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Perda auditiva sensório-neural (PASN) relacionada a otite média crônica supurativa (OMCS) foi estudada para esclarecer a participação do colesteatoma nesse contexto. OBJETIVO: Avaliar ocorrência de PASN na OMCS, correlacionando com colesteatoma, duração da doença e idade. CASUÍSTICA E MÉTODOS: Estudo retrospectivo de 115 pacientes com OMCS com e sem colesteatoma submetidos à cirurgia. Incluíram-se pacientes com doença unilateral, orelha contralateral normal e idade inferior a 60 anos. RESULTADOS: Idade média foi de 26 anos, sendo 58 homens e 57 mulheres. Tempo médio de duração da doença otológica de 12,4 anos. Limiar auditivo médio foi de 40 dB na orelha com OMCS e 22dB na orelha normal (P=0,002). Observou-se colesteatoma em 78 dos 115 casos. Na orelha com OMCS, ocorreram 15 (13%) casos de PASN, sendo 7 associadas à colesteatoma e 8 não associadas. Seis casos de PASN foram severa/profunda, correlacionando-se com idade ajustada (P=0,003), ausência de colesteatoma (P=0,01), mas não com duração da doença (P=0,458). CONCLUSÃO: PASN ocorreu em 13% dos pacientes com OMCS, correlacionando-se com o aumento da idade, mas não com a presença de colesteatoma ou com maior duração da doença otológica. Sensorineural hearing loss (SNHL) related to chronic suppurative otitis media (CSOM) was studied to clarify the involvement of cholesteatomas in this context. AIM: to evaluate SNHL related to CSOM and its association with cholesteatomas, disease duration and patients’ ages. METHODS: Retrospective analysis of 115 patients with CSOM with and without cholesteatoma submitted to surgical treatment. Inclusion criteria were active unilateral disease, normal contralateral ear and age below 60 years. RESULTS: The average age was 26.3 years, 58 males and 57 females. The duration of ear disease was, in average, 12.4 years. The average threshold of hearing was 40 dB in CSOM ear and 22 dB in the normal contralateral ear (P=0.002). CSOM with cholesteatoma occurred in 78 of 115 cases. In the abnormal ear, SNHL was seen in 15 cases, being 6 cases of profound loss, that correlated with adjusted-age (P=0.003) and absence of cholesteatoma (P=0.01), but not with disease duration (P=0.458). CONCLUSION: SNHL occurred in 13% of the patients with CSOM, and was correlated with older age, but not with the presence of cholesteatoma or longer duration of ear disease.

Ototoxicity and antiretroviral therapy seem to be associated. The aim of this study was to evaluate this possible correlation. Evaluations were carried out on 779 medical records from HIV-infected patients who were being regularly followed up, of whom 162 were being treated with antiretroviral therapy and 122 were untreated (controls). The patients undergoing treatment were older (mean: 42 years), had had serological confirmation for longer times (80 months) and had smaller viral loads (P = 0.00). CD4+ was similar between the groups (P = 0.60). In the treated group, three cases (1.8%) of idiopathic hearing loss and two (1.3%) of otosclerosis-related hearing loss were observed, which both started after antiretroviral therapy. No statistical difference relating to idiopathic hearing loss was found between the groups. While descriptive studies consider possible ototoxicity associated with antiretroviral therapy, this possible adverse effect was not related to the antiretroviral therapy in this study. Conversely, otosclerosis might have been correlated with antiretroviral therapy. This issue deserves to be studied.

We assessed the performance of HIV-1 genotyping tests in rescue therapy. Patients were divided into two groups: group 1 (genotyped), included those switching to new antiretroviral drugs based on HIV-1 genotyping data, and group 2 (standard of care -SOC), comprised those in rescue therapy who had not used this test. This was an open and non-randomized study, with 74 patients, followed up for a mean period of 12 months, from February 2002 to May 2003. The groups differed in the duration of antiretroviral use, experience with diverse drug classes (non-nucleoside reverse transcriptase inhibitors and protease inhibitors) and viral load

To study characteristics of neurological disorders in HIV/AIDS patients and their relationship to highly active antiretroviral treatment, a cross-sectional study was conducted in an infectious disease public hospital in Belo Horizonte, Brazil, between February 1999 and March 2000. Of the 417 patients enrolled, neurological disease was observed in 194 (46.5%) and a new AIDS-defining neurological event developed in 23.7% of individuals. Toxoplasmosis (42.3%), cryptococcosis meningitis (12.9%) and tuberculosis (10.8%) were the most common causes of neurological complications. The majority (79.3%) of patients were on highly active antiretroviral treatment and these individuals using HAART showed higher CD4 cell counts (p = 0.014) and presented stable neurological disease (p= 0.0001), although no difference was found with respect to the profile of neurological complications. The neurological diseases continue to be a frequent complication of HIV/AIDS and infections are still its main causes in Brazil, even in the highly active antiretroviral treatment era. Com o objetivo de estudar as doenças neurológicas em pacientes HIV/AIDS e sua relação com a terapia anti-retroviral altamente ativa, foi realizado estudo transversal em hospital público de doenças infecciosas de Belo Horizonte, Brasil, no período de fevereiro de 1999 a março de 2000. Doença neurológica foi observada em 194 (46,5%) dos 417 indivíduos incluídos e um novo episódio de doença neurológica definidora de AIDS ocorreu em 23,7% pacientes. Toxoplasmose (42,3%), criptococose (12,9%) e tuberculose (10,8%) foram as principais causas de complicações neurológicas. A maioria dos pacientes estava em uso de terapia anti-retroviral altamente ativa (79,3%) e esses indivíduos apresentaram maiores contagens de linfócitos CD4 (p = 0,014) e maior freqüência de doença neurológica clinicamente estável, embora não tenha havido diferença no perfil etiológico das complicações neurológicas. As doenças neurológicas continuam sendo causas freqüentes de complicações da infecção pelo HIV/AIdS no Brasil, e a despeito da terapia anti-retroviral altamente ativa, as infecções são ainda a principal etiologia das doenças do sistema nervoso.

The aims of this study were to describe anthropometric data and glycemic and lipidic profiles of HIV-infected patients treated or not with antiretrovirals (ARV) drugs, and to assess association between these drugs and body composition changes, lipid and glucose homeostasis disturbances. There were 176 patients included (133 ARV-treated patients and 43 ARV-naïve). The patients were submitted to clinical evaluation, laboratorial analysis, ultrasonographic measurements, bioelectrical impedance analysis and skin folds thickness measurements. The ARV-treated group showed higher waist-to-hip ratio (p= 0.0002), higher intra-abdominal fat thickness measured by ultrasonography (p= 0.003) and lower bicipital (p= 0.01) and tricipital (p= 0.0002) skin folds. This group also showed higher triglyceride (p= 0.0002), total cholesterol (p= 0.00007), HDL cholesterol (p= 0.009), glucose measurements one hour (p= 0.01) and two hours (p= 0.001) after dextrose load, higher levels of fasting insulin (p= 0.03) and higher HOMAR index (p= 0.02). The antiretroviral drugs are associated with increased visceral fat and decreased peripheral fat pads. Beside that, these drugs are associated with atherogenic lipid profile and insulin resistance, two independent risk predictors of cardiovascular disease.

Q fever has been considered non-existing in Brazil where reports of clinical cases still cannot be found. This case-series of 16 patients is a result of a systematic search for such illness by means of clinical and serologic criteria. Serologic testing was performed by the indirect microimmunofluorescence technique using phase I/II C. burnetii antigens. Influenza-like syndrome was the most frequent clinical form (eight cases - 50%), followed by pneumonia, FUO (fever of unknown origin), mono-like syndrome (two cases - 12.5% each), lymphadenitis (one case - 6.3%) and spondylodiscitis associated with osteomyelitis (one case - 6.3%). The ages varied from four to 67 years old with a median of 43.5. All but one patient had positive serologic tests for phase II IgG whether or not associated with IgM positivity compatible with acute infection. One patient had both phase I and phase II IgG antibodies compatible with chronic Q fever. Seroconvertion was detected in 10 patients. Despite the known limitations of serologic diagnosis, the cases here reported should encourage Brazilian doctors to include Q fever as an indigenous cause of febrile illness. A febre Q continua sendo considerada inexistente no Brasil onde publicações de casos clínicos ainda não são encontráveis. Esta série de casos de 16 pacientes é resultado de uma busca sistemática para esta doença usando-se critérios clínicos e sorológicos. Os testes sorológicos foram realizados pela técnica de microimunofluorescência indireta utilizando-se antígenos de C. burnetii fase I e fase II. Síndrome influenza símile foi a forma clínica mais frequente (oito casos - 50%), seguida pela pneumonia, FOI (febre de origem indeterminada), síndrome mononucleose símile (dois casos - 12,5% cada) e por fim linfoadenite (um caso - 6,3%) e espondilodiscite associada à osteomielite (um caso - 6,3%). As idades variaram de quatro a 67 anos com mediana de 43,5. Todos os pacientes, com exceção de um, tinham testes sorológicos positivos para IgG anti fase II, associado ou não a IgM anti fase II, compatíveis com infecção aguda. Um paciente tinha tanto anticorpos IgG anti fase I quanto anti fase II compatíveis com febre Q crônica. Soroconversão foi detectada em 10 pacientes. A despeito das conhecidas limitações do diagnóstico sorológico os casos aqui relatados devem encorajar os médicos brasileiros a incluir a febre Q como causa nativa de doença febril neste país a ser pesquisada.

Human Ehrlichia chaffeensis infections have been reported in North America, Asia and Europe, but only recently have human cases been reported in Brazil. Nine new human cases of E. chaffeensis infection diagnosed on a clinical and serological basis are reported. Serological tests were performed with indoor slides prepared with CDC stock DH-82 cells infected with E. chaffeensis (Arkansas strain). All but two patients were adults. Seven patients were male and two female. The fever duration varied from 4 to 120 days with a median of 6 days. All patients recalled previous tick attack. IgM was detected in four cases. Influenza like syndrome was the most frequent clinical form affecting five patients. Two patients had fever of unknown origin (FUO), one patient had blood culture-negative endocarditis and one had encephalitis. All patients except one recovered. Two patients were correctly treated. One patient with FUO had AIDS and unexplained pancytopenia. The occurrence of human ehrlichiosis by E. chaffeensis remains to be proved in Brazil; the cases reported here highlight the possibility of such disease occurrence in Brazil.

Hepatitis B and C constitute important public health problems worldwide. In Brazil, studies on prevalence of viral hepatitis have local and regional characteristics; consequently it is difficult to define the national epidemiological situation. Our objective was to evaluate the seroprevalence of hepatitis B and C in conscripts of the Brazilian Army. A transversal study among males aged 17 to 22 years was conducted nationwide. After informed consent, each volunteer filled in a social-behavioral questionnaire and had blood drawn to test for HBsAg and anti-HCV. A total of 7,372 volunteers were evaluated in the second half of 2002. The prevalence of HBsAg was 2.6% (95% confidence interval: 2.2, 3.0) and that of anti-HCV was 1.5% (95% confidence interval: 1.2, 1.8). A wide variation among macro regions and states in the same region was observed for both markers. In conclusion, although this population theoretically had a low risk for HBV and HCV infection, these results are higher than expected for this age range. These findings may indicate a change in the pattern of HBV and HCV transmission in Brazil. Due to the different dynamics of these epidemics, further studies are warranted to confirm these apparent trends.

Combined antiretroviral therapy results in sustained viral suppression and a decrease in mortality and morbidity due to HIV infection. Intrinsic strength, durability and absence of cross-resistance are key factors in the selection of antiretrovirals. Failure with nelfinavir has been associated with two protease gene mutations, D30N and L90M. The D30N mutation does not result in cross-resistance with other protease inhibitors, and it decreases viral fitness. In order to check for this mutation after failure with nelfinavir, the 246 HIV-1 genotyping test was performed on virus samples from 55 patients with failure of nelfinavir as the first protease inhibitor. Most (84%) of the viral strains were of subtype B. Nucleosides associated with mutations (NAM) were observed in 80% of the tests; no INS69, complex 151, K65R and L74V mutations, which give multi-resistance to nucleoside analogue reverse transcriptase inhibitors to tenofovir and DDI, respectively, were observed. In the tests for protease gene mutations, the D30N mutation was found in 57%, L90M in 18% and the wild-type virus in 25%. These data are similar to published reports, showing that alternative therapies used after failure with nelfinavir may be more successful, as the D30N mutation does not cause cross-resistance to other protease inhibitors.

