Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A síndrome da imunodeficiência adquirida (AIDS), causada pelo vírus da imunodeficiência humana (HIV), é uma das mais destrutivas epidemias do mundo, e a infecção pelo HIV em mulheres jovens vem aumentando rapidamente nos dias atuais. Esse fato tem um impacto importante na transmissão vertical do vírus. Apesar da grande maioria dos casos de aids pediátrica em todo mundo resultar da transmissão vertical, aproximadamente dois terços das crianças expostas ao HIV durante a vida fetal não são infectadas pelo vírus. Muitos trabalhos sugerem que durante a gestação doenças infecciosas maternas podem ter consequências complexas para o desenvolvimento do feto, e poucos trabalhos têm explorado o impacto da exposição ao HIV sobre a responsividade imunológica de crianças não infectadas a diferentes estímulos, particularmente na era das drogas antirretrovirais. Portanto, esse trabalho teve como objetivo avaliar eventos imunes em neonatos não-infectados expostos ao HIV-1 nascidos de gestantes que controlam (G1) ou não (G2) a carga viral plasmática, usando neonatos não expostos como controle. Para tanto, sangue do cordão umbilical de cada neonato foi coletado, plasma e células mononucleares foram separados e a linfoproliferação e o perfil de citocinas foram avaliados. Os resultados demonstraram que a linfoproliferação in vitro induzido por ativadores policlonais foi maior nos neonatos do G2. Entretanto, nenhuma cultura de célula respondeu a um conjunto de peptídeos sintéticos do envelope do HIV-1. A dosagem de citocinas no plasma e nos sobrenadantes das culturas ativadas policlonalmente demonstrou que, enquanto a IL-4 e IL-10 foram as citocinas dominantes produzidas nos grupos G1 e controle, a secreção de IFN-γ, IL-1, Il-6, IL-17 e TNF-α foi significativamente superior nos neonatos G2. Níveis sistêmicos de IL-10 observados dentre os neonatos G1 foram maiores naqueles nascidos de mães tratadas com drogas inibidoras da transcriptase reversa do vírus. Por outro lado, níveis superiores de citocinas inflamatórias foram observados dentre estes nascidos de gestantes tratadas com terapia antirretroviral de alta eficácia. Em resumo, nossos resultados indicam uma responsividade imune alterada em neonatos expostos in utero ao HIV-1 e reforça o papel do tratamento materno anti-viral com drogas menos potentes em atenuar tais distúrbios. / The acquired immunodeficiency syndrome (AIDS), caused by human immunodeficiency virus (HIV), is one the most destructive epidemic in the world, and the HIV-infection in young women has been increasing fast in the recent times. This fact has an important impact on vertical virus transmission. Although the great majority of the pediatric AIDS cases all over the world results from vertical transmission, approximately two thirds of the children exposed to the HIV during the fetal life are not infected by the virus. Many works suggest that during pregnancy, maternal infectious diseases could have complex consequences to the fetus development, and few works have explored the impact of HIV exposition on immunological responsiveness of uninfected children to different stimuli, particularly in the era of the anti-retroviral drugs. Therefore, this work aimed to evaluate immune events in HIV-1-exposed uninfected neonates born from pregnant women who controlled (G1) or not (G2) the plasma viral load, using unexposed neonates as control. Cord blood from each neonate was collected, plasma and mononuclear cells were separated and the lymphoproliferation and cytokine pattern were evaluated. The results demonstrated that the in vitro lymphoproliferation induced by polyclonal activators was higher in the G2 neonates. Nevertheless, no cell culture responded to poll synthetic HIV-1 envelope peptides. The cytokine dosage in the plasma and supernatants of polyclonally-activated cultures demonstrated that, while IL-4 and IL-10 were the dominant cytokines produced in G1 and control groups, the secretion of IFN-γ, IL-1, Il-6, IL-17 and TNF-α was significantly higher in G2 neonates. Systemic levels of IL-10 observed among the G1 neonates were higher in those born from mothers treated with viral transcriptase reverse inhibitors drugs. On the other hand, higher levels of inflammatory cytokines were observed among them born from pregnant women treated with highly active anti-retroviral therapy. In summary, our results indicate an altered immune responsiveness in neonates exposed in utero to HIV and support the role of maternal anti-viral treatment with less potent drugs to attenuate it.

