Concepciones de usuarios sobre nuevas vías de administración de profilaxis pre-exposición para el VIH / Users' expectations of the new pre-exposure prophylaxis for the HIV modalities

Resumen Este artículo tiene como objetivo discutir las concepciones de los Hombres Gay, Hombres Bisexuales y una Mujer Transgénero que usan o quieren usar profilaxis previa a la exposición por el virus de la inmunodeficiencia humana oral (PrEP) sobre nuevas vías de administración. Fueron entrevistados 17 usuarios del BCN Checkpoint. Las entrevistas fueron grabadas en audio, sometidas a análisis categorial temático teniendo en cuenta la perspectiva praxeográfica. Todos están adaptados al uso de la PrEP diaria y a demanda. En relación con las nuevas vías de administración (PrEP inyección intramuscular cada dos meses; pastilla mensual; inyección subcutánea cada seis meses) todos son muy receptivos a esas posibilidades, pero les falta información sobre las especificidades de cada una de ellas y una evaluación específica de sus necesidades. Tanto la satisfacción con el uso de PrEP oral, como las expectativas sobre las nuevas vías de administración son positivas. Sin embargo, lo más importante para los/a entrevistados/a es la garantía de que tendrán seguimiento para continuar cuidando de la salud afectivo-sexual, lo que no depende del tipo de vía de administración.

Abstract This article aims to discuss the expectations of Homosexual Men, Bisexual Men and a Transgender Woman, who use or want to use an oral pre-exposure prophylaxis (PrEP) for the human immunodeficiency virus (HIV) about PrEP modalities. Sixteen PrEP users, who are followed up in the BCN Checkpoint, were interviewed,. The interviews were audio-recorded, subjected to thematic categorical analysis within the theoretical framework from the praxiographic perspective. They are all adapted to the use of daily oral and event-based PrEP. In relation to the new PrEP modalities (monthly pill; intramuscular injection every two months; subcutaneous injection every six months), they are all very receptive to these possibilities, but they lack information on the specificities of each and specific assessment of their needs. Comments about the use of oral PrEP are positive, and expectations regarding the new PrEP modalities are visibly high. However, the most important thing for the interviewees is the guarantee that they will have follow-up appointments to continue taking care of their affective-sexual health, which is not dependent on the type of PrEP modalities.

Longitudinal Trends in HIV-1 Subtypes and Drug Resistance in Children from Argentina over a 15-Year Period (2006-2021)

ABSTRACT Background: Human immunodeficiency virus (HIV) drug resistance is a major cause of treatment failure in children and adolescents infected with the virus. Objectives: The objectives of the study are to investigate HIV drug resistance (HIVDR) in patients who attended a referral care center in Argentina over a 15-year period and to compare mutational patterns between HIV-1 pol sequences characterized as B or BF recombinants. Methods: Individual resistance-associated mutations (RAMs) (to protease and reverse transcriptase inhibitors) were identified according to IAS-USA guidelines in 374 HIV-1-infected children and adolescents. HIV-1 subtype was characterized by phylogenetic and recombination analysis using MEGA5.1 and Simplot. Poisson linear regression was used to model the dynamics of the RAMs over time. Results: The prevalence of RAMs to protease inhibitors (R2 = 0.52, p = 0.0012) and nucleoside reverse transcriptase inhibitors (R2 = 0.30, p = 0.0225) decreased over time. HIVDR to non-nucleoside reverse transcriptase inhibitors remained moderate to high, ranging between 33% and 76%. BF recombinants showed a higher frequency of thymidine analog mutation 1 RAMs profile and I54V mutation. Conclusion: In Argentina, HIVDR observed in children and adolescents has decreased over the past 15 years, regardless of the viral subtype.

Resistencia a los inhibidores de la integrasa en niños con el virus de la inmunodeficiencia humana por transmisión vertical: primeros casos en Uruguay / Resistance to integrase inhibitors in children with vertically-transmitted human immunodeficiency virus: First cases in Uruguay

La resistencia a los antirretrovirales (ARV) es un problema de salud pública. Con el uso de inhibidores de la integrasa (INSTI) en pediatría, también comienzan a aparecer resistencias. El objetivo de esta comunicación es describir 3 casos con resistencia a los INSTI. Se describen 3 pacientes pediátricos con transmisión vertical del virus de la inmunodeficiencia humana (VIH). Iniciaron ARV de lactantes y preescolares, con mala adherencia al tratamiento, cursaron con diferentes planes secundarios a comorbilidades asociadas y fallas virológicas por resistencia. Los 3 casos clínicos describen la rápida aparición de resistencia frente a la falla virológica y el compromiso de los INSTI. La adherencia debe ser supervisada para detectar precozmente el aumento de la viremia. La falla virológica en un paciente tratado con raltegravir obliga a un rápido cambio de esquema ARV, ya que continuar utilizándolo podría favorecer nuevas mutaciones y resistencia a los INSTI de segunda generación.

