Coinfección por VIH/VHB: estrategias terapéuticas y control serológico / HIV/HBV coinfection: Serological control and therapeutic strategies

Objetivos. La evolución y pronóstico de los pacientes coinfectados por el virus de la inmunodeficiencia humana (VIH) y el de la hepatitis B (VHB) no es bien conocida. Este estudio describe el tratamiento y el control serológico, virológico, bioquímico y elastográfico de los pacientes coinfectados por VIH/VHB. Pacientes y métodos. Estudio descriptivo, retrospectivo, de la totalidad de pacientes coinfectados por VIH/VHB seguidos en una consulta monográfica de VIH entre el 1 de enero de 2007 y el 30 de noviembre de 2008. A los pacientes se les realizaron determinaciones virológicas y serológicas para el VHB y el VIH, así como linfocitos CD4 y transaminasas, antes de comenzar el tratamiento antirretroviral y en el momento del análisis. Resultados. Se identificaron 54 (5,4%) pacientes coinfectados por VIH/VHB. Las medianas de CD4 nadir y actual fueron de 179 y 437 células/μl, respectivamente. El 70% tenían RNA-VIH indetectable. Cincuenta y dos pacientes (96,3%) seguían terapia con fármacos activos frente al VHB. Un 68,8% presentaron negativización del antígeno «e» del VHB, con un 81,6% de respuesta virológica. El antígeno de superficie del VHB se negativizó en el 10,4%. La alanina aminotransferasa era normal en el75,5%. Se realizó FibroScan® a 30 (55,6%) pacientes, obteniéndose una mediana de 7.0 KPa. Conclusiones. Los resultados obtenidos sugieren un buen control serológico, virológico, bioquímico y elastográfico de los pacientes coinfectados por VIH/VHB con los tratamientos recomendados por las guías clínicas(AU)

Objectives. The evolution and prognosis of patients co-infected by human immunodeficiency virus (HIV) and hepatitis B (HBV) is not well know. This study describes the treatment and serological, virological and biochemical and elastographic responses of HIV and HBV-coinfected patients. Patients and methods. A descriptive, retrospective study of all the HIV/HBV-coinfected patients seen in a specialized HIV department between 1 January 2007 and 30 November 2008 was performed. Virological and serological determinations of HIV and HBV infections as well as CD4 lymphocytes and transaminases prior to antiretroviral treatment and at the time of analysis were obtained. Results. A total of 54 (5.4%) cases of HIV/HBV coinfection were identified. The median nadir and current CD4 were 179 and 437 cells/L, respectively. There was undetectable RNA-HIV in 70%. There were 52 patients (96.3%) who followed active drugs treatment against HBV. After treatment, 68.8% had HBeAg negative result, with 81.6% virologic response. The HBsAg became negative in 10.4%. ALT was normal in 75.5%. FibroScan® was performed in 30 (55.6%) patients, yielding a median of 7.0kPa. Conclusions. The results obtained suggest a good serological, virological and biochemical control of HIV/HBV-coinfected patients with treatments recommended by clinical guidelines(AU)

HIV/HBV coinfection: serological control and therapeutic strategies.

OBJECTIVES: The evolution and prognosis of patients co-infected by human immunodeficiency virus (HIV) and hepatitis B (HBV) is not well know. This study describes the treatment and serological, virological and biochemical and elastographic responses of HIV and HBV-coinfected patients. PATIENTS AND METHODS: A descriptive, retrospective study of all the HIV/HBV-coinfected patients seen in a specialized HIV department between 1 January 2007 and 30 November 2008 was performed. Virological and serological determinations of HIV and HBV infections as well as CD4 lymphocytes and transaminases prior to antiretroviral treatment and at the time of analysis were obtained. RESULTS: A total of 54 (5.4%) cases of HIV/HBV coinfection were identified. The median nadir and current CD4 were 179 and 437 cells/L, respectively. There was undetectable RNA-HIV in 70%. There were 52 patients (96.3%) who followed active drugs treatment against HBV. After treatment, 68.8% had HBeAg negative result, with 81.6% virologic response. The HBsAg became negative in 10.4%. ALT was normal in 75.5%. FibroScan(®) was performed in 30 (55.6%) patients, yielding a median of 7.0kPa. CONCLUSIONS: The results obtained suggest a good serological, virological and biochemical control of HIV/HBV-coinfected patients with treatments recommended by clinical guidelines.

HIV/HBV coinfection: Serological control and therapeutic strategies. / Coinfección por VIH/VHB: estrategias terapéuticas y control serológico.

