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There has been very limited investigation regarding the genetic diversity of Mycobacterium tuberculosis (MTb) strains isolated from human immunodeficiency virus (HIV)-infected patients in Mexico. In this study, we isolated 93 MTb strains from pulmonary and extrapulmonary samples of HIV-infected patients treated in a public hospital in Mexico City to evaluate the genetic diversity using spoligotyping and mycobacterial interspersed repetitive unit-variable-number tandem-repeat (MIRU-VNTR) typing (based on 24 loci). The cohort comprised 80 male and 13 female individuals. There was a positive correlation between a high HIV viral load (>100,000 copies) and extrapulmonary tuberculosis (TB) (r = 0.306, p = 0.008). Lineage 4 was the most frequent lineage (79 strains). In this lineage, we found the H clade (n = 24), including the Haarlem, H3, and H1 families; the T clade (n = 22), including T1 and T2; the X clade (n = 15), including X1 and X3; the LAM clade (n = 14), including LAM1, LAM2, LAM3, LAM6, and LAM9; the S clade (n = 2); Uganda (n = 1); and Ghana (n = 1). We also found 12 strains in the EAI clade belonging to lineage 1, including the EAI2-Manila and EAI5 families. Interestingly, we identified one strain belonging to the Beijing family, which is part of lineage 2. One strain could not be identified. This study reports high genetic diversity among MTb strains, highlighting the need for a molecular epidemiological surveillance system that can help to monitor the spread of these strains, leading to more appropriate measures for TB control in HIV-infected patients.
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BACKGROUND: Maternal HIV infection remains a significant global health concern with potential repercussions on perinatal outcomes. Emphasis on early intervention to improve peri- and postnatal outcomes in infected mothers and infants is a valid therapeutic concern. OBJECTIVES: To comprehensively analyze perinatal outcomes associated with maternal HIV infection and evaluate adverse effects associated with the HIV infection in the existing literature. SEARCH STRATEGY: A comprehensive search of PubMed, MEDLINE, and Google Scholar was conducted from 2013 to September 2023, using relevant MeSH terms. SELECTION CRITERIA: The included studies encompassed original studies, cross-sectional, prospective, retrospective studies and observational studies focused on perinatal outcomes in the context of maternal HIV infection. DATA COLLECTION AND ANALYSIS: The selected studies underwent rigorous data collection and comprehensive quality checks and adhered to the PRISMA guidelines. MAIN RESULTS: Nine eligible studies from Brazil, China, India, Malawi, Nigeria, Tanzania, the USA, and Canada were included. These studies have consistently demonstrated that maternal HIV infection is associated with adverse perinatal outcomes. The analysis revealed a higher risk of preterm birth (OR 1.57, 95% CI: 1.39-1.78), low birth weight (OR 1.33, 95% CI: 1.18-1.49), and small for gestational age (OR 1.38, 95% CI: 1.24-1.53) among infants born to mothers living with HIV. Notably, the impact of antiretroviral treatment (ART) on these outcomes varied, but maternal HIV infection remained a significant risk factor regardless of income level and geographic region. CONCLUSION: Maternal HIV infection is consistently associated with adverse perinatal outcomes, emphasizing the need for targeted interventions and improved prenatal care in pregnant women with HIV infection.
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Infecções por HIV , Complicações Infecciosas na Gravidez , Resultado da Gravidez , Humanos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/complicações , Gravidez , Feminino , Recém-Nascido , Nascimento Prematuro/epidemiologia , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Recém-Nascido de Baixo Peso , Brasil/epidemiologia , Canadá , Recém-Nascido Pequeno para a Idade Gestacional , Índia/epidemiologia , China/epidemiologia , Nigéria/epidemiologia , Estados Unidos/epidemiologia , Tanzânia/epidemiologia , Malaui/epidemiologiaRESUMO
BACKGROUND: Drug-resistant tuberculosis (TB) is associated with higher mortality rates in patients with human immunodeficiency virus (HIV). In Mexico, the number of deaths due to TB among the HIV-positive population has tripled in recent years. METHODS: Ninety-three Mycobacterium tuberculosis strains isolated from the same number of HIV-infected patients treated in a public hospital in Mexico City were studied to determine the drug resistance to first- and second-line anti-TB drugs and to identify the mutations associated with the resistance. RESULTS: Of the 93 patients, 82.7% were new TB cases, 86% were male, and 73% had extrapulmonary TB. Most patients (94%) with a CD4 T-lymphocyte count <350 cells/mm3 were associated with extrapulmonary TB (p <0.0001), whilst most patients (78%) with a CD4 T-lymphocyte count >350 cells/mm3 were associated with pulmonary TB (p = 0.0011). Eighty-two strains were pan-susceptible, four mono-resistant, four poly-resistant, two multidrug-resistant, and one was extensively drug-resistant. In the rifampicin-resistant strains, rpoB S531L was the mutation most frequently identified, whereas the inhA C15T and katG S315T1 mutations were present in isoniazid-resistant strains. The extensively drug-resistant strain also contained the mutation gyrA D94A. CONCLUSIONS: These data highlight the need to promptly diagnose the drug resistance of M. tuberculosis among all HIV-infected patients by systematically offering access to first- and second-line drug susceptibility testing and to tailor the treatment regimen based on the resistance patterns to reduce the number of deaths in HIV-infected patients.
