期刊
PLOS ONE
卷 11, 期 8, 页码 -出版社
PUBLIC LIBRARY SCIENCE
DOI: 10.1371/journal.pone.0160460
关键词
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资金
- UK Medical Research Council (MRC) [MR/J002380/1]
- UK Department for International Development (DFID) under the MRC/DFID Concordat agreement
- European Union
- National Institute for Health Research [NF-SI-0611-10168]
- Agence Nationale de Recherche sur le SIDA et les hepatites virales (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]
- Ministry of Science and Innovation
- Spanish Network for AIDS Research (RIS) [ISCIII-RETIC RD06/006]
- Stichting HIV Monitoring
- European Commission (EuroCoord grant) [260694]
- British Columbia Government
- Alberta Government
- National Institutes of Health (NIH) [UW Center for AIDS Research (CFAR) (NIH)] [P30 AI027757]
- National Institutes of Health (NIH) [UAB CFAR (NIH)] [P30 AI027767]
- National Institutes of Health (NIH) [Vanderbilt-Meharry CFAR (NIH grant)] [P30 AI54999]
- National Institute on Alcohol Abuse and Alcoholism [U10-AA13566, U24-AA020794]
- US Department of Veterans Affairs
- Michael Smith Foundation for Health Research
- Canadian Institutes of Health Research
- VHA Office of Research and Development
- Abbott
- Gilead
- Tibotec-Upjohn
- ViiV Healthcare
- MSD
- GlaxoSmithKline
- Pfizer
- Bristol Myers Squibb
- Roche
- Boehringer-Ingelheim
- European Union Seventh Framework Programme (FP7) under EuroCoord grant [260694]
- Medical Research Council [G0700820, MR/J002380/1, G0100221] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0611-10168] Funding Source: researchfish
- MRC [G0700820, MR/J002380/1, G0100221] Funding Source: UKRI
Objectives To estimate mortality rates and prognostic factors in HIV-positive patients who started combination antiretroviral therapy between 1996-1999 and survived for more than ten years. Methods We used data from 18 European and North American HIV cohort studies contributing to the Antiretroviral Therapy Cohort Collaboration. We followed up patients from ten years after start of combination antiretroviral therapy. We estimated overall and cause-specific mortality rate ratios for age, sex, transmission through injection drug use, AIDS, CD4 count and HIV-1 RNA. Results During 50,593 person years 656/13,011 (5%) patients died. Older age, male sex, injecting drug use transmission, AIDS, and low CD4 count and detectable viral replication ten years after starting combination antiretroviral therapy were associated with higher subsequent mortality. CD4 count at ART start did not predict mortality in models adjusted for patient characteristics ten years after start of antiretroviral therapy. The most frequent causes of death (among 340 classified) were non-AIDS cancer, AIDS, cardiovascular, and liver-related disease. Older age was strongly associated with cardiovascular mortality, injecting drug use transmission with non-AIDS infection and liver-related mortality, and low CD4 and detectable viral replication ten years after starting antiretroviral therapy with AIDS mortality. Five-year mortality risk was <5% in 60% of all patients, and in 30% of those aged over 60 years. Conclusions Viral replication, lower CD4 count, prior AIDS, and transmission via injecting drug use continue to predict higher all-cause and AIDS-related mortality in patients treated with combination antiretroviral therapy for over a decade. Deaths from AIDS and non-AIDS infection are less frequent than deaths from other non-AIDS causes.
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