Boletim epidemiológico: situação epidemiológica de HIV e aids em adultos no estado de Goiás, 2020 a 2024 / Epidemiological bulletin: epidemiological situation of HIV and AIDS in adults in the state of Goiás, 2020 to 2024

Boletim epidemiológico que apresenta informações sobre os casos de HIV no estado de Goiás e tem como objetivo descrever o perfil epidemiológico, tendências da infecção na população adulta entre os anos 2020 a 2024 e fornecer subsídios para a tomada de decisão, medidas de vigilância, prevenção e controle da infecção pelo HIV em sua quinta década de epidemia. Trata-se de um estudo descritivo, a partir dos dados obtidos do Sistema de Informação de Agravos de Notificação (SINAN) e Sistema de Informação de Mortalidade (SIM). Foram tabulados os dados: diagnosticados e notificados por HIV/Aids por município de residência

Epidemiological bulletin that presents information on HIV cases in the state of Goiás and aims to describe the epidemiological profile, infection trends in the adult population between the years 2020 and 2024 and provide support for decision-making, surveillance, prevention and control of HIV infection in its fifth decade of epidemic. This is a descriptive study, based on data obtained from the Notifiable Diseases Information System (SINAN) and the Mortality Information System (SIM). The data were tabulated: diagnosed and reported by HIV/AIDS by municipality of residence

AIDS mortality in Brazil, 2012-2022: a time series study.

BACKGROUND: Human immunodeficiency virus (HIV) infection is a health problem in Brazil and worldwide. Without treatment, the infection can progress to Acquired Immunodeficiency Syndrome (AIDS), with a high mortality potential. The objective of this study was to analyze the time trend of AIDS mortality in Brazil, macro-regions, federal units and their respective capitals, from 2012 to 2022. METHODS: This is a time-series study of all AIDS deaths in Brazil from 2012 to 2022. The study included the annual number of deaths and the crude and standardized mortality rates. The Joinpoint regression model was used for the time analysis of the standardized rates. Annual percentage change (APC) and average annual percentage change (AAPC) were calculated. A 95% confidence interval (CI) and a 5% significance level were used. RESULTS: During the period analyzed, 128,678 AIDS deaths were recorded in Brazil, with a crude mortality rate of 6.3/100,000 and a standardized mortality rate of 5.3/100,000. From 2012 to 2020, three regions showed a declining trend in AIDS mortality: Central-West (AAPC - 2.3%; 95%CI -4.3 to -0.21; p = 0.03), Southeast (AAPC - 5.6%; 95%CI -6.8 to -4.0; p < 0.001), and South (AAPC - 4.4%; 95%CI -5.27 to -3.6; p < 0.001). There was also a downward trend in 10 states and 10 capitals. There was an increase in the number of deaths from 2020 onwards in the North, Northeast and Southeast regions compared to 2019. CONCLUSION: There was a downward trend in AIDS mortality from 2012 to 2020 and an upward trend from 2020 to 2022. The regional differences observed could reflect the social disparities that exist in Brazil. In addition, the Covid-19 pandemic has had an impact on the process of dealing with HIV in Brazil.

Coinfections and In-Hospital Mortality in a Group of Patients With HIV/AIDS: A Longitudinal Study.

Human immunodeficiency virus (HIV) is a global public health problem. Coinfections in HIV patients are frequent complications that increase their mortality. The aim of this study was to assess coinfections and in-hospital mortality in a group of patients infected with HIV in Colombia. A retrospective longitudinal study was carried out. Patients treated in 4 highly complex clinics in Colombia between 2015 and 2023 were included. The cases were identified from International Classification of Diseases codes related to HIV. Sociodemographic, clinical, laboratory and pharmacological variables were collected. Descriptive, bivariate, and multivariable analyses were performed. Of the 249 patients identified, 79.1% were men, and the median age was 38.0 years. Approximately 81.1% had a diagnosis of acquired immune deficiency syndrome (AIDS). Coinfections caused by Mycobacterium tuberculosis (24.1%) and Treponema pallidum (20.5%) were the most frequent. A total of 20.5% of the patients had sepsis, 12.4% had septic shock, and the fatality rate was 15.7%. Antibiotics and antifungals were used in 88.8% and 53.8%, respectively, of the patients. Patients with a diagnosis of HIV before admission, those infected with M. tuberculosis, and those who presented with sepsis were more likely to die, whereas patients who received antiretroviral agent treatment before admission presented a lower risk. In this study, most HIV patients were in an advanced stage of the disease. Coinfection with M. tuberculosis was common and was associated with an increased risk of death. Previous HIV diagnosis and sepsis also increased the risk. Approximately half of the patients with a previous HIV diagnosis were receiving antiretroviral therapy and had a better prognosis.

The impact of primary health care on AIDS incidence and mortality: A cohort study of 3.4 million Brazilians.

BACKGROUND: Primary Health Care (PHC) is essential for effective, efficient, and more equitable health systems for all people, including those living with HIV/AIDS. This study evaluated the impact of the exposure to one of the largest community-based PHC programs in the world, the Brazilian Family Health Strategy (FHS), on AIDS incidence and mortality. METHODS AND FINDINGS: A retrospective cohort study carried out in Brazil from January 1, 2007 to December 31, 2015. We conducted an impact evaluation using a cohort of 3,435,068 ≥13 years low-income individuals who were members of the 100 Million Brazilians Cohort, linked to AIDS diagnoses and deaths registries. We evaluated the impact of FHS on AIDS incidence and mortality and compared outcomes between residents of municipalities with low or no FHS coverage (unexposed) with those in municipalities with 100% FHS coverage (exposed). We used multivariable Poisson regressions adjusted for all relevant municipal and individual-level demographic, socioeconomic, and contextual variables, and weighted with inverse probability of treatment weighting (IPTW). We also estimated the FHS impact by sex and age and performed a wide range of sensitivity and triangulation analyses; 100% FHS coverage was associated with lower AIDS incidence (rate ratio [RR]: 0.76, 95% CI: 0.68 to 0.84) and mortality (RR: 0.68, 95%CI: 0.56 to 0.82). FHS impact was similar between men and women, but was larger in people aged ≥35 years old both for incidence (RR: 0.62, 95% CI: 0.53 to 0.72) and mortality (RR: 0.56, 95% CI: 0.43 to 0.72). The absence of important confounding variables (e.g., sexual behavior) is a key limitation of this study. CONCLUSIONS: AIDS should be an avoidable outcome for most people living with HIV today and our study shows that FHS coverage could significantly reduce AIDS incidence and mortality among low-income populations in Brazil. Universal access to comprehensive healthcare through community-based PHC programs should be promoted to achieve the Sustainable Development Goals of ending AIDS by 2030.

Mortality trend due to HIV/AIDS among women in Porto Alegre/RS from 2007 to 2017 / Tendência de mortalidade por HIV/AIDS entre mulheres em Porto Alegre/RS de 2007 a 2017 / Tendencia de mortalidad por VIH/SIDA entre mujeres en Porto Alegre/RS de 2007 a 2017

Background and Objectives: Porto Alegre is among the state capitals of Brazil with the highest magnitude of epidemiological indicators in relation to people living with HIV/AIDS, impacting the mortality indicators of this population. This study aimed to analyze the temporal trend of deaths from HIV/AIDS in women residents of the city of Porto Alegre, Rio Grande do Sul, Brazil, from 2007 to 2017, considering age groups, skin color and education. Method: this is an ecological time series study on the trend of HIV/AIDS mortality rates among women living with HIV residents in the city of Porto Alegre, RS. Unadjusted and standardized mortality rates were calculated according to age group, skin color and education. For trend analysis, Prais-Winsten generalized linear regression was used. Results: 1,603 deaths related to HIV/AIDS were identified in women living in the city during the study period. Mortality coefficients were higher in white, less educated women, with an increasing trend among those over 60 years of age (95%CI 0.044; 0.029) with a decline for those in the age group between 20 and 29 (95%CI - 0.566; - 0.120). Conclusion: changes in the epidemiological scenario of HIV/AIDS draw attention to the care of people over 60 years of age and with less education, requiring efforts from healthcare networks to prevent deaths.(AU)

Jutificativa e Objetivos: Porto Alegre está entre as capitais estaduais do Brasil com maior magnitude de indicadores epidemiológicos em relação às pessoas vivendo com HIV/AIDS, impactando os indicadores de mortalidade dessa população. Este estudo teve como objetivo analisar a tendência temporal de mortes por HIV/AIDS em mulheres residentes na cidade de Porto Alegre, Rio Grande do Sul, Brasil, de 2007 a 2017, considerando grupos etários, cor da pele e educação. Método: trata-se de um estudo de série temporal ecológica sobre a tendência das taxas de mortalidade por HIV/AIDS entre mulheres vivendo com HIV residentes na cidade de Porto Alegre, RS. As taxas de mortalidade não ajustadas e padronizadas foram calculadas de acordo com grupo etário, cor da pele e educação. Para análise de tendência, foi utilizada regressão linear generalizada de Prais-Winsten. Resultados: Foram identificadas 1.603 mortes relacionadas ao HIV/AIDS em mulheres residentes na cidade durante o período do estudo. Os coeficientes de mortalidade foram mais altos em mulheres brancas, menos escolarizadas, com uma tendência crescente entre aquelas com mais de 60 anos de idade (IC95% 0,044; 0,029) com declínio para aquelas na faixa etária entre 20 e 29 anos (IC95% -0,566; -0,120). Conclusão: Mudanças no cenário epidemiológico do HIV/AIDS chamam a atenção para o cuidado de pessoas com mais de 60 anos de idade e com menor escolaridade, exigindo esforços das redes de saúde para prevenir mortes.(AU)

Antecedentes y Objetivos: Porto Alegre está entre las capitales estatales de Brasil con la mayor magnitud de indicadores epidemiológicos en relación a las personas que viven con VIH/SIDA, impactando los indicadores de mortalidad de esta población. Este estudio tuvo como objetivo analizar la tendencia temporal de muertes por VIH/SIDA en mujeres residentes en la ciudad de Porto Alegre, Rio Grande do Sul, Brasil, de 2007 a 2017, considerando grupos de edad, color de piel y educación. Método: se trata de un estudio de serie temporal ecológica sobre la tendencia de las tasas de mortalidad por VIH/SIDA entre mujeres que viven con VIH residentes en la ciudad de Porto Alegre, RS. Se calcularon tasas de mortalidad no ajustadas y estandarizadas según grupo de edad, color de piel y educación. Para el análisis de tendencia, se utilizó la regresión lineal generalizada de Prais-Winsten. Resultados: Se identificaron 1.603 muertes relacionadas con el VIH/SIDA en mujeres residentes en la ciudad durante el período de estudio. Los coeficientes de mortalidad fueron más altos en mujeres blancas, menos educadas, con una tendencia creciente entre aquellas con más de 60 años de edad (IC95% 0,044; 0,029) con un declive para aquellas en el grupo de edad entre 20 y 29 años (IC95% -0,566; -0,120). Conclusión: Los cambios en el escenario epidemiológico del VIH/SIDA llaman la atención sobre el cuidado de las personas mayores de 60 años y con menor educación, requiriendo esfuerzos de las redes de salud para prevenir muertes.(AU)

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

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)

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.

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).

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.

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 in the meeting of the Tapajós and Amazon rivers: deaths in the period 2010-2018 in Santarém, Pará, Brazil / AIDS no encontro dos rios Tapajós e Amazonas: óbitos no período de 2010-2018 em Santarém, Pará, Brasil

