Association between long-term exposure to fine particulate matter and its chemical constituents and premature death in individuals living with HIV/AIDS.

Long-term exposure to fine particulate matter (PM2.5) is associated with an increased total mortality. However, the association of PM2.5 with mortality in people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS, PLWHA) and the relationship between its constituents and adverse outcomes remain unknown. In this cohort study, 28,140 PLWHA were recruited from the HIV/AIDS Comprehensive Response Information Management System of the Hubei Provincial Centre for Disease Control and Prevention in China between 2001 and 2020. The annual PM2.5 chemical composition data, including sulfate (SO42-), nitrate (NO3-), ammonium (NH4+), black carbon (BC), and organic matter (OM), was extracted from the Tracking Air Pollution (TAP) dataset in China. A Cox proportional hazard model with time-varying exposure and time-to-event quantile-based generalized (g) computation was used to assess the associations between PM2.5 chemical constituents, and mortality in PLWHA. A multivariate Cox proportional hazard model estimated an excess hazard ratio (eHR) of 0.32% [95% confidence interval (CI): (0.01%, 0.64%)] for AIDS-related death (ARD), associated with 1 µg/m3 rise in PM2.5 exposure. An increase of 1 µg/m3 in NH4+ was associated with 5.13% [95% CI: (2.89%, 7.43%)] and 2.97% [95% CI: (1.52%, 4.44%)] increase in the risk of ARD and all-cause deaths (ACD), respectively. When estimated using survival-based quantile g-computation, the eHR for ARD with a joint change in a decile increase in all five components was 6.10% [95% CI: 3.77%, 8.48%)]. Long-term exposure to PM2.5 chemical composition, particularly NH4+ increased the risk of death in PLWHA. This study provides epidemiological evidence that SO42- and NH4+ increased the risk of ARD and that NH4+ increased the risk of ACD in PLWHA. Multi-constituent analyses further suggested that NH4+ may be a key component in increasing the risk of premature death in patients with HIV/AIDS. Individuals aged ≥65 with HIV/AIDS are more vulnerable to SO42-, and consequent ACD.

The impact of HIV/AIDS on marriage in the early years of the epidemic.

The advent of the HIV/AIDS crisis transformed the desirability of committed heterosexual relationships. This paper employs a difference-in-differences approach to investigate the impact of the HIV/AIDS crisis on marriage rates. By using HIV/AIDS death rates as a proxy for HIV incidence, the study exploits county-level variations in HIV/AIDS mortality and finds that counties with higher HIV/AIDS death rates experienced larger gains in marriage rates in the early years of the epidemic. Estimates suggest that the virus increased marriage rates by approximately 0.9% in the early years of the virus (1981-1988).

Dynamic Linkages among HIV/AIDS, Health Expenditures, Environmental Degradation, Life Expectancy, and Economic Growth: A Case of Eastern Africa Countries.

BACKGROUND: Eastern African countries are among the countries with a very high HIV/AIDS prevalence rate. High HIV/AIDS prevalence is a problem that has a detrimental effect on the economic development of these countries. Previous studies have generally examined the relationship of HIV/AIDS with life expectancy or economic growth. In this study, three different models have been established and the relationship of HIV/AIDS with economic growth, health expenditures, and life expectancy has been analyzed, and current econometric methods and policy recommendations have been developed according to the results. OBJECTIVE: The aim of this study was to investigate the relationship between health expenditure, environmental degradation, life expectancy, HIV/AIDS, and economic growth. METHOD: Annual data from 9 Eastern African countries for the period of 2000-2019 were used. Panel ARDL/PMG and Dumitrescu-Hurlin methods were used. RESULTS: HIV/AIDS negatively affects economic growth and life expectancy, and positively affects health expenditures. According to the causality results, HIV/AIDS is the cause of economic growth. In addition, a bidirectional causal relationship has been found between HIV/AIDS and life expectancy. CONCLUSION: The main conclusion of the study is that HIV/AIDS plays a negative role in economic growth and life expectancy. Further steps must be taken to prevent the further spread of HIV/AIDS, which causes these factors to affect the well-being of the countries.

Boletim epidemiológico: situação epidemiológica do HIV/Aids no Estado de Goiás, 2018 a 2023 / Epidemiological bulletin: epidemiological situation of HIV/AIDS in the State of Goiás, 2018 to 2023

A síndrome da imunodeficiência adquirida (SIDA) denomina o conjunto de sintomas e infecções resultantes dos danos causados ao sistema imunológico pelo vírus da imunodeficiência humana (HIV). Nesse boletim é demonstrado a epidemiologia da infecção por HIV/Aids na população residente em Goiás conforme ano de notificação e diagnóstico laboratorial com uma análise descritiva dos dados obtidos do Sistema de Informação de Agravos de Notificação - SINAN, Sistema de Informação de Mortalidade - SIM, e Sistema de Informação de Nascidos Vivos - SINASC, no período de janeiro de 2018 a novembro de 2023,diagnosticados e notificados por município de residência pelos serviços de saúde do Estado de Goiás

Acquired immunodeficiency syndrome (AIDS) refers to the set of symptoms and infections resulting from damage caused to the immune system by the human immunodeficiency virus (HIV). This bulletin demonstrates the epidemiology of HIV/AIDS infection in the population residing in Goiás according to year of notification and laboratory diagnosis with a descriptive analysis of data obtained from the Notifiable Diseases Information System - SINAN, Mortality Information System - SIM, and Live Birth Information System - SINASC, from January 2018 to November 2023, diagnosed and notified by municipality of residence by the health services of the State of Goiás

Agreement between cause of death assignment by computer-coded verbal autopsy methods and physician coding of verbal autopsy interviews in South Africa.

