Prevention of HIV transmission with sperm washing within fertile serodiscordant couples undergoing non-stimulated intrauterine insemination.

The purpose of this prospective non-randomized study was to study the effectiveness of semen washing followed by intrauterine insemination (IUI) in Human Immune Deficiency Virus (HIV)-discordant couples in which the male partner was infected, in preventing HIV transmission to uninfected partner and offspring. The study was performed in a private assisted reproductive center specialized in couples with infectious diseases and enrolled sixty-nine fertile couples in which male partner tested positive for HIV, seeking for reproductive treatment. Triple sperm washing followed by viral RNA purification and real-time polymerase chain reaction was performed prior to IUI intervention. HIV transmission to female partner and newborns, and clinical pregnancy rate were the main outcome measures. A total of 180 IUI treatment cycles were performed in 69 couples. There were 16 clinical pregnancies (clinical pregnancy rate/cycle 9.0%, clinical pregnancy rate/patient 23.2%), one of which resulted in miscarriage (6.3%). No seroconversion was detected in the 69 women treated with sperm washing followed by IUI or in any of the newborns (tested at birth and at 3 months of age). Sperm washing followed by IUI is a safe and effective treatment option for serodiscordant couples wishing to conceive and to prevent HIV virus transmission to the mothers and newborns.

Transmitted Drug Resistance among People Living with HIV/Aids at Major Cities of Sao Paulo State, Brazil.

Human immunodeficiency virus type 1 (HIV-1) transmitted drug resistance (TDR) is an important public health issue. In Brazil, low to intermediate resistance levels have been described. We assessed 225 HIV-1 infected, antiretroviral naïve individuals, from HIV Reference Centers at two major metropolitan areas of Sao Paulo (Sao Paulo and Campinas), the state that concentrates most of the Brazilian Aids cases. TDR was analyzed by Stanford Calibrated Population Resistance criteria (CPR), and mutations were observed in 17 individuals (7.6%, 95% CI: 4.5%-11.9%). Seventy-six percent of genomes (13/17) with TDR carried a nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance mutation, mostly K103N/S (9/13, 69%), potentially compromising the preferential first-line therapy suggested by the Brazilian HIV Treatment Guideline that recommends efavirenz-based combinations. Moreover, 6/17 (35%) had multiple mutations associated with resistance to one or more classes. HIV-1 B was the prevalent subtype (80%); other subtypes include HIV-1 F and C, mosaics BC, BF, and single cases of subtype A1 and CRF02_AG. The HIV Reference Center of Campinas presented more cases with TDR, with a significant association of TDR with clade B infection (P < 0.05).

Concordance of HIV type 1 tropism phenotype to predictions using web-based analysis of V3 sequences: composite algorithms may be needed to properly assess viral tropism.

Genotypic prediction of HIV-1 tropism has been considered a practical surrogate for phenotypic tests and recently an European Consensus has set up recommendations for its use in clinical practice. Twenty-five antiretroviral-experienced patients, all heavily treated cases with a median of 16 years of antiretroviral therapy, had viral tropism determined by the Trofile assay and predicted by HIV-1 sequencing of partial env, followed by interpretation using web-based tools. Trofile determined 17/24 (71%) as X4 tropic or dual/mixed viruses, with one nonreportable result. The use of European consensus recommendations for single sequences (geno2pheno false-positive rates 20% cutoff) would lead to 4/24 (16.7%) misclassifications, whereas a composite algorithm misclassified 1/24 (4%). The use of the geno2pheno clinical option using CD4 T cell counts at collection was useful in resolving some discrepancies. Applying the European recommendations followed by additional web-based tools for cases around the recommended cutoff would resolve most misclassifications.

