Comparación entre terapia basada en dolutegravir o efavirenz en población con Virus de Inmunodeficiencia Humana / Comparison between dolutegravir or efavirenz-based therapy in population with Human Inmunodeficiency Virus

En el año 2018 la Organización Mundial de la Salud (OMS) actualizó sus recomendaciones para el tratamiento en infecciones por Virus de Inmunodeficiencia Humana (VIH), estableciendo el régimen basado en dolutegravir como primera línea y el régimen basado en efavirenz como línea alternativa, posteriormente en el año 2019 Honduras introdujo dolutegravir para su uso en hombres y mujeres con métodos de planificación familiar. Objetivo: Comparar la efectividad entre dolutegravir y efavirenz para lograr la supresión viral en población con infección por VIH en el Servicio de Atención Integral del Hospital Mario Catarino Rivas (SAI-HMCR) en el período 2017-2020. Pacientes y métodos: Estudio observacional retrospectivo, que se realizó en el SAI-HMCR en Honduras. Se estudió la población mayor de 18 años con diagnóstico nuevo de VIH que inició tratamiento antirretroviral (TAR) con base en dolutegravir en el período 2019-2020, y se comparó con los que iniciaron TAR con base en efavirenz en el período 2017-2018. Resultados: La mediana (rango intercuartil) de carga viral basal fué de 8,658 copias/ml (1,036-27,710) en el grupo con efavirenz y 44,303 copias/ml (2,040-115,240) en el grupo con dolutegravir; la carga viral a las 24 semanas de terapia fue de 0 copias/ml (0-139) y 40 copias/ml (40-90) respectivamente. Conclusiones: La terapia basada en dolutegravir es superior a la terapia basada en efavirenz para lograr la supresión viral y aumentar el conteo de linfocitos T CD4...(AU)

Enzyme production by Candida albicans and Candida dubliniensis in periodontal HIV-positive patients receiving and not receiving antiretroviral therapy / Producción enzimática de Candida albicans y Candida dubliniensis de pacientes con periodontitis VIH+ con y sin tratamiento antirretroviral

ABSTRACT Candida dubliniensis (Cd) and Candida albicans (Ca) are the most frequently isolated yeasts in HIV+ patients. Some of the enzymes produced by these yeasts are considered virulence factors since they contribute to pathogenicity of Candida spp. The aim of the present study was to compare production of enzymes such as phospholipase (Ph), proteinase (P), and hemolysin (H) by Cd and Ca strains isolated from periodontal HIV-positive patients receiving and not receiving highly active antiretroviral therapy (HAART). Subgingival biofilm samples were obtained using paper points, and a sample of oral mucosa was taken using a swab. Phenotypic and molecular methods were used to isolate 39 strains of Candida, including 25 strains of Cd and 14 strains of Ca, obtained from 33 periodontal pocket samples and 6 oral mucosa samples collected from 15 HIV+ patients (8 receiving and 7 not receiving HAART). Malt egg-yolk agar, albumin agar and blood agar were used to evaluate pH, P and H production respectively. The strains were inoculated in duplicate and incubated at 37 ºC. Colony and halo diameters were measured. A greater proportion of Ca was observed in patients not receiving HAART, and a higher proportion of Cd was observed in those under HAART, Chi2 p< 0.001. Phospholipase production was observed in 92.9% percent of isolated Ca strains but in none of the isolated Cd strains. Proteinase production was high in Ca and Cd strains isolated from patients not receiving HAART. Hemolysin production was observed in all the studied strains, though it was significantly higher (p=0.04) in Ca and Cd strains isolated from patients not receiving HAART. To sum up, the proportion of Candida dubliniensis strains was highest in the subgingival biofilm of patients receiving HAART, and Cd strains were found to express fewer virulence factors than Ca strains.

RESUMEN Las levaduras más aisladas en pacientes VIH+ son Candida dubliniensis (Cd) y Candida albicans (Ca). Algunas de sus enzimas constituyen factores de virulencia ya que favorecen la diseminación tisular. El objetivo fue comparar la producción de enzimas como fosfolipasa (F), proteinasa (P) y hemolisina (H) en cepas de Cd y Ca aisladas de pacientes VIH+ tratados y no tratados con antirretrovirales (TARGA). Se realizó la toma del biofilm de placa subgingival con conos de papel y la muestra de la mucosa bucal con hisopo. Se aislaron y tipificaron por métodos fenotípicos y moleculares 39 cepas: 25 de Cd y 14 Ca, obtenidas 33 de bolsas periodontales y 6 de mucosa bucal de 15 pacientes VIH+ (8 con y 7 sin tratamiento). Se utilizó agar malta con yema de huevo, agar albúmina y agar sangre para demostrar la producción de F, P y H, respectivamente. Se inocularon por duplicado e incubaron a 37°C. Se midieron los diámetros de las colonias y los de hidrólisis alrededor de las mismas. Se observó mayor proporción de Ca en los pacientes sin tratamiento y mayor proporción de Cd en los con tratamiento; Chi2 p< 0.001. El 92,9% de las Ca estudiadas, fueron productoras de fosfolipasa. En tanto que ninguna Cd produjo la enzima. En cuanto a la producción de proteinasa se observa una alta producción tanto en las cepas de Ca, como en las Cd aisladas en los pacientes no tratados. Todas las cepas estudiadas produjeron hemolisina, observándose una diferencia estadísticamente significativa (p=0,04) en ambas especies a favor de la alta producción de la enzima en las cepas obtenidas de pacientes no tratados. Podemos concluir que en el biofilm subgingival, en los pacientes bajo TARGA, se aíslan mayor proporción de Candida dubliniensis las cuales expresan menos factores de virulencia.

Alterações na Epiderme de Pacientes com Aids Autopsiados em Uso da Terapia Antirretroviral / Changes in the Epidermis of Autopsied AIDS Patients Using Antiretroviral Therapy

Objetivo: Avaliar a influência da terapia na morfologia da epiderme de pacientes com Síndrome da Imunodeficiência Adquirida - AIDS. Metodologia: Estudo transversal desenvolvido na Universidade Federal do Triângulo Mineiro, Brasil. Foram selecionados pacientes com AIDS de ambos os sexos, que foram agrupados de acordo com o tratamento com Terapia antir-retroviral de alta eficiência: pacientes em uso de HAART (n = 14) e pacientes sem uso de HAART (n = 14). Outras informações foram coletadas do prontuário clínico. Resultados: A idade média dos pacientes em tratamento foi de 49,07 ± 7,89 anos e dos pacientes sem TARV foi de 55,11 ± 10,17 anos. A maioria dos pacientes na terapia utilizada pertencia ao sexo feminino, 9 (64,28%). Estes apresentaram espessamento epidérmico (150,04 x 86,09µm), número de camadas celulares (8,0 x 5,5 camadas) e densidade de células de Langerhans superiores àquelas que não utilizaram a terapia, com diferença significativa. Conclusão: Nossos achados sugerem que o HAART propor-ciona a recuperação dos constituintes da epiderme alterados pela doença, melhorando sua função como barreira chave na proteção do corpo contra microorganismos ambientais. (AU)