Introdução: A Terapia Anti-Retroviral combinada (TARV) em indivíduos infectados com HIV-1 está associada ao desenvolvimento de dislipidemia, que é caracterizada por hipertrigliceridemia e hipercolesterolemia. As diretrizes atuais recomendam dieta e exercício físico como primeira intervenção para indivíduos HIV-1 com dislipidemia secundária aos anti-retrovirais, mas não há evidências clínicas com estudos randomizados que sustentem estas recomendações. Objetivo: Avaliar a influência da intervenção nutricional no desenvolvimento de dislipidemia em indivíduos com HIV-1 que iniciam TARV. Métodos: Indivíduos em acompanhamento regular e que preencheram os critérios de inclusão (necessidade de iniciar terapia anti-retroviral, idade >=18 anos e aceitar participar do estudo) e exclusão (gestantes, doença oportunista ativa, deficiência mental, diabetes melito, uso de drogas que alteram o perfil lipídico, hipolipemiantes ou drogas ilícitas), foram selecionados no ambulatório de HIV/AIDS do Hospital de Clínicas de Porto Alegre (Brasil). Os pacientes foram randomizados para receberem orientação nutricional para uma reeducação alimentar antes de iniciar a terapia anti-retroviral, e posteriormente orientação trimestral enfocando as dislipidemias, baseada no National Cholesterol Education Program (NCEP), (n = 43), durante 12 meses, ou para um grupo controle que recebeu a mesma orientação nutricional basal, porém sem seguimento orientado (n = 40). Perfil lipídico, índice de massa corporal (IMC) e razão cintura/quadril foram avaliados a cada três meses. Dados foram analisados por intenção de tratar, usando modelo linear misto Após a randomização as características basais foram semelhantes entre os grupos. Resultados: A intervenção dietoterápica propiciou uma redução nas calorias totais (média ± DP: de 2662 ± 614 para 2281 ± 512 kcal/dia) e o no percentual de gorduras (de 31 ± 7 para 21 ± 3%) ingerido, enquanto que o grupo controle aumentou a ingestão de calorias (de 2594 ± 550 para 2806 ± 653 kcal/dia) e não houve mudanças no percentual de gordura ingerido. O IMC manteve-se constante no grupo intervenção enquanto que no grupo controle aumentou significativamente (23,5 ± 3 para 24,2 ± 3 e 23,3 ± 3 para 26,2 ± 4; p < 0,001, respectivamente). A razão cintura/quadril aumentou em ambos os grupos, porém mais acentuadamente no grupo controle (0,86 ± 0,06 para 0,89 ± 0,06 e 0,86 ± 0,05 para 0,91 ± 0,06; p = 0,049, respectivamente). O colesterol total (de 151 ± 29 mg/dl para 190 ± 33 mg/dl) e o LDL-C (de 85 ± 24 mg/dl para 106 ± 31 mg/dl) aumentaram significativamente no grupo controle e permaneceram inalterados no grupo intervenção. Os níveis plasmáticos de triglicerídeos reduziram no grupo intervenção (135 ± 67 mg/dl para 101 ± 42 mg/dl) e aumentaram no controle (134 ± 70 mg/dl para 160 ± 76 mg/dl). Após 12 meses de acompanhamento, 21% dos indivíduos que receberam intervenção nutricional apresentaram níveis lipídicos compatíveis com dislipidemia comparados com 68% (p < 0,001) no grupo controle. Conclusão: O estudo demonstra que a intervenção nutricional previne dislipidemia associada à TARV em indivíduos infectados com HIV-1 em início de tratamento. / Background: Treatment of HIV-1-infected individuals with Highly Active Anti- Retroviral Therapy (HAART) is associated with dyslipidemia, which is characterized by hypertriglyceridemia and hypercholesterolemia. Current guidelines recommend diet and exercise as first step intervention for HIV-1-infected individuals with HAART-related dyslipidemia, but there is no evidence from randomized trials to support this recommendation. Objective: To evaluate the effects of dietary intervention on the development of dyslipidemia in HIV-1 infected individuals who are started on HAART. Methods: Eighty-three HIV-1- infected patients naive from previous treatment were randomized to receive HAART with dietary intervention (n = 43) or HAART without dietary intervention (controls, n = 40) for 12 months. Dietary