ABSTRACT
Parvovirus B19 (B19V) infection varies clinically depending on the host's immune status. Due to red blood cell precursors tropism, B19V can cause chronic anemia and transient aplastic crisis in patients with immunosuppression or chronic hemolysis. We report three rare cases of Brazilian adults living with human immunodeficiency virus (HIV) with B19V infection. All cases presented severe anemia and required red blood cell transfusions. The first patient had low CD4+ counts and was treated with intravenous immunoglobulin (IVIG). As he remained poorly adherent to antiretroviral therapy (ART), B19V detection persisted. The second patient had sudden pancytopenia despite being on ART with an undetectable HIV viral load. He had historically low CD4+ counts, fully responded to IVIG, and had undiagnosed hereditary spherocytosis. The third individual was recently diagnosed with HIV and tuberculosis (TB). One month after ART initiation, he was hospitalized with anemia aggravation and cholestatic hepatitis. An analysis of his serum revealed B19V DNA and anti-B19V IgG, corroborating bone marrow findings and a persistent B19V infection. The symptoms resolved and B19V became undetectable. In all cases, real time PCR was essential for diagnosing B19V. Our findings showed that adherence to ART was crucial to B19V clearance in HIV-patients and highlighted the importance of the early recognition of B19V disease in unexplained cytopenias.
Subject(s)
Acquired Immunodeficiency Syndrome , Anemia , Erythema Infectiosum , HIV Infections , Parvoviridae Infections , Parvovirus B19, Human , Male , Humans , Adult , HIV/genetics , Immunoglobulins, Intravenous , Parvoviridae Infections/complications , Parvoviridae Infections/diagnosis , Anemia/diagnosis , Anemia/etiology , Parvovirus B19, Human/genetics , HIV Infections/complications , HIV Infections/drug therapy , DNA, Viral/analysisABSTRACT
Introdução: Ao longo dos trinta anos de identificação do HIV como agente etiológico, muitas mudanças ocorreram, principalmente em relação ao tratamento dos pacientes. [...] Objetivos: Descrever o perfil genotípico por ocasião da primeira falha virológica em uso de um esquema inicial de cART; Avaliar o impacto do perfil mutacional no momento da primeira falha no uso potencial da etravirina em esquemas antirretrovirais subsequentes; Descrever o perfil da população baseando-se no escore de mutações da etravirina e analisar os fatores relacionados à redução na sensibilidade a esta droga; Avaliar a prevalência de genotipagens com de vírus selvagem e analisar os fatores associados à sua ocorrência; Descrever os fatores relacionados à mutação K65R na primeira falha à cART. Métodos: Estudo com coleta de dados a partir de prontuários médicos e exames de genotipagem de pacientes com HIV acompanhados no IPEC que tiveram a falha virológica ao esquema antirretroviral inicial no período de 2000 a 2012. [...] Resultados: Foram incluídos 166 pacientes nesse estudo. O subtipo viral predominante foi o B (65,3 por cento). Nos 113 pacientes que usaram esquemas baseados em ITRNN (66,5 por cento), a mutação mais frequente para esta classe foi a 103N. Entre os 17 pacientes que fizeram uso de IP sem booster, as mutações mais frequentes na protease foram a 30N, 32I e 46ILV e entre os 36 pacientes que fizeram uso de IP com booster as mutações mais frequentes na protease foram a 82ATF, 90M e 46ILV...
Introduction: Over thirty years of HIV epidemic, many changes have occurred, especially in term's of patients treatment. [...] Objectives: To describe the genotypic profile at the first virologic failure while using the firstline cART; evaluate the impact of the mutational profile at the time of first failure in the potential subsequent use of etravirine for salvage regimens; describe the profile of the population relying etravirine´s mutations and analyze the factors related to reduced sensitivityto this drug; evaluate the prevalence as well as the associated risk factors of genotyping withthe presence of wild-type virus; describe the factors related to the presence of K65R mutationat the first failure to cART.Methods: The study included data collection from medical records and genotyping of HIV patients followed at IPEC who had presented virologic failure for initial antiretroviral regimenin the period of 2000 to 2012. [...] Results: 166 patients were included in this study.The predominant virus subtype was B (65.3 percent). Among the 113 patients using NNRTI -based regimens, the most frequent mutation to NNRTI was 103N. Among the 17 patients who used an unboosted PI, the most prevalent mutations in protease were 30N, 32I and 46ILV. Among the 36 patients who used boosted PI the most frequent mutations in protease were 82ATF, 90M and 46ILV. The most frequent NRTI mutation into the three groups was 184VI...
