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BACKGROUND: Hearing loss in older adults affects general, generic health-related and disease-specific quality of life (QoL). The conventional strategy to address it is through hearing aids, which have been shown to improve disease-specific QoL. However, the long-term results regarding general quality of life are unknown, and communication problems and stigma associated with hearing loss may persist. An effective intervention strategy to address these problems is group communication programs, most notably Active Communication Education (ACE). This program has been shown to increase communication strategies and reduce communication activity limitations and participation restrictions. These precedents allow us to hypothesize that this program could improve general QoL. METHODS: A randomized clinical trial was conducted on 114 older adult hearing aid users. Fifty-four subjects composed the intervention group that received the ACE program, while 60 subjects composed the control group that received an informational-lectures type intervention. The WHOQOL-BREF questionnaire was used to measure general QoL. Measurements were taken before and right after the intervention, with follow-ups at 6 and 12 months. Multilevel linear mixed models were estimated, considering the WHOQOL-BREF dimension scores and total score as the outcomes, and an interaction term between time since intervention and group as the predictor. Within- and between-group comparisons were made. RESULTS: Compared to the baseline time-point, the ACE group showed significant improvements right after the intervention, and at the 6-month and 12-month follow-ups for the dimensions of psychological health, social relationships, environment, and total score. Compared to the control group, the ACE group exhibited significantly greater improvements in the social dimension at all postintervention assessments, as well as in the environment dimension and total score at the 12-month follow-up. CONCLUSIONS: The ACE program improved general QoL in terms of social relationships and environment dimensions, which lasted up to 12 months after the intervention. Therefore, ACE is positioned as an effective complement for HA users, enhancing and delivering new benefits related to broader aspects of QoL not necessarily tied to health. TRIAL REGISTRATION: ISRCTN54021189 (retrospectively registered on 18/07/2023).

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Comunicación , Audífonos , Pérdida Auditiva , Educación del Paciente como Asunto , Calidad de Vida , Humanos , Calidad de Vida/psicología , Audífonos/psicología , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Pérdida Auditiva/psicología , Pérdida Auditiva/rehabilitación , Pérdida Auditiva/terapia , Educación del Paciente como Asunto/métodos , Estudios de Seguimiento

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Human immunodeficiency virus (HIV) is a global public health problem. Coinfections in HIV patients are frequent complications that increase their mortality. The aim of this study was to assess coinfections and in-hospital mortality in a group of patients infected with HIV in Colombia. A retrospective longitudinal study was carried out. Patients treated in 4 highly complex clinics in Colombia between 2015 and 2023 were included. The cases were identified from International Classification of Diseases codes related to HIV. Sociodemographic, clinical, laboratory and pharmacological variables were collected. Descriptive, bivariate, and multivariable analyses were performed. Of the 249 patients identified, 79.1% were men, and the median age was 38.0 years. Approximately 81.1% had a diagnosis of acquired immune deficiency syndrome (AIDS). Coinfections caused by Mycobacterium tuberculosis (24.1%) and Treponema pallidum (20.5%) were the most frequent. A total of 20.5% of the patients had sepsis, 12.4% had septic shock, and the fatality rate was 15.7%. Antibiotics and antifungals were used in 88.8% and 53.8%, respectively, of the patients. Patients with a diagnosis of HIV before admission, those infected with M. tuberculosis, and those who presented with sepsis were more likely to die, whereas patients who received antiretroviral agent treatment before admission presented a lower risk. In this study, most HIV patients were in an advanced stage of the disease. Coinfection with M. tuberculosis was common and was associated with an increased risk of death. Previous HIV diagnosis and sepsis also increased the risk. Approximately half of the patients with a previous HIV diagnosis were receiving antiretroviral therapy and had a better prognosis.

Asunto(s)

Coinfección , Infecciones por VIH , Mortalidad Hospitalaria , Humanos , Masculino , Femenino , Adulto , Estudios Longitudinales , Estudios Retrospectivos , Infecciones por VIH/complicaciones , Infecciones por VIH/mortalidad , Infecciones por VIH/tratamiento farmacológico , Colombia/epidemiología , Persona de Mediana Edad , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Tuberculosis/mortalidad , Tuberculosis/epidemiología

