Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/1258
Title: Differential Survival Benefit of Universal HAART Access in Brazil: A Nation-Wide Comparison of Injecting Drug Users Versus Men Who Have Sex With Men
Authors: Malta, Monica Siqueira
Bastos, Francisco Inácio Pinkusfeld Monteiro
Silva, Cosme Marcelo Furtado Passos da
Pereira, Gerson Fernando Mendes
Lucena, Francisca de Fátima A.
Medeiros, Maria Goretti Pereira Fonseca
Strathdee, Steffanie Anne
Affilliation: Social Science Department, Sergio Arouca School of Public Health (DCS/ENSP), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
Health Information Department, Center for Scientific and Technological Information (DIS/CICT), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
Department of Epidemiology and Quantitative Methods, Sergio Arouca School of Public Health (DEMQS/ENSP), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
Surveillance Unit, Brazilian National STD/AIDS Program, Brasilia, Brazil;
Surveillance Unit, Brazilian National STD/AIDS Program, Brasilia, Brazil;
Evandro Chagas Clinical Research Institute (IPEC), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
Division of International Health and Cross Cultural Medicine, Department of Family and Preventive Medicine at University of California, San Diego (UCSD) School of Medicine, San Diego, CA
Abstract: Objective: Brazil accounts for ;70% of injection drug users (IDUs) receiving highly active antiretroviral therapy (HAART) in low-income/middle-income countries. We evaluated the impact of HAART availability/access on AIDS-related mortality among IDUs versus men who have sex with men (MSM). Design: Nation-wide analysis on Brazilian IDU and MSM diagnosed with AIDS in 2000–2006. Methods: Four national information systems were linked, and Cox regression was used to assess impact of HAART availability/access on differential AIDS-related mortality. Results: Among 28,426 patients, 6777 died during 87,792 personyears of follow-up. Compared with MSM, IDU were significantly less likely to be receiving HAART, to have ever had determinations for CD4 or viral load. After controlling for confounders, IDU had a significantly higher risk of death (adjusted hazard ratio: 1.94; 95% confidence interval: 1.84 to 2.05). Among the subset that had at least 1 CD4 and viral load determination, higher risk of death among IDU persisted (hazard ratio: 1.82; 95% confidence interval: 1.58 to 2.11). Nonwhite ethnicity significantly increased this risk, whereas prompt HAART uptake after AIDS diagnosis reduced the risk of death. After controlling for spatially correlated survival data, AIDS-related mortality remained higher in IDU than in MSM. Conclusions: Despite free/universal HAART access, differential AIDS-related mortality exists in Brazil. Efforts are needed to identify and eliminate these health disparities.
Keywords: Aids
drug user
HAART
HIV
survival
Issue Date: 2009
Publisher: Lippincott Williams & Wilkins, Inc.
Citation: J Acquir Immune Defic Syndr. Volume 52, Number 5, December 15, 2009
ISSN: 1077-9450
Copyright: open access
Appears in Collections:ICICT - Artigos de Periódicos

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