Evaluation of inflammatory biomarkers, carotid intima-media thickness and cardiovascular risk in HIV-1 treatment-naive patients.

INTRODUCTION: Mortality among HIV patients is 3-15 times higher than that among the general population. Currently, most deaths are due to non-infectious diseases. Chronic inflammation and adverse events due to antiretroviral therapy play crucial roles in increasing cardiovascular risk (CVR). METHODS: This cross-sectional study aimed to evaluate carotid intima-media thickness (CIMT) and inflammatory biomarkers (D-dimer, ADAMTS13, GDF-15, sICAM-1, MPO, myoglobin, NGAL, SAA, sVCAM-1, and p-selectin) among naïve patients. RESULTS: Sixty-seven participants were included: median age, 32 years; males, 82.1%; non-white, 61.1%; higher education level, 62.7%; and exposed to HIV through sexual relationship (men who have sex with men), 68.7%. The median viral load and LTCD4+ value were 42,033 copies/mL and 426 cells/mm³. The prevalence of arterial hypertension was 16.4%; those of diabetes mellitus and dyslipidemia were 3% and 70.1%, respectively. The CIMT was 494.08 (± 96.84mm). The mean vascular age was 33.2 ± 18.9 years, one year longer than the chronological age, without statistical significance. CONCLUSIONS: The majority of participants had a low CVR (94%). After reclassification, considering the CIMT percentiles, 13 (19.4%) patients had medium/ high CVR, while 54 (80.6%) patients had low CVR. The difference between the proportions of CVR when considering the CIMT and its corresponding percentile was statistically relevant. Body mass index was the only predictor of higher CVR (p = 0.03). No biomarker was found to predict CVR. People living with HIV have a high prevalence of dyslipidemia before ARV therapy.

Evaluation of inflammatory biomarkers, carotid intima-media thickness and cardiovascular risk in HIV-1 treatment-naive patients

Abstract INTRODUCTION Mortality among HIV patients is 3-15 times higher than that among the general population. Currently, most deaths are due to non-infectious diseases. Chronic inflammation and adverse events due to antiretroviral therapy play crucial roles in increasing cardiovascular risk (CVR). METHODS: This cross-sectional study aimed to evaluate carotid intima-media thickness (CIMT) and inflammatory biomarkers (D-dimer, ADAMTS13, GDF-15, sICAM-1, MPO, myoglobin, NGAL, SAA, sVCAM-1, and p-selectin) among naïve patients. RESULTS: Sixty-seven participants were included: median age, 32 years; males, 82.1%; non-white, 61.1%; higher education level, 62.7%; and exposed to HIV through sexual relationship (men who have sex with men), 68.7%. The median viral load and LTCD4+ value were 42,033 copies/mL and 426 cells/mm³. The prevalence of arterial hypertension was 16.4%; those of diabetes mellitus and dyslipidemia were 3% and 70.1%, respectively. The CIMT was 494.08 (± 96.84mm). The mean vascular age was 33.2 ± 18.9 years, one year longer than the chronological age, without statistical significance. CONCLUSIONS The majority of participants had a low CVR (94%). After reclassification, considering the CIMT percentiles, 13 (19.4%) patients had medium/ high CVR, while 54 (80.6%) patients had low CVR. The difference between the proportions of CVR when considering the CIMT and its corresponding percentile was statistically relevant. Body mass index was the only predictor of higher CVR (p = 0.03). No biomarker was found to predict CVR. People living with HIV have a high prevalence of dyslipidemia before ARV therapy.

Long-term protection after hepatitis B vaccination in people living with HIV.