Passive surveillance of infectious diseases with a high percentage of asymptomatic cases or long incubation periods, such as acquired immunodeficiency syndrome (AIDS), does not reflect the current transmission dynamics. Thus, a multi-strategic surveillance, such as the human immunodeficiency virus (HIV) sentinel surveillance proposed by the World Health Organization (WHO), is necessary. The Brazilian HIV sentinel surveillance was started in May 1992 with this purpose. The objectives of this study were to evaluate the feasibility and costs of HIV and hepatitis C virus (HCV) surveillance using dried blood spots (DBS) collected for neonatal screening of metabolic diseases in the state of Minas Gerais, Brazil. This was accomplished through the comparison of HIV and HCV seroprevalence with previous Brazilian studies. From December 2001 to June 2002, 24,905 newborns were tested for HIV and 4211 for HCV. HIV seroprevalence was 0.25% and the 95% confidence interval (CI) was 0.18, 0.31%; and HCV seroprevalence was 0.71% and the 95% CI was 0.46, 0.97%. These numbers are similar to previous Brazilian studies. Cost in this study was approximately US$ 3.10 per sample, which was roughly one third of the cost of the same exam at the Brazilian HIV sentinel surveillance. We conclude that it is possible and more cost-effective to use DBS for infectious diseases surveillance, albeit it is still necessary to compare these results with the usual sentinel methodology in a concomitant trial.

"The survival of liberty in our land increasingly depends on the success of liberty in other lands. The best hope for peace in our world is the expansion of freedom in all the world"

Background: There has recently been an increase in HIV infection rates among men who have sex with men (MSM). This study aimed at investigating risk factors associated with incident HIV infection in a MSM cohort–Project Horizonte, Belo Horizonte, Minas Gerais, Brazil. Methodology: This is a nested case-control study in an ongoing open cohort of homosexual and bisexual men, carried out in 1994–2010, during which 1,085 volunteers were enrolled. Each HIV seroconverted volunteer (case) was compared with three randomly selected HIV negative controls, matched by admission date and age (63 years). During follow-up, 93 volunteers seroconverted and were compared with 279 controls. Principal Findings: The risk factors associated with HIV seroconversion were: contact with partner’s blood during sexual relations (OR 3.7; 95% CI 1.2–11.6), attendance at gay saunas in search for sexual partners (OR 2.6; 95% CI 1.3–5.4), occasional intake of alcohol when flirting and engaging in sexual activity (OR 2.5; 95% CI 1.3–5.1), inconsistent use of condoms in receptive anal sex (OR 2.4; 95% CI 1.1–5.4), little interest to look up information about AIDS (OR 2.6; 95% CI 1.0– 6.7) particularly in newspapers (OR 3.4; 95% CI 1.4–8.1). Conclusions: This study shows that MSM are still engaging in risk behavior, such as unprotected anal intercourse, despite taking part in a cohort study on various preventive measures. New preventive strategies in touch with the epidemic’s development and the specificities of this particular population are needed.

Project Horizonte an open cohort of homosexual and bisexual HIV-1-negative men is a component of the Minas Gerais AIDS Vaccine Program of the Federal University of Minas Gerais Belo Horizonte Brazil. Its objectives included the evaluation of seroincidence of HIV to ascertain the role of counseling on behavior modification and to assess their willingness to participate in future HIV vaccine trials. Various means of recruitment were used including pamphlets notices in community newspapers radio and television at anonymous testing centers and by word of mouth. From October 1994 to May 1999 470 volunteers were enrolled. Their mean age was 26 years and over 70% of them had high school or college education. During the follow-up they were seen every 6 months when they received counseling and condoms and when HIV testing was done. 18 seroconversions were observed and the incidence rate estimates were 1.75/100 and 1.99/100 person-years for 36 and 48 months of follow-up respectively. During the entire period 139 volunteers were lost to follow-up. Among them 59 (42.4%) never returned after the initial visit and 51 (36.7) came only once after their initial visit. No losses were observed for those observed during follow-up for more than 3 years. At enrollment 50% of participants said they would participate in a vaccine trial and 30% said they might participate. The results obtained up to this moment confirm the feasibility of following this type of cohort for an extended period estimating HIV incidence rate and evaluating counseling for safe sexual practices in preparation for clinical trials with candidate HIV vaccines in Brazil. (authors)

OBJETIVO: O processo de envelhecimento populacional brasileiro tem sido acompanhado por transformações epidemiológicas e sociais que, em outros países, aumentaram a demanda por instituições de longa permanência. Nesse sentido, desenvolveu-se estudo sobre dinâmica da institucionalização de idosos através da análise da oferta de leitos e características demográficas dos residentes em asilos. MÉTODOS: Foi realizado levantamento dos asilos de idosos do Município de Belo Horizonte, MG. Foram registradas datas de nascimento e admissão de 1.128 residentes de 33 dos 40 asilos em funcionamento no município. A lotação foi calculada através da capacidade informada e da taxa de institucionalização, segundo dados da Pesquisa Nacional por Amostra de Domicílios (PNAD). RESULTADOS: As taxas de institucionalização de idosos (65+) do município foram 0,9% (mulheres) e 0,3% (homens). A lotação mediana dos asilos era de 92%. Dentre os 1.128 residentes arrolados (92,5% do total), as mulheres (81%) apresentavam maiores médias de idade (76,4 x 70,4 anos; p=0,00) e estada (5,6 x 4,5 anos; p=0,01). DISCUSSÃO/CONCLUSÕES: Elevada lotação, listas de espera nos asilos filantrópicos (85% do total) e rígidos critérios para admissão (metade recusava idosos demenciados ou dependentes) sugerem que a baixa taxa de institucionalização se deve à escassez de vagas. A predominância de idosas reflete a prevalência de viúvas ou separadas na comunidade (66% contra 76% de homens casados). A proporção de homens adultos (31% < 65 anos) sugere dificuldade de se auto-sustentarem após a viuvez. Elevada taxa de mortalidade (24% durante 20 meses de acompanhamento de amostra aleatória de 263 residentes), incompatível com o rigor dos critérios de admissão, determina a baixa mediana de estada (3 anos). Os dados refletem o anacronismo de um sistema não direcionado à manutenção dos idosos em seus próprios domicílios. INTRODUCTION: Epidemiological and social changes related to population aging in Brazil will probably increase the need for nursing homes (NH). The study analyses the dynamics of institutionalization in Belo Horizonte, a 3 million inhabitant city of whom 8.0% are aged 60 or more. METHODS: Age and length of stay of 1,128 NH residents (92.5% of the estimated population) was registered and occupancy and institutionalization rates were determined. RESULTS: Among women aged 65+ in Belo Horizonte, 0.88% were living in NH; among men, 0.26%. Occupancy rates were 92%. Women (81%) were older than men (76.4 x 70.4 years; two-tailed t test = 6.4; p=0.00) and lived there for a longer period (5.6 x 4.5 years; two-tailed t test = 2.6; p=0.01). Almost 1/3 of the men were aged < 65. CONCLUSIONS: High occupancy rates, long waiting lists and hard criteria for admission (half reject demented or dependent individuals) insinuates that these low institutionalization rates are related to scarcity of beds. The preponderance of women reflects the proportion of those widowed or separated in the community (66% of those aged 65-+, versus 76% of married man). The high frequency of institutionalized men aged

Os objetivos deste trabalho são avaliar risco ocupacional de exposição ao HIV entre estudantes de medicina, avaliar o conhecimento e o uso das medidas de biossegurança e a cobertura da vacinação contra hepatite B. Questionário específico foi aplicado a 136 estudantes de medicina da Universidade Federal de Minas Gerais. A maioria da população avaliada, 87 (64%) estudantes relataram participar de procedimentos cirúrgicos, 68 (50%) já sofreram algum tipo de exposição a sangue, 90 (66,2%) afirmaram conhecer as medidas universais de biossegurança e 33 (24,3%) relataram conhecer os procedimentos em caso de exposição a sangue contaminado. A população avaliada apresenta alto risco de exposição a material biológico e cerca de um terço desta tem baixo nível de conhecimento das medidas de biossegurança, apesar de fazer uso delas. Torna-se necessário a utilização de estratégias como ensino formal, treinamento em serviço e criação de serviços especializados em biossegurança para a modificação desta realidade. The objectives of this study were to evaluate the occupational risk of medical students, their knowledge and practice of universal biosafety measures and hepatitis B immunization coverage. A specific questionnaire was applied to 136 medical students of the Universidade Federal de Minas Gerais: 87 (64%) students were involved in surgical procedures, 68 (50%) had been exposed to blood, 90 (66.2%) knew the universal biosafety measures and 33 (24.3%) knew the procedure in case of blood exposure. Thus, this population has a high risk of blood exposure and although there is a low formal knowledge about universal biosafety measures, most of these were generally used. New strategies, such as formal teaching of universal biosafety measures, in loco supervision, and biosafety teams, are necessary to change this situation.

Conflicts of interest are inherent to the majority of relationships among individuals and of these with companies and institutions and, certainly, research involving human beings is no exception. In relation to clinical research, the main focus of this manuscript, conflicts of interest occur at different levels and usually permeate among them: In the pharmaceutical industry in their decisions to invest to develop new products, especially vaccines and drugs, and also in relation to marketing of these products; Among the investigators the conflicts may be related to the financial gains to participate in pharma sponsored trials, or to the expected academic career boost attained with the publication of the results of the trials and also to personal interests such as the financial support for trips to international conferences. Often the participation of host country investigators is restricted to performing phase III or IV protocols developed abroad, many times with low scientific relevance, and even lower relevance to public health; Universities or research institutes themselves also have conflicts of interest, as the sponsored projects may help increase their budgets, both directly (taxes) and indirectly (e.g., improvement of physical infrastructure of laboratories or out patient clinics); For the trial volunteers in developing countries, and Brazil is no exception despite free and universal access to its health system, participation in clinical trials is many times seen as, and can really be, an unique opportunity of receiving better health care, better treatment by the health professionals, easier access to costly lab exams and also to receiving certain medications which would otherwise be difficult to have access to. In order to handle these conflicts of interest, Brazil has a well-established and respected legal support and ethical normatization. The latter is represented by Resolution 196/96 of the Brazilian National Research Ethics Committee (CONEP). This national system was established in 1996 providing guidance to all research involving human beings and currently there are approximately 500 local research ethical committees certified by CONEP in all States of Brazil. However, there is intense international pressure mainly from the pharmaceutical industry especially to the ethical requirements emanated from the Declaration of Helsinki (DH), aiming to lower the level of ethical requirements in research to be carried out with volunteers from developing countries. Fallacious reasoning includes that the equity stated at the DH, especially the access to the best proven medical care and to the developed products to all volunteers independently of where the trial is being held, would inflate the costs of research and drive the sponsors away from the developing countries. In this line of thought, if the volunteers have not the same rights that would constitute an unacceptable double standard, or in other words, the best for the volunteers from developed countries and whatever is possible for those in developing countries. This manuscript will focus on the various levels where conflict of interest issues are more prone to happen, such as in the actions of pharmaceutical industries, their relation to health professionals, the participation of universities and research institutes, the ethical research committees and their members, including the possible pressures exerted on them by researchers, sponsors and even their institutions. Emphasis will be given to the interrelation between conflicts of interest and vulnerability, and also the causes and possible solutions to lower the risks of exploitation of volunteers in research. It will also emphasize the need to guarantee access to products that are proven efficacious to all individuals who may need them. Possible ways of empowering these volunteers will be evaluated, so that they become aware of their rights and demand for them. It will discuss the need of separating economic interests from the real needs of public health and of demystifying economic arguments used in order to justify the lowering of ethical requirements. And finally it will address the search for or the establishment of real and effective involvement of all stakeholders in an international organism really representing everyone (e.g., WHO) in order to evaluate, debate, and decrease the risks of several conflicts of interest, aiming at the establishment of research projects that can truly contribute to lower the obscene disparities of health between developed and developing countries.

A case-control study to determine factors associated with AIDS and AIDS-like syndrome among homosexual/bisexual men was conducted in the State of Minas Gerais (Brazil). Eighty-three per cent (45 patients) of all AIDS/AIDS-like syndrome cases in homosexual/bisexual men reported in Minas Gerais between February, 1986 and June, 1987 were compared to 133 seronegative controls seen at the same clinic. Blood samples were tested by ELISA and confirmed by Western blot. Sex with men from the USA, sex with someone who developed AIDS, number of male partners (greater than or equal to 100 lifetime), age (greater than or equal to 30 years old) and ethnicity (white) were independently associated with AIDS/AIDS-like syndrome (Odds Ratios = 5.5, 4.3, 3.9, 3.5 and 2.7, respectively). Thirty-nine per cent of cases and 44% of controls reported bisexual activity during the previous two years. From these, a high proportion reported anal intercourse with women in the same period (53% of bisexual cases and 33% of bisexual controls). Bisexual men had more male partners than female partners in the previous two years (median male partners = 20 for cases and five for controls; median female partners = three for both cases and controls). This explains in part why the epidemic has increased more rapidly among men then among women in Minas Gerais, despite the large proportion of bisexuals with the disease.A case control study to determine factors associated with AIDS and AIDS- like syndrome among homosexual/bisexual men was conducted in the state of Minas Gerais, Brazil. 83% (45 patients) of all AIDS/AIDS-like syndrome cases in this group of men reported in Minas Gerais between February 1986-June 1987 were compared to 133 seronegative controls seen at the same clinic. Blood samples were tested by ELISA and confirmed by western blot. Sex with men from the US, with someone who developed AIDS, number of male partners ( or = 100 lifetime), age ( or = 30 years old), and ethnicity (white) were independently associated with AIDS/AIDS-like syndrome (odds ratio=5.5, 4.3, 3.9, 3.5, and 2.7, respectively). 39% of cases and 44% of controls reported bisexual activity over the previous 2 years. From these, a high proportion reported anal intercourse with women in the same period (53% of bisexual cases and 33% of bisexual controls). Bisexual men had more male partners than female ones in the previous 2 years (median number=20 for cases and 5 for controls; median number of female partners=3 for both cases and controls). This explains in part why the epidemic has increased more rapidly among men than women in Minas Gerais, despite the large proportion of bisexuals with the disease.

