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Abstract
Mortality among HIV-infected injecting drug users (IDU) versus men who have sex with men (MSM): differential survival in a context of universal access to antiretroviral treatment in Brazil
M. Malta1, C.M.F.P. da Silva2, F.A. Lucena3, M.G.P. Fonseca4, F.I. Bastos5, S.A. Strathdee6
Background: HIV-positive injecting drug users (IDUs) appear to benefit less than other populations from HAART, often due to sub-optimal access and/or adherence. Brazil accounts for around 70% of all IDUs receiving HAART in low/middle income countries. We assessed impact of HAART availability/access on AIDS-related mortality among IDUs versus men who have sex with men (MSM) in Brazil, the first middle-income country to provide free/universal access to HAART to all eligible patients, in 1996.
Methods: Data were merged from four different national information systems (SINAN [AIDS Cases], SICLOM [patients under treatment], SISCEL [laboratory monitoring], and SIM [Mortality Information System), linked with a probabilistic linking software. Female were not included on the analysis, since they corresponded to less than 3% of the overall IDU sample and would bias comparisons with the subpopulation of male homosexuals/bisexuals. Cox regression was used to assess impact of HAART availability/access on AIDS-related mortality among IDU versus MSM who received AIDS diagnoses from 2000-2006, adjusting for demographic, clinical, and behavioral factors and controlling for spatially-correlated survival data by including a frailty effect.
Results: Among 28,426 patients with complete data (43% IDU; 57% MSM), 6,777 (23.8%) died during 87,792 person-years of follow-up. At baseline, compared to MSM, IDU were significantly less likely to be receiving HAART (24.3% vs. 31.2%; p<0.001), to have ever had a CD4 count (44.1% vs. 56.9%; p<0.001) or HIV-1 RNA viral load determination (54.2% vs. 62.5%; p<0.001). Even after controlling for frailty effects, AIDS-related mortality remained higher in IDU than MSM (AHR: 1.94; 95% CI: 1.84 - 2.05).
Conclusions: Despite having one of the largest AIDS treatment programs among low/middle-income countries worldwide, and free access to HAART, we observed considerable inequities in access to HAART, which may explain higher mortality among HIV-infected IDUs, compared to MSM in Brazil. Efforts to reduce these health disparities are clearly needed.
AIDS 2008 - XVII International AIDS Conference
Abstract no.
TUPE0208
Suggested Citation
"M.Malta, et al.
Mortality among HIV-infected injecting drug users (IDU) versus men who have sex with men (MSM): differential survival in a context of universal access to antiretroviral treatment in Brazil.
:
AIDS 2008 - XVII International AIDS Conference:
Abstract no.
TUPE0208"
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