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1.
Cad. Saúde Pública (Online) ; 34(2): e00047217, 2018. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-952381

ABSTRACT

O papel dos serviços de saúde é crucial para o alcance da meta 90-90-90 de controle da epidemia do HIV. O estudo avalia a organização dos serviços brasileiros nas ações de promoção, monitoramento e suporte à retenção no seguimento e apoio ao tratamento. Foram comparadas, por meio de variação percentual (VP), as respostas dos serviços a um questionário de avaliação da qualidade organizacional (Qualiaids) em 2007 e em 2010. Analisou-se os 419 serviços que responderam ao questionário em 2007 (83,1% dos respondentes) e 2010 (63,6%). Ações gerenciais relacionadas à retenção e apoio, embora incrementadas no período, permaneceram com baixa frequência, tais como: reuniões sistemáticas para discussão de casos; (32,7% em 2010; VP = 19,8%), registro de faltas em consulta médica (35,3%; VP = 36,8%). Ações assistenciais relacionadas à adesão ao tratamento medicamentoso permanecem majoritariamente exclusivas do médico. O aporte de recursos de provisão federal - medicamentos e exames específicos para HIV - manteve-se alto para a grande maioria dos serviços (~90%). Não se alcançará decréscimo significativo da transmissão do HIV enquanto a permanência no tratamento não for prioridade de todos os serviços de assistência.


El papel de los servicios de salud es crucial para el alcance de la meta 90-90-90 de control de la epidemia de VIH. El estudio evalúa la organización de los servicios brasileños en las acciones de promoción, monitoreo y apoyo al mantenimiento del seguimiento y tratamiento. Se compararon, mediante la variación porcentual (VP), las respuestas de los servicios a un cuestionario de evaluación de la calidad organizativa (Qualiaids) en 2007 y en 2010. Se analizaron los 419 servicios que respondieron al cuestionario en 2007 (83,1% de los participantes) y 2010 (63,6%). Las acciones de gerencia, relacionadas con el mantenimiento y apoyo, aunque se incrementaron durante el período, permanecieron con baja frecuencia, tales como: reuniones sistemáticas para discusión de casos; (32,7% en 2010; VP = 19,8%), registro de faltas en consulta médica (35,3%; VP = 36,8%). Las acciones asistenciales relacionadas con la adhesión al tratamiento farmacológico continúan siendo mayoritariamente exclusivas del médico. La aportación de recursos de provisión federal -medicamentos y exámenes específicos para VIH- se mantuvo alta para la gran mayoría de los servicios (~90%). No se alcanzará un decremento significativo en la transmisión del VIH, mientras la permanencia en el tratamiento no sea una prioridad de todos los servicios de asistencia.


Health services play a crucial role in reaching the 90-90-90 target of controlling the HIV epidemic. This study evaluates the organization of Brazilian health services in improving, monitoring, and retention in HIV care and adherence support. Percentage variation (PV) was used to compare the responses by services to an evaluation questionnaire on organizational quality (Qualiaids) in 2007 and 2010. The study analyzed the 419 services that completed the questionnaire in 2007 (83.1% of respondents) and 2010 (63.6%). Management actions of retention and support although increased in the period, but remained at low rates, for example: systematic meetings for case discussion (32.7% in 2010; PV = 19.8%) and recording of missed medical appointments (35.3%; PV = 36.8%). Patient care actions related to adherence to ART remained largely exclusive to the attending physician. The supply of funds and resources from the Federal Government (medicines and specific HIV tests) remained high for the vast majority of the services (~90%). It will not be possible to achieve a significant decrease in HIV transmission as long as retention in treatment is not a priority in all the health services.


Subject(s)
Humans , Quality of Health Care , Patient Acceptance of Health Care/statistics & numerical data , HIV Infections/therapy , Ambulatory Care/organization & administration , National Health Programs , Brazil , Surveys and Questionnaires , Acquired Immunodeficiency Syndrome/therapy , HIV Long-Term Survivors
2.
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-296616

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the progression and drug resistance of long-term non-progressors during three follow-up in Henan province.</p><p><b>METHODS</b>In May 2009, 26 cases of long-term non-progressors were recruited who infected HIV more than 10 years with blood collection and supply routes, did not receive anti-retroviral therapy, CD4(+)T lymphocyte count ≥350/μl and did not show typical symptoms of AIDS from Weishi, Shangcai, and Linying of Henan Province. Continuous follow-up were conducted three times since 2009 every two years with cohort analysis, the epidemiological information of infection routes, infection time and blood were collected, and 78 parts of 10 ml EDTA anticoagulated whole blood were collected. The changes of CD4 (+) T lymphocytes, viral load, and virus gene variety were characterized from 2009 to 2014. In-house methods were used to explore primary drug resistance of long-term non-progressors. Nonparametric Kruskal-Wallis test were used to compare CD4(+) T lymphocyte count and viral load changes during different follow-up times.</p><p><b>RESULTS</b>The average age and infection time of 26 cases were (48.51 ± 6.75) years, (13.42 ± 4.26) years, respectively. Three follow-up times, CD4(+) T lymphocyte count P50 (P25-P75) was 573.5 (487.4-789.8), 499.8 (403.5-635.7), and 418.8 (297.6-537.8)/μl (H=63.99,P<0.001), respectively. And natural logarithm of viral load P50 (P25-P75) were 3.93 (3.43-4.55), 4.29 (3.78-4.75), 4.50 (4.01-4.81) (H=3.19,P=0.355), respectively. Subtype and phylogenetic analysis of HIV showed that prevalent cases were B subtype, accounting for 88.5% (23/26), and three cases showed restructuring changes. Two cases appeared highly resistant of 18 infected patients whose viral load >1 000 copies/ml.</p><p><b>CONCLUSION</b>The CD4(+)T lymphocyte had a declining trend, virus subtype recombinant changes in a few cases, and primary drug resistance was found of long-term non-progressors in Henan province.</p>


