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2.
Front Immunol ; 12: 668113, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33936110

RESUMO

Background: People living with HIV (PLWH) have increased systemic inflammation, and inflammation has been suggested to contribute to the pathogenesis of emphysema. We investigated whether elevated cytokine concentrations (interleukin (IL)-1ß, IL-1 receptor antagonist (IL-1RA), IL-2, IL-4, IL-6, IL-10, IL-17A, tumor necrosis factor-alpha (TNFα), interferon-gamma (IFNγ), soluble CD14 (sCD14) and sCD163 were independently associated with radiographic emphysema in PLWH. Methods: We included PLWH from the Copenhagen Comorbidity in HIV Infection (COCOMO) Study without hepatitis B and C co-infection and with a plasma sample and a chest computed tomography scan available. Emphysema plus trace emphysema was defined as the percentage of low attenuation area under -950 Houndsfield Unit (%LAA-950) using a cut-off at 5%. Cytokine concentrations were measured by ELISA or Luminex immunoassays. An elevated cytokine concentration was defined as above the 75th percentile. Results: Of 783 PLWH, 147 (18.8%) had emphysema. PLWH were predominantly male (86.0%) and 743 (94.9%) had undetectable viral replication. PLWH with emphysema had higher concentrations of TNFα (median (IQR): 8.2 (6.4-9.8) versus 7.1 (5.7-8.6) pg/ml, p<0.001), IL-1ß (0.21 (0.1-0.4) versus 0.17 (0.1-0.3) pg/ml, p=0.004) and IL-6 (3.6 (2.6-4.9) versus 3.1 (2.0-4.3) pg/ml, p=0.023) than PLWH without. In a logistic regression model adjusted for age, sex, ethnicity, smoking status, BMI and CD4 nadir, elevated TNFα (adjusted odds ratio (aOR): 1.78 [95%CI: 1.14-2.76], p=0.011) and IL-1ß (aOR: 1.81 [95%CI: 1.16-2.81], p=0.009) were independently associated with emphysema. The association between IL-1ß and emphysema was modified by smoking (p-interaction=0.020) with a more pronounced association in never-smokers (aOR: 4.53 [95%CI: 2.05-9.98], p<0.001). Conclusion: Two markers of systemic inflammation, TNFα and IL-1ß, were independently associated with emphysema in PLWH and may contribute to the pathogenesis of emphysema. Importantly, the effect of IL-1ß seems to be mediated through pathways that are independent of excessive smoking. Clinical Trial Registration: clinicaltrials.gov, identifier NCT02382822.


Assuntos
Infecções por HIV/sangue , Mediadores da Inflamação/sangue , Interleucina-1beta/sangue , Enfisema Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Fator de Necrose Tumoral alfa/sangue , Adulto , Idoso , Biomarcadores/sangue , Comorbidade , Estudos Transversais , Dinamarca/epidemiologia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Enfisema Pulmonar/epidemiologia , Medição de Risco , Fatores de Risco , Regulação para Cima
3.
J Acquir Immune Defic Syndr ; 87(2): 806-817, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33587506

RESUMO

BACKGROUND: Although antiretroviral treatments have improved survival of persons living with HIV, their long-term use may limit available drug options. We estimated the prevalence of heavily treatment-experienced (HTE) status and the potential clinical consequences of becoming HTE. SETTING: EuroSIDA, a European multicenter prospective cohort study. METHODS: A composite definition for HTE was developed, based on estimates of antiretroviral resistance and prior exposure to specific antiretroviral regimens. Risks of progressing to clinical outcomes were assessed by Poisson regression, comparing every HTE individual with 3 randomly selected controls who never became HTE. RESULTS: Of 15,570 individuals under follow-up in 2010-2016, 1617 (10.4%, 95% CI: 9.9% to 10.9%) were classified as HTE. 1093 individuals became HTE during prospective follow-up (HTE incidence rate 1.76, CI: 1.66 to 1.87 per 100 person-years of follow-up). The number of HTE individuals was highest in West/Central Europe (636/4019 persons, 15.7%) and lowest in East Europe (26/2279 persons, 1.1%). Although most HTE individuals maintained controlled viral loads (<400 copies/mL), many had low CD4 counts (≤350 cells/µL). After controlling for age, immunological parameters and pre-existing comorbidities, HTE status was not associated with the risk of new AIDS (adjusted incidence rate ratio, aIRR 1.44, CI: 0.86 to 2.40, P = 0.16) or non-AIDS clinical events (aIRR 0.96, CI: 0.74 to 1.25, P = 0.77). CONCLUSIONS: HTE prevalence increased with time. After adjusting for key confounding factors, there was no evidence for an increased risk of new AIDS or non-AIDS clinical events in HTE. Additional therapeutic options and effective management of comorbidities remain important to reduce clinical complications in HTE individuals.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Adulto , Comorbidade , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Carga Viral/efeitos dos fármacos
4.
J Infect Dis ; 223(10): 1690-1698, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-33141877

