Cause-specific mortality in HIV-positive patients who survived ten years after starting antiretroviral therapy. PLoS One
Trickey et al. on behalf of the Antiretroviral Therapy Cohort Collaboration aimed to estimate mortality rates and prognostic factors in HIV-positive patients who started combination antiretroviral therapy (cART) between 1996–1999 and survived for more than ten years.
During 50’593 person years of follow up, 656 out of 13’011 (5%) patients died. The following factors were associated with a higher mortality: age, male sex, intravenous drug use, AIDS, and a lower CD4 cell count or a detectable HIV viral load 10 years after starting cART, respectively. Notably, a low CD4 cell count nadir before cART initiation was not associated with a higher mortality. The most common causes of death were non-AIDS-related liver cancer (25%), AIDS (19%), cardiovascular disease (12%), and liver-related disease (10%). Older age was strongly associated with cardiovascular mortality and with non-AIDS and non-liver malignancies, IDU with non-AIDS infection and liver-related mortality, and low CD4 count and detectable viral replication at ten years after starting ART with AIDS mortality.
In summary, this study shows that CD4 count and viral load remain important for prognosis in patients who have survived ten years after starting cART. However, deaths were mostly non-AIDS-related, and care for these patients should focus on improving management of non-HIV morbidity, in particular risk factors for cardiovascular disease and screening for non-AIDS cancer.