Optimization of production of anti-cancer vaccines based on dendritic cells

Cancer remains as one of the top killing diseases in first world countries. It���s not a single, but a set of various diseases for which different treatment approaches have been taken over the years. Cancer immunotherapy comes as a ���new��� breath on cancer treatment, taking use of the patients��� immune system to induce anti-cancer responses. Dendritic Cell (DC) vaccines use the extraordinary capacity of DCs��� antigen presentation so that specific T cell responses may be generated against cancer. In this work, we report the ex vivo generation of DCs from precursors isolated from clinical-grade cryopreserved umbilical cord blood (UCB) samples. After the thawing protocol for cryopreserved samples was optimized, the generation of DCs from CD14+ monocytes, i.e., moDCs, or CD34+ hematopoietic stem cells (HSCs), i.e, CD34-derived DCs, was followed and their phenotype and function evaluated. Functional testing included the ability to respond to maturation stimuli (including enzymatic removal of surface sialic acids), Ovalbumin-FITC endocytic capacity, cytokine secretion and T cell priming ability. In order to evaluate the feasibility of using DCs derived from UCB precursors to induce immune responses, they were compared to peripheral blood (PB) moDCs. We observed an increased endocytosis capacity after moDCs were differentiated from monocyte precursors, but almost 10-fold lower than that of PB moDCs. Maturation markers were absent, low levels of inflammatory cytokines were seen and T cell stimulatory capacity was reduced. Sialidase enzymatic treatment was able to mature these cells, diminishing endocytosis and promoting higher T cell stimulation. CD34-derived DCs showed higher capacity for both maturation and endocytic capacity than moDCs. Although much more information was acquired from moDCs than from CD34-derived DCs, we conclude the last as probably the best suited for generating an immune response against cancer, but of course much more research has to be performed.

Clinical and epidemiological features of AIDS/tuberculosis comorbidity

Considering the relevance of AIDS/tuberculosis comorbidity worldwide, especially in Brazil, this study was developed to describe the clinical and epidemiological features of the comorbid cases identified from 1989 to 1997 by the epidemiology service of the Hospital das Cl��nicas of the Universidade de S��o Paulo. METHODS: Databases containing information on all identified AIDS/tuberculosis cases cared for at the hospital were used to gather information on comorbid cases. RESULTS: During the period, 559 patients were identified as presenting with AIDS/tuberculosis comorbidity. Risk behavior for AIDS was primarily heterosexual contact (38.9%), followed by intravenous drug use (29.3%) and homosexual/bisexual contact (23.2%). Regarding clinical features, there were higher rates of extrapulmonary tuberculosis when compared to tuberculosis without comorbidity. There was an increase in reporting of AIDS by ambulatory units during the period. Epidemiologically, there was a decrease in the male/female ratio, a predominance in the 20 to 39 year-old age group, and a majority of individuals who had less than 8 years of schooling and had low professional qualifications. CONCLUSIONS: High rates of AIDS/tuberculosis cases at our hospital indicate the need for better attention towards early detection of tuberculosis, especially in its extrapulmonary form. Since the population that attends this hospital tends to be of a lower socioeconomic status, better management of AIDS and tuberculosis is required to increase the rates of treatment adherence and thus lower the social costs.

Bile duct-duodenal fistula caused by AIDS/HIV-associated tuberculosis

Allthough infrequent, digestive fistulae in HIV/AIDS patients have been reported throughout the digestive tract from the esophagus to the anus, with predominance of esophageal fistulae. AIDS/HIV-associated opportunistic infections may invade the digestive system and lead to fistula formation. Tuberculosis is the most common infection associated with these esophageal fistulae. We report here one case of bile duct-duodenal fistula in a female AIDS patient with associated abdominal Mycobacterium tuberculosis infection compromising lymphnodes of the hepatic pedicle where the fistula was found. According to the reviewed literature, this is the third case of bile duct-duodenal fistula associated with abdominal tuberculosis in AIDS patient, and the first where both the fistula and the tuberculosis infection were diagnosed at laparotomy for acute abdomen. Whether the AIDS patient with abdominal pain needs or not a laparotomy to treat an infectious disease is often a difficult matter for the surgeon to decide, as most of the times appropriate medical treatment will bring more benefit.

