A cascata do HIV e a proporção entre carga viral indetectável e detectável em adolescentes e adultos jovens dos 15 municípios com maior prevalência do HIV no estado do Rio Grande do Sul, 2006 e 2016

A epidemia de HIV no Brasil é concentrada em alguns segmentos populacionais que, muitas vezes, estão inseridos em contextos que aumentam suas vulnerabilidades e apresentam prevalência superior à média nacional. O estado do Rio Grande do Sul (RS) apresenta uma epidemia diferenciada, mantendo-se ao longo dos anos como um dos estados com maior prevalência da infecção pelo HIV no país. Uma das populações chamadas prioritárias pelo Ministério da Saúde, são os jovens. Contudo, poucos estudos relacionados ao HIV levam em conta as transições de desenvolvimento dos jovens, e estudos raramente incluem pessoas com idade de 13 a 24 anos. Neste contexto, nosso trabalho objetivou a construção da Cascata do HIV da população de adolescentes e jovens adultos dos 15 municípios de maior prevalência de HIV no estado do RS, avaliação da evolução da Carga Viral detectável e, razão entre a carga viral indetectável e detectável nessa população, entre os anos de 2006 a 2016. Por meio da vinculação de dados a nível individual para a população de indivíduos HIV positivos de bancos de vigilância de HIV brasileiros, a cascata descreve quatro estimativas de prevalência para etapas sequenciais desde o diagnóstico de HIV até a supressão viral: HIV 'diagnosticado/vinculado' 'retido em cuidado', 'em tratamento' e, 'em supressão viral'. Estratificamos a cascata por gênero, raça, nível educacional e cidade. Os dados foram analisados a partir de uma triangulação de dados dos Sistemas de Controle de Exames Laboratoriais (SISCEL) e do Sistema de Informação de Agravos de Notificação (SINAN) do Ministério da Saúde. Avaliamos a mediana da carga viral in-care de adolescentes e jovens adultos (13 a 24 anos de idade) e comparamos com a mediana da carga viral in-care da população geral de pessoas vivendo com HIV/Aids nas 15 cidades com a maior prevalência de HIV localizados no Rio Grande do Sul, de 2006 a 2016. Exploramos a proporção entre o número de indivíduos com carga viral indetectável e carga viral detectável nas duas populações estudadas. Os resultados das análises apontam para uma carência no perfil de cuidado dos adolescentes e adultos jovens. A cascata ao longo dos 11 anos avaliados mantém-se em uma "estabilidade negativa", sem apresentar evolução de melhora no perfil. Ou seja, o número de adolescentes e adultos jovens diagnosticados, vinculados, retidos, em tratamento e em supressão; não apresenta evolução de melhora no cuidado e atenção à essa população específica. O mesmo observa-se na análise da razão entre os indivíduos com carga viral indetectável em relação aos indivíduos com carga viral detectável. Ainda, em comparação com a população em geral, os adolescentes e adultos jovens apresentaram uma razão significativamente menor, mostrando-se uma população onde o número de indivíduos com carga viral detectável é superior aos adolescentes e adultos jovens que atingem supressão viral. A deficiência de informações e dados referentes à epidemia nesse recorte populacional é uma questão global. A caracterização do cenário da epidemia em adolescentes e adultos jovens é de extrema valia para que possamos embasar ações específicas e factíveis no intuito de evoluir para um cenário mais favorável.The HIV epidemic in Brazil is concentrated in some segments of the population which are often inserted in contexts that increase their vulnerability and present prevalence higher than the national average. The state of Rio Grande do Sul (RS) presents a differentiated epidemic, remaining over the years as one of the states with the highest prevalence of HIV infection in the country. One of the populations defined as a priority by the Ministry of Health is the young people. However, few HIV-related studies take into account the developmental transitions of young people, and studies rarely include people from 13 to 24 years old. In this context, our study aimed to build the adolescents and young adults' HIV cascade of 15 municipalities with the highest HIV prevalence in the State of Rio Grande do Sul, evaluate the evolution of the detectable viral load and the ratio between undetectable and detectable viral load in this population in the period of 2006 to 2016. Using linked individual-level data for the population of HIVpositive individuals in Brazilian National HIV Surveillance Databases, the cascade depicts four prevalence estimates for sequential steps from HIV diagnosis through viral suppression: HIV ‘diagnosed/linked’ to care, ‘retained’ in care, ‘on treatment’ and virologically ‘suppressed’. We stratified the cascade by gender, race, educational level, and city. Data were analyzed from a linkage triangulation of data from the Laboratory Examination Information System (SISCEL) and the Notifiable Diseases Information System (SINAN) from the Brazilian Ministry of Health. We evaluated the median in-care viral load of the adolescents and young adults (13 to 24 years of age) and compared with the median in-care viral load of the overall population of people living with HIV/Aids in the 15 cities with the highest HIV prevalence in Brazil that are located in Rio Grande do Sul from 2006 to 2016. We explored the proportion between the number of individuals with undetectable viral load and detectable viral load in the two studied populations. The results of the analyzes point to a lack of care profile among adolescents and young adults. The cascade over the evaluated 11 years remains in a "negative stability", without presenting evolution of improvement in the profile. That is, the number of adolescents and young adults diagnosed, linked, retained, treated and suppressed; there is no evolution of improvement in care and attention to this specific population. The same was observed in the analysis of the ratio between individuals with undetectable viral load in relation to individuals with detectable viral load. Still, compared to the general population, adolescents and young adults presented a significantly lower ratio, showing a population where the number of individuals with detectable viral load is higher than adolescents and young adults who reach viral suppression. The lack of information and data regarding the epidemic in this age range population is a global issue. The characterization of the epidemic scenario in adolescents and young adults is extremely valuable so that we can base specific and feasible actions in order to evolve to a more favorable scenario

