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2030-01-01
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IMMUNE STATUS AT PRESENTATION FOR HUMAN IMMUNODEFICIENCY VIRUS CLINICAL CARE IN RIO DE JANEIRO AND BALTIMORE
Author
Affilliation
Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Presidência. Programa de Computação Científica. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.
John Hopkins University. Department of Medicine. Baltimore, USA.
Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.
John Hopkins University. Department of Medicine. Baltimore, USA.
Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Presidência. Programa de Computação Científica. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.
John Hopkins University. Department of Medicine. Baltimore, USA.
Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, Brasil.
John Hopkins University. Department of Medicine. Baltimore, USA.
Abstract
Introduction—Late presentation to HIV clinical care increases individual risk of (multiple)
clinical events and death, and decreases successful response to highly active antiretroviral therapy
(HAART). In Brazil, provision of HAART free of charge to all HIV-infected individuals could
lead to increased testing and linkage to care.
Methods—We assessed the immune status of 2,555 patients who newly presented for HIV
clinical care between 1997 and 2009 at the Johns Hopkins Clinical Cohort, in Baltimore, USA and
at the Instituto de Pesquisa Clinica Evandro Chagas Clinical Cohort, in Rio de Janeiro, Brazil. The
mean change in the CD4 cell count per year was estimated using multivariate linear regression
models.
Results—Overall, from 1997 to 2009, 56% and 54% of the patients presented for HIV clinical
care with CD4 count ≤ 350 cells/mm3 in Baltimore and Rio de Janeiro, respectively. On average,
75% of the patients presented with viral load > 10,000 copies/mL. In Rio de Janeiro only, the
overall adjusted per year increase in the mean CD4 cell count was statistically significant [5 cells/
mm3 (95% CI 1, 10 cells/mm3)].
Discussion—We found that, over years, the majority of patients presented late, that is, with a
CD4 count < 350 cells/mm3. Our findings indicate that, despite the availability of HAART for
more than a decade, and mass media campaigns stimulating HIV testing in both countries, the
proportion of patients who start therapy at an advanced stage of the disease is still high.
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