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Article in English | LILACS | ID: biblio-1290529


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.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , HIV Infections/epidemiology , Socioeconomic Factors , Brazil/epidemiology , Retrospective Studies , AIDS-Related Opportunistic Infections/epidemiology
Rev. Soc. Bras. Med. Trop ; 52: e20180126, 2019. tab
Article in English | LILACS | ID: biblio-1041554


Abstract INTRODUCTION: We assessed the clinical-epidemiological profile of acquired immune deficiency syndrome (AIDS) patients in the Santos region (São Paulo state) with the highest AIDS prevalence in Brazil. METHODS Information was extracted from records of 409 AIDS-infected patients hospitalized between 2011 and 2016. RESULTS: Human immunodeficiency virus (HIV) was diagnosed in 24.7% of patients during admission, and 39.6% of already diagnosed patients received highly active antiretroviral therapy (HAART) irregularly. The mortality rate was 19.1%, and the main secondary manifestations were neurotoxoplasmosis and tuberculosis. CONCLUSIONS: AIDS patients in the Santos region had high rates of late diagnosis and low treatment adherence.

Humans , Male , Female , Adult , Prevalence , Retrospective Studies , Acquired Immunodeficiency Syndrome/epidemiology , AIDS-Related Opportunistic Infections/epidemiology , Brazil/epidemiology , Cross-Sectional Studies , Acquired Immunodeficiency Syndrome/drug therapy , Antiretroviral Therapy, Highly Active
Rev. Soc. Bras. Med. Trop ; 51(4): 479-484, July-Aug. 2018. tab
Article in English | LILACS | ID: biblio-957451


Abstract INTRODUCTION: In many settings, the lack of sensitive biomarkers of disseminated histoplasmosis (DH) leads to a clinical reliance on older diagnostic methods and delayed treatment initiation. The early recognition of DH is critical for survival, especially in patients with human immunodeficiency virus (HIV). This study aimed to identify clinical and laboratory findings associated with the definitive diagnosis of DH in low-income HIV patients in endemic areas. METHODS: Febrile AIDS patients with suspected DH who were admitted to a reference hospital in northeastern Brazil from January 2006 to January 2007 were evaluated for clinical and laboratory findings associated with DH diagnosis. RESULTS: One hundred seventeen patients with fever were included, and 48 (41%) cases of DH were determined by Histoplasma capsulatum identification. A higher fever (≥38.5ºC), maculopapular/papular rash, splenomegaly, hepatomegaly, wheezing, hemoglobin ≤9.5g/dL, platelets ≤80,000/µL, CD4 count ≤75/µL, aspartate aminotransferase (AST) level ≥2.5 times the upper limit of normal (ULN), lactate dehydrogenase (LDH) ≥5times the ULN; and international normalized ratio (INR) >2 times the ULN were significantly associated with DH. A multivariable analysis identified hepatomegaly [adjusted (a) prevalence ratio (PR)= 1.96; 95% confidence interval (CI): 1.21-3.16), CD4 count ≤75/µL (aPR = 2.02; 95% CI: 1.06-3.83), LDH ≥5 times the ULN (aPR = 2.23; 95% CI: 1.44-3.48), and maculopapular/papular rash (aPR = 1.70; 95% CI: 1.02-2.83) were independent risk factors for DH. CONCLUSIONS: These easily assessed parameters can facilitate clinical decision-making for febrile AIDS patients with suspected DH in low socioeconomic and Histoplasma-endemic regions.

Humans , Male , Female , Adolescent , Adult , Young Adult , AIDS-Related Opportunistic Infections/diagnosis , Fever/microbiology , Histoplasma/isolation & purification , Histoplasmosis/diagnosis , Socioeconomic Factors , Brazil/epidemiology , Prevalence , Prospective Studies , Risk Factors , AIDS-Related Opportunistic Infections/epidemiology , CD4 Lymphocyte Count , Histoplasmosis/epidemiology , Middle Aged
An. bras. dermatol ; 93(4): 524-528, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-949915


Abstract: Background: Kaposi's sarcoma (KS) is a rare neoplasm with indolent progression. Since 1981, the Kaposi's sarcoma epidemic has increased as co-infection with HIV. Objectives: The study aimed to identify the clinical and demographic characteristics and therapeutic approaches in HIV/AIDS patients in a regional referral hospital. Methods: We analyzed the medical records of 51 patients with histopathological diagnosis of Kaposi's sarcoma hospitalized at Hospital Universitário João de Barros Barreto (HUJBB) from 2004 to 2015. Results: The study sample consisted of individuals 15 to 44 years of age (80.4%), male (80.4%), single (86.3%), and residing in Greater Metropolitan Belém, Pará State, Brazil. The primary skin lesions identified at diagnosis were violaceous macules (45%) and violaceous papules (25%). Visceral involvement was seen in 62.7%, mainly affecting the stomach (75%). The most frequent treatment regimen was 2 NRTI + NNRTI, and 60.8% were referred to chemotherapy. Study limitations: We assumed that more patients had been admitted to hospital without histopathological confirmation or with pathology reports from other services, so that the current study probably underestimated the number of KS cases. Conclusion: Although the cutaneous manifestations in most of these patients were non-exuberant skin lesions like macules and papules, many already showed visceral involvement. Meticulous screening of these patients is thus mandatory, even if the skin lesions are subtle and localized.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Sarcoma, Kaposi/epidemiology , AIDS-Related Opportunistic Infections/epidemiology , Sarcoma, Kaposi/pathology , Sarcoma, Kaposi/drug therapy , Socioeconomic Factors , Brazil/epidemiology , Cross-Sectional Studies , Retrospective Studies , AIDS-Related Opportunistic Infections/pathology , AIDS-Related Opportunistic Infections/drug therapy , Antiretroviral Therapy, Highly Active , Tertiary Care Centers
Braz. j. infect. dis ; 22(2): 92-98, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-951638


ABSTRACT Introduction: Visceral Leishmaniasis is the most severe form of disease caused by the Leishmania donovani complex, with significant morbidity and mortality in developing countries. Worse outcomes occur among HIV-positive individuals coinfected with Leishmania. It is unclear, however, if there are significant differences on presentation between Visceral Leishmaniasis patients with or without HIV coinfection. Methods: We reviewed medical records from adult patients with Visceral Leishmaniasis treated at a reference healthcare center in Fortaleza - Ceará, Brazil, from July 2010 to December 2013. Data from HIV-coinfected patients have been abstracted and compared to non-HIV controls diagnosed with Visceral Leishmaniasis in the same period. Results: Eighty one HIV-infected patients and 365 controls were enrolled. The diagnosis in HIV patients took significantly longer, with higher recurrence and death rates. Kala-azar's classical triad (fever, constitutional symptoms and splenomegaly) was less frequently observed in Visceral Leishmaniasis-HIV patients, as well as jaundice and edema, while diarrhea was more frequent. Laboratory features included lower levels of hemoglobin, lymphocyte counts and liver enzymes, as well as higher counts of blood platelets and eosinophils. HIV-infected patients were diagnosed mainly through amastigote detection on bone marrow aspirates and treated more often with amphotericin B formulations, whereas in controls, rK39 was the main diagnostic tool and pentavalent antimony was primarily used for treatment. Conclusions: Clinical and laboratory presentation of Visceral Leishmaniasis in HIV-coinfected patients may differ from classic kala-azar, and these differences may be, in part, responsible for the delay in diagnosing and treating leishmaniasis, which might lead to worse outcomes.

Humans , Male , Female , Adolescent , Adult , Young Adult , AIDS-Related Opportunistic Infections/diagnosis , Leishmaniasis, Visceral/diagnosis , Brazil/epidemiology , Amphotericin B , Cross-Sectional Studies , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/epidemiology , Diagnosis, Differential , Coinfection/parasitology , Coinfection/virology , Leishmaniasis, Visceral/drug therapy , Leishmaniasis, Visceral/epidemiology , Leishmaniasis, Visceral/virology , Antiprotozoal Agents/therapeutic use
Ciênc. Saúde Colet ; 23(1): 115-122, Jan. 2018. tab
Article in Portuguese | LILACS | ID: biblio-890487


Resumo Esta revisão integrativa da literatura tem por objetivo identificar as principais lesões bucais que afetam pacientes pediátricos com HIV, bem como descrever o efeito da terapia antirretroviral altamente ativa (HAART) sobre essas lesões, comparando-a com a terapia antirretroviral (ART). Foi feita uma busca nas bases de dados PubMed e Scielo, seguindo critérios de inclusão e exclusão pré-determinados. Foram selecionados dezenove artigos científicos e extraídas as informações principais sobre prevalência e a frequência das manifestações bucais em pacientes pediátricos HIV positivos e o efeito da terapêutica aplicada. As lesões mais frequentes foram candidíase oral, gengivite, aumento das parótidas e eritema gengival linear. O uso da HAART mostrou diminuir a prevalência das manifestações bucais nos pacientes pediátricos com HIV e ser mais eficaz que a ART. Os achados deste estudo sugerem que a manifestação bucal mais frequente em pacientes pediátricos com HIV é a candidíase oral, seguida de alterações como gengivite e aumento das glândulas parótidas. O uso de HAART parece reduzir a prevalência dessas lesões orais, apresentando resultados mais eficazes que os da ART.

Abstract This integrative literature review aims to identify the main oral lesions affecting pediatric patients with HIV, and describe the effect of highly active antiretroviral therapy (HAART) on these injuries, comparing it to antiretroviral therapy (ART). A search was conducted in PubMed and Scielo databases, following predetermined inclusion and exclusion criteria. 19 papers were selected and the main information on the prevalence and frequency of oral manifestations in HIV-positive pediatric patients and effect of therapy applied were extracted. The most frequent injuries were oral candidiasis, gingivitis, parotid gland enlargement and linear gingival erythema. The use of HAART shown to reduce the prevalence of oral manifestations in pediatric patients with HIV and be more effective than ART. The findings of this study suggest that the most frequent oral manifestation in HIV-infected children is oral candidiasis, followed by changes such as gingivitis and enlargement parotid glands. The use of HAART appears to reduce the prevalence of these oral lesions, showing more effective results than ART.

Humans , Child , HIV Infections/complications , Anti-HIV Agents/administration & dosage , Mouth Diseases/etiology , Parotid Gland/pathology , Candidiasis, Oral/etiology , Candidiasis, Oral/prevention & control , Candidiasis, Oral/epidemiology , HIV Infections/drug therapy , HIV Infections/epidemiology , Prevalence , AIDS-Related Opportunistic Infections/prevention & control , AIDS-Related Opportunistic Infections/epidemiology , Antiretroviral Therapy, Highly Active/methods , Gingivitis/etiology , Gingivitis/prevention & control , Gingivitis/epidemiology , Mouth Diseases/prevention & control
Ciênc. Saúde Colet ; 22(11): 3781-3792, Nov. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-890185


Resumo O presente estudo buscou analisar a sobrevida de pacientes com a coinfecção AIDS-Tuberculose por meio de um estudo de coorte retrospectivo de indivíduos com 13 anos ou mais e diagnóstico de AIDS notificados nos anos de 1998-99 e seguimento de 10 anos. Dos 2.091 casos de AIDS, 517 (24,7%) tinham diagnóstico positivo para tuberculose, sendo 379 (73,3%) masculinos. O risco entre os coinfectados foi 1,65 vezes os não coinfectados. As variáveis associadas à maior sobrevida foram: sexo feminino (HR = 0,63), escolaridade ≥ oito anos (HR = 0,52), critério diagnóstico CD4 (HR = 0,64); e à menor sobrevida: faixa etária ≥ 60 anos (HR = 2,33), não uso de ARV (HR = 8,62), não investigação para hepatite B (HR = 2,44) e doenças oportunistas (≥ duas) (HR = 1,97). A sobrevivência acumulada foi de 71% nos não coinfectados e 62% nos coinfectados na região Sul e de 74% e 58%, respectivamente, na região Sudeste, 60 meses após o diagnóstico de AIDS. A AIDS e a Tuberculose exigem acompanhamento e adesão ao tratamento e são marcadores da atenção à saúde e da sobrevivência dos pacientes no Brasil.

Abstract The study investigates the survival of patients with co-infection AIDS-TB through a retrospective study of a cohort of individuals aged 13 or more and the diagnosis of AIDS reported in the years 1998-99 and following 10 years. Of the 2,091 AIDS cases, 517 (24.7%) had positive diagnosis for tuberculosis, and 379 (73.3%) were male. The risk among co-infected patients was 1,65 times the not co-infected. Have been compared the exposed and non-exposed through the Kaplan-Meier and Cox method. The variables associated with longer survival were: female gender (HR = 0.63), educational level ≥ eight years (HR = 0.52), CD4 diagnostic criteria (HR = 0.64); and shorter survival: age ≥ 60 years (HR = 2.33), no use of HAART (HR = 8.62), no investigation to Hepatitis B (HR = 2.44) and opportunistic infections ≥ two (HR = 1.97). The average survival rate, related to TB infection was 69 months for the Southeast region and 73 months for the South. AIDS and tuberculosis require monitoring and treatment adherence and they are markers of the quality of care and survival of patients in Brazil.

