Decreasing mortality and changing patterns of causes of death in the <scp>S</scp>wiss <scp>HIV C</scp>ohort <scp>S</scp>tudy

Weber, Rainer; Ruppik, M; Rickenbach, Martin; Spoerri, Adrian; Furrer, Hansjakob; Battegay, Manuel; Cavassini, Matthias; Calmy, Alexandra; Bernasconi, Enos; Schmid, Patrick; Flepp, Markus; Kowalska, Justyna D.; Ledergerber, Bruno

doi:10.1111/j.1468-1293.2012.01051.x

Cited by 342 publications

(266 citation statements)

References 39 publications

(52 reference statements)

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“…Al contrario de lo reportado en países de ingresos altos, [17][18][19] la principal causa de muerte es la enfermedad avanzada relacionada con VIH/sida y no los eventos cardiovasculares, hepáticos o neoplasias no asociadas con sida. Los pacientes de este estudio ingresaron al sistema de salud en un estado avanzado de la infección por VIH (84% de los pacientes se diagnosticaron con menos deEn países desarrollados se ha observado un cambio en las causas de mortalidad asociado con el uso extendido de TARAA, lo que refleja un aumento en la proporción de muertes por eventos cardiovasculares y por neoplasias no asociadas con sida.…”

Section: Discussionunclassified

“…Los pacientes de este estudio ingresaron al sistema de salud en un estado avanzado de la infección por VIH (84% de los pacientes se diagnosticaron con menos deEn países desarrollados se ha observado un cambio en las causas de mortalidad asociado con el uso extendido de TARAA, lo que refleja un aumento en la proporción de muertes por eventos cardiovasculares y por neoplasias no asociadas con sida. 3,[17][18][19] Martín-Onraet A y col. mediana de edad casi 10 años mayor (47 años), 18 y un estudio en un hospital de tercer nivel de Nueva York realizado hace ocho años reportó eventos definitorios de sida como causa de muerte en 18.3% de los casos. 17 Si bien en algunas cohortes de países desarrollados sigue habiendo un número significativo de muertes por sida, la proporción de muertes por eventos no definitorios va en aumento.…”

Section: Discussionunclassified

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Mortalidad hospitalaria en pacientes con infección por VIH: a diez años del acceso universal a TARAA en México

Martin-Onraët¹,

Piñeirúa-Menéndez²,

Perales-Martínez³

et al. 2014

Salud Publica Mex

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S163salud pública de méxico / vol. 57, suplemento 2 de 2015 Mortalidad hospitalaria en pacientes con VIH Artículo originAlMortalidad hospitalaria en pacientes con infección por VIH: a diez años del acceso universal a TARAA en México Alexandra Martín-Onraet, Infectol,(1) Alicia Piñeirua-Menéndez, Infectol,Diana Perales-Martínez, Intern, (1) Raúl Ortega-Pérez, MC, (3) Alejandro Barrera-García, Intern,Juan Sierra-Madero, MC, (3) Patricia Volkow-Fernández, Infectol.(1)(1) Instituto Nacional de Cancerología. México. ResumenObjetivo. Establecer las características y causas de muerte de pacientes VIH positivos que fallecen al estar hospitalizados. Material y métodos. Se incluyeron pacientes VIH positivos que fallecieron durante la hospitalización entre 2010 y 2013. Se recabaron datos sociodemográficos y clínicos, causas de muerte y muertes prevenibles. Se consideraron prevenibles aquellas muertes en pacientes con menos de seis meses de terapia antirretroviral altamente activa (TARAA) o sin tratamiento y con menos de 350 CD4+ al momento del diagnóstico o del internamiento, con o sin enfermedades oportunistas. Resultados. Se identificaron 128 muertes. La mediana de CD4+ fue 47 cels/mm 3 ; 18% llegó al internamiento sin diagnóstico de VIH, 51% tenía menos de seis meses de haber sido diagnosticado y 40.5% no había recibido TARAA. Las principales causas de muerte fueron eventos definitorios de sida (65.6%). Se identificaron 70 muertes prevenibles (57%). Conclusión. A pesar del acceso universal a TARAA, en México los pacientes VIH positivos siguen falleciendo por eventos relacionados con sida, que es un indicador de diagnóstico tardío del VIH. Es urgente implementar programas de detección temprana para hacer accesible el beneficio de la TARAA. AbstractObjective. To establish the characteristics and causes of death of HIV patients who die while hospitalized. Materials and methods. We included HIV+ patients who died during hospitalization, in three hospitals in Mexico City between 2010 and 2013. Sociodemographic and clinical data were collected as well as causes of death. We identified preventable deaths (defined as deaths that occurred in patients with less than six months of HAART, or without HAART, with less than 350 CD4 at diagnosis and/or opportunistic events as the cause of hospitalization). Results. 128 deaths were analyzed. The median of CD4 count was 47 cells/mm 3 ; 18% of the patients ignored their HIV status at the time of hospitalization, 51% had less than six months of HAART, 40.5% had never received HAART before. The main causes of death were AIDS defining events, with 65.6%. We identified 70 preventable deaths (57%). Conclusions. Despite universal access to HAART, HIV patients in Mexico are still dying of AIDS defining illnesses, an indicator of late diagnosis. It is urgent to implement HIV testing programs to allow earlier diagnosis and make HAART benefit accessible to all.

