Tratamento de hepatite C crônica em pacientes não respondedores, com a associação interferon peguilado, ribavirina e talidomida: Relato de seis casos

A infecção pelo vírus da Hepatite C (HCV) representa um importante problema de saúde pública no mundo, estima-se que mais de 170 milhões de pessoas estejam infectadas. Relatamos o encontro de 6 pacientes não respondedores à associação de Interferon Peguilado e Ribavirina que negativaram seu PCRRNA após a associação com talidomida. Trata-se do primeiro relato desta associação no tratamento da hepatite C encontrado na literatura.Hepatitis C virus (HCV) infection is an important public health issue worldwide. It is estimated that over 170 million people are infected with the virus. The present study reports six cases in which patients did not respond to combination therapy with pegylated interferon and ribavirin. However, after the addition of thalidomide to the therapy, the patients presented negative RNA PCR. The use of thalidomide combined with pegylated interferon and ribavirin for the treatment of hepatitis C is described here for the first time in the related literature

Characterization of virologic failure after an initially successful 48-week course of antiretroviral therapy in HIV/AIDS outpatients treated in Santos, Brazil

We characterized the virologic failure after an initially successful 48-week course of antiretroviral therapy among HIV/AIDS patients in a retrospective cohort study involving patients from Santos, Brazil. Patients with plasma HIV RNA below 500 copies/mL for 48 weeks were included. Variables analyzed included gender, age, level of education, marital status, mode of HIV acquisition, viral load, and CD4 cell count upon admission. There were 4,909 patients registered with the clinic, of which 669 patients met all the inclusion criteria (41.6% female and 58.4% male). Only 27.5% of the patients maintained undetectable viral loads during up to one year of follow-up. After 48 weeks, virologic failure occurred earlier in females and in patients first treated with an antiretroviral regimen other than highly active antiretroviral therapy. Patients who were married or had a steady partner experienced virologic failure later than did those who were separated or widowed. The percentage of public health clinic patients who maintain undetectable viral loads for a period of over a year is much lower than that observed among patients enrolled in clinical trials. Females, individuals in unstable relationships, single individuals and widowed individuals should be given special attention in order to improve durability of viral suppression.Fundação LusiadasUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)UNIFESP, EPMSciEL

Septicemia caused by Paracoccidioides brasiliensis (Lutz, 1908) as the cause of death of an aids patient from Santos, São Paulo State, Brazil a nonendemic area

The first case of Paracoccidioides brasiliensis in Santos (Brazil) leading to septicemia and death of an HIV-positive patient is reported here. The patient was a 34-year-old female that presented essential fever and was only diagnosed after death by positive blood culture. The authors underscore the atypical nature of the case, since the patient was a female at fertile age who was born and had always lived in Santos, which is a nonendemic area for this infection.Relata-se o primeiro caso de Paracoccidioides brasiliensis, causando septicemia e morte em um paciente HIV positivo de 34 anos, do sexo feminino, natural e procedente de Santos, S.P.. A paciente apresentava-se com quadro febril inespecífico sendo que o diagnóstico só foi realizado pós morte da paciente através da positividade da hemocultura. Os autores chamam a atenção para a atipia do caso no que se refere ao fato de ser uma mulher em idade fértil e que nasceu e sempre residiu em Santos, área não endêmica para esta infecção

HIV-1 subtypes among intravenous drug users from two neighboring cities in São Paulo State, Brazil

