Molecular docking studies and evaluation of the antiretroviral activity and cytotoxicity of the species Lafoensia pacari Saint-Hilaire / Estudos de docking molecular e avaliação da atividade antirretroviral e citotoxicidade da espécie Lafoensia pacari Saint-Hilaire

Interest in antiviral plant species has grown exponentially and some have been reported to have anti-HIV properties. This research aims to perform the bio-guided phytochemical fractionation by antiretroviral activity of Lafoensia pacari stem barks. This in vitro experimental study involved the preparation of plant material, obtention of ethanolic extract, fractionation, purification, identification and quantification of fractions, acid-base extraction, nuclear magnetic resonance, HIV-1 RT inhibition test and molecular docking studies. From the bio-guided fractionation by the antiretroviral activity there was a higher activity in the acetanolic subfractions, highlighting the acetate subfraction - neutrals with 60.98% of RT inhibition and ellagic acid with 88.61% of RT inhibition and absence of cytotoxicity. The macrophage lineage cytotoxicity assay showed that the chloroform fraction was more toxic than the acetate fraction. The analysis of the J-resolved spectrum in the aromatic region showed a singlet at 7.48 and 6.93 ppm which was identified as ellagic acid and gallic acid, respectively. The 5TIQ enzyme obtained better affinity parameter with the ellagic acid ligand, which was confirmed by the HSQC-1H-13C spectra. Gallic acid was also favorable to form interaction with the 5TIQ enzyme, being confirmed through the HSQC-1H-13C spectrum. From the PreADMET evaluation it was found that ellagic acid is a promising molecule for its RT inhibition activity and pharmacokinetic and toxicity parameters.

O interesse por espécies vegetais com ação antiviral tem crescido exponencialmente e algumas tem sido relatadas como possuídoras de propriedades anti-HIV. Essa pesquisa tem como objetivo realizar o fracionamento fitoquímico biodirecionado pela atividade antirretroviral das cascas do caule da espécie Lafoensia pacari. Trata-se de um estudo experimental in vitro e a metodologia envolve preparo do material vegetal, obtenção do extrato etanólico, fracionamento, purificação, identificação e quantificação das frações, extração ácido-base, ressonância magnética nuclear, teste de inibição da TR do HIV-1 e estudos de docking molecular. A partir do fracionamento biodirecionado pela atividade antirretroviral verificou-se uma maior atividade nas subfrações acetanólica. Com destaque para a subfração acetanólica neutros com 60,98% de inibição de TR e o ácido elágico com 88,61% de inibição de TR e ausência de citotoxicidade. Verificou-se com o teste de citotoxicidade em linhagem de macrófagos que a fração clorofórmica foi mais tóxica que a fração acetanólica. A análise do espectro J-resolvido na região aromática apresentou um simpleto em 7.48 e 6.93 ppm que foram identificados como ácido elágico e ácido gálico respectivamente. A enzima 5TIQ obteve melhor parâmetro de afinidade com o ligante ácido elágico que foi confirmado pelos espectros HSQC-1H-13C. O ácido gálico mostrou-se também favorável a formar interação com a enzima 5TIQ, sendo confirmado através do espectro HSQC-1H-13C. Através da avaliação do PreADMET verificou-se que o ácido elágico é uma molécula promissora pela sua atividade de inibição da TR e parâmetros farmacocinéticos e de toxicidade.

Inflammation and kidney involvement in human viral diseases caused by SARS-CoV-2, HIV, HCV and HBV

Inflammation is closely related to renal diseases. This is particularly true for renal diseases caused by infections as in viral diseases. In this review, we highlight the inflammatory mechanisms that underlie kidney dysfunction in SARS-CoV-2, human immunodeficiency (HIV), hepatitis C (HCV), and hepatitis B (HBV) infections. The pathophysiology of renal involvement in COVID-19 is complex, but kidney damage is frequent, and the prognosis is worse when it happens. Virus-like particles were demonstrated mostly in renal tubular epithelial cells and podocytes, which suggest that SARS-CoV-2 directly affects the kidneys. SARS-CoV-2 uses the angiotensin-converting enzyme 2 receptor, which is found in endothelial cells, to infect the human host cells. Critical patients with SARS-CoV-2-associated acute kidney injury (AKI) show an increase in inflammatory cytokines (IL-1β, IL-8, IFN-γ, TNF-α), known as cytokine storm that favors renal dysfunction by causing intrarenal inflammation, increased vascular permeability, volume depletion, thromboembolic events in microvasculature and persistent local inflammation. Besides AKI, SARS-CoV-2 can also cause glomerular disease, as other viral infections such as in HIV, HBV and HCV. HIV-infected patients present chronic inflammation that can lead to a number of renal diseases. Proinflammatory cytokines and TNF-induced apoptosis are some of the underlying mechanisms that may explain the virus-induced renal diseases that are here reviewed.(AU)

Inflammation and kidney involvement in human viral diseases caused by SARS-CoV-2, HIV, HCV and HBV

Inflammation is closely related to renal diseases. This is particularly true for renal diseases caused by infections as in viral diseases. In this review, we highlight the inflammatory mechanisms that underlie kidney dysfunction in SARS-CoV-2, human immunodeficiency (HIV), hepatitis C (HCV), and hepatitis B (HBV) infections. The pathophysiology of renal involvement in COVID-19 is complex, but kidney damage is frequent, and the prognosis is worse when it happens. Virus-like particles were demonstrated mostly in renal tubular epithelial cells and podocytes, which suggest that SARS-CoV-2 directly affects the kidneys. SARS-CoV-2 uses the angiotensin-converting enzyme 2 receptor, which is found in endothelial cells, to infect the human host cells. Critical patients with SARS-CoV-2-associated acute kidney injury (AKI) show an increase in inflammatory cytokines (IL-1β, IL-8, IFN-γ, TNF-α), known as cytokine storm that favors renal dysfunction by causing intrarenal inflammation, increased vascular permeability, volume depletion, thromboembolic events in microvasculature and persistent local inflammation. Besides AKI, SARS-CoV-2 can also cause glomerular disease, as other viral infections such as in HIV, HBV and HCV. HIV-infected patients present chronic inflammation that can lead to a number of renal diseases. Proinflammatory cytokines and TNF-induced apoptosis are some of the underlying mechanisms that may explain the virus-induced renal diseases that are here reviewed.(AU)

Complying with the HIV test algorithm for diagnosing children aged from 1 to 18 months born to HIV–positive mothers / Cumprimento do algoritmo para o diagnóstico do HIV em crianças de 1 a 18 meses nascidas de mães HIV positivas

The evolution of the epidemic of HIV in Brazil has especially affected women, and the control of mother-to-child transmission of HIV (MTCT) has been a new challenge to be faced. This study assessed the compliance with the algorithm recommended by the Ministry of Health (MH) for diagnosing the children born to HIV-positive mothers, followed-up in the Regional Central Laboratory of the Instituto Adolfo Lutz of São José do Rio Preto-X, and to evaluate the occurrence of mother-to-child transmission. This cross-sectional descriptive study collected data on the CD4+ T-cell count and viral load System for Controlling Laboratory Examinations (SISCEL) and System for Hospital Management (SIGH) from January 2009 to December 2014. In this period, 265 children were registered, being 141 (53.2%) male and 124 (46.8%) female; and only 217 (81.9%) complied with the algorithm recommended by the MH. The mean prevalence of MTCT was 5.9%. Despite the efforts exerted by the MH, the HIV algorithm noncompliance still occurs, and the vertical transmission rate is higher than 2%. These data reinforce the need to intensify the surveillance, to improve the information and the follow-up of pregnant women, and to rescue those responsible who do not strictly comply with the algorithm proposed by the MH.

A epidemia do HIV no Brasil tem afetado de maneira especial as mulheres e trouxe, como um novo desafio a ser enfrentado, o controle da transmissão vertical (TV) do HIV. O objetivo deste estudo foi de avaliar o cumprimento ao algoritmo preconizado pelo Ministério da Saúde(MS) no diagnóstico de crianças nascidas de mães HIV positivas, acompanhadas no Centro de Laboratório Regional Instituto Adolfo Lutz de São José do Rio Preto-X, e avaliar a ocorrência de TV. Foram coletados dados do Sistema de Informação e Gestão Hospitalar (SIGH) e do Sistema de Controle de Exames Laboratoriais da Rede Nacional de Contagem de Linfócitos T CD4+ e Carga Viral (SISCEL) no período de janeiro de 2009 a dezembro de 2014. Foram cadastradas265 crianças, 141 (53,2%) eram do sexo masculino e 124 (46,8%) feminino. Destas, 217 (81,9%) completaram o algoritmo preconizado pelo MS. A média da prevalência de TV foi de 5,9%. Apesar dos esforços do MS, há descumprimento no algoritmo e a taxa de TV é maior que a meta de 2%. Os dados reforçam a necessidade de intensificar a vigilância, melhorar a informação e acompanhamento de gestantes e resgate dos responsáveis que não cumprem o algoritmo do MS.

Complying with the HIV test algorithm for diagnosing children aged from 1 to 18 months born to HIV–positive mothers / Cumprimento do algoritmo para o diagnóstico do HIV em crianças de 1 a 18 meses nascidas de mães HIV positivas

The evolution of the epidemic of HIV in Brazil has especially affected women, and the control of mother-to-child transmission of HIV (MTCT) has been a new challenge to be faced. This study assessed the compliance with the algorithm recommended by the Ministry of Health (MH) for diagnosing the children born to HIV-positive mothers, followed-up in the Regional Central Laboratory of the Instituto Adolfo Lutz of São José do Rio Preto-X, and to evaluate the occurrence of mother-to-child transmission. This cross-sectional descriptive study collected data on the CD4+ T-cell count and viral load System for Controlling Laboratory Examinations (SISCEL) and System for Hospital Management (SIGH) from January 2009 to December 2014. In this period, 265 children were registered, being 141 (53.2%) male and 124 (46.8%) female; and only 217 (81.9%) complied with the algorithm recommended by the MH. The mean prevalence of MTCT was 5.9%. Despite the efforts exerted by the MH, the HIV algorithm noncompliance still occurs, and the vertical transmission rate is higher than 2%. These data reinforce the need to intensify the surveillance, to improve the information and the follow-up of pregnant women, and to rescue those responsible who do not strictly comply with the algorithm proposed by the MH.(AU)

A epidemia do HIV no Brasil tem afetado de maneira especial as mulheres e trouxe, como um novo desafio a ser enfrentado, o controle da transmissão vertical (TV) do HIV. O objetivo deste estudo foi de avaliar o cumprimento ao algoritmo preconizado pelo Ministério da Saúde(MS) no diagnóstico de crianças nascidas de mães HIV positivas, acompanhadas no Centro de Laboratório Regional Instituto Adolfo Lutz de São José do Rio Preto-X, e avaliar a ocorrência de TV. Foram coletados dados do Sistema de Informação e Gestão Hospitalar (SIGH) e do Sistema de Controle de Exames Laboratoriais da Rede Nacional de Contagem de Linfócitos T CD4+ e Carga Viral (SISCEL) no período de janeiro de 2009 a dezembro de 2014. Foram cadastradas265 crianças, 141 (53,2%) eram do sexo masculino e 124 (46,8%) feminino. Destas, 217 (81,9%) completaram o algoritmo preconizado pelo MS. A média da prevalência de TV foi de 5,9%. Apesar dos esforços do MS, há descumprimento no algoritmo e a taxa de TV é maior que a meta de 2%. Os dados reforçam a necessidade de intensificar a vigilância, melhorar a informação e acompanhamento de gestantes e resgate dos responsáveis que não cumprem o algoritmo do MS.(AU)

Argon plasma versus electrofulguration in the treatment of anal and perianal condylomata acuminata in patients with acquired immunodeficiency virus

Purpose: To compare the effectiveness of anal and perianal condylomata treatment using argon plasma and electrofulguration. Methods: From January 2013 to April 2014, 37 patients with anal and perianal condylomata, who had been diagnosed through proctological examination, oncotic cytology, polymerase chain reaction (PCR) and histology, underwent treatment with argon plasma and electrofulguration. The perianal and anal regions were divided into two semicircles. Each semicircle was treated using one of the methods by means of simple randomization. Therapeutic sessions were repeated until all clinical signs of infection by HPV were eliminated. The patients were evaluated according to several variables like the genotype of HPV, HIV infection, oncological potential per genotype, oncotic cytology and histology. Results: Among all the variables studied, only immunosuppression due to HIV influenced the results, specifically when the fulguration method was used. There was no significant difference in effectiveness between argon and fulguration based on lesion relapse (p > 0.05). However, among HIV-positive patients, fulguration presented worse results, with a significant difference (p = 0.01). Conclusion: Regarding treatment of anal and perianal condylomata acuminata, comparison between applying fulguration and argon demonstrated that these methods were equivalent, but use of fulguration presented more relapses among HIV-positive patients.(AU)

Antiviral activity of animal venom peptides and related compounds

Viruses exhibit rapid mutational capacity to trick and infect host cells, sometimes assisted through virus-coded peptides that counteract host cellular immune defense. Although a large number of compounds have been identified as inhibiting various viral infections and disease progression, it is urgent to achieve the discovery of more effective agents. Furthermore, proportionally to the great variety of diseases caused by viruses, very few viral vaccines are available, and not all are efficient. Thus, new antiviral substances obtained from natural products have been prospected, including those derived from venomous animals. Venoms are complex mixtures of hundreds of molecules, mostly peptides, that present a large array of biological activities and evolved to putatively target the biochemical machinery of different pathogens or host cellular structures. In addition, non-venomous compounds, such as some body fluids of invertebrate organisms, exhibit antiviral activity. This review provides a panorama of peptides described from animal venoms that present antiviral activity, thereby reinforcing them as important tools for the development of new therapeutic drugs.(AU)

Antiviral activity of animal venom peptides and related compounds

Viruses exhibit rapid mutational capacity to trick and infect host cells, sometimes assisted through virus-coded peptides that counteract host cellular immune defense. Although a large number of compounds have been identified as inhibiting various viral infections and disease progression, it is urgent to achieve the discovery of more effective agents. Furthermore, proportionally to the great variety of diseases caused by viruses, very few viral vaccines are available, and not all are efficient. Thus, new antiviral substances obtained from natural products have been prospected, including those derived from venomous animals. Venoms are complex mixtures of hundreds of molecules, mostly peptides, that present a large array of biological activities and evolved to putatively target the biochemical machinery of different pathogens or host cellular structures. In addition, non-venomous compounds, such as some body fluids of invertebrate organisms, exhibit antiviral activity. This review provides a panorama of peptides described from animal venoms that present antiviral activity, thereby reinforcing them as important tools for the development of new therapeutic drugs.(AU)

Antiviral activity of animal venom peptides and related compounds

Abstract Viruses exhibit rapid mutational capacity to trick and infect host cells, sometimes assisted through virus-coded peptides that counteract host cellular immune defense. Although a large number of compounds have been identified as inhibiting various viral infections and disease progression, it is urgent to achieve the discovery of more effective agents. Furthermore, proportionally to the great variety of diseases caused by viruses, very few viral vaccines are available, and not all are efficient. Thus, new antiviral substances obtained from natural products have been prospected, including those derived from venomous animals. Venoms are complex mixtures of hundreds of molecules, mostly peptides, that present a large array of biological activities and evolved to putatively target the biochemical machinery of different pathogens or host cellular structures. In addition, non-venomous compounds, such as some body fluids of invertebrate organisms, exhibit antiviral activity. This review provides a panorama of peptides described from animal venoms that present antiviral activity, thereby reinforcing them as important tools for the development of new therapeutic drugs.

CARACTERIZAÇÃO CLÍNICA, EPIDEMIOLÓGICA E LABORATORIAL DOS PACIENTES HIV EM INÍCIO DE TERAPIA ANTIRRETROVIRAL NO HOSPITAL UNIVERSITÁRIO DO TOCANTINS, 2019.

A infecção pelo HIV configura-se como uma problemática contemporânea de destaque na saúde pública. O comportamento da infecção do HIV na região Norte do Brasil contrasta com outras regiões, apresentando tendências de elevação do número de casos novos e óbitos anualmente. O objetivo do estudo foi caracterizar e descrever os pacientes que iniciaram o uso de terapia antirretroviral atendidos no Hospital de Doenças Tropicais da Universidade Federal do Tocantins (HDT-UFT), situado no município de Araguaína, Norte do estado do Tocantins, no ano 2019. Trata-se de um estudo epidemiológico com caráter: retrospectivo, documental, transversal, descritivo e com abordagem quantitativa. No período verificou-se que 119 pacientes iniciaram o uso de terapia antirretroviral (TARV), dos quais 98 pacientes foram incluídos neste estudo, foram excluídos 21 pacientes por não atenderem os critérios de inclusão. O estudo demonstrou predominância de indivíduos do sexo masculino (74,5%), solteiros (72,2%) com faixa etária de 18 a 39 anos (75,5%). A escolaridade predominante foi para o Ensino Médio Completo (38,1%), sendo observado o vínculo empregatício formal em (56,9%). Os integrantes da pesquisa residiam em três diferentes estados: Tocantins (93,9%), Pará (5,1%) e Maranhão (1,0%) e a maioria em zona urbana (96,9%). O modo de transmissão do HIV foi (100%) sexual e com a categoria de exposição predominante heterossexual (59,3%). A mediana da carga viral no início da TARV foi de 18.733 cópias/ml. A mediana da contagem de LT-CD4+, importante célula de defesa humana, no momento do início da TARV foi de 347cél/mm3, evidenciando que 51,02% do total das Pessoas Vivendo com HIV (PVHIV) foram diagnosticados de forma tardia. Não houve associação entre as características epidemiológicas e a contagem de LT-CD4+. Do total de participantes analisados, 53,1% apresentavam pelo menos uma intercorrência clinica registrada no início da TARV. Referente aos parâmetros dos exames laboratoriais, foi observada uma menor média nos participantes com contagem de LT-CD4+ < 350 cél/mm3. Destaca-se uma Infecção Sexualmente Transmissível (IST) associada ao marcador sorológico da sífilis com 26% dos testes reagentes. Com base nas características descritas a partir dos dados obtidos, evidencia-se que serão necessárias ações que visem o diagnóstico oportuno para HIV e outras infecções sexualmente transmissíveis a fim de evitar que os pacientes cheguem aos serviços de saúde em fases avançadas de deterioração imunológica e/ou com a presença de coinfecções.

HIV infection is a prominent contemporary issue in public health. The behavior of HIV infection in the Northern region of Brazil contrasts with other regions, showing an upward trend in the number of new cases and deaths annually. The aim of the study was to characterize and describe patients who started using antiretroviral therapy treated at the Hospital for Tropical Diseases of the Federal University of Tocantins (HDT-UFT), located in the municipality of Araguaína, North of the state of Tocantins, in 2019. This is an epidemiological study with a retrospective, documentary, cross- sectional, descriptive and quantitative approach. In the period, it was found that 119 patients started using antiretroviral therapy (ART), of which 98 patients were included in this study, 21 patients were excluded for not meeting the inclusion criteria. The study showed a predominance of male individuals (74.5%), single (72.2%) aged 18 to 39 years (75.5%). The predominant education was for Complete High School (38.1%), with formal employment in (56.9%). The members of the survey lived in three different states: Tocantins (93.9%), Pará (5.1%) and Maranhão (1.0%) and the majority in urban areas (96.9%). The mode of HIV transmission was (100%) sexual and with the predominantly heterosexual exposure category (59.3%). The median viral load at the start of ART was 18,733 copies/ml. The median count of LT-CD4+, an important human defense cell, at the time of initiation of ART was 347cell/mm3, showing that 51.02% of all People Living with HIV (PLHIV) were diagnosed late. Not there was an association between epidemiological characteristics and LT-CD4+ count. Of the total number of participants analyzed, 53.1% had at least one clinical complication recorded at the beginning of ART. Regarding the parameters of laboratory tests, a lower mean was observed in participants with LT-CD4+ count < 350 cells/mm3. A Sexually Transmitted Infection (STI) associated with the serological marker of syphilis stands out, with 26% of the reagent tests. Based on the characteristics described from the data obtained, it is evident that actions aimed at timely diagnosis for HIV and other sexually transmitted infections will be necessary in order to prevent patients from reaching health services in advanced stages of immunological deterioration and/ or with the presence of coinfections.

