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1.
Arq. bras. cardiol ; 117(2): 365-375, ago. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1339149

ABSTRACT

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.


Subject(s)
Humans , HIV Infections/complications , HIV Infections/drug therapy , Vasodilation , Brachial Artery/diagnostic imaging , Endothelium, Vascular/diagnostic imaging , Carotid Arteries/diagnostic imaging , Case-Control Studies , Aspirin/therapeutic use , Risk Factors , Ultrasonography , Carotid Intima-Media Thickness , Atorvastatin/therapeutic use
2.
Arq. bras. cardiol ; 114(1): 90-97, Jan. 2020. tab
Article in English | LILACS | ID: biblio-1055103

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Biomarkers/blood , Cardiovascular Diseases/blood , HIV Infections/blood , Carotid Intima-Media Thickness , Inflammation/blood , HIV Infections/complications , HIV Infections/drug therapy , Cross-Sectional Studies , Viral Load , Antiretroviral Therapy, Highly Active , Anti-Retroviral Agents/administration & dosage
3.
Arq. bras. cardiol ; 108(1): 3-11, Jan. 2017. tab, graf
Article in English | LILACS | ID: biblio-838673

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Arteriosclerosis/epidemiology , Arteriosclerosis/diagnostic imaging , Carotid Artery Diseases/epidemiology , Carotid Artery Diseases/diagnostic imaging , Acquired Immunodeficiency Syndrome/epidemiology , Carotid Intima-Media Thickness , Arteriosclerosis/etiology , Reference Values , Brazil/epidemiology , Carotid Artery Diseases/etiology , Carotid Artery Diseases/pathology , Case-Control Studies , Prevalence , Cross-Sectional Studies , Prospective Studies , Risk Factors , Sensitivity and Specificity , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/drug therapy , Statistics, Nonparametric , CD4 Lymphocyte Count , Antiretroviral Therapy, Highly Active , Ankle Brachial Index , Femoral Artery/diagnostic imaging
4.
Cad. saúde pública ; 31(12): 2505-2513, Dez. 2015. tab, graf
Article in English | LILACS | ID: lil-772102

ABSTRACT

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.


Subject(s)
Adult , Female , Humans , Male , Antitubercular Agents/therapeutic use , HIV Infections/complications , Isoniazid/therapeutic use , Latent Tuberculosis/drug therapy , Latent Tuberculosis/complications , Latent Tuberculosis/diagnosis , Latent Tuberculosis/epidemiology , Prospective Studies , Risk Factors
5.
Rev. Inst. Med. Trop. Säo Paulo ; 56(2): 127-132, Mar-Apr/2014. tab
Article in English | LILACS | ID: lil-703748

ABSTRACT

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.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Anti-HIV Agents/therapeutic use , Crack Cocaine , Cocaine-Related Disorders/complications , HIV Infections/drug therapy , Medication Adherence/statistics & numerical data , Smoking/adverse effects , Age Factors , Cross-Sectional Studies , HIV Infections/complications , Socioeconomic Factors
6.
Arq. bras. cardiol ; 99(5): 971-978, nov. 2012. ilus, tab
Article in Portuguese | LILACS | ID: lil-656636

ABSTRACT

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.


Subject(s)
Adult , Female , Humans , Male , Carotid Artery Diseases/blood , Coronary Artery Disease/blood , HIV , HIV Infections/blood , Age Factors , Antiretroviral Therapy, Highly Active/adverse effects , Biomarkers/blood , Brazil/epidemiology , Carotid Intima-Media Thickness , Carotid Artery Diseases/epidemiology , Coronary Artery Disease/epidemiology , Epidemiologic Methods , HIV Infections/drug therapy , HIV Infections/physiopathology , Metabolic Syndrome/blood , Risk Factors , Sex Distribution
7.
Mem. Inst. Oswaldo Cruz ; 107(4): 450-457, June 2012.
Article in English | LILACS | ID: lil-626436

ABSTRACT

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.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Drug Resistance, Viral/genetics , HIV Infections/virology , HIV Protease/genetics , HIV Reverse Transcriptase/genetics , HIV-1 , Mutation/genetics , Anti-HIV Agents/therapeutic use , Genotype , HIV Infections/drug therapy , HIV Infections/epidemiology , HIV-1 , Prevalence , Protease Inhibitors/therapeutic use , RNA, Viral/genetics , Reverse Transcriptase Inhibitors/therapeutic use , Socioeconomic Factors , Urban Population , Viral Load
8.
J. vasc. bras ; 11(2): 123-131, abr.-jun. 2012. tab
Article in Portuguese | LILACS | ID: lil-641658

ABSTRACT

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.


