RESUMO

OBJECTIVE: Few data exist on the efficacy of antiretroviral therapy in individuals infected with HIV in the Caribbean. We evaluated the virological and immunological responses of HIV-infected adults starting highly active antiretroviral therapy (HAART). DESIGN: This was a prospective observational cohort study. METHODS: A total of 158 antiretroviral-naive patients who initiated HAART between January 2002 and March 2003, and completed at least 6 months of treatment and follow up, were included in the analysis. The response to therapy was assessed by changes in CD4 cell counts and viral loads from baseline. The mean increase in CD4 cell count, the rate of virological success (a viral load of <50 HIV-1 RNA copies/mL) and the rate of immunological success (an increase in CD4 cell count of > or =50 cells/microL over the baseline value) after commencing HAART were measured. RESULTS: In total, 82% of patients (123 of 150) achieved viral loads of <50 copies/mL after 6 months of therapy. Viral success rate after 6 months of HAART was similar irrespective of gender, pre-HAART CD4 cell count and pre-HAART viral load. However, patients older than 40 years were significantly more likely to achieve virological success than those younger than 40 years. At 6 months after starting HAART, 79.5% of patients were estimated to have achieved immunological success and 17.9% had an increase in CD4 cell count of > or =200 cells/microL over the baseline value. The median increase in CD4 cell count for the 156 patients who had CD4 cell counts at baseline and at 6 months of therapy was 122 cells/microL. CONCLUSION: In this cohort of antiretroviral-naive HIV-infected adults, there was a high rate of virological and immunological success after 6 months of HAART, irrespective of the pre-HAART viral load and CD4 cell count.

Assuntos

RESUMO

Organisms of the Mycobacterium fortuitum complex are recognised but uncommon causes of pulmonary disease, primary cutaneous disease and a wide spectrum of nosocomial infections. M fortuitum was isolated from 20 patients over a 15 month period, with an apparent clustering of isolates occurring from January to March 1994. The molecular epidemiology of this clustering was investigated using an arbitrary primer polymerase chain reaction method (AP-PCR). 21 isolates were studied, which yielded 13 distinct profiles. Multiple isolates from a single patient yielded identical profiles. All of seven isolates recovered during the six week period from January to March 1994 shared a common profile which was distinct from all other isolates, suggesting that a single strain was isolated from specimens from all seven patients. The source of this cluster is uncertain. We can find no epidemiological basis for an episode of cross-infection within the hospital environment, and it is assumed that contamination of the specimens during collection, transport or processing was responsible for the "pseudo-outbreak" of M fortuitum.

Assuntos

RESUMO

Organisms of the Mycobacterium fortuitum complex are recognised but uncommon causes of pulmonary disease, primary cutaneous disease and a wide spectrum of nosocomial infections. M fortuitum was isolated from 20 patients over a 15 month period, with an apparent clustering of isolates occurring from January to March 1994. The molecular epidemiology of this clustering was investigated using an arbitrary primer polymerase chain reaction method (AP-PCR). 21 isolates were studied, which yielded 13 distinct profiles. Multiple isolates from a single patient yielded identical profiles. All of seven isolates recovered during the six week period from January to March 1994 shared a common profile which was distinct from all other isolates, suggesting that a single strain was isolated from specimens from all seven patients. The source of this cluster is uncertain. We can find no epidemiological basis for an episode of cross-infection within the hospital environment, and it is assumed that contamination of the specimens during collection, transport or processing was responsible for the [quot ]pseudo-outbreak[quot ] of M fortuitum.

