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Sellier P, Hamet G, Brun A, Ponscarme D, De Castro N, Alexandre G, Rozenbaum W, Molina JM, Abgrall S. Mortality of People Living with HIV in Paris Area from 2011 to 2015. AIDS Res Hum Retroviruses 2020; 36:373-380. [PMID: 31565958 DOI: 10.1089/aid.2019.0143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In high-income countries, causes of death in people living with HIV (PLHIV) have changed. Three French national surveys from 2000 to 2010 showed a decrease in AIDS-related and an increase in non-AIDS-related deaths. Deaths notified in PLHIV followed between January 1, 2011 and December 31, 2015 in 1 of 13 participating hospitals northeast of Paris area were described. Risk factors for death were assessed, using a multivariable logistic regression model. Of 14,403 individuals, 295 died. Median age at death was 52 years (interquartile range = 47-60) and 77% were men. Sixty-seven individuals (23%) died from non-AIDS-defining nonviral hepatitis-related (NaNH) malignancy, 40 (14%) from AIDS, 34 (12%) from cardiovascular disease (CVD), 33 (11%) from non-AIDS infection, 21 (7%) from liver disease, and 12 (4%) from suicide. Men and women born in sub-Saharan Africa had a lower adjusted odds ratio (aOR) of dying than men having sex with men (MSM) born in France (0.70, 95% confidence interval = 0.45-1.09; and 0.45, 0.28-0.73, respectively). Risk factors for death were older age (aOR = 2.26, 1.36-3.77 for 40-49 years and 2.91, 1.75-4.84 for >50 years vs. 18-39 years), male intravenous drug users (IVDU) transmission (2.24, 1.42-3.54 vs. MSM born in France), AIDS (2.75, 2.10-3.59), antiretroviral therapy initiation in earlier periods, time since HIV diagnosis <1 year, low CD4 cell count nadir, hepatitis B virus and/or hepatitis C virus coinfection (1.69, 1.23-2.30), and psychiatric disorders (1.73, 1.27-2.38). Our study confirms the increasing frequency of non-AIDS-related deaths, mainly NaNH malignancies and CVD, in PLHIV, justifying overall and in some specific populations (psychiatric and IVDU) prevention and screening.
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Affiliation(s)
- Pierre Sellier
- Department of Internal Medicine, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | - Gwenn Hamet
- COREVIH Ile de France Est, Saint-Louis Hospital, Paris, France
| | - Alexandre Brun
- COREVIH Ile de France Est, Saint-Louis Hospital, Paris, France
| | - Diane Ponscarme
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | - Nathalie De Castro
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | | | - Willy Rozenbaum
- COREVIH Ile de France Est, Saint-Louis Hospital, Paris, France
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
| | - Jean-Michel Molina
- Department of Infectious Diseases, Saint-Louis-Lariboisière-Fernand Widal Hospital, AP-HP, Paris, France
- University Paris Diderot, Paris, France
| | - Sophie Abgrall
- Department of Infectious Diseases, Avicenne Hospital, AP-HP, Bobigny, France
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Gheibi Z, Shayan Z, Joulaei H, Fararouei M, Beheshti S, Shokoohi M. Determinants of AIDS and non-AIDS related mortality among people living with HIV in Shiraz, southern Iran: a 20-year retrospective follow-up study. BMC Infect Dis 2019; 19:1094. [PMID: 31888541 PMCID: PMC6937831 DOI: 10.1186/s12879-019-4676-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/29/2019] [Indexed: 01/23/2023] Open
Abstract
Background Human Immunodeficiency Virus (HIV) infection has become a global concern. Determining the factors leading to death among HIV patients helps controlling Acquired Immune Deficiency Syndrome (AIDS) epidemic. Up to now, little is known about mortality and its determinants among people living with HIV in the Middle East and North Africa (MENA) region, including Iran. The purpose of this study was to assess the risk factors of AIDS-Related Mortality (ARM) and Non-AIDS-Related Mortality (NARM) among people with HIV in Iran. Methods This 20-year retrospective study was conducted on 1160 people with HIV whose data were collected from 1997 to 2017. The association of the study outcomes (ARM and NARM) with various study variables, including demographic status at the time of diagnosis and clinical indexes during the follow-up were examined to define the predictors of mortality among the patients. Regarding, Cox proportional hazard and competing risk models were fitted and Adjusted Hazard Ratios (AHR), Sub-distribution Hazard Ratio (SHR) and the 95% Confidence Intervals (CI) were reported. Results during the follow-up period, 391 individuals (33.7%) died with 86,375 person-years of follow-up. Of the total deaths, 251 (64.2%) and 140 (35.8%) were ARM and NARM, respectively. Rates