Simply offering free access to HIV treatment doesn’t mean everyone living with HIV will receive it, a Brazilian study published in AIDS showed.
Brazil has provided free antiretroviral therapy to all PLWH since 2013, yet the new study found that the main predictor of mortality among Brazilian PLWH was delayed initiation of HIV treatment. (Other predictors included coinfection with hepatitis B or C, as well as sociodemographic characteristics.)
Researchers analyzed data on 411,028 PLWH who were followed for a median of four years between 2007 and 2015. The overall mortality rate was 3.45/100 person-years. A higher risk of death was seen among people who were older, non-Caucasian, illiterate, coinfected with hepatitis B or C, and those who did not receive more than a basic education. Geographic disparities were also observed.
Among modifiable factors, starting antiretroviral therapy at a CD4 cell count < 200 cells/mm3 accounted for 14.20% of the adjusted population-attributable fraction of mortality, followed by not being on antiretrovirals at all (fraction: 14.06%). Coinfection with HCV predicted 2.44% of deaths, and coinfection with HBV 0.42%. Mortality was also higher among those who had acquired HIV through heterosexual contact (71% of participants) compared to men who have sex with men.
Systemic or health care access issues were not explored in the course of this study.
The study authors recommended additional efforts to start people early on antiretroviral treatment and treat hepatitis coinfection, as well as interventions that target specific populations, such as people who have not learned to read, to reduce the number of avoidable deaths among PLWH in Brazil.