BACKGROUND: The South African national cause of death validation (NCODV 2017/18) project collected a national sample of verbal autopsies (VA) with cause of death (COD) assignment by physician-coded VA (PCVA) and computer-coded VA (CCVA). OBJECTIVE: The performance of three CCVA algorithms (InterVA-5, InSilicoVA and Tariff 2.0) in assigning a COD was compared with PCVA (reference standard). METHODS: Seven performance metrics assessed individual and population level agreement of COD assignment by age, sex and place of death subgroups. Positive predictive value (PPV), sensitivity, overall agreement, kappa, and chance corrected concordance (CCC) assessed individual level agreement. Cause-specific mortality fraction (CSMF) accuracy and Spearman's rank correlation assessed population level agreement. RESULTS: A total of 5386 VA records were analysed. PCVA and CCVAs all identified HIV/AIDS as the leading COD. CCVA PPV and sensitivity, based on confidence intervals, were comparable except for HIV/AIDS, TB, maternal, diabetes mellitus, other cancers, and some injuries. CCVAs performed well for identifying perinatal deaths, road traffic accidents, suicide and homicide but poorly for pneumonia, other infectious diseases and renal failure. Overall agreement between CCVAs and PCVA for the top single cause (48.2-51.6) indicated comparable weak agreement between methods. Overall agreement, for the top three causes showed moderate agreement for InterVA (70.9) and InSilicoVA (73.8). Agreement based on kappa (-0.05-0.49)and CCC (0.06-0.43) was weak to none for all algorithms and groups. CCVAs had moderate to strong agreement for CSMF accuracy, with InterVA-5 highest for neonates (0.90), Tariff 2.0 highest for adults (0.89) and males (0.84), and InSilicoVA highest for females (0.88), elders (0.83) and out-of-facility deaths (0.85). Rank correlation indicated moderate agreement for adults (0.75-0.79). CONCLUSIONS: Whilst CCVAs identified HIV/AIDS as the leading COD, consistent with PCVA, there is scope for improving the algorithms for use in South Africa.

Analysis of the implementation of an AIDS mortality committee through municipal health indicators / Análise da implantação de um comitê de mortalidade por AIDS mediante indicadores de saúde municipais / Análisis de la implantación de un comité de mortalidad por SIDA a través de indicadores municipales de salud

Background and objective: the acquired immunodeficiency syndrome (AIDS) has high rates of detection and death in the state of Rio Grande do Sul. In order to better understand such deaths, in December 2017, the Uruguaiana Municipal Department of Health implemented the AIDS Mortality Committee (CMaids). This study aimed to analyze the impact of an CMaids implementation in Uruguaiana through municipal health indicators. Methods: an ecological time-series study that used secondary data from the official platforms of the Ministry of Health from 2008 to 2020. Results: a reduction in the indicators number of deaths (from 28 in 2008 to 9 in 2020), mortality rate (from 22.0 in 2008 to 7.1 deaths/100,000 inhabitants in 2020), and fatality rate (from 46.74 in 2008 to 9.61 deaths/1,000 inhabitants in 2020) was observed. Moreover, trend lines were verified between 2017-2020 through the logarithmic regression model with join points. A relevant Annual Percent Change in mortality and fatality indicators was verified, with a reduction of 59.1% and 73.4%, respectively, in 2020, when comparing the observed and expected values. Conclusion: the findings enable us to conjecture that CMaids contributed to health indicator improvement, evidencing this as a relevant strategy to handle HIV/AIDS endemic at the local level.(AU)

Justificativa e objetivo: a síndrome da imunodeficiência adquirida (aids) apresenta elevadas taxas de detecção e óbito no estado do Rio Grande do Sul. A fim de compreender melhor tais óbitos, em dezembro de 2017, a Secretaria Municipal de Saúde de Uruguaiana implementou o Comitê de Mortalidade por aids (CMaids). O objetivo deste estudo é analisar o impacto da implantação do CMaids de Uruguaiana por meio de indicadores de saúde municipais. Métodos: estudo ecológico de série temporal, utilizando dados secundários das plataformas oficiais do Ministério da Saúde entre o período de 2008 a 2020. Resultados: observou-se redução dos indicadores número de óbitos (de 28 em 2008 para 9 em 2020), taxa de mortalidade (de 22,0 em 2008 para 7,1 óbitos/100.000 habitantes em 2020) e taxa de letalidade (de 46,74 em 2008 para 9,61 óbitos/1.000 habitantes em 2020). Ainda, verificaram-se linhas de tendência entre 2017-2020 por meio do modelo de regressão logarítmica com pontos de junção. Averiguou-se relevante mudança percentual anual nos indicadores de mortalidade e letalidade, com redução de 59,1% e 73,4%, respectivamente, em 2020, ao comparar-se o valor observado e o esperado. Conclusão: os achados permitem conjecturar que o CMaids contribuiu para melhorias dos indicadores de saúde, evidenciando essa como uma estratégia relevante para o enfrentamento do HIV/aids em nível local.(AU)

