Perfil clínico-epidemiológico de pacientes coinfectados por Tuberculose/HIV acompanhados em serviço de referência HIV/aids em Nova Iguaçu, RJentre 2010-2014

Made available in DSpace on 2016-03-28T12:47:36Z (GMT). No. of bitstreams: 2 tania_brum_ioc_mest_2014.pdf: 2158293 bytes, checksum: 90c12b218d7d41525e376e2de32c26d9 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2016-01-13Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, BrasilO vírus da imunodeficiência humana (HIV) associado à tuberculose (TB) permanece como o maior desafio para a saúde pública global. TB é considerada, atualmente, a doença oportunista mais importante entre os pacientes portadores de HIV/aids nos países em desenvolvimento como o Brasil. A coinfecção TB/HIV é um desafio tanto para o seu diagnóstico quanto para o seu tratamento. Objetivo: Estudar a coinfecção TB/HIV em pacientes atendidos no Serviço de Assistência Especializada (SAE) em HIV/aids de Nova Iguaçu no período compreendido entre julho de 2010 e junho de 2014. Métodos: Estudo retrospectivo realizado entre julho de 2010 e junho de 2014 com 127 pacientes coinfectados TB/HIV no Serviço de Assistência Especializada (SAE) em HIV/aids de Nova Iguaçu, no Estado do Rio de Janeiro. Foram analisados dados referentes às características clínicas, radiológicas e laboratoriais, bem como, às condições de diagnóstico, acompanhamento e finalização dos casos. Os prontuários desses pacientes foram revistos usando formulário especialmente elaborado para a captura dos dados de interesse do estudo. Casos de síndrome inflamatória de reconstituição imune associada à TB-HIV (TB/IRIS) foram identificados e descritos. Resultados: Dos 127 pacientes estudados 45 (35,4%) tinham diagnóstico simultâneo de HIV e 82 (64,6%) tinham diagnóstico não simultâneo de HIV no momento do diagnóstico da TB. Pacientes com diagnóstico não simultâneo de HIV tinham imunossupressão menos avançada do que aqueles com diagnóstico simultâneo de HIV (mediana da contagem CD4: 232 células/\03BCl versus mediana da contagem CD4: 126 células/\03BCl) no início do tratamento de TB Isso sugere que o diagnóstico da infecção HIV foi feito muito tardiamente nesse grupo de diagnóstico simultâneo de HIV. A mediana de carga viral inicial foi > 4.0 log10 nos dois grupos de pacientes (diagnóstico simultâneo e diagnóstico não simultâneo). No conjunto estudado, predominou o sexo masculino (63,8%), a TB pulmonar (48%) e raio X suspeito de TB (62,2%). O exame de escarro foi positivo em somente 13/68 pacientes (19,1%). O tratamento de TB foi empírico em 85 (67%) pacientes e quase todos os pacientes (93,7%) iniciaram o esquema RHZE. Na finalização dos casos, observou-se que a maioria dos pacientes completou o tratamento (76,4%), entretanto, houve 21 (16,5%) abandonos e três (2,4%) óbitos. Foram identificados oito casos (6,3%) de TB/IRIS de gravidade leve a moderada e com resolução completa dos sintomas. Conclusão: A coinfecção TB/HIV acometeu predominantemente homens, a forma clínica mais frequente foi a pulmonar e a maioria dos pacientes teve o diagnóstico não simultâneo de infecção pelo HIV. O número de tratamentos empíricos foi alto, entretanto, na maioria dos casos os pacientes apresentaram melhora clínica. Contudo, a taxa de abandono foi elevada se comparada com as metas do Programa Nacional de Controle da TuberculoseImmunodeficiency virus (HIV) associated with tuberculosis (TB) remains a major challenge to global public health. TB is currently considered the most important opportunistic infectious disease among HIV - 1 - infected subjects in developing countries, such as Brazil. Objective: To study the TB/HIV - co infected patients treated at the Specialized Care Service ( SAE) in HIV/aids in Nova Iguaçu in the period between July 2010 and June 2014. Methods: A retrospective study was conducted between July 2010 and June 2014 with 127 patients who were TB/HIV - co infected, in the Specialized Care Service ( SAE) in HIV/aids Nova Iguaçu, state of Rio de Janeiro. All data related to clinical, radiological and laboratory characteristics, as we ll as the conditions for HIV/TB diagnosis, follow - up and termination of cases were analyzed. All the data of 127 patients were abstracted via chart review using a form especially made for the study . Additionally, immune reconstitution inflammatory syndrom e - TB associated were identified and described . Results: Of the 127 patients participating in the study, 45 (35.4%) had recent HIV diagnosis and 82 (64.6%) were previously diagnosed with HIV at the time TB was diagnosed. Patients with a previous HIV diagno sis had their immunosuppression less advanced than those with recent HIV diagnosis (median CD4 count 232 cells/μl versus median CD4 count 126 cells/μl). This suggests that the diagnosis of HIV infection was made too late in the newly diagnosed group with H IV. The median viral load was > 4.0 log 10 in both groups of patients (recent and previous diagnosis ) . The study population considered in its totality was mostly men (63.8%), had pulmonary TB (48%) and a TB - suspicious chest x - ray (62 .2%). Sputum examination was positive in only 13 /68 patients (19.1%). The TB treatment has been empirical in 85 (67%) patients, and almost all patients (93.7%) started the RHZE regimen. The majority of patients completed treatment (76.4%). There were 21 (16.5%) dropouts and 3 dea ths. There were 8 cases (6.3%) of TB/IRIS from mild to moderate severity with complete resolution of symptoms. Conclusion: The co infection TB/HIV affected mostly men, pulmonary TB was the most frequent clinical form and the majority had previous HIV diagno sis at TB diagnosis. The number of empirical treatment was high, however the majority improved clinically at the end of TB treatment. Meantime, the default rate was high in relation to the National TB Control Program goal