Efficient Identification of HIV Serodiscordant Couples by Existing HIV Testing Programs in South Brazil.

ObjectiveTo examine the feasibility of identifying HIV negative at risk individuals in HIV serodiscordant couples, during voluntary HIV testing in South Brazil.MethodsWe surveyed HIV testers at 4 public testing sites in Rio Grande do Sul. We obtained information on risk behaviors and sexual partnerships. HIV testing and testing for recent infection were performed; HIV prevalence and risk behaviors were assessed among subjects who reported having a steady partner who was HIV positive (serodiscordant group) and compared with the general testing population.ResultsAmong 3100 patients, 490 (15.8%) reported being in a steady relationship with an HIV positive partner. New HIV infections were diagnosed in 23% of the serodiscordant group (vs. 13% in the general population, p = 0.01); among newly positive subjects, recent HIV infections were more frequent (23/86, 26.7%) among testers with positive partners than among the general testing group (52/334; 15.6%; p = 0.016). Less than half of the serodiscordant testers reported having used a condom during the last sexual intercourse with their HIV-positive partner. Participants with inconsistent condom use with steady partner were four times more likely to test positive for HIV compared to those who reported always using condoms with the steady partner (OR: 4.2; 95% CI: 2.3 to 7.5).ConclusionIt is highly feasible to identify large numbers of HIV susceptible individuals who are in HIV serodiscordant relationships in South Brazil testing sites. Condom use within HIV serodiscordant couples is low in this setting, suggesting urgent need for biomedical prevention strategies to reduce HIV transmission

Associação da incidência de dislipidemia e anormalidades de glicose com o tratamento antirretroviral em uma coorte de crianças infectadas pelo HIV na américa latina (NISDI/PLACES)

Objetivo(s): Estimar a incidência de anormalidades metabólicas lipídicas e de glicose e sua associação com a exposição à HAART em regimes incluindo ou não inibidores de protease (IP) em crianças verticalmente infectadas pelo HIV. Projeto: Estudo de coorte longitudinal. Métodos: Foram analisados os dados de 500 crianças da coorte NISDI PLACES. Estimou-se a incidência de dislipidemia (colesterol total, HDL, LDL e TG) e anormalidades da glicose (resistência à insulina e diabetes). As curvas de sobrevida de Kaplan-Meier foram utilizadas para avaliar o tempo para o desenvolvimento de cada um dos desfechos de acordo com os diferentes regimes de ARV. Um modelo de riscos proporcionais de Cox foi utilizado para avaliar os fatores de risco, considerando o regime ARV utilizado na linha de base e de acordo com o seguimento. Resultados: Indivíduos que receberam regimes contendo IP apresentaram maior risco de desenvolver níveis de colesterol anormais (HR = 3,0, 95% intervalo de confiança [IC]: 1,2-7,6 , p = 0,022) ; níveis de colesterol LDL (HR = 2,9, IC 95%: 1,01-8,0 , p = 0,047) e triglicerídeos (HR = 2,7, IC 95 % : 1,4-5,0 , p = 0,003) em comparação com aqueles que não recebem ARVs. Conclusão: As crianças e adolescentes que receberam um esquema antirretroviral contendo IP mostraram risco substancialmente maior para o desenvolvimento de anormalidades de colesterol total, colesterol LDL e triglicerídeos, e baixos níveis de colesterol HDL.Objective(s): To estimate the incidence of lipid and glucose metabolic abnormalities and their association with HAART exposure in protease inhibitors (PI) containing and non-PI containing regimens in perinatally HIV-infected children. Design: Longitudinal cohort study. Methods: We analyzed the data of 500 children from the NISDI PLACES cohort. We estimated the incidence of dyslipidemia (TC, HDL, LDL and TG) and glucose abnormalities (Insulin resistance and diabetes). Kaplan-Meier survival curves were used to evaluate the time to development of each outcome according to the different ARV regimens. A Cox proportional hazards model was used to evaluate it as risk factors, considering the ARV regimen used at baseline in the former and the ARV regimen as a time-varying covariate in the latter. Results: Subjects receiving PI-containing regimens showed higher risk of developing abnormal cholesterol levels (HR=3.0, 95% confidence interval [CI]: 1.2-7.6; p=0.022); LDL cholesterol levels (HR=2.9, 95% CI: 1.01-8.0; p=0.047) and triglycerides levels (HR=2.7, 95% CI: 1.4-5.0; p=0.003) comparing to those not receiving ARVs. Conclusion: Children and adolescents receiving a PI-containing regimen ARV showed substantially higher for developing abnormal total cholesterol, LDL cholesterol and triglycerides levels, and low HDL cholesterol levels