INTRODUCTION: The city of Santarém, the regional healthcare center in the western Pará State, lacks studies on the epidemic of the human immunodeficiency virus (HIV), in particular, on the causes of death. OBJECTIVE: To characterize the sociodemographic and clinical profile related to the evolution of HIV infection to death. METHODS: The sample consisted of 94 medical records of patients from a reference center in the city of Santarém-PA, who died between 2010-2018. Data were collected on the sociodemographic profile, immunological and clinical characteristics of the patients. Data were analyzed using descriptive and inferential statistics, adopting p<0.05. RESULTS: Most deaths were male (67%), aged between 15-29 years (39%) and diagnosed between 30-44 years (41%), single (54%), mixed race (91.5%), from Santarém (77%) and with sexual intercourse being the main type of exposure (95.7%). Most patients were not being treated at the moment of death (56.4%), the main cause of death was respiratory failure (5%), in which, these individuals had, at the moment of death, TCD4+ lymphocytes <200 cell/mm3 (26%) and detectable viral load (29%). CONCLUSION: The lifetime from diagnosis to death was 48.45±50,30 months, and immunosuppression in the diagnosis was positively associated with the shortest survival time. However, sex was not associated with the immunological profile, age at the time of diagnosis, and death. There was only a tendency for women towards immunosuppression and detectable viral load.

INTRODUÇÃO: A cidade de Santarém, o polo assistencial da região oeste do Pará, carece de estudos sobre a epidemia do vírus da imunodeficiência humana (HIV), especialmente, sobre as causas de óbitos. OBJETIVO: Caracterizar o perfil sociodemográfico e clínico relacionado à evolução da infecção pelo HIV até a morte. MÉTODO: A amostra foi de 94 prontuários de pacientes de um centro de referência do município de Santarém-PA, que evoluíram a óbito entre os anos de 2010-2018. Foram levantados os dados sobre o perfil sociodemográfico, características imunológicas e clínicas dos pacientes. Os dados foram analisados por estatística descritiva e inferencial, adotando-se p<0,05. RESULTADOS: A maioria dos óbitos foi de indivíduos do sexo masculino (67%), com faixa etária do diagnóstico entre 15-29 anos (39%) e de falecimento entre 30-44 anos (41%), solteiros (54%), pardos (91,5%), procedentes de Santarém (77%) e com a relação sexual sendo o principal tipo de exposição (95,7%). A maioria dos pacientes não estava em tratamento no momento do óbito (56,4%), a principal causa de morte foi por insuficiência respiratória (5%), no qual, esses indivíduos apresentavam, no momento da morte, linfócitos TCD4+ <200 cél/mm3 (26%) e carga viral detectável (29%). CONCLUSÃO: O tempo de vida do diagnóstico ao óbito foi de 48,45±50,30 meses e a presença de imunossupressão no diagnóstico associou-se positivamente com o menor tempo de sobrevida. Contudo, o sexo não apresentou associação com o perfil imunológico, a idade no momento do diagnóstico e do óbito, apenas notou-se uma tendência das mulheres para a imunossupressão e carga viral detectável.

AIDS incidence and survival in a hospital-based cohort of HIV-positive patients from São Paulo, Brazil: The role of IFN-λ4 polymorphisms.

Few studies have reported the prognosis of human immunodeficiency virus (HIV)-positive patients followed for a long time in Brazil, particularly those including pre and post-HAART eras. The polymorphisms of interferon (IFN)-λ4 have been postulated as possibly associated with the pathogenesis of HIV infection. The aim of this study was to describe the incidence and mortality from a cohort of HIV-positive patients as well as whether IFN-λ4 gene polymorphisms (SNP rs8099917 and SNP rs12979860) were associated with HIV/acquired immune deficiency syndrome (AIDS) progression. We followed 402 patients for up to 30 years; 347 of them began follow-up asymptomatic, without any AIDS-defining opportunistic disease and/or a lymphocytes T CD4+ count of 350 cells/mm3 or lower. We determined the probability of the asymptomatic subjects to remain AIDS-free, and the risk of death for those entering the study already with an AIDS diagnosis, as well as for subjects developing AIDS during follow-up. We compared the prognosis of patients with two different polymorphisms for the genes encoding for IFN-λ4, variants rs8099917 and rs12979860. The follow-up time of the 347 asymptomatic-at-entry subjects was 3687 person-years. IFN-λ4 rs8099917 polymorphisms were not associated with AIDS progression, but IFN-λ4 rs12979860 wild type genotype (CC) was associated with higher mortality compared to CT and TT, with an increased probability of death from AIDS (P = .01). In conclusion, genetic variations in IFN-λ4 on rs12979860 polymorphisms in HIV-infected patients may drive mortality risk.

