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Risk of all-cause mortality associated with nonfatal AIDS and serious non-AIDS events among adults infected with HIV

Neuhaus, Jacquelinea; Angus, Brianb; Kowalska, Justyna Dc; Rosa, Alberto Lad; Sampson, Jime; Wentworth, Deboraha; Mocroft, Amandaf; for the INSIGHT SMART and ESPRIT study groups

doi: 10.1097/QAD.0b013e3283365356
Clinical Science

Objectives: Among patients with HIV, the risk of death associated with different AIDS events has been quantified, but the risk of death associated with non-AIDS events has not been examined. We compared the risk of all-cause mortality following AIDS versus serious non-AIDS (SNA) events in the Strategies for Management of Antiretroviral Therapy (SMART) study and the Evaluation of Subcutaneous Proleukin in a Randomized International Trial (ESPRIT).

Design: Data from 9583 HIV-infected participants, 5472 with a CD4+ cell count more than 350 cells/μl enrolled in SMART and 4111 with a CD4+ cell count 300 cells/μl or more enrolled in ESPRIT, were analyzed.

Methods: Cumulative mortality 6 months after AIDS and SNA events (cardiovascular, renal, hepatic disease, and malignancies) was estimated using the Kaplan–Meier method. Cox models were used to estimate hazard ratios associated with AIDS and SNA events on the risk of death overall and by treatment group within study.

Results: AIDS and SNA events occurred in 286 and 435 participants with 47 (16%) and 115 (26%) subsequent deaths, respectively. Six-month cumulative mortality was 4.7% [95% confidence interval (CI) 2.8–8.0] after experiencing an AIDS event and 13.4% (95% CI 10.5–17.0) after experiencing an SNA event. The adjusted hazard ratio for all-cause mortality for those who experienced AIDS versus those who did not was 4.9 (95% CI 3.6–6.8). The corresponding hazard ratio for SNA was 11.4 (95% CI 9.0–14.5) (P < 0.001 for difference in hazard ratios). Findings were similar for both treatment groups in SMART and both treatment groups in ESPRIT.

Conclusion: Among HIV-infected persons with higher CD4+ cell counts, SNA events occur more frequently and are associated with a greater risk of death than AIDS events. Future research should be aimed at comparing strategies to reduce morbidity and mortality associated with SNA events for HIV-infected persons.

aUniversity of Minnesota, Minneapolis, Minnesota, USA

bNuffield Department of Medicine, University of Oxford, Oxford, UK

cCopenhagen HIV Programme, Copenhagen, Denmark

dAsociacion Civil IMPACTA Salud y Educacion, Lima, Peru

eThe Research and Education Group, Portland, Oregon, USA

fUniversity College London Medical School, Royal Free Campus, London, UK.

Received 7 October, 2009

Revised 30 November, 2009

Accepted 6 December, 2009

Correspondence to Jacqueline Neuhaus, MS, Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Avenue SE, Suite 200, Minneapolis, MN 55414, USA. E-mail: jacquie@ccbr.umn.edu

© 2010 Lippincott Williams & Wilkins, Inc.