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1.
Arq. ciências saúde UNIPAR ; 26(2): 187-192, maio-ago. 2022.
Article in Portuguese | LILACS | ID: biblio-1372977

ABSTRACT

O vírus da imunodeficiência humana é o agente etiológico da AIDS, doença crônica que destrói o sistema imunológico e é caracterizada pela baixa contagem de células TCD4, alta contagem de partículas virais no sangue e manifestações clínicas da doença. O diagnóstico se dá com o aparecimento de infecções oportunistas, que levam a contagem de TCD4 a níveis menores que 200 céls/mm³. Os exames laboratoriais para o diagnóstico do HIV foram os principais avanços para o início do tratamento, reduzindo a transmissão. Detecção de anticorpos, detecção de antígenos e amplificação do genoma do vírus são alguns dos exames laboratoriais utilizados para diagnóstico. Os dois principais biomarcadores são os exames de contagem de células TCD4, que verifica o sistema imune, e a quantificação de carga viral, que informa a quantidade de partículas virais, mostrando a progressão da infecção. Quanto maior a carga viral, maior o dano ao sistema imune. Uma carga viral indetectável é inferior a 50 cópias/mL, mas valores menores ou iguais a 200 cópias/mL também impedem a transmissão. Uma declaração de consenso afirma que Indetectável é igual a Intransmissível. Portanto, quando indetectável, a transmissão inexiste. O presente estudo relata e discute o caso clínico de uma paciente diagnosticada com HIV/AIDS aos 28 anos, que sobreviveu, apesar do diagnóstico tardio, e sob presença de doença oportunista com um grave grau de diminuição de células TCD4 (22 cél/mm³). Por meio do diagnóstico, introdução e adesão correta da terapia antirretroviral e monitorização de exames laboratoriais, conseguiu evitar a morte e ter uma vida semelhante à de um HIV negativo. Ultrapassou a expectativa de vida que na descoberta era de 10 anos, com uma qualidade de vida considerável, não sendo transmissora do vírus, diminuindo assim o estigma e preconceito. O biomédico é peça fundamental nesse contexto, considerando que deve fornecer informações precisas e fidedignas, tão necessárias ao acompanhamento de pessoas vivendo com HIV, para que autoridades e profissionais de saúde adotem medidas adequadas, tanto na prevenção, quanto no diagnóstico e monitoramento da doença.


The human immunodeficiency virus is the etiological agent of AIDS, a chronic disease that destroys the immune system and is characterized by low TCD4 cell count, high viral particle count in blood and clinical manifestations of the disease. The diagnosis is due to the appearance of opportunistic infections, which lead to TCD4 counts below 200 cells / mm³. Laboratory tests for the diagnosis of HIV were the main advances in starting treatment, reducing transmission. Antibody detection, antigen detection and virus genome amplification are some of the laboratory tests used for diagnosis. The two main biomarkers are the TCD4 cell count tests, which checks the immune system, and viral load quantification, which reports the number of viral particles, showing the progression of infection. The higher the viral load, the greater the damage to the immune system. An undetectable viral load is less than 50 copies / mL, but values less than or equal to 200 copies / mL also prevent transmission. A consensus statement states that Undetectable equals Non-Transmissible. Therefore, when undetectable, transmission does not exist. The present study reports and discusses the clinical case of a patient diagnosed with HIV / AIDS at age 28, who survived despite late diagnosis and under the presence of opportunistic disease with a severe degree of TCD4 cell reduction (22 cells / mm³). Through the diagnosis, introduction and correct adherence of antiretroviral therapy and monitoring of laboratory tests, she was able to avoid death and have a life similar to that of an HIV negative. Exceeded the life expectancy that in the discovery was 10 years, with a considerable quality of life, not transmitting the virus, thus reducing the stigma and prejudice. The biomedical is a key player in this context, considering that he must provide accurate and reliable information, which is so necessary for the monitoring of people living with HIV, so that authorities and health professionals adopt appropriate measures, both in prevention, diagnosis and monitoring of the disease.


Subject(s)
Humans , Female , Adult , HIV Infections/drug therapy , HIV , Toxoplasmosis/virology , AIDS-Associated Nephropathy/virology , Acquired Immunodeficiency Syndrome , AIDS-Related Opportunistic Infections , Viral Load , Cryptococcosis/drug therapy , Antiretroviral Therapy, Highly Active , Fever/virology , Headache/virology , Anemia/virology , Meningitis/virology
2.
Rev. chil. infectol ; 39(2): 149-156, abr. 2022. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388352

ABSTRACT

Resumen La infección por VIH es una epidemia global (prevalencia de 0,8%). En Latinoamérica, Chile, Brasil y Uruguay son los países con mayores índices. Entre las más afectadas están la población transgénero (OR 48,8 respecto a la población general). Múltiples factores bio-psico-sociales explican estas cifras. Bajo uso del preservativo, la idea de reafirmación de género, el temor a ser reemplazadas(os) por personas cisgéneros, presencia de comercio sexual, entre otros, influyen en las mayores tasas de infección. Se han implementado medidas de prevención del VIH, pero pocas dirigidas en específico a personas transgénero. La profilaxis preexposición (PreP) parece ser una nueva alternativa de prevención en este grupo, y la integración de las unidades de apoyo en la reafirmación de género con las unidades que entregan PreP, podrían aumentar su adherencia y cobertura. En las personas transgénero con infección por VIH existe baja adherencia a terapia antirretroviral (TARV), en parte por priorización del tratamiento hormonal y miedo a que la TARV altere su proceso de hormonización. Los pocos datos existentes muestran que la hormonización no se afecta con la mayoría de la TARV, pero algunos tratamientos hormonales podrían disminuir las concentraciones plasmáticas y tisulares de ciertos antirretrovirales. Faltan estudios que evalúen la interacción entre antirretrovirales y tratamiento hormonal de reafirmación de género.


