ABSTRACT Conditions related to the acquired immune deficiency syndrome (AIDS) are still a significant cause of morbidity and mortality among people living with HIV (PLHIV). Longer survival in this population were reported to increase the risk of developing noncommunicable chronic diseases (NCDs). This study aimed to estimate the survival and causes of death according to age group and sex among PLHIV monitored at two referral centers in the Northeastern Brazil. This is a prospective, retrospective cohort with death records from 2007 to 2018, based on a database that registers causes of death using the International Classification of Disease (ICD-10), which were subsequently coded following the Coding Causes of Death in HIV (CoDe). A total of 2,359 PLHIV participated in the study, with 63.2% being men, with a follow-up period of 13.9 years. Annual mortality rate was 1.46 deaths per 100 PLHIV (95% CI: 1.33 – 1.60) with a frequency of 20.9%. Risk of death for men increased by 49% when compared to women, and the risk of death in PLHIV increased by 51% among those aged 50 years and over at the time of diagnosis. It was observed that 73.5% accounted for AIDS-related deaths, 6.9% for non-AIDS defining cancer, 6.3% for external causes, and 3.2% for cardiovascular diseases. Among the youngest, 97.2% presented an AIDS-related cause of death. Highest frequency of deaths from neoplasms was among women and from external causes among men. There is a need for health services to implement strategies ensuring greater adherence to treatment, especially among men and young people. Moreover, screening for chronic diseases and cancer is essential, including the establishment of easily accessible multidisciplinary care centers that can identify and address habits such as illicit drug use and alcoholism, which are associated with violent deaths. AIDS (AIDS PLHIV. . (PLHIV) NCDs. NCDs (NCDs) Brazil prospective 200 2018 ICD10, ICD10 ICD 10 , (ICD-10) CoDe. CoDe (CoDe) 2359 2 359 2,35 632 63 63.2 followup follow up 139 13 9 13. 146 1 46 1.4 95% 95 (95 CI 133 33 1.3 1.60 160 60 209 20 20.9% 49 51 5 diagnosis 735 73 73.5 AIDSrelated 69 6 6.9 nonAIDS non 3 6.3 32 3.2 youngest 972 97 97.2 treatment Moreover essential alcoholism (PLHIV (NCDs 201 ICD1 (ICD-10 (CoDe 235 35 2,3 63. 14 4 1. (9 1.6 16 20.9 7 73. 6. 3. 97. (ICD-1 23 2, ( 20. (ICD- (ICD

ABSTRACT Background: We investigated the time to death and factors associated with deaths from dengue and chikungunya during the first epidemic after the introduction of the chikungunya virus in Northeastern Brazil. Methods: This retrospective cohort study was conducted in Pernambuco between 2015 and 2018. Logistic regression was used to identify independent risk factors. The probability of survival among individuals with different arbovirus infections was estimated and the survival curves were compared using log-rank tests. Results: The lethality coefficients for dengue and chikungunya viruses were 0.08% and 0.35%, respectively. The chance of death due to chikungunya infection increased progressively from the age of 40 years. At 40-49 years, the odds ratio was 13.83 (95%CI, 1.80-106.41). At 50-59 years and 60 years or older, the odds ratio was 27.63 (95%CI, 3.70-206.48); and 78.72 (95%CI, 10.93-566.90), respectively. The probability of death associated with dengue virus infection increased from the age of 50 years. Among patients aged 50-59 years and 60 years or older, the odds ratio was 4.30 (95%CI, 1.80-10.30) and 8.97 (95%CI, 4.00-20.0), respectively. Independent factors associated death were headache and age of 50 years or older for dengue; and headache, nausea, back pain, intense arthralgia, age 0-9 years or 40 years and older, and male sex for chikungunya. The ratio between mortality rates revealed that the time to death from dengue was 2.1 times faster than that from chikungunya (95%CI, 1.57-2.72). Conclusions: The time to death was shorter in patients with dengue than in those with chikungunya disease. This study reinforces the need for faster and more effective decision-making in public health services to enhance patient outcomes and minimize mortality. Background Brazil Methods 201 2018 logrank log rank tests Results 008 0 08 0.08 035 35 0.35% respectively 4 4049 49 40-4 1383 13 83 13.8 95%CI, 95CI CI 95 (95%CI 1.80106.41. 18010641 1.80 106.41 . 1 80 106 41 1.80-106.41) 5059 59 50-5 6 2763 27 63 27.6 3.70206.48 37020648 3.70 206.48 3 70 206 48 3.70-206.48) 7872 78 72 78.7 10.93566.90, 109356690 10.93 566.90 , 10 93 566 90 10.93-566.90) 5 430 30 4.3 1.8010.30 1801030 10.30 1.80-10.30 897 8 97 8.9 4.0020.0, 400200 4.00 20.0 00 20 4.00-20.0) nausea pain arthralgia 09 9 0- 21 2 2. 1.572.72. 157272 1.57 2.72 57 1.57-2.72) Conclusions disease decisionmaking decision making 0.0 03 0.35 404 40- 138 13. 95%CI 80106 1.80106.41 1801064 180 1.8 10641 106.4 1.80-106.41 505 50- 276 27. 70206 3.70206.4 3702064 370 3.7 20648 206.4 7 3.70-206.48 787 78. 93566 10.93566.90 10935669 1093 10.9 56690 566.9 56 10.93-566.90 43 4. 8010 1.8010.3 180103 1030 10.3 1.80-10.3 89 8. 0020 4.0020.0 40020 400 4.0 200 20. 4.00-20.0 572 1.572.72 15727 157 1.5 272 2.7 1.57-2.72 0. 0.3 1.80106.4 180106 18 1. 1064 106. 1.80-106.4 7020 3.70206. 370206 37 3. 2064 206. 3.70-206.4 9356 10.93566.9 1093566 109 10. 5669 566. 10.93-566.9 801 1.8010. 18010 103 1.80-10. 002 4.0020. 4002 4.00-20. 1.572.7 1572 15 1.57-2.7 1.80106. 1.80-106. 702 3.70206 37020 3.70-206. 935 10.93566. 109356 10.93-566. 1.8010 1801 1.80-10 4.0020 4.00-20 1.572. 1.57-2. 1.80106 1.80-106 3.7020 3702 3.70-206 10.93566 10935 10.93-566 1.801 1.80-1 4.002 4.00-2 1.572 1.57-2 3.702 3.70-20 10.9356 10.93-56 1.80- 4.00- 1.57- 3.70-2 10.935 10.93-5 3.70- 10.93-