BACKGROUND: Hepatitis B vaccine is important in people living with HIV (PLHIV) since both viruses have the same transmission routes and co-infection has greater morbidity. PLHIV usually have poor response to hepatitis B vaccine. The duration of immunity in PLHIV is unknown. The objective of this study is to evaluate the duration of serological response and clinical protection provided by hepatitis B vaccination in PLHIV. METHODS: Retrospective study of a PLHIV cohort primarily vaccinated for hepatitis B virus (HBV) from 2001 to 2002. Markers of infection and protection from HBV were investigated in those individuals who were still attending the outpatient clinic, in São Paulo, Brazil from 2012 to 2014. Three groups were analyzed. Group 1: adults who responded to primary vaccine series. Group 2: non-responders to primary vaccine series. Group 3: subjects from both Groups 1 and 2 who did not receive any booster doses after seroconversion. RESULTS: A cohort of 121 PLHIV was analyzed for seroconversion and persistence of anti-HBs. The majority were female (54.5%) and mean age was 50.1years. After 11years, none of the patients had serologic evidence of HBV infection. Overall, 41/58 (70.7%) of the initial responders (Group 1) had maintained anti-HBs≥10mIU/mL. Greater CD4+ values and anti-HBs>100mIU/mL at the time of first vaccine series were associated with persistence of anti-HBs. During the time of evaluation, 35/63 (55.6%) of the initial non-responders (Group 2) successfully seroconverted (anti-HBs≥10mIU/mL) in response to one or more booster doses. From the time of their seroconversion, 70 of the patients did not receive any further booster doses (Group 3). After 10years, 54/70 (77.1%) of these individuals has maintained anti-HBs≥10mIU/mL. CONCLUSIONS: Evaluation of long-term immunity for hepatitis B in PLHIV following vaccination showed a strong persistence of anti-HBs and no serologic evidence of HBV infection. Boosters may be effective in PLHIV non-responders to primary vaccination.

Efetividade do tratamento antirretroviral nas primeiras 48 semanas após seu início, Belo Horizonte, Minas Gerais - 2010 a 2013 / Effectiveness of antiretroviral treatment in the first 48 weeks after its beginning, Belo Horizonte, Minas Gerais - 2010 to 2013

Introdução: Após mais de 30 anos da epidemia e apesar de grandes conquistas, o impacto da infecção HIV/Aids representa ainda grande problema em todo o mundo, permanecendo como um desafio a ser vencido. Método: Trata-se estudo de coorte que avalia a efetividade da terapia antirretroviral (TARV) no primeiro ano de sua introdução. Analisou-se apenas efetividade através da quantificação da carga viral (CV) 48 semanas após o início. Trocas relacionadas à intolerância e evento adverso não foram consideradas falha terapêutica. O estudo foi conduzido no Serviço de Referência em Doenças Infecto-parasitárias (CTR/DIP) Orestes Diniz, em Belo Horizonte, MG, entre outubro de 2010 e janeiro de 2013. Foram incluídos 182 pacientes que preencheram os critérios inclusão. Resultados: Houve predomínio do sexo masculino, maioria abaixo 50 anos. Encontrou-se elevada prevalência de grupos de maior vulnerabilidade para exposição ao HIV, como homens que fazem sexo com homens, que representavam 43,4% da amostra do estudo. A efetividade geral, avaliada através da proporção de CV < limite de detecção, foi 91% (166/182). Análises univariada e multivariada não encontraram associação entre variáveis estudadas e a efetividade do tratamento. Conclusão: Observou-se alta taxa sucesso terapêutico avaliado através da CV, entretanto o grande desafio é a manutenção dos indivíduos no cuidado e adesão ao tratamento. Destaca-se também menor percentual de início tardio da TARV em relação outros estudos brasileiros, entretanto, ainda elevado em relação aos países desenvolvidos. Apesar disso, as respostas imunovirológicas foram superiores às descritas pelo Ministério da Saúde e alguns estudos de eficácia. (AU)

