The Brazilian Journal of Infectious Diseases

p. 211-216Forty-nine AIDS patients, most of who were antiretroviral therapy (ARV) naïve, with active tuberculosis, were treated with Rifampin 600mg, Isoniazid 400mg and Pirazinamide 2g daily. They also received ARV, consisting of Efavirenz (600mg/day) plus 2 NRTIs. All patients were prospectively followed for at least 24 months. Baselines were: male/female ratio 2:1, mean age 34.7 ± 9.4 yrs; weight 51 ± 9.0 kg, viral load 5.6 ± 0.6 logs, CD4 cell count 101 ± 128 cells/ mm3. Follow up mean values of data logs of VL and CD4 + cell /mm3 counts were: VL 1.7 and CD4 + 265; VL 1.3 and CD4 + 251; VL 1.4 and CD4 + 326 at 6, 12 and 24 months, respectively. Weight gain changes were: 5 ± 9.9 ± 12 and 21 ± 16 kg respectively at 6, 12 and 24 months. A non-concomitant ARV regimen was introduced at least three weeks after TB treatment initiation. Severe adverse reactions included rash (two), toxic hepatitis (six), Immune Reconstitution Syndrome (seven), and four deaths. We conclude that Efavirenz at a daily dose of 600 mg is sufficient and safe to treat HIV/TB patients using a Rifampin containing regimen

Use of rhu-GM-CSF in pulmonary tuberculosis patients: results of a randomized clinical trial

It has been postulated that deficient or incomplete clinical and/or microbiological response to tuberculosis treatment is associated with cell-mediated immunological dysfunction involving monocytes and macrophages. A phase 2 safety trial was conducted by treating patients with either recombinant human granulocyte-macrophage colony-stimulating factor (rhu-GM-CSF) or a placebo, both in combination with anti-tuberculosis chemotherapy. Thirty-one patients with documented pulmonary tuberculosis were treated with rifampin/isoniazid for six months, plus pyrazinamide for the first two months. At the beginning of treatment, rhu-GM-CSF (125µg/M²) was randomly assigned to 16 patients and injected subcutaneously twice weekly for four weeks; the other 15 patients received a placebo. The patients were accompanied in the hospital for two weeks, then monthly on an out patient basis, for 12 months. Clinical outcomes were similar in both groups, with no difference in acid-fast bacilli (AFB) clearance in sputum at the end of the fourth week of treatment. Nevertheless, a trend to faster conversion to negative was observed in the rhu-GM-CSF group until the eighth week of treatment (p=0.07), after which all patients converted to AFB negative. Adverse events in the rhu-GM-CSF group were local skin inflammation and an increase in the leukocyte count after each injection, returning to normal 72 hours after rhu-GM-CSF injection. Three patients developed SGOP and SGPT > 2.5 times the normal values. All patients included in the GM-CSF group were culture negative at six months, except one who had primary TB resistance. None of the patients had to discontinue the treatment in either group. We conclude that rhu-GM-CSF adjuvant immunotherapy could be safely explored in a phase 3 trial with patients who have active tuberculosis

The Brazilian Journal of Infectious Diseases

p. 6-11Objective: To compare the clinical characteristics and outcomes of HIV-1-HTLV-1 coinfected patients, in Bahia, Brazil. Methods: Retrospective, comparative study. Results: Among a total of 123 consecutive HIV infected patients, 20 men (20.6%) and 6 women (23.1%) had detectable antibodies against HTLV-I/II. The major risk factor associated with coinfection by HTLV was intravenous drug use (57.7% of coinfected patient versus 9.2% of HTLV seronegative patients, p < 0.0001). Coinfected patients had higher absolute lymphocyte counts (1,921 + 762 versus 1,587 + 951, p = 0.03). Both groups of patients had similar means of CD4+ and CD8+ cell counts. However, among patients with AIDS CD4+ cell counts were signifi cantly higher among those coinfected with HTLV-I/II (292 ± 92 cells/mm3, versus 140 ± 177cells/mm3, p = 0.36). The frequency and type of opportunistic infections were similar for both groups, but strongyloidiasis and encephalopathy were more frequently diagnosed in coinfected patients (p < 0.05). On the other hand, patients coinfected with HTLV-I/II received signifi cantly less antiretroviral therapy than singly infected by HIV-1. Conclusion: Coinfection by HTLV-I/II is associated with an increased risk of strongyloidiasis for HIV patients. Higher CD4 count may lead to underestimation of immunodefi ciency, and delay to initiate antiretroviral therapy