RESUMO Objetivo: Descrever a implementação e os resultados da colaborativa PROADI-SUS, do Ministério da Saúde Brasileiro, para redução das infecções relacionadas à assistência à saúde: pneumonia associada à ventilação mecânica, infecção primária da corrente sanguínea associada ao cateter venoso central e infecção do trato urinário associada ao cateter vesical de demora. Métodos: Estudo observacional prospectivo que pesquisou as etapas da implementação e dos resultados por 18 meses, em cinco unidades de terapia intensiva de Recife. As reduções de infecções relacionadas à assistência à saúde em cada unidade foram calculadas pelas medianas anteriores comparadas ao período do estudo. Resultados: A meta de redução das três infecções relacionadas à assistência à saúde, ou seja, 30% em 18 meses, foi obtida em no mínimo uma das infecções relacionadas à assistência à saúde nas cinco unidades de terapia intensiva, sendo ainda atingida para duas infecções relacionadas à assistência à saúde em dois hospitais e nas três infecções relacionadas à assistência à saúde em apenas um hospital; este último atingiu a meta prevista para 36 meses. Foram ações consideradas essenciais pelas equipes gestoras locais a implantação dos bundles e o acompanhamento dos resultados pelos profissionais. Também, aquisição de insumos e disponibilização junto aos leitos, sinalização, checklists, conscientização da equipe, adaptação, criação de times, treinamento e comemoração de conquistas foram avaliados como relevantes para redução das infecções relacionadas à assistência à saúde. Conclusão: A colaborativa reduziu infecções relacionadas à assistência à saúde, apesar da adesão parcial aos bundles. A hipótese é a de que o êxito se relacione com a metodologia do projeto e equipes multiprofissionais motivadas, especialmente a enfermagem.

ABSTRACT Objective: To describe the implementation and results of the collaborative PROADI-SUS project by the Brazilian Ministry of Health to reduce healthcare-associated infections: ventilator-associated pneumonia, primary central line-associated bloodstream infection and catheter-associated urinary tract infections. Methods: This was a prospective observational study that investigated the implementation stages and outcomes during 18 months in five intensive care units in the city of Recife. Reductions in healthcare-associated infections in each unit were calculated using previous medians compared to those of the study period. Results: The goal of reducing the three healthcare-associated infections, i.e., 30% in 18 months, was achieved in at least one of the healthcare-associated infections and was also achieved for two healthcare-associated infections in two hospitals and three healthcare-associated infections in just one hospital; the latter reached the target of 36 months. Implementing the bundles and monitoring the results by the professionals were considered essential actions by the local management teams. In addition, the acquisition of supplies and their availability alongside the beds, signage, checklists, staff awareness, adaptation, team building, training and celebration of achievements were assessed as being relevant for reducing healthcare-associated infections. Conclusion: The collaborative approach reduced healthcare-associated infections, despite partial adherence to the bundles. The hypothesis is that success is related to the project methodology and motivated multidisciplinary teams, especially nursing teams.

