ABSTRACT The majority of HIV-infected patients develop Candida spp-associated clinical oral lesions. Studies have shown that asymptomatic oral colonization of Candida spp may lead to oral lesions or become a source of disseminated infections. The aim of this study was to verify the effects of periodontal conditions on Candida spp prevalence and Candida spp carriage in the oral cavity of HIV-infected patients compared to non-infected patients. Twenty-five patients not infected with HIV and 48 HIV-infected patients were classified according to periodontal conditions as being periodontal healthy or with periodontal disease. Candida spp carriage and classification were performed in oral rinse samples. Viral load and CD4+ T lymphocyte (CD4+L) counts were performed in blood samples from HIV-infected patients. No differences in Candida spp prevalence related to HIV status or periodontal condition were detected. However, Candida spp carriage was increased in periodontally affected HIV-infected patients when compared to periodontally healthy HIV-infected patients (p= 0.04). Periodontally healthy HIV-infected patients presented Candida spp carriage in similar levels as healthy or periodontally affected non-HIV-infected patients. Candida spp carriage was correlated with CD4+L counting in HIV-infected patients. We concluded that periodontal disease is associated with increased Candida spp carriage in HIV-infected patients and may be a predisposing factor to clinical manifestations of candidiasis.

Considering the changes antiretroviral therapy (ART) has brought to the treatment of HIV infection, the current clinical and laboratory profiles of HIV/AIDS individuals referred to oral health centers are crucially important in instructing dentists about the oral health management of these patients. The aim of the present study was to determine the clinical and laboratory profiles of HIV-infected individuals referred to a clinic for patients with special needs between 2005 and 2012 by retrospectively analyzing their dental records. A total of 97 records of HIV patients referred to the School of Dentistry of Ribeirão Preto, Universidade de São Paulo - USP, were analyzed. The Mann-Whitney test was used to determine the associations between mean CD4+ counts, mean viral load, and the presence of HIV-related oral lesions (HIV-OL). Most of the patients were male, and their mean age was 38.3 years. Eighty-nine (92%) patients were on regular ART, 77 (79.4%) had a CD4+ count higher than 200 cells/mm3, and 63 (64.9%) had an undetectable viral load. Twenty patients (20.6%) presented with some HIV-OL, including pseudomembranous and/or erythematous candidiasis and angular cheilitis, which were correlated with a low CD4+ count and with an undetectable viral load (p < 0.05). Among the branches of dentistry, periodontics, followed by surgery and restorative dentistry, was the most sought-after specialty, and no intercurrent events were observed during the dental treatment. It may be concluded that there are no restrictions on the dental treatment of patients on regular ART, It is important, though, that the treatment be based on local characteristics and on the prevention of oral diseases.

HIV patients infected through injected drug use have poorer prognosis than other groups. We evaluated the hematological alterations and rates of co-infections in injected drug use patients with AIDS. Injected drug use patients were younger, predominantly of male gender, and presented lower CD4, total lymphocyte, and platelet counts, but not neutrophil count, than control group. Injected drug use patients had a higher rate of hepatitis C and mycobacteria infection. Furthermore, all injected drug use patients with hemoglobin <10.0 g dL-1 and lymphocyte <1000 µL-1 had CD4 count lower than 100 µL-1. In conclusion, HIV-infected injected drug use patients constitute a special group of patients, and hemoglobin concentration and lymphocyte count can be used as surrogate markers for disease severity.

