Oral pathology in children and adolescents with HIV on antiretroviral therapy highly active

Objetivo: Determinar patologías orales en niños y adolescentes con virus de la inmunodeficiencia humana (VIH) en tratamiento antirretroviral de gran actividad (TARGA) según su estado clínico e inmunológico y las características del TARGA que recibían. Materiales y método: Es un estudio descriptivo, transversal y observacional. Se evaluaron 20 pacientes pediátricos del Hospital Nacional Hipólito Unanue, de ambos sexos, entre 2 y 13 años. Las patologías se diagnosticaron mediante el sistema recomendado por el Instituto de Problemas Orales relacionados con la infección por el VIH de la Comunidad Económica Europea, el Centro de Colaboración en Manifestaciones Orales del VIH de la Organización Mundial de la Salud y la clasificación de manifestaciones orofaciales en niños con VIH de Ramos y colaboradores. Se elaboró una base de datos, usando estadística descriptiva. Resultados: La patología oral encontrada fue herpes simple (5 %), caries dental (100 %) y gingivitis (95 %). La dentición decidua estaba presente en el 20 %, con un índice ceo de 7 ± 2, los demás presentaban dentición mixta con índices CPOD y ceo de 5 ± 6,12 y 6,81 ± 5,58 respectivamente. Respecto al Índice de Higiene Oral de Greene y Vermillion, el 85 % tuvo nivel deficiente y 15 % regular, siendo el valor promedio 2,52 ± 0,46. Conclusiones: Se atribuye la presencia mínima de patología oral asociada al VIH al TARGA. Se resalta que el tiempo y tipo de tratamiento son esenciales para la reconstitución del sistema inmunitario. Las lesiones cariosas y la gingivitis son posiblemente relacionadas a la deficiente higiene oral en la muestra estudiada.Objective: Determine oral pathologies in children and teenagers with human immunodeficiency virus (HIV) infection in antiretroviral therapy (HAART) according to their clinical and immunological status and characteristics of the receiving HAART. Materials and method: A descriptive, transversal and obser-vational study. 20 pediatric patients Hipolito Unanue National Hospital of both sexes between 2 and 13 years were evaluated. Pathologies were diagnosed by recommended by the Clearinghouse on Oral Problems related to HIV infection in the European Community and The Collaborating Center on Oral Manifestation of the Human Immunodeficiency Virus from The World Health Organization and classification of orofacial manifestations in system children with HIV Ramos et al. (1999) a database will be developed, using descriptive statistics. Results: The pathology was found herpes simplex (5 %), dental caries (100 %) and gingivitis (95 %). The 20 % of the whole population had Primary Dentition, with a “dmf index” of 7 ± 2. The other 80 % of the whole population had mixed dentition with “DMF” and “dmf” index of 5 ± 6,12 and 6,81 ± 5,58 respectively. With regard to the OHI-S Greene and Ver-milion index 85 % had a deficient level and 15 % had a regular level, with an average value of 2,52 ± 0,46. Conclusions: The minimal presence of HIV-associated oral pathology is attributed to HAART. It emphasized that the time and type of treatment are essential for the reconstitution of the immune system. Carious lesions and gingivitis are possibly related to poor oral hygiene in the sample studied

HIV-associated multi-centric Castleman’s disease with multiple organ failure: cuccessful treatment with rituximab

Introduction: Multicentric Castleman's Disease (MCD), a lymphoproliferative disorder associated with Human Herpes Virus-8 (HHV-8) infection, is increasing in incidence amongst HIV patients. This condition is associated with lymphadenopathy, polyclonal gammopathy, hepato-splenomegaly and systemic symptoms. A number of small studies have demonstrated the efficacy of the anti-CD20 monoclonal antibody, rituximab, in treating this condition. Case presentation: We report the case of a 46 year old Zambian woman who presented with pyrexia, diarrhoea and vomiting, confusion, lymphadenopathy, and renal failure. She rapidly developed multiple organ failure following the initiation of treatment of MCD with rituximab. Following admission to intensive care (ICU), she received prompt multi-organ support. After 21 days on the ICU she returned to the haematology medical ward, and was discharged in remission from her disease after 149 days in hospital. Conclusion: Rituximab, the efficacy of which has thus far been examined predominantly in patients outside the ICU, in conjunction with extensive organ support was effective treatment for MCD with associated multiple organ failure. There is, to our knowledge, only one other published report of its successful use in an ICU setting, where it was combined with cyclophosphamide, adriamycin and prednisolone. Reports such as ours support the notion that critically unwell patients with HIV and haematological disease can benefit from intensive care

Impact of ART on the fertility of HIV-positive women in sub-Saharan Africa.

OBJECTIVE: Understanding the fertility of HIV-positive women is critical to estimating HIV epidemic trends from surveillance data and to planning resource needs and coverage of prevention of mother-to-child transmission services in sub-Saharan Africa. In the light of the considerable scale-up in antiretroviral therapy (ART) coverage over the last decade, we conducted a systematic review of the impact of ART on the fertility outcomes of HIV-positive women. METHODS: We searched Medline, Embase, Popline, PubMed and African Index Medicus. Studies were included if they were conducted in sub-Saharan Africa and provided estimates of fertility outcomes (live births or pregnancies) among women on ART relative to a comparison group. RESULTS: Of 2070 unique references, 18 published papers met all eligibility criteria. Comparisons fell into four categories: fertility of HIV-positive women relative to HIV-negative women; fertility of HIV-positive women on ART compared to those not yet on ART; fertility differences by duration on ART; and temporal trends in fertility among HIV-positive women. Evidence indicates that fertility increases after approximately the first year on ART and that while the fertility deficit of HIV-positive women is shrinking, their fertility remains below that of HIV-negative women. These findings, however, were based on limited data mostly during the period 2005-2010 when ART scaled up. CONCLUSIONS: Existing data are insufficient to characterise how ART has affected the fertility of HIV-positive women in sub-Saharan Africa. Improving evidence about fertility among women on ART is an urgent priority for planning HIV resource needs and understanding HIV epidemic trends. Alternative data sources such as antenatal clinic data, general population cohorts and population-based surveys can be harnessed to understand the issue

Temporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa, 2002-2007.

OBJECTIVE: Little is known about the temporal impact of the rapid scale-up of large antiretroviral therapy (ART) services on programme outcomes. We describe patient outcomes [mortality, loss-to-follow-up (LTFU) and retention] over time in a network of South African ART cohorts. DESIGN: Cohort analysis utilizing routinely collected patient data. METHODS: Analysis included adults initiating ART in eight public sector programmes across South Africa, 2002-2007. Follow-up was censored at the end of 2008. Kaplan-Meier methods were used to estimate time to outcomes, and proportional hazards models to examine independent predictors of outcomes. RESULTS: Enrolment (n = 44 177, mean age 35 years; 68% women) increased 12-fold over 5 years, with 63% of patients enrolled in the past 2 years. Twelve-month mortality decreased from 9% to 6% over 5 years. Twelve-month LTFU increased annually from 1% (2002/2003) to 13% (2006). Cumulative LTFU increased with follow-up from 14% at 12 months to 29% at 36 months. With each additional year on ART, failure to retain participants was increasingly attributable to LTFU compared with recorded mortality. At 12 and 36 months, respectively, 80 and 64% of patients were retained. CONCLUSION: Numbers on ART have increased rapidly in South Africa, but the programme has experienced deteriorating patient retention over time, particularly due to apparent LTFU. This may represent true loss to care, but may also reflect administrative error and lack of capacity to monitor movements in and out of care. New strategies are needed for South Africa and other low-income and middle-income countries to improve monitoring of outcomes and maximize retention in care with increasing programme size

Sulfadiazine induced Stevens Johnson syndrome in toxoplasmosis patient: a case report

