Apesar dos avanços tecnológicos e terapêuticos para o manejo do HIV/aids, os desfechos desfavoráveis da doença, como é o caso das internações, se mantém com um desafio para a saúde pública. Nesse sentido, objetivou-se analisar as internações hospitalares por aids ocorridas em 2013 em um hospital de grande porte de um município do interior de São Paulo. Trata-se de estudo descritivo, exploratório, do tipo levantamento, quantitativo. Foram incluídos indivíduos com idade igual ou superior a 18 anos, hospitalizados no período de janeiro a dezembro/2013, cujas causas de internação principal ou secundárias estivessem relacionadas ao HIV/aids, considerando os seguintes códigos, segundo a Classificação Internacional de Doenças (CID-10): B20.0 ao B24, Z20, Z20.6, Z21 e R75. Elaborou-se um formulário específico para a coleta de dados, cujas fontes secundárias de informação utilizadas foram: Sistema de Internação Hospitalar, prontuário clínico, Sistema de Informação de Agravos de Notificação, HygiaWeb, Sistema de Controle Logístico de Medicamentos. Os dados foram analisados por meio de técnicas exploratórias, incluindo proporções, medidas de tendência central e variabilidade. Foram identificadas 259 internações relacionadas a 179 pessoas que viviam com aids, com reinternações no período (42,5%). O perfil dos sujeitos constitui-se por homens (62,1%); faixa etária entre 40 e 50 anos (38%); cor branca (62,1%); solteiros (50,8%); baixa escolaridade (40,2%); alguma fonte de renda (36,3%); histórico de uso de álcool (49,2%), tabaco (63,1%) e outras drogas ilícitas (46,3%) e de má adesão à terapia antirretroviral (TARV) (49,7%). A duração média das internações foi de 14,1 dias (DP± 12,6) e o desfecho predominante foi a alta médica (83,4%. Na maioria dos casos havia alguma manifestação clínica no momento da internação (55,2%), bem como a presença de doenças oportunistas (71,8%) e condições crônicas associadas (55,2%). Das pessoas internadas, a maioria possuía baixa contagem de células T CD4+ (83,8%) e carga viral detectável (71%). Quanto aos antecedentes assistenciais, 49,7% dos sujeitos tinham algum histórico de tratamento em serviços de assistência especializada em HIV/aids (SAE) da rede pública municipal. Considerando o período de 12 meses antes da internação, 35,8% dos sujeitos passaram em pelo menos uma consulta no SAE municipal; 46,9% nunca utilizaram serviços de atenção básica; 64,8% utilizaram pronto atendimento; 67,6% procederam a alguma retirada da TARV e 29% realizaram 80% ou mais das possíveis retiradas da TARV. Apesar do aprimoramento de testes diagnósticos e a disponibilização da TARV em larga escala, a hospitalização por HIV/aids mantém relação com grupos minoritários desfavorecidos, os quais possuem o status imunológico agravado em decorrência da ação viral no organismo, sugerindo disparidades que perpassam o acesso ao diagnóstico precoce, tratamento oportuno e profilaxia de infecções oportunistas. Urge a necessidade de ações intra e intersetoriais que visem a focalização de sujeitos mais vulneráveis para superar as barreiras assistenciais de modo que os benefícios da TARV sejam disponíveis a todas as pessoas que vivem com a doença / Despite technological and therapeutic advances in the HIV/ADS management unfavorable outcomes of the disease, as the case of hospitalization, remains a challenge to public health. In this sense, this study aimed to analyze hospital admissions due to AIDS in 2013 occurred in a large hospital in a city of São Paulo. This is a descriptive, exploratory study, type survey, quantitative. Were included individuals aged over 18 years, hospitalized in the period of January-December/2013 whose main or secondary causes of hospitalization were related to HIV/AIDS, considering the following codes according to the International Classification of Diseases (ICD 10) the B20.0 to B24, Z20, Z20.6, Z21 and R75. A specific form was elaborated for data collection, whose secondary sources of information were used: System Hospitalization, clinical record, System for Notifiable Diseases, HygiaWeb, Logistics Management System of Medicines. Data were analyzed using exploratory techniques, including proportions, measures of central tendency and variability. Were identified 259 hospitalizations related to 179 people living with AIDS, with readmissions in the period (42.5%). The profile of the individuals is constituted by men (62.1%); aged between 40 and 50 years (38%); white color skin (62.1%); single (50.8%); low education (40.2%); some source of income (36.3%); history of alcohol use (49.2%), tobacco (63.1%) and other illicit drugs (46.3%) and poor adherence to antiretroviral therapy (ART) (49.7%). The average length of hospitalization was 14.1 days (SD ± 12.6) and the predominant outcome was medical discharge (83.4%. In most cases there was any clinical signs at admission (55.2%) as well as the presence of opportunistic infections (71.8%) and chronic conditions associated (55.2%). of hospitalized persons, the majority had low CD4+ T cell count (83.8%) and detectable viral load (71 %). As for healthcare background, 49.7% of subjects had a history of treatment in specialized care services on HIV/AIDS (SHS) of the municipal public network. Considering the 12 months prior to admission, 35.8% the subjects passed in at least one visit in the municipal SHS; 46.9% never used primary care services; 64.8% used emergency care; 67.6% have carried out any withdrawal of antiretroviral therapy and 29% had 80% or more of possible withdrawn from ART. Despite the improvement of diagnostic tests and the availability of HAART on a large scale, hospitalization for HIV/AIDS remains relation to disadvantaged minority groups, which have the immune status worsened due to the viral action in the body, suggesting disparities that pervade the access to early diagnosis, timely treatment and prophylaxis of opportunistic infections. There is an urgent need for intra and inter-sectoral actions aimed at targeting vulnerable individuals to overcome barriers assistance so that the benefits of ART are available to all people living with the disease