Humans , Male , Female , Adolescent , Adult , Young Adult , Tuberculosis/mortality , Acquired Immunodeficiency Syndrome/mortality , AIDS-Related Opportunistic Infections/mortality , Medication Adherence , Tuberculosis/drug therapy , Tuberculosis/epidemiology , Brazil/epidemiology , Proportional Hazards Models , Sex Factors , Survival Rate , Retrospective Studies , Risk Factors , Cohort Studies , Age Factors , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/epidemiology , AIDS-Related Opportunistic Infections/epidemiology , Antiretroviral Therapy, Highly Active , Kaplan-Meier Estimate , Coinfection , Middle Aged
Cad. Saúde Pública (Online) ; 33(8): e00050916, Aug. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-952339


Resumo: Propôs-se levantar a prevalência de infecção latente por tuberculose (ILTB) entre pessoas vivendo com HIV/AIDS (PVHA), fatores associados e se entre os casos identificados houve progressão para tuberculose ativa. Trata-se de estudo epidemiológico e descritivo. A população foi composta de PVHA, atendidas entre 2003 e 2014 em um centro de referência para HIV/AIDS. Os dados foram coletados com base em prontuários e fichas do Sistema de Informação de Agravos de Notificação (SINAN). Procedeu-se à estatística bivariada, com aplicação do teste qui-quadrado, em que as variáveis com valores de p < 0,2 foram selecionadas para entrar no modelo de regressão múltipla. Foi fixado em todos os testes o erro tipo I em 5% (p < 0,05). No estudo, 690 casos foram analisados, sendo que 66 (9,4%) apresentaram o diagnóstico de ILTB, tendo uma prevalência de 7,5 casos para cada 100 pacientes. Dos 53 (80,3%) casos de ILTB que tiveram o tratamento indicado com isoniazida, apenas 26 (39,4%) concluíram e 10 (15,1%) abandonaram. Observou-se que as variáveis sexo masculino (OR ajustado = 1,8; IC95%: 1,1-3,3), situação prisional (OR ajustado = 7,6; IC95%: 2,35-24,9) e contagem de linfócitos mais altos são fatores associados ao diagnóstico de ILTB (OR ajustado = 1,1; IC95%: 1,1-1,2). Verificou-se que 47 (6,7%) dos casos de ILTB progrediram para TB ativa. O diagnóstico e o tratamento de ILTB nas PVHA não foram priorizados, o que contribuiu para o desenvolvimento de doença ativa entre os casos. O trabalho contribuiu para o avanço do conhecimento acerca da ILTB entre PVHA, demonstrando aspectos cruciais no que tange ao manejo de PVHA e ainda a importância da detecção da ILTB e a instituição precoce da isoniazida, visando à melhor qualidade de vida e prognóstico das PVHA.

Abstract: The study proposed to identify the prevalence of latent tuberculosis infection (LTBI) in persons living with HIV/AIDS (PLWHA), associated factors, and progression to active tuberculosis among the identified cases. This was an epidemiological and descriptive study. The study population consisted of PLWHA seen from 2003 and 2014 in a reference center for HIV/AIDS. Data were collected from patient files and the Brazilian Information System for Notifiable Diseases (SINAN). Bivariate statistical analysis used the chi-square test in which variables with p < 0.2 were selected to enter the multiple regression model. Type I error was set at 5% (p < 0.05) for all the tests. In the study, 690 cases were analyzed, and 66 (9.4%) had a diagnosis of LTBI, with a prevalence of 7.5 cases per 100 patients. Of the 53 cases (80.3%) of LTBI who were prescribed treatment with isoniazid, only 26 (39.4%) concluded treatment, and 10 (15.1%) dropped out. Male gender (adjusted OR = 1.8; 95%CI: 1.1-3.3), current incarceration (adjusted OR = 7.6; 95%CI: 2.35-24.9), and high lymphocyte count were associated with LTBI diagnosis (adjusted OR = 1.1; 95%CI: 1.1-1.2). Forty-seven (6.7%) of LTBI cases progressed to active TB. Diagnosis and treatment of LTBI in PLWHA were not prioritized, which contributed to the development of active disease among cases. The study contributed to knowledge on LTBI in PLWHA, demonstrating crucial aspects in the management of PLWHA and the importance of detecting LTBI and early initiation of isoniazid, aimed at improved quality of life and prognosis for PLWHA.

Resumen: Se propone averiguar la prevalencia de infección latente por tuberculosis (ILTB) entre personas viviendo con VIH/SIDA (PVVS), sus factores asociados, y si entre los casos identificados hubo progresión hacia la tuberculosis activa. Se trata de un estudio epidemiológico y descriptivo. La población estaba compuesta de PVVS, atendidas entre 2003 y 2014 en un centro de referencia para VIH/SIDA. Los datos fueron recogidos en base a historiales clínicos y fichas del Sistema Brasileiro de Información de Enfermedades de Notificación Obligatoria (SINAN). Se procedió a una estadística bivariada, con aplicación del test chi-cuadrado, donde las variables con valores de p < 0,2 fueron seleccionadas para entrar en el modelo de regresión múltiple. Se fijó en todos los tests el error tipo I en un 5% (p < 0,05). En el estudio, se analizaron 690 casos, donde 66 (un 9,4%) presentaron el diagnóstico de ILTB, teniendo una prevalencia de 7,5 casos para cada 100 pacientes. De los 53 (80,3%) casos de ILTB que tuvieron el tratamiento indicado con isoniazida, sólo 26 (39,4%) lo concluyeron y 10 (15,1%) lo abandonaron. Se observó que las variables sexo masculino (OR ajustado = 1,8; IC95%: 1,1-3,3), situación en régimen de prisión (OR ajustado = 7,6; IC95%: 2,35-24,9) y un cómputo de linfocitos más altos son factores asociados al diagnóstico de ILTB (OR ajustado = 1,1; IC95%: 1,1-1,2). Se verificó que 47 (6,7%) de los casos de ILTB progresaron hacia una tuberculosis activa. El diagnóstico y el tratamiento de ILTB en las PVVS no fueron priorizados, lo que contribuyó al desarrollo de la enfermedad activa entre los casos. El trabajo contribuyó al avance del conocimiento acerca de la ILTB entre PVVS, demostrando aspectos cruciales en lo que atañe al manejo de PVVS, e incluso la importancia de la detección de ILTB y la administración precoz de la isoniazida, con el fin de mejorar la calidad de vida y el pronóstico de las PVVS.

Humans , Male , Female , Adolescent , Adult , Young Adult , AIDS-Related Opportunistic Infections/epidemiology , Latent Tuberculosis/epidemiology , Brazil/epidemiology , Prevalence , Risk Factors , AIDS-Related Opportunistic Infections/drug therapy , Disease Progression , Latent Tuberculosis/drug therapy , Antitubercular Agents/therapeutic use
Braz. j. infect. dis ; 21(4): 402-407, July-Aug. 2017. tab
Article in English | LILACS | ID: biblio-888898


Abstract Background: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) cause infections in the female genital tract, increasing susceptibility to and infectiousness of HIV. The objectives of the present study were to determine the prevalence and associated factors of CT and GC infection among HIV-infected women in Brazil. Methods: Cross-sectional study conducted from March to December 2015, including HIV-infected women attending referral centers in nine states of Brazil, aged 18-49 years, nonpregnant. An interview was conducted including socio-demographic, epidemiological and clinical characteristics. After the interview, gynecological examination was conducted to collect cervical cytology and vaginal secretion to C. trachomatis and N. gonorrhoeae tests through molecular biology. Results: A total of 802 (89.1%) women participated. The prevalence of CT was 2.1% (17/802) and CG was 0.9% (7/802). The prevalence of a positive test for both CT and/or GC was 2.7%. The factors associated with positive CT/GC test in the multivariate logistic regression analysis were abnormal Papanicolau smear (OR 4.1; 95% CI: 1.54-11.09) and the presence of abnormal cervical discharge (OR 2.6; 95% CI: 1.02-6.71). Among 377 women who reported previous STI 245 (65.0%) reported using condom more frequently after being diagnosed. 62 (16.4%) discovered the STI after the partner told he was infected; 157 (41.6%) had STI symptoms and looked for care, and 158 (41.9%) discovered it in a routine consultation for another reason. Conclusions: The control of STI represents a unique opportunity to improve reproductive health of women living with HIV. STI diagnosis can change their behavior and reduce the sexual transmission of HIV and bacterial STI.

Humans , Male , Female , Pregnancy , Adult , Middle Aged , Aged , Young Adult , Chlamydia Infections/epidemiology , Gonorrhea/epidemiology , AIDS-Related Opportunistic Infections/epidemiology , Socioeconomic Factors , Brazil/epidemiology , Chlamydia Infections/diagnosis , Gonorrhea/diagnosis , Mass Screening , Prevalence , Cross-Sectional Studies , Risk Factors , AIDS-Related Opportunistic Infections/diagnosis
Rev. Inst. Med. Trop. Säo Paulo ; 59: e29, 2017. tab, graf
Article in English | LILACS | ID: biblio-842770


ABSTRACT The majority of HIV-infected patients develop Candida spp-associated clinical oral lesions. Studies have shown that asymptomatic oral colonization of Candida spp may lead to oral lesions or become a source of disseminated infections. The aim of this study was to verify the effects of periodontal conditions on Candida spp prevalence and Candida spp carriage in the oral cavity of HIV-infected patients compared to non-infected patients. Twenty-five patients not infected with HIV and 48 HIV-infected patients were classified according to periodontal conditions as being periodontal healthy or with periodontal disease. Candida spp carriage and classification were performed in oral rinse samples. Viral load and CD4+ T lymphocyte (CD4+L) counts were performed in blood samples from HIV-infected patients. No differences in Candida spp prevalence related to HIV status or periodontal condition were detected. However, Candida spp carriage was increased in periodontally affected HIV-infected patients when compared to periodontally healthy HIV-infected patients (p= 0.04). Periodontally healthy HIV-infected patients presented Candida spp carriage in similar levels as healthy or periodontally affected non-HIV-infected patients. Candida spp carriage was correlated with CD4+L counting in HIV-infected patients. We concluded that periodontal disease is associated with increased Candida spp carriage in HIV-infected patients and may be a predisposing factor to clinical manifestations of candidiasis.

Humans , Male , Female , Adult , Periodontal Diseases/microbiology , Candida/classification , Candidiasis, Oral/microbiology , AIDS-Related Opportunistic Infections/microbiology , Periodontal Diseases/epidemiology , Brazil/epidemiology , Candida/isolation & purification , Candidiasis, Oral/epidemiology , Carrier State , AIDS-Related Opportunistic Infections/epidemiology , CD4 Lymphocyte Count , Viral Load , Mouth/microbiology
Medicina (B.Aires) ; 76(6): 332-337, dic. 2016. tab
Article in Spanish | LILACS | ID: biblio-841605


Durante 2009-2014, en nuestro hospital fueron diagnosticados 171 casos de histoplasmosis en pacientes con HIV/sida: 64 en 2009-2011, y 107 en 2012-2014. El mayor número de casos durante el segundo trienio no tuvo relación con la infección por HIV, cuya tasa de diagnóstico permaneció estable. La relación hombre/mujer fue 3.7:1 y la edad media 37.4 años. Al diagnóstico, solo 54/171 (31.6%) recibían TARGA y el recuento de linfocitos T CD4+ varió entre 4 y 264 células/μl. El 64.3% (n = 110) presentó lesiones cutáneas (pápulas ulceradas o "moluscoides") positivas para Histoplasma capsulatum al examen microscópico con tinción Giemsa. Siguieron en frecuencia las manifestaciones respiratorias y el lavado broncoalveolar fue positivo en 41/171 (24.0%) pacientes. Las imágenes radiológicas más frecuentes en orden decreciente fueron patrón miliar, infiltrados intersticiales y condensaciones focales. Se aisló H. capsulatum en 82 (58.2%) de los 141 hemocultivos realizados. No hubo diferencia significativa entre el rendimiento diagnóstico del hemocultivo y el de las escarificaciones cutáneas (p = 0.6164). Otras infecciones oportunistas previas o concomitantes con la histoplasmosis se observaron en 70/171 (40.9%). Se registró asociación con tuberculosis en 16/171 (9.4%) y un aislamiento de Mycobacterium tuberculosis resultó multirresistente. La gravedad del caso determinó el tratamiento con anfotericina B desoxicolato en 115 (67.3%), con itraconazol en 43 (25.1%), y con terapias combinadas en 14 (8.2%). La letalidad fue 19.9% (34/171). La mayor prevalencia en el segundo trienio debe alertar a la comunidad médica a considerar el diagnóstico de la histoplasmosis en pacientes con HIV/sida para disminuir la mortalidad.

