Incidência e envelhecimento por HIV/AIDS: a influência de aspectos espaciais, sociais, individuais e clínicos

• Autor(a) principal: Melo, Géssyca Cavalcante de
• Data de Publicação: 2020
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UFS
• Texto Completo: http://ri.ufs.br/jspui/handle/riufs/16871
• topic: HIV; Epidemiologia; Análise espacial; Vulnerabilidade social; Fragilidade; HIV; Epidemiology; Spatial analysis; Social vulnerability; Frailty; CIENCIAS DA SAUDE

Introduction: The HIV edemic is still a public health problem, especially due to its rapid spread in geographic spaces, the possibility of metabolic complications due to its chronicity and reduced life expectancy of individuals who do not use timely treatment. General objective: To evaluate the influence of spatial, social, individual and clinical aspects on the incidence and aging of HIV/aids. Specific objectives: a) Assess the spatial pattern of the HIV/aids incidence index in the State of Alagoas and its association with regional socioeconomic and demographic factors. b) To analyze the association between clinical and immunological factors (HIV-1 viral load, T-CD4 + lymphocyte count and exposure to antiretroviral therapy) with the frailty phenotype in individuals living with HIV/aids. Methods: a) Ecological study; the units of analysis were the municipalities of Alagoas. Cases diagnosed between 2007 and 2016 and registered in the Notifiable Diseases System were included. The Joinpoint model was used to analyze the trend of cases. The incidence rate was smoothed by the local Bayesian method and the Moran index was used to analyze spatial dependence using Terraview. Thematic maps were built by QGis. Spearman's correlation, simple regression model and bivariate Moran Local autocorrelation compared HIV rates with regional socioeconomic indicators. b) Systematic review and meta-analysis carried out in six databases with the terms "HIV", "aids" and "frailty." The phenotype proposed by Fried was considered for the outcome. Nine studies were included in the analysis. Odds Ratio was used as a measure of association; random effects models calculated summary estimates. Results: a) 5454 cases were reported in the State. The average incidence rate was 17.5 per 100,000 inhabitants. Throughout the time frame, there was an increasing and significant linear trend in the diagnosis of infection (APC 2007-2013 = 8.0; p = <0.05), with a greater increase from 2013 (APC 2013-2016 = 29.03; p = <0.05). The Bayesian estimate discriminated a heterogeneity with more municipalities showing high rates and areas of epidemiological transition. Moran's analysis showed spatial dependence between municipalities (p=0.01). There was an association between the unemployment rate and the detection coefficient (p=0.002). The bivariate spatial autocorrelation between the detection rate and the socioeconomic indicators allowed to show the spatial dependence of most variables (p <0.05). The social vulnerability index, illiteracy rate, proportion of low-income people, Gini index, proportion of households with garbage collection, without electricity, without piped water, with male guardians and without education or with incomplete basic level presented negative autocorrelation. b) Data from 7699 individuals were analyzed. There was an association between frailty with LT-CD4 <350 (OR 2.68, 95% CI 1.68–4.62, I² = 46%), detectable CV (OR 1.67, 95% CI 1.34-2 , 08, I² = 0%) and antiretroviral containing protease inhibitor (OR 2.21, 95% CI 1.26-3.89, I = 0%). Conclusions: It is reiterated that the HIV epidemic is due to intersectoral inequalities. Each socioeconomic condition of the studied spaces contributes to the inequities that increase the risk of acquiring the virus, therefore, prevention and control strategies can be established according to each reality. Furthermore, the current available evidence shows an association between the frailty phenotype in patients with HIV infection with a CD4 T cell count <350 cells, detectable viral load and using a treatment regimen containing protease inhibitor. These results may result in developments for research that broaden the view of science to other problems that have emerged due to the chronic condition of HIV infection and include the management of morbidities in this population.