Elucidating the theoretical X-ray photoabsorption spectrum of Argon near the KM edge: Transition probabilities calculations.

We report new calculations of the transition probabilities for double electron photo-excitations near the KM edge in atomic Argon in the energy range 3220-3238 eV. The calculations were performed to study the X-ray photoabsorption spectrum of Argon near the KM edge using Multi-configurational Dirac-Hartee Fock method. Configuration interaction calculations showed that excitations to the doubly excited state [1s3p]3d2 is almost small compared to [1s3p]4p2 excitations, thus [1s3p]4p2 is the dominant transition in this energy range. The transition probabilities were convoluted into Breit-Wigner line shapes and compared to previous measurements of the X-ray photoabsorption spectrum of Argon near the KM edge, the comparison showed good agreement with experiment. The results of the calculations presentded herein therefore shed light on understanding of near KM edge features, and thereby the preferred excitation channels of the atom.

Yellow fever: factors associated with death in a hospital of reference in infectious diseases, São Paulo, Brazil, 2018

Faced with the reemergence of yellow fever (YF) in the metropolitan region of São Paulo, Brazil, we developed a retrospective study to describe the cases of YF attended at the Institute of Infectology Emilio Ribas from January to March 2018 and analyze the factors associated with death, from the information obtained in the hospital epidemiological investigation. A total of 72 cases of sylvatic YF were confirmed, with 21 deaths (29.2% lethality rate). Cases were concentrated in males (80.6%) and in the age group of 30 to 59 years (56.9%). Two logistic regression models were performed, with continuous variables adjusted for the time between onset of symptoms and hospitalization. The first model indicated age (odds ratiosadjusted [ORadj]: 1.038; CI 95%: 1.008-1.212), aspartate aminotransferase (AST) (ORadj: 1.038; CI 95%: 1.005-1.072), and creatinine (ORadj: 2.343; CI 95%: 1.205-4.553) were independent factors associated with mortality. The second model indicated age (ORadj: 1.136; CI 95%: 1.013-1.275), alanine aminotransferase (ALT) (ORadj: 1.118; CI 95%: 1.018-1.228), and creatinine (ORadj: 2.835; CI 95%: 1.352-5,941). The risk of death in the model with continuous variables was calculated from the increase of 1 year (age), 1 mg/dL (creatinine), and 100 U/L for AST and ALT. Another logistic regression analysis with dichotomous variables indicated AST > 1,841 IU/L (ORadj: 12.92; CI 95%: 1.50-111.37) and creatinine > 1.2 mg/dL (ORadj: 81.47; CI 95%: 11.33-585.71) as independent factors associated with death. These results may contribute to the appropriate clinical management of patients with YF in health-care services and improve the response to outbreaks and public health emergencies

Yellow Fever: Factors Associated with Death in a Hospital of Reference in Infectious Diseases, São Paulo, Brazil, 2018.

Faced with the reemergence of yellow fever (YF) in the metropolitan region of São Paulo, Brazil, we developed a retrospective study to describe the cases of YF attended at the Institute of Infectology Emilio Ribas from January to March 2018 and analyze the factors associated with death, from the information obtained in the hospital epidemiological investigation. A total of 72 cases of sylvatic YF were confirmed, with 21 deaths (29.2% lethality rate). Cases were concentrated in males (80.6%) and in the age group of 30 to 59 years (56.9%). Two logistic regression models were performed, with continuous variables adjusted for the time between onset of symptoms and hospitalization. The first model indicated age (odds ratiosadjusted [ORadj]: 1.038; CI 95%: 1.008-1.212), aspartate aminotransferase (AST) (ORadj: 1.038; CI 95%: 1.005-1.072), and creatinine (ORadj: 2.343; CI 95%: 1.205-4.553) were independent factors associated with mortality. The second model indicated age (ORadj: 1.136; CI 95%: 1.013-1.275), alanine aminotransferase (ALT) (ORadj: 1.118; CI 95%: 1.018-1.228), and creatinine (ORadj: 2.835; CI 95%: 1.352-5,941). The risk of death in the model with continuous variables was calculated from the increase of 1 year (age), 1 mg/dL (creatinine), and 100 U/L for AST and ALT. Another logistic regression analysis with dichotomous variables indicated AST > 1,841 IU/L (ORadj: 12.92; CI 95%: 1.50-111.37) and creatinine > 1.2 mg/dL (ORadj: 81.47; CI 95%: 11.33-585.71) as independent factors associated with death. These results may contribute to the appropriate clinical management of patients with YF in health-care services and improve the response to outbreaks and public health emergencies.

