title: Risk factors for early mortality after AIDS in the cART era: A population-based cohort study in Italy.
abstract: BACKGROUND
  Despite the dramatically improved survival due to combination antiretroviral therapies (cART), life expectancy of people with HIV/AIDS remains lower than that of the general population. This study aimed to estimate, at a population level, the survival experience of Italian people with AIDS (PWA) and to quantify the prognostic role of selected factors at diagnosis in the risk of early mortality (i.e., within six months from AIDS diagnosis).
  
  
  METHODS
  A population-based, retrospective-cohort study was conducted among Italian PWA diagnosed between 1999 and 2009 and recorded in the national AIDS registry. The vital status, up to December 2010, of 14,552 PWA was ascertained through a record linkage procedure with the Italian mortality database. Survival probabilities were estimated through Kaplan-Meier method. To identify risk factors for early mortality from any cause, odds ratios (ORs) and corresponding 95% confidence intervals (CIs), adjusted for major confounders, were computed using multivariate logistic regression models.
  
  
  RESULTS
  Of the 5,706 deaths registered among the 14,552 PWA included in the study, 2,757 (18.9%) occurred within six months from AIDS diagnosis. The probability of surviving six months increased from 81.2% in PWA diagnosed in 1999-2000 to 82.9% in 2009, while the 5-year survival augmented from 60.7% in PWA diagnosed in 1999-2000 to 65.4% for PWA diagnosed in 2005-2006. Elevated risks of early mortality were associated to older age (OR = 5.28; 95% CI: 4.41-6.32 for age ≥60 vs. <35 years), injecting drug use (OR = 1.71; 95% CI: 1.53-1.91 vs. heterosexual intercourse), and CD4 count <50 cells/mm(3) at AIDS diagnosis (OR = 1.87, 95% CI: 1.55-2.27 vs. ≥350). Elevated ORs for early mortality also emerged for PWA diagnosed with primary brain lymphoma (OR = 11.66, 95% CI: 7.32-18.57), or progressive multifocal leukoencephalopathy (OR = 4.21, 95% CI: 3.37-5.27).
  
  
  CONCLUSIONS
  Our study documented, among Italian PWA, the high - though slightly decreasing - frequency of early mortality in the full cART era. These findings indicate the need for enduring and ameliorating preventive actions aimed at timely HIV testing among all individuals at risk for HIV infection and/or those who present diseases known to be related with HIV infection.
authors.affiliation: Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy. barbara.suligoi@iss.it.
authors.forename: Barbara
authors.initials: B
authors.lastname: Suligoi
authors.affiliation: Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy. zucchetto.epi@cro.it.
authors.forename: Antonella
authors.initials: A
authors.lastname: Zucchetto
authors.affiliation: Health and social care Section, National Institute of Statistics, Rome, Italy. grande@istat.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Grande
authors.affiliation: Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy. laura.camoni@iss.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Camoni
authors.affiliation: Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy. dalmaso@cro.it.
authors.forename: Luigino
authors.initials: L
authors.lastname: Dal Maso
authors.affiliation: Health and social care Section, National Institute of Statistics, Rome, Italy. luisa.frova@istat.it.
authors.forename: Luisa
authors.initials: L
authors.lastname: Frova
authors.affiliation: Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy. svirdone@cro.it.
authors.forename: Saverio
authors.initials: S
authors.lastname: Virdone
authors.affiliation: Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy. stefano.boros@iss.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Boros
authors.affiliation: Health and social care Section, National Institute of Statistics, Rome, Italy. pappagal@istat.it.
authors.forename: Marilena
authors.initials: M
authors.lastname: Pappagallo
authors.affiliation: Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy. mtaborelli@cro.it.
authors.forename: Martina
authors.initials: M
authors.lastname: Taborelli
authors.affiliation: Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy. vincenza.regine@iss.it.
authors.forename: Vincenza
authors.initials: V
authors.lastname: Regine
authors.affiliation: Scientific Directorate, CRO Aviano National Cancer Institute, Aviano, Italy. pdepaoli@cro.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: De Paoli
authors.affiliation: Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, 33081, Aviano, Italy. serrainod@cro.it.
authors.forename: Diego
authors.initials: D
authors.lastname: Serraino
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D020010:Heterosexuality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012107:Research Design; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult