Late Entry into HIV Care: Estimated Impact on AIDS Mortality Rates in Brazil, 2003-2006

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. Methodology/Principal Findings: 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/Significance: 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.

AIDS along Brazil`s borders, 1990-2003

Objective. To study the AIDS epidemic in Brazil`s border areas, from the spatial and temporal perspective. Methods. This was an ecological study in which the cases of AIDS reported to the Ministry of Health of Brazil from 1990-2003 were grouped according to ""hunger areas"" as defined by Josue de Castro in the 1940s and according to 19 cultural subregions. Spatial assessment was based on incidence rates for border municipalities; temporal assessment considered the absolute number of cases occurring quarterly from 1990-2003 in each of the hunger areas studied (Extreme South, Midwest, and Amazon). Results. During the study period, 7 973 cases of AIDS were reported from the Brazilian border areas: 648 in the Amazon area, 1 579 in the Midwest, and 5 746 in the Extreme South (populations of 668 098, 895 489, and 2 769 361, respectively). The subregions with the highest AIDS incidence rates in each of the three border areas were those near triple-borders, between more than two Latin American countries. Sexual transmission was predominant, with heterosexual transmission being the most frequent, followed by transmission by male homosexuality. These two categories accounted for 87.2% of the cases reported. The estimates of the trend parameter in the temporal analysis were 0.53 (P < 0.0001), 0.83 (P < 0.0001), and 3.47 (P < 0.0001), respectively, for the Amazon, Midwest, and Extreme South areas. Conclusion. The improvement of health care services along Brazil`s borders may be a strategy for territorial integration and for dealing with the AIDS epidemic, as long as social, economic, and cultural differences are taken into account.

Epidemiological survey and molecular characterization of avian infectious bronchitis virus in Brazil between 2003 and 2009

As part of an epidemiological study of infectious bronchitis virus (IBV) in Brazil, 252 samples from IBV-suspect flocks were tested and the IBV-positive samples were analysed by sequencing of hypervariable regions 1 and 2 of the S1 gene. A high prevalence of IBV variants was found and the sequence analysis of 41 samples revealed a high molecular similarity among the Brazilian isolates (from 90.2 to 100% and from 85.3 to 100% nucleotide and amino acid identity, respectively). The Brazilian isolates showed low genetic relationship with Massachusetts (63.4 to 70.7%), European (45.9 to 75.6%), American (49.3 to 76.4%) and other reference serotypes (67.5 to 78.8%). The Brazilian isolates branched into one unique cluster, separate from the reference serotypes used for infectious bronchitis control in other countries. The variants analysed in this work had a high similarity with all previously published Brazilian IBV isolates, suggesting the presence and high prevalence of a unique or predominant genotype circulating in Brazil. In addition, the virus neutralization test showed that the three Brazilian isolates analysed in the present study are antigenically related to one another but are different from the Massachusetts serotype. The present study shows that IBVs of a unique genotype can be associated with different clinical diseases, and that low genetic variation was detected in this genotype over a long period of time. The molecular characterization of the Brazilian variants isolated from 2003 to 2009 from different geographic regions of the country shows that only one predominant genotype is widespread in the Brazilian territory, denominated in this study as BR-I genotype.