Deforestation and Carbon Stock Loss in Brazil’s Amazonian Settlements

We estimate deforestation and the carbon stock in 2740 (82 %) of the 3325 settlements in Brazil’s Legal Amazonia region. Estimates are made both using available satellite data and a carbon map for the “pre-modern” period (prior to 1970). We used data from Brazil’s Project for Monitoring Deforestation in Amazonia updated through 2013 and from the Brazilian Biomes Deforestation Monitoring Project (PMDBBS) updated through 2010. To obtain the pre-modern and recent carbon stocks we performed an intersection between a carbon map and a map derived from settlement boundaries and deforestation data. Although the settlements analyzed occupied only 8 % of Legal Amazonia, our results indicate that these settlements contributed 17 % (160,410 km2) of total clearing (forest + non-forest) in Legal Amazonia (967,003 km2). This represents a clear-cutting of 41 % of the original vegetation in the settlements. Out of this total, 72 % (115,634 km2) was in the “Federal Settlement Project” (PA) category. Deforestation in settlements represents 20 % (2.6 Pg C) of the total carbon loss in Legal Amazonia (13.1 Pg C). The carbon stock in remaining vegetation represents 3.8 Pg C, or 6 % of the total remaining carbon stock in Legal Amazonia (58.6 Pg C) in the periods analyzed. The carbon reductions in settlements are caused both by the settlers and by external actors. Our findings suggest that agrarian reform policies contributed directly to carbon loss. Thus, the implementation of new settlements should consider potential carbon stock losses, especially if settlements are created in areas with high carbon stocks. © 2016, The Author(s)

The HIV-Brazil Cohort Study: Design, Methods and Participant Characteristics

Background: The HIV-Brazil Cohort Study was established to analyze the effectiveness of combination antiretroviral therapy (cART) and the impact of this treatment on morbidity, quality of life (QOL) and mortality. The study design, patients’ profiles and characteristics of cART initiation between 2003 and 2010 were described. Methodology/Principal Findings: Since 2003, the HIV-Brazil Cohort has been following HIV-infected adults receiving cART at 26 public health care facilities, using routine clinical care data and self-reported QOL questionnaires. When not otherwise available, data are obtained from national information systems. The main outcomes of interest are diseases related or unrelated to HIV; suppression of viral replication; adverse events; virological, clinical and immunological failures; changes in the cART; and mortality. For the 5,061 patients who started cART between 2003 and 2010, the median follow-up time was 4.1 years (IQR 2.2–5.9 years) with an 83.4% retention rate. Patient profiles were characterized by a predominance of men (male/female ratio 1.7:1), with a mean age of 36.9 years (SD 9.9 years); 55.2% had been infected with HIV via heterosexual contact. The majority of patients (53.4%) initiated cART with a CD4+ T-cell count #200 cells/mm3. The medications most often used in the various treatment regimens were efavirenz (59.7%) and lopinavir/ritonavir (18.2%). The proportion of individuals achieving viral suppression within the first 12 months of cART use was 77.4% (95% CI 76.1–78.6). Nearly half (45.4%) of the patients presented HIV-related clinical manifestations after starting cART, and the AIDS mortality rate was 13.9 per 1,000 person-years. Conclusions/Significance: Results from cART use in the daily practice of health services remain relatively unknown in lowand middle-income countries, and studies with the characteristics of the HIV-Brazil Cohort contribute to minimizing these shortcomings, given its scope and patient profile, which is similar to that of the AIDS epidemic in the country

Traditional and HIV-specific risk factors for cardiovascular morbidity and mortality among HIV-infected adults in Brazil: a retrospective cohort study

BACKGROUND: Antiretroviral therapy (ART) agents potentially associated with adverse metabolic profiles are commonly used in low- and middle-income countries. We assessed risk factors for cardiovascular disease (CVD)-related morbidity and mortality in a cohort of HIV-infected, ART-treated adults in Rio de Janeiro, Brazil. METHODS: Hospital records and mortality data between 2000–2010 were examined for incident CVD-related ICD-10 and Coding of Death in HIV diagnoses among adults ≥18 years old on ART, enrolled in an observational cohort. Poisson regression models assessed associations between demographic and clinical characteristics and ART agent or class on CVD event risk. RESULTS: Of 2960 eligible persons, 109 had a CVD event (89 hospitalizations, 20 deaths). Participants were 65 % male, 54 % white, and had median age of 37 and 4.6 years on ART. The median nadir CD4(+) T lymphocyte count was 149 cells/mm(3). The virologic suppression rate at the end of study follow-up was 60 %. In multivariable models, detectable HIV-1 RNA prior to the event, prior CVD, less time on ART, age ≥40 at study baseline, nadir CD4(+) T lymphocyte count ≤50 cells/mm(3), non-white race, male gender, and a history of hypertension were significantly associated with CVD event incidence (p < 0.05), in order of decreasing strength. In multivariate models, cumulative use of tenofovir, zidovudine, efavirenz and ritonavir-boosted atazanavir, darunavir and/or lopinavir were associated with decreased CVD event risk. Recent tenofovir and boosted atazanavir use were associated with decreased risk, while recent stavudine, nevirapine and unboosted nelfinavir and/or indinavir use were associated with increased CVD event risk. CONCLUSIONS: Virologic suppression and preservation of CD4(+) T-lymphocyte counts were as important as traditional CVD risk factor burden in determining incident CVD event risk, emphasizing the overall benefit of ART on CVD risk and the need for metabolically-neutral first- and second-line ART in resource-limited settings. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-016-1735-4) contains supplementary material, which is available to authorized users