Highly aggressive squamous cell carcinoma in an HIV-infected patient

Unusually aggressive forms of cutaneous squamous cell carcinoma are being increasingly recognized as a complication of HIV infection. We report the case of a 59-year-old male patient with advanced HIV infection who presented with a highly aggressive SCC lesion over the scalp area with destruction of the underlying parietal bone and fulminant clinical progression.

Lues maligna in an HIV-infected patient

We report such a case of malignant syphilis in a 42-year-old HIV-infected man, co-infected with hepatitis B virus, who presented neurolues and the classical skin lesions of lues maligna. The serum VDRL titer, which was 1:64 at presentation, increased to 1:2,048 three months after successful therapy with penicillin, decreasing 15 months later to 1:8.

Neurological disease in HIV-infected patients in the era of highly active antiretroviral treatment: a Brazilian experience

To study characteristics of neurological disorders in HIV/AIDS patients and their relationship to highly active antiretroviral treatment, a cross-sectional study was conducted in an infectious disease public hospital in Belo Horizonte, Brazil, between February 1999 and March 2000. Of the 417 patients enrolled, neurological disease was observed in 194 (46.5%) and a new AIDS-defining neurological event developed in 23.7% of individuals. Toxoplasmosis (42.3%), cryptococcosis meningitis (12.9%) and tuberculosis (10.8%) were the most common causes of neurological complications. The majority (79.3%) of patients were on highly active antiretroviral treatment and these individuals using HAART showed higher CD4 cell counts (p = 0.014) and presented stable neurological disease (p= 0.0001), although no difference was found with respect to the profile of neurological complications. The neurological diseases continue to be a frequent complication of HIV/AIDS and infections are still its main causes in Brazil, even in the highly active antiretroviral treatment era.

Perfil epidemiológico de puérperas e prevalência de anticorpos para infecção pelo HIV e vírus da hepatite C em Cuiabá, Mato Grosso

Foi realizado inquérito soroepidemiológico com o objetivo de conhecer a prevalência da infecção pelo vírus da imunodeficiência humana, de anticorpos contra o vírus da hepatite C (anti-HCV), fatores de risco associados à transmissão parenteral e o perfil epidemiológico de puérperas atendidas em três hospitais conveniados com o Sistema Único de Saúde em Cuiabá-MT, no período de dezembro de 2001 a maio de 2002. Mil seiscentas e sete mulheres foram estudadas e entrevistadas de modo a se obter informações sócio-demográficas e epidemiológicas que poderiam estar associadas à transmissão do vírus da imunodeficiência humana. Foram pesquisados anticopos anti-HIV e anti-HCV, através do teste ELISA. A prevalência de infecção pelo vírus da imunodeficiência humana foi de 0,5% (IC95%= 0,2 a 1,0). A maioria das participantes tinha apenas nível de ensino fundamental (58,4%) e mantinha relacionamento estável com parceiro fixo (73%). Não foi evidenciada associação entre a presença de anti-HIV e o nível sócio-econômico, escolaridade, fatores de risco para doenças de transmissão sanguínea ou sexual, e com a presença de comportamento sexual de risco nas entrevistadas e em seus parceiros (relacionamentos com múltiplas parceiras ou bissexualidade). Presumiu-se que a via de transmissão heterossexual foi a principal causa de infecção nas mulheres em idade fértil na região. A prevalência do anti-HCV foi de 0,4% (IC95%= 0,1; 0,8), sendo mais freqüente entre as participantes mais velhas.

Freqüência das infecções pelo HIV-1, rubéola, sífilis, toxoplasmose, citomegalovírus, herpes simples, hepatite B, hepatite C, doença de Chagas e HTLV I/II em gestantes, do Estado de Mato Grosso do Sul

Objetivou-se avaliar a freqüência das infecções por sífilis, rubéola, hepatite B, hepatite C, toxoplasmose, doença de Chagas, HTLV I/II, herpes simples, HIV-1 e citomegalovírus em gestantes e relacionar a faixa etária das pacientes com a freqüência das infecções. Estudo transversal de 32.512 gestantes submetidas à triagem pré-natal no período de novembro de 2002 a outubro de 2003. As freqüências encontradas foram de 0,2% para infecção pelo vírus HIV-1, 0,03% para rubéola, 0,8% para sífilis, 0,4% para toxoplasmose, 0,05% para infecção aguda pelo citomegalovírus, 0,02% pelo vírus herpes simples, 0,3% para hepatite B (HBsAg), 0,1% para hepatite C, 0,1% para HTLV I/II e 0,1% para doença de Chagas. Houve associação significativa entre faixa etária e infecções por rubéola, citomegalovírus, doença de Chagas e herpes vírus. As freqüências de rubéola, sífilis, toxoplasmose, doença de Chagas e citomegalovírus nas gestantes encontram-se abaixo dos valores descritos na literatura.

