Debate on the paper by David Vlahov &amp; David D. Celentano

Kalichman, Artur

doi:10.1590/s0102-311x2006000400009

Cited by 4 publications

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“…The independent association between low schooling and lower survival of AIDS patients may be explained by the fact that disease perception is affected by level of education; educated individuals are more likely to have an early diagnosis and adhere to treatment [25]. If we take schooling as a proxy measure for socioeconomic status, our results are consistent with higher AIDS mortality in the city districts with greater social inequality [26].…”

Section: Discussionmentioning

confidence: 51%

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Survival of AIDS patients in Sao Paulo-Brazil in the pre- and post-HAART eras: a cohort study

Tancredi¹,

Waldman

2014

BMC Infect Dis

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BackgroundBrazil was the first middle-income country to provide free and universal access to AIDS treatment. Understanding the impact of this policy is key to promote ongoing improvement of current intervention strategies. The aim of this study was to compare mortality rates and survival in a cohort of AIDS patients before and after the introduction of antiretrovirals (ARV) and to investigate predictors of survival.MethodsA retrospective cohort study of AIDS patients aged 13 years or more living in the city of Sao Paulo was conducted. All patients were recruited from an STD/HIV outpatient clinic between 1988 and 2003 and followed up until 2005. We estimated AIDS mortality rates in person-years (py) and carried out a survival analysis using the Kaplan-Meier method. The Cox proportional hazards model was used to assess predictors of survival in AIDS patients.ResultsThe study cohort comprised 6,594 patients. The yearly mean mortality rates were 17.6, 23.2, and 7.8 per 1,000 py for the study periods 1988-1993, 1994-1996, and 1997-2003, respectively. Median survival time was 13.4 and 22.3 months for patients entering the study in the first and second study periods and survival time was 108 months or more in 72% of those entering the study during 1997-2003. Factors independently associated with shorter survival included: AIDS diagnosis during the 1994-1996 (HR 2.0) and 1988-1993 (HR 3.2) periods; 50 years of age or more (HR 2.0); exposure category of injection drug users (IDU) (HR 1.5); 8 years of schooling or less (HR 1.4); no schooling (HR 2.1); and CD4+ counts between 350 and 500 cells/mm3 (HR 1.2) and less than 350 cells/mm3 at AIDS diagnosis (HR 1.3).ConclusionsThe study showed a strong impact following the introduction of HAART in 1996 with decreased AIDS mortality, increased survival rates, and benefits with early introduction of HAART. However, some groups of patients were less likely to benefit from the new drug regimens. Public policies promoting health equity create an enabling environment helping AIDS control programs in developing countries to achieve their goals as effectively as in developed countries.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0599-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 51%

“…A possible explanation may be a higher prevalence of co-infection of HIV and hepatitis B and C in this group [17],[18],[24]. The authors of a study conducted in Sao Paulo argued that it might be due to lower access to HAART and lower CD4+ counts at AIDS diagnosis [25]. …”

Section: Discussionmentioning

confidence: 99%

Survival of AIDS patients in Sao Paulo-Brazil in the pre- and post-HAART eras: a cohort study

Tancredi¹,

Waldman

2014

BMC Infect Dis

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“… 30 The importance of this lies on the fact that cART is less beneficial in patients with coinfection, and adherence to therapy, which is already a problem in HIV–HCV coinfected patients, 6 can be even lower among drug users. 31 , 32 A meta-analysis published this year has shown that treatment of addiction results in higher hepatitis treatment completion including antivirals. 33 …”

Section: Discussionmentioning

confidence: 99%

Survival analysis of acquired immune deficiency syndrome patients with and without hepatitis C virus infection at a reference center for sexually transmitted diseases/acquired immune deficiency syndrome in São Paulo, Brazil

Alencar¹,

Duarte

Waldman

2014

The Brazilian Journal of Infectious Diseases

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“…No entanto, a importância do UDI é reconhecida e reside em ser essa uma das principais vias de aquisição da infecção pelo HCV.Um desafio em saúde pública é a emergente questão do uso de drogas injetáveis. Uma revisão recente sobre a prevalência de anti-HCV e AgHbs em UDI foi realizada por Nelson et al,182 que estimaram em aproximadamente 10,0 milhões de UDI com sorologia anti-HCV reagentes e aproximadamente 1,2 milhões com AgHbs reagentes no mundo, sendo as maiores concentrações em regiões como leste europeu e sudeste da Ásia.Os benefícios da HAART em coinfectados HIV/HCV, particularmente em UDI, são menores quando comparados com não UDI por várias razões, como questões sociais, acesso aos serviços, início tardio à HAART, aderência e resistência aos medicamentos 183,184. A interdisciplinaridade e multidisciplinaridade são vitais na atenção a esses pacientes.…”

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Análise de sobrevida de pacientes coinfectados HIV/HCV de um centro de referência em DST/AIDS no município de São Paulo

Alencar¹

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Introduction: The estimated survival of patients with HIV/AIDS has increased after highly active antiretroviral therapy; mortality due to liver diseases, however, has also increased. Objectives: To estimate the accumulated probability of survival after AIDS diagnosis among HIV/HCV co-infected individuals and to perform an exploratory analysis to investigate factors related to the survival of these patients. Method: Non-concurrent cohort study, using data from the National Disease Reporting Information System, the laboratory and epidemiological surveillance information systems of the SP-STD Reference and Training Center-CRT, of patients over 13 years of age, followed at the general outpatient clinic. The following variables were studied: hepatitis C, hepatitis B, exposure category, T CD4+ cell

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Debate on the paper by David Vlahov & David D. Celentano

Cited by 4 publications

References 0 publications

Survival of AIDS patients in Sao Paulo-Brazil in the pre- and post-HAART eras: a cohort study

Survival of AIDS patients in Sao Paulo-Brazil in the pre- and post-HAART eras: a cohort study

Survival analysis of acquired immune deficiency syndrome patients with and without hepatitis C virus infection at a reference center for sexually transmitted diseases/acquired immune deficiency syndrome in São Paulo, Brazil

Análise de sobrevida de pacientes coinfectados HIV/HCV de um centro de referência em DST/AIDS no município de São Paulo

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