Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics

Margaret T May; Robert S Hogg; Amy C Justice; Bryan E Shepherd; Dominique Costagliola; Bruno Ledergerber; Rodolphe Thiébaut; M John Gill; Ole Kirk; Ard van Sighem; Michael S Saag; Gemma Navarro; Paz Sobrino-Vegas; Fiona Lampe; Suzanne Ingle; Jodie L Guest; Heidi M Crane; Antonella D'Arminio Monforte; Jörg J Vehreschild; Jonathan A C Sterne; Antiretroviral Therapy Cohort Collaboration (ART-CC)

doi:10.1093/ije/dys164

Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics

Margaret T May, Robert S Hogg, Amy C Justice, Bryan E Shepherd, Dominique Costagliola, Bruno Ledergerber, Rodolphe Thiébaut, M John Gill, Ole Kirk, Ard van Sighem, Michael S Saag, Gemma Navarro, Paz Sobrino-Vegas, Fiona Lampe, Suzanne Ingle, Jodie L Guest, Heidi M Crane, Antonella D'Arminio Monforte, Jörg J Vehreschild, Jonathan A C SterneAntiretroviral Therapy Cohort Collaboration (ART-CC)

Institut for Klinisk Medicin

30 Citationer (Scopus)

Abstract

Background: HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. Methods: We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. Results: During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. Conclusions: Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk.

Originalsprog	Engelsk
Tidsskrift	International Journal of Epidemiology
Vol/bind	41
Udgave nummer	6
Sider (fra-til)	1807-20
Antal sider	14
ISSN	0300-5771
DOI	https://doi.org/10.1093/ije/dys164
Status	Udgivet - dec. 2012

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May, M. T., Hogg, R. S., Justice, A. C., Shepherd, B. E., Costagliola, D., Ledergerber, B., Thiébaut, R., Gill, M. J., Kirk, O., van Sighem, A., Saag, M. S., Navarro, G., Sobrino-Vegas, P., Lampe, F., Ingle, S., Guest, J. L., Crane, H. M., D'Arminio Monforte, A., Vehreschild, J. J., ... Antiretroviral Therapy Cohort Collaboration (ART-CC) (2012). Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics. International Journal of Epidemiology, 41(6), 1807-20. https://doi.org/10.1093/ije/dys164

May, MT, Hogg, RS, Justice, AC, Shepherd, BE, Costagliola, D, Ledergerber, B, Thiébaut, R, Gill, MJ, Kirk, O, van Sighem, A, Saag, MS, Navarro, G, Sobrino-Vegas, P, Lampe, F, Ingle, S, Guest, JL, Crane, HM, D'Arminio Monforte, A, Vehreschild, JJ, Sterne, JAC & Antiretroviral Therapy Cohort Collaboration (ART-CC) 2012, 'Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics', International Journal of Epidemiology, bind 41, nr. 6, s. 1807-20. https://doi.org/10.1093/ije/dys164

@article{7ca80b4616b14f1dadd10236b1520a5c,

title = "Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics",

abstract = "Background: HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. Methods: We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. Results: During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. Conclusions: Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk.",

keywords = "Acquired Immunodeficiency Syndrome, Adolescent, Adult, Age Factors, Aged, Anti-Retroviral Agents, CD4 Lymphocyte Count, Europe, Female, HIV Infections, HIV Seropositivity, Humans, Male, Middle Aged, North America, Prognosis, Risk Factors, Sex Factors, Young Adult",

author = "May, {Margaret T} and Hogg, {Robert S} and Justice, {Amy C} and Shepherd, {Bryan E} and Dominique Costagliola and Bruno Ledergerber and Rodolphe Thi{\'e}baut and Gill, {M John} and Ole Kirk and {van Sighem}, Ard and Saag, {Michael S} and Gemma Navarro and Paz Sobrino-Vegas and Fiona Lampe and Suzanne Ingle and Guest, {Jodie L} and Crane, {Heidi M} and {D'Arminio Monforte}, Antonella and Vehreschild, {J{\"o}rg J} and Sterne, {Jonathan A C} and {Antiretroviral Therapy Cohort Collaboration (ART-CC)}",

year = "2012",

month = dec,

doi = "10.1093/ije/dys164",

language = "English",

volume = "41",

pages = "1807--20",

journal = "International Journal of Epidemiology",

issn = "0300-5771",

publisher = "Oxford University Press",

number = "6",

}

TY - JOUR

T1 - Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America

T2 - relation with patient and cohort characteristics

AU - May, Margaret T

AU - Hogg, Robert S

AU - Justice, Amy C

AU - Shepherd, Bryan E

AU - Costagliola, Dominique

AU - Ledergerber, Bruno

AU - Thiébaut, Rodolphe

AU - Gill, M John

AU - Kirk, Ole

AU - van Sighem, Ard

AU - Saag, Michael S

AU - Navarro, Gemma

AU - Sobrino-Vegas, Paz

AU - Lampe, Fiona

AU - Ingle, Suzanne

AU - Guest, Jodie L

AU - Crane, Heidi M

AU - D'Arminio Monforte, Antonella

AU - Vehreschild, Jörg J

AU - Sterne, Jonathan A C

AU - Antiretroviral Therapy Cohort Collaboration (ART-CC)

PY - 2012/12

Y1 - 2012/12

N2 - Background: HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. Methods: We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. Results: During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. Conclusions: Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk.

AB - Background: HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. Methods: We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. Results: During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. Conclusions: Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk.

KW - Acquired Immunodeficiency Syndrome

KW - Adolescent

KW - Adult

KW - Age Factors

KW - Aged

KW - Anti-Retroviral Agents

KW - CD4 Lymphocyte Count

KW - Europe

KW - Female

KW - HIV Infections

KW - HIV Seropositivity

KW - Humans

KW - Male

KW - Middle Aged

KW - North America

KW - Prognosis

KW - Risk Factors

KW - Sex Factors

KW - Young Adult

U2 - 10.1093/ije/dys164

DO - 10.1093/ije/dys164

M3 - Journal article

C2 - 23148105

SN - 0300-5771

VL - 41

SP - 1807

EP - 1820

JO - International Journal of Epidemiology

JF - International Journal of Epidemiology

IS - 6

ER -

Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics

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