HIV-CAUSAL Collaboration; Ray, Maile; Logan, Roger; Sterne, Jonathan AC; Hernández-Díaz, Sonia; Robins, James M; Sabin, Caroline; Bansi, Loveleen; van Sighem, Ard; de Wolf, Frank; +17 more... Costagliola, Dominique; Lanoy, Emilie; Bucher, Heiner C; von Wyl, Viktor; Esteve, Anna; Casbona, Jordi; del Amo, Julia; Moreno, Santiago; Justice, Amy; Goulet, Joseph; Lodi, Sara; Phillips, Andrew; Seng, Rémonie; Meyer, Laurence; Pérez-Hoyos, Santiago; García de Olalla, Patricia; Hernán, Miguel A; (2010) The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals. AIDS (London, England), 24 (1). pp. 123-137. ISSN 0269-9370 DOI: https://doi.org/10.1097/QAD.0b013e3283324283
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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 |
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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 |
ISI | 272917900017 |
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