Blocking HTLV-1/2 silent transmission in Brazil: Current public health policies and proposal for additional strategies.

Human T-cell lymphotropic viruses 1 and 2 (HTLV-1/2) are relatively common in Brazil but remain silent and neglected infections. HTLV-1 is associated with a range of diseases with high morbidity and mortality. There is no curative treatment for this lifelong infection, so measures to prevent transmission are essential. This narrative review discusses HTLV-1/2 transmission routes and measures to prevent its continuous dissemination. The public health policies that are currently implemented in Brazil to avoid HTLV-1/2 transmission are addressed, and further strategies are proposed.

Characteristics and outcomes of pregnant women with SARS-CoV-2 infection and other severe acute respiratory infections (SARI) in Brazil from January to November 2020

ABSTRACT Background: Knowledge about COVID-19 in pregnancy is limited, and evidence on the impact of the infection during pregnancy and postpartum is still emerging. Aim: To analyze maternal morbidity and mortality due to severe acute respiratory infections (SARI), including COVID-19, in Brazil. Methods: National surveillance data from the SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe) was used to describe currently and recently pregnant women aged 10-49 years hospitalized for SARI from January through November, 2020. SARI cases were grouped into: COVID-19; influenza or other detected agent SARI; and SARI of unknown etiology. Characteristics, symptoms and outcomes were presented by SARI type and region. Binomial proportion and 95% confidence intervals (95% CI) for outcomes were obtained using the Clopper-Pearson method. Results: Of 945,460 SARI cases in the SIVEP-Gripe, we selected 11,074 women aged 10-49 who were pregnant (7964) or recently pregnant (3110). COVID-19 was confirmed in 49.4% cases; 1.7% had influenza or another etiological agent; and 48.9% had SARI of unknown etiology. The pardo race/ethnic group accounted for 50% of SARI cases. Hypertension/Other cardiovascular diseases, chronic respiratory diseases, diabetes, and obesity were the most common comorbidities. A total of 362 women with COVID-19 (6.6%; 95%CI 6.0-7.3) died. Mortality was 4.7% (2.2-8.8) among influenza patients, and 3.3% (2.9-3.8) among those with SARI of unknown etiology. The South-East, Northeast and North regions recorded the highest frequencies of mortality among COVID-19 patients. Conclusion: Mortality among pregnant and recently pregnant women with SARIs was elevated among those with COVID-19, particularly in regions where maternal mortality is already high.

Impact of concurrent epidemics of dengue, chikungunya, zika, and COVID-19

Abstract INTRODUCTION: This study evaluated the epidemiological implications of arbovirus infections and coronavirus disease (COVID-19) co-occurrences in Espírito Santo, Brazil. METHODS: This ecological study of dengue, chikungunya, zika, and COVID-19 was performed from January 1 to July 31, 2020. RESULTS: Espírito Santo registered 44,614, 8,092, 3,138, and 91,483 cases of dengue, chikungunya, zika, and COVID-19, respectively (January-July, 2020). In the 27 and four municipalities with a high incidence of dengue and chikungunya, respectively, the incidence of COVID-19 was 647.0-3,721.7 and 1,787.2-3,403.0 cases per 100,000 inhabitants, respectively. CONCLUSIONS: Espírito Santo experienced an overlap of epidemics, especially in urban areas.

High-risk papillomavirus infection among women living with human Immunodeficiency virus: Brazilian multicentric study.

Cervical cancer is an important health issue in Latin America. Although HPV infections can have spontaneous clearance, persistence of high-risk (HR) HPV is a risk factor for cervical cancer among women and it is even higher in HIV-infected women. To determine the prevalence of HR-HPV and risk factors among HIV-infected women attending reference services for HIV/AIDS in different regions of Brazil. Cross-sectional study conducted among HIV-infected women attended at referral care centers for HIV/AIDS in nine states of Brazil. Women from 18 to 49 years that accept to participate and were not pregnant at the time of the approach were recruited for the study. The HPV screening was realized using qPCR in closed system, in vitro Diagnostic, COBAS® -HPV Roche. The cytology results were available by the Bethesda System. A total of 802(89.1%) from the selected women agreed to participate in the study. Median age was 39(Inter quartile range [IQR34-46]) years and median education was 9(IQR6-11) years. General prevalence of HR-HPV was 28.4%(228/802). HPV-16 prevalence rate was 8.1%(65/802), HPV-18 was 3.7%(30/802) and other types of HR-HPV were 23.6% (189/802). Risk factors for HR-HPV infection in the multivariate logistic regression analysis were: age ranging from 18 to 34 years (OR = 1.43[95%CI:1.18-1.75]), illicit drugs use (OR = 1.61[95%CI:1.10-2.42]) and abnormal cervical cytology (OR = 1.56[95%CI:1.34-1.81]). Results showed a prevalence rate of 28.4% of HR-HPV infection in women living with HIV in Brazil. These infections were significantly associated with having less than 35 years old, illicit drug use and abnormal cervical cytology.

