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

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 Col...

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Vydáno v:	PloS one Ročník 11; číslo 8; s. e0160460
Hlavní autoři:	Trickey, Adam, May, Margaret T., Vehreschild, Janne, Obel, Niels, Gill, Michael John, Crane, Heidi, Boesecke, Christoph, Samji, Hasina, Grabar, Sophie, Cazanave, Charles, Cavassini, Matthias, Shepherd, Leah, d’Arminio Monforte, Antonella, Smit, Colette, Saag, Michael, Lampe, Fiona, Hernando, Vicky, Montero, Marta, Zangerle, Robert, Justice, Amy C., Sterling, Timothy, Miro, Jose, Ingle, Suzanne, Sterne, Jonathan A. C.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Public Library of Science 15.08.2016 Public Library of Science (PLoS)
Témata:	Acquired immune deficiency syndrome Adolescent Adult Age Aged AIDS Anti-HIV Agents - pharmacology Anti-HIV Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Biology and Life Sciences Cancer Cardiovascular diseases Care and treatment CD4 antigen Cohort analysis Demography Drug abuse Ecology, environment Fatalities Female Health risks HIV HIV Infections - drug therapy HIV Infections - mortality HIV patients HIV-1 - drug effects HIV-1 - physiology Human immunodeficiency virus Human immunodeficiency virus 1 Humans Infections Lentivirus Life Sciences Liver Liver cancer Liver diseases Male Medical prognosis Medicine and Health Sciences Middle Aged Mortality Mortality risk Patient outcomes Patients People and Places Replication Ribonucleic acid Risk Factors RNA Sex Sexually transmitted diseases STD Survival Survival Analysis Therapy Young Adult Canada United Kingdom > UK United States > US Europe Denmark France North America Germany Spain
ISSN:	1932-6203, 1932-6203
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Popis
Shrnutí:	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.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Membership of the ART-CC steering group and coordinating committee is provided in the Acknowledgments. Competing Interests: Abbott, Gilead, Tibotec-Upjohn, ViiV Healthcare, MSD, GlaxoSmithKline, Pfizer, Bristol Myers Squibb, Roche and Boehringer-Ingelheim are commercial organisations that have funded cohorts that provide data to the ART-CC. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials. Conceived and designed the experiments: JS MM.Analyzed the data: AT.Contributed reagents/materials/analysis tools: JV NO MJG HC CB HS SG CC MC LS AD CS MS FL VH MM RZ AJ TS JM.Wrote the paper: AT MM JV NO MJG HC CB HS SG CC MC LS AD CS MS FL VH MM RZ AJ TS JM SI JS.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0160460