Instruments to assess adherence to medication in people living with HIV: a scoping review / Instrumentos para avaliar a adesão medicamentosa em pessoas vivendo com HIV: uma revisão de escopo

ABSTRACT OBJECTIVE To compile the instruments validated in Brazil for assessing adherence of people living with HIV to antiretroviral therapy. METHODS Scoping review using the Web of Science, Scopus, Medline (via PubMed), Embase, BDENF, CINAHL and Lilacs databases. In addition, the Preprints bioRxiv, Google Scholar and OpenGrey servers were checked. There was no language restriction for the search, and it considered articles published from the year 1996 onwards. RESULTS Three publications were included in the qualitative synthesis. Following were the instruments identified "Questionário para Avaliação da Adesão ao Tratamento Antirretroviral" (Questionnaire for Assessment of Adherence to Antiretroviral Treatment) developed in Porto Alegre (RS) and published in 2007; the "Escala de autoeficácia para adesão ao tratamento antirretroviral em crianças e adolescentes com HIV/Aids" (Self-efficacy Scale for Adherence to Antiretroviral Treatment in Children and Adolescents with HIV/Aids) developed in São Paulo (SP) and published in 2008; and the "WebAd-Q, um instrumento de autorrelato para monitorar a adesão à terapia antirretroviral em serviços de HIV/Aids no Brasil" (WebAd-Q, a self-report instrument to monitor adherence to antiretroviral therapy in HIV/Aids services in Brazil) developed in São Bernardo do Campo (SP) and published in 2018. The instruments were validated in Brazil, and presented statistically acceptable values for psychometric qualities. CONCLUSION The instruments to assess adherence of people living with HIV to antiretroviral therapy are validated strategies for the Brazilian context. However, their (re)use in different settings and contexts of the nation should be expanded. The use of these instruments by health professionals can improve the understanding of factors that act negatively and positively on antiretroviral therapy adherence, and the proposition of strategies intended to consolidate good adherence and intervene in the treatment of people with low therapeutic engagement.

RESUMO OBJETIVO Compilar os instrumentos validados no Brasil para avaliação da adesão de pessoas vivendo com HIV à terapia antirretroviral. MÉTODOS Revisão de escopo, utilizando as bases de dados Web of Science, Scopus, Medline (via PubMed), Embase, BDENF, CINAHL e Lilacs. Em complementação, os servidores Preprints bioRxiv, Google Scholar e OpenGrey foram verificados. Para a busca, não houve restrição de idioma e considerou artigos publicados a partir do ano de 1996. RESULTADOS Três publicações foram incluídas na síntese qualitativa. Os instrumentos identificados foram o "Questionário para Avaliação da Adesão ao Tratamento Antirretroviral", desenvolvido em Porto Alegre (RS) e publicado em 2007; a "Escala de autoeficácia para adesão ao tratamento antirretroviral em crianças e adolescentes com HIV/Aids", desenvolvida em São Paulo (SP) e publicada em 2008; e o "WebAd-Q, um instrumento de autorrelato para monitorar a adesão à terapia antirretroviral em serviços de HIV/Aids no Brasil", desenvolvido em São Bernardo do Campo (SP) e publicado em 2018. Os instrumentos foram validados no Brasil e apresentaram valores estatisticamente aceitáveis para as qualidades psicométricas. CONCLUSÃO Os instrumentos para avaliar a adesão de pessoas vivendo com HIV à terapia antirretroviral são estratégias validadas para o contexto do Brasil. Todavia há que se expandir a (re)utilização em diferentes cenários e contextos da nação. A utilização desses instrumentos por profissionais da saúde pode melhorar a compreensão dos fatores que atuam negativa e positivamente na adesão à terapia antirretroviral, e a proposição de estratégias com o objetivo de consolidar a boa adesão e intervir no tratamento das pessoas com baixo engajamento terapêutico.

HIV knowledge and its correlation with the Undetectable = Untransmittable slogan in Brazil

ABSTRACT Knowledge about HIV transmission and prevention is a necessary step for adopting preventive behaviors. We assessed HIV knowledge and its correlation with the perceived accuracy of the "Undetectable = Untransmittable" (U=U) slogan in an online sample with 401 adult Brazilians. Overall, 28% of participants showed high HIV knowledge level. The perceived accuracy of the U=U slogan significantly correlated with HIV knowledge. Younger participants, those reporting lower income or lower education, or who had never tested for HIV showed poorer HIV knowledge. Filling gaps of knowledge among specific populations is urgent in order to increase preventive behaviors and decrease HIV stigma.

Management in the care of people with HIV in primary health care in times of the new coronavirus / Gestão no cuidado às pessoas com HIV na Atenção Primária à Saúde em tempos do novo coronavírus

ABSTRACT OBJECTIVE To understand management practices in the care of people living with the human immunodeficiency virus (HIV) in primary health care in a Brazilian capital, in times of the new coronavirus (covid-19) pandemic. METHOD Qualitative research, anchored in the methodological-analytical framework of the grounded theory, constructivist aspect. Data were collected by using intensive online interviews with nurses from health centers and managers of the municipal health department. Data collection and analysis occurred concomitantly in two phases of analysis: initial and focused coding. RESULTS They point to the development of best care practices, with emphasis on initiatives for coordination of care, decentralization of clinical management for primary health care services, establishment of protocols and flows, agreement of intersectoral partnerships, use of groups and social networks, use of tools such as teleconsultation and health surveillance spreadsheet and formation of support networks. CONCLUSION The Brazilian capital restructured its network of health services with the implementation of clinical and management protocols, seeking to maintain care for people living with HIV. We highlighted the incorporation of non-face-to-face care technologies and the facilitation of routines, as strategies for expanding access.

