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- Sociodemographic, Clinical, and Behavioral Factors Associated With Sexual Transmitted Infection Among HIV-1 Positive Migrants in Portugal: Are There Differences Between Sexes?Publication . Miranda, M; Pimentel, V; Graça, J; Seabra, S; Sebastião, C; Diniz, A; Faria, D; Teófilo, E; Roxo, F; Maltez, F; Germano, I; Oliveira, J; Ferreira, J; Poças, J; Mansinho, K; Mendão, L; Gonçalves, MJ; Mouro, M; Marques, N; Pacheco, P; Proença, P; Tavares, R; Correia de Abreu, R; Serrão, R; Faria, T; O. Martins, MR; Gomes, P; Abecasis, A; Pingarilho, MIntroduction: Sexually transmitted infections (STIs) continue to occur at high levels. According to the WHO, each year there are an estimated 374 million new infections with syphilis, gonorrhea, chlamydia, and trichomoniasis. STIs are associated with an increased risk of acquiring HIV infection. Migrants are reportedly highly affected by STIs. Objectives: This study aims to characterize factors associated with STIs in a population of HIV-positive migrants living in Portugal. Methodology: This is a cross-sectional observational study of 265 newly diagnosed HIV-1 positive migrants, who were defined as individuals born outside Portugal. This group of people were part of the BESTHOPE study that was developed in 17 Portuguese hospitals between September 2014 and December 2019, and included information collected through sociodemographic and behavioral questionnaires filled in by the migrant patients, clinical questionnaires filled in by the clinicians and HIV-1 genomic sequences generated through resistance testing (Sanger sequencing). A multivariable statistical analysis was used to analyze the association between sociodemographic characteristics, sexual behaviors, HIV testing and sexual infections. Results: Most HIV-1 positive individuals included in the study were men (66.8%) and aged between 25 and 44 years old (59.9%). Men had a higher proportion of STIs when compared to women (40.4% vs. 14.0%) and the majority of men reported homosexual contacts (52.0%). Most men reported having had two or more occasional sexual partners in the previous year (88.8%) and 50.9% reported always using condoms with occasional partners, while 13.2% never used it. For regular partners, only 29.5% of the women reported using condoms, compared to 47.3% of men. Other risk behaviors for acquiring HIV, such as tattooing and performing invasive medical procedures, were more prevalent in men (38.0% and 46.2%, respectively), when compared to women (30.4% and 45.1% respectively) and 4.7% of men reported having already shared injectable materials, with no data for comparison in the case for women. Additionally, 23.9% of women reported having had a blood transfusion while only 10.3% of men reported having had this medical procedure. Meanwhile, 30.9% of the individuals reported having been diagnosed with some type of STI in the last 12 months. In addition, 43.3% of individuals that answered a question about hepatitis reported to be infected with hepatitis B, while 13.0% reported having hepatitis C infection. According to the multivariable analysis, the only transmission route was significantly associated with reports of previous STI infection: men who have sex with men (MSM) were 70% more likely to have been diagnosed with an STI in the past 12 months compared to the heterosexual route. Conclusion: HIV-1 infected men were more likely to report previous STIs than women. On the other hand, most migrant women had a regular sexual partner and never or only sometimes used condoms. This somewhat discrepant findings suggest that gender inequalities may make women unable to negotiate safe sexual practices, resulting in increased susceptibility to infection. However, since migrant women report less STIs, we cannot exclude that these STIs may remain undiagnosed. The implementation of safer sex awareness campaigns for condom use and screening for STIs in women is crucial. On the other hand, health education campaigns for STI knowledge need to be implemented for both MSM and women and their partners.
