Cause-specific mortality among HIV-infected people in Ontario, 1995–2014: a population-based retrospective cohort study

Burchell, Ann; Raboud, Janet; Donelle, Jessy; Loutfy, Mona; Rourke, Sean B.; Rogers, T.; Rosenes, Ron; Liddy, Clare; Kendall, Claire

doi:10.9778/cmajo.20180159

Cited by 20 publications

(12 citation statements)

References 42 publications

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“…As HIV treatment has evolved in recent years, there has been a remarkable increase in patients’ ability to adhere to medication, a dramatic reduction in AIDS-related morbidity and mortality, and a shift in focus to the impact of other concomitant diseases [26]. There is high prevalence of HCV infection among people with HIV [4].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Safety and Effectiveness of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Switch Followed by Ledipasvir/Sofosbuvir HCV Therapy in HIV–HCV Coinfection

Doyle

Lee

Singer

et al. 2019

Open Forum Infectious Diseases

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Background We conducted a pilot study assessing the feasibility, efficacy, and safety of a simplified combination HIV antiretroviral and hepatitis C virus (HCV) antiviral regimen in HIV–HCV coinfection. Methods Participants on suppressive antiretrovirals and HCV genotype 1 infection were switched to single-tablet daily-dosed elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) and 1 month later initiated single-tablet-regimen daily-dosed ledipasvir-sofosbuvir for 12 weeks. E/C/F/TAF was continued during HCV treatment and for 12 weeks after. Results Twenty-six individuals were screened, 25 enrolled, and 23 completed all HIV and HCV treatment. Participants were predominantly male, with a mean age (SD) of 55 (7.5) years. The median transient elastography score (interquartile range [IQR]) was 5.9 (5.3 to 7.6) kPa, and the mean CD4 count (SD) was 579 (223) cells/µL. The median adherence to HCV medications, assessed by pill count, was 100% (95% confidence interval [CI], 100%–100%), and HIV ranged from 99% to 100% (100%; 95% CI, 90%–100%) over the 7-month study duration. HIV undetectability was maintained in all but 1 participant enrolled with unsuspected multiclass resistance. Treatment was well tolerated, with no study medication modification due to adverse events and no serious adverse event related to the study drug. All participants achieved sustained virological response. The mean CD4 count (SD) increased to 673 (361) cells/µL, and the fibrosis score (IQR) declined to 5.2 (4.4 to 7.4) kPa by week 12 after HCV treatment. There was no treatment effect on glucose metabolism. Cholesterol increased during and after treatment. Conclusions Provision of this 2-tablet daily HIV–HCV regimen is feasible, well tolerated, and safe, avoids drug–drug interactions between HIV and HCV medications, maintains HIV suppression in the absence of drug resistance, and is highly curative of HCV.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Safety and Effectiveness of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Switch Followed by Ledipasvir/Sofosbuvir HCV Therapy in HIV–HCV Coinfection

Doyle

Lee

Singer

et al. 2019

Open Forum Infectious Diseases

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“…We hypothesize that with the expanded policy, more people diagnosed in late HIV infection (who have a higher underlying risk of death) underwent resistance testing than prior to the implementation of the policy. This might also be because the resistance testing policy led to more people who live in low income neighbourhoods or rural areas (who already have a higher underlying mortality rate) [ 29 ] to get resistance tests, this could increase the rates of mortality and hospitalization immediately after the policy. Confirmation of this hypothesis would require HIV clinical histories including CD4 cell counts, which were unavailable in health administrative data for this analysis.…”

Section: Discussionmentioning

confidence: 99%

“…These analyses were conducted with due consideration of sufficient equally spaced data points before and after the intervention, linearity of pre-intervention trends, stable measurement procedures and incorporate available data on a potential confounder (timely resistance testing) [ 29 ]. Trends are illustrated graphically.…”

