Associated oral manifestations with HIV southeastern Brazilian patients on antiretroviral therapy

Abstract Objectives This study aimed to assess the prevalence of oral lesions in patients living with HIV infection and their association with CD4 count, viral load, and antiretroviral therapy in patients with HIV. Methods A cross-sectional study was conducted on a sample of 161 patients attending the… All the patients were examined for their oral lesions, current CD4 counts, type, and duration of the therapy. Data analyses were carried out using Chi-Square, Student T/Mann-Whitney, and logistic regression tests. Results Oral lesions were observed in 58.39% of patients with HIV. Periodontal disease with 78 (48.45%) or without mobility 79 (49.07%) was observed more frequently, followed by hyperpigmentation of oral mucosa 23 (14.29%), Linear Gingival Erythema (LGE) 15 (9.32%), candidiasis pseudomembranous 14 (8.70%). Oral Hairy Leukoplakia (OHL) was observed only in 3 (1.86%). A relationship between periodontal disease with dental mobility and smoking was found (p = 0.04), as well duration of treatment (p = 1.53e-3) and age (p = 0.02). Hyperpigmentation was related to race (p = 0.01) and smoking (p = 1.30e-6). CD4 count, CD4:CD8 ratio, viral load, or type of treatment were not associated with oral lesions. Logistic regression showed that the duration of treatment has a protective effect on the periodontal disease with dental mobility (OR = 0.28 [−2.27 to −0.25]; p-value = 0.03), independent of age or smoking. To hyperpigmentation, the best model included smoking (OR = 8.47 [1.18-3.10], p = 1.31e-5), without race or type and duration of treatment. Conclusion Among HIV patients undergoing antiretroviral treatment, oral lesions can be observed, predominantly periodontal disease. Pseudomembranous candidiasis and oral hairy leukoplakia were also observed. No relationship was found between associated oral manifestations in HIV patients and the start of the treatment, TCD4+ and TCD8+ cell count, TCD4:TCD8 ratio, or viral load. The data indicate that there is a protective effect of duration of treatment with relation to periodontal disease with mobility and that hyperpigmentation seems to be more related to smoking than type and duration of treatment. Level of evidence Level 3 (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence").

Intervenções associadas à entrevista motivacional para adesão antirretroviral por pessoas com HIV / Intervenciones asociadas a la entrevista motivacional para la adhesión antirretroviral de personas con VIH / Interventions associated with motivational interviewing for antiretroviral adherence by people with HIV

Resumo Objetivo Analisar as produções científicas acerca da eficácia de intervenções utilizando a entrevista motivacional para adesão à terapia antirretroviral por pessoas com o vírus da imunodeficiência humana. Métodos Revisão sistemática realizada em quatro bases de dados, o MEDLINE, CINAHL, IBECS, LILACS, e em uma biblioteca eletrônica, a SciELO, sem restrição de idioma, data e tamanho amostral. O levantamento de artigos foi realizado em setembro de 2021, utilizando-se os descritores Motivational Interviewing, HIV, Acquired Immunodeficiency Syndrome e Antiretroviral Therapy, Highly Active. Foram incluídos artigos do tipo ensaio clínico randomizado, com amostra de pessoas com vírus da imunodeficiência humana maiores de 18 anos, e excluídas pesquisas envolvendo crianças, adolescentes e gestantes. Dez artigos foram selecionados e analisados quanto ao rigor e características de cada estudo. Resultados A entrevista motivacional foi aplicada presencialmente e associada à chamada telefônica, visita domiciliar, fitas de áudio, encartes informativos, aconselhamento, teorias cognitivas-comportamentais e cognitivas-sociais. Os estudos incluídos nesta revisão evidenciaram que as intervenções utilizando a entrevista motivacional aumentaram a adesão aos antirretrovirais por pessoas com vírus da imunodeficiência humana. Conclusão O estudo contribuiu para identificar os dados existentes sobre a eficácia de intervenções com a entrevista motivacional, com foco na adesão à terapia antirretroviral por pessoas com vírus da imunodeficiência humana, tornando visíveis os pontos que precisam ser aprofundados e mostrando a importância desta estratégia, que pode ser utilizada pelos enfermeiros e demais profissionais de saúde, visando o bem-estar dos pacientes. International Prospective Register Systematic Reviews: CRD42019123724

Resumen Objetivo Analizar las producciones científicas sobre la eficacia de las intervenciones que utilizan la entrevista motivacional para la adhesión al tratamiento antirretroviral de personas con el virus de la inmunodeficiencia humana. Métodos Revisión sistemática realizada en cuatro bases de datos, MEDLINE, CINAHL, IBECS, LILACS, y en una biblioteca electrónica, SciELO, sin restricción de idioma, fecha, ni tamaño de la muestra. La recopilación de archivos fue realizada en septiembre de 2021, con los descriptores Motivational Interviewing, HIV, Acquired Immunodeficiency Syndrome y Antiretroviral Therapy, Highly Active. Se incluyeron artículos tipo ensayo clínico aleatorizado, con muestreo de personas con virus de la inmunodeficiencia humana mayores de 18 años; y se excluyeron estudios que incluían niños, adolescentes y mujeres embarazadas. Se seleccionaron diez artículos y se analizó el rigor y características de cada estudio. Resultados La entrevista motivacional se realizó presencialmente y estuvo relacionada con llamadas telefónicas, visitas domiciliares, cintas de audio, suplementos informativos, asesoramiento, teorías cognitivas conductuales y cognitivas sociales. Los estudios incluidos en esta revisión evidenciaron que las intervenciones que utilizan la entrevista motivacional aumentaron la adhesión a los antirretrovirales de personas con el virus de la inmunodeficiencia humana. Conclusión El estudio ayudó a identificar los datos existentes sobre la eficacia de intervenciones con entrevistas motivacionales, con énfasis en la adhesión al tratamiento antirretroviral de personas con el virus de la inmunodeficiencia humana, se visibilizaron los puntos en los que es necesario profundizar y se mostró la importancia de esta estrategia, que puede ser utilizada por enfermeros y demás profesionales de la salud, para el bienestar de los pacientes.

Abstract Objective To analyze scientific productions about the effectiveness of interventions using motivational interviewing for adherence to antiretroviral therapy by people with the human immunodeficiency virus. Methods This is a systematic review carried out in four databases, MEDLINE, CINAHL, IBECS, LILACS, and in an electronic library, SciELO, without language, date and sample size restrictions. The survey of articles was carried out in September 2021, using the descriptors Motivational Interviewing, HIV, Acquired Immunodeficiency Syndrome and Antiretroviral Therapy, Highly Active. Randomized clinical trial articles were included, with a sample of people with human immunodeficiency virus over 18 years old, and research involving children, adolescents and pregnant women was excluded. Ten articles were selected and analyzed regarding the rigor and characteristics of each study. Results Motivational interviewing was applied in person and associated with a telephone call, home visit, audio tapes, informational inserts, counseling, cognitive-behavioral and cognitive-social theories. The studies included in this review showed that interventions using motivational interviewing increased adherence to antiretrovirals by people with human immunodeficiency virus. Conclusion The study contributed to identify existing data on the effectiveness of interventions with motivational interviewing, focusing on adherence to antiretroviral therapy by people with human immunodeficiency virus, making visible the points that need to be deepened and showing the importance of this strategy, which can be used by nurses and other health professionals, aiming at patients' well-being.International Prospective Register Systematic Reviews: CRD42019123724

HIV and neoplasms: What do we know so far?

