Late onset of antiretroviral therapy in adults living with HIV in an urban area in Brazil: prevalence and risk factors
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2019
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Highly active antiretroviral therapy has been available since 1996. Early initiation of antiretroviral therapy (ART)
leads to improved therapeutic response and reduced HIV transmission. However, a signifcant number of people living with HIV
(PLHIV) still start treatment late. Objective. Tis study aimed to analyze characteristics and factors associated with late initiation
of ART among HIV-infected treatment-na¨ıve patients. Methods. Tis cross-sectional study included PLHIV older than 17 years
who initiated ART at two public health facilities from 2009 to 2012, in a city located in Midwestern Brazil. Pregnant women were
excluded. Data were collected from medical records, antiviral dispensing forms, and the Logistics Control of Medications System
(SICLOM) of the Brazilian Ministry of Health. Late initiation of ART was defned as CD4+ cell count < 200 cells/mm3 or presence
of AIDS-defning illness. Uni- and multivariate analysis were performed to evaluate associated factors for late ARV using SPSS ,
version 21. Te signifcance level was set at p<0.05. Results. 1,141 individuals were included, with a median age of 41 years, and 69.1%
were male. Te prevalence of late initiation of ART was 55.8% (95%CI: 52.9-58.7). Te more common opportunistic infections
at ART initiation were pneumocystosis, cerebral toxoplasmosis, tuberculosis, and histoplasmosis. Overall, 38.8% of patients had
HIV viral load equal to or greater than 100,000 copies/mL. Late onset of ART was associated with higher mortality. Afer logistic
regression, factors shown to be associated with late initiation of ARV were low education level, sexual orientation, high baseline
viral load, place of residence outside metropolitan area, and concomitant infection with hepatitis B virus. Conclusion. Tese results
revealed the need to increase early treatment of HIV infection, focusing especially on groups of people who are more socially
vulnerable or have lower self-perceived risk.
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PACHECO, Priscila Ribeiro Guimarães et al. Late onset of antiretroviral therapy in adults living with HIV in an urban area in Brazil: prevalence and risk factors. Journal of Tropical Medicine, Cairo, v. 2019, e5165313, 2019. DOI: 10.1155/2019/5165313. Disponível em: https://onlinelibrary.wiley.com/doi/10.1155/2019/5165313. Acesso em: 18 fev. 2025.