Indiana University-Purdue University Indianapolis (IUPUI) / The Gram-negative bacterium Pseudomonas aeruginosa is an opportunistic pathogen which readily establishes itself in the lungs of people with cystic fibrosis (CF). Most CF patients have life-long P. aeruginosa infections. By modulating its own virulence and forming biofilms, P. aeruginosa is able to evade both host immune responses and antibiotic treatments. Previous studies have shown that the magnesium transporter MgtE plays a role in virulence modulation by inhibiting transcription of the type III secretion system, a mechanism by which bacteria inject toxins directly into the eukaryotic host cell. MgtE had already been identified as a magnesium transporter, and thus its role in regulating cytotoxicity was indicative of dual functions for this protein. This research focused on a structure-function analysis of MgtE, with the hypothesis that the magnesium transport and cytotoxicity functions could be exerted independently. Cytotoxicity assays were conducted using a co-culture model system of cystic fibrosis bronchial epithelial cells and a ∆mgtE strain of P. aeruginosa transformed with plasmids carrying wild type or mutated mgtE. Magnesium transport was assessed using the same mgtE plasmids in a Salmonella strain deficient in all magnesium transporters. Through analysis of a number of mgtE mutants, we found two constructs – a mutation in a putative magnesium binding site, and an N-terminal truncation – which demonstrated a separation of functions. We further demonstrated the uncoupling of functions by showing that different mgtE mutants vary widely in their ability to regulate cytotoxicity, whether or not they are able to transport magnesium. Overall, these results support the hypothesis of MgtE as a dual function protein and may lead to a better understanding of the mechanisms underlying P. aeruginosa virulence. By understanding virulence mechanisms, we may be able to develop treatments to reduce infections and pave the way to better health for people with cystic fibrosis.

Por serem as manifestações pulmonares de etiologia infecciosas muito freqüentes e potencialmente graves nas crianças com aids, o diagnóstico deve ser precoce para uma rápida e efetiva intervenção terapêutica. A proteína C reativa (PCR), um dos marcadores das provas de fase aguda, tem sido usada na prática clínica como um recurso diagnóstico na diferenciação entre patologias sistêmicas de etiologia viral e bacteriana, bem como na monitorização da eficácia da terapêutica antimicrobiana frente a uma infecção. Apesar da proteína C reativa ser um exame inespecífico e poder estar aumentada em diferentes situações clínicas (infecções sistêmicas, doenças inflamatórias e neoplásicas, isquemias, queimaduras), a infecção bacteriana é a causa mais freqüente para o seu aumento. A PCR eleva-se rapidamente após a injúria tecidual, atingindo valores 10 a 1000 vezes superiores a seu nível basal: em virtude de sua curta meia vida, retorna em pouco tempo aos valores prévios após o fim da agressão. Com o objetivo de encontrar um método laboratorial auxiliar para as infecções pulmonares nas crianças com infecção pelo HIV foi estudada a proteína C reativa, pela técnica de nefelometria, em dois momentos distintos: na ausência de quadro infeccioso concomitante (grupo 1) e na vigência de pneumonia aguda (grupo 2). O grupo 1 envolveu o estudo de 66 crianças com infecção pelo HIV, resultando em 84 amostras de PCR coletadas na ausência de quadro infeccioso concomitante.No grupo 2 foram analisadas 6 crianças com infecção pelo HIV com 9 episódios de pneumonia aguda. As crianças com infecção pelo HIV foram classificadas de acordo com as categorias clínicas e imunológicas da classificação do CDC para infecção pelo HIV em crianças. Dentre as 66 crianças incluídas no grupo 1, 6 pertenciam à categoria N, 11 à categoria A, 27 à categoria B e 22 à categoria C. Das 84 amostras de PCR coletadas no grupo 1, 76 (90,48%) encontravam-se abaixo de 5 mg/l, 7 amostras entre 5 a 20 mg /l e, apenas 1 amostra entre 20 a 40 mg/l (1,15%). No grupo 2, todas as crianças eram pertencentes às categorias B3 (1/6) ou C3 (5/6), refletindo um estágio mais avançado da doença. Das 9 amostras de PCR, 6 apresentavam valores