Low variation in initial CD4 cell count in a HIV referral center, in Salvador, Brazil, from 2002 to 2015

Pereira, Marcela Fonseca; Luz, Estela; Netto, Eduardo Martins; Barbosa, M.H.F; Brites, Carlos

doi:10.1016/j.bjid.2018.05.005

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…In contrast to what was expected, regarding the initial CD4 + lymphocyte count, it was observed that during the 10 years analyzed there was no improvement, that is, the patients came to receive medical attention with the same immune deterioration. Similar to this is the report of an investigation carried out in Brazil, which studied the CD4 + cell count in 1801 patients older than 18 years, where they also did not observe improvement in terms of an earlier diagnosis in 13 years [22].…”

Section: Discussion and Analysissupporting

confidence: 87%

Trend of HIV Infection in a Specialized Medical Unit, 2007- 2016

2020

J AIDS HIV Treat

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Introduction: Viral load and CD4 cell count are the main principal indicators about evolution of the disease by HIV. Stage of infection related clinical and inmmunological status. Objective: To compare CD4 cell count, viral load and stage of HIV infection at admission of the patients for 10 years. Method: 578 clinical records were reviewed of patients infected with HIV, catered in the period 2007-2016, in CAPASITS Chihuahua. CD4 cell count, viral load and stage of HIV infection were compared yearly.Results: There was no significant difference in the CD4 cell count with p=0.272, in the initial viral load with p=0.653, and not in the infection stage with p=0.466, at admission, during the 10 years reviewed. Conclusions:There was no statistically significant difference in the 3 variables, which suggests that the patients entered with the same clinical and immunological deterioration during the 10 years.

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Section: Discussion and Analysissupporting

confidence: 87%

Trend of HIV Infection in a Specialized Medical Unit, 2007- 2016

2020

J AIDS HIV Treat

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“…The ART era enable immune restoration and improved AIDS related and non-AIDS related morbidity as well as mortality turning HIV/AIDS into chronic disease. Despite ART effectiveness, late ART initiation is a Brazilian challenge [29][30][31] . A significant number of individuals start HIV/AIDS care at later stage of infection (later presenters) and usually present low T CD4 counts even with complete viral suppression.…”

Section: Discussionmentioning

confidence: 99%

Apoptosis characterization in mononuclear blood leukocytes of HIV patients during dengue acute disease

Torrentes-Carvalho

Sánchez‐Arcila

Azamor

et al. 2020

Sci Rep

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Dengue virus (DenV) co-circulation in Brazil represents a challenge for treatment and vaccine development. Despite public health impact, the occurrence of coinfections with other viruses is a common event. Increased T cell activation and altered inflammatory response are found during DENV coinfection with Human Immunodeficiency Virus (HIV) impacting HIV-pathogenesis. Even with Antiretroviral therapy (ARt), HiV-treated patients had chronic immune activation and lymphocyte apoptosis. However, apoptotic mechanisms have not been investigated during coinfection with DenV. our attention was attracted to apoptotic cell markers expressions in pBMcs from DenV and DenV/ HIV coinfected patients. We found CD4/CD8 ratio inversion in most coinfected patients. CD4 T and CD8 T-cell subsets from DENV and DENV/HIV groups expressed low levels of anti-apoptotic protein Bcl-2. Furthermore, CD8 CD95 double positive cells frequency expressing low levels of Bcl-2 were significantly higher in these patients. Additionally, the density of Bcl-2 on classical monocytes (CD14 ++ CD16 − ) was significantly lower during DENV infection. Upregulation of pro-apoptotic proteins and anti-apoptotic proteins were found in DenV and DenV/HiV, while catalase, an antioxidant protein, was upregulated mainly in DENV/HIV coinfection. These findings provide evidence of apoptosis triggering during DenV/HiV coinfection, which may contribute to knowledge of immunological response during DenV acute infection in HiV-patients treated with ARt.Dengue virus (DENV) and Human Immunodeficiency Virus (HIV) infections are currently a major public health concern in Brazil. Dengue is caused by any one of four DENV (1-4) serotypes spread by mosquitoes of aedes genus. DENV causes an acute febrile illness of a broad clinical spectrum presenting both asymptomatic and symptomatic forms that can evolve with severe and potentially fatal condition 1 . The hallmark of most serious clinical conditions is the vascular permeability increase that causes plasma leakage, leading to shock and death. Acquired Immunodeficiency Sydrome (AIDS) (is still considered an important cause of morbidity and mortality in the world. HIV infects CD4 T-cells, monocytes/macrophages and to a lesser extent in dendritic cells leading to progressive CD4 T-cell depletion and consequently pronounced immunosuppression in the absence of effective antiretroviral therapy (ART) 2 .Apoptosis, also called type I cell death, is a regulated process of cell death highly conserved among mammals and comprises a controlled self-destruction process to eliminate damaged, neoplastic and virus-infected cells 3 . Apoptosis program regulation is determined by interactions of three members of B-cell lymphoma-2 family proteins (Bcl-2): Bcl-2 homologous 3 (BH3)-only proteins, Bcl-2 proteins and Bcl-2 associated X protein (Bax)/Bcl-2 homologous antagonist/killer (Bak) effectors. It can be triggered by extrinsic [death receptors like p55 tumor necrosis factor TNF receptor-TNFRI, Fas/CD95, TRAIL/APO2-L (TNF-related apoptosis-inducing li...

