Inquérito de Conhecimento, Atitude e Prática sobre estilo de vida saudável em pessoas com HIV / Encuesta de Conocimientos, Actitudes y Prácticas sobre estilo de vida saludable en personas con VIH / Knowledge, Attitude and Practice survey on healthy lifestyle in people with HIV

Resumo Objetivo desenvolver e avaliar um inquérito de Conhecimento, Atitude e Prática sobre estilo de vida saudável em pessoas com vírus da imunodeficiência humana. Método estudo de desenvolvimento, com elaboração do inquérito por meio de revisão integrativa e análise das diretrizes; análise de conteúdo e aparência por 22 juízes especialistas; e análise semântica por 22 pacientes em acompanhamento ambulatorial. Mensurada a proporção de avaliações positivas dos itens, considerando-se percentual igual ou maior a 85%. Resultados o inquérito teve três domínios e sete eixos: doenças crônicas em pessoas com vírus da imunodeficiência humana; controle do peso corporal; alimentação saudável; prática de exercício físico; evitar fumo, álcool e drogas ilícitas; controle/redução do estresse; adesão aos antirretrovirais e outros medicamentos. Domínios conhecimento e atitude tiveram 10 perguntas, e o de prática, 11. Na avaliação pelos juízes especialistas, participaram enfermeiros, médicos e nutricionista, com concordância positiva dos itens acima de 85%. Os pacientes fizeram a análise semântica, com concordância positiva nos domínios de 100%. Conclusão e implicações para a prática o inquérito teve evidência de validade adequada, para ser utilizado por enfermeiros e outros profissionais de saúde, para subsidiar a assistência, estratégias educativas e pesquisas com pessoas vivendo com o vírus da imunodeficiência humana.

Resumen Objetivo elaborar y evaluar una encuesta de conocimientos, actitudes y prácticas sobre estilo de vida saludable en personas con virus de inmunodeficiencia humana. Método estudio de desarrollo, con la elaboración de la encuesta a través de una revisión y análisis integrador de las directrices; análisis de contenido y apariencia por 22 jueces expertos; y análisis semántico por 22 pacientes ambulatorios. Se midió la proporción de valoraciones positivas de los ítems, considerando un porcentaje igual o superior al 85%. Resultados la encuesta tuvo tres dominios y siete ejes: enfermedades crónicas en personas portadoras del virus de la inmunodeficiencia humana; control del peso corporal; alimentación saludable; ejercicio físico; evitación del tabaquismo, alcohol y drogas ilícitas; control/reducción del estrés; adherencia a los antirretrovirales y otros medicamentos. Los dominios conocimientos y actitudes tenían 10 preguntas y los dominios práctica tenían 11. En la evaluación de los jueces expertos, participaron enfermeros, médicos y nutricionistas, con concordancia positiva de los ítems superior al 85%. Los pacientes fueron sometidos a análisis semántico, con 100% de concordancia positiva en los dominios. Conclusión e implicaciones para la práctica la encuesta tuvo pruebas adecuadas de validez, para ser utilizada por enfermeros y otros profesionales de la salud, para apoyar la asistencia, las estrategias educativas y la investigación con personas que viven con el virus de la inmunodeficiencia humana.

Abstract Objective to develop and assess a Knowledge, Attitude and Practice survey on healthy lifestyle in people with human immunodeficiency virus. Method a development study, with the elaboration of survey through of an integrative review and analysis of the guidelines; content and appearance analysis by 22 expert judges; and semantic analysis by 22 outpatients. The proportion of positive assessments of the items was measured, considering a percentage equal to or greater than 85%. Results the survey had three domains and seven axes: chronic diseases in people with human immunodeficiency virus; body weight control; healthy eating; physical exercise; avoiding smoking, alcohol and illicit drugs; stress control/reduction; antiretroviral and other medication compliance. Knowledge and attitude domains had 10 questions, and practice domains had 11. In the assessment by expert judges, nurses, doctors and nutritionists participated, with positive agreement of items above 85%. Patients underwent semantic analysis, with 100% positive agreement in the domains. Conclusion and implications for practice the survey had adequate evidence of validity, to be used by nurses and other health professionals, to support care, educational strategies and research with people living with the human immunodeficiency virus.

Cotidiano de pessoas que vivem com VIH em Bissau, Guiné-Bissau: perspectivas, desafios e vulnerabilidades / Vida diaria de las personas que viven con VIH en Bissau, Guinea-Bissau: perspectivas, desafíos y vulnerabilidades / The daily life of people living with HIV in Bissau, Guinea-Bissau: perspectives, challenges and vulnerabilities

RESUMO Objetivo compreender as perspectivas e desafios no cotidiano de pessoas após a descoberta do viver com VIH em Bissau, Guiné-Bissau, tendo em vista diferentes contextos de vulnerabilidade. Método estudo exploratório-descritivo, que utilizou entrevista semiestruturada com 16 pessoas vivendo com VIH, acompanhadas em um hospital de Bissau. Empregou-se técnica de análise de conteúdo temática. Os relatos dos participantes foram analisados a partir de duas categorias empíricas: A descoberta, os impactos e os desafios de viver com VIH; e Experiência com o antirretroviral: recomeço e perspectivas. Resultados sinalizaram que os desafios iniciam com a revelação do diagnóstico que, geralmente, desperta uma diversidade de sentimentos e comportamentos. O estigma e a discriminação estimulam a adoção do sigilo sobre o status sorológico, resultando na fragilidade de suporte emocional no enfrentamento à soropositividade. A terapia antirretroviral foi vislumbrada como esperança para o enfrentamento da doença. A vulnerabilidade social foi a dimensão que mais se destacou, e violações dos direitos humanos foram constatadas. Conclusão e implicações para a prática o estudo permite compreender as perspectivas, desafios e vulnerabilidades de pessoas que vivem com VIH. O viver com VIH merece atenção especial por parte dos profissionais de saúde que atuam no cuidado dessas pessoas, destacando-se como contribuição a relevância de um cuidado de saúde integral, em que a ética e a subjetividade estejam presentes.

