Causes of death among human immunodeficiency virus (HIV)-infected adults in the era of potent antiretroviral therapy: emerging role of hepatitis and cancers, persistent role of AIDS

Lewden, Charlotte; Salmon, Dominique; Morlat, Philippe; Bévilacqua, Sibylle; Jougla, Éric; Bonnet, Fabrice; Héripret, Laurence; Costagliola, Dominique; May, Thierry; Chêne, Geneviève

doi:10.1093/ije/dyh307

Cited by 328 publications

(268 citation statements)

References 28 publications

Supporting

Mentioning

249

Contrasting

Unclassified

Order By: Relevance

“…With this, there has been a shift in distribution of causes of death toward non‐AIDS‐defining events (NADEs) 8, 9, 10, 11, 12. Factors contributing to non‐AIDS mortality include immunodeficiency 13, 14, ART toxicity 15, 16, increasing age 17, 18, 19, 20, 21, 22, and lifestyle factors such as tobacco use and obesity 18, 21, 23.…”

Section: Introductionmentioning

confidence: 99%

Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation

et al. 2018

View full text Add to dashboard Cite

Introduction HIV‐1 infection leads to chronic inflammation and to an increased risk of non‐AIDS mortality. Our objective was to determine whether AIDS‐defining events (ADEs) were associated with increased overall and cause‐specific non‐AIDS related mortality after antiretroviral therapy (ART) initiation.MethodsWe included HIV treatment‐naïve adults from the Antiretroviral Therapy Cohort Collaboration (ART‐CC) who initiated ART from 1996 to 2014. Causes of death were assigned using the Coding Causes of Death in HIV (CoDe) protocol. The adjusted hazard ratio (aHR) for overall and cause‐specific non‐AIDS mortality among those with an ADE (all ADEs, tuberculosis (TB), Pneumocystis jiroveci pneumonia (PJP), and non‐Hodgkin's lymphoma (NHL)) compared to those without an ADE was estimated using a marginal structural model.ResultsThe adjusted hazard of overall non‐AIDS mortality was higher among those with any ADE compared to those without any ADE (aHR 2.21, 95% confidence interval (CI) 2.00 to 2.43). The adjusted hazard of each of the cause‐specific non‐AIDS related deaths were higher among those with any ADE compared to those without, except metabolic deaths (malignancy aHR 2.59 (95% CI 2.13 to 3.14), accident/suicide/overdose aHR 1.37 (95% CI 1.05 to 1.79), cardiovascular aHR 1.95 (95% CI 1.54 to 2.48), infection aHR (95% CI 1.68 to 2.81), hepatic aHR 2.09 (95% CI 1.61 to 2.72), respiratory aHR 4.28 (95% CI 2.67 to 6.88), renal aHR 5.81 (95% CI 2.69 to 12.56) and central nervous aHR 1.53 (95% CI 1.18 to 5.44)). The risk of overall and cause‐specific non‐AIDS mortality differed depending on the specific ADE of interest (TB, PJP, NHL).ConclusionsIn this large multi‐centre cohort collaboration with standardized assignment of causes of death, non‐AIDS mortality was twice as high among patients with an ADE compared to without an ADE. However, non‐AIDS related mortality after an ADE depended on the ADE of interest. Although there may be unmeasured confounders, these findings suggest that a common pathway may be independently driving both ADEs and NADE mortality. While prevention of ADEs may reduce subsequent death due to NADEs following ART initiation, modification of risk factors for NADE mortality remains important after ADE survival.

show abstract

Section: Introductionmentioning

confidence: 99%

Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation

et al. 2018

View full text Add to dashboard Cite

show abstract

“…In recent years, end stage liver disease has become a major cause of morbidity and mortality in patients chronically infected with the Human Immunodeficiency Virus (HIV) who are coinfected with hepatitis C (HCV) or B virus (HBV) (1)(2)(3)(4). This trend may be explained by a prolonged exposure to viral hepatitis, because most patients were infected with HCV in the 1980s.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies including the French national survey, "Mortalité 2000", have shown that complications of HCV and HBV are the second most frequent underlying cause of death after AIDS in HIV-infected patients, accounting for around 10% of deaths (1)(2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Emerging role of hepatocellular carcinoma among liver-related causes of deaths in HIV-infected patients: The French national Mortalité 2005 study