Prevalence of Chlamydia trachomatis and Neisseria gonorrhea and associated factors among women living with Human Immunodeficiency Virus in Brazil: a multicenter study

Abstract Background: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) cause infections in the female genital tract, increasing susceptibility to and infectiousness of HIV. The objectives of the present study were to determine the prevalence and associated factors of CT and GC infection among HIV-infected women in Brazil. Methods: Cross-sectional study conducted from March to December 2015, including HIV-infected women attending referral centers in nine states of Brazil, aged 18-49 years, nonpregnant. An interview was conducted including socio-demographic, epidemiological and clinical characteristics. After the interview, gynecological examination was conducted to collect cervical cytology and vaginal secretion to C. trachomatis and N. gonorrhoeae tests through molecular biology. Results: A total of 802 (89.1%) women participated. The prevalence of CT was 2.1% (17/802) and CG was 0.9% (7/802). The prevalence of a positive test for both CT and/or GC was 2.7%. The factors associated with positive CT/GC test in the multivariate logistic regression analysis were abnormal Papanicolau smear (OR 4.1; 95% CI: 1.54-11.09) and the presence of abnormal cervical discharge (OR 2.6; 95% CI: 1.02-6.71). Among 377 women who reported previous STI 245 (65.0%) reported using condom more frequently after being diagnosed. 62 (16.4%) discovered the STI after the partner told he was infected; 157 (41.6%) had STI symptoms and looked for care, and 158 (41.9%) discovered it in a routine consultation for another reason. Conclusions: The control of STI represents a unique opportunity to improve reproductive health of women living with HIV. STI diagnosis can change their behavior and reduce the sexual transmission of HIV and bacterial STI.

Prevalence of Chlamydia trachomatis and Neisseria gonorrhea and associated factors among women living with Human Immunodeficiency Virus in Brazil: a multicenter study.

BACKGROUND: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) cause infections in the female genital tract, increasing susceptibility to and infectiousness of HIV. The objectives of the present study were to determine the prevalence and associated factors of CT and GC infection among HIV-infected women in Brazil. METHODS: Cross-sectional study conducted from March to December 2015, including HIV-infected women attending referral centers in nine states of Brazil, aged 18-49 years, nonpregnant. An interview was conducted including socio-demographic, epidemiological and clinical characteristics. After the interview, gynecological examination was conducted to collect cervical cytology and vaginal secretion to C. trachomatis and N. gonorrhoeae tests through molecular biology. RESULTS: A total of 802 (89.1%) women participated. The prevalence of CT was 2.1% (17/802) and CG was 0.9% (7/802). The prevalence of a positive test for both CT and/or GC was 2.7%. The factors associated with positive CT/GC test in the multivariate logistic regression analysis were abnormal Papanicolau smear (OR 4.1; 95% CI: 1.54-11.09) and the presence of abnormal cervical discharge (OR 2.6; 95% CI: 1.02-6.71). Among 377 women who reported previous STI 245 (65.0%) reported using condom more frequently after being diagnosed. 62 (16.4%) discovered the STI after the partner told he was infected; 157 (41.6%) had STI symptoms and looked for care, and 158 (41.9%) discovered it in a routine consultation for another reason. CONCLUSIONS: The control of STI represents a unique opportunity to improve reproductive health of women living with HIV. STI diagnosis can change their behavior and reduce the sexual transmission of HIV and bacterial STI.

High-grade cervical lesions among women attending a reference clinic in Brazil: associated factors and comparison among screening methods.

