Casais heterossexuais sorodiscordantes para o HIV-1 : estudo comportamental e de biomarcadores para avaliar práticas sexuais de risco, adesão ao tratamento antirretroviral e transmissão sexual do HIV com outras infecções sexualmente transmissíveis

Base teórica: A epidemia da infecção pelo HIV avança devido à transmissão sexual. Reconhecendo que as estratégias de mudança comportamental não são suficientes, os pesquisadores, hoje, voltam o olhar para o uso de antirretrovirais (ARV) como prevenção da transmissão sexual do HIV em três estratégias principais: PrEP ou profilaxia pré-exposição, PEP ou profilaxia pós-exposição eTasP ou tratamento como prevenção. Nesse cenário, sabese que todas as pessoas infectadas sexualmente pelo HIV, já foram um dia um casal sorodiscordante. Pessoas nessa situação são muito importantes para estudos de avaliação dos fatores facilitadores ou protetores da transmissão sexual do HIV. Sabe-se que as outras Infecções Sexualmente Transmissíveis (IST) são fatores biológicos facilitadores da transmissão sexual do HIV enquanto o uso de ARV com carga viral indetectável é o principal fator protetor desta transmissão, dando origem à disseminação da campanha U=U (Indetectável = Não transmissível). Objetivo: O principal objetivo deste estudo foi avaliar o impacto das outras ISTs e a adesão aos ARV na transmissão sexual do HIV em casais heterossexuais sorodiscordantes cujo índice estava em uso de ARV. Metodos: Estudo transversal aninhado em uma coorte retrospectiva de casais heterossexuais sorodiscordantes para o HIV com uma amostra fixa de 200 casais e 100 solteiros com HIV recebendo tratamento ARV há três meses ou mais, em acompanhamento no serviço especializado em atendimento de pessoas vivendo com HIV/AIDS (PLVHA) no sul do Brasil. Todos assinaram termo de consentimento, responderam questionário demográfico e comportamental pelo audio computer-assisted self-interviews (ACASI), coletaram amostras de sangue e de secreção genital para marcadores biológicos. Todos os parceiros HIV negativos eram aconselhados e testados para o HIV-1. Para a avaliação dos marcadores biológicos foi utilizado o método Real Time Polymerase Chain Reaction (RT-PCR) (©Abott) para a quantificação da carga viral sérica do HIV-1. A carga viral da secreção genital foi avaliada por método de RT-PCR com kit COBAS (©Roche). Swab vaginal para o teste Rapid Stain Identification of Human Semen (RSID) foi utilizado como biomarcador de sexo vaginal desprotegido. Resultados: As características demográficas, comportamentais e de marcadores biológicos foram semelhantes entre casais e solteiros. A correlação entre PCR da secreção vaginal e carga viral sérica foi significativa na presença de Infecções Sexualmente Transmissíveis (IST) (r=0,359; P=0,017). Houve associação entre o relato de adesão pelo ACASI e a carga viral sérica indetectável (P<0,0001). A análise de regressão logística demonstrou que o regime de ARV com comprimido único (RCU) duplica a chance de adesão. A maioria dos casos índices era do sexo feminino (70%). A mediana do tempo de relacionamento dos casais foi de 72 meses. Cinco parceiros se infectaram sendo quatro homens e uma mulher com uma incidência de infecção aguda pelo HIV de 2,5% (IC95%:0,8% a 5,7%). O teste RSID avaliou sexo vaginal desprotegido com resultado positivo em 12,1% das mulheres. Os resultados das medidas de carga viral no plasma foram mais elevados nos índices dos casais que transmitiram o HIV do que nos que não transmitiram (P=0,002). A presença de IST foi significativamente maior nos casais que soroconverteram (60,0% X 13,3%;OR=9,75; IC95%:1,55 – 61,2; P=0,023). Conclusão: Investir no uso de ARV como comprimido único é a principal ferramenta para melhorar a adesão. A adesão ao uso de ARV com carga viral indetectável é o principal fator de não transmissão do HIV entre casais sorodiscordantes e neste estudo o que foi preditor de transmissão foi o tempo de carga viral indetectável e a presença de outras ISTs.Theoretic background: Sexual transmission as the major HIV epidemic driver. Knowing that behavior changing strategies are not sufficient to detain the epidemics, researchers currently are turning attention to the use of antiretrovirals (ARV) as one of three ways for curtailing HIV spread: PrEP, or pre-exposure prophylaxis; PEP, or post exposure prophylaxis; and TasP, or treatment as prevention. In this scenario, it is assumed that every single sexually infectedperson, has been part of a serodiscordant couple. Those persons are important for demographic, behavioral and biological studies which can reveal factors facilitating or deterring the HIV transmission. In this context, is known that sexual transmitted infections (STI) one cofactor for HIV transmission and undetectable viral load achieved by antiretroviral treatment makes a HIV infected person virtually incapable of transmission (undetectable = untransmissible). Objetives: Main objetives were the assessment of HIV sexual transmission among serodiscordant couples on which the índex was using ARV in the presence of other IST and also evaluate adherence to ARV. Methods: A cross sectional study nested in retrospective cohort with 200 serodiscordant couples to HIV and 100 single persons receiving ARV treatment for at least three months under follow up at a major HIV/AIDS referral Service in Southern Brazil. Informed Consent has been obtained, after which a thorough behavioral and demographic questionnaire was responded through the audio computer-assisted self-interviews (ACASI). Blood and genital secretion samples were collected for viral load testing. All HIV-negative partners were counseled after testing. HIV-1 viral load was measured by Real Time Polymerase Chain Reaction (Abbott® RT-PCR) with threshold of detection of 40 copies. Vaginal viral load was measured by RT-PCR (Roche COBAS®) which had a treshold of 17 copies. Unprotected sexual intercourse was measured by RSID (Rapid Sexual Identification of Human Semen) in self collected vaginal secretion. Results: Demographic, behavioral and biological markers were similar between couples and single participants. Women with HIV-1 serotype C had more often detectable vírus in genital secretion (P=0,006). Correlation between vaginal and serum viral load was significant in presence of STI (r=0,359; P=0.017). There was association between ACASI report of adherence and undetectable serum viral load (P<0,0001). Logistic regression analysis found single tablet ARV double the chance of adherence to treatment. Mean plasma vírus load results were higher in HIV transmitters compared to non-transmitters (p=0.02). IST were present significantly more common among seroconverting couples (60,0% X 13,3%; OR=9,75;IC95%:1,55 – 61,2; P=0,023). Conclusion: Single tablet ARV was found to be the single most efficient tool to increase adherence to antiretroviral treatment. Undetectable viral load is the main factor associated with non transmission of HIV among serodiscordant couples. HIV transmission was associated with presence of STI and a shorter time with serum undetectable viral load