Subject(s)
Adult , CD4 Lymphocyte Count , China , Cohort Studies , Disease Progression , HIV , Classification , HIV Infections , Epidemiology , HIV Long-Term Survivors , Humans , Middle Aged , Phylogeny , Viral Load
3.
Rev. colomb. bioét ; 9(n.esp): 7-58, nov. 2014.
Article in Spanish | LILACS (Americas) | ID: lil-750082

ABSTRACT

Este artículo presenta la construcción del concepto ®sobreconvivir con VIH/sida¼, desarrollado en el cruce entre la perspectiva de una bioética global y los relatos de diez y seis mujeres quindianas que encaran el reto de aprender a interactuar con el acontecimiento. Allí mismo, surgieron los trazos de un giro bioético de la epidemia, al vislumbrar modos posibles de afirmar la vida, creados por las mujeres. La hipótesis de esta investigación apunta a que la actividad reorganizativa que se desarrolla a partir del diagnóstico, en medio de interafectaciones dirigidas y contingentes, va delimitando, definiendo y desplegando una composición inédita humano–virus–tecnología, la cual expresa un saber bioético, en la medida en que se pone a prueba su capacidad de sobreconvivir. Sobreconvivir, como la posibilidad metaestable de un entramado autónomo, en el que la nueva composición se hace viable, sustentable y vale la pena ser vivida.


This manuscript develops the concept of “over-coexisting with HIV/aids” at the crossing of a global bioethics perspective with the stories of sixteen “quindiana women” who face the challenge of learning to interact with the disease. It is there that emerged a bioethics angle to the epidemic, formed by the women to envisage possible ways to affirm life. The research hypothesis suggest that the activity of reorganization developed after the diagnosis, amid direct and contingent inter-affectations, and defined and unfolded an inedited composition of human-beingvirus- technology, which expresses a bioethics knowledge to the extent that the over-coexisting capacity is tested. Over-coexisting, as a metastable possibility of an autonomous network, where the new composition is viable, sustainable and is worth living.


Este artigo apresenta a conceito da frase “sobre-convivido com HIV/AIDS”, desenvolvida com a perspectiva da bioética global e as histórias de dezesseis mulheres quem enfrentaram o desafio de aprender a interagir com a doença. E assim que realizo os caminhos para afirmar a vida, criados por as mulheres quem surgiu um rotação da epidemia bioeticista. A hipótese desta pesquisa sugere que a atividade da reorganização após o diagnóstico, a meio das inter-afetações diretas e contingentes, e definida por uma composição inédita de uma vírus tecnología humana, que expressa um conhecimento bioética em que a capacidade de sobre-coexistente é desafiado. Sobrecoexistentes, como uma possibilidade metaestável de uma rede autónoma, onde a nova composição é possível, sustentável e vale a pena viver.


Subject(s)
Acquired Immunodeficiency Syndrome , Bioethics , HIV Infections , HIV Long-Term Survivors , Women
4.
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-302596

ABSTRACT

<p><b>OBJECTIVE</b>To explore the related testing indicators variation of HIV long-term non-progress populations.</p><p><b>METHODS</b>The long-term non-progress populations in some areas of Henan were recruited, and the study was carried out according to different CD4(+)T lymphocytes counts for two groups. The dynamic characteristics of immune status and viral load between LTNP-1group (CD4(+)T lymphocytes ≥ 500/µl, 42 cases) and LTNP-2 group(350/µl ≤ CD4(+)T lymphocytes < 500/µl, 49 cases) from July 2010 to August 2013 were observed. The characteristics of HIV elite controllers during the follow-up were also described.</p><p><b>RESULTS</b>LTNP were recruited, 56% (51 cases) were men, and 44% (40 cases) were women. The study population were aged from 38 to 65 years old. A total of 320 individuals were followed-up, 14 cases were lost, 2 deaths, and 16 cases had received antiretroviral therapy during four years. To analyze the annual changes of CD4(+)T lymphocytes and VL of the group from 2010 to 2013, LTNP-1 group CD4(+)T lymphocytes from 654.0(545.2-809.5) decreased to 494.0(341.0-574.7), and LTNP-2 group decreased from 493.0 (429.5-770.0) to 343.5(253.0-500.8), CD4(+)T lymphocytes decline of over times of two groups in longitudinal analysis (χ(2) = 50.32, P < 0.01; χ(2) = 31.03, P < 0.01). lg (VL) of LTNP-1 group were 3.52 (3.15-4.27), 3.71 (2.70-4.55), 3.86 (3.59-4.55), 3.96 (3.25-4.36), and lg (VL) of TNP-2 group were 4.35 (3.72-4.83), 4.35 (3.97-4.94), 4.71 (3.96-4.95), 5.04(4.78-5.26), respectively (P > 0.05). The same year inter-group comparison found CD4(+)T lymphocytes of LTNP-1 group were higher than LTNP-2 group (Z = 5.23, P < 0.01; Z = 3.06, P < 0.01; Z = 2.51, P < 0.05; Z = 2.47, P < 0.05). VL of LTNP-2 group increased from 4.35(3.97-4.94) to 5.04 (4.78-5.26) during 2011 to 2013, were higher than LTNP-1 group in the same year (Z = 2.28, P < 0.05; Z = 2.58, P < 0.05; Z = 2.76, P < 0.05). 65 cases HCV antibody were positive in 91 individuals, and the HCV antibody positive rate was 76% (32/42), 67% (33/49) between LTNP-1 group and LTNP-2 group. Six elite controllers maintained CD4(+)T lymphocytes ≥ 500/µl, VL<1 000 copies/ml during four years follow-up.</p><p><b>CONCLUSION</b>The long-term non-progress populations in Henan were overall healthy, and VL were relatively stable, there was a decreased trend of CD4 year by year, and HCV co-infection rate was high.</p>