TRATAMENTO ANTIRRETROVIRAL DO PACIENTE HIV/AIDS: VARIÁVEIS QUE INFLUENCIAM A ADESÃO

A AIDS (do inglês Acquired Immunodeficiency Syndrom) é uma epidemia generalizada com cerca de 38 milhões de pessoas no mundo infectadas pelo vírus. No Brasil, até junho de 2019, tem-se registrado 966,058 pessoas vivendo com HIV/aids. O Estado do Rio Grande do Sul destaca-se no ranking das 100 cidades com mais de 100 mil habitantes com 12 cidades com os maiores índices de detecção de HIV (Vírus da Imunodeficiência Humana), sendo Porto Alegre, a 11ª entre as demais cidades do ranking. O início da terapia antirretroviral (TARV), preconizada pela Organização Mundial de Saúde (OMS) se dava a partir das manifestações clínicas do paciente, sendo a contagem de linfócitos TCD4+ e a carga viral os indicadores efetivos para a conduta medicamentosa. A partir de 2015, a OMS passou a recomendar o início de tratamento imediato para todas as pessoas diagnosticadas com o vírus HIV e a adoção do esquema terapêutico 3 em 1 (Tenofovir, Lamivudina e Efavirenz). Diversos estudos contribuem para demonstrar que o início precoce da TARV e adesão adequada estão associados a menores taxas de mortalidade, morbidade e diminuição da transmissão viral, auxiliando a controlar a disseminação da epidemia mundial. Entretanto, ainda que esta medida tenha contribuído para a adesão ao tratamento por conta da redução dos efeitos adversos, bem como a facilidade de administração em dose fixa combinada, inúmeros problemas têm sido relacionados à adesão ao tratamento pelos portadores de HIV/aids. Na esfera pública, dentre os principais podem ser citados a ineficiência observada nos serviços prestados pelo sistema de saúde (dificuldade quanto ao monitoramento dos pacientes a partir do sistema de notificações e realização de exames periódicos, disponibilidade e dispensação dos medicamentos, entre outros). Do mesmo modo, tanto os efeitos colaterais e as dificuldades inerentes ao uso da TARV quanto variáveis sócio econômicas e principalmente, comportamentais, têm sido apontados como relevantes para os resultados observados quanto à disseminação do vírus nas populações. Diante da complexidade de elementos que constituem a adesão a tratamentos desta natureza, faz-se necessário reconhecer e estabelecer as variáveis que contribuem para a efetividade ou ineficiência dos tratamentos preconizados para esta doença. Nesse sentido, o presente trabalho estabeleceu variáveis que possam influenciar a adesão ao tratamento, sob três aspectos principais: a efetividade do sistema de saúde, a 6 recuperação imunológica em decorrência da medicação e o contexto comportamental dos indivíduos As análises foram conduzidas a partir de coleta de dados de 678 pacientes de dois Serviços de Atendimento Especializado (SAE de Novo Hamburgo e SAE de Viamão), definidos como pontos de coleta por conta das notificações dos altos índices de infecção pelo vírus nestas regiões. O período de coleta de dados definido considerou a atendimento à normativa da OMS quanto ao uso da TARV de forma compulsória a partir do diagnóstico de infecção, independentemente dos resultados clínicos, compreendendo os anos de 2015 à 2017.Os dados relativos à carga viral e linfócitos TCD4+ , bem como a dispensação de medicamentos, comorbidades e demais dados epidemiológicos foram obtidos a partir de prontuários físicos, eletrônicos e dos Sistemas de Monitoramento do Ministério da Saúde (MS) (SISCEL Sistema de Monitoramento Clínico e SINAN Sistema Nacional de Agravos e Notificações). A fim de observar a influência do atendimento dispensado pelos profissionais de saúde responsáveis no SAE de Novo Hamburgo, bem como as percepções destes relativas à gestão do controle da epidemia, foram aplicados o questionário CEAT-HIV para PVHA (Pessoas Vivendo com HIV/aids) para 181 pacientes usuários do SAE, um questionário para 10 funcionários dos SAE e o questionário QualiAids (para gestores). Os dados avaliados indicam que o comportamento do indivíduo, adesão medicamentosa insuficiente e o serviço de saúde influenciam a adesão ao tratamento. Os resultados obtidos pelo presente estudo visam contribuir para a elaboração de indicadores que permitam o entendimento sobre quais variáveis atribuem maior valor ao processo de adesão ao tratamento, a fim de subsidiar estudos para o aprimoramento de políticas que atendam às necessidades individuais e coletivas frente à epidemia do HIV/aids, com especial foco na adesão ao tratamento na região sul do Brasil.

AIDS (Acquired Immunodeficiency Syndrom) is a widespread epidemic of the nearly 38 million people worldwide have been infected with virus. In Brazil, until June 2019, 966,058 people living with HIV / AIDS. The state of Rio Grande do Sul stands out in the ranking of 100 cities with more than 100 thousand inhabitants with 12 cities with the highest rates of detection of HIV (Human Immunodeficiency Virus), with Porto Alegre being the 11th among the other cities in the ranking. The initiation of antiretroviral therapy (ART), recommended by the World Health Organization (WHO), was based on the clinical manifestations of the patient, with the TCD4 + lymphocyte count and viral load being the effective indicators for medication management. From 2015, the WHO began to recommend the beginning of immediate treatment for all people diagnosed with the HIV virus and the adoption of the 3-in-1 therapeutic scheme (Tenofovir, Lamivudine and Efavirenz). Several studies contribute to demonstrate that the early onset of ART and adequate adherence are associated with lower rates of mortality, morbidity and decreased viral transmission, helping to control the spread of the worldwide epidemic. However, even though this measure has contributed to adherence to treatment due to the reduction of adverse effects, as well as the ease of oral administration, numerous problems have been related to adherence to treatment by people with HIV / AIDS. In the public sphere, among the main ones can be cited the inefficiency observed in the services provided by the health system (difficulty in monitoring patients from the notification system and conducting periodic examinations, availability and dispensing of medications, among others). Likewise, both the side effects and the difficulties inherent to the use of HAART and socioeconomic and, mainly, behavioral variables, have been pointed out as relevant to the results observed regarding the spread of the virus in populations. In view of the complexity of elements that constitute adherence to treatments of this nature, it is necessary to recognize and establish the variables that contribute to the effectiveness or inefficiency of the treatments recommended for this epidemic. In this sense, the present study established variables that can influence adherence to treatment, under three main aspects: the effectiveness of the health system, the immune recovery due to medication and the behavioral context of individuals 8 The analyzes were conducted based on data collection from 678 patients from two Specialized Care Services (SAE de Novo Hamburgo and SAE de Viamão), defined as collection points due to notifications of the high rates of infection by the virus in these regions. The defined data collection period considered complying with WHO regulations regarding the use of ART on a compulsory basis from the diagnosis of infection, regardless of clinical results, comprising the years 2015 to 2017. Data on viral load and lymphocytes TCD4 +, as well as the dispensing of medications, comorbidities and other epidemiological data were obtained from physical and electronic medical records and the Monitoring Systems of the Ministry of Health (MS) (SISCEL - Clinical Monitoring System and SINAN - National System of Diseases and Notifications). In order to observe the influence of the care provided by the responsible health professionals in the SAE of Novo Hamburgo, as well as their perceptions regarding the management of the control of the epidemic, the CEAT-HIV questionnaire for PLWHA (People Living with HIV / AIDS) was applied for 181 patients using SAE, a questionnaire for 10 SAE employees and the QualiAids questionnaire (for managers). The evaluated data indicate that the individual's behavior, insufficient medication adherence and the health service influence treatment adherence. The data obtained by the present study aim to contribute to the development of indicators that allow an understanding of which variables attribute greater value to the treatment adherence process, in order to support studies for the improvement of policies that meet individual and collective needs in the face of the epidemic. HIV / AIDS, with a special focus on adherence to treatment in southern Brazil.

