Mortality trends for diabetes mellitus, hypertension and cardiovascular disease among people living with and without HIV in Brazil during the COVID-19 pandemic, 2020-2022.

INTRODUCTION

People living with HIV (PLWH) face an increasing burden of non-AIDS-related chronic conditions. However, how the COVID-19 pandemic affected chronic disease-related mortality in this population remains unclear. We assessed changes in mortality among PLWH in Brazil during the COVID-19 pandemic.

METHODS

We conducted a nationwide analysis using Brazil's Mortality Information System, including adults aged ≥18 years with and without HIV mentioned on death certificates from 2016 to 2022. Age- and sex-adjusted mortality ratios (aMRs) were estimated for all-cause mortality and for deaths associated with diabetes mellitus (DM), hypertension (HTN) and cardiovascular disease (CVD) using Poisson generalized linear mixed models, with the pre-pandemic period 2016-2019 used as the reference.

RESULTS

Between 2016 and 2022, 90 888 deaths occurred among PLWH and 9 723 490 among individuals without HIV. Among PLWH, adjusted all-cause mortality ratios were lower in 2020 (aMR 0.918; 95% CI 0.900-0.936) and 2022 (aMR 0.950; 95% CI 0.932-0.968), while estimates for 2021 were close to the reference period. In contrast, individuals without HIV experienced increased mortality in 2020 (aMR 1.106; 95% CI 1.104-1.108), 2021 (aMR 1.269; 95% CI 1.267-1.272) and 2022 (aMR 1.029; 95% CI 1.027-1.031). Among PLWH, mortality associated with DM (aMRs 1.573-1.666), HTN (aMRs 1.738-1.978) and CVD (aMRs 1.242-1.377) increased consistently across all pandemic years. Among individuals without HIV, chronic disease-related mortality showed greater temporal variability, with increases in 2020 and 2021 followed by reductions in 2022.

CONCLUSIONS

Chronic disease-related mortality increased persistently among PLWH during the COVID-19 pandemic, contrasting with declining trends in the general population. These results emphasize distinct mortality dynamics among PLWH during public health crises.