intervention, according to the National Cholesterol Education Program, was given every 3 months. Before and after intervention, 24 h food records, body mass index, weight/hip ratio, and lipid profile were obtained. Data were analyzed by intention to treat, using mixed-effects models. Results: After randomization, groups had similar characteristics. Dietary intervention resulted in reduction in total caloric intake (mean ± SD: from 2,662 ± 14 to 2,281 ± 512 kcal/day) and percentage of fat intake (from 31 ± 7 to 21 ± 3% of calories), while controls increased caloric intake (from 2,594 ± 550 to 2,806 ± 653 kcal/day), with no change in percentage of fat intake. Body mass index stayed in the group intervention while in the group control it increased significantly (from 23,5 ± 3 to 24,2 ± 3 and 23,3 ± 3 to 26,2 ± 4; p < 0,001, respectively) The waist/hip ratio increased in both groups, however more strongly in the group control (from 0,86 ± 0,06 to 0,89 ± 0,06 and 0,86 ±0,05 to 0,91 ± 0,06; p = 0,049, respectively). Plasma cholesterol (from 151 ± 29 to 190 ± 33 mg/dl) and LDL-C-cholesterol (from 85 ± 24 to 106 ± 31 mg/dl) increased in the controls and were unchanged in the dietary intervention group. Plasma triglycerides were reduced by dietary intervention (from 135 ± 67 to 101 ± 42 mg/dl) and increased in controls (from 134 ± 70 to 160,76 mg/dl). After one year follow-up, 21% of patients who received dietary intervention had lipid profile compatible with dyslipidemia, while 68% (p < 0.001) of controls had dyslipidemia. Conclusion: This randomized trial demonstrates that dietary intervention prevents dyslipidemia associated with HAART in HIV-1-infected individuals.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A síndrome da imunodeficiência adquirida (AIDS), causada pelo vírus da imunodeficiência humana (HIV), é uma das mais destrutivas epidemias do mundo, e a infecção pelo HIV em mulheres jovens vem aumentando rapidamente nos dias atuais. Esse fato tem um impacto importante na transmissão vertical do vírus. Apesar da grande maioria dos casos de aids pediátrica em todo mundo resultar da transmissão vertical, aproximadamente dois terços das crianças expostas ao HIV durante a vida fetal não são infectadas pelo vírus. Muitos trabalhos sugerem que durante a gestação doenças infecciosas maternas podem ter consequências complexas para o desenvolvimento do feto, e poucos trabalhos têm explorado o impacto da exposição ao HIV sobre a responsividade imunológica de crianças não infectadas a diferentes estímulos, particularmente na era das drogas antirretrovirais. Portanto, esse trabalho teve como objetivo avaliar eventos imunes em neonatos não-infectados expostos ao HIV-1 nascidos de gestantes que controlam (G1) ou não (G2) a carga viral plasmática, usando neonatos não expostos como controle. Para tanto, sangue do cordão umbilical de cada neonato foi coletado, plasma e células mononucleares foram separados e a linfoproliferação e o perfil de citocinas foram avaliados. Os resultados demonstraram que a linfoproliferação in vitro induzido por ativadores policlonais foi maior nos neonatos do G2. Entretanto, nenhuma cultura de célula respondeu a um conjunto de peptídeos sintéticos do envelope do HIV-1. A dosagem de citocinas no plasma e nos sobrenadantes das culturas ativadas policlonalmente demonstrou que, enquanto a IL-4 e IL-10 foram as citocinas dominantes produzidas nos grupos G1 e controle, a secreção de IFN-&#947;, IL-1&#61538;, Il-6, IL-17 e TNF-&#945; foi significativamente superior nos neonatos G2. Níveis sistêmicos de IL-10 observados dentre os neonatos G1 foram maiores naqueles nascidos de mães tratadas com drogas inibidoras da transcriptase reversa do vírus. Por outro lado, níveis superiores de citocinas inflamatórias foram observados dentre estes nascidos de gestantes tratadas com terapia antirretroviral de alta eficácia. Em resumo, nossos resultados indicam uma responsividade imune alterada em neonatos expostos in utero ao HIV-1 e