OBJETIVO: Frente à necessidade prática da utilização de equações para avaliar gasto energético em portadores do HIV, o presente estudo avaliou a concordância dos valores de gasto energético obtidos pelo padrão ouro de calorimetria indireta com equações preditivas desenvolvidas a partir de população saudável: Harris-Benedict, Schofield e Cunningham e equações desenvolvidas a partir de portadores do HIV: Melchior (1991 a 1993). MÉTODOS: O estudo foi realizado no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, com 32 homens portadores do HIV em terapia antirretroviral de alta potência. O gasto energético de repouso foi medido por calometria indireta e estimado a partir de medida de consumo de O2 e produção de CO2. RESULTADOS: De acordo com análise estatística, a concordância foi fraca para equações de Harris-Benedict (0,38) e Cunningham (0,34) e satisfatória para Schofield (0,47). Apenas as duas equações de Melchior apresentaram forte concordância com valores obtidos por calometria indireta (respectivamente 0,63 e 0,66) e poderiam ser utilizadas na prática. CONCLUSÃO:: As melhores equações parecem ser população específica, como as de Melchior, desenvolvidas para portadores do HIV

OBJECTIVE: In view of the practical need to use equations for the evaluation of energy expenditure in HIV-infected patients, the objective of the present study was to determine the concordance between the energy expenditure values obtained by indirect calorimetry as the gold standard and those obtained by predictive equations elaborated from data for the healthy population: Harris-Benedict, Schofield and Cunningham, and by equations elaborated from data for HIV-infected patients: Melchior (1991-1993). METHODS: The study was conducted at the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto on 32 HIV-infected men under treatment with highly active antiretroviral therapy. Resting energy expenditure was measured by indirect calorimetry and estimated on the basis of measurement of O2 consumption and CO2 production. RESULTS: Statistical analysis revealed weak concordance for the Harris-Benedict (0.38) and Cunningham (0.34) equations and satisfactory concordance for the Schofield equation (0.47). Only the two Melchior equations (1991 and 1993) showed strong concordance with the values obtained by indirect calorimetry (0.63 and 0.66, respectively) and could be used in practice. CONCLUSION: The best equations seem to be population-specific, such as the Melchior equations elaborated for HIV-infected patients.

OBJETIVO: identificar os diferentes tipos de alterações morfológicas da síndrome da lipodistrofia (SL) em pacientes dos atendimentos ambulatoriais e relacioná-las ao esquema terapêutico utilizado. MÉTODO: estudo transversal, para o qual foram recrutados 60 pacientes com HIV e SL e 79 sem a SL, que consentiram entrevista e coleta de dados em prontuário. RESULTADOS: a região mais acometida pela lipoatrofia foi a face; pela lipo-hipertrofia o abdome e pela forma mista as alterações em abdome, face, membros superiores e inferiores. CONCLUSÃO: dentre os esquemas terapêuticos, o composto pela zidovudina, lamivudina e efavirenz pareceu proteger contra a SL. A enfermagem pode atuar na identificação precoce das alterações, além de fornecer orientações e apoio aos pacientes acometidos pelas mudanças na imagem corporal.

OBJECTIVE: to identify the different types of morphological alterations from lipodystrophy syndrome (LS) in outpatients and relate them to the therapeutic regimen used. METHOD: a cross-sectional study which recruited 60 patients with HIV and LS and 79 without LS, who consented to interview and data collection from their medical notes. RESULTS: the region most affected by lipoatrophy was the face; by lipohypertrophy, the abdomen, and by the mixed form, the alterations to the abdomen, face, and upper and lower limbs. CONCLUSION: among the therapeutic regimens, that comprised of zidovudine, lamivudine and efavirenz seemed to protect against LS. Nursing can act in the early identification of the changes, as well as providing guidance and support for patients affected by the changes in their body image.

OBJETIVO: identificar los diferentes tipos de alteraciones morfológicas del Síndrome de la lipodistrofia (SL) en pacientes de los servicios de ambulatorio y relacionarlas al esquema terapéutico utilizado. MÉTODO: estudio transversal en lo que fueron reclutados 60 pacientes con VIH y la SL y 79 sin la SL, que consintieron entrevista y recogida de datos en prontuario. RESULTADOS: la región más acometida por la lipoatrofia fue la cara; por la lipohipertrofia el Abdomen y por la forma mixta las alteraciones en Abdomen, cara, miembros superiores e inferiores. CONCLUSIÓN: entre los esquemas terapéuticos, el compuesto por la zidovudina, lamivudina y efavirenz pareció proteger contra la SL. La enfermería puede actuar en la identificación precoz de las alteraciones, además de suministrar orientaciones y apoyo a los pacientes acometidos por los cambios en la imagen corporal.

