The presence of X4-tropic variants in more than 80% of our cohort of antiretroviral-experienced children and adolescents with vertical HIV-1 infection indicates a very limited role for CCR5 antagonists as part of salvage regimens for highly treatment-experienced vertically HIV-1-infected patients with extensive antiretroviral drug resistance and limited treatment options.
Management of children with HIV/AIDS is specially challenging. Age-related issues do not allow for direct transposition of adult observations to this population. CXCR4 tropism has been associated with disease progression in adults. The geno2pheno web-base is a friendly tool to predict viral tropism on envelope V3 sequences, generating a false positive rate for a CXCR4 prediction. We evaluated the association of HIV-1 tropism prediction with clinical and laboratory outcome of 73 children with HIV/AIDS in São Paulo, Brazil. The CXCR4 tropism was strongly associated with a lower (nadir) CD4 documented during follow-up (p<0.0001) and with disease severity (clinical event and/or CD4 below 200cells/mm(3)) at the last observation, using commonly applied clinical cutoffs, such as (10%)FPRclonal (p=0.001). When variables obtained during follow-up are included, both treatment adherence and viral tropism show a significant association with disease severity. As for viremia suppression, 30% (22/73) were undetectable at the last observation, with only adherence strongly associated with suppression after adjustment. The study brings further support to the notion that antiretroviral treatment adherence is pivotal to management of HIV disease, but suggests that tropism prediction may provide an additional prognostic marker to monitor HIV disease in children.
Oitenta porcento dos casos de paracoccidioidomicose (PMC) ocorrem no Brasil. As regiõesbrasileiras com maior número de casos são: sul, sudeste e centro-oeste, sendo emergenteno norte e nordeste. A imunodifusão dupla em gel de agarose assume grande importância nodiagnóstico, por permitir o monitoramento da doença e por oferecer subsídios para levantamentossoroepidemiológicos. O objetivo deste trabalho foi de avaliar e caracterizar os pacientes atendidosno Laboratório de Imunodiagnóstico das Micoses do Instituto Adolfo Lutz de São Paulo, em 2016.Trata-se de um estudo retrospectivo realizado utilizando-se dados secundários e avaliando-se asseguintes informações: idade, sexo, procedência do pedido médico, resultado e histórico sorológico dospacientes. Dos 1.408 pacientes, 12,8% apresentaram reatividade sorológica para Paracoccidioides brasiliensis.Destes, 42,5% não possuiam histórico sorológico, sendo considerados como casos novos da doença. Aclassificação dos pacientes reagentes por gênero demonstrou que 83,4% eram do sexo masculino, com razãode masculinidade de 5:1. A faixa etária variou de um (1) a 92 anos, aproximadamente 40% dos pacienteseram da faixa etária de 41 a 60 anos. Este estudo demonstra e reforça a importância da implementação dosestudos soroepidemiológicos como ferramenta auxiliar para nortear as ações de vigilância e políticas emsaúde na PCM.
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