H1N1pdm09 Adjuvanted Vaccination in HIV-Infected Adults: A Randomized Trial of Two Single versus Two Double Doses

Since human immunodeficiency virus (HIV)-infected individuals are at increased risk of severe disease from pandemic influenza A (H1N1pdm09), vaccination was recommended as a prevention strategy. The aim of the present study was to evaluate the safety, immunogenicity and persistence of the immune response after vaccination against pandemic influenza A (H1N1pdm09) with an adjuvanted vaccine in human immunodeficiency virus (HIV)-infected adults using two single and two double doses.Open label, randomized trial to evaluate the immune response following H1N1pdm09 vaccination in HIV-infected participants compared to HIV-negative controls (NCT01155037). HIV-infected participants were randomized to receive 2 single (3.75 µg hemagglutinin) or 2 double (7.5 µg hemagglutinin) doses of the vaccine, 21 days apart. Controls received one dose of the vaccine. The primary endpoint was seroconversion as measured by hemagglutination inhibition assay. Two hundred fifty six HIV-infected participants (129 and 127 randomized to single and double doses, respectively) and 71 HIV-negative controls were enrolled. Among HIV-infected participants, seroconversion increased from 46.7% and 51.7% after the first dose to 77.2% and 83.8% after the second dose of the vaccine using single and double doses, respectively. Participants aged >40 years showed higher seroconversion compared to younger participants. Seroconversion among HIV-infected women and those with nadir CD4<200 cells/mm(3) was significantly higher with double doses. Persistence of protective antibodies six months after vaccination was achieved by 80% and 89.9% of the HIV-infected participants who received single and double doses, respectively.Our results support the recommendation of two double doses of adjuvanted H1N1pdm09 vaccine for HIV-infected individuals, particularly women, and those aged >40 years or with nadir CD4<200 cells/mm(3), to achieve antibody levels that are both higher and more sustained.ClinicalTrials.gov NCT01155037

Continuous increase of cardiovascular diseases, diabetes, and non-HIV related cancers as causes of death in HIV-infected individuals in Brazil: An analysis of nationwide data

Introduction: After antiretroviral therapy (ART) became available, there was a decline in the number of deaths in persons infected with HIV. Thereafter, there was a decrease in the proportion of deaths attributed to opportunistic infections and an increase in the proportion of deaths attributed to chronic comorbidities. Herein we extend previous observations from a nationwide survey on temporal trends in causes of death in HIV-infected patients in Brazil. Methods: We describe temporal trends in causes of death among adults who had HIV/AIDS listed in the death certificate to those who did not. All death certificates issued in Brazil from 1999 to 2011 and listed in the national mortality database were included. Generalized linear mixed-effects logistic models were used to study temporal trends in proportions. Results: In the HIV-infected population, there was an annual adjusted average increase of 6.0%, 12.0%, 4.0% and 4.1% for cancer, external causes, cardiovascular diseases (CVD) and diabetes mellitus (DM), respectively, compared to 3.0%, 4.0%, 1.0% and 3.9%, in the non-HIV group. For tuberculosis (TB), there was an adjusted average increase of 0.3%/year and a decrease of 3.0%/year in the HIV and the non-HIV groups, respectively. Compared to 1999, the odds ratio (OR) for cancer, external causes, CVD, DM, or TB in the HIV group were, respectively, 2.31, 4.17, 1.76, 2.27 and 1.02, while for the non-HIV group, the corresponding OR were 1.31, 1.63, 1.14, 1.62 and 0.67. Interactions between year as a continuous or categorical variable and HIV were significant (p <0.001) for all conditions, except for DM when year was considered as a continuous variable (p = 0.76). Conclusions: Non HIV-related co-morbidities continue to increase more rapidly as causes of death among HIV-infected individuals than in those without HIV infection, highlighting the need for targeting prevention measures and surveillance for chronic diseases among those patients. © 2014 Paula et al

Percepção de médicos e enfermeiros da Estratégia de Saúde da Família sobre terapias complementares

