Abstract
Background: Although antiretroviral therapy (ART) is known to be protective against HIV-related mortality, the expected magnitude of effect is unclear because existing estimates of the effect of ART may not directly generalize to recently HIV-diagnosed persons. Methods: In this study, we estimated 5-year mortality risks for immediate versus no ART initiation among patients (n=12 547) in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) using the complement of adjusted Kaplan-Meier survival functions. We subsequently standardized estimates to persons diagnosed with HIV in the USA between 2009 and 2011, who were enumerated using national surveillance data. Results: The 5-year mortality, had all patients in the CNICS immediately initiated ART, was 10.6% [95% confidence interval (CI): 9.3%, 11.9%] compared with 28.3% (95% CI: 19.1%, 37.5%) had ART initiation been delayed at least 5 years. The 5-year mortality risk difference due to ART among patients in the CNICS was -17.7% (95% CI: -27.0%, -8.4%). Based on methods for generalizing an estimate from a study sample to a different target population, the expected risk difference due to ART initiation among recently HIV-diagnosed persons in the USA was -19.1% (95% CI: -30.5%, -7.8%). Conclusions: Immediate ART initiation substantially lowers mortality among persons in the CNICS and this benefit is expected to be similar among persons recently diagnosed with HIV in the USA. We demonstrate a method by which concerns about generalizability can be addressed and evaluated quantitatively.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 140-150 |
| Number of pages | 11 |
| Journal | International Journal of Epidemiology |
| Volume | 45 |
| Issue number | 1 |
| DOIs | |
| State | Published - Feb 1 2016 |
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Keywords
- Antiretroviral therapy
- Effect modification
- External validity
- Generalizability
- HIV
- Mortality
- Survival analysis
ASJC Scopus subject areas
- Epidemiology
Cite this
The effect of antiretroviral therapy on all-cause mortality, generalized to persons diagnosed with HIV in the USA, 2009-11. / CNICS Investigators.
In: International Journal of Epidemiology, Vol. 45, No. 1, 01.02.2016, p. 140-150.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The effect of antiretroviral therapy on all-cause mortality, generalized to persons diagnosed with HIV in the USA, 2009-11
AU - CNICS Investigators
AU - Lesko, Catherine
AU - Cole, Stephen R.
AU - Irene Hall, H.
AU - Westreich, Daniel
AU - Miller, William C.
AU - Eron, Joseph J.
AU - Li, Jianmin
AU - Mugavero, Michael J.
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Background: Although antiretroviral therapy (ART) is known to be protective against HIV-related mortality, the expected magnitude of effect is unclear because existing estimates of the effect of ART may not directly generalize to recently HIV-diagnosed persons. Methods: In this study, we estimated 5-year mortality risks for immediate versus no ART initiation among patients (n=12 547) in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) using the complement of adjusted Kaplan-Meier survival functions. We subsequently standardized estimates to persons diagnosed with HIV in the USA between 2009 and 2011, who were enumerated using national surveillance data. Results: The 5-year mortality, had all patients in the CNICS immediately initiated ART, was 10.6% [95% confidence interval (CI): 9.3%, 11.9%] compared with 28.3% (95% CI: 19.1%, 37.5%) had ART initiation been delayed at least 5 years. The 5-year mortality risk difference due to ART among patients in the CNICS was -17.7% (95% CI: -27.0%, -8.4%). Based on methods for generalizing an estimate from a study sample to a different target population, the expected risk difference due to ART initiation among recently HIV-diagnosed persons in the USA was -19.1% (95% CI: -30.5%, -7.8%). Conclusions: Immediate ART initiation substantially lowers mortality among persons in the CNICS and this benefit is expected to be similar among persons recently diagnosed with HIV in the USA. We demonstrate a method by which concerns about generalizability can be addressed and evaluated quantitatively.
AB - Background: Although antiretroviral therapy (ART) is known to be protective against HIV-related mortality, the expected magnitude of effect is unclear because existing estimates of the effect of ART may not directly generalize to recently HIV-diagnosed persons. Methods: In this study, we estimated 5-year mortality risks for immediate versus no ART initiation among patients (n=12 547) in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) using the complement of adjusted Kaplan-Meier survival functions. We subsequently standardized estimates to persons diagnosed with HIV in the USA between 2009 and 2011, who were enumerated using national surveillance data. Results: The 5-year mortality, had all patients in the CNICS immediately initiated ART, was 10.6% [95% confidence interval (CI): 9.3%, 11.9%] compared with 28.3% (95% CI: 19.1%, 37.5%) had ART initiation been delayed at least 5 years. The 5-year mortality risk difference due to ART among patients in the CNICS was -17.7% (95% CI: -27.0%, -8.4%). Based on methods for generalizing an estimate from a study sample to a different target population, the expected risk difference due to ART initiation among recently HIV-diagnosed persons in the USA was -19.1% (95% CI: -30.5%, -7.8%). Conclusions: Immediate ART initiation substantially lowers mortality among persons in the CNICS and this benefit is expected to be similar among persons recently diagnosed with HIV in the USA. We demonstrate a method by which concerns about generalizability can be addressed and evaluated quantitatively.
KW - Antiretroviral therapy
KW - Effect modification
KW - External validity
KW - Generalizability
KW - HIV
KW - Mortality
KW - Survival analysis
UR - http://www.scopus.com/inward/record.url?scp=84964056729&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84964056729&partnerID=8YFLogxK
U2 - 10.1093/ije/dyv352
DO - 10.1093/ije/dyv352
M3 - Article
C2 - 26772869
AN - SCOPUS:84964056729
VL - 45
SP - 140
EP - 150
JO - International Journal of Epidemiology
JF - International Journal of Epidemiology
SN - 0300-5771
IS - 1
ER -