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2.
J Int AIDS Soc ; 23(8): e25587, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32767707

RESUMO

INTRODUCTION: The COVID-19 pandemic reached the African continent in less than three months from when the first cases were reported from mainland China. As COVID-19 preparedness and response plans were rapidly instituted across sub-Saharan Africa, many governments and donor organizations braced themselves for the unknown impact the COVID-19 pandemic would have in under-resourced settings with high burdens of PLHIV. The potential negative impact of COVID-19 in these countries is uncertain, but is estimated to contribute both directly and indirectly to the morbidity and mortality of PLHIV, requiring countries to leverage existing HIV care systems to propel COVID-19 responses, while safeguarding PLHIV and HIV programme gains. In anticipation of COVID-19-related disruptions, PEPFAR promptly established guidance to rapidly adapt HIV programmes to maintain essential HIV services while protecting recipients of care and staff from COVID-19. This commentary reviews PEPFAR's COVID-19 technical guidance and provides country-specific examples of programme adaptions in sub-Saharan Africa. DISCUSSION: The COVID-19 pandemic may pose significant risks to the continuity of HIV services, especially in countries with high HIV prevalence and weak and over-burdened health systems. Although there is currently limited understanding of how COVID-19 affects PLHIV, it is imperative that public health systems and academic centres monitor the impact of COVID-19 on PLHIV. The general principles of the HIV programme adaptation guidance from PEPFAR prioritize protecting the gains in the HIV response while minimizing in-person home and facility visits and other direct contact when COVID-19 control measures are in effect. PEPFAR-supported clinical, laboratory, supply chain, community and data reporting systems can play an important role in mitigating the impact of COVID-19 in sub-Saharan Africa. CONCLUSIONS: As community transmission of COVID-19 continues and the number of country cases rise, fragile health systems may be strained. Utilizing the adaptive, data-driven programme approaches in facilities and communities established and supported by PEPFAR provides the opportunity to strengthen the COVID-19 response while protecting the immense gains spanning HIV prevention, testing and treatment reached thus far.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Assistência à Saúde , Infecções por HIV/complicações , Pneumonia Viral/complicações , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/mortalidade , África ao Sul do Saara/epidemiologia , China , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Efeitos Psicossociais da Doença , Assistência à Saúde/economia , Assistência à Saúde/normas , Assistência à Saúde/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Humanos , Cooperação Internacional , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Prevalência
3.
Yonsei Med J ; 61(8): 705-711, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32734734

RESUMO

PURPOSE: In the recent antiretroviral therapy (ART) era, a large proportion of Korean patients with human immunodeficiency virus (HIV) infection were shown to have low CD4 cell counts at diagnosis and during ART initiation. We investigated the survival trends in patients living with HIV/acquired immunodeficiency syndrome (AIDS) in Korea who started ART in the 2000s, and evaluated the risk factors for mortality to elucidate the association between survival and low CD4 cell counts at ART initiation. MATERIALS AND METHODS: Patients with HIV infection who were aged >18 years and had started ART between 2001 and 2015 in the Korean HIV/AIDS cohort study were enrolled. We compared the clinical characteristics, mortality, and causes of death among the enrolled subjects based on the time of ART initiation. Cox regression analysis was used to estimate the adjusted hazard ratios of mortality based on the time of ART initiation. RESULTS: Among the 2474 patients enrolled, 105 (4.24%) died during the follow-up period of 9568 patient-years. Although CD4 cell counts at the time of ART initiation significantly increased from 161 [interquartile range (IQR), 73.5-303] in 2001-2003 to 273 (IQR, 108-399) in 2013-2015 (p<0.001), they remained low during the study period. The incidence of all-cause mortality was 10.97 per 1000 patient-years during the study period. There was no decreasing trend in mortality between 2001 and 2015. Age >40 years [adjusted hazard ratio, 3.71; 95% confidence interval (CI), 2.35-5.84] and low CD4 counts (<100 cells/mm³: adjusted hazard ratio, 2.99; 95% CI, 1.44-6.23) were significant risk factors for mortality. CONCLUSION: Despite excellent HIV care available in the recent ART era, the survival of patients with HIV/AIDS undergoing ART did not improve between 2001 and 2015 in Korea.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade , Síndrome de Imunodeficiência Adquirida/mortalidade , Adulto , Contagem de Linfócito CD4 , Causas de Morte , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Fatores de Risco , Análise de Sobrevida
4.
Public Health Rep ; 135(1_suppl): 149S-157S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735185