BACKGROUND: Although screening for cervical cancer is recommended for women in most countries, the incidence of cervical cancer is greater in developing countries. Our goal was to determine the prevalence and factors associated with high-grade lesions/cervical cancer among women attending a reference clinic in Brazil and evaluate the correlation of histology with cytology, colposcopy and the high-risk HPV (HR-HPV) tests. METHODS: A cross-sectional study of women attending a colposcopy clinic was carried out. The patients were interviewed to collect demographic, epidemiological and clinical data. Specimens were collected for cervical cytology, Chlamydia trachomatis and HPV testing using the Hybrid Capture (HC) and PCR tests. Colposcopy was performed for all patients and biopsy for histology when cell abnormalities or cervical intraepithelial neoplasia (CIN) were present. RESULTS: A total of 291 women participated in the study. The median age was 38 years (DIQ: 30-48 years). The prevalence of histologically confirmed high-grade lesions/cervical cancer was 18.2% (95%, CI: 13.8%-22.6%), with 48 (16.5%) cases of CIN-2/CIN-3 and 5 (1.7%) cases of invasive carcinoma. In the final logistic regression model, for ages between 30 and 49 years old [OR = 4.4 (95%: 1.01-19.04), history of smoking [OR = 2.4 (95%, CI: 1.14-5.18)], practice of anal intercourse [OR = 2.4 (95%, CI: 1.10-5.03)] and having positive HC test for HR-HPV [OR = 11.23 (95%, CI: 4 0.79-26, 36)] remained independently associated with high-grade lesions/cervical cancer. A total of 64.7% of the cases CIN-3\Ca in situ were related to HPV-16. Non-oncogenic HPV were only found in CIN-1 biopsy results. Compared to histology, the sensitivity of cytology was 31.8%, the specificity 95.5%; the sensitivity of colposcopy for high-grade lesions/cervical cancer was 51.0%, specificity was 91.4% and the concordance with HPV testing was high. CONCLUSIONS: The results confirm an association of HR-HPV with precursor lesions for cervical cancer. These data emphasize that cytological screening to detect precursor lesions is still important in some regions and that HR-HPV should be included for screening.

Comorbidities in children and adolescents with AIDS acquired by HIV vertical transmission in Vitória, Brazil.

BACKGROUND: Studying diseases associated with AIDS is essential for establishing intervention strategies because comorbidities can lead to death. The objectives were to describe the frequency of comorbidities and verify their distribution according to demographic, epidemiological and clinical data as well as to classify diseases in children and adolescents with AIDS in Vitória, Brazil. METHODS: A retrospective cohort study was conducted among children with AIDS, as defined according to the criteria established by the Ministry of Health, who acquired HIV via vertical transmission, were aged 0 to 18 years, and were monitored at a referral hospital from January 2001 to December 2011. RESULTS: A total of 177 patients were included, of whom 97 were female (55%). There were 60 patients (34%) <1 year old, 67 patients (38%) between the ages of 1 and 5, and 50 patients (28%) ≥6 years of age included at the time of admission to the Infectious Diseases Ward. Regarding clinical-immunological classification, 146 patients (82.5%) showed moderate/severe forms of the disease at the time of admission into the Ward, and 26 patients (14.7%) died during the study. The most common clinical signs were hepatomegaly (81.62%), splenomegaly (63.8%), lymphadenopathy (68.4%) and persistent fever (32.8%). The most common comorbidities were anaemia (67.2%), pneumonia/septicaemia/acute bacterial meningitis (ABM) (64.2%), acute otitis media (AOM)/recurrent sinusitis (55.4%), recurrent severe bacterial infections (47.4%) and dermatitis (43.1%). An association between severe clinical-immunological classification and admission to the Ward for children aged less than one year old was found for several comorbidities (p<0.001). CONCLUSION: Delayed diagnosis was observed because the majority of patients were admitted to the Infectious Diseases Ward at ≥1 year of age and were already presenting with serious diseases. The general paediatrician should be alert to this possibility to make an early diagnosis in children infected with HIV.

AIDS-related Kaposi's sarcoma in Brazil: trends and geopolitical distribution.

