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Predictors of non-AIDS related death in a national cohort of HIV-diagnosed adults

Predictors of non-AIDS related death in a national cohort of HIV-diagnosed adults. Meaghan Kall, Ruth Smith, Alison Brown, Valerie Delpech Health Protection Agency. Introduction. Dramatic declines in AIDS-related mortality since effective ART

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Predictors of non-AIDS related death in a national cohort of HIV-diagnosed adults

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  1. Predictors of non-AIDS related death in a national cohort of HIV-diagnosed adults Meaghan Kall, Ruth Smith, Alison Brown, Valerie Delpech Health Protection Agency

  2. Introduction • Dramatic declines in AIDS-related mortality since effective ART • Mortality rates among HIV-infected persons are now approaching those of the general population • Yet ~600 HIV-infected persons die annually in the UK, just under 1% of HIV-diagnosed population  half AIDS-related

  3. Aims • Estimate frequencies and incidence of non-AIDS deaths among HIV-infected individuals since ART • Identify factors associated with non-AIDS related death

  4. Methods • Population: Adults (age 15+) diagnosed with HIV and seen for HIV care between 1997-2010 in England and Wales • Design: Retrospective observational cohort study • Data: national HIV surveillance data matched to death records from the Office for National Statistics. Details include date of death and up to 6 cause of death codes (ICD9/10). • Statistical Analysis: Multivariate Cox regression models used to estimate hazard ratios for predictors of non-AIDS death

  5. Death Classification

  6. Results • 70,914 patients diagnosed and under follow-up between 1997 and 2010  319,082 person-years follow-up • 3,814 (5.4%) died • Definitive cause of death assigned for 3,594 (94%) • 50.2% (1,804/3,594) died of non-AIDS related causes

  7. Characteristics of non-AIDS related deaths: England &Wales, 1997-2010 (n=1,804)

  8. Crude mortality rates: England and Wales, 2010

  9. Frequency and Crude Incidence Rates by Specific Cause of Death: 1997 -2010 (n=1,804)

  10. Predictors of non-AIDS related death: England &Wales, 1997-2010 • Compared to MSM Heterosexual contactHR 1.40 (1.21-1.62) p<0.001 Injecting drug use HR 4.17 (3.46-5.01) p<0.001 • Compared to age <25 p<0.001 Age 25-35 HR 1.38 (1.10-1.74) Age 35-49 HR 2.34 (1.87-2.94) Age 50+ HR 4.71 (3.70-6.00) • Diagnosed late HR 1.15 (1.03-1.27) p=0.01 • Previous AIDS diagnosisHR 2.13 (1.89-2.39) p<0.001 • ART < 3 yearsHR 3.08 (2.75-3.45) p<0.001 • NS: Sex, ethnicity, year of diagnosis

  11. Limitations • Under-reporting of deaths • Misclassification of AIDS and non-AIDS • Future work: • Improved classification of cause of death • Large European initiative (CoDe) + algorithm • Cause-specific mortality analysis • Case-control study

  12. Conclusions • Non-AIDS causes account for half of deaths among HIV-infected adults • Mortality rates are twice that of the general population. • Treatment exposure and a previous AIDS diagnosis were strong predictors of non-AIDS related death • Prompt HIV care could reduce all-cause mortality of people living with HIV, not only AIDS-related deaths

  13. Acknowledgements The continuing collaboration of those who contribute to HIV surveillance in the UK is gratefully acknowledged. Without their generosity, time and effort the current level of understanding of the epidemic could not have been obtained.

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