Xerostomia em pacientes com HIV/ Aids: revisão sistemática de literatura

Introdução: a transmissão do vírus da imunodeficiênciahumana (HIV) leva à redução da resposta imunológicado indivíduo, podendo ocorrer alterações na cavidadebucal, entre elas, a xerostomia. Objetivo: por meio deuma revisão sistemática, este trabalho objetiva analisara presença e as correlações da presença de xerostomiaem pacientes HIV positivos ou com Aids. Métodos: foifeita busca nas bases de dados PubMed, SciELO e Lilacsutilizando os descritores "oral manifestations", "HIV","Aids" e "xerostomia", sendo os critérios de inclusãotrabalhos epidemiológicos descritivos e observacionaiscom no máximo 10 anos de publicação e em línguainglesa, portuguesa ou espanhola. Resultados: foramencontrados 162 artigos que, após critérios exclusivos,foram reduzidos a 15 trabalhos desenvolvidos em setepaíses, nos quais se encontraram valores variando entre2% e 76,2% na presença de xerostomia em pacientescom HIV/Aids, a maioria homens entre a terceira e aquarta década de vida. Conclusão: a xerostomia em pacientescom HIV/Aids necessita de diversas pesquisasclínicas, devido aos inúmeros fatores que podem ocasionara etiologia, além da grande divergência de resultadosencontrados. Estudos afirmam que patologias queacometem as glândulas salivares podem levar à sensaçãode boca seca nesses indivíduos e são decorrentesda utilização prolongada da terapia antirretroviral altamenteativa (Haart). (AU)

Introduction: the human immunodeficiency virus transmission reduces the immune response of individuals and may cause changes in the oral cavity, such as xerostomia. Objective: by means of a systematic review, the present study aims to analyze the presence and correlations of the presence of xerostomia in HIV+ patients or those living with AIDS. Methods: the databases PubMed, SciELO, and Lilacs were searched using the descriptors "oral manifestations", "HIV", "AIDS", and "xerostomia". Inclusion criteria consisted of observational descriptive epidemiological studies with up to 10 years of publication, in English, Portuguese, or Spanish. Results: a total of 162 articles were found, which after exclusive criteria were reduced to the quantity of 15 studies from seven countries. These studies found varying values in the presence of xerostomia in HIV/ AIDS patients, ranging from 2% to 76.2%, most of them in men between the third and fourth decades of life. Conclusion: xerostomia in HIV/AIDS patients requires several clinical studies due to the numerous factors that may cause the etiology, besides the great divergence of results found. Studies indicate that pathologies affecting the salivary glands may cause dry mouth sensation in these patients, which derives from the prolonged use of Highly Active Antiretroviral Therapy (HAART). (AU)

Histological and immunohistochemical findings of the action of botulinum toxin in salivary gland: systematic review / Achados histológicos e imunohistoquímicos da ação da toxina botulínica em glândula salivar: revisão sistemática

Abstract The treatment of sialorrhea is necessary for the constant risks posed by hypersalivation. A new therapeutic option comes up with the application of botulinum toxin in salivary glands. However, little is known about its mechanism of action in glandular tissue. Based on the above, this work had the objective to systematically review the literature about the action of botulinum toxin on submandibular and parotid salivary glands tissues. Electronic search was performed in databases of great relevance for this study (PubMed, SciELO, HighWire, Crossref, Scopus, Science Direct, MEDLINE, OLDMEDLINE, Serials Database, NLM Catalog, LILACS and IBECS). Inclusion and exclusion criteria for articles were established, and a total number of 14 articles were selected and used. There are few publications that clarify how the salivary gland acini behave with application of botulinum toxin. Although, the immunohistochemical findings were consistent among authors, showing weak immunoreactivity in glands treated with botulinum toxin. Histometric data are divergent, requiring more detailed studies to answer the questions about the efficacy and safety of botulinum toxin in salivary glands.

