Format

Send to

Choose Destination
PLoS One. 2016 Aug 15;11(8):e0160460. doi: 10.1371/journal.pone.0160460. eCollection 2016.

Cause-Specific Mortality in HIV-Positive Patients Who Survived Ten Years after Starting Antiretroviral Therapy.

Author information

1
School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
2
German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany.
3
Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany.
4
Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark.
5
Division of Infectious Diseases, University of Calgary, Calgary, Canada.
6
Center for AIDS Research, University of Washington, Seattle, WA, United States of America.
7
Department of Internal Medicine, University of Bonn, Bonn, Germany.
8
Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada, and Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
9
Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.
10
INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013, Paris, France.
11
Université Paris Descartes et Assistance Publique-Hôpitaux de Paris, Groupe hospitalier Cochin Hôtel-Dieu, Paris, France.
12
Centre Hospitalier Universitaire de Bordeaux, Hôpital Pellegrin, Bordeaux, F-33000, France.
13
Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
14
Research Department of Infection and Population Health, UCL Medical School, London, United Kingdom.
15
Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Milan, Italy.
16
Stichting HIV Monitoring, Amsterdam, the Netherlands.
17
Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, United States of America.
18
Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Avda. Monforte de Lemos, 5 28029, Madrid, Spain.
19
La Fe Hospital, Valencia, Spain.
20
Innsbruck Medical University, Innsbruck, Austria.
21
Yale University School of Medicine, New Haven, CT, United States of America, and VA Connecticut Healthcare System, West Haven, CT, United States of America.
22
Vanderbilt University School of Medicine, Nashville, TN, United States of America.
23
Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.

Abstract

OBJECTIVES:

To estimate mortality rates and prognostic factors in HIV-positive patients who started combination antiretroviral therapy between 1996-1999 and survived for more than ten years.

METHODS:

We used data from 18 European and North American HIV cohort studies contributing to the Antiretroviral Therapy Cohort Collaboration. We followed up patients from ten years after start of combination antiretroviral therapy. We estimated overall and cause-specific mortality rate ratios for age, sex, transmission through injection drug use, AIDS, CD4 count and HIV-1 RNA.

RESULTS:

During 50,593 person years 656/13,011 (5%) patients died. Older age, male sex, injecting drug use transmission, AIDS, and low CD4 count and detectable viral replication ten years after starting combination antiretroviral therapy were associated with higher subsequent mortality. CD4 count at ART start did not predict mortality in models adjusted for patient characteristics ten years after start of antiretroviral therapy. The most frequent causes of death (among 340 classified) were non-AIDS cancer, AIDS, cardiovascular, and liver-related disease. Older age was strongly associated with cardiovascular mortality, injecting drug use transmission with non-AIDS infection and liver-related mortality, and low CD4 and detectable viral replication ten years after starting antiretroviral therapy with AIDS mortality. Five-year mortality risk was <5% in 60% of all patients, and in 30% of those aged over 60 years.

CONCLUSIONS:

Viral replication, lower CD4 count, prior AIDS, and transmission via injecting drug use continue to predict higher all-cause and AIDS-related mortality in patients treated with combination antiretroviral therapy for over a decade. Deaths from AIDS and non-AIDS infection are less frequent than deaths from other non-AIDS causes.

PMID:
27525413
PMCID:
PMC4985160
DOI:
10.1371/journal.pone.0160460
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Public Library of Science Icon for PubMed Central
Loading ...
Support Center