Abstract | OBJECTIVE: Brazil accounts for approximately 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 person-years 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.
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Authors | Monica Malta, Francisco I Bastos, Cosme M F P da Silva, Gerson Fernando Mendes Pereira, Francisca F A Lucena, Maria G P Fonseca, Steffanie A Strathdee |
Journal | Journal of acquired immune deficiency syndromes (1999)
(J Acquir Immune Defic Syndr)
Vol. 52
Issue 5
Pg. 629-35
(Dec 2009)
ISSN: 1944-7884 [Electronic] United States |
PMID | 19675464
(Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Topics |
- Acquired Immunodeficiency Syndrome
(drug therapy, mortality)
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antiretroviral Therapy, Highly Active
- Brazil
(epidemiology)
- Databases, Factual
- Developing Countries
- HIV-1
- Health Services Accessibility
- Healthcare Disparities
- Homosexuality, Male
- Humans
- Male
- Middle Aged
- Risk Factors
- Substance Abuse, Intravenous
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