Equivalence between the Classical and Quantum IR Spectral Density Approaches of Weak H-Bonds in the Absence of Damping.

The aim of this paper is to overhaul the quantum elucidation of the spectral density (SD) of weak H-bonds treated without taking into account any of the damping mechanisms. The reconsideration of the SD is performed within the framework the linear response theory. Working in the setting of the strong anharmonic coupling theory and the adiabatic approximation, the simplified expression of the classical SD, in the absence of dampings, is equated to be ICl(ω) = Re[∫0∞GCl(t)e-iΩt dt] in which the classical-like autocorrelation function (ACF), GCl(t), is given by GCl(t) = tr{ρ(ß){µ(0)}{µ(t)}†}. With this consideration, we have shown that the classical SD is equivalent to the line shape obtained by F(ω) = ΩICl(ω), which in turn is equivalent to the quantum SD given by IQu(ω) = Re[∫0∞GQu(t)e-iΩt dt], where GQu(t) is the corresponding quantum ACF having for expression GQu(t) = (1/ß) tr{ρ∫0ß[µ(0)}{µ(t + iλℏ)}†â€¯dλ}. Thus, we have shown that for weak H-bonds dealt without dampings, the SDs obtained by the quantum approaches are equivalent to the SDs geted by the classical approach in which the incepation ACF is, however, of quantum nature and where the line shape is the Fourier transform of the ACF times the angular frequency. It is further shown that the classical approach dealing with the SD of weak H-bonds leads identically to the result found by Maréchal and Witkowski in their pioneering quantum treatment where they ignored the linear response theory and dampings.

Electrical anharmonicity in hydrogen bonded systems: complete interpretation of the IR spectra of the Cl-H[combining right harpoon above] stretching band in the gaseous (CH3)2OHCl complex.

Following the previous developments to simulate the fully infrared spectra of weak hydrogen bond systems within the linear response theory, an extension of the adiabatic model is presented here. A general formulation including the electrical anharmonicities in the calculation of the damped autocorrelation function of weak H-bonds is adopted to facilitate the support of the additional properties, and thus the IR spectra of the Cl-H[combining right harpoon above] stretching band in the gaseous (CH3)2OHCl complex. We have explored the origins of the broadening of the Cl-H[combining right harpoon above] stretching band. We found that the main features of the lineshape are attributed to electrical anharmonicity as a consequence of the large mixed second derivatives of the dipole moment with respect to the Cl-H[combining right harpoon above] bond and of the intermonomer elongations . In addition to providing more accurate theoretical band shapes, inclusion of the electrical anharmonicity in the present model paves the way for a more complete interpretation by generating three new Franck-Condon superposed distributions.

The burden of adult asthma in a high GDP per capita country: the QASMA study.

BACKGROUND: Asthma is a major health problem worldwide. Suboptimal asthma care and poor asthma control are common even in developed countries. Qatar has the highest gross domestic product per capita in the world and high per capita health expenditure. No prior study has assessed the burden of adult asthma in this country. OBJECTIVES: To assess asthma control, patients' level of education about asthma, and level of asthma care in a country with the highest gross domestic product per capita in the world. METHODS: A face-to-face, cross-sectional study of 520 adults with physician-diagnosed asthma conducted in various health care facilities in Qatar. RESULTS: Thirty-three percent, 41%, and 26% of patients had uncontrolled, controlled, and partly controlled asthma, respectively. Only 4.9% of patients had previously received a written asthma management plan, 3.5% had a flow meter at home, and 37.2% had a spirometry performed in the previous 5 years. In addition, 42.9% misunderstood the role of reliever and controller medications. Inhaler technique was incorrect in 47% of these patients. There was a significant association between the type of physician practice and level of asthma control, with worst control being at the general practice level. Moreover, 57.3% of patients had at least 1 asthma-related visit to the emergency department in 1 year and 18.7% had more than 3 visits. CONCLUSION: The very high gross domestic product per capita in Qatar and the high health expenditure per capita do not seem to have led to better asthma care and control. A comprehensive national asthma service improvement program is much needed.

Emerging role for colorectal cancer screening in Asian countries.

