What have we researched about HIV infection in Colombia? A bibliometric review 1983 - 2018 / Qué hemos investigado acerca de la infección por VIH en Colombia? Una revisión bibliométrica 1983 - 2018

Objective: Our objective was to quantitatively describe the research on HIV infection carried out in Colombia. Materials and methods: A bibliometric review of all studies that included people infected or affected by HIV between January 1, 1983, and August 31, 2018, was performed. Results: 587 studies were identified. Most were descriptive studies. There are a lower number of studies in the fields of prevention, education and public health. Most of the published studies were carried out in 3 departments. 72% were published in Q3, Q4 or unclassified journals. Discussion: The research performed has given priority to the description of figures and is not enough to understand and know how to treat factors like late diagnosis, the stigma and the prevention of the disease. Conclusion: There does not seem to be a national strategy to define the research needs. There is a low dissemination of the results and a low cover of the research in the country.

Objetivo: Describir cuantitativamente la investigación sobre infección por VIH realizada en Colombia. Materiales y métodos: Se realizó una revisión bibliométrica de estudios que incluyeran personas infectadas o afectadas por el VIH entre el 1 de enero de 1983 y el 31 de agosto de 2018. Resultados: Se identificaron 587 estudios. La mayoría fueron descriptivos. Hay un menor número en los campos de prevención, educación y salud pública. La mayoría se llevaron a cabo en 3 departamentos. El 72% se publicaron en Q3, Q4 o revistas no clasificadas. Discusión: La investigación realizada ha dado prioridad a la descripción de las cifras y no es suficiente para comprender y saber cómo tratar factores como el diagnóstico tardío, el estigma y la prevención de la enfermedad. Conclusión: No parece haber una estrategia nacional para definir las necesidades de investigación. Hay una baja difusión de los resultados y una baja cobertura de la investigación en el país.

Prevención de la infección por el virus de la inmunodeficiencia humana (VIH) en Colombia: brechas y realidades / Prevention of Human Immunodeficiency Virus (HIV) Infection in Colombia: Gaps and Realities / Prevenção da infeção pelo vírus da imunodeficiência humana (VIH) na Colômbia: fendas e realidades

Resumen Este artículo pretende analizar cómo ha sido la prevención de la infección por el VIH en Colombia, desde la década de los ochenta hasta la actualidad, por ser una de las principales medidas para el control de la infección. Presenta el contexto epidemiológico en el mundo y en Colombia, el desarrollo de la prevención de la infección y finaliza con reflexiones sobre brechas y realidades de lo que ha caracterizado la prevención del VIH en nuestro medio. Metodología: se analizaron documentos y artículos científicos en español, inglés y portugués del año 2000 al 2016, disponibles en PubMed Lilacs, Ebsco, Medline, Justor y Scielo. Se revisaron setenta y cinco artículos y se seleccionaron veintinueve. Conclusiones: la prevención del VIH debe avanzar del enfoque asistencialista a políticas que promuevan el desarrollo humano, social y económico, sin olvidar que la población en general se encuentra en riesgo de adquirir la infección.

Abstract This article aims to analyze how the prevention of HIV infection in Colombia -from the 1980s until now- has taken place, given that it is one of the main measures to control infection. We present the epidemiological context in the world and in Colombia, the development of the prevention of infection, and conclude with some reflections on the gaps and realities of what has characterized HIV prevention in our environment. Methodology: we analyzed papers and scientific articles in Spanish, English, and Portuguese from 2000 to 2016, available in PubMed Lilacs, Ebsco, Medline, Justor, and Scielo. Seventy-five articles were reviewed out of which twenty-nine selected. Conclusions: HIV prevention must move from the assistance-based approach to policies that promote human, social, and economic development, without leaving aside the fact that the general population is at risk of acquiring the infection.

