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Wang H, Guo C, Zhang X, Xu Y, Li Y, Wang T, Liu Z, Zhu X, Zhang T. Prognostic factors for competing risk in patients with AIDS-related Kaposi's sarcoma: A SEER population-based study. HIV Med 2024; 25:60-71. [PMID: 37574804 DOI: 10.1111/hiv.13530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES Despite the improved survival of patients with AIDS and Kaposi's sarcoma (KS), competing events are a non-negligible issue affecting the survival of such patients. In this study, we explored the prognostic factors of KS-specific and non-KS-specific mortality in patients with AIDS-related KS (AIDS-KS), accounting for competing risk. METHODS We identified 17 103 patients with AIDS-KS aged 18-65 years between 1980 and 2016 from the Surveillance, Epidemiology, and End Results (SEER) 18 registry database. Prognostic factors for KS-specific and non-KS-specific mortality were determined by the Fine and Grey proportional subdistribution hazard model. We built competing risk nomograms and assessed their predictive performance based on the identified prognostic factors. RESULTS In total, 12 943 (75.68%) patients died, 1965 (15.50%) of whom died from competing events. The KS-specific mortality rate was 14 835 per 100 000 person-years, and the non-KS specific mortality rate was 2719 per 100 000 person-years. Specifically, age >44 years was associated with an 11% decrease in the subdistribution hazard of KS-specific mortality compared with age <43 years but a 50% increase in the subdistribution hazard of non-KS-specific mortality. Being male was associated with a 26% increase in the subdistribution hazard of KS-specific mortality compared with being female but a 32% decrease in the subdistribution hazard of non-KS-specific mortality. Notably, being in the antiretroviral therapy (ART) era consistently showed a decrease in the subdistribution hazard of both KS-specific and non-KS-specific mortality than being in the pre-ART era. CONCLUSIONS Competing events commonly occurred among patients with AIDS-KS, which deserves further attention to improve the prognosis of these patients.
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Affiliation(s)
- Haili Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Chengnan Guo
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Xin Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Yiyun Xu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Yi Li
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Tianye Wang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Zhenqiu Liu
- State Key Laboratory of Genetic Engineering, Human Phenome Institute, and School of Life Sciences, Fudan University, Shanghai, China
| | - Xiaohua Zhu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Tiejun Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
- Yiwu Research Institue, Fudan University, Yiwu, China
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Sharafi M, Mirahmadizadeh A, Hassanzadeh J, Seif M. Prevalence of Late Presenters and Advanced HIV Disease in HIV Patients and Their Related Factors in Iran: Results from 19 Years of National Surveillance HIV Data. AIDS Res Hum Retroviruses 2022; 38:890-897. [PMID: 36166224 DOI: 10.1089/aid.2022.0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Late presenters (LP) and Advanced HIV Disease (AHD) represent important missed opportunities to reduce secondary transmission and undesirable HIV outcomes. Despite efforts, the diagnoses are still delayed for the majority of patients. This cross-sectional study was conducted using the Iranian national HIV surveillance database from 2001 to 2019, to determine the factors affecting AHD and LP in Iran. To determine LP (CD4 ≤ 350 cells/μL) and AHD (CD4 ≤ 200 cells/μL), the first patients' CD4 at baseline were used. To examine the relationship between the covariates and LP or AHD, a Logistic Regression was applied. The adjusted odds ratio (AOR) stated to report the relationship. Totally, 13,571 patients were included in the study. Of these, 4,060 (29.92%) were AHD and 7,161 (52.77%) LP. Female gender [AOR = 0.88, 95% confidence interval (CI): 0.80-0.97], higher education (AOR = 0.80, 95% CI: 0.69-0.93), and having a positive HIV spouse (AOR = 0.75, 95% CI = 0.66-0.85) significantly decreased odds of LP (p < .05). However, older age (AOR = 2.53, 95% CI: 2.20-2.91) was a risk factor for LP. For AHD, years of detection (AOR = 1.16, 95% CI: 1.06-1.27), older age (AOR = 2.49, 95% CI: 2.12-2.92), and having a spouse with high-risk behavior (AOR = 1.23, 95% CI: 1.02-1.49) led to higher odds. (p < .05). Also, female (AOR = 0.82, 95% CI: 0.73-0.92) and having a positive HIV spouse (AOR = 0.67, 95% CI: 0.58-0.78) were protective factors for ADH. The present study estimated that approximately two-thirds of HIV patients are LP and one-third are AHD in Iran. Older age, male gender, lower education, and having a spouse with high-risk behavior were the factors affecting LP and AHD. Thus, to reduce the percentage of patients with LP and AHD in Iran, improvements in knowledge and periodic screening programs are necessary for these groups.
