Evolving AIDS- and non-AIDS Mortality and Predictors in the PISCIS Cohort of People Living With HIV in Catalonia and the Balearic Islands (Spain), 1998-2020
Por:
Nomah, DK, Jamarkattel, S, Bruguera, A, Moreno-Fornés, S, Díaz, Y, Alonso, L, Aceitón, J, Llibre, JM, Domingo, P, Saumoy, M, Homar, F, Fanjul, F, Navarro, J, de la Mora, L, Knobel, H, Orti, A, Martin-Iguacel, R, Miró, JM, Casabona, J, Reyes-Urueña, J
Publicada:
28 mar 2024
Ahead of Print:
1 mar 2024
Resumen:
Background. Effective antiretroviral therapy (ART) has substantially reduced acquired immunodeficiency syndrome (AIDS)-related deaths, shifting the focus to non-AIDS conditions in people living with human immunodeficiency virus (HIV) (PLWH). We examined mortality trends and predictors of AIDS- and non-AIDS mortality in the Population HIV Cohort from Catalonia and Balearic Islands (PISCIS) cohort of PLWH from 1998 to 2020. Methods. We used a modified Coding Causes of Death in HIV protocol, which has been widely adopted by various HIV cohorts to classify mortality causes. We applied standardized mortality rates (SMR) to compare with the general population and used competing risks models to determine AIDS-related and non-AIDS-related mortality predictors. Results. Among 30 394 PLWH (81.5% male, median age at death 47.3), crude mortality was 14.2 per 1000 person-years. All-cause standardized mortality rates dropped from 9.6 (95% confidence interval [CI], 8.45-10.90) in 1998 through 2003 to 3.33 (95% CI, 3.14-3.53) in 2015 through 2020, P for trend = .0001. Major causes were AIDS, non-AIDS cancers, cardiovascular disease, AIDS-defining cancers, viral hepatitis, and nonhepatitis liver disease. Predictors for AIDS-related mortality included being aged >= 40 years, not being a man who have sex with men, history of AIDS-defining illnesses, CD4 < 200 cells/L, >= 2 comorbidities, and nonreceipt of ART. Non-AIDS mortality increased with age, injection drug use, heterosexual men, socioeconomic deprivation, CD4 200 to 349 cells/mu L, nonreceipt of ART, and comorbidities, but migrants had lower risk (adjusted hazard risk, 0.69 [95% CI, .57-.83]). Conclusions. Mortality rates among PLWH have significantly decreased over the past 2 decades, with a notable shift toward non-AIDS-related causes. Continuous monitoring and effective management of these non-AIDS conditions are essential to enhance overall health outcomes.
Filiaciones:
Nomah, DK:
Ctr Estudis Epidemiol Infecc Transmissio Sexual I, Dept Salut, Barcelona, Spain
Inst Invest Germans Trias I Pujol IGTP, Barcelona, Spain
Agencia Salut Publ Catalunya ASPC, Ctr Estudis Epidemiol Infecc Transmissio Sexual &, Generalitat Catalunya, Cami Escoles S-N, Badalona 08916, Barcelona, Spain
Jamarkattel, S:
Ctr Estudis Epidemiol Infecc Transmissio Sexual I, Dept Salut, Barcelona, Spain
Inst Invest Germans Trias I Pujol IGTP, Barcelona, Spain
Bruguera, A:
Ctr Estudis Epidemiol Infecc Transmissio Sexual I, Dept Salut, Barcelona, Spain
Inst Invest Germans Trias I Pujol IGTP, Barcelona, Spain
CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain
Univ Autonoma Barcelona, Dept Pediat Obstet & Ginecol & Med Prevent & Salut, Bellaterra, Spain
Agencia Salut Publ Catalunya ASPC, Ctr Estudis Epidemiol Infecc Transmissio Sexual &, Generalitat Catalunya, Cami Escoles S-N, Badalona 08916, Barcelona, Spain
Moreno-Fornés, S:
Ctr Estudis Epidemiol Infecc Transmissio Sexual I, Dept Salut, Barcelona, Spain
Inst Invest Germans Trias I Pujol IGTP, Barcelona, Spain
CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain
Díaz, Y:
Ctr Estudis Epidemiol Infecc Transmissio Sexual I, Dept Salut, Barcelona, Spain
Inst Invest Germans Trias I Pujol IGTP, Barcelona, Spain
CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain
Alonso, L:
Ctr Estudis Epidemiol Infecc Transmissio Sexual I, Dept Salut, Barcelona, Spain
Inst Invest Germans Trias I Pujol IGTP, Barcelona, Spain
Aceitón, J:
Ctr Estudis Epidemiol Infecc Transmissio Sexual I, Dept Salut, Barcelona, Spain
Inst Invest Germans Trias I Pujol IGTP, Barcelona, Spain
Llibre, JM:
Hosp Univ Germans Trias I Pujol, Infect Dis Unit, Badalona, Spain
Domingo, P:
Hosp Santa Creu I Sant Pau, Dept Infect Dis, HIV Infect Unit, Barcelona, Spain
Saumoy, M:
Hosp Univ Bellvitge, Inst Biomed Res Bellvitge IDIBELL, Dept Infect Dis, Lhosp De Llobregat, Spain
Homar, F:
Hosp Son Llatzer, Dept Internal Med, Palma De Mallorca, Spain
Fanjul, F:
Hosp Univ Son Espases, Hlth Res Inst Balear Isl IdISBa, Palma De Mallorca, Spain
Navarro, J:
Hosp Univ Vall Dhebron, Vall Dhebron Res Inst VHIR, Dept Infect Dis, Barcelona, Spain
de la Mora, L:
Univ Barcelona, Inst Invest Biomed August Pi i Sunyer, Hosp Clin, Barcelona, Spain
Knobel, H:
Hosp Mar, Dept Internal Med Infect Dis, Barcelona, Spain
Orti, A:
Hosp Verge Cinta, Internal Med & Infect Dis Serv, Tortosa, Spain
Martin-Iguacel, R:
Ctr Estudis Epidemiol Infecc Transmissio Sexual I, Dept Salut, Barcelona, Spain
Odense Univ Hosp, Dept Infect Dis, Odense, Denmark
Miró, JM:
Univ Barcelona, Inst Invest Biomed August Pi i Sunyer, Hosp Clin, Barcelona, Spain
Inst Salud Carlos III, CIBERINFEC, Madrid, Spain
Casabona, J:
Ctr Estudis Epidemiol Infecc Transmissio Sexual I, Dept Salut, Barcelona, Spain
CIBER Epidemiol & Salud Publ CIBERESP, Barcelona, Spain
Univ Autonoma Barcelona, Dept Pediat Obstet & Ginecol & Med Prevent & Salut, Bellaterra, Spain
Reyes-Urueña, J:
Ctr Estudis Epidemiol Infecc Transmissio Sexual I, Dept Salut, Barcelona, Spain
gold
|