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Int J Epidemiol. 2016 Feb;45(1):140-50. doi: 10.1093/ije/dyv352. Epub 2016 Jan 15.

The effect of antiretroviral therapy on all-cause mortality, generalized to persons diagnosed with HIV in the USA, 2009-11.

Author information

1
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, NC, USA, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, clesko2@jhu.edu.
2
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, NC, USA.
3
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
4
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, NC, USA, Department of Medicine, Division of Infectious Diseases, University of North Carolina, NC, USA and.
5
Department of Medicine, Division of Infectious Diseases, University of North Carolina, NC, USA and.
6
Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.

Abstract

BACKGROUND:

Although antiretroviral therapy (ART) is known to be protective against HIV-related mortality, the expected magnitude of effect is unclear because existing estimates of the effect of ART may not directly generalize to recently HIV-diagnosed persons.

METHODS:

In this study, we estimated 5-year mortality risks for immediate versus no ART initiation among patients (n = 12,547) in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) using the complement of adjusted Kaplan-Meier survival functions. We subsequently standardized estimates to persons diagnosed with HIV in the USA between 2009 and 2011, who were enumerated using national surveillance data.

RESULTS:

The 5-year mortality, had all patients in the CNICS immediately initiated ART, was 10.6% [95% confidence interval (CI): 9.3%, 11.9%] compared with 28.3% (95% CI: 19.1%, 37.5%) had ART initiation been delayed at least 5 years. The 5-year mortality risk difference due to ART among patients in the CNICS was -17.7% (95% CI: -27.0%, -8.4%). Based on methods for generalizing an estimate from a study sample to a different target population, the expected risk difference due to ART initiation among recently HIV-diagnosed persons in the USA was -19.1% (95% CI: -30.5%, -7.8%).

CONCLUSIONS:

Immediate ART initiation substantially lowers mortality among persons in the CNICS and this benefit is expected to be similar among persons recently diagnosed with HIV in the USA. We demonstrate a method by which concerns about generalizability can be addressed and evaluated quantitatively.

KEYWORDS:

HIV; antiretroviral therapy; effect modification; external validity; generalizability; mortality; survival analysis

PMID:
26772869
PMCID:
PMC5013889
DOI:
10.1093/ije/dyv352
[Indexed for MEDLINE]
Free PMC Article

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