Subject(s)
Humans , Male , Adult , Ankle Brachial Index , Anti-Retroviral Agents/therapeutic use , Carotid Artery Diseases/complications , Prevalence , HIV , Prospective Studies , Risk Factors , Time Factors
9.
Braz. j. infect. dis ; 16(2): 157-163, May-Apr. 2012. ilus, tab
Article in English | LILACS | ID: lil-622737

ABSTRACT

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.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , HIV Infections/epidemiology , Brazil/epidemiology , Counseling , Cross-Sectional Studies , HIV Infections/diagnosis , Homosexuality, Male , Immunoenzyme Techniques/methods , Prevalence , Socioeconomic Factors
10.
Fisioter. pesqui ; 19(1): 57-62, jan.-mar. 2012. tab
Article in Portuguese | LILACS-Express | LILACS | ID: lil-623248

ABSTRACT

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.

11.
Braz. j. infect. dis ; 16(1): 1-8, Jan.-Feb. 2012. tab
Article in English | LILACS | ID: lil-614542

ABSTRACT

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.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Angina Pectoris/epidemiology , Angina Pectoris/etiology , HIV Infections/complications , Age Distribution , Acquired Immunodeficiency Syndrome/complications , Brazil/epidemiology , Case-Control Studies , Cross-Sectional Studies , Prevalence , Risk Factors
12.
Rev. panam. salud pública ; 31(2): 121-128, feb. 2012. tab
Article in English | LILACS | ID: lil-620107

ABSTRACT

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.


Subject(s)
Adult , Female , Humans , Male , Acquired Immunodeficiency Syndrome/complications , Latent Tuberculosis/complications , Latent Tuberculosis/diagnosis , Tuberculin Test/statistics & numerical data , False Negative Reactions , Forecasting , HIV Infections/complications , Prospective Studies
13.
Arq. bras. cardiol ; 97(5): 427-433, nov. 2011. tab
Article in Portuguese | LILACS | ID: lil-608932

ABSTRACT

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.


Subject(s)
Adult , Female , Humans , Male , Atherosclerosis/epidemiology , Calcinosis/epidemiology , HIV Infections/complications , Hypercholesterolemia/complications , Smoking/adverse effects , Age Factors , Antiretroviral Therapy, Highly Active , Atherosclerosis/etiology , Atherosclerosis/pathology , Calcinosis/etiology , Calcinosis/pathology , HIV Infections/drug therapy , Hypercholesterolemia/epidemiology , Reference Values , Risk Factors , Smoking/epidemiology
14.
Arq. bras. cardiol ; 95(5): 640-647, out. 2010. ilus, graf, tab
Article in Portuguese | LILACS | ID: lil-570440

ABSTRACT

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.


Subject(s)
Adult , Female , Humans , Male , Acquired Immunodeficiency Syndrome/epidemiology , Hypertension/epidemiology , Life Style , Acquired Immunodeficiency Syndrome/drug therapy , Anti-HIV Agents/therapeutic use , Body Mass Index , Brazil/epidemiology , Chi-Square Distribution , Cohort Studies , Cross-Sectional Studies , Hypertension/classification , Lipodystrophy/epidemiology , Obesity/epidemiology , Reference Values , Risk Factors
15.
Braz. j. infect. dis ; 14(3): 281-287, May-June 2010. ilus, tab
Article in English | LILACS | ID: lil-556842

ABSTRACT

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.


Subject(s)
Adult , Female , Humans , Male , Anti-HIV Agents/therapeutic use , HIV Infections/complications , Hypertension/complications , Antiretroviral Therapy, Highly Active , Brazil/epidemiology , Epidemiologic Methods , HIV Infections/drug therapy , HIV Infections/epidemiology , Hypertension/epidemiology , Life Style , Viral Load
16.
Epidemiol. serv. saúde ; 19(1): 43-50, jan.-mar. 2010. tab
Article in Portuguese | LILACS | ID: lil-541070

ABSTRACT

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.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Papillomavirus Infections/immunology , Papillomavirus Infections/transmission , Pregnant Women , Chlamydia trachomatis , Enzyme-Linked Immunosorbent Assay , Papillomavirus Infections/diagnosis
17.
Mem. Inst. Oswaldo Cruz ; 104(5): 755-763, Aug. 2009. graf, tab
Article in English | LILACS | ID: lil-528086

ABSTRACT

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.


Subject(s)
Female , Humans , Pregnancy , AIDS-Related Opportunistic Infections/virology , Papillomaviridae/classification , Papillomavirus Infections/virology , Pregnancy Complications, Infectious/virology , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/epidemiology , Brazil/epidemiology , Cross-Sectional Studies , DNA, Viral/analysis , Genotype , Polymerase Chain Reaction , Prevalence , Papillomaviridae/genetics , Papillomavirus Infections/diagnosis , Papillomavirus Infections/epidemiology , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/epidemiology , Socioeconomic Factors
18.
Cad. saúde pública ; 25(supl.3): S373-S391, 2009. ilus, tab
Article in English | LILACS | ID: lil-534056

ABSTRACT

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.