RESUMO OBJETIVO Compreender as práticas de gestão no cuidado às pessoas que vivem com o vírus da imunodeficiência humana (HIV) na Atenção Primária à Saúde de uma capital brasileira, em tempos de pandemia do novo coronavírus (covid-19). MÉTODO Trata-se de uma pesquisa qualitativa, ancorada no referencial metodológico-analítico da teoria fundamentada nos dados, vertente construtivista. Os dados foram coletados por entrevistas intensivas online, com enfermeiros de centros de saúde e gestores da secretaria municipal. A coleta e análise dos dados ocorreram de maneira concomitante, em duas fases de análise: a codificação inicial e focalizada. RESULTADOS Apontam para o desenvolvimento das melhores práticas de cuidado, com destaque para iniciativas de coordenação do cuidado, descentralização do manejo clínico para os serviços de APS, instituição de protocolos e fluxos, pactuação de parcerias intersetoriais, utilização de grupos e redes sociais, uso de ferramentas como a teleconsulta e planilha de vigilância em saúde e formação de redes de apoio. CONCLUSÃO A capital brasileira reestruturou sua rede de serviços de saúde com a implementação de protocolos clínicos e gerenciais, buscando manter a continuidade do cuidado às pessoas que vivem com o HIV. Destacou-se a incorporação de tecnologias de cuidado não presencial e a facilitação de rotinas, como estratégias para ampliação do acesso.

Risco de Câncer em Pacientes que Vivem com HIV/Aids: Revisão Sistemática / Cancer Risk in Patients Living with HIV/AIDS: Systematic Review / Riesgo de Cáncer en Pacientes que Viven con VIH/Sida: Revisión Sistemática

Introdução: O câncer acometerá cerca de 50% dos indivíduos com infecção pelo vírus da imunodeficiência adquirida (HIV), com importante carga daqueles do tipo não definidores da síndrome da imunodeficiência adquirida (aids). Objetivo: Analisar diferentes fatores de risco para câncer do tipo não definidor na população HIV positiva, por meio da seleção de estudos de coorte realizados em diferentes Regiões do mundo. Método: Trata-se de uma revisão de literatura realizada no período de março a abril de 2019, utilizando os descritores Cancer Risck, HIV e non-AIDS-defining Cancer. Resultados: Os cânceres não definidores, que representam maior incidência entre a população HIV positiva, são o de pulmão, colorretal, cervical, de vagina e útero, gástrico, linfoma de Hodgkin e de fígado. Conclusão: Os estudos demonstram risco aumentado para diversos tipos de câncer não definidores da aids, o que nos leva a um novo paradigma, voltado não somente para o controle do HIV, mas também para a detecção precoce e tratamento oportuno, a fim de minimizar as morbidades e aumentar a expectativa de vida desses indivíduos.

Introduction: Cancer will affect about 50% of HIV (human immunodeficiency virus) infected individuals with a significant burden of non-AIDS-defining cancers (acquired immunodeficiency syndrome). Objective: To analyse different risk factors for the non-defining type in the HIV positive population through selection of cohort studies conducted in several regions of the world. Method: Literature review conducted from March to April 2019 using the descriptors Cancer Risk, HIV and non-AIDS-defining Cancer. Results: Non-defining cancers representing the greatest incidence among HIV-positive population are lung, colorectal, cervical, vaginal and uterine, gastric, Hodgkin's lymphoma, and liver. Conclusion: Studies demonstrate that there are increased risks for several types of non-AIDS defining cancers, leading to a new paradigm, not only for HIV control but for early detection and timely treatment, in order to minimize the morbidities and increase life expectancy of these individuals.

Introducción: El cáncer afectará aproximadamente al 50% de las personas con infección por virus de inmunodeficiencia adquirida (VIH) con una carga significativa de cánceres que no definen el síndrome de inmunodeficiencia adquirida (sida). Objetivo: Analizar diferentes factores de riesgo para el cáncer no definitorio en la población VIH positivo en estudios de cohortes realizados en diferentes regiones del mundo. Método: Esta es una revisión de la literatura realizada de marzo a abril de 2019 utilizando los descriptores Cancer Risk, HIV non-AIDS-defining Cancer. Resultados: Los cánceres no definitorios que representan el mayor riesgo e incidencia entre la población VIH positivo son de pulmón, colorrectal, cervical, vaginal y uterino, gástrico, linfoma de Hodgkin y de hígado. Conclusión: Los estudios muestran riesgos para varios tipos de cáncer que no definen el sida, lo que nos lleva a un nuevo paradigma, que se centra no solo en el control del VIH sino también en la detección temprana y el tratamiento oportuno.

