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

BMC Infectious Diseases

Research Article

Barbara Suligoi¹  Stefano Boros¹  Vincenza Regine¹  Laura Camoni¹  Luisa Frova²  Enrico Grande²  Marilena Pappagallo²  Paolo De Paoli³  Antonella Zucchetto⁴  Saverio Virdone⁴  Diego Serraino⁴  Martina Taborelli⁴  Luigino Dal Maso⁴ 

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

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

DOI  :  10.1186/s12879-015-0960-6

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

来源: Springer

【 摘 要 】

BackgroundDespite 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).MethodsA 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.ResultsOf 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).ConclusionsOur 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】

Unknown   
© Suligoi et al. 2015. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.