Made available in DSpace on 2015-02-04T21:42:11Z (GMT). No. of bitstreams: 1 Elton de Freitas -.pdf: 1885085 bytes, checksum: d69e2259a0667c832c44be0ac450ad14 (MD5) Previous issue date: 2011-05-27 / O surgimento da AIDS em meados da década de oitenta causou grande impacto na saúde e na sociedade. À medida que avançou o tempo, inúmeros estudos foram desenvolvidos para combater a doença. O primeiro medicamento lançado com este objetivo foi a zidovudina em 1987, mas foi apenas em 1996 com o desenvolvimento da terapia antirretroviral de alta potência (HAART) que os pacientes obtiveram real melhora do quadro gerado pela AIDS. Houve significativa redução da presença de doenças oportunistas assim como aumento na sobrevida, porém a melhora dos pacientes foi acompanhada por uma série de comorbidades decorrentes da alta toxicidade dos antirretrovirais. Estudos começaram a relatar o surgimento de alterações na distribuição da gordura corporal e no metabolismo lipídico e glicêmico. O objetivo desta pesquisa foi verificar a prevalência de lipodistrofia e a relação com a terapia antirretroviral utilizada. Assim 130 pacientes do serviço de atendimento especializado do município de São Vicente, 89 usuários de TARV e outros 41 não usuários foram avaliados. Os resultados mostraram que 88,6% dos pacientes possuem alguma alteração na distribuição de gordura, quando da utilização da TARV, todas as variáveis integrantes da síndrome lipodistrófica do HIV (SLHIV) apresentaram maior prevalência na avaliação realizada pela observação do avaliador, sugerindo a existência de relação entre a TARV e a prevalência de SLHIV. Também entre os resultados em destaque estão os dados referentes a circunferência de cintura (p.0,049), relação entre cintura/quadril (p.0,004) e a dobra cutânea supra-ilíaca (p.0,05), estes foram estatisticamente significantes no que se refere a gordura visceral, para a gordura periférica o resultado referente a dobra cutânea da panturrilha medial foi igualmente expressivo, enquanto para o perfil metabólico os valores encontrados para glicemia e triglicérides (p.0,001) foram os mais significativos, demonstrando incremento nos níveis deste marcador laboratorial quando da utilização de TARV.

INTRODUÇÃO: Embora a mortalidade geral tenha diminuído na era da terapia antirretroviral de alta potência (TARVAP), o envolvimento do Sistema Nervoso Central (SNC) ainda é elevado nos pacientes com infecção pelo HIV. O estudo sobre possíveis correlações entre neuroinfecções, a presença de déficts neurocognitivos e o uso da TARVAP é importante para se avaliar os efeitos de longo prazo do tratamento com drogas antirretrovirais em uma população. Desta forma, são necessários estudos para se avaliar a neuropatologia da infecção pelo HIV e os efeitos do tratamento bem como a adesão ao mesmo. OBJETIVOS: Analisar a frequência e o tipo de infecções oportunistas e da infecção crônica pelo HIV no SNC na era pós-TARVAP, de pacientes necropsiados em um hospital universitário, no período de 2007 a 2014. Nestes casos, avaliar o substrato neuropatológico de pacientes com Aids e histórico clínico de demência. MATERIAIS E MÉTODOS: Foram analisados os achados dos exames neuropatológicos de 123 encéfalos de pacientes autopsiados com AIDS no Serviço de Patologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP/USP), seus dados clínicos e respectivos os laudos necroscópicos. RESULTADOS: Dos 123 casos analisados, 73 (59,3%) eram do sexo masculino e a média de idade foi de 40,56 anos. Destes, 69 (56,1%) tiveram neuroinfecções causadas por agentes oportunistas, sendo a neurotoxoplasmose a mais prevalente. Da correlação entre a contagem de células CD4 e o uso da TARVAP houve diferença significativa para uma delas, àquela que foi analisada como sendo a terceira mais próxima da data do óbito (p = 0,03). Apenas 6 pacientes fizeram uso regular da TARVAP no decorrer da doença e nenhum deles apresentaram neuroinfecções durante o tratamento. CONCLUSÕES: Podemos concluir que mesmo na era pós TARVAP as infecções no SNC causadas por agentes infecciosos permanecem presentes e no caso da população estudada podem estar correlacionadas com a baixa adesão ao tratamento. / RATIONALE: Although overall mortality has decreased in the era of highly active antiretroviral therapy (HAART), the involvement of the central nervous system (CNS) is still high in patients with HIV infection. The study of possible correlations between neuroinfections, the presence of neurocognitive payment deficits and the use of HAART is important to evaluate the long-term effects of treatment with antiretroviral drugs in a population. Thus, studies are needed to evaluate the neuropathology of infection by HIV and the treatment effects and it adhesion. OBJECTIVES: To analyze the changes caused by opportunistic infections and chronic HIV infection in the CNS in the post-HAART era of autopsied patients at a university hospital, from 2007 to 2014. In