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Tuberculosis (TB) and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy and the stigma related to both diseases are complex. The patients’ subjective experiences with diseases and medications are of utmost importance in pharmaceutical care practice. This study aimed to understand the subjective medication experience of TB and HIV/AIDS coinfected patients. The study was based on descriptive research of a qualitative and quantitative nature using data collected during pharmaceutical care appointments and from medical records from September 2015 to December 2016 at a tertiary infectious diseases referral hospital in Southeastern Brazil. Data from 81 patients were analyzed. Regarding patient subjective medication experience, the following responses to the quantitative questionnaire were most frequent: preference for a route of administration (12.4%) and for non-pharmacological therapy (50.6%); concerns about price (11.1%) and adverse effects (18.5%); and association of a worsening of their health status with a change in medication dosage (23.5%). In the thematic analysis, adversity and socially constructed aspects were more prominent. Resolvability, associated with the patient’s understanding of relief from signs and symptoms and health recovery, was observed; however, feelings of ambivalence permeated the other aspects, hence leading to treatment abandonment. The evaluation of patient medication experience can be a path to understanding and intervening in the phenomenon of treatment abandonment among TB and HIV/AIDS coinfected individuals.

INTRODUCTION: The concomitant use of antituberculosis and antiretroviral drugs, as well as drugs to treat other diseases, can cause drug-drug interactions. This study aimed to describe potential drug-drug interactions (pDDI) in patients with TB and HIV/AIDS co-infection, as well as to analyze possible associated factors. METHODS: This study was performed in a reference hospital for infectious and contagious diseases in the southeastern region of Brazil and evaluated adult patients co-infected with tuberculosis and HIV/AIDS. A cross-sectional study was conducted in which sociodemographic, clinical, and pharmacotherapeutic characteristics were assessed. The pDDI were identified using the Drug-Reax software. Association analysis was performed using either a chi-squared test or a Fisher’s exact test. Correlation analysis was performed using the Spearman’s coefficient. RESULTS: The study included 81 patients, of whom 77 (95.1%) were exposed to pDDI. The most frequent interactions were between antituberculosis and antiretroviral drugs, which can cause therapeutic ineffectiveness and major adverse reactions. A positive correlation was established between the number of associated diseases, the number of drugs used, and the number of pDDI. An association was identified between contraindicated and moderate pDDI with excessive polypharmacy and hospitalization. CONCLUSIONS: We found a high frequency of pDDI, especially among those hospitalized and those with excessive polypharmacy. These findings highlight the importance of pharmacists in the pharmacotherapeutic monitoring in these patients.

Background Cryptococcosis affects more than 220,000 patients/year, with high mortality even when the standard treatment [amphotericin B (AMB), 5-flucytosin (5-FC) and fluconazole] is used. AMB presents high toxicity and 5-FC is not currently available in Brazil. In a pre-clinical study, pioglitazone (PIO - an antidiabetic drug) decreased AMB toxicity and lead to an increased mice survival, reduced morbidity and fungal burden in brain and lungs. The aim of this trial is to evaluate the efficacy and safety of PIO combined with standard antifungal treatment for human cryptococcosis. Methods A phase 1/2, randomized, double blind, placebo-controlled trial will be performed with patients from Belo Horizonte, Brazil. They will be divided into three groups (placebo, PIO 15 mg/day or PIO 45 mg/day) and will receive an additional pill during the induction phase of cryptococcosis’ treatment. Our hypothesis is that treated patients will have increased survival, so the primary outcome will be the mortality rate. Patients will be monitored for survival, side effects, fungal burden and inflammatory mediators in blood and cerebrospinal fluid. The follow up will occur for up 60 days. Conclusions We expect that PIO will be an adequate adjuvant to the standard cryptococcosis’ treatment. Trial registration ICTRP/WHO (and International Clinical Trial Registry Plataform (ICTRP/WHO) ( http://apps.who.int/trialsearch/Trial2.aspx?TrialID=RBR-9fv3f4 ), RBR-9fv3f4 ( http://www.ensaiosclinicos.gov.br/rg/RBR-9fv3f4 ). UTN Number: U1111-1226-1535. Ethical approvement number: CAAE 17377019.0.0000.5149.

