Open AccessIncreased non‐ AIDS mortality among persons with AIDS ‐defining events after antiretroviral therapy initiation
Author(s) -
Pettit April C,
Giganti Mark J,
Ingle Suzanne M,
May Margaret T,
Shepherd Bryan E,
Gill Michael J,
Fätkenheuer Gerd,
Abgrall Sophie,
Saag Michael S,
Del Amo Julia,
Justice Amy C,
Miro Jose M,
Cavasinni Matthias,
Dabis François,
Monforte Antonella D,
Reiss Peter,
Guest Jodie,
Moore David,
Shepherd Leah,
Obel Niels,
Crane Heidi M,
Smith Colette,
Teira Ramon,
Zangerle Robert,
Sterne Jonathan AC,
Sterling Timothy R
Publication year - 2018
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25031
Subject(s) - medicine , hazard ratio , pneumocystis pneumonia , viral load , tuberculosis , cause of death , proportional hazards model , immunology , mortality rate , confidence interval , cohort , pneumonia , human immunodeficiency virus (hiv) , disease , pneumocystis jirovecii , pathology
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 ( ADE s) were associated with increased overall and cause‐specific non‐ AIDS related mortality after antiretroviral therapy ( ART ) initiation. Methods We included HIV treatment‐naïve 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 ADE s, 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 ADE s and NADE mortality. While prevention of ADE s may reduce subsequent death due to NADE s following ART initiation, modification of risk factors for NADE mortality remains important after ADE survival.