Impact of the 1987 revised AIDS case definition in Denmark: a follow-up study 2 years after its adoption

Tendência da epidemia de AIDS em usuários de drogas injetáveis no Município de São Paulo de 1985 a 1997

OBJETIVO: Analisar a tendência da epidemia de AIDS em adultos, no período de 1985 a 1997, no Município de São Paulo, focalizando principalmente os usuários de drogas injetáveis (UDI), considerando o grande impacto da epidemia nesse grupo populacional. METODOLOGIA: A fonte dos dados foi a vigilância de AIDS do Estado de São Paulo. O método estatístico utilizado para a análise de tendência temporal dos 8.558 casos de AIDS entre UDI, e dos 16.756 entre não UDI, foi a regressão polinomial. RESULTADOS: No período de 1985 a 1992 a tendência foi de ascensão para os casos de AIDS entre UDI e não UDI a partir desse ponto e, observou-se um declínio para UDI e manutenção em platô elevado para os não UDI, em conseqüência do crescimento constante do número de casos entre as mulheres e homens heterossexuais. Os coeficientes de regressão ajustados (R²a) de todos os modelos ficaram acima de 70%, e os modelos que melhor explicaram as tendências foram os de segunda ordem (parábola), exceto para heterossexuais não UDI cuja tendência foi de aumento linear. CONCLUSÃO: No final do período considerado, os dados sugerem um declínio da epidemia em UDI, a estabilização em níveis elevados para o total de não UDI, e a manutenção da tendência de crescimento da epidemia para pessoas heterossexuais não UDI.

Validation of four AIDS-case definitions in HIV-infected intravenous drug users in Barcelona, Spain

The objective of the study is to assess the sensitivity and specificity of four epidemiological AIDS-Case Definitions (CDC-87, CDC-93, Europe-93 and Revised Caracas) in HIV-infected intravenous drug users (IDU). The authors carried out a cross-sectional study with 136 IDUs, HIV-infected from a Men Penitentiary Center and from a drug addiction treatment center of Barcelona, Spain, between October/93 and April/94. A protocol, including demographic, clinical and laboratory variables was used by one doctor and the laboratory tests were done in the same institution. After that, the patients were classified in the four Epidemiological AIDS-Case Definitions used by this study. As gold standard we used the CD4 Cell Count (out point 200 or 14% CD4+). The number of AIDS cases varied between 31 and 84 according to the type of AIDS definition. The CDC-93 AIDS definition implied an increase of 170.9% in the number of cases in relation to CDC-87 AIDS-Case Definition. The sensitivities of the CDC-87, CDC-93, Europe-93 and Revised Caracas Epidemiological AIDS - Case Definitions were 34.2, 88.6, 45.6 and 56.9% while the specificities were 93.0, 75.4, 75.4 and 77.2%, respectively. The positive predictive values were between 72.0% (Europe-93) and 87.1% (CDC-87) and the negative predictive values were between 50.0% (Europe-93) and 82.7% (CDC-93). The authors concluded: the sensitivity and specificity of Caracas Revised Epidemiological AIDS-Case Definition was better than Europe-93 AIDS Case Definition. So this Definition can be very useful in countries and situations where the CD4 Cell Count is not available for technical or economical reasons.

Danish AIDS patients 1988-1993: a recent decline in Pneumocystis carinii pneumonia as AIDS-defining disease related to the period of known HIV positivity

The frequency of PCP among adult Danish AIDS patients notified in 1988-93 was higher among patients tested HIV-positive less than 4 months prior to AIDS than among those known to be positive for > 1 year. Among the latter, the proportion with PCP decreased significantly over the period, from 45.3% in 1988 to 22.0% in 1993, while no such trend was found among patients tested positive for HIV less than 4 months before AIDS was diagnosed. The incidence of PCP as an AIDS-defining disease has decreased, most likely due to the use of PCP prophylaxis.