title: The "AMA-Brazil" cooperative project: a nation-wide assessment of the clinical and epidemiological profile of AIDS-related deaths in Brazil in the antiretroviral treatment era.
abstract: The objective of this study was to assess the profile of AIDS-related deaths in the post antiretroviral therapy (ART) scale up period in Brazil. A case-control study was conducted including a nationally probabilistic sample of AIDS deaths and living controls. Data were abstracted from medical records and nation-wide databases of AIDS cases, mortality, ART care, and laboratory testing. Interrupted (adjusted odds ratio--AOR 4.35, 95%CI: 3.15-6.00) or no use of ART (AOR 2.39, 95%CI: 1.57-3.65) was the strongest predictor of death, followed by late diagnosis (AOR 3.95, 95%CI: 2.68-5.82). Criterion other than CD4 < 350 had a higher likelihood of death (AOR 1.65, 95%CI: 1.14-2.40). Not receiving recommended vaccines (AOR, 1.76, 95%CI: 1.21-2.56), presenting AIDS-related diseases (AOR 2.19, 95%CI: 1.22-3.93) and tuberculosis (AOR 1.50, 95%CI: 1.14-1.97) had higher odds of death. Being an injecting drug user (IDU) had a borderline association with higher odds of death, while homo/bisexual exposure showed a protective effect. Despite remarkable successes, Brazilians continue to die of AIDS in the post-ART scale up period. Many factors contributing to continued mortality are preventable.
authors.affiliation: Departamento de Medicina Social, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brasil. maria.veras@gmail.com
authors.forename: Maria Amelia de Sousa Mascena
authors.initials: MA
authors.lastname: Veras
authors.forename: Manoel C A
authors.initials: MC
authors.lastname: Ribeiro
authors.forename: Leda Fátima
authors.initials: LF
authors.lastname: Jamal
authors.forename: Willi
authors.initials: W
authors.lastname: McFarland
authors.forename: Francisco Inácio
authors.initials: FI
authors.lastname: Bastos
authors.forename: Karina Braga
authors.initials: KB
authors.lastname: Ribeiro
authors.forename: Rita Barradas
authors.initials: RB
authors.lastname: Barata
authors.forename: José Cassio de
authors.initials: JC
authors.lastname: Moraes
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Reingold
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents