Statistical process control of manufacturing tablets for antiretroviral therapy

Abstract In this study, the manufacturing process of lamivudine (3TC) and zidovudine (AZT) tablets (150+300 mg respectively) was evaluated using statistical process control (SPC) tools. These medicines are manufactured by the Fundação para o Remédio Popular "Chopin Tavares de Lima" (FURP) laboratory, and are distributed free of charge to patients infected with HIV by the Ministry of Health DST/AIDS national program. Data of 529 batches manufactured from 2012 to 2015 were collected. The critical quality attributes of weight variation, uniformity of dosage units, and dissolution were evaluated. Process stability was assessed using control charts, and the capability indices Cp, Cpk, Pp, and Ppk (process capability; process capability adjusted for non-centered distribution; potential or global capability of the process; and potential process capability adjusted for non-centered distribution, respectively) were evaluated. 3TC dissolution data from 2013 revealed a non-centered process and lack of consistency compared to the other years, showing Cpk and Ppk lower than 1.0 and the chance of failure of 2,483 in 1,000,000 tablets. Dissolution data from 2015 showed process improvement, revealed by Cpk and Ppk equal to 2.19 and 1.99, respectively. Overall, the control charts and capability indices showed the variability of the process and special causes. Additionally, it was possible to point out the opportunities for process changes, which are fundamental for understanding and supporting a continuous improvement environment.

Efavirenz dissolution enhancement V - A combined top down/bottom up approach on nanocrystals formulation

Abstract Efavirenz is one of the most commonly used drugs in HIV therapy. However the low water solubility tends to result in low bioavailability. Drug nanocrystals, should enhance the dissolution and consequently bioavailability. The aim of the present study was to obtain EFV nanocrystals prepared by an antisolvent technique and to further observe possible effect, on the resulting material, due to altering crystallization parameters. A solution containing EFV and a suitable solvent was added to an aqueous solution of particle stabilizers, under high shear agitation. Experimental conditions such as solvent/antisolvent ratio; drug load; solvent supersaturation; change of stabilizer; addition of milling step and solvents of different polarities were evaluated. Suspensions were characterized by particle size and zeta potential. After freeze- dried and the resulting powder was characterized by PXRD, infrared spectroscopy and SEM. Also dissolution profiles were obtained. Many alterations were not effective for enhancing EFV dissolution; some changes did not even produced nanosuspensions while other generated a different solid phase from the polymorph of raw material. Nevertheless reducing EFV load produced enhancement on dissolution profile. The most important modification was adding a milling step after precipitation. The resulting suspension was more uniform and the powder presented grater enhancement of dissolution efficacy.

Pharmaceutical care and evaluation of adherence to antiretroviral therapy in people living with HIV/AIDS

Abstract Highly Active Antiretroviral therapy (HAART) depends on optimal adherence to be effective. Pharmacotherapeutic follow-up can be used as a strategy for treatment fidelity. To provide pharmaceutical care for HAART patients, to assess adherence, to identify and resolve drug related problems (DRP). This is a prospective, interventional study aimed at people on HAART. Data was collected using the pharmacotherapeutic follow-up form and CEAT-VIH. There was a predominance of women (59%), older than 33 years (75%), mostly single (43%). Regarding adherence, 64% had insufficient adherence at the start of the study, while 36% had strict/adequate adherence. After the pharmacotherapeutic follow-up, 70% presented strict/adequate adherence. Regarding HAART, the relationship between adhesion versus time of HAART and adherence versus regimen used was significant, considering that less time of therapy and regimen containing protease inhibitors are predictors for insufficient adherence. Regarding the DRP identified (f=77), missed pills (32%), untreated disease, incorrect management frequency, and undue self-medication (12%) were the most frequent. Pharmaceutical interventions (f=137) were predominantly advising related to specific pharmacological treatment (32%), non-pharmacological measures (20%), and medication suspension (9%). Pharmaceutical care was shown to be animportant strategy, within the multi professional team, to improve adherence, besides identifying and resolving DRP.

Sarcoma de Kaposi en pacientes que viven con el VIH en Guinea Ecuatorial / Kaposi sarcoma in patients living with HIV in Equatorial Guinea

Introducción: El sarcoma de Kaposi es una neoplasia oportunista asociada a la inmunodepresión causada por VIH, que se relaciona con la infección por VHH tipo 8. Objetivo: Describir la presentación del sarcoma de Kaposi en personas que viven con VIH en Guinea Ecuatorial. Métodos: Se realizó un estudio descriptivo de carácter retrospectivo para identificar la prevalencia y las características epidemiológicas y clínicas del sarcoma de Kaposi en las personas que viven con VIH que acuden a las unidades de referencia para el manejo de casos en Guinea Ecuatorial. Se revisaron las historias clínicas de una muestra aleatoria y representativa de 338 pacientes del grupo que ha recibido tratamiento en las unidades de referencia para enfermedades infecciosas de Bata, desde enero de 2007 a febrero de 2012. Resultados: Se identificaron 40 pacientes diagnosticados de sarcoma de Kaposi (prevalencia del 11, 83 por ciento). La mediana de la edad al diagnóstico de sarcoma de Kaposi fue de 43 años, siendo la ratio del sexo de 1/1. La media de linfocitos CD4 al diagnóstico fue de 166 (rango 21-375) y la frecuencia de afectación oral fue de 45 por ciento. En la mayoría de los pacientes (94,6 por ciento) la observación del sarcoma de Kaposi fue anterior al inicio del tratamiento antirretroviral. Las cifras de linfocitos T CD4/mm3 inferiores a 100 aparecían sobre todo en pacientes menores de 30 años, y esto era especialmente frecuente en el grupo de mujeres (OR 11, p <0,04, Ic 95 por ciento 0,8-148). Conclusiones: El sarcoma de Kaposi es una neoplasia prevalente en personas que viven con VIH seguidas en las unidades de referencia en Guinea Ecuatorial. En mujeres menores de 30 años podría existir un diagnóstico tardío(AU)