Objective: To evaluate the influence of therapy in the morphology of the epidermis of patients with Acquired Immunodeficiency Syndrome. Methodology: Cross-sectional study developed at the Triangulo Mineiro Federal University, Brazil. This study has been approved by Triângulo Mineiro Federal University Research Ethics Committee on protocol number 1780/2010. Patients with AIDS, of both genders were selected and arranged according to treatment with Highly Active Antiretroviral Therapy: patients in use of HAART (n = 14), and patients without use of HAART (n = 14). Other information was collected from the clinical record. Results: The mean age of the patients undergoing therapy was 49.07±7.89 years, and of the patients without HAART was 55.11±10.17 years. The majority of the patients using the therapy, belonged to the female gender, 9 (64.28%). These showed epidermal thickness (150.04 x 86.09µm), number of cell layers (8.0 x 5.5 layers) and density of Langerhans cells higher than those who did not use the therapy, with a significant difference. Conclusion: Our findings suggest that the HAART provides recovery of epidermis constituents altered by the disease, improving its function as a key barrier in protecting the body against environmental microorganisms. (AU)

Efectividad y seguridad del cambio a esquema basado en raltegravir en pacientes con infección por VIH dislipidémicos bajo terapia anti-retroviral en Fundación Arriarán / Efectiveness and safety of switching to raltegravir-based regimen in dyslipidemic HIV-infected patients receiving antiretroviral therapy at Arriaran Foundation

Resumen Introducción: El impacto del cambio de terapia antiretroviral (TAR) para tratar la dislipidemia en pacientes infectados por VIH no ha sido reportado en Chile. Objetivo: Evaluar la efectividad y seguridad a 12 meses del cambio de TAR a esquema con raltegravir (RAL) para tratar la dislipidemia. Material y Métodos: Cohorte retrospectiva de pacientes con infección por VIH en TAR, atendidos en Fundación Arriarán, con dislipidemia y que cambiaron a esquema con RAL para tratarla. Resultados: Se incluyó 73 casos, en TAR con inhibidores no nucleosídicos de transcriptasa reversa (INNTR; 50,7%) o inhibidores de proteasa (IP; 49,3%), con dislipidemia mixta (42,5%) o hipertrigliceridemia aislada (57,5%). La mediana de colesterol total (CT) y triglicéridos (TG) basales era 228 mg/dl y 420 mg/dl, respectivamente. El 94,5% tenía carga viral (CV) indetectable. Se modificó TAR de base en 58,4%; 89,1% recibía hipolipemiantes. Las concentraciones plasmáticas de lípidos descendieron significativamente a 12 meses (TG= −43,6%; CT= −19,3%). Ningún paciente presentó fracaso virológico, aunque 10,9% tuvo viremia detectable a 12 meses, mayoritariamente transitoria. Conclusiones: El cambio de TAR a RAL en pacientes dislipidémicos tratados con INNTR o IP reduce significativamente las concentraciones plasmáticas de TG y CT a 12 meses. Es una estrategia segura, pero puede observarse viremia transitoria.

Background: The impact of switching antiretroviral therapy (ART) regimen for dyslipidemia management in HIV-infected (HIV+) patients has not been reported in Chile. Aim: To assess effectiveness and safety at 12 months after switching to raltegravir-based regimen for dyslipidemia management. Methods: Retrospective cohort of HIV+ patients receiving ART at Arriaran Foundation, with dyslipidemia switched to raltegravir-based regimen for lipid management. Results: 73 patients were included, receiving ART based in nonnucleoside reverse transcriptase inhibitor (NNRTI; 50,7%) or protease inhibitor (PI; 49,3%), with mixed dyslipidemia (42,5%) or isolated hypertriglyceridemia (57,5%). At baseline, median total cholesterol (TC) and triglycerides (TG) were 228 mg/dl and 420 mg/dl, respectively; undetectable viral load (VL) was present in 94,5% of patients. Backbone ART was switched in 58,4% and lipid-lowering therapy was used by 89,1% of them. At 12 months, there was a significant decrease in TG (-43,6%) and TC (-19,3%). No cases of virologic failure were observed, although 10,9% of patients had detectable VL at 12 months, mostly transient. Conclusions: Switching ART to raltegravir-based regimen in dyslipidemic patients receiving NNRTI or PI is associated with a significative decrease in TG and TC at 12 months. This strategy is safe, but VL can be increased temporarily.

Infección por Virus de Inmunodeficiencia Humana en Niños y Adolescentes, 30 Años en Chile / Human Immunodeficiency Virus Infection in Children and Adolescents, 30 years in Chile

Resumen: El VIH ha sido la gran infección de fines del siglo XX. Esta revisión tiene como objetivos dar a cono cer la experiencia del Comité de VIH/SIDA Pediátrico de la Sociedad Chilena de Pediatría desde la detección del primer niño infectado con VIH en Chile, y promover la pesquisa y derivación de los re cién nacidos/niños expuestos al VIH y de aquellos infectados con VIH. Se analizan datos actualizados de la literatura nacional y extranjera, presentaciones a Congresos/Talleres efectuadas por el Comité VIH/SIDA Pediátrico, y experiencias de sus integrantes. Se da a conocer la historia del Programa de Atención VIH/SIDA Pediátrico en la pesquisa, diagnóstico, tratamiento y seguimiento desde su crea ción en 1990. Se presentan los datos de los pacientes detectados desde 1987 al 2008 por el Comité (Cohorte 1) y aquellos obtenidos mediante correo electrónico de los pacientes detectados desde 1987 al 2014 (Cohorte 2). El análisis de estas cohortes permitió concluir que con la aplicación del Progra ma Preventivo de Transmisión Vertical (PPTV) del VIH ha disminuido la transmisión vertical de este virus desde >35% previo a 1995 a <2% en la actualidad, y que con el uso de TARV se ha obtenido mejoría clínica, inmunológica y virológica con prolongación de la sobrevida. Finalmente se discuten los logros obtenidos comparando sus resultados con los de la literatura actual, evidenciando que Chile se encuentra a punto de lograr la meta de la eliminación de la transmisión vertical del VIH.

Abstract: HIV has been the major infection of the late 20th century. This review has the objective of dissemina ting the experience of the Pediatric HIV/AIDS Committee of the Chilean Pediatric Society since the detection of the first HIV-infected child in Chile and promoting the screening and referral of new- borns/children exposed to HIV and those infected with HIV. Updated data from the national and fo reign literature, presentations in Congresses/Workshops held by the Pediatric HIV/AIDS Committee, and experiences of its members are analyzed. It is presented the history of the Pediatric HIV/AIDS Care Program in screening, diagnosis, treatment, and follow-up since its inception in 1990. The data on patients detected from 1987 to 2008 by the Committee (Cohort 1) and those obtained by e-mail from patients detected from 1987 to 2014 (Cohort 2) are presented. The analysis of these cohorts led to the conclusion that with the application of the Preventive Vertical Transmission Program (PPTV) for HIV, the vertical transmission of this virus has decreased from >35% prior to 1995 to <2% at present, and that clinical, immunological and virological improvement with prolonged survival has been obtained with the use of ART. Finally, we discuss the achievements obtained by comparing the results with those of the current literature, showing that Chile is on the brink of achieving the goal of eradicating the vertical transmission of HIV.