Background In the central nervous system, HIV replication can occur relatively independent of systemic infection, and intrathecal replication of HIV-1 has been observed in patients with HIV-related and opportunistic neurological diseases. The clinical usefulness of HIV-1 RNA detection in the cerebrospinal fluid (CSF) of patients with opportunistic neurological diseases, or the effect of opportunistic diseases on CSF HIV levels in patients under HAART has not been well defined. We quantified CSF and plasma viral load in HIV-infected patients with and without different active opportunistic neurological diseases, determined the characteristics that led to a higher detection rate of HIV RNA in CSF, and compared these two compartments. Methods A prospective study was conducted on 90 HIV-infected patients submitted to lumbar puncture as part of a work-up for suspected neurological disease. Seventy-one patients had active neurological diseases while the remaining 19 did not. Results HIV-1 RNA was quantified in 90 CSF and 70 plasma samples. The HIV-1 RNA detection rate in CSF was higher in patients with neurological diseases, in those with a CD4 count lower than 200 cells/mm3, and in those not receiving antiretroviral therapy, as well as in patients with detectable plasma HIV-1 RNA. Median viral load was lower in CSF than in plasma in the total population, in patients without neurological diseases, and in patients with toxoplasmic encephalitis, while no significant difference between the two compartments was observed for patients with cryptococcal meningitis and HIV-associated dementia. CSF viral load was lower in patients with cryptococcal meningitis and neurotoxoplasmosis under HAART than in those not receiving HAART. Conclusion Detection of HIV-1 RNA in CSF was more frequent in patients with neurological disease, a CD4 count lower than 200 cells/mm3 and detectable plasma HIV-1. Median HIV-1 RNA levels were generally lower in CSF than in plasma but some patients showed higher CSF levels, and no difference between these two compartments was observed in patients with cryptococcal meningitis and HIV-associated dementia, suggesting the presence of intrathecal viral replication in these patients. HAART played a role in the control of CSF HIV levels even in patients with cryptococcal meningitis and neurotoxoplasmosis in whom viral replication is potentially higher.

Ninety-one children with chronic schistosomiasis mansoni were selected for this double blind trial. 48 (Group 1) were treated with a single oral dose of oxamniquine (20mg/kg body-weight) and 43 (Group 2) received the placebo. Clinical, laboratory and radiological examinations were performed before and after treatment. Dark urine and vomiting were observed only in the oxamniquine group. Pulmonary condensations with or without air bronchogram were observed in the chest X-ray of 15% of Group 1 patients, between days 3 and 5 after treatment. In the urinalysis made on the first day after treatment, a false positive reaction was reported for urobilinogen and bilirubin in up to 50% of the patients treated with oxamniquine. In Group 1, 69·6% of the patients were cured. No patient was cured in Group 2. There was a 4·4% incidence of infection in the control group. There was a 77·9% egg excretion reduction in the 14 Group 1 patients not cured by oxamniquine. The authors conclude that oral oxamniquine in the prescribed dosage, has low toxicity and good therapeutic efficacy in children with chronic schistosomiasis mansoni.

Os Autores descrevem um caso grave de esquistossomose mansoni numa criança de 9 anos de idade (forma hepática com hipertensão portai associada a forma pulmonar com hipertensão pulmonar e cor pulmonale) clinicamente caracterizado por episódios de insuficiência respiratória desencadeados em face de esforços físicos moderados. Sucessivos exames radiológicos de tórax revelaram comprometimento predominantemente arteriolar ao iado de uma micronodulação delicada e difusamente distribuída e configuração de cor pulmonale. Ao contrário do caso anteriormente descrito, a evolução se deu sem que se verificassem manifestações febris. Embora tenham sido afastadas várias hipóteses de associação da esquistossomose a concausas infectuosas, optou-se pelo tratamento de prova da tuberculose pulmonar. O fundo de olho também apresentava vários nódulos esbranquiçados disseminados pelo coróide e retina, caracterizando provável coroidite e retinite esquistossomótica. O tratamento antituberculoso resultou praticamente nulo. Não se procedeu ao tratamento específico da esquistossomose, considerando-se o alto risco da cardiopatia face aos esquistossomicidas disponíveis. A alta foi fornecida após treze meses de observação hospitalar. Não compareceu a ulterior controle.The Authors report a severe case of schistosomiasis mansoni in a 9-year-old child (heplus pulmonary form with pulmonary hypertension and cor pulmonalel The clinical features comprised episodes of respiratory insufficiency induced by moderate physical exercise. Serial chest X-raysshowed a predominantly arteriolar involvement associated with fine micronodules and the features of cor pulmonale. The fever episodes found in the case previously reported did not happen in th is patient. Even though various hypothesis of association of schistosomiasis and other infectious diseases were discarted, a trial of anti-tuberculous drugs was performed. Eye examination disclosed various whitish nodules disseminated throughout the retina and choroid, and this suggested schistosomiasis as the cause for the eye involvement. The antituberculous drugs did not change the clinical picture at all. Antischistosome drugs were. not used due to the risk of circulatory side-effects of the drugs available. The patient was discharged after 13' months and no follow-up has been done since.

A double blind trial was set up to study the pulmonary effects of specific treatment with oxamniquine of 40 patients with chronic schistosomiasis mansoni. Radiological alterations characterized by bronchopneumonitis were seen in 17.5% of the patients after treatment, but in none of the placebo group; non-migratory condensation occurred between 25 and 72 h after treatment, with a mean duration of 7 d. 86% of the patients showed spontaneous healing with no radiological sequelae after 30 d of follow-up. Slight pulmonary clinical manifestations without any functional repercussions were also seen. The alterations were probably related to the host-parasite interaction, and the lesions may have been caused by deposition of immune complexes in the lungs with local activation of complement.

A radiological study of the small intestine of 17 untreated patients in the acute phase ofschistosomiasis was performed. Twelve patients (70% of total) had alterations: nine had clear-cut thickening of the duodenal and jejunal folds, one flocculation, one fragmentation and one thickening of mucosae, flocculation and fragmentation of the barium column. There was no correlation of the gastrointestinal symptomatology (vomiting, diarrhoea, dysentery, hepatomegaly) neither with the parasitological load nor with the x-ray alterations.Foram estudados clinico-radiologicamente 17 pacientes com esquistossomose mansoni aguda, toxêmica, não tratados especificamente. Doze pacientes (70% do total) possuíam alterações radiológicas: nove com espessamento da mucosa duodenal e jejunal, um com floculação, um com fragmentação e um com espessamento da mucosa, floculação e fragmentação da coluna de bário. Não houve correlação entre a sintomatologia gastrointestinal (vômito, diarréia, disenteria, hepatomegalia) e a carga parasitária nem com as alterações radiológicas intestinais. Estes dados sugerem a participação do sistema imunológico nas alterações gastrointestinais.

BackgroundHuman immunodeficiency virus type 1 (HIV-1) subtype B predominates in Brazil, but in the southern region subtype C is the most frequent, followed by subtypes B, F1 and recombinant forms. In southern Brazil, these subtypes co-circulate in subjects with homogeneous demographic and clinical features, enabling a better understanding of the role of HIV-1 subtypes on the characteristics of infection.ObjectivesTo evaluate the prevalence of different HIV-1 subtypes in subjects with recent diagnosis for HIV infection in the extreme south of Brazil, and to study their association with demographic, behavioral, clinical and laboratorial characteristics.Study designWe have determined the genetic sequence of viral protease and reverse transcriptase (polymerase, connection and RNase H domains) isolated from studied subjects. Viral subtype was inferred by comparison with reference HIV sequences, and recombination was determined with Simplot analysis. The association of HIV-1 subtypes with studied characteristics was evaluated by chi-square, Fisher's exact, Student's t and Kruskal–Wallis tests.ResultsTwo hundred and forty-five HIV isolates were molecularly characterized, and the association with variables was studied for 233 (95.1%) patients. Of those, 46.8% followed AIDS defining criteria. HIV-1C was responsible for 56.3% of infections, and was associated with heterosexual transmission (p=0.001) and with higher CD4+ T-cell counts (p=0.02).ConclusionsThe molecular epidemiology of HIV-1 in the southernmost Brazil is currently steady with predominance of HIV-1C. This is the first study showing a robust association of the infection by this subtype and heterosexual transmission in the state of Rio Grande do Sul, Brazil.

Resumo Para documentar dois mandatos à frente da Sociedade Brasileira de Bioética, os autores fazem retrospectiva da disciplina no país, com a criação da entidade associativa, de revistas científicas, eventos nacionais e internacionais, bem como programas acadêmicos para formação em campos multidisciplinares e divulgar a bioética para a sociedade brasileira, latino-americana e lusófona. Ressalta que desde o início dos debates a bioética brasileira teve sua atuação relacionada estreitamente com a defesa dos direitos humanos. No período de gestão os desafios se relacionavam ao envelhecimento populacional, ao impacto de doenças emergentes/reemergentes, ao aumento da urbanização, ao crescimento da tecnologia, às pressões para diminuir os requisitos éticos para pesquisas envolvendo seres humanos, globalização da economia e da comunicação; somados à grave crise econômica e política internacional, que no Brasil culminou com o impeachment da presidente eleita e reformas privatistas que subtraem direitos dos trabalhadores. Isto tudo determina a pauta para o novo mandato. Abstract In order to document two consecutive terms leading the Sociedade Brasileira de Bioética (the Brazilian Society for Bioethics), the authors provide a retrospect of Brazilian bioethics since the inception of the SBB, including the establishment of dedicated ethical journals, national and international events, and of academic programs aimed at qualifying professionals in multidisciplinary fields and to disseminate this knowledge among Brazilian, Latin-American and Lusophone societies. They emphasize that since the beginning of the bioethical debate in Brazil there has been a clear focus on human rights protection. During the current board’s term, challenges have included population aging in Brazil; the impact of emerging/reemerging illnesses; the increase of urbanization; the impact of technological progress; pressures to lower ethical requirements for human research; economic and communication globalization. This has come amid a severe international economic and political crisis, culminating in Brazil with the impeachment of an elected president and with the succeeding government proposing privatizations and reforms that will negatively affect workers’ rights. All these points set the agenda for the new term of office. Resumen Para documentar dos mandatos al frente de la Sociedade Brasileira de Bioética (Sociedad Brasileña de Bioética), los autores ofrecen una retrospectiva de la disciplina en el país, con la creación de la entidad asociativa, de revistas científicas, de eventos nacionales e internacionales, así como de programas académicos para la formación en campos multidisciplinarios y para difundir la bioética en la sociedad brasileña, en Latinoamérica y en los países lusófonos. Se destaca que desde el inicio de los debates, la actuación de la bioética brasileña estuvo estrechamente relacionada con la defensa de los derechos humanos. En el período de gestión, los desafíos se relacionaban con el envejecimiento poblacional, el impacto de las enfermedades emergentes/reemergentes, el aumento de la urbanización, el crecimiento de la tecnología, las presiones para reducir los requisitos éticos para la investigación con seres humanos, la globalización de la economía y de las comunicaciones; sumados a la grave crisis económica y política internacional, que en Brasil culminó con el impeachment de una presidente electa y con reformas privatistas que afectan a los derechos de los trabajadores. En suma, todo esto determina la agenda para el nuevo mandato.

Background: Darunavir has been proven efficacious for antiretroviral-experienced HIV-1-infected patients in randomized trials. However, effectiveness of darunavir-based salvage therapy is understudied in routine care in Brazil. Methods: Retrospective cohort study of HIV-1-infected patients from three public referral centers in Belo Horizonte, who received a darunavir-based therapy between 2008 and 2010, after virologic failure. Primary endpoint was the proportion of patients with viral load

Summary Sensorineural hearing loss (SNHL) related to chronic suppurative otitis media (CSOM) was studied to clarify the involvement of cholesteatomas in this context. Aim: to evaluate SNHL related to CSOM and its association with cholesteatomas, disease duration and patients’ ages. Methods: Retrospective analysis of 115 patients with CSOM with and without cholesteatoma submitted to surgical treatment. Inclusion criteria were active unilateral disease, normal contralateral ear and age below 60 years. Results: The average age was 26.3 years, 58 males and 57 females. The duration of ear disease was, in average, 12.4 years. The average threshold of hearing was 40 dB in CSOM ear and 22 dB in the normal contralateral ear (P=0.002). CSOM with cholesteatoma occurred in 78 of 115 cases. In the abnormal ear, SNHL was seen in 15 cases, being 6 cases of profound loss, that correlated with adjusted-age (P=0.003) and absence of cholesteatoma (P=0.01), but not with disease duration (P=0.458). Conclusion: SNHL occurred in 13% of the patients with CSOM, and was correlated with older age, but not with the presence of cholesteatoma or longer duration of ear disease.

