[Monkeypox: description of two cases under follow-up in Buenos Aires]. / Viruela símica: descripción de dos casos en seguimiento en Buenos Aires.

Monkeypox is an endemic disease in several African countries. In May 2022, an outbreak was reported in dozens of non-endemic countries. On July 23, 2022, the WHO Director-General declared this multinational outbreak a public health emergency of international concern. We report two cases of patients under follow-up in Buenos Aires, Argentina, between June and July 2022. Both were men who have sex with men, with the appearance of lesions in the genital area without a prodromal period. In both cases, treatment was carried out in the first instance with suspicion of sexually transmitted infections. We highlight the importance of considering this pathology as a differential diagnosis, taking into account the current epidemiological context.

La viruela símica es una enfermedad endémica en varios países de áfrica. En mayo de 2022 varios países donde la viruela símica no es endémica notificaron casos, incluyendo algunos países de las Américas. El 23 de julio de 2022, el Director General de la OMS declaró que este brote multinacional constituye una emergencia de salud pública de importancia internacional. Comunicamos dos casos de pacientes en seguimiento en la Ciudad de Buenos Aires, Argentina, entre junio y julio de 2022. Ambos eran hombres que tienen sexo con hombres, con aparición de lesiones en zona genital sin período prodrómico. En los dos casos se realizó tratamiento en primera instancia con sospecha de infecciones de transmisión sexual. Señalamos la importancia de considerar esta enfermedad como diagnóstico diferencial teniendo en cuenta el contexto epidemiológico actual.

Viruela símica: descripción de dos casos en seguimiento en Buenos Aires / Monkeypox: description of two cases under follow-up in Buenos Aires

Resumen La viruela símica es una enfermedad endémica en varios países de África. En mayo de 2022 varios países donde la viruela símica no es endémica notificaron casos, incluyendo algunos países de las Américas. El 23 de julio de 2022, el Director General de la OMS declaró que este brote multinacional constituye una emergencia de salud pública de importancia internacional. Comunicamos dos casos de pacientes en segui miento en la Ciudad de Buenos Aires, Argentina, entre junio y julio de 2022. Ambos eran hombres que tienen sexo con hombres, con aparición de lesiones en zona genital sin período prodrómico. En los dos casos se realizó tratamiento en primera instancia con sospecha de infecciones de transmisión sexual. Señalamos la importancia de considerar esta enfermedad como diagnóstico diferencial teniendo en cuenta el contexto epidemiológico actual.

Abstract Monkeypox is an endemic disease in several African countries. In May 2022, an outbreak was repor ted in dozens of non-endemic countries. On July 23, 2022, the WHO Director-General declared this multinational outbreak a public health emergency of international concern. We report two cases of patients under follow-up in Buenos Aires, Argentina, between June and July 2022. Both were men who have sex with men, with the appea rance of lesions in the genital area without a prodromal period. In both cases, treatment was carried out in the first instance with suspicion of sexually transmitted infections. We highlight the importance of considering this pathology as a differential diagnosis, taking into account the current epidemiological context.

Uptake and effectiveness of two-drug compared with three-drug antiretroviral regimens among HIV-positive individuals in Europe.