these cases, assess the neuropathologic of AIDS patients and clinical history of dementia. MATERIALS AND METHODS: The findings of neuropathological examinations of 123 brains of patients were analyzed autopsied AIDS in Hospital Pathology Service of the Clinics of Ribeirão Preto Medical School, University of São Paulo (HCFMRP / USP) clinical data and their postmortem reports. RESULTS: The 123 cases analyzed, 73 (59.3%) were male and the average age was 40.56 years. Of these 69 (56,1%) had neuroinfections caused by opportunistic agents, toxoplasmosis being the most prevalent. The correlation between CD4 cell count and use of HAART were no significant differences for one of them to that which was analyzed as being the closest third of the date of death (p = 0.03). Only 6 patients made regular use of HAART during the disease and none of them showed neuroinfections during treatment. CONCLUSIONS: We can conclude that even in the post HAART era CNS infections caused by infectious agents remain present and in the case of the studied population can be correlated with low adherence to the treatment.

INTRODUÇÃO: Embora a mortalidade geral tenha diminuído na era da terapia antirretroviral de alta potência (TARVAP), o envolvimento do Sistema Nervoso Central (SNC) ainda é elevado nos pacientes com infecção pelo HIV. O estudo sobre possíveis correlações entre neuroinfecções, a presença de déficts neurocognitivos e o uso da TARVAP é importante para se avaliar os efeitos de longo prazo do tratamento com drogas antirretrovirais em uma população. Desta forma, são necessários estudos para se avaliar a neuropatologia da infecção pelo HIV e os efeitos do tratamento bem como a adesão ao mesmo. OBJETIVOS: Analisar a frequência e o tipo de infecções oportunistas e da infecção crônica pelo HIV no SNC na era pós-TARVAP, de pacientes necropsiados em um hospital universitário, no período de 2007 a 2014. Nestes casos, avaliar o substrato neuropatológico de pacientes com Aids e histórico clínico de demência. MATERIAIS E MÉTODOS: Foram analisados os achados dos exames neuropatológicos de 123 encéfalos de pacientes autopsiados com AIDS no Serviço de Patologia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP/USP), seus dados clínicos e respectivos os laudos necroscópicos. RESULTADOS: Dos 123 casos analisados, 73 (59,3%) eram do sexo masculino e a média de idade foi de 40,56 anos. Destes, 69 (56,1%) tiveram neuroinfecções causadas por agentes oportunistas, sendo a neurotoxoplasmose a mais prevalente. Da correlação entre a contagem de células CD4 e o uso da TARVAP houve diferença significativa para uma delas, àquela que foi analisada como sendo a terceira mais próxima da data do óbito (p = 0,03). Apenas 6 pacientes fizeram uso regular da TARVAP no decorrer da doença e nenhum deles apresentaram neuroinfecções durante o tratamento. CONCLUSÕES: Podemos concluir que mesmo na era pós TARVAP as infecções no SNC causadas por agentes infecciosos permanecem presentes e no caso da população estudada podem estar correlacionadas com a baixa adesão ao tratamento. / RATIONALE: Although overall mortality has decreased in the era of highly active antiretroviral therapy (HAART), the involvement of the central nervous system (CNS) is still high in patients with HIV infection. The study of possible correlations between neuroinfections, the presence of neurocognitive payment deficits and the use of HAART is important to evaluate the long-term effects of treatment with antiretroviral drugs in a population. Thus, studies are needed to evaluate the neuropathology of infection by HIV and the treatment effects and it adhesion. OBJECTIVES: To analyze the changes caused by opportunistic infections and chronic HIV infection in the CNS in the post-HAART era of autopsied patients at a university hospital, from 2007 to 2014. In these cases, assess the neuropathologic of AIDS patients and clinical history of dementia. MATERIALS AND METHODS: The findings of neuropathological examinations of 123 brains of patients were analyzed autopsied AIDS in Hospital Pathology Service of the Clinics of Ribeirão Preto Medical School, University of São Paulo (HCFMRP / USP) clinical data and their postmortem reports. RESULTS: The 123 cases analyzed, 73 (59.3%) were male and the average age was 40.56 years. Of these 69 (56,1%) had neuroinfections caused by opportunistic agents, toxoplasmosis being the most prevalent. The correlation between CD4 cell count and use of HAART were no significant differences for one of them to that which was analyzed as being the closest third of the date of death (p = 0.03). Only 6 patients made regular use of HAART during the disease and none of them showed neuroinfections during treatment. CONCLUSIONS: We can conclude that even in the post HAART era CNS infections caused by infectious agents remain present and in the case of the studied population can be correlated with low adherence to the treatment.

