title: Late entry into HIV care: estimated impact on AIDS mortality rates in Brazil, 2003-2006.
abstract: BACKGROUND
  Worldwide, a high proportion of HIV-infected individuals enter into HIV care late. Here, our objective was to estimate the impact that late entry into HIV care has had on AIDS mortality rates in Brazil.
  
  
  RESULTS
  We analyzed data from information systems regarding HIV-infected adults who sought treatment at public health care facilities in Brazil from 2003 to 2006. We initially estimated the prevalence of late entry into HIV care, as well as the probability of death in the first 12 months, the percentage of the risk of death attributable to late entry, and the number of avoidable deaths. We subsequently adjusted the annual AIDS mortality rate by excluding such deaths. Of the 115,369 patients evaluated, 50,358 (43.6%) had entered HIV care late, and 18,002 died in the first 12 months, representing a 16.5% probability of death in the first 12 months (95% CI: 16.3-16.7). By comparing patients who entered HIV care late with those who gained timely access, we found that the risk ratio for death was 49.5 (95% CI: 45.1-54.2). The percentage of the risk of death attributable to late entry was 95.5%, translating to 17,189 potentially avoidable deaths. Averting those deaths would have lowered the 2003-2006 AIDS mortality rate by 39.5%. Including asymptomatic patients with CD4(+) T cell counts >200 and ≤ 350 cells/mm(3) in the group who entered HIV care late increased this proportion by 1.8%.
  
  
  CONCLUSIONS
  In Brazil, antiretroviral drugs reduced AIDS mortality by 43%. Timely entry would reduce that rate by a similar proportion, as well as resulting in a 45.2% increase in the effectiveness of the program for HIV care. The World Health Organization recommendation that asymptomatic patients with CD4(+) T cell counts ≤ 350 cells/mm(3) be treated would not have a significant impact on this scenario.
authors.affiliation: Departamento de Medicina Preventiva da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. ale.grangeiro@gmail.com
authors.forename: Alexandre
authors.initials: A
authors.lastname: Grangeiro
authors.forename: Maria Mercedes
authors.initials: MM
authors.lastname: Escuder
authors.forename: Paulo Rossi
authors.initials: PR
authors.lastname: Menezes
authors.forename: Rosa
authors.initials: R
authors.lastname: Alencar
authors.forename: Euclides
authors.initials: E
authors.lastname: Ayres de Castilho
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015658:HIV Infections / Q000401:mortality / Q000628:therapy*; D006801:Humans; D015995:Prevalence; D015996:Survival Rate; D013997:Time Factors; D014944:World Health Organization; D055815:Young Adult
chemical_list: D000998:Antiviral Agents