of the mortality caused by AIDS and non-AIDS were 3.2 and 4.5 per 1000 person-months, respectively. Responding to combined Antiretroviral Treatment (cART) 6 months after initiation, receiving Pneumocystis Pneumonia (PCP) prophylaxis, and higher CD4 count at diagnosis, reduced the hazard of ARM and NARM. However, older age, late HIV diagnosis, and last HIV clinical stages increased the hazard of AIDS related to mortality. Additionally, male gender, older age, incarceration history, and last HIV clinical stages increased the non-AIDS mortality. Conclusions Mortality caused by AIDS and non-AIDS remains high among people with HIV in Iran, particularly among males and those with late diagnosis. It seems that applying effective strategies to identify infected individuals at earlier stage of the infection, and targeting individuals with higher risk of mortality can decrease the mortality rate among HIV infected people.
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Affiliation(s)
- Zahra Gheibi
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shayan
- Trauma Research Center, Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hassan Joulaei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Fararouei
- Department of Epidemiology, School of Health & Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shohreh Beheshti
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Shokoohi
- HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Division of Social and Behavioral Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Croxford S, Kitching A, Desai S, Kall M, Edelstein M, Skingsley A, Burns F, Copas A, Brown AE, Sullivan AK, Delpech V. Mortality and causes of death in people diagnosed with HIV in the era of highly active antiretroviral therapy compared with the general population: an analysis of a national observational cohort. LANCET PUBLIC HEALTH 2016; 2:e35-e46. [PMID: 29249478 DOI: 10.1016/s2468-2667(16)30020-2] [Citation(s) in RCA: 243] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Deaths in HIV-positive people have decreased since the introduction of highly active antiretroviral therapy (HAART) in 1996. Fewer AIDS-related deaths and an ageing cohort have resulted in an increase in the proportion of HIV patients dying from non-AIDS-related disorders. Here we describe mortality and causes of death in people diagnosed with HIV in the HAART era compared with the general population. METHODS In this observational analysis, we linked cohort data collected by Public Health England (PHE) for individuals aged 15 years and older, diagnosed with HIV in England and Wales from 1997 to 2012, to the Office for National Statistics (ONS) national mortality register. Cohort inclusion began at diagnosis with follow-up clinical information collected every year from all 220 National Health Service (NHS) HIV outpatient clinics nationwide. To classify causes of death we used a modified Coding Causes of Death in HIV (CoDe) protocol, which uses death certificate data and clinical markers. We applied Kaplan-Meier analysis for survival curves and mortality rate estimation and Cox regression to establish independent predictors of all-cause mortality, adjusting for sex, infection route, age at diagnosis, region of birth, year of diagnosis, late diagnosis, and history of HAART. We used standardised mortality ratios (SMRs) to make comparisons with the general population. FINDINGS Between 1997 and 2012, 88 994 people were diagnosed with HIV, contributing 448 839 person-years of follow up. By the end of 2012, 5302 (6%) patients had died (all-cause mortality 118 per 10 000 person-years, 95% CI 115-121). In multivariable analysis, late diagnosis was a strong predictor of death (hazard ratio [HR] 3·50, 95% CI 3·13-3·92). People diagnosed more recently had a lower risk of death (2003-07: HR 0·66, 95% CI 0·62-0·70; 2008-12: HR 0·65, 95% CI 0·60-0·71). Cause of death was determinable for 4808 (91%) of 5302 patients; most deaths (2791 [58%] of 4808) were attributable to AIDS-defining illnesses. Cohort mortality was significantly higher than the general population for all causes (SMR 5·7, 95% CI 5·5-5·8), particularly non-AIDS infections (10·8, 9·8-12·0) and liver disease (3·7, 3·3-4·2). All-cause mortality was highest in the year after diagnosis (SMR 24·3, 95% CI 23·4-25·2). INTERPRETATION Despite the availability of free treatment and care in the UK, AIDS continues to account for the majority of deaths in HIV-positive people, and mortality remains higher in HIV-positive people than in the general population. These findings highlight the importance of prompt diagnosis, care engagement, and optimum management of comorbidities in reducing mortality in people with HIV. FUNDING Public Health England.
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Affiliation(s)
- Sara Croxford
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, London, UK.
| | - Aileen Kitching
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Sarika Desai
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, London, UK
| | - Meaghan Kall
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK; Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, London, UK
| | - Michael Edelstein
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Andrew Skingsley
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Fiona Burns
- Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, London, UK; Royal Free London NHS Foundation Trust, London, UK
| | - Andrew Copas
- Centre for Sexual Health and HIV Research, Department of Infection and Population Health, University College London, London, UK
| | - Alison E Brown
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Ann K Sullivan
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Valerie Delpech
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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The Multifaceted Contributions of Chromatin to HIV-1 Integration, Transcription, and Latency. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2016; 328:197-252. [PMID: 28069134 DOI: 10.1016/bs.ircmb.2016.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The capacity of the human immunodeficiency virus (HIV-1) to establish latent infections constitutes a major barrier to the development of a cure for HIV-1. In latent infection, replication competent HIV-1 provirus is integrated within the host genome but remains silent, masking the infected cells from the activity of the host immune response. Despite the progress in elucidating the molecular players that regulate HIV-1 gene expression, the mechanisms driving the establishment and maintenance of latency are still not fully understood. Transcription from the HIV-1 genome occurs in the context of chromatin and is subjected to the same regulatory mechanisms that drive cellular gene expression. Much like in eukaryotic genes, the nucleosomal landscape of the HIV-1 promoter and its position within genomic chromatin are determinants of its transcriptional activity. Understanding the multilayered chromatin-mediated mechanisms that underpin HIV-1 integration and expression is of utmost importance for the development of therapeutic strategies aimed at reducing the pool of latently infected cells. In this review, we discuss the impact of chromatin structure on viral integration, transcriptional regulation and latency, and the host factors that influence HIV-1 replication by regulating chromatin organization. Finally, we describe therapeutic strategies under development to target the chromatin-HIV-1 interplay.
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Raffetti E, Albini L, Gotti D, Segala D, Maggiolo F, di Filippo E, Saracino A, Ladisa N, Lapadula G, Fornabaio C, Castelnuovo F, Casari S, Fabbiani M, Pierotti P, Donato F, Quiros-Roldan E. Cancer incidence and mortality for all causes in HIV-infected patients over a quarter century: a multicentre cohort study. BMC Public Health 2015; 15:235. [PMID: 25884678 PMCID: PMC4364101 DOI: 10.1186/s12889-015-1565-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 02/17/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND We aimed to assess cancer incidence and mortality for all-causes and factors related to risk of death in an Italian cohort of HIV infected unselected patients as compared to the general population. METHODS We conducted a retrospective (1986-2012) cohort study on 16 268 HIV infected patients enrolled in the MASTER cohort. The standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) were computed using cancer incidence rates of Italian Cancer Registries and official national data for overall mortality. The risk factors for death from all causes were assessed using Poisson regression models. RESULTS 1,195 cancer cases were diagnosed from 1986 to 2012: 700 AIDS-defining-cancers (ADCs) and 495 non-AIDS-defining-cancers (NADCs). ADC incidence was much higher than the Italian population (SIR = 30.8, 95% confidence interval 27.9-34.0) whereas NADC incidence was similar to the general population (SIR = 0.9, 95% CI 0.8-1.1). The SMR for all causes was 11.6 (11.1-12.0) in the period, and it decreased over time, mainly after 1996, up to 3.53 (2.5-4.8) in 2012. Male gender, year of enrolment before 1993, older age at enrolment, intravenous drug use, low CD4 cell count, AIDS event, cancer occurrence and the absence of antiretroviral therapy were all associated independently with risk of death. CONCLUSIONS In HIV infected patients, ADC but not NADC incidence rates were higher than the general population. Although overall mortality in HIV infected subjects decreased over time, it is about three-fold higher than the general population at present.
