Inequalities in Haart uptake and differential survival according to exposure category in Rio de Janeiro, Brazil

Bibliographic Data

ID5223516
AuthorsTatiana De Araujo Lima (Universidade do Estado do Rio de Janeiro), Chris Beyrer (0000-0003-0665-9124, Johns Hopkins Bloomberg School of Public Health, USA), Jonathan E Golub (0000-0003-2398-3145, Johns Hopkins University), Jurema Corrêa Da Mota (Fundação Oswaldo Cruz), Jurema Correa Mota (0000-0002-5007-1590, Fundação Oswaldo Cruz), Monica Siqueira Malta (Fundação Oswaldo Cruz), Mônica Malta (0000-0001-7634-6671, Escola Nacional de Saúde Pública), Cosme Marcelo Furtado Passos Da Silva (0000-0001-7789-1671, Fundação Oswaldo Cruz), Francisco I Bastos (0000-0001-5970-8896, Fundação Oswaldo Cruz)
Year2018
Volume34
Issue8
Pagese00009617-e00009617
Publication date2018-08-20
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueCadernos de Saude Publica (JOURNAL)
Journal identifiersISSN: 0102-311X • E-ISSN: 1678-4464
PublisherFapUNIFESP (SciELO) (PUBLISHER)
DOI10.1590/0102-311x00009617
PMID30133651
OpenAlexW2886267026
SCIELO_PIDS0102-311X2018000805010
LanguageEN
Citations received1
References cited41

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

Antiretroviral therapy · Human immunodeficiency virus (HIV) · Inequality · Men who have sex with men · Syphilis · Viral load · Demography · HIV-related health complications and treatments · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Immunology · Medicine · Gerontology