The HIV-Brazil cohort study: design, methods and participant characteristics

Submitted by Rodrigo Senorans ([email protected]) on 2015-06-01T18:08:15Z No. of bitstreams: 1 The HIV-Brazil Cohort study Design, methods and participant characteristics.pdf: 1222683 bytes, checksum: ef2a13de6007bf7b2e9e6b1341982954 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-06-01T18:45:27Z (GMT) No. of bitstreams: 1 The HIV-Brazil Cohort study Design, methods and participant characteristics.pdf: 1222683 bytes, checksum: ef2a13de6007bf7b2e9e6b1341982954 (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-06-01T18:46:20Z (GMT) No. of bitstreams: 1 The HIV-Brazil Cohort study Design, methods and participant characteristics.pdf: 1222683 bytes, checksum: ef2a13de6007bf7b2e9e6b1341982954 (MD5)Made available in DSpace on 2015-06-03T17:03:57Z (GMT). No. of bitstreams: 1 The HIV-Brazil Cohort study Design, methods and participant characteristics.pdf: 1222683 bytes, checksum: ef2a13de6007bf7b2e9e6b1341982954 (MD5) Previous issue date: 2014CNPq, Ministério da Saúde do Brasil, Organização Pan-Americana da Saúde, Secretaria Estadual de Saúde de São Paulo, Centro de Referência e Treinamento DST/AIDS, INI/FIOCRUZUniversidade de São Paulo. Escola de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, BrasilSecretaria Estadual de Saúde de São Paulo. Instituto de Saúde. São Paulo, SP, BrasilUniversidade de São Paulo. Escola de Medicina. Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias . São Paulo, SP, BrasilSecretaria Estadual de Saúde de São Paulo. Centro de Referência e Treinamento DST/AIDS. São Paulo, SP, BrasilSecretaria Estadual de Saúde de São Paulo. Centro de Referência e Treinamento DST/AIDS. São Paulo, SP, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, BrasilSecretaria Estadual de Saúde do Rio grande do Sul. Hospital Sanatório Partenon. Porto Alegre, RS, BrasilSecretaria Estadual de Saúde do Rio grande do Sul. Hospital Sanatório Partenon. Porto Alegre, RS, BrasilUniversidade Federal da Bahia. Complexo Hospitalar Universitário Professor Edgard Santos. Salvador, BA, BrasilUniversidade Federal de Minas Gerais. Faculdade de Medicina. Belo Horizonte, MG, BrasilFundação de Medicina Tropical Doutor Heitor Vieira Dourado. Departamento de Saúde do Estado do Amazonas , ManausSecretaria Estadual de Saúde da Bahia. Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa. Salvador, BA, BrasilUniversidade Federal de Pernambuco. Recife, PE, BrasilFundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST e AIDS. Rio de Janeiro, RJ, BrasilUniversidade de São Paulo. Escola de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, BrasilBackground: The HIV-Brazil Cohort Study was established to analyze the effectiveness of combination antiretroviral therapy (cART) and the impact of this treatment on morbidity, quality of life (QOL) and mortality. The study design, patients’ profiles and characteristics of cART initiation between 2003 and 2010 were described. Methodology/Principal Findings: Since 2003, the HIV-Brazil Cohort has been following HIV-infected adults receiving cART at 26 public health care facilities, using routine clinical care data and self-reported QOL questionnaires. When not otherwise available, data are obtained from national information systems. The main outcomes of interest are diseases related or unrelated to HIV; suppression of viral replication; adverse events; virological, clinical and immunological failures; changes in the cART; and mortality. For the 5,061 patients who started cART between 2003 and 2010, the median follow-up time was 4.1 years (IQR 2.2–5.9 years) with an 83.4% retention rate. Patient profiles were characterized by a predominance of men (male/female ratio 1.7:1), with a mean age of 36.9 years (SD 9.9 years); 55.2% had been infected with HIV via heterosexual contact. The majority of patients (53.4%) initiated cART with a CD4+ T-cell count #200 cells/mm3. The medications most often used in the various treatment regimens were efavirenz (59.7%) and lopinavir/ritonavir (18.2%). The proportion of individuals achieving viral suppression within the first 12 months of cART use was 77.4% (95% CI 76.1–78.6). Nearly half (45.4%) of the patients presented HIV-related clinical manifestations after starting cART, and the AIDS mortality rate was 13.9 per 1,000 person-years. Conclusions/Significance: Results from cART use in the daily practice of health services remain relatively unknown in lowand middle-income countries, and studies with the characteristics of the HIV-Brazil Cohort contribute to minimizing these shortcomings, given its scope and patient profile, which is similar to that of the AIDS epidemic in the country

Characteristics of the AIDS epidemic, sites involved and patient-selection process in the HIV-Brazil Cohort Study.

<p>Data Source: Features of AIDS by site: Data of the municipalities where the sites belonging to the study, with information from the National Epidemiological Surveillance System are; Characteristics of the centers: self-administered questionnaire by the manager of the service within the HIV- Brazil Cohort Study.</p><p>Abbreviations: Het., heterosexual; IDU, injection drug use; P./Ph., patient/physician; UREDIPE, <i>Unidade de Referência Especializada em Doenças Infecciosas e Parasitárias Especiais</i> (Referral Center Specializing in Specific Infectious and Parasitic Diseases); STF, specialized treatment facility; UFPE, <i>Universidade Federal de Pernambuco</i> (Federal University of Pernambuco); HUPES, <i>Hospital Universitário Professor Edgard Santos</i> (Professor Edgard Santos University Hospital); CEDAP, <i>Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa</i> (State Center Specializing in Diagnosis, Treatment and Research); IPEC, Instituto Evandro Chagas (Evandro Chagas Institute); UFMG, <i>Universidade Federal de Minas Gerais</i> (Federal University of Minas Gerais); CRT-SESSP, <i>Centro de Referência e Treinamento em DST e AIDS, Secretaria de Estado da Saúde de São Paulo</i> (São Paulo State Department of Health STD/AIDS Referral and Training Center).</p>a<p>Per 100 000 population (2006–2010).</p>b<p>2001–2005 vs. 2006–2010.</p>c<p>In relation to the total number of cases reported between 2006 and 2010.</p>d<p>Patients alive at follow-up in the services, including use and non-use of cART.</p>e<p>Proportion of the AIDS cases identified in the municipalities served by the facility.</p>f<p>Patients/Infectious disease specialists or general clinicians ratio.</p>g<p>Patients who meet the inclusion criteria between the total number of patients in the clinic follow-up sites.</p>h<p>Fourteen health care facilities affiliated with the City of São Paulo municipality.</p

Characteristics of the regions and sites in the HIV-Brazil Cohort Study.

<p>Notes: ¥ Means per 100 000 population (2006 to 2010); ^#Per capita gross domestic product (2010); £ number of physicians per 1000 inhabitants (2010). Source: Ministry of Health/DATASUS (Information Technology Department of the Brazilian National Health Care System) <i>and the Brazilian Institute of Geography and Statistics.</i></p

Descriptive analysis of loss of follow-up^a in the HIV-Brazil Cohort Study.

<p>Abbreviation: PY, person-years.</p>a<p>Maximum follow-up time of 8.8 years.</p>b<p>Not included are 798 individuals with unknown transmission categories, 2 with unknown ages and 529 without a CD4–T exam prior to cART initiation.</p

Patients included in the HIV-Brazil Cohort Study by follow-up time.

<p>Patients included in the HIV-Brazil Cohort Study by follow-up time.</p