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Kyaw NTT, Satyanarayana S, Harries AD, Kumar AMV, Kyaw KWY, Phyo KH, Hayat MJ, Castro KG, Magee MJ. Increased All-cause Mortality in People With HIV and Comorbidities: Hepatitis B and C Virus Seropositivity and Hyperglycemia in Myanmar, 2005-2017. Open Forum Infect Dis 2022; 10:ofac672. [PMID: 36632421 PMCID: PMC9830546 DOI: 10.1093/ofid/ofac672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Background Hepatitis C virus (HCV) and hepatitis B virus (HBV) coinfection are associated with increased mortality in people with HIV (PWH), and hyperglycemia is a common comorbidity in PWH. In this study, we used routinely collected clinical data to assess the associations between HBV and HCV seropositivity with all-cause mortality and whether this relationship differs by hyperglycemia status. Methods Eligible participants included adult PWH (≥15 years) who initiated antiretroviral therapy between May 2005 and June 2016 in Myanmar. HBV and HCV serostatus and hyperglycemia were measured at enrollment to HIV care using HBV surface antigen, HCV antibody tests, and random blood glucose (≥140 mg/dL), respectively. Results Among 27 722 PWH, 2260 (8%) were HBV seropositive, 2265 (9%) were HCV seropositive, 178 (0.6%) were HBV-HCV seropositive, and 1425 (5%) had hyperglycemia. During the median follow-up (interquartile range) of 3.1 (1.5-5.1) years, 3655 (13%) PWH died, and the overall mortality rate was 3.8 (95% CI, 3.7-3.9) per 100-person-years (PY). The mortality rate (per 100 PY) among PWH who were HBV seropositive was 4.6, among PWH who were HCV seropositive it was 5.1, and among PWH who were HBV-HCV seropositive it was 7.1. When stratified by glycemic status, the mortality rate was higher among patients with hyperglycemia compared with those with euglycemia (5.4 vs 4.0 per 100 PY), and the difference in mortality rate between patients with hyperglycemia and euglycemia was highest among those with HCV seropositivity (9.8 vs 5.0 per 100 PY). Conclusions Increased mortality rates associated with HBV and HCV seropositivity in PWH differed by their glycemic status. PWH with HCV seropositivity and hyperglycemia had the highest mortality rates.
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Affiliation(s)
- Nang Thu Thu Kyaw
- Correspondence: Nang Thu Thu Kyaw, MBBS, MPH, International Union Against Tuberculosis & Lung Disease, No 36, 27th Street, between 72nd & 73rd Street, Mandalay, Myanmar ()
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease, The Union South-East Asia Office, New Delhi, India
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ajay M V Kumar
- International Union Against Tuberculosis and Lung Disease, Paris, France
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India
| | - Khine Wut Yee Kyaw
- International Union Against Tuberculosis and Lung Disease, The Union Myanmar Office, Mandalay, Myanmar
| | - Khaing Hnin Phyo
- International Union Against Tuberculosis and Lung Disease, The Union Myanmar Office, Mandalay, Myanmar
| | - Matthew J Hayat
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Kenneth G Castro
- Hubert Department of Global Health and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia, USA
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Taborelli M, Suligoi B, Serraino D, Frova L, Grande E, Toffolutti F, Regine V, Pappagallo M, Pugliese L, Grippo F, Zucchetto A. Increased kidney disease mortality among people with AIDS versus the general population: a population-based cohort study in Italy, 2006-2018. BMJ Open 2022; 12:e064970. [PMID: 36456002 PMCID: PMC9716863 DOI: 10.1136/bmjopen-2022-064970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES This study aimed to assess whether an excess mortality related to kidney and other urinary tract diseases exists among Italian people with AIDS (PWA), as compared with the general population without AIDS (non-PWA). DESIGN Population-based, retrospective cohort study. SETTING AND PARTICIPANTS We conducted a nationwide study including 9481 Italian PWA, aged 15-74 years, reported to the National AIDS Registry between 2006 and 2018. METHODS Vital status and causes of death were retrieved by record linkage with the National Register of Causes of Death up to 2018. Excess mortality for PWA versus non-PWA was estimated through sex-standardised and age-standardised mortality ratios (SMRs) with corresponding 95% CIs. RESULTS Among 2613 deceased PWA, 262 (10.0%) reported at least one urinary tract disease at death, including 254 (9.7%) non-cancer diseases-mostly renal failures (225 cases, 8.6%)-and 9 cancers (0.3%). The overall SMR for non-cancer urinary tract diseases was 15.3 (95% CI 13.4 to 17.3) with statistically significant SMRs for acute (SMR=22.3, 95% CI 18.0 to 27.4), chronic (SMR=8.4, 95% CI 6.0 to 11.3), and unspecified renal failure (SMR=13.8, 95% CI 11.2 to 16.8). No statistically significant excess mortality was detected for urinary tract cancers (SMR=1.7, 95% CI 0.8 to 3.3). The SMRs were particularly elevated among PWA aged <50 years, injecting drug users, or those with the first HIV-positive test >6 months before AIDS diagnosis. CONCLUSIONS The excess mortality related to non-cancer kidney and other urinary tract diseases reported among PWA highlights the importance of implementing the recommendation for screening, diagnosis and management of such conditions among this population.
