Predictors of progression to AIDS after HIV infection diagnosis  in the pre- and post-HAART eras in a Brazilian AIDS-free cohort.
BACKGROUND
The impact of HAART (highly active antiretroviral therapy) on the time for progression from HIV diagnosis to AIDS (TPHA) has been little studied in middle-income countries. This study aimed to analyze the TPHA in the pre- and post-HAART eras and to investigate its predictors.


METHODS
We carried out a retrospective cohort study, including 1879 AIDS-free HIV-infected individuals diagnosed between 1988 and 2003 and followed up until 2005. The incidences of AIDS were estimated in person-years. The Kaplan-Meier method was applied to estimate TPHA and the Cox proportional hazard model used to assess predictors of TPHA.


RESULTS
AIDS incidence decreased from 12.8 to 5.0 per 1000 person-years over the period 1992 to 2003. TPHA (cumulative probability of AIDS-free time) for the maximum follow-up of 9 years was 21.9% among untreated individuals and 76.8% among those on HAART. Predictors of shorter TPHA included non-HAARTART treatment; no treatment; age ≥50 years; black/brown skin color; injection drug use; no schooling; and baseline CD4 lower than 500 cells/mm3.


CONCLUSIONS
HAART has decreased AIDS incidence, prolonged life and increased the number of people living with HIV/AIDS. The post-HAART era presents new challenges to healthcare services in middle-income countries, the main requirements being enhanced strategies focused on early diagnosis, more resource allocation and developing approaches for healthcare systems to manage AIDS as a chronic disease.
Mariza Vono
MV
Tancredi
Eliseu Alves
EA
Waldman
D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D023241:Antiretroviral Therapy, Highly Active; D001938:Brazil / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D018450:Disease Progression; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous; D013997:Time Factors; D055815:Young Adult