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Clin Infect Dis. 2014 Jul 15;59(2):287-97. doi: 10.1093/cid/ciu261. Epub 2014 Apr 24.

Impact of risk factors for specific causes of death in the first and subsequent years of antiretroviral therapy among HIV-infected patients.

Author information

1
School of Social and Community Medicine, University of Bristol, United Kingdom.
2
Division of Infectious Diseases, University of Calgary, Canada.
3
Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham.
4
INSERM, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux Université Bordeaux, Institut de Santé Publique, d'Epidémiologie et de Developpement (ISPED).
5
UPMC Université Paris 06, UMR_S 943 INSERM, UMR_S 943, Paris Service des maladies infectieuses et tropicales, AP-HP, Hôpital Avicenne, Bobigny, France.
6
Department of Internal Medicine, University of Cologne, Germany.
7
Stichting HIV Monitoring, and Division of Infectious Diseases and Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, The Netherlands.
8
Infectious Diseases Service, Hospital Clinic-IDIBAPS, Barcelona, Spain.
9
INSERM, UMR_S 943, Paris AP-HP, Hôpital Cochin, Unité de Biostatistique et Epidémiologie, Paris Université Paris Descartes.
10
INSERM, ISPED, Centre Inserm U897-Epidemiologie-Biostatistique, Bordeaux, France.
11
BC Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada.
12
Research Department of Infection and Population Health, University College London, United Kingdom.
13
Vanderbilt University School of Medicine, Nashville, Tennessee.
14
Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, University of Milan, Italy.
15
Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid CIBER de Epidemiología y Salud Pública, Madrid.
16
Unit of Infectious Diseases, Hospital Sierrallana, Torrelavega, Spain.
17
HIV Atlanta VA Cohort Study, Atlanta Veterans Affairs Medical Center, Decatur, Georgia.
18
Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Switzerland.
19
Clinical Epidemiology and Health Services Research Core, Center for AIDS Research, University of Washington, Seattle.

Abstract

BACKGROUND:

Patterns of cause-specific mortality in individuals infected with human immunodeficiency virus type 1 (HIV-1) are changing dramatically in the era of antiretroviral therapy (ART).

METHODS:

Sixteen cohorts from Europe and North America contributed data on adult patients followed from the start of ART. Procedures for coding causes of death were standardized. Estimated hazard ratios (HRs) were adjusted for transmission risk group, sex, age, year of ART initiation, baseline CD4 count, viral load, and AIDS status, before and after the first year of ART.

RESULTS:

A total of 4237 of 65 121 (6.5%) patients died (median, 4.5 years follow-up). Rates of AIDS death decreased substantially with time since starting ART, but mortality from non-AIDS malignancy increased (rate ratio, 1.04 per year; 95% confidence interval [CI], 1.0-1.1). Higher mortality in men than women during the first year of ART was mostly due to non-AIDS malignancy and liver-related deaths. Associations with age were strongest for cardiovascular disease, heart/vascular, and malignancy deaths. Patients with presumed transmission through injection drug use had higher rates of all causes of death, particularly for liver-related causes (HRs compared with men who have sex with men: 18.1 [95% CI, 6.2-52.7] during the first year of ART and 9.1 [95% CI, 5.8-14.2] thereafter). There was a persistent role of CD4 count at baseline and at 12 months in predicting AIDS, non-AIDS infection, and non-AIDS malignancy deaths. Lack of viral suppression on ART was associated with AIDS, non-AIDS infection, and other causes of death.

CONCLUSIONS:

Better understanding of patterns of and risk factors for cause-specific mortality in the ART era can aid in development of appropriate care for HIV-infected individuals and inform guidelines for risk factor management.

KEYWORDS:

HIV; antiretroviral therapy; cause-specific mortality

PMID:
24771333
PMCID:
PMC4073781
DOI:
10.1093/cid/ciu261
[Indexed for MEDLINE]
Free PMC Article

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