Mycoses associated with AIDS in the Third World

Despite advances in diagnosis and treatment, the epidemiological status of the human immunodeficiency virus (HIV) infection is far from under control in most of the developing world. Sub-Saharan Africa, Southeast Asia and India show increased rates of new infections. In Latin America and the Caribbean there were 1.6 million estimated cases of HIV-infected patients at the end of 1997. Fungal diseases have been one of the most relevant diagnoses in relation to the acquired immunodeficiency syndrome (AIDS), Infections due to Candida species and Cryptococcus neoformans var, neoformans are common worldwide. Histoplasma capsulatum, Coccidioides immitis and Penicillium marneffei are important causes of disease in endemic areas. Infection due to Sporothrix schenckii, Blastomyces dermatitidis and Paracoccidioides brasiliensis are uncommon even where they are endemic. Phaeohyphomycetes, hyalohyphomycetes and zygomycetes are still rare as a cause of disease among AIDS patients, However, agents pertaining to these groups, such as Aspergillus spp., have an increasing incidence. Superficial mycoses due to dermatophytes have special features from epidemiological, clinical and therapeutic points of view.

Gingival primary extranodal non-Hodgkin's lymphoma as the first manifestation of acquired immunodeficiency syndrome

Background: Non-Hodgkin's lymphomas (NHLs) are a heterogeneous group of lymphoproliferative malignancies that may be associated with acquired immunodeficiency syndrome (AIDS). NHL can disseminate to extranodal sites; however, its dissemination to the jaws and mouth is not common. This report presents and discusses two unusual cases of gingival primary extranodal non-Hodgkin's lymphoma (PE-NHL) as the first manifestation of AIDS.Methods: Two mates presented with asymptomatic gingival swelling. They were examined clinically. Biopsies of the gingival tissue were evaluated using routine histologic techniques and immunohistochemistry. The patients were tested for human immunodeficiency virus (HIV) infection.Results: The clinicopathological evaluation and the serological HIV examination of the patients led us to the final diagnosis of gingival PE-NHL as the first manifestation of AIDS. Both patients were referred to an oncologist and to an infectious disease specialist and were given antineoplastic chemotherapy and highly active antiretroviral therapy. Only one patient presented a favorable clinical evolution.Conclusion: The present case reports have important clinical implications; the two unusual presentations of gingival PE-NHL contribute to information about the differential diagnosis of rapidly progressing gingival swelling.

Growth of Candida species on complete dentures: effect of microwave disinfection

Microwave disinfection of complete dentures has been recommended to treat denture stomatitis in non-immune compromised patients. Oral candidiasis is a frequent manifestation of HIV infection. The objective of this study is to evaluate the effectiveness of microwave irradiation on the disinfection of complete dentures inoculated with American Type Culture Collection (ATCC) and HIV isolates of five species of Candida. Fifty dentures were made, sterilised and inoculated with the tested microorganisms (C. albicans, C. dubliniensis, C. krusei, C. glabrata and C. tropicalis). After incubation (37 degrees C/48 h), dentures were microwaved (650 W/3 min). Non-irradiated dentures were used as positive controls. Replicate aliquots of suspensions were plated at dilutions 10(-1) to 10(-4) and incubated (37 degrees C/48 h). Colony counts (cfu ml(-1)) were quantified. Dentures were also incubated at 37 degrees C for 7 days. Data were analysed with 2-way anova and Tukey HSD tests (alpha = 0.05). Dentures contaminated with all Candida species showed sterilisation after microwave irradiation. All control dentures showed microbial growth on the plates. The cfu ml(-1) for C. glabrata was higher than those of C. albicans, C. dubliniensis and C. tropicalis whereas the cfu ml(-1) for C. krusei was lower. The cfu ml(-1) for clinical isolates was higher than those of ATCC yeast. Microwave irradiation for 3 min at 650 W resulted in sterilisation of all complete dentures.

Prevalência e fatores de risco associados à infecção pelo Vírus da Imunodeficiência Humana em parturientes

OBJETIVO: Determinar a prevalência e os fatores de risco associados à infecção pelo Vírus da Imunodeficiência Humana (HIV) em parturientes admitidas no Hospital Estadual de Presidente Prudente, SP. MÉTODOS: Estudo epidemiológico transversal com 873 parturientes admitidas no Hospital Estadual de Presidente Prudente, SP, entre 1º de março de 2005 a 30 de dezembro de 2006. Foi aplicado um questionário semi-estruturado e obtidas informações em prontuários e carteiras de pré-natal. As variáveis foram sócio-demográficas, gestacionais, assistenciais do pré-natal e específicas da população reagente. RESULTADOS: A prevalência de parturientes com HIV foi de 2,1%, com escolaridades mais baixas e médias de idade e de gestações superiores às não reagentes. Os fatores de risco associados foram a residência fora do município de tratamento e a baixa escolaridade. Houve um aumento da prevalência do HIV em parturientes em relação a dados anteriores. CONCLUSÃO: Os fatores de risco encontrados podem estar envolvidos no aumento da prevalência e no comprometimento da profilaxia pré-natal para o HIV.

