RESUMO
Objectives: In a context of COVID-19 vaccine shortages, this study sought to evaluate the safety and efficacy of receiving one dose of Gam-COVID-Vac rAd26 followed by a second COVID-19 vaccine dose of either Gam-COVID-Vac rAd5, ChAdOx1 nCoV-19 or BBIBP-CorV in a cohort of older adults. Study design: Single-centre, randomised, open label, non-inferiority trial. Methods: Adults aged ≥65 years who had received one dose of Gam-COVID-Vac rAd26 were randomised in a 1:1:1 ratio to receive a second-dose COVID-19 vaccination of either Gam-COVID-Vac rAd5, ChAdOx1 nCoV-19 or BBIBP-CorV. The primary outcome was the assessment of the humoral immune response to vaccination (i.e. antibody titres of SARS-CoV-2 spike protein at 28 days after second-dose vaccination). In addition, neutralising antibody titres at day 28 for the three schedules were measured. Results: Of 85 participants who were enrolled in the study between 26 and July 30, 2021, 31 individuals were randomised to receive Gam-COVID-Vac rAd5, 27 to ChAdOx1 nCoV-19 and 27 to BBIBP-CorV. The mean age of participants was 68.2 years (SD 2.9) and 49 (57.6%) were female. Participants who received Gam-COVID-Vac rAd5 and ChAdOx1 nCoV1-19 showed significantly increased anti-S titres at 28 days after second-dose vaccination, but this magnitude of difference was not observed for those who received BBIBP-CorV. The ratio between the geometric mean at day 28 and baseline within each group was 11.8 (6.98-19.89) among patients assigned to Gam-COVID-Vac rAd26/rAd5, 4.81 (2.14-10.81) for the rAd26/ChAdOx1 nCoV-19 group and 1.53 (0.74-3.20) for the rAd26/BBIBP-CorV group. All of the schedules were shown to be safe. Conclusions: The findings in this study contribute to the scarce information published on the safety and immunogenicity of Gam-COVID-Vac heterologous regimens and will help the development of guidelines and vaccine programme management.
RESUMO
The EuroSIDA study was initiated in 1994 and follows adult people living with HIV (PLHIV) in 100 collaborating clinics across 35 countries covering all European regions, Israel and Argentina. The study aims to study the long-term virological, immunological and clinical outcomes of PLHIV and to monitor temporal changes and regional differences in outcomes across Europe. Annually collected data include basic demographic characteristics, information on AIDS- and non-AIDS-related clinical events, and details about antiretroviral therapy (ART), hepatitis C treatment and other medications, in addition to a range of laboratory values. The summer 2016 data set held data from a total of 23 071 individuals contributing 174 481 person-years of follow-up, while EuroSIDA's unique plasma repository held over 160 000 samples. Over the past 25 years, close to 300 articles have been published in peer-reviewed journals (h-index 52), covering a range of scientific focus areas, including monitoring of clinical and virological outcomes, ART uptake, efficacy and adverse events, the influence of hepatitis virus coinfection, variation in the quality of HIV care and management across settings and regions, and biomarker research. Recognizing that there remain unresolved issues in the clinical care and management of PLHIV in Europe, EuroSIDA was one of the cohorts to found The International Cohort Consortium of Infectious Disease (RESPOND) cohort consortium on infectious diseases in 2017. In celebration of the EuroSIDA study's 25th anniversary, this article aims to summarize key scientific findings and outline current and future scientific focus areas.
