Resistencia a los inhibidores de la integrasa en niños con el virus de la inmunodeficiencia humana por transmisión vertical: primeros casos en Uruguay / Resistance to integrase inhibitors in children with vertically-transmitted human immunodeficiency virus: First cases in Uruguay

La resistencia a los antirretrovirales (ARV) es un problema de salud pública. Con el uso de inhibidores de la integrasa (INSTI) en pediatría, también comienzan a aparecer resistencias. El objetivo de esta comunicación es describir 3 casos con resistencia a los INSTI. Se describen 3 pacientes pediátricos con transmisión vertical del virus de la inmunodeficiencia humana (VIH). Iniciaron ARV de lactantes y preescolares, con mala adherencia al tratamiento, cursaron con diferentes planes secundarios a comorbilidades asociadas y fallas virológicas por resistencia. Los 3 casos clínicos describen la rápida aparición de resistencia frente a la falla virológica y el compromiso de los INSTI. La adherencia debe ser supervisada para detectar precozmente el aumento de la viremia. La falla virológica en un paciente tratado con raltegravir obliga a un rápido cambio de esquema ARV, ya que continuar utilizándolo podría favorecer nuevas mutaciones y resistencia a los INSTI de segunda generación.

Antiretroviral (ARV) drug resistance is a public health issue. Resistance has also been observed in the case of integrase strand transfer inhibitors (INSTIs) used in pediatrics. The objective of this article is to describe 3 cases of INSTI resistance. These are the cases of 3 children with vertically-transmitted human immunodeficiency virus (HIV). They were started on ARVs as infants and preschoolers, with poor treatment adherence, and had different management plans due to associated comorbidities and virological failure due to resistance. In the 3 cases, resistance developed rapidly as a result of virological failure and INSTI involvement. Treatment adherence should be monitored so that any increase in viremia can be detected early. Virological failure in a patient treated with raltegravir forces to a rapid change in ARV therapy because its continued use may favor new mutations and resistance to second-generation INSTIs.

Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection

ABSTRACT Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors.

HIV with initial ocular Kaposi sarcoma / HIV com sarcoma de Kaposi ocular inicial

ABSTRACT We present an interesting case of a 62-year-old black female, presented to the ophthalmological hospital with a little "nevus" on the left eye previously visualized at the mirror, with one month of development. Physical examination with slit lamp (biomicroscopy) showed a group of painless veins, with vascular redness, and a mass nodular aspect in the mid temporal bulbar conjunctiva, of approximately 2mmx4mm.

RESUMO Apresentamos o interessante caso de uma mulher negra de 62 anos, que deu entrada no hospital oftalmológico com um pequeno nevo no olho esquerdo previamente visualizado ao espelho, com 1 mês de evolução. O exame físico com lâmpada de fenda (biomicroscopia) mostrou um grupo de veias indolor e vermelhidão vascular, com uma massa de aspecto nodular na conjuntiva bulbar temporal média, de aproximadamente 2mmx4mm.

Características clínicas y epidemiológicas de casos de viruela símica en personas que viven con VIH: análisis observacional

Antecedentes: La viruela del mono (mpox) es una zoonosis que se ha extendido rápida y globalmente desde mediados de 2022 y ha afectado mayoritariamente a hombres que tienen sexo con hombres (HSH). Objetivos: Caracterizar clínica y epidemiológicamente la infección por el virus mpox en personas que viven con VIH (PVVIH). Pacientes y Método: Se realizó un análisis clínico y epidemiológico a PVVIH que consultaron por sospecha de mpox en el Policlínico de Infectología del Hospital Clínico San Borja Arriarán. Se reportan los casos confirmados por reacción de polimerasa en cadena (RPC) entre el 11/07/2022 y 21/10/2022. Resultados: Se confirmó mpox en 35 pacientes, todos HSH y, la mayoría, en terapia antirretroviral. La mediana de edad fue 37 años. El promedio de días entre fase inicial sistémica inespecífica y eruptiva fue 1,7. Las lesiones fueron de tipo maculopapulares, costrosas y umbilicadas en las zonas genital, perianal, dorso y extremidades, mayoritariamente. Trece individuos presentaron complicaciones y dos requirieron hospitalización. De los con examen de VDRL solicitado, el 46,4% fue reactivo en títulos no residuales. Conclusiones: Se detectó llegada de mpox en un centro de atención de VIH en HSH en todos los niveles de estado inmune. Mayormente, los casos fueron leves a moderados y autolimitados. El cuadro clínico ha sido similar a lo descrito globalmente.

