Lopinavir/ritonavir dosing during pregnancy in Brazil and maternal/infant laboratory abnormalities

OBJECTIVES: To describe laboratory abnormalities among HIV-infected women and their infants with standard and increased lopinavir/ritonavir (LPV/r) dosing during the third trimester of pregnancy. METHODS: We evaluated data on pregnant women from NISDI cohorts (2002-2009) enrolled in Brazil, who received at least 28 days of LPV/r during the third pregnancy trimester and gave birth to singleton infants. RESULTS: 164 women received LPV/r standard dosing [(798/198 or 800/200 mg/day) (Group 1)] and 70 increased dosing [(> 800/200 mg/day) (Group 2)]. Group 1 was more likely to have advanced clinical disease and to use ARVs for treatment, and less likely to have CD4 counts > 500 cells/mm³. Mean plasma viral load was higher in Group 2. There were statistically significant, but not clinically meaningful, differences between groups in mean AST, ALT, cholesterol, and triglycerides. The proportion of women with Grade 3 or 4 adverse events was very low, with no statistically significant differences between groups in severe adverse events related to ALT, AST, total bilirubin, cholesterol, or triglycerides. There were statistically significant, but not clinically meaningful, differences between infant groups in ALT and creatinine. The proportion of infants with Grade 3 or 4 adverse events was very low, and there were no statistically significant differences in severe adverse events related to ALT, AST, BUN, or creatinine. CONCLUSION: The proportions of women and infants with severe laboratory adverse events were very low. Increased LPV/r dosing during the third trimester of pregnancy appears to be safe for HIV-infected women and their infants.

Estudantes universitários em tempos de HIV: o contexto da testagem / Undergraduate students in times of HIV: testing context

O objetivo do estudo foi conhecer o posicionamento de estudantes universitários diante da decisão de se testarem para o HIV e da possibilidade de participarem em estudos sobre vacina, caracterizando tais estudantes do ponto de vista sociodemográfico. Os participantes foram 645 estudantes matriculados em diferentes cursos de graduação de uma universidade localizada na região sul do Brasil, dentre esses participantes a média de idade era de 25,32 anos, 442 (68,5 por cento) eram do sexo feminino e 202 (31,3 por cento) do sexo masculino. Um questionário foi aplicado, com 33 questões, abordando dados sociodemográficos, bem como situações objetivas e hipotéticas, com opções de escolha simples e múltiplas. Os resultados indicaram que 197 (30,5 por cento) dos participantes se testaram para o HIV. Encontrou-se uma associação estatisticamente significativa (Teste Exato de Fisher = 0,000) e uma correlação alta (0,000) entre terem realizado o teste e terem pensado sobre o mesmo. A investigação revelou a necessidade dos espaços universitários oferecerem possibilidades de discussão e de campanhas específicas.

The aim of this study was to better explain the attitudes of university students regarding the decisionto undergo HIV testing and the possibility of taking part in studies on vaccinations, by categorizingthese students from a socio-demographic viewpoint. The participants were 645 students from differentundergraduate courses at a university in the South of Brazil – mean age 25.32 years, 442 (68.5%) were female and 202 (31.3%) were male). A questionnaire was administered, with 33 multiple choice questions, covering socio-demographic data, as well as objective and hypothetical situations. Theresults clearly showed that 197 (30.5%) of the participants had been tested for HIV. One met a statistical significant association (Exact of Fisher = 0,000) and a high correlation (0,000) between having been tested and to have thoughts on the same. The study revealed the need for universityspaces to provide for the possibility of discussions and specific campaigns.

