The association between sociodemographic characteristics, clinical indicators and body mass index in a population at risk of type 2 diabetes: A cross-sectional study in two Colombian cities.

AIMS: To assess the association between sociodemographic and clinical factors with body mass index (BMI) in a population at risk of type 2 diabetes (T2D) in Bogotá and Barranquilla, Colombia. METHODS: This cross-sectional study used data from the PREDICOL Study. Participants with a FINDRISC ≥ 12 who underwent an Oral Glucose Tolerance Test (OGTT) were included in the study (n=1166). The final analytical sample size was 1101 participants. Those with missing data were excluded from the analysis (n=65). The main outcome was body mass index (BMI), which was categorized as normal, overweight, and obese. We utilized unadjusted and adjusted ordinal logistic regression analysis to calculate odds ratios (OR) and 95 % confidence intervals (CI). RESULTS: The prevalence of overweight and obesity was 41 % (n=449) and 47 % (n=517), respectively. Participants with a 2-hour glucose ≥139 mg/dl had 1.71 times higher odds of being overweight or obese (regarding normal weight) than participants with normal 2-hour glucose values. In addition, being a woman, waist circumference altered, and blood pressure >120/80 mmHg were statistically significantly associated with a higher BMI. CONCLUSION: Strategies to control glycemia, blood pressure, and central adiposity are needed in people at risk of T2D. Future studies should be considered with a territorial and gender focus, considering behavioral, and sociocultural patterns.

T cell-mediated Immune response and correlates of inflammation and their relationship with COVID-19 clinical severity: not an intuitive guess.

BACKGROUND: Predictors of the outcome of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection remain to be fully determined. We evaluated selected viral characteristics and immunological responses that might predict and/or correlate to the clinical outcome of COVID-19. METHODS: For individuals developing divergent clinical outcomes, the magnitude and breadth of T cell-mediated responses were measured within 36 h of symptom onset. Peripheral Blood Mononuclear Cells (PBMCs) were subjected to in vitro stimulation with SARS-CoV-2-based peptides. In addition, SARS-CoV-2 sequences were generated by metagenome, and HLA typing was performed using Luminex technology. FINDINGS: CD4+ T cell activation was negatively correlated with SARS-CoV-2 basal viral load in patients with severe COVID-19 (p = 0·043). The overall cellular immune response, as inferred by the IFN-γ signal, was higher at baseline for patients who progressed to mild disease compared to patients who progressed to severe disease (p = 0·0044). Subjects with milder disease developed higher T cell responses for MHC class I and II-restricted peptides (p = 0·033). INTERPRETATION: Mounting specific cellular immune responses in the first days after symptom onset, as inferred by IFN-γ magnitude in the ELISPOT assay, may efficiently favor a positive outcome. In contrast, progression to severe COVID-19 was accompanied by stronger cellular immune responses, higher CD4 + T cell activation, and a higher number of in silico predicted high-affinity class I HLA alleles.

Glycemic status and health-related quality of life (HRQOL) in populations at risk of diabetes in two Latin American cities.

PURPOSE: To estimate the health-related quality of life (HRQOL) according to glycemic status, and its relationship with sociodemographic and clinical factors in a population at risk of developing type 2 diabetes (T2D). METHODS: Cross-sectional study, using cluster sampling. Data were collected from 1135 participants over 30 years of age, at risk of developing T2D from the PREDICOL project. Participants' glycemic status was defined using an oral glucose tolerance test (OGTT). Participants were divided into normoglycemic subjects (NGT), prediabetes and diabetics do not know they have diabetes (UT2D). HRQOL was assessed using the EQ-5D-3L questionnaire of the EuroQol group. Logistic regression and Tobit models were used to examine factors associated with EQ-5D scores for each glycemic group. RESULTS: The mean age of participants was 55.6 ± 12.1 years, 76.4% were female, and one in four participants had prediabetes or unknown diabetes. Participants reported problems most frequently on the dimensions of Pain/Discomfort and Anxiety/Depression in the different glycemic groups. The mean EQ-5D score in NGT was 0.80 (95% CI 0.79-0.81), in prediabetes, 0.81 (95% CI 0.79-0.83), and in participants with UT2D of 0.79 (95% CI 0.76-0.82), respectively. Female sex, older age, city of residence, lower education, receiving treatment for hypertension, and marital status were significantly associated with lower levels of HRQOL in the Tobit regression analysis. CONCLUSIONS: HRQOL of NGT, prediabetes, and UT2D participants was statistically similar. However, factors such as gender, age. and place of residence were found to be significant predictors of HRQOL for each glycemic group.

