Survival of adult AIDS patients in a reference hospital of a metropolitan area in Brazil

Abstract

DescritoresSíndrome de imunodeficiência adquirida, quimioterapia. Sobrevivência. Antivirais. Fatores socioeconômicos. Escolaridade. Terapia anti-retroviral. Abstract ObjectiveTo evaluate the influence of sociodemographic, clinical, and epidemiological factors in AIDS patients survival in a reference hospital. Methods A sample of 502 adult AIDS patients out of 1,494 AIDS cases registered in a hospital in Fortaleza, Brazil, was investigated between 1986 and 1998. Sixteen cases were excluded due to death at the moment of the AIDS diagnosis and 486 were analyzed in the study. Socioeconomic and clinical epidemiological were the variables studied. Statistical analysis was conducted using the Kaplan-Meier survival analysis and the Cox proportional hazards model. Results Three hundred and sixty two out of the 486 patients studied took at least one antiretroviral drug and their survival was ten times longer than those who did not take any drug (746 and 79 days, respectively, p <0.001). Patients who took two nucleoside reverse transcriptase inhibitors (NRTI) plus protease inhibitor were found to have higher survival rates (p <0.001). The risk of dying in the first year was significantly lower for patients who took NRTI and a protease inhibitor compared to those who took only NRTI. In addition, this risk was much lower from the second year on (0.10; 95%CI: 0.42-0.23). The risk of dying in the first year was significantly higher for less educated patients (15.58; and those who had two or more systemic diseases (3.03; 95%CI: 1.74-5.25). After the first year post-diagnosis, there was no risk difference for these factors. Conclusions Higher education revealed to exert a significant influence in the first-year survival. Antiretroviral drugs had a greater impact in the survival from the second year on. A more aggressive antiretroviral therapy started earlier could benefit those patients.

Sobrevida de pacientes com Síndrome da Imunodeficiência Adquirida em hospital geral no Rio de Janeiro, a partir de dados da vigilância epidemiológica

“…O esquema HAART foi introduzido no sistema de saúde brasileiro em novembro de 1996 como parte da política nacional de livre acesso aos serviços de saúde e medicamentos, sendo oferecido para toda a população como indicação de tratamento. Isto possibilitou uma redução de 33% na letalidade dos casos [1][2][3][4][5] . Como a informação direta sobre uso de antirretrovirais não está disponível no SINAN, a variável coorte de diagnós-tico foi considerada como proxy para uso de antirretrovirais, e foi tratada como tempo-dependente na análise de sobrevida realizada através do modelo de Cox generalizado.…”

“…O esquema de tratamento com pelo menos três fármacos (HAART -highly active antiretroviral therapy) permitiu uma sobrevida aumentada de doentes com SIDA em todo o mundo, incluindo o Brasil [1][2][3][4][5][6] . Por outro lado, devido a essa resposta terapêutica tão favorável da terapia antirretroviral (TARV), e enquanto diversos testes para novas vacinas ainda estão em andamento, as intervenções terapêuticas, incluindo HAART, têm sido preconizadas como possíveis intervenções preventivas, tanto em gestantes infectadas pelo HIV como em outros grupos de infectados 6 , com impactos significativos também na ampliação do tempo de incubação da doença 7 .…”

The first ten years: achievements and challenges of the Brazilian program of universal access to HIV/AIDS comprehensive management and care, 1996-2006

“…Two available studies 17,18 conducted long-term follow up of patients over both the pre and post-HAART eras, and documented two relevant issues that the national and southeastern studies did not make evident. First, in a study conducted in Fortaleza, Ceará State 17 , the median survival time for patients under follow up from 1986 to 1998 was approximately 25 months, but, unlike the abovementioned studies, low educational level was found to be an independent predictor of poorer survival one year after AIDS diagnosis.…”

Socioeconomic Status and Survival of People with Human Immunodeficiency Virus Infection before and after the Introduction of Highly Active Antiretroviral Therapy: A Systematic Literature Review

“…Therefore, it was not possible to determine the extent of mortality due to poor survival of people with HIV/AIDS versus differences in HIV incidence and prevalence by socioeconomic group. Four publications were not considered for the analysis because they provided insufficient survival analysis data [53][54][55][56].…”