Background: HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. Methods: We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. Results: During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. Conclusions: Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk. © The Author 2012; all rights reserved.

May, M., Hogg, R., Justice, A., Shepherd, B., Costagliola, D., Ledergerber, B., et al. (2012). Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: Relation with patient and cohort characteristics. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, 41(6), 1807-1820 [10.1093/ije/dys164].

Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: Relation with patient and cohort characteristics

GORI, ANDREA
2012

Abstract

Background: HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. Methods: We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. Results: During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. Conclusions: Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk. © The Author 2012; all rights reserved.
Articolo in rivista - Articolo scientifico
AIDS; Antiretroviral therapy; Cohort; Heterogeneity; HIV; Mortality; Prognostic model; Socio-economic status; Acquired Immunodeficiency Syndrome; Adolescent; Adult; Age Factors; Aged; Anti-Retroviral Agents; CD4 Lymphocyte Count; Europe; Female; HIV Infections; HIV Seropositivity; Humans; Male; Middle Aged; North America; Prognosis; Risk Factors; Sex Factors; Young Adult; Epidemiology
English
2012
41
6
1807
1820
dys164
none
May, M., Hogg, R., Justice, A., Shepherd, B., Costagliola, D., Ledergerber, B., et al. (2012). Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: Relation with patient and cohort characteristics. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, 41(6), 1807-1820 [10.1093/ije/dys164].
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/63458
Citazioni
  • Scopus 32
  • ???jsp.display-item.citation.isi??? 33
Social impact