Prevalence of apical periodontitis in people living with HIV in Southern Brazil / Prevalência de periodontite apical em pessoas vivendo com HIV no Sul do Brasil

Objective: This cross-sectional study aimed to describe the prevalence of apical periodontitis (AP) in people living with HIV (PLHIV) over 50 years old and explore its association with sociodemographic, medical, and oral characteristics. Methods: Data from 59 PLHIV were collected, and the periapical area of 1018 teeth was evaluated through periapical radiographs (Rx) using the periapical index (PAI). The presence and quality of root fillings and restorations (coronal fillings and crowns) were assessed with Rx, and caries presence was based on Rx and clinical data. Viral load (VL) and T CD4 counts were also analyzed. Results: AP prevailed in 71% of individuals and 8% of teeth. Family income of >5 Brazilian minimum wages (OR=0.06, 95% CI=0.005-0.62) and having at least one root-filled tooth (OR=14.55, 95% CI=1.45-145.72) were associated with AP prevalence, whereas VL and T CD4 were not. Caries, root filling, and restorations were associated with AP occurrence. Conclusion: PLHIV presented a high AP prevalence, but intrinsic factors related to HIV infection were not associated with AP in the studied subjects. PLHIV would benefit from oral health policies to prevent AP, as the results indicate that the endodontic disease in the present sub-population might be related to social problems.(AU)

Objetivo: este estudo transversal teve como objetivo descrever a prevalência de periodontite apical (PA) em pessoas vivendo com HIV (PVHIV) acima de 50 anos de idade, e explorar sua associação com características sociodemográficas, médicas e bucais. Métodos: os dados de 59 PVHIV foram coletados e a região periapical de 1018 dentes foi avaliada através de radiografias periapicais (Rx) usando o Índice Periapical (PAI). A presença e qualidade das obturações radiculares e restaurações (restaurações diretas e coroas) também foram avaliadas no Rx; a presença de cárie foi baseada em dados clínicos e radiográficos. Carga Viral (CV) e contagem de linfócitos T CD4 também foram avaliados. Resultados: a prevalência de PA nos indivíduos foi de 71%, e 8% dos dentes apresentaram PA. Renda familiar >5 salários mínimos (OR=0.06, 95% CI=0.005-0.62) e ter pelo menos um dente com obturação endodôntica (OR=14.55, 95% CI=1.45-145.72) foram associados com a prevalência de PA, enquanto que CV e T-CD4 não foram. A presença de cárie, obturação endodôntica e restaurações foram associadas com a presença de PA no dente. Conclusão: PVHIV apresentaram uma alta prevalência de PA, mas fatores intrínsecos relacionados à infecção pelo HIV não foram associados com PA nos sujeitos avaliados. PVHIV se beneficiariam de políticas públicas de saúde para prevenir a PA, uma vez que os resultados indicam que a doença endodôntica na presente subpopulação pode ser relacionada a problemas sociais.(AU)

Hemophagocytic Syndrome Secondary to Human Parvovirus B19 Infection in an Acquired Immunodeficiency Syndrome Patient:Report of One Case / 中国医学科学院学报

The acquired immunodeficiency syndrome patients with compromised immunity are prone to hemophagocytic syndrome secondary to opportunistic infections.This paper reports a rare case of hemophagocytic syndrome secondary to human parvovirus B19 infection in an acquired immunodeficiency syndrome patient,and analyzes the clinical characteristics,aiming to improve the diagnosis and treatment of the disease and prevent missed diagnosis and misdiagnosis.

Medidas administrativas para la reinserción laboral de personas con VIH-Sida / Administrative measures for the labor reinsertion of people with HIV-AIDS

A casi cuarenta años del registro del primer caso de VIH en Perú, se ha concretado avances en pro de los derechos fundamentales de las personas que viven con este padecimiento, a pesar de lo conservadora que es la sociedad peruana, el Estado conjuntamente con organizaciones nacionales e internacionales han pactados leyes, normas y acuerdos con el fin de garantizar, en el marco de respeto e igualdad, los principios y libertades esenciales, sin menosprecios, sobre la base del estado serológico respecto del VIH de todas las personas afectadas y sus familiares. Epidemiológicamente se ha identificado como población clave las comunidades homosexuales, mujeres transgénero y hombres que tienen sexo con hombres, siendo poblaciones que han sido discriminadas y estigmatizadas por su orientación sexual y aunado a eso deben de sentir el rechazo por padecer de este flagelo, siendo más evidente en los establecimientos de salud y en los centros laborales, aun a pesar de que las investigaciones han demostrado que la principal vía de contagio es la sexual y que la infección por VIH es considerado crónica. En este sentido, es imprescindible conseguir un mayor compromiso de los diversos sectores involucrados con la salud y el trabajo, encaminado a paliar los efectos negativos de esta enfermedad, estableciendo pautas legales que permitan la reincorporación y continuidad en los centros laborales, además de realizar campañas educativas que permita minimizar la discriminación en estos ambientes(AU)

