Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2017

Open Access 01-12-2017 | Research article

Changes in mortality rates and causes of death in a population-based cohort of persons living with and without HIV from 1996 to 2012

Authors: Oghenowede Eyawo, Conrado Franco-Villalobos, Mark W. Hull, Adriana Nohpal, Hasina Samji, Paul Sereda, Viviane D. Lima, Jeannie Shoveller, David Moore, Julio S. G. Montaner, Robert S. Hogg, for the Comparative Outcomes And Service Utilization Trends (COAST) study

Published in: BMC Infectious Diseases | Issue 1/2017

Login to get access

Abstract

Background

Non-HIV/AIDS-related diseases are gaining prominence as important causes of morbidity and mortality among people living with HIV. The purpose of this study was to characterize and compare changes over time in mortality rates and causes of death among a population-based cohort of persons living with and without HIV in British Columbia (BC), Canada.

Methods

We analysed data from the Comparative Outcomes And Service Utilization Trends (COAST) study; a retrospective population-based study created via linkage between the BC Centre for Excellence in HIV/AIDS and Population Data BC, and containing data for HIV-infected individuals and the general population of BC, respectively. Our analysis included all known HIV-infected adults (≥ 20 years) in BC and a random 10% sample of uninfected BC adults followed from 1996 to 2012. Deaths were identified through Population Data BC – which contains information on all registered deaths in BC (BC Vital Statistics Agency dataset) and classified into cause of death categories using International Classification of Diseases (ICD) 9/10 codes. Age-standardized mortality rates (ASMR) and mortality rate ratios were calculated. Trend test were performed.

Results

3401 (25%), and 47,647 (9%) individuals died during the 5,620,150 person-years of follow-up among 13,729 HIV-infected and 510,313 uninfected individuals, respectively. All-cause and cause-specific mortality rates were consistently higher among HIV-infected compared to HIV-negative individuals, except for neurological disorders. All-cause ASMR decreased from 126.75 (95% CI: 84.92-168.57) per 1000 population in 1996 to 21.29 (95% CI: 17.79-24.79) in 2011-2012 (83% decline; p < 0.001 for trend), compared to a change from 7.97 (95% CI: 7.61-8.33) to 6.87 (95% CI: 6.70-7.04) among uninfected individuals (14% decline; p < 0.001). Mortality rates from HIV/AIDS-related causes decreased by 94% from 103.85 per 1000 population in 1996 to 6.72 by the 2011–2012 era (p < 0.001). Significant ASMR reductions were also observed for hepatic/liver disease and drug abuse/overdose deaths. ASMRs for neurological disorders increased significantly over time. Non-AIDS-defining cancers are currently the leading non-HIV/AIDS-related cause of death in both HIV-infected and uninfected individuals.