Resumo O tratamento da sialorreia se faz necessário pelos constantes riscos trazidos por este estado de hipersalivação. Uma nova opção terapêutica surge com a aplicação da toxina botulínica em glândulas salivares. Entretanto, pouco se sabe sobre o seu mecanismo de ação no tecido glandular. Com base no exposto, este trabalho teve o objetivo de revisar sistematicamente na literatura a ação da toxina botulínica sobre o tecido das glândulas salivares submandibular e parótida. Foi realizada uma busca eletrônica em bases de dados de grande relevância para este estudo (PubMed, SciELO, HighWire, Crossref, Scopus, Science Direct, MEDLINE, OLDMEDLINE, Serials Database, NLM Catalog, LILACS e IBECS). Foram estabelecidos critérios de inclusão e exclusão para os artigos, e um "n" de 14 trabalhos foram selecionados e utilizados. São poucas as publicações que esclarecem como os ácinos das glândulas salivares se comportam mediante aplicação da toxina botulínica. Apesar de os achados imunohistoquímicos entre os autores serem concordantes, com imunorreatividade mais fracas nas glândulas tratadas com a toxina botulínica, os dados histométricos são divergentes e há questionamentos metodológicos, necessitando de mais estudos pormenorizados para responder as questões sobre a eficácia e segurança da toxina botulínica nas glândulas salivares.

Risk factors, hyposalivation and impact of xerostomia on oral health-related quality of life

Abstract To determine xerostomia-related frequency, factors, salivary flow rates and Oral Health-Related Quality of Life (OHRQoL) of patients attending the Universidad Andrés Bello Dental School Clinic, in the city of Viña del Mar, Chile. The study involved 566 patients assessed with xerostomia, based on a single standardized questionnaire. The severity and impact of xerostomia on OHRQoL was assessed using a visual analogue scale (VAS) and the short version of the Oral Health Impact Profile Questionnaire (OHIP-14sp), respectively. Stimulated and non-stimulated salivary flow rates were obtained from a sample of patients. Xerostomia was reported in 61 patients (10.8%), comprising 50 women (83.3%) and 11 men (16.7%) (p < 0.013). The prevalence was 13% among the women and 6.1% among the men. Gender, age and medication were found to be independent risk factors for the development of xerostomia. Hyposalivation was found in 10 of the 35 patients with xerostomia (28.6%) and in 2 patients without it (p < 0.011). Patients with xerostomia had a reduced OHRQoL, compared with patients without xerostomia, as shown by the total OHIP-14sp score (p < 0.001). Xerostomia was a common, potentially debilitating condition with a major impact on the OHRQoL of a patient population attending a university-based dental clinic. Hyposalivation was present in almost 30% of the patients who complained of xerostomia. It is important that general dentists be aware of this condition, so that they can provide patients with a good diagnosis, treatment and follow-up.

Drugs or disease: evaluating salivary function in RA patients

Abstract Oral complications of RA may include temporomandibular joint disorders, mucosa alterations and symptoms of dry mouth. The aim of this study was to evaluate the salivary gland function of subjects with rheumatoid arthritis (RA) comparing it to healthy controls. Subjects with other systemic conditions known to affect salivary functions were excluded. A questionnaire was applied for the evaluation of xerostomia. Resting and chewing-stimulated salivary flow rates (SFR) were obtained under standard conditions. There were 145 subjects included of the study (104 RA and 38 controls). About 66.7% of the RA subjects and 2.4% in control group presented xerostomia. The median resting SFR were 0.24 ml/min for RA subjects and 0.40 mL/min for controls (p = 0.04). The median stimulated SFR were 1.31 mL/min for RA subjects and 1.52 ml/min for controls (p = 0.33). No significant differences were found between resting and stimulated SFR of RA subjects not using xerogenic medications and controls. There was significantly higher number of subjects presenting hyposalivation in the RA group than among controls, even when subjects using xerogenic medications were eliminated from the analysis. In conclusion, hyposalivation and xerostomia were more frequent among RA subjects not using xerogenic medication than among controls, although there were no significant differences in the median SFR between groups.

Adenoma pleomórfico de paladar en un paciente joven: reporte de caso / Pleomorphic adenoma of the palate in a young patient: Case report

El Adenoma Pleomórfico (AP) es el tumor benigno más común de la glándula parótida, aunque se presenta frecuentemente en glándulas salivales mayores, puede encontrarse en glándulas salivales menores del paladar y del labio, siendo infrecuente en pacientes jóvenes; se detecta en muchos casos como un hallazgo casual durante el examen clínico odontológico, puede evaluarse a través de diferentes estudios imagenológicos y su diagnóstico definitivo se basa en el análisis histopatológico de la lesión. El tratamiento quirúrgico dependerá de la localización y del tamaño. En pocos casos presenta recidiva y la trasformación maligna es rara, pero es necesario realizar un seguimiento periódico a largo plazo después de su exéresis. A continuación se presenta el caso de un adenoma pleomórfico de glándula salival menor localizado en el paladar duro de una paciente de 16 años de edad, diagnosticado y tratado oportunamente mediante la resección completa con un margen adecuado de tejido sano, con un pronóstico favorable...

