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Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation
INTRODUCTION: HIV‐1 infection leads to chronic inflammation and to an increased risk of non‐AIDS mortality. Our objective was to determine whether AIDS‐defining events (ADEs) were associated with increased overall and cause‐specific non‐AIDS related mortality after antiretroviral therapy (ART) initi...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810321/ https://www.ncbi.nlm.nih.gov/pubmed/29334197 http://dx.doi.org/10.1002/jia2.25031 |
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author | Pettit, April C Giganti, Mark J Ingle, Suzanne M May, Margaret T Shepherd, Bryan E Gill, Michael J Fätkenheuer, Gerd Abgrall, Sophie Saag, Michael S Del Amo, Julia Justice, Amy C Miro, Jose M Cavasinni, Matthias Dabis, François Monforte, Antonella D Reiss, Peter Guest, Jodie Moore, David Shepherd, Leah Obel, Niels Crane, Heidi M Smith, Colette Teira, Ramon Zangerle, Robert Sterne, Jonathan AC Sterling, Timothy R |
author_facet | Pettit, April C Giganti, Mark J Ingle, Suzanne M May, Margaret T Shepherd, Bryan E Gill, Michael J Fätkenheuer, Gerd Abgrall, Sophie Saag, Michael S Del Amo, Julia Justice, Amy C Miro, Jose M Cavasinni, Matthias Dabis, François Monforte, Antonella D Reiss, Peter Guest, Jodie Moore, David Shepherd, Leah Obel, Niels Crane, Heidi M Smith, Colette Teira, Ramon Zangerle, Robert Sterne, Jonathan AC Sterling, Timothy R |
author_sort | Pettit, April C |
collection | PubMed |
description | INTRODUCTION: HIV‐1 infection leads to chronic inflammation and to an increased risk of non‐AIDS mortality. Our objective was to determine whether AIDS‐defining events (ADEs) were associated with increased overall and cause‐specific non‐AIDS related mortality after antiretroviral therapy (ART) initiation. METHODS: We included HIV treatment‐naïve adults from the Antiretroviral Therapy Cohort Collaboration (ART‐CC) who initiated ART from 1996 to 2014. Causes of death were assigned using the Coding Causes of Death in HIV (CoDe) protocol. The adjusted hazard ratio (aHR) for overall and cause‐specific non‐AIDS mortality among those with an ADE (all ADEs, tuberculosis (TB), Pneumocystis jiroveci pneumonia (PJP), and non‐Hodgkin's lymphoma (NHL)) compared to those without an ADE was estimated using a marginal structural model. RESULTS: The adjusted hazard of overall non‐AIDS mortality was higher among those with any ADE compared to those without any ADE (aHR 2.21, 95% confidence interval (CI) 2.00 to 2.43). The adjusted hazard of each of the cause‐specific non‐AIDS related deaths were higher among those with any ADE compared to those without, except metabolic deaths (malignancy aHR 2.59 (95% CI 2.13 to 3.14), accident/suicide/overdose aHR 1.37 (95% CI 1.05 to 1.79), cardiovascular aHR 1.95 (95% CI 1.54 to 2.48), infection aHR (95% CI 1.68 to 2.81), hepatic aHR 2.09 (95% CI 1.61 to 2.72), respiratory aHR 4.28 (95% CI 2.67 to 6.88), renal aHR 5.81 (95% CI 2.69 to 12.56) and central nervous aHR 1.53 (95% CI 1.18 to 5.44)). The risk of overall and cause‐specific non‐AIDS mortality differed depending on the specific ADE of interest (TB, PJP, NHL). CONCLUSIONS: In this large multi‐centre cohort collaboration with standardized assignment of causes of death, non‐AIDS mortality was twice as high among patients with an ADE compared to without an ADE. However, non‐AIDS related mortality after an ADE depended on the ADE of interest. Although there may be unmeasured confounders, these findings suggest that a common pathway may be independently driving both ADEs and NADE mortality. While prevention of ADEs may reduce subsequent death due to NADEs following ART initiation, modification of risk factors for NADE mortality remains important after ADE survival. |
format | Online Article Text |