RESUMO

OBJECTIVE: Federal funds have been spent to reduce the disproportionate effects of HIV/AIDS on racial/ethnic minority groups in the United States. We investigated the association between federal domestic HIV funding and age-adjusted HIV death rates by race/ethnicity in the United States during 1999-2017. METHODS: We analyzed HIV funding data from the Kaiser Family Foundation by federal fiscal year (FFY) and US age-adjusted death rates (AADRs) by race/ethnicity (Hispanic, non-Hispanic white, non-Hispanic black, and Asian/Pacific Islander and American Indian/Alaska Native [API+AI/AN]) from Centers for Disease Control and Prevention WONDER detailed mortality files. We fit joinpoint regression models to estimate the annual percentage change (APC), average APC, and changes in AADRs per billion US dollars in HIV funding, with 95% confidence intervals (CIs). For 19 data points, the number of joinpoints ranged from 0 to 4 on the basis of rules set by the program or by the user. A Monte Carlo permutation test indicated significant (P < .05) changes at joinpoints, and 2-sided t tests indicated significant APCs in AADRs. RESULTS: Domestic HIV funding increased from $10.7 billion in FFY 1999 to $26.3 billion in FFY 2017, but AADRs decreased at different rates for each racial/ethnic group. The average rate of change in AADR per US billion dollars was -9.4% (95% CI, -10.9% to -7.8%) for Hispanic residents, -7.8% (95% CI, -9.0% to -6.6%) for non-Hispanic black residents, -6.7% (95% CI, -9.3% to -4.0%) for non-Hispanic white residents, and -5.2% (95% CI, -7.8% to -2.5%) for non-Hispanic API+AI/AN residents. CONCLUSIONS: Increased domestic HIV funding was associated with faster decreases in age-adjusted HIV death rates for Hispanic and non-Hispanic black residents than for residents in other racial/ethnic groups. Increasing US HIV funding could be associated with decreasing future racial/ethnic disparities in the rate of HIV-related deaths.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Infecções por HIV/etnologia , Infecções por HIV/mortalidade , Prevenção Primária/economia , Síndrome de Imunodeficiência Adquirida/etnologia , Síndrome de Imunodeficiência Adquirida/mortalidade , Humanos , Estados Unidos
5.
BMC Infect Dis ; 20(1): 489, 2020 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-32646373

RESUMO

BACKGROUND: This paper introduces a comprehensive case management model uniting doctors, nurses, and non-governmental organizations (NGOs) in order to shorten the time from HIV diagnosis to initiation of antiviral therapy, improve patients' adherence, and ameliorate antiretroviral treatment (ART)-related outcomes. METHODS: All newly diagnosed human immunodeficiency virus (HIV) cases at Beijing YouAn Hospital from January 2012 to December 2013 were selected as the control group, while all newly diagnosed HIV-infected patients from January 2015 to December 2016 were selected as the intervention group, receiving the comprehensive case management model. RESULTS: 4906 patients were enrolled, of which 1549 were in the control group and 3357 in the intervention group. The median time from confirming HIV infection to ART initiation in the intervention group was 35 (18-133) days, much shorter than the control group (56 (26-253) days, P < 0.001). Participants in the intervention group had better ART adherence compared to those in the control group (intervention: 95.3%; control: 89.2%; p < 0.001). During the 2 years' follow-up, those receiving case management were at decreased odds of experiencing virological failure (OR: 0.27, 95%CI: 0.17-0.42, P < 0.001). Observed mortality was 0.4 deaths per 100 patient-years of follow-up for patients in the control group compared with 0.2 deaths per 100 patient-years of follow-up in the intervention group. CONCLUSIONS: People living with HIV engaged in the comprehensive case management model were more likely to initiate ART sooner and maintained better treatment compliance and improved clinical outcomes compared to those who received routine care. A comprehensive case management program could be implemented in hospitals across China in order to reduce the HIV disease burden in the country.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Antirretrovirais/uso terapêutico , Administração de Caso , HIV-1/imunologia , Tempo para o Tratamento , Síndrome de Imunodeficiência Adquirida/mortalidade , Adulto , Pequim/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Retenção nos Cuidados , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(20): e20146, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443329

RESUMO

BACKGROUND: An increased frequency of toxoplasma encephalitis, caused by Toxoplasma gondii, has been reported in AIDS patients, especially in those with CD4+ T cell counts <100 cells/µL. Several guidelines recommend the combination of pyrimethamine, sulfadiazine, and leucovorin as the preferred regimen for AIDS-associated toxoplasma encephalitis. However, it is not commonly used in China due to limited access to pyrimethamine and sulfadiazine. The synergistic sulfonamides tablet formulation is a combination of trimethoprim (TMP), sulfadiazine and sulfamethoxazole (SMX), and is readily available in China. Considering its constituent components, we hypothesize that this drug may be used as a substitute for sulfadiazine and TMP-SMX. We have therefore designed the present trial, and propose to investigate the efficacy and safety of synergistic sulfonamides combined with clindamycin for the treatment of toxoplasma encephalitis. METHODS/DESIGN: This study will be an open-labeled, multi-center, prospective, randomized, and controlled trial. A total of 200 patients will be randomized into TMP-SMX plus azithromycin group, and synergistic sulfonamides plus clindamycin group at a ratio of 1:1. All participants will be invited to participate in a 48-week follow-up schedule once enrolled. The primary outcomes will be clinical response rate and all-cause mortality at 12 weeks. The secondary outcomes will be clinical response rate and all-cause mortality at 48 weeks, and adverse events at each visit during the follow-up period. DISCUSSION: We hope that the results of this study will be able to provide reliable evidence for the efficacy and safety of synergistic sulfonamides for its use in AIDS patients with toxoplasma encephalitis. TRIAL REGISTRATION: This study was registered as one of 12 clinical trials under the name of a general project at chictr.gov on February 1, 2019, and the registration number of the general project is ChiCTR1900021195. This study is still recruiting now, and the first patient was screened on March 22, 2019.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Toxoplasmose Cerebral/complicações , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Síndrome de Imunodeficiência Adquirida/mortalidade , Adolescente , Adulto , Anti-Infecciosos/uso terapêutico , Antiprotozoários/uso terapêutico , China/epidemiologia , Clindamicina/uso terapêutico , Quimioterapia Combinada/métodos , Feminino , Infecções por HIV/mortalidade , Humanos , Leucovorina/uso terapêutico , Masculino , Estudos Prospectivos , Pirimetamina/uso terapêutico , Sulfadiazina/uso terapêutico , Sulfametoxazol/uso terapêutico , Sulfonamidas/uso terapêutico , T-Linfocitopenia Idiopática CD4-Positiva , Toxoplasma/efeitos dos fármacos , Toxoplasma/parasitologia , Toxoplasmose Cerebral/tratamento farmacológico , Toxoplasmose Cerebral/parasitologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Complexo Vitamínico B/uso terapêutico
7.
Salud Publica Mex ; 62(2): 211-214, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32237564

