May, Margaret T., Hogg, Robert S., Justice, Amy C., Shepherd, Bryan E., Costagliola, Dominique ORCID: 0000-0003-0765-0869, Ledergerber, Bruno ORCID: 0000-0002-6881-4401, Thiebaut, Rodolphe ORCID: 0000-0002-5235-3962, Gill, M. John, Kirk, Ole, van Sighem, Ard, Saag, Michael S., Navarro, Gemma, Sobrino-Vegas, Paz ORCID: 0000-0002-0775-1558, Lampe, Fiona ORCID: 0000-0001-6851-5471, Ingle, Suzanne, Guest, Jodie L., Crane, Heidi M., Monforte, Antonella D'Arminio, Vehreschild, Joerg J. and Sterne, Jonathan A. C. (2012). Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics. Int. J. Epidemiol., 41 (6). S. 1807 - 1821. OXFORD: OXFORD UNIV PRESS. ISSN 1464-3685

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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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
May, Margaret T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hogg, Robert S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Justice, Amy C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shepherd, Bryan E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Costagliola, DominiqueUNSPECIFIEDorcid.org/0000-0003-0765-0869UNSPECIFIED
Ledergerber, BrunoUNSPECIFIEDorcid.org/0000-0002-6881-4401UNSPECIFIED
Thiebaut, RodolpheUNSPECIFIEDorcid.org/0000-0002-5235-3962UNSPECIFIED
Gill, M. JohnUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kirk, OleUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van Sighem, ArdUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Saag, Michael S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Navarro, GemmaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sobrino-Vegas, PazUNSPECIFIEDorcid.org/0000-0002-0775-1558UNSPECIFIED
Lampe, FionaUNSPECIFIEDorcid.org/0000-0001-6851-5471UNSPECIFIED
Ingle, SuzanneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guest, Jodie L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Crane, Heidi M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Monforte, Antonella D'ArminioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vehreschild, Joerg J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sterne, Jonathan A. C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-478010
DOI: 10.1093/ije/dys164
Journal or Publication Title: Int. J. Epidemiol.
Volume: 41
Number: 6
Page Range: S. 1807 - 1821
Date: 2012
Publisher: OXFORD UNIV PRESS
Place of Publication: OXFORD
ISSN: 1464-3685
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ACTIVE ANTIRETROVIRAL THERAPY; VIROLOGICAL TREATMENT FAILURE; HIV-1-INFECTED PATIENTS; COLLABORATIVE ANALYSIS; DISEASE PROGRESSION; INFECTED PATIENTS; FOLLOW-UP; MORTALITE 2000; ADHERENCE; DEATHMultiple languages
Public, Environmental & Occupational HealthMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/47801

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