Assuntos
Infecções por HIV/tratamento farmacológico , HIV/imunologia , Hepatite C/tratamento farmacológico , RNA Viral/genética , Argentina , Contagem de Linfócito CD4 , Coinfecção , Europa (Continente) , Feminino , HIV/genética , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Israel , Perda de Seguimento , Masculino , Estudos Multicêntricos como Assunto , Resultado do Tratamento , Carga ViralRESUMO
OBJECTIVES: Up to 20% of HIV-related focal brain lesion (FBL) diagnoses cannot be determined without invasive procedures. In such cases, brain biopsy is an important step in the evaluation algorithm. The aims of this study were to describe the clinical outcomes of patients with FBL, the proportion of diagnoses confirmed by brain biopsies and their aetiologies, and to analyse the proportion of patients in whom the biopsy motivated a change in therapeutic management. METHODS: A retrospective cohort study was performed. The data from clinical records of patients with HIV-related FBL admitted between January 2005 and December 2015 were reviewed. RESULTS: A total of 137 patients were included in the study. The median age was 39 years [interquartile range (IQR) 33-44.5 years]. The median CD4 count was 54 cells/µL (IQR 21-124 cells/µL). Cerebral brain biopsy was performed in 21.16% of patients (29 of 137); 68.9% of these individuals (20 of 29) were diagnosed by histology, with results of central nervous system (CNS) lymphoma in 20.6% (six of 29), progressive multifocal leucoencephalopathy in 6.8% (two of 29), toxoplasmosis in 6.8% (two of 29), tuberculoma in 6.8% (two of 29), and other diagnoses in 27.6% (eight of 29). In nine patients, the histology was nonspecific. In 75.8% of patients (22 of 29), the result of the biopsy led to a change in the therapeutic management. We did not observe higher rates of mortality related to the procedure. Overall mortality at 30 and 90 days was similar in patients who were and were not biopsied. CONCLUSIONS: In this retrospective cohort study, cerebral biopsy was associated with significant adjustments in therapeutic management for a high percentage of patients.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Biópsia/métodos , Encefalopatias/diagnóstico , Encéfalo/patologia , Infecções por HIV/complicações , Histocitoquímica/métodos , Linfoma Relacionado a AIDS/diagnóstico , Adulto , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
BACKGROUND: Lymphangioleiomyomatosis (LAM), a rare cystic disease characterized by proliferation of smooth muscle cells in the lung interstitium, almost exclusively affects females in their reproductive years. Lung transplantation has been established as effective therapy for end-stage pulmonary LAM. METHODS: This retrospective study includes lung transplantation patients with LAM at a single institution between 1989 and 2009. RESULTS: During the study period we performed 300 lung transplantations, and in 10 cases the recipients had LAM. All patients were females with a mean age of 43.8 years. The mean time from the diagnosis to lung transplantation was 5 years. Seven patients had experienced previous pneumothoraces, five of whom were treated with pleurodesis. In all patients we performed a single-lung transplantation (left-sided = 9 and right-sided = 1). In three cases, the pleurodesis was on the same side as the transplantation, with great intraoperative bleeding in one subject (left pleurectomy). There was one early death due to infective endocarditis at posttransplant day 19. The median length of mechanical ventilation was 13 hours, while the mean hospital stay was 16.75 days. There was no case of chylothorax. Late complications included one case of native lung pneumothorax, one diaphragmatic hernia, one posttransplant lymphoproliferative disease, one respiratory sepsis, and one mycobacterial infection. The 1- and 3-year survival rates were 90% and 80%, respectively. CONCLUSION: Lung transplantation is a feasible therapeutic option for patients with LAM, despite previous ipsilateral pleurodesis. The left-sided predilection for our procedures may have been responsible for the absence of chylothorax in this series.
Assuntos
Transplante de Pulmão , Linfangioleiomiomatose/cirurgia , Adulto , Brasil , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVES: Apricitabine (ATC) is a novel deoxycytidine analogue nucleoside reverse transcriptase inhibitor (NRTI) with significant antiviral activity in vitro, including activity against HIV-1 with reverse transcriptase mutations that confer resistance to other NRTIs. ATC has shown promising antiviral activity and good tolerability when given as monotherapy for 10 days in treatment-naïve HIV-1-infected patients. METHODS: In this Phase II randomized, double-blind study, 51 treatment-experienced HIV-1-infected patients with the reverse transcriptase mutation M184V who were failing therapy which included lamivudine (3TC) were randomized to receive twice-daily 600 mg ATC, 800 mg ATC or 150 mg 3TC for 21 days. Patients remained on their existing background regimen until day 21, when background therapy could be optimized according to genotype at screening. RESULTS: At day 21, the mean change in viral load was -0.71 and -0.90 log(10) HIV-1 RNA copies/mL in the 600 and 800 mg ATC groups, respectively, compared with a -0.03 log(10) change in the 3TC group. In patients with at least three thymidine analogue mutations (TAMs) at baseline, greater reductions in viral load were observed in the 800 mg ATC group at day 21 than in the 600 mg ATC group. Few genotypic changes were detected at day 21 [two patients (600 mg ATC) lost and three patients (800 mg ATC) gained a TAM] and all patients with detectable virus retained the M184V mutation. The safety profiles of the two ATC doses were similar to that of 3TC. CONCLUSIONS: Over the 21-day treatment period, ATC showed promising antiviral activity and was well tolerated in treatment-experienced patients with M184V, with or without additional TAMs.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Desoxicitidina/análogos & derivados , Farmacorresistência Viral/efeitos dos fármacos , Infecções por HIV/tratamento farmacológico , Transcriptase Reversa do HIV/genética , HIV-1/efeitos dos fármacos , HIV-1/genética , Adulto , Argentina/epidemiologia , Austrália/epidemiologia , Desoxicitidina/uso terapêutico , Farmacorresistência Viral/genética , Feminino , Genótipo , Infecções por HIV/genética , HIV-1/enzimologia , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Resultado do Tratamento , Carga Viral/efeitos dos fármacos , Replicação Viral/efeitos dos fármacos , Adulto JovemRESUMO
OBJECTIVE: Acquired immune deficiency appears to be associated with serious non-AIDS (SNA)-defining conditions such as cardiovascular disease, liver and renal insufficiency and non-AIDS-related malignancies. We analysed the incidence of, and factors associated with, several SNA events in the LATINA retrospective cohort. MATERIALS AND METHODS: Cases of SNA events were recorded among cohort patients. Three controls were selected for each case from cohort members at risk. Conditional logistic models were fitted to estimate the effect of traditional risk factors as well as HIV-associated factors on non-AIDS-defining conditions. RESULTS: Among 6007 patients in follow-up, 130 had an SNA event (0.86 events/100 person-years of follow-up) and were defined as cases (40 with cardiovascular events, 54 with serious liver failure, 35 with non-AIDS-defining malignancies and two with renal insufficiency). Risk factors such as diabetes, hepatitis B and C virus coinfections and alcohol abuse showed an association with events, as expected. The last recorded CD4 T-cell count prior to index date (P = 0.0056, with an average difference of more than 100 cells/µL) and area under the CD4 cell curve in the year previous to index date (P = 0.0081) were significantly lower in cases than in controls. CD4 cell count at index date was significantly associated with the outcome after adjusting for risk factors. CONCLUSIONS: The incidence and type of SNA events found in this Latin American cohort are similar to those reported in other regions. We found a significant association between immune deficiency and the risk of SNA events, even in patients under antiretroviral treatment.
Assuntos
Doenças Cardiovasculares/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Hospedeiro Imunocomprometido , Hepatopatias/epidemiologia , Neoplasias/epidemiologia , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/imunologia , Adulto , Antirretrovirais/uso terapêutico , Contagem de Linfócito CD4 , Doenças Cardiovasculares/imunologia , Métodos Epidemiológicos , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Hepatopatias/imunologia , Masculino , Pessoa de Meia-Idade , Neoplasias/imunologia , Insuficiência Renal/epidemiologia , Insuficiência Renal/imunologia , América do Sul/epidemiologiaRESUMO
Chronic diarrhea is still a problem of difficult management in patients with AIDS, even in the HAART (Highly Active Antiretroviral Therapy) era. AIM: To establish the most appropriate diagnostic procedure for HIV infected patients, with CD4 count below 200 cells/ml and chronic diarrhea, starting on HAART. METHODS: Using a decision tree as the tool of a decision analysis, two alternatives were considered for the ethiologic diagnosis in AIDS associated chronic diarrhea. The compared alternatives were a minimal evaluation (stool culture and parasite stool examination), and complete evaluation (adding endoscopies with intestinal biopsies). The decision tree was constructed by TreeAge Data 32 software. Diagnostic and therapeutic data for both alternatives were obtained from medical publications. The outcome was the reported survival estimation for HIV infected patients with CD4 level bellow 200 cells/ml, starting HAART, with and without chronic diarrhea. RESULTS: In the basic analysis, as well as in the sensitivity analysis, a complete evaluation was the alternative that showed the highest expected value: 7.79 years of survival. The minimal evaluation showed a value of 7.05 years of survival. CONCLUSION: In HIV infected patients with chronic diarrhea and CD4 count below 200 cells/ml, starting on HAART, digestive endoscopies with biopsy samples are the best diagnostic approach.
La diarrea crónica constituye un problema de difícil manejo en pacientes con SIDA, aun en la era de las terapias antirretrovirales de alta eficacia (HAART). Objetivo: Establecer la conducta diagnóstica más adecuada frente a pacientes con infección por HIV, con niveles de linfocitos CD4+ menores a 200 células/mm 3 y diarrea crónica que comienza con HAART. Métodos: Utilizando el análisis de decisión, con un árbol de decisionescomo herramienta, se consideraron dos alternativas para el diagnóstico etiológico de la diarrea crónica asociada al SIDA. Las alternativas comparadas fueron la evaluación mínima (estudios microbiológicos de materia fecal) y la evaluación completa (adicionando estudios endoscópicos con biopsias). La construcción del árbol de decisiones se efectuó con el software TreeAge Data 32. Con datos obtenidos en la literatura, se estimaron las probabilidades diagnósticas y respuestas terapéuticaspara cada rama. En la estimación del resultado final se eligió la expectativa de vida publicada para pacientes con CD4 menores de 200 células/mm 3, que inician HAART, con y sin diarrea crónica. Resultados: Tanto en el escenario de base como en los análisisde sensibilidad llevados a cabo, la evaluación completa resultó la estrategia con mayor valor esperado. La expectativa de vida esperada fue de 7.79 años con ésta y de 7.05 años con la mínima. Conclusión: En pacientes HIV positivos con diarrea crónica, CD4 menores de 200 células/mm 3 y que inician HAART, las endoscopías digestivas con biopsias constituyen el major método para el diagnóstico etiológico.
Assuntos
Humanos , Masculino , Adulto , Diarreia/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Árvores de Decisões , Terapia Antirretroviral de Alta Atividade , Biópsia , Diarreia/tratamento farmacológico , Diarreia/microbiologia , Doença Crônica , Endoscopia Gastrointestinal/métodos , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/microbiologiaRESUMO
Chronic diarrhea is still a problem of difficult management in patients with AIDS, even in the HAART (Highly Active Antiretroviral Therapy) era. AIM: To establish the most appropriate diagnostic procedure for HIV infected patients, with CD4 count below 200 cells/ml and chronic diarrhea, starting on HAART. METHODS: Using a decision tree as the tool of a decision analysis, two alternatives were considered for the ethiologic diagnosis in AIDS associated chronic diarrhea. The compared alternatives were a minimal evaluation (stool culture and parasite stool examination), and complete evaluation (adding endoscopies with intestinal biopsies). The decision tree was constructed by TreeAge Data 32 software. Diagnostic and therapeutic data for both alternatives were obtained from medical publications. The outcome was the reported survival estimation for HIV infected patients with CD4 level bellow 200 cells/ml, starting HAART, with and without chronic diarrhea. RESULTS: In the basic analysis, as well as in the sensitivity analysis, a complete evaluation was the alternative that showed the highest expected value: 7.79 years of survival. The minimal evaluation showed a value of 7.05 years of survival. CONCLUSION: In HIV infected patients with chronic diarrhea and CD4 count below 200 cells/ml, starting on HAART, digestive endoscopies with biopsy samples are the best diagnostic approach.(AU)
La diarrea crónica constituye un problema de difícil manejo en pacientes con SIDA, aun en la era de las terapias antirretrovirales de alta eficacia (HAART). Objetivo: Establecer la conducta diagnóstica más adecuada frente a pacientes con infección por HIV, con niveles de linfocitos CD4+ menores a 200 células/mm 3 y diarrea crónica que comienza con HAART. Métodos: Utilizando el análisis de decisión, con un árbol de decisionescomo herramienta, se consideraron dos alternativas para el diagnóstico etiológico de la diarrea crónica asociada al SIDA. Las alternativas comparadas fueron la evaluación mínima (estudios microbiológicos de materia fecal) y la evaluación completa (adicionando estudios endoscópicos con biopsias). La construcción del árbol de decisiones se efectuó con el software TreeAge Data 32. Con datos obtenidos en la literatura, se estimaron las probabilidades diagnósticas y respuestas terapéuticaspara cada rama. En la estimación del resultado final se eligió la expectativa de vida publicada para pacientes con CD4 menores de 200 células/mm 3, que inician HAART, con y sin diarrea crónica. Resultados: Tanto en el escenario de base como en los análisisde sensibilidad llevados a cabo, la evaluación completa resultó la estrategia con mayor valor esperado. La expectativa de vida esperada fue de 7.79 años con ésta y de 7.05 años con la mínima. Conclusión: En pacientes HIV positivos con diarrea crónica, CD4 menores de 200 células/mm 3 y que inician HAART, las endoscopías digestivas con biopsias constituyen el major método para el diagnóstico etiológico.(AU)
