Introduction. Highly active antiretroviral therapy has been available since 1996. Early initiation of antiretroviral therapy (ART) leads to improved therapeutic response and reduced HIV transmission. However, a significant number of people living with HIV (PLHIV) still start treatment late. Objective. This study aimed to analyze characteristics and factors associated with late initiation of ART among HIV-infected treatment-naïve patients. Methods. This cross-sectional study included PLHIV older than 17 years who initiated ART at two public health facilities from 2009 to 2012, in a city located in Midwestern Brazil. Pregnant women were excluded. Data were collected from medical records, antiviral dispensing forms, and the Logistics Control of Medications System (SICLOM) of the Brazilian Ministry of Health. Late initiation of ART was defined as CD4+ cell count < 200 cells/mm3 or presence of AIDS-defining illness. Uni- and multivariate analysis were performed to evaluate associated factors for late ARV using SPSS®, version 21. The significance level was set at p<0.05. Results. 1,141 individuals were included, with a median age of 41 years, and 69.1% were male. The prevalence of late initiation of ART was 55.8% (95%CI: 52.9-58.7). The more common opportunistic infections at ART initiation were pneumocystosis, cerebral toxoplasmosis, tuberculosis, and histoplasmosis. Overall, 38.8% of patients had HIV viral load equal to or greater than 100,000 copies/mL. Late onset of ART was associated with higher mortality. After logistic regression, factors shown to be associated with late initiation of ARV were low education level, sexual orientation, high baseline viral load, place of residence outside metropolitan area, and concomitant infection with hepatitis B virus. Conclusion. These results revealed the need to increase early treatment of HIV infection, focusing especially on groups of people who are more socially vulnerable or have lower self-perceived risk.
INTRODUCTION:
Progressive multifocal leukoencephalopathy (PML) is a
demyelinating disease of the central nervous system caused by reactivation of
JC virus
(JCV).
METHODS:
We described the profile of laboratory-confirmed PML cases among AIDS patients.
RESULTS:
A total of 43 HIV patients with
clinical conditions compatible with PML were obtained; 5 cases were confirmed by JCV testing. The main clinical finding was mental confusion. Median CD4 count was 54 cells/mm³.
CONCLUSIONS:
Three of the five confirmed PML cases died; the time between diagnosis and death was 2, 5, and 6 months. It is important to consider JCV infection as a differential diagnosis.
Neste trabalho s3o revisadas as evidências sobre a interação entre a infecção pelo HlV/aids e a hanseníase em consonância com os programas de controle e o desenvolvimento de pesquisas nas duas últimas décadas. São apresentadas hipóteses e questões suscitadas pelo possível efeito da co-infecção pelo HIV e Mycobacterium leprae alterar o curso de cada infecção/doença e desenvolver casos mais graves. Aspectos relacionados à interação adversa entre as terapêuticas padronizadas, quando aplicadas simultaneamente para ambas infecções/doenças, e as implicações na vacinação BCG nos países em desenvolvimento são também examinados. A interação entre aids e tuberculose foi usada como exemplo de uma bem conhecida interação biológica entre infecção pelo HIV e doenças infecciosas e para traçar um paralelo com outras micobactérias. A compreensão das interações entre infecção pelo HIV e Mycobacterium leprae permanece de importância primária para implementar prevenção e tratamento com bases científicas nos programas de saúde pública.UNITERMOS: Co-infecção HlV/aids e Mycobacterium leprae. HlV/aids.Hanseníase. Micobactérias.
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