ABSTRACT
Among people with HIV, histoplasmosis represents an important cause of mortality. Previous studies provided estimates of the disease incidence. Here, we compared those estimates with the results obtained from a screening program implemented in Guatemala, which included histoplasmosis detection for people with HIV. To compare the results of this program with previous estimations, a literature search was performed and reports concerning histoplasmosis incidence were analyzed. The screening program enrolled 6366 patients. The overall histoplasmosis incidence in the screening program was 7.4%, which was almost double that estimated in previous studies. From 2017 to 2019, the screening program showed an upward trend in histoplasmosis cases from 6.5% to 8.8%. Histoplasmosis overall mortality among those who were newly HIV diagnosed showed a decrease at 180 days from 32.8% in 2017 to 21.2% in 2019. The screening approach using rapid diagnostic assays detects histoplasmosis cases more quickly, allowing a specific treatment to be administered, which decreases the mortality of the disease. Therefore, the use of these new techniques, especially in endemic areas of histoplasmosis, must be implemented.
ABSTRACT
OBJECTIVES: To describe the impact of the coronavirus disease 2019 (COVID-19) pandemic on the diagnosis of human immunodeficiency virus (HIV) and deaths from opportunistic infections in Guatemala. METHODS: A retrospective study was conducted to investigate the impact of the COVID-19 pandemic on people with HIV at a referral clinic (Clinica Familiar Luis Angel García, CFLAG), as well as the disruption of services at a diagnostic laboratory hub (DLH) which provides diagnosis for opportunistic infections to a network of 13 HIV healthcare facilities. Comparative analysis was undertaken using the months March-August from two different time periods: (i) pre-COVID-19 (2017-2019); and (ii) during the COVID-19 period (2020). RESULTS: During the COVID-19 period, 7360 HIV tests were performed at Clinica Familiar Luis Angel García, compared with an average of 16,218 tests in the pre-COVID-19 period; a reduction of 54.7% [95% confidence interval (CI) 53.8-55.4%],Deaths from opportunistic infections at 90 days were 10.7% higher in 2020 compared with 2019 (27.3% vs 16.6%; P = 0.05). Clinical samples sent to the DLH for diagnosis of opportunistic infections decreased by 43.7% in 2020 (95% CI 41.0-46.2%). CONCLUSION: The COVID-19 pandemic is having a substantial impact on HIV care in Guatemala. Diagnostic services for HIV have been severely affected and deaths from opportunistic infections have increased. The lessons learnt must guide the introduction of strategies to reduce the impact of the pandemic.
Subject(s)
COVID-19 , HIV Infections , Ambulatory Care Facilities , Guatemala/epidemiology , HIV Infections/diagnosis , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Pandemics , Retrospective Studies , SARS-CoV-2ABSTRACT
Opportunistic infections (OIs) and advanced HIV disease (AHD) contribute to HIV-related mortality. Here, we analyzed the situation of AHD and OIs in a cohort of newly diagnosed HIV patients from Guatemala. We included 2127 adult patients from 13 facilities across the country during 2017 to 2018. Patients were screened for tuberculosis (TB), nontuberculous mycobacteria (NTM), histoplasmosis, and cryptococcal disease, independently of their CD4 cell count. Of the 2127 enrolled patients, 1682 (79.1%) had a CD4 cell count available; of which 52% presented with AHD. Of the Mayan population, 65% had AHD. The overall OI incidence was 21%. Histoplasmosis was the most frequent OI (7.9%), followed by TB (7.1%); 94.4% of these infections occurred in patients with a CD4 < 350 cells/mm3. Mortality at 180 days was significantly higher in those with OIs than without OIs (29.7% vs. 5.9%, p < 0.0001). In one year, this program decreased the OI mortality by 7% and increased the OI treatment by 5.1%. Early OI diagnosis and appropriate therapy reduced OI mortality among newly diagnosed HIV patients in Guatemala. Screening for OIs should be considered in all newly diagnosed HIV patients who have a CD4 cell count < 350 cells/mm3 or those without a CD4 cell count available. To improve results, interventions such as early HIV detection and access to flucytosine and liposomal amphotericin B are required.
ABSTRACT
Se determinó la frecuencia de anticuerpos IgG para Toxoplasma gondii y los virus de paperas, sarampión, rubéola, varicela y hepatitis B en 90 estudiantes de la carrera de Química Biológica de la Facultad de CCQQ y Farmacia. La mayor frecuencia se encontró para rubéola y sarampión, 98.9% para cada prueba y la menor frecuencia fue para T. gondii con 23.3%. No se encontró asociación significativa entre la positividad y el género, entre la positividad a paperas, sarampión, varicela y el haber sufrido la infección o haber estado en contacto con personas infectadas y entre la positividad a T. gondii y el consumir carne roja y/o comida callejera (p > .05). Únicamente en el caso de la hepatitis B se encontró una asociación significativa entre la positividad y la edad (p = < .001), el hecho de estar vacunado (p < .001) y el ser sexualmente activo (p = .004). Los porcentajes de vacunación en la población en estudio fue alta únicamente para hepatitis B (80%), mientras que para las otras infecciones fue 35.6% para rubéola y sarampión, 22.2% para varicela y 10% para paperas. Más de 82% de los estudiantes presentaron protección a los seis agentes estudiados y se recomienda realizar encuestas sero-epidemiológicas constantes, evaluar los programas de inmunización, identificar los grupos a riesgo y que las personas que no presenten anticuerpos se vacunen.
The frequency of IgG antibodies for Toxoplasma gondii and the mumps, measles, rubella, varicella and hepa-titis B viruses was determined in 90 students of the Biological Chemistry career of the Faculty of CCQQ and Pharmacy. The highest frequency was found for Rubella and Measles, 98.9% each, and the lowest frequency was for T. gondii with 23.3%. No significant difference was found between positivity and gender, between positivity to mumps, measles, chicken pox and having suffered infection or having been in contact with infected persons and between positivity to T. gondii and consuming red meat and / or street food (p > .05). Only in the case of Hepatitis B a significant difference between positivity and age (p = .001), the fact of being vaccinated (p = .001) and being sexually active (p = .004 was found. The percentage of vaccination in the study population was high only for He-patitis B (80%), while for the other infections it was 35.6% for rubella and measles, 22.2% for varicella and 10% for mumps. More than 82% of the students presented protection to the six agents studied and it is recommended to carry out constant sero-epidemiological surveys, to evaluate the immunization programs, to identify the risk groups and that people who do not present antibodies get vaccinated.
