Anti-nef antibodies and other predictors of disease progression in HIV-1 seropositive injecting drug users.

A cross-sectional and retrospective longitudinal study has been conducted in three Italian infectious disease centres to evaluate the role of anti-nef antibodies and other markers (HIV-1 p24 antigen, p24 Ag; Beta 2-microglobulin, B2-M; and number of CD4+ lymphocytes) as predictors of disease progression in HIV seropositive injecting drug users (IDUs). The selected patients were: 1) HIV-seropositive IDUs in different stages of HIV infection; 2) HIV-seropositive IDUs who had developed AIDS, from whom serial serum samples were available during the asymptomatic stage, and 3) HIV seropositive IDUs who remained asymptomatic through a follow-up period of the same duration as the patients who developed AIDS. Absence of anti-nef antibodies was associated with symptomatic HIV infection. A significant association between the absence of anti-nef antibodies, the presence of p24 Ag, high levels of B2-M, a number of CD4+ lymphocytes less than 500/ml at first visit and disease progression was found. Subjects who were persistently positive for antibody to nef were less likely to develop AIDS than those who were transiently or persistently negative. This difference was statistically significant (p = 0.03). The results of this study show that absence or disappearance of anti-nef antibodies may be used as predictor of disease evolution in HIV seropositive IDUs. This study also confirms the usefulness of other markers, such as p24 Ag, B2-M and number of CD4+ lymphocytes previously shown to be predictive of rapid disease progression for predicting the course of HIV seropositive IDUs.     

Seropositivity for HIV and the development of AIDS or AIDS related condition: three year follow up of the San Francisco General Hospital cohort

The three year actuarial progression rate to the acquired immune deficiency syndrome (AIDS) in a cohort of men in San Francisco who were seropositive for the human immuno-deficiency virus (HIV) was 22%. An additional 26 (19%) developed AIDS related conditions. β₂ Microglobulin concentration, packed cell volume, HIV p24 antigenaemia, and the proportion and number of T4 lymphocytes each independently predicted progression to AIDS. β₂ Microglobulin was the most powerful predictor. The 111 subjects tested who were normal by all predictors (40%) had a three year progression rate of 7%, and the 68 subjects who were abnormal by two or more predictors (24%) had a progression rate of 57%. Two thirds of all men who progressed to AIDS were in the last group. The median T4 lymphocyte count in subjects who did not progress to AIDS fell from 626 × 10⁶ to 327 × 10⁶/1. HIV p24 antigenaemia developed in 7% of the subjects per year. The proportion who were abnormal by two or more predictive variables rose to 41%. At three years an estimated two thirds of the seropositive subjects showed clinical AIDS, an AIDS related condition, or laboratory results that were highly predictive of AIDS.It is concluded from the observed rates and the distribution of predictive variables at three years that half of the men who were seropositive for HIV will develop AIDS by six years after the start of the study, and three quarters will develop AIDS or an AIDS related condition.     

Incidence of AIDS and excess of mortality associated with HIV in haemophiliacs in the United Kingdom: report on behalf of the directors of haemophilia centres in the United Kingdom.

OBJECTIVE--To estimate the cumulative incidence of AIDS by time since seroconversion in haemophiliacs positive for HIV and to examine the evidence for excess mortality associated with HIV in those who had not yet been diagnosed as having AIDS. DESIGN--Analysis of data from ongoing national surveys. SETTING--Haemophilia centres in the United Kingdom. PATIENTS--A total of 1201 men with haemophilia who had lived in the United Kingdom during 1980-7 and were positive for HIV. INTERVENTION--None. END POINTS--Diagnosis of AIDS; death in those not diagnosed as having AIDS. MEASUREMENTS AND MAIN RESULTS--Estimation of cumulative incidence of AIDS and number of excess deaths in seropositive patients not diagnosed with AIDS. Median follow up after seroconversion was 5 years 2 months. Eight five patients developed AIDS. Cumulative incidence of AIDS five years after seroconversion was 4% among patients aged less than 25 at first test positive for HIV, 6% among those aged 25-44, and 19% among those aged greater than or equal to 45. There was little evidence that type or severity of haemophilia or type of factor VIII or IX that had caused HIV infection affected the rate of progression to AIDS. Mortality was increased among those who had not been diagnosed as having AIDS, especially among those with "AIDS related complex." Thirteen deaths were observed among 36 patients diagnosed as having AIDS related complex against 0.65 expected, and 34 deaths in 1080 other patients against 22.77 expected; both calculations were based on mortality rates observed in haemophiliacs in the United Kingdom in the late 1970s. CONCLUSIONS--Rate of progression to AIDS depended strongly on age. There is a substantial burden of fatal disease among patients positive for HIV who have not been formally diagnosed as having AIDS.     

