ABSTRACT Introduction: The human immunodeficiency virus (HIV) induces a chronic and progressive process with an enormous spectrum of manifestations and complications. Objective: Characterize the population of patients with clinical debut/AIDS, according to clinical and immunological variables. Methods: descriptive study in patients with a clinical debut diagnosis/AIDS, in the period from 2017 to 2021, in the province of Santiago de Cuba. Results: 43.6 % of the patients were hypertensive, sexually transmitted diseases occurred in 68.4 % of the cases. Pneumonia was the most common opportunistic disease (55.5 %). The mean CD4 and viral load found in the 48 patients for whom data could be obtained were 149.2 and 58615.1 respectively. The combination of Truvada/Dolutegravir was the most used antiretroviral treatment in the present series (37.9 %). Conclusions: Sexually transmitted infections and pneumonia were the most prevalent infections and diseases. The CD4 lymphocyte count and high viral load in most patients explain the mortality and rapid evolution of the disease in the study population. Secondary prevention actions in relation to treatment schemes are similar to those proposed in the National Program for the Prevention and Control of STIs/HIV/ and Hepatitis.

RESUMEN Introducción: El virus de la inmunodeficiencia humana induce a un proceso crónico y progresivo con un espectro enorme de manifestaciones y complicaciones. Objetivo: Caracterizar la población de enfermos con debut clínico/SIDA, según variables clínicas e inmunológicas. Métodos: Estudio descriptivo en 87 casos diagnosticados como debut clínico/SIDA, en el período comprendido desde 2017 hasta 2021, en la provincia de Santiago de Cuba. Resultados: El 43,6 % de los pacientes eran hipertensos, las enfermedades de transmisión sexual se presentaron en el 68,4 % de la casuística. La neumonía por Pneumocystis jirovecii fue la enfermedad oportunista más frecuente (55,5 %). La media del linfocito TCD4+ la carga viral constatada en los 48 pacientes que se pudo obtener los datos fueron 149,2 células ( mm3 y 58615,1 copias ( ml respectivamente. La combinación de Emtricitabina+Tenofovir/Dolutegravir fue el tratamiento antirretroviral más utilizado en la presente serie (37,9 %). Conclusiones: Las infecciones de transmisión sexual y las neumonías fueron las coinfecciones y enfermedades más prevalentes. El conteo de linfocitos CD4+ bajo y la carga viral elevada en la mayoría de los pacientes explica la mortalidad y evolución rápida de la enfermedad en la población de estudio. Las acciones de prevención secundaria en relación a los esquemas de tratamiento son similares a los planteados en el Programa Nacional para la Prevención y Control de las ITS/VIH/ y las Hepatitis.

RESUMO Diante da cronificação da infecção pelo HIV, fatores psicossociais surgem como potencializadores para elevação dos níveis de estresse nas PVHIV, bem como para o desequilíbrio imunológico e elevação da carga viral. O objetivo da presente pesquisa foi avaliar o nível de estresse, a contagem de linfócitos TCD4 + e a carga viral de pessoas vivendo com HIV submetidas a TARV, atendidas em um hospital público universitário. Tratou-se de um estudo observacional, transversal com 25 pacientes (40,76 anos± 9,88 anos) que vivem com HIV atendidos no ambulatório de um hospital público do Rio de Janeiro. Foi utilizado um questionário sociodemográfico para caracterização da amostra, o estresse foi avaliado através do Inventário de Sintomas de Stress de LIPP e observados exames laboratoriais recentes. Foi identificado estresse em 68% dos participantes, com predomínio de sintomas físicos e fase de resistência. Houve maior prevalência de estresse em pessoas com baixo nível socioeconômico, desemprego e diagnóstico recente. Não foram observados menores níveis de linfócitos TCD4 + ou maior carga viral nas pessoas com estresse.

ABSTRACT Given the chronicity of HIV infection, psychosocial factors emerge as potentiators for the elevation of stress levels in PLHIV, as well as for the immunological imbalance and elevation of the viral load. The present research objective was to evaluate the stress level, TCD4+ lymphocyte count and viral load of people living with HIV undergoing ART, treated at a public university hospital. This was an observational, cross-sectional research with 25 patients (40.76 years± 9.88 years) living with HIV treated at the outpatient clinic of a public hospital in Rio de Janeiro. A sociodemographic questionnaire was used to characterise the sample. Stress was evaluated through the LIPP Stress Symptom Inventory and observed in recent laboratory tests. Stress was identified in 68% of the participants, with a predominance of physical symptoms and a resistance phase. There was a higher prevalence of stress in people with low socioeconomic status, unemployment and recent diagnosis. Lower levels of CD4+ T lymphocytes or higher viral load were not observed in people with stress.

