RESUMO
Introducción: A diferencia de lo descrito en países desarrollados, en los que se informan las enfermedades crónicas no transmisibles como causa de hospitalización en pacientes con VIH, en este estudio las principales causas de admisión hospitalaria y muerte fueron las infecciones oportunistas, particularmente la tuberculosis, algo similar a lo reportado en otros países de ingresos bajos en América y África Occidental, aun con la disponibilidad de la terapia antirretroviral. Objetivos: Se determinaron las causas más frecuentes de morbilidad y mortalidad hospitalaria en pacientes con VIH. Material y métodos: Se analizaron los datos demográficos, clínicos y de laboratorio de pacientes ingresados con diagnóstico de VIH durante un año, en un hospital de Guayaquil, Ecuador. Resultados: De 151 pacientes, el 76% era del sexo masculino, con 37 años en promedio. El 56.3% conocía el diagnóstico de infección por VIH. Las principales causas de hospitalización y muerte fueron las enfermedades definitorias de sida, entre las que las formas meníngeas, como criptococosis, toxoplasmosis, sífilis y leucoencefalopatía en conjunto, siguen a la tuberculosis; el 93.5% de los fallecidos tenía recuento de CD4 menor de 200 células/mm3 (p = 0.007). Conclusión: De manera similar a lo informado en pacientes adultos jóvenes con VIH en países de bajos ingresos económicos, las infecciones oportunistas fueron la principal causa de hospitalización y muerte, relacionada con inmunosupresión intensa, estadios avanzados de la enfermedad y falta de terapia antirretroviral. Los resultados refuerzan la importancia del diagnóstico precoz y el tratamiento de la infección por VIH, así como la profilaxis de las infecciones oportunistas prevenibles.
Introduction: Unlike what has been described in developed countries where chronic non-communicable diseases are reported as the cause of hospitalization in patients with HIV, in this study the main cause of hospital admission and death were opportunistic infections, particularly tuberculosis similar to what was reported in other low-income countries in the Americas and West Africa even with the availability of antiretroviral therapy. Aim: The most frequent causes of hospital morbidity and mortality in patients with HIV were determined. Material and methods: The demographic, clinical, and laboratory data of patients admitted with a diagnosis of HIV for one year in a Guayaquil General Hospital were analyzed. Results: Of 151 patients, 76% were male with an average age of 37 years old. 56.3% knew the diagnosis of HIV infection. The main cause of hospitalization and death were AIDS-defining diseases where the meningeal forms: cryptococcosis, toxoplasmosis, syphilis and leukoencephalopathy together follow tuberculosis, and 93.5% of the deceased had a CD4 count of fewer than 200 cells/ mm3 (p = 0.007). Conclusion: Similar to what was reported in young adult patients with HIV in low-income countries, opportunistic infections were the main cause of hospitalization and death, related to severe immunosuppression, advanced stages of the disease, and without antiretroviral therapy. The results reinforce the importance of early diagnosis and treatment of HIV infection and the prophylaxis of preventable opportunistic infections.
RESUMO
Resumen Introducción: Las lesiones orales clasificadas como fuertemente asociadas a infección por VIH se presentan en casos de inmunosupresión profunda (recuento de linfocitos T CD4+ ≤ a 200 céls/mm3 de sangre). Objetivo: Asociar la presencia de lesiones orales fuertemente asociadas a infección por VIH con el recuento sérico de linfocitos T (LT) CD4+ al momento del diagnóstico. Métodos: Se realizó un estudio transversal en PVVIH atendidas en el Hospital San Juan de Dios entre 2013 y 2019. Las lesiones orales se diagnosticaron por el criterio de EC-Clearinghouse - OHARA, y la inmunosupresión fue determinada según el recuento de LT CD4+. Resultados: De los 240 pacientes reclutados, 35 pacientes presentaron lesiones fuertemente asociadas a infección por VIH y 26 de ellos presentaron inmunosupresión profunda. La probabilidad de ocurrencia de una lesión fuertemente asociada a infección por VIH fue 12,3 veces mayor en pacientes con inmunosupresión profunda. Conclusión: Existe una asociación estadísticamente significativa entre un estado de inmunosupresión profunda y la presencia de manifestaciones orales fuertemente asociadas a infección por VIH/SIDA, lo cual posee relevancia clínica pues se presenta como una herramienta clínica de diagnóstico inicial, progresión de la enfermedad y monitorización de la terapia antiretroviral.