maiores que 40 mg/l, 1 entre 20 e 40 mg/l e as 2 amostras restantes, entre 5 e 20 mg/l. Os dados sugerem portanto que a infecção pelo HIV por si só não é acompanhada de aumento da PCR, bem como não existe relação com a classificação imunológica em que o paciente se encontre. Pacientes com infecção pelo HIV na vigência de pneumonia aguda apresentam níveis aumentados de PCR. Neste estudo, o ponto de corte que diferenciou os grupos 1 e 2 foi PCR = 28,9 mg/l com sensibilidade de 77,8% e especificidade de 100% (IC 95%) / As pulmonary infection is a common and potentially serious condition in HIV-infected children, effectiveness of treatment of this kind of affection depends to a large extent on the promptness of accurate diagnosis. The C-Reactive Protein (CRP), a reasonably well-established acute phase marker, has long been used to differentiate bacterial from viral infections. Despite its lack of specifity, that is, the fact that other conditions like inflammatory diseases, neoplasms, ischemia and burns may also increase CRP levels, Bacterial infections are the most frequent cause of increased CRP found in daily clinical practice. Shortly after any tissular injury, CRP increases considerably, reaching up to 10-1000 times its previous levels. Due to its short half-life, its decrease after the end of the affection is quick as well. This study aimed at evaluating the CRP (assessed by nephelometry) as an auxiliary tool to diagnose pulmonary infection in HIV-infected children. Two groups of patients were considered in this study: group 1 was constituted by 66 HIV-infected children with no clinical signs of concomitant infection (amounting to 84 CRP samples) and group 2 was constituted by 6 HIV-infected children with pneumonia (amounting to 9 CRP samples). All the subjects were assigned to categories according to the pediatric HIV classification system (CDC, 1994). Among the 66 children from group 1, 6 were assigned to categories N, 11 to A, 27 to B and 22 to C. Regarding the levels of CRP in group 1 it was found: 76 samples (90.48%) < 5 mg/l, 7 (8.33%) in the range between 5 and 20 mg/l and 1 sample between 20 and 40 mg/l. In the group 2, all the children were assigned either to category B3 (1/6) or C3 (5/6) and the CRP level distribution was the following: 6 (6/9) > 40 mg/l, 1 (1/6) between 20 and 40 mg/l and 2 (2/6) between 5 and 20 mg/l. These results suggest that 1.HIV infection by itself does not increase the levels of CRP, regardless the immunologic classification of the patient; 2.HIV-infected children with pneumonia present increased levels of CRP 3.In this study, the cut-off point to differentiate groups 1 and 2 was 28,9 mg/l, with sensitivity of 77,8% and specificity of 100% (p < 0.05)

Made available in DSpace on 2016-01-26T12:51:37Z (GMT). No. of bitstreams: 1 arlindoschiesarijunior_dissert.pdf: 1015118 bytes, checksum: a4f2b40a6b49a66d95541b775795efb0 (MD5) Previous issue date: 2010-11-25 / Hereby we present the epidemiological and clinical profile of the HIV-infected group before and during the HAART era from a tertiary care hospital catering to a large population from the Southeastern Brazilian region. A retrospective, cross-sectional and descriptive study was carried out, which involved the analysis of the medical records of patients diagnosed with HIV-1/AIDS admitted to Hospital Escola Emílio Carlos, located in the municipality of Catanduva, State of São Paulo, Brazil. In both pre-HAART and HAART periods, HIV-1 infection was more prevalent in men. Heterosexuality and secondary education were the risk facts for acquisition of the disease in the HAART period. Statistically significant association was only observed for co-infection with HIV-1/Hepatitis C in the pre-HAART era and the number of patients with opportunistic illness (OI) was lower in the HAART period. Among all these OI it is worth mentioning pulmonary pneumocystosis, since despite being frequent in the two periods, its occurrence was considerably greater in the pre-HAART era. Concerning the distribution of OI according to the HIV-1 viral load and serial count of T CD4+ lymphocytes, a significant association was observed. The association between the number of deaths by OI and the survival rate of less than 1 year in the HAART