Temporal changes in causes of death among HIV-infected patients in the HAART era in Rio de Janeiro, Brazil.
BACKGROUND
The widespread use of highly active antiretroviral therapy (HAART) has led to marked decreases in death rates in Brazil in HIV-infected individuals. Nonetheless, there are scarce data on specific causes of death.


METHODS
Death rates from a cohort of HIV-infected patients in Rio de Janeiro, Brazil, were analyzed in 2-year periods, from 1997 to 2006. Poisson models and survival models accounting for competing risks were used to assess association of covariables. A standardized validated algorithm was used to ascertain specific causes of death.


RESULTS
Of the 1538 eligible patients, 226 (14.7%) died during the study period, corresponding to a mortality rate of 3.2 per 100 person-years. The median follow-up time was 4.61 years (interquartile range = 5.63 years) and the loss to follow-up rate was 2.4 per 100 person-years. Overall, 98 (43.4%) were classified as non-AIDS-related causes. Although opportunistic infections were the leading causes of death (37.6%), deaths due to AIDS-related causes declined significantly over time (P < 0.01). In the most recent period (2005-2006), the rate of non-AIDS-related causes of deaths was higher than that of AIDS-related causes of death.


CONCLUSIONS
In the HAART era, there has been a significant change in causes of death among HIV-infected patients in Rio de Janeiro. As access to HAART improves, integration with other public programs will become critically important for the long-term success of HIV/AIDS programs in developing countries.
Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, FIOCRUZ, Brazil. apacheco@fiocruz.br
Antonio G
AG
Pacheco
Suely H
SH
Tuboi
Silvia B
SB
May
Luiz F S
LF
Moreira
Luciana
L
Ramadas
Estevão P
EP
Nunes
Mônica
M
Merçon
José C
JC
Faulhaber
Lee H
LH
Harrison
Mauro
M
Schechter
D017088:AIDS-Related Opportunistic Infections / Q000401:mortality; D000328:Adult; D000465:Algorithms; D023241:Antiretroviral Therapy, Highly Active; D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D015331:Cohort Studies; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D013997:Time Factors; D055815:Young Adult