title: Mortality, Causes of Death and Associated Factors Relate to a Large HIV Population-Based Cohort.
abstract: BACKGROUND
  Antiretroviral therapy has led to a decrease in HIV-related mortality and to the emergence of non-AIDS defining diseases as competing causes of death. This study estimates the HIV mortality rate and their risk factors with regard to different causes in a large city from January 2001 to June 2013.
  
  
  METHODS
  We followed-up 3137 newly diagnosed HIV non-AIDS cases. Causes of death were classified as HIV-related, non-HIV-related and external. We examined the effect of risk factors on survival using mortality rates, Kaplan-Meier plots and Cox models. Finally, we estimated survival for each main cause of death groups through Fine and Gray models.
  182 deaths were found [14.0/1000 person-years of follow-up (py); 95% confidence interval (CI):12.0-16.1/1000 py], 81.3% of them had a known cause of death. Mortality rate by HIV-related causes and non-HIV-related causes was the same (4.9/1000 py; CI:3.7-6.1/1000 py), external was lower [1.7/1000 py; (1.0-2.4/1000 py)].
  Kaplan-Meier estimate showed worse survival in intravenous drug user (IDU) and heterosexuals than in men having sex with men (MSM). Factors associated with HIV-related causes of death include: IDU male (subHazard Ratio (sHR):3.2; CI:1.5-7.0) and <200 CD4 at diagnosis (sHR:2.7; CI:1.3-5.7) versus ≥500 CD4. Factors associated with non-HIV-related causes of death include: ageing (sHR:1.5; CI:1.4-1.7) and heterosexual female (sHR:2.8; CI:1.1-7.3) versus MSM. Factors associated with external causes of death were IDU male (sHR:28.7; CI:6.7-123.2) and heterosexual male (sHR:11.8; CI:2.5-56.4) versus MSM.
  
  
  CONCLUSIONS
  There are important differences in survival among transmission groups. Improved treatment is especially necessary in IDUs and heterosexual males.
authors.affiliation: Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain.|Spanish Field Epidemiology Training Programme, National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: César
authors.initials: C
authors.lastname: Garriga
authors.affiliation: Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: García de Olalla
authors.affiliation: Hospital Clinic- August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Miró
authors.affiliation: Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Inma
authors.initials: I
authors.lastname: Ocaña
authors.affiliation: Internal Medicine-Infectious Diseases, Hospital del Mar, Barcelona, Spain.
authors.forename: Hernando
authors.initials: H
authors.lastname: Knobel
authors.affiliation: Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Maria Jesús
authors.initials: MJ
authors.lastname: Barberá
authors.affiliation: Direcció General de Serveis Penitenciaris i de Rehabilitació, Departament de Justícia, Barcelona, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Humet
authors.affiliation: Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Domingo
authors.affiliation: Hospital Clinic- August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Gatell
authors.affiliation: Infectious Diseases, Hospital Vall de Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Esteve
authors.initials: E
authors.lastname: Ribera
authors.affiliation: Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Mercè
authors.initials: M
authors.lastname: Gurguí
authors.affiliation: Direcció General de Serveis Penitenciaris i de Rehabilitació, Departament de Justícia, Barcelona, Spain.
authors.forename: Andrés
authors.initials: A
authors.lastname: Marco
authors.affiliation: Epidemiology Service, Public Health Agency of Barcelona, Barcelona, Spain.|CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Joan A
authors.initials: JA
authors.lastname: Caylà
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D002423:Cause of Death; D015331:Cohort Studies; D055030:Drug Users / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D020010:Heterosexuality / Q000523:psychology; D018451:Homosexuality, Male / Q000523:psychology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications
chemical_list: D019380:Anti-HIV Agents