ABSTRACT
A review was carried out of papers published between 1996 and 2006, documenting the introduction of highly active anti-retroviral therapy (HAART) in Brazil. Papers indexed in the MEDLINE and SciELO databases were retrieved using different combinations of keywords related to the management and care of AIDS in the post-HAART era: opportunistic diseases and co-infections, adherence to therapy, survival in the pre- and post-HAART eras, adverse events and side-effects, emergence and possible transmission of resistant viral strains, metabolic and cardiovascular disorders, and issues related to access to care and equity. The review documents the dramatic changes in HIV/AIDS disease progression in the post-HAART era, including an increase in survival and quality of life and a pronounced decrease in the episodes of opportunistic diseases. Notwithstanding such major achievements, new challenges have emerged, including slow evolving co-infections (such as hepatitis C, metabolic and cardiovascular disorders), the emergence of viral resistance, with consequences at the individual level (virological failure) and the community level (primary/secondary resistance at the population level), and impacts on the cost of new therapeutic regimens.
Subject(s)
HIV Infections/drug therapy , National Health Programs , AIDS-Related Opportunistic Infections/drug therapy , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/mortality , Antiretroviral Therapy, Highly Active/adverse effects , Brazil/epidemiology , Delivery of Health Care , Drug Resistance, Viral , Epidemiologic Studies , HIV Infections/complications , HIV Infections/mortality , Humans , Metabolic Diseases/complications , Patient Compliance , Quality of Life , Survival RateABSTRACT
A review was carried out of papers published between 1996 and 2006, documenting the introduction of highly active anti-retroviral therapy (HAART) in Brazil. Papers indexed in the MEDLINE and SciELO databases were retrieved using different combinations of keywords related to the management and care of AIDS in the post-HAART era: opportunistic diseases and co-infections, adherence to therapy, survival in the pre- and post-HAART eras, adverse events and side-effects, emergence and possible transmission of resistant viral strains, metabolic and cardiovascular disorders, and issues related to access to care and equity. The review documents the dramatic changes in HIV/AIDS disease progression in the post-HAART era, including an increase in survival and quality of life and a pronounced decrease in the episodes of opportunistic diseases. Notwithstanding such major achievements, new challenges have emerged, including slow evolving co-infections (such as hepatitis C, metabolic and cardiovascular disorders), the emergence of viral resistance, with consequences at the individual level (virological failure) and the community level (primary/secondary resistance at the population level), and impacts on the cost of new therapeutic regimens.
Procedeu-se a uma revisão abrangente de artigos publicados entre 1996-2006, período posterior à introdução da terapia anti-retroviral de alta potência (HAART) no Brasil. Foram revisados artigos disponíveis nas bases de dados MEDLINE e SciELO, a partir de combinações de palavras-chave que contemplam os principais temas na área do tratamento e manejo da AIDS na era pós-HAART: doenças oportunistas e co-infecções, aderência à terapia, sobrevida pré e pós-HAART, eventos adversos e efeitos colaterais, emergência e eventual transmissão de cepas virais resistentes e complicações cardiovasculares e metabólicas, além de questões relativas ao acesso e à eqüidade. Em suma, observa-se uma transformação profunda no campo da AIDS no período pós-HAART, com aumento dramático da sobrevida e da qualidade de vida, e redução expressiva dos episódios de doenças oportunistas. Por outro lado, novas questões se colocam, como a relevância das co-infecções de evolução lenta, como a hepatite C, os distúrbios metabólicos e cardiovasculares, e o desafio posto pela emergência de cepas resistentes, com repercussões individuais (falha virológica) e coletivas (resistência primária e secundária em nível da comunidade) e, conseqüente, aumento de custos da terapia.