Changes over time in the risk of death following HIV .ppt

1、CROI 2008, Boston,Changes over time in the risk of death following HIV seroconversion compared with mortality in the general population Kholoud Porter, Krishnan Bhaskaran, Osamah Hamouda, Mette Sannes, Faroudy Boufassa, Anne Johnson, A Sarah Walker on behalf of CASCADE Collaboration,CROI 2008, Bosto

2、n,Background,Estimates of expected HIV mortality are important for clinical care and healthcare planningAs mortality rates fall, comparison to that of general population increasingly importantMortality in HIV infected individuals will increasingly be influenced by non-HIV related causes of deathsDet

3、ails of cause of death missing or unreliable and often uncertainty over what may or may not be “HIV-related”,CROI 2008, Boston,Objectives,To assess changes over calendar time in risk of excess mortality compared to general population and associated prognostic factorsTo estimate excess probability of

4、 death at various durations of HIV infection,CROI 2008, Boston,Methods (1),CASCADE: 23 cohorts from Europe, Canada and Australia of persons with well-estimated dates of HIV seroconversionAged 15 years, sexual (MSM and MSW) or IDU exposureFollow-up from SC to death/ censoringDerived expected number o

5、f deaths from general population matched to study population stratified by: age, sex, calendar year at risk, country,CROI 2008, Boston,Methods (2),Observed deaths in study population modelled using Poisson process, subtracting expected deaths time since SC divided into 1-year intervals examined chan

6、ges in risk of excess mortality over calendar time, adjusting for: age at SC, sex and risk group investigated effects of these factors on excess mortalityCalculated life-table estimates of cumulative and relative survival, by infection duration in each calendar period. Hence, cumulative mortality an

7、d cumulative excess mortality,CROI 2008, Boston,Study population,15 779 individuals, 108 329 person-yearsMale: 12363 (78%) Female: 3416 (22%)MSM: 8996 (57%) MSW: 3829 (24%) IDU: 2954 (19%)Median age at SC 29 years (IQR 24-36),CROI 2008, Boston,Excess deaths over calendar time,CROI 2008, Boston,Facto

8、rs associated with risk of excess mortality,adjusted excess HR (95% CI) Calendar year Pre-1996 1.001996-97 0.52 (0.47- 0.59)1998-99 0.16 (0.14- 0.19)2000-01 0.12 (0.10- 0.14)2002-03 0.10 (0.08- 0.12)2004-06 0.06 (0.05- 0.08)Age group (yrs)15-24 125-34 1.34 (1.21- 1.49)35-44 1.90 (1.66- 2.18)45+ 2.35

9、 (1.93- 2.85)SexMale 1.00Female 0.79 (0.7- 0.91,CROI 2008, Boston,Changes over time in effect of risk group on excess mortality,* variation within calendar period,CROI 2008, Boston, 1996,1996- 97,1998- 99,2000- 01,2002- 03,2004- 06,10,45 years,15,10,45+ years,15,-10,0,10,20,30,40,50,60,70,80,90,100,

10、5,5,Years since seroconversion,Age at SC,Cumulative % excess mortality,Cumulative excess mortality (sexual exposure only),CROI 2008, Boston,45 years at seroconversion,0.0,0.2,0.4,0.6,0.8,1.0,Estimated cumulative mortality,0,5,10,15,Time since seroconversion (years),0,5,10,15,45+ years at seroconvers

11、ion,All-cause mortality pre-1996 and 2004-06 (sexual exposure only),Pre-1996 (HIV infected),2004- 2006 (HIV infected),2004- 2006 (general uninfected),CROI 2008, Boston,Conclusions,HIV patients are surviving longer: important to consider natural background mortalityThe gap in mortality rates between

12、HIV infected individuals in our study and the general population has narrowed considerablyA significantly elevated risk of death remains for all agesIDUs remain at higher risk of death throughout HAART eraOngoing monitoring is crucial as therapies and management change,CROI 2008, Boston,CASCADE Coll

13、aborators,Steering Committee: Julia Del Amo (Chair), Laurence Meyer (Vice Chair), Heiner Bucher, Genevive Chne, Deenan Pillay, Maria Prins, Magda Rosinska, Caroline Sabin, Giota Touloumi. Co-ordinating Centre: Kholoud Porter (Project Leader), Sara Lodi, Sarah Walker, Abdel Babiker, Janet Darbyshire.

14、 Clinical Advisory Board: Heiner Bucher, Andrea de Luca, Martin Fisher, Roberto Muga. Collaborators: Australia Sydney AIDS Prospective Study and Sydney Primary HIV Infection cohort (John Kaldor, Tony Kelleher, Linda Gelgor, Tim Ramacciotti, David Cooper, Don Smith); Canada South Alberta clinic (John

15、 Gill); Denmark Copenhagen HIV Seroconverter Cohort (Louise Bruun Jrgensen, Claus Nielsen, Court Pedersen); Estonia Tartu likool (Irja Lutsar); France Aquitaine cohort (Genevive Chne, Francois Dabis, Rodolphe Thiebaut, Bernard Masquelier), French Hospital Database (Dominique Costagliola, Marguerite

16、Guiguet), Lyon Primary Infection cohort (Philippe Vanhems), SEROCO cohort (Laurence Meyer, Faroudy Boufassa); Germany German cohort (Osamah Hamouda, Claudia Kcherer); Greece Greek Haemophilia cohort (Giota Touloumi, Nikos Pantazis, Angelos Hatzakis, Dimitrios Paraskevis, Anastasia Karafoulidou); Ita

17、ly Italian Seroconversion Study (Giovanni Rezza, Maria Dorrucci, Benedetta Longo, Claudia Balotta); Netherlands Amsterdam Cohort Studies among homosexual men and drug users (Maria Prins, Liselotte van Asten, Akke van der Bij, Ronald Geskus, Roel Coutinho); Norway Oslo and Ulleval Hospital cohorts (M

18、ette Sannes, Oddbjorn Brubakk, Anne Eskild, Johan N Bruun); Poland National Institute of Hygiene (Magdalena Rosinska); Portugal Universidade Nova de Lisboa (Ricardo Camacho); Russia Pasteur Institute (Tatyana Smolskaya); Spain Badalona IDU hospital cohort (Roberto Muga), Barcelona IDU Cohort (Patric

19、ia Garcia de Olalla), Madrid cohort (Julia Del Amo, Jorge del Romero), Valencia IDU cohort (Santiago Prez-Hoyos, Ildefonso Hernandez Aguado); Switzerland Swiss HIV cohort (Heiner Bucher, Martin Rickenbach, Patrick Francioli); Ukraine Perinatal Prevention of AIDS Initiative (Ruslan Malyuta); UK Edinb

20、urgh Hospital cohort (Ray Brettle), Health Protection Agency (Valerie Delpech, Sam Lattimore, Gary Murphy, John Parry, Noel Gill), Royal Free Haemophilia cohort (Caroline Sabin, Christine Lee), UK Register of HIV Seroconverters (Kholoud Porter, Anne Johnson, Andrew Phillips, Abdel Babiker, Janet Darbyshire, Valerie Delpech), University College London (Deenan Pillay), University of Oxford (Harold Jaffe).,