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Causes of death among people living with AIDS in the pre- and post-HAART Eras in the city of São Paulo, Brazil.

Domingues CS, Waldman EA - PLoS ONE (2014)

Bottom Line: We estimated age-adjusted mortality rates for leading underlying causes of death and described underlying and associated causes of death according to sociodemographic characteristics and area of residence.Areas of residence were categorized using a socioeconomic index.There is a need for public policies aimed at adapting health care services to address the new scenario.

View Article: PubMed Central - PubMed

Affiliation: São Paulo State Program for STDs and AIDS, São Paulo State Department of Health STD and AIDS Referral and Training Center, São Paulo, Brazil; Department of Epidemiology, University of São Paulo School of Public Health, São Paulo, Brazil.

ABSTRACT

Objective: We examine the trend in causes of death among people living with AIDS in the city of São Paulo, Brazil, in the periods before and after the introduction of highly active antiretroviral therapy (HAART), and we investigate potential disparities across districts of residence.

Methods: Descriptive study of three periods: pre-HAART (1991-1996); early post-HAART (1997-1999); and late post-HAART (2000-2006). The data source was the São Paulo State STD/AIDS Program and São Paulo State Data Analysis Foundation. Causes of death were classified by the ICD-9 (1991-1995) and ICD-10 (1996-2006). We estimated age-adjusted mortality rates for leading underlying causes of death and described underlying and associated causes of death according to sociodemographic characteristics and area of residence. We used Pearson's chi-square test or Fisher's exact test to compare categorical variables. Areas of residence were categorized using a socioeconomic index. To analyze trends we apply generalized linear model with Poisson regression.

Results: We evaluated 32,808 AIDS-related deaths. Between the pre- and late post-HAART periods, the proportion of deaths whose underlying causes were non-AIDS-related diseases increased from 0.2% to 9.6% (p<0.001): from 0.01% to 1.67% (p<0.001) for cardiovascular diseases; 0.01% to 1.62% (p<0.001) for bacterial/unspecified pneumonia; and 0.03% to 1.46% (p<0.001) for non-AIDS-defining cancers. In the late post-HAART period, the most common associated causes of death were bacterial/unspecified pneumonia (35.94%), septicemia (33.46%), cardiovascular diseases (10.11%) and liver diseases (8.0%); and common underlying causes, besides AIDS disease, included non-AIDS-defining cancers in high-income areas, cardiovascular diseases in middle-income areas and assault in low-income areas.

Conclusions: The introduction of HAART has shifted the mortality profile away from AIDS-related conditions, suggesting changes in the pattern of morbidity, but heterogeneously according to area of residence. There is a need for public policies aimed at adapting health care services to address the new scenario.

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Mortality from cancers.Mortality rate (per 100,000 person-years and adjusted for age) for cancers as the underlying causes of death in people ≥ 13 years of age living with AIDS, by year of death. São Paulo, Brazil, 1996–2006. Notes: KS: Kaposi's sarcoma; NHL: non-Hodgkin's lymphoma; NADCs: non-AIDS-defining cancers.
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pone-0114661-g003: Mortality from cancers.Mortality rate (per 100,000 person-years and adjusted for age) for cancers as the underlying causes of death in people ≥ 13 years of age living with AIDS, by year of death. São Paulo, Brazil, 1996–2006. Notes: KS: Kaposi's sarcoma; NHL: non-Hodgkin's lymphoma; NADCs: non-AIDS-defining cancers.

Mentions: Fig. 2 shows our analysis of trends of deaths from major opportunistic infections after the introduction of HAART (1996–2006). We found a decreasing trend in the rate of mortality from Pneumocystis jirovecii pneumonia (from 1.70/100,000 person-years in 1996 to 0.42/100,000 person-years in 2006, corresponding to a 75.3% decrease–RR  =  0.86; r2  =  0.61; p <0.0001) and in that of mortality from tuberculosis (from 4.14/100,000 person-years in 1996 to 0.71/100,000 person-years in 2006, an 82.8% decrease–RR  =  0.88; r2  =  0.86; p <0.0001). In addition, we found an 80.5% decrease in mortality from Kaposi's sarcoma (from 0.42/100,000 person-years in 1996 to 0.08/100,000 person-years in 2006–RR  =  0.83; r2  =  0.34; p <0.0001) and a 70.8% decrease in mortality from non-Hodgkin's lymphoma (from 0.34/100,000 person-years in 1996 to 0.10/100,000 person-years in 2006–RR  =  0.93; r2  =  0.12; p  =  0.006). In contrast, as shown in Fig. 3, mortality from NADCs increased by 12.7 times (from 0.03/100,000 person-years in 1996 to 0.34/100,000 person-years in 2006–RR  =  1.20; r2  =  0.37; p <0.0001). Among the deaths that occurred in the late post-HAART period and whose underlying causes were NADCs, the most common were those caused by bronchial or lung cancer (accounting for 13.6%); malignant neoplasms of the lip, oral cavity, or pharynx (accounting for 10%); and stomach cancer (accounting for 10%).


