Sobrevida e fatores associados ao óbito em crianças, adolescentes e adultos jovens soropositivos para HIV por transmissão vertical

Detalhes bibliográficos
Autor(a) principal: Dias, Jucielma de Jesus
Data de Publicação: 2015
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Biblioteca Digital de Teses e Dissertações da UEFS
Texto Completo: http://localhost:8080/tede/handle/tede/357
Resumo: Objective: To analyze the survival and factors associated with death in children, adolescents and young adults infected with HIV through vertical transmission, enrolled in the Municipal Reference Center (CRM) STD / HIV / AIDS Feira de Santana. Methods: An observational, longitudinal study, developed from a cohort of HIV-positive to HIV, infected by vertical transmission from secondary data obtained from the review of clinical records of 37 children, 21 adolescents and five (5) young adults, ranging age between 0 and 24 years enrolled in the Specialized Care Service (SAE) of CRM, from 2003 to 2014. In the analyzes we used Pearson X2 test, exact Fisher test and its value p, to investigate factors associated with death. In addition, it used survival analysis with construction of Kaplan-Meier curves and log-rank test to verify statistically significant association between groups of variables listed. Finally, we used regression Cox proportional hazards to estimate adjusted risk factors for death. Results: There was a predominance of groups of 0-12 years (58.7%) and 13-19 years (33.3%), female (52.4%) and black / mulatto (71.8%). Most of the study population made use of ART (71.4%), 82.5% had no comorbidities and 65.1% were not affected by non-oral opportunistic infections, though, 85.7% had at least one episode oral candidiasis. . Of the subjects studied, 71.4% were alive at the end of the follow-up period; 23.8% had AIDS as a cause death and three 4.8% patients died from other causes. Risk factors associated with death highlighted the variables "age" (p = 0.02), "non-oral opportunistic infection" (p = 0.00), " oral candidiasis "(p = 0.00)," CD4 "(p = 0.03). Survival analysis showed reduction in the probability of survival time only for individuals who came to the service with CD4 cell counts less than 350 cells / mm 3 (p = 0.00). The median overall survival time was 8.8 years, and the individuals using HAART had a higher survival (10.6 years) compared to those who have not used antiretroviral (6.0 years). In the multivariate analysis, statistically significant variables were age (<13 years), behaving as a protective factor (HR: 0.88; 95% CI: 0.78 to 0.98) and non-oral opportunistic infection as a factor of risk of death (HR: 4.3; 95% CI 1.51 to 12.1). Conclusion: This study points to the increased survival among infected by vertical route, evidenced by the significant number of individuals who have reached adolescence and possibly this is due to the use of antiretroviral with longer survival time among those who used the therapy, which shows that good results can be achieved, even in countries with limited resources. Causes of death resembled the national standard, although this is in transition, considering the causes unrelated to AIDS. The opportunistic infection remained a risk factor for death, according to the literature. The results show continuing need for adjustments and developments, in order to deal with the challenge of a chronic infection among individuals in a vulnerable stage, own youth.
