A tale of two countries: all-cause mortality among people living with HIV and receiving combination antiretroviral therapy in the UK and Canada

S Patterson; S Jose; H Samji; A Cescon; E Ding; J Zhu; J Anderson; A N Burchell; C Cooper; T Hill; M Hull; M B Klein; M Loutfy; F Martin; N Machouf; Jsg Montaner; M Nelson; J Raboud; S B Rourke; C Tsoukas; R S Hogg; C Sabin; Canadian Observational Cohort (CANOC) - UK Collaborative HIV Cohort (UK CHIC) Collaboration

doi:10.1111/hiv.12505

A tale of two countries: all-cause mortality among people living with HIV and receiving combination antiretroviral therapy in the UK and Canada

HIV Med. 2017 Oct;18(9):655-666. doi: 10.1111/hiv.12505. Epub 2017 Apr 24.

Authors

S Patterson^{1

2}, S Jose³, H Samji^{1

4}, A Cescon^{1

5}, E Ding¹, J Zhu¹, J Anderson⁶, A N Burchell^{7

8

9}, C Cooper¹⁰, T Hill³, M Hull¹, M B Klein^{11

12}, M Loutfy^{13

14

15}, F Martin¹⁶, N Machouf¹⁷, Jsg Montaner^{1

18}, M Nelson¹⁹, J Raboud^{9

20}, S B Rourke²¹, C Tsoukas¹¹, R S Hogg^{1

2}, C Sabin³; Canadian Observational Cohort (CANOC) - UK Collaborative HIV Cohort (UK CHIC) Collaboration

Collaborators

Canadian Observational Cohort (CANOC) - UK Collaborative HIV Cohort (UK CHIC) Collaboration:
Deborah Kelly, Stephen Sanche, Alexander Wong, Tony Antoniou, Ahmed Bayoumi, Bohdan Nosyk, Michelle Cotterchio, Charlie Goldsmith, Silvia Guillemi, P Richard Harrigan, Marianne Harris, Sean Hosein, Sharon Johnston, Clare Liddy, Viviane Lima, David Moore, Alexis Palmer, Peter Phillips, Anita Rachlis, Marek Smieja, Benoit Trottier, Mark Wainberg, Sharon Walmsley, Chris Archibald, Ken Clement, Monique Doolittle-Romas, Laurie Edmiston, Brian Huskins, Jerry Lawless, Douglas Lee, Renee Masching, Stephen Tattle, Alireza Zahirieh, Claire Allen, Stryker Calvez, Guillaume Colley, Jason Chia, Daniel Corsi, Louise Gilbert, Nada Gataric, Alia Leslie, Lucia Light, David Mackie, Costa Pexos, Susan Shurgold, Leah Szadkowski, John Wong, Benita Yip, Jaime Younger, Jonathan Ainsworth, Sris Allan, Abdel Babiker, David Chadwick, Valerie Delpech, David Dunn, Martin Fisher, Brian Gazzard, Richard Gilson, Mark Gompels, Phillip Hay, Margaret Johnson, Stephen Kegg, Clifford Leen, Chloe Orkin, Adrian Palfreeman, Andrew Phillips, Deenan Pillay, Frank Post, Jillian Pritchard, Memory Sachikonye, Achim Schwenk, Anjum Tariq, John Walsh, Alicia Thornton, Adam Glabay, Nicky Perry, Stuart Tilbury, Elaney Youssef, Duncan Churchill, Rhiannon Everett, David Asboe, Sundhiya Mandalia, Hardik Korat, Chris Taylor, Zachary Gleisner, Fowzia Ibrahim, Lucy Campbell, Nataliya Brima, Ian Williams, Mike Youle, Fiona Lampe, Colette Smith, Rob Tsintas, Clinton Chaloner, Samantha Hutchinson, Susie Huntington, Nicky Mackie, Alan Winston, Jonathan Weber, Farhan Ramzan, Mark Carder, Janet Lynch, James Hand, Carl de Souza, Sajid Munshi, Sheila Miller, Chris Wood, Alan Wilson, Sheila Morris, Sue Allan, Khurram Memon, Adam Lewszuk, Emma Cope, Jane Gibson, Paul Main, Mandip Dhillon, Sarah Russell-Sharpe, Andrew Harte, Stephen Clay, Hazel Spencer, Ron Jones, Shirley Cumming, Claire Atkinson, Roy Trevelion

