Posts filed under ‘HIV/SIDA Laboratorio’

Cryptococcus neoformans Pulmonary Infection in HIV-1-Infected Patients

Journal of Acquired Immune Deficiency Syndrome May 1990 V.3  N.5 P.480-484

Clark, Rebecca A.; Greer, Donald L.; Valainis, Gregory T…..

Cryptococcus neoformans (Cn) is a frequent pathogen in patients infected with the human immunodeficiency virus (HIV-1).

We review the initial presentation and clinical course of 18 HIV-1-infected (HIV +) patients with a Cn pulmonary infection. Simultaneous positive cerebrospinal fluid (CSF) cultures were found in 10 (63%) of 16 examined.

The most frequent presenting symptoms were fever (87%) and pulmonary complaints (60%).

Although the most common chest radiographic finding was bilateral diffuse interstitial infiltrates, nodules and cavitary lesions were also seen. Nine (50%) of the 18 patients died within 6 weeks of diagnosis.

Of six patients with an isolated Cn pulmonary infection, five have subsequently died.

Three of these five patients did not receive maintenance therapy and had confirmed or probable relapse.

Patients initially presenting with an isolated Cn pulmonary infection may later show disseminated disease, suggesting that such patients should receive both acute and maintenance therapy.




November 24, 2018 at 8:01 pm

Clinical and epidemiological features of chronic Trypanosoma cruzi infection in patients with HIV/AIDS in Buenos Aires, Argentina

International Journal of Infectious Diseases February 2018 V.67 P.118–121

Andrés Guillermo Benchetrit, Marisa Fernández, Amadeo Javier Bava, Marcelo Corti, Norma Porteiro, Liliana Martínez Peralta


  • Chagas disease reactivation is an AIDS-defining illness with a high mortality rate.
  • Besides the vector-borne route, other means of T. cruzi infection acquisition must be assessed.
  • HIV-infected patients with lower CD4 T-cell counts are at higher risk of Chagas disease reactivation.
  • Severely immunecompromised patients infected with T. cruzi may have negative serological assay results.
  • Direct parasitological techniques should be performed in the diagnosis of patients for whom there is a suspicion of T. cruzi reactivation.


Trypanosoma cruzi reactivation in HIV patients is considered an opportunistic infection, usually with a fatal outcome. The aim of this study was to describe the epidemiological and clinical features of T. cruzi infection in HIV patients and to compare these findings between patients with and without Chagas disease reactivation.


The medical records of T. cruzi–HIV co-infected patients treated at the Muñiz Infectious Diseases Hospital from January 2005 to December 2014 were reviewed retrospectively. Epidemiological and clinical features were assessed and compared between patients with and without Chagas disease reactivation.


The medical records of 80 T. cruzi–HIV co-infected patients were reviewed. The most likely route of T. cruzi infection was vector-borne (32/80 patients), followed by intravenous drug use (12/80). Nine of 80 patients had reactivation. Patients without reactivation had a significantly higher CD4 T-cell count at diagnosis of T. cruzi infection (144 cells/μl vs. 30 cells/μl, p = 0.026). Chagas disease serology was negative in two of nine patients with reactivation.


Serological assays for T. cruzi infection may be negative in severely immunocompromised patients. Direct parasitological techniques should be performed in the diagnosis of patients for whom there is a suspicion of T. cruzi reactivation. HIV patients with a lower CD4 count are at higher risk of reactivation.



February 18, 2018 at 4:05 pm

Fiebre de origen desconocido en pacientes HIV positivos

ANALES DE MEDICINA INTERNA (Madrid), 2001 V.18 N.4 P.181-186



Departamento de Medicina Interna y Enfermedades Infecciosas. Hospital Severo Ochoa.

Leganés. Madrid



Describir la presentación clínica y la utilidad de los de tests diagnósticos habitualmente recomendados en el estudio de la fiebre de origen desconocido (FOD) en los pacientes VIH positivos.

Pacientes y métodos

Incluimos en el estudio a los 54 pacientes con infección por el VIH que ingresaron en nuestro Hospital por FOD durante un periodo de 23 meses. La FOD fue definida de acuerdo con los criterios modificados de Petersdorf´s.


La causa de la fiebre se identificó en 48 casos (89%). La tuberculosis, la micobacteriosis atípica y la leishmaniasis pueden explicar el 68% de los casos. El aspirado de médula ósea, la punción aspiración o la biopsia de los ganglios linfáticos y los cultivos para micobacterias fueron las pruebas diagnósticas más rentables.


La infección por micobacterias debe ser el primer diagnóstico de sospecha en los pacientes VIH positivos con FOD. Es posible precedir el diagnóstico de tuberculosis con una alta precisión (90,5%) con un modelo de regresión logística basado en datos clínicos y analíticos fácilmente obtenibles.


November 21, 2017 at 8:41 am


MEDICINA (Buenos Aires) 2000 V.60 N.5 P.623-630


Primera Cátedra de Clínica Médica y Terapéutica, Facultad de Ciencias Médicas, Universidad Nacional de Rosario; Hospital Provincial del Centenario, Rosario

La fiebre de origen desconocido (FOD) es frecuente en pacientes infectados por el HIV. Existen numerosas causas que pueden originar FOD y su frecuencia relativa depende de múltiples factores. Usualmente se debe a una infección oportunista agregada.

La evaluación diagnóstica depende de la presentación clínica y del estadio de la infección por HIV. Existe una asociación entre el recuento de linfocitos CD4 y ciertas enfermedades oportunistas que pueden originar FOD.