Comparison of laboratorial tests for the diagnosis of human T-lymphotropic virus type 1 (HTLV-1) and type 2 (HTLV-2) in HIV-1 infected patients / Comparação de testes laboratoriais para o diagnóstico de infecção por vírus linfotrópicos de células T humanas do tipo 1 (HTLV-1) e tipo 2 (HTLV-2) em pacientes infectados por HIV-1

The present study aimed at investigating the best algorithm definition to be employed for diagnosing the human T lymphotropic virus type 1 (HTLV-1) and type 2 (HTLV-2) in HIV-1 infected/Aids patients. Blood samples of 1,608 HIV-1 infected patients from the AIDS Reference Center (CRT DST/AIDS-SP) were tested for the presence of HTLV-1/2 antibodies using two screening assays (EIA Murex HTLV-I+II, and Gold ELISA HTLV-I/II), and confirmed by two Blots [HTLV Blot 2.4 (Western Blot WB) and INNO-LIA HTLV I/II (Line ImmunoAssay - LIA)], and one molecular assay (pol real-time PCR). The screening tests detected 51(Murex) and 49 (Gold ELISA) reagents sera. WB , confirmed 23 HTLV-1, 12 HTLV-2, six HTLV, and nine showed HTLV indeterminate profiles. LIA confirmed 24 HTLV-1, 20 HTLV-2, and six HTLV. PCR detected 18 HTLV-1- and 12 HTLV-2-infected blood samples. By using any confirmatory assay, 50 patients confirmed HTLV infection: 25 HTLV-1 (1.55 %), 21 HTLV-2 (1.31 %) and four HTLV (0.25 %). The sensitivity of LIA, WB and PCR assays were 96 %, 76 % and 60 %, respectively. By considering the assays cost as the sole variable, the best testing algorithm for diagnosing HIV-1/HTLV-coinfection in HIV-1 infected patient was the use of PCR followed by LIA technique(AU)

O presente estudo pesquisou o melhor algoritmo de testes laboratoriais para efetuar o diagnóstico de infecção por vírus linfotrópicos de células T humanas dos tipos 1 (HTLV-1) e 2 (HTLV-2) em pacientes HIV-1 positivos. Amostras de sangue de 1.608 pacientes do CRT DST/Aids-SP foram analisadas quanto à presença de anticorpos específicos usando-se dois ensaios de triagem (EIA Murex HTLV-I+II e Gold ELISA HTLV-I/II), dois confirmatórios [HTLV Blot 2.4 (Western Blot WB) e INNO-LIA HTLV I/II (Line ImmunoAssay - LIA)] e um molecular (PCR em tempo real pol). Na triagem foram detectados 51(Murex) e 49 (Gold ELISA) soros reagentes. Pelo WB, 23 soros confirmaram infecção por HTLV-1, 12 HTLV-2, seis HTLV e nove apresentaram perfis indeterminados. O LIA detectou 24 soros HTLV-1 positivos, 20 HTLV-2 e seis HTLV. A PCR evidenciou segmento pol de HTLV-1 em 18 e HTLV-2 em 12 amostras de sangue. Pelos testes confirmatórios, em 50 pacientes foi confirmada a infecção por HTLV: 25 HTLV-1 (1,55 %), 21 HTLV-2 (1,31 %) e quatro HTLV (0,25 %). As sensibilidades do LIA, WB e PCR foram de 96 %, 76 % e 60 %, respectivamente. Considerando-se apenas o custo, o melhor algoritmo diagnóstico para população infectada pelo HIV-1 foi o uso da PCR seguida do LIA(AU)

Epidemiology of HIV/HCV co-infection in patients attended at an university hospital school at in Catanduva, São Paulo - Brazil / Epidemiologia da coinfecção por HIV/HCV em um hospital escola de Catanduva, São Paulo - Brasil

The prevalence of Hepatitis C Virus (HCV) among HIV-positive was determined in this investigation. The study was conducted at Emilio Carlos Hospital, Catanduva, São Paulo, Brazil. A retrospective study on clinical-laboratory, epidemiological and socio-demographic data of 600 patients treated at a teaching hospital of tertiary level was performed from January 2004 to December 2007. The prevalence of coinfection with HIV/HCV was 11.6 % (n = 70), predominantly in male patients (71.4 %) and mean age of 43.2 years, and 57.1 % of Caucasian ethnicity and low educational level (44.3 %). The transmission of HIV/ HCV by parenteral route in men, and by sexual contact in women was statistically significant (p = 0.0005). The use of injectable illicit drugs was also significant for males (p = 0.0208). The prevalence of HCV was 14.3 % for subtype 1a and 11.4 % for 3a subtype. Despite the prevalence of co-infection in the city of Catanduva be lower than the national average, this situation is still a major problem in this population, even with the availability of TARV, requiring strategies for its control and prevention by public health authorities.(AU)