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Background and aims: Many improvements have been made in the treatment of human immunodeficiency virus (HIV) in pediatric patients; however, challenges remain in terms of achieving normal growth, body composition, and metabolism during treatment, etc. Current nutritional recommendations are based on studies performed in adults, with limited data on the HIV-infected pediatric population. Therefore, this study aimed to compare the resting energy expenditure (REE) of asymptomatic HIV-infected pediatric patients with healthy counterparts and to compare body composition, dietary intake, and physical activity between the two groups. Methods: This was a cross-sectional study of asymptomatic HIV-infected children who were receiving antiretroviral therapy; the infected group was compared with the uninfected group, matched by age (± 6 months), sex, and body mass index (± 0.5 z-score). Participants were recruited between 2021 and 2022, as outpatients. In both groups, REE was determined by indirect calorimetry and body composition by bioelectrical impedance analysis and hand strength, measured using a hydraulic hand dynamometer. Results: Seventy-eight participants were enrolled, where n = 39 HIV-infected children and n = 39 controls, with a mean age of 11.6 ± 3.4 years old. REE was significantly higher in the HIV group (1254.4 ± 334.7 kcal/day vs. 1124.7 ± 321 kcal/day, p = 0.013) than in the control group. Fat-free mass (FFM) was lower in the HIV group (28.2 ± 10.5 kg vs. 32 ± 11.2 kg, p = 0.001); this trend continued when the index skeletal muscle was evaluated (7.2 ± 1.2 vs. 7.6 ± 1.5, p = 0.04). The strength of the dominant hand was also lower in the HIV group (12 (8-18) kg vs. 20 (10.5-26) kg, p < 0.0001). Conclusions: Children with asymptomatic HIV infection have higher REE than their uninfected peers. They also present decreased FFM, skeletal muscle mass index, and muscle strength. These parameters should be considered during nutritional assessment in this population to have a favorable impact on nutritional status and growth.
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Abstract BACKGROUND: Sexually transmitted diseases (STIs) are an important public health problem in all countries. Knowledge of their relationship with the various socioeconomic levels is necessary for an understanding of their epidemiology and behavior in society. OBJECTIVE: To investigate the epidemiology of human immunodeficiency virus (HIV)-positive patients and to correlate education with history of sexually transmitted diseases, especially for syphilis. DESIGN AND SETTING: Analytical cross-sectional study carried out in the city of Juiz de Fora, Minas Gerais, Brazil. METHODS: The medical records of HIV/acquired immunodeficiency syndrome (AIDS) patients who started antiretroviral therapy (ART) between January 2010 and July 2018 were assessed. These patients were attended at the specialized assistance service for HIV/AIDS) of the Department of Sexually Transmitted Diseases (STD/AIDS) of the city of Juiz de Fora. In total, 335 patients were selected. RESULTS: In our sample, 73.13% were male; 57.36% were aged between 25 and 45 years and 24.23% were over 45 years of age. Regarding sexual orientation, 61.78% were homosexual. Regarding education, 52.88% had "unskilled education", while 47.12% had "qualified education". Analysis on the relationship between schooling and syphilis, a positive relationship between qualified schooling and syphilis was observed: odds ratio = 3.588; 95% confidence interval: 1.090-11.808. CONCLUSION: Homosexual male patients are most affected by HIV. Furthermore, this disease is not limited only to individuals with low education. Syphilis should be suspected in all individuals.
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Humanos , Masculino , Feminino , Adulto , Sífilis/epidemiologia , Infecções Sexualmente Transmissíveis/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Comportamento Sexual , Estudos Transversais , Fatores de Risco , Pessoa de Meia-IdadeRESUMO
Abstract It remains unclear whether increased inflammatory and cardiovascular risk biomarkers differ depending on the class of antiretroviral that is used. This study evaluated the plasma levels of inflammatory and cardiovascular risk biomarkers, such as MPO, hs-CRP, glucose, lipid profile, ALT (GPT), AST (GOT), urea and creatinine, as well as the blood count, of all the 164 participants in the study, either infected or un-infected with HIV. Thirty of the 104 HIV-infected individuals did not receive any antiretroviral; twenty-four of them were treated with non-nucleoside reverse transcriptase inhibitor class; and fifty took protease inhibitors. The control group consisted of sixty non-HIV infected individuals. In the case of the HIV-infected volunteers, the CD4+ T lymphocyte counts and viral load were also analyzed. Regardless of the hematological and biochemical changes resulting from the antiretroviral therapy (ART), the MPO and hs-CRP values significantly increased for the HIV-infected individuals (treated or untreated), irrespective of the class of ART that was used. This is important because these biomarkers are designed to be predictors of the risk of cardiovascular disease. The results of this study provide supporting evidence for the hypothesis that HIV-infected individuals are at increased risk of developing cardiovascular disease related to chronic inflammations, despite virological control with ART, and regardless of the class of ART that is used.
