Resumo: O estudo visou estimar a incidência dos fatores associados à soroconversão para o anti-HCV em pacientes em hemodiálise no Sistema Único de Saúde (SUS). Trata-se de um estudo prospectivo, não concorrente, utilizando dados de pacientes identificados por relacionamento determinístico-probabilístico nos registros dos sistemas de informação do SUS. Foram incluídos 47.079 pacientes que iniciaram em hemodiálise no período de 1º de janeiro de 2000 a 31 de dezembro de 2003, acompanhados até a soroconversão ou o término do estudo em 2004. Nesta pesquisa, 3% dos pacientes em hemodiálise apresentaram soroconversão para anti-HCV (incidência de 1,7 soroconversão por 100 pacientes/ano). Maior risco de soroconversão para o anti-HCV foi associado com idade, glomerulonefrites, região de residência, anti-HIV positivo e efeito da unidade de diálise. A incidência observada de soroconversão para anti-HCV foi semelhante à registrada em alguns países desenvolvidos, destacando-se a evidência de transmissão entre os pacientes em hemodiálise.

Abstract: The study aimed to estimate the incidence of HCV seroconversion in hemodialysis patients in the Brazilian Unified National Health System (SUS). This was a prospective, non-concurrent study using patients' data identified by deterministic and probabilistic record linkage in the SUS information system. The study included 47,079 patients started on hemodialysis between January 1, 2000, and December 31, 2003, followed until seroconversion or conclusion of the study in 2004. Three percent of hemodialysis patients HCV-seroconverted (1.7 per 100 patient-years). Increased risk of HCV seroconversion was associated with age, glomerulonephritis, geographic region, HIV-positivity, and dialysis service. The observed HCV seroconversion rate was similar to that in developed countries, highlighting evidence of transmission among hemodialysis patients.

Resumen: El estudio tuvo como objetivo estimar la incidencia de los factores asociados a la seroconversión para el anti-VHC en pacientes en hemodiálisis dentro del Sistema Único de Salud (SUS). Se trata de un estudio prospectivo, no concurrente, utilizando datos de pacientes identificados por relación determinístico-probabilística en los registros de los sistemas de información del SUS. Se incluyeron a 47.079 pacientes que comenzaron la hemodiálisis durante el período del 1º de enero de 2000 a 31 de diciembre de 2003, seguidos hasta la seroconversión al final del estudio en 2004. En este estudio, un 3% de los pacientes en hemodiálisis presentaron seroconversión para anti-VHC (incidencia de 1,7 seroconversiones por 100 pacientes/año). El mayor riesgo de seroconversión para el anti-VHC fue asociado a la edad, glomerulonefritis; región de residencia, presentar anti-VIH positivo y a los efectos de la unidad de diálisis. En ese estudio, la incidencia observada de seroconversión para anti-VHC fue semejante a la registrada en algunos países desarrollados, destacándose la evidencia de transmisión entre los pacientes en hemodiálisis.

Resumo: O estudo visou estimar a incidência dos fatores associados à soroconversão para o anti-HCV em pacientes em hemodiálise no Sistema Único de Saúde (SUS). Trata-se de um estudo prospectivo, não concorrente, utilizando dados de pacientes identificados por relacionamento determinístico-probabilístico nos registros dos sistemas de informação do SUS. Foram incluídos 47.079 pacientes que iniciaram em hemodiálise no período de 1º de janeiro de 2000 a 31 de dezembro de 2003, acompanhados até a soroconversão ou o término do estudo em 2004. Nesta pesquisa, 3% dos pacientes em hemodiálise apresentaram soroconversão para anti-HCV (incidência de 1,7 soroconversão por 100 pacientes/ano). Maior risco de soroconversão para o anti-HCV foi associado com idade, glomerulonefrites, região de residência, anti-HIV positivo e efeito da unidade de diálise. A incidência observada de soroconversão para anti-HCV foi semelhante à registrada em alguns países desenvolvidos, destacando-se a evidência de transmissão entre os pacientes em hemodiálise.

