Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jul 15;59(2):287-97.
doi: 10.1093/cid/ciu261. Epub 2014 Apr 24.

Impact of risk factors for specific causes of death in the first and subsequent years of antiretroviral therapy among HIV-infected patients

Suzanne M Ingle  1 , Margaret T May  1 , M John Gill  2 , Michael J Mugavero  3 , Charlotte Lewden  4 , Sophie Abgrall  5 , Gerd Fätkenheuer  6 , Peter Reiss  7 , Michael S Saag  3 , Christian Manzardo  8 , Sophie Grabar  9 , Mathias Bruyand  10 , David Moore  11 , Amanda Mocroft  12 , Timothy R Sterling  13 , Antonella D'Arminio Monforte  14 , Victoria Hernando  15 , Ramon Teira  16 , Jodie Guest  17 , Matthias Cavassini  18 , Heidi M Crane  19 , Jonathan A C Sterne  1 ; Antiretroviral Therapy Cohort Collaboration
Affiliations

Impact of risk factors for specific causes of death in the first and subsequent years of antiretroviral therapy among HIV-infected patients

Suzanne M Ingle et al. Clin Infect Dis. .

Abstract

Background: Patterns of cause-specific mortality in individuals infected with human immunodeficiency virus type 1 (HIV-1) are changing dramatically in the era of antiretroviral therapy (ART).

Methods: Sixteen cohorts from Europe and North America contributed data on adult patients followed from the start of ART. Procedures for coding causes of death were standardized. Estimated hazard ratios (HRs) were adjusted for transmission risk group, sex, age, year of ART initiation, baseline CD4 count, viral load, and AIDS status, before and after the first year of ART.

Results: A total of 4237 of 65 121 (6.5%) patients died (median, 4.5 years follow-up). Rates of AIDS death decreased substantially with time since starting ART, but mortality from non-AIDS malignancy increased (rate ratio, 1.04 per year; 95% confidence interval [CI], 1.0-1.1). Higher mortality in men than women during the first year of ART was mostly due to non-AIDS malignancy and liver-related deaths. Associations with age were strongest for cardiovascular disease, heart/vascular, and malignancy deaths. Patients with presumed transmission through injection drug use had higher rates of all causes of death, particularly for liver-related causes (HRs compared with men who have sex with men: 18.1 [95% CI, 6.2-52.7] during the first year of ART and 9.1 [95% CI, 5.8-14.2] thereafter). There was a persistent role of CD4 count at baseline and at 12 months in predicting AIDS, non-AIDS infection, and non-AIDS malignancy deaths. Lack of viral suppression on ART was associated with AIDS, non-AIDS infection, and other causes of death.

Conclusions: Better understanding of patterns of and risk factors for cause-specific mortality in the ART era can aid in development of appropriate care for HIV-infected individuals and inform guidelines for risk factor management.

Keywords: HIV; antiretroviral therapy; cause-specific mortality.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Cause-specific crude mortality rate per 1000 person-years by duration of antiretroviral therapy. Vertical axis is on log scale. Abbreviations: ART, antiretroviral therapy; CVD, cardiovascular disease.
Figure 2.
Figure 2.
Latest CD4 count before death within 6 months of death. Abbreviations: CVD, cardiovascular disease; IQR, interquartile range.
See this image and copyright information in PMC

References

    1. May M, Gompels M, Delpech V, et al. Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study. BMJ. 2011;343:d6016. - PMC - PubMed
    1. Nakagawa F, Lodwick RK, Smith CJ, et al. Projected life expectancy of people with HIV according to timing of diagnosis. AIDS. 2012;26:335–43. - PubMed
    1. May MT, Ingle SM. Life expectancy of HIV-positive adults: a review. Sex Health. 2011;8:526–33. - PubMed
    1. Leone S, Gregis G, Quinzan G, et al. Causes of death and risk factors among HIV-infected persons in the HAART era: analysis of a large urban cohort. Infection. 2011;39:13–20. - PubMed
    1. Galli L, Spagnuolo V, Salpietro S, et al. Mortality of HIV-infected patients with or without cancer: comparison with the general population in Italy. Antivir Ther. 2012;17:447–58. - PubMed

Publication types