Lima Tatiana de Araujo, Beyrer Chris, Golub Jonathan E, Mota Jurema Corrêa da, Malta Monica Siqueira, Silva Cosme Marcelo Furtado Passos da, Bastos Francisco I
Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.
Fogarty AIDS International Training and Research Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, U.S.A.
Cad Saude Publica. 2018 Aug 20;34(8):e00009617. doi: 10.1590/0102-311X00009617.
Despite substantial improvement in prognosis and quality of life among people living with HIV/AIDS (PLWHA) in Brazil, inequalities in access to treatment remain. We assessed the impact of these inequalities on survival in Rio de Janeiro over a 12-year period (2000/11). Data were merged from four databases that comprise the national AIDS monitoring system: SINAN-AIDS (Brazilian Information System for Notificable Diseases; AIDS cases), SISCEL (laboratory tests), SICLOM (electronic dispensing system), and SIM (Brazilian Mortality Information System), using probabilistic linkage. Cox regressions were fitted to assess the impact of HAART (highly active antiretroviral therapy) on AIDS-related mortality among men who have sex with men (MSM), people who inject drugs (PWID), and heterosexuals diagnosed with AIDS, between 2000 and 2011, in the city of Rio de Janeiro, RJ, Brazil. Among 15,420 cases, 60.7% were heterosexuals, 36.1% MSM and 3.2% PWID. There were 2,807 (18.2%) deaths and the median survival time was 6.29. HAART and CD4+ > 200 at baseline were associated with important protective effects. Non-whites had a 33% higher risk of dying in consequence of AIDS than whites. PWID had a 56% higher risk and MSM a 11% lower risk of dying of AIDS than heterosexuals. Non-white individuals, those with less than eight years of formal education, and PWID, were more likely to die of AIDS and less likely to receive HAART. Important inequalities persist in access to treatment, resulting in disparate impacts on mortality among exposure categories. Despite these persistent disparities, mortality decreased significantly during the period for all categories under analysis, and the overall positive impact of HAART on survival has been dramatic.
尽管巴西艾滋病毒/艾滋病感染者（PLWHA）的预后和生活质量有了显著改善，但在获得治疗方面仍存在不平等现象。我们评估了这些不平等现象在12年期间（2000年/11年）对里约热内卢生存率的影响。数据来自国家艾滋病监测系统的四个数据库：SINAN-AIDS（巴西法定传染病信息系统；艾滋病病例）、SISCEL（实验室检测）、SICLOM（电子配药系统）和SIM（巴西死亡率信息系统），采用概率链接法进行合并。使用Cox回归评估高效抗逆转录病毒疗法（HAART）对2000年至2011年期间在巴西里约热内卢市被诊断患有艾滋病的男男性行为者（MSM）、注射毒品者（PWID）和异性恋者中与艾滋病相关死亡率的影响。在15420例病例中，6C.7%为异性恋者，36.1%为男男性行为者，3.2%为注射毒品者。共有2807例（18.2%）死亡，中位生存时间为6.29年。HAART和基线时CD4 + > 200具有重要的保护作用。非白人因艾滋病死亡的风险比白人高33%。与异性恋者相比，注射毒品者死于艾滋病的风险高56%，男男性行为者则低11%。非白人、正规教育年限不足八年的人和注射毒品者更易死于艾滋病，且接受HAART的可能性更小。在获得治疗方面仍存在重大不平等现象，导致不同暴露类别之间的死亡率受到不同影响。尽管存在这些持续差异，但在分析的所有类别中，这一时期的死亡率均显著下降，HAART对生存的总体积极影响非常显著。
