A Review of the Study Designs and Statistical Methods Used in the Determination of Predictors of All-Cause Mortality in HIV-Infected Cohorts: 2002–2011 (original) (raw)
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Estimation of Mortality Rate in Five Year Cohort Analysis among HIV Infected Patients
Prabhakar B, Basavarajaiah D. M, Vidyashankar N, Shruthi K. M & Sunil Kumar D, 2013
HIV disease is a scourge which has led to marked increase of mortality. Globally 2.90 millions of HIV infected clients died every year. Since 2004, Government of India has revolutionized and integrated HAART treatment and have remarkably achieved decline of disease progression, mortality and morbidity. ART has improved survival of patients and increased the Quality of life domain, there are limited study pertaining to estimation of long survivability on HAART patients. The present study aims to estimate mortality rate, cause of death and its predictors among five years cohort of HIV infected patients. A retrospective five years cohort study was conducted among HIV patients on ART. A random sample of 597 patients who started treatment between April, 2004 and Jan 2006 were included in this study. Secondary data was extracted from ART records. The data was analysed by using SPSS -16.50 versions. KPM –Survival analysis was employed to draw the significant inference. Over five years of cohort, it was found that 108 patients died (18.16%) and it comprised of males 47(7.87%), Females 60(10.50%) and TG 01(0.16%). Overall mean duration of HAART over 5yrs of cohort was found to be 1934±121.97 (CI-95% 1695.038-2173.18). Survivability is statistically significant with mean HAART treatment duration. Low baseline CD4 count, advanced WHO staging and Age is considered as the important parameter of survivability. Heart attack, H. Lymphoma, cardiac and Renal failure is the common cause of death, So early initiation of HAART, if CD4 counts is more than 350μ/dl, then the patients mortality rate & susceptibility to OI ‘s can be reduced.
The Lancet Public Health, 2017
Background Deaths in HIV-positive people have decreased since the introduction of highly active antiretroviral therapy (HAART) in 1996. Fewer AIDS-related deaths and an ageing cohort have resulted in an increase in the proportion of HIV patients dying from non-AIDS-related disorders. Here we describe mortality and causes of death in people diagnosed with HIV in the HAART era compared with the general population. Methods In this observational analysis, we linked cohort data collected by Public Health England (PHE) for individuals aged 15 years and older, diagnosed with HIV in England and Wales from 1997 to 2012, to the Offi ce for National Statistics (ONS) national mortality register. Cohort inclusion began at diagnosis with follow-up clinical information collected every year from all 220 National Health Service (NHS) HIV outpatient clinics nationwide. To classify causes of death we used a modifi ed Coding Causes of Death in HIV (CoDe) protocol, which uses death certifi cate data and clinical markers. We applied Kaplan-Meier analysis for survival curves and mortality rate estimation and Cox regression to establish independent predictors of all-cause mortality, adjusting for sex, infection route, age at diagnosis, region of birth, year of diagnosis, late diagnosis, and history of HAART. We used standardised mortality ratios (SMRs) to make comparisons with the general population. Findings Between 1997 and 2012, 88 994 people were diagnosed with HIV, contributing 448 839 person-years of follow up. By the end of 2012, 5302 (6%) patients had died (all-cause mortality 118 per 10 000 person-years, 95% CI 115-121). In multivariable analysis, late diagnosis was a strong predictor of death (hazard ratio [HR] 3•50, 95% CI 3•13-3•92). People diagnosed more recently had a lower risk of death (2003-07: HR 0•66, 95% CI 0•62-0•70; 2008-12: HR 0•65, 95% CI 0•60-0•71). Cause of death was determinable for 4808 (91%) of 5302 patients; most deaths (2791 [58%] of 4808) were attributable to AIDS-defi ning illnesses. Cohort mortality was signifi cantly higher than the general population for all causes (SMR 5•7, 95% CI 5•5-5•8), particularly non-AIDS infections (10•8, 9•8-12•0) and liver disease (3•7, 3•3-4•2). All-cause mortality was highest in the year after diagnosis (SMR 24•3, 95% CI 23•4-25•2). Interpretation Despite the availability of free treatment and care in the UK, AIDS continues to account for the majority of deaths in HIV-positive people, and mortality remains higher in HIV-positive people than in the general population. These fi ndings highlight the importance of prompt diagnosis, care engagement, and optimum management of comorbidities in reducing mortality in people with HIV.
Clinical Infectious Diseases
Background Introduction of antiretroviral therapy (ART) has been associated with a decline in human immunodeficiency virus (HIV)-related mortality, although HIV remains a leading cause of death in sub-Saharan Africa. We describe all-cause mortality and its predictors in people living with HIV (PLWH) in the African Cohort Study (AFRICOS). Methods AFRICOS enrolls participants with or without HIV at 12 sites in Kenya, Uganda, Tanzania, and Nigeria. Evaluations every 6 months include sociobehavioral questionnaires, medical history, physical examination, and laboratory tests. Mortality data are collected from medical records and survivor interviews. Multivariable Cox proportional hazards models were used to calculate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for factors associated with mortality. Results From 2013 through 2020, 2724 PLWH completed at least 1 follow-up visit or experienced death. Of these 58.4% were females, 25.8% were aged ≥ 50 years, and 98.3% wer...
