Primary antiretroviral drug resistance among HIV type 1-infected individuals in Brazil.

Infection with drug-resistant human immunodeficiency virus type 1 (HIV-1) has been documented in all countries that have surveyed for it and may result in an unfavorable response to therapy. The prevalence and characteristics of individuals with transmitted resistance to antiretroviral drugs have been scarcely described in Brazil. We performed antiretroviral resistance testing prior to initiation of therapy in 400 subjects enrolled from 20 centers in 13 Brazilian cities between March and September 2007. Genotyping was conducted using PCR-amplified HIV pol products by automated sequencing, and genotype interpretation was done according to the IAS-USA consensus. Of 400 eligible participants, 387 (95.8%) were successfully tested. Seven percent of antiretroviral-naive patients carried viruses with one or more major mutation associated with drug resistance. The prevalence of these mutations was 1.0% for protease inhibitors, 4.4% for nonnucleoside reverse transcriptase inhibitors, and 1.3% for nucleoside reverse transcriptase inhibitors. The frequency of multidrug resistance among the resistant strains was 13.6%. Among subjects infected with drug-resistant virus, the majority were infected with subtype B viruses (91%). Subjects from the city of São Paulo had higher transmitted resistance mutations compared to the rest of the country. Reporting a partner taking antiretroviral medications was associated with a higher chance of harboring HIV variants with major drug resistance mutations [odds ratio = 2.57 (95% confidence interval, 1.07-6.16); p = 0.014]. Resistance testing in drug-naive individuals identified 7% of subjects with mutations associated with reduced susceptibility to antiretroviral drugs. Continued surveillance of drug-resistant HIV-1 in Brazil is warranted when guidelines for HIV prophylaxis and treatment are updated. Resistance testing among drug-naive patients prior to treatment initiation should be considered, mainly directed at subjects whose partners are already on antiretroviral therapy.

Vasculite com gangrena dos artelhos em um paciente com riquetsiose / Vasculitis with gangrene of the toes in a patient with brasilian spotted fever

Os autores apresentam o seguimento clínico de um paciente acometido por febre, polimialgia, exantema máculo-papular, pneumonite difusa, que evoluiu para choque septicêmico, com intensa vasculite e gangrena de extremidades inferiores, seguindo-se auto-amputaçäo das falanges distais dos artelhos. O diagnóstico de riquetsiose estabeleceu-se mediante epidemiologia e reaçäo de Weill-Felix positiva. Discutem a raridade das lesöes vasculares, täo agressivas na doenças, decorrentes da parasitose do endotélio, condiçäo incomum nas doenças difusas do tecido conjuntivo, onde o acometimento vascular é medido por imunecomplexos circulantes