RESUMEN La coinfección por leishmaniasis visceral y VIH es una preocupación mundial debido al ascenso progresivo en los últimos años, en varias regiones del mundo. La progresión de ambas enfermedades conducen al deterioro del sistema inmune, y como resultado, al fracaso terapéutico. El presunto estudio tiene como objetivo describir las características clínico-epidemiológicas de pacientes coinfectados con el virus de inmunodeficiencia humana y leishmaniasis visceral que acuden al Instituto de Medicina Tropical, en el periodo del 2016 al 2020. Es un estudio observacional, descriptivo, de corte transversal, utilizando registros médicos de pacientes con el diagnóstico de leishmaniasis visceral y VIH. Se incluyeron 51 pacientes coinfectados, entre 19 y 65 años, 42 del sexo masculino (82,3 %); 37 procedentes del área Central. Los hallazgos clínicos mas frecuentes fueron el decaimiento del estado general y la fiebre. La mayoría de los pacientes tuvieron un recuento bajo de linfocitos tCD4 y valores elevados de carga viral de VIH. Nuestro trabajo contribuye a conocer el perfil epidemiológico de pacientes coinfectados para mejorar el diagnóstico temprano y consecuentemente el tratamiento médico precoz.

ABSTRACT Co-infection by visceral leishmaniasis and HIV is a global concern due to the progressive rise in recent years, in various regions of the world. The progression of both diseases leads to the deterioration of the immune system, and as a result, to therapeutic failure. The presumed study aims to describe the clinical-epidemiological characteristics of patients co-infected with the human immunodeficiency virus and visceral leishmaniasis who attend the Institute of Tropical Medicine, in the period from 2016 to 2020. It is an observational, descriptive, cross-sectional study, using medical records of patients diagnosed with visceral leishmaniasis and HIV. 51 coinfected patients were included, between 19 and 65 years old, 42 male (82.3%); 37 from the Central area. The most frequent clinical findings were a weakness and fever. Most of the patients had a low tCD4 lymphocyte count and high HIV viral load values. Our study contributes to knowing the epidemiological profile of coinfected patients to improve early diagnosis and consequently early medical treatment.

ABSTRACT: The Feline Immunodeficiency Virus is used as a model for the study of infections by other lentiviruses, such as Human Immunodeficiency. It promotes a progressive and chronic immunodeficiency mainly due to the depletion of TCD4 + Lymphocytes. This disease has been extensively investigated but in experimentally infected cats. In this study, the neurological picture produced by the Feline Immunodeficiency Virus has been evaluated in a natural way and in the stage of asymptomatic carrier without opportunistic infections. This phase was chosen because in it the virus has a slow growth and the patients present an immune system not yet very damaged. In cats with feline immunodeficiency in the asymptomatic carrier stage with neurological signs that died, a necropsy examination was performed, taking samples from the central nervous system. Histopathology revealed encephalitis with a mild lymphoplasmacytic infiltrate and the Feline Immunodeficiency Virus was identified by immunohistochemistry, not only in the glia cells but also in the neurons. Immunohistochemistry demonstrated the presence of the virus located in relation to the histopathological lesions found in the central nervous system, this would demonstrate that the lesions are due to Feline Immunodeficiency Virus.

RESUMEN: El Virus de Inmunodeficiencia Felina es utilizado como modelo para el estudio de infecciones por otros lentivirus, como el de la Inmunodeficiencia Humana. Promueve una inmunodeficiencia progresiva y crónica por el agotamiento principalmente de los linfocitos TCD4+. Se ha investigado mucho esta enfermedad pero en gatos infectados experimentalmente. En este estudio se ha evaluado el cuadro neurológico producido por el virus de inmunodeficiencia felina en forma natural y en la etapa de portador asintomático sin infecciones oportunistas. Se eligió esta fase pues en ella el virus tiene un crecimiento lento y los pacientes presentan un sistema inmune aún no muy dañado. En los gatos con inmunodeficiencia felina en etapa de portador asintomático con signos neurológicos que fallecieron se efectuó un examen de necropsia tomándose muestras del sistema nervioso central. En la histopatología se encontró una encefalitis con infiltrado linfoplasmocitario de carácter leve y se identificó al Virus de Inmunodeficiencia Felina por medio de inmunohistoquímica, no solo en las células de la glía sino también en las neuronas. La inmunohistoquímica demostró la presencia del virus ubicado en relación con las lesiones histopatológicas halladas en el sistema nervioso central, esto demostraría que las lesiones son debidas a Virus de Inmunodeficiencia Felina.

Resumo Objetivo Descrever o intervalo de referência imunológico e hematológico de gestantes de baixo risco. Métodos Realizou-se uma análise retrospectiva, de um estudo básico e translacional, analisando o perfil hematológico e a imunofenotipagem das células TCD3 + , TCD4 + , TCD8 + , B e natural killer (NK) do sangue periférico de 79 gestantes de baixo risco e de 30 mulheres (controles) do estado de Pernambuco, Brasil. Resultados Não observamos diferenças significativas entre os perfis hematológicos do 2° e 3° trimestres. No entanto, houve redução das células B no 2° (média = 174 x 103 μL; p < 0,002) e no 3° trimestres (160 x 103 μL; p < 0,001), comparado como grupo controle (296 x 103 μL). A mediana das células NK foi menor no 2° (134 x 103 μL; p < 0,0004) e no 3° trimestres (100 x 103 μL; p < 0,0004), comparado com o grupo controle (183 x 103 μL). Porém, o percentual de TCD4+ e de TCD8+ aumentou no 2° e 3° trimestres em relação aos controles (TCD4 + : 2° trimestre = 59%; p < 0,001; 3° trimestre = 57%; p < 0,01; controle = 50%; e TCD8 + : 2° trimestre = 31%; p < 0,001; 3° trimestre = 36%; p < 0,01; controle = 24%). Conclusão Mulheres grávidas de baixo risco têm ~ 40% menos células B e NK no sangue periférico em comparação com mulheres não grávidas. Estes parâmetros podem melhorar a assistência à saúde das mães e contribuir para a definição de valores de referência para gestações normais.