Antiretroviral (ARV) drug resistance is a public health issue. Resistance has also been observed in the case of integrase strand transfer inhibitors (INSTIs) used in pediatrics. The objective of this article is to describe 3 cases of INSTI resistance. These are the cases of 3 children with vertically-transmitted human immunodeficiency virus (HIV). They were started on ARVs as infants and preschoolers, with poor treatment adherence, and had different management plans due to associated comorbidities and virological failure due to resistance. In the 3 cases, resistance developed rapidly as a result of virological failure and INSTI involvement. Treatment adherence should be monitored so that any increase in viremia can be detected early. Virological failure in a patient treated with raltegravir forces to a rapid change in ARV therapy because its continued use may favor new mutations and resistance to second-generation INSTIs.

Functions of HIV-1 Tat and its association with diseases / 中国生物制品学杂志

@#Acquired immune deficiency syndrome,or AIDS,has been a major infectious disease that troubles the public health in a global scale. Human immunodeficiency virus type 1(HIV-1)is the causative reagent responsible for AIDS development. Even though the highly active anti-retroviral therapy(HAART,or the cocktail therapy)that has been widely applied could effectively suppress the infection and replication of HIV-1,the infected people suffer from other related diseases,such as the HIV-associated neurocognitive disorder(HAND). This paper mainly focused on the function of an important regulatory protein of HIV-1,trans-activator of transcription(Tat),and its correlation with HIV-1 replication and HAND development,so as to clarify the importance of developing anti-AIDS drugs targeting Tat protein

Human papillomavirus in women infected with human immunodeficiency virus: association with viral load and lymphocyte count

ABSTRACT Women living with human immunodeficiency virus are at an increased risk of developing cancers related to human papillomavirus (HPV). Thus, it is important to combine clinical assessments, serological screening, and HPV data for planning prevention policies. This study aimed to identify HPV and its specific types in the cervical, anal, and oral mucosa of HIV-seropositive women, associating it with viral load and lymphocyte count. Sociodemographic characteristics, health data (CD4+ and CD8+ T cell counts and viral load), and biological samples (cervical, anal, and oral) were collected from 86 HIV-positive women undergoing antiretroviral therapy. Data were classified according to the presence or absence of HPV-DNA, HPV-DNA presence at one or more anatomic sites, and level of oncogenic risk, considering low- and high-risk oncogenic HPV-DNA groups. The presence of HPV in the cervicovaginal site was 65.9%, 63.8% in anal canal, and 4.2% in oral mucosa. A viral load ≥75 HIV copies/mL was associated with the presence of HPV-DNA. There was an association between viral load and the low-risk HPV or high-risk HPV groups. We found a high prevalence of HPV infection in HIV-seropositive women, particularly in the cervical and anal mucosa, with viral load ≥75 HIV copies/mL being associated with HPV-DNA presence.

HIV with initial ocular Kaposi sarcoma / HIV com sarcoma de Kaposi ocular inicial

ABSTRACT We present an interesting case of a 62-year-old black female, presented to the ophthalmological hospital with a little "nevus" on the left eye previously visualized at the mirror, with one month of development. Physical examination with slit lamp (biomicroscopy) showed a group of painless veins, with vascular redness, and a mass nodular aspect in the mid temporal bulbar conjunctiva, of approximately 2mmx4mm.

RESUMO Apresentamos o interessante caso de uma mulher negra de 62 anos, que deu entrada no hospital oftalmológico com um pequeno nevo no olho esquerdo previamente visualizado ao espelho, com 1 mês de evolução. O exame físico com lâmpada de fenda (biomicroscopia) mostrou um grupo de veias indolor e vermelhidão vascular, com uma massa de aspecto nodular na conjuntiva bulbar temporal média, de aproximadamente 2mmx4mm.

Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection

ABSTRACT Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors.

Clinico-epidemiological characteristics of adolescents and young adults living with HIV in Ghana

