Subjects with chronic liver disease are susceptible to hypovitaminosis A due to several factors. Therefore, identifying patients with vitamin deficiency and a requirement for vitamin supplementation is important. Most studies assessing vitamin A in the context of hepatic disorders are conducted using cirrhotic patients. A cross-sectional study was conducted in 43 non-cirrhotic patients with chronic hepatitis C to evaluate markers of vitamin A status represented by serum retinol, liver retinol, and serum retinol-binding protein levels. We also performed the relative dose-response test, which provides an indirect estimate of hepatic vitamin A reserves. These vitamin A indicators were assessed according to the stage of liver fibrosis using the METAVIR score and the body mass index. The sample study was predominantly composed of male subjects (63%) with mild liver fibrosis (F1). The relative dose-response test was <20% in all subjects, indicating vitamin A sufficiency. Overweight or obese patients had higher serum retinol levels than those with a normal body mass index (2.6 and 1.9 µmol/L, respectively; P<0.01). Subjects with moderate liver fibrosis (F2) showed lower levels of serum retinol (1.9 vs 2.5 µmol/L, P=0.01) and retinol-binding protein levels compared with those with mild fibrosis (F1) (46.3 vs 67.7 µg/mL, P<0.01). These results suggested an effect of being overweight on serum retinol levels. Furthermore, more advanced stages of liver fibrosis were related to a decrease in serum vitamin A levels.

The emergence of ganciclovir (GCV) resistance during the treatment of human cytomegalovirus (HCMV) infection is a serious clinical challenge, and is associated with high morbidity and mortality. In this case report, we describe the emergence of two consecutive mutations (A594V and L595W) related to GCV resistance in a patient with HCMV retinitis and long-term HIV progression after approximately 240 days of GCV use. Following the diagnosis of retinitis, the introduction of GCV did not result in viral load reduction. The detected mutations appeared late in the treatment, and we propose that other factors (high initial HCMV load, previous GCV exposure, low CD4+ cell count), in addition to the presence of resistance mutations, may have contributed to the treatment failure of HCMV infection in this patient.

O estudo do consórcio entre espécies anuais e perenes representa uma ferramenta importante no processo de implantação e manejo florestal. O objetivo deste trabalho foi avaliar a capacidade competitiva do jatobá (Hymenaea courbaril) com espécies de adubos verdes, forrageiras e plantas daninhas quanto à alocação de matéria seca, área foliar e concentração de nutrientes. Foram conduzidos dois experimentos, sendo os tratamentos compostos pela combinação de mudas de jatobá, desenvolvendo-se isoladamente ou em competição com cada uma das seguintes espécies: Brachiaria humidicola, Brachiaria brizantha, Brachiaria decumbens, Panicum maximum, Cajanus cajan, Canavalia ensiformis e Mucuna aterrima (experimento 1) e Bidens pilosa, Cenchrus echinatus, Euphorbia heterophylla, Lolium multiflorum e Solanum americanum (experimento 2), mais o cultivo de cada planta daninha e consorte isolada. Após convivência por 60 dias, as plantas foram coletadas para avaliação de matéria seca, área foliar e teor de nutrientes. Observou-se que a competição entre as plantas não promoveu alterações na produção de matéria seca ou área foliar do jatobá. Tendo em vista o exposto, verifica-se que a capacidade competitiva do jatobá não é afetada pela presença das espécies de adubos verdes e forrageiras, possibilitando convivência em fase inicial de desenvolvimento. Quanto à convivência das plantas daninhas com o jatobá, observou-se efeito positivo no acúmulo de nutrientes por estas.

The study of intercropping between annual and perennial plants is an important tool in the process of forest implantation and management. The objective of this study was to assess the competitive capacity of jatoba (Hymeneae courbaril) against green manure, forage and weed species, regarding the allocation of dry matter, leaf area and nutritional content. Two experiments were installed and the treatments consisted of combinations of jatoba seedlings per plot, alone or under competition with each one of the following plant species: Brachiaria humidicola, Brachiaria brizantha, Brachiaria decumbens, Panicum maximum, Cajanus cajan, Canavalia ensiformis and Mucuna aterrima (experiment 1) and Bidens pilosa, Cenchrus echinatus, Euphorbia heterophylla, Lolium multiflorum and Solanum americanum (experiment 2), plus the cultivation of each weed or counterpart alone. After 60 days of intercropping, the plants were collected to assess dry matter, leaf area and nutrient accumulation. Competition between the plant species did not promote any changes in jatoba dry matter production and leaf area of jatoba. Thus, the competitive capacity of jatoba is not affected by the green manure and forage species, at its early phases of development. A positive effect on nutrient accumulation by the weeds was observed when they were grown in the presence of jatoba.

Since there are some concerns about the effectiveness of highly active antiretroviral therapy in developing countries, we compared the initial combination antiretroviral therapy with zidovudine and lamivudine plus either nelfinavir or efavirenz at a university-based outpatient service in Brazil. This was a retrospective comparative cohort study carried out in a tertiary level hospital. A total of 194 patients receiving either nelfinavir or efavirenz were identified through our electronic database search, but only 126 patients met the inclusion criteria. Patients were included if they were older than 18 years old, naive for antiretroviral therapy, and had at least 1 follow-up visit after starting the antiretroviral regimen. Fifty-one of the included patients were receiving a nelfinavir-based regimen and 75 an efavirenz-based regimen as outpatients. Antiretroviral therapy was prescribed to all patients according to current guidelines. By intention-to-treat (missing/switch = failure), after a 12-month period, 65% of the patients in the efavirenz group reached a viral load <400 copies/mL compared to 41% of the patients in the nelfinavir group (P = 0.01). The mean CD4 cell count increase after a 12-month period was also greater in the efavirenz group (195 x 10(6) cells/L) than in the nelfinavir group (119 x 10(6) cells/L; P = 0.002). The efavirenz-based regimen was superior compared to the nelfinavir-based regimen. The low response rate in the nelfinavir group might be partially explained by the difficulty of using a regimen requiring a higher patient compliance (12 vs 3 pills a day) in a developing country.