Evaluation of Aids and Hepatitis-B knowledge and job satisfaction among hairdressers and barbers in Turkey

Blood-borne viruses, includingthe human immunodeficiency virus and hepatitis B virus, have certain common epidemiological characteristics and these viruses infect millions of people worldwide. This study aimed to determine the job satisfaction and the level of knowledge and practices regarding infectious diseases of employees working as hairdressers and barbers.This descriptive and cross-sectional study comprised 1200 hairdressers and barbers. The study sample comprised 628 people who consented to participate in the study. The mean age of the participants who participated in the study was 28, 13 ± 6. 9 years. The mean job satisfaction score of the participants was 3.85 ± 0.58. The job satisfaction score was found to be higher among those with sufficient knowledge of hepatitis B (p < 0.005). Employees should be provided performance trainings to achieve job satisfaction. It is recommended that employees be encouraged to wear gloves and gowns to protect their health and prevent contamination.

Comparison Between Knowledge, Behavior and Risk Perception About the STD/AIDS in Medicine and Law Students from PUC-GO / Comparação entre Conhecimento, Comportamento e Percepção de Risco Acerca das DST/AIDS nos Estudantes de Medicina e Direito da PUC-GO

There has been a rise in the incidence of STIs/AIDS in the young Brazilian population; therefore, college students are a major focus for change of risky sexual behaviors. Objective: To analyze knowledge, sexual behavior, and risk perception of students in different years of the medical and law programs at the Pontifical Catholic University of Goiás (PUC-GO), Brazil, with regard to STIs/AIDS. Methods: Administration of anonymous questionnaires to students in their first, third, and last years of the medical and law programs at PUC-GO, using probability-proportional-to-size sampling and with margin of error set at 5%. Results: Medical students answered 201 questionnaires and law students 441 questionnaires. The comparison of both programs revealed that 40.3% of law students and 19.6% of medical students believe that HIV is transmitted through kissing and that 39.9% of law students and 29.3% of medical students believe that this virus is also transmitted through utensils. Consistent condom use was reported by 21.2% of medical students and 30.1% of law students. Medical students have greater risk perception of sexual behavior, and 83.8% claim they have been exposed to STIs; furthermore, 72.6% of law students believe they are at risk. Conclusion: There was an increase in medical students' knowledge about STIs/AIDS throughout the program. Nevertheless, medical students adopt riskier sexual behavior, which is caused by the lower frequency of condom use. Medical students have, however, increased risk perception regarding sexual behavior.

Vem ocorrendo um aumento da incidência de DST/AIDS na população jovem brasileira, assim, os universitários são um importante foco para mudança de comportamento sexual de risco. Objetivo: Analisar o conhecimento, o comportamento e a percepção sexual de risco acerca das DST/AIDS dos estudantes de diversos anos dos cursos de Medicina e Direito da Pontifícia Universidade Católica de Goiás (PUC-GO). Métodos: Aplicação de questionário anônimo a alunos do primeiro, terceiro e último anos dos cursos de Medicina e Direito da PUC-GO, considerando amostra probabilística proporcional e com margem de erro de 5%. Resultados: Foram respondidos 201 questionários pelos estudantes de Medicina e 441 pelos de Direito. Quando comparados os dois cursos, 40,3% dos estudantes de Direto e 19,6% da Medicina consideram que o HIV é transmitido pelo beijo e 39,9% do Direito e 29,3% da Medicina acreditam que esse vírus também seja transmitido por utensílios. O uso consistente do preservativo foi referido por 21,2% dos alunos de Medicina e 30,1% dos de Direito. Os estudantes de Medicina possuem maior percepção sexual de risco, com 83,8% considerando estarem sujeitos às DST; no Direito, 72,6% dos estudantes se consideram sob esse risco. Conclusão: Houve aumento do conhecimento acerca das DST/AIDS pelos acadêmicos de Medicina ao longo do curso. Apesar disso, os acadêmicos de Medicina adotam maior comportamento sexual de risco no que diz respeito à menor frequência de uso do preservativo. Os acadêmicos de Medicina apresentam, entretanto, maior percepção sexual de risco.

Síndrome inflamatorio de reconstitución inmune (SIRI) en pacientes pediátricos que acuden a la consulta de VIH/SIDA del servicio de pediatría médica infecciosa del Hospital Universitario de Caracas / Immune reconstitution inflammatory syndrome (IRIS) in pediatric patients attending consultation HIV / AIDS medical service pediatric infectious Hospital Universitario de Caracas