RESUMO

BACKGROUND: Human immunodeficiency virus (HIV) infection is associated with an increased risk of chronic pulmonary diseases. We compared cytokine concentrations (interleukin 6 [IL-6], interleukin 1ß, 2, 4, 10, and 17A, tumor necrosis factor α, interferon γ, soluble CD14 [sCD14] and soluble CD163 [sCD163]) in people with HIV (PWH) and uninfected controls and investigated whether elevated cytokine concentrations were independently associated with lung function indices in PWH. METHODS: We performed spirometry and measured cytokine concentrations by Luminex immunoassays or enzyme-linked immunoassay in 951 PWH and 79 uninfected controls from the Copenhagen Comorbidity in HIV Infection study. Regression analyses were used to explore associations between elevated cytokine concentrations and lung function indices. RESULTS: PWH were predominantly male (84.6%) and 94.2% had undetectable viral replication. In PWH, elevated IL-6 was associated with lower forced expiratory volume in 1 second (-212 mL [95% confidence interval, -308 to -116 mL]), lower forced vital capacity (-208 mL [-322 to -93 mL]), and airflow limitation (aOR, 2.62 [1.58-4.36]) (all P < .001) in models adjusted for age, sex, ethnicity, smoking status, body mass index, and CD4 T-cell nadir. The association between IL-6 and dynamic lung function was modified by smoking (P for interaction = .005). CONCLUSION: IL-6 levels were elevated and independently associated with low dynamic lung function and airflow limitation in well-treated PWH, suggesting that systemic inflammation may contribute to the pathogenesis of chronic pulmonary diseases.

5.
Clin Infect Dis ; 71(12): 3214-3221, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-31900471

RESUMO

BACKGROUND: Increased risk of asthma and chronic obstructive pulmonary disease has been reported in people living with human immunodeficiency virus (PLWH). Fraction of exhaled nitric oxide (FeNO) is a marker of eosinophilic airway inflammation. We assessed FeNO levels in PLWH and matched uninfected controls and investigated whether human immunodeficiency virus (HIV) status is independently associated with elevated FeNO. METHODS: FeNO was quantified by NIOX Vero and pulmonary function was assessed by spirometry in 432 PLWH from the Copenhagen Comorbidity in HIV Infection Study and in 1618 age- and sex-matched uninfected controls from the Copenhagen General Population Study. Elevated FeNO was defined as ≥25 parts per billion. Associations between FeNO and HIV status were adjusted for known potential confounders. RESULTS: Mean age of PLWH was 50.7 (standard deviation [SD], 11.1) years and 97.4% received combination antiretroviral therapy. PLWH had higher FeNO than uninfected controls (median, 17.0 [interquartile range {IQR}, 11.0-26.0] vs 13.0 [IQR, 9.0-19.0]; P < .001). Also, PLWH had a higher prevalence of elevated FeNO than uninfected controls (27.5% vs 12.3%; P < .001). This association remained after adjusting for age, sex, height, smoking status, use of airway medication, blood eosinophils, and immunoglobulin E (adjusted OR [aOR], 3.56 [95% CI, 2.51-5.04]; P < .001). Elevated FeNO was associated with self-reported asthma (aOR, 2.65 [95% CI, 1.66-4.24]; P < .001) but not with airflow limitation (aOR, 1.07 [95% CI, .71-1.62]; P = .745). CONCLUSIONS: HIV status was independently associated with elevated FeNO, suggesting increased eosinophilic airway inflammation. The potential impact on chronic lung disease pathogenesis needs further investigation.


