Browsing by Author "Perez, Hector"

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    Acute retroviral syndrome and high baseline viral load are predictors of rapid HIV progression among untreated Argentinean seroconverters
    (2011) Socias, Maria E.; Sued, Omar; Laufer, Natalia; Lázaro, Maria E.; Mingrone, Hugo; Remondegui, Claudio; Figueroa, Maria Ines; Cesar, Carina; Gun, Ana; Turk, Gabriela; Bouzas, Maria B.; Kavasery, Rosanna; Krolewiecki, Alejandro J.; Perez, Hector; Salomon, Horacio; Pryluka, Damian
    Background Diagnosis of primary HIV infection (PHI) has important clinical and public health implications. HAART initiation at this stage remains controversial. Methods Our objective was to identify predictors of disease progression among Argentinean seroconverters during the first year of infection, within a multicentre registry of PHI-patients diagnosed between 1997 and 2008. Cox regression was used to analyze predictors of progression (LT-CD4 < 350 cells/mm3, B, C events or death) at 12 months among untreated patients. Results Among 134 subjects, 74% presented with acute retroviral syndrome (ARS). Seven opportunistic infections (one death), nine B events, and 10 non-AIDS defining serious events were observed. Among the 92 untreated patients, 24 (26%) progressed at 12 months versus three (7%) in the treated group (p = 0.01). The 12-month progression rate among untreated patients with ARS was 34% (95% CI 22.5-46.3) versus 13% (95% CI 1.1-24.7) in asymptomatic patients (p = 0.04). In univariate analysis, ARS, baseline LT-CD4 < 350 cells/mm3, and baseline and six-month viral load (VL) > 100,000 copies/mL were associated with progression. In multivariate analysis, only ARS and baseline VL > 100,000 copies/mL remained independently associated; HR: 8.44 (95% CI 0.97-73.42) and 9.44 (95% CI 1.38-64.68), respectively. Conclusions In Argentina, PHI is associated with significant morbidity. HAART should be considered in PHI patients with ARS and high baseline VL to prevent disease progression.
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    Coinfection: Helicobacter pylori/Human Immunodeficiency Virus
    (2004) Olmos, Maria; Araya, Valeria; Pskorz, Enrique; Quesada, Elvio C.; Concetti, Hugo; Perez, Hector; Cahn, Pedro
    To compare H. pylori infection prevalence and gastric mucosa damage in HIV-infected and non-HIV-infected patients, gastric biopsies were systematically taken in 209 individuals who underwent upper Gl endoscopy (102 HIV-infected and 107 non-HIV-infected). H. pylori was found in 42 (41.1%) HIV-infected patients and in 53 (49.5%) non-HIV patients (P = 0.22, chi2 = 1.47, NS). In HIV-positive patients infected with H. pylori the mean CD4 count was higher than in HIV-positive patients without H. pylori (364 and 228 cells/mm3, respectively; P = 0.0001). H. pylori gastritis was more severe in the HIV-positive group (chi2 = 15.02, P = 0.0001). The frequency of H. pylori in gastric mucosa in HIV-infected and non-HIV patients was similar. HIV-infected patients with H. pylori had a higher mean CD4 count than HIV-infected individuals without H. pylori. Gastric lesions associated with H. pylori were more severe in the HIV-positive population.
