EARLY HIV TREATMENT AND CD4 AT DIAGNOSIS: DESCRIPTIVE ANALYSIS ACROSS BRAZILIAN MACRO-REGIONS, 2015–2024

The strategy of immediate initiation of antiretroviral therapy (ART) after HIV diagnosis (“test and treat”) began to be recommended by the World Health Organization in 2015, given its role in reducing morbidity and mortality and interrupting viral transmission. Strategies such as expansion of rapid testing and targeted approaches to key populations are also recommended to achieve earlier diagnoses, with individuals not presenting advanced HIV disease or having CD4 counts > 350 cells/mm³. This study aimed to describe the time from HIV diagnosis to ART initiation and the proportion of individuals with CD4 > 350 at diagnosis across the five Brazilian macro-regions between 2015 and 2024. This was a descriptive, cross-sectional study assessing the time between HIV diagnosis and ART initiation, as well as CD4 count at diagnosis, among people living with HIV (PLHIV) newly diagnosed between 2015 and 2024 in the five Brazilian macro-regions. Data were obtained from the Integrated HIV/AIDS Care Monitoring Panel of the Ministério da Saúde. Between 2015 and 2024, an increase was observed in the number of ART prescriptions started immediately after diagnosis in four of the five Brazilian macro-regions. In the Southeast and Center-West, the proportion of people who initiated ART concomitantly with diagnosis rose from 12% to 21% and from 8% to 13%, respectively. In the South, this percentage increased from 6% to 10%, while in the Northeast it went from 11% to 13%. The exception was the North, which showed a reduction from 13% to 11% over the period. Regarding patients with CD4 > 350 at diagnosis, in the same period there was a decrease in the proportion of individuals with better immunological status in all macro-regions. In the North, the percentage dropped from 52% to 51%; in the Northeast, from 52% to 51%; in the Center-West, from 58% to 54%; in the Southeast, from 60% to 59%; and in the South, from 59% to 56%. Despite efforts to expand testing, there is still a relevant proportion of individuals diagnosed late. Moreover, despite universal access to HIV treatment in Brazil, there are evident regional discrepancies in immediate ART initiation. To expand early diagnosis and overcome regional inequalities, it is crucial that health policies consider the specific characteristics of each region and promote continuous investments in infrastructure, professional training, and adherence strategies.