Overall and cause-specific excess mortality in HIV-positive persons compared with the general population: Role of HCV coinfection.
We aimed to estimate overall and cause-specific excess mortality of HIV-positive patients compared with the general population, and to assess the effect of risk factors.We included patients aged >19 years, recruited from January 1, 2004 to May 31, 2014 in Cohort of the Spanish Network on HIV/AIDS Research. We used generalized linear models with Poisson error structure to model excess mortality rates.In 10,340 patients, 368 deaths occurred. Excess mortality was 0.82 deaths per 100 person-years for all-cause mortality, 0.11 for liver, 0.08 for non-AIDS-defining malignancies (NADMs), 0.08 for non-AIDS infections, and 0.02 for cardiovascular-related causes. Lower CD4 count and higher HIV viral load, lower education, being male, and over 50 years were predictors of overall excess mortality. Short-term (first year follow-up) overall excess hazard ratio (eHR) for subjects with AIDS at entry was 3.71 (95% confidence interval [CI] 2.66, 5.19) and 1.37 (95% CI 0.87, 2.15) for hepatitis C virus (HCV)-coinfected; medium/long-term eHR for AIDS at entry was 0.90 (95% CI 0.58, 1.39) and 3.83 (95% CI 2.37, 6.19) for HCV coinfection. Liver excess mortality was associated with low CD4 counts and HCV coinfection. Patients aged ≥50 years and HCV-coinfected showed higher NADM excess mortality, and HCV-coinfected patients showed increased non-AIDS infections excess mortality.Overall, liver, NADM, non-AIDS infections, and cardiovascular excesses of mortality associated with being HIV-positive were found, and HCV coinfection and immunodeficiency played significant roles. Differential short and medium/long-term effects of AIDS at entry and HCV coinfection were found for overall excess mortality.
National Center of Epidemiology, Instituto de Salud Carlos III Hospital Universitario de Donostia, Donostia Hospital La Paz Hospital, Doce Octubre, Madrid Hospital, Virgen de la Victoria, Malaga Hospital, Central de Asturias, Oviedo Hospital La Princesa, Madrid, Spain.
Belén
B
Alejos
Victoria
V
Hernando
Jose
J
Iribarren
Juan
J
Gonzalez-García
Asuncion
A
Hernando
Jesus
J
Santos
Victor
V
Asensi
Ana
A
Gomez-Berrocal
Julia
J
Del Amo
Inma
I
Jarrin
D000328:Adult; D015331:Cohort Studies; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality*; D006526:Hepatitis C / Q000150:complications / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology; D055815:Young Adult