ABSTRACT Background: We investigated the time to death and factors associated with deaths from dengue and chikungunya during the first epidemic after the introduction of the chikungunya virus in Northeastern Brazil. Methods: This retrospective cohort study was conducted in Pernambuco between 2015 and 2018. Logistic regression was used to identify independent risk factors. The probability of survival among individuals with different arbovirus infections was estimated and the survival curves were compared using log-rank tests. Results: The lethality coefficients for dengue and chikungunya viruses were 0.08% and 0.35%, respectively. The chance of death due to chikungunya infection increased progressively from the age of 40 years. At 40-49 years, the odds ratio was 13.83 (95%CI, 1.80-106.41). At 50-59 years and 60 years or older, the odds ratio was 27.63 (95%CI, 3.70-206.48); and 78.72 (95%CI, 10.93-566.90), respectively. The probability of death associated with dengue virus infection increased from the age of 50 years. Among patients aged 50-59 years and 60 years or older, the odds ratio was 4.30 (95%CI, 1.80-10.30) and 8.97 (95%CI, 4.00-20.0), respectively. Independent factors associated death were headache and age of 50 years or older for dengue; and headache, nausea, back pain, intense arthralgia, age 0-9 years or 40 years and older, and male sex for chikungunya. The ratio between mortality rates revealed that the time to death from dengue was 2.1 times faster than that from chikungunya (95%CI, 1.57-2.72). Conclusions: The time to death was shorter in patients with dengue than in those with chikungunya disease. This study reinforces the need for faster and more effective decision-making in public health services to enhance patient outcomes and minimize mortality.

ABSTRACT The Northeast of Brazil has experienced a triple epidemic, with the simultaneous circulation of dengue virus (DENV), chikungunya virus (CHIKV) and Zika virus (ZIKV), which may have contributed to the observed increase across this region of atypical forms of disease and deaths. In view of this fact, non-congenital neurological disorders related to arboviruses were compared with other etiologies, mortality and survival rates of patients admitted to referral neurology hospitals in Pernambuco State, Northeast Brazil, from 2015 to 2018. Blood and cerebrospinal fluid samples were collected and tested using molecular and serological assays. The arbovirus-exposed groups were compared with respect to epidemiological, clinical and neurologic characteristics by using the Pearson’s chi-square test. For the survival analysis, the Kaplan-Meier and Hazard Ratio (HR) tests were used, with a 95% confidence interval (CI). Encephalitis and encephalomyelitis were more frequent in arboviruses, while myelitis predominated in the neurological disorders of other etiologies. Guillain-Barré Syndrome (GBS) was similarly distributed amongst the groups. Exposure to one of the arboviruses caused a six-fold increase in the risk of death (HR: 6.37; CI: 2.91 - 13.9). Amongst the arbovirus-exposed groups, infection (DENV/CHIKV) increased nine times the risk of death (HR: 9.07; CI: 3.67 - 22.4). The survival curve indicates that have been exposed to some arbovirus decreased the likelihood of survival compared to those with other etiologies (Log-Rank: p<0.001). Within this scenario, neurologic manifestations of DENV, CHIKV and ZIKV have the potential to increase mortality and decrease survival, and concomitant infection (DENV/CHIKV) is an aggravating factor in reducing the likelihood of survival when compared to monoinfections.

ABSTRACT Chikungunya, a viral infection that presents with fever, rash and polyarthritis, is usually an acute febrile illness. Uncommon neurological manifestations include meningoencephalitis, encephalitis, myelitis, Guillain-Barre syndrome, myelopathy and neuropathy. During an outbreak of the disease in La Reunion Island, abnormalities were observed in the magnetic resonance imaging (MRI) of patients with encephalitis and acute disseminated encephalomyelitis, showing bilateral, frontoparietal, white matter lesions with restricted diffusion, similar to our case. We report a 57-year-old male patient with comorbidities, admitted with high fever, arthralgia, asthenia, vomiting, psychomotor agitation, behavioral changes and seizures. Cerebrospinal fluid (CSF) values revealed pleocytosis (98 cells/mm3 with 68% lymphocytes and 12% monocytes) and high levels of protein (161 mg%). Brain MRI showed hyperintense lesions in the temporal and frontal lobes and bilaterally in the posterior thalamus. CSF serology was positive for IgM antibodies to Chikungunya virus. Encephalitis due to an acute viral infection by Chikungunya was diagnosed. The patient’s clinical condition worsened and he died on the twenty-fourth day of admission to our hospital.

