title: Mortality in HIV-hepatitis C co-infected patients in Canada compared to the general Canadian population (2003-2013).
abstract: OBJECTIVE
  Recent studies suggest all-cause mortality in HIV mono-infected patients approaches that of the general population. We aimed to compare participants in the Canadian Co-infection Cohort to the general population to determine if co-infected patients have had similar improvements in mortality.
  
  
  METHODS
  Prospective multicentre cohort study.
  
  
  METHODS
  Between 2003 and 2013, deaths were captured using specific case reports and through linkage to provincial vital statistics for participants lost to follow-up. Standardized mortality ratios (SMRs) were calculated using age, sex and province-specific mortality rates from the Canadian Human Mortality Database, 2009, and compared across behavioural and clinical characteristics of participants at their most recent visit.
  
  
  RESULTS
  Among the 1150 patients, we observed 133 deaths over 3351 person-years (4.0 per 100 person-years, 95% confidence interval 3.3, 4.6). SMRs (95% confidence interval) were: 12.1(10.1, 14.2) overall; 9.3 (7.5, 11.1) for men and 19.4 (12.7, 26.2) for women. CD4 cell counts below 200 cells/μl [25.5 (17.7, 33.3)], active injection drug use [19.9 (13.9, 25.9)] and smoking [14.9 (12.1, 17.7)] were strongly associated with excess mortality. Lowest SMRs were seen for those who had spontaneous [4.5 (-0.6, 9.5)] or treatment-induced clearance of hepatitis C virus (HCV) infection [5.1 (1.3, 8.8)]. Conversely, high SMRs were seen with advanced liver disease [17.0 (11.7, 22.3)]. In no category did SMRs approach mortality seen in the general Canadian population.
  
  
  CONCLUSIONS
  HIV-HCV co-infected persons remain at markedly increased risk for death despite antiretroviral therapy. Interventions targeting modifiable risk factors such as substance use, smoking, adherence to antiretrovirals and timely provision of HCV therapy could substantially reduce death rates.
authors.affiliation: aDepartment of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montreal bCIHR Canadian HIV Trials Network, Vancouver cDepartment of Epidemiology & Biostatistics, McGill University, Montreal, Canada dDepartment of Medicine, University of Ottawa, Ottawa eDepartment of Medicine, University of Toronto, Toronto fSouthern Alberta HIV Clinic, Calgary, Canada gCentre Hospitalier de l'Université de Montréal, Notre-Dame, Montreal hUniversity of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada.
authors.forename: Marina B
authors.initials: MB
authors.lastname: Klein
authors.forename: Kathleen C
authors.initials: KC
authors.lastname: Rollet-Kurhajec
authors.forename: Erica E M
authors.initials: EE
authors.lastname: Moodie
authors.forename: Sean
authors.initials: S
authors.lastname: Yaphe
authors.forename: Mark
authors.initials: M
authors.lastname: Tyndall
authors.forename: Sharon
authors.initials: S
authors.lastname: Walmsley
authors.forename: John
authors.initials: J
authors.lastname: Gill
authors.forename: Valerie
authors.initials: V
authors.lastname: Martel-Laferriere
authors.forename: Curtis
authors.initials: C
authors.lastname: Cooper
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016019:Survival Analysis