Resumo Fundamento Pacientes com HIV têm maior probabilidade de apresentar doenças cardiovasculares quando comparados à população em geral. Objetivo Este foi um estudo de caso-controle que teve como objetivo avaliar quais fatores estavam associados a uma redução na espessura médio-intimal da carótida (IMT) da carótida e ao aumento na dilatação mediada por fluxo (DMF) da artéria braquial em pacientes com HIV que receberam atorvastatina + aspirina por um período de 6 meses. Métodos Foi realizada uma análise secundária de um ensaio clínico, que incluiu pessoas vivendo com HIV e baixo risco cardiovascular. Um total de 38 pacientes alocados para o braço de intervenção e tratados por 6 meses com uma combinação de atorvastatina + aspirina foram incluídos. Todos os participantes foram submetidos a ultrassonografia da carótida e da artéria braquial, tanto no início quanto no final do estudo. Os casos que responderam com aumento >10% da dilatação braquial (DMF) e redução da espessura médio-intimal da carótida (IMT) foram considerados casos, e aqueles que não responderam foram considerados controles. Avaliamos os fatores associados às respostas positivas obtidas através da IMT e DMF. Resultados A redução do IMT não se associou significativamente a nenhum dos fatores de risco avaliados: idade (p = 0,211), sexo (p = 0,260), tabagismo (p = 0,131) ou tempo de diagnóstico do HIV (p = 0,836). Um aumento na DMF foi significativamente associado com a idade entre aqueles na faixa etária de 40-59 anos, p = 0,015 (OR = 4,37; IC 95%: 1,07-17,79). Conclusões Os indivíduos mais velhos foram mais propensos a apresentar um aumento na DMF após 6 meses de tratamento com atorvastatina + aspirina.

Abstract Background Patients with HIV are more likely to present with cardiovascular disease when compared to the general population. Objective This was a case-control study that aimed to assess which factors were associated with a reduction in the carotid intima-media thickness (IMT) and an increase in the brachial artery flow-mediated dilation (FMD) in HIV patients who received atorvastatin + aspirin during a period of 6 months. Methods A secondary analysis of a clinical trial was conducted, which included people living with HIV infection and low cardiovascular risk. A total of 38 patients allocated to the intervention arm and treated for 6 months with a combination of atorvastatin + aspirin were included. All participants underwent a carotid and brachial artery ultrasound, both at the beginning and the end of the study. Cases that responded with an increase of >10% of the brachial dilatation (FMD) and reduction of the carotid intima-media thickness (IMT) were considered cases, and those who did not respond were considered controls. We assessed the factors associated with the positive responses obtained through IMT and FMD. Results A reduction in the IMT was not significantly associated with any of the evaluated risk factors: age (p=0.211), gender (p=0.260), smoking (p=0.131) or time since HIV diagnosis (p=0.836). An increase in the FMD was significantly associated with age amongst those in the 40-59 age group, p = 0.015 (OR = 4.37; 95% CI: 1.07-17.79). Conclusions Older individuals were more likely to present with an increased FMD after 6 months of treatment with atorvastatin + aspirin.

ABSTRACT The efficacy of direct-acting antivirals (DAAs) in the treatment of chronic hepatitis C (CHC) in liver transplant recipients is poorly understood, and several factors, including immunosuppression, drug interactions, elevated viraemia, and intolerance to ribavirin (RBV), can reduce cure rates. We conducted a real-life study on liver transplant recipients with CHC treated with a combination of sofosbuvir (SOF) and daclatasvir (DCV) or simeprevir (SIM), with or without RBV, followed-up for 12 to 24 weeks. The treatment effectiveness was assessed by determining the sustained virological response (SVR) rates at 12 or 24 weeks after the treatment cessation. Eighty-four patients were evaluated, with a mean age of 63.4 ± 7.4 years, HCV genotype 1 being the most prevalent (63.1%). Nineteen patients (22.7%) had mild fibrosis (METAVIR < F2) and 41 (48.8%) significant fibrosis (METAVIR ≥ F2). The average time between liver transplantation and the start of treatment was 4 years (2.1-6.6 years). The SOF + DCV regimen was used in 58 patients (69%). RBV in combination with DAAs was used in seven patients (8.3%). SVR was achieved in 82 patients (97.6%), and few relevant adverse events could be attributed to DAA therapy, including a patient who stopped treatment due to a headache. There was a significant reduction in ALT, AST, GGT and FA levels, or the APRI index after 4 weeks of treatment, which remained until 12/24 weeks post-treatment. DAA treatment of CHC in liver-transplanted patients achieved a high SVR rate and resulted in the normalization of serum levels of liver enzymes.

