Evolución de mortalidad y estado actual de una población infectada por VIH controlada en un centro multiprofesional / Evolution of mortality and current status of an HIV-infected population cared for at a comprehensive HIV/AIDS center in Chile

Background: Chile, a middle-income country with an HIV epidemic of moderate proportions (global infection rate 0.2%) began a government sponsored, free, highly active antiretroviral therapy (HAART) for patients from the public health system in 2001 reaching in 2004 a 100% coverage. Arriaran Foundation (AF) is the largest public AIDS care center for adults in the country. Aim: To show the present status of the AF population and the evolution of mortality. Material and Methods: Review of AF database from 1991-2004 that at 12/31/2004 had a total cumulative population of 2,259 adult patients; an active census of 1,065 patients and admitting rate 160-190 patients per years. Results: The global mortality registered was 33.4%, with decreasing annual mortality from 15.7% of its active population in 1995 to 1.9% in 2004. As of 12/31/2004, 817 patients (76.7%) were receiving antiretroviral therapy (ART); and 19.3% either did not require nor accept it. Thirty one percent received Combivir® and nevirapine, with undetectable viral load (<400 copies per ml) in 78%. Thirty percent received Combivir® and efavirenz with undetectable viral load in 80% at last count. Both regimens were used mainly as first therapy. Lopinavir/ritonavir was received by 6.3% of patients, mainly for post failure therapy and 58% had undetectable viral load. A baseline CD4 count <200 x mm3 was present in 70% of patients, 45.3% had a count below 100 and 47.8% had clinical AIDS. At the last follow up assessment, CD4 count was <200 in 36.8%, <100 in 10.6% and 200-350 in 44.9%. Conclusion: The expanded access program to ART in a public, comprehensive AIDS care center in Chile has been highly successful in reaching high undetectability (75%), reducing mortality and improving immune status despite very advanced baseline disease.

Características clínicas e historia natural de la infección por virus de inmunodeficiencia humana: estudio de una población chilena atendida en un centro piloto multiprofesional / Clinical characteristics and natural history of human immunodeficiency virus infection: study of a chilean population from a pilot multi-professional center

Four hundred and eighty six infected adults (90,7 percent men) were prospectively followed from 1988 to 1993 at a multi-professional center in Santiago, Chile. 87,8 percent of male patients (pts), 84 percent of them homo/bisexual, and 64,4 percent of women acquired the infection sexually. At the beginning of the follow up (F/U) 51 percent of men and 71 percent of women were asymptomatic and 30 percent of the total group had AIDS. (AIDS definition: CDC 1993, excluded CD4 lymphocyte count <200 x mm3). 240/486 (49,4 percent) had developed AIDS at the end of the study (12/31/93). AIDS defining events (ADE) were: interstitial pneumonia (confirmed or suggestive as caused by P. carinii [PCP]), 25 percent; tuberculosis (all forms), 22.1 percent; wasting, 13.8 percent; Kaposi Sarcoma, 9.2 percent; esophageal candidiasis, 6.7 percent; isosporiasis, 5,4 percent. Of all PCP cases, 72 percent were ADE, the rest, post AIDS'. As expected, AIDS pts continued having major complications (mainly bacterial pneumonias, PCPs, esophagitis, tuberculosis and diarrhea due to I. belli and Cryptosporidium. Less frequently, but also observed, were toxoplasmic encephalitis and cryptococcal meningitis). Known mortality (excluded abandonment of F/U) was 27 percent for the whole group and varied from 5.8 percent, 51,6 percent to 69.2 percent for the first, 4th and 6th yaer of F/U respectively. For II-III CDC pts the mortality was 5 percent and 57 percent and for IV CDC pts it was 38 percent and 100 percent during the first and 6th year of F/U respectively. 36 percent, 53 percent, 74 percent and 85 percent of the pts followed for 1, 3, 5 and 6 years respectively had developed AIDS by the end of 1993. Multifactorial causes with either diarrhea, wasting or both were responsible for the death in half the pts in whom this was known, 15 percent died of respiratory complications and 5,7 percent of cryptococcal meningitis. 80 percent of AIDS pts survived their ADE. This study has provided information about the clinical profile of the HIV infection and natural history of the disease in Chile