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Initial antiretroviral therapy (ART) in a 20-year observational cohort of patients followed at a reference center (São Paulo STD/AIDS reference center-CRT-DST/AIDS), in the city of São Paulo, Brazil, according to race/color
A.L. Carvalho Monteiro1, J. Chauveau2, M. Tancredi1, M. Ramalho1, E. Catapano Ruiz1
1Centro de Referência e Treinamento DST/AIDS SP, Epidemiology, São Paulo, Brazil, 2Research Unit UMR912 'Economic & Social Sciences, Health Systems & Societies', INSERM, Marseilles, France and IRD, Aix Marseilles Université, Marseilles, France. Southeastern Health Regional Observatory (ORS-PACA), Marseilles, France, Marseille, France
Background: Brazil's large-scale, universal distribution of antiretrovirals has improved the quality of life and increased survival of patients with HIV/AIDS.
Methods: Exploratory retrospective cohort study of 4,191 HIV-infected individuals, 13 years and over on ART at CRT-DST/AIDS, 1985-2005. Information was collected from medical records. Results relate to initial ART; patients were classified as White, Black or Other: 72%, 26% and 2% of cohort, respectively. Chi-square test (p< 0.05) was used.
Results: Socio-epidemiological features showed 3 similar groups regarding age distribution and AIDS case reporting criteria (most over 30 years and CD4 count criterion). Gender distribution was different with proportionally more women among Black (35%) than among White (25.5%) or Other (28.5) individuals; most Whites (66%) and Others (71.5%) had over 8 years of schooling, while for Blacks the category represented 53.5%, with 42.5% with 1-8 years. MSM prevailed among Whites (46.5%), and heterosexuals among Blacks (54%) and Others (45%). A higher proportion of White individuals (40.5%) began treatment in 1985-1995, while Black individuals were basically divided into the 85-95 and 96-98 periods (35% each). The 3 groups similarly entered the study as naive (roughly 80% for all) and AIDS upon initiation (roughly 60% for all); distribution of 2NRTI+NNRTI or 2NRTI+PI regimens -53.5%, 57.5% and 54.5% respectively for Whites, Blacks and Others was also not statistically different. At the end of the period, 70% of Whites were still on treatment as were 72% Blacks and 77% Others; 17% were lost to follow-up in all groups; 12.5% of Whites, 11% of Blacks and 12% of Others died.
Conclusions: The study shows that for this large CRT-DST/AIDS cohort on ART, Brazil's universal distribution of ART and national guidelines provide similar treatment regimens and outcomes, although there are differences in patients' ethnical and other socio-epidemiological characteristics.
Funding: Agence Nationale de Recherches sur le SIDA (ANRS)
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