Plasma homocysteine levels in HIV-infected men with and without lipodystrophy.

OBJECTIVE: Lipodystrophy syndrome is an unexpected clinical manifestation in patients infected with HIV and might be a clinical marker of increased risk for cardiovascular diseases (CVDs). Because hyperhomocysteinemia has been associated with CVD, the goal of the present study was to investigate homocysteine (Hcy) levels and their association with the factors of lipodystrophy syndrome in men with HIV. METHODS: Hcy metabolism-related molecules were determined in 13 men infected with HIV with lipodystrophy (HIV+LIP), 10 men with HIV without lipodystrophy (HIV), and 10 healthy controls (C). RESULTS: Significant (P < 0.05) increased Hcy plasma levels were found in HIV (20.5%) and in HIV+LIP (35.2%) compared with the control group. Plasma levels of vitamin B12 (HIV, 26.5%; HIV+LIP, 28.8%) and folate (HIV, 39.1% and HIV+LIP, 49.4%) were significantly (P < 0.05) lower in the two groups of HIV patients compared with control. HIV+LIP men presented raised plasma total sulfur-containing amino acids (20.1%) and lower total plasma thiol (11.3%) than controls. The same was not observed in the HIV group. Spearman's correlation test revealed significant (P < 0.05) association between plasma Hcy and duration of highly active antiretroviral therapy (HAART) and plasma insulin, as well as plasma adiponectin levels. CONCLUSION: Our results demonstrated that HIV+LIP men were more susceptible to disturbances in Hcy metabolism compared with men infected with HIV without lipodystrophy characteristics. Duration of HAART treatment, elevated plasma insulin, and low levels of adiponectin seem to be relevant for the appearance of these Hcy metabolic disorders.

Safety and immunovirologic outcomes with maraviroc combination regimens in patients with a history of past treatment failures and virologic resistance in Brazil: an open-label, multicenter phase 3b study.

Maraviroc is a first-in-class chemokine coreceptor type-5 (CCR5) antagonist with demonstrated immunovirologic activity in treatment-experienced (TE) patients with CCR5 (R5)-tropic HIV-1; however, experience in regimens containing newer antiretroviral agents is limited. The primary objective of this 96-week open-label, noncomparative, multicenter Phase 3b study (NCT00478231) was to assess the safety of maraviroc in combination with optimized background therapy (OBT), which could include recently introduced agents such as darunavir and raltegravir in TE patients in Brazil with R5 HIV-1 and limited therapeutic options. Immunovirologic activity was a secondary endpoint. Of 638 patients screened, 206 were treated and 125 completed the study. Approximately 70% were male; the mean age was 43.2 years. Most patients (65.0%) received an OBT combination of protease inhibitor plus nucleoside reverse transcriptase inhibitor. Adverse event (AE) and treatment-related AE incidence was 91.3% and 36.9%, respectively. The most common AEs were diarrhea, nasopharyngitis, and headache. Serious AEs and treatment-related serious AEs occurred in 16.5% and 4.4% of patients. Only eight patients (3.9%) discontinued due to AEs. Few AIDS-defining events were observed (4.9%). The proportion of patients with viral load <400 copies/ml increased from 2.4% at baseline to 43.9% at week 8, remaining >40% until week 48. At the end of treatment, 26.7% of patients had a viral load <400 copies/ml. Median CD4(+) cell count increased throughout the study; the mean change from baseline to end of treatment was 174.1 cells/µl. In conclusion, maraviroc, combined with different agents from multiple classes, was well tolerated in highly TE patients. Maraviroc plus OBT was associated with an immunovirologic response in this population.

Lactoferrin, a marker for periodontal disease.

This study evaluated the salivary concentrations of lactoferrin (Lf) in HIV-seropositive and -seronegative subjects correlating these levels with the incidence of periodontal disease, quantity of Candida spp and systemic condition of the HIV-seropositives (viral load and T lymphocytes CD-4+ count and antiretroviral therapy). Whole saliva samples were obtained from 109 subjects who were divided into four groups according to the extent of their HIV infection and their periodontal condition. The salivary Lf concentrations were determined by a standard enzyme-linked immunosorbent assay and the quantification of Candida spp. was obtained from all subjects. Among the HIV- participants, higher concentrations of Lf were found in individuals with periodontal diseases (p<0.0001). A similar result was found for HIV+ participants (p<0.0001). No correlation was found between the concentration of salivary Lf and the quantification of Candida spp or between the Lf concentration and the systemic condition of the HIV+ subjects. The existence of periodontal diseases can modulate an early inflammatory process in the oral mucosa by increasing the expression of Lf, where Lf can act as an antibacterial peptide in HIV- and HIV+ patients. These results suggest that Lf is a possible marker for periodontal diseases in immunocompetent and immunocompromised subjects.

Hypermetabolism and altered substrate oxidation in HIV-infected patients with lipodystrophy.

OBJECTIVE: Human immunodeficiency virus type 1 (HIV)-associated lipodystrophy syndrome compromises body composition and produces metabolic alterations, such as dyslipidemia and insulin resistance. This study aims to determine whether energy expenditure and substrate oxidation are altered due to human HIV-associated lipodystrophy syndrome. METHODS: We compared energy expenditure and substrate oxidation in 10 HIV-infected men with lipodystrophy syndrome (HIV+LIPO+), 22 HIV-infected men without lipodystrophy syndrome (HIV+LIPO-), and 12 healthy controls. Energy expenditure and substrate oxidation were assessed by indirect calorimetry, and body composition was assessed by dual-energy X-ray absorptiometry. The substrate oxidation assessments were performed during fasting and 30 min after eucaloric breakfast consumption (300 kcal). RESULTS: The resting energy expenditure adjusted for lean body mass was significantly higher in the HIV+LIPO+ group than in the healthy controls (P = 0.02). HIV-infected patients had increased carbohydrate oxidation and lower lipid oxidation when compared to the control group (P < 0.05) during fasting conditions. After the consumption of a eucaloric breakfast, there was a significant increase in carbohydrate oxidation only in the HIV+LIPO- and control groups (P < 0.05), but there was no increase in the HIV+LIPO+ group. CONCLUSION: Hypermetabolism and alteration in substrate oxidation were observed in the HIV+LIPO+ group.

Acidentes ocupacionais com exposição a material biológico: retrato de uma realidade / Occupational injury involving exposure to biological fluids: a portrait of reality

Objetivo: caracterizar os acidentes ocupacionais por exposição à material biológico notificados nos serviços de referência da micro região de Votuporanga- SP, no período de 2001 a 2005. Material e método: trata-se de uma pesquisa descritiva, do tipo levantamento documental retrospectivo, dos casos de acidentes ocupacionais por exposição a material biológico obtidos das 273 fichas de notificação do SINABIO encaminhadas aos bancos de dados do Serviço de Vigilância Epidemiológica da Secretaria Municipal de Saúde de Votuporanga-SP e da Direção Regional de Saúde XXII (DIRXXII) de São José do Rio Preto-SP. Resultados: dos 273 acidentes notificados, 78,4% ocorreram em trabalhadores do sexo feminino e 69,6% entre 20 e 40 anos. Votuporanga foi o município que mais notificou (89,0%) e o auxiliar de enfermagem a categoria mais exposta (48,4%). Em 99,6% dos casos, o atendimento se deu dentro das 72 horas. A exposição mais frequente foi a percutânea (86,8%), o sangue o material biológico de maior contato (98,5%) e a agulha com lúmen a que mais provocou acidentes (72,1%). Dos acidentados, 87,5% eram vacinados contra HBV e desses, 67,0% não haviam realizado o anti-HBs. Em 16,1% das notificações a fonte HIV era desconhecida e em 78,8% era conhecida para o HBV. Para o HCV, detectou se 78,8% de sorologias de pacientes-fonte, das quais 3,3% eram positivas, sendo que 25,9% dos com fonte desconhecida não fizeram acompanhamento...

