20th International AIDS Conference - Melbourne, Australia

Abstract

MOPE095 - Poster Exhibition


Late HIV diagnosis and limited access to health care: determinants of mortality due to AIDS within the HAART era in Argentina

E. Perez1, A. Durán1, A. Adazsko1, C. Brezzo2, C. Falistocco1, Grupo de Estudio de la Mortalidad por VIH/SIDA

1Ministerio de Salud, Dirección de SIDA y ETS, Buenos Aires, Argentina, 2ONUSIDA, Buenos Aires, Argentina

Background: Availability of HAART since 1996 has significantly reduced death from AIDS-related infection in Argentina. However, the absolute number of deaths and specific mortality rate have remained stable at about 1400 deaths annually during the last 10 years. The objective of this study was to identify determinants associated to deaths due to HIV-related causes during 2010 in the Metropolitan Area of Buenos Aires (AMBA) in Argentina.
Methods: Retrospective and observational study of people who died of causes related to HIV/AIDS during 2010 in the AMBA. Medical records of inpatient and/or outpatient follow-up were reviewed.
Results: During 2010, 588 deaths related to HIV-AIDS occurred at the AMBA (45% of AIDS deaths in Argentina). In a nonrandom sample, 331 deaths of people over 18 years were analyzed: 64% males and 36% female with a median age of 40 years. 80% had not completed secondary school as maximum level of instruction. The main route of transmission was unprotected sexual contact with the opposite sex in both male and female. Clinical stage at diagnosis was available in 56% of cases of which 76% had late diagnosis of HIV infection. The median time between HIV diagnosis and death was 5 years and a third of the studied population died within the first year, with gender differences. HIV diagnosis was made during the final hospitalization in 40% of people diagnosed less than one year before death.
At the time of admission, 73.7% of the population was without antiretroviral treatment. Within this group, 59% had never received HAART, while the remaining 41% was under treatment at some point in their evolution and left it. Almost 40% of deaths occurred within the first week of hospitalization and 52% in the first two weeks. The main causes of death, when etiological diagnosis was available (57.7%) were Meningeal Criptocosis, TB and CNS Toxoplasmosis. Most patients showed signs of wasting.
Conclusions: Despite sophisticated mathematical models predict optimistic results about life expectancy by using HAART, late diagnosis of HIV infection and limited access to health care are still bottlenecks in the goal of reduction the mortality due to AIDS.

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