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Survival of AIDS patients in Sao Paulo-Brazil in the pre- and post-HAART eras: a cohort study.

Tancredi MV, Waldman EA - BMC Infect. Dis. (2014)

Bottom Line: The study showed a strong impact following the introduction of HAART in 1996 with decreased AIDS mortality, increased survival rates, and benefits with early introduction of HAART.However, some groups of patients were less likely to benefit from the new drug regimens.Public policies promoting health equity create an enabling environment helping AIDS control programs in developing countries to achieve their goals as effectively as in developed countries.

View Article: PubMed Central - PubMed

Affiliation: STD/AIDS Referral and Training Center - Department of Health, R. Santa Cruz, 81, CEP:04121-000, São Paulo, Brasil. mariza@crt.saude.sp.gov.br.

ABSTRACT

Background: Brazil was the first middle-income country to provide free and universal access to AIDS treatment. Understanding the impact of this policy is key to promote ongoing improvement of current intervention strategies. The aim of this study was to compare mortality rates and survival in a cohort of AIDS patients before and after the introduction of antiretrovirals (ARV) and to investigate predictors of survival.

Methods: A retrospective cohort study of AIDS patients aged 13 years or more living in the city of Sao Paulo was conducted. All patients were recruited from an STD/HIV outpatient clinic between 1988 and 2003 and followed up until 2005. We estimated AIDS mortality rates in person-years (py) and carried out a survival analysis using the Kaplan-Meier method. The Cox proportional hazards model was used to assess predictors of survival in AIDS patients.

Results: The study cohort comprised 6,594 patients. The yearly mean mortality rates were 17.6, 23.2, and 7.8 per 1,000 py for the study periods 1988-1993, 1994-1996, and 1997-2003, respectively. Median survival time was 13.4 and 22.3 months for patients entering the study in the first and second study periods and survival time was 108 months or more in 72% of those entering the study during 1997-2003. Factors independently associated with shorter survival included: AIDS diagnosis during the 1994-1996 (HR 2.0) and 1988-1993 (HR 3.2) periods; 50 years of age or more (HR 2.0); exposure category of injection drug users (IDU) (HR 1.5); 8 years of schooling or less (HR 1.4); no schooling (HR 2.1); and CD4+ counts between 350 and 500 cells/mm(3) (HR 1.2) and less than 350 cells/mm(3) at AIDS diagnosis (HR 1.3).

Conclusions: The study showed a strong impact following the introduction of HAART in 1996 with decreased AIDS mortality, increased survival rates, and benefits with early introduction of HAART. However, some groups of patients were less likely to benefit from the new drug regimens. Public policies promoting health equity create an enabling environment helping AIDS control programs in developing countries to achieve their goals as effectively as in developed countries.

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Study design flow chart for AIDS cohort study. AIDS Cohort, CRT-DST/AIDS, 1988–2003.
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Fig1: Study design flow chart for AIDS cohort study. AIDS Cohort, CRT-DST/AIDS, 1988–2003.

Mentions: All patients recruited to the study attended the STD/AIDS Referral and Training Center (CRT-DST/AIDS) outpatient clinic. The study cohort comprised AIDS patients aged 13 years old or more living in the city of Sao Paulo with AIDS diagnosis confirmed between January 1st, 1988 and December 31, 2003 and followed up until December 31, 2005 (Figure 1). The CRT-DST/AIDS clinic is one of the three specialized centers in Sao Paulo that provide outpatient care to individuals with HIV/AIDS.Figure 1


Survival of AIDS patients in Sao Paulo-Brazil in the pre- and post-HAART eras: a cohort study.

Tancredi MV, Waldman EA - BMC Infect. Dis. (2014)

Study design flow chart for AIDS cohort study. AIDS Cohort, CRT-DST/AIDS, 1988–2003.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4247874&req=5

Fig1: Study design flow chart for AIDS cohort study. AIDS Cohort, CRT-DST/AIDS, 1988–2003.
Mentions: All patients recruited to the study attended the STD/AIDS Referral and Training Center (CRT-DST/AIDS) outpatient clinic. The study cohort comprised AIDS patients aged 13 years old or more living in the city of Sao Paulo with AIDS diagnosis confirmed between January 1st, 1988 and December 31, 2003 and followed up until December 31, 2005 (Figure 1). The CRT-DST/AIDS clinic is one of the three specialized centers in Sao Paulo that provide outpatient care to individuals with HIV/AIDS.Figure 1

Bottom Line: The study showed a strong impact following the introduction of HAART in 1996 with decreased AIDS mortality, increased survival rates, and benefits with early introduction of HAART.However, some groups of patients were less likely to benefit from the new drug regimens.Public policies promoting health equity create an enabling environment helping AIDS control programs in developing countries to achieve their goals as effectively as in developed countries.

View Article: PubMed Central - PubMed

Affiliation: STD/AIDS Referral and Training Center - Department of Health, R. Santa Cruz, 81, CEP:04121-000, São Paulo, Brasil. mariza@crt.saude.sp.gov.br.

ABSTRACT

Background: Brazil was the first middle-income country to provide free and universal access to AIDS treatment. Understanding the impact of this policy is key to promote ongoing improvement of current intervention strategies. The aim of this study was to compare mortality rates and survival in a cohort of AIDS patients before and after the introduction of antiretrovirals (ARV) and to investigate predictors of survival.

Methods: A retrospective cohort study of AIDS patients aged 13 years or more living in the city of Sao Paulo was conducted. All patients were recruited from an STD/HIV outpatient clinic between 1988 and 2003 and followed up until 2005. We estimated AIDS mortality rates in person-years (py) and carried out a survival analysis using the Kaplan-Meier method. The Cox proportional hazards model was used to assess predictors of survival in AIDS patients.

Results: The study cohort comprised 6,594 patients. The yearly mean mortality rates were 17.6, 23.2, and 7.8 per 1,000 py for the study periods 1988-1993, 1994-1996, and 1997-2003, respectively. Median survival time was 13.4 and 22.3 months for patients entering the study in the first and second study periods and survival time was 108 months or more in 72% of those entering the study during 1997-2003. Factors independently associated with shorter survival included: AIDS diagnosis during the 1994-1996 (HR 2.0) and 1988-1993 (HR 3.2) periods; 50 years of age or more (HR 2.0); exposure category of injection drug users (IDU) (HR 1.5); 8 years of schooling or less (HR 1.4); no schooling (HR 2.1); and CD4+ counts between 350 and 500 cells/mm(3) (HR 1.2) and less than 350 cells/mm(3) at AIDS diagnosis (HR 1.3).

Conclusions: The study showed a strong impact following the introduction of HAART in 1996 with decreased AIDS mortality, increased survival rates, and benefits with early introduction of HAART. However, some groups of patients were less likely to benefit from the new drug regimens. Public policies promoting health equity create an enabling environment helping AIDS control programs in developing countries to achieve their goals as effectively as in developed countries.

Show MeSH
Related in: MedlinePlus