Determinants of survival of people living with HIV/AIDS on antiretroviral therapy in Brazil 2006–2015

Abstract

Background We compared AIDS-related mortality rates in people living with HIV (PLHIV) starting antiretroviral therapy (ART) in Brazil during 2006–2015 and examined associated risk factors . Methods Data on ART use in PLHIV and AIDS mortality in Brazil was analysed with piecewise constant exponential models. Mortality rates and hazard ratios were estimated for 0–6, 6–12, 13–24, 25–36 and > 36 months of ART use and adjusted for region, age, sex, baseline CD4 cell count and calendar year of ART initiation. An additional analysis restricted to those with data on risk group was also performed. Results 269,076 individuals were included in the analysis, 165,643 (62%) males and 103,433 (38%) females, with 1,783,305 person-years of follow-up time. 21,749 AIDS deaths were reported and 8898 deaths occurred in the first year of ART. The risk of death in the first six months decreased with early ART initiation; those starting treatment early with CD4 > 500 cells per μL had a hazard ratio of 0.06 (95% CI 0.05–0.07) compared with CD4 < 200 cells per μL. Older age, male sex, intravenous drug use and starting treatment in earlier calendar years were associated with higher mortality rates. People living in the North, Northeast and South of Brazil experienced significantly higher AIDS mortality rates than those in the Southeast (HR 1.44, [95% CI 1.35–1.54], 1.10 [1.05–1.16] and 1.22 [1.17–1.28] respectively). Conclusions Early treatment is likely to have contributed to the improved survival in PLHIV on ART, with the greatest benefits observed in women, younger age-groups and those living in the North. Electronic supplementary material The online version of this article (10.1186/s12879-019-3844-3) contains supplementary material, which is available to authorized users.

Beyond the burden of cardiovascular and cancer mortality among adults: mental health as a cause of death

“…4 Deaths relating to HIV can be explained partially as due to prolongation of the lifespan of the generation with high incidence of the infection who began to receive highly active antiretroviral therapy HAART (in the early 1990s), among whom there are now higher mortality rates among older men; and partially because of HIV cases among intravenous drug users. 5 The combination of greater risk of death due to use of psychoactive drugs, suicide, cirrhosis due to alcohol intake and a proportion of human immunodeficiency virus (HIV) cases relating to intravenous drug indicates the existence of a cluster of mental health problems. This situation in Brazil is therefore relatively similar to what has been described in the United States as deaths due to overdoses of illicit drugs, cirrhosis and suicide.…”

Late diagnosis of Human Immunodeficiency Virus infection and associated factors

“…In the last few decades, a significant decrease in AIDS morbidity and mortality has been observed in the country, due to the introduction of universal and free access to antiretroviral therapy (ART), the harm reduction policy, the implementation of combined prevention strategies, the recommendation of treatment as prevention, and the wide range of diagnostic tests (1)(2)(3) . These strategies have jointly contributed to the increase in the life expectancy and quality of life of people living with HIV (PLHIV), to the decrease in hospital admissions due to the reduction of opportunistic infections, and to the reduction of HIV transmission (4)(5)(6) .…”

Effect of AIDS-defining events at initiation of antiretroviral therapy on long-term mortality of HIV/AIDS patients in southwestern China: a cohort study

“…ART can effectively reduce mortality, delay the progression of the disease, prolong the development of non-AIDS-defining events (non-ADE) to ADE, reduce complications, and prolong lifespan [9] . However, ARTtreated patients still face a higher mortality risk and lower quality of life than the general population [10][11][12][13] . Many studies have shown that a low CD4 + cell count, older age, male gender, clinical stage III/IV disease, low body mass index (BMI), and signs/symptoms of AIDS are independent factors related to death among patients on ART [4, [14][15][16][17][18] , indicating that patients with ADE may have higher mortality.…”