Ineffective penicillin treatment and absence of partner treatment may drive the congenital syphilis epidemic in Brazil

BACKGROUND: Reducing congenital syphilis has been the focus of Brazilian health programs for decades, yet the cases continue to increase. Although health interventions have targeted HIV screening and treatment, syphilis management continues to be challenging. Syphilis during pregnancy may enhance the HIV maternal seroconversion risk. The potential factors fueling the syphilis epidemic were evaluated in south Brazil, an area of high HIV or syphilis endemicity. OBJECTIVE: We hypothesized that ineffective treatment because of a lack of partner treatment, late presentation to care, and reinfection of previously treated mothers were potential drivers of syphilis mother-to-child transmission. STUDY DESIGN: Data on women diagnosed with syphilis during pregnancy between January 1, 2008 and December 31, 2018 were obtained from a large urban hospital in Porto Alegre, Brazil. The patients were stratified into effective vs ineffective treatment groups according to the World Health Organization guidelines. Crude and adjusted risk ratios for the prediction of congenital syphilis and adverse fetal or neonatal outcomes were computed using Poisson regression. RESULTS: Nearly 56,000 pregnant women delivered over the 11-year period; 1541 (2.8%) had confirmed syphilis during pregnancy, with 934 (61%) receiving ineffective syphilis treatment because of late presentation and diagnosis, delayed treatment initiation, and loss to follow-up with no treatment recorded. Ineffective treatment was associated with maternal education, prenatal care, timing of syphilis diagnosis, venereal diseases research laboratory titers, and maternal HIV coinfection. On multivariate regression analysis, ineffective treatment (adjusted risk ratio, 4.52; 95% confidence interval, 2.35–8.69), absence of prenatal care (adjusted risk ratio, 9.31; 95% confidence interval, 3.77–23.0), syphilis diagnosis at delivery (adjusted risk ratio, 3.08; 95% confidence interval, 2.07–4.58), and maternal nontreponemal titers ≥1:64 (1.09–1.93) were associated with an increased risk of fetal loss. Ineffective treatment (adjusted risk ratio, 1.71; 95% confidence interval, 1.59–1.84), year of diagnosis 2014 to 2016 (adjusted risk ratio, 1.07; 95% confidence interval, 1.02–1.13), absence of prenatal care (adjusted risk ratio, 1.44; 95% confidence interval, 1.17–1.76), and maternal nontreponemal titers >1:4 were associated with an increased risk of congenital syphilis. Although partner treatment reduced the congenital syphilis risk (adjusted risk ratio, 0.60; 95% confidence interval, 0.55–0.66), only 31.8% of partners received treatment. Maternal HIV coinfection was not associated with an increased risk of fetal loss, low birthweight, preterm birth, congenital syphilis, or symptomatic neonatal infection. CONCLUSION: Public health initiatives promoting effective syphilis treatment in pregnancy, increased access to high-quality prenatal care, and partner treatment should be considered to reduce congenital syphilis.Revisión por pare