Introduction: Kaposi sarcoma is an opportunistic neoplasm associated to the immunosuppression caused by HIV and related to infection by HHV-8. Objective: Describe the presentation of Kaposi sarcoma in people living with HIV in Equatorial Guinea. Methods: A retrospective descriptive study was conducted to identify the prevalence and the clinical and epidemiological characteristics of Kaposi sarcoma in people living with HIV attending reference units for the management of cases in Equatorial Guinea. A review was carried out of the medical records of a random sample representative of 338 patients from the group receiving treatment at Bata reference unit for infectious diseases from January 2007 to February 2012. Results: A total 40 patients diagnosed with Kaposi sarcoma were identified (prevalence of 11,83 percent). Mean age at Kaposi sarcoma diagnosis was 43 years, with a 1/1 sex ratio. The mean CD4 lymphocyte count at diagnosis was 166 (range 21-375), whereas the frequency of oral damage was 45 percent. In most patients (94.6 percent) detection of Kaposi sarcoma was prior to the start of antiretroviral therapy. CD4 T lymphocyte levels / mm3 below 100 were mainly found in patients aged under 30 years, a fact particularly frequent among women (OR 11, p< 0.04, CI 95% 0.8-148). Conclusions: Kaposi sarcoma is a neoplasm prevailing in people living with HIV who attend reference units in Equatorial Guinea. Late diagnosis could exist among women aged under 30 years(AU)

La infección por el VIH: abordaje de su prevención en hombres que tienen relaciones sexuales con hombres en Cuba / HIV infection: an approach to its prevention in men who have sex with men in Cuba

RESUMEN Este trabajo describe las principales intervenciones de prevención de la infección por el virus de inmunodeficiencia humana, dirigidas a los hombres que tienen relaciones sexuales con hombres, los que constituyen un grupo de riesgo para adquirir la enfermedad. Para su elaboración, se seleccionó la literatura científica publicada en fuentes y documentos nacionales e internacionales considerada relevante para el tema. El análisis y las recomendaciones se centraron en el sector de la salud y en el grupo de hombres que tienen relaciones sexuales con otros hombres. Las estrategias de abordaje del virus de inmunodeficiencia humana en Cuba están consideradas entre los programas de prevención de alto impacto, elaboradas tanto por la sociedad civil, a través de las subvenciones del Fondo Mundial de Lucha contra el SIDA, la Tuberculosis y la Malaria, como por los técnicos del Programa Nacional de Prevención y Control de las ITS-VIH/sida. Incluyen paquetes de servicios personalizados, que contienen elementos estructurales, biomédicos y de comportamiento para grupos de población clave en los contextos sociales donde son más necesarias. Como es sabido, el riesgo para cada individuo depende de sus prácticas y no del grupo al que pertenezca. Estas ofrecen un fundamento común para el desarrollo y la promoción de programas de eficacia comprobada para la prevención, que permiten reorganizar los esfuerzos, tener mayor impacto y lograr reducir el número de nuevas infecciones en este grupo de población (AU).

ABSTRACT This paper describes the main interventions for the prevention of human immunodeficiency virus infection, aimed at men who have sex with men, who constitute a risk group for acquiring the disease. For its preparation, the scientific literature published in national and international sources and documents considered relevant to the subject was selected. The analysis and recommendations focused on the health sector and the group of men who have sex with other men. The strategies to address the human immunodeficiency virus in Cuba are considered among the high-impact prevention programs, developed both by civil society, through grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria, and by the technicians of the National Program for the Prevention and Control of STI-HIV/AIDS. They include personalized service packages, containing structural, biomedical and behavioral elements for key population groups in the social contexts where they are most needed. As is known, the risk for each individual depends on their practices and not on the group to which they belong. These provide a common foundation for the development and promotion of proven prevention programs that allow reorganization of efforts, have greater impact, and reduce the number of new infections in this population group (AU).

Pró-Fármacos dendriméricos potencialmente ativos em Malária e Tuberculose: Síntese e avaliação da atividade biológica / Dendrimeric prodrugs potentially active in malaria and tuberculosis: Synthesis and evaluation of biological activity