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Affiliation(s)
- Mehdi Sharafi
- Student Research Committee, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jafar Hassanzadeh
- Research Centre for Health Sciences, Institute of Health, School of Health, Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Seif
- Non-Communicable Diseases Research Center, Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
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Bernardelli M, Pattussi MP, Gonçalves TR. Factors associated with the mortality of women living with HIV: a case-control study. AIDS Care 2022; 35:810-817. [PMID: 35877990 DOI: 10.1080/09540121.2022.2095334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
This case-control study investigated factors associated with death among women living with HIV (WLHIV) in the city of Porto Alegre/RS, Brazil. Sociodemographic, parental and reproductive characteristics, exposure to HIV, laboratory markers and adherence to treatmen were variables examined. The cases were selected among WLHIV who were followed up by health care services for the vertical transmission of HIV (VT) and who died between the years of 2007 and 2017. The controls were the WLHIV who did not die. Sixty-six cases and 264 controls were included. Conditional Logistic Regression was conducted to estimate the Crude and Adjusted Odds Ratio. A conceptual block model was considered for the multivariate analysis. In addition to multiple pregnancies and worse immunological characteristics, WLHIV between 18 and 29 years of age (OR = 25.72; 95% CI: 4.45-148.42), drug users (OR = 7.09; 95% CI: 1.24-40.23) and who were not followed up during prenatal care (OR = 8.43; 95% CI: 1.58-44.87) were more likely to die. Conclusion: Young WLHIV and those with greater social vulnerability have a greater chance of death, and it is essential that health care and treatment strategies consider actions for the prevention of deaths taking into account the multiple vulnerabilities of these women.
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Affiliation(s)
- Maiton Bernardelli
- UNISINOS, Universidade do Vale do Rio dos Sinos, Graduate Program in Collective Health, São Leopoldo, Rio Grande do Sul, Brazil
| | - Marcos Pascoal Pattussi
- UNISINOS, Universidade do Vale do Rio dos Sinos, Graduate Program in Collective Health, São Leopoldo, Rio Grande do Sul, Brazil
| | - Tonantzin Ribeiro Gonçalves
- UNISINOS, Universidade do Vale do Rio dos Sinos, Graduate Program in Collective Health, São Leopoldo, Rio Grande do Sul, Brazil
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Lee CY, Lin YP, Tu HP, Wang SF, Lu PL. Sex stratification of the trends and risk of mortality among individuals living with HIV under different transmission categories. Sci Rep 2022; 12:9266. [PMID: 35661129 PMCID: PMC9166722 DOI: 10.1038/s41598-022-13294-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/23/2022] [Indexed: 11/09/2022] Open
Abstract
We retrospectively examined 33,142 persons living with HIV (PLWH) in Taiwan from a nationwide database to assess sex-stratified trends and risk of all-cause mortality under different transmission categories from 1984 to 2016. Overall, 61.25% were men who have sex with men (MSM), 14.37% were men who have sex with women (MSW), 18.32% were male persons who inject drugs (M-PWID), 3.30% were women who have sex with men (WSM), and 2.74% were female PWID (F-PWID). All-cause mortality (per 100 person-years) among heterosexual people and PWID was higher in men (4.04 and 3.39, respectively) than in women (2.93 and 2.18, respectively). In each sex-stratified transmission category, the all-cause mortality reduced substantially from 1984–1996 to 2012–2016, but evolved distinctly from 2007–2011 to 2012–2016. Since 2007–2011, the decline in all-cause mortality has slowed notably in the groups with sexually transmitted HIV, but has increased in PWID, surpassing even that among groups with sexually transmitted HIV in 2012–2016. PLWH with sexually transmitted HIV had lower risks of all-cause mortality than PWID, regardless of sex. Sex and transmission category did not interact significantly on all-cause mortality. Understanding the reasons for the distinct evolving trends of all-cause mortality in each transmission category serves as a reference for developing strategies to reduce mortality in PLWH in Taiwan further.
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Affiliation(s)
- Chun-Yuan Lee
- Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).,Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan (R.O.C.).,M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
| | - Yi-Pei Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan (R.O.C.)
| | - Hung-Pin Tu
- Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
| | - Sheng-Fan Wang
- Center for Tropical Medicine and Infectious Disease, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).,Department of Medical Laboratory Science and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.)
| | - Po-Liang Lu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung, 807, Taiwan (R.O.C.). .,School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.). .,Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan (R.O.C.).
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Estrada V, Górgolas M, Peña JA, Tortajada E, Castro A, Presa M, Oyagüez I. Epidemiologic and Economic Analysis of Rapid Antiretroviral Therapy Initiation with Bictegravir/Emtricitabine/Tenofovir Alafenamide in Spain. PHARMACOECONOMICS - OPEN 2022; 6:415-424. [PMID: 35124787 PMCID: PMC9043170 DOI: 10.1007/s41669-022-00322-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 05/29/2023]
Abstract
OBJECTIVE This study aimed to assess the potential epidemiological and economic impact of rapid initiation of human immunodeficiency virus (HIV) treatment with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) on HIV transmission compared with the current initiation observed in clinical practice in Spain. METHODS A transmission model was adapted to estimate the cumulative HIV infection incidence and potential cost savings based on the number of HIV infections prevented among men who have sex with men, heterosexual males and females, and people who inject drugs (PWID) over a 20-year time horizon. The analysis compared rapid antiretroviral therapy (ART) initiation with B/F/TAF (9 days from diagnosis until treatment initiation) versus current ART initiation practice (with an average of 35 days from diagnosis to treatment). People living with HIV were distributed according to their treatment status. Risk for transmission was assigned to undiagnosed, diagnosed in care and not receiving ART, and receiving ART but virally unsuppressed, which was estimated by sexual contact, needles and syringes shared among PWID, state of HIV infection, and ART use. RESULTS In the base-case analysis, rapid ART initiation with B/F/TAF is expected to prevent 992 new HIV infections over the next 20 years compared with current ART initiation practices. Considering the lifetime costs of treating HIV infection, the reduction in HIV incidence could result in potential cost savings of €323 million. CONCLUSIONS These results suggest that rapid ART initiation with B/F/TAF in newly diagnosed patients with HIV is a high-value strategy for the Spanish National Health System and society, reducing HIV incidence and thereby reducing future related direct and indirect costs of care.