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Affiliation(s)
- Martina Taborelli
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Barbara Suligoi
- Centro Operativo AIDS, Istituto Superiore di Sanità, Roma, Italy
| | - Diego Serraino
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Luisa Frova
- Integrated system for health, social assistance and welfare, Istituto Nazionale di Statistica, Rome, Italy
| | - Enrico Grande
- Integrated system for health, social assistance and welfare, Istituto Nazionale di Statistica, Rome, Italy
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Vincenza Regine
- Centro Operativo AIDS, Istituto Superiore di Sanità, Roma, Italy
| | - Marilena Pappagallo
- Integrated system for health, social assistance and welfare, Istituto Nazionale di Statistica, Rome, Italy
| | - Lucia Pugliese
- Centro Operativo AIDS, Istituto Superiore di Sanità, Roma, Italy
| | - Francesco Grippo
- Integrated system for health, social assistance and welfare, Istituto Nazionale di Statistica, Rome, Italy
| | - Antonella Zucchetto
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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Villalva-Serra K, Barreto-Duarte B, Nunes VM, Menezes RC, Rodrigues MMS, Queiroz ATL, Arriaga MB, Cordeiro-Santos M, Kritski AL, Sterling TR, Araújo-Pereira M, Andrade BB. Tuberculosis treatment outcomes of diabetic and non-diabetic TB/HIV co-infected patients: A nationwide observational study in Brazil. Front Med (Lausanne) 2022; 9:972145. [PMID: 36186793 PMCID: PMC9523014 DOI: 10.3389/fmed.2022.972145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Tuberculosis (TB) is a worldwide public health problem, especially in countries that also report high numbers of people living with HIV (PLWH) and/or diabetes mellitus (DM). However, the unique features of persons with TB-HIV-DM are incompletely understood. This study compared anti-TB treatment (ATT) outcomes of diabetic and non-diabetic TB/HIV co-infected patients. Methods A nationwide retrospective observational investigation was performed with data from the Brazilian Tuberculosis Database System among patients reported to have TB-HIV co-infection between 2014 and 2019. This database includes all reported TB cases in Brazil. Exploratory and association analyses compared TB treatment outcomes in DM and non-DM patients. Unfavorable outcomes were defined as death, treatment failure, loss to follow-up or recurrence. Multivariable stepwise logistic regressions were used to identify the variables associated with unfavorable ATT outcomes in the TB-HIV population. Results Of the 31,070 TB-HIV patients analyzed, 999 (3.2%) reported having DM. However, in these TB-HIV patients, DM was not associated with any unfavorable treatment outcome [adjusted Odds Ratio (aOR): 0.97, 95% CI: 0.83-1.12, p = 0.781]. Furthermore, DM was also not associated with any specific type of unfavorable outcome in this study. In both the TB-HIV group and the TB-HIV-DM subpopulation, use of alcohol, illicit drugs and tobacco, as well as non-white ethnicity and prior TB were all characteristics more frequently observed in persons who experienced an unfavorable ATT outcome. Conclusion DM is not associated with unfavorable TB treatment outcomes in persons with TB-HIV, including death, treatment failure, recurrence and loss to follow up. However, consumption habits, non-white ethnicity and prior TB are all more frequently detected in those with unfavorable outcomes in both TB-HIV and TB-HIV-DM patients.