Critical analysis of old and new vaccines against N. meningitidis serogroup C, considering the meningococcal disease epidemiology in Brazil

Worldwide, the impact of meningococcal disease is substantial, and the potential for the introduction and spread of more virulent strains of N. meningitidis or strains with increased resistance to current antibiotics causes concern, making prevention essential. OBJECTIVES: Review the indications for meningococcal disease vaccines, considering the epidemiological status in Brazil. METHODS: A critical literature review on this issue using the Medline and Lilacs databases. RESULTS: In Brazil, MenB and MenC were the most important serogroups identified in the 1990s. Polysaccharide vaccines available against those serogroups can offer only limited protection for infants, the group at highest risk for meningococcal disease. Additionally, polysaccharide vaccines may induce a hypo-responsive state to MenC. New meningococcal C conjugate vaccines could partially solve these problems, but it is unlikely that in the next few years a vaccine against MenB that can promote good protection against multiple strains of MenB responsible for endemic and epidemic diseases will become available. CONCLUSIONS: In order to make the best decision about recommendations on immunization practices, better quality surveillance data are required. In Brazil, MenC was responsible for about 2,000 cases per year during the last 10 years. New conjugate vaccines against MenC are very effective and immunogenic, and they should be recommended, especially for children less than 5 years old. Polysaccharide vaccines should be indicated only in epidemic situations and for high-risk groups. Until new vaccines against MenC and MenB are available for routine immunization programs, the most important measure for controlling meningococcal disease is early diagnosis of these infections in order to treat patients and to offer chemoprophylaxis to contacts.

Vaccines in pregnancy: a review of their importance in Brazil

Neonates and young children remain susceptible to many serious infectious diseases preventable through vaccination. In general, current vaccines strategies to prevent infectious diseases are unable to induce protective levels of antibodies in the first 6 months of life. Women vaccinated during pregnancy are capable of producing immunoglobulin antibodies that are transported actively to the fetus, and maternal immunization can benefit both the mother and the child. With few exceptions, maternal immunization is not a routine, because of the concerns related to the safety of this intervention. Ethical and cultural issues make the studies on maternal immunization difficult; however, in the last decade, the development of new vaccines, which are very immunogenic and safe has reactivated the discussions on maternal immunization. In this paper we present a review of the literature about maternal immunization based on MEDLINE data (1990 to 2002). The most important conclusions are: 1) there is no evidence of risk to the fetus by immunizing pregnant women with toxoids, polysaccharide, polysaccharide conjugated and inactive viral vaccines; 2) most viral attenuated vaccines are probably safe too, but data is still insufficient to demonstrate their safety; therefore these vaccines should be avoided in pregnant women; 3) in Brazil, there is a need for a maternal immunization program against tetanus. Many new candidate vaccines for maternal immunization are available, but studies should be conducted to evaluate their safety and efficacy, as well as regional priorities based on epidemiological data.

Causes of low vision and use of optical aids in the elderly

PURPOSE: To determine the causes of low vision in an elderly population attended by a university visual rehabilitation service and to check for the use of prescribed optical aids. METHOD: A cross-sectional study was carried out on patients aged 60 years or over attending for the first time a university low vision service in 2001. Ophthalmic reevaluation and interview were performed by means of a structured questionnaire in 2002. RESULTS: The sample comprised 50 subjects aged between 60 and 90 years. Severe low vision (<FONT FACE=Symbol><</FONT>20/200) was present in 68.0% of patients. The main cause of low vision was age-related macular degeneration (44.0%). Regarding literacy, 16.0% were illiterate and 72.0% had completed fundamental schooling. Thirty-one patients (62.0%) had been prescribed optical aids; 54.8% of these patients stated that they use them. A majority (70.6%) held a favorable opinion of these aids. CONCLUSIONS: The main cause of low vision was age-related macular degeneration. Approximately half of those receiving prescriptions reported actually using the aids in their daily activities. Making best use of residual vision in the elderly population with visual impairment is a priority, given the social context, if the independence necessary for enhanced quality of life is to be achieved.

Escala de atitudes frente ao HIV/AIDS: an��lise de fatores

OBJETIVO: Este trabalho apresenta resultados acerca das propriedades psicom��tricas da "Escala de atitudes frente ao HIV/AIDS". Os dados, provenientes de uma amostra de 549 alunos entre universit��rios, ensinos m��dio e ensino fundamental. M��TODOS: Os dados foram tratados pelo m��todo dos componentes principais da an��lise fatorial. A an��lise final, postulado um eigenvalue m��nimo 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, �� prov��vel que todos os 47 itens do instrumento final elaborado me��am 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 percep����o da informa����o t��cnico-cient��fica"; "fator de percep����o da informa����o t��cnico-cient��fica versus sexualidade e preconceito"; "fator de percep����o da informa����o t��cnico-cient��fica no uso de drogas", respectivamente. CONCLUS��ES: O alfa de Cronbach encontrado para a escala como um todo foi de 0,859, sugerindo fortemente a exist��ncia da fidedignidade do instrumento que se mostrou ��til para avaliar o grau de conhecimento acerca do HIV/AIDS e o risco decorrente do desconhecimento, entre estudantes.

Associa����o entre uso de ��lcool em indiv��duos com AIDS e ades��o ao tratamento antirretroviral: uma revis��o da literatura

OBJETIVO: O objetivo deste trabalho foi fazer uma revis��o sistem��tica da literatura, utilizando a base de dados MedLine, sobre o tema: uso/abuso/depend��ncia de ��lcool como um fator de risco �� redu����o da ades��o, �� redu����o na supress��o da carga viral ou ao pior desfecho cl��nico em pacientes com AIDS em uso de highly active antiretroviral therapy (HAART). M��TODO: Foi realizada uma pesquisa sistem��tica na base de dados MedLine utilizando como unitermos "HAART", "adherence" e "alcohol", na busca de artigos que versassem sobre a tem��tica: avalia����o ou associa����o de uso/abuso/depend��ncia de ��lcool e ades��o/supress��o da carga viral/ desfecho cl��nico nos pacientes em uso de terapia antirretroviral. RESULTADOS: A busca resultou em 65 artigos. Contudo, apenas 21 deles contemplaram os crit��rios de inclus��o e foram selecionados. Foi encontrada associa����o positiva entre uso/abuso/depend��ncia de ��lcool e baixa ades��o/baixa supress��o da carga viral/pior desfecho cl��nico em 18 (85,7%) artigos. CONCLUS��O: O uso/abuso/depend��ncia de ��lcool �� um fator de risco para baixa ades��o/baixa supress��o da carga viral/pior desfecho cl��nico nos indiv��duos em uso de HAART.

Estudo do autorrelato de ades��o e uso problem��tico de ��lcool em uma popula����o de indiv��duos com AIDS em uso de HAART

OBJETIVO: O objetivo deste estudo foi analisar a for��a de associa����o entre as vari��veis autorrelato de ades��o �� medica����o e uso problem��tico de ��lcool em uma popula����o de indiv��duos com AIDS que fazem uso de HAART. M��TODO: Foram entrevistados 103 pacientes com AIDS, em uso de HAART h�� pelo menos seis meses, que frequentavam o ambulat��rio do Instituto de Doen��as Tropicais Natan Portela (IDTNP), localizado na cidade de Teresina, PI. A vari��vel independente estudada foi o uso problem��tico de ��lcool, al��m de vari��veis sociodemogr��ficas. O question��rio utilizado para avaliar o uso problem��tico de ��lcool foi o AUDIT (Alcohol Use Disorders Identification Test). A vari��vel dependente avaliada neste estudo foi o autorrelato de ades��o ao tratamento para o HIV. Para sua mensura����o, optou-se por utilizar o QSAM (Question��rio Simplificado de Ades��o �� Medica����o), por tratar-se de um question��rio bastante simples e de f��cil aplica����o. RESULTADOS: A frequ��ncia de AUDIT > 08 foi de 33%; j�� o autorrelato de ades��o, avaliado pelo QSAM, foi positivo em 45% da amostra. Testada a associa����o entre a frequ��ncia de QSAM positivo e o AUDIT positivo, encontrou-se forte associa����o entre essas vari��veis (p = 0,004). CONCLUS��O: Conclui-se deste estudo que o autorrelato de falha na ades��o ao HAART aferido por meio do QSAM �� um fator de risco para a presen��a de uso problem��tico de ��lcool.

