Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 264
Filter
1.
Medwave ; 20(9): e8049, 30-10-2020.
Article in English, Spanish | LILACS | ID: biblio-1141141

ABSTRACT

En diciembre de 2019 una nueva especie de ß-coronavirus causante de neumonía fue identificada en la ciudad China de Wuhan, el cual posteriormente fue denominado SARS-CoV-2. Este virus de ácido ribonucleico presenta ciertas similitudes con otros virus del mismo material genético, dentro de ellos se ha visto que la infección por virus de la inmunodeficiencia humana se asemeja en diversos aspectos a la infección por SARS-CoV-2. En este comentario presentamos algunas de las similitudes virológicas, inmunológicas, clínicas y farmacológicas entre estos dos virus, las cuales podrían permitirnos entender de mejor manera la inmunopatogenia de COVID-19, así como también tomar algunas decisiones en cuanto al manejo antiviral.


In December 2019, a new species of pneumonia-causing betacoronavirus was identified in Wuhan, China, which was later identified as SARS-CoV-2. This RNA virus presents certain similarities with other viruses of the same genetic material. It has been seen that infection by human immunodeficiency virus resembles the infection by SARS-CoV-2 in various aspects. In this comment, we present some of the virological, immunological, clinical, and pharmacological similarities between HIV and SARS-CoV-2, which could allow us to understand the immunopathogenesis of COVID-19 better, as well as make some decisions in regarding antiviral management.


Subject(s)
Humans , HIV Infections/virology , HIV/isolation & purification , SARS-CoV-2/isolation & purification , COVID-19/virology , Antiviral Agents/pharmacology , HIV Infections/immunology , HIV/immunology , Pandemics , SARS-CoV-2/immunology , COVID-19/immunology , COVID-19/drug therapy
2.
Prensa méd. argent ; 106(6): 371-378, 20200000. tab, fig
Article in English | LILACS, BINACIS | ID: biblio-1367088

ABSTRACT

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


Subject(s)
Humans , CD4 Antigens/immunology , HIV Infections/immunology , Cross-Sectional Studies/statistics & numerical data , Analysis of Variance , HIV Seronegativity/immunology , Dyslipidemias/pathology , Lipids/analysis
3.
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
4.
Actual. SIDA. infectol ; 28(108): 30-37, 20201000. fig, tab
Article in Spanish | LILACS | ID: biblio-1349405

ABSTRACT

La disfunción inmune asociada a la infección por el virus de la inmunodeficiencia humana (VIH) es generada por una estimulación crónica del sistema inmune secundaria a la imposibilidad del organismo de erradicar el virus. La misma se encuentra exacerbada en el contexto de la coinfección por el virus de la hepatitis C (VHC). La inflamación sistémica producto de la coinfección por ambos virus genera un aumento de la morbilidad y mortalidad en los individuos afectados. Son varios los mediadores solubles de activación inmunológica, como IP-10, TNF-α, IL-6, IL-1ß (marcadores de inflamación sistémica); IL-17 (linfocitos T CD4+ Th17); IL-2, IFN-γ (linfocitos T CD4+ Th1); IL-8 (inducción de neutrofilia); CD23s, ICAMs, CD14s, CD163s (marcadores de activación de monocitos/macrófagos), niveles circulantes de lipopolisacárido (LPS) (translocación bacteriana); entre otros. Actualmente se necesitan más estudios para lograr definir cuáles serían los biomarcadores de progresión óptimos para el seguimiento de los individuos coinfectados por VIH/VHC. El objetivo de esta revisión es realizar una reseña sobre los mecanismos inmunopatológicos de la infección por VIH/VHC involucrados en la inflamación, daño hepático y su impacto en la morbimortalidad de los individuos coinfectados


The immune dysfunction associated with Human Immunodeficiency Virus (HIV) infection is generated by a chronic stimulation of the immune system, because of the inability to eradicate the virus from the host. This immune dysfunction is exacerbated in the context of coinfection with Hepatitis C Virus (HCV). Systemic inflammation caused by coinfection with both viruses generates an increase in morbidity and mortality in affected individuals. There are several soluble mediators of immunological activation, such as IP-10, TNF-α, IL-6, IL-1ß (systemic inflammation markers); IL-17 (CD4+ T cells Th17); IL-2, IFN-γ (CD4+ T cells Th1); IL-8 (neutrophilia); CD23s, ICAMs, CD14s, CD163s, lipopolysaccharide (LPS) (monocyte/macrophage activation markers and bacterial translocation); among others. Currently, more studies are needed to define optimal progression biomarkers for the follow-up of HIV/HCV coinfected individuals. In this review, we focus on the immunopathological mechanisms of HIV/HCV infection involved in inflammation, liver damage and its impact on the morbidity and mortality of affected individuals


Subject(s)
Humans , Biomarkers , HIV Infections/immunology , Hepacivirus/immunology , Coinfection/immunology , Hepatitis/immunology , Immunity , Immune System Diseases , Inflammation/immunology
5.
Int. j. cancer ; 147((6):1629-1637): 1629-1637, 20200915. Fig., Tab., Mapa
Article in English | AIM, RSDM, AIM | ID: biblio-1354988

