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RESUMEN Objetivo: Determinar la prevalencia y las características genotípicas de la infección anal por papilomavirus en hombres que tienen sexo con hombres (HSH) VIH-positivos. Materiales y métodos: Es un estudio observacional prospectivo de corte transversal en HSH VIH-positivos del Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, realizado entre setiembre del 2017 y diciembre del 2018. El estudio del papilomavirus se realizó con una técnica de reacción en cadena de polimerasa evaluando 21 genotipos estratificados según el riesgo oncogénico: seis de bajo riesgo y quince de alto riesgo. Resultados: Se evaluaron 214 HSH VIH-positivos. La prevalencia general de la infección anal por papilomavirus fue de 70% (150/214). 86% (129/150) tuvieron genotipos de alto riesgo oncogénico, de ellos 79% (102/129) tuvieron dos o más genotipos de papilomavirus. Los genotipos de alto riesgo oncogénico más frecuentes fueron: VPH-16, 31% (46/150); VPH-52, 22% (33/150); VPH-33, 21% (31/150); VPH-58, 21% (31/150) y VPH-31, 20% (30/150). El VPH-18 alcanzó el 7% (10/150). Los genotipos de bajo riesgo oncogénico más frecuentes fueron: VPH-6, 30% (45/150) y VPH-11, 29% (44/150). Conclusiones: La prevalencia de la infección anal por papilomavirus en HSH VIH-positivos es muy alta en el hospital investigado. La gran mayoría de estas infecciones se producen con genotipos de alto riesgo oncogénico. El papilomavirus 16 fue el genotipo de alto riesgo más frecuente.
ABSTRACT Objective: To determine the prevalence and genotypic characteristics of anal papillomaviruses in HIV-positive men who have sex with men (MSM). Materials and methods: This is a prospective cross-sectional observational study of HIV-positive MSM at Almenara General Hospital between September 2017 and December 2018. HPV detection and typing was performed using a polymerase chain reaction technique that evaluated 21 genotypes stratified according to oncogenic risk into six low-risk and fifteen high-risk. Results: we evaluated 214 HIV-positive MSM. The overall prevalence of anal infection by papillomavirus infection was 70% (150/214). 86% (129/150) were caused by high-risk genotypes, 79% (102/129) of them were affected by a two or more-papillomavirus genotype. The most frequent high-risk genotypes were HPV-16, 31% (46/150); HPV-52, 22% (33/150); HPV-33, 21% (31/150); HPV-58, 21% (31/150) and HPV-31, 20% (30/150). In addition, HPV-18 reached 7% (10/150). The most frequent low-risk genotypes were HPV-6, 30% (45/150) and HPV 11, 29% (44/150). Conclusions: Prevalence of anal papillomavirus infection in HIV-positive MSM is very high in the hospital investigated. Most of these infections occurs with high-risk oncogenic genotypes. Papillomavirus 16 was the most frequent high-risk genotype.
RESUMO
RESUMEN Objetivo. Determinar la extensión de la afectación pulmonar en pacientes con neumonía por SARS-CoV-2 mediante tomografía. Método. Evaluación retrospectiva en pacientes con evidencia de COVID-19 del Hospital Nacional Guillermo Almenara Irigoyen, Lima - Perú, al inicio de la pandemia COVID-19, entre el 15 de marzo y el 14 de mayo de 2020. La extensión de la neumonía se determinó mediante tomografía con base en la Clasificación de la Sociedad Francesa de Imagen Torácica. Resultados. Se incluyeron en el estudio 485 pacientes. La extensión de la neumonía fue: ausente 1,2%, mínima 4,9%, moderada 20,6%, extensa 27,4%, grave 30,7% y crítica 15,1%. La afectación pulmonar se asoció con edad mayor de 60 años (p=0,014) y saturación de oxígeno ambiental por debajo de 90% (n=372, p=0,000). Conclusiones. Por su extensión, las neumonías por SARS-CoV-2 en los primeros dos meses de la epidemia de COVID-19 en el Hospital Almenara fueron graves, extensas y moderadas en su gran mayoría. La extensión de la neumonía se asoció con edad y saturación de oxígeno ambiental al ingreso.