OBJECTIVE: To assess the use of two-drug antiretroviral regimens (2DR) and virologic and immunologic outcomes compared with three-drug regimens (3DR) in the EuroSIDA cohort. DESIGN: Multicentre, prospective cohort study. METHODS: Logistic regression was used to analyse the uptake and outcomes among HIV-positive individuals who started or switched to a 2DR compared with those on a 3DR. Virologic outcomes were assessed on-treatment as the proportion of individuals with controlled viral load (<400 copies/ml), or with a composite modified FDA snapshot endpoint (mFDA), with mFDA success defined as controlled viral load at 6 months or 12 months for individuals with a known viral load, no regimen changes, AIDS or death. Immunologic response was defined as a 100 cells/µl or a 25% increase in CD4 cell counts from baseline. RESULTS: Between 1 July 2010 and 31 December 2016, 423 individuals started or switched to a 2DR (eight antiretroviral-naive) and 4347 started a 3DR (566 naive). Individuals on 2DR tended to have suppressed viral load, higher CD4 cell counts and more comorbidities at baseline compared with those on 3DR. There were no differences in the proportions of individuals who obtained on-treatment or mFDA success, and no significant differences in the adjusted odds ratios for mFDA success or immunologic responses between the 2DR and 3DR groups at 6 months or 12 months. CONCLUSION: In routine clinical practice, 2DR were largely used for virologically suppressed individuals with higher cumulative exposure to antiretrovirals and comorbidities. Virologic and immunologic outcomes were similar among those on 2DR or 3DR, although confounding by indication cannot be fully excluded due to the observational nature of the study.

Ergotismo y VIH: el riesgo de la automedicación / Ergotism and HIV: the risk of self-medication

El ergotismo es una complicación bien conocida, aunque poco fre-cuente, asociada a la ingesta de derivados de la ergotamina en dosis habitualmente más altas de las recomendadas. No obstante, también puede presentarse luego del uso de bajas dosis cuando se adminis-tran concomitantemente drogas que inhiben su metabolismo, entre ellas los inhibidores de proteasa (IP), ampliamente utilizados en el tra-tamiento de pacientes con infección por el virus de la inmunodeficien-cia humana (VIH). A pesar de esta interacción predecible se siguen observando en la práctica clínica diaria casos de ergotismo, probable-mente debido a que se trata de una droga de uso frecuente, bajo cos-to y que no requiere prescripción médica, sumado a la falta de conoci-miento del paciente de las potenciales interacciones. Se describen las características, diagnóstico, tratamiento y evolución de cuatro pacien-tes con infección por VIH en tratamiento antirretroviral (TARV), basa-do en IP, que presentaron un cuadro de ergotismo

Ergotism is a well-known but rare complication associated with the intake of ergotamine derivatives at doses usually higher than recommended. However, it may also occur after low doses of ergotamine when it is co-administered with drugs that inhibit its metabolism, such as protease inhibitors (PIs), widely used in the treatment of patients with human immunodeficiency virus. Despite this predictable interaction, cases of ergotism are still being observed in daily clinical practice, probably because it is a frequently used, low cost drug that does not require medical prescription, in addition to the patient's lack of knowledge of the potential interactions. We describe here the characteristics, diagnosis, treatment and evolution of four HIV-infected patients on PI-based antiretroviral treatment who presented a clinical picture of ergotism

Antiretroviral therapy and arterial elasticity in HIV-infected patients.

Cardiovascular risk is increased in HIV-infected patients and has become a leading cause of morbi-mortality in this population. The purpose of this study is to compare HIV-infected patients on antiretroviral therapy (ART) and ART-naïve HIV-infected patients regarding arterial elasticity. From September 2010 to September 2015, 105 HIV-infected subjects were enrolled, 41 ART-naïve and 64 on ART with stable viral suppression. Elasticity of large and small arteries (LAE and SAE) was assessed by analysis of radial pulse waveforms using a calibrated device. A single set of measurements was performed. Multivariate linear regression models were constructed to estimate independent correlates of arterial elasticity. On-ART and ART-naïve patients were similar with respect to gender, age, body mass index, Framingham cardiovascular risk score, smoking habits, and CD4+ counts. Median time on treatment was 60 months and 79% of patients were on regimens based on non-nucleoside reverse-transcriptase inhibitors. No significant differences in LAE and SAE assessments were found between groups. However, time on ART and cholesterol levels were independently associated with LAE impairment. No association between arterial elasticity and CD4+ counts was found. We conclude that cumulative exposure to ART may play a role on LAE impairment and deserves further investigation.