HIV-1 heterosexual transmission and association with sexually transmitted infections in the era of treatment as prevention

Objectives: HIV-1 heterosexual transmission among individuals on antiretroviral treatment (ART) with undetectable viremia is extremely rare. The aim of this study was to evaluate the risk of sexual HIV-1 transmission and other sexually transmitted infections (STIs) in HIV-1 serodifferent couples while the index partner is on ART. Methods: HIV transmission was evaluated in 200 HIV-1 heterosexual serodifferent couples in a stable relationship (≥3 months). All HIV-positive individuals had been on ART for ≥3 months and had been followed up for a median preceding time of 4.5 years (range 0.3–16 years) at the HIV couples clinic at Hospital Nossa Senhora da Conceição in Porto Alegre, Brazil. Following written informed consent, participants responded to demographic/behavioral questionnaires. Quantitative PCR for HIV RNA, T-cell subsets, and STI testing (syphilis, herpes, human papillomavirus, gonorrhea, and bacterial vaginosis) were performed. Self-collected vaginal swabs were obtained for quantitative HIV genital viral load testing. Results: Among 200 couples, 70% of index partners were female. Five seroconversions were observed; the HIV infection incidence was 2.5% (95% confidence interval 0.8% to 5.7%). Mean plasma viral load results were higher in HIV transmitters compared to non-transmitters (p = 0.02). The presence of STIs was significantly greater in couples who seroconverted (60.0% vs. 13.3%; odds ratio 9.75, 95% confidence interval 1.55–61.2; p = 0.023). The duration of undetectable HIV viremia and presence of STIs were associated with HIV transmission. Conclusions: Undetectable viremia was the main factor associated with non-transmissibility of HIV in this setting

Antiretroviral adherence and virologic suppression in partnered and unpartnered HIV-positive individuals in southern Brazil

Background: An undetectable serum HIV-1 load is key to effectiveness of antiretroviral (ARV) therapy, which depends on adherence to treatment. We evaluated factors possibly associated with ARV adherence and virologic response in HIV-infected heterosexual individuals. Methods: A cross-sectional study was conducted in 200 HIV-1 serodiscordant couples and 100 unpartnered individuals receiving ARV treatment at a tertiary hospital in southern Brazil. All subjects provided written informed consent, answered demographic/behavioral questionnaires through audio computer-assisted self-interviews (ACASI), and collected blood and vaginal samples for biological markers and assessment of sexually transmitted infections (STIs). HIV-negative partners were counseled and tested for HIV-1. Results: The study population mean age was 39.9 years, 53.6% were female, 62.5% were Caucasian, 52.6% had incomplete or complete elementary education, 63.1% resided in Porto Alegre. Demographic, behavioral and biological marker characteristics were similar between couples and single individuals. There was an association between adherence reported on ACASI and an undetectable serum viral load (P<0.0001). Logistic regression analysis demonstrated that single-tablet ARV-regimens were independently associated with adherence (OR = 2.3; 95CI%: 1.2–4.4; P = 0.011) after controlling for age, gender, education, marital status, personal income, ARV regimen, and median time of ARV use. A positive correlation between genital secretion PCR results and serum viral load was significant in the presence of STIs (r = 0.359; P = 0.017). Although HIV PCR detection in vaginal secretions was more frequent in women with detectable viremia (9/51, 17.6%), it was also present in 7 of 157 women with undetectable serum viral loads (4.5%), p = 0.005. Conclusions: ARV single tablet regimens are associated with adherence. Detectable HIV-1 may be present in the genital secretions of women with undetectable viremia which means there is potential for HIV transmission in adherent individuals with serologic suppression

Current knowledge and future prospects of lima bean (Phaseolus lunatus)-rhizobia symbiosis

Lima bean (Phaseolus lunatus) is an important species of the genus Phaseolus for human consumption in tropical regions. The seeds are important source of protein for people from South America, Africa and Mexico. In addition, as a legume plant, lima bean presents the ability to perform the biological nitrogen fixation (BNF) through the symbiosis with nitrogen-fixing bacteria. The studies about diversity and efficiency of lima bean-rhizobia symbiosis have increased worldwide, mainly in Latin America. These studies have shown Bradyrhizobium and Rhizobium as the main symbionts, although Sinorhizobium, Mesorhizobium and Allorhizobium have been found associated with lima bean. Also, there is a large variation in the efficiency of N fixation by the current isolates of rhizobia and some rhizobia have presented high capability for fixing N. This review aims to explore the studies about diversity and efficiency of rhizobia in symbiosis with lima bean.Lima bean (Phaseolus lunatus) is an important species of the genus Phaseolus for human consumption in tropical regions. The seeds are important source of protein for people from South America, Africa and Mexico. In addition, as a legume plant, lima bean presents the ability to perform the biological nitrogen fixation (BNF) through the symbiosis with nitrogen-fixing bacteria. The studies about diversity and efficiency of lima bean-rhizobia symbiosis have increased worldwide, mainly in Latin America. These studies have shown Bradyrhizobium and Rhizobium as the main symbionts, although Sinorhizobium, Mesorhizobium and Allorhizobium have been found associated with lima bean. Also, there is a large variation in the efficiency of N fixation by the current isolates of rhizobia and some rhizobia have presented high capability for fixing N. This review aims to explore the studies about diversity and efficiency of rhizobia in symbiosis with lima bean

Efficacy and Safety of Three Antiretroviral Regimens for Initial Treatment of HIV-1: A Randomized Clinical Trial in Diverse Multinational Settings

Background: Antiretroviral regimens with simplified dosing and better safety are needed to maximize the efficiency of antiretroviral delivery in resource-limited settings. We investigated the efficacy and safety of antiretroviral regimens with once-daily compared to twice-daily dosing in diverse areas of the world. Methods and Findings: 1,571 HIV-1-infected persons (47% women) from nine countries in four continents were assigned with equal probability to open-label antiretroviral therapy with efavirenz plus lamivudine-zidovudine (EFV+3TC-ZDV), atazanavir plus didanosine-EC plus emtricitabine (ATV+DDI+FTC), or efavirenz plus emtricitabine-tenofovir-disoproxil fumarate (DF) (EFV+FTC-TDF). ATV+DDI+FTC and EFV+FTC-TDF were hypothesized to be non-inferior to EFV+3TC-ZDV if the upper one-sided 95% confidence bound for the hazard ratio (HR) was ≤1.35 when 30% of participants had treatment failure. An independent monitoring board recommended stopping study follow-up prior to accumulation of 472 treatment failures. Comparing EFV+FTC-TDF to EFV+3TC-ZDV, during a median 184 wk of follow-up there were 95 treatment failures (18%) among 526 participants versus 98 failures among 519 participants (19%; HR 0.95, 95% CI 0.72–1.27; p = 0.74). Safety endpoints occurred in 243 (46%) participants assigned to EFV+FTC-TDF versus 313 (60%) assigned to EFV+3TC-ZDV (HR 0.64, CI 0.54–0.76; p<0.001) and there was a significant interaction between sex and regimen safety (HR 0.50, CI 0.39–0.64 for women; HR 0.79, CI 0.62–1.00 for men; p = 0.01). Comparing ATV+DDI+FTC to EFV+3TC-ZDV, during a median follow-up of 81 wk there were 108 failures (21%) among 526 participants assigned to ATV+DDI+FTC and 76 (15%) among 519 participants assigned to EFV+3TC-ZDV (HR 1.51, CI 1.12–2.04; p = 0.007). Conclusion: EFV+FTC-TDF had similar high efficacy compared to EFV+3TC-ZDV in this trial population, recruited in diverse multinational settings. Superior safety, especially in HIV-1-infected women, and once-daily dosing of EFV+FTC-TDF are advantageous for use of this regimen for initial treatment of HIV-1 infection in resource-limited countries. ATV+DDI+FTC had inferior efficacy and is not recommended as an initial antiretroviral regimen

