Trickey, Adam ORCID: 0000-0003-3462-2898, May, Margaret T., Vehreschild, Jorg-Janne, Obel, Niels, Gill, M. John, Crane, Heidi M., Boesecke, Christoph, Patterson, Sophie, Grabar, Sophie, Cazanave, Charles, Cavassini, Matthias, Shepherd, Leah, Monforte, Antonella d'Arminio, van Sighem, Ard, Saag, Michael, Lampe, Fiona ORCID: 0000-0001-6851-5471, Hernando, Vicky, Montero, Marta ORCID: 0000-0002-3432-5394, Zangerle, Robert, Justice, Amy C., Sterling, Timothy, Miro, Jose M., Ingle, Suzanne M., Sterne, Jonathan A. C., Boulle, Andrew ORCID: 0000-0002-7713-8062, Stephan, Christoph, Miro, Jose M., Cavassini, Matthias, Chene, Genevieve, Costagliola, Dominique, Dabis, Francois, del Amo, Julia, Van Sighem, Ard, Vehreschild, Jorg-Janne, Gill, M. John, Guest, Jodie, Haerry, David Hans-Ulrich, Hogg, Robert, Justice, Amy C., Shepherd, Leah, Obel, Niels, Crane, Heidi M., Smith, Colette ORCID: 0000-0003-2847-3355, Reiss, Peter, Saag, Michael, Sterling, Timothy, Teira, Ramon, Williams, Matthew, Zangerle, Robert, Sterne, Jonathan A. C., May, Margaret T., Ingle, Suzanne M. and Trickey, Adam ORCID: 0000-0003-3462-2898 (2017). Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV, 4 (8). S. E349 - 8. SAN DIEGO: ELSEVIER INC. ISSN 2352-3018

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Abstract

Background Health care for people living with HIV has improved substantially in the past two decades. Robust estimates of how these improvements have affected prognosis and life expectancy are of utmost importance to patients, clinicians, and health-care planners. We examined changes in 3 year survival and life expectancy of patients starting combination antiretroviral therapy (ART) between 1996 and 2013. Methods We analysed data from 18 European and North American HIV-1 cohorts. Patients (aged >= 16 years) were eligible for this analysis if they had started ART with three or more drugs between 1996 and 2010 and had at least 3 years of potential follow-up. We estimated adjusted (for age, sex, AIDS, risk group, CD4 cell count, and HIV-1 RNA at start of ART) all-cause and cause-specific mortality hazard ratios (HRs) for the first year after ART initiation and the second and third years after ART initiation in four calendar periods (1996-99, 2000-03 [comparator], 2004-07, 2008-10). We estimated life expectancy by calendar period of initiation of ART. Findings 88 504 patients were included in our analyses, of whom 2106 died during the first year of ART and 2302 died during the second or third year of ART. Patients starting ART in 2008-10 had lower all-cause mortality in the first year after ART initiation than did patients starting ART in 2000-03 (adjusted HR 0.71, 95% CI 0.61-0.83). All-cause mortality in the second and third years after initiation of ART was also lower in patients who started ART in 2008-10 than in those who started in 2000-03 (0.57, 0.49-0.67); this decrease was not fully explained by viral load and CD4 cell count at 1 year. Rates of non-AIDS deaths were lower in patients who started ART in 2008-10 (vs 2000-03) in the first year (0.48, 0.34-0.67) and second and third years (0.29, 0.21-0.40) after initiation of ART. Between 1996 and 2010, life expectancy in 20-year-old patients starting ART increased by about 9 years in women and 10 years in men. Interpretation Even in the late ART era, survival during the first 3 years of ART continues to improve, which probably reflects transition to less toxic antiretroviral drugs, improved adherence, prophylactic measures, and management of comorbidity. Prognostic models and life expectancy estimates should be updated to account for these improvements.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Trickey, AdamUNSPECIFIEDorcid.org/0000-0003-3462-2898UNSPECIFIED
May, Margaret T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vehreschild, Jorg-JanneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Obel, NielsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gill, M. JohnUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Crane, Heidi M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boesecke, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Patterson, SophieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Grabar, SophieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cazanave, CharlesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cavassini, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shepherd, LeahUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Monforte, Antonella d'ArminioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
van Sighem, ArdUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Saag, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lampe, FionaUNSPECIFIEDorcid.org/0000-0001-6851-5471UNSPECIFIED
Hernando, VickyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Montero, MartaUNSPECIFIEDorcid.org/0000-0002-3432-5394UNSPECIFIED
Zangerle, RobertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Justice, Amy C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sterling, TimothyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Miro, Jose M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ingle, Suzanne M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sterne, Jonathan A. C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Boulle, AndrewUNSPECIFIEDorcid.org/0000-0002-7713-8062UNSPECIFIED
Stephan, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Miro, Jose M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cavassini, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chene, GenevieveUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Costagliola, DominiqueUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dabis, FrancoisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
del Amo, JuliaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Van Sighem, ArdUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vehreschild, Jorg-JanneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gill, M. JohnUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Guest, JodieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Haerry, David Hans-UlrichUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hogg, RobertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Justice, Amy C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Shepherd, LeahUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Obel, NielsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Crane, Heidi M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Smith, ColetteUNSPECIFIEDorcid.org/0000-0003-2847-3355UNSPECIFIED
Reiss, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Saag, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sterling, TimothyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Teira, RamonUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Williams, MatthewUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Zangerle, RobertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sterne, Jonathan A. C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
May, Margaret T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ingle, Suzanne M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Trickey, AdamUNSPECIFIEDorcid.org/0000-0003-3462-2898UNSPECIFIED
URN: urn:nbn:de:hbz:38-224199
DOI: 10.1016/S2352-3018(17)30066-8
Journal or Publication Title: Lancet HIV
Volume: 4
Number: 8
Page Range: S. E349 - 8
Date: 2017
Publisher: ELSEVIER INC
Place of Publication: SAN DIEGO
ISSN: 2352-3018
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
LIFE EXPECTANCY; INFECTED PATIENTS; NORTH-AMERICA; INDIVIDUALS; DIAGNOSIS; MORTALITY; PEOPLE; EUROPE; IMPACT; DEATHMultiple languages
Immunology; Infectious DiseasesMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/22419

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