Cotrim

SUMMARY

Opportunistic diseases (OD) are the most common cause of death in AIDS patients. To access the incidence of OD and survival in advanced immunodeficiency, we included 79 patients with AIDS treated at Hospital Evandro Chagas (FIOCRUZ) from September 1997 to December 1999 with at least one CD4 count =

Mean follow-up period was 733 days (CI = 683-782). During the study 9 (11.4%) patients died. Survival from AIDS diagnosis was a mean of 2589 days (CI = 2363-2816) and from the date of the CD4 count CD4 =

We found a very low incidence of OD and long survival after CD4

KEYWORDS: AIDS; Morbidity; CD4 counts; Survival.

INTRODUCTION

The introduction of highly active antiretroviral treatment (HAART) has lowered incidence of opportunistic diseases (ODs)2, prolonged survival3,23 and reduced AIDS-related hospital admissions21. HAART has also had a beneficial effect on individuals with advanced immunosuppression3. Little has been done, however, to explore the effects of reconstituting CD4+ cells on OD incidence, especially among patients at an advanced stage of immunodeficiency 16.

Evaluation of the effect of universal distribution of anti-retrovirals free-of-charge in Sao Paulo revealed a 50% reduction in AIDS-related hospital admission and mortality rates18. However, the incidence of AIDSrelated events and the factors that may influence survival following this measure have yet to be evaluated in Brazil.

OBJECTIVES

To identify the factors associated with morbidity and survival in AIDS patients treated with HAART at an advanced stage of immunodeficiency, as compared with before CD4 T cell counts dropped below 100 cells/mm^sup 3^.

PATIENTS AND METHODS

We conducted a bidirectional cohort study at the Evandro Chagas Hospital Research Centre (Centro de Pesquisa Hospital Evandro Chagas, CPqHEC) of the Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, from September 1, 1997 to December 7, 1999. The CPqHEC is an institution that specializes in treating adults with HIV/AIDS or other infectious diseases, and offers reference on clinical and laboratory services.

Inclusion criteria: adult patients with at least an absolute CD4' lymphocyte count of =

Exclusion criteria: individuals monitored for less than 90 days at the end of the study were excluded.

Criterion for defining AIDS and related ODs: the CDC 1993 criterion was adopted4. This study however, did not take account of bacterial pneumonias due to the large number of presumptive diagnoses without bacteriological confirmation.

Data gathering: An initial interview was held to obtain retrospective data on diagnoses of AIDS-indicator diseases, as well as prior antiretroviral treatment. Whenever necessary, this information was complemented by consulting medical records. The monthly prospective evaluation recorded diagnoses of AIDS-related ODs, the antiretroviral treatment used and laboratory data such as plasma HIV1-RNA load and CD4+ cell count, which were repeated every four months.

CD4'T cells were counted by flow cytometry (Epics XL, Coulter Co, FL, USA), using TriTEST CD4 FITC/ CD8 PE/CD3 PerCP monoclonal antibodies (BD Immunocytometry Systems, SJ, CA, USA). Viral load was measured by NucliSens HIV- 1 QT (NASBA Diagnostics, Organon Teknika, Holland) in plasma samples. Both exams were assured by the National Network for CD4 and Viral Load Evaluation, from the National Coordination of Sexual Transmitted Diseases and AIDS, Brazilian Ministry of Health.

ACKNOWLEDGEMENT

We thank to the Day-Hospital team for the special dedication: Liane Braga da Silveira, Luci Alves, Solange Alves da Cruz, Sonilde Mello Fasolo and Marcia Regina Lyra da Silva.

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Received: 5 February 2002

Accepted: 27 June 2002

Angela J. GADELHA(I), Niurea ACCACIO(2), Regina L.B. COSTA(2), Maria Clara GALHARDO(2), Maria Regina COTRIM(2), Rogerio V. DE SOUZA(2), Mariza MORGADO(3), Keyla MARZOCHI(2), Maria Cristina LOURENCO(2) & Valeria C. ROLLA(2)

The program PAPES//Fiocruz supported this work.

(1) Escola Nacional de Saude Publica (ENSP), FIOCRUZ, Rio de Janeiro, RJ, Brazil

(2) Centro de Pesquisa Hospital Evandro Chagas (CPqHEC), FIOCRUZ, Rio de Janeiro, RJ, Brazil

(3) Laboratorio de Imunologia em HIV/AIDS, Instituto Oswaldo Cruz (IOC), FIOCRUZ, Rio de Janeiro, RJ, Brazil

Correspondence to: Dr. Valeria Rolla, Centro de Pesquisa Hospital Evandro Chagas/FIOCRUZ. Av. Brasil 4365, 21045-900 Rio de Janeiro, RJ, Brazil. Email: valeria @cpqhec.fiocruz.br; rolla@unisys.com.br

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