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AIDS-related and non-AIDS-related mortality in the Asia-Pacific region in the era of combination antiretroviral treatment

Falster, Kathleena,b; Choi, Jun Yongc; Donovan, Basila,d; Duncombe, Chrisa,e; Mulhall, Brianf; Sowden, Davidg; Zhou, Jialuna; Law, Matthew Ga; on behalf of the Australian HIV Observational Database, the TREAT Asia HIV Observational Database

doi: 10.1097/QAD.0b013e328331910c
Epidemiology and Social

Objective: Although studies have shown reductions in mortality from AIDS after the introduction of combination antiretroviral treatment (cART), little is known about cause-specific mortality in low-income settings in the cART era. We explored predictors of AIDS and non-AIDS mortality and compared cause-specific mortality across high-income and low-income settings in the Asia-Pacific region.

Methods: We followed patients in the Asia Pacific HIV Observational Database from the date they started cART (or cohort enrolment if cART initiation was identified retrospectively), until the date of death or last follow-up visit. Competing risks methods were used to estimate the cumulative incidence, and to investigate predictors, of AIDS and non-AIDS mortality.

Results: Of 4252 patients, 215 died; 89 from AIDS, 97 from non-AIDS causes and 29 from unknown causes. Age more than 50 years [hazard ratio 4.29; 95% confidence interval (CI) 2.10–8.79] and CD4 cell counts less than or equal to 100 cells/μl (hazard ratio 8.59; 95% CI 5.66–13.03) were associated with an increased risk of non-AIDS mortality. Risk factors for AIDS mortality included CD4 cell counts less than or equal to 100 cells/μl (hazard ratio 34.97; 95% CI 18.01–67.90) and HIV RNA 10 001 or more (hazard ratio 4.21; 95% CI 2.07–8.55). There was some indication of a lower risk of non-AIDS mortality in Asian high-income, and possibly low-income, countries compared to Australia.

Conclusion: Immune deficiency is associated with an increased risk of AIDS and non-AIDS mortality. Older age predicts non-AIDS mortality in the cART era. Less conclusive was the association between country-income level and cause-specific mortality because of the relatively high proportion of unknown causes of death in low-income settings.

aNational Centre in HIV Epidemiology and Clinical Research, Australia

bSchool of Public Health and Community Medicine, University of New South Wales, Sydney, Australia

cDivision of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea

dSydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales, Australia

eThe HIV Netherlands Australia Thailand Research Collaboration, Bangkok, Thailand

fSchool of Public Health, University of Sydney, Sydney, New South Wales, Australia

gClinic 87, Sunshine Coast & Cooloola HIV Sexual Health Service, Nambour, Queensland, Australia.

Received 24 February, 2009

Revised 30 July, 2009

Accepted 5 August, 2009

Correspondence to Kathleen Falster, National Centre in HIV Epidemiology and Clinical Research, Level 2, 376 Victoria St, Darlinghurst, NSW 2010, Australia. Tel: +612 9385 0900; fax: +612 9385 0920; e-mail:;

© 2009 Lippincott Williams & Wilkins, Inc.