HIV-infected youths transitioning from pediatric to adult outpatient care in a teaching tertiary care hospital in São Paulo city, Brazil.

BACKGROUND: HIV-infected children surviving until adulthood have been transitioning to adult outpatient health care service in Brazil since the late 2000's. Deterioration of clinical condition is expected during this period, as reported among youths with non-communicable chronic diseases. Despite their young age, they are long-term hosts of the virus, have prolonged exposure to antiretroviral therapy and have suffered from the social determinants and stigma of HIV infection since early childhood. OBJECTIVES: This study aimed to 1) describe demographic and clinical characteristics at the first appointment at adult care service following pediatric care of a cohort of Brazilian youths living with HIV since childhood; and 2) retrospectively address adherence and clinical variables in the last two years of pediatric follow-up. METHODS: Descriptive study. RESULTS: 41 consecutive patients referred to adult outpatient care from a pediatric HIV unit were enrolled, median age 19 years, and median lifetime CD4+nadir 117 cell/mm3; 89% reported previous AIDS-defining conditions. At first laboratory assessment in adult care, only 46% had undetectable (<400 copies/ml) HIV viral load and the median CD4+count was 250 cell/mm3. CONCLUSION: Youths living with HIV at the transition from pediatric to adult care had poor treatment adherence, low lifetime CD4+cell nadir, low CD4 cell count and detectable HIV viral load. Health care providers should closely monitor these adolescents in a youth friendly environment, prepared for open communication about all aspects of their health.

Costs and benefits of secrecy: the dilemma experienced by adolescents seropositive for HIV

This study explored the experiences of the first generation of adolescents who acquired HIV through vertical transmission when disclosing their diagnosis to friends and romantic partners. The study sample was selected by convenience, with 20 patients (13-20 years old) participating in a qualitative investigation using individual interviews (language: Portuguese; duration: 45 minutes). The participants were followed in specialized clinics for the treatment of pediatric AIDS in São Paulo, Brazil. The results suggest that families who live with HIV tend to keep it a secret, and such behavior is learned and accepted unquestioningly as natural. Respect for privacy and the fear of rejection, coupled with the belief that information about their disease will be spread, are the main beliefs with which participants justify their secrecy. In terms of romantic relationships, adolescents were aware that their HIV status should at some point be shared with current or future sexual partners. However, the decision to reveal an HIV diagnosis in romantic relationships is permeated by anxieties, uncertainties about the right time, and fear of abandonment. In any case, telling the truth requires trust, guarantees of the other's love, and, in some cases, probing romantic partners beforehand to learn their perceptions about the disease. Participants who had experiences disclosing their HIV status shared positive and negative results, including emotional support, acceptance, and understanding, along with ostracism, discrimination, and abandonment by family members. The findings of this paper reinforce the challenges of revealing an HIV diagnosis to third parties. It requires understanding the meaning and importance of the secret for each patient, along with the conflict between the right to confidentiality and the responsibility of treating others exposed to the disease. All these aspects should be discussed extensively with this population and incorporated into clinical practice

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

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

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

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

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

Health Related Quality of Life Assessment questionnaire for children aged 5 to 11 years with HIV/AIDS: cross-cultural adaptation for the Portuguese language.

The objective of this study is to describe preliminary results from the cross-cultural adaptation of the Quality of Life Assessment Questionnaire, used to measure health related quality of life (HRQL) in Brazilian children aged between 5 and 11 with HIV/AIDS. The cross-cultural model evaluated the Concept, Item, Semantic and Measurement Equivalences (internal consistency and intra-observer reliability). Evaluation of the conceptual, item, semantic equivalences showed that the Portuguese version is pertinent for the Brazilian context. Four of seven domains showed internal consistency above 0.70 (α: 0.76-0.90) and five of seven revealed intra-observer reliability (ricc: 0.41-0.70). This first Portuguese version of the HRQL questionnaire can be understood as a valuable tool for assessing children's HRQL, but further studies with large samples and more robust analyses are recommended before use in the Brazilian context.

Health Related Quality of Life Assessment questionnaire for children aged 5 to 11 years with HIV/AIDS: cross-cultural adaptation for the Portuguese language / Questionário de Avaliação da Qualidade de Vida para crianças de 5 a 11 anos com HIV/AIDS: adaptação transcultural para a língua portuguesa

The objective of this study is to describe preliminary results from the cross-cultural adaptation of the Quality of Life Assessment Questionnaire, used to measure health related quality of life (HRQL) in Brazilian children aged between 5 and 11 with HIV/AIDS. The cross-cultural model evaluated the Concept, Item, Semantic and Measurement Equivalences (internal consistency and intra-observer reliability). Evaluation of the conceptual, item, semantic equivalences showed that the Portuguese version is pertinent for the Brazilian context. Four of seven domains showed internal consistency above 0.70 (α: 0.76-0.90) and five of seven revealed intra-observer reliability (ricc: 0.41-0.70). This first Portuguese version of the HRQL questionnaire can be understood as a valuable tool for assessing children's HRQL, but further studies with large samples and more robust analyses are recommended before use in the Brazilian context.

