Mortality among people with HIV on ART significantly declined from 1996 to 2020
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Key takeaways:
- Rates of all-cause mortality among people with HIV decreased between 1996 and 2020.
- The highest decrease was observed for AIDS-related deaths, which declined from 49% to 16% during across study periods.
Rates of cause-specific mortality among people with HIV on ART declined between 1996 and 2020, with the largest reductions being in rates of AIDS-related mortality, researchers found.
“Since combination ART became available in the mid-1990s, mortality rates for people with HIV on ART have fallen dramatically and causes of death have also changed over this time,” Adam Trickey, PhD, MSc, BSc, research fellow at Bristol Medical School, told Healio.
“This analysis is, to our knowledge, the largest study of causes of death among people with HIV living in Western Europe and North America and aimed to summarize the changes in causes of death among people with HIV that have occurred since 1996,” he said.
Trickey and colleagues conducted a collaborative observational cohort study using data from all patients aged 16 and older who started ART between 1996 and 2020 from 17 European and North American HIV cohorts.
According to the study, causes of death were classified into a single cause by both a clinician and an algorithm if required data were available, or independently by two clinicians. Poisson models were then used to compare cause-specific mortality rates during the calendar periods 1996-1999, 2000-2003, 2004-2007, 2008-2011, 2012-2015 and 2016-2020.
Among 189,301 people with HIV included in this study, a total of 16,832 (8.9%) deaths were recorded. Of these deaths, 13,180 (78.3%) were classified by cause, with the most common causes being AIDS (25%), non-AIDS nonhepatitis malignancy (13.7%) and cardiovascular or heart-related (8.3%) mortality.
Throughout the study periods, rates of all-cause mortality per 1,000 person-years decreased from 16.8 deaths (95% CI, 15.4-18.4) during 1996-1999 to 7.9 deaths (95% CI, 7.6-8.2) during 2016-2020.
The data revealed that rates of cause-specific mortality also declined, with the most significant reduction being for AIDS-related mortality (0.81; 95% CI, 0.79-0.83), which declined from 49% during the 1996-1999 period to 16% during 2016-2020.
Reductions were also seen for rates of cardiovascular-related mortality (0.83; 95% CI, 0.79-0.87), liver-related mortality (0.88; 95% CI, 0.84-0.93), non-AIDS infection-related mortality (0.91; 95% CI, 0.86-0.96), non-AIDS-nonhepatocellular carcinoma malignancy-related mortality (0.94; 95% CI, 0.9-0.97) and suicide or accident-related mortality (0.89; 95% CI, 0.82-0.95).
"Although mortality among people with HIV has decreased, there is still higher mortality among people with HIV than among the general population, due both to the consequences of HIV infection and to a higher prevalence of comorbidities and risk behaviors among people with HIV," Trickey and colleagues wrote.
The researchers said that expanded access to prevention, screening and treatment of non-AIDS-related causes of death among people with HIV could narrow this gap. They also noted that progress in reducing mortality was not equal among all subgroups.
For example, men who acquired HIV through injection drug use experienced the lowest reductions in mortality, and there may have been an increase in mortality among women who acquired HIV this way, according to the study.
“Improvements in ART and HIV care have led to reductions over time in rates of most major causes of death among people with HIV on antiretroviral therapy, particularly AIDS-related deaths,” Trickey said. “The unequal reductions in mortality among different populations of people with HIV indicate that interventions should be targeted at high-risk groups, substance use, and comorbidities to further increase life expectancy among people with HIV.”
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