Risk factors for seroconversion of HIV among children exposed in the State of Santa Catarina, 2007-2017 / Fatores de risco para a soroconversão de crianças expostas ao HIV no Estado de Santa Catarina, 2007-2017

Abstract Objectives: to estimate the proportion of seroconversion cases among infants exposed to HIV and verify the risk factors associated. Methods: this was a historical cohort study conducted in the State of Santa Catarina between 2007 and 2017. The data were obtained from the Notifable Diseases Information System (SINAN - Portuguese acronym) that records HIV-infected pregnant women and HIV-exposed infants. The public health service monitored the infants from birth to 18 months of age to determine whether HIV seroconversion occurred. Results: a total of 5,554 HIV-infected pregnant women were included in the study (mean age 26.7±6.5 years). They were predominantly white, with poor education level, and were diagnosed with HIV until the 2nd trimester of pregnancy. A total of 4,559 records of HIV-exposed infants were screened, of which 130 cases (2.9%) of seroconversion were confrmed. Non-use of antiretroviral drugs during pregnancy (OR=9.31, CI95%=5.97-14.52; p<0.001) and breastfeeding (OR=3.10, CI95%=1.34-7.20; p=0.008) were independent risk factors for seroconversion. Conclusions: these data demonstrate gaps in prenatal care, regarding adherence to treatment and monitoring of HIV-infected mothers, resulting in new cases of HIV among children, which could be avoided.

Resumo Objetivos: estimar a proporção de soroconversão da criança exposta ao HIV e verificar os fatores de risco associados, no período de 2007-2017 em Santa Catarina. Métodos: o delineamento utilizado foi de coorte histórica e os dados obtidos no Sistema de Informação de Agravos de Notificação (SINAN) que registra as gestantes infectadas e as crianças expostas ao HIV. As crianças foram acompanhadas pelo serviço de saúde desde o nascimento até o 18º mês de vida, para determinar a ocorrência de soroconversão pelo HIV. Resultados: foram identificadas 5.554 gestantes infectadas pelo HIV com média de idade de 26,7±6,5 anos, predomínio da raça branca, baixa escolaridade e que receberam o diagnóstico para o HIV até o 2º trimestre gestacional. Foram incluídas 4.559 fichas de crianças expostas ao HIV, das quais 130 casos (2,9%) de soroconversão foram confrmados. O não uso de antirretroviral durante a gestação (OR=9,31, IC95%=5,97-14,52; p<0,001) e aleitamento materno (OR=3,10, IC95%=1,34-7,20; p=0,008) foram fatores de risco independentes para a soroconversão. Conclusões: esses dados demonstram lacunas na assistência pré-natal, quanto a adesão ao tratamento e acompanhamento de mães infectadas pelo HIV, resultando em casos novos de HIV entre crianças, que poderiam ser evitados.

Ocorrência de pessoas infectadas pelo HIV que realizam tratamento com antirretroviral em uma cidade do sul do Brasil: um desafio aos profissionais de saúde / Adherence of HIV-infected individuals to antiretroviral therapy in a municipality in southern Brazil: a challenge for health professionals

Introdução: A utilização da terapia com antirretroviral (TARV) é um dos maiores desafios para o sucesso do tratamento para HIV/AIDS, uma vez que é uma das ferramentas contra a pandemia, possibilitando a melhoria da qualidade de vida e longevidade da população infectada. O objetivo deste trabalho foi verificar a ocorrência de pessoas infectadas com o HIV que faziam tratamento com TARV. Métodos: O estudo foi realizado para verificar a ocorrência de pessoas infectadas com o HIV notificadas entre os anos de 2006 a 2016 que faziam tratamento com TARV, através das informações do Sistema Nacional de Informação de Agravos de Notificação (SINAN). Resultados: Dos 715 pacientes notificados desde o ano de 2006, 597 (83,5%) faziam o uso de TARV e 118 (16,5%) abandonaram a terapia. Com relação ao perfil dos infectados, o maior número de notificações de HIV eram do sexo masculino (54,83%), com idades entre 25 a 29 anos (56%) dos casos. Conclusão: Os dados apresentados no estudo mostram que algumas pessoas infectadas com HIV não dão continuidade ao tratamento, isso gera preocupação uma vez que mascara a realidade da infecção pelo vírus e diante deste cenário deve ocorrer o incentivo dos órgãos competentes para que registre os casos ocorrentes. Os profissionais de saúde nos seus mais diversos segmentos devem incentivar a utilização do TARV e notificar e acompanhar as pessoas que não retiram e não utilizam a medicação, e que sejam mais direcionadas as medidas de prevenção. (AU)

Introduction: Adherence to antiretroviral therapy (ART) is a major challenge to the success of HIV/AIDS treatment. It is a weapon against the pandemic, being capable of improving the quality of life and longevity of the infected population. The aim of this study was to ascertain the adherence to ART in HIV-infected individuals. Methods: The study assessed whether HIV-infected individuals with infection reported between 2006 and 2016 were receiving ART, using information from the National Information System for Notifiable Diseases (SINAN). Results: Of a sample of 715 patients, 597 (83.5%) were using ART and 118 (16.5%) discontinued treatment. Regarding the profile of HIV-infected individuals, most were male (54.83%), aged 25 to 29 years (56%). Conclusions: These data show that a significant proportion of HIV-infected individuals discontinue treatment, which causes concern because it conceals the reality of HIV infection. Thus, authorities should call for proper reporting. Health professionals from different areas should encourage the use of ART and follow individuals who fail to adhere to treatment, while national health policies should focus on prevention. (AU)

