Rates of adverse events of antiretroviral therapy in women living with HIV/AIDS: a systematic review and meta-analysis.

OBJECTIVE: There is limited information regarding the incidence of treatment-related adverse events (AE) following antiretroviral therapy (ART) in women. So, this review aimed to describe the incidence of AE of ART in women living with HIV/AIDS. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, Cochrane Library, Epistemonikos, Lilacs and Who Index, from inception to 9 April 2023. ELIGIBILITY CRITERIA: We included randomised controlled trials with at least 12 weeks of follow-up and evaluated AE of ART in women at any age living with HIV/AIDS, without restrictions on status, year or language of publication. We excluded post hoc or secondary analyses and open-label extensions without comparator, and trials involving pregnant or breastfeeding women or with a focus on coinfection with tuberculosis, hepatitis B or C. The primary outcomes were the incidence rate of participants with any clinical and/or laboratory AE related or not to ART and treatment discontinuation. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed the risk of bias using Cochrane's risk of bias tool 2. We used Bayesian random-effects meta-analysis to summarise event rates. Results were presented as event rates per 1000 person-years (95% credibility intervals, 95% CrI). The pooled incidence rate per 1000 person-years adjusted for duration and loss to follow-up was estimated. We assessed the certainty of the evidence using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS: A total of 24 339 studies were identified for screening, of which 10 studies (2871 women) met the eligibility criteria, with 11 different antiretrovirals (ARVs) regimens. Seven studies included exclusively women, while in the remaining three, the proportion of women ranged from 11% to 46%. Nine studies received industry funding. The pooled analysis showed a mean incidence rate of ART-related clinical and laboratory AE of 341.60 events per 1000 person-years (95% CrI 133.60-862.70), treatment discontinuation of 20.78 events per 1000 person-years (95% CrI 5.58-57.31) and ART-related discontinuation of 4.31 per 1000 person-years (95% CrI 0.13-54.72). Summary estimates were subject to significant uncertainty due to the limited number of studies and sparse data. The certainty of the evidence was graded as very low for all outcomes assessed. CONCLUSION: Existing randomised trials do not provide sufficient evidence on the incidence rates of safety outcomes from antiretroviral treatment in women living with HIV/AIDS. Large comparative studies in well-characterised populations are needed to provide a more comprehensive landscape of the safety profile of these ARV therapies in women with HIV/AIDS. PROSPERO REGISTRATION NUMBER: CRD42021251051.

Online course on vaccinating people with HIV/AIDS - effectiveness in the knowledge of nursing professionals.

OBJECTIVE: analyzing the effectiveness of an educational intervention on the knowledge of nursing professionals regarding the immunization of people with the human immunodeficiency virus. METHOD: a quasi-experimental study evaluated professionals' knowledge through a knowledge test applied before and after the development of an online training course. The data was analyzed using frequency, median, mean, standard deviation, and association tests. RESULTS: the sample consisted of 77 nursing professionals whose mean age was 43.2 years (SD+/-8.2). More than half of the individuals worked in basic health units (58.4%), 22.1% worked in specialized services that provide clinical monitoring for people with the human immunodeficiency virus, and 42 (54.5%) were nursing assistants or technicians. The professionals' performance improved after the intervention, with an increase in the median number of correct answers from 23.0 to 27.0 (p<0.001). CONCLUSION: offering an online training course on the immunization of people with the human immunodeficiency virus, as a continuing education activity, proved to be effective in improving nursing professionals' knowledge on this subject. HIGHLIGHTS: (1) Services do not evaluate the vaccination status of people living with HIV.(2) The knowledge of health professionals may influence vaccination rates.(3) Health professionals' knowledge of immunization may be insufficient.

Role of Proinflammatory Cytokines and Genetic Factors Related to Metabolic Alterations in People Living with HIV/AIDS.

Metabolic alterations are a common problem in people living with HIV (PLHIV), as a result of a stage of chronic inflammation that affects the homeostasis of the organism. Prolonged exposure to antiretroviral therapy has been associated with developing lipodystrophies that modify lipoprotein metabolism and inflammatory markers such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), which are mediators of the immune response. The study aimed to associate TNF-α and IL-6 levels with their polymorphisms and metabolic alterations in PLIHV. We hypothesized that TNF-α and IL-6 levels and their polymorphisms are associated with metabolic alterations. In total, 185 PLHIV and 51 HIV-negative people were included. Biochemical parameters were determined by colorimetric assay, cytokine levels by immunoassay, and allelic discrimination by quantitative polymerase chain reaction. A correlation was found between TNF-α levels and the variables cholesterol (r = -0.171, P = 0.020) and high-density lipoprotein (HDL) (r = -0.245, P = 0.001). There are associations between HDL levels (P = 0.011) and GG genotype of rs1800629. The results suggest a metabolic alteration related to the constant immune response, especially the production of proinflammatory cytokines such as TNF-α and IL-6. It was observed that genetic factors may influence metabolism alteration, mainly in lipids.

