Survival and mortality profile among people living with HIV in a cohort in the Northeastern region of Brazil.

Conditions related to the acquired immune deficiency syndrome (AIDS) are still a significant cause of morbidity and mortality among people living with HIV (PLHIV). Longer survival in this population were reported to increase the risk of developing noncommunicable chronic diseases (NCDs). This study aimed to estimate the survival and causes of death according to age group and sex among PLHIV monitored at two referral centers in the Northeastern Brazil. This is a prospective, retrospective cohort with death records from 2007 to 2018, based on a database that registers causes of death using the International Classification of Disease (ICD-10), which were subsequently coded following the Coding Causes of Death in HIV (CoDe). A total of 2,359 PLHIV participated in the study, with 63.2% being men, with a follow-up period of 13.9 years. Annual mortality rate was 1.46 deaths per 100 PLHIV (95% CI: 1.33 - 1.60) with a frequency of 20.9%. Risk of death for men increased by 49% when compared to women, and the risk of death in PLHIV increased by 51% among those aged 50 years and over at the time of diagnosis. It was observed that 73.5% accounted for AIDS-related deaths, 6.9% for non-AIDS defining cancer, 6.3% for external causes, and 3.2% for cardiovascular diseases. Among the youngest, 97.2% presented an AIDS-related cause of death. Highest frequency of deaths from neoplasms was among women and from external causes among men. There is a need for health services to implement strategies ensuring greater adherence to treatment, especially among men and young people. Moreover, screening for chronic diseases and cancer is essential, including the establishment of easily accessible multidisciplinary care centers that can identify and address habits such as illicit drug use and alcoholism, which are associated with violent deaths.

Survival and mortality profile among people living with HIV in a cohort in the Northeastern region of Brazil

ABSTRACT Conditions related to the acquired immune deficiency syndrome (AIDS) are still a significant cause of morbidity and mortality among people living with HIV (PLHIV). Longer survival in this population were reported to increase the risk of developing noncommunicable chronic diseases (NCDs). This study aimed to estimate the survival and causes of death according to age group and sex among PLHIV monitored at two referral centers in the Northeastern Brazil. This is a prospective, retrospective cohort with death records from 2007 to 2018, based on a database that registers causes of death using the International Classification of Disease (ICD-10), which were subsequently coded following the Coding Causes of Death in HIV (CoDe). A total of 2,359 PLHIV participated in the study, with 63.2% being men, with a follow-up period of 13.9 years. Annual mortality rate was 1.46 deaths per 100 PLHIV (95% CI: 1.33 - 1.60) with a frequency of 20.9%. Risk of death for men increased by 49% when compared to women, and the risk of death in PLHIV increased by 51% among those aged 50 years and over at the time of diagnosis. It was observed that 73.5% accounted for AIDS-related deaths, 6.9% for non-AIDS defining cancer, 6.3% for external causes, and 3.2% for cardiovascular diseases. Among the youngest, 97.2% presented an AIDS-related cause of death. Highest frequency of deaths from neoplasms was among women and from external causes among men. There is a need for health services to implement strategies ensuring greater adherence to treatment, especially among men and young people. Moreover, screening for chronic diseases and cancer is essential, including the establishment of easily accessible multidisciplinary care centers that can identify and address habits such as illicit drug use and alcoholism, which are associated with violent deaths.

Evaluation of four molecular methods for the diagnosis of tuberculosis in pulmonary and blood samples from immunocompromised patients.

The present study analysed the concordance among four different molecular diagnostic methods for tuberculosis (TB) in pulmonary and blood samples from immunocompromised patients. A total of 165 blood and 194 sputum samples were collected from 181 human immunodeficiency virus (HIV)-infected patients with upper respiratory complaints, regardless of suspicious for TB. The samples were submitted for smear microscopy, culture and molecular tests: a laboratory-developed conventional polymerase chain reaction (PCR) and real-time quantitative PCR (qPCR) and the Gen-Probe and Detect-TB Ampligenix kits. The samples were handled blindly by all the technicians involved, from sample processing to results analysis. For sputum, the sensitivity and specificity were 100% and 96.7% for qPCR, 81.8% and 94.5% for Gen-Probe and 100% and 66.3% for Detect-TB, respectively. qPCR presented the best concordance with sputum culture [kappa (k) = 0.864)], followed by Gen-Probe (k = 0.682). For blood samples, qPCR showed 100% sensitivity and 92.3% specificity, with a substantial correlation with sputum culture (k = 0.754) and with the qPCR results obtained from sputum of the corresponding patient (k = 0.630). Conventional PCR demonstrated the worst results for sputa and blood, with a sensitivity of 100% vs. 88.9% and a specificity of 46.3% vs. 32%, respectively. Commercial or laboratory-developed molecular assays can overcome the difficulties in the diagnosis of TB in paucibacillary patients using conventional methods available in most laboratories.

Evaluation of four molecular methods for the diagnosis of tuberculosis in pulmonary and blood samples from immunocompromised patients

The present study analysed the concordance among four different molecular diagnostic methods for tuberculosis (TB) in pulmonary and blood samples from immunocompromised patients. A total of 165 blood and 194 sputum samples were collected from 181 human immunodeficiency virus (HIV)-infected patients with upper respiratory complaints, regardless of suspicious for TB. The samples were submitted for smear microscopy, culture and molecular tests: a laboratory-developed conventional polymerase chain reaction (PCR) and real-time quantitative PCR (qPCR) and the Gen-Probe and Detect-TB Ampligenix kits. The samples were handled blindly by all the technicians involved, from sample processing to results analysis. For sputum, the sensitivity and specificity were 100% and 96.7% for qPCR, 81.8% and 94.5% for Gen-Probe and 100% and 66.3% for Detect-TB, respectively. qPCR presented the best concordance with sputum culture [kappa (k) = 0.864)], followed by Gen-Probe (k = 0.682). For blood samples, qPCR showed 100% sensitivity and 92.3% specificity, with a substantial correlation with sputum culture (k = 0.754) and with the qPCR results obtained from sputum of the corresponding patient (k = 0.630). Conventional PCR demonstrated the worst results for sputa and blood, with a sensitivity of 100% vs. 88.9% and a specificity of 46.3% vs. 32%, respectively. Commercial or laboratory-developed molecular assays can overcome the difficulties in the diagnosis of TB in paucibacillary patients using conventional methods available in most laboratories.

Associação dos biomarcadores com aterosclerose e risco para doença coronariana em portadores de HIV / Association of biomarkers with atherosclerosis and risk for coronary artery disease in patients with HIV

FUNDAMENTO: O uso maciço da Terapia Antirretroviral (TARV) na população com vírus da imunodeficiência adquirida (HIV) coincidiu com um aumento das doenças cardiovasculares, causa importante de morbimortalidade nesse grupo. OBJETIVO: Determinar a frequência de aterosclerose carotídea e avaliar a associação entre os níveis dos biomarcadores e o espessamento da camada médio-intimal carotídea em indivíduos HIV positivos, atendidos em serviços de referência para HIV em Pernambuco. MÉTODOS: Corte transversal com 122 pacientes HIV positivos. Considerou-se aterosclerose carotídea subclínica o aumento da espessura da camada média intimal da carótida comum > 0,8 milímetros ou placas no ultrassom de carótidas. Os biomarcadores inflamatórios analisados foram IL6, IL1-β, TNF-α, PCR-ultrassensível, sVCAM-1 e sICAM-1. RESULTADOS: Dos 122 pacientes analisados, a maioria era de homens (60,7%), com > 40 anos (57,4%), em uso de TARV (81,1%). A prevalência de aterosclerose foi de 42,6% (52 casos). Pacientes com idade acima de 40 anos e Framingham intermediário ou alto apresentaram maior chance de desenvolver aterosclerose na análise univariada. Idade acima de 40 anos (OR = 6,57 IC 2,66 -16,2; p = 0,000), sexo masculino (OR = 2,76 IC 1,12-6,79; p = 0,027) e a condição de síndrome metabólica (OR = 2,27 IC 0,94-5,50; p = 0,070) mostraram-se associados à aterosclerose na análise multivariada. Níveis elevados de citocinas inflamatórias e moléculas de adesão não mostraram associação com a presença de aterosclerose. CONCLUSÃO: Não houve associação entre os biomarcadores inflamatórios, moléculas de adesão e presença de aterosclerose carotídea. Entretanto, evidenciou-se em homens, pessoas com mais de 40 anos, portadores de escore de Framingham intermediário/alto ou síndrome metabólica maior chance de aterosclerose subclínica.

BACKGROUND: The massive use of Highly-Active Antiretroviral Therapy (HAART) in individuals with human immunodeficiency virus (HIV) coincided with an increase in cardiovascular disease, a major cause of morbidity and mortality in this group. OBJECTIVE: To determine the frequency of carotid atherosclerosis and the association between biomarker levels and carotid intimal-medial thickening in HIV-positive individuals treated for HIV at referral centers in Pernambuco. METHODS: This was a cross-sectional study of 122 HIV-positive patients. Subclinical carotid atherosclerosis was considered with the presence of increased intimal-medial thickness of the common carotid artery > 0.8 mm or plaques in the carotid ultrasound. The following inflammatory biomarkers were analyzed: IL6, IL1-β, TNF-α, high-sensitivity CRP, sVCAM-1 and sICAM-1. RESULTS: Of the 122 patients analyzed, most were men (60.7%) aged > 40 years (57.4%) receiving HAART (81.1%). The prevalence of atherosclerosis was 42.6% (52 cases). Patients older than 40 years and intermediate or high Framingham score were more likely to develop atherosclerosis at the univariate analysis. Age older than 40 years (OR = 6.57, 95%CI: 2.66 to 16.2, p = 0.000), male gender (OR = 2.76, 95%CI: 1.12 to 6.79, p = 0.027) and presence of syndrome metabolic (OR = 2.27, 95%CI: 0.94 to 5.50, p = 0.070) were associated with atherosclerosis at the multivariate analysis. Elevated levels of inflammatory cytokines and adhesion molecules were not associated with the presence of atherosclerosis. CONCLUSION: There was no association between inflammatory biomarkers, adhesion molecules and presence of carotid atherosclerosis. However, a higher chance of subclinical atherosclerosis was observed in men, those older than 40 years, with intermediate / high Framingham score or metabolic syndrome.

Association of biomarkers with atherosclerosis and risk for coronary artery disease in patients with HIV.

BACKGROUND: The massive use of Highly-Active Antiretroviral Therapy (HAART) in individuals with human immunodeficiency virus (HIV) coincided with an increase in cardiovascular disease, a major cause of morbidity and mortality in this group. OBJECTIVE: To determine the frequency of carotid atherosclerosis and the association between biomarker levels and carotid intimal-medial thickening in HIV-positive individuals treated for HIV at referral centers in Pernambuco. METHODS: This was a cross-sectional study of 122 HIV-positive patients. Subclinical carotid atherosclerosis was considered with the presence of increased intimal-medial thickness of the common carotid artery > 0.8 mm or plaques in the carotid ultrasound. The following inflammatory biomarkers were analyzed: IL6, IL1-ß, TNF-α, high-sensitivity CRP, sVCAM-1 and sICAM-1. RESULTS: Of the 122 patients analyzed, most were men (60.7%) aged > 40 years (57.4%) receiving HAART (81.1%). The prevalence of atherosclerosis was 42.6% (52 cases). Patients older than 40 years and intermediate or high Framingham score were more likely to develop atherosclerosis at the univariate analysis. Age older than 40 years (OR = 6.57, 95%CI: 2.66 to 16.2, p = 0.000), male gender (OR = 2.76, 95%CI: 1.12 to 6.79, p = 0.027) and presence of syndrome metabolic (OR = 2.27, 95%CI: 0.94 to 5.50, p = 0.070) were associated with atherosclerosis at the multivariate analysis. Elevated levels of inflammatory cytokines and adhesion molecules were not associated with the presence of atherosclerosis. CONCLUSION: There was no association between inflammatory biomarkers, adhesion molecules and presence of carotid atherosclerosis. However, a higher chance of subclinical atherosclerosis was observed in men, those older than 40 years, with intermediate / high Framingham score or metabolic syndrome.

Escore de cálcio na avaliação da aterosclerose em pacientes com HIV/AIDS / Calcium score in the evaluation of atherosclerosis in patients with HIV/Aids

FUNDAMENTO: A terapia antirretroviral aumentou drasticamente a expectativa de vida em pacientes com HIV/AIDS, embora a aterosclerose esteja associada a uma terapia de longo prazo. OBJETIVO: Investigar a prevalência de aterosclerose em pacientes com AIDS submetidos à terapia antirretroviral e a influência de tratamentos de diferentes regimes e durações. MÉTODOS: Pacientes com HIV/AIDS foram abordados durante consultas de rotina. Aqueles que estiveram em terapia antirretroviral por, pelo menos, dois anos tiveram o sangue coletado para análise do perfil lipídico e da glicemia em jejum e foram submetidos à tomografia computadorizada cardíaca para quantificação do escore de cálcio dentro de seis dias, no máximo. A aterosclerose foi definida como escore de cálcio maior que zero (CAC > 0). Fatores de risco tradicionais, síndrome metabólica e o escore de Framingham foram analisados. RESULTADOS: Cinquenta e três pacientes realizaram tomografia computadorizada cardíaca: 50,94 por cento eram do sexo masculino, com idade média de 43,4 anos; 20 por cento tinham hipertensão; 3,77 por cento tinham diabetes; 67,92 por cento tinham hipercolesterolemia; 37,74 por cento tinham hipertrigliceridemia; 47,17 por cento tinham HDL baixo; 24,53 por cento atenderam aos critérios para síndrome metabólica; 96,23 por cento foram classificados no escore de Framingham como "baixo risco"; e 18,87 por cento eram tabagistas. A duração média do tratamento antirretroviral foi de 58,98 meses. A aterosclerose coronária ocorreu em 11 pacientes (20,75 por cento). A duração da terapia antirretroviral não se relacionou à aterosclerose (p = 0,41), e não houve diferenças significativas entre os diferentes esquemas antirretrovirais (p = 0,71). Entre os fatores de risco tradicionais, o tabagismo (OR = 27,20; p = 0,023) e a idade (OR = 20,59; p = 0,033) foram significativos na presença de aterosclerose. Havia tendência para uma associação positiva da aterosclerose com a hipercolesterolemia (OR = 8,30; p = 0,0668). CONCLUSÃO: Os fatores associados à aterosclerose foram idade, tabagismo e hipercolesterolemia. A duração e o tipo de terapia antirretroviral não influenciaram a prevalência da aterosclerose.

BACKGROUND: Antiretroviral therapy has dramatically increased life expectancy in patients with HIV/AIDS although atherosclerosis has been associated with long-standing therapy. OBJECTIVE: To investigate the prevalence of atherosclerosis in patients with AIDS undergoing antiretroviral therapy and the influence of different schemes and duration of treatment. METHODS: HIV/AIDS patients were approached during routine consultations. Those who had been on antiretroviral therapy for at least two years had their blood collected for analysis of lipid profile and fasting glycemia and underwent cardiac CT for quantification of calcium score within six days at the most. Atherosclerosis was defined as calcium score greater than zero (CAC > 0). Traditional risk factors, metabolic syndrome and Framingham score were analyzed. RESULTS: Fifty-three patients performed cardiac CT. Twenty-seven (50.94 percent) were male, mean age 43.4 years; 20.00 percent had hypertension, 3.77 percent diabetes, 67.92 percent hypercholesterolemia, 37.74 percent hypertriglyceridemia and 47.17 percent low HDL. Thirteen (24.53 percent) met criteria for metabolic syndrome and 96.23 percent were classified in Framingham score as "low risk." Ten patients (18.87 percent) were smokers. Mean duration of antiretroviral treatment was 58.98 months. Coronary atherosclerosis occurred in 11 (20.75 percent) patients. Duration of antiretroviral therapy was not related to atherosclerosis (p = 0.41) and there were no significant differences between different antiretroviral regimens (p = 0.71). Among traditional risk factors, smoking (OR = 27.20; p = 0.023) and age (OR = 20.59; p = 0.033) were significant in the presence of atherosclerosis. There was a trend towards a positive association of atherosclerosis with hypercholesterolemia (OR = 8.30; p = 0.0668). CONCLUSION: Factors associated with atherosclerosis were age, smoking and hypercholesterolemia. Duration and type of antiretroviral therapy had no influence on the prevalence of atherosclerosis.