Predictors of diabetes risk in urban and rural areas in Colombia.

BACKGROUND: Nutritional habits low in fruits and vegetables and sedentary lifestyle are associated with a higher risk of developing Type 2 Diabetes (T2D). However, it is important to assess differences between urban and rural areas. This study aimed to analyze the associations between the risk of developing T2D and setting in the Colombian north coast in 2017. METHODS: This cross-sectional study included 1,005 subjects. Data was collected by interviewing self-identified members of an urban community and a rural-indigenous population. The interaction terms were evaluated as well as the confounders. Then, adjusted binary logistic regressions were used to estimate the odds ratio (OR) and 95% Confidence Intervals (CI). RESULTS: subjects with a high risk of T2D are more likely to belong to the urban setting (OR = 1.908; 95%CI = 1.201-2.01) compared with those with lower T2D after adjusting for age, Body Mass Index (BMI), physical activity, history of high levels of glycemia, and diabetes in relatives. CONCLUSIONS: Urban communities are more likely to have T2D compared with rural-indigenous populations. These populations have differences from the cultural context, including personal, and lifestyle factors.

Health-related quality of life (HRQoL) in a population at risk of type 2 diabetes: a cross-sectional study in two Latin American cities.

PURPOSE: The purpose of this study was to describe the health-related quality of life (HRQoL) characteristics in a population at risk of developing type 2 diabetes in Barranquilla and Bogotá, Colombia. METHODS: A cross-sectional study with 1135 participants older than 30 years-of-age recruited in Bogotá D.C., and Barranquilla by cluster sampling in 2018 to 2019. The Finnish Diabetes Risk Score (FINDRISC) was used to detect participants at risk of developing type 2 diabetes (T2D). HRQoL was assessed using the EQ-5D-3L questionnaire. Unadjusted and adjusted logistic regression models were used to calculate odds ratios (OR) and their corresponding 95% confidence intervals CI). RESULTS: Moderate or extreme problems appeared more frequently in the dimensions of Pain/Discomfort (60.8%) and Anxiety/Depression (30.8%). The mean score of the EQ-VAS was 74.3 (± 17.3), significantly larger in the state of complete health (11111) compared with those with problems in more than one of the quality-of-life dimensions. Being female and living in Bogota D.C., were associated with greater odds of reporting problems in the Pain (OR 1.6; 95% CI 1.2-2.2) and Discomfort dimensions (OR 1.6; 95% CI 1.2-2.0) respectively and Anxiety/Depression (OR 1.9; 95% CI 1.3-2.7), (OR 9.1; 95% CI 6.6-12.4), respectively. CONCLUSIONS: As living place and sex were associated with dimensions of Pain/Discomfort and Anxiety/Depression in the HRQoL in people at risk of T2D, greater attention should be paid to these determinants of HRQoL to design and reorient strategies with a territorial and gender perspective to achieve better health outcomes. Diabetes is one of the four non-communicable diseases with increasing prevalence in the world, which has made it a serious public health problem. In Colombia, in 2019 diabetes affected 8.4% of the Colombian adult population and more than one million Colombian adults of this age group have hidden or undetected diabetes. This disease is not only characterized by increased premature mortality, loss of productivity, and economic impact, but it also involves a deterioration in the quality of life of people with diabetes with their respective families. However, very Little is known about health-related quality of life (HRQoL) in a population at risk or with prediabetes. This study has evaluated the quality of life in patients at risk of diabetes and their behavior with some variables as sociodemographic, lifestyle, history, and established their difference in two territories of the Colombian Caribbean. The results of this study indicate that the HRQoL of people at risk of type 2 diabetes is affected by factors such as gender, city, dysglycemia, medication for hypertension and education level. Therefore, greater attention should be paid to these determinants of HRQL to design and implement strategies that reduce this risk of developing type 2 diabetes, prevent prediabetes and improve the quality of life in prediabetic or diabetic patients.

