Non-AIDS Mortality Is Higher Among Successfully Treated People Living with HIV Compared with Matched HIV-Negative Control Persons: A 15-Year Follow-Up Cohort Study in Sweden.

Zaake De Coninck,Max Petzold,Veronica Svedhem,Magnus Gisslén,Anna Mia Ekström,Göran Bratt,Laith Hussain-Alkhateeb

doi:10.1089/apc.2018.0015

Zaake De Coninck, Max Petzold + Show 5 more

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https://doi.org/10.1089/apc.2018.0015

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Abstract

There is an ongoing debate whether the life span of successfully treated people living with HIV (PLHIV) is comparable with that of the general population. The aim of this cohort study is to compare all-cause mortality between all PLHIV, successfully treated PLHIV, and HIV-negative control persons from the general population and to explore the impact of viral load (VL) at diagnosis. A total of 4066 PLHIV were matched against 8072 HIV-negative controls according to age, sex, and region of birth. Further, associations between VL at diagnosis, time on treatment, treatment outcome, and mortality were assessed over a 15-year period. Cox regression estimates were computed to compare the overall crude and adjusted hazard ratios (HRs) for mortality. After a 15-year follow-up period, successfully treated PLHIV were found to be three times more likely to die when compared with HIV-negative controls (HR 3.01, 95% CI 2.05–4.44, p < 0.001). The risk of mortality decreased from HR 6.02 after the first year of successful treatment. VL >30,000 c/mL at diagnosis was associated with an increased risk of mortality despite long-term antiretroviral therapy (ART) treatment. Although effective viral suppression has led to significant increases in longevity and quality of life, ART has not fully restored life expectancy to a level comparable with that found in HIV-negative persons. Even when PLHIV are successfully treated, there are several other important areas related to death, such as smoking and social factors, where data are still missing.

Highlights

Antiretroviral therapy (ART) has significantly reduced mortality and morbidity among people living with HIV (PLHIV).[1]
After 15 years of follow-up, successfully treated PLHIV were found to be three times more likely to die compared with HIV-negative controls (HR 3.01, 95% CI 2.05– 4.44, p < 0.001) (Table 4)
This finding is similar to those published by other authors[18,19] and suggests that life expectancy has improved considerably due to advancements in care and treatment, a significant gap remains compared with the general population

Summary

Introduction

Antiretroviral therapy (ART) has significantly reduced mortality and morbidity among people living with HIV (PLHIV).[1] This trend will continue to improve as recently concluded studies (2017) suggest that the more recently the patients are treated, the lower their risk of mortality (due to access to better drugs, better treatment and preventative measures, and better management of comorbidities).[2,3] some researchers have suggested that the life span of successfully treated PLHIV is comparable with that of the general population,[4] others continue to find that morbidity and mortality rates of PLHIV remain elevated when compared with HIV-negative persons.[5,6,7].

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