ABSTRACT

Results from two recently established population-based registries in Mozambique are reported: Beira in the central region (2014-2017) and Maputo, the capital city, in the South (2015-2017). The results are compared to those from Maputo (Lourenço Marques at the time) in 1956-1960 (appearing Cancer Incidence in Five Continents Vol 1), and with estimated incidence rates from other regions of Africa. The elevated prevalence of HIV infection (12.6% of adults in 2018) results in high rates for HIV-related cancers, and the greater prevalence in central Mozambique, compared to the south, largely explains the rather higher rates of Kaposi sarcoma (males), non-Hodgkin lymphoma, squamous cell carcinoma of conjunctiva and cervical cancer in Beira than in Maputo. Burkitt lymphoma is the commonest childhood cancer in Beira, with high rates typical of East Africa, while the low rates in Maputo are more typical of Southern Africa. Overall, 44% of cancers in Maputo and 52% in Beira are estimated to be caused by infectious agents. In the last 60 years, cancers more frequent in developed countries, such as breast and prostate, are emerging in Mozambique. The incidence of the former in Maputo has increased fivefold since 1956-1960, that of prostate cancer 2.5-fold, and that of large bowel cancer doubled. The results reported here were used to make national estimates of incidence, mortality and prevalence in Globocan 2018. The two registries were important in providing data to establish priority actions in the National Cancer Control Plan, and are a valuable resource to monitor progress toward its goals.


Subject(s)
Humans , Male , Female , Adolescent , Middle Aged , Young Adult , Chancre , Neoplasms/immunology , HIV Infections/complications , HIV Infections/immunology , HIV Infections/epidemiology , Infections/complications , Mozambique/epidemiology , Neoplasms/virology
6.
Arq. neuropsiquiatr ; 77(5): 357-365, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1011344

ABSTRACT

ABSTRACT Infections caused by the human immunodeficiency virus (HIV) and by the larvae of Taenia solium (i.e., cysticercosis) are still widespread in many developing countries. Both pathologies modify host immune status and it is possible that HIV infection may modulate the frequency and pathogeny of cysticercosis of the central nervous system (i.e., neurocysticercosis [NCC]). Objective: To describe published cases of NCC among HIV-positive patients and to evaluate whether the characteristics of NCC, including frequency, symptoms, radiological appearance, and response to treatment differed between HIV-positive and HIV-negative patients. Methods: Forty cases of NCC/HIV co-infected patients were identified in the literature. Clinical and radiological characteristics, as well as response to treatment, were compared with non-matching historical series of NCC patients without HIV infection. Results: Most of these patients had seizures and multiple vesicular parasites located in parenchyma. Clinical and radiological characteristics were similar between HIV-positive and HIV-negative patients with NCC, as well as between immunocompromised and non-immunocompromised HIV-positive patients. Conclusion: Our review did not reveal clear interactions between HIV and NCC. This may be partially due to the small number of cases and reliance on published research. A systematic, multi-institutional effort aiming to report all the cases of this dual pathology is needed to confirm this finding and to clarify the possible relationship between both pathogens.


RESUMO Las infecciones causadas por el virus de inmunodeficiencia humana (VIH) y la larva de la Tenia solium siguen estando diseminadas en países en vías de desarrollo. Ambas patologías modifican el estado inmune y es posible que la infección por el VIH module la frecuencia y la patología de la neurocisticercosis (NCC). Objetivo: Describir los casos publicados de NCC en los pacientes VIH positivos y evaluar si las características de la NCC, incluyendo frecuencia, síntomas, presentación radiológica, respuesta a tratamiento, difieren entre los sujetos VIH positivos y VIH negativos. Métodos: Cuarenta casos con coinfección NCC/VIH fueron identificados en la literatura. Se compararon sus características clínico-radiológicas, así como su respuesta al tratamiento con diferentes series de casos históricos no pareados. Resultados: La mayoría de los pacientes NCC/VIH tenían epilepsia y múltiples parásitos vesiculares en el parénquima. Las características clínico-radiológicas de la NCC así como la evolución de los pacientes fueron similares entre pacientes VIH positivos y negativos, así como entre pacientes VIH inmunocomprometidos y no inmunocomprometidos. Conclusión: No encontramos interacciones claras entre VIH y NCC. Este resultado puede haber sido influenciado por el pequeño número de casos y la parcialidad de la información publicada. Un esfuerzo multiinstitucional, sistemático encaminado a reportar todos los casos de esta patología dual es necesario para confirmar estos resultados y esclarecer la relación entre patógenos.


