TY - JOUR
T1 - Long-term exposure to combination antiretroviral therapy and risk of death from specific causes: no evidence for any previously unidentified increased risk due to antiretroviral therapy
AU - Kowalska, Justyna D.
AU - Reekie, Joanne
AU - Mocroft, Amanda
AU - Reiss, Peter
AU - Ledergerber, Bruno
AU - Gatell, Jose
AU - D'Arminio Monforte, Antonella
AU - Phillips, Andrew
AU - Lundgren, Jens D.
AU - Kirk, Ole
AU - AUTHOR GROUP
AU - van Lunzen, J.
AU - Degen, O.
AU - Stellbrink, H. J.
AU - Staszewski, S.
AU - Goethe, J. W.
AU - Bogner, J.
AU - Fätkenheuer, G.
AU - Gargalianos, P.
AU - Xylomenos, G.
AU - Perdios, J.
AU - Panos, G.
AU - Filandras, A.
AU - Karabatsaki, E.
AU - Sambatakou, H.
AU - Banhegyi, D.
AU - Mulcahy, F.
AU - Yust, I.
AU - Turner, D.
AU - Burke, M.
AU - Pollack, S.
AU - Hassoun, G.
AU - Maayan, S.
AU - Vella, S.
AU - Esposito, R.
AU - Mazeu, I.
AU - Mussini, C.
AU - Arici, C.
AU - Pristera, R.
AU - Mazzotta, F.
AU - Gabbuti, A.
AU - Vullo, V.
AU - Lichtner, M.
AU - Chirianni, A.
AU - Montesarchio, E.
AU - Gargiulo, M.
AU - Antonucci, G.
AU - Testa, A.
AU - Narciso, P.
AU - Vlassi, C.
AU - Zaccarelli, M.
PY - 2012
Y1 - 2012
N2 - Background: Despite the known substantial benefits of combination antiretroviral therapy (cART), cumulative adverse effects could still limit the overall long-term treatment benefit. Therefore we investigated changes in the rate of death with increasing exposure to cART. Methods: A total of 12 069 patients were followed from baseline, which was defined as the time of starting cART or enrolment into EuroSIDA whichever occurred later, until death or 6 months after last follow-up visit. Incidence rates of death were calculated per 1000 person-years of follow-up (PYFU) and stratified by time of exposure to cART (>= 3 antiretrovirals): less than 2, 2-3.99, 4-5.99, 6-7.99 and more than 8 years. Duration of cART exposure was the cumulative time actually receiving cART. Poisson regression models were fitted for each cause of death separately. Results: A total of 1297 patients died during 70 613 PYFU [incidence rate 18.3 per 1000 PYFU, 95% confidence interval (CI) 17.4-19.4], 413 due to AIDS (5.85, 95% CI 5.28-6.41) and 884 due to non-AIDS-related cause (12.5, 95% CI 11.7-13.3). After adjustment for confounding variables, including baseline CD4 cell count and HIV RNA, there was a significant decrease in the rate of all-cause and AIDS-related death between 2 and 3.99 years and longer exposure time. In the first 2 years on cART the risk of non-AIDS death was significantly lower, but no significant difference in the rate of non-AIDS-related deaths between 2 and 3.99 years and longer exposure to cART was observed. Conclusion: In conclusion, we found no evidence of an increased risk of both all-cause and non-AIDS-related deaths with long-term cumulative cART exposure. (C) 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
AB - Background: Despite the known substantial benefits of combination antiretroviral therapy (cART), cumulative adverse effects could still limit the overall long-term treatment benefit. Therefore we investigated changes in the rate of death with increasing exposure to cART. Methods: A total of 12 069 patients were followed from baseline, which was defined as the time of starting cART or enrolment into EuroSIDA whichever occurred later, until death or 6 months after last follow-up visit. Incidence rates of death were calculated per 1000 person-years of follow-up (PYFU) and stratified by time of exposure to cART (>= 3 antiretrovirals): less than 2, 2-3.99, 4-5.99, 6-7.99 and more than 8 years. Duration of cART exposure was the cumulative time actually receiving cART. Poisson regression models were fitted for each cause of death separately. Results: A total of 1297 patients died during 70 613 PYFU [incidence rate 18.3 per 1000 PYFU, 95% confidence interval (CI) 17.4-19.4], 413 due to AIDS (5.85, 95% CI 5.28-6.41) and 884 due to non-AIDS-related cause (12.5, 95% CI 11.7-13.3). After adjustment for confounding variables, including baseline CD4 cell count and HIV RNA, there was a significant decrease in the rate of all-cause and AIDS-related death between 2 and 3.99 years and longer exposure time. In the first 2 years on cART the risk of non-AIDS death was significantly lower, but no significant difference in the rate of non-AIDS-related deaths between 2 and 3.99 years and longer exposure to cART was observed. Conclusion: In conclusion, we found no evidence of an increased risk of both all-cause and non-AIDS-related deaths with long-term cumulative cART exposure. (C) 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
U2 - https://doi.org/10.1097/QAD.0b013e32834e8805
DO - https://doi.org/10.1097/QAD.0b013e32834e8805
M3 - Article
C2 - 22112597
SN - 0269-9370
VL - 26
SP - 315
EP - 323
JO - AIDS (London, England)
JF - AIDS (London, England)
IS - 3
ER -