Objective: to characterize occupational accidents with exposure to biological material reported in the referral services in the micro region of Votuporanga, SP, Brazil between 2001 and 2005. Material and Method: this is a descriptive survey, retrospective documentary survey of occupational accidents with exposure to biological material obtained from 273 report forms from the accident report system forwarded to the database of the Serviço de Vigilância Epidemiológica da Secretaria Municipal de Saúde de Votuporanga, SP and to the Direção Regional de Saúde XXII (DIRXXII) de São José do Rio Preto, SP, Brazil. Results: of the 273 reported accidents, 78.4% occurred with female workers and 69.6% were individuals between 20 and 40 years of age. Votuporanga was the city with the most reported accidents (89.0%) and nursing auxiliaries were the most exposed professionals (48.4%). In 99.6% of cases, care was provided within 72 hours. Percutaneous injury was the most frequent (86.8%), blood was the biological material with which there was the most contact (98.5%), and lumen needles accounted for 72.1% of the accidents. A total of 87.5% of the victims were vaccinated against Hepatitis B and 67.0% had not been tested for anti-HBs. The serological status against HIV of the source patient was unknown in 16.1% of the reports and in 78,8% was known for HBV. Hepatitis C serological tests for 78.8% of patient-sourcewere verified, of which 3.3% tested positive, 25.9% whose source was unknown did not follow-up...

Oral lesions associated with HIV infection before and during the antiretroviral therapy era in Ribeirão Preto, Brazil.

We estimated the prevalence of oral lesions associated with human immunodeficiency virus (HIV-OLs) before and during the antiretroviral therapy (ART) era. The first period was 1997, when many patients received two types of antiretroviral (ARV) drugs. The second study period was 2004 through 2008, when all patients were treated with ART (a combination of two or three classes of drugs, including protease inhibitors). A total of 148 and 388 seropositive participants were examined in 1997 and 2004-2008, respectively. The evaluation consisted of anamnesis and physical examination. The prevalence of HIV-OLs decreased between 1997 (60.1%) and 2004-2008 (29.9%). The HIV-OL responsible for the greatest reduction in prevalence between the two periods was oral candidiasis, of which erythematous candidiasis was the clinical form that decreased most, followed by pseudomembranous candidiasis. In conclusion, we observed a significant reduction in HIV-OLs, which was closely associated with the use of ART. In addition, among patients with a clinical diagnosis of AIDS, we confirmed a significant reduction in HIV-OL prevalence between 1997 and 2004-2008.

Clinical and metabolic profile of HIV-positive patients with lipodistrophy / Perfil clínico e metabólico de pacientes soropositivos para HIV portadores de lipodistrofia

Objective: To evaluate the clinical and metabolic profile of HIV-seropositive patients on HAART with a diagnosis of associated lipodystrophy. Methods: We analyzed data computed in a protocol attached to the records of patients treated at the University Hospital of the Medical School of Ribeirão Preto. Results: 69.7% of the participants were male. Mean ± standard deviation body mass index was 24.7 ± 3.6 kg/m2and 26.7 ± 5.98 kg/m2, and average weight 72.78 ± 12.7 kg and 65.94 ± 15.4 kg for males and females, respectively. The percentage of lean mass was greater in men (p = 0.0008) and body fat was greater in women (p = 0.0006)...

Objetivo: Avaliar o perfil clínico e metabólico dos pacientes soropositivo para HIV, em uso de terapia antiretroviral fortemente ativa (Highly Active Antiretroviral Therapy - HAART) e com diagnóstico de lipodistrofia associada. Métodos: A pesquisa foi realizada a partir da análise de dados computados em um protocolo anexado ao prontuário de pacientes atendidos na Unidade Especial de Tratamento para Doenças Infecciosas (UETDI), no Ambulatório de Dislipidemia (ADIS) do Hospital das Clínicas da Faculdade deMedicina de Ribeirão Preto (HC-FMRP). Resultados: 69,7% dos participantes eram do sexo masculino. As médias (DP) de IMC foram 24,7 ± 3.6 Kg/m2 e 26,7 ± 5.98 Kg/m2 e média de peso 72,78 ±12.7 Kg e 65,94 ± 15.4 Kg para o sexo masculino e feminino, respectivamente. A porcentagem de massa magra foi maior nos homens (p=0,0008) e de gordura corporal, maior no sexo oposto (p=0,0006)...

Co-infection with paracoccidioidomycosis and human immunodeficiency virus: report of a case with esophageal involvement.

Paracoccidioiodomycosis (PCM) is a systemic and deep mycosis endemic in Latin America, especially in Brazil. In patients infected with human immunodeficiency virus (HIV), PCM can manifest with prominent involvement of the reticuloendothelial system. There are no reports in the literature of esophageal involvement by PCM in that population. We report a case of PCM with pulmonary and esophageal involvement without radiologic evidence of an esophageal-bronchial fistula in an HIV-infected patient.