Introduction: sub-Saharan Africa is experiencing a boom in the number of adolescents and young adults living with HIV (AYALHIV). Existing HIV intervention programs are mainly for children and adults living with HIV, with little attention paid to AYALHIV. Characterizing this population is necessary for planning, and designing, AYALHIV-centered HIV intervention programs. Methods: a retrospective single-center, hospital-based chart review was conducted at the largest HIV clinic in Ghana. We examined routinely collected data for AYALHIV (aged 10-24 years) on antiretroviral therapy (ART) for at least 1 year and in active care from 1st January to 31st December 2019. Data was collected using a structured data extraction form. The Chi-square and the Student´s t-test were used to compare characteristics between adolescents and young adults. Results: of 252 AYALHIV, 68% (172/252) were adolescents with a median age of 17 years (IQR 13-19); 32% were young adults with a median age of 22 years (IQR: 20-24). Most (56.7% (143/252)) AYALHIV were female. Almost 40% were orphans. Eighty-six percent of AYALHIV had HIV type I infection. The commonest mode of HIV acquisition among adolescents was vertical transmission (70.5%) and that among young adults was via unprotected sex (31.3%). 88% of AYALHIV were on non-nucleoside reverse transcriptase inhibitors-based regimen. The viral suppression rate among AYALHIV was 78%. Conclusion: the study shows there is a growing population of AYALHIV most of which are adolescents. About two-fifths were orphans. Policymakers and HIV programs should ensure AYALHIV-centred interventions are developed for this vulnerable population.

Infecciones orales por VPH en personas HIV positivas de Corrientes, Argentina / Oral HPV infection in HIV-positive persons from Cor rientes, Argentina

Resumen Introducción : Las infecciones por virus del papiloma humano (VPH) en cavidad oral se asocian a un subgrupo de cánceres cuya prevalencia está en incremento en todo el mundo. Las personas portadoras HIV (PHIV) tienen un mayor riesgo de contraer una infección por VPH y eventualmente desarrollar cáncer. El presente estudio trata de relevar la frecuencia y variabilidad genotípica de dicho virus en cavidad oral y su asociación con pro bables factores de riesgo en una población HIV+ de la provincia de Corrientes. Métodos : Se tomaron enjuagados bucales de 133 participantes. Luego de la extracción de ADN se detectó por PCR anidada la presencia de VPH. Los casos positivos se tipificaron por Reverse Line Blot y por secuenciación. Resultados : En la serie analizada se detectó una fre cuencia global de VPH del 22% (29/133) en los enjuagados bucales. El 62% (18/29) de los casos positivos presentó al menos un genotipo de alto riesgo. Los participantes con más de 36 años (p = 0.03, aOR = 3.2, IC = 1.1-9,4) y una carga viral de más de 40 copias/mL (p = 0.04, aOR = 3.3, IC = 1.1-10.3) reflejaron mayor riesgo de infección por VPH. La edad de inicio de relaciones sexuales también resultó un indicador útil en los casos que presenta ron infecciones por genotipos de alto riesgo (p = 0.04, aOR = 7.2, IC = 1.6-32.3). Además, se observaron genotipos de bajo riesgo no reportados con anterioridad en cavidad oral de habitantes de la región (VPH-13 y VPH-114). Discusión : Relevar datos epidemiológicos basales en pobla ciones vulnerables y altamente expuestas a VPH ayuda a clarificar la historia natural del virus en localizaciones extragenitales y a focalizarnos en particularidades regio nales que permitan elaborar políticas de salud acordes a la magnitud del problema local.

Abstract Introduction : Oral cavity HPV infections are associ ated with a subgroup of cancers whose prevalence is increasing worldwide. HIV infected people are in an increased risk of contracting HPV infection and devel oping cancer. The present study reveals the frequency and genotypic variability of this virus in the oral cavity and its association with probable risk factors in an HIV+ population of the province of Corrientes. Methods : Mouthwashes were taken from 133 partici pants. After DNA extraction, the presence of HPV was detected by nested PCR. Positive cases were typed by reverse line blot or by sequencing. Results : HPV was detected in 22% (29/133) of the mouthwashes. In 62% (18/29) of the positive samples, at least one high-risk genotype was detected. Participants older than 36 years (p = 0.03, aOR = 3.2, CI = 1.1-9.4) and a viral load of more than 40 copies (p = 0.04, aOR = 3.3, CI = 1.1-10.3) had higher risk of infection by any HPV genotype. In relation to the age of initiation of sexual intercourse, it was a significant parameter in the case of patients with infections by high-risk genotypes (p = 0.04, aOR = 7.2, IC = 1.6-32.3). In addition, previously unreport ed low-risk genotypes were observed in the oral cavity of inhabitants of the region like HPV-13 and HPV-114. Discussion : Collecting baseline epidemiological data in this type of vulnerable population helps to clarify the natural history of the virus in extragenital locations and focus on regional particularities that allow the development of health policies in accordance with the magnitude of the regional problem.

