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Santos ME, Ribeiro RA, Protopopescu C, Nishimwe M, Yaya I, Carrieri MP, Araujo WN. Predictors of overall mortality among people living with HIV/AIDS in Brazil, 2007-2015. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In Brazil there are 926,742 people living with HIV/AIDS (PLWHA). Despite the introduction of antiretroviral therapy (ART) in 1996 and treatment for all in 2014, mortality has increased in some regions. This study aimed to estimate the factors associated with overall mortality in PLWHA to recommend public health actions.
Methods
We studied PLWHA aged ≥18 years old, followed-up from 2007 to 2015 in the universal health system in Brazil. We used a national database (disease reporting, laboratory tests, ART and death notifications). Kaplan-Meier method and Cox model were used in survival analysis. The outcome was all-cause deaths. The explanatory variables measured at baseline were sociodemographic characteristics, HIV transmission mode and coinfections by hepatitis B (HBV) and C (HCV). The time-varying variables were CD4 cell count, viral load (VL) and ART status.
Results
Study population (n = 411,281) was mainly male (61%), under 40 years old (61%), Caucasian (37%), with basic education (43%), heterosexual HIV-infection mode (41%), resident in Southeast region (48%). The co-infection rate was 2.5% for HCV, and 1.4% for HBV. Median time to ART initiation was 83 days. During the follow-up period (median: 4 years), 61,757 deaths occurred (6% HCV-coinfected and 2% HBV-coinfected). The global mortality rate was 3.44 [95% confidence interval: 3.42-3.47] per 100 person-years (PY) during 1,793,417 PY. The factors associated with increased mortality in multivariable analyses were male gender, age over 40, non-Caucasian race, HIV infection by drug use, resident in North, Northeast and South regions, HCV and HBV coinfection, VL ≥ 200 copies/mL and starting ART with CD4<200 cells/mm3.
Conclusions
Although PLWHA start ART in less than 3 months after the beginning of follow-up, there is still late treatment (at CD4<200 cells/mm3). Screening should target all populations regardless of risk group. Coinfected individuals should also be early treated for HCV and HBV infections.
Key messages
The results of our study show that all populations should be target for HIV screening regardless of risk group. PLWHA coinfected with hepatitis B and hepatitis C should be also early treated for hepatitis coinfections.
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Affiliation(s)
- M E Santos
- INSERM, IRD, SESSTIM, Aix Marseille University, Marseille, France
- Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
- ORS, PACA, Marseille, France
| | - R A Ribeiro
- Department of STI, HIV/AIDS and Viral Hepatitis, Ministry of Health of Brazil, Brasilia, Brazil
| | - C Protopopescu
- INSERM, IRD, SESSTIM, Aix Marseille University, Marseille, France
- ORS, PACA, Marseille, France
| | - M Nishimwe
- INSERM, IRD, SESSTIM, Aix Marseille University, Marseille, France
- ORS, PACA, Marseille, France
| | - I Yaya
- INSERM, IRD, University of Montpellier, Montpellier, France
| | - M P Carrieri
- INSERM, IRD, SESSTIM, Aix Marseille University, Marseille, France
- ORS, PACA, Marseille, France
| | - W N Araujo
- Faculty of Ceilandia, University of Brasilia, Brasilia, Brazil
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Siqueira AA, Santelli ACFS, Alencar LR, Dantas MP, Dimech CPN, Carmo GMI, Santos DA, Alves RMS, Lucena MBF, Morais M, Assis RMS, Fialho A, Mascarenhas JDP, Costa M, Linhares AC, Leite JPG, Araujo WN, Hatch DL. Outbreak of acute gastroenteritis in young children with death due to rotavirus genotype G9 in Rio Branco, Brazilian Amazon region, 2005. Int J Infect Dis 2010; 14:e898-903. [PMID: 20843719 DOI: 10.1016/j.ijid.2010.03.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 03/11/2010] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND An epidemic of acute gastroenteritis occurred in Rio Branco City, Acre State, in Brazil's Amazon region in 2005. An investigation was conducted to confirm the etiology and identify possible risk factors for death. METHODS Rio Branco municipality surveillance data for the period May to October 2005 were reviewed. In a case-control study, children who died following acute gastroenteritis were compared to age-matched controls with acute gastroenteritis who survived. Rotavirus A (RV-A) was investigated in 799 stool samples and genotyped by reverse transcription polymerase chain reaction (RT-PCR). RESULTS The cumulative incidence of diarrhea in children aged <5 years was 21%. A fatal outcome was significantly associated with uncovered household water storage containers. RV-A was identified in 88% of samples and G9 was the prevalent genotype (71%). CONCLUSIONS Oral rehydration solution and boiling or chlorinating drinking water likely limited mortality. This epidemic was caused by RV-A genotype G9. After the outbreak, a rotavirus vaccine was introduced into the official childhood immunization schedule in Brazil.
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Affiliation(s)
- Alessandra A Siqueira
- Field Epidemiology Training Program (EPISUS), Secretariat of Health Surveillance (SVS), Ministry of Health, Setor Comercial Sul, Edificio Principal Quadra 04, Bloco A, 3° Andar, Brasília, DF, Brazil.
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