Paracoccidioidomicose: atualização epidemiológica, clínica e terapêutica

São apresentados dados de atualização epidemiológica, clínica, diagnóstica e terapêutica relativos à paracoccidioidomicose. Discute-se a importância epidemiológica resultante do isolamento do Paracoccidioides brasiliensis a partir do tatu (Dasypus novemcinctus) em regiões do Brasil e Colômbia, assim como dos resultados de inquéritos soroepidemiológicos em cães e do surgimento do primeiro caso de paracoccidioidomicose doença em cão. As dificuldades de isolamento do fungo a partir do solo são correlacionadas com novos informes de investigação epidemiológica. São apresentados aspectos clínicos das manifestações da forma aguda da doença, assim como das manifestações da neuroparacoccidioidomicose e da enfermidade associada à infecção pelo HIV. Discute-se o papel da sorologia e da técnica da PCR no diagnóstico e dos possíveis avanços no tratamento da paracoccidioidomicose com os novos derivados triazólicos.

AIDS-related lymphoma in Brazil - Histopathology, immunophenotype, and association with Epstein-Barr virus

The occurrence of malignant lymphoma is an increasingly important cause of morbidity and mortality in AIDS patients. The incidence of AIDS-related lymphoma in some developing countries such as Brazil is increasing as the survival of HIV infection has improved. Although there is a clear association between several types of immunodeficiency related lymphomas and Epstein-Barr virus (EBV), the association of EBV infection in AIDS-related lymphoma in Brazil, where the incidence of AIDS is high, is unknown. Formalin-fixed, paraffin-embedded tissue from 24 cases of AIDS-related lymphoma in Brazil were analyzed for morphologic classification, immunophenotype, and EBV association using in situ hybridization studies with an EBV-EBER1 biotinylated probe. Twenty cases of AIDS-related lymphoma were classified as non-Hodgkin's lymphoma and four cases were Hodgkin's disease. Eleven non-Hodgkin's lymphomas were classified as diffuse large cell type, five cases were small non-cleaved cell, Burkitt-type, and four cases were large cell immunoblastic non-Hodgkin's lymphoma. Eighteen cases were of B-cell phenotype; one was a T-cell lymphoma, and one was classified as null. Epstein-Barr virus (EBV) was demonstrated in the majority of tumor cells of 11 of 20 (55%) of the cases non-Hodgkin's lymphomas and in 3 of 4 (75%) cases of Hodgkin's disease. AIDS-related lymphomas in Brazil are usually of large cell/immunoblastic type, but Hodgkin's disease is also seen. Both non-Hodgkin's lymphoma and Hodgkin's disease are often associated with EBV infection. The non-Hodgkin's lymphoma is predominantly of B-cell phenotype.

Situacao atual da quimioterapia contra a tuberculose

Actions to overcome a disease are dependant, essentially, on what is known about it. Procedures followed in the past were sometimes bizarre, but justified because of how little was known about the disease. The tuberculosis prechemotherapeutic age was somber due to the high levels of fatalities and morbidity. With the arrival of the chemotherapeutic treatment its prognosis has changed. Tuberculosis declined in the 50's and stabilized in the 80's. Nevertheless, it is back increasing alarming its numbers more than ever; probably because of some factors, among them, the public health system lack of attention and the government's policies, increasing in the migration to and from the endemic areas, development of drug multi-resistant cepa and also to the HIV infection. An universal antimycobacteria chemotherapy treatment is not accepted, maybe because of the number of drugs that are available. Modern chemotherapy, however, has an attack and a maintenance phases with the aim to eliminate the bacillus of fast and slow multiplication, respectively. The treatment period is long, when compared with other infectious diseases, that leads to the lack of compliance. In spite of the available resources in the fight against tuberculosis they seem insufficient to restrain the disease. This has forced the search for new chemotherapy alternatives to avoid strong come back of tuberculosis to the point of being called the 'white plague' well into the 21'st century.