La Organización Mundial de la Salud define al síndrome inflamatorio de reconstitución inmune (SIRI) como un grupo de signos y síntomas que resultan de la recuperación inmunológica del paciente VIH/SIDA después del inicio de la terapia retroviral de gran actividad (TARGA) cuya incidencia es del 10% al 25%. Estudiar los pacientes con diagnóstico de infección por VIH controlados en el Servicio de Pediatría Médica Infecciosa del Hospital Universitario de Caracas que desarrollaron SIRI. Se realizó estudio retrospectivo con revisión de datos de pacientes pediátricos con diagnóstico de VIH que presentaron SIRI. Los mismos fueron recabados de la base de datos de la consulta VIH/SIDA diseñada en Access 2010 y analizados con EPIINFO 3.5.4. El 15% de los pacientes con diagnóstico de VIH presentaron SIRI, siendo del sexo masculino 80%; 60% fueron clasificados inicialmente en estadio C3. La edad media fue de 5,26 años, (SD: ± 4,34). La carga viral de inicio de TARGA 320.318 copias/mL (SD: ± 260 727), contaje de linfocitos T CD4+: 127 células/mm³ (SD:±148) relación CD4/CD8: 0,17 (SD: ± 0,11); TARGA inicial: 90% utilizaron 3TC, 60% AZT, 40% ABC y 80% inhibidores de proteasa. Las manifestaciones clínicas más frecuentemente observadas fueron BCGitis (30%), tuberculosis (30%) y neumocistosis (20%). En un 90% las manifestaciones de SIRI ocurrieron en los primeros 3 meses de iniciado TARGA. Al momento del SIRI se observó en promedio un aumento del contaje de linfocitos T CD4+ en 411 células/mL y disminución de CV en 2 log. El SIRI es frecuente en pacientes pediátricos con VIH/SIDA y debe ser tomado en cuenta cuando se inicia tratamiento en estados severos de inmunodepresión

The World Health Organization defines the Immune Reconstitution Inflammatory Syndrome (IRIS) as a group of signs and symptoms as a result of the HIV/AIDS patients’ immune recovery after initiation of highly active antiretroviral therapy (HAART), being the incidence 10% to 25%. To study patients with HIV infection in control at the Pediatric Infectious Service of University Hospital of Caracas who developed IRIS. Retrospective data review of pediatric patients diagnosed with HIV who presented SIRI was performed. It was collected from 2010 Access - designed HIV/AIDS consultation database and analyzed with EPIINFO 3.5.4. 15% of patients diagnosed with HIV had IRIS, being 80% male, 60% were initially classified C3 stage. The average age was 5.26 years (SD: +4.34). Viral load (VL) starting HAART: 320 318 copies/mL (SD: ± 260,727), CD4 ± count: 127 cells/mm³ (SD: +148), CD4/CD8: 0.17 (SD: +0.11); initial HAART used: 90% 3TC,60% AZT, 40% ABC and 80% protease inhibitors. The most frequently clinical features observed were: BCGitis (30%), tuberculosis (30%) and pneumocystosis (20%). SIRI manifestations occurred, in 90% of cases, in the first 3 months after initiation of HAART. At the moment of IRIS diagnosis, an average CD4 + T count at 411 cells/ml increase and 2 log VL decreases were recorded. SIRI is common in HIV pediatric patients and should be considered when treatment is started in severe immunosuppression state

Prevalence of human papillomavirus infection, distribution of viral types and risk factors in cervical samples from human immunodeficiency virus-positive women attending three human immunodeficiency virus-acquired immune deficiency syndrome reference centres in northeastern Brazil

Human immunodeficiency virus (HIV)-positive patients have a greater prevalence of coinfection with human papillomavirus (HPV) is of high oncogenic risk. Indeed, the presence of the virus favours intraepithelial squamous cell lesion progression and may induce cancer. The aim of this study was to evaluate the prevalence of HPV infection, distribution of HPV types and risk factors among HIV-positive patients. Cervical samples from 450 HIV-positive patients were analysed with regard to oncotic cytology, colposcopy and HPV presence and type by means of polymerase chain reaction and sequencing. The results were analysed by comparing demographic data and data relating to HPV and HIV infection. The prevalence of HPV was 47.5%. Among the HPV-positive samples, 59% included viral types of high oncogenic risk. Multivariate analysis showed an association between HPV infection and the presence of cytological alterations (p = 0.003), age greater than or equal to 35 years (p = 0.002), number of partners greater than three (p = 0.002), CD4+ lymphocyte count < 200/mm3 (p = 0.041) and alcohol abuse (p = 0.004). Although high-risk HPV was present in the majority of the lesions studied, the low frequency of HPV 16 (3.3%), low occurrence of cervical lesions and preserved immunological state in most of the HIV-positive patients were factors that may explain the low occurrence of precancerous cervical lesions in this population.

Qualidade de vida de portadores de HIV/AIDS e sua relação com linfócitos CD4+, carga viral e tempo de diagnóstico / Quality of life of people living with HIV/AIDS and its relationship with CD4+ lymphocytes, viral load and time of diagnosis

