RESUMO
The objective of this study was to identify tuberculosis risk factors and possible surrogate markers among human immunodeficiency virus (HIV)-infected persons. A retrospective case-control study was carried out at the HIV outpatient clinic of the Universidade Federal de Minas Gerais in Belo Horizonte. We reviewed the demographic, social-economical and medical data of 477 HIV-infected individuals evaluated from 1985 to 1996. The variables were submitted to an univariate and stratified analysis. Aids related complex (ARC), past history of pneumonia, past history of hospitalization, CD4 count and no antiretroviral use were identified as possible effect modifiers and confounding variables, and were submitted to logistic regression analysis by the stepwise method. ARC had an odds ratio (OR) of 3.5 (CI 95% - 1.2-10.8) for tuberculosis development. Past history of pneumonia (OR 1.7 - CI 95% 0.6-5.2) and the CD4 count (OR 0.4 - CI 0. 2-1.2) had no statistical significance. These results show that ARC is an important clinical surrogate for tuberculosis in HIV-infected patients. Despite the need of confirmation in future studies, these results suggest that the ideal moment for tuberculosis chemoprophylaxis could be previous to the introduction of antiretroviral treatment or even just after the diagnosis of HIV infection.
Assuntos
Complexo Relacionado com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Tuberculose Pulmonar/epidemiologia , Complexo Relacionado com a AIDS/diagnóstico , Adolescente , Adulto , Viés , Biomarcadores , Brasil/epidemiologia , Estudos de Casos e Controles , Intervalos de Confiança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Tuberculose Pulmonar/etiologia , Tuberculose Pulmonar/prevenção & controleRESUMO
The objective of this study was to identify tuberculosis risk factors and possible surrogate markers among human immunodeficiency virus (HIV)-infected persons. A retrospective case-control study was carried out at the HIV outpatient clinic of the Universidade Federal de Minas Gerais in Belo Horizonte. We reviewed the demographic, social-economical and medical data of 477 HIV-infected individuals evaluated from 1985 to 1996. The variables were submitted to an univariate and stratified analysis. Aids related complex (ARC), past history of pneumonia, past history of hospitalization, CD4 count and no antiretroviral use were identified as possible effect modifiers and confounding variables, and were submitted to logistic regression analysis by the stepwise method. ARC had an odds ratio (OR) of 3.5 (CI 95 per cent - 1.2-10.8) for tuberculosis development. Past history of pneumonia (OR 1.7 - CI 95 0.6-5.2) and the CD4 count (OR 0.4 - CI 0.2-1.2) had no statistical significance. These results show that ARC is an important clinical surrogate for tuberculosis in HIV-infected patients. Despite the need of confirmation in future studies, these results suggest that the ideal moment for tuberculosis chemoprophylaxis could be previous to the introduction of antiretroviral treatment or even just after the diagnosis of HIV infection.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Complexo Relacionado com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Tuberculose Pulmonar/epidemiologia , Complexo Relacionado com a AIDS/diagnóstico , Viés , Biomarcadores , Brasil/epidemiologia , Estudos de Casos e Controles , Intervalos de Confiança , Infecções por HIV/complicações , Hospitalização , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Tuberculose Pulmonar/etiologia , Tuberculose Pulmonar/prevenção & controleRESUMO
El linforma no Hodgkin es una neoplasia relacionada con el SIDA, cuya incidencia se incrementa a mayor duración de la infección por el VIH. Se presenta el caso de un hombre de 21 años de edad con diagnóstico de linfoma no Hodgkin inmunoblástico de células grandes, primario del yeyuno
Assuntos
Adulto , Humanos , Masculino , Linfoma não Hodgkin/diagnóstico , Infecções por HIV/complicações , Complexo Relacionado com a AIDS/epidemiologia , Neoplasias Intestinais/etiologia , Neoplasias do Jejuno/cirurgia , Síndrome da Imunodeficiência Adquirida/complicaçõesRESUMO
