All-cause and AIDS-related mortality among people with HIV across Europe from 2001 to 2020: impact of antiretroviral therapy, tuberculosis and regional differences in a multicentre cohort study
This large European study looked at how the death rates of people living with HIV changed from 2001 to 2020, and what factors influenced these outcomes. Researchers followed over 20’000 people with HIV from 39 European countries who were part of the EuroSIDA study. They specifically examined the role of antiretroviral therapy (ART, the standard treatment for HIV), tuberculosis (TB), and regional healthcare differences.
The study found that death rates for people with HIV, including those from AIDS-related causes, have significantly decreased over the past two decades. However, the improvements were not uniform across Europe. Western and Central Eastern Europe saw the most progress, while Eastern Europe continued to have higher death rates.
One of the strongest predictors of survival was whether a person was on ART and how well their immune system was functioning (measured by CD4 cell counts and HIV viral load). People not on ART or with poor immune system function were much more likely to die. Tuberculosis also played a major role in increasing mortality risk, particularly in Eastern Europe where TB/HIV co-infection remains a serious issue.
The study revealed that people in Eastern Europe were more likely to be diagnosed later, start ART later, and have less access to routine monitoring. Many patients in this region had poor or unknown immune system status, which is associated with poorer outcomes.
Despite some progress, especially since 2016, Eastern Europe still lags behind the rest of Europe. The findings highlight an urgent need for better healthcare access, earlier HIV testing, quicker initiation of ART, and better management of co-infections like TB in Eastern Europe.
In summary, the study shows clear evidence of the life-saving benefits of ART and comprehensive HIV care. It also points to critical regional inequalities that must be addressed to improve survival for all people living with HIV in Europe.