Mortality, Causes of Death and Associated Factors Relate to a Large HIV Population-Based Cohort

Garriga, César; García, Felipe; Miró, Josep M.; Ocaña, I; Knobel, Hernando; Barberà, María Jesús; Humet, Victoria; Domingo, Peré; Gatell, Josep M.; Ribera, Esteban; Gurguí, Mercé; Marco, A; Caylà, Joan A.

doi:10.1371/journal.pone.0145701

Cited by 26 publications

(22 citation statements)

References 63 publications

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“…Similar to other studies injection drug use was significant predictor of mortality in Georgia [ 30 – 32 ]. The difference was statistically significant with all other transmission categories and this is the result of highest rate of late presentation among drug users.…”

Section: Discussionsupporting

confidence: 87%

Late presentation of HIV infection in the country of Georgia: 2012-2015

et al. 2017

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Late presentation for HIV care has important individual and population implications. The objective of this study was to explore the problem of late presentation in the country of Georgia. Data on adult persons newly diagnosed with HIV in Georgia between 2012 and 2015 were extracted from the national AIDS Health Information System. Late presenter was defined as a person diagnosed with HIV with a CD4 cell count <350 cells/mm3 or an AIDS defining illness regardless of the CD4 cell count in the six months after HIV diagnosis. Late presenter with advanced disease was defined as a person diagnosed with HIV with a CD4 cell count <200 cells/mm3 or an AIDS defining illness, regardless of CD4 cell count in the six months after HIV diagnosis. Among 2267 adults diagnosed with HIV in Georgia in 2012–2015, 1987 (87.6%) had CD4 cell count measured within 6 months of HIV diagnosis and were included in the analysis. Among them 1260 (63.4%) patients were classified as late presenters and 870 (43.8%) as late presenters with advanced disease. The proportion of late presenters declined from 71.1% in 2012 to 55.5% in 2015 (p<0.0001), while presentation late with advanced disease decreased from 56.6% in 2012 to 34.5% in 2015 (p<0.0001). Late presentation was most common among people who inject drugs (77.7%). Overall 186 patients died over the studied period. Mortality was higher both among late presenters (6.74 per 100 person-years vs. 1.08 per 100 person-years, p<0.0001) and late presenters with advanced disease (8.93 per 100 person-years vs. 1.34 per 100 person-years, p<0.0001). High prevalence of late presentation in Georgia reflects insufficiency in HIV testing services. Better testing strategies are needed to improve earlier diagnosis and disease outcomes.

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Section: Discussionsupporting

confidence: 87%

Late presentation of HIV infection in the country of Georgia: 2012-2015

et al. 2017

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“… 18 According to a previous large HIV population-based cohort study, the mortality rate was higher in patients with CD4 counts of 200 cells/mm 3 or less, and a CD4 count of less than 200 is one of the factors associated with AIDS-related causes of death. 19 However, in our study, the mortality rate and AIDS-related causes of death between CD4 < 200 cells/mm 3 and CD4 ≥ 200 cells/mm 3 groups showed no significant differences. This difference might be attributed to the fact that the previous study did not find a specific cause of death in 18.7% of patients.…”

Section: Discussioncontrasting

confidence: 73%

“…This difference might be attributed to the fact that the previous study did not find a specific cause of death in 18.7% of patients. 19 …”

Section: Discussionmentioning

confidence: 99%

Trends of Cause of Death among Human Immunodeficiency Virus Patients and the Impact of Low CD4 Counts on Diagnosis to Death: a Retrospective Cohort Study

