Skip to main content
Erschienen in: Infection 1/2011

01.02.2011 | Clinical and Epidemiological Study

Causes of death and risk factors among HIV-infected persons in the HAART era: analysis of a large urban cohort

verfasst von: S. Leone, G. Gregis, G. Quinzan, D. Velenti, G. Cologni, L. Soavi, V. Ravasio, D. Ripamonti, F. Suter, F. Maggiolo

Erschienen in: Infection | Ausgabe 1/2011

Einloggen, um Zugang zu erhalten

Abstract

Objective

We aimed to examine the clinical outcome in HIV-1-infected patients after more than 10 years of highly active antiretroviral therapy (HAART).

Methods

We analyzed data from 1,236 treatment-naïve adults who had started HAART. The primary endpoint was the yearly prevalence of death for AIDS-related causes (ARC) or for non-AIDS related causes (non-ARC). The data from our cohort were compared with that of the general population (GP) of our region.

Results

We observed that 116 patients died, and 58.6% of deaths were non-ARC. The death incidence decreased from 18.8% in 1998–1999 to 1.2% in 2008–2009. The leading causes of death were malignancies (35.3%), infections (21.6%), end-stage liver diseases (18.1%), and cardiovascular diseases (CVD) (6.9%). Yearly death rates were similar in the HIV-infected cohort and in the crude GP (odds ratio [OR] 1.1, 95% confidence interval [CI] 0.5–2.5), but when adjusted for age, HIV-infected patients showed a greater risk (OR 7.4, 95% CI 4.1–13.4). The difference was still highly significant when the analysis was restricted to non-ARCs (OR 4.3, 95% CI 2.07–9.2). Overall, malignancies (OR 5.7, 95% CI 2.6–12.8) and end-stage liver diseases (OR 35.0, 95% CI 15.5–78.8) were significantly more frequent than in the age-adjusted GP.

