Trends in Cause-Specific Mortality Among Veterans With HIV: A 35-Year (1982–2016) Analysis of the HIV Atlanta VA Cohort Study

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 92; no. 1; pp. 17 - 26
• Main Authors: Vyas, Kartavya J., Marconi, Vincent C., Moanna, Abeer, Rimland, David, Guest, Jodie L.
• Format: Journal Article
• Language: English
• Published: United States JAIDS Journal of Acquired Immune Deficiency Syndromes 01-01-2023; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Acquired immune deficiency syndrome; Aged; Aging; AIDS; Antiretroviral agents; Antiretroviral therapy; Cardiovascular diseases; Cause of Death; Cohort analysis; Cohort Studies; Hazard identification; Health care facilities; HIV; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Malignancy; Mathematical analysis; Mortality; Public health; Regression analysis; Regression models; Renal failure; Respiratory diseases; Risk analysis; Risk factors; Statistical models; Trends; Atlanta Georgia; United States > US
• ISSN: 1525-4135; 1944-7884
• DOI: 10.1097/QAI.0000000000003107

Causes of death and their trends among veterans with HIV (VWH) are different than those in the general population with HIV, but this has not been fully described. The objective was to understand the trends in, and risk factors for, all-cause and cause-specific mortality across eras of combination antiretroviral therapy (cART) among VWH.
The HIV Atlanta VA Cohort Study includes all VWH who ever sought care at the Atlanta VA Medical Center.
Age-adjusted all-cause and cause-specific mortality rates were calculated annually and compared between pre-cART (1982-1996), early-cART (1997-2006), and late-cART (2007-2016) eras. Trends were assessed using Kaplan-Meier curves, cumulative incidence functions, and joinpoint regression models. Risk factors were identified by Cox proportional hazards models.
Of the 4674 VWH in the HIV Atlanta VA Cohort Study, 1752 died; of whom, 1399 (79.9%), 301 (17.2%), and 52 (3.0%) were diagnosed with HIV in the pre-cART, early-cART, and late-cART eras, respectively. Significant increases were observed in rates of all-cause, AIDS-related, and non-AIDS-related mortality in the pre-cART era, followed by declines in the early-cART and late-cART eras. All-cause, AIDS-related, and non-AIDS-related mortality rates plummeted by 65%, 81%, and 45%, respectively, from the pre-cART to late-cART eras. However, VWH continue to die at higher rates due to AIDS-related infections, non-AIDS-related malignancies, respiratory disease, cardiovascular disease, and renal failure than those in the general population with HIV.
In older populations with HIV, it is important that providers not only monitor for and treat diseases associated with aging but also intervene and address lifestyle risk factors.