Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics
Identifieur interne : 001A36 ( Ncbi/Curation ); précédent : 001A35; suivant : 001A37Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics
Auteurs : Margaret T. May [Royaume-Uni] ; Robert S. Hogg [Canada] ; Amy C. Justice [États-Unis] ; Bryan E. Shepherd [États-Unis] ; Dominique Costagliola [France] ; Bruno Ledergerber [Suisse] ; Rodolphe Thiébaut [France] ; M John Gill [Canada] ; Ole Kirk [Danemark] ; Ard Van Sighem [Pays-Bas] ; Michael S. Saag [États-Unis] ; Gemma Navarro [Espagne] ; Paz Sobrino-Vegas [Espagne] ; Fiona Lampe [Royaume-Uni] ; Suzanne Ingle [Royaume-Uni] ; Jodie L. Guest [États-Unis] ; Heidi M. Crane [États-Unis] ; Antonella D Rminio Monforte [Italie] ; Jörg J. Vehreschild [Allemagne] ; Jonathan Ac Sterne [Royaume-Uni]Source :
- International Journal of Epidemiology [ 0300-5771 ] ; 2012.
Abstract
Url:
DOI: 10.1093/ije/dys164
PubMed: 23148105
PubMed Central: 3535877
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PMC:3535877Le document en format XML
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<author><name sortKey="Gill, M John" sort="Gill, M John" uniqKey="Gill M" first="M John" last="Gill">M John Gill</name>
<affiliation wicri:level="4"><nlm:aff id="dys164-AFF1">Division of Infectious Diseases, University of Calgary, Calgary, Canada,</nlm:aff>
<country xml:lang="fr">Canada</country>
<wicri:regionArea>Division of Infectious Diseases, University of Calgary, Calgary</wicri:regionArea>
<orgName type="university">Université de Calgary</orgName>
<placeName><settlement type="city">Calgary</settlement>
<region type="state">Alberta</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Kirk, Ole" sort="Kirk, Ole" uniqKey="Kirk O" first="Ole" last="Kirk">Ole Kirk</name>
<affiliation wicri:level="1"><nlm:aff id="dys164-AFF1">Copenhagen HIV Programme, Panum Institute, University of Copenhagen, Denmark,</nlm:aff>
<country xml:lang="fr">Danemark</country>
<wicri:regionArea>Copenhagen HIV Programme, Panum Institute, University of Copenhagen</wicri:regionArea>
<wicri:noRegion>University of Copenhagen</wicri:noRegion>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="dys164-AFF1">Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark,</nlm:aff>
<country xml:lang="fr">Danemark</country>
<wicri:regionArea>Department of Infectious Diseases, Rigshospitalet, Copenhagen</wicri:regionArea>
<placeName><settlement type="city">Copenhague</settlement>
<region type="région" nuts="2">Hovedstaden</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Van Sighem, Ard" sort="Van Sighem, Ard" uniqKey="Van Sighem A" first="Ard" last="Van Sighem">Ard Van Sighem</name>
<affiliation wicri:level="3"><nlm:aff id="dys164-AFF1">Stichting HIV Monitoring, Amsterdam, The Netherlands,</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Stichting HIV Monitoring, Amsterdam</wicri:regionArea>
<placeName><settlement type="city">Amsterdam</settlement>
<region nuts="2" type="province">Hollande-Septentrionale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Saag, Michael S" sort="Saag, Michael S" uniqKey="Saag M" first="Michael S" last="Saag">Michael S. Saag</name>
<affiliation wicri:level="2"><nlm:aff id="dys164-AFF1">Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, AL, USA,</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, AL</wicri:regionArea>
<placeName><region type="state">Alabama</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Navarro, Gemma" sort="Navarro, Gemma" uniqKey="Navarro G" first="Gemma" last="Navarro">Gemma Navarro</name>
<affiliation wicri:level="3"><nlm:aff id="dys164-AFF1">Infectious Diseases Program, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain,</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Infectious Diseases Program, Corporació Sanitària Parc Taulí, Sabadell, Barcelona</wicri:regionArea>
<placeName><settlement type="city">Barcelone</settlement>
<region nuts="2" type="region">Catalogne</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Sobrino Vegas, Paz" sort="Sobrino Vegas, Paz" uniqKey="Sobrino Vegas P" first="Paz" last="Sobrino-Vegas">Paz Sobrino-Vegas</name>
<affiliation wicri:level="3"><nlm:aff id="dys164-AFF1">Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain,</nlm:aff>
<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid</wicri:regionArea>
<placeName><settlement type="city">Madrid</settlement>
<region nuts="2" type="region">Communauté de Madrid</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Lampe, Fiona" sort="Lampe, Fiona" uniqKey="Lampe F" first="Fiona" last="Lampe">Fiona Lampe</name>
<affiliation wicri:level="3"><nlm:aff id="dys164-AFF1">Research Department of Infection and Population Health, UCL Medical School, London, UK,</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Research Department of Infection and Population Health, UCL Medical School, London</wicri:regionArea>
<placeName><settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Ingle, Suzanne" sort="Ingle, Suzanne" uniqKey="Ingle S" first="Suzanne" last="Ingle">Suzanne Ingle</name>