BACKGROUND AND AIM: Colorectal cancer (CRC) is one of the leading causes of cancer related mortality globally. Though Asia has traditionally been considered a relatively low incidence area for colorectal cancer, the incidence is reportedly increasing. The Asia Pacific Working Group for Colorectal Cancer has recommended screening of individuals at average risk starting from 50 years of age. Based on these recommendations we conducted a pilot study to assess the need and feasibility of a colorectal cancer screening program in the state of Qatar. METHODS AND RESULTS: We screened 1385 individuals by fecal immunochemical testing for occult blood, at the primary health center level and positive cases were referred for colonoscopy. Among those who tested positive for fecal occult blood, we picked up five patients with cancers and seven with neoplastic polyps. CONCLUSION: Our results compare with the yield of screening programs in western countries thus suggesting an emerging role for colorectal cancer screening in Asian countries.

Oral colonization by yeasts in HIV-positive patients in Brazil.

INTRODUCTION: In HIV-infected patients, colonization of the oral cavity by potential pathogenic yeast may lead to development of systemic fungemia. We evaluated the prevalence of yeast in the oral cavity of Brazilian HIV-positive patients and verified whether or not the species characterized were enzymatically active. Furthermore, the species identified were tested for their susceptibility to antifungal treatment. METHODS: Patient saliva and oropharyngeal candidiasis samples were collected from 60 seropositive HIV patients and identified by the API20C system. Enzymatic activity was evaluated by the production of proteinase and phospholipase. Susceptibility to antifungal treatments were determined using the broth microdilution method. RESULTS: the most commonly isolated species were C. albicans (51.56%) followed by non-albicans Candida species (43.73%), Trichosporon mucoides (3.12%) and Kodamaea ohmeri (1.56%). Oral colonization by association of different species was observed in 42% of the patients. Enzymatic activity was verified in most of species isolated, except for C. glabrata, C. lusitaniae and C. guilliermondii. Resistance to Fluconazole and Amphotericin B was observed in isolates of C. albicans, C. glabrata, C. parapsilosis, C. krusei, and K. ohmeri. CONCLUSION: HIV-positive patients are orally colonized by single or multiple species of yeast that are occasionally resistant to Fluconazole or Amphotericin B.

Oral colonization by yeasts in HIV-positive patients in Brazil / Colonização oral por leveduras em pacientes HIV-positivos no Brasil

INTRODUCTION: In HIV-infected patients, colonization of the oral cavity by potential pathogenic yeast may lead to development of systemic fungemia. We evaluated the prevalence of yeast in the oral cavity of Brazilian HIV-positive patients and verified whether or not the species characterized were enzymatically active. Furthermore, the species identified were tested for their susceptibility to antifungal treatment. METHODS: Patient saliva and oropharyngeal candidiasis samples were collected from 60 seropositive HIV patients and identified by the API20C system. Enzymatic activity was evaluated by the production of proteinase and phospholipase. Susceptibility to antifungal treatments were determined using the broth microdilution method. RESULTS: the most commonly isolated species were C. albicans (51.56 percent) followed by non-albicans Candida species (43.73 percent), Trichosporon mucoides (3.12 percent) and Kodamaea ohmeri (1.56 percent). Oral colonization by association of different species was observed in 42 percent of the patients. Enzymatic activity was verified in most of species isolated, except for C. glabrata, C. lusitaniae and C. guilliermondii. Resistance to Fluconazole and Amphotericin B was observed in isolates of C. albicans, C. glabrata, C. parapsilosis, C. krusei, and K. ohmeri. CONCLUSION: HIV-positive patients are orally colonized by single or multiple species of yeast that are occasionally resistant to Fluconazole or Amphotericin B.