Almost forty years after the registration of the first case of HIV in Peru, progress has been made in favor of the fundamental rights of people living with this condition, despite how conservative Peruvian society is, the State together with national organizations and international governments have agreed laws, regulations and agreements in order to guarantee, within the framework of respect and equality, the essential principles and freedoms, without disdain, based on the HIV serological status of all affected people and their families. Epidemiologically, homosexual communities, transgender women and men who have sex with men have been identified as key populations, being populations that have been discriminated against and stigmatized due to their sexual orientation and added to that they must feel rejection for suffering from this scourge, being more evident in health facilities and workplaces, even though research has shown that the main route of infection is sexual and that HIV infection is considered chronic. In this sense, it is essential to achieve a greater commitment from the various sectors involved with health and work, aimed at alleviating the negative effects of this disease, establishing legal guidelines that allow reincorporation and continuity in the workplace, in addition to carrying out campaigns educational measures that minimize discrimination in these environments(AU)

Lípidos anormales y síndrome de inmunodeficiencia adquirida: asociación de lípidos séricos con el estado del VIH / Abnormal Lipids and Acquired Immune Deficiency Syndrome: Association of Serum Lipids with HIV Status

Contexto y objetivo: las anomalías hematológicas se encuentran entre las complicaciones más comunes de la infección por el VIH. También se han realizado bastantes estudios sobre las alteraciones en el perfil de lípidos, aunque los resultados en gran medida no han sido concluyentes. El presente estudio se llevó a cabo para evaluar el recuento de células CD4 y el perfil de lípidos en los pacientes infectados por el VIH y el SIDA en la población india y los correlaciona con los controles sero-negativos. Materiales y métodos: El presente estudio fue diseñado como un estudio transversal, con base en un hospital, para evaluar el recuento de células CD4 y el perfil de lípidos en los pacientes infectados por VIH y SIDA en la población india y los correlaciona con los controles sero-negativos. La evaluación del perfil de lípidos se realizó utilizando Erba EM 360, un analizador automático impulsado por un fotómetro de rejilla de difracción, mientras que los recuentos de células CD4 se evaluaron utilizando el Contador de ciclo de Partec. Análisis estadístico utilizado: Los datos se analizaron con SPSS versión 15.0 (SPSS Inc., Chicago, IL, EE. UU.). La comparación de dichos parámetros se realizó mediante el análisis de varianza (ANOVA) y la prueba post-hoc de Games-Howell. Se consideró estadísticamente significativo un valor de p <0,05. Resultados: Los niveles de colesterol total y lipoproteínas de baja densidad (LDL) disminuyeron significativamente, mientras que los triglicéridos y las lipoproteínas de muy baja densidad (VLDL) aumentaron significativamente en los pacientes infectados por VIH y SIDA en comparación con los controles sero-negativos. Conclusión: El colesterol total, las LDL, los triglicéridos y las VLDL se alteraron significativamente en los pacientes infectados por VIH y con SIDA en comparación con los controles sero-negativos

Context and Aim: Hematological abnormalities are amongst the most common complications of infection with HIV.There have been quite a few studies on the alterations in lipid profile, too, though the results have largely been inconclusive. The present study was carried-out to assess CD4 cell counts and lipid profile in the HIV infected and AIDS patients in the Indian population and correlates them with the sero-negative controls. Materials and Methods: The present study was designed as a cross-sectional, hospital-based study to assess CD4 cell counts and lipid profile in the HIV infected and AIDS patients in the Indian population and correlates them with the sero-negative controls. Evaluation of lipid profile was done using Erba EM 360, an automated analyzer powered by a diffraction grating photometer while CD4 cell counts were evaluated using Partec Cyflow Counter. Statistical analysis used: The data was analyzed using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA). Comparison of the said parameters was done using Analysis of Variance (ANOVA) and post-hoc Games-Howell test. p-value of <0.05 was considered statistically significant. Results: The levels of total cholesterol and low-density lipoproteins (LDLs) were significantly decreased while triglycerides and very low density lipoproteins (VLDLs) were significantly increased in the HIV infected and AIDS patients when compared with the sero-negative controls. Conclusion: Total cholesterol, LDLs, triglycerides and VLDLs were significantly altered in the HIV infected and AIDS patients when compared with the sero-negative controls

Self-reported HIV/HAART-associated Lipodystrophy and Modifiable Risk Factors for Cardiovascular Disease

Abstract Background Patient self-report is the most common diagnostic tool in the literature to detect HIV/HAART-associated lipodystrophy. However, data on the association of cardiovascular risk factors with HIV/HAART-associated lipodystrophy assessed by self-report are still missing. Objectives To determine the prevalence of self-reported HIV/HAART-associated lipodystrophy and to identify independent associations between traditional modifiable cardiovascular risk factors and self-reported lipodystrophy. Methods We conducted a retrospective observational study at an outpatient infectious disease clinic in the Central-West of Brazil to identify the association between traditional modifiable cardiovascular risk factors and self-reported lipodystrophy. Sedentary lifestyle, smoking status, family history of cardiovascular disease, hypertension, diabetes, dyslipidemia, increased waist circumference and overweight were the cardiovascular risk factors assessed. Self-reported HIV/HART-associated lipodystrophy was categorized as: mild (noticeable by patients' close inspection), moderate (easily noticeable by patient and physician) or severe (readily noticeable by a casual observer). Prevalence ratio (PR) and 95% confidence interval (CI95%) were calculated. Multivariate Poisson's regression was used to analyze factors associated to HIV/HAART-associated lipodystrophy assessed by self-report considering a significance level of 5%. Results A total of 183 patients were included, with a mean age of 39.3±10.9 years. Most of the sample were male (77.6%), non-white (50.8%) and single (53.0%). The overall prevalence of HIV/HAART-associated lipodystrophy was 52.5% (95% CI 44.96 - 59.88). Severe lipodystrophy was observed in more than half patients (55.2%). No traditional modifiable cardiovascular risk factor was independently associated with lipodystrophy. Female sex (PR 1.49; 95% CI 1.15 - 1.95; p =0.003), time of HIV infection diagnosis of 1-3 years (PR 1.83; 95% CI 1.09 - 3.08; p =0.002) and a positive family history of CVD (PR 1.62; 95% CI 1.11 - 2.36; p <0.001) were independently associated with lipodystrophy. Conclusion HIV/HAART-associated lipodystrophy assessed by patient self-report was not associated with traditional modifiable cardiovascular risk factors. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

Evolución y secuelas cognitivas en un paciente con encefalopatía por VIH/SIDA con tratamiento antirretroviral / Evolution and cognitive consequences in a patient with HIV/AIDS encephalopathy with antiretroviral treatment

El VIH/SIDA es una enfermedad neurotrópica que afecta al sistema nervioso central y dependiendo de la fase clínica de la enfermedad genera deterioro neurológico, psiquiátrico y neuropsicológico en grado variable. Se describe el caso de un paciente que presentó un cuadro de deterioro cognitivo severo (demencia SIDA) con posterior mejoría de signos y síntomas, y establecimiento posterior de secuelas neuropsicológicas después de un año de su diagnóstico. Se comparó una evaluación neuropsicológica en etapa de deterioro cognitivo severo con otra de seguimiento, realizada un año después de iniciar el tratamiento antirretroviral. Se presentan las características clínicas del paciente utilizando el estudio de caso como herramienta metodológica y sobre la base de un procedimiento clínico y psicométrico.

HIV/AIDS is a neurotropic disease that affects the central nervous system and depending on the clinical phase of the disease generates neurological, psychiatric and neuropsychological impairment to varying degrees. The case of a patient who presented severe cognitive impairment (AIDS dementia) is described with subsequent remission of signs and symptoms, and establishment of neuropsychological sequelae after one year of diagnosis. A neuropsychological evaluation in stage of severe cognitive impairment was compared with another follow-up one year after initiating antiretroviral treatment. The clinical characteristics of the patient are presented using the case study as a methodological tool and based on a clinical and psychometric procedure.

Pitiriasis rubra pilaris tratada con lámpara excímero / Pityriasis rubra pilaris treated with excimer lamp

Resumen La pitiriasis rubra pilaris, es una dermatosis inflamatoria papuloescamosa e hiperqueratósica de origen desconocido y de progresión crónica, la cual puede evolucionar incluso a eritrodermia. El presente caso trata de un paciente de 27 años portador del virus de inmunodeficiencia humana, diagnosticado con pitiriasis rubra pilaris tipo IV, inicialmente tratado con corticosteroide tópico y fototerapia, por cuatro meses. Sin embargo, presentó reactivación de las lesiones, por lo que se recurrió a la aplicación de lámpara excímero, utilizada en otras patologías dermatológicas, mas no de uso habitual en la pitiriasis rubra pilaris.

Abstract Pityriasis Rubra Pilaris is an inflammatory papulosquamous and hyperkeratic dermatosis of unknown cause and chronic progression which can envolve even into erythroderma. This case deals with a 27-year old male patient carrier of VIH who was diagnosed with PRP type IV. Initially, it was treated with topical corticosteroid and phototherapy for four months. However, it showed reactivation of the injuries; therefore, excimer lamp was employed, which is used in other dermatologic pathologies but it is not a regular treatment for PRP type IV.

Vacunas en pacientes con VIH/SIDA / Immunizations in HIV/AIDS patients

Los sujetos con infección por Virus de inmunodeficiencia humana (VIH) tienen mayor susceptibilidad de adquirir infecciones por su deterioro inmunológico. Según el deterioro inmunológico y el uso de terapia antiretroviral (TARV) en niños y adultos VIH (+), la intensidad de la respuesta inmune a las vacunas es menor que la población general. Por este motivo es preferible administrar vacunas una vez que la TARV haya permitido la inmunoreconstitución, y se recomiendan dosis de refuerzo. Por otra parte, las vacunas vivas atenuadas deben ser usadas con precaución, y están contraindicadas en inmunosupresión severa.

Patients with Human Immunodeficiency Virus (HIV) are more susceptible to acquiring infections due to their immune deterioration. The intensity of the immune response to vaccines is lower than general population, depending on immune status and the use of antiretroviral therapy (ARV). For this reason, it is preferable to administer vaccines once ART has allowed immune reconstitution, and booster doses are recommended. On the other hand, live vaccines should be used with caution, and are contraindicated in severe immunosuppression.

Cytomegalovirus infection in AIDS patients. An illustrative case series / Infección por citomegalovirus en pacientes con SIDA. Una serie ilustrativa

ABSTRACT Background: Cytomegalovirus (CMV) is an opportunistic infection (OI) in immunosuppressed patients. However, there are no clear cut-off values available for quantitative plasmatic CMV measures (viral load [VL]) to discriminate those with CMV illness from those infected suffering a transient viral reactivation. Aim: To estimate a CMV VL cut-off point that discriminates infected patients and those with CMV related diseases, and to clinically characterize AIDS patients with this OI. Patients and Methods: Retrospective analysis of AIDS patients admitted by any reason between years 2017 and 2019 and who had a positive plasma CMV VL at any titer. Cases were categorized with illness or infected using accepted criteria and the cut-off value was obtained by receiver operating characteristic curve (ROC) analysis. Results: Twelve patients were identified as having a CMV-associated illness and seven with CMV infection. A CMV VL of 3,800 copies/mL had a sensitivity of 91.6% and 100% specificity to discriminate both states. Of the 12 patients with CMV illness, all were in AIDS stage and only five were receiving HIV therapy. Predominant clinical presentations were gastrointestinal (50%), followed by liver involvement (25%) and CMV disease (25%). All patients were treated with ganciclovir or valganciclovir. Ten patients had a favorable response (83.3%), one patient only had a laboratory improvement (8.3%) and one died during treatment (8.3%). Drug toxicity was recorded in nine patients but in only three cases, a dose adjustment was necessary. Conclusions: The predominant clinical manifestation in our series was gastrointestinal. A CMV VL cutoff level of CMV VL of 3,800 copies / mL is useful to discriminate infected patients from those with CMV related disease.

Antecedentes: Citomegalovirus (CMV) es una infección oportunista (IO) en pacientes inmunosuprimidos. Sin embargo, se requieren puntos de corte de carga viral (CV) para discriminar a aquellos con enfermedad por CMV de aquellos infectados que sufren una reactivación viral transitoria. Objetivos: Estimar un punto de corte de la CV de CMV que discrimine a los enfermos de los infectados y, además, caracterizar clínicamente a los pacientes con sida que presentan esta IO. Pacientes y Métodos: Análisis retrospectivo de pacientes con sida hospitalizados por cualquier motivo entre los años 2017 y 2019, y que presentaron un CV de CMV plasmática positiva a cualquier título. Los casos se clasificaron como enfermos utilizando criterios aceptados y el valor de corte se obtuvo mediante análisis de una curva ROC. Resultados: Durante el período de estudio, 12 pacientes fueron identificados con enfermedad asociada al CMV y siete con infección. Una CV de 3.800 copias/ml logró una sensibilidad de 91,6% y una especificidad de 100% para discriminar ambos estados. De los 12 pacientes enfermos, todos estaban en etapa de sida y solo 5 recibían terapia contra el VIH. La presentación clínica predominante fue gastrointestinal (50%) seguida del compromiso hepático (25%) y de la enfermedad por CMV (25%). Todos los pacientes fueron tratados con ganciclovir o valganciclovir. Diez pacientes tuvieron una respuesta favorable (83,3%), uno solo tuvo mejoría de laboratorio (8,3%) y otro paciente falleció durante el tratamiento (8,3%). Nueve pacientes evolucionaron con toxicidad farmacológica, pero en solo 3 casos fue necesario ajustar las dosis. Conclusiones: La forma predominante de presentación de la enfermedad fue gastrointestinal. Un punto de corte de 3.800 copias/ml discrimina pacientes infectados de aquellos con la enfermedad.

Validação da versão brasileira do World Health Organization Disability Assessment Schedule 2. 0 em indivíduos HIV/AIDS / Validation of the Brazilian version of the World Health Organization Disability Assessment Schedule 2. 0 for individuals with HIV/AIDS

Resumo O WHODAS 2.0 (World Health Organization Disability Assesment Schedule) é um instrumento criado pela OMS (Organização Mundial da Saúde) para medida de funcionalidade e deficiência, fundamentado no modelo biopsicossocial e totalmente amparado no arcabouço teórico-conceitual da CIF (Classificação Internacional de Funcionalidade, Incapacidade e Saúde). O objetivo deste artigo é validar a versão brasileira do WHODAS 2.0 para o uso em pessoas com HIV/AIDS. Participaram 100 pessoas com diagnóstico de HIV/AIDS. Foram utilizados dois instrumentos de avaliação, o WHODAS 2.0 na versão de 36 itens e o WHOQoL-HIV-Bref (World Health Organization Quality of Life em pessoas com HIV, versão abreviada). As propriedades psicométricas testadas foram consistência interna e validade de critério. A consistência interna foi adequada para todos os domínios, com exceção do domínio Atividades de Vida (α = 0,69) e Autocuidado (α = 0,32). A validade de critério foi adequada, com correlações moderadas aos domínios do WHODAS 2.0 com os domínios do WHOQoL-HIV-Abreviado. Os resultados indicaram o instrumento WHODAS 2.0 como válido para avaliação da funcionalidade de pessoas com HIV/AIDS. O uso dos dados do domínio de Autocuidado deve ser cuidadosamente considerado.

Abstract The WHODAS 2.0 (World Health Organization Disability Assessment Schedule) is an instrument developed by the WHO (World Health Organization) for functioning and disability assessment based on the biopsychosocial framework, fully supported by the theoretical-conceptual framework of the ICF (International Classification of Functioning, Disability and Health). To validate the Brazilian version of the WHODAS 2.0 for individuals with HIV/AIDS. 100 individuals with diagnosis of HIV/AIDS participated in the study. Two assessment instruments were used: the 36-item version of WHODAS 2.0 and the WHOQOL-HIV-BREF (World Health Organization Quality of Life assessment in persons infected with HIV, shorter version). The psychometric properties tested were internal consistency and criterion validity. Internal consistency was adequate for all domains, with the exception of Life Activities (α = 0.69) and Self-care (α = 0.32). Criterion validity was adequate, with moderate correlations between the WHODAS 2.0 and the WHOQOL-HIV-BREF domains. The results indicated the WHODAS 2.0 instrument as a valid tool for assessing functioning of individuals with HIV/AIDS. The use of data from the Self-care domain should be carefully considered.