Background. Monkeypox (mpox) is a zoonosis that has spread rapidly and globally since mid-2022 and has mainly affected men who have sex with men (MSM). Aim: To characterize mpox clinically and epidemiologically in people living with HIV (PLHIV). Method: A clinical and epidemiological analysis was carried out on PLHIV who consulted for suspected mpox in the Infectious Disease clinic of the San Borja Arriarán Clinical Hospital. Cases confirmed by PCR are reported between 07/11/2022 and 10/21/2022. Results: Mpox was confirmed in 35 patients, all MSM and on antiretroviral therapy. The median age was 37 years. The average number of days between the initial non-specific systemic and eruptive phase was 1.7. The lesions were maculopapular, crusted, and umbilicated, mainly in the genital, perianal, back, and extremity areas. Thirteen patients presented complications and two required hospitalizations. Of those with a requested VDRL test, 46.4% were reactive in non-residual titers. Conclusions: Arrival of mpox was detected at the HIV care center in MSM at all levels of immune status. Mostly, the cases were mild to moderate and self-limiting. The clinical picture has been similar to that described globally.

Enfermedad de Hansen en un adulto con virus de inmunodeficiencia humana / Hansen's disease in an adult infected with human immunodeficiency virus i: en

Se describe el caso clínico de un paciente infectado por el virus de la inmunodeficiencia humana en fase sintomática precoz, quien fue asistido en el Servicio de Dermatología del Hospital Clínico Quirúrgico Docente Dr. León Cuervo Rubio en Pinar del Río por presentar lesiones eritematosas infiltradas de tres meses de evolución en el miembro inferior derecho, con alteración de la sensibilidad térmica y dolorosa. Se le indicó baciloscopia y estudio histopatológico que confirmaron el diagnóstico de sospecha de lepra dimorfa tuberculoide, por lo que se comenzó a aplicar poliquimioterapia combinada con terapia antirretroviral, lo cual favoreció la evolución del paciente.

The case report of a patient infected by the human immunodeficiency virus in early symptomatic phase is described, who was seen at the Dermatology Service of the Dr. León Cuervo Rubio Teaching Clinical Surgical Hospital of Pinar del Río for presenting infiltrated erythematous lesions of three months of evolution in the right lower limb, with altered pain and thermal sensation. A basiloscopic and histopathologic study was indicated, which confirmed the presumptive diagnosis of borderline tuberculoid leprosy, and therefore polychemotherapy combined with antiretroviral therapy was started, which favored the patient's evolution.

Challenges of managing HIV cytomegalovirus co-infection in the presence of pancytopenia

A 60-year-old male patient who presented with generalized weakness and low-grade fever was diagnosed to be human immunodeficiency virus (HIV) positive with a CD4 count of 17. Routine laboratory investigations revealed pancytopenia. Serum cytomegalovirus (CMV) DNA polymerase chain reaction (PCR) was positive and fundoscopy showed CMV retinitis in the right eye. The patient was started on tablet valganciclovir. After 2 weeks, the patient was brought back in an altered sensorium. He was found to have hyponatremia which was corrected. He was started on antiretroviral therapy and tablet valganciclovir was continued. The patient came back again after one and a half months with a urinary tract infection and fissure-in-ano. He was found to have severe neutropenia. Valganciclovir was stopped. He was started on injection granulocyte colony-stimulating factor. The patient clinically improved and his hematological parameters became normal. Patients having HIV and CMV co-infection with pre-existing pancytopenia have to be closely monitored as the medicines used for treatment can exacerbate the existing conditions.

Health-related quality of life among people living with HIV/AIDS on highly active antiretroviral treatment: A questionnaire-based study

Introduction: The knowledge of the effect of sociodemographic and disease-related factors on health-related quality of life (HRQoL) among people living with HIV/AIDS (PLWHA) is important for planning comprehensive health-care services for them. Material and Methods: Two hundred PLWHA on antiretroviral therapy (ART) volunteered to complete a self-reported World Health Organization’s Quality of Life?HIV brief questionnaire (WHOQoL-HIV-BREF) that examines six domains each with four items (physical, psychological, level of independence, social, environmental, and spiritual) with 25 facets and additional 5 facets specific to PLWHA (symptoms of HIV, social inclusion, forgiveness, worries about the future, and death and dying). Results: Only 135 questionnaires from 73 (53.3%) men and 63 (46.7%) women (male: female – 1.14:1) aged 20–82 years(mean ± standard deviation: 42.9 ± 10.5 years) were found complete. Eighty-five (63%) individuals were aged 41–60 years, 78 (57.8%) individuals were matriculates, graduates, or postgraduates, 76 (56.3%) respondents were married, and 38 (28.1%) were widows/widowers. Staying-alone workers comprised 43 (31.8%) individuals. Overall health and HRQoL were rated satisfactory (n = 85.2%) and good/very good (n = 74.8%) by a significantly greater number of individuals (P = 0.001). Pearson’s Chi-squared test showed no statistically significant (P > ?) associations between good HRQoL and variables such as age >40 years, gender, education, marital status, duration of disease, disclosure of serostatus to family, ART for >3 years, and CD4 >200 cells/mL. Conclusion: Regular ART can result in adequate control of immunosuppression and no comorbidities in a majority of PLWHA, family and social acceptance, and financial security can result in overall good HRQoL in all six domains within the WHOQoL-HIV-BREF. The study is limited by its cross-sectional study design and small sample size.

