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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.

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PURPOSE: To determine the incidence of non-alcoholic fatty liver disease (NAFLD) by non-invasive methods in people living with HIV (PLWH). METHODS: Prospective cohort, in PLWH naïve to antiretroviral therapy, starting bictegravir (BIC) or dolutegravir (DTG) at the Hospital de Infectología "La Raza", in Mexico City, from February 2021 to August 2023. We measured at baseline and 48 weeks triglycerides and glucose index (TyG), fatty liver index (FLI), hepatic steatosis index (HSI) and liver ultrasonography; relative risk (RR) for developing NAFLD was determined. RESULTS: At 48 weeks, TyG index in BIC-group 4.54 (IQR 4.36-4.75), in DTG-group 4.66 (IQR 4.49-4.80), p = .080; HSI in BIC-group 30.30 (IQR 28.12-33.70), in DTG-group 30.85 (IQR 28.02-34.50), p = .650; FLI in BIC-group 14.88 (IQR 7.91-31.80), in DTG-group 19.49 (IQR 8.49-32.28), p = .729; NAFLD was detected by US in 6 [10.3% (95%CI 4.8%-20.7%)] in BIC-group and, 7 [10.9% (95%CI 6.4%-20.9%)] in DTG-group, p = .916. Risk factors for NAFLD development were baseline BMI ≥25 kg/m2, baseline HDL-c <40 mg/dL, and FIB-4 >1.3 at 48 weeks. CONCLUSION: There is a high incidence of NAFLD in PLWH who start a second generation INSTI at 48 weeks; baseline overweight, low HDL-cholesterol and FIB-4 >1.3 at 48 weeks of treatment were independent risk factors for NAFLD development.

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RESUMEN Objetivo: determinar si el inicio de tratamiento antirretroviral (TARV) preconcepción es factor de riesgo para resultados adversos neonatales comparado con el inicio de TARV durante la gestación en el tratamiento de VIH en mujeres mayores de 18 años en Hospital Belén de Trujillo (HBT). Materiales y métodos: estudio analítico, observacional de cohorte retrospectiva. El tamaño muestral estuvo conformado por 168 gestantes con diagnóstico de VIH en tratamiento antirretroviral, divididos en dos grupos: 84 gestantes que inician TARV preconcepción y 84 gestantes que inician TARV después de la gestación. El análisis se realizó con la prueba chi cuadrado y el cálculo del riesgo relativo (RR) con intervalos de confianza al 95% y significancia del 5%. Resultados: la frecuencia de resultados adversos neonatales fue 48,8% en mujeres que iniciaron TARV antes de la concepción y 21,4% en las que iniciaron terapia posconcepción, siendo esta diferencia significativa (p<0,001). Resultados neonatales adversos como el peso bajo al nacer (p=0,015) y recién nacido pequeño para la edad gestacional (p=0,035) se asociaron de manera significativa al inicio de TARV antes de la gestación. Conclusiones: el inicio de TARV antes de la gestación pareciera estar asociado con resultados adversos neonatales comparado con el inicio de TARV durante la gestación, aunque requiere ser ajustado por posibles confusores.

ABSTRACT Objective: To determine whether pre-conception initiation of antiretroviral (ARV) therapy compared to pregnancy ARV initiation is a risk factor for adverse neonatal outcomes in women more than 18 years old in Belen Hospital in Trujillo (BHT). Material and Methods: This is an analytical observational study performed in a retrospective cohort. Sample size was 168 pregnant women diagnosed with HIV infection and receiving antiretroviral (ARV) therapy, who were divided in two groups: 84 women who started ARV prior to conception and 84 who started ARV after conception. The analysis was performed using the Chi-square test and relative risk (RR) was calculated, with 95% confidence intervals (CI) and 5% significance. Results: The rate of adverse neonatal outcomes was 48.8% in women starting ARV after conception and 21.4% in those who started ARV after conception, and this difference was significant (p<0.001). Adverse neonatal outcomes, such as low birthweight (p= 0.015) and being small for gestational age (p= 0.035) were significantly associated with ARV initiation before pregnancy. Conclusion: ARV initiation before pregnancy seems to be associated with adverse neonatal outcomes when compared with ARV initiation during pregnancy, although this may be adjusted for potential confounding factors.

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BACKGROUND: Retroviruses are described as a risk factor for chronic neuropathy. However, it is still unknown if they can work as amyotrophic lateral sclerosis triggers. Over the years, some cases of this association have been described with heterogenous disclosures. CASE REPRESENTATION: This study aimed to report a case of HIV and ALS-like neuropathy and briefly discuss peculiarities of clinical aspects, such as physiopathology and treatment options. The patient underwent neurological examination associated with blood tests, electromyography, analysis of cerebrospinal fluid, and imaging studies. DISCUSSION: A non-systematic review was performed in major databases regarding the topic. The case presented mixed upper and lower motor neuron signs and was framed as a probable case of ALS following the present criteria. CONCLUSION: After a short follow-up and viral load cleansing, neurological stabilization was achieved.

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INTRODUCTION: The effectiveness of human immunodeficiency virus (HIV) post-exposure prophylaxis (PEP) depends on adherence to the protocol, which includes taking antiretrovirals (ARVs) and attending visits. We examined the adherence rate to antiretroviral agents and follow-up visits identifying the associated characteristics of adherence and the reasons for not attending HIV PEP consultations in a specialized service in São Paulo, Brazil. METHODOLOGY: This was a cross-sectional study with health service users who had an indication for PEP due to sexual exposure in an HIV/AIDS service from April to October 2019. The health service users were followed-up throughout the prophylaxis cycle. Adherence was determined through self-reports on antiretroviral agent use and attendance to follow-up consultations. RESULTS: Association measures were employed to identify adherence-related characteristics. The sample analyzed included 91 users. The mean age was 32.5 years old (SD = 9.8). The largest share was white-skinned (49.5%), men who have sex with other men (62.2%), male (86.8%), and undergraduate/graduate students (65.9%). Adherence totaled 56.7% and health insurance was the associated characteristic (p = 0.039). Work (55.9%), using a private service (15.2%), forgetfulness (11.8%) and considering follow-up unnecessary (11.8%) were the main reasons for not attending the follow-up appointments. CONCLUSIONS: Few users do attend HIV PEP consultations. The users without health insurance had the highest adherence percentage whereas work was mentioned as a reason for not attending HIV PEP consultations.

