Mortality from AIDS and tuberculosis-HIV coinfection in the Chilean AIDS Cohort of 2000-2017

Sanhueza-Sanzana, Carlos; Kerr, Ligia; Kendall, Carl

doi:10.1590/0102-311X00212920

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ARTICLE • Cad. Saúde Pública 37 (6) • 2021 • https://doi.org/10.1590/0102-311X00212920 copy

Mortality from AIDS and tuberculosis-HIV coinfection in the Chilean AIDS Cohort of 2000-2017

Mortalidad por SIDA y coinfección por tuberculosis-VIH en la Cohorte Chilena de SIDA de 2000-2017

Mortalidade por aids e coinfecção tuberculose-HIV na Coorte Chilena de Aids de 2000-2017

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

This article aims to assess the sociodemographic and epidemiological factors associated with AIDS and tuberculosis-HIV coinfection mortality in the Chilean adult population between 2000 and 2017. This is a retrospective observational study, evaluating the incidence density of TB-HIV coinfection mortality in the population over 14 years of age. We used data from the Chilean AIDS Cohort database, 17,512 people enrolled in highly active antiretroviral therapy in the public health system in Chile. The Kaplan-Meier survival function and Cox regression were applied. Incidence density of 0.05 for 39,283 person-years for mortality with TB-HIV coinfection was recorded, with an increase in new cases in people living with AIDS among Aymara and Mapuche indigenous populations. Risk factors included CD4 < 500 cells/mm³ (HR = 3.2; 95%CI: 2.2-4.9), viral load at the start of treatment > 10,000 copies/uL (HR = 1.3; 95%CI: 1.2-1.6). Having high school or higher education (HR = 0.76; 95%CI: 0.6-0.9) is a protective factor for mortality for coinfection. Mortality was concentrated in TB-HIV coinfected people with increasing mortality among women and indigenous populations. The paper contributes to the growing recognition of the role of social determinants in disease outcomes, and the requirement to improve community-focused and community-based testing, sex education in schools, and structural interventions to reduce the adult mortality in Chilean population.

Keywords:
HIV; AIDS; Tuberculosis; Adult; Mortality

Variable	2000-2005 (n = 2,811)				2006-2011 (n = 9,402)				2012-2017 (n = 5,299)
	n	%	95%CI		n	%	95%CI		n	%	95%CI
	n	%	Lower	Upper	n	%	Lower	Upper	n	%	Lower	Upper
Sex
Man	2,491	88.6	87.4	89.7	8,388	89.2	88.5	89.8	4,446	83.7	82.9	84.8 **
Woman	319	11.4	10.2	12.5	1,014	10.7	10.1	11.4	848	16.2	15.1	17.0
Age group (years)
15-29	956	34.2	32.4	36.0	2,483	26.6	25.7	27.5	2,115	42.7	41.3	44.1 **
30-49	1,711	61.3	59.4	63.1	5,939	63.8	62.8	64.7	2,482	50.2	48.7	51.5
≥ 50	124	4.4	3.6	5.2	885	9.5	8.9	10.1	349	7.1	6.3	7.7
Migrant
Chilean	2,734	98.4	97.9	98.9	9,136	97.6	97.3	97.9	4,738	90.1	89.3	90.9 **
Migrant	45	1.6	1.1	2.0	226	2.4	2.1	2.7	518	9.9	9.0	10.6
Indigenous ***
No	2,683	98.7	98.3	99.1	9,002	98.5	98.3	98.7	4,533	96.8	96.3	97.3 **
Yes	34	1.2	0.01	0.02	136	1.4	0.01	0.02	148	3.2	0.02	0.04
Education (years)
< 8	277	15.5	13.7	17.1	646	14.1	13.1	15.1	594	12.5	11.6	13.5 **
8-12	968	54.0	51.7	56.3	2,361	51.6	50.2	53.1	2,116	44.7	43.3	46.1
Higher	547	30.5	28.3	32.7	1,566	34.2	32.9	35.6	2,026	42.8	41.4	44.1
Occupation
Employed	1,540	73.6	71.7	75.5	3,822	73.3	72.0	74.5	3,588	71.4	70.1	72.6 **
Unemployed	474	22.7	20.8	24.4	1,093	20.9	19.8	22.0	716	14.3	12.2	15.5
Student	51	2.4	1.7	3.0	252	4.8	4.2	5.4	669	13.3	12.3	14.2
Retired	27	1.3	0.1	1.7	50	1.0	0.6	1.2	50	1.0	0.7	1.2
Transmission
Sexual	955	78.7	76.6	80.9	2,452	71.4	69.8	72.9	3,597	82.0	80.9	83.2 **
IDU	19	1.6	0.8	2.2	33	1.0	0.6	1.2	15	0.3	0.1	0.5
Another	240	19.7	17.5	22.0	949	27.6	26.1	29.1	770	17.5	16.4	18.6

