期刊
AIDS
卷 22, 期 16, 页码 2143-2153出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0b013e3283112b77
关键词
AIDS-defining malignancies; D:A:D study; HIV infection; mortality; non-AIDS-defining malignancies
资金
- Oversight Committee for The Evaluation of Metabolic Complications of HAART
- academic institutions
- European Agency for the valuation of Medicinal Products
- Food and Drug Administration
- 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 cle Recherches stir le SIDA (Action Coordonnee no.7, Cohortes)
- Commonwealth Department of Health and Ageing
- Australian National Council on AIDS
- Hepatitis C and Related Diseases' Clinical Trials and Research Committee
- 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]
- European Commission [CT94-1637, CT97-2713]
- Roche
- Gilead
- Merck and Co.
- Tibotec
- Swiss Federal Office for Education and Science (EuroSIDA)
- Janssen-Cilag, Italy
- Swiss National Science Foundation
- [QLK2-2000-00773]
- [LSHP-CT-2006-018632]
Objective: To evaluate deaths from AIDS-defining malignancies (ADM) and non-AIDS-defining malignancies (nADM) in the D:A:D Study and to investigate the relationship between these deaths and immunodeficiency. Design: Observational cohort study. Methods: Patients (23 437) were followed prospectively for 104 921 person-years. We used Poisson regression models to identify factors independently associated with deaths from ADM and nADM. Analyses of factors associated with mortality due to nADM were repeated after excluding nADM known to be associated with a specific risk factor. Results: Three hundred five patients died due to a malignancy, 298 prior to the cutoff for this analysis (ADM: n = 110; nADM: n = 188). The mortality rate due to ADM decreased from 20.1/1000 person-years of follow-up [95% confidence interval (CI) 14.4, 25.9] when the most recent CD4 cell count was <50 cells/mu l to 0.1 (0.03, 0.3)/1000 person-years of follow-up when the CD4 cell count was more than 500 cells/mu l; the mortality rate from nADM decreased from 6.0 (95% CI 3.3, 10.1) to 0.6 (0.4, 0.8) per 1000 person-years of follow-up between these two CD4 cell count strata. In multi-variable regression analyses, a two-fold higher latest CD4 cell count was associated with a halving of the risk of ADM mortality. Other predictors of an increased risk of ADM mortality were homosexual risk group, older age, a previous (non-malignancy) AIDS diagnosis and earlier calendar years. Predictors of an increased risk of nADM mortality included lower CD4 cell count, older age, current/ex-smoking status, longer cumulative exposure to combination antiretroviral therapy, active hepatitis B infection and earlier calendar year. Conclusion: The severity of immunosuppression is predictive of death from both ADM and nADM in HIV-infected populations. (C) 2008 Wolters Kluwer Health / Lippincott Williams & Wilkins
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