BK virus associated meningoencephalitis in an AIDS patient treated with HAART

A severely immune-suppressed AIDS patient was suspected of suffering from BK virus (BKV) meningoencephalitis, after being studied for common causes of neurological complications of co-infectious origin. Polymerase chain reaction (PCR) and sequence analysis of cerebrospinal fluid and brain samples, confirmed the presence of BKV. His clinical condition improved along with the regression of brain lesions, after modifications on his antiretroviral regime. Five months after discharge, the patient was readmitted because of frequent headaches, and a marked inflammatory reaction was evidenced by a new magnetic resonance imaging (MRI). The symptoms paralleled a rising CD4+ lymphocyte count, and immune reconstitution syndrome was suspected. This is the first non-postmortem report of BKV meningoencephalitis in an AIDS patient, showing clinical and radiographic improvement solely under HAART.

Optical aids for low vision: use of the Internet to guide teachers of the visually impaired

PURPOSES: To describe and interpret teachers' opinions about and responsiveness to guidance on optical aids for low vision. METHODS: It was conducted a cross-sectional analytical study. The convenience, non-random sample consisted of 58 teachers from the public school network of the city of Campinas. It was constructed and applied a structured questionnaire, available online at the assessed website. For qualitative data collection it was conducted an exploratory study using the focus group technique. RESULTS: Responses expressed, for the most part, a marked interest in the website, its easiness of access, and the comprehensive nature of the information provided. Most people reported frequent use of the Internet to seek information, and found it easier to access the Internet at home. Among the qualitative aspects of the evaluation, we should mention the perceived importance of the website as a source of information, despite some criticism about the accessibility and reliability of the information found on the Internet. CONCLUSION: Teachers' need for training to deal with visually impaired students and their positive response to advice and information lead to the conclusion that web-based guidelines on the use of optical aids were considered beneficial to ease the understanding of visual impairment and the rehabilitation of the affected subjects.

Aids e tuberculose: a coinfecção vista pela perspectiva da qualidade de vida dos indivíduos

A coinfecção tuberculose (TB) e HIV afeta negativamente a vida dos indivíduos, tanto nos aspectos biológicos como nos psicossociais. Com o objetivo de descrever a qualidade de vida de indivíduos com coinfecção HIV/TB, foi realizado este estudo descritivo, de corte transversal, no município de Ribeirão Preto-SP. Foram entrevistados indivíduos soropositivos para o HIV, com e sem TB, por meio do instrumento WHOQOL-HIV bref. Participaram 115 indivíduos soropositivos para o HIV - 57 coinfectados e 58 não coinfectados; a maioria do sexo masculino, heterossexuais, faixa etária predominante de 40-49 anos, com os coinfectados apresentando baixas escolaridade e renda; na avaliação da qualidade de vida os coinfectados apresentaram resultados mais baixos em todos os domínios, com diferença importante no Físico, Psicológico, Nível de Independência e Relações Sociais. TB e HIV/aids são doenças estigmatizadas historicamente e a sobreposição das duas pode ter consequências graves na saúde física e psicossocial do indivíduo.

Características da resposta à Aids de secretarias de saúde, no contexto da Política de Incentivo do Ministério da Saúde¹

OBJETIVOS: Analisar a cobertura da Política de Incentivo do Ministério da Saúde para Programas de Aids e as características das ações de prevenção, assistência, gestão e apoio às organizações da sociedade civil induzidas nos Estados e municípios. METODOLOGIA: Os Planos de Ações e Metas de 2006, das 27 Unidades Federadas e de 427 municípios incluídos na Política de Incentivo, foram analisados segundo indicadores estabelecidos para aferir a complexidade e a sustentabilidade das ações induzidas, a inclusão de populações prioritárias e a capacidade de intervenção na epidemia. Informações sobre população e casos de aids registrados foram utilizadas para mensurar a cobertura. RESULTADOS: Os municípios incluídos representaram uma cobertura de 85,2% dos casos de aids do País. Houve uma baixa proporção de secretarias estaduais (48,2%) e municipais (32,6%) de saúde que contemplaram, concomitantemente, ações de prevenção para a população geral e as de maior prevalência da doença, assim como ações para o diagnóstico do HIV, o tratamento de pessoas infectadas e a prevenção da transmissão vertical. Em relação às populações prioritárias, 51,9% dos Estados e 31,1% dos municípios propuseram ações específicas na prevenção e na assistência. Estados (44,4%) e municípios (27,9%) com Planos abrangentes estão mais concentrados no Sudeste e em cidades de grande porte, representando a maioria dos casos de aids do País. CONCLUSÃO: A Política de Incentivo do Ministério da Saúde compreende as regiões de maior ocorrência da aids no Brasil, porém, o perfil da resposta induzida encontra-se parcialmente dissociado das características epidemiológicas da doença no País.