Abstract Objective To describe the immunological and hematological reference intervals of low-risk pregnant women. Methods A cross-sectional retrospective database analysis of a basic and translational study analyzing the hematological evaluation blood counts and immunophenotyping of TCD3 + , TCD4 + , TCD8 + , B, and natural killer (NK) cells of the peripheral blood in 79 low-risk pregnant women and of 30 control women from the state of Pernambuco, Brazil, was performed. Results No significant differences were detected between the hematological profiles of the 2nd and 3rd trimesters. Nevertheless, the median level of B cells decreased significantly in the 2nd (174 x 103 μL; p < 0.002) and 3rd trimesters (160 x 103 μL; p < 0.001), compared with the control group (296 x 103 μL). Similarly, the median level of NK cells was lower in the 2nd (134 x 103 μL; p < 0.0004) and 3rd trimesters (100 x 103 μL, p < 0.0004), compared with the control group (183 x 103 μL). In contrast, relative TCD4+ and TCD8+ levels increased in the 2nd and 3rd trimesters compared with the controls (TCD4 + : 2nd trimester = 59%; p < 0.001; 3rd trimester = 57%; p < 0.01; control = 50%; and TCD8 + : 2nd trimester = 31%; p < 0.001; 3rd trimester = 36%; p < 0.01; control = 24%). Conclusion Low-risk pregnant women have ~ 40% less B and NK cells in the peripheral blood, compared with non-pregnant women. These parameters may improve health assistance for mothers and contribute to define reference values for normal pregnancies.

Resumo Objetivos: Identificar e descrever as alterações oculares em idosos com HIV ou aids através de exame oftalmológico. Avaliar a associação entre as alterações oculares encontradas e o nível de linfócitos T CD4, tempo da terapia antirretroviral, características demográficas e faixa etária. Métodos: Série de 40 casos de pacientes idosos com HIV examinados nos serviços de oftalmologia e imunologia do Hospital Universitário Gaffrée e Guinle (HUGG) de janeiro de 2017 a junho de 2018. Foi realizado o seguinte exame oftalmológico: anamnese, acuidade visual, motilidade ocular, reflexo pupilar, biomicroscopia, tonometria de aplanação e fundoscopia. As análises estatísticas foram realizadas pelo SPSS 20.0. Resultados: A média de idade dos 40 pacientes foi 64,7 anos (dp: 5,1) e o diagnóstico de infeção pelo HIV foi em média há 16.6 anos (dp:7). A maioria dos pacientes examinados possui visão normal (n=22; 55%) e pressão intraocular normal (entre 11 e 21 mmHg). As principais queixas dos pacientes durante a anamnese foram: embaçamento visual (50%), redução da acuidade visual (47.5%), prurido ocular (27.5%), lacrimejamento (25%) e ardência (25%). As alterações biomicroscópicas mais frequentes foram catarata (92.5%), seguida de olho seco (32.5%). Na fundoscopia encontrou-se 43,8 % de alterações da vascularização retiniana, 43.8 % de alterações relacionadas ao nervo óptico e 31,3% relacionadas ao pólo posterior da retina. Conclusão: Alterações oculares foram comuns e podem ser justificadas pela: senilidade, estado inflamatório gerado pela infecção crônica do HIV, efeitos adversos da Terapia antirretroviral prolongada e senescência biológica precoce associada a infecção do HIV.

Abstract Objectives: Identify and describe ocular changes in elderly with HIV or aids through ophthalmological examination. Evaluate the association between ocular alterations and the level of TCD4 lymphocytes, time of antiretroviral therapy, demographic characteristics and age range. Methods: Case series of 40 elderly patients with HIV infection. The study was carried out at the ophthalmology and immunology outpatient clinics of the Gaffrée and Guinle University Hospital (HUGG) from january 2017 to june 2018. The patients were attended at the ophthalmology clinic and underwent a ophthalmological exam including: anamnesis, visual acuity, ocular motility, pupillary reflex, biomicroscopy, aplanation tonometry and fundoscopy. Statistical analyses were performed using SPSS 20.0. Results: The average of the 40 patients was 64.7 years (sd: 5.1), aged between 60 and 78 years, and the average time of HIV infection was 16.6 years (sd: 7 years). Most of the patients examined had normal vision (55%) and normal intraocular pressure (between 11 and 21 mmHg). The main complaints of patients during anamnesis were visual blurring (50%), visual acuity reduction (47.5%), ocular itchiness (27.5%), tearing (25%) and burning (25%).The most frequent changes in biomicroscopy were: cataract (92.5%) and dry eye (32.5%). Funduscopy found 43.8% of retinal vascularization alterations, 43.8% of alterations related to the optic nerve and 31.3% related to retinal posterior pole. Conclusion: Ocular changes were common and can be explained by senility, inflamatory changes caused by chronic HIV infection, adverse effects of antiretroviral therapy and early biological ageing associated to HIV infection.