Perfil de gestantes em tratamento para a infecção pelo vírus da imunodeficiência humana / Profile of pregnant women under treatment for human immunodeficiency virus infection / Perfil de las mujeres embarazadas reciben tratamiento para la infección por el virus de inmunodeficiencia humana

Justificativa e Objetivos: A via de transmissão predominante em casos de HIV/aids pediátrica continua sendo a transmissão vertical. Sendo a infecção pelo HIV uma doença crônica e controlável, o acompanhamento do tratamento da mãe e seu filho são fundamentais. O objetivo foi verificar o perfil de gestantes portadoras do HIV atendidas em um Hospital público da região central do Rio Grande do Sul, e o momento em que ocorreu o diagnóstico da infecção. Métodos: Foi realizado um estudo descritivo, do tipo transversal, retrospectivo, com 46 gestantes recebendo terapia antirretroviral (TARV) para o HIV durante o período de janeiro a dezembro de 2015 junto a sua Unidade dispensadora de medicamentos. Os dados foram obtidos através da consulta no Sistema de Controle Logístico de Medicamentos, junto à farmácia hospitalar, e através de consulta em prontuários clínicos. Resultados: A média da idade no período da gestação foi de 29 anos (± 5,9), apenas 24% teve o diagnóstico fora de período gestacional, e a maioria (69,6%) sabia ser portadora do HIV antes da gestação atual, sendo que apenas 11,6% estavam esperando o primeiro filho. A maioria das gestantes recebeu TARV por mais de seis meses de gestação (60,9%). O pré-natal não foi realizado adequadamente em 19,6% destas gestantes resultando em TARV insatisfatória. Conclusão: Sendo o HIV uma infecção silenciosa, a gestação torna-se um momento oportuno para diagnóstico desta infecção. É necessária maior sensibilização quanto à importância de um pré-natal precoce e de adesão a TARV, buscando minimizar os riscos da transmissão vertical do HIV.(AU)

Background and Objectives: The predominant transmission route in cases of HIV/pediatric aids continues to be vertical transmission. Since HIV infection is a chronic and controllable disease, monitoring the treatment of the mother and her child is fundamental. The objective was to verify the profile of HIV- positive pregnant women attended at a public hospital in the central region of Rio Grande do Sul, and when it was made the diagnosis. Methods: A descriptive, cross-sectional, retrospective study was carried out with 46 pregnant women undergoing antiretroviral treatment (ART) for HIV during the period from January to December 2015. Data were obtained through the consultation in the Logistic Control System of Medications, in the hospital pharmacy, and in the medical records. Results: The mean age of the gestation period was 29 years old (± 5,9). Only 24% had the diagnosis outside the gestational period, and the majority (69,6%) knew to be HIV positive before the current gestation, with only 11, 6% expecting the first child. The majority of pregnant women received ART for more than 6 months of gestation (60.9%). Prenatal care was not adequately performed in 19.6%, and these pregnant women were not adequately treated. Conclusion: Since HIV is a silent infection, gestation becomes an opportune moment for the diagnosis of this infection. However, greater awareness of the importance of early prenatal care and adherence to ART is needed, in order to minimize the risk of vertical transmission of HIV.(AU)

Justificación y objetivos: La vía de transmisión predominante en casos de HIV/sida pediátrica sigue siendo la transmisión vertical. Siendo la infección por el VIH una enfermedad crónica y controlable, el seguimiento del tratamiento de la madre y su hijo son fundamentales. El objetivo fue verificar el perfil de gestantes portadoras del VIH atendidas en un Hospital público de la región central de Rio Grande do Sul, y cuando se realizó el diagnóstico. Métodos: Se realizó un estudio descriptivo ,en sección transversal, retrospectivo de 46 mujeres embarazadas que reciben terapia antirretroviral (HAART) para el VIH durante el período de enero a diciembre 2015. Los datos se obtuvieron mediante la consulta del Sistema de Gestión Logística de medicamentos en la farmacia hospitalaria y por medio de consultas en los registros clínicos. Resultados: El promedio de edad en el período de gestación fue de 29 años, sólo el 24% tuvo el diagnóstico fuera del período gestacional, y la mayoría (69,6%) sabía ser portadora del VIH antes de la gestación actual, siendo que sólo 11, 6% estaba embarazada del primer hijo. La mayoría de las mujeres embarazadas recibieron HAART durante más de seis meses de embarazo (60,9%). El prenatal no fue realizado adecuadamente en el 19,6%, quedando estas gestantes sin HAART. Conclusiones: Siendo el VIH una infección silenciosa, la gestación se convierte en un momento oportuno para el diagnóstico de esta infección. Sin embargo, es necesaria una mayor concientización en cuanto a la importancia de un pre-natal precoz y de adhesión a HAART.(AU)

Evaluación de la densidad mineral ósea en niños con infección vertical por VIH / Evaluation of bone mineral density in children with vertical infection by HIV

Resumen Los cambios en la densidad mineral ósea (DMO) son comunes en adultos infectados con virus de la inmunodeficiencia humana (VIH). Existen pocos estudios que evalúen el compromiso óseo en niños. Objetivo: Evaluar la DMO en niños infectados verticalmente por VIH. Métodos: Se estudiaron 53 niños infectados (8-18) de cinco hospitales. Se registró severidad de enfermedad, evaluación nutricional, vitamina D (25-OHD) y estado inmunológico. La DMO se midió mediante densitometría. Se utilizó análisis descriptivo, comparación de medias y regresión lineal simple y múltiple. Resultados: El 88,7% estaban en estadio B y C, 57% eran eutróficos y 18,9% tenían talla baja. El 33,3% presentaba niveles de 25-OHD < 20 ng/ml. El 11%, 6% y 4% de los niños tenían DMO < 2DE en cadera, columna y cuerpo entero, respectivamente. La DMO se correlacionó con IMC, talla, severidad de enfermedad y años de tratamiento. Sólo inhibidores de las proteasas (IP) mantuvieron su significancia al ajustar por otras variables. Conclusión: Los niños infectados con VIH tuvieron DMO más baja por edad comparados con datos de NHANES III. La severidad de la enfermedad, talla, zIMC, los años de tratamiento con anti-retrovirales, principalmente IP, están relacionados con la reducción de la masa ósea.

Changes in bone mineral density (BMD) are common in adults infected with human immunodeficiency virus (HIV). There are few studies evaluating bone involvement in children infected. Objective: To evaluate BMD in vertically HIV-infected children. Methods: We studied 53 infected children (8-18 years) from five hospitals. Disease status, nutritional assessment, vitamin D (25-OHD) levels and immunological status were recorded. BMD was measured by densitometry. Descriptive analysis, comparison of means and simple and multiple linear regression were used. Results: 88.7% children were in stage B and C, 57% were eutrophic and 18.9% had short stature. 33.3% had 25-OHD levels < 20 ng / ml. 11%, 6% and 4% of the children had BMD <-2DE in hip, spine and whole body respectively. BMD was correlated with BMI, height, disease stage and years of treatment. Only protease inhibitors (PIs) maintained their significance when adjusted for other variables. Conclusion: children infected with HIV had lower BMD by age compared to NHANES III data. The severity of the disease, height, zBMI, years of treatment with antiretrovirals, mainly IP, are related to the reduction of bone mass.