HIV/AIDS, tuberculose, malária e as doenças tropicais negligenciadas representam uma grande preocupação em Saúde em muitas regiões do mundo. Os fármacos disponíveis para o tratamento apresentam diversos problemas, tais como toxicidade e resistência ao parasita. Mesmo com esse triste panorama, o investimento em pesquisa nessa área é, ainda, pouco significativo. Assim, dentre os métodos de modificação molecular para melhorar propriedades farmacêuticas, farmacocinéticas e/ou farmacodinâmica de compostos bioativos destaca-se a latenciação. Já os dendrímeros vêm despertando interesse em aplicações biológicas, principalmente como transportadores de fármacos, além de atuarem como transportadores de genes, imagem em diagnóstico e compostos com ação per se. Face ao exposto e tendo em vista o caráter promissor dos dendrímeros como sistemas de drug delivery, o objetivo deste trabalho foi a síntese de pró-fármacos dendriméricos potencialmente ativos em malária e tuberculose. Os dendrímeros de Bis-MPA (gerações 0, 1 e 2) foram sintetizados pelo grupo do Professor Scott Grayson, da Tulane University (EUA). No Brasil, foram feitas as funcionalizações destes compostos, através do acoplamento do ácido succínico (que funciona como espaçante) e as moléculas ativas. Selecionaram-se as seguintes substâncias: (1) primaquina, com ação antimalárica e (2) isoniazida, de ação nos primeiros estágios da tuberculose. Foram sintetizados os pró-fármacos dendriméricos de isoniazida nas gerações 0 e 1 (G0-Iso e G1-Iso), e primaquina nas gerações 0, 1 e 2 (G0-Pq, G1-Pq e G2Pq). Importante mencionar que os resultados de Ressonância Magnética e Nuclear de 1H e de 13C demostraram as obtenções dos respectivos produtos, porém contendo impurezas. Já a análise do resultado proveniente da espectrometria de massas do composto G0-Iso revelou a presença de um subproduto ciclizado da isonizaida succinoilada (CIso-Suc), o qual pode ser um potencial pró-fármaco ou apresentar atividade per se. Como não se conhece este composto, o laboratório coordenado pela Profas Elizabeth Igne Ferreira e Jeanine Giarolla manifestou interesse em pesquisa-lo, principalmente quanto suas propriedades físico- químicas, bem como quanto à atividade biológica. Assim, utilizando metodologia analítica previamente estabelecida para o G0-Iso, os estudos de estabilidade química da CIso-Suc, em diferentes valores de pH, demonstraram a capacidade da forma ciclizada em se converter no protótipo Iso-Suc, majoritariamente em pH 7,4 e 8,5. Como perspectivas, destaca-se a avaliação da estabilidade enzimática deste potencial derivado. Ressalta-se, ainda, a a avaliação da respectiva atividade antimicobacteriana. Em relação aos pró-fármacos, as necessidades de aprimoramentos das sínteses são, também, evidenciadas. Uma vez sintetizados e caracterizados, estes últimos derivados serão avaliados quanto à atividade biológica. Ademais, estudos computacionais, sobretudo simulações de docking molecular, foram desenvolvidos com intuito de se entender o modo de interação de alguns compostos com alvos biológicos pré-determinados

HIV/AIDS, tuberculosis, malaria and neglected diseases are a major health concern in many regions of the world. The drugs available present various problems, such as toxicity and parasite resistance. Even with this sad outlook, research investment in this area is still insignificant. Among the molecular modification methods to improve the pharmaceutical, pharmacokinetic and/or pharmacodynamic properties we stands out prodrug design. On the other hand, dendrimers are arousing interest in biological applications, mainly as drug carriers, besides gene delivery, diagnostic imaging, as well as acting as compounds with activity per se. Considering that, added to the promising dendrimer drug delivery features, the aim of this study was to synthesize potentially active dendrimer prodrugs in malaria and tuberculosis. Bis-MPA dendrimers (generations 0, 1 and 2) were synthesized by the group of Professor Scott Grayson of Tulane University (USA). Herein in Brazil, the compounds were functionalized by coupling succinic acid (spacer group), as well as the active molecules. We selected the following substances: (1) primaquine, with antimalarial action and (2) isoniazid, acting in the early stages of tuberculosis. Isoniazid dendrimer prodrugs were synthesized generations 0 and 1 (G0-Iso and G1-Iso), and primaquine in generations 0, 1 and 2 (G0-Pq, G1-Pq and G2-Pq). It is important to mention that the results related to Nuclear and Magnetic Resonance 113C showed chemical structures features, however with impurities. Analysis of the mass spectrometry regarding G0-Iso has revealed the presence of a cyclized by-product of succinylated isonized (CIso-Suc), which may be a potential prodrug or may presentactivity itself. Using the analytical methodology performed for G0-Iso, ICso-Suc demonstrated its ability to convert the Iso-Suc prototype at different pH values, especially at pH 7.4 and 8.5. As perspectives, we highlight the determinations of the chemical stability of ICsoSuc at pH 1.5 and 6.0, as well as the evaluation of the enzymatic stability. We will also investigate the respective antimicobacterial activities. Regarding prodrugs, the needs for synthesis enhancements are also necessary. Once synthesized and characterized, these latter derivatives will be evaluated for biological activity. Moreover, computational studies, especially molecular docking simulations, were developed in order to understand the mode of interaction of some compounds with predetermined biological targets

Hepatoesplenomegalia relacionada a linfoma de Burkitt en paciente pediátrico / Hepatoesplenomegalia related to Burkitt´s lymphoma in a pediatric patient

RESUMEN El linfoma de Burkitt, se trata de un subtipo poco frecuente del linfoma no Hodgkin, con elevada frecuencia en aquellos pacientes con sida. La hepatoesplenomegalia es un signo clínico de gran importancia para el diagnóstico oportuno de algunas patologías; entre los mecanismos de formación de la hepatoesplenomegalia se encuentra la infiltración celular, ocasionada por la migración de células tumorales. Se presenta por inflamaciones debido a la presencia de infecciones por virus o bacterias las cuales son muy comunes en pacientes con sida. Se presentó un caso de un paciente masculino de 4 años, diagnosticado con VIH positivo, con la configuración correspondiente de criterios clínicos en clasificación C para sida. El cual desarrolló a nivel de cavidad oral un Burkitt primario, que se acompañó de hepatoesplenomegalia. Se pretendió describir la relación y el comportamiento de este tipo de linfoma con la hepatoesplenomegalia, así como la repercusión a nivel del sistema estomatognático, a nivel sistémico y el plan de tratamiento. Por el cuadro clínico e inmunológico del paciente estudiado, se planteó un pronóstico reservado por presentar un cuadro clínico infrecuente, en el que se observó Burkitt; tanto a nivel del sistema estomatognático como a nivel abdominal. Se hizo necesario realizar un diagnóstico oportuno y certero para iniciar el tratamiento a tiempo, se comenzó inmediatamente con tratamiento (AU).