Conclusions

Despite HAART, HIV-infected patients are at greater risk of death compared to a reference uninfected population.
Literatur
1.
Zurück zum Zitat Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338:853–60.PubMedCrossRef Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338:853–60.PubMedCrossRef
2.
Zurück zum Zitat Palella FJ Jr, Baker RK, Moorman AC, Chmiel JS, Wood KC, Brooks JT, Holmberg SD. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006;43:27–34.PubMedCrossRef Palella FJ Jr, Baker RK, Moorman AC, Chmiel JS, Wood KC, Brooks JT, Holmberg SD. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006;43:27–34.PubMedCrossRef
3.
Zurück zum Zitat Martínez E, Milinkovic A, Buira E, de Lazzari E, León A, Larrousse M, Loncá M, Laguno M, Blanco JL, Mallolas J, García F, Miró JM, Gatell JM. Incidence and causes of death in HIV-infected persons receiving highly active antiretroviral therapy compared with estimates for the general population of similar age and from the same geographical area. HIV Med. 2007;8:251–8.PubMedCrossRef Martínez E, Milinkovic A, Buira E, de Lazzari E, León A, Larrousse M, Loncá M, Laguno M, Blanco JL, Mallolas J, García F, Miró JM, Gatell JM. Incidence and causes of death in HIV-infected persons receiving highly active antiretroviral therapy compared with estimates for the general population of similar age and from the same geographical area. HIV Med. 2007;8:251–8.PubMedCrossRef
4.
Zurück zum Zitat Centers for Disease Control and Prevention (CDC). 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Morb Mortal Wkly Rep. 1992;41:1–19. Centers for Disease Control and Prevention (CDC). 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Morb Mortal Wkly Rep. 1992;41:1–19.
6.
Zurück zum Zitat Mocroft A, Brettle R, Kirk O, Blaxhult A, Parkin JM, Antunes F, Francioli P, D’Arminio Monforte A, Fox Z, Lundgren JD. Changes in the cause of death among HIV positive subjects across Europe: results from the EuroSIDA study. AIDS. 2002;16:1663–71.PubMedCrossRef Mocroft A, Brettle R, Kirk O, Blaxhult A, Parkin JM, Antunes F, Francioli P, D’Arminio Monforte A, Fox Z, Lundgren JD. Changes in the cause of death among HIV positive subjects across Europe: results from the EuroSIDA study. AIDS. 2002;16:1663–71.PubMedCrossRef
7.
Zurück zum Zitat Marin B, Thiébaut R, Bucher HC, Rondeau V, Costagliola D, Dorrucci M, Hamouda O, Prins M, Walker S, Porter K, Sabin C, Chêne G. Non-AIDS-defining deaths and immunodeficiency in the era of combination antiretroviral therapy. AIDS. 2009;23:1743–53.PubMedCrossRef Marin B, Thiébaut R, Bucher HC, Rondeau V, Costagliola D, Dorrucci M, Hamouda O, Prins M, Walker S, Porter K, Sabin C, Chêne G. Non-AIDS-defining deaths and immunodeficiency in the era of combination antiretroviral therapy. AIDS. 2009;23:1743–53.PubMedCrossRef
8.
Zurück zum Zitat The Antiretroviral Therapy Cohort Collaboration. Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996–2006: collaborative analysis of 13 HIV cohort studies. Clin Infect Dis. 2010;50:1387–96.CrossRef The Antiretroviral Therapy Cohort Collaboration. Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996–2006: collaborative analysis of 13 HIV cohort studies. Clin Infect Dis. 2010;50:1387–96.CrossRef
9.
Zurück zum Zitat Weber R, Sabin CA, Friis-Møller N, Reiss P, El-Sadr WM, Kirk O, Dabis F, Law MG, Pradier C, De Wit S, Akerlund B, Calvo G, Monforte A, Rickenbach M, Ledergerber B, Phillips AN, Lundgren JD. Liver-related deaths in persons infected with the human immunodeficiency virus: the D:A:D study. Arch Intern Med. 2006;166:1632–41.PubMedCrossRef Weber R, Sabin CA, Friis-Møller N, Reiss P, El-Sadr WM, Kirk O, Dabis F, Law MG, Pradier C, De Wit S, Akerlund B, Calvo G, Monforte A, Rickenbach M, Ledergerber B, Phillips AN, Lundgren JD. Liver-related deaths in persons infected with the human immunodeficiency virus: the D:A:D study. Arch Intern Med. 2006;166:1632–41.PubMedCrossRef
10.
