Enfermedades de transmisión sexual e infección por VIH: interacción epidemiológica y clínica / Sexual transmitted diseases and HIV infection: clinical and epidemiological interaction

Objetivo: Revisar y recopilar los conocimientos sobre la interacción entre la infección por el virus de la inmunodeficiencia humana (VIH) y las demás enfermedades de transmisión sexual (ETS), tanto desde el punto de vista clínico como epidemiológico. Fuentes revisadas: Base de datos PubMed-Medline desde 1982 y textos de consulta y guías de SIDA y de ETS. Selección de estudios: En la base de datos, editoriales, originales o revisiones en cualquier idioma, con resumen en español, francés o inglés, cuyo título (traducido al inglés en su caso) incluya los términos "HIV" y "STD" (o el nombre de cualquier ETS). Recopilación de datos: Todo sobre transmisión sexual del VIH (en presencia o no de ETS), clínica, diagnóstico o tratamiento de ETS en infectados por VIH, prevalencia de VIH en sujetos con ETS o profilaxis de la transmisión sexual del VIH. Síntesis de datos: Transmisión sexual del VIH por relaciones heterosexuales y homosexuales y su modificación en presencia de ETS coexistentes u otros factores; prevalencia y peculiaridades en la clínica, diagnóstico y tratamiento de las diferentes ETS en infectados por el VIH; importancia del papel del personal sanitario en la prevención de la transmisión sexual del VIH. Conclusiones. La infección VIH y demás ETS comparten conductas y factores de riesgo, y se potencian mutuamente en su transmisión y evolución. La infección VIH, debido al deterioro inmunológico que produce, puede alterar profundamente las manifestaciones clínicas y la respuesta terapéutica de las demás ETS. Es necesaria una labor activa de todo el personal sanitario en la detección de la infección y en la educación de la población en riesgo, una tarea que la Sanidad Militar debería considerar prioritaria (AU)

Respuesta al tratamiento antirretrovírico de gran actividad (TARGA) con inhibidores de proteasa en pacientes con infección por VIU, pretratados / Respond to TAREA (antiretroviral great activity treatment) with protease inhibitors in VIH infected patients, who have received previous treatment

Objetivo: valorar respuesta virológica, inmunológica y clínica al tratamiento antirretrovírico (TAREA), establecido mediante adición de un inhibidor de proteasa (IP) a pacientes VIH seropositivos (VIH+) previamente tratados con Inhibidores de transcriptasa (IT). Diseño: estudio prospectivo abierto de intervención terapéutica. Lugar de realización: Hospital Central de la Defensa (1996-2000). Material y métodos: 68 pacientes VIH+ pretratados con dos IT; a todos se les añadió como tercer fármaco un IP: saquinavir (SQV=23), ritonavir (RTV=22) o indinavir (IDV=23). Valoración clínica y determinaciones trimestrales de carga viral plasmática (CV) de VIH y linfocitos CD4+ durante 12 meses. Análisis estadístico: comparación de medias (ANOVA y Newman-Keuls) de variables (CD4 y CV) determinadas a los 0, 3, 6, 9 y 12 meses de TAREA; comparación de frecuencias (X2) de la gravedad clínica inicial y final. Resultados: según intención de tratar, se obtuvo carga viral indetectable ( 1 Log10 (p200 cel/microL) a los 12 meses. La proporción de pacientes graves al iniciar el estudio (26/68=38 por ciento) se redujo significativamente (p<0,001) al final del mismo (6/68=9 por ciento). No hubo fallecimientos y el 88 por ciento de los pacientes mejoraron clínicamente o permanecieron asintomáticos durante los 12 meses de tratamiento. Conclusión: el TAREA con IP logró una respuesta virológica altamente eficaz en casi la mitad de los pacientes VIH pretratados con IT, con aumento significativo de linfocitos CD4+ e importante mejoría clínica (AU)

[Discriminative value for AIDS case of erythrocyte sedimentation rate, immunoglobulins IgA and IgM, and beta 2-microglobulin in combination with the CD4+ lymphocyte count]. / Valor discriminante para caso de sida de la velocidad de sedimentación globular (VSG), inmunoglobulinas (IgA e IgM) y beta 2-microglobulina (beta 2M) en combinación con el recuento de linfocitos CD4+.

