FROM THE LANCET HIV

Mortality continues to decline for patients in the first 3 years of combination antiretroviral therapy (ART) for HIV-1 infection, according to an analysis of 18 different cohorts from 1996 to 2013.

The Antiretroviral Therapy Cohort Collaboration (ART-CC) combined data from participating cohorts from Europe and North America. Patients were at least 16 years of age, naive to ART, and starting treatment with three or more antiretroviral drugs between 1996 and 2010. Of 88,504 patients, 2% died in the first year of ART, and 3% died in the second or third year of ART.

The ART-CC has been publishing papers since 2002 , with the current study, by a writing committee from the ART-CC led by Adam Trickey, PhD , of the University of Bristol (England), appearing in The Lancet HIV (2017. doi: 10.1016/S2352-3018[17]30066-8 ).

Where the ART-CC previously reported that mortality within 1 year of starting ART had not improved from 1998 to 2003, the current analysis found lower mortality in the first year for patients starting ART in the years 2008 to 2010, compared with patients starting ART in the years 2000 to 2003 (hazard ratio, 0.71; 95% confidence interval, 0.61-0.83).

All-cause mortality also was decreased in the second and third years of ART for those respective calendar periods (HR, 0.57; 95% CI, 0.49-0.67).

“Patients who started ART during 2008-2010 whose CD4 counts exceeded 350 cells per microL 1 year after ART initiation have estimated life expectancy approaching that of the general population,” Dr. Trickey and his colleagues said.

The authors speculate that the improvements in mortality may result from better ART regimens and improved adherence. Declines in all-cause mortality may reflect better management of comorbidities.

Given the high effectiveness of ART today, for further improvement “lifestyle issues that affect adherence to ART and non-AIDS mortality, and diagnosis and treatment of comorbidities in people living with HIV will need to be addressed,” Dr. Trickey and his coauthors concluded.

The study received funding from the United Kingdom Medical Research Council, the United Kingdom Department for International Development, and the European Union European & Developing Countries Clinical Trials Partnership (EDCTP2) program. Some members of the writing committee received fees from various drug companies for work unrelated to this study.

dwatson@frontlinemedcom.com

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