Journal article
Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics
International journal of epidemiology, Vol.41(6), pp.1807-1820
12/2012
DOI: 10.1093/ije/dys164
PMCID: PMC3535877
PMID: 23148105
Abstract
Background
HIV cohort collaborations, which pool data from diverse patient
cohorts, have provided key insights into outcomes of antiretroviral therapy (ART).
However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and
mortality are unclear.
Methods
We obtained data on adult HIV-positive patients who started ART from
1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe.
Patients were followed up from 1 month to 2 years after starting ART. We examined
between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year,
CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects
meta-analysis and meta-regression.
Results
During 61 520 person-years, 754/38 706 (1.9%) patients died
and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was
reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient
characteristics. Adjusted mortality rates were inversely associated with cohorts’
estimated completeness of death ascertainment [excellent: 96–100%, good:
90–95%, average: 75–89%; mortality rate ratio 0.66 (95%
confidence interval 0.46–0.94) per category]. Mortality rate ratios comparing Europe
with North America were 0.42 (0.31–0.57) before and 0.47 (0.30–0.73) after
adjusting for completeness of ascertainment.
Conclusions
Heterogeneity between settings in outcomes of HIV treatment has
implications for collaborative analyses, policy and clinical care. Estimated mortality
rates may require adjustment for completeness of ascertainment. Higher mortality rate in
North American, compared with European, cohorts was not fully explained by completeness of
ascertainment and may be because of the inclusion of more socially marginalized patients
with higher mortality risk.
Details
- Title: Subtitle
- Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics
- Creators
- Margaret T May - University of BristolRobert S Hogg - School of Social and Community Medicine, University of Bristol, Bristol, UKAmy C Justice - School of Social and Community Medicine, University of Bristol, Bristol, UKBryan E Shepherd - School of Social and Community Medicine, University of Bristol, Bristol, UKDominique Costagliola - School of Social and Community Medicine, University of Bristol, Bristol, UKBruno Ledergerber - School of Social and Community Medicine, University of Bristol, Bristol, UKRodolphe Thiébaut - School of Social and Community Medicine, University of Bristol, Bristol, UKM John Gill - School of Social and Community Medicine, University of Bristol, Bristol, UKOle Kirk - School of Social and Community Medicine, University of Bristol, Bristol, UKArd van Sighem - School of Social and Community Medicine, University of Bristol, Bristol, UKMichael S Saag - School of Social and Community Medicine, University of Bristol, Bristol, UKGemma Navarro - School of Social and Community Medicine, University of Bristol, Bristol, UKPaz Sobrino-Vegas - School of Social and Community Medicine, University of Bristol, Bristol, UKFiona Lampe - School of Social and Community Medicine, University of Bristol, Bristol, UKSuzanne Ingle - School of Social and Community Medicine, University of Bristol, Bristol, UKJodie L Guest - School of Social and Community Medicine, University of Bristol, Bristol, UKHeidi M Crane - School of Social and Community Medicine, University of Bristol, Bristol, UKAntonella D’Arminio Monforte - School of Social and Community Medicine, University of Bristol, Bristol, UKJörg J Vehreschild - School of Social and Community Medicine, University of Bristol, Bristol, UKJonathan AC Sterne - School of Social and Community Medicine, University of Bristol, Bristol, UKAntiretroviral Therapy Cohort Collaboration
- Contributors
- Michael Ohl (Contributor) - University of Iowa, Internal Medicine
- Resource Type
- Journal article
- Publication Details
- International journal of epidemiology, Vol.41(6), pp.1807-1820
- Publisher
- Oxford University Press
- DOI
- 10.1093/ije/dys164
- PMID
- 23148105
- PMCID
- PMC3535877
- ISSN
- 0300-5771
- eISSN
- 1464-3685
- Language
- English
- Date published
- 12/2012
- Academic Unit
- Psychiatry; Internal Medicine
- Record Identifier
- 9984094521402771
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