Subject(s)
Adult , China , Epidemiology , Female , Follow-Up Studies , HIV Infections , HIV Long-Term Survivors , HIV Seropositivity , Humans , Male , Middle Aged , T-Lymphocytes , Viral Load
5.
Braz. j. infect. dis ; 17(4): 464-479, July-Aug. 2013. ilus, tab
Article in English | LILACS (Americas) | ID: lil-683135

ABSTRACT

The worldwide elderly population is expected to grow by an additional 694 million people by 2025. By that time, there will be approximately two billion elderly people in the world, most of whom (80%) will be living in developing countries. Based on recent estimates, this population will number over 40 million in 2030 in Brazil and a consequent increase in governmental spending for this population can be expected. Since highly active antiretroviral therapy became available in the mid-1990s, the life expectancy of people living with HIV has increased significantly. Approximately 12 million life years were added to the world between 1996 and 2008 as a consequence of wider access to highly active antiretroviral therapy. In Brazil, the incidence of AIDS among the population aged >50 years doubled between 1996 and 2006. The development of antiretroviral therapy has allowed individuals diagnosed at a younger age to live longer, which partially explains the aging tendency associated with the HIV/AIDS epidemic. It is estimated that by 2015, subjects aged >50 years will represent 50% of the people living with HIV undergoing clinical treatment. This scenario presents some challenges, including the fact that the diagnosis of HIV tends to be delayed in older patients compared to younger patients because the symptoms of HIV can be confused with those of other common diseases among the elderly and also because healthcare professionals do not consider this population to be at high risk for HIV infection. In regard to the individuals diagnosed with HIV, a further challenge is presented by the morbidity normally associated with aging. Finally, the elderly also exhibit higher susceptibility to the toxic effects and pharmacological interactions of medications. The present article reviews the literature regarding the profile of HIV infection among individuals aged >50 years focusing on practical features related to the clinical approach and long-term follow-up of this population.


Subject(s)
Adult , Aged , Humans , Middle Aged , Young Adult , Aging , HIV Infections/epidemiology , Age Factors , Anti-HIV Agents/therapeutic use , Brazil/epidemiology , HIV Infections/drug therapy , HIV Long-Term Survivors/statistics & numerical data , Life Expectancy/trends
6.
Rev. chil. infectol ; 29(3): 337-343, jun. 2012. tab
Article in Spanish | LILACS (Americas) | ID: lil-645601

ABSTRACT

Introduction: Highly effective antiretroviral triple therapy (TAR3) has led to a significant increase in survival of patients (pts) infected with human immunodeficiency virus. In 1999 it was started in the Chilean public health system, including Arriarán Foundation (FA) access to TAR, reaching full coverage since 2003. By October 31, 2009 124 pts had reached 10 years of uninterrupted TAR3 in FA. Objective: To describe and analyze the profile of pts, their therapeutic regimen (s) and clinical outcomes during 10 years of TAR3. Methods: Retrospective descriptive study. We reviewed the records of pts who had reached 10 years of uninterrupted TAR3 in FA. Demographic data, baseline and virological staging at start of TAR3, comorbidities and complications were recorded. Drug regimens used were analyzed, as well as toxicity, virological and immunological outcomes, frequency and reasons for change in therapy. Complications were classified as opportunistic and not opportunistic during this evolution and the latest known clinical and laboratory data were registered. A database program based on Excel was used. Results: 121/124 pts were available for analysis, 76.8% male, male-female ratio was 3.3:1. Baseline median age: 36 years (20-69); CD4 cells 176/ mm³ (8-1,224) with 65.3% < 200; median viral load (STL): 60,078 copies/ml (1,100- 7,900,000); 36.3% were in clinical AIDS stage. Patients received an average of 3.5 therapies regimens during the decade (range, 1 [14 pts, 11.5%] to 7 [3 pts, 2.4%]), with average duration of 42 months each and a median of 36 months. As initial TAR3 regimen 2 backbone nucleoside analogues (ITRN) was the most frequent, with a protease inhibitor (PI) in 51.2% and non-nucleoside RTIs (NNRTIs) in 38.8%. Adverse reactions were the main reason for change of therapy (24.7%), followed by virological failure (24.2%) and treatment simplification (16.6%). At the latest assessment, all with > 10 years of TAR3 median CD4 was 602 cells/mm³, 11 pts (9%) had CD4 < 200/mm³; 85.2% had undetectable VL (< 80 copies/mL); the remaining 14.8% had a median of 1,800 copies/mL. Only 2 pts (1.7%) were in AIDS clinical stage. Current regimens were 2 NRTI plus 1 NNRTI in 61 pts (50.4%), 2 or more NRTI plus 1 PI in 46 (38%). Seventy two pts (60.3%) had chronic comorbidities at latest follow up. Dyslipidemia, hypertension, diabetes mellitus and renal failure were the most frequent conditions; 17 pts (14%) had clinical lipodystrophy secondary to TAR. Conclusion: Achieving a decade of TAR is already a reality and in the short term will be routine. This is rarely achieved with the initial therapeutic regimen. The major obstacles to prolonged maintenance of a single therapeutic regimen have been adverse effects and virological failure, although current drugs with better efficacy and safety profile may allow longer use for each regimen. Despite the difficulty of treating these pts, they can achieve long-term survival with good virologic control, immune recovery and absence of opportunistic complications associated with HIV infection. Nonetheless, the high frequency of non opportunistic chronic comorbidities and antiretroviral therapy side effects after prolonged or life-long use is becoming a major issue.


