Factors associated with mortality in HIV patients failing antiretroviral therapy, in Salvador, Brazil.

Highly active antiretroviral therapy (HAART) has significantly improved survival of people living with HIV/Aids (PLWHA). However, poor treatment adherence to HAART and other problems, still cause therapy failure and contribute to increased morbidity and mortality of PLWHA. In this retrospective cohort study (2013-2015), we sought to evaluate the factors associated with mortality of PLWHA failing HAART in 2013, who were receiving care at a reference center for sexually transmitted diseases (STD) and HIV/AIDS. A total of 165 individuals over 18 years of age who were failing antiretroviral therapy were evaluated. In two-year follow-up, 19 (11.5%) deaths were documented. There were a significant association between mortality and report of illicit drug use (53%, p < 0.01), being attended by a larger number of medical professionals (6.3 ±â€¯3.2, p = 0.02), use of firstline non-nucleoside reverse transcriptase inhibitor (74%, p = 0.01), and history of interrupting HAART ≥3 months (90%), p = 0.02). Patients who died had a significantly higher viral load (mean 49,192.4 ±â€¯35,783.6 copies/mL) than survivors (26,389.2 ±â€¯27,416 copies/mm3, p < 0.01), lower mean CD4 cell counts (127.8 ±â€¯145.6 cells/mm3 vs. 303.3 ±â€¯202.4 cells/mm3, p < 0.01), and higher frequency of previous virologic failure (89% vs. 74.7%, p < 0.01). Our results reinforce the importance of early detection and prevention of virologic failure, to reduce the mortality associated with this event.

Factors associated with mortality in HIV patients failing antiretroviral therapy, in Salvador, Brazil

ABSTRACT Highly active antiretroviral therapy (HAART) has significantly improved survival of people living with HIV/Aids (PLWHA). However, poor treatment adherence to HAART and other problems, still cause therapy failure and contribute to increased morbidity and mortality of PLWHA. In this retrospective cohort study (2013-2015), we sought to evaluate the factors associated with mortality of PLWHA failing HAART in 2013, who were receiving care at a reference center for sexually transmitted diseases (STD) and HIV/AIDS. A total of 165 individuals over 18 years of age who were failing antiretroviral therapy were evaluated. In two-year follow-up, 19 (11.5%) deaths were documented. There were a significant association between mortality and report of illicit drug use (53%, p < 0.01), being attended by a larger number of medical professionals (6.3 ± 3.2, p = 0.02), use of firstline non-nucleoside reverse transcriptase inhibitor (74%, p = 0.01), and history of interrupting HAART ≥3 months (90%), p = 0.02). Patients who died had a significantly higher viral load (mean 49,192.4 ± 35,783.6 copies/mL) than survivors (26,389.2 ± 27,416 copies/mm3, p < 0.01), lower mean CD4 cell counts (127.8 ± 145.6 cells/mm3 vs. 303.3 ± 202.4 cells/mm3, p < 0.01), and higher frequency of previous virologic failure (89% vs. 74.7%, p < 0.01). Our results reinforce the importance of early detection and prevention of virologic failure, to reduce the mortality associated with this event.

Tuberculosis incidence among people living with HIV/AIDS with virological failure of antiretroviral therapy in Salvador, Bahia, Brazil

Abstract Antiretroviral therapy for HIV has led to increased survival of HIV-infected patients. However, tuberculosis remains the leading opportunistic infection and cause of death among people living with HIV/AIDS. Tuberculosis has been shown to be a good predictor of virological failure in this group. This study aimed to evaluate the incidence of tuberculosis and its consequences among individuals diagnosed with virological failure of HIV. This was a retrospective cohort study involving people living with HIV/AIDS being followed-up in an AIDS reference center in Salvador, Bahia, Brazil. Individuals older than 18 years with HIV infection on antiretroviral therapy for at least six months, diagnosed with virological failure (HIV-RNA greater than or equal to 1000 copies/mL), from January to December 2013 were included. Tuberculosis was diagnosed according to the criteria of the Brazilian Society of Pneumology. Fourteen out of 165 (8.5%) patients developed tuberculosis within two years of follow-up (incidence density = 4.1 patient-years). Death was directly related to tuberculosis in 6/14 (42.9%). A high incidence and tuberculosis-related mortality was observed among patients with virological failure. Diagnosis of and prophylaxis for tuberculosis in high-incidence countries such as Brazil is critical to decrease morbidity and mortality in people living with HIV/AIDS.