Perfil clínico-epidemiológico de adultos HIV-positivo atendidos emum hospital de Natal/RN / Perfil clínico-epidemiológico de adultos VIH-positivos tratados en un hospital de Natal/RN / Clinical-epidemiological profile of HIV-positive adults attended in a hospital from Natal/RN

To characterize the clinical-epidemiological profile and habits of life of HIV-positive adults. Methods: this is a descriptive, cross-sectional and quantitative study with a sample of 331 HIV-positive people with outpatient scheduling between February and August 2014 in a reference hospital from Natal/RN. Data collection was conducted through a semi-structured interview. Results: the results showed a predominance of men (52%), young people (42%) natural from the capital (58%), brown color (53%), single (56%), heterosexual (79%), poor (68 %). Most of them held the first anti-HIV test for less than five years (60%), had signs and symptoms of AIDS before the test (90%), were hospitalized (90%), started HAART for less than five years (60%), suppose they have good knowledge of the disease (75%), and believe that their health has improved (92%). Most of them do not consume alcohol (71%), are non-smokers (88%), do not use illicit drugs (92%) and had never used preservatives before diagnosis (62%). Conclusion: the identified profile follow the national trends...

Caracterizar o perfil epidemiológico-clínico e de hábitos devida de adultos HIV-positivo. Métodos: estudo descritivo, transversal e quantitativo, com uma amostra de 331 pessoas soropositivas com agendamento ambulatorial entre fevereiro e agosto de 2014 em um hospital de referência de Natal/RN. A coleta de dados foi realizada através de entrevista semiestruturada. Resultados: os resultados mostraram predominância de homens (52%), jovens (42%), procedentes da capital(58%), cor parda (53%), solteiros (56%), heterossexuais (79%), pobres (68%). A maioria realizou o primeiro exame anti-HIV há menos de cinco anos (60%), teve sinais e sintomas da AIDS antes do exame (90%), foi internada (90%), iniciou o TARV há menos de cinco anos (60%), julga ter bom conhecimento sobre a doença (75%) e acredita que sua saúde melhorou (92%). Os pacientes não consumem álcool (71%), não fumam (88%) e não usam drogas ilícitas (92%), nunca usaram preservativos antes do diagnóstico (62%). Conclusão: o perfil identificado segue as tendências nacionais...

Caracterizar el perfil epidemiológico-clínico y de hábitos de vida de los adultos VIH-positivos. Métodos: estudio descriptivo, transversal y cuantitativo con una muestra de 331 personas VIH-positivas con programación ambulatoria entre febrero y agosto de 2014 de un hospital de referencia en Natal/RN. La recolección de datos se realizó a través de entrevistas semi-estructuradas. Resultados: los resultados mostraron un predominio de hombres (52%), jóvenes (42%), procedentes de la capital (58%), mulatos (53%), solteros (56%), heterosexuales (79%), pobres (68%). La mayoría había realizado el primer examen contra el VIH hacía menos de cinco años (60%), tenían señales y síntomas del SIDA antes del examen (90%), fueron internados (90%), habían iniciado el TAR hacía menos de cinco años (60 %), juzgan tener un buen conocimiento acerca de la enfermedad (75%) y creen que su salud ha mejorado (92%). No consumen alcohol (71%), no fuman (88%), no usan drogas ilícitas (92%) y nunca usaron preservativos antes del diagnóstico (62%). Conclusión: el perfil identificado sigue las tendencias nacionales...

Depression and diagnosis of neurocognitive impairment in HIV-positive patients

Neurocognitive impairment (NCI) is frequently observed in patients infected with human immunodeficiency virus (HIV) and results from the compromise of subcortical brain structures by the virus. The manifestations of NCI range from asymptomatic impairment to dementia. In addition to cognitive impairment resulting from HIV infection, other factors such as depression are associated with the loss of cognitive functions. The aim of this study was to estimate the prevalence of NCI in HIV-positive patients in a city in southern Brazil and to establish possible associations for the prevalence of NCI with HIV-related and other risk factors. This cross-sectional study of HIV-positive outpatients was conducted in a specialized care service in the city of Pelotas in Southern Brazil. Sociodemographic data and HIV-related information were collected, and all patients underwent psychiatric and neurocognitive evaluations. The prevalence of NCI among the 392 patients was 54.1% when tracked using the IHDS (International HIV Dementia Scale) and 36.2% when the IHDS was associated with a battery of complementary tests. A bivariate analysis suggested an association of NCI with gender, age, educational level, depression, current CD4 count and lowest CD4 count. The association of NCI with depression remained in the Poisson regression (PR=1.96, 95%CI=1.12-3.42). The prevalence of cognitive impairment in HIV-positive patients estimated in this study is in accordance with international and Brazilian data. Of the factors analyzed, depression showed the greatest evidence of association with neurocognitive loss. Based on our findings, the inclusion of instruments to evaluate depression in our services for patients with HIV and acquired immunodeficiency syndrome (AIDS) is recommended.

