Risk of all-cause mortality associated with nonfatal AIDS and serious non-AIDS events among adults infected with HIV.
OBJECTIVES: Among patients with HIV, the risk of death associated with different AIDS events has been quantified, but the risk of death associated with non-AIDS events has not been examined. We compared the risk of all-cause mortality following AIDS versus serious non-AIDS (SNA) events in the Strate...
| Główni autorzy: | , , , , , , |
|---|---|
| Format: | Journal article |
| Język: | English |
| Wydane: |
2010
|
| _version_ | 1826294176819445760 |
|---|---|
| author | Neuhaus, J Angus, B Kowalska, J La Rosa, A Sampson, J Wentworth, D Mocroft, A |
| author_facet | Neuhaus, J Angus, B Kowalska, J La Rosa, A Sampson, J Wentworth, D Mocroft, A |
| author_sort | Neuhaus, J |
| collection | OXFORD |
| description | OBJECTIVES: Among patients with HIV, the risk of death associated with different AIDS events has been quantified, but the risk of death associated with non-AIDS events has not been examined. We compared the risk of all-cause mortality following AIDS versus serious non-AIDS (SNA) events in the Strategies for Management of Antiretroviral Therapy (SMART) study and the Evaluation of Subcutaneous Proleukin in a Randomized International Trial (ESPRIT). DESIGN: Data from 9583 HIV-infected participants, 5472 with a CD4 cell count more than 350 cells/microl enrolled in SMART and 4111 with a CD4 cell count 300 cells/microl or more enrolled in ESPRIT, were analyzed. METHODS: Cumulative mortality 6 months after AIDS and SNA events (cardiovascular, renal, hepatic disease, and malignancies) was estimated using the Kaplan-Meier method. Cox models were used to estimate hazard ratios associated with AIDS and SNA events on the risk of death overall and by treatment group within study. RESULTS: AIDS and SNA events occurred in 286 and 435 participants with 47 (16%) and 115 (26%) subsequent deaths, respectively. Six-month cumulative mortality was 4.7% [95% confidence interval (CI) 2.8-8.0] after experiencing an AIDS event and 13.4% (95% CI 10.5-17.0) after experiencing an SNA event. The adjusted hazard ratio for all-cause mortality for those who experienced AIDS versus those who did not was 4.9 (95% CI 3.6-6.8). The corresponding hazard ratio for SNA was 11.4 (95% CI 9.0-14.5) (P < 0.001 for difference in hazard ratios). Findings were similar for both treatment groups in SMART and both treatment groups in ESPRIT. CONCLUSION: Among HIV-infected persons with higher CD4 cell counts, SNA events occur more frequently and are associated with a greater risk of death than AIDS events. Future research should be aimed at comparing strategies to reduce morbidity and mortality associated with SNA events for HIV-infected persons. |
| first_indexed | 2024-03-07T03:41:36Z |
| format | Journal article |
| id | oxford-uuid:be13e85e-f1fb-4e5f-b16b-9374e26e4e27 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T03:41:36Z |
| publishDate | 2010 |
| record_format | dspace |
| spelling | oxford-uuid:be13e85e-f1fb-4e5f-b16b-9374e26e4e272022-03-27T05:36:35ZRisk of all-cause mortality associated with nonfatal AIDS and serious non-AIDS events among adults infected with HIV.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:be13e85e-f1fb-4e5f-b16b-9374e26e4e27EnglishSymplectic Elements at Oxford2010Neuhaus, JAngus, BKowalska, JLa Rosa, ASampson, JWentworth, DMocroft, AOBJECTIVES: Among patients with HIV, the risk of death associated with different AIDS events has been quantified, but the risk of death associated with non-AIDS events has not been examined. We compared the risk of all-cause mortality following AIDS versus serious non-AIDS (SNA) events in the Strategies for Management of Antiretroviral Therapy (SMART) study and the Evaluation of Subcutaneous Proleukin in a Randomized International Trial (ESPRIT). DESIGN: Data from 9583 HIV-infected participants, 5472 with a CD4 cell count more than 350 cells/microl enrolled in SMART and 4111 with a CD4 cell count 300 cells/microl or more enrolled in ESPRIT, were analyzed. METHODS: Cumulative mortality 6 months after AIDS and SNA events (cardiovascular, renal, hepatic disease, and malignancies) was estimated using the Kaplan-Meier method. Cox models were used to estimate hazard ratios associated with AIDS and SNA events on the risk of death overall and by treatment group within study. RESULTS: AIDS and SNA events occurred in 286 and 435 participants with 47 (16%) and 115 (26%) subsequent deaths, respectively. Six-month cumulative mortality was 4.7% [95% confidence interval (CI) 2.8-8.0] after experiencing an AIDS event and 13.4% (95% CI 10.5-17.0) after experiencing an SNA event. The adjusted hazard ratio for all-cause mortality for those who experienced AIDS versus those who did not was 4.9 (95% CI 3.6-6.8). The corresponding hazard ratio for SNA was 11.4 (95% CI 9.0-14.5) (P < 0.001 for difference in hazard ratios). Findings were similar for both treatment groups in SMART and both treatment groups in ESPRIT. CONCLUSION: Among HIV-infected persons with higher CD4 cell counts, SNA events occur more frequently and are associated with a greater risk of death than AIDS events. Future research should be aimed at comparing strategies to reduce morbidity and mortality associated with SNA events for HIV-infected persons. |
| spellingShingle | Neuhaus, J Angus, B Kowalska, J La Rosa, A Sampson, J Wentworth, D Mocroft, A Risk of all-cause mortality associated with nonfatal AIDS and serious non-AIDS events among adults infected with HIV. |
| title | Risk of all-cause mortality associated with nonfatal AIDS and serious non-AIDS events among adults infected with HIV. |
| title_full | Risk of all-cause mortality associated with nonfatal AIDS and serious non-AIDS events among adults infected with HIV. |
| title_fullStr | Risk of all-cause mortality associated with nonfatal AIDS and serious non-AIDS events among adults infected with HIV. |
| title_full_unstemmed | Risk of all-cause mortality associated with nonfatal AIDS and serious non-AIDS events among adults infected with HIV. |
| title_short | Risk of all-cause mortality associated with nonfatal AIDS and serious non-AIDS events among adults infected with HIV. |
| title_sort | risk of all cause mortality associated with nonfatal aids and serious non aids events among adults infected with hiv |
| work_keys_str_mv | AT neuhausj riskofallcausemortalityassociatedwithnonfatalaidsandseriousnonaidseventsamongadultsinfectedwithhiv AT angusb riskofallcausemortalityassociatedwithnonfatalaidsandseriousnonaidseventsamongadultsinfectedwithhiv AT kowalskaj riskofallcausemortalityassociatedwithnonfatalaidsandseriousnonaidseventsamongadultsinfectedwithhiv AT larosaa riskofallcausemortalityassociatedwithnonfatalaidsandseriousnonaidseventsamongadultsinfectedwithhiv AT sampsonj riskofallcausemortalityassociatedwithnonfatalaidsandseriousnonaidseventsamongadultsinfectedwithhiv AT wentworthd riskofallcausemortalityassociatedwithnonfatalaidsandseriousnonaidseventsamongadultsinfectedwithhiv AT mocrofta riskofallcausemortalityassociatedwithnonfatalaidsandseriousnonaidseventsamongadultsinfectedwithhiv |