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Se presenta el caso clínico de un paciente asistido en el servicio de Dermatología por tener lesión tumoral gigante en calcáneo derecho de instauración progresiva. La biopsia incisional muestra sarcoma de Kaposi endémico sin afectación visceral. El estadio tan avanzado de la enfermedad propició la evolución tórpida del paciente. El estudio histopatológico estableció el diagnóstico certero de la lesión tumoral; la biopsia fue el método auxiliar que estableció el vínculo necesario entre el examen macroscópico y microscópico de la piel, y la interrelación básico-clínica entre dos disciplinas: Anatomía Patológica y Dermatología.

We present a clinical case of a patient seen in the Dermatology service due to a progressive giant cell tumour in the right calcaneus. Incisional biopsy shows endemic Kaposi's sarcoma without visceral involvement. The advanced stage of the disease led to the torpid evolution of the patient. The histopathological study established the accurate diagnosis of the tumour lesion, the biopsy was the auxiliary method that established the necessary link between the macroscopic and microscopic examination of the skin and the basic and clinical relationship between two disciplines: Pathological Anatomy and Dermatology.

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Resumo Objetivo Avaliar a efetividade de uma cartilha educativa para promoção do estilo de vida saudável e adesão aos antirretrovirais em pessoas com HIV. Métodos Ensaio clínico randomizado em ambulatório de Fortaleza, Ceará, Brasil, com 70 pacientes no grupo intervenção e 74 no controle. Critérios de inclusão: pessoas com HIV maiores de 18 anos, de ambos os sexos, em terapia antirretroviral por mais de seis meses, ter telefone fixo ou celular, e 35 ou mais pontos na Escala de Letramento em Saúde. A coleta de dados ocorreu em quatro momentos, utilizando-se a Escala de Perfil do Estilo de Vida Individual e o Questionário para Avaliação da Adesão ao Tratamento Antirretroviral. O grupo controle recebeu a consulta médica de rotina, e o grupo intervenção, além da consulta de rotina, realizou a leitura da cartilha em consultório, e depois levou-a para o domicílio. Na estatística, utilizou-se análise de variância não paramétrica de medidas repetidas. Resultados A maioria dos participantes tinha estilo de vida insatisfatório na avaliação basal. A cartilha melhorou o estilo de vida dos pacientes após dois (P<0,001), quatro (P<0,001) e seis meses (P<0,001) da intervenção, quando comparados os diferentes tempos ao valor basal e ao controle. Houve melhora dos escores de adesão aos antirretrovirais no grupo intervenção quando comparado à linha de base (P<0,001) e ao controle (P<0,001). Conclusão A cartilha foi efetiva para promover estilo de vida saudável e melhorar a adesão aos antirretrovirais em pessoas com HIV, portanto, pode complementar as consultas ambulatoriais. Registro Brasileiro de Ensaios Clínicos (ReBEC): RBR-7p6vsr

Resumen Objetivo Evaluar la efectividad de una cartilla educativa para la promoción del estilo de vida saludable y adhesión a los antirretrovirales para personas con VIH. Métodos Ensayo clínico aleatorizado en consultorios externos de Fortaleza, estado de Ceará, Brasil, con 70 pacientes en el grupo experimental y 74 en el de control. Criterios de inclusión: personas con VIH mayores de 18 años, de ambos sexos, en tratamiento antirretroviral por más de seis meses, con teléfono fijo o celular y con 35 puntos o más en la Escala de Alfabetización en Salud. La recolección de datos se realizó en cuatro momentos, mediante la Escala de Perfil del Estilo de Vida y el Cuestionario para la Evaluación de la Adhesión al Tratamiento Antirretroviral. El grupo de control recibió una consulta médica de rutina, y el grupo experimental, además de la consulta de rutina, leyó la cartilla en el consultorio y después se la llevó a su casa. En la estadística, se usó el análisis de varianza no paramétrico de medidas repetidas. Resultados La mayoría de los participantes tenía un estilo de vida insatisfactorio en la evaluación de base. La cartilla mejoró el estilo de vida de los pacientes después de dos (P<0,001), cuatro (P<0,001) y seis meses (P<0,001) de la intervención, si se lo compara con los diferentes tiempos al valor de base y al control. Se observó una mejora de la puntuación de adhesión a los antirretrovirales en el grupo experimental si se lo compara con la línea de base (P<0,001) y con el control (P<0,001). Conclusión La cartilla fue efectiva para promover un estilo de vida saludable y mejorar la adhesión a los antirretrovirales en personas con VIH; por lo tanto, puede complementar las consultas de los consultorios externos.

Abstract Objective To assess the effectiveness of an educational booklet to promote healthy lifestyle and antiretroviral compliance in people with HIV. Methods This is a randomized clinical trial at an outpatient clinic in Fortaleza, Ceará, Brazil, with 70 patients in the intervention group and 74 in the control group. People with HIV over 18 years of age, of both sexes, on antiretroviral therapy for more than six months, with a landline or cell phone, and 35 or more points on the Health Literacy Scale were included. Data collection took place in four moments, using the Individual Lifestyle Profile Scale and the Assessment of Antiretroviral Therapy Compliance Questionnaire (Cuestionario para la Evaluación de la Adhesión al Tratamiento Antirretroviral). The control group received routine medical consultation, and the intervention group, in addition to routine consultation, read the booklet in the office, and then took it home. Non-parametric analysis of variance of repeated measures was used for statistics. Results Most participants had an unsatisfactory lifestyle at baseline. The booklet improved patients' lifestyle after two (P<0.001), four (P<0.001) and six months (P<0.001) of intervention, when comparing the different times to baseline and control. There was an improvement in antiretroviral compliance scores in the intervention group when compared to baseline (P<0.001) and control (P<0.001). Conclusion The booklet was effective in promoting a healthy lifestyle and improving antiretroviral compliance in people with HIV, therefore, it can complement outpatient consultations. Brazilian Clinical Trial Registry (ReBEC): RBR-7p6vsr

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ABSTRACT Objective: To describe the sociodemographic and gestational profile of HIV-positive women in Curitiba-PR, years 2018-2020. Method: Observational, cross-sectional research, with data obtained from the Information System of Diseases of Notification of Pregnant Women. Data were analyzed for consistency exploration, description and analysis. Results: The sample consisted mostly of women aged 13-30 years, white and with incomplete elementary school. Prenatal care was performed by 93.8% of pregnant women, 66.1% of whom knew their serological status before prenatal care and 45% received notification in the first gestational trimester. Access to antiretroviral medication occurred for 82.4% of pregnant women and for 74.6% the pregnancy outcome was alive newborns. The statistical variables associated with prenatal care were pregnancy evolution, ART prophylaxis, type of delivery and ART at delivery (p<0.00). Conclusion: The pregnant women in the sample presented desired gestational indicators. The collected data allowed describing the sample's profile and evaluating the performance of the health policy for pregnant women.

RESUMEN Objetivo: Describir el perfil sociodemográfico y gestacional de mujeres VIH positivas en Curitiba-PR, años 2018-2020. Método: Investigación observacional, de corte transversal, condatos obtenidos del Sistema de Información de Enfermedades de Notificación de la mujer embarazada. Los datos fueron analizados para exploración, descripción y análisis de consistencia. Resultados: La muestra estuvo compuesta en su mayoría por mujeres de 13 a 30 años, blancas y con instrucción básica incompleta. El control prenatal fue realizado por el 93,8% de las gestantes, siendo que el 66,1% conocía su estado serológico antes Del control prenatal y el 45% recibió notificación en el 1er trimestre. El acceso a la medicación antirretroviral ocurrió para el 82,4% de las mujeres embarazadas y para el 74,6% el resultado del embarazo fue nacido vivo. Las variables asociadas estadísticamente al control prenatal fueron evolución del embarazo, profilaxis antirretroviral, tipo de parto y antirretroviral al parto (p<0,001). Conclusión: Las gestantes de la muestra presentaron indicadores gestacionales deseados. Los datos recolectados permitieron describir el perfil de la muestra y evaluar El desempeño de la política de salud de las mujeres embarazadas.

RESUMO Objetivo: Descrever o perfil sociodemográfico e gestacional de mulheres HIV positivo de Curitiba-PR, anos 2018-2020. Método: Pesquisa observacional, transversal, com dados do Sistema de Informação de Agravos de notificação das gestantes. Os dados foram analisados para exploração de consistência, descrição e análise. Resultados: Amostra perfilou-se majoritariamente por mulheres brancas na faixa etária de 13-30 anos. Pré-natal foi realizado por 93,8% das gestantes, sendo que 66,1% sabiam sua condição sorológica antes do pré-natal e 45% receberam a notificação no 1º trimestre. O acesso à medicação antirretroviral ocorreu para 82,4% das gestantes e para 74,6% o desfecho da gestação foi bebê nascido vivo. As variáveis estatisticamente associadas ao pré-natal foram evolução da gravidez, profilaxia com antirretroviral, tipo de parto e antirretroviral no parto (p<0,001). Conclusão: As gestantes da amostra apresentaram indicadores gestacionais desejados. Os dados coletados permitiram descrever o perfil da amostra e avaliar o desempenho da política de saúde para gestantes.

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SUMMARY OBJECTIVE: The objective of this study was to evaluate cytogenetic changes in individuals submitted to oral human immunodeficiency virus pre-exposure prophylaxis use through the micronucleus test in oral mucosa. METHODS: This study consisted of 37 individuals, of whom 17 comprised the pre-exposure prophylaxis group and 20 comprised the control group. A total of 2,000 cells per slide were analyzed for the determination of micronuclei, binucleation, nuclear buds, and cytotoxicity parameters: pyknosis, karyolysis, and karyorrhexis (KR), in a double-blind manner. The repair index was also evaluated in this setting. RESULTS: In the mutagenicity parameters, the pre-exposure prophylaxis group showed increased frequencies of micronuclei (p=0.0001), binucleation (p=0.001), and nuclear buds (p=0.07). Regarding the cytotoxicity parameters, there was an increase with a statistical difference (p≤0.05) in the karyorrhexis frequency (p=0.001). Additionally, the repair system efficiency decreased in the pre-exposure prophylaxis group. CONCLUSION: These results indicate that individuals undergoing pre-exposure prophylaxis use have geno- and cytotoxicity in oral mucosal cells.

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RESUMO Objetivo compreender as perspectivas e desafios no cotidiano de pessoas após a descoberta do viver com VIH em Bissau, Guiné-Bissau, tendo em vista diferentes contextos de vulnerabilidade. Método estudo exploratório-descritivo, que utilizou entrevista semiestruturada com 16 pessoas vivendo com VIH, acompanhadas em um hospital de Bissau. Empregou-se técnica de análise de conteúdo temática. Os relatos dos participantes foram analisados a partir de duas categorias empíricas: A descoberta, os impactos e os desafios de viver com VIH; e Experiência com o antirretroviral: recomeço e perspectivas. Resultados sinalizaram que os desafios iniciam com a revelação do diagnóstico que, geralmente, desperta uma diversidade de sentimentos e comportamentos. O estigma e a discriminação estimulam a adoção do sigilo sobre o status sorológico, resultando na fragilidade de suporte emocional no enfrentamento à soropositividade. A terapia antirretroviral foi vislumbrada como esperança para o enfrentamento da doença. A vulnerabilidade social foi a dimensão que mais se destacou, e violações dos direitos humanos foram constatadas. Conclusão e implicações para a prática o estudo permite compreender as perspectivas, desafios e vulnerabilidades de pessoas que vivem com VIH. O viver com VIH merece atenção especial por parte dos profissionais de saúde que atuam no cuidado dessas pessoas, destacando-se como contribuição a relevância de um cuidado de saúde integral, em que a ética e a subjetividade estejam presentes.

RESUMEN Objetivo este estudio cualitativo tuvo como objetivo comprender perspectivas y desafíos en la vida cotidiana de las personas que viven con VIH en Bissau, Guinea-Bissau, considerando diferentes contextos de vulnerabilidad. Método estudio exploratorio-descriptivo, que utilizó una entrevista semiestructurada con 16 personas que viven con el VIH, seguido en un hospital de Bissau. Se utilizó la técnica de análisis de contenido temático. Los informes de los participantes se analizaron a partir de dos categorías empíricas: El descubrimiento, los impactos y los desafíos de vivir con el VIH; y La experiencia antirretroviral: un nuevo comienzo y perspectivas. Resultados los resultados indicaron que los desafíos comienzan con la divulgación del diagnóstico, que generalmente suscita una diversidad de sentimientos y conductas. El estigma y la discriminación fomentan la adopción del secreto sobre el estado serológico, lo que resulta en un apoyo emocional débil para hacer frente a la seropositividad. La terapia antirretroviral es una esperanza para hacer frente a la enfermedad. La vulnerabilidad social fue la dimensión que más se destacó y se encontraron violaciones a sus derechos humanos. Conclusión e implicaciones para la práctica el estudio permite comprender las perspectivas, los desafíos y las vulnerabilidades de las personas que viven con el VIH. Vivir con VIH merece especial atención por parte de los profesionales de la salud que actúan en el cuidado de estas personas, destacando como aporte la relevancia de la atención integral en salud, en la que la ética y la subjetividad están presentes.

