| Excess mortality in patients with AIDS in the era of highly active antiretroviral therapy: temporal changes and risk factors. | |
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MedLine Citation:
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PMID: 20825306 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Excess mortality has decreased among human immunodeficiency virus (HIV)-infected patients but without evidence of a decrease among patients with AIDS. We assessed temporal changes in excess mortality and elucidated risk factors for excess mortality in patients with AIDS diagnosed in the era of highly active antiretroviral therapy (HAART). METHODS: We included 1188 patients of the Longitudinal Study of Ocular Complications in AIDS who were aged 25-64 years at enrollment and who received a diagnosis of AIDS after 1995. We calculated excess mortality as the age-, year-, and sex-adjusted difference in mortality rates between patients with AIDS and persons in the US general population during the period 1999-2007. We used a relative survival model to identify risk factors for excess mortality. RESULTS: There were a mean of 50 excess deaths per 1000 person-years (95% confidence interval [CI], 44-57 excess deaths per 1000 person-years) during 1999-2007. Excess mortality almost halved, with an annual decrease of 8.0% per year (95% CI, 3.0%-12.7%; P = .002) but remained high at 36 excess deaths per 1000 person-years in 2007. Viral load >400 copies/mL (compared with <or= 400 copies/mL; risk ratio, 3.4; 95% CI, 2.3-5.0), CD4(+) count <200 cells/μL (compared with >or= 200 cells/μL; risk ratio, 2.7; 95% CI, 1.9-3.9), and cytomegalovirus retinitis (risk ratio, 1.6; 95% CI, 1.2-2.1) were the strongest risk factors for excess mortality. CONCLUSIONS: Excess mortality among patients with AIDS was nearly halved in the HAART era and most strongly linked to stage of HIV disease. These results reflect the continuing improvements in AIDS management but also highlight that excess mortality remains ∼5 times higher in patients with AIDS than in HIV-infected patients without AIDS. |
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Authors:
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Milo A Puhan; Mark L Van Natta; Frank J Palella; Adrienne Addessi; Curtis Meinert; |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Volume: 51 ISSN: 1537-6591 ISO Abbreviation: Clin. Infect. Dis. Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-09-22 Completed Date: 2011-01-04 Revised Date: 2011-10-17 |
Medline Journal Info:
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Nlm Unique ID: 9203213 Medline TA: Clin Infect Dis Country: United States |
Other Details:
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Languages: eng Pagination: 947-56 Citation Subset: IM |
Affiliation:
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Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. mpuhan@jhsph.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acquired Immunodeficiency Syndrome
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drug therapy*,
mortality* Adult Anti-HIV Agents / therapeutic use* Antiretroviral Therapy, Highly Active / methods* Female Humans Longitudinal Studies Male Middle Aged Risk Factors Survival Analysis Time Factors United States / epidemiology |