Non-alcoholic fatty liver disease in patients infected with human immunodeficiency virus: a systematic review

SUMMARY OBJECTIVE To evaluate the prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with HIV/AIDS. METHODS The systematic review included articles indexed in MEDLINE (by PubMed), Web of Science, IBECS, and LILACS. Studies eligible included the year of publication, diagnose criteria of NAFLD and HIV, and were published in English, Portuguese, or Spanish from 2006 to 2018. The exclusion criteria were studies with HIV-infection patients and other liver diseases. Two reviewers were involved in the study and applied the same methodology, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). RESULTS One hundred and sixteen papers were selected, including full articles, editorial letters, and reviews. Twenty-seven articles were excluded because they did meet the inclusion criteria. A total of 89 articles were read, and 13 were considered eligible for this review. Four case series used imaging methods to identify NAFLD, and nine included histology. The prevalence of NAFLD in HIV-patients ranged from 30%-100% and, in nonalcoholic steatohepatitis (NASH), from 20% to 89%. A positive association between dyslipidemia, insulin resistance, and body mass index was observed. There was no agreement between the studies that evaluated the relationship between antiretroviral drugs and NAFLD. CONCLUSION This systematic review showed a high prevalence of NAFLD in HIV-patients, which was associated with metabolic risk factors. The possible association between antiretroviral therapy and NAFLD needs further studies.

RESUMO OBJETIVO Avaliar a relevância da doença hepática gordurosa não alcoólica (DHGNA) em pacientes com HIV / AIDS. MÉTODOS A revisão sistemática foi realizada utilizando instrumentos de busca de material científico indexado, incluindo MEDLINE (pela PubMed), Web of Science, IBECS e LILACS. Estudos elegíveis incluíram o ano de publicação, critérios para diagnostico de DHGNA e HIV, publicados em inglês, português e espanhol, entre 2006 a 2018. Os critérios de exclusão incluíram estudos com pacientes com outras doenças do fígado. Dois revisores foram envolvidos na pesquisa dos artigos e o PRISMA (Preferred Reporting Items for Systematic Reviews and Meta - Analyses) foi utilizado nas análises. RESULTADOS Cento e dezesseis artigos foram selecionados, 27 excluídos porque não preencheram critérios de inclusão e assim, 89 foram lidos pelos investigadores. Desses, 13 artigos foram incluídos na revisão. Quatro séries de casos utilizaram métodos por imagens para identificação de DHGNA e nove estudos utilizaram biópsia hepática. A prevalência de DHGNA em pacientes com HIV variou de 30% a 100% e esteato-hepatite não alcoólica (EHNA) entre 20% e 89%. Na avaliação das principais variáveis estudadas, observou-se a associação positiva entre dislipidemia, resistência à insulina e índice de massa corporal. Não houve concordância entre os artigos que avaliaram a relação dos antiretrovirais com a DHGNA. CONCLUSÕES A presente revisão sistemática sugere elevada prevalência de DHGNA em pacientes infectados com HIV. DHGNA nesses pacientes foi associada principalmente a fatores metabólicos. A possível associação entre terapia antiretroviral e DHGNA nesses pacientes vem sendo discutida, mas são necessários mais estudos para estabelecer essa associação.

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.

A multivariate prognostic score for predicting mortality of acquired immunodeficiency syndrome patients with Hypoxemic Respiratory Failure and Pneumocystis Jiroveci Pneumonia

Background Severe hypoxemic respiratory failure (SHRF) due to Pneumocystis jiroveci pneumonia (PJP) in AIDS patients represents the main cause of admission and mortality in respiratory intensive care units (RICUs) in low- and middle-income countries. Objective The objective of this study was to develop a predictive scoring system to estimate the risk of mortality in HIV/AIDS patients with PJP and SHRF. Methods We analyzed data of patients admitted to the RICU between January 2013 and January 2018 with a diagnosis of HIV infection and PJP. Multivariate logistic regression and Kaplan–Meier method were used in data analysis. The RICU and inhospital mortality were 25% and 26%, respectively. Multivariate analysis identified four independent predictors: body mass index, albumin, time to ICU admission, and days of vasopressor support. A predictive scoring system was derived and validated internally. The discrimination was 0.869 (95% confidence interval: 0.821-0.917) and calibration intercept (α) and slope (β) were 0.03 and 0.99, respectively. The sensitivity was 47.2%, specificity was 84.6%, positive predictive value was 89.2%, and negative predictive value was 82.6%. Conclusions This scoring system is a potentially useful tool to assist clinicians, in low- and medium-income countries, in estimating the RICU and inhospital mortality risk in patients with HIV/AIDS and SHRF caused by PJP.

ICNP® Diagnoses of People Living with AIDS, and Empirical Indicators / Diagnósticos de la CIPE® de personas que viven con SIDA e Indicadores Empíricos / Diagnósticos da CIPE® de pessoas vivendo com AIDS e Indicadores Empíricos

ABSTRACT Objective: To analyze the association between the empirical indicators and ICNP® nursing diagnoses in people living with AIDS, as well as to identify the predictive indicators for the establishment of these diagnoses. Method: A cross-sectional study with 120 people living with AIDS, in a hospital in Northeastern Brazil, conducted from August to September 2015, following the steps: identification and validation of Empirical Indicators; preparation and validation of the ICNP® Nursing Diagnoses; and analysis of the association between the Empirical Indicators and the Nursing Diagnoses resulting from the two previous steps. To analyze the data, we used logistic regression. Results: 74 Empirical Indicators were identified, being 31 of which were validated. 55 diagnoses were elaborated and 19 were validated, of which 16 were associated with the Empirical Indicators, identifying 31 predictors. Conclusion: The diagnoses presented significant associations with the Empirical Indicators. In addition, it was observed that the predictive factors of these diagnoses involved the human responses and complications related to the disease, which should be considered during the care provided by the nurse.

RESUMEN Objetivo: Analizar la asociación entre los indicadores empíricos y diagnósticos de enfermería de la CIPE® en personas viviendo con Sida, así como identificar los indicadores predictores para el establecimiento de esos diagnósticos. Método: Estudio transversal con 120 personas viviendo con Sida, en un hospital en el Nordeste de Brasil, realizado de agosto a septiembre de 2015, siguiendo las etapas: identificación y validación de los indicadores empíricos; elaboración y validación de los diagnósticos de enfermería de la CIPE®; y análisis de la asociación entre los indicadores empíricos y los diagnósticos de enfermería resultantes de las dos etapas anteriores. Para el análisis de los datos se utilizó la regresión logística. Resultados: Se identificaron 74 indicadores empíricos, siendo 31 validados. Se elaboraron 55 diagnósticos y 19 fueron validados, de los cuales 16 obtuvieron asociación con los indicadores empíricos, identificándose 31 predicadores. Conclusión: Los diagnósticos presentaron asociaciones significativas con los indicadores empíricos. Además, se observó que los factores predictores de estos diagnósticos involucraron las respuestas humanas y complicaciones relacionadas con la enfermedad, las cuales deben ser consideradas durante la asistencia prestada por el enfermero.

RESUMO Objetivo: Analisar a associação entre os Indicadores Empíricos e Diagnósticos de Enfermagem da CIPE® em pessoas vivendo com AIDS, bem como identificar os indicadores preditores para o estabelecimento desses diagnósticos. Método: Estudo transversal com 120 pessoas vivendo com AIDS, em um hospital no Nordeste do Brasil, realizado de agosto a setembro de 2015, seguindo as etapas: identificação e validação dos Indicadores Empíricos; elaboração e validação dos Diagnósticos de Enfermagem da CIPE®; e análise da associação entre os Indicadores Empíricos e os Diagnósticos de Enfermagem resultantes das duas etapas anteriores. Para análise dos dados, foi utilizada a regressão logística. Resultados: Identificaram-se 74 Indicadores Empíricos, sendo 31 validados. Elaboraram-se 55 diagnósticos e 19 foram validados, dos quais 16 obtiveram associação com os Indicadores Empíricos, identificando-se 31 preditores. Conclusão: Os diagnósticos apresentaram associações significativas com os Indicadores Empíricos. Além disso, observou-se que os fatores preditores desses diagnósticos envolveram as respostas humanas e complicações relacionadas à doença, as quais devem ser consideradas durante a assistência prestada pelo enfermeiro.

Calidad de vida y variables psicológicas que afectan la adherencia al tratamiento anti-retroviral en pacientes mexicanos con infección por VIH/SIDA / Quality of life and psychological variables affecting adherence to antiretroviral treatment in Mexican patients with HIV/AIDS

Resumen Introducción: El tratamiento anti-retroviral (TAR) es indispensable en pacientes con infección por VIH/ SIDA; suprimir la carga viral requiere de un estricto apego a éste, por compromiso del paciente. El fracaso del TAR es primordialmente por falta de adherencia, que puede ser debida a una deficiente calidad de vida y/o a variables psicológicas. Objetivo: Determinar la calidad de vida, variables psicológicas y la adherencia al TAR, en pacientes con infección por VIH/SIDA. Material y Método: Se incluyeron 160 pacientes con diagnóstico de infección por VIH/SIDA y con TAR. Se recabaron los instrumentos MOS SF-36 y VPAD-24, una encuesta demográfica, y datos clínicos. Se hicieron asociaciones cuantitativas y cualitativas entre las variables. Resultados: La adherencia al TAR estuvo asociada con evitar comportamiento depresivo y con ausencia de adicciones. El comportamiento depresivo se encontró asociado con las adicciones. Un 87% de pacientes estaba en el rango de mejor calidad de vida. Por debajo del promedio del puntaje de salud general estuvieron masculinos, con orientación sexual HSH, solteros, en la vitalidad a los ≥ 38 años, en dolor corporal y función social a tres esquemas TAR. Conclusión: La buena adherencia al TAR estuvo asociada a evitar comportamiento depresivo y a la ausencia de adicciones y no se asoció a la calidad de vida.

Background: Antiretroviral treatment (ART) is essential in HIV/AIDS patients. Suppressing viral load requires strict adherence to ART in addition to the patient's commitment to treatment. The failure of ART is mainly due to lack of adherence, which may in turn be due to poor quality of life and/or to psychological variables. Aim: To determine the quality of life and psychological variables and adherence to ART, in patients with HIV/AIDS. Material and Method: 160 patients diagnosed with HIV/AIDS and with ART were included. The MOS SF-36 and VPAD-24 instruments, a socio-demographic survey, and clinical data were collected. Quantitative and qualitative associations were made between the variables. Results: The adherence to ART was associated with avoidance of depressive behavior and with the absence of addictions. Depressive behavior associated with addictions. 87% of patients ranked in the best quality of life. Below the average of the general health score were males, with MSM sexual orientation, single, in vitality at ≥ 38 years, in corporal pain and with social function to three ART schemes. Conclusion: Good adherence to ART was associated with avoiding depressive behavior and with non-addictions and not associated with quality of life.