ABSTRACT Objective to understand perspectives and challenges in the daily lives of people after the discovery of living with HIV in Bissau, Guinea-Bissau, considering different contexts of vulnerability. Method an exploratory-descriptive study conducted through semi-structured interviews with sixteen people living with HIV attending a hospital in the city of Bissau. We used the thematic content analysis technique. Participants' reports were analyzed following two empirical categories: Discovery, impacts and challenges of living with HIV; and Experience with antiretroviral therapy: new beginning and perspectives. Results the results indicate that the challenges start with the disclosure of diagnosis, which arouses a diversity of feelings and behaviors. Stigma and discrimination encourage the adoption of confidentiality about serological status, which increases the fragility of emotional support in coping with seropositivity. Antiretroviral therapy was seen as a hope for coping with the disease. Social vulnerability was the dimension that stood out the most, and human rights violations involving people living with HIV were verified. Conclusion and implications for practice the study makes it possible to understand the perspectives, challenges and vulnerabilities of people living with HIV. Living with HIV deserves special attention from health professionals who work in the care of these people, highlighting as a contribution the relevance of comprehensive health care, in which ethics and subjectivity are present.

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Infection by the human immunodeficiency virus (HIV) is apublic health problem worldwide, however, the incidence has remained relatively stable. In Mexico, around 10,000 new cases are reported each year. The Instituto Mexicano del Seguro Social (IMSS) has been a pioneer in the care of people living with HIV (PLWHA), gradually incorporating the different antiretroviral drugs (ARV). The first ARV used at the institutional level was zidovudine, in the 1990s, and later other agents were incorporated, such as protease inhibitors, drugs from the group of non-nucleoside analogs, and integrase inhibitors. In 2020, the migration to ARV schemes coformulated in a single tablet based on integrase inhibitors, which constitute a highly effective option and timely supply of drugs has been achieved in 99% of the population. In the aspect of prevention, the IMSS has also been a pioneer by being the first institution to implement HIV pre-exposure prophylaxis in 2021 at the national level and since 2022 universal post-exposure prophylaxis is available. The IMSS continues to be at the forefront incorporating the use of different management tools and instruments for the benefit of the population living with HIV. This document summarizes the history of HIV in the IMSS from the beginning of the epidemic to the present time.

La infección por el virus de la inmunodeficiencia humana (VIH) es un problema de salud pública a nivel mundial, sin embargo, la incidencia ha permanecido relativamente estable. En México se informa de alrededor de 10,000 casos nuevos al año. El Instituto Mexicano del Seguro Social (IMSS) ha sido pionero en la atención a las personas que viven con el VIH (PVV), incorporando paulatinamente los diferentes medicamentos antirretrovirales (ARV). El primer ARV utilizado a nivel institucional fue la zidovudina, en la década de los noventa, y posteriormente fueron incorporados otros agentes como los inhibidores de la proteasa, los medicamentos del grupo de los análogos no nucleósidos y los inhibidores de la integrasa. En el año 2020 ocurrió la migración a esquemas de ARV coformulados en una sola tableta a base de inhibidores de la integrasa, que constituyen una opción de alta eficacia y se ha logrado el surtimiento oportuno de los fármacos en el 99% de la población. En el aspecto de la prevención, el IMSS también ha sido pionero al ser la primera institución en implementar la profilaxis preexposición de VIH en el año 2021 a nivel nacional y desde el año 2022 se dispone de la profilaxis postexposición universal. El IMSS continúa a la vanguardia incorporando el uso de diferentes herramientas e instrumentos de gestión para beneficio de la población que vive con el VIH. En el presente documento se sintetiza la historia del VIH en el IMSS desde los inicios de la epidemia hasta el momento actual.

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Objetivo: analisar a classificação da adesão e a organização da assistência de enfermagem em serviços especializados. Método: estudo avaliativo e transversal, com abordagem quantitativa, realizado em cinco Serviços de Assistência Especializada em HIV de Pernambuco, Brasil. Participaram 358 adultos em uso de antirretrovirais e os respectivos enfermeiros dos serviços. Os dados foram coletados por meio de dois instrumentos validados e analisados a partir dos testes estatísticos. Resultados: houve prevalência de uma regular e baixa adesão à terapia antirretrovital. (41,1% e 39,4%, respectivamente). Evidenciou-se que o nível de avaliação da assistência de enfermagem não foi determinante para o escores da adesão. Conclusão: o resultado encontrado no estudo é preocupante, visto a que adesão predominante foi regular. Desenvolver a sistematização da assistência de enfermagem nos serviços especializados deve ser estimulado com vistas à promoção da adesão medicamentosa

Objective: to analyze the classification of adherence and the organization of nursing care in specialized services. Method: evaluative and cross-sectional study, with a quantitative approach, carried out in five Specialized HIV Care Services in Pernambuco, Brazil. Participated 358 adults using antiretrovirals and the respective service nurses. Data were collected using two validated instruments and analyzed using statistical tests. Results: there was a prevalence of regular and low adherence to antiretrovital therapy. (41.1% and 39.4%, respectively). It was evident that the level of assessment of nursing care was not decisive for the adherence scores. Conclusion: the result found in the study is worrying, since the predominant adherence was regular. Developing the systematization of nursing care in specialized services should be encouraged with a view to promoting medication adherence

Objetivo: analizar la clasificación de adherencia y la organización del cuidado de enfermería en servicios especializados. Método: Estudio evaluativo y transversal, con un enfoque cuantitativo, realizado en cinco servicios especializados de atención del VIH en Pernambuco, Brasil. Participaron 358 adultos usando antirretrovirales y las respectivas enfermeras de servicio. Los datos fueron recolectados usando dos instrumentos validados y analizados usando pruebas estadísticas. Resultados: hubo una prevalencia de adherencia regular y baja al tratamiento antirretrovital. (41,1% y 39,4%, respectivamente). Era evidente que el nivel de evaluación de los cuidados de enfermería no fue decisivo para los puntajes de adherencia. Conclusión: el resultado encontrado en el estudio es preocupante, ya que la adherencia predominante fue regular. Se debe fomentar el desarrollo de la sistematización de la atención de enfermería en servicios especializados con el fin de promover la adherencia a la medicación

