MORTALITY IN TREATED HIV-INFECTED ADULTS COMPARED WITH THE GENERAL POPULATION: EVIDENCE FROM HIV-BRAZIL COHORT STUDY

INTRODUCTION: Recent studies have demonstrated that subgroups of treated HIV-infected individuals may reach mortality rates close to those of the general population. This study aimed to compare mortality rates from a Brazilian cohort of treated HIV-infected individuals with those of the general population. METHODS:  Adult patients from a national cohort of 5,061 treated HIV-infected individuals were eligible if they started combination anti-retroviral therapy (cART) between 2003 and 2011 and had at least one consult in the clinic. CD4 values included in the analysis were the highest reached after start of therapy.. Standard mortality ratios (SMR) and excess mortality rates were compared with sex and age-standardized rates from the general population. Differences on the SMR were analysed with a 95% confidence interval. RESULTS : Of  5,061 study participants, 63.4% were men,  (23.6% had sex with men); median age was 36.9 years (interquartile range 29-43); median CD4 count at cART initiation was 177.51 cells/mm³ (interquartile range 75-250). Median follow-up time was 3.94 years (men 3.88 yrs, women 4.02 yrs). Overal standardized mortality rate was 1.35/100 persons/year (PY) (SMR 2,78 (IC95% 1.28-7,68); men: 1.59/100 PY (SMR 2,65 IC95% 1.03-6.14); women: 0.94/100 PY (SMR 3.25 IC95% 0.86-13.17). Among individuals reaching a CD4 count ≥ 350 (76.3% of total), standardized mortality rate was 0.95/100 PY; SMR 1.24 IC95% 0.51-7.84), whereas among those with a CD4 count ≤ 200 ( 8.2% of total)  rates were higher (10.56/100 PY; SMR 25.16 IC95% 12.38-43.40). CONCLUSIONS: Mortality rates among persons reaching CD4 counts ≥ 350 after the start of cART were close to those of the general population, although still about 25% higher than those from the general population This finding reinforces the soundness of a recent recommendation of the AIDS Brazilian program to offer cART to all recently diagnosed HIV-infected persons, regardless of their immunologic or virologic status.