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Mortality from opportunistic infections. Mortality rate (per 100,000 person-years and adjusted for age) for opportunistic infections as the underlying causes of death in people ≥ 13 years of age living with AIDS, by year of death. São Paulo, Brazil, 1996–2006.
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OBJECTIVE:We examine the trend in causes of death among people living with AIDS in the city of São Paulo, Brazil, in the periods before and after the introduction of highly active antiretroviral therapy (HAART), and we investigate potential disparities across districts of residence. METHODS:Descriptive study of three periods: pre-HAART (1991-1996);...
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Citations
... [4][5][6][7] Cardiovascular diseases have been found to account for a substantial number of deaths among HIV-infected patients in recent times. 8,9 Smith et al. 8 found that cardiovascular disease accounted for 11.0% of deaths and was the fourth most common cause of death seen in their study of HIV-positive patients, and was only preceded by AIDS-related deaths (29.0%), non-AIDSdefining cancers (15.0%) and liver disease (13.0%). ...
Background:
Right ventricular dysfunction carries a poorer prognosis in human immunodeficiency virus (HIV)-positive patients. The objectives of this study were to ascertain the prevalence of right ventricular systolic and diastolic dysfunction, as well as its predictors, in antiretroviral therapy-naïve HIV-positive patients.
Methods:
Participants in this cross-sectional, descriptive study comprised 60 HIV-positive patients and 60 HIV-negative controls. All participants had transthoracic echocardiography done to assess right ventricular systolic and diastolic function. The HIV-positive patients had their CD4 counts measured.
Results:
The mean age of the study population was 34.63 ± 8.7 years versus that of the controls (34.45 ± 9.40 years) (p = 1.000). Right ventricular systolic dysfunction was found in 11.6% of the HIV-positive patients versus the controls (3.33%, p = 0.166) while right ventricular diastolic dysfunction was found in 15.0% of HIV-positive patients versus the controls (1.7%, p = 0.021). The CD4 count did not contribute to the frequency and degree of right ventricular systolic or diastolic dysfunction.
Conclusion:
Right ventricular systolic and diastolic dysfunction was common in treatment-naïve HIV-infected individuals but the frequency and degree were not associated with the CD4 count or other measured parameters.
... Our review showed that infectious diseases are commonly assessed using multiple-cause methods, for example, to ascertain socio-demographic differentials, to identify associated health conditions, and to assess the impact of health interventions to inform targeted prevention strategies. 71,91,112,113 With new and emerging infectious diseases, multiple-cause data is crucial for descriptive epidemiology and for providing evidence to inform prevention strategies. Since the declaration of COVID-19 as a pandemic in March 2020, the WHO implemented rules for ascertaining when death was due to COVID-19 (i.e. the underlying cause), noting that under certain circumstances COVID-19 should be recorded somewhere on the death certificate. ...
Background:
Research and reporting of mortality indicators typically focus on a single underlying cause of death selected from multiple causes recorded on a death certificate. The need to incorporate the multiple causes in mortality statistics - reflecting increasing multimorbidity and complex causation patterns - is recognized internationally. This review aims to identify and appraise relevant analytical methods and practices related to multiple causes.
Methods:
We searched Medline, PubMed, Scopus and Web of Science from their inception to December 2020 without language restrictions, supplemented by consultation with international experts. Eligible articles analyzed multiple causes of death from death certificates. The process identified 4,080 items of which we reviewed 434 full-text articles.
Results:
Most articles we reviewed (76%, n=332) were published since 2001. The majority examined mortality by "any mention" of cause of death (87%, n=377) and assessed pairwise combinations of causes (57%, n=245). Since 2001, applications of methods emerged to group deaths based on common cause patterns using, for example, cluster analysis (2%, n=9), and application of multiple-cause weights to re-evaluate mortality burden (1%, n=5). We describe multiple-cause methods applied to specific research objectives for approaches emerging recently.
Conclusion:
This review confirms rapidly increasing international interest in the analysis of multiple causes of death and provides the most comprehensive overview, to our knowledge, of methods and practices to date. Available multiple-cause methods are diverse but suit a range of research objectives. With greater availability of data and technology, these could be further developed and applied across a range of settings.