A clinical and radiological picture of bronchopneumonia was observed in a patient between the second and third weeks post-infection with cercariae of S. mansoni. There was a spontaneous recovery without sequelae in 20 days and the clinical and radiological alterations were interpreted as associated with the passage of schistosomulae through the lungs.Relata-se o caso de um paciente que após 2 a 3 semanas de contato infectante com cercárias desenvolveu quadro clínico e radiológico de broncopneumonite. O paciente não possuía infecção esquistossomótica anterior. Houve recuperação espontânea, sem seqüela em 20 dias e as alterações clínico- radiológicas foram interpretadas em associação à passagem de esquistossômulos pelos pulmões.

Em estudo duplo-cego observou-se que as alterações radiológicaspulmonares após tratamento com oxamniquine de pacientes com esquistossomose mansoni crônica associam-se com a presença de eosinófilos no escarro (pIn a double-blind study, thepost-oxamniquine X-ray pulmonary alterations were associated with sputum eosinophilia (p < 0.01). This suggests the occurrence of a hypersensitivity reaction in treated human schistosomiasis mansoni infections.

The post-treatment pulmonary alterations were evaluated in patients (Study 1) and in mice (Study 2) infected with Schistosoma mansoni. Study 1: the patients were examined pre and post-treatment (with ora oxamniquine) and the following exams were performed: sputum for eosinophils and chest x-ray. Study 2: four groups of mice (total = 64) were studied; Group I (infected and treated with oxamniquine); II (infected and not treated); III (not infected and treated) and IV (not infected and not treated). All were x-rayed to check for pulmonary abnormalities pre and post-treatment and lung specimens were studied by optical microscopy and immunofluorescence. We have found abnormalities in the parameters checked in both studies and the results suggest an immunological reaction, probably due to deposition of immune complexes in the lungs, with subsequent activation of the complement system. The experimental study showed that the alterations are not dependent of the presence of eggs and/or worms of S. mansoni in the lungs, thus corroborating the hypothesis of deposition of circulating material.

Em 28,8% dos pacientes com esquistossomose mansoni tratados com oxamniquine ocorrem alterações radiológicas pulmonares caracterizadas por broncopneumonite (41%), pneumonite (35%), abaulamento do arco médio (17%) e congestão pulmonar (7%). As alterações são transitórias, com início até 3 dias após a terapêutica, em 50,7% regredindo em 15 dias, completa e espontaneamente. Predominam na faixa etária entre os 4 aos 12 anos, não dependem, de padrão radiológico pré-tratamento, cor, sexo, naturalidade ou fase/forma da doença. As alterações clínicas associadas às anormalidades radiológicas pós-tratamento são inexpressivas na forma aguda, toxêmica, enquanto na fase crônica surgem como estertores crepitantes e roncos. O encontro de eosinófilos no escarro até o décimo segundo dia após o tratamento correlaciona-se com o encontro de alterações radiológicas pulmonares pós-tratamento independentemente da fase/forma da doença.Pulmonary alterations on X-rays werefound in 28.8% of patients with schistosomiasis mansoni infection post-treatment with oxamniquine. They comprised bronchopneumonitis (41%), pneumonitis (35%), prominent medium arc (17%), and pulmonary congestion (7%). These alterations were transitory starting within 3 days after treatment. In 51% of the cases spontaneous, often complete, recovery occurred in 15 days. They were more common in patients, 4 to 12 years of age and did not depend on the pre-treatment radiologic pattern, race, sex, origin norphase of the disease. In the chronic phase of the disease there were clinical manifestations (ronchi and rales) associated with the X-ray alterations, while in the acute, toxemic phase these were absent or mild. The presence of sputum eosinophils up to the 12th day post-treatment had a direct correlation with the appearance of X-ray abnormalities and did not depend on the phase or form of the disease.

Two families, comprising 11 individuals in the toxemic form of schistosomiasis mansoni, infected in Belo Horizonte, Brazil were treated. Parasitological cure was obtained in 5 (45%) of the patients after a single oral dose of oxamniquine (Mansil®), 20 mg/kg body weight. No significant side effects were observed. To evaluate the possibility of resistance to the drug, cercariae collected from Biomphalaria glabrata infected with miracidia from eggs obtained from three of the individuals not cured were studied. Mice infected with these three strains were cured after a single oral dose of oxamniquine. It is suggested that research be continued with other therapeutic schedules and perhaps other, more potent, drugs.

Estudamos as alterações ultra-estruturais dos hepatócitos na forma aguda, toxêmica, da esquistossomose, em cinco pacientes, membros de uma mesma família infectados em idênticas condições em um córrego existente próximo da lagoa de Pampulha, em Belo Horizonte (MG), e não tratados especificamente para a esquistossomose. Este estudo confirma os dados obtidos em trabalho anterior, em sete pacientes infectados no Município de Sabara (MG). Nos cinco casos, as alterações ultra-estruturais foram inespecíficas, pouco acentuadas, embora mais intensas do que as observadas anteriormente, e se caracterizaram sobretudo pelas modificações das organelas citoplasmáticas, explicando o freqüente encontro de células claras a microscopia óptica. A identificação de alguns granulomas a microscopia eletrônica permitiu verificar que estes mostram, no exstudato, granulócitos eosinófilos, macrófagos, plasmócitos, células epitelióides e mastócitos. Entre as células havia material amorfo e finos feixes de colágeno. In this paper the authors discuss the ultrastructural changes of liver cells in the acute toxaemic form of schistosomiasis mansoni in five member of the same family who got the infection in identical conditions in an endemic area located near the Pampulha Lake, in Belo Horizonte (MG) and that did not receive specific treatment for schistosomiasis. This study confirms the data obtained and documented in a prior communication in seven patients infected in Sabará (MG). In the five cases the ultrastructural changes were also non-specific, although more intense than observed previuosly and were characterized mainly by alteration of the cytoplasmic organelles that could explain the common feature of clear cells by light microscopy. The results of the observation of some granulomas in ultrathin sections have demonstrated eosinophils, macrophages, plasma cells, epithelioid cells and mast cells. Among these cells there were also ground substance and thin bundles of collagen.

Com o objetivo de demonstrar algumas modalidades distintas do comprometimento pulmonar na esquistossomose mansoni, ressaltando sempre a diversidade dé interação dos múltiplos fatores envolvidos, os Autores iniciam a publicação de uma seqüência de casos ilustrativos, embora considerados pouco comuns na clínica diária. No caso ora descrito, ao lado de sintomatologia definida dominantemente por surtos paroxísticos de asma, o estudo radiológico seriado, durante sete anos, revelou imagem pieuro-parenquimatosa caracterizada por irregularidades de radiopacidade com traves fibróticas extensas, notadamente à direita e desvio acentuado do mediastino para este lado; a área cardíaca encontrava-se aparentemente normal. À microtoracotomia, observou-se lesão pleural dominante com enclausuramento do LSD e condensação extensa subpleural do LSD, afetando amplamente o parênquima. Procedeu-se àdetorticação do LM e LID e reexpansão parcial de seus parénquimas, bem como à biopsia pulmonar. Apesar de o estudo histopatológico haver revelado uma arterite pulmonar grave, não foram registrados sinais e sintomas de cor pulmonale. Este comprometimento pulmonar verificou-se, entretanto, isoladamente de uma forma hepato-esplênica e, conseqüentemente, na ausência de síndrome de hipertensão portai a determinar a rota oreferencial de migração de ovos e, eventualmente, de vermes aos pulmões. To demonstrate some different modalities of lung lesions in schistosomiasis mansoni, the authors relate a series of illustrative, though unusual cases, stressing the diversity of the multiple factors involved. In the present studied case, besides a definite symptomatology of paroxistic attacks of asthma, a series of radiological studies through seven years showed a pleuro-parenchymatous image characterized by irregularities of radioopacity, with extensive fibrous proliferation especially on the rightside, and marked deviation of the mediastinum also to the right; cardiac area was apparently normal. Microthoracotomy showed dominant pleural lesion enclosing the right superior lobe, affecting widely the parenchyma. Decortication of medium and right inferior lobes, partial reexpansion of their parenchyma, and pulmonary biopsy were performed. Histopathological study disclosed a predomiantly focal, but relatively extensive, and severe case of pulmonary arteritis without cor pulmonale. This pulmonary involvement occured isolated, not related to a hepato-splenic symptomatology, and consequently there was no syndrome of portal hypertension to indicate the preferentiai way of migration of the eggs, and eventually of the worms to the lungs.

There is inadequate knowledge about human immunodeficiency virus (HIV) seropositivity in hemodialysis patients. As of February 1987 there were 41 notified cases of acquired immunodeficiency syndrome (AIDS) in Minas Gerais State Brazil. 34 of these were homosexual or bisexual men 2 were hemophiliacs 2 had received multiple blood transfusions 1 was an intravenous drug addict and 2 had no identified risk factors. Examinations of blood donors for HIV antibodies had not been obligatory in Brazil. 237 patients (99.2% of the total) from 3 private dialysis centers in Belo Horizonte Minas Gerais State were studied in March 1987. Data were collected on age sex number of blood transfusions and number of hemodialysis. The sera of patients were tested by the enzyme- linked immunosorbent assay (ELISA). When the serum was positive and/or borderline in at least 2 out of 3 of these examinations they were retested by means of Western-blot analysis. There were statistically significant differences among the patients with respect to the obtained data parameters. 87% of the patients had received at least 1 blood transfusion during their lives and 74% had received at least 1 transfusion during their lives and 74% had received at least 1 transfusion during the previous year. The mean number of hemodialysis varied from 117 to 119 in the investigated centers. ELISA showed only 1 person HIV antibody positive but this case proved to be negative when retested by Western blot analysis. HIV infection does not seems to be a problem among these patients in view of the current status of AIDS epidemic in Belo Horizonte.

Mudanças relacionadas à imunossenescência estão ocorrendo em PVHIV muito mais cedo do que em indivíduos não infectados pelo HIV. As mudanças mais notáveis ocorrem no sistema imune adaptativo, especialmente no compartimento de células T. Este estudo tem como objetivo avaliar e descrever o perfil de imunossenescência e exaustão de linfócitos CD4+ e CD8+ circulantes em PVHIV, assim como avaliar a correlação existente entre os perfis de imunossenescência e os valores absolutos e percentuais de LTCD4 no tempo zero e após sessenta meses. A imunossenescência e a exaustão foram avaliadas por citometria de fluxo através da expressão dos marcadores de superfície celular: CD45RA, CD27, CD28, CD57, CD62L, CCR7, CD95/Fas e morte programada-1 (PD-1). Foram coletadas amostras de 46 PVHIV em acompanhamento no Centro de Treinamento e Referência em Doenças Infecciosas e Parasitárias - CTR-DIP Orestes Diniz, assim como de vinte (20) controles soronegativos (N). Os indivíduos soropositivos foram separados em três grupos de acordo com aspectos laboratoriais em: progressores lentos (PL), replicação ativa (RA) e TARV com sucesso. Todos os participantes assinaram um termo de consentimento livre e esclarecido (TCLE) e este projeto foi aprovado pelo comitê de ética em pesquisa da Faculdade de Medicina da UFMG. Os nossos achados mostram que, quando comparadas com o grupo controle, as PVHIV apresentaram diminuição de células naïve, bem como maior frequência e expressão de células efetoras em estádios intermediários e avançados de diferenciação. No entanto, observaram-se diferenças entre os três grupos: a) No grupo RA foram observadas a maioria das alterações imunes; b) as alterações imunofenotipicas observadas nos grupos RA e TARV foram evidenciadas em linfócitos CD4 e CD8; c) No grupo PL, essas alterações ocorreram exclusivamente no compartimento de CD8. Por outro lado, os perfis de imunossenescência se mostraram relacionados de forma negativa com os valores absolutos e percentuais de LTCD4 no tempo zero e sessenta meses depois. Em conclusão, nossos resultados mostram que perfis imunofenotipicos relacionados a imunossenescência se mostraram aumentados em linfócitos CD4 e CD8, em todos os grupos de PVHIV estudados. Por outro lado a expansão dessas células terminalmente diferenciadas teve um impacto negativo na contagem de linfócitos CD4+ no tempo de realização dos ensaios e sessenta meses após. Esses achados podem, em parte, explicar o papel prejudicial da imunossenescência no contexto da infecção crônica pelo HIV. Immunosenescence changes are occurring in PLWH much earlier than in nonHIV infected individuals. The most notable changes happen in the adaptive immune system, especially in the T cell compartment. This study aims to assess the profiles of immunosenescence and exhaustion of circulating CD4+ and CD8+ lymphocytes in PLWH, as well as the possible correlation between immunosenescence profiles and absolute values and percentages of T CD4 lymphocytes at time zero and sixty months after. The immunosenescence and exhaustion were evaluated by flow cytometry through the expression of cell surface markers: CD45RA, CD27, CD28, CD57, CD62L, CCR7, CD95/Fas and programmed death-1 (PD-1). Samples were collected from 46 PLWH on follow up at a Reference Center for Infectious and Parasitic Diseases (Centro de Treinamento e Referência e Doenças Infecciosas e Parasitarias-Orestes Diniz) in Belo Horizonte, Brazil. Another 20 HIV seronegative individuals were included as a control group. PLWH were divided into three groups according to laboratory profiles in: slow progressors (SP), active replication (AR) and HAART with success. All subjects signed an informed consent form and this project was approved by the Institutional Research Ethics Committee. Our findings show that when compared to HIV seronegative individuals, PLWH had a decrease in naïve cells, as well as higher frequency and expression of effector cells in intermediate and advanced stages of differentiation. However, differences were observed among the three groups: a) In the AR group we observed the majority of the immune changes; b) CD4 and CD8 Immunophenotypic changes were seen in patients from both the AR and HAART groups; c) In the SP group these changes occurred exclusively in the CD8 compartment. On the other hand, the presence of immunosenescence profiles were negatively correlated with T CD4 absolute values and percentages at time zero and sixty months after. In conclusion our results show an increase in CD4 and CD8 immunosenescence profiles in all groups of PLWH studied and the expansion of these terminally differentiated cells had also a negative impact in the CD4+ count at time zero and sixty months after. These findings may in part explain the harmful role of immunosenescence in the chronic HIV infection.