ABSTRACT Burkitt lymphoma (BL) is a rare subtype of non-Hodgkin lymphoma, with high frequency in those patients with AIDS. Hepatosplenomegaly is a clinical sign of great importance for the timely diagnosis of some pathologies; cellular infiltration is found among the mechanisms of hepatosplenomegaly formation; it is caused by the migration of tumor cells. It emerges by inflammations due to the presence of infections by virus or bacteria which are very common in patients with AIDS. The authors present the case of a male patient, aged 4 years, with a positive HIV diagnosis, and the correspondent configuration of clinical criteria in C classification for AIDS, who developed a primary Burkitt lymphoma at the level of oral cavity We present the case of a 4-year-old male patient diagnosed with HIV positive, with the corresponding configuration of clinical criteria in classification C for AIDS; who developed a primary LB at the oral cavity level that was accompanied by hepatosplenomegaly. The authors pretended to describe the relation and behavior of this kind of lymphoma with hepatosplenomegaly, and also the repercussion at the stomatognathic level, at the systemic level and the treatment plan. Due to the clinical and immunological characteristics of the studied patient a reserved prognosis was given because of presenting infrequent clinical characteristics in which a Burkitt was observed both, at the stomatognathic and at the abdominal level. It was necessary to make an opportune and accurate diagnosis to begin the treatment on time (AU).

Etiologia da anemia em pessoas infectadas com HIV / Anemia etiology in HIV-infected people

O HIV é o causador da AIDS, doença que representa um dos grandes problemas de saúde pública em todo o mundo. Apesar de avanços na terapia antirretroviral no sentido de aumentar a expectativa de vida dos indivíduos infectados, as alterações hematológicas, como a anemia, acompanham o curso clínico da doença. Essa condição, normalmente multifatorial, pode estar presente em qualquer fase da doença e afeta diretamente o prognóstico e a qualidade de vida do indivíduo infectado. Este artigo apresenta informações do surgimento do processo anêmico com base nas principais causas encontradas na literatura.

The human immunodeficiency virus is the cause of the acquired immunodeficiency syndrome, a disease that represents one of the major public health problems worldwide. In spite of advances in antiretroviral therapy that increase patients' life expectancy, hematological changes, such as anemia, follow the clinical course of the disease. This commonly multifactorial condition can be found in any phase of the disease and directly affects the prognosis and quality of life of patients. This article presents information on the emergence of the anemic process based on the main causes found in the literature.

Exuberant case of erythema elevatum diutinum in a patient infected with HIV and hepatitis B virus

Abstract Erythema elevatum diutinum is a small vessel vasculitis which is benign, rare, and chronic. It is clinically characterized by violaceous, brown, or yellowish plaques, nodules, and papules. It has been associated with autoimmune, infectious, and neoplastic processes. The following case describes a patient with hepatitis B virus and human immunodeficiency virus with CD4 count < 200 mm3, HIV-seropositive for 16 years, and diagnosed with hepatitis B virus at the hospital. The patient was treated with oral dapsone 100 mg/day, showing regression after seven months of treatment. The authors found three cases in the literature of association of erythema elevatum diutinum, human immunodeficiency virus, and hepatitis B virus.

Widespread use of anti-retroviral therapy elevated the prevalence of dyslipidemia in HIV-infected Chinese patients

With the widespread use of high-efficiency antiretroviral therapy (HAART), the life expectancy of HIV-infected patients has been significantly extended. However, the metabolic complications among HIV-infected patients treated with HAART have become the most common problem in the world. It is very important to explore the incidence of dyslipidaemia and studies on the role of potential risk factors in HIV-infected Chinese patients treated with HAART are sparse. Therefore, we designed current study, to investigate the effects of therapeutic intervention and continuous information support on the lifestyle of HIV/AIDS patients with dyslipidaemia. Three hundred and six HIV/AIDS patients admitted to the AIDS clinic in Beijing from January 2016 to January 2017 were recruited and assigned into two groups: the treatment group (n=64) and the control group (n=64). The median age of the participants was 38.8±11.0 years (range 20-75 years). The prevalence of dyslipidemia in control and treatment group was (59/64) 92.2% and (53/64) 82.8%, respectively. In this study, low HDL-cholesterol (HDLC) led to abnormalities 47/64 (73.3%) in the control group and 35/64 (54.7%) in HAART-treatment group. Additionally, HAART group showed higher triglyceride, total cholesterol, and low-density lipoprotein (246.1±171.8, 1.73±1.61 mmol/L, 4.46±1.1 mmol/L, 2.54±0.74 mmol/L). In multivariate analysis, gender, marital status, high BMI, dietary habits and physical activity were potential risk factors for dyslipidemia in HIV-infected Chinese patients. In this study, we reported high prevalence dyslipidemiain two HIV infected groups. We suggest that the appropriate diagnosis should be performed for analyzing the metabolic complications in HIV-infected Chinese patients. Further studies are very important to understand the role of potential risk factors in metabolic complications.

