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

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Trickey Adam, May Margaret T, Vehreschild Janne, Obel Niels, Gill Michael John, Crane Heidi, Boesecke Christoph, Samji Hasina, Grabar Sophie, Cazanave Charles, Cavassini Matthias, Shepherd Leah, d'Arminio Monforte Antonella, Smit Colette, Saag Michael, Lampe Fiona, Hernando Vicky, Montero Marta, Zangerle Robert, Justice Amy C, Sterling Timothy, Miro Jose, Ingle Suzanne, Sterne Jonathan A C, Sterne Jonathan A C,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal PloS one
Volume (Issue) 11(8)
Page(s) 0160460 - 0160460
Title of proceedings PloS one
DOI 10.1371/journal.pone.0160460

Open Access

URL http://doi.org/10.1371/journal.pone.0160460
Type of Open Access Publisher (Gold Open Access)

Abstract

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. 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. 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. 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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