A qualidade de vida (QV) acompanha o tratamento dos pacientes com AIDS, juntamente com as inovações farmacológicas, que permitiram prolongar a vida do paciente e a manutenção de seu bem-estar. O presente estudo objetivou verificar a QV desses pacientes e correlacionar com dados clínicos e laboratoriais. Participaram 205 pacientes HIV/AIDS, os quais responderam ao questionário WHOQOL-120-HIV e tiveram coletados seus dados sociodemográficos, clínicos e laboratoriais. A média etária foi de 40,59 ± 11,81 anos; contagem de linfócitos CD4+ de 397,97 ± 232,84 mm³ e 5,23 ± 3,94 anos de diagnóstico do HIV. A carga viral era <50 cópias/ml em 115 pacientes; em 61, entre 50 e 10.000; e em 29 acima de 10.000 cópias. Os domínios atingiram bons escores médios, sendo que o melhor foi o psicológico (14,5 ± 2,7), seguido de relações sociais (13,7 ± 2,2), físico (12,7 ± 3,5), nível de independência (12,6 ± 2,5), crenças pessoais (12,4 ± 2,4) e meio ambiente (12,4 ± 1,8). Os melhores escores nas facetas dor, lazer, apoio social, ambiente físico e crenças pessoais foram os com maiores níveis de CD4 (p < 0,05). Já nas facetas finanças, lazer, preocupações sobre o futuro e QV geral e percepção de saúde foram em pacientes com carga viral <50 (p < 0,05). Os melhores índices nas facetas energia e fadiga, atividade sexual, informação e transporte, sintomas da doença, cuidados e preocupações sobre o futuro foram verificados em pacientes com menor tempo de diagnóstico (p < 0,05). Os pacientes com HIV/AIDS do estudo apresentam QV de nível intermediário e associação com os níveis de CD4, CV e tempo de diagnóstico.

Quality of life (QOL) has accompanied the treatment of AIDS patients, along with pharmacological innovations that have allowed patients to live longer and maintain their well-being. The present study aimed at evaluating the QOL of these patients and correlate it with clinical and laboratory data. The study included 205 patients with HIV/AIDS, who answered the WHOQOL-120-HIV; and whose socio-demographic data, clinical and laboratory findings were collected. The average age was 40.59 ± 11.81 years; CD4+ lymphocyte count, 397.9 ± 232.84 mm³; and years of diagnosis of HIV, 5.23 ± 3.94. Viral load was <50 copies/ml in 115 patients; 50 to 10.000 in 61; and above 10.000 copies in 29 patients. Domains achieved satisfactory average scores, and the best were the psychological (14.5 ± 2.7), followed by social relationships (13.7 ± 2.2), physical (12.7 ± 3.5), independence (12.6 ± 2.5), personal beliefs (12.4 ± 2.4), and environment (12.4 ± 1.8). The best scores on pain, pleasure, social support, physical environment, and personal belief facets were observed for those with higher CD4 levels (p < 0.05). The best scores for the finance, leisure, concerns about the future, overall QOL, and perceived health facets were observed for patients with viral load <50 (p < 0.05). The highest rates for energy, fatigue, sexual activity, information, transportation, symptoms, care, and concerns about the future facets were seen in patients with less time of diagnosis (p < 0.05). HIV/AIDS patients in the study had an intermediate QOL correlating to CD4 levels, VL, and time of diagnosis.

Lipoatrofia facial associada ao HIV/AIDS: do advento aosconhecimentos atuais / HIV-Associated facial lipoatrophy: from the advent to current knowledge

O advento da AIDS trouxe novos desafios para a Dermatologia. A terapia antirretroviral mudou drasticamente a morbimortalidade associada à infecção pelo HIV/AIDS, mas contribuiu para o surgimento de outras novas situações que exigem abordagem adequada do dermatologista. A Síndrome Lipodistrófica Associada ao HIV/AIDS tem origem multifatorial, mas está fortemente associada ao uso dos antirretrovirais. Compreende alterações na distribuição da gordura corporal, acompanhada ou não de alterações metabólicas. A perda da gordura da face, chamada lipoatrofia facial, é dos sinais mais estigmatizantes da síndrome. Esta condição, muitas vezes reveladora da doença, trouxe de volta o estigma da AIDS. É necessário que os especialistas que atuam com pacientes com HIV/AIDS identifiquem estas alterações e busquem opções de tratamento, dentre as quais se destaca o implante com polimetilmetacrilato, que é disponibilizado para tratamento da lipoatrofia facial associada ao HIV/AIDS no Sistema Único de Saúde.

The advent of AIDS has brought new challenges to Dermatology. Antiretroviral therapy dramatically changed the morbidity and mortality associated with HIV / AIDS, but contributed to the emergence of other new situations that require adequate approach by the dermatologist. The HIV / AIDS Associated Lipodystrophy Syndrome is multifactorial in origin, but it is strongly associated with the use of antiretroviral drugs. It includes changes in body fat distribution, with or without metabolic changes. The loss of facial fat, called facial lipoatrophy, is one of the most stigmatizing signs of the syndrome. This condition, often revealing of the disease, brought back the stigma of AIDS. It is necessary that the specialists working with patients with HIV / AIDS identify these changes and seek treatment options, amongst which stands out the implant with polymethylmethacrylate, which is available for the treatment of HIV / AIDS facial lipoatrophy in the Brazilian Public Health System.