reforça o papel do tratamento materno anti-viral com drogas menos potentes em atenuar tais distúrbios. / The acquired immunodeficiency syndrome (AIDS), caused by human immunodeficiency virus (HIV), is one the most destructive epidemic in the world, and the HIV-infection in young women has been increasing fast in the recent times. This fact has an important impact on vertical virus transmission. Although the great majority of the pediatric AIDS cases all over the world results from vertical transmission, approximately two thirds of the children exposed to the HIV during the fetal life are not infected by the virus. Many works suggest that during pregnancy, maternal infectious diseases could have complex consequences to the fetus development, and few works have explored the impact of HIV exposition on immunological responsiveness of uninfected children to different stimuli, particularly in the era of the anti-retroviral drugs. Therefore, this work aimed to evaluate immune events in HIV-1-exposed uninfected neonates born from pregnant women who controlled (G1) or not (G2) the plasma viral load, using unexposed neonates as control. Cord blood from each neonate was collected, plasma and mononuclear cells were separated and the lymphoproliferation and cytokine pattern were evaluated. The results demonstrated that the in vitro lymphoproliferation induced by polyclonal activators was higher in the G2 neonates. Nevertheless, no cell culture responded to poll synthetic HIV-1 envelope peptides. The cytokine dosage in the plasma and supernatants of polyclonally-activated cultures demonstrated that, while IL-4 and IL-10 were the dominant cytokines produced in G1 and control groups, the secretion of IFN-&#947;, IL-1&#61538;, Il-6, IL-17 and TNF-&#945; was significantly higher in G2 neonates. Systemic levels of IL-10 observed among the G1 neonates were higher in those born from mothers treated with viral transcriptase reverse inhibitors drugs. On the other hand, higher levels of inflammatory cytokines were observed among them born from pregnant women treated with highly active anti-retroviral therapy. In summary, our results indicate an altered immune responsiveness in neonates exposed in utero to HIV and support the role of maternal anti-viral treatment with less potent drugs to attenuate it.

Introdução: A Terapia Anti-Retroviral combinada (TARV) em indivíduos infectados com HIV-1 está associada ao desenvolvimento de dislipidemia, que é caracterizada por hipertrigliceridemia e hipercolesterolemia. As diretrizes atuais recomendam dieta e exercício físico como primeira intervenção para indivíduos HIV-1 com dislipidemia secundária aos anti-retrovirais, mas não há evidências clínicas com estudos randomizados que sustentem estas recomendações. Objetivo: Avaliar a influência da intervenção nutricional no desenvolvimento de dislipidemia em indivíduos com HIV-1 que iniciam TARV. Métodos: Indivíduos em acompanhamento regular e que preencheram os critérios de inclusão (necessidade de iniciar terapia anti-retroviral, idade >=18 anos e aceitar participar do estudo) e exclusão (gestantes, doença oportunista ativa, deficiência mental, diabetes melito, uso de drogas que alteram o perfil lipídico, hipolipemiantes ou drogas ilícitas), foram selecionados no ambulatório de HIV/AIDS do Hospital de Clínicas de Porto Alegre (Brasil). Os pacientes foram randomizados para receberem orientação nutricional para uma reeducação alimentar antes de iniciar a terapia anti-retroviral, e posteriormente orientação trimestral enfocando as dislipidemias, baseada no National Cholesterol Education Program (NCEP), (n = 43), durante 12 meses, ou para um grupo controle que recebeu a mesma orientação nutricional basal, porém sem seguimento orientado (n = 40). Perfil lipídico, índice de massa corporal (IMC) e razão cintura/quadril foram avaliados a cada três meses. Dados foram analisados por intenção de tratar, usando modelo linear misto Após a randomização as características basais