Abstract Background: Oral lesions classified as strongly associated with HIV infection occur in cases of severe immunosuppression (CD4+ T lymphocyte count ≤ 200 cells/mm3 of blood). Aim: To associate the presence of oral lesions strongly associated with HIV infection with CD4+ T lymphocytes count at the time of diagnosis. Methods: A cross-sectional study was carried out in PLHIV treated at the San Juan de Dios Hospital between 2013 and 2019. Oral lesions were diagnosed by the EC-Clearinghouse - OHARA criteria and immunosuppression was determined according to the CD4+ T lymphocyte count. Results: Of the 240 recruited patients, 35 had lesions strongly associated with HIV infection and 26 of them had severe immunosuppression. The probability of occurrence of a lesion strongly associated with HIV infection is 12.3 times higher in patients with severe immunosuppression. Conclusion: There is a statistically significant association between a severe immunosuppression and the presence of oral manifestations strongly associated with HIV/ AIDS infection, which has clinical relevance since it is presented as a clinical tool for initial diagnosis, disease progression and monitoring of antiretroviral therapy.
RESUMO
Introducción: En los últimos años las mujeres constituyen uno de los grupos más vulnerables y afectados por el VIH. Objetivo: Determinar características clínico-epidemiológicas de mujeres con VIH, residentes en el municipio Boyeros. Material y métodos: investigación descriptiva, retrospectiva de pacientes femeninas con VIH, diagnosticadas y residentes en el municipio Boyeros, desde 1986 hasta el 31 de diciembre del 2016. Se incluyeron solo las pacientes mayores de 14 años, vivas, diagnosticadas y residentes en el municipio. La muestra estuvo constituida por 99 casos. La fuente de información se obtuvo de las historias clínicas de la Consulta Municipal especializada para la atención a pacientes con VIH/sida del municipio Boyeros. Resultados: Las tasas de incidencia muestran tendencia ascendente. El 49,5 por ciento se diagnostican con edades entre 15 y 29 años. Predominan las mujeres blancas en 40 por ciento, con nivel de escolaridad secundaria básica (43 por ciento). Un 19 por ciento se hizo el diagnostico como gestante y más de 50 por ciento no declararon vínculo laboral estable. El diagnóstico tardío se presentó en 43 por ciento y a edades mayores. El último conteo de T-CD4 fue mayor de 350 células/mm3 en más de 50 por ciento. El 92,9 por ciento de los casos tienen indicado TARV. Conclusiones: La población femenina con VIH del municipio Boyeros es predominantemente joven, con nivel de escolaridad básica y sin vínculo laboral. Se mantienen casos de diagnóstico tardío y las cifras de T-CD4 muestran valores adecuados en la mayoría de los casos(AU)
Introduction: Women are one of the most vulnerable groups affected by HIV during the last years. Objective: To determine the clinical and epidemiological characteristics of women with HIV in Boyeros municipality. Material and Methods: A descriptive retrospective research was conducted in female HIV patients in Boyeros municipality from 1986 to December 31, 2016. Only alive women older than 14 years living in the aforementioned municipality who were previously diagnosed with HIV were included in the study. The sample was composed of 99 cases. The information was obtained from the clinical records of the Municipal Consultation where specialized care is given to patients with HIV/AIDS. Results: The incidence rates of HIV infection in women showed a rising trend. Also, 49,5 percent of women infected with HIV were between 15 and 29 years of age. There was a prevalence of whites (40 percent) as well as women with secondary levels of education (43 percent). The diagnosis was also made in pregnant women, representing the 19 percent. More than 50 percent of them declared not to have steady jobs. Late diagnosis was identified in 43 percent of women in older ages. The latest T-CD4 count was higher than 350 cells/mm3 in more than 50 percent of them. ART was indicated in 92,9 percent of the cases. Conclusions: The female population infected with HIV in Boyeros municipality is mainly young; a lot of them have basic educational levels and do not have an employment contract. Late diagnosis of HIV infection continues to be identified. T-CD4 cell counts show adequate values in most of the cases(AU)
Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Grupos de Risco , Antígenos CD4 , Síndrome da Imunodeficiência Adquirida/epidemiologia , População Branca , Epidemiologia Descritiva , Estudos Retrospectivos , Diagnóstico TardioRESUMO
In this paper, we further extend the recently proposed Poisson-Tweedie regression models to include a linear predictor for the dispersion as well as for the expectation of the count response variable. The family of the considered models is specified using only second-moments assumptions, where the variance of the count response has the form µ+ϵp $\mu + \phi \mu^p$, where µ is the expectation, Ï and p are the dispersion and power parameters, respectively. Parameter estimations are carried out using an estimating function approach obtained by combining the quasi-score and Pearson estimating functions. The performance of the fitting algorithm is investigated through simulation studies. The results showed that our estimating function approach provides consistent estimators for both mean and dispersion parameters. The class of models is motivated by a data set concerning CD4 counting in HIV-positive pregnant women assisted in a public hospital in Curitiba, Paraná, Brazil. Specifically, we investigate the effects of a set of covariates in both expectation and dispersion structures. Our results showed that women living out of the capital Curitiba, with viral load equal or larger than 1000 copies and with previous diagnostic of HIV infection, present lower levels of CD4 cell count. Furthermore, we detected that the time to initiate the antiretroviral therapy decreases the data dispersion. The data set and R code are available as supplementary materials.