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Affiliation(s)
- Elena Raffetti
- Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
| | - Laura Albini
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
| | - Daria Gotti
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
| | - Daniela Segala
- Department of Infectious Diseases of Nuovo Polo Ospedaliero S.Anna di Cona, Ferrara, Italy.
| | - Franco Maggiolo
- Department of Infectious Diseases of Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Elisa di Filippo
- Department of Infectious Diseases of Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Annalisa Saracino
- Department of Infectious Diseases of Polyclinic of Bari, University of Bari, Bari, Italy.
| | - Nicoletta Ladisa
- Department of Infectious Diseases of Polyclinic of Bari, University of Bari, Bari, Italy.
| | - Giuseppe Lapadula
- Department of Infectious Diseases, San Gerardo de' Tintori" Hospital, Monza, Italy.
| | - Chiara Fornabaio
- Clinic of Infectious Diseases of Istituti Ospitalieri of Cremona, Cremona, Italy.
| | - Filippo Castelnuovo
- Hospital Division of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy.
| | - Salvatore Casari
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
| | - Massimiliano Fabbiani
- Institute of Clinical Infectious Diseases of Polyclinic A. Gemelli, University of Sacred Heart, Rome, Italy.
| | - Piera Pierotti
- Department of Infectious Diseases of SM, Annunziata Hospital of Florence, Florence, Italy.
| | - Francesco Donato
- Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy.
| | - Eugenia Quiros-Roldan
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy.
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Ingle SM, May MT, Gill MJ, Mugavero MJ, Lewden C, Abgrall S, Fätkenheuer G, Reiss P, Saag MS, Manzardo C, Grabar S, Bruyand M, Moore D, Mocroft A, Sterling TR, D'Arminio Monforte A, Hernando V, Teira R, Guest J, Cavassini M, Crane HM, Sterne JAC. Impact of risk factors for specific causes of death in the first and subsequent years of antiretroviral therapy among HIV-infected patients. Clin Infect Dis 2014; 59:287-97. [PMID: 24771333 PMCID: PMC4073781 DOI: 10.1093/cid/ciu261] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Among HIV-infected patients who initiated antiretroviral therapy (ART), patterns of cause-specific death varied by ART duration and were strongly related to age, sex, and transmission risk group. Deaths from non-AIDS malignancies were much more frequent than those from cardiovascular disease. Background. Patterns of cause-specific mortality in individuals infected with human immunodeficiency virus type 1 (HIV-1) are changing dramatically in the era of antiretroviral therapy (ART). Methods. Sixteen cohorts from Europe and North America contributed data on adult patients followed from the start of ART. Procedures for coding causes of death were standardized. Estimated hazard ratios (HRs) were adjusted for transmission risk group, sex, age, year of ART initiation, baseline CD4 count, viral load, and AIDS status, before and after the first year of ART. Results. A total of 4237 of 65 121 (6.5%) patients died (median, 4.5 years follow-up). Rates of AIDS death decreased substantially with time since starting ART, but mortality from non-AIDS malignancy increased (rate ratio, 1.04 per year; 95% confidence interval [CI], 1.0–1.1). Higher mortality in men than women during the first year of ART was mostly due to non-AIDS malignancy and liver-related deaths. Associations with age were strongest for cardiovascular disease, heart/vascular, and malignancy deaths. Patients with presumed transmission through injection drug use had higher rates of all causes of death, particularly for liver-related causes (HRs compared with men who have sex with men: 18.1 [95% CI, 6.2–52.7] during the first year of ART and 9.1 [95% CI, 5.8–14.2] thereafter). There was a persistent role of CD4 count at baseline and at 12 months in predicting AIDS, non-AIDS infection, and non-AIDS malignancy deaths. Lack of viral suppression on ART was associated with AIDS, non-AIDS infection, and other causes of death. Conclusions. Better understanding of patterns of and risk factors for cause-specific mortality in the ART era can aid in development of appropriate care for HIV-infected individuals and inform guidelines for risk factor management.
