TY - JOUR
T1 - Changes in the risk of death after HIV seroconversion compared with mortality in the general population
AU - Bhaskaran, Krishnan
AU - Hamouda, Osamah
AU - Sannes, Mette
AU - Boufassa, Faroudy
AU - Johnson, Anne M.
AU - Lambert, Paul C.
AU - Porter, Kholoud
AU - AUTHOR GROUP
AU - del Amo, Julia
AU - Meyer, Laurence
AU - Bucher, Heiner
AU - Chêne, Geneviève
AU - Pillay, Deenan
AU - Prins, Maria
AU - Rosinska, Magda
AU - Sabin, Caroline
AU - Touloumi, Giota
AU - Walker, Sarah
AU - Babiker, Abdel
AU - Darbyshire, Janet
AU - de Luca, Andrea
AU - Fisher, Martin
AU - Muga, Roberto
AU - Kaldor, John
AU - Kelleher, Tony
AU - Ramacciotti, Tim
AU - Gelgor, Linda
AU - Cooper, David
AU - Smith, Don
AU - Gill, John
AU - Jørgensen, Louise Bruun
AU - Nielsen, Claus
AU - Pedersen, Court
AU - Lutsar, Irja
AU - Dabis, Francois
AU - Thiebaut, Rodolphe
AU - Masquelier, Bernard
AU - Costagliola, Dominique
AU - Guiguet, Marguerite
AU - Vanhems, Philippe
AU - Kucherer, Claudia
AU - Pantazis, Nikos
AU - Hatzakis, Angelos
AU - Paraskevis, Dimitrios
AU - Karafoulidou, Anastasia
AU - Rezza, Giovanni
AU - Dorrucci, Maria
AU - Longo, Benedetta
AU - Balotta, Claudia
AU - Geskus, Ronald
AU - Coutinho, Roel
PY - 2008
Y1 - 2008
N2 - CONTEXT: Mortality among human immunodeficiency virus (HIV)-infected individuals has decreased dramatically in countries with good access to treatment and may now be close to mortality in the general uninfected population. OBJECTIVE: To evaluate changes in the mortality gap between HIV-infected individuals and the general uninfected population. DESIGN, SETTING, AND POPULATION: Mortality following HIV seroconversion in a large multinational collaboration of HIV seroconverter cohorts (CASCADE) was compared with expected mortality, calculated by applying general population death rates matched on demographic factors. A Poisson-based model adjusted for duration of infection was constructed to assess changes over calendar time in the excess mortality among HIV-infected individuals. Data pooled in September 2007 were analyzed in March 2008, covering years at risk 1981-2006. MAIN OUTCOME MEASURE: Excess mortality among HIV-infected individuals compared with that of the general uninfected population. RESULTS: Of 16,534 individuals with median duration of follow-up of 6.3 years (range, 1 day to 23.8 years), 2571 died, compared with 235 deaths expected in an equivalent general population cohort. The excess mortality rate (per 1000 person-years) decreased from 40.8 (95% confidence interval [CI], 38.5-43.0; 1275.9 excess deaths in 31,302 person-years) before the introduction of highly active antiretroviral therapy (pre-1996) to 6.1 (95% CI, 4.8-7.4; 89.6 excess deaths in 14,703 person-years) in 2004-2006 (adjusted excess hazard ratio, 0.05 [95% CI, 0.03-0.09] for 2004-2006 vs pre-1996). By 2004-2006, no excess mortality was observed in the first 5 years following HIV seroconversion among those infected sexually, though a cumulative excess probability of death remained over the longer term (4.8% [95% CI, 2.5%-8.6%] in the first 10 years among those aged 15-24 years). CONCLUSIONS: Mortality rates for HIV-infected persons have become much closer to general mortality rates since the introduction of highly active antiretroviral therapy. In industrialized countries, persons infected sexually with HIV now appear to experience mortality rates similar to those of the general population in the first 5 years following infection, though a mortality excess remains as duration of HIV infection lengthens
AB - CONTEXT: Mortality among human immunodeficiency virus (HIV)-infected individuals has decreased dramatically in countries with good access to treatment and may now be close to mortality in the general uninfected population. OBJECTIVE: To evaluate changes in the mortality gap between HIV-infected individuals and the general uninfected population. DESIGN, SETTING, AND POPULATION: Mortality following HIV seroconversion in a large multinational collaboration of HIV seroconverter cohorts (CASCADE) was compared with expected mortality, calculated by applying general population death rates matched on demographic factors. A Poisson-based model adjusted for duration of infection was constructed to assess changes over calendar time in the excess mortality among HIV-infected individuals. Data pooled in September 2007 were analyzed in March 2008, covering years at risk 1981-2006. MAIN OUTCOME MEASURE: Excess mortality among HIV-infected individuals compared with that of the general uninfected population. RESULTS: Of 16,534 individuals with median duration of follow-up of 6.3 years (range, 1 day to 23.8 years), 2571 died, compared with 235 deaths expected in an equivalent general population cohort. The excess mortality rate (per 1000 person-years) decreased from 40.8 (95% confidence interval [CI], 38.5-43.0; 1275.9 excess deaths in 31,302 person-years) before the introduction of highly active antiretroviral therapy (pre-1996) to 6.1 (95% CI, 4.8-7.4; 89.6 excess deaths in 14,703 person-years) in 2004-2006 (adjusted excess hazard ratio, 0.05 [95% CI, 0.03-0.09] for 2004-2006 vs pre-1996). By 2004-2006, no excess mortality was observed in the first 5 years following HIV seroconversion among those infected sexually, though a cumulative excess probability of death remained over the longer term (4.8% [95% CI, 2.5%-8.6%] in the first 10 years among those aged 15-24 years). CONCLUSIONS: Mortality rates for HIV-infected persons have become much closer to general mortality rates since the introduction of highly active antiretroviral therapy. In industrialized countries, persons infected sexually with HIV now appear to experience mortality rates similar to those of the general population in the first 5 years following infection, though a mortality excess remains as duration of HIV infection lengthens
U2 - https://doi.org/10.1001/jama.300.1.51
DO - https://doi.org/10.1001/jama.300.1.51
M3 - Article
C2 - 18594040
SN - 0098-7484
VL - 300
SP - 51
EP - 59
JO - JAMA
JF - JAMA
IS - 1
ER -