Jessie K Edwards1, Stephen R Cole1, Tiffany L Breger1, Jacqueline E Rudolph2, Lindsey M Filiatreau1, Kate Buchacz3, Elizabeth Humes4, Peter F Rebeiro5, Gypsyamber D'Souza4, M John Gill6, Michael J Silverberg7, W Christopher Mathews8, Michael A Horberg9, Jennifer Thorne10, H Irene Hall3, Amy Justice11, Vincent C Marconi2, Viviane D Lima12, Ronald J Bosch13, Timothy R Sterling14, Keri N Althoff4, Richard D Moore10, Michael Saag15, Joseph J Eron1. 1. University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (J.K.E., S.R.C., T.L.B., L.M.F., J.J.E.). 2. Emory University, Atlanta, Georgia (J.E.R., V.C.M.). 3. Centers for Disease Control and Prevention, Atlanta, Georgia (K.B., H.I.H.). 4. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (E.H., G.D., K.N.A.). 5. Vanderbilt University School of Medicine, Nashville, Tennessee (P.F.R.). 6. University of Calgary, Calgary, Alberta, Canada (M.J.G.). 7. Kaiser Permanente Northern California, Oakland, California (M.J.S.). 8. University of California San Diego, San Diego, California (W.C.M.). 9. Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland (M.A.H.). 10. Johns Hopkins University, Baltimore, Maryland (J.T., R.D.M.). 11. Yale School of Public Health, New Haven, Connecticut, and Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut (A.J.). 12. University of British Columbia, Vancouver, British Columbia, Canada (V.D.L.). 13. Harvard T.H. Chan School of Public Health, Boston, Massachusetts (R.J.B.). 14. Vanderbilt University Medical Center, Nashville, Tennessee (T.R.S.). 15. University of Alabama at Birmingham, Birmingham, Alabama (M.S.).
Abstract
BACKGROUND: Understanding advances in the care and treatment of adults with HIV as well as remaining gaps requires comparing differences in mortality between persons entering care for HIV and the general population. OBJECTIVE: To assess the extent to which mortality among persons entering HIV care in the United States is elevated over mortality among matched persons in the general U.S. population and trends in this difference over time. DESIGN: Observational cohort study. SETTING: Thirteen sites from the U.S. North American AIDS Cohort Collaboration on Research and Design. PARTICIPANTS: 82 766 adults entering HIV clinical care between 1999 and 2017 and a subset of the U.S. population matched on calendar time, age, sex, race/ethnicity, and county using U.S. mortality and population data compiled by the National Center for Health Statistics. MEASUREMENTS: Five-year all-cause mortality, estimated using the Kaplan-Meier estimator of the survival function. RESULTS: Overall 5-year mortality among persons entering HIV care was 10.6%, and mortality among the matched U.S. population was 2.9%, for a difference of 7.7 (95% CI, 7.4 to 7.9) percentage points. This difference decreased over time, from 11.1 percentage points among those entering care between 1999 and 2004 to 2.7 percentage points among those entering care between 2011 and 2017. LIMITATION: Matching on available covariates may have failed to account for differences in mortality that were due to sociodemographic factors rather than consequences of HIV infection and other modifiable factors. CONCLUSION: Mortality among persons entering HIV care decreased dramatically between 1999 and 2017, although those entering care remained at modestly higher risk for death in the years after starting care than comparable persons in the general U.S. population. PRIMARY FUNDING SOURCE: National Institutes of Health.
BACKGROUND: Understanding advances in the care and treatment of adults with HIV as well as remaining gaps requires comparing differences in mortality between persons entering care for HIV and the general population. OBJECTIVE: To assess the extent to which mortality among persons entering HIV care in the United States is elevated over mortality among matched persons in the general U.S. population and trends in this difference over time. DESIGN: Observational cohort study. SETTING: Thirteen sites from the U.S. North American AIDS Cohort Collaboration on Research and Design. PARTICIPANTS: 82 766 adults entering HIV clinical care between 1999 and 2017 and a subset of the U.S. population matched on calendar time, age, sex, race/ethnicity, and county using U.S. mortality and population data compiled by the National Center for Health Statistics. MEASUREMENTS: Five-year all-cause mortality, estimated using the Kaplan-Meier estimator of the survival function. RESULTS: Overall 5-year mortality among persons entering HIV care was 10.6%, and mortality among the matched U.S. population was 2.9%, for a difference of 7.7 (95% CI, 7.4 to 7.9) percentage points. This difference decreased over time, from 11.1 percentage points among those entering care between 1999 and 2004 to 2.7 percentage points among those entering care between 2011 and 2017. LIMITATION: Matching on available covariates may have failed to account for differences in mortality that were due to sociodemographic factors rather than consequences of HIV infection and other modifiable factors. CONCLUSION: Mortality among persons entering HIV care decreased dramatically between 1999 and 2017, although those entering care remained at modestly higher risk for death in the years after starting care than comparable persons in the general U.S. population. PRIMARY FUNDING SOURCE: National Institutes of Health.
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Authors: Hasina Samji; Angela Cescon; Robert S Hogg; Sharada P Modur; Keri N Althoff; Kate Buchacz; Ann N Burchell; Mardge Cohen; Kelly A Gebo; M John Gill; Amy Justice; Gregory Kirk; Marina B Klein; P Todd Korthuis; Jeff Martin; Sonia Napravnik; Sean B Rourke; Timothy R Sterling; Michael J Silverberg; Stephen Deeks; Lisa P Jacobson; Ronald J Bosch; Mari M Kitahata; James J Goedert; Richard Moore; Stephen J Gange Journal: PLoS One Date: 2013-12-18 Impact factor: 3.240
Authors: Jessie K Edwards; Stephen R Cole; Tiffany L Breger; Lindsey M Filiatreau; Lauren Zalla; Grace E Mulholland; Michael A Horberg; Michael J Silverberg; M John Gill; Peter F Rebeiro; Jennifer E Thorne; Parastu Kasaie; Vincent C Marconi; Timothy R Sterling; Keri N Althoff; Richard D Moore; Joseph J Eron Journal: Clin Infect Dis Date: 2022-09-14 Impact factor: 20.999
Authors: Jennifer Beecker; Curtis Cooper; Mark G Kirchhof; Anton L Pozniak; Juergen K Rockstroh; Kim A Papp; Jan P Dutz; Melinda J Gooderham; Robert Gniadecki; Chih-Ho Hong; Charles W Lynde; Catherine Maari; Yves Poulin; Ronald B Vender; Sharon L Walmsley Journal: Dermatol Ther (Heidelb) Date: 2022-04-21