Progressive multifocal leukoencephalopathy: a challenging diagnosis established at autopsy

Progressive multifocal leukoencephalopathy (PML) is a feared entity that occurs most frequently in conditions of extreme immunodeficiency. The diagnosis is often made long after the onset of symptoms due to the physicians' unfamiliarity, and the unavailability of diagnostic tests in some medical centers. Although the incidence of PML is decreasing among HIV patients with the advent of highly active antiretroviral therapy (HAART), in Brazil this entity is the fourth highest neurological complication among these patients. The authors present the case of a middle-aged man who tested positive for HIV concomitantly with the presentation of hyposensitivity in the face and the right side of the body, accompanied by mild weakness in the left upper limb. The clinical features worsened rapidly within a couple of weeks. The diagnostic work-up pointed to the working diagnosis of PML after brain magnetic resonance imaging; however, the detection of the John Cunningham virus (JCV) in the cerebral spinal fluid was negative. HAART was started but the patient died after 7 weeks of hospitalization. The autopsy revealed extensive multifocal patchy areas of demyelination in the white matter where the microscopy depicted demyelination, oligodendrocytes alterations, bizarre atypical astrocytes, and perivascular lymphocytic infiltration. The immunohistochemistry was positive for anti-SV40, and the polymerase chain reaction of the brain paraffin-embedded tissue was positive for JCV. The authors highlight the challenges for diagnosing PML, as well as the devastating outcome of PML among HIV patients.

(Re)significando a prática do gerenciamento do cuidado de Enfermagem diante da cronicidade do HIV/aids / (Re)signifying the practice of Nursing care management in view of the chronicity of HIV/AIDS

Esta pesquisa visa corroborar com o aprofundamento da compreensão sobre as demandas de cuidado das pessoas com HIV/AIDS no enfrentamento da condição crônica, pois é preciso captar a diversidade de significados que podem ser atribuídos aos fatos e experiências dos seres que os vivenciam. Objetivou-se compreender os significados do cuidado atribuídos pela pessoa com HIV/AIDS hospitalizada. Estudo qualitativo, exploratório, realizado num hospital de referência e excelência de cuidados a essa clientela, localizado no município do Rio de Janeiro, Brasil. Utilizou-se a Teoria Fundamentada nos Dados (TFD), seguindo a abordagem da descrição conceitual plena, e o Interacionismo Simbólico como referencial teórico-filosófico. Foram utilizadas como técnicas de coleta de dados a entrevista semiestruturada e a observação não participante. O período de coleta de dados se deu entre agosto de 2017 e maio de 2018. Foram participantes do estudo compondo diferentes grupos amostrais: 17 pessoas que vivem com HIV/AIDS hospitalizadas e outras 12 atendidas no ambulatório, 3 enfermeiros assistenciais e 4 chefias (médica e de enfermagem). Foram respeitados os aspectos éticos. Resultaram três categorias, a saber: Significando o cuidado a partir da interação consigo e com as pessoas ao seu redor com ou sem HIV; Buscando despertar na pessoa o significado da corresponsabilização no gerenciamento da situação vivenciada; e Abordando as influências das interações sob os resultados esperados no processo de cuidar de si e de ser cuidado. Cada categoria, com suas subcategorias, representou um elemento do paradigma, integradas pelo fenômeno central: Reagindo à infecção pelo HIV ao perceber o perigo de suas manifestações clínicas. Defendeu-se a seguinte tese: "Conviver com o HIV é um fenômeno social, onde não há possibilidade de desvincular o processo de adaptação à doença das relações sociais (re)construídas ao longo da vida. Este fenômeno influencia a todos na sociedade, e ainda vem acompanhado de estigmatização, rejeição e isolação. É preciso investimento na atenção à saúde daqueles que lutam para manter o seu bem-estar e a inclusão social. Ressignificar as necessidades biopiscossociais dos portadores do HIV implica no endereçamento das necessidades básicas afetadas, o que favorece o comportamento proativo, a aceitação e a resiliência, não só em relação aos cuidados necessários diante da presença do vírus e à necessidade ininterrupta de aderir à terapia medicamentosa, mas também ao lidar com os valores sociais que reproduzem modelos, que em contrapartida, podem ajudar no autoconhecimento. Assim, é necessário resgatar o protagonismo e empoderamento de todas as pessoas envolvidas nessas relações, inclusive, ao considerar o anseio pelo espaço no ambulatório para o exercício profissional do enfermeiro, que imbuído de tais premissas, pode gerenciar o cuidado em favor da qualidade de vida das PVHA". A tese foi validada por sete enfermeiros especialistas de acordo com os critérios de ajuste, compreensão e generalização teórica.