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Affiliation(s)
- Vicente Estrada
- Department of Infectious Diseases, Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel Górgolas
- Department of Infectious Diseases, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - José A Peña
- Pharmacy Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Elena Tortajada
- Pharmacy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - María Presa
- Pharmacoeconomics and Outcomes Research Iberia, Pº Joaquín Rodrigo 4- letra I, Pozuelo de Alarcón, 28224, Madrid, Spain.
| | - Itziar Oyagüez
- Pharmacoeconomics and Outcomes Research Iberia, Pº Joaquín Rodrigo 4- letra I, Pozuelo de Alarcón, 28224, Madrid, Spain
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Feng S, Zhu Z, Yang P, Jin J, Tuo H, Wang N, Bai R, Sun Y, Song L, Zhang X, Wang S, Duan Q, Huang Y, Zheng Y, Xu S. A comparative analysis on characteristics and mortalities of four key transmission populations on antiretroviral therapy: a retrospective cohort study in Northwest China. BMC Infect Dis 2022; 22:299. [PMID: 35346084 PMCID: PMC8962555 DOI: 10.1186/s12879-022-07281-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study explored disparities in characteristics and mortalities among four major transmission groups on antiretroviral therapy in northwest China as well as the survival impact of each transmission route. Methods We first examined disparities in demographics and clinical characteristics of the four transmission populations. Kaplan Meier analysis was subsequently conducted to compare survival rates among all groups. At last, Cox proportional hazards regression model was employed to analyze the survival impact of a transmission route among seven main categories of survival factors associated with all-cause mortalities. Results Survival analysis showed significant differences in all-cause, AIDS- and non-AIDS-related deaths among four HIV populations (all P < 0.05). Using homosexuals as the reference, Cox proportional hazards model further revealed that the risk of all-cause death for blood and plasma donors was significantly higher than that of the reference (aHR: 5.21, 95%CI: 1.54–17.67); the risk of non-AIDS-related death for heterosexuals (aHR: 2.07, 95%CI: 1.01–4.20) and that for blood and plasma donors (aHR: 19.81, 95%CI: 5.62–69.89) were both significantly higher than that of the reference. Conclusions Significant disparities were found in characteristics and mortalities among the four transmission groups where mortality disparities were mainly due to non-AIDS-related death. Suggestions are provided for each group to improve their survivorship. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07281-x.
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Causes of death and associated factors over a decade of follow-up in a cohort of people living with HIV in rural Tanzania. BMC Infect Dis 2022; 22:37. [PMID: 34991496 PMCID: PMC8739638 DOI: 10.1186/s12879-021-06962-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Nearly half of HIV-related deaths occur in East and Southern Africa, yet data on causes of death (COD) are scarce. We determined COD and associated factors among people living with HIV (PLHIV) in rural Tanzania. Methods PLHIV attending the Chronic Diseases Clinic of Ifakara, Morogoro are invited to enrol in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO). Among adults (≥ 15 years) enrolled in 2005–2018, with follow-up through April 2019, we classified COD in comprehensive classes and as HIV- or non-HIV-related. In the subset of participants enrolled in 2013–2018 (when data were more complete), we assessed cause-specific mortality using cumulative incidences, and associated factors using proportional hazards models. Results Among 9871 adults (65% female, 26% CD4 count < 100 cells/mm3), 926 (9%) died, among whom COD were available for 474 (51%), with missing COD mainly in earlier years. The most common COD were tuberculosis (N = 127, 27%), non-AIDS-related infections (N = 72, 15%), and other AIDS-related infections (N = 59, 12%). Cardiovascular and renal deaths emerged as important COD in later calendar years, with 27% of deaths in 2018 attributable to cardiovascular causes. Most deaths (51%) occurred within the first six months following enrolment. Among 3956 participants enrolled in 2013–2018 (N = 203 deaths, 200 with COD ascertained), tuberculosis persisted as the most common COD (25%), but substantial proportions of deaths from six months after enrolment onwards were attributable to renal (14%), non-AIDS-related infections (13%), other AIDS-related infections (10%) and cardiovascular (10%) causes. Factors associated with higher HIV-related mortality were sex, younger age, living in Ifakara town, HIV status disclosure, hospitalisation, not being underweight, lower CD4 count, advanced WHO stage, and gaps in care. Factors associated with higher non-HIV-related mortality included not having an HIV-positive partner, lower CD4 count, advanced WHO stage, and gaps in care. Conclusion Incidence of HIV-related mortality was higher than that of non-HIV-related mortality, even in more recent years, likely due to late presentation. Tuberculosis was the leading specific COD identified, particularly soon after enrolment, while in later calendar years cardiovascular and renal causes emerged as important, emphasising the need for improved screening and management. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06962-3.
