title: Predictors of immunodeficiency-related death in a cohort of low-income people living with HIV: a competing risks survival analysis.
abstract: We conducted a survival analysis with competing risks to estimate the mortality rate and predictive factors for immunodeficiency-related death in people living with HIV/AIDS (PLWH) in northeast Brazil. A cohort with 2372 PLWH was enrolled between July 2007 and June 2010 and monitored until 31 December 2012 at two healthcare centres. The event of interest was immunodeficiency-related death, which was defined based on the Coding Causes of Death in HIV Protocol (CoDe). The predictor variables were: sociodemographic characteristics, illicit drugs, tobacco, alcohol, nutritional status, antiretroviral therapy, anaemia and CD4 cell count at baseline; and treatment or chemoprophylaxis for tuberculosis (TB) during follow-up. We used Fine & Gray's model for the survival analyses with competing risks, since we had regarded immunodeficiency-unrelated deaths as a competing event, and we estimated the adjusted sub-distribution hazard ratios (SHRs). In 10 012·6 person-years of observation there were 3·1 deaths/100 person-years (2·3 immunodeficiency-related and 0·8 immunodeficiency-unrelated). TB (SHR 4·01), anaemia (SHR 3·58), CD4 <200 cells/mm3 (SHR 3·33) and being unemployed (SHR 1·56) were risk factors for immunodeficiency-related death. This study discloses a 13% coverage by highly active antiretroviral therapy (HAART) in our state and adds that anaemia at baseline or the incidence of TB may increase the specific risk of dying from HIV-immunodeficiency, regardless of HAART and CD4.
authors.affiliation: Centro de Pesquisas Aggeu Magalhães/Fundação Oswaldo Cruz,Pernambuco,Brazil.
authors.forename: M F P M
authors.initials: MF
authors.lastname: Albuquerque
authors.affiliation: Centro de Pesquisas Aggeu Magalhães/Fundação Oswaldo Cruz,Pernambuco,Brazil.
authors.forename: D N
authors.initials: DN
authors.lastname: Alves
authors.affiliation: Centro de Pesquisas Aggeu Magalhães/Fundação Oswaldo Cruz,Pernambuco,Brazil.
authors.forename: C C
authors.identifier: 0000-0002-1295-0885
authors.initials: CC
authors.lastname: Bresani Salvi
authors.affiliation: Universidade Federal da Fronteira Sul,Santa Catarina,Brazil.
authors.forename: J D L
authors.initials: JD
authors.lastname: Batista
authors.affiliation: Universidade Federal de Pernambuco,Brazil.
authors.forename: R A A
authors.initials: RA
authors.lastname: Ximenes
authors.affiliation: Universidade de Pernambuco,Brazil.
authors.forename: D B
authors.initials: DB
authors.lastname: Miranda-Filho
authors.affiliation: Universidade Federal de Pernambuco,Brazil.
authors.forename: H R L
authors.initials: HR
authors.lastname: Melo
authors.affiliation: Hospital Correia Picanço,Secretaria Estadual de Saúde,Pernambuco,Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Maruza
authors.affiliation: Universidade de Pernambuco,Brazil.
authors.forename: U R
authors.initials: UR
authors.lastname: Montarroyos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult
keywords: Cohort studies; HIV; mortality; risk factor