id | pubmed-5810321 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-58103212018-02-14 Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation Pettit, April C Giganti, Mark J Ingle, Suzanne M May, Margaret T Shepherd, Bryan E Gill, Michael J Fätkenheuer, Gerd Abgrall, Sophie Saag, Michael S Del Amo, Julia Justice, Amy C Miro, Jose M Cavasinni, Matthias Dabis, François Monforte, Antonella D Reiss, Peter Guest, Jodie Moore, David Shepherd, Leah Obel, Niels Crane, Heidi M Smith, Colette Teira, Ramon Zangerle, Robert Sterne, Jonathan AC Sterling, Timothy R J Int AIDS Soc Research Articles INTRODUCTION: HIV‐1 infection leads to chronic inflammation and to an increased risk of non‐AIDS mortality. Our objective was to determine whether AIDS‐defining events (ADEs) were associated with increased overall and cause‐specific non‐AIDS related mortality after antiretroviral therapy (ART) initiation. METHODS: We included HIV treatment‐naïve adults from the Antiretroviral Therapy Cohort Collaboration (ART‐CC) who initiated ART from 1996 to 2014. Causes of death were assigned using the Coding Causes of Death in HIV (CoDe) protocol. The adjusted hazard ratio (aHR) for overall and cause‐specific non‐AIDS mortality among those with an ADE (all ADEs, tuberculosis (TB), Pneumocystis jiroveci pneumonia (PJP), and non‐Hodgkin's lymphoma (NHL)) compared to those without an ADE was estimated using a marginal structural model. RESULTS: The adjusted hazard of overall non‐AIDS mortality was higher among those with any ADE compared to those without any ADE (aHR 2.21, 95% confidence interval (CI) 2.00 to 2.43). The adjusted hazard of each of the cause‐specific non‐AIDS related deaths were higher among those with any ADE compared to those without, except metabolic deaths (malignancy aHR 2.59 (95% CI 2.13 to 3.14), accident/suicide/overdose aHR 1.37 (95% CI 1.05 to 1.79), cardiovascular aHR 1.95 (95% CI 1.54 to 2.48), infection aHR (95% CI 1.68 to 2.81), hepatic aHR 2.09 (95% CI 1.61 to 2.72), respiratory aHR 4.28 (95% CI 2.67 to 6.88), renal aHR 5.81 (95% CI 2.69 to 12.56) and central nervous aHR 1.53 (95% CI 1.18 to 5.44)). The risk of overall and cause‐specific non‐AIDS mortality differed depending on the specific ADE of interest (TB, PJP, NHL). CONCLUSIONS: In this large multi‐centre cohort collaboration with standardized assignment of causes of death, non‐AIDS mortality was twice as high among patients with an ADE compared to without an ADE. However, non‐AIDS related mortality after an ADE depended on the ADE of interest. Although there may be unmeasured confounders, these findings suggest that a common pathway may be independently driving both ADEs and NADE mortality. While prevention of ADEs may reduce subsequent death due to NADEs following ART initiation, modification of risk factors for NADE mortality remains important after ADE survival. John Wiley and Sons Inc. 2018-01-15 /pmc/articles/PMC5810321/ /pubmed/29334197 http://dx.doi.org/10.1002/jia2.25031 Text en © 2018 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of the International AIDS Society. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Research Articles Pettit, April C Giganti, Mark J Ingle, Suzanne M May, Margaret T Shepherd, Bryan E Gill, Michael J Fätkenheuer, Gerd Abgrall, Sophie Saag, Michael S Del Amo, Julia Justice, Amy C Miro, Jose M Cavasinni, Matthias Dabis, François Monforte, Antonella D Reiss, Peter Guest, Jodie Moore, David Shepherd, Leah Obel, Niels Crane, Heidi M Smith, Colette Teira, Ramon Zangerle, Robert Sterne, Jonathan AC Sterling, Timothy R Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation |
title | Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation |
title_full | Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation |
title_fullStr | Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation |
title_full_unstemmed | Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation |
title_short | Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation |
title_sort | increased non‐aids mortality among persons with aids‐defining events after antiretroviral therapy initiation |
topic | Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810321/ https://www.ncbi.nlm.nih.gov/pubmed/29334197 http://dx.doi.org/10.1002/jia2.25031 |
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