Censoring in an epidemic with an application to hemophilia-associated AIDS

In epidemiologic studies of infectious diseases, the times of infection may be known only up to an interval. A two-stage parametric regression model is proposed for the analysis of cohort studies during an epidemic in which the exact times of infection cannot be ascertained. The methods permit joint estimation of the effects of covariates both on the risk of infection and the risk of progression to clinical disease once infected. The methodology is applied to a cohort of hemophiliacs who were at risk of infection with the AIDS virus. It was found that hemophiliacs with severe Type A hemophilia were at highest risk of infection, and the risk of infection increased sharply in the early 1980s. Hemophiliacs who were over the age of 20 at infection were at higher risk of progression to AIDS than hemophiliacs who were under age 20. The estimate of the cumulative probability of developing AIDS within t years of infection (the incubation period distribution) for hemophiliacs over age 20 was 1 - exp(-.0021t2.516). Since follow-up in this cohort was restricted to about 10 years from infection, estimates of the incubation period distribution beyond 10 years depend on model extrapolation and should be interpreted cautiously.     

HIV and HTLV-I antibody studies: pregnant women in the 1960s, patients with AIDS, homosexuals, and individuals with tropical spastic paraparesis

To investigate the possible occurrence of human immunodeficiency virus (HIV) or human T-cell lymphotropic virus, type I (HTLV-I) infections in the United States prior to 1979-1981, when acquired immune deficiency syndrome (AIDS) was first recognized, we tested sera from 310 pregnant women who participated in the Collaborative Perinatal Project during the period 1959-1964 for HIV and HTLV-I antibody. These samples included sera from 53 pregnant women who were intravenous drug users. The remainder were from women who had cervical epithelial abnormalities, who developed cervical carcinomas, who had had children with erythroblastosis fetalis, who had had children that developed malignant neoplasms early in life, or normal pregnant women. None of the 310 women had confirmed HIV or HTLV-I antibody. The rate of false-positive reactions with the HIV enzyme-linked immunosorbent assay (ELISA) antibody test in these long-frozen samples was similar to that observed in fresh sera. HIV antibody was detected in homosexual patients with AIDS; HTLV-I antibody was not detected in any of these sera. HTLV-I antibody was detected in 17 of 20 patients with tropical spastic paraparesis (TSP) and in two of seven patients with other neurological diseases diagnosed as transverse myelopathy and multiple sclerosis, and in none of nine normal controls; HIV antibody was not detected in any of these sera patients. Thus, we conclude that there was no serological evidence of infection with HIV or HTLV-I in the pregnant women studied; however, HIV antibody was present in all AIDS patients tested, and HTLV-I antibody was found in the majority of patients with TSP.     

Charitable Giving for HIV and AIDS: Results from a Canadian National Survey

Background

For the first time, a national survey of adults in Canada posed questions on charitable giving for HIV and AIDS. The objective of this analysis was to explore the behaviour and attitudes of this population in terms of charitable giving.

Methods

In 2011, individuals in Canada 16 years of age or older were recruited for a survey from an online panel supplemented by random digit dial telephone interviewing. The margin of error was +/−2.1 percentage points (95%). Chi-square tests were used to detect bivariate associations. A multivariate logistic regression model was fit to compare those who had donated to HIV and AIDS in the past 12 months with those who had donated to other disease or illness charities.

Results

2,139 participated. 82.5% had donated to a charitable cause in the past 12 months. 22.2% had ever donated to HIV and AIDS, with 7.8% doing so in the past 12 months. Individuals who had donated to HIV and AIDS versus other disease or illness charities tended to be younger (p<0.05), single (p<0.005), more highly educated (p<0.001) and to self-identify as a member of a sexual minority group (p<0.001). Multivariate analysis revealed individuals who self-identified as a member of a sexual minority group were significantly much more likely to have donated to HIV and AIDS than to other disease or illness charities in the past 12 months (OR, 7.73; p<0.001; CI 4.32–13.88).