Ética em pesquisa na dinâmica do campo científico: desafios na construção de diretrizes para ciências humanas e sociais / Research ethics in the dynamic of scientific field: challenges in the building of guidelines for social sciences and humanities

ResumoA elaboração de diretrizes para a apreciação ética de pesquisas em ciências humanas e sociais (CHS) se efetiva no campo científico, espaço marcado por disputas voltadas ao estabelecimento do padrão hegemônico de cientificidade. No Brasil, cabe ao Conselho Nacional de Saúde aprovar essas diretrizes, o que envolve certas especificidades. Com base na vivência das autoras no Grupo de Trabalho CHS da Comissão Nacional de Ética em Pesquisa (GT CHS/CONEP), este manuscrito apresenta o processo de elaboração de uma resolução para CHS e alguns dos seus desafios: a distância entre a garantia legal e a efetivação de diretrizes; a hegemonia biomédica e a posição marginal das CHS no Sistema CEP/CONEP; a inadequação da atual resolução ante as características da pesquisa em CHS; e o emprego do conceito de risco, em diretrizes voltadas a CHS no espaço da saúde. Discutem-se ainda interfaces e tensões no debate entre mérito científico e avaliação ética. A análise evidencia importantes impasses e dificuldades concernentes ao diálogo interparadigmático na pesquisa em saúde, consideradas as características das distintas tradições, a ancoragem da CONEP na perspectiva positivista e a defesa da hegemonia dessa tradição.

AbstractThe development of guidelines on research ethics for social science and humanities (SSH) takes place in the scientific field, marked by disputes aimed at the establishment of hegemonic scientific standard. In Brazil, the National Health Council is responsible for approving these guidelines, which involve certain specificities. Based on the authors' experience in the SSH Working Group of the National Commission on Research Ethics (GT CHS / CONEP), this article presents the process of development of guidelines for SSH, and some its challenges: the distance between the statutory guarantee and the effective execution of guidelines; the biomedical hegemony and the marginal position of the SSH in the CEP / CONEP system; the inadequacy of the current resolution facing the research features in CHS; the use of the concept of risk in guidelines aimed at SSH in the health area. Some interfaces and tensions in the debate between scientific merit and ethical evaluation are also discussed. The analysis highlights important impasses and difficulties regarding inter-paradigmatic dialogue in health research, considered the characteristics of the different traditions, the CONEP's heavily relying on the positivist perspective and the defense of that paradigm hegemony.

Nutritional aspects of children and adolescents with epidermolysis bullosa: literature review

Epidermolysis Bullosa is a genetic disorder that affects mainly the skin, however, all others systems are influenced. The nutritional care of children and adolescents with Epidermolysis Bullosa is a key treatment strategy, since the energy needs are increased due to the disease's metabolism, burdening the immune system and cicatrization process, symptoms caused by the disease hinder the intake and adequate absorption of nutrients, which may result in inadequate growth and development. Because this is a rare disease, there are few professionals who know the characteristics of both the clinical evolution and nutritional and dietary treatments. This literature review discusses the latest knowledge on energy and specific nutrient requirements to the dietary treatment and monitoring of children and adolescents with Epidermolysis Bullosa.

Prevalencia de microsporidios intestinales y otros enteroparásitos en pacientes con VIH positivo de Maracaibo, Venezuela / Prevalence of intestinal microsporidia and other intestinal parasites in hiv positive patients from Maracaibo, Venezuela.

Introducción. Desde 1985, los microsporidios se consideran parásitos causantes de infecciones emergentes y oportunistas en individuos inmunocomprometidos en todo el mundo. Objetivo. Detectar la presencia de microsporidios y otros enteroparásitos en pacientes con VIH/sida del Servicio Autónomo Hospital Universitario de Maracaibo (SAHUM), donde no existían estudios previos en este campo. Materiales y métodos. Las muestras fecales se analizaron mediante examen directo, método de concentración con formol-éter, coloración de Kinyoun y coloración Gram-cromotropo rápida. Se realizaron PCR separadas para diferenciar Entamoeba histolytica o Entamoeba dispar , cuando se observó el complejo E. histolytica/dispar al microscopio. Mediante historia clínica se obtuvo información del paciente. Resultados. De los 56 individuos participantes, 38 (67,86 %) presentaron alguna especie parasitaria comensal o patógena en su muestra fecal. Predominaron los individuos portadores de especies parásitas patógenas (26/38). Fueron diagnosticados protozoos como Isospora belli (17,65 %), Blastocystis spp .(17,65 %), Cryptosporidium spp. (7,84 %), complejo Entamoeba histolytica/dispar (5,88 %) , Entamoeba coli (3,92 %) , Giardia lamblia (3,92 %) , Endolimax nana (3,92 %) , Cyclospora cayetanensis (3,92 %) y Chilomastix mesnili (1,96 %). Entre los helmintos, Ascaris lumbricoides, Trichuris trichiura y Strongyloides stercoralis, presentaron un porcentaje de 27,27 % cada uno, e Hymenolepis nana , de 18,18 %. Solo se detectó E. histolytica en uno de los tres casos que presentaron el complejo al examen microscópico. Mediante Gram-cromotropo, 17 muestras evidenciaron esporas del filo Microsporidia, lo que equivale a un 33,33 % de prevalencia. Conclusión. Los microsporidios pueden ocupar el primer lugar de prevalencia en pacientes con VIH positivo, cuando se utilizan técnicas diagnósticas específicas.