foram semelhantes entre os grupos. Resultados: A intervenção dietoterápica propiciou uma redução nas calorias totais (média ± DP: de 2662 ± 614 para 2281 ± 512 kcal/dia) e o no percentual de gorduras (de 31 ± 7 para 21 ± 3%) ingerido, enquanto que o grupo controle aumentou a ingestão de calorias (de 2594 ± 550 para 2806 ± 653 kcal/dia) e não houve mudanças no percentual de gordura ingerido. O IMC manteve-se constante no grupo intervenção enquanto que no grupo controle aumentou significativamente (23,5 ± 3 para 24,2 ± 3 e 23,3 ± 3 para 26,2 ± 4; p < 0,001, respectivamente). A razão cintura/quadril aumentou em ambos os grupos, porém mais acentuadamente no grupo controle (0,86 ± 0,06 para 0,89 ± 0,06 e 0,86 ± 0,05 para 0,91 ± 0,06; p = 0,049, respectivamente). O colesterol total (de 151 ± 29 mg/dl para 190 ± 33 mg/dl) e o LDL-C (de 85 ± 24 mg/dl para 106 ± 31 mg/dl) aumentaram significativamente no grupo controle e permaneceram inalterados no grupo intervenção. Os níveis plasmáticos de triglicerídeos reduziram no grupo intervenção (135 ± 67 mg/dl para 101 ± 42 mg/dl) e aumentaram no controle (134 ± 70 mg/dl para 160 ± 76 mg/dl). Após 12 meses de acompanhamento, 21% dos indivíduos que receberam intervenção nutricional apresentaram níveis lipídicos compatíveis com dislipidemia comparados com 68% (p < 0,001) no grupo controle. Conclusão: O estudo demonstra que a intervenção nutricional previne dislipidemia associada à TARV em indivíduos infectados com HIV-1 em início de tratamento. / Background: Treatment of HIV-1-infected individuals with Highly Active Anti- Retroviral Therapy (HAART) is associated with dyslipidemia, which is characterized by hypertriglyceridemia and hypercholesterolemia. Current guidelines recommend diet and exercise as first step intervention for HIV-1-infected individuals with HAART-related dyslipidemia, but there is no evidence from randomized trials to support this recommendation. Objective: To evaluate the effects of dietary intervention on the development of dyslipidemia in HIV-1 infected individuals who are started on HAART. Methods: Eighty-three HIV-1- infected patients naive from previous treatment were randomized to receive HAART with dietary intervention (n = 43) or HAART without dietary intervention (controls, n = 40) for 12 months. Dietary intervention, according to the National Cholesterol Education Program, was given every 3 months. Before and after intervention, 24 h food records, body mass index, weight/hip ratio, and lipid profile were obtained. Data were analyzed by intention to treat, using mixed-effects models. Results: After randomization, groups had similar characteristics. Dietary intervention resulted in reduction in total caloric intake (mean ± SD: from 2,662 ± 14 to 2,281 ± 512 kcal/day) and percentage of fat intake (from 31 ± 7 to 21 ± 3% of calories), while controls increased caloric intake (from 2,594 ± 550 to 2,806 ± 653 kcal/day), with no change in percentage of fat intake. Body mass index stayed in the group intervention while in the group control it increased significantly (from 23,5 ± 3 to 24,2 ± 3 and 23,3 ± 3 to 26,2 ± 4; p < 0,001, respectively) The waist/hip ratio increased in both groups, however more strongly in the group control (from 0,86 ± 0,06 to 0,89 ± 0,06 and 0,86 ±0,05 to 0,91 ± 0,06; p = 0,049, respectively). Plasma cholesterol (from 151 ± 29 to 190 ± 33 mg/dl) and LDL-C-cholesterol (from 85 ± 24 to 106 ± 31 mg/dl) increased in the controls and were unchanged in the dietary intervention group. Plasma triglycerides were reduced by dietary intervention (from 135 ± 67 to 101 ± 42 mg/dl) and increased in controls (from 134 ± 70 to 160,76 mg/dl). After one year follow-up, 21% of patients who received dietary intervention had lipid profile compatible with dyslipidemia, while 68% (p < 0.001) of controls had dyslipidemia. Conclusion: This randomized trial demonstrates that dietary intervention prevents dyslipidemia associated with HAART in HIV-1-infected individuals.