Psychosocial factors associated with adherence to treatment and quality of life in people living with HIV/AIDS in Brazil

Objective: The objective of this article was to investigate the biopsychosocial factors that influence adherence to treatment and the quality of life of individuals who have been successfully following the HIV/AIDS treatment. Methods: It is a cross-sectional study carried out with 120 HIV positive participants in the south of Brazil. Among the variables studied, of note are: perceived stress, social support, symptoms of anxiety and depression and quality of life. Results: The results show that a moderate to high adherence to the treatment paired with a strong sense of social support indicate a higher quality of life. Conclusion: The combination of social support and antiretroviral treatment have an impact on physical conditions, improving immune response and quality of life.

AIDS na inf��ncia: acometimento card��aco com e sem a terapia anti-retroviral tr��plice combinada

OBJETIVO: Descrever a preval��ncia de altera����es card��acas ao ecocardiograma em crian��as com AIDS acompanhadas em servi��o de refer��ncia aos 18&plusmn;6 meses do diagn��stico confirmado de AIDS. M��TODOS: Estudo transversal, com corte aos 18&plusmn;6 meses do diagn��stico de AIDS. Inclu��das 93 crian��as com diagn��stico confirmado de AIDS por transmiss��o vertical, sem doen��a maligna, que, na avalia����o cardiol��gica, realizaram ecocardiograma (eco). De forma explorat��ria avaliaram-se as altera����es card��acas nos pacientes sem uso (G1) e com uso (G2) de terapia combinada anti-retroviral. RESULTADOS: Quando do diagn��stico de AIDS, as crian��as tinham em m��dia 3,07 anos e 50,50% eram do sexo feminino. Esquema de terapia combinado com anti-retrovirais foi utilizado por 47 pacientes (G2). O acometimento card��aco esteve presente em 40 crian��as (43,00%). A presen��a de disfun����o ventricular esquerda (G1:39,10%;G2:10,60%) e o aumento isolado de ventr��culo esquerdo (G1:6,60%;G2:14,90%) foram os achados mais freq��entes. Observou-se associa����o significativa entre os grupos sem e com terapia anti-retroviral combinada quanto �� presen��a de disfun����o ventricular esquerda (RP=3,42; [1,41-8,26]; p =0,02) e de desnutri����o (RP=1,79; [1,00-3,20]; p=0,04). CONCLUS��O: O acometimento card��aco foi freq��ente nas crian��as com AIDS, sendo a disfun����o ventricular esquerda a altera����o mais observada ao ecocardiograma. Houve diferen��a estatisticamente significativa entre os grupos com e sem tratamento tr��plice combinado quanto �� presen��a de disfun����o ventricular esquerda e de desnutri����o.

Apoptosis y expresi��n de receptores de reconocimiento de patrones en Polimorfonucleares Neutr��filos de individuos con infecci��n VIH/SIDA. Apoptosis and recognition patterns receptors expression in Polymorphonuclear Neutrophils of individuals with HIV/AIDS infection.

