ABSTRACT
This study aimed to describe the clinical, epidemiological and microbiological features of meningococcal meningitis in Salvador, Brazil. Between February 1996 and January 2001, a hospital-based surveillance prospectively identified cases of culture-positive meningococcal meningitis. Demographic and clinical data were collected through interview and medical chart review. Antisera and monoclonal antibodies were used to determine the serogroup and serotype:serosubtype of the isolates, respectively. Surveillance identified a total of 408 cases of meningococcal meningitis, with a case fatality rate of 8% (32/397). The mean annual incidence for the 304 culture-positive cases residing in metropolitan Salvador was 1.71 cases per 100,000 population. Infants <1 year old presented the highest incidence (14.7 cases per 100,000 population). Of the 377 serogrouped isolates, 82%, 16%, 2% and 0.3% were serogroups B, C, W135 and Y, respectively. A single serotype:serosubtype (4,7:P1.19,15) accounted for 64% of all cases. Continued surveillance is necessary to characterise strains and to define future prevention and control strategies.
Subject(s)
Meningitis, Meningococcal/diagnosis , Neisseria meningitidis/isolation & purification , Serotyping , Adolescent , Adult , Age Distribution , Brazil/epidemiology , Child , Child, Preschool , Female , Humans , Infant , Male , Meningitis, Meningococcal/drug therapy , Meningitis, Meningococcal/epidemiology , Middle Aged , Prevalence , Treatment OutcomeABSTRACT
Increased transmission of resistant HIV has been raised as a potential consequence of expanded access to antiretroviral therapy. We review how limitations in resources and health care infrastructure may impact the transmission of resistant HIV, and we examine data from Brazil as a case study. We introduce a biological and clinical framework to identify the major determinants of transmitted resistance and to discuss how these determinants may be affected by a lack of infrastructure. We then use our framework to examine HIV resistance data from Brazil. This country was chosen as a case study due to its extensive experience delivering antiretroviral drugs and because of the availability of data on the prevalence of resistant HIV there. The data from Brazil show that antiretroviral therapy can be delivered in a resource-limited setting without resulting in widespread transmission of resistant virus. While the Brazilian experience does not necessarily generalize to countries with less health care infrastructure, neither theory nor data support a foregone conclusion that resistance will necessarily dominate HIV epidemics in the developing world to a greater extent than it does in the developed world.
Subject(s)
Anti-Retroviral Agents/pharmacology , HIV Infections/drug therapy , HIV/drug effects , Antiretroviral Therapy, Highly Active , Brazil , Drug Resistance, Viral , HIV/genetics , HIV Infections/mortality , HIV Infections/transmission , HIV Infections/virology , Humans , Prevalence , Risk-TakingABSTRACT
Increased transmission of resistant HIV has been raised as a potential consequence of expanded access to antiretroviral therapy. We review how limitations in resources and health care infrastructure may impact the transmission of resistant HIV, and we examine data from Brazil as a case study. We introduce a biological and clinical framework to identify the major determinants of transmitted resistance and to discuss how these determinants may be affected by a lack of infrastructure. We then use our framework to examine HIV resistance data from Brazil. This country was chosen as a case study due to its extensive experience delivering antiretroviral drugs and because of the availability of data on the prevalence of resistant HIV there. The data from Brazil show that antiretroviral therapy can be delivered in a resource-limited setting without resulting in widespread transmission of resistant virus. While the Brazilian experience does not necessarily generalize to countries with less health care infrastructure, neither theory nor data support a foregone conclusion that resistance will necessarily dominate HIV epidemics in the developing world to a greater extent than it does in the developed world.
