title: Continuous increase of cardiovascular diseases, diabetes, and non-HIV related cancers as causes of death in HIV-infected individuals in Brazil: an analysis of nationwide data.
abstract: BACKGROUND
  After antiretroviral therapy (ART) became available, there was a decline in the number of deaths in persons infected with HIV. Thereafter, there was a decrease in the proportion of deaths attributed to opportunistic infections and an increase in the proportion of deaths attributed to chronic comorbidities. Herein we extend previous observations from a nationwide survey on temporal trends in causes of death in HIV-infected patients in Brazil.
  
  
  METHODS
  We describe temporal trends in causes of death among adults who had HIV/AIDS listed in the death certificate to those who did not. All death certificates issued in Brazil from 1999 to 2011 and listed in the national mortality database were included. Generalized linear mixed-effects logistic models were used to study temporal trends in proportions.
  
  
  RESULTS
  In the HIV-infected population, there was an annual adjusted average increase of 6.0%, 12.0%, 4.0% and 4.1% for cancer, external causes, cardiovascular diseases (CVD) and diabetes mellitus (DM), respectively, compared to 3.0%, 4.0%, 1.0% and 3.9%, in the non-HIV group. For tuberculosis (TB), there was an adjusted average increase of 0.3%/year and a decrease of 3.0%/year in the HIV and the non-HIV groups, respectively. Compared to 1999, the odds ratio (OR) for cancer, external causes, CVD, DM, or TB in the HIV group were, respectively, 2.31, 4.17, 1.76, 2.27 and 1.02, while for the non-HIV group, the corresponding OR were 1.31, 1.63, 1.14, 1.62 and 0.67. Interactions between year as a continuous or categorical variable and HIV were significant (p<0.001) for all conditions, except for DM when year was considered as a continuous variable (p = 0.76).
  
  
  CONCLUSIONS
  Non HIV-related co-morbidities continue to increase more rapidly as causes of death among HIV-infected individuals than in those without HIV infection, highlighting the need for targeting prevention measures and surveillance for chronic diseases among those patients.
authors.affiliation: Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Adelzon A
authors.initials: AA
authors.lastname: Paula
authors.affiliation: Projeto Praça Onze, Hospital Escola São Francisco de Assis, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil.
authors.forename: Mauro
authors.initials: M
authors.lastname: Schechter
authors.affiliation: GlaxoSmithKline, Rio de Janeiro, Brasil.
authors.forename: Suely H
authors.initials: SH
authors.lastname: Tuboi
authors.affiliation: Instituto de Matemática e Estatística, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.
authors.forename: José Claudio
authors.initials: JC
authors.lastname: Faulhaber
authors.affiliation: Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Paula M
authors.initials: PM
authors.lastname: Luz
authors.affiliation: Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Valdiléa G
authors.initials: VG
authors.lastname: Veloso
authors.affiliation: Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Ronaldo I
authors.initials: RI
authors.lastname: Moreira
authors.affiliation: Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.affiliation: Infectious Diseases Epidemiology Research Unit, Graduate School of Public Health and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Harrison
authors.affiliation: Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
authors.forename: Antonio G
authors.initials: AG
authors.lastname: Pacheco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000150:complications* / Q000453:epidemiology; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062486:Public Health Surveillance; D055815:Young Adult
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