Affiliations

¹ British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
² Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.
³ Research Department of Infection and Population Health, University College London, London, UK.
⁴ British Columbia Centre for Disease Control, Vancouver, BC, Canada.
⁵ Northern Ontario School of Medicine, Sudbury, ON, Canada.
⁶ Homerton University Hospital NHS Trust, London, UK.
⁷ Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada.
⁸ Li Ka Shing Knowledge Institute, Toronto, ON, Canada.
⁹ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹⁰ The Ottawa Hospital Division of Infectious Diseases, University of Ottawa, Ottawa, ON, Canada.
¹¹ Faculty of Medicine, McGill University, Montreal, QC, Canada.
¹² The Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada.
¹³ Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁴ Maple Leaf Medical Clinic, Toronto, ON, Canada.
¹⁵ Women's College Research Institute, Toronto, ON, Canada.
¹⁶ York Teaching Hospital NHS Foundation Trust, York, UK.
¹⁷ Clinique Medicale l'Actuel, Montreal, QC, Canada.
¹⁸ Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁹ Chelsea and Westminster Hospital NHS Trust, London, UK.
²⁰ Toronto General Research Institute, University Health Network, Toronto, ON, Canada.
²¹ Ontario HIV Treatment Network, Toronto, ON, Canada.

Abstract

Objectives: We sought to compare all-cause mortality of people living with HIV and accessing care in Canada and the UK.

Methods: Individuals from the Canadian Observational Cohort (CANOC) collaboration and UK Collaborative HIV Cohort (UK CHIC) study who were aged ≥ 18 years, had initiated antiretroviral therapy (ART) for the first time between 2000 and 2012 and who had acquired HIV through sexual transmission were included in the analysis. Cox regression was used to investigate the difference in mortality risk between the two cohort collaborations, accounting for loss to follow-up as a competing risk.

Results: A total of 19 960 participants were included in the analysis (CANOC, 4137; UK CHIC, 15 823). CANOC participants were more likely to be older [median age 39 years (interquartile range (IQR): 33, 46 years) vs. 36 years (IQR: 31, 43 years) for UK CHIC participants], to be male (86 vs. 73%, respectively), and to report men who have sex with men (MSM) sexual transmission risk (72 vs. 56%, respectively) (all P < 0.001). Overall, 762 deaths occurred during 98 798 person-years (PY) of follow-up, giving a crude mortality rate of 7.7 per 1000 PY [95% confidence interval (CI): 7.1, 8.3 per 1000 PY]. The crude mortality rates were 8.6 (95% CI: 7.4, 10.0) and 7.5 (95% CI: 6.9, 8.1) per 1000 PY among CANOC and UK CHIC study participants, respectively. No statistically significant difference in mortality risk was observed between the cohort collaborations in Cox regression accounting for loss to follow-up as a competing risk (adjusted hazard ratio 0.86; 95% CI: 0.72-1.03).

Conclusions: Despite differences in national HIV care provision and treatment guidelines, mortality risk did not differ between CANOC and UK CHIC study participants who acquired HIV through sexual transmission.

Keywords: AIDS; HIV; UK; Canada; antiretroviral therapy; mortality.

Publication types

Comparative Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adult
Anti-HIV Agents / therapeutic use*
Canada / epidemiology
Cohort Studies
Female
HIV Infections / drug therapy*
HIV Infections / mortality*
Humans
Male
Middle Aged
Observational Studies as Topic
Risk Factors
Sexually Transmitted Diseases, Viral / drug therapy
Sexually Transmitted Diseases, Viral / mortality
United Kingdom / epidemiology

Substances

Anti-HIV Agents

Abstract

Publication types

MeSH terms

Substances

Grants and funding