The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals.


HIV-CAUSAL Collaboration, [inc Ewings, FM; ], ; Ray, M; Logan, R; Sterne, JA; Hernández-Díaz, S; Robins, JM; Sabin, C; Bansi, L; van Sighem, A; de Wolf, F; Costagliola, D; Lanoy, E; Bucher, HC; von Wyl, V; Esteve, A; Casbona, J; del Amo, J; Moreno, S; Justice, A; Goulet, J; Lodi, S; Phillips, A; Seng, R; Meyer, L; Pérez-Hoyos, S; García de Olalla, P; Hernán, MA; (2010) The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals. AIDS (London, England), 24 (1). pp. 123-37. ISSN 0269-9370 DOI: https://doi.org/10.1097/QAD.0b013e3283324283

Full text not available from this repository. (Request a copy)

Abstract

OBJECTIVE To estimate the effect of combined antiretroviral therapy (cART) on mortality among HIV-infected individuals after appropriate adjustment for time-varying confounding by indication. DESIGN A collaboration of 12 prospective cohort studies from Europe and the United States (the HIV-CAUSAL Collaboration) that includes 62 760 HIV-infected, therapy-naive individuals followed for an average of 3.3 years. Inverse probability weighting of marginal structural models was used to adjust for measured confounding by indication. RESULTS Two thousand and thirty-nine individuals died during the follow-up. The mortality hazard ratio was 0.48 (95% confidence interval 0.41-0.57) for cART initiation versus no initiation. In analyses stratified by CD4 cell count at baseline, the corresponding hazard ratios were 0.29 (0.22-0.37) for less than 100 cells/microl, 0.33 (0.25-0.44) for 100 to less than 200 cells/microl, 0.38 (0.28-0.52) for 200 to less than 350 cells/microl, 0.55 (0.41-0.74) for 350 to less than 500 cells/microl, and 0.77 (0.58-1.01) for 500 cells/microl or more. The estimated hazard ratio varied with years since initiation of cART from 0.57 (0.49-0.67) for less than 1 year since initiation to 0.21 (0.14-0.31) for 5 years or more (P value for trend <0.001). CONCLUSION We estimated that cART halved the average mortality rate in HIV-infected individuals. The mortality reduction was greater in those with worse prognosis at the start of follow-up.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Faculty of Epidemiology and Population Health > Dept of Medical Statistics
Research Centre: Tropical Epidemiology Group
PubMed ID: 19770621
Web of Science ID: 272917900017
URI: http://researchonline.lshtm.ac.uk/id/eprint/427488

Statistics


Download activity - last 12 months
Downloads since deposit
0Downloads
278Hits
Accesses by country - last 12 months
Accesses by referrer - last 12 months
Impact and interest
Additional statistics for this record are available via IRStats2

Actions (login required)

Edit Item Edit Item