Abstract: The study aimed to estimate the incidence of HCV seroconversion in hemodialysis patients in the Brazilian Unified National Health System (SUS). This was a prospective, non-concurrent study using patients' data identified by deterministic and probabilistic record linkage in the SUS information system. The study included 47,079 patients started on hemodialysis between January 1, 2000, and December 31, 2003, followed until seroconversion or conclusion of the study in 2004. Three percent of hemodialysis patients HCV-seroconverted (1.7 per 100 patient-years). Increased risk of HCV seroconversion was associated with age, glomerulonephritis, geographic region, HIV-positivity, and dialysis service. The observed HCV seroconversion rate was similar to that in developed countries, highlighting evidence of transmission among hemodialysis patients.

Resumen: El estudio tuvo como objetivo estimar la incidencia de los factores asociados a la seroconversión para el anti-VHC en pacientes en hemodiálisis dentro del Sistema Único de Salud (SUS). Se trata de un estudio prospectivo, no concurrente, utilizando datos de pacientes identificados por relación determinístico-probabilística en los registros de los sistemas de información del SUS. Se incluyeron a 47.079 pacientes que comenzaron la hemodiálisis durante el período del 1º de enero de 2000 a 31 de diciembre de 2003, seguidos hasta la seroconversión al final del estudio en 2004. En este estudio, un 3% de los pacientes en hemodiálisis presentaron seroconversión para anti-VHC (incidencia de 1,7 seroconversiones por 100 pacientes/año). El mayor riesgo de seroconversión para el anti-VHC fue asociado a la edad, glomerulonefritis; región de residencia, presentar anti-VIH positivo y a los efectos de la unidad de diálisis. En ese estudio, la incidencia observada de seroconversión para anti-VHC fue semejante a la registrada en algunos países desarrollados, destacándose la evidencia de transmisión entre los pacientes en hemodiálisis.

IntroductionThe prevalence of sexual dysfunction (SD) and dissatisfaction with sexual life (DSL) in patients with chronic hepatitis C virus infection (CHC) was jointly investigated via a thorough psychopathological analysis, which included dimensions such as fatigue, impulsiveness, psychiatric comorbidity, health-related quality of life (HRQL) and sociodemographic and clinical characteristics.MethodsMale and female CHC patients from an outpatient referral center were assessed using the Brief Fatigue Inventory, the Barrat Impulsiveness Scale, the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale, the Hamilton Anxiety Scale (HAM-A), and the World Health Organization Quality of Life Scale-Brief Version (WHOQOL-BREF). Structured psychiatric interviews were performed according to the Mini-International Neuropsychiatric Interview. SD was assessed based on specific items in the BDI (item 21) and the HAM-A (item 12). DSL was assessed based on a specific question in the WHOQOL-BREF (item 21). Multivariate analysis was performed according to an ordinal linear regression model in which SD and DSL were considered as outcome variables.ResultsSD was reported by 60 (57.1%) of the patients according to the results of the BDI and by 54 (51.4%) of the patients according to the results of the HAM-A. SD was associated with older age, female gender, viral genotype 2 or 3, interferon-α use, impulsiveness, depressive symptoms, antidepressant and benzodiazepine use, and lower HRQL. DSL was reported by 34 (32.4%) of the patients and was associated with depressive symptoms, anxiety symptoms, antidepressant use, and lower HRQL.ConclusionsThe prevalence of SD and DSL in CHC patients was high and was associated with factors, such as depressive symptoms and antidepressant use. Screening and managing these conditions represent significant steps toward improving medical assistance and the HRQL of CHC patients.

INTRODUCTION: Chronic hepatitis C virus infection patients have higher rates of psychiatric disorders than the general population. Chronic hepatitis C virus infection is known to be associated with impaired health related quality of life. To our knowledge, there is no previous research of health related quality of life in chronic hepatitis C patients that combined structured psychiatric interview and careful psychopathological evaluation, including depression, anxiety and fatigue instruments. The aim of this study was to evaluate health related quality of life of chronic hepatitis C patients and to investigate the association with sociodemographic, psychopathological and psychiatric factors. MATERIALS AND METHODS: Eighty-one individuals with chronic hepatitis C virus infection receiving care at a Brazilian public university-based outpatient service for infectious diseases were enrolled in the study. The World Health Organization Quality of Life Scale Brief Version was used to assess health related quality of life. Standard psychiatric interview (Mini International Neuropsychiatric Interview-Plus) was conducted to establish Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I psychiatric diagnosis. Further instruments completed psychopathological investigation: Beck Depression Inventory, Hospital Anxiety and Depression Scale, Brief Fatigue Inventory, Hamilton Depression Scale and Hamilton Anxiety Scale. Pearson Chi-Square and Kruskal-Wallis were performed for categorical and continuous univariate analysis, respectively. Correlation between psychopathological and health related quality of life scores was performed according to Spearman's correlation. Multivariate analysis was performed according to stepwise forward ordinal logistic regression. The significance threshold was fixed at α = 0.05. RESULTS: Depressive disorders were associated with worse scores in overall health related quality of life and in all domains. Fatigue was associated with lower scores in physical and psychological domains, and married status with higher scores in psychological health related quality of life. We found strong correlation among scores of depression, fatigue and health related quality of life. CONCLUSION: Depression and fatigue must be properly investigated and managed in HCV patients in order to improve HRQL. WHOQOL-BREF proved to be a useful instrument to assess HRQL in HCV patients.

