Reproducción asistida en hombres infectados con el virus de VIH / Assisted reproduction in HIV positive men

Objetivo: Describir un programa de procreación responsable en parejas donde el varón está infectado con el VIH organizado en un centro ambulatorio infectológico de la ciudad de Bs. As. y llevado a cabo por un equipo interdisciplinario conformado por Infectólogos, Bioquímicos, Ginecólogos y Biólogos. Comentar algunas revisiones de la literatura que avalan la evidencia cientifica para realizar estos procedimientos. Métodos: las parejas serodiscordantes son candidatas para este programa si el varón tiene seguimiento infectológico, los estudios de esperma demuestran carga viral (CV) indetectable y DNA proviral de VIH negativo, y, la mujer tiene ADN proviral de VIH negativo en sangre, en el ciclo en el cual se realizará el procedimiento de fertilización asistida. Se realiza en la mujer pesquisa de infecciones connatales. Las muestras de esperma son procesadas con técnicas de lavado, swim up y swim down, y congeladas. Después de cada procedimiento de fertilización asistida la mujer es controlada controlada con estudios serológicos para anticuerpos (VIH ELISA) periódicos. Los recién nacidos son evaluados a través de ADN proviral de VIH en el 1er mes de vida, o, durante los primeros 6 meses de vida a través de anticuerpos (VIH ELISA). Resultadaos: desde 12/2000 y hasta mayo 2009 se incluyeron 165 parejas serodiscordantes. 147 pacientes VIH (+) realizaron estudios de muestras de esperma, 26, tuvieron muestras con estudios microbiológicos positivos (23, CV detectable, y 3, ADN proviral de VIH positivo). En 123 parejas se realizaron: 329 inseminaciones, 55 ICSI y 28 FIV. Se concretron 44 embarazos y nacieron 51 bebés. Todos los estudios realizados a las mujeres y recién nacidos mostraron resultados negativos. Conclusiones: este programa logró resultados satisfactorios en la prevención de infecciones por VIH y connatales.

Objective: to describe the data obtained during the development of an assisted reproduction program for couples where the man is HIV - Infected organized by an ambulatory infectologist center in BsAs city. a multidisciplinary team with infectious disease MD, biochemists, ginecologists and bilogist collaborate in the follow-up of the patients. Methods: couples seeking reproductive counseling were eligible for this programme if: the HIV positive male partner adhered to an infectious disease follow-up, he has undetectable viral load in the fresh sperm sample and is negative for HIV proviral DNA in the swim-up material after sperm washing, the female partner is negative for HIV proviral DNA immediately beforme each assisted reproduction attempt. Procedures comprised intrauterine insemination, intracytoplasmic sperm injection and in vitro fertilization accordin to gynecologist indication. After each procedure, women were tested for indication. After each procedure, women were tested for HIV antibodies periodically. Newborns were tested for HIV proviral DNA at one month of age or HE during the first six months. Results: One hundred and sixty five couples were assessed, semen analyses results were obtained from 147 HIV positive men, 23 had detectable viral load, 3 had positive HIV proviral DNA in swim up. One hundred and twenty three couples undervent AR procedures: 329 intrauterine inseminations, 55 intracytoplasmic sperm injections, and 28 in-vitro fertilizations. Forty four pregnancies resulted in fifty one live Births. All HE and HDP tests performed in women and new-borns were negative. Conclusions: This programme achieved satisfactory results in prevention of HIV and congenital infections.

Infeccion por citomegalovirus con compromiso hepatico en adultos inmunocompetentes / Cytomegalovirus infection with hepatic involvement in immunocompetent adults