Prevalencia de enfermedades infecciosas y parasitarias en el servicio de pacientes con necesidades especiales de la Facultad de Estomatología de la Universidad Peruana Cayetano Heredia / Prevalence of infectious and parasitic diseases in the service of patients with special needs of the Faculty of Stomatology of the Universidad Peruana Cayetano Heredia / Prevalência de doenças infecciosas e parasitárias no serviço de pacientes com necessidades especiais da Faculdade de Estomatologia da Universidad Peruana Cayetano Heredia

RESUMEN Objetivo: Determinar la prevalencia de diagnósticos médicos de las enfermedades infecciosas y/o parasitarias de pacientes que acudieron al servicio de Estomatología en Pacientes Especiales (EPE) de la Universidad Peruana Cayetano Heredia. Material y métodos: La población (n = 38) estuvo conformada por el número de diagnósticos médicos de pacientes con enfermedades infecciosas y/o parasitarias que acudieron al servicio de EPE durante los años 2015 y 2016. La información se trasladó a una base de datos en el programa Excel 2017, para posteriormente ser procesada y analizada de acuerdo con lo requerido por el programa Stata 12. Resultados: De un total de 1718 diagnósticos médicos, las enfermedades infecciosas y/o parasitarias tuvieron una prevalencia de 2,21 % (n = 38). Dentro de este grupo de enfermedades, el virus de inmunodeficiencia humana (VIH) fue el más prevalente con 63,2 % (n = 24), siendo el sexo masculino el más prevalente con 79 % (n = 19); y dentro del grupo etario de 21 a 40 años de edad, el segundo diagnóstico específico más prevalente fue la hepatitis A con un 15,8 % (n = 6), en donde el sexo femenino fue el más prevalente con 83 % (n = 5). Conclusiones: El diagnóstico específico, dentro del grupo de las enfermedades infecciosas y/o parasitarias, con mayor prevalencia fue el VIH con un 63,2 % (n = 24).

ABSTRACT Objective: To determine the prevalence of medical diagnoses of infectious and/or parasitic diseases in patients who attended the Special Patients Stomatology Service (EPE) of the Cayetano Heredia Peruvian University. Material and methods: The population (n = 38) comprised the number of medical diagnoses of patients with infectious and/or parasitic diseases who attended the EPE service during 2015 and 2016. The information was transferred to a database in the Excel 2017 program to be processed and analyzed as required by the Stata 12 program. Results: Of 1718 medical diagnoses, infectious and/or parasitic diseases had a prevalence of 2.21% (n = 38). Within this group of diseases, human immunodeficiency virus (HIV) was the most prevalent, with 63.2 % (n = 24), with the male sex being the most prevalent with 79 % (n = 19). Within the age group of 21 to 40 years of age, the second most prevalent specific diagnosis was hepatitis A with 15.8 % (n = 6), whereas the female sex was the most prevalent with 83 % (n = 5). Conclusions: The specific diagnosis within the group of infectious and/or parasitic diseases with the highest prevalence was HIV, with 63.2% (n = 24).

RESUMO Objetivo: Determinar a prevalência de diagnósticos médicos de doenças infecciosas e/ou parasitárias em pacientes que frequentaram o Serviço de Estomatologia para Pacientes Especiais (EPE) da Universidad Peruana Cayetano Heredia. Material e métodos: A população (n = 38) consistiu no número de diagnósticos médicos de pacientes com doenças infecciosas e/ou parasitárias que frequentaram o serviço EPE durante 2015 e 2016. A informação foi transferida para uma base de dados em Excel 2017, para posteriormente ser processada e analisada conforme requerido pelo programa Stata 12. Resultados: De um total de 1718 diagnósticos médicos, as doenças infeciosas e/ou parasitárias tiveram uma prevalência de 2,21 % (n = 38). Dentro deste grupo de doenças, o vírus da imunodeficiência humana (VIH) foi o mais prevalente com 63,2 % (n = 24), sendo o sexo masculino o mais prevalente com 79 % (n = 19); e dentro do grupo etário dos 21-40 anos, o segundo diagnóstico específico mais prevalente foi a hepatite A com 15,8 % (n = 6), sendo o sexo feminino o mais prevalente com 83 % (n = 5). Conclusões: O diagnóstico específico mais prevalente no grupo das doenças infecciosas e/ou parasitárias foi o VIH com 63,2 % (n = 24).

Características clínicas y epidemiológicas de casos de viruela símica en personas que viven con VIH: análisis observacional / Clinical and epidemiological characteristics of monkeypox cases in people living with HIV: observational analysis

