Risk factors for early mortality after AIDS in the cART era: A population-based cohort study in Italy

BMC Infectious Diseases

Diego Serraino²  Paolo De Paoli¹  Vincenza Regine³  Martina Taborelli²  Marilena Pappagallo⁴  Stefano Boros³  Saverio Virdone²  Luisa Frova⁴  Luigino Dal Maso²  Laura Camoni³  Enrico Grande⁴  Antonella Zucchetto²  Barbara Suligoi³ 

[1] Scientific Directorate, CRO Aviano National Cancer Institute, Aviano, Italy;Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, via Gallini 2, Aviano, 33081, Italy;Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy;Health and social care Section, National Institute of Statistics, Rome, Italy

关键词: Italy, cART;    Survival;    Early mortality;    AIDS;   

Others  :  1230409
DOI  :  10.1186/s12879-015-0960-6

 received in 2014-12-15, accepted in 2015-05-21,  发布年份 2015

【 摘 要 】

Background

Despite the dramatically improved survival due to combination antiretroviral therapies (cART), life expectancy of people with HIV/AIDS remains lower than that of the general population. This study aimed to estimate, at a population level, the survival experience of Italian people with AIDS (PWA) and to quantify the prognostic role of selected factors at diagnosis in the risk of early mortality (i.e., within six months from AIDS diagnosis).

Methods

A population-based, retrospective-cohort study was conducted among Italian PWA diagnosed between 1999 and 2009 and recorded in the national AIDS registry. The vital status, up to December 2010, of 14,552 PWA was ascertained through a record linkage procedure with the Italian mortality database. Survival probabilities were estimated through Kaplan-Meier method. To identify risk factors for early mortality from any cause, odds ratios (ORs) and corresponding 95 % confidence intervals (CIs), adjusted for major confounders, were computed using multivariate logistic regression models.

Results

Of the 5,706 deaths registered among the 14,552 PWA included in the study, 2,757 (18.9 %) occurred within six months from AIDS diagnosis. The probability of surviving six months increased from 81.2 % in PWA diagnosed in 1999–2000 to 82.9 % in 2009, while the 5-year survival augmented from 60.7 % in PWA diagnosed in 1999–2000 to 65.4 % for PWA diagnosed in 2005–2006. Elevated risks of early mortality were associated to older age (OR = 5.28; 95 % CI: 4.41-6.32 for age ≥60 vs. <35 years), injecting drug use (OR = 1.71; 95 % CI: 1.53-1.91 vs. heterosexual intercourse), and CD4 count <50 cells/mm³ at AIDS diagnosis (OR = 1.87, 95 % CI: 1.55-2.27 vs. ≥350). Elevated ORs for early mortality also emerged for PWA diagnosed with primary brain lymphoma (OR = 11.66, 95 % CI: 7.32-18.57), or progressive multifocal leukoencephalopathy (OR = 4.21, 95 % CI: 3.37-5.27).

Conclusions

Our study documented, among Italian PWA, the high - though slightly decreasing - frequency of early mortality in the full cART era. These findings indicate the need for enduring and ameliorating preventive actions aimed at timely HIV testing among all individuals at risk for HIV infection and/or those who present diseases known to be related with HIV infection.

【 授权许可】

   
2015 Suligoi et al.

【 图 表 】

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