Subject(s)
Humans , Child , Cross Infection/prevention & control , Intensive Care Units, Pediatric , Cross Infection/epidemiology , Delivery of Health Care , Risk Factors , Respiratory Tract Infections/prevention & control , Urinary Tract Infections/prevention & control
19.
Braz. j. infect. dis ; 12(4): 269-277, Aug. 2008. tab, ilus
Article in English | LILACS | ID: lil-496763

ABSTRACT

Introduction of highly active antiretroviral therapy has resulted in a significant reduction in morbimortality and significant changes in the causes of death among HIV/AIDS patients. For this reason, it has become essential to monitor survival and causes of death. We constructed a survival curve based on 597 adult patients notified as AIDS cases between 1997 and 2004, at the Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil. Among those patients, 150 (25 percent) progressed to death by December, 2005. Of these, 119 were studied in detail. The data were collected from notification files of the State Health Department and the State Mortality Information System, and were complemented by analysis of medical records. These 597 patients had a survival rate of 88 percent, 86 percent and 82 percent after one, two and five years, respectively, and a 75 percent likelihood of surviving to 1,984 days (66 months). Most of the deaths occurred during the first months after the diagnosis (median, 129 days). Patients who died were predominantly young men who had sexual exposure and came from Recife (the state capital) or its metropolitan region. When the patients were first seen, a large proportion had already presented severe signs of immunodeficiency. Comparing the patients within this group, the characteristics that were associated with lower survival were: male sex, hemoglobin < 10 mg/dL, lymphocytes < 1,000/mm³, use of fewer therapeutic drugs and antiretroviral regimens and non-introduction of protease inhibitors. Most of them died from AIDS-related diseases, particularly undefined respiratory infections.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Acquired Immunodeficiency Syndrome/mortality , Antiretroviral Therapy, Highly Active/mortality , Acquired Immunodeficiency Syndrome/drug therapy , Brazil/epidemiology , Cause of Death , Survival Analysis , Young Adult
20.
Braz. j. infect. dis ; 12(4): 293-299, Aug. 2008. ilus, tab
Article in English | LILACS | ID: lil-496766

ABSTRACT

Abnormalities found with anuscopy under colposcopic vision, anal cytology and anal biopsy were evaluated in 21 men with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) at the Federal University of Pernambuco Hospital in Brazil. Mean age was 38.4 ± 6.0 years, and mean time of HIV infection was 8.3 ± 5.1 years; 95.2 percent of the patients had been on highly active antiretroviral therapy (HAART) for an average of 6.6 ± 4.5 years. Mean CD4+ cell count was 482.2 ± 173.75 cells/mm³, and 80.9 percent presented a HIV viral load of < 5,000 copies/mL. Reported sexual preference was 52.4 percent homosexuals, 28.6 percent bisexuals, and 19.0 percentheterosexuals; 81 percent reported having had receptive anal intercourse and 61.9 percent reported more than 10 sexual partners of the same sex. Results of anuscopy under colposcopic vision revealed 17 (81.0 percent) low-grade lesions and/or condylomata or micropapillae and four (19.0 percent) high-grade lesions with or without condylomata. Among the 21 anal cytology examinations, seven (33.3 percent) revealed low-grade squamous intraepithelial lesions (LSIL); three (14.3 percent) presented atypical squamous cells of undetermined significance (ASCUS) and 11 (52.4 percent) were normal. Seventeen patients were submitted to anal biopsy with the following findings: three patients (17.6 percent) with normal epithelium, one (5.9 percent) with infection by HPV, three (17.6 percent) with condylomatas, two (11.8 percent) with AIN 1, four (23.6 percent) with AIN 2, three (17.6 percent) with AIN 3, and one (5.9 percent) with PAIN 2. Anuscopy under colposcopic vision was found to be useful for detecting anal lesions and for guiding anal biopsies. Anal cytology was less useful, as it underestimated the frequency of lesions.


Subject(s)
Adult , Humans , Male , Middle Aged , Anus Diseases/diagnosis , Anus Neoplasms/prevention & control , HIV Infections/complications , Papillomavirus Infections/diagnosis , Anus Diseases/pathology , Anus Diseases/virology , Anus Neoplasms/pathology , Anus Neoplasms/virology , Biopsy , Colonoscopy , Prevalence , Papillomavirus Infections/complications , Papillomavirus Infections/pathology , Precancerous Conditions/pathology , Risk Factors , Severity of Illness Index
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