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Overall and cause-specific mortality in HIV-positive subjects compared to the general population

INTRODUCTION: Emerging non-AIDS related causes of death have been observed in HIV-positive subjects in industrialized countries. We aimed to analyze overall and cause-specific excess of mortality of HIV-positive patients compared to the general population and to assess the effect of prognostic facto...

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Autores principales: Alejos, Belen, Hernando, Victoria, López-Aldeguer, Jose, Segura, Ferrán, Antonio Oteo, José, Rubio, Rafael, Sanvisens, Arantza, Sobrino, Paz, del Amo, Julia, Coris, Cohort
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International AIDS Society 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225377/
https://www.ncbi.nlm.nih.gov/pubmed/25397458
http://dx.doi.org/10.7448/IAS.17.4.19711
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author Alejos, Belen
Hernando, Victoria
López-Aldeguer, Jose
Segura, Ferrán
Antonio Oteo, José
Rubio, Rafael
Sanvisens, Arantza
Sobrino, Paz
del Amo, Julia
Coris, Cohort
author_facet Alejos, Belen
Hernando, Victoria
López-Aldeguer, Jose
Segura, Ferrán
Antonio Oteo, José
Rubio, Rafael
Sanvisens, Arantza
Sobrino, Paz
del Amo, Julia
Coris, Cohort
author_sort Alejos, Belen
collection PubMed
description INTRODUCTION: Emerging non-AIDS related causes of death have been observed in HIV-positive subjects in industrialized countries. We aimed to analyze overall and cause-specific excess of mortality of HIV-positive patients compared to the general population and to assess the effect of prognostic factors. MATERIAL AND METHODS: We used generalized linear models with Poisson error structure to estimate overall and cause-specific excess of mortality in HIV-positive patients from 2004 to 2012 in the cohort of the Spanish Network of HIV Research (CoRIS), compared to Spanish general population and to assess the impact of multiple risk factors. We investigated differences between short-term and long-term risk factors effects on excess of mortality. Multiple Imputation by Chained Equations was used to deal with missing data. RESULTS: In 9162 patients there were 363 deaths, 16.0% were non-AIDS malignancies, 10.5% liver and 0.3% cardiovascular related. Excess mortality was 1.20 deaths per 100 person years (py) for all-cause mortality, 0.16 for liver, 0.10 for non-AIDS malignancies and 0.03 for cardiovascular. Short-term (first-year follow-up) excess Hazard Ratio (eHR) for global mortality for baseline AIDS was 4.27 (95% CI 3.06–6.01) and 1.47 (95% CI 0.95–2.27) for HCV coinfection; long-term (subsequent follow-up) eHR for baseline AIDS was 0.88 (95% CI 0.58–1.35) and 4.48 (95% CI 2.71–7.42) for HCV coinfection. Lower CD4 count and higher viral load at entry, lower education, being male and over 50 years were predictors for overall excess mortality. Excess of liver mortality was higher in patients with CD4 counts at entry below 200 cells compared to those above 350 (eHR: 6.49, 95% CI 1.21–34.84) and in HCV-coinfected patients (eHR: 3.85, 95% CI 0.85– 17.37), although it was borderline significant. Patients over 50 years old (eHR: 5.55, 95%CI 2.4–12.85) and HCV coinfected (eHR: 5.81, 95% CI 2.6–13) showed a higher risk of non-AIDS malignancies mortality excess. Excess of cardiovascular mortality was related with HCV coinfection (eHR: 6.68, 95% CI 1.25–35.73). CONCLUSIONS: Our results show overall, liver, non-AIDS malignancies and cardiovascular excess of mortality associated with being HIV-positive, despite improvements in HIV disease management and antiretroviral therapies. Differential short-term and long-term effect of AIDS before entry and HCV coinfection was found for overall mortality.
