly frequent among women (OR 11, p< 0.04, CI 95% 0.8-148). Conclusions: Kaposi sarcoma is a neoplasm prevailing in people living with HIV who attend reference units in Equatorial Guinea. Late diagnosis could exist among women aged under 30 years(AU)

Perfil epidemiológico de casos notificados de HIV no estado de Goiás / Epidemiological profile of notified HIV cases in the state of Goiás

Objetivo: Descrever o perfil epidemiológico dos casos de Vírus da Imunodeficiência Humana (HIV) notificados no estado de Goiás, por meio de dados do Sistema de Informação de Agravos e Notificação (SINAN). Metodologia: Foi realizado um estudo observacional, descritivo, de corte transversal, com dados secundários. A população alvo foi constituída de indivíduos diagnosticados com HIV notificados pelo SINAN no estado de Goiás, no período de 2015 a 2019. Resultados: Foram registradas 7.575 notificações para HIV; destas, 79,2% eram homens, 71,1% tinham entre 20 e 39 anos de idade e 42% eram naturais da grande Goiânia. Este estudo demonstrou que entre os anos de 2015 e 2019 ocorreu aumento nas taxas de incidência de HIV. A modalidade de transmissão mais prevalente foi a homossexual. Dos casos analisados, 34% (n=2.598) apresentaram algum sintoma ou doença definidora da Síndrome da Imunodeficiência Humana (AIDS). Cerca de 60 pessoas (0,9%) foram registradas com o status de teste não realizado, inferindo que esses indivíduos foram casos descartados, ou seja, não se tratava de uma infecção por HIV. Considerações finais: É preciso que se desenvolvam políticas públicas de saúde voltadas para essa população, sendo considerados seus fatores sociodemográficos e determinantes sociais, para que medidas apropriadas e efetivas de promoção, prevenção e recuperação da saúde sejam implementadas

Objective: To describe the epidemiological profile of Human immunodeficiency vírus (HIV) cases, notified in the State of Goiás using data from the Diseases Information and Notification System (SINAN). Methodology: An observational, descriptive, cross-sectional study was carried out with secondary data. The target population consisted of individuals diagnosed with HIV notified by SINAN in the State of Goiás, in the period from 2015 to 2019. Results: Were registered 7.575 notifications for HIV, were registered, of these 79.2% were men, 71.1% were between 20 and 39 years old and 42% born in Greater Goiânia. This study demonstrated that between the years 2015 to 2019 there was an increase in HIV incidence rates. The most prevalent mode of transmission was homosexual. Of the cases, 34% (n = 2.598) of the symptoms, some symptom or disease defining AIDS (Human Immunodeficiency Syndrome). About 60 people (0.9%) were registered with the status of a test not performed, inferring that these individuals were discarded cases, that is, it was not an HIV infection. Final considerations: It is necessary to develop public health policies aimed at this population, considering their sociodemographic factors and social determinants, in order to implement appropriate and effective measures for the promotion, prevention and recovery of health

Profil clinique, immunologique et virologique des personnes vivant avec le VIH suivies au CHUD Oueme-Plateau / NA

Introduction : L'infection par le virus de l'immunodéficience humaine au (VIH) est une infection chronique caractérisée par la destruction progressive du système immunitaire par le virus. L'objectif de cette étude était de décrire le profil clinique, immunologique et virologique des personnes vivant avec le VIH et suivies au CHU Départemental Ouémé-Plateau de Porto-Novo. Méthodes : Il s'agissait d'une étude transversale et descriptive couvrant la période du 1er février 2016 au 1er mai 2016. Il a été procédé à un recrutement exhaustif de toutes les personnes vivant avec le VIH suivies en ambulatoire ou hospitalisées dans le Service de Médecine Interne du CHUD-OP, âgées d'au moins 15 ans et ayant donné leur consentement éclairé. Résultats : Au total 301 patients ont été inclus. L'âge moyen était de 42 ans ± 10,3 ans, avec des extrêmes de 19 ans et 74 ans. Les tranches d'âge les plus représentées étaient celle des 35 à 45 ans (118 patients soit 39,2%) et celle des 25 à 35 ans (72 patients soit 23,9%). Cette population était majoritairement féminine (73,1 %), soit une sex-ratio de 0,37. Les enquêtés, dans 79,4 %, étaient en couple. Le stade clinique 3 de l'OMS était prédominant (47,8%). Parmi les pathologies associées, l'hypertension artérielle était la plus fréquente (18.6%). Parmi ces patients, 300 (99,7 %) étaient porteurs de VIH 1. La charge virale a été réalisée chez 177 (58,8 %) patients et s'est révélée indétectable chez 117 patients soit 66,1 % des cas. La numération des CD4 a été réalisée chez 298 (99 %). Le nombre médian des CD4 était de 350 (Q1=206 ; Q3=504). Parmi les 301 PVVIH, 291 (96,68 %) étaient sous traitement antirétroviral. Conclusion : Cette population de personnes vivant avec le VIH est jeune et consulte tardivement

