Lípidos anormales e inmunidad adquirida Síndrome de Deficiencia: Asociación de Suero Lípidos con estatus de VIH / Abnormal Lipids and Acquired Immune Deficiency Syndrome: Association of Serum Lipids with HIV Status

Context and Aim: Hematological abnormalities are amongst the most common complications of infection with HIV.There have been quite a few studies on the alterations in lipid profile, too, though the results have largely been inconclusive. The present study was carried-out to assess CD4 cell counts and lipid profile in the HIV infected and AIDS patients in the Indian population and correlates them with the sero-negative controls. Materials and Methods: The present study was designed as a cross-sectional, hospital-based study to assess CD4 cell counts and lipid profile in the HIV infected and AIDS patients in the Indian population and correlates them with the sero-negative controls. Evaluation of lipid profile was done using Erba EM 360, an automated analyzer powered by a diffraction grating photometer while CD4 cell counts were evaluated using Partec Cyflow Counter. Statistical analysis used: The data was analyzed using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA). Comparison of the said parameters was done using Analysis of Variance (ANOVA) and posthoc Games-Howell test. p-value of <0.05 was considered statistically significant. Results: The levels of total cholesterol and low-density lipoproteins (LDLs) were significantly decreased while triglycerides and very low density lipoproteins (VLDLs) were significantly increased in the HIV infected and AIDS patients when compared with the sero-negative controls. Conclusion: Total cholesterol, LDLs, triglycerides and VLDLs were significantly altered in the HIV infected and AIDS patients when compared with the sero-negative controls.

Linfoma primario difuso de células B grandes de mucosa gingival, en paciente VIH y EBV negativos / Primary gingival diffuse large b-cell lymphoma in HIV/EBR negative patient abstract

El linfoma difuso de células B grandes (LDCBG) es el linfoma más frecuente. La presentación clínica puede ser nodal o extranodal y sus síntomas dependen de la localización tumoral; en la mayoría de los casos están asociados a algún tipo de inmunodeficiencia. Referiremos un caso de LDCBG de presentación atípica en una localización muy infrecuente. Es importante tener en cuenta estas situaciones, ya que pueden simular otros procesos patológicos, retrasando así su correcto diagnóstico y por lo tanto un adecuado tratamiento. (AU)

Diffuse large cell lymphoma B (LDCBG) is the most common type of lymphoma. It´s clinical presentation can be nodal or extranodal and it's symptoms depend where the tumor is located and whether is associated or not with an immunodeficiency disease. We present an atypical presentation of a LDCBG in a very unusual location. It´s important to consider these kind of appearance, as they can mimic other oral pathological processes, delaying their correct diagnosis and therefore an appropriate treatment. (AU)

Social and immunological differences among uninfected Brazilians exposed or unexposed to human immunodeficiency virus-infected partners

Understanding the social conditions and immunological characteristics that allow some human immunodeficiency virus (HIV)-exposed patients to remain uninfected represents an on-going challenge. In this study, the socio-demographic and sexual behaviour characteristics and immune activation profiles of uninfected individuals exposed to HIV-infected partners were investigated. A confidential and detailed questionnaire was administered and venous blood was tested using HIV-1/enzyme immunoassays, plasma HIV-1 RNA levels/bDNA and immunophenotyping/flow cytometry to determine the frequencies of CD4 and CD8 T cells expressing activation markers. The data analysis showed significant differences (p < 0.05) for immune parameters in individuals who were uninfected, albeit exposed to HIV-infected partners, compared with unexposed individuals. In particular, the exposed, uninfected individuals had a higher frequency (median, minimum-maximum) of CD4+HLA-DR+ (4.2, 1.8-6.1), CD8+HLA-DR+ (4.6, 0.9-13.7), CD4+CD45RO+ (27.5, 14.2-46.6), CD4+CD45RO+CD62L+ (46.7, 33.9-67.1), CD8+CD45RA+HLA-DR+ (12.1, 3.4-35.8) and CD8+CD45RO+HLA-DR+ (9.0, 3.2-14.8) cells, a decreased percentage of CD8+CD28+ cells (11.7, 4.5-24.0) and a lower cell-surface expression of Fcγ-R/CD16 on monocytes (56.5, 22.0-130.0). The plasma HIV-1 RNA levels demonstrated detectable RNA virus loads in 57% of the HIV-1+ female partners. These findings demonstrate an activation profile in both CD4 and CD8 peripheral T cells from HIV-1 exposed seronegative individuals of serodiscordant couples from a referral centre in Belo Horizonte, state of Minas Gerais.

