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Increase in non-AIDS related conditions as causes of death among HIV-infected individuals in the HAART era in Brazil.

Pacheco AG, Tuboi SH, Faulhaber JC, Harrison LH, Schechter M - PLoS ONE (2008)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology and Quantitative Methods in Health, National School of Public Health/Scientific Computing Program, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. apacheco@fiocruz.br

ABSTRACT

Background: In 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 findings: Odds 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/significance: 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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CVD and DM in HIV-infected/AIDS patients.Odds ratios and 95% confidence intervals comparing the chance of having the disease listed on the death certificate over time, compared with 1999. A–CVD; B–DM. Slopes for trends are significantly different between groups for CVD (p-value<0.001) and DM (p-value<0.001).
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pone-0001531-g002: CVD and DM in HIV-infected/AIDS patients.Odds ratios and 95% confidence intervals comparing the chance of having the disease listed on the death certificate over time, compared with 1999. A–CVD; B–DM. Slopes for trends are significantly different between groups for CVD (p-value<0.001) and DM (p-value<0.001).

Mentions: CVD increased in the HIV group from 4.3% in 1999 to 6.4% in 2004 (adjusted average increase of 7.79% per year; (95%CI = 5.74,9.66; p-value<0.001). In the non-HIV group, an increase of 0.80% per year was observed (95%CI = 0.28,1.33; p-value = 0.002), from 36.2% in 1999 to 39.3% in 2004. Compared to 1999, the OR for having CVD listed on the death certificate in 2004 was 1.5 (95%CI = 1.34,1.68; p-value<0.001) for the HIV group and 1.07 (95%CI = 1.04,1.10; p-value<0.001) for the non-HIV groups (Table 2). Temporal trends for both groups are shown in Figure 2A; both interactions between year as a continuous or a categorical variable were significantly different between the two groups (p-value<0.001).


Increase in non-AIDS related conditions as causes of death among HIV-infected individuals in the HAART era in Brazil.

Pacheco AG, Tuboi SH, Faulhaber JC, Harrison LH, Schechter M - PLoS ONE (2008)

CVD and DM in HIV-infected/AIDS patients.Odds ratios and 95% confidence intervals comparing the chance of having the disease listed on the death certificate over time, compared with 1999. A–CVD; B–DM. Slopes for trends are significantly different between groups for CVD (p-value<0.001) and DM (p-value<0.001).
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2211396&req=5

pone-0001531-g002: CVD and DM in HIV-infected/AIDS patients.Odds ratios and 95% confidence intervals comparing the chance of having the disease listed on the death certificate over time, compared with 1999. A–CVD; B–DM. Slopes for trends are significantly different between groups for CVD (p-value<0.001) and DM (p-value<0.001).
Mentions: CVD increased in the HIV group from 4.3% in 1999 to 6.4% in 2004 (adjusted average increase of 7.79% per year; (95%CI = 5.74,9.66; p-value<0.001). In the non-HIV group, an increase of 0.80% per year was observed (95%CI = 0.28,1.33; p-value = 0.002), from 36.2% in 1999 to 39.3% in 2004. Compared to 1999, the OR for having CVD listed on the death certificate in 2004 was 1.5 (95%CI = 1.34,1.68; p-value<0.001) for the HIV group and 1.07 (95%CI = 1.04,1.10; p-value<0.001) for the non-HIV groups (Table 2). Temporal trends for both groups are shown in Figure 2A; both interactions between year as a continuous or a categorical variable were significantly different between the two groups (p-value<0.001).

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology and Quantitative Methods in Health, National School of Public Health/Scientific Computing Program, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil. apacheco@fiocruz.br

ABSTRACT

Background: In 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 findings: Odds 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/significance: 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.

Show MeSH
Related in: MedlinePlus