Determinou-se a prevalência do vírus da hepatite C (HCV) em pacientes soropositivos para o vírus da imunodeficiência humana (HIV). O estudo foi realizado no Hospital Emílio Carlos, Catanduva, Estado de São Paulo, Brasil. Foi efetuado estudo retrospectivo de dados clínico-laboratoriais, epidemiológicos e sociodemográficos de 600 pacientes atendidos em um hospital escola de nível terciário, no período de janeiro de 2004 a dezembro de 2007. A prevalência de a coinfecção HIV/HCV foi de 11,6 % (n = 70), com predomínio no sexo masculino (71,4 %) e média de idade de 43,2 anos, sendo 57,1 % da etnia caucasóide e 44,3 % de baixo nível de escolaridade. A transmissão do HIV/HCV pela via parenteral nos homens e via sexual nas mulheres foi estatisticamente significante (p = 0,0005). O uso de drogas ilícitas injetáveis foi também significante para o sexo masculino (p = 0,0208). A prevalência do HCV foi de 14,3 % do subtipo 1a e 11,4 % do 3a. Apesar de a prevalência da coinfecção no município de Catanduva ser inferior à média nacional, esta situação é ainda um problema importante nesta população, mesmo com a disponibilidade da TARV, necessitando-se de estratégias de controle e prevenção pelas autoridades públicas de saúde.(AU)

Hepatitis B virus surface antigen seroconversion in HIV-infected individual after pegylated interferon-alpha treatment: a case report

Hepatitis B virus (HBV) infects from 6 to 14% of HIV-infected individuals. Concurrent HIV/HBV infection occurs due to the overlapping routes of transmission, particularly sexual and parenteral. HIV-infected patients that have acute hepatitis B have six times greater risk of developing chronic hepatitis B, with higher viral replication, rapid progression to end-stage liver disease and shorter survival. The coinfection is also associated with poor response to hepatitis B treatment with interferon-alpha and increased liver toxicity to the antiretroviral therapy. Herein, we describe the case of a 35-year-old man who engages in sex with men and presented with newly diagnosed HIV-1, serological markers for acute hepatitis B and progression to chronic hepatitis B infection (HBsAg+ > 6 months, high alanine aminotransferase levels and moderate hepatitis as indicated by liver biopsy). Lacking indication of antiretroviral treatment (CD4 768 cells/mm 3 ), he was treated with pegylated-interferon alpha2b (1.5 mg/kg/week) by subcutaneous injection for 48 weeks. Twelve weeks after treatment, the patient presented HBeAg seroconversion to anti-HBe. At the end of 48 weeks, he presented HBsAg seroconversion to anti-HBs. One year after treatment, the patient maintained sustained virological response (undetectable HBV-DNA). The initiation of antiretroviral therapy with nucleosides and nucleotides is recommended earlier for coinfected individuals. However, this report emphasizes that pegylated interferon remains an important therapeutic strategy to be considered for selected patients, in whom the initiation of HAART may be delayed.(AU)

Hepatitis B virus surface antigen seroconversion in HIV-infected individual after pegylated interferon-alpha treatment: a case report

Hepatitis B virus (HBV) infects from 6 to 14% of HIV-infected individuals. Concurrent HIV/HBV infection occurs due to the overlapping routes of transmission, particularly sexual and parenteral. HIV-infected patients that have acute hepatitis B have six times greater risk of developing chronic hepatitis B, with higher viral replication, rapid progression to end-stage liver disease and shorter survival. The coinfection is also associated with poor response to hepatitis B treatment with interferon-alpha and increased liver toxicity to the antiretroviral therapy. Herein, we describe the case of a 35-year-old man who engages in sex with men and presented with newly diagnosed HIV-1, serological markers for acute hepatitis B and progression to chronic hepatitis B infection (HBsAg+ > 6 months, high alanine aminotransferase levels and moderate hepatitis as indicated by liver biopsy). Lacking indication of antiretroviral treatment (CD4 768 cells/mm 3 ), he was treated with pegylated-interferon alpha2b (1.5 mg/kg/week) by subcutaneous injection for 48 weeks. Twelve weeks after treatment, the patient presented HBeAg seroconversion to anti-HBe. At the end of 48 weeks, he presented HBsAg seroconversion to anti-HBs. One year after treatment, the patient maintained sustained virological response (undetectable HBV-DNA). The initiation of antiretroviral therapy with nucleosides and nucleotides is recommended earlier for coinfected individuals. However, this report emphasizes that pegylated interferon remains an important therapeutic strategy to be considered for selected patients, in whom the initiation of HAART may be delayed.