BACKGROUND: AIDS-related Kaposi's sarcoma (KS) is a unique model of the relationship between viral infection, immunity, environmental, and genetic factors in viral cancers. The goal was to determine the distribution of KS cases among Brazilian geopolitical regions, looking at the ecological relationship with median CD4 cell count. METHODS: Ecological study using Brazilian National Diseases Reporting Databases: 1982-2009. Subjects ≥ 13 years of age who have KS cited in their AIDS reporting form were selected, and demographic and HIV exposure data were collected. RESULTS: We found 11,731 KS cases in the period, with a prevalence of 2.4% among AIDS cases; 88% were male, and 68% lived in the Southeast region, which accounted for 59% of AIDS cases. The regional and national prevalence trends were similar, although the highest proportion among women was found in the North region, which has the lowest number of both AIDS and KS cases. Heterosexual transmission accounted for 87% of HIV among women compared to 18% among men. Fifty-seven percent of all KS cases were diagnosed before antiretroviral therapy (ART). Injection drug use accounted for 11% of KS cases. Median survival was 472 days before the ART era and 1482 after it (P < 0.001). Median CD4 counts increased in all regions in the period as ART coverage expanded, and a resulting correlating decline in KS cases was observed. CONCLUSIONS: Prevalence of KS declined after the introduction of ART in all regions of Brazil, suggesting individual protection conveyed by ART.

Prevalence of and risk factors for penile infection by high-risk human papillomavirus among men infected with HIV.

This study aimed to determine the prevalence of and risk factors for high-risk human papillomavirus (HPV) genital infection and precursor lesions of penile cancer among patients infected with human immunodeficiency virus (HIV). In total, 276 men with a mean age of 34.6 years were included. All participants were subjected to peniscopic examination under magnification, collection of genital exfoliated cells for detecting HPV types using Hybrid Capture, and biopsy surgery of clinically observable lesions and aceto-white areas for histopathological studies. The prevalence of high-risk HPV types was 43%. Peniscopicy showed clinically visible lesions or aceto-white areas in 75/276 participants (27%), of which genital warts were the most common (22/75; 29%). HIV-positive (HIV(+) ) men with CD4(+) T-cell counts <200 cells/mm(3) showed a higher prevalence of penile lesions. Multivariate logistic regression was applied to identify independent risk factors for high-risk HPV types. The results showed that high-risk HPV was associated with lower education level (OR = 1.89, 95% CI: 1.15-3.13), illicit drug use (OR = 1.80, 95% CI: 1.03-3.14), mulatto ethnicity (OR = 2.51, 95% CI: 1.38-4.54), heterosexual orientation (OR = 2.12, 95% CI: 1.30-3.47) symptomatic AIDS (OR = 2.80, 95% CI: 1.65-4.77), AIDS-associated opportunistic infections (OR = 2.92, 95% CI: 1.78-4.78), on HAART (OR = 2.91, 95% CI: 1.78-4.77), and CD4(+) T-cell count <200 cells/mm(3) (OR = 3.31, 95% CI: 1.84-5.96). Immunocompromised men were more susceptible to developing penile lesions associated with high-risk HPV types.

Prevalence and correlates of preterm labor among young parturient women attending public hospitals in Brazil / Prevalencia y factores correlativos del parto prematuro en las jóvenes parturientas que acuden a los hospitales públicos del Brasil

Objective. To determine the prevalence of and risk factors for preterm labor (< 37 weeks of gestation) among young pregnant women in Brazil. Methods. A national cross-sectional study was conducted among parturient women aged 15–24 years attending Brazilian public maternities in 2009. Questionnaires were administered by interviewers during parturient admission to the maternity clinic (or soon after delivery, if survey participants were in too much pain to respond during labor). The questionnaires collected demographic, behavioral, and clinical data. Results. A total of 2 071 (86.3%) of the 2 400 parturient women invited to participate were included in the study. Mean age was 20.2 years (standard deviation [SD]: 2.7) and mean years of formal education was 8 (SD: 2.4). Preterm labor occurred in 450 women (21.7%). The highest proportion of premature labor (36.1%) was found in the North region and the lowest proportion (6.9%) was found in the South region. In the final multivariate logistic regression model, living in the North region (odds ratio [OR]: 1.43, 95% confidence interval [CI]: 1.28– 1.59); having monthly income less than twice the Brazilian minimum wage (OR: 1.27, 95% CI: 1.01–1.60); having suffered domestic violence (OR: 2.27, 95% CI: 1.23–4.18); and having had inadequate prenatal care (OR: 3.17, 95% CI: 2.54–3.97) remained significant correlates of preterm labor in this population. Conclusions. Results show a high prevalence of preterm labor among young women in Brazil. Preterm labor has multifactorial etiologies. More public health resources must be directed toward accelerating understanding of this complex process.

