BACKGROUND: Despite the known substantial benefits of combination antiretroviral therapy (cART), cumulative adverse effects could still limit the overall long-term treatment benefit. Therefore we investigated changes in the rate of death with increasing exposure to cART. METHODS: A total of 12 069 patients were followed from baseline, which was defined as the time of starting cART or enrolment into EuroSIDA whichever occurred later, until death or 6 months after last follow-up visit. Incidence rates of death were calculated per 1000 person-years of follow-up (PYFU) and stratified by time of exposure to cART (≥3 antiretrovirals): less than 2, 2-3.99, 4-5.99, 6-7.99 and more than 8 years. Duration of cART exposure was the cumulative time actually receiving cART. Poisson regression models were fitted for each cause of death separately. RESULTS: A total of 1297 patients died during 70,613 PYFU [incidence rate 18.3 per 1000 PYFU, 95% confidence interval (CI) 17.4-19.4], 413 due to AIDS (5.85, 95% CI 5.28-6.41) and 884 due to non-AIDS-related cause (12.5, 95% CI 11.7-13.3). After adjustment for confounding variables, including baseline CD4 cell count and HIV RNA, there was a significant decrease in the rate of all-cause and AIDS-related death between 2 and 3.99 years and longer exposure time. In the first 2 years on cART the risk of non-AIDS death was significantly lower, but no significant difference in the rate of non-AIDS-related deaths between 2 and 3.99 years and longer exposure to cART was observed. CONCLUSION: In conclusion, we found no evidence of an increased risk of both all-cause and non-AIDS-related deaths with long-term cumulative cART exposure.
BACKGROUND: Despite the known substantial benefits of combination antiretroviral therapy (cART), cumulative adverse effects could still limit the overall long-term treatment benefit. Therefore we investigated changes in the rate of death with increasing exposure to cART. METHODS: A total of 12 069 patients were followed from baseline, which was defined as the time of starting cART or enrolment into EuroSIDA whichever occurred later, until death or 6 months after last follow-up visit. Incidence rates of death were calculated per 1000 person-years of follow-up (PYFU) and stratified by time of exposure to cART (≥3 antiretrovirals): less than 2, 2-3.99, 4-5.99, 6-7.99 and more than 8 years. Duration of cART exposure was the cumulative time actually receiving cART. Poisson regression models were fitted for each cause of death separately. RESULTS: A total of 1297 patients died during 70,613 PYFU [incidence rate 18.3 per 1000 PYFU, 95% confidence interval (CI) 17.4-19.4], 413 due to AIDS (5.85, 95% CI 5.28-6.41) and 884 due to non-AIDS-related cause (12.5, 95% CI 11.7-13.3). After adjustment for confounding variables, including baseline CD4 cell count and HIV RNA, there was a significant decrease in the rate of all-cause and AIDS-related death between 2 and 3.99 years and longer exposure time. In the first 2 years on cART the risk of non-AIDS death was significantly lower, but no significant difference in the rate of non-AIDS-related deaths between 2 and 3.99 years and longer exposure to cART was observed. CONCLUSION: In conclusion, we found no evidence of an increased risk of both all-cause and non-AIDS-related deaths with long-term cumulative cART exposure.
Authors: Beatriz Grinsztejn; Paula M Luz; Antonio G Pacheco; Desiree V G Santos; Luciane Velasque; Ronaldo I Moreira; Maria Regina C Guimarães; Estevão P Nunes; Alberto S Lemos; Sayonara R Ribeiro; Dayse P Campos; Marco A A Vitoria; Valdilea G Veloso Journal: PLoS One Date: 2013-04-05 Impact factor: 3.240
Authors: M F P M Albuquerque; D N Alves; C C Bresani Salvi; J D L Batista; R A A Ximenes; D B Miranda-Filho; H R L Melo; M Maruza; U R Montarroyos Journal: Epidemiol Infect Date: 2017-01-09 Impact factor: 4.434
Authors: Suzanne M Ingle; Margaret T May; M John Gill; Michael J Mugavero; Charlotte Lewden; Sophie Abgrall; Gerd Fätkenheuer; Peter Reiss; Michael S Saag; Christian Manzardo; Sophie Grabar; Mathias Bruyand; David Moore; Amanda Mocroft; Timothy R Sterling; Antonella D'Arminio Monforte; Victoria Hernando; Ramon Teira; Jodie Guest; Matthias Cavassini; Heidi M Crane; Jonathan A C Sterne Journal: Clin Infect Dis Date: 2014-04-24 Impact factor: 9.079
Authors: Adam Trickey; Margaret T May; Janne Vehreschild; Niels Obel; Michael John Gill; Heidi Crane; Christoph Boesecke; Hasina Samji; Sophie Grabar; Charles Cazanave; Matthias Cavassini; Leah Shepherd; Antonella d'Arminio Monforte; Colette Smit; Michael Saag; Fiona Lampe; Vicky Hernando; Marta Montero; Robert Zangerle; Amy C Justice; Timothy Sterling; Jose Miro; Suzanne Ingle; Jonathan A C Sterne Journal: PLoS One Date: 2016-08-15 Impact factor: 3.240