Factors associated with death from dengue and chikungunya virus infection during an epidemic period in Northeast Brazil: A retrospective cohort study

ABSTRACT Background: We investigated the time to death and factors associated with deaths from dengue and chikungunya during the first epidemic after the introduction of the chikungunya virus in Northeastern Brazil. Methods: This retrospective cohort study was conducted in Pernambuco between 2015 and 2018. Logistic regression was used to identify independent risk factors. The probability of survival among individuals with different arbovirus infections was estimated and the survival curves were compared using log-rank tests. Results: The lethality coefficients for dengue and chikungunya viruses were 0.08% and 0.35%, respectively. The chance of death due to chikungunya infection increased progressively from the age of 40 years. At 40-49 years, the odds ratio was 13.83 (95%CI, 1.80-106.41). At 50-59 years and 60 years or older, the odds ratio was 27.63 (95%CI, 3.70-206.48); and 78.72 (95%CI, 10.93-566.90), respectively. The probability of death associated with dengue virus infection increased from the age of 50 years. Among patients aged 50-59 years and 60 years or older, the odds ratio was 4.30 (95%CI, 1.80-10.30) and 8.97 (95%CI, 4.00-20.0), respectively. Independent factors associated death were headache and age of 50 years or older for dengue; and headache, nausea, back pain, intense arthralgia, age 0-9 years or 40 years and older, and male sex for chikungunya. The ratio between mortality rates revealed that the time to death from dengue was 2.1 times faster than that from chikungunya (95%CI, 1.57-2.72). Conclusions: The time to death was shorter in patients with dengue than in those with chikungunya disease. This study reinforces the need for faster and more effective decision-making in public health services to enhance patient outcomes and minimize mortality.

Fatores de sucesso em colaborativa para redução de infecções relacionadas à assistência à saúde em unidades de terapia intensiva no Nordeste do Brasil / Success factors of a collaborative project to reduce healthcare-associated infections in intensive care units in Northeastern Brazil

RESUMO Objetivo: Descrever a implementação e os resultados da colaborativa PROADI-SUS, do Ministério da Saúde Brasileiro, para redução das infecções relacionadas à assistência à saúde: pneumonia associada à ventilação mecânica, infecção primária da corrente sanguínea associada ao cateter venoso central e infecção do trato urinário associada ao cateter vesical de demora. Métodos: Estudo observacional prospectivo que pesquisou as etapas da implementação e dos resultados por 18 meses, em cinco unidades de terapia intensiva de Recife. As reduções de infecções relacionadas à assistência à saúde em cada unidade foram calculadas pelas medianas anteriores comparadas ao período do estudo. Resultados: A meta de redução das três infecções relacionadas à assistência à saúde, ou seja, 30% em 18 meses, foi obtida em no mínimo uma das infecções relacionadas à assistência à saúde nas cinco unidades de terapia intensiva, sendo ainda atingida para duas infecções relacionadas à assistência à saúde em dois hospitais e nas três infecções relacionadas à assistência à saúde em apenas um hospital; este último atingiu a meta prevista para 36 meses. Foram ações consideradas essenciais pelas equipes gestoras locais a implantação dos bundles e o acompanhamento dos resultados pelos profissionais. Também, aquisição de insumos e disponibilização junto aos leitos, sinalização, checklists, conscientização da equipe, adaptação, criação de times, treinamento e comemoração de conquistas foram avaliados como relevantes para redução das infecções relacionadas à assistência à saúde. Conclusão: A colaborativa reduziu infecções relacionadas à assistência à saúde, apesar da adesão parcial aos bundles. A hipótese é a de que o êxito se relacione com a metodologia do projeto e equipes multiprofissionais motivadas, especialmente a enfermagem.

ABSTRACT Objective: To describe the implementation and results of the collaborative PROADI-SUS project by the Brazilian Ministry of Health to reduce healthcare-associated infections: ventilator-associated pneumonia, primary central line-associated bloodstream infection and catheter-associated urinary tract infections. Methods: This was a prospective observational study that investigated the implementation stages and outcomes during 18 months in five intensive care units in the city of Recife. Reductions in healthcare-associated infections in each unit were calculated using previous medians compared to those of the study period. Results: The goal of reducing the three healthcare-associated infections, i.e., 30% in 18 months, was achieved in at least one of the healthcare-associated infections and was also achieved for two healthcare-associated infections in two hospitals and three healthcare-associated infections in just one hospital; the latter reached the target of 36 months. Implementing the bundles and monitoring the results by the professionals were considered essential actions by the local management teams. In addition, the acquisition of supplies and their availability alongside the beds, signage, checklists, staff awareness, adaptation, team building, training and celebration of achievements were assessed as being relevant for reducing healthcare-associated infections. Conclusion: The collaborative approach reduced healthcare-associated infections, despite partial adherence to the bundles. The hypothesis is that success is related to the project methodology and motivated multidisciplinary teams, especially nursing teams.

O efeito da atorvastatina + aspirina na função endotelial difere com a idade em pacientes com HIV: Um estudo de caso-controle / The effect of atorvastatin + aspirin on the endothelial function differs with age in patients with HIV: A case-control study

Resumo Fundamento Pacientes com HIV têm maior probabilidade de apresentar doenças cardiovasculares quando comparados à população em geral. Objetivo Este foi um estudo de caso-controle que teve como objetivo avaliar quais fatores estavam associados a uma redução na espessura médio-intimal da carótida (IMT) da carótida e ao aumento na dilatação mediada por fluxo (DMF) da artéria braquial em pacientes com HIV que receberam atorvastatina + aspirina por um período de 6 meses. Métodos Foi realizada uma análise secundária de um ensaio clínico, que incluiu pessoas vivendo com HIV e baixo risco cardiovascular. Um total de 38 pacientes alocados para o braço de intervenção e tratados por 6 meses com uma combinação de atorvastatina + aspirina foram incluídos. Todos os participantes foram submetidos a ultrassonografia da carótida e da artéria braquial, tanto no início quanto no final do estudo. Os casos que responderam com aumento >10% da dilatação braquial (DMF) e redução da espessura médio-intimal da carótida (IMT) foram considerados casos, e aqueles que não responderam foram considerados controles. Avaliamos os fatores associados às respostas positivas obtidas através da IMT e DMF. Resultados A redução do IMT não se associou significativamente a nenhum dos fatores de risco avaliados: idade (p = 0,211), sexo (p = 0,260), tabagismo (p = 0,131) ou tempo de diagnóstico do HIV (p = 0,836). Um aumento na DMF foi significativamente associado com a idade entre aqueles na faixa etária de 40-59 anos, p = 0,015 (OR = 4,37; IC 95%: 1,07-17,79). Conclusões Os indivíduos mais velhos foram mais propensos a apresentar um aumento na DMF após 6 meses de tratamento com atorvastatina + aspirina.

