Estimation of Improvements in Mortality in Spectrum Among Adults With HIV Receiving Antiretroviral Therapy in High-Income Countries

Adam Trickey (1) , Robert Glaubius , Nikos Pantazis (2) , Robert Zangerle (3) , Linda Wittkop (4, 5) , Janne Vehreschild (6) , Sophie Grabar (7, 8) , Matthias Cavassini (9) , Ramon Teira (10) , Antonella d'Arminio Monforte (11) , Jordi Casabona (12) , Ard van Sighem (13) , Inma Jarrin (14) , Suzanne M Ingle (1) , Jonathan a C Sterne (1) , Jeffrey W Imai-Eaton (15, 16) , Leigh F Johnson (17)

1 University of Bristol [Bristol]
2 NKUA - National and Kapodistrian University of Athens
3 IMU - Innsbruck Medical University = Medizinische Universität Innsbruck
4 SISTM - Statistics In System biology and Translational Medicine
5 BPH - Bordeaux population health
6 University Hospital of Cologne [Cologne]
7 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
8 CHU Saint-Antoine [AP-HP]
9 CHUV - Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne]
10 Hospital Universitario Marqués de Valdecilla [Santander]
11 UNIMI - Università degli Studi di Milano = University of Milan
12 CEEISCAT - Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya
13 Stichting HIV Monitoring [Amsterdam]
14 ISC - Instituto de Salud Carlos III [Madrid]
15 Imperial College London
16 Harvard T.H. Chan School of Public Health
17 University of Cape Town

INTRODUCTION: Mortality rates for people living with HIV (PLHIV) on antiretroviral therapy (ART) in high-income countries continue to decline. We compared mortality rates among PLHIV on ART in Europe for 2016-2020 with Spectrum's estimates. METHODS: The AIDS Impact Module in Spectrum is a compartmental HIV epidemic model coupled with a demographic population projection model. We used national Spectrum projections developed for the 2022 HIV estimates round to calculate mortality rates among PLHIV on ART, adjusting to the age/country distribution of PLHIV starting ART from 1996 to 2020 in the Antiretroviral Therapy Cohort Collaboration (ART-CC)'s European cohorts. RESULTS: In the ART-CC, 11,504 of 162,835 PLHIV died. Between 1996-1999 and 2016-2020, AIDS-related mortality in the ART-CC decreased from 8.8 (95% CI: 7.6 to 10.1) to 1.0 (0.9-1.2) and from 5.9 (4.4-8.1) to 1.1 (0.9-1.4) deaths per 1000 person-years among men and women, respectively. Non-AIDS-related mortality decreased from 9.1 (7.9-10.5) to 6.1 (5.8-6.5) and from 7.0 (5.2-9.3) to 4.8 (4.3-5.2) deaths per 1000 person-years among men and women, respectively. Adjusted all-cause mortality rates in Spectrum among men were near ART-CC estimates for 2016-2020 (Spectrum: 7.02-7.47 deaths per 1000 person-years) but approximately 20% lower in women (Spectrum: 4.66-4.70). Adjusted excess mortality rates in Spectrum were 2.5-fold higher in women and 3.1-3.4-fold higher in men in comparison to the ART-CC's AIDS-specific mortality rates. DISCUSSION: Spectrum's all-cause mortality estimates among PLHIV are consistent with age/country-controlled mortality observed in ART-CC, with some underestimation of mortality among women. Comparing results suggest that 60%-70% of excess deaths among PLHIV on ART in Spectrum are from non-AIDS causes.

Mots clés: AIDS mortality; excess mortality; modelling; parameters; Europe; high income

Domaines: Santé publique et épidémiologie

Adam Trickey, Robert Glaubius, Nikos Pantazis, Robert Zangerle, Linda Wittkop, et al.. Estimation of Improvements in Mortality in Spectrum Among Adults With HIV Receiving Antiretroviral Therapy in High-Income Countries. Journal of Acquired Immune Deficiency Syndromes - JAIDS, 2024, 95 (1S), pp.e89-e96. ⟨10.1097/qai.0000000000003326⟩. ⟨hal-04467807⟩