Calcium score in the evaluation of atherosclerosis in patients with HIV/AIDS.

BACKGROUND: Antiretroviral therapy has dramatically increased life expectancy in patients with HIV/AIDS although atherosclerosis has been associated with long-standing therapy. OBJECTIVE: To investigate the prevalence of atherosclerosis in patients with AIDS undergoing antiretroviral therapy and the influence of different schemes and duration of treatment. METHODS: HIV/AIDS patients were approached during routine consultations. Those who had been on antiretroviral therapy for at least two years had their blood collected for analysis of lipid profile and fasting glycemia and underwent cardiac CT for quantification of calcium score within six days at the most. Atherosclerosis was defined as calcium score greater than zero (CAC > 0). Traditional risk factors, metabolic syndrome and Framingham score were analyzed. RESULTS: Fifty-three patients performed cardiac CT. Twenty-seven (50.94%) were male, mean age 43.4 years; 20.00% had hypertension, 3.77% diabetes, 67.92% hypercholesterolemia, 37.74% hypertriglyceridemia and 47.17% low HDL. Thirteen (24.53%) met criteria for metabolic syndrome and 96.23% were classified in Framingham score as "low risk." Ten patients (18.87%) were smokers. Mean duration of antiretroviral treatment was 58.98 months. Coronary atherosclerosis occurred in 11 (20.75%) patients. Duration of antiretroviral therapy was not related to atherosclerosis (p = 0.41) and there were no significant differences between different antiretroviral regimens (p = 0.71). Among traditional risk factors, smoking (OR = 27.20; p = 0.023) and age (OR = 20.59; p = 0.033) were significant in the presence of atherosclerosis. There was a trend towards a positive association of atherosclerosis with hypercholesterolemia (OR = 8.30; p = 0.0668). CONCLUSION: Factors associated with atherosclerosis were age, smoking and hypercholesterolemia. Duration and type of antiretroviral therapy had no influence on the prevalence of atherosclerosis.

Radiographic features of pulmonary tuberculosis in patients infected by HIV: is there an objective indicator of co-infection?

This study aimed to compare the radiographic characteristics of patients with pulmonary tuberculosis (TB) and human immunodeficiency virus (HIV) infection with those of HIV-negative patients. In all, 275 TB patients attending the outpatients clinics at the University Hospital/UFPE, were studied from January 1997 to March 1999. Thirty nine (14.2%) of them were HIV(+), with a higher frequency of males in this group (p=0.044). Seventy-five percent of the HIV(+) patients and 19% of the HIV(-) had a negative tuberculin test (PPD) (p < 0.001). The proportion of positive sputum smears in the two groups was similar. The radiological finding most strongly associated with co-infection was absence of cavitation (p < 0.001). It may therefore be concluded that the lack of cavitation in patients with pulmonary TB may be considered a useful indicator of the need to investigate HIV infection. This approach could contribute to increasing the effectiveness of local health services, by offering appropriate treatment to co-infected patients.

Este trabalho objetivou comparar características radiológicas de doentes com tuberculose (TB) pulmonar, soropositivos para o vírus da imunodeficiência humana (HIV), com aquelas de doentes HIV-. Estudou-se, prospectivamente, 275 doentes com TB pulmonar, atendidos no Hospital das Clínicas da UFPE, entre janeiro de 1997 e março de 1999. Destes, 39 (14,2%) eram HIV+, com um predomínio maior de homens neste grupo (p=0,044). setenta e cinco por cento dos doentes HIV+ e 19% dos HIV- apresentavam reação negativa ao teste tuberculínico (PPD) (p<0,001). A proporção de baciloscopias positivas nos dois grupos foi semelhante. A característica radiológica mais fortemente associada à co-infecção tuberculose pulmonar/HIV+ foi a ausência de cavidades (p<0,001). Conclui-se que, diante de doentes com TB pulmonar, a ausência de cavidades na telerradiografia de tórax constitui-se num indicador útil da necessidade de se investigar a infecção pelo HIV. Esta conduta pode contribuir para aumentar a efetividade dos serviços locais de saúde, permitindo oferecer tratamento adequado a estes doentes.