Confirmatory process and follow-up of 1 case with long-term HIV infection in Shandong / 中华预防医学杂志

Objective@#To describe the confirmation process and long-term follow-up results of 1 case of HIV with long term progression.@*Methods@#The subject was a HIV infected man aged 27 years old. The first HIV antibody positive was detected by ELISA in August 7th, 2013. Close contacts were identified as 3 homosexual partners who had been contacted before infection and the first sexual partner had been unable to get in touch. Adopting the first epidemiological survey questionnaire of AIDS comprehensive prevention and control information system in China, the investigators conducted face-to-face surveys on the general demographic characteristics and behavioral characteristics of the subject. After the first ELISA test result was positive, 4 rapid detections of colloid selenium, ELISA, western-blot, CD4+T and viral load test were followed up (August 14th, 21st, 30th and September 16th, 2013). Long term follow-up was performed to detect CD4+T and viral load to observe the progress of the case after the diagnosis of infection.@*Results@#The duration of sexual behavior was from 2011 to 2012 between the subject and his 1st sexual partner. During the study, repeated HIV antibody ELISA test results were negative. Sexual behavior maintained from January to April 2013 between the subject and his 2nd partner and the last one unprotected homosexual acts took place in April 2013. After the traceability survey, the 2nd sexual partner was an AIDS patient who had antiretroviral therapy in the anti HIV treatment module of AIDS comprehensive prevention information system. The subject and his 3rd partner maintained their sexual behavior from May to October 2013. The two ELISA tests of the 3rd partner were negative. Because of the need for hospital operation in August 7, 2013, the subject was tested for HIV antibody by ELISA and the result was positive while western blot test showed that the HIV-1 antibody was not confirmed (band type was gp160/gp120/p24). In the subsequent follow-up, 4 rapid detections of colloid selenium, ELISA and western-blot were conducted and all the results were positive (western-blot band type was gp160/gp120/gp41/p24/p17). Results of continuous follow-up for 5 years showed that the first four CD4+T cell counts were as follows: 520, 616, 834, 879. The following 22 CD4+T counts sustained at a high level and the median was 895 cells/μl. A total of 5 follow-up visits were conducted to detect viral load exceeding 1 000 copies/ml and the remaining 19 test results were lower than 1 000 copies/ml except that no viral load was detected in 2 follow-up visits. The result of homology analysis showed that the HIV types of the case and its 2nd sexual partner were all HIV-1 CRF_01AE. The similarity of gag region gene was 97.5%. So we inferred that the 2nd sexual partner was its source of infection, and the case was infected at the end of April 2013 with the last unprotected homosexual behavior.@*Conclusion@#The infected person was found to be an early HIV infection. Continuous follow-up test results indicated that the case belonged to a HIV long-term nonprogressor.

Hospitalization of people 50 years old or older living with HIV/AIDS / Hospitalización de personas de 50 o más años viviendo con VIH/SIDA / Hospitalização de pessoas com 50 anos ou mais vivendo com HIV/Aids

ABSTRACT Objective: Identify the rate and predictive factors of the hospitalization of people living with HIV/AIDS (PLHA), aged 50 years or older. Method: A quantitative, cross-sectional study was conducted at two inpatient units specialized in infectious diseases in a teaching hospital. Data were gathered through individual interviews between August 2011 and February 2015. All ethical precepts were followed. Results: Of the 532 admitted patients, 95 were PLHA 50 years old or older; 30.5% were admitted 3 to 4 times after being diagnosed with HIV/AIDS. Conclusion: Rate of hospitalization was 17.8%, and being 50 to 60 years old was a protective factor against hospitalization.

RESUMEN Objetivo: Identificar la tasa y los factores predictivos para hospitalización de personas viviendo con VIH/SIDA (PVHS), de edad igual o superior a 50 años. Método: Estudio cuantitativo, transversal, realizado en dos unidades de internación especializadas en cuidado de enfermedades infecciosas de un hospital universitario. Datos recolectados mediante entrevista individual, de agosto de 2011 a febrero de 2015. Fueron contemplados todos los preceptos éticos. Resultados: De las 532 internaciones, 95 correspondían a PVVS con edad igual o superior a 50 años; 56,8% recibieron el diagnóstico de VIH/SIDA antes de llegar a sus 50 años; 30,5% fueron hospitalizadas de 3 a 4 veces después del diagnóstico de infección por VIH/SIDA. Conclusión: La tasa de hospitalización fue del 17,8%, y la faja etaria de 50 a 60 años constituyó factor de protección para la hospitalización.

RESUMO Objetivo: Identificar a taxa e os fatores preditores para a hospitalização de pessoas vivendo com HIV/Aids (PVHA), com idade igual ou superior a 50 anos. Método: Estudo quantitativo, transversal, realizado em duas unidades de internação especializadas em cuidados às doenças infecciosas, de um hospital universitário. A coleta de dados foi realizada por meio de entrevista individual, no período de agosto de 2011 a fevereiro de 2015. Todos os preceitos éticos foram contemplados. Resultados: Das 532 internações, 95 eram de PVHA com idade igual ou superior a 50 anos; 56,8% receberam o diagnóstico de HIV/Aids antes de terem completado 50 anos de idade; 30,5% foram hospitalizadas de 3 a 4 vezes após o diagnóstico da infecção pelo HIV/Aids. Conclusão: A taxa de hospitalização foi de 17,8%, e a faixa etária de 50 a 60 anos foi fator de proteção para a hospitalização.

