Association of HIV infection, demographic and cardiovascular risk factors with all-cause mortality in the recent HAART era.
OBJECTIVE
To determine the relationship of HIV infection, demographic, and cardiovascular disease (CVD) risk factors with mortality in the recent highly active antiretroviral therapy era.


METHODS
Vital status was ascertained from 2004 to 2007 in 922 HIV infected and 280 controls in the Study of Fat Redistribution and Metabolic Change in HIV infection; 469 HIV infected were included in analysis comparing HIV with similar age controls. Multivariable exponential survival regression (adjusting for demographic and CVD factors) estimated hazard ratios (HRs) for death.


RESULTS
After 5 years of follow-up, the overall adjusted mortality HR was 3.4 [95% confidence interval (CI): 1.35-8.5]; HR was 6.3 among HIV infected with CD4 < 200 (95% CI: 2.2-18.2), 4.3 with CD4 200-350 (95% CI: 1.14-16.0), and 2.3 with CD4 > 350 (95% CI: 0.78-6.9). Among HIV infected, current smoking (HR = 2.73 vs. never smokers, 95% CI: 1.64-4.5) and older age (HR = 1.61 per decade, 95% CI: 1.27-2.1) were independent risk factors for death; higher baseline CD4 count was associated with lower risk (HR = 0.65 per CD4 doubling, 95% CI: 0.58-0.73).


CONCLUSIONS
HIV infection was associated with a 3-fold mortality risk compared with controls after adjustment for demographic and CVD risk factors. In addition to low baseline CD4 count, older age and current smoking were strong and independent predictors of mortality in a US cohort of HIV-infected participants in clinical care.
Cockerham
Leslie
L
Department of Medicine, University of California, San Francisco, CA, USA.
Scherzer
Rebecca
R
Zolopa
Andrew
A
Rimland
David
D
Lewis
Cora E
CE
Bacchetti
Peter
P
Grunfeld
Carl
C
Shlipak
Michael
M
Tien
Phyllis C
PC
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000401:mortality*; D018791:CD4 Lymphocyte Count; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000821:virology; D002423:Cause of Death; D002986:Clinical Trials as Topic; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D015497:HIV-1; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking / Q000401:mortality; D014481:United States / Q000453:epidemiology