Assuntos
Infecções por HIV , Óxido Nítrico , Biomarcadores , Criança , Expiração , HIV , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Inflamação
6.
APMIS ; 128(2): 121-128, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31990100

RESUMO

HIV+ persons have a significantly increased risk of cancer when compared to the general population. The excess cancer risk observed during HIV infection is particularly higher for infection-related malignancies. Mechanisms underlying this remain unclear, but both HIV-related and HIV-unrelated factors have been postulated to play a role. Here, we (i) review newly published data on cancer burden in the setting of HIV infection with a focus on HIV-related risk factors for cancer; (ii) discuss emerging data on cancer among HIV+ persons living in low- and middle-income countries; and (iii) review guideline recommendations for cancer screening among HIV+ persons and discuss ongoing studies investigating strategies for cancer screening among HIV+ patients.


Assuntos
Infecções por HIV/complicações , Neoplasias/etiologia , Neoplasias/virologia , Detecção Precoce de Câncer/métodos , Humanos , Fatores de Risco
7.
J Infect Dis ; 219(2): 254-263, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-30032171

RESUMO

Background: Pooled data from the SMART and START trials were used to compare deferred/intermittent versus immediate/continuous antiretroviral therapy (ART) on disease risk. Methods: Endpoints assessed were AIDS, serious non-AIDS (SNA), cardiovascular disease (CVD), cancer, and death. Pooled (stratified by study) hazard ratios (HRs) from Cox models were obtained for deferred/intermittent ART versus immediate/continuous ART; analyses were conducted to assess consistency of HRs across baseline-defined subgroups. Results: Among 10156 participants, there were 124 AIDS, 247 SNA, 117 cancers, 103 CVD, and 120 deaths. Interventions in each trial led to similar differences in CD4 count and viral suppression. Pooled HRs (95% confidence interval) of deferred/intermittent ART versus immediate/continuous ART were for AIDS 3.63 (2.37-5.56); SNA 1.62 (1.25-2.09); CVD 1.59 (1.07-2.37); cancer 1.93 (1.32-2.83); and death 1.80 (1.24-2.61). Underlying risk was greater in SMART than START. Given the similar HRs for each trial, absolute risk differences between treatment groups were greater in SMART than START. Pooled HRs were similar across subgroups. Conclusions: Treatment group differences in CD4 count and viral suppression were similar in SMART and START. Likely as a consequence, relative differences in risk of AIDS and SNA between immediate/continuous ART and deferred/intermittent ART were similar. Clinical Trials Registration: NCT00027352 and NCT00867048.


Assuntos
Antirretrovirais/uso terapêutico , Contagem de Linfócito CD4 , Infecções por HIV/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Fármacos Anti-HIV/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Suscetibilidade a Doenças , Feminino , HIV-1 , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias , Modelos de Riscos Proporcionais , Tempo para o Tratamento , Resultado do Tratamento
8.
J Contemp Dent Pract ; 19(9): 1072-1075, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30287706

RESUMO

INTRODUCTION: This study aimed to assess the eruption of impacted teeth in cleft lip and/or palate (CLP) after alveolar bone graft. MATERIALS AND METHODS: Research was carried out through a cross-sectional study at the Craniofacial Rehabilitation Center of the University General Hospital of the University of Cuiabá, Mato Grosso, Brazil. Variables related to cleft, cleft side, gender, age, laterality of cleft, impacted teeth, and orthodontic traction were analyzed. RESULTS: Forty-two patients treated at the institution from 2004 to 2011 had their charts retrospectively reviewed. They were 54.7% male and 45.2% female. The group aged 9 to 11 years was most affected, representing 59.5% of cases. A unilateral cleft was the most prevalent craniofacial anomaly (85.7%). A total of 57 impacted teeth were observed. Maxillary canines were the most commonly impacted teeth (97.6%) and the most frequently identified in patients with a transforamen incisor cleft (TIC) (76.3%). Orthodontic traction was required for both impacted maxillary canines and impacted lateral incisors (64.3 and 35.7% respectively). The orthodontic traction was required only in patients with a TIC (p = 0.0101). CONCLUSION: The canine teeth were the most commonly impacted teeth, found mainly in patients with a TIC. After placement of the alveolar bone graft in patients with a preforamen incisor cleft (PIC), all impacted teeth erupted spontaneously. CLINICAL SIGNIFICANCE: An impacted tooth can have negative consequences on a patient's quality of life. Thus, a survey evaluating the incidence and prognosis of impacted teeth after an alveolar bone graft for CLP was important.


Assuntos
Enxerto de Osso Alveolar , Fenda Labial/epidemiologia , Fenda Labial/fisiopatologia , Fissura Palatina/epidemiologia , Fissura Palatina/fisiopatologia , Erupção Dentária , Dente Impactado/epidemiologia , Dente Impactado/fisiopatologia , Fatores Etários , Brasil/epidemiologia , Criança , Dente Canino , Feminino , Humanos , Incidência , Masculino , Prognóstico , Fatores Sexuais
9.
Res Pract Thromb Haemost ; 2(4): 708-717, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30349890

RESUMO

Background: Effective HIV treatment with antiretroviral therapy has prolonged survival and shifted causes of death to non-AIDS illnesses such as cardiovascular disease. We have shown that inflammation and HIV viral load associate with pro- and anticoagulant factor imbalances resulting in increased thrombin generation when mathematically modeled. We explore the hypothesis that factor compositional imbalance, corresponding to increased in silico thrombin generation, predicts mortality among HIV+ persons. Methods: In a nested case-control study of HIV+ individuals on continuous antiretroviral therapy in two large trials, we evaluated cases (any non-violent mortality, n = 114) and matched controls (n = 318). Thrombin generation in response to a tissue-factor initiator for each individual was calculated by a mathematical model incorporating levels of factors (F)II, V, VII, VIII, IX, X, antithrombin, tissue factor pathway inhibitor, and protein C (PC) measured at study entry to the trials. In silico thrombin generation metrics included clot time, maximum rate (MaxR), maximum level (MaxL), and area under the curve (AUC). Results: Levels of antithrombin and PC decreased, while FV and FVIII were higher in cases vs controls. This resulted in a more procoagulant phenotype with increased MaxR, MaxL, and AUC in cases compared to controls (P < 0.05 for all). Conclusions: Antithrombin, FV, FVIII, and PC were the major contributors to the increased thrombin generation associated with mortality risk. Our results suggest that mortality in HIV is associated with an increase in in silico thrombin generation via altered balance of pro- and anticoagulant factors, likely due to an inflammatory response signal, and resulting coagulopathy.

10.
J Contemp Dent Pract ; 19(8): 904-909, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30150487

RESUMO

AIM: To evaluate the antibacterial effect of diode laser, associated or not with 2.5% sodium hypochlorite (NaOCl), against Enterococcus faecalis. MATERIALS AND METHODS: Eighty dentin blocks were obtained from single-rooted human teeth and sterilized. Seventy were inoculated with 0.01 mL of fresh bacterial inoculum (within 24 hours of preparation from pure culture) standardized to 1 McFarland turbidity. Contaminated blocks were incubated for 7 days at 37°C in humid conditions. Ten uncontaminated samples were incubated at 37°C during the contamination period to serve as a negative control group, while 10 of the infected specimens served as a positive control group. The dentin blocks were randomly divided into eight experimental groups (n = 10 each) according to the method of decontamination: 2.5% NaOCl alone; 2.5% NaOCl + photodynamic therapy (PDT) with methylene blue/660 nm laser at 18 J for 180 seconds; 2.5% NaOCl + PDT with methylene blue/660 nm laser at 8 J for 80 seconds; methylene blue alone; PDT alone with methylene blue/660 nm laser at 18 J for 180 seconds; PDT alone with methylene blue/660 nm laser at 8 J laser for 80 seconds; positive control group; and negative control group. Microbial growth was evaluated by culture medium turbidity and microbial concentration was analyzed by UV spectrophotometry (adjusted to read at wavelength l = 600 nM). RESULTS: Root canals treated with laser alone at 18 J for 180 seconds had higher bacterial contamination compared with groups in which NaOCl was used, with or without laser irradiation at 18 J for 180 seconds (p < 0.05). CONCLUSION: Photodynamic therapy with a 660 nm diode laser effectively reduced E. faecalis contamination. These findings can guide development of further studies in search of better alternatives for endodontic treatment. CLINICAL RELEVANCE: Chemical and mechanical root canal preparation plays an essential role in reducing microbial burden. However, microorganisms present in areas not mechanically reachable by endodontic instruments. As an alternative to fix this problem, the laser can be applied.


