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Is it possible to control HIV infection in a middle-income country through a multidisciplinary approach?

Despite the difficulties to follow and retain patients for a long time in the public health service, special programs may bring about increased chances of survival and better quality of life, as well as higher rates of retention in care; this is also true for middle-income developing countries such as Brazil. Our relatively small outpatient service (~500 HIV-infected patients) may not mirror the reality encountered in other settings, including São Paulo city, but retention and high quality of care may improve rates of virologic success, even in poorer settings. Furthermore, prevention of depression or anxiety, with discussion in groups of patients with the presence of a therapist, regular HIV RNA viral and CD4 cells counts, genotyping tests pre-HAART, and vigilance for drug failure, may explain this successful experience. We should also take into consideration that our cohort consists mostly of asymptomatic at-entry patients referred by the Blood Bank of São Paulo, located at the same Hospital, implying that they had a better immunological status at start than the more usual HIV population. Besides that, the degree of adherence to treatment in our service, in general, is quite high and the patients have a higher mean educational level; over 90% of the patients a high school or college education . Such features make this cohort a very specific and differentiated sample. In order to extend our findings, we intend to conduct similar studies in other HIV treatment centers, enabling comparisons of populations with different profiles.