A psychometric study of an executive function assessment instrument (TDI-FE)

Abstract Background This study aims to present and discuss the psychometric properties of executive functions, which were measured using the TDI-FE instrument. The analysis encompasses its internal structure, potential sensitivity to fatigue factors, relationships with external criteria, and diagnostic accuracy. Methods The study sample comprised 382 students from Brazil, aged 6–8 years. Child development variables were screened using the TDI-FE and gold standard tests (Cancellation Attention and Trail Making Tests). The proposed scale comprised four activities: a test with fruit images with three tasks, and one memory game. Results The one-factor model of EF of the TDI-FE failed to fit to the data. However, fit substantially improved once a latent fatigue factor was controlled in the model. The latent factor of EF assessed by the TDI-FE tasks was coherently associated with a series of external variables, including two popular collateral measures of EF. The diagnostic accuracy was reasonable, and a cut-off of 37 points produced 70% of sensitivity and 60% of specificity. Conclusion Results indicated that the TDI-FE demonstrated sound psychometric properties and diagnostic accuracy, then consisting of an efficient alternative for the assessment of EFs in early childhood education. The study also proved the need to control for response biases such as fatigue in the latent variable models of EF. The TDI-FE is notable because of its low cost and easy application, and it might fulfill a need for instruments for individuals from different contexts at this stage of development in Brazil

Efficient Identification of HIV Serodiscordant Couples by Existing HIV Testing Programs in South Brazil.

ObjectiveTo examine the feasibility of identifying HIV negative at risk individuals in HIV serodiscordant couples, during voluntary HIV testing in South Brazil.MethodsWe surveyed HIV testers at 4 public testing sites in Rio Grande do Sul. We obtained information on risk behaviors and sexual partnerships. HIV testing and testing for recent infection were performed; HIV prevalence and risk behaviors were assessed among subjects who reported having a steady partner who was HIV positive (serodiscordant group) and compared with the general testing population.ResultsAmong 3100 patients, 490 (15.8%) reported being in a steady relationship with an HIV positive partner. New HIV infections were diagnosed in 23% of the serodiscordant group (vs. 13% in the general population, p = 0.01); among newly positive subjects, recent HIV infections were more frequent (23/86, 26.7%) among testers with positive partners than among the general testing group (52/334; 15.6%; p = 0.016). Less than half of the serodiscordant testers reported having used a condom during the last sexual intercourse with their HIV-positive partner. Participants with inconsistent condom use with steady partner were four times more likely to test positive for HIV compared to those who reported always using condoms with the steady partner (OR: 4.2; 95% CI: 2.3 to 7.5).ConclusionIt is highly feasible to identify large numbers of HIV susceptible individuals who are in HIV serodiscordant relationships in South Brazil testing sites. Condom use within HIV serodiscordant couples is low in this setting, suggesting urgent need for biomedical prevention strategies to reduce HIV transmission

Sexual risk behavior of the 490 participants in serodiscordant partnerships.

<p>Sexual risk behavior of the 490 participants in serodiscordant partnerships.</p

Demographic characteristics of the entire cohort and risk factors for HIV infection.

<p>Demographic characteristics of the entire cohort and risk factors for HIV infection.</p