Primary Antiretroviral Drug Resistance among HIV Type 1-Infected Individuals in Brazil

Infection with drug-resistant human immunodeficiency virus type 1 (HIV-1) has been documented in all countries that have surveyed for it and may result in an unfavorable response to therapy. The prevalence and characteristics of individuals with transmitted resistance to antiretroviral drugs have been scarcely described in Brazil. We performed antiretroviral resistance testing prior to initiation of therapy in 400 subjects enrolled from 20 centers in 13 Brazilian cities between March and September 2007. Genotyping was conducted using PCR-amplified HIV pol products by automated sequencing, and genotype interpretation was done according to the IAS-USA consensus. Of 400 eligible participants, 387 (95.8%) were successfully tested. Seven percent of antiretroviral-naive patients carried viruses with one or more major mutation associated with drug resistance. The prevalence of these mutations was 1.0% for protease inhibitors, 4.4% for nonnucleoside reverse transcriptase inhibitors, and 1.3% for nucleoside reverse transcriptase inhibitors. The frequency of multidrug resistance among the resistant strains was 13.6%. Among subjects infected with drug-resistant virus, the majority were infected with subtype B viruses (91%). Subjects from the city of Sao Paulo had higher transmitted resistance mutations compared to the rest of the country. Reporting a partner taking antiretroviral medications was associated with a higher chance of harboring HIV variants with major drug resistance mutations [odds ratio = 2.57 (95% confidence interval, 1.07-6.16); p = 0.014]. Resistance testing in drug-naive individuals identified 7% of subjects with mutations associated with reduced susceptibility to antiretroviral drugs. Continued surveillance of drug-resistant HIV-1 in Brazil is warranted when guidelines for HIV prophylaxis and treatment are updated. Resistance testing among drug-naive patients prior to treatment initiation should be considered, mainly directed at subjects whose partners are already on antiretroviral therapy.259861867Laboratorio Pfizer do Brasi

Prevalence and risk factors for hepatitis C virus (HCV) infection among pregnant Brazilian women

Objectives: To determine the prevalence and the risk factors associated with HCV infection among women at childbirth, and to assess potential for infectivity of anti-HCV-positive women. Methods: A total of 6995 women were interviewed and screened for HCV antibodies. Association and logistic regression analyses were conducted. Results: The anti-HCV prevalence was 1.5% by EIA-3 and 0.8% by RIBA-3; HCV-RNA (RT-PCR) was detected in 74% of the RIBA-positive samples. Blood transfusion, race (blacks), alcohol abuse, a history of STD and anti-HBc positivity were independent risk factors for HCV positivity. Except for parenteral exposure, independent predictors of anti-HCV were a history of STD, anti-HBc positivity, a sex partner with multiple sex partners and a sex partner with a history of hepatitis. Conclusions: The prevalence of anti-HCV is higher in pregnant women than in blood donors. Sexual exposure may facilitate the spread of HCV and there is a high potential for mother-to-infant transmission. (C) 2000 International Federation of Gynecology and Obstetrics.70331932

Mother-to-infant transmission of hepatitis C virus (HCV) in Brazil

Sixty-one women with anti-HCV antibodies, detected by a third-generation enzyme immunoassay (EIA3), were prospectively recruited for investigation of vertical HCV transmission during childbirth, at the University Hospital of the Catholic University of Campinas, Brazil, between January 1994 and July 1998. Six of the women presented coinfection with the human immunodeficiency virus type 1 (HIV-1). All of the 72 children born in this period were followed at least until they were 18 months of age. Analyses of anti-HCV, HCV RNA, and alanine aminotransferase were performed in a minimum of two blood samples during follow-up. One (2.4 per cent; 95 per cent CI, 2.2-7) of the 42 children born to HCV viremic mothers was both anti-HCV and HCV RNA-positive, with altered ALT levels. Passively transferred maternal anti-HCV antibodies became undetectable within 9-12 months. None of the nine infants born to HIV-1 infected mothers were infected either by HIV or HCV. Thus, the mother-infant HCV transmission rate is low and seems to be associated with maternal HCV RNA positivity.50423623

The implementation of a surgical antibiotic prophylaxis program: The pivotal contribution of the hospital pharmacy