La introducción de la triterapia anti-retroviral de alta efectividad (TAR3) ha llevado a un significativo aumento en la sobrevida de los pacientes infectados por virus de inmunodeficiencia humana. En 1999 se inició en el sistema público de salud chileno, incluida la Fundación Arriarán (FA) el acceso progresivo a TAR3, que alcanzó cobertura completa desde 2003. En FA al 31 de octubre de 2009 se compatibilizaban 124 pacientes (pts) que habían alcanzado 10 años de TAR3 ininterrumpida. Objetivo: Describir y analizar el perfil de los pts, sus terapias y la evolución clínica durante el período de 10 años de TAR3. Material y Método: estudio descriptivo y retrospectivo. Se revisaron las fichas de los pts que alcanzaron 10 años de TAR3 en FA. Se registraron datos demográficos, clínicos y clasificación por etapas, co-morbilidades y complicaciones al inicio de tratamiento. Se analizaron los esquemas terapéuticos recibidos, toxicidades y desenlaces virológicos e inmunológicos, así como la frecuencia y razones de cambio de terapias, las complicaciones oportunistas y no oportunistas durante esta evolución y el último estado clínico y de laboratorio conocido. Se empleó una base de datos en base al programa Excel. Resultados: se lograron analizar 121/124 pts, 76,8% hombres, relación hombre:mujer 3,3:1. Mediana basal: edad, 36 años (20-69); recuento de linfocitos CD4 de 176 céls/mm³ (8-1.224), con 65,3% < de 200 céls/mm³; carga viral (CV): 60.078 copias/ml (1.100 -7.900.000); 44/121 (36,3%) en etapa SIDA clínica inicial. Los pacientes recibieron un promedio de 3,5 esquemas de terapias durante el decenio (rango, 1 [14 pts, 11,5 %] a 7 [3 pts, 2,4 %]), con duración promedio de 42 meses en cada uno y una mediana de 36. TAR3 inicial con dos análogos nucleosídicos (ITRN) fue lo más frecuente, con un inhibidor de la proteasa (IP) en 51,2% o con ITR no nucleosídico (ITRnN) en 38,8%. Las reacciones adversas fueron el principal motivo de cambio de esquemas (24,7%), seguido de fracaso virológico (24,2%) y simplificación terapéutica (16,6%). En su última evaluación y con > 10 años de TAR3 la mediana de linfocitos CD4 era de 602 céls/mm³; había 11 pts (9 %) con CD4 < 200/ mm³; 85,2% estaba con CV indetectable (< 80 copias/ mL), 14 (14,8%) con detectabilidad viral, y éstos con una mediana de 1.800 copias/mL. Sólo 2 pts (1,7%) estaban en etapa clínica de SIDA. El esquema de TAR3 actual más frecuente era de dos ITRN más un ITRnN, en 61 pts (50,4%) y luego dos ITRN más un IP en 46 (38%). En 72 pts (60,3%) se pesquisaron co-morbilidades crónicas: dislipidemias, hipertensión arterial, diabetes mellitus y/o insuficiencia renal; 17 pts (14%) presentaban lipodistrofia clínica secundaria a TAR3 Conclusión: Alcanzar una década de TAR3 ya está siendo una realidad y a corto plazo será rutinario. Esto rara vez se logra con la primera terapia, aunque esquemas contemporáneos más efectivos y seguros pueden hacerlo posible a futuro. Los principales obstáculos para lograr mantención prolongada de un solo esquema terapéutico son los efectos adversos y el fracaso virológico. A pesar de las dificultades terapéuticas estos pts pueden alcanzar sobrevida a largo plazo con buen control virológico, recuperación inmune y control de las complicaciones oportunistas asociadas a la infección por VIH. Destaca la alta frecuente de co-morbilidades crónicas no oportunistas y secuelas de la terapia anti-retroviral.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/epidemiology , Anti-HIV Agents/administration & dosage , Antiretroviral Therapy, Highly Active/adverse effects , HIV Long-Term Survivors/statistics & numerical data , AIDS-Related Opportunistic Infections/epidemiology , AIDS-Related Opportunistic Infections/etiology , Anti-HIV Agents/adverse effects , Antiretroviral Therapy, Highly Active/methods , Chronic Disease , Comorbidity , Chile/epidemiology , Drug Administration Schedule , Dyslipidemias/etiology , Hypertriglyceridemia/etiology , Lipodystrophy/etiology , Patient Outcome Assessment , Sex Ratio
7.
Article in English | WPRIM (Western Pacific) | ID: wprim-299581

