Co-Morbidity, ageing and predicted mortality in antiretroviral treated Australian men: a quantitative analysis

Furuya-Kanamori, L., Kelly, M. D. and McKenzie, S. J. (2013) Co-Morbidity, ageing and predicted mortality in antiretroviral treated Australian men: a quantitative analysis. PLoS One, 8 10: e78403.1-e78403.8. doi:10.1371/journal.pone.0078403


Author Furuya-Kanamori, L.
Kelly, M. D.
McKenzie, S. J.
Title Co-Morbidity, ageing and predicted mortality in antiretroviral treated Australian men: a quantitative analysis
Journal name PLoS One   Check publisher's open access policy
ISSN 1932-6203
Publication date 2013-10-25
Sub-type Article (original research)
DOI 10.1371/journal.pone.0078403
Open Access Status DOI
Volume 8
Issue 10
Start page e78403.1
End page e78403.8
Total pages 8
Place of publication San Francisco, CA, United States
Publisher Public Library of Science
Subject 1100 Agricultural and Biological Sciences
1300 Biochemistry, Genetics and Molecular Biology
2700 Medicine
Formatted abstract
Background: Life expectancy has increased in HIV-positive individuals receiving combination antiretroviral therapy (cART); however, they still experience increased mortality due to ageing-associated comorbidities compared with HIV-negative individuals.

Methods: A retrospective study of 314 Queensland HIV-infected males on cART was conducted. The negative impact of ageing was assessed by estimating the probability of 5-year mortality; comparisons were made between an HIV-specific predictive tool (VACS index) and the Australian Bureau of Statistics (ABS) life-tables to examine potential differences attributed to HIV. The negative impact of ageing was also assessed by the prevalence of comorbidities. Associations between comorbidity and estimates of predicted mortality by regression analysis were assessed.

Results: The mean predicted 5-year mortality rate was 6% using the VACS index compared with 2.1% using the ABS life-table (p<0.001). The proportion of patients at predicted high risk of mortality (>9%) using the VACS index or ABS life-table were 17% and 1.8% respectively. Comorbidities were also more prevalent in this cohort compared with rates of comorbidities in age-matched Australian men from the general population. Metabolic disease (38.2%) was the most prevalent comorbidity followed by renal (33.1%) and cardiovascular disease (23.9%). Multivariate analysis demonstrated that patients with a history of cardiovascular disease had a higher predicted risk of mortality (OR=1.69;95%CI:1.17-2.45) whereas ex-smokers had a lower predicted risk of mortality (OR=0.61;95%CI:0.41-0.92).

Conclusions: Using the VACS Index there is an increased predicted risk of mortality in cART-treated HIV infected Australian men compared with age-matched men using the ABS data. This increased predicted mortality risk is associated with cardiovascular disease and the number of comorbidities per subject; which suggests that the VACS Index may discriminate between high and low predicted mortality risks in this population. However, until the VACS Index is validated in Australia this data may suggest the VACS Index overestimates predicted mortality risk in this country.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Public Health Publications
 
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Created: Mon, 18 Nov 2013, 20:22:36 EST by Dr Anna D MacDonald (nee Holmes) on behalf of School of Public Health