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1.
Rev. Méd. Clín. Condes ; 31(3/4): 317-329, mayo.-ago. 2020. tab
Article in Spanish | LILACS | ID: biblio-1223762

ABSTRACT

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


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


Subject(s)
Humans , Infant, Newborn , Child , Adult , Vaccines/administration & dosage , Communicable Disease Control/methods , Acquired Immunodeficiency Syndrome/complications , Vaccination , Vaccines/immunology , HIV Infections/complications , Acquired Immunodeficiency Syndrome/immunology , Immunosuppression , Immunization/methods , AIDS-Related Opportunistic Infections/prevention & control , Antiretroviral Therapy, Highly Active
2.
Rev. epidemiol. controle infecç ; 10(2): 135-139, abr.-jun. 2020. ilus
Article in English | LILACS | ID: biblio-1223597

ABSTRACT

Background and objectives: Acquired Immunodeficiency Syndrome (AIDS) is a disease caused by HIV. 3% of the people living with HIV/AIDS in Brazil are 60 years old or over. Although older adults correspond to a small percentage, there has been a significant increase in the incidence in this group in recent years. Thus, HIV infection in older adults is a reality, however, literature hardly addresses this topic. The objective is to study the epidemiological clinical profile of older adults living with HIV monitored at a referral center. Methods:This is an observational, descriptive, cross-sectional study with data collection obtained from the medical records of the STI/AIDS outpatient clinic at a reference center. The data were sociodemographic, clinical and laboratory, collected from September 2018 to February 2019. Results:In the reference center, 309 older adults were registered, representing 6.7% of all patients registered in the service. Of these, 75.6% are men, 38% are married, 70% heterosexual and approximately 50% with low education. Comorbidities are associated, with dyslipidemia (54%) being the main one. At the time of diagnosis, 65.8% had detectable viral load and 62% had CD4 + cells <500 cls/mm³ and after therapeutic follow-up, only 20% had detectable viral load. Several therapeutic regimens are used, the main one being Tenofovir, Lamivudine and Efavirenz (35.3%). Conclusion: The epidemiological profile of the population served in the region follows national and global characteristics, with a predominance of men, heterosexuals, married and with low education.(AU)


Justificativa e Objetivos: A Síndrome da Imunodeficiência Adquirida (SIDA) é uma doença causada pelo HIV. Das pessoas vivendo com HIV(PVHIV)no Brasil, 3% apresentam 60 anos ou mais. Apesar dos idosos corresponderem a um pequeno percentual, há aumento significativo da incidência nesse grupo nos últimos anos. Dessa forma, a infecção pelo HIV em idosos é uma realidade, contudo, a literatura pouco aborda esse tema. O objetivo do trabalho é estudar o perfil clínico epidemiológico dos idosos vivendo com HIV acompanhados em um centro de referência. Métodos: Trata-se de um estudo observacional, descritivo, de corte transversal, com coleta de dados obtida através dos prontuários do ambulatório de IST/SIDA de um centro de referência. Os dados sociodemográficos, clínicos e laboratoriais, foram coletados no período setembro de 2018 a fevereiro de 2019. Resultados: No centro de referência, estão cadastrados 309 idosos, representando 6,7% de todos os pacientes matriculados no serviço. Destes, 75,6% são homens, 38% casados, 70% de orientação heterossexual e aproximadamente 50% com baixa escolaridade. Comorbidades estão associadas, sendo a dislipidemia (54%) a principal. No momento do diagnóstico, 65,8% apresentavam carga viral (CV) detectável,62% tinham células CD4+ < 500céls/mm³ e após seguimento terapêutico apenas 20% apresentavam CV detectável. Vários esquemas terapêuticos foram utilizados, sendo o principal Tenofovir, Lamivudina e Efavirenz (35,3%). Conclusão: O perfil epidemiológico da população atendida na região segue as características nacionais e mundiais, com predomínio de homens, heterossexuais, casados e de baixa escolaridade.(AU)


Justificación y Objetivos: El Síndrome de Inmunodeficiencia Adquirido(SIDA) es una enfermedad causada por el VIH. De las personas que viven con el VIH (PVVIH) en Brasil, el 3% tiene 60 años o más. Aunque los adultos mayor es corresponden a un pequeño porcentaje, en los últimos años se ha producido un aumento significativo de la incidencia en este grupo. La infección por VIH en los adultos mayores es una realidad; sin embargo, la literatura aborda poco este tema. El objetivo de este trabajo es estudiar el perfil clínico epidemiológico de adultos mayores que conviven con el VIH y se atienden en un centro de referencia. Métodos: Se trata de un estudio observacional, descriptivo, de corte transversal, con datos obtenidos de los registros de ETS/SIDA de un centro de referencia. Se recogieron datos sociodemográficos, clínicos y de laboratorio desde septiembre de 2018 hasta febrero de 2019. Resultados: En el centro de referencia están registrados309 adultos mayores, que representan el 6,7% de todos los pacientes inscriptos en el servicio. De ellos, el 75,6% es del sexo masculino, el 38%, casado, el 70% con orientación heterosexual y aproximadamente el 50% con baja escolaridad. De las comorbilidades asociadas, la dislipidemia esla principal (54%). En el momento del diagnóstico, el 65,8% tenía una carga viral detectable (CV), el 62%tenía células CD4+<500 células/mm³ y después del seguimiento terapéutico sólo el 20% tenía CV detectable. Se utilizaron varios esquemas terapéuticos, siendo los principales el Tenofovir, la Lamivudina y el Efavirenz (35,3%). Conclusión: El perfil epidemiológico de la población atendida en la región sigue las características nacionales e internacionales, con predominio de hombres heterosexuales, casados y de baja escolaridad.(AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , HIV Infections/epidemiology , CD4-Positive T-Lymphocytes , HIV Infections/immunology , HIV Infections/drug therapy , Cross-Sectional Studies , Acquired Immunodeficiency Syndrome/immunology , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/epidemiology , HIV/immunology , Marital Status , CD4 Lymphocyte Count , Viral Load , Sexuality , Educational Status , Health Services for the Aged
3.
Prensa méd. argent ; 106(3): 145-149, 20200000. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1368818

ABSTRACT

La coinfección entre el Treponema pallidum y el virus de la inmunodeiciencia humana (VIH) altera el curso clínico clásico de la sífilis aumentando la probabilidad de aparición de formas atípicas del secundarismo sifilítico. Entre estas formas se ha descripto a la sífilis elegante, entidad caracterizada por un exantema maculopapuloso descamativo, de aspecto anular, por lo general, con indemnidad de las regiones palmo plantar y de las mucosas. Se presenta un caso de sífilis secundaria, con lesiones típicas por su aspecto y localización, de sifílides elegantes en una paciente con diagnóstico de sida


Co-infection between Treponema pallidum and HIV alters the classic clinical course of syphilis, increasing the likelihood of atypical forms of syphilitic secondaryism. Among these forms, elegant syphilis has been described, an entity characterized by a desquamating maculopapular rash of annular appearance, with indemnity of the palmoplantar surface and mucous regions. Here, we present a case of secondary syphilis with typical lesions of elegant syphillides, in a patient diagnosed with AIDS


Subject(s)
Humans , Female , Adolescent , Syphilis, Cutaneous/diagnosis , Treponema pallidum , HIV Infections/immunology , Acquired Immunodeficiency Syndrome/immunology
4.
Rev. latinoam. enferm. (Online) ; 27: e3155, 2019. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1014201