Objective: To detect the presence of microsporidia and other enteric parasites in patients with HIVAIDS of the Autonomous Services University Hospital of Maracaibo (SAHUM), where there are no previous studies in this field. Materials and methods: Fecal samples were analyzed by means of direct exam, concetration method with formal-ether, Kinyoun coloration and fast Gram-Chromotrope coloration. Separate PCR were perfomed to differentiate Entamoeba histolytica and Entamoeba dispar , when the E. histolytica/E. dispar complex was observed in the microscope. Information on the patient was obtained trough clinical history. Results: Of 56 individuals that participated, 38 (67.86%) presented some commensal parasite and/ or pathogenic species in their fecal sample. Carriers of pathogenic species were predominat (26/38). Protozoa such as Isospora belli protozoa (17.65%), Blastocystis spp. (17.65%), Cryptosporidium spp. (7.84%), E. histolytica/E. dispar (5.88%), Entamoeba coli (3.92%), Giardia lamblia (3.92%), Endolimax nana (3.92%), Cyclospora cayetanensis (3.92%), and Chilomastix mesnilli (1.96%) were diagnosed. Among the helminths, Ascaris lumbricoides, Trichuris trichiura and Strongyloides stercoralis , had a percentage of 27.27% each, and Hymenolepis nana , 18.18%. Entamoeba histolytica was only detected in one of three cases presenting complex microscopic examination. By Gram-chromotrope, 17 samples showed spores of the Microsporidia phylum, equivalent to 33.33% prevalence. Conclusion: Microsporidia may be first prevalente in HIV positive patients when specific diagnostic techniques are used.

Qualidade de vida no contexto do HIV/AIDS: um estudo comparativo com a população em geral / Quality of life in the context of HIV/AIDS: a comparative study with the general population

A introdução da terapia antirretroviral vem permitindo um aumento na expectativa de vida dos pacientes soropositivos ao HIV, caracterizando a AIDS como uma doença passível de controle a longo prazo, influenciando assim no bem-estar e na qualidade de vida desses sujeitos. Objetivo: Avaliara percepção de qualidade de vida de pessoas com HIV/AIDS comparando-a com a de pessoas sem o diagnóstico para o HIV. Método: Contou-se com a participação de 561 pessoas soropositivas e 286 pessoas sem o diagnóstico. Foram utilizados um questionário sociodemográfico e um clínico, além da escala de qualidade de vida WHOQOL-HIV-Bref. Resultados: A qualidade de vida foi avaliada positivamente por 59% dos soropositivos, sendo mais bem avaliadas as dimensões espiritualidade e perspectiva de futuro. Dos participantes sem o diagnóstico para o HIV, 61% avaliaram-na também positivamente,sendo mais bem avaliadas as dimensões espiritualidade e independência. Com relação aos domínios da qualidade de vida, ambos os grupos apresentaram avaliação positiva para todas as dimensões. Entretanto, o grupo soropositivo avaliou de forma mais negativa os domínios ambiental e independência em comparação ao grupo sem diagnóstico. Conclusão: Os resultados sugerem que o diagnóstico de soropositividade para o HIV não é condição suficiente para que a percepção da qualidade de vida seja diferente das pessoas em geral. Além disso, a avaliação menos positiva sobre a saúde pelo grupo soropositivo parece indicar a ideia de que a saúde para estes sujeitos está relacionada aos aspectos associados às etiologias orgânicas e às consequências psicossociais da convivência com o HIV/AIDS.

The introduction of antiretroviral therapy has allowed an increase in life expectancy of HIV-positive patients with HIV/AIDS, characterizing it as a disease amenable to control the long-term, thus influencing well-being and quality of life of these subjects. Objective: To evaluate the perceived quality of life of people with HIV/AIDS compared with that of people without the diagnosis for HIV. Methods: We counted with the participation of 561 people with HIV and 286 people without the diagnosis. Specific socio-demographic and clinical questionnaires, beyond the scale of quality of life WHOQOL-HIV-Bref were applied. Results: The quality of life was assessed positively by 59% of seropositive, being the dimensions spirituality and future prospects the better evaluated. Of the participants with no HIV diagnosis, 61% positively evaluated the quality of life, being the dimensions spirituality and independence the better evaluated. Regarding the domains of quality of life, both groups showed positive evaluation for all dimensions. However, theseropositive group evaluated more negatively the domains environmental and independence compared to the group without diagnosis. Conclusion: Results suggest that the diagnosis of HIV seropositivity is not a sufficient condition for the perception of quality of life to differ from people in general. Moreover,the less positive assessment on health for HIV-positive group seems to indicate that, for these subjects, health is related to aspects associated with organic etiologies and the psychosocial consequences of living with HIV/AIDS.

Prevalence of Human Papilloma Virus DNA in HIV Positive Women in Lagos University Teaching Hospital (LUTH) Lagos, Nigeria.

