RESUMO
Viral and host factors are known to play a role in the different patterns of AIDS progression. The cocirculation of HIV-1 subtypes B, F1, BBR, and BF1; the occasional detection of HIV-1 subtype D; and an increasing prevalence of subtype C and other recombinant forms have been described in Rio de Janeiro, Brazil. The aim of this study was to evaluate the potential association of HIV-1 subtypes circulating among HIV-1+ individuals in Rio de Janeiro with AIDS disease progression. For this purpose, 246 HIV-1 individuals under clinical and laboratory follow-up from 1986 to 2011 were classified according to their progression to AIDS in typical progressors (n = 133), rapid progressors (n = 95), and long-term nonprogressors (n = 18). The env-gp120 region was amplified and sequenced. Neighbor-joining phylogenetic inferences were performed in Mega 6 and bootscan analysis was performed in Simplot 3.5.1. The Kaplan-Meier method and Cox modeling were performed to determine the time until an AIDS-defining event based on the HIV-1 subtypes/variants. Similar AIDS progression rates were observed among individuals infected with HIV-1 subtype B and variant BBR. However, a direct association between more rapid AIDS progression and HIV-1 subtypes, D and BF1, was confirmed in the multivariate analysis, corroborating previous results. Our findings contribute to the investigation of the possible influence of HIV-1 subtypes in AIDS outcome.
Assuntos
Síndrome da Imunodeficiência Adquirida/patologia , Síndrome da Imunodeficiência Adquirida/virologia , Progressão da Doença , Genótipo , HIV-1/classificação , HIV-1/genética , Adulto , Bioestatística , Brasil , Análise por Conglomerados , Feminino , Seguimentos , Proteína gp120 do Envelope de HIV/genética , HIV-1/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , Reação em Cadeia da Polimerase , Análise de Sequência de DNA , Adulto JovemRESUMO
Introdução: A política de prevenção e os avanços no tratamento dos indivíduos infectados pelo HIV contribuíram para uma desaceleração da transmissão e para aumento da sobrevida destes indivíduos, tornando a Aids uma doença mais crônica do que fatal. Conhecer os fatores que levam estes indivíduos a se internarem é importante para o planejamento das ações em saúde e para a prevenção de internações. Objetivos: Avaliar os principais fatores associados ao risco de internar pela primeira vez após 1ªsorologia positiva, por qualquer causa e pelas causas competitivas: doença definidora de Aids, doença não definidora, causas externas ou ainda a ocorrência de óbito seminternação. Método: Os pacientes HIV (+) do Instituto Nacional de Infectologia Evandro Chagas (INI/IPEC), diagnosticados entre 1996 e 2010, foram avaliados até2011. As funções do tempo decorrido do HIV(+) até a 1ª internação por qualquer causa foram descritas pelo método de Kaplan-Meier com as abordagens clássica (coorte fechada) e processo de contagem (coorte aberta) e até cada causa competitiva usando a função de incidência acumulada. A associação entre o tempo até a 1ª internação por qualquer causa e os fatores foi estimada com os modelos Weibull (coorte fechada) e Cox (coorte aberta e fechada). Na avaliação das internações por eventos competitivos de causa e óbito sem internação foi utilizada a modelagem da subdistribuição do risco. A qualidade e os resíduos dos modelos ajustados foram avaliados. A análise dos dados foi feita com o software R e as bibliotecas survival e mstate...
Introduction: The prevention politics and the advances in the treatment of HIVinfected individuals have contributed to a slower transmission and increased survival inthese individuals, making AIDS a more chronic disease than a fatal disease. To knowthe factors that lead these individuals to hospitalize is important for planning healthactions and to prevent hospitalizations. Objectives: To evaluate the main factorsassociated with the risk of the first hospitalization after 1st positive serology for anyreason and by competitive causes: AIDS-defining illness, illness-not AIDS-defining,external causes or the occurrence of death without hospitalization. Methods: Thepatients of the Instituto Nacional de Infectologia Evandro Chagas (INI / IPEC) withHIV (+), diagnosed between 1996 and 2010, were evaluated until 2011. The functionsof the elapsed time of HIV (+) until the 1st hospitalization for any cause were describedby Kaplan-Meier method with the classical approach (closed cohort) and with thecounting process (open cohort). And to analyze each competitive cause was used thefunction cumulative incidence. The association between time until the firsthospitalization for any cause and the factors was estimated with the Weibull model(closed cohort) and with the Cox model (open and closed cohort). In the assessment ofhospitalizations for competitive events of cause hospitalization and death withouthospitalization was used the modeling of the hazard subdistribution. The quality andresiduals of the adjusted models were evaluated. Data analysis was performed using theR software with survival and mstate libraries...
