Coinfection by HIV-1 and human lymphotropic virus type 1 in Brazilian children is strongly associated with a shorter survival time

Coinfection by HIV-1 and human lymphotropic virus type 1 is a frequent finding in South America, the Caribbean and Africa, and its prevalence varies from 4% to 16% according to the available reports. Although the impact of coinfection on HIV disease is still controversial, there is evidence supporting the contention that it can affect the natural history of both infections. No information is available on coinfection in children. In a nested case-control study, we evaluated 35 coinfected children matched by age, gender, and time of diagnosis to HIV monoinfected control subjects. At the first evaluation, coinfected children were more likely to present any signs and symptoms of disease (P < 0.001) than monoinfected ones despite having significantly higher CD4 cells count (1429 ± 608 vs 928 ± 768 cells/mm; P = 0.003). The proportion of deaths was higher (80%) for coinfected children than for HIV-1-infected ones (20%; relative risk, 2.1; 95% confidence interval, 1.4-3.1; P = 0.01). Survival was also significantly shorter for coinfected children (P = 0.001). Coinfection by HIV-1 and human lymphotropic vírus type 1 in Brazilian children was strongly associated with higher mortality and shorter survival time despite coinfected patients having a higher baseline CD4 cells count.     

Elevated levels of bilirubin and long-term exposure impair human brain microvascular endothelial cell integrity

The pathogenesis of encephalopathy by unconjugated bilirubin (UCB) seems to involve the passage of high levels of the pigment across the blood-brain barrier (BBB) and the consequent damage of neuronal cells. However, it remains to be clarified if and how the disruption of BBB occurs by UCB. We used confluent monolayers of human brain microvascular endothelial cells (HBMEC) to explore the sequence of events produced by UCB. A cell line and primary cultures of HBMEC were exposed to 50 or 100 μM UCB, in the presence of 100 μM human serum albumin, to mimic moderate and severe jaundice, for 1-72 h. UCB caused loss of cell viability in a concentration-dependent manner. UCB inhibited the secretion of interleukin-6, interleukin-8, monocyte chemoattractant protein-1 and vascular endothelial growth factor at early time points, but enhanced their secretion at later time points. Upregulation of mRNA expression, particularly by 100 μM UCB, preceded cytokine secretion. Other early events include the disruption of glutathione homeostasis and the increase in endothelial nitric oxide synthase expression followed by nitrite production. Prolonged exposure to UCB upregulated the expression of β-catenin and caveolin-1. In conclusion, elevated concentrations of UCB affect the integrity of HBMEC monolayers mediated by oxidative stress and cytokine release. UCB also induced increased expression of caveolin-1, which has been associated with BBB breakdown, and β-catenin, probably as an attempt to circumvent that impairment. These findings provide a basis for target-directed therapy against brain endothelial injury caused by UCB.     

Virological suppression in children and adolescents is not influenced by genotyping,but depends on optimal adherence to antiretroviral therapy

Objective

To evaluate the virological outcomes in children and adolescents infected with HIV-1 in Salvador, Bahia according to genotyping results.

Pyoderma gangrenosum – a review of 24 cases observed over 10 years

Background and objectives Pyoderma gangrenosum (PG) is a disorder, included in the spectrum of neutrophilic and auto‐inflammatory dermatoses, whose clinical aspects and outcome we intend to characterize. Materials and methods In a retrospective study based on files of patients diagnosed during a 10‐year period (2000–2009), we evaluated demographic data, anatomic locations, number of lesions, clinical variants, associated diseases, treatment regimens, healing time, and recurrence. Results A total of 24 patients were included, 19 women and five men (F/M = 3.8/1), aged between 17 and 89 years (mean 58.3 ± 24.6 years) with a diagnosis of PG. Lesions, single in 15 patients (62.5%) and multiple in nine (37.5%), were localized in the lower limbs in 19 patients (79.2%), upper limbs (4), abdomen (4), face (2) and genital area (1). Clinical variants observed were ulcerative (17 patients), pustular (4), bullous (2) and superficial granulomatous (1). Associated systemic diseases were observed in 18 patients (75%), gastrointestinal in seven patients (29.2%), hematological in seven (25%), autoimmune inflammatory in three (12%), and solid tumors in two (8.3%). Systemic steroids were used in the treatment, either alone in 10 patients (41.7%) or combined with cyclosporine in eight (33.3%). Complete healing was achieved in 20 patients, on average five months after diagnosis, but lesions recurred one or more times in four patients (16.7%). Conclusions As reported in the literature, PG is a rare disorder, more common in females, frequently associated with systemic disease, which compromises the prognosis.     

Oral health and quality of life of people living with human T-cell leukemia virus-1 in Salvador,Brazil: a cross-sectional study

Clinical Oral Investigations - To compare the oral health status and oral health-related quality of life (OHRQoL) in symptomatic and asymptomatic patients with human T-cell leukemia virus-1...