AIDS-related and non-AIDS-related mortality in the Asia-Pacific region in the era of combination antiretroviral treatment

Falster, Kathleen; Choi, Jun Yong; Donovan, Basil; Duncombe, Chris; Mulhall, Brian P.; Sowden, David; Zhou, Jialun; Law, Matthew

doi:10.1097/qad.0b013e328331910c

Cited by 32 publications

(41 citation statements)

References 37 publications

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“…This finding was rather surprising as we expected the opposite, given our definition of morbidity as number of concurrent illnesses at the time of death. In a study on AIDS and non-AIDS mortality in the era of antiretroviral therapy by Falster et al 16 , they found that of 215 deaths, 89 were AIDS related, 97 non-AIDS related and 29 were unknown. They found age greater than 50 years and CD4 counts > 100 increased the risk of non AIDS deaths (HR 4.99) whereas CD4 ≤100 and viral load >10,000 increased the risk of AIDS deaths (HR 4.21).…”

Section: Discussionmentioning

confidence: 98%

Causes of Death in Hospitalized HIV Patients in the Early Anti-Retroviral Therapy Era

Lartey¹,

Asante-Quashie²,

Essel³

et al. 2015

Ghana Medical Journal

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Section: Discussionmentioning

confidence: 98%

Causes of Death in Hospitalized HIV Patients in the Early Anti-Retroviral Therapy Era

Lartey¹,

Asante-Quashie²,

Essel³

et al. 2015

Ghana Medical Journal

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“…A follow-up study by Achhra et al concluded that this mean CD4 cell count difference translated to minimal clinical significance in terms of mortality and new AIDS-defining illness [22]. A comprehensive analysis of AIDS-related and non-AIDS-related mortality in AHOD and TAHOD also reported little evidence of differing hazard ratios of mortality in TAHOD-High and TAHOD-Low relative to AHOD [24]. However, in a TAHOD-specific study, Oyomopito et al reported less favorable treatment outcomes for sites that reported less than once-yearly RNA-VL testing compared to those sites that monitored RNA-VL at least once-yearly [25].…”

Section: Discussionmentioning

confidence: 99%

Rates and Factors Associated with Major Modifications to First-Line Combination Antiretroviral Therapy: Results from the Asia-Pacific Region

Wright¹,

Boyd

Yunihastuti

et al. 2013

PLoS ONE

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BackgroundIn the Asia-Pacific region many countries have adopted the WHO’s public health approach to HIV care and treatment. We performed exploratory analyses of the factors associated with first major modification to first-line combination antiretroviral therapy (ART) in resource-rich and resource-limited countries in the region.MethodsWe selected treatment naive HIV-positive adults from the Australian HIV Observational Database (AHOD) and the TREAT Asia HIV Observational Database (TAHOD). We dichotomised each country’s per capita income into high/upper-middle (T-H) and lower-middle/low (T-L). Survival methods stratified by income were used to explore time to first major modification of first-line ART and associated factors. We defined a treatment modification as either initiation of a new class of antiretroviral (ARV) or a substitution of two or more ARV agents from within the same ARV class.ResultsA total of 4250 patients had 961 major modifications to first-line ART in the first five years of therapy. The cumulative incidence (95% CI) of treatment modification was 0.48 (0.44–0.52), 0.33 (0.30–0.36) and 0.21 (0.18–0.23) for AHOD, T-H and T-L respectively. We found no strong associations between typical patient characteristic factors and rates of treatment modification. In AHOD, relative to sites that monitor twice-yearly (both CD4 and HIV RNA-VL), quarterly monitoring corresponded with a doubling of the rate of treatment modifications. In T-H, relative to sites that monitor once-yearly (both CD4 and HIV RNA-VL), monitoring twice-yearly corresponded to a 1.8 factor increase in treatment modifications. In T-L, no sites on average monitored both CD4 & HIV RNA-VL concurrently once-yearly. We found no differences in rates of modifications for once- or twice-yearly CD4 count monitoring.ConclusionsLow-income countries tended to have lower rates of major modifications made to first-line ART compared to higher-income countries. In higher-income countries, an increased rate of RNA-VL monitoring was associated with increased modifications to first-line ART.

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“…However, approximately 10% of PLHIV are expected to exhaust all currently available cART options after just 25.6 years, exposing these individuals to higher mortality rates [13,14]. In Fig.…”

Section: Resultsmentioning

confidence: 99%

Currently available medications in resource-rich settings may not be sufficient for lifelong treatment of HIV

Jansson

Wilson²,

Carr³

et al. 2013

Aids

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Objective Combination antiretroviral therapy (cART) has greatly improved the life expectancy of people living with HIV (PLHIV). Our study aims to project the life expectancy of PLHIV in a resource-rich setting in the context of the currently available antiretroviral treatments. Methods Patient antiretroviral treatment data were sourced from an observational cohort of 3,434 predominantly male (94.2%) PLHIV in Australia over the period 1997–2010. These data were analysed in a computer simulation model to calculate the distribution of time until exhaustion of all treatment options and expected effect on mortality. Standardised mortality ratios were used to simulate expected survival before and after treatment exhaustion. Results We estimated that the median time until exhaustion of currently available treatment options is 45.5 years (IQR 34.0–61.0 years). However, 10% of PLHIV are expected to exhaust all currently available cART options after just 25.6 years. PLHIV who start currently available cART regimens at age 20 years are expected to live to a median age of 67.4 (IQR 53.2–77.7) years. This is a substantial improvement on no cART (27.7 [IQR 23.8–32.0] years) but is still substantially less than the median general population mortality age (82.2 [IQR 74.0–87.8] years). The life expectancy gap between PLHIV and the general population is greatest for those infected at younger ages. Conclusions As treatment options are exhausted, a substantial difference in life expectancy between PLHIV and the general population could be expected even in resource-rich settings, particularly for people who acquire HIV at a younger age or who are currently highly treatment experienced.

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AIDS-related and non-AIDS-related mortality in the Asia-Pacific region in the era of combination antiretroviral treatment

Cited by 32 publications

References 37 publications

Causes of Death in Hospitalized HIV Patients in the Early Anti-Retroviral Therapy Era

Causes of Death in Hospitalized HIV Patients in the Early Anti-Retroviral Therapy Era

Rates and Factors Associated with Major Modifications to First-Line Combination Antiretroviral Therapy: Results from the Asia-Pacific Region

Currently available medications in resource-rich settings may not be sufficient for lifelong treatment of HIV

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