Population attributable fractions of mortality in people living with HIV: roles of delayed antiretroviral therapy, hepatitis coinfections and social factors

Santos, Melina; Protopopescu, Camélia; Ribero, Rachel A; Benzaken, Adèle Schwartz; Pereira, Gérson Fernando Mendes; Stevens, Antony; Nishimwe, Marie Libérée; Yaya, Issifou; Carrieri, Patrizia; Araújo, Wildo Navegantes de

doi:10.1097/qad.0000000000002621

Cited by 5 publications

(3 citation statements)

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“…Diminished immune function and recovery and higher comorbidity may contribute to an increased risk of death among older PLHIV (16). The relationship between male sex and mortality could be explained by the higher odds of late presentation for care, AHD, and late ART among men (15,17). Notably, approximately four in five PLHIV were men in this study, which was in line with previous studies (8,18), highlighting the urgent need to promote early diagnosis and treatment among them.…”

Section: Discussionsupporting

confidence: 88%

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Effect of Late Testing and Antiretroviral Treatment on Mortality Among People Living With HIV in the Era of Treat-All in Guangdong Province, China, 1992–2018: A Cohort Study

Chen

et al. 2022

Front. Public Health

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Late testing and antiretroviral therapy (ART) prevailed among people living with HIV (PLHIV) and impacted the benefit of immediate ART. This study aimed to identify the benefit of the test-and-immediate-treat policy in China, the effect of immediate ART, and the influence of late testing and ART on the whole PLHIV in Guangdong Province, China. We designed two tendency analyses in aggregative form and two cohorts (surveillance and ART cohort) in individuals' perspectives based on the HIV/AIDS Comprehensive Response Information Management System. Two interrupted time series models were conducted for tendency analysis from 2009 to 2018 to explore the all-cause and short-term mortality decrease after the test-and-immediate-treat policy. A time-dependent Cox model was performed for the surveillance cohort from 1992 to 2018 and a joint model was utilized for the ART cohort to identify the effect of immediate ART and the influence of late testing and ART on death. The tendency analysis included 324,914 and 68,679 person-year for all-cause/short-term mortality. A total of 49,289 and 26,287 PLHIV were recruited in the surveillance and ART cohort with 5,557 and 459 deaths, respectively. The short-term mortality dropped from 4.69 cases/100 person-year in January 2009 to 0.35 cases/100 person-year in December 2018 (standardized rate). The all-cause mortality saw a decreasing trend from 1.46 cases/100 person-year in January 2009 to 0.14 cases/100 person-year in December 2018 (standardized rate). The tendency analysis showed a significant short-term mortality slope decrease after the test-and-immediate-treat policy (P = 0.024). From the surveillance cohort, late testing, in general, was a risk factor for all-cause mortality [hazard ratio (HR) = 1.330, 95% CI, 1.250, 1.416]. ART cohort showed higher hazards of all-cause mortality among PLHIV with no late testing, but late ART (HR = 1.690, 95% CI, 1.166, 2.451) and both the late testing and late ART (HR = 1.335, 95% CI, 1.042, 1.710). Immediate ART might decrease the hazard of all-cause death though it is insignificant (HR = 0.923, 95% CI: 0.755, 1.129) in the ART cohort. The test-and-immediate-test policy brought benefit to PLHIV. We should enlarge HIV testing using comprehensive approaches to decrease late testing and ART and increase the benefit of immediate ART.

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Section: Discussionsupporting

confidence: 88%

“…Consistent with previous studies, older age, male sex, and lower educational attainment were independent risk factors for mortality (15,16). Diminished immune function and recovery and higher comorbidity may contribute to an increased risk of death among older PLHIV (16).…”

Section: Discussionsupporting

confidence: 87%

Effect of Late Testing and Antiretroviral Treatment on Mortality Among People Living With HIV in the Era of Treat-All in Guangdong Province, China, 1992–2018: A Cohort Study

Chen

et al. 2022

Front. Public Health

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“…Prenatal and childbirth coverage in Brazil is close to 100% and the coverage of testing for HIV infection during pregnancy is over 80% [ 55 – 57 ]. Men tend to be diagnosed later than women with AIDS-related illnesses, thus increasing the risk of mortality, particularly early mortality [ 10 , 58 – 60 ]. Here, it is important to highlight the significant burden of tuberculosis in our setting, as PWH with TB tend to seek care later than expected, with low CD4 count, greatly contributing to early mortality [ 61 , 62 ].…”

Section: Discussionmentioning

confidence: 99%

Early mortality in a cohort of people living with HIV in Rio de Janeiro, Brazil, 2004–2015: a persisting problem

et al. 2022

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Background Global mortality from AIDS-related diseases has been declining since 2005, resulting primarily from the widespread use and early initiation of combination antiretroviral therapy. Despite the significant improvements, high rates of early mortality, usually defined as that occurring within the 1st year of entry to care, have been observed, especially in resource-limited settings. This analysis draws upon data from an observational cohort of people with HIV (PWH) followed at a reference center for HIV/AIDS care and research in the city of Rio de Janeiro, Brazil, to identify the pattern and factors associated with early mortality. Methods The study population includes PWH aged 18 or older followed at the National Institute of Infectious Diseases Evandro Chagas who were enrolled between 2004 and 2015. The primary outcome was early mortality, defined as deaths occurring within 1 year of inclusion in the cohort, considering two follow-up periods: 0 to 90 days (very early mortality) and 91 to 365 days (early mortality). Cox proportional hazards models were used to identify the variables associated with the hazard of very early and early mortality. Results Overall, 3879 participants contributed with 3616.4 person-years of follow-up. Of 220 deaths, 132 happened in the first 90 days and 88 between 91 and 365 days. Very early mortality rate ratios (MRR) show no statistically significant temporal differences between the periods 2004–2006 to 2013–2015. In contrast, for early mortality, a statistically significant decreasing trend was observed: mortality rates in the periods 2004–2006 (MR = 5.5; 95% CI 3.9–7.8) and 2007–2009 (MR = 3.9; 95% CI 2.7–5.7) were approximately four and three-fold higher when compared to 2013–2015 (MR = 1.4; 95% CI 0.7–2.7). Low CD4 count and prior AIDS-defining illness were strongly associated with higher hazard ratios of death, especially when considering very early mortality. Conclusions The present study shows an excess of mortality in the 1st year of follow-up with no changes in the mortality rates within 90 days among PWH from Rio de Janeiro. We note the significant impact of initiating treatment with immunosuppression, as evidenced by the increased risk of death among those with low CD4 cell count and with AIDS-defining illnesses.

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Performance evaluation of the fully automated molecular system Alinity m in a high-throughput central laboratory

Galindo¹,

Hristov²,

Gentil

et al. 2021

Journal of Clinical Virology

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Population attributable fractions of mortality in people living with HIV: roles of delayed antiretroviral therapy, hepatitis coinfections and social factors

Cited by 5 publications

References 69 publications

Effect of Late Testing and Antiretroviral Treatment on Mortality Among People Living With HIV in the Era of Treat-All in Guangdong Province, China, 1992–2018: A Cohort Study

Effect of Late Testing and Antiretroviral Treatment on Mortality Among People Living With HIV in the Era of Treat-All in Guangdong Province, China, 1992–2018: A Cohort Study

Early mortality in a cohort of people living with HIV in Rio de Janeiro, Brazil, 2004–2015: a persisting problem

Performance evaluation of the fully automated molecular system Alinity m in a high-throughput central laboratory

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