ANTECEDENTES: La viruela del mono (mpox) es una zoonosis que se ha extendido rápida y globalmente desde mediados de 2022 y ha afectado mayoritariamente a hombres que tienen sexo con hombres (HSH). OBJETIVOS: Caracterizar clínica y epidemiológicamente la infección por el virus mpox en personas que viven con VIH (PVVIH). PACIENTES Y MÉTODO: Se realizó un análisis clínico y epidemiológico a PVVIH que consultaron por sospecha de mpox en el Policlínico de Infectología del Hospital Clínico San Borja Arriarán. Se reportan los casos confirmados por reacción de polimerasa en cadena (RPC) entre el 11/07/2022 y 21/10/2022. RESULTADOS: Se confirmó mpox en 35 pacientes, todos HSH y, la mayoría, en terapia antirretroviral. La mediana de edad fue 37 años. El promedio de días entre fase inicial sistémica inespecífica y eruptiva fue 1,7. Las lesiones fueron de tipo maculopapulares, costrosas y umbilicadas en las zonas genital, perianal, dorso y extremidades, mayoritariamente. Trece individuos presentaron complicaciones y dos requirieron hospitalización. De los con examen de VDRL solicitado, el 46,4% fue reactivo en títulos no residuales. CONCLUSIONES: Se detectó llegada de mpox en un centro de atención de VIH en HSH en todos los niveles de estado inmune. Mayormente, los casos fueron leves a moderados y autolimitados. El cuadro clínico ha sido similar a lo descrito globalmente.

BACKGROUND. Monkeypox (mpox) is a zoonosis that has spread rapidly and globally since mid-2022 and has mainly affected men who have sex with men (MSM). Aim: To characterize mpox clinically and epidemiologically in people living with HIV (PLHIV). METHOD: A clinical and epidemiological analysis was carried out on PLHIV who consulted for suspected mpox in the Infectious Disease clinic of the San Borja Arriarán Clinical Hospital. Cases confirmed by PCR are reported between 07/11/2022 and 10/21/2022. RESULTS: Mpox was confirmed in 35 patients, all MSM and on antiretroviral therapy. The median age was 37 years. The average number of days between the initial non-specific systemic and eruptive phase was 1.7. The lesions were maculopapular, crusted, and umbilicated, mainly in the genital, perianal, back, and extremity areas. Thirteen patients presented complications and two required hospitalizations. Of those with a requested VDRL test, 46.4% were reactive in non-residual titers. CONCLUSIONS: Arrival of mpox was detected at the HIV care center in MSM at all levels of immune status. Mostly, the cases were mild to moderate and self-limiting. The clinical picture has been similar to that described globally.

Enfermedad de Hansen en un adulto con virus de inmunodeficiencia humana / Hansen's disease in an adult infected with human immunodeficiency virus i: en

Se describe el caso clínico de un paciente infectado por el virus de la inmunodeficiencia humana en fase sintomática precoz, quien fue asistido en el Servicio de Dermatología del Hospital Clínico Quirúrgico Docente Dr. León Cuervo Rubio en Pinar del Río por presentar lesiones eritematosas infiltradas de tres meses de evolución en el miembro inferior derecho, con alteración de la sensibilidad térmica y dolorosa. Se le indicó baciloscopia y estudio histopatológico que confirmaron el diagnóstico de sospecha de lepra dimorfa tuberculoide, por lo que se comenzó a aplicar poliquimioterapia combinada con terapia antirretroviral, lo cual favoreció la evolución del paciente.

The case report of a patient infected by the human immunodeficiency virus in early symptomatic phase is described, who was seen at the Dermatology Service of the Dr. León Cuervo Rubio Teaching Clinical Surgical Hospital of Pinar del Río for presenting infiltrated erythematous lesions of three months of evolution in the right lower limb, with altered pain and thermal sensation. A basiloscopic and histopathologic study was indicated, which confirmed the presumptive diagnosis of borderline tuberculoid leprosy, and therefore polychemotherapy combined with antiretroviral therapy was started, which favored the patient's evolution.

Challenges of managing HIV cytomegalovirus co-infection in the presence of pancytopenia

A 60-year-old male patient who presented with generalized weakness and low-grade fever was diagnosed to be human immunodeficiency virus (HIV) positive with a CD4 count of 17. Routine laboratory investigations revealed pancytopenia. Serum cytomegalovirus (CMV) DNA polymerase chain reaction (PCR) was positive and fundoscopy showed CMV retinitis in the right eye. The patient was started on tablet valganciclovir. After 2 weeks, the patient was brought back in an altered sensorium. He was found to have hyponatremia which was corrected. He was started on antiretroviral therapy and tablet valganciclovir was continued. The patient came back again after one and a half months with a urinary tract infection and fissure-in-ano. He was found to have severe neutropenia. Valganciclovir was stopped. He was started on injection granulocyte colony-stimulating factor. The patient clinically improved and his hematological parameters became normal. Patients having HIV and CMV co-infection with pre-existing pancytopenia have to be closely monitored as the medicines used for treatment can exacerbate the existing conditions.

