Trends and characteristics of AIDS mortality in the Rio de Janeiro city after the introduction of highly active antiretroviral therapy

Abstract

We examined the characteristics of AIDS mortality in Rio de Janeiro city from 1995 to 2003. During this period, highly active antiretroviral therapy with protease inhibitors was made available, and it changed the pattern of the epidemics. There was a 47.5% reduction in the number of AIDS deaths within the period, with an increase in the proportion of women among the deceased; their schooling was lower than that of the men, similar to the trends of the national-level epidemics. The main place of death changed from university hospitals to emergency rooms. The proportion of cases reported to the National Diseases Surveillance System (SINAN) reported only through the death certificate remained high. Although there is free distribution of antiretrovirals by the public health system, many patients still lack access to diagnosis and treatment. We need to give priority to access to anti-HIV testing and treatment, to increase the quality of care and to look into the issue of adherence in order to further reduce AIDS mortality.

Cryptococcal meningitis in Rio de Janeiro State, Brazil, 1994-2004

“…They conclude that in the post-HAART era, lack of diagnosis and/or treatment of HIV infection is associated with increased risk of cryptococcosis. A study by Saraceni et al 31 on AIDS mortality in Rio de Janeiro from 1995 to 2003 revealed deficient access to HIV diagnosis, impeding the early introduction of HAART, before the development of immune deficiency, as a basis for the occurrence of opportunistic infections. They highlight that patients frequently come to emergency services without knowledge of their HIV infection and already presenting opportunistic infections.…”

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“…South Africa has the largest population of HIV-infected patients in the world (38,39 ) and has a nationwide public service ART program underway (40,41 ), requiring urgent reduction in the cost of viralload monitoring. The situation is similar in Brazil, where the absolute number of patients is high and the government is making highly active ART universally available (42,43 ). Finally, India has one of the fastest growing populations of HIV-1-positive individuals, and emerging ART programs will require affordable viral-load testing (44,45 ).…”

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“…Smaller and delayed decreases have been observed in the mortality of women compared with men, and these disparities remain [3][4][5]. In particular, HIV-related deaths have de-…”