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AIDS remains a significant global health challenge since its emergence in 1981, with millions of deaths and new cases every year. The CCR5 ∆32 genetic deletion confers immunity to HIV infection by altering a cell membrane protein crucial for viral entry. Stem cell transplants from homozygous carriers of this mutation to HIV-infected individuals have resulted in viral load reduction and disease remission, suggesting a potential therapeutic avenue. This study aims to investigate the relationship between genetic ancestry and the frequency of the CCR5 ∆32 mutation in Colombian populations, exploring the feasibility of targeted donor searches based on ancestry composition. Utilizing genomic data from the CÓDIGO-Colombia consortium, comprising 532 individuals, the study assessed the presence of the CCR5 ∆32 mutation and examined if the population was on Hardy-Weinberg equilibrium. Individuals were stratified into clusters based on African, American, and European ancestry percentages, with logistic regression analysis performed to evaluate the association between ancestry and mutation frequency. Additionally, global genomic databases were utilized to visualize the worldwide distribution of the mutation. The findings revealed a significant positive association between European ancestry and the CCR5 ∆32 mutation frequency, underscoring its relevance in donor selection. African and American ancestry showed negative but non-significant associations with CCR5 ∆32 frequency, which may be attributed to the study's limitations. These results emphasize the potential importance of considering ancestry in donor selection strategies, reveal the scarcity of potential donors in Colombia, and underscore the need to consider donors from other populations with mainly European ancestry if the CCR5 ∆32 stem cell transplant becomes a routine treatment for HIV/AIDS in Colombia.

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Jornal na sua 9ª edição (setembro 2024) com a análise e elaboração de conteúdo pela gerência de IST/AIDS e gerência de Hepatites Virais - SES- RJ.

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Organización y Administración , Virus , Preparaciones Farmacéuticas , Enfermedades de Transmisión Sexual

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OBJECTIVE: Emergence delirium is frequently observed in pediatric patients. With advancements in video-based interventions, such as cartoons, video games, and virtual reality, these modalities may contribute to a reduced incidence of emergency delirium among children. However, robust evidence supporting their efficacy remains necessary. METHODS: The authors conducted a systematic search across multiple databases, including Embase, MEDLINE, and Cochrane Library, to identify all randomized controlled trials comparing video-based interventions with control treatments in pediatric emergence delirium. Data were aggregated and analyzed using Review Manager 5.4 to evaluate the effectiveness of video-based interventions. RESULTS: The analysis included eight randomized controlled trials comprising 872 children. The intervention group showed a trend toward lower Pediatric Anesthesia Emergence Delirium scores (p = 0.10) and fewer emergence delirium events (p = 0.52). Seven studies demonstrated that video-based interventions significantly reduced preoperative anxiety, as indicated by decreased scores on the modified Yale Pre-operative Anxiety Scale (p < 0.00001). Anesthesia duration did not significantly differ between the intervention and control groups (p = 0.16). Notably, subgroup analyses revealed a significant reduction in Pediatric Anesthesia Emergence Delirium scores among children under seven years of age (p = 0.001). CONCLUSIONS: Video-based interventions were linked to lower Pediatric Anesthesia Emergence Delirium scores and a decreased incidence of emergence delirium events. However, these results did not reach statistical significance across the broader sample. Notably, in children under seven, these interventions significantly reduced the scores. LEVEL OF EVIDENCE: III.

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INTRODUCTION: Mutations associated with HIV drug resistance (DR) affect clinical outcomes. Understanding the prevalence of HIV DR and its association with viral suppression and survival in the paediatric population is key to inform patient care and health policies. METHODS: We used Brazilian monitoring systems to identify genotyping tests performed in children living with HIV aged ≤18 months between 2009 and 2020. We categorized HIV DR using three criteria: any HIV DR (R1), DR to nevirapine or efavirenz (R2), and DR to at least one antiretroviral recommended for children with HIV in Brazilian guidelines (R3). We investigated factors associated with HIV DR, viral suppression, and survival up to 3 years old using multivariable models. Lastly, we describe the annual prevalence of each type of HIV DR in Brazilian children with HIV between 2009 and 2020. RESULTS: We included 1152 children with HIV with a median age of 5 months at genotype testing; 57% were females. R1 was observed in 30%, R2 in 17%, and R3 in 21%. Children with HIV whose birth parents were exposed to nevirapine or efavirenz before delivery had higher odds of R2 (odds ratio 3.4; 95% confidence interval [CI] 1.1-10.8). Children with HIV with R1 or R3 had higher rates of death than those with HIV with no HIV DR in the adjusted models (adjusted hazard ratios 4.7 [95% CI 1.6-13.9] and 4.1 [95% CI 1.4-12.4], respectively). The prevalence of resistance to nevirapine and efavirenz peaked in 2015. Over time, the prevalence of genotyping tests with no detected resistance varied between 57% and 87%. CONCLUSION: HIV DR is highly prevalent in children with HIV and is associated with lower survival.