Highly active antiretroviral therapy (HAART) contributes to metabolic disorders and the growing prevalence of metabolic syndrome (MetS) in human immunodeficiency virus (HIV)-infected patients. Hypertension, obesity, and hyperglycemia (components of MetS) are risk factors for cardiovascular disease. Studies have shown that HIV patients on HAART have a 2-fold risk of dying from MetS. There are no such studies in Umuahia; hence the need for this study to fill this gap. Using a sample size of 192 medical records of HIV-infected patients in Federal Medical Centre, Umuahia, and applying metabolic syndrome theory, this study examined the relationships among types of HAART regimen, duration of HAART and hypertension, obesity, and hyperglycemia among HIV-infected adult patients. The records were stratified into 4 by duration of HAART. Chi-square test was used to determine associations between the nonparametric variables, whereas multiple logistic regressions were used to estimate the odds ratios. Odds of hypertension were more than 18-fold (OR = 18.52, 95% confidence interval [CI] = 5.464, 42.50) at >12 months on HAART, whereas odds of obesity was more than 5-fold (OR = 5.43, 95% CI = 2.227, 13.158) at >12 months. Odds of hyperglycemia were more than 14-fold at >12 months compared with <12 months on HAART. Statistical significance was achieved with duration of HAART for hypertension and hyperglycemia (p < .05) but none with types of HAART (p < .05). Being male, older age, and duration of HAART were associated with odds of metabolic syndrome components. This knowledge provides a base for population-based intervention programs for the HIV-positive population undergoing antiretroviral therapy in the Umuahia metropolis.

HIV infects over 33 million people worldwide with a new infection occurring every 9 seconds. Sex is the primary mode of transmission and the majority of new infections occur during unprotected sexual contact between an HIV-infected individual and an uninfected sexual partner(s) since HIV infected individuals tend to shed virus in their genital secretions. The infectiousness of an individual is closely tied to the amount of virus in blood, which is closely associated with HIV levels shed in semen or vaginal fluid or rectal secretions. Although, Highly Active Antiretroviral Therapy (HAART) is associated with complete suppression of HIV RNA in blood to undetectable levels, the impact of HAART on semen HIV RNA levels is less clear. I evaluated the correlation between systemic and mucosal HIV-specific CD8+ T cell immune responses and HIV RNA levels in blood and semen. Overall, there was a strong positive correlation between HIV RNA levels in blood and semen. Neither systemic nor mucosal (in semen) HIV-specific CD8+ responses were associated with HIV RNA levels in blood or semen, in fact CD8+ T cell immune responses in semen correlated with increased HIV RNA levels in semen. Furthermore, inflammatory cytokines (IL-6, and IL-8) CMV levels in semen were associated with increased semen HIV RNA shedding. HAART initiation was associated with complete suppression of HIV viremia, but a significant proportion of individuals on suppressive HAART continue to shed HIV RNA in semen even after 6 months, and this isolated virus was infectious and often present at high levels (> 5000 copies/mL). Nevertheless, long-term HAART was associated with complete immune reconstitution of CD4+ T cells in the sigmoid colon of HIV-infected individuals on long-term therapy. These findings demonstrate that neither systemic nor mucosal HIV-specific CD8+ responses, when assayed with IFN- production as an endpoint, were associated with reduced HIV RNA levels in blood or semen. Semen HIV RNA levels did correlate with local inflammatory cytokines and CMV reactivation. Furthermore, despite effective HAART a significant proportion of HIV-infected men continued to shed HIV RNA in semen. However, long-term completely suppressive HAART was associated with complete immune reconstitution of the sigmoid colon.

