RESUMEN

Introducción : Se promueven iniciativas para mejorar la salud de las mujeres y niños siendo el denominador común disponer de un sistema de información con repercusión en la salud de esta población. En Paraguay el SIP PLUS es utilizado con diferente grado de cobertura en los servicios maternoinfantiles. Objetivo: analizar la calidad de los datos generados para la construcción de los indicadores de Eliminación de la Sífilis Congénita (SC). Metodología: Estudio nacionalmente representativo utilizando datos generados por el SIP PLUS. Resultados: 32.479 historias perinatales cargadas desde el 2018 a julio del 2021. La representación de la muestra 1,5% en 2018 al 23% en 2021. Mayores pérdidas de información en el 2020. Para las variables de contexto con menos pérdidas de información en comparación a las de prevención primaria, secundaria y salud reproductiva. La pérdida de datos para: porcentaje de mujeres embarazadas con cuidado prenatal (4 o más) en un promedio de 64,4%; porcentaje de mujeres embarazadas tamizadas 43,1 % en el 2020 y 33,4% en 2019; positividad de la prueba de sífilis 49% en el 2020. Lo que también se observa en el indicador de tratamiento. Se registraron 506 casos de SC. Tasa de SCx1000 nacidos vivos ( 10 x1000 nacidos vivos en los 4 años analizados. Edad adolescente (p: 0,040) como factor de riesgo para SC. Conclusiones: Pérdida de registros en lo referente a ETMI, por falta de carga de datos. Alta incidencia de SC en los años analizados. Adolescentes como factor de riesgo para SC.

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Introduction: Initiatives are promoted to improve the health of women and children, the common denominator being having an information system with an impact on the health of this population. In Paraguay, the SIP PLUS is used with different degrees of coverage in maternal and child services. Objective: analyze the quality of the data generated for the construction of the indicators for the Elimination of Congenital Syphilis (CS). Methodology: Nationally representative study using data generated by the SIP PLUS. Results: 32,479 perinatal histories uploaded from 2018 to July 2021. The representation of the sample went from 1.5% in 2018 to 23% in 2021. Greater information losses in 2020. For the context variables with fewer information losses in comparison to those of primary, secondary prevention and reproductive health. Loss of data for: percentage of pregnant women with prenatal care (4 or more) averaged 64.4%; percentage of pregnant women screened 43.1% in 2020 and 33.4% in 2019; syphilis test positivity 49% in 2020. This is also observed in the treatment indicator. 506 cases of CS were recorded. Rate of SCx1000 live births  10 x1000 live births in the 4 years analyzed. Adolescent age (p: 0.040) as a risk factor for CS. Conclusions: Loss of records regarding ETMI, due to lack of data loading. High incidence of CS in the years analyzed. Adolescents as a risk factor for CS.

RESUMEN

Human immunodeficiency virus (HIV) drug resistance increases mortality and morbidity and antiretroviral therapy (ART) costs. We describe Paraguay's first nationally representative survey on pretreatment drug resistance (PDR) conducted among persons who initiated or reinitiated ART in 2019. ​​​​We conducted a cross-sectional survey of antiretroviral (ARV) drug resistance in Paraguay in 2019. Participants were sampled at four comprehensive care clinics where 90% of patients with HIV in Paraguay initiate ART. Patients included were adults ≥18 years old who initiated first-line ART or reinitiated the same first-line ART regimen after ≥3 months of discontinuation. Of 208 patients, 93.8% had no prior ART exposure, 3.8% reinitiated the same regimen, 2.4% had unknown prior ART exposure; and 31.3% had a CD4 count <200 cells/µl. Mutations associated with resistance were present in 15.4% of patients. Mutations associated with resistance to nonnucleoside reverse transcriptase inhibitors (NNRTI) were present in 13.0% of patients, nucleoside reverse transcriptase inhibitors in 4.3%, and integrase inhibitors in 3.4%. Mutations associated with resistance to tenofovir were present in 1.0% of patients and emtricitabine/lamivudine in 1.4%. ​​Nearly one in six patients had PDR in Paraguay's first nationally representative sample. High NNRTI PDR prevalence underscores the need to accelerate the transition to dolutegravir-based first-line ART. The low PDR prevalence of tenofovir and emtricitabine is reassuring as these ARVs are part of the World Health Organization (WHO)-recommended oral pre-exposure prophylaxis regimen. The high proportion of individuals initiating ART at a late disease stage highlights the need to improve treatment linkage strategies and implement WHO rapid ART initiation recommendations.