To assess the influence of human immunodeficiency virus type 1 (HIV)-induced immunodeficiency on the clinical, radiographic, and pathologic features of disseminated tuberculosis (TB), we studied 79 patients presenting in 1984 through 1987 with miliary or focal disseminated disease due to Mycobacterium tuberculosis, as well as 4 additional non-HIV patients diagnosed after 1987. Clinically defined acquired immunodeficiency syndrome (AIDS) or AIDS-related complex (ARC) was present in 51 (Group 1). A total of 20 had TB unrelated to HIV disease (Group 2). The remaining 12 were excluded because the role of HIV could not be determined. Clinical features were similar between groups aside from younger age; lower hemoglobin, total leukocyte, lymphocyte, and platelet counts; and more frequent tuberculin anergy (90 versus 40%) in AIDS/ARC patients (p less than or equal to 0.03). Chest radiographs showed a miliary pattern in about half of each group. Pleural effusion occurred only in AIDS/ARC patients (24%, p = 0.02), but intrathoracic lymphadenopathy was present in about a third of each group. Tissue biopsies (n = 70) usually revealed necrotizing granulomatous inflammation in each group, with a tendency to greater necrosis and more numerous acid-fast bacilli in Group 1. Granulomas were usually poorly formed in AIDS/ARC patients (59 versus 18%, p = 0.01). Autopsy of 9 AIDS/ARC patients with overwhelming miliary TB revealed a "nonreactive" histologic pattern with poorly organized or absent granulomas, extensive necrosis, and numerous bacilli. HIV-related disseminated TB causes a major constitutional illness with a high short-term mortality (25%).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Infecções Oportunistas/complicações , Tuberculose Miliar/complicações , Complexo Relacionado com a AIDS/complicações , Complexo Relacionado com a AIDS/diagnóstico , Complexo Relacionado com a AIDS/epidemiologia , Complexo Relacionado com a AIDS/etnologia , Complexo Relacionado com a AIDS/patologia , Síndrome da Imunodeficiência Adquirida/diagnóstico , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/etnologia , Síndrome da Imunodeficiência Adquirida/patologia , Adulto , Biópsia , Feminino , Haiti/etnologia , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Cidade de Nova Iorque/etnologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/etnologia , Infecções Oportunistas/patologia , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/complicações , Tuberculose Miliar/diagnóstico , Tuberculose Miliar/epidemiologia , Tuberculose Miliar/etnologia , Tuberculose Miliar/patologiaRESUMO
A case-control study to determine factors associated with AIDS and AIDS-like syndrome among homosexual/bisexual men was conducted in the State of Minas Gerais (Brazil). Eighty-three per cent (45 patients) of all AIDS/AIDS-like syndrome cases in homosexual/bisexual men reported in Minas Gerais between February, 1986 and June, 1987 were compared to 133 seronegative controls seen at the same clinic. Blood samples were tested by ELISA and confirmed by Western blot. Sex with men from the USA, sex with someone who developed AIDS, number of male partners (greater than or equal to 100 lifetime), age (greater than or equal to 30 years old) and ethnicity (white) were independently associated with AIDS/AIDS-like syndrome (Odds Ratios = 5.5, 4.3, 3.9, 3.5 and 2.7, respectively). Thirty-nine per cent of cases and 44% of controls reported bisexual activity during the previous two years. From these, a high proportion reported anal intercourse with women in the same period (53% of bisexual cases and 33% of bisexual controls). Bisexual men had more male partners than female partners in the previous two years (median male partners = 20 for cases and five for controls; median female partners = three for both cases and controls). This explains in part why the epidemic has increased more rapidly among men then among women in Minas Gerais, despite the large proportion of bisexuals with the disease.