Resumo Fundamento: As pessoas que vivem com HIV têm um risco aumentado de doença cardiovascular e espessamento da carótida, devido à inflamação causada pelo vírus, à terapia antirretroviral e a outros fatores de risco. No entanto, poucos estudos observaram a ocorrência de doenças cardiovasculares e espessamento carotídeo na população soropositiva com baixo risco cardiovascular e carga viral indetectável. Objetivos: Avaliar a associação entre níveis de marcadores inflamatórios e espessura da carótida em pessoas vivendo com HIV, sob terapia antirretroviral e com baixo risco cardiovascular. Métodos: Para determinar o baixo risco cardiovascular em ambos os grupos (indivíduos infectados e não-infectados pelo HIV), foi utilizado o Escore de Risco de Framingham. Os marcadores inflamatórios (IFN-γ, TNF-α, IL-1β, IL-6, sVCAM-1 e sICAM-1) foram avaliados por citometria de fluxo. A espessura da carótida (mm) foi mensurada por meio de ultrassom com Doppler. O nível de significância foi de p < 0,05. Resultados: Em pessoas vivendo com HIV, a idade e o tabagismo foram associados a alterações da espessura da carótida. No grupo não-HIV, idade e níveis mais altos de colesterol total e LDL foram associados ao aumento da espessura da carótida. Utilizando a análise multivariada, observou-se associação significativa entre os níveis de TNF-α e IL-1β e maior chance de desenvolvimento de aterosclerose no grupo com HIV. Conclusão: Ambos os grupos têm risco semelhante de desenvolver doença cardiovascular, portanto, nosso estudo demonstra que indivíduos HIV-positivos com carga viral indetectável em terapia antirretroviral sem inibidores de protease e com baixo risco cardiovascular não apresentam diferenças na espessura da carótida em relação aos indivíduos não-infectados.

Abstract Background: People living with HIV are at increased risk of cardiovascular disease and carotid thickness, due to the inflammation caused by the virus, the antiretroviral therapy, and other risk factors. However, few studies have observed the occurrence of cardiovascular diseases and carotid thickness in HIV-positive population at low cardiovascular risk and with undetectable viral load. Objectives: To evaluate the association between levels of inflammatory markers and carotid thickness in people living with HIV, under antiretroviral therapy and at low cardiovascular risk. Methods: To determine low cardiovascular risk in both groups (HIV infected and non-infected individuals), the Framingham Risk Score was used. Inflammatory markers (IFN-γ, TNF-α, IL-1β, IL-6, sVCAM-1, and sICAM-1) were assessed using flow cytometry. Carotid thickness (mm) was measured using Doppler ultrasound. Level of significance was p < 0.05. Results: In People living with HIV, age and smoking status were associated with carotid thickness alterations. In the non-HIV group, age, higher total cholesterol, and LDL levels were associated with increased carotid thickness. Using the multivariate analysis, a significant association between TNF-α and IL- 1( levels, and a higher chance of atherosclerosis development in HIV group were observed. Conclusions: Both groups have a similar risk for developing cardiovascular disease, therefore our study demonstrates that HIV-positive individuals with undetectable viral load in antiretroviral therapy without protease inhibitors and with low cardiovascular risk do not present differences in carotid thickness in relation to uninfected individuals.

ABSTRACT Chikungunya, a viral infection that presents with fever, rash and polyarthritis, is usually an acute febrile illness. Uncommon neurological manifestations include meningoencephalitis, encephalitis, myelitis, Guillain-Barre syndrome, myelopathy and neuropathy. During an outbreak of the disease in La Reunion Island, abnormalities were observed in the magnetic resonance imaging (MRI) of patients with encephalitis and acute disseminated encephalomyelitis, showing bilateral, frontoparietal, white matter lesions with restricted diffusion, similar to our case. We report a 57-year-old male patient with comorbidities, admitted with high fever, arthralgia, asthenia, vomiting, psychomotor agitation, behavioral changes and seizures. Cerebrospinal fluid (CSF) values revealed pleocytosis (98 cells/mm3 with 68% lymphocytes and 12% monocytes) and high levels of protein (161 mg%). Brain MRI showed hyperintense lesions in the temporal and frontal lobes and bilaterally in the posterior thalamus. CSF serology was positive for IgM antibodies to Chikungunya virus. Encephalitis due to an acute viral infection by Chikungunya was diagnosed. The patient’s clinical condition worsened and he died on the twenty-fourth day of admission to our hospital.