In order to assess the molecular epidemiology of HIV-1 in two neighboring cities located near the epicenter of the HIV-1 epidemics in Brazil (Santos and São Paulo), we investigated 83 HIV-1 strains obtained from samples collected in 1995 from intravenous drug users. The V3 through V5 region of the envelope of gp 120 was analyzed by heteroduplex mobility analysis. Of the 95 samples, 12 (12.6%) were PCR negative (6 samples from each group); low DNA concentration was the reason for non-amplification in half of these cases. Of the 42 typed cases from São Paulo, 34 (81%, 95% confidence limits 74.9 to 87.0%) were B and 8 (19%, 95% confidence limits 12.9 to 25.0%) were F, whereas of the 41 typed cases from Santos, 39 (95%, 95% confidence limits 91.6 to 98.4%) were B and 2 (5%, 95% confidence limits 1.6 to 8.4%) were C. We therefore confirm the relationship between clade F and intravenous drug use in São Paulo, and the presence of clade C in Santos. The fact that different genetic subtypes of HIV-1 are co-circulating indicates a need for continuous surveillance for these subtypes as well as for recombinant viruses in Brazil.Instituto Adolfo LutzUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Laboratório de RetrovirologiaFundação Pró-Sangue/Hemocentro de São PauloCentro de Referência de AIDS (CRAIDS)UNIFESP, EPM, Laboratório de RetrovirologiaSciEL

Análise ambiental do perfil de estruturas parasitárias encontradas no solo arenoso das praias do município de Santos, SP, Brasil

The environmental contamination by geohelminths represents a world public health problem and has been well documented by several authors. However, few papers describe the presence of such contamination in saline soils of coastal beaches. A study was performed on the beaches of the municipality of Santos in the period between May 2004 to April 2005 with the aim of determining the degree of contamination, and the correlation between contamination level and seasonal conditions and characteristics of the environment. Of the 2,520 samples analyzed, 18.2% (458) were contaminated, 32.3% (148) of which were localized in children's recreational areas (playgrounds). The parasite profile found in the analyzed samples indicated the presence of several zoonotic parasites: Ancylostoma larvae (82.5%), Toxocara sp. eggs (59.4%), Ancylostomidae-like eggs (37.1%), coccid oocysts (13.5%), Trichostrongylus sp. eggs and larvae, Ascaris lumbricoides eggs, (11.6%), Entamoeba sp. cysts (10.0%), Strongyloides sp. (4.8%), several free nematoids and some non-identified parasitic structures (3.3%). It was established that the highest frequency of parasitic structures occurred in the months between May and October 2004, and from February to March 2005. An increase in the diversity of parasitic forms was documented in the months between February to December 2004 and from January to April 2005, these periods having the highest rainfall.A contaminação ambiental por geohelmintos representa um problema mundial de saúde pública e tem sido bem documentada por diversos autores. No entanto, poucos trabalhos descrevem a presença de contaminação em solos salinos de praias litorâneas. Este estudo foi realizado nas praias do município de Santos no período entre maio de 2004 a abril de 2005 com o objetivo de determinar o grau de contaminação, e possíveis correlações entre sazonalidade e características ambientais. Das 2.520 amostras analisadas, 18,2% (458) estavam contaminadas, 32,3% (148) das quais foram localizadas em areas de lazer das crianças(playgrounds). O perfil parasitário encontrado nas amostras analisadas indicaram a presença de vários parasitos com potencial zoonótico: larvas de Ancylostoma (82,5%), ovos de Toxocara sp (59,4%), ovos semelhantes aos de Ancilostomídeos (37,1%), oocistos de coccídeos (13,5%), ovos de Trichostrongylus sp., ovos de Ascaris lumbricoides, (11,6%), cistos de Entamoeba sp. (10,0%), Strongyloides sp. (4,8%), vários nematóides de vida livre e algumas estruturas parasitárias não identificadas que podem corresponder a um parasita (3,3%). Foi estabelecido que a maior frequência de estruturas parasitárias ocorreu nos meses entre maio e outubro de 2004, e de fevereiro a março de 2005. Um aumento na diversidade de formas parasitárias foi documentado nos meses entre fevereiro a dezembro de 2004 e de janeiro a abril de 2005, esses períodos com a maior pluviosidade

HIV Type 1 Diversity from Newly Diagnosed Patients in Santos Metropolitan Area=Brazil