Association between soluble biomarkers - microbial translocation, inflammation and cardiovascular risk in HIV- infected individuals: a systematic review

Microbial translocation is associated with the increased risk of cardiovascular disease in HIV-infected individuals. There is scarce information regarding the possible associations between the biomarkers of microbial translocation, inflammation and cardiovascular risk that can be evaluated in clinical laboratories using plasma or serum samples. This systematic review was conducted according to the PRISMA protocol in order to verify the most used soluble biomarkers of microbial translocation, inflammation and cardiovascular risk, as well as possible associations between them, in HIV-infected individuals. A search was performed using the Medline, Scopus and Web of Science databases to identify existing studies regarding the relationship between microbial translocation biomarkers, inflammation and cardiovascular risk in HIV-infected patients. Eleven articles that presented soluble biomarkers of microbial translocation (LPS, rDNA, sCD14, LBP and EndoCAb) were selected. The most frequently evaluated soluble biomarker was sCD14, followed by LPS; the latter were associated with some lipid profile parameters. This systematic review considered soluble blood biomarkers that can be utilized in laboratory diagnosis. The aim was to identify the interconnection between microbial translocation, inflammation and cardiovascular risk. Despite the fact that a large number of inflammation and cardiovascular risk biomarkers have been previously reported, it was noted that important markers involved in the pathophysiology of cardiovascular diseases need to be included in future research.

Caracterização dos óbitos e dos itinerários terapêuticos investigados pelo Comitê Municipal de Mortalidade por Aids de Porto Alegre em 2015 / Caracterización de óbitos e itinerario terapéutico investigados por el Comité de Mortalidad por Sida de Porto Alegre, Brasil, en 2015 / Characterization of deaths and therapeutic itineraries investigated by the Porto Alegre AIDS Mortality Committee, Brazil, in 2015

Objetivo: caracterizar os óbitos por aids elegíveis para investigação pelo Comitê Municipal de Mortalidade por Aids (CMAids) de Porto Alegre, Brasil, em 2015, e seus itinerários terapêuticos. Métodos: estudo descritivo, com dados secundários de sistemas de informações de vigilância e das fichas de investigação do CMAids. Resultados: entre 336 óbitos por causas relacionadas à aids, 113 (33,6%) foram considerados evitáveis, dos quais 52 foram investigados pelo CMAids; verificou-se predomínio do sexo masculino (30/52), baixa escolaridade (29/52 casos até a 8ª série incompleta) e tempo de até 2 anos entre o diagnóstico da infecção pelo HIV e a morte (28/52); a tuberculose foi a causa de morte mais frequente (17/52); em 50/52 casos, identificou-se pelo menos uma falha no itinerário terapêutico. Conclusão: os óbitos evitáveis de pessoas com aids ocorreram, majoritariamente, em pessoas do sexo masculino, de baixa escolaridade, com diagnóstico recente de HIV e em decorrência da tuberculose.

Objetivo: caracterizar los óbitos por sida elegibles para investigación por el Comité de Mortalidad por Sida (CMSida) de Porto Alegre, Brasil, en 2015, y sus itinerarios terapéuticos. Métodos: estudio descriptivo con datos secundarios de los sistemas de información de vigilancia y formulario de investigación de CMSida. Resultados entre 336 muertes por sida, 113 (33,6%) se consideraron evitables, de las cuales 52 fueron investigadas por el CMSida; predominó el sexo masculino (30/52), el bajo nivel de educación (29/52 hasta 8º grado incompleto de primaria) y hasta 2 años entre el diagnóstico de la infección por VIH y la muerte (28/52); la tuberculosis fue la causa más frecuente de muerte (17/52); y en 50/52 casos, se identificó al menos una falla en los itinerarios terapéuticos. Conclusión: las muertes evitables de personas con sida ocurrieron principalmente en hombres, con baja escolaridad, diagnóstico reciente de VIH y debido a la tuberculosis.

Objective: to characterize AIDS deaths eligible for Porto Alegre AIDS Mortality Committee (AIDSMC) investigation, Brazil, in 2015, and their therapeutic itineraries. Methods: this was a descriptive study using secondary data from surveillance information systems and AIDSMC investigation forms. Results: out of 336 deaths from AIDS-related causes, 113 (33.6%) were considered avoidable, of which 52 were analyzed by AIDSMC; there was predominance of males (30/52), low schooling level (29/52 incomplete elementary education), and less than 2 years between HIV infection diagnosis and death (28/52); tuberculosis was the most frequent cause of death (17/52); and in 50/52 cases at least one therapeutic itinerary inadequacy was identified. Conclusion: avoidable deaths of people with AIDS occurred mostly in men, those with low education level, those with recent HIV diagnosis and most deaths were due to tuberculosis.

Revisión Bibliográfica: Trastornos Neurocognitivos en Pacientes Infectados con el Virus de la Inmunodeficiencia Humana / Literature Review: Neurocognitive Disorders in Patients infected with Human Immunodeficiency Virus

El Virus de Inmunodeficiencia Humana (VIH) tiene un carácter neurotrópico, es decir afecta tanto el sistema inmunológico como el sistema nervioso de los pacientes, generando déficits conocidos como trastorno neurocognitivo asociado con el VIH (HAND por sus siglas en inglés). Los HAND se evidencian en el deterioro de las funciones ejecutivas y las funciones cognitivas de los pacientes y pueden ser clasificados en tres tipos: 1. Deterioro neurocognitivo asintomático asociado con el VIH, 2. Trastorno neurocognitivo leve asociado con el VIH, y 3. Demencia asociada al VIH. Los HAND tienen efectos perjudiciales en la calidad de vida y en las actividades cotidianas de los pacientes, pues intervienen en el rendimiento de tareas laborales, la adherencia al tratamiento o ingesta de medicamentos, conducción de vehículos y continuidad de la independencia. Para detener o prevenir la aparición de un HAND se ha estudiado la terapia antiretroviral, sin embargo, esta acción no es definitiva, por ello deben tomarse medidas adicionales como intervenciones psicológicas y neuropsicológicas pertinentes. En muchos casos la agudeza de los trastornos neurocognitivos dificulta su identificación, siendo la detección temprana de déficits en las diferentes habilidades cognitivas un factor esencial en el diagnóstico del VIH, pues al ser una afección crónica se puede esperar un mayor deterioro a futuro en caso de no ser intervenido.(AU)

