Abstract
BackgroundNon-AIDS conditions such as cardiovascular disease and non-AIDS defining cancers dominate causes of morbidity and mortality among persons with HIV on suppressive combination antiretroviral therapy. Accurate estimates of disease incidence and of risk factors for these conditions are important in planning preventative efforts.MethodsWith use of medical records, serious non-AIDS events, AIDS events, and causes of death were adjudicated using pre-specified criteria by an Endpoint Review Committee in two large international trials. Rates of serious non-AIDS which include cardiovascular disease, end-stage renal disease, decompensated liver disease, and non-AIDS cancer, and other serious (grade 4) adverse events were determined, overall and by age, over a median follow-up of 4.3 years for 3,570 participants with CD4+ cell count ≥300 cells/mm3 who were taking antiretroviral therapy and had an HIV RNA level ≤500 copies/mL. Cox models were used to examine the effect of age and other baseline factors on risk of a composite outcome of all-cause mortality, AIDS, or serious non-AIDS.ResultsFive-year Kaplan-Meier estimates of the composite outcome, overall and by age were 8.3% (overall), 3.6% (<40), 8.7% (40–49) and 16.1% (≥50), respectively (p<0.001). In addition to age, smoking and higher levels of interleukin-6 and D-dimer were significant predictors of the composite outcome. The composite outcome was dominated by serious non-AIDS events (overall 65% of 277 participants with a composite event). Most serious non-AIDS events were due to cardiovascular disease and non-AIDS cancers.ConclusionsTo date, few large studies have carefully collected data on serious non-AIDS outcomes. Thus, reliable estimates of event rates are scarce. Data cited here, from a geographically diverse cohort, will be useful for planning studies of interventions aimed at reducing rates of serious non-AIDS events among people with HIV.
Highlights
Potent combination antiretroviral therapy has improved life expectancy for people with HIV
Older participants were more likely to have had a history of cardiovascular disease (CVD) or diabetes, and were more likely to be on medications for hypertension, hyperlipidemia, osteoporosis, diabetes, or CVD
Older participants were more likely to have been on ART longer and have a history of use of protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs)
Summary
Potent combination antiretroviral therapy (cART) has improved life expectancy for people with HIV. AIDS-related events are less common among patients taking suppressive cART [1]. Morbidity and mortality is dominated by serious nonAIDS (SNA) conditions, cardiovascular disease (CVD), end-stage renal disease, decompensated liver disease and non-AIDS defining cancer. A recent review considers several possible reasons for the excess risk of SNA events among HIV positive individuals [10]. These reasons include cART, traditional risk factors, and immune dysfunction and Characteristic. Non-AIDS conditions such as cardiovascular disease and non-AIDS defining cancers dominate causes of morbidity and mortality among persons with HIV on suppressive combination antiretroviral therapy. Accurate estimates of disease incidence and of risk factors for these conditions are important in planning preventative efforts
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