Estimation of improvements in mortality in spectrum among adults with HIV receiving antiretroviral therapy in high-income countries. JAIDS
Trickey et al. aimed to review AIDS-related and non–AIDS related mortality rates over time using data from a collaboration of cohorts of people living with HIV (PLHIV) on antiretroviral therapy (ART) in Europe and compare the estimated mortality rates for 2016–2020 with the estimates produced by Spectrum.
The AIDS Impact Module in Spectrum is a compartmental HIV epidemic model coupled with a demographic population projection model. The authors used national Spectrum projections developed for the 2022 HIV estimates round to calculate mortality rates among PLHIV on ART, adjusting to the age/country distribution of PLHIV starting ART from 1996 to 2020 in the Antiretroviral Therapy Cohort Collaboration (ART-CC)’s European cohorts.
In the ART-CC, 11,504 of 162,835 PLHIV died. Between 1996–1999 and 2016–2020, AIDS-related mortality in the ART-CC decreased from 8.8 (95% CI: 7.6 to 10.1) to 1.0 (0.9–1.2) and from 5.9 (4.4–8.1) to 1.1 (0.9–1.4) deaths per 1000 person-years among men and women, respectively. Non–AIDS-related mortality decreased from 9.1 (7.9–10.5) to 6.1 (5.8–6.5) and from 7.0 (5.2–9.3) to 4.8 (4.3–5.2) deaths per 1000 person-years among men and women, respectively. Adjusted all-cause mortality rates in Spectrum among men were near ART-CC estimates for 2016–2020 (Spectrum: 7.02–7.47 deaths per 1000 person-years) but approximately 20% lower in women (Spectrum: 4.66–4.70). Adjusted excess mortality rates in Spectrum were 2.5-fold higher in women and 3.1–3.4-fold higher in men.
In sum, this study found that Spectrum produces estimates of all-cause mortality among PLHIV that are consistent with mortality observed in ART-CC after controlling for age and country. The authors found that a substantial proportion of excess mortality among PLHIV on ART in Europe is from non-AIDS causes and that excess mortality rates among PLHIV on ART in Spectrum are 2.5–3.4-fold higher than AIDS-related death rates in the ART-CC. This suggests that 60%–70% of excess deaths among PLHIV on ART in Spectrum are from non AIDS causes. Thus, misinterpreting excess deaths as AIDS-related deaths risks overstating the numbers of deaths that might be prevented through ART, although ART should also reduce some deaths that are currently classified as non-AIDS mortality.