Frequency of subtype B and F1 dual infection in HIV-1 positive, Brazilian men who have sex with men.

BACKGROUND: Because various HIV vaccination studies are in progress, it is important to understand how often inter- and intra-subtype co/superinfection occurs in different HIV-infected high-risk groups. This knowledge would aid in the development of future prevention programs. In this cross-sectional study, we report the frequency of subtype B and F1 co-infection in a clinical group of 41 recently HIV-1 infected men who have sex with men (MSM) in São Paulo, Brazil. METHODOLOGY: Proviral HIV-1 DNA was isolated from subject's peripheral blood polymorphonuclear leukocytes that were obtained at the time of enrollment. Each subject was known to be infected with a subtype B virus as determined in a previous study. A small fragment of the integrase gene (nucleotide 4255-4478 of HXB2) was amplified by nested polymerase chain reaction (PCR) using subclade F1 specific primers. The PCR results were further confirmed by phylogenetic analysis. Viral load (VL) data were extrapolated from the medical records of each patient. RESULTS: For the 41 samples from MSM who were recently infected with subtype B virus, it was possible to detect subclade F1 proviral DNA in five patients, which represents a co-infection rate of 12.2%. In subjects with dual infection, the median VL was 5.3 × 10(4) copies/ML, whereas in MSM that were infected with only subtype B virus the median VL was 3.8 × 10(4) copies/ML (p > 0.8). CONCLUSIONS: This study indicated that subtype B and F1 co-infection occurs frequently within the HIV-positive MSM population as suggested by large number of BF1 recombinant viruses reported in Brazil. This finding will help us track the epidemic and provide support for the development of immunization strategies against the HIV.

Avaliação da prevalência de microorganismos e do perfil de resistência bacteriana em uroculturas de pacientes com bexiga neurogênica atendidos em um hospital pediátrico de ensino / Evalluation of the microorganism prevalence and the resistance bacterial profile in urine cultures of patients with neurogenic bladder seeking in a pediatric teching hospital

Bexiga neurogênica é uma disfunção causada por complicações neurológicas que conduzem a um distúrbio no controle da micção e continência, levando à desordem urinária em diferentes graus. A incontinência urinária é o principal sintoma apresentado por pacientes com bexiga neurogênica e a infecção do trato urinário (ITU) é uma das complicações mais frequentes. Este trabalho objetivou avaliar a prevalência de microorganismos e o perfil da resistência bacteriana em uroculturas de pacientes com bexiga neurogênica atendidos no serviço ambulatorial do Hospital de Pediatria da UFRN (HOSPED), no período de novembro de 2009 a novembro de 2010. Trata-se de um estudo observacional, no qual foram coletados dados epidemiológicos e microbiológicos , abordados de forma quantitativa. A média de idade dos pacientes foi de 6,5 anos sendo 53% do sexo masculino e 47% do sexo feminino. A mielomeningocele foi a causa mais comum de bexiga neurogênica (83%). A prevalência de bacteriúria foi de 72%, em grande parte assintomática (64%)... Observou-se grande resistência à ampicilina, amoxicilina/ácido clavulânico e tetraciclina.O perfil antimicrobiano encontrado apresentou maior sensibilidade do que o esperado , provavelmente devido à conduta de não tratar bacteriúria assintomática, estabelecida pelo corpo médico do HOSPED, reservando-se o tratamento para casos sintomáticos.

Characterization of partial and near full-length genomes of HIV-1 strains sampled from recently infected individuals in São Paulo, Brazil.

