Vinte anos de assistência a pessoas vivendo com HIV/AIDS no Brasil: a perspectiva de profissionais da saúde

O objetivo do estudo é descrever os significados atribuídos por profissionais de saúde à sua experiência de cuidar de pessoas com HIV/AIDS. Os dados foram coletados em entrevistas com 10 profissionais da saúde, em diferentes instituições paulistas. Três temas emergiram da análise dos dados: (a) o cenário da assistência ao paciente com HIV/AIDS; (b) relacionamento com o paciente; (c) aspectos éticos nesse cuidado. A despeito dos reconhecidos avanços na assistência a esse paciente, os achados revelam a persistência de comportamentos discriminatórios, relacionados a sentimentos de insegurança e medo do contágio, entre os profissionais nos serviços e hospitais gerais. O preparo específico para atender os pacientes estaria mais voltado aos profissionais dos centros especializados para a assistência ao HIV/AIDS, resultando em dificuldades na integração da assistência a esses pacientes nos demais serviços do SUS. Esses dados remetem aos aspectos da formação profissional na área da saúde como um todo, levando à reflexão sobre as competências que se espera dos profissionais da saúde em cuidar e relacionar-se com pessoas com HIV/AIDS, assim como sobre o impacto dessa realidade na prevenção da doença.

LIFE QUALITY of PEOPLE INFECTED BY HIV WITH OR WITHOUT ANTIRETROVIRAL TREATMENT

The "HIV/Aids-Quality of Life" (HAT-Qol) is a specific multifunctional instrument used to measure the life quality of HIV infected persons. It is divided into nine domains: general activity, sexual activity, secrecy about HIV seropositivity, concern about health, financial concern, awareness about HIV, satisfaction with life, issues about medications and belief in the doctor. The current study analyzed the life quality of HIV infected individuals-who attended the DST/Aids Program in Maringa city, Parana state-regarding the use or not of antiretroviral therapy (TARV) and their demographic, epidemiological and clinical characteristics. Data were collected by retrospective analysis from 1,200 medical charts of patients registered in the program. The HAT-Qol instrument was applied before routine medical consultation. One hundred and sixty-nine patients, who had HIV infection confirmed, were divided into two groups, G1 with 118 individuals receiving antiretroviral therapy and G2 with 51 individuals who were not under this therapy.Result analysis, regarding social and demographic characteristics, revealed no difference among responses related to gender, educational degree and sexual option. Age influenced satisfaction with sexual activity and marital status. Regarding HIV awareness, the lowest response index or worst quality of life came from, respectively, men between 50 and 69 years old and patients who did not have regular partners compared with the ones who did. Additionally, it was observed that the time of diagnosis influenced general activities, HIV awareness, concern about health and financial issues, satisfaction with life and topics about medications. The variables were compared in both groups. There was no influence on the use or not of antiretroviral therapy regarding age, sexual activity, HIV diagnosis time and the domains that evaluated general activities, financial concern, awareness of HIV and satisfaction with life. In relation to time of diagnosis, there was an influence only in persons who had been diagnosed two or three years before, in which a lower quality of life was observed among individuals who were not under antiretroviral therapy. It was not possible to compare variables about medication use, HIV plasmatic viral rate ant time of diagnosis, because G2 individuals were not receiving the antiretroviral therapy. Furthermore, no comparison was made regarding marital status and HIV awareness, because there were no married individuals in G2. Thus, the analysis of the results showed that the use of antiretroviral treatment did not influence the life quality of HIV patients studied by the HAT-Qol scale.

Willingness of Brazilian dentists to treat an HIV-infected patient

A study of the willingness of 363 general dental practices in Brazil to accept a patient infected with human immunodeficiency virus for treatment of dental pain and the provision of routine dental care showed only 44% of dental practices to be willing to provide dental care. Willingness was influenced neither by financial factors nor the local prevalence of human immunodeficiency virus disease. © 1994.

Sporotrichosis in an HIV-positive man with oral lesions: A case report

Background: Sporotrichosis is a granulomatous fungal infection caused by Sporothrix schenckii, which frequently causes cutaneous or lymphocutaneous lesions and rarely has oral manifestations. Case: A 38-year-old, white, HIV-positive man complained of a 5.0-cm, symptomatic, ulcerated lesion with thin, superficial granulation in the soft palate extending to the uvula. Exfoliative cytology of this oral lesion showed chronic granulomatous inflammatory alterations and extracellular fungal structures consisting of periodic acid-Schiff-positive budding cells and spherical or elongated (cigar bodies) free spore forms. Conclusion: The clinical and cytologic findings allowed the diagnosis of sporotrichosis, demonstrating the importance of cytodiagnosis in fungal diseases. © The International Academy of Cytology.

