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Early mortality in a cohort of people living with HIV in Rio de Janeiro, Brazil, 2004–2015: a persisting problem

BACKGROUND: Global mortality from AIDS-related diseases has been declining since 2005, resulting primarily from the widespread use and early initiation of combination antiretroviral therapy. Despite the significant improvements, high rates of early mortality, usually defined as that occurring within...

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Autores principales: Leite, Pedro H. A. C., Coelho, Lara E., Cardoso, Sandra W., Moreira, Ronaldo I., Veloso, Valdilea G., Grinsztejn, Beatriz, Luz, Paula M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9115995/
https://www.ncbi.nlm.nih.gov/pubmed/35581552
http://dx.doi.org/10.1186/s12879-022-07451-x
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author Leite, Pedro H. A. C.
Coelho, Lara E.
Cardoso, Sandra W.
Moreira, Ronaldo I.
Veloso, Valdilea G.
Grinsztejn, Beatriz
Luz, Paula M.
author_facet Leite, Pedro H. A. C.
Coelho, Lara E.
Cardoso, Sandra W.
Moreira, Ronaldo I.
Veloso, Valdilea G.
Grinsztejn, Beatriz
Luz, Paula M.
author_sort Leite, Pedro H. A. C.
collection PubMed
description BACKGROUND: Global mortality from AIDS-related diseases has been declining since 2005, resulting primarily from the widespread use and early initiation of combination antiretroviral therapy. Despite the significant improvements, high rates of early mortality, usually defined as that occurring within the 1st year of entry to care, have been observed, especially in resource-limited settings. This analysis draws upon data from an observational cohort of people with HIV (PWH) followed at a reference center for HIV/AIDS care and research in the city of Rio de Janeiro, Brazil, to identify the pattern and factors associated with early mortality. METHODS: The study population includes PWH aged 18 or older followed at the National Institute of Infectious Diseases Evandro Chagas who were enrolled between 2004 and 2015. The primary outcome was early mortality, defined as deaths occurring within 1 year of inclusion in the cohort, considering two follow-up periods: 0 to 90 days (very early mortality) and 91 to 365 days (early mortality). Cox proportional hazards models were used to identify the variables associated with the hazard of very early and early mortality. RESULTS: Overall, 3879 participants contributed with 3616.4 person-years of follow-up. Of 220 deaths, 132 happened in the first 90 days and 88 between 91 and 365 days. Very early mortality rate ratios (MRR) show no statistically significant temporal differences between the periods 2004–2006 to 2013–2015. In contrast, for early mortality, a statistically significant decreasing trend was observed: mortality rates in the periods 2004–2006 (MR = 5.5; 95% CI 3.9–7.8) and 2007–2009 (MR = 3.9; 95% CI 2.7–5.7) were approximately four and three-fold higher when compared to 2013–2015 (MR = 1.4; 95% CI 0.7–2.7). Low CD4 count and prior AIDS-defining illness were strongly associated with higher hazard ratios of death, especially when considering very early mortality. CONCLUSIONS: The present study shows an excess of mortality in the 1st year of follow-up with no changes in the mortality rates within 90 days among PWH from Rio de Janeiro. We note the significant impact of initiating treatment with immunosuppression, as evidenced by the increased risk of death among those with low CD4 cell count and with AIDS-defining illnesses. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-022-07451-x.
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spelling pubmed-91159952022-05-19 Early mortality in a cohort of people living with HIV in Rio de Janeiro, Brazil, 2004–2015: a persisting problem Leite, Pedro H. A. C. Coelho, Lara E. Cardoso, Sandra W. Moreira, Ronaldo I. Veloso, Valdilea G. Grinsztejn, Beatriz Luz, Paula M. BMC Infect Dis Research BACKGROUND: Global mortality from AIDS-related diseases has been declining since 2005, resulting primarily from the widespread use and early initiation of combination antiretroviral therapy. Despite the significant improvements, high rates of early mortality, usually defined as that occurring within the 1st year of entry to care, have been observed, especially in resource-limited settings. This analysis draws upon data from an observational cohort of people with HIV (PWH) followed at a reference center for HIV/AIDS care and research in the city of Rio de Janeiro, Brazil, to identify the pattern and factors associated with early mortality. METHODS: The study population includes PWH aged 18 or older followed at the National Institute of Infectious Diseases Evandro Chagas who were enrolled between 2004 and 2015. The primary outcome was early mortality, defined as deaths occurring within 1 year of inclusion in the cohort, considering two follow-up periods: 0 to 90 days (very early mortality) and 91 to 365 days (early mortality). Cox proportional hazards models were used to identify the variables associated with the hazard of very early and early mortality. RESULTS: Overall, 3879 participants contributed with 3616.4 person-years of follow-up. Of 220 deaths, 132 happened in the first 90 days and 88 between 91 and 365 days. Very early mortality rate ratios (MRR) show no statistically significant temporal differences between the periods 2004–2006 to 2013–2015. In contrast, for early mortality, a statistically significant decreasing trend was observed: mortality rates in the periods 2004–2006 (MR = 5.5; 95% CI 3.9–7.8) and 2007–2009 (MR = 3.9; 95% CI 2.7–5.7) were approximately four and three-fold higher when compared to 2013–2015 (MR = 1.4; 95% CI 0.7–2.7). Low CD4 count and prior AIDS-defining illness were strongly associated with higher hazard ratios of death, especially when considering very early mortality. CONCLUSIONS: The present study shows an excess of mortality in the 1st year of follow-up with no changes in the mortality rates within 90 days among PWH from Rio de Janeiro. We note the significant impact of initiating treatment with immunosuppression, as evidenced by the increased risk of death among those with low CD4 cell count and with AIDS-defining illnesses. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-022-07451-x. BioMed Central 2022-05-17 /pmc/articles/PMC9115995/ /pubmed/35581552 http://dx.doi.org/10.1186/s12879-022-07451-x Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Leite, Pedro H. A. C.
Coelho, Lara E.
Cardoso, Sandra W.
Moreira, Ronaldo I.
Veloso, Valdilea G.
Grinsztejn, Beatriz
Luz, Paula M.
Early mortality in a cohort of people living with HIV in Rio de Janeiro, Brazil, 2004–2015: a persisting problem
title Early mortality in a cohort of people living with HIV in Rio de Janeiro, Brazil, 2004–2015: a persisting problem
title_full Early mortality in a cohort of people living with HIV in Rio de Janeiro, Brazil, 2004–2015: a persisting problem
title_fullStr Early mortality in a cohort of people living with HIV in Rio de Janeiro, Brazil, 2004–2015: a persisting problem
title_full_unstemmed Early mortality in a cohort of people living with HIV in Rio de Janeiro, Brazil, 2004–2015: a persisting problem
title_short Early mortality in a cohort of people living with HIV in Rio de Janeiro, Brazil, 2004–2015: a persisting problem
title_sort early mortality in a cohort of people living with hiv in rio de janeiro, brazil, 2004–2015: a persisting problem
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9115995/
https://www.ncbi.nlm.nih.gov/pubmed/35581552
http://dx.doi.org/10.1186/s12879-022-07451-x
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