- Comorbidities and Menopause Assessment in Women Living with HIV: a Survey of Healthcare Providers Across the WHO European RegionPublication . Caixas, U; Tariq, S; Morello, J; Dragovic, G; Lourida, G; Hachfeld, A; Nwokolo, NABSTRACTWomen living with HIV are reaching older age and experiencing menopause and age-related comorbidities. Data suggest that women living with HIV experience earlier menopause and more menopausal symptoms and age-related comorbidities compared to women without HIV. However, there are no guidelines on the screening for and management of age-related comorbidities and events in women living with HIV. Moreover, little is known about provision of care to this population across Europe. We surveyed 121 HIV healthcare providers in 25 World Health Organization European countries to ascertain screening practices for, and management of, menopause, psychosocial and sexual well-being and age-related comorbidities in women with HIV. Most respondents screened for diabetes, cardiovascular disease (CVD) risk factors and poor mental health at least annually. Low bone mineral density (BMD) was regularly checked but less than once a year. Fewer regularly screened for sexual well-being and intimate partner violence. Menstrual pattern and menopausal symptoms in women aged 45-54 were assessed by 67% and 59% of respondents. 44% stated that they were not confident assessing menopausal status and/or symptoms. CVD, diabetes, low BMD and poor mental health were managed mainly within HIV clinics, whereas menopause care was mainly provided by gynaecology or primary care. Most respondents stated a need for HIV and menopause guidelines. In conclusion, we found that whilst metabolic risk factors and poor mental health are regularly screened for, psychosocial and sexual well-being and menopausal symptoms could be improved. This highlights the need for international recommendations and clinician training to ensure the health of this population.
- Actinomycetoma by Cellulosimicrobium Cellulans in a Young Man from Guinea-Bissau: Short Literature Review Regarding a Case ReportPublication . Trindade Torres, M; Sousa Nunes, B; Varandas, L; Maltez, FMycetoma is caused by the subcutaneous inoculation of filamentous fungi or aerobic filamentous bacteria. Cellulosimicrobium cellulans is a gram-positive bacterium from the order Actinomycetales that rarely causes human disease. The diagnosis is based on the clinical presentation and identification of the causative microorganism. We present a short literature review regarding the case report of a young man diagnosed with actinomycetoma due to Cellulosimicrobium cellulans and who received treatment with an association of amikacin and sulfamethoxazole/ trimethoprim (Welsh regimen).
- Tuberculous Meningitis: an Endemic Cause of Intracranial HypertensionPublication . Costa, M; Caria, JP; Bilardo Caiano, J; Caeiro, A; Maltez, FTuberculous meningitis (TBM) presents a complex clinical scenario, often marked by delayed recognition and high mortality. Our case involves a 27-year-old woman from Nepal with no significant medical history, presented with a two-week history of fatigue, altered consciousness, dizziness, vomiting, fever, holocranial headache, and photophobia. Initial examination revealed signs consistent with meningitis, including fever, hypertensive state, prostration, bilateral exophthalmos, sixth cranial nerve paresis, and positive Kernig/Brudzinski signs. Cerebrospinal fluid (CSF) exhibited characteristics typical of TBM: turbidity, lymphocytic-predominant pleocytosis, low glucose, and elevated protein. The patient was promptly started on meningeal doses of vancomycin, ceftriaxone, and acyclovir. However, persistent fever, neurological deterioration, and signs of increased intracranial pressure led to the decision to initiate conventional empiric treatment of tuberculosis (TB) with isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE) and dexamethasone 1 week before cultural positivity for Mycobacterium tuberculosis of CSF. The case underscores the importance of considering TBM in patients from endemic regions, interpreting CSF findings, and initiating empirical treatment in critical scenarios, contributing to a positive patient outcome despite the diagnostic challenges.
- Cytomegalovirus and Herpes Simplex Virus Co-Infection: Recurrence in a Kidney Transplant RecipientPublication . Santos, MB; Rodrigues Gonçalves, AC; Maltez, F
- Signo de la Raqueta de Tenis: Un Caso de Tuberculosis Pulmonar ComplicadaPublication . Alves, S; Póvoas, D; Silva, T
- Immunodeficiency and Autoimmunity Coming Together: a Nearly Missed DiagnosisPublication . Carreiro, F; Betkova, S; Sepúlveda, C; Manata, MJ; Cardoso, O; Maltez, F; Moraes-Fontes, MFThe coexistence of human immunodeficiency virus (HIV) and systemic lupus erythematosus (SLE) appears to be unusual and the prevalence of patients who carry the dual diagnosis is currently unknown. We hereby present a case of a C4 deficient HIV-1 positive Caucasian female under highly active antiretroviral therapy for the past eight years, admitted to hospital with an aggressive and potentially fatal clinical presentation of SLE. There was a favorable outcome despite a significant diagnostic delay. Despite its rarity, the case highlights that this association is remarkable and may be overlooked by clinicians familiar with either condition.
