Effectiveness of highly active antiretroviral therapy using non-brand name drugs in Brazil

In Brazil, HIV-infected individuals receive drugs (including non-brand name drugs which comprise locally produced generics and drugs that have not been tested in bioequivalence trials) free of charge from the government. The objective of the present study was to evaluate the effectiveness of highly active antiretroviral therapy (HAART) in Rio de Janeiro, Brazil, where non-brand drugs are widely used. For this purpose, we estimated the proportion of subjects with virologic failure (plasma HIV viral load greater than 400 copies/mL at 6 months after initiation of treatment). This was a retrospective cohort study of drug-naive HIV-infected subjects who initiated HAART. Subjects were included in the analysis if they were 18 years of age or older, were treatment naive, started HAART with a minimum of 3 drugs, and had available information on blood plasma HIV-1 viral load after 6 months on therapy. All subjects used antiretrovirals in dosing regimens recommended by the Brazilian National Advisory Committee for Antiretroviral Therapy. Chart reviews were conducted in three settings: at two public health outpatient units, at one clinical trial unit and at one private office. No comparisons of the effectiveness of non-brand name with the effectiveness of brand name drugs were made. We present results for 485 patients; of these, 354 (73 percent), 55 (11 percent), and 76 (16 percent) were seen at the public health outpatient units, private office, and clinical trial unit, respectively. Virologic failure was observed in 119 (25 percent) of the subjects. This study demonstrates the effectiveness of HAART in a setting where non-brand name drugs are widely used.

Calor versus dissociaçåo acida de imunocomplexos para a detecçåo da antigemia P24 / Heat versus acid dissociation of immune complexes for the detection of p24 antigemia

INTRODUÇÄO - A antigemia P24 é amplamente utilizada como marcador substitutivo de progresso da infecçåo pelo HIV e da eficácia da terapêutica. A dissociaçåo ácida de imunocomplexos, por aumentar a sensibilidade dos testes para a detecçåo do P24, tornou-se a técnica padråo. OBJETIVO - Comparar a dissociaçåo pelo calor (HD) com a dissociaçåo ácida (AD) dos imunocomplexos nos testes de captura para antígeno P24. MÉTODOS - Soros de pacientes infectados pelo HIV previamente conhecidos por serem P24 negativos por AD, foram ensaiadas paralelamente depois da AD e HD, usando um tampåo de Glicina seguido por neutralizaçåo com um tampåo tris. A HD foi realizada diluindo-se o soro 1:3 em água destilada seguido pela imersåo dos tubos em banho de água fervente por 5 minutos. Os títulos de P24 foram quantificados pela comparaçåo da densidade óptica do soro com uma curva padråo de espécimes positivos. RESULTADOS - Das 39 amostras testadas, todas permaneceram negativas por AD e 3(7,7 por cento; 95 CI= 0-16 por cento) tornaram-se positivas depois do HD. CONCLUSÄO - A HD de imunocomplexos é de execuçåo mais barata, simples e rápida do que a AD, aumentando ainda a sensibilidade das técnicas de detecçåo do antígeno P24

Prevalence of antibodies to Hepatitis C virus in populations at low and high risk for sexually transmited diseases in Rio de Janeiro

In order to investigate the sexual transmission of the Hepatitis C Virus (HCV), the prevalence of specific antibodies in populations at high and low risk for sexually transmitted diseases (STDs) was evaluated. The population at low risk for STDs was composed of persons who voluntarity donated blood at the Hospital Universitário Clementino Fraga Filho (HUCFF) between July and November, 1990 (n = 2494). The population at high risk for STDs was drawn from an ongoing study on the natural history of Human Immunodeficiency Virus (HIV) infection (n = 210, 187 with sexual risk factors for HIV infection). All samples were screened using a first generation ELISA. Repeat reactive samples were then tested in a second generation RIBA. For all ELISA positive samples, two sex and age-matched ELISA negative controls were selected. Data pertaining to the presence of antibodies to the Hepatitis B core antigen (anti-HBC antibodies) and to Treponema pallidum were abstracted from the medical records. The prevalence of RIBA 2 confirmed HCV infection among the blood donors was 2.08%, which is well above the reported prevalence in similar populations from developed western countries. Among the HIV infected homosexuals, the encountered prevalence was 7.96% (p < 0.0005). For the whole group with sexually acquired HIV infection, the prevalence was 8.02% (p < 0.000005). Anti-HBc antibodies were more frequently present in anti-HCV RIBA-2 confirmed positive blood donors than in controls (p < 0.001). 33.3% of the HCV-positive blood donors and 11.04% controls were found to be anti-HBc positive (p < 0.0005). As for the FTA-ABs, 17.6% HCV-positive donors and 4,9% controls were positive (p < 0.01). 5.9% samples from blood donors were both anti-HBc and FTA-ABS positive, whereas none of the controls reacted in both tests (p < 0.05). The association between HCV, Hepatitis B infection and syphilis in individuals at low risk for parenterally transmitted diseases suggests that sexual transmission contributes to the maintenance of the endemicity of HCV in the local population