The Pleomorphic Adenoma (PA) is the most common benign tumor of salivary glands, although frequently in major salivary glands can be found in minor salivary glands of the palate and lip, are uncommon in young patients; often detected as an incidental finding during dental clinical, examination can be assessed by different imaging studies and definitive diagnosis is based on histopathological analysis of the lesion. The surgical treatment depends on the location and size. In a few cases presented recurrence and malignant transformation is rare, but it is necessary to regularly monitor long term after excision. A case is reported of pleomorphic adenoma of minor salivary gland located in the hard palate in a 16 year old girl, diagnosed and treated by complete resection with an adequate margin of healthy tissue, with a favorable prognosis...

Aplicaciones de la toxina botulínica en glándulas salivales / Application of botulinum toxin in salivary glands

Botulinum toxin is a neuromodulator produced by Clostridium botulinum, a gram-negative, anaerobic bacterium responsible for botulism. The clinical utility of botulinum toxin initially became evident in the treatment of strabismus. Subsequently, botulinum toxin has been used for a variety of other medical conditions such as muscular hyperactivity, including blepharospasm, hemifacial spasm, and cervical dystonia. In addition to its well-known applications, within the properties of botulinum toxin are those that make possible the treatment of various diseases affecting salivary glands and oral cavity. Recently there has been an important development in research and finding new applications in otolaryngology. Recent studies have demonstrated the advantages of botulinum toxin injected into the salivary glands of patients who present drooling, reducing the salivary flow and improving their quality of life. In the same way it has proven to be effective as a treatment of sialocele in patients with parotid gland surgery. In parotid and pharyngocutaneous fistula it has proven effective in reducing the salivary flow, facilitating the closure of the defect. Moreover, in patients with Frey’s syndrome it has been effective reducing symptoms and improving quality of life. It has also been histologically demonstrated its protective effect on the glandular damage in patients undergoing radiotherapy.

Pilocarpina no tratamento de xerostomia em pacientes submetidos à iodoterapia: estudo piloto / Pilocarpine used to treat xerostomia in patients submitted to radioactive iodine therapy: a pilot study

Xerostomia é uma queixa tardia frequente associada à iodoterapia. Terapias para o tratamento desta morbidade podem proporcionar melhora na qualidade de vida dos pacientes com câncer de tireoide submetidos à iodoterapia adjuvante. OBJETIVOS: Relatar a experiência com o uso da pilocarpina no tratamento de xerostomia em pacientes com câncer de tireoide submetidos à iodoterapia adjuvante. MATERIAL E MÉTODOS: Cinco pacientes preencheram os critérios de inclusão e receberam 5mg de pilocarpina, 3 vezes ao dia, por uma semana. Os efeitos colaterais do medicamento e a resposta subjetiva à queixa de xerostomia após o tratamento foram avaliados. DESENHO DO ESTUDO: Trata-se de um estudo prospectivo, não-randomizado. RESULTADOS: Sudorese foi o efeito colateral mais comum com o uso da pilocarpina, seguido por cansaço e dor de cabeça. Dois pacientes relataram alívio da xerostomia com o uso da medicação, mas somente um paciente foi capaz de tolerar os efeitos colaterais. CONCLUSÕES: Pilocarpina parece aliviar os sintomas de xerostomia em pacientes submetidos à iodoterapia, já que o medicamento é capaz de estimular o fluxo salivar. No entanto, os efeitos colaterais observados inviabilizam seu uso por recusa por parte dos pacientes em continuar a terapia por períodos mais longos.

Xerostomia complaint is very commonly associated to radioactive iodine therapy. Alternatives to treat this morbidity can offer better quality of life to patients with thyroid cancer submitted to adjuvant iodine therapy. AIM: to report on the experience with pilocarpine on the treatment of xerostomia in thyroid cancer patients submitted to adjuvant radioactive iodine therapy (RIT). MATERIALS AND METHODS: The five patients who met the inclusion criteria received 5mg of pilocarpine, 3 tid for one week. Side effects of the drug and subjective response to xerostomia complaints after treatment were evaluated. DESIGN: it is a prospective, non-randomized study. RESULTS: Sudoresis was the most frequent side effect of pilocarpine use, followed by fatigue and headache. Two patients reported relief of xerostomia using pilocarpine, but only one patient was able to tolerate the side effects. CONCLUSIONS: Pilocarpine seems to relieve xerostomia complaints in thyroid cancer patients because it is able to stimulate salivary flow, but the observed side effects made the patients refuse long-term therapy continuation.

