Trends in mortality in people with HIV from 1999 to 2020: a multi-cohort collaboration

• Published in: Clinical infectious diseases 2024
• Main Authors: Tusch, Erich, Ryom, Lene, Pelchen-Matthews, Annegret, Mocroft, Amanda, Elbirt, Daniel, Oprea, Cristiana, Gunthard, Huldrych F, Staehelin, Cornelia, Zangerle, Robert, Suarez, Isabelle, Vehreschild, Jorg Janne, Wit, Ferdinand, Menozzi, Marianna, d'Arminio Monforte, Antonella, Spagnuolo, Vincenzo, Pradier, Christian, Carlander, Christina, Suanzes, Paula, Wasmuth, Jan-Christian, Carr, Andrew, Petoumenos, Kathy, Borgans, Frauke, Bonnet, Fabrice, de Wit, Stephane, El-Sadr, Wafaa, Neesgaard, Bastian, Jaschinski, Nadine, Greenberg, Lauren, Hosein, Sean R, Gallant, Joel, Vannappagari, Vani, Young, Lital, Sabin, Caroline, Lundgren, Jens, Peters, Lars, Reekie, Joanne, Study, D. A. D. Cohort, Study, Respond Cohort
• Format: Article
• Language: English
• Subjects: Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; Hälsovetenskap; Infektionsmedicin; Klinisk medicin; Life Sciences; Medicin och hälsovetenskap; Santé publique et épidémiologie
• ISSN: 1058-4838; 1537-6591; 1537-6591
• DOI: 10.1093/cid/ciae228

BACKGROUND: Mortality among people with HIV declined with the introduction of combination antiretroviral therapy. We investigated trends over time in all-cause and cause-specific mortality in people with HIV from 1999-2020. METHODS: Data were collected from the D:A:D cohort from 1999 through January 2015 and RESPOND from October 2017 through 2020. Age-standardized all-cause and cause-specific mortality rates, classified using Coding Causes of Death in HIV (CoDe), were calculated. Poisson regression models were used to assess mortality trends over time. RESULTS: Among 55716 participants followed for a median of 6 years (IQR 3-11), 5263 participants died (crude mortality rate [MR] 13.7/1000 PYFU; 95%CI 13.4-14.1). Changing patterns of mortality were observed with AIDS as the most common cause of death between 1999- 2009 (n = 952, MR 4.2/1000 PYFU; 95%CI 4.0-4.5) and non-AIDS defining malignancy (NADM) from 2010 -2020 (n = 444, MR 2.8/1000 PYFU; 95%CI 2.5-3.1). In multivariable analysis, all-cause mortality declined over time (adjusted mortality rate ratio [aMRR] 0.97 per year; 95%CI 0.96, 0.98), mostly from 1999 through 2010 (aMRR 0.96 per year; 95%CI 0.95-0.97), and with no decline shown from 2011 through 2020 (aMRR 1·00 per year; 95%CI 0·96-1·05). Mortality due all known causes except NADM also declined over the entire follow-up period. CONCLUSION: Mortality among people with HIV in the D:A:D and/or RESPOND cohorts decreased between 1999 and 2009 and was stable over the period from 2010 through 2020. The decline in mortality rates was not fully explained by improvements in immunologic-virologic status or other risk factors.