Alejandro Afani S

Úlceras orales recurrentes: Características clínicas y diagnóstico diferencial

Recurrent aphthous stomatitis (RAS), are common inflammatory lesions of the oral mucous, usually round or ovoid, circumscribed by erythematous haloes with a yellow-grey floor and mostly painful. The RAS has reached an incidence about 20% in general population, present on any aged group, especially adolescents and young adults. Etiopathogenesis of RAS is not entirely understood. Some factors involved include immune system anomalies, infections, nutritional deficiency, mucous traumatism, food or contact allergy, autoimmunity illness and cancer; together with psychiatric, genetic and environment agents. In this article, main clinical features, etiology related factors, differential diagnosis and initial study of patients consulting for RAS are presented.

Resistencia primaria a terapia antirretroviral en pacientes con infección por VIH/SIDA en Chile

: Mean CD4 cell count and viral load was 200 cells/ml and 142,840 RNAcopies/ml respectively. Ten mutations were identified: V179D, L10I/V, M361, L63P, A71T/V,Y115F, V118I and K20R. None of these mutations is associated to a high degree of resistance toreverse transcriptase inhibitors, nucleoside analogs (NRTI), non nucleoside analogs (NNRTI) orviral protease inhibitors.

Candidiasis esofágica en pacientes inmunocompetentes: Estudio clínico e inmunológico

Background: Esophageal candidiasis is associated with conditions that cause an immune depression. It is a defining disease for AIDS, is observed in poorly controlled diabetics, in patients with renal or hepatic failure, in patients with cancer and in subjects using medications causing immunosuppression or broad spectrum antimicrobials. Aim: To report the features of 10 immunocompetent patients with esophageal candidiasis. Patients and methods: Six males and four females aged between 48 and 82 years, without conditions associated with immunosuppression, in whom an esophageal candidiasis was found on an upper gastrointestinal endoscopy. Delayed skin hypersensitivity to eight antigens, Iymphocyte subpopulations, yeast phagocytosis and neutrophil chemotaxis were measured. Results: Six patients had a low CD4 Iymphocyte count and seven had a low CD8 count. Seven patients were anergic on skin hypersensitivity challenge. Yeast phagocytosis was abnormal in one patient and neutrophil chemotaxis was abnormal in two. Humoral immunity was normal in all subjects. All patients were treated with oral fluconazole in doses of 150 mg/day for 14 days, with complete resolution of candidiasis in all. Conclusions: Patients with esophageal candidiasis, have frequent alterations of cellular immunity, that must be diagnosed and treated (Rev Med Chile 2004; 132: 1389-94). (Key Words: Candidiasis, esophageal; Immunity, cellular; Immunocompetence)

Prevalencia de resistencia primaria en pacientes con infección reciente por VIH-1 en Chile

BACKGROUND The main cause of virological failure during AIDS treatment is the resistance to antiretroviral medications (ARV). AIM To search for mutations associated with ARV resistance in recently HIV-1 infected patients naïve to treatment, in Chile. MATERIAL AND METHODS Patients over 18 years old with HIV-1 infection, naïve to anti-retroviral drugs before the study were included. Patients with CD4 cell counts less than 200 cells/mm3, viral load below 2000 copies/mL or any condition indicative of advanced AIDS were excluded. Criteria for diagnosis of recent infection (< 18 months) were a previous negative test for HIV antibodies or a history of an acute retroviral syndrome in the past 18 months. Resistance to drugs was analyzed using the TRUGENE HIV-1 assay from Bayer and the OpenGene DNA sequencing system. RESULTS Ninety nine percent of patients had at least one mutation, 27% had 4 or more mutations, but high level resistance to ARV was found only in 2.7% of cases. Point mutations for non nucleoside reverse transcriptase inhibitors (NNRTI) were detected in 4.1% of cases (K103N in 1 patient, V179D in 2 patients), for nucleoside reverse transcriptase inhibitors (NRTI) in 8.1% of cases (T215S in 1 patient, V118I in 4 patients, M41L in 1 patient) and for protease inhibitors (PI) in 1.3% of cases. All mutations detected in the protease gene were secondary. Of these, the most common were L63P/T (38 patients), L10I/V (27 patients) and V77I (26 patients). Resistance to two or more antiretroviral classes was not detected. CONCLUSIONS This study supports that, by now, primary resistance has a low prevalence in Chile. Therefore, a genotyping test before starting antiretroviral therapy is not necessary.

