Predictors of progression to AIDS after HIV infection diagnosis in the pre- and post-HAART eras in a Brazilian AIDS-free cohort

Abstract

Background

The impact of HAART (highly active antiretroviral therapy) on the time for progression from HIV diagnosis to AIDS (TPHA) has been little studied in middle-income countries. This study aimed to analyze the TPHA in the pre- and post-HAART eras and to investigate its predictors.

Method

We carried out a retrospective cohort study, including 1879 AIDS-free HIV-infected individuals diagnosed between 1988 and 2003 and followed up until 2005. The incidences of AIDS were estimated in person-years. The Kaplan–Meier method was applied to estimate TPHA and the Cox proportional hazard model used to assess predictors of TPHA.

Results

AIDS incidence decreased from 12.8 to 5.0 per 1000 person-years over the period 1992 to 2003. TPHA (cumulative probability of AIDS-free time) for the maximum follow-up of 9 years was 21.9% among untreated individuals and 76.8% among those on HAART. Predictors of shorter TPHA included non-HAART ART treatment; no treatment; age ≥50 years; black/brown skin color; injection drug use; no schooling; and baseline CD4 lower than 500 cells/mm³.

Conclusion

HAART has decreased AIDS incidence, prolonged life and increased the number of people living with HIV/AIDS. The post-HAART era presents new challenges to healthcare services in middle-income countries, the main requirements being enhanced strategies focused on early diagnosis, more resource allocation and developing approaches for healthcare systems to manage AIDS as a chronic disease.

AIDS, AIDS-free time, HAART, HIV