Predictors of short-term mortality in HIV-infected patients admitted to intensive care unit / Fatores preditores de mortalidade de curto prazo em pacientes infectados com HIV admitidos em unidade de terapia intensiva

INTRODUCTIONn: Historically, complications of HIV infection have been related to admissions to the Intensive Care Unit (ICU). Despite therapeutic advances, the results of the analysis of prognostic factors in patients with HIV/AIDS have varied, including late diagnosis and failure to adhere to antiretroviral treatment. OBJECTIVE: To evaluate the predictors of short-term mortality in HIV-infected patients admitted to the ICU, as well as their sociodemographic and clinical characteristics. METHODS: A retrospective cohort study including patients admitted to the ICU of a teaching hospital from 2003 through 2012. Data were collected from medical records after the Institutional Review Board approval. RESULTS: 148 HIV-infected patients were identified and 131 were eligible. Among included patients, 42.75% were HIV new diagnoses and 5.34% had no information about the time of diagnosis. The main reasons for admission to the ICU were respiratory failure and sepsis while mortality was 70.23% between 2003 and 2012. Among the risk factors for mortality were low albumin, high APACHE, low CD4+ T lymphocyte count, and not using antiretroviral therapy. CONCLUSION: Despite the availability of diagnosis and treatment for HIV-infected individuals, the number of new cases of advanced Aids diagnosed in high-complexity services such as ICU is high, as well as the non-use of combination antiretroviral therapy. It is necessary to strengthen anti-HIV screening to detect and treat more cases in the early stages.

INTRODUÇÃO: Historicamente, as complicações da infecção pelo HIV estavam relacionadas às internações em Unidade de Terapia Intensiva (UTI). Apesar dos avanços terapêuticos, os fatores prognósticos em pacientes com HIV/AIDS têm variado, incluindo diagnóstico tardio e não adesão ao tratamento antirretroviral. OBJETIVO: Avaliar os fatores preditores de mortalidade a curto prazo em pacientes infectados pelo HIV internados em UTI, bem como suas características sociodemográficas e clínicas. MÉTODOS: Estudo de coorte retrospectivo incluindo pacientes internados na UTI de um hospital universitário entre 2003 a 2012. Os dados foram coletados dos prontuários médicos após a aprovação pelo Comitê de Ética em Pesquisa com Seres Humanos. RESULTADOS: 148 pacientes infectados pelo HIV foram identificados e 131 eram elegíveis. Entre os pacientes incluídos, 42,75% possuíam diagnósticos recente de HIV e 5,34% não possuíam informação sobre o momento do diagnóstico. Os principais motivos de admissão na UTI foram insuficiência respiratória e sepse, enquanto a mortalidade foi 70,23% entre 2003 e 2012. Entre os fatores de risco para mortalidade identificou-se albumina baixa, APACHE alto, baixa contagem de linfócitos T CD4+ e não uso de terapia antirretroviral. CONCLUSÃO: Apesar da disponibilidade de diagnóstico e tratamento para indivíduos infectados pelo HIV, é elevado o número de casos novos em estágio avançado de Aids diagnosticados em serviços de alta complexidade, como UTI, e o não uso de terapia antirretroviral combinada. É necessário fortalecer a triagem anti-HIV, bem como aumentar a repetição da testagem anti-HIV para detectar e tratar mais casos em estágios iniciais.

Human papillomavirus types 16 and 18 and the prognosis of patients with stage I cervical cancer

OBJECTIVE: This study sought to evaluate the prevalence of human papillomavirus (HPV) types 16 and 18 in women with clinical stage IB cervical cancer treated by radical hysterectomy with pelvic lymphadenectomy as well as to establish a correlation between HPV type and cancer prognosis. METHODS: A single-center cohort study was conducted with 86 patients who had undergone radical hysterectomy for stage I cervical cancer. Prognostic factors and the presence of HPV 16 and 18 were analyzed using a polymerase chain reaction assay. A univariate analysis using Kaplan-Meier curves was conducted to estimate survival. RESULTS: The prevalence of HPV 16 in the study group was 65.3%, and the prevalence of HPV 18 was 33.3%. The prevalence of infection with both viruses was 26.9%. Overall survival at 5 years was 91% among women with HPV 18 and 96% among those without this virus type (p = 0.133). Among the women with HPV 16, the overall survival was 94%, whereas this rate was 96% among those without this virus type (p = 0.663). Disease-free survival was unaffected by the presence of HPV type 16 or 18. CONCLUSION: In the present study, despite the high prevalence of HPV types 16 and 18, the presence of these virus types did not affect the prognosis of patients with stage I cervical cancer who underwent radical hysterectomy. .

Human papillomavirus and penile cancers in Rio de Janeiro, Brazil: HPV typing and clinical features

OBJECTIVE: To determine the prevalence of human papillomavirus (HPV) DNA in penile cancers in Rio de Janeiro, Brazil. MATERIALS AND METHODS: We studied, prospectively, 80 consecutive cases of patients with penile cancers who underwent surgical treatment at three different Hospitals in Rio de Janeiro between March 1995 and June 2000. Of these patients, 72 were diagnosed with invasive squamous cell carcinoma and 8 patients with verrucous carcinoma. The following parameters were observed: presence or absence of HPV DNA viral type, histological subtypes, clinical stage and overall survival. RESULTS: HPV DNA was detected in 75 percent of patients with invasive carcinomas and in 50 percent of patients with verrucous carcinomas. High risk HPVs were detected in 15 of 54 (27.8 percent) patients with HPV positive invasive tumors and in 1 of 4 (25 percent) patients with HPV positive verrucous tumors. HPV 16 was the most frequent type observed. No correlation was observed between HPV status and histological subtype (p = 0.51) as well as HPV status and stage stratification (p = 0.88). HPV status was also not significantly associated with the presence of regional metastases (p = 0.89). The overall survival was related to the presence of lymph node metastases (p < 0.0001). CONCLUSIONS: HPV infection may have contributed to malignant transformation in a large proportion of our penile cancer cases but only inguinal metastasis was a prognostic factor for survival in these patients with penile carcinoma.

Human papillomavirus (HPV) and cervical cancer.

Epidemiologic studies have consistently shown that the most important risk factor for cervical cancer relates to sexual activity and a sexually transmitted agent, probably a virus, is the principal causative agent. In recent years, much attention has been focused on the human papillomavirus (HPV) as the causative agent. The compelling epidemiologic evidence of the role of HPV in cervical cancer is complemented by equally strong data on the role of oncoproteins E6 and E7 of high-risk HPV strains in the molecular pathogenesis of cervical cancer. Incidence and mortality from cervical cancer have been decreasing steadily in most developed countries, but is the leading female cancer in developing countries. This variation in incidence is explicable in terms of differing levels of risk behaviour and population screening facilities and uptake. With better understanding of the aetiopathogenesis, vaccination against HPV is becoming a reality. This may be particularly useful in developing countries, where it is proving difficult to implement effective screening programmes.