Abstract HIV infection is a global epidemic, with a prevalence of 0.8%. In Latin America, Chile, Brazil and Uruguay are the countries with the highest rates. The transgender population is the most affected (OR of 48.8 compared to the general population). Multiple bio-psycho-social factors explain these issues. The low use of condoms for pressure from the partner, the idea of reaffirmation of gender, the fear to be replaced by a cisgender person, the presence of commercial sex, among others, influence the highest rates of infection. HIV prevention measures have been implemented, but few specifically targeted at transgender people. Pre-exposure prophylaxis (PreP) seems to be a new prevention alternative in this group, and the integration of support units in gender reaffirmation with units that deliver PreP could increase their adherence and coverage. In HIV (+) transgender people there is low adherence to antiretroviral therapy (ART), in part due to the prioritization of hormonal treatment and the fear that ART will alter their hormonalization process. The few data that exist show that hormonalization is not affected by ART, but that some hormonal treatments could lower the levels of certain antiretrovirals. More studies must be done to evaluate the interaction between antiretrovirals and gender affirming hormone therapy.


Subject(s)
Humans , HIV Infections/prevention & control , HIV Infections/drug therapy , HIV Infections/epidemiology , Anti-HIV Agents/therapeutic use , Transgender Persons , Pre-Exposure Prophylaxis , Sex Work
3.
Säo Paulo med. j ; 140(2): 278-283, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1366041

ABSTRACT

Abstract BACKGROUND: Sexually transmitted diseases (STIs) are an important public health problem in all countries. Knowledge of their relationship with the various socioeconomic levels is necessary for an understanding of their epidemiology and behavior in society. OBJECTIVE: To investigate the epidemiology of human immunodeficiency virus (HIV)-positive patients and to correlate education with history of sexually transmitted diseases, especially for syphilis. DESIGN AND SETTING: Analytical cross-sectional study carried out in the city of Juiz de Fora, Minas Gerais, Brazil. METHODS: The medical records of HIV/acquired immunodeficiency syndrome (AIDS) patients who started antiretroviral therapy (ART) between January 2010 and July 2018 were assessed. These patients were attended at the specialized assistance service for HIV/AIDS) of the Department of Sexually Transmitted Diseases (STD/AIDS) of the city of Juiz de Fora. In total, 335 patients were selected. RESULTS: In our sample, 73.13% were male; 57.36% were aged between 25 and 45 years and 24.23% were over 45 years of age. Regarding sexual orientation, 61.78% were homosexual. Regarding education, 52.88% had "unskilled education", while 47.12% had "qualified education". Analysis on the relationship between schooling and syphilis, a positive relationship between qualified schooling and syphilis was observed: odds ratio = 3.588; 95% confidence interval: 1.090-11.808. CONCLUSION: Homosexual male patients are most affected by HIV. Furthermore, this disease is not limited only to individuals with low education. Syphilis should be suspected in all individuals.


Subject(s)
Humans , Male , Female , Adult , Syphilis/epidemiology , Sexually Transmitted Diseases/epidemiology , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/epidemiology , Sexual Behavior , Cross-Sectional Studies , Risk Factors , Middle Aged
4.
Acta sci., Health sci ; 44: e53630, Jan. 14, 2022.
Article in English | LILACS | ID: biblio-1367783

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , HIV Infections/drug therapy , HIV Integrase Inhibitors/adverse effects , Anti-Retroviral Agents/adverse effects , Anti-Retroviral Agents/pharmacology , Pharmacovigilance , Unified Health System , Severity of Illness Index , Sex Distribution , HIV Integrase Inhibitors/therapeutic use , Anti-Retroviral Agents/therapeutic use
5.
Chinese Journal of Epidemiology ; (12): 692-695, 2022.
Article in Chinese | WPRIM | ID: wpr-935445

ABSTRACT

Objective: To analyze the dynamic changes and influencing factors of HIV-1 DNA load in HIV-1 infected individuals under antiretroviral therapy (ART) in Dehong Dai and Jingpo autonomous prefecture, Yunnan province, and provide information support for the clinical use of HIV-1 DNA quantitative detection. Methods: The HIV infection cases in recent infection cohort from Dehong Center for Disease Control and Prevention during 2009-2018 were selected as study subjects. The dynamic curve of HIV-1 DNA load varrying with time was generated and logistic regression analysis was conducted to identify the risk factors for HIV-1 load in the recent follow up after ART and statistical analysis was performed by using SPSS 17.0. Results: Among the 113 HIV infection cases detected from the recent infection cohort, the recent HIV infection rate were 49.6%(56/113) males, sexual transmission cases and drug injection transmission cases accounted for 53.1% (60/113), 80.5% (91/113) and 19.5% (22/113), respectively. The dynamic changes curve showed that HIV-1 DNA load was relatively high (>800 copies /106 PBMCs) before ART, and droped rapidly (<400 copies /106 PBMCs) after ART for 1 year. However, HIV-1 DNA load decreased insignificantly from the second year of ART, and remained to be 269 copies/106 PBMCs after ART for 6 years. Univariable logistic regression analysis indicated that OR (95%CI) of CD8, CD4/CD8 and HIV-1 DNA load were 1.00 (1.00-1.00), 0.30 (0.09-1.05) and 1.01 (1.00-1.01), respectively. Multivariable logistic regression analysis showed that OR value of HIV-1 DNA load base was 1.00 (1.00-1.01). Conclusions: HIV-1 DNA load decreased significantly in the first year of ART, then remained stable for years. HIV-1 DNA load base was the key factor associated with the decrease of HIV-1 DNA load, the lower the HIV-1 DNA load base, the lower HIV-1 DNA load. Therefore, earlier ART can contribute to the decrease of HIV-1 DNA load.


