Pesquisas brasileiras biomédicas e epidemiológicas face às metas da UNGASS

The focus of the present study is the Brazilian response within science, technology and innovation to the targets formulated in the UNGASS document. An analysis was made of items 70-73 of the UNGASS Draft Declaration of Commitment on HIV/AIDS (2001), which defined science, technology and innovation targets relating to HIV/AIDS. The main topics listed in these items were put into operation in the form of keywords, in order to guide systematic searches within the standard biomedicine databases, also including the subdivisions of the Web of Science relating to natural and social sciences. The success of Brazilian research within the field of characterization and isolation of HIV-1 is undeniable. Phase II/III vaccine studies have been developed in Rio de Janeiro, Belo Horizonte and São Paulo. Empirical studies on the monitoring of primary resistance have been developed in specific populations, through the Brazilian HIV Resistance Monitoring Network. Within the field of monitoring secondary resistance, initiatives such as the National Genotyping Network have been highlighted. Two national systems - the Mortality Information System and the Notifiable Diseases Information System (Aids) - and some studies with wider coverage have given rise to work on trends within the epidemic. The production of high-quality generic medications and their free distribution to patients have been highlighted. Brazil has implemented a consistent and diversified response within the field of HIV/AIDS, with studies relating to the development of vaccines, new medications and monitoring of the epidemic.O foco do estudo é a resposta brasileira em Ciência, Tecnologia e Inovação às metas formuladas no documento da UNGASS. Foram analisados os itens 70-73 que integram o documento Draft Declaration of Commitment for the UNGASS on HIV/AIDS, 2001, que definem metas para a Ciência, Tecnologia e Inovação em HIV/Aids. Os principais tópicos listados nesses itens foram operacionalizados sob a forma de "palavras-chave", de modo a orientar buscas sistemáticas nos bancos de dados padrão em biomedicina, incluindo ainda o Web of Science, nas suas subdivisões referentes às ciências naturais e sociais. O sucesso da pesquisa brasileira no âmbito da caracterização e isolamento do HIV-1 é inegável. Estudos vacinais fases II/III têm sido desenvolvidos no Rio de Janeiro, Belo Horizonte e São Paulo. O monitoramento da resistência primária teve estudos empíricos desenvolvidos em populações específicas, por meio da "Rede Brasileira em Monitoramento da Resistência do HIV". No âmbito do monitoramento da resistência secundária, destacaram-se iniciativas como a Rede Nacional de Genotipagem. Dois sistemas nacionais, o Sistema de Informações de Mortalidade e o Sistema de Informações de Agravos de Notificação - Aids e alguns estudos de maior abrangência têm dado origem a trabalhos sobre tendências da epidemia. A produção de medicamentos genéricos de qualidade e sua distribuição gratuita aos pacientes foram destacadas. O Brasil tem implementado uma resposta consistente e diversificada no âmbito do HIV/Aids, com estudos referentes ao desenvolvimento de vacinas, novos medicamentos e monitoramento da epidemia

Consumo de álcool e drogas: principais achados de pesquisa de âmbito nacional, Brasil 2005

OBJECTIVE: To assess alcohol and drug use in a representative sample of the urban Brazilian population and their correlation with sexual and reproductive health. METHODS: Data from a national population-based survey with a complex sampling, performed in 2005 was used. A total of 5,040 individuals from both genders, in the age group from 16 to 65 years old, were interviewed. Issues regarding drug and alcohol use and sexual behavior were assessed. Bivariate and multivariate analyses were used. RESULTS: Alcohol was the most frequently used substance, with reports of regular use in the lives of 18% of interviewees. Use of illegal drugs was mentioned by 9% of the interviewees especially marijuana and snorted cocaine; injected drugs use was not frequent. There was a decrease in snorted cocaine use and an increase in marijuana use (in the last 12 months), compared to results of a similar survey conducted in 1998. History of sexual abuse was a risk factor for drug use and regular alcohol use. Interviewees mentioning the role of religion in their background, being White, and female were less likely to use alcohol in a regular way, which is especially prevalent among elderly males.Leisure activities and absence of current religious practice were associated with drug use. CONCLUSIONS: The regular or irregular alcohol use is prevalent in the urban Brazilian population, whereas injected drug use is rare. Over the last decade there was a decline in cocaine use. A history of sexual abuse was central to later use of alcohol and drugs.OBJETIVO: Analisar os padrões de consumo de álcool e drogas de uma amostra representativa da população urbana brasileira na sua inter-relação com a saúde sexual e reprodutiva. MÉTODOS: Dados de inquérito de base populacional, de abrangência nacional, com plano amostral complexo, realizado em 2005. Foram entrevistados 5.040 indivíduos de ambos os sexos, na faixa etária de 16 a 65 anos. Analisaram-se questões relativas consumo de álcool e drogas e comportamento sexual. Utilizou-se análise bivariada e multivariada. RESULTADOS: O álcool foi a substância mais freqüentemente utilizada, com relato de uso regular, na vida, por 18% dos entrevistados. O consumo de drogas ilícitas foi referido por 9% dos entrevistados, especialmente, maconha e cocaína aspirada, com uso de drogas injetáveis infreqüente. Observou-se declínio do consumo de cocaína aspirada e incremento do uso de maconha (nos últimos 12 meses), comparados a resultados de pesquisa similar realizada em 1998. Histórico de abuso sexual constituiu fator de risco do consumo de drogas e uso regular de álcool. A referência por parte do entrevistado ao papel da religião na sua formação, ser branco e do sexo feminino se mostraram protetores frente ao consumo regular de álcool, particularmente prevalente entre homens mais velhos. As opções de lazer e a ausência de práticas religiosas atuais se mostraram associadas ao consumo de drogas. CONCLUSÕES: O consumo de álcool, regular ou não, é prevalente na população urbana brasileira, enquanto o uso de drogas injetáveis se mostrou raro. Ao longo da última década observou-se declínio no consumo de cocaína. Histórico de abuso sexual se mostrou central ao consumo posterior de drogas e álcool

