Abstract
Objectives: To estimate changes of AIDS and non-AIDS mortalities from 1996 to 2010 comparing (2004-2010) vs. (1996-2003) periods from the time of HIV-seroconversion (SC). Methods: Data derived from an Italian multicentre prospective and open cohort; competing risks approach was applied estimating the cumulative incidence functions (CIF) for AIDS and non-AIDS deaths over time from SC with delayed entries in the two cART periods. Cox-cause-specific hazards models were applied to estimate relative hazards (RH) of AIDS and non-AIDS related deaths. Results: Of 2,249 individuals with known SC date followed from SC and from January 1996 to December 2010, 1,779 were survived, seroconverted or followed during 1996-2003, while 1,715 during 2004-2010. A total of 278 deaths occurred from 1996 to 2010: 197 in the early years of cART [61 (31%) non-AIDS deaths], and 81 during more recent cART period [48 (59%) non-AIDS deaths]. The CIF of AIDS related deaths was higher than CIF of non-AIDS related deaths in the early period [for instance, estimates at 15 yrs from SC: CIF of AIDS-related death = 0.15 (95% CI: 0.12-0.19 ) and CIF of non-AIDS related = 0.09 (95% CI: 0.07-0.12)], whilst in 2004-2010 period the CIF of non-AIDS related deaths was slightly higher [estimates at 15 yrs from SC: CIF of non-AIDS related = 0.03 (95% CI: 0.02-0.04) vs. CIF of AIDS-related death = 0.02 (95% CI: 0.02-0.04)]. Comparing the two periods by Cox proportional-cause-specific models, the hazard was lower for AIDS deaths than for non-AIDS related deaths [RH of non-AIDS deaths from last viral load (VL) < 200 copies/mL was 0.60 (95% CI (0.35-1.03)], while of AIDS-deaths was 0.32 (95% CI: 0.17-0.62), both RH relative to (2004-2010) vs. (1996- 2003)]. Conclusions: Considering early years of the cART period as a reference, we observed a decrease in both AIDS and non-AIDS-mortalities. In more recent cART years, non-AIDS mortality tended to decline less than AIDS-relatedmortality since HIV-SC, even after effective cART.
Highlights
In recent years, mortality for people living with HIV has dramatically decreased
The reason for such decreasing trend is inextricably related to the introduction in the middle of 1996 of the combination antiretroviral therapy that allowed life expectancy of HIV-infected individuals to approach that of the general population when successfully treated [1]
We investigated the change over time of AIDS and non-AIDS related deaths and the association with some demographic and clinical characteristics comparing two post-combination antiretroviral therapy (cART) periods (1996-2003 and 2004-2010) in an Italian cohort [Italian HIV-seroconversion study (ISS)] composed of individuals followed since the estimated date of SC
Summary
Mortality for people living with HIV has dramatically decreased. The reason for such decreasing trend is inextricably related to the introduction in the middle of 1996 of the combination antiretroviral therapy (cART) that allowed life expectancy of HIV-infected individuals to approach that of the general population when successfully treated [1].As a consequence of such life expectancy prolongation, HIVinfected people are more likely to die from non-HIV related causes. Mortality for people living with HIV has dramatically decreased. The reason for such decreasing trend is inextricably related to the introduction in the middle of 1996 of the combination antiretroviral therapy (cART) that allowed life expectancy of HIV-infected individuals to approach that of the general population when successfully treated [1]. As a consequence of such life expectancy prolongation, HIVinfected people are more likely to die from non-HIV related causes By living longer they are more exposed to other non-AIDS related conditions such as: ageing and related co-morbidities, cardiovascular diseases (CVD), cancers, and other viral infections such as viral hepatitis B (HBV) and C (HCV). The prolonged exposure to cART regimen can lead to an increased risk of dying from therapy-related toxicities
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