OBJECTIVE: To conduct a cost-effectiveness analysis of drug alternatives with rescue therapy in case of relapse due to viral resistance for the treatment of patients with chronic hepatitis B (CHB). METHODS: Hypothetical cohort of patients with CHB, HBeAg-negative, without clinical or histological evidence of cirrhosis, detectable HBV DNA, histological diagnosis of the disease, positive serum HBsAg for longer than six months, high levels of alanine aminotransferase (ALT) (twice as high as the upper limit of normality) and mean age of 40 years. A Markov model was developed for chronic hepatitis B (HBeAg- negative) with a 40-year time horizon. Costs and benefits were discounted at 5%. Annual rates of disease progression, costs due to complications and the efficacy of medicines were obtained from the literature. One-way and probabilistic sensitivity analysis evaluated uncertainties. RESULTS: Initiation of treatments with entecavir resulted in an increase of 0.35 discounted life-years gained compared to lamivudine. The incremental cost-effectiveness ratio was R$16,416.08 per life-years gained. In the sensitivity analysis, the incremental cost-effectiveness ratio was more sensitive to variation in the probability of transition from chronic hepatitis B to compensated cirrhosis, discount rate and medicine prices (± 10%). In the probabilistic sensitivity analysis, the acceptability curve showed that beginning treatment with entecavir was the most cost-effective alternative in comparison with the use of lamivudine. CONCLUSIONS: The availability of entecavir is economically attractive as part of early treatment for patients with chronic hepatitis B without HIV co-infection.

OBJETIVO: Conduzir uma análise de custo-efetividade das alternativas medicamentosas com terapia de resgate na recaída por resistência viral para tratamento de pacientes com hepatite crônica B (HCB). MÉTODOS: Coorte hipotética de pacientes com HCB, HBeAg negativo, sem evidência clínica ou histológica de cirrose, DNA do VHB detectável, diagnóstico histológico da doença, HBsAg positivo no soro por mais de seis meses, elevados níveis de alanina transferase (ALT) (duas vezes maior que o limite superior da normalidade [LSN]) e média de idade de 40 anos. Modelo de Markov foi desenvolvido para a hepatite crônica B (antígeno HBeAg negativo) com horizonte temporal de 40 anos. Custos e benefícios foram descontados em 5%. As taxas anuais de progressão, custos devido a complicações e a eficácia dos medicamentos foram obtidos da literatura. As incertezas foram avaliadas por análises de sensibilidade unidirecional e probabilística. RESULTADOS: Iniciar o tratamento com entecavir resultou em 0,35 ano de vida ganho em relação à lamivudina. A razão de custo-efetividade incremental foi de R$ 16.416,08 por anos de vida ganhos. Na análise de sensibilidade a razão de custo-efetividade incremental foi mais sensível à variação na probabilidade de transição de hepatite crônica B para cirrose compensada, taxa de desconto e preço dos medicamentos (± 10%). Na análise de sensibilidade probabilística, a curva de aceitabilidade mostrou que iniciar com entecavir foi a alternativa mais custo-efetiva na comparação ao uso de lamivudina. CONCLUSÕES: A disponibilidade do entecavir é economicamente atrativa como parte do tratamento precoce para pacientes com hepatite crônica B sem coinfecção com o HIV.