Survival analysis of HIV/AIDS patients receiving antiretroviral therapy in Hangzhou from 2004 to 2014 / 中华临床感染病杂志

Objective To analyze the survival rate of HIV /AIDS patients receiving highly active antiretroviral therapy(HAART)since the implementation of the national Four Free and One Carepolicy against HIV in Hangzhou.Methods Clinical data of 2370 AIDS patients were collected from National AIDS Comprehensive Treatment Information System Treatment Library from 2004 to 2014.The data, including basic information,viral load,CD4 +T lymphocyte counts,starting time of treatment,WHO clinical stage,infection pathways and follow-up were respectively analyzed.Kaplan-Meier and Cox proportional hazards models were used to analyze the survival rate and the factors affecting survival.Results The total follow-up time was 3968.14 person years and 57 patients died in 2370 patients with a mortality rate of 1 .44 /100 person years (57 /3968.14).Kaplan-Meier method showed that the cumulative survival rates of the first,third and fifth year were 98.08%,96.20% and 95.24%,respectively.The overall mortality rate fell from 6.06 /100 person years in 2006 to 1 .44 /100 person years in 2014.The mortality rate of AIDS-related disease declined from 1 .10 /100 person years in 2009 to 0.90 /100 person years in 2014.Multivariate Cox regression analysis showed that the risk of death for patients with CD4 +T 200-349 cells/μL was 0.466 times(95%CI 0.246-0.882)as that for patients with CD4 +T cells <200 /μL.The risk of death was 3.408 times(95%CI 1 .365-8.506)in patients aged≥ 50 years,3.788 times(95%CI 1 .645-8.718)in patients aged 40 to <50 years,and 2.593 times(95%CI 1 .139-5.905)in patients aged 30 to 40 years as that in patients aged <30 years.The mortality risk for patients with baseline WHO stage Ⅲ and Ⅳ was 1 .960 times as patients with WHO stage Ⅰ and Ⅱ (95% CI 1 .117-3.439 ).Conclusions Patients with increased age,low CD4 +T counts and baseline WHO stage Ⅲ or Ⅳ are main risk factors affecting survival rate of HIV /AIDS patients,early antiviral therapy is the key for improving the survival rate of patients.

Quality of life, socioeconomic and clinical factors, and physical exercise in persons living with HIV/AIDS / Qualidade de vida, fatores socioeconômicos e clínicos e prática de exercício físico em pessoas vivendo com HIV/aids

ABSTRACT OBJECTIVE To analyze whether socioeconomic and clinical aspects and the aspects of healthy life habits are associated with the quality of life of persons living with HIV/AIDS. METHODS This is a cross-sectional exploratory quantitative research, with 227 persons living with HIV/AIDS, treated at two hospitals of reference between April 2012 and June 2014. We used structured questionnaires to assess socioeconomic aspects (gender, age, education level, marital status, race, socioeconomic status, dependents on family income, employment relationship), clinical parameters (time of disease diagnosis, use and time of medication, CD4 T-cell count, and viral load), and practice of physical exercise. To assess quality of life, we used the Quality of Life questionnaire (HAT-QoL). For characterization of the socioeconomic and clinical data and domains of quality of life, we conducted a descriptive analysis (simple frequency, averages, and standard deviations). We applied linear regression, following a hierarchical model for each domain of quality of life. RESULTS The domains that presented lower averages for quality of life were financial concern, concern with confidentiality, general function, and satisfaction with life. We found associations with the variables of socioeconomic status and physical exercise, therapy, and physical exercise for the last two domains, consecutively. CONCLUSIONS The quality of life of persons living with HIV/AIDS shows losses, especially in the financial and confidentiality areas, followed by general function of the body and satisfaction with life, in which socioeconomic and clinical aspects and healthy living habits, such as the practice of physical exercise, are determining factors for this reality.

RESUMO OBJETIVO Analisar se aspectos socioeconômicos, clínicos e de hábitos de vida saudável estão associados à qualidade de vida em pessoas vivendo com HIV/aids. MÉTODOS Pesquisa quantitativa exploratória de corte transversal, com 227 pessoas vivendo com HIV/aids, atendidos em dois hospitais de referência entre os períodos de abril 2012 a junho de 2014. Foram utilizados questionários estruturados para avaliar aspectos socioeconômicos (sexo, idade, escolaridade, estado civil, cor de pele, status socioeconômico, dependentes da renda familiar, vínculo empregatício), parâmetros clínicos (tempo de diagnóstico da doença, uso e tempo de medicação, contagem de células TCD4 e carga viral) e prática de exercício físico. Para avaliar qualidade de vida, utilizou-se o questionário Quality of Life (HAT-QoL). Para caracterização dos dados socioeconômicos, clínicos e domínios da qualidade de vida, conduzimos análise descritiva (frequência simples, médias e desvios-padrão). Aplicamos regressão linear, seguindo um modelo hierárquico para cada domínio da qualidade de vida. RESULTADOS Os domínios que apresentaram menores médias para a qualidade de vida foram preocupação financeira, preocupação com sigilo, função geral e satisfação com a vida. Foram encontradas associações com as variáveis status socioeconômico e exercício físico; terapia; e exercício físico para os dois últimos domínios, consecutivamente. CONCLUSÕES A qualidade de vida de pessoas vivendo com HIV/aids apresentam prejuízos, principalmente nas questões financeiras e de sigilo, seguidos da função geral do corpo e satisfações com a vida, em que os aspectos socioeconômicos, clínicos e hábitos de vida saudável, como a prática de exercício físico, são fatores determinantes para essa realidade.