ABSTRACT

Objetivo: avaliar a dor em pessoas que vivem com o vírus da imunodeficiência humana/síndrome da imunodeficiência adquirida e relacionar com fatores sociodemográficos, clínicos, sintomas depressivos e qualidade de vida relacionada à saúde. Método: estudo descritivo, analítico, observacional, de corte transversal e de caráter quantitativo. Participaram trezentas e duas (302) pessoas de um serviço de atendimento especializado. Foram utilizados instrumentos para avaliação de dados sociodemográficos, clínicos, sintomas depressivos e qualidade de vida relacionada à saúde. Empregou-se análise descritiva, bivariada e regressão logística múltipla. Resultados: foram encontrados 59,27% de presença de dor de intensidade leve, recorrente na cabeça, com interferência no humor, a maioria do sexo feminino e em indivíduos sem/baixa escolaridade. As mulheres apresentaram maior probabilidade de ter dores moderadas ou severas. Pessoas de 49 a 59 anos apresentaram maior intensidade de dor do que as de 18 a 29 anos. Sintomas depressivos e dor são variáveis diretamente proporcionais. Quanto maior o nível da qualidade de vida relacionada à saúde e escolaridade, menor a possibilidade da presença de dor. Conclusão: a presença de dor encontrada é preocupante e possui associação com o sexo feminino, sem/baixa escolaridade, pior nível da qualidade de vida relacionada à saúde e presença de sintomas depressivos.


Objective: to evaluate pain in people living with human immunodeficiency virus/acquired immunodeficiency syndrome and to relate it to sociodemographic and clinical factors, depressive symptoms and health-related quality of life. Method: descriptive, analytical, observational, cross-sectional and quantitative study. Three hundred and two (302) people assisted at a specialized care service participated in the study. Instruments were used to evaluate sociodemographic and clinical data, depressive symptoms, and health-related quality of life. Descriptive, bivariate analysis and multiple logistic regression were used. Results: the incidence of pain of mild intensity was 59.27%, recurrent in the head, with interference in mood, mostly affecting females and individuals with no schooling/low schooling. Women were more likely to have moderate or severe pain. People aged 49 to 59 years had greater pain intensity than people aged 18 to 29 years. The variables depressive symptoms and pain were directly proportional. The higher the health-related quality of life and schooling, the lower was the possibility of presence of pain. Conclusion: presence of pain is of concern and has association with female sex, lack of schooling/low schooling, worse level of health-related quality of life and presence of depressive symptoms.


Objetivos: evaluar el dolor en las personas que viven con el virus de la inmunodeficiencia humana/síndrome de inmunodeficiencia adquirida y relacionarse con factores sociodemográficos, clínicos, síntomas depresivos y calidad de vida relacionada con la salud. Método: estudio descriptivo, analítico, observacional, de corte transversal y de carácter cuantitativo. Participaron trescientos y dos (302) personas de un servicio de atención especializado. Se utilizaron instrumentos para la evaluación de datos sociodemográficos, clínicos, síntomas depresivos y calidad de vida relacionada con la salud. Se empleó el análisis descriptivo, bivariada y regresión logística múltiple. Resultados: se encontró un 59,27% de presencia de dolor de intensidad leve, recurrente en la cabeza, con interferencia en el humor, la mayoría del sexo femenino y en individuos sin/baja escolaridad. Las mujeres presentaron una mayor probabilidad de sufrir dolores moderados o severos. Las personas de 49 a 59 años presentaron mayor intensidad de dolor que las de 18 a 29 años. Los síntomas depresivos y dolor son variables directamente proporcionales. Cuanto mayor es el nivel de la calidad de vida relacionada con la salud y la escolaridad, menor es la posibilidad de la presencia de dolor. Conclusión: la presencia de dolor encontrado es preocupante y tiene asociación con el sexo femenino, sin/baja escolaridad, peor nivel de la calidad de vida relacionada a la salud y la presencia de síntomas depresivos.


Subject(s)
Humans , Pain/classification , Quality of Life/psychology , Pain Measurement/classification , Depression/psychology , Acquired Immunodeficiency Syndrome/immunology , HIV
5.
Braz. j. infect. dis ; 22(3): 245-247, May-June 2018. tab, graf
Article in English | LILACS | ID: biblio-1039214

ABSTRACT

ABSTRACT Early initiation of antiretroviral therapy increases the likelihood of effective immune restoration, quality of life, and greater life expectancy for HIV-infected individuals. We evaluated the evolution of mean CD4+ cells count at diagnosis of HIV/AIDS in Salvador, Brazil from 2002 to 2015. We identified HIV/AIDS patients older than 18 years with diagnosis of HIV infection from 2002 to 2015, who had their first laboratory evaluation at Complexo Hospitalar Prof. Edgard Santos, Federal University of Bahia. Initial mean CD4+ cells count and age, over time were evaluated. A total of 1801 patients randomly selected individuals were included in the analysis. Overall mean CD4+ count at diagnosis in the whole period was 279 ± 265, varying from 191 in 2015 to 334 in 2011. There was no improvement in the immunological status at diagnosis from 2002 to 2015. In addition, a higher frequency of CD4+ cells count < 200 cells/mL in the last two years was observed. This suggests that the adopted strategies for early diagnosis of HIV/AIDS in Salvador, Brazil, are still ineffective.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Acquired Immunodeficiency Syndrome/immunology , CD4 Lymphocyte Count/statistics & numerical data , Reference Values , Time Factors , Brazil/epidemiology , Acquired Immunodeficiency Syndrome/drug therapy , Antiretroviral Therapy, Highly Active , Early Diagnosis
6.
Rev. panam. salud pública ; 42: e14, 2018. tab
Article in English | LILACS | ID: biblio-961744

ABSTRACT

ABSTRACT Objective To identify the characteristics of clients at an HIV clinic in Mexico City who fail to collect their HIV test results and to explore the reasons for non-collection. Methods This was an exploratory, cross-sectional study that used 2016 program data from the HIV Testing and Counseling Center in Mexico City. Clients with a negative HIV-test result in 2016 were classified as collectors or non-collectors, and their sociodemographic and behavioral characteristics were compared by multivariate logistic regression. A telephone survey was conducted with individuals who failed to return for their results. Results In 2016, a total of 729 individuals obtained an HIV negative test result at the Center. Of these, 40% (n = 299) failed to collect results. In multivariate analysis, having a test requested by a physician, instead of by the individual, was the main variable associated with non-collection. The main reasons reported for not collecting were: unawareness of the collection process (23.6%, n = 21), already knowing the result (22.5%, n = 20), and scheduling difficulties (13.5%, n = 12). In all, 35% of clients were reached by telephone and 50% then returned to collect results. Conclusion Modifications to the result-delivery system are needed to increase results collection. Improving communication with clients on the collection process and with physicians that request HIV testing could be viable strategies. Alternative ways of delivering results and using rapid HIV are other possible solutions, as long as risk reduction counseling and intervention are still effectively offered.


RESUMEN Objetivo Determinar las características de las personan que acuden a un consultorio de atención de la infección por el VIH en Ciudad de México y no regresan a retirar los resultados de las pruebas de detección del VIH, y explorar las razones de este comportamiento. Métodos Este fue un estudio exploratorio y transversal que usó datos del programa correspondientes al 2016 de un centro de pruebas de detección del VIH y asesoramiento conexo en Ciudad de México. Se clasificó a las personas con resultado negativo en la prueba de detección del VIH en dos grupos, las que "retiraron los resultados" y las que "no retiraron los resultados"; sus características sociodemográficas y conductuales fueron comparadas mediante regresión logística multifactorial. Se realizó una encuesta telefónica a las personas que no regresaron a buscar sus resultados. Resultados En el 2016, 729 personas tuvieron un resultado negativo en la prueba de detección del VIH en el centro. De ellas, 40% (n = 299) no acudieron a retirar los resultados. En el análisis multifactorial, la variable principal asociada con el hecho de no acudir a buscar los resultados fue que la prueba hubiera sido solicitada por un médico, en vez de que la persona hubiera acudido por sí misma a realizársela. Las principales razones informadas para no presentarse a buscar los resultados fueron: desconocimiento de que debían ir a buscarlos (23,6%, n = 21), conocimiento previo del resultado (22,5%, n = 20) y problemas de horarios (13,5%, n = 12). En total, se logró contactar por teléfono a 35% de las personas y 50% luego acudieron a retirar los resultados. Conclusiones Es necesario modificar el sistema de entrega de resultados para aumentar el número de personas que acuden a retirarlos. Algunas estrategias viables podrían ser mejorar la comunicación sobre el mecanismo de entrega de resultados con los pacientes y los médicos que solicitan las pruebas de detección del VIH. Otras soluciones posibles podrían ser mecanismos alternativos para informar los resultados o realización de pruebas rápidas de detección del VIH, siempre que se siga ofreciendo asesoramiento sobre la reducción de riesgos e intervenciones eficaces.


RESUMO Objetivo Identificar as características dos pacientes de um serviço ambulatorial especializado em HIV na cidade do México que não voltam para buscar os resultados do teste do HIV e examinar os motivos para não voltarem para buscar os resultados. Métodos Estudo exploratório transversal realizado com dados de 2016 obtidos em um centro de testagem e aconselhamento de HIV na cidade do México. Os pacientes com resultados negativos no teste de HIV em 2016 foram divididos entre dois grupos: os que voltaram para buscar os resultados e os que não voltaram para buscar os resultados. As características sociodemográficas e de comportamento destes pacientes foram comparadas em um modelo de regressão logística multivariada. Uma pesquisa por telefone foi realizada com os que não voltaram para buscar os resultados do teste. Resultados Ao todo, em 2016, 729 pacientes tiveram resultados negativos no teste de HIV no serviço ambulatorial. Destes, 40% (n = 299) não voltaram para buscar os resultados. Na análise multivariada, ter o teste solicitado por um médico, em vez de pelo próprio indivíduo, foi a principal variável associada a não voltar para buscar os resultados. Os principais motivos informados para não voltar para buscar os resultados foram: desconhecimento do procedimento para buscar os resultados (23,6%, n = 21), saber previamente o resultado (22,5%, n = 20) e dificuldade para marcar um horário (13,5%, n = 12). Ao todo, 35% dos pacientes foram localizados por telefone e 50% voltaram para buscar os resultados. Conclusões É preciso modificar o sistema de informe dos resultados para aumentar o número de pacientes que voltam para buscá-los. Melhorar a comunicação com os pacientes sobre o processo de informe dos resultados e com os médicos que solicitam o teste de HIV poderia ser uma estratégia viável. Maneiras alternativas de informar os resultados e o uso do teste rápido de HIV são outras soluções possíveis, contanto que se continue a oferecer aconselhamento para redução dos riscos e intervenção.


Subject(s)
Humans , Acquired Immunodeficiency Syndrome/immunology , HIV , Disease Prevention , Mexico
7.
J. pediatr. (Rio J.) ; 93(5): 532-537, Sept.-Oct. 2017. tab
Article in English | LILACS | ID: biblio-894054

ABSTRACT

Abstract Objective: HIV-infected individuals (HIVI) are threatened by meningococcal infection and presented lower response to vaccines. Data are scarce on long-term persistence of human serum bactericidal antibody (hSBA) after a meningococcal C conjugate (MCC) vaccine in HIVI youth; the authors aimed to describe this persistence in HIVI. Methods: HIVI and HIV uninfected individuals (HIVU), aged 2-18 years, CD4 >15% were recruited. Seroprotection (hSBA ≥1:4) at baseline and at 12-18 months after immunization was evaluated and the association of the different factors with the long-term persistence was calculated using logistic regression. Results: A total of 145 HIVI, 50 HIVU were recruited and immunized, and their median age was 11 years (median age in HIVI group was 12 years, and 10 years in HIVU group, p-value = 0.02). 85 HIVI (44%) had undetectable viral load (UVL). Seroprotection rate was 27.2%: 24.1% in HIVI and 36% in HIVU 12-18 months after immunization (p = 0.14). Baseline immunity (odds ratio [OR] = 70.70, 95% CI: 65.2-766.6); UVL at entry (OR: 2.87, 95% CI: 0.96-8.62) and lower family income (OR: 0.09, 95% CI: 0.01-0.69) were associated with seroprotection among HIVI. Conclusion: Seroprotection at 12-18 months after single dose of MCC was low for both groups, and higher among individuals who presented baseline immunity. Among HIVI, vaccine should be administered after UVL is achieved.


Resumo Objetivo: As pessoas infectadas pelo HIV (HIVI) estão sujeitas a infecção meningocócica e apresentam menor resposta a vacinas. São escassos os dados a respeito da persistência de longo prazo do anticorpo bactericida no soro humano (hSBA) após vacina conjugada meningocócica C (MCC) em HIVI jovens e visamos a descrever essa persistência em HIVI. Métodos: Foram recrutadas pessoas HIVI e pessoas não infectadas por HIV (HIVU), entre 2 e 18 anos, CD4 > 15%. A seroproteção (hSBA ≥ 1:4) basal aos 12-18 meses após a imunização foi avaliada e a associação dos diferentes fatores com a persistência de longo prazo foi calculada com a regressão logística. Resultados: Foram recrutados 145 HIVI e 50 HIVU e imunizados e sua idade média foi determinada em 11 anos (12 no grupo HIVI e 10 no grupo HIVU, valor de p = 0,02); 85 HIVI (44%) apresentaram carga viral indetectável (CVI). A taxa de seroproteção foi 27,2%: 24,1% no grupo HIVI e 36% no grupo HIVU 12-18 meses após imunização (p = 0,14). A imunidade basal [razão de chance (RC) = 7070, IC: 65,2-7666]; CVI no momento da participação (RC: 2,87, IC de 95%: 0,96-8,62) e renda familiar mais baixa (RC: 0,09, IC de 95%: 0,01-0,69) foram associadas a seroproteção entre as pessoas HIVI. Conclusão: A seroproteção aos 12-18 meses após única dose de MCC mostrou-se baixa em ambos os grupos e mais elevada entre as pessoas que apresentaram imunidade basal. Entre as pessoas HIVI, as vacinas devem ser administradas após a CVI ser atingida.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Acquired Immunodeficiency Syndrome/immunology , Meningococcal Vaccines/immunology , Meningococcal Infections/prevention & control , Antibodies, Bacterial/immunology , Time Factors , Case-Control Studies , Meningococcal Vaccines/administration & dosage , Antibodies, Bacterial/blood
8.
Prensa méd. argent ; 103(7): 389-393, 20170000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1372348

ABSTRACT

La trombosis auricular masiva impide el pasaje de la sangre a través del orificio mitral Un paciente de 39 años de edad, HIV positivo, con diagnóstico previo de criptococosis meníngea cumplía tratamiento antifúngico con fluconazol por vía oral, consulta por mialgias y dolor cervical. Fallece repentinamente 24 horas después de su internación. La necropsia determinó la presencia de una trombosis biauricular masiva. La criptococosis meníngea es una infección oportunista que se presenta en pacientes HIV positivos con inmunodeficiencia avanzada. Clínicamente se manifiesta por un síndrome meníngeo, por lo general incompleto, o sólo con persistencia de fiebre y cefalea, sin signos meníngeos. La letalidad de la criptococosis meníngea es elevada. La causa del fallecimiento obedece a una enfermedad no relacionada con el sida


Massive atrial thrombosis prevents passage of blood through the mitral orifice. A 39-year-old HIV-positive patient with previous diagnosis of meningeal cryptococcosis and receiving antifungal treatment with oral fluconazole, consults for myalgias and neck pain and dies suddenly 24 hours after admission. Necropsy determined the presence of massive biauricular thrombosis. Meningeal cryptococcosis is an opportunistic infection that occurs in HIV-positive patients with severe immunodeficiency. Clinically it is manifested by an incomplete meningeal syndrome, or only with persistence of fever and headache, without meningeal signs. The lethality of meningeal cryptococcosis is high. The cause of the death is due to a disease not related to AIDS


Subject(s)
Humans , Male , Adult , Autopsy , Thrombosis/complications , Acquired Immunodeficiency Syndrome/immunology , Meningitis, Cryptococcal/complications , Meningitis, Cryptococcal/mortality , AIDS-Related Opportunistic Infections/complications
9.
Acta méd. costarric ; 59(1): 7-14, ene.-mar. 2017. tab
Article in Spanish | LILACS | ID: biblio-837715

ABSTRACT

ResumenJustificación y objetivo: el virus de inmunodeficiencia humana induce una activación inmune crónica que lleva a la progresión de la enfermedad por VIH. Estudios en primates han demostrado que el desarrollo de una infección retroviral patológica está determinada tanto por la respuesta del sistema inmunitario al virus, como por sus propiedades citopáticas. Esta revisión pretende resumir los conocimientos actuales acerca de los principales mecanismos envueltos en la activación inmune crónica durante la infección por VIH y sus repercusiones en la inmunidad virus-específica.Metodología: las referencias bibliográficas se obtuvieron en la base de datos PubMed. Se incluyeron todos los artículos publicados en lengua inglesa entre 1990 y 2016, hallados bajo las palabras clave "immunopathology and hiv" e "immune activation and hiv".Revisión:se discute la influencia de la inflamación persistente sobre el establecimiento de la enfermedad por VIH y la generación de condiciones patológicas no relacionadas con la infección. Tratamientos dirigidos a modular la inflamación podrían retardar el progreso de la enfermedad y reducir los daños colaterales de la estimulación inmunológica inducida por VIH.Conclusión: la evidencia parece indicar que la activación inmune crónica es la principal causa de la depleción de células T CD4+, la pérdida de inmunidad específica contra el virus y el establecimiento de enfermedades no relacionadas directamente con la infección viral en pacientes que reciben terapia antiretroviral.


AbstractBackground and purpose: The human immunodeficiency virus (HIV) induces chronic immune activation that leads to the worsening of HIV infection. Studies in primates have shown the development of pathological retroviral infection by immune system's response against the virus and its cytopathic properties. This review summarizes current facts about the main mechanisms of HIV chronic immune activation and its virus-related impairment on immunity.Methods: The references were obtained in the PubMed database, under the keywords: "immunopathology and HIV" and "immune activation and HIV". Also, all papers reviewed are in English and were published between 1990 and 2016.Review: Discussion of the persistent inflammation that establish the development of HIV disease and pathological conditions not directly related to HIV infection. Therefore, the treatments aimed to modulate inflammation could slow the disease progression and minimize collateral damage from HIV immune stimulation.Conclusion: Evidence suggests that chronic immune activation is the major cause of CD4+ T-cell depletion, loss of virus-specific immunity and the establishment of diseases not directly related to viral infection in patients on antiretroviral treatment.


Subject(s)
Humans , Acquired Immunodeficiency Syndrome/immunology , HIV
10.
Recife; s.n; 2016. 165 p. ilus, tab, graf.
Thesis in Portuguese | LILACS | ID: biblio-870283

ABSTRACT

A tese tem por objetivo identificar diferentes padrões: resposta imunológica através das trajetórias da carga viral, CD4 e os regimes de tratamento com antirretrovirais e verificar associação com o desenvolvimento de lipodistrofia (LD). Estudou-se uma coorte prospectiva de 912 pacientes, durante cinco anos, com mensurações repetidas de CD4 e carga viral. Utilizou-se análise de equações estruturais com uso de classes latentes para identificar o modelo com o melhor número de trajetórias de CD4, carga viral, regime tratamento e drogas antirretrovirais com base em parâmetros estatísticos, e a associação dessas trajetórias com o desenvolvimento de LD por meio de regressão logística. A prevalência da LD na primeira reavaliação foi 40,6%, chegando a 77,6%. As trajetórias déficit imunológico temporário, déficit imunológico mantido e carga viral alta mostraram associação com o desenvolvimento de LD na análise univariada; depois de controladas pelos fatores de confusão, apenas déficit imunológico mantido e carga viral alta permaneceram associadas. As variáveis compostas proxy da reconstituição imunológica e da imunodeficiência, apresentaram forte associação com a LD. Agrupando essas duas últimas variáveis em uma categoria, encontra-se uma forte associação com a LD. Na análise do tratamento antirretroviral observou-se que os regimes Inibidor de Transcriptase Reversa análogos de Nucleosídeos (ITRN)+ Inibidor de Transcriptase Reversa não análogos de Nucleosídeos (ITRNN) estavam associados ao desenvolvimento da LD e não havia diferença entre os indivíduos tratados e não tratados. Entre as classes latentes verificou-se associação com o desenvolvimento da LD dos regimes ITRN+ITRNN e das drogas Lamivudina (3TC)+Zidovudina (AZT)+Nevirapina (NVP) e 3TC+Tenofovir (TDF)+Efavirenz (EFV). O uso das trajetórias permitiu identificar padrões de resposta imunológica e o envolvimento do regime ITRNN associados à LD, e esta pode ocorrer devido à exposição à TARV ou apenas pela exposição ao HIV. Os modelos de equações estruturais mostraram superar as ferramentas tradicionais que, apesar de eficientes, muitas vezes não são sensíveis suficiente para detectar possíveis características ou comportamentos implícitos


The thesis aims to identify different patterns: immune response through the paths of viral load and CD4, treatment regimens and antiretroviral drug combinations and verify association with the development of lipodystrophy (LD).This was a cohort of 912 patients followed up over a period of 5years, with repeated CD4 count and viral load measurements. A structural equation analysis was conducted to identify the model with the bestnumber of CD4, viral load, treatment regimen and antiretroviral drugstrajectories, based on statistical parameters (entropy and bic), and through logistic regression, the association of these trajectories with the development of lipodystrophy. The prevalence of LD on the first visit after baseline assessment of cohort was 40.6% reaching 77.6%. The trajectories temporary immune gap, sustainedimmune gapand high viral load were associated with the development of LD in the univariate analysisand, after control for confounders, only sustained immune gap and high viral load remained associated. Composite proxy variables of immune reconstitution and immunodeficiency, suggesting the underlying inflammation, demonstratedanassociation with the LD, despite the wide confidence interval. Grouping the twolastvariables into one category, we encountereda strong association with LD. In the analysisof antiretroviral treatment (ART), it was observed that the Nucleoside reverse transcriptase inhibitors (NRTI) +Non-nucleoside reverse transcriptase inhibitors (NNRTI)regimens were associated with the development of the LD and there was no difference between treated and untreated individuals. Among the latent classes found an association of the NRTI+NNRTI regimens and combination of drugs lamivudine (3TC) +zidovudine (AZT) +nevirapine (NVP)and tenofovir (TDF) +3TC+efavirenz (EFV)with the development of LD. The use of trajectories allowed us to identifythe immunologicalresponse patterns and the involvement of NNRTI regimeassociated with the LD and that LD can occur due to ART exposure or just by HIV virus exposure. The structural equation modeling showed to overcome the traditional tools which although effective, are often not sensitive enough to detect possible features or implied behavior.