RESUMEN

Objectives: To investigate sexual practices and HIV risk perception among MSM, identifying associated risk factors and determinants. Methods: A cross-sectional epidemiological study was conducted with 144 MSM in Teresina, Piauí, Brazil, using the snowball sampling technique. Participants were recruited via snowball sampling and underwent rapid HIV testing, in addition to completing questionnaires on sexual practices, risk perception, and illicit drug use. Results: The majority of participants showed an unsatisfactory perception of HIV risk. Factors associated with this perception include non-penetrative sex as an HIV preventive measure, which increased the chances of having an unsatisfactory risk perception by 1.45 times (P = .04), engaging with known HIV-positive individuals without knowledge of their viral load (ORa = 2.70; P = .043), and using illicit drugs before/during sex (ORa = 0.29; P = .048). Conclusions: The results indicate a high prevalence of risky sexual practices and an unsatisfactory HIV risk perception among the MSM studied.

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HIV Risk and Sexual Practices Among Men Who Have Sex with Men in BrazilThis study examines sexual practices and perceptions of HIV risk among men who have sex with men (MSM) in Teresina, Brazil. MSM are significantly more likely to contract HIV compared to the general population, with various factors influencing their risk. Despite this high vulnerability, many MSM do not perceive themselves to be at significant risk of HIV infection. Researchers surveyed 144 MSM to understand their sexual behaviors and how they perceive the risk of HIV. The study found that many MSM engage in risky sexual practices, such as not using condoms during oral sex, even though most use them during anal sex. Additionally, the study revealed that MSM often has a false sense of security when having sex with steady partners compared to casual partners. Key factors associated with a poor perception of HIV risk included low family income, engaging in non-penetrative sex as a preventive measure, having sexual relations with known HIV-positive individuals without knowing their viral load, and using illicit drugs during sexual activity. For instance, using illicit drugs, known as "chemsex," significantly increases risky behaviors, leading to a higher chance of HIV transmission. The study emphasizes the need for targeted health education and interventions for MSM. It suggests promoting regular condom use, better understanding of HIV transmission risks, and discouraging the use of drugs that impair judgment during sexual activities. Effective public health initiatives should be culturally sensitive and accessible to MSM of all income levels. By addressing these issues, health programs can better support MSM, reduce HIV transmission rates, and improve overall well-being.

Asunto(s)

Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad Masculina , Asunción de Riesgos , Conducta Sexual , Humanos , Masculino , Brasil/epidemiología , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Adulto , Estudios Transversales , Homosexualidad Masculina/estadística & datos numéricos , Homosexualidad Masculina/psicología , Conducta Sexual/estadística & datos numéricos , Adulto Joven , Factores de Riesgo , Encuestas y Cuestionarios , Persona de Mediana Edad , Adolescente , Percepción , Sexo Inseguro/estadística & datos numéricos , Sexo Inseguro/psicología

RESUMEN

BACKGROUND: The use of antiretrovirals has increased the survival of People Living with HIV/AIDS (PLWHA), resulting in an aging population and a rise in the incidence of sarcopenia. The lack of uniformity among the prevalences found in studies may be associated with the use of different diagnostic criteria, highlighting the need for local studies to determine the prevalence of sarcopenia. METHODS: Cross-sectional study to estimate the prevalence and associated factors of sarcopenia using the revised criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). This study included PLWHA of both sexes, aged 40 years or older, who were treated at the infectious disease outpatient clinic of a tertiary hospital from 2019 to 2021. Muscle mass was quantified through electrical bioimpedance, using resistance and reactance to calculate appendicular lean mass (ALM) in kg/m². Muscle strength, measured in kg, was assessed using a manual dynamometer, and muscle function was evaluated using the gait speed test (m/s). Numerical variables were analyzed using measures of central tendency and dispersion. The chi-square test was used to assess associations in categorical variables. Odds ratios (OR) and 95% Confidence Intervals (CI) were calculated to evaluate the strength of associations. RESULTS: Among the 218 PLWHA, the prevalence of sarcopenia was 8.7% (95% CI: 5.6 to 13.3). The mean age of the study population was 51.8 ± 8.3 years; 53.7% were male, 72.9% were brown/Black, 97.7% reported not using illicit drugs, and 24.8% were classified as obese. Multivariate analysis showed that the time since HIV diagnosis (P = 0.022) and the use of illicit drugs were associated with the diagnosis of sarcopenia. CONCLUSION: The prevalence of sarcopenia using the EWGSOP2 criteria was low. People with a longer duration of HIV infection and those using illicit drugs were more likely to develop sarcopenia.

