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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, bem como os resultados das estimativas
relativas à epidemia nacional para o ano 2018 e as iniciativas de prevenção e rastreio em
curso no país.
Durante o ano 2019, de acordo com as notificações efetuadas até 30 de junho de 2020, foram
diagnosticados em Portugal 778 novos casos de infeção por VIH, o que corresponde a uma taxa
de 7,6 casos por 105 habitantes, não ajustada para o atraso da notificação. A maioria dos casos
correspondiam a homens (2,3 casos por cada caso comunicado em mulheres), a mediana das
idades à data do diagnóstico foi de 38,0 anos e em 24,1% dos novos casos os indivíduos tinham
idades ≥50 anos. A idade mediana mais baixa (30,0 anos) foi apurada nos casos em homens que
têm relações sexuais com homens (HSH), estes correspondem a 65,2% 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, 22,1 casos por 105 habitantes. A residência de 50,4% dos indivíduos situava-se
na Área Metropolitana de Lisboa (13,7 casos/105 habitantes) e a região do Algarve apresentou
a segunda taxa mais elevada de diagnósticos (13,5 casos/105 habitantes). A maioria dos novos
casos ocorreu em indivíduos naturais de Portugal (55,7%). Embora a transmissão heterossexual
se mantenha como a mais frequente, os casos em HSH constituíram a maioria dos novos diagnósticos
em homens (56,7%). Na primeira avaliação clínica predominaram os casos assintomáticos,
contudo, em 15,0% houve um diagnóstico concomitante de SIDA e 49,7% apresentaram-se tardiamente
(CD4<350 cél/mm3 ). Durante o ano 2019 foram também diagnosticados 172 novos casos de
SIDA (1,7 casos/105 habitantes). A pneumonia por Pneumocystis jirovecii foi a doença definidora
de SIDA mais frequente, sendo referida em 37,8% dos casos. Foram ainda notificados 197 óbitos
ocorridos em 2019, 22,8% dos quais ocorreram nos cinco anos subsequentes ao diagnóstico da
infeção.
Entre 1983 e 2019 foram diagnosticados em Portugal 61433 casos de infeção por VIH, dos quais
22835 atingiram estádio SIDA. Entre 2009 e 2018 observou-se uma redução de 47% no número
de novos casos de infeção por VIH e de 65% em novos casos de SIDA. Não obstante esta tendência
decrescente sustentada, Portugal destaca-se pelas elevadas taxas de novos casos de infeção
VIH e SIDA entre os países da Europa ocidental. Como em anos anteriores, o número de novos
diagnósticos de infeção por VIH em HSH de idades jovens continua a constituir motivo de particular
atenção, reforçando a necessidade de estratégias dirigidas a esta população. Muito embora
a evolução em termos de diagnósticos tardios seja encorajadora, o facto de quase metade dos
casos serem diagnosticados tardiamente, com particular expressão entre os homens heterossexude prevenção e promoção do diagnóstico.
As estimativas realizadas para o ano 2018 revelaram que, em Portugal, viviam 41305 pessoas com
infeção por VIH, 6,8% das quais não diagnosticadas. A proporção de infeções não diagnosticadas
era mais elevada para os casos em homens heterossexuais (13,1%) e mais baixa em utilizadores de
drogas injetadas (UDI) (1,4%). O tempo médio entre a infeção e o diagnóstico era 3,4 anos, no final
de 2018. Foram pela primeira vez efetuadas estimativas para as 10 cidades portuguesas que aderiram
à iniciativa “Cidades na Via Rápida para acabar com a epidemia de VIH”.
Em 2019, foram distribuídos, através do Programa Nacional para a Infeção VIH e Sida (PNVIHSIDA),
cerca de cinco milhões e meio de preservativos masculinos e femininos e mais de um milhão e quinhentas
mil embalagens de gel lubrificante. No âmbito do Programa Troca de Seringas (PTS) foram
distribuídas mais de um milhão e quatrocentas mil seringas entre a população utilizadora de drogas
injetadas.
Foram realizados mais de sessenta e seis mil testes rápidos para VIH em diversas estruturas de
saúde e estruturas comunitárias, mantendo-se a tendência crescente do número de testes rápidos
realizados, numa clara aposta na promoção do acesso atempado ao rastreio e diagnóstico
da infeção. Adicionalmente, foram dispensados 3.292 unidades de autoteste para VIH pelas farmácias
comunitárias, entre outubro de 2019 e agosto de 2020.
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 and data on prevention and testing initiatives. In 2019, 778 new HIV infection cases were diagnosed in Portugal, corresponding to a rate of 7.6 new cases/105 inhabitants, not adjusted for reporting delay. Those diagnoses were 2.3 times more frequent in men than in women. The median age of recently diagnosed individuals was 38.0 years and in 24.1% of the cases subjects were aged 50 years or older. The lowest median age was found among men who have sex with men (MSM) cases (30.0 y/o) which correspond to 65.2% of cases diagnosed in individuals under the age of 30 years. The highest diagnosis rate occurred among the 25-29 y/o age group (22.1 cases/105 inhabitants). 50.4% of subjects with a new diagnose of HIV infection resided in Lisbon Metropolitan Area (13.7 cases/105 inhabitants) and the second larger rate of diagnoses was identified in Algarve region (13.5 cases/105 inhabitants). Most cases occurred in subjects born in Portugal (55.7%). As observed in previous years, cases of heterosexual transmission prevailed, however, cases in MSM account for 56.7% of the new diagnoses in men. Clinical characteristics of newly diagnosed cases indicate that the majority was asymptomatic, a concurrent AIDS diagnosis occurred in 15.0% of cases and 49.7% of individuals were late presenters (TCD4+<350 cells/mm3 ). One hundred and seventy two new AIDS cases were diagnosed in individuals aged ≥15 years (1.7 cases/105 inhabitants) during 2019. Pneumocystis pneumonia was the most frequently reported AIDS-defining illness, reported in 37.8% of AIDS cases. In 2019, 197 deaths occurred in subjects with HIV infection, 22.8% of those happenning in the five years following diagnosis. Between 1983 and 2019, 61433 cases of HIV infection were cumulatively diagnosed in Portugal, of those 22835 AIDS cases. Temporal trends show that between 2009 and 2018 both new HIV and AIDS diagnoses have declined, respectively 47% and 65%. Despite this downward trend, Portugal still exhibits one of the highest rates of new HIV and AIDS diagnosis among European Union countries. As in previous years, the number of new HIV diagnoses in young MSM draw attention and reinforce the need for focused strategies for this specific population. Although the proportion of late diagnoses has slightly decreased, almost half of new cases are in that category, with a higher proportion among heterosexual men, highlighting the importance of investment in prevention and testing promotion. National estimates revealed that 41305 persons were living with HIV in Portugal by the end of 2018, 6.8% of those undiagnosed. The highest proportion of undiagnosed infections was found to be among heterosexual males (13.1%) and the lowest among IDU (1.4%). Estimated mean time from infection to diagnosis was 3.4 years. Estimates for the 10 Portuguese cities that have subscribed Fast Track Cities initiative are presented in this report. National Programme for HIV and AIDS activities concerning prevention during 2019 included the supply of 5.5 million of male and female condoms and 1.5 million lubricant gel, the highest number in recent years, and the distribution of 1.4 million syringes among intravenous drug users population through the needle exchange programme. Testing initiatives supported by the Programme maintained an increasing trend and approximately 66.000 rapid tests were performed in different settings that include primary healthcare sector and community organizations. Self-test devices, entered the market in October 2019 and community pharmacies reported to have sold 3.292 units until August 2020.
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 and data on prevention and testing initiatives. In 2019, 778 new HIV infection cases were diagnosed in Portugal, corresponding to a rate of 7.6 new cases/105 inhabitants, not adjusted for reporting delay. Those diagnoses were 2.3 times more frequent in men than in women. The median age of recently diagnosed individuals was 38.0 years and in 24.1% of the cases subjects were aged 50 years or older. The lowest median age was found among men who have sex with men (MSM) cases (30.0 y/o) which correspond to 65.2% of cases diagnosed in individuals under the age of 30 years. The highest diagnosis rate occurred among the 25-29 y/o age group (22.1 cases/105 inhabitants). 50.4% of subjects with a new diagnose of HIV infection resided in Lisbon Metropolitan Area (13.7 cases/105 inhabitants) and the second larger rate of diagnoses was identified in Algarve region (13.5 cases/105 inhabitants). Most cases occurred in subjects born in Portugal (55.7%). As observed in previous years, cases of heterosexual transmission prevailed, however, cases in MSM account for 56.7% of the new diagnoses in men. Clinical characteristics of newly diagnosed cases indicate that the majority was asymptomatic, a concurrent AIDS diagnosis occurred in 15.0% of cases and 49.7% of individuals were late presenters (TCD4+<350 cells/mm3 ). One hundred and seventy two new AIDS cases were diagnosed in individuals aged ≥15 years (1.7 cases/105 inhabitants) during 2019. Pneumocystis pneumonia was the most frequently reported AIDS-defining illness, reported in 37.8% of AIDS cases. In 2019, 197 deaths occurred in subjects with HIV infection, 22.8% of those happenning in the five years following diagnosis. Between 1983 and 2019, 61433 cases of HIV infection were cumulatively diagnosed in Portugal, of those 22835 AIDS cases. Temporal trends show that between 2009 and 2018 both new HIV and AIDS diagnoses have declined, respectively 47% and 65%. Despite this downward trend, Portugal still exhibits one of the highest rates of new HIV and AIDS diagnosis among European Union countries. As in previous years, the number of new HIV diagnoses in young MSM draw attention and reinforce the need for focused strategies for this specific population. Although the proportion of late diagnoses has slightly decreased, almost half of new cases are in that category, with a higher proportion among heterosexual men, highlighting the importance of investment in prevention and testing promotion. National estimates revealed that 41305 persons were living with HIV in Portugal by the end of 2018, 6.8% of those undiagnosed. The highest proportion of undiagnosed infections was found to be among heterosexual males (13.1%) and the lowest among IDU (1.4%). Estimated mean time from infection to diagnosis was 3.4 years. Estimates for the 10 Portuguese cities that have subscribed Fast Track Cities initiative are presented in this report. National Programme for HIV and AIDS activities concerning prevention during 2019 included the supply of 5.5 million of male and female condoms and 1.5 million lubricant gel, the highest number in recent years, and the distribution of 1.4 million syringes among intravenous drug users population through the needle exchange programme. Testing initiatives supported by the Programme maintained an increasing trend and approximately 66.000 rapid tests were performed in different settings that include primary healthcare sector and community organizations. Self-test devices, entered the market in October 2019 and community pharmacies reported to have sold 3.292 units until August 2020.
Description
Colaborações: DGS-Programa Nacional para a Infeção VIH e SIDA (Isabel Aldir, Joana Bettencourt e Ana Fernandes); Divisão de Epidemiologia e Estatística (Rita Sá Machado e Marina Ramos); INSA-Departamento de Doenças Infecciosas (Helena Cortes Martins e Celeste Moura); Departamento de Epidemiologia (Rita Roquette).
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
Citation
Publisher
Direção-Geral da Saúde, Instituto Nacional de Saúde Doutor Ricardo Jorge, IP