Impact of Non-HIV and HIV Risk Factors on Survival in HIV-Infected Patients on HAART: A Population-Based Nationwide Cohort Study

Abstract

BackgroundWe determined the impact of three factors on mortality in HIV-infected patients who had been on highly active antiretroviral therapy (HAART) for at least one year: (1) insufficient response to (HAART) and presence of AIDS-defining diseases, (2) comorbidity, and (3) drug and alcohol abuse and compared the mortality to that of the general population.Methodology/Principal FindingsIn a Danish nationwide, population-based cohort study, we used population based registries to identify (1) all Danish HIV-infected patients who started HAART in the period 1 January 1998–1 July 2009, and (2) a comparison cohort of individuals matched on date of birth and gender (N = 2,267 and 9,068, respectively). Study inclusion began 1 year after start of HAART. Patients were categorised hierarchically in four groups according to the three risk factors, which were identified before study inclusion. The main outcome measure was probability of survival from age 25 to 65 years. The probability of survival from age 25 to age 65 was substantially lower in HIV patients [0.48 (95% confidence interval (CI) 0.42–0.55)] compared to the comparison cohort [0.88 (0.86 to 0.90)]. However, in HIV patients with no risk factors (N = 871) the probability of survival was equivalent to that of the general population [0.86 (95% CI 0.77–0.92)]. In contrast, the probability of survival was 0.58 in patients with HIV risk factors (N = 704), 0.30 in patients with comorbidities (N = 479), and 0.03 in patients with drug or alcohol abuse (N = 313).ConclusionsThe increased risk of death in HIV-infected individuals is mainly attributable to risk factors that can be identified prior to or in the initial period of antiretroviral treatment. Mortality in patients without risk factors on a successful HAART is almost identical to that of the non–HIV-infected population.

Impact of HIV risk factors on survival in Iranian HIV-infected patients: A Bayesian approach to retrospective cohort

“…For effective management and planning on the prevention and control of HIV, it is crucial to focus on people living with HIV and to identify prime high-risk groups, as well as concentrating on the HIV/AIDS epidemic in the country and its longitudinal patterns of changes [8][9][10]. There are three major groups of risk factors that have been reported to increase mortality among the HIV-infected patients on highly active antiretroviral therapy (HAART) including HIV-related risk factors (AIDS defining diseases and insufficient response to HAART), co-morbidities such as hepatitis C, and non-HAART-related lifestyle factors such as drug, smoking, and alcohol abuse [11][12][13]. Several factors have been related to risk of HIV infection, varying from individual demographic characteristics for instance gender, age, and marital status, socio-economic status such as education, wealth, sexual behavior (hetero-/homosexual), clinical characteristics (i.e.…”

Assessment of ART adverse reactions and determinants at primary hospital in Ethiopia

“…Non-nucleoside reverse transcriptase inhibitor include: Efavirenz (EFZ), nevirapine (NVP), Protease Inhibitors include: Indinavir (IDV), ritonavir (RTV), lopinavir (LPV) and saquinavir (SQV). [5][6][7] Current antiretroviral therapy regimens are capable of reducing viral load of undetectable level with a consequent increase in T-lymphocyte, CD 4 + counts and reduction in development of opportunistic infections. Hence a substantial reduction in HIV associated morbidity and mortality can be attained.…”

HIV and Aging – Perhaps Not as Dramatic as We Feared?

“…For example, the annual mortality curve of HIV-positive persons in Switzerland after 1995 is a flat line, with no evidence for any recent increase in the death rate from metabolic complications [19]. In addition, when injecting drug users (who have higher death rates compared to non-users) are excluded from mortality analyses, a consistent finding from numerous cohorts is that persons with well-controlled HIV infection have survival rates that approach those of HIV-negative persons [20]. Indeed, over the past 10 years, the mortality “gap” between HIV-positive and HIV-negative persons in Western countries has considerably narrowed in the setting of effective ART [21].…”