Asunto(s)

Infecciones por VIH , Sarcopenia , Humanos , Sarcopenia/epidemiología , Masculino , Femenino , Estudios Transversales , Prevalencia , Persona de Mediana Edad , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Infecciones por VIH/tratamiento farmacológico , Adulto , Anciano , Factores de Riesgo , Fuerza Muscular

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HIV/AIDS-Targeted Quality of Life (HAT-QOL) is an instrument for evaluating health-related quality of life (HRQOL) in people living with HIV (PLWHIV). This has been adapted into Brazilian Portuguese, but its dimensional structure has not been analyzed. This study evaluated the psychometric properties of the Brazilian Portuguese version of the HAT-QOL, using a sample of 319 PLWHIV in Salvador, Brazil. The study performed Exploratory Factor Analysis (EFA) to assess the HAT-QOL dimensional structure. The analysis used a polychoric correlation matrix, Robust Diagonally Weighted Least Squares (RDWLS) as an extraction method, Parallel Analysis for factor retention, robust promin as oblique rotation, and Generalized H-index (G-H) for construct replicability of each factor. Model adequacy was assessed using the Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Index (TLI). Concurrent validity was evaluated with the 36-item Short Form Health Survey, version 2 (SF-36v2). EFA identified a HAT-QOL six-factor solution: Financial Worries, Sexual Function, Medication Concerns, Life Satisfaction, Health Worries, and Overall Function. This solution showed high G-H indexes, concurrent validity, and satisfactory adequacy indexes (X2 = 231.345, df = 291, p < 0,001; RMSEA = 0.001, CFI = 0.999, TLI = 1.028). HIV Mastery, Disclosure Worries, and Provider Trust domains were not retained in EFA and did not have evidence of concurrent validity. This study proposed a HAT-QOL six-factor model for measuring HRQOL in the Brazilian PLWHIV. Future research could help identify another latent construct from not-included domains.

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RESUMEN: El HIV/AIDS-Targeted Quality of Life (HAT-QOL) es un instrumento que evalúa calidad de vida relacionada con la salud (CVRS) en personas que viven con VIH (PVVIH). Éste ha sido adaptado al portugués brasilero, pero su estructura dimensional no ha sido analizada. Se evaluaron las propiedades psicométricas de la versión en portugués brasilero del HAT-QOL, en una muestra de 319 PVVIH en Salvador, Brasil. Se empleó un Análisis Factorial Exploratorio (AFE) para evaluar la estructura dimensional del HAT-QOL. El análisis utilizó una matriz de correlación policórica, mínimos cuadrados ponderados robustos diagonalmente (RDWLS) para extraer factores, análisis paralelo para retener factores, promin robusto como rotación oblicua y el índice H generalizado (G-H) para la replicabilidad de constructo de cada factor. La adecuación del modelo fue evaluado con el error cuadrático medio de aproximación (RMSEA) y los índices de ajuste comparativo (CFI) y Tucker-Lewis (TLI). Se evaluó la validez concurrente con el cuestionario 36-item Short Form Health, versión 2 (SF-36v2). El AFE identificó una solución de seis factores para el HAT-QOL: Preocupaciones Financieras, Función Sexual, Preocupaciones por la medicación, Satisfacción con la vida, Preocupaciones por la salud y Función general. Esta solución mostró altos índices G-H, validez concurrente e índices de adecuación satisfactorios (X2 = 231.345, df = 291, p < 0,001; RMSEA = 0.001, CFI = 0.999, TLI = 1.028). Los dominios Aceptación del VIH, Preocupaciones por el sigilo y Confianza en el profesional no fueron retenidos en el AFE y no evidenciaron validez concurrente. Se propone un modelo de seis factores del HAT-QOL para evaluar CVRS en PVVIH brasileras. Futuras investigaciones ayudarían a identificar otros constructos latentes a partir de los dominios no incluidos en la estructura.

RESUMEN

The lack of a universally accepted definition of a pandemic hinders a comprehensive understanding of and effective response to these global health crises. Current definitions often lack quantitative criteria, rendering them vague and limiting their utility. Here, we propose a refined definition that considers the likelihood of susceptible individuals contracting an infectious disease that culminates in widespread global transmission, increased morbidity and mortality, and profound societal, economic, and political consequences. Applying this definition retrospectively, we identify 22 pandemics that occurred between 165 and 2024 AD and were caused by a variety of diseases, including smallpox (Antonine and American), plague (Justinian, Black Death, and Third Plague), cholera (seven pandemics), influenza (two Russian, Spanish, Asian, Hong Kong, and swine), AIDS, and coronaviruses (SARS, MERS, and COVID-19). This work presents a comprehensive analysis of past pandemics caused by both emerging and re-emerging pathogens, along with their epidemiological characteristics, societal impact, and evolution of public health responses. We also highlight the need for proactive measures to reduce the risk of future pandemics. These strategies include prioritizing surveillance of emerging zoonotic pathogens, conserving biodiversity to counter wildlife trafficking, and minimizing the potential for zoonotic spillover events. In addition, interventions such as promoting alternative protein sources, enforcing the closure of live animal markets in biodiversity-rich regions, and fostering global collaboration among diverse stakeholders are critical to preventing future pandemics. Crucially, improving wildlife surveillance systems will require the concerted efforts of local, national and international entities, including laboratories, field researchers, wildlife conservationists, government agencies and other stakeholders. By fostering collaborative networks and establishing robust biorepositories, we can strengthen our collective capacity to detect, monitor, and mitigate the emergence and transmission of zoonotic pathogens.

