Risk of non-AIDS-related mortality may exceed risk of AIDS-related mortality among individuals enrolling into care with CD4+ counts greater than 200 cells/mm3

被引:92
作者
Lau, Bryan
Gange, Stephen J.
Moore, Richard D.
机构
[1] Johns Hopkins Univ, Sch Med, Dept Med, Baltimore, MD 21287 USA
[2] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA
关键词
cohort; competing risks; epidemiologic methods; HIV; mortality;
D O I
10.1097/01.qai.0000247229.68246.c5
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objective: To quantify cause-specific mortality risk attributable to non-AIDS-related and AIDS-related causes before and after the advent of highly active antiretroviral therapy (HAART). Methods: Competing-risk methods were used to determine the cumulative AIDS-related and non-AID S-related risk of mortality between 1990 and the end of 2003 in the Johns Hopkins HIV Clinical Cohort, a prospective cohort study. Results: Beginning in 1997 with the introduction of HAART, all-cause mortality declined and has remained stable at approximately 39 deaths per 1000 person-years. AIDS-related mortality continued to decline in this period (P = 0.008), whereas non-AIDS-related mortality increased (P < 0.001). Using competing-risk methods, the risk of dying attributable to AIDS-related causes remains significantly higher than the risk of dying attributable to non-AIDS-related causes for patients with a CD4(+) count : 200 cells/mm(3) in the HAART era. For those with a CD4(+) count > 200 cells/mm(3), however, non-AIDS-related mortality was greater than AIDS-related mortality, particularly among injection drug users. Other transmission categories had similar AIDS-related and non-AIDS-related cumulative mortalities. Conclusions: HAART has reduced mortality rates among HIV-infected individuals. but further efforts to reduce mortality in this population require increased attention to conditions that have not traditionally been considered to be HIV related.
引用
收藏
页码:179 / 187
页数:9
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