Antiretroviral therapy and arterial elasticity in HIV-infected patients

Cardiovascular risk is increased in HIV-infected patients and has become a leading cause of morbimortality in this population. The purpose of this study is to compare HIV-infected patients on antiretroviral therapy (ART) and ART-naïve HIV-infected patients regarding arterial elasticity. From September 2010 to September 2015, 105 HIV-infected subjects were enrolled, 41 ART-naïve and 64 on ART with stable viral suppression. Elasticity of large and small arteries (LAE and SAE) was assessed by analysis of radial pulse waveforms using a calibrated device. A single set of measurements was performed. Multivariate linear regression models were constructed to estimate independent correlates of arterial elasticity. On-ART and ART-naïve patients were similar with respect to gender, age, body mass index, Framingham cardiovascular risk score, smoking habits, and CD4+ counts. Median time on treatment was 60 months and 79% of patients were on regimens based on non-nucleoside reverse-transcriptase inhibitors. No significant differences in LAE and SAE assessments were found between groups. However, time on ART and cholesterol levels were independently associated with LAE impairment. No association between arterial elasticity and CD4+ counts was found. We conclude that cumulative exposure to ART may play a role on LAE impairment and deserves further investigation.

El riesgo cardiovascular está incrementado en los pacientes HIV seropositivos y se ha convertido en una de las principales causas de morbimortalidad en esta población. El objetivo de este estudio fue comparar la elasticidad de grandes y pequeñas arterias (LAE y SAE) en pacientes infectados por HIV con y sin terapia antirretroviral. De septiembre de 2010 a septiembre de 2015 se enrolaron 105 pacientes con infección por HIV, 41 vírgenes de antirretrovirales y 64 con tratamiento estable en supresión viral. LAE y SAE fueron evaluados mediante análisis de la onda de pulso radial. Se construyeron modelos de regresión lineal múltiple para evaluar los predictores independientes de la elasticidad arterial. Los grupos en tratamiento y naïve fueron similares con respecto al sexo, edad, índice de masa corporal, índice de Framingham, tabaquismo y recuento de CD4+. La mediana de tiempo en tratamiento antirretroviral fue 60 meses y el 79% de los pacientes recibieron inhibidores no nucleosídicos. No hubo diferencias significativas entre los grupos en los valores de LAE y SAE. Sin embargo, el tiempo en tratamiento y el nivel de colesterol plasmático se asociaron independientemente con deterioro de LAE. No observamos asociaciones entre la elasticidad arterial y los recuentos de CD4+. Concluimos que la exposición acumulada al tratamiento antirretroviral podría contribuir al deterioro de la LAE. Este hallazgo merece ulterior investigación.

Late diagnosis of HIV infection in asymptomatic patients.

Recent findings from the START Trial provided evidence that early initiation of antiretroviral treatment should be implemented as the global standard of care. However, a large proportion of patients are still being diagnosed in late stages. Our objective was to evaluate the temporal trend in the CD4+ cell count at diagnosis during a 13 year period and the factors associated with late HIV diagnosis in asymptomatic individuals tested in the Centre for Prevention, Counselling and Diagnosis of our hospital. It was a retrospective study including all asymptomatic patients with new diagnosis of HIV infection. Very late presenters (VLP) were defined as those with CD4+ counts < 200 and late presenters (LP) with CD4+ < 350 cell/mm3. We also evaluated the proportion of patients diagnosed with CD4+ cell counts below 500 cell/mm3. Between January 2002 and December 2014, 20 263 patients were tested for HIV, 1104 with a positive result of whom 995 asymptomatic individuals were included. Overall, median CD4+ count was 372 cells/mm3 and HIV-RNA 31 145 copies/ml. There was no evidence that the CD4+ count at diagnosis progressively increased over time, nor that the proportion of VLP and LP decreased. In a multivariate model older age, heterosexual transmission and intravenous drug use remained as independent factors associated with LP. In conclusion, late diagnosis of HIV infection remains prevalent among asymptomatic patients, highlighting the need to continue implementing strategies towards early diagnosis.