Assuntos
Modelos Lineares , Modelos Estatísticos , Análise de Regressão , Algoritmos , Antirretrovirais/uso terapêutico , Brasil , Contagem de Linfócito CD4 , Simulação por Computador , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/metabolismo , Humanos , Gravidez , Carga ViralRESUMO
Introducción: La infección por el VIH continúa siendo un problema de salud mundial y nacional. El proceso de descentralización de la atención de estos pacientes hace que cada día sean más los que se atienden en hospitales de nivel secundario. Objetivo: Caracterizar los pacientes con infección por VIH en el municipio Boyeros. Material y Métodos: Se realizó un estudio descriptivo de corte transversal, de las personas con VIH residentes en el municipio Boyeros hasta el 31 de diciembre de 2013. Se analizaron variables demográficas como edad, sexo, escolaridad, ocupación, enfermedades marcadoras de SIDA, tiempo de diagnóstico, conteo de CD4 y tratamiento antirretroviral. Resultados: El mayor número de casos es del sexo masculino, el grupo de edad más afectado es de 20 a 39 años y predomina el nivel escolar preuniversitario (50 porciento). Existe 30 porciento de casos desocupados. El 80 por ciento de los casos tienen menos de 10 años de diagnóstico, 76 por ciento de los casos se clasificaron SIDA por conteo bajo de CD4 y fue la neurotoxoplasmosis la enfermedad marcadora de SIDA más frecuente. El esquema Zidovudina- Lamivudina- Nevirapina es el más utilizado. Conclusiones: La población VIH es mayoritaria masculina y joven con escolaridad preuniversitaria y un grupo importante sin vinculo laboral. Predomina tiempo de diagnóstico menor de 10 años, los casos con CD4 por encima de 200 células/mm3 y más de la mitad de los casos tienen indicado TARV(AU)
Introduction: Infection by AIDS has being a world and national health problem. Decentralization process of the attention of these patients make possible that every day more patients assist to secondary level hospitals to be treated. Objective: To characterize patients with AIDS infection in Boyeros municipality. Material and Methods: We were carried out a descriptive, cross-sectional study, of people with AIDS residents in Boyeros municipality up to December 31 2013. Demographic variables analyzed, were age, sex, occupation, AIDS markers illnesses, time of diagnosis, CD4 count and antiretroviral treatment. Results: The biggest number of cases are of masculine sex. Most affected age groups are 20 to 39 years old and of pre-university educational level. There are 30 porciento of cases are unemployed persons. 80 porciento of the cases have less than 10 years of been diagnosed, 76 porciento were classified as AIDS with CD4 low count. More frequent AIDS illness was neurotoxoplasmosis. Zidovudina-Lamivudina-Nevirapina is the most antiretroviral treatment utilized. Conclusions: AIDS population in Boyeros is by majority masculine and young people. There is an important group of unemployed persons. The CD4 cells count is above 200 cells/mm3 and more than a half of cases have a suitable ARVT(AU)
Assuntos
Humanos , Masculino , Feminino , Atenção Terciária à Saúde , Infecções por HIV/epidemiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Epidemiologia Descritiva , Estudos RetrospectivosRESUMO
WHAT IS KNOWN AND OBJECTIVE: The trajectory of HIV viral load and CD4 count and the occurrence of clinical events are primary considerations in the evaluation of antiretroviral therapy (ART) success or failure, yet a large number of studies do not describe these events from the point of therapy initiation. This study aims to describe the virological and immune response to ART and factors associated with immune and virological success in outpatients from a HIV/AIDS clinic in southern Brazil from therapy initiation. METHODS: Longitudinal observational with ambidirectional data collection study with adult patients followed for at least 12 months after enrolment. Outcomes include (i) favourable immune response, defined as CD4 count ≥200 cells/mm³; and (ii) virological success, defined as viral load below the limit of detection (50 copies/mL). RESULTS: The study included 332 patients, mostly men (63%), whose mean age was 40 (±10) years and with median family income of BR$ 490·00 per month (IQR: 350-875). Before starting ART, 43% of patients had indications of stable immune status (CD4 count ≥200 cells/mm³); the median CD4 count was 179 cells/mm³ (IQR: 93·5, 267) and increased to 379·5 cells/mm³ (IQR: 236·5, 591·3). The proportion of patients with CD4 count ≥200 cells/mm³ increased from 76% to 83%, and with undetectable viral load (UVL) increased from 51·7% to 73%. Factors associated with immune success at the end of study follow-up were as follows: female gender, pretreatment CD4 count ≥200 cells/mm³, previous UVL (measured when started prospective follow-up) and treatment with three drugs compared with ≥4. Factors associated with virological success were as follows: UVL (measured when started prospective follow-up) and use of three drugs compared with ≥4. WHAT IS NEW AND CONCLUSIONS: Results of this study show that a large proportion (73%) of patients have rapid and successful immune and virological responses to ART and that factors which predict this response include starting ART early, whereas viral load is low and CD4 count is high, with fewer drugs. These results further support the ongoing need for ongoing programmes to increase early HIV testing, early linkage to and treatment with ART, and increased viral suppression.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adulto , Terapia Antirretroviral de Alta Atividade/métodos , Contagem de Linfócito CD4/métodos , Esquema de Medicação , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Carga Viral/efeitos dos fármacosRESUMO