RESUMEN Objetivo este estudio cualitativo tuvo como objetivo comprender perspectivas y desafíos en la vida cotidiana de las personas que viven con VIH en Bissau, Guinea-Bissau, considerando diferentes contextos de vulnerabilidad. Método estudio exploratorio-descriptivo, que utilizó una entrevista semiestructurada con 16 personas que viven con el VIH, seguido en un hospital de Bissau. Se utilizó la técnica de análisis de contenido temático. Los informes de los participantes se analizaron a partir de dos categorías empíricas: El descubrimiento, los impactos y los desafíos de vivir con el VIH; y La experiencia antirretroviral: un nuevo comienzo y perspectivas. Resultados los resultados indicaron que los desafíos comienzan con la divulgación del diagnóstico, que generalmente suscita una diversidad de sentimientos y conductas. El estigma y la discriminación fomentan la adopción del secreto sobre el estado serológico, lo que resulta en un apoyo emocional débil para hacer frente a la seropositividad. La terapia antirretroviral es una esperanza para hacer frente a la enfermedad. La vulnerabilidad social fue la dimensión que más se destacó y se encontraron violaciones a sus derechos humanos. Conclusión e implicaciones para la práctica el estudio permite comprender las perspectivas, los desafíos y las vulnerabilidades de las personas que viven con el VIH. Vivir con VIH merece especial atención por parte de los profesionales de la salud que actúan en el cuidado de estas personas, destacando como aporte la relevancia de la atención integral en salud, en la que la ética y la subjetividad están presentes.

ABSTRACT Objective to understand perspectives and challenges in the daily lives of people after the discovery of living with HIV in Bissau, Guinea-Bissau, considering different contexts of vulnerability. Method an exploratory-descriptive study conducted through semi-structured interviews with sixteen people living with HIV attending a hospital in the city of Bissau. We used the thematic content analysis technique. Participants' reports were analyzed following two empirical categories: Discovery, impacts and challenges of living with HIV; and Experience with antiretroviral therapy: new beginning and perspectives. Results the results indicate that the challenges start with the disclosure of diagnosis, which arouses a diversity of feelings and behaviors. Stigma and discrimination encourage the adoption of confidentiality about serological status, which increases the fragility of emotional support in coping with seropositivity. Antiretroviral therapy was seen as a hope for coping with the disease. Social vulnerability was the dimension that stood out the most, and human rights violations involving people living with HIV were verified. Conclusion and implications for practice the study makes it possible to understand the perspectives, challenges and vulnerabilities of people living with HIV. Living with HIV deserves special attention from health professionals who work in the care of these people, highlighting as a contribution the relevance of comprehensive health care, in which ethics and subjectivity are present.

Le taux de lymphocytes T CD4 au diagnostic de la séropositivité au virus de l'immunodéficience humaine à Libreville, 2022 / CD4 T lymphocyte count at diagnosis of human immunodeficiency virus seropositivity in Libreville, 2022

Introduction. L'efficacité du traitement antirétroviral dans la restauration immunitaire dépend fortement du stade de l'infection et du taux de lymphocyte TCD4 au moment de l'introduction du traitement. Nous avons évalué le taux de lymphocytes TCD4 à la découverte de la séropositivité au VIH pour caractériser le niveau d'infection de chaque patient. Matériel et méthodes. C'est une étude transversale et descriptive qui s'est déroulée dans le laboratoire de virologie de la faculté de médecine de Libreville. Nous avons analysé les données de la cohorte DERIRADO. Résultats. Nous avons inclus 133 patients. L'âge médian était de 45 ans (Q1-Q3 :37 ; 52). La médiane de LTCD4 était de 388 cellules/mm3 (Q1-Q3 : 250 ; 556). Le diagnostic était avancé chez 112 (84%) patients. Conclusion. La découverte de la séropositivité au Virus de l'Immunodéficience Humaine est faite à un stade d'immunodépression avancé chez la majorité des patients. Ce constat relève la nécessité de mettre en route les politiques de sensibilisation pour cibler les populations clés et amener le plus grand nombre au dépistage de l'infection par le Virus de l'Immunodéficience Humaine si l'on veut diminuer la courbe de transmission.

Introduction. The effectiveness of antiretroviral therapy in immune restoration largely depends on the stage of infection and the TCD4 lymphocyte count at the time of treatment initiation. We evaluated the rate of TCD4 lymphocytes at the discovery of HIV seropositivity to characterize the level of infection of each patient. Methods. This was a cross sectional descriptive and analytic study whose setting was the laboratory of virology of the faculty of medicine of Libreville. Our data source was DERIRADO cohort. Results. We included 133 patients. The median age was 45 (Q1- Q3:37;52). The median LTCD4 was 388 cells/mm3 (Q1-Q3: 250; 556). The diagnosis was advanced in 112 (84%) patients. Conclusion. The diagnosis of seropositivity to the Human Immunodeficiency Virus is made at a stage of immunosuppression in the majority of patients. This highlights the need to implement sensitization policies to target key populations and bring as many people as possible to screening in order to reduce the transmission curve

Religiosidade/espiritualidade e adesão à terapia antirretroviral em pessoas vivendo com HIV / Religiosity/spirituality and antiretroviral therapy adherence in people living with HIV / Religiosidad/espiritualidad y adhesión a la terapia antirretroviral en personas viviendo con VIH

Dentre os fatores associados à adesão à Terapia Antirretroviral (TARV) em pessoas vivendo com HIV, destaca-se a religiosidade/espiritualidade (R/E). O objetivo deste estudo foi apresentar as evidências disponíveis sobre a relação entre a dimensão da R/E e a adesão aos antirretrovirais. Realizou-se uma revisão integrativa de literatura com buscas nas bases/bibliotecas CINAHL, LILACS, PePSIC, PsycINFO, PubMed, SciELO, Scopus e Web of Science. Foram selecionados artigos empíricos publicados entre janeiro de 2008 e junho de 2019, sendo recuperados 49 estudos após a aplicação dos critérios de inclusão/exclusão. Encontraram-se associações positivas, negativas e neutras entre R/E e adesão à TARV, evidenciando que a R/E é uma dimensão psicossocial que pode ser preditora da adesão aos antirretrovirais. O sentido dessa influência, no entanto, ainda não é um consenso na literatura científica. Recomenda-se que essas influências sejam compreendidas a partir de elementos contextuais dessa população e não apenas de marcadores pessoais (AU).