Variable	2000-2005 (n = 2,811)				2006-2011 (n = 9,402)				2012-2017 (n = 5,299)
	n	%	95%CI		n	%	95%CI		n	%	95%CI
	n	%	Lower	Upper	n	%	Lower	Upper	n	%	Lower	Upper
Deaths
Yes	894	31.8	30.8	33.5	844	9.0	8.3	9.5	275	5.2	4.5	5.7 **
No	1,917	68.2	66.4	70.0	8,558	91.0	90.4	91.6	5,024	94.8	94.0	95.4
CD4 (cells/mm³)
< 350	1,972	72.5	70.8	74.2	7,242	79.3	78.5	80.2	3,332	66.1	64.7	67.4 **
350-500	380	13.9	12.6	15.3	939	10.3	9.6	10.9	862	17.1	16.0	18.1
≥ 500	368	13.5	12.2	14.8	942	10.3	9.7	10.9	847	16.8	16.0	18.1
AIDS stage ***
A	1,217	43.9	42.0	45.7	4,223	46.6	18.9	21.9	3,414	69.3	33.8	37.3 **
B	567	20.5	44.5	46.6	1,785	19.3	18.4	20.0	492	10.0	34.1	36.0
C	986	35.6	68.0	70.5	3,256	35.1	9.1	10.8	1,020	20.7	19.5	21.0
TB-HIV coinfection
Yes	157	10,2	9.0	11.7	466	9.5	9.0	10.3	147	10.3	9.8	11.9 **
No	1,389	89.8	88.2	91.3	4,451	90.5	89.6	91.3	1,287	89.7	88,1	91.2
Death cause
TB-HIV	88	13.6	11.1	16.4	56	12.9	10.1	16.5	13	12.1	7.2	19.8 **
Another condition	559	86.4	83.5	88.8	376	87.0	83.5	89.8	134	87.5	80.2	92.8
Cholesterol HDL
High risk	509	59.7	56.4	62.9	2,449	61.3	59.7	62.7	1,376	60.7	58.7	62.7 **
Normal	344	40.3	37.0	43.6	1,548	38.7	37.2	40.2	890	39.3	37.2	41.3
Cholesterol LDL
High risk	60	10.7	8.1	13.3	248	11.1	9.8	12.4	215	11.3	87.2	90.0 **
Normal	497	89.2	86.6	91.8	1,980	88.8	87.5	90.1	1,683	88.7	9.9	12.7
Triglycerides
Severe risk	34	2.0	1.3	2.7	82	1.5	1.1	1.7	30	0.8	0.5	1.1 **
High	648	39.8	37.4	42.2	2,198	39.2	37.9	40.5	1,234	34.2	32.6	35.7
Normal	945	58.0	55.6	60.4	3,317	59.3	57.9	60.5	2,344	65.0	63.4	66.5

Variable	HR crude	95%CI	p-value	HR adjusted *	95%CI	p-value
Education
High school or Universiry	1.00	Reference	0.23	1.00	Reference	0.24
Elementary or less	1.45	0.78-2.70		1.44	0.77-2.69
Indigenous population **
Chilean or migrant	1.00	Reference	< 0.01	1.00	Reference	< 0.01
Indigenous	5.16	2.03-13.08		5.24	2.05-13.9
Key population
Another key population ***	1.00	Reference		1.00	Reference
MSM	0.48	0.28-0.82	0.001	0.34	0.19-0.60	< 0,01
CD4 (cells/mm³)
< 350	1.00	Reference		1.00	Reference
351-500	0.27	0,10-0,76	0.01	0.32	0.11-0.89	0.03
≥ 500	0.06	0,08-0,46	< 0.01	0.07	0.01-0.56	0.01

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[1] Correspondence
C. Sanhueza-Sanzana Programa de Pós-graduação em Saúde Pública, Departamento de Saúde Comunitária, Faculdade de Medicina, Universidade Federal do Ceará. Rua Prof. Costa Mendes 1608, Fortaleza, CE 60430-140, Brasil. carlosanhueza.san@gmail.com