Loss to follow-up in a cohort of HIV-negative men who have sex with men: Project Horizonte

ABSTRACT OBJECTIVE The objective of this study is to estimate the attrition rates and evaluate factors associated with loss to follow-up between 1994 and 2011 in an open cohort of HIV-negative men who have sex with men. METHODS The Project Horizonte is an open cohort study that aimed to assess the incidence of HIV infection, evaluate the impact of educational interventions, and identify potential volunteers for HIV vaccine trials. The rates of losses to follow-up were estimated for three periods (1994-1999, 2000-2005, and 2006-2011). The variables analyzed were collected in a psychosocial questionnaire. Volunteers who dropped out were compared with the ones who remained in the study using a Cox regression model. RESULTS A total of 1,197 volunteers were recruited. The median follow-up time in the study (n = 626) was 4.2 years. The median follow-up time for the volunteers who dropped out of the study (n = 571) was 1.46 years. The overall rate of loss to follow-up was 11.6/100 person-years. Attrition rates by period were: 12.60 (1994-1999), 11.80 (2000-2005), and 9.00 (2006-2011) per 100 person-years. Factors associated with losses to follow-up were: age group of 21-30 years old, monthly per capita income of more than six or less than one Brazilian minimum wage, having more than two dependents, report of bisexual practice, and inconsistent use of condoms for receptive anal sex. CONCLUSIONS A slight decrease of the loss to follow-up was observed over time. Higher attrition rates happened in the first three years of follow-up. It is possible that the link of the volunteers were not yet well established. Those who reported inconsistent condom use in receptive anal sex were more likely to leave the study, suggesting an underestimation of the incidence of HIV infection in a cohort population. For greater effectiveness, retention strategies must be reassessed considering the connection between the characteristics of homosexual and bisexual behavior and the motivations to engage in health research.

Psychological model of ART adherence behaviors in persons living with HIV/AIDS in Mexico: a structural equation analysis

ABSTRACT OBJECTIVE The objective of this study has been to test the ability of variables of a psychological model to predict antiretroviral therapy medication adherence behavior. METHODS We have conducted a cross-sectional study among 172 persons living with HIV/AIDS (PLWHA), who completed four self-administered assessments: 1) the Psychological Variables and Adherence Behaviors Questionnaire, 2) the Stress-Related Situation Scale to assess the variable of Personality, 3) The Zung Depression Scale, and 4) the Duke-UNC Functional Social Support Questionnaire. Structural equation modeling was used to construct a model to predict medication adherence behaviors. RESULTS Out of all the participants, 141 (82%) have been considered 100% adherent to antiretroviral therapy. Structural equation modeling has confirmed the direct effect that personality (decision-making and tolerance of frustration) has on motives to behave, or act accordingly, which was in turn directly related to medication adherence behaviors. In addition, these behaviors have had a direct and significant effect on viral load, as well as an indirect effect on CD4 cell count. The final model demonstrates the congruence between theory and data (x2/df. = 1.480, goodness of fit index = 0.97, adjusted goodness of fit index = 0.94, comparative fit index = 0.98, root mean square error of approximation = 0.05), accounting for 55.7% of the variance. CONCLUSIONS The results of this study support our theoretical model as a conceptual framework for the prediction of medication adherence behaviors in persons living with HIV/AIDS. Implications for designing, implementing, and evaluating intervention programs based on the model are to be discussed.

Dentistry and HIV/AIDS related stigma / La odontología y el estigma asociado al VIH

OBJECTIVE To analyze HIV/AIDS positive individual's perception and attitudes regarding dental services.METHODS One hundred and thirty-four subjects (30.0% of women and 70.0% of men) from Nuevo León, Mexico, took part in the study (2014). They filled out structured, analytical, self-administered, anonymous questionnaires. Besides the sociodemographic variables, the perception regarding public and private dental services and related professionals was evaluated, as well as the perceived stigma associated with HIV/AIDS, through a Likert-type scale. The statistical evaluation included a factorial and a non-hierarchical cluster analysis.RESULTS Social inequalities were found regarding the search for public and private dental professionals and services. Most subjects reported omitting their HIV serodiagnosis and agreed that dentists must be trained and qualified to treat patients with HIV/AIDS. The factorial analysis revealed two elements: experiences of stigma and discrimination in dental appointments and feelings of concern regarding the attitudes of professionals or their teams concerning patients' HIV serodiagnosis. The cluster analysis identified three groups: users who have not experienced stigma or discrimination (85.0%); the ones who have not had those experiences, but feel somewhat concerned (12.7%); and the ones who underwent stigma and discrimination and feel concerned (2.3%).CONCLUSIONS We observed a low percentage of stigma and discrimination in dental appointments; however, most HIV/AIDS patients do not reveal their serodiagnosis to dentists out of fear of being rejected. Such fact implies a workplace hazard to dental professionals, but especially to the very own health of HIV/AIDS patients, as dentists will not be able to provide them a proper clinical and pharmaceutical treatment.

