HIV-Associated Histoplasmosis

Impaired immunity induced by HIV is one of the main causes of disseminated histoplasmosis in endemic areas, and thus from 1987 WHO and then the CDC classified this condition as an AIDS-defining illness. Host factors associated independently with histoplasmosis are low level of CD4 ( 200 cell/mm3. In advanced disease, the most frequent manifestation is as disseminated histoplasmosis often acute and severe, with complications such as respiratory failure, circulatory shock, and disseminated intravascular coagulation. The subacute presentation is frequent, associated with moderate involvement of the reticuloendothelial system, with great variability of clinical manifestation. Guidelines for diagnosing and managing histoplasmosis among people living with HIV have been published from WHO, IDSA, NIH, but limited data was based on randomized clinical trials

Epidemiology of Histoplasmosis

More prevalent than initially considered, histoplasmosis is primarily a non-contagious disease of the reticuloendothelial system, producing a broad spectrum of clinical manifestations, ranging from asymptomatic or self-limited infection, in immunocompetent patients to life-threatening, disseminated disease in immunocompromised ones. The causative agent is H. capsulatum, a thermally dimorphic, intracellular fungus, discovered in 1906, by the pathologist Samuel Darling, when examined tissues from a young man whose death was mistakenly attributed to miliary tuberculosis. Since then, histoplasmosis was described on six continents, with high and low endemicity areas. H. capsulatum is a soil-based fungus, commonly associated with river valleys in the temperate zone, and with the presence of bird and bat guano. Infection occurs when saprophytic spores are inhaled and change to the pathogenic yeast in the lungs, where H. capsulatum overcomes many obstacles to cause host injuries. Depending on geographic distribution, morphology, and clinical symptoms, three varieties have been historically recognized, two of them (var. capsulatum and var. duboisii) being pathogen to humans, and the third (var. farciminosum) has predominantly been described as an equine pathogen. In endemic areas, patients with AIDS or people who receive immunosuppressive therapies should be counseled to avoid high-risk activities; otherwise, precautionary measures should be taken

ACQUIRED DRUG RESISTANCE TO NRTI CLASS IN TREATMENT-EXPERIENCED HIV INFECTED PATIENTS FROM THE CONSTANTA COUNTY: THERAPEUTIC IMPLICATIONS

Objective. To determine the prevalence of acquired drug resistance (ADR) and of resistance patterns in treatment-experienced HIV infected patients from Constanta in order to establish the best therapeutic options in NRTI class. Material and methods. A retrospective study which included 144 treatment-experienced HIV patients with confirmed viral failure. The strains isolated from these patients were analysed in the Molecular Genetic Laboratory of „Matei Bals“ National Institute of Infectious Diseases, Bucharest and the resulting sequences were saved in FASTA format. The HIV-1 subtyping was based on „REGA HIV01&2 Automated subtyping tool version 2.0“ algorithm. „Stanford HIVdb Program version 8.4“ was used in order to determine the therapeutic options. For statistical calculations, the R-Project software was used. Graphic representations were performed using GNUPLOT program. Results. The prevalence of the acquired drug resistance was 92.36%. The most frequent mutation occurred at the level of the codon 184. The TAM-2 path was more frequently selected compared to TAM-1. Association between TAM1 and TAM 2 were also found, mutation K65R being rarely met. Conclusions. The prevalence of the acquired drug resistance in our study was high, The most valuable therapeutic option in the INRT class remains tenofovir, due to the mutational profile, which was selected on account of the extensive use of thymidine analogues

REZISTENŢA LA INRT LA PACIENŢII MULTIPLU EXPERIMENTAŢI DIN CONSTANŢA: IMPLICAŢII TERAPEUTICE

Obiective. Identificarea prevalenţei rezistenţei dobândite la INRT (inhibitorii non-nucleozidici de reverstranscriptază) şi al profilelor de rezistenţă la un lot de pacienţi cu multiple scheme de terapie antiretrovirală din Constanţa şi evaluarea opţiunilor terapeutice remanente. Material şi metode. Studiu retrospectiv ce a inclus 144 pacienţi seropozitivi HIV, multiplu experimentaţi terapeutic, aflaţi în eşec virusologic. Tulpinile izolate de la aceşti pacienţi au fost analizate în Laboratorul de Genetică Moleculară al Institutului Naţional de Boli Infecţioase „Matei Balş“ din Bucureşti, secvenţele rezultate fiind salvate în format Fasta. Subtiparea HIV-1 s-a efectuat pe baza algoritmului „REGA HIV-1&2 Automated subtyping tool version 2.0“. Pentru determinarea opţiunile terapeutice s-a utilizat „Stanford HIVdb Program version 8.4“. Datele au fost prelucrate statistic cu programul R-Project. Reprezentările grafice au fost realizate cu programul GNUPLOT. Rezultate. Prevalenţa rezistenţei dobândite a fost de 92,36%. Cea mai frecventă mutaţie a fost la nivelul codonului 184. Calea TAM-2 a fost mai frecvent selectată decât TAM-1, existând şi asociaţii între cele douăcăi; în schimb, mutaţia K65R a fost rar întâlnită. Concluzii. Prevalenţa rezistenţei dobândite la INRT a fost crescută. Opţiunea terapeutică cea mai valoroasă în clasa INRT a ramas tenofovirul, datorită profilului mutaţional selectat, mai ales din cauza neutilizării lui şi a folosirii extensive anterioare a analogilor timidinici

Real-time extraction of the respiratory rate from photoplethysmographic signal using wearable devices

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