Clinical aspects of influenza A (H1N1) in HIV-infected individuals in São Paulo during the pandemic of 2009

OBJECTIVE: To describe the clinical aspects of H1N1 among HIV coinfected patients seen at a reference center for AIDS treatment in São Paulo, Brazil. Design: Observational and prospective cohort study. METHODS: Descriptive study of clinical and laboratory investigation of HIV-infected patients with confirmed diagnosis of influenza A (H1N1) in 2009. We analyzed patients monitored in CRT/DST/AIDS, a specialized service for people living with HIV, located in São Paulo, Brazil. RESULTS: 108 individuals presented with symptoms of H1N1 infection at the CRT DST/AIDS in 2009. Eighteen patients (16.7 percent) had confirmation of the diagnosis of influenza A. Among the confirmed cases, ten (55.6 percent) were hospitalized and eight (44.4 percent) were outpatients. Dyspnea was present in nine patients (50 percent), hemoptysis in three (16 percent). Six patients (60 percent) required therapy with supplemental oxygen. All patients had good clinical outcomes and none died. CONCLUSIONS: In our hospital, the symptoms that led patients to seek medical care were similar to the common flu. Hospital admission and the early introduction of antibiotics associated with oseltamivir may have been the cause of the favorable outcome of our cases.

HIV-1 resistance testing influences treatment decision-making

OBJECTIVE: To investigates how the use of HIV-1 resistance tests influences physician decision-making. METHODS: Ten experienced reference physicians from the Brazilian Network for Drug Resistance each received ten patients' case histories. The selected patients had experienced at least two virological failures. First, reference physicians were asked to empirically select a new regimen for each patient. Second, after genotype report (ViroSeq 2.6) was provided, and physicians were again asked to select a new regimen considering this additional information. Finally, they were asked to select a regimen after receiving a virtual phenotype result (vircoTYPE 3.9.00). RESULTS: In 79 percent of the cases, physicians changed their empirical choice of regimen after receiving the genotype report, resulting in an increase in the mean number of active drugs from 1.8 to 2.2 (p = 0.0003), while the average number of drugs/regimen remained at 4.0. After receipt of the virtual phenotype report, additional changes were made in 75 percent of the patient cases, resulting in an increase in the number of active drugs to 2.8 (p < 0.0001), while the average number of drugs/regimen remained at 4.0. After receipt of the genotype report, 48 percent of the changes were in NRTIs, 29 percent were in NNRTIs and 60 percent were in PIs; after consideration of the virtual phenotype, 61 percent, 10 percent and 49 percent of the changes, respectively, were in these categories of drugs. Fourteen percent of the physicians rated the genotype report as "extremely useful", whereas 34 percent rated the subsequent virtual phenotype report as "extremely useful" (p = 0.0003). CONCLUSIONS: Resistance testing has a significant impact on physicians' choices of antiretroviral salvage therapies, and it promotes the selection of more active drugs.

HIV-1 resistance testing influences treatment decision-making.

OBJECTIVE: To investigates how the use of HIV-1 resistance tests influences physician decision-making. METHODS: Ten experienced reference physicians from the Brazilian Network for Drug Resistance each received ten patients' case histories. The selected patients had experienced at least two virological failures. First, reference physicians were asked to empirically select a new regimen for each patient. Second, after genotype report (ViroSeq 2.6) was provided, and physicians were again asked to select a new regimen considering this additional information. Finally, they were asked to select a regimen after receiving a virtual phenotype result (vircoTYPE 3.9.00). RESULTS: In 79% of the cases, physicians changed their empirical choice of regimen after receiving the genotype report, resulting in an increase in the mean number of active drugs from 1.8 to 2.2 (p = 0.0003), while the average number of drugs/regimen remained at 4.0. After receipt of the virtual phenotype report, additional changes were made in 75% of the patient cases, resulting in an increase in the number of active drugs to 2.8 (p < 0.0001), while the average number of drugs/regimen remained at 4.0. After receipt of the genotype report, 48% of the changes were in NRTIs, 29% were in NNRTIs and 60% were in PIs; after consideration of the virtual phenotype, 61%, 10% and 49% of the changes, respectively, were in these categories of drugs. Fourteen percent of the physicians rated the genotype report as "extremely useful", whereas 34% rated the subsequent virtual phenotype report as "extremely useful" (p = 0.0003). CONCLUSIONS: Resistance testing has a significant impact on physicians' choices of antiretroviral salvage therapies, and it promotes the selection of more active drugs.