RESUMO

OBJECTIVE: To measure the effect of the change in mortality by AIDS in life expectancy at birth of Spanish population in 1985-2017. MATERIALS AND METHODS: We analyzed 56 863 deaths by AIDS. We calculated age-standardized death rates, and we applied Poisson regression and decomposition of life expectancies. RESULTS: From 1985 to 1995, mortality by AIDS contributed to reduce life expectancy at birth of 0.64 years for men, and 0.17 for women; in 1996-2017, increase it by 0.60 years, men, and 0.17, women. CONCLUSIONS: The introduction of highly active antiretroviral therapy in 1996 and prevention were decisive to reduce mortality by AIDS and to become chronic the epidemic.


Assuntos
Síndrome de Imunodeficiência Adquirida/mortalidade , Expectativa de Vida , Causas de Morte , Feminino , Humanos , Masculino , Espanha/epidemiologia
8.
Am J Trop Med Hyg ; 103(3): 1319-1328, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32342837

RESUMO

Recent evidence indicates mass drug administration with azithromycin may reduce child mortality. This study uses verbal autopsy (VA) to investigate the causes of individual deaths during the Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) trial in Malawi. Cluster randomization was performed as part of MORDOR. Biannual household visits were conducted to distribute azithromycin or placebo to children aged 1-59 months and update the census to identify deaths for VA. MORDOR was not powered to investigate mortality effects at individual sites, but the available evidence is presented here for hypothesis generation regarding the mechanism through which azithromycin may reduce child mortality. Automated VA analysis was performed to infer the likely cause of death using two major analysis programs, InterVA and SmartVA. A total of 334 communities were randomized to azithromycin or placebo, with more than 130,000 person-years of follow-up. During the study, there were 1,184 deaths, of which 1,131 were followed up with VA. Mortality was 9% lower in azithromycin-treated communities than in placebo communities (rate ratio 0.91 [95% CI: 0.79-1.05]; P = 0.20). The intention-to-treat analysis by cause using InterVA suggested fewer HIV/AIDS deaths in azithromycin-treated communities (rate ratio 0.70 [95% CI: 0.50-0.97]; P = 0.03) and fewer pneumonia deaths (rate ratio 0.82 [95% CI: 0.60-1.12]; P = 0.22). The use of the SmartVA algorithm suggested fewer diarrhea deaths (rate ratio 0.71 [95% CI: 0.51-1.00]; P = 0.05) and fewer pneumonia deaths (rate ratio 0.58 [95% CI: 0.33-1.00]; P = 0.05). Although this study is not able to provide strong evidence, the data suggest that the mortality reduction during MORDOR in Malawi may have been due to effects on pneumonia and diarrhea or HIV/AIDS mortality.


Assuntos
Síndrome de Imunodeficiência Adquirida/mortalidade , Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Causas de Morte , Infecções por HIV/mortalidade , Pneumonia/mortalidade , Autopsia , Mortalidade da Criança , Pré-Escolar , Diarreia/mortalidade , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Macrolídeos/administração & dosagem , Malaui/epidemiologia , Masculino , Administração Massiva de Medicamentos
9.
Rev Bras Epidemiol ; 23: e200017, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32215542

RESUMO

INTRODUCTION: The trend toward stabilization regarding the AIDS epidemic in Brazil over the past decade hides a very complex scenario, where two-thirds of the Brazilian federative units exhibit AIDS standardized mortality rates (ASMR) significantly above the national average and/or in upward tendency. ASMR in Rio de Janeiro State remains virtually unchanged over the years; the state currently occupies the second position in the national ranking of this indicator. OBJECTIVE: To assess temporal trends in causes of death searching for differential profiles that could be useful for understanding mortality among patients with HIV in the state. METHODOLOGY: Causes of death were analyzed in any field of the death certificates from the Mortality Information System between 1999 and 2015 for individuals ≥ 15 years of age. Cardiovascular diseases, non-AIDS-related cancers, external causes, diabetes mellitus, and tuberculosis were established by the mention or not of their codes according to the 10th edition of International Statistical Classification of Diseases and Related Health Problems (ICD-10) in death certificates. Generalized linear mixed-effects models were used to describe odds ratios in relation to 1999 and adjusted mean annual variations. RESULTS: The results point to the emerging role of external causes and genitourinary diseases and the persistent role played by tuberculosis, differentially affecting AIDS mortality in the state, in a scenario of high mortality due to infectious diseases. CONCLUSION: These data suggest that tuberculosis remains a major cause of death among people living with HIV/AIDS (PLWHA) in Rio de Janeiro, highlighting the need for studies that identify individual-level factors impacting their survival, thus improving local HIV/AIDS control measures.


Assuntos
Infecções por HIV/mortalidade , Tuberculose/mortalidade , Síndrome de Imunodeficiência Adquirida/mortalidade , Adolescente , Adulto , Brasil/epidemiologia , Causas de Morte , Comorbidade , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Adulto Jovem
10.
Am J Public Health ; 110(4): 530-536, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32078342

RESUMO

Objectives. To assess causes of premature death and whether race/ethnicity or education is more strongly and independently associated with premature mortality in a diverse sample of middle-aged adults in the United States.Methods. The Coronary Artery Risk Development in Young Adults study (CARDIA) is a longitudinal cohort study of 5114 participants recruited in 1985 to 1986 and followed for up to 29 years, with rigorous ascertainment of all deaths; recruitment was balanced regarding sex, Black and White race/ethnicity, education level (high school or less vs. greater than high school), and age group (18-24 and 25-30 years). This analysis included all 349 deaths that had been fully reviewed through month 348. Our primary outcome was years of potential life lost (YPLL).Results. The age-adjusted mortality rate per 1000 persons was 45.17 among Black men, 25.20 among White men, 17.63 among Black women, and 10.10 among White women. Homicide and AIDS were associated with the most YPLL, but cancer and cardiovascular disease were the most common causes of death. In multivariable models, each level of education achieved was associated with 1.37 fewer YPLL (P = .007); race/ethnicity was not independently associated with YPLL.Conclusions. Lower education level was an independent predictor of greater YPLL.


Assuntos
Causas de Morte , Escolaridade , Grupos Étnicos/estatística & dados numéricos , Mortalidade Prematura , Síndrome de Imunodeficiência Adquirida/mortalidade , Adulto , Afro-Americanos/estatística & dados numéricos , Doenças Cardiovasculares/mortalidade , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Homicídio/estatística & dados numéricos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Estados Unidos/epidemiologia , População Urbana
11.
Curr HIV/AIDS Rep ; 17(1): 26-34, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31939111

RESUMO

PURPOSE OF REVIEW: The introduction of the National Free Antiretroviral Therapy Program (NFATP) in 2003 by the China National Center for AIDS/STD Control and Prevention has led to dramatic increases in antiretroviral therapy (ART) coverage among HIV-infected Chinese patients. Despite limitations in the number of available free antiretroviral drugs, the overall mortality associated with HIV/AIDS has dropped from 39.3 per 100 person-years in 2002 to 3.1 in 2014. In this review, we summarize the challenges, responses, and achievements of antiretroviral therapy (ART) in China over the past 20 years. RECENT FINDINGS: Continuous optimization of the Chinese National Guidelines for HIV/AIDS Diagnosis and Treatment has been guided by data from serial domestic multi-center studies aimed at evaluating efficacy and toxicity of available ART regimens among Chinese patients with HIV, with the goal of maximizing adherence, access, and efficacy. In addition, increasing attention has been focused on the importance of continuity in the HIV care cascade to promote linkage to care, and address the multidisciplinary chronic care needs HIV/AIDS patients on lifelong ART. Great progress has been achieved in the past 20 years in terms of access to and optimization of antiretroviral treatment in China. As the number of patients receiving long-term ART continues to grow, the focus of HIV/AIDS treatment has gradually transitioned from urgent care to the management of non-AIDS-related chronic complications and control of chronic inflammation.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Antirretrovirais/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Cooperação do Paciente/psicologia , Síndrome de Imunodeficiência Adquirida/mortalidade , Adulto , China , Continuidade da Assistência ao Paciente , Feminino , HIV , Humanos , Masculino , Programas Nacionais de Saúde
12.
Braz J Infect Dis ; 24(1): 65-72, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31835018

RESUMO

Antiretroviral therapy (ART) has modified the outcome of patients with HIV infection, providing virological control and reducing mortality. However, there are several reasons as to why patients may discontinue their antiretroviral therapy, with adverse events being one of the main reasons reported in the literature. This is a case-control nested in a cohort of people living with HIV/AIDS, conducted to identify the incidence of ART modification due to adverse events and the associated factors, in two referral services in Recife, Brazil, between 2011 and 2014. Of the modifications occurred in the first year of ART, 25.7% were driven by adverse events. The median time elapsed between initiating ART and the first modification due to adverse events was 70.5 days (95% CI: 26-161 days). The main adverse events were dermatological, neuropsychiatric and gastrointestinal. Dermatological events were the earliest to appear after initiating ART. Efavirenz was the most prescribed and most modified drug during the study period. The group of participants who used zidovudine, lamivudine, and efavirenz had a 2-fold greater chance (adjusted OR: 2.16 95% CI: 1.28-3.65) of switching ART due to adverse events when compared to the group that used tenofovir with lamivudine and efavirenz.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Fármacos Anti-HIV/efeitos adversos , Síndrome de Imunodeficiência Adquirida/mortalidade , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Benzoxazinas/efeitos adversos , Brasil , Combinação de Medicamentos , Feminino , Humanos , Estimativa de Kaplan-Meier , Lamivudina/efeitos adversos , Modelos Logísticos , Lopinavir/efeitos adversos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Ritonavir/efeitos adversos , Tenofovir/efeitos adversos , Fatores de Tempo , Adulto Jovem , Zidovudina/efeitos adversos
13.
Rev. bras. epidemiol ; 23: e200017, 2020. tab, graf
Artigo em Português | LILACS | ID: biblio-1092608

RESUMO

RESUMO: Introdução: A aparente estabilidade da mortalidade por aids no país na última década encobre uma gama de cenários, com dois terços dos estados apresentando taxa padronizada de mortalidade por aids (TPMA) significativamente acima da média nacional e/ou em tendência ascendente. No Rio de Janeiro, a TPMA vem mantendo-se alta e estável ao longo dos anos; atualmente o estado ocupa a segunda posição no ranking nacional desse indicador. Objetivo: Examinar tendências temporais em causas de óbito na busca de padrões diferenciais que contribuam para o entendimento da mortalidade por aids no estado. Metodologia: Foram analisadas causas de óbito em qualquer campo das declarações de óbito constantes do Sistema de Informação sobre Mortalidade (SIM) entre 1999 e 2015 para indivíduos ≥ 15 anos. Doenças cardiovasculares, malignidades não relacionadas à aids, causas externas, diabetes melito e tuberculose foram estabelecidas pela menção ou não de seus códigos conforme a Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde (CID-10) nas declarações de óbito. Modelos lineares generalizados com efeitos mistos foram usados para descrever odds ratios relativas a 1999 e variações anuais médias ajustadas. Resultados: Verificaram-se o aumento proporcional em causas externas e doenças geniturinárias e, sobretudo, o persistente papel desempenhado pela tuberculose, impactando diferencialmente a mortalidade por aids no estado, em um cenário de alta mortalidade por doenças infecciosas. Conclusão: Os achados reforçam a manutenção da tuberculose na mortalidade de pessoas vivendo com HIV/aids (PVHA) no Rio de Janeiro e chamam a atenção para a necessidade de avaliar determinantes individuais atuando na redução da sobrevida desses pacientes, de forma a aprimorar o programa de controle do HIV/aids no estado.


ABSTRACT: Introduction: The trend toward stabilization regarding the AIDS epidemic in Brazil over the past decade hides a very complex scenario, where two-thirds of the Brazilian federative units exhibit AIDS standardized mortality rates (ASMR) significantly above the national average and/or in upward tendency. ASMR in Rio de Janeiro State remains virtually unchanged over the years; the state currently occupies the second position in the national ranking of this indicator. Objective: To assess temporal trends in causes of death searching for differential profiles that could be useful for understanding mortality among patients with HIV in the state. Methodology: Causes of death were analyzed in any field of the death certificates from the Mortality Information System between 1999 and 2015 for individuals ≥ 15 years of age. Cardiovascular diseases, non-AIDS-related cancers, external causes, diabetes mellitus, and tuberculosis were established by the mention or not of their codes according to the 10th edition of International Statistical Classification of Diseases and Related Health Problems (ICD-10) in death certificates. Generalized linear mixed-effects models were used to describe odds ratios in relation to 1999 and adjusted mean annual variations. Results: The results point to the emerging role of external causes and genitourinary diseases and the persistent role played by tuberculosis, differentially affecting AIDS mortality in the state, in a scenario of high mortality due to infectious diseases. Conclusion: These data suggest that tuberculosis remains a major cause of death among people living with HIV/AIDS (PLWHA) in Rio de Janeiro, highlighting the need for studies that identify individual-level factors impacting their survival, thus improving local HIV/AIDS control measures.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Tuberculose/mortalidade , Infecções por HIV/mortalidade , Brasil/epidemiologia , Comorbidade , Modelos Lineares , Taxa de Sobrevida , Causas de Morte , Síndrome de Imunodeficiência Adquirida/mortalidade , Pessoa de Meia-Idade
14.
Rev. enferm. UFPE on line ; 14: [1-10], 2020. ilus, tab, graf, mapas
Artigo em Português | BDENF - Enfermagem | ID: biblio-1116287

RESUMO

Objetivo: analisar a distribuição espaço-temporal da mortalidade por aids. Método: trata-se de um estudo quantitativo, descritivo, que avaliou 959 óbitos por Aids notificados por meio do Sistema de Informação sobre Mortalidade. Analisou-se a tendência temporal por meio do software Joinpoint Regression Program, versão 4.6.0.0, e a varredura Scan foi empregada para avaliar a formação de clusters puramente espaciais de óbitos, considerando-se um nível de significância de 5%. Resultados: verifica-se que a maioria das mortes ocorreu entre indivíduos do sexo masculino (71,1%), com sete anos de estudo ou menos (79,6%), de raça parda (72,2%) e faixa etária de 30 a 39 anos (69,2%). Registrou-se um aumento estatisticamente significativo da mortalidade por Aids de 5,2% ao ano (p<0,001; IC95%: 1,0-9,5). Observa-se que a varredura espacial apontou para um cluster de óbitos estatisticamente significativo (p<0,0001), que abrangeu 18 municípios, incluindo Oeiras, Parnaíba e os da região metropolitana de Teresina. Conclusão: nota-se que a análise das tendências temporal e espacial demonstrou um aumento significativo da mortalidade ao longo do período estudado, bem como a presença de um aglomerado de óbitos que abrangeu 18 municípios, incluindo Teresina, Oeiras e Parnaíba.(AU)


