Trends in AIDS-defining opportunistic illnesses incidence over 25 Years in Rio de Janeiro, Brazil

Submitted by Rodrigo Senorans ([email protected]) on 2015-05-08T17:22:46Z No. of bitstreams: 1 Trends in AIDS-defining opportunistic illnesses incidence over 25 years in Rio de Janeiro, Brazil.pdf: 421919 bytes, checksum: 0b85223bf4c07c5988bd74fcfa014379 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-05-11T12:43:03Z (GMT) No. of bitstreams: 1 Trends in AIDS-defining opportunistic illnesses incidence over 25 years in Rio de Janeiro, Brazil.pdf: 421919 bytes, checksum: 0b85223bf4c07c5988bd74fcfa014379 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-05-11T12:44:45Z (GMT) No. of bitstreams: 1 Trends in AIDS-defining opportunistic illnesses incidence over 25 years in Rio de Janeiro, Brazil.pdf: 421919 bytes, checksum: 0b85223bf4c07c5988bd74fcfa014379 (MD5)Made available in DSpace on 2015-05-11T15:39:03Z (GMT). No. of bitstreams: 1 Trends in AIDS-defining opportunistic illnesses incidence over 25 years in Rio de Janeiro, Brazil.pdf: 421919 bytes, checksum: 0b85223bf4c07c5988bd74fcfa014379 (MD5) Previous issue date: 2014CNPq, FAPERJFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Departamento de Fisiologia e Farmacodinâmica. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, BrasilObjectives: To assess the temporal trends in incidence of AIDS-defining opportunistic illnesses in an urban cohort of a middle-income country. Methods: HIV infected patients aged $18 years at cohort entry were included in this analysis. We calculated incidence rates per 1000 persons-years of observation for the first opportunistic illness presented after cohort enrollment, from 1987 to 2012. Trends for overall and specific opportunistic illnesses were tested and incidence rate ratios for the most recent calendar period were calculated as the ratio between the incidence rate observed in the most recent period of the study (2009–2012) and the incidence rate observed in first period of the study (1987–1990). Results: Overall, 3378 patients were included in this analysis; of which 1119 (33%) patients presented an opportunistic illness during follow up. Incidence rates of all opportunistic illnesses decreased over time, and the overall opportunistic illness incidence rates fell from 295.4/1000 persons-years in 1987–1990 to 34.6/1000 persons-years in 2009–2012. Tuberculosis, esophageal candidiasis, cerebral toxoplasmosis and Pneumocystis jirovecii pneumonia were the most incident opportunistic illnesses in the cohort. Tuberculosis had the highest incidence rate in the study period. The peak in tuberculosis incidence occurred in 1991–1993 (80.8/1000 persons-years). Cerebral toxoplasmosis was the third most incident opportunistic illness in the study, with a peak of incidence of 43.6/1000 persons-year in 1987–1990. Conclusions: All opportunistic illnesses incidence rates decreased over the years but they still occur in an unacceptable frequency. Tuberculosis co-infection among HIV-infected persists as an important challenge for health care professionals and policy makers in our setting. Impressively high rates of cerebral toxoplasmosis were found suggesting that its incidence among HIV-infected is linked to the high prevalence of Toxoplasma gondii infection in the general population

Improved virologic outcomes over time for HIV-infected patients on antiretroviral therapy in a cohort from Rio de Janeiro, 1997–2011

