Adjudicated Morbidity and Mortality Outcomes by Age among Individuals with HIV Infection on Suppressive Antiretroviral Therapy
Miller, Christopher J. (University of Minnesota, Minneapolis, Minnesota)
Baker, Jason V. (Hennepin County Medical Center, Minneapolis, USA)
Bormann, Alison M. (Division of Infectious Diseases, University of Minnesota)
Erlandson, Kristine M. (University of Colorado Anschutz Medical Campus)
Huppler Hullsiek, Katherine (University of Minnesota, Minneapolis, Minnesota)
Justice, Amy C. (School of Medicine and Public Health, Yale University)
Neuhaus, Jacqueline (University of Minnesota, Minneapolis)
Paredes, Roger (Universitat Autònoma de Barcelona. Departament de Medicina)
Petoumenos, Kathy (University of New South Wales, Sidney)
Wentworth, Deborah (University of Minnesota)
Winston, Alan (Imperial College London. Department of Medicine)
Wolfson, Julian (University of Minnesota)
Neaton, James D. (University of Minnesota)

Data:	2014
Resum:	Non-AIDS conditions such as cardiovascular disease and non-AIDS defining cancers dominate causes of morbidity and mortality among persons with HIV on suppressive combination antiretroviral therapy. Accurate estimates of disease incidence and of risk factors for these conditions are important in planning preventative efforts. With use of medical records, serious non-AIDS events, AIDS events, and causes of death were adjudicated using pre-specified criteria by an Endpoint Review Committee in two large international trials. Rates of serious non-AIDS which include cardiovascular disease, end-stage renal disease, decompensated liver disease, and non-AIDS cancer, and other serious (grade 4) adverse events were determined, overall and by age, over a median follow-up of 4. 3 years for 3,570 participants with CD4 + cell count ≥300 cells/mm 3 who were taking antiretroviral therapy and had an HIV RNA level ≤500 copies/mL. Cox models were used to examine the effect of age and other baseline factors on risk of a composite outcome of all-cause mortality, AIDS, or serious non-AIDS. Five-year Kaplan-Meier estimates of the composite outcome, overall and by age were 8. 3% (overall), 3. 6% (<40), 8. 7% (40-49) and 16. 1% (≥50), respectively (p<0. 001). In addition to age, smoking and higher levels of interleukin-6 and D-dimer were significant predictors of the composite outcome. The composite outcome was dominated by serious non-AIDS events (overall 65% of 277 participants with a composite event). Most serious non-AIDS events were due to cardiovascular disease and non-AIDS cancers. To date, few large studies have carefully collected data on serious non-AIDS outcomes. Thus, reliable estimates of event rates are scarce. Data cited here, from a geographically diverse cohort, will be useful for planning studies of interventions aimed at reducing rates of serious non-AIDS events among people with HIV.
Nota:	Altres ajuts: NIAID (AI007432-15); NIAID (U01AI042170, U01AI46362); ESPRIT (U01AI46957, U01AI068641)
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	PloS one, Vol. 9 (april 2014) , ISSN 1932-6203

DOI: 10.1371/journal.pone.0095061
PMID: 24728071

11 p, 395.6 KB

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