A retrospective study was carried out on 171 cases of disseminated histoplasmosis diagnosed in HIV/AIDS patients during the period 2009-2014. Although HIV diagnosis rates remained stable over the study period, a sensible increase in the number of histoplasmosis cases was observed in the last three years. Disseminated histoplasmosis was prevalent in males with an average age of 37.8 years. At diagnosis, only 54/171 (31.6%) were receiving HAART, and CD4+ T-lymphocyte counts ranged from 4 to 264 cells/μl. Cutaneous lesions, including ulcerated papules or molluscoid plaques, were present in 110/171 (64.3%), with Histoplasma capsulatum being observed in all skin scraping specimens upon Giemsa staining. Respiratory manifestations were second in frequency with bronchoalveolar lavage showing a high diagnostic performance. Radiological findings included milliary patterns, interstitial infiltrates, and focalized condensations. Out of 141 blood cultures performed, H. capsulatum was isolated in 82 (58.2%). No significant difference in diagnostic performance was found between blood cultures and skin scraping (p = 0.6164). Other opportunistic infections were observed in 70/171 (40.9%) prior to or concomitantly with histoplasmosis. Association with Mycobacterium tuberculosis was recorded in 16/171 (9.4%) and one had a multi-drug resistant isolate. The severity of histoplasmosis determined the monotherapy with amphotericin B deoxycholate in 115 (67.3%), itraconazole in 42 (24.5%), and combined therapies in 14 (8.2%). Mortality was 19.9% (34/171). Finally, we emphasize that the higher prevalence in the last three years of the study should prompt the medical community to consider the diagnosis of histoplasmosis to reduce mortality of AIDS patients.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , AIDS-Related Opportunistic Infections/epidemiology , Histoplasmosis/epidemiology , Argentina/epidemiology , Time Factors , Prevalence , Retrospective Studies , Risk Factors , Analysis of Variance , AIDS-Related Opportunistic Infections/pathology , CD4 Lymphocyte Count , Antiretroviral Therapy, Highly Active , Histoplasmosis/pathology , Histoplasmosis/virology , Immunocompetence
Braz. j. infect. dis ; 20(6): 569-575, Nov.-Dec. 2016. tab
Article in English | LILACS | ID: biblio-828154


ABSTRACT Background: Infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae are the most common bacterial sexually transmitted infections throughout the world. These sexually transmitted infections are a growing problem in people living with HIV/AIDS. However, the presence of these agents in extra genital sites, remains poorly studied in our country. The objective of this study was to estimate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae anal and genital infection in people living with HIV/AIDS followed in a reference center in Salvador, Brazil. Methods: Cross-sectional study, from June 2013 to June 2015. Proven HIV-infected people attending this reference center were invited. Clinical and epidemiological data were obtained through interview with standardized form. Chlamydia trachomatis and Neisseria gonorrhoeae screening was performed using qPCR (COBAS 4800® Roche). Results: The frequency of positive cases of Chlamydia trachomatis and Neisseria gonorrhoeae was 12.3% in total, 9.2% cases amongst women and 17.1% amongst men. We found 14.0% of positive cases in anus and 3.1% in genital region in men, while 5.6% and 3.6%, in women, respectively. Among men, anal infection was associated with age <29 years (p = 0.033), report of anal intercourse (p = 0.029), pain during anal intercourse (p = 0.028). On the other hand, no association between genital infection and other variables were detected in bivariate analysis. Among women, we detected an association between Chlamydia trachomatis genital infection and age <29 years (p < 0.001), younger age at first sexual intercourse (p = 0.048), pregnancy (p < 0.001), viral load >50 copies/mL (p = 0.020), and no antiretroviral use (p = 0.008). Anal infection in women was associated with age <29 years old (p < 0.001) and pregnancy (p = 0.023), and was not associated with report of anal intercourse (p = 0.485). Conclusion: Missed opportunities for diagnosis in extra genital sites could impact on HIV transmission. The extra genital sites need to be considered to break the HIV and bacterial sexually transmitted infections chain-of-transmission.

Humans , Male , Female , Pregnancy , Adult , Rectum/microbiology , Chlamydia Infections/epidemiology , Gonorrhea/epidemiology , AIDS-Related Opportunistic Infections/epidemiology , Genitalia, Female/microbiology , Socioeconomic Factors , Brazil/epidemiology , Chlamydia Infections/diagnosis , Gonorrhea/diagnosis , Chlamydia trachomatis/isolation & purification , Prevalence , Cross-Sectional Studies , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/microbiology , Neisseria gonorrhoeae/isolation & purification
Rev. chil. infectol ; 33(supl.1): 2-10, oct. 2016. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-844430


Background: Chilean AIDS Cohort is the oldest and extensive in Latin America and one of most numerous and with longer follow up time to international level. Records information from 14,873 patients out of approximately 22,000 in antiretroviral therapy in the public system and its results have allowed to know the national reality and have contributed to the adoption of public policies. Aim: To describe the demographic, clinical and immunological characteristics of patients who have started ART in Chile and its evolution over the past 15 years. Patients and Methods: The cases were stratified by five-year periods: 2001-2005, 2006-2010 and 2011-2015. The data analysis included calculating proportions, their respective confidence intervals 95% and X² test for significance analysis was applied. Results: 17.4% of patients starting ART are women and the proportion has remained relatively constant. The highest proportion of new HIV cases are 30 and 39 years old, nevertheless the layer of 15-29 years demonstrates a significant increase from 21.7 to 36.4% in 2011-2015 especially in men. 12.1% of new cases are older than 50 years old with a stable trend over time; however, women over 50 have increased from 11.0 to 15.6%. Antiretroviral therapy initiation with CD4+ T lymphocytes less than 200 cells/mm³ has decreased from 79.7 to 42.4% and in stage C from 45.4 to 22.6%. Late presentation to antiretroviral therapy is higher in men but this gap has narrowed in the last five years. Pneumocystis jiroveci, wasting syndrome, tuberculosis, Kaposi’s sarcoma and esophageal candidiasis are the most common opportunistic diseases without significant changes in the three-year periods analyzed. In the last five years, 15.5% of opportunistic diseases occurs in patients with CD4+ TL > 200 cells/mm3. Discussion: Despite the limitations of observational studies present report describes the characteristics and evolution of the epidemics in Chile in the last 15 years. The infection occurs at younger ages in men, whereas in women there is an increase over 50 years old. Despite advances in treatment access have reduced late presentation to therapy, important challenges remain to achieve more timely initiation of antiretroviral therapy in accordance with WHO 90-90-90 goals.