Health-related quality of life among people living with HIV/AIDS on highly active antiretroviral treatment: A questionnaire-based study

Introduction: The knowledge of the effect of sociodemographic and disease-related factors on health-related quality of life (HRQoL) among people living with HIV/AIDS (PLWHA) is important for planning comprehensive health-care services for them. Material and Methods: Two hundred PLWHA on antiretroviral therapy (ART) volunteered to complete a self-reported World Health Organization’s Quality of Life?HIV brief questionnaire (WHOQoL-HIV-BREF) that examines six domains each with four items (physical, psychological, level of independence, social, environmental, and spiritual) with 25 facets and additional 5 facets specific to PLWHA (symptoms of HIV, social inclusion, forgiveness, worries about the future, and death and dying). Results: Only 135 questionnaires from 73 (53.3%) men and 63 (46.7%) women (male: female – 1.14:1) aged 20–82 years(mean ± standard deviation: 42.9 ± 10.5 years) were found complete. Eighty-five (63%) individuals were aged 41–60 years, 78 (57.8%) individuals were matriculates, graduates, or postgraduates, 76 (56.3%) respondents were married, and 38 (28.1%) were widows/widowers. Staying-alone workers comprised 43 (31.8%) individuals. Overall health and HRQoL were rated satisfactory (n = 85.2%) and good/very good (n = 74.8%) by a significantly greater number of individuals (P = 0.001). Pearson’s Chi-squared test showed no statistically significant (P > ?) associations between good HRQoL and variables such as age >40 years, gender, education, marital status, duration of disease, disclosure of serostatus to family, ART for >3 years, and CD4 >200 cells/mL. Conclusion: Regular ART can result in adequate control of immunosuppression and no comorbidities in a majority of PLWHA, family and social acceptance, and financial security can result in overall good HRQoL in all six domains within the WHOQoL-HIV-BREF. The study is limited by its cross-sectional study design and small sample size.

Síndrome de linfocitosis infiltrativa difusa con neumonía intersticial en un paciente con VIH / Diffuse infiltrative lymphocytosis syndrome with interstitial pneumonia in a patient with HIV

El síndrome de linfocitosis infiltrativa difusa se produce en asociación con la infección por virus de la inmunodeficiencia humana; requiere cumplir con los criterios diagnósticos y descartar otras patologías infecciosas y autoinmunes. Se presenta el caso de una mujer de 47 años que consultó por edema parotídeo bilateral, síndrome sicca, tos y síndrome de impregnación. Se observó en la tomografía de tórax infiltrado en «vidrio esmerilado¼, parcheado y bilateral. Se realizó diagnóstico de virus de la inmunodeficiencia humana positivo y fibrobroncoscopia con lavado broncoalveolar sin desarrollo de patógenos. Se interpreta como neumonía intersticial linfoidea asociada a síndrome de linfocitosis infiltrativa difusa. Se inició terapia antirretroviral con buena evolución y desaparición de los síntomas y de los infiltrados pulmonares.

Diffuse infiltrative lymphocytosis syndrome occurs in association with HIV infection; it requires meeting the diagnostic criteria and ruling out other infectious and autoimmune pathologies. We present the case of a 47-year-old woman who consulted for bilateral parotid edema, sicca syndrome, cough and impregnation syndrome, which was observed in the chest tomography infiltrated in ground glass, patched and bilateral. A diagnosis of HIV positive and fiberoptic bronchoscopy with bronchoalveolar lavage was made without the development of pathogens. It is interpreted as lymphoid interstitial pneu monia associated with DILS. Antiretroviral therapy was started with good evolution and disappearance of symptoms and pulmonary infiltrates.

Lumbar puncture for neurosyphilis investigation in asymptomatic patients with HIV-syphilis coinfection: a cross-sectional study among infectious disease specialists

ABSTRACT BACKGROUND: Syphilis is a major public health issue worldwide. In people living with human immunodeficiency virus (PLHIV), there are higher incidences of both syphilis and neurosyphilis. The criteria for referring PLHIV with syphilis for lumbar puncture is controversial, and the diagnosis of neurosyphilis is challenging. OBJECTIVE: To describe the knowledge, attitudes, and practices of infectious disease specialists and residents in the context of care for asymptomatic HIV-syphilis coinfection using close-ended questions and case vignettes. DESIGN AND SETTING: Cross-sectional study conducted in three public health institutions in São Paulo (SP), Brazil. METHODS: In this cross-sectional study, we invited infectious disease specialists and residents at three academic healthcare institutions to answer a self-completion questionnaire available online or in paper form. RESULTS: Of 98 participants, only 23.5% provided answers that were in line with the current Brazilian recommendation. Most participants believed that the criteria for lumbar puncture should be extended for people living with HIV with low CD4+ cell counts (52.0%); in addition, participants also believed that late latent syphilis (29.6%) and Venereal Disease Research Laboratory (VDRL) titers ≥ 1:32 (22.4%) should be conditions for lumbar puncture in PLHIV with no neurologic symptoms. CONCLUSION: This study highlights heterogeneities in the clinical management of HIV-syphilis coinfection. Most infectious disease specialists still consider syphilis stage, VDRL titers and CD4+ cell counts as important parameters when deciding which patients need lumbar puncture for investigating neurosyphilis.