Bachground: Although surgical site infection rates have decreased with the prophylactic use of antibiotics, the inappropriateness of surgical antibiotic prophylaxis is still a worldwide problem. Various strategies have been used to address. This problem This study describes the implementation of a perioperative antibiotic prophylaxis protocol that emphasizes the contribution of the pharmacist, Methods: A descriptive study design was used cc evaluate the Impact of the protocol on the appropriateness of prophylaxis in a private university hospital, The surgical antibiotic prophylaxis of all surgeries was evaluated for 1 month before and 1 month after the implementation of the protocol, Results: The appropriateness of the indication for prophylaxis rose from 56.4% to 100% and that of the postoperative maintenance prophylactic antibiotics rose from 21.9% to 95.7%. The cost of the perioperative antibiotic prophylaxis per surgery decreased 40.5%. Conclusion: The implementation of a cost-effective perioperative antibiotic prophylaxis protocol was the result of a multidisciplinary effort. The hospital pharmacist participated in education activities as part of the discussion groups on the perioperative antibiotic prophylaxis protocol that involved all participants and in managerial actions that optimized the process of ordering, dispensing, administering, and documenting the perioperative antibiotic prophylaxis.301SI495

Knowledge about aids and drugs among undergraduate students in a higher education institution in the state of Paraná El conocimiento sobre sida y drogas entre alumnos de graduación de una institución de enseñanza superior en el estado de Paraná Conhecimento sobre aids e drogas entre alunos de graduação de uma instituição de ensino superior do estado do Paraná

The main objective of this study was to measure the knowledge of undergraduate nursing students about Acquired Immunodeficiency Syndrome (AIDS) and drugs. The study was carried out in 2007 with a random sample of 289 undergraduate students at a State University in the Northwest of Paraná, Brazil. The students self-applied a questionnaire validated by experts. Questions were divided into three levels of complexity: low, average and high. The level of correct answers was higher in the questions of low complexity, diminishing as the questions' complexity increased. Thirteen percent of questions concerning risk factors and vulnerability to HIV infection among injection drug users (IDU) and biological material for diagnosis of AIDS was correctly answered by 90% of students. Students possessed knowledge concerning AIDS and drugs, however such knowledge was considered insufficient, showing lack of information and gaps in education with a dissociation of interdisciplinary and inter-curricular content.<br>Este trabajo tuvo como principal objetivo investigar el conocimiento de universitarios sobre el síndrome de inmunodeficiencia adquirida (SIDA) y drogas. La investigación se realizó en el año 2007 a partir de una muestra aleatoria de 289 alumnos de los cursos de graduación de una facultad estatal de la región noroeste de Paraná, en Brasil. Los alumnos respondieron un cuestionario auto aplicable, validado por especialistas del área. Las preguntas fueron divididas en tres niveles de complejidad: baja, media y alta. El índice de aciertos de los alumnos fue mayor en las preguntas de baja complejidad, disminuyendo con el aumento del grado de complejidad. El índice de 90% de aciertos ocurrió en 13% de las preguntas, que se referían a los factores de riesgo y vulnerabilidad para la infección por el virus de la inmunodeficiencia humana (HIV) en usuarios de drogas inyectables (UDI) y el material biológico para el diagnóstico de SIDA. Los alumnos poseían conocimientos sobre SIDA y drogas, sin embargo, este es insuficiente, demostrando falta de información y vacíos en la enseñanza, con disociación de contenidos interdisciplinares e intercurriculares.<br>Este trabalho teve como principal objetivo investigar o conhecimento de universitários sobre a síndrome de imunodeficiência adquirida (AIDS) e drogas. Realizou-se a pesquisa no ano 2007 a partir de amostra aleatória de 289 alunos dos cursos de graduação de uma faculdade estadual da região noroeste do Paraná. Os alunos responderam um questionário autoaplicável, validado por especialistas na área. As questões foram divididas em três níveis: baixa, média e alta complexidade. O índice de acertos dos alunos foi maior nas questões de baixa complexidade, diminuindo com o aumento do grau de complexidade. O índice de 90% de acertos ocorreu em 13% das questões, que se referiam aos fatores de risco e vulnerabilidade para a infecção pelo vírus da imunodeficiência humana (HIV) em usuários de drogas injetáveis (UDI) e o material biológico para o diagnóstico de AIDS. Os alunos possuíam conhecimento sobre AIDS e drogas, porém, insuficiente, demonstrando falta de informação e lacunas no ensino, com dissociação de conteúdos interdisciplinares e intercurriculares