Introduction: After more than 30 years of epidemic and despite all achievements, HIV infection represents healthy problem that still has to be faced. Methods: It is cohort study that analyzes the efficacy of TARV after a year of use. It has studied the effectiveness through the quantification of viral load (VL) change after 48 weeks of use. The changes related to intolerance or adverse effects were not considered as therapeutic failure. The study was conduced in outpatient clinic in Belo Horizonte, MG. It was include 182 patients with HIV that fulfilled the inclusion criteria. Results: There were found 91% of efficacy. There were more male patients, and the majority was younger than 50 years. The vulnerable group, like men who have sex with men, was the majority (43.4%). Conclusion: There was a high rate of therapeutic success assessed by VL. However, the biggest challenge is the maintenance of the patients in the treatment. This study also highlights the lower percentage of late onset of TARV compared with other Brazilian studies. Unfortunately, our percentage is s higher compared with develop countries. Despite of that, immune and viral response in this study was higher than the values described by Ministry of Health. It is important to remember that our study did not considered the change of initial antiretroviral treatment due intolerance or toxicity as a failed and that could had increased the success rate of this cohort. (AU)

Segunda opinião formativa: como fica a terapia antitrombótica diante de um diagnóstico de dengue? Há necessidade de interrupção da medicação?

O texto refere-se ao processo de decisão de interrupção do uso de anticoagulantes e antiagregantes plaquetários no contexto da dengue, considerando a avaliação do risco-benefício para as diferentes situações clínicas.

Como é realizado o diagnóstico e qual é o manejo clínico na Febre do Chikungunya?

A confirmação da febre do Chicungunya (CHKV) é feita através do diagnóstico laboratorial utilizando-se um dos três testes a seguir, a depender da data do início dos sintomas: 1- Isolamento viral, 2- Reação em cadeia de polimerase em tempo real (RT-PCR), 3- Sorologias IgM e IgG. Para o isolamento viral a amostra de sangue deve ser coletada de preferência nos 3 primeiros dias do início dos sintomas e do 1º ao 8º dias para o PCR. Para a pesquisa de anticorpos IgM coletar amostras preferencialmente a partir do 4º dia de início de sintomas (até aproximadamente 2 meses, embora IgM possa persistir por maior tempo). Para pesquisa de anticorpos IgG ou ensaio de anticorpo neutralizante mostrando títulos crescentes, devem ser coletadas duas amostras, separadas por intervalo de 14 dias, sendo a primeira amostra coletada após o 70 dia do início dos sintomas. Além do sangue outras amostras podem ser utilizadas como o liquido cérebro-espinhal, líquido sinovial, ou ainda biópsias de tecidos ou órgãos. Não existe até o momento antiviral específico para o CHKV, sendo o tratamento inteiramente sintomático ou de suporte. Para o tratamento da fase aguda, que dura em média 7 dias, recomenda-se manter o paciente em repouso e aplicar compressas frias nas articulações acometidas. Prescrever dipirona ou paracetamol para controle da febre e dor, ou codeína para os casos refratários. Ingestão de líquidos (oral ou endovenoso, de acordo com a gravidade do quadro) para reposição de perdas por sudorese, vômitos e outras perdas deve ser instituída. Os anti-inflamatórios não esteroides (ibuprofeno, naproxeno, ácido acetilsalicílico) não devem ser utilizados na fase aguda. Ressalte-se que o ácido acetilsalicílico também é contraindicado nessa fase da doença pelo risco de Síndrome de Reye e de sangramento. Os esteroides estão contraindicados na fase aguda, pelo risco do efeito rebote. Pode-se indicar fisioterapia com exercícios leves para os pacientes em recuperação. Já nas fases subaguda (com duração média de 3 meses) ou crônica (duração maior que 3 meses), indica-se anti-inflamatório não hormonal para alívio do componente artrítico. Uso de analgésicos mais potentes como morfina ou uso de corticosteroides podem ser necessários para pacientes com dor intensa que não obtiveram alívio com os anti-inflamatórios não hormonais. Na presença de fatores de risco (gestantes, crianças < 2 anos, idosos, pacientes com comorbidades) está indicado controle clínico diário até desaparecimento da febre. Diante de sinais de gravidade, recomenda-se manejo em leito de internação. A Febre do CHKV é doença de notificação compulsória imediata, devendo ser notificada imediatamente (menos de 24h) por telefone para Gerencia de Epidemiologia GEREPI ou Centro de Informações Estratégicas em Vigilância em Saúde (CIEVS).

