Perspective from W. David Hardy, MD
Disclosures: Edwards reports receiving financial support from the FDA, National Institute of General Medical Sciences, National Institute of Allergy and Infectious Diseases and North Carolina State Legislature on behalf of her institution. Please see the study for all other authors’ relevant financial disclosures. Glesby reports receiving research support from Gilead Sciences on behalf of his institution. Gulick reports receiving research grants from the NIH on behalf of his institution. He also reports being section editor and reviewer for ART for UpToDate, wrote chapters on ART for Elsevier and wrote a chapter on HIV for Wolters Kluwer.
July 06, 2021
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Mortality gap narrows between patients with HIV, general population

Perspective from W. David Hardy, MD
Disclosures: Edwards reports receiving financial support from the FDA, National Institute of General Medical Sciences, National Institute of Allergy and Infectious Diseases and North Carolina State Legislature on behalf of her institution. Please see the study for all other authors’ relevant financial disclosures. Glesby reports receiving research support from Gilead Sciences on behalf of his institution. Gulick reports receiving research grants from the NIH on behalf of his institution. He also reports being section editor and reviewer for ART for UpToDate, wrote chapters on ART for Elsevier and wrote a chapter on HIV for Wolters Kluwer.
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The mortality rate among patients entering HIV care “dramatically decreased” in the United States from 1999 to 2017, according to researchers.

Jessie K. Edwards, PhD, an assistant professor in the department of epidemiology at the University of North Carolina at Chapel Hill, and colleagues estimated that the 5-year mortality rate was only 2.7 percentage points higher among patients entering HIV care between 2011 and 2017 compared with the general population.

Edwards JK, et al. Ann Intern Med. 2021;doi:10.7326/M21-0065.
Source: Edwards JK, et al. Ann Intern Med. 2021;doi:10.7326/M21-0065.

“HIV-related mortality has been decreasing since the introduction of effective treatment in 1996 due to improving treatment options and evolving care guidelines, but the extent to which persons entering HIV care in the United States have higher risk for death over the following years compared with peers in the general population over the same period remains unclear,” the researchers wrote in Annals of Internal Medicine. “Prior work to elucidate temporal trends in mortality among adults with HIV in the years after entering care has not made comparisons with the general U.S. population.”

Edwards and colleagues used data from the National Center for Health Statistics to compare all-cause mortality over 5 years among 82,766 patients entering HIV care at 13 U.S. sites and a subset of the U.S. population. The participants were matched based on calendar time, age, gender, race, ethnicity and county.

Among the HIV-positive cohort, 84% of participants were men, 46% non-Hispanic Black and 16% were Hispanic. The median age upon entering care was 42 years.

Overall, the researchers reported that the 5-year, all-cause mortality rate was 10.6% among patients entering HIV care and 2.9% among the general population, yielding a difference of 7.7 (95% CI, 7.4-7.9) percentage points. This mortality difference decreased over time, from 11.1 percentage points between 1999 and 2004 to 2.7 percentage points between 2011 and 2017.

In a related editorial, infectious disease experts at Weill Medical College of Cornell University said an “important caveat” of the study is that the HIV cohort was limited to patients who were diagnosed and engaged in care. The authors — Marshall J. Glesby, MD, PhD, associate chief of the division of infectious diseases and director of the HIV clinical trials unit, and Roy M. Gulick, MD, MPH, professor of medicine and chief of the division of infectious diseases — cited data from the CDC that indicate 14% of people living with HIV are not diagnosed, “and only 58% receive continuous medical care.”

“Although the mortality gap relative to the general population seems to be narrowing over time, this trend is predicated on prompt diagnosis and receipt of ongoing appropriate care,” they wrote.

Still, Glesby and Gulick noted that the mortality trends appear to be “promising,” and recent advancements, including the FDA approval of a long-acting injectable regimen, could further improve outcomes for people living with HIV.

“Reducing mortality is a key goal, but it is also important to improve quality of life in people with HIV, which may be adversely affected by comorbidities and aging-related issues,” they wrote. “The past 40 years of the epidemic saw remarkable progress in improving survival in people living with HIV; with ongoing commitment and innovations, further gains can be anticipated.”

References:

Edwards JK, et al. Ann Intern Med. 2021;doi:10.7326/M21-0065.

Glesby MJ, Gulick RM. Ann Intern Med. 2021;doi:10.7326/M21-2586.