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Human Herpesviruses (HHVs) play a significant role in neurological diseases such as encephalitis and meningitis, adding significant morbidity. This study aims to retrospectively analyze the effect of HHVs on patients with neurological symptoms, focusing on the Herpesviridae family's contributions to central nervous system (CNS) infections. METHODS: This retrospective cohort study included 895 patients suspected of viral CNS infections, utilizing molecular diagnosis via qPCR to identify HHVs in cerebrospinal fluid (CSF) samples. This was conducted at a reference tertiary care hospital for infectious diseases in the western Brazilian Amazon from January 2015 to December 2022, focusing on the Herpesviridae family's clinical repercussions and of Cytomegalovirus in CNS infections. RESULTS: The findings revealed that 7.5% of the analyzed samples tested positive for HHVs, with Human Cytomegalovirus (HCMV) and Epstein-Barr Virus (EBV) being the most prevalent. A significant association was found between HHVs and neurological diseases such as encephalitis and meningitis, especially among people living with HIV/AIDS (PLWHA), highlighting the opportunistic nature of these viruses. The study underscores the critical role of CSF analysis in diagnosing CNS infections and the complexity of managing these infections in HIV patients due to their immunocompromised status. CONCLUSIONS: The results emphasize the need for comprehensive diagnostic approaches and tailored treatment strategies for CNS infections in immunocompromised individuals. The study calls for ongoing research and advancements in clinical practice to improve patient outcomes facing CNS infections, particularly those caused by HHVs.

Asunto(s)

Infecciones por Herpesviridae , Herpesviridae , Humanos , Estudios Retrospectivos , Femenino , Masculino , Adulto , Persona de Mediana Edad , Herpesviridae/aislamiento & purificación , Herpesviridae/genética , Brasil/epidemiología , Infecciones por Herpesviridae/virología , Infecciones por Herpesviridae/líquido cefalorraquídeo , Adulto Joven , Adolescente , Infecciones del Sistema Nervioso Central/virología , Infecciones del Sistema Nervioso Central/líquido cefalorraquídeo , Infecciones del Sistema Nervioso Central/epidemiología , Niño , Preescolar , Citomegalovirus/genética , Citomegalovirus/aislamiento & purificación , Anciano , Lactante , Enfermedades Virales del Sistema Nervioso Central/virología , Enfermedades Virales del Sistema Nervioso Central/líquido cefalorraquídeo , Enfermedades Virales del Sistema Nervioso Central/diagnóstico , Infecciones por VIH/virología , Infecciones por VIH/complicaciones , Infecciones por VIH/líquido cefalorraquídeo

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The peptide CIGB-210 inhibits HIV replication, inducing a rearrangement of vimentin intermediate filaments. The assessment of the in vitro serum and plasma stability of this peptide is important to develop an optimal pharmacological formulation. A half-life of 17.68 ± 0.59 min was calculated for CIGB-210 in human serum by reverse-phase high-performance liquid chromatography (HPLC) and mass spectrometry (MS). Eight metabolites of CIGB-210 were identified with this methodology, all of them lacking the N-terminal moiety. A previously developed CIGB-210 in-house competitive ELISA was used to compare the stability of CIGB-210 derivatives containing either D-amino acids, acetylation at the N-terminus, or both modifications. The half-life of CIGB-210 in serum was five times higher when measured by ELISA than by HPLC/MS, and twice higher in plasma as compared to serum. The substitution of D-asparagine on position 6 doubled the half-life, while D-amino acids on positions 8 and 9 did not improve the stability. The acetylation of the N-terminus resulted in a 24-fold more stable peptide in plasma. The positive effect of N-terminal acetylation on CIGB-210 serum stability was confirmed by the HPLC/MS method, as the half-life of the peptide was not reached after 2 h of incubation, which represents more than a 6.8-fold increase in the half-life with respect to the original peptide.

RESUMEN

There is evidence to support the use of mHealth tools for improving medication adherence. Building on this evidence, our study team culturally adapted and translated the WiseApp for improving antiretroviral medication adherence in Spanish-speaking persons with HIV. We are currently conducting a multi-site randomized controlled trial (RCT) to test the effectiveness and sustainability of the WiseApp for Spanish speakers in New York City and the Dominican Republic.