Subject(s)
Humans , Male , Female , HIV Infections/complications , Neurocysticercosis/etiology , Coinfection/immunology , Coinfection/therapy , HIV Infections/immunology , HIV Infections/therapy , Treatment Outcome , AIDS-Related Opportunistic Infections/immunology , CD4 Lymphocyte Count , Neurocysticercosis/immunology , Neurocysticercosis/therapy , Immunocompetence
7.
Braz. j. infect. dis ; 22(5): 392-401, Sept.-Oct. 2018. tab
Article in English | LILACS | ID: biblio-974240

ABSTRACT

ABSTRACT Background: Antiretroviral therapy (ART) saved millions from HIV-1 infection and AIDS, but some patients do not experience adequate CD4+ T cells gain despite achieving viral suppression. The genetic component of this condition is not yet completely elucidated. Objective: To identify predictive genetic markers of immune response to ART. Methods: Case-control study. Out of 176 HIV-infected patients recruited in the city of Recife, Northeast Brazil, 67 patients with no immunologic response were the cases and the remaining 109 patients who responded were the controls. A set of 94 selected single nucleotide polymorphisms (SNPs) involved in antiretroviral drugs pharmacodynamic pathways and immune system homeostasis were genotyped, while the remaining 48 were ancestry informative markers (AIMs) for controlling for eventual hidden population structure. Results: Male patients were overrepresented in non-responder group (p = 0.01). Non-responders also started with lower absolute CD4+ T cell counts (p < 0.001). We found five SNPs significantly associated with the outcome, being three more frequent in non-responders than responders: rs2243250 (IL4) A allele (p = 0.04), rs1128503 (ABCB1) A allele (p = 0.03) and rs707265 (CYP2B6) A allele (p = 0.02), whereas the other two were less frequent in non-responders: rs2069762 (IL2) C allele (p = 0.004) and rs4646437 (CYP3A4) A allele (p = 0.04). Conclusion: Some significant univariate associations remained independently associated at multivariate survival analysis modeling, such as pre-treatment CD4+ T cells counts, IL2 and ABCB1 genotypes, and use of protease inhibitors, yielding a predictive model for the probability for immune response. More studies are needed to unravel the genetic basis of ART immunological non-response.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , HIV Infections/immunology , HIV Infections/drug therapy , Polymorphism, Single Nucleotide/immunology , Anti-Retroviral Agents/pharmacology , Immune System/drug effects , Brazil , Genetic Markers , Multivariate Analysis , Retrospective Studies , Statistics, Nonparametric , CD4 Lymphocyte Count , Viral Load , Antiretroviral Therapy, Highly Active , Immunogenetic Phenomena/drug effects , Immunogenetic Phenomena/genetics , Genetic Association Studies , Gene Frequency
8.
Int. j. odontostomatol. (Print) ; 12(3): 219-224, Sept. 2018. tab
Article in English | LILACS | ID: biblio-975736

ABSTRACT

ABSTRACT: The influence of cytokine on the progression of chronic periodontitis in human immunodeficiency virus (HIV) patients is still controversial and poorly investigated. This study aimed to analyze and compare IL-6 and IFN-α levels in the gingival crevicular fluid of HIV-1-positive and HIV-1-negative patients with chronic periodontitis and different grades of tissue destruction and inflammation. Samples from the gingival crevicular sulcus were obtained from 35 HIV-1-positive individuals with chronic periodontitis and 35 seronegative patients with chronic periodontitis. Probing depth and clinical attachment level, as well as the results of the Enzyme-Linked Immunosorbent Assay for confirmation of patient diagnostics, were evaluated. Statistical analyses were performed using Student t, Mann-Whitney and Spearman tests. IL-6 levels were significantly lower, while IFN-α levels were significantly higher in HIV-1 patients. Clinical attachment level was directly associated with IFN-α levels in HIV-1 carriers, connected to probing depth in these patients. Clinical data in association with gingival crevicular fluid cytokine levels may reveal a localized immunological response pattern, which may contribute to the understanding of periodontitis pathogenesis in HIV-1 carriers.


RESUMEN: La influencia de la citocina en la progresión de la periodontitis crónica en pacientes con el virus de la inmunodeficiencia humana (VIH) sigue siendo controvertida y poco investigada. Este estudio tuvo como objetivo analizar y comparar los niveles de interleuquina-6 (IL6) e interferón-α (IFN-α) en el líquido crevicular gingival de pacientes VIH-1-positivos y VIH-1-negativos con periodontitis crónica y diferentes grados de destrucción e inflamación tisular. Se obtuvieron muestras del surco crevicular gingival de 35 individuos VIH-1 positivos con periodontitis crónica y 35 pacientes seronegativos con periodontitis crónica. Se evaluaron la profundidad de sondeo y el nivel de inserción clínica, así como los resultados del Ensayo Inmunoabsorbente Ligado a Enzimas para la confirmación del diagnóstico del paciente. Los análisis estadísticos se realizaron utilizando pruebas t de Student, Mann-Whitney y Spearman. Los niveles de IL-6 fueron significativamente más bajos, mientras que los niveles de IFN-a fueron significativamente más altos en los pacientes con VIH-1. El nivel de inserción clínica se asoció directamente con los niveles de IFN-α en los portadores del VIH1, conectados a la profundidad del sondaje en estos pacientes. Los datos clínicos en asociación con los niveles de citoquinas de los fluidos creviculares gingivales pueden revelar un patrón de respuesta inmunológica localizado, que puede contribuir a la comprensión de la patogénesis de la periodontitis en los portadores del VIH-1.