Subject(s)
China/epidemiology , DNA/therapeutic use , HIV Infections/drug therapy , HIV Seropositivity , HIV-1/genetics , Humans , Male , Viral Load
6.
Chinese Journal of Epidemiology ; (12): 598-602, 2022.
Article in Chinese | WPRIM | ID: wpr-935433

ABSTRACT

The expectancy and quality of life among people with HIV have improved remarkably with the widespread use of antiretroviral therapy (ART). In the meantime, the risks for HIV-related metabolic diseases have increased significantly, in particular diabetes mellitus. Multi-factors coeffect to increasing the risk of diabetes mellitus among HIV patients. Recently, growing of research has reported an association between HIV infections and ART and the development of diabetes mellitus. In this article, we summarize the recent studies investigating HIV infection and ART in diabetes mellitus to clarify their mechanism on the development of diabetes.


Subject(s)
Diabetes Mellitus/drug therapy , HIV Infections/drug therapy , Humans , Metabolic Diseases , Quality of Life
7.
Clin. biomed. res ; 42(2): 186-189, 2022.
Article in Portuguese | LILACS | ID: biblio-1391649

ABSTRACT

O sarcoma de Kaposi é uma neoplasia maligna associada à infecção pelo herpes vírus humano 8 em doentes imunossupressos. O sarcoma de Kaposi Epidêmico é o tipo epidemiológico mais frequente e afeta indivíduos VIH-positivos. A região anoperineal é raramente envolvida e as lesões suspeitas devem ser biopsiadas para confirmação histológica. A base do tratamento é a restauração imune do doente. Relatamos o caso de um jovem, com diagnóstico recente de infeção pelo VIH, sem tratamento, que foi admitido no serviço de infectologia apresentando sintomas constitucionais, adenomegalias inguinais e extensa lesão verrucosa e ulcerada na região anoperineal. As biópsias confirmaram o diagnóstico de sarcoma de Kaposi e o doente iniciou terapia antirretroviral e quimioterapia. Houve recuperação clínica, regressão das lesões e desaparecimento das adenomegalias. Este relato objetiva alertar as equipes médicas no sentido de se incluir o sarcoma de Kaposi no diagnóstico diferencial das lesões que afetam a região anoperineal.


Kaposi's sarcoma is a malignant neoplasm associated with human herpesvirus 8 infection in immunocompromised patients. Epidemic Kaposi's sarcoma is the most common epidemiological type and affects HIV-positive patients. Perineal involvement is rare, and suspicious lesions should be biopsied to confirm histological diagnosis. Treatment consists of restoring the patient's immune system. We report the case of a young patient recently diagnosed with HIV, without treatment, who was admitted to the Department of Infectious Diseases with nonspecific symptoms, inguinal lymphadenopathy, and an extensive verrucous ulcerated lesion in the perineal region. Biopsy confirmed the diagnosis of Kaposi's sarcoma, and the patient was started on antiretroviral therapy and chemotherapy. Clinical recovery was achieved, with lesion reduction and inguinal adenopathy resolution. This case report aims to encourage physicians to include Kaposi's sarcoma in the differential diagnosis of perineal lesions.


Subject(s)
Humans , Male , Adult , Anus Neoplasms/diagnosis , Sarcoma, Kaposi/diagnosis , HIV Infections/diagnosis , Anus Neoplasms/drug therapy , Sarcoma, Kaposi/drug therapy , Doxorubicin/therapeutic use , HIV Infections/drug therapy , Antiretroviral Therapy, Highly Active/statistics & numerical data , Antibiotics, Antineoplastic/therapeutic use
8.
J. health inform ; 14(1): 19-25, 20220000.
Article in Portuguese | LILACS | ID: biblio-1370254

ABSTRACT

Objetivo: Investigar dados dos sistemas de informação em saúde do HIV e sua relação com o conjunto mínimo de dados da atenção à saúde (CMD) brasileiro. Métodos: Realizou-se estudo descritivo e transversal em janeiro/2019, a partir dos dados coletados nos formulários dos sistemas que registram o tratamento antirretroviral e exames laboratoriais. Resultados: Foram analisados 282 campos dos formulários. Após agregação dos campos comuns, restaram 83 variáveis, 17 (20,5%) consideradas aplicáveis ao CMD. Conclusão: O CMD coleta dados sobre consultas e exames de seguimento dos contatos assistenciais do HIV, porém não registra tratamento antirretroviral. A maioria das variáveis coletadas nos sistemas do HIV poderão compor o modelo de informação clínica do HIV para Registro Eletrônico de Saúde.


Objective: It was to investigate data of the health information systems of HIV and its relationship with Brazilian minimum data set of health care (MDS). Methods: A descriptive and cross-sectional study was carried out in January/2019, based on data collected in the forms of the systems that register the antiretroviral treatment and laboratory tests. Results: Were analyze 282 fields of the forms, after aggregation of the common ones, 83 variables remained, 17 (20.5%) considered applicable to MDS. Conclusion: The MDS collects data on consultations and follow-up examinations of HIV care, does not register antiretroviral treatment. Most of the variables collected in HIV systems may be part of the HIV clinical information model for the Electronic Health Record.