Assuntos
Cavidade Pulpar/microbiologia , Dentina/microbiologia , Enterococcus faecalis/efeitos da radiação , Lasers Semicondutores , Fotoquimioterapia , Antibacterianos/farmacologia , Relação Dose-Resposta à Radiação , Farmacorresistência Bacteriana , Enterococcus faecalis/efeitos dos fármacos , Humanos , Hipoclorito de Sódio/farmacologia
11.
J Contemp Dent Pract ; 19(8): 933-936, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30150492

RESUMO

AIM: This study aimed to assess the eruption of impacted teeth in cleft lip and/or palate (CLP) after alveolar bone graft. MATERIALS AND METHODS: Research was carried out through a cross-sectional study at the Craniofacial Rehabilitation Center of the University General Hospital of the University of Cuiaba, Mato Grosso, Brazil. Variables related to cleft, cleft side, gender, age, laterality of cleft, impacted teeth, and orthodontic traction were analyzed. RESULTS: Forty-two patients treated at the institution from 2004 to 2011 were recruited. There were 54.76% males and 45.24% females. The age group between 9 and 11 years was most affected in 59.53% of cases. The unilateral cleft was the most prevalent (85.71%). A total of 57 impacted teeth were observed. Maxillary canine was the most prevalent impacted teeth (97.61%) and more frequent in transforamen incisor cleft (TIC) (76.3%). The orthodontic traction was needed in both maxillary canines and lateral incisor impacted teeth, 64.3 and 35.7% respectively. The orthodontic traction was needed only in TIC (p = 0.0101). CONCLUSION: The canine teeth were the most prevalent, mainly related to the TIC and all impacted teeth erupted spontaneously in the preforamen incisor cleft (PIC) after placement of the bone graft. CLINICAL SIGNIFICANCE: There was spontaneous eruption of impacted teeth after secondary alveolar bone graft in CLP.


Assuntos
Enxerto de Osso Alveolar , Fenda Labial/epidemiologia , Fissura Palatina/epidemiologia , Erupção Dentária , Dente Impactado/epidemiologia , Adolescente , Brasil/epidemiologia , Criança , Estudos Transversais , Dente Canino , Feminino , Humanos , Masculino , Ortodontia Corretiva/estatística & dados numéricos , Prevalência
12.
AIDS ; 32(16): 2405-2416, 2018 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-30134296

RESUMO

OBJECTIVES: To describe changes in the prevalence of comorbidities and risk factors among HIV-positive individuals in the EuroSIDA study. DESIGN: Comparison of two cross-sectional cohorts of HIV-positive adults under active follow-up in 2006 and 2014. METHODS: Baseline demographics and prevalence of comorbidities were described. Factors associated with the prevalence of chronic kidney disease (CKD) and cardiovascular disease (CVD) were assessed by logistic regression modelling using generalized estimating equations. RESULTS: Nine thousand, seven hundred and ninety-eight individuals were under active follow-up in EuroSIDA during 2006 and 12 882 during 2014. Compared with study participants in 2006, those in 2014 were older [median age 48.6 years (IQR 40.3-55.1) vs. 43.1 years (37.2-50.0) in 2006] and had higher prevalence of hypertension (59.6 vs. 47% in 2006), diabetes (6.3 vs. 5.4%), CKD (6.9 vs. 4.1%) and CVD (5.0 vs. 3.7%). Individuals in the 2014 cohort had higher odds for CKD (unadjusted OR 2.62, 95% CI 2.30-2.99, P < 0.0001) and CVD (OR 1.88, CI 1.68-2.10, P < 0.0001), but after multivariable adjustment for age group, comorbidities and other factors, year of cohort was no longer significantly associated with the odds of CKD [adjusted OR (aOR) 0.97, CI 0.52-1.82, P = 0.92) or of CVD (aOR 0.94, CI 0.54-1.63, P = 0.82). CONCLUSION: Between 2006 and 2014, the population aged and experienced an overall higher prevalence of non-AIDS comorbidities, including CKD and CVD. The increase in CVD could be explained by the aging population, and the increase in CKD by aging and changes in other factors. Treatment strategies balancing HIV outcomes with long-term management of comorbidities remain a priority.