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    Expansion of CD25-Negative Forkhead Box P3-Positive T Cells during HIV and Mycobacterium tuberculosis Infection
    (2017-05-09) Angerami, Matías T; Suarez, Guadalupe V; Vecchione, María B; Laufer, Natalia; Ameri, Diego; Ben, Graciela; Perez, Hector; Sued, Omar; Salomon, Horacio ; Quiroga, María F
    Tuberculosis (TB) and HIV alter the immune system, and coinfected (HIV-TB) individuals usually present deregulations of T-lymphocytic immune response. We previously observed an increased frequency of “unconventional” CD4+CD25−FoxP3+ Treg (uTreg) population during HIV-TB disease. Therefore, we aimed to explore the phenotype and function of uTreg and conventional CD4+CD25+FoxP3+ Treg subsets (cTreg) in this context. We evaluated the expression of CD39, programmed cell death protein 1 (PD1), glucocorticoid-induced tumor necrosis factor receptor (GITR), and the effector/memory distribution by flow cytometry in cTreg and uTreg. Also, IL-10, TGF-β, IFN-γ production, and the suppressor capacity of uTregs were analyzed in cocultures with effector lymphocytes and compared with the effect of regulatory T cells (Tregs). We found diminished expression of CD39 and higher levels of PD1 on uTreg compared to cTreg in both HIV-TB and healthy donors (HD). In addition, uTreg and cTreg showed differences in maturation status in both HIV-TB and HD groups, due to the expansion of effector memory uTregs. Interestingly, both HIV-TB and HD showed a pronounced production of IFN-γ in uTreg population, though no significant differences were observed for IL-10 and TGF-β production between uTreg and cTreg. Moreover, IFN-γ+ cells were restricted to the CD39− uTreg population. Finally, when the suppressor capacity was evaluated, both uTreg and cTreg inhibited polyclonal T cell-proliferation and IFN-γ production in a similar extent. These findings suggest that uTregs, which are expanded during HIV-TB coinfection, exert regulatory functions in a similar way to cTregs despite an altered surface expression of Treg characteristic markers and differences in cytokine production.
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    Improving care for women living with HIV: initial outcomes of an integration experience
    (2012) Fink, Valeria; Zurita, Daniela; Tejo, Marta; Perez, Hector; Cesar, Carina; Figueroa, Maria Ines; Patterson, Patricia; Sued, Omar; Cahn, Pedro
    Background Women living with HIV are at higher risk of developing HPV-related diseases. Albeit they are systematically referred for cervical cancer screening, difficulties in obtaining timely appointments are the main barrier for an adequate gynecological care. In our unit, according to a previous survey, 67% of women reported this problem. Therefore, in January 2011 the integration of HIV and gynecological care was sought through the provision of gynecological care within the Infectious Diseases Unit in our hospital. Methods A weekly specific clinic for women living with HIV cared by HIV and gynecological specialists was implemented. Appointments are given at the HIV clinic, with no need of referral. Pap smear and colposcopy are offered in the same place. Data are collected through standardized forms. Baseline data from the first hundred patients referred are presented. Results Ninety-six women were assisted. Median age was 40 years (IQR 36–46.5). Median time from HIV diagnosis was 10.6 years (IQR 4.9–16.4). 82% patients were on HAART. Median CD4 cell count was 473 cells/cc (IQR: 287–614) and 49% had viral load<50. 48% lacked a gynecological control for the last 2 years. 24% had been previously diagnosed and/or treated for HPV-related pathology. Cervical Pap smear results (n=94): 59% were negative; 20% had LGSIL and 2% had HGSIL. Of those diagnosed with SIL, 29% had history of HPV-related lesions. Of note, 23% had infections or inflammatory results. Clinically significant abnormal colposcopies were seen in 21/93 (23%) patients. Of those, 30% were diagnosed SIL in the Pap smear. Conclusions Integrating the gynecologist with the ID Unit allowed women living with HIV easier access to gynecological control. The high number of abnormalities in the Pap smears detected in this pilot study reinforces the need of improving cervical cancer screening for prevention and early treatment through integrated approaches.
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    Routine HIV Testing among Hospitalized Patients in Argentina. Is It Time for a Policy Change?
