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Advisor(s)
Abstract(s)
Neste relatório conjunto da DGS e do INSA, são apresentados os dados mais recentes da vigilância epidemiológica da infeção por VIH em Portugal, das estimativas relativas à epidemia nacional, da monitorização
dos objetivos 90-90-90 e das iniciativas de prevenção e rastreio no país.
Até 30 de junho de 2019, foram notificados em Portugal 973 novos casos de infeção por VIH com diagnóstico durante o ano 2018, o que corresponde a uma taxa de 9,5 casos por 105 habitantes, não ajustada para
o atraso da notificação. Foram reportados 2,5 casos em homens por cada caso comunicado em mulheres,
a mediana das idades à data do diagnóstico foi de 40,0 anos e em 28,0% dos novos casos os indivíduos
tinham idades ≥50 anos. Os casos em homens que têm relações sexuais com homens (HSH) apresentaram
a idade mediana mais baixa (31,0 anos) e correspondem a 63,2% dos casos diagnosticados em indivíduos
de idade inferior a 30 anos. A taxa de diagnóstico mais elevada registou-se no grupo etário 25-29 anos, 23,8
casos por 105 habitantes. A residência de 47,2% dos indivíduos situava-se na Área Metropolitana de Lisboa
(16,1 casos/105 habitantes) e a região do Algarve apresentou a segunda taxa mais elevada de diagnósticos
(10,3 casos/105 habitantes). A maioria dos novos casos ocorreu em indivíduos naturais de Portugal (64,2%).
Manteve-se o predomínio de casos de transmissão heterossexual, no entanto, os casos em HSH corresponderam 49,2% dos novos diagnósticos em homens. Embora a maioria dos novos casos se apresentasse sem
sintomas na primeira avaliação clínica, em 15,9% houve um diagnóstico concomitante de SIDA e 55,8%
apresentaram-se tardiamente (CD4<350 cél/mm3). Nos casos com diagnóstico de novo em 2018 a prevalência de mutações de resistência para alguma classe de fármacos foi de 14,6%, sendo mais frequente para os
inibidores da transcritase reversa não nucleósidos (11,2%). Durante o ano 2018 foram também diagnosticados 227 novos casos de SIDA (2,2 casos/105 habitantes) nos quais a pneumonia por Pneumocystis jirovecii
foi a doença definidora de SIDA mais frequente. Foram ainda notificados 261 óbitos ocorridos em 2018,
26,8% dos quais ocorreram nos cinco anos subsequentes ao diagnóstico da infeção.
Encontram-se notificados em Portugal 59913 casos de infeção por VIH, com diagnóstico entre 1983 e
2018, dos quais 22551 atingiram estádio SIDA. A análise das tendências temporais revela que entre 2008
e 2017 observou-se uma redução de 46% no número de novos casos de infeção por VIH e de 67% em
novos casos de SIDA. Não obstante esta tendência decrescente mantida, Portugal tem apresentado das
mais elevadas taxas de novos casos de infeção VIH e SIDA da Europa ocidental.
As estimativas realizadas para o ano 2017 revelaram que, em Portugal, viviam 39820 pessoas com infeção
por VIH, 7,8% das quais não estavam diagnosticadas. A proporção de infeções não diagnosticadas era
mais elevada para os casos em homens heterossexuais (13,9%) e mais baixa em UDI (1,5%). O tempo médio
entre a infeção e o diagnóstico era 3,4 anos, no final de 2017.
Os dados da monitorização da estratégia 90-90-90 revelaram que Portugal atingiu no final de 2017 os 3
objetivos, com 92,2% das pessoas que vivem com VIH diagnosticadas, destas 90,3% em tratamento e
dessas 93,0% com virémia suprimida. Apesar desta conquista, a aposta na disponibilização de meios preventivos e de redução de riscos e minimização de danos, assim como a promoção do rastreio da
infeção e da referenciação das pessoas com resultados reativos para os cuidados hospitalares mantêm-se
como eixos prioritários da resposta nacional à infeção. Em 2018, foram distribuídos cerca de cinco milhões
de preservativos masculinos, cento e setenta mil preservativos femininos e um milhão e trezentas mil seringas, e até ao presente iniciaram PrEP cerca de 1000 pessoas, maioritariamente cisgénero masculino.
