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.

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.

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)

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.

ASPECTOS CLÍNICOS E EPIDEMIOLÓGICOS DE GESTANTES VIVENDO COM HIV ATENDIDAS NO HOSPITAL DE DOENÇAS TROPICAIS DA UNIVERSIDADE FEDERAL DO TOCANTINS

Milhares de pessoas foram infectadas pelo vírus da imunodeficiência humana (HIV) desde o início da epidemia, e diversas morreram em decorrência das complicações desta, a qual tem se tornado crescente na população feminina devido ao aumento da transmissão heterossexual.As mulheres que se encontram em idade reprodutiva apresentam maior possibilidade de engravidarem e quando infectadas, há a necessidade de cuidados para a prevenção da infecção materno-infantil, a qual é responsável pela maioria da infecção em menores de 13 anos. Foiapresentada neste trabalho uma revisão de literatura acerca do tema, abordando o histórico da infecção pelo HIV, a etiologia, epidemiologia, patogenia, os aspectos clínicos, o diagnóstico da infecção,o tratamento especialmente em gestantes, e as medidas de prevenção e controle tanto da infecção como da transmissão vertical. Apresentou-se ainda um estudo epidemiológico e clínico em gestantes portadoras do HIV que foram atendidas no hospital de Doenças Tropicais da Universidade Federal do Tocantins (HDT-UFT) durante o período de 2015 a 2019 com o intuito de conhecer as características das gestantes infectadas. A coleta de dados ocorreu no HDT-UFT por meio da análise dos prontuários clínicos,em que apósa tabulação foram submetidos à análise estatística, considerando a frequência absoluta e percentual. Para as variáveis qualitativas fez um estudo de dispersão através do teste exato de Fisher e Qui-quadrado e para as variáveis quantitativas fez-se o teste F, utilizando-se os tratamentos carga viral detectável e não detectável, cuja probabilidade de erro tipo 1 foi de 0,05. A média de idade das 85 gestantes foi de 26 anos, sendo a faixa etária de 26 a 34 anos observada na maioria destas (48,24%). O grau de instrução predominante foi o Ensino Médio Completo (37,64%) e a cor autodeclarada foi a parda (91,76%). Estas eram oriundas de três estados: Tocantins (90,58%), Pará (7,06%) e Maranhão (2,35%), e possuíam em sua maioria com parceiro fixo (80%), cuja maior parte desconhecia seu status sorológico (44,11%). Foi observada diferença significativa(p=0.0001) entre as gestantes com idade 25 anos e < 25 anos em relação à carga viral. Cerca de 56,47% destaseram diagnosticadas com HIV antes da gestação, 45,88%, iniciaram o acompanhamento no primeiro trimestre gestacional e 5,88% contraíram sífilis durante a gestação. A carga viral do HIV (CV-HIV) foi indetectável em 57,65% das gestantes, e a terapia antirretroviral (TARV) mais utilizada (50,60%) no tratamento do HIVabrangeu o uso dotenofovir (TDF), lamivudina (3TC) e efavirenz (EFZ),cuja adesão compreendeu 85,90% das gestantes estudadas, com um percentual de abandono de 14,10%. Constatou-se diferença significativa entre as variáveis diagnóstico do HIV (p=0.0133) e trimestre gestacional (p=0.0001), as quais influenciaram na carga viral do HIV. A importância da adesão às recomendações do ministério da saúde para prevenção da transmissão vertical é observada no fato de a maioria das gestantes estarem aderentes ao tratamento, possuírem baixos níveis de carga viral, evidenciando que estas se preocuparam com sua qualidade de vida e da criança, buscando um rápido atendimento e assim redução do risco de transmissão da infecção.

Thousands of people have been infected with the human immunodeficiency virus (HIV) since the beginning of the epidemic, and several have died as a result of its complications, which has been growing in the female population due to the increase in heterosexual transmission. Women who are of reproductive age are more likely to become pregnant and when infected, there is a need for care to prevent maternal and child infection, which is responsible for the majority of the infection in children under 13 years old. A literature review on the topic was presented in this work, addressing the history of HIV infection, the etiology, epidemiology, pathogenesis, clinical aspects, diagnosis of the infection, treatment especially in pregnant women, and prevention and control measures both infection and vertical transmission. An epidemiological and clinical study was also presented in pregnant women with HIV who were seen at the Tropical Diseases Hospital of the Federal University of Tocantins (HDT-UFT) during the period from 2015 to 2019 in order to learn about the characteristics of the infected pregnant women. Data collection took place at HDT-UFT through the analysis of clinical records, in which, after tabulation, they were submitted to statistical analysis, considering the absolute and percentage frequency. For the qualitative variables, a dispersion study was carried out using Fisher's exact test and the Chi-square test, and for the quantitative variables, the F test was performed, using the treatments detectable and non-detectable viral load, whose type 1 error probability was 0.05. The average age of the 85 pregnant women was 26 years old, with the age group from 26 to 34 years old observed in most of them (48.24%). The predominant level of education was High School (37.64%) and the self-declared color was brown (91.76%). These were from three states: Tocantins (90.58%), Pará (7.06%) and Maranhão (2.35%), and they mostly had a steady partner (80%), most of whom were unaware of their status serological (44.11%). A significant difference was observed (p = 0.0001) between pregnant women aged 25 years and <25 years in relation to viral load. Approximately 56.47% of these were diagnosed with HIV before pregnancy, 45.88%, started follow-up in the first trimester of pregnancy and 5.88% contracted syphilis during pregnancy. The HIV viral load (CV-HIV) was undetectable in 57.65% of pregnant women, and the most used antiretroviral therapy (ART) (50.60%) in the treatment of HIV included the use of tenofovir (TDF), lamivudine ( 3TC) and efavirenz (EFZ), whose adherence comprised 85.90% of the studied pregnant women, with a dropout rate of 14.10%. There was a significant difference between the variables HIV diagnosis (p = 0.0133) and gestational trimester (p = 0.0001), which influenced the viral load of HIV. The importance of adhering to the recommendations of the Ministry of Health for the prevention of vertical transmission is observed in the fact that the majority of pregnant women are adherent to the treatment, have low levels of viral load, showing that they were concerned with their quality of life and that of the child, seeking rapid care and thus reducing the risk of transmission of the infection.

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.

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.

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)

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.

Terapia Antirretroviral no Controle do Vírus da Imunodeficiência Felina

O vírus da imunodeficiência felina (FIV) apresenta estrutura molecular similar ao vírus da imunodeficiência humana (HIV) e pode assim causar síndrome de imunodeficiência adquirida em gatos, estando o tratamento antirretroviral indicado em animais acometidos por infecções recorrentes, neuropatias e gengivoestomatite crônica. Entretanto, a zidovudina, apresenta-se como o único fármaco anti-HIV recomendado para tratamento de gatos infectados pelo FIV, sendo a ação da maioria das drogas antirretrovirais desconhecida diante do agente. Dessa maneira, o presente trabalho teve como objetivo avaliar a ação terapêutica do fármaco raltegravir em gatos naturalmente infectados por FIV, mediante a análise de imunofenotipagem e carga viral plasmática pré, trans e pós terapia. A pesquisa foi conduzida a partir da avaliação de 9 gatos com infecção por FIV provenientes da rotina de atendimento médico do Hospital de Clínicas Veterinária da UFPel durante o ano de 2016. Esses animais foram classificados em dois grupos: o grupo 1 (G1) composto de 5 animais FIV positivos submetidos ao tratamento com o fármaco raltegravir e o grupo 2 (G2) constituído de 4 animais FIV positivos não tratados com o antirretroviral. Cada animal foi submetido a 3 avaliações em momentos distintos, a 1ª avaliação (pré-terapia) foi realizada até 2 dias antes do início do tratamento, a 2ª avaliação (trans-terapia) entre o 10º e 12º dia de tratamento e a 3ª avaliação (pós- terapia) realizada até dois após a suspensão do medicamento. A dose de 40mg/gato q 12h, via oral, administrada por 21 dias demonstrou-se tolerável e segura nos gatos, pois não induziu nenhuma reação adversa durante o tratamento. Contudo a contagem de linfócitos CD4+ e o quociente CD4+/CD8+ não demonstrou elevação de valores, assim como a carga viral plasmática não apresentou supressão após o tratamento com raltegravir pelo mesmo período. Sendo assim, não foi possível estabelecer atividade antiviral in vivo do antirretroviral raltegravir diante do FIV.

Feline immunodeficiency virus (FIV) presents molecular structure similar to the human immunodeficiency virus (HIV) and can cause acquired immunodeficiency syndrome in cats, this way the antiretroviral therapy is encouraged in animals affected by recurrent infections, neuropathy and chronic gingivostomatitis. However, zidovudine is the only anti-HIV drug recommended for the treatment of FIV infected cats, being unknown the action of most of the antiretroviral drugs against the virus. In that way, the present work had the objective of evaluating the therapeutic action of raltegravir in cats naturally infected by FIV, through immunofenotyping and plasma viral load before, trans and after-therapy. The research was conducted by evaluating 9 cats naturally infected by FIV from the medical routine of the Veterinary Clinics Hospital (UFPel) during the year of 2016. These animals were classified in two groups: group 1 (G1) composed by 5 FIV positive animals treated with raltegravir and group 2 (G2) with 4 FIV positive animals non-treated with the antiretroviral. Each animal was submitted to 3 evaluations in distinct moments, the first evaluation (before therapy) was performed until two days before the beginning of the treatment, the second evaluation (trans-therapy) was between the 10th and the 12th day of treatment and the third evaluation (after-therapy) was performed until two days after the suspension of the drug. The dose of 40mg/ cat q 12h, PO, administered for 21 days has showed to be tolerable and safe in the cats, because it did not induce any adverse reaction during the treatment. However, the CD4+ lymphocyte count and the CD4+/CD8+ quotient did not show elevation of values, as well as the plasma viral load did not present suppression after the treatment with raltegravir for the same period. Thus, it was not possible to establish in vivo antiviral activity of the antiretroviral raltegravir against FIV.

Toxoplasmose aguda em pacientes HIV/aids no extremo sul do Brasil

A infecção por Toxoplasma gondii em indivíduos imunossuprimidos pelo HIV pode evoluir para doença oportunista. A neurotoxoplasmose tende a ser a forma mais prevalente, levando a quadros mais ou menos graves, a depender do grau de imunossupressão. Este trabalho objetivou analisar os aspectos clínico-epidemiológicos da toxoplasmose aguda em pacientes HIV/aids atendidos no Serviço de Assistência Especializada da Faculdade de Medicina da Universidade Federal de Pelotas. Os dados foram coletados através da análise de prontuários de todos os pacientes que estiveram em tratamento no período de 1998 a 2016, após a implantação do uso da terapia antirretroviral (HAART). A prevalência de toxoplasmose aguda foi de 3,65%. Destes, os índices foram de 77,6% para neurotoxoplasmose, 13% para toxoplasmose ocular e 9,3% para títulos elevados de IgG. Hemiparesia e diminuição de acuidade visual foram os sinais clínicos mais comuns de neurotoxoplasmose e toxoplasmose ocular, respectivamente. Foram constatados como fatores de risco para o desenvolvimento de infecção aguda por T. gondii, através do modelo de regressão logística: níveis baixos de linfócitos T CD4+ (OR=6,65), baixa relação CD4/CD8 (OR=8,03), uso irregular de antirretrovirais (OR=2,83; IC95%=2,34 -12,73) e o não uso dos mesmos (OR=1,13). Os resultados indicam a frequência de infecção aguda por T.gondii entre esses pacientes, com lesões predominantemente neurológicas, e que sua ocorrência está diretamente relacionada ao não uso ou uso inadequado da terapia específica antirretroviral, que resulta em grave imunossupressão, permitindo a agudização da infecção pelo protozoário, até então latente.

