Pettit, April C., Giganti, Mark J., Ingle, Suzanne M., May, Margaret T., Shepherd, Bryan E., Gill, Michael J., Fatkenheuer, Gerd, Abgrall, Sophie, Saag, Michael S., Del Amo, Julia, Justice, Amy C., Miro, Jose M., Cavasinni, Matthias, Dabis, Francois, Monforte, Antonella D., Reiss, Peter, Guest, Jodie ORCID: 0000-0002-3650-3975, Moore, David, Shepherd, Leah, Obel, Niels, Crane, Heidi M., Smith, Colette ORCID: 0000-0003-2847-3355, Teira, Ramon, Zangerle, Robert, Sterne, Jonathan A. C. and Sterling, Timothy R. (2018). Increased non-AIDS mortality among persons with AIDS-defining events after antiretroviral therapy initiation. J. Int. AIDS Soc., 21. CHICHESTER: JOHN WILEY & SONS LTD. ISSN 1758-2652

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Abstract

Introduction HIV-1 infection leads to chronic inflammation and to an increased risk of non-AIDS mortality. Our objective was to determine whether AIDS-defining events (ADEs) were associated with increased overall and cause-specific non-AIDS related mortality after antiretroviral therapy (ART) initiation. Methods We included HIV treatment-naive adults from the Antiretroviral Therapy Cohort Collaboration (ART-CC) who initiated ART from 1996 to 2014. Causes of death were assigned using the Coding Causes of Death in HIV (CoDe) protocol. The adjusted hazard ratio (aHR) for overall and cause-specific non-AIDS mortality among those with an ADE (all ADEs, tuberculosis (TB), Pneumocystis jiroveci pneumonia (PJP), and non-Hodgkin's lymphoma (NHL)) compared to those without an ADE was estimated using a marginal structural model. Results The adjusted hazard of overall non-AIDS mortality was higher among those with any ADE compared to those without any ADE (aHR 2.21, 95% confidence interval (CI) 2.00 to 2.43). The adjusted hazard of each of the cause-specific non-AIDS related deaths were higher among those with any ADE compared to those without, except metabolic deaths (malignancy aHR 2.59 (95% CI 2.13 to 3.14), accident/suicide/overdose aHR 1.37 (95% CI 1.05 to 1.79), cardiovascular aHR 1.95 (95% CI 1.54 to 2.48), infection aHR (95% CI 1.68 to 2.81), hepatic aHR 2.09 (95% CI 1.61 to 2.72), respiratory aHR 4.28 (95% CI 2.67 to 6.88), renal aHR 5.81 (95% CI 2.69 to 12.56) and central nervous aHR 1.53 (95% CI 1.18 to 5.44)). The risk of overall and cause-specific non-AIDS mortality differed depending on the specific ADE of interest (TB, PJP, NHL). Conclusions In this large multi-centre cohort collaboration with standardized assignment of causes of death, non-AIDS mortality was twice as high among patients with an ADE compared to without an ADE. However, non-AIDS related mortality after an ADE depended on the ADE of interest. Although there may be unmeasured confounders, these findings suggest that a common pathway may be independently driving both ADEs and NADE mortality. While prevention of ADEs may reduce subsequent death due to NADEs following ART initiation, modification of risk factors for NADE mortality remains important after ADE survival.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Pettit, April C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Giganti, Mark J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ingle, Suzanne M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
May, Margaret T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shepherd, Bryan E.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gill, Michael J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fatkenheuer, GerdUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Abgrall, SophieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Saag, Michael S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Del Amo, JuliaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Justice, Amy C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Miro, Jose M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cavasinni, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dabis, FrancoisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Monforte, Antonella D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Reiss, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guest, JodieUNSPECIFIEDorcid.org/0000-0002-3650-3975UNSPECIFIED
Moore, DavidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shepherd, LeahUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Obel, NielsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Crane, Heidi M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Smith, ColetteUNSPECIFIEDorcid.org/0000-0003-2847-3355UNSPECIFIED
Teira, RamonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zangerle, RobertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sterne, Jonathan A. C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sterling, Timothy R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-200700
DOI: 10.1002/jia2.25031
Journal or Publication Title: J. Int. AIDS Soc.
Volume: 21
Date: 2018
Publisher: JOHN WILEY & SONS LTD
Place of Publication: CHICHESTER
ISSN: 1758-2652
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
HIV-INFECTED PATIENTS; HUMAN-IMMUNODEFICIENCY-VIRUS; LIFE EXPECTANCY; COLLABORATIVE ANALYSIS; RISK-FACTORS; DEATH; IMPACT; INDIVIDUALS; TRENDS; ERAMultiple languages
Immunology; Infectious DiseasesMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/20070

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