period was significant. The clinical and epidemiological picture of a specialized HIV-1/AIDS Center in a municipality in the southeastern region of Brazil is consistent with the current epidemiology of AIDS in the country. In conclusion, our results indicate that the OI are still important causes of morbi-mortality among HIV-1/AIDS infected patients in the municipality of Catanduva, particularly pulmonary pneumocystosis, tuberculosis and cryptococcal meningoencephalitis. We are aware that retrospective studies such as ours, which involve the review of patients medical records, may present some limitations arising from the scarcity or even absence of information. / Nós apresentamos o perfil clínico e epidemiológico de indivíduos portadores do HIV-1 antes e durante a era da terapia antirretroviral altamente ativa (HAART) de um hospital terciário que atende uma grande população da região Sudeste do Brasil. Estudo retrospectivo, transversal e descritivo que envolveu a análise de prontuários dos pacientes diagnosticados com HIV-1/AIDS atendidos no Hospital Escola Emílio Carlos, localizado no município de Catanduva, Estado de São Paulo, Brasil. Em ambos os períodos pré-HAART e HAART, a infecção por HIV-1 foi mais prevalente em homens. Heterossexualidade e nível de escolaridade do ensino médio foram os fatores de risco para aquisição da doença no período HAART. Associação estatisticamente significante foi observada somente para a coinfecção HIV-1/Hepatite C na era pré-HAART e o número de pacientes com infecções oportunistas (IO) foi menor no período HAART. Entre todas estas IO vale à pena mencionar a pneumocistose pulmonar, pois apesar de ser freqüente nos dois períodos, sua ocorrência foi significativamente maior na era pré-HAART. Quanto à distribuição de IO de acordo com a carga viral do HIV-1 e contagem de linfócitos T CD4 +, uma associação significativa foi observada. A associação entre o número de mortes por IO e a taxa de sobrevivência de menos de um ano na era HAART foi significativa. O quadro clínico e epidemiológico de um centro de atendimento especializado em HIV-1/AIDS em um município na região sudeste do Brasil é compatível com a epidemiologia atual da AIDS no país. Em conclusão, nossos resultados indicam que as IO ainda são importantes causas de morbi-mortalidade entre os pacientes infectados por HIV-1/AIDS no município de Catanduva, particularmente a pneumocistose pulmonar, a tuberculose e a meningoencefalite criptococócica. Estamos cientes de que estudos retrospectivos como o nosso, que envolvem a revisão de prontuários médicos, podem apresentar algumas limitações decorrentes da escassez, ou mesmo da ausência de informações.

Por serem as manifestações pulmonares de etiologia infecciosas muito freqüentes e potencialmente graves nas crianças com aids, o diagnóstico deve ser precoce para uma rápida e efetiva intervenção terapêutica. A proteína C reativa (PCR), um dos marcadores das provas de fase aguda, tem sido usada na prática clínica como um recurso diagnóstico na diferenciação entre patologias sistêmicas de etiologia viral e bacteriana, bem como na monitorização da eficácia da terapêutica antimicrobiana frente a uma infecção. Apesar da proteína C reativa ser um exame inespecífico e poder estar aumentada em diferentes situações clínicas (infecções sistêmicas, doenças inflamatórias e neoplásicas, isquemias, queimaduras), a infecção bacteriana é a causa mais freqüente para o seu aumento. A PCR eleva-se rapidamente após a injúria tecidual, atingindo valores 10 a 1000 vezes superiores a seu nível basal: em virtude de sua curta meia vida, retorna em pouco tempo aos valores prévios após o fim da agressão. Com o objetivo de encontrar um método laboratorial auxiliar para as infecções pulmonares nas crianças com infecção pelo HIV foi estudada a proteína C reativa, pela técnica de nefelometria, em dois momentos distintos: na ausência de quadro infeccioso concomitante (grupo 1) e na vigência de pneumonia aguda (grupo 2). O grupo 1 envolveu o estudo de 66 crianças com infecção pelo HIV, resultando em 84 amostras de PCR coletadas na ausência de quadro infeccioso concomitante.No grupo 2 foram analisadas 6 crianças com infecção pelo HIV com 9 episódios de pneumonia aguda. As crianças com infecção pelo