Abuso de Substâncias e Emergências Psiquiátricas: Avaliação Integrada e Intervenções Eficazes

Objective: Emphasize the importance of an integrated approach in addressing these issues, focusing on personalized and effective interventions. Methodology: A comprehensive review of scientific literature was conducted using databases such as PubMed, Latindex, and Scielo to identify relevant studies on substance abuse in psychiatric emergency contexts using MeSH Finder: "Nerve Agents"; "Neurotransmitter Agents"; "Mental Health". Results: The focus is on personalized interventions, such as specific therapies and emotional support, highlighting the importance of ongoing education and community involvement for prevention and recovery. The ultimate goal is to promote well-being through a multidisciplinary approach in complex situations. Conclusion: Collaboration between mental health and specialists is essential to address substance abuse and psychiatric emergencies. Personalized interventions, continuous education, and community involvement are crucial for prevention and recovery, aiming to promote well-being in complex situations.Objetivo: Destacar a importância da abordagem integrada na avaliação desses problemas, enfocando intervenções personalizadas e eficazes. Metodologia: Realizou-se uma revisão abrangente da literatura científica utilizando bases de dados, como PubMed, Latindex e Scielo, para identificar estudos relevantes sobre abuso de substâncias em contextos de emergências psiquiátricas utilizando os MeSH Finder: “Nerve Agents”; “Neurotransmitter Agents”; “Mental Health”.&nbsp; Resultados: O foco recai sobre intervenções personalizadas, como terapias específicas e apoio emocional, enquanto ressalta a importância da educação contínua e do envolvimento da comunidade para prevenção e recuperação. O objetivo final é promover o bem-estar por meio de uma abordagem multidisciplinar em situações complexas. Conclusão: A colaboração entre saúde mental e especialistas é essencial para enfrentar abuso de substâncias e emergências psiquiátricas. Intervenções personalizadas, educação contínua e envolvimento comunitário são cruciais para prevenção e recuperação, visando promover o bem-estar em situações complexas

Treatment as Prevention: Characterization of Partner Infections in the HIV Prevention Trials Network 052 Trial

HIV Prevention Trials Network (HPTN) 052 demonstrated that antiretroviral therapy (ART) prevents HIV transmission in serodiscordant couples. HIV from index-partner pairs was analyzed to determine the genetic linkage status of partner infections. Forty-six infections were classified as linked, indicating that the index was the likely source of the partner’s infection. Lack of viral suppression and higher index viral load were associated with linked infection. Eight linked infections were diagnosed after the index started ART: four near the time of ART initiation and four after ART failure. Linked infections were not observed when the index participant was stably suppressed on ART

Desafios Contemporâneos na Gestão de Doenças Cardiovasculares: uma perspectiva de Saúde Coletiva