ABSTRACT Introduction The human immunodeficiency virus (HIV) pandemic remains an important issue. In 2020, approximately 37.7 million people were living with the disease and there were more than 680 thousand deaths due to complications linked to the disease. Despite these exorbitant numbers, the introduction of highly active antiretroviral therapy has marked a new era, changing the epidemiological profile of the infection and related pathologies, including neoplasms. Objective We performed a literature review to assess the role of neoplasms in patients with HIV after the introduction of antiretroviral therapy. Methods A literature review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, searching the MEDLINE, LILACS, and COCHRANE databases for articles published from 2010 onwards. Results Using specific key terms, 1,341 articles were identified; two were duplicates, 107 were selected for full-text evaluation, and 20 were included in the meta-analysis. The selected studies included 2,605,869 patients. Fifteen of the 20 articles indicated a reduction in the global incidence of AIDS-defining neoplasms and 12 indicated an overall increase in non-AIDS-defining cancers after the introduction of antiretrovirals. This growth trend could be explained by a range of factors including the aging population with HIV, risky behaviors, and coinfection with oncogenic viruses. Conclusions There was a decreasing trend in the incidence of AIDS-defining neoplasms and increasing trend in non-AIDS-defining neoplasms. However, the carcinogenic effect of antiretrovirals could not be confirmed. In addition, studies focusing on the oncogenic role of HIV and screening for neoplasms in individuals with HIV are required.

Suppression of HIV in the first 12 months of antiretroviral therapy: a comparative analysis of dolutegravir- and efavirenz-based regimens

ABSTRACT Objective To compare viral suppression in treatment-naïve adults starting antiretroviral therapy with dolutegravir (50mg)- and efavirenz (600mg)-based regimens. Methods We analyzed secondary data from Brazilian health information systems of people living with human immunodeficiency virus who started antiretroviral therapy between 2015 and 2017 in Minas Gerais, Brazil. The outcome was viral suppression, defined as the achievement of the first viral load <50 copies/mL within 12 months after initiating antiretroviral therapy. This outcome was also compared with viral load <1,000 copies/mL and analyzed in two scenarios: intention-to-treat versus per-protocol. Time to viral suppression and adjusted odds ratio accompanied by 95% confidence intervals were estimated. Results Of the 2,599 participants enrolled, 77.5% were men, and the median age was 34 years. In the intention-to-treat analysis, viral suppression was 58.1% for efavirenz and 76.7% for dolutegravir. People living with HIV on dolutegravir-based regimen were more likely to achieve viral suppression (aOR: 2.44; 95%CI: 2.01-2.95) and had a shorter median time to viral suppression (p<0.0001). Antiretroviral therapy initiation within <120 days, baseline CD4⁺T-cells ≥200 cells/mm3, and viral load <100,000 copies/mL had higher odds of viral suppression. According to the per-protocol analysis, viral suppression ≥90% was observed by considering viral load <1,000 copies/mL. Conclusion Our study demonstrated that viral suppression improved after introducing dolutegravir, although the proportion of patients with viral load <50 copies/mL was lower than expected. Improved access to routine viral load examinations and continuous surveillance of the effectiveness of antiretroviral therapy should be considered.

Prevalence of periodontitis in young adults living with HIV/Aids using antiretroviral therapy / Prevalência da periodontite em adultos jovens vivendo com HIV/Aids em uso de terapia antirretroviral

ABSTRACT The therapeutic management, as well as the HIV virus itself, has been associated with alterations at the bone level, which may also have a relationship with the maxillomandibular alveolar processes and potential development of periodontal diseases, especially periodontitis. Objective: The objective of this study was to evaluate the periodontal health condition of young adults living with HIV/AIDS, through the measurement of the Periodontal Clinical Insertion Level (CAL) and to raise general data on the health conditions facing HIV and on the quality of life of this audience. Methods: Data were collected at a Reference Center for STI/AIDS in São Paulo - SP, Brazil. The method used was guided by previously validated indicators. In total, 31 individuals aged between 20 and 24 years, both genders and using TAAP were evaluated. For the analyses, the Excel Microsoft® software was used. Results: There was a prevalence of periodontitis in the assessed public of 45.17%. In view of the quality of life, the public was classified as "Regular" and no cases of Necrozing Periodontitis were observed, which is strongly associated with HIV infection. Conclusions: The evaluated public showed a high prevalence of periodontitis, which reinforces the importance of Dentistry in monitoring People Living with HIV/AIDS, in order to prevent the worsening of periodontal diseases.

RESUMO O manejo terapêutico, bem como o próprio vírus do HIV tem sido associados à quadros de alterações em nível ósseo, podendo ter uma relação também com os processos alveolares maxilo-mandibulares e potencial desenvolvimento de quadros de doenças periodontais, em especial a periodontite. Objetivo: O objetivo do trabalho foi avaliar a condição da saúde periodontal de indivíduos adultos jovens vivendo com HIV/AIDS, por meio da aferição do Nível de Inserção Clínica Periodontal e levantar dados gerais sobre as condições de saúde frente ao HIV e sobre a qualidade de vida desse público. Os dados foram coletados em um Centro de Referência em IST/AIDS de São Paulo - SP, Brasil. Métodos: O método empregado teve como guia norteadora indicadores previamente validados. No total, foram avaliados 31 indivíduos com idades entre 20 e 24 anos, ambos os gêneros e em uso da terapia antirretroviral. Para as análises foi utilizado o software Excel Microsoft®. Resultados: Foi observado uma prevalência de periodontite no público avaliado de 45,17%. Frente a qualidade de vida o público foi classificado como "Regular" e não foi observado quadros de Periodontite Necrozante, que está fortemente associado a infecção pelo HIV. Conclusão: O público avaliado apresentou alta prevalência de periodontite, o que reforça a importância da Odontologia no acompanhamento das Pessoas Vivendo com HIV/Aids, no sentido de prevenir o agravamento dos quadros de doenças periodontais.

