Perfil epidemiológico, mortalidad y causas de muerte en el primer año de los pacientes con diagnóstico nuevo de VIH atendidos en el Hospital Rafael Ángel Calderón Guardia, en el periodo comprendido entre enero de 2015 y diciembre de 2017
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2019
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ANTECEDENTES: La epidemia VIH continúa siendo una grave amenaza, a pesar de los esfuerzos realizados por el sector salud, en nuestro país todavía hay grandes vacíos epidemiológicos acerca del VIH, carecemos de datos locales representativos y de calidad que fundamenten las intervenciones. MÉTODOS: se realizó un estudio retrospectivo, observacional y descriptivo de las características epidemiológicas, mortalidad y causas de muerte en el primer año posterior al diagnóstico de VIH en un hospital especializado entre 2015 y y 2017. Se analizó también presentación tardía, seguimiento posterior al diagnóstico y curvas de supervivencia. RESULTADOS Y CONCLUSIONES: La población de nuevo diagnóstico de VIH en su mayoría fueron hombres (relación 9:1 respecto al sexo femenino) adultos jóvenes, menores de 29 años, costarricenses, solteros, que residían en la provincia de San José y con secundaria incompleta. En la mayoría de pacientes se logró iniciar la TARV 87.6% (461) y el esquema más utilizado fue la combinación de TDF, xTC y EFV para 61,7% (325). El 26,7% de los pacientes se presentó con enfermedad avanzada y el 44,0% con diagnóstico tardío. La mortalidad en el primer año posterior al diagnóstico de VIH fue de 7,5%. La principal causa de muerte identificada fue la toxoplasmosis del sistema nervioso central a diferencia de lo reportado a nivel mundial, donde continúa siendo la tuberculosis. En cuanto a la mortalidad, se identificaron como factores protectores: tener menos de 40 años (RR 0,25 IC95% 0,15-0,42), CV menor a 100 000 copias/ml (RR 0,2, IC95% 0,1-0,4) y TARV (RR 0,2 IC95% 0,1-0,3). Como factores de riesgo: escolaridad incompleta o menos (RR 2,7 IC95%:1,5-4,7), diagnóstico tardío (RR 5,6 IC95% 2,8-11,4) y enfermedad avanzada (RR 5,1 IC95% 2,9-9,0). Los pacientes no fueron enlazados a la atención de manera adecuada, y existe una demora importante en cada punto del proceso que va desde el diagnóstico hasta el inicio del...
Inglés: BACKGROUND: The HIV epidemic continues to be a serious health threat, despite the efforts made by the healthcare providers. In Costa Rica there are still large HIV- related epidemiological gaps and it lacks representative and quality local data to support strategic interventions . METHODS: A retrospective, observational and descriptive study of the epidemiological characteristics, mortality and causes of death in the first year after the diagnosis of HIV in a specialized hospital between 2015 and 2017 was conducted. Late presentation, follow-up after diagnosis and survival curves were also analyzed. RESULTS AND CONCLUSIONS: The population of newly diagnosed HIV patients was mostly male (9 to 1 male:female ratio), young adults, under 29 years of age, costa rican, single, residing in the province of San José and with incomplete scholarity. In the majority of patients, 87.6% ART was started (461) and the mostly used combination was TDF, xTC and EFV for 61.7% (325). 26.7% of the patients had advanced disease at presentation and 44.0% with late diagnosis. Mortality in the first year after the diagnosis was 7.5%. The main identifiable cause of death was CNS toxoplasmosis opposite of what is reported worldwide literature which describes tuberculosis. Regarding mortality, several protective factors were identified: <40 years (RR 0.25 IC95% 0.15-0.42), viral load <100 000 copies / ml (RR 0.2, IC95% 0 , 1 -0.4) and ART (RR 0.2 IC95% 0.1-0.3). And as for its risk factors: incomplete high school or lesser educational status (RR 2.7 IC95%: 1.5-4.7), late diagnosis (RR 5.6 IC95% 2.8-11.4) and advanced disease (RR 5, 1 IC95% 2.9-9.0). The patients were not linked to proper healthcare, and important delay in each point of the process that goes from the diagnosis to the beginning of the ART was detected, making this a challenge in the approach of these patients and a great opportunity for improvement.
Inglés: BACKGROUND: The HIV epidemic continues to be a serious health threat, despite the efforts made by the healthcare providers. In Costa Rica there are still large HIV- related epidemiological gaps and it lacks representative and quality local data to support strategic interventions . METHODS: A retrospective, observational and descriptive study of the epidemiological characteristics, mortality and causes of death in the first year after the diagnosis of HIV in a specialized hospital between 2015 and 2017 was conducted. Late presentation, follow-up after diagnosis and survival curves were also analyzed. RESULTS AND CONCLUSIONS: The population of newly diagnosed HIV patients was mostly male (9 to 1 male:female ratio), young adults, under 29 years of age, costa rican, single, residing in the province of San José and with incomplete scholarity. In the majority of patients, 87.6% ART was started (461) and the mostly used combination was TDF, xTC and EFV for 61.7% (325). 26.7% of the patients had advanced disease at presentation and 44.0% with late diagnosis. Mortality in the first year after the diagnosis was 7.5%. The main identifiable cause of death was CNS toxoplasmosis opposite of what is reported worldwide literature which describes tuberculosis. Regarding mortality, several protective factors were identified: <40 years (RR 0.25 IC95% 0.15-0.42), viral load <100 000 copies / ml (RR 0.2, IC95% 0 , 1 -0.4) and ART (RR 0.2 IC95% 0.1-0.3). And as for its risk factors: incomplete high school or lesser educational status (RR 2.7 IC95%: 1.5-4.7), late diagnosis (RR 5.6 IC95% 2.8-11.4) and advanced disease (RR 5, 1 IC95% 2.9-9.0). The patients were not linked to proper healthcare, and important delay in each point of the process that goes from the diagnosis to the beginning of the ART was detected, making this a challenge in the approach of these patients and a great opportunity for improvement.
Descripción
Tesis (médico especialista en infectología)--Universidad de Costa Rica. Sistema de Estudios de Posgrados. Programa de Estudios de Posgrado en Infectología, 2019
Palabras clave
Hospital Dr. Rafael Angel Calderón Guardia (Costa Rica) - CASOS, HISTORIAS CLINICAS, ESTADISTICAS, ETC, MORTALIDAD - CAUSAS - COSTA RICA, PERSONAS VIH POSITIVAS - COSTA RICA, VIH - DIAGNÓSTICO - COSTA RICA, VIH - EPIDEMIOLOGÍA - COSTA RICA