Fatores prognósticos para o desfecho do tratamento da tuberculose pulmonar em Recife, Pernambuco, Brasil / Prognostic factors for pulmonary tubeculosis outcome in Recife, Pernambuco, Brazil

OBJETIVOS: O objetivo deste estudo caso-controle foi identificar fatores prognósticos para desfecho do tratamento da tuberculose pulmonar em 297 pacientes (Hospital das Clíinicas, Universidade Federal de Pernambuco, Brasil) entre 1994 e 1999. MATERIAS E METODOS: Foram considerados casos indivíduos com alta por óbito, abandono ou falencia do tratamento. Os controles foram indivíduos com alta cura. Foram realizadas análises uni e multivariada com as variáveis independentes sexo; idade; esoclaridade; hábito de fumar; hábito de ingerir álcool; tratamento anterior para tuberculose; resposta ao teste turberculínico; soroligia para HIV; grau de resistencia aos antimicrobianos; resultado da pesquisa direta de bacilos álcool-ácido-resistentes' esquema terapeuticco utilizado. Além disso, repetiramse as análises uni e multivariada considerando como casos apenas os óbitos e os indivíduos com falencia do tratamento. RESULTADOS: A ingestao excessiva de álcool (OR=2,58; P=0,014), a co-infecçao pelo HIV (OR=3,40; P=0,28), o a tratamento anterior para tuberculose (OR=4,89; P0,001) e resistencia a duas ou mais drogas antituberculose (OR=3,49; P=0,017) foram fatores de risco para o insucesso do tratamento. Na segunda análise multivariada, excluindo os casos de abandono, nao houve associaçao entre a o ingestao excessiva de álcool e desfecho do tratamento, mantendo-se as demais associaçoes, o que sugere uma estreita relaçao entre o abandono do tratamento e o estilismo. CONCLUSOES: Os fatores prognósticos para insuccesso do tratamento da tuberculose pulmonar entre os indivíduos estudados estao interrelacionados, sendo de natureza biológica, clínica e social. Devem ser identificados no início do tratamento para que sejam implementados procedimentos diferenciados de acompanhamento, tais como tratamento diretamente surperisionado, de forma a fortalecer o controle da tuberculose em nível local

Objective. The objective of this case-control study was to identify prognostic factors for the outcome of pulmonary tuberculosis among 297 patients who were treated between 1994 and 1999 at the Federal University of Pernambuco Clinics Hospital, in Recife, Pernambuco, Brazil. Methods. The cases were defined as individuals whose treatment ended in death, dropout, or failure. The controls were persons whose treatment ended in cure. The following independent variables were submitted to uni- and multivariate analyses: sex, age, schooling, being a smoker, consuming alcohol, previous treatment for tuberculosis, response to the tuberculin test, HIV serology, resistance to antimicrobial agents, results of direct investigation of alcohol- and acid-resistant bacilli, and treatment approach used. After that, the uni- and multivariate analyses were repeated, including as cases only deaths and individuals with treatment failure. Results. Four risk factors for tuberculosis treatment failure were found: excessive alcohol intake (odds ratio (OR) = 2.58; P = 0.014), co-infection with HIV (OR = 3.40; P = 0.028), previous tuberculosis treatment (OR = 4.89; P < 0.001), and resistance to two or more antituberculosis drugs (OR = 3.49; P = 0.017). In the second multivariate analysis, which excluded dropout cases, no association was found between treatment outcome and excessive alcohol consumption, but the other associations remained. This result suggests a close relationship between alcoholism and treatment dropout. Conclusions. In the group that was studied the prognostic factors for failure of pulmonary tuberculosis treatment were interrelated and were of a biological, clinical, and social character. These factors should be identified at the beginning of treatment in order to allow implementation of specific follow-up procedures such as the strategy of directly observed treatment. This would strengthen tuberculosis control at the local level

O retratamento da tuberculose no município do Recife, 1997: uma abordagem epidemiológica / Repeated treatment of tuberculosis in the city of Recife, 1997: an epidemiological approach