Vulnerabilidade ao HIV/AIDS entre casais sorodiscordantes acompanhados no Instituto de Pesquisa Clínica Evandro Chagas/FIOCRUZ / Vulnerability to HIV/AIDS among serodiscordant couples followed at Instituto Evandro Chagas Clinical Research /FIOCRUZ

O ano de 1996 evidenciou um importante marco no tratamento da aids em função do avanço das pesquisas clínicas e farmacológicas. No mundo surgiu novo tratamento da aids, conhecido na sigla em inglês por Highly Active Antiretroviral Therapy (HAART) ou Terapia Antirretroviral Potente, em português, regime de tratamento que combina várias medicações para suprimir a replicação viral e a progressão da doença. O advento desses novos medicamentos amplia os recursos terapêuticos, melhora a expectativa e a qualidade de vida das pessoas vivendo com HIV e aids. Esse cenário mundial traz para as pessoas vivendo com HIV e aids a perspectiva de poderem desfrutar de vida social: trabalhar, estudar, ter relacionamentos amorosos, casar e ter filhos. Esses relacionamentos podem ser com pessoas que têm a mesma sorologia para o HIV, definidas como soroconcordantes ou sorologias diferentes, casais sorodiscordantes, em que um é infectado pelo HIV ou tem aids e o outro não. Os temas relacionados aos casais sorodiscordantes, como revelação do diagnóstico ao parceiro, conjugalidade, práticas sexuais, uso do preservativo e reprodução, começam a ser discutidos entre profissionais de saúde e pesquisadores a partir do final dos anos 1990 nos EUA e dos anos 2000 no Brasil. Este estudo com os casais sorodiscordantes está inserido no campo teórico do construcionismo social em psicologia e utiliza o método qualitativo da análise das práticas discursivas e produção de sentidos no cotidiano. Foram realizadas 17 entrevistas com 13 casais heterossexuais e 04 casais homossexuais, acompanhados no Instituto de Pesquisa Clínica Evandro Chagas da Fundação Oswaldo Cruz, no Rio de Janeiro. O estudo teve como objetivo compreender como são construídas as três dimensões da vulnerabilidade programática, social e individual entre os casais sorodiscordantes. Os resultados da análise dos discursos, a partir do material transcrito das gravações, indicam questões importantes relacionadas a essas dimensões da vulnerabilidade dentre as quais podemos destacar a forma prescritiva em que é feito o trabalho de prevenção primária e secundária, pelos profissionais de saúde; a falta de informação sobre sexualidade na família e nas escolas; os conhecimentos distorcidos sobre a transmissão do HIV e suas formas de prevenção; as inadequações na forma como o teste anti-HIV é realizado e como o resultado é comunicado para as pessoas pelos profissionais de saúde; a ausência de apoio para ajudar na revelação do diagnóstico a parceiros e/ou familiares, assim como no suporte das questões relacionadas à conjugalidade. Alguns dos casais entrevistados incorporaram em seus relacionamentos sexuais novas tecnologias de prevenção, como a adesão ao tratamento como forma de prevenção, combinadas às técnicas de redução de riscos para infecção pelo HIV como alternativas ao uso do preservativo.

The year of 1996 showed an important milestone in AIDS treatment due to the advancement of clinical and pharmacological researchs. In the world appears a new AIDS treatment, known by Highly Active Antiretroviral Therapy (HAART), which is a treatment scheme that combines several medications to suppress viral replication and the progression of AIDS. The advent of these new drugs expands the therapeutic resources, improves expectancy and quality of life of people living with HIV and AIDS.This world scenario brings for people living with HIV/AIDS the perspective of having a social life: working, studying, having loving relationships, marry and have children. These relationships can be with people with the same HIV status, defined as seroconcordant or different serology, serodiscordant couples, in which one is infected with HIV or have AIDS and the other not.Topics related to serodiscordant couples, like disclosure to partner, conjugality, sexual practices, condom use and reproduction, began to be discussed between health professionals and researchers from the late 1990s in the U.S. and the 2000s in Brazil. This study with serodiscordant couples is inserted into the theoretical field of social constructionism in psychology and uses the method of qualitative analysis of discursive practices and production of meanings in everyday life. 17 interviews were conducted with 13 heterosexual couples and 04 gay couples treated at Instituto Evandro Chagas Clinical Research, Oswaldo Cruz Foundation in Rio de Janeiro. The aim of the study was to understand how are constructedthree dimensions of vulnerability: programmatic, social and individual.The results of the analysis of discourse, trought the transcribed material, indicated importants issues related to these dimensions of vulnerability, among which we can highlight a prescriptive manner how is done the primary and secondary prevention by health professionals; lack of information about sexuality; distorted knowledge about the transmission of HIV and its forms of prevention; inadequacies in how HIV testing is conducted and how the result is revealed to the people by health professionals; lack of support to help in HIV status disclosure to partners or family members and issues related to conjugality. Some of the couples interviewed incorporated in their sexual relationships new prevention technologies, such as treatment as prevention, combined with techniques of risk reduction for HIV infection as alternatives to the use of condoms.