Assuntos
Humanos , Masculino , Adulto , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Árvores de Decisões , Diarreia/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Biópsia , Linfócitos T CD4-Positivos , Doença Crônica , Diarreia/tratamento farmacológico , Diarreia/microbiologia , Endoscopia Gastrointestinal/métodos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/microbiologiaRESUMO
El objetivo del estudio fue describir y comparar las características de internación de pacientes infectadospor el HIV en dos períodos, uno previo y otro posterior a la disponibilidad del tratamientoantirretroviral de alta eficacia en nuestro medio. Diseñamos un estudio retrospectivo observacional. Se relevóla información demográfica y las características de las internaciones: motivo, días de hospitalización, evolucióny tratamiento antirretroviral al ingreso. Se revisaron 522 internaciones correspondientes a 330 pacientes en 2períodos: 1995-96 (n=289) y 2001-02 (n=233). Los motivos más frecuentes de internación fueron las enfermedadesmarcadoras de sida: 57.1% y 59.7% en los períodos 1 y 2 respectivamente. La tuberculosis fue la causaprincipal de internación en ambos períodos (23.9% y 15.5%), seguida de criptococosis (3.5% y 7.3%), neumoníapor Pneumocystis jiroveci (5.9% y 9.4%) y toxoplasmosis (6.9% y 8.6%). La mortalidad no se modificó de manerasignificativa (13.5% y 16.1%). La infección por HIV se diagnosticó en el 30% de los pacientes internados. Durante el 2° período, observamos una disminución en el número de pacientes que se internaron más de una vez (41.7% y 26.8%). El porcentaje de pacientes con tratamiento antirretroviral al ingreso aumentó del 8% al 25%. No observamos diferencias en las causas de internación y en la evolución de los pacientes en los períodos estudiados. Latuberculosis fue la enfermedad que más frecuentemente motivó la hospitalización. El número de internaciones se mantuvo estable, mientras que se observó un aumento en el número de consultas ambulatorias en ambos períodos (1678, 2512, 5670 y 7074 consultas para los años 1995, 1996, 2001 y 2002 respectivamente).
The purpose of this study was todescribe and to compare the characteristics of patient admissions during two periods, one pre HAARTand the other when HAART was fully available. A retrospective analysis of demographic data, ambulatory care information and hospitalization characteristics was performed. Causes of admission, outcome, mortality, length of hospitalization and type of antiretroviral therapy were analyzed. A total of 330 medical records were reviewed, corresponding to 522 admissions during both study periods: 1995-96 (n=289) and 2001-02 (n=233). The most frequent causes of hospitalization were AIDS defining events (period 1: 57.1%; period 2: 59.7%). Tuberculosis was the main cause of admission in both periods (23.9% and 15.5%). Criptococosis (3.5%-7.3%), Pneumocystis jiroveci pneumonia (5.9%-9.4%), and CNS toxoplasmosis (6.9 -8.6%) followed tuberculosis. Mortality did not vary significantly (13.5%-16.1%). HIV-1 infection was diagnosed at admission in 30% of cases. During 2nd period, a significant decrease in re-admission (41.6-26.8%) was observed, whereas there was an increase in the percentage of patients with previous antiretroviral treatment on admission (8%-25%). An increase in the ambulatory care clinic consultations (1995: n=1678; 1996: n=2512; 2001: n=5670; 2002: n=7074) was observed. No significant differences in the causes of admission and outcome in both periods were found. Tuberculosis is the most frequent disease that motivates hospitalization. The relation between ambulatory consultations and the amount of admissions significantly increased.