Introduction: HIV-infected women have a high prevalence of Human Papilloma virus (HPV) infection and are more likely to be infected with high risk genotypes with the potential of progressing to cervical cancer. There is paucity of data regarding the prevalence of sexually transmitted HPV infection among HIV positive women in Nigeria. Aims: The objective of this cross-sectional prospective study was to determine the prevalence of high risk HPV among HIV positive and negative women in LUTH, Lagos, Nigeria and to relate HPV genotypes in the study population to commercially available HPV vaccine types that would be or not be appropriate for implementation of vaccination programs in Lagos State. Place and Duration of Study: AIDS Prevention Initiative In Nigeria (APIN) clinic as well as the Gynecologic outpatient clinic of LUTH, Lagos between August 2011 and August 2012. Methodology: A combination of PCR and flow through hybridization method was used in the genotyping of HPV from samples obtained from 98 HIV positive and 97 HIV negative women. Data was analyzed using Epi info 3.5.6. Non parametric variables were compared with chi-square or Fisher exact test as appropriate. The differences in mean for parametric variables were compared using student T test. P value <0.05 were considered significant. Results: The prevalence of HPV among HIV positive women was 44.9% while the prevalence of high risk types was 37.5%. The commonest high risk types seen were types 31, 52, 53 and 35. The prevalence of HPV among the HIV negative women was 11%. The commonest high risk types seen were types 18, 16, 52 and 56. Conclusion: In view of the high prevalence and diversity of HPV genotypes among the HIV positive women, adequate screening protocols should be put in place for screening this category of women. Studies should also be carried out to determine the efficacy of existent HPV vaccines on this group of patients.

Perfil epidemiológico dos indivíduos HIV positivo e coinfecção HIV-Leishmania em um serviço de referência em São Luís, MA, Brasil / The epidemiological profile of HIV-positive individuals and HIV-Leishmaniasis co-infection in a referral center in São Luis, Maranhão, Brazil

A Aids é um problema de saúde pública e a Leishmaniose visceral (LV) a forma mais frequente de coinfecção. O objetivo é descrever aspectos epidemiológicos dos indivíduos HIV positivo e investigar a ocorrência de coinfecção HIV-Leishmania. Trata-se de estudo descritivo realizado com 287 indivíduos HIV positivo atendidos no Centro de Referência para DST/Aids em São Luís (MA). Foi realizado teste de Intradermorreação de Montenegro, aspirado de medula óssea para detecção da infecção por Leishmania sp e aplicado um questionário na coleta dos dados epidemiológicos. O teste qui-quadrado foi usado para diferenças entre gênero, com p < 0,05 de significância. Houve significância estatística entre os homens relacionados ao uso de fossa séptica e renda até dois salários. Quanto à exposição, foi predominante a categoria heterossexual para ambos os sexos, sendo observado um aumento entre as mulheres. Entre os indivíduos HIV positivo 4,2% apresentavam sintomatologia sugestiva de LV sendo identificadas formas amastigotas para Leishmania sp no aspirado de medula óssea. O perfil dos indivíduos HIV positivo não diferiu de outras regiões do Brasil com predomínio de jovens em idade produtiva, sendo constatada uma sobreposição das áreas de transmissão para a coinfecção HIV-LV.

AIDS is a public health problem and visceral leishmaniasis (VL) is the most frequent co-infection. This study seeks to describe the epidemiological aspects of HIV-positive individuals and to investigate the occurrence of HIV-Leishmania co-infection. It is a descriptive study with 287 HIV=positive individuals assisted at the reference center for HIV/AIDS in São Luís, MA. Montenegro's intradermal reaction and bone marrow aspiration were performed for detecting the Leishmania sp. infection. Epidemiological data were collected by means of a questionnaire. The chi-square test was used for gender differences, with p < 0.05 of statistical significance level. There was statistical significance among men regarding the use of septic tanks, and income of up to two salaries. Regarding exposure, heterosexual orientation was the most frequent category for both genders, and we observed an increase in this category among women. Among HIV-positive individuals, 4.2% had suggestive symptoms of VL with identification of Leishmania amastigotes in bone marrow aspirate (myelogram). The profile of HIV-positive individuals did not differ from what is commonly found in Brazil, with predominance of young people of productive age. Furthermore, a superposition of the transmission areas for HIV-LV co-infection was found.

Risk factors of HIV-related oral lesions in adults / Fatores de risco de lesões bucais associadas ao HIV em adultos / Factores de riesgo de lesiones bucales asociadas al VIH en adultos

OBJECTIVE: To assess the risk factors in the occurrence of oral lesions in HIV-positive adults. METHODS: A retrospective analytical-descriptive survey was conducted using the medical/dental records of 534 patients with oral lesions associated with HIV. The data were collected from five referral centers for managing HIV and associated comorbidities in the city of Porto Alegre, Southern Brazil, between 1996 and 2011. Using a standardized form, socio-demographic and clinical data were recorded. Exclusively and definitively diagnosed oral pathologies were included and classified according to ECC criteria on Oral Problems Related to HIV Infection. For data analysis cross-tabulations, Chi-squared tests and logistic regression models were used where appropriate. RESULTS: CD4+ counts lower than 350 cells/mm³ (p < 0.001), alcohol consumption (p = 0.011) and female gender (p = 0.031) were predisposing factors for oral candidiasis. The occurrence of hairy leukoplakia was independently associated with CD4+ counts below 500 cells/mm³, (p = 0.029) a viral load above 5,000 copies/mm³ (p = 0.003) and smoking (p = 0.005). CONCLUSIONS: Moderate and severe degrees of immunodeficiency and detectable viral loads were risk factors for the onset of oral lesions. Smoking and alcohol consumption also increased susceptibility to the development of opportunistic infections in HIV-positive adults from Porto Alegre, irrespective of the use of antiretroviral therapy.