Resumo O objetivo foi identificar os fatores associados ao não início do tratamento preventivo para tuberculose (TB) latente (TBLi) em pessoas vivendo com o HIV/AIDS (PVHA). Um estudo de coorte prospectivo foi realizado com PVHA, idade ≥ 18 anos, de dois serviços de referência para HIV/AIDS. De 232 pacientes elegíveis para tratamento da TBLi, 69,8% iniciaram o tratamento. Após análise de regressão logística multivariada, apenas ser tratado em um dos serviços de referência esteve associado ao não início do tratamento para TBLi (p < 0,001). A taxa de incidência de TB na coorte foi de 0,6/100 pessoas/ano. Para os pacientes que iniciaram o tratamento para TBLi, a taxa de incidência de TB foi de 0,4/100 pessoas/ano e para aqueles que não iniciaram, a taxa foi de 1,2/100 pessoas/ano, mas esta diferença não foi estatisticamente significativa. O achado mais interessante deste estudo foi o fato de o principal fator associado ao aumento da probabilidade de ser tratado para TBLi foi a unidade de saúde onde o paciente foi acompanhado.

Abstract The aim was to identify factors associated with non-initiation of prophylactic treatment of latent tuberculosis infection (LTBi) in persons living with HIV/AIDS (PLWA), based on a prospective cohort study of PLWA ≥ 18 years of age in two referral services for HIV/AIDS. Of the 232 patients eligible for treatment of LTBi, 69.8% initiated treatment. Following multivariate logistic regression analysis, only treatment in one of the two referral services was associated with non-initiation of treatment for LTBi (p < 0.001). TB incidence in the cohort was 0.6/100 person-years. TB incidence in patients that initiated treatment of LTBi was 0.4/100 person-years, compared to 1.2/100 person-years in those that did not initiate treatment, but the difference was not statistically significant. The study’s most interesting finding was that the main factor associated with the likelihood of treatment for LTBi was the health service where the patient was treated.

Resumen El objetivo fue identificar los factores asociados a no iniciar el tratamiento preventivo para la tuberculosis (TB) latente (TBLi) en personas viviendo con VIH/SIDA (PVHA). Un estudio de cohorte prospectivo fue realizado con PVHA, edad ≥ 18 años, de dos servicios de referencia para VIH/SIDA. De 232 pacientes elegibles para el tratamiento de la TBLi, 69,8% iniciaron el tratamiento. Tras el análisis de regresión logística multivariada, simplemente ser tratado en uno de los servicios de referencia estuvo asociado a no comenzar el tratamiento para TBLi (p < 0,001). La tasa de incidencia de TB en la cohorte fue de 0,6/100 personas-año. Para los pacientes que iniciaron el tratamiento para TBLi, la tasa de incidencia de TB fue de 0,4/100 personas-año y para aquellos que no lo iniciaron, la tasa fue de 1,2/100 personas-año, pero esa diferencia no fue estadísticamente significativa. El hallazgo más interesante de este estudio fue el hecho de que el principal factor asociado al aumento de la probabilidad de ser tratado para TBLi fue la unidad de salud donde se realizó el seguimiento del paciente.

Resumo O objetivo foi identificar os fatores associados ao não início do tratamento preventivo para tuberculose (TB) latente (TBLi) em pessoas vivendo com o HIV/AIDS (PVHA). Um estudo de coorte prospectivo foi realizado com PVHA, idade ≥ 18 anos, de dois serviços de referência para HIV/AIDS. De 232 pacientes elegíveis para tratamento da TBLi, 69,8% iniciaram o tratamento. Após análise de regressão logística multivariada, apenas ser tratado em um dos serviços de referência esteve associado ao não início do tratamento para TBLi (p < 0,001). A taxa de incidência de TB na coorte foi de 0,6/100 pessoas/ano. Para os pacientes que iniciaram o tratamento para TBLi, a taxa de incidência de TB foi de 0,4/100 pessoas/ano e para aqueles que não iniciaram, a taxa foi de 1,2/100 pessoas/ano, mas esta diferença não foi estatisticamente significativa. O achado mais interessante deste estudo foi o fato de o principal fator associado ao aumento da probabilidade de ser tratado para TBLi foi a unidade de saúde onde o paciente foi acompanhado.

Abstract The aim was to identify factors associated with non-initiation of prophylactic treatment of latent tuberculosis infection (LTBi) in persons living with HIV/AIDS (PLWA), based on a prospective cohort study of PLWA ≥ 18 years of age in two referral services for HIV/AIDS. Of the 232 patients eligible for treatment of LTBi, 69.8% initiated treatment. Following multivariate logistic regression analysis, only treatment in one of the two referral services was associated with non-initiation of treatment for LTBi (p < 0.001). TB incidence in the cohort was 0.6/100 person-years. TB incidence in patients that initiated treatment of LTBi was 0.4/100 person-years, compared to 1.2/100 person-years in those that did not initiate treatment, but the difference was not statistically significant. The study’s most interesting finding was that the main factor associated with the likelihood of treatment for LTBi was the health service where the patient was treated.