OBJECTIVES: The evolution and prognosis of patients co-infected by human immunodeficiency virus (HIV) and hepatitis B (HBV) is not well know. This study describes the treatment and serological, virological and biochemical and elastographic responses of HIV and HBV-coinfected patients. PATIENTS AND METHODS: A descriptive, retrospective study of all the HIV/HBV-coinfected patients seen in a specialized HIV department between 1 January 2007 and 30 November 2008 was performed. Virological and serological determinations of HIV and HBV infections as well as CD4 lymphocytes and transaminases prior to antiretroviral treatment and at the time of analysis were obtained. RESULTS: A total of 54 (5.4%) cases of HIV/HBV coinfection were identified. The median nadir and current CD4 were 179 and 437 cells/L, respectively. There was undetectable RNA-HIV in 70%. There were 52 patients (96.3%) who followed active drugs treatment against HBV. After treatment, 68.8% had HBeAg negative result, with 81.6% virologic response. The HBsAg became negative in 10.4%. ALT was normal in 75.5%. FibroScan(®) was performed in 30 (55.6%) patients, yielding a median of 7.0kPa. CONCLUSIONS: The results obtained suggest a good serological, virological and biochemical control of HIV/HBV-coinfected patients with treatments recommended by clinical guidelines.

Déficit adquirido del factor VIII / Adquired factor VIII inhibitor

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Infiltrado pulmonar micronodular como primera manifestación de un carcinoma hepatocelular metastásico / Multiple bilateral pulmonary micronodules as first manifestation of metastatic hepatocellular carcinoma

Las causas más frecuentes de infiltrados micronodulares en la radiografía de tórax, son las infecciosas, sobre todo granulomatosas tipo tuberculosis, y las metastásicas. Múltiples tumores se han descrito como productores de metástasis micronodulares, siendo los más característicos el de tiroides, melanoma y gastrointestinal (colon y páncreas). El hepatocarcinoma con frecuencia produce metástasis pulmonares, pero es raro que éstas se presenten en forma de patrón micronodular. Presentamos el caso de una mujer con un hepatocarcinoma, cuya forma de presentación fue un infiltrado bilateral micronodular en la radiografía de tórax (AU)

[Micronodular pulmonary infiltration as first manifestation of metastatic hepatocellular carcinoma]. / Infiltrado pulmonar micronodular como primera manifestación de un carcinoma hepatocelular metastásico.

Infectious diseases, as tuberculosis, and metastatic cancers are the main causes of multiple pulmonary micronodules on chest radiographs. Many cancers can produce this anomaly, but the most common are thyroid, melanoma and gastrointestinal (colon and pancreas). Hepatocellular carcinoma can produce lung metastasis, but seldom makes bilateral pulmonary micronodules. Here we present the case of a woman with a hepatocarcinoma that appeared as a bilateral micronodular disease on the chest radiograph.

[Solitary hepatic mass as initial manifestation of non-hodgkin lymphoma]. / Masa hepática única como forma de presentación de un linfoma no Hodgkin.

A 55 years-old woman was admitted to the hospital because fifteen days of malaise, right upper quadrant pain and fever. Physical exam revealed hepato-splenomaly and radiologic evaluation (abdominal ultrasonography and CT) showed a solid hepatic mass with several retroperitoneal lymphadenopathies. Through an hepatic fine needle aspiration biopsy and a bone marrow biopsy, the diagnosis of a high grade non-Hodgkin lymphoma was made. The histopathological study of a retroperitoneal lymphadenopathy surgical biopsy got the definitive diagnosis. This form of liver involvement (big solid hepatic mass) by lymphoma is not usual and when it is found, it's necessary to make a differential diagnosis with primary hepatic tumors, hepatic metastases and primary lymphoma of the liver.

Masa hepática única como forma de presentación de un linfoma no Hodgkin / Solitary hepatic mass as initial manifestation of a non-Hodgkin lymphoma

Una mujer de 55 años acudió por un cuadro constitucional de 15 días de evolución junto con dolor en hipocondrio derecho a lo que se añadió el día previo al ingreso fiebre. En la exploración física destacaba hepatoesplenomegalia y en las pruebas de imagen se constató la existencia de una masa hepática sólida y adenopatías retroperitoneales. La realización de una punción-aspiración con aguja fina de la masa hepática y una biopsia de médula ósea demostró la existencia de un linfoma no Hodgkin de alto grado que se confirmó posteriomente con el estudio histopatológico de una adenopatía resecada. Esta forma de afectación hepática (masa única de gran tamaño) en los linfomas es poco frecuente y puede plantear el diagnóstico diferencial con tumores primarios hepáticos, metastásicos o incluso con el linfoma hepático primario (AU)