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HIV Med. 2017 Oct;18(9):655-666. doi: 10.1111/hiv.12505. Epub 2017 Apr 24.

A tale of two countries: all-cause mortality among people living with HIV and receiving combination antiretroviral therapy in the UK and Canada.

Author information

1
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
2
Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
3
Research Department of Infection and Population Health, University College London, London, UK.
4
British Columbia Centre for Disease Control, Vancouver, BC, Canada.
5
Northern Ontario School of Medicine, Sudbury, ON, Canada.
6
Homerton University Hospital NHS Trust, London, UK.
7
Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada.
8
Li Ka Shing Knowledge Institute, Toronto, ON, Canada.
9
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
10
The Ottawa Hospital Division of Infectious Diseases, University of Ottawa, Ottawa, ON, Canada.
11
Faculty of Medicine, McGill University, Montreal, QC, Canada.
12
The Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada.
13
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
14
Maple Leaf Medical Clinic, Toronto, ON, Canada.
15
Women's College Research Institute, Toronto, ON, Canada.
16
York Teaching Hospital NHS Foundation Trust, York, UK.
17
Clinique Medicale l'Actuel, Montreal, QC, Canada.
18
Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
19
Chelsea and Westminster Hospital NHS Trust, London, UK.
20
Toronto General Research Institute, University Health Network, Toronto, ON, Canada.
21
Ontario HIV Treatment Network, Toronto, ON, Canada.

Abstract

OBJECTIVES:

We sought to compare all-cause mortality of people living with HIV and accessing care in Canada and the UK.

METHODS:

Individuals from the Canadian Observational Cohort (CANOC) collaboration and UK Collaborative HIV Cohort (UK CHIC) study who were aged ≥ 18 years, had initiated antiretroviral therapy (ART) for the first time between 2000 and 2012 and who had acquired HIV through sexual transmission were included in the analysis. Cox regression was used to investigate the difference in mortality risk between the two cohort collaborations, accounting for loss to follow-up as a competing risk.

RESULTS:

A total of 19 960 participants were included in the analysis (CANOC, 4137; UK CHIC, 15 823). CANOC participants were more likely to be older [median age 39 years (interquartile range (IQR): 33, 46 years) vs. 36 years (IQR: 31, 43 years) for UK CHIC participants], to be male (86 vs. 73%, respectively), and to report men who have sex with men (MSM) sexual transmission risk (72 vs. 56%, respectively) (all P < 0.001). Overall, 762 deaths occurred during 98 798 person-years (PY) of follow-up, giving a crude mortality rate of 7.7 per 1000 PY [95% confidence interval (CI): 7.1, 8.3 per 1000 PY]. The crude mortality rates were 8.6 (95% CI: 7.4, 10.0) and 7.5 (95% CI: 6.9, 8.1) per 1000 PY among CANOC and UK CHIC study participants, respectively. No statistically significant difference in mortality risk was observed between the cohort collaborations in Cox regression accounting for loss to follow-up as a competing risk (adjusted hazard ratio 0.86; 95% CI: 0.72-1.03).

CONCLUSIONS:

Despite differences in national HIV care provision and treatment guidelines, mortality risk did not differ between CANOC and UK CHIC study participants who acquired HIV through sexual transmission.

KEYWORDS:

AIDS ; HIV ; UK ; Canada; antiretroviral therapy; mortality

PMID:
28440036
PMCID:
PMC5600099
DOI:
10.1111/hiv.12505
[Indexed for MEDLINE]
Free PMC Article

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