Abstract Background Patients with HIV are more likely to present with cardiovascular disease when compared to the general population. Objective This was a case-control study that aimed to assess which factors were associated with a reduction in the carotid intima-media thickness (IMT) and an increase in the brachial artery flow-mediated dilation (FMD) in HIV patients who received atorvastatin + aspirin during a period of 6 months. Methods A secondary analysis of a clinical trial was conducted, which included people living with HIV infection and low cardiovascular risk. A total of 38 patients allocated to the intervention arm and treated for 6 months with a combination of atorvastatin + aspirin were included. All participants underwent a carotid and brachial artery ultrasound, both at the beginning and the end of the study. Cases that responded with an increase of >10% of the brachial dilatation (FMD) and reduction of the carotid intima-media thickness (IMT) were considered cases, and those who did not respond were considered controls. We assessed the factors associated with the positive responses obtained through IMT and FMD. Results A reduction in the IMT was not significantly associated with any of the evaluated risk factors: age (p=0.211), gender (p=0.260), smoking (p=0.131) or time since HIV diagnosis (p=0.836). An increase in the FMD was significantly associated with age amongst those in the 40-59 age group, p = 0.015 (OR = 4.37; 95% CI: 1.07-17.79). Conclusions Older individuals were more likely to present with an increased FMD after 6 months of treatment with atorvastatin + aspirin.

Inflammatory Biomarkers and Carotid Thickness in HIV Infected Patients under Antiretroviral Therapy, Undetectable HIV-1 Viral Load, and Low Cardiovascular Risk / Biomarcadores Inflamatórios e Espessura Carotídea em Pacientes Infectados pelo HIV em Terapia Antirretroviral, com Carga Viral de HIV-1 Indetectável e Baixo Risco Cardiovascular

Abstract Background: People living with HIV are at increased risk of cardiovascular disease and carotid thickness, due to the inflammation caused by the virus, the antiretroviral therapy, and other risk factors. However, few studies have observed the occurrence of cardiovascular diseases and carotid thickness in HIV-positive population at low cardiovascular risk and with undetectable viral load. Objectives: To evaluate the association between levels of inflammatory markers and carotid thickness in people living with HIV, under antiretroviral therapy and at low cardiovascular risk. Methods: To determine low cardiovascular risk in both groups (HIV infected and non-infected individuals), the Framingham Risk Score was used. Inflammatory markers (IFN-γ, TNF-α, IL-1β, IL-6, sVCAM-1, and sICAM-1) were assessed using flow cytometry. Carotid thickness (mm) was measured using Doppler ultrasound. Level of significance was p < 0.05. Results: In People living with HIV, age and smoking status were associated with carotid thickness alterations. In the non-HIV group, age, higher total cholesterol, and LDL levels were associated with increased carotid thickness. Using the multivariate analysis, a significant association between TNF-α and IL- 1( levels, and a higher chance of atherosclerosis development in HIV group were observed. Conclusions: Both groups have a similar risk for developing cardiovascular disease, therefore our study demonstrates that HIV-positive individuals with undetectable viral load in antiretroviral therapy without protease inhibitors and with low cardiovascular risk do not present differences in carotid thickness in relation to uninfected individuals.

Resumo Fundamento: As pessoas que vivem com HIV têm um risco aumentado de doença cardiovascular e espessamento da carótida, devido à inflamação causada pelo vírus, à terapia antirretroviral e a outros fatores de risco. No entanto, poucos estudos observaram a ocorrência de doenças cardiovasculares e espessamento carotídeo na população soropositiva com baixo risco cardiovascular e carga viral indetectável. Objetivos: Avaliar a associação entre níveis de marcadores inflamatórios e espessura da carótida em pessoas vivendo com HIV, sob terapia antirretroviral e com baixo risco cardiovascular. Métodos: Para determinar o baixo risco cardiovascular em ambos os grupos (indivíduos infectados e não-infectados pelo HIV), foi utilizado o Escore de Risco de Framingham. Os marcadores inflamatórios (IFN-γ, TNF-α, IL-1β, IL-6, sVCAM-1 e sICAM-1) foram avaliados por citometria de fluxo. A espessura da carótida (mm) foi mensurada por meio de ultrassom com Doppler. O nível de significância foi de p < 0,05. Resultados: Em pessoas vivendo com HIV, a idade e o tabagismo foram associados a alterações da espessura da carótida. No grupo não-HIV, idade e níveis mais altos de colesterol total e LDL foram associados ao aumento da espessura da carótida. Utilizando a análise multivariada, observou-se associação significativa entre os níveis de TNF-α e IL-1β e maior chance de desenvolvimento de aterosclerose no grupo com HIV. Conclusão: Ambos os grupos têm risco semelhante de desenvolver doença cardiovascular, portanto, nosso estudo demonstra que indivíduos HIV-positivos com carga viral indetectável em terapia antirretroviral sem inibidores de protease e com baixo risco cardiovascular não apresentam diferenças na espessura da carótida em relação aos indivíduos não-infectados.

Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals / Espessamento Mediointimal nas Carótidas e Femorais para Detectar Aterosclerose em Pessoas que Vivem com o Vírus da Imunodeficiência Humana

Abstract Background: The prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population. Objectives: To assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls. Methods: Eighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant. Results: An IMT > P75 or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17]). Conclusion: In HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects.

Resumo Fundamento: Pessoas que vivem com o HIV (HIV +) têm maior prevalência de aterosclerose e a desenvolvem mais precocemente do que a população geral. Objetivos: Foi avaliar e comparar as prevalências de aterosclerose avaliada pela medida da espessura mediointimal (EMI) das carótidas comuns e femorais, e do índice tornozelo-braquial (ITB) nos grupos controle e HIV com e sem inibidores de protease (IPs). Métodos: Foram incluídas 80 pessoas com HIV + [40 usavam IPs e 40 não] e 65 controles. O diagnóstico de aterosclerose foi determinado pela medição da EMI (carótidas e femorais) e do ITB. Fatores de risco clássicos para aterosclerose e específicos para o HIV foram comparados entre os grupos, usando testes estatístcos. O valor de p ≤ 0,05 foi cosiderado significativo. Resultados: A EMI > P75 ou presença de placa foi mais elevada no grupo de HIV sem IP que no controle (37,5% vs 19%, p = 0,04). A análise comparativa mostrou diferença significativa (p=0,014) na EMI nas artérias carótidas entre HIV + com IPs (0,71 ± 0,28 mm), sem IPs (0,63 ± 0,11 mm) e controles (0,59 ± 0,11 mm), A EMI na femoral não teve diferença significante entre os grupos. Não houve diferença significante entre os grupos controle e de HIV + quanto ao ITB. No entanto, observou-se uma diferença significativa (p=0,015) no ITB entre os grupos HIV + sem IPs (1,17 [1,08 - 1,23]), e controles [1,08 (1,07 - 1,17)]. Conclusão: Em pacientes com HIV, a aterosclerose é mais prevalente e parece ocorrer mais precocemente, com características distintas, em comparação a indivíduos HIV-negativos.

