Preliminary results of a prospective cohort of HIV+ patients in Guatemala: the Mangua project
B. Samayoa1, V. Isern2, L. Serra3, B.E. Rivera4, M. Nikiforov3, E. Arathoon4, M. Castro5, X. Vallés2, A. Batres6, M. Sabidò3, A.J. Betancourt2, J. Casabona2, C. Alvarez3
1Asociacion de Salud Integral (ASI), Guatemala, Guatemala, 2Centre d'Estudis Epidemiològics sobre ITS/VIH/SIDA de Catalunya, Barcelona, Spain, 3Fundació Sida i Societat, Barcelona, Spain, 4Asociación de Salud Integral (ASI) Clínica Familiar Luis Angel García, Guatemala, Guatemala, 5Programa Nacional de ITS/VIH/SIDA Ministerio de Salud Pública y Asistencia Social, Guatemala, Guatemala, 6Sistema de Información Gerencial de Salud, Guatemala, Guatemala
Background: There are not systematic surveillance data available about HIV/AIDS incidence and prevalence in Guatemala, and effectivity of the ARV regimes currently in use.
Methods: An informatic application, has been developed and implemented in 3 HIV/AIDS referral hospitals; data from all patients diagnosed at entry between 2005 and 2009 has been analysed. We aimed to describe the epidemiological characteristics of newly diagnosed HIV patients in Guatemala; and the clinical pattern of HIV infected patients being followed.
Results: 2258 patients have been included for follow-up, with a mean age 37 years; 59.3% men; ,62% had no educational level or without completing primary school; 83.7% were heterosexual, 6.4% men who have sex relations with men (MSM) and 5.5% were bisexuals. Among these who initiated care, CD4 and VL were available in 1291 (58.3%) and in 463 (20.9%) respectively, being mean CD4 count: 202 cells/ul (1-1600) and mean VL: 5.51 log10 copies/ml (1.7-6.04). Among those who started combined antiretroviral treatment (1031, 45%) , the most frequently ARV treatment were a combination of 2 nucleoside reverse transcriptase inhibitors with 1 non-nucleoside (83%); and a boosted based approach with 1 protease inhibitor (12%). 315 persons (14%) died on follow-up (person years) . AIDS-related diseases were responsible for 86% of deaths, with a further 6% due to non-related AIDS causes.
Conclusions: Many HIV-infected people in Guatemala do not learn about its infection till very advanced stages of the disease. The short term mortality is very high. Efforts should be directed to improve detection and move towards treating people earlier. The future generalization of the MANGUA project will help to provide better information of the use and effectivity of ARV in the Central America region.
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