Síndrome de linfocitosis infiltrativa difusa con neumonía intersticial en un paciente con VIH / Diffuse infiltrative lymphocytosis syndrome with interstitial pneumonia in a patient with HIV

El síndrome de linfocitosis infiltrativa difusa se produce en asociación con la infección por virus de la inmunodeficiencia humana; requiere cumplir con los criterios diagnósticos y descartar otras patologías infecciosas y autoinmunes. Se presenta el caso de una mujer de 47 años que consultó por edema parotídeo bilateral, síndrome sicca, tos y síndrome de impregnación. Se observó en la tomografía de tórax infiltrado en «vidrio esmerilado¼, parcheado y bilateral. Se realizó diagnóstico de virus de la inmunodeficiencia humana positivo y fibrobroncoscopia con lavado broncoalveolar sin desarrollo de patógenos. Se interpreta como neumonía intersticial linfoidea asociada a síndrome de linfocitosis infiltrativa difusa. Se inició terapia antirretroviral con buena evolución y desaparición de los síntomas y de los infiltrados pulmonares.

Diffuse infiltrative lymphocytosis syndrome occurs in association with HIV infection; it requires meeting the diagnostic criteria and ruling out other infectious and autoimmune pathologies. We present the case of a 47-year-old woman who consulted for bilateral parotid edema, sicca syndrome, cough and impregnation syndrome, which was observed in the chest tomography infiltrated in ground glass, patched and bilateral. A diagnosis of HIV positive and fiberoptic bronchoscopy with bronchoalveolar lavage was made without the development of pathogens. It is interpreted as lymphoid interstitial pneu monia associated with DILS. Antiretroviral therapy was started with good evolution and disappearance of symptoms and pulmonary infiltrates.

Lumbar puncture for neurosyphilis investigation in asymptomatic patients with HIV-syphilis coinfection: a cross-sectional study among infectious disease specialists

ABSTRACT BACKGROUND: Syphilis is a major public health issue worldwide. In people living with human immunodeficiency virus (PLHIV), there are higher incidences of both syphilis and neurosyphilis. The criteria for referring PLHIV with syphilis for lumbar puncture is controversial, and the diagnosis of neurosyphilis is challenging. OBJECTIVE: To describe the knowledge, attitudes, and practices of infectious disease specialists and residents in the context of care for asymptomatic HIV-syphilis coinfection using close-ended questions and case vignettes. DESIGN AND SETTING: Cross-sectional study conducted in three public health institutions in São Paulo (SP), Brazil. METHODS: In this cross-sectional study, we invited infectious disease specialists and residents at three academic healthcare institutions to answer a self-completion questionnaire available online or in paper form. RESULTS: Of 98 participants, only 23.5% provided answers that were in line with the current Brazilian recommendation. Most participants believed that the criteria for lumbar puncture should be extended for people living with HIV with low CD4+ cell counts (52.0%); in addition, participants also believed that late latent syphilis (29.6%) and Venereal Disease Research Laboratory (VDRL) titers ≥ 1:32 (22.4%) should be conditions for lumbar puncture in PLHIV with no neurologic symptoms. CONCLUSION: This study highlights heterogeneities in the clinical management of HIV-syphilis coinfection. Most infectious disease specialists still consider syphilis stage, VDRL titers and CD4+ cell counts as important parameters when deciding which patients need lumbar puncture for investigating neurosyphilis.

Advances in the research of HIV-1 envelope glycoprotein gp120 inhibitors / 药学学报

From the process of human immunodeficiency virus-1 (HIV-1) invading cells, the combination of gp120 and CD4 is the first step for HIV-1 to invade cells. Interfering with this process can prevent HIV from recognizing target cells and inhibit virus replication. Therefore, HIV-1 gp120 is an important part of the HIV-1 life cycle. Fostesavir, a phosphatate prodrug derived from the gp120 inhibitor BMS-626529 modified by the prodrug strategy, was approved for the treatment of adult patients with multidrug resistant HIV-1 infection by the US FDA and the European Medicines Agency in 2020 and 2021, respectively. In this review, we focus on the research progress of small molecule inhibitors targeting the interaction of gp120-CD4 from the perspective of medicinal chemistry, in order to provide reference for the subsequent research of gp120 inhibitors.