Discussion

Despite a generally philanthropic orientation, relatively few respondents had ever been involved in charitable giving for HIV and AIDS. Those who had could be understood relationally as individuals at closer social proximity to HIV and AIDS such as members of sexual minority groups.     

Sexual behaviour, contraceptive practice and knowledge of AIDS of Oxford University students

In 1987, a questionnaire was sent to 584 undergraduate students at Oxford University requesting information about their sexual behavior and contraceptive practices as well as the impact of acquired immunodeficiency syndrome (AIDS) on both these factors. Of the 374 responders, 65% of the women and 62% of the men had experienced sexual intercourse; 1st intercourse had occurred at ages 16-20 years for 89% of the experienced women and 83% of the men. For 36% of women and 37% of men intercourse had been with 1 partner only, for 28% of women and 27% of men with 2-3 partners, and for 36% of both men and women with more than 3 partners. 27% of the women reported no contraceptive was used at the time of 1st intercourse. During the 4 weeks preceding completion of the questionnaire, 15% of sexually active female undergraduates reported not using adequate contraception. Users during this period selected the pill (64%), condom (19%), IUD or diaphragm (9%), or withdrawal/rhythm (8%). General knowledge about AIDS was highly accurate among these students. Most students considered themselves to be at lower risk of contracting AIDS than others of their age and sex. Of the 78% of students describing themselves as at lower than average risk, 14% had had intercourse with more than 3 partners, while 50% of the 20% of students who ranked themselves as at average risk had this number of partners. Only 2% placed themselves as at above average risk, and 65% of these students had had more than 3 sexual partners. Of students who were sexually active, 35% of the females and 44% of the males indicated they are now more likely to use a condom because of fear of AIDS. 49% of the females and 30% of the males indicated they had, or would have, fewer sexual partners because of the AIDS risk. However, there was no association between increased likelihood of condom use and the total number of sexual partners and having had intercourse with someone in a high-risk group for AIDS (prostitutes). Overall, however, these findings suggest that the AIDS threat is producing reductions in high-risk behaviors.     

Enzymatic profile of Cryptococcus neoformans strains by using the API-ZYM system

Determination of the enzymatic profile of 41 Cryptococcus neoformans strains, 20 isolated from AIDS patients and 21 from bird droppings, was performed by using the API-ZYM commercial kit system (Bio-Mérieux, France), which tests 19 different kinds of enzymes. All the strains showed positive enzymatic activity to the esterase (C4) (n. 3). On the contrary, alkaline phosphatase (n. 2), cystine arylamidase (n. 8), trypsin (n. 9), chymotripsin (n. 10), alpha-galactosidase (n. 13), beta-glucuronidase (n. 15), alpha-mannosidase (n. 19), alpha-fucosidase (n. 20) were negative in all the strains. The other 10 enzymes (n. 4,5,6,7,11,12,14,16,17,18) were distributed among the strains in different positive percentages. From the results of each enzymatic profile obtained, the 20 AIDS strains were grouped into 15 types, while the 21 bird dropping strains were grouped into 14 types. Interestingly, only one enzyme profile type occurred in the strains isolated from the AIDS patients and from the bird droppings. These results suggest that the API ZYM system is useful in discriminating between the AIDS strains and the bird dropping strains.     

AIDS in the infant

Recently, we and others have encountered a group of infants who developed AIDS. They were born from parents who belonged to identified risk factors for AIDS. The clinical and immunologic features were described. The existence of a pediatric form of AIDS transmitted other than by transfusion suggests the possibility of transplacental perinatal or postnatal transmission.     

Epidemiology of HIV infection and AIDS in Croatia--an overview

This article presents an overview of HIV/AIDS epidemiology and surveillance in Croatia 20 years after the first documented case of AIDS in the country. Here we describe strategies employed for HIV/AIDS surveillance in Croatia as well as preliminary results of HIV seroprevalence among most-at-risk populations (MARPs) research conducted by the Infectious Diseases Epidemiology Service at the Croatian National Institute of Public Health (CNIPH). Croatia has a low incidence and prevalence of HIV and AIDS. At the end of 2005, there were 553 documented cases of HIV infection, 239 of which progressed to AIDS. In Croatia, AIDS is being registered within MARPs only and dominantly among men who have sex with men (MSM). AIDS patients and HIV infected persons are found in all parts of the country. Crude prevalence of HIV among MARPs was found to be 0.9%. It is necessary to continue with current prevention and control measures in the country, and to create a culture of awareness and precaution, a strategy that has proven effective in reducing risk of HIV infection.     