Objetivo: Investigar datos de los sistemas de información en salud del VIH y su relación con el conjunto mínimo de datos de la atención a la salud (CMD) brasileño. Métodos: Se realizó estudio descriptivo y transversal en enero/2019, a partir de los formularios de los sistemas del tratamiento antirretroviral y exámenes de laboratorio. Resultados: Se analizaron 282 campos de los formularios, después de la agregación de los comunes, quedaron 83 variables, 17 (20,5%) consideradas aplicables al CMD. Conclusión: El CMD recoge datos sobre consultas y exámenes de seguimiento de la asistencia del VIH, no registra tratamiento antirretroviral. La mayoría de las variables del VIH podrán componer modelo de información clínica del Registro Electrónico de Salud.


Subject(s)
Humans , HIV Infections/drug therapy , Antiretroviral Therapy, Highly Active , Electronic Health Records , Health Information Systems , Datasets as Topic , Epidemiology, Descriptive , Cross-Sectional Studies
9.
Acta Paul. Enferm. (Online) ; 35: eAPE03661, 2022. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1364242

ABSTRACT

Resumo Objetivo Analisar aspectos relacionados à adesão ao tratamento da tuberculose em pessoas que vivem com coinfecção tuberculose/vírus da imunodeficiência humana. Métodos Trata-se de um estudo exploratório, do tipo descritivo, com abordagem qualitativa sobre a adesão ao tratamento da tuberculose entre pessoas que apresentam a coinfecção tuberculose/vírus da imunodeficiência humana. O cenário do estudo foi um centro de referência para vírus da imunodeficiência humana/síndrome da imunodeficiência adquirida do estado de São Paulo, localizado na capital. O instrumento de coleta de dados continha questões relacionadas ao perfil sóciodemográfico e de saúde. Para a análise do material empírico foi utilizado o método de análise de discurso que permitiu a depreensão de frases temáticas. Resultados Foram entrevistadas 16 pessoas, sendo a maioria do sexo masculino, da cor parda, na faixa etária entre 30 a 39 anos, com 9 a 12 anos de estudo, que moravam sozinhos, solteiros e que se declararam homossexuais. Da análise dos depoimentos emergiram três categorias de análise: Processo saúde doença: o impacto do diagnóstico e os significados de viver a coinfecção; Tratamento medicamentoso: motivos para o seguimento, facilidades e dificuldades envolvidas; e Cuidado no serviço de saúde: acolhimento e redes de apoio que favorecem a adesão ao tratamento. Conclusão A adesão ao tratamento na coinfecção tuberculose/vírus da imunodeficiência humana mostrou-se relacionada à forma como a pessoa está inserida na sociedade, suas condições de vida e trabalho. Ressalta-se também que o cuidado nos serviços de saúde interfere na adesão, dada a importância do vínculo entre o profissional de saúde e o usuário.


Resumen Objetivo Analizar los aspectos relacionados con la adherencia al tratamiento de tuberculosis en personas que viven con la coinfección tuberculosis/virus de la inmunodeficiencia humana. Métodos Se trata de un estudio exploratorio, tipo descriptivo, con enfoque cualitativo, sobre la adherencia al tratamiento de tuberculosis en personas que presentan la coinfección tuberculosis/virus de la inmunodeficiencia humana. El escenario de estudio fue un centro de referencia del virus de la inmunodeficiencia humana/síndrome de inmunodeficiencia adquirida del estado de São Paulo, ubicado en la capital. El instrumento de recopilación de datos contenía preguntas relacionadas con el perfil sociodemográfico y de salud. Para analizar el material empírico se utilizó el método de análisis de discurso que permitió extraer frases temáticas. Resultados Se entrevistaron 16 personas, de las cuales la mayoría era de sexo masculino, de color pardo, del grupo de edad entre 30 y 39 años, con 9 a 12 años de estudios, que vivían solos, solteros y que se declararon homosexuales. Del análisis de los relatos surgieron tres categorías de análisis: Proceso de salud y enfermedad: el impacto del diagnóstico y los significados de vivir la coinfección; Tratamiento farmacológico: motivos para el acompañamiento, facilidades y dificultades relacionadas, y Cuidado en el servicio sanitario: contención y redes de apoyo que favorecen la adherencia al tratamiento. Conclusión La adherencia al tratamiento de la coinfección tuberculosis/virus de la inmunodeficiencia humana demostró estar relacionada con la forma como la persona está insertada en la sociedad, su condición de vida y trabajo. También se observó que el cuidado en los servicios de salud interfiere en la adherencia, debido a la importancia del vínculo entre los profesionales de la salud y los usuarios.


Abstract Objective To analyze aspects related to adherence to tuberculosis treatment in people living with tuberculosis/human immunodeficiency virus coinfection. Methods This is an exploratory, descriptive, qualitative study on adherence to tuberculosis treatment among people with tuberculosis/human immunodeficiency virus coinfection. The study setting was a reference center for human immunodeficiency virus/acquired immunodeficiency syndrome located in the capital of the state of São Paulo. The data collection instrument contained socio-demographic and health profile related questions. The discourse analysis method was used for the analysis of the empirical material, which allowed the comprehension of thematic phrases. Results Sixteen people were interviewed. Most were male, mixed race, in the age group of 30-39 years, with 9-12 years of study, living alone, single and declared themselves homosexuals. Three categories of analysis emerged from the analysis of testimonies: Health-disease process: the impact of the diagnosis and the meanings of living with coinfection; Drug treatment: reasons for follow-up, facilities and difficulties involved; and Care in the health service: embracement and support networks that favor treatment adherence. Conclusion Adherence to treatment in the tuberculosis/human immunodeficiency virus coinfection has shown a relation to the way people are inserted in society, their living and working conditions. The fact that care in health services interferes with adherence is also noteworthy, given the importance of the bond between the health professional and the user.


Subject(s)
Humans , Male , Female , Adult , Perception , Tuberculosis/drug therapy , HIV Infections/drug therapy , Antiretroviral Therapy, Highly Active , Coinfection , Treatment Adherence and Compliance , Quality of Life , Health-Disease Process , Epidemiology, Descriptive , Interviews as Topic , Evaluation Studies as Topic
10.
Cad. Saúde Pública (Online) ; 38(1): e00290620, 2022. tab
Article in Portuguese | LILACS | ID: biblio-1355979

ABSTRACT

Resumo: A profilaxia pré-exposição ao HIV (PrEP) tem sido considerada uma estratégia fundamental para o controle da epidemia de HIV/aids, e desde 2018 tem sido objeto de estudo de implementação (Estudo ImPrEP Stakeholders), realizado no Brasil, no México e no Peru. Um componente qualitativo desse estudo foi desenvolvido com o objetivo de identificar os contextos sociais e estruturais que envolvem e organizam a oferta de serviços de PrEP no Brasil, as subjetividades dos atores envolvidos e as diferentes percepções que podem impactar a efetivação dessa estratégia. O presente artigo teve como foco de análise o acesso das populações vulneráveis aos serviços de PrEP, na perspectiva de gestores, profissionais de saúde, lideranças ou ativistas e usuários de PrEP. É um estudo qualitativo com o uso de metodologia compreensiva, realizado em seis capitais brasileiras, em que foram entrevistados 71 atores-chave no período de novembro de 2018 a maio de 2019. A análise foi pautada pelos modelos analíticos sobre acesso propostos por Giovanella & Fleury, McIntyre et al. e Penchansky & Thomas. Os resultados são apresentados com base em três eixos: "percepções sobre prevenção combinada e PrEP"; "disponibilidade e adequação: perfil e estrutura dos serviços no contexto do ImPrEP"; e "aceitabilidade: atitudes e práticas dos profissionais de saúde e usuários".


Abstract: HIV preexposure prophylaxis (PrEP) has been considered a fundamental strategy for controlling the HIV/AIDS epidemic, and since 2018 it has been the object of an implementation study (ImPrEP Stakeholders Study), conducted in Brazil, México, and Peru. A qualitative component of this study was developed with the objective of identifying the social and structural contexts that involve and organize the supply of PrEP services in Brazil, the stakeholders' subjectivities, and the different perceptions that can impact the strategy's implementation. The current article's focus was to analyze access by vulnerable populations to PrEP services from the perspective of managers, health professionals, leaders or activists, and users of PrEP. This was a qualitative study using a comprehensive methodology, conducted in six Brazilian state capitals, interviewing 71 key actors from November 2018 to May 2019. The analysis was based on access analysis models as proposed by Giovanella & Fleury, McIntyre et al. and Penchansky & Thomas. The results are presented along three lines: "perceptions of combined prevention and PrEP", "availability and adequacy: profile and structure of services in the context of ImPrEP", and "acceptability: attitudes and practices of health professionals and users".


Resumen: La profilaxis preexposición al VIH (PrEP) ha sido considerada una estrategia fundamental para el control de la epidemia de VIH/sida y desde 2018 ha sido objeto de estudio de implementación (Estudio ImPrEP Stakeholders), realizado en Brasil, México y Perú. Un componente cualitativo de este estudio se desarrolló con el objetivo de identificar los contextos sociales y estructurales que engloban y organizan la oferta de servicios de PrEP en Brasil, las subjetividades de los actores implicados y las diferentes percepciones que pueden impactar en hacer efectiva esa estrategia. El objetivo de este artículo es el análisis del acceso de las poblaciones vulnerables a los servicios de PrEP, desde la perspectiva de los gestores, profesionales de salud, líderes o activistas y usuarios de la PrEP. Se trata de un estudio cualitativo con uso de metodología comprensiva, realizado en seis capitales brasileñas, en las que fueron entrevistados 71 actores-clave, durante el período de noviembre de 2018 a mayo de 2019. El análisis se pautó mediante modelos analíticos sobre acceso, propuestos por Giovanella & Fleury, McIntyre et al. y Penchansky & Thomas. Los resultados se presentan a partir de tres ejes: "percepciones sobre prevención combinada y PrEP", "disponibilidad y adecuación: perfil y estructura de los servicios en el contexto de la ImPrEP" y "aceptabilidad: actitudes y prácticas de los profesionales de salud y usuarios".


Subject(s)
Humans , HIV Infections/prevention & control , HIV Infections/drug therapy , Anti-HIV Agents/therapeutic use , Pre-Exposure Prophylaxis/methods , Brazil , Health Personnel , Vulnerable Populations
11.
Rev. chil. infectol ; 38(6): 783-789, dic. 2021. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388321

ABSTRACT

INTRODUCCIÓN: Se desconoce el grado de supresión viral en pacientes con infección por VIH que inician terapia antirretroviral (TAR) con cargas virales (CV) muy altas. OBJETIVO: Conocer el porcentaje de supresión viral en pacientes con VIH que inician TAR con CV ≥ 500.000 copias/mL a 96 semanas. PACIENTES Y MÉTODO: Estudio retrospectivo. Se incluyeron pacientes que iniciaron TAR con CV ≥ 500.000 copias/mL, entre los años 2008 y 2018, estratificándose en base a escala logarítmica. Se determinó el porcentaje de supresión viral, y las variables asociadas a este desenlace. RESULTADOS: Se incluyeron 221 pacientes. La mediana de edad y CV era de 43 años y 6,0 log, respectivamente, estando la mayoría (37%) en estadio C3 al inicio de TAR. El 48,8 y 87,7% de los pacientes logró la supresión viral al año y dos años de seguimiento, respectivamente. Se observó que, a mayor edad, a mayor inmunosupresión, y a mayor CV, mayor el tiempo para lograr la indetectabilidad. Sólo se demostró fracaso virológico en tres pacientes. DISCUSIÓN: Los pacientes con infección por VIH que inician TAR con CV muy altas demoran más tiempo en lograr la supresión viral, lo cual es proporcional a la magnitud de ésta y al grado de inmunosupresión, sin que esto conlleve mayor riesgo de fracaso virológico.


BACKGROUND: The degree of viral suppression in HIV patients who start antiretroviral therapy (ART) with very high viral loads (CV) is unknown. AIM: To know the percentage of viral suppression in HIV patients who start ART with CV ≥ 500,000 copies/mL at 96 weeks. METHOD: Retrospective study. Patients who started ART with a CV ≥ 500,000 copies/mL between 2008 and 2018 were included, stratifying on the basis of a logarithmic scale. The percentage of viral suppression and the variables associated with this outcome were determined. RESULTS: 221 patients were included. The median age and CV were 43 years and 6.0 log, respectively, with the majority (37%) being in stage C3 at the start of ART. 48.8 and 87.7% of the patients achieved viral suppression at one year and two years of follow-up, respectively. It was observed that the older the immunosuppression, and the higher CV, the longer the time to achieve undetectability. Virological failure was only demonstrated in three patients. DISCUSSION: Patients with HIV infection who start ART with very high CVs take longer to achieve viral suppression, which is proportional to the magnitude of this and the degree of immunosuppression, without this entailing a greater risk of virological failure.


Subject(s)
Humans , HIV Infections/drug therapy , Anti-HIV Agents/therapeutic use , Serologic Tests , Retrospective Studies , CD4 Lymphocyte Count , Viral Load , Antiretroviral Therapy, Highly Active
12.
Rev. chil. obstet. ginecol. (En línea) ; 86(6): 554-562, dic. 2021. ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388697

ABSTRACT

INTRODUCCIÓN: Existen 35 millones de casos de infección por el virus de la inmunodeficiencia humana (VIH) en el mundo, y de ellos, 15 millones corresponden a mujeres en edad fértil. El embarazo en las mujeres seropositivas genera efectos relevantes que afectan la condición psicosocial y física. Los cambios que genera el embarazo en una mujer VIH positiva se relacionan con resultados perinatales adversos, como hemorragia posparto, sepsis puerperal, parto prematuro y mortalidad. OBJETIVO: Conocer los efectos físicos y psicosociales que tiene el embarazo en la evolución de la mujer portadora del VIH. MÉTODO: Revisión narrativa. Se realiza un análisis de contenido de fuentes primarias obtenidas mediante búsqueda en las bases de datos CINAHL, PubMed y SciELO. La búsqueda abarcó un periodo de 10 años, en idioma español e inglés. Para la presente investigación se incluyen 22 artículos, de los que se consideraron las secciones de resultados y conclusiones. RESULTADOS: Se seleccionaron inicialmente 318 artículos y 22 fueron elegibles para su inclusión. En esta revisión se plantean tres dimensiones de análisis psicosocial, fisiopatología y características clínicas, y tratamiento farmacológico. La literatura evidencia un efecto psicológico negativo en la población de estudio, y en cuanto al tratamiento se manifiesta un escaso porcentaje de eventos adversos frente a la terapia antirretroviral, por lo que los beneficios superan los riesgos. CONCLUSIONES: Las tres dimensiones planteadas se relacionan entre sí, definiendo los efectos del embarazo en mujeres VIH positivas y lo que conlleva esta condición en la salud de la madre. Se identificaron diversos problemas que afectan la salud de las mujeres seropositiva que se embarazan. Sin embargo, estas mujeres pueden embarazarse siguiendo un tratamiento óptimo, con atenciones de salud en periodos regulares, evitando así la mayoría de los efectos que pueden afectar su salud.


INTRODUCTION: There are 35 million cases of human immunodeficiency virus (HIV) worldwide, 15 million correspond to women of childbearing age. This pregnancy condition in seropositive women generates relevant effects that affect the psychosocial and physical condition. The changes generated by pregnancy in an HIV positive woman are related to adverse perinatal results such as postpartum hemorrhage, puerperal sepsis, premature delivery and mortality. OBJECTIVE: To know the physical and psychosocial effects that pregnancy has on the evolution of women with HIV. METHOD: Narrative review. Content analysis of primary sources obtained through searches in the CINAHL, PubMed and SciELO databases is performed. The search was carried out within a 10-year range, in Spanish and English. For the present investigation 22 articles are included. The sections for the analysis were results and conclusions. RESULTS: 318 articles were initially selected, 22 articles were eligible for inclusion. In this review, three dimensions of psychosocial analysis, pathophysiology and clinical characteristics, and pharmacological treatment are proposed. The literature shows the negative psychological effect in the study population, in terms of treatment there is a low percentage of adverse events compared to ART, so the benefits outweigh the risks. CONCLUSIONS: The three dimensions raised are related to each other, defining the effects of pregnancy in HIV positive women and what the condition entails on the mothers health. Various problems were identified that affect the health of an HIV-positive woman who becomes pregnant. However, these HIV positive women can become pregnant, following optimal treatment, with regular health care, thus avoiding most of the effects that can affect her health.