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Different therapeutic strategies have been investigated to target and eliminate HIV-1-infected cells by using armed antibodies specific to viral proteins, with varying degrees of success. Herein, we propose a new strategy by combining photodynamic therapy (PDT) with HIV Env-targeted immunotherapy, and refer to it as HIV photoimmunotherapy (PIT). A human anti-gp41 antibody (7B2) was conjugated to two photosensitizers (PSs) with different charges through different linking strategies; "Click" conjugation by using an azide-bearing porphyrin attached via a disulfide bridge linker with a drug-to-antibody ratio (DAR) of exactly 4, and "Lysine" conjugation by using phthalocyanine IRDye 700DX dye with average DARs of 2.1, 3.0 and 4.4. These photo-immunoconjugates (PICs) were compared via biochemical and immunological characterizations regarding the dosimetry, solubility, and cell targeting. Photo-induced cytotoxicity of the PICs were compared using assays for apoptosis, reactive oxygen species (ROS), photo-cytotoxicity, and confocal microscopy. Targeted phototoxicity seems to be primarily dependent on the binding of PS-antibody to the HIV antigen on the cell membrane, whilst being independent of the PS type. This is the first report of the application of PIT for HIV immunotherapy by killing HIV Env-expressing cells.
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Ânions , Fármacos Anti-HIV/farmacologia , Cátions , Imunoconjugados/farmacologia , Fotoquimioterapia , Fármacos Fotossensibilizantes/farmacologia , Ânions/química , Fármacos Anti-HIV/química , Anticorpos Monoclonais , Apoptose/efeitos dos fármacos , Cátions/química , Linhagem Celular Tumoral , Células Cultivadas , Citometria de Fluxo , Imunofluorescência , HIV/efeitos dos fármacos , HIV/genética , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Imunoconjugados/química , Fármacos Fotossensibilizantes/química , Espécies Reativas de Oxigênio/metabolismo , Replicação Viral/efeitos dos fármacos , Produtos do Gene env do Vírus da Imunodeficiência Humana/antagonistas & inibidores , Produtos do Gene env do Vírus da Imunodeficiência Humana/genética , Produtos do Gene env do Vírus da Imunodeficiência Humana/metabolismoRESUMO
Histoplasmosis occurs in 5-10% of HIV-infected patients in endemic areas and evolves to severe and disseminated infection with mortality rates over 50% in some regions. This report presents epidemiological, clinical and outcome data from HIV-infected patients with histoplasmosis confirmed by culture and/or at necropsy who were admitted to a Brazilian teaching hospital. Data from 65 patients were obtained from their respective medical and necropsy records. From 2005 to 2018, 36 HIV-infected patients were diagnosed with histoplasmosis confirmed by culture. At admission, most of these patients presented disseminated fungal infection, whereas 15 (41.7%) were simultaneously diagnosed with both HIV infection and histoplasmosis. Fever, weight loss, hepatosplenomegaly, respiratory and digestive symptoms were present in 86.2%, 50%, 44.4% and 41.7% of the patients, respectively. At admission, 24 patients had low CD4 T-cell count and high viral load values. Among the 30 patients who received antifungals, 16 (53.3%) were cured, 13 (43.3%) died, and one was lost to follow-up. Six patients died prior to therapy. From 1990 to 2018, 63 necropsies of patients with Histoplasma capsulatum infection were performed. Of these patients, 29 (46.0%) were HIV-infected individuals, including 21 (72.4%) who presented disseminated histoplasmosis and 21 (72.4%) who were diagnosed with histoplasmosis at necropsy. The epidemiological, clinical and outcome profiles presented herein are similar to those described elsewhere and reinforce the difficulties that are still present in limited-resource settings where advanced immunodeficiency, combined with severe fungal infection and late patient admissions, is related to poor outcomes.
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Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções por HIV/complicações , Histoplasma/isolamento & purificação , Histoplasmose/diagnóstico , Adulto , Autopsia , Brasil/epidemiologia , Contagem de Linfócito CD4 , Feminino , Hospitais de Ensino , Humanos , Terapia de Imunossupressão , Masculino , PrevalênciaRESUMO
The HIV-1 envelope protein (Env) mediates the membrane fusion process allowing virus entry to target cells and the efficiency to induce membrane fusion is an important determinant of HIV-1 pathogenicity. In addition to virus receptors, other adhesion/signaling molecules on infected and target cells and virus particles can enhance fusion. The presence of antilymphocyte autoantibodies (ALA) in HIV patients' serum suggests that they may contribute to the inhibition of Env-mediated membrane fusion. Here, sera from 38 HIV-1 infected treatment-naïve men and 30 healthy donors were analyzed for the presence of IgG and IgM able to bind to CD4-negative Jurkat cells. The use of CD4-negative cells precluded the binding of virus-antibody immune complexes, and allowed detection of ALA different from anti-CD4 antibodies. IgG and IgM antibodies binding to Jurkat CD4-negative cells was detected in 74% and 84% of HIV-positive sera, respectively. Then, the activity of sera on fusion of CD4+ with HIV Env+ Jurkat cells was determined before and after their adsorption on CD4-negative Jurkat cells to remove ALA. Sera inhibited fusion at variable extents, and inhibitory activity decreased in 58% of serum samples after adsorption, indicating that ALA contributed to fusion inhibition in these sera (herein called fusion inhibitory ALA). The contribution of ALA to fusion inhibition in individual sera was highly variable, with an average of 33%. IgG purified from a pool of HIV+ sera inhibited fusion of primary CD4 T lymphocytes with Jurkat Env+, and adsorption of IgG on CD4-negative Jurkat cells diminished the fusion inhibitory activity. Thus, the inhibitory activity of sera was related to IgG ALA. Our observations suggest that fusion inhibitory ALA other than anti-CD4 antibodies may contribute significantly to the inhibition of Env-mediated cell-cell fusion. Fusion inhibitory ALA, but not total ALA levels, associated with low plasma viral loads, suggesting that specific ALA may participate in virus containment by inhibiting virus-cell fusion in a significant fraction of HIV-infected patients.
