Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies

Hogg, Robert S.; Lima, Viviane D.; Sterne, Jonathan A C; Grabar, Sophie; Battegay, Manuel; Bonarek, M.; Monforte, Antonella d’Arminio; Esteve, Anna; Gill, M. John; Harris, RJ; Justice, Amy C.; Hayden, Anna; Lampe, Fiona; Mocroft, Amanda; Wasmuth, JC; Mugavero, M; Staszewski, Schlomo; Sighem, Ard van; Kitahata, Mari M.; Guest, Jodie L; Egger, Matthias; May, Margaret T

doi:10.1016/s0140-6736(08)61113-7

Cited by 1,423 publications

(521 citation statements)

References 42 publications

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“…Patients in our cohort were treated before the release of these guidelines and we observed the opposite trend of delayed treatment in older patients: the median CD4 cell count at the start of treatment was lower in older patients than in younger patients (176 vs. 200/µl, p = 0.017). It was previously shown that a lower CD4 cell nadir at the start of ART was a predictor for increased mortality [3,4,13,20]. Thus, our data demonstrate that older patients were in fact disadvantaged with regard to optimal care in the past, highlighting the need for improved care of older patients through earlier initiation of ART.…”

Section: Discussionsupporting

confidence: 52%

Risk Factors Associated with Older Age in Treatment-Naive HIV-Positive Patients

et al. 2012

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Background: Older HIV patients are defined as aged 50 years and older. This group is a growing population in developed countries. In order to improve care for older HIV patients, we intended to gain insight into the specific features of transmission, epidemiology, immunology and antiretroviral treatment (ART) of this population. Patients and Methods: All patients from the RESINA cohort were analyzed, comprising 2,085 individuals at the beginning of 2010. RESINA is an ongoing study analyzing epidemiological and immunological data, resistance patterns and therapeutic data in treatment-naive HIV-positive patients from North Rhine-Westphalia, Germany. Patients are included in the RESINA cohort at the time of the intended start of ART. For statistical evaluation, we used χ² and Mann-Whitney U tests. Results: A total of 14.6% of patients in our cohort was above 50 years. Men were significantly more prevalent among older patients (86.8 vs. 78.6%; p < 0.001). The proportion of older patients was significantly higher in the heterosexual group (30%) as compared to bisexual (20%), homosexual (13%) and intravenous drug user (4%) modes of transmission (p < 0.001). When comparing ethnic groups, older patients were most often found among Caucasians (17 vs. 4% in other groups, p < 0.001). No significant difference for transmitted drug resistance patterns was found. The proportion of older patients with CDC stage A was significantly lower than with stages B or C (10 vs. 21 vs. 21%, p < 0.001). In older patients, changes of ART regimes were more frequent (p = 0.015) and the median CD4 cell count at the start of treatment was lower (176 vs. 200/µl, p = 0.017). After 72 weeks of ART, the relative increase of CD4 cells was significantly lower in older as compared to younger patients (200 vs. 231/µl, p = 0.017). Conclusions: Our results provide insight into the epidemiology of HIV in the elderly. In our cohort, the typical older patient was a Caucasian male who had acquired HIV through heterosexual contact. The prognosis in older patients is worsened as a result of several unfavorable circumstances, such as delayed start of ART, more frequent treatment changes and diminished immune reconstitution. As a consequence, better strategies for more frequent HIV testing in patients at risk for HIV are needed, and ART should be offered to older patients at earlier time points and higher CD4 cell counts.

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Section: Discussionsupporting

confidence: 52%

Risk Factors Associated with Older Age in Treatment-Naive HIV-Positive Patients

et al. 2012

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“…In the era of antiretroviral therapy (ART), there have been striking decreases in acquired immune deficiency syndrome (AIDS)‐related mortality 1, 2, 3 and prolongation of life expectancy 4, 5, 6, 7 for people living with HIV infection (PLWH). With this, there has been a shift in distribution of causes of death toward non‐AIDS‐defining events (NADEs) 8, 9, 10, 11, 12.…”