Atualmente, a infecção pelo HIV é considerada uma condição crônica, com grande aumento da sobrevida daqueles em tratamento adequado e com isto facilitando o aparecimento de outras comorbidades com possível risco de ocorrer polifarmácia. As interações medicamentosas devem ser consideradas como fator preocupante devido á polifarmácia e ao perfil dessas interações, bem como suas consequências nas pessoas vivendo com HIV (PVHIV). Os objetivos desse estudo foram verificar o perfil dessas interações, avaliar sua prevalência com a terapia antirretroviral (TARV) e classificá-las de acordo com o potencial para interações significativas ou não em PVHIV, baseado no banco de dados da Universidade de Liverpool. Entre o período de junho de 2015 a julho de 2016, PVHIV, cadastradas em um serviço de referência de Belo Horizonte, foram investigadas quanto a presença de interações com a TARV e outros medicamentos em uso. Foram estudados 304 pacientes e a prevalência de interações medicamentosas encontrada foi de 50%. Mais da metade da população tinha menos de 50 anos de idade (75%) e era do sexo masculino (66,4%); 37,8% deles se autoreferiram como pardos. Aproximadamente 24% dos participantes estavam em uso de cinco ou mais medicamentos. Pacientes com idade superior a 50 anos apresentaram maior frequência de interações medicamentosas dos antirretrovirais (ARV) com outros medicamentos, em comparação com os pacientes mais jovens (p = 0,005). Não foi encontrada relação entre o número de interações medicamentosas e a efetividade da TARV. Em análise univariada, ter idade acima de 50 anos se associou ao aumento de interações medicamentosas com a TARV (OR = 1,028, IC 95% 1,008-1049, p = 0,003). Em análise multivariada utilizar maior número de medicamentos (OR = 1,129, IC 95% = 1.111-1.147; p = 0,001) e utlizar esquema estruturado com inibidor de protease (IP) (OR = 1,101, IC 95% = 1,004-1,209; p = 0,04) se associou ao aumento destas interações. Este foi o primeiro estudo a avaliar o impacto das interações medicamentosas em PVHIV no Brasil. A maior frequência de interações medicamentosas em pacientes acima de 50 anos sugere há relação entre o envelhecimento da população e o risco da polifarmácia, levando a interações clinicamente significativas, bem como possível impacto na efetividade da resposta terapêutica. O risco dessas interações foi maior com esquema antirretroviral estruturado com IP. Esse diagnóstico é fundamental para incorporação de medidas preventivas e para o aumento da segurança medicamentosa para as PVHIV. HIV infection may be considered a chronic condition for people living with HIV (PLWH) with access to antiretrovirals (ARVs) and this has effectively increased survival. In the same token this has also facilitated the emergence of other comorbidities, increasing the risk for drug interactions (DIs) and polypharmacy.The profile of these interactions, as well as their consequences in PLWH are still not completely elucidated. The objectives of this study included the description of the profile of these interactions, their prevalenceand their classification accordingly to the potential for significant or nonsignificant DIs. From June 2015 to July 2016, PLWH, on follow-up in an Infectious Diseases Referral Center in Belo Horizonte, Brazil have been investigated for the presence of DIs. A total of 304 patients were included and the majority (75%) had less than 50 years of age, were male (66.4%) and 37.8% were self-defined as brown skinned. Approximately 24% were on five or more medications and half of them presented with DIs. Patients older than 50 years had a higher frequency of ARV DIs with other drugs when compared to younger patients (p = 0.002). No relationship was found between the number of DIs and the effectiveness of ARV. As expected, the higher the number of non-HIV medications used (OR = 1.129 95%CI 1.004-1.209, p = 0.04) was associated with an increase in DIs. The high prevalence of DIs found and the data collected should be useful to establish measures of quaternary prevention and to increase the medication security for PLWH.

O principal papel dos comitês de ética em pesquisa (CEP) é proteger os participantes das pesquisas por meio da revisão adequada dos estudos a eles submetidos para apreciação ética. Os membros que compõem os comitês devem estar capacitados para o exercício da função. Entretanto, há poucas ferramentas brasileiras disponíveis para a capacitação em ética na pesquisa. Nesse contexto, traduzir e adaptar um programa educativo internacional em ética na pesquisa apresenta-se como estratégia viável e de baixo custo. Este trabalho se propõe a traduzir e adaptar o programa online Training and Resources in Research Ethics Evaluation (TRREE) para a legislação e realidade brasileiras e analisar os efeitos da capacitação dos membros dos CEP do município de Belo Horizonte (BH), Minas Gerais, por meio do e-learning TRREE-Versão Brasil. Por meio desta pesquisa foi possível finalizar a tradução e adaptação do TRREE e definir um protocolo específico de 12 passos para essa atividade, que poderá ser aplicado à outras ferramentas de capacitação em ética na pesquisa, além da construção de um suplemento nacional brasileiro. Após finalizar o e-learning TRREE-Versão Brasil, fez-se necessário realizar um estudo-piloto com a inclusão de membros de três CEPs de BH, com o objetivo de analisar os efeitos dessa ferramenta educativa para membros de comitês, conhecer a opinião dos participantes acerca do TRREE e entender se o programa é uma estratégia que deveria ser considerada para a capacitação dos membros de CEP. Apenas 19,40% (n=11) dos convidados para participar nessa etapa da pesquisa (n=67) realizaram todas as etapas deste estudo. Os resultados do estudo-piloto demonstraram aumento na mediana de acertos no questionário pré e pós-realização do TRREE-Versão Brasil dos participantes do estudo, de 7,3 para 8,7 (p=0,04). Também foi observado que, na opinião de 92,3% dos participantes, a realização do programa TRREE contribuiu de alguma forma para a revisão de protocolos de pesquisa. Os participantes sugeriram melhorias no e-learning TRREE, principalmente quanto ao aperfeiçoamento da linguagem do programa. Ao final do estudo, concluiu-se que o learning TRREE-Versão Brasil é uma ferramenta para capacitação de membros de CEP que deve ser considerada e que a tradução e adaptação de um programa educativo internacional em ética na pesquisa são necessárias e viáveis por meiodo trabalho em equipe multicultural e multiprofissional. Espera-se que sua ampla utilização possa contribuir para a promoção do conhecimento dos membros dos CEP e para a proteção dos participantes de pesquisa. The main role of research ethics committees (REC) is to protect research participants by means of adequate reviews of the studies they are submitted to, by evaluating their ethical dimension. The members that make up the committees should be adequately trained to exercise this function, in the face, however, of few Brazilian tools available for this purpose in research ethics. In this context, to translate and adapt an international educational programme in research ethics presents itself as a feasible and low cost strategy. We propose in this work to translate and adapt the online programme Training and Resources in Research Ethics Evaluation (TRREE) to bring it into line with Brazilian legislation and the real situation in Brazil, and then analyse, by means of a pilot study, the effects of this capacitation of REC members from the municipality of Belo Horizonte (BH), Minas Gerais, using the adapted version which we are calling e-learning TRREE Brazil version. By means of the study it was possible to finalize the translation and adaptation of the TRREE and define a specific protocol of 12 stages for this activity that can be applied to other capacitation tools in research ethics, as well as to construct a Brazilian National supplement. After finalising the e-learning TRREE Brazil version, the pilot study was carried out with the inclusion ofmembers of three RECs in BH, with the objectives of analysing the effects of this educational tool for committee members, of getting to know participants opinion of it, and to decide whether the programme is a strategy that should be considered for the capacitation of REC members. Only 19.40% (n=11) of those invited to participate in this stage of the research (n=67) completed all the stages of this study. The results of the pilot study showed an increase in the median of correct answers on the questionnaire before and after realization of the TRREE-Brazil Version by the participants in the study, from 7.3 to 8.7 (p=0.04). It was also observed that in the opinion of 92.3% of the participants, doing the TRREE programme contributed in some way to the review of the research protocols. The participants suggested improvements to the e-learning TRREE, mainly in relation to perfecting the programme language. At the end of the study, we concluded that the learning TRREE-Brazil Version is a tool for the capacitation of REC members that should be considered, and that the translation and adaptation of an international educational programme in research ethics is necessary and feasible through work in a multi-cultural and multi-professional team. It is to be hoped that its wide utilisation will contribute to promoting the knowledge that REC members possess of the subject, and consequently to the protection of research participants.

A pesquisa discute a eutanásia e o suicídio assistido, condutas tipificadas como crime no Brasil, tendo como ponto de partida os livros O Escafandro e a Borboleta, de Jean- Dominique Bauby, e Cartas do Inferno, de Ramón Sampedro. Faremos uma análise daquilo que é sagrado e de como o sagrado é interpretado nas religiões e no Direito para propor uma reestruturação conceitual do bem jurídico vida, a fim de que nele possam ser incorporadas tanto a noção de vida dada quanto a de vida construída. Assim, será criado um espaço de escolha para que as pessoas possam, de forma livre e responsável, determinar até quando e como viver. The research discusses euthanasia and assisted suicide, which are legally typified as criminal conducts in Brazil. The study departs from an analysis of the books O Escafandro e a Borboleta, from Jean-Dominique Bauby, and Cartas do Inferno, from Ramón Sampedro, to scrutinize the meaning of what is considered to be sacred and holy both in Religion and Law. The aim of this study is to conceptually restructure the notion of life as a protected legal interest that embodies both the ideas of the life given and the life built. This restructuration, thus, might provide people a space of choice to make free and responsible decisions concerning the way and how long they want to live.

O contato humano com resíduos sólidos implica em riscos biológicos, químicos e físicos à saúde dos trabalhadores envolvidos com a coleta, transporte e armazenamento. A exposição abrange fatores como excesso de ruído, exposição à radiação solar, esforço muscular excessivo, presença de materiais perfurocortantes, agentes patogênicos e reagentes químicos perigosos. Os resíduos de serviços de saúde (RSS), devido às suas características, são potenciais fontes de disseminação de agentes etiológicos. Assim, este trabalho avalia o risco de infecção pelos vírus das hepatites B e C inerente àatividade de manuseio de RSS, se comparado ao manuseio de resíduos sólidos domiciliares, bem como a percepção dos trabalhadores sobre a rotina de coleta e seus riscos. A metodologia abrangeu revisão da literatura, meta-análise, estudo epidemiológico transversal e entrevistas com grupos focais. O estudo transversal foicomposto por 522 trabalhadores, sendo 461 indivíduos expostos a resíduos sólidos domiciliares e 61 expostos a resíduos de serviços de saúde, entre novembro de 2014 e janeiro de 2015. Também foram realizados seis grupos focais com trabalhadores em atividades de coleta de resíduos sólidos. Foram encontradas similaridades em relação à prevalência da hepatite B entre os dois grupos, e um resultado marginalmente superior, embora não significativo, da prevalência da hepatite C nos expostos a RSS em relação aos expostos a resíduos sólidos domiciliares. Os trabalhadores associam a ocorrência dedoenças à atividade que desempenham, entendem que o trabalho oferece riscos e consideram acidente apenas os eventos que os afastam do trabalho, desconsiderando, na maioria das vezes, os cortes provocados por materiais perfurocortantes. Human contact with waste involves biological, chemical and physical health damages of workers involved in the collection, transportation and storage. The exposure to wastes covers factors such as excessive noise, solar radiation, excessive muscular effort, exposure to pathogens and toxic chemicals. Healthcare wastes HCW are potential sources of spread of disease. The aim of this thesis is to evaluate the risk of infection with hepatitis B and C inherent in the HCW management activity, compared to the management of domestic waste. It will also be assessed the perception of the workers about the routine collection and its health risks. The applied methodology included literature review, meta-analisys, cross-sectional epidemiological study and focal groups.The cross-sectional study included 522workers, 461 subjects exposed to domestic waste and 61 subjects exposed to healthcare waste, between November 2014 and January 2015. Six focal groups were conducted with exposed to wastes. Were found similarities between hepatitis B prevalence between two groups, and a higher marginal result ofhepatitis C prevalence in exposed to healthcare waste if compared to those expose to domestic wastes, although not statistically significant. Workers associated the occurrence of diseases to the activity they performed, they comprehended risk associated to labor and considered labor accident just the events that they could not continue working, not considering many cuts provided by sharps.

