Mortality, Causes of Death and Associated Factors Relate to a Large HIV Population-Based Cohort

PLoS One. 2015 Dec 30;10(12):e0145701. doi: 10.1371/journal.pone.0145701. eCollection 2015.

Abstract

Introduction: Antiretroviral therapy has led to a decrease in HIV-related mortality and to the emergence of non-AIDS defining diseases as competing causes of death. This study estimates the HIV mortality rate and their risk factors with regard to different causes in a large city from January 2001 to June 2013.

Materials and methods: We followed-up 3137 newly diagnosed HIV non-AIDS cases. Causes of death were classified as HIV-related, non-HIV-related and external. We examined the effect of risk factors on survival using mortality rates, Kaplan-Meier plots and Cox models. Finally, we estimated survival for each main cause of death groups through Fine and Gray models.

Mortality results: 182 deaths were found [14.0/1000 person-years of follow-up (py); 95% confidence interval (CI):12.0-16.1/1000 py], 81.3% of them had a known cause of death. Mortality rate by HIV-related causes and non-HIV-related causes was the same (4.9/1000 py; CI:3.7-6.1/1000 py), external was lower [1.7/1000 py; (1.0-2.4/1000 py)].

Survival results: Kaplan-Meier estimate showed worse survival in intravenous drug user (IDU) and heterosexuals than in men having sex with men (MSM). Factors associated with HIV-related causes of death include: IDU male (subHazard Ratio (sHR):3.2; CI:1.5-7.0) and <200 CD4 at diagnosis (sHR:2.7; CI:1.3-5.7) versus ≥500 CD4. Factors associated with non-HIV-related causes of death include: ageing (sHR:1.5; CI:1.4-1.7) and heterosexual female (sHR:2.8; CI:1.1-7.3) versus MSM. Factors associated with external causes of death were IDU male (sHR:28.7; CI:6.7-123.2) and heterosexual male (sHR:11.8; CI:2.5-56.4) versus MSM.

Conclusion and recommendation: There are important differences in survival among transmission groups. Improved treatment is especially necessary in IDUs and heterosexual males.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / mortality*
  • Adult
  • Anti-HIV Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active / methods
  • Cause of Death*
  • Cohort Studies
  • Drug Users / psychology
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / etiology
  • HIV Infections / mortality*
  • Heterosexuality / psychology
  • Homosexuality, Male / psychology
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Risk Factors
  • Substance Abuse, Intravenous / complications

Substances

  • Anti-HIV Agents

Grants and funding

The work was supported by 12/PEAC-06, Programa de Epidemiología Aplicada de Campo (Field Epidemiology Training Programme), Instituto de Salud Carlos III (Carlos III Public Health Institute). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.