Tuberculosis incidence among people living with HIV/AIDS with virological failure of antiretroviral therapy in Salvador, Bahia, Brazil.

Antiretroviral therapy for HIV has led to increased survival of HIV-infected patients. However, tuberculosis remains the leading opportunistic infection and cause of death among people living with HIV/AIDS. Tuberculosis has been shown to be a good predictor of virological failure in this group. This study aimed to evaluate the incidence of tuberculosis and its consequences among individuals diagnosed with virological failure of HIV. This was a retrospective cohort study involving people living with HIV/AIDS being followed-up in an AIDS reference center in Salvador, Bahia, Brazil. Individuals older than 18 years with HIV infection on antiretroviral therapy for at least six months, diagnosed with virological failure (HIV-RNA greater than or equal to 1000copies/mL), from January to December 2013 were included. Tuberculosis was diagnosed according to the criteria of the Brazilian Society of Pneumology. Fourteen out of 165 (8.5%) patients developed tuberculosis within two years of follow-up (incidence density=4.1 patient-years). Death was directly related to tuberculosis in 6/14 (42.9%). A high incidence and tuberculosis-related mortality was observed among patients with virological failure. Diagnosis of and prophylaxis for tuberculosis in high-incidence countries such as Brazil is critical to decrease morbidity and mortality in people living with HIV/AIDS.

Evolução da mortalidade infantil e componentes neonatal e pós-neonatal, 1979-2002, em Feira de Santana, Bahia / The progression of neonatal and postnatal infant mortality in Feira de Santana, Bahia, in the period 1979-2002

O Coeficiente de Mortalidade Infantil tem sido considerado um bom indicador das condições de saúde infantil e nível socioeconômico de uma população. Objetivo: descrever a evolução da mortalidade infantil e componentes em Feira de Santana-BA, no período 1979-2002. Método: estudo de evolução temporal utilizando dados do Sistema de Informação de Mortalidade e população estimada de menores de um ano. Foram elaboradas curvas com dados brutos e cálculo direto da mortalidade infantil e componentes e evolução desses óbitos segundo grupos de causas. Resultados: verificou-se distribuição irregular dos óbitos infantis, com flutuações discrepantes que permitiram a definição de períodos distintos: 1979-1988 e 1989-2002; predominaram os óbitos pós-neonatais, como principal componente da mortalidade infantil; elevado percentual de óbitos por causas mal definidas. Conclusões: o padrão de distribuição dos óbitos infantis em Feira de Santana, no período estudado, a partir de dados do SIM, sugere problemas de captação, regularidade e qualidade de dados, apontando necessidade de avaliação da operacionalização desse Sistema, quanto ao gerenciamento e capacitação para aprimoramento na coleta, assim como a co-responsabilização dos profissionais de saúde e gestores públicos. Estas medidas podem subsidiar a formulação e implementação de políticas de saúde materno-infantil nos níveis regional e municipal.

Evolução da mortalidade por causas violentas em crianças e adolescentes, Feira de Santana, Brasil / The evolution of mortality caused by violence in children and adolescents in Feira de Santana, Brazil

Objetivo: avaliar a evolução da mortalidade por causas violentas nas faixas etárias de menores de 19 anos, em Feira de Santana. Materiais e métodos: estudo retrospectivo da mortalidade por causas violentas, no período de 1979-1999, utilizando como fonte de dados o Sistema de Informação de Nortalidade - SIM e população estimada por sexo e faixa etária, segundo os censos demográficos. Resultados: os "Demais Acidentes" constituíram o principal grupo de mortalidade por causas externas, apresentando tendência de declínio nas duas faixas etárias. No período do estudo, os Acidentes de Trânsito mostraram tendência de crescimento e ocupam o segundo posto entre as mortes por causas violentas nas duas faixas etárias. Os homicídios apresentaram seu maior coeficiente em 1997 (28,3 óbitos/100.000 hab), com aumento expressivo na faixa de 15 a 19 anos e aumento dos registros dessas mortes por arma de fogo, a partir de 1996. Conclusões: esses resultados apontam a necessidade de implementação de políticas públicas voltadas à prevenção dos Acidentes de Trânsito e Homicídios, garantindo segurança e vida para adolescentes, em Feira de Santana.