Segunda opinião formativa: O que devemos saber sobre a Febre do Chikungunya?

A Febre do Chicungunya (CHKV) é uma doença aguda causada pelo vírus chicungunya, vírus RNA, do gênero Alphavirus, pertencente à família Togaviridae. Trata-se de arbovirose, transmitida aos humanos pelos mosquitos Aedes, mesmos vetores responsáveis por transmitir o vírus da dengue. Considerada primariamente doença tropical, sua distribuição geográfica ocorria mais frequentemente na África, Ásia e ilhas do Oceano Índico. Mais recentemente, em fins de 2013, a transmissão autóctone (local) foi documentada na América Central, na região do Caribe. Os primeiros casos autóctones notificados no Brasil ocorreram em 2014, sendo notificados até o momento em algumas cidades no Amapá, Bahia, Mato Grosso do Sul e Minas Gerais. A doença já afetou milhões de pessoas e continua a causar epidemias em muitos países. Artralgias persistentes podem interferir na qualidade de vida do paciente e em suas atividades laborais. O quadro clínico é inespecífico, constituindo-se de sinais e sintomas comuns a várias doenças infecciosas. Febre alta de início agudo (até 7 dias) e artralgia/artrite (não explicada por outras condições), geralmente simétrica, migratória, com presença de edema, podendo ser debilitante, acometendo especialmente mãos, punhos, tornozelos e pés são os achados mais frequentes. A doença é em geral auto-limitada com a maior parte dos pacientes recuperando em 1 a 3 semanas. Porém, contingente significativo de pacientes pode cursar com quadro de artrite de longa duração, persistindo por meses a anos, podendo ocorrer acometimento articular intenso. Considerando a duração dos sintomas, o Chicungunya pode determinar doença aguda (duração de até semanas), subaguda (de semanas até 3 meses) e crônica (duração > 3 meses). As medidas de prevenção podem ser pensadas em termos de proteção individual e coletiva e incluem uso de vestimentas que reduzam a área de pele exposta, repelente (especialmente em situações de viagens para áreas de transmissão) e mudança de hábitos que evitem condições que propiciam a multiplicação dos vetores. As medidas que reduzem os criadouros para os vetores são de responsabilidade individual e dos órgãos de saúde pública. Todos os casos suspeitos devem ser mantidos sob mosquiteiros durante o período febril da doença. Não existe vacina disponível até o momento, mas seu desenvolvimento está em progresso. Nos locais onde não se registra ainda ocorrência de casos autóctones deve-se investigar histórico de viagens a áreas onde existe a circulação do vírus. Por se tratar de situação dinâmica, informações epidemiológicas nacionais e internacionais devem ser atualizadas e disponibilizadas para os profissionais de saúde e para a comunidade.

Evaluation of late presentation for HIV treatment in a reference center in Belo Horizonte, Southeastern Brazil, from 2008 to 2010

Introduction: Since 1996 Brazil has provided universal access to free antiretroviral therapy, and as a consequence, HIV/AIDS patients' survival rate has improved dramatically. However, according to scientific reports, a significant number of patients are still late presenting for HIV treatment, which leads to consequences both for the individual and society. Clinical and immunological characteristics of HIV patients newly diagnosed were accessed and factors associated with late presentation for treatment were evaluated. Methods: A cross-sectional study was carried out in an HIV/AIDS reference center in Belo Horizonte, Minas Gerais, in Southeastern Brazil from 2008 to 2010. Operationally, patients with late presentation (LP) for treatment were those whose first CD4 cell count was less than 350 cells/mm3 or presented an AIDS defining opportunistic infection. Patients with late presentation with advanced disease (LPAD) were those whose first CD4 cell count was less than 200 cells/mm3 or presented an AIDS defining opportunistic infection. LP and LPAD associated risk factors were evaluated using logistic regression methods. Results: Five hundred and twenty patients were included in the analysis. The median CD4 cell count was 336 cells/mm3 (IQR: 130-531). Two hundred and seventy-nine patients (53.7%) were classified as LP and 193 (37.1%) as LPAD. On average, 75% of the patients presented with a viral load (VL) >10,000 copies/ml. In multivariate logistic regression analysis the factors associated with LP and LPAD were age, being symptomatic at first visit and VL. Race was a factor associated with LP but not with LPAD. Conclusion: The proportion of patients who were late attending a clinic for HIV treatment is still high, and effective strategies to improve early HIV detection with a special focus on the vulnerable population are urgently needed. .