HIV foram classificadas de acordo com as categorias clínicas e imunológicas da classificação do CDC para infecção pelo HIV em crianças. Dentre as 66 crianças incluídas no grupo 1, 6 pertenciam à categoria N, 11 à categoria A, 27 à categoria B e 22 à categoria C. Das 84 amostras de PCR coletadas no grupo 1, 76 (90,48%) encontravam-se abaixo de 5 mg/l, 7 amostras entre 5 a 20 mg /l e, apenas 1 amostra entre 20 a 40 mg/l (1,15%). No grupo 2, todas as crianças eram pertencentes às categorias B3 (1/6) ou C3 (5/6), refletindo um estágio mais avançado da doença. Das 9 amostras de PCR, 6 apresentavam valores maiores que 40 mg/l, 1 entre 20 e 40 mg/l e as 2 amostras restantes, entre 5 e 20 mg/l. Os dados sugerem portanto que a infecção pelo HIV por si só não é acompanhada de aumento da PCR, bem como não existe relação com a classificação imunológica em que o paciente se encontre. Pacientes com infecção pelo HIV na vigência de pneumonia aguda apresentam níveis aumentados de PCR. Neste estudo, o ponto de corte que diferenciou os grupos 1 e 2 foi PCR = 28,9 mg/l com sensibilidade de 77,8% e especificidade de 100% (IC 95%) / As pulmonary infection is a common and potentially serious condition in HIV-infected children, effectiveness of treatment of this kind of affection depends to a large extent on the promptness of accurate diagnosis. The C-Reactive Protein (CRP), a reasonably well-established acute phase marker, has long been used to differentiate bacterial from viral infections. Despite its lack of specifity, that is, the fact that other conditions like inflammatory diseases, neoplasms, ischemia and burns may also increase CRP levels, Bacterial infections are the most frequent cause of increased CRP found in daily clinical practice. Shortly after any tissular injury, CRP increases considerably, reaching up to 10-1000 times its previous levels. Due to its short half-life, its decrease after the end of the affection is quick as well. This study aimed at evaluating the CRP (assessed by nephelometry) as an auxiliary tool to diagnose pulmonary infection in HIV-infected children. Two groups of patients were considered in this study: group 1 was constituted by 66 HIV-infected children with no clinical signs of concomitant infection (amounting to 84 CRP samples) and group 2 was constituted by 6 HIV-infected children with pneumonia (amounting to 9 CRP samples). All the subjects were assigned to categories according to the pediatric HIV classification system (CDC, 1994). Among the 66 children from group 1, 6 were assigned to categories N, 11 to A, 27 to B and 22 to C. Regarding the levels of CRP in group 1 it was found: 76 samples (90.48%) < 5 mg/l, 7 (8.33%) in the range between 5 and 20 mg/l and 1 sample between 20 and 40 mg/l. In the group 2, all the children were assigned either to category B3 (1/6) or C3 (5/6) and the CRP level distribution was the following: 6 (6/9) > 40 mg/l, 1 (1/6) between 20 and 40 mg/l and 2 (2/6) between 5 and 20 mg/l. These results suggest that 1.HIV infection by itself does not increase the levels of CRP, regardless the immunologic classification of the patient; 2.HIV-infected children with pneumonia present increased levels of CRP 3.In this study, the cut-off point to differentiate groups 1 and 2 was 28,9 mg/l, with sensitivity of 77,8% and specificity of 100% (p < 0.05)

Magister Public Health - MPH / Antiretroviral therapy (ART) improves the quality of lives of people living with HIV/AIDS by suppressing HIV replication and improving the patient’s immunity. An improved immunity will help prevent patients from contracting opportunistic infections. Adherence to ART is vital to obtain good clinical outcome for patients. Defaulting ART leads to increase in viral load, decreased host immunity, development of HIV drug resistant strains, exposure to opportunistic infections and ultimately death. HIV positive patients who are on ART face many challenges in adhering to their medications, these challenges act as barriers to their adherence to treatment. This study explores the barriers that adult patients in a hospital in Eastern Cape of South Africa face while on treatment. These barriers include individual factors, socio-economic factors, health service factors, medical regimen factors.

