Evolving AIDS- and non-AIDS Mortality and Predictors in the PISCIS Cohort of People Living With HIV in Catalonia and the Balearic Islands (Spain), 1998-2020

Daniel K Nomah; Suju Jamarkattel; Andreu Bruguera; Sergio Moreno-Fornés; Yesika Díaz; Lucía Alonso; Jordi Aceitón; Josep M Llibre; Pere Domingo; Maria Saumoy; Francesc Homar; Francisco Fanjul; Jordi Navarro; Lorena de la Mora; Hernando Knobel; Amat Orti; Raquel Martin-Iguacel; José M Miró; Jordi Casabona; Juliana Reyes-Urueña

doi:10.1093/ofid/ofae132

Evolving AIDS- and non-AIDS Mortality and Predictors in the PISCIS Cohort of People Living With HIV in Catalonia and the Balearic Islands (Spain), 1998-2020

Open Forum Infect Dis. 2024 Mar 8;11(4):ofae132. doi: 10.1093/ofid/ofae132. eCollection 2024 Apr.

Authors

Daniel K Nomah^{1

2}, Suju Jamarkattel¹, Andreu Bruguera^{1

2

3

4}, Sergio Moreno-Fornés^{1

2

3}, Yesika Díaz^{1

2

3}, Lucía Alonso^{1

2}, Jordi Aceitón^{1

2}, Josep M Llibre⁵, Pere Domingo⁶, Maria Saumoy⁷, Francesc Homar⁸, Francisco Fanjul⁹, Jordi Navarro¹⁰, Lorena de la Mora¹¹, Hernando Knobel¹², Amat Orti¹³, Raquel Martin-Iguacel^{1

14}, José M Miró^{11

15}, Jordi Casabona^{1

2

3

4}, Juliana Reyes-Urueña¹

Affiliations

¹ Departament de Salut, Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Barcelona, Spain.
² Institut d'Investigació Germans Trias i Pujol (IGTP), Barcelona, Spain.
³ CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain.
⁴ Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain.
⁵ Infectious Disease Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
⁶ Department of Infectious Diseases, HIV Infection Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
⁷ Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institute of Biomedical Research of Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain.
⁸ Department of Internal Medicine, Hospital de Son Llàtzer, Palma, Spain.
⁹ Hospital Universitario Son Espases, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.
¹⁰ Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
¹¹ Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
¹² Department of Internal Medicine-Infectious Diseases, Hospital del Mar, Barcelona, Spain.
¹³ Internal Medicine and Infectious Disease Service, Hospital Verge de la Cinta, Tortosa, Spain.
¹⁴ Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
¹⁵ CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.

Abstract

Background: Effective antiretroviral therapy (ART) has substantially reduced acquired immunodeficiency syndrome (AIDS)-related deaths, shifting the focus to non-AIDS conditions in people living with human immunodeficiency virus (HIV) (PLWH). We examined mortality trends and predictors of AIDS- and non-AIDS mortality in the Population HIV Cohort from Catalonia and Balearic Islands (PISCIS) cohort of PLWH from 1998 to 2020.

Methods: We used a modified Coding Causes of Death in HIV protocol, which has been widely adopted by various HIV cohorts to classify mortality causes. We applied standardized mortality rates (SMR) to compare with the general population and used competing risks models to determine AIDS-related and non-AIDS-related mortality predictors.

Results: Among 30 394 PLWH (81.5% male, median age at death 47.3), crude mortality was 14.2 per 1000 person-years. All-cause standardized mortality rates dropped from 9.6 (95% confidence interval [CI], 8.45-10.90) in 1998 through 2003 to 3.33 (95% CI, 3.14-3.53) in 2015 through 2020, P for trend = .0001. Major causes were AIDS, non-AIDS cancers, cardiovascular disease, AIDS-defining cancers, viral hepatitis, and nonhepatitis liver disease. Predictors for AIDS-related mortality included being aged ≥40 years, not being a man who have sex with men, history of AIDS-defining illnesses, CD4 < 200 cells/µL, ≥2 comorbidities, and nonreceipt of ART. Non-AIDS mortality increased with age, injection drug use, heterosexual men, socioeconomic deprivation, CD4 200 to 349 cells/µL, nonreceipt of ART, and comorbidities, but migrants had lower risk (adjusted hazard risk, 0.69 [95% CI, .57-.83]).

Conclusions: Mortality rates among PLWH have significantly decreased over the past 2 decades, with a notable shift toward non-AIDS-related causes. Continuous monitoring and effective management of these non-AIDS conditions are essential to enhance overall health outcomes.

Keywords: AIDS; HIV; antiretroviral therapy; mortality; non-AIDS cancers.