Assuntos
Adolescente , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Terapia Antirretroviral de Alta Atividade , Hospitalização/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Argentina/epidemiologia , Distribuição de Qui-Quadrado , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Infecções por HIV/mortalidade , Estudos Retrospectivos , Tuberculose/mortalidadeRESUMO
El objetivo del estudio fue describir y comparar las características de internación de pacientes infectadospor el HIV en dos períodos, uno previo y otro posterior a la disponibilidad del tratamientoantirretroviral de alta eficacia en nuestro medio. Diseñamos un estudio retrospectivo observacional. Se relevóla información demográfica y las características de las internaciones: motivo, días de hospitalización, evolucióny tratamiento antirretroviral al ingreso. Se revisaron 522 internaciones correspondientes a 330 pacientes en 2períodos: 1995-96 (n=289) y 2001-02 (n=233). Los motivos más frecuentes de internación fueron las enfermedadesmarcadoras de sida: 57.1% y 59.7% en los períodos 1 y 2 respectivamente. La tuberculosis fue la causaprincipal de internación en ambos períodos (23.9% y 15.5%), seguida de criptococosis (3.5% y 7.3%), neumoníapor Pneumocystis jiroveci (5.9% y 9.4%) y toxoplasmosis (6.9% y 8.6%). La mortalidad no se modificó de manerasignificativa (13.5% y 16.1%). La infección por HIV se diagnosticó en el 30% de los pacientes internados. Durante el 2º período, observamos una disminución en el número de pacientes que se internaron más de una vez (41.7% y 26.8%). El porcentaje de pacientes con tratamiento antirretroviral al ingreso aumentó del 8% al 25%. No observamos diferencias en las causas de internación y en la evolución de los pacientes en los períodos estudiados. Latuberculosis fue la enfermedad que más frecuentemente motivó la hospitalización. El número de internaciones se mantuvo estable, mientras que se observó un aumento en el número de consultas ambulatorias en ambos períodos (1678, 2512, 5670 y 7074 consultas para los años 1995, 1996, 2001 y 2002 respectivamente).(AU)
The purpose of this study was todescribe and to compare the characteristics of patient admissions during two periods, one pre HAARTand the other when HAART was fully available. A retrospective analysis of demographic data, ambulatory care information and hospitalization characteristics was performed. Causes of admission, outcome, mortality, length of hospitalization and type of antiretroviral therapy were analyzed. A total of 330 medical records were reviewed, corresponding to 522 admissions during both study periods: 1995-96 (n=289) and 2001-02 (n=233). The most frequent causes of hospitalization were AIDS defining events (period 1: 57.1%; period 2: 59.7%). Tuberculosis was the main cause of admission in both periods (23.9% and 15.5%). Criptococosis (3.5%-7.3%), Pneumocystis jiroveci pneumonia (5.9%-9.4%), and CNS toxoplasmosis (6.9 -8.6%) followed tuberculosis. Mortality did not vary significantly (13.5%-16.1%). HIV-1 infection was diagnosed at admission in 30% of cases. During 2nd period, a significant decrease in re-admission (41.6-26.8%) was observed, whereas there was an increase in the percentage of patients with previous antiretroviral treatment on admission (8%-25%). An increase in the ambulatory care clinic consultations (1995: n=1678; 1996: n=2512; 2001: n=5670; 2002: n=7074) was observed. No significant differences in the causes of admission and outcome in both periods were found. Tuberculosis is the most frequent disease that motivates hospitalization. The relation between ambulatory consultations and the amount of admissions significantly increased. (AU)