OBJETIVO Analizar la percepción y las actitudes de las personas que viven con VIH/sida hacia los servicios odontológicos.MÉTODOS Participaron 134 voluntarios (30.0% mujeres y 70.0% hombres) de Nuevo León, México (2014), que contestaron un cuestionario estructurado de tipo analítico, auto-administrado y anónimo. Además de las variables sociodemográficas, fueron analizadas la percepción sobre los servicios y los prestadores de servicios odontológicos públicos y privados; igualmente se exploró mediante escala tipo Likert la percepción del estigma asociado al VIH/sida. El análisis estadístico incluyó análisis factorial y declustersno jerárquico.RESULTADOS Se presentaron desigualdades sociales en la búsqueda de atención de prestadores y servicios odontológicos públicos y privados. La mayoría ocultó su serodiagnóstico y concordó en que el odontólogo debe capacitarse en la atención del VIH. El análisis factorial reveló dos factores: experiencias de estigma y discriminación en la consulta odontológica y sentimientos de preocupación por la actitud del odontólogo o su personal hacia el serodiagnóstico del paciente. El análisis de clustersidentificó tres grupos: usuarios que no han experimentado estigma ni discriminación (85.0%); los que no han experimentado estigma ni discriminación, pero sienten una ligera preocupación (12.7%); y finalmente, los que han experimentado estigma y discriminación, y sienten preocupación (2.3%).CONCLUSIONES Se presentó un bajo porcentaje de estigma y discriminación en la consulta odontológica; sin embargo, la mayoría de las personas que viven con VIH/sida no revelan al odontólogo su serodiagnóstico por temor al rechazo. Estos hechos plantean un riesgo laboral para el odontólogo, pero especialmente para la propia salud de las personas que viven con VIH/sida, dado que el odontólogo no podrá proporcionar un tratamiento clínico y farmacológico adecuado.

Terapia nutricional nas alterações metabólicas em pessoas vivendo com HIV/aids / Nutritional therapy in metabolic changes in individuals with HIV/AIDS

OBJETIVO: Analisar o efeito do tratamento nutricional sobre as alterações metabólicas provocadas pelo uso da terapia antirretroviral em adultos vivendo com HIV/aids. MÉTODOS: Revisão sistemática de literatura no PubMed, Lilacs e Cochrane, entre 1996 e 2010, do tipo ensaio clínico, controlado, randomizado, crossover, adultos, vivendo com HIV/aids em uso de terapia antirretroviral e sem doenças oportunistas. A intervenção de interesse foi suplementação nutricional via oral e/ou mudança de estilo de vida por tratamento dietoterápico específico: dislipidemia, resistência insulínica, lipodistrofia e hipertensão arterial sistêmica. A escala de Jadad foi utilizada para classificação qualitativa dos artigos. RESULTADOS: Foram localizados 385 artigos e sete foram incluídos. As intervenções utilizadas nesses estudos foram: dieta, dieta mais exercício físico, dieta mais suplemento e somente suplementos. Dislipidemia foi desfecho avaliado em todos os estudos. Os estudos que avaliaram suplementação com ômega 3 encontraram redução significativa dos triglicérides. Dieta específica mais suplementação de ômega 3 mostrou aumento de HDL-colesterol. Suplementação com nicotinato de cromo não teve efeito sobre a dislipidemia. Modificação de estilo de vida, incluindo dieta e atividade física, reduziu significativamente a circunferência da cintura, lipodistrofia e pressão arterial sistólica. CONCLUSÕES: A redução de triglicérides pela suplementação com ômega 3 foi a intervenção nutricional com maiores evidências científicas. A prescrição de dieta específica parece ser a intervenção mais adequada para aumentar HDL-colesterol. Não é possível fazer inferências sobre o tratamento nutricional do colesterol total, LDL-colesterol e resistência insulínica. Modificações no estilo de vida podem promover melhora da lipodistrofia e pressão arterial.

OBJECTIVE: To analyze the effect of nutritional treatment on metabolic changes caused by the use of antiretroviral therapy in adults with HIV/AIDS. METHODS: A systematic review of literature was conducted in the PubMed, Lilacs and Cochrane databases, between 1996 and 2010, including crossover and randomized controlled clinical trials performed in adults with HIV/AIDS using antiretroviral therapy and without opportunistic diseases. The intervention of interest was oral nutritional supplementation and/or a change in lifestyle due to specific dietary treatment: dyslipidemia, insulin resistance, lipodystrophy and systemic arterial hypertension. The Jadad scale was used for a qualitative classification of articles. RESULTS: A total of 385 articles were found, of which seven were included. The interventions used in these studies were as follows: diet, diet and physical exercises, diet and supplementation, and only supplementation. Dyslipidemia was the outcome assessed in all studies. Studies that assessed omega-3 supplementation found a significant reduction in triglycerides. The specific diet with omega-3 supplementation showed an increase in HDL-cholesterol. Chrome nicotinate supplementation did not have an effect on dyslipidemia. Changing one's lifestyle, including diet and physical activity, significantly reduced waist circumference, lipodystrophy and systolic blood pressure. CONCLUSIONS: Reduction in tryglicerides with omega-3 supplementation was the nutritional intervention with the strongest scientific evidence. Prescribing a specific diet appeared to be the most adequate intervention to increase HDL-cholesterol. Inferences could not be made about the nutritional treatment of total cholesterol, LDL-cholesterol and insulin resistance. Changes in lifestyle can promote an improvement in lipodystrophy and blood pressure.