Factors associated with treatment for latent tuberculosis in persons living with HIV/AIDS / Fatores associados ao tratamento da tuberculose latente em pessoas vivendo com HIV/AIDS / Factores asociados al tratamiento de la tuberculosis latente en personas viviendo con VIH/SIDA

Abstract The aim was to identify factors associated with non-initiation of prophylactic treatment of latent tuberculosis infection (LTBi) in persons living with HIV/AIDS (PLWA), based on a prospective cohort study of PLWA ≥ 18 years of age in two referral services for HIV/AIDS. Of the 232 patients eligible for treatment of LTBi, 69.8% initiated treatment. Following multivariate logistic regression analysis, only treatment in one of the two referral services was associated with non-initiation of treatment for LTBi (p < 0.001). TB incidence in the cohort was 0.6/100 person-years. TB incidence in patients that initiated treatment of LTBi was 0.4/100 person-years, compared to 1.2/100 person-years in those that did not initiate treatment, but the difference was not statistically significant. The study’s most interesting finding was that the main factor associated with the likelihood of treatment for LTBi was the health service where the patient was treated.

Resumo O objetivo foi identificar os fatores associados ao não início do tratamento preventivo para tuberculose (TB) latente (TBLi) em pessoas vivendo com o HIV/AIDS (PVHA). Um estudo de coorte prospectivo foi realizado com PVHA, idade ≥ 18 anos, de dois serviços de referência para HIV/AIDS. De 232 pacientes elegíveis para tratamento da TBLi, 69,8% iniciaram o tratamento. Após análise de regressão logística multivariada, apenas ser tratado em um dos serviços de referência esteve associado ao não início do tratamento para TBLi (p < 0,001). A taxa de incidência de TB na coorte foi de 0,6/100 pessoas/ano. Para os pacientes que iniciaram o tratamento para TBLi, a taxa de incidência de TB foi de 0,4/100 pessoas/ano e para aqueles que não iniciaram, a taxa foi de 1,2/100 pessoas/ano, mas esta diferença não foi estatisticamente significativa. O achado mais interessante deste estudo foi o fato de o principal fator associado ao aumento da probabilidade de ser tratado para TBLi foi a unidade de saúde onde o paciente foi acompanhado.

Resumen El objetivo fue identificar los factores asociados a no iniciar el tratamiento preventivo para la tuberculosis (TB) latente (TBLi) en personas viviendo con VIH/SIDA (PVHA). Un estudio de cohorte prospectivo fue realizado con PVHA, edad ≥ 18 años, de dos servicios de referencia para VIH/SIDA. De 232 pacientes elegibles para el tratamiento de la TBLi, 69,8% iniciaron el tratamiento. Tras el análisis de regresión logística multivariada, simplemente ser tratado en uno de los servicios de referencia estuvo asociado a no comenzar el tratamiento para TBLi (p < 0,001). La tasa de incidencia de TB en la cohorte fue de 0,6/100 personas-año. Para los pacientes que iniciaron el tratamiento para TBLi, la tasa de incidencia de TB fue de 0,4/100 personas-año y para aquellos que no lo iniciaron, la tasa fue de 1,2/100 personas-año, pero esa diferencia no fue estadísticamente significativa. El hallazgo más interesante de este estudio fue el hecho de que el principal factor asociado al aumento de la probabilidad de ser tratado para TBLi fue la unidad de salud donde se realizó el seguimiento del paciente.

Association beteeen smoking, crack cocaine abus and the discontinuation of commbination antiretroviral therapy in recife, pernambuco, Brazil / Associacao entre tabagismo e o uso de crack com a descontinuidade da terapia antirretroviral combinada em Recife, Pernambuco, Brasil

Despite the effectiveness of combination antiretroviral therapy in the treatment of people living with HIV/AIDS (PLWHA), nonadherence to medication has become a major threat to its effectiveness. This study aimed to estimate the prevalence of self-reported irregular use of antiretroviral therapy and the factors associated with such an irregularity in PLWHA. A cross-sectional study of PLWHA who attended two referral centers in the city of Recife, in Northeastern Brazil, between June 2007 and October 2009 was carried out. The study analyzed socioeconomic factors, social service support and personal habits associated with nonadherence to antiretroviral therapy, adjusted by multivariable logistic regression analysis. The prevalence of PLWHA who reported irregular use of combination antiretroviral therapy (cART) was 25.7%. In the final multivariate model, the irregular use of cART was associated with the following variables: being aged less than 40 years (OR = 1.66, 95%-CI: 1.29-2.13), current smokers (OR = 1.76, 95%-CI: 1.31-2.37) or former smokers (OR = 1.43, 95%-CI: 1.05-1.95), and crack cocaine users (OR = 2.79, 95%-CI: 1.24-6.32). Special measures should be directed towards each of the following groups: individuals aged less than 40 years, smokers, former smokers and crack cocaine users. Measures for giving up smoking and crack cocaine should be incorporated into HIV-control programs in order to promote greater adherence to antiretroviral drugs and thus improve the quality of life and prolong life expectancy.

Apesar da eficácia da terapêutica antirretroviral combinada para o tratamento de pessoas vivendo com HIV/Aids, a não adesão aos medicamentos tem se tornado uma das maiores ameaças à efetividade dessa terapêutica. O objetivo desse estudo foi estimar a prevalência de uso irregular autorreferido da terapia antirretroviral e os fatores associados com essa irregularidade em pessoas vivendo com HIV. Foi realizado um estudo seccional de pessoas vivendo com HIV/Aids atendidas em dois centros de referência no Recife, Nordeste do Brasil, entre junho 2007 e outubro de 2009. Foram analisados os fatores socioeconômicos, de apoio social e de hábitos do indivíduo, ajustados através de análise de regressão logística multivariada. A prevalência de pessoas vivendo com HIV/Aids que relataram o uso irregular da terapia antirretroviral combinada (TARC) foi de 25,7%. No modelo multivariado final, o uso irregular da TARC esteve associado às seguintes variáveis: ter menos de 40 anos (OR = 1,66, IC95%: 1,29-2,13), fumantes (OR = 1,76, IC95%: 1,31-2,37) ou ex-fumantes (OR = 1,43, IC95%: 1,05-1,95) e ser usuário de crack (OR = 2,79, IC95%: 1,24-6,32). Medidas especiais devem ser direcionadas para cada um dos seguintes grupos: adultos com menos de 40 anos, fumantes, ex-fumantes e usuários de crack. Ações voltadas para a cessação do tabagismo e do crack devem ser incorporadas ao programa de controle dos infectados pelo HIV, visando promover a maior adesão aos antirretrovirais e, consequentemente, aumentar a expectativa e a qualidade de vida.