Estudio clínico-epidemiológico de la criptococosis en Venezuela: años 1994-2003 / Clinical-epidemological study of cryptococcosis in Venezuela: 1994-2003

La criptococosis es una enfermedad oportunista de distribución mundial. Frecuentemente es una infección definitoria de SIDA. El tratamiento antirretroviral ha disminuido su frecuencia. El impacto de esta entidad en Venezuela es desconocido. El objetivo de este trabajo es describir las características más relevantes de la criptococosis en nuestro país. Se revisaron 110 historias clínicas de pacientes hospitalizados con el diagnostico de criptococosis, entre 1994 y 2003, en 6 hospitales. Los datos recolectados incluyeron: características demográficas, clínicas, diagnósticas, terapéuticas y la evolución de los pacientes. Para el análisis se utilizaron los programas SPSS 10.0 y EpiInfo 6.04 (2001). Dentro de los 110 pacientes evaluados se incluyeron 17 protocolos de autopsia. Uno solo de los pacientes tenia 8 años de edad, el resto era mayor de 15 años. 91 eran del sexo masculino y 19 femenino. 91 (82,73 por ciento) tenían SIDA y 19 (17,27 por ciento) eran VIH negativo. En los pacientes con SIDA el valor promedio de CD4+ fue < 200 cel/mm³ y la carga viral era > 30000 copias/mL; 52 (57,14 por ciento) de los casos no tenían otra infección oportunista y 39 (42,86 por ciento) tenían otras condiciones asociadas, tales como tuberculosis (30,97 por ciento), neumocistosis (28,21 por ciento), y toxoplasmosis (20,51 por ciento). En los pacientes VIH negativo, el uso de esteroides (25 por ciento) fue el factor de riesgo predominante. Dos pacientes eran embarazadas. En 107 (57,27 por ciento) se encontró infección del SNC. 12 (13,19 por ciento) de los pacientes con SIDA tenían alteración de pares craneales. Se encontró afectación pulmonar en 4 (3,77 por ciento) pacientes, 1 de ellos con SIDA. La criptococosis fue la enfermedad definitoria de SIDA en el 61,54 por ciento de los casos. 33 (30 por ciento) de los pacientes fallecieron. En la mayoría de los pacientes la criptococosis se asoció a SIDA. A pesar de la eficacia del tratamiento antirretrovial, esta micosis es todavia ...

Cryptococcosis is an opportunistic disease of worldwide distribution. It is frequently an AIDS-defining infection. Antiretroviral treatment has reduced its occurrence. In Venezuela, the impact of this disease is unknown. The aim of this study is to describe the most relevant features of cryptococcosis in our country. 110 clinical records with a diagnosis of cryptococcosis hospitalized between 1994 and 2003 in 6 Venezuelan hospitals were analyzed. Data collected included demographic, clinical, diagnostic, therapeutic and outcome information. SPSS 10.0 software and EpiInfo 6, version 6.04 (2001) were used. 110 patients with cryptococcosis were enrolled, including 17 autopsy protocols. One was 8 years old, the rest were over 15. Nineteen were female and 91 male; 91 (82.73 percent) had AIDS, 19 (17.27 percent) were HIV negative. Among the AIDS patients, average CD4+ count was < 200 cel/mm3 and viral load was > 30000 copies/ml; 52 (57.14 percent) did not have other opportunistic infections or AIDS-related disease, and 39 (42.86 percent) had other associated conditions, such as tuberculosis (30.97 percent), PCP (28.21 percent) and toxoplasmosis (20.51 percent). In HIV negative patients, use of steroids (25 percent) was the predominant risk factor. Two patients were pregnant. 107 (57.27 percent) presented CNS infection; 12 (13.19 percent) with AIDS had cranial nerve alterations. Pulmonary disease was found in 4 (3.77 percent), of which one had AIDS. Cryptococcosis was an AIDS-defining infection in 61.54 percent of cases; 33 (30 percent) of the patients died. In most of the patients, cryptococcosis was associated with AIDS. In spite of the efficacy of antiretroviral treatment, this mycosis is still significant in Venezuela, perhaps due to late HIV infection diagnosis

High prevalence and association of HIV-1 non-B subtype with specific sexual transmission risk among antiretroviral naïve patients in Porto Alegre, RS, Brazil / Alta prevalência e associação do subtipo não-B do vírus HIV-1 com risco específico de transmissão sexual entre pacientes virgens de tratamento antirretroviral em Porto Alegre, Brasil

In South Brazil the circulation of two HIV-1 subtypes with different characteristics represents an important scenario for the study of the impact of HIV-1 diversity on the evolution of the HIV-1 epidemic and AIDS disease. HIV-1 B, the predominant variant in industrialized countries and HIV-1 C, the most prevalent subtype in areas with rapid epidemic growth, are implicated in most infections. We evaluated blood samples from 128 antiretroviral (ARV) naïve patients recruited at entry to the largest HIV outpatient service in Porto Alegre. Based on partial pol region sequencing, HIV-1 C was observed in 29 percent, HIV-1 B in 22.6 percent and, the recently identified CRF31_BC, in 23.4 percent of 128 volunteers. Other variants were HIV-1 F in 10 percent and other mosaics in 5.5 percent. In order to evaluate the association of socio-behavioral characteristics and HIV-1 subtypes, interviews and laboratory evaluation were performed at entry. Our data suggest an established epidemic of the three major variants, without any evidence of partitioning in either of the subgroups analyzed. However, anal sex practices were associated with subtype B, which could indicate a greater transmissibility of non-B variants by vaginal intercourse. This study provides baseline information for epidemiologic surveillance of the changes of the molecular characteristics of HIV-1 epidemics in this region.