PIP: A case control study to determine factors associated with AIDS and AIDS- like syndrome among homosexual/bisexual men was conducted in the state of Minas Gerais, Brazil. 83% (45 patients) of all AIDS/AIDS-like syndrome cases in this group of men reported in Minas Gerais between February 1986-June 1987 were compared to 133 seronegative controls seen at the same clinic. Blood samples were tested by ELISA and confirmed by western blot. Sex with men from the US, with someone who developed AIDS, number of male partners ( or = 100 lifetime), age ( or = 30 years old), and ethnicity (white) were independently associated with AIDS/AIDS-like syndrome (odds ratio=5.5, 4.3, 3.9, 3.5, and 2.7, respectively). 39% of cases and 44% of controls reported bisexual activity over the previous 2 years. From these, a high proportion reported anal intercourse with women in the same period (53% of bisexual cases and 33% of bisexual controls). Bisexual men had more male partners than female ones in the previous 2 years (median number=20 for cases and 5 for controls; median number of female partners=3 for both cases and controls). This explains in part why the epidemic has increased more rapidly among men than women in Minas Gerais, despite the large proportion of bisexuals with the disease.
Assuntos
Complexo Relacionado com a AIDS/epidemiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Bissexualidade , Homossexualidade , Complexo Relacionado com a AIDS/etnologia , Síndrome da Imunodeficiência Adquirida/etnologia , Brasil/epidemiologia , Estudos de Casos e Controles , Humanos , Infecções/complicações , Masculino , Fatores de Risco , Comportamento SexualRESUMO
In the 13-month period between June 1985 and July 1986, 27 children were found to be HIV positive in the Princess Margaret Hospital in Nassau. Nineteen of the children had clinical AIDS, four were in the prodromal phase and four were symptom free. The clinical course of these infants is presented. Of the 18 mothers 16 were screened and were all seropositive and asymptomatic. They remained healthy in spite of subsequent pregnancies in nine of them (56%) during a follow-up period of between 13 and 65 months (mean 40 months). Fifteen of the 18 mothers were Haitian but only three had other risk factors, throwing doubt on the value of selective screening in Afro-Caribbean countries.
PIP: From June 1985 through July 1986, HIV screening (ELISA/Abbott) was performed on all donated blood, on family members of those found to be HIV positive, and those who were thought to be infected on clinical groups alone at the Princess Margaret Hospital in Nassau. Positive cases were confirmed in Miami, Florida, using the Western blot method. Laboratory confirmation of infections was made whenever possible. Selection of the 27 children for testing was based on clinical suspicion in 19, because of seropositive siblings in 4, and as the result of screening paternal blood donations in 4. The 27 children were born to 18 mothers. 19 of the HIV-positive children were classified as having Acquired Immune Deficiency Syndrome (AIDS), 4 had AIDS-related complex (ARC), and 4 were HIV positive but asymptomatic. The 19 children with AIDS exhibited clinical signs and symptoms of their disease within the 1st 18 months of life (range 2-18 months). They were hospitalized on 79 occasions and seen frequently as outpatients because of bacterial infections. Children with ARC became symptomatic later in general than those with AIDS (range 3 months to 6 years). The course of the disease was variable. Of the 27 HIV-positive children, 14 were less than 15 months of age when tested initially. 9 of these children developed AIDS (5 have died), 2 have ARC, and 3 were symptom-free at the end of the period, although 1 is known to have developed AIDS subsequently. 15 of the 18 mothers were Haitian, but only 3 had other risk factors, raising doubt about the value of selective screening in Afro-Caribbean countries.
Assuntos
Síndrome da Imunodeficiência Adquirida/congênito , Complexo Relacionado com a AIDS/congênito , Complexo Relacionado com a AIDS/epidemiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Bahamas , Pré-Escolar , Doenças em Gêmeos , Ensaio de Imunoadsorção Enzimática , Saúde da Família , Soropositividade para HIV/diagnóstico , Humanos , Lactente , Recém-NascidoRESUMO
In the 13 month period between June 1985 and July 1986, 27 children were found to be HIV positive in the Princess Margaret Hospital in Nassau. Nineteen of the children had clinical AIDS, four were in the prodromal phase and four were symptom free. The clinical course of these infants is presented. Of the 18 mothers 16 were screened and were all seropositive and asymptomatic. They remained healthy in spite of subsequent pregnancies in nine of them (56 percent during a follow-up period of between 13 and 65 months (mean 40 months). Fifteen of the 18 mothers were Haitian but only three had other risk factors, throwing doubt on the valur of selective screening in Afro-Caribbean countries. (AU)