A transformação do HIV/AIDS em doença crônica produziu indagações sobre a qualidade de vida das pessoas vivendo com essa doença. Neste estudo analisou-se a qualidade de vida das pessoas vivendo com HIV/AIDS na região Norte do estado de Minas Gerais, Brasil. Trata-se de um estudo transversal, descritivo e analítico em que foram avaliados 226 indivíduos vivendo com HIV/AIDS com idade acima de 18 anos, residentes principalmente em 52 municípios da mesorregião Norte de Minas Gerais, em tratamento em dois Serviços de Assistência Especializada em HIV/AIDS e assistidos entre maio de 2013 e maio de 2014. Foram usados os seguintes instrumentos de coleta de dados: questionário sociodemográfico, questionário clínico, Mini Exame do Estado Mental, Inventário de Depressão de Beck, CAGE e o questionário específico para avaliar qualidade de vida proposto pela Organização Mundial de Saúde o WHOQOL-HIV Bref. Nessa população 51,8% são do sexo masculino, a idade mínima foi 19 anos, a máxima de 73 e média de 44 anos. São analfabetos 16,4%, 35,4% têm apenas o primário, 16,4% completaram o ensino fundamental, 25,7% têm o ensino médio e apenas 6,2% têm curso superior. Em relação à renda individual 56,3% ganham até um salário mínimo e 20,9% ganham entre 1,1 e 2 salários mínimos, 11,7 recebem entre 2,1 e 3 salários e 11,2% tem remuneração superior a 3 salários mínimos; de acordo com a classificação econômica 8,0% pertencem à classe B, 54,9% à classe C e 37,2% estão na classe D e não houve nenhum paciente da classe A neste estudo. O uso de medicação antirretroviral foi confirmado para 89,8% dos pacientes, 7,1% apresentaram contagem de linfócitos T CD4+ abaixo de 200 cels/mm3 37,2% entre 201 e 500 e 55,8% acima de 500cels/mm3. A qualidade de vida foi auto avaliada como boa ou muito boa por 65% dos entrevistados. A avaliação realizada com o uso do WHOQOL-HIV Bref demonstrou que, no geral, a qualidade de vida dessa população encontra-se num nível intermediário, com os maiores escores encontrados no domínio espiritualidade e os menores no domínio meio ambiente. Os sintomas depressivos impactaram a qualidade de vida em todos os domínios: físico OR=11,3, psicológico OR=12,4, nível de independência OR=7,2, relações sociais OR=4,1, meio ambiente OR=5,7, espiritualidade OR=5,3, e na qualidade de vida geral OR=3,0 todos com IC95% e p

A ciência, preocupada com a comprovação de teorias, alcance de tratamentos inéditos e eficazes, bem como com a realização de novas descobertas, esforça-se por ultrapassar seus limites. Nem sempre se preocupa ou se ocupa corretamente com a reflexão ética acerca das posturas adotadas. Desse modo, compete à bioética demarcar os limites de atuação da ciência, conferir legitimidade aos métodosenvolvidos e oferecer o crivo ético sobre qual método a ciência se empenhará em promover a generalização e a fruição das benesses do resultado das pesquisas. O Código de Nuremberg, a Declaração de Helsinque e a resolução 466/12 do Ministério da Saúde do Brasil representam posicionamentos éticos diante do uso indiscriminado das biotecnociências ocorrido nas últimas décadas do século XX einício do século XXI. Ambos constituem-se mecanismos de respostas éticas da sociedade à avalanche de descomedimentos biotecnocientíficos trazidas à baila pela pós-modernidade. Diante do exposto, a questão norteadora desse trabalho reside na compreensão dos limites e das possibilidades da proteção oferecida às vulnerabilidades dos participantes de pesquisas clínicas pela resolução 466/12, a fim de elucidar os avanços e/ou retrocessos descortinados por este novo diploma legal. A metodologia empregada foi pesquisa qualitativa de caráter exploratório e descritivo. Como instrumento de coleta de dados, utilizou-se a entrevista episódica e os dados foram analisados com análise argumentativa. Os participantes da pesquisaforam membros dos comitês de pesquisa de CEPS do estado de Minas Gerais. Os resultados obtidos foram: interferência direta da experiência do entrevistado como membro de CEP e a sua percepção do enfraquecimento das garantias e proteções dos participantes da pesquisa clínica em seus direitos e garantias e a participaçãoburocrática nos CEPS desta situação e a avaliação da autora dos dados obtidos. Assim, conclui-se pelo fortalecimento do sistema CEP/CONEP e pela conjugação entre os princípios da bioética da autonomia para os princípios da bioética da proteção. The science, concerned about proving theories, the range of original and effective treatments, as well as the realization of new discoveries, strives to exceed its limits. It isnt always worried or properly concerned about the ethical observation of adopted postures. Thus, competes to bioethics delimitate the limits of action of science, attest legitimacy on the involved methods and offer ethical cribble on which method the science will work to promote the widespread and fruition of the benefits of the results of research. The Nuremberg Code, the Helsinki Declaration and 466/12 Resolution of the Health Department of Brazil represents the ethical positions on the indiscriminate use of biotechnosciences occurred in the last decades of the 20th century and early 21st century. Both constitute itself as mechanisms of ethical responses of society tothe avalanche of biotechnoscientific slights brought by the postmodernity. Given above, the guiding question of this work lies on understanding the limits and possibilities of offered protection to the participant vulnerabilities of clinical research by 466/12 Resolution, in order to elucidate the progress and/or setbacks revealed by this new law. The methodology used was qualitative exploratory and descriptive research. As data collection instrument, was used the episodic interviews and datawere analyzed with argumentative analysis. Survey participants were members of CEPS research committees of the state of Minas Gerais. The results were: direct experience interference of the interviewee as a CEP member and their perception of the weakening of guarantees and protections of clinical research participants on their rights and the bureaucratic participation in CEPS of this situation and the evaluationof the obtained data by the author. Thus, was decided for the strengthening of the CEP/CONEP system and the combination between the bioethics of autonomy principles and the bioethics of protection principles.

Introdução: A epidemia pelo HIV representa um grande problema de saúde pública mundial e um desafio a ser vencido. O diagnóstico tardio, situação frequentemente relatada na literatura em diversos países, gera implicações negativas para o indivíduo e a sociedade. A introdução da TARV transformou uma doença de alta letalidade em um processo crônico, de manejo clínico mais fácil e possibilitou aumento da sobrevida e qualidade de vida das pessoas vivendo com HIV/Aids (PVHA). Existem poucos dados brasileiros sobre a efetividade do primeiro esquema ARV o que justifica o desenvolvimento do presente estudo. Objetivos: Descrever as características clinico-epidemiológicas da população em estudo, sua resposta imunológica e virológica ao tratamento; analisar a efetividade do primeiro esquema ARV em 48 semanas de inicio da TARV. Metodologia: Trata-se de estudo de coorte conduzido para avaliar a efetividade do primeiro esquema antirretroviral em pacientes adultos iniciando TARV no Serviço de Referência em Doenças Infecto-parasitárias (CTR/DIP) Orestes Diniz entre outubro de 2010 e janeiro de 2013. O projeto foi aprovado pelo COEP-UFMG nº. ETIC 0251.0.203.000-11. Resultados: Foram incluídos 191 pacientes com predominância do sexo masculino, raça parda, idade média de 37,5 anos e com 8 a 11 anos de estudo. Quanto às sorologias para hepatites virais disponíveis, 2,4% eram HbsAg positivo e 4,6% apresentavam sorologia positiva para Hepatite C. A mediana inicial de CD4 foi baixa (275 céls/mL) e 11,7% apresentavam CV inicial maior 100.000 cópias/mL. O esquema ARV mais utilizado foi AZT/3TC e EFZ (49,7%). Os regimes contendo IP representaram apenas 17,7%. A taxa de efetividade medida através da CV< 50 cópias/mL foi 91,4% no período de tempo estudado. Discussão: Os dados sócio-demográficos encontrados foram semelhantes aos descritos pelo MS e os ARV prescritos seguiram as recomendações vigentes na época. Percebe-se inicio tardio dos ARV com boa resposta terapêutica. Conclusão: Apesar do inicio tardio da TARV as respostas imunológica e virológica foram superiores às estimadas demonstrando uma maior efetividade em relação a outros estudos. Introduction: The epidemic of the human immunodeficiency virus HIV is a major public health problem worldwide and a challenge to be overcome. The diagnosis of HIV is delayed, which generates negative implications for the person as an individual and society. The introduction of Highly Active Antiretroviral Therapy (HAART) turned a highly lethal disease into a chronic process, it made the clinical management easier and significantly increased the survival rate and quality of life of people living with HIV/AIDS (PLWHA). There are few Brazilian data on the effectiveness of the first ARV regimen, which justifies the development of this study. Objectives: To describe the clinical and epidemiological features of the studied population, their immunological and virological response to treatment; to analyze the effectiveness of the first antiretroviral regimen within 48 weeks of initiation of HAART. Methods: All patients undergoing treatment at CTR-DIP HC-UFMG / PBH service that started HAART for the treatment of HIV infection between October 2010 and January 2013, that had 18 years of age, both sexes, were invited to participate the study. The project was approved by paragraph COEP-UFMG. ETIC 0251.0.203.000-11. Results: 191 patients were included with a male predominance, neither white or black, median age 37,5 years old and with 8 to 11 years of study. As to serology for viral hepatitis are available, 2.4% were seropositive for HBsAg and 4.6% for hepatitis C. The average initial CD4 cell count was low (275 cells / mL) and 11.7% had initial VL larger than 100,000 copies / mL. The most commonly used ARV regimen AZT / 3TC and EFV (49.7%). PI-containing regimens accounted for only 17.7%. The rate of effectiveness measured through VL

Introdução: Diversos estudos documentaram a eficácia e efetividade dos novos antirretrovirais (ARVs), que orientados pelo teste de genotipagem possibilitaram confeccionar esquemas de resgate que sustentam níveis plasmáticos do HIV abaixo de 50 cópias/ml. Entretanto, a efetividade da terapia de resgate ainda não foi avaliada noBrasil. Objetivos: avaliar, em pacientes com ampla experiência aos ARVs, a efetividade virológica e imunológica e fatores associados à falha terapêutica na semana 48 de esquemas de resgate contendo darunavir (DRV) e/ou raltegravir (RAL) e/ou enfuvirtida (ENF), bem como a evolução daqueles que realizaram substituição de ENF por RAL, estando com CV menor que 400 cóias/ml. Método: coorte retrospectiva com pacientes de 14 centros de referência do Brasil, distribuídos em sete diferentes estados, que iniciaram tratamento de resgate entre os anos de 2005-2010, após falha virológica documentada. Os desfechos primários avaliados na semana 48 (± 4semanas) de acompanhamento foram a proporção de pacientes com carga viral (CV) 100 células/mm3 (OR=0,42; IC95%=0,29 0,59) foram fatores protetores em relação falha terapêutica nos esquemas iniciados com DRV, ambos com p 50.000 ou > 100.000cópias/ml, relacionaram-se fortemente com falha terapêutica (OR=2,84; IC95%=1,67 4,83 e 3,14; IC 95%=1,82-5,42 respectivamente, ambos com p100 cel/ml had less chance of virologic failure: OR=0.42 (CI95% 0.26 0.67) and OR=0.42 (CI95%=0.29 0.59) respectively. Among patients onRAL group, high viral load (>50,000 or 100,000 copies/ml) was related with therapeutic failure (OR=2.84; CI95%=1.67 4.83 and OR=3.14; CI95%=1.82-5.42, both with p