Subject(s)
Humans , Middle Aged , Periodontal Diseases/diagnosis , HIV Infections/immunology , Gingival Crevicular Fluid/immunology , Chronic Periodontitis/classification , Brazil , Cytokines/analysis , Gingival Crevicular Fluid/chemistry , Acquired Immunodeficiency Syndrome , Interleukin-6/analysis , Interferon-alpha , Statistics, Nonparametric , Ethics Committees, Research
9.
Braz. j. infect. dis ; 22(2): 142-145, Mar.-Apr. 2018. tab
Article in English | LILACS | ID: biblio-1039213

ABSTRACT

ABSTRACT The HIV-1 initial viral infection may present diverse clinical and laboratory course and lead to rapid, intermediate, or long-term progression. Among the group of non-progressors, the elite controllers are those who control the infection most effectively, in the absence of antiretroviral therapy (ART). In this paper, the TH1, TH2 and TH17 cytokines profiles are described, as well as clinical and laboratory aspects of an HIV-infected patient with undetectable viral load without antiretroviral therapy. Production of IL-6, IL-10, TNF-α, IFN-γ, and IL-17 was detected; in contrast IL-4 was identified. Host-related factors could help explain such a level of infection control, namely the differentiated modulation of the cellular immune response and a non-polarized cytokine response of the TH1 and TH2 profiles.


Subject(s)
Humans , Female , Adult , HIV Infections/immunology , Cytokines/immunology , HIV-1 , HIV Long-Term Survivors , CD4-Positive T-Lymphocytes/immunology , HIV Infections/blood , HIV Infections/virology , Th2 Cells/immunology , Th1 Cells/immunology , CD8-Positive T-Lymphocytes/immunology , Viral Load , Antiretroviral Therapy, Highly Active , Immunity, Cellular/immunology
10.
Arch. endocrinol. metab. (Online) ; 62(1): 64-71, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-887635

ABSTRACT

ABSTRACT Objective The present study compares immune and endocrine parameters between HIV-infected patients who underwent the Immune Reconstitution Inflammatory Syndrome (IRIS-P) during antiretroviral therapy (ART) and HIV-patients who did not undergo the syndrome (non-IRIS-P). Materials and methods Blood samples were obtained from 31 HIV-infected patients (15 IRIS-P and 16 non-IRIS-P) before ART (BT) and 48 ± 2 weeks after treatment initiation (AT). Plasma Interleukin-6 (IL-6) and Interleukin-18 (IL-18) were determined by ELISA. Cortisol, dehydroepiandrosterone sulfate (DHEA-S) and thyroxin concentrations were measured using chemiluminescence immune methods. Results Concentrations of IL-6 (7.9 ± 1.9 pg/mL) and IL-18 (951.5 ± 233.0 pg/mL) were significantly higher (p < 0.05) in IRIS-P than in non-IRIS-P (3.9 ± 1.0 pg/mL and 461.0 ± 84.4 pg/mL, respectively) BT. Mean T4 plasma level significantly decreased in both groups of patients after treatment (p < 0.05). In both groups cortisol levels were similar before and after ART (p > 0.05). Levels of DHEA-S in IRIS-P decreased AT (1080.5 ± 124.2 vs. 782.5 ± 123.8 ng/mL, p < 0.05) and they were significantly lower than in non-IRIS-P (782.5 ± 123.8 vs. 1203.7 ± 144.0 ng/mL, p < 0.05). IRIS-P showed higher values of IL-6 and IL-18 BT and lower levels of DHEA-S AT than in non-IRIS-P. Conclusion These parameters could contribute to differentiate IRIS-P from non-IRIS-P. The significant decrease in DHEA-S levels in IRIS-P after ART might suggest a different adrenal response in these patients, which may reflect the severity of the disease.


Subject(s)
Humans , Male , Female , Middle Aged , Biomarkers/blood , HIV Infections/blood , Antiretroviral Therapy, Highly Active/adverse effects , Immune Reconstitution Inflammatory Syndrome/blood , Thyroxine/blood , Enzyme-Linked Immunosorbent Assay , Hydrocortisone/blood , HIV Infections/immunology , HIV Infections/metabolism , HIV Infections/drug therapy , Prospective Studies , Interleukin-6/blood , CD4-CD8 Ratio , Dehydroepiandrosterone Sulfate/blood , Viral Load , Interleukin-18/blood , Luminescence , Immune Reconstitution Inflammatory Syndrome/immunology , Immune Reconstitution Inflammatory Syndrome/metabolism
11.
Rev. Soc. Bras. Med. Trop ; 51(1): 21-29, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-897054