OBJECTIVE: To conduct a cost-effectiveness analysis of drug alternatives with rescue therapy in case of relapse due to viral resistance for the treatment of patients with chronic hepatitis B (CHB). METHODS: Hypothetical cohort of patients with CHB, HBeAg-negative, without clinical or histological evidence of cirrhosis, detectable HBV DNA, histological diagnosis of the disease, positive serum HBsAg for longer than six months, high levels of alanine aminotransferase (ALT) (twice as high as the upper limit of normality) and mean age of 40 years. A Markov model was developed for chronic hepatitis B (HBeAg- negative) with a 40-year time horizon. Costs and benefits were discounted at 5%. Annual rates of disease progression, costs due to complications and the efficacy of medicines were obtained from the literature. One-way and probabilistic sensitivity analysis evaluated uncertainties. RESULTS: Initiation of treatments with entecavir resulted in an increase of 0.35 discounted life-years gained compared to lamivudine. The incremental cost-effectiveness ratio was R$16,416.08 per life-years gained. In the sensitivity analysis, the incremental cost-effectiveness ratio was more sensitive to variation in the probability of transition from chronic hepatitis B to compensated cirrhosis, discount rate and medicine prices (± 10%). In the probabilistic sensitivity analysis, the acceptability curve showed that beginning treatment with entecavir was the most cost-effective alternative in comparison with the use of lamivudine. CONCLUSIONS: The availability of entecavir is economically attractive as part of early treatment for patients with chronic hepatitis B without HIV co-infection.

OBJETIVO: Analizar la tasa costo/efectividad de las alternativas medicamentosas con terapia de rescate en la recaída por resistencia viral en el tratamiento de pacientes con hepatitis crónica B (HCB). MÉTODOS: Cohorte hipotética de pacientes con HCB HBeAg negativo, sin evidencia clínica o histológica de cirrosis, DNA del VHB detectable, diagnóstico histológico de la enfermedad, HBsAg positivo en el suero por más de seis meses, elevados niveles de alanina transferasa (ALT) (dos veces mayor que el límite superior de la normalidad [LSN] y promedio de edad de 40 años. Se desarrolló el Modelo de Markov para la hepatitis crónica B (antígeno HBeAg negativo) con horizonte temporal de 40 años. Costos y beneficios se descontaron en 5%. Las tasas anuales de progresión, costos debido a complicaciones y la eficacia de los medicamentos se obtuvieron de la literatura. Las incertezas se evaluaron por análisis de sensibilidad unidireccional y probabilística. RESULTADOS: Iniciar el tratamiento con entecavir resultó en ganancia de 0,35 año/vida con relación a la lamivudina. El cociente de costo-efectividad incremental fue de R$ 16.416,08 por años de vida ganados. En el análisis de sensibilidad el cociente de costo-efectividad incremental fue más sensible a la variación en la probabilidad de transición de hepatitis crónica B para cirrosis compensada, tasa de descuento y precio de los medicamentos (±10%). En el análisis de sensibilidad probabilística, la curva de aceptación mostró que iniciar con entecavir fue la alternativa más costo-efectiva en comparación al uso de lamivudina. CONCLUSIONES: La disponibilidad del entecavir es económicamente atractiva como parte del tratamiento precoz para pacientes con hepatitis crónica B sin co-infección con el VIH.

The host immune response plays an important role in viral clearance in patients who are chronically infected with hepatitis C virus (HCV) and are treated with interferon and ribavirin. Activation of the immune system involves the release of pro and anti-inflammatory molecules that can be measured in plasma samples. The present study aimed to evaluate the association between pretreatment plasma levels of chemokines and soluble tumor necrosis factor receptors (sTNF-R) and the virological response in treated patients with chronic hepatitis C infection. Forty-one chronically-infected HCV patients that were being treated with interferon-α (IFN-α) plus ribavirin were included in the study. Socio-demographic, clinical and laboratory data were collected and pretreatment plasma levels of chemokine CCL2, CCL3, CCL11, CCL24, chemokine CXCL9, CXCL10, sTNF-R1 and sTNF-R2 were measured. The virological response was assessed at treatment week 12, at the end of treatment and 24 weeks after treatment. Pretreatment CXCL10 levels were significantly higher in patients without an early virological response (EVR) or sustained virological response (SVR) compared to responders [512.9 pg/mL vs. 179.1 pg/mL (p = 0.011) and 289.9 pg/mL vs. 142.7 pg/mL (p = 0.045), respectively]. The accuracy of CXCL10 as a predictor of the absence of EVR and SVR was 0.79 [confidence interval (CI) 95%: 0.59-0.99] and 0.69 (CI 95%: 0.51-0.87), respectively. Pretreatment plasma levels of the other soluble inflammatory markers evaluated were not associated with a treatment response. Pretreatment CXCL10 levels were predictive of both EVR and SVR to IFN-α and ribavirin and may be useful in the evaluation of candidates for therapy.