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Muñoz Hornero C, Muriel A, Montero M, Iribarren JA, Masía M, Muñoz L, Sampériz G, Navarro G, Moreno S, Pérez-Elías MJ. Differences in epidemiology and mortality between men and women with HIV infection in the CoRIS cohort from 2004 to 2014. ACTA ACUST UNITED AC 2021; 39:372-382. [PMID: 34373227 DOI: 10.1016/j.eimce.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/19/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study sought to analyse differences in epidemiology and survival between women and men living with HIV (WLHIV and MLHIV) in the CoRIS cohort and the course of their disease over a 10-year period. METHODS Variables of interest between WLHIV and MLHIV were compared. A trend analysis was performed using the Mantel-Haenszel test. Kaplan-Meier survival curves and a Cox regression analysis were used to study survival. RESULTS A total of 10,469 people were enrolled; of them, 1,742 (16.6%) were women. At the time of enrolment in the cohort, WLHIV, compared to MLHIV, had higher rates of transmission due to intravenous drug use (IDU), hepatitis C virus (HCV) coinfection, AIDS-stage disease and foreign origin. They also had a worse immunovirological status and a lower educational level. These differences were maintained in the trend study. Regarding age, the women included in the cohort were older whereas the men were younger. In the comparative analysis between women according to place of origin, we found that the group of Spanish WLHIV featured older women with higher rates of IDU transmission and HCV coinfection, whereas the group of WLHIV born outside of Spain featured women with higher rates of syphilis infection. There were no major differences in relation to other characteristics such as educational level or disease status. Although sex was not a determinant of survival, conditions more prevalent in women were determinants of survival. CONCLUSIONS HIV-infected women presented at diagnosis with certain epidemiological and HIV-associated characteristics that made them more vulnerable. These trends became more marked or did not improve during the years of observation.
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Affiliation(s)
| | - Alfonso Muriel
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, YRICIS, CIBERESP, Madrid, Spain
| | - Marta Montero
- Servicio de Enfermedades Infecciosas, Hospital La Fe, Valencia, Spain
| | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, Spain
| | - Mar Masía
- Servicio de Enfermedades Infecciosas, Hospital de Elche, Elche, Alicante, Spain
| | - Leopoldo Muñoz
- Servicio de Enfermedades Infecciosas, Hospital San Cecilio, Granada, Spain
| | - Gloria Sampériz
- Servicio de Enfermedades Infecciosas, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Gemma Navarro
- Servicio de Enfermedades Infecciosas, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Santiago Moreno
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain
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Mohammadi Y, Mirzaei M, Shirmohammadi-Khorram N, Farhadian M. Identifying risk factors for late HIV diagnosis and survival analysis of people living with HIV/AIDS in Iran (1987-2016). BMC Infect Dis 2021; 21:390. [PMID: 33906638 PMCID: PMC8077959 DOI: 10.1186/s12879-021-06100-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/21/2021] [Indexed: 12/04/2022] Open
Abstract
Background Late-diagnosis of HIV is a major challenge for the control and prevention of AIDS in the world. The present study aimed to specify factors associated with the late diagnosis of HIV in Iran from 1987 to 2016. Methods In this retrospective cohort study, data for 4402 diagnosed HIV/AIDS patients were extracted from 158 behavioral disease counseling centers of 31 Iranian provinces. We defined late diagnosis as having a CD4 count less than 350 within 3 months after diagnosis. Multiple logistic regression analysis was used to determine the factors influencing late diagnosis. Moreover, we used multivariate Cox regression to assess the association of these factors with the patients’ survival. Results In this study, the prevalence of late diagnosis among the patients was 58.2%. People aged 50 years and over (adjusted OR = 3.55), transmission through blood transfusion (adjusted OR = 2.89), co-infection with tuberculosis (adjusted OR = 2.06), and male gender (adjusted OR = 1.38) were the strongest predictors for late diagnosis of HIV. On the other hand, baseline CD4 (adjusted HR = 2.21), people aged 50 and over (adjusted HR = 1.81), male gender (adjusted HR = 1.76), being a widow (adjusted HR = 1.68), people with unknown transmission way (adjusted HR = 18.24), people who inject drugs (adjusted HR = 1.87), diagnosis at previous years (adjusted HR = 2.45) and co-infection with tuberculosis (adjusted OR = 1.77) significantly associated with the survival of patients. Conclusion The prevalence of late diagnosis is high among Iranian HIV/AIDS. The risk factors of late diagnoses include being males and aged 50 years and over, transmission through blood transfusion, and co-infection with tuberculosis. Therefore, implementation of screening programs for early diagnosis of HIV these high risk groups is recommended to Iranian health providers and policymakers.
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Affiliation(s)
- Younes Mohammadi
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Mirzaei
- Hamadan Health Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Maryam Farhadian
- Research Center for Health Sciences, Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, P.O. Box 4171-65175, Hamadan, Iran.