Submitted by Rodrigo Senorans ([email protected]) on 2015-06-24T16:11:10Z No. of bitstreams: 1 Improved virologic outcomes over time for.pdf: 800815 bytes, checksum: 3517789e40d259bc0ea29082a16251a4 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-06-30T16:21:06Z (GMT) No. of bitstreams: 1 Improved virologic outcomes over time for.pdf: 800815 bytes, checksum: 3517789e40d259bc0ea29082a16251a4 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-06-30T16:21:15Z (GMT) No. of bitstreams: 1 Improved virologic outcomes over time for.pdf: 800815 bytes, checksum: 3517789e40d259bc0ea29082a16251a4 (MD5)Made available in DSpace on 2015-06-30T17:22:59Z (GMT). No. of bitstreams: 1 Improved virologic outcomes over time for.pdf: 800815 bytes, checksum: 3517789e40d259bc0ea29082a16251a4 (MD5) Previous issue date: 2014University of California. Los Angeles, CA, United States of AmericaFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilUniversity of California. Los Angeles, CA, United States of AmericaUniversity of California. Los Angeles, CA, United States of AmericaFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilUniversity of California. Los Angeles, CA, United States of AmericaFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilBackground Previous cohort studies have demonstrated the beneficial effects of antiretroviral therapy (ART) on viral load suppression. We aimed to examine the factors associated with virologic suppression for HIV-infected patients on ART receiving care at the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation in Rio de Janeiro, Brazil. Methods HIV-1 RNA levels and CD4+ T-cell counts at the date closest to midyear (1 July) were evaluated for 1,678 ART-naïve patients ≥18 years of age initiating ART between 1997 and 2010. The odds ratios (OR) and 95% confidence intervals (CI) for having an undetectable viral load (≤400 copies/mL) were estimated using generalized estimating equations regression models adjusted for clinical and demographic factors. Time-updated covariates included age, years since HIV diagnosis, hepatitis C diagnosis and ART interruptions. Results Between 1997 and 2011, the proportion of patients with an undetectable viral load increased from 6% to 78% and the median [interquartile range] CD4+ T-cell count increased from 207 [162, 343] to 554 [382, 743] cells/μL. Pre-treatment median CD4+ T-cell count significantly increased over the observation period from 114 [37, 161] to 237 [76, 333] cells/μL (p 1 month per calendar significantly decreased the odds [aOR = 0.32 (95% CI = 0.27-0.38)] of having an undetectable viral load. Patients initiating on a protease inhibitor (PI)-based first-line regimen were less likely to have undetectable viral load [aOR = 0.72 (95% CI = 0.63-0.83)] compared to those initiating on a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. Conclusions Our results demonstrate significant improvements in virologic outcomes from 1997 to 2011, which persisted after adjusting for other factors. This may in part be due to improvements in care and new treatment options. NNRTI- versus PI-based first-line regimens were found to be associated with increased odds of having an undetectable viral load, consistent with previous studies. Treatment interruptions were found to be the most important determinant of not having an undetectable viral load. Studies are needed to characterize the reasons for treatment interruptions and to develop subsequent strategies for improving adherence to ART

Cascade of access to interventions to prevent HIV mother to child transmission in the metropolitan area of Rio de Janeiro, Brazil

OBJECTIVES: To describe the access to the interventions for the prevention of Human Immunodeficiency Virus (HIV) mother to child transmission and mother to child transmission rates in the outskirts of Rio de Janeiro, from 1999 to 2009.METHODS: This is a retrospective cohort study. Prevention of HIV mother to child transmission interventions were accessed and mother to child transmission rates were calculated.RESULTS: The study population is young (median: 26 years; interquartile range: 22.0-31.0), with low monthly family income (40.4% up to one Brazilian minimum wage) and schooling (62.1% less than 8 years). Only 47.1% (n = 469) knew the HIV status of their partner; of these women, 39.9% had an HIV-seronegative partner. Among the 1259 newborns evaluated, access to the antenatal, intrapartum and postpartum prevention of HIV mother to child transmission components occurred in 59.2%, 74.2%, and 97.5% respectively; 91.0% of the newborns were not breastfed. Overall 52.7% of the newborns have benefited from all the recommended interventions. In subsequent pregnancies (n = 289), 67.8% of the newborns received the full package of interventions. The overall rate of HIV vertical transmission was 4.7% and the highest annual rate occurred in 2005 (7.4%), with no definite trend in the period.CONCLUSIONS: Access to the full package of interventions for the prevention of HIV vertical transmission was low, with no significant trend of improvement over the years. The vertical transmission rates observed were higher than those found in reference services in the municipality of Rio de Janeiro and in the richest regions of the country

First opportunistic illness after enrollment in IPEC cohort, absolute numbers and incidence rates per 1000 persons-years for 1987–2012 and by calendar period.

<p>Diseases with less than 10 cases reported during the study period are not shown (progressive multifocal leukoencephalopathy n = 8, invasive cervical cancer n = 1, coccidioidomycosis n = 1).</p>a<p>Trend was tested for all illnesses with 40 cases of more during the study period.</p>b<p>Incidence rate ratio between 2009–2012 and 19987–1990 periods.</p>c<p>Reference period was 1994–1996 since the IR in previous periods were equal to zero.</p

Unprotected sex among men who have sex with men living with HIV in Brazil: a cross-sectional study in Rio de Janeiro

Submitted by Rodrigo Senorans ([email protected]) on 2015-06-23T16:27:16Z No. of bitstreams: 1 Unprotected sex among men who have sex with.pdf: 373067 bytes, checksum: d2d63dcc89be503d182309684aba4a81 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-06-26T15:59:29Z (GMT) No. of bitstreams: 1 Unprotected sex among men who have sex with.pdf: 373067 bytes, checksum: d2d63dcc89be503d182309684aba4a81 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-07-06T13:21:06Z (GMT) No. of bitstreams: 1 Unprotected sex among men who have sex with.pdf: 373067 bytes, checksum: d2d63dcc89be503d182309684aba4a81 (MD5)Made available in DSpace on 2015-07-08T13:38:47Z (GMT). No. of bitstreams: 1 Unprotected sex among men who have sex with.pdf: 373067 bytes, checksum: d2d63dcc89be503d182309684aba4a81 (MD5) Previous issue date: 2014FAPERJUniversidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilChildren's Hospital Los Angeles. Division of Infectious Diseases. Los Angeles, CA, United States of AmericaFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilBackground Many countries are facing concentrated HIV epidemics among vulnerable populations, including men who have sex with men (MSM). Unprotected anal intercourse (UAI) is the main HIV transmission route among them and its understanding in the different cultures and how it relates to HIV transmission, re-infection and development of HIV antiretroviral resistance has important public health implications. Data on UAI among Brazilian MSM are scarce. This study aims to evaluate the prevalence and associated factors of UAI among HIV-infected MSM who had sex with seronegative or male partners with an unknown serostatus. Method A cross-sectional study nested in a cohort was conducted in Rio de Janeiro, Brazil. The one hundred and fifty five MSM included in the study answered an ACASI interview and provided biological samples. Generalized linear models were used to identify variables associated with UAI. Results Overall, UAI with an HIV-negative or unknown serostatus male partner was reported by 40.6% (63/155) of MSM. Lifetime sexual abuse or domestic violence was reported by 35.9%, being more frequent among MSM who reported UAI compared to those who did not (P = 0.001). Use of stimulants before sex was reported by 20% of the MSM, being slightly higher among those who reported UAI (27.0% vs. 15.2%; P = 0.072). Commercial sex was frequent among all MSM (48.4%). After multivariate modeling, the report of sexual abuse or domestic violence (OR = 2.70; 95% CI: 1.08-7.01), commercial sex (OR = 2.28; 95% CI: 1.04- 5.10), the number of male sexual partners (p = 0.039) and exclusively receptive anal intercourse (OR = 0.21; 95% CI: 0.06-0.75) remained associated with UAI. CD4 levels, HIV viral load and antiretroviral therapy were not associated with UAI. Conclusion The UAI prevalence found with negative or unknown HIV status partners points out that other interventions are needed as additional prevention tools to vulnerable MSM. The main factors associated with UAI were a lifetime history of violence, commercial sex and the number of male sexual partners. This clustering of different behavioral, health and social problems in this population reinforce the need of a comprehensive approach on treating and preventing HIV among MSM

Incidence rates (per 1000 persons-years) and confidence interval for overall opportunistic illnesses, tuberculosis, <i>Pneumocystis jirovecii</i> pneumonia, cerebral toxoplasmosis and esophageal candidiasis by calendar period.

<p>Incidence rates (per 1000 persons-years) and confidence interval for overall opportunistic illnesses, tuberculosis, <i>Pneumocystis jirovecii</i> pneumonia, cerebral toxoplasmosis and esophageal candidiasis by calendar period.</p

CD4 cell counts of patients under follow-up by calendar period: for each period medians and interquartile ranges are displayed.

<p>CD4 cell counts of patients under follow-up by calendar period: for each period medians and interquartile ranges are displayed.</p

Use of antiretroviral therapy by calendar period.

<p>Use of antiretroviral therapy by calendar period.</p

Outcomes of second-line combination antiretroviral therapy for HIV-infected patients: a cohort study from Rio de Janeiro, Brazil

Submitted by Rodrigo Senorans ([email protected]) on 2015-06-25T17:14:55Z No. of bitstreams: 1 Outcomes of secondline combination antiretroviral therapy for HIVinfected patients a cohort study from Rio de Janeiro, Brazil.pdf: 632625 bytes, checksum: 922cb146b0b47fa63d010b4ac4681c3b (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-07-09T13:09:43Z (GMT) No. of bitstreams: 1 Outcomes of secondline combination antiretroviral therapy for HIVinfected patients a cohort study from Rio de Janeiro, Brazil.pdf: 632625 bytes, checksum: 922cb146b0b47fa63d010b4ac4681c3b (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-07-09T13:09:51Z (GMT) No. of bitstreams: 1 Outcomes of secondline combination antiretroviral therapy for HIVinfected patients a cohort study from Rio de Janeiro, Brazil.pdf: 632625 bytes, checksum: 922cb146b0b47fa63d010b4ac4681c3b (MD5)Made available in DSpace on 2015-07-15T11:58:36Z (GMT). No. of bitstreams: 1 Outcomes of secondline combination antiretroviral therapy for HIVinfected patients a cohort study from Rio de Janeiro, Brazil.pdf: 632625 bytes, checksum: 922cb146b0b47fa63d010b4ac4681c3b (MD5) Previous issue date: 2014BG and PML acknowledge funding from the National Council of Technological and Scientific Development (CNPq) and the Research Funding Agency of the State of Rio de Janeiro (FAPERJ).Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil / Universidade Federal do Estado do Rio de Janeiro. Departamento de Matemática e Estatística. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, BrasilJohns Hopkins University. Baltimore, MD, United States of AmericaFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, BrasilBackground: World-wide, the notable expansion of HIV/AIDS treatment programs in resource-limited settings has lead to an increasing number of patients in need of second-line cART. To adequately address and prepare for this scenario, critical assessments of the outcomes of second-line cART are particularly relevant in settings where monitoring strategies may be inadequate. We evaluated virologic outcomes of second-line combination antiretroviral therapy (cART) among HIV-infected individuals from Brazil. Methods: This study was conducted at the Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, at Rio de Janeiro, Brazio. For this study we included all patients who started first-line and second-line cART between 2000 and 2013. Second-line cART required a switch in the anchor drug of first-line cART. We evaluated time from second-line start to virologic failure and factors associated with increased risk of failure using multivariable Cox proportional hazards regression models. Results: Among the 1,311 patients who started first-line cART a total of 386 patients (29.5%) initiated second-line cART, out of which 35.0% and 60.6% switched from their first-line to their second-line cART when their HIV RNA was undetectable and after documented virologic failure, respectively. At second line cART initiation, median age was 38 years [interquartile range (IQR): 31-45years]. Median CD4 count was significantly different for patients starting second-line cART undetectable [412 cells/mm3 (IQR: 240-617)] compared to those starting second-line cART after documented virologic failure [230 cells/mm3 (IQR: 118-322.5)] (p < 0.01). Median time from second-line cART initiation to failure was also significantly different for patients starting second-line cART undetectable compared to those who with documented virologic failure (log-rank test p < 0.01). Multivariable Cox models showed that younger age, lower education, and HIV RNA level were independently associated with an increased hazard of second-line failure among those with documented virologic failure at start of second-line cART. Conclusions: We have shown that in a middle-income country with universal access to cART, having a detectable HIV RNA at the start of second-line cART as well as younger age and lower education negatively impact second-line outcomes. Our findings could guide HIV treatment efforts as to which strategies would help maximize the durability of these regimens