Since the discovery of HIV, diagnosis and treatment have advanced significantly in Brazil. However, global targets for diagnosis and treatment inclusion have not reached the desired levels, and the impact of the pandemic on disease progression is currently under investigation. During the COVID-19 pandemic, reduced diagnostic testing was reported and a potential increase in severe cases and deaths has been analyzed. We observed the profile of patients newly diagnosed at the State Reference Center (CRT) at diagnosis and assessed on-demand diagnostic testing, comparing with prior unit data.

Patients admitted from January 2021 to June 2023 in the research clinic were analyzed. They participate in a surveillance study approved by the Research Ethics Committee; all signed informed consent. Demographics, baseline labs before treatment and at 8–12 weeks after treatment initiation were assessed. On-demand HIV testing volumes were also reviewed.

We evaluated 232 charts. Age ranged from 19 to 64 years (mean 33). Fifty-five (23.7%) were 19–25 years old, 58 (25%) were 26–35 years, and 17 (7.3%) were ≥ 50 years. At first labs, 41 (17.7%) had CD4 < 200 cells/mm³ and 91 (39.2%) had CD4 < 350 cells/mm³. Service data published in 2017 showed that among 499 enrollees, 128 (25.7%) had CD4 < 200 at first consult (chi-square = 5.67, p = 0.017). On-demand HIV testing at the unit decreased from 4,233 tests in 2019 to 4,078 in 2020, then increased to 6,051 in 2021 and 6,766 in 2022.

During the COVID-19 pandemic, test availability and access remained stable at the CRT. Nonetheless, despite nationwide mass campaigns, the disease still affects many young people (23.7% aged ≤ 25 and 48.7% ≤ 35), and late diagnosis, formerly > 90% after 40 years, occurs in 17.7% of cases. Persistent high rates of late diagnosis among youth remain a challenge, requiring intensified interventions to mitigate high infection rates and adverse outcomes in this population.