Sinais e sintomas associados às doenças sexualmente transmissíveis no Brasil, 2005

OBJECTIVE: Sexually transmitted infections (STIs) are a major determinant of population disease burden worldwide. The objective of the study was to assess self-reported morbidity associated to STIs according to gender. METHODS: The study data were obtained from a 2005 study consisting of a multistage probabilistic sample of 5,040 respondents, aged 16-65 years, living in urban areas in Brazil. These data were compared with those from a previous 1998 study. Bivariate analyses were carried out using Pearson's chi-square test and simple linear regression followed by logistic regression. RESULTS: In both men and women, the variables: previous HIV testing, personal belief in unfaithful love, and number of sexual partners in a lifetime were significantly associated to STIs. In women only, the covariates: low family income, living in the Center-West, Southeast and South regions, and reporting of physical violence were independently associated to STIs. In men, the variables associated were: age group (35 years or more), living in the South region and in the state of São Paulo, and self-perceived HIV infection risk. CONCLUSIONS: Signs and symptoms associated to STIs have strong gender differences in the general population and education interventions should be specifically targeted to either men or women.OBJETIVO: As doenças sexualmente transmissíveis (DST) constituem um dos principais determinantes da carga de doença das populações em todo o mundo. O objetivo do estudo foi avaliar a morbidade auto-referida associada à ocorrência de DST, segundo gênero. MÉTODOS: Os dados analisados referem-se à pesquisa realizada em 2005 e foram obtidos a partir de amostra probabilística em múltiplos estágios de 5.040 entrevistados, com 16-65 anos de idade, moradores nas regiões urbanas do Brasil. Esses dados foram cotejados com aqueles de pesquisa anterior, de 1998. Realizaram-se análises bivariadas, utilizando teste qui-quadrado de Pearson e regressão linear simples, seguidas por regressão logística. RESULTADOS: Tanto para homens quanto para mulheres as variáveis: testagem anterior para o HIV, crença pessoal de que pode haver amor sem fidelidade e número de pessoas com quem teve relações sexuais na vida mostraram-se significativamente associadas ao desfecho. Porém, somente entre as mulheres as covariáveis a seguir se mostraram independentemente associadas ao desfecho: renda familiar baixa, residência na Região Centro-Oeste, Sudeste e Sul, e relato de violência física. Para os homens, as variáveis independentemente associadas foram: faixa etária (35 anos ou mais), residência na Região Sul e Estado de São Paulo, e auto-avaliação de risco de se infectar com o HIV. CONCLUSÕES: Sinais e sintomas associados às DST apresentam forte diferencial de gênero na população geral, devendo ser objeto de intervenções educativas claramente distintas

Leprosy among Patient Contacts: A Multilevel Study of Risk Factors

Leprosy is an infectious disease that can lead to physical disabilities, social stigma, and great hardship. Transmitted from person to person, it is still endemic in developing countries, like Brazil and India. Effective treatment has been available since 1960, but early diagnosis of the disease remains the most effective way to stop the transmission chain and avoid late diagnoses and subsequent disabilities. Knowledge of the risk factors for leprosy can facilitate early detection; therefore, our study aimed to investigate the factors presented by leprosy patients and their contacts, who are considered at highest risk of contracting the disease. We studied 6,158 contacts of 1,201 patients under surveillance from 1987 to 2007 in a Public Health Care Center in the City of Rio de Janeiro, Brazil. We evaluated the ways patient and contact demographics and epidemiological characteristics were associated with the detection of leprosy. Statistical analyses took into account both individual and group characteristics and their interrelationships. The main characteristics facilitating the contraction of leprosy among contacts were shown to be consanguinity and household association. Conversely, the bacillary load index of leprosy patients was the principle factor leading to disease among their contacts

Pathogen-Specific Epitopes as Epidemiological Tools for Defining the Magnitude of Mycobacterium leprae Transmission in Areas Endemic for Leprosy