Resumen El objetivo fue identificar los factores asociados a no iniciar el tratamiento preventivo para la tuberculosis (TB) latente (TBLi) en personas viviendo con VIH/SIDA (PVHA). Un estudio de cohorte prospectivo fue realizado con PVHA, edad ≥ 18 años, de dos servicios de referencia para VIH/SIDA. De 232 pacientes elegibles para el tratamiento de la TBLi, 69,8% iniciaron el tratamiento. Tras el análisis de regresión logística multivariada, simplemente ser tratado en uno de los servicios de referencia estuvo asociado a no comenzar el tratamiento para TBLi (p < 0,001). La tasa de incidencia de TB en la cohorte fue de 0,6/100 personas-año. Para los pacientes que iniciaron el tratamiento para TBLi, la tasa de incidencia de TB fue de 0,4/100 personas-año y para aquellos que no lo iniciaron, la tasa fue de 1,2/100 personas-año, pero esa diferencia no fue estadísticamente significativa. El hallazgo más interesante de este estudio fue el hecho de que el principal factor asociado al aumento de la probabilidad de ser tratado para TBLi fue la unidad de salud donde se realizó el seguimiento del paciente.

No Brasil, a epidemia do HIV-1 adquiriu novas características ao longo do tempo, como o aumento da transmissão heterossexual e um declínio da razão homens:mulheres em casos de AIDS. Foi oferecida triagem para a infecção pelo HIV a todos os pacientes atendidos no Centro de Testagem e Aconselhamento da cidade de Paulista, Região Metropolitana de Recife, Pernambuco, Nordeste do Brasil, com o objetivo de determinar a incidência do HIV-1. Foi usado o enzimaimunoensaio de captura BED (BED-CEIA) para determinar a incidência do HIV-1, comparando-o com o método de índice de avidez AxSYM (Ax-AI). No período analisado, 2006-2009, 14.014 pessoas foram testadas, e apenas 18 gestantes foram diagnosticadas para a infecção por HIV, resultando em uma incidência de 0,15% ao ano (IC95%: 0,00-0,33), significativamente menor do que os homens (1,03; IC95%: 0,45-1,61) e mulheres não-grávidas (0,50; IC95%: 0,11-0,89). Apesar da baixa incidência de HIV-1 entre as mulheres grávidas, a alta taxa de infecção recente reforça cuidados no pré-natal para esta infecção, para evitar a transmissão vertical.

The HIV-1 epidemic in Brazil has displayed new characteristics over time, with an increase in heterosexual transmission and a decline in the male-to-female ratio in AIDS cases. HIV screening was offered to patients attending the Voluntary Counseling and Testing Center in Paulista, Greater Metropolitan Recife, Pernambuco State, in Northeast Brazil, to determine HIV-1 incidence. BED capture enzyme immunoassay (BED-CEIA) was used to measure HIV-1 incidence, comparing it to the AxSYM avidity index method (Ax-AI). From 2006 to 2009, 14,014 individuals were tested, and only 18 pregnant women were diagnosed with HIV infection, resulting in 0.15% annual incidence (95%CI: 0-0.33), significantly lower than in men (1.03; 95%CI: 0.45-1.61) and non-pregnant women (0.50; 95%CI: 0.11-0.89). Despite the low HIV-1 incidence in pregnant women, the high rate of recent infection detected during prenatal care emphasizes the need to increase measures to prevent vertical transmission.

En Brasil, epidemia del VIH-1 adquiere nuevas características con tiempo, como el aumento de la transmisión heterosexual y disminución de la razón hombres:mujeres en los casos de SIDA. La detección de infección por VIH se ofrece a todos los pacientes que acuden al Centro de Asesoramiento y Pruebas (CTA) en la ciudad de Paulista, área metropolitana de Recife, noreste - Brasil, con objetivo de determinar la incidencia del VIH-1. BED inmunoensayo enzimático de captura (BED-CEIA) se utilizó para determinar la incidencia de VIH-1, comparándolo con el método del índice de avidez AxSYM (AX AI). En el período de 2006-2009, 14.014 personas se pusieron a prueba, 18 mujeres embarazadas fueron diagnosticados con infección por VIH, com incidencia de 0.15% anual (IC95%: 0-0.33), inferior a los hombres (1.03; IC95%: 0.45-1.61) y las mujeres no embarazadas (0.50; IC95%: 0.11-0.89). A pesar de la baja incidencia de VIH-1 en las mujeres embarazadas, alta tasa de infección reciente aumenta en la atención prenatal para esta infección para prevenir la transmisión vertical.

