Apresentao do PowerPoint

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ARV THERAPY IN 2004 IMPLICATIONS FOR MIDDLE
INCOME COUNTRIES
The Brazilian Experience Bangkok, Thailand 13
July 2004
Celso Ramos, M.D. Federal University of Rio de
Janeiro Souza Marques School of Medicine
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AIDS IN BRAZIL

• CUMULATIVE AIDS CASES (Up to 2003) 310,310
  gt170,751 alive
• ESTIMATED NUMBER OF PLWA (2002) 597,443
• PREVALENCE 0.65 (Population 15 to 49 years)
• MORTALITY RATE 6.3/100,000 (2002)
• INCIDENCE RATE (2002) 12.8/100,000
• NEW CASES PER YEAR 25,000
• MEAN SURVIVAL IN AIDS 58 months
• REDUCTION IN LIFE EXPECTANCY 3 months

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PEOPLE LIVING WITH AIDS
600,000 PLWA (estimated, 2002 - 15 to 49 years)
Estimated. SourcePN DST/AIDS - SVS - MS
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MUNICIPALITIES WITH AIDS CASES. BRAZIL, 1980 -
2002.
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R2 0,7533 (1998-2003) p-value 0.025
R2 0,9951 (1992-1998) p-value lt 0.001
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Source Brazilian STD/AIDS Program Preliminary
data
Source PN DST/Aids
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Brazil Government Expenditure with STD/AIDS
(1997-2001)
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Impact of Antiretroviral Therapy
Policy(1996-2002)

• Reduced Mortality - 40
• 90,000 deaths avoided
• Reduced Morbidity - 70
• Reduced Hospital Admissions in 80
• 358,000 admissions avoided average hospital
  admissions per patient/year declined from 1.65 in
  1996 to 0.28 in 2001)
• Costs Averted
• USD 1.23 billion in costs for medical care
• USD 960 million in discounted drug prices

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EXPENDITURES WITH ARV DRUGS, BY YEARBRAZIL,
1996-2003
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Mean cost (USD) of ARV treatment per patient/year
1996 - 2003
Preliminary data
MOH, 2004
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Variation in prices of ARV without local
production Brazil, 1996-2003
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Variation in prices of ARV with local production
Brazil, 1996-2003
MEAN REDUCTION 83
Source Ministry of Health/Brazil
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Marked reduction in acquisition prices year of
introduction vs. 2004

• EFAVIRENZ 77,4
• USD 2.32/cap. (1999) ? U 0.525/cap.
• NELFINAVIR 56,5
• USD 1.075/tablet (1998) ? U 0.468/tablet
• LOPINAVIR/r 56,2
• USD 2.97/caps. (2001) ? U 1.30/caps.
• ATAZANAVIR 76,4
• USD 13.8/caps. (2003) ? U 3.25/caps.

2003 - EFAVIRENZ 600mg U 1.575/tablet
(600mg) ? U 0.525/cap (200mg)
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HIV/AIDS Care Units BRAZIL, 2004
1
1
1
1
6
1
1
4
1
7
2
1
1
5
1
4
3
1
2
1
3
1
5
2
4
7
2
2
1
12
2
2
1
1
1
1
1
1
3
TOTAL 950
1
1
2
6
4
4
12
5
2
7
Accredited hospitals 388
6
5
1
40
1
4
9
1
36
Day-care units 79
8
1
9
7
4
26
6
Outpatient units 420
55
159
18
18
91
105
3
1
12
Homecare units 63
17
16
5
26
3
10
49
29
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Source UDAT/PN-DST/AIDS 2004
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CD4 CELL COUNT VIRAL LOAD DETERMINATIONS BRAZIL
, 2004
RR
AP
AM
PA
MA
CE
RN
PI
PB
AC
PE
TO
RO
AL
MT
BA
SE
DF
GO
MG
MS
ES
RJ
SP
PR

• CD4 CELL COUNT
• 82 Laboratories
• VIRAL LOAD
• 70 Laboratories

SC
RS
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Source Tanuri, A. Aids 2003, 171063-9
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TYPES OF ARV REGIMENS BRAZIL, 1997-2003
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RELATIVE USE () OF INDIVIDUAL NRTI BRAZIL
1997-2003
Source PN-DST/AIDS
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RELATIVE USE () OF INDIVIDUAL NNRTI BRAZIL,
1997-2003
Source PN-DST/AIDS
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RELATIVE USE () OF INDIVIDUAL PIs BRAZIL,
1997-2003
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ACKNOWLEDGEMENTS
The following personnel of the Brazilian
National STD/AIDS Program were instrumental in
providing data and slides for this presentation

• Dr. Cledy Eliana dos Santos
• Dr. Draurio Barreira
• Ms. Karim Sakita
• Ms. Lilian Amaral Inocêncio
• Dr. Suelene Mamede de Oliveira