Introduction : Human immunodeficiency virus (HIV) infection is a chronic infection characterized by the progressive destruction of the immune system by the virus. The objective of this study was to describe the clinical, immunological and virological profile of people living with HIV and monitored at the Ouémé-Plateau Departmental University Hospital in Porto-Novo. Methods: This was a cross-sectional and descriptive study covering the period from February 1, 2016 to May 1, 2016. An exhaustive recruitment was carried out of all people living with HIV followed on an outpatient basis or hospitalized in the Service of Internal Medicine of the CHUD-OP, at least 15 years old and having given their informed consent. Results: A total of 301 patients were included. The mean age was 42 ± 10.3 years, with extremes of 19 and 74 years. The most represented age groups were that of 35 to 45 years (118 patients or 39.2%) and that of 25 to 35 years (72 patients or 23.9%). This population was predominantly female (73.1%), i.e. a sex ratio of 0.37. The respondents, in 79.4%, were in a relationship. WHO clinical stage 3 was predominant (47.8%). Among the associated pathologies, arterial hypertension was the most common (18.6%). Of these patients, 300 (99.7%) were carriers of HIV 1. Viral load was achieved in 177 (58.8%) patients and was undetectable in 117 patients, or 66.1% of cases. CD4 counts were performed in 298 (99%). The median CD4 count was 350 (Q1 = 206; Q3 = 504). Among the 301 PLHIV, 291 (96.68%) were on antiretroviral therapy. Conclusion: This population of people living with HIV is young and consults late.

HIV infection in the west region of Pará: clinical and socioeconomic characterization / Infecção pelo HIV na região oeste do Pará: caracterização clínica e socioeconômica

Aims: knowledge of the patient's profile, for the evaluation and suggested behaviors, promotes a favorable outcome. Thus, the objective of the study is to analyze the socioeconomic, clinical, and immunological characteristics of patients infected by the human immunodeficiency virus in the western region of the state of Pará.Methods: were analyzed 1966 medical records of patients whose first visit to a reference center, in the municipality of Santarém-PA, was between 1998 and 2018. Socioeconomic, clinical, and immunological information was collected from patient medical records. Data were analyzed using descriptive and inferential statistics, adopting p <0.05. Results: there was a predominance of males (62.5%), aged 20-39 years (69.1%), elementary school (58.6%), single (57.3%), and employed (66.4%). Immunosuppression was present in 22% of patients and a viral load was detectable in 66%. Tuberculosis (37%) and toxoplasmosis (23%) predominated as opportunistic infections, and syphilis (62.6%) and human papillomavirus (HPV; 14%) as other infections. Conclusions: it is concluded that both opportunistic infections and other infections were present in 25-22% of the patients and that the presence of opportunistic infections favors the installation of another infection, or vice versa. Toxoplasmosis, HPV, and syphilis are positively associated with men, and toxoplasmosis and tuberculosis with age >35 years. Immunosuppression was shown to be positively associated with men and age >35 years, as well as favoring the onset of tuberculosis, toxoplasmosis, and detectable viral load.