No Brasil, a epidemia do HIV-1 adquiriu novas características ao longo do tempo, como o aumento da transmissão heterossexual e um declínio da razão homens:mulheres em casos de AIDS. Foi oferecida triagem para a infecção pelo HIV a todos os pacientes atendidos no Centro de Testagem e Aconselhamento da cidade de Paulista, Região Metropolitana de Recife, Pernambuco, Nordeste do Brasil, com o objetivo de determinar a incidência do HIV-1. Foi usado o enzimaimunoensaio de captura BED (BED-CEIA) para determinar a incidência do HIV-1, comparando-o com o método de índice de avidez AxSYM (Ax-AI). No período analisado, 2006-2009, 14.014 pessoas foram testadas, e apenas 18 gestantes foram diagnosticadas para a infecção por HIV, resultando em uma incidência de 0,15% ao ano (IC95%: 0,00-0,33), significativamente menor do que os homens (1,03; IC95%: 0,45-1,61) e mulheres não-grávidas (0,50; IC95%: 0,11-0,89). Apesar da baixa incidência de HIV-1 entre as mulheres grávidas, a alta taxa de infecção recente reforça cuidados no pré-natal para esta infecção, para evitar a transmissão vertical.

The HIV-1 epidemic in Brazil has displayed new characteristics over time, with an increase in heterosexual transmission and a decline in the male-to-female ratio in AIDS cases. HIV screening was offered to patients attending the Voluntary Counseling and Testing Center in Paulista, Greater Metropolitan Recife, Pernambuco State, in Northeast Brazil, to determine HIV-1 incidence. BED capture enzyme immunoassay (BED-CEIA) was used to measure HIV-1 incidence, comparing it to the AxSYM avidity index method (Ax-AI). From 2006 to 2009, 14,014 individuals were tested, and only 18 pregnant women were diagnosed with HIV infection, resulting in 0.15% annual incidence (95%CI: 0-0.33), significantly lower than in men (1.03; 95%CI: 0.45-1.61) and non-pregnant women (0.50; 95%CI: 0.11-0.89). Despite the low HIV-1 incidence in pregnant women, the high rate of recent infection detected during prenatal care emphasizes the need to increase measures to prevent vertical transmission.

En Brasil, epidemia del VIH-1 adquiere nuevas características con tiempo, como el aumento de la transmisión heterosexual y disminución de la razón hombres:mujeres en los casos de SIDA. La detección de infección por VIH se ofrece a todos los pacientes que acuden al Centro de Asesoramiento y Pruebas (CTA) en la ciudad de Paulista, área metropolitana de Recife, noreste - Brasil, con objetivo de determinar la incidencia del VIH-1. BED inmunoensayo enzimático de captura (BED-CEIA) se utilizó para determinar la incidencia de VIH-1, comparándolo con el método del índice de avidez AxSYM (AX AI). En el período de 2006-2009, 14.014 personas se pusieron a prueba, 18 mujeres embarazadas fueron diagnosticados con infección por VIH, com incidencia de 0.15% anual (IC95%: 0-0.33), inferior a los hombres (1.03; IC95%: 0.45-1.61) y las mujeres no embarazadas (0.50; IC95%: 0.11-0.89). A pesar de la baja incidencia de VIH-1 en las mujeres embarazadas, alta tasa de infección reciente aumenta en la atención prenatal para esta infección para prevenir la transmisión vertical.

Apesar da eficácia da terapêutica antirretroviral combinada para o tratamento de pessoas vivendo com HIV/Aids, a não adesão aos medicamentos tem se tornado uma das maiores ameaças à efetividade dessa terapêutica. O objetivo desse estudo foi estimar a prevalência de uso irregular autorreferido da terapia antirretroviral e os fatores associados com essa irregularidade em pessoas vivendo com HIV. Foi realizado um estudo seccional de pessoas vivendo com HIV/Aids atendidas em dois centros de referência no Recife, Nordeste do Brasil, entre junho 2007 e outubro de 2009. Foram analisados os fatores socioeconômicos, de apoio social e de hábitos do indivíduo, ajustados através de análise de regressão logística multivariada. A prevalência de pessoas vivendo com HIV/Aids que relataram o uso irregular da terapia antirretroviral combinada (TARC) foi de 25,7%. No modelo multivariado final, o uso irregular da TARC esteve associado às seguintes variáveis: ter menos de 40 anos (OR = 1,66, IC95%: 1,29-2,13), fumantes (OR = 1,76, IC95%: 1,31-2,37) ou ex-fumantes (OR = 1,43, IC95%: 1,05-1,95) e ser usuário de crack (OR = 2,79, IC95%: 1,24-6,32). Medidas especiais devem ser direcionadas para cada um dos seguintes grupos: adultos com menos de 40 anos, fumantes, ex-fumantes e usuários de crack. Ações voltadas para a cessação do tabagismo e do crack devem ser incorporadas ao programa de controle dos infectados pelo HIV, visando promover a maior adesão aos antirretrovirais e, consequentemente, aumentar a expectativa e a qualidade de vida.

