1. Long-term exposure to combination antiretroviral therapy and risk of death from specific causes: no evidence for any previously unidentified increased risk due to antiretroviral therapy
- Author
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Kowalska, Justyna D., Joanne Reekie, Amanda Mocroft, Peter Reiss, Bruno Ledergerber, Jose Gatell, Arminio Monforte, Antonella D., Andrew Phillips, Lundgren, Jens D., Ole Kirk, EuroSIDA Study Group, Matti Ristola, Amsterdam institute for Infection and Immunity, Amsterdam Public Health, Global Health, Kowalska, Justyna D., Reekie, Joanne, Mocroft, Amanda, Reiss, Peter, Ledergerber, Bruno, Gatell, Jose, D'arminio Monforte, Antonella, Phillips, Andrew, Lundgren, Jens D., Kirk, Ole, Eurosida Study, Group, Castagna, Antonella, University of Zurich, and Kowalska, J D
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Male ,Time Factors ,Comorbidity ,non-AIDS event ,10234 Clinic for Infectious Diseases ,cause of death ,0302 clinical medicine ,immune system diseases ,Risk Factors ,Antiretroviral Therapy, Highly Active ,Cause of Death ,Immunology and Allergy ,030212 general & internal medicine ,Prospective Studies ,Prospective cohort study ,Cause of death ,0303 health sciences ,Smoking ,virus diseases ,Hepatitis C ,Middle Aged ,Viral Load ,Hepatitis B ,3. Good health ,AIDS ,Infectious Diseases ,Hypertension ,symbols ,2723 Immunology and Allergy ,Disease Progression ,combination antiretroviral therapy ,RNA, Viral ,Drug Therapy, Combination ,Female ,Human ,Cart ,Adult ,medicine.medical_specialty ,Time Factor ,Anti-HIV Agents ,Immunology ,610 Medicine & health ,Follow-Up Studie ,03 medical and health sciences ,symbols.namesake ,Pharmacotherapy ,Internal medicine ,adverse effect ,mental disorders ,medicine ,Humans ,Poisson regression ,Adverse effect ,2403 Immunology ,Acquired Immunodeficiency Syndrome ,030306 microbiology ,business.industry ,Risk Factor ,HIV ,Anti-HIV Agent ,2725 Infectious Diseases ,medicine.disease ,mortality ,Confidence interval ,CD4 Lymphocyte Count ,Prospective Studie ,nervous system ,HIV-1 ,business ,Follow-Up Studies - Abstract
Background: Despite the known substantial benefits of combination antiretroviral therapy (cART), cumulative adverse effects could still limit the overall long-term treatment benefit. Therefore we investigated changes in the rate of death with increasing exposure to cART. Methods: A total of 12 069 patients were followed from baseline, which was defined as the time of starting cART or enrolment into EuroSIDA whichever occurred later, until death or 6 months after last follow-up visit. Incidence rates of death were calculated per 1000 person-years of follow-up (PYFU) and stratified by time of exposure to cART (>= 3 antiretrovirals): less than 2, 2-3.99, 4-5.99, 6-7.99 and more than 8 years. Duration of cART exposure was the cumulative time actually receiving cART. Poisson regression models were fitted for each cause of death separately. Results: A total of 1297 patients died during 70 613 PYFU [incidence rate 18.3 per 1000 PYFU, 95% confidence interval (CI) 17.4-19.4], 413 due to AIDS (5.85, 95% CI 5.28-6.41) and 884 due to non-AIDS-related cause (12.5, 95% CI 11.7-13.3). After adjustment for confounding variables, including baseline CD4 cell count and HIV RNA, there was a significant decrease in the rate of all-cause and AIDS-related death between 2 and 3.99 years and longer exposure time. In the first 2 years on cART the risk of non-AIDS death was significantly lower, but no significant difference in the rate of non-AIDS-related deaths between 2 and 3.99 years and longer exposure to cART was observed. Conclusion: In conclusion, we found no evidence of an increased risk of both all-cause and non-AIDS-related deaths with long-term cumulative cART exposure. (C) 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
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- 2012
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