Justificación y objetivo: el síndrome de inmunodeficiencia adquirida (sida) presenta altas tasas de detección y muerte en el estado de Rio Grande do Sul. Para entender mejor esas muertes, en diciembre de 2017, la Secretaría Municipal de Salud de Uruguaiana implementó el Comité de Mortalidad por SIDA (CMaids). El objetivo de este estudio es analizar el impacto de la implementación del CMaids de Uruguaiana a través de los indicadores de salud municipales. Métodos: estudio ecológico de series temporales, utilizando datos secundarios de las plataformas oficiales del Ministerio de Salud desde 2008 hasta 2020. Resultados: se observó la reducción de los indicadores de número de óbitos (de 28 en 2008 a 9 en 2020), tasa de mortalidad (de 22,0 en 2008 a 7,1 muertes/100.000 habitantes en 2020) y tasa de letalidad (de 46,74 en 2008 a 9,61 muertes/1.000 habitantes en 2020). Además, se verificaron líneas de tendencia entre 2017-2020 a través del modelo de regresión logarítmica con puntos de unión. Se verificó un cambio porcentual anual relevante en los indicadores de mortalidad y letalidad, con una reducción de 59,1% y 73,4%, respectivamente, en 2020, al comparar los valores observados y esperados. Conclusión: los resultados permiten conjeturar que el CMaids contribuye a mejorar los indicadores de salud, evidenciando que es una estrategia relevante para la lucha contra el VIH/SIDA a nivel local.(AU)

TB-related deaths among adults in Guinea-Bissau.

SETTING: In an urban demographic, high TB burden surveillance site in Guinea-Bissau, most deaths occur at home, and information on cause of death (CoD) is lacking.OBJECTIVE: To examine CoD and the proportion of TB deaths in three groups: among patients examined for TB without a verified diagnosis after diagnostic workup, described as "assumed TB-negative" (aTBneg), among patients with a confirmed diagnosis of TB and in a sample of the background population.DESIGN: Verbal autopsies (VAs) were obtained for registered deaths occurring between 1 January 2010 and 15 June 2016. All deaths among aTBneg and patients with TB, and a sample of deaths in the background population were included.RESULTS: VAs were obtained from 104/112 aTBneg patients, 140/155 patients with TB, and 172/219 from the general population. The leading CoD was TB in respectively 20%, 69% and 9% of the cohorts. HIV/AIDS-related deaths were the most frequent CoD among aTBneg patients (45%) and in the background population (27%), and accounted for 9% of patients with TB.CONCLUSION: TB was shown to be a frequent CoD, not only among patients diagnosed with TB, but also among aTBneg patients and the background population. This indicates a low TB case detection rate.

Análise da tendência da mortalidade por doenças definidoras e não definidoras de HIV/aids segundo características sociodemográficas, por Unidade da Federação e Brasil, 2000-2018 / Análisis de las tendencias de mortalidad por enfermedades definitorias y no definitorias de VIH/SIDA, según características sociodemográficas por Unidad de la Federación y Brasil, 2000-2018 / Analysis of trend in mortality due to HIV/AIDS-defining and non-HIV/AIDS defining illnesses according to sociodemographic characteristics, by Federative Unit and Brazil, 2000-2018

Objetivo: Analisar a tendência temporal da taxa mortalidade por doenças definidoras e não definidoras de HIV/aids no Brasil entre 2000 e 2018. Métodos: Estudo ecológico de série temporal, com dados do Sistema de Informações sobre Mortalidade, no Brasil e Unidades da Federação. Utilizou-se a regressão de Prais-Winsten para a análise de tendências, de acordo com taxa de mortalidade geral, sexo, faixa etária, estado civil e raça/cor da pele. Resultados: Foram registrados 237.435 óbitos no período. No país, as doenças definidoras apresentaram taxas mais elevadas (7,4 a 4,4 óbitos/100 mil habitantes no período) que as observadas entre as não definidoras (0,4 a 0,8 óbito/100 mil hab. no período). A mortalidade geral por doenças definidoras foi decrescente (-6,3%; IC95% -8,8;-3,8); e por doenças não definidoras, crescente (11,0%; IC95% 6,5;15,7). Conclusão: Houve mudança no perfil de mortalidade por HIV/aids no decorrer dos anos observados, verificando-se decréscimo de óbitos por doenças definidoras de HIV/aids.

Objetivo: Analizar la tendencia temporal de la tasa de mortalidad por enfermedades definitorias y no definitorias de VIH/SIDA en Brasil entre 2000 y 2018. Métodos: Estudio de serie temporal ecológica con datos del Sistema de Información de Mortalidad de Brasil y Unidades de la Federación. Se utilizó la regresión de Prais-Winsten para analizar las tendencias según tasa de mortalidad general, sexo, grupo de edad, estado civil y raza/color. Resultados: Se registraron 237.435 muertes en el período. En el país, las enfermedades definitorias presentaron tasas superiores (7,4 a 4,4 óbitos/100 mil habitantes en el período) que las observadas entre las enfermedades no definitorias (0,4 a 0,8 óbito/100 mil habitantes en el período). La mortalidad general por enfermedades definitorias estaba disminuyendo (-6,3%; IC95% -8,8;-3,8) y para las enfermedades no definitorias estaba aumentando (11,0%; IC95% 6,5;-15,7). Conclusión: Hubo un cambio en el perfil de mortalidad por VIH/SIDA a lo largo de los años, con una disminución en las muertes por enfermedades definitorias de VIH/SIDA.