Acidente de trabalho: adesão à conduta prescrita póes-exposição e material biológico / Accidente de trabajo: adhesión conducta prescripta pos-exposición material biológico / Accident at work: adhesion to the conduct prescribed after exposures to biological material

Este trabalho tem como objetivo avaliar a adesão à conduta prescrita (quimioprofilaxia, controle e seguimento) após o acidente ocupacional com riscos de contaminação pelo vírus da imunodefiiência humana, o vírus da Hepatite B e o vírus da Hepatite C. É um estudo epidemiológico descritivo dos casos notificados à Secretaria de Estado da Saúde de São Paulo, Brasil, no ano 2000, pelos serviços de saúde pertencentes a uma das regiões administrativas de saúde do Estado de São Paulo. Observou-se 13,4 por cento de recusa à quimioprofilaxia contra o HIV por meio de anti-retrovirais, e 37,8 por cento dos trabalhadores que aceitaram a quimioprofilaxia contra o HIV não completaram o tratamento no tempo previsto de quatro semanas. Na profilaxia contra a hepatite B, 69,8 por cento dos acidentados haviam recebido as três doses da vacina antes do acidente. No acompanhamento sorológico dos acidentados, em torno de 25 por cento dos trabalhadores não concluíram os exames de seguimento (anti-HIV, HbsAg, anti-HBs e Anti-HCV) no sexto mês após o acidente. Conclui-se que a adesão é baixa, uma vez que é necessário receber pelo menos 80 por cento da medicação para que o acidentado seja considerado aderente ao tratamento e ao seguimento. Em razão desse diagnóstico, evidencia-se a necessidade de que as instituições envolvidas estabeleçam estratégias que possibilitem um aumento na adesão dos trabalhadores da saúde a esses cuidados

This study aims to evaluate the adherence to the conduct prescribed (prophylactic treatment, control and follow up tests) after occupacional accident that brings risks of contamination by human imminodeficientcy virus, hepatitis B virus and hepatitis C virus. This report is a descriptive epidemiological study of the notified cases to the State Health Secretariat of São Paulo, Brazil, in the year 2000, through the health system that belongs to one of the administrative regions of health in State of São Paulo. In this study it is study observed 13,4 per cent of refusal to the prophylactic treatment to human immunodeficiency virus through antiretrovirals, and 37,8 per cent of the health workers who had prophylactic treatment against HIV didn´t conclude the treatment in the determined time of four weeks. For the hepatitis B virus (HBV) prophylaxis only 69,8 per cent of the exposed personnel had previously received the 3 doses of the immunization against hepatitis B. In the serologic follow up of the exposed health care workers, around 25 per cent didn´t conclude the follow up tests in the sixth month after the accident (anti-HIV, HbsAg, anti-HBs and anti-HCV). Therefore the adherence to the prophylaxis of human immunodeficiency virus and the follow up tests show up tests show a low rate, considering the need of 80 per cent of the use of medication to consider adherence to the treatment and to the follow up tests. Through this diagnosis there is the necessity of the institutions to establish strategies that make it possible an increase of the adherence of the health workers regarding this care

Este studio tiene como objetivo evaluar la adhesión a conducta prescripta (quimil profilaxis, control y seguimiento), después de accidente ocupacional con riesgos de contaminación al virus de la inmunodeficiencia humana, virus de hepatitis B y virus de hepatitis C. Este trabajo es un estudio epidemiológico descriptivo de los casos notificados a la Secretaria del Estado de la Salud de São Paulo - Brasil, en el año 2000, por los servicios de salud correspondientes a una de las regiones administrativas de salud, del estado de São Paulo. En este estudio pudo observar 13,4 por ciento de resistencia al quimil profilaxis contra HIV por el uso de los antiretrovirais, y 37,8 por ciento de los que tenían quimil profilaxis contra HIV no completaron el tratamiento en el tiempo previsto de cuatro semanas. En la profilaxis a hepatitis B, 69,8 por ciento de los accidentados habían recibidos anteriormente al accidente al accidente a las tres dosis de vacuna. En el acompañamiento sorológico de los accidentados en torno de 25 por ciento no completaron los exámemes de seguimiento en el sexto mes después del accidente (Anti-HIV, HbsAg, Anti-HBs y Anti-HCV). Así la adherencia a quimil profilaxis contra HIV y a los exámenes de seguimiento es baja, aceptando la necessidad de 80 por ciento del uso de la medicación para aceptar adherente al tratamiento, y al seguimiento. Por este diagnóstico hay necessidad de las instituciones envolvías establecieren estrategias que possibiliten un aumento en la adhesión de los trabajadores de la salud en su cuidado