Inequalities in HAART uptake and differential survival according to exposure category in Rio de Janeiro, Brazil
Abstract: Despite substantial improvement in prognosis and quality of life among people living with HIV/AIDS (PLWHA) in Brazil, inequalities in access to treatment remain. We assessed the impact of these inequalities on survival in Rio de Janeiro over a 12-year period (2000/11). Data were merged from four databases that comprise the national AIDS monitoring system: SINAN-AIDS (Brazilian Information System for Notificable Diseases; AIDS cases), SISCEL (laboratory tests), SICLOM (electronic dispensing system), and SIM (Brazilian Mortality Information System), using probabilistic linkage. Cox regressions were fitted to assess the impact of HAART (highly active antiretroviral therapy) on AIDS-related mortality among men who have sex with men (MSM), people who inject drugs (PWID), and heterosexuals diagnosed with AIDS, between 2000 and 2011, in the city of Rio de Janeiro, RJ, Brazil. Among 15,420 cases, 60.7% were heterosexuals, 36.1% MSM and 3.2% PWID. There were 2,807 (18.2%) deaths and the median survival time was 6.29. HAART and CD4+ > 200 at baseline were associated with important protective effects. Non-whites had a 33% higher risk of dying in consequence of AIDS than whites. PWID had a 56% higher risk and MSM a 11% lower risk of dying of AIDS than heterosexuals. Non-white individuals, those with less than eight years of formal education, and PWID, were more likely to die of AIDS and less likely to receive HAART. Important inequalities persist in access to treatment, resulting in disparate impacts on mortality among exposure categories. Despite these persistent disparities, mortality decreased significantly during the period for all categories under analysis, and the overall positive impact of HAART on survival has been dramatic.
Main Authors: | Lima,Tatiana de Araujo, Beyrer,Chris, Golub,Jonathan E., Mota,Jurema Corrêa da, Malta,Monica Siqueira, Silva,Cosme Marcelo Furtado Passos da, Bastos,Francisco I. |
---|---|
Format: | Digital revista |
Language: | English |
Published: |
Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
2018
|
Online Access: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2018000805010 |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
Similar Items
-
Survival of HIV patients with tuberculosis started on simultaneous or deferred HAART in the THRio cohort, Rio de Janeiro, Brazil
by: Saraceni,Valeria, et al.
Published: (2014) -
CHAGASIC MENINGOENCEPHALITIS IN AN HIV INFECTED PATIENT WITH MODERATE IMMUNOSUPPRESSION: PROLONGED SURVIVAL AND CHALLENGES IN THE HAART ERA
by: BUCCHERI,Renata, et al.
Published: (2015) -
Hepatitis B virus in HIV-infected patients in northeastern South Africa: Prevalence, exposure, protection and response to HAART
by: Ayuk,J, et al.
Published: (2013) -
Rabies immunoglobulin should not be forgotten in category III exposure
by: Gozdas,Hasan Tahsin
Published: (2021) -
Neurologic complications of HIV in the HAART era: where are we?
by: Silva,Monica M. Gomes da
Published: (2012)