Objetivo. Determinar la prevalencia y los factores de riesgo de parto prematuro (menos de 37 semanas de gestación) en las jóvenes embarazadas del Brasil. Métodos. Se llevó a cabo un estudio transversal a escala nacional en jóvenes parturientas de 15 a 24 años de edad que acudieron a las maternidades públicas brasileñas en el 2009. Los entrevistadores administraron cuestionarios al ingresar la parturienta en la maternidad (o poco después de parto, si las mujeres participantes tenían demasiado dolor como para responder durante el trabajo del parto). Las participantes respondieron a un cuestionario que recopilaba datos demográficos, conductuales y clínicos. Resultados. Se incluyeron en el estudio un total de 2 071 (86,3%) parturientas de las 2 400 invitadas a participar. La media de edad fue de 20,2 años (desviación estándar [SD]: 2,7) y el promedio de años de enseñanza escolar fue de 8 (SD: 2,4). Se produjo un parto prematuro en 450 mujeres (21,7%). La proporción más alta de parto prematuro (36,1%) se observó en la región del Norte y la proporción más baja (6,9%) en la región del Sur. En el modelo final de regresión logística con variables múltiples, el vivir en la región del Norte (razón de posibilidades [OR]: 1,43; intervalo de confianza [IC] de 95%: 1,28–1,59); el tener ingresos mensuales inferiores a dos veces el salario mínimo brasileño (OR: 1,27, IC de 95%: 1,01–1,60); el haber sido víctima de violencia doméstica (OR: 2,27, IC de 95%: 1,23–4,18); y el haber recibido una atención prenatal inadecuada (OR: 3,17, IC de 95%: 2,54–3,97) seguían siendo factores correlativos significativos de parto prematuro en esta población. Conclusiones. Los resultados muestran una alta prevalencia del parto prematuro en las mujeres jóvenes del Brasil. El parto prematuro presenta una etiología multifactorial. Se deben destinar más recursos de salud pública para acelerar el conocimiento de este complejo proceso.

Clinical and laboratorial study of HPV infection in men infected with HIV.

OBJECTIVES: To determine the prevalence of precursor lesions of penile cancer, to establish the concordance of diagnostic techniques (PCR, Hybrid Capture (HC) and peniscopy with acetic acid 5%) in the diagnosis of Human Papilloma Virus (HPV) of the penis of men infected with HIV and to evaluate the influence of the immune status. PATIENTS, METHODS AND RESULTS: 276 men were studied, with a median age of 34.6 years. Prevalence of High Risk HPV, Low Risk HPV and infection with both, according to HC, was 43%, 32% and 22%, respectively. PCR showed 50% of positivity for HPV DNA. Peniscopy was positive in 27% of individuals. Peniscopy showed good specificity and low sensitivity for the detection of penile HPV, and low concordance with PCR. Men with white lesions had a 3.6 higher relative risk of positivity for HPV. The most common clinical lesion observed was vegetation, identified in 29% of patients. PCR and HC techniques showed high sensitivity for HPV DNA and there was an excellent correlation between them. Immunosuppressed individuals with CD4 < 200 cells/mm(3) had the highest prevalence of premalignant lesions that were observed in 10% of the studied individuals. CONCLUSIONS: Peniscopy was important for identification and treatment of subclinical lesions. PCR and HC techniques were sensitive methods for the detection of HPV DNA with high concordance. Severely immunosuppressed individuals showed a higher prevalence of pre-malignant lesions of the penis.

Clinical and laboratorial study of HPV infection in men infected with HIV

OBJECTIVES: To determine the prevalence of precursor lesions of penile cancer, to establish the concordance of diagnostic techniques (PCR, Hybrid Capture (HC) and peniscopy with acetic acid 5%) in the diagnosis of Human Papilloma Virus (HPV) of the penis of men infected with HIV and to evaluate the influence of the immune status. PATIENTS, METHODS AND RESULTS: 276 men were studied, with a median age of 34.6 years. Prevalence of High Risk HPV, Low Risk HPV and infection with both, according to HC, was 43%, 32% and 22%, respectively. PCR showed 50% of positivity for HPV DNA. Peniscopy was positive in 27% of individuals. Peniscopy showed good specificity and low sensitivity for the detection of penile HPV, and low concordance with PCR. Men with white lesions had a 3.6 higher relative risk of positivity for HPV. The most common clinical lesion observed was vegetation, identified in 29% of patients. PCR and HC techniques showed high sensitivity for HPV DNA and there was an excellent correlation between them. Immunosuppressed individuals with CD4< 200 cells/mm3 had the highest prevalence of pre-malignant lesions that were observed in 10% of the studied individuals. CONCLUSIONS: Peniscopy was important for identification and treatment of subclinical lesions. PCR and HC techniques were sensitive methods for the detection of HPV DNA with high concordance. Severely immunosuppressed individuals showed a higher prevalence of pre-malignant lesions of the penis.

Low bone mass prevalence, therapy type, and clinical risk factors in an HIV-infected Brazilian population.

Low bone mineral density (BMD) has been described in human immunodeficiency virus (HIV)-infected patients, but data on associated factors are still unclear, and to our knowledge, no reports are available in Brazil. Our goal was to evaluate BMD in HIV patients attending an outpatient clinic in Vitoria, Brazil. A sectional study was performed in 300 HIV-infected patients to measure BMD by dual-energy X-ray absorptiometry (DXA). Age, gender, anthropometric parameters, nadir and current CD4 cell count, HIV viral load, smoking habit, and current antiretroviral therapy (ART) associations were investigated by multivariable analysis. Based on World Health Organization T-score ranges, low BMD (T-score <-1.0 standard deviation [SD] in postmenopausal women and men aged 50 and older or Z-score <- 2.0 SD in premenopausal women and men below the age of 50) was detected in 54.7% (95% confidence interval: 49.1-60.3%) of the 300 enrolled patients. The observed median age was 46 yr (interquartile range: 39-52), 58% were male, 88.5% were on ART, and 21.4% smoked. The following factors were identified, by multiple logistic modeling, as being independently associated with low BMD: (1) male gender (4.6 [1.28-16.39]), (2) body mass index lower than 25 kg/m(2) (2.9 [1.31-6.49]), (3) menopause (13.4 [2.53-71.12]), and (4) HIV-1 undetectable viral load (7.9 [1.96-32.25]). Conversely, zidovudine (0.2 [0.04-0.85]) and nevirapine (0.1 [0.02-0.38]) use were inversely associated with low BMD. Low BMD was frequently found in our cohort of about 300 Brazilian HIV-infected subjects. This study supports the need for periodic DXA testing in HIV outpatient clinics.

Resultados do estudo sentinela-parturiente, 2006: desafios para o controle da sífilis congênita no Brasil / Results of the sentinel surveillance project, 2006: challenges for the control of congenital syphilis in Brazil

Objetivo: estimar a prevalência de HIV e sífilis em parturientes e a cobertura dos testes de HIV e sífilis na gestação com base em informações registradas nos cartões de pré-natal e nos prontuários hospitalares. Métodos: o processo de amostragem foi probabilístico, em dois estágios de seleção. No primeiro, foram selecionadas 150 maternidades do SUS, estratificadas por porte populacional do município. Em cada maternidade, foram selecionadas 100 a 120 parturientes. A cobertura de sífilis foi estimada entre as parturientes que realizaram dois testes na gestação e um na hora do parto. A taxa de prevalência de sífilis foi estimada entre as parturientes que realizaram o teste na hora do parto. Resultados: somente 14,1% das parturientes obedeceram às recomendações de dois testes de sífilis durante a gestação e um no parto. O percentual de gestantes que apresentaram pelo menos um teste no cartão de pré-natal foi de 75,1%, porém apenas 16,9% apresentaram os resultados dos dois testes. Das parturientes que realizaram o teste no parto, 1,1% teve resultado positivo. Entre as mulheres que haviam feito o primeiro teste no pré-natal e obtiveram resultado negativo, 0,4% teve resultado positivo no segundo teste. Entre as gestantes que não fizeram atendimento pré-natal, 1,8% teve resultado positivo na hora do parto. Conclusão: a baixa cobertura do segundo teste de sífilis no pré-natal indica que as recomendações do Ministério da Saúde não estão sendo seguidas rotineiramente. Os achados aqui apresentados indicam a necessidade de realização do segundo teste de sífilis no pré-natal para o adequado controle da transmissão vertical.

Objective: estimating HIV and syphilis prevalence rates among parturient women and coverage of HIV and syphilis testing during pregnancy bymeans of registered information in prenatal and hospital records. Methods: the sampling was probabilistic in two selection stages. In the first one,150 hospitals were selected, stratified by population size of the municipality. In each health establishment, 100-120 parturient were randomly selected.Coverage of syphilis testing was estimated among parturient women who took two syphilis tests during prenatal care and one test at delivery. Syphilis prevalence rate was estimated among parturient women tested at the delivery. Results: only 14.1% of the women followed the recommendations of two syphilis tests during pregnancy and one at the delivery. The percentage of pregnant women with at least one syphilis test registered in the prenatal record was 75.1% but only 16.9% showed two test results. Among pregnant women that were tested at delivery, 1.1% had positive results.Among women that were tested during prenatal care and were negative, 0.4% got positive in the second test. Among women who did not have prenatalcare and were tested at delivery, 1.8% had positive results. Conclusion: the low coverage of the second syphilis test indicates that the Ministry of Health recommendations are not being obeyed in the routine of health services. The findings depicted indicate the need of the second syphilis test during pregnancy for the adequate vertical transmission control.

Radioiodine therapy and subsequent pregnancy.

OBJECTIVES: To evaluate abortion and fetal congenital anomaly rates in women previously submitted to radioiodine therapy for differentiated thyroid carcinoma. STUDY DESIGN: A case-control study of 108 pregnant women, 48 cases whose pregnancies were evaluated after they had undergone radioiodine therapy for differentiated thyroid carcinoma, and the control group consisted of 60 healthy pregnant women. RESULTS: Of a total of 66 pregnancies, 14 conceived within the first year, 51 one or more years after the last administration of 131I, the medical record of one patient was not available. The interval between the last radioiodine therapy administration and conception ranged from 1 month to 10 years. There were a total of 4 miscarriages, 2 of them for unknown reasons. There was one case of congenital anomaly and two preterms birth. Nine women presented the following pregnancy events: placental insufficiency, hypertensive crisis, placental detachment, risk of miscarriage, preterm labour and four miscarriages. No statistical difference was observed between the studied and control groups. CONCLUSION: Radioiodine was followed by no significant increase in untoward effects in neither the pregnancy nor the offspring.

Radioiodine therapy and subsequent pregnancy

OBJECTIVES: To evaluate abortion and fetal congenital anomaly rates in women previously submitted to radioiodine therapy for differentiated thyroid carcinoma. STUDY DESIGN: A case-control study of 108 pregnant women, 48 cases whose pregnancies were evaluated after they had undergone radioiodine therapy for differentiated thyroid carcinoma, and the control group consisted of 60 healthy pregnant women. RESULTS: Of a total of 66 pregnancies, 14 conceived within the first year, 51 one or more years after the last administration of 131I, the medical record of one patient was not available. The interval between the last radioiodine therapy administration and conception ranged from 1 month to 10 years. There were a total of 4 miscarriages, 2 of them for unknown reasons. There was one case of congenital anomaly and two preterms birth. Nine women presented the following pregnancy events: placental insufficiency, hypertensive crisis, placental detachment, risk of miscarriage, preterm labour and four miscarriages. No statistical difference was observed between the studied and control groups. CONCLUSION: Radioiodine was followed by no significant increase in untoward effects in neither the pregnancy nor the offspring.

OBJETIVO: Avaliar a taxa de aborto e anomalia congênita em mulheres que engravidaram após radioiodoterapia para carcinoma diferenciado de tireóide. PACIENTES E MÉTODO: Estudo de caso controle com 108 mulheres, 48 submetidas à radioiodoterapia para carcinoma diferenciado de tireóide e 60 mulheres saudáveis (grupo controle). RESULTADOS: De 66 gestações (grupo de pacientes que receberam radioiodo), 14 ocorreram no primeiro ano e 51 mais de um ano após a administração do 131I. Não foi possível coletar dados de uma paciente. O intervalo entre a última dose de 131I e a concepção variou de 1 mês a 10 anos. Ocorreram 4 abortos, 2 de causas desconhecidas. Houve 1 caso de anomalia congênita e 2 pretermos. Nove pacientes que receberam 131I apresentaram intercorrências durante a gravidez: insuficiência placentária, crise hipertensiva, descolamento de placenta, ameaça de aborto, trabalho de parto prematuro e 4 abortos. Não houve diferença estatística entre o grupo estudado e o controle. CONCLUSÃO: O uso da radioiodoterapia para carcinoma diferenciado de tireóide em mulheres não foi relacionado com aumento de efeitos adversos nas mães e suas proles.

