Jessie K Edwards1, Stephen R Cole1, Tiffany L Breger2, Lindsey M Filiatreau1, Lauren Zalla1, Grace E Mulholland1, Michael A Horberg3, Michael J Silverberg4, M John Gill5, Peter F Rebeiro6, Jennifer E Thorne7, Parastu Kasaie8, Vincent C Marconi9, Timothy R Sterling10, Keri N Althoff8, Richard D Moore11, Joseph J Eron2. 1. Department of Epidemiology, University of North Carolina at Chapel Hill, North Carolina, USA. 2. School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 3. Kaiser Permanent Mid-Atlantic Permanente Research Institute, Rockville, Maryland, USA. 4. Kaiser Permanente Northern California, Oakland, California, USA. 5. Department of Medicine, University of Calgary, Calgary, Alberta, Canada. 6. Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. 7. School of Medicine, Johns Hopkins University, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 8. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 9. School of Medicine, and Rollins School of Public Health, Emory University, Atlanta, Georgia, USA. 10. Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USAand. 11. School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Abstract
BACKGROUND: Mortality among adults with human immunodeficiency virus (HIV) remains elevated over those in the US general population, even in the years after entry into HIV care. We explore whether the elevation in 5-year mortality would have persisted if all adults with HIV had initiated antiretroviral therapy within 3 months of entering care. METHODS: Among 82 766 adults entering HIV care at North American AIDS Cohort Collaboration clinical sites in the United States, we computed mortality over 5 years since entry into HIV care under observed treatment patterns. We then used inverse probability weights to estimate mortality under universal early treatment. To compare mortality with those for similar individuals in the general population, we used National Center for Health Statistics data to construct a cohort representing the subset of the US population matched to study participants on key characteristics. RESULTS: For the entire study period (1999-2017), the 5-year mortality among adults with HIV was 7.9% (95% confidence interval [CI]: 7.6%-8.2%) higher than expected based on the US general population. Under universal early treatment, the elevation in mortality for people with HIV would have been 7.2% (95% CI: 5.8%-8.6%). In the most recent calendar period examined (2011-2017), the elevation in mortality for people with HIV was 2.6% (95% CI: 2.0%-3.3%) under observed treatment patterns and 2.1% (.0%-4.2%) under universal early treatment. CONCLUSIONS: Expanding early treatment may modestly reduce, but not eliminate, the elevation in mortality for people with HIV.
BACKGROUND: Mortality among adults with human immunodeficiency virus (HIV) remains elevated over those in the US general population, even in the years after entry into HIV care. We explore whether the elevation in 5-year mortality would have persisted if all adults with HIV had initiated antiretroviral therapy within 3 months of entering care. METHODS: Among 82 766 adults entering HIV care at North American AIDS Cohort Collaboration clinical sites in the United States, we computed mortality over 5 years since entry into HIV care under observed treatment patterns. We then used inverse probability weights to estimate mortality under universal early treatment. To compare mortality with those for similar individuals in the general population, we used National Center for Health Statistics data to construct a cohort representing the subset of the US population matched to study participants on key characteristics. RESULTS: For the entire study period (1999-2017), the 5-year mortality among adults with HIV was 7.9% (95% confidence interval [CI]: 7.6%-8.2%) higher than expected based on the US general population. Under universal early treatment, the elevation in mortality for people with HIV would have been 7.2% (95% CI: 5.8%-8.6%). In the most recent calendar period examined (2011-2017), the elevation in mortality for people with HIV was 2.6% (95% CI: 2.0%-3.3%) under observed treatment patterns and 2.1% (.0%-4.2%) under universal early treatment. CONCLUSIONS: Expanding early treatment may modestly reduce, but not eliminate, the elevation in mortality for people with HIV.
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