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HIV/Aids em 2016 Manejo e Prevenção nos dias de hoje

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HIV/Aids em 2016 Manejo e Prevenção nos dias de hoje

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HIV/Aids em 2016 Manejo e Prevenção nos dias de hoje

  1. 1. Alexandre Naime Barbosa MD, PhD Professor Doutor - Infectologia Treinamento da Rede Secretaria Municipal de Saúde Set/2016 - Botucatu - SP - Brasil
  2. 2. Declaro ter recebido incentivos na forma de inscrições de eventos científicos e/ou; viagens aéreas e terrestres e/ou; gastos com alimentação, hospedagem e translados e/ou; patrocínio para a realização de congressos; pagamentos por serviços prestados e/ou consultorias das seguintes empresas ou instituições nos últimos 12 meses: - Abbvie - Bristol-Myers Squibb - CNPq - DECIT - FAMESP - Gilead - GSK-ViiV - Jansen - Ministério da Saúde - DDAHV - Merck Sharp and Dohme - Prefeitura de Botucatu - SMS - Sociedade Brasileira de Infectologia - Sociedade Paulista de Infectologia - UNESCO - UNESP
  3. 3. O material que se segue faz parte do projeto didático do Prof. Dr. Alexandre Naime Barbosa Objetivos 1. Ensino: Treinamento de Estudantes e Profissionais da Área de Saúde; 2. Extensão: Facilitar o Contato da População em Geral com Conceitos Científicos; 3. Científico: Fomentar a Discussão Científica e Compartilhar Material Didático. Autoria e Cessão 1. Conteúdo: Os dados contidos estão referenciados, em respeito ao autor original; 2. Uso: Está permitido o uso do material, desde que citada a fonte; 3. Contato: fale com o autor e conheça o seu projeto didático em:
  4. 4. Saúde Global
  5. 5. Unaids - Aids Epidemic Update, 2014 ONU - 2015 1981-2014: 80 milhões de casos 1981-2014: 40 milhões de mortes 2014: 37 milhões de PVHA 2014: 2 milhões de casos novos 2014: 1,2 milhões de mortes
  6. 6. Brasil, MS - 2015 Prevalência Absoluta: 734 mil [610 mil – 1 milhão] de PVHA Prevalência Relativa: 0,4 a 0,7 % da população em geral Incidência Absoluta: 44.000 [31.000 – 57.000] de casos novos Mortalidade: 16.000 [9.900 – 23.000] de óbitos em PVHA
  7. 7. Brasil - Ministério da Saúde - BEP HIV/Aids, 2015
  8. 8. Brasil - Ministério da Saúde - BEP HIV/Aids, 2015
  9. 9. Brasil - Ministério da Saúde - BEP HIV/Aids, 2015
  10. 10. Brasil - Ministério da Saúde - BEP HIV/Aids, 2015
  11. 11. Slide cedido pelo dr. Fábio Mesquita - Epidemia presente em todas as segmentos - Concentrada em populações vulneráveis
  12. 12. - Epidemia presente em todas as segmentos - Concentrada em populações vulneráveis Slide Cedido pela Dra. Maria Clara Gianna
  13. 13. A JH K I G F E D C B
  14. 14. Caso 1 - Aluna da Veterinária - 30 a 40 anos - Heterossexual - Teve 4 namorados - Diagnóstico de HIV no Pré-Natal - Namorado: HIV+ - Sempre saudáveis - Nunca foram testados
  15. 15. Caso 2 - Aluno da Medicina - 20 a 30 anos - Homossexual - Namorados: ? - Diagnóstico de Sífilis: 1° ano - Diagnóstico de HIV: 3° ano - Sempre saudável - Fazia testagem regular
  16. 16.  Mucosa ou Epitélio  Vascularização  Rede Linfática  Área de Exposição  DSTs ou Lesões de Órgãos
  17. 17.  Lesões por Atrito  Lubrificação  Retenção fluídos  Fluídos Sexuais  Muco anal  Sangue
  18. 18.  Uso de Drogas  Uso de Álcool
  19. 19.  Festas Barebacking  Saunas e Casas de Banho  Casas de Swing  Gang Bang, Roleta Russa  Transmissão Intencional
  20. 20. Brasil, Ministério da Saúde - Pesquisa de Conhecimentos, Atitudes e Práticas na População Brasileira (PCAP), 2014
  21. 21. Brasil - Ministério da Saúde - BEP HIV/Aids, 2015
  22. 22. Dados Científicos até Setembro de 2016 - Não há relato de transmissão do HIV de fonte virologicamente suprimida
  23. 23. Brasil - Ministério da Saúde - BEP HIV/Aids, 2015
  24. 24. Brasil - Ministério da Saúde - BEP HIV/Aids, 2015
  25. 25. Brasil, Ministério da Saúde - 2015
  26. 26. Brasil, Ministério da Saúde - 2015
  27. 27. Brasil, Ministério da Saúde - 2015
