Effect of diagnostic criteria for AIDS and Adherence to antiretroviral treatment on clinical progression in HIV / AIDS

Abstract

A AIDS, desde o seu surgimento no in??cio dos anos 80, apresentou-se como um relevante problema de sa??de p??blica. Al??m da preven????o de doen??as oportunistas e do tratamento da AIDS foi essencial estabelecer crit??rios para definir casos da doen??a. O objetivo do presente estudo foi ressaltar as diferen??as observadas nas fun????es de sobrevida de casos definidos por diferentes crit??rios e conhecer o efeito da ades??o ?? terapia anti-retroviral(TARV) no progn??stico dos pacientes HIV/AIDS. No primeiro artigo, 1.415 indiv??duos HIV+ atendidos no IPEC foram avaliados pelos crit??rios de defini????o de caso do Minist??rio da Sa??de (MS/2004) e dos Centers for Disease Control and Prevention (CDC/1993), e afun????o de sobrevida foi estimada para cada crit??rio, considerando o uso de TARV e cofatores s??cio-demogr??ficos e cl??nicos. Os resultados desta avalia????o mostraram que a sobrevida estimada depende do crit??rio adotado al??m de apresentar preditores distintos. No segundo artigo, em buscas no Medline e Lilacs, selecionou-se 38 artigos que avaliaram a ocorr??ncia de desfechos relevantes na evolu????o da AIDS em fun????o da ades??o ao tratamento. Na avalia????o desses artigos, foi evidenciado que a ades??o dos pacientes ao tratamento antiretroviral nos diversos matizes considerados na literatura mostrou-se um preditor importante dos desfechos nas suas m??ltiplas representa????es no acompanhamento dos pacientes, independente do estadiamento cl??nico, uso pr??vio de tratamento, CD4 ecarga viral basais. No terceiro artigo, para 711 pacientes foram considerados os dados de fornecimento de anti-retrovirais (dispensas) dispon??veis no Sistema de Controle Log??stico de Medicamentos (SICLOM) para avaliar a ades??o e estimar o risco de falha terap??utica pelo modelo de Cox. Com base neste estudo, pode-se concluir que o grau de n??o ades??o ?? HAART est?? diretamente associado com o maior risco de ocorr??ncia de desfechos desfavor??veis, e que a ades??o <75 por cento teve impacto substancial na evolu????o da doen??a, independente de outros fatores. Em suma, pode-se concluir que apesar das dificuldades dese comparar estudos, devido ?? evolu????o do tratamento, dos in??meros desfechos e formas de avalia????es, ?? incontest??vel o melhor progn??stico nos anos recentes. Ainda que o sucesso do tratamento dependa da ades??o, e esta, por sua vez, dependa de in??meros fatores, ?? poss??vel afirmar que melhorando a ades??o do paciente ao tratamento, independente de praticamente todos demais fatores, ?? poss??vel obter um bom progn??stico para a evolu????o da doen??a.Since its emergence in the early 1980s, AIDS has appeared as a relevant public health problem. In addition to preventing opportunistic diseases and treating AIDS it was essential to establish disease-defining criteria. The aim of the present study was to highlight the differences in cases survival functions defined by different criteria and to know the effect of adherence to antiretroviral therapy on the prognosis of patients with HIV/AIDS. In the first article, 1,415 HIV+ subjects seen at IPEC were assessed by two case-defining criteria (MS/2004 and CDC/1993), their survival function was estimated for each standard, considering the use of ARV and socio-demographic and clinical cofactors. The results showed that estimated survival depends on the chosen standard, besides presenting distinct predictors. In the second article, through searches at MEDLINE and LILACS, there were selected 38 articles that evaluated the occurrence of relevant outcomes to the development of AIDS in function of adherence to treatment. The analysis of these articles emphasized that the adherence of patients to ARV or HAART in various aspects considered in the literature was an important predictor of outcomes in their multiple representations in the monitoring of patients, independent of their clinical staging, use of prior treatment and baseline CD4 and viral load. In the third article, to 711 patients, there were considered data from antiretroviral disposal available at SICLOM for adherence assessment and estimation of therapeutic failure risk by the Cox model. In this study, it can be concluded that the level of non-adherence to HAART is directly associated with the highest risk of adverse outcomes, and adherence <75% had a substantial impact on the evolution of the disease, independent of other factors. In short, it can be concluded that despite the difficulties of comparing studies, due to treatment development, innumerable outcomes and forms of evaluations, there is no doubt about the occurrence of better prognosis in recent years. Even though the success of treatment depends on adherence, and this, in turn, depends on numerous factors, it is possible to say that improving patient adherence to treatment, independent of practically all other factors, it is possible to obtain a good prognosis for the development of the disease