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Proteína gp120 do Envelope de HIV/metabolismo , Infecções por HIV/imunologia , HIV-1/fisiologia , Adolescente , Adulto , Anticorpos Antivirais/metabolismo , Soro Antilinfocitário/metabolismo , Antígenos CD4/metabolismo , Humanos , Imunoglobulina G/metabolismo , Imunoglobulina M/metabolismo , Células Jurkat , Masculino , Pessoa de Meia-Idade , Ligação Proteica , Carga Viral , Internalização do Vírus , Adulto JovemRESUMO
In this work a hollow mesoporous structured molecularly imprinted polymer was synthetized and used as adsorbent in pipette-tip solid-phase extraction for the determination of lamivudine (3TC), zidovudine (AZT) and efavirenz (EFZ) from plasma of human immunodeficiency virus (HIV) infected patients by high-performance liquid chromatography (HPLC). All parameters that influence the recovery of the pipette tip based on hollow mesoporous molecularly imprinted polymer solid-phase extraction (PT-HM-MIP-SPE) method were systematically studied and discussed in detail. The adsorbent material was prepared using methacrylic acid and 4-vinylpyridine as functional monomers, ethylene glycol dimethacrylate as crosslinker, acetonitrile as solvent, 4,4'-azobis(4-cyanovaleric acid) as radical initiator, benzalkonium chloride as surfactant, 3TC, and AZT as templates. The simultaneous separation of 3TC, AZT and EFZ by HPLC-UV was performed using a Gemini C18 Phenomenex® column (250 mm × 4.6 mm, 5 µm) and mobile phase consisting of acetonitrile: water pH 3.2 (68:32, v/v), flow rate of 1.0 mL/min and λ = 260 nm. The method was linear over the concentration range from 0.25 to 10 µg/mL for 3TC and EFZ, and 0.05 to 2.0 µg mL-1 for AZT, with correlation coefficients larger than 0.99 for all analytes. Recovery ± relative standard deviations (RSDs %) were 41.99 ± 2.38%, 82.29 ± 1.63%, and 83.72 ± 7.52% for 3TC, AZT, and EFZ, respectively. The RSDs and relative errors (REs) were lower than 15% for intra and interday assays. The method has been successfully applied for monitoring HIV-infected patients outside the therapeutic dosage.
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Antirretrovirais/sangue , Infecções por HIV/tratamento farmacológico , Impressão Molecular/métodos , Extração em Fase Sólida/métodos , Antirretrovirais/isolamento & purificação , Antirretrovirais/uso terapêutico , Cromatografia Líquida de Alta Pressão , Humanos , Limite de Detecção , Modelos Lineares , Reprodutibilidade dos TestesRESUMO
Youth living with HIV (YLH) experience multiple disease-related stresses along with the same structural and developmental challenges faced by their uninfected peers; alcohol use among YLH represents a risk behavior by virtue of potential effects on youth health and increased likelihood of engaging in unprotected sex while drinking alcohol. Research aimed at better understanding the interplay of individual- and neighborhood-level influences on alcohol use for YLH is needed to inform interventions. This study examined whether socioeconomic disadvantage (SED) and social support influence, independently and through interaction, alcohol use in YLH. Data from the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) consisted of YLH across 538 neighborhoods in the United States who acquired HIV behaviorally. Neighborhood-specific data were compiled from the 2010 U.S. Census Bureau and matched with individual-level data from the ATN (N = 1,357) to examine effects that contribute to variation in frequency of alcohol use. Other drug use, being male, being non-Black, and older age were associated with greater alcohol use. Higher social support was negatively associated with alcohol use frequency. A cross-level interaction indicated that the association found between decreasing social support and increasing alcohol use frequency was weakened in areas with lower SED. Implications are discussed.