Subject(s)
Humans , Female , Pregnancy , Pregnancy/psychology , HIV Infections/psychology , Pregnancy/drug effects , Pregnancy/physiology , HIV Infections/drug therapy , Antiretroviral Therapy, Highly Active
13.
Rev. chil. infectol ; 38(5): 655-666, oct. 2021. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1388299

ABSTRACT

INTRODUCCIÓN: Chile enfrenta una reemergencia de la epidemia del VIH concentrada en hombres gay y otros HSH. La profilaxis pre exposición (PrEP) es una intervención biomédica que ha resultado ser efectiva en la prevención del VIH en el grupo de HSH. OBJETIVO: Estimar niveles de aceptabilidad del uso de PrEP en hombres gay y otros HSH participantes en estudio LAMIS 2018 - Chile, identificando características y factores asociados a la aceptabilidad del uso de PrEP. MATERIAL Y MÉTODOS: Estudio basado en datos de LAMIS-2018 Chile, encuesta transversal por internet dirigida a hombres gay, bisexual, trans y otros HSH. La submuestra de este estudio consiste en 3.976 participantes que se auto-reportaron ser VIH negativos o desconocer su estado serológico, quienes respondieron preguntas sociodemográficas, de comportamiento, sobre su aceptabilidad a usar PrEP y otros aspectos relacionados. Se realizó análisis bivariados y regresión logística multivariable para identificar los factores asociados a la aceptabilidad a usar PrEP. RESULTADOS Y DISCUSIÓN: Se identificó que 55,7% de la muestra reportó una alta aceptabilidad a usar la PrEP. La regresión logística multivariable mostró que tener relaciones sexuales sin condón (ORa = 1,67, IC 95% 1,42-1,97) y haber intentado usar PrEP (ORa = 1,99, IC 95% 1,41-1, 62) se asociaron positivamente a la aceptabilidad a usar PrEP mientras que tener una relación con pareja estable, se asoció negativamente. Se identificó una aceptabilidad a usar la PrEP relativamente alta en los participantes. No obstante, se hace necesario considerar intervenciones relacionada a aumentar el conocimiento y promover la demanda de la PrEP. Además, el presente estudio muestra la necesidad de considerar la participación de las organizaciones de la sociedad civil en su implementación, fenómenos emergentes y la pertinencia territorial.


BACKGROUND: Chile is facing a re-emergence of the HIV epidemic, concentrated among men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is a biomedical intervention that effectively prevents HIV transmission among MSM. AIM: The study was designed to estimate acceptability of PrEP and identify factors associated with PrEP-related attitudes and behaviors among MSM using LAMIS 2018 - Chile study data. Methods: Data were taken from the LAMIS 2018 - Chile study, a cross-sectional study of gay, bisexual, transgender, and other MSM. Our subsample included 3976 participants with self-reported HIV-negative or unknown status who responded to sociodemographic questions and items related to PrEP. Bivariate analysis and multivariate logistic regression analysis were performed to identify factors associated with acceptability of PrEP. RESULTS AND DISCUSSION: A total of 55.7% of the sample reported high PrEP acceptability. Logistic regression indicated that engaging in sex without a condom (ORa = 1.67, IC 95% 1.42-1.97) and having previously used PrEP (ORa = 1.99, IC 95% 1.41-1.62) were associated with high acceptability to use PrEP, while having a stable partner was associated with low acceptability. The estimate of PrEP acceptability was relatively high among participants. However, interventions to increase awareness and promote demand for PrEP may be beneficial. Furthermore, this study demonstrates the need for non-governmental organizations to participate in such strategies and for measures that address regionally-relevant emerging phenomena.


Subject(s)
Humans , Male , Female , HIV Infections/drug therapy , Anti-HIV Agents/therapeutic use , Pre-Exposure Prophylaxis/methods , Sexual and Gender Minorities , Patient Acceptance of Health Care , Chile , Health Knowledge, Attitudes, Practice , Cross-Sectional Studies , Homosexuality, Male
15.
Säo Paulo med. j ; 139(4): 405-411, Jul.-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1290245

ABSTRACT

ABSTRACT BACKGROUND: Low bone mineral content (BMC) and bone mineral density (BMD) have been identified in human immunodeficiency virus (HIV)-infected children and adolescents. The direct adverse effects of HIV infection and combined antiretroviral therapy (ART) negatively contribute to bone metabolism. A direct relationship between muscle strength levels and BMD in HIV-infected adults and older adults has been described. However, it is unknown whether handgrip strength (HGS) is associated with bone mass in pediatric populations diagnosed with HIV. OBJECTIVE: To ascertain whether HGS levels are associated with BMC and BMD in HIV-infected children and adolescents. DESIGN AND SETTING: Cross-sectional study conducted in Florianãpolis, Brazil, in 2016. METHODS: The subjects were 65 children and adolescents (8-15 years) diagnosed with vertically-transmitted HIV. Subtotal and lumbar-spine BMC and BMD were obtained via dual-emission X-ray absorptiometry (DXA). HGS was measured using manual dynamometers. The covariates of sex, ART, CD4+ T lymphocytes and viral load were obtained through questionnaires and medical records. Sexual maturation was self-reported and physical activity was measured using accelerometers. Simple and multiple linear regression were used, with P < 0.05. RESULTS: HGS was directly associated with subtotal BMD (β = 0.002; R² = 0.670; P < 0.001), subtotal BMC (β = 0.090; R² = 0.734; P = 0.005) and lumbar-spine BMC (β = 1.004; R² = 0.656; P = 0.010) in the adjusted analyses. However, no significant association was found between HGS and lumbar-spine BMD (β = 0.001; R² = 0.464; P = 0.299). CONCLUSION: HGS was directly associated with BMD and BMC in HIV-infected children and adolescents.