Toxoplasma gondii infection in HIV-immunocompromised individuals may progress to opportunistic diseases. Neurotoxoplasmosis tends to be the most prevalent form leading to more or less severe immunosuppression, depending on the degree of immunosuppression. This study aimed to analyze the clinical and epidemiological aspects of acute toxoplasmosis in HIV/AIDS patients who have been treated at the Specialized Assistance Service in the School of Medicine in Federal University of Pelotas. Data were collected through the medical records analysis of all patients who underwent treatment from 1998 to 2016, after the implementation of antiretroviral therapy (HAART). The prevalence of acute toxoplasmosis was 3.65%. From them, the rates were 77.6% for neurotoxoplasmosis, 13% for ocular toxoplasmosis and 9.3% for increased IgG titers. Hemiparesis and decreased visual acuity were the most common clinical signs of neurotoxoplasmosis and ocular toxoplasmosis, respectively. Low CD4 +T lymphocytes (OR=6.65), low CD4/CD8 ratio (OR=8.03), irregular use of antiretrovirals (OR=2.83, 95% CI=2.34-12.73) and non-use (OR=1.13) have been found as risk factors for the development of acute toxoplasmosis using a logistic regression model. The findings show the frequency of clinical toxoplasmosis among the patients with predominantly neurological lesions, and occurrence of them is directly related to the inadequate use or non-use at all of specific antiretroviral therapy, which leads to severe immunosuppression, allowing exacerbation of infection by the protozoan, latent until then.

PP65 antigenemia in the diagnosis of cytomegalovirus infection in AIDS patients

Cytomegalovirus causes significant morbidity and mortality in AIDS patients and those having undergone bone marrow or another transplant. PP65 antigenemia is based on detecting viral antigen in peripheral blood leukocytes through immunochemistry and by monitoring the infection in immunocompromised individuals. The present study aimed to set up this diagnostic technique in AIDS patients with active cytomegalovirus infection and verify its occurrence in the Botucatu region of São Paulo state, Brazil. Fifty patients, 35 men and 15 women aged from 24 to 69 years, were recruited from those attended at the Department of Tropical Diseases of Botucatu Medical School, UNESP, and divided into three groups according to CD4+ T lymphocyte counts and antiretroviral treatment. The control group comprised bone marrow transplant patients. Fourteen AIDS patients with low CD4+ cell counts tested positive for PP65 antigenemia, which could predict cytomegalovirus infection and indicate prophylactic treatment.(AU)

HAART therapy does not reduce the proteinase and phospholipase secretion by oral Candida albicans isolated from HIV-positive patients

Production of exoenzymes, specifically the proteinase and phospholipase, is considered one of the most important of pathogenicity mechanisms of C. albicans, which is crucial for tissue invasion. This study aimed at evaluating the production of these exoenzymes in 50 oral C. albicans isolates from HIV-positive (HIV+) patients treated with highly active anti-retroviral therapy (HAART), and from 50 control individuals. For testing the production of phospholipase and proteinase, the culture media containing egg yolk and bovine albumin were used, respectively. The results were obtained by measuring the diameter of the colony and divided by the diameter of colony plus the precipitation zone, defined as Pz. Data were statistically analyzed by Students t test (5). Statistically significant difference (p = 0.001) was observed between the mean values of Pz for proteinase in isolates from HIV+ patients (Pz = 0.358±0.295) and from control group (Pz = 0.660±0.370). The same results were observed for phospholipase production (Pz = 0.399±0.227 for HIV+ group; Pz =0.635±0.292 control group). Both enzymes were highly produced by C. albicans isolated from HIV+ patients when compared with those secreted by C. albicans obtained from control group, suggesting that HAART did not reduce the secretion of these enzymes by this pathogenic fungus infecting HIV+ patients.(AU)

Morphometric analysis of dendritic cells from anal mucosa of HIV-positive patients and the relation to intraepithelial lesions and cancer seen at a tertiary health institution in Brazil / Análise morfométrica das células dendríticas da mucosa anal de pacientes HIV-positivos e relação com as lesões intraepiteliais e o câncer numa instituição de saúde terciária no Brasil

PURPOSE: To morphometrically quantify CD1a+ dentritic cells and DC-SIGN+ dendritic cells in HIV-positive patients with anal squamous intraepithelial neoplasia and to evaluate the effects of HIV infection, antiretroviral therapy and HPV infection on epithelial and subepithelial dendritic cells. METHODS: A prospective study was performed to morphometrically analyze the relative volume of the dendritic cells and the relationship between anal intraepithelial neoplasia and cancer in HIV-positive patients from the Tropical Medicine Foundation of Amazonas, Brazil. All patients were submitted to biopsies of anorectal mucosa to perform a classic histopathological and immunohistochemical analysis, employing antibodies against CD1a and DC-SIGN for the morphometric quantification of dendritic cells. RESULTS: HIV-negative patients displayed a CD1a DC density significantly higher than that of HIV-positives patients (3.75 versus 2.54) (p=0.018), and in patients with severe anal intraepithelial neoplasia had correlated between DC CD1a density with levels of CD4 + cells (p: 0.04) as well as the viral load of HIV-1 (p: 0.035). A not significant rise in the median density of CD1a+ DC was observed in the HIV positive/ HAART positive subgroup compared to the HIV positive/ HAART negative subgroup. The CD1a+ DC were also significantly increased in HIV-negative patients with anorectal condyloma (2.33 to 3.53; p=0.05), with an opposite effect in HIV-positive patients. CONCLUSIONS: Our data support an enhancement of the synergistic action caused by HIV-HPV co-infection on the anal epithelium, weakening the DC for its major role in immune surveillance. Notoriously in patients with severe anal intraepithelial neoplasia, the density of CD1a+ epithelial dendritic cells was influenced by the viral load of HIV-1.(AU)

OBJETIVO: Quantificar morfometricamente as células dendríticas DC CD1a+ e DC DC-SIGN+ em pacientes HIV positivos portadores de neoplasia escamosa intraepitelial anal e avaliar os efeitos da infecção pelo HIV, da terapia antirretroviral e da infecção pelo HPV sobre as células dendríticas epiteliais e subepiteliais. MÉTODOS: Um estudo prospectivo foi realizado para analisar morfometricamente o volume relativo das células dendríticas e as relações entre neoplasia intraepitelial anal e o câncer em pacientes HIV positivos da Fundação de Medicina Tropical do Amazonas, Brasil.Todos os pacientes foram submetidos a biópsia da mucosa retal para realizar uma análise clássica histopatológica e imunohistoquímica utilizando anticorpos contra anti-CD1a e anti-DC-SIGN, para a quantificação morfométrica das células dendríticas. RESULTADOS: Os pacientes HIV negativos apresentaram densidade das DC CD1a+ significativamente maior do que a dos pacientes HIV positivos (3,75 versus 2,54) (p:0,018), e os pacientes com severa apresentaram correlação das DC CD1a com os níveis de células TCD4(p:0,04) assim como a carga viral do HIV-1 (p:0,035). Observamos no subgrupo HIV-positivo/HAART positivo elevação não significativa na mediana da densidade das DC CD1a+ em relação ao grupo HIV-positivo/HAART negativo. As DC CD1a+ também se elevaram nos pacientes HIV negativo portadores de condiloma anorretal(2,33 para 3,53; p:0,05), com efeito inverso nos pacientes HIV positivos. CONCLUSÕES: Nossos dados confirmam a potencialização da ação sinérgica representada pela coinfecção HIV-HPV sobre o epitélio anal, fragilizando as DC em sua função primordial de vigilância imune. Notoriamente nos pacientes com neoplasia intraepithelial anal grave, a densidade das DC CD1a+ epiteliais sofreu influência da carga viral do HIV-1.(AU)

Coinfecção Trypanosoma cruzi/HIV, no extremo sul do Brasil

A reativação da doença de Chagas (DCH) em indivíduos com a coinfecção Trypanosoma cruzi/HIV foi considerada uma condição definidora de AIDS em 2004, mas a frequência com que ocorre ainda não está estabelecida. A solicitação da sorologia para Chagas faz parte do protocolo de assistência a portadores do vírus HIV por isso este estudo visou avaliar a prevalência de solicitação de sorologia para DCH nos pacientes atendidos no Serviço de Atendimento Especializado. Foi realizado um estudo transversal com dados secundários para estimar a magnitude da situação. Adicionalmente, foi realizado um estudo transversal em 200 indivíduos HIV positivos da região sul do Rio Grande do Sul, dos quais foram colhidas amostras sanguíneas para avaliação sorológica para Trypanosoma cruz. Também foram coletados dados socioeconômicos, demográficos, comportamentais, bem como informações sobre terapia antirretroviral, carga viral e linfócitos T CD4+ destes pacientes. As análises estatísticas foram realizadas no programa Stata 12 ®. A prevalência de solicitação da sorologia para DCH foi de 3,2%. Dez indivíduos apresentaram resultado positivo para infecção por T. cruzi, o que representou uma prevalência de 5% (IC95% 2,0 8,0) de coinfecção T. cruzi/HIV. Todos os dez indivíduos estavam em uso de Terapia Antirretroviral e não apresentavam nenhuma lesão atribuível à DCH. O estudo detectou um baixo índice de solicitação para DCH e uma prevalência de 5% de positividade para a doença em pacientes HIV colaborando para o conhecimento da prevalência da coinfecção em região endêmica, reiterando a importância do conhecimento do status sorológico para DCH já na primeira consulta do indivíduo portador de HIV.

Reactivation of Chagas disease in patients with Trypanosoma cruzi and HIV co-infection was considered an AIDS defining condition since 2004, however, the frequency of this co-infection, as well as its reactivation, is not well established. Chagas disease serology is part of assistance protocols for HIV patients. This study aimed to assess the prevalence of serological request for Chagas in HIV positive patients of a Specialized Care Service. A cross-sectional study using secondary data from medical records was conducted in to evaluate the magnitude of the situation. Additionally, it was performed a cross-sectional study in HIV-positive patients attending a specialized clinic in southern Rio Grande do Sul, Brazil. The study includes a questionnaire including socioeconomic, demographic, and behavioral characteristics, as also information about antiretroviral therapy, viral load and CD4 + T lymphocytes. Blood samples were collected for serological testing for Chagas disease. Statistical analyzes were performed using Stata 12 ®. In the medical records the prevalence of serologic testing for Chagas disease was 3.2%. In the cross-sectional study ten individuals tested positive for Chagas disease, representing a prevalence of 5% (95% CI 2.0 to 8.0) of T. cruzi / HIV co-infection. All ten subjects were in use of antiretroviral therapy and did not have any signs related to Chagas disease. The study found a low rate of serology request for Chagas disease and a prevalence of 5% positive of this disease in HIV positive patients contributing to the knowledge of the prevalence of co-infection in an endemic region and reiterating the importance of knowledge of Chagas status among those patients.

Nosocomial infections in human immunodeficiency virus type 1 (HIV-1) infected and AIDS patients: major microorganisms and immunological profile

Antiretroviral therapy advances have proportioned to AIDS patients a survival increase. At the same time, the permanence of the seropositive people in the nosocomial environment becomes common not only by the adverse reactions caused by this therapy, but also by several opportunistic diseases that take them into and out of hospital environment. During the hospital permanence, the patients expose their impaired immune system to the nosocomial virulent microorganisms, and acquire destructive nosocomial infections that sometimes can be lethal. Among several hospital syndromes described, little is known about infections in immunocompromised patients and how their immune system is able to determine the course of the infection. The objective of this study was to describe the major microorganisms involved in the nosocomial infections of HIV-1 seropositive patients associated with their immunological status. The survey was carried out with the Hospital Infection Control Service records, from University Hospital, Londrina, Paraná, Southern of Brazil, during the period from July 2003 to July 2004. From all the cases studied (n=969), 24 patients (2.5%) had AIDS diagnosis and a half of them was women with the mean of CD4+ T cells counts of 158/mm³. The main topography of the infection was pulmonary (50.0%) and the main isolated microorganisms were Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. A major incidence of infection was observed in patients with CD4+ T cells counts lower than 50/mm³. The study of the relationship between the impairment of the immune system and infectious agents could provide a better healthcare of people living with HIV/AIDS and advances into the nosocomial infection control systems.

Avanços na terapia anti-retroviral têm proporcionado aos pacientes com AIDS um aumento na sobrevida. Ao mesmo tempo, a permanência de pacientes soropositivos no ambiente nosocomial torna-se comum não só pelos efeitos colaterais desta terapia, mas também pelas diversas doenças oportunistas que acometem estes indivíduos dentro e fora do ambiente hospitalar. Durante o período de internação, a fragilidade do sistema imunológico é exposta à virulência da microbiota nosocomial, adquirindo infecções hospitalares graves e muitas vezes fatais. Dentre as diversas síndromes de infecções hospitalares descritas, pouco se sabe sobre estas infecções em pacientes imunocomprometidos e sobre como o estado imunológico é capaz de determinar o curso destas infecções. Este trabalho teve como objetivo determinar os principais microrganismos envolvidos nas infecções hospitalares de pacientes soropositivos para a infecção pelo HIV-1 e descrever a associação com seu perfil imunológico. Realizou-se análise de dados de notificações do Serviço de Controle de Infecção Hospitalar do Hospital Universitário, Londrina, Paraná, na região sul do Brasil, no período de julho de 2003 a julho de 2004. Do total de casos estudados (n=969), 24 pacientes (2,5%) tinham o diagnóstico de AIDS, sendo metade do gênero feminino, com contagem média de células T CD4+ de 158,4/mm³. A principal topografia foi o sítio pulmonar (50,0%), sendo Staphylococcus aureus, Pseudomonas aeruginosa e Escherichia coli os principais microrganismos isolados. Observou-se maior incidência de infecção em pacientes com contagem de células T CD4+ menor que 50/mm³. O estudo da relação entre sistema imunológico e microrganismos causadores de infecções poderá contribuir para melhorias nos cuidados de pacientes com AIDS e avanços nos sistemas de controle de infecção hospitalar.

Occurrence of pneumocystis pneumonia in hiv-infected patients and the interference of the highly active antiretroviral therapy

From the beginning of the AIDS epidemic, pneumocystis pneumonia (PCP) has been distinguished as one of the most frequent opportunistic diseases with high morbid-mortality. As from 1996, the advent of the highly active antiretroviral therapy (HAART) has changed the characteristics of such epidemic by reducing its related diseases and, as a result, AIDS-related mortality. With the purpose to estimate PCP occurrence and HAART interference, 376 HIV-infected or AIDS patients were studied from January 1992 to December 2002. Among them, 58 (15.5%) PCP cases were found. There was a higher occurrence of PCP in the group of patients in which HAART was not used, with 40 (69.0%) of the episodes. As regards the studied period, a tendency to a linear reduction in annual PCP incidence was observed. The mean of T CD4+ lymphocytes in the patients with PCP (117 cells/mm³) was significantly lower when compared to that of the other individuals (325 cells/mm³). Therefore, this study suggests a temporal reduction in PCP occurrence related to HAART use with higher T CD4+ lymphocyte counts. Nevertheless, this opportunistic infection still shows significant incidence in AIDS patients. (NCT00516581).

Different nutritional-state indicators of HIV-positive individuals undergoing antiretroviral therapy

This study aimed at learning about the nutritional profile of HIV-positive individuals undergoing antiretroviral therapy and at comparing the performance of nutritional-state indicators. A transversal study was performed on 94 patients attending the Tropical Diseases Outpatient Hospital of Botucatu Medical School (FMB) - UNESP. The body mass index (BMI) and the classification by Papini-Berto (PB) were used to evaluate nutritional state, aiming at detecting malnutrition and obesity. The waist-to-hips ratio (W/HR) and waist circumference (WC) were adopted for identification of abdominal obesity and lipodystrophy. According to BMI, most of the individuals were eutrophic, followed by 30.9% overweight and 6.4% malnourished. By using the PB classification, the frequency of malnourished increased (22.3%). The analysis of the PB classification in relation to BMI indicated that the former presented high sensitivity and good specificity for malnutrition diagnosis, namely 100% and 83%, respectively. The prevalence of abdominal obesity was 7.44% according to WC, and a higher prevalence (38.3%) was observed when taking W/HR into account. There was significant positive association between nutritional diagnosis according to PB and T CD4+ lymphocyte. The results support the use of PB classification for malnutrition detection as well as that of BMI and W/HR for overweight and fat redistribution.