Behavioural differences between users seeking HIV-testingat the testing and counseling center in the city of Montes Claros, state of Minas Gerais

The human immunodeficiency virus (HIV) epidemic is a global, dynamic and unstable phenomenon, whose form of occurrence dependson the individual and collective human behavior, among other factors. Objective: to identify the social and behavioral differences related to the risk of HIV infection, prevalence of HIV and the rate between genders in users of the Testing and Counseling Center (CTA) of the city of Montes Claros, MinasGerais State. Methods: this is a cross-sectional study. The sample included 1,409 users' records (716 men, 693 women) from the CTA of Montes Claros,from December 2007 to March 2009. For organization and statistical analysis, the Statistical Package for Social Sciences (SPSS) 15.0 was used and asignificance level of 5% (p < 0,05) was considered. Results: significant differences (p < 0.05) between genders were found, indicating a higher percentageof singles (65.3%), drug users (73.5%) and those who have had three or more sexual partners (41.9%) during the past year among men. Men used condomsmore regularly in fixed (20.1%) and eventual (44.4%) partners. HIV prevalence was of 2% and the rate between the genders was of 1:1. Conclusion: menwere engaged in more risk behaviors for HIV, but women were infected in the same proportion. Prevention programs must consider social and cultural components to structure gender inequalities.

Factores asociados a respuesta virológica en mujeres que usaron profilaxis antirretroviral de gran actividad para transmisión materno-fetal del virus de la inmunodeficiencia humana tipo 1 / Factors associated with virological response in women receiving highly-active antiretroviral prophylaxis for HIV-1 mother-to-child transmission

INTRODUCCIÓN. El embarazo es una circunstancia única en la infección por el virus de la inmunodeficiencia humana tipo 1 (VIH-1) que necesita respuesta virológica urgente al esquema antirretroviral debido a la influencia de la cargaviral plasmática (CVP) en la transmisión materno-fetal (TMF).El objetivo del estudio es evaluar factores relacionados con el tiempo para obtener CVP < 400 copias/ml durante la profilaxis antirretroviral de TMF.MÉTODOS. Cohorte de gestantes infectadas por elVIH-1 controladas entre 2000 y 2005 con linfocitos CD4+> 300/ml; uso de profilaxis antirretroviral de gran actividad durante, mínimo, 4 semanas; interrupción posparto de antirretrovirales y evaluaciones de laboratorio disponibles. RESULTADOS. Se analizaron 75 gestaciones. Los valores medianos iniciales fueron: CVP de 3,71 log10 copias/ml y573 linfocitos CD4+/ml. En el 75% de los casos la profilaxisse inició después de 26,6 semanas de gestación y duró hasta 11,7 semanas. El esquema profiláctico cambió en12 embarazos, 7 por toxicidad. El inhibidor de la proteasa fue parte de 33 profilaxis, 11 con lo pinavir. La profilaxis resultó en CVP < 400 copias/ml en menos de 6,7 semanas en el 75% de los casos; en 5 casos permaneció detectable. El tiempo para obtener CVP < 400 copias/ml se redujo si la CVP inicial era < 100.000 copias/ml y no se cambió el esquema antirretroviral profiláctico. CONCLUSIONES. La profilaxis antirretroviral no debería postergarse después de 26-28 semanas de gestación para alcanzar una CVP < 400 copias/ml en el parto. El tiempo para obtener respuesta virológica debe reducirse con esquemas antirretrovirales profilácticos potentes y bientolerados. Se recomienda estudiar nuevas alternativas, como lopinavir, para casos con diagnóstico prenatal tardío o CVP > 100.000 copias/ml (AU)

INTRODUCTION. Pregnancy is the only circumstance in HIV infection requiring urgent virological response to the antiviral approach because of the influence of plasmaviral load (VL) on mother-to-child transmission (MCT)of the disease. This study analyzes factors related to the time needed to reach VL < 400 copies/mL during antiretroviral prophylaxis for MCT.METHODS. The study included a cohort of HIV-1 infected pregnant women enrolled between 2000 and 2005with baseline CD4+ lymphocyte count > 300 cells/mL, highly-active antiretroviral prophylaxis for at least4 weeks, antiretroviral interruption after delivery, and available laboratory data. RESULTS. Seventy-five pregnancies were analyzed. Median baseline VL was 3.71 log10 copies/mL andCD4+ count was 573 cells/mL. Prophylaxis started after 26.6 weeks of gestation and lasted up to11.7 weeks in 75% of cases. The prophylactic regimen was changed in 12 pregnancies, 7 because of toxicity. A protease inhibitor was included in 33 prophylacticregimens, 11 of them with lopinavir. Prophylaxis resulted in undetectable HIV-1 VL within 6.7 weeks in75% of pregnancies. VL was detectable at the end of prophylaxis in 5 cases. Time to undetectable VL was shorter if baseline VL was less than 100,000 copies/mL and the antiretroviral regimen was not changed during prophylaxis. CONCLUSIONS. To achieve VL < 400 copies/mL at delivery, antiretroviral prophylaxis should be started before 26 to28 weeks of pregnancy. A potent and well-tolerated prophylactic antiretroviral regimen will likely reduce the time to virological response. Trials investigating alternative regimens (e.g., lopinavir-containing) for patients with late diagnosis during prenatal care or VL >100,000 copies/mL are warranted (AU)

Enfermeiros e qualidade: alguns conceitos / Nurses and quality: some concepts

Atualmente as pessoas estäo mais exigentes e interessadas na qualidade dos produtos ou serviços que adquirem. Nos hospitais a qualidade tem sido estudada, principalmente, por profissionais da área administrativa, com o objetivo de aplicá-la para os serviços prestados e assim, satisfazer as necessidades dos clientes, diminuir os custos e garantir a sobrevivência num mercado cada vez mais competitivo. Tendo em vista o crescente interesse pela normatizaçäo da qualidade para os serviços de saúde, torna-se necessário o conhecimento sobre o assunto e sua aplicaçäo para os enfermeiros, uma vez que estes profissionais atuam tanto na prestaçäo de serviços de saúde, quanto no gerenciamento e ensino dos mesmos. Neste trabalho as autoras fazem um breve levantamento de alguns conceitos de qualidade como um primeiro passo para compreensäo do tema.