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style="font-size: 10pt / font-family: &quot / Times New Roman&quot / ,&quot / serif&quot / ">Background: The care and treatment for people with HIV/AIDS (PLWHA) at the Kagera regional hospital began in February 2005. It is important to evaluate quality of life (QOL) of highly active anti-retroviral therapy (HAART) recipients periodical to assess HAART&rsquo / s effectiveness. This study aimed to assess the health-related QOL (HRQOL) of HAART recipients and determine factors associated with it, two years after the programme had started at the kagera regional hospital in Tanzania. Results: The HRQOL of HAART recipients was generally lower than that of the general population. However, the general health perceptions (p=0.191) and mental health (p=0.161) means score of HAART recipients were not different from those of the Tanzanian general population. About 89% of the HAART recipients reported better health than in the previous years. Chronic diseases were associated with lower HRQOL of HAART recipients independently of other factors. HAART recipients with chronic diseases co-morbidity were more likely to score below the general population&rsquo / s mean score for mental health (p=0.007). While the effect of chronic diseases on HRQOL among those who recorded CD4+ cell increase was negative (OR=13.6,95%CI=3.7 / 49.9), there was no effect on those who did not have such an increase. Adherence to ARVs and CD4+ cell count were not associated with HRQOL. &nbsp / &nbsp / &nbsp / &nbsp / &nbsp / &nbsp / <span style=""> <o:p></o:p></span></span></p> <p style="margin-bottom: 0.0001pt / line-height: normal / " class="MsoNormal"><span style="font-size: 12pt / font-family: &quot / Times New Roman&quot / ,&quot / serif&quot / "><o:p>&nbsp / </o:p></span></p> <span style="font-size: 12pt / font-family: &quot / Times New Roman&quot / ,&quot / serif&quot / "><span style="">&nbsp / </span><span style="">&nbsp / </span><span style="">&nbsp / </span><span style="">&nbsp / </span><span style=""> </span><o:p></o:p></span></p> <p>&nbsp / </p>

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style="font-size: 10pt / font-family: &quot / Times New Roman&quot / ,&quot / serif&quot / ">Background: The care and treatment for people with HIV/AIDS (PLWHA) at the Kagera regional hospital began in February 2005. It is important to evaluate quality of life (QOL) of highly active anti-retroviral therapy (HAART) recipients periodical to assess HAART&rsquo / s effectiveness. This study aimed to assess the health-related QOL (HRQOL) of HAART recipients and determine factors associated with it, two years after the programme had started at the kagera regional hospital in Tanzania. Results: The HRQOL of HAART recipients was generally lower than that of the general population. However, the general health perceptions (p=0.191) and mental health (p=0.161) means score of HAART recipients were not different from those of the Tanzanian general population. About 89% of the HAART recipients reported better health than in the previous years. Chronic diseases were associated with lower HRQOL of HAART recipients independently of other factors. HAART recipients with chronic diseases co-morbidity were more likely to score below the general population&rsquo / s mean score for mental health (p=0.007). While the effect of chronic diseases on HRQOL among those who recorded CD4+ cell increase was negative (OR=13.6,95%CI=3.7 / 49.9), there was no effect on those who did not have such an increase. Adherence to ARVs and CD4+ cell count were not associated with HRQOL. &nbsp / &nbsp / &nbsp / &nbsp / &nbsp / &nbsp / <span style=""> <o:p></o:p></span></span></p> <p style="margin-bottom: 0.0001pt / line-height: normal / " class="MsoNormal"><span style="font-size: 12pt / font-family: &quot / Times New Roman&quot / ,&quot / serif&quot / "><o:p>&nbsp / </o:p></span></p> <span style="font-size: 12pt / font-family: &quot / Times New Roman&quot / ,&quot / serif&quot / "><span style="">&nbsp / </span><span style="">&nbsp / </span><span style="">&nbsp / </span><span style="">&nbsp / </span><span style=""> </span><o:p></o:p></span></p> <p>&nbsp / </p>