Introducción: La Cohorte Chilena de SIDA es la más antigua y extensa de Latinoamérica y una de las más numerosas y con mayor tiempo de seguimiento a nivel internacional. Registra información de 14.873 pacientes de los aproximadamente 22.000 en TARV en el sistema público y sus resultados han permitido conocer la realidad nacional y han contribuido a la adopción de políticas públicas. El objetivo de este estudio es describir las características demográficas, clínicas e inmunológicas de los pacientes que han comenzado TARV en Chile y su evolución en los últimos 15 años. Pacientes y Métodos: Los casos fueron estratificados por quinquenios: 2001-2005, 2006-2010 y 2011-2015. El análisis de los datos incluyó el cálculo de proporciones, sus respectivos intervalos de confianza 95% y se aplicó test de X² para análisis de significación. Resultados: El 17,4% de los casos que inician TARV corresponde a mujeres y la proporción se ha mantenido relativamente constante. Por edad, destaca el grupo de adultos entre 30 y 39 años aunque el estrato de 15-29 años evidencia un importante aumento desde 21,7 a 36,4% en 2011-2015, especialmente en hombres. Un 12,1% del total de los inicios de TARV son mayores de 50 años con una tendencia estable en el tiempo; sin embargo, las mujeres mayores de 50 años han aumentado de 11,0 a 15,6%. El inicio de TARV con LT CD4 menor de 200 céls/mm³ ha disminuido desde 79,7 a 42,4% y en etapa C desde 45,4 a 22,6%. La presentación tardía a TARV es mayor en hombres pero esta diferencia se ha reducido en el último quinquenio. Neumonía por Pneumocystis jiroveci, síndrome consuntivo, tuberculosis, sarcoma de Kaposi y candidiasis esofágica son las enfermedades oportunistas más frecuentes sin cambios significativos en los tres quinquenios analizados. En el último quinquenio, 15,5% de las enfermedades oportunistas se presenta en pacientes con LT CD4 > 200 céls/mm³. Discusión: Pese a las limitaciones de los estudios observacionales el presente reporte describe las características y evolución de la epidemia en Chile en los últimos 15 años. La infección se presenta a edades más jóvenes en hombres, mientras que en mujeres hay un aumento en mayores de 50 años. Pese a los avances en acceso a tratamiento que han permitido reducir la presentación a tardía a terapia, aún persisten importantes desafíos para alcanzar un inicio de TARV más oportuno, en concordancia con las metas 90-90-90 de OMS.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/epidemiology , Antiretroviral Therapy, Highly Active/statistics & numerical data , Time Factors , Chile/epidemiology , Sex Factors , Cohort Studies , Age Factors , AIDS-Related Opportunistic Infections/epidemiology , Sex Distribution , Age Distribution , CD4 Lymphocyte Count
Rev. Soc. Bras. Med. Trop ; 49(3): 312-318, tab
Article in English | LILACS | ID: lil-785793


Abstract: INTRODUCTION: This study aimed to estimate the prevalence and risk factors associated with Chlamydia trachomatis (CT) infection among women with HIV in São Paulo. METHODS: This cross-sectional study included women with HIV who were receiving care from sixteen public health services in São Paulo (October 2013 to March 2014). All participants answered a questionnaire regarding their sociodemographic, behavioral, and clinical characteristics. A urine sample was tested for CT and Neisseria gonorrhoeae (NG) using the polymerase chain reaction. The chi-square test and a logistic regression model were used to test the associations with CT or NG infections. RESULTS: We evaluated 853 women and ultimately included 836 (98%) women. The mean age was 40.5 ± 0.34 years, and the prevalences of CT and NG infections were 1.8% and 0.5%, respectively. CT infection was associated with CD4+ T-cell counts of <350 cells/mm3 [adjusted odds ratio (ORadj): 24.5], age of 18-25 years (ORadj: 23.2), the non-use of condoms during the last 6 months (ORadj: 10.2), a self-reported history of a sexually transmitted infection (ORadj: 9.4), and having two or more sexual partners during the last year (ORadj: 6.1). CONCLUSIONS: Although we observed a low prevalence of CT infection among women with HIV, younger age was associated with a high risk of infection. Therefore, it may be appropriate to include screening for CT as part of the routine care for this population.

Humans , Female , Adolescent , Adult , Young Adult , Chlamydia Infections/diagnosis , Chlamydia trachomatis , AIDS-Related Opportunistic Infections/diagnosis , Socioeconomic Factors , Brazil/epidemiology , Chlamydia Infections/epidemiology , Prevalence , Cross-Sectional Studies , Risk Factors , AIDS-Related Opportunistic Infections/epidemiology , Middle Aged
Säo Paulo med. j ; 134(3): 187-192, tab
Article in English | LILACS | ID: lil-785811


CONTEXT AND OBJECTIVE: Kaposi's sarcoma (KS) is a common neoplastic disease in AIDS patients. The aim of this study was to evaluate the frequency of human herpesvirus 8 (HHV-8) infection in human immunodeficiency virus (HIV)-infected patients, with or without KS manifestations and correlate HHV-8 detection with KS staging. DESIGN AND SETTING: Analytic cross-sectional study conducted in a public tertiary-level university hospital in Ribeirão Preto, São Paulo, Brazil. METHODS: Antibodies against HHV-8 lytic-phase antigens were detected by means of the immunofluorescence assay. HHV-8 DNA was detected in the patient samples through a nested polymerase chain reaction (nested PCR) that amplified a region of open reading frame (ORF)-26 of HHV-8. RESULTS: Anti-HHV-8 antibodies were detected in 30% of non-KS patients and 100% of patients with KS. Furthermore, the HHV-8 DNA detection rates observed in HIV-positive patients with KS were 42.8% in serum, 95.4% in blood samples and 100% in skin biopsies; and in patients without KS, the detection rate was 4% in serum. Out of the 16 serum samples from patients with KS-AIDS who were classified as stage II, two were positive (12.5%); and out of the 33 samples from patients in stage IV, 19 (57.6%) were positive. CONCLUSION: We observed an association between HHV-8 detection and disease staging, which was higher in the serum of patients in stage IV. This suggests that detection of HHV-8 DNA in serum could be very useful for clinical assessment of patients with KS and for monitoring disease progression.

CONTEXTO E OBJETIVO: Sarcoma de Kaposi (SK) é uma doença neoplásica comum em pacientes com aids. O objetivo deste estudo foi avaliar a frequência da infecção por herpesvírus humano 8 (HHV-8) em pacientes infectados por HIV, com ou sem SK e associar a detecção do HHV-8 com o estadiamento do SK. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico realizado em hospital universitário público terciário de Ribeirão Preto, São Paulo, Brasil. MÉTODOS: Anticorpos contra antígenos de fase lítica do HHV-8 foram detectados por imunofluorescência. O DNA viral de HHV-8 foi detectado em amostras de pacientes pela reação em cadeia da polimerase do tipo nested (nested PCR), que amplificou uma região do fragmento de leitura aberta (ORF)-26 do HHV-8. RESULTADOS: Anticorpos anti-HHV-8 foram detectados em 30% dos pacientes sem SK e 100% dos com SK. Além disso, a detecção de HHV-8 DNA observada em pacientes HIV-positivos com SK foi de 42,8% no soro, 95,4% em amostras de sangue e 100% em biópsias de pele, e em pacientes sem SK foi de 4% no soro. Das 16 amostras de soro de pacientes com SK-AIDS classificados como estádio II, duas foram positivas (12,5%) e, das 33 amostras de pacientes no estádio IV, 19 (57,6%) foram positivas. CONCLUSÃO: Observamos associação entre a detecção do HHV-8 e o estadiamento da doença, que foi maior no soro de pacientes no estágio IV. Isso sugere que a detecção do HHV-8 no soro poderia ser muito útil para a avaliação clínica de pacientes com SK e para o monitoramento da progressão da doença.

Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , AIDS-Related Opportunistic Infections/virology , Herpesvirus 8, Human/isolation & purification , Sarcoma, Kaposi/blood , Skin Neoplasms/blood , Biopsy , Brazil/epidemiology , DNA, Viral/blood , Polymerase Chain Reaction , Prevalence , Cross-Sectional Studies , Reproducibility of Results , Fluorescent Antibody Technique , Acquired Immunodeficiency Syndrome/blood , Acquired Immunodeficiency Syndrome/epidemiology , HIV Seropositivity/virology , AIDS-Related Opportunistic Infections/pathology , AIDS-Related Opportunistic Infections/blood , AIDS-Related Opportunistic Infections/epidemiology , Disease Progression , Antibodies, Viral/blood , Neoplasm Staging
Rev. ADM ; 72(6): 299-305, nov.-dic. 2015. tab
Article in Spanish | LILACS | ID: lil-786687


El síndrome de inmunodeficiencia adquirida (SIDA) se caracteriza por una infección adquirida ocasionada por el virus de la inmunodeficiencia humana (VIH), que afecta a la población linfocitaria CD4+ y que predispone al paciente a un estado de inmunodefi ciencia que lo hace susceptible a infecciones oportunistas severas y/o neoplasias inusuales. La infección por el VIH es un problema grave de salud pública, ya que hay alrededor de 34 millones de personas infectadas según el Centro Nacional de Prevención de Enfermedades de Atlanta; de esta población seropositiva para VIH 68 por ciento vive en África Subsahariana. El VIH se transmite a través de la contaminación con sangre, semen, fluidos vaginales y leche materna. Muchos de los portadores de este virus son asintomáticos lo que complica la situación en virtud de que si no se toman las precauciones de bioseguridad adecuadas, esta situación representa un riesgo para el profesional de la salud oral. Los odontólogos deben brindar un tratamiento adecuado a este tipo de pacientes e identifi car oportunamente cualquier riesgo de infección y complicaciones asociadas

cquired immunodeficiency syndrome (AIDS) is characterized by a seemingly irreversible impairment acquired in CD4 + lymphocyte population that predisposes the host to severe opportunistic infections and/or neoplastic unusual. Infection produced by human immunode-fi ciency virus (HIV) is a serious public health problem, as there are about 34 million people infected reported by the National Center for Disease Prevention Atlanta, this 68% HIV-positive population lives in Sub-Saharan Africa. HIV is transmitted through blood contamination, semen, vaginal fl uids and breast milk. Many patients infected with this virus are asymptomatic complicating the situation under if appropriate biosecurity measures are not taken; this situation represents a risk for oral health professional. Dentists should provide adequate treatment to these patients and promptly identify any risk of infection and as-sociated complications.

Humans , Male , Female , Child , Dental Care for Chronically Ill/methods , Dental Care for Children/methods , Mouth Diseases/etiology , HIV Infections/complications , Oral Manifestations , Antibiotic Prophylaxis , Comprehensive Dental Care , Infection Control, Dental/standards , Periodontal Diseases/etiology , AIDS-Related Opportunistic Infections/epidemiology , AIDS-Related Opportunistic Infections/therapy , Tooth Diseases/etiology
Rev. Soc. Bras. Med. Trop ; 48(2): 149-156, mar-apr/2015. tab
Article in English | LILACS | ID: lil-746232


INTRODUCTION : In this study, clinical-laboratory and epidemiological characteristics are described for a group of 700 individuals with HIV (human immunodeficiency virus)/AIDS (acquired immunodeficiency syndrome) in the ART (antiretroviral therapy) era at a teaching hospital that provides a quaternary level of care, with an emphasis on opportunistic infections (OIs), co-infections and immune profile. METHODS : A retrospective cross-sectional study of AIDS cases was conducted from 1998 to 2008 by reviewing medical records from the Base Hospital/FUNFARME (Fundação Faculdade Regional de Medicina), São José do Rio Preto, São Paulo, Brazil. RESULTS: The individuals were 14 to 75 years of age, and 458 were males. Heterosexuals accounted for 31.1% of all patients. Eighty-three percent were on ART, and 33.8% of those presented difficulties with treatment adherence. OIs were analyzed from medical records, and Pneumocystis jiroveci pneumonia was the most prevalent, regardless of the LTCD4+ (TCD4+ Lymphocytes) levels. Individuals whose viral loads were ≥10,000 showed a 90% greater chance of neurotoxoplasmosis. For P. jiroveci pneumonia, neurotoxoplasmosis, esophageal candidiasis, pulmonary tuberculosis and neurocryptococcosis, the chances of infection were higher among patients with LTCD4+ levels below 200 cells/mm3. HIV/hepatitis C virus (HCV) and HIV/hepatitis B virus (HBV) co-infections were significantly associated with death. CONCLUSIONS : OIs remain frequent in the ART era even in populations where the access to medical care is considered satisfactory. .

Adult , Female , Humans , Male , Middle Aged , Young Adult , AIDS-Related Opportunistic Infections/epidemiology , Antiretroviral Therapy, Highly Active , HIV-1 , Brazil/epidemiology , Cross-Sectional Studies , Hospitals, Teaching , Prevalence , Retrospective Studies , Viral Load
Arch. endocrinol. metab. (Online) ; 59(1): 34-41, 02/2015. tab
Article in English | LILACS | ID: lil-746440


Objective To investigate risk factors associated with hypovitaminosis D in adult patients infected with HIV/aids, at a referral hospital in Maceió, Brazil. Subjects and methods This cross-sectional study involved 125 patients evaluated from April to September 2013 by means of interviews, review of medical records, physical examination, and laboratory tests. The data were analyzed using the SPSS® software, version 17.0; the prevalence of hypovitaminosis D and mean levels of vitamin D were determined. The association between hypovitaminosis D and the independent variables was assessed using the Chi-square or the Fisher’s exact tests; mean vitamin D concentrations were analyzed using Kolmogorov-Smirnov, Mann-Whitney, and Kruskal-Wallis tests. The level of significance was set at 5% across tests. Results The prevalence of hypovitaminosis D was 24%, with a significant association with higher household income (p < 0.05). Higher vitamin D levels were associated with female gender (p < 0.001), no use of sunscreen (p < 0.05), and previous opportunistic infections (p < 0.01). Lower values were associated with the use of antiretroviral medication (p < 0.05), overweight and obesity (p < 0.01). Conclusion Lower vitamin D concentrations were significantly associated with well-known risk factors for hypovitaminosis D: use of sunscreen, antiretroviral medication, overweight, and obesity. The prevalence of hypovitaminosis D in this study, considering values > 20 ng/mL or > 30 ng/mL as vitamin D sufficiency, was lower to that of previous studies with HIV-infected patients, a fact that might be related to the low latitude and high intensity of solar radiation of the location of the present study. .