Convivendo com HIV/AIDS: fatores que influenciam na qualidade de vida e condição de saúde bucal

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Estudo da ocorrência de atitudes discriminatórias na assistência à saúde de pessoas com HIV/AIDS

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

O tratamento com implantes dentários para pacientes com hiv é uma realidade?

Patients infected with HIV can present several complications related to oral health. Today, the reduction of morbidity and mortality is evidenttreatment with antiviral enhances the quality of life of patients. The increase in comfort, stability, function and improving quality of life have led these patients to seek treatment with osseointegrated implants. This study aimed to discuss, based on the literature, the rehabilitation treatment with osseointegrated implants in patients HIV positive. For this we carried out a literature review including the subject in the databases: PubMed, Cochrane, ISI Dentistry and Oral Science in the last 20 years. The issue was addressed for the first time in 1998, describing a clinical case, the patient had successful rehabilitation with osseointegrated implants. However, the literature states that the indications must be carefully analyzed (2007), since there are few prospective controlled studies. There is doubt as to the use of dental implant therapy in patients with HIV-positive, and the complications are related to the patient’s systemic condition. It is essential to understand the clinical manifestations and complications of the disease before the implant therapy. It is observed that the dental implant therapy in patients with HIV positive is a predictable treatment option, it´s need an adequate control of oral and systemic conditions, and studies with larger sample, longer follow-up and randomized studies are important for evaluating the success therapy.

Vivendo com HIV/AIDS: estudos da ocorrência de discrimição nos serviços de saúde

Introduction: The discrimination experienced by people with HIV / AIDS, not only by society but also by health professionals is one of the major problems observed relative the epidemic. Objective: To verify and to analyze the occurrence of discriminatory attitudes in the assistance to the health of people living with HIV/AIDS. Methods: It was a quantitative research was carried out with the participation of sixty-eight HIV-positive individuals from four Brazilian cities. The participants answered auto-administrate questionnaires that contained open and closed questions including the considered subject. Results: 41.2% of the total participants, HIV + people, said they had been discriminated against by health professionals. Among the discriminatory situations experienced by HIV patients, 34.2% nursing professionals were involved, in 34.2% dentists and in 31.6% doctors were involved. Those who have suffered discrimination, 78.6% said they had been discriminated against in public health service. Conclusion: The occurrence of discrimination in the assistance to the health of HIV-positive patients was high. The majority of discrimination situations occurred in the public health service. It is necessary the institution of strategies aiming at human attendance to these patients.

Detection of immunoglobulin G antibodies to Neospora caninum in humans: High seropositivity rates in patients who are infected by human immunodeficiency virus or have neurological disorders

Considering that little is known about the epidemiology of Neospora caninum infection in humans, particularly in populations with high Toxoplasma gondii infection rates, the present study aimed to investigate the presence of antibodies to N. caninum in T. gondii-seropositive and -seronegative individuals. A total of 256 serum samples divided into four groups (61 samples from human immunodeficiency virus [HIV]-positive patients, 50 samples from patients with neurological disorders, 91 samples from newborns, and 54 samples from healthy subjects) were assessed for N. caninum and T. gondii serologies by indirect fluorescent-antibody test, enzyme-linked immunosorbent assay, and immunoblotting (IB). Immunoglobulin G antibodies to N. caninum were predominantly detected in HIV-infected patients (38%) and patients with neurological disorders (18%), while newborns and healthy subjects showed lower seropositivity rates (5% and 6%, respectively). Seropositivity to N. caninum was significantly associated with seropositivity to T. gondii in both HIV-infected patients and patients with neurological disorders. Seroreactivity to N. caninum was confirmed by IB, with positive sera predominantly recognizing the 29-kDa antigen of N. caninum. The results of this study indicate the presence of N. caninum infection or exposure in humans, particularly in HIV-infected patients or patients with neurological disorders, who could have opportunistic and concurrent infections with T. gondii. These findings may bring a new concern for the unstable clinical health of HIV-infected patients and the actual role of N. caninum infection in immunocompromised patients.

