All-cause and AIDS-related mortality among people with HIV across Europe from 2001 to 2020: impact of antiretroviral therapy, tuberculosis and regional differences in a multicentre cohort study

作者：Christian Kraef, Erich Tusch, Sabine Singh, Lars Østergaard, Gerd Fätkenheuer, Antonella Castagna, Santiago Moreno, Katharina Kusejko, Bartosz Szetela, Anastasiia Kuznetsova, Janez Tomažič, Jovan Ranin, Robert Zangerle, Fredrik Månsson, Giulia Marchetti, Stéphane De Wit, Amanda Clarke, Jan Gerstoft, Daria Podlekareva, Lars Peters, Joanne Reekie, Ole Kirk · 发表于：The Lancet Regional Health - Europe · 年份：2024 · DOI：10.1016/j.lanepe.2024.100989 · 被引用次数：15 · 研究领域：HIV-related health complications and treatments、HIV/AIDS Research and Interventions、Tuberculosis Research and Epidemiology

Background: All-cause and AIDS-mortality in Europe has been decreasing between 1996 and 2020. However, regional differences as well as their drivers remain unclear. This study investigates mortality differences and their drivers, including usage of and response to antiretroviral therapy (ART) and active tuberculosis (TB), among people with HIV across Europe. Methods: and viral load (VL) > 200 copies/ml), good (CD4 ≥ 500 and VL < 200), or intermediate (remaining combinations). Participants missing either CD4-cell count or VL were categorized as unknown. Regional differences in mortality were analyzed using multivariable Poisson regression with interaction analyses between regions of Europe and IVS, ART, or TB status. Findings: (IQR: 291-638), and most were male 14,993/20,346 (73.3%). A total of 2639 died during 192,591 person-years of follow-up (crude mortality rate 13.7/1000 person-years, 95% CI: 13.2-14.2), 519/2639 (19.7%) from AIDS (2.7/1000 person-years, 2.5-2.9). All-cause and AIDS-mortality rates decreased over time but remained higher in Eastern Europe after adjusting for confounders. Being off ART (aIRR 2.42; 95% CI 2.14-2.74), poor IVS (aIRR 4.2; 95% CI 3.39-5.20) and prior TB (aIRR 3.33; 95% CI 2.75-4.03) were associated with higher all-cause mortality. For all-cause mortality the effect of ART (test for interaction: p < 0.001) and IVS (p = 0.02), but not TB (p = 0.5) varied across regions. Interpretation: Overall mortality and AIDS-mortality rates decreased over ti...