The majority of persons infected with HIV live in large metropolitan areas and many such areas have implemented intensified HIV testing programs. A national indicator of HIV testing outcomes is late diagnosis of HIV infection (stage 3, AIDS). Based on National HIV Surveillance System data, 23.3 % of persons with HIV diagnosed in 2012 had a late diagnosis in large MSAs, 26.3 % in smaller MSAs, and 29.6 % in non-metropolitan areas. In the 105 large MSAs, the percentage diagnosed late ranged from 13.2 to 47.4 %. During 2003-2012, the percentage diagnosed late decreased in large MSAs (32.2-23.3 %), with significant decreases in 41 of 105 MSAs overall and among men who have sex with men. Sustained testing efforts may help to continue the decreasing trend in late-stage HIV diagnosis and provide opportunities for early care and treatment and potential reduction in HIV transmission.
Assuntos
Diagnóstico Tardio , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Programas de Rastreamento/psicologia , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Cidades , Etnicidade/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Porto Rico/epidemiologia , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Despite the known benefits of early treatment initiation for individual morbidity and mortality, as well as for reducing the risk of transmission, late presentation (LP) to HIV/AIDS services remains a major concern in many countries. There is little information on LP from middle- and low-income countries and studies that do evaluate LP commonly disaggregate data by sex. It is rare, however, for researchers to further disaggregate the data by pregnancy status so it remains unclear if pregnancy status modifies the effects associated with sex. The study was conducted at the only State Reference Center for HIV/AIDS in Salvador, Brazil's third largest city. LP was defined as a patient accessing services with a CD4 < 350 cells/mm(3). Data were abstracted from the electronic medical records of 1421 patients presenting between 2007 and 2009. CD4 counts and viral load (VL) information was validated with data from the National CD4/VL Database. Descriptive and bivariate statistics were conducted to inform the multivariate analysis. Adjusted prevalence ratios (APR) were estimated using generalized linear models due to the high frequency of the outcome. Half of the sample (52.5%; n = 621) was classified as LP. Compared to the prevalence among pregnant women (21.1%), the prevalence of LP was more than twice as high among non-pregnant women (56.0%) and among men (55.4%). The multivariate analysis demonstrated no statistical difference between men and nonpregnant women (APR 1.04; 95%CI 0.92-1.19), but the APR of LP for nonpregnant women was 53% less than men (APR 0.47; 95%CI 0.33-0.68). These results highlight the importance of analyzing data disaggregated not only by sex but also by pregnancy status to accurately identify the risk factors associated with LP so that programs and policies can effectively and efficiently address LP in Brazil and beyond.
Assuntos
Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/diagnóstico , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade/métodos , Brasil/epidemiologia , Estudos Transversais , Diagnóstico Tardio , Progressão da Doença , Feminino , Infecções por HIV/sangue , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Prevalência , Fatores de Risco , Fatores de Tempo , Carga Viral/efeitos dos fármacosRESUMO
CD4 + lymphocyte counts are routinely ordered during the early phases of antiretroviral therapy and for prophylaxis of opportunistic infections in HIV-positive patients. Flow cytometry is the standard methodology for CD4 counts in Brazilian reference laboratories. However, these laboratories are located in large cities, frequently distant from patients, thus limiting patient access and delaying results. We compared a point-of-care test with flow cytometry determination of CD4(+) T lymphocyte counts in HIV patients. We analysed 107 consecutive samples by both methods. Overall, the point-of-care test performed well, with excellent agreement between it and the standard method. Test results were concordant for patients with CD4(+) T lymphocyte values above and below 200 cells/mm (3). The performance characteristics obtained were sensitivity 94% (95% CI 89.5-98.5%), specificity 93% (95% CI 88.2-97.8%), positive predictive value 86% (95% CI 79.4-92.6%), and negative predictive value 97% (95% CI 94-100%). The high sensitivity and specificity of the point-of-care test methodology suggest its utility as an alternative method for rapid measurement of CD4(+) T lymphocytes in patients with limited access to reference laboratories, enabling prompt therapeutic intervention for patients at risk of progression to AIDS.