- Signo de la Raqueta de Tenis: un Caso de Tuberculosis Pulmonar ComplicadaPublication . Alves, S; Póvoas, D; Silva, T
- Tuberculosis Infection in HIV Vs Non‐HIV PatientsPublication . Rego de Figueiredo, I; Branco Ferrão, J; Dias, S; Vieira Alves, R; Drummond Borges, D; Torres, M; Guerreiro Castro, S; Lourenço, F; Antunes, AM; Gruner, H; Panarra, AObjectives: Tuberculosis (TB) is the most common opportunistic infection and cause of mortality among people living with HIV, and it is possible that it may also influence the evolution of the HIV infection. We assessed the differences between HIV-positive and -negative people infected with TB. Methods: The present study is a cross-sectional retrospective study by electronic record revision. We included patients admitted to a tertiary hospital with a diagnosis of TB between 2011 and 2016, comparing those with HIV coinfection with non-HIV patients, according to demographic and clinical characteristics. Results: This study included 591 patients, of whom 32% were HIV-coinfected. HIV-TB patients were younger, with a predominance of male gender. Considering TB risk factors, there was a higher prevalence of homelessness and intravenous drug use in the HIV group. In the non-HIV group, direct contact with other patients with TB and immunosuppression were more prevalent. Relative to TB characteristics, the HIV-coinfected group presents with a higher prevalence of disseminated disease and a higher occurrence of previous TB infection. Cancer was the most frequent cause of immunosuppression in the HIV group and the number testing positive for TB via microbiological culture was lower. Assessment of microbiological resistance and in-hospital mortality showed similar numbers in both groups. Conclusions: There are few papers comparing clinical course of TB between HIV-infected and non-infected patients. Our study differs from others in the literature as we focused on a country with middling incidence of TB and further characterized the differences between HIV-infected and non-infected patients which can contribute to the management of these patients.
- The Association Between Hepatitis B Virus Infection and Nonliver Malignancies in Persons Living with HIV: Results from the EuroSIDA StudyPublication . Mocroft, A; Miro, J; Wandeler, G; Llibre, J; Boyd, A; van Bremen, K; Beniowski, M; Mikhalik, J; Cavassini, M; Maltez, F; Duvivier, C; Uberti Foppa, C; Knysz, B; Bakowska, E; Kuzovatova, E; Domingo, P; Zagalo, A; Viard, JP; Degen, O; Milinkovic, A; Benfield, T; Peters, L; Harxhi, A; Losso, M; Kundro, M; Schmied, B; Zangerle, R; Karpov, I; Vassilenko, A; Mitsura, V; Paduto, D; Clumeck, N; De Wit, S; Delforge, M; Florence, E; Vandekerckhove, L.; Hadziosmanovic, V; Begovac, J; Machala, L; Sedlacek, D; Kronborg, G; Gerstoft, J; Katzenstein, T; Pedersen, C; Johansen, I; Ostergaard, L; Wiese, L; Moller, N; Nielsen, L; Zilmer, K; Smidt, J; Aho, I; Lacombe, K; Pradier, C; Fontas, E; Rockstroh, J; Behrens, G; Hoffmann, C; Stellbrink, H; Stefan, C; Bogner, J; Fätkenheuer, G; Chkhartishvili, N; Sambatakou, H; Adamis, G; Paissios, N; Szlávik, J; Gottfredsson, M; Devitt, E; Tau, L; Turner, D; Burke, M; Shahar, E; Wattad, L; Elinav, H; Haouzi, M; Elbirt, D; D’Arminio