| Titre : | AII-cause mortality in treated HIV-infected adults with CD4>=500/mm3 compared with the general population : evidence from a large European observational cohort collaboration. (2012) |
| Auteurs : | Charlotte LEWDEN ; Andrea ANTINORI ; Vincent Bouteloup ; Alexandra CALMY ; Antonella CASTAGNA ; Geneviève Chêne ; Jan CHRISTIAN WASMUTH ; Antonella D'ARMINIO MONFORTE ; Francois Dabis ; Stéphane DE WIT ; Matthias EGGER ; Jade GHOSN ; Jesper GRARUP ; Virginia ISERN ; Ole KIRK ; Catherine Leport ; Murielle MARY-KRAUSE ; Amanda MOCROFT ; Cristina MUSSINI ; Niels OBEL ; George PANOS ; Santiago PEREZ-HOYOS ; Caroline Sabin ; Ard-Van SIGHEM ; Paz SOBRINO-VEGAS ; Christoph STEPHAN ; Ramon TEIRA ; Carlo TORTI |
| Type de document : | Article |
| Dans : | International journal of epidemiology (vol. 41, n° 2, 2012) |
| Pagination : | 433-445 |
| Langues: | Anglais |
| Mots-clés : | Facteur ; Mortalité ; Epidémiologie ; Thérapeutique ; Sida ; Adulte ; Population ; Etude comparée ; Europe ; Coopération européenne ; Médicament antiviral ; Virose ; Infection ; Homme ; Immunopathologie |
| Résumé : | [BDSP. Notice produite par INIST-CNRS R0xGBBr7. Diffusion soumise à autorisation]. Background Using data from a large European collaborative study, we aimed to identify the circumstances in which treated HIV-infected individuals will experience similar mortality rates to those of the general population. Methods Adults were eligible if they initiated combination anti-retroviral treatment (cART) between 1998 and 2008 and had one prior CD4 measurement within 6 months. Standardized mortality ratios (SMRs) and excess mortality rates compared with the general population were estimated using Poisson regression. Periods of follow-up were classified according to the current CD4 count. Results Of the 80 642 individuals, 70% were men, 16% were injecting drug users (IDUs), the median age was 37 years, median CD4 count 225/mm3 at cART initiation and median follow-up was 3.5 years. The overall mortality rate was 1.2/100 person-years (PY) (men : 1.3, women : 0.9), 4.2 times as high as that in the general population (SMR for men : 3.8, for women : 7.4). Among 35316 individuals with a CD4 count>=500/mm3, the mortality rate was 0.37/100 PY (SMR 1.5) ; mortality rates were similar to those of the general population in non-IDU men [SMR 0.9,95% confidence interval (95% CI) 0.7-1.3] and, after 3 years, in women (SMR 1.1,95% CI 0.7-1.7). Mortality rates in IDUs remained elevated, though a trend to decrease with longer durations with high CD4 count was seen. A prior AIDS diagnosis was associated with higher mortality. Conclusions Mortality patterns in most non-IDU HIV-infected individuals with high CD4 counts on cART are similar to those in the general population. The persistent role of a prior AIDS diagnosis underlines the importance of early diagnosis of HIV infection. |
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