Serum lactic dehydrogenase predicts mortality in patients with AIDS and Pneumocystis pneumonia.

Serum lactic dehydrogenase (LDH) activity was compared with mortality in patients with the acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia during the first four days of admission to assess the test''s predictive value. In 30 admissions, 29 patients who survived an episode of Pneumocystis pneumonia had a mean LDH value of 385 IU, with five values greater than 520 IU. Eight with pneumonia who died had a mean value of 926 IU: all had values higher than 520 IU. The mean LDH values for 20 patients with AIDS (35 admissions) who survived and 4 who died of non-Pneumocystis disease were 240 IU and 350 IU, respectively; these patients were the control population. The positive and negative predictive values for survival using 520 IU as the threshold are 61% and 100%. Thus, LDH measurements in the first days of admission for P carinii pneumonia predict mortality and are useful in guiding future management.     

AIDS awareness among rural Utah physicians.

Studies of physicians'' attitudes and knowledge of the acquired immunodeficiency syndrome (AIDS) and the clinical precautions they take against exposure to the human immunodeficiency virus (HIV) have focused on urban physicians. To determine rural physicians'' knowledge and attitudes about AIDS, a questionnaire was mailed to 321 physicians practicing in rural Utah. Of the 169 physicians who completed questionnaires, 96% thought that their community or area of service had only a minor or no problem with AIDS; 89%, however, thought that their chance of seeing a patient who was HIV-positive was fair to moderate. Of the 169 respondents, 3% were not sure whether they would even treat a patient who had AIDS, 67% said they would, and 30% said they would not. Although all physicians are at risk of seeing a patient who has had exposure to HIV and other blood-borne diseases such as hepatitis B, only 55% of the respondents felt a need to take clinical precautions to prevent their exposure to the virus. Our study shows the need for all rural Utah physicians to reevaluate their risk of exposure to HIV, to increase precautionary measures for their own protection, to consider the ethical responsibility of treating AIDS patients, and to take a more active role in teaching their patients how to protect themselves from exposure to the virus.     

Neurological dysfunction in asymptomatic HIV-1 infected men: evidence from evoked potentials

Neurological function in 159 subjects infected by the human immunodeficiency virus (HIV) who had no neurological symptoms or signs (129 asymptomatic, 30 with ARC/AIDS) was compared to that of 62 controls by means of pattern-reversal evoked potentials (PREPs), brain-stem auditory evoked potentials (BAEPs), median nerve somatosensory evoked potentials (MSEPs), tibial nerve somatosensory evoked potentials (TSEPs) and nerve conduction studies (NCSs). Central nervous system somatosensory conduction from lumbar cord to cortex was prolonged in both asymptomatic seropositive and ARC/AIDS groups, while peripheral somatosensory conduction, NCSs and PREP delays occurred only in the ARC/AIDS group. BAEPs did not show significant differences among groups. TSEPs were abnormal in 8% of asymptomatic carriers and 43% of patients with ARC/AIDS, MSEPs in 7% and 20%, PREPs in 4% and 0%, and BAEPs in 1% and 0% respectively. One or more evoked potentials were abnormal in 18 of 129 (14%) asymptomatic carriers and 13 of 30 (43%) subjects with ARC/AIDS as compared with 1 of 62 (2%) seronegative controls. We conclude that asymptomatic HIV carriers have subclinical neurological impairment of central somatosensory function and that the neurological impairment increases with disease progression to involve peripheral nerves and visual system.     

Does the onset of tuberculosis in AIDS predict shorter survival? Results of a cohort study in 17 European countries over 13 years. AIDS in Europe Study Group.