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“…Approximately 50% of our patients with meningeal cryptococcosis were on HAART, with probably poor adherence to medical treatment. In a recent study in Brazil, a higher frequency of patients with CD4 + cell count <200 cells/mL was observed in 2014-2015 when compared to the previous years [ 9 ]. This suggests that the adopted strategies for early diagnosis of HIV/AIDS are still ineffective.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal Meningitis: A Retrospective Cohort of a Brazilian Reference Hospital in the Post-HAART Era of Universal Access

Azambuja

Neto

Watte

et al. 2018

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Objective Cryptococcus neoformans is a common opportunistic infection in adults with acquired immunodeficiency syndrome worldwide. However, limited data exist for HIV-infected patients in the post-HAART (highly active antiretroviral therapy) era in Brazil. The aim of this study was to describe the clinical characteristics and outcomes of cryptococcosis in a cohort of patients attending a teaching tertiary care hospital in southern Brazil after the introduction of HAART in Brazil. Patients and Methods A retrospective study was conducted in tertiary care hospital in southern Brazil. Detailed data on risk factors, clinical manifestations, diagnosis methods, treatment, and prognosis of patients with meningeal cryptococcosis were evaluated from January 2009 to December 2016. Results Seventy-nine cases of cryptococcal meningitis were identified. Most of the patients presented positive CSF (cerebrospinal fluid) cultures for Cryptococcus neoformans (96%). The prevalence of males and females with meningeal cryptococcosis was similar. The age of the patients ranged from 5 to 67 years. The median time of hospitalization was 28 days. The most common underlying disease was HIV (82%), followed by solid transplant (10%). Fever, nausea, vomiting, headache, and altered mental status were the most common clinical manifestations. Initial opening intracranial pressures varied from 30 to 130 cm H2O. CNS imaging abnormalities include hydrocephalus and hypodensities. Widened Virchow–Robin spaces were described in only 2 patients (2.5%). Induction treatment of the majority of the patients consisted of amphotericin B and flucytosine (67%) followed by amphotericin B and fluconazole (19%). Multivariate analysis of Cox regression identified headache at presentation, mechanical ventilation, CSF glucose <20 mg/dL, and CSF cryptococcal antigen ≥1 : 1000 for independent risk factors for death. All-cause 30-day and 60-day mortalities were 19% and 24%, respectively. Conclusions Meningeal cryptococcosis mostly caused by C. neoformans continues to occur predominantly in HIV-infected adults despite HAART being widely distributed in Brazil. Cryptococcosis remains a significant opportunistic infection in solid organ transplant recipients. Despite adequate antifungal treatment and management of intracranial hypertension in a reference tertiary care hospital, mortality was high. Identification of risk factors and additional treatment modalities, especially for intracranial hypertension, are necessary to improve care for patients with cryptococcal meningitis.

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Low variation in initial CD4 cell count in a HIV referral center, in Salvador, Brazil, from 2002 to 2015

Cited by 4 publications

References 15 publications

Trend of HIV Infection in a Specialized Medical Unit, 2007- 2016

Trend of HIV Infection in a Specialized Medical Unit, 2007- 2016

Apoptosis characterization in mononuclear blood leukocytes of HIV patients during dengue acute disease

Cryptococcal Meningitis: A Retrospective Cohort of a Brazilian Reference Hospital in the Post-HAART Era of Universal Access

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