title: Mortality in Brazilian children with HIV/AIDS: the role of non-AIDS-related conditions after highly active antiretroviral therapy introduction.
abstract: AIDS-related mortality has been significantly reduced in areas that systematically adopted highly active antiretroviral therapy (HAART). In Brazil, despite advances in control policy, there is still a lack of evidence about trends in children on causes of death related or not related to HIV/AIDS. We evaluate temporal trends in mortality due to non-HIV-related causes of death in relation to HIV/AIDS-related conditions among children with and without HIV infection. This nationwide study included all deaths in children reported from 1999 to 2007. Mortality odds ratios (MOR) and rates were calculated to assess time trends of death in children with or without HIV/AIDS. These data were analyzed by calendar year, as obtained from official national database. A total of 680,763 deaths occurred in Brazilian children under 13 years of age; of these, 2191 (0.32%) had causes related to HIV/AIDS listed on the death certificate. The mortality rate from HIV/AIDS-related causes in Brazilian children ranged from 0.72 per 100,000 children in 1999 to 0.40 per 100,000 children in 2007, while for selected nonrelated causes the rate of death among HIV-infected children was stable at 0.08 per 100,000 Brazilian children. In children with HIV/AIDS, the MOR of having selected conditions unrelated to HIV/AIDS as a cause of death in 2007 (compared to 1999) was 1.85 (95% confidence interval [CI] = 1.11-3.08, p = 0.02), but without a significant temporal trend (p = 0.413) through the analyzed period. In Brazil, deaths related to HIV/AIDS mortality in children significantly decreased, while the unrelated causes in HIV-infected children maintained a stable trend. These data reinforce the success of national public health policies and the need to offer comprehensive care to children with HIV/AIDS.
authors.affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil. novaes@ufc.br
authors.forename: Alberto Novaes
authors.initials: AN
authors.lastname: Ramos
authors.forename: Luiza Harunari
authors.initials: LH
authors.lastname: Matida
authors.forename: Norman
authors.initials: N
authors.lastname: Hearst
authors.forename: Jorg
authors.initials: J
authors.lastname: Heukelbach
mesh_terms: D023241:Antiretroviral Therapy, Highly Active; D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003644:Death Certificates; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D016017:Odds Ratio; D013997:Time Factors