El Virus de la Inmunodeficiencia Humana tipo 1 (VIH-1) afecta principalmente a la respuesta inmune espec��fica causando una p��rdida progresiva de los linfocitos T CD4+. Sin embargo, este virus tambi��n afecta a c��lulas del sistema inmune innato, tales como los Polimorfonucleares Neutr��filos (PMN). Existen evidencias de alteraciones funcionales de los PMN durante la progresi��n de la infecci��n por VIH y una de las explicaciones de estos defectos, la atribuye a una muerte celular programada o apoptosis constitutiva incrementada. El compromiso de la apoptosis de los PMN en la infecci��n por VIH no est�� totalmente dilucidado, por ello, los objetivos de este proyecto son investigar el efecto de la infecci��n por VIH sobre la apoptosis de PMN, analizar la expresi��n de mol��culas y receptores de patrones de reconocimiento en estas c��lulas y evaluar el impacto de la terapia antirretroviral sobre la apoptosis y expresi��n de mol��culas y receptores en PMN. Se incluir��n individuos en distintos estadios cl��nicos e inmunol��gicos de la infecci��n con o sin tratamiento antirretroviral y se determinar��n par��metros hematol��gicos, inmunol��gicos y virol��gicos a fin de correlacionar el nivel de apoptosis y expresi��n de mol��culas y receptores con el nivel de linfocitos T CD4+ y carga viral. La importancia de los PMN en el control de la infecci��n por el VIH es actualmente un ��rea de mucho inter��s, ya pueden ejercer un efecto anti-VIH directo, y al mismo tiempo, ser blancos de la infecci��n viral. Los mecanismos que conducen a la muerte acelerada de los PMN no han sido totalmente dilucidados, por ello, su estudio permitir�� entender las bases bioqu��micas de los cambios morfol��gicos y determinar los mecanismos que definen su iniciaci��n y regulaci��n. En el presente proyecto, el estudio de la apoptosis de PMN de pacientes con infecci��n VIH/SIDA posibilitar�� caracterizar la sobrevida de ��stas c��lulas y su relaci��n con el estado inmunol��gico, virol��gico y la terapia antirretroviral. Adem��s, el estudio de los receptores reconocedores de patrones moleculares asociados a pat��genos permitir�� aclarar algunos aspectos de la activaci��n de la respuesta inmune innata y su conexi��n con la inmunidad adaptativa. Comprender aspectos claves de la cascada de la apoptosis de PMN y de la expresi��n de receptores reconocedores de patrones moleculares en la infecci��n VIH/SIDA podr��a en un futuro aportar posibles blancos terap��uticos para restaurar la funci��n de estas c��lulas durante esta infecci��n.

Perfil lip��dico, fatores de risco cardiovascular e s��ndrome metab��lica em um grupo de pacientes com AIDS

FUNDAMENTO: Desde o advento da AIDS, a terapia antiretroviral desenvolveu-se significantemente, incluindo a terapia antiretroviral altamente ativa (HAART) e a doen��a adquiriu uma caracter��stica cr��nica. Entretanto, ap��s a introdu����o da HAART, v��rias altera����es metab��licas foram observadas, principalmente relacionadas ao perfil lip��dico. OBJETIVO: Avaliar e comparar os perfis lip��dicos, analisar o risco cardiovascular, e descrever a preval��ncia da s��ndrome metab��lica em pacientes com AIDS tratados ou n��o com HAART. M��TODOS: Durante um per��odo de 18 meses, 319 pacientes tratados em ambulat��rios na cidade de S��o Paulo, Brasil, foram selecionados. RESULTADOS: A amostra final incluiu 215 pacientes tratados com HAART e 69 pacientes virgens de tratamento com HAART. A idade m��dia era 39,5 anos, e 60,9% eram do sexo masculino. Os principais fatores de risco cardiovascular eram o fumo (27%), hipertens��o (18%) e hist��rico familiar de aterosclerose (40%). Os valores m��dios de colesterol total, HDL-colesterol, triglic��rides e glicose foram mais altos no grupo HAART do que no grupo n��o-HAART (205 vs 180 mg/dl, 51 vs 43 mg/dl, 219 vs 164 mg/dl e 101 vs 93 mg/dl respectivamente; p < 0,001 para todos). De acordo com o escore de risco de Framingham, o risco cardiovascular era moderado a alto em 11% dos pacientes tratados com HAART e 4% dos pacientes n��o-HAART. De acordo com a defini����o do Adult Treatment Panel III, a s��ndrome metab��lica foi observada em 13% e 12% dos pacientes, respectivamente, com e sem HAART. CONCLUS��O: Embora os valores m��dios do colesterol total, HDL-c e triglic��rides tenham sido mais altos no grupo HAART, um maior risco cardiovascular n��o foi identificado no primeiro grupo. A preval��ncia de s��ndrome metab��lica foi compar��vel em ambos os grupos.