Salmon‐Céron

Rosenthal

Lewden

et al. 2009

Journal of Hepatology

106

View full text Add to dashboard Cite

show abstract

“…Current estimations find that more than one-fourth of HIV-infected patients are coinfected with HCV, 1 and HCV-related deaths are now the third cause of death in HIVinfected patients. 2 When compared to the general population, HCVinfected patients have a 2.5-fold increased risk of developing hepatic steatosis (HS), 3 often associated with faster fibrosis progression and more severe hepatic fibrosis, 4 an increased risk of hepatocellular carcinoma development, 5 and lower rates of sustained viral response to HCV antiviral therapy, mainly in genotype 3. 6 There are two types of HS in HCV infection, a viral-related HS and a metabolic-related HS.…”

mentioning

confidence: 99%

Hepatic steatosis in patients coinfected with human immunodeficiency virus/hepatitis C virus: A meta-analysis of the risk factors

2010

View full text Add to dashboard Cite

Hepatic steatosis (HS) is frequent in patients with hepatitis C virus (HCV) infection, occurring in 40%-80%, associating with metabolic and virus-related factors, namely, genotype 3 and viral load. Human immunodeficiency virus (HIV) infection and antiretroviral treatment seem to be risk factors for HS. Several studies addressed this issue in coinfected patients, with discrepant results. A meta-analysis was performed on the HS risk factors in coinfected patients. Eligible studies were identified through structured keywords including coinfection, HCV, HIV, and steatosis in relevant databases including PubMed. Pooled odds ratios (ORs) and confidence limits (CIs) were obtained with the random-effects model and the DerSimonian-Laird method. Twelve studies, including 1,989 coinfected patients, were selected. Twenty percent were infected with HCV genotype 3. The overall prevalence of HS was 50.8% (23%-72%). Four studies also included 1,540 HCV monoinfected patients, not showing an increased risk for HS in coinfected patients (OR 1.61, 95% CI 0.84-3.10, P 5 0.151). In coinfected patients, HS was associated with higher body mass index (OR 1.13, 95% CI 1.07-1.19, P < 0.001), diabetes mellitus (OR 2.32, 95% CI 1.32-4.07, P 5 0.003), elevated alanine aminotransferase levels (OR 1.28, 95% CI 1.02-1.61, P 5 0.035), necroinflammatory activity (OR 1.72, 95% CI 1.11-2.67, P 5 0.016), and fibrosis (OR 1.67, 95% CI 1.20-2.34, P 5 0.003). No associations were found between HS and gender, other metabolic factors (dyslipidemia, glucose, metabolic syndrome), HCV-related factors (genotype, viral load), or HIV-related factors (viral load, CD4 count, antiretroviral therapy, and class of medication). Conclusion: In coinfected patients, HS does not seem to be more frequent than in HCV monoinfected patients and is mostly associated with metabolic factors, such as increased weight, diabetes mellitus, and more severe liver disease. The fact that no associations with HCV factors were found may be due to the small percentage of genotype 3-infected patients. (HEPATOLOGY 2010;52:71-78)

show abstract

Causes of death among human immunodeficiency virus (HIV)-infected adults in the era of potent antiretroviral therapy: emerging role of hepatitis and cancers, persistent role of AIDS

Abstract: Improved strategies for detecting HIV infection before AIDS-defining complications occur are needed in the era of HAART. The prevention of non-AIDS related cancers, especially lung cancer, the management of non-Hodgkin's lymphoma, and of viral hepatitis are also important priorities.

Cited by 328 publications

References 28 publications

Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation

Increased non‐AIDS mortality among persons with AIDS‐defining events after antiretroviral therapy initiation

Emerging role of hepatocellular carcinoma among liver-related causes of deaths in HIV-infected patients: The French national Mortalité 2005 study

Hepatic steatosis in patients coinfected with human immunodeficiency virus/hepatitis C virus: A meta-analysis of the risk factors

Contact Info

Product

Resources

About