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Kim Y, Kim SW, Chang HH, Kwon KT, Bae S, Hwang S. Trends of Cause of Death among Human Immunodeficiency Virus Patients and the Impact of Low CD4 Counts on Diagnosis to Death: a Retrospective Cohort Study. J Korean Med Sci 2020; 35:e355. [PMID: 33107229 PMCID: PMC7590652 DOI: 10.3346/jkms.2020.35.e355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Monitoring the full spectrum of causes of death among human immunodeficiency virus (HIV) patients has become increasingly important as survival improves because of highly active antiretroviral therapy. However, there are no recently published data regarding the changes in the causes of death among HIV patients based on year of HIV diagnosis, and the impact of low CD4 count at the time of HIV diagnosis on the clinical outcome is still unclear in Korea. METHODS A retrospective cohort study was conducted with 801 patients with HIV infection who were followed up at a tertiary university hospital and diagnosed with HIV between July 1984 and October 2019. The causes of death were analyzed by descriptive analysis based on CD4 count and the year of HIV diagnosis. Kaplan-Meier and log rank tests were performed to compare the prognosis between the CD4 < 200 cells/mm³ and CD4 ≥ 200 cells/mm³ groups. RESULTS Among 801 patients, 67 patients were eligible for the death cause analysis. Infection-related death accounted for 44 patients (65.7%) and non-infection related death accounted for 23 patients (32.4%). Pneumocystis pneumonia (29.9%) was the single most common cause of death in both past and present cases, and tuberculosis (19.4%) was the second leading cause of death from infections, but the frequency has declined in recent years. Causes of infection-related death have decreased, whereas non-infection related causes of death have increased remarkably. Malignancy-related death was the most common cause of non-infection related death. Acquired immunodeficiency syndrome (AIDS) non-related malignancy accounted for 11.9%, whereas AIDS-related malignancy accounted for 6.0% of the total death among HIV patients. No significant statistical differences were found in mortality rate (P = 0.228), causes of death (P = 0.771), or survival analysis (P = 0.089) between the CD4 < 200 cells/mm³ and CD4 ≥ 200 cells/mm³ groups. CONCLUSION Being diagnosed with CD4 < 200 cells/mm³ at the time of HIV diagnosis was not an indicator of greater risk of death compared with the CD4 ≥ 200 cells/mm³ group. Malignant tumors have become an important cause of death in recent years, and an increasing tendency of AIDS-non-related malignancy causes has been observed.
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Affiliation(s)
- Yoonjung Kim
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Shin Woo Kim
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Hyun Ha Chang
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ki Tae Kwon
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sohyun Bae
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Soyoon Hwang
- Division of Infectious Disease, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Cao Z, Li J, Chen H, Song C, Shen Z, Zhou X, Lan G, Zhu Q, Liang S, Xing H, Liao L, Feng Y, Shao Y, Ruan Y. Effects of HIV-1 genotype on baseline CD4+ cell count and mortality before and after antiretroviral therapy. Sci Rep 2020; 10:15875. [PMID: 32985559 PMCID: PMC7522205 DOI: 10.1038/s41598-020-72701-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023] Open
Abstract
To assess whether human immunodeficiency virus type 1 (HIV-1) genotype influences baseline CD4+ T lymphocyte (CD4+) cell count and mortality of patients. The study was conducted from 2014 to 2019 in Guangxi, China, and included 2845 newly diagnosed HIV patients. We used a median regression model to compare CD4+ cell counts in patients newly diagnosed with different HIV-1 genotypes, and a Cox regression model to analyze the associations between HIV-1 genotypes and mortality before and after antiretroviral treatment (ART). In newly diagnosed HIV patients, the baseline CD4+ cell counts of patients with CRF01_AE were significantly lower than those of patients with CRF07_BC, CRF08_BC, and other genotypes. Compared with CRF01_AE, patients infected with CRF07_BC (hazard ratio, 0.55; 95% CI 0.36–0.85), CRF08_BC (hazard ratio, 0.67; 95% CI 0.52–0.85), or other genotypes (hazard ratio, 0.52; 95% CI 0.29–0.94) had significantly lower mortality rates before ART. There were no significant associations between different HIV-1 genotypes and mortality after ART. HIV-1 genotype significantly influences baseline CD4+ cell count and mortality before ART in newly diagnosed HIV patients. We find no significant difference in the outcome of death after ART in patients with different HIV-1 genotypes.
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Affiliation(s)
- Zhiqiang Cao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Jianjun Li
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Huanhuan Chen
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Chang Song
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Zhiyong Shen
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Xinjuan Zhou
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Guanghua Lan
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Qiuying Zhu
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Shujia Liang
- Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control, Nanning, China
| | - Hui Xing
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Lingjie Liao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yi Feng
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yiming Shao
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control (SKLID), National Center for AIDS/STD Control and Prevention (NCAIDS), Chinese Center for Disease Control and Prevention (China CDC), Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China.