Asunto(s)

Infecciones por VIH , Cumplimiento de la Medicación , Aplicaciones Móviles , Humanos , Fármacos Anti-VIH/uso terapéutico , República Dominicana , Hispánicos o Latinos , Infecciones por VIH/tratamiento farmacológico , Ciudad de Nueva York , Telemedicina , Ensayos Clínicos Controlados Aleatorios como Asunto

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INTRODUCTION: The present study investigated the impact of immune recovery and the duration of antifungal adherence in the consolidation phase of disseminated histoplasmosis (DH) in acquired immune deficiency syndrome (AIDS) patients living in a hyperendemic area in northeastern Brazil. MATERIAL AND METHODS: Sixty-nine patients with DH/AIDS, admitted to the São José Hospital between 2010 and 2015, who continued histoplasmosis consolidation therapy at the outpatient clinic were studied. The follow-up duration was at least 24 months. RESULTS: Sixty-eight patients used itraconazole 200-400 mg/day or amphotericin B deoxycholate weekly during the consolidation phase, and six patients relapsed during follow-up. The overall median duration of consolidation antifungal use was 250 days [IQR 101 - 372]. Antifungal withdrawal by medical decision occurred in 41 patients (70.7 %) after a median of 293 days [IQR 128 - 372] of use; 16 patients discontinued by their own decision, with a median of 106 days [IQR 37 - 244] of therapy; three patients had no information available, and nine continued on AF therapy. The median CD4+ T-cell count in the group without relapse was 248 cells/µL [IQR 115-355] within 6 months after admission; conversely, in the relapse group, the median cell count remained below 100 cells/µL. Irregular adherence to highly active antiretroviral therapy (HAART) was the leading risk factor associated with relapse and death (p< 0.01). DISCUSSION: The regular use of HAART, combined with immune recovery, proved to be highly effective in preventing relapses in DH/AIDS patients, suggesting that long-term antifungal therapy may not be necessary.

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Infecciones Oportunistas Relacionadas con el SIDA , Síndrome de Inmunodeficiencia Adquirida , Anfotericina B , Antifúngicos , Ácido Desoxicólico , Histoplasmosis , Humanos , Histoplasmosis/tratamiento farmacológico , Histoplasmosis/inmunología , Masculino , Femenino , Antifúngicos/uso terapéutico , Antifúngicos/administración & dosificación , Adulto , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/inmunología , Persona de Mediana Edad , Ácido Desoxicólico/uso terapéutico , Ácido Desoxicólico/administración & dosificación , Anfotericina B/uso terapéutico , Anfotericina B/administración & dosificación , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Recuento de Linfocito CD4 , Brasil/epidemiología , Itraconazol/uso terapéutico , Itraconazol/administración & dosificación , Reconstitución Inmune , Combinación de Medicamentos , Quimioterapia de Consolidación , Estudios Retrospectivos , Cumplimiento de la Medicación/estadística & datos numéricos , Recurrencia , Duración de la Terapia , Resultado del Tratamiento , Estudios de Seguimiento , Terapia Antirretroviral Altamente Activa

RESUMEN

This study aimed to investigate the effects of caffeine ingestion by chewing gum (GUMCAF) combined with priming exercise on pulmonary oxygen uptake (V˙O2) and near-infrared spectroscopy-derived muscle oxygen extraction (HHb + Mb) kinetics during cycling performed in a severe-intensity domain. Fifteen trained cyclists completed four visits: two under a placebo gum (GUMPLA) and two under GUMCAF ingestion. Each visit consisted of two square-wave cycling bouts at Δ70 intensity (70% of difference between the V˙O2 at first ventilatory threshold and V˙O2max) with duration of 6 min each and 5 min of passive rest between the bouts. The GUMPLA or GUMCAF (400 mg) was chewed for 5 min, 12 min before the first Δ70 bout in a randomized double-blind procedure. The fundamental phase and slow component of HHb + Mb and V˙O2 kinetics were evaluated. For HHb + Mb kinetics, regardless of ingested gum, priming exercise effects occurred on the time constant (GUMCAF 16.0 ± 4.0 vs. 13.9 ± 2.9 s; GUMPLA 15.7 ± 6.1 vs. 13.2 ± 2.5 s), amplitude, slow component, time delay, and mean response time parameters (p ≤ .032). For V˙O2 kinetics, there were significant effects of bouts on the amplitude, slow component, end V˙O2, and the gain kinetics parameters (p < .017). Baseline V˙O2 was higher during GUMCAF than GUMPLA (p = .020). No significant effects occurred for the interaction between gum and bout in any parameter of V˙O2 or HHb + Mb kinetics. Therefore, unlike the priming exercise in severe-intensity exercise, GUMCAF is not an effective strategy for improving V˙O2 or HHb + Mb kinetics acceleration.