The Human Immunodeficiency Virus (HIV) has a neurotropic character, so it affects both the immune system and the nervous system of the patients, producing deficits known as HIV associated neurocognitive disorder (HAND). HANDs are evidenced with the deterioration of executive and cognitive functions, and can be classified into three types: 1. Asymptomatic neurocognitive impairment associated with HIV, 2. Mild neurocognitive disorder associated with HIV and 3. HIV associated dementia. HANDs have detrimental effects on the quality of life and the daily activities of the patient, as they interfere in work performance, adherence to treatment or ingestion of drugs, operation of vehicles and continuity of independence. To stop or prevent the onset of a HAND, antiretroviral therapy has been studied, however, this action is not definitive, therefore additional measures as timely psychological and neuropsychological interventions should be taken. In many cases, the acuity of neurocognitive disorders makes identification difficult. Early detection of cognitive deficits is an essential factor in the diagnosis of HIV, because it is a chronic condition, further deterioration can be expected in the future if intervention is not applied on time. regarding endothelial glycocalyx damage and ischemia-reperfusion injury.(AU)

Diagrama de Ishikawa: causas e soluções da infecção ao HIV adquirida por profissionais de enfermagem através de materiais perfurocortantes / Ishikawa Diagram: causes and solutions of HIV infection in nursing professionals due to sharps use / Diagrama de Ishikawa: causas y soluciones de la infección al vih adquirida por profesionales de enfermado a través de materiales perfurocortantes

Objective: The study's goal has been to analyze, through the Ishikawa Diagram, the causes and solutions of HIV infection in nursing professionals due to sharps handling. Methods: It is a literature review based on the Construction of the Ishikawa Diagram, which was carried out in May 2017 in the PubMed and Virtual Health Library databases. Results: The following are the main causes of HIV infection through sharps: work overload, perception of frail risk, careless use of needles, lack of training. Regarding the solutions: adequate post-exposure management, implementing and monitoring compliance with biosafety standards, improving the notification of accidents with sharps. Conclusion: There is a need to alerting managers towards intervening in the factors that might trigger accidents with sharp materials by the nursing team

Objetivo: Analisar por meio do Diagrama de Ishikawa as causas e soluções da infecção ao HIV adquirida por profissionais de enfermagem no manuseio de materiais perfurocortantes. Métodos: Revisão da literatura baseada na Construção do Diagrama de Ishikawa, realizado em maio de 2017 nas bases de dados Pubmed e Biblioteca Virtual de Saúde. Resultados: Dentre as causas da infecção ao HIV através de perfurocortantes: sobrecarga de trabalho, percepção de risco fragilizada, utilização descuidada de agulhas, ausência de treinamento. Quanto às soluções: gestão pós exposição adequada, implementar e fiscalizar o cumprimento das normas de biossegurança, aprimorar a notificação de acidentes com materiais perfurocortantes. Conclusão: Destaca-se a necessidade de sensibilizar gestores para intervir nos fatores que podem desencadear acidentes com materiais perfurocortantes pela equipe de enfermagem

Objetivo: Analizar por medio del Diagrama de Ishikawa las causas y soluciones de la infección al VIH adquirida por profesionales de enfermería en el manejo de materiales punzocortantes. Métodos: Revisión de la literatura basada en la construcción del diagrama de Ishikawa, realizado en mayo de 2017 en las bases de datos Pubmed y Biblioteca Virtual de Salud.Resultados: Entre las causas de la infección por el VIH a través de punzocortantes: sobrecarga de trabajo, percepción de riesgo fragilizada, utilización descuidada de agujas, ausencia de entrenamiento. En cuanto a las soluciones: gestión post exposición adecuada, implementar y fiscalizar el cumplimiento de las normas de bioseguridad, mejorar la notificación de accidentes con materiales punzocortantes. Conclusión: Se destaca la necesidad de sensibilizar a los gestores para intervenir en los factores que pueden desencadenar accidentes con materiales punzocortantes por el equipo de enfermería

Estudio de alteraciones neurocognitivas en pacientes infectados por el virus de la inmunodeficiencia humana / Study of neurocognitive alterations in patients infected by the human immunodeficiency virus

El virus de inmunodeficiencia humana, conocido por su impacto en el sistema inmunológico, ocasionamanifestacionesneurológicas progresivas con afectación cognitiva, perturbando funciones de atención, memoria, lenguaje, ejecución y procesamiento de la información, lo cual interfiere de forma negativa en la vida social, laboral y familiar del paciente. Objetivos: Evaluar las alteraciones de diferentes funciones neurocognitivas de los pacientes con infección por el virusde inmunodeficienciahumana, en una institución prestadora de servicios de salud de la cuidad de Ibagué - Colombia. Método: Se utilizó la Evaluación Cognitiva Montreal (MoCA), la cual fue diseñada como un instrumento ágil para determinar alteraciones cognitivas leves. La población objeto de estudio la constituyeron 44 pacientes portadores de virus de inmunodeficiencia humana, seleccionados dentro de un marco de muestreo no-probabilístico con muestra intencional o de conveniencia, entre los 14 y 75 años de edad. Resultados: Mayor deterioro neurocognitivo en los pacientes diagnosticados con virus de inmunodeficiencia humana de mayor edad; datos epidemiológicos indican que la edad más avanzada se asocia a una mayor prevalencia de desorden neurocognitivo asociado al virus de inmunodeficiencia humana. Conclusiones: El estudio de los mecanismos del deterioro neurocognitivo en pacientes con virus de inmunodeficiencia humana se hace cada vez más relevante, porque cada día aumenta su esperanza de vida, pero a su vez genera complicaciones con mayor predominio de la comorbilidad médica, psiquiátrica y neurológica(AU)