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Abstract Highly Active Antiretroviral therapy (HAART) depends on optimal adherence to be effective. Pharmacotherapeutic follow-up can be used as a strategy for treatment fidelity. To provide pharmaceutical care for HAART patients, to assess adherence, to identify and resolve drug related problems (DRP). This is a prospective, interventional study aimed at people on HAART. Data was collected using the pharmacotherapeutic follow-up form and CEAT-VIH. There was a predominance of women (59%), older than 33 years (75%), mostly single (43%). Regarding adherence, 64% had insufficient adherence at the start of the study, while 36% had strict/adequate adherence. After the pharmacotherapeutic follow-up, 70% presented strict/adequate adherence. Regarding HAART, the relationship between adhesion versus time of HAART and adherence versus regimen used was significant, considering that less time of therapy and regimen containing protease inhibitors are predictors for insufficient adherence. Regarding the DRP identified (f=77), missed pills (32%), untreated disease, incorrect management frequency, and undue self-medication (12%) were the most frequent. Pharmaceutical interventions (f=137) were predominantly advising related to specific pharmacological treatment (32%), non-pharmacological measures (20%), and medication suspension (9%). Pharmaceutical care was shown to be animportant strategy, within the multi professional team, to improve adherence, besides identifying and resolving DRP.

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ABSTRACT Tenofovir Disoproxil Fumarate (TDF) is one of the drugs in the initial first-line antiretroviral regimen for the treatment of hepatitis B and HIV infections. Despite its effectiveness and few adverse effects, it is related to renal and bone toxicity. We described two cases of HIV-positive middle-aged women who had been using TDF for two and four years (cases 1 and 2, respectively) and were admitted to the emergency room. Case 1 presented with metabolic ileum and diffuse bone pain while case 2 presented with bilateral coxo-femoral pain after a fall from standing height. Both cases had similar laboratory tests: hyperchloremic metabolic acidosis, hypophosphatemia, hypokalemia, hypouricemia and elevated plasma creatinine. In urinary exams, there was evidence of renal loss of electrolytes, justifying the serum alterations, in addition to glucosuria and proteinuria. The bone pain investigation identified bone fractures and reduced bone mineral density, together with increased levels of parathyroid hormone, alkaline phosphatase and vitamin D deficiency. These two cases illustrate the spectrum of adverse renal and bone effects associated with TDF use. TDF was discontinued and treatment was focused on correcting the electrolyte disturbances and acidosis, in addition to controlling the bone disease through vitamin D and calcium supplementation. The renal changes found in both cases characterized the Fanconi's syndrome, and occurred due to TDF toxicity to proximal tubule cells mitochondria. Bone toxicity occurred due to direct interference of TDF in bone homeostasis, in addition to vitamin D deficiency and phosphaturia resulting from tubulopathy. During the follow-up, both cases evolved with chronic kidney disease and in one of them, the Fanconi's syndrome did not revert. We emphasize the need to monitor markers of bone metabolism and glomerular and tubular functions in patients using TDF.

RESUMO

Trata-se de uma coorte retrospectivo, com objetivo de verificar a ocorrência e os fatores predisponentes para alterações metabólicas em pessoas que vivem com o HIV (PVHIV) durante 60 meses ao uso da terapia antirretroviral (TARV) no município de Maceió-AL. A coleta de dados foi realizada em um Serviço de Atendimento Especializado (SAE) por meio de prontuários. O seguimento da pesquisa ocorreu durante 60 meses, com início entre janeiro de 2014 e março de 2015. Foram incluídos prontuários de PVHIV, de ambos os sexos, maior de 18 anos, em acompanhamento no serviço de referência do estudo, virgem de tratamento e que tivesse iniciado o uso da TARV entre 01 de janeiro de 2014 a 30 de março de 2015; e excluídos prontuários de gestantes; indivíduos em situações de confinamento e/ou reclusos; prontuários com menos de três exames laboratoriais; prontuário de pessoas que apresentarem alguma condição clínica e/ou cognitiva que dificultasse o tratamento; pacientes que foram transferidos para outros serviços e os que foram a óbito. Uma amostra não probabilística foi formada por 123 indivíduos. Utilizou-se um instrumento semiestruturado e foi realizado um estudo piloto 30 prontuários com o objetivo de analisar a viabilidade da pesquisa e necessidade de adequações.. O projeto foi aprovado pelo comitê de ética sob protocolo nº CAAE 58758316.3.0000.5393. A prevalência de alterações metabólicas em PVHIV, por meio dos exames laboratoriais, após 60 meses de uso da TARV foi 30% (n=24) com alteração de glicose, 28,7% (n=36) com alteração da pressão arterial e 70,7% (n=65) com alteração lipídica. Houve aumento significado de disglicemia, quando comprado antes e após 60 meses de TARV (p=0,013). Também foi evidenciado aumento progressivo das células TCD4+ a cada 12 meses (p<0,001) e declínio da carga viral (p<0,001). Sofreram alteração ao longo dos meses: colesterol (p<0,001), LDL-c 24 meses (p=0,02), 36 meses (3º ano) (p=0,018) e 60 meses (p=0,005), triglicerídeos, as alterações aconteceram já nos primeiros 12 meses (p=0,028) e no último ano do seguimento de acompanhamento de 60 meses (p=0,012). Na glicose foram registradas alterações nos 24 meses (p=0,008), 48 meses (p=0,006) e 60 meses (p=0,011) após a TARV. E as modificações na pressão arterial foram encontradas na Pressão Arterial Sistólica nos 48 meses (p=0,004) e Pressão Arterial Distólica nos 24 meses (p=0,025). Houve também associação do desfecho disglicemia e a cor branca (OR:2,5; IC:1,3-4,7 p=0,003); e hipertensão arterial com o uso de bebida alcoólica (OR:1,87; IC:0,99-3,5; p=0,053). Conclui-se que as PVHIV, acompanhadas ambulatoriamente, apresentam significativa prevalência e aumento progressivo de alterações metabólicas após 60 meses de uso da TARV, bem como fatores sociodemográficos e comportamentais associados. Assim, faz-se necessário à construção e implementação de estratégias voltadas à promoção, prevenção e controle dos fatores de risco para as alterações metabólicas nas PVHIV. Considerando a complexidade das condições crônicas, a mudança dos hábitos de vida e identificação precoce de outros fatores de risco deve ser o foco das ações voltadas às PVHIV

This is a retrospective cohort, with the objective of verifying the occurrence and the predisposing factors for metabolic alterations in people living with HIV (PLHIV) for 60 months using antiretroviral therapy (ART) in the city of Maceió-AL. Data collection was performed in a Specialized Care Service (SAE) through medical records. The follow-up of the research took place for 60 months, starting between January 2014 and March 2015. Records of PLHIV, of both sexes, over 18 years of age, being followed up at the reference service of the study, new to treatment and who were had started using ART between January 1, 2014 and March 30, 2015; and excluded the medical records of pregnant women; individuals in situations of confinement and/or inmates; medical records with less than three laboratory tests; medical records of people who have some clinical and/or cognitive condition that would make treatment difficult; patients who were transferred to other services and those who died. A nonprobabilistic sample consisted of 123 individuals. A semi-structured instrument was used and a pilot study was carried out on 30 medical records with the objective of identifying and correcting weaknesses in the research. The project was approved by the ethics committee under protocol nº CAAE 58758316.3.0000.5393. The prevalence of metabolic alterations in PLHIV, through laboratory tests, after 60 months of ART use was 30% (n=24) with glucose alterations, 28.7% (n=36) with alterations in blood pressure and 70.7% (n=65) with lipid alteration. There was a significant increase in dysglycemia when purchased before and after 60 months of ART (p=0.013). There was also a progressive increase in CD4+ T cells every 12 months (p<0.001) and a decline in viral load (p<0.001). Changed over the months: cholesterol (p<0.001), LDL-c 24 months (p=0.02), 36 months (3rd year) (p=0.018) and 60 months (p=0.005), triglycerides, changes occurred in the first 12 months (p=0.028) and in the last year of the 60-month follow-up (p=0.012). Changes in glucose were recorded at 24 months (p=0.008), 48 months (p=0.006) and 60 months (p=0.011) after ART. And changes in blood pressure were found in systolic blood pressure at 48 months (p=0.004) and diastolic blood pressure 24 months (p=0.025). There was also an association between dysglycemia and white skin color (OR:2.5; CI:1.3-4.7 p=0.003); and arterial hypertension with the use of alcoholic beverages (OR:1.87; CI:0.99-3.5; p=0.053). It is concluded that PLHIV, monitored in an outpatient setting, have a significant prevalence and progressive increase in metabolic alterations after 60 months of ART use, as well as associated sociodemographic and behavioral factors. Thus, it is necessary to build and implement strategies aimed at promoting, preventing and controlling risk factors for metabolic changes in PLHIV. Considering the complexity of chronic conditions, changing lifestyle habits and early identification of other risk factors should be the focus of actions aimed at PLHIV

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RESUMO

Trata-se de uma coorte retrospectivo, com objetivo de verificar a ocorrência e os fatores predisponentes para alterações metabólicas em pessoas que vivem com o HIV (PVHIV) durante 60 meses ao uso da terapia antirretroviral (TARV) no município de Maceió-AL. A coleta de dados foi realizada em um Serviço de Atendimento Especializado (SAE) por meio de prontuários. O seguimento da pesquisa ocorreu durante 60 meses, com início entre janeiro de 2014 e março de 2015. Foram incluídos prontuários de PVHIV, de ambos os sexos, maior de 18 anos, em acompanhamento no serviço de referência do estudo, virgem de tratamento e que tivesse iniciado o uso da TARV entre 01 de janeiro de 2014 a 30 de março de 2015; e excluídos prontuários de gestantes; indivíduos em situações de confinamento e/ou reclusos; prontuários com menos de três exames laboratoriais; prontuário de pessoas que apresentarem alguma condição clínica e/ou cognitiva que dificultasse o tratamento; pacientes que foram transferidos para outros serviços e os que foram a óbito. Uma amostra não probabilística foi formada por 123 indivíduos. Utilizou-se um instrumento semiestruturado e foi realizado um estudo piloto 30 prontuários com o objetivo de analisar a viabilidade da pesquisa e necessidade de adequações.. O projeto foi aprovado pelo comitê de ética sob protocolo nº CAAE 58758316.3.0000.5393. A prevalência de alterações metabólicas em PVHIV, por meio dos exames laboratoriais, após 60 meses de uso da TARV foi 30% (n=24) com alteração de glicose, 28,7% (n=36) com alteração da pressão arterial e 70,7% (n=65) com alteração lipídica. Houve aumento significado de disglicemia, quando comprado antes e após 60 meses de TARV (p=0,013). Também foi evidenciado aumento progressivo das células TCD4+ a cada 12 meses (p<0,001) e declínio da carga viral (p<0,001). Sofreram alteração ao longo dos meses: colesterol (p<0,001), LDL-c 24 meses (p=0,02), 36 meses (3º ano) (p=0,018) e 60 meses (p=0,005), triglicerídeos, as alterações aconteceram já nos primeiros 12 meses (p=0,028) e no último ano do seguimento de acompanhamento de 60 meses (p=0,012). Na glicose foram registradas alterações nos 24 meses (p=0,008), 48 meses (p=0,006) e 60 meses (p=0,011) após a TARV. E as modificações na pressão arterial foram encontradas na Pressão Arterial Sistólica nos 48 meses (p=0,004) e Pressão Arterial Distólica nos 24 meses (p=0,025). Houve também associação do desfecho disglicemia e a cor branca (OR:2,5; IC:1,3-4,7 p=0,003); e hipertensão arterial com o uso de bebida alcoólica (OR:1,87; IC:0,99-3,5; p=0,053). Conclui-se que as PVHIV, acompanhadas ambulatoriamente, apresentam significativa prevalência e aumento progressivo de alterações metabólicas após 60 meses de uso da TARV, bem como fatores sociodemográficos e comportamentais associados. Assim, faz-se necessário à construção e implementação de estratégias voltadas à promoção, prevenção e controle dos fatores de risco para as alterações metabólicas nas PVHIV. Considerando a complexidade das condições crônicas, a mudança dos hábitos de vida e identificação precoce de outros fatores de risco deve ser o foco das ações voltadas às PVHIV.