Associação dos biomarcadores com aterosclerose e risco para doença coronariana em portadores de HIV / Association of biomarkers with atherosclerosis and risk for coronary artery disease in patients with HIV

FUNDAMENTO: O uso maciço da Terapia Antirretroviral (TARV) na população com vírus da imunodeficiência adquirida (HIV) coincidiu com um aumento das doenças cardiovasculares, causa importante de morbimortalidade nesse grupo. OBJETIVO: Determinar a frequência de aterosclerose carotídea e avaliar a associação entre os níveis dos biomarcadores e o espessamento da camada médio-intimal carotídea em indivíduos HIV positivos, atendidos em serviços de referência para HIV em Pernambuco. MÉTODOS: Corte transversal com 122 pacientes HIV positivos. Considerou-se aterosclerose carotídea subclínica o aumento da espessura da camada média intimal da carótida comum > 0,8 milímetros ou placas no ultrassom de carótidas. Os biomarcadores inflamatórios analisados foram IL6, IL1-β, TNF-α, PCR-ultrassensível, sVCAM-1 e sICAM-1. RESULTADOS: Dos 122 pacientes analisados, a maioria era de homens (60,7%), com > 40 anos (57,4%), em uso de TARV (81,1%). A prevalência de aterosclerose foi de 42,6% (52 casos). Pacientes com idade acima de 40 anos e Framingham intermediário ou alto apresentaram maior chance de desenvolver aterosclerose na análise univariada. Idade acima de 40 anos (OR = 6,57 IC 2,66 -16,2; p = 0,000), sexo masculino (OR = 2,76 IC 1,12-6,79; p = 0,027) e a condição de síndrome metabólica (OR = 2,27 IC 0,94-5,50; p = 0,070) mostraram-se associados à aterosclerose na análise multivariada. Níveis elevados de citocinas inflamatórias e moléculas de adesão não mostraram associação com a presença de aterosclerose. CONCLUSÃO: Não houve associação entre os biomarcadores inflamatórios, moléculas de adesão e presença de aterosclerose carotídea. Entretanto, evidenciou-se em homens, pessoas com mais de 40 anos, portadores de escore de Framingham intermediário/alto ou síndrome metabólica maior chance de aterosclerose subclínica.

BACKGROUND: The massive use of Highly-Active Antiretroviral Therapy (HAART) in individuals with human immunodeficiency virus (HIV) coincided with an increase in cardiovascular disease, a major cause of morbidity and mortality in this group. OBJECTIVE: To determine the frequency of carotid atherosclerosis and the association between biomarker levels and carotid intimal-medial thickening in HIV-positive individuals treated for HIV at referral centers in Pernambuco. METHODS: This was a cross-sectional study of 122 HIV-positive patients. Subclinical carotid atherosclerosis was considered with the presence of increased intimal-medial thickness of the common carotid artery > 0.8 mm or plaques in the carotid ultrasound. The following inflammatory biomarkers were analyzed: IL6, IL1-β, TNF-α, high-sensitivity CRP, sVCAM-1 and sICAM-1. RESULTS: Of the 122 patients analyzed, most were men (60.7%) aged > 40 years (57.4%) receiving HAART (81.1%). The prevalence of atherosclerosis was 42.6% (52 cases). Patients older than 40 years and intermediate or high Framingham score were more likely to develop atherosclerosis at the univariate analysis. Age older than 40 years (OR = 6.57, 95%CI: 2.66 to 16.2, p = 0.000), male gender (OR = 2.76, 95%CI: 1.12 to 6.79, p = 0.027) and presence of syndrome metabolic (OR = 2.27, 95%CI: 0.94 to 5.50, p = 0.070) were associated with atherosclerosis at the multivariate analysis. Elevated levels of inflammatory cytokines and adhesion molecules were not associated with the presence of atherosclerosis. CONCLUSION: There was no association between inflammatory biomarkers, adhesion molecules and presence of carotid atherosclerosis. However, a higher chance of subclinical atherosclerosis was observed in men, those older than 40 years, with intermediate / high Framingham score or metabolic syndrome.

Primary resistance of HIV to antiretrovirals among individuals recently diagnosed at voluntary counselling and testing centres in the metropolitan region of Recife, Pernambuco

Determining the prevalence and type of antiretroviral (ARV) resistance among ARV-naïve individuals is important to assess the potential responses of these individuals to first-line regimens. The prevalence of primary resistance and the occurrence of recent infections among individuals with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) were identified among recently diagnosed patients at five sexually transmitted disease/AIDS testing and counselling centres in the metropolitan region of Recife (RMR), Pernambuco, Brazil, between 2007-2009. One-hundred and eight samples were analysed using the Calypte® BED assay. Males predominated (56%), as did patients aged 31-50 years. Twenty-three percent presented evidence of a recent HIV infection. The median CD4+ T lymphocyte count was 408 cells/mm³ and the median viral load was 3.683 copies/mL. The prevalence of primary resistance was 4.6% (confidence interval 95% = 1-8.2%) based on criteria that excluded common polymorphisms in accordance with the surveillance drug resistance mutation criteria. The prevalence of resistance to non-nucleoside reverse transcriptase, nucleoside/nucleotide reverse transcriptase and protease inhibitors were 3.8%, 1.5% and 0.8%, respectively. Fifty-seven percent of strains were from clade B, 37.7% were clade F and 3.1% were clade C; there were no statistically significant differences with respect to resistance between clades. Recent infection tended to be more common in men (p = 0.06) and in municipalities in the south of the RMR (Jaboatão dos Guararapes and Cabo de Santo Agostinho) (p = 0.046). The high prevalence of recent infection and the high prevalence of non-B strains in this poor Brazilian region merit further attention.

Efeito da terapia antirretroviral e dos níveis de carga viral no complexo médio-intimal e no índice tornozelo-braço em pacientes infectados pelo HIV / Antirretroviral therapy effect in the intima-medio complex and ankle-brachial index in patients infected by HIV

OBJETIVOS: Identificar precocemente a prevalência de aterosclerose, por causa do espessamento do complexo médio-intimal das carótidas comuns e do índice tornozelo-braço. Essas medidas foram relacionadas com os fatores de risco clássicos de aterosclerose e os específicos dos infectados pelo HIV (tempo de doença, tempo de tratamento, tipo de tratamento, tipo de terapia antirretroviral utilizada, CD4 e carga viral). MÉTODOS: Setenta casos infectados com o HIV foram avaliados pela medida automática do complexo médio-intimal nas carótidas e do índice tornozelo-braço. Consideraram-se os fatores de risco clássicos de aterosclerose (idade, sexo, hipertensão arterial sistêmica, tabagismo, hipercolesterolemia, hipertrigliceridemia, obesidade e história familiar de evento cardiovascular), as medidas antropométricas e as variáveis relacionadas ao HIV. O nível de significância assumido foi de 5%. RESULTADOS: O tempo médio de diagnóstico do HIV foi de 104,9 meses e de tratamento foi de 97,9 meses. Quanto ao tipo de tratamento, 47 (67,1%) fizeram uso de inibidor de protease por mais de seis meses e 36 (51,4%) estão em uso atualmente. O índice tornozelo-braço estava aumentado em um único paciente (0,7%) e não se evidenciou espessamento do complexo médio-intimal em nenhum indivíduo. Não existiu associação significante da medida do complexo médio-intimal da carótida comum direita com nenhuma das variáveis analisadas. CONCLUSÕES: Indivíduos jovens, sob o uso de terapia antirretroviral por cinco anos ou mais, não apresentaram espessamento do complexo médio-intimal ou aumento do índice tornozelo-braço. Não houve diferença do espessamento do complexo médio-intimal associada ao tipo de esquema antirretroviral utilizado ou nível de carga viral.