Masters of Art / This project suggested that HIV people in Region A (Nelson Mandela Metropole, formerly Port Elizabeth) health district of the Eastern Cape, seek HIV testing when they are already in stages three (late disease) and four (AIDS) of HIV infection. Data had been obtained from the AIDS Training Information and Counselling Centre in the Nelson Mandela Metropole in 2000. The consequences of diagnoses only in the advanced stages of HIV infection will have a devastating impact on case management. Therefore, this paper yielded important data for South African policy makers to write health and welfare policies that might improve the quality of life of those terminally infected with HIV. / South Africa

Chronic granulomatous disease (CGD) is associated with defective function of the NADPH-oxidase system in conjunction with phagocytic defects which leads to granuloma formation and serious infectious complications. This is often associated with significant morbidity and mortality. The association of defective phagocyte function with other coincidental immune defects is unknown. Defects in innate pathways seen with CGD, including complement systems, and toll-like and dectin receptor pathways, have not been described before. We present the case of a 2-year old male patient hospitalized with recurrent pneumonia, a non-healing skin ulcer, necrotizing lung granulomas, and epididymo-orchitis. Defective neutrophil chemiluminescence was detected by dihydrorhodamine (DHR) testing. Further evaluation demonstrated characteristic molecular mutations of CYBB consistent with CGD. Immune evaluation demonstrated polyclonal hyperglobulinemia, but a greatly reduced mannose binding lectin (MBL) level. Six biallelic polymorphisms in MBL gene and its promoter were analyzed using Light Cycler™ Real-time PCR assay. The LXPA/LYPB haplotype of MBL was detected in our patient; the latter is the defective haplotype associated with low MBL levels. Due to the implications for innate immunity and the protection against bacterial, viral, and fungal infections provided by MBL, a deficiency of this protein may have disastrous consequences on the long term outcomes of CGD. MBL deficiency can also complicate other disorders affecting the immune system, significantly increasing the risk of infection in such patients. Further studies looking at the frequency and implications of MBL deficiency in CGD are needed.

This study investigates whether the HIV/AIDS and Life Skills Education Programme for schools was implemented in accordance with the Ministry's directives. It also seeks to establish whether the programme was effective or not by identifying and examining different implementation strategies and methodologies. Fieldwork was undertaken in the Lupane Area Development Programme where nine schools were randomly selected from sixteen primary schools. A total of nine head-teachers responded to the heads' questionnaire and fifty-eight Grade 4 to 7 teachers responded to the teachers' questionnaire. The study reveals that to a very large extent the HIV/AIDS and Life-skills Education Programme was implemented from Grades 4 to 7 in the primary schools. However, substantial improvements still need to be made in mobilising reading and financial resources. More training and the introduction of more participatory methodologies need to be stepped up for the children to realise more benefits from this life skills education programme. / Development Studies / M.A. (Development Studies)

A colonização nasal por Staphylococcus aureus e a infecção pelo HIV representam problemas de saúde pública de preocupação mundial. O objetivo geral foi identificar os fatores de risco para a colonização nasal por Staphylococcus aureus em pessoas vivendo com HIV/aids. Para tanto, foi realizado um estudo tipo caso-controle, com pessoas vivendo com HIV/aids internadas nas unidades especializadas na assistência às doenças infecciosas de um hospital de ensino no interior paulista. A coleta de dados ocorreu de janeiro/2013 a fevereiro/2015, por meio de entrevista individual contemplando dados sociodemográficos e clínicos, além da coleta da secreção nasal com auxílio do swab em meio Stuart, ambos nas primeiras 24 horas de internação. As amostras foram encaminhadas e processadas pelo Laboratório de Microbiologia da própria instituição. Os critérios de inclusão foram: ter idade acima de 18 anos, ser soropositivo ao HIV, estar internado. Nas análises estatísticas foram realizados