Zurück zum Zitat Crum NF, Riffenburgh RH, Wegner S, Agan BK, Tasker SA, Spooner KM, Armstrong AW, Fraser S, Wallace MR. Comparisons of causes of death and mortality rates among HIV-infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. J Acquir Immune Defic Syndr. 2006;41:194–200.PubMedCrossRef Crum NF, Riffenburgh RH, Wegner S, Agan BK, Tasker SA, Spooner KM, Armstrong AW, Fraser S, Wallace MR. Comparisons of causes of death and mortality rates among HIV-infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. J Acquir Immune Defic Syndr. 2006;41:194–200.PubMedCrossRef
11.
Zurück zum Zitat van Sighem A, Danner S, Ghani AC, Gras L, Anderson RM, de Wolf F. Mortality in patients with successful initial response to highly active antiretroviral therapy is still higher than in non-HIV-infected individuals. J Acquir Immune Defic Syndr. 2005;40:212–8.PubMedCrossRef van Sighem A, Danner S, Ghani AC, Gras L, Anderson RM, de Wolf F. Mortality in patients with successful initial response to highly active antiretroviral therapy is still higher than in non-HIV-infected individuals. J Acquir Immune Defic Syndr. 2005;40:212–8.PubMedCrossRef
12.
Zurück zum Zitat Jaggy C, von Overbeck J, Ledergerber B, Schwarz C, Egger M, Rickenbach M, Furrer HJ, Telenti A, Battegay M, Flepp M, Vernazza P, Bernasconi E, Hirschel B. Mortality in the Swiss HIV Cohort Study (SHCS) and the Swiss general population. Lancet. 2003;362:877–8.PubMedCrossRef Jaggy C, von Overbeck J, Ledergerber B, Schwarz C, Egger M, Rickenbach M, Furrer HJ, Telenti A, Battegay M, Flepp M, Vernazza P, Bernasconi E, Hirschel B. Mortality in the Swiss HIV Cohort Study (SHCS) and the Swiss general population. Lancet. 2003;362:877–8.PubMedCrossRef
13.
Zurück zum Zitat Keiser O, Taffé P, Zwahlen M, Battegay M, Bernasconi E, Weber R, Rickenbach M. All cause mortality in the Swiss HIV Cohort Study from 1990 to 2001 in comparison with the Swiss population. AIDS. 2004;18:1835–43.PubMedCrossRef Keiser O, Taffé P, Zwahlen M, Battegay M, Bernasconi E, Weber R, Rickenbach M. All cause mortality in the Swiss HIV Cohort Study from 1990 to 2001 in comparison with the Swiss population. AIDS. 2004;18:1835–43.PubMedCrossRef
14.
Zurück zum Zitat Patel P, Hanson DL, Sullivan PS, Novak RM, Moorman AC, Tong TC, Holmberg SD, Brooks JT. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992–2003. Ann Intern Med. 2008;148:728–36.PubMed Patel P, Hanson DL, Sullivan PS, Novak RM, Moorman AC, Tong TC, Holmberg SD, Brooks JT. Incidence of types of cancer among HIV-infected persons compared with the general population in the United States, 1992–2003. Ann Intern Med. 2008;148:728–36.PubMed
15.
Zurück zum Zitat Powles T, Robinson D, Stebbing J, Shamash J, Nelson M, Gazzard B, Mandelia S, Møller H, Bower M. Highly active antiretroviral therapy and the incidence of non-AIDS-defining cancers in people with HIV infection. J Clin Oncol. 2009;27:884–90.PubMedCrossRef Powles T, Robinson D, Stebbing J, Shamash J, Nelson M, Gazzard B, Mandelia S, Møller H, Bower M. Highly active antiretroviral therapy and the incidence of non-AIDS-defining cancers in people with HIV infection. J Clin Oncol. 2009;27:884–90.PubMedCrossRef
16.
Zurück zum Zitat Monforte A, Abrams D, Pradier C, Weber R, Reiss P, Bonnet F, Kirk O, Law M, De Wit S, Friis-Møller N, Phillips AN, Sabin CA, Lundgren JD. HIV-induced immunodeficiency and mortality from AIDS-defining and non-AIDS-defining malignancies. AIDS. 2008;22:2143–53.PubMedCrossRef Monforte A, Abrams D, Pradier C, Weber R, Reiss P, Bonnet F, Kirk O, Law M, De Wit S, Friis-Møller N, Phillips AN, Sabin CA, Lundgren JD. HIV-induced immunodeficiency and mortality from AIDS-defining and non-AIDS-defining malignancies. AIDS. 2008;22:2143–53.PubMedCrossRef
17.
Zurück zum Zitat Chaturvedi AK, Pfeiffer RM, Chang L, Goedert JJ, Biggar RJ, Engels EA. Elevated risk of lung cancer among people with AIDS. AIDS. 2007;21:207–13.PubMedCrossRef Chaturvedi AK, Pfeiffer RM, Chang L, Goedert JJ, Biggar RJ, Engels EA. Elevated risk of lung cancer among people with AIDS. AIDS. 2007;21:207–13.PubMedCrossRef
18.
Zurück zum Zitat Engels EA. Non-AIDS-defining malignancies in HIV-infected persons: etiologic puzzles, epidemiologic perils, prevention opportunities. AIDS. 2009;23:875–85.PubMedCrossRef Engels EA. Non-AIDS-defining malignancies in HIV-infected persons: etiologic puzzles, epidemiologic perils, prevention opportunities. AIDS. 2009;23:875–85.PubMedCrossRef
19.