| Grant Support | |
ID/Acronym/Agency:
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5M01 RR00046/RR/NCRR NIH HHS; 5MO1 RR 00043/RR/NCRR NIH HHS; 5MO1 RR 00188/RR/NCRR NIH HHS; 5MO1 RR 05280/RR/NCRR NIH HHS; 5MO1 RR00047/RR/NCRR NIH HHS; 5MO1RR 00865/RR/NCRR NIH HHS; 5MO1RR 05096/RR/NCRR NIH HHS; M01 RR00096/RR/NCRR NIH HHS; MO1 RR 00052/RR/NCRR NIH HHS; U01 AI 25858/AI/NIAID NIH HHS; U01 AI 25903/AI/NIAID NIH HHS; U01 AI 27660/AI/NIAID NIH HHS; U01 AI 27663/AI/NIAID NIH HHS; U01 AI 27674/AI/NIAID NIH HHS; U01AI 276670/AI/NIAID NIH HHS; U01AI 32783/AI/NIAID NIH HHS; U10 EY 08052/EY/NEI NIH HHS; U10 EY 08057/EY/NEI NIH HHS; U10 EY 08067/EY/NEI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Anti-HIV Agents |
| Investigator | |
Investigator/Affiliation:
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Richard Alan Lewis / ; John Michael Bourg / ; Victor Fainstein / ; Zbigniew Krason / ; Joseph F Morales / ; Silvia Orengo-Nania / ; Tobias C Samo / ; Steven Spencer / ; Mitchell P Weikert / ; Richard C Allen / ; Pamela Frady / ; Ronald Gross / ; Allison Schmidt / ; Laura Shawver / ; James Shigley / ; Benita Slight / ; Rachel Sotuyo / ; Stephen Travers / ; Sunil K Srivastava / ; Allison Gibbs / ; Deborah Gibbs / ; Debora Jordan / ; Bob Myles / ; Janna Rutter / ; Antonio Capone / ; David Furukuwa / ; Baker Hubbard / ; Daniel F Martin / ; Mitchell Goldman / ; Janice Brown / ; Thomas Ciulla / ; Jean Craft / ; Ronald Danis / ; Paul Fry / ; Hua Gao / ; Samir Gupta / ; Janet Hernandez / ; Debra Poe / ; Linda Pratt / ; James D Richardson / ; Tim Steffens / ; L Joseph Wheat / ; Beth Zwickl / ; J P Dunn / ; Diane M Brown / ; David Emmert / ; Mark Herring / ; Adam Jacobowitz / ; Henry A Leder / ; Alison G Livingston / ; Yavette Morton / ; Kisten D Nolan / ; Richard D Semba / ; Priscilla Soto / ; Jennifer E Thorne / ; Patricia Barditch-Crovo / ; Marie-Lyne Bélair / ; Stephen G Bolton / ; Joseph B Brodine / ; Lisa M Brune / ; Anat Galor / ; Douglas A Jabs / ; Meera Kapoor / ; Sanjay R Kedhar / ; John H Kempen / ; Stephen J Kim / ; Armando L Oliver / ; George B Peters / ; Ricardo Stevenson / ; Michelle Yue Wang / ; Donald Bergsma / ; Rebecca Clark / ; Robin Cooper / ; Jasmine Elison / ; Butler Fuller / ; Christine Jarrott / ; Lynn Otillio / ; Maria Reinoso / ; Christine Romero / ; Bruce Barron / ; Robin Bye / ; Mandi Conway / ; Larry Dillon / ; Audrey Lombard / ; Gholman Peyman / ; Ronald Rescigno / ; Neelakshi Bhagat / ; Rosa Paez-Boham / ; Marta Paez-Quinde / ; Murk-Hein Heinemann / ; Susana Coleman / ; Sara Daniel / ; Roberta Janis / ; Aziz Khanifer / ; Andrzej Kozbial / ; Diane Iglesias Rivera / ; Kent Sepkowitz / ; Kenneth Boyd / ; Robinson V P Chan / ; Cynthia Chiu / ; Charles Cole / ; Charles Doering / ; Jasmine Elison / ; Sangwoo Lee / ; Fang Lu / ; Joseph Murphy / ; Sophia Pachydaki / ; Christina Peroni / ; Firas M Rahhal / ; Ashok Reddy / ; Scott Warden / ; Dorothy N Friedberg / ; Adrienne Addessi / ; Douglas Dieterich / ; Monica Lorenzo-Latkany / ; Maria Pei / ; Alex McMeeking / ; Alice T Lyon / ; Lori Ackatz / ; Manjot Gill / ; Lori Kaminski / ; Rukshana Mirza / ; Robert Murphy / ; Frank