期刊
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
卷 41, 期 6, 页码 1807-1820出版社
OXFORD UNIV PRESS
DOI: 10.1093/ije/dys164
关键词
HIV; AIDS; antiretroviral therapy; mortality; cohort; heterogeneity; prognostic model; socio-economic status
资金
- UK Medical Research Council [G0700820, MR/J002380/1]
- Agence Nationale de Recherche contre le SIDA (ANRS)
- Institut National de la Sante et de la Recherche Medicale (INSERM)
- French Ministry of Health
- Italian Ministry of Health
- Spanish Ministry of Health
- Swiss National Science Foundation [33CS30_134277]
- Stichting HIV Monitoring
- European Commission [260694]
- British Columbia Government
- Alberta Government
- National Institutes of Health (NIH)
- UW CFAR, USA [P30 AI027757]
- Michael Smith Foundation for Health Research
- Canadian Institutes of Health Research
- VHA Office of Research and Development
- GlaxoSmithKline
- Pfizer
- Bristol Myers Squibb
- Roche
- Boehringer-Ingelheim
- UW CFAR [P30 AI027757]
- Spanish Network for AIDS Research (RIS) [ISCIII-RETIC RD06/006]
- MRC [G0700820, MR/J002380/1] Funding Source: UKRI
- Medical Research Council [G0700820, MR/J002380/1] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0611-10168] Funding Source: researchfish
Background HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. Methods We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. Results During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. Conclusions Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk.
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