Regional patterns of the temporal evolution of the AIDS epidemic in Brazil following the introduction of antiretroviral therapy.

We examined the characteristics of the AIDS epidemic in the northeastern region of Brazil, comparing it to the epidemic in Brazil as a whole, and to the state of São Paulo, with respect to the temporal evolution of morbidity and mortality during the period 1990 to 1999, using information from communicable disease reports and mortality records. Since 1996, the incidence rate of AIDS in adults in Brazil as a whole and in São Paulo has been showing a trend towards stability, whereas in the Brazilian northeast the incidence rates of the disease continue to grow. In the northeast, sexual transmission is responsible for more than 80% of cases, injectable drug users (IDU) comprising only a small percentage of cases. There is a greater incidence of AIDS among groups with lower educational levels throughout the country. The comparative analysis of cases of AIDS and of deaths from AIDS shows growth, both in the number of cases and in the number of deaths; however, from 1996 onwards there has been a progressive reduction in the number of deaths in all regions analyzed. With respect to the incidence of cases of the disease acquired by vertical transmission, a significant growth trend can be seen in all regions for cases born in the period 1990-6, but in 1997 temporal analysis showed evidence of a reduction in this growth. In conclusion, temporal changes have occurred in the AIDS epidemic in Brazil, which has been showing a trend towards stability since 1996, when potent ARV therapy was introduced. However, this deceleration is not homogenous throughout all the regions.