Continuous increase of cardiovascular diseases, diabetes, and non-HIV related cancers as causes of death in HIV-infected individuals in Brazil: An analysis of nationwide data

Introduction: After antiretroviral therapy (ART) became available, there was a decline in the number of deaths in persons infected with HIV. Thereafter, there was a decrease in the proportion of deaths attributed to opportunistic infections and an increase in the proportion of deaths attributed to chronic comorbidities. Herein we extend previous observations from a nationwide survey on temporal trends in causes of death in HIV-infected patients in Brazil. Methods: We describe temporal trends in causes of death among adults who had HIV/AIDS listed in the death certificate to those who did not. All death certificates issued in Brazil from 1999 to 2011 and listed in the national mortality database were included. Generalized linear mixed-effects logistic models were used to study temporal trends in proportions. Results: In the HIV-infected population, there was an annual adjusted average increase of 6.0%, 12.0%, 4.0% and 4.1% for cancer, external causes, cardiovascular diseases (CVD) and diabetes mellitus (DM), respectively, compared to 3.0%, 4.0%, 1.0% and 3.9%, in the non-HIV group. For tuberculosis (TB), there was an adjusted average increase of 0.3%/year and a decrease of 3.0%/year in the HIV and the non-HIV groups, respectively. Compared to 1999, the odds ratio (OR) for cancer, external causes, CVD, DM, or TB in the HIV group were, respectively, 2.31, 4.17, 1.76, 2.27 and 1.02, while for the non-HIV group, the corresponding OR were 1.31, 1.63, 1.14, 1.62 and 0.67. Interactions between year as a continuous or categorical variable and HIV were significant (p <0.001) for all conditions, except for DM when year was considered as a continuous variable (p = 0.76). Conclusions: Non HIV-related co-morbidities continue to increase more rapidly as causes of death among HIV-infected individuals than in those without HIV infection, highlighting the need for targeting prevention measures and surveillance for chronic diseases among those patients. © 2014 Paula et al

Monotherapy with lopinavir/ritonavir as maintenance after HIV-1 viral suppression: results of a 96-week randomized, controlled, open-label, pilot trial (KalMo Study)

Estevão P. Nunes. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.Long-term adverse events and expenses associated with HAART have led to an interest in simplifi ed therapy. Lopinavir/ritonavir monotherapy is attractive due to its potency and high genetic barrier. Methods: This is a 96-week, open-label, randomized study to assess the feasibility of using LPV/r monotherapy in patients with undetectable viral load after being on successful HAART for at least 6 months. Subjects were randomized (1:1) to either switch from HAART to LPV/r monotherapy or to maintain their previous regimen. Results: 60 patients were enrolled. Baseline characteristics were similar in both groups. At Week 96, by intention-to-treat analysis, 24/30 (80.0%) subjects in monotherapy group and 26/30 (86.6%) in the control group had a plasma viral load of 500 copies/mL) in each arm. Genotyping testing identifi ed no resistance-associated mutations. The patient on the monotherapy arm was successfully resuppressed to <80 copies/mL after intensifi cation with tenofovir and lamivudine. No statistically signifi cant differences were found with regard to changes in CD4 counts. One subject in the monotherapy group discontinued due to diarrhea. Five subjects in the control group underwent regimen changes due to drug-related toxicities. Viral load from semen samples collected at the end of follow-up was undetectable on 14/15 patients randomized to monotherapy. Conclusions: Switching from various HAART regimens to LPV/r monotherapy in patients who were virologically suppressed and without a history of previous virologic failure was effective, safe, and well tolerated through 96 weeks.2021-01-0

Continuous Increase of Cardiovascular Diseases, Diabetes, and Non-HIV Related Cancers as Causes of Death in HIV-Infected Individuals in Brazil: An Analysis of Nationwide Data

Abstract Introduction: After antiretroviral therapy (ART) became available, there was a decline in the number of deaths in persons infected with HIV. Thereafter, there was a decrease in the proportion of deaths attributed to opportunistic infections and an increase in the proportion of deaths attributed to chronic comorbidities. Herein we extend previous observations from a nationwide survey on temporal trends in causes of death in HIV-infected patients in Brazil

<b>Table1.</b> Definition of groups of disease and ICD-10 codes used in this study.

<p><b>Table1.</b> Definition of groups of disease and ICD-10 codes used in this study.</p

Odds ratios and 95% confidence intervals comparing the chance of having the disease listed on the death certificate over time of Non-HIV related cancers (A), external causes (B), cardiovascular diseases (C), Diabetes Mellitus (D) and Tuberculosis (E); year as a categorical variable and 1999 as the baseline reference.

<p>Odds ratios and 95% confidence intervals comparing the chance of having the disease listed on the death certificate over time of Non-HIV related cancers (A), external causes (B), cardiovascular diseases (C), Diabetes Mellitus (D) and Tuberculosis (E); year as a categorical variable and 1999 as the baseline reference.</p