The association of lipodystrophy and oxidative stress biomarkers in HIV-infected men.

The aim of this study was to describe the status of oxidative stress and antioxidant biomarkers and their association with metabolic and body composition components of HIV-lipodystrophy syndrome. In a cross-sectional study of blood samples from HIV-infected men with lipodystrophy syndrome (HIV+LIPO+ = 10), HIV-infected men without lipodystrophy syndrome (HIV+LIPO- = 22), and healthy subjects (control = 12), the following oxidative stress biomarkers were analyzed: total hydroperoxide, thiobarbituric acid reactive substances (TBARS), and advanced oxidation protein products (AOPP). In addition, antioxidant biomarkers, including total glutathione, uric acid, alpha-tocopherol, and metabolic components were tested. Dual-energy x-ray absorciometry (DXA) was used to measure the fat mass. The duration of HIV infection and the duration and type of highly active antiretroviral therapy were similar between the two HIV-infected groups. Higher levels of total hydroperoxide were observed in the HIV+LIPO+ (50 +/- 33 H(2)O(2)/L) group compared to the HIV+LIPO- (19 +/- 13 H(2)O(2)/L) and control (5 +/- 5 H(2)O(2)/L) groups (p < 0.05). Similarly, higher levels of AOPP were observed in the HIV+LIPO+ (326 +/- 173 micromol/L) group compared to the HIV+LIPO- (105 +/- 92 micromol/L) and control groups (80 +/- 20 micromol/L) (p < 0.05). Total hydroperoxide significantly correlated with insulin serum levels in the HIV+LIPO+ (r = 0.47, p < 0.05) and HIV+LIPO- groups (r = 0.29, p < 0.05), while AOPP significantly correlated with insulin serum levels in the HIV+LIPO+ (r = 0.73, p < 0.05) and HIV+LIPO- (r = 0.54, p < 0.05) groups. Therefore, higher lipid and protein oxidation were found in HIV-infected patients with lipodystrophy syndrome, and both were associated with insulin levels.

Primary antiretroviral drug resistance among HIV type 1-infected individuals in Brazil.

Infection with drug-resistant human immunodeficiency virus type 1 (HIV-1) has been documented in all countries that have surveyed for it and may result in an unfavorable response to therapy. The prevalence and characteristics of individuals with transmitted resistance to antiretroviral drugs have been scarcely described in Brazil. We performed antiretroviral resistance testing prior to initiation of therapy in 400 subjects enrolled from 20 centers in 13 Brazilian cities between March and September 2007. Genotyping was conducted using PCR-amplified HIV pol products by automated sequencing, and genotype interpretation was done according to the IAS-USA consensus. Of 400 eligible participants, 387 (95.8%) were successfully tested. Seven percent of antiretroviral-naive patients carried viruses with one or more major mutation associated with drug resistance. The prevalence of these mutations was 1.0% for protease inhibitors, 4.4% for nonnucleoside reverse transcriptase inhibitors, and 1.3% for nucleoside reverse transcriptase inhibitors. The frequency of multidrug resistance among the resistant strains was 13.6%. Among subjects infected with drug-resistant virus, the majority were infected with subtype B viruses (91%). Subjects from the city of São Paulo had higher transmitted resistance mutations compared to the rest of the country. Reporting a partner taking antiretroviral medications was associated with a higher chance of harboring HIV variants with major drug resistance mutations [odds ratio = 2.57 (95% confidence interval, 1.07-6.16); p = 0.014]. Resistance testing in drug-naive individuals identified 7% of subjects with mutations associated with reduced susceptibility to antiretroviral drugs. Continued surveillance of drug-resistant HIV-1 in Brazil is warranted when guidelines for HIV prophylaxis and treatment are updated. Resistance testing among drug-naive patients prior to treatment initiation should be considered, mainly directed at subjects whose partners are already on antiretroviral therapy.

Primary aspergilloma and subacute invasive aspergillosis in two AIDS patients.

Although uncommon, invasive aspergillosis in the setting of AIDS is important because of its peculiar clinical presentation and high lethality. This report examines two AIDS patients with a history of severe cellular immunosuppression and previous neutropenia, who developed subacute invasive aspergillosis. One female patient developed primary lung aspergilloma, with dissemination to the mediastinum, vertebrae, and spine, which was fatal despite antifungal treatment. The second patient, who had multiple cavitary brain lesions, and eye and lung involvement, recovered following voriconazole and itraconazole, and drugs for increasing neutrophil and CD4+ lymphocyte levels. These cases demonstrate the importance of Aspergillus infections following neutropenia in AIDS patients, and emphasize the need for early and effective antifungal therapy.

Primary aspergilloma and subacute invasive aspergillosis in two AIDS patients / Aspergiloma primário e aspergilose invasiva subaguda em dois pacientes com AIDS

Although uncommon, invasive aspergillosis in the setting of AIDS is important because of its peculiar clinical presentation and high lethality. This report examines two AIDS patients with a history of severe cellular immunosuppression and previous neutropenia, who developed subacute invasive aspergillosis. One female patient developed primary lung aspergilloma, with dissemination to the mediastinum, vertebrae, and spine, which was fatal despite antifungal treatment. The second patient, who had multiple cavitary brain lesions, and eye and lung involvement, recovered following voriconazole and itraconazole, and drugs for increasing neutrophil and CD4+ lymphocyte levels. These cases demonstrate the importance of Aspergillus infections following neutropenia in AIDS patients, and emphasize the need for early and effective antifungal therapy.

A aspergilose invasiva em pacientes com aids, embora incomum, é relevante pela apresentação clínica peculiar e alta letalidade. Este relato descreve os casos de dois pacientes com aids com grave imunossupressão celular e neutropenia prévia, os quais tiveram aspergiloma pulmonar primário, com disseminação para mediastino, vértebras e medula espinhal, evoluindo para óbito apesar do tratamento antifúngico. O segundo paciente, que tinha lesões cavitárias múltiplas no cérebro e infecção ocular e pulmonar, recuperou-se após tratamento com voricanazol, itraconazol e com drogas para aumentar o número de neutrófilos e de linfócitos CD4+. Estes casos demonstram o risco de infecção por Aspergillus após episódios de neutropenia em pacientes com aids e alertam para o início precoce de terapia antifúngica eficaz.

Genetic polymorphism of matrix metalloproteinase (MMP)-9 does not affect plasma MMP-9 activity in healthy subjects.

BACKGROUND: Plasma MMP-9 levels have been shown to predict cardiovascular risk, and a functional substitution C to T at position -1562 in the promoter region of the MMP-9 gene has been associated with the severity of cardiovascular diseases. We examined the association between the C(-1562)T polymorphism and MMP-9 activity in healthy subjects. METHODS: We studied 200 healthy male white volunteers (age range: 20-55 y) who were nonsmokers and were not taking medicines. Genomic DNA was extracted and genotypes for the C(-1562)T polymorphism were determined by PCR and restriction fragment length digestion. Plasma was assayed for pro-MMP-9 and MMP-9 activities by gelatin zymography. RESULTS: The frequency of the alleles "C" and "T" were 90% and 10%, respectively. Because of the relatively low frequency of the TT genotype, we combined both TT and CT genotypes together (CT+TT group) and compared with the CC genotype group. We found no differences in pro-MM9 and MMP-9 activity levels among the genotype groups (both P>0.05). CONCLUSIONS: While the present study indicates lack of effect for the C(-1562)T polymorphism on MMP-9 activity in plasma, it is possible that the C(-1562)T polymorphism contributes to an increased cardiovascular risk under conditions of induced MMP-9 expression.

[Greater survival among patients with immunogenetic markers of rapid progression to AIDS: subsidies for nursing care]. / Maior sobrevida em pacientes com marcadores imunogenéticos de rápida progressão para a AIDS: subsídios para a assistência de enfermagem.

This study sought subsidies for improving nursing care programs for AIDS patients and aimed to verify the influence of changes in sexual behavior, including the adoption of safe sex practices, associated with the survival of AIDS patients with immunogenetic markers of rapid disease progression. 27 AIDS patients were interviewed, with genetic predisposition to rapid progression to AIDS. Genes were typified through the polymerase chain reaction. In spite of the presence of immunogenetic factors, associated with individual predisposition to a rapid evolution of the disease, changes in sexual behavior, including safe sex practices and antiretroviral therapy, may be related to greater survival. This suggests that counseling, detection of risk attitudes and health education, focusing on positive health behavior, are tools nursing must use with HIV-positive patients, with a view to better quality of life and greater survival among these individuals, even among those with genetic predisposition to rapid disease progression.

Lipodistrofia em portadores do HIV / Lipodystrophy in HIV patients

Apesar de aumento da sobrevida, reducao de episodios morbidos e consequente aumento da qualidade de vida, a terapia anti-retroviral prolongada apresenta efeitos indesejaveis em portadores do HIV, como a sindrome da lipodistrofia. Alteracoes na imagem corporal, com as quais se confrontam tais pacientes, podem repercutir a consequencias marcantes para saude afetivo-emocional e, mesmo considerando os beneficios da terapeutica antiretroviral, contraditoriamente parecem reduzir a qualidade de vida. Dada a complexidade e a heterogeneidade da sindrome da lipodistrofia, o presente estudo tem como objetivo descrever os aspectos psicossociais associados as alteracoes corporeas da lipodistrofia e oferecer informacoes atualizadas e sumarizadas que possam ser utilizadas na assistencia a portadores do HIV

Methodological issues affecting the determination of plasma matrix metalloproteinase (MMP)-2 and MMP-9 activities.

OBJECTIVES: To examine whether a linear relationship exists between the volume of plasma loaded in each gel lane and the gelatinolytic activities of plasma matrix metalloproteinase (pMMP)-2 and pMMP-9, and the influences of plasma storage temperature, fasting, and a variable number of repeated freeze-thaw cycles. DESIGN AND METHODS: Plasma from venous blood collected into EDTA tubes was stored for 1 month at -20 degrees C or at -70 degrees C until assayed for gelatin zymography of pMMP-2 and pMMP-9. The effects of food intake, repeated freeze-thaw cycles, and the gelatinolytic activity produced by serial dilutions of plasma were examined. RESULTS: Storage temperature, fasting, and up to five repeated freeze-thaw cycles had no effect on the activities of pMMPs (all P < 0.05). A linear relationship was found with plasma volumes below 0.75 microL/lane for MMP-2, and from 0.75 microL/lane to 2 microL/lane for MMP-9. CONCLUSIONS: Different volumes of plasma should be studied when pMMP-2 and pMMP-9 activities are studied. Storage temperature, repeated freeze-thaw cycles, and food intake do not affect the activities of pMMPs.

Maior sobrevida em pacientes com marcadores imunogenéticos de rápida progressão para a AIDS: subsídios para a assistência de enfermagem / Greater survival among patients with immunogenetic markers of rapid progression to AIDS: subsidies for nursing care

Com enfoque em subsídios para o aperfeiçoamento de programas de enfermagem, direcionados a pacientes com aids, o presente estudo foi realizado com o objetivo de verificar a influência do comportamento sexual na sobrevida de pacientes com aids, portadores de genes associados à rápida progressão da doença. Foram entrevistados 27 pacientes com aids, geneticamente predispostos à rápida progressão da doença. As tipificações dos genes foram realizadas pela reação em cadeia da polimerase. Os resultados sugerem que, apesar da presença de fatores imunogenéticos, associados à predisposição individual para rápida evolução da doença, as mudanças do comportamento sexual, com adoção de práticas de sexo seguro, junto ao uso da terapia anti-retroviral, podem estar relacionadas com maior sobrevida. O aconselhamento, a detecção de atitudes de risco e a educação para saúde, enfocando o comportamento positivo de saúde, são ferramentas que a enfermagem deve utilizar a portadores do HIV, visando à melhor qualidade de vida e maior sobrevida desses indivíduos, mesmo naqueles geneticamente predispostos à rápida progressão da doença

Fatores epidemiológicos, relacionados à progressão lenta da síndrome da imunodeficiência adquirida (AIDS) / Epidemiological factors related to slow progression of the acquired immune deficiency syndrome (AIDS)

Com o objetivo de identificação de fatores envolvidos na progressão lenta para aids, realizou-se estudo transversal para avaliação de dados epidemiológicos de indivíduos infectados pelo Vírus da Imunodeficiência Humana tipo 1 (HIV-1), atendidos no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP. Foram selecionados pacientes, conforme critérios definidos, constituíndo duas populações: população 1, composta por lentos progressores (P1), que possuía anticorpos anti-HIV há mais de oito anos e com ocorrência de menos de duas doenças oportunistas no último ano, e a população 2 (P2), pacientes rápidos progressores, com diagnóstico de infecção pelo HIV e doença manifesta a menos de dois anos e com mais de duas doenças oportunistas, diagnosticadas no último ano. Todos os indivíduos foram submetidos a questionário, contendo dados demográficos, profissão, ocorrência de outras doenças sexualmente transmissíveis, forma de contágio, data de diagnóstico e hábitos. O período do estudo foi de março de 1998 a outubro de 1999. Obtivemos na P1: doze homens e quatro mulheres, idade média 30,7 anos, forma de contágio predominantemente sangüínea, tempo de progressão da doença 10,5 anos; P2: 12 homens e 4 mulheres; idade média 34,8 anos, forma de contágio predominantemente sexual, tempo de progressão da doença de 1,5 anos. Tabagismo foi o principal vício em ambas as populações. Quando interrogados sobre a causa do bom estado de saúde, os indivíduos da P1 responderam estar ela relacionada à fé e ao uso adequado das medicações. Os pacientes da P2 não foram interrogados sobre a causa de seu estado de saúde. Quanto à prática sexual, nove pacientes da P1 mantinham relações, sendo cinco sem uso regular do preservativo. Na P2, apenas um paciente utilizava preservativo. Dois pacientes da P1 e um da P2 revelaram ter apresentado DST, Sífilis e Papiloma Vírus Humano. Em vista do reduzido número de pacientes, não foi possível estabelecer associação entre as variáveis estudadas e os padrões de progressão da doença. Os dados sobre hábitos não parecem contribuir para o padrão de desenvolvimento da doença. O estudo oferece um perfil epidemiológico dessas populações de pacientes

Características clínicas e epidemiológicas de pacientes da região de Ribeirão Preto, SP, Brasil, com AIDS e infecções oportunistas / Clinical and epidemiological characteristics of patients from Ribeirão Preto, SP, Brazil, with AIDS and oportunistic infections

Com o objetivo de conhecer e atualizar as características clínicas e epidemiológicas dos pacientes com aids e infecções oportunistas na região de Ribeirão Preto, foram revisados os prontuários médicos de 1019 pacientes com aids, do sub-grupo IVc (CDC), atendidos no HCFMRP, no período de janeiro de 1992 a agosto de 1996. Os seguintes itens foram analisados: data do primeiro atendimento, sexo, idade, cidade em que residia, via provável de aquisição do HIV, época do primeiro exame anti-HIV positivo, número de linfócitos CD4/mm3 por ocasião do primeiro atendimento, data da primeira manifestação infecciosa após o início do seguimento, tipo e número de complicação(ões) infecciosa(s), data do óbito e tipo de infecção(ões) diagnosticada(s) nos pacientes que faleceram. Os resultados, quando comparados com os obtidos no período de 1987 a 1991, apontam para modificações importantes em algumas características dos pacientes no segundo período, como aumento da via de transmissão heterossexual do HIV, aumento da participação de mulheres na casuística, uma tendência de diagnóstico mais precoce da infecção pelo HIV e aumento da sobrevida dos pacientes. Por outro lado, os pacientes continuam sendo acometidos por ampla gama de processos infecciosos durante a evolução da aids, com destaque para a candidíase, as pneumonias bacterianas, a neurotoxoplasmose, a pneumonia por P. carinii, a sinusite, a diarréia e a neurocriptococose. Menção especial deve ser feita à tuberculose que acometeu cerca de 30 por cento dos pacientes durante o período de seguimento

Métodos laboratoriais para o diagnóstico da infecçäo pelo vírus da imunodeficiência humana (HIV) / Laboratory methods for the diagnosis of human immunodeficiency virus (HIV) infection

Os autores revisam os principais métodos laboratoriais, atualmente conhecidos e disponíveis para o diagnóstico da infecçäo pelo Vírus da Imunodeficiência Humana (HIV), salientando as orientaçöes gerais sobre sua aplicaçäo e interpretaçäo.