Brazil was the first middle-income country to offer universal access to AIDS treatment. Monitoring the impact of this policy is relevant for continuous updating of intervention strategies. This study aimed to estimate the survival of people living with AIDS (PLWA) with > 13 years of age and to investigate predictors of death with a basic AIDS cause, in Brazil, among 2003-2007, followed up until 2014.
Retrospective cohort. Data from the Brazilian Integrated Base of AIDS Cohort (BIAIDS-BRASIL Cohort) was obtained from a probabilistic record linkage methodology applied to databases of the Ministry of Health: Information System of Notification Diseases, Control of Laboratory Tests, Logistic Control System of Medicines and Mortality Information System. Kaplan-Meier method, Cox model and estimates of the hazard ratios (HR), with 95% confidence intervals (CI = 95%) were used for survival analysis. The main variable was the antiretroviral therapy (ART). To identify factors associated with the outcomes of interest, sociodemographic characteristics, clinical, therapeutic and laboratory evolution were analyzed.
During the 2003-2007 period, 104,806 PLWA were reported, with 27,147 deaths. The probability of surviving 144 months was 33% for those who did not use ART, 75% for those with Pre-HAART, 84% with HAART1 and 89% with HAART2. They were associated with AIDS death independent of other exposures: use of HAART1 (HR=2.1; 95%CI1.7-2.4); use of Pre-HAART (HR=4.8; 95%CI2.5-11.7); without ART (HR=5.3; 95%CI4.0-5.6); feminine gender (HR=0.8; 95%CI0.7-0.8), <8 years of study (HR=1.5; 95%CI1.4-1.6); without study (HR=1.8; 95%CI1.6-2.0); age of 30-49 years (HR=0.9; 95%CI0.9-1.0); > 50 years (HR=1.2; 95%CI1.1-1.3); heterosexual (HR=1.2; 95%CI1.1-1.3); injecting drug users (HR=2.1; 95%CI1.9-2.3); black (HR=1.3; 95%CI1.2-1.4); brown (HR=1.1; 95%CI1.0-1.1); indigenous (HR=1.7; 95%CI1.1-2.7); TCD4+ in the diagnosis among 350-499 cells/mm³ (HR=1.2; 95%CI1.1-1.4); among 200-349 cells/mm³ (HR=1.5; 95%CI1.3-1.6); <200 cells/mm³ (HR=2.3; 95%CI2.1-2.5); and viral load >500 copies (HR=1.8; 95%CI1.7-2.0).
Survival was massively increased, from 33% to 89% in 144 months, due to the introduction of more potent therapeutic regimens adopted in the country. HAART, sex, schooling, ethnicity, exposure category, age, TCD4+, and viral load at the time of diagnosis were associated with survival time as an independent prognostic factor.