The effect of antiretroviral therapy on all-cause mortality, generalized to persons diagnosed with HIV in the USA, 2009-11

CNICS Investigators

Research output: Contribution to journalArticle

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 languageEnglish (US)
Pages (from-to)140-150
Number of pages11
JournalInternational Journal of Epidemiology
Volume45
Issue number1
DOIs
StatePublished - Feb 1 2016

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HIV
Mortality
Confidence Intervals
Therapeutics
Health Services Needs and Demand
Acquired Immunodeficiency Syndrome
Survival
Research

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 journalArticle

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title = "The effect of antiretroviral therapy on all-cause mortality, generalized to persons diagnosed with HIV in the USA, 2009-11",
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.",
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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.

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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.

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KW - Effect modification

KW - External validity

KW - Generalizability

KW - HIV

KW - Mortality

KW - Survival analysis

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