INTRODUÇÃO: A hepatite crônica B é uma das doenças infecciosas mais frequentes no mundo e constitui um grave problema de saúde pública MÉTODOS: Para avaliar a eficácia dos análogos de núcleosídeo/nucletídeo utilizados no seu tratamento (adefovir dipivoxil, entecavir e telbivudina) foi conduzida uma revisão sistemática de ensaios clínicos randomizados. Foram consultadas, dentre outras, as bases de dados PubMed e LILACS RESULTADOS: Foram selecionados 29 artigos entre os publicados de janeiro/1970 até dezembro/2009 CONCLUSÕES: Todos os análogos de núcleosídeo/nucletídeo apresentam eficácia superior ou similar à lamivudina. O entecavir pode ser indicado para o tratamento da hepatite B crônica como alternativa à lamivudina em pacientes HBeAg positivo e negativo virgens de tratamento, considerando seu baixo potencial de resistência viral. A adição de adefovir à lamivudina apresentou bons resultados em pacientes resistentes à lamivudina. O uso de entecavir e telbivudina nesses pacientes apresenta risco de resistência cruzada. Telbivudina é um dos mais recentes antivirais disponíveis, mas resistência antiviral já documentada representa limitação ao seu uso como opção terapêutica à lamivudina. Eventos adversos aos análogos de núcleosídeo/nucletídeo foram similares em características, gravidade e incidência quando comparados à lamivudina e placebo.

INTRODUCTION: Chronic hepatitis B is one of the most frequent infectious disease in the world and represents a serious problem of public health METHODS: A systematic review of randomized clinical trials was conducted to evaluate the efficacy of the nucleoside/nucleotide analogues (adefovir, entecavir and telbivudine) used for the treatment of chronic hepatitis B. The databases PubMed and LILACS were consulted, among others RESULTS: Twenty nine articles published between January/1970 to December/2009 were selected CONCLUSIONS: All nucleoside/nucleotide analogues demonstrate upper or similar efficacy to lamivudine. The entecavir can be appropriate for patients with chronic hepatitis B, HBeAg positive and negative treatment-naive as alternative to lamivudine, considering its low potential of viral resistance. The addition of adefovir to lamivudine presented good results in lamivudine resistant patients. The use of entecavir and telbivudine in those patients presents risk of crossed resistance. TBV is one of the most recent antivirals available, but antiviral resistance already documented represents limitation to its use as therapeutic option to LAM. Adverse events of nucleoside/nucleotide analogues were similar in characteristics, gravity and incidence when compared to the lamivudina and placebo.

BACKGROUND: This study evaluated the role of HA as a marker of liver fibrosis in patients with hepatitis C on haemodialysis. METHODS: This is a cross-sectional study in which 52 patients were divided into two groups: Group 1: patients with hepatitis C and end-stage renal disease (ESRD) undergoing haemodialysis (n = 23); and Group 2: patients with hepatitis C without ESRD (n = 29). Plasma levels of HA were associated with histological data of the samples obtained by liver biopsy and classified by METAVIR group scoring system. RESULTS: Higher plasma levels were significantly correlated to significant liver fibrosis (METAVIR > F2). In Group 1, the HA cutoff to discriminate significant fibrosis was 984.8 ng/mL, with accuracy, sensitivity and specificity of 80.8%, 83.0%, and 70.0%, respectively. In Group 2, the HA cutoff was 222.3 ng/mL, with accuracy, sensitivity and specificity of 74.5%, 70.0%, and 94.0%, respectively. CONCLUSION: HA was an accurate noninvasive marker in predicting significant fibrosis in patients with hepatitis C on haemodialysis.