Stevens johnson syndrome is an acute, self-limited disease, presenting as severe mucosal erosions with widespread erythematous, cutaneous macules or atypical targets. Even though sulfadiazine has been mainly associated with haematological-related adverse effects, sulfadiazine induced skin necrosis has received less attention or went unrecognized. Here is a 29-year- old Indian male received T. Sulfadiazine 500mg 1-1-1-1 and experienced a severe skin reaction which was diagnosed as stevens johnson syndrome (SJS). The above drug will be implicated in cases of stevens johnson syndrome (SJS)/toxic epidermal necrosis (TEN). There are few case reports of that have been associated with stevens johnson syndrome (SJS)/toxic epidermal necrosis (TEN). We hope that this case report creates awareness to the health care professionals. Clinicians must be aware of these adverse reactions and advise their patients to contact them as soon as they observe any unexpected clinical response. Early diagnosis helps the clinician to elude secondary infection and subsequent complications. The offending drug should be discontinued and never be rechallenged.

Impact of Human Immunodeficiency Virus in the Pathogenesis and Outcome of Patients with Glioblastoma Multiforme.

BackgroundImprovement in antiviral therapies have been accompanied by an increased frequency of non-Acquired Immune Deficiency Syndrome (AIDS) defining malignancies, such as glioblastoma multiforme. Here, we investigated all reported cases of human immunodeficiency virus (HIV)-positive patients with glioblastoma and evaluated their clinical outcomes. A comprehensive review of the molecular pathogenetic mechanisms underlying glioblastoma development in the setting of HIV/AIDS is provided.MethodsWe performed a PubMed search using keywords "HIV glioma" AND "glioblastoma," and "AIDS glioma" AND "glioblastoma." Case reports and series describing HIV-positive patients with glioblastoma (histologically-proven World Health Organization grade IV astrocytoma) and reporting on HAART treatment status, clinical follow-up, and overall survival (OS), were included for the purposes of quantitative synthesis. Patients without clinical follow-up data or OS were excluded. Remaining articles were assessed for data extraction eligibility.ResultsA total of 17 patients met our inclusion criteria. Of these patients, 14 (82.4%) were male and 3 (17.6%) were female, with a mean age of 39.5±9.2 years (range 19-60 years). Average CD4 count at diagnosis of glioblastoma was 358.9±193.4 cells/mm3. Tumor progression rather than AIDS-associated complications dictated patient survival. There was a trend towards increased median survival with HAART treatment (12.0 vs 7.5 months, p=0.10).ConclusionOur data suggests that HAART is associated with improved survival in patients with HIV-associated glioblastoma, although the precise mechanisms underlying this improvement remain unclear

IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME: A POTENTIAL PITFALL IN THE MANAGEMENT OF KAPOSI’S SARCOMA IN HIV POSITIVE PATIENTS? – A CASE REPORT

A diversidade de apresentações clínicas da síndrome de reconstituição imune faz da mesma um desafio clínico, na medida em que é difícil o manejo de infecções oportunistas e outras condições clínicas relacionadas com tal síndrome. A relevância da mencionada síndrome o Sarcoma de Kaposi após o início da terapia antiretroviral é notável, principalmente em países que possuem altos níveis de transmissão de doenças sexualmente transmissíveis e HIV. Desta forma, clínicos e dermatologistas devem estar atentos para identificar sinais e sintomas dessa progressão neoplásica e diferenciá-los do Sarcoma de Kaposi relacionado à síndrome de reconstituição imune de acordo com os critérios de classificação recentes da doença. Vital mencionar que terapia anti-retroviral não deve ser interrompida na maioria dos casos.The variety of immune reconstitution inflammatory syndrome’s (IRIS) clinical presentations makes this syndrome a challenge, in that it is difficult to manage opportunistic infections and other serious clinical conditions related to the manifestation of this syndrome. The relevance of immune reconstitution inflammatory syndrome – associated with Kaposi sarcoma (IRIS-KS) after initiation of highly active antiretroviral therapy (HAART) is noteworthy, mainly in coun tries that still have high levels of transmission of sexually transmitted diseases and HIV. Clinicians and dermatologists should be aware to identify signs and symptoms of this neoplasm progression and to differentiate them from KS related IRIS according to the recent classification criteria of this disease and antiretroviral therapy should not be discontinued in the most cases