Abstract
OBJECTIVE: To quantify cause-specific mortality risk attributable to non-AIDS-related and AIDS-related causes before and after the advent of highly active antiretroviral therapy (HAART). METHODS: Competing-risk methods were used to determine the cumulative AIDS-related and non-AIDS-related risk of mortality between 1990 and the end of 2003 in the Johns Hopkins HIV Clinical Cohort, a prospective cohort study. RESULTS: Beginning in 1997 with the introduction of HAART, all-cause mortality declined and has remained stable at approximately 39 deaths per 1000 person-years. AIDS-related mortality continued to decline in this period (P = 0.008), whereas non-AIDS-related mortality increased (P < 0.001). Using competing-risk methods, the risk of dying attributable to AIDS-related causes remains significantly higher than the risk of dying attributable to non-AIDS-related causes for patients with a CD4 count ≤200 cells/mm in the HAART era. For those with a CD4 count >200 cells/mm, however, non-AIDS-related mortality was greater than AIDS-related mortality, particularly among injection drug users. Other transmission categories had similar AIDS-related and non-AIDS-related cumulative mortalities. CONCLUSIONS: HAART has reduced mortality rates among HIV-infected individuals, but further efforts to reduce mortality in this population require increased attention to conditions that have not traditionally been considered to be HIV related.
Original language | English (US) |
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Pages (from-to) | 179-187 |
Number of pages | 9 |
Journal | Journal of Acquired Immune Deficiency Syndromes |
Volume | 44 |
Issue number | 2 |
DOIs | |
State | Published - Feb 2007 |
Keywords
- Cohort
- Competing risks
- Epidemiologic methods
- HIV
- Mortality
ASJC Scopus subject areas
- Infectious Diseases
- Pharmacology (medical)