CASCADE collaboration. Changes in the risk of death after HIV seroconversion compared with mortality in the general population

MRC Clinical Trials Unit, 222 Euston Rd, London NW1 2DA, United Kingdom.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 08/2008; 300(1):51-9. DOI: 10.1001/jama.300.1.51
Source: PubMed


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.
To evaluate changes in the mortality gap between HIV-infected individuals and the general uninfected 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.
Excess mortality among HIV-infected individuals compared with that of the general uninfected population.
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).
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.

Download full-text


Available from: Faroudy Boufassa, Oct 08, 2015
43 Reads
    • "Injection drug users had a lower life expectancy in concurrence with their higher risk of death, which may be due not only to access to adherence obstacles, but also may be related to substance abuse and co-infections, in this population.[1718] In addition to infection, the patient may also differ from the general population in behavioral risk factors and socioeconomic factors, both of which can impact life expectancy and AYLL.[16] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Predicting life expectancy is an important component of public health, in that, it may affect policy making in fields such as social security and medical care., To estimate the life expectancy and the average years of life lost (AYLL) of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)-infected population, compared with that of the general population, and also to assess the impact of the CD4 count, risk factors of transmission, marital status, and employment status on life expectancy. This study is a population-based cohort study. The sample consisted of HIV/AIDS-infected patients receiving care from 2001-2011. The patients were all adults (20-64 years) who were recruited from the Counseling Center of Behavioral Diseases. Life expectancy was measured based on an abridged life table, according to age-specific mortality rates and average years of life lost (AYLL) during the study period. Forty-three of the 205 eligible patients died during 853 person-years follow-up. Compared to the general population, the life expectancy for patients with HIV infection at age 20 is about 36 years less. We have found that out a total of 1597 years of life lost during 2001-2011, compared to an overall AYLL for all HIV/AIDS, the deaths had occurred 36 years earlier than the life expectancy. Life expectancy in HIV/AIDS-infected patients is about 38 years less than that of the general population at the exact age of 20. The deaths caused by HIV/AIDS occurred about 36 years before what was expected in the general population at ages 20-64, and many of these years of life lost could be saved if the health care system was implemented against the risk factors of HIV/AIDS.
    Journal of research in medical sciences 12/2013; 18(12):1040-5. · 0.65 Impact Factor
  • Source
    • "More than 50,000 patients receive highly active antiretroviral therapy (HAART) [1]. After more than a decade of widespread application of HAART, the life expectancy of HIV-infected patients has approached the level of the non-infected population [2]. In general, efficacy of first-line HAART exceeds 80%, measured by the proportion of patients with a viral load below the detection limit [3]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The efficacy of highly active antiretroviral therapy (HAART) in the treatment of HIV infection is influenced by factors such as potency of applied drugs, adherence of the patient, and resistance-associated mutations. Up to now, there is insufficient data on the impact of the therapeutic setting. Since 2001, the prospective multicenter RESINA study has examined the epidemiology of primary HIV drug resistance in Nordrhein-Westfalen, the largest federal state of Germany by population. Characteristics of patients treated in hospital-based outpatient units were compared to those of patients treated in medical practices. Longitudinal data of all participants are being followed in a cohort study. Overall, 1,591 patients were enrolled between 2001 and 2009 with follow-up until the end of 2010. Of these, 1,099 cases were treated in hospital-based units and 492 in private practices. Significant differences were found with respect to baseline characteristics. A higher rate of patients with more advanced disease and non-European nationality were cared for in hospital units. Patients in medical practices were predominantly Caucasian men who have sex with men (MSM) harboring HIV-1 subtype B, with lower CDC stage and higher CD4 cell count. Median viral load was 68,828 c/mL in hospital-based units and 100,000 c/mL in private practices (P = 0.041). Only median age and rate of primary drug resistance were not significantly different. After 48 weeks, 81.9% of patients in hospital units and 85.9% in private practices had a viral load below the limit of detection (P = 0.12). A similar result was seen after 96 weeks (P = 0.54). Although the baseline CD4 cell count was different (189.5/muL in hospital units and 246.5/muL in private practices, P <0.001), a consistent and almost identical increase was determined in both groups. The RESINA study covers a large HIV-infected patient cohort cared for in specialized facilities in Germany. Despite significant differences of patients' baseline characteristics in hospital-based units compared to medical practices, we could not find significant differences in treatment outcome up to 2 years after the initiation of HAART.
    11/2013; 18(1):48. DOI:10.1186/2047-783X-18-48
  • Source
    • "population (Bhaskaran et al., 2008). Cardiovascular disease (CVD), however, has emerged as a major cause of morbidity and mortality in adults with HIV infection (Gill et al., 2010), often accounting for one quarter of non-HIV-related deaths (Sackoff, Hanna, Pfeiffer, & Torian, 2006). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cardiovascular disease (CVD) has emerged as a major cause of morbidity and mortality in HIV-infected adults. Research in noninfected populations has suggested that knowledge of CVD risk factors significantly influences perceptions of risk. This cross-sectional study describes CVD risk factor knowledge and risk perception in HIV-infected adults. We recruited 130 HIV-infected adults (mean age = 48 years, 62% male, 56% current smokers, mean years since HIV diagnosis, 14.7). The mean CVD risk factor knowledge score was fairly high. However, controlling for age, CVD risk factor knowledge was not predictive of perceived risk [F(1, 117) = 0.13, p > .05]. Estimated risk and perceived risk were weakly but significantly correlated; r (126) = .24, p = .01. HIV-infected adults are at increased risk for CVD. Despite having adequate risk-factor knowledge, CVD risk perception was inaccurate. Improving risk perception and developing CVD risk reduction interventions for this population are imperative.
    The Journal of the Association of Nurses in AIDS Care: JANAC 09/2013; 25(1). DOI:10.1016/j.jana.2013.07.006 · 1.27 Impact Factor
Show more