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IntroductionWe describe temporal trends in the mortality rates and factors associated with AIDS and non-AIDS related mortality at the Evandro Chagas Clinical Research Institute (IPEC), Oswaldo Cruz Foundation (FIOCRUZ).MethodsAdult patients enrolling from 1986 through 2009 with a minimum follow up of 60 days were included. Vital status was exhaustively checked using patients’ medical charts, through active contact with individuals and family members and by linkage with the Rio de Janeiro Mortality database using a previously validated algorithm. The CoDe protocol was used to establish the cause of death. Extended Cox proportional hazards models were used for multivariate modeling.ResultsA total of 3530 individuals met the inclusion criteria, out of which 868 (24.6%) deceased; median follow up per patient was 3.9 years (interquartile range 1.7–9.2 years). The dramatic decrease in the overall mortality rates was driven by AIDS-related causes that decreased from 9.19 deaths/100PYs n 1986–1991 to 1.35/100PYs in 2007–2009. Non-AIDS related mortality rates remained stable overtime, at around 1 death/100PYs. Immunodeficiency significantly increased the hazard of both AIDS-related and non-AIDS-related causes of death, while HAART use was strongly associated with a lower hazard of death from either cause.ConclusionsOur results confirm the remarkable decrease in AIDS-related mortality as the HIV epidemic evolved and alerts to the conditions not traditionally related to HIV/AIDS which are now becoming more frequent, needing careful monitoring.

The antibiotic cotrimoxazole was associated with poly(lactic acid-co-glycolic acid) (PLGA) and maghemite, aiming to reach a controlled drug release system. PLGA was synthesized through the polycondensation of lactic acid and glycolic acid in an equimolar ratio, and maghemite was synthesized through the coprecipitation method. The drug cotrimoxazole was inserted in the composite through three different procedures: solution, fusion, and in situ to check the best insertion method. Several techniques were used to characterize the materials. The copolymer was characterized by nuclear magnetic resonance and size-exclusion chromatography. In addition, the maghemite, the composites containing the drug, and the polymer were characterized by Fourier transform infrared spectroscopy (FTIR) with attenuated total reflectance device, small-angle X-ray scattering, and magnetic force, this last according to the methodology developed by our group. The root mean square error was used to compare the FTIR spectra of the samples, proving that the fusion method was the best way to insert the drug and maghemite in the polymer. Therefore, composites containing the drug and the nanoparticles were prepared by the fusion method. These composites were used for dissolution profile studies, which were monitored with and without magnetic field, aiming to understand the influence of the magnetic field on the dissolution profile. The dissolution was monitored and quantified using the ultraviolet-visible spectrophotometry, following the United States Pharmacopeia (USP) method for cotrimoxazole tablets. Results demonstrated that nanocomposites presented a good magnetic force, able to keep the magnetic composite trapped in a specific place or tissue. The presence of the nanoparticles in the composites changed the kinetics of the drug release, as they constitute physical barriers to the drug diffusion, contributing to a sustained drug release process. Furthermore, in the presence of a magnetic field, the magnetic nanoparticles were able to perform a magnetic constriction of the material, making the drug release faster than in the absence of the magnetic field, which may be useful to perform a fine tuning of the system, allowing the easier adjustment of the speed and amount of released drug, useful to improve medical treatments and even the welfare of the patients.

This retrospective cohort study assessed the results of the implementation of preventive recommendations for tuberculosis (TB) among renal transplant recipients in an endemic area (Rio de Janeiro, Brazil). Subjects were defined as at high risk for TB if they had latent tuberculosis infection (LTBI), reported recent close contact with individuals with TB or received a graft from a donor with LTBI. A 6-month course of isoniazid preventive therapy (IPT) was targeted to high-risk subjects. The study end point was TB confirmed by culture. Altogether, 535 patients were included. Median follow-up was 59 months. The overall cumulative incidence of TB was 2.1% while among the 274 patients in whom the preventive protocol was fully implemented, the incidence was only 0.7%. The incidence of TB among 75 high-risk recipients not treated with isoniazid (7%) was significantly higher than that observed in 209 untreated low-risk patients (1%, p ¼ 0.006) and in 65 high-risk subjects that received IPT (no case, p ¼ 0.03). In conclusion, the implementation of preventive recommendations for TB in an endemic area allowed the appropriate discrimination between high-and low-risk renal transplant recipients and was associated with long-term reduction in the incidence of this complication among high-risk subjects.