Objetivo: o conhecimento sobre o perfil do paciente para a avaliação e as propostas de condutas colabora com um desfecho favorável. Assim, o objetivo deste estudo é analisar as características socioeconômicas, clínicas e imunológicas de pacientes infectados pelo vírus da imunodeficiência humana na região Oeste do Estado do Pará. Métodos: foram analisados 1.966 prontuários de pacientes que tiveram seu primeiro atendimento em um centro de referência, no município de Santarém (Pará), no período de 1998 a 2018. Levantaram-se informações socioeconômicas, clínicas e imunológicas nos referidos prontuários. Os dados foram analisados por estatística descritiva e inferencial, adotando-se p<0.05. Resultados: observou-se predominância do sexo masculino (62,5%), faixa etária de 20-39 anos (69,1%), ensino fundamental (58,6%), solteiros (57,3%) e com vínculo empregatício (66,4%). A imunossupressão estava presente em 22% dos pacientes e a carga viral detectável em 66%. A tuberculose (9,1%) e a toxoplasmose (5,6%) predominaram como infecções oportunistas, e a sífilis (14,1%) e o papiloma vírus humano (HPV; 3,2%) como outras infecções. Conclusão: conclui-se que tanto as infecções oportunistas como as outras infecções estavam presentes em 25 (22%) dos pacientes e que a presença da infecção oportunista favorece a instalação da outra infecção, ou vice-versa. A toxoplasmose, HPV e a sífilis se associaram positivamente aos homens, bem como, a toxoplasmose e a tuberculose com as idades >35 anos. A imunossupressão demonstrou estar associada positivamente aos homens e idades >35 anos, bem como, favorece a instalação da tuberculose, da toxoplasmose e da carga viral detectável.

Vacunas en pacientes con VIH/SIDA / Immunizations in HIV/AIDS patients

Los sujetos con infección por Virus de inmunodeficiencia humana (VIH) tienen mayor susceptibilidad de adquirir infecciones por su deterioro inmunológico. Según el deterioro inmunológico y el uso de terapia antiretroviral (TARV) en niños y adultos VIH (+), la intensidad de la respuesta inmune a las vacunas es menor que la población general. Por este motivo es preferible administrar vacunas una vez que la TARV haya permitido la inmunoreconstitución, y se recomiendan dosis de refuerzo. Por otra parte, las vacunas vivas atenuadas deben ser usadas con precaución, y están contraindicadas en inmunosupresión severa.

Patients with Human Immunodeficiency Virus (HIV) are more susceptible to acquiring infections due to their immune deterioration. The intensity of the immune response to vaccines is lower than general population, depending on immune status and the use of antiretroviral therapy (ARV). For this reason, it is preferable to administer vaccines once ART has allowed immune reconstitution, and booster doses are recommended. On the other hand, live vaccines should be used with caution, and are contraindicated in severe immunosuppression.

Boletim epidemiológico HIV/AIDS - 2020 / HIV/AIDS Epidemiological Bulletin - 2020

As informações deste Boletim têm por objetivo descrever e divulgar o cenário dos casos de HIV e Aids registrados no Estado de Goiás, abrangendo suas 18 Regiões de Saúde e os 246 municípios, bem com subsidiar o planejamento e aperfeiçoamento das ações da atenção, prevenção e vigilância desses agravos no Estado. Os dados aqui disponibilizados foram extraídos do Sistema de Informação de Agravos de Notificação (Sinan) da base de dados da Secretaria Estadual da Saúde de Goiás e teve como análise período de 2007 a junho de 2020

The information in this Bulletin aims to describe and disseminate the scenario of HIV and AIDS cases registered in the State of Goiás, covering its 18 Health Regions and 246 municipalities, as well as subsidizing the planning and improvement of care, prevention and surveillance actions. of these grievances in the state. The data available here were extracted from the Notifiable Diseases Information System (Sinan) from the database of the Goiás State Health Department and analyzed from 2007 to June 2020

Line immunoassay for confirmation and discrimination of human t-cell lymphotropic virus infections in inconclusive western blot serum samples from Brazil