The impact of primary health care on AIDS incidence and mortality: A cohort study of 3.4 million Brazilians.

BACKGROUND: Primary Health Care (PHC) is essential for effective, efficient, and more equitable health systems for all people, including those living with HIV/AIDS. This study evaluated the impact of the exposure to one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality. METHODS AND FINDINGS: A retrospective cohort study carried out in Brazil from January 1, 2007 to December 31, 2015. We conducted an impact evaluation using a cohort of 3,435,068 ≥13 years low-income individuals who were members of the 100 Million Brazilians Cohort, linked to AIDS diagnoses and deaths registries. We evaluated the impact of FHS on AIDS incidence and mortality and compared outcomes between residents of municipalities with low or no FHS coverage (unexposed) with those in municipalities with 100% FHS coverage (exposed). We used multivariable Poisson regressions adjusted for all relevant municipal and individual-level demographic, socioeconomic, and contextual variables, and weighted with inverse probability of treatment weighting (IPTW). We also estimated the FHS impact by sex and age and performed a wide range of sensitivity and triangulation analyses; 100% FHS coverage was associated with lower AIDS incidence (rate ratio [RR]: 0.76, 95% CI: 0.68 to 0.84) and mortality (RR: 0.68, 95%CI: 0.56 to 0.82). FHS impact was similar between men and women, but was larger in people aged ≥35 years old both for incidence (RR: 0.62, 95% CI: 0.53 to 0.72) and mortality (RR: 0.56, 95% CI: 0.43 to 0.72). The absence of important confounding variables (e.g., sexual behavior) is a key limitation of this study. CONCLUSIONS: AIDS should be an avoidable outcome for most people living with HIV today and our study shows that FHS coverage could significantly reduce AIDS incidence and mortality among low-income populations in Brazil. Universal access to comprehensive healthcare through community-based PHC programs should be promoted to achieve the Sustainable Development Goals of ending AIDS by 2030.

The challenges of Chile to achieve control the HIV/AIDS pandemic the year 2030: A review.

Chile is contending with the highest rates of new human immunodeficiency virus (HIV) cases in both Latin America and globally, despite substantial ongoing investments in treatment. This comprehensive study, derived from PUBMED and Google searches, ANID data, and various organizational reports, highlights key areas for improvement. Over the past decade, Chile's annual infection rate has risen, signaling an urgent need for detailed analysis and effective solutions. The study includes 44 references, comprising 32 scientific articles and 12 reports from entities like the WHO and the Pan American Health Organization. Data was meticulously collected through diverse means, such as scientific congresses, meetings with authorities, and direct data requests. Fourteen critical points are identified for addressing the HIV epidemic in Chile, spanning from legislative reforms to enhanced prevention campaigns. Key recommendations include universal diagnosis, decentralized healthcare, the availability of self-tests, and a focus on mental health and the impact of migration. Despite Chile's strong economic indicators, factors such as inadequate sexual education, outdated legislation, and centralized diagnostic processes contribute to the persistent increase in new cases. The study underscores the pressing need for enhanced investment in prevention policies. Chile faces significant challenges in meeting the 90/90/90 targets, yet there is optimism in aiming for the 95/95/95 strategy by 2030. Achieving success requires a global commitment, an emphasis on prevention, and collaborative efforts among authorities, healthcare providers, and patients. Overcoming these identified barriers is essential for Chile to reach its ambitious goal and ultimately end the HIV epidemic.

