Very high incidence of syphilis in HIV-infected men who have sex with men in Buenos Aires city: a retrospective cohort study.

BACKGROUND: The incidence of sexually transmitted infections (STIs), particularly syphilis, is high and continues to rise among some populations, especially among men who have sex with men (MSM). Furthermore, a higher incidence of STIs has been reported in HIV-positive than in HIV-negative MSM. OBJECTIVE: To determine the incidence of syphilis in a cohort of men with HIV in Buenos Aires city. METHODS: Retrospective cohort study. We examined the records and visits made by men with HIV aged >18 years in our institution during a 1-year period. Venereal Disease Reference Laboratory (VDRL) results for all the men in our cohort during the study period were analysed. We considered a case of syphilis as incident if a person had a VDRL result of ≥16 DILS, provided that this was increased at least fourfold compared with a previous determination. All VDRL results ≤8 were investigated, and analysed together with the medical records, to determine if they were new cases. RESULTS: We analysed the VDRL results and the clinical records of 1150 men followed up in our centre during the study period. Mean age was 40.9 years. According to the definition used, we registered 171 new cases of syphilis-that is, an incidence of 14.9/100 patients/year (95% CI 12.9 to 17.0). No significant differences in incidence according to age group were found, but there was a trend towards a lower incidence in older men. Ten men had two new episodes during the study. CONCLUSIONS: The incidence of syphilis in this cohort of men with HIV (predominantly MSM) was very high. In addition to maintaining high surveillance for early diagnosis and treatment, it is necessary to implement newer and more effective measures to prevent syphilis and other STIs in this population.

Nutritional Status and Lipid Profile in HIV-Infected Adults.

In the last decades, there have been many reports of HIV infection and abnormalities in lipid metabolism and cardiovascular disease (CVD). This study aims at describing the nutritional status of HIV-infected adults and its relation to lipid profile through traditional [total cholesterol (TC), HDL cholesterol (HDL), triglycerides (TG), non-HDL cholesterol and LDL cholesterol (LDL)] and other parameters [Apolipoprotein B (ApoB), fibrinogen, and high sensitive-C-reactive protein (hs-CRP)]. A cross-sectional descriptive study was performed. Body mass index (BMI) was calculated and references were taken from WHO. TC, HDL, TG and glucose were determined and non-HDL cholesterol and LDL were calculated. ApoB and fibrinogen were determined by quantitative radial immunodiffusion on agar plates (Diffuplate,Biocientífica SA,Argentina) and hs-CRP by immunoturbidimetric test. Qualitative variables were compared with the Chi-square test or Fisher's exact test. Quantitative variables were compared applying parametrics or nonparametric tests. Pearson test for correlations. Software SPSS 17.0. 97 patients were analyzed: 69.1% were men. 80% were on antiretroviral treatment. Average (SD) BMI was 24.3 (4.1) kg/m(2). 29.4% were overweight and 5.9% obese. Patients with a BMI ≥25.0 kg/m(2) presented significantly higher levels of TG, ApoB and glycemia than well-nourished people [246.1(169.0) vs. 142.9(78.4) mg/dL;p=0.029, 198.6(69.3) vs. 126.4(50.6) mg/dL;p=0.01 and 100 (3.2) vs. 90.2 (6.9) mg/dL;p=0.008 resp.] and a significantly decreased HDL [37.2(1.5) vs. 49.8(10.4) mg/dL;p<0.01]. No statistically significant correlation was found between ApoB and non-HDL (p=0,063). There was no evidence that there is a direct relation between Apo B and the other lipid parameters. The potential increase in CVD in this group of patients, would be related to the higher levels of TG, ApoB and overweight/obesity. Nutritional education is needed to promote a healthy weight to warn against the risk of cardiovascular disease.

[Cytomegalovirus polyradiculomyelopathy in AIDS]. / Poliradiculomielopatia causada por citomegalovirus en pacientes con SIDA.

To evaluate the efficacy of ganciclovir, foscarnet, or the combination of both for the treatment of cytomegalovirus polyradiculomyelopathy (CMV-PRAM), we reviewed the records of seven patients with AIDS, diagnosed with CMV-PRAM. Muscle strength was graded according to the Medical Research Council (MRC) scale. Response to treatment was also classified according to MRC scale, based on the degree of improvement in muscle strength. Six of 7 patients had a good response to treatment, reaching the MRC scale of 4, or improving at least 3 degrees in the same scale. CMV-PRAM may be treated with ganciclovir alone or in combination with foscarnet.

Inadequate dietary intake and altered nutrition status in early HIV-1 infection.

Recent studies indicate that multiple nutritional abnormalities occur relatively early in the course of human immunodeficiency virus (HIV-1) infection. Decreased plasma levels of vitamins B6, B12, A, and E and zinc have been correlated with dietary intake and associated with significant alterations in immune response and cognitive function. To determine the level of intake consistent with normal plasma nutrient levels, we examined nutrition status in relation to food consumption and nutrient supplementation in HIV-1-seropositive (HIV+) and -seronegative (HIV-) homosexual men. The mean level of total intake (diet plus supplements) for all nutrients was significantly higher in HIV+ men. To achieve normal plasma nutrient values, the HIV+ men appeared to require intake in multiples of the recommended dietary allowance (RDA) for vitamins A, E, B6, and B12 and zinc. For the HIV+ men, a relatively high proportion of biochemical deficiency was associated with consumption of vitamin B6 and zinc at the RDA level. Because little evidence of deficiency was observed with elevated intake in both groups, an effective program of nutritional supplementation may be beneficial in maintaining adequate plasma nutrient levels.