BACKGROUND: Genetic variability is a major feature of human immunodeficiency virus type 1 (HIV-1) and is considered the key factor frustrating efforts to halt the HIV epidemic. A proper understanding of HIV-1 genomic diversity is a fundamental prerequisite for proper epidemiology, genetic diagnosis, and successful drugs and vaccines design. Here, we report on the partial and near full-length genomic (NFLG) variability of HIV-1 isolates from a well-characterized cohort of recently infected patients in São Paul, Brazil. METHODOLOGY: HIV-1 proviral DNA was extracted from the peripheral blood mononuclear cells of 113 participants. The NFLG and partial fragments were determined by overlapping nested PCR and direct sequencing. The data were phylogenetically analyzed. RESULTS: Of the 113 samples (90.3% male; median age 31 years; 79.6% homosexual men) studied, 77 (68.1%) NFLGs and 32 (29.3%) partial fragments were successfully subtyped. Of the successfully subtyped sequences, 88 (80.7%) were subtype B sequences, 12 (11%) BF1 recombinants, 3 (2.8%) subtype C sequences, 2 (1.8%) BC recombinants and subclade F1 each, 1 (0.9%) CRF02 AG, and 1 (0.9%) CRF31 BC. Primary drug resistance mutations were observed in 14/101 (13.9%) of samples, with 5.9% being resistant to protease inhibitors and nucleoside reverse transcriptase inhibitors (NRTI) and 4.9% resistant to non-NRTIs. Predictions of viral tropism were determined for 86 individuals. X4 or X4 dual or mixed-tropic viruses (X4/DM) were seen in 26 (30.2%) of subjects. The proportion of X4 viruses in homosexuals was detected in 19/69 (27.5%). CONCLUSIONS: Our results confirm the existence of various HIV-1 subtypes circulating in São Paulo, and indicate that subtype B account for the majority of infections. Antiretroviral (ARV) drug resistance is relatively common among recently infected patients. The proportion of X4 viruses in homosexuals was significantly higher than the proportion seen in other study populations.

[Prevalence of methicillin-resistant Staphylococcus spp isolated in a teaching maternity hospital in the city of Natal, State of Rio Grande do Norte]. / Prevalência de Staphylococcus spp resistentes à meticilina isolados em uma maternidade escola da Cidade de Natal, Estado do Rio Grande do Norte.

Analyses on 1,576 clinical specimens from hospitalized patients were performed with the aim of determining the prevalence of methicillin-resistant Staphylococcus spp isolated in the Januário Cicco Teaching Maternity Hospital in Natal, Rio Grande do Norte, in 2002 and 2003. The samples were collected, processed and identified according to standard procedures, for each clinical specimen. In vitro susceptibility profiles were obtained using the Kirby-Bauer method. 188 strains of Staphylococcus spp were isolated: 105 were identified as Staphylococcus aureus and 83 as coagulase-negative Staphylococcus. Staphylococcus aureus was isolated most often in secretions, whereas coagulase-negative Staphylococcus was most prevalent in blood cultures. The high (41.5%) prevalence of methicillin-resistant Staphylococcus spp shows the need for immediate prophylactic measures aimed at impeding the dissemination of this phenomenon.

Prevalência de Staphylococcus spp resistentes à meticilina isolados em uma maternidade escola da Cidade de Natal, Estado do Rio Grande do Norte / Prevalence of methicillin-resistant Staphylococcus spp isolated in a teaching maternity hospital in the city of Natal, State of Rio Grande do Norte

Com o objetivo de determinar a prevalência de Staphylococcus spp resistentes à meticilina isolados na Maternidade Escola Januário Cicco, Natal, RN, no período de 2002 a 2003, analisou-se 1.576 materiais clínicos de pacientes hospitalizados. As amostras foram coletadas, processadas e identificadas conforme procedimento padrão para cada espécime clínico. O perfil de susceptibilidade in vitro foi realizado pelo método de Kirby-Bauer. Isolou-se 188 cepas de Staphylococcus spp, das quais 105 foram identificadas como Staphylococcus aureus e 83 como Staphylococcus coagulase negativos. Staphylococcus aureus foi isolado com mais freqüência em secreções enquanto Staphylococcus coagulase negativos foram mais prevalentes em hemoculturas. A elevada (41,5 por cento) prevalência dos Staphylococcus spp resistentes à meticilina demonstra a necessidade de medidas profiláticas imediatas com o objetivo de impedir a disseminação desse fenômeno.

Analyses on 1,576 clinical specimens from hospitalized patients were performed with the aim of determining the prevalence of methicillin-resistant Staphylococcus spp isolated in the Januário Cicco Teaching Maternity Hospital in Natal, Rio Grande do Norte, in 2002 and 2003. The samples were collected, processed and identified according to standard procedures, for each clinical specimen. In vitro susceptibility profiles were obtained using the Kirby-Bauer method. 188 strains of Staphylococcus spp were isolated: 105 were identified as Staphylococcus aureus and 83 as coagulase-negative Staphylococcus. Staphylococcus aureus was isolated most often in secretions, whereas coagulase-negative Staphylococcus was most prevalent in blood cultures. The high (41.5 percent) prevalence of methicillin-resistant Staphylococcus spp shows the need for immediate prophylactic measures aimed at impeding the dissemination of this phenomenon.