Religiosity and spirituality (R/S) have stood out among factors associated with adherence to antiretroviral therapy (ART) in people living with HIV. This study aimed to identify evidence on the relationship between R/S and adherence to ART. An integrative literature review was conducted within the CINAHL, LILACS, PePSIC, PsycINFO, PubMed, SciELO, Scopus, and Web of Science databases. Empirical articles published between January 2008 and June 2019 were selected, and 49 studies were retrieved after applying the inclusion/exclusion criteria. Positive, negative, and neutral associations were found between R/S and adherence to ART, showing that R/S is a psychosocial dimension that can be a predictor of adherence to antiretrovirals. The meaning of this influence, however, is not yet a consensus in the scientific literature. It is recommended that these influences be understood from the contextual elements of this population and not just from personal markers (AU).

Entre los factores asociados a la adherencia a la Terapia Antirretroviral (TARV) en personas diagnosticadas con VIH, destaca la religiosidad/espiritualidad (R/E). El objetivo de este estudio fue presentar las evidencias disponibles sobre la relación entre la dimensión de la R/E y la adherencia a los antirretrovirales. Se realizó una revisión integradora de la literatura con búsquedas en las bases de datos/bibliotecas CINAHL, LILACS, PePSIC, PsycINFO, PubMed, SciELO, Scopus y Web of Science. Se seleccionaron artículos empíricos publicados entre enero de 2008 y junio de 2019, y se recuperaron 49 estudios tras aplicar los criterios de inclusión/exclusión. Fueron encontradas asociaciones positivas, negativas y neutras entre la R/E y la adherencia al TARV, lo que demuestra que la R/E es una dimensión psicosocial que puede ser un predictor de la adherencia a los medicamentos antirretrovirales. Sin embargo, el significado de esta influencia aún no está consensuado en la literatura científica. Se recomienda que estas influencias se entiendan a partir de los elementos contextuales de esta población y no solo de los marcadores personales (AU).

Sociodemographic and pharmacoepidemiological profile of people on antiretroviral therapy in the coast of the state of Paraná

The aim of this study was to investigate possible factors related to antiretroviral therapy (ART) that contribute to the understanding of the highest rate of Aids detection on the coast of the state of Paraná, a port region identified administratively as the 1stRegional Health Division (1stHD) in the state of Paraná. Data on the sociodemographic profile of the population undergoing antiretroviral treatment (ART), medication changes, dropout of therapy, proportion of the population undergoing treatment and viral load were obtained through computerized systems. Between July 1, 2018 and June 31, 2019, 1,393 people were on ART in the 1stRS. Of these, 57.6% were male. During this period, 110 people started ART with a predominance of the age group between 30 and 39 years old. ART was switched for169 people and 211 patient dropouts were detected. The proportion of people diagnosed with HIV without treatment (gap) is still high, however 92.7% people on ART have suppressed viral load. It can be concluded that the lower educational level of the population undergoing treatment, the late diagnosis of those infected and the treatment gapprobably contribute to the highest rate of Aids detection in the 1stRS.

Pharmacovigilance of antiretroviral dolutegravir in the state of Paraná

The aim of this study was to investigate adverse reactions to Dolutegravir, a drug recently made available by the Unified Health System (SUS) for treating HIV infections. The frequency, severity and sex distribution of adverse reactions to Dolutegravir were identified over the first 18 months of its availability in users in the state of Paraná. Information was obtained through the pharmacovigilance questionnaire prepared by the Ministry of Health, accessed through the Logistics Control System for Medicines(SICLOM). During the study period, dolutegravirwas dispensed to 9,865 patients in the state. However, 9,207 users (93.3%) answered the pharmacovigilance questionnaire. Among them, 1.75% reported 279 adverse reactions. This population was composed mainly of male people (69.57%), in the ratio of 2.29 men for each woman, white (67.08%), aged between 20 and 29 years (26.71%), single (45.34%) and with education between 8 and 11 years of study (41.61%). Gastrointestinal (36.92%) and nervous system (14.34%) disorders were the most prevalent. 77.78% adverse reactions were considered non-serious by users. It can be concluded that dolutegravirhad a low prevalence of adverse reactions in users in the state of Paraná, demonstrating to be safe for use by the population in therapy against HIV, in accordance with clinical trials.

Time trend and causes of HIV/AIDS mortality in the state of Santa Catarina, 2010­2019 / Tendência temporal e causas de mortalidade por HIV/AIDS no estado de Santa Catarina, 2010­2019

Introduction: Although the acquired immunodeficiency syndrome (AIDS) has no cure, antiretroviral treatment has considerably increased the survival of people living with the disease or with the human immunodeficiency virus (HIV), reducing the incidence of opportunistic infections in these patients. Thus, this treatment changed mortality rates and diversified the causes of death, including reasons related to increased longevity, such as chronic noncommunicable diseases, common in the uninfected population. Therefore, the current epidemiological transition motivated us to study the death profile of people with HIV/AIDS in the state of Santa Catarina. Objective: To investigate case characteristics, as well as the time trend and distribution of deaths, among people with HIV/AIDS in Santa Catarina between 2010 and 2019. Methods: In this ecological, epidemiological study, we consulted all death records from the Santa Catarina Mortality Information System that had HIV/AIDS among the causes and occurred between 2010 and 2019. Results: A total of 5,174 death records were analyzed. In the period, the mean mortality rate among people with HIV/AIDS was 7.64 deaths per 100 thousand inhabitants (95% confidence interval ­ 95%CI 6.61­8.67) ­ 8.99 in 2010 and 6.06 in 2019 ­, showing a downward trend of 0.38% per year. Conclusion: We identified a downward trend in mortality. Deaths were concentrated on the coast, in more populous cities. Furthermore, the finding of improper completion of the death certificate points to the need to invest in improving the training of professionals responsible for this document.