O presente estudo teve como objetivo identificar áreas de risco para a co-infecção HIV/TB no município de Ribeirão Preto através da distribuição espacial dos casos notificados em 2006. Trata-se de um estudo de caráter ecológico em que a unidade de observação é um conjunto de indivíduos do município de Ribeirão Preto-SP. A população do estudo foi constituída por 48 casos novos de co-infecção HIV/TB notificados e residentes em Ribeirão Preto no ano de 2006. As informações sobre os doentes de TB co-infectados foram coletadas do sistema de notificação TB-WEB. Outra fonte de informação utilizada foi a base de dados dos setores censitários do município disponibilizada pelo Instituto Brasileiro de Geografia e Estatística (IBGE) referentes ao censo demográfico do ano 2000. Para caracterização dos doentes foram selecionadas variáveis sócio-demográficas (sexo, data de nascimento, escolaridade e endereço do doente) e clínico-epidemiológicas (tipo de caso, forma clínica, tipo de tratamento, encerramento de caso e local de atendimento). Para caracterizar os setores censitários foram selecionadas variáveis relacionadas a: renda média dos responsáveis pelos domicílios, média de anos de instrução das pessoas responsáveis pelos domicílios, renda média das mulheres chefes de família, média de anos de instrução das mulheres chefes de família, proporção de pessoas analfabetas, proporção de mulheres analfabetas, porcentagem de domicílios com 5 ou mais moradores. Os casos novos de co-infecção selecionadas foram então georreferenciados utilizando-se o software ArcGIS 9.1, da Esri. A Unidade espacial de análise considerada foi a de setor censitário e a análise estatística realizada foi a de componentes principais. Após o cálculo dos fatores socioeconômicos, foi escolhido o responsável pela maior variação (83%) que foi chamado de fator socioeconômico. Dos setores que permaneceram para análise (633), estes foram ordenados de forma decrescente e divididos em tercis. Assim, os tercis foram classificados em 3 faixas socioeconômicas: superior (condições socioeconômicas mais favoráveis), intermediária e inferior (condições socioeconômicas desfavoráveis). Em 2006, no período da coleta, 190 casos de TB estavam notificados no TB-WEB, sendo 58 (30,5%) casos de co-infecção. Foram considerados para este estudo 48 casos novos de co-infecção. Os resultados mostraram que: 68,7% dos casos eram do sexo masculino, faixa etária de 20 a 39 anos (47,9%), 4 a 7 anos de escolaridade (58,3%), forma clínica pulmonar (75%), sob o tratamento supervisionado (48%), 48% foram curados e 31% em tratamento no HCFMRPUSP. A distribuição espacial mostrou uma concentração dos casos de co-infecção nas regiões oeste e norte do município (58,3%) e 52,1% dos casos localizam-se na faixa socioeconômica inferior, seguido da faixa intermediária. O estudo evidenciou a forte ligação entre o aparecimento da TB e aspectos sociais entre os casos de AIDS. O conhecimento de alguns determinantes sociais e mesmo a desigualdade que permeia um espaço geográfico pode favorecer um planejamento mais adequado de ações para controle dessas doenças. / This ecological study aimed to identify the risk areas for HIV/TB (Human Immunodeficiency Virus, HIV/tuberculosis) co-infection in the city of Ribeirão Preto, state of São Paulo, through the spatial distribution of the cases registered in 2006. The unit of observation was a set of individuals from Ribeirão Preto. The study population consisted of 48 new cases of HIV/TB co-infection, registered and of patients living in Ribeirão Preto in 2006. The information about co-infected TB patients was collected in the TB-WEB register system. Another source of information used was the database of the census sectors of the city, published by the Brazilian Institute for Geography and Statistics (IBGE) regarding the demographic census of the year 2000. Sociodemographic variables (gender, birth date, educational level and address) and clinical-epidemiological variables (type of case, clinical form, type of treatment, case closing and venue of care) were selected for patients\' characterization. To characterize the census sectors, variables related to the following topics were selected: average income of the individuals responsible for the households, average years of education of the individuals responsible for the households, average income of the women head of families, average years of education of the women head of families, proportion of illiterate people, proportion of illiterate women, percentage of households with 5 or more residents. The selected new coinfection cases were then georeferentiated using the ArcGIS 9.1 software, by Esri. The census sector was considered the spatial analysis unit and the statistical analysis was carried out with the main components. After the calculation of the socioeconomic factors, the responsible for the main variation (83%) was chosen, and it was entitled socioeconomic factor. The sectors remaining for analysis (633) were ordered decreasingly and divided into tertiles. Thus, the tertiles were classified in socioeconomic bands: upper (more favorable socioeconomic conditions), intermediate and lower (unfavorable socioeconomic conditions). In 2006, during the data collection period, 190 TB cases were registered in the TB-WEB, of which 58 (30.5%) were cases of co-infection. In this study, 48 new cases of co-infection were considered. The results showed that: 68.7% of the cases were of male subjects, aged between 20 and 39 years of age (47.9%), having studied between 4 to 7 years (58.3%), pulmonary clinical form (75%), under supervised treatment (48%), 48% had been cured and 31% were under treatment at HCFMRP-USP (Hospital das Clinicas of the University of São Paulo at Ribeirao Preto Medical School). The spatial distribution showed the concentration of the cases of coinfection in the West and North regions of the city (58.3%) and 52.1% of the cases were located in the lower socioeconomic band, followed by the intermediate band. The study evidenced a strong relation between the outcome of TB and social aspects among the cases of AIDS. The knowledge of certain social determinants and even the inequality that permeates a geographic space can favor a more appropriate planning of actions for the control of these diseases.