Elevated risk for HIV-1 infection in adolescents and young adults in São Paulo, Brazil.

BACKGROUND: Recent studies have sought to describe HIV infection and transmission characteristics around the world. Identification of early HIV-1 infection is essential to proper surveillance and description of regional transmission trends. In this study we compare people recently infected (RI) with HIV-1, as defined by Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS), to those with chronic infection. METHODOLOGY/PRINCIPAL FINDINGS: Subjects were identified from 2002-2004 at four testing sites in São Paulo. Of 485 HIV-1-positive subjects, 57 (12%) were defined as RI. Of the participants, 165 (34.0%) were aware of their serostatus at the time of HIV-1 testing. This proportion was statistically larger (p<0.001) among the individuals without recent infection (n = 158, 95.8%) compared to 7 individuals (4.2%) with recently acquired HIV-1 infection. In the univariate analysis, RI was more frequent in <25 and >59 years-old age strata (p<0.001). The majority of study participants were male (78.4%), 25 to 45 years-old (65.8%), white (63.2%), single (61.7%), with family income of four or more times the minimum wage (41.0%), but with an equally distributed educational level. Of those individuals infected with HIV-1, the predominant route of infection was sexual contact (89.4%), with both hetero (47.5%) and homosexual (34.5%) exposure. Regarding sexual activity in these individuals, 43.9% reported possible HIV-1 exposure through a seropositive partner, and 49.4% reported multiple partners, with 47% having 2 to 10 partners and 37.4% 11 or more; 53.4% of infected individuals reported condom use sometimes; 34.2% reported non-injecting, recreational drug use and 23.6% were reactive for syphilis by VDRL. Subjects younger than 25 years of age were most vulnerable according to the multivariate analysis. CONCLUSIONS/SIGNIFICANCE: In this study, we evaluated RI individuals and discovered that HIV-1 has been spreading among younger individuals in São Paulo and preventive approaches should, therefore, target this age stratum.

Prevalence of Candida species in umbilical catheters implanted in newborns in Natal, Brazil

All the newborns with umbilical venous catheters, hospitalized in the neonatal intensive care unit at Januário Cicco Maternity Hospital in Natal, Brazil, between January, 2003 and December, 2004 were studied. The prevalence of Candida species in the tips of intra-venous catheters was assessed, as well as the coexisting exposures that the patients were subjected to. Catheter tips were cultivated in blood agar and when yeast culture occurred, the colony was subcultivated for species identification through morphologic and biochemical assays. From a total of 240 catheters, 41 were positive for yeasts, and 34 were submitted to identification. The following agents were isolated: 13 C. albicans (38 percent), 10 Candida parapsilosis (29 percent), 8 C. tropicalis (20 percent), one C. guilliermondii (3 percent), one C. famata (3 percent) and one Trichosporon spp. (3 percent). Three patients among those with positive catheter tip fungal cultures were also hemoculture positive, with the same fungal species at both sites. Among the coexisting exposures, it should be pointed out that all the patients underwent broad spectrum antibiotic therapy, used a nasogastric probe, in addition to undergoing other invasive procedures such as mechanical ventilation and umbilical catheter implantation.

Foram estudados, entre janeiro de 2003 a dezembro de 2004, todos os recém-nascidos internados na UTI neonatal da Maternidade Escola Januário Cicco, portadores de cateter venoso umbilical. Avaliou-se a prevalência de espécies de Candida nas pontas de cateteres intra-venosos dos neonatos, e os fatores associados a que os pacientes estavam submetidos. As pontas de cateter foram cultivadas em ágar sangue, e, quando houve crescimento de colônia leveduriforme, esta foi subcultivada para a realização de provas morfológicas e bioquímicas para identificar a espécie. Do total de 240 cateteres analisados, 41 apresentaram crescimento de leveduras, sendo 34 encaminhados para identificação, observando-se os seguintes agentes: 13 C. albicans (38 por cento), 10 Candida parapsilosis (29 por cento), 8 C. tropicalis (20 por cento), 1 C. guilliermondii (3 por cento), 1 C. famata (3 por cento) e 1 Trichosporon spp. (3 por cento). Dos pacientes que apresentaram cultura de ponta de cateter positiva para fungos, três tiveram hemocultura positiva com a mesma espécie em ambos os sítios. Entre os fatores de risco destaca-se que todos os pacientes faziam uso de antibioticoterapia de amplo espectro, portavam sonda nasogástrica, além de outros procedimentos invasivos, como ventilação mecânica e cateter umbilical.

