Estimation of improvements in mortality in Spectrum among adults with HIV receiving antiretroviral therapy in high-income countries

Adam J W Trickey*, Rob Glaubius, Nikos Pantazis, Robert Zangerle, Linda Wittkop, Jorg-Janne Vehreschild, Sophie Grabar, Matthias Cavassini, Ramon Teira, Antonella d'Arminio Monforte, Jordi Casabona, Ard van Sighem, Inma Jarrin, Suzanne M Ingle, Jonathan A C Sterne, Jeffrey W Eaton, Leigh Johnson

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

1 Citation (Scopus)

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.
Original languageEnglish
Pages (from-to)e89-e96
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume95
Issue number1S
DOIs
Publication statusPublished - 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.

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