Palella / ; Carmen Ramirez / ; Zuzanna Rozenbajgier / ; Dawn Ryan / ; Evica Simjanoski / ; Alexander Habib / ; Jill Koecher / ; Jeevan Mathura / ; Annmarie Muñana / ; Jonathan Shankle / ; David V Weinberg / ; James Yuhr / ; Mathew W MacCumber / ; Bruce Gaynes / ; Christina Giannoulis / ; Pamela Hulvey / ; Harold Kessler / ; Heena S Khan / ; Andrea Kopp / ; Pauline Merrill / ; Frank Morini / ; Nada Smith / ; Allen Tenorio / ; Denise Voskuil-Marre / ; Kisung Woo / ; Baruch D Kuppermann / ; Bogdan Alexandiescu / ; Donald N Forthal / ; Jeff Grijalva / ; Faisal Jehan / ; Karen Lopez / ; Rosie Magallon / ; Nader Moinfar / ; Bret Trump / ; Melody Vega / ; Randy Williams / ; Gary N Holland / ; Robert D Almanzor / ; Margrit E Carlson / ; Jose T Castellanos / ; Jeffrey A Craddock / ; Serina Gonzales / ; Ann K Johiro / ; Partho S Kalyani / ; Michael A Kapamajian / ; David L LeBeck / ; Kristin M Lipka / ; Susan S Ransome / ; Suzette A Chafey / ; Alexander C Charonis / ; Peter J Kappel / ; Ardis A Moe / ; Germán Piñón / ; Angela Sanderson / ; Kayur H Shah / ; Robert Stalling / ; Dennis Thayer / ; Jean D Vaudaux / ; William R Freeman / ; Denise Cochran / ; Igor Kozak / ; Megan Loughran / ; Luzandra Magana / ; Victoria Morrison / ; Vivian Nguyen / ; Stephen Oster / ; Sunan Chaidhawanqual / ; Lingyun Cheng / ; Tom Clark / ; Mark Cleveland / ; Randall L Gannon / ; Claudio Garcia / ; Daniel Goldberg / ; Joshua Hedaya / ; Marietta Karavellas / ; Tiara Kemper / ; Brian Kosobucki / ; Alona Mask / ; Nicole Reagan / ; Mi-Kyoung Song / ; Francesca Torriani / ; Dorothy Wong / ; Tekeena Young / ; Jacque Duncan / ; Fermin Ballesteros / ; Robert Bhisitkul / ; Debra Brown / ; David Clay / ; Michael Deiner / ; Donald Eubank / ; Mark Jacobson / ; Mary Lew / ; Todd Margolis / ; Judith Aberg / ; Jacqueline Hoffman / ; Alexander Irvine / ; James Larson / ; Jody Lawrence / ; Michael Narahara / ; Monique Trinidad / ; Travis A Meredith / ; Sandy Barnhart / ; Debra Cantrell / ; Seema Garg / ; Elizabeth Hartnett / ; Maurice B Landers / ; Sarah Moyer / ; David Wohl / ; Stephanie Betran / ; Kelly DeBoer / ; David Eifrig / ; John Foley / ; Angela Jeffries / ; Jan Kylstra / ; Barbara Longmire / ; Sharon Myers / ; Fatima N'Dure / ; Kean T Oh / ; Jeremy Pantell / ; Susan Pedersen / ; Cadmus Rich / ; Cecilia A Sotelo / ; Charles van der Horst / ; Samir Wadhvania / ; Charles W Nichols / ; Mark Bardsley / ; Cheryl C Devine / ; Jay Kostman / ; Albert Maguire / ; William Nyberg / ; Leslie Smith / ; Chris Helker / ; RobRoy MacGregor / ; Karen McGibney / ; Keith Mickelberg / ; Jennifer I Lim / ; Rizwan Bhatti / ; John Canzano / ; Thomas S Chang / ; Alexander Charonis / ; Lawrence Chong / ; Robert Equi / ; Amani Fawzi / ; Christina Flaxel / ; Jesus Garcia / ; Todd Klesert / ; Francoise Kramer / ; Lori Levin / ; Tracy Nichols / ; Christopher Pelzek / ; Margaret Podilla / ; Richine Len / ; Danny Romo / ; Srinivas Sadda / ; Richard Scartozzi / ; Robert See / ; Kevin Shiramizu / ; Mark Thomas / ; A Frances Walonker / ; Alexander Walsh / ; Ziquiang Wu / ; Peter Reed Pavan / ; JoAnn Leto / ; Brian Madow / ; Richard Oehler / ; Nandesh Patel / ; Wyatt Saxon / ; Susan Sherouse / ; Andrew Burrows / ; Steve Carlton / ; Burton Goldstein / ; Sandra Gompf / ; Bonnie Hernandez / ; Mohan Iyer / ; Patrick Kelty / ; Amy Kramer / ; Sharon Millard / ; Jeffrey Nadler / ; Scott E Paulter / ; Jennifer Tordilla-Wadia / ; Nancy Walker / ; Garvin Davis / ; Robert Blem / ; J Mike Bourg / ; John Horna / ; Craig Kelso / ; Zbigniew Krason / ; Helen K Li / ; Lan-Chi Nguyen / ; Rhonda Nolen / ; Michelle Onarato / ; David Paar / ; Steven Rivas / ; Vicky Seitz / ; Happy Spillar / ; Sami Uwaydat / ; Douglas A Jabs / ; Yasmin Hilal / ; Melissa Nieves / ; Karen Pascual / ; Jill Slutsky / ; Maria Stevens / ; Judith C Southall / ; Curtis L Meinert / ; Alka Ahuja / ; Debra A Amend-Libercci / ; Karen L Collins / ; Betty J Collison / ; Ryan Colvin / ; John Dodge / ; Michele Donithan / ; Cathleen Ewing / ; Kevin Frick / ; Janet T Holbrook / ; Milana R Isaacson / ; Rosetta M Jackson / ; Hope Livingston / ; Lee McCaffrey / ; Milo Puhan / ; Girlie Reyes / ; Jacki Smith / ; Michael Smith / ; Elizabeth Sugar / ; Jennifer E Thorne / ; James A Tonascia / ; Mark L Van Natta / ; Annette Wagoner / ; Carley Benham / ; Gregory Foster / ; Judith Harle / ; Adele M Kaplan Gilpin / ; John H Kempen / ; Barbara K Martin / ; Nancy Min / ; Laurel Murrow / ; Maria J Oziemkowska / ; Wai Ping Ng / ; Pamela E Scott / ; Erica Smothers / ; Emily West / ; Claudine Woo / ; Albert Wu / ; Alice Zong / ; Ronald Danis / ; Charles Chandler / ; Sapna Gangaputra / ; Gregory Guilfoil / ; Larry Hubbard / ; Jeffrey Joyce / ; Thomas Pauli / ; Nancy Robinson / ; Dennis Thayer / ; Jeong Won Pak / ; Grace Zhang / ; Michael Altaweel / ; Jane Armstrong / ; Matthew D Davis / ; Sheri Glaeser / ; Katrina Hughes / ; Dolores Hurlburt / ; Linda Kastorff / ; Michael Neider / ; Therese Traut / ; Marilyn Vanderhoof-Young / ; Hugh Wabers / ; Natalie Kurinij / ; Douglas A Jabs / ; Ronald Danis / ; Natalie Kurinij / ; Curtis L Meinert / ; Jennifer E Thorne / ; Matthew D Davis / ; Janet T Holbrook / ; Douglas A Jabs / ; Ronald Danis / ; James P Dunn / ; Gary N Holland / ; Milana R Isaccson / ; Mark Jacobson / ; Natalie Kurinij / ; Richard Lewis / ; Kisten D Nolan / ; Curtis L Meinert / ; William Nyberg / ; Frank Palella / ; Jennifer E Thorne / ; Adrienne Addessi / ; Lisa Brune / ; Rebecca Clark / ; Tom Clark / ; Janet Davis / ; Matthew D Davis / ; William R Freeman / ; Dorothy Friedberg / ; James Gilman / ; Janet T Holbrook / ; John Horna / ; Larry Hubbard / ; Mark Jacobson / ; Daniel F Martin / ; Travis A Meredith / ; Annmarie Muñana / ; Robert Murphy / ; P Reed Pavan / ; Steven Spencer / ; Tim Steffens / ; Dennis Thayer / ; Charles van der Horst / ; Fran Wallach / ; John P Phair / ; Brian P Conway / ; Barry R Davis / ; Douglas A Jabs / ; Natalie Kurinij / ; Curtis L Meinert / ; David Musch / ; Robert B Nussenblatt / ; Jennifer E Thorne / ; Richard Whitley / ; B William Brown / ; Matthew D Davis / ; James Grizzle / ; Argye Hillis / ; Janet T Holbrook / ; Harmon Smith / ; James A Tonascia / ; Steven Spencer / ; Robert D Almanzor / ; Deborah Gibbs / ; Milana Isaacson / ; Mary Lew / ; Richard Alan Lewis / ; Ferman Ballesteros / ; Jeff Grijalva / ; Karen Lopez / ; Laura G Neisser / ; Rosa Paez-Boham / |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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