No abstract

The increase of cases of patients with chronic obstructive pulmonary disease in HIV positive patients is a reality since the TAAE era. In its beginning, infectious respiratory diseases were the most frequent and prevalent. Different factors were associated to this entity such as the HIV virus itself, antiretroviral treatment, tobacco habit, the use of marijuana, anemia, coinfection with HCV, BMI, nadir and current value of CD4 and viral load. The control of the patient through dyspnea assessment scales and complementary studies such as spirometry, chest CT, 6-minute walk test and carbon dioxide diffusion test have provided tools to contribute to the diagnosis, treatment and prevention of the complications inherent in COPD. Our patient presented a severe respiratory obstruction with FCV less than 70%, FEV1 less than 80%, FEV1/CFV ratio less than 70%, diffusion test less than 80% and central emphysema and paralobulillar CT. Its CD4 values and viral load within normal parameters.

Physical examPatient lucido oriented in time and space. Preserved vital signs,no alterations are observed. Complementary methodsAnti-HIV serology on 3 samples, with two different enzyme-immunoassay techniques, Roche (rp=2320, 2220), Abbot (rp=587). Detectable proviral DNA. On a new sample, we repeat the viral load with ND result. We discard type 2 HIV infection using nucleic acid test for blood bank (Cobas Taqscreen MPX test, V2.0, Roche). Considering the possibility of mutations in the binding region of the primers of the quantification technique, we used a RT-PCR-NESTED protocol that amplifies protease and retro viral transcriptase, in which we did not obtain amplification product [2,3].On the other hand, we requested serology for HBV, HCV, Chagas, Toxoplasmosis and Syphilis, all negative.Given the incongruity in the studies performed, we contacted the parent company of Roche in the USA, where an investigation is initiated yielding the following result: sequencing of the gag region with positive result, the sequence corresponds to a Wild type virus, and sequencing of the negative LTR region. They conclude that this is a wild virus, with low or no viral load, which in the absence of treatment, corresponds to a case of HIV elite control. Antiretroviral therapy with zidovudine/lamivudine is started twice daily. The patient is monitored during the course of pregnancy; the ACTG 076 protocol is decided. The baby was born by vaginal delivery, with negative serology, is repeated at two months where it is again negative and again negative at three months. The baby was treated with zidovudine the first month of life [4]. DiscussionVertical transmission remains the main form of infection for more than 90% of children who acquire this infection. However, in pregnant women receiving antiretroviral therapy, this transmission decreased to below 2%. It can occur during pregnancy, during delivery or after delivery through breastfeeding [5,6].So far there is no guide with precise indications about handling in this situation. The ACTG 076 study demonstrated a 67% reduction in vertical transmission with zidovudine monotherapy [7].Regarding the time of the beginning of the treatment, both national and European guidelines recommend its establishment as soon as possible and no later than the second trimester [5,6]. In our case the patient was 20 weeks and the beginning was at the time of diagnosis.It was decided to start with the combination of zidovudine and lamivudine in order to reduce the risk of vertical transmission. In the literature we present a case of an HIV positive female elite control in Zimbabwe 15 weeks' gestation where zidovudine monotherapy was instituted following the guidance of the BHIVA guideline and was offered to the elective cesarean patient, with therapeutic success. Lactation was contraindicated [8]. AbstractHIV positive patients with sustained viral load <50 copies/mL are defined as elite controls in the absence of antiretroviral therapy and normal CD4+ values. The occurrence of this type of infections in...

<p>El tratamiento antirretroviral en los pacientes con VIH ha logrado la cronificación de la enfermedad por lo cual estos pacientes llegan a edades más avanzadas. La hipertensión arterial representa una gran preocupación para nuestros pacientes. Un adecuado control metabólico, y la instauración de un tratamiento correcto, son aspectos que necesariamente deben analizarse.</p>