A Brazilian study showed that the chance of death in HIV patients diagnosed late is 6.17 times greater than that of people who discovered the virus in the early stages. The research brings data from the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da USP (HCFMRP-USP), from 2015 to 2019, and was published by The Brazilian Journal of Infectious Diseases, in October.
The material also points out that cases originating in ward care (when there is already an opportunistic or chronic disease present) had 87.73% more deaths than those treated outside of an emergency situation.
Until September 2022, according to data from the latest Clinical Monitoring Report from the Ministry of Health, the average of late discoveries was 29%, reaching 45% in the age group over 50 years old.
The proportions of late presentation of diagnosis for the disease were 13% among individuals aged 2 to 11 years, 9% for those aged 12 to 17 years, 13% among those aged 18 to 24 years and 21% of 25 to 29 years old. From 30 to 49 years old, the discovery at an advanced stage represented 35% of diagnoses, reaching 45% for the age group of 50 years and over.
Late and very late diagnoses in Brazil can make it difficult to achieve the goals of the World Health Organization (WHO), which by 2030 aims to eradicate the transmission of the syndrome globally.
Bernardo Porto Maia, infectious disease doctor and medical supervisor of the Emergency Room at the Emílio Ribas Institute of Infectious Diseases, an entity that promotes a free event on the topic this December 1st, World AIDS Day, for health professionals, sees the Brazilian scenario with concern.
This is because, despite the arrival in 2023 of new preventatives (capable of avoiding virus infection for up to 2 months) and new medications that guarantee simpler treatment with fewer side effects, the country still sees an increase in new infections and existence of deaths from the disease — there were 13 thousand losses in 2022.
“Approximately 30% of our patients living with HIV are already diagnosed in an advanced disease situation. Having this diagnosis as soon as possible and starting antiretroviral treatment greatly reduces morbidity, we ensure that patients have less chance of developing opportunistic diseases or chronic diseases related to long-term HIV infection”, says Maia.
The doctor also highlights that early therapy guarantees a better immune response and a reduction in mortality, as well as a block in the virus transmission cascade. “Early treatment achieves undetectability of the viral load of this virus in the blood and, therefore, makes this virus untransmissible from relationships [sexuais ou verticais, como as de gestação] established by the people who live with him. Today we know that undetectable is the same as untransmittable”, reinforces the expert.
Last year, Brazil had 51 thousand new cases of HIV, which represents a 24.4% increase in the total number of new records compared to the previous year, when 40.8 thousand new patients living with the infection were admitted. The number represents 5% of the 1,088,536 people living with the comorbidity in the country.
The increase in the detection of new cases in 2022, according to Maia, can be attributed to several factors, such as the resumption of activities after the Covid-19 pandemic and greater access to testing.
Late and very late diagnoses in Brazil, in turn, can make it difficult to achieve the goals of the WHO (World Health Organization), which by 2030 aims to eradicate HIV transmission globally.
Unaids (Joint United Nations Program on HIV/AIDS) considers the Brazilian transmission situation to be far from ideal. “Cases of HIV infections remain high in the country, despite the SUS (Unified Health System) offering free HIV and AIDS prevention, diagnosis and treatment services”, says Claudia Velasquez, director and representative of Unaids in Brazil .
Velasquez, who spoke through a consultancy with the report, also highlighted that countries such as Botswana, Rwanda, the United Republic of Tanzania and Zimbabwe, on the African continent, the most affected by the AIDS pandemic, have already achieved the three targets 95-95-95 of the WHO for the 2030 objective.
“This means that, in these countries, 95% of people living with HIV know their serological status; 95% of people who know they are living with HIV are on antiretroviral treatment; and 95% of people on treatment have their viral load suppressed” , says the director.
In Brazil, according to a 2023 UNAIDS report, only the goal of viral suppression was achieved. Furthermore, 91% of people living with HIV know their serological status and 81% have access to treatment.
For infectologist Bernardo Porto Maia, the health system as a whole needs to organize itself to enable early diagnosis, with easier testing, without prejudice, and accessible to key populations, such as people deprived of liberty, transsexuals and men who do sex with other men.
“Another group that has been more vulnerable, for example, is people aged 15 to 24, in which we still have an increase in the number of new infections. There is still a racial divide, unfortunately. We have had a reduction in AIDS mortality, from 2010 to 2020, 29.9%, but more than 60% of these deaths were restricted to the black population in our country”, says Maia.
Some important advances were also recorded in the country, however. The recent incorporation by the SUS in 2023 of the substances dolutegravir at 50 milligrams and lamivudine at 300 milligrams in a single dose should make a lot of difference. “This new medication is another possibility to increase adherence to treatment, as it is a simplification of the existing one, in addition to avoiding side effects and keeping the viral load under control”, says Velasquez.
This year’s adoption of new public health guidelines should also bring improvements. “Several changes were incorporated in the update of the Clinical Protocol and Therapeutic Guidelines, the PCDT. The document was divided into three modules —Treatment, Co-infections and opportunistic infections and Comorbidities— and, for the first time, provides information that people with an undetectable viral load do not transmit the virus sexually”, says the director of Unaids Brazil.
The recent publication of new pre-exposure prophylaxis (PrEP) strategies in a long-acting injectable model (every two months) is another novelty that has just been released in Brazil. “This medication has already been approved and is being implemented in the public health system, replacing the daily intake of PrEP tablets and with even greater effectiveness in protecting against HIV infection”, says Maia.
The doctor also remembers that the field of studies on AIDS is growing, ranging from the search for a cure through a global vaccine to solutions for transplants for immunosuppressed people. “We also have prevention studies that are not based on vaccines, such as PrEP, even more long term, for subcutaneous antiretrovirals lasting 6 months, to try to facilitate adherence [ao tratamento] and reduce the number of new HIV cases”, says the doctor.