AIDS
Population attributable fractions of mortality in people living with HIV: raies of delayed ART, hepatitis coinfections and social factors
Manuscri pt Number:
Full Titre:
Article Type:
Keywords:
Correspondinig Author:
Correspondinig Author Secondary Information:
Correspondinig Author's Institution:
Correspondin19 Author's Secondary Institution:
First Author:
First Author Secondary Information:
Order of Authors:
Order of Authors Secondary Information:
-Manuscript Draft-
AIDS-D-19-01016R1
Population attributable fractions of mortality in people living with HIV: roles of delayed ART, hepatitis coinfections and social factors
Ori ginal paper (Epidemiology I Social)
HIV; Hepatitis C; Hepatitis B; Coinfection; Mortality; Socioeconomic Factors Melina E. SANTOS, PhD
SESSTIM UMR 1252 Marseille, FRANCE
SESSTIM UMR 1252
Melina E. SANTOS, PhD
Melina E. SANTOS, PhD Camelia PROTOPOPESCU, PhD Rachel A RIBEIRO
Adele S BENZAKEN, PhD Gerson F M PEREIRA, PhD Antony STEVENS, PhD Marie L NISHIMWE, MSc lssifou YAYA, PhD Patrizia CARRIER!, PhD Wildo N ARAÛJO, PhD
Abstract: Objectives
Despite free access to antiretroviral therapy (ART) from 1996 onward, and treatrnent for all people living with HIV (PLWHIV) from 2013, mortality in Brazil has not homogeneously decreased. We investigated to what extent delayed ART, hepatitis coinfections and sociodemographic factors predict ait-cause mortality in Brazilian PLWHIV.
Design
We included PLWHIV �18 years, with complete CD4 count data, followed up between 2007 and 2015 in Brazil.
Methods
After multiple imputation, an extended Cox model helped estimate the effects of fixed and tirne-varying covariates on mortality.
Results
The study population (n=411,028) were mainly male (61%). Caucasian (55%), �O years (61 %), heterosexually HIV-infected (71 %), living in the Southeast region (48%) and had basic education (79%). HCV and HBV coinfection prevalel'lces were 2.5% and 1.4%, respectively. During a 4-year rnedian follow-up, 61,630 deaths occurred and the mortality rate was 3.45 [95% confidence interval (Cl): 3.42-3.47] per 100 person-years. Otder age, male gender, non-Caucasian ethnicity, illiteracy/basic education and living outside the Southeast and Central-West regions were independently associated with increased mortality. The main modifiable predictors of mortality were delayed ART (i.e., CD4<200 cells/mm3 at ART initiation) (adjusted population attributable fraction: 14.20% [95% Cl:
13.81-14.59)), being ART-untreated (14.06% [13.54-14.59)), and ART-treated with unrecorded CD4 at ART initiation (5.74% [5.26-6.21)). HCV and HBV coinfeclions accounted for 2.44% [2.26-2.62) and 0.42% [0.31-0.53] of mortality, respectively.
Conclusions
This study demonstrates that basides early ART and coinfection contrai, actions targeting males, non-Caucasians and illiterate people and those with basic education are important to reduce avoidable deaths among Brazilian PLWHIV.