O objetivo deste estudo é descrever os resultados preliminares da adaptação, para o uso no Brasil, do questionário Quality of Life Assessment, usado para mensurar qualidade de vida relacionada à saúde (HRQL) em crianças com HIV/AIDS. O modelo de adaptação cultural considerou as avaliações de equivalência Conceitual, Itens, Semântica e de Mensuração (consistência interna e reprodutibilidade). As avaliações da equivalência conceitual, itens e semântica, mostraram que a versão para o Português é pertinente para o contexto brasileiro. Quatro de sete domínios apresentaram consistência interna acima de 0,70 (α: 0.76-0.90) e cinco de sete apresentaram reprodutibilidade (ricc: 0.41-0.70). Esta primeira versão em Português do questionário de HRQL pode ser entendida como uma valiosa ferramenta para mensurar HRQL em crianças, porém outros estudos com amostras maiores e análises mais robustas, são recomendados antes do uso no contexto brasileiro.

Recomendações: atualização de condutas em pediatria

Conteúdos Conteúdo: Influenza A(H1N1): uso de vacinas - Helena Keico Sato e Heloisa Helena de Souza Marques. -- Atenção domiciliar a crianças e adolescentes - Fernando Jorge da C. Lyra Filho e Mário Roberto Hirschheimer.(AU)

Hanseníase em crianças e adolescentes: revisão bibliográfica e situação atual no Brasil / Leprosy in children and adolescents: bibliographical review and current situation in Brasil

Introdução: A hanseníase é uma doença endêmica no Brasil, com prevalência acima do esperado pela Organização Mundial da Saúde para todas as faixas etárias, inclusive a pediátrica. Objetivo: Esse trabalho tem o objetivo de revisar os aspectos epidemiológicos, históricos, imuno-patológicos e clínicos da hanseníase e suas peculiaridades na população infantil. Fontes pesquisadas: Foi realizada uma ampla revisão bibliográfica no PubMed e em sites oficiais do Ministério da Saúde do Brasil e da Organização Mundial da Saúde, com as palavras hanseníase em crianças e adolescentes. Síntese dos dados: Com a suspeita clínica, diagnóstico precoce, tratamento adequado com a poliquimioterapia, controle dos contactantes íntimos com exame clínico e aplicação da BCG, é possível o controle da doença, interrompendo o ciclo de transmissão e diminuindo os casos em crianças, adolescentes e adultos, para níveis inferiores a 1 /10.000 habitantes, como recomendado.

Introduction: Leprosy is endemic in Brazil, with prevalence higher than expected by the World Health Organization for all ages, including children. Objective: This paper aims to review the epidemiology, history, immunology, pathology and clinical aspect of leprosy and its peculiarities in childhood. Data Source: Wasperformed an extensive literature review on PubMed and on official websites of Health’ Ministry in Brazil and World Health Organization with the words leprosy in children and adolescents. Data Synthesis: With clinical suspicion, early diagnosis, adequate treatment with multidrug therapy and prevention contacts withBCG administration, Brazil can control the disease by interrupting the transmission cycle and reducing the cases in children, adolescents and adults for levels less than 1 / 10,000 individuals, as recommended...

Quando o pediatra deve suspeitar de infecção pelo HIV? / When should the pediatrician suspect of HIV ocurrence?

No Brasil foram notificados 433.067 casos de AIDS desde 1980 até junho de 200, sendo que 6.067 (3,7 por cento) casos são de crianças até 13 anos de idade, nos quais a forma de transmissão mais comum foi por infecção vertical/perinatal, em 81,1 por cento dos casos...

Avaliação de reação adversa a medicamentos em um caso de confusão mental / Adverse drug reaction assessment in a mental confusion case

Objetivo: mostrar a sistemática de avaliação de reação adversa a medicamentos realizada em um caso. Descrição do caso: uma menina de 9 anos de idade estava com AIDS em estágio clínico-imunológico C3, e em tratamento com esquema de...

Objective: to underline the importance of a systematic surveillance focusing drug's adverse effects proceeded in one case. Case report: a nine year-old girl was affected by AIDS in C3 clinical-immunological stadium, and received...

