Universität zu Köln

Trickey, Adam ORCID: 0000-0003-3462-2898, May, Margaret T., Vehreschild, Janne, Obel, Niels, Gill, Michael John ORCID: 0000-0002-8546-8790, Crane, Heidi, Boesecke, Christoph, Samji, Hasina ORCID: 0000-0002-4555-7609, Grabar, Sophie, Cazanave, Charles, Cavassini, Matthias, Shepherd, Leah, Monforte, Antonella d'Arminio, Smit, Colette, 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, Ingle, Suzanne and Sterne, Jonathan A. C. (2016). Cause-Specific Mortality in HIV-Positive Patients Who Survived Ten Years after Starting Antiretroviral Therapy. PLoS One, 11 (8). SAN FRANCISCO: PUBLIC LIBRARY SCIENCE. ISSN 1932-6203

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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 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. 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Trickey, Adam UNSPECIFIED orcid.org/0000-0003-3462-2898 UNSPECIFIED May, Margaret T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Vehreschild, Janne UNSPECIFIED UNSPECIFIED UNSPECIFIED Obel, Niels UNSPECIFIED UNSPECIFIED UNSPECIFIED Gill, Michael John UNSPECIFIED orcid.org/0000-0002-8546-8790 UNSPECIFIED Crane, Heidi UNSPECIFIED UNSPECIFIED UNSPECIFIED Boesecke, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Samji, Hasina UNSPECIFIED orcid.org/0000-0002-4555-7609 UNSPECIFIED Grabar, Sophie UNSPECIFIED UNSPECIFIED UNSPECIFIED Cazanave, Charles UNSPECIFIED UNSPECIFIED UNSPECIFIED Cavassini, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Shepherd, Leah UNSPECIFIED UNSPECIFIED UNSPECIFIED Monforte, Antonella d'Arminio UNSPECIFIED UNSPECIFIED UNSPECIFIED Smit, Colette UNSPECIFIED UNSPECIFIED UNSPECIFIED Saag, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Lampe, Fiona UNSPECIFIED orcid.org/0000-0001-6851-5471 UNSPECIFIED Hernando, Vicky UNSPECIFIED UNSPECIFIED UNSPECIFIED Montero, Marta UNSPECIFIED orcid.org/0000-0002-3432-5394 UNSPECIFIED Zangerle, Robert UNSPECIFIED UNSPECIFIED UNSPECIFIED Justice, Amy C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sterling, Timothy UNSPECIFIED UNSPECIFIED UNSPECIFIED Miro, Jose UNSPECIFIED UNSPECIFIED UNSPECIFIED Ingle, Suzanne UNSPECIFIED UNSPECIFIED UNSPECIFIED Sterne, Jonathan A. C. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-266563
DOI:	10.1371/journal.pone.0160460
Journal or Publication Title:	PLoS One
Volume:	11
Number:	8
Date:	2016
Publisher:	PUBLIC LIBRARY SCIENCE
Place of Publication:	SAN FRANCISCO
ISSN:	1932-6203
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CD4 CELL COUNT; HIV-1-INFECTED PATIENTS; COLLABORATIVE ANALYSIS; INFECTED INDIVIDUALS; PROPORTIONAL-HAZARDS; CLINICAL-PRACTICE; RISK-FACTORS; DRUG-USE; DEATH; COHORT Multiple languages Multidisciplinary Sciences Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/26656