Reductions in all-cause and cause-specific mortality among HIV-infected individuals receiving antiretroviral therapy in British Columbia, Canada: 2001-2012

OBJECTIVES

Since 2006, the British Columbia HIV/AIDS Drug Treatment Program (DTP) has expanded enrolment and dramatically increased its number of participants. We examined the effect this expansion has had on the underlying cause of death in HIV-infected individuals.

METHODS

We analysed data from participants aged 18 years and older in the DTP to measure 2-year mortality rates and causes of death from 2001 to 2012. We conducted tests of trend for all-cause and cause-specific mortality, and compared demographics and characteristics of individuals. Cox proportional hazard models were used to determine the risk of death.

RESULTS

A total of 8185 participants received antiretroviral therapy (ART) during the study period. Mortality declined from 3.88 per 100 person-years (PY) in 2001-2002 to 2.15 per 100 PY in 2011-2012 (P = 0.02). There were significant decreases in HIV-related deaths (2.34 to 0.56 per 100 PY; P = 0.02) and deaths attributable to chronic liver disease (0.20 to 0.09 per 100 PY; P = 0.01), cardiovascular disease (0.24 to 0.05 per 100 PY; P = 0.03) and suicides (0.47 to 0 per 100 PY; P = 0.003). Multivariate models, adjusted for age, gender, history of injecting drug use, AIDS diagnoses and baseline CD4 cell counts, demonstrated that initiation of ART in all time periods after 2001-2002 was independently associated with reduced mortality (P < 0.001).

CONCLUSIONS

We observed declines in HIV-related mortality and certain non-HIV-related causes of death among participants in the BC DTP from 2001 to 2012. These findings suggest that there may be broader benefits to the increasingly liberal HIV treatment guidelines, including reductions in death caused by cardiovascular disease and chronic liver disease.

Quality of life and self-esteem in patients with paraplegia and pressure ulcers: a controlled cross-sectional study

OBJECTIVE

To evaluate health-related quality of life (HRQoL) and self-esteem in patients with traumatic spinal cord injury (SCI) and pressure ulcers.

METHOD

This study was a controlled cross-sectional study. HRQoL was assessed using the generic Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) questionnaire and the Rosenberg Self-Esteem/UNIFESP-EPM Scale. A total of 120 patients with traumatic SCI were included in the sample, of which 60 had pressure ulcers and were assigned to the study group, and 60 had no pressure ulcers and were assigned to the control group. Statistical analysis was performed using the chi-square test, Fisher's exact test, and Student's t-test.

RESULTS

Of the 60 patients in the study group, 83.3% were men and the mean age was 38.17 years (SD = 9.08 years). When compared with controls, patients in the study group reported significantly lower scores (worse health status) on all SF-36 subscales (p less than or equal to 0.0013) except for general health (p=0.109). The RSE/UNIFESP-EMP scale total score indicated that patients with pressure ulcers had significantly lower self-esteem than controls (p<0.001).

CONCLUSION

Pressure ulcers had an adverse impact on the HRQoL and self-esteem of patients with SCI.

DECLARATION OF INTEREST

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.