The Virological and Immunological Characteristics of the HIV-1-Infected Population in Brazil: From Initial Diagnosis to Impact of Antiretroviral Use

Immunological and virological status of HIV-infected individuals entering the Brazilian public system over time was analyzed. We evaluated the impact of ART on virological, immunological and antiretroviral resistance over time.

CD4+ T cell counts, viral loads and genotypes from patients over 13 years old from 2001–2011 were analyzed according to demographic data. We compared groups using parametric t-tests and linear regression analysis in the R statistical software language.

Mean baseline CD4+ T cell counts varied from 348 (2003) to 389 (2009) and was higher among women (p = 1.1 x 10⁻⁸), lower in older patients (p< 1 x 10⁻⁸) and lower in less developed regions (p = 1.864 x 10⁻⁵). Percentage of treated patients with undetectable viral loads increased linearly from 46% (2001) to 77% (2011), was lower among women (p = 2.851 x 10⁻⁶), younger ages (p = 1 x 10⁻³), and in less developed regions (p = 1.782 x 10⁻⁴). NRTI acquired resistance was 86% in 2001–3 and decreased over time. NNRTI resistance increased from 2001-3(50%) to 2006–9 (60%), PI resistance decreased from 2001–3 (60%) to 2009 (40%), and 3-class resistance was stable over time around 25%. Subtype prevalence comprised B (75.3%), B/F recombinants (12.2%), C (5.7%), F (5.3%) and B/C recombinants (1.5%), with regional variations. Three-class resistance was 26.5% among Bs, 22.4% among Fs and 17.2% among Cs.

HIV diagnosis occurs late, especially among elderly Brazilians. Younger individuals need special attention due to poor virological response to treatment. Antiretroviral Resistance profile is subtype related.

Below:  CD4 cell counts at initial screening.  CD4+ T cell counts among antiretroviral naïve individuals at first presentation from 2001 to 2009.

Below:  CD4 cell counts by gender. Mean CD4+ T cell counts by gender according to the first measurement for each patient from 2001 to 2009.

Below: CD4 cell counts by age. Mean CD4+ T cell counts by age according to the first measurement for each patient from 2001 to 2009.

Below: CD4 cell counts by region. Mean CD4+ T cell counts by region according to the first measurement for each patient from 2001 to 2009.

Below:  Viral loads below detection limit. Percentage of viral loads below detection among all individuals on antiretroviral treatment by age from 2001 to 2011

Below:  Mean basal viral load. Mean basal viral load by age and gender according to the first measurement for each patient from 2001 to 2009.

Below:  Evolution of third ART treatment over time. Number of treatments containing non-nucleoside reverse transcriptase inhibitors (NNRTIs), unboosted protease inhibitors (PIs) and ritonavir-boosted PI from 2004 to 2009.

Below:  Antiretroviral resistance by class. Percentage of resistance to different antiretroviral classes and number of 3 class resistances among individuals in which the genotype test have been performed in Brazil from 2003 to 2009.

Below:  Antiretroviral class resistance by clade. Percentage of resistance to different antiretroviral classes by Clade (B, C and F) among patients treated between 2003 and 2009.

Full article at: http://goo.gl/VUHwyb

By:

Ricardo Sobhie Diaz, Lilian A. Inocêncio, Maria Cecilia Araripe Sucupira, James Hunter

Federal University of São Paulo, São Paulo, Brazil

Lilian A. Inocêncio, Anderson Alvarenga Pereira, Denise F. C. Souza

Brazilian STD/AIDS and Viruses Hepatitis Department, Ministry of Health, Brasilia, DF, Brazil

João Eduardo Ferreira, Luciano V. Araújo, Ester Cerdeira Sabino

University of Sao Paulo, Sao Paulo, Brazil

  

More at:  https://twitter.com/hiv_insight