Resumo Este artigo visa analisar como foi a prevenção da infeção pelo VIH na Colômbia, desde a década de oitenta para hoje, por ser uma das principais medidas para o controle da infeção. Apresenta o contexto epidemiológico no mundo e na Colômbia, o desenvolvimento da prevenção da infeção e finda com reflexões sobre fisgas e realidades do que já caracterizou a prevenção do VIH no nosso meio. Metodologia: analisaram-se documentos e artigos científicos em espanhol, inglês e português do ano 2000 para 2016, disponíveis em PubMed Lilacs, Ebsco, Medline, Justor e Scielo. Revisaram-se setenta e cinco artigos e selecionaram-se vinte e nove. Conclusões: a prevenção do VIH deve avançar do enfoque assistencialista para políticas promovendo o desenvolvimento humano, social e económico, sem esquecer que a população em geral encontra-se em risco de adquirir a infeção.

Secundarismo sifilítico: un amplio espectro de manifestaciones dermatológicas / Syphilitic Secondaryism: A Wide Spectrum of Dermatological Manifestations

El artículo describe el caso de un paciente de 28 años de edad con antecedente de VIH, quien presentaba múltiples lesiones en la piel y las mucosas, producto de sífilis secundaria, y quien mostraba un amplio espectro de manifestaciones cutáneas características de esta enfermedad.

We describe the case of a 28-year-old patient with HIV history who has multiple skin and mucous lesions that showing a broad spectrum of cutaneous manifestations of secondary syphilis.

Assessment of pharmaceutical services in HIV/AIDS health units in the city of Niterói, Brazil

ABSTRACT This study aimed to conduct an assessment of pharmaceutical services in HIV/AIDS in the city of Niteroi, Brazil, with emphasis on management. It was done a descriptive cross-sectional study, and the approach used was a normative assessment focused on quality. The indicators used were analyzed individually or grouped according to the components of pharmaceutical services. The assessment identified some good points, especially regarding the good availability of ARVs, and good guide patients in the use of these drugs, and also some problems such as low levels of compliance in relation to good dispensing practices criteria and storage and a high time for the distribution of medicines. The result was a degree of 50.3% compliance with the quality criteria, considered only regular in accordance with trial made. Proposals were suggested for actions and interventions, especially in relation to the improvement of structural conditions of pharmacies of health facilities in the city, and increased training of professionals involved in the services.

Demencia en pacientes adultos con síndrome de inmunodeficiencia adquirida, atendidos en el Hospital Mario Catarino Rivas / Dementia in adult patients with acquired immunodeficiency syndrome treated at Hospital Mario Catarino Rivas

Introducción: La demencia asociada al virus de inmunodeficiencia humana (D-VIH) es un tipo de demencia subcortical debido a infecciones crónicas por VIH; y combina alteraciones cognitivas, motoras y conductuales, afectando del 20 al 30% de los pacientes adultos que sufren esta enfermedad. La Escala de Demencia por VIH (EDV) es una herramienta sensible que se utiliza para tamizaje de pacientes infectados por VIH y con riesgo de desarrollar demencia. Objetivos. Aplicar la EDV en pacientes con infección avanzada por VIH que asistían al Centro de Atención Integral (CAI) del Hospital Mario Catarino Rivas (HMCR) y analizar su relación con el conteo de células TCD4 <200. Metodología. Se trata de un estudio cuantitativo, descriptivo, de corte transversal con un muestreo intencionado. En el estudio se incluyó pacientes mayores de 18 años con VIH confirmado, quienes asisten al CAI, alfabetos, con conteo reciente de linfocitos CD4 menor de 200 células y que consintieron participar en el estudio. Se les aplicó la EDV como tamizaje para evaluar su función mental. Resultados. El 81% de los pacientes entrevistados presentaron riesgo de D-VIH con un rango de edad de mayor prevalencia entre 38 y 57 años, siendo el género femenino el de mayor riesgo. Conclusión de acuerdo a los resultados obtenidos, la EDV es una herramienta costo-efectiva para determinar la función cognitiva en los pacientes...(AU)

Glycodendritic structures: tools to interact with DC-SIGN

The key role of carbohydrates in many biological events has attracted the interest of the scientific community. This fact has demanded the access to new tools necessary to understand this role and the interaction of carbohydrates with their corresponding receptors, lectins. Glycodendrimers and glycodendritic structures in general, have demonstrated to be very efficient and interesting tools to intervene in those processes where carbohydrates participate. In this review, we discuss the different glycodendritic structures that have been used to interfere with DC-SIGN, a very attractive lectin involved in infection processes and in the regulation of the immune response.

