A cascata de cuidados para pessoas vivendo com a infecção pelo HIV no Sul do Brasil: resultados obtidos em uma rede pública de saúde Serie de cuidados para personas que viven con una infección de VIH en el sur de Brasil: resultados en una red pública de salud AbstractThe cascade of care for people living with HIV infection (PLHIV) describes steps in diagnosis, linkage and retention in care, as well as the provision and success of combination antiretroviral therapy (cART). The aim of this study was to evaluate the rates regarding the retention in care, on cART, and suppressed viral load for PLHIV attended at a Brazilian public health network. Data on PLHIV from 116 cities of Paraná, Southern Brazil, attended from 2012 to 2015, were retrospectively collected through the Laboratory Tests Control System (SISCEL). The number of PLHIV related to care increased about 22.5% from 2012 to 2015 (4,106 to 5,030 individuals). The proportion of PLHIV retained in care showed a trend toward stabilization around 81.7-86.9%. Every year, the use of cART increased up to 90.3% for PLHIV retained in care. Viral load suppression was achieved by 72.8% of patients on cART and 57.1% by those linked to care. Retention in care and HIV viral suppression were more likely to occur in older PLHIV than younger ones; similarly, patients living in medium-sized cities were more susceptible to these factors than in large-or small-sized cities. In conclusion, the study showed a high level of retention in care and HIV suppression on cART, as well as emphasized that current efforts for treating already-infected PLHIV remain a challenge for our health public institutions and may contribute to highlight steps for improvement of the HIV cascade of care in our population. HIV; Highly Active Antiretroviral Therapy; Sustained Virologic ResponseCorrespondence E. M. V. Reiche

The latest Brazilian guideline recommended the reduction of routine CD4+ T cell counts for the monitoring of patients with human immunodeficiency virus type 1 (HIV-1) under combination antiretroviral therapy (cART). The aim of this study was to evaluate the safety of monitoring response to cART in HIV-1 infection using routine viral load at shorter intervals and CD4+ T cell count at longer intervals. CD4+ T cell counts and HIV-1 viral load were evaluated in 1,906 HIV-1-infected patients under cART during a three-year follow-up. Patients were stratified as sustained, non-sustained and non-responders. The proportion of patients who showed a CD4+ T > 350cells/µL at study entry among those with sustained, non-sustained and non-responders to cART and who remained with values above this threshold during follow-up was 94.1%, 81.8% and 71.9%, respectively. HIV-1-infected patients who are sustained virologic responders and have initial CD4+ T cell counts > 350cells/µL showed a higher chance of maintaining the counts of these cells above this threshold during follow-up than those presenting CD4+ T ≤ 350cells/µL (OR = 39.9; 95%CI: 26.5-60.2; p < 0.001). This study showed that HIV-1-infected patients who had sustained virologic response and initial CD4+ T > 350cells/µL were more likely to maintain CD4+ T cell counts above this threshold during the next three-year follow-up. This result underscores that the evaluation of CD4+ T cell counts in longer intervals does not impair the safety of monitoring cART response when routine viral load assessment is performed in HIV-1-infected patients with sustained virologic response.

O objetivo do trabalho foi avaliar fatores sociodemográficos e laboratoriais dos pacientes infectados pelo HIV em uso de terapia antirretroviral (TARV) associados ao Índice de Desenvolvimento Humano Municipal (IDHM). O estudo envolveu 4.900 pacientes de 116 municípios do Paraná, atendidos no período de 2012 a 2015. Os pacientes foram divididos em três grupos de acordo com o tamanho e o IDHM do município de residência. Cidades de pequeno porte/IDHM médio apresentaram taxas mais elevadas de mulheres, indivíduos mais jovens e baixa escolaridade, quando comparadas com as cidades de grande porte/IDHM alto. As taxas totais de resposta imunológica, virológica e completa à TARV foram de 71,9%, 68,2% e 57,1%, respectivamente, com melhores resultados para o grupo vivendo em municípios de grande porte/IDHM alto. Apesar dessas diferenças, as respostas imunológica e virológica foram semelhantes entre os grupos, sugerindo que o grau de desenvolvimento do município não está associado com a efetividade da terapia para o HIV-1.