COVID-19 en la Región Caribe Colombiana: un análisis documental / Covid19 in the Colombian Caribbean Region: A Documentary analysis

Resumen Introducción: El impacto social y sanitario que ha generado la pandemia COVID-19 a nivel global permite repensar aspectos de vigilancia epidemiológica y comunicación en tiempos de crisis. Objetivo: Describir el comportamiento de la pandemia COVID-19 en los departamentos y distritos especiales de la región caribe colombiana. Materiales y Métodos: Análisis documental e interpretativo a partir de fuentes secundarias de vigilancia nacional "SIVIGILA" y datos de entes territoriales. Resultados: Cartagena de Indias es la primera unidad territorial del Caribe en presentar casos por COVID-19, seguido de Santa Marta y Barranquilla. El mayor número de casos se registró en Barranquilla, Atlántico, Cartagena y Córdoba. Así mismo, la mayor tasa de muertes por 100 000 habitantes se registró en Barranquilla, Atlántico, Córdoba, Santa Marta, Sucre y Cartagena. En el Caribe se implementaron estrategias de distanciamiento social como prohibición de eventos masivos y cierre de fronteras. Discusión: Para describir el comportamiento de la pandemia es importante que las autoridades sanitarias continúen asumiendo el reto para la detección, sistematización y manejo oportuno de los casos. El comportamiento de la pandemia ha sido similar en los departamentos del Caribe Colombiano, hay una homogeneidad al momento de acatar las normas del gobierno, y cada región adaptó diferentes estrategias dentro de un marco general para reducir la incidencia de la enfermedad. Se recomienda fortalecer la similitud entre los datos reportados por el Ministerio de Salud, SIVIGILA y los entes territoriales. El talento humano en salud cualificado puede soportar este ejercicio a fin de superar la actuación mediática y avanzar hacia la gobernanza.

Abstract Background: The social and health impact generated by the COVID-19 pandemic allows us to re-think aspects of epidemiological surveillance and communication in struggle-times. Objective: To describe the behavior of the COVID-19 pandemic in the departments and special districts of the Colombian Caribbean region. Methodology: This is a documentary and interpretive analysis from secondary sources of National Surveillance "SIVIGILA" and data from local governments. Results: Cartagena de Indias is the first territorial area in the Caribbean to present cases COVID-19, followed by Santa Marta and Barranquilla. The highest number of cases was registered in Barranquilla, Atlántico, Cartagena and Córdoba. Likewise, the highest death rate per 100,000 inhabitants was observed in Barranquilla, Atlántico, Córdoba, Santa Marta, Sucre and Cartagena. In the Caribbean, social distancing was implemented, as well as the limitation of mass gatherings and border closure. Discussion: To describe the pandemic behavior, it is important that health authorities continue to assume the challenges of detection, systematization, and timely handling of cases. The COVID-19 performance has been similar in the Colombian Caribbean. There is a homogeneity regarding the government regulations compliance and each region adapted different strategies to reduce the incidence of the dicease. It is recommended to strengthen the concordance between the data reported by the Ministry of Health, SIVIGILA, and the territorial entities. Qualified human talent can support this exercise in order to overcome the media performance through the strengthening of governance.

Who eats what? Unravelling microbial conversion of coal to methane.

Microbial communities in subsurface coal seams are responsible for the conversion of coal organic matter to methane. This process has important implications for both energy production and our understanding of global carbon cycling. Despite the environmental and economic importance of this process, little is known about which components of the heterogeneous coal organic matter are biodegradable under methanogenic conditions. Similarly, little is known about which taxa in coal seams carry out the initial stages of coal organics degradation. To identify the biodegradable components of coal and the microorganisms responsible for their breakdown, a subbituminous coal was fractionated into a number of chemical compound classes which were used as the sole carbon source for growth by a coal seam microbial community. This study identifies 65 microbial taxa able to proliferate on specific coal fractions and demonstrates a surprising level of substrate specificity among members of this coal-degrading microbial consortia. Additionally, coal kerogen, the solvent-insoluble organic component of coal often considered recalcitrant to microbial degradation, appeared to be readily converted to methane by microbial degradation. These findings challenge our understanding of coal organic matter catabolism and provide insights into the catabolic roles of individual coal seam bacteria.

[Implementation of a clinical guideline for detection of gestational diabetes in primary care]. / Diabetes gestacional: implementación de una guía para su detección en la atención primaria de salud.

BACKGROUND: Gestational diabetes (GD) impacts maternal and fetal morbidity. In 2012, the World Diabetes Foundation provided financing project in Barranquilla (Colombia), aimed to implement a clinical guide for the diagnosis and treatment of this condition. AIM: To estimate the adherence of the guide in primary care centers. MATERIAL AND METHODS: A Cross-sectional study of pregnant women suspected of having gestational diabetes. Pregnant women were classified according to the week of admission to the prenatal control program: < week 24 or later. Women with a fasting blood glucose over 92 mg/dL and under 126 mg/dL or with some positive result to the oral glucose tolerance test were included. RESULTS: Nine percent (1,887 women) of 21,699 registries of pregnant women, were at risk for gestational diabetes. Of these, 1,880 registries with complete data were analyzed. Sixty nine entered the program at less than 24 weeks of pregnancy and 71% had had a fasting blood glucose measured in the first control. In 69.2% of these women, criteria for gestational diabetes was met. A glucose tolerance test was suggested to women with a blood glucose below 92 mg/dl. Among 72% of the latter, the glucose tolerance test met the criteria for gestational diabetes. Among the 498 women who entered the program after 24 weeks of gestation, 68% met the criteria for gestational diabetes with the fasting blood glucose levels. In 90 women, a glucose tolerance test was performed and 80% met the criteria for gestational diabetes. CONCLUSIONS: An adequate adherence to guidelines favors the detection of pregnant women with gestational diabetes.

Diabetes gestacional: implementación de una guía para su detección en la atención primaria de salud / Implementation of a clinical guideline for detection of gestational diabetes in primary care

Background: Gestational diabetes (GD) impacts maternal and fetal morbidity. In 2012, the World Diabetes Foundation provided financing project in Barranquilla (Colombia), aimed to implement a clinical guide for the diagnosis and treatment of this condition. Aim: To estimate the adherence of the guide in primary care centers. Material and Methods: A Cross-sectional study of pregnant women suspected of having gestational diabetes. Pregnant women were classified according to the week of admission to the prenatal control program: < week 24 or later. Women with a fasting blood glucose over 92 mg/dL and under 126 mg/dL or with some positive result to the oral glucose tolerance test were included. Results: Nine percent (1,887 women) of 21,699 registries of pregnant women, were at risk for gestational diabetes. Of these, 1,880 registries with complete data were analyzed. Sixty nine entered the program at less than 24 weeks of pregnancy and 71% had had a fasting blood glucose measured in the first control. In 69.2% of these women, criteria for gestational diabetes was met. A glucose tolerance test was suggested to women with a blood glucose below 92 mg/dl. Among 72% of the latter, the glucose tolerance test met the criteria for gestational diabetes. Among the 498 women who entered the program after 24 weeks of gestation, 68% met the criteria for gestational diabetes with the fasting blood glucose levels. In 90 women, a glucose tolerance test was performed and 80% met the criteria for gestational diabetes. Conclusions: An adequate adherence to guidelines favors the detection of pregnant women with gestational diabetes.

Thalidomide is Associated With Increased T Cell Activation and Inflammation in Antiretroviral-naive HIV-infected Individuals in a Randomised Clinical Trial of Efficacy and Safety.

