Longitudinal trends in causes of death among adults with HIV in Europe and North America on antiretroviral therapy from 1996 to 2020: a collaboration of cohort studies
Notice bibliographique
Résumé
BACKGROUND Mortality rates among persons with HIV (PWH) have fallen since 1996 following the widespread availability of effective antiretroviral therapy (ART). Patterns of cause-specific mortality are evolving as the population of PWH ages. We aimed to investigate longitudinal trends in cause-specific mortality rates among PWH starting ART in Europe and North America. METHODS We used data on PWH aged ≥16 years old when starting ART between 1996 and 2020 from 17 European and North American HIV cohorts contributing data to the Antiretroviral Therapy Cohort Collaboration. Causes of death were classified by both a clinician and an algorithm if ICD9/10 data were available, or independently by two clinicians. Disagreements were resolved through panel discussion. We used Poisson models to compare cause-specific mortality rates during calendar periods 1996-99, 2000-03, 2004-07, 2008-11, 2012-15 and 2016-20, adjusted for time-updated age, CD4 count, and whether ART-naïve at the start of each period. FINDINGS Among 189,301 PWH, 16,832 (8.9%) died. Causes of death were classified for 13180 (78%) deaths: the most common causes were AIDS (4203 deaths; 25%), non-AIDS non-hepatitis malignancy (2311; 14%) and cardiovascular (1403; 8%). The proportion of deaths due to AIDS declined from 49% during 1996-9 to 16% during 2016-20. Rates of all-cause mortality per 1000 person-years decreased from 16.8 (95%CI: 15.4-18.4) during 1996-99 to 7.9 (7.6-8.2) during 2016-20. Rates of all-cause mortality declined with time: the average adjusted mortality rate ratio [aMRR] per calendar period was 0.86 (95%CI 0.85-0.87). Rates of cause-specific mortality also declined: the most pronounced reduction was for AIDS-related mortality (average aMRR per period 0.82; 95%CI 0.80-0.85). There were also reductions in rates of cardiovascular-related, liver-related, non-AIDS infection-related, non-AIDS-non-hepatocellular carcinoma malignancy-related, and suicide/accident-related mortality (average aMRRs per period 0.83 (0.79-0.87), 0.90 (0.85-0.94), 0.92 (0.88-0.97), 0.95 (0.91-0.98), and 0.89 (0.83-0.95), respectively). Mortality rates among people who acquired HIV through injecting drug use were stable among men and increased among women. INTERPRETATION There have been reductions over time in rates of most major causes of death, particularly AIDS-related deaths, among PWH on ART. However, such reductions were not seen for all subgroups. Interventions targeted at high-risk groups, substance use, and comorbidities may further increase life expectancy in PWH towards that in the general population. FUNDING US National Institute on Alcohol Abuse and Alcoholism.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,010 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,003 | 0,004 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».