ABSTRACT The Northeast of Brazil has experienced a triple epidemic, with the simultaneous circulation of dengue virus (DENV), chikungunya virus (CHIKV) and Zika virus (ZIKV), which may have contributed to the observed increase across this region of atypical forms of disease and deaths. In view of this fact, non-congenital neurological disorders related to arboviruses were compared with other etiologies, mortality and survival rates of patients admitted to referral neurology hospitals in Pernambuco State, Northeast Brazil, from 2015 to 2018. Blood and cerebrospinal fluid samples were collected and tested using molecular and serological assays. The arbovirus-exposed groups were compared with respect to epidemiological, clinical and neurologic characteristics by using the Pearson’s chi-square test. For the survival analysis, the Kaplan-Meier and Hazard Ratio (HR) tests were used, with a 95% confidence interval (CI). Encephalitis and encephalomyelitis were more frequent in arboviruses, while myelitis predominated in the neurological disorders of other etiologies. Guillain-Barré Syndrome (GBS) was similarly distributed amongst the groups. Exposure to one of the arboviruses caused a six-fold increase in the risk of death (HR: 6.37; CI: 2.91 - 13.9). Amongst the arbovirus-exposed groups, infection (DENV/CHIKV) increased nine times the risk of death (HR: 9.07; CI: 3.67 - 22.4). The survival curve indicates that have been exposed to some arbovirus decreased the likelihood of survival compared to those with other etiologies (Log-Rank: p<0.001). Within this scenario, neurologic manifestations of DENV, CHIKV and ZIKV have the potential to increase mortality and decrease survival, and concomitant infection (DENV/CHIKV) is an aggravating factor in reducing the likelihood of survival when compared to monoinfections.

Abstract INTRODUCTION The incidence of syphilis has increased since the 1970s. METHODS This was a descriptive and analytical cross-sectional study with a non-probabilistic sample. RESULTS: Of 973 patients with human immunodeficiency virus, 179 (18.4%) tested positive for both human immunodeficiency virus and syphilis, 84.8% were men, 50.9% were aged between 36 and 50 years, 47.8% with syphilis were diagnosed with human immunodeficiency virus for 10-20 years, and 40.3% received antiretroviral therapy for 10-20 years. CONCLUSIONS The prevalence of syphilis in patients with human immunodeficiency virus is higher than expected, making it urgent to adopt efficient public health measures.

Resumo Fundamento: Pessoas que vivem com o HIV (HIV +) têm maior prevalência de aterosclerose e a desenvolvem mais precocemente do que a população geral. Objetivos: Foi avaliar e comparar as prevalências de aterosclerose avaliada pela medida da espessura mediointimal (EMI) das carótidas comuns e femorais, e do índice tornozelo-braquial (ITB) nos grupos controle e HIV com e sem inibidores de protease (IPs). Métodos: Foram incluídas 80 pessoas com HIV + [40 usavam IPs e 40 não] e 65 controles. O diagnóstico de aterosclerose foi determinado pela medição da EMI (carótidas e femorais) e do ITB. Fatores de risco clássicos para aterosclerose e específicos para o HIV foram comparados entre os grupos, usando testes estatístcos. O valor de p ≤ 0,05 foi cosiderado significativo. Resultados: A EMI > P75 ou presença de placa foi mais elevada no grupo de HIV sem IP que no controle (37,5% vs 19%, p = 0,04). A análise comparativa mostrou diferença significativa (p=0,014) na EMI nas artérias carótidas entre HIV + com IPs (0,71 ± 0,28 mm), sem IPs (0,63 ± 0,11 mm) e controles (0,59 ± 0,11 mm), A EMI na femoral não teve diferença significante entre os grupos. Não houve diferença significante entre os grupos controle e de HIV + quanto ao ITB. No entanto, observou-se uma diferença significativa (p=0,015) no ITB entre os grupos HIV + sem IPs (1,17 [1,08 - 1,23]), e controles [1,08 (1,07 - 1,17)]. Conclusão: Em pacientes com HIV, a aterosclerose é mais prevalente e parece ocorrer mais precocemente, com características distintas, em comparação a indivíduos HIV-negativos.

Abstract Background: The prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population. Objectives: To assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls. Methods: Eighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant. Results: An IMT > P75 or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17]). Conclusion: In HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects.

RESUMO OBJETIVO Descrever o processo de codificação das causas de morte em pessoas vivendo com HIV/Aids, e classificar os óbitos como relacionados ou não relacionados à imunodeficiência aplicando o sistema Coding Causes of Death in HIV (CoDe). MÉTODOS Estudo transversal, que codifica e classifica as causas dos óbitos ocorridos em uma coorte de 2.372 pessoas vivendo com HIV/Aids acompanhadas entre 2007 e 2012 em dois serviços de atendimento especializado em HIV em Pernambuco. As causas de óbito já codificadas a partir da Classificação Internacional de Doenças foram recodificadas e classificadas como óbitos relacionados e não relacionados à imunodeficiência pelo sistema CoDe. Foram calculadas as frequências dos códigos CoDe das causas do óbito em cada categoria de classificação. RESULTADOS Ocorreram 315 (13%) óbitos no período do estudo; 93 (30%) tinham como causa uma doença definidora de Aids da lista do Centers for Disease Control and Prevention. No total 232 óbitos (74%) foram relacionados à imunodeficiência após aplicar o CoDe. As infecções foram as causas mais comuns, tanto nos óbitos relacionados (76%) como não relacionados (47%) à imunodeficiência, seguindo-se de malignidades (5%) no primeiro grupo e de causas externas (16%), malignidades (12%) e doenças cardiovasculares (11%) no segundo. A tuberculose compreendeu 70% das infecções definidoras de imunodeficiência. CONCLUSÕES Infecções oportunistas e doenças do envelhecimento foram as causas mais frequentes de óbito, imprimindo carga múltipla de doenças aos serviços de saúde. O sistema CoDe aumenta a probabilidade de classificar os óbitos com maior precisão em pessoas vivendo com HIV/Aids.

ABSTRACT OBJECTIVE Describe the coding process of death causes for people living with HIV/AIDS, and classify deaths as related or unrelated to immunodeficiency by applying the Coding Causes of Death in HIV (CoDe) system. METHODS A cross-sectional study that codifies and classifies the causes of deaths occurring in a cohort of 2,372 people living with HIV/AIDS, monitored between 2007 and 2012, in two specialized HIV care services in Pernambuco. The causes of death already codified according to the International Classification of Diseases were recoded and classified as deaths related and unrelated to immunodeficiency by the CoDe system. We calculated the frequencies of the CoDe codes for the causes of death in each classification category. RESULTS There were 315 (13%) deaths during the study period; 93 (30%) were caused by an AIDS-defining illness on the Centers for Disease Control and Prevention list. A total of 232 deaths (74%) were related to immunodeficiency after application of the CoDe. Infections were the most common cause, both related (76%) and unrelated (47%) to immunodeficiency, followed by malignancies (5%) in the first group and external causes (16%), malignancies (12 %) and cardiovascular diseases (11%) in the second group. Tuberculosis comprised 70% of the immunodeficiency-defining infections. CONCLUSIONS Opportunistic infections and aging diseases were the most frequent causes of death, adding multiple disease burdens on health services. The CoDe system increases the probability of classifying deaths more accurately in people living with HIV/AIDS.

RESUMO OBJETIVO Descrever o processo de codificação das causas de morte em pessoas vivendo com HIV/Aids, e classificar os óbitos como relacionados ou não relacionados à imunodeficiência aplicando o sistema Coding Causes of Death in HIV (CoDe). MÉTODOS Estudo transversal, que codifica e classifica as causas dos óbitos ocorridos em uma coorte de 2.372 pessoas vivendo com HIV/Aids acompanhadas entre 2007 e 2012 em dois serviços de atendimento especializado em HIV em Pernambuco. As causas de óbito já codificadas a partir da Classificação Internacional de Doenças foram recodificadas e classificadas como óbitos relacionados e não relacionados à imunodeficiência pelo sistema CoDe. Foram calculadas as frequências dos códigos CoDe das causas do óbito em cada categoria de classificação. RESULTADOS Ocorreram 315 (13%) óbitos no período do estudo; 93 (30%) tinham como causa uma doença definidora de Aids da lista do Centers for Disease Control and Prevention. No total 232 óbitos (74%) foram relacionados à imunodeficiência após aplicar o CoDe. As infecções foram as causas mais comuns, tanto nos óbitos relacionados (76%) como não relacionados (47%) à imunodeficiência, seguindo-se de malignidades (5%) no primeiro grupo e de causas externas (16%), malignidades (12%) e doenças cardiovasculares (11%) no segundo. A tuberculose compreendeu 70% das infecções definidoras de imunodeficiência. CONCLUSÕES Infecções oportunistas e doenças do envelhecimento foram as causas mais frequentes de óbito, imprimindo carga múltipla de doenças aos serviços de saúde. O sistema CoDe aumenta a probabilidade de classificar os óbitos com maior precisão em pessoas vivendo com HIV/Aids.

ABSTRACT OBJECTIVE Describe the coding process of death causes for people living with HIV/AIDS, and classify deaths as related or unrelated to immunodeficiency by applying the Coding Causes of Death in HIV (CoDe) system. METHODS A cross-sectional study that codifies and classifies the causes of deaths occurring in a cohort of 2,372 people living with HIV/AIDS, monitored between 2007 and 2012, in two specialized HIV care services in Pernambuco. The causes of death already codified according to the International Classification of Diseases were recoded and classified as deaths related and unrelated to immunodeficiency by the CoDe system. We calculated the frequencies of the CoDe codes for the causes of death in each classification category. RESULTS There were 315 (13%) deaths during the study period; 93 (30%) were caused by an AIDS-defining illness on the Centers for Disease Control and Prevention list. A total of 232 deaths (74%) were related to immunodeficiency after application of the CoDe. Infections were the most common cause, both related (76%) and unrelated (47%) to immunodeficiency, followed by malignancies (5%) in the first group and external causes (16%), malignancies (12 %) and cardiovascular diseases (11%) in the second group. Tuberculosis comprised 70% of the immunodeficiency-defining infections. CONCLUSIONS Opportunistic infections and aging diseases were the most frequent causes of death, adding multiple disease burdens on health services. The CoDe system increases the probability of classifying deaths more accurately in people living with HIV/AIDS.

