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. 2016 Aug 15;11(8):e0160460.
doi: 10.1371/journal.pone.0160460. eCollection 2016.

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

Adam Trickey  1 , Margaret T May  1 , Janne Vehreschild  2   3 , Niels Obel  4 , Michael John Gill  5 , Heidi Crane  6 , Christoph Boesecke  7 , Hasina Samji  8 , Sophie Grabar  9   10   11 , Charles Cazanave  12 , Matthias Cavassini  13 , Leah Shepherd  14 , Antonella d'Arminio Monforte  15 , Colette Smit  16 , Michael Saag  17 , Fiona Lampe  14 , Vicky Hernando  18 , Marta Montero  19 , Robert Zangerle  20 , Amy C Justice  21 , Timothy Sterling  22 , Jose Miro  23 , Suzanne Ingle  1 , Jonathan A C Sterne  1 ; Antiretroviral Therapy Cohort Collaboration (ART-CC)
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Cause-Specific Mortality in HIV-Positive Patients Who Survived Ten Years after Starting Antiretroviral Therapy

Adam Trickey et al. PLoS One. .

Abstract

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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Conflict of interest statement

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.

Figures

Fig 1
Fig 1. Frequency distribution of patients grouped by five-year mortality risk, overall and by age-group.
See this image and copyright information in PMC

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