... Our review showed that infectious diseases commonly assessed using multiple cause methods, for example, to ascertain socio-demographic differentials, to identify associated health conditions, and to assess the impact of health interventions to inform targeted prevention strategies. 71,86,108,109 With new and emerging infectious diseases, MC data is crucial for descriptive epidemiology and for providing evidence to inform prevention All rights reserved. No reuse allowed without permission. ...
Background
Research and reporting of mortality indicators typically focus on a single underlying cause of death selected from multiple causes recorded on a death certificate. The need to incorporate the multiple causes in mortality statistics - reflecting increasing multimorbidity and complex causation patterns - is recognised internationally. This review aims to identify and appraise relevant multiple cause analytical methods and practices.
Methods
We searched Medline, PubMed, Scopus and Web of Science from inception to December 2020 without language restrictions, supplemented by consultation with international experts. Eligible articles included those analysing multiple causes of death from death certificates. The process identified 4,080 articles; after screening, 434 full texts were reviewed.
Results
Most reviewed articles (77%, n=332) were published since 2001. The majority examined mortality by “any-mention” of a cause of death (87%, n=377) and assessed pairwise combinations of causes (56%, n=245). Recently emerging (since 2001) were applications of methods to group deaths based on common cause patterns using, for example, cluster analysis (2%, n=9), and the application of multiple cause weights to re-evaluate mortality burden (1%, n=5). Multiple cause methods applied to specific research objectives are described for recently emerging approaches.
Conclusion
This review confirms rapidly increasing international interest in the analysis of multiple causes of death and provides the most comprehensive overview of methods and practices to date. Available multiple cause methods are diverse but suit a range of research objectives, that with greater data availability and technology could be further developed and applied across a range of settings.
... In people living with HIV/AIDS (PLWHA), cryptococcosis is one of the opportunistic AIDS-defining infections and one of the main causes of death [2][3][4][5][6][7]. ...
Objetivo: Analisar as características clínicas-epidemiológicas, segundo a infecção pelo HIV, dos casos de criptococose no estado de Goiás. Métodos: Estudo transversal dos casos de criptococose no período de 2011 a 2014. Utilizou-se registros laboratoriais e prontuários médicos de unidades de saúde referência para a doença. Aplicou testes estatísticos para comparar o grupo HIV positivos e HIV negativos com as variáveis estudadas. Resultados: Identificou 130 casos de criptococose, 116(89,2%) HIV positivos e 14(10,8%) negativos. A meningoencefalite foi a forma clínica predominante em ambos os grupos, assim como a espécie Cryptococcus neoformans. Entre os casos HIV negativos (64,3%) usavam medicamentos imunossupressores. A média da contagem de células TCD4 dos casos HIV positivos foi 58,7 células/mm3e 60,8% foram a óbito, entre os sobreviventes, 43,1% ficaram com sequelas, sendo o déficit visual o mais frequente. Conclusões: A criptococose é uma doença grave, dada a elevada letalidade e potencial de provocar danos funcionais.
... In people living with HIV/AIDS (PLWHA), cryptococcosis is one of the opportunistic AIDS-defining infections and one of the main causes of death [2][3][4][5][6][7]. ...
Background
Cryptococcal meningitis causes high mortality in immunocompromised and immunocompetent patients. The objective of this study was to identify early predictors of clinical outcome, available at the first days of hospitalization, in patients with cryptococcal meningitis in a tertiary center in Brazil.
Methods
Ninety-six cases of cryptococcal meningitis with clinical, epidemiological and laboratory data, and identification and antifungal susceptibility of the strains were analyzed. Quantitative CSF yeast counts were performed by direct microscopic exam with a Fuchs-Rosenthal cell counting chamber using an institutional protocol. Univariable and multiple analyses using logistic regression were performed to identify predictors, available at the beginning of hospitalization, of in-hospital mortality. Moreover, we performed a secondary analysis for a composite outcome defined by hospital mortality and intensive care unit transfer.
Results
The species and the antifungal susceptibility were not associated with the outcomes evaluated. The variables significantly associated with the mortality were age (OR = 1.08, 95% CI 1.02–1.15), the cerebrospinal fluid (CSF) yeasts count (OR = 1.65, 95% CI 1.20–2.27), systemic arterial hypertension (OR = 22.63, 95% CI 1.64–312.91) and neurological impairment identified by computed tomography (OR = 41.73, 95% CI 3.10–561.65). At the secondary analysis, CSF yeast count was also associated with the composite outcome, in addition to the culture of Cryptococcus spp. from bloodstream and cerebral toxoplasmosis. The associations were consistent with survival models evaluated.
Conclusions
Age and CSF yeast count were independently associated with in-hospital mortality of patients with cryptococcal meningitis but Cryptococcus species identification and antifungal susceptibility were not associated with the outcomes. Quantitative CSF yeast counts used in this study can be evaluated and implemented in other low and middle-income settings.
... ARVs emerged in the 20th century when acquired immunodeficiency syndrome (AIDS) quickly spread across the five continents [11]. Nowadays, therapies with ARVs aim to reduce viral load, improving the host immune system once HIV mainly attacks the CD4+T cells, a crucial component in the body's immune system [12][13][14]. Based on their molecular mechanism of action, three classes of ARVs are widely used: (i) nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), namely abacavir, didanosine, lamivudine, tenofovir, and zidovudine; (ii) non-nucleoside reverse transcriptase inhibitors (NNRTIs), namely efavirenz, etravirine, and nevirapine; and (iii) protease inhibitors (PI), namely atazanavir, darunavir, lopinavir, ritonavir, and tipranavir. ...
... Based on their molecular mechanism of action, three classes of ARVs are widely used: (i) nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), namely abacavir, didanosine, lamivudine, tenofovir, and zidovudine; (ii) non-nucleoside reverse transcriptase inhibitors (NNRTIs), namely efavirenz, etravirine, and nevirapine; and (iii) protease inhibitors (PI), namely atazanavir, darunavir, lopinavir, ritonavir, and tipranavir. Each of these classes, represented by 13 ARVs, target a phase of the HIV virus life cycle [12][13][14]. Advances in ARVs treatment, essentially after the development of Highly Active Antiretroviral Therapy (HAART), a treatment regimen comprising a combination of three or more ARVs, made it possible to transform a syndrome, that was previously perceived to be a diagnostic to an announced death, into a disease with chronicity prospects [12][13][14]. ...
... Each of these classes, represented by 13 ARVs, target a phase of the HIV virus life cycle [12][13][14]. Advances in ARVs treatment, essentially after the development of Highly Active Antiretroviral Therapy (HAART), a treatment regimen comprising a combination of three or more ARVs, made it possible to transform a syndrome, that was previously perceived to be a diagnostic to an announced death, into a disease with chronicity prospects [12][13][14]. ...
Antiretrovirals (ARVs) have been detected in aquatic ecosystems throughout the world; however, studies focused on assessing their ecotoxicological effects on marine aquatic organisms are still rare. In the present study, the predicted environmental concentration (PEC) of 13 ARVs was estimated for surface seawater from Santos Bay, Brazil, according to the European Medicines Agency (EMEA) guidelines. The results indicated that all ARVs need to be assessed for their ecological effects, considering that they all exceeded the EMEA guideline limits (PEC > 0.01 µg L−1). In this sense, three ARVs (namely atazanavir, nevirapine and efavirenz) were selected for the acute and chronic tests with sea urchin (Echinometra lucunter). Furthermore, the Environmental Risk Assessment (ERA) for these three ARVs was also performed by calculating the risk quotient. The acute and chronic toxicity results showed inhibitory concentrations (IC) for the fertilization (IC50; 1 h; range: 11.46–84.61 mg L−1) and for the embryo–larval development (IC50; 42 h; range: 0.52–0.97 mg L−1) of the sea urchin, respectively. Moreover, the ERA showed that these three ARVs are potentially hazardous for aquatic life in Santos Bay, raising concerns about the continuous introduction of ARVs in aquatic ecosystems. The data presented may contribute to the provision of subsidies for the development of monitoring public policies that aim to reduce the introduction of ARVs into the aquatic environment.
... People Living with HIV(PLHIV) have endured the HIV and AIDS epidemic for decades, studies have been carried out to examine the effects of the disease on the quality of life (QoL) of people affected by the disease (Joint United Nations Programme on HIV/AIDS, 2014). Consequently, the expansion of ART treatment and the decline in opportunistic infections resulted into increased survival rates and disease chronicity (Domingues and Waldman, 2014). Antiretroviral Therapy (ART) and aging with HIV are risk factors associated with Non Communicable Diseases (NCDs) that affects the quality of life of patients (Domingues and Waldman, 2014). ...
... Consequently, the expansion of ART treatment and the decline in opportunistic infections resulted into increased survival rates and disease chronicity (Domingues and Waldman, 2014). Antiretroviral Therapy (ART) and aging with HIV are risk factors associated with Non Communicable Diseases (NCDs) that affects the quality of life of patients (Domingues and Waldman, 2014). Thus, understanding the effects of community based NCD services and the QoL among patients has become one of the main objectives of HIV and AIDS research (Gaspar et al., 2011). ...
A comprehensive and culturally applicable community based Non Communicable Diseases (NCD) services package was implemented with an aim to test the effectiveness of the community based NCD services that integrate HIV and Non-Communicable Diseases in communities to improve the quality of life (QoL) of people with HIV living with NCDs in Uganda. The Randomized Controlled Trial (RCT) was conducted to compare the efficacy of the community based NCD services as intervention. The control group received the usual HIV services in the community by the HIV expert clients in Uganda. Participants were randomly allocated to receive weekly and monthly intervention sessions by village health teams (VHTs), expert clients and community volunteers or standard care in the community ARV drug distribution points. Independent t-tests were performed to compare changes in the QoL scores at the baseline and the endline. The effect of the intervention on the QoL was tested using Pearson correlation and linear regression analysis. Between November and December 2018, 1076 individuals were screened, of whom 438 were randomly assigned to either the intervention or control group in the ratio of 1:1. The post intervention results revealed that the community based NCD services were effective and contributed 31.9% to the overall improved the QoL in all the three domains; the physical, environmental and social relationship domains. Therefore, designing such interventions in all community HIV drug distribution points would reduce the co-morbidities related to NCDs and HIV, and improve the overall quality of life. Furthermore, it could be useful to reduce stigma and increase their social support network. Findings could be utilized at regular community service settings for its sustainability and long-term effect. The intervention created improved understanding of HIV and NCD integration health promotion strategies and community support systems activities by the VHT, ART expert clients and the community volunteers.
... In Brazil, the governmental AIDS program provides universal access to diagnosis, therapy and routine laboratory tests (including CD4 lymphocytes count, measures of viral load and genotyping of viral resistance) [7]. This approach reduced mortality and slowed the growth of the epidemics [8], [9]. On the other hand, it failed to interrupt a relevant epidemiological trend, the interiorization. ...
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly recognized as a threat for people living with HIV/AIDS (PLWHA). However, the magnitude of asymptomatic MRSA colonization in that group varies among different countries and geographic regions.
Methods: We conducted a study that aimed at identifying the prevalence, risk factors and spatial epidemiology of both overall S. aureus and MRSA colonization among PLWHA from small cities from inner São Paulo State, Brazil. MRSA isolates were characterized using Pulsed-Field Gel Electrophoresis (PFGE), and submitted to typing of the Staphylococcal Chromosome Cassete (SCC)mec. Spatial analysis was performed to search for geographical clusters and correlation with socioeconomic indicators.
Results: In a first point prevalence survey, nasal and oropharyngeal swabs of 368 people were collected. Sixty-seven subjects from the city of Botucatu were surveyed for colonization in two other occasions, and had swabs collected from household members. The prevalence rates for S. aureus and MRSA in the first survey were 25.8% and 2.7%. The overall S. aureus colonization was negatively associated with the use of beta-lactams and of illicit drugs. On the other hand, MRSA colonized subjects were more likely to use crack and to have been admitted to a hospital during the past year. Repeated surveys found additional cases of MRSA colonization, but all subjects were positive in only one occasion. Four PFGE clusters were characterized, grouping subjects in household, city and region level. Of 19 total MRSA isolates, only one did not harbor SCCmec type IV. Spatial analysis of households of subjects living in the city of Botucatu found significant overdispersion of cases, but no association with socio-economic indicators.