OBJECTIVE--To assess the impact of tuberculosis on mortality in patients with AIDS. DESIGN--Community based cohort study. SETTING--52 centres in 17 countries (AIDS in Europe study). SUBJECTS--5249 patients who were alive and free of tuberculosis one month after the diagnosis of AIDS, enrolled between 1979 and 1989, and followed up until 1992. MAIN OUTCOME MEASURES--Onset of clinically active tuberculosis or death, or both. RESULTS--During a mean follow up period of 15 months 201 (4%) patients developed tuberculosis and 3889 (74%) died. Patients who developed tuberculosis survived significantly longer (median 22 months) than those who did not (median 16 months). This apparent survival advantage was due to patients who survived longer having more opportunity to develop tuberculosis (or any other disease). In models that took into account the time at which tuberculosis was diagnosed, the onset of tuberculosis was associated with a significant increase in mortality (adjusted relative hazard of death 1.34; 95% confidence interval 1.12 to 1.60). CONCLUSIONS--The onset of tuberculosis in patients with AIDS predicts a substantial increase in mortality. Whether this increased mortality is directly attributable to the tuberculosis remains uncertain. If the association is causal preventive chemotherapy and aggressive treatment of tuberculosis could improve survival in AIDS.     

Changing disease patterns in patients with AIDS in a referral centre in the United Kingdom: the changing face of AIDS.

OBJECTIVE--To study the changes in morbidity, mortality, and survival patterns in a population of patients with AIDS in the United Kingdom from 1982 to 1989. DESIGN--A retrospective analysis of inpatient and outpatient records of patients with AIDS. SUBJECTS--347 Patients with AIDS, predominantly homosexual or bisexual men. SETTING--Departments of immunology and genitourinary medicine, St Mary''s Hospital, London. MAIN OUTCOME MEASURES--Presenting diagnosis of AIDS, occurrence of other opportunist diseases, cause of death, and survival since AIDS was diagnosed, in particular for those patients with Pneumocystis carinii pneumonia or Kaposi''s sarcoma. RESULTS--The overall proportion of patients who developed P carinii pneumonia dropped from 56% (20/36) in 1984 to 24% (46/194) in 1989, although it has remained the index diagnosis in about half of new patients. Kaposi''s sarcoma has decreased as index diagnosis from 30% (20/67) to 20% (15/74) over the same period, though the prevalence has remained constant at around 35%. P carinii pneumonia accounted for 46% (16/35) of known causes of death in 1986 but only 3% (1/31) in 1989. Conversely, deaths due to Kaposi''s sarcoma rose from 14% (1/7) to 32% (10/31) between 1984 and 1989. Lymphoma accounted for an increased proportion of deaths among these patients with 16% (5/31) of deaths in 1989. Their median survival increased from 10 months in 1984-6 to 20 months in 1987. CONCLUSIONS--The changing patterns of disease in patients with AIDS have important implications both for health care provision and future medical research. Medical and nursing provision must be made for the increased morbidity of these diseases and the increased survival of these patients. Research should now be directed towards developing effective treatments for the opportunist infections which are currently more difficult to treat, the secondary malignancies of AIDS, as well as more effective immunorestorative treatments. Future changes in disease patterns must be recognised at an early stage so that resources can be adequately planned and allocated.     

Underreporting of AIDS cases in Canada: a record linkage study.

To estimate the rate of underreporting of AIDS (acquired immune deficiency syndrome) to the Federal Centre for AIDS (FCA), in 1988 the initials, date of birth and place of residence of 66 patients with AIDS known to the Toronto Sexual Contact Study (TSCS), 65 patients with AIDS known to the Vancouver Lymphadenopathy-AIDS Study (VLAS) and other participants in both studies who did not have AIDS were sent to the Bureau of Epidemiology and Surveillance, FCA. The FCA conducted a manual record linkage to link these data to the national registry of reported cases. The rate of underreporting was 12% (8/65) for the VLAS and 18% (12/66) for the TSCS. The specific diagnosis was not related to the rate of underreporting. For the TSCS the rate of underreporting had increased from 0% in 1983-84 to 44% in 1987-88 (p = 0.001). Differences in the observed rates of underreporting between the two studies are likely the result of differences in the reporting responsibilities of physicians involved in the studies.     

Campaign against AIDS in Switzerland: evaluation of a nationwide educational programme.

