Five Years after Seroconversion, HIV Positive Individuals on HAART Are No More Likely to Die than the General Population

Mortality among HIV positive individuals has decreased dramatically in countries with good access to antiretroviral treatment. Now, researchers have found that 5 years after HIV seroconversion, individuals in industrialized countries who are receiving HAART are no more likely to die than HIV negative individuals in the general population, according to a report published in the July 2, 2008 issue of the Journal of the American Medical Association.

The aim of the current study was to evaluate changes in the "mortality gap" or "excess mortality" between HIV-infected individuals and the general, uninfected population.

Researchers at 23 medical centers in Europe, Australia, and Canada compared mortality rates following HIV seroconversion among 16,534 participants enrolled in CASCADE -- a large multinational collaboration of HIV seroconverter cohorts -- with expected mortality calculated based on rates in a general population matched for demographic factors.

A Poisson-based model adjusted for duration of infection was used to assess changes over time in the excess death rate among HIV-infected individuals. Data covering the years 1981-2006 were pooled in September 2007 and analyzed in March 2008. The median duration of follow-up was 6.3 years (range 1 day to 23.8 years).

Results

• Of 16,534 enrolled participants, 2571 died during the observation period, compared with 235 deaths expected in an equivalent general population cohort.

• The excess mortality rate decreased from 40.8 per 1000 person-years before the introduction of HAART (pre-1996) to 6.1 per 1000 person-years in the 2004-2006 period (adjusted excess hazard ratio 0.05).

• By 2004-2006, no excess mortality was observed during the first 5 years following HIV seroconversion among those infected through sexual contact.

• Individuals infected through injection drug use, however, still had a higher mortality rate compared with the general population.

• HIV positive individuals continued to have a cumulative excess probability of death over a longer term -- the first 10 years after seroconversion -- ranging from 4.8% for people who seroconverted at age 15-24 to 4.3% for those who seroconverted at age 45 or later.

These findings show that since the introduction of HAART in 1996, mortality rates for individuals with HIV have become very similar to general population mortality rates. These study results suggest that use of combination antiretroviral therapy has improved the survival prospects of HIV positive people so much that death rates among those recently infected in developed countries have become comparable to those of people never exposed to the virus.

In their conclusion, the study authors wrote, "In industrialized countries, persons infected sexually with HIV now appear to experience mortality rates similar to those of the general population in the first 5 years following infection, though a mortality excess remains as duration of HIV infection lengthens."

Medical Research Council Clinical Trials Unit, London, UK; Robert Koch Institute, Berlin, Germany; Ulleval University Hospital, Oslo, Norway; INSERM U822, Hôpital Bicêtre, Paris, France; University College London, London, UK; University of Leicester, Leicester, UK.

7/04/08

Reference
K Bhaskaran, O Hamouda, M Sannes, and others (for the CASCADE Collaboration). Changes in the risk of death after HIV seroconversion compared with mortality in the general population. Journal of the American Medical Association 300(1): 51-59. July 2, 2008.

Abstract