Hepatitis C is an important burden worldwide being an important cause of cirrhosis and liver cancer in different parts of the world. Host immune response, especially T helper type 1 (Th1) cell-mediated, seems to play an important role in disease progression but is also crucial for viral elimination following specific therapy. Immune activation can be evaluated using peripheral levels of different cytokines, such as different chemokines (e.g. CCL5, CXCL10) and tumor necrosis factor alpha (TNF-α), and their soluble receptors (e.g. soluble TNF-α receptors 1 (sTNF-R1) and 2 (sTNF-R2). This review article focuses on the potential use of peripheral inflammatory markers as predictors of liver histological changes and therapeutic response among patients with chronic hepatitis C.

Pegylated interferon-alpha combined with ribavirin is the current gold standard treatment for chronic hepatitis C. Illicit drug dependence is not a rare co-morbidity among chronic hepatitis C population, what can make antiviral treatment an outmost challenge. Despite high sustained virological response rate following antiviral treatment, serious psychiatric adverse reactions may occur, like depression and suicide attempt. We report a patient with recurrent depressive disorder, previous history of suicide attempt and illicit drug dependence. We discuss the singularities and challenges of managing this patient in order to complete the antiviral treatment.

RESUMO OBJETIVO: Evidências indicam que pacientes com transtornos mentais têm elevada prevalência de infecções sexualmente transmissíveis, mas dados brasileiros são escassos. O objetivo deste estudo foi determinar a prevalência do HIV, hepatites C e B, e sífilis entre pacientes com transtornos mentais no Brasil. MÉTODO: Uma amostra representativa de pacientes adultos com transtornos mentais foi aleatoriamente selecionada de instituições públicas de saúde mental no Brasil. Dados sociodemográficos, comportamentais e clínicos foram obtidos por entrevista face-a-face e sangue foi coletado para exames sorológicos. Soroprevalências com intervalo de 95% de confiança foram obtidas com correção para o esquema amostral. RESULTADOS: Dos 2.475 pacientes entrevistados, 2.238 tiveram sangue coletado. A maioria era sexualmente ativa ao longo da vida (88,8%) ou nos últimos seis meses (61,4%), do gênero feminino (51,9%), solteira (66,6%), com metade dos participantes com menos de cinco anos de escolaridade e renda média mensal baixa individual (US$210). Uso de preservativo foi baixo em toda a vida (8%) ou nos últimos seis (16%). As soroprevalências gerais foram 1,12%, 0,80%, 1,64%, 14,7% e 2,63% para, respectivamente, sífilis, HIV, HBsAg, anti-HBc e anti-HCV. CONCLUSÕES: As soroprevalências encontradas são maiores do que outros estudos com populações representativas no Brasil, com altos índices de comportamento sexual de risco. Isto é preocupante e estratégias de prevenção e cuidado para as infecções sexualmente transmissíveis entre pacientes psiquiátricos devem ser urgentemente implementadas pelos serviços de saúde.

ABSTRACT OBJECTIVE: There is evidence that patients with mental illness have increased prevalence of sexually transmitted infections, but data in Brazil are scarce. The objective of this study was to determine the prevalence of HIV, hepatitis C and B, and syphilis among patients with mental illness in Brazil. METHOD: A multicenter representative sample of adults with mental illness was randomly selected from 26 mental health institutions throughout Brazil. Sociodemographic, sexual behavior and clinical data were obtained from person-to-person interviews and blood was collected for serology testing. Seroprevalence with 95% confidence limits were obtained correcting for sampling scheme. RESULTS: Of the 2,475 patients interviewed, 2,238 had blood collected. Most participants were sexually active ever (88.8%) or in the last 6 months (61.6%), female (51.9%), and single (66.6%). Half of the sample had less than 5 years of schooling and the mean monthly individual income was low (US$ 210.00). Condom use was very low either during lifetime (8%) or in the last 6 months (16%). Overall seroprevalence were 1.12%, 0.80%, 1.64%, 14.7% and 2.63% for, respectively, syphilis, HIV, HBsAg, anti-HBc and anti-HCV. CONCLUSIONS: Seroprevalences found were higher than other populations with representative studies in Brazil, with high rates of sexual risk behavior. This is of public health concern, and prevention and care strategies for sexually transmitted infections among psychiatric patients should urgently be implemented by health authorities.

