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Increased non-AIDS mortality among persons with AIDS-defining events after antiretroviral therapy initiation

dc.rights.licenseopenen_US
dc.contributor.authorPETTIT, A. C.
dc.contributor.authorGIGANTI, M. J.
dc.contributor.authorINGLE, S. M.
dc.contributor.authorMAY, M. T.
dc.contributor.authorSHEPHERD, B. E.
dc.contributor.authorGILL, M. J.
dc.contributor.authorFATKENHEUER, G.
dc.contributor.authorABGRALL, S.
dc.contributor.authorSAAG, M. S.
dc.contributor.authorDEL AMO, J.
dc.contributor.authorJUSTICE, A. C.
dc.contributor.authorMIRO, J. M.
dc.contributor.authorCAVASINNI, M.
hal.structure.identifierBordeaux population health [BPH]
dc.contributor.authorDABIS, Francois
dc.contributor.authorMONFORTE, A. D.
dc.contributor.authorREISS, P.
dc.contributor.authorGUEST, J.
dc.contributor.authorMOORE, D.
dc.contributor.authorSHEPHERD, L.
dc.contributor.authorOBEL, N.
dc.contributor.authorCRANE, H. M.
dc.contributor.authorSMITH, C.
dc.contributor.authorTEIRA, R.
dc.contributor.authorZANGERLE, R.
dc.contributor.authorSTERNE, J. A.
dc.contributor.authorSTERLING, T. R.
dc.date.accessioned2020-12-14T14:03:13Z
dc.date.available2020-12-14T14:03:13Z
dc.date.issued2018-01
dc.identifier.issn1758-2652 (Electronic) 1758-2652 (Linking)en_US
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/21447
dc.description.abstractEnINTRODUCTION: 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-naive 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.
dc.language.isoENen_US
dc.subject.enMORPH3Eus
dc.subject.enART-CC
dc.title.enIncreased non-AIDS mortality among persons with AIDS-defining events after antiretroviral therapy initiation
dc.title.alternativeJ Int AIDS Socen_US
dc.typeArticle de revueen_US
dc.identifier.doi10.1002/jia2.25031en_US
dc.subject.halSciences du Vivant [q-bio]/Santé publique et épidémiologieen_US
dc.identifier.pubmed29334197en_US
bordeaux.journalJournal of the International AIDS Societyen_US
bordeaux.volume21en_US
bordeaux.hal.laboratoriesBordeaux Population Health Research Center (BPH) - U1219en_US
bordeaux.issue1en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.teamMORPH3Eusen_US
bordeaux.teamART-CCen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.exportfalse
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