Conclusions

Despite the significant mortality rate reductions observed among HIV-infected individuals from 1996 to 2012, they still have excess mortality risk compared to uninfected individuals. Additional efforts are needed to promote effective risk factor management and appropriate screening measures among people living with HIV.
Literature
1.
Hogg RS, Heath KV, Yip B, Craib KJ, O’Shaughnessy MV, Schechter MT, Montaner JS. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279(6):450–4.CrossRefPubMed
2.
Palella Jr FJ, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, Aschman DJ, Holmberg SD. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338(13):853–60.CrossRefPubMed
3.
Mocroft A, Ledergerber B, Katlama C, Kirk O, Reiss P, d’Arminio Monforte A, Knysz B, Dietrich M, Phillips AN, Lundgren JD. Decline in the AIDS and death rates in the EuroSIDA study: an observational study. Lancet. 2003;362(9377):22–9.CrossRefPubMed
4.
Bangsberg DR, Ragland K, Monk A, Deeks SG. A single tablet regimen is associated with higher adherence and viral suppression than multiple tablet regimens in HIV+ homeless and marginally housed people. AIDS. 2010;24(18):2835–40.CrossRefPubMedPubMedCentral
5.
Nachega JB, Parienti JJ, Uthman OA, Gross R, Dowdy DW, Sax PE, Gallant JE, Mugavero MJ, Mills EJ, Giordano TP. Lower pill burden and once-daily antiretroviral treatment regimens for HIV infection: A meta-analysis of randomized controlled trials. Clin Infect Dis. 2014;58(9):1297–307.CrossRefPubMedPubMedCentral
6.
Lima VD, Hogg RS, Harrigan PR, Moore D, Yip B, Wood E, Montaner JS. Continued improvement in survival among HIV-infected individuals with newer forms of highly active antiretroviral therapy. AIDS. 2007;21(6):685–92.CrossRefPubMed
7.
8.
Samji H, Cescon A, Hogg RS, Modur SP, Althoff KN, Buchacz K, Burchell AN, Cohen M, Gebo KA, Gill MJ, et al. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013;8(12):e81355.CrossRefPubMedPubMedCentral
9.
Mills EJ, Bakanda C, Birungi J, Chan K, Ford N, Cooper CL, Nachega JB, Dybul M, Hogg RS. Life expectancy of persons receiving combination antiretroviral therapy in low-income countries: a cohort analysis from Uganda. Ann Intern Med. 2011;155(4):209–16.CrossRefPubMed
10.
Antiretroviral Therapy Cohort Collaboration. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet. 2008;372(9635):293–9.CrossRef
11.
Mocroft A, Brettle R, Kirk O, Blaxhult A, Parkin JM, Antunes F, Francioli P, D’Arminio Monforte A, Fox Z, Lundgren JD, et al. Changes in the cause of death among HIV positive subjects across Europe: results from the EuroSIDA study. AIDS. 2002;16(12):1663–71.CrossRefPubMed
12.
Crum NF, Riffenburgh RH, Wegner S, Agan BK, Tasker SA, Spooner KM, Armstrong AW, Fraser S, Wallace MR, Triservice ACC. Comparisons of causes of death and mortality rates among HIV-infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. J Acquir Immune Defic Syndr. 2006;41(2):194–200.CrossRefPubMed
13.
Krentz HB, Kliewer G, Gill MJ. Changing mortality rates and causes of death for HIV-infected individuals living in Southern Alberta, Canada from 1984 to 2003. HIV Med. 2005;6(2):99–106.CrossRefPubMed
14.
Antiretroviral Therapy Cohort Collaboration. Causes of death in HIV-1-infected patients treated with antiretroviral therapy, 1996–2006: collaborative analysis of 13 HIV cohort studies. Clin Infect Dis. 2010;50(10):1387–96.CrossRef
15.
Palella Jr FJ, Baker RK, Moorman AC, Chmiel JS, Wood KC, Brooks JT, Holmberg SD, Investigators HIVOS. Mortality in the highly active antiretroviral therapy era: changing causes of death and disease in the HIV outpatient study. J Acquir Immune Defic Syndr. 2006;43(1):27–34.CrossRefPubMed
16.
Leone S, Gregis G, Quinzan G, Velenti D, Cologni G, Soavi L, Ravasio V, Ripamonti D, Suter F, Maggiolo F. Causes of death and risk factors among HIV-infected persons in the HAART era: analysis of a large urban cohort. Infection. 2011;39(1):13–20.CrossRefPubMed
17.
Hogg RS, Heath KV, Strathdee SA, Montaner JS, O’Shaughnessy MV, Schechter MT. HIV/AIDS mortality in Canada: evidence of gender, regional and local area differentials. AIDS. 1996;10(8):889–94.CrossRefPubMed
18.
Lima VD, Lepik KJ, Zhang W, Muldoon KA, Hogg RS, Montaner JS. Regional and temporal changes in HIV-related mortality in British Columbia, 1987–2006. Can J Public Health. 2010;101(5):415–9.PubMed
19.
Belvedere LM, Miller CL, Hogg RS. Shifting sands: changing regional and gender-specific patterns of HIV/AIDS mortality in Canada, 1987 to 2008. Can J Public Health. 2012;103(3):202–6.PubMed
20.
Lima VD, Eyawo O, Ma H, Lourenco L, Chau W, Hogg RS, Montaner JS. The impact of scaling-up combination antiretroviral therapy on patterns of mortality among HIV-positive persons in British Columbia, Canada. J Int AIDS Soc. 2015;18:20261.PubMedPubMedCentral
21.
Cheung CC, Ding E, Sereda P, Yip B, Lourenco L, Barrios R, Montaner J, Hogg RS, Lima V, Moore DM. Reductions in all-cause and cause-specific mortality among HIV-infected individuals receiving antiretroviral therapy in British Columbia, Canada: 2001–2012. HIV Med. 2016;17(9):694–701.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
Nosyk B, Colley G, Yip B, Chan K, Heath K, Lima VD, Gilbert M, Hogg RS, Harrigan PR, Montaner JS. Application and validation of case-finding algorithms for identifying individuals with human immunodeficiency virus from administrative data in British Columbia, Canada. PLoS One. 2013;8(1):e54416.CrossRefPubMedPubMedCentral
33.
Chiang CL: Standard error of the age-adjusted death rate. In: Vital Statistics Special Reports Volume 47, edn. Edited by US Department of Health Education and Welfare; 1961: 271–285.
34.
Breslow NE, Day NE. Statistical methods in cancer research. Volume II—The design and analysis of cohort studies. IARC Sci Publ. 1987;82:1–406.
35.
36.
Martinez E, Milinkovic A, Buira E, de Lazzari E, Leon A, Larrousse M, Lonca M, Laguno M, Blanco JL, Mallolas J, et al. Incidence and causes of death in HIV-infected persons receiving highly active antiretroviral therapy compared with estimates for the general population of similar age and from the same geographical area. HIV Med. 2007;8(4):251–8.CrossRefPubMed
37.
Lohse N, Hansen AB, Pedersen G, Kronborg G, Gerstoft J, Sorensen HT, Vaeth M, Obel N. Survival of persons with and without HIV infection in Denmark, 1995–2005. Ann Intern Med. 2007;146(2):87–95.CrossRefPubMed
38.
Croxford S, Kitching A, Desai S, Kall M, Edelstein M, Delpech V. Survival and causes of death among people diagnosed with HIV infection in England and Wales in the era of effective antiretroviral therapy. HIV Med. 2015;16 Suppl 2:47.
39.
Lewden C, Salmon D, Morlat P, Bevilacqua S, Jougla E, Bonnet F, Heripret L, Costagliola D, May T, Chene G, et al. Causes of death among human immunodeficiency virus (HIV)-infected adults in the era of potent antiretroviral therapy: emerging role of hepatitis and cancers, persistent role of AIDS. Int J Epidemiol. 2005;34(1):121–30.CrossRefPubMed
40.
Smith CJ, Ryom L, Weber R, Morlat P, Pradier C, Reiss P, Kowalska JD, de Wit S, Law M, el Sadr W, et al. Trends in underlying causes of death in people with HIV from 1999 to 2011 (D:A:D): a multicohort collaboration. Lancet. 2014;384(9939):241–8.CrossRefPubMed
41.
Aldaz P, Moreno-Iribas C, Egues N, Irisarri F, Floristan Y, Sola-Boneta J, Martinez-Artola V, Sagredo M, Castilla J. Mortality by causes in HIV-infected adults: comparison with the general population. BMC Public Health. 2011;11:300.CrossRefPubMedPubMedCentral
42.
Weber R, Ruppik M, Rickenbach M, Spoerri A, Furrer H, Battegay M, Cavassini M, Calmy A, Bernasconi E, Schmid P, et al. Decreasing mortality and changing patterns of causes of death in the Swiss HIV Cohort Study. HIV Med. 2013;14(4):195–207.CrossRefPubMed
43.
Arnold DM, Julian JA, Walker IR, Association of Hemophilia Clinic Directors of C. Mortality rates and causes of death among all HIV-positive individuals with hemophilia in Canada over 21 years of follow-up. Blood. 2006;108(2):460–4.CrossRefPubMed
44.
Klein MB, Rollet-Kurhajec KC, Moodie EE, Yaphe S, Tyndall M, Walmsley S, Gill J, Martel-Laferriere V, Cooper C, Canadian Co-infection Cohort I. Mortality in HIV-hepatitis C co-infected patients in Canada compared to the general Canadian population (2003–2013). AIDS. 2014;28(13):1957–65.CrossRefPubMed
45.
van Sighem A, Danner S, Ghani AC, Gras L, Anderson RM, de Wolf F, Study ANOC. Mortality in patients with successful initial response to highly active antiretroviral therapy is still higher than in non-HIV-infected individuals. J Acquir Immune Defic Syndr. 2005;40(2):212–8.CrossRefPubMed
46.
47.
48.
Montaner JS, Hogg RS, Wood E, Kerr T, Tyndall M, Levy AR, Harrigan PR. The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. Lancet. 2006;368(9534):531–6.CrossRefPubMed
49.
Joy R, Druyts EF, Brandson EK, Lima VD, Rustad CA, Zhang W, Wood E, Montaner JS, Hogg RS. Impact of neighborhood-level socioeconomic status on HIV disease progression in a universal health care setting. J Acquir Immune Defic Syndr. 2008;47(4):500–5.CrossRefPubMed
50.
Collaboration of Observational HIV Epidemiological Research Europe in EuroCoord (COHERE), Lewden C, Bouteloup V, De Wit S, Sabin C, Mocroft A, Wasmuth JC, van Sighem A, Kirk O, Obel N, et al. All-cause mortality in treated HIV-infected adults with CD4 ≥ 500/mm3 compared with the general population: evidence from a large European observational cohort collaboration. Int J Epidemiol. 2012;41(2):433–45.CrossRef
Metadata
Title
Changes in mortality rates and causes of death in a population-based cohort of persons living with and without HIV from 1996 to 2012
Authors
Oghenowede Eyawo
Conrado Franco-Villalobos
Mark W. Hull
Adriana Nohpal
Hasina Samji
Paul Sereda
Viviane D. Lima
Jeannie Shoveller
David Moore
Julio S. G. Montaner
Robert S. Hogg
for the Comparative Outcomes And Service Utilization Trends (COAST) study
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2017
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-017-2254-7

Other articles of this Issue 1/2017

BMC Infectious Diseases 1/2017 Go to the issue

Research article

Genotyping and drug susceptibility testing of mycobacterial isolates from population-based tuberculosis prevalence survey in Ghana

Research article

The current incidence, prevalence, and residual risk of hepatitis B viral infections among voluntary blood donors in China

Research article

Prevalence of Escherichia coli O157:H7 in beef cattle at slaughter and beef carcasses at retail shops in Ethiopia

Research article

Trends in baseline CD4 cell counts and risk factors for late antiretroviral therapy initiation among HIV-positive patients in Shanghai, a retrospective cross-sectional study

Research article

An evaluation of a recombinant multiepitope based antigen for detection of Toxoplasma gondii specific antibodies

Research article

Brain and liver pathology, amyloid deposition, and interferon responses among older HIV-positive patients in the late HAART era

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits