Demographic determinants of survival of people living with HIV attending an outpatient reference unit in the city of Três Lagoas, state of Mato Grosso do Sul, Brazil, in the period 1984-2009.

INTRODUCTION: While the incidence of HIV infection and AIDS is increasing in small Brazilian cities, epidemiological studies are often conducted in large urban centers. METHODS: Our group conducted a retrospective analysis of survival determinants among 358 patients who attended a reference unit in a small city. RESULTS: Death risk was lower among men that had sex with men, patients with an HIV-seropositive partner, and those admitted after highly active antiretroviral therapy (HAART) was available. CONCLUSIONS: The study documents the striking beneficial effect of HAART. The finding of other groups with improved survival may aid in the development of programmatic strategies.

Demographic determinants of survival of people living with HIV attending an outpatient reference unit in the city of Três Lagoas, state of Mato Grosso do Sul, Brazil, in the period 1984-2009

INTRODUCTION: While the incidence of HIV infection and AIDS is increasing in small Brazilian cities, epidemiological studies are often conducted in large urban centers. METHODS: Our group conducted a retrospective analysis of survival determinants among 358 patients who attended a reference unit in a small city. RESULTS: Death risk was lower among men that had sex with men, patients with an HIV-seropositive partner, and those admitted after highly active antiretroviral therapy (HAART) was available. CONCLUSIONS: The study documents the striking beneficial effect of HAART. The finding of other groups with improved survival may aid in the development of programmatic strategies.

Acurácia da radiografia de tórax associada a eletrocardiograma no diagnóstico de hipertrofia em hipertensos / Accuracy of chest radiography plus electrocardiogram in diagnosis of hypertrophy in hypertension

FUNDAMENTO: A radiografia de tórax e o eletrocardiograma (ECG) tem sido criticados em razão de sua baixa sensibilidade no diagnóstico da Hipertrofia Ventricular Esquerda (HVE) quando comparada ao ecocardiograma. Entretanto, esse exame não está disponível nos centros de atendimento primário para toda a população de hipertensos. OBJETIVO: Avaliar se a radiografia de tórax associada ao eletrocardiograma apresenta acurácia que justifique seu uso na detecção de HVE em hipertensos, bem como a utilidade do índice cardiotorácico e das radiografias oblíquas na avaliação das dimensões das câmaras cardíacas esquerdas. MÉTODOS: Estudo prospectivo realizado em 177 pacientes hipertensos consecutivos, através da radiografia do tórax, eletrocardiograma e ecocardiograma. Testes de acurácia foram utilizados para comparar esses métodos utilizando a ecocardiografia convencional como padrão de referência. RESULTADOS: O índice cardiotorácico mostrou sensibilidade de 17% para o diagnóstico de HVE, somente detectando alterações cardíacas mais acentuadas. As incidências póstero-anterior e perfil tiveram sensibilidade de 52%, aumentando para 54% quando a radiografia de tórax foi associada ao eletrocardiograma. As incidências oblíquas não melhoraram significativamente a acurácia da radiografia de tórax que, por sua vez, apresentou alta especificidade e boa sensibilidade para a detecção do aumento da aorta. Foi interessante notar que essa alteração estava presente em metade dos hipertensos com HVE. CONCLUSÃO: A associação da radiografia de tórax com eletrocardiograma é útil na avaliação inicial de hipertensos para o diagnóstico de hipertrofia ventricular esquerda, especialmente se a ecocardiografia não estiver disponível. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

BACKGROUND: Chest radiography and electrocardiogram have been criticized due to their low sensitivity for Left Ventricular Hypertrophy diagnosis compared to echocardiogram. This one, however, is not available in primary health care centers to all hypertensive population. OBJECTIVE: To evaluate whether the association chest radiography-electrocardiogram provides the accuracy to justify its use in left ventricular hypertrophy detection in hypertensive patients, as well as the usefulness of the cardiothoracic ratio and oblique radiographs in relation to frontal and lateral views in evaluating dimensions of left cardiac chambers. METHODS: This was a prospective study including 177 consecutive hypertensive patients through chest radiography, electrocardiogram and echocardiography. Accuracy test was used to compare these methods using echocardiography as gold standard. RESULTS: The cardiothoracic ratio showed 17% sensitivity for detection of left ventricular hypertrophy, only indicating cardiac alterations at an advanced stage. Frontal plus lateral views showed sensitivity of 52%, which rose to 54% when chest radiography was associated with electrocardiogram. The oblique views did not significantly improve chest radiography accuracy. Chest radiography presented high specificity and elevated sensitivity for detection of aortal enlargement. Interestingly, this alteration was present in half of the hypertensive patients with left ventricular hypertrophy. CONCLUSION: We conclude that the association chest radiography-electrocardiogram is useful for the screening of hypertensive patients for the diagnosis of left ventricular hypertrophy, especially if echocardiogram is unavailable. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

Accuracy of chest radiography plus electrocardiogram in diagnosis of hypertrophy in hypertension.

BACKGROUND: Chest radiography and electrocardiogram have been criticized due to their low sensitivity for Left Ventricular Hypertrophy diagnosis compared to echocardiogram. This one, however, is not available in primary health care centers to all hypertensive population. OBJECTIVE: To evaluate whether the association chest radiography-electrocardiogram provides the accuracy to justify its use in left ventricular hypertrophy detection in hypertensive patients, as well as the usefulness of the cardiothoracic ratio and oblique radiographs in relation to frontal and lateral views in evaluating dimensions of left cardiac chambers. METHODS: This was a prospective study including 177 consecutive hypertensive patients through chest radiography, electrocardiogram and echocardiography. Accuracy test was used to compare these methods using echocardiography as gold standard. RESULTS: The cardiothoracic ratio showed 17% sensitivity for detection of left ventricular hypertrophy, only indicating cardiac alterations at an advanced stage. Frontal plus lateral views showed sensitivity of 52%, which rose to 54% when chest radiography was associated with electrocardiogram. The oblique views did not significantly improve chest radiography accuracy. Chest radiography presented high specificity and elevated sensitivity for detection of aortal enlargement. Interestingly, this alteration was present in half of the hypertensive patients with left ventricular hypertrophy. CONCLUSION: We conclude that the association chest radiography-electrocardiogram is useful for the screening of hypertensive patients for the diagnosis of left ventricular hypertrophy, especially if echocardiogram is unavailable.

Immune response and neutralization capacity of antibodies produced in young sheep immunized with Crotalus durissus terrificus native or Cobalt-60 irradiated venom / esposta imune e capacidade de neutralização de anticorpos produzidos em ovinos jovens imunizados com veneno de Crotalus durissus terrificus nativo e irradiado com Cobalto 60

The ELISA technique was used to evaluate and compare young ovine humoral immune response during crotalic antiserum production. Animals were clinically evaluated throughout this process, and the neutralizing capacity of antisera raised against natural (NV) and Cobalt-60 irradiated (IrV) venoms of Crotalus durissus terrificus (C.d.t.) was verified by means of in vitro challenges. Three groups of six animals each were used: G1 received NV; G2 was inoculated with IrV; and G3 was used as control. Animals received six immunizations during 84 days at 14-day intervals. ELISA of antibody profile showed significant difference (p<5%) between experimental groups (G1

A técnica de Elisa foi utilizada para avaliar e comparar a resposta imune humoral de ovinos jovens para a produção de soro anticrotálico. Durante o processo de soroprodução, foi realizada a avaliação clínica dos animais. A capacidade de neutralização do soro produzido a partir de veneno de serpente Crotalus durissus terrificus, nativo (VN) e irradiado (VIr) com Cobalto–60 foi verificada por meio de desafios in vitro. Um grupo de seis animais recebeu veneno nativo, o segundo grupo recebeu veneno irradiado e o terceiro grupo foi o controle. Os animais receberam seis imunizações durante 84 dias com intervalo de14 dias. Houve diferença significativa (p<5%) no teste de ELISA do perfil de anticorpos produzidos pelos grupos experimentais (VN

[Seroprevalence of Chagas infection among inhabitants of municipalities in the Botucatu region, State of São Paulo]. / Soroprevalência da infecção chagásica em moradores de municípios da região de Botucatu, Estado de São Paulo.

The aim of this study was to look for evidence of vector transmission of Chagas disease, in and around the homes of individuals living in municipalities in the Botucatu region who presented a positive xenodiagnosis. Fifty-eight subjects were studied and blood samples were collected from them for laboratory analysis. The results from this study showed that the individuals in both groups presented low formal education levels and had been working in unskilled professions There was a slight predominance of females. In comparison with previous conditions, it was observed that there had been a slight improvement in the subjects' housing conditions, but on the other hand there had been an increase in the numbers of individuals living in rural areas. Subjects born before 1983 presented statistically greater knowledge of and contact with triatomines than did those born from 1983 onwards. Analysis and comparison of the results from the serological tests, including indirect passive hemagglutination, indirect immunofluorescence and immunoenzymatic assay, showed that ELISA presented greatest sensitivity. The results from this study have shown that the population born from 1983 onwards did not know about the transmission vector for Chagas disease.

Soroprevalência da infecção chagásica em moradores de municípios da região de Botucatu, Estado de São Paulo / Seroprevalence of Chagas infection among inhabitants of municipalities in the Botucatu region, State of São Paulo

O objetivo deste estudo foi o de procurar evidências da transmissão vetorial da doença de Chagas, nos domicílios e peridomicílios de indivíduos residentes em municípios da região de Botucatu, que tiveram xenodiagnóstico positivos. Foram estudados 58 indivíduos e foi coletada amostra do sangue para a realização de exames laboratoriais. Os resultados deste estudo mostraram que os indivíduos, de ambos os grupos, tinham baixa escolaridade e exerciam profissões que não exigiam qualificações técnicas. Houve discreto predomínio de indivíduos do sexo feminino. Quando comparadas às condições anteriores, verificou-se que houve discreta melhora nas condições de habitação, por outro lado, houve aumento de moradores em zona rural. Os indivíduos nascidos antes de 1983, apresentaram conhecimento e contato com triatomídeo estaticamente mais elevado quando comparado com os nascidos a partir 1983. A análise e comparação dos resultados das sorologias, referentes aos hemaglutinação passiva indireta, imunofluorescência indireta e ensaio imunoenzimático, mostrou que o ELISA apresentou maior sensibilidade. Os resultados deste estudo mostram que a população nascida a partir de 1983 não conhecia o vetor transmissor da doença de Chagas.

The aim of this study was to look for evidence of vector transmission of Chagas disease, in and around the homes of individuals living in municipalities in the Botucatu region who presented a positive xenodiagnosis. Fifty-eight subjects were studied and blood samples were collected from them for laboratory analysis. The results from this study showed that the individuals in both groups presented low formal education levels and had been working in unskilled professions There was a slight predominance of females. In comparison with previous conditions, it was observed that there had been a slight improvement in the subjects' housing conditions, but on the other hand there had been an increase in the numbers of individuals living in rural areas. Subjects born before 1983 presented statistically greater knowledge of and contact with triatomines than did those born from 1983 onwards. Analysis and comparison of the results from the serological tests, including indirect passive hemagglutination, indirect immunofluorescence and immunoenzymatic assay, showed that ELISA presented greatest sensitivity. The results from this study have shown that the population born from 1983 onwards did not know about the transmission vector for Chagas disease.

Definition of a diagnostic routine in individuals with inconclusive serology for Chagas disease.

Despite the existence of highly sensitive tests, inconclusive serological results are frequent in chronic chagasic infection. This study aimed to define a diagnostic conduct for 30 individuals with inconclusive serology (G3) for chagasic infection assisted at the Outpatient Unit for Infectious and Parasitic Diseases of the Botucatu School of Medicine. Twenty-one individuals with negative serology (G1) and 33 with positive serology (G2) were also studied. Serological methods ELISA, HAI, IFI and immunoblotting TESA-cruzi were used for G1, G2 and G3, and parasitological methods xenodiagnosis, hemoculture and PCR-LIT were used for G2 and G3 individuals. ELISA, HAI and IFI were performed in 5 different blood samples in G2 and G3. TESA-cruzi was carried out only once in G1, G2 and G3 and, since it is the most sensitive, it was utilized as standard. In G3, positivity for ELISA reached 86% in the fifth blood sample; the ELISA+HAI+IFI combination showed a maximum of 44.8% in the second sample; and TESA-cruzi, 76% in one single sample. Xenodiagnosis positivity was 9.4%; hemoculture showed 15.2%; and PCR-LIT exhibited 22% positivity in G2. Nevertheless, in G3, positivity percentage was 3.4% for xenodiagnosis, 6.7% for PCR-LIT, and no positive result was found for hemoculture. In G3, PCR-LIT resolved one case which was still inconclusive according to serology tests. In order to define inconclusive diagnoses, the results suggest the combined use of ELISA+HAI+IFI in 2 blood samples, decreasing the occurrence of false positive/negative results. If results remain inconclusive, the performance of TESA-cruzi and PCR-LIT, if necessary, is recommended.

Definition of a diagnostic routine in individuals with inconclusive serology for chagas disease

Despite the existence of highly sensitive tests, inconclusive serological results are frequent in chronic chagasic infection. This study aimed to define a diagnostic conduct for 30 individuals with inconclusive serology (G3) for chagasic infection assisted at the Outpatient Unit for Infectious and Parasitic Diseases of the Botucatu School of Medicine. Twenty-one individuals with negative serology (G1) and 33 with positive serology (G2) were also studied. Serological methods ELISA, HAI, IFI and immunoblotting TESA-cruzi were used for G1, G2 and G3, and parasitological methods xenodiagnosis, hemoculture and PCR-LIT were used for G2 and G3 individuals. ELISA, HAI and IFI were performed in 5 different blood samples in G2 and G3. TESA-cruzi was carried out only once in G1, G2 and G3 and, since it is the most sensitive, it was utilized as standard. In G3, positivity for ELISA reached 86 percent in the fifth blood sample; the ELISA+HAI+IFI combination showed a maximum of 44.8 percent in the second sample; and TESA-cruzi, 76 percent in one single sample. Xenodiagnosis positivity was 9.4 percent; hemoculture showed 15.2 percent; and PCR-LIT exhibited 22 percent positivity in G2. Nevertheless, in G3, positivity percentage was 3.4 percent for xenodiagnosis, 6.7 percent for PCR-LIT, and no positive result was found for hemoculture. In G3, PCR-LIT resolved one case which was still inconclusive according to serology tests. In order to define inconclusive diagnoses, the results suggest the combined use of ELISA+HAI+IFI in 2 blood samples, decreasing the occurrence of false positive/negative results. If results remain inconclusive, the performance of TESA-cruzi and PCR-LIT, if necessary, is recommended.

Teste tuberculínico em indivíduos com infecção pelo vírus da imunodeficiência humana: relação com número de linfócitos T periféricos e atividade tuberculosa / Tuberculin testing of individuals infected with the human immunodeficiency virus: relationship with peripheral T-cell counts and active tuberculosis

OBJETIVO: Avaliar os resultados do teste tuberculínico e relacioná-los com a presença ou não de tuberculose em atividade e com a contagem de linfócitos T CD4+/CD8+. MÉTODOS: Foram revisados 802 prontuários de pacientes com síndrome da imunodeficiência adquirida atendidos no período de agosto de 1985 a março de 2003. Cento e oitenta e cinco pacientes realizaram o teste tuberculínico (23,1 por cento) e, destes, 107 eram do sexo masculino (57,8 por cento). A média de idade no grupo de reatores ao teste tuberculínico foi de 30,6 anos, com desvio-padrão de 6,62 anos, e entre os não reatores de 34,45 anos com desvio-padrão de 10,32 anos. Foram constituídos dois grupos de estudo: reatores ao teste tuberculínico, com 28 pacientes, e não reatores ao teste tuberculínico, com 157 pacientes. RESULTADOS: Grande parte dos indivíduos foi pouco responsiva ao teste tuberculínico. Constatou-se, no grupo de reatores, maior porcentagem de indivíduos com tuberculose ativa à época da realização do teste, quando se comparou com os não reatores. Dez pacientes entre os reatores e onze entre os não reatores apresentavam alguma forma clínica de tuberculose em atividade à época da realização do teste, sendo que seis do primeiro grupo e oito do segundo tinham contagem de linfócitos T CD4+ menor que 200 células/mm³. CONCLUSÃO: Indurações maiores do que 5 mm não se relacionaram com contagens absolutas mais altas de células T CD4+.

