HIV Cerebrospinal Fluid (CSF) viral escape is a condition characterized by inadequate virological control within the CSF despite systemic antiretroviral therapy, often assessed through discordant CSF and plasma HIV viral loads. The clinical relevance of CSF viral escape remains poorly understood, but it is thought to contribute to a spectrum of neurological and neurocognitive manifestations. The present study details the case of a 51-year-old individual from São Paulo, Brazil, presenting with acute meningoencephalitis and seizures in the context of persistent low-level viremia. Differential diagnoses were considered to rule out other conditions, such as infectious and immune-related diseases, eventually leading to a diagnosis of HIV CSF viral escape, confirmed through clinical presentation and a series of diagnostic evaluations. Antiretroviral therapy was subsequently optimized to improve central nervous system penetration, resulting in clinical improvement, resolution of neurological symptoms and undetectable CSF viral load.

Donovanosis is a chronic granulomatous sexually transmitted infection that may clinically mimic malignancy. We report a 64-year-old man with well-controlled HIV infection presenting with a chronic infiltrated vegetative scrotal ulcer showing progressive enlargement, exophytic growth, and hemorrhagic ulceration. Despite prolonged antimicrobial therapy with azithromycin and doxycycline, followed by adjunctive acyclovir because of suspected chronic herpes simplex coinfection, the lesion continued to progress, raising concern for squamous cell carcinoma. Initial histopathological and microbiological investigations, including cytology for Donovan bodies, were inconclusive. Repeat biopsy demonstrated pseudoepitheliomatous hyperplasia with a dense plasma cell-rich inflammatory infiltrate without cytological atypia, while periodic acid-Schiff staining identified intracellular Donovan bodies, confirming donovanosis. Doxycycline was reintroduced and maintained until complete healing after four months. This case highlights the diagnostic challenges of pseudotumoral donovanosis in patients living with HIV.

This study aimed to evaluate the efficacy of prednisolone in the treatment of persistent interstitial lung disease following severe SARS-CoV-2 pneumonia. A single-center, randomized, double-blind, placebo-controlled clinical trial was conducted. All participants presented residual pulmonary opacities on high-resolution chest computed tomography 4-months after COVID-19 diagnosis. Patients received either prednisolone (1 mg/kg/day for 1-month followed by gradual dose reduction) or placebo and were reassessed after 3- and 6-months of follow-up. Evaluations included clinical assessment; measurement of erythrocyte sedimentation rate, C-reactive protein, and D-dimer levels; pulmonary function tests; 6-Minute Walk Test (6MWT); Modified Medical Research Council (MRC) dyspnea scale; Short Form-36 (SF-36) quality of life questionnaire; and Post-COVID-19 Functional Status (PCFS) Scale. Statistical analyses were performed using analysis of variance (ANOVA) and log-binomial regression models. The placebo group (n = 31) comprised 60% male participants with a median age of 51-years, whereas the prednisolone group (n = 35) included 52% male participants with a median age of 53-years. Baseline comorbidities and treatments prior to randomization were comparable between groups. During follow-up, forced vital capacity (% predicted) increased from 78% to 89% in the placebo group and from 83% to 91% in the prednisolone group. Significant improvements were also observed in forced expiratory volume in one second, diffusion lung capacity, and maximal expiratory pressure in both groups. No significant differences were identified between groups regarding MRC dyspnea scores, SF-36 domains, or PCFS scale at baseline or at the final evaluation. Functional capacity scores in the SF-36 increased from 55 to 71 in the placebo group and from 57 to 69 in the prednisolone group. Walking distance increased significantly only in the prednisolone group. Tomographic variables demonstrated similar progression patterns in both groups throughout follow-up. In conclusion, systemic corticosteroid therapy with prednisolone did not provide additional benefits in patients with post-COVID interstitial lung disease. Both placebo and prednisolone groups exhibited comparable functional improvements over the six-month follow-up period.

Glucose-6-Phosphate Dehydrogenase Deficiency (G6PDd) is the most prevalent enzymopathy worldwide and is particularly frequent in malaria-endemic regions. In Brazil, the distribution of G6PD variants is heterogeneous, with predominance of the African A- variant, although regional diversity remains incompletely characterized. This study aimed to genotype seven G6PD variants previously reported in Brazilian populations using a multiplex assay, to determine their frequencies among G6PD Deficient (G6PDd) individuals as well as in a malaria-endemic population from northern Brazil. This study was conducted including two groups from the states of Acre, Amazonas, and Rondônia. The first group comprised 63 males with known G6PD enzymatic status, enabling genotype-phenotype correlation. The second group included 481 individuals from rural communities to estimate population allele frequencies. The multiplex assay successfully genotyped all targeted variants in a single reaction. Among G6PD deficient individuals, 95.8% carried the African A- (376G/202A) variant, confirming its major contribution to G6PDd in this population. In the population-based group, allele frequencies were 7.0% for 376 G and 3.2% for 202A, with higher frequencies observed in Porto Velho, consistent with greater African ancestry. Strong linkage disequilibrium between 376 G and 202A was detected (D' = 1.0). The remaining variants were rare or absent. No significant association was observed between African G6PD variants and self-reported number of previous malaria episodes in statistical models adjusted for age, area of residence and genetic ancestry. This study demonstrates that multiplex SNaPshot® genotyping is a viable approach for targeted screening of the seven candidate G6PD variants. Despite the predominance of the G6PD A- variant in northern Brazil, regional differences in genetic ancestry likely lead to variable contributions of specific G6PD variants to the deficiency phenotype. Therefore, population-specific genetic surveillance is essential to support safer and more effective malaria treatment strategies in endemic areas.