Predictors of immunodeficiency-related death in a cohort of low-income people living with HIV: a competing risks survival analysis

Abstract

We conducted a survival analysis with competing risks to estimate the mortality rate and predictive factors for immunodeficiency-related death in people living with HIV/AIDS (PLWH) in northeast Brazil. A cohort with 2372 PLWH was enrolled between July 2007 and June 2010 and monitored until 31 December 2012 at two healthcare centres. The event of interest was immunodeficiency-related death, which was defined based on the Coding Causes of Death in HIV Protocol (CoDe). The predictor variables were: sociodemographic characteristics, illicit drugs, tobacco, alcohol, nutritional status, antiretroviral therapy, anaemia and CD4 cell count at baseline; and treatment or chemoprophylaxis for tuberculosis (TB) during follow-up. We used Fine & Gray's model for the survival analyses with competing risks, since we had regarded immunodeficiency-unrelated deaths as a competing event, and we estimated the adjusted sub-distribution hazard ratios (SHRs). In 10 012·6 person-years of observation there were 3·1 deaths/100 person-years (2·3 immunodeficiency-related and 0·8 immunodeficiency-unrelated). TB (SHR 4·01), anaemia (SHR 3·58), CD4 <200 cells/mm3 (SHR 3·33) and being unemployed (SHR 1·56) were risk factors for immunodeficiency-related death. This study discloses a 13% coverage by highly active antiretroviral therapy (HAART) in our state and adds that anaemia at baseline or the incidence of TB may increase the specific risk of dying from HIV-immunodeficiency, regardless of HAART and CD4.

Determinants of AIDS and non-AIDS related mortality among people living with HIV in Shiraz, southern Iran: a 20-year retrospective follow-up study

“…These results were not in agreement with those reported from several developed countries [28]. In a study on low-income individuals in Brazil, Albuquerque et al claimed that tuberculosis, anemia, and CD4 count lower than 200 cell/mm 2 were the main reasons for NARM [22].…”

“…Moreover, several cohort studies have demonstrated that HIV/AIDS-related conditions are the most frequent causes of death [2, 3]. However, the causes of mortality, including non-AIDS-related malignancies, cancers, liver and renal failures, cardiovascular diseases, and drug abuse are getting more diverse [10, 22, 23]. Despite the large number of studies conducted on the causes of death among PLWH, no efficient study has been performed in this field in Iran up to now.…”

HIV and Substance Use in Latin America: A Scoping Review

“…Higher mortality rates among PLWH in Brazil [ 141 , 142 , 143 , 144 , 145 , 146 , 147 ] and Mexico [ 44 ] have been associated with SU. Brazilian PLWH using drugs had a relative mortality risk of 3.1 compared to non-SU [ 143 ].…”

Determinantes do desfecho do tratamento, sobrevida e causa de óbito a curto e longo-prazo de pacientes adultos com tuberculose no Estado de São Paulo

“…Este problema é relatado em outros países e sistemas de saúde 83,84 , assim como por outros investigadores no Brasil e cidades do Estado de São Paulo [85][86][87][88] Com a abordagem das causas específicas de mortalidade, conseguimos investigar com detalhe o impacto dos determinantes da sobrevida e seu efeito em cada mortalidade específica. Alguns estudos utilizaram a metodologia de riscos competitivos em pacientes com coinfecção TB-HIV, inclusive um nacional com dados de dois centros 93 . Porém, para uma coorte geral de pacientes com TB, somente conhecemos um estudo que empregou esta metodologia para estimar a sobrevida a longo-prazo 94 .…”