Kim

Chang

et al. 2020

J Korean Med Sci

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Background Monitoring the full spectrum of causes of death among human immunodeficiency virus (HIV) patients has become increasingly important as survival improves because of highly active antiretroviral therapy. However, there are no recently published data regarding the changes in the causes of death among HIV patients based on year of HIV diagnosis, and the impact of low CD4 count at the time of HIV diagnosis on the clinical outcome is still unclear in Korea. Methods A retrospective cohort study was conducted with 801 patients with HIV infection who were followed up at a tertiary university hospital and diagnosed with HIV between July 1984 and October 2019. The causes of death were analyzed by descriptive analysis based on CD4 count and the year of HIV diagnosis. Kaplan–Meier and log rank tests were performed to compare the prognosis between the CD4 < 200 cells/mm 3 and CD4 ≥ 200 cells/mm 3 groups. Results Among 801 patients, 67 patients were eligible for the death cause analysis. Infection-related death accounted for 44 patients (65.7%) and non-infection related death accounted for 23 patients (32.4%). Pneumocystis pneumonia (29.9%) was the single most common cause of death in both past and present cases, and tuberculosis (19.4%) was the second leading cause of death from infections, but the frequency has declined in recent years. Causes of infection-related death have decreased, whereas non-infection related causes of death have increased remarkably. Malignancy-related death was the most common cause of non-infection related death. Acquired immunodeficiency syndrome (AIDS) non-related malignancy accounted for 11.9%, whereas AIDS-related malignancy accounted for 6.0% of the total death among HIV patients. No significant statistical differences were found in mortality rate ( P = 0.228), causes of death ( P = 0.771), or survival analysis ( P = 0.089) between the CD4 < 200 cells/mm 3 and CD4 ≥ 200 cells/mm 3 groups. Conclusion Being diagnosed with CD4 < 200 cells/mm 3 at the time of HIV diagnosis was not an indicator of greater risk of death compared with the CD4 ≥ 200 cells/mm 3 group. Malignant tumors have become an important cause of death in recent years, and an increasing tendency of AIDS-non-related malignancy causes has been observed.

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“…Despite advances in availability and tolerability of treatment, mortality remains high among HIV- positive PWID when compared with other key populations of PLHIV, in low-, middle-, and high-income settings [6–9,10*,11,12,13*,14,15,16*,17–23]. For example, across the 16 European and North American cohorts in the Antiretroviral Therapy Cohort Collaboration, which comprise 32 703 HIV-positive adults who started ART between 2000 and 2009, all- cause mortality among people with a history of injection drug use (IDU) was more than twice that of individuals with no history of IDU [10*].…”

Section: Introductionmentioning

confidence: 99%

Reducing rates of preventable HIV/AIDS-associated mortality among people living with HIV who inject drugs

Parashar

Collins

Montaner

et al. 2016

Current Opinion in HIV and AIDS

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Purpose of review The modern antiretroviral therapy (ART) era has seen substantial reductions in mortality among people living with HIV. However, HIV-positive people who inject drugs (PWIDs) continue to experience high rates of suboptimal HIV-related outcomes. We review recent findings regarding factors contributing to premature and preventable mortality among HIV-positive PWID, and describe the promise of interventions to improve survival in this group. Recent findings The current leading causes of death among HIV-positive PWID are HIV/AIDS-related causes, overdose, and liver-related causes, including infection with hepatitis C virus. Elevated mortality levels in this population are driven by social–structural barriers to ART access and adherence, particularly criminalization and stigmatization of drug use. In contexts where opioid substitution therapy and ART adherence support programs are widely accessible, evidence highlights comparable levels of survival among HIV-positive PWID and people living with HIV who do not inject drugs. Summary The life-saving benefits of ART can be realized among HIV-positive PWID when it is paired with strategies that address barriers to evidence-based medical care. Joint administration of ART and opioid substitution therapy, as well as repeal of punitive laws that criminalize drug users, are urgently needed to reduce HIV and injection-related mortality among PWID.

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Mortality, Causes of Death and Associated Factors Relate to a Large HIV Population-Based Cohort

Cited by 26 publications

References 63 publications

Late presentation of HIV infection in the country of Georgia: 2012-2015

Late presentation of HIV infection in the country of Georgia: 2012-2015

Trends of Cause of Death among Human Immunodeficiency Virus Patients and the Impact of Low CD4 Counts on Diagnosis to Death: a Retrospective Cohort Study

Reducing rates of preventable HIV/AIDS-associated mortality among people living with HIV who inject drugs

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