Introdução: Embora a síndrome da imunodeficiência adquirida (AIDS) não tenha cura, o tratamento antirretroviral aumentou consideravelmente a sobrevida das pessoas que vivem com a doença ou com o vírus da imunodeficiência humana (HIV), diminuindo a ocorrência de infecções oportunistas nesses pacientes. Assim, esse tratamento mudou as taxas de mortalidade e diversificou as causas de óbito, incluindo motivos relacionados ao aumento da longevidade, como doenças crônicas não transmissíveis comuns à população não infectada. Dessa forma, a atual transição epidemiológica motiva o estudo do perfil dos óbitos em pessoas com HIV/AIDS no estado de Santa Catarina. Objetivo: Investigar as características dos casos, a tendência temporal e a distribuição dos óbitos em pessoas com HIV/AIDS no estado de Santa Catarina entre os anos de 2010 e 2019. Métodos: Neste estudo epidemiológico com delineamento ecológico, foram consultados todos os registros de óbitos do Sistema de Informação sobre Mortalidade de Santa Catarina ocorridos entre os anos de 2010 e 2019 que apresentassem entre as causas o HIV/AIDS. Resultados: Foram analisados 5.174 registros de óbitos. A taxa de mortalidade média entre pessoas com HIV/AIDS do período foi de 7,64 óbitos a cada 100 mil habitantes (95% intervalo de confiança ­ IC95% 6,61­8,67), sendo de 8,99 em 2010 e 6,06 em 2019, mostrando tendência de queda de 0,38 pontos percentuais ao ano. Conclusão: Observou-se tendência de queda na mortalidade. A concentração dos óbitos foi na faixa litorânea, em cidades mais populosas. Ademais, a constatação do falho preenchimento da declaração de óbito aponta para a necessidade de investir no aprimoramento do treinamento dos profissionais responsáveis por esse documento.

Fatores relacionados à sarcopenia em pessoas vivendo com o vírus da imunodeficiência humana / Sarcopenia-relate factors in people living with human immunodeficiency virus

As terapias antirretrovirais (TARVs) aumentaram a expectativa de vida de pessoas vivendo com HIV (PVHIV). Contudo, os efeitos residuais do HIV e a toxicidade das TARVs parecem prejudicar a integridade do músculo esquelético (ME), deixando as PVHIV mais suscetíveis à sarcopenia. Assim, os objetivos deste estudo foram: (i) compreender os mecanismos fisiopatológicos que explicam o motivo pelo qual PVHIV são mais suscetíveis à sarcopenia; (ii) rastrear entre as PVHIV e que não vivem com HIV (PNVHIV) a prevalência de estar sob risco de sarcopenia, a qualidade de vida relacionada à sarcopenia e os fatores associados; (iii) verificar a prevalência de sarcopenia e dinapenia entre as PVHIV, comparar os componentes da sarcopenia em relação às PNVHIV e verificar os fatores associados aos componentes da sarcopenia; (iv) identificar na literatura científica os estudos que avaliaram o efeito de intervenções nutricionais sobre os parâmetros relacionados ao ME de PVHIV. Assim, quatro artigos foram redigidos para responder cada um dos objetivos descritos acima, incluindo uma revisão narrativa (RN), dois estudos transversais e uma revisão sistemática (RS). Para a RN, estudos pré-clínicos e clínicos foram identificados no MEDLINE/PubMed utilizando as palavras-chave "HIV", "Sarcopenia" e "Antirretrovirais". Nos estudos de delineamento transversal, foram avaliadas PVHIV atendidas no Serviço de Extensão ao Atendimento de Pacientes HIV/AIDS que foram comparadas às PNVHIV. No inquérito virtual foram aplicados o SARC-F e o SarQoL® para identificar a prevalência de estar sob risco de sarcopenia (≥ 4 pontos) e a qualidade de vida relacionada à sarcopenia (abaixo da mediana do escore geral), respectivamente. No estudo presencial foram avaliados a força de preensão manual (FPM), o índice de massa magra apendicular (IMMA), a velocidade de marcha (VM) e os fatores associados à sarcopenia. Em seguida, foi comparada a prevalência de sarcopenia, dinapenia e obesidade dinapênica entre as PVHIV e PNVHIV. Ambos os estudos foram compostos por homens e mulheres com idade ≥18 anos, residentes no estado de São Paulo. Finalmente, a RS foi registrada no prospero CRD42019139981 e seguiu os critérios PICOS para condução da busca. Os dados da RN revelaram que fatores como a inflamação sistêmica, desordens metabólicas e disfunção mitocondrial proveniente das TARVs aumentam a chance de PVHIV desenvolverem sarcopenia. O inquérito virtual (n= 344; 45,5±13,1 anos; 211 PVHIV) revelou que 10,43% (95 % IC: 6,6 - 15,4%) e 0,75% (95% IC: 1,90e-4 ­ 4%) das PVHIV e PNVHIV estão sob risco de sarcopenia, respectivamente. Similar, PVHIV apresentam pior qualidade de vida relacionada à sarcopenia e os problemas com o sono (OR 7,343; 95 % IC: 3,261 ­ 16,536; p< 0,001) e a obesidade (OR 4.945; 95% IC: 1,597 ­ 15,304; p= 0.006) são os principais fatores positivamente associados, ao passo que a prática regular de exercícios físicos está associada a melhor qualidade de vida relacionada à sarcopenia (OR 0.173; 95% IC: 0,080 ­ 0,375; p< 0,001). O estudo presencial (n= 70; 45,5±7,73 anos; n= 35 PVHIV) revelou que PVHIV e PNVHIV não atenderam os critérios para sarcopenia; entretanto, as PVHIV apresentaram menor FPM (­6,68 kg; p= 0,005) comparativamente às PNVHIV. Ainda, a razão massa gorda: massa magra foi o principal fator associado à menor FPM (ß= -15,476; p< 0,001). O IMMA não diferiu entre os grupos (-0,138 kg/m2; p= 0,641). Finalmente, na RS, nenhuma intervenção nutricional proposta entre os estudos promoveu aumento da massa muscular em PVHIV.

Antiretroviral therapies (ARTs) have increased the life expectancy of people living with HIV (PLWH). However, residual effects of HIV and toxicity from ARTs appear to impair skeletal muscle (SkM) integrity, leaving PLWH more susceptible to sarcopenia. Thus, this study's purpose was: to comprehend the pathophysiological mechanisms that explain why PLWH are more susceptible to sarcopenia; (ii) to verify among PLWH and not living with HIV (PNLWH) the prevalence of living at risk of sarcopenia, sarcopenia-related quality of life, and associated factors; (iii) to verify the prevalence of sarcopenia and dynapenia among PLWH, to compare the components of sarcopenia with PNVHIV and to verify the factors associated with the features of sarcopenia; (iv) to identify the studies that evaluated the effect of nutritional interventions on the SkM-related parameters. Thus, four articles were written to answer each of the purposes, including one narrative review (NR), two cross-sectional studies, and one systematic review (SR). For the NR, preclinical and clinical studies were identified in MEDLINE/PubMed using the keywords "HIV," "Sarcopenia," and "Antiretrovirals." In the cross-sectional design studies, PLWH was evaluated and compared to PNLWH. In the web-based survey, SARC-F and SarQoL® were applied to identify at risk of sarcopenia (≥ 4 points) prevalence and lower sarcopenia-related quality of life (below overall score median), respectively. In the second study, handgrip strength (HGS), appendicular lean mass index (ApLMI), walking speed (WS), and factors associated with sarcopenia were evaluated. Consequently, the prevalence of sarcopenia, dynapenia, and dynapenic obesity among PLWH and PNLWH was compared. Both studies were composed of men and women aged ≥ 18 years, residing in the state of São Paulo. Finally, the SR was registered in the PROSPERO CRD42019139981 and followed the PICOS criteria for searching. The data from the NR revealed that factors such as systemic inflammation, metabolic disorders, and mitochondrial dysfunction arising from ARTs increase the odds of PLWH being sarcopenic. The web-based survey (n= 344; 45.5±13.1 years; 211 PLHIV) revealed that 10.43% (95% CI: 6.6 - 15.4%) and 0.75% (95% CI: 1.90e-4 - 4%) of PLWH and PNLWH are at risk of sarcopenia, respectively. Similar, PLWH have worse sarcopenia-related quality of life and sleep problems (OR 7.343; 95% CI: 3.261 - 16.536; p< 0.001) and obesity (OR 4.945; 95% CI: 1.597 - 15.304; p= 0.006) are the main positively associated factors, whereas regular exercise is associated with lower odds to poor sarcopenia-related quality of life (OR 0.173; 95% CI: 0.080 - 0.375; p< 0.001). The second transversal study (n= 70; 45.5±7.73 years; n= 35 PLHIV) revealed that PLWH and PNLWH did not meet criteria for sarcopenia; however, PLWH had lower HGS (-6.68 kg; p= 0.005) compared to PNLWH. Also, the fat mass: lean mass ratio was the main factor associated with lower HGS (ß= -15.476; p< 0.001). ApLMI did not differ between groups (-0.138 kg/m2; p= 0.641). Finally, no nutritional intervention in SR promoted increased muscle mass in PLWH.

Assistência de enfermagem e adesão à terapia antirretroviral / Nursing assistance and adherence to antiretroviral therapy / Asistencia de enfermería y adherencia a la terapia antiretroviral

Objetivo: analisar a classificação da adesão e a organização da assistência de enfermagem em serviços especializados. Método: estudo avaliativo e transversal, com abordagem quantitativa, realizado em cinco Serviços de Assistência Especializada em HIV de Pernambuco, Brasil. Participaram 358 adultos em uso de antirretrovirais e os respectivos enfermeiros dos serviços. Os dados foram coletados por meio de dois instrumentos validados e analisados a partir dos testes estatísticos. Resultados: houve prevalência de uma regular e baixa adesão à terapia antirretrovital. (41,1% e 39,4%, respectivamente). Evidenciou-se que o nível de avaliação da assistência de enfermagem não foi determinante para o escores da adesão. Conclusão: o resultado encontrado no estudo é preocupante, visto a que adesão predominante foi regular. Desenvolver a sistematização da assistência de enfermagem nos serviços especializados deve ser estimulado com vistas à promoção da adesão medicamentosa

Objective: to analyze the classification of adherence and the organization of nursing care in specialized services. Method: evaluative and cross-sectional study, with a quantitative approach, carried out in five Specialized HIV Care Services in Pernambuco, Brazil. Participated 358 adults using antiretrovirals and the respective service nurses. Data were collected using two validated instruments and analyzed using statistical tests. Results: there was a prevalence of regular and low adherence to antiretrovital therapy. (41.1% and 39.4%, respectively). It was evident that the level of assessment of nursing care was not decisive for the adherence scores. Conclusion: the result found in the study is worrying, since the predominant adherence was regular. Developing the systematization of nursing care in specialized services should be encouraged with a view to promoting medication adherence

Objetivo: analizar la clasificación de adherencia y la organización del cuidado de enfermería en servicios especializados. Método: Estudio evaluativo y transversal, con un enfoque cuantitativo, realizado en cinco servicios especializados de atención del VIH en Pernambuco, Brasil. Participaron 358 adultos usando antirretrovirales y las respectivas enfermeras de servicio. Los datos fueron recolectados usando dos instrumentos validados y analizados usando pruebas estadísticas. Resultados: hubo una prevalencia de adherencia regular y baja al tratamiento antirretrovital. (41,1% y 39,4%, respectivamente). Era evidente que el nivel de evaluación de los cuidados de enfermería no fue decisivo para los puntajes de adherencia. Conclusión: el resultado encontrado en el estudio es preocupante, ya que la adherencia predominante fue regular. Se debe fomentar el desarrollo de la sistematización de la atención de enfermería en servicios especializados con el fin de promover la adherencia a la medicación

Opportunistic Infections and associated factors among HIV infected patients on anti-retroviral treatment at Bombo Hospital in Tanga Region, Tanzania

Background: A substantive number of People Living with HIV (PLHIV) develop Opportunistic Infections (OIs). The introduction of Anti-Retroviral Therapy (ART) in Tanzania led to a significant decline in opportunistic infections and a slower progression to AIDS, but OIs are still prevalent. This study was set to determine the magnitude of OIs and associated factors among HIV/AIDS patients on Anti-Retroviral Therapy (ART) attending care and treatment clinic at Bombo Regional Referral hospital, Tanga region. Materials And Methods: A cross­sectional descriptive study was conducted on HIV/AIDS patients on ART attending Bombo Hospital in Tanga from July to October 2019. A non-probability, consecutive sampling technique was employed to obtain study participants. Data were collected using available data obtained from the patients' files, hospital record books and interviews of study participants by using semi-structured questionnaires. Data were entered into the computer using Excel 2013, cleaned and analysed using Epi Info version 7.2.2.6. Any p-value of < 0.05, at a 95% confidence interval was regarded as statistically significant. Results : The study showed that out of the 360 participants, 126 cases (35.0%) of OIs were reported. Pulmonary Tuberculosis had the highest prevalence of 18.0% among PLHIV while other opportunistic Infections altogether contributed 17.0%. Late ART initiation (OR=10.9, 95% CI: 6.5 ­ 18.3, p-value <0.001), Poor drug adherence (OR=19, 95% CI: 9.0 ­ 39.7, p-value <0.001), female gender (69% vs. 31%), which was however, not statistically significant (p-value ­ 0.904), Informal and Primary School education (OR = 1.6, 95% CI: 1.1 ­ 1.6, p-value 0.04) being married (OR=2.1, 95% CI: 1.3 ­ 3.4, p ­ value 0.004) and widowed/widower (OR=7.7, 95% CI: 1.7 ­ 33.7, p ­ value 0.007) respectively were found to be associated with OIs to PLHIV.CONCLUSION : The rate of OIs still high among PLHIV, Pulmonary Tuberculosis is the leading disease with 18.0% of all OIs symptomatic patients. Delay in ART initiation after positive test results, poor drug adherence and moderate malnutrition have been identified as major risk factors affecting 66.0%, 70.0%, 71%of PLWHA with OIs. We recommend early initiation of ART, Education on ART adherence and refilling of large quantities of ARV drugs to individuals working far from their homes.

Correlates of hypertension among persons living with HIV at Livingstone Central Hospital: A cross sectional study

Background: Persons living with HIV (PLWH) are more likely to develop hypertension and cardiovascular disease than the HIV-negative population. The new hypertension guidelines by the American Heart Association (AHA) and the American College of Cardiology (ACC) lowered the definition of hypertension from systolic and diastolic blood pressure (BP) of ≥ 140/90mmHg to ≥ 130/80, respectively. This study was aimed at determining the prevalence and factors associated with hypertension in PLWH in Livingstone using the new hypertension diagnostic criteria. Methods: This was a cross-sectional study. We recruited 226 antiretroviral treated PLWH attending routine visits. Socio-demographic, health and clinical data including BP readings were collected. Interviewer-structured questionnaires adapted from the World Health Organization Stepwise approach to Surveillance ( WHO STEPs) and the international physical activity questionnaire (IPAQ) were used to collect data. Statistical evaluations were employed to elucidate relationships between hypertension and all response variables. Results: The prevalence of hypertension using the old and new guidelines was 16% and 42%, respectively. Factors significantly associated with increased and reduced odds of developing hypertension after adjustments in multivariate logistic regression were age, body mass index (BMI), employment status, fasting blood sugar (FBS) and table salt consumption, respectively (p<0.05 for all). Using the new AHA/ACC criteria for hypertension shifted the prevalence from 16% (old criteria) to 42%.Conclusion: The prevalence of hypertension in PLH in Livingstone was 42% and the major risk factors associated with hypertension in PLWH were increasing age, BMI and FBS. We recommend the inclusion of FBS in routine measurements in PLWH. The AHA/ ACC new guidelines should be reenforced in low-cost settings to increase the treatment of hypertension among PLWH.