Cartilha para estilo de vida saudável em pessoas com HIV: ensaio clínico / Cartilla de estilo de vida saludable para personas con VIH: ensayo clínico / Booklet for healthy lifestyle in people with HIV: a clinical trial

Resumo Objetivo Avaliar a efetividade de uma cartilha educativa para promoção do estilo de vida saudável e adesão aos antirretrovirais em pessoas com HIV. Métodos Ensaio clínico randomizado em ambulatório de Fortaleza, Ceará, Brasil, com 70 pacientes no grupo intervenção e 74 no controle. Critérios de inclusão: pessoas com HIV maiores de 18 anos, de ambos os sexos, em terapia antirretroviral por mais de seis meses, ter telefone fixo ou celular, e 35 ou mais pontos na Escala de Letramento em Saúde. A coleta de dados ocorreu em quatro momentos, utilizando-se a Escala de Perfil do Estilo de Vida Individual e o Questionário para Avaliação da Adesão ao Tratamento Antirretroviral. O grupo controle recebeu a consulta médica de rotina, e o grupo intervenção, além da consulta de rotina, realizou a leitura da cartilha em consultório, e depois levou-a para o domicílio. Na estatística, utilizou-se análise de variância não paramétrica de medidas repetidas. Resultados A maioria dos participantes tinha estilo de vida insatisfatório na avaliação basal. A cartilha melhorou o estilo de vida dos pacientes após dois (P<0,001), quatro (P<0,001) e seis meses (P<0,001) da intervenção, quando comparados os diferentes tempos ao valor basal e ao controle. Houve melhora dos escores de adesão aos antirretrovirais no grupo intervenção quando comparado à linha de base (P<0,001) e ao controle (P<0,001). Conclusão A cartilha foi efetiva para promover estilo de vida saudável e melhorar a adesão aos antirretrovirais em pessoas com HIV, portanto, pode complementar as consultas ambulatoriais. Registro Brasileiro de Ensaios Clínicos (ReBEC): RBR-7p6vsr

Resumen Objetivo Evaluar la efectividad de una cartilla educativa para la promoción del estilo de vida saludable y adhesión a los antirretrovirales para personas con VIH. Métodos Ensayo clínico aleatorizado en consultorios externos de Fortaleza, estado de Ceará, Brasil, con 70 pacientes en el grupo experimental y 74 en el de control. Criterios de inclusión: personas con VIH mayores de 18 años, de ambos sexos, en tratamiento antirretroviral por más de seis meses, con teléfono fijo o celular y con 35 puntos o más en la Escala de Alfabetización en Salud. La recolección de datos se realizó en cuatro momentos, mediante la Escala de Perfil del Estilo de Vida y el Cuestionario para la Evaluación de la Adhesión al Tratamiento Antirretroviral. El grupo de control recibió una consulta médica de rutina, y el grupo experimental, además de la consulta de rutina, leyó la cartilla en el consultorio y después se la llevó a su casa. En la estadística, se usó el análisis de varianza no paramétrico de medidas repetidas. Resultados La mayoría de los participantes tenía un estilo de vida insatisfactorio en la evaluación de base. La cartilla mejoró el estilo de vida de los pacientes después de dos (P<0,001), cuatro (P<0,001) y seis meses (P<0,001) de la intervención, si se lo compara con los diferentes tiempos al valor de base y al control. Se observó una mejora de la puntuación de adhesión a los antirretrovirales en el grupo experimental si se lo compara con la línea de base (P<0,001) y con el control (P<0,001). Conclusión La cartilla fue efectiva para promover un estilo de vida saludable y mejorar la adhesión a los antirretrovirales en personas con VIH; por lo tanto, puede complementar las consultas de los consultorios externos.

Abstract Objective To assess the effectiveness of an educational booklet to promote healthy lifestyle and antiretroviral compliance in people with HIV. Methods This is a randomized clinical trial at an outpatient clinic in Fortaleza, Ceará, Brazil, with 70 patients in the intervention group and 74 in the control group. People with HIV over 18 years of age, of both sexes, on antiretroviral therapy for more than six months, with a landline or cell phone, and 35 or more points on the Health Literacy Scale were included. Data collection took place in four moments, using the Individual Lifestyle Profile Scale and the Assessment of Antiretroviral Therapy Compliance Questionnaire (Cuestionario para la Evaluación de la Adhesión al Tratamiento Antirretroviral). The control group received routine medical consultation, and the intervention group, in addition to routine consultation, read the booklet in the office, and then took it home. Non-parametric analysis of variance of repeated measures was used for statistics. Results Most participants had an unsatisfactory lifestyle at baseline. The booklet improved patients' lifestyle after two (P<0.001), four (P<0.001) and six months (P<0.001) of intervention, when comparing the different times to baseline and control. There was an improvement in antiretroviral compliance scores in the intervention group when compared to baseline (P<0.001) and control (P<0.001). Conclusion The booklet was effective in promoting a healthy lifestyle and improving antiretroviral compliance in people with HIV, therefore, it can complement outpatient consultations. Brazilian Clinical Trial Registry (ReBEC): RBR-7p6vsr

Vulnerabilidade individual, social e programática na adesão ao tratamento antirretroviral em adultos / Individual, social and program-related vulnerability in adults' adherence to antiretroviral treatment / Vulnerabilidad individual, social y programática en la adherencia al tratamiento antirretroviral en adultos

Objetivo: analisar a associação da adesão à terapia antirretroviral em adultos com HIV/Aids e as dimensões das vulnerabilidades. Métodos: estudo quantitativo, com 230 pacientes de serviço especializado, por meio de questionários de avaliação da adesão ao tratamento, com dados submetidos à análise estatística inferencial. Resultados: dos pacientes, 44,3% apresentaram boa/adequada adesão com elementos da vulnerabilidade individual: apoio para conversar/desabafar sobre o problema de saúde (p=0,002); apoio para se divertir ou fazer atividade de lazer (p=0,000); e deixar de tomar a medicação devido à alteração na prescrição médica (p=0,018); social: sexo (p=0,005); nível de instrução (p=0,010); renda familiar (p=0,034); e condição empregatícia (p=0,007); e programática: acesso ao serviço (p=0,005); recebimento de informações (p=0,039); comunicação com os profissionais (p=0,024); educação em saúde (p=0,013); e deixar de tomar a medicação por não tê-la (p=0,039). Conclusão: a adesão foi classificada como boa/adequada e apontam-se elementos de vulnerabilidades que fragilizam ou potencializam a adesão.

Objective: to examine how adherence to antiretroviral therapy among adults with HIV/Aids associated with dimensions of vulnerability. Methods: this quantitative study of 230 patients in a specialized service used questionnaires to assess adherence to treatment. The resulting data were submitted to inferential analysis. Results: adherence was good/adequate in 44.3% of patients and associated with elements of vulnerability, which could be individual: support to talk or vent about the health problem (p = 0.002), support for fun or leisure activities (p = 0.000), and for not taking medication due to a change in medical prescription (p = 0.018); social: sex (p = 0.005); education level (p = 0.010), family income (p = 0.034), and employment status (p = 0.007); or program-related: access to the service (p = 0.005), receiving information (p = 0.039), communication with professionals (p = 0.024), health education (p = 0.013), and not taking medication for not having them (p = 0.039). Conclusion: Adherence was classified as good or adequate, and pointed to elements of vulnerability that weaken or strengthen adherence.

Objetivo: analizar la asociación de la adherencia a la terapia antirretroviral en adultos con VIH/SIDA y las dimensiones de las vulnerabilidades. Métodos: estudio cuantitativo, junto a 230 pacientes de servicios especializados, mediante cuestionarios para evaluar la adherencia al tratamiento, cuyos datos se sometieron al análisis estadístico inferencial. Resultados: el 44,3% de los pacientes tuvo buena / adecuada adherencia con elementos de vulnerabilidad individual: apoyo para hablar o desahogarse sobre el problema de salud (p = 0,002); apoyo para divertirse o realizar actividades de ocio (p = 0,000) y no tomar medicación por cambio de prescripción médica (p = 0,018); social: sexo (p = 0,005); nivel educativo (p = 0,010); ingresos familiares (p = 0,034) y situación laboral (p = 0,007); y programática: acceso al servicio (p = 0,005); recibir información (p = 0.039); comunicación con profesionales (p = 0,024); educación en salud (p = 0,013) y no tomar medicamentos por no tenerlos (p = 0,039). Conclusión: La adherencia se clasificó como buena / adecuada y se señalan elementos de vulnerabilidades que debilitan o mejoran la adherencia.

