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%) had confirmation of the diagnosis of influenza A. Among the confirmed cases, ten (55.6%) were hospitalized and eight (44.4%) were outpatients. Dyspnea was present in nine patients (50%), hemoptysis in three (16%). Six patients (60%) 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.

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.

O Movimento Negro do ABC Paulista: diálogos sobre a prevenção das DST/aids / Black Movement in São Paulo ABC Region: dialogues on STD/AIDS prevention

OBJETIVO: Apresentar a avaliação realizada sobre as possibilidades de integração entre as agendas do movimento negro e a prevenção das DST/aids. METODOLOGIA: Utilizou-se o instrumento qualitativo chamado de Panel Delphi, dada a sua flexibilidade de consultas. Foram cadastradas 135 entidades do movimento negro, tendo 41 delas aceitado a proposta de participar do painel de questões. O projeto foi extensivo aos sete municípios da região do ABC paulista, sendo que 32,8 por cento do total da população da região é composta de pretos e pardos. RESULTADOS: O grupo de 41 entidades participantes propôs-se a atuar em ações de prevenção das DST/aids diretamente (agregando-as às suas atividades cotidianas), ou indiretamente (através de ações de controle social) e avaliou a necessidade de um entendimento sócio-histórico da vulnerabilidade da população negra, em relação não somente à prevenção de DTS/aids, mas também da saúde como um todo e da totalidade da vida: "[...] a história do negro é de desumanização, negação da condição de ser humano, que expõe os negros a qualquer doença. A informação fica sem credibilidade vinda dessa maneira. O negro precisa ser visto como ser pleno." (1.10.1). CONCLUSÕES: O racismo vivenciado tem impacto nas condições de acesso à saúde e tem se refletido na maior vulnerabilidade de homens e mulheres negros para a infecção de HIV. Os elementos de afirmação da identidade racial contribuem para a promoção da saúde da população negra. Ações conjuntas entre os serviços de saúde e o movimento social possibilitam condições de fortalecimento de uma política de enfrentamento das DST/aids entre as negras e os negros brasileiros.

OBJECTIVE: To present the integration possibility evaluation (between the agendas of the black movement with the themes of health, particularly in relation to prevention of STD/AIDS). METHODS: We used the qualitative instrument called the Delphi Panel, given its flexibility to consultations with stakeholders with different power resources. 135 were registered entities of the black movement: 41 of them agreed to participate in the panel of questions. The project was extended to seven cities in the ABC region, bringing together 655,886 inhabitants (browns and blacks), who represent 32.8 percent of the total population of the region. RESULTS: The group of 41 participating (grass-roots organizations) proposed to act in actions of prevention of STD/AIDS directly (by adding them to their daily activities) or indirectly (through actions of social control) and assessed the need to understand socio-history of the greater vulnerability of the black population, not only in relation to the prevention of STD/AIDS, but also of health as a whole and the totality of life: "[...] the history of black dehumanization is a denial of the condition to be human, which exposes blacks to any disease. The information is unreliable, if coming this way. Blacks must be seen as a whole. CONCLUSIONS: The racism is understood as something that precedes any other, it has an impact on the access to health and has been reflected in the greater vulnerability of black men and women to HIV infection. The elements of affirmation of racial identity contribute to promoting the health of black people. Joint actions between health services and social movements provide conditions to strengthen a policy of confronting STD/AIDS among black women and black men, all Brazilians.

Hepatitis C virus and human T-lymphotropic virus coinfection: epidemiological, clinical, laboratory and histopathological features.

Twenty-four hepatitis C virus patients coinfected with human T-lymphotropic virus type 1 were compared with six coinfected with HTLV-2 and 55 with HCV alone, regarding clinical, epidemiological, laboratory and histopathological data. Fischer's discriminant analysis was applied to define functions capable of differentiating between the study groups (HCV, HCV/HTLV-1 and HCV/HTLV-2). The discriminant accuracy was evaluated by cross-validation. Alcohol consumption, use of intravenous drugs or inhaled cocaine and sexual partnership with intravenous drug users were more frequent in the HCV/HTLV-2 group, whereas patients in the HCV group more often reported abdominal pain or a sexual partner with hepatitis. Coinfected patients presented higher platelet counts, but aminotransferase and gamma-glutamyl transpeptidase levels were higher among HCV-infected subjects. No significant difference between the groups was seen regarding liver histopathological findings. Through discriminant analysis, classification functions were defined, including sex, age group, intravenous drug use and sexual partner with hepatitis. Cross-validation revealed high discriminant accuracy for the HCV group.

Hepatitis C virus and human T-lymphotropic virus coinfection: epidemiological, clinical, laboratory and histopathological features / Coinfecção vírus da hepatite C-vírus linfotrópico de células T humanas: aspectos epidemiológicos, clínicos, laboratoriais e histopatológicos

Twenty-four hepatitis C virus patients coinfected with human T-lymphotropic virus type 1 were compared with six coinfected with HTLV-2 and 55 with HCV alone, regarding clinical, epidemiological, laboratory and histopathological data. Fischer's discriminant analysis was applied to define functions capable of differentiating between the study groups (HCV, HCV/HTLV-1 and HCV/HTLV-2). The discriminant accuracy was evaluated by cross-validation. Alcohol consumption, use of intravenous drugs or inhaled cocaine and sexual partnership with intravenous drug users were more frequent in the HCV/HTLV-2 group, whereas patients in the HCV group more often reported abdominal pain or a sexual partner with hepatitis. Coinfected patients presented higher platelet counts, but aminotransferase and gamma-glutamyl transpeptidase levels were higher among HCV-infected subjects. No significant difference between the groups was seen regarding liver histopathological findings. Through discriminant analysis, classification functions were defined, including sex, age group, intravenous drug use and sexual partner with hepatitis. Cross-validation revealed high discriminant accuracy for the HCV group.