Effects of prolonged treatment with Syzygium cumini on the salivary glands of spontaneously diabetic mice

It is estimated that 190 million people worldwide have diabetes mellitus. Several attempts have been made to elucidate the deleterious effects of diabetes on various organ systems, as well as the reversal of these effects by treatment and/or diet. Thus, the objective of the present study was to analyze the effects of prolonged treatment with Syzygium cumini (Jambolan) sheet aqueous extract on the structure of cells responsible for secretory processes in the parotid and submandibular salivary glands of spontaneously diabetic mice. Ten female mice, including five diabetic Nod mice (group I) and five BALB/c mice (group II), were used. After characterization of the diabetic state, animals of group I received Syzygium cumini extract and group II animals received water ad libitum. After the experimental period, the salivary glands were collected from the animals for stereological analysis. The results showed structural alterations in the salivary glands of diabetic animals characterized by nuclear and cytoplasmic atrophy and the occurrence of inflammatory cells, as well as elevated glycemia levels. We conclude that no recovery of normal glycemia levels or glandular tissue structure occurs in diabetic animals even when treated with Syzygium cumini extract, a fact that might result in changes in the functional mechanisms of these organs.

Morfometría de la parótida de ratón infectado por la cepa RAL de Trypanosoma cruzi en función del sexo / Morphometry of the parotid Gland in mice infected by the RAL strain of Trypanosoma cruzi in function of the sex

Fueron estudiadas las alteraciones y el nivel de deterioro de las parótidas de animales infectados con la cepa RAL de Trypanosoma cruzi. Se utilizaron ratones albinos (Mus musculus) de ambos sexos, debido al dimorfismo sexual de las glándulas salivares, inoculados con 2 x 104 tripomastigotes sanguíneos de la cepa RAL del T. cruzi. Los animales fueron sacrificados al 12° día de infección, coincidiendo con el pico parasitémico. La parótida fue procesada histológicamente y, posteriormente, evaluada histopatológica y morfométricamente. Los resultados permitieron verificar intenso parasitismo en la glándula, la que presentó desorganización estructural y atrofia generalizada de acinos y conductos, más intensos en las hembras. Concluyendo, la cepa RAL del T. cruzi mostró un comportamiento atípico en relación a otras cepas, causando modificaciones más evidentes en las hembras, debido, posiblemente, a alteraciones hormonales desencadenadas por el T. cruzi.

They were studied the alterations and the level of deterioration of the parotid gland in mice infected with the RAL strain oí Trypanosoma cruzi. They were used albino mice (Mus musculus) of both sexes, due to the existence of sexual dimorphism of the salivary glands, inoculated with 2 x 104 blood trypomastigotes of the RAL strain of T cruzi. The animals were sacrificed at the 12th day of infection, coinciding with the parasitemic peak, and the parotid gland was histologically processed and histopathologically and histometrically studied. The results allow verifying intense parasitism in the parotid gland with structural disorganization and widespread atrophy of acini and ducts, more marked in the females. Concluding, the RAL strain of T cruzi shows an atypical behavior in relation to other strains, provoking more clear modifications in the females, probably due to the hormonal alterations motivated by the T cruzi.

Rincones olvidados de la gastroenterología II: las glándulas salivales y el papel de la saliva / Forgotten corners of the gastrointestinal tract ii: the salivary glands and the role of saliva

Los gastroenterólogos consideramos que el tubo digestivo comienza en el esófago y no nos vemos enfrentados a la patología oral. Por ello le otorgamos poca importancia al papel que cumple la saliva. El papel de la saliva tiende a asociarse con la boca solamente. Sin embargo, ella no sólo cumple un papel importante en la defensa de la cavidad oral sino que también del esófago y en cierta medida también del estómago. Revisaremos sucintamentela composición de la saliva y la regulación de su secreción. Describiremos el rol fisiológico de la saliva y detallaremos especialmente cuales son los mecanismos por los cuales constituye la primera línea en la defensa del esófago contra el reflujo ácido, así como su posible papel complementario en la protección gástrica. La importancia de la saliva se hace muy manifiestaaquellos pacientes que sufren de hipofunción de las glándulas salivales. Revisaremos las causas más frecuentes de disfunción salival, las más frecuentes de las cuales son de origen iatrogénico y analizaremos su impacto en la fisiología digestiva.