Changes in the NK cell repertoire related to initiation of TB treatment and onset of immune reconstitution inflammatory syndrome in TB/HIV co-infected patients in Rio de Janeiro, Brazil-ANRS 12274

Submitted by Janaína Nascimento ([email protected]) on 2019-12-13T14:36:39Z No. of bitstreams: 1 ve_Giacoia-Gripp_Carmem_etal_INI_2019.pdf: 6220733 bytes, checksum: f410b79bb31706b3a1ef853889ee7b8a (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-12-13T14:59:57Z (GMT) No. of bitstreams: 1 ve_Giacoia-Gripp_Carmem_etal_INI_2019.pdf: 6220733 bytes, checksum: f410b79bb31706b3a1ef853889ee7b8a (MD5)Made available in DSpace on 2019-12-13T14:59:57Z (GMT). No. of bitstreams: 1 ve_Giacoia-Gripp_Carmem_etal_INI_2019.pdf: 6220733 bytes, checksum: f410b79bb31706b3a1ef853889ee7b8a (MD5) Previous issue date: 2019Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Aids e Imunologia Molecular. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Aids e Imunologia Molecular. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Aids e Imunologia Molecular. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.Nova Iguaçu General Hospital. HIV Clinical Research Center. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa em Imunização e Vigilância em Saúde. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Plataforma de Pesquisa Clínica. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Aids e Imunologia Molecular. Rio de Janeiro, RJ, Brasil / Nova Iguaçu General Hospital. HIV Clinical Research Center. Rio de Janeiro, RJ, Brazil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em Micobacterioses. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Aids e Imunologia Molecular. Rio de Janeiro, RJ, Brasil.Pasteur Institute. Unit of Lymphocyte Cell Biology. Paris, France.Tuberculosis (TB) is the most common comorbidity and the leading cause of death among HIV-infected individuals. Although the combined antiretroviral therapy (cART) during TB treatment improves the survival of TB/HIV patients, the occurrence of immune reconstitution inflammatory syndrome (IRIS) in some patients poses clinical and scientific challenges. This work aimed to evaluate blood innate lymphocytes during therapeutic intervention for both diseases and their implications for the onset of IRIS. Natural killer (NK) cells, invariant NKT cells (iNKT), γδ T cell subsets, and in vitro NK functional activity were characterized by multiparametric flow cytometry in the following groups: 33 TB/HIV patients (four with paradoxical IRIS), 27 TB and 25 HIV mono-infected subjects (prior to initiation of TB treatment and/or cART and during clinical follow-up to 24 weeks), and 25 healthy controls (HC). Concerning the NK cell repertoire, several activation and inhibitory receptors were skewed in the TB/HIV patients compared to those in the other groups, especially the HCs. Significantly higher expression of CD158a (p = 0.025), NKp80 (p = 0.033), and NKG2C (p = 0.0076) receptors was detected in the TB/HIV IRIS patients than in the non-IRIS patients. Although more NK degranulation was observed in the TB/HIV patients than in the other groups, the therapeutic intervention did not alter the frequency during follow-up (weeks 2-24). A higher frequency of the γδ T cell population was observed in the TB/HIV patients with inversion of the Vδ2+/Vδ2- ratio, especially for those presenting pulmonary TB, suggesting an expansion of particular γδ T subsets during TB/HIV co-infection. In conclusion, HIV infection impacts the frequency of circulating NK cells and γδ T cell subsets in TB/HIV patients. Important modifications of the NK cell repertoire were observed after anti-TB treatment (week 2) but not during the cART/TB follow-up (weeks 6-24). An increase of CD161+ NK cells was related to an unfavorable outcome. Despite the low number of cases, a more preserved NK cell profile was detected in IRIS patients previous to treatment, suggesting a role for these cells in IRIS onset. Longitudinal evaluation of the NK repertoire showed the impact of TB treatment and implicated these cells in TB pathogenesis in TB/HIV co-infected patients

