Epidemiological patterns of mortality due to visceral leishmaniasis and HIV/AIDS co-infection in Brazil, 2000-2011.
BACKGROUND
Visceral leishmaniasis (VL)-HIV/AIDS co-infection is an emerging health problem with high case fatality. This study presents the epidemiological and clinical aspects of deaths related to VL-HIV/AIDS co-infection in Brazil.


METHODS
This was a nationwide population-based study based on mortality data obtained from the Brazilian Mortality Information System. We included all deaths between 2000 and 2011 (about 12.5 million), and analyzed those in which VL and HIV/AIDS were mentioned in the same death certificate.


RESULTS
VL and HIV/AIDS were mentioned in 272 deaths. HIV/AIDS was the underlying cause in 59.6% (162/272) of deaths by VL-HIV/AIDS co-infection, and VL the underlying cause in 39.3% (107/272). Predominating characteristics were: male gender (79.0%, 215/272), age 30-39 years (41.0%, 111/271), brown race/color (61.6%, 159/258) and residence in the Northeast region (47.4%, 129/272). Average annual age-adjusted mortality rate was 0.13 deaths/1 000 000 inhabitants. Deaths were distributed in 20 of 27 Brazilian states. There was an increasing trend of mortality (annual percent change: 16.4%). Infectious/parasitic (58.8%) and respiratory (51.1%) diseases/disorders, particularly sepsis, respiratory failure and pneumonia, were most commonly associated with deaths related to this co-infection.


CONCLUSIONS
VL-HIV/AIDS co-infection is an increasing public health problem in Brazil. The systematic description of the epidemiological characteristics and magnitude of mortality related to VL-HIV/AIDS co-infection reflects the need to intensify control measures and disease surveillance.
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
Francisco Rogerlândio
FR
Martins-Melo
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
Mauricélia da Silveira
Mda S
Lima
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
Carlos Henrique
CH
Alencar
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
Alberto Novaes
AN
Ramos
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil Anton Breinl Centre for Public Health and Tropical Medicine, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia heukelbach@web.de.
Jorg
J
Heukelbach
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D060085:Coinfection / Q000401:mortality; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000453:epidemiology* / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011634:Public Health / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D062206:Spatial Analysis; D055815:Young Adult
AIDS; Brazil; Co-infection; HIV; Mortality; Visceral leishmaniasis