Brazilian Journal of Infectious Diseases

p.245-252It has been postulated that deficient or incomplete clinical and/or microbiological response to tuberculosis treatment is associated with cell-mediated immunological dysfunction involving monocytes and macrophages. A phase 2 safety trial was conducted by treating patients with either recombinant human granulocyte-macrophage colony-stimulating factor (rhu-GM-CSF) or a placebo, both in combination with anti-tuberculosis chemotherapy. Thirty-one patients with documented pulmonary tuberculosis were treated with rifampin/isoniazid for six months, plus pyrazinamide for the first two months. At the beginning of treatment, rhu-GM-CSF (125µg/M2) was randomly assigned to 16 patients and injected subcutaneously twice weekly for four weeks; the other 15 patients received a placebo. The patients were accompanied in the hospital for two weeks, then monthly on an out patient basis, for 12 months. Clinical outcomes were similar in both groups, with no difference in acid-fast bacilli (AFB) clearance in sputum at the end of the fourth week of treatment. Nevertheless, a trend to faster conversion to negative was observed in the rhu-GM-CSF group until the eighth week of treatment (p=0.07), after which all patients converted to AFB negative. Adverse events in the rhu-GM-CSF group were local skin inflammation and an increase in the leukocyte count after each injection, returning to normal 72 hours after rhu-GM-CSF injection. Three patients developed SGOP and SGPT > 2.5 times the normal values. All patients included in the GM-CSF group were culture negative at six months, except one who had primary TB resistance. None of the patients had to discontinue the treatment in either group. We conclude that rhu-GM-CSF adjuvant immunotherapy could be safely explored in a phase 3 trial with patients who have active tuberculosis.Salvado

Prevalence and risk of blood-borne and sexually transmitted viral infections in incarcerated youth in Salvador, Brazil: opportunity and obligation for intervention

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2015-06-03T14:08:57Z No. of bitstreams: 1 Fialho M Prevalence and Risk of Blood....pdf: 201517 bytes, checksum: 25fa3d4b37bf635e1d217c15d75f1729 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2015-06-03T14:23:47Z (GMT) No. of bitstreams: 1 Fialho M Prevalence and Risk of Blood....pdf: 201517 bytes, checksum: 25fa3d4b37bf635e1d217c15d75f1729 (MD5)Made available in DSpace on 2015-06-03T14:23:47Z (GMT). No. of bitstreams: 1 Fialho M Prevalence and Risk of Blood....pdf: 201517 bytes, checksum: 25fa3d4b37bf635e1d217c15d75f1729 (MD5) Previous issue date: 2008Centro de Referência do Estado da Bahia para AIDS. CREAIDS. Salvador, BA, Brasil.Centro de Referência do Estado da Bahia para AIDS. CREAIDS. Salvador, BA, Brasil,University of California San Francisco. Center for AIDS Prevention Studies. San Francisco, CA, USA,Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil,Centro de Referência do Estado da Bahia para AIDS. CREAIDS. Salvador, BA, Brasil,Universidade Federal da Bahia. Infectious Diseases Service. Salvador, BA, Brasil,Centro de Estudos em AIDS do Rio Grande do Sul . CEARGS. Porto Alegre, RS, Brasil,Universidade Federal da Bahia. Infectious Diseases Service. Salvador, BA, Brasil,To determine the prevalence of sexually transmitted and blood-borne infections among incarcerated adolescents in Salvador, Brazil, we interviewed 300 incarcerated youth aged 11-18 years to participate in a physical examination and to provide a blood sample to test for HIV-1, hepatitis B and C viruses exposure, human T-cells lymphotrophic virus, and syphilis. Overall prevalence was anti-HIV, 0.34%; anti-HBc, 11.1%; HBsAg, 2.4%; anti-HCV, 6.4%; HTLV, 1.09%; and syphilis, 3.4%. The majority (86.3%) reported a history of sexual activity; 27% had never used condoms. Girls also reported previous pregnancy (35%), abortion (26%) and sexual abuse (74%). Many youth reported a family history of alcohol abuse (56%), illicit drug use (24.7%), or legal problems (38%). Serological results show that youth in Salvador are at high risk for blood-borne and sexually transmitted infections. Policies to reduce the risk and impact of these infections should be a requisite part of health care for incarcerated youth