Prevalencia de lesiones bucales en pacientes VIH +, relación con contaje de células CD4+ y carga viral en una población Venezolana

Objetivo: Determinar la prevalencia de las lesiones bucales en un grupo de pacientes VIH+, su relación con el contaje de linfocitos CD4 y la carga viral, en una muestra de la población venezolana Materiales y métodos: En el presente estudio se evaluaron 75 pacientes adultos VIH+, provenientes del Centro para la Atención de Pacientes con Enfermedades Infectocontagiosas de la Facultad de Odontología de la Universidad Central de Venezuela. Cada uno de ellos fue examinado clínicamente para la detección de las lesiones presentes en la mucosa bucal. Igualmente se les determinó el contaje de células CD4+ mediante citometría de flujo, así como la carga viral mediante la técnica TR-RCP (Transcriptasa Reversa-Reacción en Cadena de la Polimerasa) (Amplicor HIV-1-RNA, TM test 1.5, Roche). Resultados: 85% (64/75) de los pacientes VIH/SIDA presentaron lesiones asociadas a la infección por VIH. Entre ellas, la Candidiasis constituyó la forma más frecuente representando un 61% (39/64), seguida por la Leucoplasia Vellosa con 53% (34/64), Leucoplasia Bucal 34% (22/64), Hiperpigmentación Melánica 38% (18/64). Papiloma 13% (6/64), Eritema Gingival Lineal 8% (5/64), Estomatitis Aftosa Recidivante 5% (4/64), Sarcoma de Kaposi 5% (3/64). Se presentó un solo caso (2%) de cada una de las lesiones que se enumeran a continuación: Linfoma No Hodgkin, Hiperplasia Epitelial Multifocal, Herpes Labial, Histoplasmosis y Molusco Contagioso. Los pacientes con una carga viral de 30.000 copias/mm3, presentaron lesiones bucales relacionadas con VIH independientemente del contaje de células CD4+, aunque los pacientes con niveles de CD4+ menores a 200 cel//mm3, fueron mas susceptibles a desarrollar estas lesiones. Conclusiones: La lesión oral mas frecuente fue la Candidiasis bucal, seguida por la Leucoplasia vellosa, Leucoplasia bucal, e Hiperpigmentación melánica. Una alta carga viral estuvo fuertemente asociada a la presencia de lesiones, independientemente del contaje de células CD4+.Aim: To determine the prevalence of oral lesions in a HIV + group of patients, related to CD4 cell count and viral load in a Venezuelan population. Materials and methods : In the present study, we evaluated 75 HIV+adult patients, attended at the Center of Infectious Diseases, at the Faculty of Dentistry, Central University of Venezuela. Each patient was clinically examined for detection of oral mucosal lesions. In addition, CD4 cell count was determined by flow cytometry, as well as viral load by RT-PCR (Amplicor HIV-RNA, TM test 1.5, Roche) Results: 85% (64/75) of HIV/AIDS patients showed associated HIV lesions. Oral Candidiasis constituted the most common lesion representing a 61% (39/64), followed by Oral Hairy Leukoplakia 53% (34/64); Oral Leukoplakia 34% (22/64), Melanic Hiperpigmentation 38% (18/64); Papilloma 13 (6/64), Lineal Gingival Erithema 8% (5/64); Aphtous Recurrent Stomatitis 5% (4/64) and Kaposi's Sarcoma 5% (3/64). Only one case of the following lesions were represented by Non Hodgkin Lymphoma, Multifocal Epithelial Hyperplasia, Recurrent Herpes, Histoplasmosis and Molluscum Contagiosum. The patients with a viral load of 30.000 copies/mm3 exhibited oral lesions related with HIV, independent of CD4 cell count, although patients with CD4+ levels of 200 cel/mm3 were more susceptible to develop these lesions. Conclusions: The most common oral lesion was Oral Candidiasis followed by Oral Hairy Leukoplakia, Oral Leukoplakia and Melanic Hyperpigmentation. A high viral load was strongly associated to the oral lesions occurrence independently of CD4+ cell count

Epstein Barr Virus detection and latent membrane protein 1 in oral hairy leukoplakia in HIV+ Venezuelan patients

Purpose: To determine the prevalence of Epstein Barr Virus (EBV) in oral hairy leukoplakia lesions (OHL) in HIV+ Venezuelan patients. Material and Method: In this case study, we evaluated 21 HIV+ adult patients with clinically present OHL lesions, 11 who were undergoing antiretroviral therapy, 10 who were not undergoing therapy and 10 HIV-negative adult patients with hyperkeratotic oral mucosal lesions. All of the subjects were assessed at the Infectious Disease Center, Faculty of Dentistry, Central University of Venezuela, and were clinically examined to detect oral mucosal lesions with the confirmed histopathologic diagnosis. Nested-PCR was used to determine the EBV infection and the latent membrane protein-1 (LMP-1) expression by immunohistochemistry. Results: Of the subjects, 16/21 (76%) of the HIV+/AIDS patients tested positive for EBV, whereas 5/10 (50%) of the HIV-negative subjects tested positive for EBV. Conclusions: In the present study, a higher EBV prevalence was observed in HIV-positive patients when compared to HIV-negative patients without oral hairy leukoplakia, confirming the etiologic role in this entity. The LMP-1 in OHL patients who were both HIV+ and EBV+ was highly expressed (60%) at the epithelial basal cells. No association between the alcohol and tobacco consumption was observed among the EBV-positive cases

Prevalence of HPV and EBV infection and their relationship with the p53 and PCNA expression in oral carcinoma patients

Introduction: Infection caused by potentially oncogenic viruses, such as HPV and EBV, favors the role of certain oncoproteins that can induce dysplasias and malignant lesions. Objective: To evaluate the prevalence of HPV and EBV and their relation with the expression of p53 and PCNA in patients with oral carcinoma. Methodology: Twenty-seven oral squamous cell carcinomas (OSCC) were evaluated; DNA extraction was conducted using the QIAamp DNA mini kit; viral detection was obtained using the INNO-LiPA kit for HPV, and nested PCR was used for EBV. The evaluation of molecular markers was performed through immunohistochemical staining. Results: The mean age of the patients was 60.55±13.94 years, and 52% of these were female. Of the patients, 59% were tobacco users and 63% were alcohol consumers. HPV was detected in 70% of the patients with the predominance of genotype 16 (60%). As for EBV infection, it was observed in 59% of cases. p53 and PCNA immunopositivity corresponded to 44% and 59%, respectively. The tongue was the anatomical location with highest positivity for both viruses as well as for the expression of molecular markers. The 48% of the cases presented infection by both viruses.&nbsp

Prevalence of oral lesions in HIV patients related to CD4 cell count and viral load in a Venezuelan population

Aim: To determine the prevalence of oral lesions in a HIV + group of patients, related to CD4 cell count and viral load in a Venezuelan population. Materials and methods: In the present study, we evaluated 75 HIV+adult patients, attended at the Center of Infectious Diseases, at the Faculty of Dentistry, Central University of Venezuela. Each patient was clinically examined for detection of oral mucosal lesions. In addition, CD4 cell count was determined by flow cytometry, as well as viral load by RT-PCR (Amplicor HIV-RNA, TM test 1.5, Roche) Results: 85% (64/75) of HIV/AIDS patients showed associated HIV lesions. Oral Candidiasis constituted the most common lesion representing a 61% (39/64), followed by Oral Hairy Leukoplakia 53% (34/64); Oral Leukoplakia 34% (22/64), Melanic Hiperpigmentation 38% (18/64); Papilloma 13 (6/64), Lineal Gingival Erithema 8% (5/64); Aphtous Recurrent Stomatitis 5% (4/64) and Kaposi?s Sarcoma 5% (3/64). Only one case of the following lesions were represented by Non Hodgkin Lymphoma, Multifocal Epithelial Hyperplasia, Recurrent Herpes, Histoplasmosis and Molluscum Contagiosum. The patients with a viral load of 30.000 copies/mm3 exhibited oral lesions related with HIV, independent of CD4 cell count, although patients with CD4+ levels of 200 cel/mm3 were more susceptible to develop these lesions. Conclusions: The most common oral lesion was Oral Candidiasis followed by Oral Hairy Leukoplakia, Oral Leukoplakia and Melanic Hyperpigmentation. A high viral load was strongly associated to the oral lesions occurrence independently of CD4+ cell count

Cytokines and MMPs levels in gingival crevicular fluid from patients with chronic periodontitis before and after non-surgical periodontal therapy.

The study of host response in periodontal disease may provide a mechanism to monitor disease progression. The purpose of the present research was to determine the levels of IL-1α, IL-1β, TNF-α, IL-6, IL-6sR, IL-8, IL-10, MMP-3 and MMP-8 in gingival crevicular fluid (GCF), before and after non-surgical periodontal treatment (NSPT) in order to evaluate therapy response. Methodology: Eleven patients diagnosed with chronic periodontitis and eleven healthy subjects were selected for this study. Clinical measurements, including probing depth (PD) and clinical attachment loss (CAL) were carried out in patients diagnosed with chronic periodontitis and periodontal healthy controls. The clinical indexes evaluated were: gingival index (GI) and plaque index (PI). Samples of GCF were taken from one tooth per quadrant before and 45 days after NSPT. The levels of inflammatory mediators were measured by ELISA. Results: The values of all clinical parameters decreased significantly after treatment. The concentration levels of all cytokines and MMP-3 and MMP-8 in the GCF sample were higher in patients diagnosed with chronic periodontitis compared to the healthy group. All inflammatory mediators decreased after therapy, but did not reach control values; IL-6, Il-6sR, IL-10 and TNF-α, attained the highest reduction (70% -54%); the vales of MMP3, IL-1α, IL-1β and IL-8 were reduced between 50% - 34%; and MMP-8 showed the lowest decrease (28%). Conclusion: All clinical parameters and cytokines levels decreased after NSPT. The mediators TNF-α IL-6, IL-6sR, and IL-10 showed the largest variation between before and after NSPT and could thus be used to evaluate therapy response

Evaluation of mediators IL-1α, IL-1β and TNF-α, in crevicular gingival fluid of patients with periodontitis

Objetivo. Evaluar los niveles de mediadores químicos inflamatorios como la interleucina- 1α (IL-1α), interleucina-1β (IL-1β), factor de necrosis tumoral-α (TNF-α) y los parámetros clínicos en pacientes diagnosticados con periodontitis crónica o agresiva, antes y después de la terapia periodontal no quirúrgica (TPNQ). Métodos. Se tomaron muestras de fluido gingival crevicular (FGC) en 11 pacientes diagnosticados con periodontitis y 11 controles sanos para evaluar niveles de IL-1α, IL-1β, TNF-α antes y después de la TPNQ, mediante la técnica de ELISA (Enzyme-Linked Immuno Sorbent Assay). Resultados. En el grupo con periodontitis se observó disminución significativa de los parámetros clínicos después del tratamiento (p<0,05). En FGC, IL-1β presentó los niveles más elevados, seguido de IL-1α y TNF-α. Posterior a la TPNQ, IL-1β disminuyó 17 veces su concentración e IL-1α 4 veces en relación a los valores iniciales, sin embargo, solo se observó una relación estadísticamente significativa para TNF-α. Las mayores correlaciones con los parámetros clínicos de la enfermedad periodontal se observaron para IL-1β (p<0,01), seguido por IL-1α (p<0,05) y una baja correlación con TNF-α. Conclusiones. En este trabajo, el grupo de pacientes con periodontitis presentó mayores niveles de IL-1α, IL-1β y TNF-α en FGC, siendo IL-1β la citocina más elevada. Posterior al TPNQ, se observó disminución significativa de los valores clínicos periodontales. Así mismo, las interleucinas redujeron sus valores promedios, sin alcanzar los del grupo control. Las correlaciones observadas entre los índices periodontales y los mediadores sugieren mayor correlación de IL-1β con los signos clínicos de la enfermedad periodontal.Objective. Evaluate the levels of inflammatory chemical mediators such as interleukin- 1α(IL-1α), interleukin-1β (IL-1β), tumorosis factor-α (TNF-α) and clinical parameters in patients diagnosed with chronic or aggressive periodontitis, before and after non-surgical periodontal therapy (NSPT). Methods. Crevicular gingival fluid (CGF) samples were taken in 11 patients diagnosed with periodontitis and 11healthy controls for evaluating levels of IL-1α, IL-1β, TNF-α before and after the NSPT, using the ELISA technique (Immunosorbent Assay Linked to enzymes). Results. In the group with periodontitis the decrease of the clinical parameters after the treatment is also observed (p <0.05). In FGC, IL-1β had the highest levels, followed by IL-1α and TNF-α. After NSPT, IL-1β decreased 17 times its concentration and IL-1α 4 times in relation to the initial values, however, only a statistically significant relationship for TNF-α. The major relationships with the clinical parameters of periodontal disease were observed for IL-1β(p<0.01), followed by IL-1α (p<0.05) and a low correlation with TNF-α. Conclusions. In this study, the group of patients with periodontitis presented higher levels of IL-1α, IL-1β and TNF-α in FGC, with IL-1β being the highest cytokine. After NSPT, periodontal clinical values have been significantly reduced. Likewise, the interleukins reduced their average values, without reaching the control of the group. The correlations observed between periodontal indices and mediators are mostly related to IL-1β with the clinical signs of periodontal disease

Evaluación de virus papiloma humano de alto y bajo riesgo oncogénico en la cavidad bucal de pacientes VIH positivos

Objective. Perform human papilomavirus (HPV) detection and typing in the oral cavity in a group of HIV positive patients, treated at the Center for Care of Patients with Infectious Diseases (CAPEI) of the Faculty of Dentistry-Central University of Venezuela. Methods. Thirty-one oral swabs from HIV-positive patients were evaluated to detect HPV infection using the INNO-LiPA Reverse Hybridization System that detects 28 HPV genotypes of high and low oncogenic risk. Results. The 61.0% of the evaluated samples had an HPV infection. The low risk genotype 6 was the most frequent (73.68%), followed by genotypes 18, 11 and 16 with 63.16%, 37.0%, and 32.0%, respectively. Seventy-four percent of HPV positive samples had multiple infections, being the more frequent the mixed coinfection (35.70%), with HPV genotypes 6/18 of low and high oncogenic risk, 21.40% with genotypes 11/6/18 and 6/11, each one, followed by 14.30% of the samples presented infection with HPV-6/11/16/18 and 7.10% with the 11/16 genotypes of low and high oncogenic risk. Conclusions. The high frequency of infection with high oncogenic risk HPV types and the presence of multiple genotypes observed in the oral cavity of HIV positive patients, who did not present lesions compatible with this infection in the extra and intraoral examination, indicates that molecular diagnostic methods are important in the detection of subclinical and latent infections, which may allow better follow-up and more timely management of these patients with a higher risk of developing malignant lesions in the oral cavity.Objetivo. Realizar la detección y tipificación de virus papiloma humano (VPH) en la cavidad bucal de un grupo de pacientes VIH positivos, atendidos en el Centro de Atención de Pacientes con Enfermedades Infectocontagiosas (CAPEI) de la Facultad de Odontología-Universidad Central de Venezuela. Métodos. Se evaluaron 31 hisopados bucales de pacientes VIH positivos para la infección por VPH, mediante el Sistema de Hibridación Reversa de INNO-LiPA que detecta 28 genotipos de VPH de alto y bajo riesgo oncogénico. Resultados. El 61,0% de las muestras evaluadas presentó infección por VPH. El genotipo 6 fue el más frecuente (73,68%), seguido de los genotipos 18, 11 y 16 con 63,16%, 37,0% y 32,0% respectivamente. El 74,0% de las muestras positivas para VPH presentaron infecciones múltiples, siendo más frecuente la coinfección mixta (35,70%) con los genotipos de VPH-6/18 de bajo y alto riesgo oncogénico, 21,40% con los genotipos 6/11/18 y 6/11, cada una. Seguido de 14,30% de las muestras que presentaron infección con VPH-6/11/16/18 y 7,10% con los genotipos 11/16 de bajo y alto riesgo oncogénico. Conclusiones. La alta frecuencia de infección con VPH de alto riesgo oncogénico y la presencia de múltiples genotipos observada en la cavidad bucal de individuos VIH positivos, que no presentaron lesiones compatibles con esta infección en el examen extra e intrabucal, indica que los métodos moleculares de diagnóstico son importantes en la detección de infecciones subclínicas y latentes, lo que puede permitir un mejor seguimiento y manejo más oportuno de estos pacientes con mayor riesgo de desarrollar neoplasias malignas en la cavidad bucal

Presencia de lesiones preinvasoras e invasoras de cérvix, relación con el virus papiloma humano y factores epidemiológicos en Mérida, Venezuela

  Las lesiones de cérvix se han asociado a infección por Virus Papiloma Humano (VPH). 300 mujeres mayores de quince años que acudieron al Hospital Universitario de Los Andes (HULA), fueron estudiadas para identificar lesiones, detectar y tipificar VPH, y determinar factores asociados. Se realizó citología, colposcopia, cepillados cervicales utilizando (DNA collection device Digene®) y biopsias en los casos pertinentes. Se aisló el ADN mediante (QIAamp DNA Mini Kit QIAGEN®), siendo cuantificado y almacenado a -20 ºC. Se detectó VPH por Reacción en Cadena de la Polimerasa (PCR) de regiones L1 y E6/E7. La genotipificación por PCR anidada múltiple E6/E7, C. trachomatis se detectó por PCR. El VPH se detectó en 35 % (105) muestras, 88,46 % (92/105) fueron positivas para al menos uno de los genotipos evaluados. VPHAR se encontraron en 97,82 %, (90/92), VPH18 en 82 % (74/90), VPH16 en 44 % (40/90). 56,52 % (52/92) correspondieron a infecciones múltiples, VPH18/16 (20/52) fue la más frecuente. C. trachomatis se detectó en 9 % (27/300) pacientes. La citología mostró cambios sugestivos de infección en solo 16,35 % de las pacientes VPH positivas. 17/18 biopsias sugirieron infección viral y fueron positivas para VPH AR por biología molecular (94,44 %). La colposcopia sugirió infección viral en 46,15 %. El 66,34 % de pacientes fueron menores de 35 años. Se encontró relación estadísticamente no significativa entre infección por VPH, número de parejas sexuales, coinfección con C. trachomatis y hábito tabáquico. Estos resultados muestran elevada frecuencia de infección por VPH AR, asociada a factores epidemiológicos, cuyo diagnóstico certero y tratamiento oportuno son claves en la prevención de su transmisión y del desarrollo de lesiones en cérvix.   Palabras clave: Cáncer cervical, virus papiloma humano, reacción en cadena de la polimerasa.   Abstract   Cervical lesions have been associated with infection by Human Papilloma Virus (HPV). Three hundred women older than 15 years old who attended at the Hospital Universidad de Los Andes (HULA), were studied to identify lesions, detect and typify HPV, and determine associated factors. Cytology, colposcopy, cervical brushing using (DNA collection device Digene®) and biopsies were performed in the pertinent cases. DNA was isolated by (QIAamp DNA Mini Kit QIAGEN®), being quantified and stored at -20 ° C. HPV was detected by Polymerase Chain Reaction (PCR) of regions L1 and E6 / E7. The genotyping by multiple nested PCR E6 / E7, C. trachomatis was detected by PCR. HPV was detected in 35% (105) samples, 88.46% (92/105) were positive for at least one of the genotypes evaluated. VPHAR were found in 97.82% (90/92), HPV18 in 82% (74/90), HPV16 in 44% (40/90). 56.52% (52/92) corresponded to multiple infections, HPV18 / 16 (20/52) was the most frequent. C. trachomatis was detected in 9% (27/300) patients. The cytology showed changes suggestive of infection in only 16.35% of the HPV positive patients. 17/18 biopsies suggested viral infection and were positive for ARV HPV by molecular biology (94.44%). Colposcopy suggested viral infection in 46.15%. 66.34% of patients were under 35 years old. A statistically non-significant relationship was found between HPV infection, number of sexual partners, coinfection with C. trachomatis and smoking habit. These results show high frequency of infection by HPV AR, associated with epidemiological factors, whose accurate diagnosis and timely treatment are key in the prevention of its transmission and the development of lesions in the cervix.   Keywords: Cervical cancer, human papilloma virus, polymerase chain reaction

A Research Agenda for Helminth Diseases of Humans: Social Ecology, Environmental Determinants, and Health Systems

In this paper, the Disease Reference Group on Helminth Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR), with the mandate to review helminthiases research and identify research priorities and gaps, focuses on the environmental, social, behavioural, and political determinants of human helminth infections and outlines a research and development agenda for the socioeconomic and health systems research required for the development of sustainable control programmes. Using Stockols' social-ecological approach, we describe the role of various social (poverty, policy, stigma, culture, and migration) and environmental determinants (the home environment, water resources development, and climate change) in the perpetuation of helminthic diseases, as well as their impact as contextual factors on health promotion interventions through both the regular and community-based health systems. We examine these interactions in regard to community participation, intersectoral collaboration, gender, and possibilities for upscaling helminthic disease control and elimination programmes within the context of integrated and interdisciplinary approaches. The research agenda summarises major gaps that need to be addressed