Prevalence of toxoplasmosis, HIV, syphilis and rubella in a population of puerperal women using Whatman 903® filter paper

OBJECTIVES: to determine the seroprevalence rate of toxoplasmosis, HIV, syphilis and rubella in a population of puerperal women. METHODS: a prospective, cross-sectional study was performed from February 2007 to April 2008 at Hospital Geral, Universidade de Caxias do Sul in a population of 1,510 puerperal women. Women that gave birth to live born or stillborn infants were included in the study; maternal and perinatal variables were analyzed. Descriptive statistics and Pearson's chi-square with occasional Fisher's correction were used for comparisons. Alpha was set in 5 percent. RESULTS: a total of 148 cases of congenital infection (9.8 percent) were identified: 66 cases of syphilis (4.4 percent), 40 cases of HIV (2.7 percent), 27 cases of toxoplasmosis (1.8 percent) and 15 cases of rubella (1.0 percent). In ten cases there was co-infection (four cases of HIV and syphilis, two cases of HIV and rubella, one case of HIV and toxoplasmosis, two cases of rubella and syphilis, and one case of toxoplasmosis and rubella). In a comparison between puerperal women with and without infection there was no statistical significance in relation to incidence of abortions, small for gestational age, prematurity, live births and stillbirths, and prenatal care. Need of neonatal intensive care unit (NICU), maternal schooling, maternal age higher than 35 years and drug use (alcohol, cocaine and crack) had statistical significance. CONCLUSION: the prevalence rate of infections was 9.8 percent. Need of NICU, maternal schooling lower than eight years, maternal age higher than 35 years and drug use were significantly associated with occurrence of congenital infection.

Evaluation of the human immunodeficiency virus type 1 and 2 antibodies detection in dried whole blood spots (dbs) samples / Pesquisa de anticorpos contra o vírus da imunodeficiência humana tipos 1 e 2 em amostras de sangue seco coletadas em papel filtro

Human Immunodeficiency Vírus Type 1 and 2 antibodies detection was performed in 457 dried whole blood spots samples (S&S 903). Q-Preven HIV 1+2 was the screening test used. The results were compared with the gold standard serum tests by ELISA (Cobas Core e Axsym HIV1/2 gO) and imunofluorescence was the definitive confirmatory test. The samples were obtained from the Hospital Nossa Senhora da Conceição in Porto Alegre, RS - Brazil, through whole blood transfer to filter paper card and sent to Caxias do Sul, RS - Brazil where the tests were performed. The dried whole blood spot stability was evaluated with two different panels. The first one was composed of five negative and five positive samples stored at room temperature, 4 ºC, -20 ºC and -70 ºC, while the second was composed of two negative and three positive samples stored at 37 ºC (humidity <50 percent). Each sample was screened every week for six weeks. These measurement results didn't show variation during the study period. The detected sensibility was 100 percent, specificity was 99.6 percent, the positive predictive value was 99.5 percent and negative predictive values were 100 percent. The results demonstrated high performance characteristics, opening a new perspective of dried whole blood spot utilization in HIV screening diagnosis.

Foram realizados 457 testes para detectar anticorpos contra o Vírus da Imunodeficiência Humana tipos 1 e 2, em amostras de sangue total seco coletadas em papel filtro (S&S 903), com o teste de triagem Q-Preven HIV 1+2, comparando-se com os resultados dos testes de triagem no soro (Cobas Core e Axsym HIV1/2 gO), sendo a imunofluorescência indireta o teste confirmatório. As amostras foram obtidas no Hospital Conceição em Porto Alegre, pela transferência de sangue total para cartão de papel filtro e encaminhadas para Caxias do Sul para a realização dos testes. Foi analisada a estabilidade da amostra em papel filtro com a utilização de dois painéis: o primeiro com cinco amostras negativas e cinco positivas armazenadas por seis semanas à temperatura ambiente, 4 ºC, -20 ºC e -70 ºC; o segundo com duas negativas e três positivas armazenadas por seis semanas com avaliações semanais a 37 ºC (umidade <50 por cento). Os resultados de todas as amostras testadas foram mantidos. A sensibilidade foi de 100 por cento, a especificidade de 99,6 por cento, o valor preditivo positivo de 99,5 por cento e o valor preditivo negativo de 100 por cento. O excelente desempenho observado na análise da utilização de sangue seco em papel filtro, abre uma nova perspectiva no diagnóstico da infecção pelo HIV.