TY - JOUR
T1 - Excess mortality in patients with AIDS in the era of highly active antiretroviral therapy
T2 - Temporal changes and risk factors
AU - Puhan, Milo A.
AU - Van Natta, Mark L.
AU - Palella, Frank J.
AU - Addessi, Adrienne
AU - Meinert, Curtis
N1 - Funding Information:
Financial support. LSOCA is supported by cooperative agreements from the National Eye Institute, Bethesda, Maryland, to Mount Sinai School of Medicine (grant no. U10 EY 08052), Johns Hopkins University Bloom-berg School of Public Health (grant no. U10 EY 08057), and University of Wisconsin, Madison (grant no. U10 EY 08067). Additional support was provided by the National Center for Research Resources, Bethesda, Maryland, through General Clinical Research Center grants 5MO1 RR 00188 (Baylor College of Medicine), MO1 RR 00052 (Johns Hopkins University School of Medicine), M01 RR00096 (NYU School of Medicine), 5MO1 RR 05096 (Louisiana State University, Tulane, Charity Hospital), 5MO1 RR 00865 (University of California, Los Angeles), 5MO1 RR 05280 (University of Miami), 5M01 RR00046 (University of North Carolina, Chapel Hill), 5MO1 RR 00043 (University of Southern California), and 5MO1 RR 00047 (Weill Medical College of Cornell University). Support also is provided through cooperative agreements U01 AI 27674 (Louisiana State University, Tulane), U01 AI 27660 (University of California, Los Angeles), U01 AI 276670 (University of California, San Diego), U01 AI 27663 (University of California, San Francisco), U01 AI 25858 (University of North Carolina, Chapel Hill), U01 AI 25903 (Washington University at St. Louis), and U01 AI 32783 (University of Pennsylvania) from the National Institutes of Health.
PY - 2010/10/15
Y1 - 2010/10/15
N2 - Background. Excess mortality has decreased among human immunodeficiency virus (HIV)-infected patients but without evidence of a decrease among patients with AIDS. We assessed temporal changes in excess mortality and elucidated risk factors for excess mortality in patients with AIDS diagnosed in the era of highly active antiretroviral therapy (HAART). Methods. We included 1188 patients of the Longitudinal Study of Ocular Complications in AIDS who were aged 25-64 years at enrollment and who received a diagnosis of AIDS after 1995. We calculated excess mortality as the age-, year-, and sex-adjusted difference in mortality rates between patients with AIDS and persons in the US general population during the period 1999-2007. We used a relative survival model to identify risk factors for excess mortality. Results. There were a mean of 50 excess deaths per 1000 person-years (95% confidence interval [CI], 44-57 excess deaths per 1000 person-years) during 1999-2007. Excess mortality almost halved, with an annual decrease of 8.0% per year (95% CI, 3.0%-12.7%; P = .002) but remained high at 36 excess deaths per 1000 person-years in 2007. Viral load >400 copies/mL (compared with ≤400 copies/mL; risk ratio, 3.4; 95% CI, 2.3-5.0), CD4+ count <200 cells/μL (compared with ≥200 cells/μL; risk ratio, 2.7; 95% CI, 1.9-3.9), and cytomegalovirus retinitis (risk ratio, 1.6; 95% CI, 1.2-2.1) were the strongest risk factors for excess mortality. Conclusions. Excess mortality among patients with AIDS was nearly halved in the HAART era and most strongly linked to stage of HIV disease. These results reflect the continuing improvements in AIDS management but also highlight that excess mortality remains ∼5 times higher in patients with AIDS than in HIV-infected patients without AIDS.
AB - Background. Excess mortality has decreased among human immunodeficiency virus (HIV)-infected patients but without evidence of a decrease among patients with AIDS. We assessed temporal changes in excess mortality and elucidated risk factors for excess mortality in patients with AIDS diagnosed in the era of highly active antiretroviral therapy (HAART). Methods. We included 1188 patients of the Longitudinal Study of Ocular Complications in AIDS who were aged 25-64 years at enrollment and who received a diagnosis of AIDS after 1995. We calculated excess mortality as the age-, year-, and sex-adjusted difference in mortality rates between patients with AIDS and persons in the US general population during the period 1999-2007. We used a relative survival model to identify risk factors for excess mortality. Results. There were a mean of 50 excess deaths per 1000 person-years (95% confidence interval [CI], 44-57 excess deaths per 1000 person-years) during 1999-2007. Excess mortality almost halved, with an annual decrease of 8.0% per year (95% CI, 3.0%-12.7%; P = .002) but remained high at 36 excess deaths per 1000 person-years in 2007. Viral load >400 copies/mL (compared with ≤400 copies/mL; risk ratio, 3.4; 95% CI, 2.3-5.0), CD4+ count <200 cells/μL (compared with ≥200 cells/μL; risk ratio, 2.7; 95% CI, 1.9-3.9), and cytomegalovirus retinitis (risk ratio, 1.6; 95% CI, 1.2-2.1) were the strongest risk factors for excess mortality. Conclusions. Excess mortality among patients with AIDS was nearly halved in the HAART era and most strongly linked to stage of HIV disease. These results reflect the continuing improvements in AIDS management but also highlight that excess mortality remains ∼5 times higher in patients with AIDS than in HIV-infected patients without AIDS.
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U2 - 10.1086/656415
DO - 10.1086/656415
M3 - Article
C2 - 20825306
AN - SCOPUS:77957843595
SN - 1058-4838
VL - 51
SP - 947
EP - 956
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 8
ER -