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Biomedical subjects

A J Duarte

Publications and source records attributed to A J Duarte.

62 records · Page 4Linked to original sources
PubMedDate not supplied

HIV heterosexual transmission to stable sexual partners of HIV-infected Brazilian hemophiliacs.

Nineteen Brazilian HIV-infected hemophiliacs and their stable heterosexual sexual partners were studied with the aim of assessing the rate of HIV transmission in this at risk group. The mean length of relationship between couples was 7.4 years. The hemophiliac men were Class II (n = 6), III (n = 11) and IVa (n = 2) of the CDC classification. They had decreased CD4+ and elevated CD8+ cell numbers; five had p24 antigenemia. We found 3 HIV-infected women (15.8 percent) by routine and confirmatory tests, a prevalence similar to that seen in other countries. They were asymptomatic and had no detectable p24 antigenemia. The 3 seropositive women's partners were Class II and III-CDC, and had normal CD4+ and CD8+ values and no p24 antigenemia. All seronegative women also had normal CD4+ and CD8+ numbers, except for elevated CD8+ cells in three of them, but immune abnormalities had already been seen in some seronegative partners at high risk for HIV infection. Our results reinforce previous suggestions that heterosexual transmission to stable female partners occurs preferentially early after initiation of sexual exposure, and possibly when the transmitter had high levels of viremia and regular sexual activity.

Adolescent↗
PubMedDate not supplied

[Common variable immunodeficiency (hypogammaglobulinemia of late onset or acquired hypogammaglobulinemia): initial follow-up of 11 cases].

The present paper describes the clinical and laboratory follow-up of 11 patients with the diagnosis of common variable immunodeficiency. Their age varied from 8 to 45 years. The mean disease time was 12.6 years and mean diagnosis time 4.3 years. Infectious manifestations, mainly of the respiratory and digestive tracts, occurred in all patients. Polyadenomegaly was noted in seven, hepatomegaly in six, splenomegaly in five and arthralgia in four patients. All of them presented serum IgG less than 250 mg/dl. IgA less than 33 mg/dl and IgM less than 31 mg/dl, except one with IgM = 176 mg/dl. The isohaemagglutinin titers were less than 1/20 in all but one patient. The determination of the number of B lymphocytes in the peripheral blood revealed normal counts in three, elevated in one and decreased in five patients. The CD-4/CD-8 ratio was less than 1 in 8 and greater than 1 in three of them. Five patients had positive cutaneous late reactions to at least one of the following antigens: PPD, SK-SD (Varidase), Trichophytin and Levedurin (Candidin). A decrease of the proliferative activity of peripheral blood mononuclear cells stimulated by lectins (PHA, Con-A, PWM) was also noted. Natural killer function was decreased. The association a possible role of regulatory lymphocytes in the immunopathogenesis of this disease. The data presented here emphasize the diversity of clinical and immunological manifestations of this disease, which could be noted between diverse patients and in the follow-up of a single one. In our cases the disease had an evolutive character, with a primarily humoral dysfunction followed by cellular immunity disturbances that determined poorer prognosis and progressive difficulties in the therapeutics. We suggest a conceptual reevaluation of this condition and a new denomination, for instance "Late-Onset Combined Immunodeficiency". The long delay between the initial clinical manifestations of the disease and its diagnosis was a handicap for an adequate treatment. Early intervention could certainly decrease the morbidity and mortality of the disease.

Adolescent↗
PubMedDate not supplied

[Immunologic changes associated with human immunodeficiency virus (HIV)].

Infection by HIV usually leads to dysfunction of the immune system which, facilitates the development of opportunistic infections or neoplasia in which almost always are fatal. The pathological process associated with this infection involves, characteristically, the destruction or malfunction of helper T lymphocytes (CD4+), due to, besides other factors, direct parasitism of the virus or to the secondary immune response, which seems to include autoimmune mechanisms. These pathological changes, along with the action of the virus on other components of the immune system, disturb the production of trophic factors and also the proliferation, differentiation and effector ability of different cells of the immune system. The long latent period, when a large number of infected individuals remain asymptomatic or with only minor clinical and/or laboratory disturbances suggest the possible role of some as yet uncharacterized cofactors, either inherent to the host or to other environmental agents; these cofactors may play a role in the modulation of the progression to this syndrome (AIDS).

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The value of the lymphocyte proliferation test with phytohemagglutinin in the immune evaluation of Brazilian HIV-infected patients.

We evaluated phytohemagglutinin (PHA) lymphocyte proliferation and delayed-type hypersensitivity tests in 130 Brazilian HIV-infected patients with the objective of assessing the value of these tests in staging HIV infection. Patients were divided into three groups according to their CD4+ cell counts (cells/mm3): < 200 (n = 28); 200 to 499 (n = 50); and > or = 500 (n = 52). An additional 114 individuals, who had come to the same institution for elective surgeries, were enrolled as controls. Results showed a significant decrease in PHA responses when CD4+ cell counts fell below 500 cells/mm3. This decrease was, however, indistinguishable from that of patients with < 200 cells/mm3. In contrast, skin test anergy to common antigenic preparations was only evident in the group of patients with less than 200 CD4+ cells/mm3. Decreases in PHA responses and in CD4+ cell counts were significantly correlated. Since the introduction of antiretroviral therapy is recommended when CD4+ cell counts are below 500 cells/mm3, the PHA proliferation test, in our conditions, could be useful as an additional parameter to initiate antiretroviral therapy. Further prospective studies are needed to establish the value of this test in HIV-infected patients.

Adult↗
PubMedDate not supplied

[X-linked agammaglobulinemia in nine patients: review of the literature].

The X-linked agammaglobulinemia (XLA) is a rare immunodeficiency, characterized by absence or accentuated diminuition of all the isotypes of serum immunoglobulins and greater susceptibility to infections, mainly after the sixth mouth of life. The authors present nine patients bearers of XLA, with recurrent infectious processes (pneumonias 7/9, otitis 7/9, sinusitis 5/9, sepsis 5/9, diarrheas 3/9, infectious arthritis 3/9, meningitis 3/9, pyodermitis 3/9, viral encephalitis 1/9), with the beginning of symptoms on average in a nine months life. The laboratory examination showed absence of antibody response, with normal cellular immunity. The patients received immunoglobulin with control of the infectious processes. Five children received prophylactic antibiotic therapy for sinusitis control. The precocious diagnosis of XLA is of extreme importance, with institution of therapy with intravenous immunoglobulin for reduction in infectious process occurrence and complications, besides improving the patient's life quality.

Agammaglobulinemia↗