Difficulties in confirming and discriminating human T-cell lymphotropic virus type 1 (HTLV-1) and HTLV-2 infections by serological Western blot (WB) assays (HTLV Blot 2.4; MP Biomedicals) have been reported in Brazil, mainly in HIV/AIDS patients, with a large number of WB-indeterminate and WB-positive but HTLV-untypeable results. Nonetheless, a line immunoassay (LIA) (INNO-LIA HTLV-I/II; Fujirebio) provided enhanced specificity and sensitivity for confirming HTLV-1/2 infections. To add information concerning the improved ability of the LIA in relation to WB when applied to samples of individuals from different risk groups from Brazil, we performed the present study. Three groups were analyzed group 1 (G1), with 62 samples from HIV/AIDS patients from São Paulo, SP (48 WB indeterminate and 14 HTLV untypeable); group 2 (G2), with 24 samples from patients with hepatitis B or hepatitis C from São Paulo (21 WB indeterminate and 3 HTLV untypeable; 17 HIV seropositive); and group 3 (G3), with 25 samples from an HTLV outpatient clinic in Salvador, Bahia (16 WB indeterminate and 9 HTLV untypeable; all HIV seronegative). Overall, the LIA confirmed HTLV-1/2 infection (HTLV-1, HTLV-2, or HTLV) in 66.1% (G1), 83.3% (G2), and 76.0% (G3) of samples. Interestingly, the majority of WB-indeterminate results were confirmed by the LIA as being HTLV-2 positive in G1 and G2 but not in G3, in which the samples were defined as being HTLV-1 or HTLV positive. These results agree with the virus types that circulate in such patients of different regions in Brazil and emphasize that the LIA is the bes

Eficácia antimicrobiana da terapia fotodinâmica no tratamento da candidíase oral em pessoas vivendo com HIV/Aids / Antimicrobial efficacy of photodynamic therapy on the treatment of oral candidiasis in people living with HIV/Aids / Eficacia antimicrobiana de la terapia fotodinámica en el tratamiento de la candidiasis bucal en personas viviendo con VIH/Sida

Objetivo: avaliar a eficácia antimicrobiana da terapia fotodinâmica no tratamento da candidíase oral em pessoas vivendo com HIV/aids. Método: estudo experimental, qualitativo e descritivo com 18 pessoas vivendo com HIV/aids que manifestavam a candidíase oral, maiores de 18 anos, que estavam em tratamento no Hospital Universitário Gaffrée e Guinle. Este grupo subdividiu-se em um grupo controle, composto por sete pessoas, que recebeu tratamento com a terapia fotodinâmica e antifúngicos, e um grupo experimental, com 11, que recebeu apenas a terapia fotodinâmica. A evolução do tratamento de cada participante foi acompanhada por registros fotográficos em duas consultas, inicial e final. Esta pesquisa foi aprovada pelo Comitê de Ética em Pesquisa do hospital, parecer número 2.431.107. Resultados: a maioria dos participantes apresentou melhora clínica, ainda que discreta, e em apenas um houve piora clínica. Conclusão: a terapia fotodinâmica antimicrobiana pode ser eficaz no tratamento da candidíase oral em pessoas vivendo com HIV/Aids

Objective: evaluate the antimicrobial efficacy of photodynamic therapy in the treatment of oral candidiasis in people living with HIV/ aids. Method: experimental, qualitative and descriptive study with 18 people living with HIV/aids who presented oral candidiasis, over 18 years of age, who were being treated at the Gaffrée and Guinle University Hospital. This group was subdivided into a control group, composed of seven people, who received treatment with photodynamic and antifungal therapy, and an experimental group, with 11, who received only the photodynamic therapy. The evolution of the treatment of each participant was followed by photographic registers in two appointments, initial and final. This research was approved by the Research Ethics Committee from the hospital, dictum number 2.431.107. Results: most of the participants showed clinical improvement, albeit discrete, and in only one there was clinical worsening. Conclusion: antimicrobial photodynamic therapy may be effective in the treatment of oral candidiasis in people living with HIV/Aids

Objetivo: evaluar la eficacia antimicrobiana de la terapia fotodinámica en el tratamiento de la candidiasis bucal en personas que viven con VIH/sida. Método: estudio experimental, cualitativo y descriptivo con 18 personas viviendo con VIH/sida que manifestaban la candidiasis bucal, mayores de 18 años, que estaban en tratamiento en el Hospital Universitario Gaffrée y Guinle. Este grupo se subdividió en grupo control, compuesto por siete personas, que recibió tratamiento con la terapia fotodinámica y antifúngicos, y un grupo experimental, con 11, que recibió sólo la terapia fotodinámica. La evolución del tratamiento de cada participante fue acompañada por registros fotográficos en dos consultas, inicial y final. La investigación fue aprobada por el Comité de Ética en Investigación del lugar, dictamen número 2.431.107. Resultados: la mayoría de los participantes presentó mejoría clínica, aunque discreta, y en apenas uno hubo empeoramiento clínico. Conclusión: la terapia fotodinámica antimicrobiana puede ser eficaz en el tratamiento de la candidiasis bucal en personas que viven con el VIH/Sida