Despite the effectiveness of combination antiretroviral therapy in the treatment of people living with HIV/AIDS (PLWHA), nonadherence to medication has become a major threat to its effectiveness. This study aimed to estimate the prevalence of self-reported irregular use of antiretroviral therapy and the factors associated with such an irregularity in PLWHA. A cross-sectional study of PLWHA who attended two referral centers in the city of Recife, in Northeastern Brazil, between June 2007 and October 2009 was carried out. The study analyzed socioeconomic factors, social service support and personal habits associated with nonadherence to antiretroviral therapy, adjusted by multivariable logistic regression analysis. The prevalence of PLWHA who reported irregular use of combination antiretroviral therapy (cART) was 25.7%. In the final multivariate model, the irregular use of cART was associated with the following variables: being aged less than 40 years (OR = 1.66, 95%-CI: 1.29-2.13), current smokers (OR = 1.76, 95%-CI: 1.31-2.37) or former smokers (OR = 1.43, 95%-CI: 1.05-1.95), and crack cocaine users (OR = 2.79, 95%-CI: 1.24-6.32). Special measures should be directed towards each of the following groups: individuals aged less than 40 years, smokers, former smokers and crack cocaine users. Measures for giving up smoking and crack cocaine should be incorporated into HIV-control programs in order to promote greater adherence to antiretroviral drugs and thus improve the quality of life and prolong life expectancy.

FUNDAMENTO: O uso maciço da Terapia Antirretroviral (TARV) na população com vírus da imunodeficiência adquirida (HIV) coincidiu com um aumento das doenças cardiovasculares, causa importante de morbimortalidade nesse grupo. OBJETIVO: Determinar a frequência de aterosclerose carotídea e avaliar a associação entre os níveis dos biomarcadores e o espessamento da camada médio-intimal carotídea em indivíduos HIV positivos, atendidos em serviços de referência para HIV em Pernambuco. MÉTODOS: Corte transversal com 122 pacientes HIV positivos. Considerou-se aterosclerose carotídea subclínica o aumento da espessura da camada média intimal da carótida comum > 0,8 milímetros ou placas no ultrassom de carótidas. Os biomarcadores inflamatórios analisados foram IL6, IL1-β, TNF-α, PCR-ultrassensível, sVCAM-1 e sICAM-1. RESULTADOS: Dos 122 pacientes analisados, a maioria era de homens (60,7%), com > 40 anos (57,4%), em uso de TARV (81,1%). A prevalência de aterosclerose foi de 42,6% (52 casos). Pacientes com idade acima de 40 anos e Framingham intermediário ou alto apresentaram maior chance de desenvolver aterosclerose na análise univariada. Idade acima de 40 anos (OR = 6,57 IC 2,66 -16,2; p = 0,000), sexo masculino (OR = 2,76 IC 1,12-6,79; p = 0,027) e a condição de síndrome metabólica (OR = 2,27 IC 0,94-5,50; p = 0,070) mostraram-se associados à aterosclerose na análise multivariada. Níveis elevados de citocinas inflamatórias e moléculas de adesão não mostraram associação com a presença de aterosclerose. CONCLUSÃO: Não houve associação entre os biomarcadores inflamatórios, moléculas de adesão e presença de aterosclerose carotídea. Entretanto, evidenciou-se em homens, pessoas com mais de 40 anos, portadores de escore de Framingham intermediário/alto ou síndrome metabólica maior chance de aterosclerose subclínica.

BACKGROUND: The massive use of Highly-Active Antiretroviral Therapy (HAART) in individuals with human immunodeficiency virus (HIV) coincided with an increase in cardiovascular disease, a major cause of morbidity and mortality in this group. OBJECTIVE: To determine the frequency of carotid atherosclerosis and the association between biomarker levels and carotid intimal-medial thickening in HIV-positive individuals treated for HIV at referral centers in Pernambuco. METHODS: This was a cross-sectional study of 122 HIV-positive patients. Subclinical carotid atherosclerosis was considered with the presence of increased intimal-medial thickness of the common carotid artery > 0.8 mm or plaques in the carotid ultrasound. The following inflammatory biomarkers were analyzed: IL6, IL1-β, TNF-α, high-sensitivity CRP, sVCAM-1 and sICAM-1. RESULTS: Of the 122 patients analyzed, most were men (60.7%) aged > 40 years (57.4%) receiving HAART (81.1%). The prevalence of atherosclerosis was 42.6% (52 cases). Patients older than 40 years and intermediate or high Framingham score were more likely to develop atherosclerosis at the univariate analysis. Age older than 40 years (OR = 6.57, 95%CI: 2.66 to 16.2, p = 0.000), male gender (OR = 2.76, 95%CI: 1.12 to 6.79, p = 0.027) and presence of syndrome metabolic (OR = 2.27, 95%CI: 0.94 to 5.50, p = 0.070) were associated with atherosclerosis at the multivariate analysis. Elevated levels of inflammatory cytokines and adhesion molecules were not associated with the presence of atherosclerosis. CONCLUSION: There was no association between inflammatory biomarkers, adhesion molecules and presence of carotid atherosclerosis. However, a higher chance of subclinical atherosclerosis was observed in men, those older than 40 years, with intermediate / high Framingham score or metabolic syndrome.

