16th International AIDS Conference Toronto, Canada - August 13 - 18, 2006

IMPACT OF FREE AND UNIVERSAL ACCESS TO ANTIRETROVIRAL TREATMENT ON THE SURVIVAL AMONG BRAZILIAN CHILDREN WITH AIDS

Int Conf AIDS. 2006 Aug 13-18;16 Abstract No. MoAb0202

Matida L.H.¹, Novaes A.², Moncau J.E.C.³, Marcopito L.F.³, Marques H.H.S.⁴, Succi R.C.M.³, Della Negra M.⁵, Hearst N.⁶, Brazilian Group of Survival Study in Children with HIV
¹National Program of STD/AIDS, Sao Paulo, Brazil, ²Federal University of Ceara-Brazil, Fortaleza, Brazil, ³Federal University of Sao Paulo, Sao Paulo, Brazil, ⁴University of Sao Paulo, Sao Paulo, Brazil, ⁵Institute of Infectology Emilio Ribas, Sao Paulo, Brazil, ⁶University of California, San Francisco, United States

ISSUES: Besides the existing social inequality and the differences on access to health services, Brazil with his vast geographical area, offers free and universal access to antiretroviral treatment (ART) for AIDS patients. This technical and political attitude has brought substantial improvement in survival among pediatric patients with HIV, in Brazilian regions.

DESCRIPTION: We obtained data on retrospective cohort study in 10 Brazilian cities to examine trends in diagnostics and survival with a representative sample of AIDS cases in persons younger than 13 years old listed in the Brazilian national AIDS registry with years of diagnosis between 1983 and 1998 and followed until 2002 (N for analysis = 1,154). Date of last clinical contact was used as a censor date for children not known to have died.

lESSONS LEARNED: Survival time increased steadily and substantially in all regions despite the observed differences. The survival probability on 60 months after the diagnosis for the period from 1988 to 1992 was 0.246 (CI 95%: 0.150-0.356) and it increased to 0.605 (CI 95%: 0.521-0.680) for the 1997 to 1998 period in children followed up to 2002. Among children infected by maternal transmission, the median time since birth to diagnosis was 12.2 months, and in the Northeast region this time was 18.3 months, and in the Southeast region belonged to 4.7 months. The Brazilian experience thus provides the first evidence regarding the impact of such treatment on the survival of perinatally acquired AIDS cases in the developing world.

RECOMMENDATIONS: A free and universal access to ART, even in a country that lacks an ideal health infrastructure, can make a substantial difference in survival. These results argue strongly for making such treatment available to children elsewhere in the developing world.

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2006-08-13
MoAb0202

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