O papel chave dos carboidratos em muitos eventos biológicos tem atraído interesse da comunidade científica. Este fato demonstrou o acesso de novas ferramentas para a compreensão da interação dos carboidratos com seus receptores correspondentes, lectinas. Glicodendrímeros e estruturas glicodendríticas, em geral, mostram-se como ferramentas muito eficientes e interessantes para intervir nos processos em que os carboidratos participam. Nesta revisão, discutimos diferentes estruturas glicodendríticas que têm sido úteis para interferir com DC-SIGN, uma lectina muito atraente envolvida em processos infecciosos e na regulação da resposta imune.

Activity of antiretroviral drugs in human infections by opportunistic agents

Highly active antiretroviral therapy (HAART) is used in patients infected with HIV. This treatment has been shown to significantly decrease opportunist infections such as those caused by viruses, fungi and particularly, protozoa. The use of HAART in HIV-positive persons is associated with immune reconstitution as well as decreased prevalence of oral candidiasis and candidal carriage. Antiretroviral therapy benefits patients who are co-infected by the human immunodeficiency virus (HIV), human herpes virus 8 (HHV-8), Epstein-Barr virus, hepatitis B virus (HBV), parvovirus B19 and cytomegalovirus (CMV). HAART has also led to a significant reduction in the incidence, and the modification of characteristics, of bacteremia by etiological agents such as Staphylococcus aureus, coagulase negative staphylococcus, non-typhoid species of Salmonella, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Mycobacterium tuberculosis. HAART can modify the natural history of cryptosporidiosis and microsporidiosis, and restore mucosal immunity, leading to the eradication of Cryptosporidium parvum. A similar restoration of immune response occurs in infections by Toxoplasma gondii. The decline in the incidence of visceral leishmaniasis/HIV co-infection can be observed after the introduction of protease inhibitor therapy. Current findings are highly relevant for clinical medicine and may serve to reduce the number of prescribed drugs thereby improving the quality of life of patients with opportunistic diseases.

A terapia HAART (terapia antirretroviral altamente ativa) é usada em pacientes infectados pelo vírus da imunodeficiência humana (HIV) e demonstrou diminuição significativa de infecções oportunistas, tais como as causadas por vírus, fungos, protozoários e bactérias. O uso da HAART está associado com a reconstituição imunológica e diminuição na prevalência de candidíase oral. A terapia antirretroviral beneficia pacientes co-infectados pelo HIV, vírus herpes humano 8 (HHV-8), vírus Epstein-Barr (EBV), vírus da hepatite B (HBV), parvovírus B19 e citomegalovírus (CMV). A HAART também apresentou redução significativa da incidência e modificou as características da bacteremia por agentes etiológicos, tais como Staphylococcus aureus, espécies não-tifóides de Salmonella, Streptococcus pneumoniae, Pseudomonas aeruginosa, Mycobacterium tuberculosis. A HAART é capaz de modificar significativamente a história natural da criptosporidiose e microsporidiose. HAART pode efetivamente restaurar a imunidade da mucosa, levando à erradicação de Cryptosporidium parvum. Semelhante restauração da resposta imune ocorre em infecções por Toxoplasma gondii. O declínio na incidência de co-infecção leishmaniose visceral/HIV pode ser observada após a introdução da terapia com inibidores da protease. Os resultados atuais são altamente relevantes para a medicina clínica e podem proporcionar diminuição no número de prescrições medicamentosas e, consequentemente, melhor qualidade de vida para pacientes com doenças oportunistas.

Quality of life of HIV+ patients undergoing pharmacotherapeutic follow-up

The influence of pharmacotherapeutic follow-up (PTF) on quality of life was evaluated in 45 HIV+ patients, who were undergoing initial antiretroviral therapy at a specialized care center in northeast Brazil. PTF lasted nine months and quality of life was analyzed at the 1st and 9th meetings using a questionnaire validated for Brazil. The study identified 643 problems related to antiretrovirals and there were 590 pharmaceutical interventions during the PTF. The comparative analysis between the results of the 1st and the 9th meeting was statistically significant for all domains of the questionnaire. For asymptomatic patients, only one domain was statistically significant. For symptomatic patients, six domains were significant. Patients with one year of HIV/AIDS diagnosis had statistically significant differences in five domains. The results suggest that the PTF contributed to improving quality of life, particularly for symptomatic patients and those diagnosed for at least one year - important target groups for Pharmaceutical Treatment.