Objetivo: Este estudo descreve as características e analisa o acompanhamento de casos de retratamento ocorridos em residentes no município do Recife, no ano de 1997, com o objetivo de avaliar a importância deste grupo de doentes para a vigilância da tuberculose nos sistemas locais de saúde. Casuística e métodos: Foi realizado um estudo transversal com uma amostra de 240 casos de retratamento que representaram 16,2 por cento dos casos de tuberculose notificados à Secretaria Estadual de Saúde do Estado de Pernambuco, em 1997. Resultados: O abandono do tratamento anterior foi o principal motivo para o retratamento (55,8 por cento), seguido por casos de recidiva da doença (39,2 por cento). Os doentes eram predominantemente do sexo masculino, com idade entre 30 e 49 anos, com baixa ou nenhuma escolaridade, e apresentavam um predomínio da forma pulmonar. Chama a atenção que 42,7 por cento dos casos de retratamento tinham história de dois ou mais tratamentos anteriores. Em relação ao desfecho do retratamento, 52,5 por cento dos casos apresentaram resultado desfavorável. Entre estes, 44,2 por cento dos indivíduos abandonaram o esquema terapêutico e 39,6 por cento deles fizeram-no até o primeiro mês. Os casos que voltaram a tratar-se após recidiva apresentaram maior percentual de desfecho favorável de retratamento (64 por cento) quando comparados com os casos que voltaram a tratar-se após falência ou abandono do tratamento anterior e esta diferença foi estatisticamente significante (chi² = 19,55; p < 0,01). Entre os casos da forma pulmonar de tuberculose, 27,1 por cento reiniciaram a quimioterapia sem realizar a pesquisa do bacilo de Koch no escarro e apenas 5 por cento realizaram cultivo com teste de sensibilidade. Encontrou-se ainda que 30,2 por cento dos casos voltaram a tratar-se apenas com as drogas do esquema I. Conclusões: Os resultados encontrados apontam para a necessidade de implementar as atividades de assistência e seguimento dos casos de retratamento de tuberculose, de forma rotineira, no âmbito dos serviços de saúde. O tratamento com drogas adequadas e o acompanhamento dos doentes até a cura são métodos simples e baratos para prevenir o aparecimento de cepas de bacilos resistentes às drogas. Devem, portanto, ser entendidos como estratégias de fortalecimento do sistema de vigilância epidemiológica à tuberculose no nível local

Vigilância de doenças endêmicas em áreas urbanas: a interface entre mapas de setores censitários e indicadores de morbidade / Surveillance of endemic diseases in urban areas: the interface between census tract maps and morbidity data

Discute-se o eixo metodológico utilizado na construçäo de modelo de vigilância de endemias em áreas urbanas, orientado por uma análise de situçöes de risco e por indicadores epidemiológicos espaciais. Säo apresentadas as premissas básicas do modelo, os critérios de seleçäo de variáveis sócio-econômicas e as etapas metodológicas necessárias na construçäo do indicador sintético de risco. Comenta-se, também, como algumas questöes operacionais relativas à construçäo de mapas digitais de setores censitários e vinculaçäo de bancos de dados foram equacionadas. Essa abordagem, incorporando o componente da organizaçäo do espaço na vigilância de doenças endêmicas, tendo como exemplo a hanseníase e a tuberculose, privilegia o uso integrado de sistemas de informaçäo já existentes, na perspectiva de estratificar áreas urbanas diferenciadas que permite discriminar riscos desiguais para ocorrência de endemias. Essa é uma ferramenta para o planejamento e o gerenciamento das açöes voltadas para o controle das endemias nas cidades.

Monitoring the elimination of leprosy in Brazil

A decreasing trend in the prevalence rate of leprosy was reached in Brazil only after the introduction of the World Health Organization multidrug therapy (WHO/MDT) program in 1990. This paper analyzes leprosy morbidity indicators and the prevalence rate, and their utilization in monitoring the progress of leprosy elimination in Brazil. Since these indicators are modified by changes in health service procedures, comparing prevalence rates from different endemic countries or current prevalence rates with old ones from the same endemic region needs careful attention. The current official prevalence rate of 6.72/10,000 inhabitants in Brazil could be considered high when compared with rates from other countries, but it is important to remember that defaulters and patients being treated with old regimens are kept on the active registers in Brazil, while in most other endemic countries they are not.