Escala de atitudes frente ao HIV/AIDS: análise de fatores

OBJETIVO: Este trabalho apresenta resultados acerca das propriedades psicométricas da Escala de atitudes frente ao HIV/AIDS. Os dados, provenientes de uma amostra de 549 alunos entre universitários, ensinos médio e ensino fundamental. MÉTODOS: Os dados foram tratados pelo método dos componentes principais da análise fatorial. A análise final, postulado um eigenvalue mínimo de 2, resultou cinco fatores. Foram eliminados itens que apresentaram carga fatorial menor que 0,30. Neste estudo, o menor alfa observado foi de 0,79. Portanto, é provável que todos os 47 itens do instrumento final elaborado meçam o mesmo construto: atitude frente ao HIV/AIDS. RESULTADOS: Escores inferiores a 96 foram considerados fraco grau de conhecimento sobre HIV/AIDS; entre 96 e 192 moderado grau de conhecimento e acima de 192 alto grau de conhecimento sobre HIV/AIDS. Foram estabelecidos os fatores: 1, 2 e 3, sendo fator geral de percepção da informação técnico-científica; fator de percepção da informação técnico-científica versus sexualidade e preconceito; fator de percepção da informação técnico-científica no uso de drogas, respectivamente. CONCLUSÕES: O alfa de Cronbach encontrado para a escala como um todo foi de 0,859, sugerindo fortemente a existência da fidedignidade do instrumento que se mostrou útil para avaliar o grau de conhecimento acerca do HIV/AIDS e o risco decorrente do desconhecimento, entre estudantes.

Lipodystrophy in HIV/AIDS patients with different levels of physical activity while on antiretroviral therapy

INTRODUÇÃO: A lipodistrofia relacionada ao uso de terapia antirretroviral (TARV) pode causar estigma estético e elevar o risco de doenças cardiovasculares. A atividade física pode ser uma alternativa válida para o tratamento e prevenção da lipodistrofia. Entretanto, poucos estudos tratam dessa temática. O objetivo deste estudo foi verificar a ocorrência de lipodistrofia relacionada ao uso de TARV em portadores de HIV/AIDS, com diferentes hábitos de atividades físicas. MÉTODOS: A casuística foi formada por 42 portadores de HIV em uso de TARV, do Centro de Testagem e Aconselhamento de Presidente Prudente. Para obtenção do nível de atividade física aplicou-se o Questionário Internacional de Atividade Física (IPAQ); a lipodistrofia foi diagnosticada pelo autorrelato do paciente e a confirmação médica. O percentual de gordura de tronco foi estimado pela absortometria por raio-X de dupla energia (DEXA). Foram coletados também dados referentes a sexo, idade, tempo de uso de TARV, valores de CD4 e carga viral. RESULTADOS: Verificou-se maior ocorrência de lipodistrofia no grupo sedentário quando comparado ao ativo, além de fator protetor da prática da atividade física em relação à ocorrência da lipodistrofia. O grupo com valores mais elevados de CD4 também apresentou maior proporção de sujeitos com lipodistrofia, além de maior proporção de ativos e de indivíduos com menor faixa etária. Os acometidos pela lipodistrofia apresentaram maiores valores de percentual de gordura de tronco, bem como, os sedentários em relação aos ativos. CONCLUSÕES: O estilo de vida fisicamente ativa resultou em efeito protetor para ocorrência da lipodistrofia relacionada ao uso da TARV.

Changes of metabolic and inflammatory markers in HIV infection: glucose, lipids, serum Hs-CRP and myeloperoxidase

Objective: HIV infection is exacerbated through additional pro-atherogenic mechanisms related to the processes of immune activation, inflammation, coagulation, and the modification of lipoproteins (e.g., particles of high density lipoprotein), contributing to increased cardiovascular risk. The aim of this study was to analyze the serum concentrations of myeloperoxidase (MPO) and other laboratory parameters in HIV-infected patients treated or not with antiretroviral drugs compared to non-infected individuals.Materials/Methods: The study included 154 volunteers: 47 non-infected individuals (control group - CON), 27 infected and untreated individuals (NTARv group) and 80 treated individuals (TARV group). We analyzed the counts of CD4+ lymphocytes and the viral load of the infected patients, along with the blood count, fasting glucose, total serum cholesterol (CHOL), HDL cholesterol, LDL cholesterol, triglycerides, MPO and high-sensitivity C-reactive protein (CRP) of all study participants.Results: There were significant increases in glucose, CHOL, LDL cholesterol, and triglycerides in the TARV group and significant reductions in the levels of HDL cholesterol for the TARV and NTARV groups. Significantly elevated levels of Hs-CRP were observed only in the TARV group, while levels of MPO were significantly higher in the TARV and NTARV groups compared to the control group. A correlation of MPO with Hs-CRP (r = 0.21, p = 0.032) was observed for HIV-infected patients, but MPO did not correlate significantly with the other analyzed parameters.Conclusions: The investigation of early biomarkers for cardiovascular risk evaluation, such as MPO, contributes to the clinical monitoring of HIV-infected individuals. The serum levels of MPO correlated with Hs-CRP and were high in HIV-infected individuals, indicating a possible predictor of cardiovascular events in these patients. (c) 2012 Elsevier B.V. All rights reserved.