HIV infects over 33 million people worldwide with a new infection occurring every 9 seconds. Sex is the primary mode of transmission and the majority of new infections occur during unprotected sexual contact between an HIV-infected individual and an uninfected sexual partner(s) since HIV infected individuals tend to shed virus in their genital secretions. The infectiousness of an individual is closely tied to the amount of virus in blood, which is closely associated with HIV levels shed in semen or vaginal fluid or rectal secretions. Although, Highly Active Antiretroviral Therapy (HAART) is associated with complete suppression of HIV RNA in blood to undetectable levels, the impact of HAART on semen HIV RNA levels is less clear. I evaluated the correlation between systemic and mucosal HIV-specific CD8+ T cell immune responses and HIV RNA levels in blood and semen. Overall, there was a strong positive correlation between HIV RNA levels in blood and semen. Neither systemic nor mucosal (in semen) HIV-specific CD8+ responses were associated with HIV RNA levels in blood or semen, in fact CD8+ T cell immune responses in semen correlated with increased HIV RNA levels in semen. Furthermore, inflammatory cytokines (IL-6, and IL-8) CMV levels in semen were associated with increased semen HIV RNA shedding. HAART initiation was associated with complete suppression of HIV viremia, but a significant proportion of individuals on suppressive HAART continue to shed HIV RNA in semen even after 6 months, and this isolated virus was infectious and often present at high levels (> 5000 copies/mL). Nevertheless, long-term HAART was associated with complete immune reconstitution of CD4+ T cells in the sigmoid colon of HIV-infected individuals on long-term therapy. These findings demonstrate that neither systemic nor mucosal HIV-specific CD8+ responses, when assayed with IFN- production as an endpoint, were associated with reduced HIV RNA levels in blood or semen. Semen HIV RNA levels did correlate with local inflammatory cytokines and CMV reactivation. Furthermore, despite effective HAART a significant proportion of HIV-infected men continued to shed HIV RNA in semen. However, long-term completely suppressive HAART was associated with complete immune reconstitution of the sigmoid colon.

La infecció pel virus de la immunodeficiència humana (VIH) constitueix una de les epidèmies més importants actualment. El VIH es caracteritza per la seva elevada variabilitat genètica al llarg de la seva història natural. Les múltiples variants existents dins del mateix hoste, el que es coneix com quasiespècies, constitueixen una font d'adaptabilitat del virus, ja que permeten la disponibilitat d'una variant d'escapament davant una possible pressió selectiva en l'ambient (resposta immune, fàrmacs antiretrovirals, etc) . Malgrat els grans avenços en el desenvolupament de tractaments eficaços, actualment no ha estat possible l'eradicació de la infecció. El tractament antiretroviral de gran activitat (TARGA) ha disminuït significativament la morbi-mortalitat associada a la infecció pel VIH, però, no aconsegueix l'eliminació del virus. Conseqüència directa d'això és que, en suspendre'l, el virus reapareix en sang perifèrica, i caldrà mantenir el tractament de per vida, amb els seus costos tant a nivell d'efectes secundaris com econòmics. Davant aquesta situació, ha estat necessari el disseny de teràpies alternatives com les teràpies immunomediades (interrupcions estructurades del tractament o vacunes terapèutiques), enfocades a estimular el sistema immunològic del pacient per poder suspendre el TARGA de forma definitiva o, almenys, durant períodes variables de temps. Avui en dia no es coneixen amb exactitud els efectes que pugui tenir la variabilitat del VIH en les teràpies immunomediades, i