A comparative evaluation of open loop and closed loop drug administration strategies in the treatment of AIDS.

In recent years, many researchers in the field of biomedical sciences have made successful use of mathematical models to study, in a quantitative way, a multitude of phenomena such as those found in disease dynamics, control of physiological systems, optimization of drug therapy, economics of the preventive medicine and many other applications. The availability of good dynamic models have been providing means for simulation and design of novel control strategies in the context of biological events. This work concerns a particular model related to HIV infection dynamics which is used to allow a comparative evaluation of schemes for treatment of AIDS patients. The mathematical model adopted in this work was proposed by Nowak & Bangham, 1996 and describes the dynamics of viral concentration in terms of interaction with CD4 cells and the cytotoxic T lymphocytes, which are responsible for the defense of the organism. Two conceptually distinct techniques for drug therapy are analyzed: Open Loop Treatment, where a priori fixed dosage is prescribed and Closed Loop Treatment, where the doses are adjusted according to results obtained by laboratory analysis. Simulation results show that the Closed Loop Scheme can achieve improved quality of the treatment in terms of reduction in the viral load and quantity of administered drugs, but with the inconvenience related to the necessity of frequent and periodic laboratory analysis.

Doença arterial coronariana: Um novo paradigma na AIDS

The HIV-infected individuals have been identified as a peculiar group whose propensity to the development of abnormalities in lipids metabolism supports the hypothesis that AIDS itself can be considered as an independent risk factor for the occlusive diseases development. The AIDS progression, as well as the therapy against HIV has been capable to show an array of metabolic disturbances that HIV-infected patients are prone to. These metabolic alterations affect the fate of plasmatic lipids and homocysteine as a result of three factor mainly: (i) the viral infection per se which triggers the development of hypertriglyceridemia and hipocholesterolemia; (ii) multiple vitamins and micronutrients deficiencies, that favors an onset of hyperhomocysteinemia; (iii) the state-of-the-art therapy for HIV infection, which is accompanied to idiosyncratic effects encompassing the lipid metabolism. In this context, a variety of risk factors to atherosclerosis can be identified in the HIV-infected individual. Of note, it must be considered that once life expectancy of these patients has been expanded due to the effective therapy, on the other hand they can accelerate atherosclerotic disease or its pathological appearance in the same extent.

Social Panorama of Latin America 2005

Includes bibliography

Paracoccidioidomicose é esporotricose associada à imunossupressão

Paracoccidioidomycosis is caused by Paracoccidioides brasiliensis, a dimorphic fungus, prevalent in tropical and subtropical America. It is rare in the United States of America, Canada, Asia and Europe and in these countries it is related to immigrants from endemic areas. Paracoccidioidomycosis associated with immunosuppression runs a course with rapid progression and dissemination of the disease, with many cutaneous lesions. The mortality rate is up to 35% when associated with HIV infection or AIDS. The diagnosis depends on visualization of the agent through direct examination, histopathology, or culture. First choice treatment is done with Amphotericin B deoxycholate. Itraconazole is an option for long term treatment. Sporotrichosis is caused by Sporothrix schenckii, the species of reference. Other species have been considered such as: Sporothrix brasiliensis, S.globosa and S.mexicana and the S.schenckii var. lurei. It is a ubiquitous disease although more prevalent in tropical and subtropical areas. Currently, it has been reported as a zoonotic disease of cats and dogs, with transmission to their owners in the city of Rio de Janeiro (Brazil). Sporotrichosis associated to immunosuppression is uncommon or underreported. There were 34 cases in association with HIV infection or AIDS reported so far. Presenting with disseminated disease and non cutaneous lesions including joints, lungs and central nervous system. Amphotericin B deoxycholate is the first choice for treatment and itraconazol considered an alternative.

Desenvolvimento de métodos analíticos qualitativos para a análise de darunavir comprimidos

Darunavir is a protease inhibitor used in the treatment of HIV infection. It is a pillar of the drug cocktail for patients diagnosed with the virus. Quality control in the pharmaceutical industry, to verify the content of active substance and study the physicochemical characteristics of the drug, is essential to ensure final product quality. Until now, standardized methods for the analysis of darunavir have not been available in official compendia. This justifies new research, to develop and validate analytical methods, as well as physicochemical and pharmaceutical analysis for this drug, both as a raw material and a finished product. Thus, in this study, (a) the average weight of darunavir tablets and (b) the melting point of the pure drug were determined, and the following analytical techniques were performed: (c) thin-layer chromatography, (d) ultraviolet spectroscopy, (e) infrared spectroscopy and (f) high performance liquid chromatography. By developing the above techniques, it is possible to make a qualitative assessment of the quality of darunavir tablets.

