RESUMEN
OBJECTIVES: To analyse risk factors for morbidity and survival associated with blood cytomegalovirus (CMV) detection with the antigenemia method among AIDS patients. PATIENTS AND METHODS: CMV antigenemia and CMV blood cultures in 277 AIDS patients IgG-CMV sero-positive with a CD4 level lower than 200 x 10(6)/l under antiretroviral monotherapy were analysed. We consider cases the 116 patients with one or more positive blood samples tested for pp65 antigenemia or CMV culture. They were matched with 161 control patients with negative antigenemia or viremia. RESULTS: Multivariate analysis pointed out a significant positive association for blood CMV reactivation with the following variables: CMV disease development and CMV urine detection, sex-acquired HIV infection, CD4+ < 50 x 10(6)/l and matched time from AIDS diagnosis to CMV blood culture correlated with positive antigenemias. Quantitative antigenemia title showed predictive value for risk of CMV disease although 23% of retinitis patients had persistent undetectable antigenemia. CMV invasive disease developed in 48% of cases and 11% of controls (relative risk [RR]: 7.9; 95% confidence interval [CI]: 4.2-14.7). Mortality after 12 months of follow-up was 73% vs 52% respectively (p < 0.001). Time survival curves after CD4+ count adjusting remained significantly lower for case patients (median, 127 days vs 355 days; p < 0.01 by log-rank test). Increased death rate was found in patients with CMV disease (74%), followed by patients with CMV antigenemia but no disease (70%) and patients without antigenemia or CMV disease (mortality 49%). CONCLUSIONS: CMV blood detection in AIDS patients may be considered as a bad prognosis marker for CMV morbidity and survival. This risk increases with higher CMV antigenemias. Therefore, pre-emptive anti-CMV therapy should be considered in this restricted population.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/virología , Antígenos Virales/sangre , Infecciones por Citomegalovirus/inmunología , Infecciones por Citomegalovirus/virología , Citomegalovirus/inmunología , Citomegalovirus/aislamiento & purificación , VIH-1 , Fosfoproteínas/sangre , Proteínas de la Matriz Viral/sangre , Viremia/inmunología , Viremia/virología , Infecciones Oportunistas Relacionadas con el SIDA/etiología , Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Adulto , Recuento de Linfocito CD4 , Estudios de Cohortes , Infecciones por Citomegalovirus/etiología , Infecciones por Citomegalovirus/mortalidad , Femenino , Humanos , Masculino , Pronóstico , Estudios Prospectivos , Factores de Riesgo , España/epidemiologíaRESUMEN
The usefulness of an enzyme-immunoassay (EIA) monotest (TESTPACK HIV-1/HIV-2, ABBOTT) was evaluated in the rapid diagnosis of anti-HIV antibodies in whole saliva in an intravenous drug abuser population (IVDA). Anti-HIV antibodies were simultaneous and prospectively measured in serum and whole saliva from 70 IVDA patients. To improve the sensitivity of the test 100 microliters of saliva were added instead of the recommended serum volume. In the 35 seropositive subjects saliva yielded a distinct positive result (Sensitivity=1), and in the 35 seronegative subjects a negative result (Specificity = 1). A statistically significant association between serum and saliva antibody levels was observed. These findings show the usefulness of a EIA monotest with whole saliva as an alternative sample to serum in the measurement of HIV-antibodies in high-risk patients.
