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


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Federal University of São Paulo, São Paulo, Brazil.
Ricardo Sobhie
RS
Diaz
Federal University of São Paulo, São Paulo, Brazil; Brazilian STD/AIDS and Viruses Hepatitis Department, Ministry of Health, Brasilia, DF, Brazil.
Lilian A
LA
Inocêncio
Federal University of São Paulo, São Paulo, Brazil.
Maria Cecilia Araripe
MC
Sucupira
Brazilian STD/AIDS and Viruses Hepatitis Department, Ministry of Health, Brasilia, DF, Brazil.
Anderson Alvarenga
AA
Pereira
Federal University of São Paulo, São Paulo, Brazil.
James
J
Hunter
University of Sao Paulo, Sao Paulo, Brazil.
João Eduardo
JE
Ferreira
University of Sao Paulo, Sao Paulo, Brazil.
Luciano V
LV
Araújo
Brazilian STD/AIDS and Viruses Hepatitis Department, Ministry of Health, Brasilia, DF, Brazil.
Denise F C
DF
Souza
University of Sao Paulo, Sao Paulo, Brazil.
Ester Cerdeira
EC
Sabino
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001938:Brazil; D018791:CD4 Lymphocyte Count; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology* / Q000821:virology*; D006801:Humans; D057230:Limit of Detection; D008297:Male; D008875:Middle Aged; D019562:Viral Load; D055815:Young Adult