OBJETIVOS: Identificar precocemente a prevalência de aterosclerose, por causa do espessamento do complexo médio-intimal das carótidas comuns e do índice tornozelo-braço. Essas medidas foram relacionadas com os fatores de risco clássicos de aterosclerose e os específicos dos infectados pelo HIV (tempo de doença, tempo de tratamento, tipo de tratamento, tipo de terapia antirretroviral utilizada, CD4 e carga viral). MÉTODOS: Setenta casos infectados com o HIV foram avaliados pela medida automática do complexo médio-intimal nas carótidas e do índice tornozelo-braço. Consideraram-se os fatores de risco clássicos de aterosclerose (idade, sexo, hipertensão arterial sistêmica, tabagismo, hipercolesterolemia, hipertrigliceridemia, obesidade e história familiar de evento cardiovascular), as medidas antropométricas e as variáveis relacionadas ao HIV. O nível de significância assumido foi de 5%. RESULTADOS: O tempo médio de diagnóstico do HIV foi de 104,9 meses e de tratamento foi de 97,9 meses. Quanto ao tipo de tratamento, 47 (67,1%) fizeram uso de inibidor de protease por mais de seis meses e 36 (51,4%) estão em uso atualmente. O índice tornozelo-braço estava aumentado em um único paciente (0,7%) e não se evidenciou espessamento do complexo médio-intimal em nenhum indivíduo. Não existiu associação significante da medida do complexo médio-intimal da carótida comum direita com nenhuma das variáveis analisadas. CONCLUSÕES: Indivíduos jovens, sob o uso de terapia antirretroviral por cinco anos ou mais, não apresentaram espessamento do complexo médio-intimal ou aumento do índice tornozelo-braço. Não houve diferença do espessamento do complexo médio-intimal associada ao tipo de esquema antirretroviral utilizado ou nível de carga viral.

OBJECTIVES: To precociously identify the prevalence of atherosclerosis caused by thickening of the intima-media complex of the common carotid arteries and of the ankle brachial index. These measurements were associated with the classical risk factors of atherosclerosis and the specific factors of those infected by HIV (duration of disease, length of treatment, kind of treatment, kind of antiretroviral therapy used, CD4 and viral load). METHODS: Seventy cases infected by HIV were assessed by automatic measurement of the intima-media complex in the carotids and of the ankle brachial index. The classical risk factors of atherosclerosis (age, gender, systemic arterial hypertension, smoking, hypercholesterolemia, hypertriglyceridemia, obesity, and family history of cardiovascular events), anthropometric measurements and the variables related to HIV were taken into consideration. The adopted level of significance was 5%. RESULTS: The mean time of HIV diagnosis was 104.9 months, mean duration of treatment was 97.9 months. As regard to the type of treatment, 47 (67.1%) used protease inhibitor for more than six months and 36 (51.4%) are using it recently. The ankle brachial index was increased in one patient (0.7%), and the intima-media complex was not thickened in any individual. There was no significant association of the measurement of the intima-media complex of the right common carotid with any of the variables analyzed. CONCLUSIONS: Young individuals under the use of antiretroviral therapy for five years or more did not show increase in thickness of the intima-media complex or increase in the ankle brachial index, and there was no difference in the intima-media complex thickness associated with the therapeutical scheme of antiretroviral used or the viral load level.

O objetivo deste trabalho foi realizar um estudo bacteriológico comparativo entre os sistemas de umidificação aquoso aquecido (UAA) e filtro trocador de calor e umidade (FTCU) quanto à colonização bacteriana e a incidência de infecção respiratória em pacientes submetidos à ventilação mecânica (VM). Trata-se de uma pesquisa prospectiva, controlada e randomizada, na qual 15 pacientes internados na Unidade de Terapia Intensiva (UTI) foram distribuídos em dois grupos. O primeiro fez uso de UAA (n=7) e o outro de FTCU (n=8). Foram coletadas amostras da secreção traqueal, condensado do circuito e FTCU na admissão do paciente, no quarto e oitavo dias, e realizada análise bacteriológica dos mesmos. Quanto às características antropométricas, não observou-se diferenças entre os grupos estudados. A prevalência de pneumonia associada à ventilação (PAV) foi de 57,1% no UAA e 62,5% no FTCU. Ao realizar a análise bacteriológica quantitativa entre eles, não foram observadas variações, sugerindo não haver diferença na prevenção de PAV entre os sistemas de umidificação; porém a presença das mesmas bactérias na secreção traqueal e no condensado e ausência destas na membrana do FTCU podem indicar que a principal fonte de contaminação é o próprio paciente.

The aim of this study was to conduct a bacteriological research comparing the aqueous heated humidification systems (HH) and filter heat and moisture exchanger (FHME) and to bacterial colonization and the incidence of respiratory infection in patients undergoing mechanical ventilation. It is a prospective, controlled trial, in that 15 intensive care unit (ICU) patients were divided into two groups. The first made use of HH (n=7) and the other, FHME (n=8). We collected samples of tracheal secretions, and condensate circuit FHME at admission in the fourth and eighth day and bacteriological analysis of the same place. Regarding the anthropometric characteristics, no differences were observed between the groups. The prevalence of ventilator associated pneumonia (VAP) was 57.1% in the HH and 62.5% in FHME. When performing quantitative bacteriological analysis between the group and HH and FHME, differences were not observed, suggesting no variation in the prevention of VAP between the humidification systems, but the presence of these bacteria in the tracheal and condensate and in the absence of these membrane FHME may indicate that the main source of contamination is the patient himself.

OBJECTIVE: The outcome of interest was repetition of the tuberculin skin test (TST) and the objectives were to estimate the rate of TST repetition, the probability of no TST repetition after 1 year, and the probability of no TST repetition at the end of the follow-up period in patients whose initial test was nonreactive. The study also set out to analyze factors associated with the time until TST repetition at two HIV/AIDS referral services that carry out the TST on a routine basis in Recife, Pernambuco, Brazil. METHODS: A cohort of HIV-positive patients who initially tested nonreactive on the TST were followed from November 2007 to February 2010. The Kaplan-Meier method was used to estimate the probability of not repeating the TST, and Cox's regression analysis was used to analyze the factors associated with time until repeating the TST. Cox's multivariate analysis was stratified according to each hospital where patients were followed, because this variable did not respect the principle of proportionality of risk. RESULTS: The probability of not repeating the TST for 1 year was 80.0% and at the end of the follow-up period it was 42.0%. The variables that remained associated with TST repetition in the final Cox multivariate model were an age of 40 years or older, body mass index between 18.0 and 24.9, being female, and years of schooling. CONCLUSIONS: This study encountered a very low TST repetition rate after 1 year of follow-up and identified groups of individuals who should be the target of interventions aimed at repeating the TST.

OBJETIVO: El resultado principal de interés fue la repetición de la prueba de la tuberculina (PT) y los objetivos fueron calcular la tasa de repetición de la PT, la probabilidad de no repetir la PT después de un año y la probabilidad de no repetir la PT al final del período de seguimiento en los pacientes cuya prueba inicial fue no reactiva. En el estudio también se analizaron los factores asociados con el tiempo hasta la repetición de la PT en dos servicios de referencia de infección por el VIH/sida que llevan a cabo la PT de manera sistemática en Recife, Pernambuco, Brasil. MÉTODOS: Entre noviembre del 2007 y febrero del 2010 se siguió a una cohorte de pacientes seropositivos para el VIH con una PT inicialmente no reactiva. Para calcular la probabilidad de no repetir la PT se empleó el método de Kaplan-Meier, y para analizar los factores asociados con el tiempo hasta la repetición de la PT se usó el análisis de regresión de Cox. El análisis multifactorial de Cox se estratificó conforme a cada hospital donde se seguía a los pacientes, dado que esta variable no respetaba el principio de proporcionalidad del riesgo. RESULTADOS: La probabilidad de no repetir la PT durante un año fue de 80,0% y hacia el final del período de seguimiento fue de 42,0%. Las variables asociadas con la repetición de la PT en el modelo multifactorial de Cox final fueron una edad de 40 años o más, un índice de masa corporal de 18,0 a 24,9, el sexo femenino y los años de escolaridad. CONCLUSIONES: En este estudio se encontró una tasa de repetición de la PT muy baja después de un año de seguimiento y se identificó a los grupos de individuos que deben ser los destinatarios de las intervenciones dirigidas a repetir la prueba de la tuberculina.

Realizou-se revisão sistemática de estudos observacionais sobre fatores de risco para infecção relacionada aos cuidados de saúde em Unidades de Terapia Intensiva (UTI) pediátrica. Foram incluídos estudos em inglês, francês, espanhol ou português indexados no MEDLINE, LILACS, Cochrane Library, BDENF, CAPES, entre 1987 e 2006. As palavras-chave foram "Infecção Hospitalar" e "Unidades de Terapia Intensiva Pediátricas", com diferentes formas de escrever. Onze artigos foram selecionados a partir de 419 resumos encontrados: quatro tinham como desfecho infecção em qualquer topografia; três eram sobre infecções de vias aéreas inferiores; três estudaram infecção da corrente sanguínea confirmada laboratorialmente e um analisou infecção do trato urinário. A produção de evidências na UTI pediátrica não vem acompanhando o ritmo dos estudos em adultos - existem poucos estudos com desenhos e análise estatística adequados. A diversidade metodológica não permitiu a realização de medição sumarizada dos fatores de risco.