ABSTRACT Objective. To determine the extent of pulmonary involvement in patients with SARS-CoV-2 pneumonia using tomography. Method. Retrospective evaluation in patients with evidence of COVID-19 at the Guillermo Almenara Irigoyen National Hospital, Lima - Peru, at the beginning of the COVID-19 pandemic, between March 15 and May 14, 2020. The extent of pneumonia was determined by means of tomography based on the Classification of the French Society of Thoracic Imaging. Results. 485 patients were included in the study. The extent of pneumonia was: 1.2% absent, 4.9% minimal, 20.6% moderate, 27.4% extensive, 30.7% severe, and 15.1% critical. Lung involvement was associated with age older than 60 years (p = 0.014) and ambient oxygen saturation below 90% (n = 372, p = 0.000). Conclusions. Due to its extension, the SARS- CoV-2 pneumonia in the first two months of the COVID-19 epidemic at Hospital Almenara were severe, extensive and mostly moderate. The extent of pneumonia was associated with age and ambient oxygen saturation at admission.
RESUMO
Limited and contradictory information exists regarding the prognosis of HIV/HTLV-I co-infection. Our goal was to estimate the effect of HTLV-I infection on mortality in HIV-infected patients at a HIV reference center in Peru. We studied a retrospective cohort of HIV-infected patients, who were exposed or unexposed to HTLV-I. Exposed patients were Western Blot (WB) positive for both retroviruses. Unexposed patients were WB positive for HIV, and had least one negative EIA for HTLV-I. These were selected among patients who entered our Program immediately before and after each exposed patient, between January 1990 and June 2004. Survival time was considered between the diagnosis of exposure to HTLV-I and death or censoring. Confounding variables were age, gender, baseline HIV clinical stage, baseline CD4+ T cell count, and antiretroviral therapy. We studied 50 exposed, and 100 unexposed patients. Exposed patients had a shorter survival compared to unexposed patients [median survival: 47 months (95 percent CI: 17-77) vs. 85 months (95 percent CI: 70-100), unadjusted p = 0.06]. Exposed patients had a higher rate of mortality compared to unexposed patients (HIV/HTLV-I (24/50 [48 percent]) vs. HIV only (37/100 [37 percent]), univariable p = 0.2]. HTLV-I exposure was not associated to a higher risk of death in the adjusted analysis: HR: 1.2 (0.4-3.5). AIDS clinical stage and lack of antiretroviral therapy were associated to a higher risk of dying. In conclusions, HTLV-I infection was not associated with a higher risk of death in Peruvian HIV-infected patients. Advanced HIV infection and lack of antiretroviral therapy may explain the excess of mortality in this population.
Existe informação limitada e contraditória sobre o prognóstico da co-infecção pelo Vírus da Imunodeficiência Humana Tipo 1 (HIV-1) e Vírus Linfotrópico de Células T Humanas Tipo I (HTLV-I). Nosso objetivo foi estimar o efeito da infecção pelo HTLV-I na mortalidade de pacientes infectados pelo HIV-1 em Centro de Referência de HIV no Peru. Trata-se de uma coorte retrospectiva de pacientes infectados pelo HIV, expostos ou não expostos ao HTLV-I. Os pacientes expostos tiveram resultados positivos no Western Blot (WB) para ambos retrovírus. Os pacientes não expostos tiveram resultados positivos para o HIV-1 e pelo menos um teste de EIA negativo para o HTLV-I. Esses pacientes foram selecionados entre aqueles que entraram no nosso Programa imediatamente antes ou depois de cada paciente exposto, no período de janeiro de 1990 a junho de 2004. O tempo de sobrevida foi considerado entre o diagnóstico da exposição ao HTLV-I e a morte. As variáveis de confusão foram: idade, gênero, estágio clínico basal da infecção pelo HIV-1, contagem basal de células CD4, e terapia anti-retroviral. Estudamos 50 pacientes expostos e 100 não expostos. Os pacientes expostos tiveram menor sobrevida quando comparados aos não expostos [mediana de sobrevida: 47 meses (95 por cento IC: 17-77) versus 85 meses (70-100), p não ajustado < 0.06]. Os pacientes expostos tiveram maior risco de morte quando comparados aos não expostos (HIV-1/HTLV-I (24/50 [48 por cento]) versus HIV-1 só (37/100 [37 por cento]) p univariado = 0.2). A exposição ao HTLV-I não foi associada a maior risco de morte na análise ajustada: HR: 1.2 (0.4-3.5). O estágio clínico da infecção pelo HIV-1 e a ausência de terapia anti-retroviral foram associados a maior risco de morte. Em conclusão, a infecção pelo HTLV-I não foi associada a maior risco de morte em pacientes peruanos infectados pelo HIV-1. A infecção avançada pelo HIV-1 e a falta de terapia anti-retroviral podem explicar o excesso de mortalidade ...