Condición inmunológica y virológica de los pacientes adultos con infección por VIH al inicio de la terapia anti-retroviral en el Hospital Carlos van Buren. Comparación de los períodos 2013 y 2015 / Immunological and virological condition of adult patients with HIV infection at the beginning of antiretroviral therapy at Carlos van Buren Hospital. Comparison of 2013 and 2015 periods

Resumen Introducción: La terapia anti-retroviral (TARV) en pacientes con infección por VIH ha causado una disminución de la morbimortalidad y del riesgo de transmisión. Las recomendaciones internacionales actuales sugieren un inicio precoz de TARV, independiente del recuento de linfocitos T CD4. Objetivo: Describir el impacto del inicio de TARV en el recuento de CD4 y carga viral (CV) al año de tratamiento en pacientes que ingresaron al Programa de VIH del HCVB en los años 2013 y 2015. Métodos: Estudio descriptivo que incluyó a todos los pacientes que iniciaron TARV durante los años mencionados. Resultados: 78 y 100 pacientes iniciaron TARV el año 2013 y 2015; respectivamente. El año 2013, 48 (61,5%) pacientes, y el año 2015, 55 (55%) pacientes iniciaron terapia con un recuento de CD4 > 200 céls/mm3. En el primer grupo, al año de seguimiento, 43 (55%) pacientes tuvieron una CV indetectable; mientras que en el segundo grupo, esta meta se logró en 72% de los casos (p = 0,001). Conclusiones: El inicio temprano de TARV aumentó la proporción de pacientes con CV indetectable. Sin embargo, debemos mejorar las estrategias para optimizar los resultados.

Introduction: Anti-retroviral therapy (ART) in HIV patients has shown reduction in morbidity and mortality, and decrease in contagious risk. International recommendations include early initiation of ART, irrespectively of CD4 cell count. Objective: To describe the impact of ART initiation in CD4 cell count and viral load at the end of the first year of HIV treatment, for patients who entered the program at 2013 and 2015. Methodology: Descriptive study. The sample comprehends all patients who started their ART treatment in the indicated years, at HCVB. Results: 78 and 100 patients initiated ART treatment in 2013 and 2015, respectively. In 2013, 48 out of 78 patients (61.5%), and in 2015, 55 (55%) patients started therapy with CD4 > 200 cell/mm3. The follow-up in the first group resulted on 43 (55%) patients with an undetectable CV at the end of first year of treatment, meanwhile in the second group 72% achieved this target (p = 0.001). Conclusions: Early ART initiation increased the proportion of patients with undetectable CV. However, we must improve strategies to optimize results.

Trastornos de la densidad mineral ósea en personas con VIH en tratamiento antirretroviral Pereira-Risaralda-Colombia / Disorders of bone mineral density in patients with HIV on antiretroviral treatment-Colombia Risaralda Pereira

Objetivo: La osteoporosis es común en las personas con el virus de inmunodeficiencia humana (VIH). La etiología es multifactorial, involucrando factores de riesgo tradicionales, efectos directos de la infección por el VIH y efectos de los medicamentos antiretrovirales (ARV). Las nuevas evidencias sugieren que el aumento de la prevalencia de la osteoporosis en las personas infectadas por el VIH se traduce en un mayor riesgo de fractura que puede conducir al aumento de morbilidad y mortalidad. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal en 180 pacientes, que permitió conocer los trastornos de baja masa ósea que presentaban los pacientes estudiados que recibían terapia ARV. Para la medición se usó el método DXA (Dual Energy X Ray Absorptiometry) de columna lumbar y cuello femoral y para la clasificación los criterios de la OMS . Resultados: Se evaluaron 180 pacientes, 76,5% fueron hombres, con un promedio de edad de 41± 11,27 años. Resultaron normales 72,6%, Osteopenia 20,6% y osteoporosis en el 20,6% y osteoporosis en el 6,7%. El análisis multivariado mostró una asociación significativa importante de la Nevirapina frente a la disminución de la masa ósea (OR 0,10 IC95% 0,01 - 0,8). La combinación Tenofovir / Emtricitabina mostró una frecuencia más alta entre pacientes con disminución de la masa ósea (ORa 3.664 IC95% 1.2 - 11.0) . Conclusiones: Se hace necesario realizar tamizaje DXA a los pacientes que reciben TAR, para realizar un diagnóstico y tratamiento temprano y evitar complicaciones óseas que alteren la calidad de vida de las personas con VIH.

Objective: Osteoporosis is common in people with human immunodeficiency virus (HIV). The etiology is multifactorial, involving traditional risk factors, direct effects of HIV infection and effects of antiretroviral drugs (ARVs). New evidence suggests that the increased prevalence of osteoporosis in people with HIV results in an increased risk of fracture that can lead to increased morbidity and mortality. Materials and Methods: A descriptive cross-sectional study was undertaken of 180 patients, which allowed us to see the low bone mass disorders in patients of the study who were receiving ARV therapy. Measurements of lumber spine and femoral neck were made using the DXA (Dual Energy X-Ray Absorptiometry) method and for the classification, criteria of the WHO were used. Results: 180 patients were evaluated. 76.5% were men, with an average age of 41 +-11.27 years. 72.6% were normal, 20.6% had osteopenia and 6.7% osteoporosis. The multivariate analysis showed an important significant association of Nevirapine with the decreased bone mass (ORa 0.10 IC95% 0.01 - 0.8). The combination of Tenofovir / Emtricitabine showed a higher frequency among patients with low bone mass (ORa 3,664 IC95% 1.2 - 11.0). Conclusions: DXA screening is necessary for patients receiving TAR, in order to make a diagnosis, give early treatment and prevent bone complications that affect the quality of life of people with HIV.

Adherencia al tratamiento anti-retroviral para el VIH/SIDA en mujeres: una mirada socio-cultural / Antiretroviral treatment adherence for HIV/AIDS in women: a sociocultural perspective

Resumen Introducción: La adecuada adherencia a la TARV tiene un alto impacto en la sobrevida en el SIDA. Existe poco consenso sobre las causas de la baja adherencia al tratamiento en mujeres, estando éstas en una situación de desigualdad en términos de prevención y cuidados relacionados. Objetivos: Explorar y describir los aspectos socioculturales vinculados a la adherencia de mujeres al tratamiento anti-retroviral para el VIH/SIDA. Material y Métodos: Estudio cualitativo, exploratorio-descriptivo. La población de estudio fueron mujeres chilenas de 18 de edad o más con infección por VIH/SIDA. El tamaño de la muestra se definió por saturación de información. Se realizaron entrevistas en profundidad a 16 mujeres contactadas en siete centros públicos de atención a personas con infección por VIH en cuatro regiones del país, atendiendo al criterio de saturación de la información. Resultados: Existen diversos factores socio-culturales que determinan el grado de adherencia que las mujeres adoptan en relación al TARV. Los más relevantes son la satisfacción vital, el imaginario sobre el VIH, la disposición de sus redes frente al diagnóstico y la disponibilidad de información. Discusión: Se hace necesario incursionar en intervenciones específicas considerando los aspectos socio-culturales y satisfaciendo las necesidades psicosociales de las mujeres. Se hace imprescindible que las políticas públicas y los equipos de salud consideren dichos aspectos para mejorar la adherencia a la TARV.

Background: Adequate adherence to HAART has a high impact on survival of AIDA patients. There is little consensus on the causes of low adherence to treatment in women, who are in a situation of inequality in terms of prevention and related care. Objectives: To explore and describe the socio-cultural aspects related to the adherence of women to antiretroviral treatment for HIV / AIDS. Material and Methods: Qualitative, exploratory-descriptive study. The study population was focused on Chilean women, who are 18 years of age or older, living with HIV/AIDS. The sample size was defined by information saturation. In-depth interviews were conducted with 16 women contacted in seven public care centers for people living with HIV (PLHIV) in 4 regions of the country, and it was take into account the saturation of the information. Results: There are several sociocultural factors that determine the level of adherence that women adopt in relation to HAART. The most relevant ones are the vital satisfaction, the imaginary about HIV, the availability of their networks in front of diagnosis and the availability of information are fundamental. Discussion: It is necessary to enter into specific interventions considering the sociocultural aspects and satisfying the psychosocial needs of women. It is imperative that public policies and health teams consider these aspects to improve adherence to HAART.