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Affiliation(s)
- Suzanne M Ingle
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Margaret T May
- School of Social and Community Medicine, University of Bristol, United Kingdom
| | - M John Gill
- Division of Infectious Diseases, University of Calgary, Canada
| | - Michael J Mugavero
- Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham
| | - Charlotte Lewden
- INSERM, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux Université Bordeaux, Institut de Santé Publique, d'Epidémiologie et de Developpement (ISPED)
| | - Sophie Abgrall
- UPMC Université Paris 06, UMR_S 943 INSERM, UMR_S 943, Paris Service des maladies infectieuses et tropicales, AP-HP, Hôpital Avicenne, Bobigny, France
| | | | - Peter Reiss
- Stichting HIV Monitoring, and Division of Infectious Diseases and Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Michael S Saag
- Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham
| | | | - Sophie Grabar
- INSERM, UMR_S 943, Paris AP-HP, Hôpital Cochin, Unité de Biostatistique et Epidémiologie, Paris Université Paris Descartes
| | - Mathias Bruyand
- INSERM, ISPED, Centre Inserm U897-Epidemiologie-Biostatistique, Bordeaux, France
| | - David Moore
- BC Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Amanda Mocroft
- Research Department of Infection and Population Health, University College London, United Kingdom
| | | | | | - Victoria Hernando
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid CIBER de Epidemiología y Salud Pública, Madrid
| | - Ramon Teira
- Unit of Infectious Diseases, Hospital Sierrallana, Torrelavega, Spain
| | - Jodie Guest
- HIV Atlanta VA Cohort Study, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Heidi M Crane
- Clinical Epidemiology and Health Services Research Core, Center for AIDS Research, University of Washington, Seattle
| | - Jonathan A C Sterne
- School of Social and Community Medicine, University of Bristol, United Kingdom
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Gotti D, Raffetti E, Albini L, Sighinolfi L, Maggiolo F, Di Filippo E, Ladisa N, Angarano G, Lapadula G, Pan A, Esposti AD, Fabbiani M, Focà E, Scalzini A, Donato F, Quiros-Roldan E. Survival in HIV-infected patients after a cancer diagnosis in the cART Era: results of an italian multicenter study. PLoS One 2014; 9:e94768. [PMID: 24760049 PMCID: PMC3997420 DOI: 10.1371/journal.pone.0094768] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 03/19/2014] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES We studied survival and associated risk factors in an Italian nationwide cohort of HIV-infected individuals after an AIDS-defining cancer (ADC) or non-AIDS-defining cancer (NADC) diagnosis in the modern cART era. METHODS Multi-center, retrospective, observational study of HIV patients included in the MASTER Italian Cohort with a cancer diagnosis from January 1998 to September 2012. Malignancies were divided into ADC or NADC on the basis of the Centre for Disease Control-1993 classification. Recurrence of cancer and metastases were excluded. Survivals were estimated according to the Kaplan-Meier method and compared according to the log-rank test. Statistically significant variables at univariate analysis were entered in a multivariate Cox regression model. RESULTS Eight hundred and sixty-six cancer diagnoses were recorded among 13,388 subjects in the MASTER Database after 1998: 435 (51%) were ADCs and 431 (49%) were NADCs. Survival was more favorable after an ADC diagnosis than a NADC diagnosis (10-year survival: 62.7%±2.9% vs. 46%±4.2%; p = 0.017). Non-Hodgkin lymphoma had lower survival rates than patients with Kaposi sarcoma or cervical cancer (10-year survival: 48.2%±4.3% vs. 72.8%±4.0% vs. 78.5%±9.9%; p<0.001). Regarding NADCs, breast cancer showed better survival (10-year survival: 65.1%±14%) than lung cancer (1-year survival: 28%±8.7%), liver cancer (5-year survival: 31.9%±6.4%) or Hodgkin lymphoma (10-year survival: 24.8%±11.2%). Lower CD4+ count and intravenous drug use were significantly associated with decreased survival after ADCs or NADCs diagnosis. Exposure to cART was found to be associated with prolonged survival only in the case of ADCs. CONCLUSIONS cART has improved survival in patients with an ADC diagnosis, whereas the prognosis after a diagnosis of NADCs is poor. Low CD4+ counts and intravenous drug use are risk factors for survival following a diagnosis of ADCs and Hodgkin lymphoma in the NADC group.