Restauración de la inmunidad innata en pacientes con infección por VIH/SIDA después de inicio de terapia antirretroviral

25 naive HIV/AIDS patients, from San Jose Hospital and University of Chile ClinicalHospital, Santiago, Chile, were studied between years 2002-2003. Every 4 months after HAARTinitiation, CD3+, CD4+, CD8+ T lymphocytes and CD16/56+ natural killer (NK) cells werequantified by flow cytometry. NK cell cytotoxicity was measured using radioactive chrome liberation(Cr51). Tumor necrosis factor alpha (TNF-

Guía Clínica de VIH/SIDA

n este numero de Revista Chilena de Infectologia se publican las Guias Clinicas de VIH/SIDA. Este es el fruto de un arduo trabajo de muchos meses de un grupo de especialistas con un directo quehacer en la atencion de pacientes infectados por VIH. Estas guias fueron presentadas hace meses al Ministerio de Salud y se ofi cializaron a principios de 2010. Los objetivos centrales de la guia son dos:• Detener la progresion de la enfermedad por VIH, dis-minuir la morbi-mortalidad por SIDA y enfermedades asociadas y mejorar la calidad de vida de los adultos infectados por VIH, mediante el acceso universal y oportuno a tratamiento con asociaciones de antire-trovirales (ARV) de efi cacia, durabilidad y seguridad probadas.• Disminuir la tasa de transmision vertical del VIH a menos de 2% global y a 1% o menos en los binomios madre-hijo que reciben protocolo completo, mediante la oferta universal del test de VIH en la mujer embara-zada con consejeria previa y la aplicacion de medidas farmacologicas y no farmacologicas de eficacia probada en la reduccion de la transmision, sin afectar las posibilidades terapeuticas futuras de la madre y del hijo.Un objetivo adicional de la presente guia era actualizar la terapia antiretroviral (TAR) en el pais que, a pesar de haber sido pionero, se habia quedado atras incluso a lo recomendado por la Organizacion Mundial de la Salud. Esta actualizacion se ha dado tanto en la indicacion de inicio de terapia, llevandola a etapas mas precoces, donde ya se habia demostrado su superioridad, incluyendo nuevas situaciones donde es necesario iniciar la terapia e incorporar las muy necesarias nuevos farmacos ARV. Creemos que el resultado fi nal de esta guias resuelve, en gran medida, estas nuevas necesidades y para un pais con un sistema de autorizacion y otorgamiento de la TAR tan centralizado, constituye un gran respaldo para la aplicacion por parte de los equipos tratantes de los mejores estandares de atencion posible. Son muchas las evidencias que hacen aconsejable el inicio mas precoz de TAR, por lo que se establecio empe-zarla con un recuento de linfocitos TCD4 de 350 por mm

Resistencia a la terapia antirretroviral en pacientes infectados con el virus VIH-1 en Chile 2002-2005

l and 228784 RNA copies/ml, respectively.The frequency of resistance to nucleoside RT inhibitors (NRTI), non nucleoside RT inhibitors(NNRTI) and protease inhibitors (PI) was 71%, 62% and 22%, respectively. The most commonmutations found were T215Y (46%), L10F (44%), M184V (38%), K103N (35%) and M41L (32%).Fifty five percent of mutations corresponded to the TAM (thymidine analogue mutations) group.Multiresistance was 47% to NNRTI, 7% to NRTI, 4% to PI and 0.7% to all groups. During the fouryears of the study, there was a significant increase in NNRTI resistance.

Resistencia a la terapia antiretroviral en la infección por virus de inmunodeficiencia humana

Resistance to anti-retroviral therapy is one of the main problems in the favorable outcome of treatment in HIV patients, as well as toxicity and adherence to treatment. Resistance has increased in recent years, and it is evaluated through genotyping and phenotypic tests. Information provided by these studies is crucial when deciding the most appropriate treatment. However, genotype interpretation is complex and subject to frequent change, because of the incorporation of new drugs and the appearance of new resistance patterns. This review aims ,understanding the fundamental concepts of antiretroviral resistance (ARV), which examines the general principles, mechanisms and patterns of resistance, both for the traditional family of anti-retrovirals, as well as for the most recently licensed drugs.

Alergia a beta-lactámicos

Betalactams allergy is the first cause of drug allergy in the world. In Chile cutaneous test are performed without considering international standardizations. This review focuses in betalactam allergy diagnosis and its management. Betalactams allergic reactions can be classified according to their temporal profile, into immediate, accelerated or late reactions which coincides with symptoms and pathogenic mechanisms. Most of immediate and accelerated reactions are mediated by specific IgE, with symptoms of immediate hypersensitivity. Toxicodermies and maculo-papular exanthemas are expression of late reaction, late hypersensitivity is probably the main mechanism in the pathogenesis of these reactions. Allergens which cause immediate hypersensitivity reactions to betalactams can be major determinants (75% of the cases), minor determinants or the side chains of the suspected drugs. The study of allergic patients includes specific IgE, skin and challenge tests. The objectives of his evaluation are to detect crossed reactivities or uni-sensibilizations, and to authorize or forbid the utilization of a specific drug or its alternatives.