Abnormalities in apolipoprotein and lipid levels in an HIV-infected Brazilian population under different treatment profiles: the relevance of apolipoprotein E genotypes and immunological status

HIV infection is associated with disturbances in lipid metabolism due to a host's response mechanism and the current antiretroviral therapy. The pathological appearance and progression of atherosclerosis is dependent on the presence of injurious agents in the vascular endothelium and variations in different subsets of candidate genes. Therefore, the Hha I polymorphism in the apolipoprotein E gene was evaluated in addition to triglycerides, total cholesterol, very low-density lipoprotein (VLDL), LDL, high-density lipoprotein (HDL), and apolipoprotein (apo) Al, B and E levels in 86 Brazilian HIV-infected patients and 29 healthy controls. The allele frequency for apoE in the HIV-infected group and controls was in agreement with data on the Brazilian population. Dyslipidemia was observed in the HIV group and verified by increased levels of triglycerides, VLDL and apoE, and decreased levels of HDL and apoAl. The greatest abnormalities in these biochemical variables were shown in the HIV-infected individuals whose immune function was more compromised. The effect of the genetic variation at the APOE gene on biochemical variables was more pronounced in the HIV-infected individuals who carried the apoE2/3 genotype. The highly active antiretroviral therapy (HAART)-receiving group presented increased levels of total cholesterol and apoE. Dyslipidemia was a predictable consequence of HIV infection and the protease inhibitors intensified the increase in apoE values.

CCR5 genotype and plasma ß-chemokine concentration of Brazilian HIV-infected individuals

The 32-bp deletion in the HIV-1 co-receptor CCR5 confers a high degree of resistance to HIV-1 infection in homozygous individuals for the deleted allele and partial protection against HIV-1 during disease progression in heterozygotes. Natural ligands for CCR5, MIP-1alpha, MIP-1ß and RANTES, have been shown to inhibit HIV replication in CD4+ T cells. In the present study, we examined the CCR5 genotype by PCR and the plasma levels of RANTES and MIP-1alpha by ELISA among blood donors (N = 26) and among HIV-1-infected individuals (N = 129). The control group consisted of healthy adult volunteers and HIV-1-infected subjects were an asymptomatic and heterogeneous group of individuals with regard to immunologic and virologic markers of HIV-1 disease. The frequency of the CCR5 mutant allele (delta32ccr5) in this population was 0.032; however, no delta32ccr5 homozygote was detected. These results could be related to the intense ethnic admixture of the Brazilian population. There was no correlation between circulating ß-chemokines (MIP-1alpha, RANTES) and viral load in HIV-infected individuals. RANTES concentrations in plasma samples from HIV+ patients carrying the homozygous CCR5 allele (CCR5/CCR5) (28.23 ng/ml) were higher than in the control samples (16.07 ng/ml; P<0.05); however, this HIV+ patient group (mean 26.23 pg/ml) had significantly lower concentrations of MIP-1alpha than those observed in control samples (mean 31.20 pg/ml; P<0.05). Both HIV-1-infected and uninfected individuals heterozygous for the delta32ccr5 allele had significantly lower concentrations of circulating RANTES (mean 16.07 and 6.11 ng/ml, respectively) than CCR5/CCR5 individuals (mean 28.23 and 16.07 ng/ml, respectively; P<0.05). These findings suggest that the CCR5 allele and ß-chemokine production may affect the immunopathogenesis of HIV-1.

Frequency of class I anti-HLA alloantibodies in patients infected by HIV-1

O objetivo deste estudo foi avaliar a presença de aloanticorpos anti-HLA classe I em pacientes infectados pelo HIV-1 e relacioná-la aos diferentes cursos clínicos da doença. Amostras de sangue de 145 indivíduos HIV positivo foram coletadas em tubos com EDTA. A infecção pelo HIV-1 foi confirmada por teste ELISA e a presença de aloanticorpos anti-HLA classe I determinada em seguida. A evolução clínica foi definida como rápida (<1 ano entre diagnóstico e morte), moderada (1-3 anos) ou lenta (>3 anos). A presença de aloanticorpos anti-HLA classe I foi menor em indivíduos saudáveis em relação aos infectados pelo HIV-1 (4,2% contra 32,4%). Porém, a distribuição destes aloanticorpos entre os indivíduos infectados foi igual, independente da evolução clínica. Deste modo, a presença de aloanticorpos anti-HLA classe I não é um fator determinante na piora clínica do paciente.