Criação e implantação do Centro de Testagem e Aconselhamento para o Vírus da Imunodeficiência Humana em Nova Iguaçu: contribuições de Enfermagem / Creation and implementation of the Testing and Counseling Center for the Human Immunodeficiency Virus in Nova Iguaçu: contributions from Nursing

Trata-se de um estudo histórico-social, de abordagem qualitativa, na perspectiva da História do Tempo Presente, cujo cenário foi o Centro de Testagem e Aconselhamento do município de Nova Iguaçu. As fontes históricas diretas escritas constituíram-se de Manuais, projeto de criação do CTA de Nova Iguaçu, relação nominal da equipe de profissionais, fôlder de eventos científicos, entre outros; as fontes diretas orais constaram de 11 entrevistas; as fontes indiretas foram artigos científicos e livros sobre o tema. Esta pesquisa tem como objeto de estudo: a atuação do enfermeiro no processo de criação e implantação do Centro de Testagem e Aconselhamento (CTA) para HIV/Aids, do município Nova Iguaçu. O marco inicial é o ano de 1995, quando tiveram início as atividades do CTA/NI. Nesse mesmo ano, foi publicada a Portaria n.o 931, de 1995, que designava um enfermeiro como Gerente Técnico da Unidade de Gerenciamento Municipal do Programa de DST/Aids, no município do estudo. O marco final é o ano de 1996, mediante a consolidação do CTA, com atendimento expressivo de usuários nesse curto período ‒ ou seja, 851 atendimentos de julho de 1995 a dezembro de 1996. Os objetivos da Tese foram: Descrever o processo de criação do Centro de Testagem e Aconselhamento no município de Nova Iguaçu; Analisar as estratégias ou lutas simbólicas empreendidas pelo enfermeiro no processo de criação do Centro de Testagem e Aconselhamento, no município de Nova Iguaçu; Discutir os efeitos simbólicos para os enfermeiros que atuaram nas ações de prevenção, controle e tratamento do HIV/Aids no Centro de Testagem e Aconselhamento, no município de Nova Iguaçu. Os resultados: no Brasil, em meados do século XX, o aparecimento da Aids considerada ‒ nova doença no campo da saúde ‒, causou um grande impacto na sociedade em função da alta mortalidade e do estigma ao doente. No sentido de minimizar os efeitos da epidemia, algumas iniciativas foram implementadas pelas autoridades de saúde, à época, como a criação do Centro de Testagem e Aconselhamento, em âmbito nacional. pesquisa evidenciou que, para a criação do Centro de Testagem e Aconselhamento para HIV/Aids de Nova Iguaçu, houve um grande investimento por parte do enfermeiro, designado Gerente Técnico da Unidade de Gerenciamento de DST/Aids. Iniciado em 1995, tal Centro alinhou-se com a Política de Saúde nacional, com a elaboração do Projeto de Criação do COAS/CTA, a escolha do local adequado para funcionamento do Centro, a composição da equipe de saúde, a capacitação dos profissionais visando um novo fazer, além da realização de cursos e eventos científicos, com a divulgação de conhecimentos sobre a temática. Foi possível concluir que o enfermeiro, apoiado por uma aliança pactuada com o Secretário de Saúde do Município de Nova Iguaçu, em atender às exigências para o controle da epidemia, na região, contribuiu para que o CTA atendesse aos critérios e objetivos determinados pelo Programa Nacional de Controle de DST/Aids. Dessa forma, o enfermeiro se destacou, empreendendo eficazes estratégias, e alcançou resultados significativos nas ações de prevenção, diagnóstico e tratamento do HIV/Aids. À medida que participava desse investimento, transformava-se em porta-voz legítimo de um discurso autorizado no campo da infectologia em Nova Iguaçu. Assim, a incorporação de um novo serviço reconfigurou o habitus profissional nas ações para o controle da epidemia, evidenciando sua importância enquanto integrantes da equipe de saúde e com ganhos simbólicos para a enfermagem.

