medigraphic.com
Instituto Nacional de Salud Pública

2015, Number S2

<< Back Next >>

salud publica mex 2015; 57 (S2)

In-hospital mortality in HIV-infected patients: 10 years after the implementation of universal access to HAART in Mexico

Martín-Onraet A, Piñeirua-Menéndez A, Perales-Martínez D, Ortega-Pérez R, Barrera-García A, Sierra-Madero J, Volkow-Fernández P

Language: Spanish
References: 24
Page: 163-170
PDF size: 230.25 Kb.


ABSTRACT

Objective. To establish the characteristics and causes of death of HIV patients who die while hospitalized. Materials and methods. We included HIV+ patients who died during hospitalization, in three hospitals in Mexico City between 2010 and 2013. Sociodemographic and clinical data were collected as well as causes of death. We identified preventable deaths (defined as deaths that occurred in patients with less than six months of HAART, or without HAART, with less than 350 CD4 at diagnosis and/or opportunistic events as the cause of hospitalization). Results. 128 deaths were analyzed. The median of CD4 count was 47 cells/mm3; 18% of the patients ignored their HIV status at the time of hospitalization, 51% had less than six months of HAART, 40.5% had never received HAART before. The main causes of death were AIDS defining events, with 65.6%. We identified 70 preventable deaths (57%). Conclusions. Despite universal access to HAART, HIV patients in Mexico are still dying of AIDS defining illnesses, an indicator of late diagnosis. It is urgent to implement HIV testing programs to allow earlier diagnosis and make HAART benefit accessible to all.


REFERENCES

  1. Morris A, Creasman J, Turner J, Luce JM, Wachter RM, Huang L. Intensive care of Human Immunodeficiency Virus–infected patients during the era of Highly Active Antiretroviral Therapy. Am J Respir Crit Care Med 2002;166:262-267.

  2. Afessa B, Green B. Clinical course, prognostic factors, and outcome prediction for HIV patients in the ICU, The PIP (Pulmonary Complications, ICU Support, and Prognostic Factors in Hospitalized Patients With HIV) Study. Chest 2000;118:138-45.

  3. Ingle SM, May MT, Gill MJ, Mugavero MJ, Lewden C, Abgrall S et al, for The ARV therapy cohort collaboration. Impact of risk factors for specific causes of death in the first and subsequent years of antiretroviral therapy among HIV-infected patients. CID 2014;59(2):287-297.

  4. Klevens RM. Update: AIDS --- United States, 2000. MMWR 2002;51(27);592-559.

  5. Mocroft A, Ledergerber B, Katlama C, Kirk O, Reiss P, d’Arminio-Monferte A, et al. Decline in the AIDS and death rates in the EuroSIDA study: an observational study. Lancet 2003;362(9377):22-29.

  6. The World Bank. World development indicators 2012 [documento en internet] [consultado el 22 de noviembre de 2014]. Disponible en: www. data.wolrdbank.org/

  7. Chasioti Y. Global Access of HIV patients to HAART therapy. What after Doha? Medical School of National and Kapodistrian University of Athens, 2012 [documento en internet] [consultado el 22 de noviembre de 2014]. Disponible en: http://crisis.med.uoa.gr/elibrary/16.pdf

  8. Wong EB, Omar T, Setlhako GJ, Osih R, Feldman C, Murdoch DM, et al. Causes of death on antiretroviral therapy: A post-mortem study from South Africa. PLoS ONE 2012;7(10): doi:10.1371/journal.pone.0047542

  9. Lee SH, Kim KH, Lee SG, Chen DH, Jung DS, Moon CS, et al. Trends of mortality and cause of death among HIV-infected patients in Korea, 1990- 2011. J Korean Med Sci 2013;28:67-73.

  10. van Lettow M, ̊kesson AA, Martiniuk AL, Ramsay A, Chan AK, Anderson ST, et al. Six-month mortality among HIV-infected adults presenting for antiretroviral therapy with unexplained weight loss, chronic fever or chronic diarrhea in Malawi. PloSONE 2012;7(11): e48856. doi: 10.1371/ journal.pone.0048856.

  11. Fisher M. Late diagnosis of HIV infection: major consequences and missed opportunities. Curr Opin Infect Dis 2008;21:1-3.

  12. Grinsztejn B, Luz PM, Pacheco AG, Santos D, Velasque V, Moreira RI, et al. Changing mortality profile among HIV-infected patients in Rio de Janeiro, Brazil: Shifting from AIDS to Non-AIDS related conditions in the HAART era. Plos One 2013;8(4): e59768.doi 10.1371/journal. pone.0059768.

  13. May M, Gompels M, Delpech V, Porter K, Post F, Johnson M, et al. Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study. BMJ 2011;343:d6016. doi 10.1136/bmj.d6016.

  14. Crabtree-Ramirez B, Villasis-Keever A, Galindo-Fraga A, Del Río C, Sierra-Madero J. Effectiveness of Highly Active Antiretroviral Therapy (HAART) among HIV-infected patients in Mexico. AIDS Res Hum Retroviruses 2010;24(6):373-378.

  15. Crabtree-Ramírez B, Caro-Vega Y, Shepherd BE, Wehbe F, Cesar C, Cortés C, et al. Cross-sectional analysis of late HAART initiation in Latin America and the Caribbean: late testers and late presenters. PLoS ONE 2011;6(5): e20272. doi:10.1371/journal.pone.0020272.

  16. Kowalska JD, Friis-Møller N, Kirk O, Bannister W, Mocroft A, Sabin C, et al. The coding causes of death in HIV (CoDe) Project. Epidemiology 2011;22:516-523.

  17. Kim JH, Psevdos G Jr, Gonzalez E, Singh S, Kilayko MC, Sharp V. Allcause mortality in hospitalized HIV-infected patients at an acute tertiary care hospital with a comprehensive outpatient HIV care program in New York City in the era of highly active antiretroviral therapy (HAART). Infection 2013;41(2):545-551.

  18. Weber R, Ruppik M, Rickenbach M, Spoerri A, Furrer H, Batteger M, et al. Decreasing mortality and changing patterns of causes of death in the Swiss HIV Cohort Study. HIV Medicine 2013;14:195-207.

  19. Reekie J, Kowalska JD, Karpov I, Rockstroh J, Karlsson A, Rakhmanova A, et al, for EuroSIDA and EuroCoord. Regional differences in AIDS and non-AIDS related mortality in HIV-positive individuals across Europe and Argentina: The EuroSIDA Study. PLoS ONE 2012;7(7):e41673. doi:10.1371/journal.pone.0041673.

  20. Lewden C, Drabo YF, Zannou DM, Maiga MY, Minta DK, Sow PS, et al. Disease patterns and causes of death of hospitalized HIV-positive adults in West Africa: a multicountry survey in the antiretroviral treatment era. J Int AIDS Soc 2014;17:18797.

  21. The Caribbean, Central and South America Network for HIV Research (CCASAnet) Collaboration, International Epidemiologic Databases to Evaluate AIDS (IeDEA) Program. Mortality during the first year of potent antiretroviral therapy in HIV-1-infected patients in 7 sites throughout Latin America and the Caribbean. J Acquir Immune Defic Syndr 2009;51(5):615-623.

  22. Wood E, Kerr T, Marshall BD, Li K, Zhang R, Hogg RS, et al. Longitudinal community plasma HIV-1 RNA concentrations and incidence of HIV-1 among injecting drug users: prospective cohort study. BMJ 2009;338:b1649.

  23. Anglemyer A, Rutherford GW, Baggaley RC, Egger M, Siegfried N. Antiretroviral therapy for prevention of HIV transmission in HIV-discordant couples. Cochrane Database Syst Rev 2011;(8):CD009153. doi: 10.1002/14651858.CD009153.pub2.

  24. Jia Z, Mao Y, Zhang F, Ruan Y, Ma Y, Li J, et al. Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003-11): a national observational cohort study. Lancet 2013;382(9899):1195-203. doi: 10.1016/S0140-6736(12)61898-4.




2020     |     www.medigraphic.com