Perfil dos usuários vivendo com HIV/Aids atendidos em um Centro de Testagem e Aconselhamento no interior da Bahia: um estudo longitudinal retrospectivo / Profile of users living with HIV/AIDS assisted at a Counseling and Testing Center in the countryside of Bahia state: a longitudinal retrospective study

RESUMO: Objetivo: Caracterizar o perfil clínico e epidemiológico dos usuários vivendo com HIV/Aids atendidos em um Centro de Testagem e Aconselhamento (CTA) localizado no município de Paulo Afonso, no interior da Bahia. Casuística e métodos: Estudo retrospectivo, observacional, baseado em dados secundários obtidos mediante consulta aos registros dos usuários cadastrados no serviço durante o período de 2002 a 2019. Os dados foram tratados e analisa-dos por estatística descritiva e inferencial. Resultados: Foram identificados 301 indivíduos vivendo com HIV/Aids, correspondendo a uma média de 12,4 ± 9,5 casos/ano; 58,4% eram do sexo masculino com idade média de 40,6 ± 13,8 anos. Os indivíduos mais afetados possuíam o ensino fundamental incompleto e eram provenientes de bair-ros periféricos. Dos 226 indivíduos avaliados laboratorialmente, 49 (21,7%) foram diagnosticados na fase de Aids. Diferenças significativas foram observadas na contagem de linfócitos T CD4+, razão entre os linfócitos T CD4+/CD8+e linfócitos T CD45+ entre indivíduos vivendo com HIV e aqueles diagnosticados na fase de Aids (p<0,001). Con-clusão: A taxa de detecção de pessoas vivendo com HIV/Aids aumentou nos últimos anos no município de Paulo Afonso, Bahia. Esse aumento no número de casos deve-se, possivelmente, aos avanços nos métodos diagnósticos, bem como da implementação do CTA na região. O perfil dos indivíduos avaliados segue a tendência nacional, com predomínio do sexo masculino, jovem, com ensino fundamental incompleto. Como esperado, indivíduos diagnosti-cados na fase Aids apresentam resultados laboratoriais diferentes dos indivíduos vivendo com HIV. (AU)

ABSTRACT: Objective: To characterize the clinical and epidemiological profile of users living with HIV/AIDS treated at a Coun-seling and Testing Center (CTC) located in the municipality of Paulo Afonso, in the countryside of Bahia. Casuistry and methods: A retrospective, observational study, based on secondary data obtained by consulting the records of users registered within the service, during the period from 2002 to 2019. The data were treated and analyzed using descriptive and inferential statistics. Results: 301 individuals living with HIV/AIDS were identified, corresponding to a mean of 12.4 ± 9.5 cases/year; 58.4% were male with a mean age of 40.6 ± 13.8 years. The most affected individuals had incomplete primary education and came from peripheral neighborhoods. Of the 226 individuals eval-uated in the laboratory, 49 (21.7%) were diagnosed in the AIDS phase. Significant differences were observed in the CD4+ T lymphocyte count, ratio between CD4+/CD8+ T lymphocytes and CD45+ T lymphocytes between individuals living with HIV and those diagnosed in the AIDS phase (p<0.001). Conclusion: The detection rate of people living with HIV/AIDS has increased in recent years in the municipality of Paulo Afonso, Bahia. This increase in the number is possibly due to advances in diagnostic methods, as well as the implementation of CTC in the region. The profile of the individuals evaluated follows the national tendency, with a predominance of young men with incomplete el-ementary education. As expected, individuals diagnosed in the AIDS phase have different laboratory results from individuals living with HIV.

Serum antiphospholipid antibody levels as biomarkers for diagnosis of pulmonary tuberculosis patients.

SETTING: Salvador, Bahia, Brazil. OBJECTIVE: To evaluate the immunoglobulin (Ig)M and total IgG antibody response to cardiolipin (CL), phosphatidylcholine (PTC), phosphatidylethanolamine (PE), phosphatidylinositol (PI) and sulfatide (SL-I) as biosignatures that can be used to diagnose pulmonary tuberculosis (TB) and its applicability for monitoring the efficacy of anti-tuberculosis treatment. DESIGN: Serum samples from 37 adult pulmonary TB patients and 48 controls (16 healthy household contacts, 19 household contacts with latent tuberculous infection [LTBI] and 13 non-TB patients with lung disease) were screened using enzyme-linked immunosorbent assays (ELISAs) for IgM and total IgG against phospholipids. RESULTS: Levels of IgM response to CL, PE and PI, and IgG response to CL, PE, PI and PTC were significantly higher in TB patients than in control groups. Anti-CL IgG had the best performance characteristics, with a sensitivity and specificity of respectively 86.5% and 87.2%. This IgG anti-CL ELISA test detected 86.5% (32/37) of the TB patients, whereas the number detected using sputum smear was only 65.9% (24/37). After anti-tuberculosis treatment, the median value for all anti-phospholipid antibodies decreased significantly compared with baseline values (P < 0.05). CONCLUSION: Our results suggest that the total IgG anti-CL level could be useful to complement conventional bacteriological tests for the rapid diagnosis of adult pulmonary TB.

Risk factors for failure to complete a course of latent tuberculosis infection treatment in Salvador, Brazil.

BACKGROUND: Although treatment of latent tuberculosis infection (LTBI) is an essential component of tuberculosis (TB) control in countries such as the United States, it is not widely practiced in most TB-endemic countries. OBJECTIVE: To examine the practice of and adherence to LTBI treatment in a high-risk population in Brazil. DESIGN: We followed household contacts (HHCs) of patients hospitalized with pulmonary TB in Salvador, Brazil, for 6 months after they initiated LTBI treatment with isoniazid (INH). HHCs were asked to return to the hospital once a month for 6 months for follow-up visits and INH refills. RESULTS: Of 101 HHCs who initiated LTBI treatment, 54 (53.5%) completed the 6-month regimen. The risk of treatment non-completion was significantly higher in HHCs who reported side effects to INH (RR 2.69, 95%CI 1.3-5.8, P = 0.01), and in those who had to take two buses for a one-way trip to the hospital (RR 1.8, 95%CI 1.01-3.3, P = 0.04). Of the 101 HHCs, 29 (28.7%) did not return for any follow-up visits; these HHCs were significantly more likely to have a 2-bus commute to the hospital compared to HHCs who completed treatment (OR 20.69, 95%CI 2.1-208.4, P = 0.01). CONCLUSION: Nearly 50% of HHCs at high risk for developing TB completed a 6-month course of LTBI treatment. Completion of LTBI treatment was most affected by medication intolerance and commuting difficulties for follow-up visits.

Analysis of discordance between the tuberculin skin test and the interferon-gamma release assay.

OBJECTIVE: To analyze factors associated with discordance between tuberculin skin test (TST) and interferon-gamma release assay (IGRA) results among household contacts of pulmonary tuberculosis (PTB) patients. DESIGN: TST (purified protein derivative) and IGRA (QuantiFERON-TB Gold) were performed on household contacts of PTB patients diagnosed between 2006 and 2007 in Salvador, Brazil. Discordant test groups were compared with the TST-/IGRA- group. RESULTS: Of 261 household contacts satisfactorily tested by TST, 145 (55.6%) had positive TST results; of 298 satisfactorily tested by IGRA, 127 (43.1%) had positive results. The test agreement was 0.76 (kappa = 0.53, 95%CI 0.43-0.63). Sixty-one (24%) were discordant: 44 (72%) with TST+/IGRA- and 17 (28%) with TST-/IGRA+ results. Compared to the TST-/IGRA- group, the TST+/IGRA- and TST+/IGRA+ groups were significantly more likely to have a chest X-ray showing old lung scars (OR = 6.8, 95%CI 1.3-35.0; OR = 7.4, 95%CI 2.2-24.4, respectively). The TST-/IGRA+ group was exposed to their index cases for significantly longer than the TST-/IGRA- group (OR = 7.2, 95%CI 1.7-29.3). CONCLUSION: The TST+/IGRA- and TST+/IGRA+ groups shared more similar characteristics with each other than with the TST-/IGRA- group. In a setting endemic for TB, TST results appear to be more suitable in the decision to treat latent TB infection.