Challenges encountered by human immunodeficiency virus positive pregnant women on taking antiretrovirals in a public health unit of the Manzini region, Swaziland

In Swaziland, the Ministry of Health adopted the prevention of mother-to-transmission (PMTCT) Option A as a feasible and less costly way to expand the PMTCT services nationwide. Despite major success since the programme started, some barriers, such as the challenge of follow-up care for human immunodeficiency virus (HIV)-positive pregnant mothers still exist. The present study aimed to describe the challenges that HIV-positive pregnant mothers encountered on taking antiretrovirals (ARVs) in a health unit of the Manzini region, Swaziland. A qualitative, exploratory and descriptive research design was used, and data were collected through semi-structured individual interviews and field notes. Purposive sampling was used to select the study site and the population. Permission was requested from the participants to record the interviews. The study population were HIV-positive pregnant mothers, aged between 18 and 40 years, which were enrolled in the PMTCT B+ programme. The PMTCT B+ programme was perceived as preventing the transfer of HIV transmission from mother to child. It boosts the mother's immune system, prevents opportunistic infections and prolongs life. Challenges of taking ARVs emerged as a theme. The participants displayed knowledge and understanding of the programme, yet discrimination and no support from families and partners were mentioned. (Afr J Reprod Health 2022; 26[5]: 41-49).

Family APGAR and treatment outcomes among HIV patients at two ART Centers in Kumasi, Ghana

objectives: This study aimed to examine the association between Family Adaptability, Partnership, Growth, Affection and Resolve (Family APGAR) and HIV treatment outcomes. Design: A cross-sectional study using the Family APGAR questionnaire Setting: The study was conducted in Kumasi, Ghana, at the Komfo Anokye Teaching Hospital and the Kwame Nkrumah University of Science and Technology Hospital Participants: Consenting HIV-positive patients who had been on treatment for at least 12 months were recruited. Main outcome measures: The Family APGAR questionnaire was administered, and relevant data were extracted from hospital records and analysed using STATA® software. The relationship between Family APGAR and treatment outcomes was determined using Chi-squared tests or Fisher's exact test. Results: Approximately 70.1% of 304 participants were females with a mean age of 41.8 years (±9.9). At treatment initiation, 47.4% of the patients presented at World Health Organisation (WHO) clinical stages I and II and had a CD4 count ≥ 200 cells/mm3 . Females were less likely (Odds Ratio= 0.52; 95% CI=0.31 ­ 0.90, p = 0.018) to report late for treatment compared with the males. After 12 months of treatment, approximately 70% recorded undetectable viral load. Patients with functional families constituted 70.4%, which had a statistically significant relationship with viral load (p = 0.041). Conclusion: HIV care providers should incorporate family functionality evaluation into clinical practice and provide early essential support to enhance treatment outcomes

Barriers and facilitators to adherence for antiretroviral therapy the perspectives of patients from a wellness center in the Mpumalanga Province, South Africa

Introduction. Patients' non-adherence to antiretroviral treatment remains a public health concern in many developing countries, especially in South Africa. Objectives: The objective of the study was to explore the barriers and facilitators of patients' ART adherence in one health care facility in Mpumalanga Province, South Africa. Methods: A qualitative, exploratory, and descriptive design was employed to collect data using a semi-structured interview guide through individual in-depth interviews among twenty (20) purposively selected patients. The thematic analysis approach was used to generate themes from the data. Results: A majority of the participants were female (n=12, 60%), married (n=13, 65%), and employed (n=12, 60%). Barriers to ART adherence include insufficient medical staff at the health center and waiting time being too long. Facilitators included service providers' positive attitude, clear instructions for taking medication, benefits of adhering to ART, and dangers of defaulting treatment. Conclusion: Barriers and facilitators for adherence included several factors related to the health system, health care workers, and the patients. Achievement of optimal adherence to ART requires the commitment of both patients and providers

Violência sexual e adesão ao protocolo de atendimento de um hospital do sul do Brasil / Sexual violence and adherence to the protocol of attendance of a south brazil hospital

Objetivo: Descrever os casos de violência sexual, identificar as características sociodemográficas das vítimas e da agressão, verificar a adesão à quimioprofilaxia e a realização de coletas sorológicas de um Hospital Geral do Sul do Brasil, durante o período de janeiro de 2007 a dezembro de 2017. Métodos: Delineamento de coorte histórica em que foram analisadas as fichas de notificação compulsória e dados do prontuário, entre janeiro de 2007 a dezembro 2017. Resultados: No período, 118 pessoas procuraram atendimento hospitalar por violência sexual. A mediana de idade das vítimas foi de 14 (IIQ 12,25), variando de 1 a 78 anos. Houve predomínio de notificações entre mulheres (84,7%), raça branca (83,9%), escolaridade de 0 a 8 anos de estudo (43,2%), solteira (63,6%). Identificou-se um caso reagente para sífilis, e somente 5,9% tiveram adesão ao seguimento proposto. Conclusão: A baixa adesão ao protocolo de atendimento aumenta os riscos à saúde e chance de sequelas pelo agravo, sendo necessária outras estratégias dos serviços para ações de continuidade das ações profiláticas e terapêuticas. (AU)

Objective: Describe the cases of sexual violence, identify the sociodemographic characteristics of the victims and the aggression, verify adherence to chemoprophylaxis and the performance of serological collections at a General Hospital in Southern Brazil, from January 2007 to December 2017. Methods: A historical cohort study in which compulsory notification forms and medical record data were analyzed from January 2007 to December 2017. Results: During the years of the study, 118 people looked for a hospital care for sexual violence. The average age of the reported victims was 14 (IQ 12.25), ranging from 1 to 78 years of age. The reports were predominant among women (84.7%), white race (83.9%), low education with 0-8 years of schooling (43,2%), single (63.6%). A reactive case for syphilis was identified, and only 5.9% adhered to the proposed follow-up. Conclusion: The low adherence to the protocol of care increases the health risks and chance of sequel by the injury, requiring other strategies of the services for continuity of prophylactic and therapeutic actions. (AU)