Assuntos

RESUMO

PIP: Because of the prevalence of leptospirosis in Barbados, patients who present to the hospital with febrile illnesses are routinely screened for Leptospira infection and their sera are stored for future reference. While the majority of patients are infected with Leptospira, some are not. Since some symptoms of acute HIV-1 illness are similar to those of leptospirosis, patient records were reviewed to identify patients whose clinical symptoms may have been due to HIV-1 infection. 10 HIV-1-positive patients originally hospitalized during 1990-94 were identified whose medical histories suggested the occurrence of acute HIV-1 illness at the time of Leptospira testing. Stored sera from those patients were then tested for the presence of HIV-1 p24 antigen and by Western blotting. Evidence of acute HIV-1 infection was considered to be a positive p24 test or a characteristic Western blot profile occurring at or shortly before the time of seropositivity for HIV-1 antibody. The authors determined the sequence of viral RNA from the 12 remaining sera samples from 8 patients, including paired samples drawn at 3- or 4-day intervals from 4 people. The Barbados patient variants aligned more closely with HIV-1 clade B reference strains than with the other subtypes. 2 variants, however, align separately from the classic B subtype and somewhat closer to variants from clades A and C. The Venezuelan isolate, although different from the patient sequences, is also separate from the other B variants.^ieng

Assuntos

RESUMO

Descriptions of primary HIV-1 infection have so far been based on Caucasians living in industrialized nations. Due to studies of leptospirosis in the predominantly black population of Barbados, serum was available for patients admitted with acute febrile illnesses to the Queen Elizabeth Hospital (QEH). By searching the medical records of 510 adult patients with known HIV-1 infection we identified 10 patients who had stored serum from an admission for an acute febrile illness that predated or coincided with their first HIV-1-positive test. Serological testing confirmed primary HIV-1 infection in 9 and was suggestive in the 10th patient. The clinical features of these 10 patients were in keeping with previous descriptions of primary HIV-1 infection but differed from leptospirosis cases seen at the QEH. One patient died during his seroconversion illness and another died 3 months after seroconversion. The findings suggest that severe primary HIV-1 infection could be a relatively uncommon occurrence, that the condition may be misdiagnosed, and that cases may not occur until the AIDS epidemic is established.

PIP: A retrospective review was conducted of the medical records of 510 HIV-1-positive adult patients who had attended the Queen Elizabeth Hospital (QEH) to determine whether any had been admitted for an illness compatible with a diagnosis of primary HIV-1 infection. A serum bank, created from patients who had been admitted with acute febrile illnesses and investigated for leptospirosis, provided serological evidence for primary HIV-1 infection in 10 patients. Serological testing of the serum samples confirmed primary HIV-1 infection in nine patients and was suggestive in the tenth. The clinical features of the 10 patients fit the earlier descriptions of primary HIV-1 infection, but differed from the leptospirosis cases seen at the QEH. One patient died during his seroconversion illness and another died 3 months after seroconversion. These findings suggest that severe primary HIV-1 infection could be a relatively uncommon occurrence, that the condition may be misdiagnosed, and that cases may not occur until the AIDS epidemic is established.

Assuntos

RESUMO

A knowledge, attitudes, beliefs, and practices (KABP) survey was performed among Barbadian secondary schoolchildren 11-16 years old in January 1990. The survey sought to assess the children's knowledge of AIDS and human immunodeficiency virus (HIV) transmission; their attitudes toward people with HIV/AIDS; their sexual practices; and changes needed in education programs seeking to reduce childhood HIV transmission. A pretested self-administered questionnaire was used. The survey sample was derived by selecting every eleventh student on the rosters of all the secondary schools in Barbados. All of the survey respondents completed the questionnaire on the same day, having been assembled examination-style for that purpose. The results showed high levels of correct knowledge about the principal routes of HIV transmission. However, a considerable proportion of the respondents harbored incorrect beliefs regarding mosquito transmission and dangers to blood donors, and many showed uncertainty or incorrect knowledge regarding possible HIV transmission by biting, spitting, or use of public toilets. About a third of the children (51.4% of the boys and 18.7% of the girls) said they had experienced sexual intercourse, though only 20% reported being sexually active in the year preceding the survey. Three-quarters of the sexually experienced group said they knew how to use condoms, but only a third said there was any time when they had used protection during sexual intercourse. Overall, the results indicate that education efforts prior to the survey had been effective, but that reinforcement of such efforts as well as their extension into the primary schools is warranted. Further research directed at helping these efforts to encourage more meaningful changes in sexual behavior is also needed.