Assuntos
Envelhecimento , Doenças Cardiovasculares/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estudos Transversais , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
13.
Medicine (Baltimore) ; 97(29): e11564, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30024557

RESUMO

Correct classification of death causes is an important component of transplant trials.We aimed to develop and validate a system to classify causes of death in hematopoietic stem cell (HSCT) and solid organ (SOT) transplant recipients.Case record forms (CRF) of fatal cases were completed, including investigator-designated cause of death. Deaths occurring in 2010 to 2013 were used for derivation; and were validated by deaths occurring in 2013 to 2015. Underlying cause of death (referred to as recorded underlying cause) was determined through a central adjudication process involving 2 external reviewers, and subsequently compared with the Danish National Death Cause Registry.Three hundred eighty-eight recipients died 2010 to 2015 (196 [51%] SOT and 192 [49%] HSCT). The main recorded underlying causes of death among SOT and HSCT were classified as cancer (20%, 48%), graft rejection/failure/graft-versus-host-disease (35%, 28%), and infections (20%, 11%). Kappa between the investigator-designated and the recorded underlying cause of death was 0.74 (95% CI 0.69-0.80) in derivation and comparable in the validation cohort. Death causes were concordant with the Danish National Death Cause Registry in 37.2% (95% CI 31.5-42.9) and 38.4% (95% CI 28.8-48.0) in the derivation and validation cohorts, respectively.We developed and validated a method to systematically and reliably classify the underlying cause of death among transplant recipients. There was a high degree of discordance between this classification and that in the Danish National Death Cause Registry.


Assuntos
Causas de Morte , Transplantados/estatística & dados numéricos , Transplante/mortalidade , Adulto , Idoso , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros
14.
Curr HIV/AIDS Rep ; 15(2): 162-171, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29504063

RESUMO

PURPOSE OF REVIEW: Optimal control of HIV can be achieved by early diagnosis followed by the initiation of antiretroviral therapy (ART). Two large randomised trials (TEMPRANO and START) have recently been published documenting the clinical benefits to HIV-positive adults of early ART initiation. Main findings are reviewed with a focus on serious non-AIDS (SNA) conditions. RECENT FINDINGS: Data from the two trials demonstrated that initiating ART early in the course of HIV infection resulted in marked reductions in the risk of opportunistic diseases and invasive bacterial infections. This indicates that HIV causes immune impairment in early infection that is remedied by controlling viral replication. Intriguingly, in START, a marked reduction in risk of cancers, both infection-related and unrelated types of cancers, was observed. Like the findings for opportunistic infections, this anti-cancer effect of early ART shows how the immune system influences important pro-oncogenic processes. In START, there was also some evidence suggesting that early ART initiation preserved kidney function, although the clinical consequence of this remains unclear. Conversely, while no adverse effects were evident, the trials did not demonstrate a clear effect on metabolic-related disease outcomes, pulmonary disease, or neurocognitive function. HIV causes immune impairment soon after acquisition of infection. ART reverses this harm at least partially. The biological nature of the immune impairment needs further elucidation, as well as mechanisms and clinical impact of innate immune activation. Based on the findings from TEMPRANO and START, and because ART lowers the risk of onward transmission, ART initiation should be offered to all persons following their diagnosis of HIV.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Neoplasias/complicações , Infecções Oportunistas Relacionadas com a AIDS/complicações , Esquema de Medicação , Humanos , Fatores de Tempo
15.
J Contemp Dent Pract ; 19(1): 3-12, 2018 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29358528

RESUMO

AIM: With the development of the light-emitting diode (LED) to photo-activate composite resin, greater intensities could be reached without greater elevation of temperature in the mass of the composite resin and in the dental structure arisen from the irradiance in comparison to halogen equipments. This new scenario created a necessity to investigate the influence of temperature over the composite polymerization. MATERIALS AND METHODS: Several curing temperatures (Tcure- 0, 25, 50, 75, and 100°C) were used to polymerize a composite resin (Filtek Z250, 3M ESPE) for 40 and 60 s, using the halogen equipment Gnatus Optilight Digital (halogen) and two LEDs that use a new technology to assembly the diodes: LEC 1000 and bright LEC (MM Optics) (LED 1 and LED 2 respectively). The influence of curing temperature, added by the other variables studied, was evaluated using a methodology developed and improved at IFSC/USP, in which the penetration of a fluorescent dye in the body of the photopolymerized composite resin was quantified using fluorescence spectroscopy. RESULTS: According to the final data submitted to an analysis of variance, the presence of two groups of results could be verified: Between 0 and 25°C, both had a great percentage of the dye penetration compared with other Tcure with a variation in penetration from 69.26 ± 8.19% to 90.99 ± 3.38%. In this analysis, the effects of time and temperature were highly notable (p < 0.05) and the lesser value of dye penetration took place at 60 s of photoactivation This penetration was, in average, smaller with the Tcure of 25°C. The results showed that there was an interaction between the equipment and time and between time and temperature; the other group is regarding the Tcure was from 50, 75, and 100°C, despite the p = 0.05, the effect of temperature was notable. The penetration of the dye ranged from 8.87 ± 3.55 to 39.47 ± 8.9%. The effects of equipment and time were highly notable. The penetration with the time of 60 s was in average smaller. Except with the equipment LED 1, the percentages of the dye penetration were greater with the Tcure of 100°C. The smallest average was the Tcure of 50°C and 60 s of photoactivation. CONCLUSION: Based on the available data regarding the influence of curing temperature on the polymerization process of composite resins, was possible to concluded that small increments of heat increased the degree of conversion. We can assume that the energy supply through the generation of heat by the photopolymerizing devices can function as a heating medium for the reagent system by reducing its viscosity and increasing the mobility and agitation of its components. CLINICAL SIGNIFICANCE: The dentist must be aware of the effects that exist between the activation devices on the light output and their heat transmission to the composite and the tooth itself. This heat transmission might create a polymer with better characteristics.


