Abstract
This study analyzed data from two consecutive retrospective cohort samples (1983 to 1998 and 1999 to 2002) of Brazilian children with AIDS (N = 1,758) through mother-to-child-transmission. Late-stage diagnosis (CDC category C) was investigated in relation to the following variables: year of birth, year of HIV diagnosis, and time periods related to changes in government treatment guidelines. Late-stage diagnosis occurred in 731 (41.6%) of cases and was more prevalent in infants under 12 months of age. The rate of late-stage diagnosis decreased from 48% to 36% between the two periods studied. We also observed a reduction in the proportion of late-stage diagnoses and the time lapse between HIV diagnosis and ART initiation. A significant association was found between timely diagnosis and having been born in recent years (OR = 0.62; p = 0.009) and year of HIV diagnosis (OR = 0.72; p = 0.002/OR = 0.62; p < 0.001). Infants under the age of 12 months were more likely to be diagnosed at a late stage than older children (OR = 1.70; p = 0.004). Despite advances, there is a need to improve the effectiveness of policies and programs focused on improving early diagnosis and management of HIV/AIDS.
Highlights
MethodsThe implementation of national health system programs to promote early HIV diagnosis in pregnant women is a fundamental strategy to prevent mother-to-child transmission of the disease 1
We observed a reduction in the proportion of latestage diagnoses and the time lapse between HIV diagnosis and antiretroviral treatment (ART) initiation
HIV replication plays an important role in disease pathogenesis [6,7] and early antiretroviral treatment (ART) in children has been shown to be associated with long-term control of HIV-1 replication and improved clinical and immunological outcomes [4,5,6]
Summary
MethodsThe implementation of national health system programs to promote early HIV diagnosis in pregnant women is a fundamental strategy to prevent mother-to-child transmission of the disease 1. Two retrospective cohort studies of children diagnosed with AIDS in two distinct periods (1983 to 1998 and 1999 to 2002) showed a 52.8% and 88.3% increase in probability of survival after 60 months 17, a populationbased study of 84,694 patients aged 15 years or over showed that a high proportion of patients undertaking HAART began at an advanced stage of the infection 18. This scenario reinforces the need to review strategies within the Brazilian Unified National Health System (SUS) aimed at ensuring early diagnosis
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