Mortality of HIV-infected patients starting potent antiretroviral therapy: comparison with the general population in nine industrialized countries

M Zwahlen, RJ Harris, M May, RS Hogg, D Costagliola, F de Wolf, J Gill, G Fatkenheuer, C Lewden, M Saag, S Staszewski, A d'Arminio Monforte, J Casabona, F Lampe, A Justice, V von Wyl, M Egger

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146 Citations (Scopus)

Abstract

Background: Mortality in HIV-infected patients has declined substantially with combination antiretroviral therapy (ART), but it is unclear whether it has reached that of the general population. We compared mortality in patients starting ART in nine countries of Europe and North America with the corresponding general population, taking into account their response to ART. Methods: Eligible patients were enrolled in prospective cohort studies participating in the ART Cohort Collaboration. We calculated the ratio of observed to expected deaths from all causes [standardized mortality ratio (SMR)], measuring time from 6 months after starting ART, according to risk group, clinical stage at the start of ART and CD4 cell count and viral load at 6 months. Expected numbers of deaths were obtained from age-, sex- and country-specific mortality rates. Results: Among 29 935 eligible patients, 1134 deaths were recorded in 131 510 person-years of follow-up. The median age was 37 years, 8162 (27%) patients were females, 4400 (15%) were injecting drug users (IDUs) and 6738 (23%) had AIDS when starting ART. At 6 months, 23 539 patients (79%) had viral load measurements 4500 copies/ml. The lowest SMR, 1.05 [95% confidence interval (CI) 0.82–1.35] was found for men who have sex with men (MSM) who started ART free of AIDS, reached a CD4 cell count of 5350 cells/mL and suppressed viral replication to 4500 copies/ml by the sixth month. In contrast, the SMR was 73.7 (95% CI 46.4– 116.9) in IDUs who failed to suppress viral replication and had CD4 cell counts
Translated title of the contributionMortality of HIV-infected patients starting potent antiretroviral therapy: comparison with the general population in nine industrialized countries
Original languageEnglish
Pages (from-to)1624 - 1633
Number of pages10
JournalInternational Journal of Epidemiology
Volume38
DOIs
Publication statusPublished - Oct 2009

Bibliographical note

Other: International Journal of Epidemiology 2009;38:1624-1633

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