El área geográfica y la prevalencia local de infecciones endémicas es un factor importante. Las infecciones de distribución mundial como la tuberculosis siempre deben ser consideradas y otras como la histoplasmosis diseminada son causa frecuente de FOD en áreas endémicas como la Argentina.

La mayor utilidad diagnóstica se obtiene con los cultivos de esputo y hemocultivos para micobacterias, y entre los métodos invasivos con cultivos a partir de la aspiración/biopsia de ganglio linfático, la biopsia de médula ósea y la biopsia hepática.

La eficacia del tratamiento empírico ha sido documentada en ciertas infecciones.


November 21, 2017 at 8:34 am

2017-07 Guidelines for the managing advanced HIV disease and rapid initiation of antiretroviral therapy. WHO 56 pags


The objectives of these guidelines are to provide recommendations outlining a public health approach to managing people presenting with advanced HIV disease, and to provide guidance on the timing of initiation of antiretroviral therapy (ART) for all people living with HIV.

The first set of recommendations addresses the specific needs of people with advanced HIV disease and defines a package of interventions aimed at reducing HIV-associated morbidity and mortality. WHO recommends that a package of screening, prophylaxis, rapid ART initiation and intensified adherence interventions be offered to everyone living with HIV presenting with advanced disease. This is a strong recommendation that applies to all populations and age groups. The guidelines also include an algorithm to support decision making for providing care for people with advanced HIV disease.

The second set of recommendations defines how rapidly ART should be initiated within the context of the “treat all” policy, especially when coinfections are present. WHO strongly recommends that rapid ART initiation should be offered to people living with HIV following confirmed diagnosis and clinical assessment. Rapid initiation of ART is defined as within seven days of HIV diagnosis. WHO further strongly recommends ART initiation on the same day as HIV diagnosis based on the person’s willingness and readiness to start ART immediately, unless there are clinical reasons to delay treatment. Both of these recommendations apply to all populations and age groups. People with advanced HIV disease should be given priority for clinical assessment and treatment initiation.


August 7, 2017 at 9:56 am

HIV DRUG RESISTANCE REPORT 2017 – WHO – CDC – The Global Fund 82 pags.

Antimicrobial resistance (AMR) is a growing global public health threat, which urgently requires collective action to ensure effective prevention and treatment of infections. Minimizing the emergence and transmission of HIV drug resistance (HIVDR) is a critical aspect of the broader global response to AMR. Prevention, monitoring and response to HIVDR is key to building and sustaining gains in HIV treatment scale-up, and achieving the global 90-90-90 targets for treatment. These widely adopted targets reflect the global community’s commitment to expanding access to antiretroviral therapy (ART) including: diagnosing 90% of all people with HIV infection; providing treatment to 90% of those diagnosed; and ensuring 90% of people on treatment achieve virological suppression, by 2020. By the end of 2016, 70% of people living with HIV (PLHIV) were diagnosed,77% of those who knew their HIV status received ART, and 82% of those on treatment were virally suppressed…


August 7, 2017 at 8:03 am

Identification of Acute HIV-1 Infection by Hologic Aptima HIV-1 RNA Qualitative Assay

Clin. Microbiol. July 2017 55:2064-2073

Mark M. Manak, Leigh Anne Eller, Jennifer Malia, Linda L. Jagodzinski, Rapee Trichavaroj, Joseph Oundo, Cornelia Lueer, Fatim Cham, Mark de Souza, Nelson L. Michael, Merlin L. Robb, and Sheila A. Peel

aU.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, USA

bHenry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA

cArmed Forces Research Institute of Medical Sciences, Bangkok, Thailand

dWalter Reed Project, Kericho, Kenya

eMbeya Medical Research Centre, Mbeya, Tanzania

fMakerere University Walter Reed Project, Kampala, Uganda

The Hologic Aptima HIV-1 Qualitative RNA assay was used in a rigorous screening approach designed to identify individuals at the earliest stage of HIV-1 infection for enrollment into subsequent studies of cellular and viral events in early infection (RV 217/Early Capture HIV Cohort [ECHO] study).

Volunteers at high risk for HIV-1 infection were recruited from study sites in Thailand, Tanzania, Uganda, and Kenya with high HIV-1 prevalence rates among the populations examined. Small-volume blood samples were collected by finger stick at twice-weekly intervals and tested with the Aptima assay.

Participants with reactive Aptima test results were contacted immediately for entry into a more comprehensive follow-up schedule with frequent blood draws. Evaluation of the Aptima test prior to use in this study showed a detection sensitivity of 5.5 copies/ml (50%), with all major HIV-1 subtypes detected. A total of 54,306 specimens from 1,112 volunteers were examined during the initial study period (August 2009 to November 2010); 27 individuals were identified as converting from uninfected to infected status.

A sporadic reactive Aptima signal was observed in HIV-1-infected individuals under antiretroviral therapy. Occasional false-reactive Aptima results in uninfected individuals, or nonreactive results in HIV-1-infected individuals not on therapy, were observed and used to calculate assay sensitivity and specificity.

The sensitivity and specificity of the Aptima assay were 99.03% and 99.23%, respectively; positive and negative predictive values were 92.01% and 99.91%, respectively.

Conversion from HIV-1-uninfected to -infected status was rapid, with no evidence of a prolonged period of intermittent low-level viremia.


June 23, 2017 at 3:39 pm

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