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. 2022 Sep 14;75(5):867-874.
doi: 10.1093/cid/ciab1030.

Five-Year Mortality for Adults Entering Human Immunodeficiency Virus Care Under Universal Early Treatment Compared With the General US Population

Jessie K Edwards  1 , Stephen R Cole  1 , Tiffany L Breger  2 , Lindsey M Filiatreau  1 , Lauren Zalla  1 , Grace E Mulholland  1 , Michael A Horberg  3 , Michael J Silverberg  4 , M John Gill  5 , Peter F Rebeiro  6 , Jennifer E Thorne  7 , Parastu Kasaie  8 , Vincent C Marconi  9 , Timothy R Sterling  10 , Keri N Althoff  8 , Richard D Moore  11 , Joseph J Eron  2
Affiliations

Five-Year Mortality for Adults Entering Human Immunodeficiency Virus Care Under Universal Early Treatment Compared With the General US Population

Jessie K Edwards et al. Clin Infect Dis. .

Abstract

Background: Mortality among adults with human immunodeficiency virus (HIV) remains elevated over those in the US general population, even in the years after entry into HIV care. We explore whether the elevation in 5-year mortality would have persisted if all adults with HIV had initiated antiretroviral therapy within 3 months of entering care.

Methods: Among 82 766 adults entering HIV care at North American AIDS Cohort Collaboration clinical sites in the United States, we computed mortality over 5 years since entry into HIV care under observed treatment patterns. We then used inverse probability weights to estimate mortality under universal early treatment. To compare mortality with those for similar individuals in the general population, we used National Center for Health Statistics data to construct a cohort representing the subset of the US population matched to study participants on key characteristics.

Results: For the entire study period (1999-2017), the 5-year mortality among adults with HIV was 7.9% (95% confidence interval [CI]: 7.6%-8.2%) higher than expected based on the US general population. Under universal early treatment, the elevation in mortality for people with HIV would have been 7.2% (95% CI: 5.8%-8.6%). In the most recent calendar period examined (2011-2017), the elevation in mortality for people with HIV was 2.6% (95% CI: 2.0%-3.3%) under observed treatment patterns and 2.1% (.0%-4.2%) under universal early treatment.

Conclusions: Expanding early treatment may modestly reduce, but not eliminate, the elevation in mortality for people with HIV.

Keywords: HIV; antiretroviral therapy; cohort studies; mortality.

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Conflict of interest statement

Potential conflicts of interest. L. M. F. reports payment to their institution from ViiV Healthcare to cover the cost of doctoral training (tuition and associated fees) and to support Statistical Horizons workshop attendance. M. J. S. reports a research grant to his institution from Gilead. M. J. G. has been an ad hoc advisor to national HIV advisory boards for Merck, Gilead, and ViiV Healthcare. P. F. R. reports payment from Gilead for participation in a panel in 2020. V. C. M. received research grants from Gilead Sciences and ViiV Healthcare and served as an advisory board member for Eli Lilly and Novartis. T. R. S. reports royalties from UpToDate for textbook chapters on tuberculosis. K. N. A. serves as a consultant to the All of Us Research Program (NIH) and on the scientific advisory board for TrioHealth. J. J. E. reports ad hoc consultancies to Merck, Gilead Sciences, ViiV Healthcare, and Janssen and contracts to his institution for clinical research, for which he receives support from Gilead Sciences, ViiV Healthcare, and Janssen. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Probability of starting antiretroviral (ART) over time since entry into human immunodeficiency virus (HIV) care by calendar period among 82 766 patients entering care at US North American AIDS Cohort Collaboration clinical sites between 1999 and 2017.
Figure 2.
Figure 2.
Five-year mortality differences (with 95% confidence intervals [CIs]) comparing mortality risks between the matched US general population and 82 766 patients entering care for human immunodeficiency virus at US North American AIDS Cohort Collaboration clinical sites between 1999 and 2017 under both observed treatment patterns (black) and universal early treatment (blue). Points represent mortality risk differences, and lines, 95% CIs.
See this image and copyright information in PMC

References

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