Zidovudine, a brief history before the first antirretroviral in Mexico.

In the 1980s in Mexico, that of the «moral renewal¼, there was the opening to the market and the manifestation of human immunodeficiency virus (HIV) and AIDS. In this writing, the historical and therapeutic conditions are related to alleviate the syndrome until the arrival of the first antiretroviral. It is a reconstruction of the events, of which the medical-social, main clinical manifestations and of course the pharmacological therapy, until de the development zidovudina or azidotimidina of AZT, the first antiretroviral to be approved. Nevertheless, in the Mexican context, this event wasn't decisive to significantly change the morbility and the mortality.

En el México de la década de 1980, el de la «renovación moral¼, se vivió la apertura al mercado y la manifestación del virus de la inmunodeficiencia humana (VIH) y el sida. En este escrito se relatan las condiciones históricas y terapéuticas del síndrome en los pacientes mexicanos, hasta la llegada del primer antirretroviral. Se trata de una reconstrucción de los hechos, de los cuales se ha profundizado en aspectos médico-sociales, principales manifestaciones clínicas y terapéutica farmacológica, hasta que interviene en la patogenia del VIH/sida el desarrollo de la zidovudina o azidotimidina (AZT), primer antirretroviral en ser aprobado. No obstante, en el contexto mexicano este suceso no fue determinante para cambiar de manera significativa la morbimortalidad de los infectados.

Public health heritage and policy: HIV and AIDS in museums and archives.

In the last five years there has been a resurgence of scholarly research and museum exhibitions on the history of HIV and AIDS. This work has called into question some of the conventions of archiving and interpreting the history of the pandemic. It is increasingly clear that a narrow range of materials have been saved. As historians and curators turn to these holdings for analysis and exhibition, they find they inadequately represent the impact of AIDS across diverse groups as well as the range of local, national, international responses. This essay considers some of the factors that shape collection of the material culture, particularly the heritage of public health, and the consequences for our understanding of lessons from the past.

Public health heritage and policy: HIV and AIDS in museums and archives / Herança e política de saúde pública: HIV e aids em museus e arquivos

Abstract In the last five years there has been a resurgence of scholarly research and museum exhibitions on the history of HIV and AIDS. This work has called into question some of the conventions of archiving and interpreting the history of the pandemic. It is increasingly clear that a narrow range of materials have been saved. As historians and curators turn to these holdings for analysis and exhibition, they find they inadequately represent the impact of AIDS across diverse groups as well as the range of local, national, international responses. This essay considers some of the factors that shape collection of the material culture, particularly the heritage of public health, and the consequences for our understanding of lessons from the past.

Resumo Nos últimos cinco anos, retomaram-se as pesquisas acadêmicas e exposições museológicas sobre a história do HIV e da aids. Este trabalho questiona algumas das convenções de arquivamento e interpretação da história da pandemia. Fica cada vez mais claro que foi preservada uma pequena amostra de materiais. À medida que historiadores e curadores recorrem a esse patrimônio para análise e exposição, descobrem que representam de maneira inadequada o impacto da aids em diversos grupos, bem como o escopo das respostas locais, nacionais e internacionais. Este artigo considera alguns dos fatores que influenciam a coleção de cultura material, em particular o legado da saúde pública e as consequências de nossa compreensão das lições do passado.

Size of the Adult HIV-Infected Population Adjusted for the Unreported AIDS Mortality in the Santa Catarina State, Brazil, 2008-2017.

