Abstract
Introduction:HIV cohort data from high-income European countries were compared with the UNAIDS Spectrum modelling parameters for these same countries to validate mortality rates and excess mortality estimates for people living with HIV (PLHIV) on antiretroviral therapy (ART).Methods:Data from 2000 to 2015 were analysed from the Antiretroviral Therapy Cohort Collaboration (ART-CC) for Austria, Denmark, France, Italy, the Netherlands, Spain, and Switzerland. Flexible parametric models were used to compare all-cause mortality rates in the ART-CC and Spectrum. The percentage of AIDS-related deaths and excess mortality (both are the same within Spectrum) were compared, with excess mortality defined as that in excess of the general population mortality.Results:Analyses included 94026 PLHIV with 585784 person-years of follow-up, from which there were 5515 deaths. All-cause annual mortality rates in Spectrum for 2000-2003 were 0.0121, reducing to 0.0078 in 2012-2015, whilst the ART-CC's corresponding annual mortality rates were 0.0151 [95% confidence interval (95% CI): 0.0130-0.0171] reducing to 0.0049 (95% CI: 0.0039-0.0060). The percentage of AIDS-related deaths in Spectrum was 74.7% in 2000-2003, dropping to 43.6% in 2012-2015. In the ART-CC, AIDS-related mortality constitutes 45.3% (95% CI: 38.4-52.9%) of mortality in 2000-2003 and 26.7% (95% CI: 19-46%) between 2012 and 2015. Excess mortality in the ART-CC was broadly similar to the Spectrum estimates, dropping from 75.3% (95% CI: 60.3-95.2%) in 2000-2003 to 30.7% (95% CI: 25.5-63.7%) in 2012-2015.Conclusion:All-cause mortality assumptions for PLHIV on ART in high-income European settings should be adjusted in Spectrum to be higher in 2000-2003 and decline more quickly to levels currently captured for recent years.
| Originalsprog | Engelsk |
|---|---|
| Tidsskrift | AIDS |
| Vol/bind | 33 |
| Sider (fra-til) | S271-S281 |
| ISSN | 0269-9370 |
| DOI | |
| Status | Udgivet - 2019 |
Finansiering
aPopulation Health Sciences, University of Bristol, Bristol, UK, bStichting HIV Monitoring, Amsterdam, The Netherlands, cAvenir Health, Glastonbury, Connecticut, USA, dDepartment of Internal Medicine, Antoine Béclère Hospital, Clamart, eUniversity of Paris Saclay, Paris-Sud University, UVSQ, fCESP INSERM U1018, Le Kremlin-Bicêtre, gSorbonne Université, INSERM, Institut Pierre Louis d’épidemiologie et de Santé Publique (IPLESP), Unité de Biostatistique et d’épidémiologie Groupe hospitalier Cochin Broca Hôtel-Dieu, Assistance Publique Hôpitaux de Paris (AP-HP), and Université Paris Descartes, Sorbonne Paris Cité, Paris, hUniversity of Bordeaux, ISPED, INSERM U1219 and CHU de Bordeaux, Bordeaux, France, iHospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain, jFirst Department of Internal Medicine, University of Cologne, Cologne, Germany, kCEEISCAT/Agència de Salut Pública de Catalunya, Campus Can Ruti and CIBERESP, Badalona, Catalonia, Spain, lClinic of Infectious and Tropical Diseases, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy, mService of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland, nNational Epidemiology Center, Carlos III Health Institute, Madrid, Spain and National Plan on AIDS, Ministry of Health, Madrid, Spain, oInnsbruck Medical University, Austria, pDivision of Infectious Diseases, University of Calgary, Calgary, Canada, and qDepartment of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark. Correspondence to Adam Trickey, Population Health Sciences, University of Bristol, Oakfield House, Bristol BS8 2BN, UK. E-mail: [email protected] Received: 28 January 2019; accepted: 24 July 2019. Declaration of interests: The following members of the writing committee, or their institution, received fees from the following entities for work unrelated to this article. M.J.G. has received personal fees as an ad-hoc member of the Canadian HIV advisory boards of Gilead, Merck, and ViiV. The European Centre for Disease Prevention and Control funded Stichting HIV Monitoring for work by A.V.S. All other members of the writing committee declare no competing interests. S.A. has received travel grant from Gilead and ViiVand is member of Janssen-Cilag HIV board. J.B. has received research grants from AbbVie, Gilead, Merck, and ViiV; as well as personal fees from AbbVie, Gilead, Janssen, Merck, and ViiV. F.B. has served as a speaker for BMS, Gilead, MSD, and ViiV Healthcare, a consultant for Pierre Fabre and ViiV Healthcare, and has received research funding from Gilead and Janssen. Funding: This work was supported by the UK Medical Research Council (MRC; grant number MR/J002380/ 1) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement and is also part of the EDCTP2 programme supported by the European Union. The ART-CC is funded by the US National Institute on Alcohol Abuse and Alcoholism (U01-AA026209). J.A.C.S. is funded by National Institute for Health Research Senior Investigator award NF-SI-0611-10168. Data from 11 European cohorts were pooled within COHERE in EuroCoord. COHERE receives funding from the European Union Seventh Framework Programme (FP7/2007–2013) under EuroCoord grant agreement number 260694. Sources of funding of individual cohorts include the Agence Nationale de Recherche sur le SIDA et les hépatites virales (ANRS), the Institut National de la Santé et de la Recherche Médicale (INSERM), the French, Italian, and Spanish Ministries of Health, the Swiss National Science Foundation (grant 33CS30_134277), the Ministry of Science and Innovation and the Spanish Network for AIDS Research (RIS; ISCIII-RETIC RD06/006), the Stichting HIV Monitoring, the European Commission (EuroCoord grant 260694), and unrestricted grants from Abbott, Gilead, Tibotec-Upjohn, ViiV Healthcare, MSD, GlaxoSmithKline, Pfizer, Bristol-Myers Squibb, Roche, and Boehringer Ingelheim. The Danish HIV Cohort Study is funded by the Preben and Anne Simonsens Foundation.
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