Prevalência de infecção pelo HIV, sífilis e hepatites em homens em com sinais e sintomas de DST / Prevalence of HIV infection, syphilis and hepatitis in men with sti symptoms

Introdução: O acesso e monitoramento de dados de prevalência são componentes importantes nas ações de vigilância epidemiológica das DST epodem ser utilizados, por meio de análise das tendências, para o planejamento das estratégias de prevenção e assistência à saúde. Objetivo: estimar a soroprevalência de infecção pelo HIV, sífilis, hepatites B e C em homens que se apresentam nos serviços de saúde pública com sinais e sintomas de DST. Métodos: estudo sentinela realizado em 28 sítios em 2003. A metodologia utilizada foi anônima, não-vinculada. As amostras foram coletadas durante 16 semanas, entre usuários do sexo masculino, de 15 a 49 anos de idade. As amostras foram testadas para a detecção de anticorpos para HIV, sífilis, vírus de hepatite C (VHC) e pesquisa de antígeno de superfície do vírus de hepatite B. Resultados: foram coletadas e testadas 5.408 amostras de soro de homens com sintomas e sinais de outras DST. A média de idade foi de 31 anos (DP 9,8). As taxas de soroprevalência encontradas foram: 3,8% (IC 95% 3,2-4,2) de infecção pelo HIV, 12,9% (IC 95% 11,9-13,7) de sífilis, 9,6% (IC 95% 7,8-11,2) de infecção pelo vírus hepatite B e 2,7% (IC 95% 1,9-3,5) de vírus da hepatite C. Conclusão: o acesso e monitoramento desses dados, que mostraram alta prevalência das infecções avaliadas, são componentes importantes nas ações de vigilância epidemiológica do HIV/DST.

Introduction: Access of and monitoring of prevalence data are important components for epidemiological surveillance of STD, by trends analysis,they can be useful for prevention and assistance strategies of health. Objectives: estimate seroprevalence of HIV infection, syphilis, and hepatitis B and C virus among male population with STI symptoms attending Health clinics. Methods: sentinel study was performed in 28 sites in 2003. Theused methodology was anonym, not associated blind. Samples were collected during 16 weeks, among male attendees from 15 to 49 years old. The samples were tested for determining antibody to HIV, syphilis, hepatitis C (HCV), and for the detection of surface antigen of hepatitis B. Results: itwas collected and tested 5,408 samples among men with symptoms of other STI. Mean age was 31.0 (SD 9.8) years old. Prevalence rates were: 3.8% (CI 95% 3.2-4.2) for HIV infection, 12.9% (CI 95% 11.9-13.7) for syphilis, 9.6% (CI 95% 7.8-11.2) for HBV infection and 2.7% (CI 95% 1.9-3.5) of HCV infection. Conclusion: the access and monitoring of these data, that showed high prevalence of infections, are important skills forHIV/AIDS/STI epidemiological surveillance actions

Impacto da infecçäo pela chlamydia trachomatis na saúde reprodutiva / Impact of chlamydia trachomatis infection of reprodutive health

Nas últimas décadas, a chlamydia tem sido reconhecida como um dos organismos sexualmente transmitidas mais difundidos nos países desenvolvidos e causam grande impacto na saúde reprodutiva. Em mulheres, ela pode causar uretrite, cervicite, doença inflamatória pélvica, além de sequelas destas condiçöes, como a infertilidade, gravidez ectópica e dor pélvica crönica. Em homens, a infecçäo pela Chlamydia tracomatis pode causar uretrite e epididimite

Infecçäo pelo HIV e sífilis em pessoas que procuram atendimento em uma clínica de DST no Brasil / HIV infection and syphilis among people attending a STD clinic in Brazil

Objetiva identificar o perfil epidemiológico e determinar a prevalência de infecçäo pelo HIV e sífilis entre usuários de clínica de DST