Incidence and determinants of severe morbidity among HIV-infected patients from Rio de Janeiro, Brazil, 2000-2010.
BACKGROUND
Reliable information on severe morbidity is essential for identifying priorities for case management and to guide resource allocation within the health sector.


METHODS
This study describes overall, AIDS- and non-AIDS-related severe morbidity as well as mortality and its determinants in an urban cohort of HIV-infected individuals from a public healthcare institution, the Evandro Chagas Research Institute (IPEC) of the Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. Severe morbid events were defined as all clinical diagnoses listed in hospitalization discharge records; all diagnoses were checked and validated. Generalized estimating equation models were used to estimate incidence rates while adjusting for within-subject correlation.


RESULTS
Between 2000 and 2010, 3,537 patients were followed for a total of 16,960 person-years (PY) of follow-up. Over the years, annual incidence rate of severe morbid events, AIDS-related events, non-AIDS-related events, and deaths significantly decreased from, respectively, 36.6, 12.9, 23.7 and 3.2 per 100 PY in 2000 to 25.3, 7.9, 17.4 and 1.9 per 100 PY in 2010. Patients' immunological profiles significantly improved with time; 84% of the patients used combination antiretroviral therapy (cART) per year. Immunodeficiency was associated with a higher incidence rate of AIDS- and non-AIDS-related events as well as with the incidence rate of specific non-AIDS events (bacterial infections, toxicities, cardiovascular, renal and respiratory diseases).


CONCLUSIONS
Our results show that in a middle income country with access to cART, non-AIDS-related events represent an important cause of severe morbidity alongside a still high incidence rate of AIDS-related events.
Instituto de Pesquisa Clinica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Sayonara R
SR
Ribeiro
Paula M
PM
Luz
Dayse P
DP
Campos
Ronaldo I
RI
Moreira
Lara
L
Coelho
André
A
Japiassu
Fernando
F
Bozza
Valdilea G
VG
Veloso
Genevieve
G
Chene
Beatriz
B
Grinsztejn
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000266:history; D049674:History, 21st Century; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015995:Prevalence; D062486:Public Health Surveillance; D012307:Risk Factors; D055815:Young Adult