Subject(s)
Humans , Male , Female , Adult , HIV , HIV Infections/complications , Lipodystrophy/complications , Statistical Analysis , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/immunology , Anti-Retroviral Agents/adverse effects , Anti-Retroviral Agents/therapeutic use , Cohort Studies , Health Profile , HIV Infections/immunology , HIV Infections/therapy , Lipodystrophy/immunology , Immune Reconstitution Inflammatory Syndrome/complications , Viral Load
11.
Med. interna (Caracas) ; 31(3): 146-153, 2015. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1009726

ABSTRACT

La cuantificación de las células TCD4 en pacientes que viven con VIH/SIDA es indicador de estado inmunológico. Factores como el estrés físico, psicológico, embarazo, entre otros, pueden disminuir su valor. Objetivo: Evaluar el nivel de autoestima y su relación con el valor absoluto de linfocitos T CD4. Metodos: Se realizó un estudio de casos, analítico del tipo correlacional. Para ello, se utilizó la técnica de la encuesta escrita como medio de recolección de datos en los pacientes atendidos en la "Unidad de Infectología del Hospital Universitario Dr. Ángel Larralde (HUAL)" durante el periodo marzo junio del 2015. Resultados: De los 100 pacientes, predominó el sexo masculino y se registró una edad promedio de 28,22 años ± 0,81 siendo más frecuente edades entre 18 y 29 años (65 casos). El tiempo de diagnóstico que predominó fue entre 1 y 5 años (58 casos). El nivel alto de autoestima prevaleció entre los pacientes del estadio 2 (20/38) y en estadio 1 (19/53). Entre los pacientes con 1 y 5 años de diagnóstico predominó el nivel de autoestima medio (27/58), y en los pacientes con menos de un año de diagnóstico predominó el nivel alto (9/20). El mayor promedio registrado de linfocitos TCD4 correspondió a aquellos pacientes con autoestima alta y el promedio más bajo se observó en aquellos pacientes con autoestima baja. Conclusiones: Hubo diferencia estadísticamente significativa entre el nivel de autoestima y el promedio de células TCD4; se encontró relación directa entre el nivel de autoestima y estadio de la enfermedad al mismo tiempo que se encontró relación directa entre el tiempo de diagnóstico y el nivel de autoestima(AU)


The number of CD4+ cells in patients living with HIV / AIDS is known as an indicator of immune status. Factors such as physical and psychological stress, pregnancy, among others, may decline the number of CD4. Objective: To assess the level of self- esteem and its relationship to the absolute value of TCD4 lymphocytes in patients living with HIV / AIDS. Methods: A case study, correlational and analytical was performed. A written survey technique was used as by a data collection questionnaire applied to the patients with AIDS attending the "Unidad de Infectología del Hospital Universitario Dr. Ángel Larralde (HUAL)" during the period from March to June 2015. Results: The sample was 100 patients, with a male the prevalent sex and an average age of 28.22 years ± 0.81, being more frequent between 18 and 29 years (65 cases). The predominant diagnosis time was between 1 and 5 years (58 cases). The high level of self-esteem prevailed among patients of stage 2 (20/38) and stage 3 (19/53). Among patients with 1 and 5 years of diagnosis, the medium level of self-esteem (27/58) was the predominant. Patients within a year of diagnosis registered high level of self-esteem (9/20). The highest average CD4 cells registered corresponded to those with high self-esteem and the lowest average was observed in patients with low self-esteem. Conclusions: There was a statistically significant difference between the level of self-esteem and the average of Lympochytes T CD4 cells and also a direct relationship between self-esteem, the stage of disease and between time of diagnosis and the level of self-esteem.(AU)


Subject(s)
Humans , Self Concept , Stress, Physiological/immunology , Acquired Immunodeficiency Syndrome/immunology , Immune System , Internal Medicine
13.
Medicina (B.Aires) ; 73(4): 324-330, jul.-ago. 2013. graf, tab
Article in Spanish | LILACS | ID: lil-694788

ABSTRACT

El curso de la infección por HIV se caracteriza principalmente por una depleción grave de los linfocitos TCD4+ y una activación inmune marcada, hallazgos centrales que conducen a variaciones numéricas y fenotípicas de las poblaciones linfocitarias TCD4+. El tratamiento antirretroviral (TARV) combinado ha modificado sustancialmente el curso de la infección por HIV, y la correcta adherencia al mismo resulta en una disminución de la carga viral a niveles indetectables, y a un incremento significativo en la repoblación de los linfocitos T periféricos. En este trabajo se evaluó en 28 niños HIV (+) la relación entre los cambios en los niveles de las poblaciones linfocitarias y la adherencia al TARV, luego de 9 meses en promedio de iniciado el mismo. El grupo de 18 niños con buena adherencia, superior al 95%, presentó un aumento significativo en los porcentajes de células naive CD4+CD45RA+CD62L+ y un descenso en las células de memoria central CD4+CD45RA-CD62L+, entre ambos momentos del seguimiento. Por el contrario, los 10 niños con fallas en la adherencia no mostraron diferencias significativas en los niveles de tales poblaciones. La buena adherencia al TARV produce el rápido y significativo descenso de la replicación viral lo cual se asocia a la progresiva reconstitución cuantitativa y funcional del sistema inmune.


Human immunodeficiency virus infection causes a severe depletion of TCD4+ lymphocytes and a sustained immune activation state, hallmarks findings that led to numerical and phenotypic changes in the TCD4+ subsets. Highly active anti-retroviral therapy has substantially modified the course of HIV infection. Correct adherence to the treatment results in a decrease in viral load at undetectable levels and a significant increase in the number of peripheral T cell lymphocytes. In the present study association between changes in T cell subsets and treatment adherence was evaluated in 28 HIV (+) infected children, before and after 9 months on average, from starting anti-retroviral therapy. The group of 18 patients with good adherence, above 95%, showed a significant increase in CD4+CD45RA+CD62L+ naive cells percentual levels and a decrease in the CD4+CD45RA-CD62L+ central memory subset, between the two points of the follow-up period. Conversely, 10 children with failure in the adherence did not show significant differences in the percentual levels of both subsets. Improvement in the percentage of adherence among paediatric population, optimizing antiretroviral treatment, allows a quick and significant reduction of viral replication. This feature is associated with the progressive reconstitution of the immune system.


