HIV Pre-Exposure Prophylaxis (PrEP) in a Brazilian Clinical Setting: Adherence, Adverse Events, Sexual Behavior, and Sexually Transmitted Infections.

Tenofovir/emtricitabine (TDF/FTC) has been used as pre-exposure prophylaxis (PrEP) in preventing HIV infection. PrEP is an effective prevention tool as demonstrated in clinical trials and studies in clinical practice and was incorporated into the Brazilian public health system in December 2017. The present study was a prospective cohort that included 219 PrEP users monitored over a 10 month follow-up period in a capital city in Northeastern Brazil. Data were collected from the PrEP users' electronic medical records platform made available by the Brazilian Health Ministry. During the observation period, there was good user retention to the prevention program (84%) and there was high adherence to medication (90%). Almost half the users (49%) presented an adverse event, although these were mild and transient, 30 days after starting prophylaxis. There was a significant reduction in creatinine clearance (p < .001), from 104.9 to 83.5 mL/min; however, there was no need for drug discontinuation. Throughout the cohort, there was no significant change in the number of sexual partners, but the use of condoms during sexual intercourse decreased (p < .001). There was a non-significant increase in the incidence of syphilis (p = .08), and there was a 50% decrease in reporting signs and symptoms of sexually transmitted infections. No cases of HIV infection were observed. PrEP proved to be an effective tool in HIV prevention, presenting few complications of adverse events.

PRK em olhos com topografia atípica e pentacam normal / PRK in eyes with atypical topography and normal pentacam

OBJETIVO: Avaliar a segurança do PRK em olhos com topografia de córnea atípica, porém sem características de ceratocone no Pentacam. MÉTODOS: Foram analisados dados de pacientes submetidos à PRK que apresentavam topografia corneana atípica e tomografia normal no pré-operatório. A amostra foi composta de dezenove olhos de dez pacientes. Foram considerados critérios de irregularidade corneana: aumento de curvatura superior a 47D com assimetria inferior-superior menor que 1,5D, ápice deslocado acima de 1,5D e assimetria inferior-superior maior ou igual a 1,5D. Todos tinham índices de elevação anterior, elevação posterior e perfil de progressão paquimétrica obtidos através do Pentacam considerados normais. A segurança foi avaliada quanto à perda da acuidade visual e/ou desenvolvimento de doença ectásia. RESULTADOS: Dos dez pacientes, nove (90%) eram do sexo feminino e um (10%) do sexo masculino. A média de idade foi de 31,8 anos, variando de 24 a 47 anos. A distribuição quanto à irregularidade corneana apresentou 11 olhos (57,89%) com aumento da curvatura acima de 47D e assimetria inferior-superior menor que 1,5D, 3 olhos (15,78%) com deslocamento do ápice acima de 1,5D, 2 olhos (10,52%) com assimetria inferior-superior acima de 1,5D e 3 olhos (15,78%) que incluiam mais de um critério. Os pacientes foram acompanhados por um período médio de 16,4 meses. Em nenhum caso houve perda de acuidade visual ou desenvolvimento de ectasia. CONCLUSÃO: Este estudo sugere que a tomografia corneana pode ser decisiva na indicação de cirurgia refrativa. Estudos prospectivos com maior tempo de seguimento devem ser realizados para uma avaliação mais efetiva.

OBJECTIVE: To evaluate the safety of PRK in patients with atypical corneal topography, but without features of keratoconus in Pentacam. METHODS: Medical records of patients who underwent PRK method that presented atypical corneal topography and Pentacam rates considered normal in the pre operative were analyzed. The sample consisted of nineteen eyes of ten patients. The considered criteria of corneal irregularity were: increased curvature greater than 47D with asymmetry less than 1,5D, 1,5D displacement above the apex and inferior-superior asymmetry greater than or equal to 1,5D. All eyes had rates of anterior elevation, posterior elevation and profile of progression pachymetric within the normal range. The safety of the procedure was evaluated for loss of visual acuity and / or development of ectasia. RESULTS: Nine (90%) of the patients were female and one (10%) was male. The average age was 31.8 years, ranging from 24 to 47 years. The distribution of corneal irregularity had 11 eyes (57.89%) with increased corneal curvature greater than 47D and inferior-superior asymmetry less than 1,5D, 3 eyes (15.78%) with displacement of the apex above 1,5D , 2 eyes (10.52%) with inferior-superior asymmetry above 1,5D and 3 eyes (15.78%) which included more than one criteria. Patients were followed postoperatively with an average of 16.4 months. Loss of visual acuity or development of ectasia disease was not present in any eyes. CONCLUSION: This study suggests that corneal tomography may be decisive to perform corneal refractive surgery. Prospective studies with longer follow-up time must be done to confirm our findings.