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Differential survival benefit of universal HAART access in Brazil: a nation-wide comparison of injecting drug users versus men who have sex with men

Malta, M.; Bastos, F.I.; da Silva, C.M.F.P.; Pereira, G.F.M.; Lucena, F.F.A.; Fonseca, M.G.P.; Strathdee, S.A.

Journal of Acquired Immune Deficiency Syndromes 52(5): 629-635

2009

ISSN/ISBN: 1944-7884
PMID: 19675464
DOI: 10.1097/qai.0b013e3181b31b8a
Document Number: 208791
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). Nation-wide analysis on Brazilian IDU and MSM diagnosed with AIDS in 2000-2006. Four national information systems were linked, and Cox regression was used to assess impact of HAART availability/access on differential AIDS-related mortality. 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. 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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