Factores asociados a sobrevida en pacientes con co-infección VIH-TBC en el Servicio de Infectología del Hospital Nacional Arzobispo Loayza, Perú, durante los años 2004-2012 / Factors associated to survival in patients with HIV-TB in the Department of Infectious Diseases of the Arzobispo Loayza National Hospital, Perú, since 2004 to 2012

Resumen Introducción La principal causa de muerte en pacientes infectados con VIH es la tuberculosis (TBC). Pocos estudios latinoamericanos han evaluado la sobrevida de pacientes co-infectados. Objetivo Determinar factores asociados a sobrevida en pacientes con co-infección VIH-TBC atendidos en un hospital peruano. Materiales y Métodos Estudio de cohorte, retrospectivo, en base a registros clínicos de pacientes atendidos en el Servicio de Infectología del Hospital Nacional Arzobispo Loayza durante los años 2004-2012. Se evaluó la sobrevida de 315 pacientes, utilizando las curvas de Kaplan-Meier y el método de Riesgos Proporcionales de Cox. Resultados De 315 pacientes, 82 murieron durante el seguimiento. La mediana de seguimiento para cada participante fue de 730 días. El análisis multivariado mostró que recibir TARGA (HR: 0,31; IC: 0,20-0,50; p < 0,01) y tener mayor peso (HR: 0,96; IC 0,94-0,98; p < 0,01) al momento del diagnóstico de la co-infección fueron factores protectores; mientras que tener una patología distinta a TBC (HR: 1,88; IC: 1,19-2,98; p < 0,01), edad mayor a 34 años (HR: 1,76; IC: 1,12-2,74; p ≤ 0,01), y estar hospitalizado al momento del diagnóstico (HR: 1,69; IC 1,02-2,80; p < 0,04) se asociaron a menor sobrevida. Discusión Recibir TARGA y tener mayor peso al momento del diagnóstico de la coinfección se asociaron a mayor sobrevida.

Background The main cause of death in HIV patients is tuberculosis (TB). However, few Latin American studies have evaluated the prognosis of patients with coinfection. Aim To determine the factors associated with survival in patients with HIV-TB coinfection treated at a Peruvian referral hospital. Methods A retrospective cohort study was performed based on clinical records of patients treated at the Department of Infectious Diseases in the Arzobispo Loayza National Hospital from 2004 to 2012. Survival was assessed using the Kaplan-Meier estimator and Cox Proportional Hazard Model. Results From 315 patients, 82 died during the follow-up. The mean of follow for each patient was 730 days. The multivariate analysis showed that receiving HAART (HR: 0,31; IC: 0,20-0,50; p < 0,01) and having more weight (HR: 0,96; IC 0,94-0,98; p < 0,01) when the coinfection was diagnosed, were protective factors; while having a pathology different from TB (HR: 1,88; IC: 1,19-2,98; p < 0,01), age in years (HR: 1,76; IC: 1,12-2,74; p ≤ 0,01) and being hospitalized when diagnosed with TB (HR: 1,69; IC 1,02-2,80; p < 0,04) were associated with lower survival. Discussion Receiving HAART and having more weight when the coinfection is diagnosed were associated with a higher chance of survival.

Factors affecting virological non-suppression amongst HIV-positive patients on antiretroviral therapy: Uganda, August 2014 - July 2015

Introduction: virological suppression is a critical indicator for HIV treatment success and reduction in HIV transmission risk. However, despite the increasing number of people on antiretroviral therapy (ART), there is limited information about non-suppression and its determinants among HIV-positive (HIV+) individuals enrolled in care in many resource-limited settings. This study estimated the virological non-suppression rates amongst HIV+ patients who had been on ART for at least 6 months and the factors associated with non-suppression. Methods: a descriptive cross-sectional study was conducted using routinely collected data from viral load testing samples from 100,678 HIV+ patients enrolled in HIV care across the country between August 2014 and July 2015. Viral load testing was conducted at the Central Public Health Laboratories in Kampala, Uganda. We extracted data on socio-demographic, clinical and viral load testing results. We defined virological non-suppression as having ≥ 1000 copies of viral RNA/ml of blood for plasma or ≥ 5000 copies of viral RNA/ml of blood for dry blood spots. We used logistic regression to identify factors associated with virological non-suppression. Results: majority of the patients (68%) were females. The overall non-suppression rate was 11%. Second-time testers had a higher non-suppression rate than first-time testers (50% vs. 10%, OR = 7.0, 95%CI = 6.2-7.9); and children aged < 5 years (29%, OR = 5.3, 95%CI = 4.8-6.0) and adolescents aged 15-19 (27%, OR = 4.1, 95%CI = 3.7-4.5) had higher non-suppression rates than persons of other age groups. Non-suppression rates were also higher among suspected treatment failures (29%, OR = 4.0, 95%CI = 3.7-4.4), patients with reported adherence levels < 85% (35%, OR = 3.4, 95%CI = 3.0-3.9), and patients with active TB (20%, OR = 2.0, 95%CI = 1.5-2.3) than those without these conditions. Breastfeeding (6%, OR = 0.61, 95%CI = 0.54-0.69) and pregnant women (8%, OR = 0.77, 95%CI = 0.65-0.91) had lower non-suppression rates than non-breastfeeding and non-pregnant women (10%). Conclusion: virological non-suppression was associated with second time testers, young age, poor adherence, and TB co-infection. To maximize the benefits of the expanded ART, we recommend close follow-up and intensified targeted adherence support for second time testers, children and adolescents. Adherence to standard guidelines for managing TB/HIV co-infections should be emphasized by all ART clinics

Ratio of monocytes to lymphocytes in peripheral blood in patients diagnosed with active tuberculosis

Objective: The ratio of monocytes to lymphocytes in peripheral blood could reflect an indi- vidual's immunity to Mycobacterium tuberculosis. The objective of this study was to evaluate the relationship between ratio of monocytes to lymphocytes and clinical status of patients with active tuberculosis. Methods: This was a retrospective review of data collected from the clinical database of The Fifth People's Hospital of Wuxi, Medical College of Jiangnan University. A total of 419 patients who had newly diagnosed active tuberculosis and 108 cases from 419 patients with tuberculosis therapy either near completion or completed were selected. Controls were 327 healthy donors. Results: Median ratio of monocytes to lymphocytes was 0.36 (IQR, 0.22-0.54) in patients before treatment, and 0.16 (IQR, 0.12-0.20) in controls (p < 0.001). Ratio of monocytes to lymphocytes <9% or >25% was significant predictors for active tuberculosis (OR = 114.73, 95% CI, 39.80-330.71; OR = 89.81, 95% CI, 53.18-151.68, respectively). After treatment, the median ratio of monocytes to lymphocytes recovered to be nearly normal. Compared to other patients, patients with extrapulmonary tuberculosis and of age >60 years were more likely to have extreme ratio of monocytes to lymphocytes (AOR = 2.57, 95% CI, 1.08-6.09; AOR = 4.36, 95% CI, 1.43-13.29, respectively). Conclusions: Ratio of monocytes to lymphocytes <9% or >25% is predictive of active tuberculosis. .

Provider-initiated HIV testing and counseling among tuberculosis patients in a hospital in the Oromia region of Ethiopia

Routine testing for human immunodeficiency virus [HIV] in settings with generalized HIV epidemics affords the benefit of diagnosing the infection early and thereby preventing morbidity, mortality and sustained transmission; early detection hastens the initiation of cotrimoxazole prophylaxis and anti-retroviral treatment [ART]. Therefore, the objective of this study was to assess HIV counseling and testing among tuberculosis patients under routine care conditions in the Bishoftu hospital within the Oromia region of Ethiopia. A retrospective study was conducted from a tuberculosis [TB] registry, which included data from all adult patients who were diagnosed and treated at Bishoftu Hospital in Oromia from 2009 through 2011. The data were reviewed, coded and entered into the computer software, SPSS version 16.0, for analysis. We used a descriptive and multi-variable logistic regression model to predict HIV-positive status. Among the 682 patients recorded on the TB registry, the required variables for this study were completed for 681 adult tuberculosis patients. Out of all the TB patients for whom the variables were collected, 98% [669/681] were offered HIV counseling and testing, and nearly all of them [668/669] accepted and were tested for HIV. Among those patients who accepted for testing and were tested for HIV, 32.2% [215/668] tested positive. Pulmonary TB, among all types of all forms of TB, urban residence and the 25-64 age group were more generally associated with an HIV-positive status; however, male sex and pulmonary-positive types of TB were less likely to be HIV-positive. The acceptance rate for HIV counseling and testing services among TB patients was very high. However, there were missed cases in which the test was not offered. The prevalence of HIV was very high, and the infection was more prevalent among urban residents, females, young people and pulmonary-negative TB patients; thus, these patients need attention from all concerned parties

Avaliação do papel do interferon-y na modulação da resposta tecidual durante a infecção pelo Mycobacterium bovis / Evaluation of the role of interferon-y in the modulation of tissue response during infection with Mycobacterium bovis