Perfil sociodemográfico e farmacoepidemiológico de crianças infectadas pelo HIV / Sociodemographic and pharmacoepidemiology profile of HIV infected children

RESUMO A terapia antirretroviral interfere na replicação do vírus HIV, impede a progressão da infecção para a Aids e previne a mortalidade precoce das crianças infectadas. Esta pesquisa investigou o perfil sociodemográfico e os parâmetros relacionados com o tratamento antirretroviral das crianças HIV positivas residentes no estado do Paraná. Trata-se de um estudo observacional descritivo e analítico realizado com dados secundários do ano de 2020 referentes às crianças com até 12 anos de idade. Foram investigados: perfil, prevalência, medicamentos em uso, abandono da terapia, resistência e supressão viral. Foram identificadas 148 crianças, com uma prevalência igual a 8,1/100 mil no Paraná. Apesar de todas as crianças diagnosticadas com HIV terem iniciado o tratamento, 17,2% encontravam-se em abandono da terapia antirretroviral. Entre as crianças que permaneciam em tratamento, 9,8% não atingiram a supressão viral e suas cargas virais comumente ultrapassavam mil cópias virais/mL. Houve um predomínio de esquemas medicamentosos provavelmente prescritos após falhas terapêuticas. Os resultados indicam que o Paraná apresenta bons resultados quanto ao início rápido da terapia e à supressão viral das crianças. Entretanto, existe um número considerável de abandonos da terapia e de falhas terapêuticas, indicando a necessidade de reforçar a vinculação desta população aos serviços de saúde.

ABSTRACT Antiretroviral therapy interferes with the replication of the HIV virus, stops the progression of infection, and prevents early mortality in infected children. This research investigated the sociodemographic profile and parameters related to the antiretroviral treatment of HIV positive children living in the state of Paraná. This is a descriptive observational and analytical study, carried out with secondary data from the year 2020, referring to children up to 12 years of age. The profile, prevalence, medicines in use, treatment abandonment, viral resistance, and viral suppression were investigated. A total of 148 children were identified, with a prevalence equal to 8.1/100,000 in Paraná. All infants had begun their treatment, but 17,2% abandoned it. Among children who remained on treatment, 9.8% did not achieve viral suppression and their viral loads commonly exceeded 1000 viral copies/mL. There was a predominance of drug regimens probably prescribed after treatment failures. The results indicate that Paraná presents good results in terms of rapid initiation of therapy and viral suppression in children. However, there is a considerable number of abandonments of therapy and therapeutic failures, indicating the need to strengthen the link between this population and health services.

Comportamiento del virus de inmunodeficiencia humana/sida en la provincia de Cienfuegos (2014-2019)

RESUMEN Fundamento La infección por virus de inmunodeficiencia humana/sida continúa siendo un problema de salud a pesar de la reducción de sus tasas de incidencia. Objetivo describir el comportamiento del virus de inmunodeficiencia humana/sida en la provincia Cienfuegos en el período 2014-2019. Métodos se realizó un estudio descriptivo, con un universo de 556 pacientes diagnosticados con el Virus de Inmunodeficiencia Humana. Se utilizaron las series cronológicas de casos y se analizaron las variables incidencia, prevalencia, edad, sexo, accesibilidad al tratamiento antirretroviral y transmisión materno infantil. Se calcularon, además, tasas y por cientos. Resultados predominaron los pacientes de 25 a 49 años de edad, quienes representaron un 67 %. Se observó tendencia al descenso en las tasas de incidencia de la enfermedad en la provincia. Al concluir 2019, el 98,2% de los pacientes se encontraba bajo tratamiento antirretroviral. No se reportó transmisión materno infantil en el período de estudio. Conclusión El estudio realizado evidenció las características de la epidemia de virus de inmunodeficiencia humana/sida en la provincia de Cienfuegos durante el periodo de estudio, la cual mostró tendencia a la reducción de sus tasas de incidencia, así como el acceso garantizado al tratamiento antirretroviral, que, unido a los protocolos de atención, ha permitido eliminar la transmisión materno infantil.

ABSTRACT Background Human immunodeficiency virus infection/AIDS continues to be a health problem despite the reduction in its incidence rates. Objective to describe the behavior of the human immunodeficiency virus/AIDS in the Cienfuegos province from 2014 to 2019. Methods a descriptive study was carried out, 556 patients were studied and diagnosed with the Human Immunodeficiency Virus. Chronological series of cases were used and the variables incidence, prevalence, age, sex, accessibility to antiretroviral treatment and mother-to-child transmission were analyzed. Rates and percentages were also calculated. Results patients from 25 to 49 years of age predominated, who represented 67%. A downward trend was observed in the incidence rates of the disease in the province. At the end of 2019, 98.2% of patients were under antiretroviral treatment. No mother-to-child transmission was reported in the study period. Conclusion The study carried out evidenced the characteristics of the human immunodeficiency virus/AIDS epidemic in the Cienfuegos province during the study period, which showed a tendency to reduce its incidence rates, as well as guaranteed access to antiretroviral treatment, which, together with care protocols, has made it possible to eliminate mother-to-child transmission.

Changes of inflammatory cytokines and T lymphocyte activation in the peripheral blood of human immunodeficiency virus infected patients during anti-retroviral therapy / 中华传染病杂志

Objective:To explore the dynamic changes of inflammatory cytokines and T lymphocyte activation in the peripheral blood of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients during anti-retroviral therapy (ART).Methods:Two hundred and six HIV/AIDS patients with ART at clinic of the Department of Infectious Diseases in Second Xiangya Hospital, Central-South University between January 2017 and December 2019 were selected as HIV infection group. They were followed up regularly and the blood samples before treatment and at month 6, month 12, month 24 of treatment were collected. Meanwhile, 52 healthy cases were enrolled in the healthy control group and their blood samples were collected. Enzyme-linked immunosorbent assay was used to detect the plasma concentrations of interleukin (IL)-6, hypersensitive C-reactive protein (hsCRP) and tumor necrosis factor (TNF)-α. Flow cytometry was used to detect the CD3 + CD4 + T lymphocytes count and the percentage of CD4 + CD38 + T lymphocytes and CD8 + CD38 + T lymphocytes in the peripheral blood mononuclear cells. Plasma HIV RNA viral load was determined using a quantitative real-time polymerase chain reaction technique. Statistical methods used paired t test and Pearson correlation analysis. Results:The concentrations of IL-6, hsCRP and TNF-α in HIV infection group were (13.42±2.35) pg/mL, (4 012.46±1 012.35) μg/L and (51.78±11.32) μg/L, respectively, which were higher than those in healthy control group ((6.14±0.78) pg/mL, (707.21±305.76) μg/L and (19.01±6.48) μg/L, respectively). The differences were all statistically significant ( t=12.56, 16.79 and 13.45, respectively, all P<0.001). They decreased gradually after initiation of ART in HIV infection group, and returned to normal levels at month 24 of ART. CD3 + CD4 + T cells count was (256.00±65.32)/μL and HIV RNA viral load was (4.467±4.244) lg copies/mL before ART in HIV infection group, which were negatively correlated ( r=-0.625, P=0.041). The percentages of CD8 + CD38 + T lymphocytes before treatment and at month 12 or month 24 of treatment in HIV infection group were higher than those in healthy control group. The differences were all statistically significant ( t=3.85, 6.84 and 2.57, respectively, all P<0.050). The percentage of CD8 + CD38 + T lymphocytes was positively correlated with HIV RNA viral load before ART ( r=0.768, P=0.026). The percentages of CD4 + CD38 + T lymphocytes before treatment and at month 12 or month 24 of treatment in the HIV infection group were lower than those in the healthy control group, and the differences were all statistically significant ( t=6.80, 1.10, and 2.11, respectively, all P<0.050). Conclusions:HIV infection could not only cause insufficiency in immune system, but also abnormal activation of immune system, which could get better gradually with ART.

