医療微生物学と診断

Cytomegalovirus Infections in Patients with HIV/AIDS in a Unit of Health of the Amazonian Region, Belém, Pará, Brazil

Abstract

Silva DFL, Arruda LMF, Silva NF, Sagica FES, Moraes MM, JR JLSA, Santos TVR and Medeiros RS

Introduction: With the increase in prevalence of HIV/AIDS in the world, infection by CMV became a serious public health problem because of the immunodeficiency caused by HIV and the reduction of TCD4+ cells. Objective: Clinical-epidemiological and laboratory aspects of patients were evaluated, which were admitted in a public hospital in the Amazon Region, Belém-Pará, Brazil. Methods: We collected clinical and epidemiological data by questionnaires and medical records, and whole blood for detection of anti-CMV antibodies by ELISA; and the method of Polymerase Chain Reaction in Real Time (qPCR) for detecting viral load. Results: The socioeconomic data indicated high frequency of individuals with incomplete level of basic education (35.3%) and low income (57.7%). Important comorbidities were found by using medical records; pulmonary tuberculosis (19.9%), toxoplasmosis (19.5%), extrapulmonary tuberculosis (14.5%) and diarrheal syndrome (14.1%) occurred more frequently. According to the serological analysis it was observed that only 2.1 of patients had acute infection profile ( IgG+IgM+), while in qPCR more than 50% of patients had high viral load (M =107,479.48 copies/ ml). During this study, 49 patients died, 63.3% were co-infected by HIV/CMV detected using molecular method. It was observed the highest occurrence of CMV-infected individuals when the TCD4 lymphocytes were <100cells/mm3. There were significant differences between molecular data and serological results (Z=12.98, p<0.0001). Conclusions: Molecular methods are the most appropriate technique to help in the clinical diagnosis of secondary CMV infection in immunodeficiencies and the reduction of CD4+<100/mm³ cells is an important risk factor that predisposes people with HIV/AIDS to opportunistic infections.