Knowledge and attitudes of Korean dentists towards human immunodeficiency virus/acquired immune deficiency syndrome

PURPOSE: Infection with human immunodeficiency virus (HIV) remains a major global threat, and although the prevalence is comparatively still very low, the number of HIV-positive Koreans is increasing. However, there are no official guidelines as to how to treat people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHA) or how to screen for potentially infectious people. This study assessed the level of knowledge and attitudes of dentists in Korea toward PLWHA, and their attitudes to screening patients for HIV infections. METHODS: A cross-sectional prospective survey targeting dentists working in Korea was conducted using a self-administered questionnaire. RESULTS: A satisfactory level of knowledge about HIV/AIDS and a relatively positive attitude toward PLWHA was found. Most of the respondents preferred rapid HIV testing using oral fluid as a specimen. The general attitude of dentists toward HIV/AIDS is sufficiently positive to enable provision of the best treatment to the patients in need. CONCLUSIONS: Most of the dentists require HIV testing in dental clinics. In spite of their needs, there are several obstacles. It is hoped that financial considerations and official legal requirements related to HIV testing strategies will be considered.

Knowledge and attitudes of Korean dentists towards human immunodeficiency virus/acquired immune deficiency syndrome

PURPOSE: Infection with human immunodeficiency virus (HIV) remains a major global threat, and although the prevalence is comparatively still very low, the number of HIV-positive Koreans is increasing. However, there are no official guidelines as to how to treat people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHA) or how to screen for potentially infectious people. This study assessed the level of knowledge and attitudes of dentists in Korea toward PLWHA, and their attitudes to screening patients for HIV infections. METHODS: A cross-sectional prospective survey targeting dentists working in Korea was conducted using a self-administered questionnaire. RESULTS: A satisfactory level of knowledge about HIV/AIDS and a relatively positive attitude toward PLWHA was found. Most of the respondents preferred rapid HIV testing using oral fluid as a specimen. The general attitude of dentists toward HIV/AIDS is sufficiently positive to enable provision of the best treatment to the patients in need. CONCLUSIONS: Most of the dentists require HIV testing in dental clinics. In spite of their needs, there are several obstacles. It is hoped that financial considerations and official legal requirements related to HIV testing strategies will be considered.

Qualidade de vida e adesão ao tratamento anti-retroviral de pacientes portadores de HIV: [revisão] / Calidad de vida y adhesión al tratamiento antiretroviral de pacientes portadores de VIH: [revisión] / Quality of life and adherence to HAART in HIV-infected patients: [review]

Foi realizada uma revisão da literatura científica sobre adesão terapêutica à highly active antiretroviral therapy e sobre a qualidade de vida dos pacientes portadores do HIV, indexada no MEDLINE no período entre 1998 e 2008. Foram incluídos estudos em pacientes maiores de 18 anos, publicados em português, espanhol ou inglês. Foram excluídos estudos de revisão, relatos de caso e cartas. Dos 21 estudos encontrados, 12 foram incluídos (três ensaios clínicos, três coortes prospectivos, seis transversais). A relação entre qualidade de vida e adesão terapêutica permanece controversa, embora estudos descritivos apontem a possibilidade de uma relação positiva. Os resultados podem ter sido influenciados por características específicas dos ensaios clínicos descritos e mostram não haver consenso sobre o impacto da adesão terapêutica sobre a qualidade de vida dos pacientes.

A review on adherence to highly active antiretroviral therapy and the quality of life of patients living with HIV in the scientific literature, indexed in MEDLINE between 1998 and 2008, was performed. Studies published in Portuguese, Spanish or English with patients over 18 years of age were included. Reviews, case reports and letters were excluded. Of the 21 studies found, 12 were included (three clinical trials, three prospective cohorts and six cross-sectional studies). The relationship between quality of life and treatment adherence remains controversial, despite descriptive studies indicating the possibility of a positive association. The results may have been influenced by the specific characteristics of the described clinical trials and do not show a consensus regarding the impact of treatment adherence on patients' quality of life.

Se realizó una revisión de la literatura científica sobre adhesión terapéutica a la terapia antirretroviral altamente activa y sobre la calidad de vida de los pacientes portadores de VIH, indexados en el MEDLINE en el período entre 1998 y 2008. Se incluyeron estudios en pacientes mayores de 18 años, publicados en portugués, español o inglés. Se excluyeron estudios de revisión, relatos de caso y cartas. De los 21 estudios encontrados, 12 fueron incluidos (tres ensayos clínicos, tres cohortes prospectivas, seis transversales). La relación entre calidad de vida y adhesión terapéutica permanece controversial a pesar de que estudios descriptivos señalen la posibilidad de una relación positiva. Los resultados pueden haber sido influenciados por características específicas de los ensayos clínicos descritos y muestran no haber consenso con relación al impacto de la adhesión terapéutica sobre la calidad de vida de los pacientes.