Hepatitis B virus surface antigen seroconversion in HIV-infected individual after pegylated interferon-alpha treatment: a case report

Hepatitis B virus (HBV) infects from 6 to 14% of HIV-infected individuals. Concurrent HIV/HBV infection occurs due to the overlapping routes of transmission, particularly sexual and parenteral. HIV-infected patients that have acute hepatitis B have six times greater risk of developing chronic hepatitis B, with higher viral replication, rapid progression to end-stage liver disease and shorter survival. The coinfection is also associated with poor response to hepatitis B treatment with interferon-alpha and increased liver toxicity to the antiretroviral therapy. Herein, we describe the case of a 35-year-old man who engages in sex with men and presented with newly diagnosed HIV-1, serological markers for acute hepatitis B and progression to chronic hepatitis B infection (HBsAg+ > 6 months, high alanine aminotransferase levels and moderate hepatitis as indicated by liver biopsy). Lacking indication of antiretroviral treatment (CD4 768 cells/mm 3 ), he was treated with pegylated-interferon alpha2b (1.5 mg/kg/week) by subcutaneous injection for 48 weeks. Twelve weeks after treatment, the patient presented HBeAg seroconversion to anti-HBe. At the end of 48 weeks, he presented HBsAg seroconversion to anti-HBs. One year after treatment, the patient maintained sustained virological response (undetectable HBV-DNA). The initiation of antiretroviral therapy with nucleosides and nucleotides is recommended earlier for coinfected individuals. However, this report emphasizes that pegylated interferon remains an important therapeutic strategy to be considered for selected patients, in whom the initiation of HAART may be delayed.

Diagnosis of the pulmonary tuberculosis by polymerase chain reaction: a comparative study between HIV - positive and - negative individuals

This study was performed to assess the efficiency of polymerase chain reaction (PCR) directly from sputum for the diagnosis of pulmonary tuberculosis by comparison between HIV-positive and HIV-negative individuals. Sputum samples were collected from hospitalized patients admitted with a clinical diagnosis of pulmonary tuberculosis, and subjected to smear microscopy, culture on LJ medium and detection of M. tuberculosis by PCR. Sensitivity, specificity, and predictive values (positive and negative) were calculated using smear and/or culture at day 42 as the gold standard, by comparing the yield in HIV-positive and HIV-negative individuals. Regardless of serostatus, the technique's yield had 62% sensitivity, 70% specificity, 79% positive predictive value, 50% negative predictive value, and 65% accuracy. HIV-negative had 64% sensitivity, 74% specificity, 75% positive predictive value, 63% negative predictive value, and 68% accuracy. HIV-positive had 59% sensitivity, 33% specificity, 87% positive predictive value, 10% negative predictive value, and 56% accuracy. The PCR showed a higher yield in HIV-negative individuals compared to HIV-positive individuals.

Intestinal parasitic infections in HIV/AIDS patients: epidemiological, nutritional and immunological aspects

This study applied a socioeconomic questionnaire designed to evaluate the frequency of intestinal parasites and characterize epidemiological, nutritional, and immunological variables in 105 HIV/AIDS patients - with and without parasitic infections, attending the Day Hospital in Botucatu, UNESP, from 2007 to 2008. Body mass index was calculated and the following tests performed: parasitological stool examinations; eosinophil, IgE, CD4+ T and CD8+ T lymphocyte cell counts; albumin test; viral load measure; and TNF-α, IFN-γ, IL-2, IL-5 and IL-10 cytokine levels. Results were positive for parasitic intestinal infections in 12.4% of individuals. Most patients had good socioeconomic conditions with basic sanitation, urban dwellings, treated water supply and sewage, good nutritional and immunological status and were undergoing HAART. Parasites were found at the following frequencies: Entamoeba - five patients (38.5%), Giardia lamblia - four (30.7%), Blastocystis hominis - three (23.0%), Endolimax nana - two (15.4%), and Ascaris lumbricoides - one (7.7%). There were no significant differences between the two groups for eosinophils, albumin, IgE, CD4+ T and CD8+ T lymphocytes, INF-γ, IL-2, or IL-10. Most patients also showed undetectable viral load levels. Significant differences were found for TNF-α and IL-5. These results show the importance of new studies on immunodeficient individuals to increase understanding of such variables.(AU)

Intestinal parasitic infections in HIV/AIDS patients: epidemiological, nutritional and immunological aspects

This study applied a socioeconomic questionnaire designed to evaluate the frequency of intestinal parasites and characterize epidemiological, nutritional, and immunological variables in 105 HIV/AIDS patients - with and without parasitic infections, attending the Day Hospital in Botucatu, UNESP, from 2007 to 2008. Body mass index was calculated and the following tests performed: parasitological stool examinations; eosinophil, IgE, CD4+ T and CD8+ T lymphocyte cell counts; albumin test; viral load measure; and TNF-α, IFN-γ, IL-2, IL-5 and IL-10 cytokine levels. Results were positive for parasitic intestinal infections in 12.4% of individuals. Most patients had good socioeconomic conditions with basic sanitation, urban dwellings, treated water supply and sewage, good nutritional and immunological status and were undergoing HAART. Parasites were found at the following frequencies: Entamoeba - five patients (38.5%), Giardia lamblia - four (30.7%), Blastocystis hominis - three (23.0%), Endolimax nana - two (15.4%), and Ascaris lumbricoides - one (7.7%). There were no significant differences between the two groups for eosinophils, albumin, IgE, CD4+ T and CD8+ T lymphocytes, INF-γ, IL-2, or IL-10. Most patients also showed undetectable viral load levels. Significant differences were found for TNF-α and IL-5. These results show the importance of new studies on immunodeficient individuals to increase understanding of such variables.(AU)

Diphtheria Antibodies and T lymphocyte Counts in Patients Infected with HIV-1

We assessed the IgG levels anti-diphtheria (D-Ab) and T cell counts (CD4+ and CD8+) in HIV-1 infected subjects undergoing or not highly active antiretroviral therapy (HAART). Approximately 70% of all HIV-1 patients were unprotected against diphtheria. There were no differences in D-Ab according to CD4 counts. Untreated patients had higher D-Ab (geometric mean of 0.62 IU/ml) than HAART-patients (geometric mean of 0.39 IU/ml). The data indicated the necessity of keeping all HIV-1 patients up-to-date with their vaccination.