Causes of death and risk factors among HIV-infected persons in the HAART era: analysis of a large urban cohort.
OBJECTIVE
We aimed to examine the clinical outcome in HIV-1-infected patients after more than 10 years of highly active antiretroviral therapy (HAART).


METHODS
We analyzed data from 1,236 treatment-naïve adults who had started HAART. The primary endpoint was the yearly prevalence of death for AIDS-related causes (ARC) or for non-AIDS related causes (non-ARC). The data from our cohort were compared with that of the general population (GP) of our region.


RESULTS
We observed that 116 patients died, and 58.6% of deaths were non-ARC. The death incidence decreased from 18.8% in 1998-1999 to 1.2% in 2008-2009. The leading causes of death were malignancies (35.3%), infections (21.6%), end-stage liver diseases (18.1%), and cardiovascular diseases (CVD) (6.9%). Yearly death rates were similar in the HIV-infected cohort and in the crude GP (odds ratio [OR] 1.1, 95% confidence interval [CI] 0.5-2.5), but when adjusted for age, HIV-infected patients showed a greater risk (OR 7.4, 95% CI 4.1-13.4). The difference was still highly significant when the analysis was restricted to non-ARCs (OR 4.3, 95% CI 2.07-9.2). Overall, malignancies (OR 5.7, 95% CI 2.6-12.8) and end-stage liver diseases (OR 35.0, 95% CI 15.5-78.8) were significantly more frequent than in the age-adjusted GP.


CONCLUSIONS
Despite HAART, HIV-infected patients are at greater risk of death compared to a reference uninfected population.
Division of Infectious Diseases, Ospedali Riuniti, Largo Barozzi 1, Bergamo, Italy. sebastianoleone@yahoo.it
S
S
Leone
G
G
Gregis
G
G
Quinzan
D
D
Velenti
G
G
Cologni
L
L
Soavi
V
V
Ravasio
D
D
Ripamonti
F
F
Suter
F
F
Maggiolo
D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002423:Cause of Death; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
D019380:Anti-HIV Agents
J Clin Oncol. 2009 Feb 20;27(6):884-90
19114688
Clin Infect Dis. 2010 May 15;50(10):1387-96
20380565
AIDS. 2004 Sep 3;18(13):1835-43
15316345
Clin Infect Dis. 2010 May 1;50(9):1316-21
20297953
Infection. 2010 Aug;38(4):301-19
20514509
Arch Intern Med. 2006 Aug 14-28;166(15):1632-41
16908797
J Acquir Immune Defic Syndr. 2005 Oct 1;40(2):212-8
16186740
AIDS. 2009 May 15;23(8):875-85
19349851
J Acquir Immune Defic Syndr. 2006 Feb 1;41(2):194-200
16394852
Ann Intern Med. 2008 May 20;148(10):728-36
18490686
AIDS. 2007 Jan 11;21(2):207-13
17197812
Lancet. 2009 Apr 18;373(9672):1352-63
19361855
Lancet. 2003 Sep 13;362(9387):877-8
13678976
Curr Opin Infect Dis. 2009 Feb;22(1):7-10
19532075
Infection. 2009 Jun;37(3):270-82
19479193
N Engl J Med. 1998 Mar 26;338(13):853-60
9516219
AIDS. 2009 Aug 24;23(13):1743-53
19571723
AIDS. 2002 Aug 16;16(12):1663-71
12172088
HIV Med. 2007 May;8(4):251-8
17461853
J Acquir Immune Defic Syndr. 2006 Sep;43(1):27-34
16878047
AIDS. 2008 Oct 18;22(16):2143-53
18832878