Abstract Regulatory Т cells (Tregs) are key mediators of the immune response; they have a collection of suppressive mechanisms that allow them to control both, self-reactive lymphocytes and conventional T cell clones. Although this population corresponds only to 5-10% of the CD4Tcells compartment, their absence has been related to the development of autoimmunity, the worsening of proinflammatory conditions and even abortions. Tregs can originate at the thymus or the periphery, however thymic Tregs are characterized by their stable phenotype and their capacity to recognize auto-antigens. In this review, we aim to provide a general understanding of the characteristics of Tregs and their importance within pathologies with a special focus on thymic Tregs; we offer herein a general picture of T cell ontogeny emphasizing the mechanisms and molecules involved in Treg generation.

Resumen Las células T reguladoras (Treg) son mediadoras fundamentales de la respuesta inmune, cuentan con una serie de mecanismos supresores que les permite controlar tanto clonas autorreactivas como linfocitos T convencionales. Si bien esta población corresponde únicamente al 5-10% de las células CD4+, su ausencia se ha relacionado con el desarrollo de patologías autoinmunes, condiciones proinflamatorias e incluso con abortos. Las células Treg pueden originarse tanto en el timo como en la periferia, sin embargo, aquellas originadas en el timo se caracterizan por su fenotipo estable y por su capacidad para reconocer autoantígenos. El objetivo de esta revisión es ofrecer al lector una visión general de las características de las células Treg así como su importancia en el contexto de diversas patologías; nos enfocaremos especialmente en los mecanismos y moléculas involucradas en la ontogenia de las células Treg de origen tímico.

La obesidad es un problema de salud pública creciente a nivel mundial. Se ha clasificado como una enfermedad ocasionada por acumulación excesiva de triglicéridos en el tejido adiposo (TA). El TA visceral (TAV), se considera un factor importante en el desarrollo de enfermedades crónicas no transmisibles. Esto principalmente porque el adipocito aumenta en tamaño y número, lo cual lleva a hipoxia, liberación de ácidos grasos, movilización y activación de subpoblaciones leucocitarias (linfocitos T, B, macrófagos, neutrófilos y eosinófilos), liberación de mediadores proinflamatorios (factor de necrosis tumoral- α (TNF-α), interleucina (IL)-6, resistina) y disminución en la secreción de antiinflamatorios (adiponectina, IL-10, IL-4 e IL-13). Estos cambios en el TAV generan un estado de inflamación crónica de baja intensidad, que se ha relacionado con resistencia a la insulina (RI). La RI es el signo fundamental para el desarrollo del Síndrome Metabólico (SM), que inicialmente se presenta localmente en el TAV y después se vuelve sistémica. En la investigación de la obesidad y el desarrollo de sus comorbilidades, la trascendencia del TAV en la interacción entre células adiposas e inmunitarias, así como de liberación de mediadores para desencadenar el proceso inflamatorio crónico, es clave para el desarrollo de RI y SM; sin embargo, se ha observado que la masa músculo-esquelética está implicada en este proceso, aparte de las células y mediadores de los que se sabe su participación. De esta manera a los linfocitos T CD4 y T CD8 se les señala como proinflamatorios, en cambio a los eosinófilos y a la adiponectina se les clasifica como protectores del proceso.

Obesity is a widespread public health problem worldwide. This disease has been classified as a condition caused by excessive accumulation of triglycerides in adipose tissue (TA). Visceral TA is an important factor in the development of several chronic diseases, since the adipocyte increases in size and number, leading to hypoxia, fatty acid release, mo-bilization and activation of leukocyte subpopulations (macrophages, neutrophils, eosinophils, NK cells, T lymphocytes and B); release of pro-inflammatory mediators (TNF-á, IL-6, PAI-1, resistin and visfatin), and decreased secretion of anti-inflammatory cytokines (adiponectin, IL-10, IL-4 and IL-13). These changes in TAV generate a chronic inflammation state of low inten-sity, that has been linked to insulin resistance (IR), initially local and then becomes systemic, which represents the determining factor for the development of metabolic syndrome (SM). The transcendence of TAV in the interaction between adipose and immune cells, as well as the release of mediators that trigger the chronic inflammatory process, is key for the development of IR and SM. However, in the investigation of obesity and the development of its comorbidities, it has been observed that the skeletal-muscle mass is involved in this process, apart from the cells and mediators of which their participation is known. In this way, TCD4 and TCD8 lymphocytes are recognized as pro-inflammatory. In contrast, eosinophils and adiponectin are considered as protective of the process.

Introducción: Las manifestaciones orales en pacientes que viven con el Virus de la inmunodeficiencia humana (VIH) pueden ser el primer signo de la enfermedad, y hablar del deterioro del sistema inmune. Objetivo: Determinar la frecuencia de manifestaciones orales en personas que viven con VIH (PVVIH), estableciendo la asociación con el conteo de linfocitos TCD4 y la carga Viral. Materiales y métodos: Se estudiaron 177 pacientes que viven con VIH en control y/o tratamiento del Hospital Base de Valdivia en Chile, a los cuales se les realizó un examen clínico bucal y se recolectaron los valores del último conteo de linfocitos TCD4 y carga viral. Resultados: La muestra estaba formada por un 78,5% de varones; la edad promedio fue de 40,1±12,02 años y el 92,7% estaba bajo terapia antirretroviral. Las lesiones bucales se presentaron en el 93,8% de los pacientes, de las cuales el 39,2% pertenecían a manifestaciones orales de la Clasificación CEE. Se observó que los pacientes con manifestaciones bucales tenían valores de linfocitos TCD4 más bajos (427,40 ± 224,51) que los que no las presentaron (530,8 ± 222,7); encontrando que ambos valores son independiente de la carga viral. Conclusión: Las lesiones orales en PVVIH están asociadas mayormente a un conteo de linfocitos TCD4 bajo, independientemente de la terapia antirretroviral que reciben y la carga viral que presenten al momento del examen bucal.

Introduction: Oral Manifestations in patients living with Human Immunodeficiency Virus (HIV) may be the first sign of the disease, and talk about the deterioration of the immune system. Objective: Determine the frequency of oral manifestations in people living with HIV (PLHIV), establishing the association with CD4 lymphocyte count and viral load. Materials and methods: 177 patients living with HIV in control and / or treatment of the Base Hospital of Valdivia in Chile, where he underwent an oral examination and values of the last count of CD4 lymphocytes and viral load were collected were studied. Results: The sample consisted of 78.5% males; the average age was 40.1±12.02 years, and 92.7% were on antiretroviral therapy. The oral lesions occurred in 93.8% of patients, of which 39.2% belonged to oral manifestations of the EEC Classification. It was observed that patients with oral manifestations had values lower CD4 lymphocytes (427.40 ± 224.51) than those who did not submit (530.8 ± 222.7); finding that both values are independent of viral load. Conclusion: Oral lesions in people living with HIV are mostly associated with a low CD4 lymphocyte count, regardless of receiving antiretroviral therapy and viral load at the time of presenting oral exam.

Resumo A gestação é um estado fisiológico que exige adaptações imunológicas para que transcorra normalmente. Nesse período a mãe e o feto apresentam uma relação imunológica, ou seja, a interface materno fetal. A enzima indoleamina 2,3 dioxigenase (IDO) desempenha um papel importante na tolerância materno fetal, por ser responsável pela metabolização do triptofano, impedindo por diversas vias a proliferação principalmente de linfócitos TCD8. Diversos tipos celulares estão presentes na interface materno fetal e vários deles podem expressar a IDO. Os leucócitos com perfil Th1 produzem uma citocina conhecida: o interferon γ que estimula a expressão da IDO em vários tipos celulares. Os linfócitos são divididos em subpopulações de acordo com sua função e fenótipo. Seus tipos incluem linfócitos T, linfócitos B e as células natural killer (NK). Hormônios também atuam nesse processo a progesterona que exerce função determinante sobre a resposta imunológica materna podendo alterar o prognóstico gestacional e o estrógeno essencial para a tolerância materno fetal e manutenção da prenhez. Dessa maneira este trabalho tem por objetivo principal identificar os linfócitos presentes na placenta bovina em cultivo que expressam IDO (linfócitos T, linfócitos B e células NK), frente a estimulação por progesterona, estrógeno e interferon γ nas diversas fases gestacionais utilizando a citometria de fluxo. Segundo os resultados no período de 67,5 a 77, 5 dias com a adição de interferon γ a expressão da enzima IDO aumentou discretamente nos linfócitos TCD3, TCD4, e diferente dos linfócitos T CD8 apresentaram uma elevada expressão da enzima (4,48 ± 2,12 - 8,65± 4,91). No período de 92,5 a 172, 5 dias os linfócitos TCD4, TCD8 e TCD25 apresentaram uma diminuição da IDO. No período final de 195 a 222,5 dias, os linfócitos TCD3, TCD4 e os BCD25 aumentaram a expressão da IDO quando submetidos ao interferon γ, no entanto, os linfócitos T CD8 e as células NK não apresentaram alterações significativas. Com base nos resultados apresentados pode-se concluir que todos os tipos celulares foram capazes de expressar a IDO mediante a suplementação com interferon γ, sendo que o linfócito T CD8 apresentou uma diferença bastante significativa quanto ao aumento da IDO, já o estrógeno elevou a expressão da IDO somente nos linfócitos B (CD25) e a progesterona diminuiu a expressão da enzima nos linfócitos T (CD3 e CD4) e nas células NK. Estes resultados sugerem um mecanismo de regulação do sistema imunológico desempenhado pelos hormônios esteroides presentes durante o processo gestacional, particularmente pela modulação da expressão da IDO.