Analysis of the occurrence time and risk factors of anemia in AIDS patients caused by HAART regimen containing zidovudine / 中国药房

OBJECTIVE To investigate the occurrence time and risk factors of anemia in patients with acquired immune deficiency syndrome （AIDS） after taking highly active antiretroviral therapy （HAART） containing zidovudine. METHODS The clinical data of 2 150 AIDS patients who were followed up in the care clinic of Liuzhou People’s Hospital from January 1， 2010 to December 31， 2022 were collected. The occurrence time of anemia was analyzed retrospectively， and the risk factors of anemia were analyzed by univariate analysis and binary Logistic regression analysis. RESULTS A total of 854 AIDS patients receiving HAART containing zidovudine were collected， and 107 patients （12.53%） developed anemia. Most of them （63.55%） developed anemia within 3 months after treatment. Baseline hemoglobin [OR＝2.944， 95%CI （1.195， 7.501）， P＝0.019]， baseline CD4+ T lymphocyte count [OR＝2.472， 95%CI （1.117， 5.469）， P＝0.026] and baseline human immunodeficiency virus-ribonucleic acid （HIV-RNA） [OR＝4.299， 95%CI （1.905， 9.705）， P＜0.001] was associated with anemia. CONCLUSIONS The median time of anemia in AIDS patients receiving HAART containing zidovudine is the second month after initiation of treatment. Baseline hemoglobin≤110 g/L， baseline CD4+ T lymphocyte E-mail：1315775863@qq.com count≤100 /mm3， and baseline HIV-RNA≥100 000 copies/mL are independent risk factors for anemia in these patients.

Emergency department approach to monkeypox / 世界急诊医学杂志（英文）

@#BACKGROUND: Monkeypox (mpox) is a viral infection that is primarily endemic to countries in Africa, but large outbreaks outside of Africa have been historically rare. In June 2022, mpox began to spread across Europe and North America, causing the World Health Organization (WHO) to declare mpox a public health emergency of international concern. This article aims to review clinical presentation, diagnosis, and prevention and treatment strategies on mpox, providing the basic knowledge for prevention and control for emergency providers. METHODS: We conducted a review of the literature using PubMed and SCOPUS databases from their beginnings to the end of July 2023. The inclusion criteria were studies on adult patients focusing on emerging infections that described an approach to a public health emergency of international concern, systematic reviews, clinical guidelines, and retrospective studies. Studies that were not published in English were excluded. RESULTS: We included 50 studies in this review. The initial symptoms of mpox are non-specific: fever, malaise, myalgias, and sore throat. Rash, a common presentation of mpox, usually occurs 2-4 weeks after the prodrome, but the presence of lymphadenopathy may distinguish mpox from other infections from the Poxviridae family. Life-threatening complications such as pneumonia, sepsis, encephalitis, myocarditis, and death can occur. There are documented co-occurrences of human immunodeficiency virus (HIV) and other sexually transmitted infections that can worsen morbidity. CONCLUSION: The initial presentation of mpox is non-specific. The preferred treatment included tecovirimat in patients with severe illness or at high risk of developing severe disease and vaccination with two doses of JYNNEOS. However, careful history and physical examination can raise the clinicians’ suspicion and point toward a prompt diagnosis. There are different modalities to prevent and treat mpox infection.

Establishment of a membrane metalloproteinase TRABD2A blocking method for HIV reservoir detection / 中华检验医学杂志

