RESUMO
HIV infection is associated with numerous abnormalities affecting both the myeloid and lymphoid lineages. We studied the features associated with peripheral cytopenias as the first sign of HIV infection in children. Peripheral blood (PB) counts, PB and bone marrow (BM) lymphocyte subsets, as well as viral load and serum levels of ferritin, vitamin B12, and folic acid were determined. Five children were naive of treatment (Group 1) and three were under HAART (Group 2). In Group 1 all patients had anemia of chronic disease. One had a bone marrow culture positive for Mycobacterium avium intracellulare and pancytopenia. Besides this, neutropenia and thrombocytopenia were seen in one patient each. In Group 2 anemia was found in all, neutropenia in one, and thrombocytopenia in two patients. Peripheral blood cytopenias were due to HAART toxicity in one patient. In the other two they were due to iron or folate deficiency. Bone marrow cytology showed cell abnormalities mainly in granulocytic precursors and megakaryocytes. All except two (taking HAART) patients had a high viral load. There was a straight correlation between viral load in PB and bone marrow. Viral load was correlated with peripheral CD4 but not with CD8 lymphocytes. A decrease in bone marrow B lymphocytes was seen in all patients. The introduction of HAART improved peripheral cytopenias. Bone marrow examination was useful for determining the etiology of the cytopenias and for detection of opportunistic infection. Hemopoietic cell abnormalities were similar to those seen in adults and indicative of HIV infection.
Assuntos
Medula Óssea/patologia , Infecções por HIV/complicações , Doenças Hematológicas/patologia , Doenças Hematológicas/virologia , Anemia Aplástica/epidemiologia , Anemia Aplástica/patologia , Anemia Aplástica/virologia , Terapia Antirretroviral de Alta Atividade , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Infecções por HIV/tratamento farmacológico , Doenças Hematológicas/epidemiologia , Humanos , Lactente , Masculino , Estatísticas não Paramétricas , Carga ViralRESUMO
The polymerase chain reaction (PCR) has been the most promising test for HIV-1 early diagnosis in infants suspected of perinatal transmission. The first and second reactions of the amplification in 41 infants (under 18 months old) suspected of HIV-1 perinatal infection, were standardized and carried out in the present study. The first and the second PCR were carried out with the sets of primers JA4-JA7, JA9-JA12, JA13-JA16, and JA17-JA20 for the first reaction of amplification (outer primers) and JA5-JA6, JA10-JA11, JA14-JA15, and JA18-JA19 for the second reaction of amplification (inner primers), resulting in amplification of 131, 341, 172, and 129 pb, respectively. From 41 patients analysed, 12 patients presented positive to HIV-1 infection by PCR. The gag, env (region 1), and pol regions presented a greater sensitivity. The first and the second reactions of the amplification were performed with the same concentration of MgCl2 for all sets of primers. The results agree with several studies that affirm that the PCR is the indicated method for HIV-1 early diagnosis in infants suspected of perinatal infection.