Idoso e infecção pelo HIV/aids: perfil epidemiológico e de adesão ao tratamento em um serviço de atendimento especializado do Sistema Único de Saúde

Abstract

The HIV/aids epidemic has undergone several changes in its profile over time, among which the phenomenon of aging and a significant increase in the number of cases among older adults has been reported worldwide. Infected individuals aged 50 years or older are referred to as elderly due to clinical and epidemiological characteristics that include a faster progression to Aids. In order to characterize the epidemiological clinical profile of patients diagnosed with HIV infection aged 50 or over in a specialized public answering service, a descriptive study was developed using secondary data from medical records in the years 2014 to 2018 and those patients who had doctor’s appointments in other institutions of medical or private assistance and with a diagnosis prior to the age of 50 years who were inadvertently classified in this age group in the medical record were excluded. The compiled, sociodemographic, health and lifestyle, clinical and treatment-related data were organized into a database using the Statistical Package of the Social Sciencies program, version 21. Quantitative variables were expressed as mean (or median) ± standard deviation (or interquartile distance) and categorical variables expressed as number and percentage of patients. Association analyzes were performed using the chi-square test. AIDS-specific mortality and mortality and overall 24-month survival were determined. Significance level adopted at 5%. 149 patients were included, with a predominance of males (62.4%), aged between 50 and 59 years (65.8%), self-reported as white (57.7%). In 53.7% of them, there was no completion of basic education or they were illiterate 29.5% of the patients were considered severe immunodeficient and 23.5% had a moderate degree of immunodeficiency on admission. Values less than or equal to 200 cells / mm3 in the T CD4 lymphocyte count were recorded in 46.3% of the sample. 80 patients (56.7%) who performed 6 or more monthly withdrawals in the first 6 months of treatment and 81 (60%) of users who had more than 11 withdrawals at 12 months of follow-up were adherent. It is noteworthy that adherence was significantly higher among patients over 60 years of age in the first 12 months. Immune recovery, observed by the increase in T CD4 cell count over time, increased on average 139.63 in the first 6 months and 50.51 from the first 6 months to 12 months of follow-up, with an average increase in the first 12 months of 157 , 63 cells, noting also a difference in the count of TCD4 cells according to age group, being found in only 9.1% of the patients over 60 years old counting above 500 cells / mm3 after 6 months of treatment. A total of 19 patients died in the analyzed period, resulting in AIDS lethality of 8%, proportional mortality (considering confirmed causes) of 68% and overall survival in 24 months of 84.1%. The delay in diagnosis implies patients with advanced disease and a negative impact on the prognosis. Health professionals must be aware of measures to prevent infections related to sexual transmission in more advanced age groups, and the specific health care needs of this group, which requires the intersection of the multidisciplinary team in strengthening the bond and maintaining treatment. Investigating potential risk factors for non-adherence to therapy is essential for satisfactory management of the disease in this population.