Compararam-se 24 pacientes coinfectados pelos vírus da hepatite C/vírus linfotrópico de células T humanas do tipo 1 com 6 coinfectados por VHC/HTLV-2 e 55 infectados pelo VHC, no tocante a dados clínico-epidemiológicos, laboratoriais e histopatológicos. A análise discriminante de Fischer foi utilizada para definir funções capazes de diferenciar os grupos de estudo (VHC, VHC/HTLV-1 e VHC/HTLV-2). A acurácia discriminatória foi avaliada pelo por validação cruzada. O uso de álcool, drogas endovenosas, cocaína inalatória e a parceria sexual com UDEV foram mais freqüentes no grupo VHC/HTLV-2, enquanto queixa de dor abdominal e parceiro sexual com hepatite predominaram no grupo VHC. Os coinfectados apresentaram número maior de plaquetas, enquanto as aminotransferases e a gamaglutamiltranspeptidase foram mais altas no grupo VHC. Não houve diferença entre os grupos à análise histopatológica do fígado. Por análise discriminante definiram-se funções classificatórias, incluindo as variáveis sexo, faixa etária, uso de drogas endovenosas e parceiro sexual com hepatite, com acurácia discriminante alta para o grupo VHC.

Portal CD4+ and CD8+ T lymphocyte correlate to intensity of interface hepatitis in chronic hepatitis C.

BACKGROUND: The pathogenesis of chronic hepatitis C is still a matter of debate. CD4+ and CD8+ T lymphocytes (TL) are typically observed within the portal and periportal spaces of affected livers, but their functional role in hepatitis C progression has not been fully elucidated. METHODS: CD4+ and CD8+ TL were quantified by immunohistochemistry in portal and periportal spaces of 39 liver biopsies from patients with chronic hepatitis C. They were associated to demographic data, histological parameters, laboratory findings of patients and hepatitis C genotypes. RESULTS: There was high numbers of CD4+ and CD8+ TL from which the density of CD4+ T was higher than CD8+ TL in portal and periportal spaces. CD4+ and CD8+ TL were directly correlated to intensity of interface hepatitis. CD8+ TL correlated to serum enzyme levels. CONCLUSION: The high numbers of CD4+ and CD8+ TL in portal and periportal spaces and their correlation to interface hepatitis suggest that hepatitis C evolution depends on the action of intrahepatic T lymphocytes, lending support to the notion of an immune-mediated mechanism in the pathogenesis of chronic hepatitis C.

Portal cd4+ and cd8+ t lymphocyte correlate to intensity of interface hepatitis in chronic hepatitis C

BACKGROUND: The pathogenesis of chronic hepatitis C is still a matter of debate. CD4+ and CD8+ T lymphocytes (TL) are typically observed within the portal and periportal spaces of affected livers, but their functional role in hepatitis C progression has not been fully elucidated. METHODS: CD4+ and CD8+ TL were quantified by immunohistochemistry in portal and periportal spaces of 39 liver biopsies from patients with chronic hepatitis C. They were associated to demographic data, histological parameters, laboratory findings of patients and hepatitis C genotypes. RESULTS: There was high numbers of CD4+ and CD8+ TL from which the density of CD4+ T was higher than CD8+ TL in portal and periportal spaces. CD4+ and CD8+ TL were directly correlated to intensity of interface hepatitis. CD8+ TL correlated to serum enzyme levels. CONCLUSION: The high numbers of CD4+ and CD8+ TL in portal and periportal spaces and their correlation to interface hepatitis suggest that hepatitis C evolution depends on the action of intrahepatic T lymphocytes, lending support to the notion of an immune-mediated mechanism in the pathogenesis of chronic hepatitis C.

INTRODUÇÃO: A patogênese da hepatite C crônica ainda está em discussão. Sabe-se que linfócitos T (LT) CD4+ e CD8+ são tipicamente observados no espaço portal e peri-portal de pacientes com hepatite C crônica, mas o conhecimento exato de suas ações no fígado, bem como sua influência na progressão da doença hepática ainda estão em discussão. MÉTODOS: Os LT CD4+ e T CD8+ foram quantificados por imunohistoquímica nos espaços porta e peri-portais em 39 biópsias hepáticas de pacientes cronicamente infectados pelo vírus da hepatite C. Esses dados foram associados com os dados demográficos, as alterações histológicas, os achados laboratoriais dos pacientes com hepatite C e com os genótipos do vírus da hepatite C. RESULTADOS: Houve grande quantidade tanto de LT CD4+ como de CD8+, sendo que houve maior densidade de LTCD4+ do que CD8+ nos espaços portal e peri-portal. Tanto o número de linfócitos T CD4+ como de CD8+ foram diretamente relacionados com a intensidade da hepatite de interface. Os linfócitos T CD8+ foram estatisticamente relacionados às enzimas hepáticas. CONCLUSÃO: O encontro de numerosos linfócitos T CD4+ e linfócitos T CD8+ no espaço-portal e peri-portal e sua correlação com a hepatite de interface sugerem que a evolução da hepatite C dependa da ação dos linfócitos T intra-hepáticos, ou seja, há um mecanismo imuno-mediado na patogênese da hepatite C crônica.