Introduction: The Human Immunodeficiency Virus, known for its impact on the immune system, causes progressive neurologic manifestations with cognitive impairment, disrupting attention functions, memory, language, execution and processing of information. The latter negatively interferes in social, work and family life of the patient. Objectives: To evaluate alterations in varied neurocognitive functions on patients with Human Immunodeficiency Virusinfection, at a health institution in Ibague, Colombia. Method: The Montreal Cognitive Assessment (MoCA) was used. It was designed as a tool to determine mild cognitive alterations. The study population was made up of 44 carriers of Human Immunodeficiency Virus who were selected within a framework of non-probabilistic sampling and with purposive sample or convenience, between 14 and 75 years old. Results: Greater neurocognitive impairment in patients diagnosed with Human Immunodeficiency Virus in legal age; someepidemiological data indicate that the older age is associated with a higher prevalence of neurocognitive disorder associated with Human Immunodeficiency Virus. Conclusions: The study of the neurocognitive impairment mechanisms in patients with Human Immunodeficiency Virus becomes increasingly more relevant, as their life expectancy increases daily. On the other hand, it causes complications with greater prevalence of medical psychiatric and neurological comorbidity(AU)

Caracterización epidemiológica de personas que viven con VIH/sida / Epidemiological Characterization of People Living with HIV/AIDS

RESUMEN Introducción: El VIH/sida afecta a personas de todo el mundo, de diferentes edades, sexos y clases sociales. Por lo tanto, conocer el perfil de las personas que viven con VIH/sida es de suma importancia para el desarrollo de estrategias de prevención y tratamiento. Objetivo: Identificar el perfil epidemiológico de las personas que viven con el VIH/sida y las diferencias en función del sexo. Métodos: Estudio descriptivo transversal realizado en dos clínicas especializadas en la atención de personas con VIH/sida ubicados en la ciudad de Ribeirao Preto, en el estado de Sao Paulo, Brasil. Los participantes del estudio fueron 331 (50,9 por ciento) personas que buscaron atención de 2007 a 2010. Los datos fueron recolectados a través de entrevistas con un cuestionario específico para el estudio. Fue realizado la prueba de chi-cuadrado para analizar la asociación entre las variables. Resultados: Las variables estado civil (p < 0,001), educación (p = 0,001), ingreso (p < 0,001), presencia de comorbilidades (p = 0,004) y tiempo del diagnóstico (p < 0,001) mostraron una diferencia estadísticamente significativa en la comparación entre los sexos. Conclusiones: La mayoría de las personas que viven con el VIH/sida que participaron en este estudio eran jóvenes, con bajo nivel educativo e informaron que habían sido infectados por vía sexual. Además, al evaluar las diferencias entre los sexos, se identificó que las variables la educación, el ingreso, comorbilidades y el tiempo de diagnóstico mostraron diferencias significativas(AU)

ABSTRACT Introduction: HIV/AIDS affects people all over the world, of different ages, sexes and social classes. Therefore, knowing the profile of people living with HIV/AIDS is of paramount importance for the development of prevention and treatment strategies. Objective: To identify the epidemiological profile of people living with HIV/AIDS and their differences regarding sex. Methods: Cross-sectional and descriptive study conducted in two clinics specialized in the care of people with HIV/AIDS and located in the city of Ribeirao Preto, in the state of Sao Paulo, Brazil. The study participants were 331 (50.9 percent) people who sought care from 2007 to 2010. The data was collected through interviews with a specific questionnaire for the study. The chi-square test was performed in order to analyze the association between the variables. Results: The variables marital status (p< 0.001), education (p=0.001), incomes (p < 0.001), presence of comorbidities (p=0.004), and time of diagnosis (p < 0.001) showed a statistically significant difference in the comparison regarding sex. Conclusions: Most people living with HIV/AIDS who participated in this study were young, had low educational level and reported that they had been infected through sexual contact. In addition, when evaluating the differences regarding sex, it was identified that the variables education, income, comorbidities and time of diagnosis showed significant differences(AU)

Aspectos epidemiológicos del virus de inmunodeficiencia humana en costa rica / Epidemiological Aspects of the human immunodeficiency virus in Costa Rica

Resumen El virus de la imnumodeficiencia humana realizo el salto interespecie hace ya más de 100 años de los monos hacia los humanos, produciendo dos tipos de virus capaces de infectar al ser humano, el virus de la inmunodeficiencia humana tipo 1 y el tipo 2. Estos se han diseminado desde África al resto del mundo por diversas vías, llegando a Costa Rica en los años 80. Y desde entonces se han producido con cada año que pasa más casos nuevos, siendo el número de personas infectadas cada vez mayor que en el año anterior estudiado, sin hasta el momento poder frenar la diseminación del virus a pesar de los métodos de prevención existentes.