TRIAL DESIGN: Open-label, randomised, controlled, pilot proof-of-concept clinical trial. METHODS: Participants: Antiretroviral naïve adult males with CD4 count ≥350cells/mm3. INTERVENTIONS: Patients were randomised to receive thalidomide 200mg QD for 3weeks (Thalidomide group) or not (Control group) and followed for 48weeks. OBJECTIVE: We hypothesized that short-term Thalidomide use would reduce HIV related inflammation and HIV replication among antiretroviral naïve HIV infected individuals. OUTCOME: Viral loads, CD4/CD8 counts, ultra-sensitive C-reactive protein (US-CRP), cell activation markers, and plasma lipopolysaccharide (LPS) were analyzed. Randomisation: Unrestricted randomisation. Blinding: No blinding was used. RESULTS: Numbers randomised: Thirty recruited individuals were randomised to Thalidomide (16 patients) or Control (14 patients) groups. Recruitment: Patients were recruited from April 2011 to January 2013. OUTCOME: Viral loads remained stable in both groups. During thalidomide treatment, a decrease in CD4/CD8 ratio (p=0.04), a decrease in CD4 count (p=0.04), an increase in cell activation calculated by the percentage of CD38 +/HLA-DR+ CD8 cells (p<0.05) and an increase in US-CRP (p<0.01) were observed in the Thalidomide group, with all parameters returning to baseline levels after thalidomide interruption. We confirmed that thalidomide increased HIV replication in vitro of 6 of 7 samples from long-term antiretroviral suppressed individuals. HARMS: No class 3/4 adverse events occurred. CONCLUSIONS: Short-term use of thalidomide led to an intense transient increase in T cell activation and inflammation, with a decrease in the CD4+ cell count without changes to the CD8+ cell count. We confirmed that thalidomide acts in vitro as a latency reversal agent and speculate that the in vivo results obtained were due to an increase in HIV replication.

Prevalence of transmitted HIV-1 antiretroviral resistance among patients initiating antiretroviral therapy in Brazil: a surveillance study using dried blood spots.

INTRODUCTION: In Brazil, the use of antiretrovirals is widespread: more than 260,000 individuals are currently undergoing treatment. We conducted a survey targeting antiretroviral-naïve individuals who were initiating antiretroviral therapy (ART) according to local guidelines. This survey covered five Brazilian regions. METHODS: The HIV Threshold Survey methodology (HIV-THS) of the World Health Organization was utilized, and subjects were selected from seven highly populated cities representative of all Brazilian macro-regions. Dried blood spots (DBS) were collected on SS903 collection cards and were transported by regular mail at room temperature to a single central laboratory for genotyping. RESULTS: We analysed samples from 329 individuals initiating highly active antiretroviral therapy (HAART), 39 (11.8%) of whom were harbouring transmitted drug resistance (TDR). The mean CD4+ T cell count was 253 cells/µL, and the mean viral load was 142,044 copies/mL. The regional prevalence of resistance was 17.0% in the Northeast, 12.8% in the Southeast, 10.6% in the Central region, 8.5% in the North and 8.5% in the South. The inhibitor-specific TDR prevalence was 6.9% for nucleoside reverse transcriptase inhibitors, 4.9% for non-nucleoside reverse transcriptase inhibitors and 3.9% for protease inhibitors; 3.6% of individuals presented resistance to more than one class of inhibitors. Overall, there were trends towards higher prevalences of subtype C towards the South and subtype F towards the North. Of the DBS samples collected, 9.3% failed to provide reliable results. DISCUSSION: We identified variable TDR prevalence, ranging from intermediate to high levels, among individuals in whom HIV disease progressed, thus implying that resistance testing before initiating ART could be effective in Brazil. Our results also indicate that the use of DBS might be especially valuable for providing access to testing in resource-limited and remote settings.

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.

Limited penetration of lopinavir and ritonavir in the genital tract of men infected with HIV-1 in Brazil.