l'interès del nostre estudi parteix d'aquesta premissa. Per això, l'objectiu d'aquesta tesi és analitzar, per primera vegada, l'evolució del virus en pacients sotmesos a vacunació terapèutica (en el nostre cas, una vacuna terapèutica de cèl•lules dendrítiques polsades amb el virus autòleg inactivat per calor). / La infección por el virus de la inmunodeficiencia humana (VIH) constituye una de las epidemias más importantes actualmente. El VIH se caracteriza por su elevada variabilidad genética a lo largo de su historia natural. Las múltiples variantes existentes dentro del mismo huésped, lo que se conoce como cuasiespecie, constituyen una fuente de adaptabilidad del virus, pues permiten la disponibilidad de una variante de escape frente una posible presión selectiva en el ambiente (respuesta inmune, fármacos antiretrovirales, etc). A pesar de los grandes avances en el desarrollo de tratamientos eficaces, actualmente no ha sido posible la erradicación de la infección. El tratamiento antirretroviral de gran actividad (TARGA) ha disminuido significativamente la morbi-mortalidad asociada a la infección por el VIH, no obstante, no consigue la eliminación del virus. Consecuencia directa de ello es que, al suspenderlo, el virus reaparece en sangre periférica, siendo necesario mantener el tratamiento de por vida, con sus costes tanto a nivel de efectos secundarios como económicos. Frente esta situación, ha sido necesario el diseño de terapias alternativas como las terapias inmunomediadas (interrupciones estructuradas del tratamiento o vacunas terapéuticas), enfocadas a estimular el sistema inmunológico del paciente para poder suspender el TARGA de forma definitiva o, al menos, durante períodos variables de tiempo. Hoy en día no se conocen con exactitud los efectos que pueda tener la variabilidad del VIH en las terapias inmunomediadas, y el interés de nuestro estudio parte de esta premisa. Por ello, el objetivo de esta tesis es analizar, por primera vez, la evolución del virus en pacientes sometidos a vacunación terapéutica (en nuestro caso, una vacuna terapéutica de células dendríticas pulsadas con el virus autólogo inactivado por calor). / Human Immunodeficiency Virus (HIV) infection is one of the largest epidemics today. HIV is characterized by high genetic variability throughout its natural history. Multiple variants exist within the same host, which is known as quasispecies. These quasispecies are a source of adaptability of the virus, and allow the availability of alternative escape variants against a possible selective pressure in the environment (immune response, antiretroviral drugs, etc). Despite the great advances in the development of effective treatments, now has not been possible to eradicate the infection. Antiretroviral therapy (HAART) has significantly decreased morbidity and mortality associated with HIV infection, however, it fails to eliminate the virus. Direct consequence is that, when HAART is stopped, virus rebound in peripheral blood, being necessary to maintain treatment for life, with its costs both in terms of side effects and economic burden. Facing this situation, it has been necessary to design alternative therapies such as immune-mediated therapies (structured treatment interruptions or therapeutic vaccines), aimed to stimulate the patient's immune system to permanently remove HAART or, at least, for varying periods of time. Today, effects of the variability of HIV in immune-mediated therapies are not exactly known , and the interest of our study is based on this premise. Therefore, the objective of this thesis is to analyze, for the first time, the evolution of HIV in patients undergoing therapeutic vaccination (in our case, a therapeutic vaccine based on dendritic cells pulsed with autologous heat-inactivated virus).

