Trends in mortality among ART‐treated HIV‐infected adults in the Asia‐Pacific region between 1999 and 2017: results from the TREAT Asia HIV Observational Database (TAHOD) and Australian HIV Observational Database (AHOD) of IeDEA Asia‐Pacific

Abstract

IntroductionAIDS‐related deaths in people living with HIV/AIDS have been decreasing in number since the introduction of combination antiretroviral treatment (cART). However, data on recent causes of death in the Asia‐Pacific region are limited. Hence, we analysed and compared AIDS‐related and non‐AIDS–related mortality in high‐ and low‐income settings in the region.MethodsPatients from the TREAT Asia HIV Observational Database (TAHOD) and Australian HIV Observational Database (AHOD) receiving cART between 1999 and 2017 were included. Causes of death verification were based on review of the standardized Cause of Death (CoDe) form designed by the D:A:D group. Cohorts were grouped as AHOD (all high‐income sites), TAHOD‐high (high/upper‐middle income countries) and TAHOD‐low (lower‐middle income countries). TAHOD sites were split into high/upper‐middle income and lower‐middle income country settings based on World Bank classifications. Competing risk regression was used to analyse factors associated with AIDS and non‐AIDS–related mortality.ResultsOf 10,386 patients, 522 died; 187 from AIDS‐related and 335 from non‐AIDS–related causes. The overall incidence rate of deaths during follow‐up was 0.28 per 100 person‐years (/100 PYS) for AIDS and 0.51/100 PYS for non‐AIDS. Analysis indicated that the incidence rate of non‐AIDS mortality decreased from 0.78/100 PYS to 0.37/100 PYS from year groups 2003 to 2007 to 2013 to 2017 (p < 0.001). Similarly, incidence rates of AIDS‐related deaths decreased from 0.51/100 PYS to 0.09/100 PYS from year groups 2003 to 2007 to 2013 to 2017 (p < 0.001). More recent years of follow‐up were associated with reduced hazard for non‐AIDS mortality (2008 to 2012: aSHR (adjusted sub‐hazard ratio) 0.72, 95% confidence interval (CI) 0.54 to 0.96, p = 0.027; 2013 to 2017: aSHR 0.64, 95% CI 0.47 to 0.87, p = 0.004) compared to years 2003 to 2007. The AHOD cohort had almost twice the hazard of non‐AIDS mortality compared to TAHOD‐low (lower‐middle income sites) (aSHR 1.72, 95% CI, 1.20 to 2.46, p = 0.003); there were no differences between cohorts for AIDS‐related mortality (p = 0.834).ConclusionAIDS and non‐AIDS–related mortality rates have decreased over the past years in the Asia‐Pacific region. There is a greater risk for non‐AIDS–associated deaths in the AHOD cohort compared to lower‐middle income settings in TAHOD.

Incidence and determinants of mortality among HIV infected adult patients on antiretroviral therapy in Ethiopia: A systematic review and Meta-analysis

“…In this analysis, patients diagnosed with TB at initiation of HAART were three times more likely to die than those patients without TB. This finding is in line with study done in assessing determinants of mortality in South Africa (45), Iran (40) and a meta-analysis study at LMIC (36). This might be due to HIV infected patients co-infected with TB are prone to develop advanced AIDS stage easily as their immune system have been deteriorated.…”

“…Tanzania with OR of 2.3 (95% CI, 1.0-5.5) that the vast majority of the patients who were died had advanced HIV disease stage (36,37). People presented with advanced HIV disease are at high risk of opportunistic infections and increased incidence of death, even after starting HAART.…”

“…Early initiation of treatment before the development of advanced WHO clinical stage of the disease will reduce morbidity and prevent the high mortality rate occurred among patients with advanced WHO clinical stage of the disease (36,37,38).…”

“…Tanzania (37) and In trend mortality analysis in Asia -pacific region (36). Immediate HAART Initiation to all HIV infected patients at higher CD4 cells counts has been associated with several health benefits.…”

“…Immediate HAART Initiation to all HIV infected patients at higher CD4 cells counts has been associated with several health benefits. These may include reduce the risk of mortality, slow progression of the infection to AIDS stage, can improve the likelihood of immunological recovery (CD4 T -Cells counts reaching 800cells/mm 3 or more after HAART), can increase the percentage of individuals who achieved rapid viral suppression, prolongs survival of the patients and quality of life (36,37,41).…”