Journal
AIDS
Volume 24, Issue 10, Pages 1537-1548Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0b013e32833a0918
Keywords
death; modifiable risk factors
Categories
Funding
- Oversight Committee for The Evaluation of Metabolic Complications of HAART
- European Agency for the evaluation of Medicinal Products
- Food and Drug Administration
- patient community
- Abbott
- Boehringer Ingelheim
- Bristol-Myers Squibb
- Gilead Sciences
- GlaxoSmithKline
- Merck
- Pfizer
- Hoffman-LaRoche
- Health Insurance Fund Council, Amstelveen, the Netherlands [CURE/97-46486]
- Agence Nationale de Recherches sur le SIDA
- Australian Government Department of Health and Ageing
- United States National Institutes of Health's National Institute of Allergy and Infectious Diseases (NIAID) [U01-AI069907]
- Foundation for AIDS Research
- Fondo de Investigacion Sanitaria (FIS) [99/0887]
- Fundacion para la Investigacion y la Prevencion del SIDA en Espana (FIPSE) [3171/00]
- National Institute of Allergy and Infectious Diseases, National Institutes of Health [5U01AI042170-10, 5U01AI046362-03]
- Terry Beirn Community Programs for Clinical Research on AIDS (CPCRA)
- BIOMED [CT94-1637, CT97-2713]
- European Commission [QLK2-2000-00773]
- Roche
- Gilead
- GSK
- Janssen-Cilag
- Swiss National Science Foundation
- MRC [G0701639] Funding Source: UKRI
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Objective: To investigate any emerging trends in causes of death amongst HIV-positive individuals in the current cART era, and to investigate the factors associated with each specific cause of death. Design: An observational multicentre cohort study. Methods: All HIV-positive individuals included in one of the cohorts in the Data Collection on Adverse Events of Anti-HIV drugs (D:A:D) Study were included. The association between HIV-specific and non HIV-specific risk factors and death were studied using multivariable Poisson regression. Results: We observed 2482 deaths in 180 176 person-years (PY) on 33 308 individuals [rate/1000 PY = 13.8 (95% CI 13.2-14.3)]. Primary causes of death were: AIDS (n = 743; rate/1000 PY = 4.12), liver-related (341; 1.89), CVD-related (289; 1.60), non-AIDS malignancy (286; 1.59). The overall rate of death fell from 16.9 in 1999/2000 to 9.6/1000 PY in 2007/2008. Smoking was associated with CVD and non-AIDS cancers, HBV and HCV co-infection with liver-related deaths, and hypertension with liver-related and CVD deaths. Diabetes was a risk factor for all specific causes of death except non-AIDS cancers, and higher current HIV RNA for AIDS-related deaths. Lower CD4 cell counts were associated with a higher risk of death from all specific causes of death. Conclusion: Multiple potentially modifiable traditional and HIV-specific risk factors for death of HIV-infected persons were identified. The maximum reduction in mortality in HIV-infected populations will require that each of these factors be appropriately addressed. No trends in terms of emerging causes of unexpected deaths were observed, although monitoring will continue. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins
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