A qualitative study on high risk behaviors of HIV/AIDS among young adult males in Shandong Province / 中国学校卫生

Objective@#To identify high risk behaviors and infection related factors among young adult males diagnosed with HIV/AIDS in Shandong Province, to provide evidence for targeted AIDS prevention and control strategies.@*Methods@#By using convient sampling method, an face to face in depth interview on HIV related behaviors was conducted among young adult males newly diagnosed with HIV/AIDS in Shandong Province in July 2021.@*Results@#A total of 31 young adult males diagnosed with HIV/AIDS were interviewed. All were male and infected through homosexuality behavior. Average age was (20.6±1.8) years. Totally 90.3% (28/31) were enrolled in tertiary education at the time of diagnosis. The findings revealed that 93.5% (29/31) of participants got infection due to unprotected homosexual behavior with the temporary partner whose HIV infection status was unknown, and 86.2% (25/29) got in touch with these temporary partner by social software. The awareness rate of knowledge about AIDS among all the participants was 100%, however, 83.9% (26/31) reported occasion condom usage while having homosexual behavior, and 16.1% (5/31) never did. Totally 74.2% (23/31) of the young adult males diagnosed with HIV/AIDS had a history of HIV testing before diagnosis.@*Conclusion@#The primary high risk behavior of HIV infection in young adult students are unawareness of HIV infection status for temporary sexual partner and the separation of knowing and doing. A targeted strategy should be developed to control the spread of HIV in young adult students.

Genetic Subtypes and Pretreatment Drug Resistance in the Newly Reported Human Immunodeficiency Virus-Infected Men Aged≥50 Years Old in Guangxi / 中国医学科学院学报

Objective To analyze the genetic subtypes of human immunodeficiency virus (HIV) and the prevalence of pretreatment drug resistance in the newly reported HIV-infected men in Guangxi. Methods The stratified random sampling method was employed to select the newly reported HIV-infected men aged≥50 years old in 14 cities of Guangxi from January to June in 2020.The pol gene of HIV-1 was amplified by nested reverse transcription polymerase chain reaction and then sequenced.The mutation sites associated with drug resistance and the degree of drug resistance were then analyzed. Results A total of 615 HIV-infected men were included in the study.The genetic subtypes of CRF01_AE,CRF07_BC,and CRF08_BC accounted for 57.4% (353/615),17.1% (105/615),and 22.4% (138/615),respectively.The mutations associated with the resistance to nucleoside reverse transcriptase inhibitors (NRTI),non-nucleoside reverse transcriptase inhibitors (NNRTI),and protease inhibitors occurred in 8 (1.3%),18 (2.9%),and 0 patients,respectively.M184V (0.7%) and K103N (1.8%) were the mutations with the highest occurrence rates for the resistance to NRTIs and NNRTIs,respectively.Twenty-two (3.6%) patients were resistant to at least one type of inhibitors.Specifically,4 (0.7%),14 (2.3%),4 (0.7%),and 0 patients were resistant to NRTIs,NNRTIs,both NRTIs and NNRTIs,and protease inhibitors,respectively.The pretreatment resistance to NNRTIs had much higher frequency than that to NRTIs (2.9% vs.1.3%;χ2=3.929,P=0.047).The prevalence of pretreatment resistance to lamivudine,zidovudine,tenofovir,abacavir,rilpivirine,efavirenz,nevirapine,and lopinavir/ritonavir was 0.8%, 0.3%, 0.7%, 1.0%, 1.3%, 2.8%, 2.9%, and 0, respectively. Conclusions CRF01_AE,CRF07_BC,and CRF08_BC are the three major strains of HIV-infected men≥50 years old newly reported in Guangxi,2020,and the pretreatment drug resistance demonstrates low prevalence.

Exploration of adaptation process and experience among the HIV/AIDS patients based on the comprehensive task-based adaptation model / 中南大学学报(医学版)

OBJECTIVES@#Patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) confront multiple difficulties during the disease adaptation process. Based on the comprehensive task-based adaptation model, this study aims to explore the process and experience of adapting to living with HIV among HIV/AIDS patients and to provide evidence for promoting the adaptation of this population.@*METHODS@#With the design of the phenomenon study, we purposefully recruited 43 HIV/AIDS patients and conducted semi-structural interviews. The qualitative data was analyzed by Van Manen method.@*RESULTS@#There were 1 307 significant quotes and 6 themes with 14 sub-themes. "The shadow comes along with the sunshine" was proposed to describe the process of adapting to life with HIV. Another 5 themes emerged to represent the tasks as follows: the direction of the mental anchor, the management of physical tasks, social network and support, the occupational dilemma and benefits, and the consideration of the future.@*CONCLUSIONS@#The adapting process possesses both common and personalized characteristics. Future intervention development should address the integrality and interaction of the adaptation tasks, contributing to the positive adaptation outcomes of HIV/AIDS patients.

Constrictive Pericarditis and Cardiac Tamponade Due to Tuberculosis as Presentation of Human Immunodeficiency Virus/Syndrome of Acquired Immunodeficiency: Case Report / Pericarditis constrictiva y taponamiento cardíaco por tuberculosis como presentación de virus de inmunodeficiencia humana/síndrome de inmunodeficiencia adquirida: presentación de caso / Pericardite constritiva e tamponamento cardíaco devido à tuberculose com uma apre-sentação do vírus da imunodeficiência adquirida: relato de cas

We report a case of constrictive pericarditis due to extrapulmonary tuberculosis associated with Human Immuno-deficiency Virus, complicated by cardiac tamponade that required surgical intervention in a drug user patient. The importance of early diagnosis and management is widely highlighted

El artículo presenta un caso de pericarditis constrictiva secundaria a tuberculosis extrapulmonar en un paciente con prueba positiva para virus de inmunodeficiencia humana (VIH) consumidor de sustancias psicoactivas, quien durante la hospitalización desarrolló un taponamiento cardíaco con requerimiento de intervención quirúrgica. Se plantea la discusión de la importancia de cada una de las pruebas solicitadas y el manejo adecuado en pacientes con dichas patologías

O artigo apresenta um caso de pericardite constritiva secundária à tuberculose extrapulmonar em paciente com teste positiva para vírus da imunodeficiência humana (HIV) e usuário de substâncias psicoativas que, durante a internação, desenvolveu tamponamento cardíaco com necessidade de intervenção cirúrgica. Discute-se a importância de cada um dos exames solicitados e o manejo ade-quado de pacientes com essas patologias

Sífilis e outras infecções sexualmente transmissíveis em pessoas soropositivas em região de tríplice fronteira internacional Brasil- Paraguai-Argentina / Syphilis and other sexually transmitted infections in seropositive people in the triple international border region Brazil-Paraguay-Argentina / Sífilis y otras infecciones de transmisión sexual en personas seropositivas en la región de la triple frontera internacional Brasil-Paraguay-Argentina

Este estudo objetivou identificar a prevalência de Sífilis e outras Infecções Sexualmente Transmissíveis, bem como o comportamento sexual de risco em indivíduos com vírus da imunodeficiência humana na região da tríplice fronteira, Brasil, Paraguai e Argentina. Estudo transversal, descritivo/quantitativo, realizado no Serviço de Atenção Especializada de Foz do Iguaçu, Brasil. A amostra populacional final consistiu-se de 307 pacientes e os dados foram coletados no Sistema de Informação de Exames Laboratoriais e por meio de um questionário estruturado. Foram incluídos pacientes que viviam com o vírus da imunodeficiência humana/síndrome da imunodeficiência adquirida. O estado in- fectado e as variáveis independentes foram verificados com o emprego das análises uni- variada e multivariada (p≤0,05). Entre os 307 participantes, a prevalência de Sífilis e ou- tras Infecções Sexualmente Transmissíveis foi de 9,5% e 5,2%, respectivamente. Para o diagnóstico de Sífilis, houve prevalência da faixa etária de 18 a 44 anos, nacionalidade brasileira, residência em Foz do Iguaçu, estudantes de graduação em Cidade do Leste, ≥ 12 anos completos de estudo, estado civil solteiro, um a cinco parceiros sexuais masculi- nos, baixo uso de preservativo e declarado ter recebido orientações sobre infecções sexu- almente transmissíveis (<0,05). A frequência de teste de carga viral do vírus da imunode- ficiência humana foi de 25,7% e 12,1% detectaram carga viral no último exame realizado. Esses achados indicam que as infecções sexualmente transmissíveis, sobretudo a Sífilis, decorreu de comportamentos sexuais de risco entre pessoas que viviam com o vírus da imunodeficiência humana/síndrome da imunodeficiência adquirida na região da tríplice fronteira, Brasil-Paraguai-Argentina.

This study aimed to identify the prevalence of Syphilis and other Sexually Transmitted Infections, as well as sexual risk behavior in individuals with human immu- nodeficiency virus in the triple border region, Brazil, Paraguay and Argentina. Cross- sectional, descriptive/quantitative study, carried out at the Specialized Care Service in Foz do Iguaçu, Brazil. The final population sample consisted of 307 patients and data were collected in the Laboratory Test Information System and through a structured ques- tionnaire. Patients living with human immunodeficiency virus/acquired immunodefi- ciency syndrome were included. The infected state and the independent variables were verified using univariate and multivariate analyzes (p≤0.05). Among the 307 participants, the prevalence of syphilis and other sexually transmitted infections was 9.5% and 5.2%, respectively. For Syphilis diagnoses, there was a prevalence of the 18-44 year old age group, Brazilian nationality, Foz do Iguaçu residency, undergraduate students in East City, ≥ 12 full years of education, single marital status, one to five male sex partners, low condom use, and declared having received guidelines on sexually transmitted infections (<0.05). The frequency of human immunodeficiency virus V viral load testing was 25.7% and 12.1% had detected viral load in their last exam performed. These findings indicate that sexually transmitted infections, especially syphilis, resulted from sexual risk behav- iors among people living with the human immunodeficiency virus/acquired immunodefi- ciency syndrome in the triple border region, Brazil-Paraguay-Argentina.