Objective: To analyze the temporal trend of mortality rate due to HIV/AIDS defining and non-HIV/AIDS defining illnesses in Brazil between 2000 and 2018. Methods: This was an ecological time series study, using data from the Mortality Information System, in Brazil and the Federative Units. Trend analysis was performed by means of Prais-Winsten regression model, according to overall mortality rate, sex, age group, marital status and race/skin color. Results: A total of 237,435 deaths were recorded in the period. In the country, defining illnesses showed higher rates (7.4 to 4.4 deaths/100,000 inhabitants in the period) than those observed among non-defining diseases (0.4 to 0.8 death/100,000 inhabitants in the period). It could be seen a decrease in overall mortality due to defining diseases (-6.3%; 95%CI -8.8;-3.8); while it increased due to non-defining diseases (11.0%; 95%CI 6.5;15.7). Conclusion: There was a change in HIV/AIDS mortality profile over the years, with a decrease in deaths due to HIV/AIDS-defining diseases.

Anos potenciais de vida perdidos por aids no sexo feminino, no Sul do Brasil: estudo descritivo, 2007-2017 / Años potenciales de vida perdidos por sida en el sexo femenino, del Sur de Brasil: un estudio descriptivo, 2007-2017 / Years of potential life lost due to AIDS in female, in Southern Brazil: a descriptive study, 2007-2017

Objetivo: descrever os anos potenciais de vida perdidos (APVPs) por aids na população do sexo feminino e analisar sua associação com raça/cor da pele e indicadores de vulnerabilidade social em Porto Alegre/RS, Brasil. Métodos: estudo descritivo, considerando-se os óbitos do sexo feminino por aids em 2007-2017; os dados foram obtidos no banco do Sistema de Informações sobre Mortalidade; foram calculados valores brutos e taxas de APVPs por 1 mil óbitos, considerando-se os distritos sanitários e a raça/cor da pele. Resultados: entre 1.539 óbitos, foram estimados cerca de 51 mil anos potenciais de vida, representando 86,5 anos perdidos/1 mil pessoas do sexo feminino; identificou-se maior proporção de óbitos naquelas de raça/cor da pele branca (53,4%); porém, maior taxa de APVPs ocorreu para as de raça/cor da pele preta/parda residentes em regiões de maior vulnerabilidade. Conclusão: os resultados sugerem o impacto de desigualdades raciais na diminuição dos anos potenciais de vida, em função do óbito por aids.

Objetivo: describir los años potenciales de vida perdidos (APVP) por SIDA en la población femenina y analizar la asociación con raza/color e indicadores de vulnerabilidad social en Porto Alegre/RS, Brasil. Métodos: estudio descriptivo considerando muertes por SIDA en el sexo femenino entre 2007 y 2017; los datos se obtuvieron de la base de datos del sistema de información de mortalidad; los valores brutos y las tasas de APVP por cada 1 mil muertes se calcularon considerando los distritos de salud y la raza/color de piel. Resultados: entre 1.539 muertes, se perdieron 51.000 años potenciales de vida, lo que representa 86,5 años perdidos por cada 1 mil personas del sexo femenino; se identificó una mayor proporción de muertes para la raza blanca/color de piel (53,4%), pero una mayor tasa de APVP entre las negras que viven en regiones de mayor vulnerabilidad. Conclusión: los resultados sugieren el impacto de las desigualdades raciales en la reducción de los años potenciales de vida, por muerte por SIDA.

Objective: to describe the years of potential life lost (YPLL) due to AIDS among the female population and analyze its association with race/skin color and social vulnerability indicators in Porto Alegre, capital city of the state of Rio Grande do Sul, Brazil. Methods: this was a descriptive study that took into consideration AIDS deaths in female between 2007 and 2017; data were obtained from the Mortality Information System; crude values and YPLL rates per 1,000 deaths were calculated, taking into consideration health districts and race/skin color. Results: of the 1,539 deaths, approximately 51,000 years of potential life were estimated, representing 86.5 years lost/1,000 female; it could be seen a higher proportion of deaths among female of White race/ skin color (53.4%); however, a higher rate of YPLL was found among female of Black and mixed race/skin color living in regions of greater vulnerability. Conclusion: the results suggest the impact of racial inequalities on the decrease in years of potential life due to AIDS deaths.

