Recuperação imunológica e supressão virológica no uso dos antirretrovirais nos pacientes recém diagnosticados com HIV no SAE adulto da Cidade de Santos no ano de 2016

Abstract

According to UNAIDS, by 2018 there were 37.9 million people living with HIV worldwide, of these, 1.7 million people were reported as new cases of infections. About 23.3 million people living with HIV (61.5%) have access to antiretroviral treatment. Until this same year 2018, 770 thousand people died from AIDS, HIV infection is considered one of the most relevant diseases for current public health and it is present in all countries of the world. The fight against this disease comprises actions that allow early diagnosis, access to antiretroviral treatment, attention to vulnerable groups, research, health policies and information. The goal 90-90-90 determined by the Paris Declaration of 2014, based on scientific evidence of early treatment in people living with HIV, advocates the maximum reach of people receiving treatment to achieve virological suppression. The non transmission of HIV in people undergoing virological suppression, guaranteed by antiretroviral treatment, is one of the most important actions to face the epidemic. The Paris Declaration also calls for each city to take its own actions because they have particular characteristics of infrastructure, social issues and ways of preventing their populations. In this scenario, the city of Santos needs to continually know the characteristics and profile of people living with HIV. Objective: To characterize immunological recovery and virological suppression in the use of antiretrovirals in newly diagnosed patients in 2016 at the reference center for HIV / AIDS in Santos - SAE Adult. Methodology: Prospective cohort study of 1 year (2016- 2017) using secondary data. The purpose of the study was to determine immunological recovery and virological suppression in recent infections in people newly diagnosed with the HIV-1 virus enrolled at the AIDS Reference Center - SAE Adult in Santos. People recently diagnosed in the 2016 period had their histories followed for a period of one year to obtain virological evolution (SISCEL database), immunological evolution (SISCEL database), antiretroviral treatment (SICLOM database) and profile socio / demographic (SAE - Adult). Statistical analysis was performed using the chi-square test of variables dependent on the detection of viral copies, the limits of 350 cells/¿L for TCD4 lymphocytes and adherence to antiretroviral drugs with the independent sociodemographic, virological and immunological variables. Results: Of 295 enrolled in 2016, only 193 were included in the study. The enrolled included in the study were divided in two groups: Group of Accompanied Entrants and Group of Unaccompanied Entrants by the service of Epidemiological Surveillance of Santos. TCD4 cell averages evolved from 551.26 cells/¿L of the diagnosis to 694.34 cells/¿L after one year of follow-up under antiretroviral treatment. From the Accompanied Group, 14 people had virological failure after 1 year, while 46 people from the Unaccompanied Group did not have adherence to antiretroviral treatment, providing an estimate of 31.8% of people enrolled in 2016 in possible virological failure. The Adherence Index was associated with virological suppression and therefore suppression was associated with immune recovery, particularly in people with TCD4 lymphocytes > 350 cells/¿L. Women on antiretroviral treatment did not experience virological failure. Both virological suppression and immune recovery showed some associations with socio / demographic characteristics. The 3rd guideline of Goal 90-90-90 was reached in the studied population, however there are still gaps in reaching the 2nd guideline. Conclusion: Immune recovery and virological suppression present characteristics at diagnosis and during treatment that can impair coping with the epidemic. Recognizing the immune profile compromised in low quantifications of TCD4 lymphocytes allows greater attention in future interventions. Virological suppression was guaranteed for the population studied within the recommended guidelines, but there are still gaps in the achievement of the goals, especially the 2nd guideline of the 90-90-90 goal.