Changing Mortality Profile among HIV-Infected Patients in Rio de Janeiro, Brazil: Shifting from AIDS to Non-AIDS Related Conditions in the HAART Era

Beatriz Grinsztejn,Antonio G Pacheco,Maria Regina C Guimarães,Valdilea G Veloso,Marco A A Vitoria,Sayonara R Ribeiro,Alberto S Lemos,Estevão P Nunes,Paula M Luz,Ronaldo I Moreira,Desiree V G Santos,Dayse P Campos,Luciane Velasque

doi:10.1371/journal.pone.0059768

Abstract

IntroductionWe describe temporal trends in the mortality rates and factors associated with AIDS and non-AIDS related mortality at the Evandro Chagas Clinical Research Institute (IPEC), Oswaldo Cruz Foundation (FIOCRUZ).MethodsAdult patients enrolling from 1986 through 2009 with a minimum follow up of 60 days were included. Vital status was exhaustively checked using patients’ medical charts, through active contact with individuals and family members and by linkage with the Rio de Janeiro Mortality database using a previously validated algorithm. The CoDe protocol was used to establish the cause of death. Extended Cox proportional hazards models were used for multivariate modeling.ResultsA total of 3530 individuals met the inclusion criteria, out of which 868 (24.6%) deceased; median follow up per patient was 3.9 years (interquartile range 1.7–9.2 years). The dramatic decrease in the overall mortality rates was driven by AIDS-related causes that decreased from 9.19 deaths/100PYs n 1986–1991 to 1.35/100PYs in 2007–2009. Non-AIDS related mortality rates remained stable overtime, at around 1 death/100PYs. Immunodeficiency significantly increased the hazard of both AIDS-related and non-AIDS-related causes of death, while HAART use was strongly associated with a lower hazard of death from either cause.ConclusionsOur results confirm the remarkable decrease in AIDS-related mortality as the HIV epidemic evolved and alerts to the conditions not traditionally related to HIV/AIDS which are now becoming more frequent, needing careful monitoring.

Highlights

We describe temporal trends in the mortality rates and factors associated with AIDS and non-AIDS related mortality at the Evandro Chagas Clinical Research Institute (IPEC), Oswaldo Cruz Foundation (FIOCRUZ)
Our objective was to describe the overall and the AIDS and non-AIDS related mortality rates, their temporal trends and the factors associated with the causes of death in a reference center for human immunodeficiency virus (HIV) care, the Evandro Chagas Clinical Research Institute (IPEC), Oswaldo Cruz Foundation (FIOCRUZ)
Some demographic and clinical characteristics were significantly different across the groups alive, death due to non-AIDS related and death due to AIDS-related causes of deaths (Table 1), such as gender (65%, 68.9% and 75.1% male, respectively), baseline CD4 counts (323, 264.5 and 124.5 cells/mm3, respectively), Highly-active antiretroviral therapy (HAART) use (74.7%, 53.8% and 28.3%, respectively), AIDS diagnosis at baseline (41.2%, 68,4% and 82.2%, respectively) and median follow-up time (4.6, 2.9 and 2 years, respectively)

Summary

Introduction

We describe temporal trends in the mortality rates and factors associated with AIDS and non-AIDS related mortality at the Evandro Chagas Clinical Research Institute (IPEC), Oswaldo Cruz Foundation (FIOCRUZ). As survival increases, so does the likelihood that diseases other than those related to AIDS will incur among HIV-infected individuals Within this changing scenario, the surveillance of causes of death in HIV-infected patients is critically important to understand the changing epidemiology of HIV disease, to improve HIV clinical management and the management of co-morbidities, and to identify the potential side effects of antiretroviral therapy. Our objective was to describe the overall and the AIDS and non-AIDS related mortality rates, their temporal trends and the factors associated with the causes of death in a reference center for HIV care, the Evandro Chagas Clinical Research Institute (IPEC), Oswaldo Cruz Foundation (FIOCRUZ)

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