Sobrevivência de pacientes adultos com AIDS em hospital de referência estadual do Ceará

Abstract

Objective: To evaluate the influence of social-demographic and clinical-epidemiological factors in the patients' survival with AIDS, in Fortaleza, Northeastern Brazil. Methods: A study with 502 adult AIDS patients was carried out between 1983 and April of 1998. The influence of the variables in the patients' survival was evaluated through the method of Kaplan-Meier and the test log-rank was used to evaluate possible statistical differences between the subgroups. The Cox proportional hazards model was performed in the multivariate analysis. Results: Patients who took at least one anti-retroviral dmg had a significant greater survival than those who did not take anyone (p <0.001). Because anti-retroviral therapy for AIDS has been used systematically and has improved the survival of those patients, we decided for studying only those ones that have made any anti-retroviral use. The median survival for the whole cohort was 746 days. Sex, age, category of transmission, disease marker of AIDS, having one or more systemic disease, having CD4 ^ 100 x 106/1, being diagnosed by Caracas criteria, coming from dififerent origin (capital and interior) or the socioeconomic conditions of the residence neighborhood was not found to have statistically different survival. However, patients with hemoglobin s: 11 g/dl (p <0.001) and those who took two nucleoside reverse transcriptase inhibitors (NRTI) plus protease inhibitor were found to have higher survival (p <0.001). The multivariate analysis was performed separately for the first and second year after the AIDS diagnosis because the proportional hazards assumptions were not satisfied. The risk of dying in the first year was significantly lower (0.25; 95%CI: 0.12-0.50) for those who took NRTF and protease inhibitor regarding to those who took only NRTI. Furthermore, this risk was much lower from the second year on (0.10; 95%CI: 0.42-0.23). The risk of dying in the first year was

44 found to be significantly higher for those who did not achieve higher level of education (graduation) (15.58; 95%CI: 6.64-36.58) and those who presented two or more systemic diseases (3.03; 95%CI: 1.74-5.25). After the first year of diagnosis, no difference in this risk was found for these factors (0.61; 95%CI: 0.36-1.04 and 0.79; 95%CI: 0.47-1.33, respectively). Conclusions: The best socioeconomic level, measured indirectly by the educational achievement, demonstrated great influence in the survival in the first year. We concluded, also, that the anti-retroviral dmgs had higher impact in the survival from the second year on, as well as the risk of dying for patients with two or more systemic diseases was equal to those who did not have it, for the same period. Therefore, the earlier start and more aggressive anti-retroviral therapy could benefit those patient.