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Ciclismo , Cafeína , Goma de Mascar , Estudios Cruzados , Músculo Esquelético , Consumo de Oxígeno , Espectroscopía Infrarroja Corta , Humanos , Método Doble Ciego , Ciclismo/fisiología , Adulto , Masculino , Cafeína/administración & dosificación , Cafeína/farmacología , Músculo Esquelético/metabolismo , Músculo Esquelético/efectos de los fármacos , Adulto Joven , Cinética , Ejercicio Físico/fisiología

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Histoplasmosis is an increasing infection that mainly affects immunocompromised individuals such as patients with HIV/AIDS, with the disseminated form, especially gastrointestinal, being common in this population. The clinical presentation ranges from asymptomatic to symptoms that mimic other abdominal diseases. Jejunal perforation due to histoplasmosis, although rare, has been reported in a few cases, typically in men living with HIV in their fourth decade of life. We present the case of a 34-year-old male, with a history of HIV and colonic histoplasmosis who presented with acute abdominal pain requiring exploratory laparotomy and intestinal resection due to jejunal perforation, with histological confirmation of histoplasmosis in the resected intestinal segment.

RESUMEN

OBJECTIVE: There is limited information regarding the incidence of treatment-related adverse events (AE) following antiretroviral therapy (ART) in women. So, this review aimed to describe the incidence of AE of ART in women living with HIV/AIDS. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase, Cochrane Library, Epistemonikos, Lilacs and Who Index, from inception to 9 April 2023. ELIGIBILITY CRITERIA: We included randomised controlled trials with at least 12 weeks of follow-up and evaluated AE of ART in women at any age living with HIV/AIDS, without restrictions on status, year or language of publication. We excluded post hoc or secondary analyses and open-label extensions without comparator, and trials involving pregnant or breastfeeding women or with a focus on coinfection with tuberculosis, hepatitis B or C. The primary outcomes were the incidence rate of participants with any clinical and/or laboratory AE related or not to ART and treatment discontinuation. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed the risk of bias using Cochrane's risk of bias tool 2. We used Bayesian random-effects meta-analysis to summarise event rates. Results were presented as event rates per 1000 person-years (95% credibility intervals, 95% CrI). The pooled incidence rate per 1000 person-years adjusted for duration and loss to follow-up was estimated. We assessed the certainty of the evidence using Grading of Recommendations, Assessment, Development and Evaluation. RESULTS: A total of 24 339 studies were identified for screening, of which 10 studies (2871 women) met the eligibility criteria, with 11 different antiretrovirals (ARVs) regimens. Seven studies included exclusively women, while in the remaining three, the proportion of women ranged from 11% to 46%. Nine studies received industry funding. The pooled analysis showed a mean incidence rate of ART-related clinical and laboratory AE of 341.60 events per 1000 person-years (95% CrI 133.60-862.70), treatment discontinuation of 20.78 events per 1000 person-years (95% CrI 5.58-57.31) and ART-related discontinuation of 4.31 per 1000 person-years (95% CrI 0.13-54.72). Summary estimates were subject to significant uncertainty due to the limited number of studies and sparse data. The certainty of the evidence was graded as very low for all outcomes assessed. CONCLUSION: Existing randomised trials do not provide sufficient evidence on the incidence rates of safety outcomes from antiretroviral treatment in women living with HIV/AIDS. Large comparative studies in well-characterised populations are needed to provide a more comprehensive landscape of the safety profile of these ARV therapies in women with HIV/AIDS. PROSPERO REGISTRATION NUMBER: CRD42021251051.

Asunto(s)

Infecciones por VIH , Humanos , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Incidencia , Antirretrovirales/efectos adversos , Antirretrovirales/uso terapéutico , Fármacos Anti-VIH/efectos adversos , Fármacos Anti-VIH/uso terapéutico , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/epidemiología

RESUMEN

India is one of the world's largest producers of tree nuts, yet it paradoxically remains a net importer of these commodities. This study aims to analyze the demand for imported tree nuts in India, motivated by the need to understand the factors contributing to this imbalance. The primary objective is to calculate income elasticities and own- and cross-price elasticities for five categories of imported tree nuts using the linear approximate almost ideal demand system model. Data is sourced from monthly import records from the United Nations Comtrade database covering 2014 to 2022. The tree nuts considered are almonds, cashews, pistachios, walnuts, and hazelnuts. Key findings reveal all imported tree nuts are normal goods. Cashews exhibit income elasticity (1.2), indicating a significant demand increase with rising incomes, while other nuts show income inelasticity. Cashews are price-elastic (-1.3), while other nuts are price-inelastic. Compensated cross-price elasticities indicate notable substitution effects, particularly between almonds and cashews. The study recommends enhancing domestic cashew production to meet growing demand and developing targeted marketing strategies to address competitive dynamics within the tree nut market. These strategies aim to reduce India's dependency on imports and promote a balanced, sustainable domestic market.

