Antiretroviral treatment, government policy and economy of HIV/AIDS in Brazil: is it time for HIV cure in the country?
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AIDS Research and Therapy Open Access
REVIEW
Antiretroviral treatment, government policy and economy of HIV/AIDS in Brazil: is it time for HIV cure in the country? Adele S. Benzaken1, Gerson F. M. Pereira2, Lendel Costa3, Amilcar Tanuri3, André F. Santos3 and Marcelo A. Soares3,4*
Abstract Brazil is a low-and-middle income country (LMIC) that, despite having a large population and continental dimensions, has been able to successfully fight HIV/AIDS through a number of governmental and societal measures. These included an early response to the epidemic, the development of a universal and free public health system, incisive discussions with pharmaceutical companies to reduce antiretroviral (ARV) drug prices, investments towards the development of generic drugs and compulsory licensing of ARVs. Through such measures, Brazil is among the leading LMIC towards achieving the 90-90-90 UNAIDS goals in the years to come. In this review, we analyze Brazil’s progress throughout the HIV/AIDS epidemic to achieve state-of-the-art ARV treatment and to reduce AIDS mortality in the country. The top-quality HIV/AIDS research in Brazil towards HIV prophylactic and functional cure, the next step towards the economic sustainability of the battle against HIV, is also discussed. Keywords: HIV, AIDS, HIV cure, Antiretroviral treatment, Brazil Background Brazil is the fifth largest country in the world. It covers over half of South America and harbors almost 210 million inhabitants. This immense developing South American country was hit hard by the HIV/AIDS pandemic in the 1980s; its first AIDS case was identified in 1980. From then to June 2018, over 900,000 AIDS cases have been notified in Brazil—around 559,000 men, and 307,000 women [1]. By 2017, an estimated 866,000 people were living with HIV/AIDS within its borders [2]. The Brazilian Ministry of Health’s Department of STI, HIV/AIDS and Viral Hepatitis (DIAHV) is directly responsible for dealing with this reality—and, thus, for HIV/AIDS policy development, implementation and monitoring within Brazil’s public health system, all-encompassing Unified Health System (Sistema Único de Saúde/SUS).
*Correspondence: [email protected] 4 Programa de Oncovirologia, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil Full list of author information is available at the end of the article
Brazil has responded to the HIV pandemic in a number of bold and innovative ways. In 1996, Brazil was the world’s first middle-income country to offer free antiretroviral therapy (ART) to all people living with HIV (PLWHIV). In 2013, it was the third to provide all PLWHIV with ART regardless of C D4+ T cell counts, whereas the World Health Organization began to recommend this treatment for all 2 years later, in 2015. Presently, approximately 600,000 PLWHIV are on ART in Brazil [2]. The Brazilian treat all policy has driven down the number of notified HIV cases in the country over recent years and led to a recent drop in AIDS-related deaths (see below). Brazil’s combination prevention strategy is ano
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