Este estudio tuvo como objetivo identificar la prevalencia de Sífilis y otras Infecciones de Transmisión Sexual, así como el comportamiento sexual de riesgo en in- dividuos con virus de inmunodeficiencia humana en la triple región fronteriza, Brasil, Paraguay y Argentina. Estudio transversal, descriptivo/cuantitativo, realizado en el Ser- vicio de Atención Especializada de Foz do Iguaçu, Brasil. La muestra poblacional final fue de 307 pacientes y los datos fueron recolectados en el Sistema de Información de Pruebas de Laboratorio y a través de un cuestionario estructurado. Fueron incluidos pa- cientes portadores del virus de inmunodeficiencia humana/síndrome de inmunodeficien- cia adquirida. El estado de infección y las variables independientes se verificaron medi- ante análisis univariantes y multivariantes (p≤0,05). Entre los 307 participantes, la prev- alencia de sífilis y de otras infecciones de transmisión sexual fue del 9,5% y del 5,2%, respectivamente. Para los diagnósticos de sífilis, hubo prevalencia en el grupo de edad de 18 a 44 años, nacionalidad brasileña, residencia en Foz do Iguaçu, estudiantes de pregrado en Ciudad del Este, ≥ 12 años completos de educación, estado civil soltero, de uno a cinco compañeros sexuales masculinos, bajo uso de preservativo y declaración de haber reci- bido orientaciones sobre infecciones de transmisión sexual (<0,05). La frecuencia de pruebas de carga viral del virus de la inmunodeficiencia humana V fue del 25,7% y en el 12,1% se había detectado carga viral en el último examen realizado. Estos hallazgos in- dican que las infecciones de transmisión sexual, especialmente la sífilis, son el resultado de comportamientos sexuales de riesgo entre las personas que viven con el virus de la inmunodeficiencia humana/síndrome de inmunodeficiencia adquirida en la región de la triple frontera, Brasil-Paraguay-Argentina.

Construção e validação de tecnologia educacional para prevenção do hiv/aids em mulheres privadas de liberdade / Construction and validation of educational technology for hiv/aids prevention in women deprived of freedom / Construcción y validación de tecnología educativa para la prevención del vih/sida en mujeres privadas de libertad

RESUMO: Objetivo: descrever o processo de elaboração e validação de tecnologia educacional para prevenção do Vírus da Imunodeficiência Humana em população feminina privada de liberdade. Método: estudo metodológico realizado em um complexo prisional no Centro Oeste do Brasil, de janeiro a julho de 2019, utilizando escala Likert de quatro pontos. Os dados foram analisados com testes Alfa de Cronbach e KAPPA. Considerou-se o Índice de Validade de Conteúdo mínimo de 0,80 para validação e concordância mínima de 75%. Resultados: os itens do material foram pertinentes com obtenção do Índice de Validade de Conteúdo total de (IVCt=0,87) para especialistas e (IVCt=0,95) para mulheres. Os especialistas avaliaram a cartilha, classificando-a com grau de recomendação "superior" (média de 91%). Houve adequações, alcançando, ao final, índice de concordância superior a 88,7%. Conclusão: acredita-se que essa tecnologia represente um avanço para a Saúde Pública, já que utilizou medidas e instrumentos confiáveis e apropriados para o público-alvo.

ABSTRACT Objective: to describe the process of elaboration and validation of educational technology for prevention of Human Immunodeficiency Virus in female population deprived of freedom. Method: methodological study conducted in a prison complex in the Midwest of Brazil, from January to July 2019, using a four-point Likert scale. Data were analyzed with Cronbach's Alpha and KAPPA tests. A minimum Content Validity Index of 0.80 was considered for validation and minimum 75% agreement. Results: The items of the material were relevant with a total Content Validity Index of (CVI t=0.87) for specialists and (CVI t=0.95) for women. The specialists evaluated the booklet, classifying it with a "superior" degree of recommendation (average of 91%). There were adjustments, reaching, in the end, a concordance index higher than 88.7%. Conclusion: we believe that this technology represents an advance for Public Health, since it used reliable and appropriate measures and instruments for the target audience.

RESUMEN Objetivo: describir el proceso de elaboración y validación de tecnología educativa para la prevención del Virus de Inmunodeficiencia Humana en población femenina privada de libertad. Método: estudio metodológico realizado en un complejo penitenciario del Centro-Oeste de Brasil, de enero a julio de 2019, utilizando una escala Likert de cuatro puntos. Los datos se analizaron con las pruebas alfa de Cronbach y KAPPA. Se consideró un Índice de Validez del Contenido mínimo de 0,80 para la validación y un acuerdo mínimo del 75%. Resultados: los ítems del material fueron pertinentes con la obtención del Índice de Validez de Conocimiento total de (IVCt=0,87) para especialistas e (IVCt=0,95) para mujeres. Los expertos evaluaron el folleto, calificándolo de "superior" (media del 91%). Hubo adecuaciones, alcanzando, al final, índice de concordancia superior a 88,7%. Conclusión: esta tecnología representa un avance para la sanidad pública, ya que utiliza medidas e instrumentos fiables y apropiados para el público objetivo.