First survey for detecting the presence of human herpesvirus 8 infection (HHV-8) in Maputo, Mozambique

Human herpesvirus 8 (HHV-8), the etiological agent of Kaposi's sarcoma (KS), is endemic in parts of the sub-Saharan, and KS has increased concomitantly with the HIV/AIDS epidemic. In Mozambique (MZ), no data concerning HHV-8 infection was available, thus the main of this work was to investigate, for the first time, the presence of HHV-8 infection in Maputo, MZ. Latent and lytic HHV-8-specific antibodies were assessed in blood samples from 189 individuals from the Central Hospital of Maputo, MZ, using "in-house" immunofluorescence assays conducted in São Paulo, Brazil. The results obtained were analyzed according to socio-demographic and clinical variables using the Chi-square test and logistic regression. An HHV-8 seropositivity of 1.8 percent and 9.7 percent was detected among 57 medical students and 31 individuals from the staff, respectively, in contrast to 16.4 percent detected among 67 out-patients. Concerning 34 hospitalized patients from the Dermatology Unit, 47.1 percent were HHV-8-seropositive overall, while the rate was 85.7 percent among KS patients. The present survey, conducted in Maputo, MZ, demonstrates great variation in HHV-8 infection frequencies depending on the group analyzed and epidemiological variables. An association between HHV-8 seropositivity and male gender (OR 5.72), the central origin of patients (OR 5.33), blood transfusions (OR 3.25), and KS (OR 24.0) was detected among hospitalized patients, and primary school (OR 7.18) and HIV-1 infection (OR 8.76) among out-patients.

First survey for detecting the presence of human herpesvirus 8 infection (HHV-8) in Maputo, Mozambique.

Human herpesvirus 8 (HHV-8), the etiological agent of Kaposi's sarcoma (KS), is endemic in parts of the sub-Saharan, and KS has increased concomitantly with the HIV/AIDS epidemic. In Mozambique (MZ), no data concerning HHV-8 infection was available, thus the main of this work was to investigate, for the first time, the presence of HHV-8 infection in Maputo, MZ. Latent and lytic HHV-8-specific antibodies were assessed in blood samples from 189 individuals from the Central Hospital of Maputo, MZ, using 'in-house' immunofluorescence assays conducted in São Paulo, Brazil. The results obtained were analyzed according to socio-demographic and clinical variables using the Chi-square test and logistic regression. An HHV-8 seropositivity of 1.8% and 9.7% was detected among 57 medical students and 31 individuals from the staff, respectively, in contrast to 16.4% detected among 67 out-patients. Concerning 34 hospitalized patients from the Dermatology Unit, 47.1% were HHV-8-seropositive overall, while the rate was 85.7% among KS patients. The present survey, conducted in Maputo, MZ, demonstrates great variation in HHV-8 infection frequencies depending on the group analyzed and epidemiological variables. An association between HHV-8 seropositivity and male gender (OR 5.72), the central origin of patients (OR 5.33), blood transfusions (OR 3.25), and KS (OR 24.0) was detected among hospitalized patients, and primary school (OR 7.18) and HIV-1 infection (OR 8.76) among out-patients.