<p>Bakgrund: Varje dag smittas i genomsnitt cirka 14 000 personer av HIV i världen. Ny behandling har gjort att dessa patienter idag lever längre. Sjukdomsförlopp samt komplikationer går inte att förutsäga utan är individuellt. Eftersom personer med HIV/AIDS-diagnos nu lever längre kommer behovet av arbetsterapeutiska insatser att öka. Syfte: Syftet med studien är att beskriva arbetsterapeutiska insatser för personer med HIV/AIDS samt vilken roll arbetsterapeuten har i arbetet kring dessa personer. Metod: En systematisk litteraturstudie gjordes för att få svar på syftet. Resultat: Vi har kommit fram till att arbetsterapeutiska insatser för personer med HIV/AIDS kan delas in i fem teman; Handledning, Hjälpmedel och anpassning, Undervisning, Förhållningssätt samt Existentiella frågor och andlighet. Arbetsterapeuten hjälper patienten att formulera målsättningar och att uppnå ökad självständighet genom att bland annat tillhandahålla hjälpmedel och bedriva utbildning. HIV/AIDS-patienters bakgrund är viktig att tänka på då den kan visa hur mottaglig en patient är för olika arbetsterapeutiska behandlingsmetoder. Slutsats: Arbetsterapeutiska insatser som används i arbetet med HIV/AIDS-patienter skiljer sig inte mot insatser riktade till andra patientgrupper.</p>

<p>The quantitative findings indicated high levels of HIV/AIDS knowledge, self-concept and self-efficacy. Risky sexual behaviour was measured in terms of condom use and the number of sexual partners in the 12 months prior to the study with males reporting significantly more risky sexual behaviour. More males (70% vs. 43 % females) reported no condom use when engaging in sex. More males (62 % vs. 28 % females) reported having had two or more sexual partners in the 12 months prior to the study. Results also suggested that an increase in knowledge of HIV/AIDS would predict an increase in the use of condoms particularly for males. Lower self-efficacy seemed to predict an increase in the number of sexual partners for males. The focus group discussions highlighted students' views of HIV/AIDS knowledge in relation to their sexual practices, attitudes and sexual decision-making. Influences such as personal factors (self-concept and self-efficacy), social factors (e.g. peer influences, gender, and status) and environmental factors (e.g. media) were investigated. Participants also commented on the effectiveness of HIV/AIDS campaigns and the adequacy in provision of health services at college and community level. From the findings, guidelines were developed which may be used to reflect on current intervention programmes and may be considered when developing future interventions programmes, policies, or campaigns in promoting safer sexual practices amongst youth as a means of addressing the HIV/AIDS pandemic.</p>