RESUMEN

It is estimated that 45% of individuals with cognitive impairment experience sleep disturbances prior to the onset of cognitive symptoms. Assessing sleeping problems and enhancing sleep quality are critical first steps to reduce the risk of cognitive impairment. Objective: To review existing literature based on predefined eligibility criteria to understand the connection between sleep disturbance and Alzheimer's disease. Methods: A thorough and systematic evaluation of numerous studies was carried out to assess one or more of the following epidemiological factors: (1) sleep disorders, (2) cognitive impairment, and (3) risk estimates for cognitive impairment due to sleep. Results: Studies suggest that individuals who experience memory loss may encounter sleep disturbances before noticing other symptoms. Numerous sleep disorders, such as excessive and inadequate sleep duration, poor sleep quality, circadian rhythm abnormalities, insomnia, and obstructive sleep apnea were found to increase the risk of cognitive dysfunction and dementia. Additionally, lower sleep quality and shorter sleep duration have been linked to higher cerebral-ß-amyloid levels. Objective evidence for the development of cognitive impairment is provided by the architecture of sleep stages. Patients experiencing sleep problems may benefit from specific types of sleep medicine as a preventative measure against cognitive decline. Conclusion: Sleep disorders can have adverse effects on cognitive health. The duration and quality of sleep are fundamental factors for maintaining a healthy brain as we age. Proper sleep can aid prevent cognitive impairment, particularly Alzheimer's disease and dementia.

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Acredita-se que 45% dos indivíduos com comprometimento cognitivo experimentem distúrbios do sono antes do início dos sintomas cognitivos. Avaliar problemas de sono e melhorar a qualidade do sono são passos críticos iniciais para reduzir o risco de comprometimento cognitivo. Objetivo: Revisar a literatura existente com base em critérios de elegibilidade predefinidos para entender a conexão entre distúrbios do sono e a Doença de Alzheimer. Métodos: Uma avaliação completa e sistemática de vários estudos foi realizada para avaliar um ou mais dos seguintes fatores epidemiológicos: (1) distúrbios do sono, (2) comprometimento cognitivo e (3) estimativas de risco de comprometimento cognitivo decorrente do sono. Resultados: Os estudos sugerem que indivíduos que experimentam perda de memória podem enfrentar distúrbios do sono antes de notarem outros sintomas. Foi constatado que vários distúrbios do sono, como duração excessiva e inadequada do sono, má qualidade do sono, anormalidades no ritmo circadiano, insônia e apneia obstrutiva do sono, podem aumentar o risco de disfunção cognitiva e demência. Além disso, menor qualidade do sono e duração mais curta do sono têm sido associadas a níveis mais altos de ß-amiloide cerebral. Evidências objetivas para o desenvolvimento de comprometimento cognitivo são fornecidas pela arquitetura dos estágios do sono. Pacientes que experimentam problemas de sono podem se beneficiar de tipos específicos de medicamentos para o sono como medida preventiva contra o declínio cognitivo. Conclusão: Os distúrbios do sono podem ter efeitos adversos na saúde cognitiva. A duração e a qualidade do sono são fatores fundamentais para manter um cérebro saudável à medida que envelhecemos. Um sono adequado pode ajudar a prevenir o comprometimento cognitivo, especialmente a Doença de Alzheimer e a demência.

RESUMEN

RESUMONas últimas quatro décadas e meia, a história da pandemia de HIV passou por várias fases que podem ser pensadas como ondas distintas em termos da resposta social e política que a pandemia gerou. Ao longo dessa história, houve batalhas importantes sobre os significados e interpretações que a resposta à pandemia produziu. Mas, especialmente na última década, parece haver uma crescente desconexão entre as alegações de sucesso feitas por muitas agências globais de saúde e formuladores de políticas e a realidade empírica que essas alegações encobrem. Este comentário argumenta que a 'ampliação' ('scale-up') da resposta à pandemia essencialmente chegou ao fim e enfatiza a importância de um debate político mais honesto sobre o estado atual da resposta global ao HIV. Argumenta que, a fim de melhor definir os rumos que tal resposta deve tomar no futuro, exige que pensemos criticamente sobre as formas como essa resposta se desenvolveu historicamente, que reconheçamos os avanços significativos alcançados nas últimas décadas, mas também que reconheçamos a encruzilhada a que chegou em meados da década de 2020.

Asunto(s)

Síndrome de Inmunodeficiencia Adquirida , Salud Global , Política de Salud , Humanos , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Pandemias , Epidemias , Política , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control