Objetivo: Describir los casos de violencia sexual, identifique las características sociodemográficas de las víctimas y la agresión, verifique la adhesión a la quimioprofilaxis y la realización de colectas serológicas en un Hospital General del Sur de Brasil, desde enero de 2007 hasta diciembre de 2017. Métodos: Delineamiento de corte histórica en que fueron analizadas las fichas de notificación compulsoria y de datos del prontuario, entre enero de 2007 a diciembre de 2017. Resultados: En el período, 118 personas buscaron atendimiento hospitalario por violencia sexual. La media de edad de las víctimas fue de 14(IIQ 12,25), variando de 1 a 78 años. Hubo predominio de notificaciones entre mujeres (84,7%) raza blanca (83,9%), escolaridad de 0 a 8 años de estudio (43,2%), soltera (63,6%). Se identificó un caso positivo de sifilis y solamente 5,9% tuvieron adhesión al seguimiento propuesto. Conclusión: la baja adhesión al protocolo de atendimiento aumenta los riesgos a la salud y la chance de sequelas pelo agravamiento, siendo necesaria otras estrategias de los servicios para acciones de continuidad de las acciones profilácticas y terapéuticas. (AU)

Resistencia antirretroviral en pacientes con virus de inmuno- deficiencia humana en Hospital Nacional Mario Catarino Rivas / Resistance to antiretroviral drugs in patients with human immunodeficiency virus in Mario Catarino Rivas National Hospital

Introducción: La terapia antirretroviral de primera línea utilizada en el país desde hace varios años, consiste en un inhibidor de la transcriptasa reversa no nucleósido con dos inhibidores de la transcriptasa reversa nucleósidos, está asociada al fallo terapéutico y se ha reportado resis- tencia a la misma. Objetivo: conocer la resistencia a la terapia antirretroviral de primera línea en pacientes tratados por Virus de Inmunodeficiencia Humana en Hospital Nacional Mario Catarino Rivas desde octubre 2016 al 2017. Pacientes y métodos: Investigación observacio- nal, descriptiva; tipo cohorte transversal, retrospectiva. Población de 313 pacientes a quienes se le realizó prueba de genotipo, de los cuales se tomaron como muestra 291 pacientes distri- buidos por grupos: sin previa exposición a antirretrovirales, pediátricos, con 12 meses de trata- miento y 48 o más meses de tratamiento a quienes se les realizó prueba de genotipo. Resulta- dos: Hubo amplificación en el 52% (152) de los pacientes, de los cuales el 56% (85) presentó resistencia a tratamiento antirretroviral, con prevalencia de resistencia de inhibidores de trans- criptasa reversa análogo de nucleósidos del 75% (64), los inhibidores de transcriptasa reversa no nucleósidos (ITRNN) con 89% (76) y los inhibidores de proteasa del 15% (13). Se encontró una prevalencia de resistencia primaria del 19% en pacientes de diagnóstico nuevo. Conclu- sión: Se recomienda el cambio de primera línea de terapia antirretroviral ya que se identifica- ron mutaciones de resistencia a los ITRNN en un 91% en los pacientes con diagnóstico recien- te y sin exposición a ARV. La OMS recomienda retirar los ITRNN como primera línea e incluir fármacos con mejor barrera genética, cuando los niveles de resistencia para los ITRNN sean >10%...(AU)

Síndrome inflamatória multissistêmica em crianças associada à infecção pelo coronavírus: relato de caso / Multisystem inflammatory syndrome in children associated with coronavirus infection: a case report

No dia 11 de março de 2020 a Organização Mundial da Saúde declarou pandemia pelo novo coronavírus, Sars-Cov-2. A doença, denominada COVID-19, expandiu-se de forma rápida e grave, gerando sérias preocupações mundiais. Estudos envolvendo a população pediátrica estão revelando o perfil de acometimento do coronavírus em crianças e, embora muitas delas apresentem casos de COVID-19 de forma assintomática, algumas desenvolvem casos graves da doença. Uma série de relatos de casos publicados recentemente, especialmente na Europa, Ásia, América do Norte e América Latina, descreveram uma forma mais grave pela infecção do Sars-Cov-2 em crianças: a síndrome inflamatória multissistêmica associada à COVID-19 na Criança (MIS-C). Acredita-se que uma reação hiperinflamatória causada por uma resposta imune inata desregulada seja a causa dos danos teciduais. No entanto, a fisiopatologia dessa síndrome ainda não está completamente elucidada. As manifestações clínicas dessa síndrome se assemelham a algumas doenças já conhecidas, como a Doença de Kawasaki e a Síndrome do Choque Tóxico, dentre outras. Dessa forma, os protocolos para diagnóstico e terapêutica a serem empregados na MIS-C estão sendo desenvolvidos com base naqueles já utilizados no manejo dessas duas enfermidades, e medicamentos como corticoides, anticoagulantes e antirretrovirais têm apresentado bons resultados. Ainda há muito a ser investigado em relação à MIS-C, mas já se faz presente a necessidade do acompanhamento ambulatorial após alta hospitalar a fim de prevenir e tratar as possíveis consequências dessa hiperinflamação.

On March 11, 2020 the World Health Organization declared a pandemic caused by the new coronavirus, SARS-CoV-2. The disease, named COVID-19, has expanded rapidly and severely, generating serious global concern. Studies involving the pediatric population are revealing the profile of coronavirus involvement in children, and although many children present as asymptomatic cases of COVID-19, some develop severe forms of the disease. A number of recently published case reports, especially from Europe, Asia, North America, and Latin America, have described a more severe form of Sars-Cov-2 infection in children: the multisystem inflammatory syndrome associated with COVID-19 in children (MIS-C). A hyperinflammatory reaction caused by a dysregulated innate immune response is believed to be the cause of tissue damage. However, the pathophysiology of this syndrome is not yet fully elucidated. The clinical manifestations of this syndrome resemble those of some known diseases, such as Kawasaki disease and toxic shock syndrome, among others. Thus, the protocols for diagnosis and therapy to be employed in MIS-C are being developed based on those already used in the management of these two diseases, and drugs such as corticoids, anticoagulants, and antiretroviral drugs have shown good results. There is still much to be investigated regarding MIS-C, but outpatient follow-up after hospital discharge is required to prevent and treat the possible consequences of this hyperinflammation.