No sul do Brasil a circulação de dois subtipos de HIV-1 com características diferentes representa importante cenário para o estudo do impacto da diversidade do HIV-1 na evolução da epidemia e na AIDS. O HIV-1 B, variante predominante nos países industrializados e o HIV-1 C, o subtipo mais prevalente em áreas com maiores taxas de crescimento da epidemia, estão implicados na maioria das infecções. Avaliamos amostras de sangue de 128 pacientes sem exposição a antirretrovirais, recrutados ao ingressarem no maior serviço ambulatorial de HIV/AIDS de Porto Alegre. Com base no sequenciamento parcial da região pol, o HIV-1 C foi observado em 29 por cento, HIV-1 B em 22,6 por cento e uma forma recombinante recentemente descrita, CRF31_BC, foi observada em 23,4 por cento entre 128 voluntários. Outras variantes encontradas foram HIV-1 F em 10 por cento e outros mosaicos em 5,5 por cento. Para avaliar associações entre características sócio-comportamentais e subtipos do HIV-1 foram realizadas entrevistas e exames laboratoriais na entrada do estudo. Nossos dados sugerem uma epidemia estabelecida dessas três variantes principais, sem evidência de compartilhamento em nenhum subgrupo analisado. Entretanto, prática sexual anal se mostrou associada à transmissão de subtipo B, o que pode indicar maior transmissibilidade das variantes não-B por intercurso vaginal. Este estudo permite delinear uma linha de base para o monitoramento epidemiológico das mudanças nas características moleculares da epidemia do HIV-1 nesta região.

Início da terapia anti-retroviral em estágio avançado de imunodeficiência entre indivíduos portadores de HIV/AIDS em Belo Horizonte, Minas Gerais, Brasil / Initiation of antiretroviral therapy in HIV-infected patients with severe immunodeficiency in Belo Horizonte, Minas Gerais State, Brazil

O objetivo deste trabalho foi verificar a proporção de início tardio da terapia anti-retroviral (TARV) e seus fatores associados. Estudo de corte transversal com pacientes de dois serviços públicos de referência (n = 310) em Belo Horizonte, Minas Gerais, Brasil. Atraso no início da TARV foi definido como ter contagem de linfócitos T CD4+ < 200 células/mm³ ou manifestação clínica de imunodepressão grave. A maioria era do sexo masculino (63,9 por cento) e não possuía plano de saúde (76,1 por cento). A proporção de início tardio da TARV foi 68,4 por cento. Grande parte (75,2 por cento) iniciou TARV < 120 dias após a primeira consulta médica. Estar desempregado, realizar anti-HIV por indicação de profissional de saúde, < 2 consultas no serviço até seis meses antes do início da TARV e tempo entre primeira consulta para o HIV e início da TARV < 120 dias estiveram associados de forma independente com início tardio da TARV. São necessários estudos que avaliem o custo-efetividade da realização do anti-HIV como teste de rastreamento da população geral. Facilitar o acesso dos pacientes com resultado positivo aos serviços de referência pode contribuir para a redução do número de pacientes que iniciam tardiamente a TARV.

The main objective was to assess the proportion of delayed initiation of antiretroviral therapy (ART) and associated factors. This was a cross-sectional study of 310 patients enrolled in two public health centers in Belo Horizonte, Minas Gerais State, Brazil. Delayed ART initiation was defined as starting treatment with a CD4 count lower than 200 cells/mm³ or clinical symptoms of severe immunodepression at the time of first antiretroviral prescription. The majority of participants were males (63.9 percent), had no health insurance (76.1 percent), and started ART less than 120 days after the first medical visit (75.2 percent). The proportion of delayed ART initiation was 68.4 percent. Unemployment, referral by a health professional for HIV testing, fewer than two medical visits in the six months prior to ART initiation, and time between first medical visit and ART initiation less than 120 days were independently associated with the outcome. Our results suggest that every patient 13 to 64 years of age should be offered HIV testing, which could increase the rate of early HIV diagnosis, and thus patients that tested positive could benefit from timely follow-up and antiretroviral therapy.

Tratamiento antirretroviral de gran actividad en niños VIH positivos: evolución de la enfermedad relacionada con parámetros clínicos, inmunológicos y virológicos al comienzo del tratamiento / Highly active antiretroviral therapy in HIV sero-positive children: disease progression by baseline clinical, immunological and virological status

Introducción. Desde 1996, los niños infectados por el virus de la inmunodeficiencia humana reciben tratamientos antirretrovirales denominados de gran actividad (TARGA). El inicio tardío puede restarle eficacia; la administración prolongada aumenta el riesgo de episodios adversos y desarrollo de resistencia, y dificulta la adherencia. Nuestro objetivo fue establecer si existe relación entre los parámetros clínicos, inmunológicos y virológicos al inicio del tratamiento TARGA, y la evolución de los pacientes. Población, material y métodos. Estudio retrospectivo-prospectivo observacional de una cohorte de niños VIH positivos tratados con TARGA a partir de 1998 (n= 564) en hospitales de Buenos Aires y Rosario (promedio de tratamiento: 46,78 meses. Intervalo: 2-91 meses). Se los agrupó según edad (menor o mayor de un año) y evolución (favorable o desfavorable). Se correlacionaron el estadio clínico, porcentaje de linfocitos CD4 y carga viral al comienzo del tratamiento con la evolución. Resultados. No hubo diferencias entre porcentaje y recuento de CD4 y carga viral al inicio entre los niños menores de un año con buena (n= 79) o mala evolución (n: 4). Entre los niños mayores (450 con buena evolución, 31 con evolución desfavorable), fueron predictores de mala evolución al iniciar TARGA, el compromiso clínico grave (estadio C) (p= 0,006), CD4 menor 15 por ciento (p< 0,001) y recuento de CD4 menor de 500 células/mm3 (p= 0,003). Conclusiones. Los niños mayores de un año tienen mejor pronóstico cuando empiezan tratamiento en estadios previos al C, con CD4 > 15 por ciento o más de 500 células CD4/mm3.

Revelando o vírus, ocultando pessoas: exames de monitoramento (CD4 e CVP) e relação médico-paciente no contexto da AIDS / Disclosing the virus, hiding the patients: follow-up tests (CD4 and VL) and the physician-patient relationship in the AIDS setting

The aim of this study is to discuss the meanings associated with the CD4 lymphocyte count and HIV plasma viral load (VL) for patients living with AIDS and the attending physicians, seeking to analyze the impacts of the increasing use of these tests in the treatment setting. A qualitative study was performed in two HIV/AIDS referral centers with participant observation and semi-structured interviews with 27 patients living with AIDS and four physicians. Observation of the medical consultations showed that they are quick, objective, and centered on the CD4 and VL test results, thus reinforcing a hegemonic view of medical knowledge and a biomedical perspective that instrumentalizes their practice. For physicians and patients, the tests tend to reflect the "truth" on the patient's disease, to the detriment of the patient history and clinical examination, impacting the therapeutic relationship and leading to the physician's lack of attention to the patients' subjectivity. More than ever, there is a need to reclaim good clinical practice and acknowledge the subject's role in medical practice as a healing art.

O objetivo deste artigo é discutir os significados associados aos exames de contagem de linfócitos CD4 e quantificação da carga viral plasmática do HIV (CVP) para pacientes vivendo com AIDS e médicos da atenção, buscando analisar os reflexos de sua crescente utilização na relação terapêutica. Foi realizado um estudo qualitativo em dois centros de referência em HIV/AIDS com observação participante e entrevistas semi-estruturadas com 27 pacientes vivendo com AIDS e quatro médicos. A observação das consultas médicas mostrou que elas são rápidas, objetivas e centradas no resultado dos exames CD4 e CVP, o que reforça uma visão hegemônica do saber médico e uma perspectiva biomédica que instrumentaliza a sua prática. Para médicos e pacientes, os exames passam a refletir a "verdade" sobre a doença do paciente em detrimento da anamnese e do exame clínico, fato que se reflete na relação terapêutica e na desatenção por parte dos médicos à subjetividade dos pacientes. Mais do que nunca há necessidade da retomada da prática da boa clínica e do reconhecimento do papel do sujeito na prática da medicina como arte de curar.

Get back to where you once belonged: monitoring the AIDS pandemic in the 21st century / Volte para o lugar de onde saiu: monitorando a pandemia da aids no século XXI

This paper reviews the concepts and methodological strategies that have shaped the monitoring of the AIDS pandemic, today in its third decade. A deliberate effort was made to highlight aspects usually forgotten by the canon. The paper aims to track the footsteps of the evolving strategies in the field of surveillance & monitoring, with the help of disciplines such as epidemiology, molecular biology, social, and behavioral sciences. The deep divide that opposes societies severely affected by the epidemic and affluent societies much less affected by the epidemic is contrasted with the scarce human and financial resources of the societies facing harshest epidemic vis-à-vis the comprehensiveness of the response to the epidemic in their affluent counterparts in terms of the scope and high standards of their initiatives on monitoring, prevention, management & care. The pressing need to implement feasible alternatives to the current sophisticated and expensive ones is briefly discussed. Beyond the renewed challenge posed to the creativity of scientists and health professionals, the AIDS pandemic is described as a major public health crisis, compromising the social fabric in some contexts, and as a never fulfilled calling for an ethics of solidarity between different societies and different social strata of each given society.

O artigo procede a uma retrospectiva histórica dos conceitos e estratégias metodológicas que informaram e informam o monitoramento da pandemia de aids, hoje na sua terceira década. Procurou-se iluminar aspectos raramente abordados pela história canônica da epidemia, buscando traçar as raízes e desdobramentos das atuais alternativas de vigilância e monitoramento, no campo da epidemiologia, da biologia molecular e das ciências sociais e comportamentais. O profundo cisma que opõe sociedades duramente afetadas pela epidemia e que contam com recursos humanos e financeiros escassos a serem empregados tanto no monitoramento, como na implementação ampla e adequada de estratégias de prevenção e tratamento às pessoas vivendo com HIV/aids nas sociedades afluentes e substancialmente menos afetadas pela epidemia é criticamente revisado, em prol de soluções factíveis e prementes, dado o alto custo e a complexidade de boa parte das alternativas-padrão em curso nos países mais ricos. Mais do que um desafio à engenhosidade de cientistas e profissionais de saúde, a pandemia de aids é revista como uma crise de grandes proporções da saúde pública, da vida social e um chamamento renovado à frustrada ética solidária entre as diferentes sociedades e segmentos sociais.

