RETROVIRUS RESEARCH CENTER

1
RETROVIRUS RESEARCH CENTER
CLINICAL, SOCIODEMOGRAPHIC AND IMMUNOLOGICAL
PROFILE BEFORE, DURING AND AFTER THE
IMPLEMENTATION OF HAART THERAPY.
Universidad Central del Caribe School of
Medicine, University Hospital Ramon Ruiz Arnau
Bayamon, Puerto Rico
2
Puerto Rico Health Regions
3
Rationale

• Retrovirus Research Center has been collecting
  data prospectively since 1992
• Availability of HAART began shortly after 1995
• Data on socio-demographic, clinical and
  immunological variables are available for study.

4
Methods

• Study Design
• A cross sectional study from a longitudinal
  cohort.
• Setting
• The study group comes from the Bayamon area in
  the northern part of the island. Our health
  facilities serves eleven municipalities with a
  population of 660,440 inhabitants.
• Study Group
• 3,151 HIV infected patients seen between 1992
  through 2002.

5
Methods

• Variables
• Period of entry (1992-1995, 1996-1998,
  1999-2002)
• Sociodemographic age, gender.
• HIV transmission mode and risk behaviors IDU,
  heterosexual, MHSM, others
• Clinical presentation (Stage of infection,
  patterns of chronic diseases, and profile of OI,
  medical therapy)
• Immunological variables( CD4, CD8, HIV viral load
• Survival analysis (time between AIDS diagnosis
  and last event (death or not death).

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Methods

• Statistical Analyses
• Frequency, Percents, Mean, Median, SD,
  proportions, mortality rates.
• Differences in proportions Chi-Square, Fisher
  Exact test
• Differences in mean T-test for independent
  samples ANOVA.
• Survival Analyses Kaplan Meier procedure and
  Cox Model.
• The overall significance level used was set to
  0.05.
• The statistical package used was SPSS 11.0 for
  Windows.

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Patient Flow Chart
TOTAL (at December 2002)
MALE 76 72 66 FEMALE
24 28 34
P.0001
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Stage at Presentation
Percent
Years
P.0001
9
AGE OF PATIENTS AT STUDY ENTRY
Percent
Years
plt.0001
10
Mean Age at Entry
Plt0.01
11
AGE AND ENTRY WITH CLINICAL AIDS
Percent
Years
P.0001
12
HIV RISK SCENARIO
Percent
P.0001
13
AIDS DEFINING CONDITIONS AS PER YEAR Percent of
Patients
lt1996 1996-98 gt1998
Candida Esophageal. 30.7 31.8 27.2
CMV 2.6 3.7 5.6
KS 4.9 4.5 3.2
Pulmonary Tb 7.3 5.6 4
Pcp 34.9 30.7 13.6
Toxo 19.2 15 15
Recurrent Bkp 2.3 3 4
plt.01
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PRESENCE OF CHRONIC CONDITIONS PERCENT OF
PATIENTS
lt1996 1996-98 gt1998
DIABETES MELLITUS 2.7 5.4 6.7
CAR-VASC CONDITION 3.9 3.6 12.2
ANEMIA 28.4 29.7 22.4
Plt001
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USE OF ANTIRETROVIRAL THERAPY PERCENT OF PATIENTS
ART lt1996 1996-98 gt1998
NONE 89 69.2 38.3
ONE 11.2 3.3 1.3
gtONE 0 27.6 60.4
Plt001
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Median Levels of CD4 Cell Count Per Year
of Entry
Plt.026
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Early MortalityMortality prior to last day of
first interval
Percent
Plt.0001
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MEDIAN OF SURVIVAL BY HIV/AIDS DIAGNOSIS
n Years Median S.E. 95 C.I.
HIV patients 372 lt1996 5.22 .27 4.69, 5.74
264 1996-98 7.44 .33 6.79, 8.10
347 gt1998 10.50 .59 9.53, 11.66
AIDS patients 957 lt1996 1.66 .10 1.46, 1.87
664 1996-98 1.34 .19 .97, 1.72
547 gt1998 5.01 .40 4.22, 5.80
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Survival analysis within the HIV patients
describe by years of entry, n982.






Plt.0001
20
Survival analysis within the AIDS diagnosed
patients describe by years of entry, n2167.
Plt .0001
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CONCLUSIONS

• INCREASED
• FEMALES
• HETEROSEXUAL BEHAVIOR AS RISK
• AGE (OLDER PATIENTS IN PARTICULAR gt55Y)
• PATIENTS WITH IMMUNOLOGICAL AIDS AT ENTRY
• CHRONIC CONDITIONS (DM,CV)
• USE OF HAART INTERVENTION
• MEDIAN SURVIVAL IN HIV AND AIDS

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CONCLUSIONS

• DECREASED
• IVU AS RISK FACTOR
• CLINICAL AIDS AND HIV STAGE AT ENTRY
• TOTAL CD4 CELL COUNT IN HIV AND AIDS
• PCP, TOXO, TB AS INFECTIONS IN AIDS)
• MORTALITY WITHIN SIX MONTHS OF ENTRY

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THANKS

• INVESTIGATORS
• Robert Hunter Mellado, MD, FACP
• María A. Gómez Escudero, Ph.D.
• Diana M. Fernández Santos, MS, Ed.D. (candidate)
• Angel M. Mayor Becerra, MD, MS
• Eddy Ríos Olivares, Ph.D., MPH
• José W. Rodríguez, Ph.D.
• Carlos Leon Valiente, MD
• Beatriz Martinez Ph.D.
• Jose Rodriguez Ph.D.
• Boukli Nawal Ph.D.
• Data Analysts
• Doris V. Báez Feliciano, MS
• Alejandro Amill Rosario, MPH
• Miriam Velázquez Díaz, MS
• Data Abstractors
• Gisela I. Cestero Salas, BA
• Glenda L. Ortiz Torres, BA
• Heidy Ortiz Marrero, BA