Abstract Pregnancy is a physiological state that requires immune adaptation in order to be successfully carried on. During this period, mother and fetus establish an immune tolerance status at the maternal fetal interface. Indoleamine 2,3-dioxygenase (IDO) plays an important role in maternal-fetal tolerance by metabolizing tryptophan, impairs by several pathways, mainly T CD8 cells proliferation. Several cell types are present in the maternal fetal interface and several of them can express IDO. Leucocytes with Th1 produce a cytokine known as interferon γ that stimulates the expression of IDO in several cell types. Lymphocytes are divided into sub-populations according to their function and phenotype: T lymphocytes, B lymphocytes and natural killer cells (NK). Hormones also involved in this process where progesterone exerts decisive role on maternal immune response that may change gestational outcome and estrogen is essential for fetal maternal tolerance and maintenance of pregnancy. Therefore, the main objective of this study was to identify lymphocytes in the bovine placental cell culture that are sensitive to progesterone, estrogen and interferon γ, IDO expression in various gestational stages using flow cytometry. According to the results in the gestational period from 67.5 to 77.5 days with the addition of interferon γ expression IDO was slightly increased in TCD3 lymphocytes, CD4, and differently from the other T cells CD8 displayed an higher expression of the enzyme (4.48±2.12 to 8.65±4.91). In the period from 92.5 to 172. 5 days the CD4 lymphocytes, CD8 and TCD25 showed a significant decrease of IDO expression (p<0.05). At the final stages between 195 and 222, 5 days TCD3 lymphocytes, CD4 and BCD25 increased expression when subjected to interferon γ supplementation; however, CD8 T cells and NK cells showed no significant changes. Based on the results presented we can conclude that all cell types were able to express IDO by supplementation with interferon γ, and that T CD8 lymphocyte showed an highly significant increase of IDO expression, whereas estrogen increased the expression of IDO only in B lymphocytes (CD25), and progesterone decreased enzyme expression in T lymphocytes (CD3 and CD4) and in NK cells. These results suggest a regulatory mechanism of the immunological system by steroidal hormones during gestation, particularly by modulating IDO expression.

INTRODUÇÃO: As lesões bucais e peribucais são comuns nos pacientes infectados pelo vírus HIV e podem representar os primeiros sinais da doença, antes mesmo das manifestações sistêmicas. OBJETIVO: Este estudo objetivou estimar a prevalência de manifestações bucais em indivíduos soropositivos para o HIV, considerando aspectos sociodemográficos, imunológicos e terapêuticos. MATERIAL E MÉTODO: Foi realizado um estudo de natureza clínico-epidemiológica transversal, entre outubro de 2007 e abril de 2008, com amostra composta por 40 pacientes. Utilizou-se a técnica de observação direta intensiva por meio de exame clínico apropriado. Os dados foram registrados em fichas pré-elaboradas e analisados por estatística descritiva e inferencial. RESULTADO: Verificou-se a prevalência do gênero feminino (52,5%), na faixa etária de 40 a 49 anos (45%). O tratamento com antirretrovirais foi constatado em 85,0% dos casos, sendo todos com terapia de alta potência (HAART). Observou-se que 52,5% dos pacientes apresentaram a contagem de linfócitos TCD4+ acima de 500cél/mm³ e 50,0% apresentaram carga viral indetectável. A prevalência das manifestações bucais foi 42,5%, sendo a mais expressiva a candidose pseudomembranosa (19,23%), seguida da periodontite úlcero-necrosante (15,38%), da leucoplasia pilosa (11,54%) e da queilite angular (11,54%). Não foi verificada associação entre manifestações bucais e carga viral (p=0,1268), nem com o número de células T CD4 (p=0,3458). CONCLUSÃO: A prevalência de algumas manifestações bucais associadas à infecção pelo HIV ainda é alta, sendo a candidose pseudomembranosa a infecção mais prevalente, principalmente entre pessoas com baixo nível de escolaridade e maior tempo de infecção pelo vírus HIV, independentemente da terapia utilizada e do estado imunológico do paciente.

INTRODUCTION: The oral and perioral lesions are common in patients infected with HIV, and may represent the first signs of the disease, even before the systemic manifestations. OBJECTIVE : This study aimed to estimate the prevalence of oral manifestations in HIV seropositive individuals, considering the aspects socio-demographic, immunological and therapeutic. MATERIAL AND METHOD: Was performed nature study clinical-epidemiological transverse, between October 2007 to April 2008, with a sample of 40 patients. Was used the technique of intensive direct observation through appropriate clinical exam. Data were recorded on data sheets pre-prepared and analyzed by descriptive and inferential statistics. RESULT: There was a prevalence of females (52.5%), aged 40-49 years (45%). Treatment with antiretroviral drugs was found in 85.0% of cases, all being with high power therapy (HAART). It was observed that 52.5% of patients had a TCD4+ lymphocyte count above 500cél/mm ³ and 50.0% had an undetectable viral load. The prevalence of oral manifestations was 42.5%, the most significant for pseudomembranous candidiasis (19.23%), followed necrotizing ulcerative periodontitis (15.38%), hairy leukoplakia (11.54%) and angular cheilitis (11.54%). No association was observed between oral lesions and viral load (p=0.1268) nor the TCD4 cell count (p=0.3458). CONCLUSION: Prevalence of some oral manifestations associated with HIV infection is still high, with pseudomembranous candidiasis infection more prevalent, mainly among people with low education levels and longer HIV infection, independent of the therapy and immune status of the patient.

