Late-stage diagnosis of HIV infection in Brazilian children: evidence from two national cohort studies

• Published in: Cadernos de saúde pública Vol. 29; no. 7; pp. 1291 - 1300
• Main Authors: Ramos, Jr, Alberto Novaes, Matida, Luiza Harunari, Alencar, Carlos Henrique, Hearst, Norman, Heukelbach, Jorg
• Format: Journal Article
• Language: English
• Published: Brazil Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz 01-07-2013; Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz
• Subjects: Brazil - epidemiology; Child; Child, Preschool; Cohort Studies; Delayed Diagnosis - statistics & numerical data; Diagnóstico Tardío; Female; HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Infections - transmission; Humans; Infant; Male; Niño; PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH; Retrospective Studies; VIH; Brazil; HIV; VIH; Diagnóstico Tardio; Delayed Diagnosis; Diagnóstico Tardío; Niño; Child; Criança
• ISSN: 0102-311X; 1678-4464; 1678-4464; 0102-311X
• DOI: 10.1590/S0102-311X2013000700004

This study analyzed data from two consecutive retrospective cohort samples (1983 to 1998 and 1999 to 2002) of Brazilian children with AIDS (N = 1,758) through mother-to-child-transmission. Late-stage diagnosis (CDC category C) was investigated in relation to the following variables: year of birth, year of HIV diagnosis, and time periods related to changes in government treatment guidelines. Late-stage diagnosis occurred in 731 (41.6%) of cases and was more prevalent in infants under 12 months of age. The rate of late-stage diagnosis decreased from 48% to 36% between the two periods studied. We also observed a reduction in the proportion of late-stage diagnoses and the time lapse between HIV diagnosis and ART initiation. A significant association was found between timely diagnosis and having been born in recent years (OR = 0.62; p = 0.009) and year of HIV diagnosis (OR = 0.72; p = 0.002/OR = 0.62; p < 0.001). Infants under the age of 12 months were more likely to be diagnosed at a late stage than older children (OR = 1.70; p = 0.004). Despite advances, there is a need to improve the effectiveness of policies and programs focused on improving early diagnosis and management of HIV/AIDS.