Abstract
This article aims to assess the sociodemographic and epidemiological factors associated with AIDS and tuberculosis-HIV coinfection mortality in the Chilean adult population between 2000 and 2017. This is a retrospective observational study, evaluating the incidence density of TB-HIV coinfection mortality in the population over 14 years of age. We used data from the Chilean AIDS Cohort database, 17,512 people enrolled in highly active antiretroviral therapy in the public health system in Chile. The Kaplan-Meier survival function and Cox regression were applied. Incidence density of 0.05 for 39,283 person-years for mortality with TB-HIV coinfection was recorded, with an increase in new cases in people living with AIDS among Aymara and Mapuche indigenous populations. Risk factors included CD4 < 500 cells/mm3 (HR = 3.2; 95%CI: 2.2-4.9), viral load at the start of treatment > 10,000 copies/uL (HR = 1.3; 95%CI: 1.2-1.6). Having high school or higher education (HR = 0.76; 95%CI: 0.6-0.9) is a protective factor for mortality for coinfection. Mortality was concentrated in TB-HIV coinfected people with increasing mortality among women and indigenous populations. The paper contributes to the growing recognition of the role of social determinants in disease outcomes, and the requirement to improve community-focused and community-based testing, sex education in schools, and structural interventions to reduce the adult mortality in Chilean population.
Highlights
It is estimated that 38 million people are currently living with HIV worldwide
Since 2010, these infections have been reduced by 16%, whereas new infections in children have been reduced by 41%, from 280,000 to 160,000 children in 2018, which is attributed to the combined prevention strategies, besides the prevention protocols for vertical transmission 4
To assess the disparities on the health of the Chilean population living with HIV/AIDS, this study aimed to assess the sociodemographic and epidemiological factors associated with AIDS and TB-HIV coinfection mortality in the Chilean adult population between 2000 and 2017
Summary
It is estimated that 38 million people are currently living with HIV worldwide. An early report from the Joint United Nations Program on HIV/AIDS (UNAIDS) indicated that by 2017 a reduction in the annual number of deaths from AIDS-related illnesses would have been reached at all ages, from 1.9 million (1.4-2.7 million) in 2004 to 940,000 (670,000-1,300,000) representing a 34% reduction, attributable to the global expansion of antiretroviral treatment [1,2]. Chile according to UNAIDS estimates, was the country in the region of the Americas where there was the greatest increase in new HIV infections, of 34% 2, joining a group of 14 countries worldwide with the largest increase of new HIV infections in the adult population, of more than 50% between 2010 to 2017, mainly of 25 to 29 year old, with a rate of 109.5 per 100,000 inhabitants [5,6] Another aspect is the increase of infections in women, with the male-female ratio of 5.3 in 2017, compared to 18.3 in the early 1990s 6,7
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