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

Abstract

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.

Population-Based Estimates of Life Expectancy After HIV Diagnosis

“…While some estimates of mortality and life expectancy are available 6-11 , the studies were either done outside of the United States or on a subset of PLWDH, such as those receiving care at a particular health care facility, and therefore did not represent large population-based estimates of life expectancy. The only large surveillance-data based estimates of life expectancy available from the United States 1 covered PLWDH, with HIV diagnosed by year 2005 and included data from only 25 states.…”

Diferenças e similaridades entre mulheres que vivem e não vivem com HIV: aportes do estudo GENIH para a atenção à saúde sexual e reprodutiva

“…As for differences in education, from 2004 to 2014 there was a downward trend in reported AIDS cases among women with incomplete primary schooling or less and an increase in women with incomplete or complete university schooling 11,12 , which may be reflected in our data. The following aspects are also relevant: first, Brazil's policy of universal access to ART and the high cost of medication may be attracting women with more schooling to the health services; and second, the shorter survival of WLHIV with less schooling 13 may increase the proportion of prevalent cases among women with more schooling. # Test of significance for differences between events that accurred before or after HIV diagnosis for WLHIV and those that accurred in the lifetime or at time of interview for women of the primary healthcare system; ## % for current use only considered women sexually active in the previous year and not pregnant, and at the time of diagnosis the analysis excluded WLHIV that were diagnosed during prenatal care (n = 270);…”

Relación entre la adherencia al tratamiento antirretroviral en pacientes VIH+ y el consumo de alcohol, asociado o no al uso de otras sustancias

“…Durante 2015, se estimaron alrededor de 9,44 nuevos casos por cada 100.000 habitantes (Instituto de Salud Carlos III, 2016). Desde la instauración del tratamiento antirretroviral de gran actividad (TARGA) como terapia de elección en la infección por VIH, se ha producido una mejora significativa en la calidad y esperanza de vida de los individuos afectados (Tancredi y Waldman, 2014;Poorolajal, Hooshmand, Mahjub, Esmailnasab y Jenabi, 2016). Los beneficios de dicha pauta, no obstante, están íntimamente ligados al estricto cumplimiento terapéutico, habiéndose postulado la falta de adherencia al mismo como la primera causa de fracaso del tratamiento a corto plazo (Braithwaite y Bryant, 2010), además de favorecer el desarrollo de cepas víricas resistentes (Cohen, 2006).…”