Mortalidad por sida en Uruguay: Perfil de las personas fallecidas en 2014

Susana Cabrera; Daniel Pérez; Juan José Meré; Victoria Frantchez; Carolina Iglesias; Elisa Cabeza

doi:10.29193/RMU.35.3.2

Authors

Susana Cabrera Ministerio de Salud Pública, Dirección General de la Salud, Área Programática de ITS/VIH-Sida. https://orcid.org/0000-0002-2126-0640
Daniel Pérez Ministerio de Salud Pública, Dirección General de la Salud, Área Programática de ITS/VIH-Sida. https://orcid.org/0000-0003-3371-6614
Juan José Meré United Nations Fund for Population Activities https://orcid.org/0000-0001-8719-5928
Victoria Frantchez Universidad de la República, Facultad de Medicina, Cátedra de Enfermedades Infecciosas. https://orcid.org/0000-0001-8719-5928
Carolina Iglesias Consultant https://orcid.org/0000-0002-2498-4046
Elisa Cabeza consultant https://orcid.org/0000-0002-5256-0056

DOI:

https://doi.org/10.29193/RMU.35.3.2

Keywords:

AIDS MORTALITY, ACQUIRED IMMUNODEFICIENCY SYNDROME, DELAYED DIAGNOSIS, HIV CARE CASCADE

Abstract

Introduction: Early diagnosis of HIV and early and continuos antirretroviral treatment constitute key strategies to avoid dying of aids. After a steady increase, HIV-related mortality has remained stable since 2005, although the expected reduction has not occurred. A study was conducted in order to characterize the clinical and epidemiological profile of the population that died of AIDS in Uruguay in 2014 and to assess the distribution of deaths in the continuum of care cascade”.
Method: Retrospective and observational study, based on information kept in files containing death certificates and medical histories of people who were 18 years old or older and died of AIDS in 2014.
Results: We had access to 124 records of the 175 deaths, finding that 105 corresponded to HIV-related deaths, 77% of them came from the public subsector and 68% of them being men. Most of them were young adults (43.711.6 years old) and lived in vulnerable conditions (47.1% had used drugs; 15.4% were homeless or in prison; 37.5% benefited from social plans). In 71.4% of cases diagnosis was late and 37.1% died within the first year of diagnosis. 60% died without having consulted the health system or continued treatment (11.4% failed to seek health assistance, 48.6% interrupted treatment).
Conclusions: The increased proportion of patients who died without having sought health assistance or follow up in the health system within a population of social vulnerability evidences the need to adopt comprehensive strategies that have been proved successful to increase access and continuation of treament.

References

(1) Antiretroviral Therapy Cohort Collaboration. Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996-2006: collaborative analysis of 13 HIV cohort studies. Clin Infect Dis 2010; 50:1387-96.

(2) Smith CJ, Ryom L, Weber R, Morlat P, Pradier C, Reiss P, et al. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. Lancet 2014; 384:241-8.

(3) Low A, Gavriilidis G, Larke N, B-Lajoie MR, Drouin O, Stover J, et al. Incidence of opportunistic infections and the impact of antiretroviral therapy among HIV-infected adults in low-and middle-income countries: a systematic review and meta-analysis. Clin Infect Dis 2016; 62(12):1595-603.

(4) Roger AJ, Lodwick R, Schechter M, Deeks S, Amin J, Gilson R, et al. Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general populations. AIDS 2013; 27(6):973-9.

(5) Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human inmunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1989; 338(13):853-60.

(6) Montaner JS, Lima VD, Harrigan PR, Lourenço L, Yip B, Nosyk B, et al. Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: the ‘‘HIV Treatment as Prevention’’ experience in a Canadian setting. PLoS One 2014; 9(2):e87872.

(7) Palella FJ Jr, Baker RK, Moorman AC, Chmiel JS, Wood KC, Brooks JT, et al. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr 2006; 43:27–34.

(8) Chadborn TR, Delpech VC, Sabin CA, Sinka K, Evans BG. The late diagnosis and consequent short-term mortality of HIV-infected heterosexuals (England and Wales, 2000-2004). AIDS 2006; 20:2371-9.

(9) Ulett KB, Willig JH, Lin HY, Routman JS, Abroms S, Allison J, et al. The therapeutic implications of timely linkage and early retention to HIV care. AIDS Patient Care STDS 2009; 23:41-9.

(10) Torian LV, Wiewel EW, Liu KL, Sackoff JE, Frieden TR. Risk factors for delayed initiation of medical care after diagnosis of human immunodeficiency virus. Arch Intern Med 2008; 168:1181-7.

(11) Mugavero MJ, Davila JA, Nevin CR, Giordano TP. From access to engagement: measuring retention in outpatient HIV clinical care. AIDS Patient Care STDS 2010; 24:607-13.

(12) Durán A, Pérez E, Adaszko A. Mortalidad por sida en la Argentina. Perfil de las personas fallecidas por sida en el Área Metropolitana de Buenos Aires durante el año 2010. Bs. As: Ministerio de Salud, 2014. Disponible en: http://www.msal.gob.ar/sida/images/stories/4-publicaciones/pdf/2014-11-13_estudio-mortalidad-sida.pdf (Consulta: abril 2018).

(13) Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis 2011; 52:793-800.

(14) Mugavero MJ, Amico KR, Horn T, Thompson MA. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis 2013; 57:1164-71.

(15) Egger M, May M, Chêne G, Phillips AN, Ledergerber B, Dabis F, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet 2002; 360:119-29.

(16) Kitahata MM, Gange SJ, Abraham AG, Merriman B, Saag MS, Justice AC, et al. Effect of early versus deferred antiretroviral therapy for HIV on survival. N Engl J Med 2009; 360:1815-26.

(17) HIV-CAUSAL Collaboration, Ray M, Logan R, Sterne JA, Hernández-Díaz S, Robins JM, et al. The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals. AIDS 2010; 24:123-37.

(18) Krentz HB, MacDonald J, John Gill M. High mortality among human immunodeficiency virus (HIV)-infected individuals before accessing or linking to HIV care: a missing outcome in the cascade of care? Open Forum Infect Dis 2014; 1(1):ofu011.

(19) Ministerio de Salud Pública. Departamento de Vigilancia en Salud-Programa ITS-VIH/SIDA. Situación epidemiológica del VIH/SIDA en Uruguay. Bol Epidemiol 2015; 1-44.

(20) Uruguay. Ministerio de Salud Pública. Estudio de Carga Global de Enfermedad. Programa de Prevención de Enfermedades No Transmisibles. Montevideo: MSP, 2010. Disponible en: http://www.msp.gub.uy/sites/default/files/archivos_adjuntos/Estudio_de_Carga_Global.pdf (Consulta: abril 2018).

(21) Cesar C, Koethe JR, Giganti MJ, Rebeiro P, Althoff KN, Navapravnik S, et al. Health outcomes among HIV-positive Latinos initiating antiretroviral therapy in North America versus Central and South America. J Int AIDS Soc 2016; 19(1):20684.

(22) Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet 2009; 373:48-57.

(23) McNairy ML, Lamb MR, Gachuhi AB, Nuwagaba-Biribonwoha H, Burke S, Mazibuko S, et al. Effectiveness of a combination strategy for linkage and retention in adult HIV care in Swaziland: the Link4Health cluster randomized trial. PLoS Med 2017; 14(11):e1002420.

(24) Giordano TP. Strategies for linkage to and engagement with care: focus on intervention. Top Antivir Med 2018; 26(2):62-5.

(25) Kredo T, Ford N, Adeniyi FB, Garner P. Decentralising HIV treatment in lower-and middle- income countries. Cochrane Database Syst Rev 2013; (6):CD009987. doi: 10.1002/14651858.CD009987.pub2.