Evolución de mortalidad, abandono, traslado y retención a corto, mediano y largo plazo en pacientes con infección por VIH: Fundación Arriarán 1990-2015 / Evolution of mortality, retention and loss to follow up of HIV infected subjects followed in a special clinic

Background: The HIV epidemic reached Chile in late 1980s and as an early response, AIDS care centers were organized. Fundación Arriarán (FA) was the first center. Free antiretroviral therapy (ART) was later provided with progressive coverage and complexity over the years. Aim: To quantify evolution of mortality, retention and loss to follow up (LTFU) over 25 years according to different periods of access to ART, from no availability to full coverage with current drugs at FA center. Material and Methods: Retrospective analysis of FA database of 5,080 adults admitted between 1990 and 2014. The sample was distributed in 7 groups: A: no ART (1990-92), B: monotherapy, C: dual therapy, D: dual/triple ART, E: early triple therapy with incomplete coverage, F same as E but with complete coverage and G: contemporary ART (2008-14). Mortality, retention and LTFU were evaluated at 1, 3, 5, 7 and 10 years and at 31/12/2015. Results: Mortality varied from 40% to 2%, and 62% to 7% at 1 and 5 years, for groups A and G respectively; from 71% to 16% at 10 years for groups A and E, respectively. Retention at 5 years were 28%, 23%, 39%, 62%, 75%, 75% and 77% for groups A to G, respectively. LTFU was 10%, 19%, 15%, 17%, 9% 12% and 10% at 5 years for same groups, respectively. At 12/31/2015 22% of patients had died, 11% were LTFU, 60% were retained in care and 6% had been transferred. Conclusions: There is a marked reduction in mortality and increase in retention of HIV patients' concomitant to expanded access to modern therapy, although LTFU remains a problem.

Perfil de personas con infección por VIH/SIDA: diferencial étnico, económico y socio-cultural en Chile / Persons living with HIV/AIDS: ethnic and sociocultural differences in Chile

Resumen Introducción: La asociación entre etnicidad e infección por VIH/SIDA constituye un tema emergente y poco explorado en Chile. Objetivo: Describir el perfil de pacientes con infección por VIH/SIDA según etnia Mapuche y no Mapuche asociados a condiciones clínicas, factores socio-económicos y oportunidad terapéutica en pacientes de dos centros de atención de las regiones Araucanía y Metropolitana, Chile. Material y Método: Estudio de corte transversal con 558 pacientes cuyos datos se recolectaron mediante un formulario que contenía las variables del estudio, obtenidos tras consentimiento informado. Se realizó análisis descriptivo, asociaciones crudas y estratificadas por cada variable. Resultados: Los pacientes Mapuche fueron en su mayoría de sexo masculino, 53,1% heterosexuales, edad promedio 36,7 años, y nivel educacional e ingresos más bajos que los no Mapuche. La mediana de LT CD4 basal fue más baja en pacientes Mapuche, 51 céls/mm3 o menos y bajo el percentil 25 (IC 38-123). Se observó que existe mayor consumo de drogas, comercio sexual, sexo entre hombres y mayor número de parejas sexuales en último mes, en personas de la etnia no Mapuche y que, además, tienen mejores niveles de ingreso y educación. Conclusión: Existen perfiles diferenciados según etnia respecto de la condición sociocultural y de ingreso de los pacientes a control, generando inequidad en un tratamiento oportuno hacia los pacientes Mapuche, de baja escolaridad y menor educación.

Background: The association between ethnicity and HIV/AIDS is an emerging and unexplored issue in Chile. Aim: To determine the profile of patients with HIV/AIDS by ethnicity and socioeconomic factors associated with diagnostic-therapeutic opportunity in the Araucania and Metropolitan regions. Methods: Cross-sectional study with 558 patients from two centers of HIV/AIDS in Chile. Data were collected using a questionnaire with clinical and sociocultural data obtained under informed consent. Descriptive analysis raw and stratified associations for each variable was performed. Results: Mapuche patients were mostly male, heterosexual (53.1%), lower average age (36.7 years), educational and income level lower than no Mapuche patients. The median of CD4(+) lymphocytes from Mapuche patients was the lowest in the sample, less than 51 cells/mm3, under 25 percentile (CI 38-123). Lifestyle variables indicated that drug use, number of sexual partners, and relationships between men were associated with higher levels of income, education and no Mapuche ethnicity. Conclusion: There are differences between Mapuche and non Mapuche patients regarding their sociocultural and clinical status, which generates health inequalities.