ABSTRACT

Abstract INTRODUCTION The functioning of the immune system during pregnancy is altered in both human immunodeficiency virus (HIV)-infected and uninfected women. Unfavorable socioeconomic conditions have been indicative of higher morbidity and mortality and worsening of the immune system. The aim of this study was to correlate social status with levels of interleukin (IL)-10 (non-inflammatory) and interferon-gamma (IFN-γ; inflammatory) cytokines. METHODS A cross-sectional study was conducted with three groups of women: 33 pregnant HIV-infected (G1); 40 non-pregnant, HIV-infected (G2); and 35 pregnant, HIV-uninfected. To measure the social status, a compound indicator called the social status index (SSI), was established using sociodemographic variables (i.e., education level, housing conditions, per capita income, and habitation and sanitary conditions). RESULTS The HIV-infected women had a higher proportion of unfavorable SSI (73% and 75% of G1 and G2, respectively). There were significantly lower IL-10 levels in the G1 group with both unfavorable and favorable SSI than in the other groups. No significant difference in IFN-γ levels was observed among groups. However, the G1 group had higher IFN-γ values among both favorable and unfavorable SSI groups. CONCLUSIONS Higher rates of unfavorable conditions, including lower education levels, IL-10 levels, and a trend for higher IFN-γ levels, were identified among HIV-infected women, pregnant and non-pregnant. These factors may interfere in health care and lead to poor outcomes during pregnancy. Therefore, we suggest that health policies could be created to specifically address these factors in this population.


Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Complications, Infectious/immunology , HIV Infections/immunology , Interferon-gamma/blood , Interleukin-10/blood , Pregnancy Complications, Infectious/blood , Pregnancy Complications, Infectious/virology , Social Conditions , Socioeconomic Factors , Brazil , HIV Infections/blood , Cross-Sectional Studies , Interferon-gamma/immunology , Interleukin-10/immunology
12.
Rev. chil. infectol ; 35(3): 326-328, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-1042646

ABSTRACT

Resumen Introducción: La terapia anti-retroviral (TARV) en pacientes con infección por VIH ha causado una disminución de la morbimortalidad y del riesgo de transmisión. Las recomendaciones internacionales actuales sugieren un inicio precoz de TARV, independiente del recuento de linfocitos T CD4. Objetivo: Describir el impacto del inicio de TARV en el recuento de CD4 y carga viral (CV) al año de tratamiento en pacientes que ingresaron al Programa de VIH del HCVB en los años 2013 y 2015. Métodos: Estudio descriptivo que incluyó a todos los pacientes que iniciaron TARV durante los años mencionados. Resultados: 78 y 100 pacientes iniciaron TARV el año 2013 y 2015; respectivamente. El año 2013, 48 (61,5%) pacientes, y el año 2015, 55 (55%) pacientes iniciaron terapia con un recuento de CD4 > 200 céls/mm3. En el primer grupo, al año de seguimiento, 43 (55%) pacientes tuvieron una CV indetectable; mientras que en el segundo grupo, esta meta se logró en 72% de los casos (p = 0,001). Conclusiones: El inicio temprano de TARV aumentó la proporción de pacientes con CV indetectable. Sin embargo, debemos mejorar las estrategias para optimizar los resultados.


Introduction: Anti-retroviral therapy (ART) in HIV patients has shown reduction in morbidity and mortality, and decrease in contagious risk. International recommendations include early initiation of ART, irrespectively of CD4 cell count. Objective: To describe the impact of ART initiation in CD4 cell count and viral load at the end of the first year of HIV treatment, for patients who entered the program at 2013 and 2015. Methodology: Descriptive study. The sample comprehends all patients who started their ART treatment in the indicated years, at HCVB. Results: 78 and 100 patients initiated ART treatment in 2013 and 2015, respectively. In 2013, 48 out of 78 patients (61.5%), and in 2015, 55 (55%) patients started therapy with CD4 > 200 cell/mm3. The follow-up in the first group resulted on 43 (55%) patients with an undetectable CV at the end of first year of treatment, meanwhile in the second group 72% achieved this target (p = 0.001). Conclusions: Early ART initiation increased the proportion of patients with undetectable CV. However, we must improve strategies to optimize results.


Subject(s)
Humans , Male , Adult , HIV Infections/drug therapy , CD4 Lymphocyte Count , Anti-HIV Agents/therapeutic use , Viral Load , Antiretroviral Therapy, Highly Active , HIV Infections/immunology , HIV Infections/virology , Follow-Up Studies
14.
Actual. SIDA. infectol ; 25(96): 80-83, 20170000.
Article in Spanish | LILACS, BINACIS | ID: biblio-1355240

ABSTRACT

El ergotismo es una complicación bien conocida, aunque poco fre-cuente, asociada a la ingesta de derivados de la ergotamina en dosis habitualmente más altas de las recomendadas. No obstante, también puede presentarse luego del uso de bajas dosis cuando se adminis-tran concomitantemente drogas que inhiben su metabolismo, entre ellas los inhibidores de proteasa (IP), ampliamente utilizados en el tra-tamiento de pacientes con infección por el virus de la inmunodeficien-cia humana (VIH). A pesar de esta interacción predecible se siguen observando en la práctica clínica diaria casos de ergotismo, probable-mente debido a que se trata de una droga de uso frecuente, bajo cos-to y que no requiere prescripción médica, sumado a la falta de conoci-miento del paciente de las potenciales interacciones. Se describen las características, diagnóstico, tratamiento y evolución de cuatro pacien-tes con infección por VIH en tratamiento antirretroviral (TARV), basa-do en IP, que presentaron un cuadro de ergotismo


