Risk of all-cause mortality associated with nonfatal AIDS and serious non-AIDS events among adults infected with HIV

Neuhaus, Jacqueline; Angus, Brian; Kowalska, Justyna D.; Rosa, Alberto La; Sampson, Jim; Wentworth, Deborah; Mocroft, Amanda

doi:10.1097/qad.0b013e3283365356

Cited by 158 publications

(135 citation statements)

References 34 publications

(27 reference statements)

Supporting

Mentioning

121

Contrasting

Unclassified

Order By: Relevance

“…With this, there has been a shift in distribution of causes of death toward non‐AIDS‐defining events (NADEs) 8, 9, 10, 11, 12. Factors contributing to non‐AIDS mortality include immunodeficiency 13, 14, ART toxicity 15, 16, increasing age 17, 18, 19, 20, 21, 22, and lifestyle factors such as tobacco use and obesity 18, 21, 23.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

show abstract

“…CVD-related mortality is anticipated to increase as HIV-infected patients initiate antiretroviral therapy (ART) at CD4+ counts >200 and opportunistic infections become uncommon [3–5]. In sub-Saharan Africa, there are numerous challenges in the diagnosis and control of hypertension (HTN), including low awareness among patients and providers [6], overcrowded clinics, and limited opportunities for HTN screening [7].…”

Section: Introductionmentioning

confidence: 99%

Awareness and management of elevated blood pressure among human immunodeficiency virus–infected adults receiving antiretroviral therapy in urban Zambia: a call to action

Bauer

Mwanza

Chilengi

et al. 2017

Global Health Action

View full text Add to dashboard Cite

The prevalence of high blood pressure (HBP) and hypertension (HTN), awareness of the diagnoses, and use of anti-hypertensive drugs were examined among human immunodeficiency virus (HIV)-infected individuals on antiretroviral therapy (ART) in Zambia’s capital Lusaka. Within a prospective cohort based at two public sector ART clinics, BP was measured at ART initiation and every 6 months thereafter as a routine clinic procedure. Predictors of HBP (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) during one year on ART were analyzed using logistic regression, and the proportion with HTN (2+ episodes of HBP >3 months apart) described. A phone survey was used to understand patient awareness of HBP, use of anti-hypertensive drugs, and history of cardiovascular events (CVE; myocardial infarction or stroke). Among 896 cohort participants, 887 (99.0%) had at least one BP measurement, 98 (10.9%) had HBP, and 57 (6.4%) had HTN. Increasing age (10-year increase in age: adjusted odds ratio [AOR] = 1.50; 95% confidence interval [CI] 1.20–1.93), male sex (AOR = 2.33, 95% CI 1.43–3.80), and overweight/obesity (AOR = 4.07; 95% CI 1.94–8.53) were associated with HBP. Among 66 patients with HBP, 35 (53.0%) reported awareness of the condition, and nine (25.7%) of these reported having had a CVE. Only 14 (21.2%) of those reached reported ever taking an anti-hypertensive drug, and one (1.5%) was currently on treatment. These data suggest that major improvements are needed in the management of HBP among HIV-infected individuals in settings such as Zambia.

show abstract

“…Most studies of AIDS have analyzed the factors associated with therapeutic failure, such as death, opportunistic disease, detect Viral Load (VL) or low levels of immunity, using semi parametric Cox models (Pradeep et al, 2010;Muralidhar et al, 2010;Keiser et al, 2010;Koethe et al, 2010;Neuhaus et al, 2010). However, it is also important to consider chronicity and the relatively slow progression of the disease and to assess the multiple immune states resulting from the effect of the virus on the human immune system.…”

Section: Introductionmentioning

confidence: 99%

Multi-State Models of Hiv/Aids by Homogeneous Semi-Markov Process

Dessie¹

2014

American Journal of Biostatistics

View full text Add to dashboard Cite

Multi-state stochastic models are useful tools for studying complex dynamics such as chronic diseases. The purpose of this study is to determine factors associated with the progression between different stages of the disease and to model the progression of HIV/AIDS disease of an individual patient under ART follow-up using semi-Markov processes. A sample of 1456 patients has been taken from a hospital record at Amhara Referral Hospitals, Amhara Region, Ethiopia, who have been under ART follow up from June 2006 to August 2013. The states of disease progression adopted in the multi-state model were defined based on of the following CD4 cell counts: ≥500(SI); 200 to 499(SII); <200(SIII); and Death (D). The first three states are named as good. Female patients were 1.6 times more likely to move from state 2 to state 1 than those of male patients (adjusted HR = 1.60, CI = 1.02-2.49). Patients, who is not drug addicted, were 2.49 times more likely to move from state 3 to state 2 than those of drug addicted(adjusted HR = 2.67, CI = 1.52-4.68). Patients with tuberculosis were 2.67 times more likely to move from state 3 to state 4 than those with no tuberculosis (adjusted HR = 2.67, CI = 1.52-4.68). On the other hand, the probability of staying in same state until a given number of month decreases with increasing time. Multi-state modeling is a powerful approach for studying chronic diseases and estimating factors associated with transitions between each stage of progression. The major predictors of the intensity of transitions between different states of HIV/AIDS patients were gender, age, drug addicted and TB status. The dynamic nature of the AIDS progression is confirmed with particular findings that there is more likely to be in worse state than better one unless interventions are made.

show abstract

Risk of all-cause mortality associated with nonfatal AIDS and serious non-AIDS events among adults infected with HIV

Cited by 158 publications

References 34 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

Awareness and management of elevated blood pressure among human immunodeficiency virus–infected adults receiving antiretroviral therapy in urban Zambia: a call to action

Multi-State Models of Hiv/Aids by Homogeneous Semi-Markov Process

Contact Info

Product

Resources

About