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spelling Costa, Maria Conceição Oliveira01674379501http://lattes.cnpq.br/8866400272615591Dias, Jucielma de Jesus2016-07-15T00:58:46Z2015-03-25DIAS, Jucielma de Jesus. Sobrevida e fatores associados ao óbito em crianças, adolescentes e adultos jovens soropositivos para HIV por transmissão vertical. 2015. 88 f. Dissertação (Mestrado Acadêmico em Saúde Coletiva)- Universidade Estadual de Feira de Santana, Feira de Santana, 2015.http://localhost:8080/tede/handle/tede/357Objective: To analyze the survival and factors associated with death in children, adolescents and young adults infected with HIV through vertical transmission, enrolled in the Municipal Reference Center (CRM) STD / HIV / AIDS Feira de Santana. Methods: An observational, longitudinal study, developed from a cohort of HIV-positive to HIV, infected by vertical transmission from secondary data obtained from the review of clinical records of 37 children, 21 adolescents and five (5) young adults, ranging age between 0 and 24 years enrolled in the Specialized Care Service (SAE) of CRM, from 2003 to 2014. In the analyzes we used Pearson X2 test, exact Fisher test and its value p, to investigate factors associated with death. In addition, it used survival analysis with construction of Kaplan-Meier curves and log-rank test to verify statistically significant association between groups of variables listed. Finally, we used regression Cox proportional hazards to estimate adjusted risk factors for death. Results: There was a predominance of groups of 0-12 years (58.7%) and 13-19 years (33.3%), female (52.4%) and black / mulatto (71.8%). Most of the study population made use of ART (71.4%), 82.5% had no comorbidities and 65.1% were not affected by non-oral opportunistic infections, though, 85.7% had at least one episode oral candidiasis. . Of the subjects studied, 71.4% were alive at the end of the follow-up period; 23.8% had AIDS as a cause death and three 4.8% patients died from other causes. Risk factors associated with death highlighted the variables "age" (p = 0.02), "non-oral opportunistic infection" (p = 0.00), " oral candidiasis "(p = 0.00)," CD4 "(p = 0.03). Survival analysis showed reduction in the probability of survival time only for individuals who came to the service with CD4 cell counts less than 350 cells / mm 3 (p = 0.00). The median overall survival time was 8.8 years, and the individuals using HAART had a higher survival (10.6 years) compared to those who have not used antiretroviral (6.0 years). In the multivariate analysis, statistically significant variables were age (<13 years), behaving as a protective factor (HR: 0.88; 95% CI: 0.78 to 0.98) and non-oral opportunistic infection as a factor of risk of death (HR: 4.3; 95% CI 1.51 to 12.1). Conclusion: This study points to the increased survival among infected by vertical route, evidenced by the significant number of individuals who have reached adolescence and possibly this is due to the use of antiretroviral with longer survival time among those who used the therapy, which shows that good results can be achieved, even in countries with limited resources. Causes of death resembled the national standard, although this is in transition, considering the causes unrelated to AIDS. The opportunistic infection remained a risk factor for death, according to the literature. The results show continuing need for adjustments and developments, in order to deal with the challenge of a chronic infection among individuals in a vulnerable stage, own youth.Objetivo: analisar a sobrevida e fatores associados ao óbito em crianças, adolescentes e adultos jovens infectados pelo HIV , por transmissão vertical, matriculados no Centro de Referência Municipal (CRM) DST/HIV/AIDS de Feira de Santana. Métodos: estudo observacional, longitudinal, desenvolvido a partir de uma coorte de soropositivos para HIV, infectados por transmissão vertical, a partir de dados secundários obtidos da revisão de prontuários clínicos de 37 crianças, 21 adolescentes e cinco (5) adultos jovens, na faixa etária compreendida entre 0 e 24 anos , matriculados no Serviço de Atenção Especializada (SAE) do CRM, no período de 2003 a 2014. Nas análises foi utilizado teste 2 de Pearson, teste exato de Fisher e respectivo valor p, para investigar fatores associados ao óbito. Além disso, foi utilizada análise de sobrevida com construção das curvas de Kaplan-Meier e teste log-rank a fim de verificar associação estatisticamente significante entre os grupos das variáveis elencadas. Finalmente, utilizou-se regressão de riscos proporcionais de cox para estimativa ajustada dos fatores de risco para óbito. Resultados: Houve predomínio das faixas de 0-12 anos (58,7%) e 13 a 19 anos (33,3%), sexo feminino (52,4%) e cor negra/parda (71,8%).. A maioria da população estudada fazia uso de TARV (71,4%), 82,5% não apresentavam comorbidades e 65,1% não foram acometidos por infecções oportunistas não orais, embora, 85,7% apresentaram, pelo menos, um episódio de candidíase oral. . Dos indivíduos estudados, 71,4% estavam vivos até o fim do período de seguimento; 23,8% tiveram Aids como causa morte e três 4,8% óbitos ocorreram por outras causas. Como fatores de risco associados ao óbito destacaram-se as variáveis “faixa etária” (p=0,02), “infecção oportunista não oral” ( p=0,00), “candidíase oral” (p=0,00), “contagem de células CD4” (p=0,03). A análise de sobrevivência demonstrou probabilidade na redução do tempo de sobrevida apenas para indivíduos que chegaram ao serviço com contagem de células CD4 menor que 350 células/mm3 ( p=0,00). A mediana do tempo de sobrevida geral foi de 8,8 anos, sendo que os indivíduos em uso de TARV apresentaram sobrevida maior (10,6 anos) quando comparados aos que não usaram antirretroviral (6,0 anos). Na análise multivariada, as variáveis estatisticamente significativas foram idade (< 13 anos), comportando-se como fator de proteção (HR:0,88; IC 95%: 0,78-0,98) e infecção oportunista não oral como fator de risco para óbito (HR:4,3; IC 95%: 1,51-12,1). Conclusão: Este estudo aponta para o aumento da sobrevida entre infectados por via vertical, evidenciado através do número significativo de indivíduos que chegaram à adolescência e, possivelmente, isto deve-se à utilização de antirretroviral com tempo de sobrevida maior entre aqueles que faziam uso da terapia, o que demonstra que bons resultados podem ser alcançados, mesmo em países com recursos limitados. As causas de óbito assemelharam-se ao padrão nacional, embora esse esteja em processo de transição, considerando as causas não relacionadas à Aids. A infecção oportunista permaneceu como fator de risco para óbito, concordando com a literatura. Os resultados apontam necessidade contínua de adequações e empreendimentos, a fim de lidar com o desafio de uma infecção crônica entre indivíduos em fase de vulnerabilidade, próprias da juventude.Submitted by Ricardo Cedraz Duque Moliterno (ricardo.moliterno@uefs.br) on 2016-07-15T00:58:46Z No. of bitstreams: 1 Dissertação versão final pós defesa.pdf: 1222902 bytes, checksum: 40007ee76422c5102a64eba0abe995f4 (MD5)Made available in DSpace on 2016-07-15T00:58:46Z (GMT). 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dc.title.por.fl_str_mv Sobrevida e fatores associados ao óbito em crianças, adolescentes e adultos jovens soropositivos para HIV por transmissão vertical
title Sobrevida e fatores associados ao óbito em crianças, adolescentes e adultos jovens soropositivos para HIV por transmissão vertical
spellingShingle Sobrevida e fatores associados ao óbito em crianças, adolescentes e adultos jovens soropositivos para HIV por transmissão vertical
Dias, Jucielma de Jesus
HIV
Sobrevida
Fatores associados
Transmissão vertical
Crianças
Adolescentes
Adultos jovens
Survival
Associated factors
Vertical transmission
Children
Teens
Young adults
HIV
CIENCIAS DA SAUDE::SAUDE COLETIVA
title_short Sobrevida e fatores associados ao óbito em crianças, adolescentes e adultos jovens soropositivos para HIV por transmissão vertical
title_full Sobrevida e fatores associados ao óbito em crianças, adolescentes e adultos jovens soropositivos para HIV por transmissão vertical
title_fullStr Sobrevida e fatores associados ao óbito em crianças, adolescentes e adultos jovens soropositivos para HIV por transmissão vertical
title_full_unstemmed Sobrevida e fatores associados ao óbito em crianças, adolescentes e adultos jovens soropositivos para HIV por transmissão vertical
title_sort Sobrevida e fatores associados ao óbito em crianças, adolescentes e adultos jovens soropositivos para HIV por transmissão vertical
author Dias, Jucielma de Jesus
author_facet Dias, Jucielma de Jesus
author_role author
dc.contributor.advisor1.fl_str_mv Costa, Maria Conceição Oliveira
dc.contributor.authorID.fl_str_mv 01674379501
dc.contributor.authorLattes.fl_str_mv http://lattes.cnpq.br/8866400272615591
dc.contributor.author.fl_str_mv Dias, Jucielma de Jesus
contributor_str_mv Costa, Maria Conceição Oliveira
dc.subject.por.fl_str_mv HIV
Sobrevida
Fatores associados
Transmissão vertical
Crianças
Adolescentes
Adultos jovens
topic HIV
Sobrevida
Fatores associados
Transmissão vertical
Crianças
Adolescentes
Adultos jovens
Survival
Associated factors
Vertical transmission
Children
Teens
Young adults
HIV
CIENCIAS DA SAUDE::SAUDE COLETIVA
dc.subject.eng.fl_str_mv Survival
Associated factors
Vertical transmission
Children
