Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980�2015: the Global Burden of Disease Study 2015

Background Timely assessment of the burden of HIV/AIDS is essential for policy setting and programme evaluation. In this report from the Global Burden of Disease Study 2015 (GBD 2015), we provide national estimates of levels and trends of HIV/AIDS incidence, prevalence, coverage of antiretroviral therapy (ART), and mortality for 195 countries and territories from 1980 to 2015. Methods For countries without high-quality vital registration data, we estimated prevalence and incidence with data from antenatal care clinics and population-based seroprevalence surveys, and with assumptions by age and sex on initial CD4 distribution at infection, CD4 progression rates (probability of progression from higher to lower CD4 cell-count category), on and off antiretroviral therapy (ART) mortality, and mortality from all other causes. Our estimation strategy links the GBD 2015 assessment of all-cause mortality and estimation of incidence and prevalence so that for each draw from the uncertainty distribution all assumptions used in each step are internally consistent. We estimated incidence, prevalence, and death with GBD versions of the Estimation and Projection Package (EPP) and Spectrum software originally developed by the Joint United Nations Programme on HIV/AIDS (UNAIDS). We used an open-source version of EPP and recoded Spectrum for speed, and used updated assumptions from systematic reviews of the literature and GBD demographic data. For countries with high-quality vital registration data, we developed the cohort incidence bias adjustment model to estimate HIV incidence and prevalence largely from the number of deaths caused by HIV recorded in cause-of-death statistics. We corrected these statistics for garbage coding and HIV misclassification. Findings Global HIV incidence reached its peak in 1997, at 3·3 million new infections (95 uncertainty interval UI 3·1�3·4 million). Annual incidence has stayed relatively constant at about 2·6 million per year (range 2·5�2·8 million) since 2005, after a period of fast decline between 1997 and 2005. The number of people living with HIV/AIDS has been steadily increasing and reached 38·8 million (95% UI 37·6�40·4 million) in 2015. At the same time, HIV/AIDS mortality has been declining at a steady pace, from a peak of 1·8 million deaths (95% UI 1·7�1·9 million) in 2005, to 1·2 million deaths (1·1�1·3 million) in 2015. We recorded substantial heterogeneity in the levels and trends of HIV/AIDS across countries. Although many countries have experienced decreases in HIV/AIDS mortality and in annual new infections, other countries have had slowdowns or increases in rates of change in annual new infections. Interpretation Scale-up of ART and prevention of mother-to-child transmission has been one of the great successes of global health in the past two decades. However, in the past decade, progress in reducing new infections has been slow, development assistance for health devoted to HIV has stagnated, and resources for health in low-income countries have grown slowly. Achievement of the new ambitious goals for HIV enshrined in Sustainable Development Goal 3 and the 90-90-90 UNAIDS targets will be challenging, and will need continued efforts from governments and international agencies in the next 15 years to end AIDS by 2030. Funding Bill & Melinda Gates Foundation, and National Institute of Mental Health and National Institute on Aging, National Institutes of Health. © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY licens

Empirical Use Of Aztreonam Associated With Ampicillin Or Vancomicin For Treatment Of Severe Infections: Multicenter Study [uso Empírico De Aztreonam Associado à Ampicilina Ou Vancomicina No Tratamento De Infecções Severas: Estudo Multicêntrico]

Objective: To analyze the treatment of patient with severe infections with aztreonam as monotherapy or in association with ampicillin or vancomicin. Setting: Thirteen Brazilian centers. Study design: Open multicenter and non comparative study. Casuistic: Patients above 18 years old, with severe infections and in need of empirical treatment were included. The infections were sepsis, infection of inferior respiratory tract, intra-abdominal infection and urinary tract infection. Neutropenic patients were excluded. The follow up was until the hospital discharge date and the patients were analyzed according to clinical or microbiological response to treatment. Results: 27 patients were studied with a mean age of 48 years. The male gender was more frequent (74%). There were a total of 31 infections and the most frequent was the infection of inferior respiratory tract (15), followed by urinary tract infection (7), sepsis (8), and intra-abdominal infection (1). P. aeruginosa was the most frequent etiologic agent isolated (14), followed by E. coli (10). The average duration of therapy with aztreonam was 11.7 days. The clinical cure was found in 19 patients (70%), the partial cure in six (22%) and failure was found in one patient (3.7%). The microbiological cure was found in 17 (68%) patients. There were two (7.4%) adverse effects, both were thrombophlebitis. Conclusion: The empirical therapy with aztreonam in patients with severe infections were found to be efficacious for the majority of indications.706327331Almeida, F.A., Narvaez, G.A., Lopes, H.V., Godoy, I., Pasternak, Baldy, J.L.S., Szpeiter, Badaro, R., Avaliação da eficácia do aztreonam no tratamento de infecções graves Estudo de 55 casos (1993) Rev Bras Cir, 83Stutman, H.R., Aztreonam: Clinical pharmacology (1989) Pediatr Infect Dis J, 8, pp. S104-108Fried, J., Hinthorn, D.R., New antibiotics. 1985: A review of recently developed betalactams (1985) Hosp Formul, 20, pp. 1154-1160Mattie, H., Clinical pharmacokinetics of aztreonam (1988) Clin Pharmcokinetics, 14, pp. 148-155Goldoni, S., Galassi, P., Gandolfi, P., Di Francesco, E., Simonella, A., Torreli, L., Miano, L., (1987) Curr Therap Res, 42, pp. 880-888Shibl, A.M., Ishag, A.H., Durgham, S.M., (1983) Chemotherapy, 35, pp. 72-76Bjornson, H.S., Randa-Ramirez, C., Saavedra, S., Rivera-Vázquez, C.R., Liu, C., Hinthorn, D.R., Comparison of empiric aztreonam and aminoglycoside regimens in the treatment of serious gram-negative lower respiratory infectons (1993) Clin Therpeut, 15, pp. 65-78Pasternak, J., Ganme, A.P.P., Ritchman, R., Rodrigues, E.A., Aztreonam-ceftriaxone em infecções severas (1994) Arq Bras Med, 68, pp. 353-355Fekete, T., Castellano, M., Ramirez, J., Siefkin, A., Martin, M., Redington, J.J., North, D., Gagnon, S., A randomized comparative trial of aztreonam plus cefazolin versus ceftazidime for the treatment of nosocomial pneumonia (1994) Drug Infect, 7, pp. 117-126Birolini, D., Moraes, M.F., Souza, O.S., Estudo comparativo entre as associações aztreonam/clindamicina e tobramicina/clindamicina no tratamento de infecções intra-abdominals (1992) Arq Bras Med, 6

Sex With Animals (swa): Behavioral Characteristics And Possible Association With Penile Cancer. A Multicenter Study

Introduction. Zoophilia has been known for a long time but, underreported in the medical literature, is likely a risk factor for human urological diseases. Aim. To investigate the behavioral characteristics of sex with animals (SWA) and its associations with penile cancer (PC) in a case-control study. Methods. A questionnaire about personal and sexual habits was completed in interviews of 118 PC patients and 374 controls (healthy men) recruited between 2009 and 2010 from 16 urology and oncology centers. Main Outcome Measures. SWA rates, geographic distribution, duration, frequency, animals involved, and behavioral habits were investigated and used to estimate the odds of SWA as a PC risk factor. Results. SWA was reported by 171 (34.8%) subjects, 44.9% of PC patients and 31.6% of controls (P<0.008). The mean ages at first and last SWA episode were 13.5 years (standard deviation [SD] 4.4 years) and 17.1 years (SD 5.3 years), respectively. Subjects who reported SWA also reported more venereal diseases (P<0.001) and sex with prostitutes (P<0.001), and were more likely to have had more than 10 lifetime sexual partners (P<0.001) than those who did not report SWA. SWA with a group of men was reported by 29.8% of subjects and SWA alone was reported by 70.2%. Several animals were used by 62% of subjects, and 38% always used the same animal. The frequency of SWA included single (14%), weekly or more (39.5%), and monthly episodes (15%). Univariate analysis identified phimosis, penile premalignancies, smoking, nonwhite race, sex with prostitutes, and SWA as PC risk factors. Phimosis, premalignant lesions, smoking, and SWA remained as risk factors in multivariate analysis. However, SWA did not impact the clinicopathological outcomes of PC. Conclusion. SWA is a risk factor for PC and may be associated with venereal diseases. 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Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems

Background Human immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico. Methods We performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017. Results All countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017. Conclusions Our subnational estimates of HIV mortality revealed significant spatial variation and diverging local trends in HIV mortality over time and by age. This analysis provides a framework for incorporating data and uncertainty from incomplete VR systems and can help guide more geographically precise public health intervention to support HIV-related care and reduce HIV-related deaths