OBJECTIVE: to identify the different types of morphological alterations from lipodystrophy syndrome (LS) in outpatients and relate them to the therapeutic regimen used. METHOD: a cross-sectional study which recruited 60 patients with HIV and LS and 79 without LS, who consented to interview and data collection from their medical notes. RESULTS: the region most affected by lipoatrophy was the face; by lipohypertrophy, the abdomen, and by the mixed form, the alterations to the abdomen, face, and upper and lower limbs. CONCLUSION: among the therapeutic regimens, that comprised of zidovudine, lamivudine and efavirenz seemed to protect against LS. Nursing can act in the early identification of the changes, as well as providing guidance and support for patients affected by the changes in their body image.

OBJETIVO: identificar los diferentes tipos de alteraciones morfológicas del Síndrome de la lipodistrofia (SL) en pacientes de los servicios de ambulatorio y relacionarlas al esquema terapéutico utilizado. MÉTODO: estudio transversal en lo que fueron reclutados 60 pacientes con VIH y la SL y 79 sin la SL, que consintieron entrevista y recogida de datos en prontuario. RESULTADOS: la región más acometida por la lipoatrofia fue la cara; por la lipohipertrofia el Abdomen y por la forma mixta las alteraciones en Abdomen, cara, miembros superiores e inferiores. CONCLUSIÓN: entre los esquemas terapéuticos, el compuesto por la zidovudina, lamivudina y efavirenz pareció proteger contra la SL. La enfermería puede actuar en la identificación precoz de las alteraciones, además de suministrar orientaciones y apoyo a los pacientes acometidos por los cambios en la imagen corporal.

OBJETIVO: identificar os diferentes tipos de alterações morfológicas da síndrome da lipodistrofia (SL) em pacientes dos atendimentos ambulatoriais e relacioná-las ao esquema terapêutico utilizado. MÉTODO: estudo transversal, para o qual foram recrutados 60 pacientes com HIV e SL e 79 sem a SL, que consentiram entrevista e coleta de dados em prontuário. RESULTADOS: a região mais acometida pela lipoatrofia foi a face; pela lipo-hipertrofia o abdome e pela forma mista as alterações em abdome, face, membros superiores e inferiores. CONCLUSÃO: dentre os esquemas terapêuticos, o composto pela zidovudina, lamivudina e efavirenz pareceu proteger contra a SL. A enfermagem pode atuar na identificação precoce das alterações, além de fornecer orientações e apoio aos pacientes acometidos pelas mudanças na imagem corporal.

INTRODUÇÃO: A infecção ocupacional pelo HIV entre os trabalhadores de saúde é uma importante questão em exposições envolvendo sangue e fluidos corporais. Os dados na literatura são escassos quanto ao potencial infectivo do HIV-1 em material contaminado e o intervalo de tempo em que a infectividade é mantida em condições adversas. MÉTODOS: Realizamos a quantificação de RNA viral do HIV-1 em agulhas ocas com calibre 25X8mm, após punções, em 25 pacientes infectados pelo HIV-1 selecionados durante coleta de sangue para exames. Todos os pacientes selecionados tinham idade variando entre 18 e 55 anos. De 16 pacientes foram coletadas 5 amostras: 1 amostra de sangue para quantificação imediata do RNA viral do HIV-1 no plasma e 4 agulhas para a análise ás 0h, 6h, 24h e 72h após a coleta. Em nove pacientes, um outro teste foi realizado no sangue de uma agulha adicional, na qual foi avaliada a presença de RNA viral do HIV-1 após 168h após a coleta do sangue. O método usado para avaliar o RNA do HIV-1 foi a amplificação baseada na sequência de ácidos nucléicos. RESULTADOS: O RNA do HIV-1 foi detectado em todas as agulhas até o sétimo dia após a coleta. O RNA viral manteve-se estável até 168h após a punção, sem diferença estatisticamente significante entre as agulhas coletadas. CONCLUSÕES: Embora a infectividade do material viral nas agulhas seja desconhecido, os dados apontam necessidade de reavaliação das condutas em casos de acidente com fonte desconhecida.