Characteristics of amino acid sequences of envelop protein V3 loop of human immunodeficiency virus type 1 quasi-species in long-term non-progressors infected with human immunodeficiency virus type 1 / 中华传染病杂志

Objective To investigate the characteristics of V3 loop amino acid sequences of human immunodeficiency virus type 1 (HIV-1) quasi-species in long-term non-progressors (LTNP)infected with HIV. Methods End-point limiting dilution polymerase chain reaction (EPLD PCR) was used to amplify the env gene c2-v3-c3 region of single HIV-1 provirus from five LTNPs at sequential time points. The PCR products were then sequenced and the amino acid sequences of V3 loop were analyzed by sequence confirm analysis technology. Results The results showed that there were one to ten kinds of polymorphisms in the V3 region of HIV-1 quasi-species which were found from the serial samples of the five LTNP. However, the sequences of the predominant strains were either completely consistent or at most changed at one or two residues in the serial samples of individual patient. The tetramer compositions of the tip of V3 loop were consistent in each patient. It was GPGR in four patients and GPGK in one patient. It was speculated the co-receptor of HIV-1 was CC chemokine receptor (CCR)-5 based on the amino acids at the residue 11 and residue 25 of V3 loop and the net charge of V3 loop. Conclusions There are various polymorphisms at the HIV V3 loop in LTNP. However, the tetramer composition of the tip part of V3 loop is stable. The LTNP are very likely infected with non-syncytium inducing (NSI) strain.

Estudo do reconhecimento de epitopos das proteínas Gag e Nef do HIV-1 por linfócitos T em indivíduos cronicamente infectados pelo HIV-1 não progressores por longo tempo / Study of the recognition of HIV-1 Gag and Nef epitopes by T lymphocytes in chronically infected HIV-1 long-term non-progressors

Os linfócitos T têm um papel central no controle da infecção pelo HIV-1. As respostas mediadas por esses linfócitos contra epitopos do HIV-1 restritos a moléculas HLA de classe I podem estar associadas à proteção natural em indivíduos LTNP. Relatos sugerem que determinados alelos HLA apresentam-se mais representados entre os LTNP. Para avaliar esses aspectos na coorte francesa ALT, coletamos células mononucleares de sangue periférico (CMSP) de 24 indivíduos LTNP e verificamos a frequência de respostas específicas para o HIV-1. Para isso, utilizamos pools de peptídeos sobrepostos de Gag e regiões imunodominantes da RT e Nef, e identificamos epitopos do HIV-1 restritos a moléculas HLA de classe I, associados ou não à proteção, através do ensaio de ELISPOT IFN-?. Todos os indivíduos apresentaram respostas específicas aos pools testados, com uma mediana de 5 (2-12). Todas as proteínas do HIV-1 foram reconhecidas, sendo que Gag-p24 e Nef foram as mais frequentemente reconhecidas pelas CMSP dos indivíduos avaliados. A intensidade total de resposta de linfócitos T específicos aos pools de Gag, RT e Nef do HIV-1 em cada indivíduo variou de 160 a 12307 SFC/106 CMSP (mediana: 2025). Observamos o reconhecimento de 22 epitopos já descritos na literatura, contidos nas proteínas Gag-p17, Gag-p24 e Nef do HIV-1, restritos a moléculas HLA de classe I, a maioria descrita como protetoras da progressão para a doença. Quatro novos epitopos ainda não descritos na literatura também foram observados. Concluímos que: respostas específicas mediadas por linfócitos T, eficazes e dirigidas contra um amplo painel de epitopos do HIV-1, estão presentes nos indivíduos LTNP; a presença de moléculas HLA de classe I associadas à proteção favorece o reconhecimento preferencial de epitopos do HIV-1 restritos por elas na maioria dos indivíduos LTNP; esses aspectos devem ser levados em conta na perspectiva do desenvolvimento de uma vacina candidata contra o HIV-1.

T lymphocytes (T-L) have a paramount role in the control of HIV-1 infection. The responses mediated by these cells against HLA class I epitopes may be associated to the natural protection in long-term non-progressors (LTNP). The literature suggests that some HLA alleles relate to the protection against the immune dysfunction. The aim of this research is to study the recognition of HIV-1 Gag, Nef and RT epitopes by T-L through an ELISPOT IFN-? assay in the peripheral blood mononuclear cells (PBMC) of 24 LTNP selected from French ALT study group. We evaluated the frequency of anti-HIV-1 responses and identified HLA class I epitopes. All individuals presented specific responses to the pools of peptides tested with a median of 5 (2-12). Gag-p24 and Nef were the most frequently recognized proteins. The magnitude of the responses varied from 160 to 12307 SFC/106 PBMC (median=2025). We observed the recognition of 22 epitopes already described in HIV-1 Gag-p17, Gag-p24 and Nef, restricted to HLA class I molecules reported as protective. We have also observed four new epitopes not already described in the literature. Our results suggest that: HIV-1 responses by T-L are present in LTNP; the presence of HLA class I molecules associated with protection in the majority of LTNP are related to the recognition of MHC restricted HIV-1 epitopes; these aspects must be taken into account in the development of a candidate vaccine against HIV-1.