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12
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Muñoz Hornero C, Muriel A, Montero M, Iribarren JA, Masía M, Muñoz L, Sampériz G, Navarro G, Moreno S, Pérez-Elías MJ. Differences in epidemiology and mortality between men and women with HIV infection in the CoRIS cohort from 2004 to 2014. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30220-2. [PMID: 32680794 DOI: 10.1016/j.eimc.2020.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This study sought to analyse differences in epidemiology and survival between women and men living with HIV in the CoRIS cohort and the course of their disease over a 10-year period. METHODS Variables of interest between women living with HIV and men living with HIV were compared. A trend analysis was performed using the Mantel-Haenszel test. Kaplan-Meier survival curves and a Cox regression analysis were used to study survival. RESULTS A total of 10,469 people were enrolled; of them, 1,742 (16.6%) were women. At the time of enrolment in the cohort, women living with HIV, compared to men living with HIV, had higher rates of transmission due to intravenous drug use (IDU), hepatitisC virus (HCV) coinfection, AIDS-stage disease and foreign origin. They also had a worse immunovirological status and a lower educational level. These differences were maintained in the trend study. Regarding age, the women included in the cohort were older whereas the men were younger. In the comparative analysis between women according to place of origin, we found that the group of Spanish women living with HIV featured older women with higher rates of IDU transmission and HCV coinfection, whereas the group of women living with HIV born outside of Spain featured women with higher rates of syphilis infection. There were no major differences in relation to other characteristics such as educational level or disease status. Although sex was not a determinant of survival, conditions more prevalent in women were determinants of survival. CONCLUSIONS HIV-infected women presented at diagnosis with certain epidemiological and HIV-associated characteristics that made them more vulnerable. These trends became more marked or did not improve during the years of observation.
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Affiliation(s)
| | - Alfonso Muriel
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal. YRICIS. CIBERESP, Madrid, España
| | - Marta Montero
- Servicio de Enfermedades Infecciosas, Hospital La Fe, Valencia, España
| | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, España
| | - Mar Masía
- Servicio de Enfermedades Infecciosas, Hospital de Elche, Elche, Alicante, España
| | - Leopoldo Muñoz
- Servicio de Enfermedades Infecciosas, Hospital San Cecilio, Granada, España
| | - Gloria Sampériz
- Servicio de Enfermedades Infecciosas, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Gemma Navarro
- Servicio de Enfermedades Infecciosas, Hospital Parc Taulí, Sabadell, Barcelona, España
| | - Santiago Moreno
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España
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13
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Fontela C, Aguinaga A, Moreno-Iribas C, Repáraz J, Rivero M, Gracia M, Floristán Y, Fresán U, Miguel RS, Ezpeleta C, Castilla J. Trends and causes of mortality in a population-based cohort of HIV-infected adults in Spain: comparison with the general population. Sci Rep 2020; 10:8922. [PMID: 32488053 PMCID: PMC7265289 DOI: 10.1038/s41598-020-65841-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
Combination antiretroviral therapy reduces mortality of HIV-infected persons. In Spain, where this therapy is widely available, we aim to evaluate mortality trends and causes of death in HIV-infected adults, and to estimate the excess mortality compared to the general population. From 1999 to 2018 mortality by causes was analyzed in a population-based cohort of adults aged 25 to 74 years diagnosed with HIV infection in Spain. Observed deaths and expected deaths according mortality in the general population of the same sex and age were compared using standardized mortality ratios (SMRs). HIV-infected people increased from 839 in 1999–2003 to 1059 in 2014–2018, median age increased from 37 to 47 years, the annual mortality rate decreased from 33.5 to 20.7 per 1000 person-years and the proportion of HIV-related deaths declined from 64% to 35%. HIV-related mortality declined from 21.4 to 7.3 (p < 0.001), while non-HIV-related mortality remained stable: 12.1 and 13.4 per 1000, respectively. Mortality decreased principally in persons diagnosed with AIDS-defining events. In the last decade, 2009–2018, mortality was still 8.1 times higher among HIV-infected people than in the general population, and even after excluding HIV-related deaths, remained 4.8 times higher. Excess mortality was observed in non-AIDS cancer (SMR = 3.7), cardiovascular disease (SMR = 4.2), respiratory diseases (SMR = 7.9), liver diseases (SMR = 8.8), drug abuse (SMR = 47), suicide (SMR = 5.3) and other external causes (SMR = 6). In conclusion, HIV-related mortality continued to decline, while non-HIV-related mortality remained stable. HIV-infected people maintained important excess mortality. Prevention of HIV infections in the population and promotion of healthy life styles in HIV-infected people must be a priority.
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Affiliation(s)
- Carmen Fontela
- Department of Pharmacy, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - Aitziber Aguinaga
- Department of Clinical Microbiology, Complejo Hospitalario de Navarra- IdiSNA, Pamplona, Spain
| | - Conchi Moreno-Iribas
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain
| | - Jesús Repáraz
- Infectious Diseases Unit, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - María Rivero
- Infectious Diseases Unit, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - María Gracia
- Infectious Diseases Unit, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - Yugo Floristán
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain
| | - Ujué Fresán
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain
| | - Ramón San Miguel
- Department of Pharmacy, Complejo Hospitalario de Navarra - IdiSNA, Pamplona, Spain
| | - Carmen Ezpeleta
- Department of Clinical Microbiology, Complejo Hospitalario de Navarra- IdiSNA, Pamplona, Spain
| | - Jesús Castilla
- Instituto de Salud Pública de Navarra - IdiSNA, Pamplona, Spain. .,CIBER Epidemiología y Salud Pública (CIBERESP), Pamplona, Spain.
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14
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Vallecillo G, Robles MJ, Durán X, Lerma E, Horcajada JP, Torrens M. Trends in AIDS Mortality, Retention in Opioid Agonist Therapy, and HIV RNA Suppression in HIV-Infected People Who Injected Drugs from 2000 to 2015. AIDS Behav 2018; 22:2766-2772. [PMID: 29372455 DOI: 10.1007/s10461-018-2033-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIDS is a major cause of preventable mortality in HIV-infected people who inject drugs (HIV-PWID). An observational study was conducted to examine trends in AIDS mortality and related factors among HIV-infected individuals who died between 2000 and 2015 at an urban hospital. Overall HIV-mortality was 6.5% (413/6307) with no changes over time (p 0.76). AIDS mortality dropped in HIV-PWID (p 0.02) although it represented 26.4% at the end of study period. Age (per one-year increase) [odds ratio (OR) 0.95], third study period (2010-2015) (OR 0.54), HIV-PWID on opioid agonist therapy (OAT) (OR 0.39), and HIV RNA suppression (OR 0.15) were associated with AIDS mortality. OAT was reported in 58.3% (161/276) and RNA suppression in 30.9% (85/276) of HIV-PWID. OAT non-retention was due to drop-outs [85.2% (98/115)] and rejection [14.8% (17/115)] in HIV-PWID. Therefore, additional strategies are required to improve OAT retention and HIV RNA suppression to continue reducing AIDS mortality.
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Affiliation(s)
- G Vallecillo
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain.
- Addiction Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain.
| | - M J Robles
- Geriatric Unit, Hospital del Mar, Barcelona, Spain
| | - X Durán
- Department of Methodological Advice in Biomedical Research (AMIB), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - E Lerma
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
- Addiction Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - J P Horcajada
- Infectious Disease Department, Hospital del Mar, Barcelona, Spain
| | - M Torrens
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, Passeig Marítim 25-29, 08003, Barcelona, Spain
- Addiction Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
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15
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Valencia Ortega M. Malignancies and infection due to the human immunodeficiency virus. Are these emerging diseases? Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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16
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Late presentation of HIV infection in the country of Georgia: 2012-2015. PLoS One 2017; 12:e0186835. [PMID: 29084276 PMCID: PMC5662083 DOI: 10.1371/journal.pone.0186835] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 10/09/2017] [Indexed: 01/25/2023] Open
Abstract
Late presentation for HIV care has important individual and population implications. The objective of this study was to explore the problem of late presentation in the country of Georgia. Data on adult persons newly diagnosed with HIV in Georgia between 2012 and 2015 were extracted from the national AIDS Health Information System. Late presenter was defined as a person diagnosed with HIV with a CD4 cell count <350 cells/mm3 or an AIDS defining illness regardless of the CD4 cell count in the six months after HIV diagnosis. Late presenter with advanced disease was defined as a person diagnosed with HIV with a CD4 cell count <200 cells/mm3 or an AIDS defining illness, regardless of CD4 cell count in the six months after HIV diagnosis. Among 2267 adults diagnosed with HIV in Georgia in 2012–2015, 1987 (87.6%) had CD4 cell count measured within 6 months of HIV diagnosis and were included in the analysis. Among them 1260 (63.4%) patients were classified as late presenters and 870 (43.8%) as late presenters with advanced disease. The proportion of late presenters declined from 71.1% in 2012 to 55.5% in 2015 (p<0.0001), while presentation late with advanced disease decreased from 56.6% in 2012 to 34.5% in 2015 (p<0.0001). Late presentation was most common among people who inject drugs (77.7%). Overall 186 patients died over the studied period. Mortality was higher both among late presenters (6.74 per 100 person-years vs. 1.08 per 100 person-years, p<0.0001) and late presenters with advanced disease (8.93 per 100 person-years vs. 1.34 per 100 person-years, p<0.0001). High prevalence of late presentation in Georgia reflects insufficiency in HIV testing services. Better testing strategies are needed to improve earlier diagnosis and disease outcomes.
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17
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Valencia Ortega ME. Malignancies and infection due to the human immunodeficiency virus. Are these emerging diseases? Rev Clin Esp 2017; 218:149-155. [PMID: 28874261 DOI: 10.1016/j.rce.2017.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 06/17/2017] [Accepted: 07/30/2017] [Indexed: 12/26/2022]
Abstract
Since the start of the human immunodeficiency virus (HIV) epidemic, tumour disease among patients has been significant. The collection of malignancies can be divided primarily into 2 groups: those associated with HIV (all of which are related to viral diseases) and those not associated with HIV (only some of which are associated with viral diseases). The origin of these malignancies is multifactorial, and the main causes that have led to an increase in tumour disease are immunosuppression, coinfection with oncogenic viruses and life prolongation secondary to the use of antiretroviral therapy. Establishing the general characteristics of the undiagnosed AIDS tumours is difficult, mainly because they are a highly heterogeneous group formed by malignancies of a diverse nature. The treatments do not differ from those used in the general population, although the management can be more difficult due to the late diagnosis, drug interactions and associated comorbidities.
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Affiliation(s)
- M E Valencia Ortega
- Servicio de Medicina Interna-Unidad de VIH, Hospital Universitario La Paz, Madrid, España.
