The Virological and Immunological Characteristics of the HIV-1-Infected Population in Brazil: From Initial Diagnosis to Impact of Antiretroviral Use

• Published in: PloS one Vol. 10; no. 10; p. e0139677
• Main Authors: Diaz, Ricardo Sobhie, Inocêncio, Lilian A, Sucupira, Maria Cecilia Araripe, Pereira, Anderson Alvarenga, Hunter, James, Ferreira, João Eduardo, Araújo, Luciano V, Souza, Denise F C, Sabino, Ester Cerdeira
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28-10-2015; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; AIDS; Antiretroviral agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Brazil; CD4 antigen; CD4 Lymphocyte Count; Demographics; Diagnosis; Drug resistance; Drug Resistance, Viral; Drug therapy; Female; Forecasts and trends; Genotypes; Geriatrics; Highly active antiretroviral therapy; HIV; HIV infections; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - virology; Human immunodeficiency virus; Humans; Immunology; Life assessment; Limit of Detection; Lymphocytes T; Male; Medical diagnosis; Methods; Middle Aged; Mutation; Older people; Patient outcomes; Patients; Population (statistical); Recombinants; Regression analysis; Statistical analysis; Viral Load; Young Adult; Brazil; Canada; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0139677

Immunological and virological status of HIV-infected individuals entering the Brazilian public system over time was analyzed. We evaluated the impact of ART on virological, immunological and antiretroviral resistance over time.
CD4+ T cell counts, viral loads and genotypes from patients over 13 years old from 2001-2011 were analyzed according to demographic data. We compared groups using parametric t-tests and linear regression analysis in the R statistical software language.
Mean baseline CD4+ T cell counts varied from 348 (2003) to 389 (2009) and was higher among women (p = 1.1 x 10(-8)), lower in older patients (p< 1 x 10(-8)) and lower in less developed regions (p = 1.864 x 10(-5)). Percentage of treated patients with undetectable viral loads increased linearly from 46% (2001) to 77% (2011), was lower among women (p = 2.851 x 10(-6)), younger ages (p = 1 x 10(-3)), and in less developed regions (p = 1.782 x 10(-4)). NRTI acquired resistance was 86% in 2001-3 and decreased over time. NNRTI resistance increased from 2001-3(50%) to 2006-9 (60%), PI resistance decreased from 2001-3 (60%) to 2009 (40%), and 3-class resistance was stable over time around 25%. Subtype prevalence comprised B (75.3%), B/F recombinants (12.2%), C (5.7%), F (5.3%) and B/C recombinants (1.5%), with regional variations. Three-class resistance was 26.5% among Bs, 22.4% among Fs and 17.2% among Cs.
HIV diagnosis occurs late, especially among elderly Brazilians. Younger individuals need special attention due to poor virological response to treatment. Antiretroviral Resistance profile is subtype related.