Abstract
BackgroundWe determined the impact of three factors on mortality in HIV-infected patients who had been on highly active antiretroviral therapy (HAART) for at least one year: (1) insufficient response to (HAART) and presence of AIDS-defining diseases, (2) comorbidity, and (3) drug and alcohol abuse and compared the mortality to that of the general population.Methodology/Principal FindingsIn a Danish nationwide, population-based cohort study, we used population based registries to identify (1) all Danish HIV-infected patients who started HAART in the period 1 January 1998–1 July 2009, and (2) a comparison cohort of individuals matched on date of birth and gender (N = 2,267 and 9,068, respectively). Study inclusion began 1 year after start of HAART. Patients were categorised hierarchically in four groups according to the three risk factors, which were identified before study inclusion. The main outcome measure was probability of survival from age 25 to 65 years. The probability of survival from age 25 to age 65 was substantially lower in HIV patients [0.48 (95% confidence interval (CI) 0.42–0.55)] compared to the comparison cohort [0.88 (0.86 to 0.90)]. However, in HIV patients with no risk factors (N = 871) the probability of survival was equivalent to that of the general population [0.86 (95% CI 0.77–0.92)]. In contrast, the probability of survival was 0.58 in patients with HIV risk factors (N = 704), 0.30 in patients with comorbidities (N = 479), and 0.03 in patients with drug or alcohol abuse (N = 313).ConclusionsThe increased risk of death in HIV-infected individuals is mainly attributable to risk factors that can be identified prior to or in the initial period of antiretroviral treatment. Mortality in patients without risk factors on a successful HAART is almost identical to that of the non–HIV-infected population.
Highlights
Since the introduction of highly active antiretroviral therapy (HAART), the risk of death has decreased substantially in the HIV-infected population, but remains markedly higher than in the general population [1]
The increased risk of death in HIV-infected individuals is mainly attributable to risk factors that can be identified prior to or in the initial period of antiretroviral treatment
We identified 871 individuals in Group 1, 704 in Group 2, 379 in Group 3, 313 in Group 4, and 9,068 in the general population comparison cohort (Group 0), which in stratified analyses were divided in 4 comparison cohorts
Summary
Since the introduction of highly active antiretroviral therapy (HAART), the risk of death has decreased substantially in the HIV-infected population, but remains markedly higher than in the general population [1]. Three groups of risk factors consistently have been reported to increase mortality among the HIV-infected patients on HAART: (1) HIV-related risk factors (AIDS defining diseases and insufficient response to HAART), (2) comorbidities including hepatitis C, and (3) drug and alcohol abuse. We used a Danish population-based cohort of HIV-infected patients and a comparison cohort from the general population to (1) estimate the impact of risk factors identifiable in the initial period of antiretroviral therapy on long-term mortality in the HIV-infected population and (2) determine the relative risk of death, compared to the background population, among successfully treated HIV-infected patients without such risk factors. We determined the impact of three factors on mortality in HIV-infected patients who had been on highly active antiretroviral therapy (HAART) for at least one year: (1) insufficient response to (HAART) and presence of AIDSdefining diseases, (2) comorbidity, and (3) drug and alcohol abuse and compared the mortality to that of the general population
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