Factors associated with HIV/syphilis co-infection initiating of antiretroviral therapy / Fatores associados à coinfecção HIV/sífilis no início da terapia antirretroviral

ABSTRACT OBJECTIVE To evaluate the prevalence and factors associated with HIV/syphilis co-infection in people initiating antiretroviral therapy in Belo Horizonte, capital of the state of Minas Gerais. METHODS A sectional section of a prospective cohort study was carried out with people living with HIV, treatment-naive, initiating antiretroviral therapy, older than 16 years, and in follow-up treatment at specialized HIV/Aids care services in Belo Horizonte. Sociodemographic, behavioral, clinical, laboratory and pharmacological treatment-related data were obtained through interviews, medical records, and information systems for logistical control of antiretroviral medications and laboratory tests. The dependent variable was the first episode of active syphilis, recorded by the physician in clinical records, within 12 months after beginning of the antiretroviral therapy. Factors associated with HIV/syphilis co-infection were assessed using binary multiple logistic regression. RESULTS Among the 459 individuals included, a prevalence of 19.5% (n = 90) of sexually transmitted infections (STI) was observed, with syphilis (n = 49) being the most frequent STI in these individuals. The prevalence of HIV/syphilis co-infection was 10.6% (n = 49), and the associated independent factors were alcohol use (OR = 2.30; 95%CI: 1.01-5.26), and having a diagnosis of other sexually transmitted infections (OR = 3.33; 95%CI: 1.24-8.95). CONCLUSIONS There was a high prevalence of HIV/syphilis co-infection in people living with HIV initiating antiretroviral therapy in Belo Horizonte. HIV/syphilis co-infection was associated with behavioral and clinical factors, such as alcohol use and diagnosis of other sexually transmitted infections. Prior knowledge about the factors associated with this co-infection may support the decisions of health professionals engaged in the care to people living with HIV, with regard to timely diagnosis, guidance, follow-up and adequate treatment, both for syphilis and HIV.

RESUMO OBJETIVO Avaliar a prevalência e os fatores associados à coinfecção HIV/sífilis em pessoas no início da terapia antirretroviral no município de Belo Horizonte, Minas Gerais. MÉTODOS Foi realizado um corte seccional de um estudo de coorte prospectivo, com pessoas vivendo com HIV, sem tratamento prévio da infecção, em início da terapia antirretroviral, maiores de 16 anos e em acompanhamento em serviços de assistência especializada em HIV/aids de Belo Horizonte. Dados sociodemográficos, comportamentais, clínicos, laboratoriais e relacionados ao tratamento farmacológico foram obtidos por meio de entrevistas, coleta em prontuários clínicos e nos sistemas de informação de controle de medicamentos antirretrovirais e exames laboratoriais. A variável dependente foi o primeiro episódio de sífilis ativa, registrado pelo médico em prontuário clínico, em um período de 12 meses após início da terapia antirretroviral. Os fatores associados à coinfecção HIV/sífilis foram avaliados por meio de regressão logística binária múltipla. RESULTADOS Dentre os 459 indivíduos avaliados, observou-se uma prevalência de 19,5% (n = 90) de infecções sexualmente transmissíveis, sendo a sífilis (n = 49) a infecção sexualmente transmissível mais frequente nesses indivíduos. A prevalência da coinfecção HIV/sífilis foi de 10,6% (n = 49) e os fatores independentes associados foram o uso de álcool (OR = 2,30; IC95% 1,01-5,26) e ter diagnóstico de outras infecções sexualmente transmissíveis (OR = 3,33; IC95% 1,24-8,95). CONCLUSÕES Houve alta prevalência de coinfecção HIV/sífilis em pessoas vivendo com HIV em início de terapia antirretroviral em Belo Horizonte. A coinfecção HIV/sífilis foi associada a fatores comportamentais e clínicos, como uso de álcool e diagnóstico de outras infecções sexualmente transmissíveis. O conhecimento prévio sobre os fatores associados à essa coinfecção pode subsidiar as decisões dos profissionais de saúde inseridos no cuidado às pessoas vivendo com HIV, no que diz respeito ao diagnóstico oportuno, orientações, acompanhamento e tratamento adequado, tanto da sífilis quanto do HIV.

Epidemiological characteristics and adherence of a cohort of elderly people with HIV/AIDS in the Public Health System

ABSTRACT Objective To characterize the epidemiological profile of patients aged 50 years or older diagnosed as HIV/AIDS, in a Specialized Service of the Public Health System. Methods A retrospective cohort study using secondary data from medical records in the period 2014 to 2018. Sociodemographic and clinical characteristics, and features related to treatment adherence were organized in a database. Quantitative variables were expressed as mean (or median) ± standard deviation (or interquartile range), and categorical variables expressed as number and percentage of patients. The Kaplan-Meier method was applied to assess the probability of overall specific survival. Results Of the 241 initially eligible patients, 149 patients were evaluated, registering 19 deaths in the studied period. There was a predominance of males aged 50-59 years, with severe immunodeficiency upon admission (29.7%), and with a CD4+ T lymphocyte count below 200 cells in 62 (46.3%) of patients. Elderly people aged 61 or over were more adherent. There was an increase in the CD4+ T lymphocyte count by an average of 139.63 in the first 6 months, and 50.51 from the first 6 months to 12 months of follow-up, with an average increase in the first 12 months of 157.63 cells. Specific overall survival in the period was 85%. Conclusion Patients older than 50 years had an immune response and no viral load detection in the 12-month period, deserving further studies to improve survival.

Diferencias entre los modelos de riesgo Framingham y DAD en la evaluación del riesgo cardiovascular en pacientes con VIH bajo terapia antirretroviral: experiencia en una población del caribe colombiano / Differences between the Framingham and D:A:D risk models for cardiovascular risk assessment in HIV-positive patients on antiretroviral therapy: an experience in a Colombian Caribbean population

RESUMEN Objetivo: Evaluar el riesgo de enfermedad cardiovascular a cinco y a diez años en pacientes con infección por VIH en terapia antirretroviral, por medio de las escalas Framingham y Data collection on Adverse Effects of Anti-HIV Drugs Study. Materiales y métodos: Estudio observacional de corte transversal y prospectivo. Se incluyeron pacientes con infección por el VIH en tratamiento antirretroviral de un centro de referencia para pacientes con VIH, entre el 1 de enero y el 30 de abril de 2019. Se realizó evaluación del riesgo cardiovascular a cinco y a diez años a través de los modelos de predicción de Framingham y la escala Data collection on Adverse Effects of Anti-HIV Drugs Study (DAD), y una comparación entre ellos a través de modelos estadísticos. Resultados: Se incluyeron 159 pacientes, con un promedio de edad de 48,90 años ± 9,90. La media de valoración del riesgo cardiovascular por escala de Framingham a 5 años fue de 2,70 % ± 2,80; Framingham a 10 años fue 6,10 % ± 5,70; DAD a 5 años, 3,50 % ± 4,10; DAD a 10 años, de 6,90 % ± 7,70; y el riesgo escala de Framingham a 10 años recalculado para Colombia (multiplicado por 0,75) fue de 4,50 ± 4,20. A través de un modelo de regresión logística, se determinó que la puntuación con mayor número de variables significativamente relacionadas con el resultado de riesgo cardiovascular alto es el modelo DAD a 10 años. Conclusiones: El estudio evidenció una diferencia significativa, con mayor riesgo estimado de enfermedad cardiovascular al utilizar el modelo DAD en comparación con el Framingham, tanto para la estimación a cinco años como a diez.

ABSTRACT Objective: To assess the five- and ten-year cardiovascular disease risk in HIV-positive patients on antiretroviral therapy, using the Framingham risk score and the Data collection on adverse effects of anti-HIV drugs (D:A:D) study. Materials and methods: An observational prospective cross-sectional study. HIV-positive patients on antiretroviral treatment from a referral center for HIV patients were included in the study between January 1 and April 30, 2019. A five- and ten-year cardiovascular risk assessment was performed using the Framingham risk score and the D:A:D study. Additionally, both risk models were compared through statistical models. Results: The study population consisted of 159 patients with a mean age of 48.90 years ± 9.90. The mean cardiovascular risk according to the five-year Framingham risk score was 2.70 % ± 2.80, the ten-year Framingham risk score was 6.10 % ± 5.70, the five-year D:A:D study was 3.50 % ± 4.10, the ten-year D:A:D study was 6.90 % ± 7.70, and the ten-year Framingham risk score recalculated for Colombia (multiplied by 0.75) was 4.50 % ± 4.20. Using a logistic regression model, it was determined that the ten-year D:A:D study provided the greatest number of variables significantly related to a high cardiovascular risk. Conclusions: The study showed a significant difference between the risk models. Both the five- and ten-year D:A:D study provided a better cardiovascular disease risk estimation than the five- and ten-year Framingham model.

Chronic Cystoisospora belli infection in a Colombian patient living with HIV and poor adherence to highly active antiretroviral therapy / Infección crónica por Cystoisospora belli en un paciente colombiano con HIV y cumplimiento deficiente de la terapia antirretroviral de gran actividad

Abstract | Cystoisospora belli is an intestinal Apicomplexan parasite associated with diarrheal illness and disseminated infections in humans, mainly immunocompromised individuals such as those living with the human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). An irregular administration of highly active antiretroviral therapy (HAART) in HIV patients may increase the risk of opportunistic infections like cystoisosporiasis. We describe here a case of C. belli infection in a Colombian HIV patient with chronic gastrointestinal syndrome and poor adherence to HAART. His clinical and parasitological cure was achieved with trimethoprim-sulfamethoxazole treatment. Although a reduction in the number of C. belli cases has been observed since the use of HAART, this parasite still has to be considered as a differential diagnosis of diarrheal disease in HIV/AIDS patients. Effective interventions enhancing adherence to HAART should be included in HIV patient care programs.

Resumen | Cystoisospora belli es un parásito intestinal del filo Apicomplexa asociado con enfermedades diarreicas e infecciones diseminadas en humanos, principalmente en individuos inmunocomprometidos, como aquellos infectados con el virus de la inmunodeficiencia humana (HIV) o el síndrome de inmunodeficiencia adquirida (sida). El cumplimiento inadecuado de la terapia antirretroviral de gran actividad (TARGA) puede aumentar el riego de infecciones oportunistas, incluida la cistoisosporiasis. Se describe el caso de infección por C. belli en un paciente colombiano con HIV, que presentó un síndrome gastrointestinal crónico e incumplía el tratamiento con la TARGA. Después del diagnóstico parasitológico, el paciente fue tratado con trimetoprim-sulfametoxazol, lográndose la recuperación clínica y la cura parasitológica. Aunque se ha observado una reducción en el número de casos de C. belli desde la implementación de la TARGA, este parásito aún debe considerarse en el diagnóstico diferencial de las enfermedades diarreicas en pacientes con HIV/sida. Los programas de atención deben incluir intervenciones efectivas que potencien el cumplimiento de la TARGA en estos pacientes.

Representações sociais da terapia antirretroviral para pessoas vivendo com HIV / Las representaciones sociales de la terapia antirretroviral para las personas que viven con el VIH / Social representations of antiretroviral therapy for people living with HIV

Objetivo: analisar a representação social da terapia antirretroviral para pessoas vivendo com HIV. Método: estudo qualitativo, com a utilização da teoria das representações sociais. A coleta de dados incluiu 50 participantes, sendo realizada de fevereiro a setembro de 2020, utilizando um questionário de caracterização sociodemográfica e um formulário para evocações livres. O cenário do estudo foi uma unidade de tratamento de HIV na região metropolitana do Rio de Janeiro. A análise dos dados foi realizada pelo software EVOC. Resultados: o núcleo central da representação da terapia antirretroviral reforça o controle do HIV e a imagem do medicamento como algo bom. Conclusão: a estrutura representacional sugere que o grupo tende à normalização da terapia antirretroviral, fazendo referência a um medicamento que controla o HIV. O estudo possibilitou reconhecer os diferentes conteúdos representacionais da terapia antirretroviral para o grupo estudado, além da variada complexidade entre as imagens identificadas.

Objective: analyzing the social representation of antiretroviral therapy for people living with HIV. Method: a qualitative study using the Theory of Social Representations. Data collection included 50 participants, being performed from February to September 2020 using a sociodemographic characterization questionnaire and a form for free evocations. The study scenario was an HIV treatment unit in the metropolitan region of Rio de Janeiro. Data analysis was performed by the EVOC software. Results: the central nucleus of the representation of antiretroviral therapy reinforces HIV control and the image of the drug as something good. Conclusion: the representational structure suggests that the group tends to normalize antiretroviral therapy, referring to a drug that controls HIV. The study made it possible to recognize the different representational contents of antiretroviral therapy for the studied group, in addition to the varied complexity among the images identified.

