A epidemia da Aids: impacto social, científico, econômico e perspectivas

The emergence of the Aids epidemic and the increase in the incidence of HIV infection are still a health challenge for the 21st century. The way the epidemic is being confronted and how it will be in the years to come will be of fundamental importance on the discussion of public health, ethics and human rights. The diverse aspects of the epidemic are here discussed, including the possible interventions necessary to its control. Changes in the decision-making process for the allocation of resources, both for public health care and research, as well the expansion of the ethical debate and the need to improve the standard of living of all individuals, are imperative conditions in order to face this very serious public health problem.O surgimento da Aids e o aumento da incidência da infecção pelo HIV continuam como um dos grandes desafios mundiais para o século XXI. A maneira como esse enfrentamento vem se dando e como será nos próximos anos será de importância fundamental para a discussão geral sobre saúde pública, ética e direitos humanos. Os diversos aspectos relacionados à epidemia da Aids são aqui discutidos, incluindo as possíveis intervenções para seu controle. Mudanças nas decisões sobre a alocação de recursos, tanto para a saúde pública quanto para as pesquisas, bem como a expansão da discussão ética, dos direitos humanos e a necessidade de melhorar o padrão de vida da população são condições indispensáveis para enfrentar esse grave problema de saúde pública

Assessment of work-related accidents associated with waste handling in Belo Horizonte (Brazil).

As more urban solid waste is generated, managing it becomes ever more challenging and the potential impacts on the environment and human health also become greater. Handling waste - including collection, treatment and final disposal - entails risks of work accidents. This article assesses the perception of waste management workers regarding work-related accidents in domestic and health service contexts in Belo Horizonte, Brazil. These perceptions are compared with national data from the Ministry of Social Security on accidents involving workers in solid waste management. A high proportion of accidents involves cuts and puncture injuries; 53.9% among workers exposed to domestic waste and 75% among those exposed to health service waste. Muscular lesions and fractures accounted for 25.7% and 12.5% of accidents, respectively. Data from the Ministry of Social Security diverge from the local survey results, presumably owing to under-reporting, which is frequent in this sector. Greater commitment is needed from managers and supervisory entities to ensure that effective measures are taken to protect workers' health and quality of life. Moreover, workers should defend their right to demand an accurate registry of accidents to complement monitoring performed by health professionals trained in risk identification. This would contribute to the improved recovery of injured workers and would require managers in waste management to prepare effective preventive action

The circumovat precipitin test as a control of cure in children with chronic schistosomiasis mansoni

Seventy nine children in the 6-14 age group, with chronic schistosomiasis man- soni were selected for this stud,y. Sixty seven (850/o) with positive circumoval pre- cipitin test (COPT) were divided in two groups: 86 children (Group l) were treat_ ed with oxamniquine (20 mg/kg in a singre orar dose) and 31 children (Group 2) were given placebo under the same conditions. Follow-up was mantained for 1.0 months with monthly quantitative stool examinations and the absence of fecal eggs from the first month onwards was considered as a successful treatment. COPT was repeated on the tenth month. In Group L, 6gVo were cured. Group P showed no cures. rn the 28 Group I patients considered cured, copr was negative in20 (87%). Negative reactions were also found in BZo/o of the Group p children, after 10 months. These false negative reactions occurred in patients with a smaller stool egg count. The Authors conclude that copr shows a high positivity ratio in the diagnosis of chronic schistosomiasis mansoni, with negative reactions post cure in the majority of cases. However, a significant number of false negative results does rlot allow the isolated use of COPT in the control of cure of schistosomiasis mansoni

Seroprevalence of hepatitis B and C among domestic and healthcare waste handlers in Belo Horizonte, Brazil.

Infection with the hepatitis B and C viruses may occur through contact with infected body fluids, including injury with infected sharps. Collectors of domestic or healthcare wastes are potentially exposed to these infections. The aim of this article is to investigate the risk factors associated with the prevalence of hepatitis B and C viruses (HBV and HCV) infection among domestic and healthcare waste workers in Belo Horizonte, Brazil. A cross-sectional study of hepatitis B and C infection was conducted from November 2014 to January 2015, through blood sample collection and interviews about socio-demographic factors with 61 workers exposed to healthcare waste ('exposed') and 461 exposed only to domestic wastes ('unexposed'). The prevalence of antibodies to HCV (Anti-HCV) antibodies was 3.3% in 'exposed' workers and 0.9% in 'unexposed', and of antibody to hepatitis B core antigen (Anti-HBc) was 9.8% and 5.6% in 'exposed' and 'unexposed' workers, respectively. Only 207 (44.9%) of those exposed to domestic waste and 45 (73.8%) of those handling healthcare waste were effectively immunised against hepatitis B virus (HBV). Exposures to domestic waste and to healthcare wastes were associated with similar risks of infection with HBV. The risk of hepatitis C virus (HCV) infection was marginally higher among healthcare waste workers compared with domestic waste workers, probably because of needlestick accidents owing to deficient sharps management systems. Immunisation against hepatitis B and screening tests to ensure the success of vaccination should be a condition for recruitment for both groups of waste workers

Diferenças nas situações de risco para HIV de homens bissexuais em suas relações com homens e mulheres