Asunto(s)

Fármacos Anti-VIH , Infecciones por VIH , VIH-1 , Adolescente , Adulto , Fármacos Anti-VIH/farmacología , Fármacos Anti-VIH/uso terapéutico , Antirretrovirales/uso terapéutico , Estudios Transversales , Farmacorresistencia Viral/genética , Emtricitabina/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , VIH-1/genética , Humanos , Paraguay/epidemiología , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Tenofovir/uso terapéutico , Carga Viral

RESUMEN

Background: Clinical trials have shown that HAART is able to reduce HIV plasma viral loads to undetectable in 70%-90% of patients (pts). HAART in developing countries is reported to be much less effective. Objectives: To evaluate the virologic response to HAART in children with HIV infection and to determine the factors associated to sustained decrease in the viral load. Material and methods: Retrospective, observational study that included pts1.5 log reduction in viral load after week 12 of HAART initiation, which was maintained during the follow-up period. Results: 169 pts with HIV infection form the cohort of the institution, with a mean age of 7.5±3.8 years. 76 patients met the inclusion criteria. During the follow-up (85% of the pts with HAART =12 months), 48 pts (63%) achieved viral suppression whereas 28 (37%) do not. The viral load before the HAART were similar in both groups (50% and 43% of the pts with HIV-RNA >100.000 copies/ml) as well as in the CD4 count (35% vs. 43%). More pts in the non-responder group were female (60% vs.38%, p< 0.05). They were no differences between the age at HAART start, the current mean age, nutritional condition, percentage of orphans, and assistance to Day Care Center (DCC), between both groups. 42% in the responder-group were receiving protease-inhibitor vs. 8% of the non-responders (p< 0.05). Conclusions: The 37% of patients without HIV-1 suppression highlight need to be include a proteaseinhibitor based regimen as the first line treatment in developing countries

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Resumen Los ensayos clínicos han demostrado que la TARGA es capaz de reducir la carga viral de VIH en plasma a niveles indetectables en el 70%-90% de los pacientes (pts). Sin embargo, se ha observado que la TARGA en los países en desarrollo podría ser menos efectiva. Objetivos: Evaluar la respuesta virológica a TARGA en niños con infección por VIH y determinar los factores asociados al descenso sostenido en los niveles de supresión viral. Materiales y métodos: Estudio retrospectivo y observacional que incluyó pts 100.000 copias/ml), así como el recuento de CD4 <25% (48% vs 43% de los pts). En el grupo no respondedor la mayoría eran mujeres (60% vs38%, p <0,05). No hubo diferencias entre la edad de inicio de TARGA, la edad media actual, el estado nutricional, el porcentaje de huérfanos, así como la asistencia a guarderías entre ambos grupos. El 42% en el grupo respondedor estaban recibiendo un inhibidor de la proteasa frente al 8% de los pacientes no respondedores (p<0,05). Conclusión:El 37% de los pacientes de la presente cohorte de niños con VIH-1 no alcanzaron supresión viral, la cual se ha correlacionado con la ausencia dentro del esquema de un inhibidor de proteasa. El presente estudio sugiere imperiosa la necesidad de incluir un inhibidor de la proteasa en el tratamiento de primera línea de niños con VIH en países en desarrollo.