OBJETIVO: Analisar fatores de risco para a ocorrência de lesões bucais em adultos soropositivos para o HIV. MÉTODOS: Estudo transversal, descritivo analítico de prontuários médicos/odontológicos de 534 pacientes com lesões bucais associadas ao HIV em Porto Alegre, RS, no período de 1996 a 2011. Os dados foram coletados em cinco centros de referência em saúde para o atendimento de portadores do HIV e comorbidades associadas. Os dados sociodemográficos e clínico-laboratoriais foram coletados em formulários padronizados. Foram incluídos dados exclusivamente de lesões com diagnóstico definitivo e classificadas de acordo com os critérios da ECC on Oral Problems Related to HIV Infection. A análise dos dados foi realizada mediante a aplicação de tabulações cruzadas, teste do Qui-quadrado e modelos de regressão logística. RESULTADOS: Níveis de CD4+ < 350 células/mm³ (p < 0,001), consumo de álcool (p = 0,011) e sexo feminino (p = 0,031) foram predisponentes para candidíase bucal. A ocorrência de leucoplasia pilosa foi associada com contagens de CD4+ < 500 células/mm³ (p = 0,029), cargas virais > 5.000 cópias/mm³ (p = 0,003) e tabagismo (p = 0,005). CONCLUSÕES: Graus de imunodeficiência moderados e severos e cargas virais detectáveis foram fatores de risco para o desenvolvimento de lesões bucais. O consumo de tabaco e álcool aumentou a suscetibilidade de desenvolver infecções oportunistas em adultos HIV positivos, independentemente do uso de terapia antirretroviral.

OBJETIVO: Analizar factores de riesgo para la ocurrencia de lesiones bucales en adultos seropositivos para VIH. MÉTODOS: Estudio transversal, descriptivo analítico de prontuarios médicos/odontológicos de 534 pacientes con lesiones bucales asociadas al VIH en Porto Alegre, RS, Brasil, en el período de 1996 a 2011. Los datos se colectaron en cinco centros de referencia en salud para la atención de portadores del VIH y comorbilidades asociadas. Los datos sociodemográficos y clínico-laboratoriales se colectaron en formularios estandarizados. Se incluyeron datos exclusivamente de lesiones con diagnóstico y clasificadas de acuerdo con los criterios de la ECC on Oral Problems Related to HIV Infection. El análisis de los datos fue realizado mediante la aplicación de tabulaciones cruzadas, prueba de Chi-cuadrado y modelos de regresión logística. RESULTADOS: Niveles de CD4+ < 350 células/mm³ (p<0,001), consumo de alcohol (p=0,011) y sexo femenino (p = 0,031) predispusieron para candidiasis bucal. La ocurrencia de leucoplasia pilosa estuvo asociada con contaje de CD4+ < 500 células/mm³ (p = 0,029), cargas virales > 5.000 copias/mm³ (p = 0,003) y tabaquismo (p = 0,005). CONCLUSIONES: Grados de inmunodeficiencia moderados y severos y cargas virales detectables fueron factores de riesgo para el desarrollo de lesiones bucales. El consumo de tabaco y alcohol aumentó la susceptibilidad de desarrollar infecciones oportunistas en adultos VIH positivos, independientemente del uso de terapia anti=retroviral.

HIV positivity in TB suspects - An observational, nonrandomized study.

Aims: The present study was carried out to determine the prevalence of TB, HIV, and TB- HIV co-infection in 618 patients who attended the health institute for TB diagnosis and treatment at a rural tertiary care hospital in Punjab. Methods: Pulmonary T.B was diagnosed by sputum smear microscopy, culture and extra-pulmonary TB was diagnosed by X-ray, CT and other methods.HIV diagnosis was made by testing the sera by 3E/R/S (ELISA/RAPID/SIMPLE) tests as per NACO guidelines. Results: Of the total 618 patients, 74(12%) were patients of pulmonary TB, out of whom 72 were diagnosed by Ziehl Neelsen (ZN) staining and two were diagnosed by culture as the ZN stained smear was negative, 169(27.3%) were cases of extra-pulmonary TB. Three out of 618 were HIV positive. 1.23% were TB- HIV co-infected. Conclusion: The risk of developing TB increases in patients with HIV. So, HIV and TB programmes should be collaborated together and should be closely integrated with medical care to curb the spread of these deadly diseases.

TB/HIV coordination through public private partnership: Lessons from the field.

Background: Co-infection with tuberculosis adversely affects the quality of life of HIV infected individuals and additionally, HIV testing among TB patients gives an opportunity for prevention and treatment of HIV infection. TB-HIV coordination activities are therefore a good public health intervention. Methods: It was a three-year Public Private Partnership Project, implemented in four districts of Maharashtra, to improve access to public health facilities through community awareness and motivating referrals. Outreach workers were engaged to motivate patients attending Integrated Counselling and Testing Centres (ICTCs) and Designated Microscopy Centres (DMCs) for cross referrals and adherence to services. Community leaders and private health providers were sensitized to issues around TB and HIV/AIDS. Observations: 357 outreach workers referred 17,200 individuals for HIV testing and 32,549 TB suspects were referred for testing. An average of 18% TB cases (13% to 26%) and 7% (4% to 13%) HIV infected cases were identified. Involvement of PLHA and cured TB patients can better motivate symptomatics to avail of diagnostic services. Erratic funding affects smooth implementation of programmes. Conclusion: Public Private Partnerships improve access to care. Constant dialogue between all stake holders is essential for successful implementation of such partnerships.