OBJECTIVE: To describe bisexual men's behavior in terms of sexual identity, condom use, frequency of sexual intercourse and types of partners and to determine rates of inconsistent condom according to partner's gender. METHODS: Cross-sectional study nested in a cohort of HIV-negative homosexual and bisexual men in the city of Belo Horizonte, Southeastern Brazil, followed up since 1994 (Horizonte Project). Of 1,025 subjects enrolled between 1994 and 2005, 195 volunteers who reported at admission having sexual relations with men and women during the previous six months were selected. A behavioral risk index, called Horizonte Risk Index, was estimated. It incorporates a constant assigned to each type of unprotected sexual act, adjusted for the number of sexual encounters. RESULTS: Sexual activity with men predominated; most considered themselves as bisexual (55%) and homosexual (26%). During the six months prior to the study, median number of casual male partners (4) was higher than both casual female partners (2) and steady male or female partners (1). During vaginal sex with a steady partner, the rate of inconsistent condom use was 55%, compared to 35% and 55% in anal insertive and anal receptive sex, respectively, with steady male partners. The index was higher for those having sex with men and women compared to those having sex either exclusively with women or men (p=0.004). CONCLUSIONS: HIV risk behavior was more frequent among men who reported sexual activity both with men and women. Bisexual men display different sexual and protective behavior according to gender and steadiness of relationships, and female steady partners had more unprotected encounters.OBJETIVO: Descrever o comportamento bissexual masculino quanto à identidade sexual, uso de preservativo, freqüência de relações sexuais e tipos de parceria e verificar diferenças entre práticas protegidas nas suas relações com homens e mulheres. MÉTODOS: Estudo transversal aninhado em coorte de homossexuais e bissexuais HIV negativos implantada em 1994 em Belo Horizonte (Projeto Horizonte). Dos 1.025 voluntários recrutados entre 1994 e 2005, foram selecionados 195 que relataram, na admissão, ter tido relações sexuais com homens e mulheres nos seis meses anteriores à entrevista. Foi criado índice de risco comportamental, designado Índice de Risco Horizonte, que incorpora uma constante para cada prática sexual não protegida, ajustada segundo o número de encontros sexuais. RESULTADOS: Houve predomínio de atividade sexual com homens; a maioria se auto-referiu como bissexual (55%) e homossexual (26%). A mediana do número de parceiros homens ocasionais nos últimos seis meses (4) foi superior ao de parceiras ocasionais (2) e de parceiros fixos de ambos os sexos (1). No sexo vaginal com parceira fixa, o uso inconsistente do preservativo foi de 55%, comparado com 35% e 55% no sexo anal insertivo e receptivo com parceiros fixos. O índice foi maior para os que relataram terem tido sexo com homens e mulheres comparado com os que tiveram sexo exclusivamente com mulheres ou homens. CONCLUSÕES: As situações de risco para HIV foram mais freqüentes entre os homens que relataram atividade sexual com homens e mulheres. Os comportamentos sexuais e de proteção dos bissexuais diferem conforme gênero e estabilidade da parceria, havendo maior desproteção com parceiras fixas mulheres

Factors influencing cerebrospinal fluid and plasma HIV-1 RNA detection rate in patients with and without opportunistic neurological disease during the HAART era

<p>Abstract</p> <p>Background</p> <p>In the central nervous system, HIV replication can occur relatively independent of systemic infection, and intrathecal replication of HIV-1 has been observed in patients with HIV-related and opportunistic neurological diseases. The clinical usefulness of HIV-1 RNA detection in the cerebrospinal fluid (CSF) of patients with opportunistic neurological diseases, or the effect of opportunistic diseases on CSF HIV levels in patients under HAART has not been well defined. We quantified CSF and plasma viral load in HIV-infected patients with and without different active opportunistic neurological diseases, determined the characteristics that led to a higher detection rate of HIV RNA in CSF, and compared these two compartments.</p> <p>Methods</p> <p>A prospective study was conducted on 90 HIV-infected patients submitted to lumbar puncture as part of a work-up for suspected neurological disease. Seventy-one patients had active neurological diseases while the remaining 19 did not.</p> <p>Results</p> <p>HIV-1 RNA was quantified in 90 CSF and 70 plasma samples. The HIV-1 RNA detection rate in CSF was higher in patients with neurological diseases, in those with a CD4 count lower than 200 cells/mm³, and in those not receiving antiretroviral therapy, as well as in patients with detectable plasma HIV-1 RNA. Median viral load was lower in CSF than in plasma in the total population, in patients without neurological diseases, and in patients with toxoplasmic encephalitis, while no significant difference between the two compartments was observed for patients with cryptococcal meningitis and HIV-associated dementia. CSF viral load was lower in patients with cryptococcal meningitis and neurotoxoplasmosis under HAART than in those not receiving HAART.</p> <p>Conclusion</p> <p>Detection of HIV-1 RNA in CSF was more frequent in patients with neurological disease, a CD4 count lower than 200 cells/mm³and detectable plasma HIV-1. Median HIV-1 RNA levels were generally lower in CSF than in plasma but some patients showed higher CSF levels, and no difference between these two compartments was observed in patients with cryptococcal meningitis and HIV-associated dementia, suggesting the presence of intrathecal viral replication in these patients. HAART played a role in the control of CSF HIV levels even in patients with cryptococcal meningitis and neurotoxoplasmosis in whom viral replication is potentially higher.</p