Late diagnosis of HIV infection in asymptomatic patients

Recent findings from the START Trial provided evidence that early initiation of antiretroviral treatment should be implemented as the global standard of care. However, a large proportion of patients are still being diagnosed in late stages. Our objective was to evaluate the temporal trend in the CD4+ cell count at diagnosis during a 13 year period and the factors associated with late HIV diagnosis in asymptomatic individuals tested in the Centre for Prevention, Counselling and Diagnosis of our hospital. It was a retrospective study including all asymptomatic patients with new diagnosis of HIV infection. Very late presenters (VLP) were defined as those with CD4+ counts < 200 and late presenters (LP) with CD4+ < 350 cell/mm³. We also evaluated the proportion of patients diagnosed with CD4+ cell counts below 500 cell/mm3. Between January 2002 and December 2014, 20 263 patients were tested for HIV, 1104 with a positive result of whom 995 asymptomatic individuals were included. Overall, median CD4+ count was 372 cells/mm3 and HIV-RNA 31 145 copies/ml. There was no evidence that the CD4+ count at diagnosis progressively increased over time, nor that the proportion of VLP and LP decreased. In a multivariate model older age, heterosexual transmission and intravenous drug use remained as independent factors associated with LP. In conclusion, late diagnosis of HIV infection remains prevalent among asymptomatic patients, highlighting the need to continue implementing strategies towards early diagnosis.

Los resultados del estudio START han evidenciado que la iniciación temprana del tratamiento antirretroviral debe ser un estándar global. No obstante, una gran proporción de pacientes aún se diagnostican en etapas tardías. Nuestro objetivo fue evaluar la tendencia en el recuento de CD4+ al diagnóstico de infección por HIV, la proporción de presentadores tardíos entre 2002 y 2014, y los factores asociados con el diagnóstico tardío en pacientes asintomáticos en el Centro de Prevención, Asesoramiento y Diagnóstico de nuestro hospital. Se incluyeron en un estudio retrospectivo todos los sujetos asintomáticos con un diagnóstico de HIV. Se consideraron presentadores muy tardíos (PMT) a aquellos pacientes con CD4+ < 200 y presentadores tardíos (PT) con cifras de CD4+ < 350 células/mm³. Adicionalmente evaluamos la proporción de pacientes diagnosticados con recuentos de CD4+ inferiores a 500 células/mm³. Desde enero 2002 a diciembre de 2014 se testearon para HIV 20 263 pacientes, 1104 con resultado positivo, de los cuales 995 eran asintomáticos. Globalmente, la mediana de CD4+ fue 372 células/mm3 y la de HIV-ARN de 31 145 copias/ml. No hubo evidencia de que el recuento de CD4+ al diagnóstico haya aumentado en el tiempo, ni de disminución de la proporción de PT o PMT. En un modelo multivariado, la mayor edad, la transmisión heterosexual y el uso de drogas intravenosas se asociaron independientemente con PT. En conclusión, el diagnóstico tardío de infección por HIV se mantiene prevalente en pacientes asintomáticos, resaltando la necesidad de continuar implementando estrategias orientadas a favorecer el diagnóstico temprano.

Elasticidad de grandes y pequeñas arterias en pacientes con infección por VIH 1 con o sin tratamiento antirretroviral / Large and small artery elasticity in HIV1-infected patients with or without antiretroviral therapy

