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AIDS, Liver Disease Down as Death Causes
in Paris HIV Group; Cancer and CVD Up
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16th European AIDS Conference, October 25-27, 2017. Milan
Mark Mascolini
Proportions of death from AIDS and liver diseases appear to be falling in a large Paris HIV group, while non-AIDS nonhepatitis cancers and cardiovascular disease (CVD) account for large and possibly growing proportions of deaths in this cohort [1]. Being born outside of France did not raise the death risk in this 2011-2014 analysis.
Researchers from a French hospital group using the same electronic medical record system noted that three national French surveys in 2000, 2005, and 2010 documented a drop in the proportion of AIDS-related deaths across those three periods and a jump in non-AIDS causes of mortality in people with HIV. In particular this research attributed growing proportions of deaths in the HIV population to non-AIDS nonviral-hepatitis-related malignancy and to cardiovascular disease.
To extend these observations through 2015, the investigators focused on 14,403 HIV patients seen with at least one follow-up visit in 13 Paris hospital clinics from January 2011 through December 2015. They compared death rates in that period with 2010 rates in the French national analysis, so the comparison involves two different cohorts. The researchers divided causes of death into AIDS-related causes, non-AIDS nonhepatitis-related malignancies, liver diseases, cardiovascular disease, non-AIDS infections, suicides/violent deaths/other causes, and unknown. They used multivariable logistic regression to assess death risks in the Paris group.
Of the 14,403 Paris patients seen during the 2011-2015 study period, 295 (2%) died. The researchers compared these 295 Paris residents with 728 people who died in the 2010 French national study. Three quarters of both groups were men, and median duration of HIV infection stood at about 15 years in both cohorts. The Paris and national groups had median ages of 52 and 50 at death, median CD4 counts of 241 and 243, and proportions with HCV antibody 29% and 30%. The Paris cohort included a higher proportion with a viral load below 50 copies (61% versus 56%) and a doubled proportion of non-France natives (56% versus 27%). HIV transmission risks did not differ substantially between the Paris group and the national group.
AIDS accounted for 14% of deaths in the 2011-2014 Paris group, nearly half the 25% in the 2010 French national group. In contrast, slightly higher proportions of death in the Paris group than in the national group could be explained by non-AIDS nonhepatitis malignancies (23% versus 22%), non-AIDS infections (11% versus 9%), and cardiovascular disease (12% versus 10%). The Paris group had lower proportions of death attributed to liver disease (7% versus 11%), unexplained sudden death (2% versus 4%), and suicide (4% versus 5%). Interpreting these differences is difficult, though, because the Paris team could not determine 25% of death causes, compared with only 4% in the French national group.
Within the Paris cohort, multivariable logistic regression identified several factors independently linked to higher odds of death, at the following adjusted odds ratios (aOR) (and 95% confidence intervals):
-- Male sex: aOR 1.47 (1.08 to 2.00)
-- Age 50 or older vs 40 to 49: aOR 1.48 (1.13 to 1.96)
-- Injecting drugs vs heterosexual HIV transmission: aOR 2.46 (1.60 to 3.79)
-- Having an AIDS diagnosis: aOR 3.72 (2.88 to 4.80)
-- Under 1 year since HIV diagnosis vs 5 to 15 years: aOR 4.04 (1.97 to 8.27)
-- ART duration under 1 year or none vs 15 years or more: aOR 1.95 (1.04 to 3.65)
-- CD4 count at ART initiation under 350 vs 500 or more: aOR 1.61 (1.09 to 2.37)
-- HBV or HCV positivity: aOR 1.66 (1.16 to 2.37)
-- Psychiatric disorders: aOR 1.93 (1.41 to 2.65)
People not born in France did not have a higher death risk than French natives.
The researchers believe the downtrend in deaths from AIDS and liver disease reflects broader access to ART and treatment for viral hepatitis. They urged colleagues to make screening for non-AIDS cancers a priority in people with HIV. And they stressed that "people recently entered into care for HIV and recently treated are still at high risk for death."
Reference
1. Sellier P, Abgrall S, Brun A, et al. Causes of death among HIV-infected patients in a large French hospital network from 2011 to 2015. 16th European AIDS Conference. October 25-27, 2017. Milan. Abstract PE21/2.
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