Universidade Federal de Minas Gerais, Faculdade de Farmácia, Programa de Pós-Graduação Stricto Sensu em Medicamentos e Assistência Farmacêutica, Belo Horizonte, MG, Brasil.
Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-graduação Stricto Sensu em Infectologia e Medicina Tropical, Belo Horizonte, MG, Brasil.
Rev Soc Bras Med Trop. 2020 Dec 11;53:e20200360. doi: 10.1590/0037-8682-0360-2020. eCollection 2020.
The first Brazilian HIV treatment recommendation was put forward in 1996, resulting in 12 subsequent guidelines. Several changes were made regarding "when" and "how" to begin treatment. The latest guideline recommends immediate initiation of antiretroviral therapy (ART). This study aimed to describe the evolution of HIV treatment among people living with HIV (PLHIV) who initiated ART between 2004 and 2018 based on the national guideline recommendations concerning T-CD4+ and VL measurements.
A cross-sectional analysis of data of PLHIV aged >18 years, in Minas Gerais who received ART between 2004 and 2018 was conducted. Clinical, therapeutic, and demographic information were obtained from national healthcare databases. The study was divided into four periods: 2004-2007, 2008-2012, 2013-2016, and 2017-2018. Descriptive analyses were performed.
A total of 60,618 PLHIV initiated ART (67% male and 48% aged 25-39 years), 36% of whom had CD4 counts at ART initiation and 51% documented VL after ART initiation. The median CD4 count ranged from 288 to 373 cells/µL. The median time to ART initiation decreased from 604 to 28 days and was lower among males (p <0.01). The median time from ART initiation to the first VL result decreased from 101 to 62 days over the study period, while the median VL after ART initiation ranged from 2.3 to 1.7 log10 copies/ml.
Although our results demonstrated that most recommendations were followed, there seemed to be little impact on CD4 counts and VL testing. This may result in an inadequate evaluation of ART effectiveness.
1996 年，巴西首次提出了 HIV 治疗建议，随后又提出了 12 项后续指南。在“何时”和“如何”开始治疗方面，发生了多次变化。最新的指南建议立即开始抗逆转录病毒治疗（ART）。本研究旨在根据国家指南中关于 T-CD4+和 VL 测量的建议，描述 2004 年至 2018 年间接受 ART 的 HIV 感染者（PLHIV）治疗的演变。
对 2004 年至 2018 年间在米纳斯吉拉斯州接受 ART 的年龄>18 岁的 PLHIV 进行了一项基于国家医疗保健数据库的横断面数据分析。获取了临床、治疗和人口统计学信息。该研究分为四个时期：2004-2007 年、2008-2012 年、2013-2016 年和 2017-2018 年。进行了描述性分析。
共有 60618 名 PLHIV 开始接受 ART（67%为男性，48%年龄在 25-39 岁之间），其中 36%在开始 ART 时有 CD4 计数，51%在开始 ART 后有 VL 记录。CD4 计数的中位数范围为 288 至 373 个细胞/µL。开始 ART 的中位时间从 604 天缩短至 28 天，男性的中位时间更短（p<0.01）。从开始 ART 到第一次 VL 结果的中位时间从 101 天缩短至 62 天，而开始 ART 后的 VL 中位数范围为 2.3 至 1.7 log10 拷贝/ml。
尽管我们的结果表明大多数建议都得到了遵循，但似乎对 CD4 计数和 VL 检测的影响不大。这可能导致对 ART 效果的评估不足。