OBJECTIVE: To establish the probability to discriminate the evolution to "AIDS case" in relation to the common laboratory parametres in the follow-up of the HIV infection. MATERIAL AND METHODS: We have studied a cohort of 118 patients (1986-95) with HIV infection, 14 of them (12%) had clinical criteria for AIDS (CDC/93) during the follow-up. Clinical evaluations and CD4+ and CD8+ lymphocytes, beta 2M, IgG, IgA, IgM and E.S.R determinations were done. Multivariate analysis (RSIGMA) was done. with the initial laboratory values, according to the clinical diagnostic (AIDS and NO AIDS) done during the follow-up. RESULTS: By multiple logistic regression those laboratory variables with more predictor value for "AIDS CASE" were selected. With the initial value of these variables (E.S.R., beta 2M, IgA, IgM and CD4+ lymphocytes) and the clinical diagnostic of AIDS done during the follow-up, we did the linear discriminatory analysis between two groups (AIDS, NO AIDS) obtaining generalized distance between both groups of 3,4609 and a probability of classification error of 4%. A very significant difference (p < 0.001) was obtaining when we compare the variables' mean of each of the clinical groups. CONCLUSION: In the HIV infection the values of ESR, beta 2M, IgA and IgM in combination with the absolute value of the CD4+ lymphocytes allows to discriminate those patients who will develop AIDS with a probability of classifications error of 4%. This has clinical interest in absence of viral load and helps to take therapeutical decisions.

[Megestrol in the treatment of AIDS associated cachexia. Evaluation by bioelectric impedance analysis of body composition]. / Megestrol en el tratamiento de la caquexia del SIDA. Valoración mediante análisis de composición corporal por impedancia bioeléctrica.

OBJECTIVE: To value the effects of megestrol acetate wer the weight and the body composition (fat, lean and body water) in patients with AIDS associated cachexia, by bioelectric impedance analysis. SUBJECTS: 25 patients between 23 and 57 years of age, with confirmed HIV infection and prior weight lost of 7.96 +/- 4.6 kg in relation to their habitual weight in the previous months. All the patients were under antiretroviral therapy. METHOD: Basal determination, before the beginning of the antianorexic treatment and at the end of it, using bioelectric impedance analysis by Maltron BF 905 analyzer, calculating fat, lean and total body water in relation to weight, height, age and sex. Oral administration of 320 mg/day megestrol acetate for three consecutive months. Statistical comparation (RSIGMA and SPSS) by paired t-test of the mean weight, body mass index, fat, lean and total body water. RESULTS: During the three months treatment the mean basal body weight of the patients increased 3.54 Kg (p < 0.001) at the expense of an increase of 2.24 kg in the total body lean (p < 0.01), while the increment of the body fat (1.2 kg) was not statistically significant. The total body water increased 1.48 L (p < 0.001) and the body mass index in 1.22 kg/m2 (p < 0.001). CONCLUSION: Treatment with megestrol acetate results in a substained and very significant increase of the weight and body mass index in patients with AIDS related cachexia. This increment in weight is at the expense of body lean.

[Differences in laboratory parameters in clinical categories (CDC/93) of HIV infection]. / Diferencias en parámetros de laboratorio entre las categorías clínicas (CDC/93) de la infección por VIH.

OBJECTIVE: To establish the difference between the evolutive clinical categories (CDC/93) of the HIV infection, on the basis of diverse laboratory parameters. MATERIAL AND METHOD: 332 samples of blood, from 118 patients with HIV infection revised every three months from 1986, were studied. Determinations: haematologic, biochemical and immunologic study. Classification in each review by CDC/93 system. Statistical analysis (R-SIGMA) comparing by ANOVA and NEWMANN-KEULS the averages of the laboratory variables in the clinics categories ("A", "B" and "C"). RESULTS: There are very significant laboratory differences (p < 0.01) between the asymptomatic patients ("A") and the AIDS cases ("C"), with important decrease of hemoglobin, platelets, leukocytes, albumin, CD4+ and CD8+ T cells in the "C" category. On the contrary there is a marked increase of erythrocyte sedimentation, triglycerides, immunoglobulin A and beta 2-microglobulin in those patients with AIDS. CONCLUSION: AIDS patients present very significant differences in ten laboratory parameters, compared to the asymptomatic HIV infected patients. The follow up of these parameters may have prognostic value of AIDS evolution and be useful for the therapeutic decision making.