Objective:To investigate the therapeutic effect of humanized TRAB domain-containing protein 2A (TRABD2A) monoclonal blocking antibody to HIV-1 reservoir cells, and to explore novel methods for measuring the sizes/capacities of HIV-1 infected reservoirs in HIV-1 infected individuals on receiving combined antiretroviral therapy (cART).Methods:A total number of 51 subjects were collected from the First Affiliated Hospital of China Medical University from May 2021 to December 2021. Among them, there were 2 healthy persons, 41 HIV-1 infected persons receiving cART (cART group) and 8 HIV-1 infected persons not receiving cART (no cART group). Humanized TRABD2A monoclonal antibody was constructed based on the phage display technology, the PBMCs and CD4+T cells separated from the peripheral blood mononuclear cells (PBMCs) and CD4+T cells of HIV-1 infected patients treated with receiving cART, or the HIV-1 infected patients without cART treatment and healthy controls were treated with TRABD2A monoclonal antibodies. The luciferase reporter system, single molecule immune array detection technology and other methods were used to detect the virus content in the supernatant of cell culture. At the same time, flow cytometry and fluorescence real-time quantitative polymerase chain reaction were used to detect the activation of the treated cells and the expression of virus genes. The statistical differences between different treatment the amount of virus release and the level of surface activation markers CD25, CD69, human leukocyte antigen DR (HLA-DR) of different groups in the amount of virus release and the expression of surface activation markers CD25, CD69, HLA-DR were compared.Results:The PBMCs of HIV-1 infected persons receiving cART were tested for HIV-1 production after being treated with humanized TRABD2A monoclonal antibody. The amount of virus released by the untreated group was 0 (0, 440), and the amount of virus released by the use of negative antibody was 0 (0, 390). There was no significant difference between the two ( P>0.05). The amount of virus released by the use of positive antibody was 1 259 (0, 4 269), 3 142 (1 292, 5 060), compared with the amount of virus released by the use of negative antibody, The difference was statistically significant ( P<0.05). The healthy control PBMC was used to conduct multiple dilutions to the infected PBMC. After positive antibody treatment, the amount of virus release decreased in equal proportions [the HIV-1 production corresponding to 5, 25, 125, 625 times of undiluted, diluted PBMC was 4 670 (3 339, 7 697), 1 860 (1 509, 4 615), 1 550 (1 150, 2 680), 602 (255, 1 441), 2 (0, 37), respectively].In addition, there was no significant difference in the resting state of cells treated with TRABD2A antibodies compared with the untreated group (The percentage of CD25 positive cells in the untreated group and positive antibody 1 treated group were 3.89±1.31 and 4.60±1.74, the percentage of CD69 positive cells were 2.50±1.27 and 2.18±0.51, and the percentage of HLA-DR positive cells were 7.66±3.78 and 8.79±3.42, respectively, P>0.05). The viral gag expression levels of untreated and positive antibody 1 were 1 and 0.82±0.55, respectively, with no significant difference. Conclusions:The humanized TRABD2A monoclonal antibody can effectively block the protein activity of TRABD2A, and can significantly promote the release of progeny viruses from viral reservoir in the peripheral blood of HIV-1 infected persons without changing the cell resting state and the whole genome transcription level. The amount of virus released in this way is positively related to the number of reservoir cells.

Clinical characteristics and microbiological tests analysis of 18 patients with Talaromyces marneffei infection / 中国热带医学

@#Abstract:Objective　To investigate the clinical characteristics and early diagnostic methods of patients with Talaromyces marneffei infection, so as to reduce the mortality of patients. Methods The clinical characteristics and microbiological analysis data including fungal culture, smear examination and mass spectrometry were collected from 18 patients with Talaromyces marneffei infection in the Department of Respiratory Medicine, Department of Tuberculosis, and Department of Critical Respiratory Medicine in Fuzhou Pulmonary Hospital from January 2017 to December 2021, and descriptive analysis was conducted. Results　All the 18 patients were confirmed to be infected with Talaromyces marneffei by conventional culture and matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry (MS). The main infection sites of 18 patients with Talaromyces marneffei infection were lungs and lymph nodes, and the patients were accompanied by clinical manifestations such as cough, sputum and fever. The imaging features such as patchy shadows, mediastinal lymph node shadows and nodular shadows were common. Microbiological testing showed a statistically significant difference between smear and culture with a higher positive culture rate (χ2=13.74, P<0.05). The positive rate of blood culture in microbiological test was 60.0% (9/15), the positive rate of bronchial lavage fluid culture was 26.7% (4/15), the positive rate of sputum culture was 5.6% (1/18), one case each of pus, bone marrow, pleural fluid and cerebrospinal fluid was positive for culture and the other cases were negative, one case of sputum and one case of pus were positive for smear and the rest were negative. Colony characteristics showed that the colony morphology was mycelial phase at 25 ℃, producing red pigment, and the branching pattern of the penicillus was seen microscopically as monoverticillate or biverticillate; At 35 ℃, the yeast phase appeared at the initial stage, and then the mycelium phase changed after 5-6 days; the yeast phase was observed at 37 ℃, and yeast-like cells were seen under the microscope. All 18 patients with Talaromyces marneffei infection got better after using antifungal drugs. Compared with non-HIV patients with Talaromyces marneffei infection, leukopenia and anemia were common in HIV patients with Talaromyces marneffei infection, and the differences were statistically significant (P<0.05). 　Conclusions The infection of Talaromyces marneffei can be divided into localized type and disseminated type, which usually invade the lungs, skin, lymph nodes and other places. The main manifestations of patients are fever, cough, phlegm and other atypical symptoms. At present, the diagnosis of Talaromyces marneffei infection is mostly based on the fungal culture test, and the application of MALDI-TOF MS method can effectively shorten the diagnosis time of Talaromycosis marneffei. Clinical characteristics combined with microbiological analysis provide an objective basis for early diagnosis of patients with Talaromyces marneffei infection, and timely use of antifungal therapy can improve the prognosis of patients.