In-hospital outcomes in preterm and small-for-gestational-age newborns: a cohort study.

OBJECTIVE: To compare in-hospital outcomes between small-for-gestational-age and appropriate-for-gestational-age preterm neonates who needed intensive care. METHODS: A retrospective cohort study with preterm newborns, from January to December 2017. The results are presented as median, frequency, and odds ratio. Numerical variables were compared using the Wilcoxon test. Categorical variables were compared using the χ2 test. We considered p<0.05 as significant. RESULTS: Out of 129 preterm newborns included, 20.9% were small-for-gestational-age. Median gestational age was 31 2/7 weeks, birthweight was 1,450g, and length of hospital stay was 39 days. Preterm small-for-gestational-age newborns presented a higher chance of peri-intraventricular hemorrhage (odds ratio of 3.23; p=0.02), retinopathy of prematurity (odds ratio of 2.78 p=0.02), patent ductus arteriosus (odds ratio of 2.50; p=0.04) and a lower chance of presumptive early-onset sepsis (odds ratio of 0.37; p=0.03). CONCLUSION: Preterm small-for-gestational-age neonates were associated with peri-intraventricular hemorrhage, retinopathy of prematurity and patent ductus arteriosus. This emphasizes the need of special care for these neonates.

In-hospital outcomes in preterm and small-for-gestational-age newborns: a cohort study

ABSTRACT Objective To compare in-hospital outcomes between small-for-gestational-age and appropriate-for-gestational-age preterm neonates who needed intensive care. Methods A retrospective cohort study with preterm newborns, from January to December 2017. The results are presented as median, frequency, and odds ratio. Numerical variables were compared using the Wilcoxon test. Categorical variables were compared using the χ2 test. We considered p<0.05 as significant. Results Out of 129 preterm newborns included, 20.9% were small-for-gestational-age. Median gestational age was 31 2/7 weeks, birthweight was 1,450g, and length of hospital stay was 39 days. Preterm small-for-gestational-age newborns presented a higher chance of peri-intraventricular hemorrhage (odds ratio of 3.23; p=0.02), retinopathy of prematurity (odds ratio of 2.78 p=0.02), patent ductus arteriosus (odds ratio of 2.50; p=0.04) and a lower chance of presumptive early-onset sepsis (odds ratio of 0.37; p=0.03). Conclusion Preterm small-for-gestational-age neonates were associated with peri-intraventricular hemorrhage, retinopathy of prematurity and patent ductus arteriosus. This emphasizes the need of special care for these neonates.

Psychometric Validation of the Brazilian Portuguese Version of the Derriford Appearance Scale-24 (DAS-24) for People Living with HIV/AIDS.

The changes in appearance of people living with HIV/AIDS (PLHA) interferes with how people around them react to their body, how social interactions take place, and how each person perceives and accepts their body. The definition of itself can be severely challenged when the body changes as a result of illness and the person does not look healthier anymore. People living with HIV/AIDS (PLHA) are an especially vulnerable group when it comes to "distress" and the psychosocial impact of appearance, yet the assessment of body image changes in these people was subjective in Brazil. The aim of this paper was to assess the psychometric properties of the Brazilian version of Derriford Appearance Scale 24 (DAS-24) for a sample of Brazilians living with HIV/AIDS. A sample of 400 patients were recruited from an HIV/AIDS ambulatory, aged between 18 and 78 years, of both sexes. The psychometric properties of DAS-24 were investigated while using confirmatory factor analysis (CFA), with unweighted least square estimation and listwise deletion for missing data. The adjustment of three structural models previously established for DAS-24 (single-factor, two-factor, and three-factor) was investigated. Evidences of construct validity-convergent and discriminant-and internal consistency-Cronbach's alpha and construct reliability-were also generated for the measure model. The results showed that the one-factor model had the best adjustment, after eliminating items 8, 17, and 20, and accepting the covariance of errors between items 4 and 10; 9 and 23; 11 and 14; and, 14 and 22. Additionally, validity and reliability evidence were satisfactory for the model. The Brazilian Portuguese version of DAS-24 seems to be a psychometrically sound scale for measuring body image distress for people living with HIV/AIDS (PLHA).

Early Identification of IgA Anti-SARSCoV-2 in Milk of Mother With COVID-19 Infection.

INTRODUCTION: Human milk cannot currently be considered a major source of COVID-19 infection. On the other hand, it can contain specific antibodies that could modulate a possible newborn infection by SARS-CoV-2. MAIN ISSUE: A 32-year-old pregnant woman, gestational age 37 and 3/7 weeks, was admitted with a flu-like syndrome caused by COVID-19. The female newborn was appropriate for gestational age, with a birth weight of 2,890 g, length 48 cm, and head circumference 34 cm. MANAGEMENT: The mother-infant dyad remained in the rooming-in unit during hospitalization, exclusively breastfeeding and following World Health Organization recommendations for contact and airway precautions. On the 3rd day after delivery, two mother's milk samples (3 and 5 mL) were collected by hand expression. The samples were centrifuged for 10 min twice consecutively to separate fat, which was removed, and the remaining material was transferred to another tube to determine anti-SARS-CoV-2 Immunoglobulin A and Immunoglobulin G (ELISA, Kit EUROIMMUN AG, Luebeck, Germany). Anti-SARS-CoV-2 Immunoglobulin A was detected in the two samples evaluated, whose values were 2.5 and 1.9, respectively. No anti-SARSCoV-2 immunoglobulin G was detected. The exclusively-breastfed infant remained well through 45 days of age. CONCLUSION: The presence of SARS-CoV-2 Immunoglobulin A in the milk of mothers infected with COVID-19 may be related to protection against the transmission and severity of the disease in their infants.

The QualiRede intervention: improving the performance of care continuum in HIV, congenital syphilis, and hepatitis C in health regions.