ABSTRACT

<p><b>INTRODUCTION</b>There is little detailed information on human immunodeficiency virus (HIV) amongst older adults in Singapore.</p><p><b>MATERIALS AND METHODS</b>A retrospective study of 121 consecutive referrals of patients presenting for HIV care was conducted. Demographic, clinical and laboratory variables were collected. A prognostic model derived from the North American Veterans' Affairs Cohort Study (VACS) was used to estimate prognosis.</p><p><b>RESULTS</b>The median age at presentation was 43 (range, 18 to 76). Thirty-eight patients (31%) were aged 50 or older and 106 patients (88%) were male. Older patients were more likely to be of Chinese ethnicity (P = 0.035), married (P = 0.0001), unemployed or retired (P = 0.0001), and to have acquired their infection heterosexually (P = 0.0002). The majority of patients in both groups were symptomatic at presentation. Eighty-one (67%) had CD4 counts less than 200 at baseline with no observable differences in HIV ribonucleic acid (RNA) or clinical stage based on age. Non-Acquired Immunodeficiency Syndrome (AIDS) morbidity was observed more frequently amongst older patients. The estimated prognosis of patients differed significantly based on age. Using the VACS Index and comparing younger patients with those aged 50 and above, mean 5 year mortality estimates were 25% and 50% respectively (P <0.001). A trend towards earlier antiretroviral therapy was noted amongst older patients (P = 0.067) driven mainly by fewer financial difficulties reported as barriers to treatment.</p><p><b>CONCLUSION</b>Older patients form a high proportion of newly diagnosed HIV/AIDS cases and present with more non-AIDS morbidity. This confers a poor prognosis despite comparable findings with younger patients in terms of clinical stage, AIDS-defining illness, CD4 count and HIV viral load.</p>


Subject(s)
Acquired Immunodeficiency Syndrome , Mortality , Adolescent , Adult , Age Factors , Aged , Female , HIV Infections , Mortality , HIV Long-Term Survivors , Humans , Male , Middle Aged , Models, Theoretical , Mortality , Prognosis , Retrospective Studies , Singapore , Epidemiology , Social Class , Young Adult
8.
Niterói; s.n; 2011. 149 p. graf, tab.
Thesis in Portuguese | LILACS (Americas) | ID: lil-688419

ABSTRACT

Desde 1980, ano da identificação do primeiro caso de aids no Brasil, mais de meio milhão de novos casos foram notificados no país. A região Sudeste foi a mais atingida com mais de 300 mil casos. No estado do Rio de Janeiro foram identificados 81.606 casos da doença, 48.061 dos quais na capital apenas...Este estudo foi aprovado pelo Comitê de Ética em Pesquisa do HUAP. Num período de 13 meses, foram estudados 235 pacientes, sendo a maioria do sexo masculino(55,3%). A média de idade dos pacientes foi de 43,1 anos, com o predomínio de raça não branca (50,6%). Em relação ao estado nutricional 5,5% da população estudada apresentava baixo peso , 54,4% apresentavam classificação normal, 26% sobrepeso e 11,1% obesidade. Os exames de glicemia de jejum estavam alteradas em 13,7% dos indivíduos, o colesterol total em 40,8%, o LDL em 33,5% e o HDL em 47,9% deles. Este estudo mostra elevado sobrepeso e obesidade na população com HIV/aids, identificando a necessidade em se conhecer o perfil nutricional desses pacientes e tomando as medidas necessárias para o seu controle precoce.


Subject(s)
Humans , HIV , HIV Long-Term Survivors , Nutritional Sciences , Nutritional Status , Obesity, Abdominal , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/diet therapy , Blood Glucose , Dyslipidemias
9.
São Paulo; s.n; 2011. 95 p.
Thesis in Portuguese | LILACS (Americas) | ID: lil-643255

ABSTRACT

Introdução: As práticas integrativas e complementares em saúde (PIC), entre as quais se inclui a acupuntura, vêm ganhando espaço nas últimas décadas no serviço público no Brasil. Em 2006 foi aprovada a lei que regulamenta a Política Nacional de Práticas Integrativas e Complementares (PNPIC), proporcionando maior impulso para essas práticas no SUS. Alinhada com essa política, a Unidade de Medicinas Tradicionais (UMT), no município de São Paulo, vem oferecendo desde 2005 atendimento com as PIC de maneira ampla e contínua. Entre os pacientes atendidos na UMT, há uma parcela de pacientes HIV positivos, cujo perfil é desconhecido. Objetivo: Descrever o perfil dos pacientes atendidos na Unidade de Medicinas Tradicionais e, em particular, dos pacientes HIV positivos, caracterizando: origem do encaminhamento, queixas, expectativas em relação ao tratamento e aspectos que mais influenciam negativamente a qualidade de vida desses pacientes. Métodos: Foi realizado um estudo transversal descritivo, analisando-se todos os prontuários dos pacientes atendidos na UMT entre 2006 e 2009. Os pacientes HIV positivos foram identificados e contatados para entrevista, para que informações detalhadas fossem obtidas. Foram usados um questionário de qualidade de vida específico para pacientes HIV positivos (HIV/AIDS-Targeted Quality of Life Instrument HAT-QoL) e um questionário desenvolvido pelo pesquisador. Resultados Foram incluídos 1960 pacientes, dos quais 81 por cento eram mulheres; 68,3 por cento acima dos 50 anos; e 74,1 por cento com demanda espontânea. As queixas principais foram dor (66 por cento ) e queixas mentais (26 por cento ), com duração mediana de 24 meses. Foram identificados 57 pacientes soropositivos, dos quais 71,9 por cento eram do sexo masculino. As queixas principais também foram dor (22 por cento ) e queixas mentais (21,3 por cento ), sendo 72,1 por cento com demanda espontânea. Entre as expectativas, estavam: alívio das queixas, melhora da qualidade de vida, bem-estar e melhora da imunidade. Na avaliação das dimensões de qualidade de vida, as mais afetadas foram função sexual e preocupação em revelar a doença.


Subject(s)
Medicine, Traditional , Acquired Immunodeficiency Syndrome/therapy , HIV Long-Term Survivors/psychology , Acupuncture Therapy/psychology , Ambulatory Care , Cross-Sectional Studies , Public Health , Quality of Life/psychology , Unified Health System
10.
Article in English | WPRIM (Western Pacific) | ID: wprim-129410

ABSTRACT

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


Subject(s)
Acquired Immunodeficiency Syndrome , AIDS-Related Opportunistic Infections , Surveys and Questionnaires , Dental Clinics , Dentists , HIV , HIV Long-Term Survivors , Humans , Korea , Mass Screening , Prevalence , Prospective Studies
11.
Article in English | WPRIM (Western Pacific) | ID: wprim-129395

ABSTRACT

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


Subject(s)
Acquired Immunodeficiency Syndrome , AIDS-Related Opportunistic Infections , Surveys and Questionnaires , Dental Clinics , Dentists , HIV , HIV Long-Term Survivors , Humans , Korea , Mass Screening , Prevalence , Prospective Studies
12.
Indian J Med Sci ; 2010 Oct; 64(10) 441-447
Article in English | IMSEAR (South-East Asia), GHL | ID: sea-145565

ABSTRACT

Background: HIV/AIDS being a behavioral disease, appropriate knowledge is important for those who are infected. Objectives: To elicit and compare knowledge and attitude about HIV/AIDS among newly diagnosed and previously diagnosed HIV/AIDS patients attending or admitted in Calcutta School of Tropical Medicine, (CSTM), Kolkata. Materials and Methods: A cross-sectional descriptive study was undertaken among previously diagnosed HIV/AIDS Patients admitted in indoor wards and newly diagnosed HIV/AIDS patients attending Integrated Counseling and Testing Centre (ICTC) of the School of Tropical Medicine, Kolkata. Data were gathered by interviewing patients using a predesigned, pretested, semi-structured questionnaire. Results: More in-patients had heard about AIDS than ICTC patients. Television was the most popular source of information in both groups, followed by health personnel and friends. Correct knowledge about transmission, symptoms, prevention of AIDS, and lifestyles desirable for affected patients was significantly higher among in-patients who had already been counseled, than the newly diagnosed ICTC patients yet to receive. Within each group of patients, the knowledge score was significantly higher among females, Christians, urban residents, patients educated beyond middle school, and non- migrants. In-patients had a significantly higher attitudinal score toward HIV/AIDS. Conclusion: Repeated counseling is required to keep up high level of knowledge and positive attitude pertaining to HIV/AIDS to reduce risk behavior, prevent disease transmission, and improve quality of life.


Subject(s)
Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/transmission , Counseling/methods , Continuity of Patient Care , Cross-Sectional Studies , Health Knowledge, Attitudes, Practice , HIV Infections/psychology , HIV Long-Term Survivors , Humans , India , Inpatients/education , Outpatients/education , Patient Education as Topic , Perception , Population Groups , Quality of Life , Surveys and Questionnaires
13.
Braz. j. infect. dis ; 13(4): 276-279, Aug. 2009. tab
Article in English | LILACS (Americas) | ID: lil-539763

ABSTRACT

There are only scarce data on HIV progression in vertically infected children in developing countries. The aim of this study is to describe factors from neonatal period associated with long term non-progression (LTNP), in a Brazilian cohort. A cohort study, with data systematically collected from the "Peixe" Cohort (cohort study of children conducted at the main HIV Pediatric Center in Rio de Janeiro, from 1996 to 2005). The study included children who were vertically infected and started follow up at 5 years of age or younger. LTNP, defined as not reaching category C or severe immunosuppression before 5 years of age. Neonatal and demographic factors were studied. Variables with p-value<0.15 were included in a logistic regression model. 213 patients were included, of whom 42 percent (89/213) were classified as LTNP. Variables independently associated with LTNP were: baseline (at study entry) CD4+ cells (per percent) (OR= 1.06, 95 percentCI=1.01-1.12); age of initiating follow-up, per month (OR= 1.03, 95 percentCI=1.01-1.06); ZDV use duriing newborn period (OR= 3.31, 95 percentCI=0.86-12.71); use of antiretroviral (ART) before classification C or severe immunosuppression (OR= 5.89, 95 percentCI=2.03-17.10). Adjusting for age at the beginning of follow-up, antiretroviral that was unsuccessfully used to prevent maternal-to-child transmission (ZDV use in neonatal period) was associated with better prognosis. ARTs initiation before category C or severe immunosuppression was also associated with LTNP.


Subject(s)
Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Anti-HIV Agents/therapeutic use , HIV Infections/transmission , HIV Long-Term Survivors/statistics & numerical data , Infectious Disease Transmission, Vertical , Brazil , Cohort Studies , HIV Infections/drug therapy , HIV Infections/immunology , Prospective Studies , Viral Load
14.
Article in Portuguese | LILACS (Americas) | ID: lil-549625

ABSTRACT

O relato de caso aborda os mecanismos de controle da infecção pelo vírus da imunodeficiência humana tipo 1 que podem estar presentes nos indivíduosditos não progressores em longo prazo. São apresentados dois casos clínicos de pacientes acompanhados no Serviço de Atendimento Especializado da Policlínica Oswaldo Cruz, em Porto Velho, Rondônia, Brasil. A possibilidade de controle da infecção viral sem a utilização da terapia antirretroviral abreperspectivas para outros tipos de tratamento.


This case report is about the control mechanisms of human immunodefi ciency virus type-1 infection that may be present in long-term nonprogressors individuals. Two clinical cases about patients belonging at the Service in Specialized Attendance at Oswaldo Cruz Policlinics, Porto Velho City, Rondônia,Brazil, were presented. The possibility of viral infection control without the antiretroviral therapy's use gives us perspectives to others types of treatment.


Subject(s)
Humans , Male , Female , Adult , Acquired Immunodeficiency Syndrome , HIV Infections , HIV Long-Term Survivors , Sexually Transmitted Diseases , Retroviridae Infections
15.
Article in English | WPRIM (Western Pacific) | ID: wprim-296019

ABSTRACT

<p><b>OBJECTIVE</b>To study the specific amino acid variation in Nef that may be related to disease progression after infection with HIV-1 subtype B, a predominant strain circulating in China, and to determine whether changes in Nef secondary structure may influence different stages of AIDS development based on the concept that the Nef gene of HIV infection dramatically alter the severity of viral infection and virus replication and disease progression, and that long-term non-progressors (LTNP) of HIV infection are commonly associated with either a deletion of the Nef gene or the defective Nef alleles.</p><p><b>METHODS</b>The study subjects were divided into LTNP1(n=14), LTNP2 (n=16) and slow progressor (SP, n=19) groups for mutational analysis of the Nef sequence. The data were obtained by using Bioedit, MEGA, Anthewin and SAS software.</p><p><b>RESULTS</b>Residues in Nef TA(48/49) and K151 occurred more frequently in the LTNP group while AA(48/49) was more frequently observed in the SP group. Of the differences observed in the secondary structure comparison using Nef consensus sequences of these three groups, one was roughly corresponding to the Nef(48/49) mutation site.</p><p><b>CONCLUSION</b>TA(48/49), K(151), and AA(48/49) in the Nef gene might be associated with the different stages of HIV infection, and there may be a link between the Nef secondary structure and the progression of HIV-1 infection.</p>


Subject(s)
Amino Acid Sequence , Base Sequence , Blood Donors , CD4 Lymphocyte Count , China , Epidemiology , Disease Progression , Gene Products, nef , Genetics , HIV Infections , Epidemiology , Virology , HIV Long-Term Survivors , HIV-1 , Classification , Genetics , Humans , Molecular Sequence Data , Mutation , Genetics , Time Factors
16.
São Paulo; s.n; 2008. [235] p. ilus, tab, graf.
Thesis in Portuguese | LILACS (Americas) | ID: lil-586866

ABSTRACT

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


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


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Acquired Immunodeficiency Syndrome , Epitopes, T-Lymphocyte , HIV , HIV Long-Term Survivors , HLA Antigens , Peptides , T-Lymphocytes
17.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-111541

ABSTRACT

There are various diagnostic methods for detection of HIV infection. Among them, ELISA has been using most widely as a screening test. On the other hand, the Western blot method has been used as a confirmative test. The final confirmative tests are conducted on the seropositive sample and other supplementary methods such as HIV antigen test or molecular tests involving polymerase chain reaction should be performed in addition to Western blot for the confirmation. The clinical consequences of HIV infection encompass a spectrum ranging from an acute syndrome associated with primary infection to a prolonged asymptomatic state and advanced disease. It is best to regard HIV disease as beginning at the time of primary infection and progressing through various stages. Throughout the course of HIV infection, active viral replication and progressive immunologic impairment occur in most patients. With the exception of rare true long-term nonprogressors, HIV disease, when untreated, inexorably progresses even during the clinically latent stage. However, anti-retroviral therapy has had a major impact on blocking or slowing the progression of disease over extended periods of time in a substantial proportion of adequately treated patients. Overall, the clinical spectrum of HIV disease is constantly changing as patients live longer and new and better approaches to treatment and prophylaxis are developed.