os testes qui-quadrado de Pearson, Exato de Fisher, t-Student, Wilcoxon e Regressão Logística Univariada e Multivariada, por meio do software SAS®. Os dados estão apresentados em tabelas e figuras. O presente estudo foi aprovado pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de Ribeirão Preto (No CAAE 38990114.5.0000.5393) e pela instituição co-participante (No CAAE 38990114.5.3001.5440). Participaram do estudo 240 pessoas vivendo com HIV/aids, sendo 120 Casos e 120 Controles, houve predominância do sexo masculino em 65,0% dos Casos e 55,0% dos Controles, 35,8% dos Casos estavam na faixa etária de 30 a 39 anos e 45,8% dos Controles tinham idade de 40 a 49 anos, a etnia predominante foi a branca para Casos e Controles, 74,2% e 64,2%, respectivamente. Os grupos foram homogêneos entre si em relação ao sexo, etnia e escolaridade. A média do tempo de diagnóstico foi de 9 anos para Casos e 8,8 anos para Controles. O modelo final de regressão logística evidenciou como fatores de risco associados à colonização nasal por Staphylococcus aureus em pessoas vivendo com HIV/aids, ser da etnia branca, p=0,05 (OR:1,85; IC95% 1,00 - 3,57); ter carga viral >40 cópias/mL, p= 0,03 (OR: 2,90; IC95% 1,15 - 7,30); estar com contagem de LT-CD4+ <200 células/mm3 p=0,001 (OR: 2,71; IC95% 1,53 - 4,81); e apresentar doença oportunista p=0,014 (OR: 2,09; IC95% 1,20 - 3,67). Além disso, foi evidenciado como fator de proteção para a colonização nasal pelo Staphylococcus aureus em pessoas vivendo com HIV/aids o uso de antirretroviral p=0,008 (OR: 0,45; IC95% 0,25 - 0,81). Concluímos que a colonização nasal por Staphylococcus aureus nas pessoas vivendo com HIV/aids foi associada aos fatores: etnia, carga viral, contagem de LT-CD4+ , infecção oportunista e uso de antirretroviral / Staphylococcus aureus nasal colonization and HIV infection represent public health problems of global concern. The overall objective was to identify the risk factors for nasal colonization by Staphylococcus aureus in people living with HIV / AIDS. Therefore, a case-control study was conducted, with people living with HIV / AIDS hospitalized at the units specialized in infectious disease care at a teaching hospital in the interior of São Paulo. Data were collected from January / 2013 to February / 2015 by means of an individual interview, including sociodemographic and clinical data, as well as the collection of nasal secretions with the aid of swab in Stuart\'s medium, both during the first 24 hours of hospitalization. The samples were sent and processed by the Laboratory of Microbiology of the institution itself. The inclusion criteria were: to be over 18 years of age, to be known as infected HIV, to be hospitalized. Statistical analyzes were performed using the Pearson chi-square test, Fisher\'s exact test, Student t-test, Wilcoxon test, and Univariate and Multivariate logistic regression using the SAS® software. The data are presented in tables and figures. The present study was approved by the Research Ethics Committee of the Ribeirão Preto College of Nursing (CAAE 38990114.5.0000.5393) and by the co- participating institution (CAAE 38990114.5.3001.5440). A total of 240 people living with HIV / AIDS participated in the study, of which 120 were Cases and 120 Controls; 65.0% of Cases and 55.0% of Controls were male: 35.8% of Cases were in the age group of 30 at 39 years and 45.8% of the Controls were aged from 40 to 49 years, the predominant ethnicity was white for Cases and Controls, 74.2% and 64.2%, respectively. The groups were homogeneous among themselves in relation to gender, ethnicity and schooling. The mean time of diagnosis was 9 years for Cases and 8.8 years for Controls. The final logistic regression model showed that the risk factors associated with Staphylococcus aureus nasal colonization in people living with HIV / AIDS were white, p = 0.05 (OR: 1.85, 95% CI: 1.00 - 3.57); having viral load> 40 copies / mL, p = 0.03 (OR: 2.90; IC95% 1.15 - 7.30); being with LT-CD4+ <200 cells / mm3 p = 0.001 (OR: 2.71; IC95% 1.53 - 4.81); and present opportunistic disease p = 0.014 (OR: 2,09; IC95% 1,20 - 3,67). In addition, it was also obtained by the final regression final model that the use of antiretroviral therapy is a protection factor of p = 0.008 (OR: 0.45; 95% CI 0.25 - 0.81) for nasal colonization by Staphylococcus aureus. We conclude that nasal colonization by Staphylococcus aureus in people living with HIV/AIDS was associated with factors: ethnicity, viral load, LT-CD4+ count, opportunistic infection, and antiretroviral use