Ergotism is a well-known but rare complication associated with the intake of ergotamine derivatives at doses usually higher than recommended. However, it may also occur after low doses of ergotamine when it is co-administered with drugs that inhibit its metabolism, such as protease inhibitors (PIs), widely used in the treatment of patients with human immunodeficiency virus. Despite this predictable interaction, cases of ergotism are still being observed in daily clinical practice, probably because it is a frequently used, low cost drug that does not require medical prescription, in addition to the patient's lack of knowledge of the potential interactions. We describe here the characteristics, diagnosis, treatment and evolution of four HIV-infected patients on PI-based antiretroviral treatment who presented a clinical picture of ergotism


Subject(s)
Humans , Male , Female , Protease Inhibitors/therapeutic use , Self Medication , HIV Infections/immunology , Ergotism , Antiretroviral Therapy, Highly Active , Ergotamine/administration & dosage , Prescription Drug Misuse
15.
Clinics ; 72(11): 652-660, Nov. 2017. tab, graf
Article in English | LILACS | ID: biblio-890691

ABSTRACT

OBJECTIVES: The impact of Chagas disease (CD) in HIV-infected patients is relevant throughout the world. In fact, the characterization of the adaptive immune response in the context of co-infection is important for predicting the need for interventions in areas in which HIV and Chagas disease co-exist. METHODS: We described and compared the frequency of cytokine-producing T cells stimulated with soluble antigen of Trypanosoma cruzi (T. cruzi) using a cytometric assay for the following groups: individuals with chronic Chagas disease (CHR, n=10), those with Chagas disease and HIV infection (CO, n=11), those with only HIV (HIV, n=14) and healthy individuals (C, n=15). RESULTS: We found 1) a constitutively lower frequency of IL-2+ and IFN-γ+ T cells in the CHR group compared with the HIV, CO and healthy groups; 2) a suppressive activity of soluble T. cruzi antigen, which down-regulated IL-2+CD4+ and IFN-γ+CD4+ phenotypes, notably in the healthy group; 3) a down-regulation of inflammatory cytokines on CD8+ T cells in the indeterminate form of Chagas disease; and 4) a significant increase in IL-10+CD8+ cells distinguishing the indeterminate form from the cardiac/digestive form of Chagas disease, even in the presence of HIV infection. CONCLUSIONS: Taken together, our data suggest the presence of an immunoregulatory response in chronic Chagas disease, which seems to be driven by T. cruzi antigens. Our findings provide new insights into immunotherapeutic strategies for people living with HIV/AIDS and Chagas disease.


Subject(s)
Humans , Male , Female , Adult , CD4-Positive T-Lymphocytes/immunology , HIV Infections/immunology , Cytokines/biosynthesis , Chagas Disease/immunology , CD8-Positive T-Lymphocytes/immunology , Adaptive Immunity/immunology , HIV Infections/complications , Chronic Disease , Chagas Disease/complications , Coinfection/immunology , Flow Cytometry
16.
Rev. Inst. Med. Trop. Säo Paulo ; 59: e30, 2017. tab, graf
Article in English | LILACS | ID: biblio-842788

ABSTRACT

ABSTRACT Immunological and clinical findings suggestive of some immune dysfunction have been reported among HIV-exposed uninfected (HEU) children and adolescents. Whether these defects are persistent or transitory is still unknown. HEU pediatric population at birth, 12 months, 6-12 years were evaluated in comparison to healthy age-matched HIV-unexposed controls. Plasma levels of LPS, sCD14, cytokines, lymphocyte immunophenotyping and T-cell receptor excision circles (TREC) were assessed. HEU and controls had similar LPS levels, which remained low from birth to 6-12 years; for plasma sCD14, IL-2, IL-6, IL-7, IL-10, IL-12p70, IL-13, IL-17, IFN-γ, TNF-α, G-CSF, GM-CSF and MCP-1, which increased from birth to 12 months and then decreased at 6-12 years; and for TREC/106 PBMC at birth in HEU and controls. By contrast, plasma MIP-1β levels were lower in HEU than in controls (p=0.009) at 12 months, and IL-4 levels were higher in HEU than controls (p=0.04) at 6-12 years. Immune activation was higher in HEU at 12 months and at 6-12 years than controls based on frequencies of CD38+HLA-DR+CD8+T cells (p=0.05) and of CD38+HLA-DR+CD4+T cells (p=0.006). Resting memory and activated mature B cells increased from birth to 6-12 years in both groups. The development of the immune system in vertically HEU individuals is comparable to the general population in most parameters, but subtle or transient differences exist. Their role in influencing clinical incidences in HEU is unknown.