As gastroenterologists, we tend to assume that the digestive tract begins at the esophagus and are not faced with oral pathology. That is why we tend to overlook the role of saliva. Saliva is usually associated only with the mouth. Yet, saliva not only has a role in the defense of the oral cavity but also of the esophagus and, up to a certain extent, ofthe stomach. We shall briefly review the composition of saliva and the regulation of its secretion. We will analyze the physiologic role of saliva and specifically detail which arethe mechanisms by which it constitutes a first line of defense of the esophagus against acid reflux and also its possible additional role in the protection of the stomach. The importance of saliva is clearly illustrated in individuals suffering from salivary glands hypofunction. We shall review the most frequent causes of salivary gland dysfunction, the most frequent of which derive from iatrogenic causes, and analyze its impact on digestive physiology.

Unidad de saliva como fluido diagnóstico / Saliva unit as a diagnostic fluid

La saliva constituye una muestra biológica de fácil obtención, de bajo costo, indolora y sin el uso de técnicas invasivas, cuya composición puede reflejar, en gran medida, ciertos acontecimientos patológicos de manifestación sistémica. En el presente trabajo se pretende realizar una revisión de las diferentes posibilidades diagnósticas que ofrece la saliva en el estudio de diversas patologías infecciosas, hormonales, inmunológicas, tóxicas y metabólicas. En base a la información recogida se puede afirmar que la saliva representa un medio diagnóstico de creciente utilidad

Diangóstico diferencial del dolor orofacial I. Asociado a estructura intracraneanas, extracraneanas y desórdenes sicogénicos / Differential diagnosis of orofacial pain I. Associated with intracranial, extracranial structures and psychogenic disorders

El dolor orofacial (DOF) es un problema común en el población y representa una condición potencialmente deteriorante y debilitante. Un diagnóstico correcto es la base principal para un manejo adecuado; en pacientes con DOF esta tarea puede ser pequeña y simple, o bien convertirse en una experiencia complicada y frustrante para ambos, clínico y pacinetes. Sin embargo, el conocimiento por parte del clínico de todas las posibles condiciones de dolor que pueden afectar la región orofacial facilitará el proceso diagnóstico. Es importante destacar que es muuy difícil diagnosticar algo que no se conoce y aunque "las cosas comunes ocurren comúnmente" no es extraño encontrar pacientes con patologías "raras", de poca ocurrencia, que el clínico ha olvidado o no conoce. El hecho de que el clínico no considere todos estos aspectos durante la evaluación clínica puede llevarlo fácilmente a confundirse, lo que finalmente terminará en un diagnóstico incorrecto, mal manejo clínico y posiblemente consecuencias devastadoras para los pacientes. Esta es una serie de tres artículos que tienen como propósito presentar una revisión de la literatura de las condiciones que se han considerado para establecer el diagnóstico diferencial del dolor orofacial. Los dolores asociados a las estructuras intracraneales (cefaleas por tumores cerebrales), extracraneales (dientes, ojos, senos paranasales, entre otros) y el dolor sicogénico serán discutidos en este primer artículo

Manejo terapéutico del paciente con xerostomía / Therapeutic management of the xerostomia patient

La xerostomía es una manifestación clínica más común de las disfunciones salivales y consiste en una disminución de la secreción salival. Aunque no es considerada como una enfermedad "per se", puede implicar la presencia de alteraciones relacionadas directamente con las glándulas salivales o ser el resultado de trastornos sistémicos. Etiológicamente la xerostomía es la consecuencia de varias condiciones de tipo reversibles o irreversibles entre las cuales encontramos: ingesta de medicamentos, terapias oncológicas (radiación y/o quimioterapia), terapia quirúrgica, alteraciones psicológicas, nfermedades autoinmunes como el Síndrome de Sjogren y el Lupus eritematoso sistémico, entre otras. La importancia de la saliva se apoya en los elementos que la conforman y cómo éstos llevan a cabo sus actividades dentro de la cavidad bucal. Estas funciones se encuentran comprometidas cuando existe disminución del flujo salival y producen gran impacto en la calidad de vida de estos pacientes. Al examen clínico se observa la presencia de caries extensas, aparición de enfermedades oportunistas como la candidiasis y la mucosa bucal se observa eritematosa. Por lo tanto, es importante para el odontólogo reconocer esta condición realizando un apropiado diagnóstico del paciente con "síndrome de boca seca" o xerostomía, investigar su etiología y determinar la capacidad secretora de las glándulas salivales, todo esto con el propósito de aplicar el tratamiento más adecuado para el paciente