O IFN-y tem sido implicado na defesa do hospedeiro contra as micobactérias. Esta citocina, produzida e liberada por linfócitos T recrutados para o sítio da infecção, é considerada o agente chave da ativação endógena, promovendo efeitos antimicobacterianos de macrófagos. Diversos modelos experimentais têm sido desenvolvidos para delinear o papel de citocinas responsáveis pelo controle da tuberculose. O presente estudo visa delinear o papel do IFN-y na modulação da resposta inflamatória granulomatosa no tecido hepático e pulmonar em camundongos infectados experimentalmente com o M. bovis. Os experimentos foram realizados utilizando-se camundongos com deficiência do gene responsável pela produção do IFN-y (C57BL/6 IFN-y-l-) e camundongos que produzem IFN-y (C57BL/6 IFN-y+l+), ambos infectados por via intravenosa com M. bovis. Avaliou-se a capacidade de sobrevida e multiplicação do M. bovis no fígado e pulmões, assim como características histopatógicas nestes dois órgãos. No curso da infecção (15, 30, 50 e 100 dias pós-infecção) a CFU (unidade formadora de colônia) foi quantificada no tecido hepático e pulmonar dos dois grupos de camundongos. A carga bacilar dos animais IFN-y-l- foi significantemente maior que nos IFN-y+/+. A quantidade de CFU foi maior no fígado que nos pulmões dos animais IFN-y-l- durante todo o estudo, enquanto nos IFN-y+/+ apenas no primeiro ponto estudado (15 dias pós-infecção). Adicionalmente, nos camundongos IFN-y/- ocorreu um aumento contínuo da carga bacilar com o transcurso da infecção, enquanto os camundongos IFN-y+/+ foram capazes de reduzir a carga bacilar no tecido hepático nos períodos mais tardios da análise. As alteraíões histopatológicas começam mais tardiamente nos camundongos IFN-y-/- (30 dias de pós-infecção). Estes formam granulomas sempre em menor número e tamanho que os IFN-y+/+. As alterações granulomatosas no fígado persistem até os 100 dias no camundongo IFN-y-l- e diminuem nos IFN-y+/+. Portanto, a presença do...

HIV infection in patients with tuberculosis in Baghdad [1996-1998]

A three-staged prospective study involving 430 patients with tuberculosis was conducted at the Tuberculosis Institute, Baghdad during 1996-98. Of the 430 patients, 270 were males, 370 patients were diagnosed as pulmonary tuberculosis and 60 patients had extrapulmonary tuberculosis. Considering some risk factors for human immunodeficiency virus [HIV] infection, 11 patients had tattoos, 13 were prisoners and 5 were barbers. All the patients were tested for HIV infection and all were negative

Micobacterioses em pacientes portadores da síndrome da imunodeficiência adquirida: importância de uma investigação sistemática / Mycobacteriosis in patients with acquired immunodeficiency syndrome: the importance of systematic research

Com o objetivo de demonstrar a importância da investigação sistemática de micobactérias em pacientes com SIDA, independente dos sintomas apresentados, a autora pesquisou a presença de Mycobacterium tuberculosis e micobactéria atípica em materiais obtidos em três sitios: pulmão (escarro espontâneo ou induzido), urina e medula óssea. Para tal, realizou um estudo transversal em 24 pacientes com SIDA, internados em um hospital público de Salvador. 12 pacientes (50%) tiveram diagnóstico de micobacteriose: através da cultura foi identificado um paciente (4%) com uma associação de micobactérias atípicas e seis (25%) com Mycobacterium tuberculosis. Cinco pacientes (21%) apresentaram positividade apenas à baciloscopia, que correspondiam provavelmente ao Mycobacterium tuberculosis. Para a obtenção de secreção das vias aéreas inferiores nos pacientes que não expectoraram espontaneamente para três amostras, foi utilizada a técnica da indução do escarro através da nebulização com solução hipertônica, o que levou a um acréscimo de 8% no diagnóstico de micobacteriose. No entanto, a obtenção de secreção com esta técnica só ocorreu nos pacientes com anormalidade clinica do aparelho respiratório, sendo improdutiva a sua utilização naqueles pacientes sem alteração deste aparelho. A pesquisa em sitios extra-pulmonares de fácil acesso, através da urocultura e do aspirado de medula óssea, acrescentou mais 17%, cada exame, ao diagnóstico de micobacteriose. Quando analisados em associação ao escarro induzido, acrescentaram 25% ao número de casos diagnosticados. A presença de poucos bacilos foi uma constante em todas as amostras dos pacientes com exames positivos, o que evidenciou a importância da obtenção de amostras seriadas do escarro para aumentar a chance de diagnóstico de micobactéria pulmonar. Neste estudo, foram ainda observados aspectos clinicos, concluindo-se que micobactérias devem ser pesquisadas em todos os pacientes que expectorem espontaneamente ou...