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Consumo de Bebidas Alcoólicas/epidemiologia , Infecções por HIV , Pobreza , Características de Residência , Apoio Social , Adolescente , Adulto , Feminino , Humanos , Masculino , Porto Rico/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Nasopharyngeal carriage is a precursor for pneumococcal disease and can be useful for evaluating pneumococcal conjugate vaccine (PCV) impact. We studied pre-PCV pneumococcal carriage among HIV-infected and -uninfected children in Mozambique. Between October 2012 and March 2013, we enrolled HIV-infected children age <5 years presenting for routine care at seven HIV clinics in 3 sites, including Maputo (urban-south), Nampula (urban-north), and Manhiça (rural-south). We also enrolled a random sample of HIV-uninfected children <5 years old from a demographic surveillance site in Manhiça. A single nasopharyngeal swab was obtained and cultured following enrichment in Todd Hewitt broth with yeast extract and rabbit serum. Pneumococcal isolates were serotyped by Quellung reaction and multiplex polymerase chain reaction. Factors associated with pneumococcal carriage were examined using logistic regression. Overall pneumococcal carriage prevalence was 80.5% (585/727), with similar prevalences among HIV-infected (81.5%, 339/416) and HIV-uninfected (79.1%, 246/311) children, and across age strata. Among HIV-infected, after adjusting for recent antibiotic use and hospitalization, there was no significant association between study site and colonization: Maputo (74.8%, 92/123), Nampula (83.7%, 82/98), Manhiça (84.6%, 165/195). Among HIV-uninfected, report of having been born to an HIV-infected mother was not associated with colonization. Among 601 pneumococcal isolates from 585 children, serotypes 19F (13.5%), 23F (13.1%), 6A (9.2%), 6B (6.2%) and 19A (5.2%) were most common. The proportion of serotypes included in the 10- and 13-valent vaccines was 44.9% and 61.7%, respectively, with no significant differences by HIV status or age group. Overall 36.9% (n = 268) of children were colonized with a PCV10 serotype and 49.7% (n = 361) with a PCV13 serotype. Pneumococcal carriage was common, with little variation by geographic region, age, or HIV status. PCV10 was introduced in April 2013; ongoing carriage studies will examine the benefits of PCV10 among HIV-infected and-uninfected children.
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Humanos , Infecções Pneumocócicas/imunologia , Streptococcus pneumoniae/imunologia , Infecções/virologia , Pneumonia/imunologia , Portador Sadio/epidemiologia , Pré-Escolar , Moçambique/epidemiologiaRESUMO
Pregnancy and postpartum control in HIV infected women. We present data from a retrospective observational descriptive study with the objective of evaluating characteristics of HIV-infected pregnant women, analyze the level of control of pregnancy and assess adherence to treatment and loss of follow up after delivery. We analyzed reported data of 104 pregnancies, 32.7% of them under 25 years old. The diagnosis was performed as part of pregnancy control in 36.5% of women. TARV started before 24 weeks of pregnancy in 70% of them and a regimen with 2 nucleos(t)ides and 1 ritonavir potenciated protease inhibitor (PIr) was prescribed in 84.5%. Elective c-section was the most frequent mode of delivery. The viral load after 32 weeks of pregnancy was available in 82.7%, being less than 1000 cop/ml in 78 (75%), less than 200 cop/ml in 70 (67.3%) and not available in 18 (17.3%) of cases. We observed a considered high rate of adherence failure and loss of follow up after delivery. Reported data should alert programs on the need to implement strategies to promote early pregnancy control and increase adherence and retention in care, especially in the postpartum period.
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Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Adesão à Medicação/estatística & dados numéricos , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adulto , Western Blotting , Contagem de Linfócito CD4 , Esquema de Medicação , Ensaio de Imunoadsorção Enzimática , Feminino , Seguimentos , Humanos , Período Pós-Parto , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Estudos Retrospectivos , Carga Viral , Adulto JovemRESUMO
PURPOSE: The 144-week results of the open-label, multicenter Atazanavir/Ritonavir Induction with Epzicom Study (ARIES) were stratified by gender to compare treatment responses. METHODS: A total of 369 HIV-infected, antiretroviral-naïve subjects receiving once-daily abacavir/lamivudine + atazanavir/ritonavir (ATV/r) whose HIV-1 RNA was <50 copies/mL by week 30 were randomized 1:1 at week 36 to maintain or discontinue ritonavir for 108 subsequent weeks. Between- and within-treatment gender-related efficacy and safety differences were analyzed. RESULTS: Subjects were 85% male; 64% white; and had a mean age of 39 years, baseline median HIV-1 RNA of 114,815 copies/mL, and median CD4+ cell count of 198 cells/mm3. Gender (ATV [n=189]: 29 females/160 males; ATV/r [n=180]: 25 females/155 males) and most other demographics were similar between groups; more females than males were black (65% vs 25%) and fewer females had baseline HIV-1 RNA ≥100,000 copies/mL (41% vs 58%). At week 144, no significant differences between genders were observed in proportion maintaining HIV-1 RNA <50 copies/mL (ATV, 79% vs 77%; ATV/r, 60% vs 75%) or <400 copies/mL (ATV, 83% vs 84%; ATV/r, 68% vs 82%) (intent-to-treat-exposed: time to loss of virologic response analysis); median CD4+ change from baseline (ATV, +365 vs +300 cells/mm3; ATV/r, +344 vs +301 cells/mm3); proportion with treatment-related grade 2-4 adverse events (baseline to week 144: ATV, 41% vs 31%; ATV/r, 36% vs 43%; weeks 36 to 144: ATV, 14% vs 13%; ATV/r, 24% vs 23%); or proportion developing fasting lipid changes. Female and male virologic failure rates (ATV, 0 vs 5; ATV/r, 2 vs 4) and proportions completing the study were similar during the extension phase. Primary withdrawal reasons were loss to follow-up and pregnancy for females and loss to follow-up and other for males. CONCLUSION: Over 144 weeks, no significant gender differences were observed in efficacy, safety, or fasting lipid changes with abacavir/lamivudine +ATV or abacavir/lamivudine +ATV/r.