Perfil epidemiologico de usuarios de serviços Municipais de Testagem e Aconselhamento em DST/HIV, com resultados positivos para o HIV-1. Cidade de Sao Paulo. Novembro de 2000 a Abril de 2001 / Epidemiological profile of HIV-infected people attended at HIV/STD Counseling and Testing Centers. Sao Paulo City. November 2000 to May 2001

Os centros de testagem e aconselhamento em DST/HIV (CTA) constituem importante fonte de dados para a investigacao do perfil epidemiologico de pessoas infectadas pelo HIV, ou dos que procuram os servicos de testagem. Utilizando-se dados de sorologia e de questionarios aplicados de rotina, em cinco desses CTA, observou-se prevalencia de sorologia positiva para o HIV-1, de 3,1 porcento (IC95 porcento:2,6 - 3,5 porcento). Este artigo descreve os usuarios por sexo e por CTA. Observa-se que usuarios com resultado positivo possuem em media, 32 naos; 75 porcento dos usuarios do CTA Henfil sao homo/bissexuais enquanto que nos demais serviços grande maioria, solteiros com parceria multipla. Entre as pessoas do sexo feminino, observa-se entre as que utilizam outros serviços, menor nivel de escolaridade, maior proporcao de parcerias unica e menor uso de preservativos. Fica evidente a necessidade de analise em separado dos dados do CTA Henfil, que e o serviço de maior demanda e apresenta usuarios com perfil epidemiologico distinto dos demais servicos. A analise de dados de sorologia positiva permite, ainda, identificar problemas na coleta e registro de informacoes, contribuindo para a melhoria da qualidade dos dados

Establishment of the serologic testing algorithm for recent human immunodeficiency virus (HIV) seroconversion (STARHS) strategy in the city of São Paulo, Brazil

Several strategies aim at characterizing the AIDS epidemic in different parts of the world. Among these, the identification of recent HIV-1 infections using the recently described serologic testing algorithm for recent human immunodeficiency virus (HIV) seroconversion (STARHS) strategy was employed in four testing sites of the City of São Paulo Public Health Department (CSPPHD). Those identified as recently infected were invited to participate in a prospective clinical and laboratory evaluation study. We describe the establishment of the patient identification network and the success in enrolling the participants, as well as their clinical and laboratory characteristics. From May to December 2002, 6,443 persons were tested for HIV in the four participating sites, of whom 384 (5.96 percent) tested HIV-1 positive; 43 (11.2 percent) of them were identified as recently infected. Twenty-two were successfully enrolled in the follow-up study, but three of them did not meet clinical and/or laboratory criteria for recent HIV-1 infection. After these exclusions, the laboratory findings revealed a median CD4+ T lymphocyte count of 585 cells/muL (inter-quartile range 25-75 percent [IQR], 372-754), a CD8+ T lymphocyte count of 886 cells/muL (IQR, 553-1098), a viral load of 11,000 HIV-RNA copies/mL (IQR, 3,650-78,150), log10 of 4.04 (IQR 3.56-4.88). The identification of recent HIV infections is an extremely valuable way to evaluate the spread of the virus in a given population, especially when cohort studies, considered the gold standard method to evaluate incidence, are not available. This work demonstrated that establishing a network to identify such patients is a feasible task, even considering the difficulties in a large, resource-limited country or city.