INTRODUCTION: Occupational HIV infection among healthcare workers is an important issue in exposures involving blood and body fluids. There are few data in the literature regarding the potential and the duration of infectivity of HIV type 1 (HIV-1) in contaminated material under adverse conditions. METHODS: We quantified HIV-1 viral RNA in 25×8mm calibre hollow-bore needles, after punctures, in 25 HIV-1-infected patients selected during the sample collection. All of the patients selected were between the ages of 18 and 55. Five samples were collected from 16 patients: one sample for the immediate quantification of HIV-1 RNA in the plasma and blood samples from the interior of 4 needles to be analyzed at 0h, 6h, 24h, and 72h after collection. In nine patients, another test was carried out in the blood from one additional needle, in which HIV-1 RNA was assessed 168h after blood collection. The method used to assess HIV-1 RNA was nucleic acid sequence-based amplification. RESULTS: Up to 7 days after collection, HIV-1 RNA was detected in all of the needles. The viral RNA remained stable up to 168h, and there were no statistically significant differences among the needle samples. CONCLUSIONS: Although the infectivity of the viral material in the needles is unknown, the data indicate the need to re-evaluate the practices in cases of occupational accidents in which the source is not identified.

The increasing HIV/AIDS number of cases for elderly people appears as a challenge, highlighting the need to observe about the quality of life of this population. Descriptive study to investigate the clinical-epidemiological profile of HIV/AIDS infection diagnosed in elderly aged 50 years old and over who were in a clinical follow-up at a referral hospital from January 2001 to December 2008. Data collection occurred through analysis of patient records between January 2008 and July 2009. From 208 medical records analyzed, 45,7% were women and 54,3% were man, age average 60,6 years old. The sexual exposure category was predominant and concerning CD4 counting, 68,2% presented level lower than 200 cell/mm3. The mortality rate was high (44,7%). This increasing number of HIV\AIDS in the elderly population is concerning and these results emphasize the need for better care to this group.

El aumento del número de casos de VIH/SIDA en la población anciana surge como un desafío, destacando la necesidad de atención a calidad de vida de esta población. Estudio descriptivoobjetivó investigarel perfil clínico epidemiológico de la infección por VIH/SIDA diagnosticados en ancianos con 50 años o más que estuvieron en acompañamiento clínico en un hospital referencia de enero de 2001 a diciembre de 2008. Recolecta de datos fue hecha a partir de registros médicos entre enero de 2008 a julio de 2009.De los 208 registros analizados, 45,7% eran de mujeres y 54,3% de hombres, con edad media de 60,6 años. Categoría de exposición sexualfue predominante y cuanto al CD4, 68,2% presentaron contaje menor que 200 cel./mm3. La mortalidad fue elevada (44,7%). El aumento del número de casos de VIH\SIDA en la población anciana es preocupante y estos resultados refuerzan la necesidad de mayor atención a este grupo.

O aumento dos casos de HIV/AIDS na população idosa é desafiante, evidenciando a necessidade de atentar-se à qualidade de vida desta população. Estudo descritivo com objetivo de investigaro perfil clínico epidemiológico da infecção pelo HIV/AIDS diagnosticada em idosos com 50 anos ou mais e que estiveram em seguimento clínico em um hospital referência, de janeiro de 2001 a dezembro de 2008. A coleta de dados ocorreu por meio de consulta aos prontuários, entre janeiro de 2008 e julho de 2009. Dos 208 prontuários analisados, 45,7% eram de mulheres e 54,3% de homens, com idade média de 60,6 anos. Categoria de exposição sexualfoi a predominante e quanto ao CD4, 68,2% apresentaram contagem menor que 200 cel/mm³. A mortalidade foi elevada (44,7%). É preocupante o aumento do número de casos de HIV/AIDS na população idosa e estes resultados reforçam a necessidade de maior atenção a este grupo.