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Infant , Child , Pregnancy Complications, Infectious/immunology , HIV Infections/immunology , Lipopolysaccharides/blood , Cytokines/blood , CD4 Lymphocyte Count , Lipopolysaccharide Receptors/blood , Reference Values , Time Factors , Biomarkers/blood , Case-Control Studies , Lipopolysaccharides/immunology , Cytokines/immunology , Maternal Exposure , Lipopolysaccharide Receptors/immunology , Flow Cytometry , Immunologic Memory
17.
Rev. chil. infectol ; 33(6): 650-655, dic. 2016. tab
Article in Spanish | LILACS | ID: biblio-844418

ABSTRACT

Introduction: Pediatric antiretroviral therapy (ART), changed the prognosis of the disease, allowing young women infected by vertical transmission (TV) to be pregnant without risk for their fetus of acquiring this infection. Aim: To describe the clinical-immune status in pregnant women that acquired HV by vertical transmission, treatments received, monitoring of pregnancy and newborn characteristics. Material and Methods: A protocol was performed, evaluating clinical and immunological parameters during pregnancy, ART used, protocol preventing vertical transmission (PPTV), and follow up of children to 18 months of age. Results: Of 358 HIV-positive patients vertically infected, five women became pregnant, between 14 and 24 years old. Pregnancies were controlled in clinical/immune-stage N2 C3. They had received two to five therapies. Full PPTV was performed in all binomials. Pre-natal undetectable viral loads ranged from 4,700 ARN copies/mL. Five living children were born by Caesarean section, four of them with 37 weeks of completed gestation and one of them with 34 weeks of gestation. All received zidovudine (AZT) for 6 weeks. CD4 at 72 hours of life ranged from 48% to 74.6%. All children were born uninfected with HIV. Only two had mild anemia. Conclusions: Expectations of HIV mothers vertically infected to have healthy children are similar to those infected by horizontal transmission, using PPTV


Introducción: La terapia anti-retroviral en pediatría (TARV), cambió el pronóstico de la enfermedad, permitiendo embarazarse a mujeres jóvenes infectadas por transmisión vertical (TV). Objetivos: Conocer las características clínico-inmunológicas de las mujeres embarazadas, tratamientos recibidos, condición al embarazo y seguimiento de sus recién nacidos. Material y Método: Se efectuó un protocolo, evaluando etapas clínico-inmunológicas en el embarazo, TARV usadas, protocolo de prevención de transmisión vertical (PPTV) y seguimiento de los niños hasta 18 meses. Resultados: De 358 pacientes con infección por VIH adquirida por TV, cinco mujeres se embarazaron, con edades entre 14 a 24 años, embarazos que fueron controlados por el equipo de salud, encontrándose en etapa clínico-inmunológica N2 a C3. Habían recibido dos a cinco esquemas de TARV. Se efectuó PPTV completo en todos los binomios. Las cargas virales previas al parto fluctuaron entre indetectable y 4.700 copias ARN/ml. Nacieron por cesárea cinco niños vivos, cuatro de término y uno con 34 semanas de gestación. Todos recibieron zidovudina (AZT) durante seis semanas. Los CD4 a las 72 h de vida fluctuaron entre 48 y 74,6%. Ninguno de los niños adquirió la infección por VIH en forma vertical. Sólo dos presentaron anemia leve. Conclusiones: Las expectativas de madres con infección por VIH de adquisición vertical de tener hijos sanos son semejantes a las infectadas por transmisión horizontal, al usar PPTV.


Subject(s)
Humans , Male , Pregnancy , Infant, Newborn , Adolescent , Young Adult , Pregnancy Complications, Infectious/virology , HIV Infections/transmission , Infectious Disease Transmission, Vertical/prevention & control , Anti-HIV Agents/therapeutic use , Pregnancy Complications, Infectious/drug therapy , Pregnancy Outcome , HIV Infections/immunology , HIV Infections/prevention & control , Follow-Up Studies , CD4 Lymphocyte Count , Viral Load , Drug Therapy, Combination , Genotype
18.
Rev. AMRIGS ; 60(4): 359-362, out.-dez. 2016. ilus
Article in Portuguese | LILACS | ID: biblio-847830

ABSTRACT

A associação entre Vírus da Imunodeficiência Humana (HIV) e Malária é um evento de grande repercussão clínica. A grande importância de tal concomitância de diagnósticos dá-se por sua associação negativa, na qual se observa risco aumentado de infecção por malária em pacientes com HIV e o aumento de replicação viral nesses pacientes em decorrência da coinfecção pela malária. Os achados radiológicos incluem infiltrado intersticial ou alveolar, localizado preferencialmente nas regiões peri-hilares e em bases pulmonares, que pode ser associado a derrame pleural. O caso relatado é de um homem de 40 anos, branco, previamente hígido, que interna por quadro de febre, mialgia difusa e fadiga, após viagem de turismo ao continente africano. Em investigação laboratorial inicial, apresenta hemoconcentração e plaquetopenia importante. No decorrer da internação, tem diagnóstico de malária (demonstração do parasita no esfregaço sanguíneo) e inicia tratamento específico. Solicitou-se sorologia para HIV, a qual se apresentou positiva. O paciente evolui com febre ictero-hemorrágica, confusão mental, vômitos, insuficiência ventilatória e insuficiência renal aguda, sendo transferido para Unidade de Terapia Intensiva. Comprovou-se comprometimento pulmonar grave através da realização de Tomografia Computadorizada de Tórax de Alta Resolução, que evidenciou espessamento de septos interlobulares e de bainhas peribroncovasculares, com áreas esparsas de atenuação em vidro fosco e de consolidações, além de evidência de derrame pleural. Conclui-se que padrão de comprometimento radiológico do paciente foi compatível com os relatos já descritos pela literatura, o que corrobora para unificação de apresentação do quadro nos exames de imagem (AU)