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Presentamos los datos de un estudio descriptivo observacional retrospectivo realizado con el objetivo de evaluar las características de las mujeres embarazadas infectadas por HIV, analizar el nivel de control del embarazo y evaluar la adherencia al tratamiento y las pérdidas de seguimiento posterior al parto. Analizamos los datos informados de 104 embarazos, 32.7% de mujeres menores de 25 años. El diagnóstico se realizó durante el control del embarazo en 36.5% de ellos. La terapia antirretroviral (TARV) se inició antes de la semana 24 en 70% de los embarazos. El régimen utilizado incluyó 2 nucleós(t)idos + 1 inhibidor de la proteasa potenciado con ritonavir (IPr) en 84.5% de los casos. La cesárea electiva fue el modo mas frecuente de parto. La carga viral luego de la semana 32 de embarazo estaba disponible en el 82.7% de las pacientes siendo menor a 1000 copias/ml en 78 (75%) y menor a 200 en 70 (67.3%), no hallándose disponible en 18 (17.3%) de los casos. Observamos una alta frecuencia de fallos de adherencia y pérdidas de seguimiento posteriores al parto. Los datos comunicados deben alertar a los programas y centro de atención sobre la necesidad de implementar estrategias que promuevan el control temprano del embarazo e incrementen la adherencia y la retención en cuidado, especialmente en el período posterior al parto.
We present data from a retrospective observational descriptive study with the objective of evaluating characteristics of HIV-infected pregnant women, analyze the level of control of pregnancy and assess adherence to treatment and loss of follow up after delivery. We analyzed reported data of 104 pregnancies, 32.7% of them under 25 years old. The diagnosis was performed as part of pregnancy control in 36.5% of women. TARV started before 24 weeks of pregnancy in 70% of them and a regimen with 2 nucleos(t)ides and 1 ritonavir potenciated protease inhibitor (PIr) was prescribed in 84.5%. Elective c-section was the most frequent mode of delivery. The viral load after 32 weeks of pregnancy was available in 82.7%, being less than 1000 cop/ml in 78 (75%), less than 200 cop/ml in 70 (67.3%) and not available in 18 (17.3%) of cases. We observed a considered high rate of adherence failure and loss of follow up after delivery. Reported data should alert programs on the need to implement strategies to promote early pregnancy control and increase adherence and retention in care, especially in the postpartum period.
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Humanos , Feminino , Gravidez , Adulto , Adulto Jovem , Complicações Infecciosas na Gravidez/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Fármacos Anti-HIV/administração & dosagem , Adesão à Medicação/estatística & dados numéricos , Complicações Infecciosas na Gravidez/diagnóstico , Esquema de Medicação , Ensaio de Imunoadsorção Enzimática , Western Blotting , Estudos Retrospectivos , Seguimentos , Contagem de Linfócito CD4 , Carga Viral , Período Pós-PartoRESUMO
Late diagnosis of HIV remains a public health issue in Mexico. Most national programs target high-risk groups, not including women. More data on factors associated with late diagnosis and access to care in women are needed. In 2012-2013, Mexican women recently diagnosed with HIV were interviewed. Socio-cultural background, household-dynamics and clinical data were collected. Of 301 women, 49 % had <200 CD4 cells/mm3, 8 % were illiterate, 31 % had only primary school. Physical/sexual violence was reported by 47/30 %; 75 % acquired HIV from their stable partners. Prenatal HIV screening was not offered in 61 %; 40 % attended consultation for HIV-related symptoms without being tested for HIV. Seeking medical care ≥3 times before diagnosis was associated with baseline CD4 <200 cells/mm3 (adjusted OR 3.74, 95 % CI 1.88-7.45, p < 0.001). There were missed opportunities during prenatal screening and when symptomatic women seeked medical care. Primary care needs to be improved and new strategies implemented for early diagnosis in women.