Introduction: the clinical presentation is a particular phenomenon in the HIV / AIDS that has been observed worldwide. Objective: to describe a case of AIDS clinical onset whose diagnosis was delayed. Objective: to describe a case of clinical debut of been whose diagnosis was late. Case presentation: a case is reported with Human Immunodeficiency Virus (HIV). Its clinical onset was characterized by respiratory symptoms and genital and perianal injuries by herpes virus for more than 3 months. In this case, HIV diagnosis was late. A state of immunosuppression by CD4+ T count was present. A hospital diagnosis was made, but it could have done earlier. The epidemiological element as target population in higher risk was identified. Conclusions: in this case, late diagnosis of AIDS was made in clinical stage category C3. A good interview, including epidemiological background aspects and a correct and complete physical examination are the basis for an accurate scientific reasoning in the diagnostic procedure.

Introducción: el debut clínico es un fenómeno particular dentro de la epidemia de VIH/SIDA que se viene observando en todo el mundo. Objetivo: describir un caso de debut clínico de SIDA cuyo diagnóstico fue tardío. Presentación del caso: se reporta un caso con Virus de Inmunodeficiencia Humana que su debut clínico estuvo caracterizado por manifestaciones respiratorias y lesiones por herpes virus genitales y peri anales de más de 3 meses de evolución, en el cual su diagnóstico serológico fue tardío, presentándose con estado de inmunodepresión por conteo TCD4. El diagnóstico fue hecho hospitalario, pero pudo haberse realizado antes. Se identificó el elemento epidemiológico como población clave de mayor riesgo. Conclusiones: en el caso estudiado se realizó el diagnóstico tardío de SIDA, en etapa clínica categoría C3. Un buen interrogatorio, que incluya aspectos de antecedentes de tipo epidemiológico y un correcto y completo examen físico, es la base para un certero razonamiento científico en el proceder diagnóstico.

Introducción. Se han desarrollado modelos para la predicción de la tasa de disminución de células CD4 en pacientes con VIH/sida con base en redes neurales y, también, en la variabilidad de la disminución de los recuentos de CD4 en pacientes seropositivos y seronegativos, con el recurso de métodos epidemiológicos. Objetivo. Predecir la población de linfocitos T CD4, a partir de la información del cuadro hemático sobre leucocitos y linfocitos, mediante la teoría de la probabilidad. Métodos. Se evaluaron los cuadros hemáticos de siete casos particulares, determinando la cantidad total de leucocitos y linfocitos, y la cantidad de linfocitos CD4 por medio de citometría de flujo. A partir de un trabajo previo, se desarrolló una inducción con la que se determinaron los conjuntos A, B, C y D, con base en los cuales se calculó la probabilidad de aparición de combinaciones específicas de valores de leucocitos, linfocitos y CD4, en rangos de 1.000 leucocitos para 128 casos. Resultado. Se predice que los rangos de leucocitos inferiores a 5.000 y 4.000 por mm3 de sangre periférica se asocian a menos de 570 linfocitos CD4 por µl con una probabilidad de 0,92 y 1, respectivamente. A medida que disminuye la cantidad de las poblaciones de leucocitos, el porcentaje de aciertos entre las tres medidas es más efectivo. Conclusión. La teoría de la probabilidad reveló una autoorganización matemática de las poblaciones celulares estudiadas, que permitió desarrollar predicciones clínicas para el número de células CD4 a partir del cuadro hemático, disminuyendo los costos y deduciendo los resultados de la citometría de flujo.

Background: Models for the prediction of the CD4 decrease rate in VIH/AIDS patients have been developed with neural networks, and also for the prediction of the variability in CD4 counts decrease in seropositive and seronegative patients with epidemiological models. Objective: to predict the TCD4 lymphocyte population, beginning with the Complete Blood Count (CBC) information of leucocytes and lymphocytes, through probabilistic theories. Methods: Seven CBC of particular cases were evaluated, by determining the total count of leucocytes and lymphocytes, and the proportion of CD4 Lymphocytes by flow cytometry. Based on a previous work an induction was developed; with that induction the sets A, B, C and D were determined. Based on that sets we established the probability of aparition of specific combinations of leucocytes, Lymphocytes ans CD4 values, in ranges of 1.000 leucocytes, in 128 cases. Results: it is predicted that the leucocytes ranges lower than 5,000 and 4,000 per cubic milimeter of peripheral blood are associated with less than 570 CD4 per microliter with a probability of 0.92 and 1 respectively. As the quantity of populations diminishes, the success percentage between the three measures is more effective. Conclusion: The probability theory revealed a mathematical self-organization of the studied cellular populations, allowing the development of predictions in a clinical level for the CD4 number from the CBC, diminishing costs and deducting the results of the flow cytometry.

