RESUMO
BACKGROUND: Antibody binding assays carried out by our group have consistently indicated a higher reactivity of sera from male HIV-1 infected individuals. This study was carried out in order to analyze the importance of gender, route of transmission, disease progression and HIV-1 genotype in seroreactivity assays. STUDY DESIGN: Specificity of antibody binding was studied in plasma of 247 HIV-1 seropositive individuals belonging to patient groups of pregnant women, injecting drug users (IDUs) and recent seroconvertors, resident in Rio de Janeiro, RJ. Recognition of synthetic peptides corresponding to antigenically important epitopes in the envelope of HIV-1 (gp41 immunodominant epitope, V3 loop, V2 loop and gp41 735-752 epitope) was determined. RESULTS: The immunodominant gp41 peptide (amino acids 594-613, HIV-1 MN sequence) was recognized by 85% of all plasma tested. Reactivity with the gp41 735-752 peptide and gp120 V2 loop peptides was low but quite variable, being generally more often specific to a Brazilian V2 peptide used than to the HIV-1 MN derived V2 peptide. The overall recognition of the different V3 peptides tested varied from 41 to 76%. Patients with more advanced disease showed a more frequent reactivity with the peptides studied than did asymptomatic patients. Statistically significant differences in peptide recognition were observed by multiple logistic analyses comparing plasma derived from individuals infected by blood or sexual HIV transmission, adjusting for disease progression and gender. Plasma from individuals infected by sexual transmission showed lower peptide recognition than did plasma from individuals infected through HIV positive blood. Association attempts between seroreactivity and genotype indicated that plasma derived from patients infected with HIV-1 of the F subtype showed highest recognition of heterologous V3 peptides, as well as a slightly more frequent recognition of the non-V3 peptides tested. Recognition of homologous peptides was generally higher than recognition of heterologous peptides. Differences were most pronounced between the prototypical HIV-1 B subtype and the Brazilian B" variant of this subtype but almost non-existent between the HIV-1 B and F subtypes. CONCLUSIONS: Individual gender was shown to be a confounder when investigating the relationships of peptide reaction to HIV-1 route of transmission through multivariate statistical methods: patients infected by blood transmission (IDU) present higher frequency of peptide recognition than individuals infected by sexual HIV-1 transmission. Plasma from individuals infected with the B" variant (GWG) of B subtype HIV-1 showed lower heterologous peptide recognition than that from HIV-1 B (GPG) or F infected individuals.
Assuntos
Anticorpos Anti-HIV/imunologia , Infecções por HIV/imunologia , HIV-1/imunologia , Sequência de Aminoácidos , Feminino , Infecções por HIV/transmissão , Humanos , Masculino , Dados de Sequência Molecular , GravidezRESUMO
We describe the third case in the literature of Parinaud's syndrome as the sole manifestation of brainstem toxoplasmosis, in a positive HIV-1 patient and review the literature concerning the possible etiologies of Parinaud's syndrome, enforcing that it is a rare manifestation of central nervous system toxoplasmosis. We refer to its occurrence without simultaneous obstructive hydrocephalus and increased intracranial pressure, pointing out the Collier signal which is not very well known, but has great semiotic value once it locates the lesion in the brainstem.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Doenças Palpebrais/etiologia , Soropositividade para HIV/complicações , HIV-1 , Transtornos da Motilidade Ocular/etiologia , Toxoplasmose Cerebral/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Adulto , Doenças Palpebrais/diagnóstico , Humanos , Masculino , Transtornos da Motilidade Ocular/diagnóstico , Síndrome , Toxoplasmose Cerebral/diagnósticoRESUMO
Efforts to characterize HIV-1 polymorphism and anti-HIV immune response are being made in areas where anti-HIV/AIDS vaccines are to be employed. Anti-HIV-1 humoral immune response is being studied in infected individuals residents in Rio de Janeiro, in distinct cohorts involving recent seroconvertors, pregnant women or intravenous drug users (IDU). Comparative analyses of specificity of antibody response towards epitopes important for anti-HIV-1 immune response indicate quantitative differences between cohorts, with an exceptionally strong response in IDUs and weakest response in pregnant women. However, a comparative analysis between pregnant women cohorts from Rio de Janeiro and Rio Grande do Sul indicated an even lower response (with exception of the anti-V3-C clade peptide recognition) for the southern cohort. Studies analysing the immune function of the humoral response indicate a quite elevated occurrence of antibodies capable for neutralizing heterologous primary HIV-1 isolates from Rio de Janeiro. Attempts to correlate seroreactivity with HIV-1 neutralization with respect to HIV-1 polymorphism were not very successful: while the Brazilian B clade B " variant could be recognized by binding assays, no significant distinction of HIV-1 clades/variants was observed in viral neutralization assays.
Assuntos
Formação de Anticorpos/imunologia , Especificidade de Anticorpos , Anticorpos Anti-HIV/imunologia , Infecções por HIV/imunologia , HIV-1/imunologia , Brasil , Estudos de Coortes , Feminino , Genótipo , Anticorpos Anti-HIV/genética , Infecções por HIV/genética , Infecções por HIV/transmissão , Humanos , Masculino , Testes de Neutralização , GravidezRESUMO
BACKGROUND/AIMS: It is generally accepted that chronic hepatic encephalopathy (HE) is a stable form of neuropsychiatric disorder, usually related to porto-systemic shunts and with no exogenous precipitating factors. Bacterial infections are frequent causes of morbidity in cirrhosis, including the development of HE in its acute form, but there are no reports of its role in chronic forms of HE. METHODOLOGY: We studied 168 episodes of hepatic encephalopathy in 111 patients with cirrhosis who were admitted to hospital during the last four years. Clinical staging was used for the diagnosis of acute and chronic HE, complemented by number connection tests and EEG. In chronic HE the diagnostic criteria were intolerance to animal proteins and a continuous need for medications and/or special diets. Alcohol was the etiology of cirrhosis in 81.1% of patients, hepatitis B or C virus in 12.6% and various factors in 6.3%. The male/female ratio was 3:1 and mean age was 53 years. RESULTS: Twenty patients (18%) were characterized as having chronic HE, whereas ninety-one (82%) presented acute HE. Precipitating factors could be detected in 43 out of 57 (75.4%) of chronic forms and in 108 of 111 (97.3%) episodes of acute HE. Bacterial infections were associated with HE in 15 of 43 cases (34.8%) of chronic HE and in 37 of 108 (34.7%) cases of acute HE (p < 0.05). Spontaneous bacterial peritonitis was the most prevalent infection in acute HE, whereas urinary tract infection was most frequent in chronic HE. Mortality was higher in acute than in chronic HE (p < 0.001), associated with Child C prognostic classification, grades III and IV of HE and more severe precipitating factors. CONCLUSIONS: The diagnosis and control of precipitating factors, especially bacterial infection, should also be considered during the treatment of chronic hepatic encephalopathy.