INTRODUCTION: Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). METHODS: HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility's process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. RESULTS: The indicators are available at www.qualirede.org. The workshops took place in the regions of Alto Tietê, Baixada Santista, Grande ABC, and Registro (São Paulo) and of Foz do Rio Itajaí (Santa Catarina), which resulted in regional action plans in São Paulo, but not in Santa Catarina. A lack of awareness was observed regarding the new HIV and HCV protocols, as well as an incipient use of indicators in routine practices. CONCLUSION: Improving the performance of the care continuum requires appropriation of performance indicators and coordination of care flows at local, regional, and state levels of management.

Cross Cultural adaptation into Brazilian Portuguese language of Derriford Appearance Scale 24 (DAS-24) for people living with HIV/AIDS / Adaptação cultural em Português Brasileiro da Derriford Appearance Scale - 24 (DAS-24) para pessoas vivendo com HIV/AIDS

INTRODUCTION: Body image can be defined as the representation of beliefs, emotions and perceptions about the body itself, manifested in behaviors directed to the body. When the body changes because of a disease and does not seem healthy, the self-concept may be severely challenged. People living with HIV/AIDS (PLHA) are particularly vulnerable to the distress and psychosocial impact of appearance, but in Brazil the assessment of those body image changes was subjective because there was not an available scale in Brazilian Portuguese to assess body image changes in clinical practice or research. OBJECTIVE: To carry out the cross-cultural adaptation to the Brazilian Portuguese of the Derriford Appearance Scale 24 (DAS-24), with the verification of the linguistic, semantic, conceptual and cultural equivalence of the people living with HIV/AIDS in Brazil METHODS: We followed the five stages of culturally sensitive translation: direct translations, synthesis of translations, back-translations, expert committee meeting and pre-tests. The process of cultural adaptation was presented in a descriptive and analytical way, following patterns of methodological studies. The minimum, maximum and median values of the responses of each item were calculated from the pool of data from the third pretest group of 50 participants. The median of the item scores, the correlation on each item with the total score and the internal reliability, were calculated using the Cronbach alpha test. RESULTS: The analysis of the responses of the last pre-test group indicated that attention must be given to items A, H, T and V in a future psychometric study. The present study is not enough for this scale to be used in clinical practice. To ensure that the culturally adapted instrument generates valid and reliable data, a subsequent study investigating its psychometric properties should be conducted. CONCLUSION: The cross-cultural adaptation of the Derriford Appearance Scale 24 (DAS-24) in its components of linguistic, semantic, conceptual and cultural equivalence to Brazilian Portuguese for the population of people living with HIV/AIDS was fully carried out. Despite this achievement, it is emphasized that the use of the Brazilian version of DAS-24 in research and clinical routine is advised only after a psychometric study with this instrument.

INTRODUÇÃO: A imagem corporal pode ser definida como a representação das crenças, emoções e percepções a respeito do próprio corpo, manifesta em comportamentos voltados ao corpo. Quando o corpo muda como consequência de doença e não parece mais saudável, a definição de si mesmo pode ser severamente desafiada. As pessoas vivendo com HIV/AIDS (PVHA) são um público especialmente vulnerável quando se trata do "distress" e do impacto psicossocial da aparência, mas a avaliação destas alterações de imagem corporal era subjetiva porque não havia nenhuma escala em Português Brasileiro para avaliar alterações da imagem disponível para uso clínico ou para pesquisa. OBJETIVO: Realizar a adaptação transcultural para o português Brasileiro da Derriford Appearance Scale 24 (DAS-24), com a verificação da equivalência idiomática, semântica, conceitual e cultural, para o público-alvo pessoas vivendo com HIV/AIDS (PVHA) no Brasil MÉTODO: Seguiu-se guia de cinco etapas para adaptação de escala transcultural: traduções, síntese de traduções, retrotraduções, reunião de comitê de especialistas e pré-testes. O processo de adaptação cultural foi apresentado de forma descritiva e analítica, seguindo padrões de estudos metodológicos. Os valores mínimo, máximo e mediano das respostas de cada item foram calculados a partir do pool de dados do terceiro grupo de pré-teste de 50 participantes. A mediana dos escores dos itens, a correlação de cada item com o escore total e a confiabilidade interna foram calculados pelo teste alfa de Cronbach. RESULTADO: A análise das respostas do último grupo pré-teste indicou que deve ser dada atenção aos itens A, B, G, H e K em um futuro estudo psicométrico. O presente estudo não é suficiente para que essa escala seja utilizada na prática clínica. Para garantir que o instrumento culturalmente adaptado gere dados válidos e confiáveis, um estudo subsequente que investigue suas propriedades psicométricas deve ser conduzido. CONCLUSÃO: A adaptação transcultural da Derriford Appearance Scale 24 (DAS-24), em seus componentes de equivalência linguística, semântica, conceitual e cultural para o português brasileiro para a população de pessoas vivendo com HIV/AIDS foi plenamente realizada. Apesar dessa conquista, ressalta-se que o uso da versão brasileira do DAS-24 em pesquisa e rotina clínica é aconselhado somente após um estudo psicométrico com este instrumento.

The QualiRede intervention: improving the performance of care continuum in HIV, congenital syphilis, and hepatitis C in health regions / A intervenção QualiRede: melhoria do desempenho do contínuo do cuidado em HIV, sífilis congênita e hepatite C em regiões de saúde

ABSTRACT Introduction: Care continuum models have supported recent strategies against sexually transmitted diseases, such as HIV and Hepatitis C (HCV). Methods: HIV, HCV, and congenital syphilis care continuum models were developed, including all stages of care, from promotion/prevention to clinical control/cure. The models supported the intervention QualiRede, developed by a University-Brazilian National Health System (SUS) partnership focused on managers and other professionals from six priority health regions in São Paulo and Santa Catarina. Indicators were selected for each stage of the care continuum from the SUS information systems and from the Qualiaids and QualiAB facility's process evaluation questionnaires. The indicators acted as the technical basis of two workshops with professionals and managers in each region: the first one to identify problems and to create a Regional Technical Group; and the second one to design action plans for improving regional performance. Results: The indicators are available at www.qualirede.org. The workshops took place in the regions of Alto Tietê, Baixada Santista, Grande ABC, and Registro (São Paulo) and of Foz do Rio Itajaí (Santa Catarina), which resulted in regional action plans in São Paulo, but not in Santa Catarina. A lack of awareness was observed regarding the new HIV and HCV protocols, as well as an incipient use of indicators in routine practices. Conclusion: Improving the performance of the care continuum requires appropriation of performance indicators and coordination of care flows at local, regional, and state levels of management.

RESUMO Introdução: Modelos de cuidado contínuo baseiam recentes estratégias em HIV, infecções sexualmente transmissíveis e hepatite C (HCV). Métodos: Desenvolveram-se modelos de contínuo do cuidado em HIV, HCV e sífilis congênita incluindo todas as etapas da atenção, desde a promoção e a prevenção até o controle clínico/cura. O modelo baseou a intervenção QualiRede, desenvolvida em parceria entre universidade e Sistema Único de Saúde (SUS), direcionada a gestores e demais profissionais de 6 regiões de saúde prioritárias em São Paulo e Santa Catarina. Selecionaram-se indicadores para cada etapa do contínuo do cuidado, provenientes dos sistemas de informação do SUS e dos questionários de avaliação de processo Qualiaids e QualiAB. Os indicadores formaram a base técnica de duas oficinas com profissionais e gestores de cada região: a primeira para identificar problemas e formar um Grupo Técnico Regional; e a segunda para construir planos de ação e metas a fim de melhorar o desempenho regional. Resultados: Os indicadores estão disponíveis no website www.qualirede.org. As oficinas ocorreram em quatro regiões de São Paulo (Alto Tietê, Baixada Santista, Grande ABC e Registro) e uma região de Santa Catarina (Foz do Rio Itajaí), resultando em planos regionais em São Paulo, mas não em Santa Catarina. Observou-se domínio limitado dos novos protocolos para HIV e HCV e uso incipiente de indicadores na rotina dos serviços. Conclusão: Melhorar o desempenho do contínuo do cuidado exige apropriação dos indicadores de desempenho e coordenação integrada dos fluxos de atenção em todos os níveis de gestão.

Prevalência de sarcoma de Kaposi em pacientes com aids e fatores associados, São Paulo-SP, 2003-2010 / Prevalencia de sarcoma de Kaposi en pacientes con SIDA y factores asociados, São Paulo-SP, Brasil, 2003-2010 / Prevalence of Kaposi's sarcoma in patients with AIDS and associated factors, São Paulo-SP, Brazil, 2003-2010

OBJETIVO: estimar a prevalência de sarcoma de Kaposi (SK) em pacientes com aids e identificar os fatores associados à ocorrência da neoplasia. MÉTODOS: estudo transversal com dados de notificação em dois centros de referência em aids de São Paulo-SP, Brasil, de janeiro/2003 a março/2010; empregaram-se métodos de linkage probabilístico e regressão logística múltipla. RESULTADOS: entre 3.557 casos de aids, 213 (6%) apresentavam SK, 95,3% deles do sexo masculino; associaram-se à ocorrência de SK sexo masculino (OR=3,1; IC95%=1,4;6,6), idade no momento do diagnóstico de aids >28 anos (OR=1,6; IC95%=1,0; 2,6), homens que fazem sexo com homens (OR=3,2; IC95%=2,0;4,9), uso prévio de terapia antirretroviral de alta atividade (HAART) (OR=0,4; IC95%=0,3;0,5), período de diagnóstico de aids de 2007-2010 (OR=0,3; IC95%=0,2;0,4) e contagem de linfócitos T CD4+ <200cel/mm³ (OR=16,0; IC95%=6,0;42,7) e 200-500cel/mm³ (OR=2,5; IC95%=1,1;6,4). CONCLUSÃO: o SK tem alta prevalência em São Paulo-SP; estratégias para o diagnóstico precoce do HIV podem resultar em diminuição desta prevalência.

OBJETIVO: estimar la prevalencia del sarcoma de Kaposi (SK) en pacientes con SIDA e identificar los factores asociados. MÉTODOS: estudio transversal para identificar la asociación entre el SK y SIDA en São Paulo-SP, Brasil; los datos se obtuvieron entre enero de 2003 y marzo de 2010 y se analizaron con el método de linkage probabilística y regresión logística múltipla. RESULTADOS: en 3.557 casos de SIDA, la prevalencia de SK fue 6%; entre los 213 casos de SK, el 95,3% eran varones; estuvieron asociados con SK el sexo masculino (OR=3,1; IC95%=1,4;6,6), la edad >28 años (OR=1,6; IC95%=1,01;2,5 2,6), HSH (OR=3,2; IC95%= 2,0;4,9), el uso previo de HAART (OR=0,4; IC95%=0,3;0,5), diagnóstico de SIDA en 2007-2010 (OR=0,3 IC95%=0,2;0,4) y células T CD4+ <200cel/mm3 (OR=16,0; IC95%=6,0;42,7) y 200-500cel/mm³ (OR=2,5 IC95%=1,1;6,4). CONCLUSIÓN: el SK tiene una alta prevalencia en São Paulo-SP; las estrategias para el diagnóstico precoz del VIH pueden reducirlo.

OBJECTIVE: to estimate the prevalence of Kaposi's sarcoma (KS) in patients with AIDS and identify the associated factors to the occurrence of this neoplasm. METHODS: this is a cross-sectional study with notification data from two AIDS reference centers in São Paulo-SP, Brazil, from January, 2003 to March, 2010; probabilistic linkage and multiple logistic regression methods were applied. RESULTS: among 3,557 AIDS cases, 213 (6%) presented KS; 95.3% of them occurred in males; male sex (OR=3.1; 95%CI=1.4;6.6), age at the AIDS diagnosis >28 years old (OR=1.6; 95%CI=1.0;2.6), MSM (OR=3.2; 95%CI=2.0;4.9), prior use of HAART (OR=0.4; 95%CI=0.3;0.5), AIDS diagnosis between 2007-2010 (OR=0.3; 95%CI=0.2;0.4), and CD4+ T-cell counting under 200cells/mm3 (OR=16.0; 95%CI=6.0;42.7) and 200-500cells/mm³ (OR=2,5; 95%CI=1.1;6.4) were associated to the occurrence of KS. CONCLUSION: KS has a high prevalence in São Paulo-SP; strategies for early HIV diagnosis may reduce this prevalence.