OBJECTIVES: To precociously identify the prevalence of atherosclerosis caused by thickening of the intima-media complex of the common carotid arteries and of the ankle brachial index. These measurements were associated with the classical risk factors of atherosclerosis and the specific factors of those infected by HIV (duration of disease, length of treatment, kind of treatment, kind of antiretroviral therapy used, CD4 and viral load). METHODS: Seventy cases infected by HIV were assessed by automatic measurement of the intima-media complex in the carotids and of the ankle brachial index. The classical risk factors of atherosclerosis (age, gender, systemic arterial hypertension, smoking, hypercholesterolemia, hypertriglyceridemia, obesity, and family history of cardiovascular events), anthropometric measurements and the variables related to HIV were taken into consideration. The adopted level of significance was 5%. RESULTS: The mean time of HIV diagnosis was 104.9 months, mean duration of treatment was 97.9 months. As regard to the type of treatment, 47 (67.1%) used protease inhibitor for more than six months and 36 (51.4%) are using it recently. The ankle brachial index was increased in one patient (0.7%), and the intima-media complex was not thickened in any individual. There was no significant association of the measurement of the intima-media complex of the right common carotid with any of the variables analyzed. CONCLUSIONS: Young individuals under the use of antiretroviral therapy for five years or more did not show increase in thickness of the intima-media complex or increase in the ankle brachial index, and there was no difference in the intima-media complex thickness associated with the therapeutical scheme of antiretroviral used or the viral load level.

Recent HIV infection rates among HIV positive patients seeking voluntary counseling and testing centers in the metropolitan region of Recife - Pe, Brazil

The BED capture enzyme immunoassay test makes it possible to determine whether individuals were recently infected with HIV. OBJECTIVE: In this study, the overall HIV and recent infections prevalences were determined at five Voluntary Counseling and Testing (VCT) centers, in the Metropolitan Region of Recife, Northeastern of Brazil. MATERIAL AND METHODS: A cross-sectional study was conducted among users of five VCTs in the metropolitan region of Recife between July 2007 and April 2009. Out of the individuals who tested positive for HIV, 169 were analyzed to assess the prevalence of recent infection by means of the BED-CEIA (BED-Calypte®). RESULTS: Out of 46,696 individuals tested 916 (1.96%) turned out positive for HIV infection The highest prevalence was in Recife (3.9%). The prevalence was higher among males (3.93%), and men who have sex with men (MSM) (12.4%). The frequency of recent infections among the 169 subjects evaluated was 23.7%. Recent infections were more common among individuals under 25 years of age. There was slight predominance of men and higher frequency of heterosexuals in both groups, but still a significant portion of MSM (33%). Subtype B predominated, followed by a high proportion of subtype F. CONCLUSIONS: Recent infection occurs mainly among young individuals and heterosexuals, despite a significant proportion of recent infection among MSM. These results suggest that preventive actions aimed at the MSM community remains a challenge and efforts focusing this group should continue to be a priority.

Trocador de calor e umidade: proteção contra infecções pulmonares? Estudo piloto / Heat and moisture exchanger: protection against lung infections? Pilot study

O objetivo deste trabalho foi realizar um estudo bacteriológico comparativo entre os sistemas de umidificação aquoso aquecido (UAA) e filtro trocador de calor e umidade (FTCU) quanto à colonização bacteriana e a incidência de infecção respiratória em pacientes submetidos à ventilação mecânica (VM). Trata-se de uma pesquisa prospectiva, controlada e randomizada, na qual 15 pacientes internados na Unidade de Terapia Intensiva (UTI) foram distribuídos em dois grupos. O primeiro fez uso de UAA (n=7) e o outro de FTCU (n=8). Foram coletadas amostras da secreção traqueal, condensado do circuito e FTCU na admissão do paciente, no quarto e oitavo dias, e realizada análise bacteriológica dos mesmos. Quanto às características antropométricas, não observou-se diferenças entre os grupos estudados. A prevalência de pneumonia associada à ventilação (PAV) foi de 57,1% no UAA e 62,5% no FTCU. Ao realizar a análise bacteriológica quantitativa entre eles, não foram observadas variações, sugerindo não haver diferença na prevenção de PAV entre os sistemas de umidificação; porém a presença das mesmas bactérias na secreção traqueal e no condensado e ausência destas na membrana do FTCU podem indicar que a principal fonte de contaminação é o próprio paciente.

The aim of this study was to conduct a bacteriological research comparing the aqueous heated humidification systems (HH) and filter heat and moisture exchanger (FHME) and to bacterial colonization and the incidence of respiratory infection in patients undergoing mechanical ventilation. It is a prospective, controlled trial, in that 15 intensive care unit (ICU) patients were divided into two groups. The first made use of HH (n=7) and the other, FHME (n=8). We collected samples of tracheal secretions, and condensate circuit FHME at admission in the fourth and eighth day and bacteriological analysis of the same place. Regarding the anthropometric characteristics, no differences were observed between the groups. The prevalence of ventilator associated pneumonia (VAP) was 57.1% in the HH and 62.5% in FHME. When performing quantitative bacteriological analysis between the group and HH and FHME, differences were not observed, suggesting no variation in the prevention of VAP between the humidification systems, but the presence of these bacteria in the tracheal and condensate and in the absence of these membrane FHME may indicate that the main source of contamination is the patient himself.

Angina pectoris in patients with HIV/AIDS: prevalence and risk factors

INTRODUCTION: The incidence of ischemic heart disease is higher in patients with HIV/AIDS. However, the frequency of angina pectoris in these patients is still not known. Literature about this subject is still scarce. OBJECTIVE: To evaluate the prevalence of angina pectoris and risk factors for coronary disease and to examine the association between traditional risk factors and HIV-related risk factors and angina pectoris. METHOD: An epidemiological cross-sectional study, analyzed as case-control study, involving 584 patients with HIV/AIDS. Angina pectoris was identified by Rose questionnaire, classified as definite or possible. Information regarding risk factors was obtained through a questionnaire, biochemical laboratory tests, medical records and anthropometric measures taken during consultations at AIDS treatment clinics in Pernambuco, Brazil, from June 2007 to February 2008. To adjust the effect of each factor in relation to others, multiple logistic regression was used. RESULTS: There was a preponderance of men (63.2 percent); mean ages were 39.8 years for men, 36.8 years for women. The prevalence of definite and possible angina were 11 percent and 9.4 percent, respectively, totaling 20.4 percent, with independent associations between angina and smoking (OR = 2.88; 95 percent CI: 1.69-4.90), obesity (OR = 1.62; 95 percent CI: 0.97-2.70), family history of heart attack (OR = 1.70; 95 percent CI: 1.00-2.88), low schooling (OR = 2.11; 95 percent CI: 1.24-3.59), and low monthly income (OR = 2.93; 95 percent CI: 1.18-7.22), even after adjustment for age. CONCLUSION: This study suggests that angina pectoris is underdiagnosed, even in patients with medical monitoring, revealing lost opportunities in identification and prevention of cardiovascular morbidity.