The association between human immunodeficiency virus (HIV) and malaria is an event of great clinical repercussion. The great importance of such concomitance of diagnoses is due to its negative association, where there is an increased risk of malaria infection in patients with HIV and increased viral replication in these patients due to malaria co-infection. Radiological findings include interstitial or alveolar infiltrate, preferably located in the peri-hilar regions and at the lung bases, which may be associated with pleural effusion. The case reported here is of a white 40-year-old man, previously healthy, who was hospitalized for fever, diffuse myalgia and fatigue after a trip to the African continent. In initial laboratory investigation, he presented hemoconcentration and important thrombocytopenia. During the hospitalization, malaria was diagnosed (demonstration of the parasite in the blood smear) and specific treatment was initiated. HIV serology was requested and positive. As the patient progressed with icterohemorrhagic fever, mental confusion, vomiting, ventilatory failure and acute renal failure, he was transferred to the Intensive Care Unit. Severe pulmonary involvement was confirmed by high-resolution computed tomography, which showed thickening of interlobular septa and peribroncovascular sheaths, with sparse areas of ground-glass attenuation and consolidations, as well as evidence of pleural effusion. It was concluded that the patient's radiological involvement pattern was consistent with the reports already described in the literature, which corroborates the unification of the presentation of the picture in the imaging tests (AU)


Subject(s)
Humans , Male , Adult , HIV Infections/complications , Malaria, Falciparum/complications , Pulmonary Edema/etiology , HIV Infections/immunology , Malaria, Falciparum/immunology , Pulmonary Edema/pathology , Risk Factors
19.
Rev. chil. infectol ; 33(5): 531-536, oct. 2016. ilus, graf, tab
Article in English | LILACS | ID: biblio-844404

ABSTRACT

Introduction: Red Salud UC is an Academic health network where HIV-infected patients from the public and private health system are followed by a multidisplinary team. Aim: To determine virologic and immunologic response after 144 weeks of starting first antiretroviral therapy in these patients. Methods: A retrospective analysis of adult HIV patients attended between 1992 and 2011 was performed. Demographic and clinical characteristics, antiretroviral therapies data and immunologic and virologic outcomes were collected. CD4 count and HIV viral load changes up to 144 weeks after initiation of antiretroviral therapy were analyzed. Results: 860 patients were included in the analyses. Median age was 42 years, 93% were men. Median CD4+ count at baseline was 202 cells/mm³. The most used ART regimen was zidovudine/lamivudine plus efavirenz. First line anti-retroviral therapy was changed in 42% patients, being the most common cause, drug toxicity. At week 144, median CD4+ lymphocyte cell count was 449 cells/mm³. Ninety percent and 96% had undetectable viral load measured as < 50 copies/mL or < 400 copies/mL respectively. Discussion: First report of a university cohort, with CD4 and viral load follow up for 144 weeks, including Chilean patients from public and private system. After initiation of ART, an excellent immunologic and virologic response was observed in this cohort.


Introducción: La Red de Salud UC es una red académica de atención, donde pacientes portadores del VIH del área pública y privada de salud son atendidos por un equipo profesional multidisciplinario. Objetivo: Determinar las respuestas virológicas e inmunológicas a 144 semanas de iniciada la primera terapia antiretroviral en dichos pacientes. Métodos: Análisis retrospectivo de registros de pacientes adultos portadores de VIH atendidos entre 1992 y 2011. Se recolectaron datos demográficos, clínicos, terapia anti-retroviral, resultados inmunológicos y virológicos. Se analizaron los resultados de linfocitos T CD4+ y carga viral de VIH a las 144 semanas de iniciada la primera terapia anti-retroviral. Resultados: Fueron incluidos en el análisis 860 pacientes. El promedio de edad fue 42 años, 93% hombres. La mediana basal de LT CD4+ fue 202 céls/mm³. La terapia más utilizada fue zidovudina/lamivudina/efavirenz. En 42% de los pacientes se cambió la terapia de primera línea; la causa más común fue toxicidad a los anti-retrovirales. A la semana 144 de iniciada la terapia, la mediana de LT CD4+ fue de 449 céls/mm³. Alcanzaron cargas virales indetectables 90 y 96% con < 50 copias ARN/mL o < 400 copias ARN/mL respectivamente. Discusión: Primer reporte de pacientes tratados en un centro universitario, con seguimiento inmuno-virológico a 144 semanas, que incluye pacientes del área pública y privada de salud chilena. Después del inicio de la terapia, se observó una excelente respuesta inmuno-virológica.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , HIV Infections/drug therapy , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Time Factors , RNA, Viral , HIV Infections/immunology , HIV Infections/virology , Chile , Retrospective Studies , CD4 Lymphocyte Count , Viral Load
20.
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
SELECTION OF CITATIONS
SEARCH DETAIL