Clinical and laboratory profile of HIV-positive patients at the moment of diagnosis in Bahia, Brazil

Abstract

In Brazil, current trends of the AIDS epidemic include an increase in transmission through heterosexual contact, predominantly from men to women, with more cases of AIDS in women and more children contaminated by vertical transmission. There is also a high proportion of cases in poor people or people living in small towns. HIV-infected patients with high levels of immunodeficiency are frequently hospitalized after their first visit to the clinic due to opportunistic infections, characteristic of advanced disease. This study characterized the clinical and laboratory pattern of AIDS in a sample of patients attended for the first time in the AIDS clinic of the Federal University of Bahia Hospital (HUPES) in Salvador, Brazil. We revised medical charts of cases of subjects registered at the outpatient AIDS clinic from January 1997 to December 2003. The demographics, clinical data, and laboratory characteristics were analyzed to determine the degree of immunodeficiency at the time of admission. A total of 377 patients were evaluated (58.6% were male, with a mean sample age of 33.4 years). The most frequent clinical manifestations were asthenia, weight loss, fever, anemia, dermatitis, oral thrush and diarrhea. CDC criteria were not adequate to define the initial cases. After admission to the outpatient clinic, nearly 25% of the patients were hospitalized immediately, indicating delay in the diagnosis. In Bahia, the initial presentation of HIV-infected patients to health care assistance is occurring at a late stage of the disease, when signs and symptoms of immunodeficiency are already established. Efforts are necessary to construct strategies to make an early diagnosis of these patients, improve the quality of care, and guarantee the benefits of antiretroviral therapy, when it is indicated.