Valganciclovir e ganciclovir para profilaxia e tratamento de infecções pelo citomegalovírus (CMV) em pacientes imunossuprimidos pelo HIV / Valganciclovir and ganciclovir for prophylaxis and treatment of cytomegalovirus (CMV) infections in HIV-immunosuppressed patients

INTRODUÇÃO: O HIV é o agente causador da Síndrome da Imunodeficiência Adquirida (Aids), uma doença sexualmente transmissível, que compromete o sistema imunológico dos pacientes. Estima-se haver mais de um milhão de pessoas vivendo com HIV/Aids (PVHA) no Brasil. Entre as possíveis comorbidades associada à Aids estão as infecções oportunistas e, dentre elas, as infecções causadas pelo CMV. Infecções por CMV em pacientes imunocompetentes normalmente são brandas e não demandam tratamento medicamentoso. Entretanto, em pacientes imunocomprometidos, a infecção pode ser grave, acometendo a retina (retinopatia) e o trato gastrointestinal. O ganciclovir intravenoso (IV) ou o valganciclovir para tratamento de CMV em PVHA podem ser utilizados, mas nenhuma dessas tecnologias foi avaliada pela Conitec para esta indicação. PERGUNTA: Valganciclovir e ganciclovir são eficazes, efetivos, seguros e custo-efetivos para o tratamento e profilaxia de infecções por CMV em pacientes adultos e crianças imunossuprimidos pelo HIV? EVIDÊNCIAS CLÍNICAS: A análise das evidências disponíveis na literatura permitiu constatar a eficá

Padrão temporal, distribuição espacial e fatores associados a incidência de HIV/AIDS entre jovens no Brasil / Temporal pattern, spatial distribution, and factors associated with the incidence of HIV/AIDS among young people in Brazil / Patrón temporal, distribución espacial y factores asociados a la incidencia de la infección por el VIH/sida en jóvenes en Brasil

[RESUMO]. Objetivo. Descrever o padrão temporal e espacial e identificar os fatores associados a incidência de HIV/ AIDS entre jovens no Brasil. Método. Estudo ecológico que incluiu jovens brasileiros de 15 a 24 anos notificados com HIV/AIDS de 2001 a 2021. Utilizou-se o método joinpoint para a análise temporal. Aglomerados espaciais foram detectados pelos métodos Bayesiano, autocorrelação espacial, Getis-Ord Gi* e Varredura Scan. Quatro modelos de regressão não espacial e espacial foram usados para identificar fatores associados ao desfecho. Todas as análises estatísticas consideraram p < 0,05. Resultados. No Brasil, a incidência média foi de 12,29 por 100 000 habitantes, com aumento de 7,3% ao ano no período 2007-2014 e posterior decréscimo de 3,4% em 2014-2021. Observou-se padrão Alto/Alto e hots- pots, principalmente em municípios do Sul, Sudeste, Centro-Oeste e Norte. O cluster primário localizou-se em 572 municípios do Rio Grande do Sul e Santa Catarina e os maiores riscos relativos em Manaus (Amazonas) e Rondonópolis (Mato Grosso). A taxa de analfabetismo (β = -0,08), Índice de GINI (β = -3,74) e Cobertura da Estratégia de Saúde da Família (β = -0,70) apresentaram relação negativa com o desfecho. Em contrapar- tida, o Índice Firjan de Desenvolvimento Municipal (β = 2,37), o Índice de Vulnerabilidade Social (β = 6,30), o percentual de pessoas que recebem o Bolsa Família (β = 0,04) e renda per capita (β = 0,008) apresentaram associação positiva. Conclusão. Houve tendência de aumento da incidência de HIV/AIDS até 2014 com posterior declínio até 2021. Aglomerados de altas taxas concentraram-se, especialmente, em municípios das regiões Norte, Sul, Sudeste e Centro-Oeste. Indicadores de vulnerabilidade socioeconômica influenciam o desfecho positiva- mente ou negativamente, dependendo do território investigado.

[ABSTRACT]. Objective. To describe temporal and spatial patterns and identify the factors associated with the incidence of HIV/AIDS among young people in Brazil. Method. Ecological study of young Brazilians aged 15-24 years with reported HIV/AIDS, from 2001 to 2021. The Joinpoint method was used for the temporal analysis. Spatial clusters were detected using Bayesian methods, spatial autocorrelation, Getis-Ord Gi*, and scan techniques. Four non-spatial and spatial regression models were used to identify factors associated with the result. All statistical analyses considered p < 0.05. Results. In Brazil, the average incidence was 12.29 per 100 000 inhabitants, with an annual increase of 7.3% in the period 2007-2014 and a subsequent 3.4% decrease in 2014-2021. A high-high pattern and hotspots were observed, mainly in municipalities in the South, Southeast, Central-West, and North regions. The primary cluster was located in 572 municipalities in Rio Grande do Sul and Santa Catarina, with the highest relative risks in Manaus (Amazonas) and Rondonópolis (Mato Grosso). The illiteracy rate (β = -0.08), GINI Index (β = -3.74) and Family Health Strategy coverage (β = -0.70) were negatively associated with the result. In contrast, the Firjan Municipal Development Index (β = 2.37), Social Vulnerability Index (β = 6.30), percentage of Bolsa Família recipients (β = 0.04), and per capita income (β = 0.008) showed a positive association. Conclusion. There was an upward trend in the incidence of HIV/AIDS until 2014, followed by a decline until 2021. High-rate clusters were concentrated in municipalities in the North, South, Southeast and Central-West regions in particular. Indicators of socioeconomic vulnerability had positive or negative effects on the result, depending on the territory investigated.