Infección por VIH/SIDA en niños y adolescentes: cohorte chilena 1987-2014 / HIV/AIDS infection in children and adolescents: Chilean cohort 1987-2014

The present document describes the Cohort of HIV/AIDS children detected in Chile from 1987 to August 2014 and the effectiveness of the Protocol for Prevention of Vertical Transmission (PPVT) of HIV infection. Of the 375 HIV infected children enrolled since 1987 to August 2014, 245 of them are still in pediatric control. From the analysis of the Cohort is inferred that: a) it has observed an improvement in the detection of the HIV infected child, in number and precocious time; b) the majority of these children continue to be detected by clinic symptoms and signs (mainly unspecific and infectious manifestations); c) the ARVT use has meant a clinic and immunologic improvement with diminution of the infections, principally opportunistic infections, with a better life quality, a prolongation of survival and a diminution of lethality; d) as more survival has been produced, cancer has begun to be detected, a very infrequent complication observed in them before the ARVT use. The PPVT started in 1995, and was reinforced in 2005 with the "Joint Norm of HIV and Syphilis Vertical Transmission Prevention" (MINSAL), both have meant a diminution of the HIV vertical transmission from > 35% (before 1995) to < 2% nowadays in the mother-child binomial; also have permitted a second generation of HIV exposed children born without infection. In spite this PPVT, still HIV infected child continue to be detected which imply failures in some points of the health system.

Se presentan datos de la cohorte de niños con infección por VIH/SIDA detectados en Chile desde el año 1987 a agosto de 2014 y datos de la transmisión vertical (TV) del VIH con uso de protocolos de prevención de TV (PPTV). De los 375 niños infectados con VIH en este período, siguen en control pediátrico 245. Del análisis de la cohorte se desprende que: a) ha habido una mejoría en la pesquisa de los niños infectados con VIH, tanto en número como en precocidad; b) estos niños siguen detectándose, en su mayoría, por hechos clínicos (manifestaciones inespecíficas e infecciosas principalmente); c) el uso de TARV ha significado una mejoría clínica e inmunológica con disminución de las infecciones, principalmente las oportunistas, con una mejor calidad de vida, prolongación de la sobrevida, y disminución de la letalidad; d) por su mayor sobrevida, se ha observado el desarrollo de cánceres, muy infrecuentes en ellos antes del uso de terapia anti-retroviral. La aplicación de Protocolos de Prevención de la TV desde 1995, reforzada el 2005 con la “Norma Conjunta de la Prevención de la Transmisión Vertical del VIH y Sífilis” (MINSAL), ha significado una disminución de la TV del VIH desde más de 35% (antes de 1995) a < 2% actualmente en los binomios en prevención; además ha permitido que una segunda generación de niños expuestos al VIH nazca no infectada. A pesar de estos PPTV, aún siguen naciendo niños infectados con VIH, lo que implica fallas en algunos puntos del sistema de salud.

Respuesta virológica e inmunológica a la terapia anti-retroviral en pacientes portadores de infección por VIH atendidos en una red de salud académica de Chile / Virological and immunological outcomes to antiretroviral therapy in HIV-infected patients of an academic medical center in Chile

Introduction: Red Salud UC is an Academic health network where HIV-infected patients from the public and private health system are followed by a multidisplinary team. Aim: To determine virologic and immunologic response after 144 weeks of starting first antiretroviral therapy in these patients. Methods: A retrospective analysis of adult HIV patients attended between 1992 and 2011 was performed. Demographic and clinical characteristics, antiretroviral therapies data and immunologic and virologic outcomes were collected. CD4 count and HIV viral load changes up to 144 weeks after initiation of antiretroviral therapy were analyzed. Results: 860 patients were included in the analyses. Median age was 42 years, 93% were men. Median CD4+ count at baseline was 202 cells/mm³. The most used ART regimen was zidovudine/lamivudine plus efavirenz. First line anti-retroviral therapy was changed in 42% patients, being the most common cause, drug toxicity. At week 144, median CD4+ lymphocyte cell count was 449 cells/mm³. Ninety percent and 96% had undetectable viral load measured as < 50 copies/mL or < 400 copies/mL respectively. Discussion: First report of a university cohort, with CD4 and viral load follow up for 144 weeks, including Chilean patients from public and private system. After initiation of ART, an excellent immunologic and virologic response was observed in this cohort.

Introducción: La Red de Salud UC es una red académica de atención, donde pacientes portadores del VIH del área pública y privada de salud son atendidos por un equipo profesional multidisciplinario. Objetivo: Determinar las respuestas virológicas e inmunológicas a 144 semanas de iniciada la primera terapia antiretroviral en dichos pacientes. Métodos: Análisis retrospectivo de registros de pacientes adultos portadores de VIH atendidos entre 1992 y 2011. Se recolectaron datos demográficos, clínicos, terapia anti-retroviral, resultados inmunológicos y virológicos. Se analizaron los resultados de linfocitos T CD4+ y carga viral de VIH a las 144 semanas de iniciada la primera terapia anti-retroviral. Resultados: Fueron incluidos en el análisis 860 pacientes. El promedio de edad fue 42 años, 93% hombres. La mediana basal de LT CD4+ fue 202 céls/mm³. La terapia más utilizada fue zidovudina/lamivudina/efavirenz. En 42% de los pacientes se cambió la terapia de primera línea; la causa más común fue toxicidad a los anti-retrovirales. A la semana 144 de iniciada la terapia, la mediana de LT CD4+ fue de 449 céls/mm³. Alcanzaron cargas virales indetectables 90 y 96% con < 50 copias ARN/mL o < 400 copias ARN/mL respectivamente. Discusión: Primer reporte de pacientes tratados en un centro universitario, con seguimiento inmuno-virológico a 144 semanas, que incluye pacientes del área pública y privada de salud chilena. Después del inicio de la terapia, se observó una excelente respuesta inmuno-virológica.

Fatores associados ao uso de polimetilmetacrilato na lipoatrofia facial em pacientes tratados com antirretrovirais / Associated factors to use of polymethylmethacrylate in facial lipoatrophy in patients treated with antiretrovirals

Objetivos: Identificar fatores associados ao uso do polimetilmetacrilato em pacientes HIV positivos sob tratamento antirretroviral em Santa Catarina e definir o perfil dos pacientes que buscam o tratamento para lipoatrofia facial. Métodos: Estudo transversal com 219 pacientes elaborado a partir de registros no SINAN (Sistema de Informação de Agravos de Notificação) e concomitantemente no serviço realizador da intervenção para lipoatrofia facial no âmbito do Sistema Único de Saúde no Estado de Santa Catarina, no período de 2008 a 2011, em que foram avaliados possíveis fatores de risco em variáveis sóciodemográficas e clínicas relacionadas à doença e à intervenção. Resultados: Os pacientes tinham em média 48 anos variando de 30 a 74 anos, sendo predominantemente do sexo masculino (70,8%). Foi encontrada associação significativa entre hipertensão arterial sistêmica (p=0,0006), sexo masculino (p=0,0010), realização de transfusão sanguínea (p=0,013), pacientes não etilistas (p=0,014) e portadores de HIV há mais de 5 anos (p=0,049) e a maior aplicação de polimetilmetacrilato. Em média, o grupo homossexual necessitou de quase 0,6 intervenções a mais do que o grupo heterossexual para uso de metacrilato, assim como maior volume (6,16mL). Conclusão: Pacientes do sexo masculino, homossexuais, hipertensos, que realizaram transfusão sanguínea, não etilistas e que possuem diagnóstico da doença há mais de 5 anos fizeram aplicação de maior volume de polimetilmetacrilato.