Subject(s)
Asymptomatic Diseases , Blotting, Western , Diagnosis , Enzyme-Linked Immunosorbent Assay , Hand , HIV , HIV Infections , HIV Long-Term Survivors , Humans , Mass Screening , Polymerase Chain Reaction
18.
Rev. saúde pública ; 40(supl): 70-79, abr. 2006. graf
Article in Portuguese | LILACS (Americas) | ID: lil-427680

ABSTRACT

O trabalho teve por objetivo avaliar a assistência à população com Aids no Brasil e a capacidade do Sistema Unico de Saúde (SUS) de prover intervenções para enfrentamento da epidemia e discutir a sustentabilidade da iniciativa brasileira de distribuição universal e gratuita dos anti-retrovirais. O trabalho considerou dados originais de uma pesquisa sobre a capacidade potencial de distribuição de uma futura vacina anti-HIV no Brasil, envolvendo 119 entrevistados. Nas abordagens da assistência hospitalar e da assistência farmacêutica foram utilizados dados do Sistema de Informações Hospitalares do SUS e do Sistema de Controle Logístico de Medicamentos do Programa Nacional de DST/Aids. Os resultados mostraram bom desempenho da política de distribuição de anti-retrovirais. Entretanto, o acesso ao tratamento de doenças oportunistas foi deficitário. Os valores pagos pelo Sistema Unico de Saúde pelas internações por Aids mantiveram-se muito baixos, com valor médio em torno de R$700,00, em 2004. A assistência a pacientes com HIV/Aids no Brasil tem sido tratada como um direito do cidadão, com o respaldo de uma articulação efetiva entre as esferas de governo e a sociedade civil. Os desafios que se colocam atualmente dizem respeito ao monitoramento mais fino dos processos e resultados obtidos e à sustentabilidade da distribuição universal e gratuita de anti-retrovirais.


Subject(s)
Anti-HIV Agents/economics , Anti-HIV Agents/supply & distribution , Delivery of Health Care/organization & administration , Health Services Administration , HIV Long-Term Survivors , AIDS-Related Opportunistic Infections/prevention & control , AIDS-Related Opportunistic Infections/therapy , Acquired Immunodeficiency Syndrome/prevention & control , Acquired Immunodeficiency Syndrome/therapy , Unified Health System , Brazil
19.
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-305556

ABSTRACT

<p><b>BACKGROUND</b>To investigate variant genotyping of CCR2-64I, SDF1-3'A and CCR5Delta32 in HIV-1 infected Chinese Long-term nonprogressors and to study their association with disease progression.</p><p><b>METHODS</b>The genotypes of CCR2-64I, SDF1-3'A and CCR5Delta32 were detected by polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP) assay in seventeen HIV-1 infected Chinese Long-term nonprogressors (LTNPs) and thirty-nine Chinese typical progressors (TPs).</p><p><b>RESULTS</b>The frequency of CCR2-64I and SDF1-3'A in LTNPs are 50% and 62.5%, higher than those (23.08% and 33.33%) in TPs. Only one heterozygous CCR5 mutant was detected in LTNPs, and no CCR5 mutant in TPs.</p><p><b>CONCLUSION</b>Variant genotyping of CCR2-64ISDF1-3'A and CCR5Delta32 may be protective factors for delaying disease progression in HIV-1 infected Chinese LTNPs.</p>


Subject(s)
Chemokine CXCL12 , Genetics , China , Gene Frequency , Genotype , HIV Infections , Genetics , Pathology , Virology , HIV Long-Term Survivors , HIV-1 , Physiology , Host-Pathogen Interactions , Humans , Mutation , Polymerase Chain Reaction , Polymorphism, Restriction Fragment Length , Receptors, CCR2 , Genetics , Receptors, CCR5 , Genetics , Receptors, HIV , Genetics
20.
Estud. psicol. (Campinas) ; 22(4): 415-423, out.-dez. 2005.
Article in Portuguese | LILACS (Americas) | ID: lil-466580

ABSTRACT

O artigo apresenta a narrativa de uma experiência psicanalítica em enquadramento clínico diferenciado com pacientes soropositivos para o HIV. Os portadores do HIV estão potencialmente sujeitos a vivências de estados agônicos em função do diagnóstico, do convívio e da severidade do tratamento de sua condição de soropositividade. As autoras foram levadas a buscar um enquadre clínico que contemplasse com maior pertinência o sofrimento existencial daquelas pessoas. A experiência clínica foi inspirada pela psicanálise winnicottiana. Utilizando a confecção de velas ornamentais como materialidade mediadora, isto é, como forma de contato com os pacientes, as autoras tomam "o brincar" como paradigma para a instalação do campo clínico e o "jogo do rabisco" como modelo. O artigo visa apresentar um empreendimento fielmente ancorado na utilização do método psicanalítico, aqui compreendido como ruptura/transformação do campo das agonias impensáveis.


The paper presents the narrative of a psychoanalytic experience in a special clinical setting with HIV positive patients. HIV positive patients are likely to experience high levels of suffering because of the diagnosis, the involvement, and the harshness of the treatment for their condition. The authors had sank a clinical setting that encompassed those people's existential suffering of. The clinical experience was inspired by the Winnicottian psychoanalysis. Using the ornamental candles crafting as a materiality mediator, i.e., as a patients' consultation method, the authors uses the playing activities as a paradigm of the clinical setting establishment, and the Squiggle game as a model. The aim of the paper is to demonstrate a project faithfully anchored in the psychoanalytic method, here understood as rupture/transformation of the unimaginable suffering field.


Subject(s)
HIV Long-Term Survivors , Stress, Psychological , Psychoanalytic Therapy/methods
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