HIV-related mortality has decreased since 1996 due to improving treatments and evolving care guidelines, but the extent to which persons entering HIV care have a higher risk for death over the following years, compared with peers in the general population, has been unclear.
Joseph Eron, MD, the Herman and Louise Smith Distinguished Professor of Medicine and chief of the division of infectious diseases, was the senior investigator on this novel observational study that advances the understanding of trends in mortality in the years after entering HIV care, compared with the general US population, published recently in the Annals of Internal Medicine.
The study was led by Jessie K. Edwards, PhD, assistant professor in the department of epidemiology, and utilized 13 sites from the North American AIDS Cohort Collaboration on Research and Design. Participants included 82,766 adults entering HIV clinical care between 1999 and 2017, and a subset of the US population, matched on calendar time, age, sex, race/ethnicity, and county using mortality and population data compiled by the National Center for Health Statistics.
The results showed a dramatic mortality decrease between 1999 and 2017, although those entering care remained at higher risk for death in the years after starting care than comparable adults in the general US population. Five-year mortality for people entering HIV care was 10.6%, and mortality among the matched U.S. population was 2.9%, for a difference of 7.7 (95% CI, 7.4 to 7.9) percentage points. This difference decreased over time, from 11.1 percentage points among those entering care between 1999 and 2004 to 2.7 percentage points among those entering care between 2011 and 2017.
“While we have seen substantial improvement in survival for people with HIV after they enter care, there is still a modest but real difference in survival compared to a carefully matched population of people without HIV,” Eron said. “Some of our patients still enter care years after infection and cannot take full advantage the improvements in treatment and care.”
Researchers acknowledge that understanding the differences in mortality between persons entering HIV care and the matched US population is critical to improving care, and that gaps still remain. Being able to quantify the elevation in mortality observed for persons in HIV care will inform future efforts to address both AIDS and non–AIDS-related consequences of HIV infection and long-term ART.
The study was supported by the National Institutes of Health; the Centers for Disease Control and Prevention; the Agency for Healthcare Research and Quality; the Health Resources and Services Administration; Grady Health System; the Canadian Institutes of Health Research; the Ontario Ministry of Health and Long-Term Care; and the Government of Alberta, Canada.