Abstract
BackgroundIn 1996, Brazil became the first developing country to provide free and universal access to HAART. Although a decrease in overall mortality has been documented, there are no published data on the impact of HAART on causes of death among HIV-infected individuals in Brazil. We assessed temporal trends of mortality due to cardiovascular diseases (CVD), diabetes mellitus (DM) and other conditions generally not associated with HIV-infection among persons with and without HIV infection in Brazil between 1999 and 2004.Methodology/Principal FindingsOdds ratios were used to compare causes of death in individuals who had HIV/AIDS listed on any field of the death certificate with those who did not. Logistic regression models were fitted with generalized estimating equations to account for spatial correlation; co-variables were added to the models to control for potential confounding. Of 5,856,056 deaths reported in Brazil between 1999 and 2004 67,249 (1.15%) had HIV/AIDS listed on the death certificate and non-HIV-related conditions were listed on 16.3% in 1999, increasing to 24.1% by 2004 (p<0.001). The adjusted average yearly increases were 8% and 0.8% for CVD (p<0.001), and 12% and 2.8% for DM (p<0.001), for those who had and did not have HIV/AIDS listed on the death certificate, respectively. Similar results were found for these conditions as underlying causes of death.Conclusions/SignificanceIn Brazil between 1999 and 2004 conditions usually considered not to be related to HIV-infection appeared to become more likely causes of death over time than reported causes of death among individuals who had HIV/AIDS listed on the death certificate than in those who did not. This observation has important programmatic implications for developing countries that are scaling-up access to antiretroviral therapy.
Highlights
The introduction and widespread use of highly active antiretroviral therapy (HAART) has had a profound impact on the HIV/AIDS epidemic, turning a fatal disease into a manageable chronic condition
The online availability of all death certificates issued in Brazil provided the opportunity to compare reported causes of death in 1999, the first year in which death certificates contained primary, secondary, and contributing causes of death according to International Classification of Diseases 10th revision (ICD-10) codes, with later years among individuals who had HIV/AIDS listed on the death certificate
This is the first report on temporal changes in causes of death among HIV/AIDS patients at the population level in a developing country in the HAART era
Summary
The introduction and widespread use of highly active antiretroviral therapy (HAART) has had a profound impact on the HIV/AIDS epidemic, turning a fatal disease into a manageable chronic condition. A decrease in overall mortality has been documented, there are no published data on the impact of HAART on causes of death among HIV-infected individuals in Brazil. In Brazil between 1999 and 2004 conditions usually considered not to be related to HIV-infection appeared to become more likely causes of death over time than reported causes of death among individuals who had HIV/AIDS listed on the death certificate than in those who did not. This observation has important programmatic implications for developing countries that are scaling-up access to antiretroviral therapy
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