Resumo O objetivo foi identificar os fatores associados ao não início do tratamento preventivo para tuberculose (TB) latente (TBLi) em pessoas vivendo com o HIV/AIDS (PVHA). Um estudo de coorte prospectivo foi realizado com PVHA, idade ≥ 18 anos, de dois serviços de referência para HIV/AIDS. De 232 pacientes elegíveis para tratamento da TBLi, 69,8% iniciaram o tratamento. Após análise de regressão logística multivariada, apenas ser tratado em um dos serviços de referência esteve associado ao não início do tratamento para TBLi (p < 0,001). A taxa de incidência de TB na coorte foi de 0,6/100 pessoas/ano. Para os pacientes que iniciaram o tratamento para TBLi, a taxa de incidência de TB foi de 0,4/100 pessoas/ano e para aqueles que não iniciaram, a taxa foi de 1,2/100 pessoas/ano, mas esta diferença não foi estatisticamente significativa. O achado mais interessante deste estudo foi o fato de o principal fator associado ao aumento da probabilidade de ser tratado para TBLi foi a unidade de saúde onde o paciente foi acompanhado.

Abstract The aim was to identify factors associated with non-initiation of prophylactic treatment of latent tuberculosis infection (LTBi) in persons living with HIV/AIDS (PLWA), based on a prospective cohort study of PLWA ≥ 18 years of age in two referral services for HIV/AIDS. Of the 232 patients eligible for treatment of LTBi, 69.8% initiated treatment. Following multivariate logistic regression analysis, only treatment in one of the two referral services was associated with non-initiation of treatment for LTBi (p < 0.001). TB incidence in the cohort was 0.6/100 person-years. TB incidence in patients that initiated treatment of LTBi was 0.4/100 person-years, compared to 1.2/100 person-years in those that did not initiate treatment, but the difference was not statistically significant. The study’s most interesting finding was that the main factor associated with the likelihood of treatment for LTBi was the health service where the patient was treated.

Resumen El objetivo fue identificar los factores asociados a no iniciar el tratamiento preventivo para la tuberculosis (TB) latente (TBLi) en personas viviendo con VIH/SIDA (PVHA). Un estudio de cohorte prospectivo fue realizado con PVHA, edad ≥ 18 años, de dos servicios de referencia para VIH/SIDA. De 232 pacientes elegibles para el tratamiento de la TBLi, 69,8% iniciaron el tratamiento. Tras el análisis de regresión logística multivariada, simplemente ser tratado en uno de los servicios de referencia estuvo asociado a no comenzar el tratamiento para TBLi (p < 0,001). La tasa de incidencia de TB en la cohorte fue de 0,6/100 personas-año. Para los pacientes que iniciaron el tratamiento para TBLi, la tasa de incidencia de TB fue de 0,4/100 personas-año y para aquellos que no lo iniciaron, la tasa fue de 1,2/100 personas-año, pero esa diferencia no fue estadísticamente significativa. El hallazgo más interesante de este estudio fue el hecho de que el principal factor asociado al aumento de la probabilidad de ser tratado para TBLi fue la unidad de salud donde se realizó el seguimiento del paciente.

Resumo O objetivo foi identificar os fatores associados ao não início do tratamento preventivo para tuberculose (TB) latente (TBLi) em pessoas vivendo com o HIV/AIDS (PVHA). Um estudo de coorte prospectivo foi realizado com PVHA, idade ≥ 18 anos, de dois serviços de referência para HIV/AIDS. De 232 pacientes elegíveis para tratamento da TBLi, 69,8% iniciaram o tratamento. Após análise de regressão logística multivariada, apenas ser tratado em um dos serviços de referência esteve associado ao não início do tratamento para TBLi (p < 0,001). A taxa de incidência de TB na coorte foi de 0,6/100 pessoas/ano. Para os pacientes que iniciaram o tratamento para TBLi, a taxa de incidência de TB foi de 0,4/100 pessoas/ano e para aqueles que não iniciaram, a taxa foi de 1,2/100 pessoas/ano, mas esta diferença não foi estatisticamente significativa. O achado mais interessante deste estudo foi o fato de o principal fator associado ao aumento da probabilidade de ser tratado para TBLi foi a unidade de saúde onde o paciente foi acompanhado.

Abstract The aim was to identify factors associated with non-initiation of prophylactic treatment of latent tuberculosis infection (LTBi) in persons living with HIV/AIDS (PLWA), based on a prospective cohort study of PLWA ≥ 18 years of age in two referral services for HIV/AIDS. Of the 232 patients eligible for treatment of LTBi, 69.8% initiated treatment. Following multivariate logistic regression analysis, only treatment in one of the two referral services was associated with non-initiation of treatment for LTBi (p < 0.001). TB incidence in the cohort was 0.6/100 person-years. TB incidence in patients that initiated treatment of LTBi was 0.4/100 person-years, compared to 1.2/100 person-years in those that did not initiate treatment, but the difference was not statistically significant. The study’s most interesting finding was that the main factor associated with the likelihood of treatment for LTBi was the health service where the patient was treated.

