Enteric parasites and AIDS

OBJECTIVE: To report on the importance of intestinal parasites in patients with AIDS, showing relevant data in the medical literature, with special emphasis on epidemiology, diagnosis and treatment of enteroparasitosis, especially cryptosporidiasis, isosporiasis, microsporidiasis and strongyloidiasis. DESIGN: Narrative review.OBJETIVO: Relatar a importância das parasitoses intestinais em pacientes com Aids, mostrando dados relevantes na literatura médica, com enfoque em especial, abordando a epidemiologia, diagnóstico e tratamento das enteroparasitoses, principalmente da criptosporidíase, isosporíase, microsporidíase e estrongiloidíase.TIPO DE ESTUDO: Revisão narrativa.Instituto de Infectologia Emílio RibasUniversidade Federal de São Paulo (UNIFESP)University of Mogi das CruzesEscola Paulista de MedicinaUNIFESP, EPMSciEL

Perfil lipídico, factores de riesgo cardiovascular y síndrome metabólico en un grupo de pacientes con SID

BACKGROUND: Since the advent of AIDS, the anti-HIV therapy has developed significantly, including the highly active antiretroviral therapy (HAART) and the disease acquired a chronic characteristic. However, after the introduction of HAART, several metabolic alterations were observed, mainly related to the lipid profile. OBJECTIVES: to evaluate and compare lipid profiles, analyze cardiovascular risk, describe the prevalence of metabolic syndrome in AIDS patients with or without HAART. METHODS: Over an 18-month period, 319 patients treated at outpatient clinics in the city of São Paulo, Brazil were selected. RESULTS: The final sample included 215 patients receiving HAART and 69 HAART-naive patients. The mean age was 39.5 years, and 60.9% were males. The main cardiovascular risk factors were smoking (27%), hypertension (18%) and family history of atherosclerosis (40%). Mean total cholesterol, HDL-cholesterol, triglycerides and glucose were higher in the HAART group than in the non-HAART group (205 vs 180 mg/dl, 51 vs 43 mg/dl, 219 vs 164 mg/dl and 101 vs 93 mg/dl respectively; p < 0.001 for all). According to the Framingham risk score, the cardiovascular risk was moderate to high in 11% of the patients receiving HAART and 4% of the HAART-naïve patients. According to the Adult Treatment Panel III definition, the metabolic syndrome was observed in 13% and 12% of the patients with or without HAART, respectively. CONCLUSIONS: Although the mean values for total cholesterol, HDL-c and triglycerides were higher in the HAART group, a higher cardiovascular risk was not identified in the former. The prevalence of metabolic syndrome was comparable in both groups.FUNDAMENTO: Desde el surgimiento del SIDA, la terapia antiretroviral se desarrolló significantemente. Al incluir la terapia antiretroviral altamente activa (HAART), la enfermedad adquirió una característica crónica. Sin embargo, tras la introducción de HAART, diversas alteraciones metabólicas se observaron, principalmente relacionadas al perfil lipídico. OBJETIVO: Evaluar y comparar los perfiles lipídicos, analizar el riesgo cardiovascular, y describir la prevalencia del síndrome metabólico en pacientes con SIDA tratados o no con HAART. MÉTODOS: Durante un período de 18 meses, se seleccionaron a 319 pacientes tratados en ambulatorios en la ciudad de São Paulo, Brasil. RESULTADOS: La muestra final incluyó a 215 pacientes tratados con HAART y a 69 pacientes vírgenes de tratamiento con HAART. La edad promedio era de 39,5 años, y el 60,9% eran del sexo masculino. Los principales factores de riesgo cardiovascular eran el fumo (27%), hipertensión (18%) e histórico familiar de aterosclerosis (40%). Los valores promedios de colesterol total, HDL-colesterol, triglicéridos y glucosa fueron más altos en el Grupo HAART que en el Grupo no-HAART (205 vs. 180 mg/dL, 51 vs. 43 mg/dL, 219 vs. 164 mg/dL, 101 vs. 93 mg/dL respectivamente; p < 0,001 para todos). De conformidad con el score de riesgo de Framingham, el riesgo cardiovascular era moderado y alto en el 11% de los pacientes tratados con HAART y el 4% de los pacientes no-HAART. Según la definición del Adult Treatment Panel III, el síndrome metabólico se observó en el 13% y el 12% de los pacientes, respectivamente, con y sin HAART. CONCLUSIÓN: Aunque los valores promedios del colesterol total, HDL-c y triglicéridos fueron más altos en el Grupo HAART, un mayor riesgo cardiovascular no se identificó en el primer grupo. La prevalencia de síndrome metabólico fue comparable en ambos grupos.FUNDAMENTO: Desde o advento da AIDS, a terapia antiretroviral desenvolveu-se significantemente, incluindo a terapia antiretroviral altamente ativa (HAART) e a doença adquiriu uma característica crônica. Entretanto, após a introdução da HAART, várias alterações metabólicas foram observadas, principalmente relacionadas ao perfil lipídico. OBJETIVO: Avaliar e comparar os perfis lipídicos, analisar o risco cardiovascular, e descrever a prevalência da síndrome metabólica em pacientes com AIDS tratados ou não com HAART. MÉTODOS: Durante um período de 18 meses, 319 pacientes tratados em ambulatórios na cidade de São Paulo, Brasil, foram selecionados. RESULTADOS: A amostra final incluiu 215 pacientes tratados com HAART e 69 pacientes virgens de tratamento com HAART. A idade média era 39,5 anos, e 60,9% eram do sexo masculino. Os principais fatores de risco cardiovascular eram o fumo (27%), hipertensão (18%) e histórico familiar de aterosclerose (40%). Os valores médios de colesterol total, HDL-colesterol, triglicérides e glicose foram mais altos no grupo HAART do que no grupo não-HAART (205 vs 180 mg/dl, 51 vs 43 mg/dl, 219 vs 164 mg/dl e 101 vs 93 mg/dl respectivamente; p < 0,001 para todos). De acordo com o escore de risco de Framingham, o risco cardiovascular era moderado a alto em 11% dos pacientes tratados com HAART e 4% dos pacientes não-HAART. De acordo com a definição do Adult Treatment Panel III, a síndrome metabólica foi observada em 13% e 12% dos pacientes, respectivamente, com e sem HAART. CONCLUSÃO: Embora os valores médios do colesterol total, HDL-c e triglicérides tenham sido mais altos no grupo HAART, um maior risco cardiovascular não foi identificado no primeiro grupo. A prevalência de síndrome metabólica foi comparável em ambos os grupos.Universidade Federal de São Paulo (UNIFESP)Secretaria Municipal de Saúde de São PauloUNIFESPSciEL

Avaliação do eixo hipotálamo-hipofisário-adrenocortical na síndrome de imunodeficiência adquirida (AIDS).

BV UNIFESP: Teses e dissertaçõe

Estudo da função adrenocortical na síndrome de imunodeficiência adquirida (AIDS).

BV UNIFESP: Teses e dissertaçõe

Less sensitive HIV-1 enzyme immunoassay as an adjuvant method for monitoring patients receiving antiretroviral therapy

Viral suppression after antiretroviral therapy is monitored by determining plasma HIV-1 through viral load assays. However, such assays only provide HIV-1 replication rates at the moment samples are drawn and do not reflect any trend in viremia fluctuation preceding sample collection. the objective of this study was to correlate the optical density (OD) of the less sensitive HIV-1 enzyme immunoassay (EIA), used in the serologic testing algorithm for recent HIV seroconversion, with viral loads in a group of HIV-infected patients on antiretroviral therapy. We studied samples from 20 previously antiretroviral-naive subjects treated with the zidovudine-lamivudine combination plus indinavir for a 20-week period. Viral loads were assessed using the less sensitive HIV-1 EIA at baseline and at 4-week intervals. There was a strong correlation between lower OD and viral load after introduction of antiretroviral drugs (p < 0.01). the ODs tended to decrease in parallel with drops in viral loads and remain steady when viral loads did not change significantly. These results suggest that the less sensitive HIV-1 EIA may be used as a complementary method for monitoring the efficacy of antiretroviral therapy, with special appeal in resource-poor areas where health professionals have limited laboratory expertise.Universidade Federal de São Paulo, Paulista Sch Med, Lab Retrovirol, BR-04039032 São Paulo, BrazilUniversidade Federal de São Paulo, Paulista Sch Med, Lab Retrovirol, BR-04039032 São Paulo, BrazilWeb of Scienc

Decrease in Lipoatrophy in a Pilot Study Using a Short-Term Treatment Interruption Strategy for 48 Weeks in São Paulo, Brazil

Universidade Federal de São Paulo, Retrovirol Lab, Div Infect Dis, Paulista Sch Med,EPM, BR-04039 São Paulo, BrazilUniversidade Federal de São Paulo, Retrovirol Lab, Div Infect Dis, Paulista Sch Med,EPM, BR-04039 São Paulo, BrazilWeb of Scienc

Imbalance between endothelial progenitors cells and microparticles in HIV-infected patients naive for antiretroviral therapy

Background: Cardiovascular events have been reported among HIV-infected patients following antiretroviral therapy. However, the role of HIV itself in determining vascular damage is less described. Chronic inflammatory state might impair some regulatory endothelium properties leading to its activation, apoptosis or erosion.Objectives: To evaluate the balance between endothelial progenitor cells and micro-particles in HIV-infected antiretroviral drug-naive patients.Design: A case-control study comparing HIV-infected patients (n = 35) with sex-matched and age-matched healthy controls (n = 33).Methods: Endothelial progenitor cells populations expressing CD34(+), CD133(+) and KDR(+) were quantified by flow cytometry. Endothelial-derived microparticles, expressing CD51(+), and platelet-derived microparticles, expressing CD31(+)/CD42(+), were also measured. Endothelial function was estimated by flow-mediated dilation.Results: Lower percentages of endothelial progenitor cells (CD34(+)/KDR(+)) were observed in HIV-infected individuals compared with controls (0.02 vs. 0.09%, P = 0.045). in addition, endothelial microparticles concentration was higher in HIV-infected individuals (1963 vs. 436 microparticles/ml platelet-poor plasma, P = 0.003), with similar number of platelet-derived microparticles among groups. Furthermore, flow-mediated dilation was lower among HIV-infected individuals compared with controls [mean (SEM): 10 (1) and 16% (2), respectively; P = 0.03].Conclusion: Our findings suggest an imbalance between endothelial progenitor cells mobilization and endothelial apoptosis. the alteration in the turnover of endothelial cells may contribute to cardiovascular events in HIV-infected patients. (C) 2011 Wolters Kluwer Health | Lippincott Williams & WilkinsFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Universidade Federal de São Paulo, Div Infect Dis, São Paulo, BrazilUniversidade Federal de São Paulo, Cardiovasc Div, Lipids Atherosclerosis & Vasc Biol Sect, São Paulo, BrazilUniversidade Federal de São Paulo, Div Infect Dis, São Paulo, BrazilUniversidade Federal de São Paulo, Cardiovasc Div, Lipids Atherosclerosis & Vasc Biol Sect, São Paulo, BrazilFAPESP: 2008/55223-6Web of Scienc