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. 2014 Apr 11;9(4):e94636.
doi: 10.1371/journal.pone.0094636. eCollection 2014.

Continuous increase of cardiovascular diseases, diabetes, and non-HIV related cancers as causes of death in HIV-infected individuals in Brazil: an analysis of nationwide data

Adelzon A Paula  1 , Mauro Schechter  2 , Suely H Tuboi  3 , José Claudio Faulhaber  4 , Paula M Luz  5 , Valdiléa G Veloso  5 , Ronaldo I Moreira  5 , Beatriz Grinsztejn  5 , Lee H Harrison  6 , Antonio G Pacheco  1
Affiliations

Continuous increase of cardiovascular diseases, diabetes, and non-HIV related cancers as causes of death in HIV-infected individuals in Brazil: an analysis of nationwide data

Adelzon A Paula et al. PLoS One. .

Abstract

Introduction: After antiretroviral therapy (ART) became available, there was a decline in the number of deaths in persons infected with HIV. Thereafter, there was a decrease in the proportion of deaths attributed to opportunistic infections and an increase in the proportion of deaths attributed to chronic comorbidities. Herein we extend previous observations from a nationwide survey on temporal trends in causes of death in HIV-infected patients in Brazil.

Methods: We describe temporal trends in causes of death among adults who had HIV/AIDS listed in the death certificate to those who did not. All death certificates issued in Brazil from 1999 to 2011 and listed in the national mortality database were included. Generalized linear mixed-effects logistic models were used to study temporal trends in proportions.

Results: In the HIV-infected population, there was an annual adjusted average increase of 6.0%, 12.0%, 4.0% and 4.1% for cancer, external causes, cardiovascular diseases (CVD) and diabetes mellitus (DM), respectively, compared to 3.0%, 4.0%, 1.0% and 3.9%, in the non-HIV group. For tuberculosis (TB), there was an adjusted average increase of 0.3%/year and a decrease of 3.0%/year in the HIV and the non-HIV groups, respectively. Compared to 1999, the odds ratio (OR) for cancer, external causes, CVD, DM, or TB in the HIV group were, respectively, 2.31, 4.17, 1.76, 2.27 and 1.02, while for the non-HIV group, the corresponding OR were 1.31, 1.63, 1.14, 1.62 and 0.67. Interactions between year as a continuous or categorical variable and HIV were significant (p<0.001) for all conditions, except for DM when year was considered as a continuous variable (p = 0.76).

Conclusions: Non HIV-related co-morbidities continue to increase more rapidly as causes of death among HIV-infected individuals than in those without HIV infection, highlighting the need for targeting prevention measures and surveillance for chronic diseases among those patients.

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Conflict of interest statement

Competing Interests: BG is a PLOS ONE Editorial Board member. SHT was an employee of GlaxoSmithKline Group for part of the duration of this study. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Odds ratios and 95% confidence intervals comparing the chance of having the disease listed on the death certificate over time of Non-HIV related cancers (A), external causes (B), cardiovascular diseases (C), Diabetes Mellitus (D) and Tuberculosis (E); year as a categorical variable and 1999 as the baseline reference.
See this image and copyright information in PMC

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