Predictive factors for repetition of the tuberculin test after a nonreactive test in patients with HIV/AIDS / Factores predictivos para la repetición de la prueba de la tuberculina después de un resultado no reactivo en pacientes con infección por el VIH/sida

OBJECTIVE: The outcome of interest was repetition of the tuberculin skin test (TST) and the objectives were to estimate the rate of TST repetition, the probability of no TST repetition after 1 year, and the probability of no TST repetition at the end of the follow-up period in patients whose initial test was nonreactive. The study also set out to analyze factors associated with the time until TST repetition at two HIV/AIDS referral services that carry out the TST on a routine basis in Recife, Pernambuco, Brazil. METHODS: A cohort of HIV-positive patients who initially tested nonreactive on the TST were followed from November 2007 to February 2010. The Kaplan-Meier method was used to estimate the probability of not repeating the TST, and Cox's regression analysis was used to analyze the factors associated with time until repeating the TST. Cox's multivariate analysis was stratified according to each hospital where patients were followed, because this variable did not respect the principle of proportionality of risk. RESULTS: The probability of not repeating the TST for 1 year was 80.0 percent and at the end of the follow-up period it was 42.0 percent. The variables that remained associated with TST repetition in the final Cox multivariate model were an age of 40 years or older, body mass index between 18.0 and 24.9, being female, and years of schooling. CONCLUSIONS: This study encountered a very low TST repetition rate after 1 year of follow-up and identified groups of individuals who should be the target of interventions aimed at repeating the TST.

OBJETIVO: El resultado principal de interés fue la repetición de la prueba de la tuberculina (PT) y los objetivos fueron calcular la tasa de repetición de la PT, la probabilidad de no repetir la PT después de un año y la probabilidad de no repetir la PT al final del período de seguimiento en los pacientes cuya prueba inicial fue no reactiva. En el estudio también se analizaron los factores asociados con el tiempo hasta la repetición de la PT en dos servicios de referencia de infección por el VIH/sida que llevan a cabo la PT de manera sistemática en Recife, Pernambuco, Brasil. MÉTODOS: Entre noviembre del 2007 y febrero del 2010 se siguió a una cohorte de pacientes seropositivos para el VIH con una PT inicialmente no reactiva. Para calcular la probabilidad de no repetir la PT se empleó el método de Kaplan-Meier, y para analizar los factores asociados con el tiempo hasta la repetición de la PT se usó el análisis de regresión de Cox. El análisis multifactorial de Cox se estratificó conforme a cada hospital donde se seguía a los pacientes, dado que esta variable no respetaba el principio de proporcionalidad del riesgo. RESULTADOS: La probabilidad de no repetir la PT durante un año fue de 80,0 por ciento y hacia el final del período de seguimiento fue de 42,0 por ciento. Las variables asociadas con la repetición de la PT en el modelo multifactorial de Cox final fueron una edad de 40 años o más, un índice de masa corporal de 18,0 a 24,9, el sexo femenino y los años de escolaridad. CONCLUSIONES: En este estudio se encontró una tasa de repetición de la PT muy baja después de un año de seguimiento y se identificó a los grupos de individuos que deben ser los destinatarios de las intervenciones dirigidas a repetir la prueba de la tuberculina.

Escore de cálcio na avaliação da aterosclerose em pacientes com HIV/AIDS / Calcium score in the evaluation of atherosclerosis in patients with HIV/Aids

FUNDAMENTO: A terapia antirretroviral aumentou drasticamente a expectativa de vida em pacientes com HIV/AIDS, embora a aterosclerose esteja associada a uma terapia de longo prazo. OBJETIVO: Investigar a prevalência de aterosclerose em pacientes com AIDS submetidos à terapia antirretroviral e a influência de tratamentos de diferentes regimes e durações. MÉTODOS: Pacientes com HIV/AIDS foram abordados durante consultas de rotina. Aqueles que estiveram em terapia antirretroviral por, pelo menos, dois anos tiveram o sangue coletado para análise do perfil lipídico e da glicemia em jejum e foram submetidos à tomografia computadorizada cardíaca para quantificação do escore de cálcio dentro de seis dias, no máximo. A aterosclerose foi definida como escore de cálcio maior que zero (CAC > 0). Fatores de risco tradicionais, síndrome metabólica e o escore de Framingham foram analisados. RESULTADOS: Cinquenta e três pacientes realizaram tomografia computadorizada cardíaca: 50,94 por cento eram do sexo masculino, com idade média de 43,4 anos; 20 por cento tinham hipertensão; 3,77 por cento tinham diabetes; 67,92 por cento tinham hipercolesterolemia; 37,74 por cento tinham hipertrigliceridemia; 47,17 por cento tinham HDL baixo; 24,53 por cento atenderam aos critérios para síndrome metabólica; 96,23 por cento foram classificados no escore de Framingham como "baixo risco"; e 18,87 por cento eram tabagistas. A duração média do tratamento antirretroviral foi de 58,98 meses. A aterosclerose coronária ocorreu em 11 pacientes (20,75 por cento). A duração da terapia antirretroviral não se relacionou à aterosclerose (p = 0,41), e não houve diferenças significativas entre os diferentes esquemas antirretrovirais (p = 0,71). Entre os fatores de risco tradicionais, o tabagismo (OR = 27,20; p = 0,023) e a idade (OR = 20,59; p = 0,033) foram significativos na presença de aterosclerose. Havia tendência para uma associação positiva da aterosclerose com a hipercolesterolemia (OR = 8,30; p = 0,0668). CONCLUSÃO: Os fatores associados à aterosclerose foram idade, tabagismo e hipercolesterolemia. A duração e o tipo de terapia antirretroviral não influenciaram a prevalência da aterosclerose.