The concentrations of lopinavir and ritonavir in seminal and blood plasma and the seminal human immunodeficiency virus (HIV) viral load were quantified by HPLC and the Nuclisens assay, respectively, in a cross-sectional study of 16 HIV-1-infected Brazilian men under stable treatment with a lopinavir/ritonavir containing antiretroviral regimen. Semen and blood samples were collected on 2 occasions: at 6 to 60 minutes before ("trough"), and 5 to 6 hours after ("peak") ingestion of regular doses of lopinavir/ritonavir. Median seminal lopinavir levels were 120.6 ng/mL (range, <20-1481.8 ng/mL) and 233.1 ng/mL (range, 48.4-1133.4 ng/mL) at trough and peak points, respectively. The corresponding values for ritonavir were 9.2 ng/mL (range, <5-47 ng/mL) and 17.1 ng/mL (range, 6.6-66.7 ng/mL). The median concentrations of lopinavir and ritonavir in semen were, respectively, 1.9% to 3% and 3.7% to 4.4% of those measured in blood plasma samples collected within 30 minutes. HIV-1 viral load was detectable in the semen of 2 and in the blood of 6 of 16 patients. These results may have implications for drug-resistant HIV-1 evolution and transmission.

Manifestaçöes neurológicas da Síndrome da Imunodeficiência Adquirida / Neurologic manifestations of AIDS - Acquired Immunodeficiency Syndrome

A incidência de complicações neurológicas da Sida, que já chegou a 70 por cento durante a primeira década da epidemia, vem apresentando um declínio, que acompanha a melhora do tratamento anti-retroviral. Entretanto, ainda hoje pelo menos 40 por cento dos pacientes infectados pelo HIV desenvolvem sintomas neurológicos no curso de sua doença. O diagnóstico etiológico é muitas vezes difícil, atrasando o início de tratamento específico. Anamnese, exame físico detalhado e procedimentos diagnósticos, se prontamento implementados, evitam o empirismo e diminuem a margem de erro. Este artigo revê a apresentação clínica, procedimentos diagnósticos e tratamento das principais causas de comprometimento neurológico em pacientes contaminados pelo HIV

Síndrome de imunodeficiência adquirida (AIDS-SIDA): revisäo da literatura e apresentaçäo de casos de necrópsias da cidade do Rio de Janeiro / Acquired immunodeficiency syndrome: review of the literature and report of cases of necropsy of the Rio de Janeiro city

A Síndrome de Imunodeficiência Adquirida é discutida, em sua evoluçäo progressiva, desde os aspectos iniciais até os recentemente evidenciados. Sendo uma entidade nova, sua própria conceituaçäo, convencionada pelo C.D.C., vem sofrendo modificaçöes adicionais, à medida que surgem novos conhecimentos a respeito desta patologia, que é, sem dúvida, a mais grave e ameaçadora do século XX. Embora esteja, por enquanto, restrita basicamente à América do Norte (EUA e Canadá), à Europa Ocidental (França, Bélgica, Suíça, Dinamarca, Holanda e Inglaterra), à América do Sul (Brasil) e de forma catastrófica, à Africa Central e ao Caribe (Haiti), esta condiçäo tem potencial de fácil expansäo para toda a Asia e, como a perspectiva dessa calamidade mundial näo tem fronteiras e é de gravidade e de proporçöes inimagináveis, torna-se indispensável uma efetiva participaçäo de cada país no programa de profilaxia recomendado pela Organizaçäo Mundial de Saúde. Transmitindo-se basicamente através de contatos sexuais e pelo sangue e seus derivados, além de outros meios, esta epidemia é de controle desafiador, pelo fato de serem o sangue e o sexo absolutamente essenciais à sobrevivência da humanidade. Näo somente os pontos epidemiológicos säo marcantes nas infecçöes pelo HTLV-III/LAV, mas as próprias características patogênicas que conferem a esse vírus o poder de, ao agredir o sistema imune, incapacitá-lo na defesa contra os patógenos primários e oportunistas, outra situaçäo incompatível com a vida humana. Segue-se uma exposiçäo minuciosa das características clínicas da infeççäo pelo HTLV-III/LAV, bem como de 33 casos de necrópsias realizadas no Rio de Janeiro. Ainda no que se refere ao enfoque clínico, é sublinhado o papel que vem assumindo a tuberculose nos processos infecciosos nesta condiçäo. As medidas terapêuticas e profiláticas na SIDA säo apresentadas em consideraçöes finais