Perfil epidemiológico dos usuários de um centro de testagem e aconselhamento para DST/HIV da rede municipal de São Paulo, com sorologia positiva para o HIV / Epidemiological profile of HIV positive individuals from a HIV/STD counseling and testing center (CTA) in the city of São Paulo, Brazil

Centros de Testagem e Aconselhamento em DST/HIV (CTA) oferecem, entre outras atividades, a realização de testes sorológicos anti-HIV e VDRL. Estes serviços dispõem de coleta sistemática de dados permitindo conhecer o perfil epidemiológico dos indivíduos infectados. O presente estudo descreve o perfil epidemiológico das pessoas com sorologia positiva que utilizaram um dos maiores CTA do país, durante os anos de 2001 e 2002. Foram utilizados dados de sorologia positiva e das entrevistas (pré e pós teste) realizadas de rotina. Observou-se 470 (4 por cento) resultados positivos entre 10657 testes sorológicos realizados, sendo que grande parte (81,4 por cento) dos usuários com sorologia positiva são do sexo masculino. A idade média dos indivíduos estudados foi 32, 3 anos, sem diferencial para sexo (p=0,968); 75 por cento trabalham; 41 por cento dos usuários do sexo feminino e 77 por cento masculino são solteiros (p<0,001); 43 por cento possuem segundo grau (completo e incompleto). Quanto à categoria de exposição, 36 por cento são homossexuais, 34 por cento são heterossexuais e 27 por cento bissexuais. Alto percentual refere ter parceiros múltiplos (82 por cento); 32 por cento referem utilizar preservativo sempre.

Establishment of the serologic testing algorithm for recent human immunodeficiency virus (HIV) seroconversion (STARHS) strategy in the city of São Paulo, Brazil.

Several strategies aim at characterizing the AIDS epidemic in different parts of the world. Among these, the identification of recent HIV-1 infections using the recently described serologic testing algorithm for recent human immunodeficiency virus (HIV) seroconversion (STARHS) strategy was employed in four testing sites of the City of Sao Paulo Public Health Department (CSPPHD). Those identified as recently infected were invited to participate in a prospective clinical and laboratory evaluation study. We describe the establishment of the patient identification network and the success in enrolling the participants, as well as their clinical and laboratory characteristics. From May to December 2002, 6,443 persons were tested for HIV in the four participating sites, of whom 384 (5.96%) tested HIV-1 positive; 43 (11.2%) of them were identified as recently infected. Twenty-two were successfully enrolled in the follow-up study, but three of them did not meet clinical and/or laboratory criteria for recent HIV-1 infection. After these exclusions, the laboratory findings revealed a median CD4+ T lymphocyte count of 585 cells/microL (inter-quartile range 25-75% [IQR], 372-754), a CD8+ T lymphocyte count of 886 cells/microL (IQR, 553-1098), a viral load of 11,000 HIV-RNA copies/mL (IQR, 3,650-78,150), log10 of 4.04 (IQR 3.56-4.88). The identification of recent HIV infections is an extremely valuable way to evaluate the spread of the virus in a given population, especially when cohort studies, considered the gold standard method to evaluate incidence, are not available. This work demonstrated that establishing a network to identify such patients is a feasible task, even considering the difficulties in a large, resource-limited country or city.

Sobre o morrer: a vida psíquica e suas implicações na exposição ao HIV / On dying: the psychic life and its implications in the exposition to the HIV

Identifica alguns aspectos da vida psíquica que estejam imbricados no processo do morrer. É uma pesquisa de abordagem qualitativa, por meio de entrevistas abertas, não estruturadas, com pessoas infectadas pelo vírus HIV, que forma convidadas a falarem sobre si, suas vidas, como e quais circunstâncias acreditavam que se infectaram. A análise das entrevistas pautou-se no referencial teórico psicanalítico.

Sobre o morrer: a vida psíquica e suas implicações na exposição ao HIV / On dying: the psychic life and its implications in the exposition to the HIV

Partindo da concepção de que a morte está presente na construção da vida de todo o ser humano, o objetivo desse estudo é identificar alguns aspectos da vida psíquica que estejam imbricados no processo de morrer. Trata-se de uma pesquisa de ordem qualitativa, por meio de entrevistas abertas, nao estruturadas, com pessoas infectadas pelos vírus HIV, que foram convidadas a falarem sobre si, suas vidas, como e em quais circunstâncias acreditavam que se infectaram. A análise das entrevistas pautou-se no referencial teórico psicanalítico.(AU)