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

Background: HIV can compromise the immune system, making individuals more Vulnerable to COVID-19. People living with HIV (PLWH) have higher rates of comorbidities such as hypertension (HTN), diabetes mellitus (DM) and cardiovascular diseases (CVD), known risk factors for severe COVID-19. We aimed to understand the impact of the COVID-19 pandemic on mortality among PLWH in Brazil. Methods: Using data from the Brazilian mortality system, we investigated mortality among individuals with and without mention of HIV on their death certificates from 2019 to 2022. The dataset included all recorded causes of death, as specified on death certificates. Adjusted Mortality Ratios (aMRs) for overall, HTN, DM, and CVD, were determined by comparing mortality rates from 2020 to 2022 with 2019. Poisson regression models were used to estimate aMRs. Findings: A significant increase in the overall mortality rate was observed among non-HIV individuals during the pandemic. Conversely, PLWH exhibited only a modest increase in the mortality rates in 2021 and 2022 (of 7% and 3%, respectively). Among PLWH, aMRs increased in 2020, 2021 and 2022 for DM (41%, 39·7% and 39·3%), HTN (41·5%, 59·7% and 57·6%) and CVD (14·2%, 27·8% and 26%), respectively. Interpretation: This study highlights high mortality rates for DM, HTN and CVD among PLWH in Brazil between 2020 and 2022, compared to 2019. These findings underscore the importance of public health policies in managing chronic diseases, thus preventing the exacerbation of health inequalities, with special attention to vulnerable populations, such as PLWH. Funding: This study was partially supported by Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Fundação Osvaldo Cruz (FIOCRUZ) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Declaration of Interest: The authors declare that they have no competing interests related to this study. Ethical Approval: This research utilized publicly available information and aggregated data without individual identification (DataSUS and IBGE data). Thus, an exemption from submission to the Research Ethics Committee is granted by the Brazilian federal resolution, CNS No. 510, from 2016.