Excess mortality in patients with AIDS in the era of highly active antiretroviral therapy: temporal changes and risk factors
| Autor: | Milo A, Puhan, Mark L, Van Natta, Frank J, Palella, Adrienne, Addessi, Curtis, Meinert, Rosa, Paez-Boham |
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| Rok vydání: | 2010 |
| Předmět: |
Microbiology (medical)
Adult Male medicine.medical_specialty Pediatrics Time Factors Anti-HIV Agents Retinitis Article Acquired immunodeficiency syndrome (AIDS) Risk Factors Immunopathology Antiretroviral Therapy Highly Active Epidemiology medicine Humans Longitudinal Studies Risk factor Sida Survival analysis Acquired Immunodeficiency Syndrome biology business.industry Middle Aged medicine.disease biology.organism_classification Survival Analysis United States Infectious Diseases Immunology Female Viral disease business |
| Zdroj: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 51(8) |
| ISSN: | 1537-6591 |
| Popis: | Excess mortality has decreased among human immunodeficiency virus (HIV)-infected patients but without evidence of a decrease among patients with AIDS. We assessed temporal changes in excess mortality and elucidated risk factors for excess mortality in patients with AIDS diagnosed in the era of highly active antiretroviral therapy (HAART).We included 1188 patients of the Longitudinal Study of Ocular Complications in AIDS who were aged 25-64 years at enrollment and who received a diagnosis of AIDS after 1995. We calculated excess mortality as the age-, year-, and sex-adjusted difference in mortality rates between patients with AIDS and persons in the US general population during the period 1999-2007. We used a relative survival model to identify risk factors for excess mortality.There were a mean of 50 excess deaths per 1000 person-years (95% confidence interval [CI], 44-57 excess deaths per 1000 person-years) during 1999-2007. Excess mortality almost halved, with an annual decrease of 8.0% per year (95% CI, 3.0%-12.7%; P = .002) but remained high at 36 excess deaths per 1000 person-years in 2007. Viral load400 copies/mL (compared withor= 400 copies/mL; risk ratio, 3.4; 95% CI, 2.3-5.0), CD4(+) count200 cells/μL (compared withor= 200 cells/μL; risk ratio, 2.7; 95% CI, 1.9-3.9), and cytomegalovirus retinitis (risk ratio, 1.6; 95% CI, 1.2-2.1) were the strongest risk factors for excess mortality.Excess mortality among patients with AIDS was nearly halved in the HAART era and most strongly linked to stage of HIV disease. These results reflect the continuing improvements in AIDS management but also highlight that excess mortality remains ∼5 times higher in patients with AIDS than in HIV-infected patients without AIDS. |
| Databáze: | OpenAIRE |
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