Abstract HIV-1 from infected subjects has been characterized in order to provide a more accurate view of the strains that are currently found in a given region. In this report, we focused on characterizing the pol gene diversity obtained from newly diagnosed patients in Santos metropolitan area, Brazil. This region is composed of nine cities and an international port. Analysis of the 33 samples revealed that 22 strains belonged to subtype B, 4 to subtype F, and 2 to subtype C; 5 strains were B=F recombinants. Our results demonstrated that 18.2% of samples were primary antiretroviral resistance genotypic mutations, with high-level resistance to reverse transcriptase inhibitors in both subtypes B and F and in recombinant forms B=F. Our data revealed that the primary antiretroviral resistance genotypic mutations should be carefully investigated in developing countries with widespread access to antiretrovirals, such as Brazil

Treatment of chronic hepatitis C in non-responsive patients with pegylated interferon associated with ribavirin and thalidomide: report of six cases of total remission Tratamento de hepatite C crônica em pacientes não respondedores, com a associação interferon peguilado, ribavirina e talidomida: Relato de seis casos

Hepatitis C virus (HCV) infection is an important public health issue worldwide. It is estimated that over 170 million people are infected with the virus. The present study reports six cases in which patients did not respond to combination therapy with pegylated interferon and ribavirin. However, after the addition of thalidomide to the therapy, the patients presented negative RNA PCR. The use of thalidomide combined with pegylated interferon and ribavirin for the treatment of hepatitis C is described here for the first time in the related literature.<br>A infecção pelo vírus da Hepatite C (HCV) representa um importante problema de saúde pública no mundo, estima-se que mais de 170 milhões de pessoas estejam infectadas. Relatamos o encontro de 6 pacientes não respondedores à associação de Interferon Peguilado e Ribavirina que negativaram seu PCRRNA após a associação com talidomida. Trata-se do primeiro relato desta associação no tratamento da hepatite C encontrado na literatura

Prevalence and incidence of HIV-1 infection from 1995 to 2000 and resistence primary genotypic of antiretroviral in center of anon testagem for HIV-1 on district of Santos, SP

Objetivo: Determinar a prevalencia de Resistencia genotipica primaria aos antiretrovirais em individuos recem-infectados pelo HIV-1, no municipio de Santos, no ano de 1999 e a incidencia e prevalencia, da infeccao pelo HIV-1, atraves da realizacao da metodologia Sensitive / less sensitive, Detuned no periodo de 1995 a 2000. Metodos: Utilizou-se teste imunoenzimatico modificado para se determinar individuos infectados nos ultimos 3 meses e posteriormente estes individuos com infeccao recente e um grupo controle, posteriormente ambos os grupos tiveram seu genoma sequenciado para se determinar mutacoes relacionadas a resistencia aos medicamentos antiretrovirais utilizados pelos pacientes HIV / Sida, caracterizando resistencia adquirida. Resultados: No periodo entre 1995 e 2000, no que se refere aos individuos recentemente infectados detectados pelo metodo de detuned mostram uma incidencia crescente, de 0,93 em 1995 para 2,8 no ano de 2000, estatisticamente significativo, mostrando uma correlacao forte entre ano de diagnostico e o aumento do numero de casos de individuos recentemente infectados com relacao a prevalencia de mutacoes de resistencia aos medicamentos antiretrovirais, tinham resistencia aos inibidores da transcriptase reversa 20 por cento dos casos e 16 por cento aos inibidores de transcriptase reversa nao nucleosideo; quando comparados a um grupo controle foi significativa a diferenca entre eles, nao foram observadas mutacoes significativas relacionadas aos inibidores de protease. Conclusoes: Estes dados mostram que a incidencia da infeccao pelo HIV-1 vem crescendo em nosso municipio bem como e alta a ocorrencia de transmissao de cepas resistentes aos medicamentos antiretrovirais disponiveis.BV UNIFESP: Teses e dissertaçõe