Monforte, A; Esposito, R; Mazeu, I; Mussini, C; Mazzotta, F; Gabbuti, A; Lazzarin, A; Castagna, A; Gianotti, N; Galli, M; Ridolfo, A; Uzdaviniene, V; Matulionyte, R; Staub, T; Hemmer, R; Dragas, S; Stevanovic, M; vd Valk, M; Trajanovska, J; Reikvam, D; Maeland, A; Bruun, J; Szetela, B; Inglot, M; Flisiak, R; Grzeszczuk, A; Parczewski, M; Maciejewska, K; Aksak‐Was, B; Mularska, E; Jablonowska, E; Kamerys, J; Wojcik, K; Mozer‐Lisewska, I; Rozplochowski, B; Mansinho, K; Radoi, R; Oprea, C; Gusev, D; Trofimova, T; Khromova, I; Borodulina, E; Ranin, J; Tomazic, J; Miró, J; Laguno, M; Martinez, E; Garcia, F; Blanco, J; Martinez‐Rebollar, M; Mallolas, J; Callau, P; Rojas, J; Inciarta, A; Moreno, S; del Campo, S; Clotet, B; Jou, A; Paredes, R; Puig, J; Santos, J; Gutierrez, M; Mateo, G; Sambeat, M; Laporte, J; Svedhem, V; Thalme, A; Sönnerborg, A; Brännström, J; Flamholc, L; Kusejko, K; Braun, D; Calmy, A; Furrer, H; Battegay, M; Schmid, P; Kuznetsova, A; Sluzhynska, M; Johnson, A; Simons, E; Edwards, S; Phillips, A; Johnson, M; Orkin, C; Winston, A; Clarke, A; Leen, C; Karpov, I; Losso, M; Lundgren, J; Rockstroh, J; Aho, I; Rasmussen, L; Svedhem, V; Pradier, C; Chkhartishvili, N; Matulionyte, R; Oprea, C; Kowalska, J; Begovac, J; Miró, J; Guaraldi, G; Paredes, R; Paredes, R; Larsen, J; Bojesen, A; Neesgaard, B; Jaschinski, N; Fursa, O; Sather, M; Raben, D; Hansen, E; Kristensen, D; Fischer, A; Jensen, S; Elsing., T; Phillips, A; Reekie, J; Cozzi‐Lepri, A; Amele, S; Pelchen‐Matthews, A; Roen, A; Tusch, E; Bannister., WObjectives: The aim of this study was to assess the impact of hepatitis B virus (HBV) infection on non-liver malignancies in people living with HIV (PLWH). Methods: All persons aged ≥ 18 years with known hepatitis B virus (HBV) surface antigen (HBsAg) status after the latest of 1 January 2001 and enrolment in the EuroSIDA cohort (baseline) were included in the study; persons were categorized as HBV positive or negative using the latest HBsAg test and followed to their first diagnosis of nonliver malignancy or their last visit. Results: Of 17 485 PLWH included in the study, 1269 (7.2%) were HBV positive at baseline. During 151 766 person-years of follow-up (PYFU), there were 1298 nonliver malignancies, 1199 in those currently HBV negative [incidence rate (IR) 8.42/1000 PYFU; 95% confidence interval (CI) 7.94-8.90/1000 PYFU] and 99 in those HBV positive (IR 10.54/1000 PYFU; 95% CI 8.47-12.62/1000 PYFU). After adjustment for baseline confounders, there was a significantly increased incidence of nonliver malignancies in HBV-positive versus HBV-negative individuals [adjusted incidence rate ratio (aIRR) 1.23; 95% CI 1.00-1.51]. Compared to HBV-negative individuals, HBsAg-positive/HBV-DNA-positive individuals had significantly increased incidences of nonliver malignancies (aIRR 1.37; 95% CI 1.00-1.89) and NHL (aIRR 2.57; 95% CI 1.16-5.68). There was no significant association between HBV and lung or anal cancer. Conclusions: We found increased rates of nonliver malignancies in HBsAg-positive participants, the increases being most pronounced in those who were HBV DNA positive and for NHL. If confirmed, these results may have implications for increased cancer screening in HIV-positive subjects with chronic HBV infection.