Revista de SIDA e investigación clínica

Combined Antiretroviral Therapy (cART) Reduces AIDS-Related and Non- AIDS-Related Mortality: A Temporal Analysis from Time of Seroconversion (SC)

Abstract

Maria Dorrucci, Luca Colarusso, Vincenza Regine, Simona Di Giambenedetto, Giovanni Di Perri, Francesco Castelli, Laura Camoni, Angela Calamo, Massimo Giuliani, Rino Bellocco, Francesca Farchi, Mauro Zaccarelli and Barbara Suligoi

Objectives: To estimate changes of AIDS and non-AIDS mortalities from 1996 to 2010 comparing (2004-2010) vs. (1996-2003) periods from the time of HIV-seroconversion (SC).

Methods: Data derived from an Italian multicentre prospective and open cohort; competing risks approach was applied estimating the cumulative incidence functions (CIF) for AIDS and non-AIDS deaths over time from SC with delayed entries in the two cART periods. Cox-cause-specific hazards models were applied to estimate relative hazards (RH) of AIDS and non-AIDS related deaths.

Results: Of 2,249 individuals with known SC date followed from SC and from January 1996 to December 2010, 1,779 were survived, seroconverted or followed during 1996-2003, while 1,715 during 2004-2010. A total of 278 deaths occurred from 1996 to 2010: 197 in the early years of cART [61 (31%) non-AIDS deaths], and 81 during more recent cART period [48 (59%) non-AIDS deaths]. The CIF of AIDS related deaths was higher than CIF of non-AIDS related deaths in the early period [for instance, estimates at 15 yrs from SC: CIF of AIDS-related death = 0.15 (95% CI: 0.12-0.19 ) and CIF of non-AIDS related = 0.09 (95% CI: 0.07-0.12)], whilst in 2004-2010 period the CIF of non-AIDS related deaths was slightly higher [estimates at 15 yrs from SC: CIF of non-AIDS related = 0.03 (95% CI: 0.02-0.04) vs. CIF of AIDS-related death = 0.02 (95% CI: 0.02-0.04)]. Comparing the two periods by Cox proportional-cause-specific models, the hazard was lower for AIDS deaths than for non-AIDS related deaths [RH of non-AIDS deaths from last viral load (VL) < 200 copies/mL was 0.60 (95% CI (0.35-1.03)], while of AIDS-deaths was 0.32 (95% CI: 0.17-0.62), both RH relative to (2004-2010) vs. (1996- 2003)].

Conclusions: Considering early years of the cART period as a reference, we observed a decrease in both AIDS and non-AIDS-mortalities. In more recent cART years, non-AIDS mortality tended to decline less than AIDS-relatedmortality since HIV-SC, even after effective cART.