Tendências da epidemia de Aids no Brasil após a terapia anti-retroviral

OBJECTIVE: Universal access to antiretroviral therapy starting from 1996 has changed HIV/AIDS epidemic profile in Brazil. The objective of this study was to review the epidemiology of HIV/AIDS epidemic in Brazil. METHODS: Indicators of temporal trends were developed for Brazilian regions from 1990 to 2003 using the Ministry of Health's databases. Exponential regression models adjusted to the 1990-1996 trends were used to estimate expected values for the entire period. RESULTS: The proportion of AIDS hospitalizations has not changed over the study period but there was a decrease in hospitalizations among those using ARV therapy. There was a 2.7 growth in those receiving Highly Active Anti-Retroviral Therapy (HAART) from 1997 to 2003. HIV/AIDS incidence and mortality rates rose up to 1995 in all regions. From 1996, there has been a gradual reduction in mortality rates while incidence rates have increased. In all regions, except in the Northern region, expected incidence rates have been greater than the observed ones in the last years but these differences were statistically significant only in the Southeastern and Midwestern regions. CONCLUSIONS: The observed trend can be explained by universal access to ARV therapy in Brazil, which had a significant impact on HIV/AIDS mortality. But other factors, such as years of epidemic, prevention actions, knowledge on HIV/AIDS, years of schooling, need to be considered as well.OBJETIVO: A terapia anti-retroviral disponível no Brasil a partir de 1996, modificou o curso da epidemia de Aids, alterando sua evolução e tendências. Nesse sentido, o estudo teve por objetivo avaliar a epidemia da Aids no Brasil, nos seus aspectos epidemiológicos. MÉTODOS: Estudo realizado a partir de bases de dados do Ministério da Saúde que caracterizavam a evolução temporal da Aids nas macrorregiões brasileiras, de 1990 a 2003. Foram utilizados modelos de regressão exponencial, ajustados à série temporal de 1990 a 1996 e estimados valores esperados para toda a série. RESULTADOS: O percentual de internações não se modificou no tempo, mas ocorreu diminuição de hospitalizações entre os usuários de terapia anti-retrovial. Houve um incremento de 2,7 vezes no número de indivíduos em uso da terapia, de 1997 a 2003. Incidência e mortalidade apresentaram crescimentos uniformes até 1995, em todas as regiões. A partir de 1996, verificou-se uma redução progressiva da mortalidade, embora a incidência continue crescendo. Em todas as regiões, exceto a Norte, as incidências esperadas foram maiores do que as observadas nos últimos anos, embora as diferenças somente tenham atingido níveis de significância estatística nas regiões Sudeste e Centro-Oeste. CONCLUSÕES: As mudanças observadas no perfil de morbi-mortalidade da epidemia de Aids no Brasil poderiam ser explicadas pelo amplo acesso a terapia anti-retroviral. Tal fato representou um impacto importante sobre a mortalidade por HIV/Aids, porém, outros fatores devem ser considerados, como idade da epidemia, medidas de prevenção, conhecimento sobre HIV/Aids e anos de escolaridade

Seroprevalence of Hepatitis B and C in Brazilian Army Conscripts in 2002. A Cross-Sectional Study

Hepatitis B and C constitute important public health problems worldwide. In Brazil, studies on prevalence of viral hepatitis have local and regional characteristics; consequently it is difficult to define the national epidemiological situation. Our objective was to evaluate the seroprevalence of hepatitis B and C in conscripts of the Brazilian Army. A transversal study among males aged 17 to 22 years was conducted nationwide. After informed consent, each volunteer filled in a socialbehavioral questionnaire and had blood drawn to test for HBsAg and anti-HCV. A total of 7,372 volunteers were evaluated in the second half of 2002. The prevalence of HBsAg was 2.6% (95% confidence interval: 2.2, 3.0) and that of anti-HCV was 1.5% (95% confidence interval: 1.2, 1.8). A wide variation among macro regions and states in the same region was observed for both markers. In conclusion, although this population theoretically had a low risk for HBV and HCV infection, these results are higher than expected for this age range. These findings may indicate a change in the pattern of HBV and HCV transmission in Brazil. Due to the different dynamics of these epidemics, further studies are warranted to confirm these apparent trends

Seroprevalence of hepatitis B and C in Brazilian army conscripts in 2002: a cross-sectional study

Hepatitis B and C constitute important public health problems worldwide. In Brazil, studies on prevalence of viral hepatitis have local and regional characteristics; consequently it is difficult to define the national epidemiological situation. Our objective was to evaluate the seroprevalence of hepatitis B and C in conscripts of the Brazilian Army. A transversal study among males aged 17 to 22 years was conducted nationwide. After informed consent, each volunteer filled in a social-behavioral questionnaire and had blood drawn to test for HBsAg and anti-HCV. A total of 7,372 volunteers were evaluated in the second half of 2002. The prevalence of HBsAg was 2.6% (95% confidence interval: 2.2, 3.0) and that of anti-HCV was 1.5% (95% confidence interval: 1.2, 1.8). A wide variation among macro regions and states in the same region was observed for both markers. In conclusion, although this population theoretically had a low risk for HBV and HCV infection, these results are higher than expected for this age range. These findings may indicate a change in the pattern of HBV and HCV transmission in Brazil. Due to the different dynamics of these epidemics, further studies are warranted to confirm these apparent trends