Seropositivity of HIV and HBV Co-infection.

The rise of HIV as well as HBV infections in rural population is alarming. Different studies suggest, approximately one third of HIV infected individuals also harbour Hepatitis B virus simultaneously. Co-infection of HIV and HBV leads to complex immuno-pathological disease heralding poor prognosis. The present study was undertaken to ascertain sero-positivity of HIV and Hepatitis B virus co-infection in and around the rural area of Loni. The rate of sero-positivity for HIV infection was 2.61%; however, that of Hepatitis B was 1.26 %. The incidence of Hepatitis B in HIV infected individuals was found to be 2.5 %.

Time series cross-correlation analysis of HIV seropositivity and pulmonary tuberculosis among migrants entering Kuwait

There is a paucity of published data on burden and pattern of dual infection with Mycobacterium tuberculosis and HIV among migrants from South Asia, South-east Asia and sub-Saharan Africa entering the Middle-East, particularly Kuwait. Therefore, this study assessed the overall prevalence of HIV infection and pulmonary tuberculosis [TB] and evaluated the ecological relationship between them. Time series cross-correlation analysis was used to determine the ecological time-lagged relationship between the monthly proportions [per 100,000] of HIV seropositive and pulmonary TB cases among migrant workers that entered Kuwait between January 1, 1997 and December 31, 2006. During the study period, overall prevalence [per 100,000] of HIV seropositivity and pulmonary TB among the migrants was 21 [494/23,28,582] [95% CI: 19-23], and 198 [4608/23,28,582] [95% CI: 192-204], respectively. Estimated cross-correlation function revealed a significant positive correlation [0.292 +/- 0.093] at lag -3 representing a positive relationship between the proportions of HIV seropositive [per 100,000] migrants tested 3 months earlier and the proportion of pulmonary TB [per 100,000] cases detected among migrants in a given month. Thus, the peak in proportion of pulmonary TB cases preceded the peak in proportion of HIV seropositive migrants indicating a direct time-lagged association between HIV seropositivity and the prevalence of pulmonary TB among migrants. HIV infection seemed to have played a significant role in the re-activation of latent M. tuberculosis infection in this migrant population. While currently less evident, in near future, however, TB and HIV/AIDS control programmes in the countries of origin of migrants may face a crucial challenge. Knowledge of serious consequences of association between HIV infection and pulmonary TB allows the promotion of public heath education to reduce the exposure to these infections. Future studies may focus on evaluating the impact of public health education programs on this dual burden of HIV infection and pulmonary TB in migrants

Study of Cryptococcal Meningitis in HIV Seropositive Patients.

Cryptococcal meningitis is an emerging opportunistic fungal infection among HIV infected patients and important risk factors for the morbidity and mortality of these patients. A total of 8 specimens of CSF out of 45 from known HIV positive patients samples yielded Cryptococcus neoformans during the period of one year. The prevalence of cryptococcal meningitis among HIV seropositive patients in this region is 17.78%.

Anal cancer precursor lesions in HIV-positive and HIV-negative patients seen at a tertiary health institution in Brazil / Lesões precursoras do câncer anal em pacientes HIV-positivos e HIV-negativos atendidos numa instituição de saúde terciária no Brasil

Purpose: To investigate the prevalence of anal squamous intraepithelial lesions (ASIL) or anal cancer in patients attended at the Tropical Medicine Foundation of Amazonas. Methods: 344 patients consecutively attended at the institution, in 2007/2008, were distributed in the following strata according to presence/abscense of at risk conditions for anal cancer: Group 1 _ HIV-positive men-who-have-sex-with-men (101); Group 2 _ HIV-positive females (49); Group 3 _ patients without any at risk condition for anal cancer (53); Group 4 _ HIV-positive heterosexual men (38); Group 5 _ HIV-negative patients, without anoreceptive sexual habits, but with other at risk conditions for anal cancer (45); Group 6 _ HIV-negative men-who-have-sex-with-men (26); and Group 7 _ HIV-negative anoreceptive females (32). The histopathological results of biopsies guided by high-resolution anoscopy were analyzed by frequentist and bayesian statistics in order to calculate the point-prevalence of ASIL/cancer and observe any eventual preponderance of one group over the other. Results: The point-prevalence of ASIL for all the patients studied was 93/344 (27 percent), the difference between HIV-positive and negative patients being statistically significant (38.3 percent versus 13.5 percent; p < 0.0001). The prevalence of ASIL for each one of the groups studied was: Group 1 = 49.5 percent, Group 2 = 28.6 percent, Group 3 = 3.8 percent, Group 4 = 21.1 percent, Group 5 = 11.1 percent, Group 6 = 30.8 percent and Group 7 = 18.8 percent. Standard residual analysis demonstrated that ASIL was significantly prevalent in patients of Group 1 and high-grade ASIL in patients of Group 2. The odds for ASIL of Group 1 was significantly higher in comparison to Groups 2, 3, 4, 5 and 7 (p < 0.03). The odds for ASIL of Groups 2, 4 and 6 were significantly higher in comparison to Group 3 (p < 0.03). Conclusions: In the patients studied, ASIL (low and/or high-grade) tended to be significantly more prevalent in HIV-positive patients. Nonetheless, HIV-negative anoreceptive patients also presented great probability to have anal cancer precursor lesions, mainly those of the male gender.