A influência do seguimento farmacoterapêutico (SFT) sobre a qualidade de vida foi avaliada em 45 pacientes HIV+ assistidos em serviço de atendimento especializado do nordeste brasileiro. O SFT teve duração de 9 meses e a qualidade de vida foi analisada no 1º e 9º encontros através de questionário validado no País. Identificaram-se 643 problemas relacionados aos antirretrovirais e realizaram-se 590 intervenções farmacêuticas durante o SFT. A análise comparativa entre os resultados de qualidade de vida do 1º e 9º encontro foi estatisticamente significativa em todos os domínios do questionário. Quando analisados somente os pacientes assintomáticos, apenas um domínio apresentou significância estatística. Entre os sintomáticos, seis domínios foram significativos. Pacientes com até um ano de diagnóstico de HIV/AIDS apresentaram validade estatística em cinco domínios. Os resultados sugerem que o SFT contribuiu para a melhoria da qualidade de vida dos pacientes, sobretudo dos sintomáticos e/ou com até um ano de diagnóstico, representando grupos-alvo para a prática da Atenção Farmacêutica.

Molecular epidemiology of HIV.

The phylogenic analysis of the nucleotide sequences of the env gene has enabled classification of HIV-1 into three groups. The group M of HIV-1 infection has been classified into 9 different genetic subtypes A-K, with E and I being classified as circulating recombinants forms (CRFs). The groups O and N are less frequently encountered in human infections. Presently group M of HIV-1 globally causes 99.6 per cent of all human infections. The epidemiological trends suggest that subtype C strains would dominate the HIV pandemic in the coming years. The geographic spread of subtype C strains is also very diverse with prevalence in Africa, Latin America and Asia. Data from India show a high prevalence of subtype C. In north and western India, 78.4 and 96 per cent of HIV-1 strains respectively were shown to be subtype C. Among female sex workers in Kolkata 95 per cent of the HIV-1 strains were subtype C. The south Indian subtype data are very similar to the data from the rest of India. The HIV-2 groups (subtypes) recognized are A-H. Unlike HIV-1, HIV-2 strains are predominantly found in Africa. The Indian HIV-2 strains identified till date are subtype A. This is also the predominant strain circulating in western African countries. This group (subtype) is estimated to cause 0.11 per cent of all HIV infections in humans.

Effect of lamivudine [epivir], nevirapine [vivumine] and stavudine [stavir] on CD[4][+] count of HIV patients attending university of Benin Teaching Hospital [UBTH], Benin city, Edo State, Nigeria

Anti-retroviral drugs are broadly used to alleviate the sufferings of HIV patients in Sub-Saharan countries. Few studies have been carried out to assess the effects of these drugs on the immunological parameters of patients in the above-mentioned region. To assess the effect of the Lamivudine, Nevirapine and Stavudine combination on the CD4+ count of HIV patients attending the University of Benin Teaching Hospital, Benin City, Nigeria. An assessment of CD4+ counts of 37 HIV patients from different socio-economic groups on tritherapy, notably Lamivudine-Nevirapine-Stavudine combinations, attending the University of Benin Teaching Hospital, was carried out before therapy, three months and six months after administration of the drugs using Dynabeads[R] T4 -T8 Quantification Protocol [DYNAL BIOTECH ASA: NORWAY]. Out of the 37 studied subjects, 32 [86.48%] patients showed a marked increase in their CD4+ counts at three and six months, four [12.5%] subjects showed a continuous decrease in CD4+ level up to six months after therapy, while one [3.12%] patient had a decrease in CD4+ after three months and a sudden rise at six months. The mean CD4+ cell count increased from 255 at base line to 284 at week 12, and to 346 at week 24. Traders were the most affected by HIV virus followed by people in the group referred to as 'others', civil servants, and students with prevalence rates of 43.24%, 24.32%, 18.91%, 13.51% respectively. Statistically, there was a significant difference between HIV-1, HIV-2 and HIV-1 and 2 which had a prevalence rate of 89.19%, 8.10% and 2.70% respectively [p<0.05]. The importance of early diagnosis, continuous evaluation and sound clinical management of HIV is strongly emphasized

HIV vaccine development: a subtype E-specific strategy.

