Positive impact on survival for children with AIDS in Brazil: combined analysis of two national studies, 1983-1998 and 1999-2002
Presented by Luiza Harunari Matida (Brazil).
L.H. Matida1, A.N. Ramos Jr.2, J. Heukelbach2, A. Sanudo3, R.C.M. Succi4, H.H.S. Marques5, M. Della Negra6, N. Hearst7, Brazilian Study Group on Survival in Children with AIDS
1State Program of STD/AIDS-Sao Paulo, Brazil, Sao Paulo, Brazil, 2Federal University of Ceara, Fortaleza, Brazil, 3Federal University of Sao Paulo, Sao Paulo, Brazil, 4Federal University of São Paulo - UNIFESP, Sao Paulo, Brazil, 5University Of Sao Paulo, Sao Paulo, Brazil, 6Infectology Institute Emilio Ribas, Sao Paulo, Brazil, 7University California San Francisco, San Francisco, United States
Background: Brazil is known for its effective AIDS control program, including guaranteed universal access to prevention, diagnosis, and treatment. The government uses patient survival data as one indicator for program monitoring and evaluation. However, there are no systematic data on survival of children with AIDS.
Methods: This analysis is based on two retrospective cohort studies of children under age 13 diagnosed in Brazil in 1983-1998 and 1999-2002 (N=914 and 920, respectively). Both were randomly sampled from all reported cases in the country and employed similar methods. We calculated probability of survival to 60 months for children diagnosed with AIDS due to vertical transmission.
Results: In the first study (1983-1998), overall survival to 60 months was 52.8% (95% confidence interval: 41.9%-60.8%). In the second study (1999-2002), overall survival increased to 86.5% (83.0%-89.3%). During the entire period, the probability of survival to 60 months increased by 4.5-fold, rising from about 20% to 90% (see figure; p< .001 by log-rank test). Among the 16 cases diagnosed 1983-1987, survival was 19.7% (11.2%-30.0%). For the 265 cases in 1988-1992, it was 27.3% (22.9%-31.9%). For 1993-1994, survival was 39.7% (N=196; 33.4%-45.9%). For 1995-1996, it was 59.5% (N=221; 52.8%-65.6%). For 1997-1998, it was 68.2% (N=216; 61.6%-73.9%). For 1999-2000, it was 86.5% (N=470; 83.0%-89.3%); and for 2001-2002, it was 90.2% (N=450; 87.0%-92.7%).
[Survival, Children with AIDS, 1983-2002, Brazil]
Conclusions: These results demonstrate the impact of Brazilian policies for children with AIDS. But this achievement creates new challenges related to providing longitudinal comprehensive care and maintaining high quality as well as quantity of survival.
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