Fatores associados ao óbito por tuberculose e HIV/aids em presídios: revisão integrativa / Factores asociados al fallecimiento por tuberculosis y VIH/sida en cárceles: revisión integradora / Factors associated with death from tuberculosis and HIV/aids in prisons: integrative review

Resumo Objetivo Analisar o perfil epidemiológico e os fatores associados ao óbito por tuberculose e HIV/aids no sistema prisional. Métodos Revisão integrativa, realizada em julho de 2020, cuja pergunta de estudo e palavras-chave foram delineadas por meio da estratégia PEO. As buscas foram realizadas nas bases de dados MEDLINE, CINAHL, Scopus, ASP, SocINDEX, Embase e LILACS. A seleção de estudos e a extração dos dados foram feitas por dois revisores independentes. A avaliação da qualidade metodológica dos artigos incluídos na revisão foi conduzida com a utilização de instrumentos específicos propostos pelo Joanna Briggs Institute. Resultados Foram recuperados 1.329 estudos, dos quais quatro foram incluídos na revisão. O perfil epidemiológico e os fatores associados ao óbito por tuberculose no sistema prisional contemplaram as seguintes variáveis: idade ≥ 43 anos, analfabetos ou baixa escolaridade, concomitância de tuberculose pulmonar e extrapulmonar, não realização de tratamento diretamente observado e histórico de abuso de álcool. Quanto ao óbito por HIV e aids, destacaram-se o sexo masculino, média de idade de 34 anos, solteiros, raça/cor preta e hispânica, uso de drogas e aprisionamento prolongado, infecção avançada e início recente de terapia antirretroviral. Conclusão O perfil epidemiológico e os fatores associados ao óbito pela tuberculose e pelo HIV/aids no sistema prisional mostram a necessidade de uma estratificação de risco com abordagem continuada e integral da assistência prestada à população afetada por tais condições de saúde.

Resumen Objetivo Analizar el perfil epidemiológico y los factores asociados al fallecimiento por tuberculosis y por VIH/sida en el sistema penitenciario. Métodos Revisión integradora, realizada en julio de 2020, cuya pregunta de estudio y palabras clave fueron definidas por medio de la estrategia PEO. Las búsquedas fueron realizadas en las bases de datos MEDLINE, CINAHL, Scopus, ASP, SocINDEX, Embase y LILACS. La selección de estudios y la extracción de datos fueron llevadas a cabo por dos revisores independientes. La evaluación de calidad metodológica de los artículos incluidos en la revisión fue realizada con la utilización de instrumentos específicos propuestos por el Joanna Briggs Institute. Resultados Fueron recuperados 1.329 estudios, de los cuales cuatro fueron incluidos en la revisión. El perfil epidemiológico y los factores asociados al fallecimiento por tuberculosis en el sistema penitenciario contemplaron las siguientes variables: edad ≥ 43 años, analfabetos o escolaridad baja, concomitancia de tuberculosis pulmonar y extrapulmonar, no realización de tratamiento directamente observado e historial de exceso de alcohol. Respecto al fallecimiento por VIH y sida, las variables destacadas fueron el sexo masculino, edad promedio de 34 años, solteros, raza/color negro e hispánico, uso de drogas y encarcelación prolongada, infección avanzada e inicio reciente de tratamiento antirretroviral. Conclusión El perfil epidemiológico y los factores asociados al fallecimiento por tuberculosis y por VIH/sida en el sistema penitenciario demuestran la necesidad de una estratificación de riesgo con un enfoque continuo e integral de la atención brindada a la población afectada por tales condiciones de salud.

Abstract Objective Analyze the epidemiological profile and the factors associated with death from tuberculosis and HIV/aids in the prison system. Methods Integrative review, conducted in July 2020, whose research question and keywords were outlined through the PEO strategy. The searches were undertaken in the MEDLINE, CINAHL, Scopus, ASP, SocINDEX, Embase and LILACS databases. Two independent reviewers selected the studies and extracted the data. To assess the methodological quality of the articles included in the review, specific tools proposed by the Joanna Briggs Institute were used. Results 1,329 studies were retrieved, four of which were included in the review. The epidemiological profile and factors associated with death from tuberculosis in the prison system included the following variables: age ≥ 43 years, illiterate or low education level, concomitant pulmonary and extrapulmonary tuberculosis, non-performance of directly observed treatment and history of alcohol abuse. As for death from HIV and aids, males, mean age of 34 years, singles, black and Hispanic race/color, drug use and prolonged imprisonment, advanced infection and recent initiation of antiretroviral therapy stood out. Conclusion The epidemiological profile and the factors associated with death from tuberculosis and HIV/aids in the prison system show the need for a risk stratification with a continuous and comprehensive approach to the care provided to the population affected by these health conditions.

Perfil epidemiológico HIV/AIDS no estado do piauí em 2019 / Epidemiological Profile HIV/AIDS In The Piauí State In 2019 / Perfil Epidemiológico VIH/SIDA En El Estado Piauí En 2019

