Determinants of survival of people living with HIV/AIDS on antiretroviral therapy in Brazil 2006-2015

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Title: Determinants of survival of people living with HIV/AIDS on antiretroviral therapy in Brazil 2006-2015
Authors: Mangal, T
Meireles, M
Pascom, ARP
Coelho, RDA
Benzaken, AS
Hallett, T
Item Type: Journal Article
Abstract: Background We compared AIDS-related mortality rates in people living with HIV (PLHIV) starting antiretroviral therapy (ART) in Brazil during 2006–2015 and examined associated risk factors . Methods Data on ART use in PLHIV and AIDS mortality in Brazil was analysed with piecewise constant exponential models. Mortality rates and hazard ratios were estimated for 0–6, 6–12, 13–24, 25–36 and > 36 months of ART use and adjusted for region, age, sex, baseline CD4 cell count and calendar year of ART initiation. An additional analysis restricted to those with data on risk group was also performed. Results 269,076 individuals were included in the analysis, 165,643 (62%) males and 103,433 (38%) females, with 1,783,305 person-years of follow-up time. 21,749 AIDS deaths were reported and 8898 deaths occurred in the first year of ART. The risk of death in the first six months decreased with early ART initiation; those starting treatment early with CD4 > 500 cells per μL had a hazard ratio of 0.06 (95% CI 0.05–0.07) compared with CD4 < 200 cells per μL. Older age, male sex, intravenous drug use and starting treatment in earlier calendar years were associated with higher mortality rates. People living in the North, Northeast and South of Brazil experienced significantly higher AIDS mortality rates than those in the Southeast (HR 1.44, [95% CI 1.35–1.54], 1.10 [1.05–1.16] and 1.22 [1.17–1.28] respectively). Conclusions Early treatment is likely to have contributed to the improved survival in PLHIV on ART, with the greatest benefits observed in women, younger age-groups and those living in the North.
Issue Date: 28-Feb-2019
Date of Acceptance: 21-Feb-2019
ISSN: 1471-2334
Publisher: BioMed Central
Journal / Book Title: BMC Infectious Diseases
Volume: 19
Copyright Statement: © 2019 The Author(s). Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Sponsor/Funder: Bill & Melinda Gates Foundation
Medical Research Council (MRC)
Funder's Grant Number: OPP1084364
Keywords: Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Antiretroviral treatment
0605 Microbiology
1103 Clinical Sciences
1108 Medical Microbiology
Publication Status: Published
Article Number: 206
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care

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