Bakgrund: Varje dag smittas i genomsnitt cirka 14 000 personer av HIV i världen. Ny behandling har gjort att dessa patienter idag lever längre. Sjukdomsförlopp samt komplikationer går inte att förutsäga utan är individuellt. Eftersom personer med HIV/AIDS-diagnos nu lever längre kommer behovet av arbetsterapeutiska insatser att öka. Syfte: Syftet med studien är att beskriva arbetsterapeutiska insatser för personer med HIV/AIDS samt vilken roll arbetsterapeuten har i arbetet kring dessa personer. Metod: En systematisk litteraturstudie gjordes för att få svar på syftet. Resultat: Vi har kommit fram till att arbetsterapeutiska insatser för personer med HIV/AIDS kan delas in i fem teman; Handledning, Hjälpmedel och anpassning, Undervisning, Förhållningssätt samt Existentiella frågor och andlighet. Arbetsterapeuten hjälper patienten att formulera målsättningar och att uppnå ökad självständighet genom att bland annat tillhandahålla hjälpmedel och bedriva utbildning. HIV/AIDS-patienters bakgrund är viktig att tänka på då den kan visa hur mottaglig en patient är för olika arbetsterapeutiska behandlingsmetoder. Slutsats: Arbetsterapeutiska insatser som används i arbetet med HIV/AIDS-patienter skiljer sig inte mot insatser riktade till andra patientgrupper.

Toxoplasmosis is an important cause of congenital disease, and it is one of the most common opportunistic infections in patients with acquired immunodeficiency syndrome. The need for a reliable experimental model of this infection is crucial not only for achieving a better understanding of the patho-physiology of the disease, but also for developing better methods for evaluating new therapeutic regimens. The purpose of the present study was to investigate the role of CD4+CD25+ T regulatory lymphocytes in mice infected with Toxoplasma gondii. T regulatory (Treg) cells have been shown to play an important role in our immune system in controlling the activity of other T lymphocytes. These cells are differentiated from other T lymphocyte populations based on the co-expression of CD4 and CD25 and expression of the Foxp3 gene. The results of several recent studies have suggested that certain pathogens may be able to increase their survival in the host by exploiting T reg cell activity. T regulatory cells have been shown to control the persistence of the protozoan parasite, Leishmania major, in mice; however, this population of cells plays only a limited role during murine infection with Trypanosoma cruzi. In the present study we have investigated the role of Treg cells during murine infection with the ME49 strain of T. gondii. In vivo depletion of Treg cells was accomplished by injecting mice with a monoclonal antibody (Mab) isolated from the 7D4 rat hybridoma cell line. This Mab is specific for the interleukin-2 receptor chain (also known as CD25). Female Swiss Webster mice of approximately 6-7 weeks of age were depleted of Treg cells by intraperitoneal injection of 400µg of Mab, mice were injected once 7days prior to infection, and a second time 1 day prior to infection, with 20 tissue cysts of T. gondii. Mouse weight and tissue cyst numbers were monitored to evaluate the impact of Treg depletion on the outcome of infection. Our results suggest that depletion of Treg cells has little measurable impact during the acute stage of infection with the ME49 strain of T. gondii. Further studies will be required to determine what role, if any, these cells play in the chronic stage of murine toxoplasmosis.

<p>The quantitative findings indicated high levels of HIV/AIDS knowledge, self-concept and self-efficacy. Risky sexual behaviour was measured in terms of condom use and the number of sexual partners in the 12 months prior to the study with males reporting significantly more risky sexual behaviour. More males (70% vs. 43 % females) reported no condom use when engaging in sex. More males (62 % vs. 28 % females) reported having had two or more sexual partners in the 12 months prior to the study. Results also suggested that an increase in knowledge of HIV/AIDS would predict an increase in the use of condoms particularly for males. Lower self-efficacy seemed to predict an increase in the number of sexual partners for males. The focus group discussions highlighted students' views of HIV/AIDS knowledge in relation to their sexual practices, attitudes and sexual decision-making. Influences such as personal factors (self-concept and self-efficacy), social factors (e.g. peer influences, gender, and status) and environmental factors (e.g. media) were investigated. Participants also commented on the effectiveness of HIV/AIDS campaigns and the adequacy in provision of health services at college and community level. From the findings, guidelines were developed which may be used to reflect on current intervention programmes and may be considered when developing future interventions programmes, policies, or campaigns in promoting safer sexual practices amongst youth as a means of addressing the HIV/AIDS pandemic.</p>

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karol inst., 2003. / Härtill 5 uppsatser.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2006. / Härtill 4 uppsatser.