OBJECTIVES: The aim of this prospective study was to compare changes in lipid metabolism and nutritional status after either 6 and 12 months of follow-up in subjects with lipodystrophy syndrome after traditional lifestyle therapy with or without fibric acid analogue intervention (bezafibrate and clofibrate). METHODS: Food intake, alterations in body composition and metabolic abnormalities were assessed in subjects with lipodystrophy syndrome at the beginning of the study. The nutritional status and metabolic alterations of the subjects were monitored, and the subjects received nutritional counseling each time they were seen. The subjects were monitored either two times over a period no longer than six months (Group A; n = 18) or three times over a period of at least 12 months (Group B; n = 35). All of the subjects underwent nutrition counseling that was based on behavior modification. The fibric acid analogue was only given to patients with serum triglyceride levels above 400 mg/dL. RESULTS: After six months of follow-up, Group A showed no alterations in the experimental parameters. After twelve months, there was a decrease in serum triglyceride levels (410.4 ± 235.5 vs. 307.7 ± 150.5 mg/dL, p< 0.05) and an increase in both HDLc levels (37.9±36.6 vs. 44.9 ±27.9 mg/dL, p,0.05) and lean mass (79.9 ± 7.8 vs. 80.3 ± 9.9 %, p< 0.05) in Group B. CONCLUSION: After one year of follow-up (three sessions of nutritional and medical counseling), the metabolic parameters of the subjects with lipodystrophy improved after traditional lifestyle therapy with or without fibric acid analogue intervention.

This study aimed to evaluate the adherence of nursing professionals to clinical follow-up after occupational exposure to biological material, in a special outpatient clinic for Occupational Accidents among Health Care Workers (AOPS). Data refer to accidents occurred to nursing professionals between July and December of 2006, and were obtained by consulting patient files. The study was developed in two outpatient clinics in a large sized University Hospital located in Ribeirão Preto/ Brazil. It was observed that in 30.4% of the cases the use of antiretroviral agents was indicated for chemoprevention, and 31.3% of those presented adverse effects. It is highlighted that 69.6% of the professionals completed the indicated clinical treatment. It is fundamental to implement an educational program among health workers to prevent occupational exposures and promote the adherence to clinical follow-up after exposure.

El estudio tuvo como objetivo evaluar la adhesión de los profesionales de enfermería al seguimiento clínico tras la exposición ocupacional a material biológico, en la clínica especializada en Accidentes Ocupacionales en Profesionales de la Salud (AOPS). Los datos, obtenidos por medio de consulta a los registros médicos, se refieren a accidentes ocurridos con profesionales de enfermería entre julio y diciembre de 2006. El estudio fue desarrollado en dos unidades de un hospital universitario de gran porte en la ciudad de Ribeirão Preto, Brasil. Se observó que, en 30,4%, fue indicado el uso de agentes antirretrovirales para quimioprevención. De los que efectuaron el uso, 31,3% presentaron efectos adversos. Se destaca que 69,6% de los profesionales completaron el seguimiento clínico indicado. Es fundamental la implementación de un programa de educación permanente entre los trabajadores de salud para prevención de exposiciones ocupacionales y adhesión al seguimiento clínico tras la exposición.