Objetivo: analizar la representación social de la terapia antirretroviral para las personas que viven con el VIH. Método: un estudio cualitativo utilizando la Teoría de las Representaciones Sociales. La recolección de datos incluyó a 50 participantes, realizándolos de febrero a septiembre de 2020 utilizando un cuestionario de caracterización sociodemográfica y un formulario para evocaciones libres. El escenario del estudio fue una unidad de tratamiento del VIH en la región metropolitana de Río de Janeiro. El análisis de los datos fue realizado por el software EVOC. Resultados: el núcleo central de la representación de la terapia antirretroviral refuerza el control del VIH y la imagen del fármaco como algo bueno. Conclusión: la estructura representacional sugiere que el grupo tiende a normalizar la terapia antirretroviral, refiriéndose a un fármaco que controla el VIH. El estudio ha permitido reconocer los diferentes contenidos representacionales de la terapia antirretroviral para el grupo estudiado, además de la variada complejidad entre las imágenes identificadas.

Potential impact of the COVID-19 in HIV-infected individuals: a systematic review Impact of the COVID-19 in HIV-Infected Individuals

SUMMARY BACKGROUND: Although much has been studied about the SARS-Cov-2 virus, its effects, and the effectiveness of possible treatments, little is known about its interaction with other infectious diseases. OBJECTIVE: The aim is to study its clinical features and morbidity, and mortality outcomes of COVID-19 patients with HIV/AIDS coinfection. DATA SOURCES: MEDLINE, Web of Science, Embase, CINAHL, LILACS, Scopus, ClinicalTrials.gov, and Cochrane. STUDY ELIGIBILITY CRITERIA: Atudies in any language, published after 2019, were describing COVID-19 patients with HIV/AIDS. STUDY APPRAISAL: JBI Levels of Evidence, Joanna Briggs Institute. SYNTHESIS METHODS: As shown in the PRISMA flow diagram, two authors separately screened the search results from the obtained titles and abstracts. RESULTS: Chest CT was observed in patients with pneumonia by SARS-CoV-2 with findings of multiple ground-glass opacities (GGO) in the lungs, there is a need for supplemental oxygenation. One patient developed encephalopathy and complicated tonic-clonic seizures; four patients were transplanted (two, liver; two, kidneys), one patient developed severe SARS-CoV-2 pneumonia and 30 patients died (mortality rate, 11%). CONCLUSION: HIV did not show any relevance directly with the occurrence of COVID-19. Some studies suggest that HIV-1 infection through induction levels of IFN-I, may to some extent, stop the apparent SARS-CoV-2 infection, thus leading to undetectable RNA. Moreover, some authors suggest retroviral therapy routinely used to control HIV infection could be used to prevent COVID-19 infection.

Prevalencia de resistencia transmitida a drogas antirretrovirales en pacientes con infección por VIH en Chile (2014-2018)

Background: Transmitted drug resistance (TDR) occurs in patients with HIV infection who are not exposed to antiretroviral drugs but who are infected with a virus with mutations associated with resistance. Aim: To determine the prevalence of TDR and characterize HIV reverse transcriptase and protease mutation patterns. Material and Methods: HIV infected antiretroviral treatment-naive patients treated in three centers between 2014 and 2018 were studied. A genotyping study was carried out. The HIVdb Program (Stanford University) and the World Health Organization (WHO) TDR surveillance mutation list were used to register resistance-associated mutations. Results: We enrolled 220 patients aged a median of 29 (interquartile range (IQR) 24-34) years, 99% men. Median CD4 count was 365 cells/μL (IQR 250-499 cells/μL) and median viral load was 39.150 copies/mL (IQR 9,270 −120,000). The overall prevalence of RTD was 10.45% (95% CI 6.7-15.2, N = 23/220). The higher frequency of TDR was against non-nucleoside reverse transcriptase inhibitors, reaching 9.0% (95% CI 5.6-13.6), followed by nucleoside reverse transcriptase inhibitors reaching 1.8% (95% CI 0.49-4.5) and protease inhibitors reaching 0.45% (95% CI 0.01-2.5). The mutations in reverse transcriptase were M41L, L210W, D67N, K70E, M184V, K103N (6.36%, 95% CI 3.5-10.4), G190A, E138A, K101E, and I84V in protease. Conclusions: These results should prompt a change in recommendations for starting antiretoviral therapy, especially in first-line regimens that include non-nucleoside reverse transcriptase inhibitors.

Hipertensión y síndrome metabólico en pacientes con Virus de la Inmunodeficiencia-Humana / Hypertension and metabolic syndrome in HIV infected patients

Resumen La enfermedad cardiovascular y sus factores de riesgos como hipertensión arterial (HTA) y síndrome metabólico (SM), son una creciente causa de mortalidad entre los infectados con HIV. Nuestros objetivos fueron determinar la prevalencia HTA y SM en pacientes HIV positivos de la ciudad de Córdoba su asociación con el estado inmunológico, inflamación y terapia antirretroviral (TARAA). Fue un estudio aleatorizado de corte transversal. Se incluyeron 65 pacientes HIV positivos del programa provincial HIV-Córdoba, 57 (87%) recibían TARAA, 39 (60%) eran masculinos, con edad promedio de 44.7 ± 10 años. La concentración de linfocitos T CD4+ (LTCD4+) fue 404.4 ± 289.6 cel./ml. La carga viral (CV) fue indetectable en 56 (86.2%). La prevalencia de HTA fue de 40% (26/65) y se asoció a la duración de TARAA (p < 0.05). No hubo asociación entre años de infección por HIV, LTCD4+ y CV con HTA. La prevalencia de SM fue de 38.5% (25/65). El uso de TARAA fue más frecuente en aquellos con SM (OR: 1.80; IC95%: 1.43-2.28; p = 0.02). Pacientes bajo TARAA presentaron alta tasa de hipertrigliceridemia, intolerancia a la glucosa y niveles bajos de HDL (todos p < 0.01). SM se asoció a la duración de TARAA (p < 0.01). La TARAA se asoció a HTA y SM, no encontrándose relación con estado inmunológico, CV o marcadores de inflamación.

Abstract Cardiovascular diseases (CVD) are a growing cause of mortality between human immunodeficiency virus (HIV) infected patients. Hypertension (HTN) and metabolic syndrome (MS) are important causes of CVD. The prevalence of HTN and MS in HIV infected patients in Córdoba, Argentina is unknown. Our aim is to determine the prevalence of HTN and MS in HIV patients in Córdoba and their association with immunological state, inflammation and highly active antiretroviral therapy (HAART) in an observational study. Sixty-five HIV infected patients from the provincial HIV program were randomly selected. Fifty-seven (87%) were on HAART, 39 (60%) were males. The mean age was 44.7 ± 10 years. Mean CD4+ T lymphocytes (CD4+T) count was 404.4 ± 289.6 cells/ml. Viral load (VL) was undetectable in 56 (86.2%). The prevalence of HTN was 40%, and it was associated with the duration of HAART (p < 0.05). There was no association between years of HIV infection, CD4+T, VL and blood pressure. The prevalence of MS was 38.5% (25/65). MS was more frequent between those with HAART (OR: 1.80; CI 95%; 1.43-2.28; p = 0.02). Patients on HAART had higher rates of hypertriglyceridemia, impaired glucose tolerance and lower levels of HDLc (p < 0.01). MS was associated with the HAART duration (p < 0.01). HIV infected patients had a high prevalence of HTN and MS. HAART was associated with both HTN and MS, but there was no association between immunological status, VL or inflammatory markers.

Subclinical Carotid Atherosclerosis and Reduced DAD Score for Cardiovascular Risk Stratification in HIV-Positive Patients / Aterosclerose Carotídea Subclínica e DAD Escore Reduzido para Estratificação de Risco Cardiovascular em Pacientes HIV Positivos

Abstract Background: HIV-positive patients are twice as likely than the general population to have a heart attack and are four times at greater risk of sudden death. In addition to the increased risk, these individuals present with cardiovascular events on average approximately 10 years earlier than the general population. Objective: To compare Framingham and reduced DAD (Data Collection on Adverse Effects of Anti-HIV Drugs Cohort) scores for cardiovascular risk assessment in HIV-positive patients and potential impact on clinical decision after evaluation of subclinical carotid atherosclerosis. Methods: Seventy-one HIV-positive patients with no history of cardiovascular disease were clinically evaluated, stratified by the Framingham 2008 and reduced DAD scores and submitted to subclinical carotid atherosclerosis evaluation. Agreement between scores was assessed by Kappa index and p < 0.05 was considered statistically significant. Results: mean age was 47.2 and 53.5% among males. The rate of subclinical atherosclerosis was 39.4%. Agreement between scores was 49% with Kappa of 0.735 in high-risk patients. There was no significant difference between scores by ROC curve discrimination analysis. Among patients with intermediate risk and Framingham and reduced DAD scores, 62.5% and 30.8% had carotid atherosclerosis, respectively. Conclusion: The present study showed a correlation between the scores and medium-intimal thickening, besides a high correlation between patients classified as high risk by the Framingham 2008 and reduced DAD scores. The high prevalence of carotid atherosclerosis in intermediate risk patients suggests that most of them could be reclassified as high risk.

Resumo Fundamento: Pacientes HIV positivos possuem 2 vezes maior risco que a população geral de apresentarem infarto e 4 vezes maior de morte súbita. Além do risco aumentado, esses indivíduos apresentam eventos cardiovasculares, em média, aproximadamente, 10 anos antes que a população geral. Objetivo: Comparar os escores Framingham e DAD reduzido para avaliação de risco cardiovascular em pacientes HIV positivos e o potencial impacto na decisão clínica após avaliação de aterosclerose carotídea subclínica. Métodos: Foram avaliados clinicamente 71 pacientes HIV positivos sem antecedentes de doenças cardiovasculares, estratificados pelos escores Framingham 2008 e DAD reduzido e submetidos a avaliação de aterosclerose carotídea subclínica. A concordância entre os escores foi avaliada pelo índice Kappa e os valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: A idade média foi 47,2 e 53,5% do sexo masculino. A ocorrência de aterosclerose subclínica foi de 39,4%. A concordância entre os escores foi de 49% com Kappa de 0,735 nos pacientes de alto risco. Não houve diferença significativa entre os escores por meio de análise de discriminação com curva ROC. Dos pacientes com risco intermediário no Framingham e DAD reduzido, 62,5% e 30,8% respectivamente apresentavam aterosclerose carotídea. Conclusão: O presente estudo mostrou correlação entre os escores e espessamento médio-intimal e alta concordância entre os pacientes classificados como alto risco nos escores Framingham 2008 e DAD escore reduzido. A observação de alta prevalência de aterosclerose carotídea em pacientes de risco intermediário sugere que grande parte desses pacientes poderia ser reclassificada como alto risco.

Quality of life in individuals initiating antiretroviral therapy: a cohort study / Qualidade de vida em indivíduos iniciando a terapia antirretroviral: um estudo de coorte

ABSTRACT OBJECTIVE To assess longitudinally the change in quality of life in people living with HIV initiating antiretroviral therapy in three public reference services specialized in HIV care in Belo Horizonte, Brazil. METHODS Prospective cohort study among people living with HIV, aged 18 years or older, and initiating antiretroviral therapy. We obtained sociodemographic, behavioral, clinical data related to pharmacological treatment and to the service by face-to-face interviews, and supplemented these data with information from clinical records and Information Systems of the Brazilian HIV/AIDS Program. We measured the quality of life using the WHOQOL-HIV bref instrument, with a minimum interval of six months between the baseline and the follow-up interviews. We used paired t-test to assess the mean change in quality of life between the two interviewsand evaluated factors associated with this outcome using multiple linear regression. RESULTS The overall quality of life, as well as the physical, psychological, level of independence, environment and spiritual quality of life domains were statistically higher in people living with HIV using antiretroviral therapy at the end of the follow-up. Factors independently associated with the increase in quality of life were having religious belief and living with other people. Having signs or symptoms of anxiety and depression and the number of adverse drug reactions reported were predictors associated with worsening quality of life. CONCLUSIONS These results show an improvement in the quality of life over time in people living with HIV on antiretroviral therapy. They also highlight the need to monitor and provide health care support, especially for individuals with signs and symptoms of anxiety and depression and that report adverse reactions to medicines at the beginning of treatment.

RESUMO OBJETIVO Avaliar longitudinalmente a alteração da qualidade de vida em pessoas que vivem com HIV iniciando a terapia antirretroviral, atendidas em três serviços públicos de referência na assistência especializada ao HIV em Belo Horizonte. MÉTODOS Estudo de coorte prospectivo, com o acompanhamento de pessoas que vivem com HIV, com 18 anos de idade ou mais, e iniciando terapia antirretroviral. Dados sociodemográficos, comportamentais, clínicos, relacionados ao tratamento farmacológico e ao serviço foram obtidos por entrevistas, complementados com informações dos prontuários clínicos e dos sistemas de informação do Programa Brasileiro de HIV/AIDS. A qualidade de vida foi avaliada utilizando o instrumento WHOQOLHIV-bref, por meio de entrevista face a face, com intervalo mínimo de seis meses entre as entrevistas. A alteração média na qualidade de vida entre as duas entrevistas foi avaliada utilizando o teste t pareado. Os fatores associados foram avaliados por meio de regressão linear múltipla. RESULTADOS A qualidade de vida global, assim como a qualidade de vida nos domínios físico, psicológico, nível de independência, ambiente e espiritual foram estatisticamente melhores em pessoas que vivem com HIV usando terapia antirretroviral no final do tempo de acompanhamento. Fatores independentemente associados ao incremento na qualidade de vida foram possuir crença religiosa e morar com outras pessoas. Enquanto ter sinais ou sintomas de ansiedade e depressão e o número de reações adversas a medicamentos reportadas foram preditores associados à piora da qualidade de vida. CONCLUSÕES Os resultados evidenciam melhora na qualidade de vida em pessoas vivendo com HIV iniciando a terapia antirretroviral ao longo do tempo. Evidenciam ainda a necessidade de se acompanhar e prover cuidados de saúde, em especial para indivíduos com sinais e sintomas de ansiedade e depressão e que relatam reações adversas a medicamentos no início do tratamento.