[RESUMEN]. Objetivo. Describir el patrón temporal y espacial, y determinar los factores asociados a la incidencia de infec- ción por el VIH/sida en jóvenes en Brasil. Método. Estudio ecológico en jóvenes brasileños de 15 a 24 años con diagnóstico de infección por el VIH/ sida en el período 2001-2021. Para el análisis temporal se utilizó el método de regresión de puntos de infle- xión (joinpoint). Los conglomerados espaciales se detectaron con métodos Bayesianos y de autocorrelación espacial, Gi* de Getis-Ord y escaneo. Se utilizaron cuatro modelos de regresión espacial y no espacial para detectar los factores asociados al resultado. En todos los análisis estadísticos se estableció un valor de p < 0,05 como umbral de significación. Resultados. En Brasil, la incidencia media fue de 12,29 por 100 000 habitantes, con un aumento del 7,3% anual en el período 2007-2014 y una reducción posterior del 3,4% en el período 2014-2021. Se observó un patrón alto/alto y la presencia de puntos calientes, principalmente en municipios del Sur, Sudeste, Centro- Oeste y Norte. El principal conglomerado se localizó en 572 municipios de Rio Grande do Sul y Santa Catarina, y los riesgos relativos más altos se observaron en Manaus (Amazonas) y Rondonópolis (Mato Grosso). La tasa de analfabetismo (β = -0,08), el índice de Gini (β = -3,74) y la cobertura de la estrategia de salud familiar (β = -0,70) mostraron una asociación negativa con el resultado. En cambio, el índice de Firjan de desarrollo muni- cipal (β = 2,37), el índice de vulnerabilidad social (β = 6,30), el porcentaje de personas que reciben ayuda del programa de bienestar social Bolsa Família (β = 0,04) y los ingresos per cápita (β = 0,008) mostraron una asociación positiva. Conclusión. Hubo una tendencia al aumento de la incidencia de infección por el VIH/sida hasta el 2014, con una reducción posterior hasta el 2021. Los conglomerados de tasas elevadas se concentraron especialmente en los municipios de las regiones Norte, Sur, Sudeste y Centro-Oeste. Los indicadores de vulnerabilidad socioeconómica tienen una influencia positiva o negativa en el resultado, según el territorio investigado.

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.

["Revealing in the gerund": secrecy and stigma in practices of care for children and adolescents living with HIV/Aids]. / "Revelando", no gerúndio: segredo e estigma nas práticas de cuidado às crianças e adolescentes vivendo com HIV/Aids.

This article analyzes practices of care and the HIV diagnosis disclosure process to children and adolescents living with HIV/AIDS. A case study was conducted in an outpatient clinic located in a public hospital in Rio de Janeiro through participant observation, semi-structured interviews with health professionals, and the consultation of documents produced by the professionals. The analysis, based on the sociology of Simmel and Goffman, points to the revelation of the diagnosis as a hallmark that accompanies all the care established with users and sheds light on issues such as secrecy, stigma and the possible understandings about the health condition established. As a result, institutionalized relationships contribute to a progressive contact with the condition of bearing a stigma and enable phases of a patient's life protected by information to exist.

O artigo analisa as práticas de cuidado e o processo de revelação do diagnóstico a crianças e adolescentes vivendo com HIV/Aids. Foi realizado um estudo de caso em um ambulatório localizado em um hospital público do Rio de Janeiro (RJ), através de observação participante, entrevistas semiestruturadas com profissionais de saúde e consulta a documentos produzidos pelos profissionais. A análise, baseada na sociologia de Simmel e Goffman, aponta a revelação do diagnóstico como uma marca que acompanha todo o cuidado estabelecido com os usuários e dá luz a questões como o segredo, o estigma e as possíveis compreensões acerca da condição de saúde estabelecidas. Com isso, as relações institucionalizadas contribuem para um progressivo contato com a condição de portador de um estigma e fazem existir fases de uma carreira de doente protegido pela informação.

