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

Abstract 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.