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2016-07-06T14:36:10Z No. of bitstreams: 1 arlindosjunior_dissert.pdf: 1444679 bytes, checksum: 3c39df3ac849b54a266ccc0a6c1cc238 (MD5) / Made available in DSpace on 2016-07-06T14:36:10Z (GMT). No. of bitstreams: 1 arlindosjunior_dissert.pdf: 1444679 bytes, checksum: 3c39df3ac849b54a266ccc0a6c1cc238 (MD5) Previous issue date: 2010-11-25 / Hereby we present the epidemiological and clinical profile of the HIV-infected group before and during the HAART era from a tertiary care hospital catering to a large population from the Southeastern Brazilian region. A retrospective, cross-sectional and descriptive study was carried out, which involved the analysis of the medical records of patients diagnosed with HIV-1/AIDS admitted to Hospital Escola Emílio Carlos, located in the municipality of Catanduva, State of São Paulo, Brazil. In both pre-HAART and HAART periods, HIV-1 infection was more prevalent in men. Heterosexuality and secondary education were the risk facts for acquisition of the disease in the HAART period. Statistically significant association was only observed for co-infection with HIV-1/Hepatitis C in the pre-HAART era and the number of patients with opportunistic illness (OI) was lower in the HAART period. Among all these OI it is worth mentioning pulmonary pneumocystosis, since despite being frequent in the two periods, its occurrence was considerably greater in the pre-HAART era. Concerning the distribution of OI according to the HIV-1 viral load and serial count of T CD4+ lymphocytes, a significant association was observed. The association between the number of deaths by OI and the survival rate of less than 1 year in the HAART period was significant. The clinical and epidemiological picture of a specialized HIV-1/AIDS Center in a municipality in the southeastern region of Brazil is consistent with the current epidemiology of AIDS in the country. In conclusion, our results indicate that the OI are still important causes of morbi-mortality among HIV-1/AIDS infected patients in the municipality of Catanduva, particularly pulmonary pneumocystosis, tuberculosis and cryptococcal meningoencephalitis. We are aware that retrospective studies such as ours, which involve the review of patients’ medical records, may present some limitations arising from the scarcity or even absence of information. / Nós apresentamos o perfil clínico e epidemiológico de indivíduos portadores do HIV-1 antes e durante a era da terapia antirretroviral altamente ativa (HAART) de um hospital terciário que atende uma grande população da região Sudeste do Brasil. Estudo retrospectivo, transversal e descritivo que envolveu a análise de prontuários dos pacientes diagnosticados com HIV-1/AIDS atendidos no Hospital Escola Emílio Carlos, localizado no município de Catanduva, Estado de São Paulo, Brasil. Em ambos os períodos pré-HAART e HAART, a infecção por HIV-1 foi mais prevalente em homens. Heterossexualidade e nível de escolaridade do ensino médio foram os fatores de risco para aquisição da doença no período HAART. Associação estatisticamente significante foi observada somente para a coinfecção HIV-1/Hepatite C na era pré-HAART e o número de pacientes com infecções oportunistas (IO) foi menor no período HAART. Entre todas estas IO vale à pena mencionar a pneumocistose pulmonar, pois apesar de ser freqüente nos dois períodos, sua ocorrência foi significativamente maior na era pré-HAART. Quanto à distribuição de IO de acordo com a carga viral do HIV-1 e contagem de linfócitos T CD4 +, uma associação significativa foi observada. A associação entre o número de mortes por IO e a taxa de sobrevivência de menos de um ano na era HAART foi significativa. O quadro clínico e epidemiológico de um centro de atendimento especializado em HIV-1/AIDS em um município na região sudeste do Brasil é compatível com a epidemiologia atual da AIDS no país. Em conclusão, nossos resultados indicam que as IO ainda são importantes causas de morbi-mortalidade entre os pacientes infectados por HIV-1/AIDS no município de Catanduva, particularmente a pneumocistose pulmonar, a tuberculose e a meningoencefalite criptococócica. Estamos cientes de que estudos retrospectivos como o nosso, que envolvem a revisão de prontuários médicos, podem apresentar algumas limitações decorrentes da escassez, ou mesmo da ausência de informações.