Assuntos
Resinas Compostas/química , Materiais Dentários/química , Corantes Fluorescentes/química , Cura Luminosa de Adesivos Dentários , Temperatura , Teste de Materiais , Polimerização , Espectrometria de Fluorescência , Propriedades de Superfície
16.
J Contemp Dent Pract ; 19(11): 1322-1328, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30602635

RESUMO

AIM: This study aimed to evaluate the influence of labial and dentogingival characteristics on facial and smile attractiveness. MATERIALS AND METHODS: Four different close-up photographs each of six women models with different labial and dentogin-gival characteristics were obtained. One of the models was considered standard. Photographs were arranged in an album were evaluated by 100 laypersons, and 30 dentists who ranked each close-up of the models from according to the degree of attractiveness from first to sixth place, with first being the model considered most attractive and justified the reasons for choosing. RESULTS: The standard model received the best scores for both lips (7.75) and face (5.18). Medium-sized lips were preferred (p < 0.05), and the smile positively or negatively interfered with esthetic perception depending on the dentogingival alteration present. Diastema was the alteration that had the greatest negative influence. CONCLUSION: Not all dentogingival alterations interfere with esthetic evaluation. The lips are not decisive in facial attractiveness. Attraction is assessed significantly differently by laypeople than by dentists. The smile directly influences the analysis of facial beauty. CLINICAL SIGNIFICANCE: Dentogingival alterations may be imperceptible, especially when evaluating the facial joint, so its correction will not always be necessary.


Assuntos
Beleza , Dentição Permanente , Estética Dentária/psicologia , Face/anatomia & histologia , Face/fisiologia , Lábio/anatomia & histologia , Lábio/fisiologia , Sorriso/fisiologia , Estudos Transversais , Diastema , Face/diagnóstico por imagem , Expressão Facial , Feminino , Humanos , Lábio/diagnóstico por imagem , Fotografação
17.
J Contemp Dent Pract ; 18(11): 1051-1055, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29109320

RESUMO

INTRODUCTION: The aim of this study was to evaluate the effects of bleaching gel using 35% hydrogen peroxide (HP), associated with red carmine pigment (RC), in the 3:1 or 1:1 ratio, on fracture resistance and dentin microhardness of endodontically treated teeth. MATERIALS AND METHODS: A total of 40 lower incisors were endodontically treated and divided into four groups (n = 10), according to the bleaching protocol: G1 (HP3), 35% HP + RC (3:1); G2 (HP1), 35% HP + RC (1:1); G3 (positive), 38% HP; and G4 (negative), unbleached. Four dental bleaching sessions were performed. The dental crowns were restored after the last session and submitted to the fracture resistance test. Totally, 60 specimens from the endodontically treated lower incisor crowns were prepared to evaluate the effects on dentin microhardness. The analysis was measured (in Knoop) prior to and after the last dental bleaching session using similar bleaching protocols. RESULTS: G2 presented the lowest fracture resistance (p < 0.05). The other groups were similar to each other (p > 0.05). No difference was observed in the reduction of dentin microhardness among the groups (p > 0.05). CONCLUSION: A 1:1 ratio (bleaching gel:pigment) caused a significant fracture resistance reduction in relation to the other protocols. No effect on the dentin microhardness reduction was observed. CLINICAL SIGNIFICANCE: The pigment addition to the bleaching agent accelerates the bleaching chemical reaction. However, no studies have evaluated the ideal proportion to optimize tooth bleaching.


