Barriers to treatment of hepatitis C in HIV/HCV coinfected adults in Brazil

The objective of this study was to assess the prevalence of barriers to interferon treatment in a population of HIV/HCV coinfected patients. A cross-sectional study was conducted at two AIDS Outpatient Clinics in Brazil. The study included all HIV infected patients followed at these institutions from January 2005 to November 2007. Medical records of 2,024 HIV-infected patients were evaluated. The prevalence of anti-HCV positive patients among them was 16.7 percent. Medical records of HCV/HIV coinfected patients were analyzed. 189 patients with the following characteristics were included in our study: mean age 43 years; male gender 65 percent; former IDUs (52 percent); HCV genotype 1 (66.4 percent); HCV genotype 3 (30.5 percent); median CD4+ T cell count was 340 cells/mm³. Among 189 patients included in the analyses, only 75 (39.6 percent) were considered eligible for HCV treatment. The most frequent reasons for non-treatment were: non-compliance during clinical follow-up (31.4 percent), advanced HIV disease (21.9 percent), excessive alcohol consumption or active drug use (18.7 percent), and psychiatric disorders (10.1 percent). CONCLUSIONS: In Brazil, as in elsewhere, more than half of HIV/HCV coinfected patients (60.4 percent) have been considered not candidates to received anti-HCV treatment. The main reasons may be deemed questionable: non-adherence, drug abuse, and psychiatric disease. Our results highlight the importance of multidisciplinary teams to optimize the access of coinfected patients to HCV treatment.

Metabolic profile and cardiovascular risk factors among Latin American HIV-infected patients receiving HAART

OBJECTIVE: Determine the prevalence of metabolic abnormalities (MA) and estimate the 10-year risk for cardiovascular disease (CVD) among Latin American HIV-infected patients receiving highly active anti-retroviral therapy (HAART). METHODS: A cohort study to evaluate MA and treatment practices to reduce CVD has been conducted in seven Latin American countries. Adult HIV-infected patients with at least one month of HAART were enrolled. Baseline data are presented in this analysis. RESULTS: A total of 4,010 patients were enrolled. Mean age (SD) was 41.9 (10) years; median duration of HAART was 35 (IQR: 10-51) months, 44 percent received protease inhibitors. The prevalence of dyslipidemia and metabolic syndrome was 80.2 percent and 20.2 percent, respectively. The overall 10-year risk of CVD, as measured by the Framingham risk score (FRF), was 10.4 (24.7). Longer exposure to HAART was documented in patients with dyslipidemia, metabolic syndrome and type 2 diabetes mellitus. The FRF score increased with duration of HAART. Male patients had more dyslipidemia, high blood pressure, smoking habit and higher 10-year CVD than females. CONCLUSIONS: Traditional risk factors for CVD are prevalent in this setting leading to intermediate 10-year risk of CVD. Modification of these risk factors through education and intervention programs are needed to reduce CVD.

Humoral response to low molecular weight antigens of Mycobacterium tuberculosis by tuberculosis patients and contacts

Much effort has been devoted to the identification of immunologically important antigens of Mycobacterium tuberculosis and to the combination of target antigens to which antibodies from serum of tuberculous patients could react specifically. We searched for IgG antibodies specific for antigens of 45 to 6 kDa obtained after sonication of the well-characterized wild M. tuberculosis strain in order to detect differences in the antibody response to low molecular weight antigens from M. tuberculosis between patients with pulmonary tuberculosis and contacts. Specific IgG antibodies for these antigens were detected by Western blot analysis of 153 serum samples collected from 51 patients with confirmed pulmonary tuberculosis. Three samples were collected from each patient: before therapy, and after 2 and 6 months of treatment. We also analyzed 25 samples obtained from contacts, as well as 30 samples from healthy individuals with known tuberculin status, 50 samples from patients with other lung diseases and 200 samples from healthy blood donors. The positive predictive value for associated IgG reactivity against the 6-kDa and 16-kDa antigens, 6 and 38 kDa, and 16 and 38 kDa was 100 percent since simultaneous reactivity for these antigens was absent in healthy individuals and individuals with other lung diseases. This association was observed in 67 percent of the patients, but in only 8 percent of the contacts. The humoral response against antigens of 16 and 6 kDa seems to be important for the detection of latent tuberculosis since the associated reactivity to these antigens is mainly present in individuals with active disease.

Combined use of Western blot/ELISA to improve the serological diagnosis of human tuberculosis

Two recombinant antigens and a crude bacterial antigen of a wild M. tuberculosis strain were used to detect specific IgG antibodies in sera from 52 patients with pulmonary tuberculosis, confirmed by an acid-fast smear and serum culture of these patients and that of 25 contacts. The patients were not infected with HIV. We evaluated the sensitivity and specificity of ELISA, based on the recombinant TbF6® and TbF6/DPEP antigen and a search for reactivity patterns in the Western blot technique, using whole mycobacterium antigen. Serum samples from 22 healthy individuals and from 30 patients with lung diseases other than tuberculosis were used as controls. The best ELISA results were obtained with the TbF6/DPEP antigen combination, which gave 85 percent sensitivity and 91 percent specificity. ELISA sensitivity improved from 85 percent to 92 percent when the Western blot results were used. Western blot specificity was 100 percent when antibody reactivity with different antigenic bands was analyzed and associated. The association of TbF6/DPEP antigens used in ELISA with specific patterns of reactivity determined by Western blot can help make an identification when classic methods for the diagnosis of pulmonary tuberculosis are not sufficient.

