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

Adam Trickey; Margaret T May; Jorg-Janne Vehreschild; Niels Obel; Michael John Gill; Heidi M Crane; Christoph Boesecke; Hasina Samji; Sophie Grabar; Charles Cazanave; Matthias Cavassini; Leah Shepherd; Antonella D'Arminio Monforte; Colette Smit; Michael S Saag; Fiona Lampe; Vicky Hernando; Marta Montero; Robert Zangerle; Amy C Justice; Timothy R Sterling; Jose M Miró; Suzanne Ingle; Jonathan A C Sterne; Antiretroviral Therapy Cohort Collaboration (ART-CC)

doi:10.1371/journal.pone.0160460

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

Adam Trickey, Margaret T May, Jorg-Janne Vehreschild, Niels Obel, Michael John Gill, Heidi M Crane, Christoph Boesecke, Hasina Samji, Sophie Grabar, Charles Cazanave, Matthias Cavassini, Leah Shepherd, Antonella D'Arminio Monforte, Colette Smit, Michael S Saag, Fiona Lampe, Vicky Hernando, Marta Montero, Robert Zangerle, Amy C JusticeTimothy R Sterling, Jose M Miró, Suzanne Ingle, Jonathan A C Sterne, Antiretroviral Therapy Cohort Collaboration (ART-CC)

Department of Clinical Medicine

41 Citations (Scopus)

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 liverrelated 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.

Original language	English
Article number	e0160460
Journal	PLOS ONE
Volume	11
Issue number	8
Number of pages	16
ISSN	1932-6203
DOIs	https://doi.org/10.1371/journal.pone.0160460
Publication status	Published - Aug 2016

Keywords

Journal Article

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Trickey, A., May, M. T., Vehreschild, J-J., Obel, N., Gill, M. J., Crane, H. M., Boesecke, C., Samji, H., Grabar, S., Cazanave, C., Cavassini, M., Shepherd, L., D'Arminio Monforte, A., Smit, C., Saag, M. S., Lampe, F., Hernando, V., Montero, M., Zangerle, R., ... Antiretroviral Therapy Cohort Collaboration (ART-CC) (2016). Cause-Specific Mortality in HIV-Positive Patients Who Survived Ten Years after Starting Antiretroviral Therapy. PLOS ONE, 11(8), [e0160460]. https://doi.org/10.1371/journal.pone.0160460

Trickey, A, May, MT, Vehreschild, J-J, Obel, N, Gill, MJ, Crane, HM, Boesecke, C, Samji, H, Grabar, S, Cazanave, C, Cavassini, M, Shepherd, L, D'Arminio Monforte, A, Smit, C, Saag, MS, Lampe, F, Hernando, V, Montero, M, Zangerle, R, Justice, AC, Sterling, TR, Miró, JM, Ingle, S, Sterne, JAC & Antiretroviral Therapy Cohort Collaboration (ART-CC) 2016, 'Cause-Specific Mortality in HIV-Positive Patients Who Survived Ten Years after Starting Antiretroviral Therapy', PLOS ONE, vol. 11, no. 8, e0160460. https://doi.org/10.1371/journal.pone.0160460

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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 liverrelated 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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T1 - Cause-Specific Mortality in HIV-Positive Patients Who Survived Ten Years after Starting Antiretroviral Therapy

AU - Trickey, Adam

AU - May, Margaret T

AU - Vehreschild, Jorg-Janne

AU - Obel, Niels

AU - Gill, Michael John

AU - Crane, Heidi M

AU - Boesecke, Christoph

AU - Samji, Hasina

AU - Grabar, Sophie

AU - Cazanave, Charles

AU - Cavassini, Matthias

AU - Shepherd, Leah

AU - D'Arminio Monforte, Antonella

AU - Smit, Colette

AU - Saag, Michael S

AU - Lampe, Fiona

AU - Hernando, Vicky

AU - Montero, Marta

AU - Zangerle, Robert

AU - Justice, Amy C

AU - Sterling, Timothy R

AU - Miró, Jose M

AU - Ingle, Suzanne

AU - Sterne, Jonathan A C

AU - Antiretroviral Therapy Cohort Collaboration (ART-CC)

PY - 2016/8

Y1 - 2016/8

N2 - 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 liverrelated 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.

AB - 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 liverrelated 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.

KW - Journal Article

U2 - 10.1371/journal.pone.0160460

DO - 10.1371/journal.pone.0160460

M3 - Journal article

C2 - 27525413

SN - 1932-6203

VL - 11

JO - PLoS Computational Biology

JF - PLoS Computational Biology

IS - 8

M1 - e0160460

ER -

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

Abstract

Keywords

UN SDGs

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