title: Survival analysis of acquired immune deficiency syndrome patients with and without hepatitis C virus infection at a reference center for sexually transmitted diseases/acquired immune deficiency syndrome in São Paulo, Brazil.
abstract: BACKGROUND
  Survival of patients with acquired immune deficiency syndrome has improved with combination antiretroviral therapy; mortality due to liver diseases, however, has also increased in these patients.
  
  
  OBJECTIVE
  To estimate the accumulated probability of survival in human immunodeficiency virus-hepatitis C virus coinfected and non-coinfected patients and to investigate factors related to acquired immune deficiency syndrome patients' survival.
  
  
  METHODS
  Non-concurrent cohort study using data from surveillance information systems of acquired immune deficiency syndrome patients over 13 years of age. Hepatitis C and B, human immunodeficiency virus exposure category, CD4+ T cell count, age group, schooling, race, sex, and four acquired immune deficiency syndrome diagnosis periods were studied. Kaplan-Meier survival analysis and Cox model with estimates of the hazard ratio and 95% confidence interval were used.
  
  
  RESULTS
  Of the total 2864 individuals included, with median age was 35 years, 219 died (7.5%), and 358 (12.5%) were human immunodeficiency virus-hepatitis C virus coinfected. The accumulated probability of survival in human immunodeficiency virus-hepatitis C virus coinfected patients, after acquired immune deficiency syndrome diagnosis, at 120 months, was 0%, 38.9%, 83.8% in 1986-1993, 1994-1996, 1997-2002, respectively, and 92.8% at 96 months in 2003-2010; survival in non-coinfected patients at 120 months was 80%, 90.2%, 94% in 1986-1993, 1994-1996, 1997-2002, respectively, and 94.1% at 96 months in 2003-2010. In the multivariate model the following variables were predictive of death: hepatitis C virus coinfection (hazard ratio=2.7; confidence interval 2.0-3.6); Hepatitis B virus coinfection (hazard ratio=2.4; confidence interval 1.7-3.6); being ≥ 50 years old (hazard ratio=2.3; confidence interval 1.3-3.8); having 8-11 years of schooling (hazard ratio=1.6; confidence interval 1.1-2.3), having 4-7 years of schooling (hazard ratio=1.9; confidence interval 1.3-2.8) and having up to 3 years of schooling (hazard ratio=3.3; confidence interval 2.0-5.5).
  
  
  CONCLUSIONS
  Among patients diagnosed after 1996, there was a significant increase in the cumulative probability of survival in human immunodeficiency virus-hepatitis C virus coinfected individuals; among those diagnosed with acquired immune deficiency syndrome from 2003 to 2010, this probability was similar between coinfected and non-coinfected patients.
authors.affiliation: Centro de Referência e Treinamento DST/AIDS-SP, São Paulo, SP, Brazil. Electronic address: wong@crt.saude.sp.gov.br.
authors.forename: Wong Kuen
authors.initials: WK
authors.lastname: Alencar
authors.affiliation: Setor de Medicina Nuclear do Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, SP, Brazil.
authors.forename: Paulo Schiavom
authors.initials: PS
authors.lastname: Duarte
authors.affiliation: Departamento de Epidemiologia da Faculdade de Saúde Pública da Universidade de São Paulo, SP, Brazil.
authors.forename: Eliseu Alves
authors.initials: EA
authors.lastname: Waldman
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality*; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D060085:Coinfection / Q000401:mortality*; D004522:Educational Status; D005260:Female; D006526:Hepatitis C / Q000401:mortality*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis
keywords: Acquired immunodeficiency syndrome; HIV; Hepatitis viruses; Survival analysis