Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studies

Boulle, Andrew; Schomaker, Michael; May, Margaret T; Hogg, Robert S; Shepherd, Bryan E; Monge Corella, Susana; Keiser, Olivia; Lampe, Fiona C; Giddy, Janet; Ndirangu, James; Garone, Daniela; Fox, Matthew; Ingle, Suzanne M; Reiss, Peter; Dabis, François; Costagliola, Dominique; Castagna, Antonella; Ehren, Kathrin; Campbell, Colin; Gill, M John; Saag, Michael; Justice, Amy C; Guest, Jodie; Crane, Heidi M; Egger, Matthias; Sterne, Jonathan A C

Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studies

BACKGROUND: High early mortality in patients with HIV-1 starting antiretroviral therapy (ART) in sub-Saharan Africa, compared to Europe and North America, is well documented. Longer-term comparisons between settings have been limited by poor ascertainment of mortality in high burden African settings...

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Autores:	Boulle, Andrew, Schomaker, Michael, May, Margaret T, Hogg, Robert S, Shepherd, Bryan E, Monge Corella, Susana, Keiser, Olivia, Lampe, Fiona C, Giddy, Janet, Ndirangu, James, Garone, Daniela, Fox, Matthew, Ingle, Suzanne M, Reiss, Peter, Dabis, François, Costagliola, Dominique, Castagna, Antonella, Ehren, Kathrin, Campbell, Colin, Gill, M John, Saag, Michael, Justice, Amy C, Guest, Jodie, Crane, Heidi M, Egger, Matthias, Sterne, Jonathan A C
Tipo de recurso:	artículo
Fecha de publicación:	2014
País:	España
Institución:	Instituto de Salud Carlos III (ISCIII)
Repositorio:	Repisalud
Idioma:	inglés
OAI Identifier:	oai:repisalud.isciii.es:20.500.12105/6590
Acceso en línea:	http://hdl.handle.net/20.500.12105/6590
Access Level:	acceso abierto
Palabra clave:	Adult Anti-HIV Agents Antiretroviral Therapy, Highly Active Cohort Studies Europe Female Follow-Up Studies HIV Infections Humans Male Middle Aged Mortality North America Prospective Studies South Africa Cooperative Behavior HIV-1

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spelling	Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studiesBoulle, AndrewSchomaker, MichaelMay, Margaret THogg, Robert SShepherd, Bryan EMonge Corella, SusanaKeiser, OliviaLampe, Fiona CGiddy, JanetNdirangu, JamesGarone, DanielaFox, MatthewIngle, Suzanne MReiss, PeterDabis, FrançoisCostagliola, DominiqueCastagna, AntonellaEhren, KathrinCampbell, ColinGill, M JohnSaag, MichaelJustice, Amy CGuest, JodieCrane, Heidi MEgger, MatthiasSterne, Jonathan A CAdultAnti-HIV AgentsAntiretroviral Therapy, Highly ActiveCohort StudiesEuropeFemaleFollow-Up StudiesHIV InfectionsHumansMaleMiddle AgedMortalityNorth AmericaProspective StudiesSouth AfricaCooperative BehaviorHIV-1BACKGROUND: High early mortality in patients with HIV-1 starting antiretroviral therapy (ART) in sub-Saharan Africa, compared to Europe and North America, is well documented. Longer-term comparisons between settings have been limited by poor ascertainment of mortality in high burden African settings. This study aimed to compare mortality up to four years on ART between South Africa, Europe, and North America. METHODS AND FINDINGS: Data from four South African cohorts in which patients lost to follow-up (LTF) could be linked to the national population register to determine vital status were combined with data from Europe and North America. Cumulative mortality, crude and adjusted (for characteristics at ART initiation) mortality rate ratios (relative to South Africa), and predicted mortality rates were described by region at 0-3, 3-6, 6-12, 12-24, and 24-48 months on ART for the period 2001-2010. Of the adults included (30,467 [South Africa], 29,727 [Europe], and 7,160 [North America]), 20,306 (67%), 9,961 (34%), and 824 (12%) were women. Patients began treatment with markedly more advanced disease in South Africa (median CD4 count 102, 213, and 172 cells/µl in South Africa, Europe, and North America, respectively). High early mortality after starting ART in South Africa occurred mainly in patients starting ART with CD4 count <50 cells/µl. Cumulative mortality at 4 years was 16.6%, 4.7%, and 15.3% in South Africa, Europe, and North America, respectively. Mortality was initially much lower in Europe and North America than South Africa, but the differences were reduced or reversed (North America) at longer durations on ART (adjusted rate ratios 0.46, 95% CI 0.37-0.58, and 1.62, 95% CI 1.27-2.05 between 24 and 48 months on ART comparing Europe and North America to South Africa). While bias due to under-ascertainment of mortality was minimised through death registry linkage, residual bias could still be present due to differing approaches to and frequency of linkage. CONCLUSIONS: After accounting for under-ascertainment of mortality, with increasing duration on ART, the mortality rate on HIV treatment in South Africa declines to levels comparable to or below those described in participating North American cohorts, while substantially narrowing the differential with the European cohorts. Please see later in the article for the Editors' Summary.Public Library of Science (PLOS)20182018-11-1420142014-09-0120142014-09-01journal articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/20.500.12105/6590reponame:Repisaludinstname:Instituto de Salud Carlos III (ISCIII)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2Atribución 4.0 Internacionalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:repisalud.isciii.es:20.500.12105/65902026-06-12T12:43:37Z
dc.title.none.fl_str_mv	Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studies
title	Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studies
spellingShingle	Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studies Boulle, Andrew Adult Anti-HIV Agents Antiretroviral Therapy, Highly Active Cohort Studies Europe Female Follow-Up Studies HIV Infections Humans Male Middle Aged Mortality North America Prospective Studies South Africa Cooperative Behavior HIV-1
title_short	Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studies
title_full	Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studies
title_fullStr	Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studies
title_full_unstemmed	Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studies
title_sort	Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studies
dc.creator.none.fl_str_mv	Boulle, Andrew Schomaker, Michael May, Margaret T Hogg, Robert S Shepherd, Bryan E Monge Corella, Susana Keiser, Olivia Lampe, Fiona C Giddy, Janet Ndirangu, James Garone, Daniela Fox, Matthew Ingle, Suzanne M Reiss, Peter Dabis, François Costagliola, Dominique Castagna, Antonella Ehren, Kathrin Campbell, Colin Gill, M John Saag, Michael Justice, Amy C Guest, Jodie Crane, Heidi M Egger, Matthias Sterne, Jonathan A C
author	Boulle, Andrew
author_facet	Boulle, Andrew Schomaker, Michael May, Margaret T Hogg, Robert S Shepherd, Bryan E Monge Corella, Susana Keiser, Olivia Lampe, Fiona C Giddy, Janet Ndirangu, James Garone, Daniela Fox, Matthew Ingle, Suzanne M Reiss, Peter Dabis, François Costagliola, Dominique Castagna, Antonella Ehren, Kathrin Campbell, Colin Gill, M John Saag, Michael Justice, Amy C Guest, Jodie Crane, Heidi M Egger, Matthias Sterne, Jonathan A C
author_role	author
author2	Schomaker, Michael May, Margaret T Hogg, Robert S Shepherd, Bryan E Monge Corella, Susana Keiser, Olivia Lampe, Fiona C Giddy, Janet Ndirangu, James Garone, Daniela Fox, Matthew Ingle, Suzanne M Reiss, Peter Dabis, François Costagliola, Dominique Castagna, Antonella Ehren, Kathrin Campbell, Colin Gill, M John Saag, Michael Justice, Amy C Guest, Jodie Crane, Heidi M Egger, Matthias Sterne, Jonathan A C
author2_role	author author author author author author author author author author author author author author author author author author author author author author author author author
dc.contributor.none.fl_str_mv
dc.subject.none.fl_str_mv	Adult Anti-HIV Agents Antiretroviral Therapy, Highly Active Cohort Studies Europe Female Follow-Up Studies HIV Infections Humans Male Middle Aged Mortality North America Prospective Studies South Africa Cooperative Behavior HIV-1
topic	Adult Anti-HIV Agents Antiretroviral Therapy, Highly Active Cohort Studies Europe Female Follow-Up Studies HIV Infections Humans Male Middle Aged Mortality North America Prospective Studies South Africa Cooperative Behavior HIV-1
description	BACKGROUND: High early mortality in patients with HIV-1 starting antiretroviral therapy (ART) in sub-Saharan Africa, compared to Europe and North America, is well documented. Longer-term comparisons between settings have been limited by poor ascertainment of mortality in high burden African settings. This study aimed to compare mortality up to four years on ART between South Africa, Europe, and North America. METHODS AND FINDINGS: Data from four South African cohorts in which patients lost to follow-up (LTF) could be linked to the national population register to determine vital status were combined with data from Europe and North America. Cumulative mortality, crude and adjusted (for characteristics at ART initiation) mortality rate ratios (relative to South Africa), and predicted mortality rates were described by region at 0-3, 3-6, 6-12, 12-24, and 24-48 months on ART for the period 2001-2010. Of the adults included (30,467 [South Africa], 29,727 [Europe], and 7,160 [North America]), 20,306 (67%), 9,961 (34%), and 824 (12%) were women. Patients began treatment with markedly more advanced disease in South Africa (median CD4 count 102, 213, and 172 cells/µl in South Africa, Europe, and North America, respectively). High early mortality after starting ART in South Africa occurred mainly in patients starting ART with CD4 count <50 cells/µl. Cumulative mortality at 4 years was 16.6%, 4.7%, and 15.3% in South Africa, Europe, and North America, respectively. Mortality was initially much lower in Europe and North America than South Africa, but the differences were reduced or reversed (North America) at longer durations on ART (adjusted rate ratios 0.46, 95% CI 0.37-0.58, and 1.62, 95% CI 1.27-2.05 between 24 and 48 months on ART comparing Europe and North America to South Africa). While bias due to under-ascertainment of mortality was minimised through death registry linkage, residual bias could still be present due to differing approaches to and frequency of linkage. CONCLUSIONS: After accounting for under-ascertainment of mortality, with increasing duration on ART, the mortality rate on HIV treatment in South Africa declines to levels comparable to or below those described in participating North American cohorts, while substantially narrowing the differential with the European cohorts. Please see later in the article for the Editors' Summary.
publishDate	2014
dc.date.none.fl_str_mv	2014 2014-09-01 2014 2014-09-01 2018 2018-11-14
dc.type.none.fl_str_mv	journal article http://purl.org/coar/resource_type/c_6501 VoR http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv	info:eu-repo/semantics/article
format	article
dc.identifier.none.fl_str_mv	http://hdl.handle.net/20.500.12105/6590
url	http://hdl.handle.net/20.500.12105/6590
dc.language.none.fl_str_mv	Inglés eng
language_invalid_str_mv	Inglés
language	eng
dc.rights.none.fl_str_mv	open access http://purl.org/coar/access_right/c_abf2 Atribución 4.0 Internacional http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv	info:eu-repo/semantics/openAccess
rights_invalid_str_mv	open access http://purl.org/coar/access_right/c_abf2 Atribución 4.0 Internacional http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv	openAccess
dc.format.none.fl_str_mv	application/pdf
dc.publisher.none.fl_str_mv	Public Library of Science (PLOS)
publisher.none.fl_str_mv	Public Library of Science (PLOS)
dc.source.none.fl_str_mv	reponame:Repisalud instname:Instituto de Salud Carlos III (ISCIII)
instname_str	Instituto de Salud Carlos III (ISCIII)
reponame_str	Repisalud
collection	Repisalud
repository.name.fl_str_mv
repository.mail.fl_str_mv
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Mortality in patients with HIV-1 infection starting antiretroviral therapy in South Africa, Europe, or North America: a collaborative analysis of prospective studies

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