The campaign against the spread of the acquired immune deficiency syndrome (AIDS) in Switzerland includes a nationwide educational programme. A booklet about AIDS was mailed to every Swiss household in March 1986, and in 1987 there has been a mass media campaign promoting the use of condoms. We evaluated the results of the first phase--the distribution of the booklet--using a separate sample pretest and post-test design. The pretest was carried out 15 days before the booklet was mailed (sample n = 1056) and the post-test two months after the booklet was mailed (n = 1278). Of the population aged 20-69, to whom the book was sent, 56% read the booklet. For those who read the booklet compared with those who did not the results showed an improvement in knowledge and a better understanding of the risks of specific behaviours and of exposed groups and thus less fear of becoming infected through daily activities. The mean indices of knowledge and beliefs were significantly different when tested by the Kruskal-Wallis method. Having better information does not imply that people will change their behaviour, but both the high reading rate and the increase in knowledge suggest that the Swiss educational programme reached its objectives. Moreover, the success of this campaign helps to support other campaigns that are being developed to promote the use of condoms.     

Incidence of tuberculosis among reported AIDS cases in Quebec from 1979 to 1996

BACKGROUND: The impact of HIV infection on tuberculosis (TB) rates in Quebec has not been fully established. Because concurrent HIV infection is the single most important factor in TB reactivation, the authors used Quebec AIDS surveillance data to quantify the extent of TB among reported AIDS cases and to identify the characteristics of AIDS patients with TB. METHODS: The study population comprised people aged 15 years and over with AIDS diagnosed between Jan. 1, 1979, and Dec. 31, 1996, and reported by Mar. 13, 1997. Patients with TB (all forms) and those without TB were compared. Multivariate logistic regression analysis was used to examine the independent effect of each variable on the AIDS-TB cases. The authors also compared the number of AIDS-TB cases with the number of TB cases to estimate the effect of HIV infection on TB incidence. RESULTS: Of the 4684 people with AIDS reported in Quebec, 242 (5.2%) had active TB at some point during the course of their illness. During 1992-1995, 9.6% of the people with TB in Montreal, and 5.8% in the province of Quebec, also had HIV infection. Those with AIDS and TB were predominantly male (75.2%), manual workers (40.1%) and residents of Montreal (86.4%) and were born in an HIV-endemic country (63.8%). The multivariate analysis indicated that AIDS patients who were born in HIV-endemic countries in the Caribbean, sub-Saharan Africa or other developing regions were 21.8 times (95% confidence interval [CI] 19.5-28.5), 17.9 times (95% CI 12.7-27.1) and 4.9 times (95% CI 3.5-7.0) more likely to have TB than those born in Canada; manual workers and unemployed people with AIDS were 1.6 times (95% CI 1.3-2.0) and 2.0 times (95% CI 1.5-2.6) more likely to have TB than professional workers; and people who acquired HIV infection through heterosexual contact were 2.1 times (95% CI 1.6-3.1) more likely to have TB than men who acquired it through sexual contact with other men. INTERPRETATION: AIDS seems to contribute significantly to the number of TB cases. The results of this study reinforce the importance of offering HIV testing to people in high-risk groups, such as those born in a country where HIV and TB is endemic.     

Increase in non-AIDS related conditions as causes of death among HIV-infected individuals in the HAART era in Brazil

Background

In 1996, Brazil became the first developing country to provide free and universal access to HAART. Although a decrease in overall mortality has been documented, there are no published data on the impact of HAART on causes of death among HIV-infected individuals in Brazil. We assessed temporal trends of mortality due to cardiovascular diseases (CVD), diabetes mellitus (DM) and other conditions generally not associated with HIV-infection among persons with and without HIV infection in Brazil between 1999 and 2004.

Methodology/Principal Findings

Odds ratios were used to compare causes of death in individuals who had HIV/AIDS listed on any field of the death certificate with those who did not. Logistic regression models were fitted with generalized estimating equations to account for spatial correlation; co-variables were added to the models to control for potential confounding. Of 5,856,056 deaths reported in Brazil between 1999 and 2004 67,249 (1.15%) had HIV/AIDS listed on the death certificate and non-HIV-related conditions were listed on 16.3% in 1999, increasing to 24.1% by 2004 (p<0.001). The adjusted average yearly increases were 8% and 0.8% for CVD (p<0.001), and 12% and 2.8% for DM (p<0.001), for those who had and did not have HIV/AIDS listed on the death certificate, respectively. Similar results were found for these conditions as underlying causes of death.

Conclusions/Significance

In Brazil between 1999 and 2004 conditions usually considered not to be related to HIV-infection appeared to become more likely causes of death over time than reported causes of death among individuals who had HIV/AIDS listed on the death certificate than in those who did not. This observation has important programmatic implications for developing countries that are scaling-up access to antiretroviral therapy.