Evaluation of late presentation for HIV treatment in a reference center in Belo Horizonte, Southeastern Brazil, from 2008 to 2010.

INTRODUCTION: Since 1996 Brazil has provided universal access to free antiretroviral therapy, and as a consequence, HIV/AIDS patients' survival rate has improved dramatically. However, according to scientific reports, a significant number of patients are still late presenting for HIV treatment, which leads to consequences both for the individual and society. Clinical and immunological characteristics of HIV patients newly diagnosed were accessed and factors associated with late presentation for treatment were evaluated. METHODS: A cross-sectional study was carried out in an HIV/AIDS reference center in Belo Horizonte, Minas Gerais, in Southeastern Brazil from 2008 to 2010. Operationally, patients with late presentation (LP) for treatment were those whose first CD4 cell count was less than 350 cells/mm(3) or presented an AIDS defining opportunistic infection. Patients with late presentation with advanced disease (LPAD) were those whose first CD4 cell count was less than 200 cells/mm(3) or presented an AIDS defining opportunistic infection. LP and LPAD associated risk factors were evaluated using logistic regression methods. RESULTS: Five hundred and twenty patients were included in the analysis. The median CD4 cell count was 336 cells/mm(3) (IQR: 130-531). Two hundred and seventy-nine patients (53.7%) were classified as LP and 193 (37.1%) as LPAD. On average, 75% of the patients presented with a viral load (VL) >10,000 copies/ml. In multivariate logistic regression analysis the factors associated with LP and LPAD were age, being symptomatic at first visit and VL. Race was a factor associated with LP but not with LPAD. CONCLUSION: The proportion of patients who were late attending a clinic for HIV treatment is still high, and effective strategies to improve early HIV detection with a special focus on the vulnerable population are urgently needed.

Profile of patients diagnosed with AIDS at age 60 and above in Brazil, from 1980 until June 2009, compared to those diagnosed at age 18 to 59

OBJECTIVES: The aim of this study was to learn more about people diagnosed with acquired immunodeficiency syndrome (AIDS) at age 60 and above in Brazil, and to compare them with people diagnosed at a younger age. METHODS: This study was based on the analysis of secondary data from the Brazilian AIDS Program. The study population consisted of people diagnosed with AIDS at age 60 and above. The comparison group was comprised of a 20% random sample of people diagnosed at age 18 to 59, frequency-matched by year of diagnosis. RESULTS: 544,846 cases of AIDS were reported in Brazil from 1980 until June 2009. Over 90% of cases were diagnosed between 18 and 59 years of age, and 13,657 (2.5%) at age 60 and above. The first case of AIDS among the elderly was reported in 1984. The comparison group consisted of 101,528 patients. Gender proportion was similar for both groups, and the proportion of people identified with AIDS after death in the Brazilian Mortality Information System (SIM) was 4% higher among the elderly. Both groups were also similar regarding the region of residence; a markedly higher proportion lived in Southeastern Brazil. Older people were more likely to have lower education and to have contracted AIDS by heterosexual contact, and less likely to be intravenous drug users. Male to female ratio among those diagnosed with AIDS at or above age 60 decreased over the years, in the same way as observed for the whole cohort. Mortality was higher among men in both groups. CD4 category (taken closest to the date of AIDS diagnosis) was very similar in both groups. CONCLUSION: The characteristics of the epidemic among the elderly show similarities to the younger group considering gender distribution and CD4 category, but differ regarding educational level and exposure category. Also, the elderly were more likely not to have their AIDS condition promptly diagnosed.

