Langerhans cell density in cervical intraepithelial neoplasia associated with human papillomavirus infection in HIV-infected and HIV-noninfected Brazilian women.

OBJECTIVE: Local immunity plays an important role in the cervical defense mechanisms that prevent the development of cervical intraepithelial neoplasia. The objective of this study was to determine the involvement of local immunity by evaluating Langerhans cell (LC) density in cervical biopsies of human immunodeficiency virus (HIV)-positive and HIV-negative women. MATERIALS AND METHODS: A cross-sectional study was developed by including HIV-positive and HIV-negative women. All patients presented human papillomavirus DNA from the uterine cervix, which was detected by polymerase chain reaction or hybrid capture II. Cervical biopsies were assessed for LC density and cervical intraepithelial neoplasia. Langerhans cells were identified by immunohistochemistry using anti-CD1a and anti-S100 antibodies. Associations among cervical LC density, the type of cervical lesion, CD4 lymphocyte count, and HIV viral load were analyzed using logistic regression (SPSS, version 12.0). RESULTS: Seventy-seven women (40 seropositive and 37 seronegative) were enrolled. The mean ± SD LC density identified with the anti-CD1a antibody was 0.80 ± 0.7 cells versus 2.6 ± 1.6 cells (P < 0.0001), whereas the mean ± SD LC density identified by the anti-S100 antibody was 1.3 ± 1.0 cells versus 3.6 ± 1.7 cells (P < 0.0001) among the HIV-positive and HIV-negative women, respectively. There were no associations between LC density and HIV viral load, CD4 lymphocyte count, or human papillomavirus genotype (P > 0.05). In a logistic regression model, HIV infection was the only factor independently associated with a decrease in LC density. CONCLUSIONS: Human immunodeficiency virus infection was found to be an independent factor that explains the decrease in local immunity in the uterine cervix, which could allow the development of cervical lesions. This effect was not associated with CD4 lymphocyte count or HIV viral load.

Atividade sexual antes e após o diagnóstico da infecção pelo vírus da imunodeficiência humana: existe modificação? / Sexual activity before and after diagnosis of infection by virus of human immunodeficiency: is there any change?

Introdução: estudos de abrangência nacional na área de comportamento sexual, riscos e proteção frente à infecção pelo vírus da imunodeficiência humana e às demais doenças sexualmente transmissíveis (DST) são necessários para formular e avaliar políticas públicas. Objetivo: avaliar se existe mudança na atividade sexual de pacientes antes e após o diagnóstico da infecção pelo HIV. Métodos: realizou-se um estudo de corte transversal com 87 pacientes HIV soropositivas, com confirmação por testes realizados previamente. Estas foram submetidas à anamnese, com abordagem de dados clínicos e epidemiológicos. Resultados: a idade do grupo variou de 18 a 71 anos. A forma de contágio predominante foi a sexual (92%). A idade de início da atividade sexual variou de12 a 30 anos. Considerando a utilização do preservativo como mecanismo de proteção de DST, observou-se que 35 pacientes (40,2%) relataram a utilização deste anteriormente à descoberta da infecção. Atualmente, 60 pacientes relatam algum tipo de proteção, representado por abstinência sexual ou utilização de preservativo. A comparação entre estas variáveis mostrou uma associação signifi cativa a p < 0,001. Conclusão: conclui-se que existe mudança na atividade sexual das pacientes após o diagnóstico da infecção pelo HIV, representada pela abstinência sexual ou pelo uso sistemático de preservativo nas relações sexuais

Introduction: national scope studies in the area of sexual behavior, risk and protection against infection by human immunodefi ciency virus and othersexually transmitted diseases (STD) are required to formulate and evaluate public policies. Objective: the aim of this study was to evaluate whether there is change in sexual activity of patients before and after diagnosis of HIV infection. Methods: a cross-sectional study was conducted with 87 HIV seropositive patients confi rmed by tests carried out previously. They were submitted to anamnesis with approach to clinical and epidemiological data. Results: the group ranged in age from 18 to 71 years. The predominant form of contagion of the human immunodefi ciency virus was sexual (92%). The onset of sexual activity ranged in age from 12 to 30 years. Considering the use of condom as a mechanism of protection from STD, it was observed that 35 patients (40.2%) reported its use prior to discovery of the infection. Currently, 60 patients report some kind of protection, represented by sexual abstinence or use of condom. Thecomparison between these variables showed a signifi cant association with p < 0001. Conclusion: we concluded that there is change in sexual activity of patients after diagnosis of infection with human immunodeficiency virus, represented by sexual abstinence or use of systematic condom in sex.

Prevalência do aleitamento materno em município de médio porte do sudeste brasileiro / Prevalence of breastfeeding in a middle-sized city in southeastern Brazil

Este artigo teve como objetivo principal apresentar o diagnóstico da situação do aleitamento materno e do uso de chupeta e mamadeira por crianças menores de um ano,residentes em Juiz de Fora (MG). Foi utilizado inquérito transversal realizado na Campanha Nacional de Vacinação do referido município em 2002, tendo sido entrevistadas 1859 pessoas. Verificou-se que, em Juiz de Fora, 92,8%das crianças amamentavam no primeiro dia em casa. As taxas de Aleitamento Materno Exclusivo até os 4 meses de idade foram de 20,8% e, até os 6 meses, de 15,7%. A taxa de Alimentação Complementar Oportuna foi de 43,8%e a de Aleitamento até 12 meses foi de 55,9% . O índice de uso de chupeta até os 12 meses foi de 65,8% e o de mamadeira até a mesma idade foi de 70 %. Foi observado que, embora 92,8% das crianças iniciem a amamentação no primeiro dia de vida em casa, este índice não se mantém. As taxas de aleitamento materno exclusivo aos 4 e 6 meses de idade (20,8% e 15,7% , respectivamente) e de aleitamento materno até um ano (56%), são baixas e muito aquém do que recomenda a OMS. A taxa de Aleitamento Materno Exclusivo aos 4 meses é inferior às taxas de todas capitais brasileiras, com exceção de Cuiabá. Esta situação indica a necessidade urgente de programas de apoio e incentivo à amamentação, bem como da promoção da mesma no município.

This work aimed to diagnose the standard of breast feedingand the use of pacifiers and baby-bottles of children underone year of age, living in Juiz de Fora, MG, Brazil. The methodology used was a cross-sectional survey of 1859 subjects, undertaken during a National Immunization Campaign,in 2002. 92.8% of the children started breast feedingon their first day of life, at home. 20.8% were exclusive lybreastfed in the first four months of life, and 15.7% in the first six months. The complementary feeding rate was 43.8% and the breast feeding rate at 12 months was 56%.At 12 months, 65.8% used pacifiers, and 70% used baby bottles.We concluded that most children started breast feedingon their first day of life, at home (92.8%), although this rate declined steadily (56% at 12 months). Exclusive breastfeeding rates in the first four and six months of life(20.8% and 15.7%, respectively) and breast feeding rate at one year (56%), were extremely low and failed to live up to WHO`s guidelines. Exclusive Breastfeeding rate at four months of life was lower than that of all Brazilian capitals,except Cuiabá. This situation calls for the urgent implementation of programs aimed at supporting and promoting breastfeeding in the city.