HIV genotyping among female sex workers in the State of Santa Catarina

The objective of this study was to investigate the frequency of HIV infection among female sex workers in the port area of Imbituba (State of Santa Catarina), and to identify the viral subtype and its susceptibility to antiretroviral medications. Ninety women were interviewed between December 2003 and February 2004. Six (6.7%) were HIV-positive. Genotyping for HIV, performed on four samples, detected subtype C in three of them, which is predominant in Africa and Asia, and subtype B in one of them, which is prevalent in Brazil, USA and Europe. The results suggest that the Port of Imbituba may be one of the gateways for HIV-1 subtype C to enter Brazil, and for its dissemination to the rest of the country and the Mercosul area, along the highway BR-101. This points towards the need for preventive work to reduce the introduction and dissemination of HIV subtype C in Brazil.

Identificação microbiológica e sensibilidade in vitro de Candida isoladas da cavidade oral de indivíduos HIV positivos

A candidíase orofaríngea é a infecção fúngica mais comum entre os pacientes infectados pelo vírus da imunodeficiência humana e seu tratamento é realizado com antifúngicos tópicos ou sistêmicos, que são indicados empiricamente com base em dados clínicos. O objetivo deste estudo foi determinar a freqüência de leveduras em lavados bucais de indivíduos HIV positivos, comparando os resultados entre pacientes com diferentes condições de imunodeficiência e verificar o perfil de susceptibilidade das espécies isoladas frente aos antifúngicos visando avaliar se as opções de tratamento utilizadas na prática clínica atingem a maioria das espécies identificadas. Leveduras foram isoladas em 58% das amostras de lavado bucal coletadas e Candida albicans foi a espécie mais (93%) freqüente. Resistência ou susceptibilidade dose dependente, frente aos antifúngicos testados foi registrada em aproximadamente 17% das amostras. A importante variabilidade de resposta sugere limitações quanto à eficácia das terapias instituídas empiricamente.

Prevalência da co-infecção HIV-sífilis em um hospital universitário da cidade do Rio de Janeiro no ano de 2005

Estudo de prevalência da co-infecção HIV-sífilis realizado com 830 pacientes em acompanhamento ambulatorial para HIV/aids entre janeiro e maio de 2005 no Hospital na cidade do Rio de Janeiro. Os participantes realizaram exames de VDRL (veneral disease research laboratory), contagens de células CD4+/CD8+ e de carga viral e responderam perguntas sobre características sócio-demográficas e história prévia de sífilis. A prevalência da sífilis foi de 2,7% (22), a relação entre homens e mulheres co-infectados foi de 4:1, aproximadamente. Homossexuais masculinos foram os mais acometidos e não encontramos associação entre co-infecção e idade, escolaridade e parâmetros laboratoriais testados. Do total de casos com sífilis, 73% (16) relataram tratamento prévio; destes, 14 (88%) pacientes foram re-infectados, enquanto 2 (12%) pacientes realizaram tratamento inapropriado. A presença de co-infecção HIV-sífilis em pacientes em acompanhamento rotineiro alerta-nos para necessidade de aconselhá-los a adotar práticas sexuais seguras durante os seus atendimentos ambulatoriais.

Risky behavior regarding drug use and HIV infection: an Internet questionnaire coupled with short education texts for Portuguese speakers

Surveys of risky behavior relating to HIV/AIDS are generally made for groups at risk of infection, for which HIV/AIDS prevalence is usually expected to be higher than in the general population. Therefore, an educational homepage in Portuguese was created on the Internet to inform/ask internauts regarding knowledge and behavior. The internauts were classified as adolescents (13 to 25 years) and adults (>25 years). The number of STDs was reported as 1. 8 ± 2. 6 infections (range: 1 to 20 infections); 43% used condoms during sexual intercourse. Alcohol consumption was reported by 63% and illicit drug use by 32% (marijuana 24% and inhalants 15%). Among the adolescents, 31% did not classified alcohol as a drug. The adults more frequently reported homosexuality, anal intercourse and STDs, although the adolescents also presented high rates of risky behavior. These results show the need to reach out to internauts through better control strategies. Different types of strategies must be encouraged, in order to reach people that use this means of communication and entertainment.

