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A tale of two countries: all‐cause mortality among people living with HIV and receiving combination antiretroviral therapy in the UK and Canada
Author(s) -
Patterson S,
Jose S,
Samji H,
Cescon A,
Ding E,
Zhu J,
Anderson J,
Burchell AN,
Cooper C,
Hill T,
Hull M,
Klein MB,
Loutfy M,
Martin F,
Machouf N,
Montaner JSG,
Nelson M,
Raboud J,
Rourke SB,
Tsoukas C,
Hogg RS,
Sabin C
Publication year - 2017
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12505
Subject(s) - medicine , interquartile range , cohort , demography , confidence interval , cohort study , proportional hazards model , antiretroviral therapy , men who have sex with men , human immunodeficiency virus (hiv) , viral load , family medicine , syphilis , sociology
Objectives We sought to compare all‐cause mortality of people living with HIV and accessing care in Canada and the UK . Methods Individuals from the Canadian Observational Cohort ( CANOC ) collaboration and UK Collaborative HIV Cohort ( UK CHIC ) study who were aged ≥ 18 years, had initiated antiretroviral therapy ( ART ) for the first time between 2000 and 2012 and who had acquired HIV through sexual transmission were included in the analysis. Cox regression was used to investigate the difference in mortality risk between the two cohort collaborations, accounting for loss to follow‐up as a competing risk. Results A total of 19 960 participants were included in the analysis ( CANOC , 4137; UK CHIC , 15 823). CANOC participants were more likely to be older [median age 39 years (interquartile range ( IQR ): 33, 46 years) vs . 36 years ( IQR : 31, 43 years) for UK CHIC participants], to be male (86 vs . 73%, respectively), and to report men who have sex with men ( MSM ) sexual transmission risk (72 vs . 56%, respectively) (all P < 0.001). Overall, 762 deaths occurred during 98 798 person‐years ( PY ) of follow‐up, giving a crude mortality rate of 7.7 per 1000 PY [95% confidence interval ( CI ): 7.1, 8.3 per 1000 PY ]. The crude mortality rates were 8.6 (95% CI : 7.4, 10.0) and 7.5 (95% CI : 6.9, 8.1) per 1000 PY among CANOC and UK CHIC study participants, respectively. No statistically significant difference in mortality risk was observed between the cohort collaborations in Cox regression accounting for loss to follow‐up as a competing risk (adjusted hazard ratio 0.86; 95% CI : 0.72–1.03). Conclusions Despite differences in national HIV care provision and treatment guidelines, mortality risk did not differ between CANOC and UK CHIC study participants who acquired HIV through sexual transmission.