INTRODUÇÃO: meninos e meninas têm iniciado sua vida sexual cada vez mais cedo e em contextos diferenciados. As práticas sexuais dos jovens têm sido descritas como dinâmicas e em constantes transformações, o que pode impactar na sua vida sexual e reprodutiva. OBJETIVOS: 1) avaliar os conhecimentos sobre modos de prevenção e de transmissão de DST/HIV; 2) determinar a prevalência de comportamentos de risco e 3) traçar os perfis de vulnerabilidades juvenis a esses agravos. MÉTODOS: trata-se de um estudotransversal com uma amostra aleatória definida em duas etapas. A amostra final foi composta por 775 adolescentes de onze escolas públicas de Montes Claros, Minas Gerais, Brasil. Os sujeitos responderam a um questionário autoaplicável com perguntas no modelo Comportamentos Atitudes e Práticas (CAP). Os dados foram coletados entre 2008 e 2009 e analisados com o auxílio do pacote estatístico SPSS. Seguiu-se uma abordagem bivariada com uso dostestes Qui-quadrado e Exato de Fisher quando indicado. RESULTADOS:Constatou-se predominância de adolescentes do sexo feminino (73,2%), com idades até os 17 anos (89,1%). A maioria estava matriculada no ensino fundamental (73,1%), residiam com ambos os pais (51,7%) e praticavam a religião católica (55,8%). A experiência sexual foi relatada por 34,8% da amostra, sendo 57,2% meninos e 26,6% meninas (p

A tuberculose (TB) é doença infecciosa cujo controle, até o momento, permanece um desafio. O Brasil está entre os 20 países responsáveis por 80% dos casos do mundo. A forma pulmonar é responsável pela disseminação da doença, particularmente em regiões urbanas, o que vem sendo atribuído a fatores como pobreza, aglomeração domiciliar, instabilidade social e infecção pelo HIV. Objetivos: avaliar fatores de risco para TB pulmonar com baciloscopia positiva em BeloHorizonte; avaliar os níveis dos marcadores proteína C reativa (PCR), albumina e lactato dehidrogenase (LDH) nesses pacientes; descrever suas manifestações clínicas e radiológicas; avaliar a freqüência de tuberculose multirresistente na população estudada. Métodos: estudo caso-controle pareado; pacientes com baciloscopia de escarro positiva e controles procedentes da mesma unidade de saúde, de mesmo sexo e idade (± cinco anos), sem sintomas respiratórios. Foram investigados, através de um questionário estruturado, as características demográficas, aglomeração domiciliar, classificação sócio-econômica, tabagismo, história de infecções sexualmente transmissíveis, uso de drogas, exposição à sílica e à fumaça de fogão a lenha, história de transfusão sanguínea, hepatite, diabetes, contato com TB nos dois anos anteriores, história pregressa de TB, história familiar de TB e alcoolismo. Amostras de sangue foram colhidas em jejum para adeterminação da glicemia e para sorologias para HIV, hepatites B e C, além de dosagens de (PCR), albumina, (LDH), aspartato aminotransferase, alanina aminotransferase, fosfatase alcalina, creatinina e hemograma. As radiografias do tórax foram examinadas. Cultura e teste de sensibilidade foram realizados em 158 (70,5%) casos. As análises estatísticas foram feitas através dos testes de McNemar, Wilcoxon e regressão logística condicional. A probabilidade de significância foi inferior a 5%. Resultados: Duzentos e vinte e quatro casos e 224 controles foram incluídos, dos quais 150 (67,0%) eram homens. A média de idade dos casos e dos controles foi de 39,3 (± 13,0) e 39,5 (± 12,9) anos, respectivamente. Foram fatores de risco independentes para TB pulmonar: alcoolismo (OR = 6,65, IC 95% 5,74 -7,56; p < 0,001), história prévia de TB (OR = 6,43, IC 95% 5,31 - 7,56; p = 0,001), diabetes (OR = 5,90, IC 95% 4,70 - 7,10; p = 0,004), sorologia antiHBc IgG positiva (OR = 5,15 IC 95% 4,22 - 6,08; p = 0,001), história familiar de TB (OR = 4,71, IC 95% 3,98 - 5,44; p = 0,001), tabagismo atual (OR = 4,36, IC 95% 3,65 - 5,07; p < 0,001), e não ser casado (OR = 2,73, IC 95% 2,06 - 3,40; p = 0,003). PCR quantitativa e albumina foram significativamente alteradas. Manifestações pulmonares ocorreram em mais de 90% e sistêmicas em mais de 70% dos casos. O tempo entre o início dos sintomas e o diagnóstico foi, em média, de 16,26 (± 18,75)semanas. As radiografias do tórax evidenciaram cavitações em 67,1% dos casos. TBMR foi encontrada em três de 158 (1,9%) casos que realizaram cultura. Conclusão: Alcoolismo, história prévia de TB, diabetes, sorologia positiva anti HBc, história familiar de TB, tabagismo atual, ser não casado foram fatores de risco para TB pulmonar. A PCR e a albumina podem ser marcadores de atividade da doença. O diagnóstico da tuberculose pulmonar com baciloscopia positiva foi tardio e a apresentação clínica foi de doença avançada, com elevada freqüência de lesões cavitárias na radiografia do tórax. TB multirresistente foi observada em 1,9% dos casos que realizaram a cultura de escarro. Tuberculosis (TB) control is still defying the world. Brazil is one of the 20 high burden countries. Pulmonary TB is responsible for the maintenance of the dissemination of the disease. TB rates are particularly high in urban areas associated mainly with factors such as poverty, crowded living conditions, social instability and HIV infection. Objective: to evaluate risk factors for positive pulmonary tuberculosis in Belo Horizonte; to evaluate the levels of inflammatory markers C-reactive protein (CRP),albumin and lactate dehydrogenate (LDH) in pulmonary TB patients; to describe clinical and radiological manifestations of pulmonary TB in the same setting; to measure the resistance to chemotherapy in the studied group. Methods: design: matched case control study; patients with positive smear and controls from the same health unit matched by sex and age (± 5 years), with no respiratory symptom. Demographic data, domiciliary crowding, social status, smoking, history of sexuallytransmitted infections and use of illicit drugs, exposition to silica or to biomass smoke, blood transfusion, hepatitis, diagnosis of diabetes, contact with TB in the previous two years, previous TB, family history of TB and a validated version in Portuguese of the CAGE alcoholism screening test were investigated utilizing a structured questionnaire. Blood samples were drawn for the determination of glucose level and for HIV, hepatitis B and C serology. Chest radiographs (CXR) were examined. Sputum specimens were cultured. Results: Two hundred and twenty four cases and 224 controls were included. One hundred and fifty cases (67.0%) were male. Age of cases and of controls had mean of 39.3 (± 13.0) and of 39.5 (± 12.9) respectively. The conditional logistic regression model showed that alcoholism (OR = 6.65, IC 95% 5.74 - 7.56; p < 0.001), previous history of TB (OR = 6.43, IC 95% 5.31 - 7.56; p = 0.001), diabetes (OR = 5.90, IC 95% 4.70 - 7.10; p < 0.004), positive anti HBc IgG serology (OR = 5.15 IC 95% 4.22 - 6.08; p < 0.001), family history of TB (OR = 4.71, IC 95% 3.98 - 5.44; p < 0.001), tobacco smoking (OR = 4.36, IC 95%3.65 - 5.07; p < 0,001) and being not married (OR = 2.73, IC 95% 2.06 - 3.40; p = 0,003) were independently associated with pulmonary TB. C-reactive protein and albumin were significantly altered. Pulmonary manifestations occurred in more than 90% of the patients and systemic in more than 70%. Time from beginning of symptoms and diagnosis was 16.26 (± 18.75) weeks. CXR showed cavitations in 67.1% of cases. TBMR occurred in three of 158 of those who had sputum cultured (1,9%). Conclusion: Alcoholism, previous history of TB, diabetes, positive anti HBc serology, smoking, family history of TB, and being not married were risk factors for pulmonary TB. CRP and albumin may be used as markers of disease activity. Contrarily to what is thought to be, the sputum positive pulmonary TB may be a late diagnosed disease made when clinical presentation is advanced and cavitary lesions are frequent. Multiresistant TB was observed in 1.9%

O Brasil tem um programa modelo de prevenção, diagnóstico e tratamento da infecção pelo HIV-1 e os monitoramentos regionais da epidemiologia molecular e da resistência transmitida às drogas (RTD) são primordiais. No estudo de mutações do HIV-1 são habitualmente incluídas as regiões da protease (PR) e polimerásica da transcriptase reversa (TR), mas estudos recentes indicam que mutações nos domínios C-terminais da TR podem contribuir para a resistênciaprimária ou compensatória na presença ou ausência de mutações aos análogos timidínicos (TAM). Em relação à heterogeneidade genética do HIV-1, a região Sul apresenta um padrão diferente do Brasil, com predomínio do subtipo C, seguido pelo B, formas recombinantes e subtipo F1. Objetivos: avaliar a prevalência de RTD em pacientes com diagnóstico recente de infecção pelo HIV-1 com diferentes subtipos virais no extremo sul do Brasil e correlacionar estes dadoscom as características demográficas, comportamentais, clínicas e laboratoriais da população estudada. Pacientes e métodos: Foi realizado um estudo transversal com pacientes virgens de TARV diagnosticados entre janeiro-2005 e dezembro- 2008 no Hospital Universitário da Universidade Federal do Rio Grande (RS).Foram sequenciadas as regiões genômicas virais referentes à protease (PR) e regiões polimerásica, Conexão (CN) e RNase H da TR. O subtipo viral foi determinado usando sequências-referência obtidas na base de dados de Los Alamos. Sequências em que o subtipo atribuído variava em função da região genômica foram submetidas à análises de recombinação no programa Simplot. A pesquisa de mutações de RTD foi feita na base de dados de HIV de Stanford eanalisada segundo o algoritmo específico para RTD. Nos domínios CN e RNAse H, as mutações consideradas nesta pesquisa foram: N348I; 360V; T369I/V; A371V. A400T na CN e I506L, Q509L; Q547K na RNaseH. Um banco de dados com as variáveis estudadas foi montado no programa Excel para posterior análise estatística no programa Stata 9.2. Para estudar a associação dos subtipos e das mutações de resistência com as variáveis incluídas foram usados os testes de qui-quadrado, exato de Fisher, t de Student e o teste não-paramétrico de Kruskal-Wallis. Resultados: foram obtidas análises moleculares de 245 isolados e a correlação com os dados clínicos foi estudada em 233 pacientes. Destes, 46,8% preenchiam critérios de Aids. O subtipo C foi responsável por 56,3% das infecções e associado com transmissão heterossexual (p=0,001) e maior contagem de LTCD4+ (p=0,02). A prevalência de RTD no domínio polimerásico da TR e PR foi de 6,56%, com 3,45% aos INTRs e INNTRs; 1,42% para IP e 1,64% MDR. Na região da CN, a prevalência de resistência foi de 36%, com 3,65% paraA371V; 1,82% para T369I/V e 32,92% para A400T. No domínio RNase H a prevalência de resistência foi de 3,57%, com 2,98% para Q547K e 0,60% para I506L. As mutações A360V; N348I e Q509L não foram encontradas. A associação de mutações de resistência nos domínios C-terminais com os subtipos mostrou que o C teve menor RTD na CN (p = 0,001) às custas da substituição A400T, presente em 36% dos isolados, que teve menor prevalência neste subtipo (p =0,001) e na RNase H (p = 0,003). Conclusões: A epidemiologia molecular do HIV-1 no extremo sul do Brasil encontra-se estabilizada com predomínio do subtipo C. Este é o 1º estudo mostrando associação entre o subtipo C e a transmissão heterossexual do HIV-1 no Brasil. A prevalência de RTD na região polimerásica da TR e PR é baixa e não foi associada com os subtipos. Entretanto, nos domínios C-terminais houve associação significativa entre RTD e subtipos virais. Brazil has a program which is a model in the prevention, diagnosis and treatment of HIV-1 infections. Besides, the regional monitoring of molecular epistemology and transmitted drug resistance (TDR) are essential. The studies of HIV-1 mutations usually include protease (PR) and polymerase regions of reverse transcriptase (RT), however, recent studies have shown that mutations in the Cterminal of RT domains may contribute to primary or compensatory resistance in the presence or absence of timidine analog mutation (TAM). Regarding the HIV-1 genetic heterogeneity, the southern region has shown a pattern which is different from the whole countrys: there is predominance of subtype C, followed by B, recombined forms and subtype F1. Objectives: to evaluate the prevalence of TDR in patients who have just been diagnosed with HIV-1 infection with different viral subtypes in the very south of Brazil and to correlate these data to the demographic, behavioral, clinical and laboratorial characteristics of the population under study. Patients and methods: A transversal study with patients who had not undergone HAART (High Activity Antiretroviral Therapy), diagnosed from January 2005 to December 2008 in the university hospital that belongs to the Universidade Federal do Rio Grande, RS, was carried out. Genomic viral regions which refer to the protease (PR) and the polymerase regions, Connection (CN) and the RNase H of the reverse transcriptase (RT) were sequenced. The viral subtype was determined by using reference-sequences obtained from the Los Alamos database. Sequences in which the attributed subtype varied according to the genomic region underwent recombination analyses in the Simplot program. The research on TDR mutations was carried out in the Stanford HIV database and analyzed according to the specific TDR algorithm. In the CN and RNase H domains, the mutations that were considered in this research were: N348I; 360V; T369I/V; A371V and A400T in CN and I506L, Q509L and Q547K in RNase H. A database with the variables under study was assembled in an Excel program for further statistical analysis in Stata10.2. In order to study the association of subtypes and the mutations of resistance with the variables, the Chi square test, the Fischers exact test, the Students t-test and the Kruskal-Wallis non-parametric test were applied. Results: Molecular analyses of 245 isolates were obtained and the correlation with the clinical data was studied in 231 patients; 46.8% of them met the AIDS criteria. Subtype C was responsible for 56.3% of infections and associated with heterosexuality (p=0.001) and the highest LTCD4+ counting (p=0.02). The prevalence of TDR in the polymerase domain of PR and RT was 6.56%, with 3.45% to NRTI and NNRTI; 1.42% to IP and 1.64% MRD. In the CN region, the prevalence of resistance was 36%, with 3.65% to A371V; 1.82% to T369I/V and 32.92% to A400T. In the RNase H domain, the prevalence of resistance was 3.57%, with 2.98% to Q547K and 0.60% to I506L. Mutations A360V, N348I and Q509L were not found. The association of the mutations of resistance in the C-terminal domains with the subtypes showed that C had lower TDR in CN (p=0.001) due to the substitution A400T, present in 36% of the isolates which had lower prevalence in this subtype (p= 0.001) and in RNase H (p= 0.003). Conclusions: The molecular epidemiology of HIV-1 has been stabilized with predominance of subtype C in the very south of Brazil. This is the first study which shows the association of subtype C and the HIV-1 heterosexual transmission in Brazil. The prevalence of TDR in the polymerase region of RT and PR is low and was not associated with the subtypes. However, there was meaningful association among TDR and viral groups in the C-terminal domains.