In vitro susceptibility of Thai seronegative donor CD8+ T lymphocytes to human immunodeficiency virus-1 (HIV-1) infection.

To determine whether CD8+ T lymphocytes from Thai donor cells are susceptible to HIV-1 infection, undepleted peripheral blood mononuclear cells (PBMC) and CD8-enriched PBMC were infected with HIV-1 Thai subtype B and CRF01_AE (E) primary isolates. Virus kinetics in HIV-1 infection of CD4+ and CD8+ T lymphocytes peaked at day 7 or 10 post infection (pi); the TCID50 used for cell infection was proportional to the level of p24 production in the cultures. We also found that the level of p24 antigen in the supernatants of infected undepleted PBMC was significantly higher than that of infected CD8-enriched PBMC. Interestingly, both single positive T lymphocytes (CD4+ and CD8+ T lymphocytes) as well as double positive CD4+/CD8+ T lymphocytes were infected with HIV-1. The double positive T lymphocytes in PBMC were found only in the presence of both CD4+ and CD8+ T lymphocytes. The majority of p24+/CD4-/CD8- T lymphocytes were HIV-1 infected CD4 down-modulated PBMC. This report provides direct evidence that single positive CD8+ T lymphocytes and double positive CD4+/ CD8+ T lymphocytes from Thai donors can be infected with HIV-1 subtypes B and E in vitro.

Lymphocyte and NK cell subpopulations in HIV seronegative Thais.

Lymphocyte subpopulations, i.e. T, B and natural killer (NK) cells including NK cell subsets which express CD16 molecules (with or without co-expression of CD56 molecules) and NK cell subsets which express CD56 molecules (with or without co-expression of CD16 molecules) were enumerated by two color-flow cytometry in a total of 125 HIV seronegative Thai adults. The study demonstrated relatively low CD4 counts in the subjects, i.e. 26.3% of them had a CD4 count of less than 500 cells/microl. In contrast, their NK cell counts were relatively high. Statistical analyses of the percentage values showed that females had significantly higher CD3 (total T cells), but lower NK cell counts as compared to males (p < 0.05). Regarding age variation, an increase of 1.1% of CD4 cells per decade was seen. It was roughly estimated that about 86% of NK cells harbored both CD16 and CD56 molecules. Collective data from several studies including the present one suggest that high NK cell counts may be a compensation for low CD4 cell counts in Mongoloid people. Thus, the role of NK cells in the defense cascade against viral infections, especially human immunodeficiency virus infections deserves further investigation.

Cytotoxic T lymphocyte responses to vaccinia virus antigens but not HIV-1 subtype E envelope protein seen in HIV-1 seronegative Thais.

The HIV-1 prime boost phase I/II vaccine trial using a recombinant canarypox vector, vCP1521, containing subtype E env (gp120), and subtype B env (gp41), gag and protease has started in Thailand. We have demonstrated that although 4 from 15 human immunodeficiency virus type 1 (HIV-1) seronegative Individuals showed cytotoxic T lymphocyte (CTL) responses to vaccinia virus antigens, none of them showed specific CTL responses to subtype E Env after in vitro stimulation. This preliminary study suggests that specific CTL responses to subtype E envelope detected in HIV-1 seronegative Individuals after vaccination should be considered as specific responses to the immunization.

Cellular and humoral factors in colostrum of HIV infected and uninfected lactating mothers.

