title: Trends in AIDS and mortality in HIV-infected subjects with hemophilia from 1985 to 2003: the competing risks for death between AIDS and liver disease.
abstract: OBJECTIVE
  To study trends in progression to AIDS, all-cause mortality, and cause-specific mortality (AIDS-related, liver disease, and hemorrhagic complications) over calendar periods with different exposure to highly active antiretroviral therapy (HAART) in a cohort of hemophiliacs in Spain, taking into account the competing risks of the causes of death.
  
  
  METHODS
  Multicenter cohort of HIV-infected hemophiliacs. HIV seroconversion was estimated using mathematic techniques for interval-censored data from 1979 through 1985. Rates of AIDS and cause-specific death were calculated by Poisson regression, allowing for late entry, for the periods 1985 through 1992, 1993 through 1996, 1997 through 2000 (early HAART), and 2001 through 2003 (late HAART), also allowing for competing risks.
  
  
  RESULTS
  Of 585 subjects, 44% were younger than 15 years of age, 82% had severe hemophilia, 86% had type A hemophilia, and the median seroconversion date was October 1982. Calendar period and age at HIV seroconversion strongly influenced AIDS and death rates. Compared with 1993 through 1996, decreases of 75% (relative risk [RR] = 0.25, 95% confidence interval [CI]: 0.14 to 0.43) and 72% (RR = 0.28, 95% CI: 0.12 to 0.63) in the RR of AIDS were observed in early and late HAART. For all-cause mortality, 72% (RR = 0.28, 95% CI: 0.18 to 0.42) and 83% (RR = 0.17, 95% CI: 0.09 to 0.33) decreases were observed by 1997 through 2000 and 2001 through 2003. For liver-related deaths, increases were observed in the late-HAART period (RR = 2.80, 95% CI: 0.94 to 8.36) compared with 1993 through 1996, but using competing risks, this RR was substantially reduced (RR = 1.70, 95% CI: 0.57 to 5.04).
  
  
  CONCLUSIONS
  Major reductions in AIDS and death rates were observed from 1997 to 2003 in hemophiliacs. These survival improvements are largely attributable to decreases in AIDS-related deaths and have been accompanied by increases in liver disease death rates, which are overestimated if competing risks are not taken into account.
authors.affiliation: Department of Public Health, Universidad Miguel Hernández, Campus de San Juan Ctra, Alicante-Valencia, Km 87, 03550 San Juan-Alicante, Spain. jamo@umh.es
authors.forename: Julia
authors.initials: J
authors.lastname: del Amo
authors.forename: Santiago
authors.initials: S
authors.lastname: Pérez-Hoyos
authors.forename: Alicia
authors.initials: A
authors.lastname: Moreno
authors.forename: Manuel
authors.initials: M
authors.lastname: Quintana
authors.forename: Isabel
authors.initials: I
authors.lastname: Ruiz
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Cisneros
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Ferreros
authors.forename: Cristina
authors.initials: C
authors.lastname: González
authors.forename: Patricia
authors.initials: P
authors.lastname: García de Olalla
authors.forename: Rosario
authors.initials: R
authors.lastname: Pérez
authors.forename: Ildefonso
authors.initials: I
authors.lastname: Hernández
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D006679:HIV Seropositivity / Q000453:epidemiology; D006467:Hemophilia A / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D008297:Male; D016012:Poisson Distribution; D013030:Spain / Q000453:epidemiology; D013997:Time Factors