Section: Introductionmentioning

confidence: 99%

Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation

et al. 2018

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Introduction HIV‐1 infection leads to chronic inflammation and to an increased risk of non‐AIDS mortality. Our objective was to determine whether AIDS‐defining events (ADEs) were associated with increased overall and cause‐specific non‐AIDS related mortality after antiretroviral therapy (ART) initiation.MethodsWe included HIV treatment‐naïve adults from the Antiretroviral Therapy Cohort Collaboration (ART‐CC) who initiated ART from 1996 to 2014. Causes of death were assigned using the Coding Causes of Death in HIV (CoDe) protocol. The adjusted hazard ratio (aHR) for overall and cause‐specific non‐AIDS mortality among those with an ADE (all ADEs, tuberculosis (TB), Pneumocystis jiroveci pneumonia (PJP), and non‐Hodgkin's lymphoma (NHL)) compared to those without an ADE was estimated using a marginal structural model.ResultsThe adjusted hazard of overall non‐AIDS mortality was higher among those with any ADE compared to those without any ADE (aHR 2.21, 95% confidence interval (CI) 2.00 to 2.43). The adjusted hazard of each of the cause‐specific non‐AIDS related deaths were higher among those with any ADE compared to those without, except metabolic deaths (malignancy aHR 2.59 (95% CI 2.13 to 3.14), accident/suicide/overdose aHR 1.37 (95% CI 1.05 to 1.79), cardiovascular aHR 1.95 (95% CI 1.54 to 2.48), infection aHR (95% CI 1.68 to 2.81), hepatic aHR 2.09 (95% CI 1.61 to 2.72), respiratory aHR 4.28 (95% CI 2.67 to 6.88), renal aHR 5.81 (95% CI 2.69 to 12.56) and central nervous aHR 1.53 (95% CI 1.18 to 5.44)). The risk of overall and cause‐specific non‐AIDS mortality differed depending on the specific ADE of interest (TB, PJP, NHL).ConclusionsIn this large multi‐centre cohort collaboration with standardized assignment of causes of death, non‐AIDS mortality was twice as high among patients with an ADE compared to without an ADE. However, non‐AIDS related mortality after an ADE depended on the ADE of interest. Although there may be unmeasured confounders, these findings suggest that a common pathway may be independently driving both ADEs and NADE mortality. While prevention of ADEs may reduce subsequent death due to NADEs following ART initiation, modification of risk factors for NADE mortality remains important after ADE survival.

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“…Access to anti-retroviral therapy (ART) improved the life expectancies of people living with Human Immunodeficiency Virus (HIV) globally [1,2]. However, their medication adherence remains salient.…”

Section: Introductionmentioning

confidence: 99%

Harmful alcohol drinking among HIV-positive people in Nepal: an overlooked threat to anti-retroviral therapy adherence and health-related quality of life

Pokhrel

Pokhrel²,

Neupane³

et al. 2018

Global Health Action

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Background: People living with Human Immunodeficiency Virus (HIV) often suffer from alcohol-use disorders resulting in their poor health and treatment outcomes. Little is known about the association of harmful alcohol drinking with their adherence to anti-retroviral therapy (ART) and health-related quality of life (QOL) in low-resource settings. Objective: This study aimed to investigate associations between harmful alcohol drinking, adherence to ART and health-related QOL in HIV-positive people, stratified by gender, in Nepal. Methods: We conducted a cross-sectional study of 682 HIV-positive people on ART to measure their self-reported harmful alcohol drinking and non-adherence to ART in the previous month of data collection. We also measured health-related QOL using a WHOQOL-HIV BREF scale. The association between harmful alcohol drinking and non-adherence to ART was examined using multiple logistic regressions. Additionally, multiple linear regressions examined association between harmful alcohol drinking and QOL. Results: Harmful alcohol drinking was associated with non-adherence to ART among men (AOR: 2.48, 95% CI: 1.50, 4.11, p < 0.001) and women (AOR: 2.52, 95% CI: 1.32, 4.80, p = 0.005). Men were more likely to have lower score for the psychological (β = −0.55, p = 0.021) and level of independence (β = −0.68, p = 0.018) domains when they had harmful alcohol drinking. Moreover, women were more likely to have lower scores for the physical (β = −1.01, p = 0.015), social relations (β = −0.82, p = 0.033), environmental (β = −0.88, p = 0.011), and spiritual (β = −1.30, p = 0.005) domains of QOL when they had harmful alcohol drinking. Conclusions: Harmful alcohol drinking had a negative association with ART adherence and QOL in both HIV-positive men and women in Nepal. Screening for alcohol-use disorders and community-based counseling services should be provided while delivering ART services to improve treatment adherence and QOL.

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Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies

Cited by 1,423 publications

References 42 publications

Risk Factors Associated with Older Age in Treatment-Naive HIV-Positive Patients

Risk Factors Associated with Older Age in Treatment-Naive HIV-Positive Patients

Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation

Harmful alcohol drinking among HIV-positive people in Nepal: an overlooked threat to anti-retroviral therapy adherence and health-related quality of life

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