Objetivo: Investigar a prevalência de lesões intraepiteliais escamosas anais (ASIL) ou câncer anal em pacientes atendidos na Fundação de Medicina Tropical do Amazonas. Métodos: 344 pacientes consecutivamente atendidos na instituição, em 2007/2008, foram distribuídos nos seguintes estratos conforme a presença/ausência de fatores de risco para o câncer anal: Grupo 1 _ homens-que-fazem-sexo-com-homens HIV-positivos (101); Grupo 2 _ mulheres HIV-positivas (49); Grupo 3 _ pacientes sem condição de risco para o câncer anal (53); Grupo 4 _ homens heterossexuais HIV-positivos (38); Grupo 5 _ pacientes HIV-negativos, sem hábitos sexuais anorreceptivos, mas com outras condições de risco para o câncer anal (45); Grupo 6 _ homens-que-fazem-sexo-com-homens HIV-negativos (26); e Grupo 7 _ mulheres HIV-negativas, com hábitos sexuais anorreceptivos (32). Os resultados histopatológicos das biópsias anais dirigidas pela colposcopia anal foram analisados por meio de estatística frequentista e bayesiana para a determinação da prevalência-ponto de ASIL/câncer e verificar eventual preponderância estatística de um grupo sobre o outro. Resultados: A prevalência-ponto de ASIL para todos os pacientes estudados foi de 93/344 (27 por cento), sendo significativa a diferença entre HIV-positivos e negativos (38,3 por cento versus 13,5 por cento; p < 0,0001). A prevalência de ASIL para cada um dos grupos estudados foi: Grupo 1 = 49,5 por cento, Grupo 2 = 28,6 por cento, Grupo 3 = 3,8 por cento, Grupo 4 = 21,1 por cento, Grupo 5 = 11,1 por cento, Grupo 6 = 30,8 por cento e Grupo 7 = 18,8 por cento. A análise de resíduos demonstrou prevalência significante de ASIL para o Grupo 1 e de ASIL de alto-grau para o Grupo 2. A razão-de-chances do Grupo 1 para ASIL foi significantemente maior em comparação com os Grupos 2, 3, 4, 5 e 7 (p < 0,03). A razão-de-chances para ASIL dos Grupos 2, 4 e 6 foi significantemente maior em comparação com o Grupo 3 (p < 0.03). Conclusões: Nos pacientes estudados, ASIL (baixo e/ou alto-grau) foi significantemente mais prevalente em pacientes HIV-positivos. Entretanto, pacientes HIV-negativos anorreceptivos também apresentaram grande probabilidade de possuir as lesões, especialmente os do gênero masculino.

Alcohol, drugs, and risky sexual behavior are related to HIV infection in female adolescents / Álcool, drogas e comportamento sexual de risco estão relacionados à infecção por HIV em mulheres adolescentes

OBJECTIVE: To examine associations between risk factors for HIV infection in a sample of young women who sought HIV testing in a city of southern Brazil. METHOD: Cross-sectional study with a consecutive convenience sample of 258 female adolescents aged 13 to 20 years evaluated in an anonymous testing site for HIV and sexually transmitted diseases in Brazil. Risk behavior for HIV was assessed with the Brazilian version of the Risk Assessment Battery and HIV status was assessed through ELISA (Enzyme Linked Immunosorbent Assay). RESULTS: Overall seropositivity rate was 7.4 percent. HIV-seropositive patients had significantly more sexual intercourse in exchange for money, higher rates of pregnancy and abortion, as well as earlier sexual debut. In multiple analyses with the inclusion of two composite variables (sex risk and drug risk), only drug risk was associated with positive HIV status (OR = 4.178; IC 95 percent = 1.476-11.827). CONCLUSION: Our findings suggest that high HIV seropositivity among female adolescents seeking HIV testing in Brazil directly reflects the need for effective interventions specifically designed to prevent risk behaviors in order to halt the spread of HIV infection.

OBJETIVO: Descrever fatores de risco para infecção pelo HIV numa amostra de adolescentes do sexo feminino que procurou fazer o teste HIV em uma cidade do sul do país. MÉTODO: Num estudo transversal, 258 adolescentes do sexo feminino foram avaliadas em relação ao seu estado sorológico para o vírus HIV e comportamentos de risco utilizando-se a versão brasileira da escala Risk Assessment Battery. RESULTADOS: A taxa geral de soropositividade foi de 7,4 por cento. As jovens soropositivas tiveram significativamente mais relações sexuais em troca de dinheiro, história de gravidez e aborto prévio, bem como iniciação sexual mais precoce do que as adolescentes soronegativas. Nas análises multivariadas, com a inclusão de duas variáveis compostas ("risco sexual" e "risco por drogas"), apenas "risco por drogas" esteve associada com o estado sorológico HIV positivo (OR = 4,178 IC 95 por cento = 1,476-11,827). CONCLUSÃO: Nossos achados indicam que a alta soropositividade encontrada nas jovens adolescentes que procuraram testagem evidencia a necessidade de que se desenvolvam medidas de intervenção preventivas especialmente dirigidas para comportamento de risco em mulheres adolescentes para evitar a disseminação da infecção HIV.