• Antiretroviral Therapy Cohort Collaboration, Marcel Zwahlen, Ross Harris, Margaret May, Robert Hogg, Dominique Costagliola, Frank de Wolf, John Gill, Gerd Fätkenheuer, Charlotte Lewden, Mike Saag, Sholmo Staszewski, d'Arminio Monforte Antonella A, Jordi Casabona, Fiona Lampe, Amy Justice, Viktor von Wyl, and Matthias Egger.
• Int J Epidemiol. 2009 Dec 1; 38 (6): 1624-33.

BackgroundMortality in HIV-infected patients has declined substantially with combination antiretroviral therapy (ART), but it is unclear whether it has reached that of the general population. We compared mortality in patients starting ART in nine countries of Europe and North America with the corresponding general population, taking into account their response to ART.MethodsEligible patients were enrolled in prospective cohort studies participating in the ART Cohort Collaboration. We calculated the ratio of observed to expected deaths from all causes [standardized mortality ratio (SMR)], measuring time from 6 months after starting ART, according to risk group, clinical stage at the start of ART and CD4 cell count and viral load at 6 months. Expected numbers of deaths were obtained from age-, sex- and country-specific mortality rates.ResultsAmong 29 935 eligible patients, 1134 deaths were recorded in 131 510 person-years of follow-up. The median age was 37 years, 8162 (27%) patients were females, 4400 (15%) were injecting drug users (IDUs) and 6738 (23%) had AIDS when starting ART. At 6 months, 23 539 patients (79%) had viral load measurements or=350 cells/microL and suppressed viral replication to 10 were 4, 14 and 47%.ConclusionsIn industrialized countries, the mortality experience of HIV-infected patients who start ART and survive the first 6 months continues to be higher than in the general population, but for many patients excess mortality is moderate and comparable with patients having other chronic conditions. Much of the excess mortality might be prevented by earlier diagnosis of HIV followed by timely initiation of ART.

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