Prevalence of Kaposi's sarcoma in patients with AIDS and associated factors, São Paulo-SP, Brazil, 2003-2010. / Prevalência de sarcoma de Kaposi em pacientes com aids e fatores associados, São Paulo-SP, 2003-2010.

OBJECTIVE: to estimate the prevalence of Kaposi's sarcoma (KS) in patients with AIDS and identify the associated factors to the occurrence of this neoplasm. METHODS: this is a cross-sectional study with notification data from two AIDS reference centers in São Paulo-SP, Brazil, from January, 2003 to March, 2010; probabilistic linkage and multiple logistic regression methods were applied. RESULTS: among 3,557 AIDS cases, 213 (6%) presented KS; 95.3% of them occurred in males; male sex (OR=3.1; 95%CI=1.4;6.6), age at the AIDS diagnosis >28 years old (OR=1.6; 95%CI=1.0;2.6), MSM (OR=3.2; 95%CI=2.0;4.9), prior use of HAART (OR=0.4; 95%CI=0.3;0.5), AIDS diagnosis between 2007-2010 (OR=0.3; 95%CI=0.2;0.4), and CD4+ T-cell counting under 200cells/mm3 (OR=16.0; 95%CI=6.0;42.7) and 200-500cells/mm³ (OR=2,5; 95%CI=1.1;6.4) were associated to the occurrence of KS. CONCLUSION: KS has a high prevalence in São Paulo-SP; strategies for early HIV diagnosis may reduce this prevalence.

A percepção de Lipodistrofia associada ao HIV - e suas repercussões na qualidade de vida de homens que fazem sexo com homens / La percepción de la Lipodistrofía asociada al VIH - y sus repercusiones en la calidad de vida de los hombres que hacen sexo con hombres / The perception of HIV associated Lipodystrophy - and its repercussions in the quality of life of men getting sex with men

Introdução: A Síndrome da Imunodeficiência Adquirida (AIDS), desde seu início vem acarretando inúmeras consequências à vida daspessoas vivendo com HIV (PVHIV). O surgimento de uma nova classe de medicamentos conhecida como Terapia Antirretroviral de AltaPotência (HAART) é considerada uma das maiores conquistas no tratamento do HIV/AIDS. Entretanto, entre os seus inúmeros efeitoscolaterais, está a Lipodistrofia Associada ao HIV (LAHIV). Objetivo: Relatar a percepção de LAHIV e suas repercussões na qualidade devida de homens que se relacionam sexualmente com homens (HSH). Método: Estudo qualitativo desenvolvido por entrevistas com 33pessoas, de 20 a 60 anos, do sexo masculino, com comportamento sexual HSH, HIV+, e que estavam em tratamento em um Centro deReferência e Tratamento (CRT) DST/HIV/AIDS de São Bernardo do Campo, São Paulo-Brasil. Resultados: Entre os resultados observados,no que se refere a percepção de alterações corporais, 13 citaram enormes dificuldades em lidar com as consequências visuais dalipodistrofia corporal, e 1 com a atrofia facial. Quanto à percepção de alterações clínicas, 9 apresentaram dificuldades em convivercom enjoos, diarreias e desconfortos estomacais...

Introduction: Since the beginning, the Acquired Immunodeficiency Syndrome (AIDS) has caused countless consequences for the livesof people living with HIV (PLHIV). The emergence of a new class of medicines known as High Potency Antiretroviral Therapy (HPART)is considered one of the greatest achievements in the treatment of HIV/AIDS. However, among their many side effects we find theLipodystrophy associated with HIV (LAHIV). Objective: To report the perception of LAHIV and its repercussions on the quality of life ofmen who use to be sexually related with men (MSM). Method: It is a qualitative study, carried out through interviews to 33 people, 20 - 60years old, male, with sexual behavior MSM, HIV+, who were being treated at a CRT/ STD/HIV/AIDS Reference and Treatment Center inSão Bernardo do Campo, São Paulo-Brazil. Results: Among the results observed, regarding the perception of body changes, 13 of themmentioned huge difficulties in dealing with the visual consequences of corporal lipodystrophy, and 1 with facial atrophy also. Regardingthe perception of clinical alterations, 9 presented difficulties in living with nausea, diarrhea and stomach discomfort. And with regard toemotional repercussions, 11 reported marked feelings of persecuteness, hypervigilance, low self-esteem and hopelessness. The isolationduring hospitalization was unanimously pointed out...

Introducción: El síndrome de inmunodeficiencia adquirida (SIDA), desde su creación ha estado causando numerosas consecuencias en lavida de las personas que viven con el VIH (PVVIH). La aparición de una nueva clase de fármacos conocidos como terapia antirretroviralde alta potencia (HAART) es considerado uno de los mayores logros en el tratamiento del VIH/SIDA. Sin embargo, entre sus numerososefectos secundarios esta la lipodistrofia asociada al VIH. Objetivo: Reportar la percepción de LDHIV y su impacto en la calidad de vida delos hombres que se relacionan sexualmente con hombres (HSH). Método: Estudio cualitativo desarrollado por entrevistas con 33 personas,20 a 60 años de edad, de sexo masculino, con el comportamiento sexual HSH, VIH+ y que seguian en tratamiento en un Centro deReferencia en Tratamiento (CRT/VIH/ SIDA) en San Bernardo do Campo, Sao Paulo-Brasil. Resultados: Entre los resultados observados,en cuanto a la percepción de cambios en la forma del cuerpo, 13 citaron enormes dificultades para enfrentar las consecuencias visualesde la lipodistrofia del cuerpo, y uno con atrofia facial. Sobre la percepción de alteraciones clínicas, 9 tenían dificultades con la sensaciónde náusea, diarrea y malestar estomacal. Y en el caso de las repercusiones emocionales, 11 reportaron sentimientos de persecutoriedade,hipervigilancia, baja autoestima y desesperación...

Preenchimento facial com Polimetilmetacrilato em pacientes que vivem com a síndrome da imunodeficiência adquirida (AIDS) / Facial filling with polymethylmethacrylate in patients with acquired immunodeficiency syndrome

INTRODUÇÃO: Pacientes que vivem com síndrome da imunodeficiência adquirida (AIDS) em uso da Terapia Antirretroviral de Alta Potência (TARV) são suscetíveis a desenvolver síndrome lipodistrófica. O preenchimento facial com polimetilmetacrilato é opção de tratamento. O objetivo é analisar o procedimento de preenchimento facial e avaliar os pacientes em relação à percepção, incômodo, revelação do diagnóstico, expectativa quanto ao preenchimento e a satisfação e impacto em suas vidas. MÉTODOS: Análise em 63 pacientes submetidos ao preenchimento facial. Foram realizados procedimentos, analisados prontuários dos pacientes e o Protocolo do Ambulatório de Lipodistrofia do Programa Municipal de doenças sexualmente transmissíveis (DST)/AIDS e Hepatites Virais de São Bernardo do Campo, atendidos no período de janeiro a julho de 2009. RESULTADOS: Todos os 63 pacientes iniciais que concordaram em participar da pesquisa permaneceram até o término deste trabalho. Apenas seis pacientes (9,5%) eram de origem de outros municípios, enquanto 57 pacientes (90,5%) eram moradores de São Bernardo. 68,2% eram homens e 100% brancos. A média das idades foi 49,7 anos. Em média, o Vírus da Imunodeficiência Humana (HIV) foi diagnosticado há 11,5 anos, com tempo médio de uso de TARV por 10 anos e tempo médio de lipoatrofia facial de 3,8 anos. A maioria fez uso de Estavudina e/ou Efavirenz. Quem ficava mais desconfortável com as alterações na face eram os próprios pacientes. 85,7% não revelaram o diagnóstico para terceiros. 100% dos pacientes ficaram satisfeitos ou muito satisfeitos com o resultado obtido. CONCLUSÃO: 100% dos pacientes ficaram satisfeitos ou muito satisfeitos com o resultado obtido. Em 100% dos casos houve um impacto favorável na vida. Não houve efeitos adversos ao procedimento cirúrgico de preenchimento.

INTRODUCTION: Patients with acquired immunodeficiency syndrome (AIDS) who use highly active antiretroviral therapy (HAART) can develop lipodystrophy syndrome, for which facial filling with polymethylmethacrylate is a treatment option. The objective is to analyze the procedure of facial filling and evaluate patients in relation to their perception, discomfort, revelation of the diagnosis to third parties, expectation concerning facial filling, and satisfaction with the treatment outcome and its impact on their lives. METHODS: Sixty-three patients who underwent facial filling were evaluated. Procedures performed between January and July 2009 were assessed, the records of the patients were analyzed, and the outpatient lipodystrophy protocol of the STD/AIDS and Viral Hepatitis Municipal Program of São Bernardo do Campo was used. RESULTS: All the 63 patients who agreed to participate in the research completed the study. Only 6 patients (9.5%) were from other municipalities, while 57 patients (90.5%) were residents of São Bernardo. Of the patients, 68.2% were men and 100% were Caucasian. The mean age of the patients was 49.7 years. Human immunodeficiency virus was diagnosed 11.5 years prior on average, with 10-year average use of HAART and 3.8-year average time of facial lipoatrophy. Most of the patients used stavudine and/or efavirenz. The patients themselves felt more uncomfortable with facial changes. Among the patients, 85.7% did not reveal the diagnosis to third parties. CONCLUSION: All of the patients were satisfied or very satisfied with the result obtained, which had a favorable impact on their lives. The filling surgical procedure had no adverse effects.

The clinical effectiveness of pegylated interferon and ribavirin for the treatment of chronic hepatitis C in HIV-infected patients in Brazil: a multicentric study

Introduction: in Brazil, chronic hepatitis C in patients coinfected with the human immunodeficiency virus (HIV) is treated with pegylated interferon (Peg-IFN) and ribavirin (RBV). However, few studies have evaluated the effectiveness of this treatment in this particular population. The identification of the factors that predict sustained virological response (SVR) under current clinical practice would enable clinicians to more accurately estimate the probability of achieving an SVR and therefore utilize the appropriate therapeutics, especially in the era of direct-acting antiviral (DAA) agents. Aims: the primary aim of our study was to determine the SVR rate under current clinical practice. The secondary aims were as follows: (1) to determine the factors before and during treatment that predict SVR; and (2) to identify the causes of treatment interruption. Methods: within a cohort of HIV/hepatitis C virus (HCV)-coinfected patients in Brazil, we performed a retrospective analysis of those individuals treated with Peg-IFN and RBV. Results: among the 382 analyzed patients, SVR was observed in 118 [30.9% (95% confidence interval (CI): 26.3-35.8)], which included 25.9% (75/289) of the patients with genotypes 1 and 4 and 48.2% (41/85) of those with genotypes 2 and 3. After multivariate analyses the independent positive predictors for SVR after treatment for chronic hepatitis C with PegIFN and RBV were: absence of an AIDS-defining illness (p = 0.001), HCV viral load lower than 600,000 IU/mL at the onset of treatment (p = 0.003), higher liver enzyme levels (p = 0.039) at baseline, infection with genotypes 2 or 3 (p = 0.003), and no transient treatment interruption (p = 0.001). The treatment was interrupted in 25.6% (98/382) of the patients because of adverse events (11.3%, 43/382), virologic failure (7.8%, 30/382), and dropout (6.5%, 43/382). The main adverse events were cytopenia and psychiatric disorders. Conclusions: ...

The clinical effectiveness of pegylated interferon and ribavirin for the treatment of chronic hepatitis C in HIV-infected patients in Brazil: a multicentric study.

INTRODUCTION: in Brazil, chronic hepatitis C in patients coinfected with the human immunodeficiency virus (HIV) is treated with pegylated interferon (Peg-IFN) and ribavirin (RBV). However, few studies have evaluated the effectiveness of this treatment in this particular population. The identification of the factors that predict sustained virological response (SVR) under current clinical practice would enable clinicians to more accurately estimate the probability of achieving an SVR and therefore utilize the appropriate therapeutics, especially in the era of direct-acting antiviral (DAA) agents. AIMS: the primary aim of our study was to determine the SVR rate under current clinical practice. The secondary aims were as follows: (1) to determine the factors before and during treatment that predict SVR; and (2) to identify the causes of treatment interruption. METHODS: within a cohort of HIV/hepatitis C virus (HCV)-coinfected patients in Brazil, we performed a retrospective analysis of those individuals treated with Peg-IFN and RBV. RESULTS: among the 382 analyzed patients, SVR was observed in 118 [30.9% (95% confidence interval (CI): 26.3-35.8)], which included 25.9% (75/289) of the patients with genotypes 1 and 4 and 48.2% (41/85) of those with genotypes 2 and 3. After multivariate analyses the independent positive predictors for SVR after treatment for chronic hepatitis C with Peg-IFN and RBV were: absence of an AIDS-defining illness (p=0.001), HCV viral load lower than 600,000IU/mL at the onset of treatment (p=0.003), higher liver enzyme levels (p=0.039) at baseline, infection with genotypes 2 or 3 (p=0.003), and no transient treatment interruption (p=0.001). The treatment was interrupted in 25.6% (98/382) of the patients because of adverse events (11.3%, 43/382), virologic failure (7.8%, 30/382), and dropout (6.5%, 43/382). The main adverse events were cytopenia and psychiatric disorders. CONCLUSIONS: in our Brazilian case series, the SVR rate under current clinical practice conditions was similar to that reported in other studies. There was a correlation between an SVR and being infected by genotypes 2 and 3, low viral load, high ALT levels at the onset of treatment, and absence of an AIDS-defining illness. Cytopenia and psychiatric disorders were the major causes of treatment interruption. Efforts should be focused on optimizing management of side effects and counseling to improve adherence and to keep patients on treatment.

Revelação diagnóstica do HIV/Aids para crianças: um relato de experiência / Diagnostic disclosure of HIV/Aids to children: an experience report / Revelación diagnóstica del VIH/SIDA para Niños: un testimonio de experiencia

Trata-se de um relato de experiência sobre a condução e manejo do processo de revelação diagnóstica em crianças vivendo com o HIV/Aids, em dois centros de referência localizados no município de São Paulo, Brasil. O modelo utilizado para compartilhar as informações sobre a doença e tratamento à população pediátrica foi iniciado no ano de 2003 e envolve 5 etapas: captação dos pacientes desconhecedores de sua condição sorológica; encaminhamento para avaliação psicológica; entrevistas com os familiares para o planejamento do processo de revelação; abertura diagnóstica e acompanhamento pós-revelação. A experiência tem demonstrado que após o conhecimento da doença as crianças participam e colaboram com o tratamento, os pais sentem-se aliviados e os profissionais ficam à vontade, durante as consultas, para conversarem abertamente com os pequenos pacientes sobre os exames, acompanhamento clínico e tratamento. A descrição detalhada do trabalho desenvolvido poderá auxiliar outros serviços no desenvolvimento de ações para que a prática da revelação diagnóstica possa ser integrada de forma mais efetiva no contexto do cuidado das crianças que vivem com o HIV/Aids...

This is an experience report on the conduct and management of the process of revealing the diagnosis of children living with HIV/AIDS in two leading centers located in São Paulo, Brazil. The model used to share information about the disease and treatment in the pediatric population was initiated in 2003 and involves 5 steps: gathering patients unaware of their HIV status; referrals for psychological assessment; interviews with family members to plan the disclosure process; open diagnostic and monitoring after the disclosure. Experience has shown that after knowledge of the disease, the children participate and cooperate with treatment, parents feel relieved and professionals are comfortable during consults, to talk openly with young patients about the exams, clinical monitoring and treatment. A detailed description of the work may assist other services in developing actions so that the practice of diagnostic disclosure can be more effectively integrated in the context of the care of children living with HIV/AIDS...

Se trata de un testimonio de experiencia acerca de la conducción y manejo del proceso de revelación diagnóstica en niños que conviven con el VIH/SIDA en dos centros de referencia ubicados en el municipio de San Pablo, Brasil. El modelo utilizado para compartir las informaciones acerca de la enfermedad y tratamiento a la población pediátrica ha sido iniciado en el año de 2003 e involucra 05 etapas: captación de los pacientes que desconocen su condición de serología; encaminamiento para evaluación psicológica; entrevistas con los familiares para la planeación del proceso de revelación; apertura diagnóstica y acompañamiento pos revelación. La experiencia ha demostrado que luego del conocimiento de la enfermedad los niños participan y colaboran con el tratamiento, los padres se sienten aliviados y los profesionales se sienten a gusto, durante las consultas, para hablar abiertamente con los pequeños pacientes acerca de los exámenes, del acompañamiento clínico y del tratamiento. La descripción detallada del trabajo desarrollado podrá auxiliar otros servicios en el desarrollo de acciones para que la práctica de la revelación diagnóstica pueda ser integrada de manera más efectiva en el contexto del cuidado de los niños que conviven con el VIH/SIDA...

[The sexuality of HIV-positive adolescents: rights and challenges for healthcare]. / A sexualidade de adolescentes vivendo com HIV: direitos e desafios para o cuidado.

Sexuality and reproductive healthcare represent relevant issues for comprehensive care of HIV-positive adolescents. However, public policies and health services give this issue insufficient attention. The scope of this article is to assess how HIV-positive young people and teenagers cope with their sexuality, dating and the urge to have children and start a family. In a qualitative study, in-depth interviews were staged with 21 HIV-positive (contracted by vertical, sexual or intravenous transmission) teenagers and 13 caregivers of children and youths living in Sao Paulo and Santos. The interviews revealed the different ways teenagers cope with their sexuality and with the anxiety of HIV disclosure in this context. Lack of information about HIV prevention, lack of support and skills to cope with their sexuality were revealed in the reports. Furthermore, stigma and discrimination were the most frequently reported difficulties. The main challenges to be faced in Brazil in regard to this issue are discussed, especially the need to consider HIV-positive youth as entitled to sexual rights. Recommendations are also made for incorporating the issue into a humanized and comprehensive care approach for HIV-positive children and young people.

A sexualidade de adolescentes vivendo com HIV: direitos e desafios para o cuidado / The sexuality of HIV-positive adolescents: rights and challenges for healthcare

Sexualidade e saúde reprodutiva configuram questões relevantes para o cuidado integral à saúde de pessoas vivendo com HIV. Políticas públicas e serviços de saúde, entretanto, têm dedicado insuficiente atenção ao assunto. O objetivo deste trabalho é compreender como adolescentes e jovens soropositivos lidam com suas experiências sexuais e projetos de namoro, desejo de constituir família e de ter filhos. O estudo qualitativo entrevistou em profundidade 21 adolescentes vivendo com HIV (por transmissão vertical, sexual ou sanguínea) e 13 cuidadores de crianças e jovens, vivendo em São Paulo e em Santos, Brasil. As narrativas descrevem como aprenderam a lidar com a sexualidade e a ansiedade da revelação do diagnóstico nesse contexto. Destacam-se nas narrativas o despreparo, a desinformação sobre prevenção e a falta de apoio para lidar com a situação, assim como o estigma e a discriminação que atravessa grande parte das dificuldades relatadas. O artigo discute criticamente alguns dos desafios postos para uma adequada atenção à questão no Brasil, especialmente a consideração de jovens soropositivos como sujeitos de direitos sexuais, sugerindo diretrizes para a incorporação desta temática a um cuidado integral e humanizado de crianças e jovens vivendo com HIV.

Sexuality and reproductive healthcare represent relevant issues for comprehensive care of HIV-positive adolescents. However, public policies and health services give this issue insufficient attention. The scope of this article is to assess how HIV-positive young people and teenagers cope with their sexuality, dating and the urge to have children and start a family. In a qualitative study, in-depth interviews were staged with 21 HIV-positive (contracted by vertical, sexual or intravenous transmission) teenagers and 13 caregivers of children and youths living in Sao Paulo and Santos. The interviews revealed the different ways teenagers cope with their sexuality and with the anxiety of HIV disclosure in this context. Lack of information about HIV prevention, lack of support and skills to cope with their sexuality were revealed in the reports. Furthermore, stigma and discrimination were the most frequently reported difficulties. The main challenges to be faced in Brazil in regard to this issue are discussed, especially the need to consider HIV-positive youth as entitled to sexual rights. Recommendations are also made for incorporating the issue into a humanized and comprehensive care approach for HIV-positive children and young people.

Atividades para melhoria da adesão à TARV em serviços de saúde do SUS no estado de São Paulo, 2007 / Interventions to enhance heart adherence in HIV/Aids health services in the State of São Paulo, Brazil, 2007

O sucesso da terapia antirretroviral (TARV) para o tratamento da Aids depende da manutenção de altas taxas de adesão à terapêutica medicamentosa. Em que pese o destaque que o plano propositivo do Programa Nacional de DST/Aids tem dado para a questão, não se conhecem as tecnologias voltadas para a adesão em curso nos serviços. Com base na análise de questionário semiestruturado distribuído a todos os serviços ambulatoriais do Estado de São Paulo, este estudo descreve os tipos de intervenções implantados. No Estado de São Paulo, a adesão à TARV está incorporada nas atividades ambulatoriais dos serviços que assistem PVHA. Quase todos os serviços informam realizar atividades individuais e, a maioria, pelo menos uma atividade coletiva para melhorar a adesão. Entretanto, para grande parte dos serviços as atividades para a adesão, bem como a avaliação da adesão do paciente, ocorrem nas consultas médicas e de enfermagem. Isso indica que o trabalho de adesão consiste predominantemente de questionamentos e discussões com o paciente: o profissional decide de que modo e quando abordar a adesão. Os serviços especializados e que acompanham o maior número de pacientes tendem a apresentar atividades mais qualificadas e mais específicas.

Validity and reliability of a self-efficacy expectancy scale for adherence to antiretroviral therapy for parents and carers of children and adolescents with HIV/AIDS.

OBJECTIVE: To validate and evaluate the reproducibility of a self-efficacy (SE) scale for adherence to antiretroviral therapy in children and adolescents with HIV/AIDS, taking into account the perspective of parents/guardians. METHODS: The study was carried out at the Hospital-Dia, Centro de Referência e Treinamento em DST/AIDS (CRT/SP), in São Paulo, Brazil. The parents/guardians of 54 children and adolescents aged 6 months to 20 years were interviewed during routine consultations at our service. Data on SE were collected using the Self-Efficacy for Following Anti-Retroviral Prescription Scale, and SE scores were calculated in two different ways: factor analysis and a predefined formula. The scale's internal consistency was verified using Cronbach's alpha coefficient. Validity was tested by comparing the mean scores of a group of patients who did adhere to antiretroviral treatment with those of a group that did not (Mann-Whitney test) and by calculating the Spearman correlation coefficient for agreement between scores and clinical parameters. Reproducibility was verified using the Wilcoxon test, intraclass correlation coefficients (r(icc)) and Bland-Altman plots. RESULTS: The SE scale demonstrated good internal consistency (alpha = 0.87) and good reproducibility (r(icc) = 0.69 and r(icc) = 0.75). In terms of validity, the SE scale was capable of differentiating adherent patients from those who did not adhere to their antiretroviral treatment (p = 0.002) and exhibited a significant correlation with CD4 counts (r = 0.28; p = 0.04). CONCLUSIONS: The SE scale can be used to assess adherence to antiretroviral therapy in children and adolescents with HIV/AIDS, taking into account the perspective of parents/carers.

