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

Details

Ressource 1Download: BIB_6AFBA389E9F2.P001.pdf (356.65 [Ko])
State: Public
Version: Final published version
Serval ID
serval:BIB_6AFBA389E9F2
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Cause-Specific Mortality in HIV-Positive Patients Who Survived Ten Years after Starting Antiretroviral Therapy.
Journal
PloS one
Author(s)
Trickey A., May M.T., Vehreschild J., Obel N., Gill M.J., Crane H., Boesecke C., Samji H., Grabar S., Cazanave C., Cavassini M., Shepherd L., d'Arminio Monforte A., Smit C., Saag M., Lampe F., Hernando V., Montero M., Zangerle R., Justice A.C., Sterling T., Miro J., Ingle S., Sterne J.A.
Working group(s)
Antiretroviral Therapy Cohort Collaboration (ART-CC)
ISSN
1932-6203 (Electronic)
ISSN-L
1932-6203
Publication state
Published
Issued date
2016
Peer-reviewed
Oui
Volume
11
Number
8
Pages
e0160460
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
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.
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.
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.
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.

Keywords
Adolescent, Adult, Aged, Anti-HIV Agents/pharmacology, Anti-HIV Agents/therapeutic use, Demography, Female, HIV Infections/drug therapy, HIV Infections/mortality, HIV-1/drug effects, HIV-1/physiology, Humans, Male, Middle Aged, Risk Factors, Survival Analysis, Young Adult
Pubmed
Web of science
Open Access
Yes
Create date
15/09/2016 20:05
Last modification date
20/08/2019 14:25
Usage data