Objectives: Identify factors associated with use of polymethylmetacrylate HIV-infected patients in with treatment on antiretroviral in Santa Catarina and define the profile of patients seeking treatment for lipoatrophy. Methods: Cross-sectional study with 219 patients compiled from records in SINAN (Information System for Notifiable Diseases) and concurrently director of the service intervention for facial lipoatrophy in the SUS in the state of Santa Catarina, from 2008 to 2011, where they were assessed possible risk factors in clinical and sociodemographic variables related to illness and intervention. Results: Patients had an mean of 48 years ranging from 30 to 74 years, predominantly male (70.8%). There was use of higher volume of polymethyl methacrylate in the face of patients with hypertension (p = 0.0006), male gender (p = 0.0010), performance of blood transfusion (p = 0.013), non-alcoholic patients (p = 0.014) and HIV for over 5 years (p = 0.049). On mean, the homosexual group interventions needed almost 0.6 more than the heterosexual group for use methacrylate as well as higher volume (6.16 mL). Conclusion: Homossexual men, hypertensive, patients who underwent blood transfusion, nondrinkers as well as who have a diagnosis of the disease for more than 5 years showed increased risk for higher volume of polymethyl methacrylate in the face male patients.

Infección por virus de inmunodeficiencia humana en niños y adolescentes: Más de 25 años en Chile / Human immunodeficiency virus infection in children and adolescents: More of 25 years in Chile

In this article, the following topics about pediatric HIV infection and AIDS are summarized: a description of pathogenic and clinical aspects of HIV infection in children, the clues for its suspicion, the preventive strategies to avoid the vertical transmission of HIV, the study to certify or to rule out the HIV infection in infants and children, the main recommendations of antiretroviral treatment and how to prevent and treat manifestations of HIV infection. Besides, the evolution in Chile of the pediatric HIV infection is described with details, since the first child detected with AIDS in 1987, infected by transfusion and the first infants (twin) diagnosed in 1989, infected by vertical twins transmission, to 2014, with the progress obtained, snags, hopes and challenges addressed.

En este artículo se describe en forma resumida la patogénesis y aspectos clínicos de la infección por VIH en niños, las claves para su sospecha, las medidas preventivas para evitar su transmisión vertical, el estudio necesario para certificar o descartar la infección en lactantes y niños mayores, y las principales recomendaciones para la terapia anti-retroviral y cómo tratar y prevenir las manifestaciones de la infección por VIH. Se relata a continuación, en forma detallada, la evolución que ha experimentado en Chile la infección por VIH en pediatría, desde el primer caso pesquisado en el año 1987, producto de una transfusión sanguínea, y los primeros lactantes (mellizos) detectados en 1989, que fueran infectados en forma vertical, hasta el año 2014, con el progreso obtenido, las trabas, esperanzas y desafíos enfrentados.

Incidencia de reacciones adversas a medicamentos en pacientes que inician o cambian terapia anti-retroviral / Incidence of adverse drug reactions in patients initiating or changing antiretroviral therapy

In the Chilean AIDS Cohort, the 15.9% of the patients change the first scheme of HAART because of toxicity, which is also the cause of 47% suspensions of treatment occurred in the first months of therapy. Aim: To analyze the incidence and causality of adverse drug reactions in patients initiating or changing antiretroviral therapy. Materials andMethods: 92 patients who started or changed antiretroviral treatment in a period from May to July 2011 were followed to detect adverse drug reactions. Results: 75% (n: 69) of patients had at least one adverse event. From a total of 76 adverse drug reactions detected the most frequent ones were diarrhea (21.1%, n: 16) and hyperbilirubinemia (19.7% n: 15). 85.9% of the adverse events where grade depending on its seriousness, 34.1% had grade 1 toxicity, 32.9% grade 2, 9.4% grade 3 and only 3.5% grade 4. Only 22 patients (31.8%) required a treatment change. The most frequent causes for changing treatment were because of anaemia by AZT (45.4%, n: 10) and diarrhea associated with the use of LPV/r (27.3%, n: 6). Conclusion: Knowing the real incidence rate of adverse drug reactions may help the health team giving proper management and monitoring of these reactions in the patient, in order to avoid an early change of HAART. Defining a multidisciplinary team which includes a pharmacist is essential for proper pharmacosurveillance.

En la Cohorte Chilena de SIDA, 15,9% de los pacientes requiere cambio de su primer esquema de TARV por toxicidad, siendo además la causa de 47% de las suspensiones de tratamiento ocurrida en los primeros meses de terapia. Objetivo: Analizar la incidencia y causalidad de las reacciones adversas a medicamentos en pacientes que inician o cambian terapia anti-retroviral. Material y Métodos: Se realizó un seguimiento para la detección de reacciones adversas a medicamentos a 92 pacientes que iniciaron o cambiaron tratamiento anti-retroviral en un período comprendido entre mayo y julio del 2011. Resultados: 75% (n: 69) de los pacientes presentó al menos un evento adverso. De las 76 reacciones adversas a medicamentos detectadas, las más frecuentes fueron: diarrea (21,1%; n: 16) e hiperbilirrubinemia (19,7% n: 15). El 85,9% de las notificaciones se calificó según su gravedad; obtuvo una toxicidad grado 1 en 34,1%; 32,9% grado 2; 9,4% grado 3 y 3,5% grado 4. Sólo 22 pacientes (31,8%) requirieron un cambio de tratamiento, las causas más frecuentes de cambio fueron: anemia por AZT (45,4%; n: 10) y diarrea asociada al uso de LPV/r (27,3%; n: 6). Conclusión: El conocimiento de la real incidencia de estas reacciones adversas a medicamentos puede ayudar a los equipos tratantes para un adecuado control y manejo de éstos en el paciente, con el fin de evitar un cambio anticipado de TARV. Es fundamental conformar un equipo multidisciplinario que incluya al químico farmacéutico para una adecuada farmacovigilancia.