The pandemic of HIV/AIDS consists of multiple foci with distinct epidemiological characteristics. Among the approximately one million Southeast Asians infected with HIV, subtype (clade) E infections predominate. This subtype, a recombinant virus comprised of a clade A core (gag) gene and a mosaic clade A/clade E envelope (env) gene, became broadly epidemic in Thailand beginning in 1989. Since then, subtype E HIV has become increasingly prevalent throughout Southeast Asia. Consistent with the recent introduction of clade E HIV, the diversity of Southeast Asian subtype E viruses is narrow (6% nucleotide diversity across env). Since neutralizing antibodies may play a protective role against HIV infection, and are relatively clade specific for genotype E viruses, a subtype E-derived candidate vaccine tested in Southeast Asia would provide an optimal test of vaccine concept. It would also provide, for the first time to a developing region of the world, a non-B clade candidate vaccine designed specifically for the local epidemic. A consortium of industry (Chiron Vaccines and Pasteur Merieux Connaught), academic (Mahidol and Chiang Mai Universities) and military (United States and Royal Thai Army Medical Departments) medicine is working together to develop and test HIV vaccines for the genotype E epidemic. A genotype B recombinant glycoprotein (rgp)120 candidate vaccine has undergone phase I/II testing in Thailand and confirmed to be safe and immunogenic in this ethnic group. An rgp120 (E) has been produced and a phase I/II trial of the bivalent product (B/E) is in the final stages of approval. This vaccine construct is designed to elicit humoral immune responses. To augment these antibody responses with CD8+ CTL responses, an E-specific, live-vectored vaccine is being developed which will be used in conjunction with rgp120 in a second vaccine approach. Canarypox (ALVAC) constructs containing multiple HIV genes (gag/pol/env) currently designed for the subtype B epidemics will be modified to contain a clade E env gene sequence. After predetermined milestones have been met, these two subtype E-specific candidate vaccines will be assessed for protection in a large collaborative efficacy trial. Since neither animal models nor laboratory assays are validated as predictive of HIV vaccine efficacy, it must be through such a phase III trial that vaccine-induced protection and immunologic correlates will be determined.

Taller de epidemiología molecuar sobre enfermedades virales / Molecular epidemiology workshop on viral diseases

Con el propósito de promover la interacción entre investigadores en epidemiología y virología se realizó un taller sobre epidemiología molecular de virus en la Facultad de Medicina de la Universidad Nacional Autónoma de México el 29 de septiembre de 1995. En este taller, en el que participaron 18 ponentes de 10 instituciones diferentes, los investigadores presentaron sus trabajos y experiencias en esta área. Durante el taller se hizo un análisis somero de la frecuencia y distribución de las enfermedades virales de importancia epidemiológica y se presentaron trabajos sobre: rotavirus, poliovirus, virus sincitial respiratorio, virus del dengue, papilomavirus, VIH virus de la rabia y virus de las hepatitis

Utilidad clínica de marcadores sustitutos del recuento absoluto de linfocitos TcD4 en pacientes infectados y enfermos por virus de inmunodeficiencia humana / Clinic utility of sustituts markers of the count absoluty of lymphocytes in patients infect and diseases by human inmunodeficience virus