Prior history of sexually transmitted diseases in women living with AIDS in São Paulo, Brazil

OBJECTIVES: To describe the epidemiological profile, risk behaviors, and the prior history of sexually transmitted diseases (STDs) in women living with acquired immunodeficiency syndrome (AIDS). METHODS: Cross-sectional study, performed at the Centro de Referência e Treinamento em DST/AIDS of São Paulo. The social, demographic, behavioral, and clinical data such as age, schooling, marital status, age at first sexual intercourse, number of sexual partners, parity, use of drugs, time of HIV diagnosis, CD4 count, and viral load determination were abstracted from the medical records of women living with AIDS who had gynecological consultation scheduled in the period from June 2008 to May 2009. RESULTS: Out of 710 women who were scheduled to a gynecological consultation during the period of the study, 598 were included. Previous STD was documented for 364 (60.9%; 95% CI: 56.9%-64.8%) women. The associated factors with previous STDs and their respective risks were: human development index (HDI) < 0.50 (ORaj = 5.5; 95% CI: 2.8-11.0); non-white race (ORaj = 5.2; 95% CI: 2.5-11.0); first sexual intercourse at or before 15 years of age (ORaj = 4.4; 95% CI: 2.3-8.3); HIV infection follow-up time of nine years or more (ORaj = 4.2; 95% CI: 2.3-7.8)]; number of sexual partners during the entire life between three and five partners (ORaj = 2.2; 95% CI: 1.1-4.6), and six or more sexual partners (ORaj = 3.9; 95% CI: 1.9-8.0%); being a sex worker (ORaj = 1.9; 95% CI: 1.1-3.1). CONCLUSIONS: A high prevalence of a prior history of STDs in the studied population was found. It is essential to find better ways to access HIV infection prevention, so that effective interventions can be more widely implemented.

Comensalidade e cuidado: meninas-jovens-mulheres órfãs no contexto de HIV/Aids

O "monopólio da cozinha", histórica e culturalmente, é atribuído às mulheres, mães. Para cuidar da família, elas elegem alimentos, compram, cozinham e os servem. Sustentam a comensalidade. Em contextos de HIV/Aids, onde há perda da mãe, as filhas tornam-se responsáveis por esses cuidados. O que pensam as meninas do papel de cuidadoras com o qual, prematuramente, deparam-se? O que dizem seus irmãos sobre isso? Realizamos entrevistas semidirigidas com 14 jovens órfãos. Os dados foram analisados pela proposta de Mills (2009). As jovens não demonstram insatisfação por executarem novas tarefas, mas deploram o fato de impedirem o estudo e a vida além-casa. Seus irmãos entendem a lida da cozinha como coisa de mulher e, por isso, dificilmente colaboram. Essas jovens necessitam de cuidados direcionados à situação vulnerável em que vivem. As políticas de Saúde Pública poderiam pleitear macroestruturas que atuassem sobre essa demanda.

Orfandade por aids ou por homicídio apresenta efeitos sobre o estado nutricional das crianças?

O artigo tem como objetivos avaliar o estado nutricional de órfãos por aids ou homicídios residentes em São Paulo e estimar a associação de índices nutricionais com variáveis relacionadas à orfandade. Trata-se de estudo transversal de base domiciliar que utilizou amostra representativa de 484 indivíduos de 5 a 14 anos que perderam um ou ambos os pais durante os anos de 2000 e 2004 devido à aids ou a homicídio no município de São Paulo. A avaliação nutricional foi feita com o índice de massa corporal-para-idade (IMC) e da altura-para-idade (altura). A associação entre os índices nutricionais e as variáveis relacionadas à orfandade foi estimada em análise hierárquica, com uso de modelo de regressão linear múltiplo. Órfãos por aids ou homicídios diferiram quanto às características da orfandade e à idade média. As condições econômicas, domiciliares, o estado de saúde e o estado nutricional foram semelhantes entre os grupos. O déficit de IMC ocorreu em 1,3% das crianças abaixo de 10 anos e em 2,1% dos adolescentes. O déficit de altura ocorreu em 0,7% das crianças e em 4,0% dos adolescentes. O excesso de peso ocorreu em 19% e 20% das crianças e adolescentes, respectivamente. A análise hierárquica indicou ausência de efeito das variáveis relacionadas à orfandade sobre o IMC ou a altura; o principal determinante do estado nutricional foi de natureza econômica. Os órfãos por aids ou homicídio de São Paulo apresentaram estado nutricional semelhante e majoritariamente influenciado pela situação econômica. O perfil nutricional identificado no grupo, caracterizado pelo excesso de peso, sugere que os órfãos de São Paulo não apresentam riscos adicionais decorrentes da orfandade.

Association between muscle strength and the cardiopulmonary status of individuals living with HIV/AIDS

OBJECTIVE: The purpose of this study was to compare aerobic function [anaerobic threshold (%_VVO2-AT), respiratory compensation point (%_VVO2-RCP) and peak oxygen uptake (_VVO2peak)] between physically active patients with HIV/AIDS and matched controls and to examine associations between disease status, poor muscle strength, depression (as estimated by the profile of mood states questionnaire) and the aerobic performance of patients. METHODS: Progressive treadmill test data for %_VVO2-AT (V-slope method), RCP and (_VVO2peak) were compared between 39 male patients with HIV/AIDS (age 40.6¡1.4 years) and 28 male controls (age 44.4¡2.1 years) drawn from the same community and matched for habitual physical activity. Within-patient data were also examined in relation to CD4+ counts (nadir and current data) and peak isokinetic knee torque. RESULTS: AT, RCP and (_VVO2peak) values were generally similar for patients and controls.Within the patient sample, binary classification suggested that AT, RCP and (_VVO2peak) values were not associated with either the nadir or current CD4+ count, but treadmill test variables were positively associated with peak isokinetic knee torque. CONCLUSION: The aerobic performance of physically active patients with HIV/AIDS is generally well conserved. Nevertheless, poor muscle strength is observed in some HIV/AIDS patients, which is associated with lower anaerobic power and (_VVO2peak), suggesting the possibility of enhancing the aerobic performance of patients with weak muscles through appropriate muscle-strengthening activities.

The Gemini planet-finding campaign: the frequency of giant planets aroud debris disk stars

We have completed a high-contrast direct imaging survey for giant planets around 57 debris disk stars as part of the Gemini NICI Planet-Finding Campaign. We achieved median H-band contrasts of 12.4 mag at 0.''5 and 14.1 mag at 1'' separation. Follow-up observations of the 66 candidates with projected separation <500 AU show that all of them are background objects. To establish statistical constraints on the underlying giant planet population based on our imaging data, we have developed a new Bayesian formalism that incorporates (1) non-detections, (2) single-epoch candidates, (3) astrometric and (4) photometric information, and (5) the possibility of multiple planets per star to constrain the planet population. Our formalism allows us to include in our analysis the previously known β Pictoris and the HR 8799 planets. Our results show at 95% confidence that <13% of debris disk stars have a ≥5 M Jup planet beyond 80 AU, and <21% of debris disk stars have a ≥3 M Jup planet outside of 40 AU, based on hot-start evolutionary models. We model the population of directly imaged planets as d 2 N/dMdavpropm α a β, where m is planet mass and a is orbital semi-major axis (with a maximum value of a max). We find that β < –0.8 and/or α > 1.7. Likewise, we find that β < –0.8 and/or a max < 200 AU. For the case where the planet frequency rises sharply with mass (α > 1.7), this occurs because all the planets detected to date have masses above 5 M Jup, but planets of lower mass could easily have been detected by our search. If we ignore the β Pic and HR 8799 planets (should they belong to a rare and distinct group), we find that <20% of debris disk stars have a ≥3 M Jup planet beyond 10 AU, and β < –0.8 and/or α < –1.5. Likewise, β < –0.8 and/or a max < 125 AU. Our Bayesian constraints are not strong enough to reveal any dependence of the planet frequency on stellar host mass. Studies of transition disks have suggested that about 20% of stars are undergoing planet formation; our non-detections at large separations show that planets with orbital separation >40 AU and planet masses >3 M Jup do not carve the central holes in these disks.

The Gemini NICI planet-finding campaign: the frequency of giant planets around young B and A stars

We have carried out high contrast imaging of 70 young, nearby B and A stars to search for brown dwarf and planetary companions as part of the Gemini NICI Planet-Finding Campaign. Our survey represents the largest, deepest survey for planets around high-mass stars (≈1.5-2.5 M ☉) conducted to date and includes the planet hosts β Pic and Fomalhaut. We obtained follow-up astrometry of all candidate companions within 400 AU projected separation for stars in uncrowded fields and identified new low-mass companions to HD 1160 and HIP 79797. We have found that the previously known young brown dwarf companion to HIP 79797 is itself a tight (3 AU) binary, composed of brown dwarfs with masses 58$^{+21}_{-20}$ M Jup and 55$^{+20}_{-19}$ M Jup, making this system one of the rare substellar binaries in orbit around a star. Considering the contrast limits of our NICI data and the fact that we did not detect any planets, we use high-fidelity Monte Carlo simulations to show that fewer than 20% of 2 M ☉ stars can have giant planets greater than 4 M Jup between 59 and 460 AU at 95% confidence, and fewer than 10% of these stars can have a planet more massive than 10 M Jup between 38 and 650 AU. Overall, we find that large-separation giant planets are not common around B and A stars: fewer than 10% of B and A stars can have an analog to the HR 8799 b (7 M Jup, 68 AU) planet at 95% confidence. We also describe a new Bayesian technique for determining the ages of field B and A stars from photometry and theoretical isochrones. Our method produces more plausible ages for high-mass stars than previous age-dating techniques, which tend to underestimate stellar ages and their uncertainties.