Section: Methodsmentioning

confidence: 99%

The impact of routine HIV drug resistance testing in Ontario: A controlled interrupted time series study

et al. 2021

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Background Knowledge of HIV drug resistance informs the choice of regimens and ensures that the most efficacious options are selected. In January 2014, a policy change to routine resistance testing was implemented in Ontario, Canada. The objective of this study was to investigate the policy change impact of routine resistance testing in people with HIV in Ontario, Canada since January 2014. Methods We used data on people with HIV living in Ontario from administrative databases of the Institute for Clinical Evaluative Sciences (ICES) and Public Health Ontario (PHO), and ran ordinary least squares (OLS) models of interrupted time series to measure the levels and trends of 2-year mortality, 2-year hospitalizations and 2-year emergency department visits before (2005–2013) and after the policy change (2014–2017). Outcomes were collected in biannual periods, generating 18 periods before the intervention and 8 periods after. We included a control series of people who did not receive a resistance test within 3 months of HIV diagnosis. Results Data included 12,996 people with HIV, of which 8881 (68.3%) were diagnosed between 2005 and 2013, and 4115 (31.7%) were diagnosed between 2014 and 2017. Policy change to routine resistance testing within 3 months of HIV diagnosis led to a decreasing trend in 2-year mortality of 0.8% every six months compared to the control group. No significant differences in hospitalizations or emergency department visits were noted. Interpretation The policy of routine resistance testing within three months of diagnosis is beneficial at the population level.

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“… 23 The introduction of combination ART also marked an important achievement toward prolonging the lifespan of HIV patients, resulting in shifting patterns in both mortality rates and leading causes of death in high-income countries. 24 …”

Section: Discussionmentioning

confidence: 99%

Trends of Cause of Death among Human Immunodeficiency Virus Patients and the Impact of Low CD4 Counts on Diagnosis to Death: a Retrospective Cohort Study

Kim

Chang

et al. 2020

J Korean Med Sci

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Background Monitoring the full spectrum of causes of death among human immunodeficiency virus (HIV) patients has become increasingly important as survival improves because of highly active antiretroviral therapy. However, there are no recently published data regarding the changes in the causes of death among HIV patients based on year of HIV diagnosis, and the impact of low CD4 count at the time of HIV diagnosis on the clinical outcome is still unclear in Korea. Methods A retrospective cohort study was conducted with 801 patients with HIV infection who were followed up at a tertiary university hospital and diagnosed with HIV between July 1984 and October 2019. The causes of death were analyzed by descriptive analysis based on CD4 count and the year of HIV diagnosis. Kaplan–Meier and log rank tests were performed to compare the prognosis between the CD4 < 200 cells/mm 3 and CD4 ≥ 200 cells/mm 3 groups. Results Among 801 patients, 67 patients were eligible for the death cause analysis. Infection-related death accounted for 44 patients (65.7%) and non-infection related death accounted for 23 patients (32.4%). Pneumocystis pneumonia (29.9%) was the single most common cause of death in both past and present cases, and tuberculosis (19.4%) was the second leading cause of death from infections, but the frequency has declined in recent years. Causes of infection-related death have decreased, whereas non-infection related causes of death have increased remarkably. Malignancy-related death was the most common cause of non-infection related death. Acquired immunodeficiency syndrome (AIDS) non-related malignancy accounted for 11.9%, whereas AIDS-related malignancy accounted for 6.0% of the total death among HIV patients. No significant statistical differences were found in mortality rate ( P = 0.228), causes of death ( P = 0.771), or survival analysis ( P = 0.089) between the CD4 < 200 cells/mm 3 and CD4 ≥ 200 cells/mm 3 groups. Conclusion Being diagnosed with CD4 < 200 cells/mm 3 at the time of HIV diagnosis was not an indicator of greater risk of death compared with the CD4 ≥ 200 cells/mm 3 group. Malignant tumors have become an important cause of death in recent years, and an increasing tendency of AIDS-non-related malignancy causes has been observed.

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Cause-specific mortality among HIV-infected people in Ontario, 1995–2014: a population-based retrospective cohort study

Cited by 20 publications

References 42 publications

Evaluation of Safety and Effectiveness of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Switch Followed by Ledipasvir/Sofosbuvir HCV Therapy in HIV–HCV Coinfection

Evaluation of Safety and Effectiveness of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Switch Followed by Ledipasvir/Sofosbuvir HCV Therapy in HIV–HCV Coinfection

The impact of routine HIV drug resistance testing in Ontario: A controlled interrupted time series study

Trends of Cause of Death among Human Immunodeficiency Virus Patients and the Impact of Low CD4 Counts on Diagnosis to Death: a Retrospective Cohort Study

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