Se ha especulado que el aumento de cepas del virus de la inmunodeficiencia humana (VIH) resistentes a medicamentos podría ser el resultado de un mayor acceso al tratamiento con antirretrovíricos. Tomando como ejemplo datos propios del Brasil, en este trabajo examinamos la manera en que la escasez de recursos y las carencias de la infraestructura sanitaria podrían estar influyendo en la transmisión de cepas resistentes de VIH. Empleamos un marco biológico y clínico para identificar los principales factores determinantes del aumento de la resistencia y exploramos la forma en que dichos factores podrían verse afectados por la falta de infraestructura. Posteriormente empleamos ese mismo marco para examinar las cifras de resistencia del Brasil, país que se eligió como ejemplo porque en él los medicamentos antirretrovíricos han tenido amplia distribución y porque hay abundantes datos acerca de la prevalencia de cepas de VIH en el territorio nacional. Las cifras del Brasil demuestran que se puede administrar el tratamiento con antirretrovíricos en lugares donde hay pocos recursos sin que ello provoque la transmisión generalizada de cepas víricas resistentes. Aunque la experiencia brasileña no necesariamente se puede proyectar a países con menos infraestructura sanitaria, no hay ningún esquema teórico ni datos que respalden la conclusión a priori de que en el mundo en desarrollo la epidemia de VIH transcurrirá con mayores cifras de resistencia que en países desarrollados.
Subject(s)
Humans , HIV , Anti-Retroviral Agents/pharmacology , HIV Infections/drug therapy , HIV , Antiretroviral Therapy, Highly Active , Brazil , Drug Resistance, Viral , HIV Infections/mortality , HIV Infections/transmission , HIV Infections/virology , Prevalence , Risk-TakingSubject(s)
Anti-Retroviral Agents , HIV , Antiretroviral Therapy, Highly Active , Drug Resistance, Viral , HIV Infections , Brazil , Prevalence , Risk-TakingABSTRACT
O Brasil fornece gratuitamente terapia anti-retroviral (ARV) para cerca de 150 mil pessoas vivendo com HIV/ AIDS. A terapia ARV requer aderência ótima, visando alcançar carga viral indetectável e evitar resistência viral. Os médicos desempenham papel central quanto à aderência à ARV, mas há escassa informação sobre a comunicação entre médicos/pessoas vivendo com HIV/ AIDS. Entrevistas em profundidade foram realizadas com 40 médicos assistentes de seis hospitais de referência do Rio de Janeiro, Brasil. Tópicos da entrevista incluíram: experiências relativas ao tratamento de pessoas vivendo com HIV/AIDS, relacionamento/diálogo com pacientes, barreiras/facilitadores para aderência aos serviços disponíveis e eficácia destes. As barreiras para aderência à ARV se referiam, principalmente, ao relacionamento médico-paciente. Outras barreiras estavam relacionadas a estilos de vida "caóticos" de alguns pacientes, conhecimento inadequado/crenças negativas sobre HIV/AIDS e a eficácia da ARV. É necessário melhorar as redes de serviços de saúde, com encaminhamento mais ágil e maior integração entre diferentes profissionais de saúde. Essas mudanças estruturais podem melhorar a aderência e a qualidade de vida das pessoas vivendo com HIV/AIDS.
Subject(s)
Antiretroviral Therapy, Highly Active , Acquired Immunodeficiency SyndromeABSTRACT
Brazil provides free antiretroviral (ARV) therapy to some 150,000 individuals living with HIV/ AIDS). ARV regimens require optimal adherence to achieve undetectable viral loads and to avoid viral resistance. Physicians play a key role to foster ARV adherence, but until now little is known about the communication between physicians/ people living with HIV/AIDS in this setting. In-depth interviews were conducted with 40 physicians treating people living with HIV/AIDS at six public reference centers in Rio de Janeiro, Brazil. Interview topics included: experiences in the treatment of people living with HIV/AIDS, relationship and dialogue with patients, barriers/facilitators to adherence, and effectiveness of available services. Barriers to ARV adherence were mainly related to the low quality of patient-provider relationship. Other barriers were related to "chaotic" patients' lifestyles, and inadequate knowledge and/or negative beliefs about HIV/AIDS and ARV effectiveness. It is necessary to improve networking between services, establish agile referral systems, and improve health professionals' integration. These structural changes could contribute to improved adherence, resulting in improved quality of life for people living with HIV/AIDS.
