Bryan Lau1, Stephen J Gange, Richard D Moore. 1. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. blau1@jhmi.edu
Abstract
OBJECTIVE: To quantify cause-specific mortality risk attributable to non-AIDS-related and AIDS-related causes before and after the advent of highly active antiretroviral therapy (HAART). METHODS: Competing-risk methods were used to determine the cumulative AIDS-related and non-AIDS-related risk of mortality between 1990 and the end of 2003 in the Johns Hopkins HIV Clinical Cohort, a prospective cohort study. RESULTS: Beginning in 1997 with the introduction of HAART, all-cause mortality declined and has remained stable at approximately 39 deaths per 1000 person-years. AIDS-related mortality continued to decline in this period (P = 0.008), whereas non-AIDS-related mortality increased (P < 0.001). Using competing-risk methods, the risk of dying attributable to AIDS-related causes remains significantly higher than the risk of dying attributable to non-AIDS-related causes for patients with a CD4 count <or=200 cells/mm in the HAART era. For those with a CD4 count >200 cells/mm, however, non-AIDS-related mortality was greater than AIDS-related mortality, particularly among injection drug users. Other transmission categories had similar AIDS-related and non-AIDS-related cumulative mortalities. CONCLUSIONS: HAART has reduced mortality rates among HIV-infected individuals, but further efforts to reduce mortality in this population require increased attention to conditions that have not traditionally been considered to be HIV related.
OBJECTIVE: To quantify cause-specific mortality risk attributable to non-AIDS-related and AIDS-related causes before and after the advent of highly active antiretroviral therapy (HAART). METHODS: Competing-risk methods were used to determine the cumulative AIDS-related and non-AIDS-related risk of mortality between 1990 and the end of 2003 in the Johns Hopkins HIV Clinical Cohort, a prospective cohort study. RESULTS: Beginning in 1997 with the introduction of HAART, all-cause mortality declined and has remained stable at approximately 39 deaths per 1000 person-years. AIDS-related mortality continued to decline in this period (P = 0.008), whereas non-AIDS-related mortality increased (P < 0.001). Using competing-risk methods, the risk of dying attributable to AIDS-related causes remains significantly higher than the risk of dying attributable to non-AIDS-related causes for patients with a CD4 count <or=200 cells/mm in the HAART era. For those with a CD4 count >200 cells/mm, however, non-AIDS-related mortality was greater than AIDS-related mortality, particularly among injection drug users. Other transmission categories had similar AIDS-related and non-AIDS-related cumulative mortalities. CONCLUSIONS: HAART has reduced mortality rates among HIV-infected individuals, but further efforts to reduce mortality in this population require increased attention to conditions that have not traditionally been considered to be HIV related.
Authors: Alan R Lifson; Jacqueline Neuhaus; Jose Ramon Arribas; Mary van den Berg-Wolf; Ann M Labriola; Timothy R H Read Journal: Am J Public Health Date: 2010-08-19 Impact factor: 9.308
Authors: Jacqueline Neuhaus; Brian Angus; Justyna D Kowalska; Alberto La Rosa; Jim Sampson; Deborah Wentworth; Amanda Mocroft Journal: AIDS Date: 2010-03-13 Impact factor: 4.177
Authors: Joseph K Leader; Kristina Crothers; Laurence Huang; Mark A King; Alison Morris; Bruce W Thompson; Sonia C Flores; Michael B Drummond; William N Rom; Philip T Diaz Journal: J Acquir Immune Defic Syndr Date: 2016-04-01 Impact factor: 3.731
Authors: Pragna Patel; Charles E Rose; Pamela Y Collins; Bernardo Nuche-Berenguer; Vikrant V Sahasrabuddhe; Emmanuel Peprah; Susan Vorkoper; Sonak D Pastakia; Dianne Rausch; Naomi S Levitt Journal: AIDS Date: 2018-07-01 Impact factor: 4.177
Authors: Stephen R Cole; Sonia Napravnik; Michael J Mugavero; Bryan Lau; Joseph J Eron; Michael S Saag Journal: Am J Epidemiol Date: 2009-12-09 Impact factor: 4.897
Authors: Nathan B Hansen; Ellen L Vaughan; Courtenay E Cavanaugh; Christian M Connell; Kathleen J Sikkema Journal: Health Psychol Date: 2009-03 Impact factor: 4.267