Predictive models-assisted diagnosis of AIDS-associated Pneumocystis jirovecii pneumonia in the emergency room, based on clinical, laboratory, and radiological data.

We assessed predictive models (PMs) for diagnosing Pneumocystis jirovecii pneumonia (PCP) in AIDS patients seen in the emergency room (ER), aiming to guide empirical treatment decisions. Data from suspected PCP cases among AIDS patients were gathered prospectively at a reference hospital's ER, with diagnoses later confirmed through sputum PCR analysis. We compared clinical, laboratory, and radiological data between PCP and non-PCP groups, using the Boruta algorithm to confirm significant differences. We evaluated ten PMs tailored for various ERs resource levels to diagnose PCP. Four scenarios were created, two based on X-ray findings (diffuse interstitial infiltrate) and two on CT scans ("ground-glass"), incorporating mandatory variables: lactate dehydrogenase, O2sat, C-reactive protein, respiratory rate (> 24 bpm), and dry cough. We also assessed HIV viral load and CD4 cell count. Among the 86 patients in the study, each model considered either 6 or 8 parameters, depending on the scenario. Many models performed well, with accuracy, precision, recall, and AUC scores > 0.8. Notably, nearest neighbor and naïve Bayes excelled (scores > 0.9) in specific scenarios. Surprisingly, HIV viral load and CD4 cell count did not improve model performance. In conclusion, ER-based PMs using readily available data can significantly aid PCP treatment decisions in AIDS patients.

Serophobia related to HIV and AIDS: what is debated in digital social networks in Brazil? / Sorofobia relacionada ao HIV e à Aids: o que se debate nas redes sociais digitais no Brasil?

The aim of this article is to analyze the serophobic content explicit in the publications published in Digital Social Networks in the context of HIV and AIDS in Brazil. This is a qualitative study of the descriptive exploratory type, based on documents. The data obtained were evaluated using the methodology of documentary analysis through Thematic Content Analysis with the aid of NVivo®12 Plus (Windows). A total of 187 codes were generated, subsequently grouped according to the semantics of the words, originating five thematic categories: #LivingWithHIV, #WeNeedtoTalkAboutIt, #WhatISSEROPHOBIA, #SerophobiaIsACrime, and #NoSerophobia. The results showed the main manifestations of HIV and AIDS-related serophobia on social networks. The shared content discussed the difficulties of living with a disease that has social dimensions; the relevance of talking and disseminating content about HIV and AIDS; the elements that make up the stigmatization process and, consequently, structure serophobia in society; the social and civil rights of people living with HIV; measures to combat serophobia in health institutions; and the implications of serophobia in the field of public health.

O objetivo do artigo é analisar o conteúdo sorofóbico explicitado nas publicações veiculadas nas redes sociais digitais no contexto do HIV e da Aids no Brasil. Trata-se de um estudo qualitativo do tipo exploratório descritivo, de base documental. Os dados obtidos foram avaliados utilizando a metodologia de análise documental por meio da análise de conteúdo temático com auxílio do software NVivo®12 Plus (Windows). Foram gerados 187 códigos, posteriormente agrupados conforme a semântica das palavras, originando cinco categorias temáticas: #VivendoComHIV, #PrecisamosFalarSobreIsso, #OQueÉSOROFOBIA, #SorofobiaéCrime e #SorofobiaNÃO. Os resultados evidenciaram as principais manifestações acerca da sorofobia relacionada ao HIV e à Aids nas redes sociais. O conteúdo compartilhado debateu as dificuldades de viver com uma doença que apresenta dimensões sociais; a relevância de falar e difundir conteúdo sobre o HIV e a Aids; os elementos que compõem o processo de estigmatização e, consequentemente, estruturam a sorofobia na sociedade; os direitos sociais e civis das pessoas vivendo com HIV; as medidas de combate à sorofobia nas instituições de saúde; e as implicações da sorofobia no âmbito da saúde pública.

Evaluating social protection mitigation effects on HIV/AIDS and Tuberculosis through a mathematical modelling study.