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Diagnóstico Tardio , Infecções por HIV/diagnóstico , Programas de Rastreamento , Diagnóstico Pré-Natal , Atenção Primária à Saúde , Adulto , Diagnóstico Precoce , Intervenção Médica Precoce , Feminino , Humanos , Modelos Logísticos , México , Análise Multivariada , Razão de Chances , Comportamento Sexual , Parceiros SexuaisRESUMO
Patients infected with human immunodeficiency virus (HIV) are living longer, healthier lives on highly active antiretroviral therapy and, as a result, interest in kidney transplantation for HIV-infected patients with end-stage renal disease has increased. HIV is no longer considered a contraindication to solid-organ transplantation and the number of kidney transplants performed in HIV-infected patients each year is increasing steadily. HIV-infected kidney transplant recipients have had excellent outcomes overall, but there are still significant challenges, including high rates of acute rejection, drug-drug interactions, and poor outcomes in patients co-infected with hepatitis C virus. The gap between supply and demand for organs remains a challenge but new developments in HIV-positive to HIV-positive kidney transplantation may help bridge this gap.
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Fármacos Anti-HIV/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Infecções por HIV/tratamento farmacológico , Imunossupressores/uso terapêutico , Falência Renal Crônica/cirurgia , Transplante de Rim , Terapia Antirretroviral de Alta Atividade , Coinfecção , Interações Medicamentosas , Infecções por HIV/complicações , Hepatite C Crônica/complicações , Humanos , Falência Renal Crônica/complicações , Resultado do TratamentoRESUMO
PURPOSE: Antiretroviral therapy medication adherence is a complex phenomenon influenced by multiple factors. This study examines its evolution and predictors among perinatally HIV-infected youths in São Paulo, Brazil. METHODS: During a 1-year longitudinal cohort study, perinatally HIV-infected youths aged 13-21 years taking antiretroviral therapy were recruited in hospitals and HIV/AIDS reference centers. Data were collected at baseline and after 12 months. Variables assessed were adherence, self-efficacy regarding medication intake, social support, stress level, depression, CD4 cell count, viral load, and symptoms. Adherence was defined as taking ≥95% of prescribed HIV medication in the past 7 days. Generalized estimating equation and analysis of variance methods were used. RESULTS: A total of 268 adolescents participated in the study (59% female; mean age of 16 years). At baseline, 63.06% of the sample was adherent to their HIV medication, and 52.99% had an undetectable viral load. All participants, regardless of adherence, reported: low levels of stress and symptoms of depression; high perception of medication self-efficacy and social support; and a mean of 6.8 symptoms related to their HIV medication. Predictors of adherence were: high perception of medication self-efficacy (odds ratio = 2.81; 95% confidence interval: 1.94-4.05) and low number of reported medication side effects (odds ratio = .97; 95% confidence interval: .95-.99]. Between baseline and follow-up, 49.6% remained adherent, 22.3% remained nonadherent, and the adherence level changed over time for 28.2%. CONCLUSIONS: These findings suggest the need to develop interventions to enhance self-efficacy toward medication and to help youth better manage HIV medication symptoms.
Assuntos
Terapia Antirretroviral de Alta Atividade/psicologia , Infecções por HIV/tratamento farmacológico , Adesão à Medicação/psicologia , Autoeficácia , Adolescente , Análise de Variância , Fármacos Anti-HIV/uso terapêutico , Brasil , Contagem de Linfócito CD4/estatística & dados numéricos , Depressão/psicologia , Feminino , Infecções por HIV/fisiopatologia , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Humanos , Estudos Longitudinais , Masculino , Adesão à Medicação/estatística & dados numéricos , Estresse Psicológico/psicologia , Inquéritos e Questionários , Carga Viral/estatística & dados numéricos , Adulto JovemRESUMO
A lactoferrina é uma glicoproteína de ligação ao ferro, que está presente na saliva, no leite, e em outras secreções exócrinas. Essa proteína tem inúmeras funções biológicas, incluindo efeitos antifúngicos e antibacterianos, além de imunomoduladores. O objetivo do presente estudo foi avaliar, in vitro, pela primeira vez, a atividade antifúngica da lactoferrina contra cepas de Candida nãoalbicans isoladas da cavidade oral de crianças infectadas pelo HIV e crianças saudáveis. Além disso, mensurar a degradação da lactoferrina por essas cepas através de SDS-PAGE (análise eletroforética em gel de poliacrilamida) e determinar, in vitro, a concentração mínima inibitória de lactoferrina capaz de matar 50% das células de Candida não-albicans. Cepas de Candida spp. foram obtidas através da coleta de saliva de 70 crianças infectadas pelo HIV e 50 crianças sem evidências de imunossupressão, com idade de 3 a 13 anos (ALVES, 2014). As diferentes espécies de Candida foram identificadas através de assimilação e fermentação de açúcar (API 20Cï¢, Biomérieux, França). Para o ensaio, in vitro, de morte de celular na presença de lactoferrina, 24 isolados de Candida, entre elas parapsilosis, tropicalis, krusei, guillermondi e dubliniensis, foram selecionados. Para a realização da análise por SDS-PAGE, cepas de todas as espécies consideradas resistentes nos ensaios de morte celular, foram incluídas. O porcentual de morte celular (%) de Candida não- albicans com a adição de 100 µg/ml de lactoferrina variou de 3,1% (C. dubliniensis) a 88,1% (C. tropicalis) no grupo HIV, e de 