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Evolving AIDS- and non-AIDS Mortality and Predictors in the PISCIS Cohort of People Living With HIV in Catalonia and the Balearic Islands (Spain), 1998–2020.

Evolving AIDS- and non-AIDS Mortality and Predictors in the PISCIS Cohort of People Living With HIV in Catalonia and the Balearic Islands (Spain), 1998–2020.

Authors :
Nomah, Daniel K
Jamarkattel, Suju
Bruguera, Andreu
Moreno-Fornés, Sergio
Díaz, Yesika
Alonso, Lucía
Aceitón, Jordi
Llibre, Josep M
Domingo, Pere
Saumoy, Maria
Homar, Francesc
Fanjul, Francisco
Navarro, Jordi
de la Mora, Lorena
Knobel, Hernando
Orti, Amat
Martin-Iguacel, Raquel
Miró, José M
Casabona, Jordi
Reyes-Urueña, Juliana
Source :
Open Forum Infectious Diseases; Apr2024, Vol. 11 Issue 4, p1-10, 10p
Publication Year :
2024

Abstract

Background Effective antiretroviral therapy (ART) has substantially reduced acquired immunodeficiency syndrome (AIDS)-related deaths, shifting the focus to non-AIDS conditions in people living with human immunodeficiency virus (HIV) (PLWH). We examined mortality trends and predictors of AIDS- and non-AIDS mortality in the Population HIV Cohort from Catalonia and Balearic Islands (PISCIS) cohort of PLWH from 1998 to 2020. Methods We used a modified Coding Causes of Death in HIV protocol, which has been widely adopted by various HIV cohorts to classify mortality causes. We applied standardized mortality rates (SMR) to compare with the general population and used competing risks models to determine AIDS-related and non-AIDS-related mortality predictors. Results Among 30 394 PLWH (81.5% male, median age at death 47.3), crude mortality was 14.2 per 1000 person-years. All-cause standardized mortality rates dropped from 9.6 (95% confidence interval [CI], 8.45–10.90) in 1998 through 2003 to 3.33 (95% CI, 3.14–3.53) in 2015 through 2020, P for trend =.0001. Major causes were AIDS, non-AIDS cancers, cardiovascular disease, AIDS-defining cancers, viral hepatitis, and nonhepatitis liver disease. Predictors for AIDS-related mortality included being aged ≥40 years, not being a man who have sex with men, history of AIDS-defining illnesses, CD4 < 200 cells/µL, ≥2 comorbidities, and nonreceipt of ART. Non-AIDS mortality increased with age, injection drug use, heterosexual men, socioeconomic deprivation, CD4 200 to 349 cells/µL, nonreceipt of ART, and comorbidities, but migrants had lower risk (adjusted hazard risk, 0.69 [95% CI,.57–.83]). Conclusions Mortality rates among PLWH have significantly decreased over the past 2 decades, with a notable shift toward non–AIDS-related causes. Continuous monitoring and effective management of these non-AIDS conditions are essential to enhance overall health outcomes. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
23288957
Volume :
11
Issue :
4
Database :
Complementary Index
Journal :
Open Forum Infectious Diseases
Publication Type :
Academic Journal
Accession number :
177167789
Full Text :
https://doi.org/10.1093/ofid/ofae132