Long-Term survival in HIV positive patients with up to 15 years of antiretroviral therapy

McManus, Hamish, O'Connor, Catherine C., Boyd, Mark, Broom, Jennifer, Russell, Darren, Watson, Kerrie, Roth, Norman, Read, Phillip J., Petoumenos, Kathy and Law, Matthew G. (2012) Long-Term survival in HIV positive patients with up to 15 years of antiretroviral therapy. Plos One, 7 11: e48839.1-e48839.9. doi:10.1371/journal.pone.0048839

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Author McManus, Hamish
O'Connor, Catherine C.
Boyd, Mark
Broom, Jennifer
Russell, Darren
Watson, Kerrie
Roth, Norman
Read, Phillip J.
Petoumenos, Kathy
Law, Matthew G.
Title Long-Term survival in HIV positive patients with up to 15 years of antiretroviral therapy
Journal name Plos One   Check publisher's open access policy
ISSN 1932-6203
Publication date 2012-11-01
Sub-type Article (original research)
DOI 10.1371/journal.pone.0048839
Open Access Status DOI
Volume 7
Issue 11
Start page e48839.1
End page e48839.9
Total pages 9
Editor Michael Alan Polis
Place of publication San Francisco, United States
Publisher Public Library of Science
Language eng
Formatted abstract
Background: Life expectancy has increased for newly diagnosed HIV patients since the inception of combination antiretroviral treatment (cART), but there remains a need to better understand the characteristics of long-term survival in HIV-positive patients. We examined long-term survival in HIV-positive patients receiving cART in the Australian HIV Observational Database (AHOD), to describe changes in mortality compared to the general population and to develop longer-term survival models.

Methods: Data were examined from 2,675 HIV-positive participants in AHOD who started cART. Standardised mortality ratios (SMR) were calculated by age, sex and calendar year across prognostic characteristics using Australian Bureau of Statistics national data as reference. SMRs were examined by years of duration of cART by CD4 and similarly by viral load. Survival was analysed using Cox-proportional hazards and parametric survival models.

Results: The overall SMR for all-cause mortality was 3.5 (95% CI: 3.0–4.0). SMRs by CD4 count were 8.6 (95% CI: 7.2–10.2) for CD4<350 cells/µl; 2.1 (95% CI: 1.5–2.9) for CD4 = 350–499 cells/µl; and 1.5 (95% CI: 1.1–2.0) for CD4≥500 cells/µl. SMRs for patients with CD4 counts <350 cells/µL were much higher than for patients with higher CD4 counts across all durations of cART. SMRs for patients with viral loads greater than 400 copies/ml were much higher across all durations of cART. Multivariate models demonstrated improved survival associated with increased recent CD4, reduced recent viral load, younger patients, absence of HBVsAg-positive ever, year of HIV diagnosis and incidence of ADI. Parametric models showed a fairly constant mortality risk by year of cART up to 15 years of treatment.

Conclusion: Observed mortality remained fairly constant by duration of cART and was modelled accurately by accepted prognostic factors. These rates did not vary much by duration of treatment. Changes in mortality with age were similar to those in the Australian general population.
Keyword Cd4 Cell Counts
Life Expectancy
Collaborative Analysis
Controlled-Trial
Mortality
Cohort
Population
Individuals
Infection
Diagnosis
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
 
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