Significant Increases in Cardiovascular Diseases and Diabetes as Causes of Death in HIVInfected Indi

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Significant Increases in Cardiovascular Diseases
and Diabetes as Causes of Death in HIV-Infected
Individuals in the HAART Era in Brazil A
Population Based Analysis

• Antonio G Pacheco, Suely H Tuboi, José C
  Faulhaber, Lee H Harrison and Mauro Schechter

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Background

• Marked decrease in mortality and morbidity
• Also reported in Brazil
• Increased survival
• More time at risk for other diseases
• Chronic exposure to medication
• Increased risk of adverse events

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Background

• Widespread use of HAART in developed countries
• Decreasing frequency of HIV-related conditions as
  causes of morbidity and of mortality
• Increasing frequency of non-HIV-related causes of
  morbidity and of mortality

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Background

• In 1996 Brazil became the first developing
  country to provide free and universal access to
  HAART
• There are no published studies on temporal
  changes in causes of death in Brazil after the
  introduction of HAART

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Objective

• To assess temporal trends of overall mortality
  and of selected conditions not usually attributed
  to HIV-infection in Brazil between 1999 and 2004

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Methods

• Death certificates (DC), with no personal
  identifiers, are publicly available online
• Since 1999 DCs include secondary causes of death
• ICD-10 codes B20-B24 used to define HIV status

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Methods

• Mortality Odds Ratios (MOR)
• Temporal trends compared to 1999
• Outcomes
• Non-HIV-related (overall)
• CVD
• DM
• Co-variables
• State of Residence, Age, Gender

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Methods

• Algorithm to capture causes of death
• Python
• PostgreSQL Server
• GEE
• Spatial correlation
• Interchangeable structure
• Others tested
• R for Windows
• geepack

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HIV Mortality RatesBrazil, 1996-2004
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Non-HIV-related Causes of Death (2000-2004)
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Cardiovascular Diseases as Causes of Death
(2000-2004)
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Diabetes Mellitus as Cause of Death (2000-2004)
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Conclusions

• Similarly to developed countries, causes of death
  are changing among HIV infected individuals in
  Brazil
• Non-HIV related causes of death are becoming
  increasingly more frequent
• CVD and DM as causes of death are increasing much
  faster among HIV-infected individuals than in the
  general population

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Limitations

• Lack of sensitivity/specificity of death
  certificates
• Not trying to infer mortality rates
• Reasonable for temporal trends
• Confounders not taken into account
• E.g., smoking, ART, etc
• Changes in the frequency of HIV reporting
• Unlikely stable figures

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Implications

• Clinical management
• Prevention, diagnosis and treatment of
  potentially preventable and treatable conditions
• Public Health
• Need to integrate HIV/AIDS program with other
  programs
• Other countries scaling up HAART use
• Help to prepare for changes in morbidity/mortality

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Acknowledgements

• My colleagues in this work
• Suely
• Claudio
• Prof. Lee Harrison
• Prof. Mauro Schechter
• Funding agencies
• Fogarty International Center
• CNPq

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Questions