Introdução:O vírus da imunodeficiência Humana e a Síndrome daImunodeficiência Adquirida (HIV/Aids) ainda é expressivamente presente em grupos que sofrem de vulnerabilidades sociais, sendo umdesafio ainda não superado, principalmente no que diz respeito ao desempenho de ações de saúde e por parte dos gestores no sentidoda realização de prevenções amplas, baseadas nos contextos epidemiológicos das comunidades, cabendo também considerar os problemasde estrutura da rede de saúde para com o manejo diagnóstico, contextos de desigualdade e gênero que são as principais influencias para o desenvolvimento da doença.Objetivo:observar por meio de indicadores o panorama da situação do HIV/Aids no Piauí no ano de 2019. Metodologia:Estudo epidemiológico realizado através da plataforma do Departamento de informática do Sistema Único de Saúde. Foram consultadosdados referentes ao período de 2019do Estado do Piauí. Utilizou-se os indicadores de incidência, sexo, raça/cor, faixa etária, escolaridade e exposição, com foco nas taxas de incidência, óbitos e letalidade. Os dados foram agrupados e tabulados por meio dos programas Excel e Tabwin, utilizandoo método de análise a técnica de percentagem.Resultados:No período vigente, o Estado apresentou 207 novos casos. A incidência foi de 6,32/100.000 habitantes, tendo maior detecção parao público masculino (73,91%), faixa etária de 30-39 anos, maior predominância da população parda, escolaridade de ensino médio completo e heterossexuais. Quanto a mortalidade, foram notificados134 óbitos por HIV, predominante para o sexo masculino. A Letalidade mostrou que 65% foram realmente afetadas pela doença.Conclusões:O perfil epidemiológico dos casos de HIV/Aids no Piauí foi caracterizado pela prevalência emdeterminados grupos, demonstrando que apesar da existência de políticas públicas que buscam a prevenção da doença, essa realidade ainda é presente nos dias atuais. Ressalta-se a importância da realização de estudos epidemiológicos para comparação e analise situacionais futuras (AU).

Introduction:The Human Immunodeficiency Virus and the Acquired Immunodeficiency Syndrome (HIV/Aids) is still significantly present in groups that suffer from social vulnerabilities, being a challenge that has not yet been overcome, especially with regard to the performance of health actions and by the managers in the sense of carrying out comprehensive prevention, based on the epidemiological contexts of the communities, and it is also necessary to consider the problems of the structure of the health network in terms of diagnostic management, contexts of inequality and gender, which are the main influences on the development of the disease. Objective: observe through indicators the panorama of the situation of HIV/Aidsin Piauí in theyear 2019. Methodology:Epidemiological study carried out through the platform of the Information Technology Department of the Unified Health System. Data for the period 2019 in the State of Piauí were consulted. Indicators of incidence, sex, race/color, age, education and exposure were used, focusing on incidence rates, deaths and lethality. Data were grouped and tabulated using Excel and Tabwin programs, using the method of analysis and the percentage technique. Results: In the current period, the State presented 207 new cases. The incidence was 6.32/100,000 inhabitants, with greater detection for the male population (73.91%), age group 30-39 years, greater predominance of the brown population, complete high school education and heterosexuals. As for mortality, 134 deaths from HIV were reported, predominantly for males. Lethality showed that 65% were actually affected by the disease.Conclusions: The epidemiological profile of HIV/Aidscases in Piauí was characterized by the prevalence in certain groups, demonstrating that despite the existence of public policies that seek to prevent the disease, this reality is still present today. The importance of conducting epidemiological studies for future situational comparison and analysis is highlighted (AU).

Introducción: El Virus de la Inmunodeficiencia Humanael Síndrome de Inmunodeficiencia Adquirida (VIH/Sida) sigue estando presente de manera significativa en grupos que padecen vulnerabilidades sociales, siendo un desafío aún no superado, especialmente en lo que respecta al desempeño de las acciones de salud y por el gestores en el sentido de realizar una prevención integral, con base en los contextos epidemiológicos de las comunidades, y también es necesario considerar los problemas de la estructura de la red de salud en términos de gestión diagnóstica, contextos de desigualdad y género, que son los principales influencias en desarrollo deenfermedad. Objetivo: observar indicadores a través del panoramade situación del VIH/Sidaen Piauí en el año 2019. Metodología: Estudio epidemiológico realizado a través de la plataforma del Departamento de Tecnología de la Información del Sistema Único de Salud. Se consultó la fecha para el período 2019 enEstado de Piauí. Se utilizaron indicadores de incidencia, sexo, raza/color, edad, educación y exposición, centrándose en las tasas de incidencia, las muertes y letalidad. Los datos se agruparon, tabularon medianteprogramas Excel y Tabwin, utilizando método de análisis ytécnica de porcentaje. Resultados: Enperíodo actual, el Estado presentó 207 nuevos casos. La incidencia fue de 6,32/100.000 habitantes, con mayor detecciónpara población masculina (73,91%), grupo etario 30-39 años, mayor predominio de la población morena, bachillerato completo y heterosexuales. En cuantola mortalidad, se reportaron 134 muertes por VIH, predominantemente por males. La letalidad mostró que el 65% estaba realmente afectadopor enfermedad. Conclusiones: El perfil epidemiológico delos casos de VIH/Sida en Piauí se caracterizó porprevalencia de ciertos grupos, demostrando que a pesar de la existencia de políticas públicas que buscan prevenir la enfermedad, esta realidad sigue presenteen actualidad. Se destacaimportancia de realizar estudios epidemiológicos para futuros análisis y comparaciones situacionales (AU).

[Influencing factors on the death of HIV/AIDS patients treated with antiviral treatment in Butuo county, Liangshan Yi Autonomous Prefecture, 2010-2019].