>Magister Scientiae - MSc / Amperometric sensors for Tenofovir, a model nucleotide/ nucleoside reverse transcriptase inhibitor ARV drug, were studied based on the principle of ion-transfer electrochemistry at the membrane-stabilized oil/ water interface (O||W) in a four-electrode cell set-up. Solutions of the hydrophobic salts tetradodecylammonium tetrakis(4-chlorophenyl) borate (ETH500), ethyl violet tetraphenylborate (EthVTPB), tetrabutylammonium tetraphenylborate (TBATPB), tetraphenylphosphnium tetraphenylborate (TPphTPB) and three ionic liquids (Methyltrioctylammonium bis(trifluoromethyl sulfonyl)imide (IL1), 1-butyl-3- methylimdazolium bis(trifluoromethyl sulfonyl)imide (IL3) and 1-propyl-3- methylimdazolium bis(trifluoromethylsulfonyl)imide (IL4)) in nitrobenzene (NB), 1,2- dichloroethane (DCE), and 2-nitrophenyloctyl ether (NPOE) were each tested as O-phases. The cyclic voltammograms of the resulting O||W interfaces in aq. Li2SO4 or aq. MgSO4 were compared with respect to noise, potential window, and other parameters. The three ILs were also tested as self-sufficient salts without a solvent medium. In the end, the ETH500/ DCE salt/ solvent pair was found to yield the best behaved polarizable O||W interface in aq. MgSO4. The analytical characteristics of the resulting sensors to tenofovir without (Ag|ETH500/DCE||) and with the dibenzo-18-crown-6 (Ag|ETH5000/DB18C6/DCE|| in the O-phase were studied with respect to the two pairs of peaks in the CV, namely the WO ion transfer peak and the reverse OW peak. Both sensors exhibited operational stability of 90 min. After consideration of reasonable S/N ratio and sample throughput rates, the scan rate of 25 mV/ s was used in subsequent signal interrogation with CV. The final potential windows were 0.95 V wide for Ag|ETH500 (10 mM)/ DCE|| in aq. MgSO4 (50 mM) and 0.70 V wide for Ag|ETH500 (10 mM)/ DB18C6 (50 mM)/ DCE|| in aq. MgSO4 (50 mM). From plots of peak currents versus square of scan rate, tenofovir diffusion coefficients of about 2.48 × 10-11 cm2/ s were estimated, which indicated diffusion through the supporting membrane as the rate limiting process. Based on WO ion transfer peaks, the first one exhibited a detection limit of about 5 M, a linear range of 15 – 100 M, and sensitivity of 7.09 nA M-1 towards tenofovir, whereas for the second one these were respectively 3 M, 6.32 nA M-1, and 9 – 100 M. In this way, a four-electrode amperometric detection of ion transfer process at liquid | liquid interface, both under simple and ionophore-facilitated mode, has been demonstrated as promising for analysis of tenofovir as a representative of the nucleotide/ nucleoside reverse transcriptase inhibitor ARV drugs

HIV is one of the world’s most potent killers. It’s a name we have most likely heard of before, and yet there are aspects of this disease that do not get as much of the spotlight. One such aspect of HIV is adherence. Adherence is a colossal issue when dealing with anti-retroviral (ART) medications. A lack of adherence to ART dosage can lead to viral immunity and even AIDS if not treated. Despite many attempts from providers to solve the issue of adherence, studies tell us that the challenges of adherence lie within deep-seeded sociocultural and economic backgrounds. As a result, an anthropological approach seems necessary in order to grasp these challenges. Overall, I believe that adherence is learned and innate. I aim to prove this by exploring the various provider discourses regarding HIV adherence by delving into the history of AIDS, the patient/provider hierarchy, and media representations of HIV.

A research report submitted to the faculty of Health Sciences, University of the Witwatersrand in partial fulfillment of the requirements for the Master of Science Degree in Epidemiology. / Antiretroviral therapy (ART) recommendations among HIV – infected pregnant women have been revised several times by the World Health Organization (WHO). Option B+, which is the latest recommendation continues to be rolled out in several countries across the globe but mostly in sub-Saharan Africa. Retention in care and adherence to antiretroviral (ARV) drugs taken by these women remains unclear in this new program. We assessed ability to stay in care (retention) and adherence to ART among HIV – infected women starting life-long treatment during pregnancy and after, at an HIV care and treatment clinic in Ifakara Tanzania. Our study provided an opportunity to understand the trends in adherence to ART and retention in care for this population. Methods We analyzed data of HIV-infected pregnant women registered and starting ART for the first time in the Kilombero and Ulanga Antiretroviral Cohort in 2009 and 2010 with a follow up period of up to two years to 2011 and 2012 respectively. Adherence was by patient self-report (PSR) and was sufficient (good) if the woman took all the prescribed pills of the issued batch or insufficient (poor) if she missed two or more pills. Women that missed two or more consecutive scheduled visits to the clinic were not retained while those that honored their scheduled visits were retained in care. Two sample t test and Wilcoxon rank sum test were used to test predictor outcome associations for continuous variables while Pearson’s and Fisher’s exact tests were used for categorical ones. Hazard ratios of each