Subject(s)
Anti-Retroviral Agents/therapeutic use , HIV Infections/drug therapy , Patient Compliance , Physician-Patient Relations , Acquired Immunodeficiency Syndrome/drug therapy , Adult , Antiretroviral Therapy, Highly Active , Brazil , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
OBJECTIVE: To investigate trends in AIDS mortality and incidence in Brazil over the period of 1984 to 2000 and to assess the impact of the introduction of universal access to highly active antiretroviral therapy (HAART) in the country in 1996. METHODS: Data from the Brazilian disease notification system and the national mortality information system were used to calculate annual region-specific and sex-specific AIDS incidence and mortality rates. We also calculated sex- and region-specific ratios of the number of AIDS deaths in one year to the number of AIDS cases notified two years earlier. RESULTS: AIDS mortality rates for both men and women and in all five of the geographic regions of Brazil declined following introduction of HAART, despite continued growth in AIDS incidence. The ratio of the number of AIDS deaths in one year to the number of AIDS cases notified two years earlier for men equalized rapidly with the ratio for women following introduction of HAART. More recently, AIDS incidence declined for both sexes and in most of the regions of Brazil. CONCLUSIONS: Despite Brazil's resource limitations and disparities in wealth between men and women and among the country's regions, the introduction of universal access to HAART in Brazil has helped achieve impressive declines in AIDS mortality, and it may also be contributing to declines in AIDS incidence.
Subject(s)
Acquired Immunodeficiency Syndrome/drug therapy , Antiretroviral Therapy, Highly Active , Health Services Accessibility , Acquired Immunodeficiency Syndrome/mortality , Adolescent , Adult , Anti-HIV Agents/therapeutic use , Brazil/epidemiology , Disease Progression , Female , Humans , Incidence , Male , Middle Aged , National Health Programs , Registries , Sex Distribution , Socioeconomic FactorsABSTRACT
OBJETIVO: Investigar las tendencias que han mostrado la mortalidad y la incidencia del sida en el Brasil durante el período de 1984 a 2000 y evaluar el efecto de la introducción en el país en 1996 de la terapia antirretrovírica de gran actividad (TAGA) accesible a toda la población. MÉTODOS: Se usaron datos procedentes del sistema de notificación de enfermedades del Brasil y del sistema nacional de información sobre mortalidad para calcular las tasas de incidencia y de mortalidad por sida en cada región del país y según el sexo. También calculamos para cada región y según el sexo, las razones dadas por el número de muertes por sida en un año contra el número de casos de sida notificados dos años antes. RESULTADOS: Las tasas de mortalidad en las cinco regiones del Brasil descendieron tanto en hombres como en mujeres después de adoptarse la TAGA, a pesar de que la incidencia de sida siguió aumentando. La razón del número de muertes por sida en un año al número de casos de sida notificados dos años antes llegó a emparejarse muy pronto en hombres y mujeres después de la introducción de la TAGA. En época más reciente, la incidencia de sida se ha reducido en ambos sexos en la mayoría de las regiones del Brasil. CONCLUSIONES: A pesar de los limitados recursos que posee el Brasil y de las disparidades económicas observadas entre hombres y mujeres en las distintas regiones del país, la introducción de la TAGA accesible a toda la población ha ayudado a lograr un descenso muy notable de la mortalidad por sida y podría estar contribuyendo a reducir la incidencia de la enfermedad.
Objective. To investigate trends in AIDS mortality and incidence in Brazil over the period of 1984 to 2000 and to assess the impact of the introduction of universal access to highly active antiretroviral therapy (HAART) in the country in 1996. Methods. Data from the Brazilian disease notification system and the national mortality information system were used to calculate annual region-specific and sex-specific AIDS incidence and mortality rates. We also calculated sex- and region-specific ratios of the number of AIDS deaths in one year to the number of AIDS cases notified two years earlier. Results. AIDS mortality rates for both men and women and in all five of the geographic regions of Brazil declined following introduction of HAART, despite continued growth in AIDS incidence. The ratio of the number of AIDS deaths in one year to the number of AIDS cases notified two years earlier for men equalized rapidly with the ratio for women following introduction of HAART. More recently, AIDS incidence declined for both sexes and in most of the regions of Brazil. Conclusions. Despite Brazil's resource limitations and disparities in wealth between men and women and among the country's regions, the introduction of universal access to HAART in Brazil has helped achieve impressive declines in AIDS mortality, and it may also be contributing to declines in AIDS incidence