Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: an analysis of a national observational cohort

Croxford, Sara; Kitching, A.; Desai, Sarika; Kall, Meaghan; Edelstein, Michael; Skingsley, Andrew; Burns, Fiona; Copas, Andrew; Brown, Alison E; Sullivan, Ann; Delpech, Valérie

doi:10.1016/s2468-2667(16)30020-2

Cited by 313 publications

(293 citation statements)

References 22 publications

Supporting

Mentioning

269

Contrasting

Unclassified

Order By: Relevance

“…As seen in British [24,25] and Swiss [26] HIV cohorts, we observed a steady decline in all-cause mortality among PLWHA over the past 20 years. As of December 31, 2018, 85.6% of persons diagnosed in the pre-highly active antiretroviral therapy era had died compared with 65.3%, 34.3%, and 12.7% in 1997-2006, 2007-2012, and 2013-2018, respectively.…”

Section: Discussionsupporting

confidence: 66%

The Epidemiology of HIV in Oman, 1984–2018: A Nationwide Study from the Middle East

Elgalib

Shah

Wahaibi

et al. 2020

JEGH

View full text Add to dashboard Cite

We used population-based data on all diagnosed people living with Human Immunodeficiency (HIV) reported to the National AIDS Programme in 1984–2018 to describe the HIV epidemiology in Oman. A total of 3060 Omanis were diagnosed with HIV from 1984 to 2018. The proportions of new infections attributed to sexual contact accounted for 56.3% (376/668) in 1984–1996 compared with 80.7% (630/780) in 2013–2018. Of 1417 patients with a documented CD4 count at the entry of care, 45.3% had a baseline CD4 count of <200 cells/mm 3 . Compared with heterosexuals, homosexuals had higher rates of advanced HIV disease [42.7% (388/908) vs 50.4% (136/270), respectively]. Rates of advanced disease and death within a year of HIV diagnosis rose consistently with age at diagnosis. Approximately half (48.8%) of the patients diagnosed in 1984–2018 had died by December 2018. The majority (85.6%; 572/668) of people who were diagnosed in 1984–1997 had died compared with 12.7% (99/780) of those diagnosed in 2013–2018. However, people died more recently had a higher proportion of death within a year of HIV diagnosis [74.7% (74/99) in 2013–2018 compared with 13.8% (79/572) in 1984–1996]. This study shows that the HIV epidemic in Oman is a low-prevalence one. Of concern, a large proportion of new HIV diagnoses continued to present late, which has resulted in a substantial increase in short-term mortality over the past 20 years. Nevertheless, we observed a remarkable decline in overall mortality over time, which may be explained by the improvement in the quality of HIV care in Oman.

show abstract

Section: Discussionsupporting

confidence: 66%

The Epidemiology of HIV in Oman, 1984–2018: A Nationwide Study from the Middle East

Elgalib

Shah

Wahaibi

et al. 2020

JEGH

View full text Add to dashboard Cite

show abstract

“…Monitoring the HIV continuum of care in relation to migrant populations is particularly challenging because of the lack of information (especially for undocumented migrants, who are the most vulnerable group and least likely to be in HIV care, receive treatment and achieve viral suppression ) and high levels of mobility. The absence of data is of concern because migrants account for a significant proportion of new HIV diagnoses in Europe, are most likely to be diagnosed late and to die sooner , and may be less likely to seek health care because of concerns about migration status .…”

Section: Discussionmentioning

confidence: 99%

Monitoring the HIV continuum of care in key populations across Europe and Central Asia

Brown

Hales³

et al. 2018

HIV Medicine

View full text Add to dashboard Cite

Few reporting countries can produce the continuum of HIV care for the three key populations. Where data are available, differences exist in outcomes between the general and key populations. While MSM broadly mirror national outcomes (in the West), PWID and migrants experience poorer treatment and viral suppression. Countries must develop continuum measures for key populations to identify and address inequalities.

show abstract

“…An analysis of the Swiss HIV Cohort Study (SHCS) found that during the years 1988 to 2008, suicide rates decreased somewhat with the introduction of cART, but remained above the rate observed in the general population. A recent study in the UK also found that in the cART era, HIV‐related suicide rates were higher than in the general population .…”

Section: Introductionmentioning

confidence: 96%

Mortality from suicide among people living with HIV and the general Swiss population: 1988‐2017

et al. 2019

View full text Add to dashboard Cite

Introduction In many countries, mortality due to suicide is higher among people living with HIV than in the general population. We aimed to analyse trends in suicide mortality before and after the introduction of triple combination antiretroviral therapy (cART), and to identify risk factors associated with death from suicide in Switzerland. Methods We analysed data from the Swiss HIV Cohort Study from the pre‐cART (1988‐1995), earlier cART (1996‐2008) and later cART (2009‐2017) eras. We used multivariable Cox regression to assess risk factors for death due to suicide in the ART era and computed standardized mortality ratios (SMRs) to compare mortality rates due to suicide among persons living with HIV with the general population living in Switzerland, using data from the Swiss National Cohort. Results and Discussion We included 20,136 persons living with HIV, of whom 204 (1.0%) died by suicide. In men, SMRs for suicide declined from 12.9 (95% CI 10.4‐16.0) in the pre‐cART era to 2.4 (95% CI 1.2‐5.1) in the earlier cART and 3.1 (95% CI 2.3‐4.3) in the later cART era. In women, the corresponding ratios declined from 14.2 (95% CI 7.9‐25.7) to 10.2 (3.8‐27.1) and to 3.3 (95% CI 1.5‐7.4). Factors associated with death due to suicide included gender (adjusted hazard ratio 0.58 (95% CI 0.38‐0.87) comparing women with men), nationality (1.95 (95% CI 1.34‐2.83) comparing Swiss with other), Centers for Disease Control and Prevention clinical stage (0.33 (95% CI 0.24‐0.46) comparing stage A with C), transmission group (2.64 (95% CI 1.71‐4.09) for injection drug use and 2.10 (95% CI 1.36‐3.24) for sex between men compared to other), and mental health (2.32 (95% CI 1.71‐3.14) for a history of psychiatric treatment vs. no history). There was no association with age. Conclusions Suicide rates have decreased substantially among people living with HIV in the last three decades but have remained about three times higher than in the general population since the introduction of cART. Continued emphasis on suicide prevention among men and women living with HIV is important.

show abstract

Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: an analysis of a national observational cohort

Abstract: Public Health England.

Cited by 313 publications

References 22 publications

The Epidemiology of HIV in Oman, 1984–2018: A Nationwide Study from the Middle East

The Epidemiology of HIV in Oman, 1984–2018: A Nationwide Study from the Middle East

Monitoring the HIV continuum of care in key populations across Europe and Central Asia

Mortality from suicide among people living with HIV and the general Swiss population: 1988‐2017

Contact Info

Product

Resources

About