Rânula: aspectos clínicos e histopatológicos de 15 casos / Ranula: a clinical and histopatological analysis of 15 cases

A rânula (mucocele do assoalho oral) é uma lesäo benigna, relativamente frequente, que acomete, na maioria das vezes, as glândulas sublinguais maiores de crianças e adultos jovens. De acordo com a sua localizaçäo, é denominada de rânula do tipo intra-oral ou cervical. Quando näo há aumento de volume na regiäo do assoalho oral, o diagnóstico clínico de rânula näo é claro, podendo esta ser confundida com várias lesöes que acometem os espaços submandibular e sublingual do pescoço. De acordo com a literatura, o tratamento destas lesöes pode ser realizado através de cirurgia, uso de injeçöes esclerosantes, radioterapia e o emprego de dióxido de carbono. O objetivo deste trabalho é apresentar quinze casos de mucoceles do assoalho oral diagnosticados e tratados no Serviço de Cirurgia Buco-Maxilo-Facial do Hospital Universitário Pedro Ernesto. Além disso, consideraçöes sobre a prevalência, aspectos clínicos, histopatológicos e detalhes sobre seu tratamento seräo discutidos

Sindrome de Sjogren (SS) / Sjogren syndrome (SS)

Atendiendo a la ineludible responsabilidad del odontólogo de profundizar en el conocimiento de aquellas enfermedades cuya manifestación clínica se evidencie en el complejo maxilofacial. El presente artículo recoge, en apretada síntesis, una visión integradora del sindrome de Sjogren (SS), abordando aspectos históricos, definición, características clínicas, epidemiología y aspectos hísticos e inmunopatológicos de las alteraciones en glándulas salivales menores. Se plantea la participación del odontólogo en el diagnóstico de la enfermedad, atendiendo al conjunto de agresiones que pueden provocar alteraciones en el parénquima de las glándulas salivales menores, lo que puede ser de gran valor en la justa evaluación clínica de estos pacientes. Desde el punto de vista inmunopatológico, existe coincidencia al plantear que las células predominatnes en el infiltrado linfocítico de las glándulas salivales accesorias son las T-colaboradoras (CD4+) de 3-4:1. Las células B, constituyen aproximadamente el 20 por ciento del total de la población involucrada, mientras que las NK son las menos frecuentes (5 por ciento)

Estudo das glândulas parótidas e submandibulares em pacientes portadores da síndrome de Sjogren, por meio da sialografia / Study of major salivary glands from patients with Sjogren's syndrome, using sialography

O trabalho apresenta as imagens das glândulas parótidas e submandibulares por meio das sialografias, em pacientes com síndrome de Sjogren, de acordo com a evoluçäo da patologia

Patología de cavidad oral: maxilares y gládulas salivales: estudio restrospectivo Hospital de Clínicas, Departamento de Patología y Maxilo Facial: años 1984-1993 / Oral pathology: maxillan and salivary glands retrospective study at in Department of maxillofacial pathology at Hospital de Clinicas 1984-1993

Se describen los resultados del estudio longitudinal, retrospectivo, analitico de la casuistica de patologia de cavidad oral, maxilares y glandulas saliales en los años 1984 a 1994 correlacionandose los archivos de los departamentos de anatomia patologica y maxilo facial, del hospital de clinicas de la ciudad de La Paz, estableciendose el porcentaje de su presentación, en base a diferentes variables y sobre todo a su tipificacion histologica.

Hepatitis crónica C, VIH y síndrome de Sjögren: informe de un caso / Chronic C-hepatitis, AIDS and Sjögren syndrome: a case report

El síndrome de Sjögren es una linfoexocrinopatía autoinmune de etiología desconocida, que se presenta como 1) forma primaria o 2) asociada a diversas enfermedades autoinmunes. Diversos virus intervienen en su origen (Epptein-Barr, citomegalovirus, herpes simple, retrovirus). En fechas recientes se ha relacionado con el virus C de la hepatitis; también se ha descrito asociado a hepatitis crónica, cirrosis biliar primaria y a trombocitopenias autoinmunes. Presentamos el caso de un paciente con hepatitis crónica C, seropositivo al VIH que desarrolló síndrome de Sjögren