INTRODUÇÃO: Em pacientes infectados pelo HIV, a colonização da cavidade bucal por leveduras patogênicas pode levar ao desenvolvimento de fungemias. No presente estudo, avaliamos a prevalência de leveduras na cavidade bucal de pacientes HIV-positivos e verificamos se as espécies isoladas foram enzimaticamente ativas. Além disso, as espécies identificadas foram testadas quanto à suscetibilidade a antifúngicos. MÉTODOS: Amostras de saliva e de candidose orofaríngea foram coletadas de 60 pacientes soropositivos para HIV e identificados pelo sistema API20C. A atividade enzimática foi avaliada pela produção de proteinase e fosfolipase. A suscetibilidade a antifúngicos foi determinada utilizando o método de microdiluição em caldo. RESULTADOS: As espécies mais comumente isoladas foram C. albicans (51,56 por cento), seguido por espécies de Candida não-albicans (43,73 por cento), Trichosporon mucoides (3,12 por cento) e Kodamaea ohmeri (1,56 por cento). A colonização bucal por associação de diferentes espécies foi observada em 42 por cento dos pacientes. A atividade enzimática foi verificada na maioria das espécies isoladas, com exceção de C. glabrata, C. lusitaniae e C. guilliermondii. Resistência ao fluconazol e anfotericina B foi observada em isolados de C. albicans, C. glabrata, C. parapsilosis, C. krusei, e K. ohmeri. CONCLUSÃO: Os pacientes HIV-positivos são colonizados por espécies únicas ou múltiplas de levedura que ocasionalmente são resistentes ao fluconazol ou anfotericina B.

Oral Candida albicans isolates from HIV-positive individuals have similar in vitro biofilm-forming ability and pathogenicity as invasive Candida isolates.

BACKGROUND: Candida can cause mucocutaneous and/or systemic infections in hospitalized and immunosuppressed patients. Most individuals are colonized by Candida spp. as part of the oral flora and the intestinal tract. We compared oral and systemic isolates for the capacity to form biofilm in an in vitro biofilm model and pathogenicity in the Galleria mellonella infection model. The oral Candida strains were isolated from the HIV patients and included species of C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, C. krusei, C. norvegensis, and C. dubliniensis. The systemic strains were isolated from patients with invasive candidiasis and included species of C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, C. lusitaniae, and C. kefyr. For each of the acquired strains, biofilm formation was evaluated on standardized samples of silicone pads and acrylic resin. We assessed the pathogenicity of the strains by infecting G. mellonella animals with Candida strains and observing survival. RESULTS: The biofilm formation and pathogenicity in Galleria was similar between oral and systemic isolates. The quantity of biofilm formed and the virulence in G. mellonella were different for each of the species studied. On silicone pads, C. albicans and C. dubliniensis produced more biofilm (1.12 to 6.61 mg) than the other species (0.25 to 3.66 mg). However, all Candida species produced a similar biofilm on acrylic resin, material used in dental prostheses. C. albicans, C. dubliniensis, C. tropicalis, and C. parapsilosis were the most virulent species in G. mellonella with 100% of mortality, followed by C. lusitaniae (87%), C. novergensis (37%), C. krusei (25%), C. glabrata (20%), and C. kefyr (12%). CONCLUSIONS: We found that on silicone pads as well as in the Galleria model, biofilm formation and virulence depends on the Candida species. Importantly, for C. albicans the pathogenicity of oral Candida isolates was similar to systemic Candida isolates, suggesting that Candida isolates have similar biofilm-forming ability and virulence regardless of the infection site from which it was isolated.

Vicriviroc in combination therapy with an optimized regimen for treatment-experienced subjects: 48-week results of the VICTOR-E1 phase 2 trial.

BACKGROUND: Agents that block the CCR5 coreceptor for human immunodeficiency virus (HIV) have demonstrated potent antiretroviral activity. In early clinical studies, the CCR5 antagonist vicriviroc proved to be a safe and effective component of combination antiretroviral therapy. METHODS: This double-blind, dose-ranging, phase 2 trial randomized subjects to receive 30 mg or 20 mg of vicriviroc or placebo once daily plus re-optimized background therapy containing a protease inhibitor with ritonavir. Subjects were adults infected with CCR5-tropic HIV who were experiencing failure of triple antiretroviral regimens. The primary end point was mean change in baseline log(10) HIV RNA level at 48 weeks, based on an intent-to-treat analysis. RESULTS: One hundred fourteen persons received vicriviroc at 30 mg (n = 39), vicriviroc at 20 mg (n =40), or placebo (n = 35). The mean change in baseline HIV RNA level at week 48 was -1.77 log(10) copies/mL for 30 mg of vicriviroc and -1.75 log(10) copies/mL for 20 mg of vicriviroc, compared with -0.79 log(10) copies/mL for placebo (P =.002 and P=.003, respectively, compared with placebo). Mean CD4 counts increased by 102, 136, and 63 cells/mm(3) for 30 mg vicriviroc, 20 mg vicriviroc, and placebo, respectively (P = .260 and P = .039, respectively, compared with placebo). Rates of adverse events (mostly mild-to-moderate) were 111.4, 112.5, and 147.4 events per 100 subject-years, respectively. CONCLUSIONS: Vicriviroc administered with a protease inhibitor plus ritonavir-containing regimen shows potent antiretroviral and immunologic activity sustained over 48 weeks in treatment-experienced patients. CLINICAL TRIALS REGISTRATION: NCT00243230 .