Meningite Pneumocócica em crianças : relato de 19 casos

O artigo analisa 19 casos de meningite pneumocócica internados na Unidade de Infectologia do ICR do HC-FMUSP, durante operíodo de janeiro de 1980 a agosto de 1992.Arquivo em PDF. Requer o Adobe Acrobat Reader

Acremonium kiliense infection in a child with chronic granulomatous disease

Infection by unusual microorganisms can be one of the clinical manifestations of primary immunodeficiency (PID). We report on a four-month-old child with pneumonia caused by the fungus Acremonium kiliense as the first clinical manifestation of chronic granulomatous disease. We emphasize the importance of an active search for unusual organisms in immunodeficient patients, and a precise diagnosis and early institution of specific treatment against such microorganisms for the reduction of the morbidity and mortality of these patients.

Acremonium kiliense infection in a child with chronic granulomatous disease.

Infection by unusual microorganisms can be one of the clinical manifestations of primary immunodeficiency (PID). We report on a four-month-old child with pneumonia caused by the fungus Acremonium kiliense as the first clinical manifestation of chronic granulomatous disease. We emphasize the importance of an active search for unusual organisms in immunodeficient patients, and a precise diagnosis and early institution of specific treatment against such microorganisms for the reduction of the morbidity and mortality of these patients.

Improving survival among Brazilian children with perinatally-acquired AIDS

Brazil was the first developing country to provide free, universal access to antiretroviral treatment for AIDS patients. The Brazilian experience thus provides the first evidence regarding the impact of such treatment on the survival of perinatally acquired AIDS cases in the developing world. MATERIAL AND METHODS: This retrospective cohort study used medical record reviews to examine characteristics and trends in the survival of a representative sample of 914 perinatally acquired AIDS cases in 10 Brazilian cities diagnosed between 1983 and 1998. RESULTS: Survival time increased steadily and substantially. Whereas half of the children died within 20 months of diagnosis at the beginning of the epidemic, 75 percent of children diagnosed in 1997 and 1998 were still alive after four years of follow-up. CONCLUSIONS: Advances in management and treatment have made a great difference in the survival of Brazilian children with AIDS. These results argue strongly for making such treatment available to children in the entire developing world.

Improving survival among Brazilian children with perinatally-acquired AIDS.

UNLABELLED: Brazil was the first developing country to provide free, universal access to antiretroviral treatment for AIDS patients. The Brazilian experience thus provides the first evidence regarding the impact of such treatment on the survival of perinatally acquired AIDS cases in the developing world. MATERIAL AND METHODS: This retrospective cohort study used medical record reviews to examine characteristics and trends in the survival of a representative sample of 914 perinatally acquired AIDS cases in 10 Brazilian cities diagnosed between 1983 and 1998. RESULTS: Survival time increased steadily and substantially. Whereas half of the children died within 20 months of diagnosis at the beginning of the epidemic, 75% of children diagnosed in 1997 and 1998 were still alive after four years of follow-up. CONCLUSIONS: Advances in management and treatment have made a great difference in the survival of Brazilian children with AIDS. These results argue strongly for making such treatment available to children in the entire developing world.

Tuberculose em crianças com Aids / Tuberculosis in children with acquired immunodeficiency syndrome

A tuberculose e a doenca infecciosa, associada ao HIV, mais comum nos paises em desenvolvimento; nao e raro que seja a manifestacao inicial da Aids e ate sirva como uma "doenca sentinela" para a suspeicao e investigacao da infeccao pelo HIV. O objetivo do trabalho e avaliar a evolucao da infeccao pelo Mycobacterium tuberculosis em criancas com Aids acompanhadas no Instituto da Crianca do Hospital das Clinica da FMUSP no periodo de 1989 a 1999. Dos 360 pacientes acompanhados nos servico no periodo, 29 criancas tinham diagnostico de tuberculose e Aids. Essas foram submetidas a um estudo retrospectivo, utilizando a analise dos prontuarios medicos, atraves de um questionario que continha dados de identificacao, epidemiologicos, clinicos, laboratoriais e evolutivos dos pacientes. Do grupo estudado as idades oscilaram entre meses e 15 anos. 9 criancas tiveram diagnostico de tuberculose antes ou simultaneamente ao de Aids e em 20 criancas esse diagnostico foi feito posteriormente. 23 pacientes haviam recebido a vacina BCG. Os achados clinicos mais comuns foram tosse ou outros sintomas respiratorios, febre, deficit de ganho ponderal. A localizacao da infeccao foi predominantemente pulmonar. A pesquisa do agente etiologico foi positiva em 15 criancas. 20 criancas receberam tratamento com esquema I, havendo alta taxa de cura. a letalidade do grupo estudado foi de 18 porcento. A tuberculose e uma infeccao frequente em criancas infectadas pelo HIV. A forma mais comum da doenca nessas criancas, assim como em criancas saudaveis, e a pulmonar. Os achados clinicos podem ser atipicos e o diagnostico e presuntivo na maior parte dos casos. A evolucao costuma ser boa com as drogas habituais na grande maioria dos casos, exceto naqueles pacientes com Aids em fases avancadas ou com tuberculose disseminada, onde a taxa de mortalidade e elevada