BACKGROUND: Antiretroviral therapy has dramatically increased life expectancy in patients with HIV/AIDS although atherosclerosis has been associated with long-standing therapy. OBJECTIVE: To investigate the prevalence of atherosclerosis in patients with AIDS undergoing antiretroviral therapy and the influence of different schemes and duration of treatment. METHODS: HIV/AIDS patients were approached during routine consultations. Those who had been on antiretroviral therapy for at least two years had their blood collected for analysis of lipid profile and fasting glycemia and underwent cardiac CT for quantification of calcium score within six days at the most. Atherosclerosis was defined as calcium score greater than zero (CAC > 0). Traditional risk factors, metabolic syndrome and Framingham score were analyzed. RESULTS: Fifty-three patients performed cardiac CT. Twenty-seven (50.94 percent) were male, mean age 43.4 years; 20.00 percent had hypertension, 3.77 percent diabetes, 67.92 percent hypercholesterolemia, 37.74 percent hypertriglyceridemia and 47.17 percent low HDL. Thirteen (24.53 percent) met criteria for metabolic syndrome and 96.23 percent were classified in Framingham score as "low risk." Ten patients (18.87 percent) were smokers. Mean duration of antiretroviral treatment was 58.98 months. Coronary atherosclerosis occurred in 11 (20.75 percent) patients. Duration of antiretroviral therapy was not related to atherosclerosis (p = 0.41) and there were no significant differences between different antiretroviral regimens (p = 0.71). Among traditional risk factors, smoking (OR = 27.20; p = 0.023) and age (OR = 20.59; p = 0.033) were significant in the presence of atherosclerosis. There was a trend towards a positive association of atherosclerosis with hypercholesterolemia (OR = 8.30; p = 0.0668). CONCLUSION: Factors associated with atherosclerosis were age, smoking and hypercholesterolemia. Duration and type of antiretroviral therapy had no influence on the prevalence of atherosclerosis.

Perfil dos pacientes com hipertensão arterial incluídos em uma coorte com HIV/AIDS em Pernambuco, Brasil / Profile of patients with hypertension included in a cohort with HIV/AIDS in the state of Pernambuco, Brazil

FUNDAMENTO: Hipertensão arterial sistêmica (HAS) é fator de risco modificável, cujo controle pode reduzir doença cardiovascular nos pacientes com vírus da imunodeficiência adquirida (HIV). OBJETIVO: Estimar a prevalência de HAS e descrever as características dos pacientes com HAS e pré-hipertensão infectados pelo HIV/AIDS. MÉTODOS: Estudo seccional alinhado a uma coorte de pacientes com HIV/AIDS. Considerou-se hipertensão em níveis > 140/90 mmHg ou uso de anti-hipertensivos e pré-hipertensão em níveis > 120/80 mmHg. RESULTADOS: Dos 958 pacientes, 388 (40,5 por cento) eram normotensos, 325 (33,9 por cento) pré-hipertensos e 245 (25,6 por cento) hipertensos. Desses 245 pacientes, 172 (70,2 por cento) sabiam ser hipertensos e 36 (14,8 por cento) apresentavam pressão arterial controlada. Tiveram diagnóstico de HAS após o diagnóstico do HIV 62 pacientes (54,4 por cento). Lipodistrofia ocorreu em 95 (46,1 por cento) dos pacientes, já sobrepeso/obesidade em 129 (52,7 por cento). Utilização de antirretrovirais ocorreu em 184 (85,9 por cento), 89 (41,6 por cento) com inibidores de protease (IP) e 95 (44,4 por cento) sem IP. Utilizavam antivirais > 24 meses 74,7 por cento. Idade, antecedentes familiares de hipertensão, circunferência abdominal, índice de massa corporal e triglicerídeos foram maiores entre pacientes hipertensos. Tempo de infecção pelo HIV, contagem de linfócitos CD4, carga viral, tempo e tipo de esquema antirretroviral foram semelhantes nos hipertensos e pré-hipertensos. CONCLUSÃO: A elevada frequência de hipertensos não controlados e de riscos cardiovasculares nos infectados pelo HIV apontam a necessidade de medidas preventivas e terapêuticas contra HAS nesse grupo.

BACKGROUND: Hypertension (HBP) is modifiable risk factor, whose control may reduce cardiovascular disease in patients with human immunodeficiency virus (HIV). OBJECTIVE: To estimate the prevalence of hypertension and describe the characteristics of patients with hypertension infected by HIV/AIDS. METHODS: A cross-sectional study aligned to a cohort of patients with HIV/AIDS. The study considered hypertension at levels > 140/90 mmHg or use of antihypertensive drugs and pre-hypertension at levels > 120/80 mmHg. RESULTS: Out of 958 patients, 388 (40.5 percent) were normotensive, 325 (33.9 percent) were pre-hypertensive, and 245 (25.6 percent) were hypertensive. Out of these 245 patients, 172 (70.2 percent) were aware of the fact there they were hypertensive, and 36 (14.8 percent) had blood pressure controlled. Sixty-two (62) patients (54.4 percent) were diagnosed with hypertension after HIV diagnosis. Lipodystrophy occurred in 95 (46.1 percent) patients; overweight/obesity in 129 (52.7 percent). Use of antiretrovirals occurred in 184 (85.9 percent), 89 (41.6 percent) with protease inhibitors (PI) and 95 (44.4 percent) without PI. Out of these patients, 74.7 used antivirals > 24 months. Age, family history of hypertension, waist circumference, body mass index and triglyceride levels were higher among hypertensive patients. Time of HIV infection, CD4 count, viral load, time and type of antiretroviral regimen were similar in hypertensive and prehypertensive patients. CONCLUSION: The high frequency of uncontrolled hypertensive patients and cardiovascular risks in HIV-infected patients point out to the need for preventive and therapeutic measures against hypertension in this group.

Risk factors related to hypertension among patients in a cohort living with HIV/AIDS

INTRODUCTION: Studies disagree as to whether there is a greater prevalence of hypertension among HIV/AIDS patients and the role of antiretroviral therapy. OBJECTIVE: Evaluate the prevalence of hypertension and risk factors in a cohort of HIV-infected patients, with emphasis on antiretroviral therapy. METHOD: Case-control study conducted at baseline of a cohort, between June/2007 and December/2008 in Pernambuco/Brazil. Blood pressure was classified as normal, prehypertension, and hypertension. RESULTS: Of 958 patients, 245 (25.6 percent) had hypertension (cases), 325 (33.9 percent) had prehypertension, and 388 (40.5 percent) were normotensive (controls). Comparison between hypertensive and normotensive patients showed that traditional factors, such as age > 40 (OR = 3.06, CI = 1.91-4.97), male gender (OR = 1.85, CI = 1.15-3.01), BMI > 25 (OR = 5.51, CI = 3.36-9.17), and triglycerides > 150 mg/dL (OR = 1.69, CI = 1.05-2.71), were independently associated with hypertension. Duration of antiretroviral therapy and CD4 > 200 cells/mm³ were associated with hypertension in univariate analysis, but did not remain in final model. Type of antiretroviral schema and lipodystrophy showed no association with hypertension. CONCLUSION: Hypertension in HIV/AIDS patients is partially linked to invariable factors, such as age and sex. Efforts should be directed toward controlling reversible factors, particularly excessive weight gain and unsuitable diet.

