Asunto(s)
Terapia Antirretroviral Altamente Activa , Brotes de Enfermedades/prevención & control , Infecciones por VIH/tratamiento farmacológico , VIH-1/efectos de los fármacos , Terapia Antirretroviral Altamente Activa/efectos adversos , Recuento de Linfocito CD4 , Guyana Francesa/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Humanos , Riesgo , Factores Socioeconómicos , Carga ViralRESUMEN
Risk factors for death in an HIV-infected cohort in French Guiana were studied in 1374 patients between 1996 and 2005. Of these patients, 48.5% were male and 76% were immigrants. Covariates were measured at the time of consultation. There were 223 deaths. Addictions [adjusted hazard ratio (HR)=13; 95% confidence interval (CI) 5.5-30.6; P<0.001], age>60 years (HR=1.5; 95% CI 0.9-2.5; P=0.13), male gender (HR=1.5; 95% CI 1.03-2.5; P=0.03) and CD4 count<50 cells/microL (HR=9.1; 95% CI 5.1-16.3; P<0.001) were independently associated with death. These results suggest that strategies promoting early diagnosis and better follow-up of addicted patients would have a significant impact on mortality.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Infecciones por VIH/mortalidad , VIH , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adulto , Distribución por Edad , Causas de Muerte , Transmisión de Enfermedad Infecciosa , Femenino , Estudios de Seguimiento , Guyana Francesa/epidemiología , Infecciones por VIH/epidemiología , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Factores de Riesgo , Distribución por Sexo , MigrantesRESUMEN
Immune reconstitution syndrome (IRIS) is an unusual inflammatory reaction to an opportunistic infection in an HIV-positive patient. This syndrome occurs when immunity is restored in the first months of an effective highly active antiretroviral treatment (HAART). First, we described all patients with a cutaneous form of IRIS. Then, between 1992 and 2004 we conducted a retrospective cohort study comparing Herpes Zoster and Herpes Simplex infections among untreated patients, patients treated by HAART for < or = six months, and patients treated for > six months. We observed three cases of atypical leprosy and three original observations: two of these were fistulisation of lymph node histoplasmosis and tuberculosis, the third one reports the recurrence of a treated cutaneous leishmaniasis. Multivariate analysis showed that, after controlling for age, sex and CD4 counts, patients receiving HAART for < or = six months were more likely to develop Herpes Zoster or herpes simplex infections (p < 0.005). Herpes Simplex and Herpes Zoster infections are the two most frequent dermatological manifestations in our tropical setting. Although mycobacterial infections are more rarely observed than in visceral IRIS, the increased incidence of leprosy may be quite significant when the availability of HAART spreads to developing countries.
Asunto(s)
Terapia Antirretroviral Altamente Activa , Dermatitis/etiología , Infecciones por VIH/tratamiento farmacológico , Lepra/complicaciones , Enfermedades Cutáneas Infecciosas/etiología , Absceso/etiología , Adulto , Estudios de Cohortes , Fístula Cutánea/etiología , Dermatitis/inmunología , Susceptibilidad a Enfermedades , Femenino , Fístula/etiología , Guyana Francesa/epidemiología , Infecciones por VIH/complicaciones , Herpes Simple/etiología , Herpes Simple/inmunología , Herpes Zóster/etiología , Herpes Zóster/inmunología , Histoplasmosis/complicaciones , Histoplasmosis/inmunología , Humanos , Huésped Inmunocomprometido , Memoria Inmunológica , Leishmaniasis Cutánea/complicaciones , Leishmaniasis Cutánea/inmunología , Lepra/inmunología , Enfermedades Linfáticas/etiología , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Enfermedades Cutáneas Infecciosas/inmunología , Tuberculosis Ganglionar/complicaciones , Tuberculosis Ganglionar/inmunologíaRESUMEN
A case of balantidial dysentery is reported in a patient infected with the HIV in French Guiana. This case is the first described in medical literature. The patient presented also a disseminated histoplasmosis. Immunosuppression probably favoured the evolution of asymptomatic carriage to clinical dysentery. This clinical case did not present any complications. Treatment with doxycycline had to be carried out for 20 days in order to obtain a clinical and parasitological cure.