Major depression is the most common psychiatric diagnosis in Human Immunodeficiency Virus (HIV). However a few studies have focused on clinical depression as a risk factor for HIV infection. There are evidences to show that individuals with depressive symptoms can be predisposed to diseases such as HIV infection. Literature point out that the negative influence of depression as a risk factor for HIV can be explained because physical deterioration or depression can result in fatigue, physical impairment, and loss of motivation and self-confidence to engage in food and income generating activity. Other authors point out that this increased risk is thought to be due to high rates of substance use including injection drug use (IDU), risky sexual behavior, sexual victimization, and prostitution. It´s consensus that are needed social support for HIV-infected patients that includes treatment for depression and substance abuse. Screening of depression should also be conducted regularly to provide a full psychiatric profile to decrease the risk of depression and improve quality of life in this population.
Background: Antiretroviral treatment (ART) has reduced morbidity and mortality due to AIDS. However, treatment options can be impaired by the development of antiretroviral drug resistance. Resistant virus strains can be transmitted to new hosts and, subsequently, can lead to antiretroviral treatment failure. Methods: Th A systematic review of articles on resistance to antiretroviral therapy for HIV-infected individuals, published from January 1, 2014 to June 16, 2014, on SCOPUS and PUBMED databases wascarried out. Search terms were "AIDS" (Medical Subject Headings [MeSH]), "HIV" (MeSH), "treatment" (keyword), "resistance" (keyword) and "antiretroviral therapy" (MeSH). Of the 118 retrieved studies, 24 met the eligibility criteria. Results: The main classes of antiretroviral drugs are Non Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), Nucleoside Reverse Transcriptase Inhibitors (NRTIs), and Protease Inhibitors (PIs). Antiretroviral treatment selects for drug resistance. Resistant strains become prevalent in the population and are transmitted to new patients. Discussion: A higher prevalence of certain mutations are present and characterize resistant strains that are prevalent in the population making it more difficult to treat these infected individuals. Poor compliance with antiretroviral therapy increases the potential for developing these and other resistant strains.
Objective: Economic evaluation of a scientific advisory program with the Public Defenders Office to mitigate the impacts of the judicialization on health in the municipality, as well as the implementation of an active follow-up program to monitor health outcomes arising from court demands. Methods: A two-step study, the first documental, retrospective, with data collection of lawsuits in the region of Barbalha (CE), Brazil, from 2013 to 2018, and the second stage, prospective and intervention, through mediation between the citizen and the Public Defenders Office, aiming to reduce the occurrence of the judicialization, and the monitoring of the health outcomes of the processes. The study adopted the Consolidated Health Economic Evaluation Reporting Standards protocol for economic health assessments. The data obtained from the processes were grouped and treated for characterization of the scenario. A comparison of the profile of the lawsuits in the period of 12 months before and after the installation of the program to delimit a complete fiscal cycle was carried out. Results: The advisory service promoted a decrease of 40% (p=0.01) in lawsuits. There was a 31% reduction in court costs (p=0.003), with medicines accounting for 33% of this amount. There was a decrease in inputs outside the Sistema Único de Saúde lists (27%; p=0.003), however there was no statistical difference among several demanding groups, suggesting an equanimous approach. Conclusion: Data from the initial survey were comparable to those reported in Brazil regarding the profile of judicial demands. In view of the scenario, the proposal proved feasible as a means to mitigate the costs of the judicialization through mediation. Finally, the initiative can serve as a model for adoption by municipalities that have characteristics similar to those presented in this study.
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