Foram realizados mais de cinquenta mil testes rápidos para VIH em diversas estruturas de Saúde e Organizações Não-Governamentais, registando-se um aumento de cerca de 28% no número de testes realizados,
comparativamente ao ano de 2017.
O incremento da qualidade dos dados e da informação disponível permite a tomada de decisões mais
sustentada, bem como avaliar a efetividade de medidas adotadas e identificar necessidades de intervenção.
This report is a joint publication from the Directorate-General of Health and the National Institute of Health Dr. Ricardo Jorge and presents updated HIV surveillance data from Portugal, national HIV infection estimates, 90-90-90 targets monitoring findings and data on prevention and screening initiatives. In 2018, 973 new HIV infection cases were diagnosed in Portugal, corresponding to a rate of 9.5 new cases/105 inhabitants, not adjusted for reporting delay. Those diagnoses were 2.5 times more frequent in men than in women. The median age of recently diagnosed individuals was 40.0 years and in 28.0% of the cases subjects were aged 50 years or older. Men who have sex with men (MSM) were younger than other individuals (median age=31.0 years) and correspond to 63,2% of cases diagnosed in individuals under the age of 30 years. The highest diagnosis rate occurred among the 25-29 y/o age group (23.8 cases/105 inhabitants). 47.2% of subjects with a new diagnose of HIV infection resided in Lisbon Metropolitan Area (16.1 cases/105 inhabitants) and Algarve region presented the second larger rate of diagnoses (10.3 cases/105 inhabitants). Most cases occurred in subjects born in Portugal (64.2%). As observed in previous years, cases of heterosexual transmission prevailed, however, cases in MSM account for 49.2% of the new diagnoses in men. Clinical characteristics of newly diagnosed cases indicate that the majority was asymptomatic, a concurrent AIDS diagnosis occurred in 15.9% of cases and 55.8% of individuals were late presenters (TCD4+<350 cells/mm3 ). Transmitted resistance data was collected for the first time in Portugal among the new diagnosed cases and a prevalence of 14.6% was found for resistance mutations to any drug class, mutations to NNRTI being the most frequent (11.2%). Two hundred and twenty-seven new AIDS cases were diagnosed in individuals aged ≥15 years (2.2 cases/105 inhabitants) during 2018. Pneumocystis pneumonia was the most frequently reported AIDS-defining illness. In 2018, 261 deaths occurred in subjects with HIV infection, in 26.8% of those it happened in the five years following diagnosis. Between 1983 and 2018, 59913 cases of HIV infection were diagnosed in Portugal, of those 22551 AIDS cases. Temporal trends show that between 2008 and 2017 both new HIV and AIDS diagnoses have declined, respectively 46% and 67%. Despite this downward trend, Portugal still exhibits one of the highest rates of new HIV and AIDS diagnosis among European Union countries. The number of new HIV diagnoses in young MSM and of late diagnoses in heterosexual males remains a concern, highlighting the need for more effective and innovative prevention and early diagnosis strategies. National estimates revealed that 39820 persons were living with HIV in Portugal by the end of 2017, of those 7.8% were not diagnosed. The highest proportion of undiagnosed infections was found to be among heterosexual males (13.9%) and the lowest among IDU (1.5%). Estimated mean time from infection to diagnosis was 3.4 years. Portugal achieved the 90-90-90 goals in 2017, monitoring data showed that 92.2% of people living with HIV were already diagnosed, 90,3% of those were in antiretroviral treatment and 93.0% attained viral suppression. Despite this achievement, prevention, harm reduction, test promotion and referral of new cases still are a priority in the national response to HIV. During 2018 approximately 5 million male condoms, 750 thousand female condoms and 1.3 million syringes were distributed, and approximately 1000 at-risk individuals started a PrEP regimen, mainly males. More than 50 thousand HIV rapid tests were done at several healthcare facilities and community based sites, 28% more than in the previous year. Increasing data quality and available information contributes to a sustained decision-making process, also enabling the evaluation of adopted measures and the identification of intervention priorities.
This report is a joint publication from the Directorate-General of Health and the National Institute of Health Dr. Ricardo Jorge and presents updated HIV surveillance data from Portugal, national HIV infection estimates, 90-90-90 targets monitoring findings and data on prevention and screening initiatives. In 2018, 973 new HIV infection cases were diagnosed in Portugal, corresponding to a rate of 9.5 new cases/105 inhabitants, not adjusted for reporting delay. Those diagnoses were 2.5 times more frequent in men than in women. The median age of recently diagnosed individuals was 40.0 years and in 28.0% of the cases subjects were aged 50 years or older. Men who have sex with men (MSM) were younger than other individuals (median age=31.0 years) and correspond to 63,2% of cases diagnosed in individuals under the age of 30 years. The highest diagnosis rate occurred among the 25-29 y/o age group (23.8 cases/105 inhabitants). 47.2% of subjects with a new diagnose of HIV infection resided in Lisbon Metropolitan Area (16.1 cases/105 inhabitants) and Algarve region presented the second larger rate of diagnoses (10.3 cases/105 inhabitants). Most cases occurred in subjects born in Portugal (64.2%). As observed in previous years, cases of heterosexual transmission prevailed, however, cases in MSM account for 49.2% of the new diagnoses in men. Clinical characteristics of newly diagnosed cases indicate that the majority was asymptomatic, a concurrent AIDS diagnosis occurred in 15.9% of cases and 55.8% of individuals were late presenters (TCD4+<350 cells/mm3 ). Transmitted resistance data was collected for the first time in Portugal among the new diagnosed cases and a prevalence of 14.6% was found for resistance mutations to any drug class, mutations to NNRTI being the most frequent (11.2%). Two hundred and twenty-seven new AIDS cases were diagnosed in individuals aged ≥15 years (2.2 cases/105 inhabitants) during 2018. Pneumocystis pneumonia was the most frequently reported AIDS-defining illness. In 2018, 261 deaths occurred in subjects with HIV infection, in 26.8% of those it happened in the five years following diagnosis. Between 1983 and 2018, 59913 cases of HIV infection were diagnosed in Portugal, of those 22551 AIDS cases. Temporal trends show that between 2008 and 2017 both new HIV and AIDS diagnoses have declined, respectively 46% and 67%. Despite this downward trend, Portugal still exhibits one of the highest rates of new HIV and AIDS diagnosis among European Union countries. The number of new HIV diagnoses in young MSM and of late diagnoses in heterosexual males remains a concern, highlighting the need for more effective and innovative prevention and early diagnosis strategies. National estimates revealed that 39820 persons were living with HIV in Portugal by the end of 2017, of those 7.8% were not diagnosed. The highest proportion of undiagnosed infections was found to be among heterosexual males (13.9%) and the lowest among IDU (1.5%). Estimated mean time from infection to diagnosis was 3.4 years. Portugal achieved the 90-90-90 goals in 2017, monitoring data showed that 92.2% of people living with HIV were already diagnosed, 90,3% of those were in antiretroviral treatment and 93.0% attained viral suppression. Despite this achievement, prevention, harm reduction, test promotion and referral of new cases still are a priority in the national response to HIV. During 2018 approximately 5 million male condoms, 750 thousand female condoms and 1.3 million syringes were distributed, and approximately 1000 at-risk individuals started a PrEP regimen, mainly males. More than 50 thousand HIV rapid tests were done at several healthcare facilities and community based sites, 28% more than in the previous year. Increasing data quality and available information contributes to a sustained decision-making process, also enabling the evaluation of adopted measures and the identification of intervention priorities.
Description
O relatório reúne informação epidemiológica que caracteriza a situação em Portugal a 31 de dezembro de 2018, obtida a partir das notificações de casos de infeção por VIH e SIDA que o Instituto Ricardo Jorge recebe, colige e analisa desde 1985. São ainda apresentados dados das estimativas relativas à epidemia nacional, da monitorização dos objetivos 90-90-90 e das iniciativas de prevenção e rastreio no país.
Keywords
Infeção VIH e SIDA Vírus da Imunodeficiência Humana Síndrome de Imunodeficiência Adquirida Informação Epidemiológica Infecções Sexualmente Transmissíveis Doenças Infeciosas Estados de Saúde e de Doença Saúde Pública Portugal
Pedagogical Context
Citation
Publisher
Direção-Geral da Saúde, Instituto Nacional de Saúde Doutor Ricardo Jorge, IP