Objective: to analyze the spatial-temporal distribution of AIDS mortality. Method: this is a quantitative, descriptive study, which evaluated 959 aids deaths reported through the Mortality Information System. The temporal trend was analyzed using the Joinpoint Regression Program, version 4.6.0.0, and the Scan scanning was used to evaluate the formation of purely spatial clusters of deaths, considering a significance level of 5%. Results: most deaths occurred among males (71.1%), with seven years of schooling or less (79.6%), of pardo race (72.2%) and age group from 30 to 39 years (69.2%). There was a statistically significant increase in AIDS mortality of 5.2% per year (p<0.001; 95% CI: 1.0- 9.5). The spatial scanning pointed to a statistically significant cluster of deaths (p<0.0001), which covered 18 municipalities, including Oeiras, Parnaíba and those in the metropolitan region of Teresina. Conclusion: the analysis of temporal and spatial trends showed a significant increased mortality over the period studied, as well as the presence of a cluster of deaths that covered 18 municipalities, including Teresina, Oeiras and Parnaíba.(AU)


Objetivo: analizar la distribución espacio-temporal de la mortalidad por SIDA. Método: se trata de un estudio cuantitativo y descriptivo que evaluó 959 muertes por SIDA reportadas a través del Sistema de Información sobre Mortalidad. La tendencia temporal se analizó utilizando el software Joinpoint Regression Program, versión 4.6.0.0, y el escaneo Scan se utilizó para evaluar la formación de grupos puramente espaciales de muertes, considerando un nivel de significancia del 5%. Resultados: se verificó que la mayoría de las muertes ocurrieron entre los varones (71,1%), con siete años de escolaridad o menos (79,6%), de raza parda (72,2%) y grupos de edad de 30 a 39 años (69,2%). Hubo un aumento estadísticamente significativo de la mortalidad por SIDA del 5,2% anual (p<0.001; IC del 95%: 1,0-9,5). Se observó que el escaneo espacial apuntaba a un grupo estadísticamente significativo de muertes (p<0.0001), que abarcaba 18 municipios, incluyendo Oeiras, Parnaíba y los de la región metropolitana de Teresina. Conclusión: se observa que el análisis de las tendencias temporales y espaciales mostró un aumento significativo de la mortalidad durante el período estudiado, así como la presencia de un grupo de muertes que abarcó 18 municipios, entre ellos Teresina, Oeiras y Parnaíba.(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Síndrome de Imunodeficiência Adquirida , Síndrome de Imunodeficiência Adquirida/mortalidade , HIV , Mapeamento Geográfico , Análise Espacial , Análise Espaço-Temporal , Registros de Mortalidade , Epidemiologia Descritiva
15.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(11): 1398-1402, 2019 Nov 10.
Artigo em Chinês | MEDLINE | ID: mdl-31838811

RESUMO

Objective: To understand the survival time and influencing factors of HIV/AIDS cases in Gansu province from 1997 to 2018. Methods: A retrospective cohort study was conducted to analyze the AIDS epidemic data of Gansu from 1997 to 2018 collected from the National HIV/AIDS information system. Life-span table were used to calculate survival rate, Kaplan-Meier method was used to draw the survival curves and calculate the average survival time, the Cox proportional hazard regression model were used to analyze the risk factors for death for HIV/AIDS cases. Results: Among 6 813 HIV/AIDS cases, 715 (10.5%) died, and the average survival time was 195.9 months (95%CI: 189.7-202.2). The survival rates of 12 months, 60 months, 120 months and 180 months were 91.5%, 86.1%, 79.9% and 73.8%, respectively. Cox proportional hazard regression model showed that the risk factors for death in the HIV/AIDS cases were age (≥51 years old vs. ≤25 years old, HR=1.906, 95%CI: 1.353-2.685), transmission route (blood borne and others transmission vs. heterosexual transmission, HR=1.593, 95%CI: 1.226-2.069), detection way (hospital admission detection, blood transfusion and preoperative examination vs. entry-exit health examination, pre-marital examination and physical examination of recruits, HR=5.113, 95%CI: 2.083-12.547), disease phase (AIDS phase vs. HIV infection phase: HR=4.012, 95%CI: 3.401-4.732), baseline CD(4) count (no CD(4) detected vs. CD(4) count ≥350/µl, HR=5.446, 95%CI: 3.835-7.732), antiretroviral therapy (receiving no antiretroviral therapy vs. receiving antiretroviral therapy, HR=12.019, 95%CI: 9.861-14.648). Conclusions: The average survival time of HIV/AIDS cases was above 16 years in Gansu during 1997 to 2018. Death risk of HIV/AIDS cases might be increased by age ≥51 years, hospital admission detection, blood transfusion and preoperative examination, AIDS phase of disease phase, no baseline CD(4) detected and no receiving antiretroviral therapy. It is necessary to conduct early HIV test, diagnosis and antiretroviral treatment and increase antiretroviral treatment rates and CD(4) testing rate to improve the survival of HIV/AIDS cases.