Os portadores de doenças mentais crônicas encontram-se em risco para a infecção pelo HIV e outras infecções sexualmente transmissíveis. Entretanto, a prevalência dessas infecções entre portadores de doença mental crônica ainda não está claramente estabelecida nesta população. A maioria dos trabalhos sobre o tema foi conduzida em países desenvolvidos, com amostras relativamente pequenas e não representativas. Foi realizada uma revisão sistemática da literatura para identificar estudos sobre a prevalência do HIV, sífilis, hepatite B e C entre pacientes com doença mental crônica no Brasil e no mundo. De um modo geral, as prevalências variaram de 0% a 29%, 3 a 66%, 0,4 a 38% e 3,3% a 7,6% para HIV, hepatite B, hepatite C e sífilis, respectivamente. Vários fatores de risco foram identificados e discutidos, embora a literatura atual não demonstre achados significativos gerados por estudos representativos. Tal revisão destaca a escassez de informação sobre a prevalência de infecções sexualmente transmitidas e seus fatores associados entre portadores de doenças mentais crônicas e identifica lacunas no conhecimento atual em países desenvolvidos bem como nos em desenvolvimento.

A limited number of studies worldwide have investigated the prevalence of HIV, syphilis, and hepatitis B and C infection among psychiatric patients. However, prevalence of these infections in the population with chronic mental illness has not been clearly established. Most of the published papers are from developed countries and have derived from relatively small and non-representative samples. We performed a systematic review of the published literature to identify studies on these infectious diseases within psychiatric populations in Brazil and other developing countries. Overall, prevalence rates varied from 0% to 29% for HIV; 1.6% to 66% for HBV; 0.4% to 38% for HCV; and 1.1% to 7.6% for syphilis. Several risk factors were identified and discussed, although sampling limitations restrict the generalization of study findings. This review highlights the lack of information on the prevalence of sexually transmitted diseases and their associated factors among persons with chronic mental illness and identifies gaps in the knowledge base in both developing and developed countries.

Os portadores de doenças mentais crônicas encontram-se em risco para a infecção pelo HIV e outras infecções sexualmente transmissíveis. Entretanto, a prevalência dessas infecções entre portadores de doença mental crônica ainda não está claramente estabelecida nesta população. A maioria dos trabalhos sobre o tema foi conduzida em países desenvolvidos, com amostras relativamente pequenas e não representativas. Foi realizada uma revisão sistemática da literatura para identificar estudos sobre a prevalência do HIV, sífilis, hepatite B e C entre pacientes com doença mental crônica no Brasil e no mundo. De um modo geral, as prevalências variaram de 0% a 29%, 3 a 66%, 0,4 a 38% e 3,3% a 7,6% para HIV, hepatite B, hepatite C e sífilis, respectivamente. Vários fatores de risco foram identificados e discutidos, embora a literatura atual não demonstre achados significativos gerados por estudos representativos. Tal revisão destaca a escassez de informação sobre a prevalência de infecções sexualmente transmitidas e seus fatores associados entre portadores de doenças mentais crônicas e identifica lacunas no conhecimento atual em países desenvolvidos bem como nos em desenvolvimento.

A limited number of studies worldwide have investigated the prevalence of HIV, syphilis, and hepatitis B and C infection among psychiatric patients. However, prevalence of these infections in the population with chronic mental illness has not been clearly established. Most of the published papers are from developed countries and have derived from relatively small and non-representative samples. We performed a systematic review of the published literature to identify studies on these infectious diseases within psychiatric populations in Brazil and other developing countries. Overall, prevalence rates varied from 0% to 29% for HIV; 1.6% to 66% for HBV; 0.4% to 38% for HCV; and 1.1% to 7.6% for syphilis. Several risk factors were identified and discussed, although sampling limitations restrict the generalization of study findings. This review highlights the lack of information on the prevalence of sexually transmitted diseases and their associated factors among persons with chronic mental illness and identifies gaps in the knowledge base in both developing and developed countries.

Few patients with symptomatic neurosyphilis present with signs and symptoms of acute meningitis. Here we report two cases of syphilitic meningitis diagnosed in HIV patients with meningeal syndrome. The first case, a 30-year-old black bisexual male, had concurrent meningeal and ocular syphilis with persistent unusually low CSF glucose levels. He responded well to 21 days of intravenous penicillin therapy. The second case was a 55-year-old female with epilepsy, depression, behavioral disorder and confusion. The diagnosis of HIV infection was made after onset of the syphilitic meningitis. She was treated with 21 days i.v. penicillin with improvement in her clinical condition. The clinical aspects of combined neurosyphilis and HIV infection, plus special features of diagnosis and treatment are discussed.