Impact of highly active antiretroviral therapy (HAART) on the incidence of opportunistic infections, hospitalizations and mortality among children and adolescents living with HIV/AIDS in Belo Horizonte, Minas Gerais State, Brazil

Candiani, Talitah Michel Sanchez; Pinto, Jorge; Cardoso, Claudete Aparecida Araújo; Carvalho, Inácio R.; Dias, Arlete C. M.; Carneiro, Mariângela; Goulart, Eugênio Marcos Andrade

doi:10.1590/s0102-311x2007001500009

Cited by 66 publications

(77 citation statements)

References 26 publications

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“…A study conducted in Italy in a cohort of 1,402 children exposed to HIV through MTCT and representative of the pre-HAART (1985-1995) and HAART (1996-2000 and 2001-2005) periods showed the progressive reduction in the rate of specific clinical events, similar to our study with persisting high rates of serious bacterial infections, particularly pneumonia [11]. In Brazil, a previous study conducted in Minas Gerais State (Southeast region) in a referral center showed that the effectiveness of HAART was associated with significant reduction in the incidence of opportunistic infections in 371 children observed between 1989 and 2003 [18]. However, these data were not representative for the AIDS population.…”

Section: Discussionsupporting

confidence: 85%

“…However, few population-based studies have evaluated changes in the pattern of occurrence of diseases associated with HIV/AIDS [11,18,28,29]. Our data show a significant reduction in occurrence of all opportunistic illness in the HAART era: children that were born, or diagnosed with HIV/AIDS or had ART initiation after 1996 consistently and significantly reducing the chances of having opportunistic illness.…”

Section: Discussionmentioning

confidence: 64%

“…Few studies have evaluated changes of clinical patterns with the introduction of HAART in children [18]. The aim of this study is to determine the global and specific frequencies of AIDS-defining illnesses and associated factors in the two national Brazilian cohorts of children with AIDS.…”

Section: Introductionmentioning

confidence: 99%

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Opportunistic illnesses in Brazilian children with AIDS: results from two national cohort studies, 1983-2007

Ramos

Matida²,

Hearst

et al. 2011

AIDS Res Ther

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BackgroundHAART has significantly reduced AIDS-related morbidity in children. However, limited evidence is available from developing countries regarding patterns of opportunistic illnesses. We describe these events and their associated factors in children with AIDS in Brazil.MethodsThis study is based on two representative retrospective multi-center cohorts including a total 1,859 children with AIDS, infected via mother-to-child transmission (MTCT), between 1983-2002. Opportunistic illnesses were described and analyzed over time. The association of demographic, clinical and operational data with the occurrence of opportunistic diseases was assessed.ResultsIn total, 1,218 (65.5%) had at least one event of an opportunistic disease. Variables significantly associated with occurrence of these events included: region of residence (OR 2.68-11.33, as compared to the Northern region), age < 1 year at diagnosis (OR 2.56, 95% CI 1.81-3.61, p < 0.001), and non-performance of MTCT prevention measures (OR 1.58, 95% CI 1.21-2.07, p < 0.001). Protective factors included year of HIV diagnosis in the HAART era (OR 0.34, 95% CI 0.15-0.76, p = 0.009) and ART use (OR 0.58, 95% CI 0.44-0.77, p < 0.001). In both periods bacterial infections represented the most common opportunistic events (58.6 vs. 34.7%; p < 0.001), followed by Pneumocystis jirovecii pneumonia (21.9 vs. 13.2%; p < 0.001), and bacterial meningitis/sepsis (16.8 vs. 7.4%; p < 0.001).ConclusionsDespite the significant reduction in recent years, opportunistic illnesses are still common in Brazilian children with AIDS in the HAART era, especially bacterial diseases. The data reinforce the need for scaling up prevention of MTCT, early diagnosis of infection, and improvement of comprehensive pediatric care.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 64%

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Opportunistic illnesses in Brazilian children with AIDS: results from two national cohort studies, 1983-2007

Ramos

Matida²,

Hearst

et al. 2011

AIDS Res Ther

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“…1 This scenario was made possible by the advent of highly active antiretroviral therapy (HAART), which, alongside various prophylactic measures, has decreased morbidity and mortality rates in this group. [2][3][4][5] In Brazil, 11,607 cases of childhood AIDS due to motherto-child transmission were reported between the years of 1980 and 2008. 6 Clinical observation and follow-up of this population has shown that, as the HIV/AIDS wears on, the challenges faced by care providers and patients have also changed.…”

Section: Introductionmentioning

confidence: 99%

A transição de adolescentes com HIV/AIDS para a clínica de adultos: um novo desafio

Machado¹,

Succi²,

Turato³

2010

J. Pediatr. (Rio J.)

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Objective: To review the literature on transition from pediatric to adult-oriented health care and discuss this issue in the specific context of chronic conditions. Sources: MEDLINE and LILACS were searched for relevant English and French-language articles published between 1990 and 2010. Summary of the findings:The transition of adolescents with chronic diseases from pediatric care to adultoriented services has been a growing concern among pediatric specialties. In recent years, young people living with HIV/AIDS have begun to reach adulthood, giving rise to several challenges. The studies reviewed herein discuss such relevant topics as: the difference between transfer, an isolated event, and transition, a gradual process; the transition models used in different services; the importance of transitioning in a planned and individualized manner; the need for comprehensive interaction between pediatric and adult-oriented care teams; the importance of joint participation of adolescents, their families, and health professionals in the process; barriers to and factors that promote successful transitions; and the special needs of adolescents with HIV/AIDS in this important period of life. Conclusions:Several authors agree that transitioning adolescents to adult-oriented health care should be a gradual process not determined by age alone. It requires a plan established with ample dialogue among adolescents, their families, and pediatric and adult care teams. However, there is little evidence to support any specific model of health care transition. This should prompt researchers to conduct more prospective studies on the theme, especially in more vulnerable groups such as adolescents living with HIV/AIDS.

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“…[1][2][3] The decision of starting antiretroviral therapy is based on clinical and laboratory parameters. [4][5][6][7] Laboratory parameters, CD4+ T-lymphocytes count (CD4+TL) and plasma viral count of HIV, require sophisticated and expensive technology that is not easily available in developing countries.…”

Section: Introductionmentioning

confidence: 99%

Avaliação dos parâmetros hematológicos, virológicos e antropométricos como marcadores de progressão em crianças infectadas pelo HIV-1

Carvalho¹,

Pinto²,

Cardoso³

et al. 2009

J. Pediatr. (Rio J.)

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Impact of highly active antiretroviral therapy (HAART) on the incidence of opportunistic infections, hospitalizations and mortality among children and adolescents living with HIV/AIDS in Belo Horizonte, Minas Gerais State, Brazil

Abstract: The impact of highly active antiretroviral therapy (HAART)

Cited by 66 publications

References 26 publications

Opportunistic illnesses in Brazilian children with AIDS: results from two national cohort studies, 1983-2007

Opportunistic illnesses in Brazilian children with AIDS: results from two national cohort studies, 1983-2007

A transição de adolescentes com HIV/AIDS para a clínica de adultos: um novo desafio

Avaliação dos parâmetros hematológicos, virológicos e antropométricos como marcadores de progressão em crianças infectadas pelo HIV-1

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