INTRODUCCION: En los pacientes con infección por VIH1, existe un mayor riesgo cardiovascular debido a la inflamación provocada por el virus y los trastornos metabólicos inducidos por el tratamiento antiviral. Varios estudios exploran la elasticidad de grandes y pequeñas arterias (EGA y EPA) como marcador temprano de riesgo cardiovascular en la población general. Sin embargo, pocos trabajos usan esta técnica en pacientes infectados, comparando pacientes naive y tratados.OBJETIVO: Media EGA y EPA en pacientes con infección por VIH1, comparando pacientes naive y con tratamiento antirretroviral.METODOS: Se realizó un seguimiento en el Hospital Ramos Mejía de Buenos Aires durante 2010. Los pacientes infectados, sin eventos cardiovasculares ni oportunistas previos, fueron divididos en dos grupos: uno con supresión virológica de al menos un año por tratamiento antirretroviral (N = 27) y otro con pacientes naive (N = 30). La EGA/EPA fue estimada utilizando el análisis de la onda de pulso, y las diferencias entre grupos se evaluaron mediante el test de Mann Whitney. La muestra se estratificó en cuartilos según las mediciones de EGA y EPA, buscando asociaciones con los factores de riesgo cardiovascular tradicionales.RESULTADOS: No hubo diferencias significativas al comparar la EGA entre los grupos bajo tratamiento antirretroviral y naive (p = 0,20). Respecto a la EPA, los pacientes naive tuvieron valores más elevados (p = 0,03). El factor de riesgo tradicional que se asoció en la muestra con detrimento de la EGA fue el nivel de colesterol total (p = 0,0197), mientras que la EPA mostró una asociación inversa con la edad (p = 0,001) y el colesterol (p = 0,0014).CONCLUSIONES: Los pacientes VIH1 bajo tratamiento antirretroviral mostraron EPA inferiores a los pacientes naive. Dadas las limitaciones, como el modesto tamaño muestral y su diseño de corte transversal, se necesitan mayores estudios prospectivos para evaluar el riesgo cardiovascular temprano en esta población.

INTRODUCTION: In HIV1-infected patients there is an increased cardiovascular risk due to virtal inflammation and metabolic disorders induced by antiretroviral therapy. There are several studies that explore large and small artery elasticity (LAE and SAE) as an early marker for cardiovascular disease in general population. However, few studies were conducted in infected patients with this technique, comparing treatment-naive and treated patients.OBJECTIVE: To determine LAE and SAE in HIV1-infected patients, comparing patients taking antiretroviral therapy versus naive patients.METHODS: The study took place in the Ramos Mejía Hospital from Buenos Aires during 2010. HIV1-infected patients without previous cardiovascular or opportunistic events were divided into two groups: those with virologic suppression for at least one year due to antiretroviral trearment (N = 27) versus naive patients (N = 30). LAE and SAE were estimated using the analysis of the pulse waveform, and differences between groups were analyzed through the Mann-Whitney test. The sample was stratified into quartiles according to LAE and SAE measurements in order to assess the traditional risk factors.RESULTS: No significant differences between groups were found when comparing LAE (p = 0.20). Naive patients showed higher SAE measurements (p = 0.03) than those with antiretroviral therapy. The traditional risg factor that was associated in the sample to the detriment of the LAE was the level of total cholesterol (p = 0.0197), while the SAE was inversely associated with age (p = 0.001) and cholesterol (p = 0.0014).CONCLUSIONS: HIV1-infected patients under antiretroviral treatment showed lower SAE than naive patients. Due to limitations such as small sample size and corss-sectional nature of the study, it will be necessary to conduct further prospective studies to evaluate the early cardiovascular risk in this population.

Elasticidad de grandes y pequeñas arterias en pacientes con infección por VIH 1 con o sin tratamiento antirretroviral / Large and small artery elasticity in HIV1-infected patients with or without antiretroviral therapy