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Affiliation(s)
- Klauss Villalva-Serra
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil
| | - Beatriz Barreto-Duarte
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil,Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vanessa M. Nunes
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil
| | - Rodrigo C. Menezes
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil,Grupo de Estudos em Medicina Intensiva (GEMINI), Salvador, Brazil
| | - Moreno M. S. Rodrigues
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Laboratório de Análise e Visualização de Dados, Fundação Oswaldo Cruz, Porto Velho, Brazil
| | - Artur T. L. Queiroz
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Center of Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - María B. Arriaga
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marcelo Cordeiro-Santos
- Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil,Fundação Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil,Faculdade de Medicina, Universidade Nilton Lins, Manaus, Brazil
| | - Afrânio L. Kritski
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil,Programa Acadêmico de Tuberculose da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Timothy R. Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Mariana Araújo-Pereira
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil,Curso de Medicina, Faculdade de Ciência e Tecnologia (UNIFTC), Salvador, Brazil
| | - Bruno B. Andrade
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil,Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil,Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil,Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States,Curso de Medicina, Faculdade de Ciência e Tecnologia (UNIFTC), Salvador, Brazil,*Correspondence: Bruno B. Andrade
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Seang K, Javanbakht M, Lee SJ, Brookmeyer R, Pheng P, Chea P, Saphonn V, Gorbach PM. Differences in prevalence and risk factors of non-communicable diseases between young people living with HIV (YLWH) and young general population in Cambodia. PLoS One 2022; 17:e0269989. [PMID: 35727763 PMCID: PMC9212152 DOI: 10.1371/journal.pone.0269989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 06/01/2022] [Indexed: 11/18/2022] Open
Abstract
Understanding non-communicable diseases (NCDs) among young people living with HIV (YLWH) is critical given the potential for aging-associated comorbidities resulting from HIV, especially in Cambodia where such data are limited. Therefore, we examined the prevalence and correlates of NCDs in YLWH and compared it to a nationally representative sample of young people not otherwise infected. We collected data from a sample of 370 YLWH aged 18-29 years attending three HIV clinics in Cambodia between 2019 and 2020. Our comparison group were 486 young people who participated in the Ministry of Health/WHO 2016 Noncommunicable Disease Risk Factor Surveillance (STEP survey). Both surveys used a standardized questionnaire to collect information on lifestyle factors and World Health Organization protocols for physical and biochemical measurements. We compared the prevalence of diabetes, hypertension, and high cholesterolemia between the two groups and examined the relationship between these conditions and HIV. We found 16 (4%), 22 (6%), and 72 (20%) had diabetes, hypertension, and high cholesterolemia, respectively, among YLWH, compared to 4 (1%), 22 (4%), and 49 (11%) among the general population. In logistic regression, YLWH were at higher odds of diabetes/prediabetes and high cholesterolemia compared with the young general population, aOR = 6.64 (95% CI 3.62-12.19) and aOR = 7.95 (95% CI 3.98-15.87), respectively. Our findings demonstrate that YLWH in Cambodia face multiple metabolic disorders and NCDs despite their young age and that accessible screening measures and treatment for these conditions are needed in order to combat NCDs in the future.
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Affiliation(s)
- Kennarey Seang
- Grant Management Office, University of Health Sciences, Phnom Penh, Cambodia
- * E-mail:
| | - Marjan Javanbakht
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Sung-Jae Lee
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
| | - Ron Brookmeyer
- Department of Biostatistics, University of California Los Angeles, Los Angeles, California, United States of America
| | - Phearavin Pheng
- Grant Management Office, University of Health Sciences, Phnom Penh, Cambodia
| | - Phalla Chea
- International Relation Division, University of Health Sciences, Phnom Penh, Cambodia
| | | | - Pamina M. Gorbach
- Department of Epidemiology, University of California Los Angeles, Los Angeles, California, United States of America
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Tasca KI, Fagundes Vidal VVM, Martinez Manfio V, Naime Barbosa A, de Souza LDR. Contributory role of ART in the development of non-AIDS comorbidities in asymptomatic PLWHA. J Appl Biomed 2021; 19:73-82. [PMID: 34907718 DOI: 10.32725/jab.2021.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 01/21/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Despite the many benefits that follow antiretroviral therapy (ART) initiation, its chronic use contributes to the early aging of people living with HIV/AIDS (PLWHA). The aim of this cross-sectional study was to trace the prevalence of and investigate possible renal, bone and metabolic changes, as well as cardiovascular risk in 94 asymptomatic PLWHA, relating them to the duration of ART use. METHODS Four groups were evaluated according to ART use: G1 (n = 21), ART-naïve individuals; G2 (n = 17), <2 years; G3 (n = 40), 2-10 years; and G4 (n = 16) on ART for more than 10 years. RESULTS Our results showed a high prevalence of dyslipidemic individuals (64%), especially in those under ART. Lower creatine phosphokinase levels were observed in G1 as compared to the others (p < 0.05). Regarding the Framingham score, 12.1% of PLWHA showed moderate and high risk, and the highest proportion (38.5%) occurred in G4 (p = 0.003). A decrease in glomerular filtration rates occurred in 20% of patients, which was also more significant in G3 and G4 (p = 0.007). High prevalences of osteopenia and osteoporosis (53.2%) were found, especially in G1 and G4; however, G1 showed the lowest means for alkaline phosphatases (AP, p = 0.04 and BAP, p = 0.005) and osteocalcin (p = 0.005), in addition to higher vitamin-D concentrations (p = 0.04). CONCLUSIONS Our study showed the possible contributory role of ART in these changes, which leads us to reflect on the need for specific conducts and patient care, pointing out the importance of individualized care in an attempt to increase life expectancy.
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Affiliation(s)
- Karen Ingrid Tasca
- Sao Paulo State University - UNESP, Institute of Biosciences of Botucatu, Department of Microbiology and Immunology, Botucatu, Sao Paulo State, Brazil
| | - Vania V M Fagundes Vidal
- Specialist Outpatient Service for Infectious Diseases "Domingos Alves Meira" (SAEI-DAM), Botucatu, Sao Paulo State, Brazil
| | - Vanessa Martinez Manfio
- Sao Paulo State University - UNESP, Botucatu Medical School, Department of Tropical Diseases and Imaging Diagnosis, Botucatu, Sao Paulo State, Brazil
| | - Alexandre Naime Barbosa
- Specialist Outpatient Service for Infectious Diseases "Domingos Alves Meira" (SAEI-DAM), Botucatu, Sao Paulo State, Brazil.,Sao Paulo State University - UNESP, Botucatu Medical School, Department of Tropical Diseases and Imaging Diagnosis, Botucatu, Sao Paulo State, Brazil
| | - Lenice do Rosario de Souza
- Specialist Outpatient Service for Infectious Diseases "Domingos Alves Meira" (SAEI-DAM), Botucatu, Sao Paulo State, Brazil.,Sao Paulo State University - UNESP, Botucatu Medical School, Department of Tropical Diseases and Imaging Diagnosis, Botucatu, Sao Paulo State, Brazil
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Costa AN, Val F, Macedo ÁE, Cubas-Vega N, Tejo PLD, Marques MM, Alencar Filho ACD, Lacerda MVGD. Increased prevalence of hypertension among people living with HIV: where to begin? Rev Soc Bras Med Trop 2020; 53:e20190564. [PMID: 32935775 PMCID: PMC7491555 DOI: 10.1590/0037-8682-0564-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/13/2020] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Cardiovascular diseases (CDVs) have become increasingly important for progressively older people living with HIV (PLHIV). Identification of gaps requiring improvement in the care cascade for hypertension, a primary risk factor for CVDs, is of utmost importance. This study analyzed the prevalence of hypertensive status and described the care cascade for hypertension screening, diagnosis, treatment, treatment adherence, and management in PLHIV. METHODS This cross-sectional study included 298 PLHIV (age >40 years) who visited a referral center in the western Brazilian Amazon. Data were collected through a structured questionnaire interview and medical examinations. Thus, information regarding sociodemographic and clinical aspects, blood pressure, weight, height, body mass index, and laboratory profile was obtained. Descriptive and analytical statistics were performed, and results were considered significant ifp <0.05. RESULTS In total, 132 (44.3%) participants reported that their blood pressure was never measured. The prevalence of hypertension was found to be 35.9% (107/298). Of these 107 participants, only 36 (33.6%) had prior knowledge of their hypertensive status, and 19 of 36 (52.7%) participants had visited a physician or cardiologist to seek treatment. Adherence to the BP-lowering treatment was noted in 11 (10.2%) participants. CONCLUSIONS An increased prevalence of hypertension was found, and most of the hypertensive participants were unaware of their hypertensive status. In addition, blood pressure control was poor in the study population. This indicated that public health professionals did not sufficiently consider the full spectrum of healthcare and disease management for PLHIV.
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Affiliation(s)
- Aldrey Nascimento Costa
- Universidade do Estado do Amazonas, Escola Superior de Ciências da Saúde, Manaus, AM, Brasil.,Universidade Federal do Amazonas, Manaus, AM, Brasil
| | - Fernando Val
- Universidade do Estado do Amazonas, Escola Superior de Ciências da Saúde, Manaus, AM, Brasil.,Universidade Federal do Amazonas, Manaus, AM, Brasil.,Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil
| | - Álvaro Elias Macedo
- Universidade do Estado do Amazonas, Escola Superior de Ciências da Saúde, Manaus, AM, Brasil
| | - Nadia Cubas-Vega
- Universidade do Estado do Amazonas, Escola Superior de Ciências da Saúde, Manaus, AM, Brasil.,Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil
| | - Paola López Del Tejo
- Universidade do Estado do Amazonas, Escola Superior de Ciências da Saúde, Manaus, AM, Brasil.,Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil
| | - Marly M Marques
- Universidade do Estado do Amazonas, Escola Superior de Ciências da Saúde, Manaus, AM, Brasil.,Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brasil
| | | | - Marcus Vinicius Guimarães de Lacerda
- Universidade do Estado do Amazonas, Escola Superior de Ciências da Saúde, Manaus, AM, Brasil.,Instituto Leônidas & Maria Deane, Fundação Oswaldo Cruz, Manaus, AM, Brasil
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Taborelli M, Suligoi B, Toffolutti F, Frova L, Grande E, Grippo F, Pappagallo M, Pugliese L, Regine V, Serraino D, Zucchetto A. Excess liver-related mortality among people with AIDS compared to the general population: an Italian nationwide cohort study using multiple causes of death. HIV Med 2020; 21:642-649. [PMID: 32876382 DOI: 10.1111/hiv.12937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Liver diseases have become a leading cause of death among people with AIDS (PWA). This study aimed to investigate whether PWA experienced excess mortality related to liver diseases as compared to the general population (non-PWA), using a multiple cause of death (MCoD; i.e. all conditions reported on death certificates) approach. METHODS A population-based, nationwide, retrospective cohort study was conducted among Italian people, aged 15-74 years, who had been diagnosed with AIDS since 2006. Date of death and MCoD data were retrieved, up to December 2015, by individual record linkage with national mortality data. Sex- and age-standardized mortality ratios (SMRs), with 95% confidence intervals (CIs), were estimated by dividing the observed number of deaths related to a specific condition among PWA to the expected number, based on non-PWA mortality rates. RESULTS Among 7912 PWA (34 184 person-years), 2076 deaths occurred. The number of death certificates reporting liver diseases among MCoDs was 583 (28.1%), including 382 (18.4%) reporting viral hepatitis, 370 (17.8%) reporting nonviral liver diseases, and 41 (2.0%) reporting liver cancers. The corresponding SMRs were 40.4 (95% CI 37.2-43.8) for all liver diseases, 131.1 (95% CI 118.3-145.0) for viral hepatitis, 29.9 (95% CI 27.0-33.1) for nonviral liver diseases, and 11.2 (95% CI 8.1-15.3) for liver cancers. Particularly elevated SMRs emerged among PWA aged 15-49 years and those infected by injecting drug use. CONCLUSIONS The high excess liver-related mortality observed among PWA warrants preventive actions to limit the burden of viral hepatitis coinfections, alcohol abuse, and metabolic disorders, especially among younger PWA and injecting drug users.
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Affiliation(s)
- M Taborelli
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - B Suligoi
- National AIDS Unit, National Health Institute, Rome, Italy
| | - F Toffolutti
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - L Frova
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - E Grande
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - F Grippo
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - M Pappagallo
- Integrated System for Health, Social Assistance, Welfare and Justice, National Institute of Statistics, Rome, Italy
| | - L Pugliese
- National AIDS Unit, National Health Institute, Rome, Italy
| | - V Regine
- National AIDS Unit, National Health Institute, Rome, Italy
| | - D Serraino
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - A Zucchetto
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
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