Validação e reprodutibilidade de uma escala de auto-eficácia para adesão ao tratamento anti-retroviral em pais ou cuidadores de crianças e adolescentes vivendo com HIV/AIDS / Validity and reliability of a self-efficacy expectancy scale for adherence to antiretroviral therapy for parents and carers of children and adolescents with HIV/AIDS

OBJETIVO: Validar uma escala de auto-eficácia para adesão ao tratamento anti-retroviral em crianças e adolescentes com HIV/AIDS, levando em consideração a perspectiva dos pais/responsáveis, e avaliar a sua reprodutibilidade. MÉTODOS: O estudo foi realizado no Hospital-Dia do Centro de Referência e Treinamento em DST/AIDS de São Paulo. Foram entrevistados os pais/responsáveis de 54 crianças e adolescentes de 6 meses a 20 anos que passaram em consulta de rotina pelo serviço. Os dados de auto-eficácia foram levantados pela escala de auto-eficácia para seguir prescrição anti-retroviral (AE), que foi calculada de duas maneiras: análise fatorial e fórmula já definida. A consistência interna da escala foi verificada pelo coeficiente ade Cronbach. A validade foi avaliada pela comparação das médias dos escores entre grupos de pacientes aderentes e não aderentes ao tratamento anti-retroviral (teste de Mann-Whitney) e cálculo do coeficiente de correlação de Spearman entre os escores e parâmetros clínicos. A reprodutibilidade foi verificada por meio do teste de Wilcoxon, pelo coeficiente de correlação intraclasse (CCI) e pelo gráfico de Bland-Altman. RESULTADOS: A escala de AE apresentou boa consistência interna (a= 0,87) e boa reprodutibilidade (CCI = 0,69 e CCI = 0,75). Quanto à validade, a escala de AE conseguiu discriminar pacientes aderentes e não aderentes ao tratamento anti-retroviral (p = 0,002) e apresentou correlação significativa com a contagem de CD4 (r = 0,28; p = 0,04). CONCLUSÕES: A escala de AE pode ser utilizada para avaliar a adesão à terapia anti-retroviral em crianças e adolescentes com HIV/AIDS, levando em consideração a perspectiva dos pais/cuidadores.

OBJECTIVE: To validate and evaluate the reproducibility of a self-efficacy (SE) scale for adherence to antiretroviral therapy in children and adolescents with HIV/AIDS, taking into account the perspective of parents/guardians. METHODS: The study was carried out at the Hospital-Dia, Centro de Referência e Treinamento em DST/AIDS (CRT/SP), in São Paulo, Brazil. The parents/guardians of 54 children and adolescents aged 6 months to 20 years were interviewed during routine consultations at our service. Data on SE were collected using the Self-Efficacy for Following Anti-Retroviral Prescription Scale, and SE scores were calculated in two different ways: factor analysis and a predefined formula. The scale's internal consistency was verified using Cronbach's acoefficient. Validity was tested by comparing the mean scores of a group of patients who did adhere to antiretroviral treatment with those of a group that did not (Mann-Whitney test) and by calculating the Spearman correlation coefficient for agreement between scores and clinical parameters. Reproducibility was verified using the Wilcoxon test, intraclass correlation coefficients (r icc) and Bland-Altman plots. RESULTS: The SE scale demonstrated good internal consistency (a= 0.87) and good reproducibility (r icc = 0.69 and r icc = 0.75). In terms of validity, the SE scale was capable of differentiating adherent patients from those who did not adhere to their antiretroviral treatment (p = 0.002) and exhibited a significant correlation with CD4 counts (r = 0.28; p = 0.04). CONCLUSIONS: The SE scale can be used to assess adherence to antiretroviral therapy in children and adolescents with HIV/AIDS, taking into account the perspective of parents/carers.

Falha terapeutica em crianças com AIDS / Therapeutic failure in children with AIDS

A falha terapeutica em criancas com aids é hoje uma das principais responsaveis pela necessidade de troca de esquemas terapeuticos. O teste de genotipagem do HIV pode ser um importante auxiliar na escolha de um novo esquema. O objetivo do trabalho foi traçar o perfil dos pacientes acompanhados no CRT-DST/AIDS/PESP apresentado falha terapeutica, além de avaliar os beneficios da genotipagem na orientação das trocas de esquemas terapêuticos de 29 pacientes avaliados. Todas as genotipagens analisadas apresentaram algum padrão de resistência aos antiretrovirais (ARV), sendo 92,8 porcento aos ITRNs, 64,2 porcento aos ITRNNs, 64,2 porcento aos IPs, 60,7 porcento aos ITRNts. Com base nos resultados das genotipagens foram feitas mudanças de esquemas ARVs, observando-se a resposta de elevação de CD4 e queda de carga viral 6 meses após as trocas, sendo que cerca de 25 porcento evoluiram com nova falha terapeutica durante a evolucao, definida com falha terapeutica posterior (nos meses subsequentes). Foi observado que os pacientes que nao apresentaram boa resposta (apos o periodo de 6 meses de observação) eram aqueles sem adesão prévia, adolescentes, classificação C3 e com uso de maior número de esquemas terapeuticos anteriores. Concluimos que a genotipagem foi um importante instrumento diagnostico para orientação de troca de ARV em pacientes com falha terapeutica, sendo a adesão, o tempo de evolução da doença, assim como a classificação e o historico prévio de uso de grande número de drogas fatores limitantes para o sucesso terapeutico.