Infectious Disease

The mortality gap between people with HIV and the general population is narrowing

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Disclosure:
Edwards reports that he has received financial assistance on behalf of his institution from the FDA, the National Institute of General Medical Sciences, the National Institute of Allergy and Infectious Diseases, and North Carolina state lawmakers. Please refer to the study for all relevant financial information from the other authors. Glesby reports that he has received research funding from Gilead Sciences on behalf of his institution. Gulick reports that he has received research grants from the NIH on behalf of his institution. He also reports that he was section editor and reviewer for ART for UpToDate, chapters on ART for Elsevier, and a chapter on HIV for Wolters Kluwer.

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The death rate of patients undergoing HIV treatment in the United States “dropped dramatically” from 1999 to 2017, according to researchers.

Jessie K. Edwards, PhD, an assistant professor in the Epidemiology Department of the University of North Carolina at Chapel Hill and colleagues estimated that the 5-year mortality rate in patients who received HIV treatment between 2011 and 2017 was just 2.7 percentage points compared to the general population was higher.

Source: Edwards JK, et al. Anna Intern Med. 2021; doi: 10.7326 / M21-0065.

“HIV-related mortality has declined since effective treatment was introduced in 1996 due to improved treatment options and evolving care guidelines, but the extent to which people entering HIV treatment in the United States have increased in subsequent years Risk of death as compared to peers in the general population over the same period remains unclear, ”the researchers wrote in Annals of Internal Medicine. “Previous work investigating temporal trends in adult mortality with HIV in the post-care years has not drawn any comparison with the general US population.”

Edwards and colleagues used data from the National Center for Health Statistics to compare all-cause mortality over a 5-year period in 82,766 patients enrolled on HIV treatment in 13 US sites and a subset of the US population. Participants were assigned based on calendar time, age, gender, race, ethnicity, and county.

In the HIV-positive cohort, 84% of the participants were men, 46% were non-Hispanic blacks, and 16% were Hispanic. The average age at entry into nursing care was 42 years.

Overall, the researchers reported that the 5-year all-cause mortality rate in patients who joined HIV treatment was 10.6% and in the general population was 2.9%, a difference of 7.7 (95% CI, 7.4-7.9) percentage points. This difference in mortality decreased over time from 11.1 percentage points between 1999 and 2004 to 2.7 percentage points between 2011 and 2017.

In a related editorial, infectious disease experts at Cornell University’s Weill Medical College said a “major limitation” of the study is that the HIV cohort was limited to patients who were diagnosed and cared for. The authors – Marshall J. Glesby, MD, PhD, Deputy Head of Infectious Diseases Division and Head of HIV Clinical Trials Division, and Roy M. Gulick, MD, MPH, Professor of Medicine and Head of Infectious Diseases Division – cited data from the CDC suggesting that 14% of people living with HIV go undiagnosed, “and only 58% receive continuous medical care”.

“Although the mortality gap relative to the total population appears to be narrowing over time, this trend relies on being diagnosed immediately and on receiving ongoing adequate care,” they wrote.

Still, Glesby and Gulick noted that mortality trends appear “promising” and recent advances, including FDA approval of a long-acting injectable regimen, could further improve outcomes for people with HIV.

“Reducing mortality is an important goal, but it is also important to improve the quality of life for people living with HIV, who can be affected by comorbidities and age-related problems,” they wrote. “Over the past 40 years of the epidemic, remarkable strides have been made in improving the survival of people living with HIV; With continuous commitment and innovations, further growth can be expected. ”

References:

Edwards JK et al. Anna Intern Med. 2021; doi: 10.7326 / M21-0065.

Glesby MJ, Gulick RM. Anna Intern Med. 2021; doi: 10.7326 / M21-2586.

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