Resumen El objetivo fue identificar los factores asociados a no iniciar el tratamiento preventivo para la tuberculosis (TB) latente (TBLi) en personas viviendo con VIH/SIDA (PVHA). Un estudio de cohorte prospectivo fue realizado con PVHA, edad ≥ 18 años, de dos servicios de referencia para VIH/SIDA. De 232 pacientes elegibles para el tratamiento de la TBLi, 69,8% iniciaron el tratamiento. Tras el análisis de regresión logística multivariada, simplemente ser tratado en uno de los servicios de referencia estuvo asociado a no comenzar el tratamiento para TBLi (p < 0,001). La tasa de incidencia de TB en la cohorte fue de 0,6/100 personas-año. Para los pacientes que iniciaron el tratamiento para TBLi, la tasa de incidencia de TB fue de 0,4/100 personas-año y para aquellos que no lo iniciaron, la tasa fue de 1,2/100 personas-año, pero esa diferencia no fue estadísticamente significativa. El hallazgo más interesante de este estudio fue el hecho de que el principal factor asociado al aumento de la probabilidad de ser tratado para TBLi fue la unidad de salud donde se realizó el seguimiento del paciente.

No Brasil, a epidemia do HIV-1 adquiriu novas características ao longo do tempo, como o aumento da transmissão heterossexual e um declínio da razão homens:mulheres em casos de AIDS. Foi oferecida triagem para a infecção pelo HIV a todos os pacientes atendidos no Centro de Testagem e Aconselhamento da cidade de Paulista, Região Metropolitana de Recife, Pernambuco, Nordeste do Brasil, com o objetivo de determinar a incidência do HIV-1. Foi usado o enzimaimunoensaio de captura BED (BED-CEIA) para determinar a incidência do HIV-1, comparando-o com o método de índice de avidez AxSYM (Ax-AI). No período analisado, 2006-2009, 14.014 pessoas foram testadas, e apenas 18 gestantes foram diagnosticadas para a infecção por HIV, resultando em uma incidência de 0,15% ao ano (IC95%: 0,00-0,33), significativamente menor do que os homens (1,03; IC95%: 0,45-1,61) e mulheres não-grávidas (0,50; IC95%: 0,11-0,89). Apesar da baixa incidência de HIV-1 entre as mulheres grávidas, a alta taxa de infecção recente reforça cuidados no pré-natal para esta infecção, para evitar a transmissão vertical.

The HIV-1 epidemic in Brazil has displayed new characteristics over time, with an increase in heterosexual transmission and a decline in the male-to-female ratio in AIDS cases. HIV screening was offered to patients attending the Voluntary Counseling and Testing Center in Paulista, Greater Metropolitan Recife, Pernambuco State, in Northeast Brazil, to determine HIV-1 incidence. BED capture enzyme immunoassay (BED-CEIA) was used to measure HIV-1 incidence, comparing it to the AxSYM avidity index method (Ax-AI). From 2006 to 2009, 14,014 individuals were tested, and only 18 pregnant women were diagnosed with HIV infection, resulting in 0.15% annual incidence (95%CI: 0-0.33), significantly lower than in men (1.03; 95%CI: 0.45-1.61) and non-pregnant women (0.50; 95%CI: 0.11-0.89). Despite the low HIV-1 incidence in pregnant women, the high rate of recent infection detected during prenatal care emphasizes the need to increase measures to prevent vertical transmission.

En Brasil, epidemia del VIH-1 adquiere nuevas características con tiempo, como el aumento de la transmisión heterosexual y disminución de la razón hombres:mujeres en los casos de SIDA. La detección de infección por VIH se ofrece a todos los pacientes que acuden al Centro de Asesoramiento y Pruebas (CTA) en la ciudad de Paulista, área metropolitana de Recife, noreste - Brasil, con objetivo de determinar la incidencia del VIH-1. BED inmunoensayo enzimático de captura (BED-CEIA) se utilizó para determinar la incidencia de VIH-1, comparándolo con el método del índice de avidez AxSYM (AX AI). En el período de 2006-2009, 14.014 personas se pusieron a prueba, 18 mujeres embarazadas fueron diagnosticados con infección por VIH, com incidencia de 0.15% anual (IC95%: 0-0.33), inferior a los hombres (1.03; IC95%: 0.45-1.61) y las mujeres no embarazadas (0.50; IC95%: 0.11-0.89). A pesar de la baja incidencia de VIH-1 en las mujeres embarazadas, alta tasa de infección reciente aumenta en la atención prenatal para esta infección para prevenir la transmisión vertical.