Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada.

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Abstract

Combination antiretroviral therapy (ART) has significantly increased survival among HIV-positive adults in the United States (U.S.) and Canada, but gains in life expectancy for this region have not been well characterized. We aim to estimate temporal changes in life expectancy among HIV-positive adults on ART from 2000-2007 in the U.S. and Canada.

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Correcting for noncompliance and dependent censoring in an AIDS Clinical Trial with inverse probability of censoring weighted (IPCW) log-rank tests.

J Robins, D Finkelstein (2000)

AIDS Clinical Trial Group (ACTG) randomized trial 021 compared the effect of bactrim versus aerosolized pentamidine (AP) as prophylaxis therapy for pneumocystis pneumonia (PCP) in AIDS patients. Although patients randomized to the bactrim arm experienced a significant delay in time to PCP, the survival experience in the two arms was not significantly different (p = .32). In this paper, we present evidence that bactrim therapy improves survival but that the standard intent-to-treat comparison failed to detect this survival advantage because a large fraction of the subjects either crossed over to the other therapy or stopped therapy altogether. We obtain our evidence of a beneficial bactrim effect on survival by artificially regarding the subjects as dependently censored at the first time the subject either stops or switches therapy; we then analyze the data with the inverse probability of censoring weighted Kaplan-Meier and Cox partial likelihood estimators of Robins (1993, Proceedings of the Biopharmaceutical Section, American Statistical Association, pp. 24-33) that adjust for dependent censoring by utilizing data collected on time-dependent prognostic factors.

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The combined effect of modern highly active antiretroviral therapy regimens and adherence on mortality over time.

R E Hogg, Luis Montaner, David R Bangsberg … (2009)

To characterize the impact of longitudinal adherence on survival in drug-naive individuals starting currently recommended highly active antiretroviral therapy (HAART) regimens. Eligible study participants initiated HAART between January 2000 and November 2004 and were followed until November 2005 (N = 903). HAART regimens contained efavirenz, nevirapine, or ritonavir-boosted atazanavir or lopinavir. Marginal structural modeling was used to address our objective. The all-cause mortality was 11%. Individual adherence decreased significantly over time, with the mean adherence shifting from 79% within the first 6 months of starting HAART to 72% within the 24- to 30-month period (P value <0.01). Nonadherence over time (<95%) was strongly associated with higher risk of mortality (hazard ratio: 3.13; 95% confidence interval (CI): 1.95 to 5.05). Nonadherent (<95%) patients on nonnucleoside reverse transcriptase inhibitor (NNRTI)-based and boosted protease inhibitor-based regimens were, respectively, 3.61 times (95% CI: 2.15 to 6.06) and 3.25 times (95% CI: 1.63 to 6.49) more likely to die than adherent patients. Within the NNRTI-based regimens, nonadherent individuals on efavirenz were at a higher risk of mortality. Incomplete adherence to modern HAART over time was strongly associated with increased mortality, and patients on efavirenz-based NNRTI therapies were particularly at a higher risk if nonadherent. These results highlight the need to develop further strategies to help sustain high levels of adherence on a long-term basis.

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HIV and aging: time for a new paradigm.

Amy Justice (2010)

The population of patients with HIV infection achieving viral suppression on combination antiretroviral therapy is growing, aging, and experiencing a widening spectrum of non-AIDS diseases. Concurrently, AIDS-defining conditions are becoming less common and are variably associated with outcome. Nonetheless, the spectrum of disease experienced by those aging with HIV remains strongly influenced by HIV, its treatment, and the behaviors, conditions, and demographics associated with HIV infection. Our focus must shift from a narrow interest in CD4 counts, HIV-RNA, and AIDS-defining illnesses to determining the optimal management of HIV infection as a complex chronic disease in which the causes of morbidity and mortality are multiple and overlapping. We need a new paradigm of care with which to maximize functional status, minimize frailty, and prolong life expectancy. A composite index that summarizes a patient's risk of morbidity and mortality could facilitate this work and help chart its progress.

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Journal

Journal ID (iso-abbrev): PLoS ONE

Title: PloS one

Publisher: Public Library of Science (PLoS)

ISSN (Electronic): 1932-6203

ISSN (Print): 1932-6203

Publication date (Electronic): 2013

Volume: 8

Issue: 12

Affiliations

[1 ] British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.

[2 ] British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada ; Simon Fraser University, Burnaby, British Columbia, Canada.

[3 ] Johns Hopkins University, Baltimore, Maryland, United States of America.

[4 ] Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.

[5 ] Ontario HIV Treatment Network, Toronto, Ontario, Canada.

[6 ] The Core Center, Bureau of Health Services of Cook County, Chicago, Illinois, United States of America.

[7 ] University of Calgary, Calgary, Alberta, Canada.

[8 ] Veterans Administration Connecticut Healthcare System and Yale University, West Haven, Connecticut, United States of America.

[9 ] McGill University Health Centre, Montreal, Quebec, Canada.

[10 ] Oregon Health and Science University, Portland, Oregon, United States of America.

[11 ] University of California San Francisco, San Francisco, California, United States of America.

[12 ] University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America.

[13 ] Vanderbilt University, Nashville, Tennessee, United States of America.

[14 ] Kaiser Permanente Northern California, Oakland, California, United States of America.

[15 ] San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America.

[16 ] Harvard School of Public Health, Boston, Massachusetts, United States of America.

[17 ] University of Washington, Seattle, Washington, United States of America.

[18 ] National Cancer Institute, Rockville, Maryland, United States of America.

Article

Publisher Item ID: PONE-D-13-20154

DOI: 10.1371/journal.pone.0081355

PMC ID: 3867319

PubMed ID: 24367482

SO-VID: b7cd708f-1b09-4dc3-9134-bee47b040340

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Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada.

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Most cited references 12

Correcting for noncompliance and dependent censoring in an AIDS Clinical Trial with inverse probability of censoring weighted (IPCW) log-rank tests.

The combined effect of modern highly active antiretroviral therapy regimens and adherence on mortality over time.

HIV and aging: time for a new paradigm.

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