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Antiretroviral Therapy, Highly Active , Acquired Immunodeficiency Syndrome/drug therapy , Anti-Retroviral Agents/therapeutic use , /drug effects , Medication Adherence , Acquired Immunodeficiency Syndrome/immunology , Anti-Retroviral Agents/immunology , Antiretroviral Therapy, Highly Active/adverse effects , Blotting, Western , /cytology , Enzyme-Linked Immunosorbent Assay , Polymerase Chain Reaction , Time Factors , Treatment Outcome , Viral Load
14.
Actual. SIDA. infectol ; 21(80): 37-41, jul. 2013.
Article in Spanish | LILACS | ID: lil-781696

ABSTRACT

Introducción: la histoplasmosis constituye la segunda micosis sistémica en orden de frecuencia en Argentina, después de criptococosis, en pacientes HIV positivos. En éstos, la forma clínica diseminada progresiva es marcadora de sida. La coinfección HIV-Histoplasmosis diseminada (HD) en nuestro país ha sido reportada entre 5,3 y 6 %. Métodos: estudio descriptivo, retrospectivo, realizado en un hospital de agudos de CABA, que incluyó pacientes HIV positivos con HD, en el período 2000-2011. Resultados: n:80. Edad, media (desvío estándar, DE): 37 años (8,1). Varones: 81,2%. CD4, mediana (rango intercuartil, RIC): 19,5 cél/µL (7-54). HD como primera marcadora de sida: 70%; serología HIV previa desconocida: 38,7 %. El 11,8% recibía terapia antirretroviral (TARV) al diagnóstico de HD. Otra infección oportunista concomitante al diagnóstico: 29,4%. Clínica 84,7% fiebre, 75% síndrome de impregnación, 72,2% síntomas respiratorios, 56,9% lesiones cutáneo-mucosas, 30,5% hepatosplenomegalia. Laboratorio: 76,2% anemia, 60,3% leucopenia, 42,1% plaquetopenia. Aislamientos: hemocultivos: 81,8%; muestras positivas: piel y mucosas: 39 pacientes, respiratorias: 16 pacientes, médula ósea: 6 pacientes. Radiografía de tórax patológica: 77,6%. Tratamiento: anfotericina B: 58,5%; itraconazol: 91%. Recaída: 21,2%. Mortalidad global: 20,2%, atribuible a HD: 5,9%. Conclusión: HD fue la primera marcadora en el 70% de los pacientes, alrededor de un 40% desconocían su serología y sólo 1 de cada 10 recibía TARV, lo que refleja un retraso en el diagnóstico de HIV en nuestra población. Las principales manifestaciones clínicas semejan otras infecciones oportunistas siendo importante la sospecha diagnóstica para el tratamiento temprano.


Introduction: Histoplasmosis is the second most frequente fungal infection in Argentina, after cryptococcosis in HIV positive patients. In these patients the disseminated clinical presentation is an AIDS-defining condition. Disseminated histoplasmosis (DH) and HIV coinfection has been reported between 5.3 and 6 % in Argentina. Methods: Retrospective, descriptive study, performed in an acute care hospital of Buenos Aires city, including HIV positive patients with DH, between 2000-2011. Results: n: 80. Mean age (standard deviation, SD): 37 years (8.1). Male: 81.2%. Median CD4 (interquartile range, IQR): 19.5 cells/uL (7-54). DH as the first AIDS defining condition: 70%; unknown prior HIV test: 38.7%. ONly 11.8% were receiving antiretroviral treatment at the time of diagnosis of DH. Other concomitant oportunistic infections: 29.4 %. Clinical manifestations: fever 84.7%, constitutinal symptoms 75%, respiratory symptoms 72.2 %, mucocutaneous lesions 56.9%, liver and/or spleen enlargement 30.5%. Laboratory abnormalities: anemia 76.2 %, leucopenia 60.3%, thrombocytopenia 42.1% Microbiological isolates: blood culture 81.8%; others positive samples: 39 of skin and mucosa, 16 of respiratory specimens, 6 of bone marrow. X-ray chest abnormalities: 77.6%. Treatment: amphotericin B: 58.5%; itraconazole: 91%. Relapse: 21.2%. Global mortality: 20.2%, DH atributable mortality: 5.9%. Conclusion: DH was the first AIDS defining condition in 70% of our patients, about 40% were unaware of their serostatus and only one in ten received antiretroviral treatment, reflecting a delay in diagnosis of HIV in our population. The main clinical manifestations resemble other oportunistic infections, so diagnostic of DH should be for considered in order to provide timely treatment.


Subject(s)
Humans , Male , Adult , Young Adult , Amphotericin B/therapeutic use , Epidemiologic Factors , Epidemiology, Descriptive , Histoplasmosis/diagnosis , Opportunistic Infections/epidemiology , Itraconazole/therapeutic use , Retrospective Studies , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/immunology , Acquired Immunodeficiency Syndrome/microbiology
15.
Clinics ; 68(3): 359-364, 2013. graf, tab
Article in English | LILACS | ID: lil-671427

ABSTRACT

OBJECTIVE: The purpose of this study was to compare aerobic function [anaerobic threshold (%VO2-AT), respiratory compensation point (%VO2-RCP) and peak oxygen uptake (VO2peak)] between physically active patients with HIV/AIDS and matched controls and to examine associations between disease status, poor muscle strength, depression (as estimated by the profile of mood states questionnaire) and the aerobic performance of patients. METHODS: Progressive treadmill test data for %VO2-AT (V-slope method), RCP and (VO2peak) were compared between 39 male patients with HIV/AIDS (age 40.6±1.4 years) and 28 male controls (age 44.4±2.1 years) drawn from the same community and matched for habitual physical activity. Within-patient data were also examined in relation to CD4+ counts (nadir and current data) and peak isokinetic knee torque. RESULTS: AT, RCP and (VO2peak) values were generally similar for patients and controls.Within the patient sample, binary classification suggested that AT, RCP and (VO2peak) values were not associated with either the nadir or current CD4+ count, but treadmill test variables were positively associated with peak isokinetic knee torque. CONCLUSION: The aerobic performance of physically active patients with HIV/AIDS is generally well conserved. Nevertheless, poor muscle strength is observed in some HIV/AIDS patients, which is associated with lower anaerobic power and (VO2peak), suggesting the possibility of enhancing the aerobic performance of patients with weak muscles through appropriate muscle-strengthening activities.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Acquired Immunodeficiency Syndrome/physiopathology , Anaerobic Threshold/physiology , Muscle Strength/physiology , Anthropometry , Acquired Immunodeficiency Syndrome/immunology , Case-Control Studies , Exercise Test , Oxygen Consumption/physiology , Surveys and Questionnaires
16.
Mem. Inst. Oswaldo Cruz ; 107(8): 985-992, Dec. 2012. graf
Article in English | LILACS | ID: lil-660644

ABSTRACT

Human immunodeficiency virus (HIV)-1 infection has an important impact on malaria. Plasmodium falciparum and HIV-1 co-infected patients (Pf/HIV) present with a high degree of anaemia, enhanced parasitaemia and decreased CD4+ T cell counts, which increase the risk of developing severe malaria. In addition, infection with either Pf or HIV-1 alone causes extensive immune activation. Our hypothesis was that lymphocyte activation is potentiated in Pf/HIV co-infected patients, consequently worsening their immunosuppressed state. To test this hypothesis, 22 Pf/HIV patients, 34 malaria patients, 29 HIV/AIDS patients and 10 healthy controls without malaria or HIV/acquired immune deficiency syndrome (AIDS) from Maputo/Mozambique were recruited for this study. As expected, anaemia was most prevalent in the Pf/HIV group. A significant variation in parasite density was observed in the Pf/HIV co-infected group (110-75,000 parasites/µL), although the median values were similar to those of the malaria only patients. The CD4+ T cell counts were significantly lower in the Pf/HIV group than in the HIV/AIDS only or malaria only patients. Lymphocyte activation was evaluated by the percentage of activation-associated molecules [CD38 expression on CD8+ and human leukocyte antigen-DR expression on CD3+ T cells]. The highest CD38 expression was detected in the Pf/HIV co-infected patients (median = 78.2%). The malaria only (median = 50%) and HIV/AIDS only (median = 52%) patients also exhibited elevated levels of these molecules, although the values were lower than those of the Pf/HIV co-infected cases. Our findings suggest that enhanced T-cell activation in co-infected patients can worsen the immune response to both diseases.