OBJECTIVE: To estimate the number of 15-79-year-old individuals infected with HIV in the Santa Catarina state, Brazil, during the period 2008-2017. METHODS: Three official registers of the HIV-infected individuals were compiled: SINAN for the HIV/AIDS epidemiological surveillance, SIM for mortality and SISCEL for the HIV viral load and CD4/CD8 cell count. Their records were linked by a unique personal identifier. Capture-recapture estimates were obtained by log-linear modelling with both the main effects and interaction between the registers, adjusted for age, sex and period. An adjustment for underreporting of AIDS-related deaths used published data on ill-defined causes of death and AIDS mortality. RESULTS: After data sorting, 67340 HIV/AIDS records were identified: 29734 (44.2%) by SINAN, 5540 (8.2%) by SIM and 32066 (47.6%) by SISCEL. After record linkage, the HIV population size was estimated at 45707, whereas the capture-recapture method added 44 individuals. The number of new HIV/AIDS notifications per year increased significantly in 2014-2017 compared to the period 2011-2013 among 15-34-year-old men and less so for older men and women. Including 1512 unreported AIDS-related deaths gave an estimated 47263 HIV-infected individuals with 95% confidence interval (CI) of 47245-47282 and corresponding incidence of 93 (95% CI 91-96) p/100000. Case ascertainment of 62.9%, 78.5% and 67.8% was estimated for SINAN, SIM and SISCEL, respectively. CONCLUSION: Three major HIV/AIDS registers in Brazil showed significant under-notification of the HIV/AIDS epidemiological surveillance amenable to significant improvement by routine record linkage.

Incidence and determinants of severe morbidity among HIV-infected patients from Rio de Janeiro, Brazil, 2000-2010.

BACKGROUND: Reliable information on severe morbidity is essential for identifying priorities for case management and to guide resource allocation within the health sector. METHODS: This study describes overall, AIDS- and non-AIDS-related severe morbidity as well as mortality and its determinants in an urban cohort of HIV-infected individuals from a public healthcare institution, the Evandro Chagas Research Institute (IPEC) of the Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. Severe morbid events were defined as all clinical diagnoses listed in hospitalization discharge records; all diagnoses were checked and validated. Generalized estimating equation models were used to estimate incidence rates while adjusting for within-subject correlation. RESULTS: Between 2000 and 2010, 3,537 patients were followed for a total of 16,960 person-years (PY) of follow-up. Over the years, annual incidence rate of severe morbid events, AIDS-related events, non-AIDS-related events, and deaths significantly decreased from, respectively, 36.6, 12.9, 23.7 and 3.2 per 100 PY in 2000 to 25.3, 7.9, 17.4 and 1.9 per 100 PY in 2010. Patients' immunological profiles significantly improved with time; 84% of the patients used combination antiretroviral therapy (cART) per year. Immunodeficiency was associated with a higher incidence rate of AIDS- and non-AIDS-related events as well as with the incidence rate of specific non-AIDS events (bacterial infections, toxicities, cardiovascular, renal and respiratory diseases). CONCLUSIONS: Our results show that in a middle income country with access to cART, non-AIDS-related events represent an important cause of severe morbidity alongside a still high incidence rate of AIDS-related events.

The Haiti research-based model of international public health collaboration: the GHESKIO Centers.

For 3 decades, GHESKIO (the Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes), the Haitian Ministry of Health, and Weill Cornell have pursued a tripartite mission of service, training, and translational research. The initial focus was on AIDS and tuberculosis. The mission has expanded to include the local community and now provides maternal-child health, family planning, cancer prevention and treatment, immunizations (including human papillomavirus, cholera), and primary education through vocational and microcredit programs. Outcome measures include a reduction in HIV prevalence from 6.2% to the current 2.2%, extensive tuberculosis and cholera prevention and treatment programs, and national training programs for biomedical and community health workers.

Reviewing the history of HIV-1: spread of subtype B in the Americas.