RESUMO: Introdução: A vinculação é um passo fundamental para o cuidado contínuo da infecção pelo vírus da imunodeficiência humana (HIV/aids), sendo essencial para proporcionar o acesso à terapia antirretroviral, bem como ao cuidado integral. Metodologia: Estudo transversal, com pessoas vivendo com HIV (PVHIV), idade ≥ 18 anos, vinculadas entre janeiro e dezembro de 2015, em um serviço de referência para assistência ambulatorial e hospitalar especializada em HIV/aids em Belo Horizonte (MG). O tempo de vinculação foi definido como o tempo do diagnóstico até a vinculação ao serviço. Considerou-se vinculação oportuna quando esse tempo foi menor ou igual a 90 dias. Os dados foram coletados por meio de prontuários clínicos. Realizou-se análise de regressão logística com intervalo de confiança de 95% (IC95%). Resultados: Entre os 208 pacientes, a maioria era do sexo masculino (77,8%) com idade média de 39 anos. Cerca de 45% apresentaram condições definidoras de aids na vinculação. O tempo de vinculação apresentou média de 138 ± 397 dias, e a vinculação oportuna ocorreu para 76,9% dos pacientes. As variáveis associadas com a vinculação oportuna foram: ter idade ≥ 48 anos (odds ratio - OR = 8,50; IC95% 1,53 - 47,28), estar trabalhando (OR = 3,69; IC95% 1,33 - 10,25) no momento da vinculação e apresentar contagem de linfócitos T CD4 (LT CD4+) ≤ 200 células/mm3 no momento do diagnóstico de HIV (OR = 4,84; IC95% 1,54 - 15,18). Observou-se proporção importante de vinculação oportuna entre as PVHA, porém com diagnóstico tardio. Conclusão: Intervenções devem ser direcionadas para pessoas mais jovens e com maior contagem de LT CD4+, visando uma melhor prestação de cuidados contínuos em HIV. ABSTRACT: Introduction: Linkage is a critical step in the ongoing care of human immunodeficiency virus (HIV/aids) infection and is essential for providing access to antiretroviral therapy, as well as comprehensive care. Methodology: Cross-sectional study on people living with HIV (PLHIV), aged ≥ 18 years old, linked between January and December 2015, in a referral service for outpatient and hospital care specialized in HIV/AIDS in Belo Horizonte, Minas Gerais. Linkage time was defined as the time from diagnosis to service linkage. Timely care linkage was considered when this time was ≤ 90 days. Data were collected through clinical records. A logistic regression analysis with a confidence interval of 95% (95%CI) was performed. Results: Among 208 patients, most of them were males (77.8%) with a mean age of 39 years. About 45% presented AIDS-defining conditions at the moment of linkage. Linkage time presented a mean of 138 ± 397 days. And timely linkage occurred for 76.9% of the patients. The variables associated with timely care linkage were: age ≥ 48 years (odds ratio - OR = 8.50; 95%CI 1.53 - 47.28), currently working (OR = 3.69; 95%CI 1.33 - 10.25) at the time of linkage, and present CD4+ T lymphocyte count (CD4+ T) ≤ 200 cells/mm3 at the time of HIV diagnosis (OR = 4.84; 95%CI 1.54 - 15.18). There was an important proportion of timely care linkage among PLHIV, but with late diagnosis. Conclusion: Interventions should be targeted at younger people with higher CD4+ T lymphocyte counts, in order to better provide continuous HIV care.

Background: Tuberculosis (TB) remains an important cause of morbidity, the leading cause of death in patients with human immunodeficiency virus (HIV) infection, and a challenge to global public health. This study aimed to analyze the predictors associated with mortality among individuals coinfected with TB/HIV at a reference center in southeastern Brazil. Method: This retrospective cohort study used the data obtained from clinical records and information systems from 2007 to 2014. The data were analyzed using Cox proportional hazards model to identify the independent predictors. Results: Among the 924 individuals studied, 72.7 % were men. The median age was 38 years (range: 16–78 years). The mortality rate was 21.6%. The predictors associated with mortality were as follows: age over 50 years (Adjusted Hazard Ratio [AHR] : 2.52, 95% confidence interval [CI]: 1.39–4.59), CD4+ T lymphocyte count ≤200 cells/mm3 [AHR]: 1.40, 95% [CI]: 0.86–2.27), detectable viral load [AHR]: 1.73, 95% [CI]: 0.98–3.01), and non-use of antiretroviral therapy [AHR]: 2.91, 95% [CI]: 1.71–4.93). Conclusion: Results demonstrated that patients coinfected with TB/HIV have high mortality rates. Therefore, it is necessary to address the social determinants of health to provide every individual an equal opportunity to gain access to healthcare to cope with TB/HIV coinfection. Key words: Tuberculosis/HIV, Mortality, Retrospective cohort, Brazil.

Linkage is a critical step in the ongoing care of human immunodeficiency virus (HIV/aids) infection and is essential for providing access to antiretroviral therapy, as well as comprehensive care.Cross-sectional study on people living with HIV (PLHIV), aged ≥ 18 years old, linked between January and December 2015, in a referral service for outpatient and hospital care specialized in HIV/AIDS in Belo Horizonte, Minas Gerais. Linkage time was defined as the time from diagnosis to service linkage. Timely care linkage was considered when this time was ≤ 90 days. Data were collected through clinical records. A logistic regression analysis with a confidence interval of 95% (95%CI) was performed.Among 208 patients, most of them were males (77.8%) with a mean age of 39 years. About 45% presented AIDS-defining conditions at the moment of linkage. Linkage time presented a mean of 138 ± 397 days. And timely linkage occurred for 76.9% of the patients. The variables associated with timely care linkage were: age ≥ 48 years (odds ratio - OR = 8.50; 95%CI 1.53 - 47.28), currently working (OR = 3.69; 95%CI 1.33 - 10.25) at the time of linkage, and present CD4+ T lymphocyte count (CD4+ T) ≤ 200 cells/mm3 at the time of HIV diagnosis (OR = 4.84; 95%CI 1.54 - 15.18). There was an important proportion of timely care linkage among PLHIV, but with late diagnosis.Interventions should be targeted at younger people with higher CD4+ T lymphocyte counts, in order to better provide continuous HIV care.A vinculação é um passo fundamental para o cuidado contínuo da infecção pelo vírus da imunodeficiência humana (HIV/aids), sendo essencial para proporcionar o acesso à terapia antirretroviral, bem como ao cuidado integral.Estudo transversal, com pessoas vivendo com HIV (PVHIV), idade ≥ 18 anos, vinculadas entre janeiro e dezembro de 2015, em um serviço de referência para assistência ambulatorial e hospitalar especializada em HIV/aids em Belo Horizonte (MG). O tempo de vinculação foi definido como o tempo do diagnóstico até a vinculação ao serviço. Considerou-se vinculação oportuna quando esse tempo foi menor ou igual a 90 dias. Os dados foram coletados por meio de prontuários clínicos. Realizou-se análise de regressão logística com intervalo de confiança de 95% (IC95%).Entre os 208 pacientes, a maioria era do sexo masculino (77,8%) com idade média de 39 anos. Cerca de 45% apresentaram condições definidoras de aids na vinculação. O tempo de vinculação apresentou média de 138 ± 397 dias, e a vinculação oportuna ocorreu para 76,9% dos pacientes. As variáveis associadas com a vinculação oportuna foram: ter idade ≥ 48 anos (odds ratio - OR = 8,50; IC95% 1,53 - 47,28), estar trabalhando (OR = 3,69; IC95% 1,33 - 10,25) no momento da vinculação e apresentar contagem de linfócitos T CD4 (LT CD4+) ≤ 200 células/mm3 no momento do diagnóstico de HIV (OR = 4,84; IC95% 1,54 - 15,18). Observou-se proporção importante de vinculação oportuna entre as PVHA, porém com diagnóstico tardio.Intervenções devem ser direcionadas para pessoas mais jovens e com maior contagem de LT CD4+, visando uma melhor prestação de cuidados contínuos em HIV.

