A Brazilian university hospital position regarding transplantation criteria for HIV-positive patients according to the current literature

Human immunodeficiency virus (HIV) infection was considered a contraindication for solid organ transplantation (SOT) in the past. However, HIV management has improved since highly active antiretroviral therapy (HAART) became available in 1996, and the long-term survival of patients living with HIV has led many transplant programs to reevaluate their policies regarding the exclusion of patients with HIV infection. Based on the available data in the medical literature and the cumulative experience of transplantation in HIV-positive patients at our hospital, the aim of the present article is to outline the criteria for transplantation in HIV-positive patients as recommended by the Immunocompromised Host Committee of the Hospital das Clínicas of the University of São Paulo.

Preenchimento facial com Polimetilmetacrilato em pacientes que vivem com a síndrome da imunodeficiência adquirida (AIDS) / Facial filling with polymethylmethacrylate in patients with acquired immunodeficiency syndrome

INTRODUÇÃO: Pacientes que vivem com síndrome da imunodeficiência adquirida (AIDS) em uso da Terapia Antirretroviral de Alta Potência (TARV) são suscetíveis a desenvolver síndrome lipodistrófica. O preenchimento facial com polimetilmetacrilato é opção de tratamento. O objetivo é analisar o procedimento de preenchimento facial e avaliar os pacientes em relação à percepção, incômodo, revelação do diagnóstico, expectativa quanto ao preenchimento e a satisfação e impacto em suas vidas. MÉTODOS: Análise em 63 pacientes submetidos ao preenchimento facial. Foram realizados procedimentos, analisados prontuários dos pacientes e o Protocolo do Ambulatório de Lipodistrofia do Programa Municipal de doenças sexualmente transmissíveis (DST)/AIDS e Hepatites Virais de São Bernardo do Campo, atendidos no período de janeiro a julho de 2009. RESULTADOS: Todos os 63 pacientes iniciais que concordaram em participar da pesquisa permaneceram até o término deste trabalho. Apenas seis pacientes (9,5%) eram de origem de outros municípios, enquanto 57 pacientes (90,5%) eram moradores de São Bernardo. 68,2% eram homens e 100% brancos. A média das idades foi 49,7 anos. Em média, o Vírus da Imunodeficiência Humana (HIV) foi diagnosticado há 11,5 anos, com tempo médio de uso de TARV por 10 anos e tempo médio de lipoatrofia facial de 3,8 anos. A maioria fez uso de Estavudina e/ou Efavirenz. Quem ficava mais desconfortável com as alterações na face eram os próprios pacientes. 85,7% não revelaram o diagnóstico para terceiros. 100% dos pacientes ficaram satisfeitos ou muito satisfeitos com o resultado obtido. CONCLUSÃO: 100% dos pacientes ficaram satisfeitos ou muito satisfeitos com o resultado obtido. Em 100% dos casos houve um impacto favorável na vida. Não houve efeitos adversos ao procedimento cirúrgico de preenchimento.

INTRODUCTION: Patients with acquired immunodeficiency syndrome (AIDS) who use highly active antiretroviral therapy (HAART) can develop lipodystrophy syndrome, for which facial filling with polymethylmethacrylate is a treatment option. The objective is to analyze the procedure of facial filling and evaluate patients in relation to their perception, discomfort, revelation of the diagnosis to third parties, expectation concerning facial filling, and satisfaction with the treatment outcome and its impact on their lives. METHODS: Sixty-three patients who underwent facial filling were evaluated. Procedures performed between January and July 2009 were assessed, the records of the patients were analyzed, and the outpatient lipodystrophy protocol of the STD/AIDS and Viral Hepatitis Municipal Program of São Bernardo do Campo was used. RESULTS: All the 63 patients who agreed to participate in the research completed the study. Only 6 patients (9.5%) were from other municipalities, while 57 patients (90.5%) were residents of São Bernardo. Of the patients, 68.2% were men and 100% were Caucasian. The mean age of the patients was 49.7 years. Human immunodeficiency virus was diagnosed 11.5 years prior on average, with 10-year average use of HAART and 3.8-year average time of facial lipoatrophy. Most of the patients used stavudine and/or efavirenz. The patients themselves felt more uncomfortable with facial changes. Among the patients, 85.7% did not reveal the diagnosis to third parties. CONCLUSION: All of the patients were satisfied or very satisfied with the result obtained, which had a favorable impact on their lives. The filling surgical procedure had no adverse effects.

Patología quirúrgica en pacientes VIH/SIDA / Surgical pathology in HIV/AIDS patients

Se analiza el tipo de patología quirúrgica más prevalente en pacientes VIH (+)-Sida, su distribución por sexo, su relación con la etapa CDC de la enfermedad y tratamiento antiviral, el manejo que ésta haya recibido y la eventual presencia de complicaciones perioperatorias. Los resultados se obtuvieron de la revisión de 368 fichas clínicas de pacientes con diagnóstico VIH (+) pertenecientes al Area Occidente (Policlínico Sida, Servicios de Cirugía y Medicina del Hospital San Juan de Dios). Todos los casos fueron estudiados con un mismo protocolo. Se concluye que en estos pacientes el tipo de patología quirúrgica mas frecuente es la anorrectal, seguida de la genital y gastrointestinal y la intervención mas realizada fue la biopsia excisional. Al momento del diagnóstico la mitad de los pacientes se encontraba en etapa CDC IV, y sólo un tercio recibía terapia antiviral. No se observó variación en la frecuencia y tipo de complicaciones quirúrgicas ni en el tiempo intraoperatorio respecto a pacientes no VIH. Se incluye en esta revisión una pauta con las precauciones para el manejo quirúrgico de pacientes con VIH/Sida

HIV/AIDS in surgical patients

The number of cases of HIV infection and AIDS are increasing every year. A fraction of patients with surgical problems might be sero-positive against HIV or frank sufferer of AIDS, expose the surgical team to this gruesome virus. Hence, surgical team must be aware of this problem, in our community and adopt sufficient precautions to avoid accidental infection by HIV virus

Riesgos de infección por VIH en cirugía / Rosk infection by HIV in surgery

La infección por el virus de inmunodeficiencia humana, es el evento inicial que lleva al desarrollo del SIDA. El incremento en forma contínua del número de casos infectados y pacientes con SIDA, y la necesidad de atención hospitalaria a estos se acompañan de un mayor riesgo de exposición a materiales como sangre o fluidos corporales contaminados con VIH. El riesgo de trasmisión ocupacional de este patógeno a los trabajadores de la salud en el caso del VIH es de menos del 1 por ciento . En el caso del cirujano se puede mencionar que el riesgo de trasmisión de infección por VIH de un paciente al equipo de salud durante el acto operatorio es de 1 en cada 8 a 80 años, dependiendo de la incidencia de la infección entre los pacientes quirúrgicos. La recomendación básica del control de infección ante un riesgo de exposición anticipado durante el acto quirúrgico más que la presencia de infección diagnósticada en el paciente es un concepto nuevo que puede ser evaluado

Clinical presentation of HIV infection and AIDS in surgery: Tanzanian experience

Reports of various studies conducted in one of the three general surgical firms of Muhimbili Medical Centre on opportunistic diseases common in surgical practice occurring in HIV/AIDS subjects is presented. Cervical lymphadenopathy in these subjects due to tuberculosis; non-specific adenitis; and Kaposi's sarcoma were found to be common; while lymphomas were rare. Pyomyositis; Kaposi's sarcoma; throactic empyema and pericardial effusion occur in a significant number of these patients. An attempt is made to establish the pattern of the various clinical manifestations in HIV/AIDS subjects