PIP: A knowledge, attitude, beliefs, and practices (KABP) survey was performed among Barbadian secondary schoolchildren ages 11-16 in January 1990. The survey sought to assess the children's knowledge of AIDS and human immunodeficiency virus (HIV) transmission; their attitudes towards people with HIV/AIDS; their sexual practices; and changes needed in education programs seeking to reduce childhood HIV transmissions. A pretested self-administered questionnaire was used. The survey sample was derived by selecting every 11th student on the rosters of all secondary school in Barbados. All of the survey respondents completed the questionnaire on the same day, having been assembled examination- style for that purpose. Results showed high levels of correct knowledge concerning the principle routes of HIV transmission; however, a considerable portion of the respondents maintained incorrect beliefs with regard to mosquito transmission and dangers to blood donors, and many demonstrated uncertainty or incorrect knowledge concerning possible HIV transmission by biting, spitting, or use of public toilets. About 1/3 of the children (51.4% of the boys and 18.7% of the girls) said they had experienced sexual intercourse, although only 20% said they were sexually active in the year preceding the survey. 3/4 of the sexually experienced group said they knew how to use condoms, but only 1/3 said there was any time when they had used protection during sexual intercourse. Overall, results indicate that education efforts prior to the survey had been effective, but that reinforcement of such efforts as well as their extension into the primary schools is warranted. Further research directed at aiding in this effort to encourage more meaningful changes in sexual behavior is also necessary.

Assuntos

RESUMO

A knowledge, attitudes beliefs, and practices (KABP) survey was performed among Barbadian secondary schoolchildren 11-16 years old in January 1990. The survey sought to assess the children's knowledge of AIDS and human immunodeficiency virus (HIV) transmission; their attitudes toward people with HIV/AIDS; their sexual practices; and changes needed in education programs seeking to reduce childhood HIV transmission. A pretested self-administered questionnaire was used. The survey sample was derived by selecting every eleventh student on the rosters of all the secondary schools in Barbados. All of the survey respondents completed the questionnaire on the same day, having been assembled examination-style for that purpose. The results showed high levels of correct knowledge about the principal routes of HIV transmission. However, a considerable proportion of the respondents harbored incorrect beliefs regarding mosquito transmission and dangers to blood donors, and many showed uncertainty or incorrect knowledge regarding possible HIV transmission by bitting, spitting, or use of public toilets. About a third of the children (51,4 per cent of the boys and 18,7 per cent of the girls) said they had experienced sexual intercourse, though only 20 per cent reported being sexually active in the year preceding the survey. Three-quarters of the sexually experienced group said they knew how to use condoms, but only a third said there was any time when they had used protection during sexual intercourse. Overall, the results indicate that education efforts prior to the survey had been efective, but that reinforcement of such efforts as well as their extension into the primary schools is warranted. Further research directed at helping these efforts to encourage more meaningful changes in sexual behavior is also needed

Assuntos

RESUMO

A knowledge, attitudes beliefs, and practices (KABP) survey was performed among Barbadian secondary schoolchildren 11-16 years old in January 1990. The survey sought to assess the children's knowledge of AIDS and human immunodeficiency virus (HIV) transmission; their attitudes toward people with HIV/AIDS; their sexual practices; and changes needed in education programs seeking to reduce childhood HIV transmission. A pretested self-administered questionnaire was used. The survey sample was derived by selecting every eleventh student on the rosters of all the secondary schools in Barbados. All of the survey respondents completed the questionnaire on the same day, having been assembled examination-style for that purpose. The results showed high levels of correct knowledge about the principal routes of HIV transmission. However, a considerable proportion of the respondents harbored incorrect beliefs regarding mosquito transmission and dangers to blood donors, and many showed uncertainty or incorrect knowledge regarding possible HIV transmission by bitting, spitting, or use of public toilets. About a third of the children (51,4 per cent of the boys and 18,7 per cent of the girls) said they had experienced sexual intercourse, though only 20 per cent reported being sexually active in the year preceding the survey. Three-quarters of the sexually experienced group said they knew how to use condoms, but only a third said there was any time when they had used protection during sexual intercourse. Overall, the results indicate that education efforts prior to the survey had been efective, but that reinforcement of such efforts as well as their extension into the primary schools is warranted. Further research directed at helping these efforts to encourage more meaningful changes in sexual behavior is also needed

Assuntos