Opportunistic infections in patients with aids admitted to an university hospital of the Southeast of Brazil

Abstract

Opportunistic diseases in HIV-infected patients have changed since the introduction of highly active anti-retroviral therapy (HAART). This study aims at evaluating the frequency of associated diseases in patients with AIDS admitted to an university hospital of Brazil, before and after HAART. The medical records of 342 HIV-infected patients were reviewed and divided into two groups: group 1 comprised 247 patients before HAART and, group 2, 95 patients after HAART. The male-to-female rate dropped from 5:1 to 2:1for HIV infection. There was an increase in the prevalence of tuberculosis and toxoplasmosis, with a decrease in Kaposi's sarcoma, histoplasmosis and cryptococcosis. A reduction of in-hospital mortality (42.0% vs. 16.9%; p = 0.00002) has also occurred. An agreement between the main clinical diagnoses and autopsy findings was observed in 10 out of 20 cases (50%). Two patients with disseminated schistosomiasis and 2 with paracoccidioidomycosis are reported. Overall, except for cerebral toxoplasmosis, it has been noticed a smaller proportion of opportunistic conditions related to severe immunosuppression in the post HAART group. There was also a significant reduction in the in-hospital mortality, possibly reflecting improvement in the treatment of the HIV infection.

Clinical and epidemiological analysis of patients with HIV/AIDS admitted to a reference hospital in the northeast region of Brazil

“…A large number of cases of Pneumocystis carinii pneumonia were verified (22.2%), in contrast with other studies that show a reduction in PCP frequency in the post-HAART era 11,23 . Furthermore, various studies indicate a strong correlation of hospitalization due to PCP with: 1) a lack of health assistance or 2) absence of knowledge of HIV infection status by the patient 1 .…”

“…The registered cases of active tuberculosis were lower than those reported in the medical literature 22,23 . In a series of 135 patients in India, this was the most common opportunistic infection, present in 71.1% of patients 29 .…”

“…Since then, the survival of individuals with HIV infection has increased and morbimortality rates have declined. The frequency of opportunistic infections affecting these patients has reduced and the variety has also changed 23,25 .…”

Revisiting the concept of hepatosplenic schistosomiasis and its challenges using traditional and new tools

“…In endemic areas, schistosomotics are frequently heavy drinkers. Is there really a place in the world for pure schistosomiasis 74,75,[76][77][78][79][80][81][82] ?…”

Schistosomiasis mansoni and severe gastrointestinal cytomegalovirus disease in a patient with acquired immunodeficiency syndrome

“…In Brazil, patients who died with AIDS and were found at autopsy to also be coinfected with S. mansoni, unveiled some interesting data 15 : 1) small and incomplete granulomas were observed around the eggs deposited in the tissues; and 2) a miliary distribution of eggs occurred in many organs (liver, spleen, lungs, intestine, pancreas and testes). The inferences derived from these cases and based on previous experimental work 3 4 5 8 , were of two kinds: a) without well formed granulomas the eggs do not reach the gut lumen and diagnosis of schistosomiasis based on stool examination is not possible; and b) without good immunity, the worms are not confined to the mesenteric vessels, migrate to unusual places in the body and lay their eggs in different organs 9 .…”