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Epidemiological Patterns of AIDS in a Reference Center from Catanduva, São Paulo State, Brazil*

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Epidemiological Patterns of AIDS in a Reference Center from Catanduva, São Paulo State, Brazil* Open Journal of Medical Microbiology, 2012, 2, 47-53 http://dx.doi.org/10.4236/ojmm.2012.23007 Published Online September 2012 (http://www.SciRP.org/journal/ojmm) Epidemiological Patterns of AIDS in a Reference Center * from Catanduva, São Paulo State, Brazil Arlindo Schiesari Jr.1,2, Kátia Jaira Galisteu3, Luciana Ventura Cardoso3, Vanessa Maria Brogio Schiesari2, Adriana Antônia da Cruz Furini4, Andrea Regina Baptista Rossit5, Ricardo Luiz Dantas Machado3# 1Integrated College Padre Albino, Catanduva, Brazil 2STD/AIDS Municipal Program, Catanduva, Brazil 3Department of Dermatology, Parasitic and Infectious Diseases, Medicine School in São José do Rio Preto, São José do Rio Preto, Brazil 4Rio Preto University Center, São José do Rio Preto, Brazil 5Biomedical Institute, Microbiology and Parasitical Diseases from Fluminense Federal University, Niteroi, Brazil Email: #[email protected] Received March 21, 2012; revised May 6, 2012; accepted May 21, 2012 ABSTRACT Objective: Hereby we present the epidemiological and clinical profile of HIV-infected population before and during the highly active antiretroviral therapy (HAART) era from a tertiary care hospital in the Southeastern region of Brazil. Methods: A retrospective, cross-sectional and descriptive study was carried out, this involved the analysis of the medi- cal records of patients diagnosed with HIV-1/AIDS admitted to Hospital Escola Emílio Carlos, located in the munici- pality of Catanduva, State of São Paulo, Brazil. Results: In both pre-HAART and HAART periods, HIV-1 infection was more prevalent in men. Heterosexuality and secondary education were associated with AIDS in the HAART period. Statistically significant association was only observed for co-infection with HIV-1/Hepatitis C in the pre-HAART era and the number of patients with opportunistic infection (OI) was lower in the HAART period. Among all OI it is worth mentioning pulmonary pneumocystosis, which despite being common in two periods, its occurrence was considerably greater in the pre-HAART era. Concerning the distribution of OIs according to the HIV-1 viral load and serial count of T CD4+ lymphocytes, a significant association was observed. The association between the number of deaths by OIs and death in the 1st year of diagnosis in the HAART treatment was significant. Conclusions: The clinical and epidemiol- ogical profile of a specialized HIV-1/AIDS center in Catanduva, Southeastern Brazilian region, is consistent with the epidemiology of AIDS in the country. Keywords: HIV-Infected Population; Antiretroviral Therapy Highly Active; Brazil 1. Introduction quency of AIDS-related OI still impacts morbid-mortality in the HIV-1 infected population [4]. Almost 30 years after the beginning of the AIDS epidemic, In Latin America one-third of all HIV-1-positive indi- human immunodeficiency virus-1 infection (HIV-1) is still viduals reside in Brazil, a country that 544,846 AIDS a serious world health problem. An estimated 33.4 million cases were notified from 1980 to 2009, and approxi- people around the world carry the virus, and, in 2008 alone, mately 60% of these cases occurred in the Southeastern there were 2 million AIDS-related deaths [1]. Despite region of the country [5,6]. Current statistics indicate the these alarming statistics, the highly active antiretroviral occurrence of significant epidemiological changes in the therapy (HAART), which has been available since 1996, HIV-1 infection epidemic in Brazil, where the dissemi- has revolutionized the treatment of HIV-1 infection and al- nation of the disease has increased in small urban centers lowed the control of the disease in the long term, signify- in individuals with heterosexual practice and in people cantly reducing the frequency of OI and death related with low education [6-9]. In 1996, the country has drawn AIDS [2,3]. However, even in the HAART era, the fre- worldwide attention for its decision of making HAART available to all AIDS patients, which has substantially *Municipal Program of Sexually Transmissible Diseases/AIDS, Faculdades Integradas Padre Albino—FIPA and Faculty of Medicine from São José contributed to reduce mortality and increase the survival do Rio Preto-FAMERP. rate of the referred population [10], according to the in- #Corresponding author. ternational standard. Copyright © 2012 SciRes. OJMM 48 A. SCHIESARI JR. ET AL. Despite the access to HAART, AIDS-related diseases tification and frequency of AIDS-defining opportunistic are still important causes of death in some regions of the illnesses (OI), serial count of LT CD4+ and VL in the country, especially OI, such as pulmonary pneumocysto- presence of OI, the dates of death, survival from the di- sis and tuberculosis [11-14]. The city of Catanduva, lo- agnosis of HIV-1 infection until death, and