The global economic downturn due to the COVID-19 pandemic, war in Ukraine, and worldwide inflation surge may have a profound impact on poverty-related infectious diseases, especially in low-and middle-income countries (LMICs). In this work, we developed mathematical models for HIV/AIDS and Tuberculosis (TB) in Brazil, one of the largest and most unequal LMICs, incorporating poverty rates and temporal dynamics to evaluate and forecast the impact of the increase in poverty due to the economic crisis, and estimate the mitigation effects of alternative poverty-reduction policies on the incidence and mortality from AIDS and TB up to 2030. Three main intervention scenarios were simulated-an economic crisis followed by the implementation of social protection policies with none, moderate, or strong coverage-evaluating the incidence and mortality from AIDS and TB. Without social protection policies to mitigate the impact of the economic crisis, the burden of HIV/AIDS and TB would be significantly larger over the next decade, being responsible in 2030 for an incidence 13% (95% CI 4-31%) and mortality 21% (95% CI 12-34%) higher for HIV/AIDS, and an incidence 16% (95% CI 10-25%) and mortality 22% (95% CI 15-31%) higher for TB, if compared with a scenario of moderate social protection. These differences would be significantly larger if compared with a scenario of strong social protection, resulting in more than 230,000 cases and 34,000 deaths from AIDS and TB averted over the next decade in Brazil. Using a comprehensive approach, that integrated economic forecasting with mathematical and epidemiological models, we were able to show the importance of implementing robust social protection policies to avert a significant increase in incidence and mortality from AIDS and TB during the current global economic downturn.

ST88 ceftazidime-resistant Stenotrophomonas maltophilia is present in the saliva and gingival crevicular fluid of patients with periodontitis and AIDS from São Paulo State, Brazil.

Stenotrophomonas maltophilia (S. maltophilia) is an intrinsically drug-resistant and biofilm-forming bacteria causing infections in immunocompromised humans. This study reports the isolation of five S. maltophilia strains from saliva and gingival crevicular fluid (GCF) of AIDS patients with periodontitis in São Paulo, Brazil, showing resistance to ceftazidime, strong biofilm formation capacity and a close genetic relationship. The presence of S. maltophilia strains in saliva and CGF of patients with AIDS and periodontitis is a concern for the presence and persistence of intrinsically resistant bacteria in the oral environment, enhancing the risk for the development of severe infections in immunocompromised patients.

Social stigma towards people with HIV/AIDS, in dentistry students from Concepción

Objective: Characterize HIV/AIDS Social stigma towards people with HIV/AIDS in a sample of dentistry students from Concepción. Materials and methods: Cultural adaptation and pre-test were developed for the Stigma and HIV/AIDS Scale in dental students. Researchers collected the data from the instrument, demographic (sex/age), and academic information (course/training in HIV/AIDS, knowing a person with HIV/AIDS, provision of dental services to people living with HIV/AIDS [PLHIV]). To characterize the sample, univariate and bivariate descriptive statistics were performed with absolute and relative frequencies; the reliability of the scale was assessed with Cronbach's alpha; the relationship between the quantitative and ordinal variables was analyzed with the Spearman correlation coefficient. Results: The final sample comprised 138 dental students, whereas most of them reported not having training in HIV/AIDS nor providing dental services to PLHIV. Stigma and HIV/AIDS Scale showed good reliability. Two items expressing that PLHIV must disclose their condition to health professionals so they can take precautions have the highest values. A weak inverse correlation was found between Stigma and the variables age and course. Conclusions: Dental school students from Universidad of Concepción have a low social stigma towards people with HIV/AIDS. Items regarding professional practice showed higher stigma levels.

Microsporum canis pseudomycetoma and disseminated Mycobacterium genavense infection in an HIV/AIDS patient, an unusual combination.

Pseudomycetomas are rare fungal subcutaneous infections caused by dermatophytes, which are mainly observed in immunocompromised patients. Mycobacterium genavense is considered an opportunistic pathogen in people living with HIV/AIDS (PLWHA), clinically resembling the presentation of Mycobacterium avium complex (MAC). Here, we describe the case of a 26-year-old PLWHA with a 3-month history of a 4cm tumoral, duroelastic and painful lesion located on the back. Histopathology of the tumoral lesion revealed chronic granulomatous inflammation with grains composed of PAS-positive and Grocott-positive septate hyphae, as well as acid-fast bacilli (AFB). Culture on Sabouraud and lactrimel agar developed colonies that were later identified as Microsporum canis. In successive samples, the AFB were identified as M. genavense by restriction analysis of PCR products. Immunocompromised PLWHA not only suffer increased susceptibility to diseases due to unusual pathogens but also atypical clinical presentation of frequently encountered pathogens.

