AIDS incidence and mortality in a hospital-based cohort of HIV-1-seropositive patients receiving highly active antiretroviral therapy in São Paulo, Brazil.
Brazilian AIDS and HIV-1-seropositive patients have had free access to highly active antiretroviral therapy (HAART) since November 1996. Although secondary data based on official mortality statistics indicate a sharp decrease in AIDS mortality, few if any studies tried to estimate the prognosis for patients with HIV who have been followed from the beginning of the HAART era. An observational study, with retrospective and prospective components, was done in 233 adult HIV-1-infected subjects who were recruited in the last 10 years at the outpatient sector of the Secondary Immunodeficiencies Clinic of the Department of Dermatology, Hospital das Clinicas da FMUSP, Sao Paulo, Brazil. The definition of AIDS followed the guidelines issued by the Centers for Disease Control (CDC) in 1987. One hundred sixty patients were asymptomatic, 46 had AIDS, 24 had AIDS-related complex, and 3 presented with acute infection at study entry. Twenty-nine (18%) of the asymptomatic subjects developed AIDS during follow-up, with 5 (3%) deaths. Among the 46 AIDS cases at entry, 7 (17%) died during follow-up. Thus, a total of 12 people (5.2%) died of AIDS in this cohort over a mean follow-up of 5.2 years and 24 people were lost to follow-up (10.3%). Ninety percent of the survivors were on combined therapy (82% with 3 or more drugs, and 8% with 2 drugs), while 10% were not taking antiretrovirals. People with AIDS at entry were 5 times more likely to die during this period compared to patients who were asymptomatic at entry (p = 0.006). Women showed better outcomes than men, reflecting differences in CD4+ T-cell counts at study entry. All but 1 patient progressed to AIDS during the pre-HAART era (before 1996). In spite of its recent decline, mortality from AIDS-related conditions remains an important public health issue.
Casseb
Jorge
J
Departamento de Dermatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Fonseca
Luiz Augusto Marcondes
LA
Veiga
Ana Paula Rocha
AP
de Almeida
Alexandre
A
Bueno
Analice
A
Ferez
Antonio Carlos
AC
Gonsalez
Claudio R
CR
Brigido
Luis F M
LF
Mendonça
Marcelo
M
Rodrigues
Rosangela
R
Santos
Niraldo
N
Malacarne
Eunice
E
Ronchini
Karla O M
KO
Zihlmann
Karina F
KF
Duarte
Alberto J S
AJ
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D015497:HIV-1; D006801:Humans; D015994:Incidence; D008297:Male; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D019562:Viral Load