Effect of sociodemographic, clinical-prophylactic and therapeutic procedures on survival of AIDS patients assisted in a Brazilian outpatient clinic

Abstract

The Brazilian AIDS Program offers free and universal access to antiretroviral therapy. This study investigates the influence of sociodemographic, clinical-prophylactic and therapeutic factors on survival, after AIDS diagnosis, in an open cohort of 1,420 patients assisted in a university hospital in the city of Rio de Janeiro (1995 _ 2002). Kaplan-Meier and Cox proportional hazards models were used to estimate the effect of variables in the three dimensions studied. The overall survival time of the upper quartile was 24 months (CI95%= 20.5-27.5), increasing from 14 months, in 1995, to 46 months, in 1998. We found a protective effect of heterosexual behavior against death that could be attributed to the increasing female-to-male sex ratio in the cohort, which coincided with the time of therapy introduction. Low schooling, hospital admission and lack of follow-up were identified as risk factors for death; PCP and Toxoplasmosis prophylaxis were protective. The number of attempts required to consolidate the antiretroviral therapy showed no significant effect on survival. The full model, which includes the number of antiretroviral drugs in the regimen, confirmed the triple therapy as the best regimen. This study brings important information for designing guidelines to deal with different aspects related to the practical management of patients and their behavior, thus contributing to the success of the program of free access to antiretroviral therapy implemented in Brazil.

Survival of AIDS patients and characteristics of those who died over eight years of highly active antiretroviral therapy, at a referral center in northeast Brazil

“…In another study, in Rio de Janeiro, Brazil, the 75th percentile survival increased from 14 months among patients diagnosed in 1995 to 46 months among those diagnosed in 1998. The medians for these two times (1995 and 1998) were 35 and 68 months, respectively, with a 74% probability of survival for one year and 56% for two years in 1995, and 81% and 77%, in 1996 [10]. In Taiwan, an analysis covering the period from 1997 to 2003 showed that patients presented a five-year survival rate of 58%, when they had already been diagnosed with AIDS, and 89%, when they were still asymptomatic HIV patients [11].…”

“…Also, in a study by Signorini [10] published in 2005, the likelihood of survival increased with the inclusion of more antiretroviral drugs. In Brazil, loss from follow-up was associated with lower survival over the period from 1995 to 2002 [10]. On the other hand, between 1989 and 1992, individuals whose interval between consultations was greater than six months presented a lower risk of progressing to death; this result was attributed to the fact that patients who were more severely affected would be more motivated to seek the health services, despite access difficulties [18].…”

What should we know about metabolic syndrome and lipodystrophy in AIDS?

“…Increased survival experienced by HIV-infected patients after the advent of highly active antiretroviral therapy (HAART) has been followed by the frequent occurrence of chronic metabolic abnormalities, such as dyslipidemia, the metabolic syndrome (MS), and HIV-related lipodystrophy (LD-HIV) 1,2 .…”

Adolescents with HIV and facial lipoatrophy: response to facial stimulation

“…The increased survival experienced by human immunodeficiency virus (HIV) infected patients after the advent of highly effective antiretroviral therapies has been accompanied by the frequent occurrence of chronic metabolic abnormalities, such as HIV-related lipodystrophy ( 1 - 5 ). Facial lipoatrophy associated with HIV has become epidemic and can be cosmetically disfiguring ( 6 ).…”