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: firstname.lastname@example.org; email@example.com