In the infection by the Human Immune Deficiency Virus (HIV) the deterioration of the immune system due to a diminution of the TCD4 lymphocytes increases the sensitivity of suffering from different pathologies in oral cavity and among them those in periodontal region. This research paper was aimed at determining the prevalence and severity of periodontal diseases in people living with HIV/AIDS and the association with factors such as: TCD4 counting, the use of antiretroviral therapy and the Rate of Simplified Oral Health. Local risk factors for periodontal diseases were determined. To carry it out, a descriptive and cross sectional study taking 207 people living with HIV/AIDS in Pinar del Rio (2008), who underwent to a serological control at the research time. Both, Rates of Simplified Oral Health and Russell Periodontal Rate were verified. Absolute and relative frequencies and to describe the association among variables, Bartholomew and chi-square tests up to 95% of confidence were applied. A high prevalence of periodontal disease was observed (78,3%). Most frequent local risk factors were dento-bacterial plaque, caries and non-existence of teeth without restitution. A significant relation between the results of TCD4 and periodontal status was observed as well as oral hygiene, where no association with periodontal disease and retroviral treatment was found.

En la infección por el virus de la inmunodeficiencia humana (VIH) el deterioro del sistema inmune por una disminución de los linfocitos TCD4 aumenta la susceptibilidad a padecer diferentes patologías en la cavidad oral y entre ellas las del periodonto. Fueron objetivos de esta investigación determinar la prevalencia y gravedad de la enfermedad periodontal de las PVIH/sida, así como su asociación a los factores como el conteo de TCD4, el uso de terapia antirretroviral y el índice de higiene bucal simplificado. Se determinaron además los factores de riesgo locales de enfermedad periodontal. Para ello, se realizó un estudio descriptivo y transversal en 207 personas viviendo con VIH/sida pertenecientes a la provincia de Pinar del Río en el año 2008, los cuales asistieron al control serológico en el momento de la investigación. Se utilizaron los índices de higiene bucal simplificado y el índice periodontal de Russell revisado. Se usaron las frecuencias absolutas y relativas y para describir la asociación entre variables las pruebas de Bartholomew y ji cuadrado al 95 % de confianza. Se determinó una alta prevalencia de la enfermedad obteniéndose un 78,3 %. Los factores de riesgo locales en la enfermedad periodontal más frecuentes son la placa dentobacteriana, caries y dientes ausentes no restituidos. Se identificó una relación significativa entre los resultados de los TCD4 y el estado periodontal, así como con la higiene bucal. No se encontró asociación con la enfermedad periodontal y el tratamiento antirretroviral.

Introduction: In HIV/AIDS patients are many the risk factors involved in appearance of the bacterial pneumonia (BP) of different origin without to know the causal germ of respiratory picture. Methods: Authors studied 85 HIV/AIDS patients diagnosed with BP according the clinical, radiological and laboratory criteria in the "Pedro Kourí" Tropical Medicine Institute between November, 2007 and April, 2008. Results: S. pneumoniae (40,5 %), enterobacteria (28,3%) and no-fermented bacilli (13,5 %) were the more frequent identified. There was prevalence of subjects aged under 50 (91,7 %), smokers (65,9 %), with a TDC4 lymphocytes count under 200 cél/mm3 (64,7 %) with a high-performance anti-retroviral therapy (54,7 %). Risk factors of BP due to enterobacteria included age ³ 50 years (OR 2,50; 95 % CI 1,40-15,1) and malnutrition (OR 2,53; 95 % CI 1,83-7,91). Conclusions: It was demonstrated that the etiological agents identified in sputum from HIV/AIDS Cuban patients presenting with BP are similar to those described by other authors at international level, being more probable that the ill persons aged over 50 and also malnourished have a BP due to enterobacteria than remainder microorganisms.

Introducción: En los pacientes VIH/sida son múltiples los factores de riesgo que se involucran en la aparición de la neumonía bacteriana de diversa etiología, sin que en ocasiones se conozca el germen causal del cuadro respiratorio. Métodos: Se estudiaron 85 pacientes VIH/sida con diagnóstico de neumonía bacteriana según criterios clínicos, radiológicos y de laboratorio en el Instituto de Medicina Tropical "Pedro Kourí", entre noviembre de 2007 y abril de 2008. Resultados: Se identificaron con mayor frecuencia S. pneumoniae (40,5 %), las enterobacterias (28,3 %) y los bacilos no fermentadores (13,5 %). Prevalecieron los individuos menores de 50 años de edad (91,7 %), fumadores (65,9 %), con un conteo de linfocitos TCD4 menor de 200 cél/mm³ (64,7 %)y que emplearon terapia antirretroviral de alta eficacia (54,7 %). Constituyeron factores de riesgo para presentar una neumonía bacteriana por enterobacterias, la edad ³ 50 años (OR 2,50; IC= 95 % 1,40-15,1) y la desnutrición (OR 2,53; IC= 95 % 1,83-7,91). Conclusiones: Se demostró que los agentes etiológicos identificados en esputos de pacientes VIH/sida cubanos con NB, son similares a los descritos por otros autores a nivel internacional, siendo más probable que los enfermos mayores de 50 años y desnutridos presenten una NB causada por enterobacterias que por el resto de los microorganismos.