Epidemiological Profile, Spatial Dynamics, and Survival Outcomes of HIV/AIDS Patients in Brazil (2014-2024): A Nationwide Study of AIDS-stage Notification and Mortality.

Abstract

Despite universal access to combined antiretroviral therapy in Brazil, substantial inequalities persist in the HIV/AIDS epidemic. This nationwide retrospective study analyzed 753,071 notifications from the Brazilian Notifiable Diseases Information System (SINAN) between 2014 and 2024 to characterize the epidemiological profile, temporal trends, spatial distribution, factors associated with AIDS-stage notification, and predictors of AIDS-related mortality. HIV infection notifications accounted for 491,976 records, while AIDS case notifications accounted for 261,095. HIV infection notifications were concentrated among young adults, particularly men aged 20-29 years, whereas AIDS case notifications were more frequent in older age groups. Spatial analysis showed significant positive autocorrelation of smoothed municipal notification rates (Moran's I = 0.2306; p < 0.001), with significant High-High clusters mainly in the South and Southeast regions. In the multivariable logistic regression model, older age was strongly associated with AIDS-stage notification, reaching the highest odds among individuals aged 60 years or older (AOR = 2.03; 95% CI: 1.96-2.09), while higher education was associated with lower odds. In the Cox model, age at diagnosis was the main predictor of mortality, with increased risk among individuals aged 30-49 years (AHR = 1.42; 95% CI: 1.36-1.49) and 50 years or older (AHR = 1.95; 95% CI: 1.86-2.05). Lower education and injecting drug use were also strongly associated with AIDS-related mortality. These findings indicate that, although AIDS case notifications have declined over time, AIDS-stage notification and mortality remain concentrated in socially and geographically vulnerable groups.