The dispersal of HIV-1 subtype B (HIV-1B) is a reflection of the movement of human populations in response to social, political, and geographical issues. The initial dissemination of HIV-1B outside Africa seems to have included the passive involvement of human populations from the Caribbean in spreading the virus to the United States. However, the exact pathways taken during the establishment of the pandemic in the Americas remain unclear. Here, we propose a geographical scenario for the dissemination of HIV-1B in the Americas, based on phylogenetic and genetic statistical analyses of 313 available sequences of the pol gene from 27 countries. Maximum likelihood and bayesian inference methods were used to explore the phylogenetic relationships between HIV-1B sequences, and molecular variance estimates were analyzed to infer the genetic structure of the viral population. We found that the initial dissemination and subsequent spread of subtype B in the Americas occurred via a single introduction event in the Caribbean around 1964 (1950-1967). Phylogenetic trees present evidence of several primary outbreaks in countries in South America, directly seeded by the Caribbean epidemic. Cuba is an exception insofar as its epidemic seems to have been introduced from South America. One clade comprising isolates from different countries emerged in the most-derived branches, reflecting the intense circulation of the virus throughout the American continents. Statistical analysis supports the genetic compartmentalization of the virus among the Americas, with a close relationship between the South American and Caribbean epidemics. These findings reflect the complex establishment of the HIV-1B pandemic and contribute to our understanding between the migration process of human populations and virus diffusion.

AIDS in Brazilian children: history, surveillance, antiretroviral therapy, and epidemiologic transition, 1984-2008.

We present a systematic review of historical, political, and epidemiologic aspects of AIDS in Brazilian children. Over 25 years, Brazil has developed different strategies to control AIDS in children. Three revisions of criteria for defining AIDS cases in children and nine national guidelines on antiretroviral therapy administration for management of HIV infection were published. These guidelines represent important progress, including aspects of HIV/AIDS surveillance, antiretroviral treatment, opportunistic conditions, prophylaxis, and laboratory testing. Brazil has significantly expanded access to free therapy with different classes of antiretroviral drugs. Initially focusing on treatment for HIV and opportunistic conditions, the scope of treatment guidelines gradually expanded to comprehensive health care for children and adolescents. From 1996 to 2008, the number of AIDS cases and deaths in children has been reduced by 67% and 65%, respectively, as a result of different strategies to prevent mother-to-child transmission of HIV and highly active antiretroviral therapy administration to infected children. Improved morbidity, mortality, and survival of Brazilian children with AIDS demonstrate clear benefits of adopting a policy of free and universal access to antiretroviral drugs associated with comprehensive care. However, important issues remain to be resolved, mainly concerning social, operational, and regional inequalities in coverage and quality of care, and epidemiological surveillance in different regions of the country. This broad review shows that the overall situation of pediatric AIDS in Brazil represents an incomplete process of epidemiologic and demographic transition, with the coexistence of old and new clinical and epidemiologic challenges.

Guía de terapia antirretroviral en adultos con VIH / Guide antiretroviral therapy in adults with HIV

La Dirección General de Servicios de Salud a través del Componente de ITS,VIH, y SIDA del Minitserio de Salud y la Asociación Nicaraguense de Infectología, han elaborado estas recomendaciones de tratamiento, dirigidas a médicos generales y médicos especialistas con el objetivo de brindar las herramientas necesarias que permitan al clínico la toma de decisiones sobre las diferentes esquemas terapéuticos para el manejo de la infección por VIH, e infecciones Oportunistas en el entorno de la atención integral de las personas con VIH en nuestro país. Además esta guía trata de abordar los diferentes tópicos de manera sencilla y esquematizada para facilitar su implementación en diferentes niveles de atención institucional. Estos tópicos incluyen aspectos relacionados al diagnóstico de la infección, a los criterios de inicio y cambio de la TAR en adultos, asi como el abordaje integral tanto a nivel ambulatorio como hospitalario...

A 27 años del descubrimiento del VIH: breve historia de una nueva enfermedad del siglo XX / 27 years from the discovery of the Human Immunodeficiency Virus: short history of a new disease of the XX Century

Se trata de abordar de manera breve la historia del descubrimiento del virus VIH productor del Síndrome de Inmunodeficiencia Adquirida (SIDA). Se exponen las teorías que tratan de explicar su surgimiento así como las más aceptadas en estos momentos. Se reconoce el surgimiento en África del virus, así como su presencia anterior a la década de los 80 del pasado siglo. También se hace una breve reseña del estado actual de las investigaciones acerca de la terapéutica y la búsqueda de una vacuna, que se dificulta por las trasformaciones génicas del propio virus teniendo una variabilidad de recombinación elevada, por lo que lo más eficaz en estos momentos constituye aún la prevención(AU)

