Souza-Jr, PRB, Szwarcwald CL, Castilho EA. Delay in introducing antiretroviral therapy in patients infected by HIV in Brazil, 2003. Clinics. 2007 62(5):579-84. PURPOSE:To characterize the population of HIV+ Brazilian patients with late introduction of antiretroviral therapy (ARVT), using information from the Laboratory Exam Control System. METHODS: The study analyzed 84,694 patients, representing all individuals in Brazil age 15 or over with an initial CD4 + T lymphocyte count requested between 2003 and 2006, and whose ARVT start date was later than their initial CD4 + T cell count. These patients were considered antiretroviral treatment naive. The initial CD4 + T cell distribution was analyzed according to sex, age, region and year. RESULTS: Most of the patients were between 15 and 49 years of age (91%); 56% were males; 76% were asymptomatic; 50% lived in the Southeastern region of the country, with an additional 20% in the South. Initial CD4 + counts for one-third of the patients were less than 200 cells/mm 3 . When combined with the number of symptomatic individuals, 41% of the total group was in need of immediate ARVT. This group included 47% of the men and 53% of the patients aged 50 years and over. CONCLUSIONS: Despite universal access to ARVT in Brazil, results show that a high proportion of patients initiate ARVT at an advanced stage of disease, indicating the need to develop strategies to promote early diagnosis of HIV infection nationwide.

Methods In a prospective study among 2269 HIV-1 infected ARTnaïve women from 7 countries in East and southern Africa, we examined the effect of pregnancy on HIV-1 disease progression. We used random effects models to compare CD4 and plasma viral load changes between pregnant, postpartum and non-pregnant periods (prenatal periods from women who became pregnant and all periods from women who did not become pregnant). Among women who became pregnant, we compared CD4 counts during prenatal, pregnant, and postpartum periods. Results Women contributed 3471 person-years and 475 women became pregnant (7.2% of time was pregnant and 6.8% was postpartum). After accounting for baseline levels, CD4 counts were 67.7 cells/ mm 3 lower (95% CI 55.5-79.9) during pregnant compared to nonpregnant periods and 81.2 cells/mm 3 lower (95% CI 65.3-97.2) during pregnant compared to postpartum periods. After adjustment for baseline viral load, there were small increases in plasma viral load: a 0.05 log 10 increase in pregnant vs. non-pregnant periods (95% CI 0.01-0.10) and a 0.08 log 10 increase in pregnant vs. postpartum periods (95% CI 0.01-0.14). Postpartum CD4 and plasma viral loads were not different from non-pregnant periods (p = 0.1 and p = 0.5). Among women who experienced pregnancy, CD4 counts were 59.6 cells/mm 3 lower (95% CI 35.2-84.0) during pregnant versus prenatal periods and 71.6 cells/ mm 3 lower (95% CI 48.0-95.1) during pregnant versus postpartum periods. Prenatal and postpartum CD4 counts were similar (p = 0.4). Conclusion CD4 count and plasma viral load changes among HIV-1 infected women during pregnancy are not permanent and are likely to return to prenatal levels. Pregnancy was not associated with subsequent disease progression. Background There is evidence of sexual HCV transmission among HIV-positive MSM from the UK and Europe. We estimated HCV seroincidence and its risk factors in a North American population of HIV-positive MSM with no known history of injection drug use. Methods We analysed data from the OHTN Cohort Study, an ongoing cohort of persons in HIV care in Ontario, Canada. Data were obtained from medical charts, interviews, and record linkage with the provincial public health laboratories. We restricted the analysis to 1,534 MSM who: (1) did not report injection drug use; (2) were under follow-up in 2000-2010; and (3) had 2+ HCV antibody tests, of which the first was negative. Person-time commenced at the later of the HCV-negative result or HIV diagnosis and ended at the first HCV+ or last date of follow-up (median 6.1 person-years (PY) of follow-up; sum 9,987PY). Results We observed 51 HCV seroconversions, for an overall incidence of 0.51 per 100PY (CI: 0.39-0.67). Annual incidence varied from 0.16 to 0.89 per 100 PY, with no statistical evidence of a temporal trend. Seroconversion was statistically-significantly associated with acute syphilis infection in the previous 6 months (adjusted hazard ratio = 4.9, CI 1.2-21) and there was a marginally statistically-significant association for men who had no...