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. 2009 Aug 15;51(5):624-30.
doi: 10.1097/QAI.0b013e3181a4ecf5.

Temporal changes in causes of death among HIV-infected patients in the HAART era in Rio de Janeiro, Brazil

Antonio G Pacheco  1 , Suely H Tuboi, Silvia B May, Luiz F S Moreira, Luciana Ramadas, Estevão P Nunes, Mônica Merçon, José C Faulhaber, Lee H Harrison, Mauro Schechter
Affiliations

Temporal changes in causes of death among HIV-infected patients in the HAART era in Rio de Janeiro, Brazil

Antonio G Pacheco et al. J Acquir Immune Defic Syndr. .

Abstract

Background: The widespread use of highly active antiretroviral therapy (HAART) has led to marked decreases in death rates in Brazil in HIV-infected individuals. Nonetheless, there are scarce data on specific causes of death.

Methods: Death rates from a cohort of HIV-infected patients in Rio de Janeiro, Brazil, were analyzed in 2-year periods, from 1997 to 2006. Poisson models and survival models accounting for competing risks were used to assess association of covariables. A standardized validated algorithm was used to ascertain specific causes of death.

Results: Of the 1538 eligible patients, 226 (14.7%) died during the study period, corresponding to a mortality rate of 3.2 per 100 person-years. The median follow-up time was 4.61 years (interquartile range = 5.63 years) and the loss to follow-up rate was 2.4 per 100 person-years. Overall, 98 (43.4%) were classified as non-AIDS-related causes. Although opportunistic infections were the leading causes of death (37.6%), deaths due to AIDS-related causes declined significantly over time (P < 0.01). In the most recent period (2005-2006), the rate of non-AIDS-related causes of deaths was higher than that of AIDS-related causes of death.

Conclusions: In the HAART era, there has been a significant change in causes of death among HIV-infected patients in Rio de Janeiro. As access to HAART improves, integration with other public programs will become critically important for the long-term success of HIV/AIDS programs in developing countries.

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Figures

Figure 1
Figure 1
Temporal trends of deaths in the cohort. A – Overall death rates and 95% CIs and linear trend over time (Poisson model); B – AIDS and Non-AIDS-related death rates and 95% CIs and linear trend over time (Poisson model); C – Cumulative incidence functions (CIFs) of the subdistributions of deaths associated with AIDS-, non-AIDS-related and unknown causes in a competing risks framework.
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