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spelling pubmed-42253772014-11-13 Overall and cause-specific mortality in HIV-positive subjects compared to the general population Alejos, Belen Hernando, Victoria López-Aldeguer, Jose Segura, Ferrán Antonio Oteo, José Rubio, Rafael Sanvisens, Arantza Sobrino, Paz del Amo, Julia Coris, Cohort J Int AIDS Soc Poster Sessions – Abstract P179 INTRODUCTION: Emerging non-AIDS related causes of death have been observed in HIV-positive subjects in industrialized countries. We aimed to analyze overall and cause-specific excess of mortality of HIV-positive patients compared to the general population and to assess the effect of prognostic factors. MATERIAL AND METHODS: We used generalized linear models with Poisson error structure to estimate overall and cause-specific excess of mortality in HIV-positive patients from 2004 to 2012 in the cohort of the Spanish Network of HIV Research (CoRIS), compared to Spanish general population and to assess the impact of multiple risk factors. We investigated differences between short-term and long-term risk factors effects on excess of mortality. Multiple Imputation by Chained Equations was used to deal with missing data. RESULTS: In 9162 patients there were 363 deaths, 16.0% were non-AIDS malignancies, 10.5% liver and 0.3% cardiovascular related. Excess mortality was 1.20 deaths per 100 person years (py) for all-cause mortality, 0.16 for liver, 0.10 for non-AIDS malignancies and 0.03 for cardiovascular. Short-term (first-year follow-up) excess Hazard Ratio (eHR) for global mortality for baseline AIDS was 4.27 (95% CI 3.06–6.01) and 1.47 (95% CI 0.95–2.27) for HCV coinfection; long-term (subsequent follow-up) eHR for baseline AIDS was 0.88 (95% CI 0.58–1.35) and 4.48 (95% CI 2.71–7.42) for HCV coinfection. Lower CD4 count and higher viral load at entry, lower education, being male and over 50 years were predictors for overall excess mortality. Excess of liver mortality was higher in patients with CD4 counts at entry below 200 cells compared to those above 350 (eHR: 6.49, 95% CI 1.21–34.84) and in HCV-coinfected patients (eHR: 3.85, 95% CI 0.85– 17.37), although it was borderline significant. Patients over 50 years old (eHR: 5.55, 95%CI 2.4–12.85) and HCV coinfected (eHR: 5.81, 95% CI 2.6–13) showed a higher risk of non-AIDS malignancies mortality excess. Excess of cardiovascular mortality was related with HCV coinfection (eHR: 6.68, 95% CI 1.25–35.73). CONCLUSIONS: Our results show overall, liver, non-AIDS malignancies and cardiovascular excess of mortality associated with being HIV-positive, despite improvements in HIV disease management and antiretroviral therapies. Differential short-term and long-term effect of AIDS before entry and HCV coinfection was found for overall mortality. International AIDS Society 2014-11-02 /pmc/articles/PMC4225377/ /pubmed/25397458 http://dx.doi.org/10.7448/IAS.17.4.19711 Text en © 2014 Alejos BT et al; licensee International AIDS Society http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Poster Sessions – Abstract P179
Alejos, Belen
Hernando, Victoria
López-Aldeguer, Jose
Segura, Ferrán
Antonio Oteo, José
Rubio, Rafael
Sanvisens, Arantza
Sobrino, Paz
del Amo, Julia
Coris, Cohort
Overall and cause-specific mortality in HIV-positive subjects compared to the general population
title Overall and cause-specific mortality in HIV-positive subjects compared to the general population
title_full Overall and cause-specific mortality in HIV-positive subjects compared to the general population
title_fullStr Overall and cause-specific mortality in HIV-positive subjects compared to the general population
title_full_unstemmed Overall and cause-specific mortality in HIV-positive subjects compared to the general population
title_short Overall and cause-specific mortality in HIV-positive subjects compared to the general population
title_sort overall and cause-specific mortality in hiv-positive subjects compared to the general population
topic Poster Sessions – Abstract P179
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225377/
https://www.ncbi.nlm.nih.gov/pubmed/25397458
http://dx.doi.org/10.7448/IAS.17.4.19711
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