Momento diagnóstico da infecção pelo HIV em relação à contagem de LTCD4+, carga viral e quadro clínico em um serviço especializado de Belo Horizonte de 2008 a 2010

Abstract

Introduction: Since the early 1980´s, after the first cases of HIV were reported in Brazil, the Brazilian governments response to the epidemic was forceful. It was based on early diagnosis, treatment and prevention. In 1996 Brazil became the first developing country to ensure free universal access to antiretroviral therapy (ARV). Consequently, survival rates among Brazilian AIDS patients have improved dramatically. However, the majority of our patients are still late presenting for treatment for HIV, particularly due to delayed diagnosis. This fact leads to consequences both for the individual and society. Objective: clinical and immunological characteristics of HIV patients recently diagnosed were accessed, and factors associated with late presentation to care facilities were evaluated. Methods: A cross-section analysis was performed in a reference center for HIV/AIDS in Belo Horizonte, Minas Gerais in Southeastern Brazil from 2008 to 2010. The variable of interest was the first CD4 cell count measurement. In order to compare to other studies of the same kind, two terms were defined: Late presentation for treatment (LP) was defined as the subjects whose first CD4 cell count was less than 350 cells/mm³ or presented an AIDS defining opportunistic infection; late presentation with advanced disease (LPAD) as the subjects whose first CD4 cell count was less than 200 cells/mm³ or presented an AIDS defining opportunistic infection. LP and LPAD associated risk factors were evaluated using logistic regression methods. Results: Five hundred and twenty patients were included in the analysis (77.3% were male and the median age was 35.1). The median of the CD4 cell count was 336 cells/mm³ (IQR: 130-531). Two hundred and seventy nine patients (53.7%) were classified as LP and 193 (37.1%) classified as LPAD. In multivariate logistic analyses the factors associated with LP and LPAD were age over 35 years, being symptomatic at first attendance and high VL. Non-white race was a factor associated with LP but not LPAD. Presenting with a positive VDRL was associated with a lower chance of being LP and LPAD. Conclusion: The proportion of patients attending HIV treatment late is still high. This is despite the availability of free ARV treatment in Brazil for more than fifteen years and massive media campaigns encouraging HIV testing in the country. These results suggest that earlier treatment will have little impact in prevention, unless effective strategies to increase universal HIV testing are implemented. Effective strategies to increase HIV testing with a special focus on the vulnerable population are urgently needed.