Asunto(s)
Anticuerpos Anti-VIH/análisis , Infecciones por VIH/diagnóstico , Técnicas para Inmunoenzimas , Saliva/inmunología , Adolescente , Adulto , Femenino , Anticuerpos Anti-VIH/sangre , Humanos , Masculino , Estudios Prospectivos , Trastornos Relacionados con SustanciasRESUMEN
BACKGROUND: The presence of immunoglobulins in saliva has allowed it to be proven that they are specific against certain antigens. Antibodies to the human immunodeficiency virus (HIV) have been observed in saliva. The aim of this study was to evaluate the detection of the same by commercial enzymoinmmunoassay (EIA) and standardize the technique. METHODS: In 78 intravenous drug user patients the presence of antibodies against HIV in serum and saliva were determined by recombinant EIA (Abbott HIV-1/HIV-2 recombinant EIA). The determinations in saliva were made taking volumes of 10 and 50 microliters. RESULTS: In 43 patients the presence of antibodies against HIV-1 was demonstrated in serum, 42 of which were positive in saliva in the determination with 50 microliters and 16 with 10 microliters. No false positives were reported. With the use of 50 microliters of saliva the test showed a sensitivity of 0.98, specificity of 1, predictive value of a positive result of 1, predictive value of negative result of 0.98 and diagnostic efficacy of 0.99. CONCLUSIONS: The determination of antibodies against HIV in saliva in intravenous drug users is a highly sensitive and specific method with the use of volumes of 50 microliters in the tests.
Asunto(s)
Infecciones por VIH/diagnóstico , VIH/aislamiento & purificación , Saliva/microbiología , Adolescente , Adulto , Femenino , Anticuerpos Anti-VIH/análisis , VIH-1/aislamiento & purificación , VIH-2/aislamiento & purificación , Humanos , Técnicas para Inmunoenzimas , Masculino , Estudios Prospectivos , Juego de Reactivos para Diagnóstico , Sensibilidad y Especificidad , Abuso de Sustancias por Vía IntravenosaRESUMEN
Tuberculosis is currently one the more frequent opportunistic infections in patients infected by Human Immunodeficiency Virus (HIV) in our setting. Its extrapulmonary localization is considered as diagnostic of the Acquired Immunodeficiency Syndrome (AIDS). We have evaluated the epidemiological, clinical, microbiological, histological and immunological characteristics of 120 patients in the Asturias region who had a tuberculosis diagnosed in any localization, during the period between 1984 and 1991, belonging to a series of 570 patients infected by HIV. Pulmonary types were comparatively analyzed to the extrapulmonary and disseminated ones. Tuberculosis was pulmonary only in 44 occasions (PT), in 36 it was extrapulmonary (EPT) and in 52 disseminated (DT). The more frequent risk factor for the HIV infection was the parenteral consumption of drugs (78.8%). The final diagnosis was microbiologic in 81% of the cases, while bacilloscopia was positive in 62% of the cases. The histologic study showed the presence of granulomas in 86% of the tissues studied and necrosis in 81%. EPT and DT were related with a worse immune situation, bigger mortality rates attributed to tuberculosis and worse survival (p 0.069). Tuberculosis in patients infected by HIV appears mainly in CDVP, being its symptoms the normal ones; but extrapulmonary forms are clearly predominant and within this group those with a ganglionar localization. Normal diagnostic procedures yield a good result. EPT and DT are significantly related to a more severe immunodeficiency in comparison with PT. Survival and prognosis are better in the PT group.
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Infecciones por VIH/complicaciones , Tuberculosis/epidemiología , Análisis Actuarial , Adulto , Femenino , Humanos , Masculino , Estudios Retrospectivos , Factores de Riesgo , España/epidemiología , Tuberculosis/complicaciones , Tuberculosis/diagnósticoAsunto(s)
Derrame Pleural/etiología , Neumonía por Pneumocystis/diagnóstico , Adulto , Humanos , MasculinoRESUMEN
2 cases of simultaneous acute infection caused by HIV and CV that showed clinical features of infectious mononucleosis with spontaneous resolution and good evolution is presented. After 12 months following them up, both are symptom free carriers of HIV and without clinical features of CV infection. These cases had a good evolution, which is contrary to what is described in other medical literature.
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Infecciones por Citomegalovirus/complicaciones , Infecciones por VIH/complicaciones , Serodiagnóstico del SIDA , Enfermedad Aguda , Adulto , Femenino , Humanos , MasculinoRESUMEN
A case of a female infected by HIV whose first manifestation was a focal defect of the motor function caused by a brain lesion shown in the CT scan and NMR as a hemispheric mass with discreet expansive effect and central necrosis. The histologic study showed a necrotic leukoencephalitis related to HIV as etiologic agent. We point out the difficulties in diagnosing and treating this disease.