The safety and efficacy of switching stavudine to tenofovir df in combination with lamivudine and efavirenz in hiv-1-infected patients: three-year follow-up after switching therapy.

BACKGROUND: Study 903 is a phase 3 trial with a completed 144-week, double-blind phase comparing tenofovir DF (TDF) with stavudine (d4T), in combination with lamivudine (3TC) and efavirenz (EFV), and an ongoing 336-week open-label extension phase. METHOD: Patients in 3 countries completing the d4T treatment phase were allowed to switch d4T to TDF and receive once-daily TDF+3TC+EFV in the extension phase. RESULTS: At the time of switch, 100% and 99% of patients (n = 85; 60% male, 64% White; mean age 37 years; mean CD4 = 650 cells/mm3) had HIV RNA <400 and <50 copies/mL. At 144 weeks after the switch, 89% (missing = failure) had HIV RNA <400 copies/mL and 87% had HIV RNA <50 copies/mL. Mean CD4 cell count increased 155 cells/mm3. No patient had virologic failure. Significant decreases from switch to week 144 in mean fasting total cholesterol (-22 mg/dL, p < .0001) and triglycerides (-78 mg/dL, p < .0001) were observed. Mean limb fat increased significantly from 4.5 kg to 5.8 kg, 144 weeks after switch (p < .0001). CONCLUSION: In virologically suppressed patients, switching d4T to TDF as part of a once-daily regimen with 3TC and EFV resulted in maintenance of virologic suppression and continued CD4 cell increases through 144 weeks, with significant improvements in metabolic parameters.

The safety and efficacy of tenofovir DF in combination with lamivudine and efavirenz through 6 years in antiretroviral-naïve HIV-1-infected patients.

BACKGROUND: Study 903 is a phase 3 trial with a completed 144-week, double-blind phase comparing tenofovir DF (TDF) to stavudine (d4T) in combination with lamivudine (3TC) and efavirenz (EFV) and an ongoing additional 336-week open-label extension phase. METHOD: Patients in Brazil, Argentina, and the Dominican Republic who completed the 144-week double-blind phase on TDF were eligible to roll over to the extension phase (weeks 144-480). Results from an interim week 288 analysis are presented. RESULTS: Eighty-six patients (62% male, 70% white) initially randomized to the TDF arm continued treatment with TDF. At the end of the 144-week, double-blind phase, 85 of the 86 had HIV-1 RNA <400 copies/mL, of whom 84% maintained virologic suppression through week 288. CD4 counts continued to improve with a mean increase of 135 cells/mm(3) from entry into the open-label extension to week 288. No patient discontinued due to renal adverse events. Small changes in bone mineral density at the lumbar spine and hip were seen in the first 48 weeks but were nonprogressive through 288 weeks. Mean limb fat increased from 8.0 kg at week 96 to 8.8 kg at week 288. CONCLUSION: Through 288 weeks, once-daily TDF+3TC+EFV demonstrated sustained antiretroviral activity with continued immunologic recovery. TDF treatment was not associated with renal adverse events or limb fat loss in antiretroviral-naïve patients.

Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients: a 3-year randomized trial.