A tuberculose é uma doença infecciosa que atinge milhões de pessoas em todo o mundo, constituindo-se em um grave problema de saúde pública. O tratamento deve ser feito, preferencialmente, em caráter ambulatorial, conforme preconizado pela DOTS (Estratégia doTratamento Diretamente Observado). A hospitalização é recomendada apenas nos casos de meningoencefalite; indicações clínicas ou cirúrgicas em decorrência da tuberculose ou de comorbidades; intolerância medicamentosa incontrolável em ambulatório; estado geral que não permita tratamento em ambulatório; em casos sociais, como ausência de residência fixa ou grupos com maior probabilidade de abandono, especialmente se for um caso de retratamento ou falência. Apesar das restritas indicações para a hospitalização e dos enormesinvestimentos na estruturação de uma rede ambulatorial capaz de receber e acompanhar os pacientes, ocorreram 17.502 internações no ano de 2008, que geraram um gasto do Sistema Único de Saúde R$ 19.545.384,18. O objetivo da pesquisa foi o de conhecer o perfil dospacientes que foram internados na enfermaria de tisiopneumologia do Hospital Eduardo de Menezes no ano de 2008 e os fatores associados a internações prolongadas. Um dos critérios de exclusão era de pacientes HIV positivo ou com aids, pois nesta enfermaria só se internavam os pacientes soro-negativos. Foi definida como internação prolongada aquela de período superior a 25 dias, e os dados clínicos e sociais dos pacientes foram analisados no Epi Info e no pacote SPSS. O total de pacientes foi de 64 e o perfil médio pode ser caracterizado como sendo homem, com idade entre 35 e 54 anos, não branco, com renda inferior a um salário mínimo, escolaridade de até 1º grau, tabagista, usuário de álcool, com desnutrição, hipoalbuminemia e anemia, que receberam o tratamento com o esquema 1 e com tempo médio de internação de 64 dias. A maioria foi encaminhada para a internação hospitalar deunidades de pronto-atendimento ou de hospitais. A baixa escolaridade e a história de abandono de tratamento tiveram relevância estatisticamente significativa como determinantes de internação prolongada (p 0,02 e 0,018, respectivamente) e a internação por intolerância medicamentosa teve relevância estatística para internações por um período igual ou menor que 25 dias (p 0,05). O grande comprometimento clínico e a precária situação social da maioria dos pacientes, assim como o pequeno tamanho amostra, que apresentou relativa homogeneidade, podem ter dificultado o encontro de outros indicadores relevantes para internações prolongadas. A baixa escolaridade geralmente está associada à pior situação social e, consequentemente, apresentação clínica mais grave da doença, o que prolonga as internações. O histórico de abandono leva, no mais das vezes, a internações prolongadas pelo medo de novos abandonos, agravamento da doença e de suas sequelas e, também, do risco dodesenvolvimento de multirresistência. A internação motivada pela intolerância medicamentosa é interrompida tão logo o paciente apresente condições clínicas de continuar o tratamento em regime ambulatorial, o que acontece, na maioria dos casos, num espaço detempo menor que 25 dias. Entre as propostas que fortaleçam as estratégias de tratamento ambulatorial eficaz e que auxiliem nas estratégias para a redução do tempo de internação hospitalar no tratamento da tuberculose está a de implantar a investigação estratégica da tuberculose nos hospitais de urgência e emergência nos grandes centros urbanos e em grupos de maior risco, além de facilitar o acesso dos pacientes às unidades básicas de saúde; incentivo permanente à capacitação dos profissionais de saúde, com ênfase na capacitaçãomédica para identificação de intolerância e abordagem ambulatorial; construção de ações comuns entre os programas do Sistema Único de Saúde e os do Sistema de Assistência Social, com estudos epidemiológicos de cada área de abrangência das unidades de saúde para elaboração de estratégias que possibilitem reverter o quadro social e a baixa escolaridade, indutores da tuberculose. Também, a ampliação do Programa de Saúde da Família voltado para o atendimento às populações de rua; oferecer abrigos, moradias temporárias e laresabrigados que possam ser utilizados no acolhimentos dos pacientes sem moradia, até o término do tratamento, possibilitando a redução do tempo de internação hospitalar. Toda a equipe de saúde deve se envolver num esforço para reduzir os percentuais de abandono. Porfim, estabelecer políticas públicas de melhoria de qualidade da alimentação, acesso a alimentação saudável e acessível, devem fazer parte das políticas de controle da tuberculose. Tuberculosis is an infectious disease that affects millions of people around the world, thus becoming a serious public health problem. Treatment should be done, preferably, on an outpatient basis, as recommended by the DOTS strategy (Directly Observed Treatment).Hospitalization is recommended only in cases of meningoencephalitis, clinical indications and surgical due to tuberculosis or comorbidities, drug intolerance uncontrollable ambulatory, general do not allow day-care, in social affairs, as no fixed abode or groups with higherlikelihood of abandonment, especially if a retreatment or bankruptcy. Despite the limited indications for hospitalization and the huge investments in building a network capable of receiving outpatient care and follow up patients, there were 17,502 admissions in 2008, whichgenerated an expense in the Health System R$ 19,545,384.18. The objective of this research was to know the profile of patients who were admitted to the ward tisiopneumologia Hospital Eduardo de Menezes in 2008 and the factors associated with prolonged hospital stay. One ofthe exclusion criteria was HIV positive or with AIDS, because this ward only interned patients HIV negative. Was defined as that of hospital stay longer than 25 days, and the clinical and social data were analyzed using Epi Info and SPSS. The total number of patients was 64 and the average profile can be characterized as being a man, aged between 35 and 54 years, not white, with incomes below the minimum wage, with schooling up to 1 degree, smoker, user spirit, malnutrition, hypoalbuminemia and anemia, who were treated with regimen 1 and the mean hospital stay of 64 days. Most were sent to the hospital units of emergency care orhospitals. The low educational level and history of noncompliance with treatment had a statistically significant relevance as determinants of prolonged hospitalization (p 0.02 and 0.02, respectively) and hospitalization due to drug intolerance was statistically significant forhospitalization for a period equal to or less than 25 days. The greatest clinical impairment and the precarious social situation of most patients, as well as the small size of the sample, which showed relative homogeneity made it difficult to meet other indicators relevant to prolonged hospitalizations. The low educational level is usually associated with poor social situation and therefore clinic, which prolongs the hospital. The history of early leads in most cases, the prolonged hospital stay for fear of further noncompliance, worsening of the disease and its sequels and also the risk of developing multidrug resistance. Admission motivated by intolerance to medication is discontinued once the patient has medical conditions to continue treatment on an outpatient basis, what happens in most cases, within a time less than 25 days.The proposals that strengthen the strategies of outpatient treatment and effective strategies that help to reduce the length of hospital stay to treat tuberculosis is to implement the strategic research of tuberculosis in hospital emergency rooms in major cities and in groups higher risk,and facilitate patients' access to primary health care and encouraging the ongoing training of health professionals, with emphasis on medical training to identify and intolerance outpatient approach, the construction of common stock between the programs of the SUS and Social System, with epidemiological studies of each area covered by the health units to develop strategies that could reverse the social environment and low education inducers of tuberculosis. Also, the expansion of the Health Program of Family-oriented care to street people. Providing shelter, temporary housing and shelters that can be used in the care ofhomeless patients by the end of treatment. All healthcare staff should be involved to reduce the percentage of abandonment. Establish public policies for improving the quality of food, access to healthy food is affordable and should be part of policies to control tuberculosis

Introdução: A epidemia da infecção pelo HIV continua se propagando em condições alarmantes e estimava-se que em 2007 cerca de 33 milhões de pessoas estariam vivendo com o HIV em todo o mundo. Após a introdução da terapia anti-retroviral de alta potência, chamada em inglês de highly active antiretroviral therapy (HAART) a infecção pelo HIV evoluiu com características de uma doença crônica, em que há um bom controle imuno-virológico na grande maioria dos casos. Entretanto, as reações adversas aos fármacos transformaram-se em desafios com os quais toda a equipe que dá assistência ao paciente infectado pelo HIV precisa lidar. As alterações metabólicas (dislipidemia e alterações da homeostase da glicose) e modificações da gordura corporal, que começaram a ser descritas após a introdução da terapia anti-retroviral (TARV) combinada, são conhecidos fatores de risco cardiovascular na população geral. O objetivo geral deste trabalho foi avaliar fatores preditivos de risco cardiovascular em pacientes infectados pelo HIV em tratamento anti-retroviral (ARV) ou não e os objetivos específicos foram verificar a associação entre o uso de anti-retrovirais e os níveis de proteína C reativa ultra-sensível (PCR-us); correlacionar os níveis de PCR-us a tradicionais fatores de risco cardiovascular e a parâmetros próprios da infecção pelo HIV e comparar as equações de avaliação de risco cardiovascular de Framingham, SCORE (Systematic Coronary Risk Evaluation) e PROCAM (Prospective Cardiovascular Munster) em pacientes infectados pelo HIV sem doença cardiovascular clinicamente aparente. Metodologia: Esta tese é apresentada no formato de três artigos. No primeiro artigo realizou-se revisão de artigos médicos relacionados às complicações cardiovasculares em pacientes infectados pelo HIV, principalmente as doenças isquêmicas, antes e após o uso da terapia anti-retroviral de alta potência. Foi dado maior destaque aos estudos longitudinais avaliando incidência de eventos cardiovasculares na população infectada pelo HIV. No segundo artigo foram avaliados os níveis da PCR-us em pacientes tratados ou não com ARV e sua correlação com fatores tradicionais de risco cardiovascular como níveis glicêmicos e de lípides plasmáticos e com fatores próprios da infecção pelo HIV, como carga viral e contagem de linfócitos CD4+. Foram avaliados 171 pacientes, sendo 129 pacientes usuários de drogas anti-retrovirais e 42 não usuários. Estes pacientes foram submetidos a avaliação antropométrica, medida da pressão arterial, exames laboratoriais, ultrassonografia para medida da gordura intra-abdominal e impedanciometria. No terceiro artigo foi realizada uma comparação entre equações para cálculo de risco cardiovascular (equações de Framingham, SCORE e PROCAM) em pacientes infectados pelo HIV não portadores de doença cardíaca sabidamente manifesta. Foram incluídos 220 pacientes, sendo 164 usuários de ARV e 56 não usuários. Resultados: Primeiro artigo: A maior parte dos estudos já publicados em que foram avaliadas grandes populações infectadas pelo HIV acompanhadas durante vários anos mostrou maior incidência de eventos cardiovasculares nesta população quando comparada à população geral. Entretanto, os dados são bastante controversos. Ainda não está claro o papel que os medicamentos ARV, a inflamação sub-clínica secundária à infecção pelo HIV e os transtornos metabólicos podem desempenhar no desenvolvimento da doença aterosclerótica nesta população. Os estudos prospectivos observacionais desenhados para esta finalidade poderão ser mais esclarecedores. Segundo artigo: Os níveis plasmáticos da PCR-us foram mais elevados em pacientes em uso de ARV (p