Impact of Non-HIV and HIV Risk Factors on Survival in HIV-Infected Patients on HAART: A Population-Based Nationwide Cohort Study

We determined the impact of three factors on mortality in HIV-infected patients who had been on highly active antiretroviral therapy (HAART) for at least one year: (1) insufficient response to (HAART) and presence of AIDS-defining diseases, (2) comorbidity, and (3) drug and alcohol abuse and compare...

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Published in:PloS one Vol. 6; no. 7; p. e22698
Main Authors: Obel, Niels, Omland, Lars Haukali, Kronborg, Gitte, Larsen, Carsten S., Pedersen, Court, Pedersen, Gitte, Sørensen, Henrik Toft, Gerstoft, Jan
Format: Journal Article
Language:English
Published: United States Public Library of Science 25.07.2011
Public Library of Science (PLoS)
Subjects:
Acquired immune deficiency syndrome
Adult
Age
AIDS
Alcohol abuse
Alcoholic beverages
Alcoholism
Alcoholism - complications
Antiretroviral agents
Antiretroviral drugs
Antiretroviral Therapy, Highly Active
Cardiovascular disease
Cohort analysis
Cohort Studies
Comorbidity
Confidence intervals
Denmark - epidemiology
Drug abuse
Female
Health risk assessment
Health risks
Highly active antiretroviral therapy
HIV
HIV infections
HIV Infections - complications
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV Infections - mortality
HIV patients
Human immunodeficiency virus
Humans
Male
Medical diagnosis
Medical research
Medicine
Middle Aged
Mortality
Patient outcomes
Patients
Population studies
Population-based studies
Risk analysis
Risk Factors
Statistical analysis
Survival
Survival Analysis
Treatment Outcome
Denmark
ISSN:1932-6203, 1932-6203
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Summary:We determined the impact of three factors on mortality in HIV-infected patients who had been on highly active antiretroviral therapy (HAART) for at least one year: (1) insufficient response to (HAART) and presence of AIDS-defining diseases, (2) comorbidity, and (3) drug and alcohol abuse and compared the mortality to that of the general population. In a Danish nationwide, population-based cohort study, we used population based registries to identify (1) all Danish HIV-infected patients who started HAART in the period 1 January 1998-1 July 2009, and (2) a comparison cohort of individuals matched on date of birth and gender (N = 2,267 and 9,068, respectively). Study inclusion began 1 year after start of HAART. Patients were categorised hierarchically in four groups according to the three risk factors, which were identified before study inclusion. The main outcome measure was probability of survival from age 25 to 65 years. The probability of survival from age 25 to age 65 was substantially lower in HIV patients [0.48 (95% confidence interval (CI) 0.42-0.55)] compared to the comparison cohort [0.88 (0.86 to 0.90)]. However, in HIV patients with no risk factors (N = 871) the probability of survival was equivalent to that of the general population [0.86 (95% CI 0.77-0.92)]. In contrast, the probability of survival was 0.58 in patients with HIV risk factors (N = 704), 0.30 in patients with comorbidities (N = 479), and 0.03 in patients with drug or alcohol abuse (N = 313). The increased risk of death in HIV-infected individuals is mainly attributable to risk factors that can be identified prior to or in the initial period of antiretroviral treatment. Mortality in patients without risk factors on a successful HAART is almost identical to that of the non-HIV-infected population.
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Conceived and designed the experiments: NO. Performed the experiments: NO. Analyzed the data: NO LHO GK CSL CP GP HTS JG. Contributed reagents/materials/analysis tools: NO LHO GK CSL CP GP HTS JG. Wrote the paper: NO. Reviewed the first draft of the paper and approved the manuscript: NO LHO GK CSL CP GP HTS JG.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0022698