Advanced search
3 files | 340.81 KB Add to list

Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics

Author
Organization
Abstract
Background: HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. Methods: We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. Results: During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. Conclusions: Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk.
Keywords
MORTALITE 2000, CARE, PROTEASE INHIBITOR, DISEASE PROGRESSION, FOLLOW-UP, COLLABORATIVE ANALYSIS, HIV-1-INFECTED PATIENTS, INFECTED PATIENTS, VIROLOGICAL TREATMENT FAILURE, ACTIVE ANTIRETROVIRAL THERAPY, socio-economic status, prognostic model, heterogeneity, cohort, mortality, antiretroviral therapy, HIV, AIDS

Downloads

  • (...).doc
    • full text
    • |
    • UGent only
    • |
    • application/msword
    • |
    • 44.03 KB
  • (...).pdf
    • full text
    • |
    • UGent only
    • |
    • PDF
    • |
    • 211.27 KB
  • (...).doc
    • full text
    • |
    • UGent only
    • |
    • application/msword
    • |
    • 85.50 KB

Citation

Please use this url to cite or link to this publication:

MLA
May, Margaret T, Robert S Hogg, Amy C Justice, et al. “Heterogeneity in Outcomes of Treated HIV-positive Patients in Europe and North America: Relation with Patient and Cohort Characteristics.” INTERNATIONAL JOURNAL OF EPIDEMIOLOGY 41.6 (2012): 1807–1820. Print.
APA
May, M. T., Hogg, R. S., Justice, A. C., Shepherd, B. E., Costagliola, D., Ledergerber, B., Thiébaut, R., et al. (2012). Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, 41(6), 1807–1820.
Chicago author-date
May, Margaret T, Robert S Hogg, Amy C Justice, Bryan E Shepherd, Dominique Costagliola, Bruno Ledergerber, Rodolphe Thiébaut, et al. 2012. “Heterogeneity in Outcomes of Treated HIV-positive Patients in Europe and North America: Relation with Patient and Cohort Characteristics.” International Journal of Epidemiology 41 (6): 1807–1820.
Chicago author-date (all authors)
May, Margaret T, Robert S Hogg, Amy C Justice, Bryan E Shepherd, Dominique Costagliola, Bruno Ledergerber, Rodolphe Thiébaut, M John Gill, Ole Kirk, Ard van Sighem, Michael S Saag, Gemma Navarro, Paz Sobrino-Vegas, Fiona Lampe, Suzanne Ingle, Jodie L Guest, Heidi M Crane, Antonella D’Arminio Monforte, Jörg J Vehreschild, Jonathan AC Sterne, the Antiretroviral Therapy Cohort Collaboration (ART-CC), and Linos Vandekerckhove. 2012. “Heterogeneity in Outcomes of Treated HIV-positive Patients in Europe and North America: Relation with Patient and Cohort Characteristics.” International Journal of Epidemiology 41 (6): 1807–1820.
Vancouver
1.
May MT, Hogg RS, Justice AC, Shepherd BE, Costagliola D, Ledergerber B, et al. Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics. INTERNATIONAL JOURNAL OF EPIDEMIOLOGY. 2012;41(6):1807–20.
IEEE
[1]
M. T. May et al., “Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics,” INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, vol. 41, no. 6, pp. 1807–1820, 2012.
@article{4352127,
  abstract     = {Background: HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. 
Methods: We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. 
Results: During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. 
Conclusions: Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk.},
  author       = {May, Margaret T and Hogg, Robert S and Justice, Amy C and Shepherd, Bryan E and Costagliola, Dominique and Ledergerber, Bruno and Thiébaut, Rodolphe and Gill, M John and Kirk, Ole and van Sighem, Ard and Saag, Michael S and Navarro, Gemma and Sobrino-Vegas, Paz and Lampe, Fiona and Ingle, Suzanne and Guest, Jodie L and Crane, Heidi M and Monforte, Antonella D'Arminio and Vehreschild, Jörg J and Sterne, Jonathan AC and Antiretroviral Therapy Cohort Collaboration (ART-CC), the and Vandekerckhove, Linos},
  issn         = {0300-5771},
  journal      = {INTERNATIONAL JOURNAL OF EPIDEMIOLOGY},
  keywords     = {MORTALITE 2000,CARE,PROTEASE INHIBITOR,DISEASE PROGRESSION,FOLLOW-UP,COLLABORATIVE ANALYSIS,HIV-1-INFECTED PATIENTS,INFECTED PATIENTS,VIROLOGICAL TREATMENT FAILURE,ACTIVE ANTIRETROVIRAL THERAPY,socio-economic status,prognostic model,heterogeneity,cohort,mortality,antiretroviral therapy,HIV,AIDS},
  language     = {eng},
  number       = {6},
  pages        = {1807--1820},
  title        = {Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics},
  url          = {http://dx.doi.org/10.1093/ije/dys164},
  volume       = {41},
  year         = {2012},
}

Altmetric
View in Altmetric
Web of Science
Times cited: