Trends in mortality in people with HIV from 1999 to 2020: a multi-cohort collaboration

Erich Tusch; Lene Ryom; Annegret Pelchen-Matthews; Amanda Mocroft; Daniel Elbirt; Cristiana Oprea; Huldrych F Günthard; Cornelia Staehelin; Robert Zangerle; Isabelle Suarez; Jörg Janne Vehreschild; Ferdinand Wit; Marianna Menozzi; Antonella d'Arminio Monforte; Vincenzo Spagnuolo; Christian Pradier; Christina Carlander; Paula Suanzes; Jan-Christian Wasmuth; Andrew Carr; Kathy Petoumenos; Frauke Borgans; Fabrice Bonnet; Stephane De Wit; Wafaa El-Sadr; Bastian Neesgaard; Nadine Jaschinski; Lauren Greenberg; Sean R Hosein; Joel Gallant; Vani Vannappagari; Lital Young; Caroline Sabin; Jens Lundgren; Lars Peters; Joanne Reekie; D:A:D cohort study; RESPOND cohort study

doi:10.1093/cid/ciae228

Trends in mortality in people with HIV from 1999 to 2020: a multi-cohort collaboration

Clin Infect Dis. 2024 Apr 26:ciae228. doi: 10.1093/cid/ciae228. Online ahead of print.

Authors

Erich Tusch¹, Lene Ryom^{1

2

3}, Annegret Pelchen-Matthews⁴, Amanda Mocroft^{1

4}, Daniel Elbirt⁵, Cristiana Oprea⁶, Huldrych F Günthard^{7

8}, Cornelia Staehelin⁹, Robert Zangerle¹⁰, Isabelle Suarez¹¹, Jörg Janne Vehreschild¹¹, Ferdinand Wit¹², Marianna Menozzi¹³, Antonella d'Arminio Monforte¹⁴, Vincenzo Spagnuolo¹⁵, Christian Pradier¹⁶, Christina Carlander¹⁷, Paula Suanzes¹⁸, Jan-Christian Wasmuth¹⁹, Andrew Carr²⁰, Kathy Petoumenos²¹, Frauke Borgans²², Fabrice Bonnet²³, Stephane De Wit²⁴, Wafaa El-Sadr²⁵, Bastian Neesgaard¹, Nadine Jaschinski¹, Lauren Greenberg¹, Sean R Hosein²⁶, Joel Gallant²⁷, Vani Vannappagari²⁸, Lital Young²⁹, Caroline Sabin⁴, Jens Lundgren¹, Lars Peters¹, Joanne Reekie¹; D:A:D cohort study; RESPOND cohort study

Collaborators

W El-Sadr, G Calvo, F Bonnet, F Dabis, O Kirk, A Mocroft, M Law, A d'Arminio Monforte, L Morfeldt, C Pradier, P Reiss, R Weber, S De Wit, A Lind-Thomsen, R Salbøl Brandt, M Hillebreght, S Zaheri, F W N M Wit, A Scherrer, F Schöni-Affolter, M Rickenbach, A Tavelli, I Fanti, O Leleux, J Mourali, F Le Marec, E Boerg, E Thulin, A Sundström, G Bartsch, G Thompsen, C Necsoi, M Delforge, E Fontas, C Caissotti, K Dollet, S Mateu, F Torres, K Petoumenos, A Blance, R Huang, R Puhr, K Grønborg Laut, D Kristensen, C A Sabin, A N Phillips, D A Kamara, C J Smith, A Mocroft, C I Hatleberg, A Lind-Thomsen, R S Brandt, D Raben, C Matthews, A Bojesen, A L Grevsen, J D Lundgren, L Ryom, B Powderly, N Shortman, C Moecklinghoff, G Reilly, X Franquet, L Ryom, A Mocroft, O Kirk, P Reiss, C Smit, M Ross, C A Fux, P Morlat, E Fontas, D A Kamara, C J Smith, J D Lundgren, C J Smith, L Ryom, C I Hatleberg, A N Phillips, R Weber, P Morlat, C Pradier, P Reiss, F W N M Wit, N Friis-Møller, J Kowalska, J D Lundgren, C A Sabin, L Ryom, C I Hatleberg, M Law, A d'Arminio Monforte, F Dabis, F Bonnet, P Reiss, F W N M Wit, C J Smith, D A Kamara, J Bohlius, M Bower, G Fätkenheuer, A Grulich, J D Lundgren, A Sjøl, P Meidahl, J S Iversen, Central P Reiss, S Zaheri, M Hillebregt, F W N M Wit, J M Prins, T W Kuijpers, H J Scherpbier, J T M van der Meer, F W N M Wit, M H Godfried, P Reiss, T van der Poll, F J B Nellen, S E Geerlings, M van Vugt, D Pajkrt, J C Bos, W J Wiersinga, M van der Valk, A Goorhuis, J W Hovius, J van Eden, A Henderiks, A M H van Hes, M Mutschelknauss, H E Nobel, F J J Pijnappel, S Jurriaans, N K T Back, H L Zaaijer, B Berkhout, M T E Cornelissen, C J Schinkel, X V Thomas, Admiraal De Ruyter Ziekenhuis, M van den Berge, A Stegeman, S Baas, L Hage de Looff, D Versteeg, Catharina Ziekenhuis, M J H Pronk, H S M Ammerlaan, E S De Munnik, A R Jansz, J Tjhie, M C A Wegdam, B Deiman, V Scharnhorst, A van der Plas, A M Weijsenfeld, M E van der Ende, T E M S De Vries-Sluijs, E C M van Gorp, C A M Schurink, J L Nouwen, A Verbon, B J A Rijnders, H I Bax, M van der Feltz, N Bassant, J E A van Beek, M Vriesde, L M van Zonneveld, A de Oude-Lubbers, H J van den Berg-Cameron, F B Bruinsma-Broekman, J de Groot, M de Zeeuw- de Man, C A B Boucher, M P G Koopmans, J J A van Kampen, S D Pas, Erasmus Mc-Sophia, G J A Driessen, A M C van Rossum, L C van der Knaap, E Visser, J Branger, A Rijkeboer-Mes, C J H M Duijf-van de Ven, Haga Ziekenhuis, E F Schippers, C van Nieuwkoop, J M van IJperen, J Geilings, G van der Hut, P F H Franck, A van Eeden, W Brokking, M Groot, L J M Elsenburg, M Damen, I S Kwa, P H P Groeneveld, J W Bouwhuis, J F van den Berg, A G W van Hulzen, G L van der Bliek, P C J Bor, P Bloembergen, M J H M Wolfhagen, G J H M Ruijs, F P Kroon, M G J de Boer, M P Bauer, H Jolink, A M Vollaard, W Dorama, N van Holten, E C J Claas, E Wessels, J G den Hollander, K Pogany, A Roukens, M Kastelijns, J V Smit, E Smit, D Struik-Kalkman, C Tearno, M Bezemer, T van Niekerk, O Pontesilli, S H Lowe, A M L Oude Lashof, D Posthouwer, R P Ackens, J Schippers, R Vergoossen, B Weijenberg-Maes, I H M van Loo, T R A Havenith, E M S Leyten, L B S Gelinck, A van Hartingsveld, C Meerkerk, G S Wildenbeest, J A E M Mutsaers, C L Jansen, J W Mulder, S M E Vrouenraets, F N Lauw, M C van Broekhuizen, H Paap, D J Vlasblom, P H M Smits, M C Zuiderzee, S Weijer, R El Moussaoui, A S Bosma, M G A van Vonderen, D P F van Houte, L M Kampschreur, K Dijkstra, S Faber, J Weel, G J Kootstra, C E Delsing, M van der Burg-van de Plas, H Heins, E Lucas, W Kortmann, G van Twillert, J W T Cohen Stuart, B M W Diederen, D Pronk, F A van Truijen-Oud, W A van der Reijden, R Jansen, K Brinkman, G E L van den Berk, W L Blok, P H J Frissen, K D Lettinga, W E M Schouten, J Veenstra, C J Brouwer, G F Geerders, K Hoeksema, M J Kleene, I B van der Meché, M Spelbrink, H Sulman, A J M Toonen, S Wijnands, M Damen, D Kwa, E Witte, P P Koopmans, M Keuter, A J A M van der Ven, H J M Ter Hofstede, A S M Dofferhoff, R van Crevel, M Albers, M E W Bosch, K J T Grintjes-Huisman, B J Zomer, F F Stelma, J Rahamat-Langendoen, D Burger, C Richter, E H Gisolf, R J Hassing, G Ter Beest, P H M van Bentum, N Langebeek, R Tiemessen, C M A Swanink, S F L van Lelyveld, R Soetekouw, N Hulshoff, L M M van der Prijt, J van der Swaluw, N Bermon, W A van der Reijden, R Jansen, B L Herpers, D Veenendaal, D W M Verhagen, M van Wijk, St Elisabeth Ziekenhuis, M E E van Kasteren, A E Brouwer, B A F M de Kruijf-van de Wiel, M Kuipers, R M W J Santegoets, B van der Ven, J H Marcelis, A G M Buiting, P J Kabel, W F W Bierman, H Scholvinck, K R Wilting, Y Stienstra, H de Groot-de Jonge, P A van der Meulen, D A de Weerd, J Ludwig-Roukema, H G M Niesters, A Riezebos-Brilman, C C van Leer-Buter, M Knoester, A I M Hoepelman, T Mudrikova, P M Ellerbroek, J J Oosterheert, J E Arends, R E Barth, M W M Wassenberg, E M Schadd, D H M van Elst-Laurijssen, E E B van Oers-Hazelzet, S Vervoort, M van Berkel, R Schuurman, F Verduyn-Lunel, A M J Wensing, E J G Peters, M A van Agtmael, M Bomers, J de Vocht, M Heitmuller, L M Laan, A M Pettersson, C M J E Vandenbroucke-Grauls, C W Ang, Wilhelmina Kinderziekenhuis, S P M Geelen, T F W Wolfs, L J Bont, N Nauta, P Reiss, D O Bezemer, A I van Sighem, C Smit, F W N M Wit, T S Boender, S Zaheri, M Hillebregt, A de Jong, D Bergsma, P Hoekstra, A de Lang, S Grivell, A Jansen, M J Rademaker, M Raethke, R Meijering, S Schnörr, L de Groot, M van den Akker, Y Bakker, E Claessen, A El Berkaoui, J Koops, E Kruijne, C Lodewijk, L Munjishvili, B Peeck, C Ree, R Regtop, Y Ruijs, T Rutkens, L van de Sande, M Schoorl, A Timmerman, E Tuijn, L Veenenberg, S van der Vliet, A Wisse, T Woudstra, B Tuk, F Bonnet, F Dabis, M Dupon, V Gaborieau, D Lacoste, D Malvy, P Mercié, P Morlat, D Neau, J L Pellegrin, S Tchamgoué, E Lazaro, C Cazanave, M Vandenhende, M O Vareil, Y Gérard, P Blanco, S Bouchet, D Breilh, H Fleury, I Pellegrin, G Chêne, R Thiébaut, L Wittkop, L Wittkop, O Leleux, S Lawson-Ayayi, A 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Elsing, S Shahi, O Valdenmaiier, J Reekie, L Greenberg, L Bansi-Matharu, A Pelchen-Matthews, K Petoumenos, D Byonanebye, E Tusch, W Bannister, A Roen

Affiliations

¹ CHIP, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
² Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, Denmark.
³ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁴ Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK.
⁵ Allergy, Immunology and HIV Unit, Kaplan Medical Center, Rehovot, Israel.
⁶ Victor Babes Clinical Hospital for Infectious and Tropical Diseases, Bucharest, Romania.
⁷ Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich.
⁸ Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
⁹ Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
¹⁰ Austrian HIV Cohort Study (AHIVCOS), Medizinische Universität Innsbruck, Innsbruck, Austria.
¹¹ University Hospital Cologne, Cologne, Germany.
¹² AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort, HIV Monitoring Foundation, Amsterdam, the Netherlands.
¹³ Modena HIV Cohort, Università degli Studi di Modena, Modena, Italy.
¹⁴ Italian Cohort Naive Antiretrovirals (ICONA), ASST Santi Paolo e Carlo, Milano, Italy.
¹⁵ IRCCS San Raffaele Scientific Institute, Milano, Italy.
¹⁶ Nice HIV Cohort, Université Côte d'Azur et Centre Hospitalier Universitaire, Nice, France.
¹⁷ Swedish InfCare HIV Cohort, Karolinska University Hospital, Sweden.
¹⁸ Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.
¹⁹ University Hospital Bonn, Bonn, Germany.
²⁰ HIV and Immunology Unit, St Vincent's Hospital, Sydney, Australia.
²¹ The Australian HIV Observational Database (AHOD), UNSW, Sydney, Australia.
²² Frankfurt HIV Cohort Study, Goethe-University Hospital, University Hospital, Department of Internal Medicine, Infectious Diseases, Germany.
²³ University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre & CHU de Bordeaux, Saint-André Hospital, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, Cedex, France.
²⁴ Department of Infectious Diseases, St Pierre University Hospital, Brussels, Belgium.
²⁵ Mailman School of Public Health, Columbia University, New York, USA.
²⁶ European AIDS Treatment Group (EATG), Brussels, Belgium.
²⁷ Gilead Sciences, Foster City, California, USA.
²⁸ ViiV Healthcare, Research Triangle Park, North Carolina, USA.
²⁹ Merck Sharp & Dohme, Rahway, New Jersey, USA.

PMID: 38663013
DOI: 10.1093/cid/ciae228

Abstract

Background: Mortality among people with HIV declined with the introduction of combination antiretroviral therapy. We investigated trends over time in all-cause and cause-specific mortality in people with HIV from 1999-2020.

Methods: Data were collected from the D:A:D cohort from 1999 through January 2015 and RESPOND from October 2017 through 2020. Age-standardized all-cause and cause-specific mortality rates, classified using Coding Causes of Death in HIV (CoDe), were calculated. Poisson regression models were used to assess mortality trends over time.

Results: Among 55716 participants followed for a median of 6 years (IQR 3-11), 5263 participants died (crude mortality rate [MR] 13.7/1000 PYFU; 95%CI 13.4-14.1). Changing patterns of mortality were observed with AIDS as the most common cause of death between 1999- 2009 (n = 952, MR 4.2/1000 PYFU; 95%CI 4.0-4.5) and non-AIDS defining malignancy (NADM) from 2010 -2020 (n = 444, MR 2.8/1000 PYFU; 95%CI 2.5-3.1). In multivariable analysis, all-cause mortality declined over time (adjusted mortality rate ratio [aMRR] 0.97 per year; 95%CI 0.96, 0.98), mostly from 1999 through 2010 (aMRR 0.96 per year; 95%CI 0.95-0.97), and with no decline shown from 2011 through 2020 (aMRR 1·00 per year; 95%CI 0·96-1·05). Mortality due all known causes except NADM also declined over the entire follow-up period.

Conclusion: Mortality among people with HIV in the D:A:D and/or RESPOND cohorts decreased between 1999 and 2009 and was stable over the period from 2010 through 2020. The decline in mortality rates was not fully explained by improvements in immunologic-virologic status or other risk factors.

Keywords: HIV; cohort collaboration; mortality; observational cohort; people with HIV.

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