Conclusion: We found small but relevant prevalence of MRSA among PLWHA. Community and healthcare-associated risk factors were identified, so that predominant routes of transmission could not be determined on epidemiological grounds.
... One of the strengths of our study lies in the unique population we studied, a mix of HIVinfected and HIV-uninfected patients. Even in the current ART era, HIV-associated malignancies remain an increasing cause of mortality among individuals affected with this virus in developed and developing countries alike [22,23]. It is, therefore, necessary to determine the performance of FDG-PET/CT in accurate staging and its metabolic parameters in the determination of the presence of distant metastases among HIV-infected individuals with carcinoma of the cervix. ...
Objectives
To determine the impact of FDG-PET/CT in the initial staging of cervical cancer among women with and without HIV and to determine the abilities of FDG-PET/CT metabolic parameters in predicting the presence of distant metastasis.
Methods
We reviewed the FDG-PET/CT images of women with FIGO stage IB2 to IVA carcinoma of the cervix. We compared the FIGO stage before and after FDG-PET/CT. Maximum and mean standardized uptake values (SUVmax and SUVmean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the primary lesion were determined. We compared these parameters between the HIV-infected and uninfected woman and also determined their abilities to predict the presence of distant metastasis.
Results
126 women, mean age 48.05 ± 11.80 years were studied. Seventy-three patients were HIV-infected. The disease was upstaged in 65 patients, 32 of which were upstaged to stage IVB. HIV-infected women were younger (43.36 ± 8.03 years versus 54.51 ± 13.12, p<0.001) and had more advanced disease (p = 0.022) compared with HIV-uninfected. In a univariate logistic regression adjusted for the FIGO stage of the disease, there were significant associations between MTV and TLG of the primary tumor and distant metastasis. SUVmax, SUVmean, MTV and TLG performed well in predicting the presence of distant metastasis with areas under the curves (AUCs) of 0.63, 0.66, 0.80 and 0.77 respectively. These performances improved after adjustment for the FIGO stage of the disease with AUCs of 0.80, 0.79, 0.84 and 0.82 for SUVmax, SUVmean, MTV and TLG respectively.
Conclusion
Inclusion of ¹⁸F-FDG-PET/CT in the pre-therapy assessment of cervical cancer improves the accuracy of staging in about half of the patients. The metabolic parameters of the primary tumor perform well in predicting the presence of distant metastases.
... vinculadas a los avances de la terapia medicamentosa, proporcionaron cambios en los patrones de la infección por el VIH, que poco a poco pasó a adquirir características de enfermedad crónica(3,4) . Este nuevo panorama proporcionó el aumento de la supervivencia, la mejora de la calidad de vida y la consiguiente apertura de espacios para las interacciones sociales, lo que favoreció la aparición de relaciones conyugales entre PVVS, incluso generando configuraciones de parejas seroconcordantes (en las que los dos son infectados por el virus) y serodiscordantes (en los que sólo uno de ellos es infectado)(5) .En las parejas serodiscordantes, el principal desafío en su salud sexual es el riesgo de transmisión del VIH, principalmente en relaciones duraderas. ...
Objective
To analyze the influence of sexual orientation on sociodemographic, clinical and behavioral variables among sexual partners of people living with Human immunodeficiency virus/Acquired immunodeficiency syndrome
Methods
A cross-sectional study carried out in a medical assistance service specialized in the treatment of people with Human Immunodeficiency Virus, with 173 participants. Pearson's Chi-square or Fisher's exact test was used to analyze the results
Results
We identified an association between sexual orientation and variables such as gender, age, marital status, age, education, income, type of exposure, type of birth, consistent condom use, presence of infection, sexual practice, partner in routine consultations, disclosure of HIV to the partner and considers disclosure of their condition to the partner
Conclusion
Establishing a sexual partnership in the context of HIV and having a non-heterosexual orientation presented statistical differences between sociodemographic and behavioral variables.
