SÍNDROME DE IMUNODEFICIÊNCIA ADQUIRIDA
The aim of this study was to describe the effect of non-adherence on the main laboratory outcomes, TCD4+ lymphocyte count and viral load, routinely used to monitor patients initiating treatment according to three different approaches to measure adherence to antiretroviral therapy. Among 288 participants, 22.9%, 31.9% and 74.3% were considered non-adherent, according to medical charts, self-report and pharmacy records, respectively. Depending on the adherence measures used, the average gain in TCD4+ lymphocyte count ranged from 142.4 to 195.4 cells/mm3 among adherent patients, and from 58.5 to 99.8 lymphocytes TCD4+/mm3 among those non-adherent. The average reduction on viral load ranged from 4.25 to 4.62 log copies/mL among the adherent patients, and from 1.99 to 4.07 log among those non-adherent. Monitoring antiretroviral adherence should be considered a priority in these public AIDS referral centers in order to identify patients at high risk of developing virologic failure. Early interventions are necessary in order to maintain the initial therapeutic regimens for longer periods. AVALIAÇÃO DE PROGRAMAS The aim of this study was to evaluate strategies by the Brazilian Ministry of Health to expand the municipal response to AIDS. Cities "included" and "not included" in Federal strategies for "municipalization" of the response were compared according to the response profile and trends in the epidemic. Multinomial logistic regression was used, among other statistical procedures. Municipalities included from 1994 to 1998 showed higher chances of providing HIV diagnostic testing [OR = 15.0; 95%CI: 5.6-40.1], of having AIDS services [OR = 18.4; 95%CI: 8.4-40.5], and reducing cases involving heterosexual [OR = 3.1; 95%CI: 1.4-7.3], homosexual/bisexual [OR = 3.0; 95%CI: 1.4-6.2], and IDU transmission [OR = 6.6; 95%CI: 2.9-14.9] as compared to those "included in 2003" and "not included". There were no associations between the included Municipalities, greater coverage in prevention, the reduction in cases due to vertical transmission or blood transfusion, or mortality rates. Municipalities with a more structured response were associated with better results. The findings suggest that the municipalization policy contributed to improvement in the local response to AIDS. INFECÇÃO POR HIV The paper reviews the serological methods employed in the estimation of HIV incidence based on cross-sectional studies, as well as the main findings from studies carried out in Brazil that have used such methods. Each method is briefly described, as well as their advantages and limitations. The different methods are also analyzed as a set of complementary but sometimes contradictory strategies under permanent criticism and review, still far from a gold standard. Finally, an additional question % central to the accurate monitoring of the AIDS epidemic using such methods % is discussed: whether the different methods should or should not be adjusted. The debate is open and controversy should be viewed as an unavoidable consequence of a very dynamic research field, informed by the progress in sciences as diverse as epidemiology, biostatistics, mathematical modeling and different branches of basic science, such as immunology, virology, and molecular biology. SOBREVIDA The objective of this study is to characterize survival in children with AIDS diagnosed in Brazil between 1999-2002, compared with the first national study (1983-1998). This national retrospective cohort study examined a representative sample of Brazilian children exposed to HIV from mother-to-child transmission and followed through 2007. The survival probability after 60 months was analyzed by sex, year of birth and death, clinical classification, use of antiretroviral therapy (ART) and prophylaxis for opportunistic diseases. 920 children were included. The survival probability increased: comparing cases diagnosed before 1988 with those diagnosed from 2001-2002 it increased by 3.5-fold (from 25% to 86.3%). Use of ART, initial clinical classification, and final classification were significant (p < 0.001) predictors of survival. Issues regarding quality of records and care were identified. The results point to the success of the Brazilian policy of providing ART. The improvement of clinical status contributes to quality of life, while indicating challenges, particularly practices to improve long-term care. |
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