OBJECTIVE: To evaluate tuberculin test results and relate them to the presence or absence of active tuberculosis, as well as to CD4+ and CD8+ T-lymphocyte counts. METHOD: The charts of 802 patients with acquired immunodeficiency syndrome treated between August of 1985 and March of 2003 were reviewed. Of the 185 patients submitted to tuberculin tests (23.1 percent), 107 (57.8 percent) were male, and 78 (42.2 percent) were female. Patients were divided into two study groups: tuberculin test reactors (n = 28); and tuberculin test non-reactors (n = 157). Among the reactors, the mean age was 30.60 years, with a standard deviation of 6.62 years, compared with 34.45 years, with a standard deviation of 10.32 years, among the non-reactors. RESULTS: Most of the individuals tested presented only a mild response to the tuberculin test. We found that, at the time of the test, the percentage of individuals with active tuberculosis was greater in the reactor group than in the non-reactor group. During the test period, 10 reactor group patients and 11 non-reactor group patients presented some clinical form of active tuberculosis. In addition, CD4+ T-lymphocyte counts were lower than 200 cells/mm³ in 6 reactor group patients and in 8 non-reactor group patients. CONCLUSION: Indurations greater than 5 mm were unrelated to higher absolute CD4+ T-cell counts.

Tuberculin testing of individuals infected with the human immunodeficiency virus: relationship with peripheral T-cell counts and active tuberculosis.

OBJECTIVE: To evaluate tuberculin test results and relate them to the presence or absence of active tuberculosis, as well as to CD4+ and CD8+ T-lymphocyte counts. METHOD: The charts of 802 patients with acquired immunodeficiency syndrome treated between August of 1985 and March of 2003 were reviewed. Of the 185 patients submitted to tuberculin tests (23.1%), 107 (57.8%) were male, and 78 (42.2%) were female. Patients were divided into two study groups: tuberculin test reactors (n = 28); and tuberculin test non-reactors (n = 157). Among the reactors, the mean age was 30.60 years, with a standard deviation of 6.62 years, compared with 34.45 years, with a standard deviation of 10.32 years, among the non-reactors. RESULTS: Most of the individuals tested presented only a mild response to the tuberculin test. We found that, at the time of the test, the percentage of individuals with active tuberculosis was greater in the reactor group than in the non-reactor group. During the test period, 10 reactor group patients and 11 non-reactor group patients presented some clinical form of active tuberculosis. In addition, CD4+ T-lymphocyte counts were lower than 200 cells/mm(3) in 6 reactor group patients and in 8 non-reactor group patients. CONCLUSION: Indurations greater than 5 mm were unrelated to higher absolute CD4+ T-cell counts.

[Soroprevalence of HTLV-I/II, HIV, siphylis and toxoplasmosis among pregnant women seen at Botucatu - São Paulo - Brazil: risk factors for HTLV-I/II infection]. / Soroprevalência de vírus linfotrópico de células T humanas, vírus da imunodeficiência humana, sífilis e toxoplasmose em gestantes de Botucatu - São Paulo - Brasil: fatores de risco para vírus linfotrópico de células T humanas.

In order to asses the soroprevalence of HTLV- I/II, HIV, siphylis, and toxoplasmosis infection among pregnant women seen at Basic Health Units in the municipality of Botucatu - São Paulo - Brazil, and risk factors for HTLV- I/II infection, sorologic surveys were carried out and results of sorologic surveys carried in pregnance routine evaluation were assessed. Seroprevalence was 0.1% (1 in 913) for both HTLV-I and HTLV-II. Seroprevalence was 0.1% (1 in 913) for both HTLV-I and HTLV-II. Siphylis, toxoplasmosis and HIV were identified. None of the factors or characteristics risks was found to be useful to identify those prenant women HTLV-II infected. Infection among pregnant women and southeast brazilian blood donnors were not diferent in statistical evaluation.