<affiliation wicri:level="1"><nlm:aff id="dys164-AFF1">School of Social and Community Medicine, University of Bristol, Bristol, UK,</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>School of Social and Community Medicine, University of Bristol, Bristol</wicri:regionArea>
<wicri:noRegion>Bristol</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Guest, Jodie L" sort="Guest, Jodie L" uniqKey="Guest J" first="Jodie L" last="Guest">Jodie L. Guest</name>
<affiliation wicri:level="2"><nlm:aff id="dys164-AFF1">HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA,</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>HIV Atlanta VA Cohort Study (HAVACS), Atlanta Veterans Affairs Medical Center, Decatur, GA</wicri:regionArea>
<placeName><region type="state">Géorgie (États-Unis)</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Crane, Heidi M" sort="Crane, Heidi M" uniqKey="Crane H" first="Heidi M" last="Crane">Heidi M. Crane</name>
<affiliation wicri:level="2"><nlm:aff id="dys164-AFF1">University of Washington School of Medicine, Seattle, WA, USA,</nlm:aff>
<country xml:lang="fr">États-Unis</country>
<wicri:regionArea>University of Washington School of Medicine, Seattle, WA</wicri:regionArea>
<placeName><region type="state">Washington (État)</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="D Rminio Monforte, Antonella" sort="D Rminio Monforte, Antonella" uniqKey="D Rminio Monforte A" first="Antonella" last="D Rminio Monforte">Antonella D Rminio Monforte</name>
<affiliation wicri:level="1"><nlm:aff wicri:cut=" and" id="dys164-AFF1">Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, University of Milan, Italy</nlm:aff>
<country xml:lang="fr">Italie</country>
<wicri:regionArea>Clinic of Infectious Diseases and Tropical Medicine, San Paolo Hospital, University of Milan</wicri:regionArea>
<wicri:noRegion>University of Milan</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Vehreschild, Jorg J" sort="Vehreschild, Jorg J" uniqKey="Vehreschild J" first="Jörg J" last="Vehreschild">Jörg J. Vehreschild</name>
<affiliation wicri:level="1"><nlm:aff id="dys164-AFF1">First Department of Internal Medicine, University Hospital of Cologne, Cologne, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>First Department of Internal Medicine, University Hospital of Cologne, Cologne</wicri:regionArea>
<wicri:noRegion>Cologne</wicri:noRegion>
<wicri:noRegion>Cologne</wicri:noRegion>
<wicri:noRegion>Cologne</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Sterne, Jonathan Ac" sort="Sterne, Jonathan Ac" uniqKey="Sterne J" first="Jonathan Ac" last="Sterne">Jonathan Ac Sterne</name>
<affiliation wicri:level="1"><nlm:aff id="dys164-AFF1">School of Social and Community Medicine, University of Bristol, Bristol, UK,</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>School of Social and Community Medicine, University of Bristol, Bristol</wicri:regionArea>
<wicri:noRegion>Bristol</wicri:noRegion>
</affiliation>
</author>
</analytic>
<series><title level="j">International Journal of Epidemiology</title>
<idno type="ISSN">0300-5771</idno>
<idno type="eISSN">1464-3685</idno>
<imprint><date when="2012">2012</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass></textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><p><bold>Background</bold>
HIV cohort collaborations, which pool data from diverse patient
cohorts, have provided key insights into outcomes of antiretroviral therapy (ART).
However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and
mortality are unclear.</p>
<p><bold>Methods</bold>
We obtained data on adult HIV-positive patients who started ART from
1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe.
Patients were followed up from 1 month to 2 years after starting ART. We examined
between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year,
CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects
meta-analysis and meta-regression.</p>
<p><bold>Results</bold>
During 61 520 person-years, 754/38 706 (1.9%) patients died
and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was
reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient
characteristics. Adjusted mortality rates were inversely associated with cohorts’
estimated completeness of death ascertainment [excellent: 96–100%, good:
90–95%, average: 75–89%; mortality rate ratio 0.66 (95%
confidence interval 0.46–0.94) per category]. Mortality rate ratios comparing Europe
with North America were 0.42 (0.31–0.57) before and 0.47 (0.30–0.73) after
adjusting for completeness of ascertainment.</p>
<p><bold>Conclusions</bold>
Heterogeneity between settings in outcomes of HIV treatment has
implications for collaborative analyses, policy and clinical care. Estimated mortality
rates may require adjustment for completeness of ascertainment. Higher mortality rate in
North American, compared with European, cohorts was not fully explained by completeness of
ascertainment and may be because of the inclusion of more socially marginalized patients
with higher mortality risk.</p>
</div>
</front>
</TEI>
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