Profile of patients diagnosed with AIDS at age 60 and above in Brazil, from 1980 until June 2009, compared to those diagnosed at age 18 to 59.

OBJECTIVES: The aim of this study was to learn more about people diagnosed with acquired immunodeficiency syndrome (AIDS) at age 60 and above in Brazil, and to compare them with people diagnosed at a younger age. METHODS: This study was based on the analysis of secondary data from the Brazilian AIDS Program. The study population consisted of people diagnosed with AIDS at age 60 and above. The comparison group was comprised of a 20% random sample of people diagnosed at age 18 to 59, frequency-matched by year of diagnosis. RESULTS: 544,846 cases of AIDS were reported in Brazil from 1980 until June 2009. Over 90% of cases were diagnosed between 18 and 59 years of age, and 13,657 (2.5%) at age 60 and above. The first case of AIDS among the elderly was reported in 1984. The comparison group consisted of 101,528 patients. Gender proportion was similar for both groups, and the proportion of people identified with AIDS after death in the Brazilian Mortality Information System (SIM) was 4% higher among the elderly. Both groups were also similar regarding the region of residence; a markedly higher proportion lived in Southeastern Brazil. Older people were more likely to have lower education and to have contracted AIDS by heterosexual contact, and less likely to be intravenous drug users. Male to female ratio among those diagnosed with AIDS at or above age 60 decreased over the years, in the same way as observed for the whole cohort. Mortality was higher among men in both groups. CD4 category (taken closest to the date of AIDS diagnosis) was very similar in both groups. CONCLUSION: The characteristics of the epidemic among the elderly show similarities to the younger group considering gender distribution and CD4 category, but differ regarding educational level and exposure category. Also, the elderly were more likely not to have their AIDS condition promptly diagnosed.

Durability of the first combined antiretroviral regimen in patients with AIDS at a reference center in Belo Horizonte, Brazil, from 1996 to 2005.

Finding a better first antiretroviral regimen is one of the strategies used to improve span and quality of life of HIV/AIDS patients. 891 patients were followed during 24 months or until interruption/abandonment of treatment, changing regimen or death. At the end of 6 months, 69% of the patients were still being treated with the first regimen, 54% at 12 months, 48% at 18 months and 39% at 24 months. AZT-3TC-EFV was the most prescribed regimen and with the lesser discontinuation. NNRTI regimens showed high effectiveness and durability compared to PI regimens. Irregular medication dispensation was the only risk factor for failure/interruption of treatment in multivariate analyses. Intolerance/adverse effects were mainly responsible for first regimen discontinuation, followed by abandonment/non-adherence and virologic failure. Results showed significant difference between causes of interruption of first HAART with higher percentage of intolerance/adverse effects with PI regimens and higher immunologic failure with NNRTI regimens. Even with the availability of more potent and tolerable drugs, lack of adherence to HAART and high level of adverse effects are still the most important barriers to prolonged success of treatment. This study adds relevant information about durability and effectiveness of HAART in the first decade of its use in Brazil.

Durability of the first combined antiretroviral regimen in patients with AIDS at a reference center in Belo Horizonte, Brazil, from 1996 to 2005