Causes of death among people living with AIDS in the pre- and post-HAART Eras in the city of São Paulo, Brazil.

Domingues CS, Waldman EA - PLoS ONE (2014)

Mortality from cancers.Mortality rate (per 100,000 person-years and adjusted for age) for cancers as the underlying causes of death in people ≥ 13 years of age living with AIDS, by year of death. São Paulo, Brazil, 1996–2006. Notes: KS: Kaposi's sarcoma; NHL: non-Hodgkin's lymphoma; NADCs: non-AIDS-defining cancers.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4263674&req=5

pone-0114661-g003: Mortality from cancers.Mortality rate (per 100,000 person-years and adjusted for age) for cancers as the underlying causes of death in people ≥ 13 years of age living with AIDS, by year of death. São Paulo, Brazil, 1996–2006. Notes: KS: Kaposi's sarcoma; NHL: non-Hodgkin's lymphoma; NADCs: non-AIDS-defining cancers.
Mentions: Fig. 2 shows our analysis of trends of deaths from major opportunistic infections after the introduction of HAART (1996–2006). We found a decreasing trend in the rate of mortality from Pneumocystis jirovecii pneumonia (from 1.70/100,000 person-years in 1996 to 0.42/100,000 person-years in 2006, corresponding to a 75.3% decrease–RR  =  0.86; r2  =  0.61; p <0.0001) and in that of mortality from tuberculosis (from 4.14/100,000 person-years in 1996 to 0.71/100,000 person-years in 2006, an 82.8% decrease–RR  =  0.88; r2  =  0.86; p <0.0001). In addition, we found an 80.5% decrease in mortality from Kaposi's sarcoma (from 0.42/100,000 person-years in 1996 to 0.08/100,000 person-years in 2006–RR  =  0.83; r2  =  0.34; p <0.0001) and a 70.8% decrease in mortality from non-Hodgkin's lymphoma (from 0.34/100,000 person-years in 1996 to 0.10/100,000 person-years in 2006–RR  =  0.93; r2  =  0.12; p  =  0.006). In contrast, as shown in Fig. 3, mortality from NADCs increased by 12.7 times (from 0.03/100,000 person-years in 1996 to 0.34/100,000 person-years in 2006–RR  =  1.20; r2  =  0.37; p <0.0001). Among the deaths that occurred in the late post-HAART period and whose underlying causes were NADCs, the most common were those caused by bronchial or lung cancer (accounting for 13.6%); malignant neoplasms of the lip, oral cavity, or pharynx (accounting for 10%); and stomach cancer (accounting for 10%).

Bottom Line: We estimated age-adjusted mortality rates for leading underlying causes of death and described underlying and associated causes of death according to sociodemographic characteristics and area of residence.Areas of residence were categorized using a socioeconomic index.There is a need for public policies aimed at adapting health care services to address the new scenario.

View Article: PubMed Central - PubMed

Affiliation: São Paulo State Program for STDs and AIDS, São Paulo State Department of Health STD and AIDS Referral and Training Center, São Paulo, Brazil; Department of Epidemiology, University of São Paulo School of Public Health, São Paulo, Brazil.

ABSTRACT

Objective: We examine the trend in causes of death among people living with AIDS in the city of São Paulo, Brazil, in the periods before and after the introduction of highly active antiretroviral therapy (HAART), and we investigate potential disparities across districts of residence.

Methods: Descriptive study of three periods: pre-HAART (1991-1996); early post-HAART (1997-1999); and late post-HAART (2000-2006). The data source was the São Paulo State STD/AIDS Program and São Paulo State Data Analysis Foundation. Causes of death were classified by the ICD-9 (1991-1995) and ICD-10 (1996-2006). We estimated age-adjusted mortality rates for leading underlying causes of death and described underlying and associated causes of death according to sociodemographic characteristics and area of residence. We used Pearson's chi-square test or Fisher's exact test to compare categorical variables. Areas of residence were categorized using a socioeconomic index. To analyze trends we apply generalized linear model with Poisson regression.

Results: We evaluated 32,808 AIDS-related deaths. Between the pre- and late post-HAART periods, the proportion of deaths whose underlying causes were non-AIDS-related diseases increased from 0.2% to 9.6% (p<0.001): from 0.01% to 1.67% (p<0.001) for cardiovascular diseases; 0.01% to 1.62% (p<0.001) for bacterial/unspecified pneumonia; and 0.03% to 1.46% (p<0.001) for non-AIDS-defining cancers. In the late post-HAART period, the most common associated causes of death were bacterial/unspecified pneumonia (35.94%), septicemia (33.46%), cardiovascular diseases (10.11%) and liver diseases (8.0%); and common underlying causes, besides AIDS disease, included non-AIDS-defining cancers in high-income areas, cardiovascular diseases in middle-income areas and assault in low-income areas.

Conclusions: The introduction of HAART has shifted the mortality profile away from AIDS-related conditions, suggesting changes in the pattern of morbidity, but heterogeneously according to area of residence. There is a need for public policies aimed at adapting health care services to address the new scenario.

Show MeSH
Related in: MedlinePlus