Frequência de Papilomavírus humano (HPV) e Chlamydia trachomatis em gestantes / Frequency of Human Papillomavirus (HPV) and Chlamydia trachomatis in Pregnant Women

Este estudo transversal de caráter analítico teve por objetivo avaliar a frequência da infecção pelo Papilomavírus humano (HPV) e Chlamydia trachomatis, bem como de alterações citopatológicas e colposcópicas em um grupo de 96 gestantes (51 HIV soropositivas e 45 HIV soronegativas) no período de abril de 2006 a maio de 2007. Todas responderam a questionário padrão seguido de atendimento ginecológico. Foram coletadas amostras da cérvice uterina para pesquisa de HPV e C. trachomatis pela técnica de Captura de Híbrido (CH II®) para a colpocitologia oncótica e, por fim, realizou-se o exame colposcópico. Os dados foram armazenados e analisados no Epi Info, versão 6.04 e SPSS versão 9.0. Utilizou-se o teste do Qui-quadrado considerando o valor de 5 por cento (p<0,05) como limiar de significância para análise estatística. Das gestantes HIV positivas, 62,7 por cento foram positivas para HPV e 17,6 por cento para C. trachomatis. Entre as gestantes HIV negativas, 17,8 por cento e 4,4 por cento foram positivas para o HPV e para a C. trachomatis, respectivamente. A colpocitologia oncótica identificou maior frequência de lesões intraepiteliais escamosas cervicais de baixo grau em ambos os grupos, sendo 21,6 por cento entre as gestantes HIV positivas e 13,3 por cento no grupo HIV negativo. O epitélio acetobranco foi o achado colposcópico mais reiterado nos dois grupos. Concluiu-se que a infecção pelo HPV e por C. trachomatis é mais freqüente em gestantes infectadas pelo HIV caracterizando, desta forma, à luz de conhecimentos atuais, uma população de maior risco de desenvolver câncer cervical.

A cross-sectional analytical study was conducted in order to identify the frequency of the Human Papillomavirus (HPV) infection, Chlamydia trachomatis, colposcopic and cytological findings in a group of 96 pregnant women (51 HIV positive and 45 HIV negative) from April 2006 to May 2007. All patients went through a standard questionnaire, followed by gynecological examination. Samples were collected for HPV survey and C. trachomatis by the Hybrid Capture II technique for oncotic colpocytology (Papanicolaou), followed by colposcopy. Data were stored and analyzed using Epi Info, version 6.04 and SPSS version 9.0. For statistical analysis the chi-square test were used with level of significance set at 5 percent. Among the HIV positive pregnant women 62.7 percent were positive for HPV and 17.6 percent were positive for C. trachomatis. In contrast, for HIV negative pregnant women 17.8 percent and 4.4 percent were positive for HPV and C. trachomatis, respectively. The Pap smear identified a larger amount of low grade squamous intraepithelial lesions in both groups, 21.6 percent in HIV positive pregnant women and 13.3 percent in HIV negative pregnant women. The aceto white epithelium was the most frequent colposcopy abnormality. In conclusion, the infection by HPV and C. trachomatis is more common in pregnant women infected with HIV, characterizing, thus, based on current knowledge, a population that is more susceptible to cervical cancer.

Frequency and types of human papillomavirus among pregnant and non-pregnant women with human immunodeficiency virus infection in Recife determined by genotyping

Women with human immunodeficiency virus (HIV) infection present a higher risk of infection by the human papillomavirus (HPV) and cervical cancer. To determine HPV genotypes and frequencies among HIV-positive women, an analytical cross-sectional study was carried out on 147 women (51 were pregnant and HIV-positive, 45 pregnant and HIV-negative and 51 HIV-positive and not pregnant), who were attended at a maternity hospital in Recife between April 2006-May 2007. They answered a questionnaire and underwent a gynaecological examination, with samples collected for HPV investigation by PCR, hybrid capture II, oncotic colpocytology (Papanicolau) and colposcopy. The frequency of HPV DNA was 85.3 percent (122/143), with a high proportion of HPV types that have been identified as high risk for cervical cancer. Among HIV-positive pregnant women, there was an HPV prevalence of 96 percent (48/50), of whom 60.4 percent (29/48) were high-risk. HPV 16, 58, 18, 66 and 31 were the most frequent types. Colpocytological abnormalities were observed in 35.3 percent (18/51) of HIV-positive non-pregnant women, 21.6 percent (11/51) of HIV-positive pregnant women and 13.3 percent (6/45) of HIV-negative pregnant women with a predominance of low-level lesions. A high prevalence of HPV infection was identified, especially with the high-risk types 16, 58, 18 and 66. This study identified high-risk HPV types in all three groups examined (HIV-positive pregnant women, HIV-negative pregnant women and HIV-positive not pregnant), characterising its distribution in this setting.

Risk factors for healthcare-associated infection in pediatric intensive care units: a systematic review / Fatores de risco para infecções associadas aos cuidados de saúde em unidades de terapia intensiva pediátrica: uma revisão sistemática

A systematic review of observational studies on risk factors for healthcare-associated infection in pediatric Intensive Care Units (ICU) was carried out. Studies indexed in MEDLINE, LILACS, Cochrane, BDENF, CAPES databases published in English, French, Spanish or Portuguese between 1987 and 2006 were included and cross references added. Key words for search were "cross infection" and "Pediatric Intensive Care Units" with others sub-terms included. 11 studies were selected from 419 originally found: four studies had healthcare-associated infection as the main outcome without a specific site; three articles identified factors associated with lower respiratory tract infection (pneumonia or tracheitis); three articles were concerned with laboratory-confirmed bloodstream infection; and a single retrospective study analyzed urinary tract infection. The production of evidence on risk factors Paediatric ICU has not kept up the same pace of that on adult - there are few studies with adequate design and statistical analysis. The methodological diversity of the studies did not allow for a summarized measurement of risk factors.

Realizou-se revisão sistemática de estudos observacionais sobre fatores de risco para infecção relacionada aos cuidados de saúde em Unidades de Terapia Intensiva (UTI) pediátrica. Foram incluídos estudos em inglês, francês, espanhol ou português indexados no MEDLINE, LILACS, Cochrane Library, BDENF, CAPES, entre 1987 e 2006. As palavras-chave foram "Infecção Hospitalar" e "Unidades de Terapia Intensiva Pediátricas", com diferentes formas de escrever. Onze artigos foram selecionados a partir de 419 resumos encontrados: quatro tinham como desfecho infecção em qualquer topografia; três eram sobre infecções de vias aéreas inferiores; três estudaram infecção da corrente sanguínea confirmada laboratorialmente e um analisou infecção do trato urinário. A produção de evidências na UTI pediátrica não vem acompanhando o ritmo dos estudos em adultos - existem poucos estudos com desenhos e análise estatística adequados. A diversidade metodológica não permitiu a realização de medição sumarizada dos fatores de risco.