Clinical characteristics and mortality risk factors among 400,509 individuals diagnosed with AIDS in Brazil: A nationwide observational study.

OBJECTIVES

AIDS remains a major global public-health challenge, with persistent care-cascade gaps driving preventable deaths, especially in LMICs. In Brazil, uneven progress and late presentation reflect social and regional inequities. We used the national notifiable diseases system (SINAN) to profile AIDS at diagnosis and identify mortality risk factors.

STUDY

DESIGN

National retrospective cohort study using the SINAN from 2007 to 2022.

METHODS

We included all SINAN records of AIDS diagnoses in Brazil between 2007 and 2022. Extracted variables comprised demographics (age, sex, education, race), clinical data (AIDS-defining conditions, comorbidities), and outcomes (vital status, time to death). Annual trends and state-level patterns were described using time-series and spatial analyses. Independent mortality factors were identified with multivariable logistic regression. Kaplan-Meier curves compared survival for the most versus least prevalent conditions, with sub-analyses of frequent diseases.

RESULTS

Among 400,509 patients, 17.2% died. Those who died were older, predominantly black and mixed-race, and had higher education. Seventeen variables were independently associated with mortality; the strongest were non-Hodgkin lymphoma (Burkitt/diffuse large B-cell; aOR: 3.16, 95%CI: 2.84-3.51), extrapulmonary cryptococcosis (2.96, 2.72-3.22), disseminated histoplasmosis (2.50, 2.25-2.79), Pneumocystis jirovecii pneumonia (2.25, 2.15-2.35), and central nervous system dysfunction (1.83, 1.75-1.91). Kaplan-Meier curves showed shorter survival for prevalent conditions, especially Pneumocystis pneumonia (p < 0.001).

CONCLUSIONS

Mortality was driven by AIDS-defining conditions, particularly non-Hodgkin lymphoma, extrapulmonary cryptococcosis, and disseminated histoplasmosis. Classic signs and symptoms (prolonged fever, weight loss, cytopenias) also predicted death. Early recognition and timely treatment of these high-risk presentations are essential in Brazil.