This is a historical-social study, with a qualitative approach, from the perspective of the History of the Present Time, whose setting was the Testing and Counseling Center (TCC) in the city of Nova Iguaçu. The direct written historical sources consisted of Manuals, the creation project of the TCC of Nova Iguaçu, nominal list of the team of professionals, folder of scientific events, among others; direct oral sources consisted of 11 interviews; indirect sources were scientific articles and books on the subject. This research has as its object of study: the role of nurses in the process of creation and implementation of the Testing and Counseling Center (TCC) for HIV/AIDS, in the municipality of Nova Iguaçu. The initial milestone is the year 1995, when the activities of the TCC/NI began. In that same year, Ordinance No. 931, of 1995, was published, which designated a nurse as Technical Manager of the Municipal Management Unit of the STD/AIDS Program in the municipality of the study. The final milestone is the year 1996, through the consolidation of the TCC, with expressive service to users in this short period ‒ that is, 851 assistances from July 1995 to December 1996. The objectives of the Thesis were: Describe the process of creating the Testing and Counseling Center in the municipality of Nova Iguaçu; To analyze the strategies or symbolic struggles undertaken by nurses in the process of creating the Testing and Counseling Center, in the city of Nova Iguaçu; Discuss the symbolic effects for nurses who worked in the actions of prevention, control and treatment of HIV/AIDS at the Testing and Counseling Center, in the city of Nova Iguaçu. The results: in Brazil, in the mid-twentieth century, the emergence of AIDS, considered a new disease in the health field, caused a great impact on society due to the high mortality and stigma to the patient. In order to minimize the effects of the epidemic, some initiatives were implemented by the health authorities at the time, such as the creation of the Testing and Counseling Center, nationwide. The research showed that, for the creation of the HIV/AIDS Testing and Counseling Center in Nova Iguaçu, there was a large investment by the nurse, designated as Technical Manager othe STD/AIDS Management Unit. Beginning in 1995, this Center aligned itself with the national Health Policy, with the elaboration of the OSSC/TCC Creation Project, the choice of the appropriate place for the Center to function, the composition of the health team, the training of professionals aiming a new task, in addition to holding courses and scientific events, with the dissemination of knowledge on the subject. It was possible to conclude that the nurse, supported by an alliance agreed with the Secretary of Health of the Municipality of Nova Iguaçu, in meeting the requirements for the control of the epidemic in the region, contributed to the TCC meeting the criteria and objectives determined by the National Program of STD/AIDS Control. Thus, the nurse stood out, undertaking effective strategies, and achieved significant results in HIV/AIDS prevention, diagnosis and treatment actions. As he participated in this investment, he became the legitimate spokesperson for an authorized discourse in the field of infectious diseases in Nova Iguaçu. Thus, the incorporation of a new service reconfigured the professional habitus in actions to control the epidemic, highlighting their importance as members of the health team and with symbolic gains for nursing.

Análisis de la mortalidad por tuberculosis, en Costa Rica / Tuberculosis Mortality Analysis in Costa Rica