Objective: The aim of this article is to analyze and present a comprehensive understanding of contemporary challenges in the management of cardiovascular diseases, with a special emphasis on the perspective of public health. Seeking to identify and discuss factors contributing to the complexity of managing these diseases, considering epidemiological, social, and technological nuances.Methodology: This involves a comprehensive literature review of scientific literature across databases such as PubMed, Scielo, Latindex, and Medline. Health Science Descriptors (DeCS) were utilized, including “Cardiology,” “Public Health,” and “Health-Disease Process.” No restrictions were applied regarding time and metrology. Results: Exploration of how the public health approach can provide valuable insights and innovative strategies to address these challenges. The integration of care, the application of health technologies, and the promotion of equity are crucial elements to be addressed in light of the collective perspective, aiming to provide a holistic and effective view in managing these conditions. Conclusion: In summary, an in-depth analysis of contemporary challenges in the management of cardiovascular diseases was provided, highlighting the crucial perspective of public health. By exploring epidemiological, social, and technological factors, we identified the complexity involved in managing these conditions. The collective approach, integrating care, technology, and promoting equity, emerges as a fundamental strategy to address these challenges and promote a more effective and comprehensive management of cardiovascular diseases.Objetivo: O objetivo deste artigo é analisar e apresentar uma compreensão aprofundada dos desafios contemporâneos na gestão de doenças cardiovasculares, com uma ênfase especial na perspectiva de saúde coletiva. Buscando identificar e discutir os fatores que contribuem para a complexidade da gestão dessas doenças, considerando as nuances epidemiológicas, sociais e tecnológicas. Metodologia: Trata-se de uma revisão bibliográfica abrangente da literatura científica em bases de dados como PubMed, Scielo, Latindex e Medline. Com a utilização dos DeCs (descritores de saúde): “Cardiology”; “Public Health”; Health-Disease Process”. Sem restrições de tempo e de metrologia. Resultados: Exploração de como a abordagem de saúde coletiva pode oferecer insights valiosos e estratégias inovadoras para enfrentar esses desafios. A integração de cuidados, a aplicação de tecnologias em saúde e a promoção da equidade são elementos cruciais que serão abordados à luz da perspectiva coletiva, visando proporcionar uma visão holística e eficaz na gestão dessas condições. Conclusão: Em suma, proporcionou-se uma análise aprofundada dos desafios contemporâneos na gestão de doenças cardiovasculares, destacando a perspectiva crucial da saúde coletiva. Ao explorar fatores epidemiológicos, sociais e tecnológicos, identificamos a complexidade envolvida na gestão dessas condições. A abordagem coletiva, integrando cuidados, tecnologia e promovendo a equidade, emerge como uma estratégia fundamental para enfrentar esses desafios e promover uma gestão mais eficaz e abrangente das doenças cardiovasculares

Transtorno Bipolar: uma abordagem integrativa entre neurobiologia, terapias e psicoterapia

Introduction: Bipolar disorder is characterized by a variation in episodes and moods, which can range from a feeling of euphoria to a depressive state. Symptoms of this disorder may include difficulty sleeping, lack of energy or motivation, as well as a loss of meaning in reality. These signs may vary according to the crisis present at the time and the condition the individual is in. Objective: Understand bipolar disorder and the factors that may be associated with this disease. Methodology: A systematic literature review was carried out covering the years from January 2003 to December 2023. The study was based and guided by the question mentioned throughout the article. Conclusion: In summary, the integrated approach combining mood stabilizing medications and psychotherapy is crucial to effectively managing Bipolar Disorder, providing support and promoting a better understanding of the condition for a more stable quality of life.Introdução: O transtorno bipolar se caracteriza pela variação de&nbsp; episódios e quadros de humor, que podem ir da sensação de euforia até o estado depressivo. Os sintomas desse distúrbio podem incluir dificuldade para dormir, falta de energia ou motivação, além da perda de sentido com a realidade. Esses sinais podem variar de acordo com a crise presente no momento e com o quadro que o indivíduo se encontra. Objetivo: Compreender o transtorno da bipolaridade e os fatores que podem ser associados a essa doença. Metodologia: Foi realizada uma revisão sistemática de literatura abrangendo os anos de janeiro de 2003 a dezembro de 2023. O estudo teve como base e norteamento a pergunta citada no decorrer do artigo. Conclusão: Em resumo, a abordagem integrada que combina medicamentos estabilizadores de humor e psicoterapia é crucial para gerenciar eficazmente o Transtorno Bipolar, proporcionando suporte e promovendo uma melhor compreensão da condição para uma qualidade de vida mais estável