Evaluamos retrospectivamente a 73 adultos inmunocompetentes que consultaron entre marzo de 1999 y marzo de 2004 a un centro infectológico ambulatorio por fiebre y astenia, con elevación discreta de las transaminasas y serología compatible con infección reciente por citomegalovirus (CMV). Excluimos a pacientes con antecedentes de transfusiones, adicciones e inmunodeficiencias, así como aquellos con alteraciones hepáticas preexistentes o con serología compatible con infección aguda por hepatitis A, B, C (VHA, VHB, VHC) o virus Epstein Barr (VEB). El diagnóstico de infección reciente por citomegalovirus se efectuó mediante la detección de IgM específica (ELISA de captura), seroconversión o aumento cuádruple del título de IgG específica, en presencia de un cuadro clínico compatible. Los síntomas más frecuentes fueron: fiebre (85%) y astenia (83%), cefalea (25%), esplenomegalia (20%), adenomegalia (22%), faringitis (25%), mialgia (25%) y hepatomegalia (19 %). Se encontró elevación discreta de transaminasas y linfomonocitosis en todos los pacientes (73/73). La elevación promedio de GPT fue de 6 veces y la de GOT fue de 3.5 veces su valor límite. Las características clínicas que diferencian la infección por CMV de la infección por VEB son la menor frecuencia de poliadenopatías y faringitis en la primera. El diagnóstico diferencial de la infección por CMV con compromise hepático con las hepatitis A y B agudas se basa en la ausencia de ictericia, la menor elevación de las transaminasas, la linfomonocitosis intensa y la presencia de IgM específica que caracterizan a la infección por CMV. En conclusión, ante un paciente joven, previamente sano, con fiebre, astenia intensa, linfomonocitosis y elevación discreta de transaminasas, es importante investigar infección por citomegalovirus.

We retrospectivelyevaluated 73 immunocompetent adult patients assisted at our Infectious Diseases Clinic betweenMarch 1999 and March 2004 who presented fever and asthenia, mild to moderate increase of transaminasesand serological findings compatible with recent cytomegalovirus infection. We excluded patients with a history oftransfusions, drug abuse, immunodeficiencies, preexistent hepatic impairment or serological findings compatible with acute hepatitis A, B and C (HAV, HBV, HCV) and Epstein Barr virus (EBV). The laboratory diagnosis ofrecent cytomegalovirus infection was made by especific IgM detection (ELISA) or a significant increase of specific IgG. The most frequent symptoms were fever (85%) and asthenia (83%), followed by cephalea (25%), splenomegaly (20%), adenomegalies (22%), pharyngitis (25%), myalgias (25%) and hepatomegaly (19%). All the patients showed moderate increase of transaminases and lymphomonocytosis (73/73). In average, ALT wasincreased by 6 fold and AST by 3.5 fold. The clinical characteristics that differentiate CMV infection from Epstein-Barr infection are the lesser frequency of adenomegalies and pharyngitis in the former. The differential diagnosisof CMV infection with hepatic involvement from acute hepatitis A and B, is based on the absence of jaundice,the lower elevation of transaminases, the intense lymphomonocytosis and the presence of specific IgMagainst CMV that are characteristic of CMV infection. In conclusion, in previously healthy young adults with fever, intense asthenia, lymphomonocytosis and moderate increase in transaminases levels, cytomegalovirus infectionshould be investigated.

Teicoplanina en el tratamiento de las infecciones osteoarticulares por Staphylococcus meticilino-resistente. Experiencia en adultos / Teicoplanin in the treatment of bone and joint infections due to methicillin resistant staphylococci. Experience in adult patients

We retrospectively evaluated 89 episodes of bone and joint infections due to methicillin-resistant staphylococci: 56 chronic osteomyelitis (CO), 10 septic arthritis (SA) and 23 infections associated to arthroplasties (IAA). We analyzed the efficacy of Teicoplanin (T) in three times a week or daily administration schemes and adequate surgery (AS). Also, we determined cost savings derived from outpatient parenteral antibiotic therapy (OPAT). The overall efficacy of T in CO and both in cases with and without implants, was higher when antibiotic therapy was associated to AS (86 vs. 46, p = 0.001; 100 vs. 33, p = 0.0049 and 76 vs. 50, p = 0.09). All SA were cured. The overall efficacy of T was higher in IAA with implant removal vs. surgical debridement (100 vs. 54, p = 0.045). In all cases, T was similarly effective when administered three times a week vs. daily administration, when associated to AS. The savings derived from OPAT were 897 days/bed and USS 179,400. Adverse effects were few and light (8 episodes, 9). The results obtained are similar to those published in the literature and show that T administered daily or in a three times a week scheme and associated to AS, is effective and safe for the treatment of bone and joint infections. The savings derived from OPAT, mainly related to reduced hospitalization, are significant in these pathologies, which usually require long treatment periods