RESUMEN
Hepatitis B virus (HBV) molecular profiles were determined for 44 patients who were infected with human immunodeficiency virus (HIV) type 1 and had antibodies to the hepatitis B core antigen (anti-HBc), with and without other HBV serological markers. In this population, 70 percent of the patients were under lamivudine treatment as a component of antiretroviral therapy. HBV DNA was detected in 14 (32 percent) patients. Eight out of 12 (67 percent) HBsAg positive samples, 3/10 (30 percent) anti-HBc only samples, and 3/22 (14 percent) anti-HBs positive samples were HBV DNA positive. HBV DNA loads, measured by real time polymerase chain reaction, were much higher in the HBsAg positive patients (mean, 2.5 Î 10(9) copies/ml) than in the negative ones (HBV occult infection; mean, 2.7 Î 10(5) copies/ml). Nine out of the 14 HBV DNA positive patients were under lamivudine treatment. Lamivudine resistant mutations in the polymerase gene were detected in only three patients, all of them belonging to the subgroup of five HBsAg positive, HBV DNA positive patients. A low mean HBV load (2.7 Î 10(5) copies/ml) and an absence of lamivudine resistant mutations were observed among the cases of HBV occult infection.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/complicaciones , VIH-1 , Virus de la Hepatitis B/inmunología , Hepatitis B/diagnóstico , Lamivudine/uso terapéutico , Brasil , ADN Viral/análisis , Farmacorresistencia Viral/genética , Ensayo de Inmunoadsorción Enzimática , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Anticuerpos contra la Hepatitis B/sangre , Antígenos del Núcleo de la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Virus de la Hepatitis B/genética , Hepatitis B/complicaciones , Mutación/genética , Reacción en Cadena de la Polimerasa , Factores de Riesgo , Carga ViralRESUMEN
Opportunistic diseases (OD) are the most common cause of death in AIDS patients. To access the incidence of OD and survival in advanced immunodeficiency, we included 79 patients with AIDS treated at Hospital Evandro Chagas (FIOCRUZ) from September 1997 to December 1999 with at least one CD4 count <=100 cells/mm³. The incidence of OD was analyzed by Poisson's regression, and survival by Kaplan Meier and Cox analysis, considering a retrospective (before CD4 <=100 cells/mm³) and a prospective (after CD4 <=100 cells/mm³) period, and controlling for demographic, clinical and laboratory characteristics. The confidence interval estipulated was 95 percent. Mean follow-up period was 733 days (CI = 683-782). During the study 9 (11.4 percent) patients died. Survival from AIDS diagnosis was a mean of 2589 days (CI = 2363-2816) and from the date of the CD4 count CD4 <=100 cells/mm³ was a mean of 1376 (CI = 1181-1572) days. Incidence of OD was 0.51 pp/y before CD4 <= 100 cells/mm³ and 0.29 pp/y after CD4 <= 100 cells/mm³. A lower number of ODs before CD4 < 100 cells/mm³ was associated with lower incidence rates after CD4 <= 100 cells/mm³. AIDS diagnosis based on CD4+ counts <= 200 cells/mm³ was associated with lower incidence rates after CD4 <= 100 cells/mm³. Baseline CD4 counts above 50 cells/mm³ (HR = 0.13) and restoration of baseline CD4+ counts above 100 cells/mm³ (HR = 0.16) were associated with a lower risk of death. Controling both variables, only restoration of baseline counts was statistically significant (HR = 0.22, p = 0.04). We found a very low incidence of OD and long survival after CD4 < 100 cells/mm³. Survival was significantly associated with restoration of baseline CD4 counts above 100 cells/mm³