The present research of doctorate in nursing aims to corroborate with the deepening of the understanding about the demands of care of people with HIV/AIDS in facing the chronic condition, since it is necessary to capture the diversity of meanings that can be attributed to the facts and experiences of the beings who experience them. Aimed to understand the meaning of care given by the person with HIV/AIDS hospitalized. It was a qualitative, exploratory study that used the Grounded Theory (GT), following the approach of the full conceptual description, and the Symbolic Interactionism as the theoretical-philosophical reference. Was conducted at a referral and excellence care hospital, located in the city of Rio de Janeiro, Brazil. The semi-structured interview and non- participant observation were used as data collection techniques. Data were collected between August 2017 and May 2018. Participants in this study were 17 inpatients with HIV/AIDS hospitalized at a referral hospital with excellence of care for these clients, as well as 12 outpatients, 3 nursing assistants, and 4 medical and nursing leaders. Ethical aspects were respected. Three categories resulted from the thesis: Meaning the care from self-interaction and with other people around with or without HIV; Seeking to awaken in the person the meaning of co-responsibility in the management of the situation experienced; and Addressing the influence of interaction on expected outcomes in the self-care and self-care process. Each category, with its subcategories, represented an element of the paradigm, integrated by the central phenomenon: Reacting to HIV infection by realizing the danger of its clinical manifestations. The following thesis was defended: "Living with HIV is a social phenomenon, where there is no possibility of disconnecting the process of adaptation to the disease from (re) built social relationships throughout life. This phenomenon influences everyone in society, and is still accompanied by stigmatization, rejection and isolation. Investment is needed in health care for those struggling to maintain their well-being and social inclusion. Re-meaning the biopsychosocial needs of people with HIV implies addressing the basic needs affected, which favors proactive behavior, acceptance and resilience, not only in relation to the care needed in the presence of the virus and the uninterrupted need to adhere to drug therapy, but also in dealing with the social values that reproduce models, which in turn can help in self-knowledge. Thus, it is necessary to rescue the protagonism and empowerment of all people involved in these relationships, including considering the yearning for space in the outpatient clinic for the nurse's professional practice, which, imbued with such premises, can manage care in favor of quality of life of PLWHA". This thesis was validated by seven specialist nurses according to the criteria of adjustment, comprehension and theoretical generalization.

La presente investigación busca corroborar con la profundidad de la comprensión sobre las demandas de cuidado de las personas con VIH/SIDA en el enfrentamiento de la condición crónica, pues es necesario captar la diversidad de significados que pueden ser atribuidos a los hechos y experiencias de los seres que los viven. Tuvo como objetivo comprender el significado del cuidado atribuido por la persona con VIH/SIDA hospitalizada. Investigación cualitativa, exploratoria, que utilizó la Teoría Fundamentada en los Datos (TFD), siguiendo el enfoque de la descripción conceptual plena, y el Interaccionismo Simbólico como referencial teórico-filosófico. Se realizó en un hospital de referencia y atención de excelencia, ubicado en Río de Janeiro, Brasil. Se utilizaron como técnicas de recolección de datos la entrevista semiestructurada y la observación no participante. La recopilación de datos tuvo lugar entre agosto de 2017 y mayo de 2018. En este estudio participaron 17 personas que viven con VIH/SIDA internadas, 12 pacientes ambulatorios, 3 enfermeros asistenciales y 4 jefaturas médicas y de enfermería. Se han respetado aspectos éticos. Se obtuvieron tres categorías: Significando el cuidado a partir de la interacción consigo y con las personas a su alrededor con o sin VIH; Tratando de despertar en la persona el significado de corresponsabilidad en el manejo de la situación experimentada; y Abordando las influencias de las interacciones sobre los resultados esperados en el proceso de autocuidado y de ser cuidado. Cada categoría, con sus subcategorías, representaba un elemento del paradigma, integrado por el fenómeno central: reaccionar a la infección por VIH al darse cuenta del peligro de sus manifestaciones clínicas. Se defendió la siguiente tesis: "Vivir con VIH es un fenómeno social, donde no hay posibilidad de desconectar el proceso de adaptación a la enfermedad de las relaciones sociales (re) construidas a lo largo de la vida. Este fenómeno influye en todos los miembros de la sociedad y aún se acompaña de estigmatización, rechazo y aislamiento. Se necesita inversión en atención en salud para quienes luchan por mantener su bienestar e inclusión social. Resignificar las necesidades biopsicosociales de las personas con VIH implica abordar las necesidades básicas afectadas, lo que favorece el comportamiento proactivo, la aceptación y la capacidad de recuperación, no solo en relación con la atención necesaria en presencia del virus y la necesidad ininterrumpida de adherirse a la terapia con medicamentos, pero también al tratar con los valores sociales que reproducen modelos, que a su vez pueden ayudar en el autoconocimiento. Por lo tanto, es necesario rescatar el protagonismo y el empoderamiento de todas las personas involucradas en estas relaciones, lo que incluye considerar el anhelo de espacio en la clínica ambulatoria para la práctica profesional de la enfermera, que, imbuida de tales premisas, puede administrar la atención a favor de la calidad de vida de las PLWHA". Esta tesis fue validada por siete enfermeras especializadas según los criterios de ajuste, comprensión y generalización teórica.

Reduction of relative handgrip strength and cardiometabolic risk in individuals with HIV/AIDS

Abstract INTRODUCTION: Low handgrip strength (HS) is associated with cardiometabolic alterations that have affected people with HIV/AIDS. METHODS: This was a cross-sectional study performed in adults receiving antiretroviral treatment. HS was evaluated using a dynamometer and divided by body weight to obtain the relative strength. The association between relative HS and overweight, increased waist circumference (WC), high body fat percentage, glycemia, and lipid ratios were assessed using logistic regression. RESULTS: Low relative HS was identified in 35% of participants and associated with increased WC (odds ratio = 9.7; 95% confidence interval = 2.8-33.0). CONCLUSIONS: The prevalence of low HS was high and associated with increased WC.