During recent years, comparative genomic analysis has allowed the identification of Mycobacterium leprae-specific genes with potential application for the diagnosis of leprosy. In a previous study, 58 synthetic peptides derived from these sequences were tested for their ability to induce production of IFN-γ in PBMC from endemic controls (EC) with unknown exposure to M. leprae, household contacts of leprosy patients and patients, indicating the potential of these synthetic peptides for the diagnosis of sub- or preclinical forms of leprosy. In the present study, the patterns of IFN-γ release of the individuals exposed or non-exposed to M. leprae were compared using an Artificial Neural Network algorithm, and the most promising M. leprae peptides for the identification of exposed people were selected. This subset of M. leprae-specific peptides allowed the differentiation of groups of individuals from sites hyperendemic for leprosy versus those from areas with lower level detection rates. A progressive reduction in the IFN-γ levels in response to the peptides was seen when contacts of multibacillary (MB) patients were compared to other less exposed groups, suggesting a down modulation of IFN-γ production with an increase in bacillary load or exposure to M. leprae. The data generated indicate that an IFN-γ assay based on these peptides applied individually or as a pool can be used as a new tool for predicting the magnitude of M. leprae transmission in a given population

Circulating levels of insulin-like growth factor-I (IGF-I) correlate with disease status in leprosy

<p>Abstract</p> <p>Background</p> <p>Caused by <it>Mycobacterium leprae </it>(ML), leprosy presents a strong immune-inflammatory component, whose status dictates both the clinical form of the disease and the occurrence of reactional episodes. Evidence has shown that, during the immune-inflammatory response to infection, the growth hormone/insulin-like growth factor-I (GH/IGF-I) plays a prominent regulatory role. However, in leprosy, little, if anything, is known about the interaction between the immune and neuroendocrine systems.</p> <p>Methods</p> <p>In the present retrospective study, we measured the serum levels of IGF-I and IGBP-3, its major binding protein. These measurements were taken at diagnosis in nonreactional borderline tuberculoid (NR BT), borderline lepromatous (NR BL), and lepromatous (NR LL) leprosy patients in addition to healthy controls (HC). LL and BL patients who developed reaction during the course of the disease were also included in the study. The serum levels of IGF-I, IGFBP-3 and tumor necrosis factor-alpha (TNF-α) were evaluated at diagnosis and during development of reversal (RR) or erythema nodosum leprosum (ENL) reaction by the solid phase, enzyme-labeled, chemiluminescent-immunometric method.</p> <p>Results</p> <p>The circulating IGF-I/IGFBP-3 levels showed significant differences according to disease status and occurrence of reactional episodes. At the time of leprosy diagnosis, significantly lower levels of circulating IGF-I/IGFBP-3 were found in NR BL and NR LL patients in contrast to NR BT patients and HCs. However, after treatment, serum IGF-I levels in BL/LL patients returned to normal. Notably, the levels of circulating IGF-I at diagnosis were low in 75% of patients who did not undergo ENL during treatment (NR LL patients) in opposition to the normal levels observed in those who suffered ENL during treatment (R LL patients). Nonetheless, during ENL episodes, the levels observed in RLL sera tended to decrease, attaining similar levels to those found in NR LL patients. Interestingly, IGF-I behaved contrary to what was observed during RR episodes in R BL patients.</p> <p>Conclusions</p> <p>Our data revealed important alterations in the IGF system in relation to the status of the host immune-inflammatory response to ML while at the same time pointing to the circulating IGF-I/IGFBP-3 levels as possible predictive biomarkers for ENL in LL patients at diagnosis.</p

Dengue-2 and yellow fever 17DD viruses infect human dendritic cells, resulting in an induction of activation markers, cytokines and chemokines and secretion of different TNF-α and IFN-α profiles

Flaviviruses cause severe acute febrile and haemorrhagic infections, including dengue and yellow fever and the pathogenesis of these infections is caused by an exacerbated immune response. Dendritic cells (DCs) are targets for dengue virus (DENV) and yellow fever virus (YF) replication and are the first cell population to interact with these viruses during a natural infection, which leads to an induction of protective immunity in humans. We studied the infectivity of DENV2 (strain 16681), a YF vaccine (YF17DD) and a chimeric YF17D/DENV2 vaccine in monocyte-derived DCs in vitro with regard to cell maturation, activation and cytokine production. Higher viral antigen positive cell frequencies were observed for DENV2 when compared with both vaccine viruses. Flavivirus-infected cultures exhibited dendritic cell activation and maturation molecules. CD38 expression on DCs was enhanced for both DENV2 and YF17DD, whereas OX40L expression was decreased as compared to mock-stimulated cells, suggesting that a T helper 1 profile is favoured. Tumor necrosis factor (TNF)-α production in cell cultures was significantly higher in DENV2-infected cultures than in cultures infected with YF17DD or YF17D/DENV. In contrast, the vaccines induced higher IFN-α levels than DENV2. The differential cytokine production indicates that DENV2 results in TNF induction, which discriminates it from vaccine viruses that preferentially stimulate interferon expression. These differential response profiles may influence the pathogenic infection outcome