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Trends and causes of mortality in a population-based cohort of HIV-infected adults in Spain: comparison with the general population

Combination antiretroviral therapy reduces mortality of HIV-infected persons. In Spain, where this therapy is widely available, we aim to evaluate mortality trends and causes of death in HIV-infected adults, and to estimate the excess mortality compared to the general population. From 1999 to 2018 m...

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Autores principales: Fontela, Carmen, Aguinaga, Aitziber, Moreno-Iribas, Conchi, Repáraz, Jesús, Rivero, María, Gracia, María, Floristán, Yugo, Fresán, Ujué, Miguel, Ramón San, Ezpeleta, Carmen, Castilla, Jesús
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265289/
https://www.ncbi.nlm.nih.gov/pubmed/32488053
http://dx.doi.org/10.1038/s41598-020-65841-0
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author Fontela, Carmen
Aguinaga, Aitziber
Moreno-Iribas, Conchi
Repáraz, Jesús
Rivero, María
Gracia, María
Floristán, Yugo
Fresán, Ujué
Miguel, Ramón San
Ezpeleta, Carmen
Castilla, Jesús
author_facet Fontela, Carmen
Aguinaga, Aitziber
Moreno-Iribas, Conchi
Repáraz, Jesús
Rivero, María
Gracia, María
Floristán, Yugo
Fresán, Ujué
Miguel, Ramón San
Ezpeleta, Carmen
Castilla, Jesús
author_sort Fontela, Carmen
collection PubMed
description Combination antiretroviral therapy reduces mortality of HIV-infected persons. In Spain, where this therapy is widely available, we aim to evaluate mortality trends and causes of death in HIV-infected adults, and to estimate the excess mortality compared to the general population. From 1999 to 2018 mortality by causes was analyzed in a population-based cohort of adults aged 25 to 74 years diagnosed with HIV infection in Spain. Observed deaths and expected deaths according mortality in the general population of the same sex and age were compared using standardized mortality ratios (SMRs). HIV-infected people increased from 839 in 1999–2003 to 1059 in 2014–2018, median age increased from 37 to 47 years, the annual mortality rate decreased from 33.5 to 20.7 per 1000 person-years and the proportion of HIV-related deaths declined from 64% to 35%. HIV-related mortality declined from 21.4 to 7.3 (p < 0.001), while non-HIV-related mortality remained stable: 12.1 and 13.4 per 1000, respectively. Mortality decreased principally in persons diagnosed with AIDS-defining events. In the last decade, 2009–2018, mortality was still 8.1 times higher among HIV-infected people than in the general population, and even after excluding HIV-related deaths, remained 4.8 times higher. Excess mortality was observed in non-AIDS cancer (SMR = 3.7), cardiovascular disease (SMR = 4.2), respiratory diseases (SMR = 7.9), liver diseases (SMR = 8.8), drug abuse (SMR = 47), suicide (SMR = 5.3) and other external causes (SMR = 6). In conclusion, HIV-related mortality continued to decline, while non-HIV-related mortality remained stable. HIV-infected people maintained important excess mortality. Prevention of HIV infections in the population and promotion of healthy life styles in HIV-infected people must be a priority.
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spelling pubmed-72652892020-06-05 Trends and causes of mortality in a population-based cohort of HIV-infected adults in Spain: comparison with the general population Fontela, Carmen Aguinaga, Aitziber Moreno-Iribas, Conchi Repáraz, Jesús Rivero, María Gracia, María Floristán, Yugo Fresán, Ujué Miguel, Ramón San Ezpeleta, Carmen Castilla, Jesús Sci Rep Article Combination antiretroviral therapy reduces mortality of HIV-infected persons. In Spain, where this therapy is widely available, we aim to evaluate mortality trends and causes of death in HIV-infected adults, and to estimate the excess mortality compared to the general population. From 1999 to 2018 mortality by causes was analyzed in a population-based cohort of adults aged 25 to 74 years diagnosed with HIV infection in Spain. Observed deaths and expected deaths according mortality in the general population of the same sex and age were compared using standardized mortality ratios (SMRs). HIV-infected people increased from 839 in 1999–2003 to 1059 in 2014–2018, median age increased from 37 to 47 years, the annual mortality rate decreased from 33.5 to 20.7 per 1000 person-years and the proportion of HIV-related deaths declined from 64% to 35%. HIV-related mortality declined from 21.4 to 7.3 (p < 0.001), while non-HIV-related mortality remained stable: 12.1 and 13.4 per 1000, respectively. Mortality decreased principally in persons diagnosed with AIDS-defining events. In the last decade, 2009–2018, mortality was still 8.1 times higher among HIV-infected people than in the general population, and even after excluding HIV-related deaths, remained 4.8 times higher. Excess mortality was observed in non-AIDS cancer (SMR = 3.7), cardiovascular disease (SMR = 4.2), respiratory diseases (SMR = 7.9), liver diseases (SMR = 8.8), drug abuse (SMR = 47), suicide (SMR = 5.3) and other external causes (SMR = 6). In conclusion, HIV-related mortality continued to decline, while non-HIV-related mortality remained stable. HIV-infected people maintained important excess mortality. Prevention of HIV infections in the population and promotion of healthy life styles in HIV-infected people must be a priority. Nature Publishing Group UK 2020-06-02 /pmc/articles/PMC7265289/ /pubmed/32488053 http://dx.doi.org/10.1038/s41598-020-65841-0 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Fontela, Carmen
Aguinaga, Aitziber
Moreno-Iribas, Conchi
Repáraz, Jesús
Rivero, María
Gracia, María
Floristán, Yugo
Fresán, Ujué
Miguel, Ramón San
Ezpeleta, Carmen
Castilla, Jesús
Trends and causes of mortality in a population-based cohort of HIV-infected adults in Spain: comparison with the general population
title Trends and causes of mortality in a population-based cohort of HIV-infected adults in Spain: comparison with the general population
title_full Trends and causes of mortality in a population-based cohort of HIV-infected adults in Spain: comparison with the general population
title_fullStr Trends and causes of mortality in a population-based cohort of HIV-infected adults in Spain: comparison with the general population
title_full_unstemmed Trends and causes of mortality in a population-based cohort of HIV-infected adults in Spain: comparison with the general population
title_short Trends and causes of mortality in a population-based cohort of HIV-infected adults in Spain: comparison with the general population
title_sort trends and causes of mortality in a population-based cohort of hiv-infected adults in spain: comparison with the general population
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265289/
https://www.ncbi.nlm.nih.gov/pubmed/32488053
http://dx.doi.org/10.1038/s41598-020-65841-0
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