Jorg Heukelbach

Cutaneous larva migrans (creeping eruption) in an urban slum in Brazil

Background  Cutaneous larva migrans (CLM) is caused by the penetration of larvae of animal hookworms into the skin. Knowledge about this ectoparasitosis is mainly based on the examination of travelers or other expatriates. Population‐based studies in an endemic area have never been performed.

309 Positive Impact on Survival for Children with Aids in Brazil: Combined Analysis of Two National Studies, 1983-1998 and 1999-2002

Background: Brazil is known for its AIDS control program, including universal access to prevention, diagnosis, and treatment. Survival data is one indicator for program monitoring and evaluation. However, there are no systematic data on survival of children with AIDS. Methods: This analysis is based on 2 retrospective cohort studies of children under age 13 diagnosed in 1983-1998 and 1999-2002 (N=914 and 920, respectively). Both were randomly sampled from all reported cases in the country and employed similar methods. We calculated probability of survival to 60 months for children diagnosed with AIDS due to vertical transmission. Results: In the first study (1983-1998), overall survival to 60 months was 52.8% (95% CI: 41.9%- 60.8%). In the second study (1999-2002), overall survival increased to 86.5% (83.0%-89.3%). During the entire period, the probability of survival to 60 months increased by 4.5-fold, rising from about 20% to 90% (see figure; p<.001 by log-rank test). Among the 16 cases diagnosed 1983-1987, survival was 19.7% (11.2%-30.0%). For the 265 cases in 1988- 1992, it was 27.3% (22.9%-31.9%). For 1993-1994, survival was 39.7% (N=196; 33.4%-45.9%). For 1995-1996, it was 59.5% (N=221; 52.8%-65.6%). For 1997-1998, it was 68.2% (N=216; 61.6%- 73.9%). For 1999-2000, it was 86.5% (N=470; 83.0%-89.3%); and for 2001-2002, it was 90.2% (N=450; 87.0%-92.7%). Figure Conclusions: These results demonstrate the impact of Brazilian policies for children with AIDS. But this achievement creates new challenges related to providing longitudinal comprehensive care and maintaining high quality as well as quantity of survival.