Epidemiological and molecular characteristics of HIV-1 infection among female commercial sex workers, men who have sex with men and people living with AIDS in Paraguay / Características epidemiológicas e moleculares da infecção por HIV-1 entre as mulheres que trabalham no comércio do sexo, entre homens que mantém relações sexuais com homens e nas pessoas convivendo com AIDS no Paraguai

An HIV seroprevalence and molecular study was conducted among 935 subjects: 723 female commercial sex workers, 92 men who have sex with men and 120 HIV-positive volunteers. The reported injection drug use rates were 0.7 percent in female commercial sex workers and 3 percent in men who have sex with men. Sexually transmitted infections were reported in 265 (37 percent) of the female commercial sex workers and 38 (41 percent) of the men who have sex with men. A total of 20 (2.8 percent) female commercial sex workers and 12 (13 percent) men who have sex with men became HIV infected during the study period. A history of sexually transmitted infection increased the risk of subsequent HIV infection twofold (adjusted odds ratio of 2.5) among the female commercial sex workers, while cocaine use had an adjusted odds ratios of 6.61 among men who have sex with men. From 130 samples, and based on heteroduplex mobility assaying for the env gene, with sequencing of part of pol and/or full genomes, subtype B was the predominant subtype identified (66 percent); followed by subtype F (22 percent) and subtype C (4 percent). Recombinant CRF12-BF strains were identified in 6 percent and CRF17_BF was identified in 2 percent.

Um estudo de soroprevalência e de avaliação molecular do HIV foi realizado com 935 indivíduos: 723 mulheres que trabalhavam no comércio do sexo, 92 homens que mantinham relações sexuais com outros homens e com 120 voluntários HIV-positivos. O relato de uso de drogas injetáveis foi de 0,7 por cento nas mulheres que trabalhavam no comércio do sexo e de 3 por cento nos homens que mantinham relações sexuais com outros homens. Infecções sexualmente transmitidas foram relatadas por 265 (37 por cento) das mulheres que trabalhavam no comércio do sexo e em 38 (41 por cento) dos homens que mantinham relações sexuais com homens. Um total de 20 (2,8 por cento) mulheres que trabalhavam no comércio do sexo e 12 (13 por cento) homens que mantinham relações sexuais com homens se infectou com HIV durante o período do estudo. História prévia de infecção sexualmente transmitida aumentou em duas vezes o risco de infecção subseqüente por HIV (odds ratio ajustado de 2,5) entre as mulheres que trabalhavam no comércio do sexo, enquanto cocaína apresentou odds ratio ajustado de 6,61 entre os homens que mantinham relações sexuais com outros homens. De 130 amostras, com base no ensaio da mobilidade heteroduplex para o gene env, com sequenciamento de parte do pol e/ou genomas completos, o subtipo B foi o subtipo mais identificado (66 por cento); seguido pelo subtipo F (22 por cento) e subtipo C (4 por cento). Cepas recombinantes CRF12-BF foram identificadas em 6 por cento e CRF17_BF foi identificada em 2 por cento.

Factors associated with clinical, immunological and virological responses in protease-inhibitor-experienced brazilian children receiving highly active antiretroviral therapy containing Lopinavir-Ritonavir

This study evaluates clinical, virological and immunological responses to antiretroviral (ARV) therapy based on Lopinavir/ritonovir (LPV/r) in previously protease -inhibitor-experienced children. The study included 29 Brazilian children (median age = 5.91 years) who had failed previous ARV therapy and had begun a regimen based on LPV/r. At 12 months follow-up, a good virological response to LPV/r therapy was defined as achieving an undetectable viral load or as a decrease in plasma HIV RNA levels to > 1 log. A good immunological response was defined as an increase in CD4+ cell count from baseline sufficient to attain a better CDC immune stage classification. The number of infectious episodes 12 months before and 12 months after beginning LPV/r was assessed. Sixteen (55.2 percent) and 19 (65.5 percent) of 29 patients exhibited good virological and immunological responses, respectively. Baseline CD4+ values (>500) predicted both virological and immunological responses (p<0.05). Older children were less likely to develop an immunological response (p<0.001) than younger children. Nine children receiving 3 ARV drugs plus LPV/r showed an immunological response (100 percent) compared to 10/20 (50 percent) children receiving 2 drugs plus LPV/r (p=0.01). A lower number (n<5) of infectious episodes was noted after 12 months follow-up in children using the LPV/r regimen (p=0.006). There was a positive correlation between children whose baseline CD4+ values were greater than 500 cells/mm³ and virological responses. Although virological responses to therapy were seen in about half the children (55.2 percent), the use of HAART containing LPV/r provided clinical and immmunological benefits.