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Section: Discussionunclassified

Mortalidad hospitalaria en pacientes con infección por VIH: a diez años del acceso universal a TARAA en México

Martin-Onraët¹,

Piñeirúa-Menéndez²,

Perales-Martínez³

et al. 2014

Salud Publica Mex

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“…Based on the SMART and ESPRIT clinical trials in well-controlled HIV infected individuals, patients with CD4 counts ranging of 200-500 had a 1.8 times increased hazard of non-AIDS death compared to the general population, but those with CD4 >500 had no increased risk of death [35]. Patients with CD4 <200 could die from AIDS in addition to their baseline risk of death from other causes [36].…”

Section: Clinical Inputsmentioning

confidence: 99%

Potential Cost-Effectiveness of Pre-exposure Prophylaxis Combined with HIV Vaccines in the United States

Adamson¹,

Carlson²,

Kublin³

et al. 2017

Preprint

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This economic evaluation aims to support policy-making on the combined use of preexposure prophylaxis (PrEP) with HIV vaccines by evaluating the potential cost-effectiveness of implementation that would support the design of clinical trials for assessment of combined product safety and efficacy. The target study population is a cohort of men who have sex with men (MSM) in the United States. Policy strategies considered include standard HIV prevention, daily oral PrEP, HIV vaccine, and their combination. We constructed a Markov model based on clinical trial data and published literature. We used a payer perspective, monthly cycle length, a lifetime horizon, and a 3% discount rate. We assumed a price of $500 per HIV vaccine series in the base case. HIV vaccines dominated standard care and PrEP. At current prices,PrEP was not cost-effective alone or in combination. A combination strategy had the greatest health benefit but was not cost-effective (ICER=$463,448/QALY) as compared to vaccination alone. Sensitivity analyses suggest a combination may be valuable for higher-risk men with good adherence. Vaccine durability and PrEP drug prices were key drivers of cost-effectiveness. Results suggest that boosting potential may be key to HIV vaccine value.

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“…Among HIV-positive people, the introduction of combination antiretroviral therapy (cART) has led to dramatic reductions in mortality rates [5][6], with an increasing proportion of deaths in treated HIV-positive people being due to causes not conventionally considered HIV-related [7]. Such changes may lead to emergent differences between mortality rates in treated HIV positive men and women but, unfortunately, sex-stratified analyses are not commonly reported given the low proportion of women among the Western HIV epidemics.…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in Overall and Cause-Specific Mortality among HIV-Infected Adults on Antiretroviral Therapy in Europe, Canada and the US

Jarrín¹,

Moreno²,

Ingle³

et al. 2015

Antiviral Therapy

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms 1 Sex differences in overall and cause-specific mortality among HIV-infected adults on Methods:The ART Cohort Collaboration (ART-CC) combines 19 cohorts of individuals started on cART in Europe and North America (NA). We analyzed patients infected via injecting drug use (IDU) or heterosexual sex using Cox proportional hazards models.Results: 32,443 European (45.9% women), 1,162 (32.5% women) Canadian and 2,721 (15.5% women) US patients were included. In Europe and NA, women were younger, more likely to have acquired HIV heterosexually, be AIDS-free and have higher CD4 counts and lower HIV-1 RNA at baseline. European women had lower rates of all-cause (adjusted Hazard Ratio:0.76; 95%CI: 0.68-0.84) and non-AIDS mortality (0.67; 0.57-0.78) than men, but AIDS-mortality rates were similar (0.90; 0.75-1.09). Women had lower mortality due to non-AIDS infections (0.6 versus 1.3 per 1000 person-years), liver diseases (0.4 versus 1.7), non-AIDS malignancies (0.6 versus 2.0) and cardiovascular diseases (0.6 versus 1.0). Between-sex differences in all-cause mortality were larger in heterosexuals (0.70; (interaction p-value=0.043). No sex differences in all-cause mortality were found in Canada (HR women 1.13; 0.82-1.56) or US (HR women 1.12; 0.79-1.58). Conclusions:The increasing importance of non-AIDS mortality is leading to emergent sex differences among HIV-positive patients in Europe, as in the general population. In spite of the better clinical characteristics at cART initiation, women in NA had similar mortality to men. 3 INTRODUCTIONHigher life expectancy in women compared with men has been well documented since the early and mid 20 th century in the general population of industrialised countries [1][2][3], and since 2006 in developing countries [4]. The reasons are not fully understood, but important reductions in between-sex mortality differences have occurred in countries with high female smoking rates and high levels of female participation in the work-force, supporting a strong contribution of lifestyle factors and gender roles [1][2][3][4].Among HIV-positive people, the introduction of combination antiretroviral therapy (cART) has led to dramatic reductions in mortality rates [5][6], with an increasing proportion of deaths in treated HIV-positive people being due to causes not conventionally considered HIV-related [7]. Such changes may lead to emergent differences between mortality rates in treated HIV positive men and women but, unfortunately, sex-stratified analyses are not commonly reported given the low proportion of women among the Western HIV epidemics.Studies reported to date have produced contradictory results. Reports from the United States, largely based on seroprevalent cohorts, continue to report worse outcomes in HIV-infected women than men [8][9][10]. In Canada, no se...

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Decreasing mortality and changing patterns of causes of death in the Swiss HIV Cohort Study

Cited by 342 publications

References 39 publications

Mortalidad hospitalaria en pacientes con infección por VIH: a diez años del acceso universal a TARAA en México

Mortalidad hospitalaria en pacientes con infección por VIH: a diez años del acceso universal a TARAA en México

Potential Cost-Effectiveness of Pre-exposure Prophylaxis Combined with HIV Vaccines in the United States

Sex Differences in Overall and Cause-Specific Mortality among HIV-Infected Adults on Antiretroviral Therapy in Europe, Canada and the US

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