Predictors of HBeAg status and hepatitis B viraemia in HIV-infected patients with chronic hepatitis B in the HAART era in Brazil.

BACKGROUND: HBV-HIV co-infection is associated with an increased liver-related morbidity and mortality. However, little is known about the natural history of chronic hepatitis B in HIV-infected individuals under highly active antiretroviral therapy (HAART) receiving at least one of the two drugs that also affect HBV (TDF and LAM). Information about HBeAg status and HBV viremia in HIV/HBV co-infected patients is scarce. The objective of this study was to search for clinical and virological variables associated with HBeAg status and HBV viremia in patients of an HIV/HBV co-infected cohort. METHODS: A retrospective cross-sectional study was performed, of HBsAg-positive HIV-infected patients in treatment between 1994 and 2007 in two AIDS outpatient clinics located in the São Paulo metropolitan area, Brazil. The baseline data were age, sex, CD4 T+ cell count, ALT level, HIV and HBV viral load, HBV genotype, and duration of antiretroviral use. The variables associated to HBeAg status and HBV viremia were assessed using logistic regression. RESULTS: A total of 86 HBsAg patients were included in the study. Of these, 48 (56%) were using combination therapy that included lamivudine (LAM) and tenofovir (TDF), 31 (36%) were using LAM monotherapy, and 7 patients had no previous use of either one. Duration of use of TDF and LAM varied from 4 to 21 and 7 to 144 months, respectively. A total of 42 (48.9%) patients were HBeAg positive and 44 (51.1%) were HBeAg negative. The multivariate analysis revealed that the use of TDF for longer than 12 months was associated with undetectable HBV DNA viral load (serum HBV DNA level < 60 UI/ml) (p = 0.047). HBeAg positivity was associated with HBV DNA > 60 UI/ml (p = 0.001) and ALT levels above normality (p = 0.038). CONCLUSION: Prolonged use of TDF containing HAART is associated with undetectable HBV DNA viral load. HBeAg positivity is associated with HBV viremia and increased ALT levels.

Sources of discrepancy in patient and physician global assessments of rheumatoid arthritis disease activity.

OBJECTIVE: To investigate discrepancy in the perception of rheumatoid arthritis (RA) disease activity between patient and physician, and its possible sources. METHODS: Eighty patients with RA rated their level of disease activity on a visual analog scale (VAS). Physician global assessment (MDGA) of disease activity was performed blinded to the patient evaluation except for the results of laboratory tests. A discrepancy score (DS) was calculated by subtracting MDGA from patient global assessment (PTGA), leading to definition of 3 groups of patients: (1) no discrepancy when PTGA and MDGA were within 1.0 or 3.0 cm of each other; (2) negative discrepancy when PTGA was under-rated relative to the physician; and (3) positive discrepancy when PTGA was over-rated relative to the physician. Age, sex, disease duration, education, income, residence area, employment, use of antirheumatic drugs, comorbidity, pain score, Health Assessment Questionnaire (HAQ) rating, tender (TJC) and swollen (SJC) joint count, and Disease Activity Score (DAS28) were recorded. RESULTS: Negative discrepancy was found in 27.5% (VAS 1 cm) and 8.7% (VAS 3 cm) of patients, positive discrepancy in 43.7% (VAS 1 cm) and 23.7% (VAS 3 cm), and no discrepancy in 28.7% (VAS 1 cm) and 67.5% (VAS 3 cm). Patients were predominantly older (mean age near 50 yrs), female, with long disease duration and low income. The negative discrepancy group had a lower level of education and higher C-reactive protein (p < 0.05). The positive discrepancy group presented a higher pain score, HAQ score, and TJC (p < 0.0001). The no-discrepancy group had lower SJC (p < 0.05). CONCLUSION: Our results indicate that for disease activity in patients with RA assessed on pain score, HAQ, and TJC, the only important feature that determined perception of their RA disease activity was education.

Agressäo física e classe social / Physical aggression and social class

Considerando-se o aumento da violência e a escassez de informaçöes sobre a relaçäo classe social e vitimizaçäo por agressäo física, realizou-se estudo com o objetivo de investigar esta associaçäo. Foi adotado o estudo de caso-controle. Foram incluídos 191 casos de agressäo física e 222 controles selecionados entre os indivíduos com queixas clínico-cirúrgicas näo violentas, pareados por freqüência aos casos segundo sexo e idade, todos recrutados no período de 1/10/93 a 19/1/95, em pronto-socorro de Sorocaba, SP, Brasil. Foi aplicado questionário para obtençäo de informaçöes sobre classe social, cor, situaçäo conjugal, hábito de fumar, ingestäo de álcool e uso de drogas ilícitas. Ajustando-se os resultados por sexo, idade e os outros fatores estudados encontrou-se um risco de vitimizaçäo por agressäo física significantemente maior para o subproletariado, com "Odds ratio" igual a 3,28 e Intervalo de Confiança de 95 por cento igual a 1,42-7,59. Classe social é um fator importante no fenômeno da vitimizaçäo por agressäo física, devendo o subproletariado receber atençäo especial nas estratégias de intervençäo para o problema