El objetivo es establecer si individualmente o en combinación, los parámetros: recuento total de linfocitos, B-2 microglobulina. Hematocrito y proteina C reactiva predicen el recuento de linfocitos TDC4 en nuestro medio, para facilitar la toma de decisiones terapéuticas, basadas en parámetros paraclinicos de fácil acceso, utilizando los recursos disponibles. Se incluyeron 76 pacientes seropositivos para el Virus de Inmunodeficiencia Humana de las salas de Hospitalización y Consulta de Medicina Interna del Hospital Universitario de Caracas, a quienes se les determinó recuento total de linfocitos, B-2 microglobulina, Proteina C reactiva y recuento absoluto de linfocitos TDC4. Para evaluar la capacidad predictiva de los marcadores estudiados sobre el recuento absoluto de linfocitos TDC4 se realizaron cálculos de coeficiencia de correlación, con modelos de regresión simple, múltiple y el método del paso acertado (Step-Wise). Se calculó la sensibilidad y la especificidad del recuento de linfocitos totales, definiendo sensibilidad como la proporción de pacientes con cuenta absoluta de TDC4 < 200 céls/mm3 que tenían un recuento linfocitario total < 1500 céls/mm3 que tenían linfocitos totales >1500 céls/mm3. La muestra se distribuyó de la siguiente manera: 59 hombres, con edad media de 34 años y 17 mujeres, con edad mediade 35 años. El análisis de regresión de las variables recuento total de linfocitos, B-2 microglobulina y hematocritos sobre la variable dependiente TDC4 mostraron valores de p < 0.001, resultando la cuenta total de linfocitos con el más alto coeficiente de correlación 56.2, y el Método de Step-Wise, estableció como variable que más afectan la variación de la variable dependiente a cuenta total de linfocitos y hematocritos. Por modelo de regresión múltiple, las combinaciones CDC1 (pacientes con cuenta absoluta de TCD4 mayores de 500 céls/mm3 y CDC3 (paciente con cuenta absoluta de TCD4 menores de 200 céls/mm3) tiene un coeficiente de correlación del 70, determinándose que en grupo CDC1 las variables que guardan mayor correlación con el CD4 fueron cuenta total de linfocitos y hematocritos y para el grupo CDC3 cuenta total de linfocitos y B-2 microglobulina. Las variables de los marcadores estudiados: cuenta de linfocitos, B-2 microglobulina, hematocritos, están asociados con variaciones de TDC4, sin embargo, no lo sustituyen

Sindrome da imunodeficiencia adquirida no adulto / Acquired immunodeficiency syndrome

Este texto foi formulado para a disciplina Imunologia Medica (BIO-624) do curso de Medicina da Universidade Federal do Rio Grande do Sul com o objetivo de facilitar o ensino de um assunto tao complexo. Basicamente, a Sindrome da Imunodeficiencia Adquirida e uma doenca multissistemica e que lesa de forma irreversivel o sistema imune. Nesta doenca, as celulas do sistema imune sao afetadas de forma quantitativa e/ou qualitativa. O primeiro a ser afetado e o linfocito T (CD4) por quem o virus da imunodeficiencia humana (HIV) tem particular afinidade, pois e com o CD4 que o virus se liga para penetrar no linfocito. Outras celulas do sistema imune (linfocitos B, celulas NK, macrofagos) tambem sofrem alteracoes. E, devido as alteracoes celulares, a producao de citoquinas tambem se altera. Esta completa falencia do sistema imune e que propicia o aparecimento de infeccoes oportunistas contra as quais o organismo nao pode se defender

Sindrome de inmunodeficiencia adquirida: revision bibliografica / Acquired immunodeficiency syndrome: bibliographical revision

La infeccion por el virus de la inmunodeficiencia humana es un problema de salud publica que amenaza seriamente los logros alcanzados por los servicios de salud despues de muchos anos de multiples esfuerzos y constituye una de las prioridades internacionales en el campo de la atencion sanitaria. Su complejidad demanda el esfuerzo integrado de varios sectores de la organizacion social y su reciente aparicion obliga a los trabajadores de la salud a mantenerse enterados sobre los conocimientos que aparezcan sobre el tema. Por el momento, ante la provisoriedad del conocimiento presente y la urgencia de cortar la cadena de transmision compete a los equipos de salud organizar su trabajo alrededor de aquellas medidas que ofrezcan maxima seguridad para la poblacion sin deteriorar la calidad de vida con acciones que hagan de la intervencion algo mas penoso que la misma enfermedad.