Teens
Young adults
HIV
dc.subject.cnpq.fl_str_mv CIENCIAS DA SAUDE::SAUDE COLETIVA
description Objective: To analyze the survival and factors associated with death in children, adolescents and young adults infected with HIV through vertical transmission, enrolled in the Municipal Reference Center (CRM) STD / HIV / AIDS Feira de Santana. Methods: An observational, longitudinal study, developed from a cohort of HIV-positive to HIV, infected by vertical transmission from secondary data obtained from the review of clinical records of 37 children, 21 adolescents and five (5) young adults, ranging age between 0 and 24 years enrolled in the Specialized Care Service (SAE) of CRM, from 2003 to 2014. In the analyzes we used Pearson X2 test, exact Fisher test and its value p, to investigate factors associated with death. In addition, it used survival analysis with construction of Kaplan-Meier curves and log-rank test to verify statistically significant association between groups of variables listed. Finally, we used regression Cox proportional hazards to estimate adjusted risk factors for death. Results: There was a predominance of groups of 0-12 years (58.7%) and 13-19 years (33.3%), female (52.4%) and black / mulatto (71.8%). Most of the study population made use of ART (71.4%), 82.5% had no comorbidities and 65.1% were not affected by non-oral opportunistic infections, though, 85.7% had at least one episode oral candidiasis. . Of the subjects studied, 71.4% were alive at the end of the follow-up period; 23.8% had AIDS as a cause death and three 4.8% patients died from other causes. Risk factors associated with death highlighted the variables "age" (p = 0.02), "non-oral opportunistic infection" (p = 0.00), " oral candidiasis "(p = 0.00)," CD4 "(p = 0.03). Survival analysis showed reduction in the probability of survival time only for individuals who came to the service with CD4 cell counts less than 350 cells / mm 3 (p = 0.00). The median overall survival time was 8.8 years, and the individuals using HAART had a higher survival (10.6 years) compared to those who have not used antiretroviral (6.0 years). In the multivariate analysis, statistically significant variables were age (<13 years), behaving as a protective factor (HR: 0.88; 95% CI: 0.78 to 0.98) and non-oral opportunistic infection as a factor of risk of death (HR: 4.3; 95% CI 1.51 to 12.1). Conclusion: This study points to the increased survival among infected by vertical route, evidenced by the significant number of individuals who have reached adolescence and possibly this is due to the use of antiretroviral with longer survival time among those who used the therapy, which shows that good results can be achieved, even in countries with limited resources. Causes of death resembled the national standard, although this is in transition, considering the causes unrelated to AIDS. The opportunistic infection remained a risk factor for death, according to the literature. The results show continuing need for adjustments and developments, in order to deal with the challenge of a chronic infection among individuals in a vulnerable stage, own youth.
publishDate 2015
dc.date.issued.fl_str_mv 2015-03-25
dc.date.accessioned.fl_str_mv 2016-07-15T00:58:46Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
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dc.identifier.citation.fl_str_mv DIAS, Jucielma de Jesus. Sobrevida e fatores associados ao óbito em crianças, adolescentes e adultos jovens soropositivos para HIV por transmissão vertical. 2015. 88 f. Dissertação (Mestrado Acadêmico em Saúde Coletiva)- Universidade Estadual de Feira de Santana, Feira de Santana, 2015.
dc.identifier.uri.fl_str_mv http://localhost:8080/tede/handle/tede/357
identifier_str_mv DIAS, Jucielma de Jesus. Sobrevida e fatores associados ao óbito em crianças, adolescentes e adultos jovens soropositivos para HIV por transmissão vertical. 2015. 88 f. Dissertação (Mestrado Acadêmico em Saúde Coletiva)- Universidade Estadual de Feira de Santana, Feira de Santana, 2015.
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dc.publisher.none.fl_str_mv Universidade Estadual de Feira de Santana
dc.publisher.program.fl_str_mv Mestrado Acadêmico em Saúde Coletiva
dc.publisher.initials.fl_str_mv UEFS
dc.publisher.country.fl_str_mv Brasil
dc.publisher.department.fl_str_mv DEPARTAMENTO DE SAÚDE
publisher.none.fl_str_mv Universidade Estadual de Feira de Santana
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repository.name.fl_str_mv Biblioteca Digital de Teses e Dissertações da UEFS - Universidade Estadual de Feira de Santana (UEFS)
repository.mail.fl_str_mv bcuefs@uefs.br|| bcref@uefs.br||bcuefs@uefs.br
_version_ 1809288771016851456