This is a retrospective cohort, with the objective of verifying the occurrence and the predisposing factors for metabolic alterations in people living with HIV (PLHIV) for 60 months using antiretroviral therapy (ART) in the city of Maceió-AL. Data collection was performed in a Specialized Care Service (SAE) through medical records. The follow-up of the research took place for 60 months, starting between January 2014 and March 2015. Records of PLHIV, of both sexes, over 18 years of age, being followed up at the reference service of the study, new to treatment and who were had started using ART between January 1, 2014 and March 30, 2015; and excluded the medical records of pregnant women; individuals in situations of confinement and/or inmates; medical records with less than three laboratory tests; medical records of people who have some clinical and/or cognitive condition that would make treatment difficult; patients who were transferred to other services and those who died. A nonprobabilistic sample consisted of 123 individuals. A semi-structured instrument was used and a pilot study was carried out on 30 medical records with the objective of identifying and correcting weaknesses in the research. The project was approved by the ethics committee under protocol nº CAAE 58758316.3.0000.5393. The prevalence of metabolic alterations in PLHIV, through laboratory tests, after 60 months of ART use was 30% (n=24) with glucose alterations, 28.7% (n=36) with alterations in blood pressure and 70.7% (n=65) with lipid alteration. There was a significant increase in dysglycemia when purchased before and after 60 months of ART (p=0.013). There was also a progressive increase in CD4+ T cells every 12 months (p<0.001) and a decline in viral load (p<0.001). Changed over the months: cholesterol (p<0.001), LDL-c 24 months (p=0.02), 36 months (3rd year) (p=0.018) and 60 months (p=0.005), triglycerides, changes occurred in the first 12 months (p=0.028) and in the last year of the 60-month follow-up (p=0.012). Changes in glucose were recorded at 24 months (p=0.008), 48 months (p=0.006) and 60 months (p=0.011) after ART. And changes in blood pressure were found in systolic blood pressure at 48 months (p=0.004) and diastolic blood pressure 24 months (p=0.025). There was also an association between dysglycemia and white skin color (OR:2.5; CI:1.3-4.7 p=0.003); and arterial hypertension with the use of alcoholic beverages (OR:1.87; CI:0.99-3.5; p=0.053). It is concluded that PLHIV, monitored in an outpatient setting, have a significant prevalence and progressive increase in metabolic alterations after 60 months of ART use, as well as associated sociodemographic and behavioral factors. Thus, it is necessary to build and implement strategies aimed at promoting, preventing and controlling risk factors for metabolic changes in PLHIV. Considering the complexity of chronic conditions, changing lifestyle habits and early identification of other risk factors should be the focus of actions aimed at PLHIV

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ABSTRACT BACKGROUND: High prevalence of human immunodeficiency virus (HIV) infection and occurrence of drug-resistant strains have been recorded in northern Brazil. Abandonment of treatment and insufficient and inadequate adherence to antiretroviral therapy (ART) among people living with HIV/AIDS (PLWHA) have been recorded in the metropolitan area of Belém, the capital of the state of Pará. OBJECTIVES: To identify the sociodemographic profile and level of adherence to ART among women seen at a referral unit in the interior of Pará, northern Brazil. DESIGN AND SETTING: Cross-sectional study at a referral unit for care for PLWHA. METHODS: We included 86 women living with HIV/AIDS (WLWHA) in the Rio Caeté integrated region, northeastern Pará. Social, demographic and behavioral information, as well as the ART level, were obtained using forms that have been described in the scientific literature. Logistic regression models were used to assess associations of variables with ART. RESULTS: Most WLWHA were single (52.4%), young (47.7%) and heterosexual (97.7%), had low levels of education (63.0%), were unemployed (69.8%), had one sexual partner (75.7%), used condoms (46.7%) and were not using either licit drugs (68.7%) or illicit drugs (89.6%). Their adherence level was classified as insufficient , and only their viral load showed an association with ART. CONCLUSIONS: The participants' low level of education and poor socioeconomic conditions may have been interfering with their adherence to ART. Such influences can be minimized through multiprofessional interventions that take the individuality of women served by the healthcare service into consideration.

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Objetivo: analisar a representação social da terapia antirretroviral para pessoas vivendo com HIV. Método: estudo qualitativo, com a utilização da teoria das representações sociais. A coleta de dados incluiu 50 participantes, sendo realizada de fevereiro a setembro de 2020, utilizando um questionário de caracterização sociodemográfica e um formulário para evocações livres. O cenário do estudo foi uma unidade de tratamento de HIV na região metropolitana do Rio de Janeiro. A análise dos dados foi realizada pelo software EVOC. Resultados: o núcleo central da representação da terapia antirretroviral reforça o controle do HIV e a imagem do medicamento como algo bom. Conclusão: a estrutura representacional sugere que o grupo tende à normalização da terapia antirretroviral, fazendo referência a um medicamento que controla o HIV. O estudo possibilitou reconhecer os diferentes conteúdos representacionais da terapia antirretroviral para o grupo estudado, além da variada complexidade entre as imagens identificadas.

Objective: analyzing the social representation of antiretroviral therapy for people living with HIV. Method: a qualitative study using the Theory of Social Representations. Data collection included 50 participants, being performed from February to September 2020 using a sociodemographic characterization questionnaire and a form for free evocations. The study scenario was an HIV treatment unit in the metropolitan region of Rio de Janeiro. Data analysis was performed by the EVOC software. Results: the central nucleus of the representation of antiretroviral therapy reinforces HIV control and the image of the drug as something good. Conclusion: the representational structure suggests that the group tends to normalize antiretroviral therapy, referring to a drug that controls HIV. The study made it possible to recognize the different representational contents of antiretroviral therapy for the studied group, in addition to the varied complexity among the images identified.

Objetivo: analizar la representación social de la terapia antirretroviral para las personas que viven con el VIH. Método: un estudio cualitativo utilizando la Teoría de las Representaciones Sociales. La recolección de datos incluyó a 50 participantes, realizándolos de febrero a septiembre de 2020 utilizando un cuestionario de caracterización sociodemográfica y un formulario para evocaciones libres. El escenario del estudio fue una unidad de tratamiento del VIH en la región metropolitana de Río de Janeiro. El análisis de los datos fue realizado por el software EVOC. Resultados: el núcleo central de la representación de la terapia antirretroviral refuerza el control del VIH y la imagen del fármaco como algo bueno. Conclusión: la estructura representacional sugiere que el grupo tiende a normalizar la terapia antirretroviral, refiriéndose a un fármaco que controla el VIH. El estudio ha permitido reconocer los diferentes contenidos representacionales de la terapia antirretroviral para el grupo estudiado, además de la variada complejidad entre las imágenes identificadas.