CONTEXT: Tenofovir disoproxil fumarate (DF) is a once-daily nucleotide analogue reverse transcriptase inhibitor. OBJECTIVE: To evaluate the efficacy and safety of tenofovir DF compared with stavudine in antiretroviral-naive patients. DESIGN, SETTING, AND PARTICIPANTS: A prospective, randomized, double-blind study conducted at 81 centers in the United States, South America, and Europe from June 9, 2000, to January 30, 2004. A total of 753 patients infected with HIV who were antiretroviral naive were screened and 602 patients entered the study. INTERVENTION: Patients were randomized to receive either tenofovir DF (n = 299) or stavudine (n = 303), with placebo, in combination with lamivudine and efavirenz. MAIN OUTCOME MEASURE: Proportion of patients with HIV RNA levels of less than 400 copies/mL at week 48. RESULTS: In the primary intent-to-treat analysis in which patients with missing data or who added or switched antiretroviral medications before week 48 were considered as failures, the proportion of patients with HIV RNA of less than 400 copies/mL at week 48 was 239 (80%) of 299 in patients receiving tenofovir DF and 253 (84%) of 301 in patients receiving stavudine (95% confidence interval, -10.4% to 1.5%), exceeding the predefined -10% limit for equivalence. However, equivalence was demonstrated in the secondary analyses (HIV RNA <50 copies/mL) at week 48 and through 144 weeks. Virologic failure was associated most frequently with efavirenz and lamivudine resistance. Through 144 weeks, the K65R mutation emerged in 8 and 2 patients in the tenofovir DF and stavudine groups, respectively (P =.06). A more favorable mean change from baseline in fasting lipid profile was noted in the tenofovir DF group at week 144: for triglyceride levels (+1 mg/dL for tenofovir DF [n = 170] vs +134 mg/dL for stavudine [n = 162], P<.001), total cholesterol (+30 mg/dL [n = 170] vs +58 mg/dL [n = 162], P<.001), direct low-density lipoprotein cholesterol (+14 mg/dL [n = 169] vs +26 mg/dL [n = 161], P<.001), and high-density lipoprotein cholesterol (+9 mg/dL [n = 168] vs +6 mg/dL [n = 154], P =.003). Investigator-reported lipodystrophy was less common in the tenofovir DF group compared with the stavudine group (9 [3%] of 299 vs 58 [19%] of 301, P<.001). The number of bone fractures and the renal safety profile were similar between the 2 groups. CONCLUSIONS: Through 144 weeks, the combination of tenofovir DF, lamivudine, and efavirenz was highly effective and comparable with stavudine, lamivudine, and efavirenz in antiretroviral-naive patients. However, tenofovir DF appeared to be associated with better lipid profiles and less lipodystrophy.

Angiomatose bacilar com comprometimento osseo: relato de caso e revisão de literatura / Bone lesions due to bacillary angiomatosis: case report and literature review

Bacillary angiomatosis is an infectious disease characterized by proliferation of small blood vessels in the skin and visceral organs of immunodeficient patients, mainly those infected with the human immunodeficiency v¡rus. ln this report, a 41-year-old man with seropositivity for HIV-1 presented with a five-months history of pain, edema, and movement restriction of his left wrist, elbow, knee, and ankle. In addition, he had nodular and ulcerated bleeding lesions in his right arm and leg, and a granulomatous nasal lesion. He had lost 8 kg in this five months period. He had sought an orthopedic medical center where long bone roentgenograms revealed diffuse lytic lesions, and bone scan showed uptake in left wrist, knee, and ankle. These findings were consistent with either neoplasm or osteomyelitis. During investigation, seropositivity for HIV-1 was detected. The patient was then referred to the Em¡lio Ribas lnfectious Diseases lnstitute [Instituto de Infectologia Em¡lio Ribas]. Histologic examination of bone and skin biopsy showed changes which are typical in bacillary angiomatosis cases. Electron microscopy findings were compatible with Bartonella species. Immunohistochemistry identified the bacteria as Bartonella quintana. Therapy with 2 g erythromycin per day was initiated. Cutaneous and osseous lesions were gradually resolved over the two ensuing months

Alterações oculares em pacientes com AIDS tratados com inibidor de protease / Ocular findings in AIDS patients treated with protease inhibitor

Objetivo: estudo visando comparar a eficácia clínica, segurança e toxicidade do indinavir e da zidovudina quando administrados isoladamente e quando administrados concomitantemente. Métodos: Foram estudados, prospectivamente, a partir de abril de 1995, 300 pacientes (599 olhos), soropositivos para o HIV-1, sem infecçäo oportunista e com CD4 entre 50 e 250 células/nm 3, que fizeram parte de um estudo duplo-cego, randomizado. O parâmetro de eficácia determinado era o aparecimento de infecçöes oportunistas. Em julho de 1996 os pacientes que recebiam zidovudina isoladamente passaram a receber lamivudina associada. Em fevereiro de 1997 o estudo passa a ser aberto e todos os pacientes passam a receber a associaçäo das 3 drogas. Resultado: Säo referidos os achados oculares observados no início do estudo e as alteraçöes observadas prospectivamente em um período de 4 anos. Ocorreu retinite por CMV em 3 pacientes (4 olhos, 1,33 por cento), sendo todos do braço inicial do estudo que recebeu zidovudina isoladamente. Conclusäo: Os resultados sugerem reduçäo da incidência de retinite por CMV em pacientes tratados com inibidor de protease.