Submitted by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-01-23T16:14:43Z No. of bitstreams: 5 anne.pdf: 708252 bytes, checksum: 4181732fe1d95bea52fbf78610b24a96 (MD5) license_url: 52 bytes, checksum: 3d480ae6c91e310daba2020f8787d6f9 (MD5) license_text: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) license.txt: 2109 bytes, checksum: aa477231e840f304454a16eb85a9235f (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2015-02-10T11:08:27Z (GMT) No. of bitstreams: 5 anne.pdf: 708252 bytes, checksum: 4181732fe1d95bea52fbf78610b24a96 (MD5) license_url: 52 bytes, checksum: 3d480ae6c91e310daba2020f8787d6f9 (MD5) license_text: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) license.txt: 2109 bytes, checksum: aa477231e840f304454a16eb85a9235f (MD5) / Made available in DSpace on 2015-02-10T11:08:27Z (GMT). No. of bitstreams: 5 anne.pdf: 708252 bytes, checksum: 4181732fe1d95bea52fbf78610b24a96 (MD5) license_url: 52 bytes, checksum: 3d480ae6c91e310daba2020f8787d6f9 (MD5) license_text: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) license.txt: 2109 bytes, checksum: aa477231e840f304454a16eb85a9235f (MD5) Previous issue date: 2013 / A pesquisa intitulada ?Sa?de Bucal de portadores de HIV-AIDS: influ?ncia de fatores sist?micos e locais no determinante sa?de-doen?a?, foi realizada durante o ano de 2012 em Diamantina, Minas Gerais. O objetivo desta pesquisa foi avaliar as condi??es bucais e sist?micas de portadores HIV/AIDS atendidos pelo Programa Municipal de DST-AIDS de Diamantina, provenientes de 24 munic?pios do Vale do Jequitinhonha. Para isso, foram avaliados 118 pacientes com HIV-AIDS. Foram observadas as condi??es de sa?de bucal e geral dos pacientes, condi??es socioecon?micas, aspectos epidemiol?gicos da infec??o pelo HIV (forma de contamina??o e de diagn?stico), uso de terapia antirretroviral de alta pot?ncia (HAART), contagem de linf?citos T CD4, h?bitos presentes (fumo, ?lcool e outras drogas), bem como o acesso destes pacientes a servi?os de Odontologia. Os resultados revelaram que a maioria dos pacientes pertencia ao g?nero masculino (53,4%), a m?dia de idade encontrada foi de 39,7 anos, a forma de contamina??o de 98,3% dos pacientes foi por via sexual e a renda familiar de 44,9% dos pacientes foi de at? 1 (um) sal?rio m?nimo mensal. Foi observado um alto ?ndice de doen?as e les?es bucais, sendo as mais prevalentes as doen?as periodontais (70,3%), a hiperpigmenta??o da mucosa (52,5%), a queilite angular (32,2%) e ulcera??es aftosas recorrentes (29,7%). A hiperpigmenta??o de mucosa parece ser mais frequente entre pacientes em uso de HAART e em tabagistas. A candidose bucal foi associada com diabetes, anemia, xerostomia, uso de HAART e taxa de CD4 > 500 cel/mm3, enquanto a ulcera??o aftosa recorrente foi associada com tabagismo, etilismo e xerostomia. / ABSTRACT The research entitled "Oral Health of HIV-AIDS patients: influence of local and systemic factors" was held during the year 2012 in Diamantina, Minas Gerais. The aim of this research was to evaluate the oral and systemic conditions of patients with HIV / AIDS attended by Municipal DST-AIDS of Diamantina, from 24 cities of Jequitinhonha Valley. To do this, 118 patients with HIV-AIDS were evaluated. The patients were observed about their conditions of oral and general health, socioeconomic aspects, epidemiological aspects of HIV infection (form of contamination and diagnosis), use of highly active antiretroviral therapy (HAART), CD4 count, customs(smoking, alcohol and other drugs), as well as access of these patients to dental services. The results revealed that most of the patients were males (53.4%), mean age was 39.7 years, the form of contamination of 98.3% of patients was through sex and the family income of 44.9% of patients is a monthly wage like $362,00. There was a high rate of disease and oral lesions, the most prevalent periodontal diseases (70.3%), mucosal hyperpigmentation (52.5%), angular cheilitis (32.2%) and recurrent aphthous ulcerations ( 29.7%). Hyperpigmentation of mucosa seems to be more frequent among patients on HAART and in smokers. Oral candidiasis was associated with diabetes, anemia, xerostomia, HAART use and CD4 count> 500 cells/mm3, while recurrent aphthous ulceration was associated with smoking, alcohol and xerostomia.

Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-09-19T12:33:33Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação de Mestrado com Ficha Catalográfica - Leonilda (6).pdf: 1607291 bytes, checksum: 83e1d52bc2be1f64f2a2a27dc1f58889 (MD5) / Made available in DSpace on 2016-09-19T12:33:33Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) Dissertação de Mestrado com Ficha Catalográfica - Leonilda (6).pdf: 1607291 bytes, checksum: 83e1d52bc2be1f64f2a2a27dc1f58889 (MD5) Previous issue date: 2016-02-18 / A infecção pelo Vírus da Imunodeficiência Humana 1 (HIV-1) tem como característica clássica a depleção de linfócitos T (LT) CD4+, que quando não tratada culmina na Síndrome da Imunodeficiência Adquirida (AIDS). Com o surgimento terapia antirretroviral (TARV), na década de 80, ocorreu uma verdadeira revolução. A TARV, apesar de não eliminar o vírus, consegue manter a carga viral em níveis indetectáveis, melhorando a qualidade de vida dos portadores. No entanto, entre 15-30% dos indivíduos em uso regular de TARV e com carga viral indetectável não consegue recuperar os níveis de LT CD4+ (Recuperação Imunológica). Estudos apontam que a apoptose pode estar envolvida na diminuição dos LT CD4+ e que variações genéticas como polimorfismos de base única (SNPs) em moléculas envolvidas nas vias da apoptose podem levar a diferentes respostas imunológicas do indivíduo à infecção. Neste sentido, o presente estudo se propôs a investigar o papel de SNPs (rs1800692, rs767455, rs2270926, rs8904, rs1800629) em genes codificadores de proteínas que ativam a via extrínseca da apoptose através do TNF-α/TNFR1, e sua relação com a recuperação imunológica de pacientes com uso regular de TARV. Foram estudados 113 pacientes HIV positivos, atendidos e tratados no Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), em uso de TARV por um ano e com carga viral indetectável, os quais foram divididos em dois grupos: sucesso imunológico (controle) e falha imunológica (caso). Não foram observadas associações entre os polimorfismos dos genes estudados com o sucesso ou falha imunológica apresentada pelos indivíduos fazendo uso regular da TARV. Também não foi observada nenhuma associação entre a falha imunológica e as variáveis clínicas: peso, etnia, idade, gênero e esquema terapêutico. Apesar da ausência de associações dos SNPs estudados com a falha imunológica, alguns fatores limitantes do estudo devem ser considerados (pequeno número amostral, não inclusão de outras moléculas da via estudada), se fazendo necessário novos estudos de réplica em outras populações. / Infection by Human Immunodeficiency Virus 1 (HIV-1) has as a classic feature the depletion of T lymphocytes (TL) CD4 + that, when untreated, culminates in Acquired Immunodeficiency Syndrome (AIDS). With the advent of HAART (Highly Active Antiretroviral Therapy), in the 80s, there was a real revolution. The ART, although it doesn't eliminate the virus, it can keep the viral load in undetectable levels, improving the quality in patient's' lifes. However, 15-30% of individuals regularly using HAART and with undetectable viral load, cannot recover CD4 + LT levels (Immune Recovery). Studies have shown that apoptosis may be involved in CD4 + depletion and genetic variations, such as single nucleotide polymorphisms (SNPs), in molecules involved in apoptosis pathways can lead to different immune responses from the individuals to the infection. Therefore, the present study aims to investigate the role of SNPs (rs1800692, rs767455, rs2270926, rs8904, rs1800629) in genes encoding proteins that activate the extrinsic pathway of apoptosis, by TNF-α / TNFR1, and its relationship with immune recovery of patients in regular use of HAART. We studied 113 HIV-positive patients assisted and treated by the Institute of Integrative Medicine Professor Fernando Figueira (IMIP), who were under HAART for at least one year and with undetectable viral load, which we divided into two groups: immunological success (control) and immunological failure (case). There were no associations between the polymorphisms of the studied genes with the immune failure presented by individuals making regular use of HAART. Also, it has been observed no associations between the immunologic failure with the clinical variables: weight, ethnicity, age, gender and treatment regimen. Despite the absence of associations of SNPs studied with immunological failure, some limitations of the study should be considered (small sample size, no inclusion of other molecules of the studied pathway), thus new replica studies in other populations are necessary.

Magister Scientiae Dentium - MSc(Dent) / HIV/AIDS remains a global health problem. Orofacial manifestations of HIV/AIDS have been found to be among the first signs of immune suppression and have been used in the clini-cal staging of the disease. Infants and children are prone to opportunistic infections because of the immature immune system. Orofacial manifestations of HIV can therefore be used to predict prog-nosis and progression of infection. The introduction of highly active anti-retroviral therapy (HAART) has since seen a decline in the development of opportunistic infections and HIV-related orofacial manifestations.