Objective: To understand influencing factors on the deaths of HIV/AIDS patients receiving antireviral treatment in Butuo county of Liangshan Yi Autonomous Prefecture (Liangshan) from 2010 to 2019, to provide data for drug replacement and sustainable antiviral treatment strategy. Methods: A matched case-control study was used to collect basic and follow-up information on AIDS death patients receiving antiviral treatment in Butuo county of Liangshan from 2010 to 2019. The control group was formed by sampling twice the number of cases. The logistic regression model was used to analyze the risk factors affecting mortality. Results: In 3 355 patients of HIV/AIDS treated with antiviral therapy, 1 179 cases in the death group and 2 176 cases in the control group. Including 81.34% were 30-49 years old, 69.09％males, 99.55% Yi nationality, 91.12% were married or cohabitated, 95.77% had junior high school education or below, and 88.41% peasants. Amultivariate logistic stepwise regression model showed that among the death risk factors, age ≥50 years old was 5.08 times (95%CI:3.05-8.48) that of the 18-29, female was 0.70 times (95%CI: 0.52-0.94) than male, the transmission rate of intravenous drug use was 1.43 times (95%CI: 1.06-1.91) that of heterosexual transmission, CD4+T lymphocyte (CD4) count ≥350 cells/µl before treatment was 0.38 times (95%CI: 0.30-0.48) that of CD4 <200 cells/µl before treatment, the most recent antiviral treatment regimen containing LPV/r was 0.04 times (95%CI: 0.01-0.18) than that of stavudine (d4T) + lamivudine (3TC) + nevirapine (NVP)/efavirenz (EFV) regimen, drug resistance was 3.40 times (95%CI: 2.13-5.42) of non-drug resistance, non-viral load and non-drug resistance test results were 12.98 times (95%CI: 10.28-16.40) of non-drug resistance. Conclusions: Age, gender, transmission route, CD4 before treatment, the latest antiviral treatment program, and drug resistance test after antiviral therapy were the influencing factors of HIV/AIDS death in Butuo county. It is necessary to expand the coverage of viral load and drug resistance test to change the antiviral therapeutic schedule scientifically and carry out publicity and education on the compliance of patients with antiviral treatment and medical staff training in order to reduce the mortality of patients with antiviral treatment.

[Analysis on mortality in HIV/AIDS cases aged 15 years and older under antiretroviral treatment in Henan province, 2002-2019].

Objective: To analyze the mortality in HIV/AIDS cases aged ≥15 years under antiretroviral treatment (ART) in Henan province from 2002 to 2019, and provide evidence for reducing the mortality rate of HIV/AIDS and AIDS prevention and treatment. Methods: Data of HIV/AIDS cases aged ≥15 years who received ART in Henan from 2002 to 2019 were obtained from "Infectious Disease Surveillance System - Basic Information on AIDS Prevention and Control". In this retrospective study, Cox proportional risk model was used to analyze the influencing factors for HIV/AIDS related deaths. Software SPSS 23.0 was used for statistical analysis. Results: From 2002 to 2019, a total of 72 986 HIV/AIDS cases aged ≥15 years received ART, in whom, 16 634 died during this period. Most of the death cases were aged ≥40 years old (68.5%,11 393/16 634), males (62.6%,10 419/16 634), infected through blood-borne transmission (71.7%,11 927/16 634), and farmers or migrant workers (91.7%,15 249/16 634). Most of the deaths were due to AIDS related diseases (73.7%, 12 261/16 634), and the case fatality rate was 16.8% (12 261/72 986). A total of 34.6% (4 237/12 261) of HIV/AIDS cases died of AIDS-related diseases in the first year of ART, and the cumulative survival rates at 10 and 18 years of ART were 78.3% and 71.8%, respectively. The proportion of the HIV/AIDS cases with baseline CD4+T lymphocyte (CD4) counts <200 cells/µl at age 15 years when ART started was 45.5% (30 432/66 898). Cox proportional risk regression model showed that, compared with the cases with baseline CD4 counts ≥350 cells/µl, the risk of death was 1.78 times higher than in the cases with CD4 counts <200 cells/µl (95%CI: 1.64-1.94) and 1.24 times higher in the cases with CD4 counts ≥200 cells/µl (95%CI: 1.13-1.36), respectively. The risk of death in symptomatic cases at baseline survey was 1.25 times higher than that in asymptomatic cases (95%CI: 1.16-1.35). The cases with a latest viral load ≥1 000 copies/ml had 7.09 times higher risk of death than those with a last viral load<1 000 copies/ml (95%CI: 6.65-7.54). Conclusions: The majority of HIV/AIDS deaths occurred in the cases aged ≥15 years receiving ART in Henan province during 2002-2019, who were infected through blood-borne transmission and farmers/migrant workers, and AIDS-related diseases were the main causes of the deaths. With the gradual implementation of ART policy, the high survival rate in HIV/AIDS cases can be maintained for a long time in Henan. To reduce the case fatality rate and improve the quality of life of HIV/AIDS patients, CD4 counts test should be further strengthened and eligible HIV/AIDS patients should be covered by standard ART in a timely manner.

Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the "Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions".

