HIV morbidity and mortality in Jamaica: analysis of national surveillance data, 1993--2005.
OBJECTIVE
Pre-antiretroviral therapy (ART) HIV-related survival and timing of HIV identification have not been reported from the Caribbean. Using Jamaican national surveillance data, we estimated overall, AIDS-free, and AIDS survival, identified factors influencing HIV-related mortality, and examined factors associated with late HIV/AIDS identification.


METHODS
The Jamaican HIV/AIDS tracking system (HATS) national surveillance data included timing of first positive HIV test, stage at identification, date of AIDS diagnosis, and death. We estimated overall and AIDS-free survival by initial stage, using a proportional hazard model to identify factors associated with worse survival, and logistic regression to examine factors related to later case identification.


RESULTS
Of 10674 reported HIV cases, 48% were asymptomatic, 14% symptomatic, and 38% first reported with AIDS. Five-year AIDS-free survival was 77% for asymptomatic persons and 63% for symptomatic. Median survival after AIDS diagnosis was 1.02 years. Age, number of opportunistic diseases, and initial stage were strongly associated with mortality. Older age, drug use, and sex with a commercial sex worker were associated with later identification.


CONCLUSIONS
In the pre-ART era, over one-third of HIV-infected persons in Jamaica were first identified with advanced disease. This highlights the need for earlier diagnosis as ART programs roll out in the Caribbean.
Losina
Elena
E
Division of General Medicine and Infectious Diseases, Massachusetts General Hospital, 50 Staniford St, 9th Floor, Boston, Massachusetts 02114, USA. elosina@partners.org
Figueroa
Peter
P
Duncan
Jacqueline
J
Divi
Nomita
N
Wolf
Lindsey L
LL
Hirschhorn
Lisa R
LR
Robertson
Minnette
M
Harvey
Kevin
K
Whorms
Sheldon
S
Freedberg
Kenneth A
KA
Gebre
Yitades
Y
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D020276:HIV Long-Term Survivors / Q000706:statistics & numerical data; D006801:Humans; D007563:Jamaica / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D016016:Proportional Hazards Models; D012307:Risk Factors; D018571:Sentinel Surveillance; D016019:Survival Analysis
D019380:Anti-HIV Agents
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