Existe-t-il une surmortalité par sida en Aquitaine ? Étude sur les données de déclaration obligatoire, 1982–2005

Abstract

Objectives The mortality rate among AIDS patients reported through the French mandatory reporting system since 1982 is particularly high in Aquitaine, a south west area of France. This study was made to confirm that mortality was higher in Aquitaine patients than in the rest of France, and to determine its causes. Design All the cases reported between January 1982 and June 2005 were included. Cox's proportional hazard models were used to determine the relative risk (RR) of death among patients living in Aquitaine. Two periods were considered to take into account the introduction of highly active antiretroviral therapy (HAART) in 1996. Results Since 1982, 60,212 AIDS patients were reported. After adjustment on the main patient features, the risk of death was significantly higher in AIDS patients living in Aquitaine than in other regions (RR = 1.12; IC95% = [1.06–1.18]) before the introduction of HAART. After 1996, this difference did not persist, and an opposite trend was even observed (RR = 0.90; IC95% = [0.75–1.09]). Conclusions The higher overall mortality rate in Aquitaine was due to a higher risk of death in that area before 1996. Several hypotheses can explain this result, such as a less exhaustive notification, or different characteristics of the subjects. The opposite trend that was observed after the introduction of HAART will have to be checked in the next few years.