OBJECTIVE: Chagas disease (CD) globalization facilitated the co-infection with Human Immunodeficiency Virus (HIV) in endemic and non-endemic areas. Considering the underestimation of Trypanosoma cruzi (T. cruzi)-HIV co-infection and the risk of life-threatening Chagas Disease Reactivation (CDR), this study aimed to analyze the major co-infection clinical characteristics and its mortality rates. METHODS: This is a cross-sectional retrospective multicenter study of patients with CD confirmed by two serological or one parasitological tests, and HIV infection confirmed by immunoblot. CDR was diagnosed by direct microscopy with detection of trypomastigote forms in the blood or other biological fluids and/or amastigote forms in inflammatory lesions. RESULTS: Out of 241 patients with co-infection, 86.7% were from Brazil, 47.5% had <200 CD4+ T cells/µL and median viral load was 17,000 copies/µL. Sixty CDR cases were observed. Death was more frequent in patients with reactivation and was mainly caused by CDR. Other causes of death unrelated to CDR were the manifestation of opportunistic infections in those with Acquired Immunodeficiency Syndrome. The time between the co-infection diagnosis to death was shorter in patients with CDR. Lower CD4+ cells count at co-infection diagnosis was independently associated with reactivation. Similarly, lower CD4+ cells numbers at co-infection diagnosis and male sex were associated with higher lethality in CDR. Additionally, CD4+ cells were lower in meningoencephalitis than in myocarditis and milder forms. CONCLUSION: This study showed major features on T. cruzi-HIV co-infection and highlighted the prognostic role of CD4+ cells for reactivation and mortality. Since lethality was high in meningoencephalitis and all untreated patients died shortly after the diagnosis, early diagnosis, immediate antiparasitic treatment, patient follow-up and epidemiological surveillance are essentials in T. cruzi/HIV co-infection and CDR managements.

AIDS-related deaths in Turkey between 2009 and 2018.

The prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is increasing day by day in the region, including Turkey. The study aimed to examine AIDS-related deaths in Turkey between 2009 and 2018 according to the national death registration system records. In this descriptive study, data on AIDS-related deaths were obtained from the Turkish Statistical Institute. The data consist of the cause of death codes, year of death, age and gender. Findings were presented using numbers and percentages. Seven hundred twenty-one AIDS-related deaths were reported in Turkey between 2009 and 2018. AIDS-related deaths in Turkey increased more than twice at the end of 10 years. The male/female death ratio is 4.5. Deaths under the age of 15 were 4.2% in total; however, they were increased to 10.2% in 2018. AIDS-related deaths are decreasing in the world but increasing in Turkey. The data from the Ministry of Health do not match the data of the national death registration system. Establishing a strong and accurate HIV/AIDS reporting system and identifying the causes and risk groups of this increase in AIDS-related deaths are critical.

Factors associated with prognostic or treatment outcomes in HIV/AIDS patients with and without hypertension in Eswatini.

Non-communicable diseases are increasing faster in HIV/AIDS patients than in the general population. We studied the association between hypertension and other possible confounding factors on viral load and CD4-cell counts in hypertensive and non-hypertensive HIV/AIDS patients receiving antiretroviral therapy (ART) at a large hospital in Eswatini over a 4-year period. We performed a retrospective longitudinal review of the medical records of 560 ART patients divided into non-hypertension and hypertension groups (n = 325 and n = 235) from July 27 to September 8, 2018. Generalized Estimated Equation was used to analyze the longitudinal data. Hypertensive patients were more likely to have improved CD4-cell counts than non-hypertensive patients (OR = 1.83, [1.37-2.44]). ART patients with hypertension were more likely to have detectable viral loads, though not significant (OR = 1.37 [0.77-2.43]). In non-hypertensive patients, second line ART was significantly associated with viral load (OR = 8.61 [2.93-25.34]) and adverse side effects (OR = 3.50 [1.06-11.54]), while isoniazid preventive therapy was significantly associated with CD4-cell counts (OR = 1.68 [1.16-2.45]). In hypertensive patients, factors associated with viral load were WHO HIV stage (OR = 2.84 [1.03-7.85]) and adherence (OR = 8.08 [1.33-49.04]). In both groups, CD4-cell counts significantly and steadily increased over time (p-value < 0.001). Results show a significant association between hypertension and CD4 cell counts but not viral load. In ART patients with and without hypertension, the factors associated with prognostic markers were different. More attention may need to be paid to ART patients with well controlled HIV status to monitoring and controlling of hypertension status.

Protocol for analysing the epidemiology of maternal mortality in Zimbabwe: A civil registration and vital statistics trend study.

BACKGROUND: Sub-Saharan Africa (SSA) carries the highest burden of maternal mortality, yet, the accurate maternal mortality ratios (MMR) are uncertain in most SSA countries. Measuring maternal mortality is challenging in this region, where civil registration and vital statistics (CRVS) systems are weak or non-existent. We describe a protocol designed to explore the use of CRVS to monitor maternal mortality in Zimbabwe-an SSA country. METHODS: In this study, we will collect deliveries and maternal death data from CRVS (government death registration records) and health facilities for 2007-2008 and 2018-2019 to compare MMRs and causes of death. We will code the causes of death using classifications in the maternal mortality version of the 10th revision to the international classification of diseases. We will compare the proportions of maternal deaths attributed to different causes between the two study periods. We will also analyse missingness and misclassification of maternal deaths in CRVS to assess the validity of their use to measure maternal mortality in Zimbabwe. DISCUSSION: This study will determine changes in MMR and causes of maternal mortality in Zimbabwe over a decade. It will show whether HIV, which was at its peak in 2007-2008, remains a significant cause of maternal deaths in Zimbabwe. The study will recommend measures to improve the quality of CRVS data for future use to monitor maternal mortality in Zimbabwe and other SSA countries of similar characteristics.