TY - JOUR
T1 - Long-term exposure to combination antiretroviral therapy and risk of death from specific causes: no evidence for any previously unidentified increased risk due to antiretroviral therapy
AU - Kowalska, Justyna D
AU - Reekie, Joanne
AU - Mocroft, Amanda
AU - Reiss, Peter
AU - Ledergerber, Bruno
AU - Gatell, Jose
AU - Monforte, Antonella d'Arminio
AU - Phillips, Andrew
AU - Lundgren, Jens D
AU - Kirk, Ole
AU - for the EuroSIDA study group
PY - 2012/1/28
Y1 - 2012/1/28
N2 - BACKGROUND:: Despite the known substantial benefits of combination antiretroviral therapy (cART), cumulative adverse effects could still limit the overall long-term treatment benefit. Therefore we investigated changes in the rate of death with increasing exposure to cART. METHODS:: 12069 patients were followed from baseline, which was defined as the time of starting cART or enrolment into EuroSIDA whichever occurred later, until death or six months after last follow-up visit. Incidence rates (IR) of death were calculated per 1000 person-years of follow-up (PYFU) and stratified by time of exposure to cART (≥3 antiretrovirals): 8 years. Duration of cART exposure was the cumulative time actually receiving cART. Poisson regression models were fitted for each cause of death separately. RESULTS:: 1297 patients died during 70613 PYFU (IR 18.3 per 1000 PYFU, 95%CI: 17.4-19.4), 413 due to AIDS (5.85, 95%CI: 5.28-6.41) and 884 due to non-AIDS-related cause (12.5, 95%CI: 11.7-13.3). After adjustment for confounding variables, including baseline CD4 cell count and HIV RNA, there was a significant decrease in the rate of all-cause and AIDS-related death between 2-3.99 years and longer exposure time. In the first two years on cART the risk of non-AIDS death was significantly lower, but no significant difference in the rate of non-AIDS-related deaths between 2-3.99 years and longer exposure to cART was observed. CONCLUSIONS:: In conclusion, we found no evidence of an increased risk of both all-cause and non-AIDS related deaths with long-term cumulative cART exposure.
AB - BACKGROUND:: Despite the known substantial benefits of combination antiretroviral therapy (cART), cumulative adverse effects could still limit the overall long-term treatment benefit. Therefore we investigated changes in the rate of death with increasing exposure to cART. METHODS:: 12069 patients were followed from baseline, which was defined as the time of starting cART or enrolment into EuroSIDA whichever occurred later, until death or six months after last follow-up visit. Incidence rates (IR) of death were calculated per 1000 person-years of follow-up (PYFU) and stratified by time of exposure to cART (≥3 antiretrovirals): 8 years. Duration of cART exposure was the cumulative time actually receiving cART. Poisson regression models were fitted for each cause of death separately. RESULTS:: 1297 patients died during 70613 PYFU (IR 18.3 per 1000 PYFU, 95%CI: 17.4-19.4), 413 due to AIDS (5.85, 95%CI: 5.28-6.41) and 884 due to non-AIDS-related cause (12.5, 95%CI: 11.7-13.3). After adjustment for confounding variables, including baseline CD4 cell count and HIV RNA, there was a significant decrease in the rate of all-cause and AIDS-related death between 2-3.99 years and longer exposure time. In the first two years on cART the risk of non-AIDS death was significantly lower, but no significant difference in the rate of non-AIDS-related deaths between 2-3.99 years and longer exposure to cART was observed. CONCLUSIONS:: In conclusion, we found no evidence of an increased risk of both all-cause and non-AIDS related deaths with long-term cumulative cART exposure.
U2 - 10.1097/QAD.0b013e32834e8805
DO - 10.1097/QAD.0b013e32834e8805
M3 - Journal article
C2 - 22112597
SN - 0269-9370
VL - 26
SP - 315
EP - 323
JO - AIDS
JF - AIDS
IS - 3
ER -