Abstract The Human Immunodeficiency Virus take an interspecie jump more than 100 years ago from the monkeys to the humans, by transforming into two types of viruses capable to infect the human being, the human immunodeficiency virus Type1 and type 2. This type of virus have spread from Africa to the rest of the world by different ways, arriving to Costa Rica in the 80´s. Since the arrival of the virus, every year, there have been reported more new cases, than the last year studied, and the efforts in prevention to stop the spread of the disease show no results.

Proptosis ocular a causa de la infección-enfermedad por VIH-sida / Ocular proptosis caused by HIV-AIDS infection-disease

RESUMEN Se presenta a un paciente que ingresó en el antiguo Hospital Provincial Clínico Quirúrgico Docente "José Ramón López Tabrane", de Matanzas. El motivo del ingreso fue una proptosis ocular derecha de instauración súbita en el curso de la infección-enfermedad por VIH-sida. Se le realizaron múltiples estudios para poder definir la causa, y, pese a imponer tratamiento oportuno, falleció a los 15 días del mismo. La epidemia de sida continúa creciendo mundialmente. El conocimiento de las manifestaciones oculares; tanto las alteraciones del segmento anterior como las del posterior, y las infecciones asociadas, permiten mayor posibilidad de preservar la función visual en estos pacientes (AU).

ABSTRACT We present the case of a patient who entered the former Provincial Teaching Clinical Surgical Hospital "José Ramón López Tabrane", of Matanzas. The cause of admission was a sudden right ocular proptosis in the course of an HIV-AIDS infection-disease. Many different studies were carried out to define the cause, and although he was timely treated, he died 15 days after the treatment. The AIDS epidemic is still growing around the world. The knowledge of ocular manifestations, the alterations of the anterior segment as much as the alterations of the posterior one, and the associated infections allow a higher possibility of preserving the visual function in these patients (AU).

Xerostomia em pacientes com HIV/ Aids: revisão sistemática de literatura

Introdução: a transmissão do vírus da imunodeficiênciahumana (HIV) leva à redução da resposta imunológicado indivíduo, podendo ocorrer alterações na cavidadebucal, entre elas, a xerostomia. Objetivo: por meio deuma revisão sistemática, este trabalho objetiva analisara presença e as correlações da presença de xerostomiaem pacientes HIV positivos ou com Aids. Métodos: foifeita busca nas bases de dados PubMed, SciELO e Lilacsutilizando os descritores "oral manifestations", "HIV","Aids" e "xerostomia", sendo os critérios de inclusãotrabalhos epidemiológicos descritivos e observacionaiscom no máximo 10 anos de publicação e em línguainglesa, portuguesa ou espanhola. Resultados: foramencontrados 162 artigos que, após critérios exclusivos,foram reduzidos a 15 trabalhos desenvolvidos em setepaíses, nos quais se encontraram valores variando entre2% e 76,2% na presença de xerostomia em pacientescom HIV/Aids, a maioria homens entre a terceira e aquarta década de vida. Conclusão: a xerostomia em pacientescom HIV/Aids necessita de diversas pesquisasclínicas, devido aos inúmeros fatores que podem ocasionara etiologia, além da grande divergência de resultadosencontrados. Estudos afirmam que patologias queacometem as glândulas salivares podem levar à sensaçãode boca seca nesses indivíduos e são decorrentesda utilização prolongada da terapia antirretroviral altamenteativa (Haart). (AU)

Introduction: the human immunodeficiency virus transmission reduces the immune response of individuals and may cause changes in the oral cavity, such as xerostomia. Objective: by means of a systematic review, the present study aims to analyze the presence and correlations of the presence of xerostomia in HIV+ patients or those living with AIDS. Methods: the databases PubMed, SciELO, and Lilacs were searched using the descriptors "oral manifestations", "HIV", "AIDS", and "xerostomia". Inclusion criteria consisted of observational descriptive epidemiological studies with up to 10 years of publication, in English, Portuguese, or Spanish. Results: a total of 162 articles were found, which after exclusive criteria were reduced to the quantity of 15 studies from seven countries. These studies found varying values in the presence of xerostomia in HIV/ AIDS patients, ranging from 2% to 76.2%, most of them in men between the third and fourth decades of life. Conclusion: xerostomia in HIV/AIDS patients requires several clinical studies due to the numerous factors that may cause the etiology, besides the great divergence of results found. Studies indicate that pathologies affecting the salivary glands may cause dry mouth sensation in these patients, which derives from the prolonged use of Highly Active Antiretroviral Therapy (HAART). (AU)

Infección por citomegalovirus en pacientes VIH/sida / Cytomegalovirus infection in HIV/ aids patients

El citomegalovirus (CMV) se considera un microorganismo oportunista común entre individuos con infección por el virus de inmunodeficiencia humana (VIH), agente causal del síndrome de inmunodeficiencia adquirida (Sida). La principal consecuencia de la replicación persistente del VIH es la reducción gradual del número de linfocitos T CD4+, lo que eventualmente conduce a la pérdida de la competencia inmunológica. El CMV humano pertenece a la familia de los herpes virus y con frecuencia produce enfermedades en diferentes órganos, principalmente cuando el conteo de linfocitos T CD4+ es muy bajo(AU)

The cytomegalovirus (CMV) is considered a common opportunist microorganism among individuals with human immunodeficiency virus (HIV), the causal agent of the acquired immunodeficiency syndrome (Aids). The main consequence of the persistent transduction of HIV is the gradual reduction of the number of T cells CD4+, which eventually causes loss of immunologic competition. This human virus belongs to the family of herpes virus and frequently produces diseases mainly in different organs when the T CD4+ count is very low(AU)