Soroprevalência de vírus linfotrópico de células T humanas, vírus da imunodeficiência humana, sífilis e toxoplasmose em gestantes de Botucatu - São Paulo - Brasil: fatores de risco para vírus linfotrópico de células T humanas / Soroprevalence of HTLV-I/II, HIV, siphylis and toxoplasmosis among pregnant women seen at Botucatu - São Paulo - Brazil: risk factors for HTLV-I/II infection

Com o objetivo de estudar a soroprevalência de vírus linfotrópico de células T humanas I/II (HTLV-I/II), vírus da imunodeficiência humana, sífilis e toxoplasmose, em gestantes atendidas em unidade básicas de saúde do município de Botucatu - São Paulo - Brasil, bem como os fatores de risco para a infecçäo pelo HTLV -I/II, foram realizados inquérito sorológico e avaliaçäo dos resultados de exames solicitados na rotina do prénatal. Em 913 gestantes, a soroprevalência de HTLV- I e de HTLV- II foi de 0,1 por cento. Sífilis, toxoplasmose e infecçäo pelo HIV foram encontradas. Nenhum dos fatores de risco pesquisados mostrou-se seguro para identificar gestantes com infecçäo pelo HTLV- I/II. A comparaçäo da proporçäo de gestantes infectadas e de doadores de sangue da regiäo sudeste do Brasil com testes reagentes para HTLV- I/II näo mostrou diferença estatística.

Tratamento anti-retroviral combinado potente. Comparacao entre inibidores da transcriptase reversa nao analogos de nucleosideos e inibidores de protease / Highly active antiretroviral therapy. Comparison between nucleoside non-analogue reverse transcriptase inhibitors and protease inhibitors

Esquemas terapeuticos de alta potencia para aids alteram a progressao da doenca e diminuem a incidencia de infeccoes oportunisticas e a proporcao de mortes. o objetivo deste trabalho foi comparar a acao de inibidores da transcritpase reversa nao analogos de nucleosideos (ITRNN) e inibidores de protease (IP). Foram incluidos 113 pacientes acompanhados na Area de Doencas Tropicais, da Faculdade de Medicina de Botucatu-UNESP, no periodo de nvoembro de 1996 a dezembro de 2001. eram 64(56,7 porcento) pacientes do sexo masculino e 49(43,3 porcento) do feminino, com idades que variaram de 16 a 65 anos. G1, 37 pacientes que receberam esquema com IP apos tratamento previo; G2, 30 pacientes que receberam esquema com ITRNN apos tratamento previo; G3, 29 individuos que receberam IP como primeiro tratamento e G4, 22 pacientes que receberam ITRNN como primeiro tratamento. Os pacientes que receberam tratamento previo tiveram menor variacao de peso do que os virgens de tratamento. Os que receberam IP tiveram maior variacao de CD4+ do que os que receberam ITRNN. Houve aumento de 82 celulas para G1, 30 para G2, 129 para G3 e 131 para G4. Nao foram observadas diferencas estatisticas significantes na comparacao entre os grupos quanto a variacao da carga viral. Quanto a evolucao clinica, os pacientes que eram virgens de tratamento apresentaram desempenho superior do que aqueles com tratamento previo; observou-se, tambem, melhor desempenho dos que receberam IP, quando comparados aos que receberam ITRNN. O presente estudo sugere que esquemas combinados com IP devem ser indicados para pacientes com doenca mais avancada e os ITRNN, para aqueles assintomaticos, mesmo que a contagem de linfocitos T CD4+ esteja abaixo de 200/mm3 e que a carga viral plasmatica esteja em niveis altos.

Acquired immunodeficiency syndrome in Brazil.

AIM: To describe the acquired immunodeficiency syndrome (AIDS) epidemic in Brazil and analyze the impact of federal government measures addressing the problem since its onset. METHOD: Retrospective review of AIDS epidemic data from its onset in 1980 up to the last published data in June 2001. RESULTS: AIDS was first reported in Brazil in 1980. By 1988, all 27 Brazilian states had diagnosed cases, and until June 2000 more than half of Brazilian municipalities had recorded at least one case of the disease. The AIDS incidence reached its peak between 1996 and 1997 (14.7 per 100,000 population), and then declined between 1998 and 2000 to 9 per 100,000 population. In the last two decades, the proportion of deaths has been also significantly reduced. These were not random events, but reflected the efficiency of the program implemented by the Brazilian Health Ministry's Coordination on Sexually Transmitted Diseases and AIDS. The program includes an epidemiological surveillance modeling system, which records cases from several regular epidemiological bulletins; national network of diagnosis and monitoring of HIV-infected individuals (ill or not); highly active antiretroviral therapy available free to all patients; mother-infant protection program; educational programs on condom use; the introduction of the female condom; development of AIDS studies in different areas to provide practical solutions; constant preoccupation about drug costs accounting for the patent breaking; and national production of many drugs currently in use. CONCLUSION: Well-planned and implemented national program against AIDS can significantly reduce the burden of this disease to the population.

Apresentação tipica de tuberculose pulmonar em pacientes com aids e baixas contagens de linfocitos T CD4+ / Typical pulmonary tuberculosis in AIDS patients with low CD4+ T lymphocyte counts

Varios autores referem que as alterações na radiografia simples do torax de pacientes com aids e tuberculose pulmonar estao diretamente relacionadas a contagem de linfocitos T CD4+. Pacientes com mais de 200 linfocitos T CD4+/mm3 teriam tendencia a apresentar imagens radiologicas toracicas tipicas de tuberculose, semelhantes aos pacientes nao infectados pelo HIV. Com a perda da imunidade, principalmente celular, decorrente da infeccao pelo HIV, ha tendencia de surgirem apresentacoes atipicas da doenca. Sao descritos, neste artigo, dois casos diagnosticados e tratados como tuberculose pulmonar em pacientes com aids, que possuiam contagem de linfocitos T CD4+ abaixo de 50 celulas/mm3, porem, com apresentacoes radiograficas tipicas de pacientes com contagens de linfocitos T CD4+ mais elevadas. Os dois casos apresentados chamam a atencao que podem ocorrer formas tipicas de tuberculose pulmonar em pacientes com baixa contagem de linfocitos T CD4+, apesar da pequena incidencia. Alguns autores sugerem que se deva solicitar o teste sorologico para a pesquisa de anti-HIV em pacientes com tuberculose pulmonar que nao apresentam cavidades nas alteracoes radiograficas pulmonares, porem, os casos relatados no presente estudo sugerem que se faca esta pesquisa mesmo na presenca de imagens radiologicas tipicas da doenca

Soroprevalência de anticorpos contra o sarampo de uma determinada polulaçäo infantil de Botucatu, SP / A seroprevalence of measles antibodies of a children population of Botucatu, Säo Paulo State, Brazil

Esta pesquisa trata-se de um estudo de soroprevalência de anticorpos contra o sarampo, de uma determinada populaçäo infantil residente em Botucatu, SP, com o objetivo de avaliar o estado imunológico, induzido quer por infecçäo natural, quer por meio de vacinaçäo. Foram estudadas 101 crianças, sendo que todas receberam a vacina contra o sarampo. Os exames laboratoriais utilizadas para avaliar a presença de anticorpos, nas amostras de sangue coletadas, foram o teste de Inibiçäo de Hemaglutinaçäo (IH) e o Ensaio imunoenzimático (ELISA). Os resultados do teste de IH, mostraram que 92,1 por cento das amostras apresentavam anticorpos contra o sarampo. As amostras com títulos < que 1:4, quando estudadas pela IH, foram retestadas no mesmo laboratório por meio do ELISA, e somente duas mantiveram-se negativas para anticorpos contra o sarampo. Portanto, em 98 por cento das amostras de soro das crianças estudadas os anticorpos contra o sarampo estavam presentes