Objetivo Investigar fatores de risco associados à hipovitaminose D em pacientes adultos infectados por HIV/aids, num centro de referência em Maceió-AL. Sujeitos e métodos Por meio de desenho transversal, 125 pacientes foram avaliados por entrevista, revisão de prontuário, exame físico e laboratorial, no período de abril a setembro de 2013. Os dados foram analisados por meio do software SPSS®, versão 17.0, sendo determinados a prevalência de hipovitaminose D e os níveis médios de vitamina D. Para avaliação da associação entre hipovitaminose D e as variáveis pesquisadas, foram utilizados o teste Qui-quadrado ou o teste exato de Fisher, enquanto para os níveis médios de vitamina D foram utilizados os testes Kolmogorov-Smirnov, Mann-Whitney e Kruskal-Wallis. O nível de significância foi de 5% para todos os testes. Resultados Foi observada prevalência de hipovitaminose D de 24% com associação significativa com maior renda familiar (p < 0,05); níveis de vitamina D mais altos nas mulheres (p < 0,001), em pacientes que não faziam uso de filtro solar (p < 0,05) e naqueles com infecções oportunistas pregressas (p < 0,01). Valores mais baixos foram associados ao uso de antirretrovirais (p < 0,05), sobrepeso e obesidade (p < 0,01). Conclusão Níveis mais baixos de vitamina D estiveram significativamente associados com tradicionais fatores de risco para hipovitaminose D como uso de filtro solar e antirretrovirais, sobrepeso e obesidade. A prevalência de hipovitaminose encontrada, considerando suficiência de vitamina D tanto para valores acima de 20 ng/mL quanto de 30 ng/mL, foi inferior a estudos anteriores em pacientes infectados pelo HIV, fato que pode estar relacionado às características da localidade do estudo, com baixa latitude e elevada incidência solar. .

Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , AIDS-Related Opportunistic Infections/epidemiology , Acquired Immunodeficiency Syndrome/complications , Vitamin D Deficiency/etiology , Vitamin D/blood , Acquired Immunodeficiency Syndrome/epidemiology , Brazil/epidemiology , Cross-Sectional Studies , Prevalence , Risk Factors , Referral and Consultation/statistics & numerical data , Sex Factors , Socioeconomic Factors , Sunscreening Agents/administration & dosage , Vitamin D Deficiency/epidemiology , Vitamin D Deficiency/virology
Braz. j. infect. dis ; 19(1): 23-29, Jan-Feb/2015. tab, graf
Article in English | LILACS | ID: lil-741228


Objective: To evaluate the occurrence, clinical presentations and diagnostic methods for tuberculosis in a cohort of HIV-infected infants, children and adolescents from Latin America. Methods: A retrospective analysis of children with tuberculosis and HIV was performed within a prospective observational cohort study conducted at multiple clinical sites in Latin America. Results: Of 1114 HIV-infected infants, children, and adolescents followed from 2002 to 2011, 69 that could be classified as having confirmed or presumed tuberculosis were included in this case series; 52.2% (95% CI: 39.8-64.4%) had laboratory-confirmed tuberculosis, 15.9% (95% CI: 8.2-26.7%) had clinically confirmed disease and 31.9% (95% CI: 21.2-44.2%) had presumed tuberculosis. Sixty-six were perinatally HIV-infected. Thirty-two (61.5%) children had a history of contact with an adult tuberculosis case; however information on exposure to active tuberculosis was missing for 17 participants. At the time of tuberculosis diagnosis, 39 were receiving antiretroviral therapy. Sixteen of these cases may have represented immune reconstitution inflammatory syndrome. Conclusions: Our study emphasizes the need for adequate contact tracing of adult tuberculosis cases and screening for HIV or tuberculosis in Latin American children diagnosed with either condition. Preventive strategies in tuberculosis-exposed, HIV-infected children should be optimized. .

Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Young Adult , AIDS-Related Opportunistic Infections/epidemiology , Tuberculosis, Pulmonary/epidemiology , AIDS-Related Opportunistic Infections/diagnosis , Latin America/epidemiology , Prospective Studies , Retrospective Studies , Risk Factors , Tuberculosis, Pulmonary/diagnosis
Rev. chil. infectol ; 32(supl.1): 44-56, feb. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-742525


In this article, the following topics about pediatric HIV infection and AIDS are summarized: a description of pathogenic and clinical aspects of HIV infection in children, the clues for its suspicion, the preventive strategies to avoid the vertical transmission of HIV, the study to certify or to rule out the HIV infection in infants and children, the main recommendations of antiretroviral treatment and how to prevent and treat manifestations of HIV infection. Besides, the evolution in Chile of the pediatric HIV infection is described with details, since the first child detected with AIDS in 1987, infected by transfusion and the first infants (twin) diagnosed in 1989, infected by vertical twins transmission, to 2014, with the progress obtained, snags, hopes and challenges addressed.

En este artículo se describe en forma resumida la patogénesis y aspectos clínicos de la infección por VIH en niños, las claves para su sospecha, las medidas preventivas para evitar su transmisión vertical, el estudio necesario para certificar o descartar la infección en lactantes y niños mayores, y las principales recomendaciones para la terapia anti-retroviral y cómo tratar y prevenir las manifestaciones de la infección por VIH. Se relata a continuación, en forma detallada, la evolución que ha experimentado en Chile la infección por VIH en pediatría, desde el primer caso pesquisado en el año 1987, producto de una transfusión sanguínea, y los primeros lactantes (mellizos) detectados en 1989, que fueran infectados en forma vertical, hasta el año 2014, con el progreso obtenido, las trabas, esperanzas y desafíos enfrentados.

Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Pregnancy , AIDS-Related Opportunistic Infections/epidemiology , HIV Infections/epidemiology , Infectious Disease Transmission, Vertical/prevention & control , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/epidemiology , Anti-Retroviral Agents/therapeutic use , Chile/epidemiology , Disease Progression , HIV , HIV Infections/drug therapy , HIV Infections/transmission , Infectious Disease Transmission, Vertical/legislation & jurisprudence