Subject(s)
Adult , Female , Humans , Male , Anemia/parasitology , /immunology , HIV Infections/immunology , Lymphocyte Activation/immunology , Malaria, Falciparum/immunology , Parasitemia/immunology , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/immunology , Case-Control Studies , Cross-Sectional Studies , HIV Infections/complications , Mozambique , Malaria, Falciparum/complications , Severity of Illness Index
17.
Rev. Assoc. Med. Bras. (1992) ; 58(5): 561-567, set.-out. 2012. tab
Article in English | LILACS | ID: lil-653768

ABSTRACT

OBJECTIVE: To analyze the costs of human immunodeficiency virus (HIV) outpatient treatment for individuals with different CD4 cell counts in the Brazilian public health system, and to compare to costs in other national health systems. METHODS: A retrospective survey was conducted in five public outpatient clinics of the Brazilian national HIV program in the city of São Paulo. Data on healthcare services provided for a period of one year of HIV outpatient treatment were gathered from randomly selected medical records. Prices of inputs used were obtained through market research and public sector databases. Information on costs of HIV outpatient treatment in other national health systems were gathered from the literature. Annual costs of HIV outpatient treatment from each country were converted into 2010 U.S. dollars. RESULTS: Annual cost of HIV outpatient treatment for the Brazilian national public program was US$ 2,572.92 in 2006 in São Paulo, ranging from US$ 1,726.19 for patients with CD4 cell count > 500 to US$ 3,693.28 for patients with 51 < CD4 cell count < 200. Antiretrovirals (ARVs) represented approximately 62.0% of annual HIV outpatient costs. Comparing among different health systems during the same period, HIV outpatient treatment presented higher costs in countries where HIV treatment is provided by the private sector. CONCLUSION: The main cost drivers of HIV outpatient treatment in different health systems were: ARVs, other medications, health professional services, and diagnostic exams. Nevertheless, the magnitude of cost drivers varied among HIV outpatient treatment programs due to health system efficiency. The data presented may be a valuable tool for public policy evaluation of HIV treatment programs worldwide.


OBJETIVO: Analisar custos de tratamento ambulatorial de pacientes portadores do vírus da imunodeficiência humana (HIV) com diferentes níveis de CD4 no sistema público de saúde brasileiro e comparar aos custos de outros sistemas de saúde. MÉTODOS: Foi conduzida pesquisa retrospectiva em cinco ambulatórios especializados do programa DST/AIDS no município de São Paulo. Dados referentes à assistência ambulatorial para tratamento de pacientes HIV durante um ano foram obtidos em prontuários médicos selecionados aleatoriamente. Preços dos recursos utilizados foram obtidos via pesquisa de mercado e bancos de dados do setor público. Informações sobre custos do tratamento ambulatorial de pacientes HIV em outros sistemas de saúde foram obtidos na literatura. Os custos anuais de tratamento ambulatorial de pacientes HIV em cada país foram convertidos em dólares norte-americanos no ano base 2010. RESULTADOS: O custo anual de tratamento ambulatorial para pacientes HIV no programa público nacional foi US$ 2.572,92 em 2006 no município de São Paulo, variando entre US$ 1.726,19 para pacientes com CD4 > 500 e US$ 3.693,28 para pacientes com 51 < CD4 < 200. Medicamentos antirretrovirais (ARVs) representaram aproximadamente 62,0% dos custos de tratamento ambulatorial de pacientes HIV. Comparando-se custos entre diferentes sistemas de saúde no mesmo período, o tratamento ambulatorial de pacientes HIV apresentou custos superiores nos países onde a provisão do tratamento é realizada pelo setor privado. CONCLUSÃO: Os principais determinantes dos custos de tratamento ambulatorial de pacientes HIV são: medicamentos ARVs, outros medicamentos, profissionais de saúde e exames diagnósticos. No entanto, a magnitude de participação dos determinantes de custos nos programas de tratamento ambulatorial de pacientes HIV varia em decorrência da eficiência do sistema de saúde. Os dados apresentados constituem importante instrumento para avaliação de políticas públicas de saúde relacionadas ao tratamento de pacientes HIV mundialmente.


Subject(s)
Humans , Ambulatory Care/economics , Anti-Retroviral Agents/economics , Antiretroviral Therapy, Highly Active/economics , Health Care Costs , HIV Infections/drug therapy , National Health Programs/economics , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/economics , Acquired Immunodeficiency Syndrome/immunology , Anti-Retroviral Agents/therapeutic use , Brazil , Health Policy , HIV Infections/economics , HIV Infections/immunology , National Health Programs/statistics & numerical data , Retrospective Studies
18.
Acta méd. costarric ; 54(3): 159-164, jul.-set. 2012. ilus, graf, tab
Article in Spanish | LILACS | ID: lil-700625

ABSTRACT

Objetivo: comparar el estado inmunológico al momento del diagnóstico durante 3 años, de los pacientes con VIH/Sida atendidos en el Hospital San Juan de Dios.Materiales y métodos: estudio retrospectivo, descriptivo de los casos nuevos diagnosticados con VIH/Sida, mayores de 14 años, en 2003, 2006 y 2009, en la Clínica de Atención al Paciente con VIH del Hospital San Juan de Dios, Costa Rica, según los datos en los expedientes clínicos. Para evaluar el estado inmunológico se utilizó el recuento de linfocitos T CD4+ al momento del diagnóstico del VIH, estableciéndose como diagnóstico tardío <200 células/ul. Para el análisis se realizó la estimación de las frecuencias y fuerzas de asociación entre las variables...


Subject(s)
Humans , Male , Adolescent , Adult , Animals , Female , Pregnancy , Infant, Newborn , Infant , Child, Preschool , Child , Middle Aged , Diagnosis , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/immunology
19.
Rev. bras. epidemiol ; 15(1): 75-84, mar. 2012. tab
Article in Portuguese | LILACS | ID: lil-618267

ABSTRACT

A qualidade de vida (QV) acompanha o tratamento dos pacientes com AIDS, juntamente com as inovações farmacológicas, que permitiram prolongar a vida do paciente e a manutenção de seu bem-estar. O presente estudo objetivou verificar a QV desses pacientes e correlacionar com dados clínicos e laboratoriais. Participaram 205 pacientes HIV/AIDS, os quais responderam ao questionário WHOQOL-120-HIV e tiveram coletados seus dados sociodemográficos, clínicos e laboratoriais. A média etária foi de 40,59 ± 11,81 anos; contagem de linfócitos CD4+ de 397,97 ± 232,84 mm³ e 5,23 ± 3,94 anos de diagnóstico do HIV. A carga viral era <50 cópias/ml em 115 pacientes; em 61, entre 50 e 10.000; e em 29 acima de 10.000 cópias. Os domínios atingiram bons escores médios, sendo que o melhor foi o psicológico (14,5 ± 2,7), seguido de relações sociais (13,7 ± 2,2), físico (12,7 ± 3,5), nível de independência (12,6 ± 2,5), crenças pessoais (12,4 ± 2,4) e meio ambiente (12,4 ± 1,8). Os melhores escores nas facetas dor, lazer, apoio social, ambiente físico e crenças pessoais foram os com maiores níveis de CD4 (p < 0,05). Já nas facetas finanças, lazer, preocupações sobre o futuro e QV geral e percepção de saúde foram em pacientes com carga viral <50 (p < 0,05). Os melhores índices nas facetas energia e fadiga, atividade sexual, informação e transporte, sintomas da doença, cuidados e preocupações sobre o futuro foram verificados em pacientes com menor tempo de diagnóstico (p < 0,05). Os pacientes com HIV/AIDS do estudo apresentam QV de nível intermediário e associação com os níveis de CD4, CV e tempo de diagnóstico.