Finding a better first antiretroviral regimen is one of the strategies used to improve span and quality of life of HIV/AIDS patients. 891 patients were followed during 24 months or until interruption/abandonment of treatment, changing regimen or death. At the end of 6 months, 69 percent of the patients were still being treated with the first regimen, 54 percent at 12 months, 48 percent at 18 months and 39 percent at 24 months. AZT-3TC-EFV was the most prescribed regimen and with the lesser discontinuation. NNRTI regimens showed high effectiveness and durability compared to PI regimens. Irregular medication dispensation was the only risk factor for failure/interruption of treatment in multivariate analyses. Intolerance/adverse effects were mainly responsible for first regimen discontinuation, followed by abandonment/non-adherence and virologic failure. Results showed significant difference between causes of interruption of first HAART with higher percentage of intolerance/adverse effects with PI regimens and higher immunologic failure with NNRTI regimens. Even with the availability of more potent and tolerable drugs, lack of adherence to HAART and high level of adverse effects are still the most important barriers to prolonged success of treatment. This study adds relevant information about durability and effectiveness of HAART in the first decade of its use in Brazil.

Randomized trial of recombinant hepatitis B vaccine in HIV-infected adult patients comparing a standard dose to a double dose.

Because HIV and hepatitis B virus share many common risk factors, it is important to try to vaccinate HIV patients against hepatitis B. There are numerous reports describing a variety of dose schedules, limited success and markers associated with impaired response to HBV vaccine in these individuals. All studies have been small in size making it difficult to draw conclusions within and between studies. The purpose of this study was to evaluate a double dose of hepatitis B vaccine under more definitive guidelines: double blinded, randomized, controlled, with numbers for statistical validity. Two hundred and ten HIV infected subjects received a standard dose (20 microg) or a double dose (40 microg) of recombinant hepatitis B vaccine IM 0, 1 and 6 months. Ninety-four receiving standard dose and 98 receiving double dose completed the study. The seroconversion rate (anti-HBs > or = 10 mIU/mL) was 47 and 34% for double dose and standard dose, respectively (p = 0.07). A statistically significant higher seroconversion rate was associated with double dose comparing with standard dose for patients with CD4 cell counts > or = 350 cells/mm3 (64.3% x 39.3%; p = 0.008) but made no difference to seroconversion in those with CD4 <350 (23.8% x 26.3%; p = 0.80). Double dose also improved seroconversion comparing with standard dose for patients with HIV viral load <10,000 copies/mL (58.3% x 37.3%; p = 0.01) but made no difference to seroconversion in those with HIV viral load > or = 10,000 copies/mL (16% x 17%; p = 0.7). Based on the results of this study, the best current strategy for hepatitis B vaccination in HIV patients would be to use a double dose as a primary series when the viral load is likely to be low and CD4> or = 350, when there is likely to be an adequate immune response.

Uso da vacina contra hepatite B e em indivíduos infectados pelo vírus da imunodeficiência humana / Hepatitis B vaccination in human immunodeficiency virus infected patients

O objetivo deste ensaio clínico, randomizado, simples cego, foi comparar a resposta vacinal em pacientes HIV positivos, utilizando a vacina recombinante da hepatite B. em dois esquemas diferentes. A dose regular de 20g de HBsAg (0, 1, 6 meses), via IM, foi administrada em 94 pacientes e a dose em dobro (40g) em 98 pacientes. Os grupos foram homogêneos quanto às variáveis sexo, idade, categoria de exposição, uso de tabaco, bebida e média de células CD4. A taxa de soroconversão (anti-HBsAg  10mUI/ml) / The objetive of this randomized, simple blinded clinical trial was to compare the response of two different schedules of recombinant hepatitis B vaccine in HIV-infected patients. A total of 94 patients received 20g of HBsAg at 0,1, 6 months in the deltoid region and 98 patients received a dose of 40g. Both groups distribution were similar according to gender, age, smoking and drinking habits, as well as mean CD4 counts and HIV exposition category. The total seroconvertion rate to anti-HBs ( 10mUI/ml)...

Dengue: epidemiologia, diagnóstico diferencial e manejo clínico.

Esta webaula contempla informações sobre epidemiologia, diagnóstico diferencial e manejo clínico da dengue.

Malária em área extra-amazônica - Parte 2: quadro clínico, diagnóstico e tratamento

Esta webaula aborda informações sobre quadro clínico, diagnóstico e tratamento da malária.