Ambulatory and hospitalized patients with suspected and confirmed mpox: an observational cohort study from BrazilResearch in context

Summary: Background: By October 30, 2022, 76,871 cases of mpox were reported worldwide, with 20,614 cases in Latin America. This study reports characteristics of a case series of suspected and confirmed mpox cases at a referral infectious diseases center in Rio de Janeiro, Brazil. Methods: This was a single-center, prospective, observational cohort study that enrolled all patients with suspected mpox between June 12 and August 19, 2022. Mpox was confirmed by a PCR test. We compared characteristics of confirmed and non-confirmed cases, and among confirmed cases according to HIV status using distribution tests. Kernel estimation was used for exploratory spatial analysis. Findings: Of 342 individuals with suspected mpox, 208 (60.8%) were confirmed cases. Compared to non-confirmed cases, confirmed cases were more frequent among individuals aged 30–39 years, cisgender men (96.2% vs. 66.4%; p < 0.0001), reporting recent sexual intercourse (95.0% vs. 69.4%; p < 0.0001) and using PrEP (31.6% vs. 10.1%; p < 0.0001). HIV (53.2% vs. 20.2%; p < 0.0001), HCV (9.8% vs. 1.1%; p = 0.0046), syphilis (21.2% vs. 16.3%; p = 0.43) and other STIs (33.0% vs. 21.6%; p = 0.042) were more frequent among confirmed mpox cases. Confirmed cases presented more genital (77.3% vs. 39.8%; p < 0.0001) and anal lesions (33.1% vs. 11.5%; p < 0.0001), proctitis (37.1% vs. 13.3%; p < 0.0001) and systemic signs and symptoms (83.2% vs. 64.5%; p = 0.0003) than non-confirmed cases. Compared to confirmed mpox HIV-negative, HIV-positive individuals were older, had more HCV coinfection (15.2% vs. 3.7%; p = 0.011), anal lesions (45.7% vs. 20.5%; p < 0.001) and clinical features of proctitis (45.2% vs. 29.3%; p = 0.058). Interpretation: Mpox transmission in Rio de Janeiro, Brazil, rapidly evolved into a local epidemic, with sexual contact playing a crucial role in its dynamics and high rates of coinfections with other STI. Preventive measures must address stigma and social vulnerabilities. Funding: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz)

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

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