Immune reconstitution inflammatory syndrome associated with pulmonary sarcoidosis in an HIV-infected patient: an immunohistochemical study

Sarcoidosis has been rarely described in literature as a cause of interstitial pulmonary disease associated with AIDS. This study reports a case of immune reconstitution inflammatory syndrome associated with pulmonary sarcoidosis in a patient with a history of previous pulmonary tuberculosis concomitant with HIV infection. Results of the immunohistochemical study of samples from the resected right lower lobe are described. Pathological findings suggest a role of Th1, Th2 and Th17 response in IRIS associated sarcoidosis.

Evaluation of disease patterns, treatment and prognosis of tuberculosis in AIDS patient

Patterns of disease, diagnosis, treatment and prognosis of tuberculosis in 100 patients co-infected with AIDS at Casa da AIDS clinic was studied. Demographic characteristics were as follows: 76 male patients, 24 female patients, 67 caucasian, average 35.8 years-old (SD +/- 8.5). Sexual transmission of HIV was reported in 68 patients. Pulmonary tuberculosis was seen in 40 patients, extrapulmonary in 11, and combined in 49 patients. In 63 patients, TCD(4)(+) counts were below 200/mm(3) when tuberculosis was diagnosed. Fifty-five patients had their diagnoses confirmed by bacteriological identification of Mycobacterium; either through direct observation and/or culture. Tuberculosis was treated with rifampin, isoniazid and pyrazinamide in 60 patients, reinforced treatment in 14 and alternative treatment in the other 13 patients. Tuberculosis therapy lasted up to 9 months in 66 of the patients. Fifty-four patients were treated with a two-drug antiretroviral regimen and the remaining 46 patients received a triple regimen, which included a protease inhibitor. Among the latter, 35 patients were co-treated with rifampin. The occurrence of hepatic liver enzyme abnormalities was statistically related to alternative antiretroviral regimens (p = 0.01) and to the co-administration of rifampin and protease inhibitor (p = 0.019). Clinical resolution of tuberculosis was obtained in 74 patients. Twelve patients died during tuberculosis treatment. Resolution of tuberculosis was statistically significant related to antituberculosis treatment adherence (p = 0.001). The risk of no response to the treatment was 1.84 times more frequent among patients treated with alternative regimens regardless of the duration of the therapy. We conclude that the characteristics of tuberculosis in HIV infected patients requires that special attention be directed to the types and duration of both antiretroviral and anti-TB therapy in order to achieve the highest level of care.

Estudo comparativo da flora microbiana cervicovaginal e outras variaveis da rotina ginecologica em mulheres infectadas e nao infectadas pelo virus da imunodeficiencia humana / Comparative study of the cervicovaginal microbial flora and other variables in the gynecological routine among infected and no infected women with the human immunodeficiency virus

O objetivo deste trabalho foi estudar a flora microbiana cervicovaginal, e outras variaveis da rotina ginecologica em mulheres infectadas pelo HIV, com contagem de linfocitos T CD4+ maior ou igual a 200 celulas/mm3, comparados as mulheres nao infectadas. Os resultados demonstraram frequencias similares no exame ginecologico, microbiologia cervicovaginal, citologia, vaginoscopia e exame anatomopatologico. Nas pacientes infectadas pelo HIV, observaram-se diferencas estatisticamente significativas no que se refere a inversao de leucocitos e Bacilos de Doderlein a bacterioscopia, achados colposcopicos e vulvoscopicos, indicando a necessidade de maior cuidado no exame dessas pacientes

Fatores preditivos de abandono de tratamento por pacientes com tuberculose / Predictive factors of abandoning treatment in tuberculosis patients

Apesar dos esforços para controlar a disseminaçäo da tuberculose em todo o mundo, esta doença persiste como um dos maiores problemas de Saúde Publica. Neste contexto, o aparecimento de cepas multirresistentes as drogas tem um efeito dramático. O abandono do tratamento tem relaçäo direta com a disseminaçäo da doença e o aparecimento de cepas multirresistentes. Para verificar se é possivel identificar pacientes com alto risco de abandono do tratamento a partir de dados obtidos na primeira consulta, estudamos uma populaçäo envolvida em um estudo prospectivo. Entre 257 pacientes consecutivos avaliados entre janeiro de 1991 e janeiro de 1994, comparamos 87 pacientes que abandonaram o tratamento antes de seis meses (A) com 97 pacientes que completaram seis meses de tratamento (C). A taxa de abandono nesta populaçäo foi de 33,85 por cento, bem maior que a média de 12,9 por cento apontada pelo Ministério da Saúde...