Subject(s)
Humans , Child , Adolescent , Aged , Bone Density , HIV Infections/drug therapy , Cross-Sectional Studies , Hand Strength , Lumbar Vertebrae
16.
Arq. bras. cardiol ; 117(2): 365-375, ago. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1339149

ABSTRACT

Resumo Fundamento Pacientes com HIV têm maior probabilidade de apresentar doenças cardiovasculares quando comparados à população em geral. Objetivo Este foi um estudo de caso-controle que teve como objetivo avaliar quais fatores estavam associados a uma redução na espessura médio-intimal da carótida (IMT) da carótida e ao aumento na dilatação mediada por fluxo (DMF) da artéria braquial em pacientes com HIV que receberam atorvastatina + aspirina por um período de 6 meses. Métodos Foi realizada uma análise secundária de um ensaio clínico, que incluiu pessoas vivendo com HIV e baixo risco cardiovascular. Um total de 38 pacientes alocados para o braço de intervenção e tratados por 6 meses com uma combinação de atorvastatina + aspirina foram incluídos. Todos os participantes foram submetidos a ultrassonografia da carótida e da artéria braquial, tanto no início quanto no final do estudo. Os casos que responderam com aumento >10% da dilatação braquial (DMF) e redução da espessura médio-intimal da carótida (IMT) foram considerados casos, e aqueles que não responderam foram considerados controles. Avaliamos os fatores associados às respostas positivas obtidas através da IMT e DMF. Resultados A redução do IMT não se associou significativamente a nenhum dos fatores de risco avaliados: idade (p = 0,211), sexo (p = 0,260), tabagismo (p = 0,131) ou tempo de diagnóstico do HIV (p = 0,836). Um aumento na DMF foi significativamente associado com a idade entre aqueles na faixa etária de 40-59 anos, p = 0,015 (OR = 4,37; IC 95%: 1,07-17,79). Conclusões Os indivíduos mais velhos foram mais propensos a apresentar um aumento na DMF após 6 meses de tratamento com atorvastatina + aspirina.


Abstract Background Patients with HIV are more likely to present with cardiovascular disease when compared to the general population. Objective This was a case-control study that aimed to assess which factors were associated with a reduction in the carotid intima-media thickness (IMT) and an increase in the brachial artery flow-mediated dilation (FMD) in HIV patients who received atorvastatin + aspirin during a period of 6 months. Methods A secondary analysis of a clinical trial was conducted, which included people living with HIV infection and low cardiovascular risk. A total of 38 patients allocated to the intervention arm and treated for 6 months with a combination of atorvastatin + aspirin were included. All participants underwent a carotid and brachial artery ultrasound, both at the beginning and the end of the study. Cases that responded with an increase of >10% of the brachial dilatation (FMD) and reduction of the carotid intima-media thickness (IMT) were considered cases, and those who did not respond were considered controls. We assessed the factors associated with the positive responses obtained through IMT and FMD. Results A reduction in the IMT was not significantly associated with any of the evaluated risk factors: age (p=0.211), gender (p=0.260), smoking (p=0.131) or time since HIV diagnosis (p=0.836). An increase in the FMD was significantly associated with age amongst those in the 40-59 age group, p = 0.015 (OR = 4.37; 95% CI: 1.07-17.79). Conclusions Older individuals were more likely to present with an increased FMD after 6 months of treatment with atorvastatin + aspirin.


Subject(s)
Humans , HIV Infections/complications , HIV Infections/drug therapy , Vasodilation , Brachial Artery/diagnostic imaging , Endothelium, Vascular/diagnostic imaging , Carotid Arteries/diagnostic imaging , Case-Control Studies , Aspirin/therapeutic use , Risk Factors , Ultrasonography , Carotid Intima-Media Thickness , Atorvastatin/therapeutic use
20.
Ciênc. Saúde Colet. (Impr.) ; 26(4): 1346-1354, abr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1285925

ABSTRACT

Abstract The verification of factors associated with growth, body composition and nutritional and nutritional aspects after HIV infection in children or adolescents in Brazil is fundamental for progress in this area. We selected articles published until 2018, available on the platforms PubMed and Lilacs, using the keywords The following descriptors and their associations were used, extracted from MeSH: "Children", "Adolescent", "Anthropometry", "Nutritional Assessment", "HIV", "Brazil" adding the filter "and" for advanced searches. A total of 1,450 articles were found, and after selection and full reading, 19 were selected. The studies agreed that children and adolescents living with HIV present or may present alterations in bone metabolism, lipid metabolism and body composition due to infection or associated with therapy. Significant differences were observed in weight and height in infected infants compared to uninfected infants. The evaluation and monitoring of diet quality, as well as serum micronutrient monitoring, are fundamental to guarantee the clinical and treatment conditions of these patients, as well as to prevent disorders due to low nutrient intakes.


Resumo A verificação de fatores associados ao crescimento, composição corporal e aspectos alimentares e nutricionais, após a infecção pelo HIV em crianças ou adolescentes no Brasil é fundamental para avanços nesta área. Foram selecionados artigos publicados até 2018, disponibilizados nas plataformas PubMed e Lilacs, extraídas do MeSH: "Children", "Adolescent", "Anthropometry", "Nutritional Assessment", "HIV", "Brazil" adicionadas do filtro "and" para as pesquisas. Foram encontrados 1.450 artigos e após seleção e leitura integral foram selecionados 19. Os estudos concordaram que crianças e adolescentes vivendo com HIV apresentam ou podem apresentar alterações no metabolismo ósseo, de lipídeos e na composição corporal devido à infecção ou associadas à terapia. Observou-se diferença significativa do peso e estatura em crianças infectadas em relação às não infectadas. Percebe-se que a avaliação e o monitoramento da qualidade da dieta, bem como o acompanhamento sérico de micronutrientes, são fundamentais para garantir as condições clínicas e de tratamento destes pacientes, bem como para prevenir desordens por baixo consumo de nutrientes.


Subject(s)
Humans , Infant , Child , Adolescent , HIV Infections/drug therapy , Antiretroviral Therapy, Highly Active , Body Weight , Brazil/epidemiology , Nutritional Status
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