[Adenosine deaminase (ADA) and beta 2-microglobulin (beta 2M) as discriminating serum markers of progression to AIDS]. / Adenosina desaminasa (ADA) y beta 2-microglobulina (beta 2 M) como marcadores séricos discriminantes de progresión al SIDA.

BACKGROUND: To establish the discriminatory value of ADA and beta 2M serum levels as markers of AIDS progression. METHODS: We have followed quarterly during two years a cohort of 24 patients with HIV infection; 103 clinical and laboratory evaluations were done (CDC/93 classification). In each of those blood samples we determined ADA, beta 2M, IgG, IgA, IgM, and CD4+ and CD8+ lymphocytes. RESULTS: 26 evaluations belong to cases that kept stable in the clinic category A or B, CDC/93, ("stables": ADA = 19.05 +/- 10.79 U/L; beta 2M = 2.95 +/- 1.1 mg/L); the remaining 77 evaluations are from patients who clinical progressed to AIDS ("progressors": ADA = 32.03 +/- 13.2 U/L; beta 2M = 4.74 +/- 1.94 mg/L). When we compared statistically (RSIGMA software) the ADA and beta 2M means of both groups (Student t) and the means of all the variables in a block (multivariate analysis: Hotelling T2), very significant differences were appreciated (p < 0.001). CONCLUSIONS: ADA and beta 2M are significantly increased in serum of HIV infected patients who clinical progress to AIDS. ADA and beta 2M can be used as serum markers of AIDS progression with a mistaken classification probability in the discriminatory analysis of 0.25; this probability decreases to 0.06 when immunoglobulins and lymphocytes subpopulations are evaluated too.

[Peritoneal mesothelioma: long-course ascites as the only clinical manifestation]. / Mesotelioma peritoneal: ascitis de larga evolución como única manifestación clínca.

The mesothelioma is a rare tumor, especially in its peritoneal location (20%). Most of these cases are related to an exposition to asbestos long time age. We present a patient with long-evolution ascites and without any other clinical manifestations. The study of the ascitic fluid, the imaging techniques and the peritoneoscopy did not allow the diagnosis in the first place. Only after one year of follow-up and when the patient recalled, in a directed interrogation, her occupational contact with asbestos thirty years age, the diagnosis could be established.

[HIV infection at the Central Military Hospital of Madrid]. / La infección por VIH en el Hospital Militar Central de Madrid.

UNLABELLED: We describe the infection by HIV observed in the scope of the Military Hospital and we evaluate the clinical usefulness of the current classification systems. We have retrospectively studied (1986-1993) 80 confirmed cases of infection by HIV: 21 women and 59 men (age range: 17-65 years). Quarterly clinico-biological controls. Initial and final classification according to CDC 87/93 systems. STATISTICAL ANALYSIS: RSIGMA. We have detected in 26% of the patients heterosexual contagion; in 55%, toxicomania and in 17%, homosexuality; 39% had less than 200 CD4/microL upon admission. During the follow-up, 35 patients fulfilled AIDS criteria (17% due to tuberculosis); 17 died (21%) and 30 gave up (37%). CONCLUSIONS: HIV infection is less frequent in the military sociofamiliar environment, with lower incidence of tuberculosis. There is a greater proportion of women, heterosexual transmission and asymptomatic patients. CDC-93 classification is the system best adapted to the natural history of the HIV infection.

[Maxillary sinus lymphoma associated with HIV infection]. / Linfoma de seno maxilar asociado a infección VIH.

We present the case of a patient with positive antibodies against the human immunodeficiency virus, erroneously diagnosed, on the basis of conventional radiology and clinical signs, as right maxillary sinusitis. CT showed a tumoral mass at the maxillary sinus, with histology of highly malignant Non-Hodgkin's Lymphoma (NHL). The chemotherapy (CHOP) resulted in clinical remission, but the appearance of acute myelodepression forced the staggering of cycles, resulting in recurrency of the disease. The addition of G-CSF allowed to continue chemotherapy at full doses, again with positive responses. The lymphoma located at the maxillary sinus is extremely rare in patients with AIDS. Chemotherapy is complicated by myelodepression and the frequent development of opportunistic infections. The use of stimulant factors of the hematopoietic growth facilitates the management of AIDS-associated neoplasias.