Causes of Death among People Living with AIDS in the Pre- and Post-HAART Eras in the City of São Paulo, Brazil

Abstract

ObjectiveWe examine the trend in causes of death among people living with AIDS in the city of São Paulo, Brazil, in the periods before and after the introduction of highly active antiretroviral therapy (HAART), and we investigate potential disparities across districts of residence.MethodsDescriptive study of three periods: pre-HAART (1991–1996); early post-HAART (1997–1999); and late post-HAART (2000–2006). The data source was the São Paulo State STD/AIDS Program and São Paulo State Data Analysis Foundation. Causes of death were classified by the ICD-9 (1991–1995) and ICD-10 (1996–2006). We estimated age-adjusted mortality rates for leading underlying causes of death and described underlying and associated causes of death according to sociodemographic characteristics and area of residence. We used Pearson's chi-square test or Fisher's exact test to compare categorical variables. Areas of residence were categorized using a socioeconomic index. To analyze trends we apply generalized linear model with Poisson regression.ResultsWe evaluated 32,808 AIDS-related deaths. Between the pre- and late post-HAART periods, the proportion of deaths whose underlying causes were non-AIDS-related diseases increased from 0.2% to 9.6% (p<0.001): from 0.01% to 1.67% (p<0.001) for cardiovascular diseases; 0.01% to 1.62% (p<0.001) for bacterial/unspecified pneumonia; and 0.03% to 1.46% (p<0.001) for non-AIDS-defining cancers. In the late post-HAART period, the most common associated causes of death were bacterial/unspecified pneumonia (35.94%), septicemia (33.46%), cardiovascular diseases (10.11%) and liver diseases (8.0%); and common underlying causes, besides AIDS disease, included non-AIDS-defining cancers in high-income areas, cardiovascular diseases in middle-income areas and assault in low-income areas.ConclusionsThe introduction of HAART has shifted the mortality profile away from AIDS-related conditions, suggesting changes in the pattern of morbidity, but heterogeneously according to area of residence. There is a need for public policies aimed at adapting health care services to address the new scenario.

Qualidade de vida e fatores associados em pessoas vivendo com HIV/AIDS

“…In contrast, cancer mortality has increased by 12.7 times, lung cancer being the most common (13.6%), followed by lip malignancies, oral and pharynx cavity (10%), and stomach cancer (10%). (2) Since the occurrence of the first HIV infection cases in the world, homo-affective relations have represented an important, key, vulnerable group with a significant influence on quality of life. (20) …”

“…(2) In this context, the possibility of a longer life is not directly linked to a good quality of life, because HIV infection also implies changes related to coping with the HIV serostatus, such as the regular use of antiretroviral therapy, self-perception and the clinical stage of the disease, bodily changes, personal income, occupation, victimization due to discrimination and prejudice, lack of social support, and depressive symptoms. (3)(4)(5) As a broad World Health Organization (WHO) concept, quality of life is the individuals' perception of their position in life, in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns.…”

Quality of life of elderly people living with HIV/AIDS in outpatient follow-up

“…The HAT-QoL survey was used to measure the quality of life of people living with HIV/ AIDS in the last four weeks (8) , consisting of 34 items distributed in 9 categories: general function, satisfaction with life, concerns about health, financial concerns, medication concerns, HIV acceptance, concerns about confidentiality, physician confidence, and sexual function, all of which are related to a greater or lesser perception of quality of life. The answers are on a Likert scale of five points: all time (1) , most of the time (2) , part of the time (3) , few time (4) and never (5) ; so that the dimensions of the survey are measured in scores ranging from one (perceived lower quality of life) to one hundred (higher quality of life perceived).…”

“…Thus, with advancement in treatment and with the decrease of secondary infections, such as increased survival rates and disease chronicity, understanding the factors related to better QoL has become one of the main objectives of HIV/AIDS research (2)(3) . Chronicity of AIDS was a milestone in improving the living conditions of people living with HIV/AIDS (PLHA).…”

Sexual orientation and quality of life of people living with HIV/Aids

“…In Brazil, where high rates of incidence are found (3) , universal access to antiretroviral therapy provided a change in the perception of the disease, which changed its status from a fatal disease to a chronic health condition (4) . Access to treatment, good adherence to antiretroviral therapy and an increase in diagnosis have caused impacts on the quality of life of these people, leading to an increase in survival time, reduction in morbidity and mortality, increase in life expectancy, and redefinition of future projects (5) . Currently, living with HIV, requires much more than treating the disease.…”