A systematic review of observational studies on risk factors for healthcare-associated infection in pediatric Intensive Care Units (ICU) was carried out. Studies indexed in MEDLINE, LILACS, Cochrane, BDENF, CAPES databases published in English, French, Spanish or Portuguese between 1987 and 2006 were included and cross references added. Key words for search were "cross infection" and "Pediatric Intensive Care Units" with others sub-terms included. 11 studies were selected from 419 originally found: four studies had healthcare-associated infection as the main outcome without a specific site; three articles identified factors associated with lower respiratory tract infection (pneumonia or tracheitis); three articles were concerned with laboratory-confirmed bloodstream infection; and a single retrospective study analyzed urinary tract infection. The production of evidence on risk factors Paediatric ICU has not kept up the same pace of that on adult - there are few studies with adequate design and statistical analysis. The methodological diversity of the studies did not allow for a summarized measurement of risk factors.

Realizou-se revisão sistemática de estudos observacionais sobre fatores de risco para infecção relacionada aos cuidados de saúde em Unidades de Terapia Intensiva (UTI) pediátrica. Foram incluídos estudos em inglês, francês, espanhol ou português indexados no MEDLINE, LILACS, Cochrane Library, BDENF, CAPES, entre 1987 e 2006. As palavras-chave foram "Infecção Hospitalar" e "Unidades de Terapia Intensiva Pediátricas", com diferentes formas de escrever. Onze artigos foram selecionados a partir de 419 resumos encontrados: quatro tinham como desfecho infecção em qualquer topografia; três eram sobre infecções de vias aéreas inferiores; três estudaram infecção da corrente sanguínea confirmada laboratorialmente e um analisou infecção do trato urinário. A produção de evidências na UTI pediátrica não vem acompanhando o ritmo dos estudos em adultos - existem poucos estudos com desenhos e análise estatística adequados. A diversidade metodológica não permitiu a realização de medição sumarizada dos fatores de risco.

A systematic review of observational studies on risk factors for healthcare-associated infection in pediatric Intensive Care Units (ICU) was carried out. Studies indexed in MEDLINE, LILACS, Cochrane, BDENF, CAPES databases published in English, French, Spanish or Portuguese between 1987 and 2006 were included and cross references added. Key words for search were "cross infection" and "Pediatric Intensive Care Units" with others sub-terms included. 11 studies were selected from 419 originally found: four studies had healthcare-associated infection as the main outcome without a specific site; three articles identified factors associated with lower respiratory tract infection (pneumonia or tracheitis); three articles were concerned with laboratory-confirmed bloodstream infection; and a single retrospective study analyzed urinary tract infection. The production of evidence on risk factors Paediatric ICU has not kept up the same pace of that on adult - there are few studies with adequate design and statistical analysis. The methodological diversity of the studies did not allow for a summarized measurement of risk factors.

Abnormalities found with anuscopy under colposcopic vision, anal cytology and anal biopsy were evaluated in 21 men with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) at the Federal University of Pernambuco Hospital in Brazil. Mean age was 38.4 ± 6.0 years, and mean time of HIV infection was 8.3 ± 5.1 years; 95.2% of the patients had been on highly active antiretroviral therapy (HAART) for an average of 6.6 ± 4.5 years. Mean CD4+ cell count was 482.2 ± 173.75 cells/mm³, and 80.9% presented a HIV viral load of < 5,000 copies/mL. Reported sexual preference was 52.4% homosexuals, 28.6% bisexuals, and 19.0%heterosexuals; 81% reported having had receptive anal intercourse and 61.9% reported more than 10 sexual partners of the same sex. Results of anuscopy under colposcopic vision revealed 17 (81.0%) low-grade lesions and/or condylomata or micropapillae and four (19.0%) high-grade lesions with or without condylomata. Among the 21 anal cytology examinations, seven (33.3%) revealed low-grade squamous intraepithelial lesions (LSIL); three (14.3%) presented atypical squamous cells of undetermined significance (ASCUS) and 11 (52.4%) were normal. Seventeen patients were submitted to anal biopsy with the following findings: three patients (17.6%) with normal epithelium, one (5.9%) with infection by HPV, three (17.6%) with condylomatas, two (11.8%) with AIN 1, four (23.6%) with AIN 2, three (17.6%) with AIN 3, and one (5.9%) with PAIN 2. Anuscopy under colposcopic vision was found to be useful for detecting anal lesions and for guiding anal biopsies. Anal cytology was less useful, as it underestimated the frequency of lesions.