International Journal of Virology and AIDS, 2016
Volume 3 | Issue 2 ciency Virus (HIV) associated mortality both in developed [1-5] and developing countries [6,7], prolonged Acquired Immunodeficiency Syndrome (AIDS) free survival [5] and clinical benefits by viral suppression [8]. HAART reduces morbidity and mortality by suppression of viral replication, restoration and preservation of immune function, and prevention of drug resistance [9]. Mortality was higher in low-income settings than in high-income settings. Patients starting HAART in resource-poor settings had an increased mortality rates in the first months on therapy, compared with those in developed countries [10]. Finding from previous studies on HIV-infected person's mortality showed that baseline CD4 cell count [9,11-13], baseline hemoglobin level [11,14,15], World Health Organization (WHO) AIDS staging [14,16,17], body mass index [18], age [18-21], gender [12,14,16,18], and adherence to ART [11,22] were important influencing factors for HIV survival differentials. The prevalence of HIV among adult Ethiopian in 2011 was 1.5% [23]. There are nearly 789,900 people currently living with HIV/ AIDS (607,700 adults and 182,200 children aged 0-14 years); and 952,700 AIDS orphans [24]. Few studies conducted so far reported that mortality rate in Ethiopia among HIV-infected adults on HAART ranged from 7.2% to 14.8% [25-28]. These studies' findings are based on few sample size. So that this study aimed at assessing the mortality and factors contributing to it using a data of large cohort of HIV/ AIDS patients in southern Ethiopia. Materials and Methods This retrospective cohort study was conducted in Dilla University hospital, Gedio zone, South Ethiopia. The hospital has been providing free Antiretro Viral Therapy (ART) to eligible HIV positive people since September, 2005 according to the national ART guideline. The eligibility of the patients determined by WHO AIDS disease staging and CD4 counts (if WHO clinical stage is above II or CD4 cell count is ≤ 200 cell/mm 3). Patients who are aged 15 years and above and whose record is completely available, and who entered in HIV/AIDS care and support program from September 2005 to September 2013were eligible for analysis. Outcome All cause mortality was the outcome and those patients alive in September, 2013 and lost to follow up were censored in the analysis.
Long-Term Mortality in HIV-Infected Individuals 50 Years or Older
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2016
Background: Although the prevalence of HIV-infection among individuals 50yearsofagehasincreased,theimpactofHIVinfectiononriskofdeathinthispopulationremainstobeestablished.Ouraimwastoestimatelong−termmortalityamongHIV−infectedindividualswhowere50yearsorolder,whencomparedwithanindividually−matchedcohortfromthebackgroundpopulation.Methods:Population−basedcohort−studyincludingHIV−infectedindividuals50 years of age has increased, the impact of HIVinfection on risk of death in this population remains to be established. Our aim was to estimate long-term mortality among HIV-infected individuals who were 50 years or older, when compared with an individually-matched cohort from the background population. Methods: Population-based cohort-study including HIV-infected individuals 50yearsofagehasincreased,theimpactofHIVinfectiononriskofdeathinthispopulationremainstobeestablished.Ouraimwastoestimatelong−termmortalityamongHIV−infectedindividualswhowere50yearsorolder,whencomparedwithanindividually−matchedcohortfromthebackgroundpopulation.Methods:Population−basedcohort−studyincludingHIV−infectedindividuals50 years, who were alive 1 year after HIV-diagnosis (n = 2440) and a comparison cohort individually-matched by age and gender extracted from the background population (n = 14,588). Cumulative survival was evaluated using Kaplan-Meier method and Mortality Rate Ratios (MRRs) were estimated using Cox Regression Models. Study period 1996-2014. Results: Estimated median survival time from age 50 years for HIV-infected individuals increased from 11.8 years (95% CI: 10.2 to 14.5) during 1996-1999 to 22.8 years (20.0-24.2) in 2006-2014. MRR decreased with increasing age from 3.8 (3.1-4.7) for 50-55 years to 1.6 (1.0-2.6) for 75-80 years. In a cohort of well-treated HIV-infected individuals 50yearswithoutAIDS−definingeventsorcomorbidityatstudyinclusion(n=517).MRRwas1.7(1.2−2.3)comparedwithpopulationcontrolswithoutcomorbidity.Conclusion:AmongHIV−infectedindividualsestimatedmediansurvivaltimefromage50yearshasincreasedbymorethan10yearsfrom1996−1999to2006−2014,butisstillsubstantiallylowerthaninthebackgroundpopulation.Evenamongwell−treatedHIVinfectedindividuals50 years without AIDS-defining events or comorbidity at study inclusion (n = 517). MRR was 1.7 (1.2-2.3) compared with population controls without comorbidity. Conclusion: Among HIV-infected individuals estimated median survival time from age 50 years has increased by more than 10 years from 1996-1999 to 2006-2014, but is still substantially lower than in the background population. Even among well-treated HIVinfected individuals 50yearswithoutAIDS−definingeventsorcomorbidityatstudyinclusion(n=517).MRRwas1.7(1.2−2.3)comparedwithpopulationcontrolswithoutcomorbidity.Conclusion:AmongHIV−infectedindividualsestimatedmediansurvivaltimefromage50yearshasincreasedbymorethan10yearsfrom1996−1999to2006−2014,butisstillsubstantiallylowerthaninthebackgroundpopulation.Evenamongwell−treatedHIVinfectedindividuals50 years without comorbidity or AIDSdefining events the estimated median survival time remains lower than in the general population.