Antiretroviral resistance mutations in human immunodeficiency virus type 1 infected patients enrolled in genotype testing at the Central Public Health Laboratory, São Paulo, Brazil: preliminary results

Antiretroviral resistance mutations (ARM) are one of the major obstacles for pharmacological human immunodeficiency virus (HIV) suppression. Plasma HIV-1 RNA from 306 patients on antiretroviral therapy with virological failure was analyzed, most of them (60%) exposed to three or more regimens, and 28% of them have started therapy before 1997. The most common regimens in use at the time of genotype testing were AZT/3TC/nelfinavir, 3TC/D4T/nelfinavir and AZT/3TC/efavirenz. The majority of ARM occurred at protease (PR) gene at residue L90 (41%) and V82 (25%); at reverse transcriptase (RT) gene, mutations at residue M184 (V/I) were observed in 64%. One or more thymidine analogue mutations were detected in 73%. The number of ARM at PR gene increased from a mean of four mutations per patient who showed virological failure at the first ARV regimens to six mutations per patient exposed to six or more regimens; similar trend in RT was also observed. No differences in ARM at principal codon to the three drug classes for HIV-1 clades B or F were observed, but some polymorphisms in secondary codons showed significant differences. Strategies to improve the cost effectiveness of drug therapy and to optimize the sequencing and the rescue therapy are the major health priorities.

A Metacommunity Framework for Enhancing the Effectiveness of Biological Monitoring Strategies

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Higher education in evening courses in Brazil: history, growth and public policies at the beginning of the XXI Century

There are three distinct and complementary objectives in this article in order to clarify the higher education outline in Brazil, specifically evening courses (classes are held on weekdays, generally from 7:00 pm to 10:30 pm) and thesecurrent sector policies. The first objective is to present a short historical overview on the establishment of evening courses in Brazil, including those in the higher education level, occurred on the middle of last century. The second objective is to demonstrate the growth of evening higher education in Brazil, considering that in 1998, of the 2.1 million college enrollments, 55.3% were enrolled in evening courses; in 2010, twelve years later, of the 5.4 million students enrolled, there were 63.5% enrolled in evening courses. This expansion is due to the growing need of many students who must work while attending college, to defray costs of the study as well as personal and family costs. The reality of the working student is hostile considering external factors, such as transport problems, public security and lack of legislation for flexible working hours. The third objective is to discuss current public policies to expand eveningopenings in public institutions which represent nowadays only 16.1% of the 3.4 million enrollments for evening classes, including federal (6.8%), state (7.0%) and municipal (2.3%) institutions. In the third objective it is included the discussion of programs for scholarships and tuition loans. The methodology applied was to rescue historical information on the establishment and the expansion of evening courses in Brazil, analyzing the current general Brazilian policies and the specific ones from the State of São Paulo. The research results pointed to the importance of federal programs for scholarships and tuition loans for students from private institutions such as the 1,382,484 scholarships since 2004 (PROUNI Program) and the 847,000 tuition loans since 1999 (FIES Program). Important steps have been made by the Brazilian government. Considering that there are 3,987,424 enrollments in private institutions, the effectiveness of the programs for scholarships and tuition loans is still insufficient to meet the universal benefits for the student’s needs. Evening courses became the real instrument of social inclusion for many Brazilian youths and must be expanded quantitatively and qualitatively, with aggressive public policies, including also, scholarships and tuition loans.