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18
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Abstract
PURPOSE OF REVIEW The purpose is to describe and understand the sociodemographic determinants of survival in people living with HIV within high-income countries in the context of the current recommendation of universal antiretroviral therapy for all HIV-infected persons, irrespective of their CD4 cell count. RECENT FINDINGS Survival rates in people living with HIV have experienced remarkable increases in the last decade because of more efficacious and well tolerated treatments. Still, these improvements are unevenly distributed between regions across the world as well as within regions. HIV outcomes are heavily influenced by what are known as the 'social determinants' of health which have traditionally encompassed the gender, race/ethnicity, and socioeconomic axes. The evidence that these social determinants are now more important than before (more and earlier interventions are now available), has become stronger in the last 2 years. SUMMARY Because antiretroviral therapy is now recommended for all HIV-infected persons, sociodemographic factors limiting access to testing, treatment, and retention in care will undoubtedly jeopardize the UNAIDS aspirational objective to end AIDS by 2030. Innovative interventions targeting individuals with social vulnerability are urgently needed to ensure that social inequalities do not continue to be linked with higher mortality.
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19
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Parashar S, Collins AB, Montaner JSG, Hogg RS, Milloy MJ. Reducing rates of preventable HIV/AIDS-associated mortality among people living with HIV who inject drugs. Curr Opin HIV AIDS 2016; 11:507-513. [PMID: 27254749 PMCID: PMC5055433 DOI: 10.1097/coh.0000000000000297] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The modern antiretroviral therapy (ART) era has seen substantial reductions in mortality among people living with HIV. However, HIV-positive people who inject drugs (PWIDs) continue to experience high rates of suboptimal HIV-related outcomes. We review recent findings regarding factors contributing to premature and preventable mortality among HIV-positive PWID, and describe the promise of interventions to improve survival in this group. RECENT FINDINGS The current leading causes of death among HIV-positive PWID are HIV/AIDS-related causes, overdose, and liver-related causes, including infection with hepatitis C virus. Elevated mortality levels in this population are driven by social-structural barriers to ART access and adherence, particularly criminalization and stigmatization of drug use. In contexts where opioid substitution therapy and ART adherence support programs are widely accessible, evidence highlights comparable levels of survival among HIV-positive PWID and people living with HIV who do not inject drugs. SUMMARY The life-saving benefits of ART can be realized among HIV-positive PWID when it is paired with strategies that address barriers to evidence-based medical care. Joint administration of ART and opioid substitution therapy, as well as repeal of punitive laws that criminalize drug users, are urgently needed to reduce HIV and injection-related mortality among PWID.
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Affiliation(s)
- Surita Parashar
- aBritish Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, VancouverbFaculty of Health Sciences, Simon Fraser University, BurnabycDepartment of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
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20
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Adih WK, Selik RM, Hall HI, Babu AS, Song R. Associations and Trends in Cause-Specific Rates of Death Among Persons Reported with HIV Infection, 23 U.S. Jurisdictions, Through 2011. Open AIDS J 2016; 10:144-157. [PMID: 27708746 PMCID: PMC5037936 DOI: 10.2174/1874613601610010144] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/25/2016] [Accepted: 05/27/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Published death rates for persons with HIV have not distinguished deaths due to HIV from deaths due to other causes. Cause-specific death rates would allow better assessment of care needs. Methods: Using data reported to the US national HIV surveillance system, we examined a) associations between selected decedent characteristics and causes of death during 2007-2011, b) trends in rates of death due to underlying causes among persons with AIDS during 1990-2011, and among all persons with diagnosed HIV infection (with or without AIDS) during 2000-2011. Results: During 2007-2011, non-HIV-attributable causes of death with the highest rates per 1,000 person-years were heart disease (2.0), non-AIDS cancers other than lung cancer (1.4), and accidents (0.8). During 1990-2011, among persons with AIDS, the annual rate of death due to HIV-attributable causes decreased by 89% (from 122.0 to 13.2), and the rate due to non-HIV-attributable-causes decreased by 57% (from 20.0 to 8.6), while the percentage of deaths caused by non-HIV-attributable causes increased from 11% to 43%. During 2000-2011, among persons with HIV infection, the rate of death due to HIV-attributable causes decreased by 69% (from 26.4 to 8.3), and the rate due to non-HIV-attributable causes decreased by 28% (from 10.5 to 7.6), while the percentage of deaths caused by non-HIV-attributable causes increased from 25% to 48%. Conclusion: Among HIV-infected persons, as rates of death due to HIV-attributable causes decreased, rates due to non-HIV-attributable causes also decreased, but the percentages of deaths due to non-HIV-attributable causes, such as heart disease and non-AIDS cancers increased.
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Affiliation(s)
- William K Adih
- Division of HIV/AIDS Prevention - National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard M Selik
- Division of HIV/AIDS Prevention - National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - H Irene Hall
- Division of HIV/AIDS Prevention - National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ruiguang Song
- Division of HIV/AIDS Prevention - National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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21
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Berenguer J. [Mortality in people infected by Human Immunodeficiency Virus]. Enferm Infecc Microbiol Clin 2016; 34:217-8. [PMID: 26926261 DOI: 10.1016/j.eimc.2016.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 01/25/2016] [Accepted: 01/30/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Juan Berenguer
- Hospital General Universitario Gregorio Marañón/Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España.
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