RESUMEN
OBJECTIVES: Tuberculosis (TB) is the most common opportunistic infection and cause of mortality among people living with HIV, and it is possible that it may also influence the evolution of the HIV infection. We assessed the differences between HIV-positive and -negative people infected with TB. METHODS: The present study is a cross-sectional retrospective study by electronic record revision. We included patients admitted to a tertiary hospital with a diagnosis of TB between 2011 and 2016, comparing those with HIV coinfection with non-HIV patients, according to demographic and clinical characteristics. RESULTS: This study included 591 patients, of whom 32% were HIV-coinfected. HIV-TB patients were younger, with a predominance of male gender. Considering TB risk factors, there was a higher prevalence of homelessness and intravenous drug use in the HIV group. In the non-HIV group, direct contact with other patients with TB and immunosuppression were more prevalent. Relative to TB characteristics, the HIV-coinfected group presents with a higher prevalence of disseminated disease and a higher occurrence of previous TB infection. Cancer was the most frequent cause of immunosuppression in the HIV group and the number testing positive for TB via microbiological culture was lower. Assessment of microbiological resistance and in-hospital mortality showed similar numbers in both groups. CONCLUSIONS: There are few papers comparing clinical course of TB between HIV-infected and non-infected patients. Our study differs from others in the literature as we focused on a country with middling incidence of TB and further characterized the differences between HIV-infected and non-infected patients which can contribute to the management of these patients.
Asunto(s)
Coinfección , Infecciones por VIH , Tuberculosis , Antituberculosos , Coinfección/tratamiento farmacológico , Estudios Transversales , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Masculino , Estudios Retrospectivos , Tuberculosis/complicaciones , Tuberculosis/diagnóstico , Tuberculosis/epidemiologíaRESUMEN
Pneumocystis pneumonia (PCP) is caused by the fungus Pneumocystis jirovecii, and its incidence has been on the rise in immunosuppressed patients without HIV. We performed a cross sectional study in patients with PCP and assessed demographic, clinical presentation and outcome measures such as mechanical ventilation and mortality differences between HIV and non-HIV patients. The two groups were statistically significantly different, with the HIV group being younger (45.5 years vs 55.9 years, p-value 0.001) and mostly composed of male patients (69% vs 31%, p-value <0.001). Also, the HIV patients had higher percentage of respiratory complaints (90% vs 68%, p-value 0.02) and lactate dehydrogenase elevation (73% vs 40%, p-value 0.001). In contrast, non-HIV patients had worse outcomes with higher incidence of invasive mechanical ventilation (23% vs 46%, p-value 0.005) and in-hospital mortality (13% vs 37%, p-value 0.002). These results reflect the literature and should raise awareness to a potentially fatal medical situation of increasing incidence.
Asunto(s)
Infecciones por VIH/epidemiología , Mortalidad Hospitalaria , Huésped Inmunocomprometido , Neumonía por Pneumocystis/epidemiología , Respiración Artificial/estadística & datos numéricos , Adulto , Anciano , Comorbilidad , Estudios Transversales , Femenino , Infecciones por VIH/inmunología , Humanos , L-Lactato Deshidrogenasa/sangre , Masculino , Persona de Mediana Edad , Neumonía por Pneumocystis/inmunología , Neumonía por Pneumocystis/mortalidad , Portugal/epidemiología , Estudios RetrospectivosRESUMEN
OBJECTIVE: To determine the prevalence and characteristics of central nervous system disease in systemic lupus erythematosus (CNS/SLE) with particular reference to disease activity and to the presence of antiphospholipid (aPL) antibodies. PATIENTS AND METHODS: From 340 unselected SLE patients attending our lupus clinic, we found 96 (28%) to have definite CNS manifestations not attributed to any cause other than SLE. Patients with mild migraine or cognitive disorders were excluded. The control group consisted of 100 SLE patients without CNS or thromboembolic manifestations. RESULTS: Fifty-six of our CNS patients had transient ischemic attacks or strokes, 24 had epilepsy, and 12 had psychiatric disorders; the other 4 did not fulfill SLE criteria. In all, 55% of patients (53) were found to be positive for aPL antibodies, whereas only 20% of the SLE control group were positive (P < 0.001). Based on a physicians' global clinical assessment tool together with laboratory analysis, only 42 (44%) patients were found to be active at the onset of CNS manifestations, and the other 54 (56%) were nonactive. A finding of aPL antibodies was associated strongly with the inactive CNS/SLE group (P = 0.001). Of the 53 patients who underwent magnetic resonance imaging (MRI) study, 33 showed small high-density lesions suggestive of vasculopathy. Twenty-six (79%) of them were positive for aPL antibodies; whereas of the 20 patients with normal MRIs, only 8 (40%) were positive for aPL antibodies (P < 0.01). CONCLUSION: We confirm that CNS disease in SLE is significantly associated with the presence of aPL antibodies. The CNS manifestations can occur in about half of SLE patients without any other evidence of lupus activity. Abnormal MRIs highly correlate with positive aPL antibodies.