ABSTRACT
PURPOSE OF REVIEW: Cervical cancer, the third cause of death by cancer among Brazil's women, is associated with human papillomavirus (HPV) infection. In some countries of South America, North America, Europe, and Oceania, initial screening for HPV DNA and subsequent follow-up with HPV-positive patients using colposcopy and cytological testing are used as preventative measures. RECENT FINDINGS: For HPV DNA detection, it is necessary to obtain cervical cells by conventional clinical collection method or self-collection of the cells that flake off from the uterine cervix and vaginal canal. Self-collection has been shown to be a viable option for obtaining samples and is a less invasive method that is more accepted by women. Thus, it can potentially decrease the limitations of the conventional clinical collection methods. The efficiency of the self-collection method aligned with the implementation of HPV molecular testing, if adopted by public and private health care systems, may extend the reach of current cervical cancer prevention efforts. In addition, considering all phases from triage to treatment, this method may reduce health care costs and the time spent by patients and health care teams to conduct examinations and collect samples.
ABSTRACT
OBJECTIVES: The goal of the authors was to determine the epidemiological and clinical characteristics of all HIV-positive children and adolescents infected by vertical transmission. METHODS: A descriptive, cross-sectional and retrospective study was conducted that included all HIV-positive patients infected by vertical transmission who attended the referral services of the municipality of Campo Grande from 1993 to 2009, and who used antiretrovirals (ARV). The data were collected from medical records after local institutional review board approval. RESULTS: 78 patients were included, and almost half of the living patients (75) in 2009 were 11-15 years of age. The average age at diagnosis was 38.8 months, treatment was most often initiated from 12 to 35 months of age, and HAART was the most common treatment. Most patients (51.3%) were hospitalised between one and five times, and the first regimen was not associated with hospitalisation (p=0.2). The majority of patients did not exhibit virological suppression at the last examination, and genotyping revealed the presence of resistance mutations. Failure of therapy was often the result of non-adherence to therapy. Five patients died, and the causes of death were pneumonia, sepsis, cerebral cryptococcosis and myocarditis. CONCLUSIONS: Despite the availability of drugs and appropriate laboratory tests, a significant number of paediatric patients were failing ARV therapy due to non-adherence. Further interventions to enhance adherence in this population are needed.