Effectiveness of dual and triple antiretroviral therapy in the treatment of HIV-infected children

OBJETIVOS: Como iniciar a terapia anti-retroviral é uma questão amplamente discutida no manejo de crianças infectadas pelo HIV. O objetivo deste estudo foi comparar a efetividade da terapia dupla e tríplice em uma coorte de crianças infectadas pelo HIV. MÉTODO: Este estudo foi realizado em um serviço de referência para assistência à criança infectada da Faculdade de Medicina da UFMG. Foram incluídas crianças que iniciaram o primeiro regime anti-retroviral entre janeiro de 1998 e dezembro de 2000, com seguimento até dezembro de 2001. O evento final para análise foi a primeira falha terapêutica ou óbito. RESULTADOS: Foram analisados 101 pacientes, sendo 58 (57,4 por cento) e 43 (42,6 por cento) com terapia dupla e tríplice, respectivamente. Não houve diferença entre os grupos quanto ao sexo, idade, contagem de linfócitos CD4+ e carga viral basal. A média de duração da terapia dupla foi de 26,3 meses (IC95 por cento 21,3-31,3) e da terapia tríplice, de 34,3 meses (IC95 por cento 29,2-39,5 por cento). Falha terapêutica ocorreu em 33 (56,9 por cento) pacientes em terapia dupla e 11 (25,6 por cento) em terapia tríplice (log rank 5,03; p = 0,025). O risco relativo de falha para terapia dupla foi 2,2 vezes maior (IC = 1,3-3,9). O percentual de linfócitos T CD4+ inicial foi preditor de risco para falha terapêutica (p = 0,001). Pacientes em terapia tríplice apresentaram maior redução da carga viral (p = 0,001). CONCLUSÃO: A terapia tríplice permaneceu eficaz por mais tempo e apresentou melhor resposta virológica do que a terapia dupla nesta coorte de crianças infectadas pelo HIV, justificando a sua escolha como regime preferencial de tratamento.

OBJECTIVE: The use of antiretroviral therapy in HIV-infected children has been a widely discussed issue. The aim of this study was to compare the effectiveness of dual nucleoside analogue reverse transcriptase inhibitor (NRTI) regimens and three-drug regimens [2NRTI+ non-nucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI)] in a cohort of HIV-infected children. METHODS: The study was carried out in a referral center for the management of infected children, which is affiliated with the School of Medicine of Universidade Federal de Minas Gerais (UFMG). Those children whose antiretroviral therapy was implemented between January 1998 and December 2000 and who were followed up until December 2001 were included in the study. Therapeutic failure or death was regarded as the endpoint in our analysis. RESULTS: A total of 101 patients were assessed, 58 (57.4 percent) on dual therapy and 43 (42.6 percent) on triple therapy. No statistically significant difference was observed between the groups in terms of gender, age, CD4+ count and baseline viral load. The average duration of dual therapy was 26.3 months (95 percentCI 21.3-31.3) and that of triple therapy was 34.3 months (95 percentCI 29.2-39.5 percent). There was therapeutic failure in 33 (56.9 percent) patients on dual therapy and in 11 (25.6 percent) patients on triple therapy (log rank = 5.03; p = 0.025). The relative risk of therapeutic failure of the dual therapy was 2.2 times higher (95 percentCI = 1.3-3.9). The percentage of initial CD4+ T cells was a predictor of risk for therapeutic failure (p = 0.001). Patients on triple therapy showed a more remarkable reduction in their viral load (p = 0.001). CONCLUSION: Triple therapy was efficient for a longer time period and showed better virologic response than dual therapy in this cohort of HIV-infected children. Therefore, triple therapy should be the treatment of choice.

A multiplex PCR assay able to simultaneously detect Torque teno virus isolates from phylogenetic groups 1 to 5

Torque teno virus (TTV) is a circular, single-stranded DNA virus that chronically infects healthy individuals of all ages worldwide. TTV has an extreme genetic heterogeneity which is reflected in its current classification into five main phylogenetic groups (1-5). Using specific PCR assays, it has been shown that many individuals are co-infected with TTV isolates belonging to different phylogenetic groups. Here, a multiplex PCR assay was developed, using five recombinant plasmids. Each plasmid carried an insert of different size issued from a TTV isolate belonging to a different group. The assay was able to simultaneously amplify DNAs of TTV isolates belonging to all five phylogenetic groups. Multiplex PCR was then tested satisfactorily on DNAs extracted from 55 serum samples (47 health care workers and 8 AIDS patients). All individuals but nine were infected with at least one TTV isolate. Co-infection with multiple isolates was found in 29/47 (62 percent) health care workers and in 8/8 (100 percent) AIDS patients. A number of discrepancies were observed when results obtained with three thermostable DNA polymerases were compared. For example, four TTV phylogenetic groups were detected in a particular serum sample by using one of the three DNA polymerases, whereas the other two enzymes were able to detect only three TTV groups. However, none of the three enzymes used could be broadly considered to be more efficient than the others. Despite its limitations, the assay described here constitutes a suitable tool to visualize the degree of co-infection of a given population, avoiding time-consuming experiments.