HIV/AIDS epidemic in the State of Amazonas: characteristics and trends from 2001 to 2012

Abstract

70www.scielo.br/rsbmt I www.rsbmt.org.br Revista da Sociedade Brasileira de Medicina Tropical 48(Suppl I):70-78, 2015http://dx.doi. org/10.1590/0037-8682-0121-2013 Review Article ABSTRACT A scoping review was conducted to describe the epidemiological characteristics of the human immunodefi ciency virus/acquired immunodefi ciency syndrome (HIV/AIDS) epidemic in the State of Amazonas, Brazil, from 2001 to 2012, and temporary patterns were estimated from surveillance data. The results suggest that in its third decade, the Amazon HIV/AIDS epidemic is far from being stabilized and displays rising AIDS incidence and mortality rates and late diagnoses. The data suggest that AIDS cases are hitting mostly young adults and have recently shifted toward men, both homosexual and heterosexual. AIDS cases among the indigenous people have remained stable and low. However, the epidemic has disseminated to the interior of the state, which adds diffi culties to its control, given the geographical isolation, logistical barriers, and culturally and ethnically diverse population. Antiretroviral (ARV) therapy has been decentralized, but peripheral ARV services are still insuffi cient and too distant from people who need them. Recently, the expansion of point-of-care (POC) rapid HIV testing has been contributing to overcoming logistical barriers. Other new POC devices, such as the PIMA CD4 analyzer, will bring the laboratory to the patient. AIDS uniquely coexists with other tropical infections, sharing their epidemiological profi les. The increased demand for HIV/AIDS care services can only be satisfi ed through increased decentralization to peripheral health units, which can also naturally integrate care with other tropical infections and can promote a shift from vertical to integrated programming. Future challenges involve building surveillance data on HIV case notifi cation and covering the spectrum of engagement in care, including adherence to treatment and follow-up loss.

Perfil epidemiológico dos pacientes com HIV em um centro de referência no sul do Brasil. Características de dez anos.

“…16 Em relação ao comportamento sexual na pesquisa realizada no Amazonas, verificou-se uma tendência significativa no aumento de casos tanto em indivíduos homossexuais quanto em heterossexuais. 17 Esses dados corroboram com os resultados encontrados em nosso estudo.…”

Epidemiological transition of tropical diseases in the Brazilian Amazon

“…Trends and challenges of HIV/AIDS in the State of Amazonas are analyzed by Oliveira et al (15) to reveal a worrying scenario characterized by the epidemic in regions where the socio-economic conditions, the quality and quantity of health services, as well as access to services are real obstacles to the full implementation of control program actions. Attention should focus on a possible imminent emergence of syndromes associated with co-infections with pathogens prevalent in the Amazon scenario.…”

“…Attention should focus on a possible imminent emergence of syndromes associated with co-infections with pathogens prevalent in the Amazon scenario. HIV/AIDS is currently the fastest growing disease in the North of Brazil, with similar endemic features to the 1980s including late diagnosis and high frequency of opportunistic infections because of non-adherence to antiretroviral therapy (15) .…”

Immunologic Biomarkers, Morbidity and Mortality Among HIV Patients Hospitalized in a Tertiary Care Hospital in the Brazilian Amazon

“…As of 2018, more than 900,000 AIDS cases had been reported in Brazil and approximately 600,000 are on ART 1 . After a signi cant reversal in mortality due to the adoption of ART in 1996, deaths related to the HIV/AIDS epidemic have been showing a downward trend in Brazil as a whole, however this trend is still subtle in the northern and northeastern regions 1,3,5 .…”

“…The Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD), located in the middle of the city, is a tertiary care hospital which performs HAART services and admits moderate to severely ill people living with HIV. This represents a contingent greater than 85% of all patients receiving ART, as well as concentrating data on incidence levels of AIDS, mortality rates and late diagnosis 2,5 . Studies on the HIV/AIDS epidemic in the region have indicated over time that the trend in the number of cases continues to increase principally in men, that tuberculosis (TB) is still the leading cause of death, and that respiratory failure is the main cause of hospital admission for these patients [5][6][7][8] .…”