Life expectancy of recently diagnosed asymptomatic HIV-infected patients approaches that of uninfected individuals

Sighem, A.I. van; Gras, Luuk; Reiss, Peter; Brinkman, Kees; Wolf, Frank de

doi:10.1097/qad.0b013e32833a3946

Cited by 359 publications

(215 citation statements)

References 26 publications

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“…In the era of antiretroviral therapy (ART), there have been striking decreases in acquired immune deficiency syndrome (AIDS)‐related mortality 1, 2, 3 and prolongation of life expectancy 4, 5, 6, 7 for people living with HIV infection (PLWH). With this, there has been a shift in distribution of causes of death toward non‐AIDS‐defining events (NADEs) 8, 9, 10, 11, 12.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…Women living with HIV have important, specific sexual and reproductive health-related needs (Patterson et al, 2017). Increased access to antiretroviral treatment (ART) and starting early with ART after diagnosis has, together with the effectiveness of ART, reduced mortality and morbidity in HIV-positive people (Nakagawa et al, 2012; Van Sighem, Gras, Reiss, Brinkman, & De Wolf, 2010). Therefore, HIV infection is today considered a chronic disease in well treated individuals.…”

Section: Introductionmentioning

confidence: 99%

Sexuality and childbearing as it is experienced by women living with HIV in Sweden: a lifeworld phenomenological study

Carlsson-Lalloo

Berg

Mellgren

et al. 2018

International Journal of Qualitative Studies on Health and Well

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The effectiveness of antiretroviral treatment has reduced sexual HIV transmission and mother-to-child-transmission. To optimally support women living with HIV, health care providers need deepened knowledge about HIV, sexuality and childbearing. The aim of this study was to describe the phenomenon sexuality and childbearing as experienced by women living with HIV in Sweden. Data were collected by phenomenon-oriented interviews with 18 HIV-positive women. A reflective lifeworld analysis based on phenomenological philosophy was conducted, describing the meaning structure of the phenomenon. The essence of the phenomenon is that perceptions about HIV and its contagiousness profoundly influence sexual habits and considerations in relation to pregnancy and childbearing. These perceptions are formed in combination with knowledge and interpretations about HIV by the women themselves and by their environments. The essence is further described by its constituents: Risk of transmission imposes demands on responsibility; The contagiousness of HIV limits sexuality and childbearing; Knowledge about HIV transmission provides confident choices and decisions; and To re-create sexuality and childbearing. Although HIV has a low risk of transmission if being well treated, our study shows that HIV-positive women feel more or less contagious, which influences sexuality and decision-making in relation to become pregnant and give birth.

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“…To calculate the time since HIV infection among reported cases in Brazil, we started from the premise that among antiretroviral therapy (ART)-naïve individuals, CD4 cell counts decrease over time [30] and that the time since infection can be estimated by applying a CD4 count depletion model, developed as an adaptation of model [1].…”

Section: Cd4 Depletion Modelmentioning

confidence: 99%

“…Over the past two decades, antiretroviral therapy has brought enormous health benefits to people living with HIV/AIDS (PLWHA), with remarkable increase in survival [1]. To ensure effective implementation of prompt access to treatment and other prevention interventions, it is essential to have estimates of HIV incidence for describing the current dynamics of the epidemic [2,3].…”

Section: Introductionmentioning

confidence: 99%

Results from a Method for Estimating HIV Incidence Based on the First Cd4 Count among Treatment-Naïve Cases: Brazil, 2004-2013

Szwarcwald¹,

Júnior²,

Pascom³

et al. 2016

J AIDS Clin Res

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Life expectancy of recently diagnosed asymptomatic HIV-infected patients approaches that of uninfected individuals

Abstract: The life expectancy of asymptomatic HIV-infected patients who are still treatment-naive and have not experienced a CDC-B or C event at 24 weeks after diagnosis approaches that of non-infected individuals. However, follow-up time is short compared to the expected number of years lived.

Cited by 359 publications

References 26 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

Sexuality and childbearing as it is experienced by women living with HIV in Sweden: a lifeworld phenomenological study

Results from a Method for Estimating HIV Incidence Based on the First Cd4 Count among Treatment-Naïve Cases: Brazil, 2004-2013

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