Trends in Mortality in People With HIV From 1999 through 2020: A Multicohort Collaboration
Erich Tusch, Lene Ryom, Annegret Pelchen–Matthews, Amanda Mocroft, Daniel Elbirt, Cristiana Oprea, Huldrych F. Günthard, Cornelia Staehelin, Robert Zangerle, Isabelle Suárez, Jörg Janne Vehreschild, Ferdinand Wit, Marianna Menozzi, Antonella d'Arminio Monforte, Vincenzo Spagnuolo, Christian Pradier, Christina Carlander, Paula Suanzes, Jan‐Christian Wasmuth, Andrew Carr, Kathy Petoumenos, Frauke Borgans, Fabrice Bonnet, Stéphane De Wit, Wafaa El‐Sadr, Bastian Neesgaard, Nadine Jaschinski, Lauren Greenberg, Sean R Hosein, Joel E. Gallant, Vani Vannappagari, Lital Young, Caroline Sabin, Jens Lundgren, Lars Peters, Joanne Reekie, D:A:D cohort study, W El-Sadr, G Calvo, Fidéline Bonnet-Serrano, F Dabis, O Kirk, A Mocroft, Matthew Law, A d’Arminio Monforte, Linda Morfeldt, C Pradier, P Reiss, R Weber, S De Wit, A Lind-Thomsen, Rikke Brandt, M Hillebreght, S Zaheri, F W N M Wit, Alexandra Scherrer, F. Schöni-Affolter, Martin Rickenbach, Alessandro Tavelli, Iuri Fanti, O Leleux, J. Mourali, F Le Marec, Eloïse Boerg, Eva Thulin, A Sundström, Georg Bartsch, G Thompsen, Coca Necsoi, M Delforge, E Fontas, C Caissotti, K Dollet, S Mateu, Ferràn Torres, K Petoumenos, A Blance, Robin Huang, R Puhr, Kamilla Grønborg Laut, Daniel Tuyet Kristensen, Caroline Sabin, Andrew Phillips, D A Kamara, C J Smith, A Mocroft, C I Hatleberg, A Lind-Thomsen, Rikke Brandt, D Raben, Charles E. Matthews, Anders Bojesen, Anne Louise Grevsen, J D Lundgren, L Ryom, William G. Powderly, N. Shortman, Christiane Moecklinghoff, Gerry Reilly, Xavier Franquet
Abstract
BACKGROUND: Mortality among people with human immunodeficiency virus (HIV) declined with the introduction of combination antiretroviral therapy. We investigated trends in mortality in people with HIV from 1999 through 2020. METHODS: Data were collected from the Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) cohort between January 1999 through January 2015 and the International Cohort Consortium of Infectious Disease (RESPOND) from October 2017 through December 2020. Age-standardized all-cause and cause-specific mortality rates, classified using Coding Causes of Death in HIV, were calculated. Poisson models were used to assess mortality over time. RESULTS: Among 55 716 participants followed for median 6 years (interquartile range, 3-11), 5263 died (mortality rate [MR], 13.7/1000 person-years of follow-up [PYFU]; 95% confidence interval [CI], 13.4-14.1). Changing mortality was observed: AIDS mortality was most common between 1999-2009 (n = 952; MR, 4.2/1000 PYFU; 95% CI, 4.0-4.5) and non-AIDS-defining malignancy (NADM) between 2010-2020 (n = 444; MR, 2.8/1000 PYFU; 95% CI, 2.5-3.1). In multivariable analysis, all-cause mortality declined (adjusted mortality rate ratio [aMRR], 0.97 per year; 95% CI, .96-.98), mostly 1999-2010 (aMRR, 0.96 per year; 95% CI, .95-.97) but was stable 2011-2020 (aMRR, 1.00 per year; 95% CI, .96-1.05). Mortality due to all known causes except NADM also declined. CONCLUSIONS: Mortality among people with HIV in the D:A:D and/or RESPOND cohorts declined between 1999-2009 and was stable over the period 2010-2020. This decline in mortality was not fully explained by improvements in immunologic-virologic status or other risk factors.