Análise de sobrevida de pacientes coinfectados HIV/HCV de um centro de referência em DST/AIDS no município de São Paulo / Survival analysis of HIV/HCV co-infected patients at a STD/AIDS reference center in the city of São Paulo

AUTOR(ES)
FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

16/09/2011

RESUMO

Introduction: The estimated survival of patients with HIV/AIDS has increased after highly active antiretroviral therapy; mortality due to liver diseases, however, has also increased. Objectives: To estimate the accumulated probability of survival after AIDS diagnosis among HIV/HCV co-infected individuals and to perform an exploratory analysis to investigate factors related to the survival of these patients. Method: Non-concurrent cohort study, using data from the National Disease Reporting Information System, the laboratory and epidemiological surveillance information systems of the SP-STD Reference and Training Center-CRT, of patients over 13 years of age, followed at the general outpatient clinic. The following variables were studied: hepatitis C, hepatitis B, exposure category, T CD4+ cell count, age group, schooling, color, sex, and AIDS diagnostic periods: 1986 to 1993, 1994 to 1996, 1997 to 2002 and 2003 to 2010. Survival analysis was performed using the Kaplan-Meier estimator and the Cox model, with estimates of the hazard ratio (HR) and respective confidence intervals (95 per cent CI). Results: Of a total of 2,864 individuals included, with a median age of 35 years, 219 died (7.5 per cent ). Of the 358 (12.5 per cent ) HIV/HCV co-infected individuals, 159 (45.1 per cent ) were injecting drug users (IDU), and of the non-co-infected 2,506, 96 (3.9 per cent ) were IDU. The accumulated probability of survival among HIV/HCV co-infected individuals at 60, 168, 168 and 96 months as of AIDS diagnosis, was 100 per cent in the 1986 -1993 period; 27,8 per cent in the 1994-1996 period; 76,3 per cent in the 1997-2002 period; and 92,8 per cent in the 2003-2010 period. The survival curves were different between co-infected and non-co-infected individuals in the 1994-1996 (log rank = 19,8; p <0,001) and in the 1997-2002 (log rank = 38,8; p <0,001). In the multivariate model, regardless of other variables, the following were predictors of death: having hepatitis C (HR = 2.9; CI 2.1-3.9); having hepatitis B (HR = 2.5; CI 1.7-3.6); being 50 years old or over (HR = 2.1; CI 1.3-3.2) and having up to 3 years of schooling (HR = 2.3; CI 1.5-3.6). AIDS diagnosis between 1997 and 2010 was shown to be a protective factor for death (HR = 0.4; CI 0.3-0.5). Conclusions: HIV/HCV co-infected individuals had shorter survival, when compared to non-co-infected individuals in the 1994-1996 and in the 1997-2002 AIDS diagnostic periods. As of the 1994-1996 period, a significant increase in the accumulated probability of survival among HIV/HCV co-infected individuals was observed. In the 2003-2010 period, the probability was similar between co-infected and non-coinfected individuals, showing the possible impact of hepatitis treatment

ASSUNTO(S)

aids aids análise de sobrevida hepatite c hepatitis c survival analysis

ACESSO AO ARTIGO

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