Unsatisfactory long-term virological suppression in human immunodeficiency virus-infected children in the Amazonas State, Brazil.

INTRODUCTION: Achieving viral suppression (VS) in children is challenging despite the exponential increase in access to antiretroviral therapy (ART). We evaluated VS in children >1 year of age and adolescents 5 years after they had begun ART, in Manaus, Amazonas state, Brazil. METHODS: HIV-infected, ART-naive children >1 year of age between 1999 and 2016 were eligible. Analysis was stratified by age at ART initiation: 1-5 y, >5-10 y, and >10-19 y. CD4+ T-cell count and viral load were assessed on arrival at the clinic, on ART initiation, and at 6 months, 1 year, 2 years, and 5 years after ART initiation. The primary outcome was a viral load <50 copies/mL 5 years after ART initiation. RESULTS: Ultimately, 121 patients were included. The mean age at diagnosis was 4.8 years (SD 3.5), mean CD4% was 17.9 (SD 9.8), and mean viral load was 4.6 log10 copies/ml (SD 0.8). Five years after ART initiation, the overall VS rate was 46.9%. VS by patient age group was as follows: 36.6% for 1-5 y, 53.3% for >5-10 y, and 30% for >10-19 y. Almost all children (90,4%) showed an increase in CD4%+ T cell count. There were no statistically significant predictors for detecting children who do not achieve VS with treatment. VS remained below 65% in all the evaluated periods. CONCLUSIONS: Considerable immunological improvement is seen in children after ART initiation. Further efforts are needed to maintain adequate long-term VS levels and improve the survival of this vulnerable population.

Unsatisfactory long-term virological suppression in human immunodeficiency virus-infected children in the Amazonas State, Brazil

Abstract INTRODUCTION: Achieving viral suppression (VS) in children is challenging despite the exponential increase in access to antiretroviral therapy (ART). We evaluated VS in children >1 year of age and adolescents 5 years after they had begun ART, in Manaus, Amazonas state, Brazil. METHODS: HIV-infected, ART-naive children >1 year of age between 1999 and 2016 were eligible. Analysis was stratified by age at ART initiation: 1-5 y, >5-10 y, and >10-19 y. CD4+ T-cell count and viral load were assessed on arrival at the clinic, on ART initiation, and at 6 months, 1 year, 2 years, and 5 years after ART initiation. The primary outcome was a viral load <50 copies/mL 5 years after ART initiation. RESULTS: Ultimately, 121 patients were included. The mean age at diagnosis was 4.8 years (SD 3.5), mean CD4% was 17.9 (SD 9.8), and mean viral load was 4.6 log10 copies/ml (SD 0.8). Five years after ART initiation, the overall VS rate was 46.9%. VS by patient age group was as follows: 36.6% for 1-5 y, 53.3% for >5-10 y, and 30% for >10-19 y. Almost all children (90,4%) showed an increase in CD4%+ T cell count. There were no statistically significant predictors for detecting children who do not achieve VS with treatment. VS remained below 65% in all the evaluated periods. CONCLUSIONS: Considerable immunological improvement is seen in children after ART initiation. Further efforts are needed to maintain adequate long-term VS levels and improve the survival of this vulnerable population.

Síntomas tempranos de neurotoxicidad por exposición prolongada a plaguicidas / Early symptoms of neurotoxicity by lengthy exposure to pesticides

Es un diseño descriptivo de corte transversal, clínico epidemiológico, realizado entre diciembre 2000 - septiembre 2001. Con una muestra no probabilística, 28 agricultores voluntarios, género masculino, una edad promedio de 29 años, habitantes de la comunidad Gabante, Municipio Tovar, Estado Aragua, Venezuela. Un proceso de trabajo similar, dedicados al cultivo de durazno diez (10) horas diarias, lunes a sábado. Exposición a plaguicidas de 11 a 15 años. Un nivel de escolaridad (42.9 por ciento) de primaria incompleta. La entrevista clínico psicológica comprendió: historia de salud, historia laboral, antecedentes patológicos - neurológicos y antecedentes patológicos - psiquiátricos. Los resultados mostraron que los síntomas padecidos en los últimos tres meses mareos un 39 por ciento. Los hábitos psicobiológicos, alcohol (100 por ciento) y tabaco (42 por ciento) arrojaron porcentajes resaltantes. Las pruebas neuropsicológicas, Benton, PFN y destreza manual calificaron con resultados apreciables. El análisis estadístico se realizó con el PSICOTOX que clasificó el 72 por ciento tipo 2 o dudosos y el EPI-INFO 2000.