  28. 28. Esquemas Preferenciais - 2 ITRN + ITRNN - ITRN: TDF + 3TC - ITRNN: EFZ Esquemas Alternativos - 2ITRN + ITRNN - 2 ITRN + IP/r - ITRN: 1. AZT, 2. ABC, 3. ddI - ITRNN: 1. NVP - IP: 2. LOP/r, 3. ATV/r, 4. FPV/r Brasil, Ministério da Saúde - 2015
  29. 29.  HAART: CV indetectável  Supressão em virgens ou não  Grande redução da mortalidade  Taxas próximas do normal Objetivo da TARV Tempo Carga Viral 4 - 6 semanas ↓ 1 log 4 meses ↓ 2 log 6 meses Indetectável À longo prazo Indetectável
  30. 30.  Doença Cardiovascular (IAM, AVE)  Câncer (Não-Aids)  Osteopenias e Fraturas  Disfunção Ventricular Esquerda  Insuficiência Hepática  Insuficiência Renal  Distúrbios Neuro-Cognitivos  “Síndrome da Fragilidade”  Imunossenescência Weber et al. HIV Med 2013; 14:195 HIV+ HIV+ HIV+ HIV -
  31. 31. ↑ Comorbidades Contágio na 3ª Idade Aumento da Sobrevida Inflamação Crônica Hábitos de Vida Toxicidade dos ARVs
  32. 32. Deeks, 2011
  33. 33. Slide cedido pelo dr. Fábio Mesquita
  34. 34. Patient and Partner Education Refraining from Sex Having only one sexual partner Male Circumcision PEP Treatment as Prevention (Tasp) Sexual Partners  Sharing Needles Older Age at Initiation of Sexual Activity Correct & Consistent Condom Use Treatment of STIs PrEP Prevention of mother- to-child transmission Behavioral Interventions Aim: to lower the number of partners, alter risk-taking behavior High-impact HIV Prevention Biomedical Interventions Aim: to reduce the efficiency of transmission or to shorten the duration of infectiousness
  35. 35. PEP: O que é? - Proteção Pós Exposição de Risco - Funciona até 72 horas - Exposição Sexual Consentida - Violência Sexual - Exposição Ocupacional - 3 cps, 1 x/dia, por 28 dias - Altíssima Eficácia, Urgência Médica - 451 Locais no Estado de São Paulo: www3.crt.saude.sp.gov.br/profilaxia/hotsite
  36. 36. < 72h, chance de impedir a formação de pró-vírus, ARVs impedem a perpetuação da infecção Infecção crônica pelo HIV, ARVs controlam replicação, mas não esterilizam as células
  37. 37. PEPs SAEI-DAM & HC UNESP (Infectologia FMB-HC UNESP (Jan/2014 - Jun/2015) Categoria de Exposição Nº Acidente Ocupacional 44 Exp. Hetero Ocasional 41 Violência Sexual - Mulher 17 HSH 8 Trabalhador(a) do Sexo 5 Violência Sexual - Criança 5 Outros 4 MSM 1 Violência Sexual - Adolescente 1 Usuário de Drogas 0 Total 126 35% 33% 13% 6% 4% 4% 3% 1% 1% 0% Acidente Ocupacional Exp. Sex. Hetero Ocasional Violência Sexual - Mulher Exp. Sex. HSH Trabalhador(a) do Sexo Violência Sexual - Criança Outros Exp. Sex. MSM Violência Sexual - Adolescente SAEI-DAM, 2015
  38. 38. PEPs SAEI-DAM & HC UNESP (Infectologia FMB-HC UNESP (Jan/2014 - Jun/2015) SAEI-DAM, 2015 6% 10% 34% 26% 18% 6% Crianças (< 13 anos) 13 - 19 20 - 29 30 - 39 40 - 49 50 ou mais Idade Nº Crianças (< 13 anos) 8 13 - 19 12 20 - 29 43 30 - 39 33 40 - 49 22 50 ou mais 8 Total 126 51%49% Feminino Masculino Sexo Nº Feminino 64 Masculino 62 Total 126
  39. 39. PEPs SAEI-DAM & HC UNESP (Infectologia FMB-HC UNESP (Jan/2014 - Jun/2015) SAEI-DAM, 2015 0% 20% 40% 60% 80% 100% PEP Completa: Sim PEP Completa: Não Completou PEP Nº PEP Completa: Sim 126 PEP Completa: Não 0 Total 126 0% 20% 40% 60% 80% 100% Transmissão HIV: Sim Transmissão HIV: Não Transmissão HIV Nº Transmissão HIV: Sim 0 Transmissão HIV: Não 126 Total 126
  40. 40. PrEP: O que é? - Proteção Pré Exposição de Risco - Populações ↑ Vulnerabilidade - 1 cp, 1 x/dia, uso contínuo - Altíssima eficácia - Aprovado nos EUA e Europa - Em Estudo Clínico no Brasil - Ainda não aprovado pela ANVISA (Set/2016)
  41. 41. Abdool Karim S, Abdool Karim Q, et al. Lancet. 2011;378:e23-e25.
  42. 42.  HIV/Aids: um dos mais graves problemas de saúde global  Brasil: desperdício oportunidades, mais infecções e mortes  Importante otimizar ferramentas disponíveis, sem banalizar  Referenciar sempre que tiver dúvidas  Divulgar em grupos mais vulneráveis  Promover sempre o uso do preservativo  Oferecer sempre a possibilidade de PEP  PrEP: janela de oportunidades  Testar e Tratar Sempre
  43. 43. Obrigado pela Atenção! SAE de Infectologia HC UNESP Botucatu Faculdade de Medicina UNESP

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