Randomized, double-blind trial comparing indinavir alone, zidovudine alone and indinavir plus zidovudine in antiretroviral therapy-naive hiv-infected individuals with CD4 cell counts between 50 and 250/mm3

Treatment with indinavir has been shown to result in marked decreases in viral load and increases in CD4 cell counts in HIV-infected individuals. A randomized double-blind study to evaluate the efficacy of indinavir alone (800 mg q8h), zidovidine alone (200 mg q8h) or the combination was performed to evaluate progression to AIDS. 996 antiretroviral therapy-naive patients with CD4 cell counts of 50-250/mm3 were allocated to treatment. During the trial the protocol was amended to add lamivudine to the zidovudine-containing arms. The primary endpoint was time to development of an AIDS-defining illness or death. The study was terminated after a protocol-defined interim analysis demonstrated highly significant reductions in progression to a clinical event in the indinavir-containing arms, compared to the zidovudine arm (<0.0001). Over a median follow-up of 52 weeks (up to 99 weeks), percent reductions in hazards for the indinavir plus zidovudine and indinavir groups compared to the zidovudine group were 70 percent and 61 percent, respectively. Significant reductions in HIV RNA and increases in CD4 cell counts were also seen in the indinavir-containing groups compared to the zidovudine group. Improvement in both CD4 cell count and HIV RNA were associated with reduced risk of disease progression. All three regimens were generally well tolerated

Achados oculares em AIDS no Instituto de Infectologia Emilio Ribas antes da introduçäo das drogas inibidoras de protease / Ocular findings in Aids at the Emilio Ribas Infectology Institute before the introduction of the protease inhibitor drugs

Foram examinados, pelo autor, 178 pacientes (356 olhos)com Sindrome da Imunodeficiência Adquirida (AIDS), no período de agosto de 1995 a abril de 1996, no Instituto de Infectologia "Emilio Ribas". Säo relatados os achados oculares e a sua incidência, em um hospital de referência para tratamento de AIDS, na cidade de Säo Paulo, antes da introduçäo das drogas inibidoras de protease na terapia anti-retroviral. Foram observadas patologias em 67,42 por cento dos olhos. A infecçäo oportunista mais frequente foi a retinite por citomegalovírus (CMV) (16,57 por cento), seguida pela toxoplasmose ocular (6,17 por cento), retinite herpética (1,96 por cento), coroidite (1,68 por cento) e uveíte sifilitica (0,56 por cento)

Estudo de fase II de acetato de megestrol em anorexia e perda de peso em pacientes com AIDS / Phase II trial of megestrol acetate in patients with Aids-related anorexia and weight loss

Objetivos: Avaliar o efeito da suspensäo oral de acetato de megestrol na alteraçäo de peso corpóreo, na diminuiçäo da anorexia e na melhora da qualidade de vida de pacientes com AIDS. Desenho do Estudo: Estudo aberto, com 600 mg de acetato de megestrol em suspensäo oral, por dia, por 12 semanas. Pacientes: Foram envolvidos no estudo 20 pacientes soropositivos para HIV, estando na faixa de 30 porcento de seu peso ideal e que perderam mais de 10 por cento de seu peso corpóreo inicial desde o diagnóstico da infecçäo por HIV. Resultados: Foram avaliados 20 pacientes soropositivos para HIV, sendo 8 (40 por cento) do sexo feminino, 12 (60 por cento) do sexo masculino, com idade média de 33,7 anos, recebendo 600mg/dia de acetato de megestrol. Antes do uso da medicaçäo do estudo, os pacientes apresentavam peso médio de 55,3 Kg e após o uso da mesma este valor passou a 62,8 Kg com ganho percentual de 13,6 porcento. Conclusöes: A ingestäo do medicamento acetato de megestrol teve grande importância na melhora do estado nutricional dos pacientes, uma vez que a maioria apresentou aumento de apetite e conseqüente aumento de peso sem apresentar intercorrências que pudessem interferir no diagnóstico do seu estado nutricional.