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Affiliation(s)
- Daria Gotti
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
- * E-mail:
| | - Elena Raffetti
- Section of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | - Laura Albini
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Laura Sighinolfi
- Division of Infectious Diseases, University Hospital of Ferrara, Ferrara, Italy
| | - Franco Maggiolo
- Division of Infectious Diseases and Unit of Antiviral Therapy, AO Papa Giovanni XXIII, Bergamo, Italy
| | - Elisa Di Filippo
- Division of Infectious Diseases and Unit of Antiviral Therapy, AO Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Giuseppe Lapadula
- Clinic of Infectious Diseases, San Gerardo de' Tintori" Hospital, Monza, Italy
| | - Angelo Pan
- Clinic of Infectious Diseases, Hospital of Cremona, Cremona, Italy
| | - Anna Degli Esposti
- Clinic of Infectious Diseases, “Santa Maria Annunziata” Hospital, Firenze, Italy
| | - Massimiliano Fabbiani
- Institute of Clinical Infectious Diseases, Catholic University of Sacred Heart, Roma, Italy
| | - Emanuele Focà
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
| | - Alfredo Scalzini
- Hospital Division of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy
| | - Francesco Donato
- Section of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | - Eugenia Quiros-Roldan
- University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy
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Zirkzee EJM, Huizinga TWJ, Bollen ELEM, Buchem MAV, Middelkoop HAM, Wee NJAVD, Cessie SL, Steup-Beekman GM. Mortality in neuropsychiatric systemic lupus erythematosus (NPSLE). Lupus 2013; 23:31-8. [DOI: 10.1177/0961203313512540] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The standardized mortality ratio (SMR) for systemic lupus erythematosus (SLE) is three; SMR increases to six in case of renal involvement. Up to now data on survival in case of neuropsychiatric involvement in SLE (NPSLE) have been scarce, therefore we calculated an SMR for NPSLE. Furthermore, we identified characteristics that influenced survival by Cox regression analyses. All patients suspected of NPSLE in our center since 1989 were evaluated and included in this study when a diagnosis of primary NPSLE could be established. Patient’s life/death status was tracked using the civic registries. Thirty-two (19%) of the 169 included NPSLE patients died within a median follow-up period of six years (range 0.5–24 years). This resulted in a significantly increased mortality rate compared to the general population: SMR 9.5 (95% CI 6.7–13.5). Hazard ratios (HRs) were highest in patients with acute confusional state (HR 3.4) and older age at diagnosis of NPSLE (HR 1.1). A decreased mortality risk was seen with the prescription of antiplatelet therapy (HR 0.22). The time period in which NPSLE was diagnosed did not significantly influence survival. Most frequent causes of death were infection and NPSLE itself.
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Affiliation(s)
- EJM Zirkzee
- Department of Rheumatology, Leiden University Medical Center, Netherlands
| | - TWJ Huizinga
- Department of Rheumatology, Leiden University Medical Center, Netherlands
| | - ELEM Bollen
- Department of Neurology, Leiden University Medical Center, Netherlands
| | - MA van Buchem
- Department of Radiology, Leiden University Medical Center, Netherlands
| | - HAM Middelkoop
- Department of Neurology and Clinical Neuropsychology, Leiden University Medical Center, Netherlands
- Institute of Psychology, Clinical Neuropsychology Unit, University of Leiden, Netherlands
| | - NJA van der Wee
- Department of Psychiatry, Leiden University Medical Center, Netherlands
- Leiden Institute for Brain and Cognition, University of Leiden, Netherlands
| | - S le Cessie
- Department of Clinical Epidemiology and Medical Statistics, Leiden University Medical Center, Netherlands
| | - GM Steup-Beekman
- Department of Rheumatology, Leiden University Medical Center, Netherlands
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