Perfil dos pacientes com hipertens��o arterial inclu��dos em uma coorte com HIV/AIDS em Pernambuco, Brasil

FUNDAMENTO: Hipertens��o arterial sist��mica (HAS) �� fator de risco modific��vel, cujo controle pode reduzir doen��a cardiovascular nos pacientes com v��rus da imunodefici��ncia adquirida (HIV). OBJETIVO: Estimar a preval��ncia de HAS e descrever as caracter��sticas dos pacientes com HAS e pr��-hipertens��o infectados pelo HIV/AIDS. M��TODOS: Estudo seccional alinhado a uma coorte de pacientes com HIV/AIDS. Considerou-se hipertens��o em n��veis > 140/90 mmHg ou uso de anti-hipertensivos e pr��-hipertens��o em n��veis > 120/80 mmHg. RESULTADOS: Dos 958 pacientes, 388 (40,5%) eram normotensos, 325 (33,9%) pr��-hipertensos e 245 (25,6%) hipertensos. Desses 245 pacientes, 172 (70,2%) sabiam ser hipertensos e 36 (14,8%) apresentavam press��o arterial controlada. Tiveram diagn��stico de HAS ap��s o diagn��stico do HIV 62 pacientes (54,4%). Lipodistrofia ocorreu em 95 (46,1%) dos pacientes, j�� sobrepeso/obesidade em 129 (52,7%). Utiliza����o de antirretrovirais ocorreu em 184 (85,9%), 89 (41,6%) com inibidores de protease (IP) e 95 (44,4%) sem IP. Utilizavam antivirais > 24 meses 74,7%. Idade, antecedentes familiares de hipertens��o, circunfer��ncia abdominal, ��ndice de massa corporal e triglicer��deos foram maiores entre pacientes hipertensos. Tempo de infec����o pelo HIV, contagem de linf��citos CD4, carga viral, tempo e tipo de esquema antirretroviral foram semelhantes nos hipertensos e pr��-hipertensos. CONCLUS��O: A elevada frequ��ncia de hipertensos n��o controlados e de riscos cardiovasculares nos infectados pelo HIV apontam a necessidade de medidas preventivas e terap��uticas contra HAS nesse grupo.

Escore de c��lcio na avalia����o da aterosclerose em pacientes com HIV/AIDS

FUNDAMENTO: A terapia antirretroviral aumentou drasticamente a expectativa de vida em pacientes com HIV/AIDS, embora a aterosclerose esteja associada a uma terapia de longo prazo. OBJETIVO: Investigar a preval��ncia de aterosclerose em pacientes com AIDS submetidos �� terapia antirretroviral e a influ��ncia de tratamentos de diferentes regimes e dura����es. M��TODOS: Pacientes com HIV/AIDS foram abordados durante consultas de rotina. Aqueles que estiveram em terapia antirretroviral por, pelo menos, dois anos tiveram o sangue coletado para an��lise do perfil lip��dico e da glicemia em jejum e foram submetidos �� tomografia computadorizada card��aca para quantifica����o do escore de c��lcio dentro de seis dias, no m��ximo. A aterosclerose foi definida como escore de c��lcio maior que zero (CAC > 0). Fatores de risco tradicionais, s��ndrome metab��lica e o escore de Framingham foram analisados. RESULTADOS: Cinquenta e tr��s pacientes realizaram tomografia computadorizada card��aca: 50,94% eram do sexo masculino, com idade m��dia de 43,4 anos; 20% tinham hipertens��o; 3,77% tinham diabetes; 67,92% tinham hipercolesterolemia; 37,74% tinham hipertrigliceridemia; 47,17% tinham HDL baixo; 24,53% atenderam aos crit��rios para s��ndrome metab��lica; 96,23% foram classificados no escore de Framingham como "baixo risco"; e 18,87% eram tabagistas. A dura����o m��dia do tratamento antirretroviral foi de 58,98 meses. A aterosclerose coron��ria ocorreu em 11 pacientes (20,75%). A dura����o da terapia antirretroviral n��o se relacionou �� aterosclerose (p = 0,41), e n��o houve diferen��as significativas entre os diferentes esquemas antirretrovirais (p = 0,71). Entre os fatores de risco tradicionais, o tabagismo (OR = 27,20; p = 0,023) e a idade (OR = 20,59; p = 0,033) foram significativos na presen��a de aterosclerose. Havia tend��ncia para uma associa����o positiva da aterosclerose com a hipercolesterolemia (OR = 8,30; p = 0,0668). CONCLUS��O: Os fatores associados �� aterosclerose foram idade, tabagismo e hipercolesterolemia. A dura����o e o tipo de terapia antirretroviral n��o influenciaram a preval��ncia da aterosclerose.