HIV and AIDS in the state of Paraná, Brazil, 2007-2022: trends and spatiotemporal distribution.

OBJECTIVE: The aim of this study was to analyze the spatiotemporal evolution of the incidence rates of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the state of Paraná, Brazil. METHODS: An ecological study with an analytical component of time series analysis was conducted in the state of Paraná from 2007 to 2022. The data source was the Notifiable Diseases Information System. To study the trend, the Prais-Winsten generalized linear regression model was used by decomposing the time series, and for spatial analysis, the Moran's index was applied. RESULTS: The total sample consisted of 50,676 HIV/AIDS records. The incidence rate showed an increasing trend, with an average growth of 2.14% [95% confidence interval - 95%CI 1.16-3.13] per month. From 2007 to 2014 and from 2015 to 2022, the average number of cases in the state was 105.64 and 159.20 per 100,000 inhabitants, respectively, with significant variation among municipalities. Spatial clusters of high risk persisted in the metropolitan region, the capital, and coastal areas, and a new cluster was observed in the northern region of the state. CONCLUSION: The incidence rates of HIV/AIDS showed an upward trend over time. The number of cases varied considerably in some municipalities, especially in the coastal region. Spatial analysis revealed geospatial patterns of high risk in the main metropolitan areas of Paraná: Curitiba (including the coastal area), Londrina, and Maringá, which share characteristics such as a high degree of urbanization and ongoing economic development.

Insights, experiences, and perspectives on the rapid diagnosis of tuberculosis, histoplasmosis, and cryptococcosis in people with advanced HIV disease in Porto Alegre

People living with HIV (PLHIV) with severe advanced disease are at high risk of developing opportunistic infections and may face barriers related to diagnosis and treatment. The objective of this study was to describe insights, experiences and perspectives around the feasibility of implementing a package for the rapid diagnosis of frequent opportunistic infections among patients with advanced HIV, in order to support the development and implementation of HIV care policies. The study was carried out between June 30 and October 30, 2023, comprising two focus groups with health professionals involved in the rapid diagnosis intervention (n=10); four in-depth interviews with health managers dedicated to HIV care policies; and 12 interviews with patients with advanced HIV. The intervention in question was considered relevant for allowing a more timely diagnosis of diseases that are difficult to investigate. Patient compliance was generally collaborative, especially in research hospitals, but more vulnerable patients may require expanded psychosocial support. Among the barriers, delays in results, communication challenges between professionals and patients were highlighted, as well as the lack of alignment in the flow of exam request, collection, results and communication for patients and the extended team. At the management level, the importance of integrating the intervention into the line of care for patients with HIV was highlighted. It is relevant to investigate the issue of social determinants of HIV/AIDS mortality in the future to provide valuable insights into improving prevention and treatment strategies.

Linfoma de células B primario de mama en una paciente con sida. Presentación de un caso y revisión de la literatura / Primary B-cell lymphoma of the breast in an AIDS patient. Case report and literature review

Los LNH constituyen la segunda neoplasia más frecuente en pacientes con VIH. Estas neoplasias están ligadas a la inmunodeficiencia, suelen ser de período de latencia prolongado y más frecuentes en hombres. Más del 95% de estas neoplasias son de fenotipo B, de alto grado de malignidad, extranodales y representan la causa de muerte en un 12% al 16% de los casos. El linfoma no Hodgkin primitivo de mama (LPM) es una entidad infrecuente, que representa el 2,2% de todos los linfomas extranodales y el 0,5% de todas las neoplasias malignas de la mama. Se presenta una mujer con sida y linfoma primario de mama. (AU)

NHL is the second most common neoplasm in patients with HIV. It is linked to immunodeficiency, tends to have a long latency period and is more common in men. More than 95% of these neoplasms are of phenotype B, high-grade, extranodal and are the cause of death in 12% to 16% of cases. Primitive non-Hodgkin lymphoma of the breast is a rare entity, accounting for 2.2% of all extranodal lymphomas and 0.5% of all breast malignancies. A woman with AIDS and primary breast lymphoma is presented. (AU)

Mortality trend due to HIV/AIDS among women in Porto Alegre/RS from 2007 to 2017 / Tendência de mortalidade por HIV/AIDS entre mulheres em Porto Alegre/RS de 2007 a 2017 / Tendencia de mortalidad por VIH/SIDA entre mujeres en Porto Alegre/RS de 2007 a 2017

