Resum

Antiretroviral therapy (ART) use was followed by mortality reductions and a shift in the causes of death from AIDS to non-AIDS deaths in most settings. In Mexico, mortality due to HIV/AIDS has remained constant even after the expansion of ART use in 2004. Information regarding time from HIV diagnosis to death and causes of death may provide important information on the contribution of late diagnosis on mortality and therefore help to identify gaps in the early phases of the continuum of care. We aimed to estimate the proportion of people dying in the first year after HIV diagnosis, and to describe their causes of death in recent years. Using national death registry data, we identified all registered deaths among HIV-infected people between 2004-2015. We define early mortality (EM) as deaths occurring within the first year after HIV-diagnosis and very early mortality (VEM) as deaths in the first month after HIV–diagnosis. We describe changes in the proportion of EM by calendar year and stratified by gender using logistic models. We classified the main cause of death according to ICD-10, and described the most frequent causes of death by gender, calendar year and EM condition. Between 2004 and 2015 there were 10,872 deaths in HIV-infected women and 48,824 in men. AIDS-related deaths occurred in 74% of all subjects. The most frequent AIDS-related causes of death were: pneumonia (n=14070, 23%), tuberculosis (n=4646, 8%), pneumocystis (n=2197, 4%), and AIDS malignancy (n=1281, 2%); non-AIDS-related causes were: sepsis (n=7352, n=12%) and non-AIDS malignancy (n=1281, 2%) (Fig 1A). When stratified by sex there were non-significant differences in causes of death over time. Fifty three percent (n=3,677) and 57% (n=17,824) were classified as EM in women and men, respectively and did not change along time in both groups. VEM increased from 15% to 22% p<0.001, with no differences by sex (Fig 1B). AIDS explained 75% of EM. Overall, men had a higher risk of EM (OR: 1.14 [95%CI: 1.09-1.18], p<0.01). The stable EM, increasing VEM and the high percentage of deaths related to AIDS are markers of late HIV diagnosis, which persists along time in Mexico. Non-AIDS causes of death are a small proportion, with modest increase in later years in acute myocardial infarction and non-AIDS malignancies. These results support that policy efforts should be directed to expand HIV diagnosis and early linkage to care.