OBJECTIVE: To compare the cellular and humoral factors in colostrum from HIV infected and uninfected lactating mothers. DESIGN: Cross sectional study. SETTING: Maternity Ward. METHODS: Colostrum was collected from 130 mothers (62 HIV seropositives and 68 HIV seronegatives). These colostrum samples were tested for total cell count, cell viability, differential count, phagocytic activity of macrophages, 'T' cell counts, IgA, IgM and IgG levels. RESULTS: There was a statistically significant decrease in the phagocytosis and 'T' cell number (p <0.001) and in the IgA and IgG levels (p<0. 05) in the colostrum obtained from HIV seropositive mothers as compared to HIV seronegative ones. CONCLUSION: Some of the cellular and humoral factors are reduced in colostrum samples obtained from HIV seropositives as compared to normals.

Anti-fungal and cytokine producing activities of CD8 + T lymphocytes from HIV-1 infected individuals

Lymphokine activated killer (LAK) cells are capable of killing not only malignant cells but also hyphal form of Candida albicans in vitro. When peripheral blood mononuclear cells (PBMC) from normal healthy donors were cultured for 72-96 hrs with 1,500 international unit (IU)/ml interleukin-2 (IL-2), marked LAK activity was induced. However, even prior to IL-2 activation, PBMC isolated from some normal subjects and those from almost all individuals who are infected by human immunodeficiency virus type 1 (HIV-1) exhibited significant levels of anti-fungal activity. Such pre-activation in situ antifungal activity of PBMC decreased during the initial 48 hrs of IL-2 activation. PBMC from HIV-1 seropositive subjects showed higher levels of in situ anti-fungal activity than normal PBMC did. After a decline of in situ activity during the initial 48 hours, LAK activity gradually increased and reached near maximal levels by day 4 and remained more or less constant until day 6. No significant difference was observed between the LAK activity of normal and HIV-1(+) PBMCs on days 4-6. In IL-2 activated normal and HIV-1(+) PBMC cultures, both CD4 and CD8 T cells produced IL-2, INF-gamma as well as TNF-alpha. Production of IL-2 by both CD4 and CD8 T cells was suppressed in HIV-1(+) PBMC cultures, but no significant suppression of INF-gamma production was noted. Meanwhile, TNF-alpha production by CD4 was very much suppressed but no significant changes in TNF-alpha production by CD8 T cells was noted in HIV-1(+) PBMC cultures

Un problema de diagnóstico perinatal: pacientes serológicamente negativos pero infectados por el VIH / A perinatal diagnostic problem: HIV infected patients who are serologically negative

A 142 pacientes se les realizó ELISA, Inmuno blot de IgG, Inmuno blot de IgA (en los menores de 24 meses), determinación de antígeno en plasma, aislamiento viral por cultivo de detección de genoma viral por amplificación con la reacción de polimerasa en cadena (PCR). El diagnóstico integral demostró que 10 por ciento (14 pacientes) que resultaron negativos o indeterminados para detección de anticuerpos IgG anti-VIH-1, estaban infectados por el virus. Once de estos pacientes tienen entre 2 y 24 meses de edad; dos, entre 4 y 6.5 años, y uno, 30 años. El diagnóstico se emitió en cuatro de los casos por presencia de antígeno en plasma; en cinco por amplificación por PCR de ADN proviral presente en células mononucleares periféricas; en cuatro casos por PCR positivo e inmunofluorescencia (IF) del cultivo, y el último caso, presentó Inmuno blot positivo e IF del cultivo. Dichos casos presentan el problema de resultados falsos negativos por serología de anticuerpos anti-VIH, especialmente en niños menores de 24 meses

Comprehensive HIV diagnosis of 142 patients was done by ELISA, IgG immunoblot, IgA immunoblot (in patients under 24 months), plasma antigen determination, viral isolation by culture and genome detection by polymerasa chain reaction (PCR) amplification. Results showed that 14 patients (10%) with negative or indefinite results for anti-HIV-1 IgG antibody were in fact infected by the virus. Eleven of these patients were between 2 and 24 months of age, two between 4 and 6.5 years and one was 30 years old. Diagnosis was obtained by antigen positivity in four of them; by PCR amplification of peripheral mononuclear cells of proviral DNA in five of them; by PCR and immunofluorescence (II) of cultured cells in four cases, and the last diagnosis was made by IgG immunoblot and IF of the viral culture. These cases pose a problem because of false negative HIV serology, particularly in patients under 24 months of age.