Initial antiretroviral therapy in a 20-year observational cohort followed in the city of São Paulo, Brazil according to exposure category
E.A.C. Ruiz1, M.V. Tancredi2, M. Ramalho1, Â. Tayra1, A. Monteiro1, J. Chauveau3, W.K. Alencar4
1Centro de Referencia e Treinamento DST/AIDS-Sao Paulo, Epidemiology, Sao Paulo, Brazil, 2Centro de Referencia e Treinamento DST/AIDS-Sao Paulo, Epidemiology, Santo Andre, Brazil, 3INSERM, Marseilles, France and IRD, Aix Marseilles Université, Marseilles, France. Southeastern Health Regional Observatory (ORS-PACA), Research Unit UMR912 'Economic & Social Sciences, Health Systems & Societies', Marseilles, France, 4Centro de Referencia DST/Aids de Sao Paulo, São Paulo, Brazil
Background: Data support the observation that Brazil's large-scale, universal and free distribution of antiretrovirals has improved the quality of life and increased survival of patients with HIV/AIDS. There is little detailed data describing characteristics of patients and their treatment regimens.
Methods: Exploratory retrospective study of initial ART of 4,191 HIV-infected individuals, 13 years and over at CRT-DST/AIDS, from 1985 to 2005. Patients were classified as Heterosexual (Hetero), men who have sex with men (MSM), injecting drug users (IDU).
Results: After excluding other/missing, 3,947 patients remained: 41.4% hetero, 46.2% MSM and 12.4% IDU, the latter under represented among patients treated, given IDU are roughly 20% of patients of the center. Although the number of patients in the three groups grew over the years, growth was less marked for IDU. The three categories were similar in terms of age group and color. However IDU had a higher proportion of men (80% versus 61.5% among hetero); and a high proportion of less than 8 years of schooling (49.3%) while 73.7% of MSM had 8 years and more of schooling. The proportion of non naïve among IDU was lower (19.6%) in comparison to hetero (16.7%) and MSM (14.7%); and they received less triple therapy (47.7%) than hetero (57.6) and MSM (51.3%). The UDI group also had a higher proportion of lost to follow-up (21%) and deaths (17.1%) than the other two groups (14.2 and 13% -hetero; 17.2 and 9.7%-MSM).
Conclusions: Among exposure categories, IDU are a minority and with less schooling in our sample. These factors point toward less treatment, less adherence and more deaths in the group and may also be related to the perception of the disease among these individuals. A special look and approach to this group of patients at the service and policy level is called for.
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