Associaçao tuberculose e infecçao pelo HIV no Brasil / HIV infections and tuberculosis in Brazil

Este artigo objetiva analisar a magnitude do problema da associaçao tuberculose-infecçao pelo HIV in Brasil, á luz das informaçoes disponíveis pelos meios oficiais e por estudos desenvolvidos em diversos serviços no país e, em particular, correlacionar situaçoes específicas de grandes populaçoes urbanas, como as das cidades de Sao Paulo e do Rio de Janeiro com outras cidades e regiones onde tal associaçao alcança alarmantes para o sistema de saúde

Discussão sobre terapia das infecções oportunistas em aids

Esta publicacao transcreve a gravacao magnetica da reuniao de atualizacao em infeccoes oportunistas na AIDS, realizada na cidade de São Paulo durante os dias 18 e 19 do corrente ano.

Associaçao tuberculose e infecçao pelo HIV no Brasil / HIV infections and tuberculosis in Brazil

Este artigo objetiva analisar a magnitude do problema da associaçao tuberculose-infecçao pelo HIV in Brasil, á luz das informaçoes disponíveis pelos meios oficiais e por estudos desenvolvidos em diversos serviços no país e, em particular, correlacionar situaçoes específicas de grandes populaçoes urbanas, como as das cidades de Sao Paulo e do Rio de Janeiro com outras cidades e regiones onde tal associaçao alcança alarmantes para o sistema de saúde

Discussäo sobre terapia das infecçöes oportunistas em aids / Discussion on terapy aids-related opportunistic infections

Esta publicacao transcreve a gravacao magnetica da reuniao de atualizacao em infeccoes oportunistas na AIDS, realizada na cidade de Säo Paulo durante os dias 18 e 19 do corrente ano

Enteroparasitoses em pacientes acometidos pela síndrome de imunodeficiência adquirida (AIDS/SIDA) / Intestinal parasitic infections among patients with acquired immunodeficiency syndrome (AIDS)

No período compreendido entre fevereiro de 1984 e abril de 1987, examinaram-se, na Seção de Enteroparasitoses do Instituto Adolfo Lutz, 771 amostras de fezes de pacientes atendidos pelo Programa de Controle e Prevenção da AIDS, da Secretaria de Estado da Saúde de São Paulo. Do total, 483 pacientes estavam acometidos por AIDS e os demais 288 pertenciam a grupos de risco para infecção por HIV. Examinaram-se, também, no mesmo período, as fezes de 432 indivíduos atendidos por Unidades Sanitárias mantidas pela rede estadual de atenção primária à saúde, que, por sorteio, constituíram grupo controle. Os resultados indicaram maior frequência de parasitismo por Entamoeba histolytica e Isospora belli entre os pacientes aidéticos e os pertencentes a grupos de risco para infecção por HIV, além de índices mais elevados de infecção por Strogyloides stercoralis entre os aidéticos, quando comparados aos demais grupos. Revelou-se, ainda, infecção por Crytosporidium sp. em 12,1% dos aidéticos e 2,5% dos componentes de grupos de risco (AU).

Enteroparasitoses em pacientes acometidos pela sindrome de imunodeficiencia adquirida (AIDS/SIDA)

No período compreendido entre fevereiro de 1984 e abril de 1987, examinaram-se, na Secäo de Enteroparasitoses do Instituto Adolfo Lutz, 771 amostras de fezes de pacientes atendidos pelo Programa de Controle e Prevencäo da AIDS, da Secretaria de Estado da Saúde de Säo Paulo. Do total, 483 pacientes estavam acometidos por AIDS e os demais 288 pertenciam a grupos de risco para infeccäo por HIV. Examinaram-se, também, no mesmo período, as fezes de 432 indivíduos atendidos por Unidades Sanitárias mantidas pela rede estadual de atencäo primária à saúde, que, por sorteio, constituíram grupo controle. Os resultados indicaram maior frequência de parasitismo por Entamoeba histolytica e Isospora belli entre os pacientes aidéticos e os pertencentes a grupos de risco para infeccäo por HIV, além de índices mais elevados de infeccäo por Strogyloides stercoralis entre os aidéticos, quando comparados aos demais grupos. Revelou-se, ainda, infeccäo por Crytosporidium sp. em 12,1 por cento dos aidéticos e 2,5 por cento dos componentes de grupos de risco