Condições de vulnerabilidades de pessoas idosas vivendo com o Vírus da Imunodeficiência Humana (HIV) / Conditions of vulnerability of elderly people living with the Human Immunodeficiency Virus (HIV) / Condiciones de vulnerabilidades de personas ancianas que viven con el Virus de la Inmunodeficiencia Humana (HIV)

Estudo com objetivo de descrever as condições de vulnerabilidades de pessoas idosas ao Vírus da Imunodeficiência Humana (HIV). Trata-se de um estudo qualitativo e que utilizou como método a história oral temática, realizado no Serviço de Atendimento Especializado, com seis idosos com 65 anos ou mais. A coleta de dados se deu por uma entrevista em profundidade com questões sobre vulnerabilidades individuais, sociais e programáticas e os dados foram explorados por meio da análise de conteúdo temática. Entre as condições encontradas estão a ausência de preservativo nas relações sexuais; baixo grau de conhecimento e de procura por consultas e exames de rotina; presença do preconceito e discriminação; ruptura no convívio familiar; descoberta tardia do HIV e baixa capacitação da equipe de saúde. Enfrentar essas condições de vulnerabilidade pressupõe um debate sobre as políticas e normativas do cuidado às pessoas com HIV e a reconfiguração do modelo de cuidado focado na prevenção. (AU)

The aim of this study was to describe the conditions of vulnerability to HIV among older people. Using the thematic oral history method, we conducted a qualitative study in the SAE with six people aged 65 and over. The data were collected using in-depth interviews covering issues related to individual, social and programmatic vulnerabilities. The data were analyzed using content analysis. Vulnerability conditions included not using a condom, low level of knowledge of appointments and tests and health-seeking behavior; prejudice and discrimination; family break-ups; late diagnosis of HIV; and limited capacity of health teams. To tackle these vulnerability conditions, it is necessary to promote a debate about policies and regulations geared towards the care of people with HIV and reshape the prevention-based care model. (AU)

Estudio con el objetivo de describir las condiciones de vulnerabilidades de personas ancianas al VIH. Un estudio cualitativo, usando como método la historia oral temática, realizado en el SAE, con seis ancianos de 65 años o más, y la colecta de datos fue realizada mediante una entrevista en profundidad con preguntas sobre vulnerabilidades individuales, sociales y programáticas. Se realizó el análisis de contenido temático. Entre las condiciones encontradas están la ausencia de preservativo en las relaciones sexuales, bajo grado de conocimiento y de búsqueda de consultas y exámenes de rutina, presencia de prejuicios y discriminación, ruptura en la convivencia familiar, descubrimiento tardío del VIH y la baja capacitación del equipo de salud. El enfrentamiento de esas condiciones de vulnerabilidad presupone un debate con relación a las políticas y normativas del cuidado con las personas con VIH y la reconfiguración del modelo de cuidado enfocado en la prevención. (AU)

Technology for the treatment promotion of adults living with HIV: Positive o Cuidado (Positive the Care) / Tecnología para la promoción del tratamiento de usuario adulto viviendo con VIH: Positiva el Cuidado / Tecnologia para a promoção do tratamento de usuário adulto vivendo com HIV: Positive o Cuidado

ABSTRACT Objectives: to develop a responsive website focused on treatment adherence for adult users living with HIV. Methods: technological study conducted between August and October 2020, in the light of Pierre Lévy's theoretical-philosophical framework, using the Double Diamond Process methodology associated with the five stages of The Elements of User Experience framework. Results: it was developed the responsive website Positive Care (Positive o Cuidado), composed of an initial presentation screen and 13 other screens named: Family Health and You; Undetectable = Untransmissible; Antiretroviral Drugs; Routine Tests; Vaccination; Antiretroviral Delivery; Drug Interactions; Combined Prevention; Support Services; Healthy Life; Family and Reproductive Planning; Covid 19; and Questions, Curiosities, and Myths. Final Considerations: the responsive website was developed based on the software design and programming process and has requirements/functionalities with the potential to strengthen the collective intelligence about HIV and, consequently, to promote treatment adherence by its users.

RESUMEN Objetivo: desarrollar sitio responsivo con enfoque en la adhesión al tratamiento de usuarios adultos viviendo con VIH. Métodos: estudio tecnológico realizado entre agosto y octubre de 2020, basado en el referencial teórico-filosófico de Pierre Lévy, usando la metodología Double Diamond Process relacionada a los cinco planes del framework The Elements of User Experience. Resultados: fue desarrollado el sitio responsivo "Positiva el Cuidado", compuesto por pantalla inicial de presentación y miás 13 pantallas denominadas: Salud de la familia y tú; Indétectable = Intransmisible; Medicaciones antirretrovirales; Exámenes de rutina; Vacunación; Entrega de antirretrovirales; Interacciones medicamentosas; Prevención combinada; Servicios de apoyo; Vida saludable; Planeamiento familiar y reproductivo; Covid-19; y Dudas, Curiosidad y Mitos. Consideraciones Finales: el sitio responsivo fue desarrollado basado en el proceso de diseño y programación del software y posee requisitos/funcionalidades con potencial de fortalecer la inteligencia colectiva acerca del VIH y, consecuentemente, promover la adhesión al tratamiento por sus usuarios.

RESUMO Objetivos: desenvolver site responsivo com foco na adesão ao tratamento de usuários adultos vivendo com HIV. Métodos: estudo tecnológico realizado entre agosto e outubro de 2020, à luz do referencial teórico-filosófico de Pierre Lévy, usando a metodologia Double Diamond Process associada aos cinco planos do framework The Elements of User Experience. Resultados: foi desenvolvido o site responsivo "Positive o Cuidado", composto por tela inicial de apresentação e mais 13 telas denominadas: Saúde da família e você; Indetectável = Intransmissível; Medicações antirretrovirais; Exames de rotina; Vacinação; Entrega de antirretrovirais; Interações medicamentosas; Prevenção combinada; Serviços de apoio; Vida saudável; Planejamento familiar e reprodutivo; Covid-19; e Dúvidas, Curiosidade e Mitos. Considerações Finais: o site responsivo foi desenvolvido com base no processo de design e programação do software e possui requisitos/funcionalidades com potencial de fortalecer a inteligência coletiva acerca do HIV e, consequentemente, promover a adesão ao tratamento por seus usuários.

Hyperferritinemic sepsis secondary to invasive Toxoplasma gondii in a child with untreated HIV / Sepsis hiperferritinémica secundaria a Toxoplasma gondii invasiva en un paciente pediátrico con virus de inmunodeficiencia humana sin tratamiento

Abstract Background: Untreated human immunodeficiency virus (HIV)-immunosuppressed pediatric patients show high morbidity and mortality from opportunistic infections. Limited cases of hyperferritinemic sepsis have been described in patients with toxoplasmosis. Case report: We describe the case of a 13-year-old female patient with a history of untreated HIV who presented with hyperferritinemic sepsis secondary to Toxoplasma gondii infection and Pneumocystis jirovecci pneumonia. She received ventilatory support, inotropic drugs, treatment for opportunistic germs, and high-dose corticosteroids, but with unfavorable evolution. Conclusions: The global approach to sepsis with elevated ferritin guides to using of therapies aimed at neutralizing the severe inflammatory response. A timely diagnosis would allow prompt treatment and minimize complications.

Resumen Introducción: Los pacientes pediátricos inmunodeprimidos por el virus de la inmunodeficiencia humana (VIH) sin tratamiento presentan una elevada morbilidad y mortalidad por infecciones oportunistas. Se han descrito limitados casos de sepsis hiperferritinémica en pacientes con toxoplasmosis. Caso clínico: Se describe el caso de una paciente de 13 años con antecedente de VIH sin tratamiento que presentó sepsis hiperferritinémica secundaria a una infección por Toxoplasma gondii y neumonía por Pneumocystis jirovecci. Recibió soporte ventilatorio, uso de inotrópicos, tratamiento para gérmenes oportunistas y corticoides en altas dosis, pero su evolución fue desfavorable. Conclusiones: El abordaje global de la sepsis con ferritina elevada orienta a utilizar terapias dirigidas a neutralizar la respuesta inflamatoria severa, por lo que un diagnóstico oportuno permitiría iniciar el tratamiento prontamente y minimizar las complicaciones.

Audit of emergency obstetric referrals at a Tertiary Center in Kano

Introduction: Maternal and perinatal deaths could be prevented if functional referral systems are in place to allow pregnant women to get appropriate services when complications occur. Methodology: The study was a 1-year retrospective study of obstetric referrals in Aminu Kano Teaching hospital, from 1st January to 31st December 2019. Records of all emergency obstetrics patients referred to the hospital for 1 year were reviewed. A structured proforma was used to extract information such as sociodemographic characteristics of the patients, indications for referral, and pre-referral treatment. The care given at the receiving hospital was extracted from the patients' folders. An Audit standard was developed and the findings were compared with the standards in order to determine how the referral system in the study area perform in relation to the standard. Results: There were total of 180 referrals, the mean age of the women was 28.5 ± 6.3 years. Majority (52%) of the patients were referred from Secondary Centres and only 10% were transported with an ambulance. The most common diagnosis at the time of referral was severe preeclampsia. More than half of the patients (63%) had to wait for 30 to 60 minutes before they see a doctor. All the patients were offered high quality care and majority (70%) were delivered via caesarean section. Conclusion: There were lapses in the management of patients before referral; failure to identify high risk conditions, delay in referral, and lack of treatment during transit to the referral centre.