Seasonal profile and level of CD4+ lymphocytes in the occurrence of cryptosporidiosis and cystoisosporidiosis in HIV/AIDS patients in the Triângulo Mineiro region, Brazil

Patients with AIDS are particularly susceptible to infection with intestinal coccidia. In this study the prevalence of infections with Cryptosporidium sp and Cystoisospora belli were evaluated among HIV/AIDS patients in the Triângulo Mineiro region, Brazil. Between July 1993 and June 2003 faecal samples from 359 patients were collected and stained by a modified Ziehl-Neelsen method, resulting in 19.7% of positivity for coccidian (8.6% with Cryptosporidium sp, 10.3% with Cystoisospora belli and 0.8% with both coccidian). Patients with diarrhoea and T CD4+ lymphocyte levels < 200 cells/mm3 presented higher frequency of these protozoans, demonstrating the opportunistic profile of these infections and its relationship with the immunological status of the individual. It was not possible to determine the influence of HAART, since only 8.5% of the patients positive for coccidian received this therapy regularly. Parasitism by Cryptosporidium sp was more frequent between December and February and thus was characterised by a seasonal pattern of infection, which was not observed with Cystoisospora belli.

Clinical and radiographic features of HIV-related pulmonary tuberculosis according to the level of immunosuppression

Medical charts and radiographs from 38 HIV-infected patients with positive cultures for Mycobacterium tuberculosis from sputum or bronchoalveolar lavage were reviewed in order to compare the clinical, radiographic, and sputum bacilloscopy characteristics of HIV-infected patients with pulmonary tuberculosis according to CD4+ lymphocyte count (CD4). The mean age of the patients was 32 years and 76% were male. The median CD4 was 106 cells/mm³ and 71% had CD4 < 200 cells/mm³. Sputum bacilloscopy was positive in 45% of the patients. Patients with CD4 < 200 cells/mm³ showed significantly less post-primary pattern (7% vs. 63%; p = 0.02) and more frequently reported weight loss (p = 0.04). Although not statistically significant, patients with lower CD4 showed lower positivity of sputum bacilloscopy (37% vs. 64%; p = 0.18). HIV-infected patients with culture-confirmed pulmonary tuberculosis had a high proportion of non-post-primary pattern in thoracic radiographs. Patients with CD4 lower than 200 cells/mm³ showed post-primary patterns less frequently and reported weight loss more frequently.

Autoimmune hemolytic anemia in HCV/HIV coinfected patients during treatment with pegylated alpha-2a interferon plus ribavirin

Two cases of autoimmune hemolytic anemia that occurred during the treatment of chronic hepatitis C with pegylated alpha-2a interferon and ribavirin, in HIV coinfected patients, are presented and described. The late occurrence (after six months of therapy) of this severe hemolytic anemia leads to the recommendation that hemoglobin levels should be monitored throughout the treatment period, even among patients who presented stable hemoglobin levels in the preceding months.

Epidemiological and molecular characteristics of HIV-1 infection among female commercial sex workers, men who have sex with men and people living with AIDS in Paraguay

An HIV seroprevalence and molecular study was conducted among 935 subjects: 723 female commercial sex workers, 92 men who have sex with men and 120 HIV-positive volunteers. The reported injection drug use rates were 0.7% in female commercial sex workers and 3% in men who have sex with men. Sexually transmitted infections were reported in 265 (37%) of the female commercial sex workers and 38 (41%) of the men who have sex with men. A total of 20 (2.8%) female commercial sex workers and 12 (13%) men who have sex with men became HIV infected during the study period. A history of sexually transmitted infection increased the risk of subsequent HIV infection twofold (adjusted odds ratio of 2.5) among the female commercial sex workers, while cocaine use had an adjusted odds ratios of 6.61 among men who have sex with men. From 130 samples, and based on heteroduplex mobility assaying for the env gene, with sequencing of part of pol and/or full genomes, subtype B was the predominant subtype identified (66%); followed by subtype F (22%) and subtype C (4%). Recombinant CRF12-BF strains were identified in 6% and CRF17_BF was identified in 2%.