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Introdução: A capacidade do vírus da imunodeficiência humana (HIV) de invadir células do sistema imunológico, principalmente células T CD4+, para se multiplicar e manter-se vivo, quando não revertido, possui, como desfecho inevitável, a síndrome da imunodeficiência adquirida (SIDA), evento no qual os pacientes começam a apresentar doenças secundárias como infecções oportunistas e câncer. Objetivo:Identificar casos de linfoma de Hodgkin em pacientes HIV+ em uso dos antirretrovirais de alta efetividade. Método: Estudo do tipo observacional transversal com delineamento exploratório e descritivo e abordagem quali-quantitativa, realizado durante o mês de outubro de 2018, a partir da análise de 57prontuários de pacientes HIV+ diagnosticados com câncer e internados em um hospital localizado em Fortaleza, CE. Resultados: Foi identificado um total de 21 cânceres não definidores de SIDA. Destes, os mais comuns foram o câncer de pele com 14,3% (3); seguido do câncer de mama com 9,5% (2); linfoma de Hodgkin com 9,5% (2); e o câncer de estômago com 9,5% (2) dos casos. Conclusão: Os dados obtidos no presente estudo colocam o linfoma de Hodgkin em segundo lugar entre os cânceres não definidores de SIDA encontrados. Contudo, ao considerar o baixo número de casos, resultante das limitações da pesquisa, essas informações não permitem concluir sobre a real quantidade de linfomas de Hodgkin entre os demais cânceres não definidores de SIDA ocorridos em pacientes HIV+ na localidade, tampouco estimar a participação do HIV, carga viral, condição imunológica e coinfecções como fatores de risco.

Introduction: The ability of the human immunodeficiency virus (HIV) of invading immune system cells, especially CD4+ to multiply and stay alive, when not reversed, has as inevitable outcome the acquired immunodeficiency syndrome (AIDS), an event in which patients start to develop secondary diseases such as opportunistic infections and cancer. Objective: To identify cases of Hodgkin's lymphoma in HIV+ patients using highly effective antiretrovirals. Method: Cross-sectional observational study with exploratory and descriptive design and qualitative and quantitative approach, carried out during the month of October 2018 based on the analysis of 57 HIV-infected patients' charts diagnosed with cancer and admitted to a hospital located in Fortaleza, CE. Results: A total of 21 non-AIDS-defining cancers were detected. Of these, skin cancer, with 14.3% (3) followed by breast cancer, with 9.5% (2), Hodgkin's lymphoma, 9.5% (2) and stomach cancer, with 9.5% (2) were the most common cases. Conclusion: The data obtained in the present study rank Hodgkin's lymphoma in second place among the non-AIDS-defining cancers encountered. However, while considering the small number of cases, due to the study limitations, these data are scanty to conclude the actual quantity of Hodgkin's lymphoma among the non-AIDS-defining cancers occurred in HIV-positive patients locally or to estimate the participation of HIV, viral load, immune condition and co-infection as risk factors.

Introducción: La capacidad del virus de inmunodeficiencia humana (VIH) para invadir las células del sistema inmunitario, especialmente las células T CD4 + para multiplicarse y mantenerse con vida, cuando no se revierte, tiene el resultado inevitable del síndrome de inmunodeficiencia adquirida (SIDA), evento en el que los pacientes comienzan a presentar enfermedades secundarias como infecciones oportunistas y cáncer. Objetivo: Identificar los casos de linfoma de Hodgkin en pacientes VIH+ utilizando los antirretrovirales de alta eficacia. Método: Este es un estudio observacional transversal con diseño exploratorio y descriptivo y enfoque cualitativo, realizado durante octubre de 2018 a partir del análisis de 57 registros médicos de pacientes VIH + diagnosticados con cáncer y hospitalizados en un hospital ubicado en Fortaleza, CE. Resultados: Se identificaron un total de 21 cánceres que no definen el SIDA. De estos, los más comunes fueron cáncer de piel con 14,3% (3), seguido de cáncer de seno con 9,5% (2), linfoma de Hodgkin 9,5% (2) y cáncer de estómago con 9,5% (2) de los casos. Conclusión: Los datos obtenidos en el presente estudio colocan al linfoma de Hodgkin en segundo lugar entre los cánceres no definitorios de SIDA encontrados. Sin embargo, considerando el bajo número de casos resultantes de las limitaciones de la investigación, esta información no nos permite concluir acerca de la cantidad real de linfoma de Hodgkin entre los otros cánceres no definitorios de SIDA en pacientes VIH + en la localidad, ni estimar la participación del VIH, la carga viral, la condición inmune y las coinfecciones como factores de riesgo.

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ABSTRACT The aim of this study was to evaluate health care quality and medication adherence in people living with human immunodeficiency virus in specialized care services. This is a cross-sectional, evaluative study, with a quantitative approach, carried out in ten services in Pernambuco. Two instruments were validated and analyzed by statistical tests were used and 306 adults and their service managers participated. The quality standard was equivalent for most indicators. Only in the countryside, the indicators referring to the availability of antiretroviral drugs and care in the absence of medication were associated with low adherence (p-value=0.033 and p-value=0.011), the latter being a predictor for low adherence. Services with insufficient quality standards showed a 19% higher occurrence of low medication adherence. 81% of users had low adherence to antiretroviral drugs. There is a deficiency in adherence to antiretroviral drugs, and those assisted in services in the countryside have more complicating factors related to the quality of health care for satisfactory adherence.

RESUMO O objetivo deste estudo foi avaliar a qualidade da assistência à saúde e a adesão à medicação em pessoas vivendo com vírus da imunodeficiência humana em serviços de assistência especializada. Trata-se de um estudo transversal, avaliativo, com abordagem quantitativa, realizado em dez serviços em Pernambuco. Utilizaram-se dois instrumentos validados e analisados por testes estatísticos, dos quais participaram 306 adultos e os respectivos gerentes dos serviços. O padrão de qualidade foi equivalente para a maioria dos indicadores. Apenas no interior, os indicadores referentes à disponibilidade de antirretrovirais e atendimento na falta do medicamento foram associados à baixa adesão (p-valor=0,033 e p-valor=0,011), sendo o último preditor para baixa adesão. Serviços com padrão de qualidade insuficiente apresentaram uma ocorrência 19% maior de baixa adesão à medicação. 81% dos usuários apresentaram baixa adesão aos antirretrovirais. Há deficiência na adesão aos antirretrovirais, e aqueles assistidos nos serviços do interior apresentam mais fatores complicadores relacionados à qualidade da assistência à saúde para uma adesão satisfatória.