OBJECTIVE: To analyze Estratégia de Saúde da Família (Family Health Strategy) professionals' perception of complementary and integrative therapies. METHODS: A study with 177 doctors and nurses was conducted in 2008, based on a self-administered questionnaire. The outcome variables were "interest in complementary and integrative therapies" and "agreement with the National Policy on Complementary and Integrative Therapies. Sex, age, graduate level of education, postgraduate level of education, length of time since graduation, length of time of work, having children, providing complementary and integrative therapies in the workplace, and using homeopathy or acupuncture comprised the independent variables. Data were analyzed using Chi-square test and Fisher's exact test. RESULTS: A total of 17 health centers provided complementary and integrative therapies; 12.4% of professionals had a specialization in homeopathy or acupuncture; 43.5% of doctors were specialists in family and community medicine/family health. Of all participants, 88.7% did not know the national directives for this area, although 81.4% agreed with their inclusion in the Sistema Único de Saúde (Unified Health System). The majority (59.9%) showed an interest in qualifications and all agreed that these therapies should be approached during the graduate course. Agreement with the inclusion of such therapies was significantly associated with the fact of being a nurse (p = 0.027) and using homeopathy for oneself (p = 0.019). Interest in complementary therapies was associated with the use of homeopathy for oneself (p = 0.02) and acupuncture by family members (p = 0.013). CONCLUSIONS: Complementary and integrative therapies are accepted by the professionals studied. This acceptance is associated with previous contact with such therapies and, probably, with residency/specialization in family and community medicine/family health.OBJETIVO: Analisar a percepção de profissionais da Estratégia de Saúde da Família sobre práticas integrativas e complementares. MÉTODOS: Estudo com 177 médicos e enfermeiros a partir de um questionário auto-aplicado em 2008. As variáveis desfecho foram "interesse pelas práticas integrativas e complementares" e "concordância com a Política Nacional de Práticas Integrativas e Complementares". Sexo, idade, graduação, pós-graduação, tempo de formado e de trabalho, possuir filhos, oferta de práticas integrativas e complementares no local de trabalho e uso de homeopatia ou acupuntura compuseram as variáveis independentes. Os dados foram analisados pelo teste do qui-quadrado e teste exato de Fisher. RESULTADOS: Dezessete centros de saúde ofereciam práticas integrativas e complementares; 12,4% dos profissionais possuíam especialização em homeopatia ou acupuntura; 43,5% dos médicos eram especialistas em medicina de família e comunidade/saúde da família. Dos participantes, 88,7% desconheciam as diretrizes nacionais para a área, embora 81,4% concordassem com sua inclusão no Sistema Único de Saúde. A maioria (59,9%) mostrou interesse em capacitações e todos concordaram que essas práticas deveriam ser abordadas na graduação. A concordância com a inclusão dessas práticas mostrou-se associada significativamente com o fato de ser enfermeiro (p = 0,027) e com o uso de homeopatia para si (p = 0,019). Interesse pelas práticas complementares esteve associado a usar homeopatia para si (p = 0,02) e acupuntura para familiares (p = 0,013). CONCLUSÕES: Existe aceitação das práticas integrativas e complementares pelos profissionais estudados, associada ao contato prévio com elas e possivelmente relacionada à residência/especialização em medicina de família e comunidade/saúde da família.OBJETIVO: Analizar la percepción de profesionales de la Estrategia Salud de la Familia sobre prácticas integrales y complementarias. MÉTODOS: Se realizó estudio con 177 médicos y enfermeros a partir de un cuestionario auto-aplicado en 2008. Las variables consideradas fueron "interés por las prácticas integrales y complementarias" y "concordancia con la Política Nacional de prácticas integrales y complementarias". Sexo, edad, estudio universitario, postgrado, tiempo de formación y de trabajo, poseer hijos, oferta de prácticas integrales y complementarias en el lugar de trabajo y uso de homeopatía o acupuntura conformaron las variables independientes. Los datos fueron analizados por la prueba de chi-cuadrado y la prueba exacta de Fisher. RESULTADOS: Diecisiete centros de salud ofrecían prácticas integrales y complementarias; 12,4% de los profesionales poseían especialización en homeopatía o acupuntura; 43,5% de los médicos eran especialistas en medicina de familia y comunidad/salud de la familia. De los participantes, 88,7% desconocían las directrices nacionales para el área, a pesar de que el 81,4% concordasen con su inclusión en el Sistema Único de Salud. La mayoría (59,9%) mostró interés en capacitaciones y todos concordaran que esas prácticas deberían ser abordadas en el estudio universitario. La concordancia con la inclusión de tales prácticas se mostró asociada significativamente con el hecho de ser enfermero (p=0,027) y con el uso de homeopatía para sí mismo (p=0,019). Interés por las prácticas complementarias estuvo asociado con el uso de homeopatía para sí mismo (p=0,02) y acupuntura para familiares (p=0,013). CONCLUSIONES: Existe aceptación de las prácticas integrales y complementarias por los profesionales estudiados, asociada al contacto previo con las mismas y posiblemente relacionada a la residencia/especialización en medicina de familia y comunidad/salud de la familia