Impacto do treinamento resistido na força e hipertrofia muscular em HIV-soropositivos / Impact of resistance training on strength and muscle hypertrophy in HIV-seropositive

O presente estudo investigou o efeito de 24 semanas de treinamento resistido (TR) sobre a força e hipertrofia muscular de pacientes HIV-soropositivos. Participaram deste estudo 45 voluntários submetidos à terapia antirretroviral fortemente ativa (HAART), destes, 23 realizaram 3 sessões semanais, com 10 repetições a 80% 1RM. O teste de 1RM foi realizado de acordo com a metodologia proposta por Kraemer e Fry (1995), para estimativa da hipertrofia muscular adotou-se as equações de Frisancho (1984). Em comparação aos valores, o TR melhorou a força de 1RM nos exercícios de agachamento em 49% (21,0±4,9 vs. 31,2±5,1; P=0,001), supino reto em 13% (34,3±8,1 vs. 39,8±9,4; P=0,04), cadeira extensora em 34,1% (26,3±7,1 vs. 37,1±6,6; P=0,01), tríceps em 51% (22,9±4,0 vs. 38,3±4,9; P=0,001), pulley costas em 31,5% (31,7±3,9 vs. 41,7±4,4; P=0,01), cadeira flexora em 37,2% (18,9±3,4 vs. 27,3±3,2; P=0,01) e rosca bíceps em 60% (27,9±6,9 vs. 40,4±4,5; P=0,001). Não foram observadas diferenças (P<0,05) entre os valores basais e finais para o grupo controle. Observou-se aumento significativo (P<0,05) na área muscular do braço isenta de massa óssea, no grupo TR (52,8±14,5 cm²) em relação ao controle (39,5±12,4 cm²). Ademais, o TR resultou em significativa (P<0,05) redução da glicemia sanguínea de jejum (96,5±18,3 vs. 90,5±12,6), pressão arterial sistólica (126,3±14,3 vs. 120,0±10,0) e circunferência de cintura (83,0±12,5 vs. 80,6±10,2). Conclui-se que seis meses de TR resultaram em melhora na força e hipertrofia, ademais, o treinamento aplicado contribuiu para a regulação das variáveis metabólicas dos pacientes. Uma vez que a HAART é inevitável ao HIV-soropositivo, recomenda-se que o exercício físico seja realizado no intuito de dirimir os efeitos colaterais advindos desta terapia.

The aim of this study was to investigate the effect of 24 weeks of resistance training (RT) on the strength and muscle hypertrophy in patients with HIV-seropositive. Participated in the study 45 subjects undergoing highly active antiretroviral therapy (HAART). They were divided into two groups: control (n=22) and RT (n=23). The RT group realized three sessions, with 10 repetitions at 80% of 1MR. The MR tests were performed pre and post 24 weeks according to Kraemer and Fry (1995) and the equations proposed by Frisancho (1984) were adopted to estimate bone-free upper arm muscle area. Compared to baseline, the RT improved the strength of 1MR in the squat exercise at 49% (21.0±4.9 vs. 31.2±5.1; P=0.001), bench press by 13% (34.3±8.1 vs. 39.8±9.4, P=0.04), leg extension in 34.1% (26.3±7.1 vs. 37.1±6.6, P=0.01), triceps in 51% (22.9±4.0 vs. 38.3±4.9, P=0.001), pulley in 31.5% (31.7±3.9 vs. 41.7±4.4, P=0.01), leg curl in 37.2% (18.9±3.4 vs. 27.3±3.2, P=0.01) and biceps in 60% (27.9±6.9 vs. 40.4±4.5, P=0.001); there were no significant differences between baseline and final at control. The Bone-free upper arm muscle area at RT group (52.8±14.5 cm²) was significant increased (P<0.05) comparing to control (39.5±12.4 cm²). Moreover, the RT resulted in significant reduction (P<0.05) in fasting blood glucose (96.5±18.3 vs. 90.5±12.6, P<0.05), systolic blood pressure (126.3±14.3 mmHg vs. 120.0±10.0 mmHg) and waist circumference (83.0±12.5 cm vs. 80.6±10.2 cm). We conclude that six months of RT resulted in improvement in strength and hypertrophy; in addition, this training contributed to regulate the metabolic variables from these patients. Since the HAART is inevitable to HIV-seropositive, It's recommended that physical exercise be realized to minimize the side effects from this therapy.

Estudo da função auditiva em indivíduos com HIV/AIDS submetidos e não submetidos à terapia antirretroviral / Study of hearing functions in individuals with HIV/AIDS submitted and not submitted to antiretroviral therapies

OBJETIVO: Caracterizar as manifestações audiológicas em indivíduos com HIV/AIDS (Vírus da Imunodeficiência Humana/Síndrome da Imunodeficiência Adquirida) submetidos e não submetidos à terapia antirretroviral. MÉTODOS: A avaliação audiológica foi realizada em 28 indivíduos do Grupo Pesquisa I (GPI) com HIV/AIDS, submetidos à terapia antirretroviral; 24 indivíduos do Grupo Pesquisa II (GPII) com HIV/AIDS, não submetidos à terapia antirretroviral e 45 indivíduos saudáveis do Grupo Controle (GC). Os exames audiológicos que compuseram esta pesquisa foram: Audiometria Tonal Convencional, Logoaudiometria e Audiometria em Altas Frequências. RESULTADOS: Houve diferença nos grupos GPI e GPII, para os resultados obtidos tanto na avaliação audiológica convencional, como na avaliação em altas frequências, observando-se limiares auditivos mais elevados quando comparados aos indivíduos do GC, porém sem diferença significativa entre GPI e GPII. CONCLUSÃO: Indivíduos com HIV/AIDS apresentam mais alteração na Audiometria Tonal Convencional e na Audiometria em Altas Frequências quando comparados a indivíduos saudáveis (GC) sugerindo comprometimento do sistema auditivo, sendo observada maior ocorrência de perda auditiva na Audiometria em Altas Frequências quando comparada à Audiometria Tonal Convencional nos grupos GPI e GPII. Não houve diferença entre indivíduos com HIV/AIDS submetidos (GPI) e não submetidos (GPII) à terapia antirretroviral para a Audiometria Tonal Convencional e Audiometria em Altas Frequências.

PURPOSE: To characterize the audiologic manifestations in individuals with HIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome) submitted and not submitted to antiretroviral therapy. METHODS: The audiologic evaluation was carried out in 28 individuals in Research Group I (RGI) with HIV/AIDS submitted to antiretroviral therapy; 24 individuals in Research Group II (RGII) with HIV/AIDS not submitted to antiretroviral therapy, and 45 healthy individuals in the Control Group (CG). The audiologic tests that comprised this study were: Conventional Pure Tone Audiometry, Speech Audiometry and High Frequency Audiometry. RESULTS: There were differences between groups RGI and RGII regarding conventional audiologic evaluation and high frequency audiometry. There were higher thresholds for both Conventional and High Frequency Audiometries when compared with CG subjects, however without significant difference among RGI and RGII. CONCLUSION: Individuals with HIV/AIDS present more abnormal results in Conventional Pure Tone Audiometry and High Frequency Audiometry than healthy individuals (CG), which indicates impairment in the hearing system. Individuals with HIV/AIDS present more abnormal findings in High Frequency Audiometry when compared to Conventional Pure Tone Audiometry. There was no difference between individuals with HIV/AIDS submitted (RGI) and not submitted (RGII) to antiretroviral therapy regarding Conventional Pure Tone Audiometry and High Frequency Audiometry.