Polimorfismos de nucleotídeo simples (SNPs) em genes codificadores de citocinas e suas correlações com parâmetros clínicos e laboratoriais de pacientes portadores do vírus da imunodeficiência humana

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Perfil epidemiológico dos doadores de sangue da Fundação Hemopa em Belém-Pará, infectados pelo Vírus da imunodeficiência humana

O estudo do perfil dos doadores de sangue com sorologia positiva para o HIV é essencial para rever os métodos que têm sido empregados na triagem clínica, para que o cumprimento rigoroso das normas estabelecidas para a exclusão de candidatos à doação seja possível. A avaliação desse perfil foi realizada através de um estudo, no qual, doadores de sangue confirmadamente positivos para o HIV-1 (n=96) foram comparados com um grupo controle de doadores com resultados falso-positivos no teste de triagem para o HIV (n=224). Esta pesquisa, realizada com foco na segurança transfusional e na redução do risco residual de transmissão do virus por transfusão, foi feita no período de 01 de janeiro de 2006 a 31 de março de 2008. Os dados demográficos e os potenciais fatores de risco para a infecção pelo HIV foram avaliados em entrevistas pós-doação. A omissão de fatores de risco na triagem clínica - que deveriam ter gerado recusa dos doadores - foi relatada em 74,69% dos entrevistados. Na análise multivariada os fatores de risco para a infecção pelo HIV foram: doadores homens que mantiveram relação sexual com outros homens, doadores que tiveram quatro ou mais parceiros sexuais nos últimos 12 meses, doadores usuários de drogas ilícitas, doadores que fizeram uso inconsistente de preservativo nas relações sexuais, todos com significância estatística (p<0,0001) e chance de risco maior que 1,0 (OR>1,0). Conclui-se que estes fatores elencados acima são importantes na transmissão de HIV por transfusão de sangue e que os HSH continuam sendo os maiores preditores da infecção pelo HIV na população estudada.

A sexualidade de mulheres vivendo com AIDS: contribuições da psicanálise

A feminização do HIV/aids é uma realidade no Brasil, de acordo com os dados epidemiológicos do Ministério da Saúde. Este trabalho fundamenta-se no referencial da psicanálise e apresenta o estudo de caso de Larissa, paciente do ambulatório do Serviço de Assistência Especializada em HIV/aids do Hospital Universitário João de Barros Barreto. Partiu-se da hipótese que as mulheres que vivem com o vírus HIV/aids, podem apresentar consequências subjetivas, diante de um diagnóstico traumático associado a tabus como morte e sexualidade. Para Larissa ter aids significava rejeição, discriminação e abandono pelo companheiro e pais. Nos atendimentos trouxe sua preocupação em como contar ao companheiro sobre o vírus, temendo sua reação agressiva, além de relatos sobre sua infância e adolescência de conflitos com os pais, das agressões por parte do pai, e queixas em torno de sua mãe, principalmente voltadas a nada ter-lhe dito sobre sexualidade. Em seus relacionamentos amorosos com homens com problemas com a lei, pode-se pensar, segundo anuncia a teoria psicanalítica, em seu desamparo, conduzindo-a ao masoquismo. O ideal de amor de Larissa junto a esses parceiros aponta para aspectos de um amor romântico, em que esperava encontrar no parceiro proteção e confiança. Ressalto que esta pesquisa aponta ainda, um mal estar em falar da sexualidade, corpo e desejo feminino entre mães e filhas, ou seja, ausência de educação sexual que, no caso de Larissa, deixou-a à mercê dos parceiros, sem recursos para se proteger de doenças como a aids e, da gravidez na adolescência. O relato de Larissa está em consonância com os de outras pacientes mulheres vivendo com HIV, investigadas nesta pesquisa, e pode servir de alerta sobre a problemática apresentada nos dados do Boletim Epidemiológico do Brasil 2012, onde é crescente a incidência de casos de infecção pelo HIV em jovens de 13 a 19 anos, sendo as mulheres em maior número. A escuta clinica, para Larissa, ao poder falar de sua sexualidade, permitiu encontrar os significados dos aspectos traumáticos vivenciados em sua infância e adolescência, encontrar-se com seus conflitos internos e seu sentimento de desamparo, pensar sua relação com a mãe e suas filhas e, finalmente, afirmar que estava “aprendendo a ser mulher”, o que significava, para ela, estar “mais preparada” para a vida.