The impact of scaling-up combination antiretroviral therapy on patterns of mortality among HIV-positive persons in British Columbia, Canada

INTRODUCTION: Despite the tremendous improvements in survival, some groups of people living with HIV (PLHIV) continue to have lower survival rates than the overall HIV-positive population. Here, we characterize the evolving pattern of mortality among PLHIV in British Columbia since the beginning of the expansion of antiretroviral treatment in 2003. METHODS: This retrospective cohort study included 3653 individuals ≥20 years old, who enrolled on treatment between January 1, 2003, and December 31, 2012, and were followed until December 31, 2013. All-cause mortality rates and standardized mortality ratios (SMRs) were calculated to compare mortality outcomes of PLHIV to the general population. Abridged life tables were constructed to estimate the life expectancy at age 20 years for PLHIV. RESULTS: The overall crude mortality rate was 28.57 per 1000 person-years, the SMR was 3.22 and the life expectancy was 34.53 years. Interestingly, if we considered only individuals alive after the first year, the life expectancy increased to 48.70 years (41% increase). The SMRs for males and females decreased over time. Although females had higher SMRs in 2003 to 2008, this difference no longer existed in 2009 to 2011. There were also important differences in mortality outcomes for different clinical and demographical characteristics. CONCLUSIONS: Mortality outcomes of PLHIV who initiated antiretroviral treatment have dramatically improved over the last decade. However, there is still room for improvement and multilateral efforts should continue to promote early, sustained engagement of PLHIV on treatment so that the impact of treatment can be fully realized.