Inadequate food intake among adults living with HIV / Inadequacao do consumo alimentar em adultos vivendo com HIV

CONTEXT AND OBJECTIVE The number of people living with HIV (PLHIV) in Brazil is between 600,000 and 890,000. Assessing the diet is important in planning healthcare actions and improving PLHIV's quality of life. This study aimed to estimate the prevalence of inappropriate protein, total fat, saturated fat, carbohydrate, fiber, sodium, calcium and cholesterol intake among PVHIV on highly-active antiretroviral therapy (HAART). DESIGN AND SETTING Cross-sectional study in nine Specialized STD/AIDS Healthcare Centers in São Paulo. METHODS Men and women aged 20 to 59 years, on HAART for at least three months, were included. Nutrient intake was assessed using 24-hour food recall applied in person and repeated among 30% of the population by telephone. The between and within-person variances were corrected. RESULTS 507 individuals were evaluated: 58% male, mean age 41.7 years (standard deviation, SD = 7.8). The mean time since HIV diagnosis was 6.6 years (SD = 4.1), and since HAART onset, 5.1 years (SD = 3.3). More than 20% of the population presented intake above the recommendations for saturated fat, cholesterol and/or sodium, and below the recommendations for fiber. The recommended maximum tolerable sodium level was exceeded by 99% of the sample, and 86% of men and 94% of women did not reach the daily recommendations for calcium. Protein, carbohydrate and total fat intakes were adequate for the majority of the population. CONCLUSIONS A significant portion of the population presented inappropriate intake of saturated fat, sodium, fiber and calcium. Interventions aimed at improving PLHIV's dietary quality are needed. .

CONTEXTO E OBJETIVO O número de pessoas vivendo com HIV (PVH) no Brasil oscila entre 600.000 e 890.000. A avaliação de dietas é relevante para o planejamento de ações de saúde e melhoria da qualidade de vida desses indivíduos. Este estudo visa estimar a prevalência de inadequação do consumo de proteínas, lipídios totais, lipídios saturados, carboidratos, fibras, sódio, cálcio e colesterol em PVH em terapia antirretroviral de alta atividade (TARV). TIPO DE ESTUDO E LOCAL Estudo transversal em nove Centros de Assistência Especializados em DST/Aids localizados em São Paulo. MÉTODOS Homens e mulheres com idade entre 20 e 59 anos, em TARV por no mínimo 3 meses, foram incluídos. O consumo de nutrientes foi avaliado com um recordatório alimentar de 24 horas aplicado pes-soalmente e repetido em 30% da população por telefone. A variabilidade intra e interpessoal foi corrigida. RESULTADOS Foram avaliados 507 indivíduos, 58% homens e idade média de 41,7 anos (desvio padrão, DP = 7,8). O tempo médio de infecção por HIV foi de 6,6 anos (DP = 4,1), e de TARV, de 5,1 anos (DP = 3,3). Mais que 20% da população apresentou consumo acima das recomendações para lipídios saturados, colesterol e/ou sódio, e abaixo para fibras. Excederam a recomendação máxima tolerada para sódio 99% da amostra, enquanto 86% dos homens e 94% das mulheres não atingiram as recomendações diárias para o cálcio. O consumo de proteínas, carboidratos e lipídios totais mostrou-se adequado para a maioria da população. CONCLUSÕES Uma importante parcela da população apresentou consumo inadequado para lipídios saturados, sódio, fibras ...

Body changes: antiretroviral therapy and lipodystrophy syndrome in people living with HIV/aids / Alterações corporais: terapia antirretroviral e síndrome da lipodistrofia em pessoas vivendo com HIV/AIDS / Alteraciones corporales: terapia antirretroviral y síndrome de la lipodistrofia en personas que viven con VIH/SIDA

OBJECTIVE: to identify the different types of morphological alterations from lipodystrophy syndrome (LS) in outpatients and relate them to the therapeutic regimen used. METHOD: a cross-sectional study which recruited 60 patients with HIV and LS and 79 without LS, who consented to interview and data collection from their medical notes. RESULTS: the region most affected by lipoatrophy was the face; by lipohypertrophy, the abdomen, and by the mixed form, the alterations to the abdomen, face, and upper and lower limbs. CONCLUSION: among the therapeutic regimens, that comprised of zidovudine, lamivudine and efavirenz seemed to protect against LS. Nursing can act in the early identification of the changes, as well as providing guidance and support for patients affected by the changes in their body image.

OBJETIVO: identificar os diferentes tipos de alterações morfológicas da síndrome da lipodistrofia (SL) em pacientes dos atendimentos ambulatoriais e relacioná-las ao esquema terapêutico utilizado. MÉTODO: estudo transversal, para o qual foram recrutados 60 pacientes com HIV e SL e 79 sem a SL, que consentiram entrevista e coleta de dados em prontuário. RESULTADOS: a região mais acometida pela lipoatrofia foi a face; pela lipo-hipertrofia o abdome e pela forma mista as alterações em abdome, face, membros superiores e inferiores. CONCLUSÃO: dentre os esquemas terapêuticos, o composto pela zidovudina, lamivudina e efavirenz pareceu proteger contra a SL. A enfermagem pode atuar na identificação precoce das alterações, além de fornecer orientações e apoio aos pacientes acometidos pelas mudanças na imagem corporal.

OBJETIVO: identificar los diferentes tipos de alteraciones morfológicas del Síndrome de la lipodistrofia (SL) en pacientes de los servicios de ambulatorio y relacionarlas al esquema terapéutico utilizado. MÉTODO: estudio transversal en lo que fueron reclutados 60 pacientes con VIH y la SL y 79 sin la SL, que consintieron entrevista y recogida de datos en prontuario. RESULTADOS: la región más acometida por la lipoatrofia fue la cara; por la lipohipertrofia el Abdomen y por la forma mixta las alteraciones en Abdomen, cara, miembros superiores e inferiores. CONCLUSIÓN: entre los esquemas terapéuticos, el compuesto por la zidovudina, lamivudina y efavirenz pareció proteger contra la SL. La enfermería puede actuar en la identificación precoz de las alteraciones, además de suministrar orientaciones y apoyo a los pacientes acometidos por los cambios en la imagen corporal.

Percepção dos usuários sobre acolhimento na adesão à terapia antirretroviral de alta atividade / Perception of users on host adherence in high activity antiretroviral therapy

O sucesso da terapia antirretroviral depende da manutenção de altas taxas de adesão ao tratamento. O presente artigo tem por objetivo avaliar a percepção dos usuários da terapia antirretroviral de alta atividade com relação ao acolhimento propiciado pelos profissionais de saúde, procurando verificar as dificuldades na adesão entre pacientes com histórico de abandono da mesma. A metodologia utilizada é o estudo qualitativo em uma amostra aleatória de treze indivíduos. Os dados foram analisados a partir dos discursos coletados por meio de entrevistas, utilizando-se a análise de conteúdo. Os resultados indicam que os fatores contribuintes para a interrupção do tratamento foram: a ausência de estrutura para o atendimento em saúde, voltada para a adesão e o acolhimento dos pacientes, deficiências de apoio social aos pacientes e familiares, atitudes de preconceito relacionadas à doença, intolerância gastrointestinal e condições socioeconômicas. A conclusão a que se chega é a de que a organização da assistência e o atendimento acolhedor podem contribuir para a melhoria da adesão ao tratamento de pessoas vivendo com Aids.

The success of antiretroviral therapy depends on maintaining high rates of adherence to treatment. This article aims to assess the perception of users in high activity antiretroviral therapy in relation to the partnership afforded by health professionals, seeking to ascertain the difficulties in adherence among patients with a history of abandoning it. The methodology used is the qualitative study on a random sample of thirteen individuals. Data were analyzed from the discourse collected through interviews, using content analysis. The results indicate that the factors contributing to discontinuing treatment were the lack of healthcare infrastructure focused on adherence and care for patients, deficiencies in social support to patients and family members, prejudiced attitudes toward the disease, gastrointestinal intolerance, and socioeconomic conditions. The conclusion obtained is that the organization of care and service in partnership with the patient can help improve adherence to treatment for people living with AIDS.