Zurück zum Zitat Stebbing J, Duru O, Bower M. Non-AIDS-defining cancers. Curr Opin Infect Dis. 2009;22:7–10.PubMedCrossRef Stebbing J, Duru O, Bower M. Non-AIDS-defining cancers. Curr Opin Infect Dis. 2009;22:7–10.PubMedCrossRef
20.
Zurück zum Zitat Sterne JA, May M, Costagliola D, de Wolf F, Phillips AN, Harris R, Funk MJ, Geskus RB, Gill J, Dabis F, Miró JM, Justice AC, Ledergerber B, Fätkenheuer G, Hogg RS, Monforte AD, Saag M, Smith C, Staszewski S, Egger M, Cole SR. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies. Lancet. 2009;373:1352–63.PubMedCrossRef Sterne JA, May M, Costagliola D, de Wolf F, Phillips AN, Harris R, Funk MJ, Geskus RB, Gill J, Dabis F, Miró JM, Justice AC, Ledergerber B, Fätkenheuer G, Hogg RS, Monforte AD, Saag M, Smith C, Staszewski S, Egger M, Cole SR. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies. Lancet. 2009;373:1352–63.PubMedCrossRef
21.
Zurück zum Zitat Prosperi MC, Cozzi-Lepri A, Castagna A, Mussini C, Murri R, Giacometti A, Torti C, Costantini A, Narciso P, Ghinelli F, Antinori A, d’Arminio Monforte A; Icona Foundation Study Group. Incidence of malignancies in HIV-infected patients and prognostic role of current CD4 cell count: evidence from a large Italian cohort study. Clin Infect Dis. 2010;50:1316–21.PubMedCrossRef Prosperi MC, Cozzi-Lepri A, Castagna A, Mussini C, Murri R, Giacometti A, Torti C, Costantini A, Narciso P, Ghinelli F, Antinori A, d’Arminio Monforte A; Icona Foundation Study Group. Incidence of malignancies in HIV-infected patients and prognostic role of current CD4 cell count: evidence from a large Italian cohort study. Clin Infect Dis. 2010;50:1316–21.PubMedCrossRef
23.
Zurück zum Zitat Antinori A, Ammassari A, Torti C, Marconi P, Andreoni M, Angarano G, Bonora S, Castagna A, Cauda R, Clerici M, Monforte A, De Luca A, Di Perri G, Galli M, Girardi E, Gori A, Lazzarin A, Lo Caputo S, Mazzotta F, Montella F, Mussini C, Perno CF, Puoti M, Rizzardini G, Rusconi S, Vullo V, Carosi G. Italian consensus statement on management of HIV-infected individuals with advanced disease naïve to antiretroviral therapy. Infection. 2009;37:270–82.PubMed Antinori A, Ammassari A, Torti C, Marconi P, Andreoni M, Angarano G, Bonora S, Castagna A, Cauda R, Clerici M, Monforte A, De Luca A, Di Perri G, Galli M, Girardi E, Gori A, Lazzarin A, Lo Caputo S, Mazzotta F, Montella F, Mussini C, Perno CF, Puoti M, Rizzardini G, Rusconi S, Vullo V, Carosi G. Italian consensus statement on management of HIV-infected individuals with advanced disease naïve to antiretroviral therapy. Infection. 2009;37:270–82.PubMed
24.
Zurück zum Zitat Giaquinto C, Penazzato M, Rosso R, Bernardi S, Rampon O, Nasta P, Ammassari A, Antinori A, Badolato R, Castelli Gattinara G, d’Arminio Monforte A, De Martino M, De Rossi A, Di Gregorio P, Esposito S, Fatuzzo F, Fiore S, Franco A, Gabiano C, Galli L, Genovese O, Giacomet V, Giannattasio A, Gotta C, Guarino A, Martino A, Mazzotta F, Principi N, Regazzi MB, Rossi P, Russo R, Saitta M, Salvini F, Trotta S, Viganò A, Zuccotti G, Carosi G. Italian consensus statement on paediatric HIV infection. Infection. 2010;38:301–19.PubMedCrossRef Giaquinto C, Penazzato M, Rosso R, Bernardi S, Rampon O, Nasta P, Ammassari A, Antinori A, Badolato R, Castelli Gattinara G, d’Arminio Monforte A, De Martino M, De Rossi A, Di Gregorio P, Esposito S, Fatuzzo F, Fiore S, Franco A, Gabiano C, Galli L, Genovese O, Giacomet V, Giannattasio A, Gotta C, Guarino A, Martino A, Mazzotta F, Principi N, Regazzi MB, Rossi P, Russo R, Saitta M, Salvini F, Trotta S, Viganò A, Zuccotti G, Carosi G. Italian consensus statement on paediatric HIV infection. Infection. 2010;38:301–19.PubMedCrossRef
Metadaten
Titel
Causes of death and risk factors among HIV-infected persons in the HAART era: analysis of a large urban cohort
verfasst von
S. Leone
G. Gregis
G. Quinzan
D. Velenti
G. Cologni
L. Soavi
V. Ravasio
D. Ripamonti
F. Suter
F. Maggiolo
Publikationsdatum
01.02.2011
Verlag
Springer-Verlag
Erschienen in
Infection / Ausgabe 1/2011
Print ISSN: 0300-8126
Elektronische ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-010-0079-z

Weitere Artikel der Ausgabe 1/2011

Infection 1/2011 Zur Ausgabe

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.