Tuberculose ganglionar em adultos / Lymph node tuberculosis in adults

A linfadenite e uma importante forma de acometimento tuberculoso extra-pulmonar que contribui com 8,4 por cento do total de casos de tuberculose nos adultos tratados em nosso Servico. A exerese ganglionar com exame histologico do fragmento, propiciou o diagnostico em 77,8 por cento dos casos. A boa evolucao clinica e a alta porcentagem de reatores ao PPD (84,2 por cento) faz-nos supor a predominancia de M. tuberculosis como o agente etiologico da linfadenite na nossa serie. Houve boa resposta em 75 por cento dos pacientes submetidos ao esquema quimioterapico com seis meses de duracao.

Human parasitism by Phagicola sp (trematoda, heterophyidae) in Cananeia, Sao Paulo State Brazil

Relata-se o primeiro caso de parasitismo humano por Phagicola sp. registrado no Brasil em paciente do sexo feminino e de 31 anos de idade que viajara, no iniciop de 1987, para Cananeia, no litoral sul do Estado de Sao Paulo, permanecendo alguns meses nesse municipio, por motivos profissionais. A paciente queixava-se dores em colica no abdomem; no exame parasitologico de fezes encontraram-se ovos de Phagicola sp. e dicreto aumento da quantidade de eosinofilos (8 por cento) no hemograma. A paciente admitiu a ingestao de pedacos crus da tainha (Mugil sp.), em diversas ocasioes, durante sua permanencia em Cananeia. O tratamento com praziquantel (75 mg/Kg/dia/3 dias) resultou em cura clinica e parasitologica. Nao existem outros relatos de parasitismo humano por Phagicola sp. no Brasil. Em outros paises, cuidadosa revisao da literatura nao logrou encontrar referencias de acometimento humano, salvo vaga citacao acerca da possivel ocorrencia de alguns casos no sudeste dos Estados Unidos da America do Norte

Infecçäo por Clonorchis sinensis em imigrantes asiáticos no Brasil: tratamento com praziquantel / Clonorchis sinensis infections in Asian immigrants in Brazil: treatment with praziquantel

Estudaram-se quinze pacientes com infecçäo assintomática por Clonorchis sinensis, revelada através de exame parasitológico de fezes. Todos eram de origem asiática e procuraram o Laboratório Central do Instituto Adolfo Lutz para se submeterem a exames laboratoriais necessários a regularizaçäo de sua situaçäo, face a nova legislaçäo sobre imigrantes. Eram todos indivíduos adultos, seis pertencendo ao sexo feminino e nove ao masculino. Os quinze pacientes comn clonorquíase foram internados no Hospital das Clínicas da FMUSP e tratados com Praziquantel, na dosagem de 60 mg/Kg de peso corporal, dividida em duas tomadas. Foram realizados exames coprológicos quantitativos (método de Kato-Katz), antes do tratamento específico e no 15§, 30§ e 60§ dias após a terapêutica. Na última avaliaçäo (60§ dias após terapêutica), em nove pacientes (60,0%) näo se encontraram ovos do treamatódeo nas fezes e nos seis (40,0%), que continuavam eliminando ovos, notou-se reduçäo na quantidade eliminada (superior a 90% em cinco e a 30% no paciente restante). Os pacientes foram também submetidos a exames subsidiários, para avaliaçäo do estado geral e funçäo hepática, antes da administraçäo de Praziquantel e, posteriormente, no seguimento ambulatorial. A medicaçäo foi relativamente bem tolerada pelos pacientes, verificando-se a ocorrência de efeitos colaterais representados por náuseas e vômitos (dois casos), vertigens e tonturas (dois casos), epigastralgia (dois casos) e diarréia no 3§ dia após tratamento (um caso)

Silicose em cavadores de pocos. / Silicosis in well diggers

Sao apresentados 24 casos de silicose em cavadores de pocos cuja idade media era de 44 anos (29 a 58). Todos eram sintomaticos sendo os sintomas mais comuns a dispneia e a tosse. Todos apresentaram lesoes radiologicas, predominando a fibrose pulmonar nos lobos superiores. O eletrocardiograma mostrou sobrecarga de camara direita em tres casos, bloqueio de ramo direito em dois, sendo normal em 19 casos.A espirometria revelou um disturbio funcional misto em 12 casos, restricao pura em cinco, obstrucao pura em tres e foi normal em quatro casos