Abstract
IntroductionAfter 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.MethodsWe 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.ResultsIn 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).ConclusionsNon 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.
Highlights
After antiretroviral therapy (ART) became available, there was a decline in the number of deaths in persons infected with HIV
Causes of death traditionally associated with HIV/AIDS continue to play a prominent role, other conditions, including cardiovascular diseases (CVD), diabetes mellitus (DM), and cancer emerged as frequent causes of death [4,5,6,7,8]
151,706 (1.23%) had HIV/AIDS reported in any field of the death certificate (DC)
Summary
After antiretroviral therapy (ART) became available, there was a decline in the number of deaths in persons infected with HIV. We extend previous observations from a nationwide survey on temporal trends in causes of death in HIV-infected patients in Brazil. The widespread availability of ART led to an initial abrupt decrease in mortality in individuals infected with HIV, which leveled off in most countries after a few years [1,2,3]. We have previously described an increase in causes of death due to conditions generally not associated with HIV infection in Brazil at the local, regional, and national levels [1,4,9]. The aim of the present study was to expand our previous analyses of national temporal trends in selected non-AIDS-related causes of death and TB in persons with HIV infection
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