INTRODUCCION: En los pacientes con infección por VIH1, existe un mayor riesgo cardiovascular debido a la inflamación provocada por el virus y los trastornos metabólicos inducidos por el tratamiento antiviral. Varios estudios exploran la elasticidad de grandes y pequeñas arterias (EGA y EPA) como marcador temprano de riesgo cardiovascular en la población general. Sin embargo, pocos trabajos usan esta técnica en pacientes infectados, comparando pacientes naive y tratados.OBJETIVO: Media EGA y EPA en pacientes con infección por VIH1, comparando pacientes naive y con tratamiento antirretroviral.METODOS: Se realizó un seguimiento en el Hospital Ramos Mejía de Buenos Aires durante 2010. Los pacientes infectados, sin eventos cardiovasculares ni oportunistas previos, fueron divididos en dos grupos: uno con supresión virológica de al menos un año por tratamiento antirretroviral (N = 27) y otro con pacientes naive (N = 30). La EGA/EPA fue estimada utilizando el análisis de la onda de pulso, y las diferencias entre grupos se evaluaron mediante el test de Mann Whitney. La muestra se estratificó en cuartilos según las mediciones de EGA y EPA, buscando asociaciones con los factores de riesgo cardiovascular tradicionales.RESULTADOS: No hubo diferencias significativas al comparar la EGA entre los grupos bajo tratamiento antirretroviral y naive (p = 0,20). Respecto a la EPA, los pacientes naive tuvieron valores más elevados (p = 0,03). El factor de riesgo tradicional que se asoció en la muestra con detrimento de la EGA fue el nivel de colesterol total (p = 0,0197), mientras que la EPA mostró una asociación inversa con la edad (p = 0,001) y el colesterol (p = 0,0014).CONCLUSIONES: Los pacientes VIH1 bajo tratamiento antirretroviral mostraron EPA inferiores a los pacientes naive. Dadas las limitaciones, como el modesto tamaño muestral y su diseño de corte transversal, se necesitan mayores estudios prospectivos para evaluar el riesgo cardiovascular temprano en esta población.

INTRODUCTION: In HIV1-infected patients there is an increased cardiovascular risk due to virtal inflammation and metabolic disorders induced by antiretroviral therapy. There are several studies that explore large and small artery elasticity (LAE and SAE) as an early marker for cardiovascular disease in general population. However, few studies were conducted in infected patients with this technique, comparing treatment-naive and treated patients.OBJECTIVE: To determine LAE and SAE in HIV1-infected patients, comparing patients taking antiretroviral therapy versus naive patients.METHODS: The study took place in the Ramos Mejía Hospital from Buenos Aires during 2010. HIV1-infected patients without previous cardiovascular or opportunistic events were divided into two groups: those with virologic suppression for at least one year due to antiretroviral trearment (N = 27) versus naive patients (N = 30). LAE and SAE were estimated using the analysis of the pulse waveform, and differences between groups were analyzed through the Mann-Whitney test. The sample was stratified into quartiles according to LAE and SAE measurements in order to assess the traditional risk factors.RESULTS: No significant differences between groups were found when comparing LAE (p = 0.20). Naive patients showed higher SAE measurements (p = 0.03) than those with antiretroviral therapy. The traditional risg factor that was associated in the sample to the detriment of the LAE was the level of total cholesterol (p = 0.0197), while the SAE was inversely associated with age (p = 0.001) and cholesterol (p = 0.0014).CONCLUSIONS: HIV1-infected patients under antiretroviral treatment showed lower SAE than naive patients. Due to limitations such as small sample size and corss-sectional nature of the study, it will be necessary to conduct further prospective studies to evaluate the early cardiovascular risk in this population.

Two cases of Saint Louis encephalitis in HIV-1 infected patients in Buenos Aires

Saint Louis encephalitis virus (SLE) is a mosquito borne disease. Only a small proportion of cases progress to severe clinical forms. There have been few reports on HIV-infected patients and the relationship between immunodeficiency and the course of the disease remains unclear. Herein we describe two cases of SLE in HIV-1-infected patients in Buenos Aires city.

Two cases of Saint Louis encephalitis in HIV-1 infected patients in Buenos Aires.

Saint Louis encephalitis virus (SLE) is a mosquito borne disease. Only a small proportion of cases progress to severe clinical forms. There have been few reports on HIV-infected patients and the relationship between immunodeficiency and the course of the disease remains unclear. Herein we describe two cases of SLE in HIV-1-infected patients in Buenos Aires city.