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. 2019 Feb 28;19(1):206.
doi: 10.1186/s12879-019-3844-3.

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

Tara D Mangal  1 , Mariana Veloso Meireles  2 , Ana Roberta Pati Pascom  3 , Ronaldo de Almeida Coelho  3 , Adele Schwartz Benzaken  3 , Timothy B Hallett  4
Affiliations

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

Tara D Mangal et al. BMC Infect Dis. .

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.

Keywords: Antiretroviral treatment; Brazil; HIV/AIDS; Mortality.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval was not required for this retrospective study of anonymised data collected during routine HIV care. All identifying data were removed from the datasets before use in this study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
AIDS mortality hazard ratios for baseline characteristics of individuals starting ART. Values presented are the simple main effects with other variables fixed at baseline. X-axis is on the log scale. Data on region are missing for 32 individuals. HR – hazard ratio
Fig. 2
Fig. 2
Annual mortality rates over time by CD4 cell count at ART initiation in the first six months of ART (upper panels) and after 36 months on ART (lower panels) for men aged 20. Rates are stratified by the region of residence
Fig. 3
Fig. 3
Hazard ratios associated with risk group and adjusted for age, CD4 count at ART initiation, year of initiation, region and time on ART. Interactions between CD4 cell count at ART initiation and age / region were included. X-axis is on the log scale. 98,146 (36%) individuals were missing data on risk. IDU – intravenous drug user; MSM – men who have sex with men
See this image and copyright information in PMC

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