In a short way we approached the history of the discovery of the Human Immunodeficiency Virus causing the Adult's Immunodeficiency Syndrome. We expose all the theories that try to explain its beggining and also those wich are more accepted at this moment. We recognize the emergency of the virus in Africa, and also its precense before the 80 es of the last century. We also make a short review on the current status of the investigations on its therapeutics and on the searchs for a vaccine, difficulted by genic transformations of the proper virus, which shows an elevated recombination variability. That is why, prevention is the most eficaceous way of avoiding it(AU)

A 27 años del descubrimiento del VIH: breve historia de una nueva enfermedad del siglo XX / 27 years from the discovery of the Human Immunodeficiency Virus: short history of a new disease of the XX Century

Se trata de abordar de manera breve la historia del descubrimiento del virus VIH productor del Síndrome de Inmunodeficiencia Adquirida (SIDA). Se exponen las teorías que tratan de explicar su surgimiento así como las más aceptadas en estos momentos. Se reconoce el surgimiento en África del virus, así como su presencia anterior a la década de los 80 del pasado siglo. También se hace una breve reseña del estado actual de las investigaciones acerca de la terapéutica y la búsqueda de una vacuna, que se dificulta por las trasformaciones génicas del propio virus teniendo una variabilidad de recombinación elevada, por lo que lo más eficaz en estos momentos constituye aún la prevención.

In a short way we approached the history of the discovery of the Human Immunodeficiency Virus causing the Adult's Immunodeficiency Syndrome. We expose all the theories that try to explain its beggining and also those wich are more accepted at this moment. We recognize the emergency of the virus in Africa, and also its precense before the 80 es of the last century. We also make a short review on the current status of the investigations on its therapeutics and on the searchs for a vaccine, difficulted by genic transformations of the proper virus, which shows an elevated recombination variability. That is why, prevention is the most eficaceous way of avoiding it.

[Casa Siloé: the history of an NGO for children with HIV/AIDS]. / Casa Siloé: a história de uma ONG para crianças portadoras de HIV/aids.

Casa Siloé (Siloam House) is a Catholic support house that shelters children with human immunodeficiency virus or acquired immunodeficiency syndrome. The article presents a history of the institution and discusses its work. A qualitative approach was used, relying on oral history techniques and documental analysis. Eight key informants were interviewed: the president of the institution, two coordinators who worked at the home, a member of the supporting foundation, a volunteer social worker, a member of the state NGO/AIDS forum, a physician, and a psychologist from the state public service. Topics addressed include the Catholic Church and AIDS, community mobilization, the Casa Siloé, the State and civil society, and project evaluation and outlook.

O ensino da medicina através das humanidades médicas: análise do filme And the band played on e seu uso em atividades de ensino/aprendizagem em educação médica / Teaching medecine through medical humanities: analysis of the movie 'And the band played on'and its use in teaching/leaarning activities in medical education

O uso de uma atividade instrucional específica nas Artes Cinemáticas (enquanto Humanidade Médica) para mediar o ensino/aprendizagem de objetivos humanísticos na Educação Médica. Analisou-se o filme And the band played on, identificaram-se aspectos médicos relevantes e proveram-se exemplos concretos do uso da discussão do filme como atividade instrucional. A análise fílmica abordou aspectos narratológicos e estilísticos, gerando interpretações centradas na crise vocacional do protagonista e na análise da instância narrativa. /This thesis proposes the use of a specific instructional activity in the Cinematic Arts (as Medical Humanities) to mediate the teaching/learning of humanistic objectives in Medical Education. The movie And the band played on was analyzed, relevant medical aspects were identified and concrete examples were provided to attest to the potential use of the film discussion as instructional activity. Film analysis consisted of narratological elationship and breaking bad news were approached...