    (2013) Socias, Maria E.; Hermida, L.; Singman, M.; Kulgis, G.; Díaz Armas, A.; Cando, O.; Sued, Omar; Perez, Hector; Ricardo, Hermes; José Luis Presas; Cahn, Pedro
    Introduction The Argentinean AIDS Program estimates that 110,000 persons are living with HIV/AIDS in Argentina. Of those, approximately 40% are unaware of their status, and 30% are diagnosed in advanced stages of immunosuppression. Though studies show that universal HIV screening is cost-effective in settings with HIV prevalence greater than 0.1%, in Argentina, with the exception of antenatal care, HIV testing is always client-initiated. Objective We performed a pilot study to assess the acceptability of a universal HIV screening program among inpatients of an urban public hospital in Buenos Aires. Methods Over a six-month period, all eligible adult patients admitted to the internal medicine ward were offered HIV testing. Demographics, uptake rates, reasons for refusal and new HIV diagnoses were analyzed. Results Of the 350 admissions during this period, 249 were eligible and subsequently enrolled. The enrolled population was relatively old compared to the general population, was balanced on gender, and did not report traditional high risk factors for HIV infection. Only 88 (39%) reported prior HIV testing. One hundred and ninety (76%) patients accepted HIV testing. In multivariable analysis only younger age (OR 1.02; 95%CI 1.003-1.05) was independently associated with test uptake. Three new HIV diagnoses were made (undiagnosed HIV prevalence: 1.58%); none belonged to a most-at-risk population. Conclusions Our findings suggest that universal HIV screening in this setting is acceptable and potentially effective in identifying undiagnosed HIV-infected individuals. If confirmed in a larger study, our findings may inform changes in the Argentinean HIV testing policy.
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    The coughing patient: TB or not TB; That is the question
    (2010) Laufer, Natalia; Sued, Omar; Abusamra, Lorena; Cabrini, Mercedes; Socias, Maria E.; Sisto, Alicia; Perez, Hector; Cahn, Pedro
    Tuberculosis (TB) has been declared a global emergency, increasing approximately 1% each year. There are evidences that TB is being underdiagnosed worldwide1,2. One of the reasons is the failure of healthcare workers to consider TB in the differential diagnosis of patients with respiratory symptoms. Delay in the diagnosis of TB in HIV-infected people in an important contributor to the excess morbidity and mortality 2,3. The main purpose of this prospective study was to define clinical and epidemiological characteristics that can guide physician to the rapid diagnosis of pulmonary TB in HIV patients. During 18 month (10/2004 to 04/2006), all patients attending for unscheduled visits to an Infectious Diseases Division of a public Hospital in Argentina, were asked if they present cough among their symptoms and if so they were invited to participate in the study. Patients, who signed informed consent, filled a questionnaire and their clinical records were evaluated prospectively. Chest X-Rays were classified according to the classification described by Tattevin, et al.4. Epidemiological and clinical data were compared between HIV patients with TB coinfection and those with HIV and other diagnosis. X2 and t-test were used to compare data. During the period studied, 9245 unscheduled visits were recorded, with 286 patients presenting cough. Among the patients with cough, 40 did not sign the consent. Of the remaining who agreed to participated, 35 (13%) presented a TB diagnosis (positive sputum smear and/or positive sputum or blood culture for M. tuberculosis), 211 have a non-TB diagnosis (most of them with PCP –n=51, 24%-, community acquired pneumonia –n=70, 33%-). Twenty three of the TB patients were HIV co-infected. When TB-HIV-coinfected patients were evaluated (Table 1) and compared with HIV-infected patients who have cough but non-TB diagnosis, statistical association with TB was found with: hepatomegaly (p=0.005); splenomegaly (p=0.003); night-sweats (p=0.001); weight-loss of more than 5 kg (p=0.003; duration of symptoms between 15 and 30 days (p=0.03) but not with longer time; elevate alkaline phosphatase (p=0.03); chest X-ray pattern of typical (p=0.0003) or compatible (p=0.013) with TB and previous contact with a patient with TB. We could not find association (p >0.05) with hemoptysis, pulmonary physical examination, previous TB or incarceration, lower educational level, LT CD4 count, HIV-1 viral load, number of previous opportunistic infections or white cell count.
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    Tuberculosis and HIV: A Partnership Against the Most Vulnerable
    (2003) Cahn, Pedro; Perez, Hector; Ben, Graciela; Ochoa, Claudia
    Tuberculosis and HIV: A Partnership Against the Most Vulnerable