Chronic hepatitis B is considered a major public health problem, and its treatment entails increasing health budget expenses with high-cost drugs covered by Unified National Health System. The objective of this study was to compare the efficacy of interferon (conventional; pegylated - PEG2a) and lamivudine (LAM) for the treatment of chronic hepatitis B through a systematic review, selecting randomized, controlled clinical trials identified in PubMed and LILACS. Target outcomes were virological, biochemical, and histological response, seroconversion, and adverse effects. The review selected 35 articles. Presence or absence of HBeAg and pre-treatment alanine aminotransferase (ALT) levels were considered important factors in the initial therapeutic indication. Treatment with conventional interferon enables lasting disease inactivation and can result in HBsAg seroconversion. PEG2a showed better efficacy than interferon and LAM and similar side effects to interferon. LAM presents advantages such as its sensitivity in the HbeAg-negative phenotype, while its main disadvantage is the development of resistance.

A hepatite crônica B constitui um grave problema de saúde pública e vem demonstrando crescentes gastos com financiamento de medicamentos de dispensação em caráter excepcional e de alto custo no Sistema Único de Saúde (SUS). O objetivo do estudo foi comparar a eficácia do interferon (convencional; peguilado - PEG2a) e lamivudina (LAM) para o tratamento da hepatite crônica B, pelo método de revisão sistemática selecionando ensaios clínicos randomizados e controlados identificados nas bases PubMed e LILACS. As medidas de resultado consideradas foram resposta virológica, soroconversão, resposta bioquímica, resposta histológica e efeitos adversos. Foram selecionados 35 artigos. A presença ou ausência do HBeAg e os níveis de alanina amino transferase (ALT) no pré-tratamento demonstraram papel fundamental na indicação terapêutica inicial. O tratamento com interferons convencionais permite a inativação da doença por longos períodos de tempo, podendo resultar em soroconversão HBsAg. O PEG 2a demonstrou eficácia superior ao interferon e LAM e efeitos colaterais semelhantes ao interferon. A LAM apresenta vantagem de ser sensível para os pacientes HBeAg negativo e apresenta como maior desvantagem o desenvolvimento de resistência.

Objective: To determine the frequency of drug therapy problem in the treatment of patients with tuberculosis and HIV/AIDS. Methods: Data were obtained through a cross-sectional study conducted between September 2015 and December 2016 at a reference hospital in infectious diseases in Belo Horizonte (MG), Brazil. Sociodemographic, clinical, behavioral and pharmacotherapeutic variables were evaluated through a semi-structured questionnaire. Drug-related problems of pharmaceutical care were classified using the Pharmacotherapy Workup method. Factors associated with indication, effectiveness, safety and compliance drug therapy problem were assessed through multiple logistic regression. Results: We evaluated 81 patients, and 80% presented at least one drug therapy problem, with indication and adherence drug therapy problem being the most frequent. The factors associated with drug therapy problem were age, marital status, new case, ethnicity, time of HIV diagnosis and time to treat tuberculosis. Conclusion: The frequency of drug therapy problem in coinfected patients was high and the identification of the main drug therapy problem and associated factors may lead the multiprofessional health team to ensure the use of the most indicated, effective, safe and convenient medicines for the patients clinical condition. Tuberculosis and HIV/AIDS coinfected individuals aged over 40 years are more likely to have drug therapy problems during treatment; in that, the most frequente are those that signal toward need of medication for an untreated health condition and non-compliance to treatment. Thus, older patients, unmarried or married, who have treated tuberculosis before, with a shorter time to tuberculosis treatment and longer time to diagnose HIV/AIDS, should receive special attention and be better followed by a multiprofessional health team because they indicate a higher chance of presenting Problems related to the use of non-adherent drugs.