Background and Objectives: Porto Alegre is among the state capitals of Brazil with the highest magnitude of epidemiological indicators in relation to people living with HIV/AIDS, impacting the mortality indicators of this population. This study aimed to analyze the temporal trend of deaths from HIV/AIDS in women residents of the city of Porto Alegre, Rio Grande do Sul, Brazil, from 2007 to 2017, considering age groups, skin color and education. Method: this is an ecological time series study on the trend of HIV/AIDS mortality rates among women living with HIV residents in the city of Porto Alegre, RS. Unadjusted and standardized mortality rates were calculated according to age group, skin color and education. For trend analysis, Prais-Winsten generalized linear regression was used. Results: 1,603 deaths related to HIV/AIDS were identified in women living in the city during the study period. Mortality coefficients were higher in white, less educated women, with an increasing trend among those over 60 years of age (95%CI 0.044; 0.029) with a decline for those in the age group between 20 and 29 (95%CI - 0.566; - 0.120). Conclusion: changes in the epidemiological scenario of HIV/AIDS draw attention to the care of people over 60 years of age and with less education, requiring efforts from healthcare networks to prevent deaths.(AU)

Jutificativa e Objetivos: Porto Alegre está entre as capitais estaduais do Brasil com maior magnitude de indicadores epidemiológicos em relação às pessoas vivendo com HIV/AIDS, impactando os indicadores de mortalidade dessa população. Este estudo teve como objetivo analisar a tendência temporal de mortes por HIV/AIDS em mulheres residentes na cidade de Porto Alegre, Rio Grande do Sul, Brasil, de 2007 a 2017, considerando grupos etários, cor da pele e educação. Método: trata-se de um estudo de série temporal ecológica sobre a tendência das taxas de mortalidade por HIV/AIDS entre mulheres vivendo com HIV residentes na cidade de Porto Alegre, RS. As taxas de mortalidade não ajustadas e padronizadas foram calculadas de acordo com grupo etário, cor da pele e educação. Para análise de tendência, foi utilizada regressão linear generalizada de Prais-Winsten. Resultados: Foram identificadas 1.603 mortes relacionadas ao HIV/AIDS em mulheres residentes na cidade durante o período do estudo. Os coeficientes de mortalidade foram mais altos em mulheres brancas, menos escolarizadas, com uma tendência crescente entre aquelas com mais de 60 anos de idade (IC95% 0,044; 0,029) com declínio para aquelas na faixa etária entre 20 e 29 anos (IC95% -0,566; -0,120). Conclusão: Mudanças no cenário epidemiológico do HIV/AIDS chamam a atenção para o cuidado de pessoas com mais de 60 anos de idade e com menor escolaridade, exigindo esforços das redes de saúde para prevenir mortes.(AU)

Antecedentes y Objetivos: Porto Alegre está entre las capitales estatales de Brasil con la mayor magnitud de indicadores epidemiológicos en relación a las personas que viven con VIH/SIDA, impactando los indicadores de mortalidad de esta población. Este estudio tuvo como objetivo analizar la tendencia temporal de muertes por VIH/SIDA en mujeres residentes en la ciudad de Porto Alegre, Rio Grande do Sul, Brasil, de 2007 a 2017, considerando grupos de edad, color de piel y educación. Método: se trata de un estudio de serie temporal ecológica sobre la tendencia de las tasas de mortalidad por VIH/SIDA entre mujeres que viven con VIH residentes en la ciudad de Porto Alegre, RS. Se calcularon tasas de mortalidad no ajustadas y estandarizadas según grupo de edad, color de piel y educación. Para el análisis de tendencia, se utilizó la regresión lineal generalizada de Prais-Winsten. Resultados: Se identificaron 1.603 muertes relacionadas con el VIH/SIDA en mujeres residentes en la ciudad durante el período de estudio. Los coeficientes de mortalidad fueron más altos en mujeres blancas, menos educadas, con una tendencia creciente entre aquellas con más de 60 años de edad (IC95% 0,044; 0,029) con un declive para aquellas en el grupo de edad entre 20 y 29 años (IC95% -0,566; -0,120). Conclusión: Los cambios en el escenario epidemiológico del VIH/SIDA llaman la atención sobre el cuidado de las personas mayores de 60 años y con menor educación, requiriendo esfuerzos de las redes de salud para prevenir muertes.(AU)