O objetivo deste estudo foi avaliar a adesão dos profissionais de enfermagem ao seguimento clínico, após a exposição ocupacional a material biológico, no ambulatório especializado (AOPS). Os dados se referem a acidentes ocorridos com profissionais de enfermagem no período julho a dezembro de 2006 e foram obtidos por meio de consulta ao prontuário. O estudo foi desenvolvido nas duas unidades (campus e emergência) de um hospital universitário de grande porte na cidade de Ribeirão Preto. Observou-se que em 30,4% foi indicado o uso de anti-retrovirais para quimioprofilaxia; dos que fizeram o uso, 31,3% apresentaram efeitos adversos. Destaca-se que 69,6% dos profissionais completaram o seguimento clínico indicado. É premente a necessidade de implementação de um programa de educação permanente junto aos trabalhadores de saúde para prevenção de exposições ocupacionais e adesão ao seguimento clínico após exposição.

Em março de 2009, houve o início de uma epidemia de gripe no México que, em pouco tempo, levou ao surgimento de casos semelhantes em outros países, alertando as autoridades sanitárias para o risco de uma pandemia. Neste artigo, descrevemos os principais sinais e sintomas da infecção pelo vírus Influenza A (H1N1) de origem suína, as medidas a serem tomadas para os casos suspeitos ou confirmados e como proceder em relação aos contactantes. Comentamos também quais drogas são utilizadas para o tratamento e profilaxia.

In March of 2009, a flu epidemic began in Mexico. Shortly thereafter, similar cases appeared in other countries, alerting authorities to the risk of a pandemic. This article details the principal signs and symptoms of infection with the swine-origin Influenza A (H1N1) virus. In addition, the measures to be taken in suspected or confirmed cases are addressed, as are the procedures to follow in relation to contacts. Furthermore, the drugs used in the prophylaxis against and the treatment of infection with the H1N1 virus are described.

Primary gastric non-Hodgkin's lymphoma (NHL) is a co-morbidity that can be observed during the clinical course of acquired immunodeficiency syndrome (AIDS). We evaluated the prevalence, clinical-evolutive aspects and form of endoscopic presentation of primary gastric NHL associated with AIDS. Two hundred and forty-three HIV patients were submitted to upper digestive endoscopy, with evaluation of clinical, endoscopic and histological data. A CD4 count was made by flow cytometry and viral load was determined in a branched-DNA assay. Six cases (five men; mean age: 37 years; range: 29-46 years) of primary gastric NHL were detected. The median CD4 count was 140 cells/mm³ and the median viral load was 40,313 copies/mL. Upper digestive endoscopy revealed polypoid (in four patients) ulcero-infiltrative (two patients) and ulcerated (two patients) lesions and combined polypoid and ulcerated lesions (two patients). Histology of the gastric lesions demonstrated B cell NHL (four patients) and T cell NHL (two patients). Five of the six patients died of complications related to gastric NHL. We concluded that primary gastric NHL is an important cause of mortality associated with AIDS.

Lesões cutâneas, na vigência da leishmaniose visceral (LV) ou calazar, são raramente observadas, sendo mais comum a ocorrência após o tratamento do calazar, conhecidas como lesões dérmicas pós calazar. Lesões cutâneas causadas por Leishmania donovani são freqüentemente observadas na co-infecção AIDS-LV. No Brasil, a concomitância das formas cutânea ou mucosa da leishmaniose tegumentar com a AIDS é mais comumente relatada. A seguir, relata-se um caso de co-infecção AIDS-LV com inusitado comprometimento digestivo e cutâneo, atribuído a L. (L.) chagasi, chamando a atenção para o aspecto ectimatóide da lesão cutânea, aliado à ausência do parasito ao exame histopatológico da pele.

Concomitant skin lesions in visceral leishmaniasis (VL) or kala-azar are rare, being more common the description of post-kala-azar dermal leishmaniasis occurring post treatment of kala-azar. Skin lesions caused by Leishmania donovani are frequently seen in the aids-VL co-infection. In Brazil cutaneous or mucosal forms of tegumentary leishmaniasis concomitant with aids are more commonly registered. Here we present a case of aids-VL co-infection, with unusual cutaneous and digestive compromising attributed to L. (L.) chagasi, with special attention to ecthymatous aspect of the lesion, allied to the absence of parasite on the histological skin biopsy.