14,1% a 30,37% no grupo não-HIV (C . parapsilosis). Não houve correlação entre a densidade celular e o percentual de morte celular. C. dubliniensis foi a espécie mais resistente a lactoferrina e o porcentual de morte celular de C. parapsilosis foi significativamente maior em comparação com C. krusei na concentração de 1X104 células/ml (p = 0,033). Todos os isolados foram capazes de degradar a lactoferrina na concentração 1x108 células/ml, especialmente C. parapsilosis, pelo grupo HIV. Além disso, a lactoferrina na concentração de 500 µg/ml foi capaz de matar mais de 50% das células apenas dos isolados de C. tropicalis e C. guilliermondii. Concluiu-se que a lactoferrina tem atividade antifúngica contra Candida não-albicans de crianças infectadas pelo HIV, mas algumas espécies apresentam alguma resistência a esta proteína. Além disso, todas as Candida spp. foram capazes de degradar a lactoferrina quando estavam em concentração de 1X108 cels/ml, e a lactoferrina na concentração de 500µl/ml foi capaz de matar mais que 50% das células de C. tropicalis e C. guillermondii
Lactoferrin is an iron-binding glycoprotein, which is present in saliva, milk and other exocrine secretions. This protein has a number of biological functions, including antifungical, antimicrobial and immunomodulatory effects. The aim of this study was to evaluate, for the first time, the antifungal activity of lactoferrin against isolates of Candida spp. from the oral cavity of HIV-infected children and children with no clinical evidence of immunosuppression. Furthermore, measure, in vitro, the degradation of lactoferrin by Candida spp. through SDS-PAGE (electrophoretic analysis on polyacrylamide gel) and determine, in vitro, the minimum inhibitory concentration of lactoferrin able to kill 50% of cells of Candida non-albicans. Strains of Candida spp. were obtained through saliva collect of 70 HIV-infected children and 50 children without evidence of immunosuppression ageing between 3 to13 years old (ALVES, 2014). All Candida species were identified by sugar assimilation and fermentation (API 20Cï¢, Biomerieux, France). For the in vitro study, death of lactoferrin of 24 Candida isolates, including parapsilosis, tropicalis, krusei, guillermondii, and dubliniensis, were selected. To perform the analysis by SDS-PAGE, strains of all available species considered resistants, which were observed at lactoferrin death`s study, were included. The cell death percentage (%) of non-albicans Candida by addition of 100 µg of lactoferrin range from 3.1% (C. dublinienes) to 88.1% (C. tropicalis) in HIV group, and 14.1% to 30.37% in N-HIV (C. parapsilosis), but there was no correlation between cell density and death %. C. dubliniensis was the most resistant specie to lactoferrin and the cell death % of C. parapsilosis was significant higher comparing to C. krusei at 1X104 cells/ml (p=0.033). All the isolates were able to degrade lactoferrin at 108 cells/ml, mainly C. parapsilosis from HIV. Furthermore, lactoferrin at 500 µg/ml concentration was able to kill more than 50% of the cells only for C. tropicalis and C. guillermondii isolates. It was concluded that lactoferrin has antifungal activity against non-albicans Candida from HIV children, but some species present some resistance to this protein. Furthermore, all Candida spp. were able to degrade lactoferrin when was at concentration of 1x108 cells / ml, also, lactoferrin at concentration 500µl / ml was able to kill more than 50% of C. tropicalis and C. guillermondii cells.
Assuntos
Humanos , Criança , Antifúngicos/farmacologia , Candida/efeitos dos fármacos , HIV , Lactoferrina/administração & dosagem , Candida/isolamento & purificação , Estudos de Casos e Controles , Lactoferrina/farmacologia , SalivaRESUMO
HIV-infected children usually live in vulnerable situations, experiencing discrimination and stigma commonly felt by other people living with HIV/AIDS. The present study aims to analyse primary socialisation of HIV-infected children and adolescents recruited from a public health service in Rio de Janeiro (Brazil) as a social process that shapes a new generation of stigmatised and vulnerable persons. Research was informed by an interactionist perspective, focusing on key aspects of HIV-infected children and adolescents life histories under the conceptual frame of Erving Goffman's theories regarding "moral careers". Goffman defines the making of a moral career as the process through which a person learns that she/he possesses a particular attribute, which may lead her/him to be discredited by members of the surrounding society. We have identified aspects of life histories of HIV-vertically infected children and adolescents for each aspect of "moral career" as described by Goffman, relating them to as family structure, the experience of living HIV within the family, and the position and family role of a given subject. The patterns of "moral career" proposed by Goffman in 1963 were useful in identifying components of HIV-related stigma among children and adolescents. These include gender and social disadvantages, difficulty in coping with a child with a potentially severe disease, orphanhood, abandonment, adoption and disclosure of one's HIV serostatus. Primary socialisation of HIV-infected children and adolescents is a key piece of the complex HIV/AIDS-labelling process that could be targeted by interventions aiming to decrease stigma and marginalisation. Health care workers and stakeholders should be committed to ensuring education and guaranteeing the legal rights of this specific population, including the continuous provision of quality health care, full access to school and support to full disclosure of HIV diagnosis.