Assuntos
Síndrome de Imunodeficiência Adquirida/mortalidade , Antirretrovirais/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Adulto , China/epidemiologia , Progressão da Doença , Feminino , Infecções por HIV/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida
16.
PLoS One ; 14(12): e0226683, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31887156

RESUMO

BACKGROUND: Acquired ImmunoDeficiency Syndrome (AIDS) related illnesses are the leading cause of death in the developing world. However; there is limited evidence regarding the incidence of mortality among admitted HIV patients in Ethiopia. OBJECTIVE: To determine the incidence of mortality and its predictors among admitted HIV/AIDS patients in selected tertiary care hospitals in Ethiopia. METHODS: A prospective cohort study involving 136 admitted HIV/AIDS patients from April 1 to August 31, 2018 was conducted in selected tertiary care hospitals in Ethiopia. Data were collected on socio-demographic, clinical characteristics, and drug related variables. Kaplan-Meier and Cox regression were used to compare survival experience of the patients and identify independent predictors of mortality. Hazard ratio was used as a measure of strength of association and p-value of <0.05 was considered to declare statistical significance. RESULTS: Of 136 patients, 80 (58.8%) were females. The overall in-hospital incidence of mortality was 2.83 per 1000 person-years. The incidences of mortality due to AIDS and non-AIDS related admissions were 6.1 [3.95, 8.67] and 5.3 [3.35, 8.23] per 1000 person-years respectively. The mean ± SD survival times among patients with AIDS and non-AIDS related illnesses were 32 ± 3.1 and 34 ± 3.3 days respectively (log rank p = 0.599). Being on non-invasive ventilation (AHR: 2.99, 95%CI; [1.24, 7.28]; p = 0.015) and having baseline body mass index (BMI) of less than 18.5 (AHR: 2.6, 95%CI; [1.03, 6.45]; p = 0.04) were independent predictors of mortality. CONCLUSION: The study found high incidence of in-hospital mortality among admitted HIV/AIDS patients in Ethiopian tertiary care hospitals. Being on non-invasive ventilation and body mass index (BMI) of less than 18.5 were found to be independent predictors of mortality.


Assuntos
Síndrome de Imunodeficiência Adquirida/mortalidade , Infecções por HIV/mortalidade , Atenção Terciária à Saúde , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Índice de Massa Corporal , Etiópia/epidemiologia , Feminino , Infecções por HIV/tratamento farmacológico , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Resultado do Tratamento , Ventiladores Mecânicos
17.
BMC Public Health ; 19(1): 1516, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718615

RESUMO

BACKGROUND: In populations that lack vital registration systems, under-5 mortality (U5M) is commonly estimated using survey-based approaches, including indirect methods. One assumption of indirect methods is that a mother's survival and her children's survival are not correlated, but in populations affected by HIV/AIDS this assumption is violated, and thus indirect estimates are biased. Our goal was to estimate the magnitude of the bias, and to create a predictive model to correct it. METHODS: We used an individual-level, discrete time-step simulation model to measure how the bias in indirect estimates of U5M changes under various fertility rates, mortality rates, HIV/AIDS rates, and levels of antiretroviral therapy. We simulated 4480 populations in total and measured the amount of bias in U5M due to HIV/AIDS. We also developed a generalized linear model via penalized maximum likelihood to correct this bias. RESULTS: We found that indirect methods can underestimate U5M by 0-41% in populations with HIV prevalence of 0-40%. Applying our model to 2010 survey data from Malawi and Tanzania, we show that indirect methods would underestimate U5M by up to 7.7% in those countries at that time. Our best fitting model to correct bias in U5M had a root median square error of 0.0012. CONCLUSIONS: Indirect estimates of U5M can be significantly biased in populations affected by HIV/AIDS. Our predictive model allows scholars and practitioners to correct that bias using commonly measured population characteristics. Policies and programs based on indirect estimates of U5M in populations with generalized HIV epidemics may need to be reevaluated after accounting for estimation bias.


Assuntos
Viés , Mortalidade da Criança , Métodos Epidemiológicos , Infecções por HIV/mortalidade , Mortalidade Infantil , Mães/estatística & dados numéricos , Inquéritos e Questionários/normas , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/mortalidade , Adolescente , Adulto , Fármacos Anti-HIV/uso terapêutico , Coeficiente de Natalidade , Causas de Morte , Pré-Escolar , Epidemias , Feminino , HIV , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Lactente , Recém-Nascido , Malaui/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Tanzânia/epidemiologia , Adulto Jovem
18.
Rev Invest Clin ; 71(5): 311-320, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31599877

RESUMO

Background: Severe hypoxemic respiratory failure (SHRF) due to Pneumocystis jiroveci pneumonia (PJP) in AIDS patients represents the main cause of admission and mortality in respiratory intensive care units (RICUs) in low- and middle-income countries. Objective: The objective of this study was to develop a predictive scoring system to estimate the risk of mortality in HIV/AIDS patients with PJP and SHRF. Methods: We analyzed data of patients admitted to the RICU between January 2013 and January 2018 with a diagnosis of HIV infection and PJP. Multivariate logistic regression and Kaplan-Meier method were used in data analysis. The RICU and inhospital mortality were 25% and 26%, respectively. Multivariate analysis identified four independent predictors: body mass index, albumin, time to ICU admission, and days of vasopressor support. A predictive scoring system was derived and validated internally. The discrimination was 0.869 (95% confidence interval: 0.821-0.917) and calibration intercept (α) and slope (ß) were 0.03 and 0.99, respectively. The sensitivity was 47.2%, specificity was 84.6%, positive predictive value was 89.2%, and negative predictive value was 82.6%. Conclusions: This scoring system is a potentially useful tool to assist clinicians, in low- and medium-income countries, in estimating the RICU and inhospital mortality risk in patients with HIV/AIDS and SHRF caused by PJP.


Assuntos
Síndrome de Imunodeficiência Adquirida/mortalidade , Infecções por HIV/mortalidade , Pneumonia por Pneumocystis/mortalidade , Insuficiência Respiratória/mortalidade , Síndrome de Imunodeficiência Adquirida/complicações , Adulto , Estudos de Coortes , Feminino , Infecções por HIV/complicações , Mortalidade Hospitalar , Humanos , Hipóxia/etiologia , Hipóxia/mortalidade , Unidades de Terapia Intensiva , Masculino , Pneumonia por Pneumocystis/etiologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Insuficiência Respiratória/etiologia , Sensibilidade e Especificidade
19.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 936-940, 2019 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-31484257

RESUMO

Objective: To study the survival time and influencing factors of HIV/AIDS cases who began receiving antiretroviral therapy (ART) from 2005 to 2015 in Tianjin. Methods: Data related to HIV/AIDS cases that receiving ART between 2005 and 2015 in Tianjin, were collected from the Chinese HIV/AIDS Basic Information Management System. A retrospective cohort study was conducted to analyze data of collection. Life table was used to calculate the survival proportion and Cox proportion hazard regression model was used to analyze the factors associated to the time of survival. Results: A total of 2 057 HIV/AIDS cases were involved, including 51 died from AIDS related disease, ending up with the survival rates of 1, 3, 5 and 10 years as 98.4%, 97.8%, 97.4% and 95.8%, respectively. Results from the multivariate Cox proportion hazard regression model showed that when comparing with the cases aged<30 years, aHR (95%CI) of the cases aged 30-39 years, 40-49 years, 50 years or above appeared as 4.506 (1.226-9.059), 5.944 (1.479-13.892) and 15.958 (5.309-27.206) respectively. When comparing with the cases having no loss of follow-up during ART process, the aHR of the cases having lost of follow-up during ART was 5.645 (95%CI: 3.124-10.200). When comparing with the cases diagnosed by other institutions, the aHR of the cases diagnosed by hospitals was 3.823 (95%CI: 1.423-10.274). When compared with the cases had no hepatitis B or hepatitis C before ART, aHR of the cases with hepatitis B or C prior to ART was 2.580 (95%CI:1.210-5.502). Compared with the cases receiving ART at Ⅰ/Ⅱ clinical stages, the aHR of the cases at Ⅲ/Ⅳ clinical stages was 3.947 (95%CI: 2.167-7.188). Compared with the cases with junior high school education or below, the aHR of the cases with high school education or above was 0.440 (95%CI: 0.238-0.810). Compared with the cases diagnosed before operation, aHR of the cases from special investigation and from counseling and testing (VCT) were 0.111 (0.027-0.456) and 0.182 (0.049-0.674) respectively. Conclusions: The survival rate of HIV/AIDS cases that received ART was high in Tianjin. Risk factors related to the survival of cases would include: old age when started receiving ART, loss of follow-up during ART, diagnosed by hospitals, co-infected with hepatitis B or hepatitis C and receiving ART at Ⅲ/Ⅳ clinical stages. Meanwhile, protective factors related to the survival of cases would include: having high school or above education, diagnosis was made through other special programs or from VCT services.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/mortalidade , Adulto , Distribuição por Idade , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Socioeconômicos , Análise de Sobrevida , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
Rev Saude Publica ; 53: 71, 2019 Sep 09.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31508778

RESUMO

OBJECTIVE: To describe the epidemiological aspects of HIV infection and AIDS among indigenous peoples of the state of Mato Grosso do Sul, Brazil. METHODS: This is a descriptive epidemiological study on the occurrence and distribution of HIV infection and AIDS in the indigenous population assisted by the Distrito Sanitário Especial Indígena (Indigenous Special Health District) Mato Grosso do Sul between 2001 and 2014, based on three secondary databases. Annual rates of HIV and AIDS detection and prevalence were calculated, considering case distribution according to village, Health Base Pole and sociodemographic variables. Accumulated rates of detection, mortality and case fatality were calculated by ethnic group and for the Health Base Pole with the highest number of cases. RESULTS: The HIV detection rate fluctuated between 0.0 and 18.0/100 thousand people in the study period. For AIDS, there was no notification before 2007, but in 2012 its rate reached 16.6/100 thousand. HIV prevalence grew between 2001 and 2011, and it continuously grew for AIDS starting from 2007. The highest HIV detection rates occurred among Guarani peoples (167.1/100 thousand) and for AIDS, among the Kaiowá peoples (79.3/100 thousand); mortality and fatality rates were higher among the Kaiowá. Regarding the Dourados Health Base Pole, the AIDS detection rate increased, and the mortality and fatality rates decreased. CONCLUSIONS: HIV infection and AIDS have been increasing among indigenous peoples, with distribution of the disease mainly in the Health Base Poles of the southern region of the state, where greater economic and social vulnerability are also observed. The endemic character of HIV and AIDS can become epidemic in some years given the existence of cases in other villages in the state. Its occurrence among the Guarani and Kaiowá populations indicates the need for expanded diagnosis, access to treatment and prevention measures.


Assuntos
Síndrome de Imunodeficiência Adquirida/mortalidade , Infecções por HIV/mortalidade , Síndrome de Imunodeficiência Adquirida/diagnóstico , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Escolaridade , Feminino , Infecções por HIV/diagnóstico , Soroprevalência de HIV/tendências , Serviços de Saúde do Indígena , Humanos , Índios Sul-Americanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
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