Assuntos
Corantes/administração & dosagem , Análise do Estresse Dentário , Dentina , Peróxido de Hidrogênio/administração & dosagem , Clareadores Dentários/administração & dosagem , Fraturas dos Dentes , Dente não Vital , Géis , Testes de Dureza , Humanos , Técnicas In Vitro
18.
Clin Infect Dis ; 64(10): 1413-1421, 2017 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-28329090

RESUMO

Background: Antiretrovirals (ARVs) affect bone density and turnover, but their effect on risk of fractures and osteonecrosis of the femoral head is less understood. We investigated if exposure to ARVs increases the risk of both bone outcomes. Methods: EuroSIDA participants were followed to assess fractures and osteonecrosis. Poisson regression identified clinical, laboratory and demographic predictors of either bone outcome. Ever, current, and cumulative exposures to ARVs were assessed. Results: During 86118 PYFU among 11820 included persons (median age 41y, 75% male, median baseline CD4 440/mm3, 70.4% virologically suppressed), there were 619 fractures (incidence/1000 PYFU 7.2; 95% CI 6.6-7.7) and 89 osteonecrosis (1.0; 0.8-1.3). Older age, white race, lower BMI, IV drug use, lower baseline CD4, HCV coinfection, prior osteonecrosis, prior fracture, cardiovascular disease, and recent non-AIDS cancer (last 12 months) were associated with fractures. After adjustment, persons who had ever used tenofovir disoproxil fumarate (TDF) (1.40; 1.15-1.70) or who were currently on TDF (1.25; 1.05-1.49) had higher incidence of fractures. There was no association between cumulative exposure to TDF and fractures (1.08/5 y exposure; 0.94-1.25). No other ARV was associated with fractures (all P > .1). Risk of osteonecrosis was associated with white race, lower nadir CD4, prior osteonecrosis, prior fracture, and prior AIDS. After mutual adjustment, no ARV was associated with osteonecrosis. Conclusions: In human immunodeficiency virus (HIV) infection, host factors, HIV-specific variables, and comorbidities contribute to risk of fractures and osteonecrosis. Exposure to TDF, but not other ARVs, was an independent risk factor for fractures.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Fraturas Ósseas/etiologia , Infecções por HIV/complicações , Osteonecrose/etiologia , Adulto , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Densidade Óssea/efeitos dos fármacos , Contagem de Linfócito CD4 , Estudos de Coortes , Coinfecção/epidemiologia , Coleta de Dados , Europa (Continente)/epidemiologia , Feminino , Fraturas do Fêmur/epidemiologia , Fraturas do Fêmur/etiologia , Fraturas do Fêmur/virologia , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etnologia , Fraturas Ósseas/virologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteonecrose/epidemiologia , Osteonecrose/virologia , Análise de Regressão , Fatores de Risco , Tenofovir/efeitos adversos , Tenofovir/uso terapêutico
20.
Curr Opin HIV AIDS ; 12(1): 12-19, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27755153

RESUMO

PURPOSE OF REVIEW: To review the newest research about the effects of combination antiretroviral therapy (cART) on cancer risk. RECENT FINDINGS: HIV+ persons are at increased risk of cancer. As this risk is higher for malignancies driven by viral and bacterial coinfections, classifying malignancies into infection-related and infection-unrelated has been an emerging trend. Cohorts have detected major reductions in the incidence of Kaposi sarcoma and non-Hodgkin lymphoma (NHL) following cART initiation among immunosuppressed HIV+ persons. However, recent randomized data indicate that cART reduces risk of Kaposi sarcoma and NHL also during early HIV infection before overt immunosuppression occurs. Long-term effects of cART exposure on cancer risk are not well defined; according to basic and epidemiological research, there might be specific associations of each cART class with distinct patterns of cancer risk. SUMMARY: The relationship between cART exposure and cancer risk is complex and nuanced. It is an intriguing fact that, whether initiated during severe immunosuppression or not, cART reduces risk of Kaposi sarcoma and NHL. Further research should identify mediators of the benefit of immediate cART initiation in reducing cancer risk, understand the relationship between long-term cART exposure and cancer incidence and assess whether adjuvant anti-inflammatory therapies can reduce cancer risk during treated HIV infection.


Assuntos
Antirretrovirais/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Neoplasias/epidemiologia , Humanos , Medição de Risco
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