Quality of life (QOL) has accompanied the treatment of AIDS patients, along with pharmacological innovations that have allowed patients to live longer and maintain their well-being. The present study aimed at evaluating the QOL of these patients and correlate it with clinical and laboratory data. The study included 205 patients with HIV/AIDS, who answered the WHOQOL-120-HIV; and whose socio-demographic data, clinical and laboratory findings were collected. The average age was 40.59 ± 11.81 years; CD4+ lymphocyte count, 397.9 ± 232.84 mm³; and years of diagnosis of HIV, 5.23 ± 3.94. Viral load was <50 copies/ml in 115 patients; 50 to 10.000 in 61; and above 10.000 copies in 29 patients. Domains achieved satisfactory average scores, and the best were the psychological (14.5 ± 2.7), followed by social relationships (13.7 ± 2.2), physical (12.7 ± 3.5), independence (12.6 ± 2.5), personal beliefs (12.4 ± 2.4), and environment (12.4 ± 1.8). The best scores on pain, pleasure, social support, physical environment, and personal belief facets were observed for those with higher CD4 levels (p < 0.05). The best scores for the finance, leisure, concerns about the future, overall QOL, and perceived health facets were observed for patients with viral load <50 (p < 0.05). The highest rates for energy, fatigue, sexual activity, information, transportation, symptoms, care, and concerns about the future facets were seen in patients with less time of diagnosis (p < 0.05). HIV/AIDS patients in the study had an intermediate QOL correlating to CD4 levels, VL, and time of diagnosis.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , HIV Infections , Quality of Life , Viral Load , Acquired Immunodeficiency Syndrome/blood , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/immunology , Acquired Immunodeficiency Syndrome/virology , Cross-Sectional Studies , HIV Infections/blood , HIV Infections/diagnosis , HIV Infections/immunology , HIV Infections/virology , Time Factors
20.
Rev. GASTROHNUP ; 14(2): 44-48, ene.15, 2012. tab
Article in Spanish | LILACS | ID: lil-648026

ABSTRACT

Introducción: La desnutrición (DNT) es una de las complicaciones más tempranas que se presenta en niños con infección por VIH/SIDA, asociada a su morbimortalidad. Igualmente como consecuencia de la terapia antriretroviral y otros medicamentos utilizados, se han encontrado problemas de resistencia a la insulina y obesidad. Objetivo: Determinar la prevalencia de malnutrición (MNT) en niños con infección por VIH/SIDA por carga viral de la Clínica de VIH/SIDA del Hospital Universitario del Valle de Cali, Colombia (HUV) y su posible asociación con algunos factores de riesgo. Metodología: Estudio descriptivo, observacional de corte transversal, con análisis de casos y controles, a quienes se les tomaron datos como carga viral, %CD4, peso y talla. Se categorizó la carga viral (copias/ml) en: <400, ≥400-<300000, ≥30000-<1 millón y ≥1 millón; y el %CD4 en: <15%, ≥15%-<25% y ≥25%. Se consideró DNT global (déficit P/E≥10%), DNT crónica (déficit T/E≥5%), DNT aguda (déficit P/T≥10%) y sobrepeso (exceso P/T≥10%). Resultados: Fueron incluidos 111 niños entre 0 meses y 15 años de edad, con predominio del género masculino (51,3%), con modo de transmisión vertical en 91,8%. El 58.5% tenían entre ≥400-<300000 copias/ml de carga viral; y el 59% presentaron %CD4 ≥25%. La valoración nutricional evidenció DNT global en 64%, DNT aguda en 58%, DNT crónica en 22% y sobrepeso en 18%. Hubo riesgo de 1.7, 1.5 y 2.0 veces más de presentar DNT global, aguda y crónica, respectivamente, si la carga viral era ≥400 copias/ml. Conclusión: En niños con infección por VIH/SIDA por carga viral de la Clínica Pediátrica de VIH/SIDA del HUV de Cali, Colombia, la prevalencia de MNT fue superior al 18%, con una relación positiva superior a 1.5 veces entre carga viral y los diferentes tipos de DNT.


Introduction: Undernutrition (UNT) is a complication that occurs earlier in children with HIV/AIDS associated morbidity and mortality. Also as a result of anti-retroviral therapies and other drugs used, have encountered problems of insulin resistance and obesity. Objective: To determine the prevalence of malnutrition (MNT) in children diagnosed with HIV/AIDS by viral load in the Pediatric Clinic HIV/AIDS at the Hospital Universitario del Valle in Cali, Colombia (HUV) and its possible association with certain risk factors. Methodology: A descriptive cross-sectional study, with case-control analysis, whose data were taken as viral load, CD4%, weight and height. Were categorized viral load (copies / ml): <400, ≥ 400 - <300000, ≥ 30000 - <1 million and ≥ 1 million, and the %CD4 <15%, ≥ 15% - <25% ≥ 25%. UNT is considered global (low W/A≥10%), chronic (low H/A≥5%), acute (low W/H≥10%) and overweight (excess W/H≥10%). Results: We included 111 children from 0 months to 15 years old with male predominance (51.3%), mode of transmission in 91.8%. 58.5% were aged ≥ 400 - <300,000 copies/ml viral load, and 59% had CD4% ≥25%. Nutritional assessment showed 64% global UNT, 58% acute UNT, 22% chronic UNT and 18% overweight. Risk was 1.7, 1.5 and 2.0 times the present global, acute and chronic UNT, respectively, if the viral load was ≥ 400 copies / ml. Conclusion: In children diagnosed with HIV/AIDS by viral load of Pediatric Clinic HIV/AIDS at the HUV in Cali, Colombia, the prevalence of MNT was higher than 18%, with a positive relationship more than 1.5 times between viral load and the different types of UNT.


Subject(s)
Humans , Male , Female , Child , Malnutrition/classification , Malnutrition/diagnosis , Malnutrition/epidemiology , Malnutrition/etiology , Malnutrition/immunology , Malnutrition/mortality , Malnutrition/pathology , Malnutrition/drug therapy , Malnutrition/blood , Acquired Immunodeficiency Syndrome/classification , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/congenital , Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/nursing , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/etiology , Acquired Immunodeficiency Syndrome/physiopathology , Acquired Immunodeficiency Syndrome/genetics , Acquired Immunodeficiency Syndrome/history , Acquired Immunodeficiency Syndrome/immunology , Acquired Immunodeficiency Syndrome/mortality , Acquired Immunodeficiency Syndrome/pathology , Acquired Immunodeficiency Syndrome/prevention & control , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/blood
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