predictor variable were calculated using Cox regression. Student No: 737395 Page v Results A total of 1,282 HIV – infected women were registered in KIULARCO between 2009 and 2010. Fifty (50) were pregnant and started life-long ART upon registration in this period. Of these, 25 (50%) were registered in 2009 and the other 25 (50%) in 2010. Slightly more than half, 52.2% had CD4 cell counts above 350cells/mm3. Almost half, 49% of the women were registered in their final (third) pregnancy trimester. About 82% were in WHO stage one and 60% of all the 50 women were initiated on AZT/3TC/EFV regimen. Only 5.7% had secondary education while the rest had primary or no education at all. Of the women that reported their partners HIV state, 54.5% had partners that had never tested for HIV. Adherence for all participants was reported as sufficient (good) for the entire period the women were in care. No one had insufficient (poor) adherence. Retention in care was higher during pregnancy than after delivery. Generally, loss to follow up was 40%. About 30% were lost during pregnancy and the majority, 70% lost after they had delivered their babies. There was no evidence to prove that any of the factors studied independently predicted non retention. The most likely time to non retention was six months after delivery. Conclusions Our study, despite small sample size, shows that among women diagnosed HIV – infected and starting life-long ART during pregnancy (Option B+), adherence to ART is sufficient and retention in care similar during and after pregnancy. Counseling on the importance of staying in care especially around the first few months after delivery should be emphasized at ANC.

A identificação de ateroma de carótida em radiografia panorâmica de pacientes com alterações sistêmicas que predispõem a aterosclerose é mais frequente do que em amostras da população em geral. O uso da terapia antirretroviral combinada (TARVc), que prolongou a sobrevida dos pacientes portadores do HIV (HIV+), também contribuiu para o aumento da incidência de alterações metabólicas e provavelmente de complicações cardiovasculares. Este estudo teve o objetivo de investigar a prevalência de imagens suspeitas de ateromas de carótida (ISAC) em radiografias panorâmicas de pacientes HIV+ em tratamento no Centro de Atendimento de Pacientes Especiais (CAPE) da Faculdade de Odontologia da Universidade de São Paulo, bem como tentar identificar variáveis associadas à ocorrência destas imagens. Foram avaliadas 300 radiografias de pacientes de ambos os gêneros e com média de idade de 40 anos (18-73 anos). A prevalência de radiografias com ISAC foi de 8,2% (25/300). Estes pacientes apresentaram a média de idade significativamente maior do que a dos pacientes sem ISAC (p= 0,008) e a mediana do nadir de CD4 significativamente menor (p=0,019). O uso do medicamento lopinavir/r (LPV/r) estava associado a chance 2,8 vezes maior para presença de ISAC (OD=2,79 1,12-6,95 IC=95%, p=0,045). Conclui-se que quanto maior a idade maior a probabilidade de ocorrência de ISAC e que as variáveis significativas encontradas (nadir de CD4 e LPV/r) são compatíveis com os fatores de risco cardiovascular observados em pacientes portadores do HIV, relacionados tanto à gravidade da infecção como ao uso de medicamentos. / The identification of calcified carotid artery atheroma (CCAA) in panoramic radiography of patients with systemic diseases that predispose the atherosclerosis is more frequent than in the general population samples. The use of high active antiretroviral therapy (HAART), which prolonged the life of patients with HIV (HIV+), also increase the incidence of cardiovascular complications, probably by the use of protease inhibitors (PI). This study aimed to investigate the prevalence of suspected images of CCAA in panoramic radiographs of HIV+ patients in treatment in the Special Care Dentistry Center of the University of São Paulo, São Paulo, Brazil, as well as trying to identify variables associated with these images. Three hundred radiographs of patients of both genders, with a mean age of 40 years (18-73 years) were evaluated. The prevalence of CCAA suspected images was 8.2% (25/300). This patients showed the mean age significantly higher than that of the patients without CCAA images (p = 0.008) and the CD4 nadir median significantly lower (p = 0.019). The use of HAART with lopinavir/r (LPV/r) was associated with a greater chance for CCAA images (OD 2.79, CI 95% 1.12-6.95; p = 0.045). In conclusion, patients with higher age are more susceptible to CCAA suspected image and the significant variables found (CD4 nadir and LPV/r) are compatible with the cardiovascular risk factors in patients HIV+, related both to the severity of the infection and the use of antiretroviral.