the identi- cated in the Southeastern Brazil is among the 100 mu- fication and frequency of the OI that caused death were nicipalities with the greatest incidence of AIDS cases in also collected. Besides, the antiretroviral treatment and the country [6]. Nevertheless, there is no clinical and epi- therapeutic adherence by individuals who died from the demiological characterization of individuals with HIV/ OI in the HAART era were evaluated. Good compliance AIDS in this city, which may impact the design and im- with the antiretroviral therapy, patient attendance for plementation of health policies tailored to this area. We previously scheduled medical appointments and collec- present the epidemiological and clinical profile of the tion for laboratory testing were considered therapeutic HIV-infected patients before and during the HAART era adherence criteria. from a tertiary care hospital in Southeastern Brazilian Analyses were performed using R statistical software region. version 2.4.1 (The R Foundation for Statistical Comput- ing ISBN 3-900051-070, http://www.r-project.org, Vi- 2. Material and Methods enna, Austria). To obtain the independence among pro- portions, we applied the v2 test or the Fisher exact test. A retrospective, cross-sectional and descriptive study The selected significance level for statistical inference was carried out. This involved the analysis of the medical was 5%. records of patients diagnosed with HIV-1/AIDS admitted to Hospital Escola Emílio Carlos, located in the munici- 3. Results pality of Catanduva, State of São Paulo, Brazil. This hospital is a philanthropic tertiary care facility associated Of the 302 selected patients’ medical records, 65 were with the medical and nursing schools of Faculdades Inte- from the pre-HAART period (from January 1991 to De- gradas Padre Albino. It offers treatment for several medi- cember 1995) and 237 were from the HAART period cal conditions, including infectious and contagious dis- (from January 2002 to December 2009. The mean age eases, on outpatient and inpatient bases. Catanduva has was 37.5 years old for patients form the pre-HAART 114,812 inhabitants and is located 380 km from the State period and 41.3 years old for those patients in the capital. In the present study, the medical records of pa- HAART period. In both periods, HIV-1 infection was tients 18 years or older diagnosed with infection by HIV-1/ more prevalent in men (75.4% and 59.9% in pre-HAART AIDS and residing in of Catanduva were examined. Two and HAART periods), but there has been a considerable different periods were selected and simultaneously inves- increase in the infection rate among women in the tigated: the pre-HAART period (from January 1991 to HAART period (P = 0.03). Concerning the patients edu- December 1995) and the HAART period (from January cation, there have been significantly higher infection 2002 to December 2009), which corresponds to before rates between people with secondary education during and after more potent drugs have become available in the HAART period (P = 0.001). Analysis of patient ad- Brazil. Of the total 633 individuals diagnosed with HIV-1/ mission to the out patients clinic health care center re- AIDS infection in the two periods of the study, 302 pa- veals that less patients sought health services in the tients records were selected, 65 from the pre-HAART HAART period (P = 0.04). When compared to the possi- period and 237 from the HAART period. The other re- ble ways of getting HIV-1 in the two periods, hetero- cords (especially from the pre-HAART period) were not sexuality was the main risk fact for acquisition of the available for the study. The protocol for this study was disease in the HAART period (P < 0.001), whereas bi- reviewed and approved (Process number 235/2006) by sexuality and use of injectable drugs (UID) were statisti- the ethical and Research Board of the Faculty of Medi- cally significant high risk factors in the pre-HAART pe- cine from São José do Rio Preto, São Paulo state, Brazil. riod (P = 0.03 and P < 0.0001, respectively). No associa- In order to collect the data from the patients records, a tion was observed between prevalence of the infection standard form containing the following items was used: and marital status and residence area (rural versus urban) age, gender, marital status, reason for patient admission of these patients. to the health care unit, area of residence (rural or urban), In the pre-HAART period, 24 of 65 patients’ records education, possible HIV mechanism of transmission, date with information on serial count of T CD4+ (LT CD4+) of diagnosis of HIV-1 infection, serial count of T CD4+ lymphocytes and HIV-1 (CV HIV-1) viral load when the lymphocytes, and HIV-1 viral load in the medical care patients were first admitted to hospital. Ten patients delivered to the patient as soon as he/she was admitted to (41.6%) had LT CD4+ count < 200 cells/mm3 and nine hospital. Data on co-infection with hepatitis B or C, iden- (37.5%) had CV HIV-1 higher than 100,000 copies/ml.
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