Resumen Justificación: La mortalidad por tuberculosis reúne características para ser estudiada con un enfoque de causa básica y de causa múltiple, debido a que compite frecuentemente con otras patologías como causa básica de muerte. Los objetivos de este estudio son caracterizar las defunciones por tuberculosis en ambas formas, utilizando las variables: tiempo, lugar y persona; cuantificar la concordancia entre las defunciones por tuberculosis registradas por el Programa Institucional, y el certificado de defunción, e identificar la contribución de esta enfermedad en la mortalidad con un enfoque multicausal, en Costa Rica, durante el periodo 2016-2019. Materiales y métodos: Estudio descriptivo. La población de estudio correspondió a todas las defunciones por tuberculosis y con tuberculosis registradas en el libro de registro del programa de de la Caja Costarricense de Seguro Social, ocurridas en 2016 - 2019. Por medio del expediente de salud se depuraron las defunciones registradas y se categorizaron de acuerdo con la Clasificación Internacional de Enfermedades 10 en defunciones por tuberculosis (A15 al A19), tuberculosis / virus de inmunodeficiencia humana (A15 al A19-B24 ), tuberculosis / diabetes mellitus (A15 al A19-E10,E11), tuberculosis / cáncer (A15 al A19-C34,22,18) y tuberculosis / otras (A15 al A19- J44,J45). En el certificado de defunción se revisó la secuencia informada de las causas de muerte y la causa contribuyente, para identificar la tuberculosis como causa básica o múltiple. Se agruparon los resultados por edad y se calculó: porcentajes, tasas, proporción de concordancia observada, proporción de concordancia esperada y el índice de Kappa (va de 0 a 1, y el 1 representa la máxima concordancia). Resultados: Durante el periodo de estudio (4 años), se registró un total de 113 defunciones, lo que corresponde a una tasa de mortalidad de 0,57 / 100 000 hab.; de éstas, el 73% (83) correspondió a personas del sexo masculino y el 27 %, al sexo femenino. El mayor número de defunciones ocurrió principalmente en el grupo de mayores de 65 años, tanto para los hombres como para las mujeres. La proporción de concordancia observada correspondió a un 0,77 %, y la proporción de concordancia esperada a un 26%. Al ser la proporción de concordancia observada mayor que la esperada, y con un índice de Kappa de 0,70, concluimos que la concordancia existente es considerable y se atribuye más a ser causal que al azar. El análisis de mortalidad de tubercolosis por causa múltiple no mostró cambios en la tasa de mortalidad, tomando en cuenta este evento como causa básica de defunción o como causa múltiple. Conclusiones: Con base en los resultados del estudio, se evidencia que existe una concordancia considerable entre el registro de las defunciones por tuberculosis anotadas en el libro del programa institucional y el certificado de defunción.

Abstract Background: Tuberculosis mortality has the characteristics to be studied as a basic and multiple cause of death, because it can be compared with other pathologies as a basic cause of death. The goals of this study are to characterize deaths from tuberculosis including basic and multiple cause of death using time, place and person as variables, to measure the concordance of deaths from tuberculosis recorded in the Institutional Program Record Book and death certificate; and to identify the contribution of this disease in mortality with a multicausal approach, in Costa Rica during the period 2016-2019. Methods: Descriptive study. The study population corresponded to all deaths from tuberculosis and tuberculosis recorded in the Program Registration Book of the Social Security Costa Rican entity, that occurred in the period between 2016 and 2019. Using the health files, the deaths registered in the Program Registration Book were purified and categorized according to International Classification of Diseases 10 in deaths due to tuberculosis (A15 through A19), tuberculosis/human immunodeficiency virus (A15 through A19-B24), tuberculosis/diabetes mellitus (A15 through A19-E10, E11), tuberculosis/cancer (A15 through A19 -C34,22,18) and tuberculosis/others (A15 through A19-J44, J45). In the death certificate, the reported sequence of the causes of death and the contributing cause to identify tuberculosis as a basic or multiple cause were reviewed. Percentages, rates, observed concordance ratio, expected concordance ratio and Kappa index were calculated (value from 0 to 1, 1 representing the maximum concordance). Results: During the study period (4 years), a total of 113 deaths were registered, with a mortality rate of 0.57/100,000 inhabitants. Of these, 73% (83) corresponded to the male sex and 27% (30) to the female sex. The highest number of deaths occurred mainly in the group of people over 65 years, for both men and women. The observed concordance ratio corresponded to 0.77% and the expected concordance ratio to 26%. Since the observed concordance ratio is greater than expected concordance ratio and when obtaining a Kappa index of 0.70, it is concluded that the existing concordance is attributed more causally than by chance. The multiple cause tuberculosis mortality analysis did not show changes in the mortality rate, taking this event into account only as a basic cause of death or as a multiple cause. Conclusions: The study made it possible to show that there is a considerable concordance between the register of deaths from tuberculosis recorded in the register of the Institutional Program and the death certificate.

Characterization of deaths and therapeutic itineraries investigated by the Porto Alegre AIDS Mortality Committee, Brazil, in 2015. / Caracterização dos óbitos e dos itinerários terapêuticos investigados pelo Comitê Municipal de Mortalidade por Aids de Porto Alegre em 2015.

OBJECTIVE: to characterize AIDS deaths eligible for Porto Alegre AIDS Mortality Committee (AIDSMC) investigation, Brazil, in 2015, and their therapeutic itineraries. METHODS: this was a descriptive study using secondary data from surveillance information systems and AIDSMC investigation forms. RESULTS: out of 336 deaths from AIDS-related causes, 113 (33.6%) were considered avoidable, of which 52 were analyzed by AIDSMC; there was predominance of males (30/52), low schooling level (29/52 incomplete elementary education), and less than 2 years between HIV infection diagnosis and death (28/52); tuberculosis was the most frequent cause of death (17/52); and in 50/52 cases at least one therapeutic itinerary inadequacy was identified. CONCLUSION: avoidable deaths of people with AIDS occurred mostly in men, those with low education level, those with recent HIV diagnosis and most deaths were due to tuberculosis.

[Contributions of change in mortality by HIV/AIDS to Spanish life expectancy]. / Contribuciones del cambio en mortalidad por sida a la esperanza de vida en España.

OBJECTIVE: To measure the effect of the change in mortality by AIDS in life expectancy at birth of Spanish population in 1985-2017. MATERIALS AND METHODS: We analyzed 56 863 deaths by AIDS. We calculated age-standardized death rates, and we applied Poisson regression and decomposition of life expectancies. RESULTS: From 1985 to 1995, mortality by AIDS contributed to reduce life expectancy at birth of 0.64 years for men, and 0.17 for women; in 1996-2017, increase it by 0.60 years, men, and 0.17, women. CONCLUSIONS: The introduction of highly active antiretroviral therapy in 1996 and prevention were decisive to reduce mortality by AIDS and to become chronic the epidemic.

OBJETIVO: Medir el efecto del cambio en mortalidad por sida en la esperanza de vida de la población española en 1985-2017. MATERIAL Y MÉTODOS: Se analizaron 56 863 defunciones por sida. Se calcularon tasas estandarizadas de mortalidad y se aplicó regresión de Poisson y descomposición de esperanzas de vida. RESULTADOS: En 1985-1995, la mortalidad por sida contribuyó a disminuir la esperanza de vida 0.64 años en hombres y 0.17 en mujeres. En 1996-2017, la hizo crecer 0.60 en hombres y 0.17 en mujeres. CONCLUSIONES: La introducción en 1996 de los tratamientos antirretrovirales de gran actividad y la prevención fueron decisivas para disminuir la mortalidad por sida y cronificar la epidemia.

Contribuciones del cambio en mortalidad por sida a la esperanza de vida en España / Contributions of change in mortality by HIV/AIDS to Spanish life expectancy

Resumen: Objetivo: Medir el efecto del cambio en mortalidad por sida en la esperanza de vida de la población española en 1985-2017. Material y métodos: Se analizaron 56 863 defunciones por sida. Se calcularon tasas estandarizadas de mortalidad y se aplicó regresión de Poisson y descomposición de esperanzas de vida. Resultados: En 1985-1995, la mortalidad por sida contribuyó a disminuir la esperanza de vida 0.64 años en hombres y 0.17 en mujeres. En 1996-2017, la hizo crecer 0.60 en hombres y 0.17 en mujeres. Conclusión: La introducción en 1996 de los tratamientos antirretrovirales de gran actividad y la prevención fueron decisivas para disminuir la mortalidad por sida y cronificar la epidemia.

Abstract: Objective: To measure the effect of the change in mortality by AIDS in life expectancy at birth of Spanish population in 1985-2017. Materials and methods: We analyzed 56 863 deaths by AIDS. We calculated age-standardized death rates, and we applied Poisson regression and decomposition of life expectancies. Results: From 1985 to 1995, mortality by AIDS contributed to reduce life expectancy at birth of 0.64 years for men, and 0.17 for women; in 1996-2017, increase it by 0.60 years, men, and 0.17, women. Conclusion: The introduction of highly active antiretroviral therapy in 1996 and prevention were decisive to reduce mortality by AIDS and to become chronic the epidemic.