Abstract
Introduction
Mortality rates for people living with HIV (PLHIV) on antiretroviral therapy (ART) in high-income countries continue to decline. We compared mortality rates among PLHIV on ART in Europe for 2016-20 with Spectrum’s estimates.
Methods
The AIDS Impact Module in Spectrum is a compartmental HIV epidemic model coupled with a demographic population projection model. We used national Spectrum projections developed for the 2022 HIV estimates round to calculate mortality rates on ART, adjusting to the age/country distribution of PLHIV starting ART from 1996-2020 in the Antiretroviral Therapy Cohort Collaboration (ART-CC)’s European cohorts.
Results
In the ART-CC, 11,504 of 162,835 PLHIV died. Between 1996-1999 and 2016-2020, AIDS-related mortality in the ART-CC decreased from 8.8 (95%CI: 7.6-10.1) to 1.0 (0.9-1.2) and from 5.9 (4.4-8.1) to 1.1 (0.9-1.4) deaths per 1000 person-years among men and women, respectively. Non-AIDS-related mortality decreased from 9.1 (7.9-10.5) to 6.1 (5.8-6.5) and from 7.0 (5.2-9.3) to 4.8 (4.3-5.2) deaths per 1000 person-years among men and women, respectively. Adjusted all-cause mortality rates in Spectrum among males were near ART-CC estimates for 2016-20 (Spectrum: 7.02-7.47 deaths per 1000 person-years) but ~20% lower in females (Spectrum: 4.66-4.70). Adjusted excess mortality rates in Spectrum were 2.5-fold higher in females and 3.1-3.4-fold higher in males in comparison to the ART-CC’s AIDS-specific mortality rates.
Discussion
Spectrum’s all-cause mortality estimates among PLHIV are consistent with age/country-controlled mortality observed in ART-CC, with some underestimation of mortality among women. Comparing results suggest 60%-70% of excess deaths among PLHIV on ART in Spectrum are from non-AIDS causes.
Mortality rates for people living with HIV (PLHIV) on antiretroviral therapy (ART) in high-income countries continue to decline. We compared mortality rates among PLHIV on ART in Europe for 2016-20 with Spectrum’s estimates.
Methods
The AIDS Impact Module in Spectrum is a compartmental HIV epidemic model coupled with a demographic population projection model. We used national Spectrum projections developed for the 2022 HIV estimates round to calculate mortality rates on ART, adjusting to the age/country distribution of PLHIV starting ART from 1996-2020 in the Antiretroviral Therapy Cohort Collaboration (ART-CC)’s European cohorts.
Results
In the ART-CC, 11,504 of 162,835 PLHIV died. Between 1996-1999 and 2016-2020, AIDS-related mortality in the ART-CC decreased from 8.8 (95%CI: 7.6-10.1) to 1.0 (0.9-1.2) and from 5.9 (4.4-8.1) to 1.1 (0.9-1.4) deaths per 1000 person-years among men and women, respectively. Non-AIDS-related mortality decreased from 9.1 (7.9-10.5) to 6.1 (5.8-6.5) and from 7.0 (5.2-9.3) to 4.8 (4.3-5.2) deaths per 1000 person-years among men and women, respectively. Adjusted all-cause mortality rates in Spectrum among males were near ART-CC estimates for 2016-20 (Spectrum: 7.02-7.47 deaths per 1000 person-years) but ~20% lower in females (Spectrum: 4.66-4.70). Adjusted excess mortality rates in Spectrum were 2.5-fold higher in females and 3.1-3.4-fold higher in males in comparison to the ART-CC’s AIDS-specific mortality rates.
Discussion
Spectrum’s all-cause mortality estimates among PLHIV are consistent with age/country-controlled mortality observed in ART-CC, with some underestimation of mortality among women. Comparing results suggest 60%-70% of excess deaths among PLHIV on ART in Spectrum are from non-AIDS causes.
| Original language | English |
|---|---|
| Pages (from-to) | e89-e96 |
| Number of pages | 8 |
| Journal | Journal of Acquired Immune Deficiency Syndromes |
| Volume | 95 |
| Issue number | 1S |
| DOIs | |
| Publication status | Published - 1 Jan 2024 |
Bibliographical note
Funding Information: The authors would like to thank our funders (US NIAAA) as well as all the patients and the clinical teams associated with the participating cohort studies.Publisher Copyright: Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.
