AIDS-related and non-AIDS-related mortality in the Asia-Pacific region in the
era of combination antiretroviral treatment
Falster, Kathleen; Choi, Jun Yong; Donovan, Basil; Duncombe, Chris; Mulhall,
Brian; Sowden, David; Zhou, Jialun; Law, Matthew G;

on behalf of the Australian HIV Observational Database, the TREAT Asia HIV
Observational Database

AIDS:
13 November 2009 - Volume 23 - Issue 17 - p 2323-2336
doi: 10.1097/QAD.0b013e328331910c
Epidemiology and Social

Abstract

Objective: Although studies have shown reductions in mortality from AIDS after
the introduction of combination antiretroviral treatment (cART), little is known
about cause-specific mortality in low-income settings in the cART era. We
explored predictors of AIDS and non-AIDS mortality and compared cause-specific
mortality across high-income and low-income settings in the Asia-Pacific region.

Methods: We followed patients in the Asia Pacific HIV Observational Database
from the date they started cART (or cohort enrolment if cART initiation was
identified retrospectively), until the date of death or last follow-up visit.
Competing risks methods were used to estimate the cumulative incidence, and to
investigate predictors, of AIDS and non-AIDS mortality.

Results: Of 4252 patients, 215 died; 89 from AIDS, 97 from non-AIDS causes and
29 from unknown causes. Age more than 50 years [hazard ratio 4.29; 95%
confidence interval (CI) 2.10-8.79] and CD4 cell counts less than or equal to
100 cells/μl (hazard ratio 8.59; 95% CI 5.66-13.03) were associated with an
increased risk of non-AIDS mortality.

Risk factors for AIDS mortality included CD4 cell counts less than or equal to
100 cells/μl (hazard ratio 34.97; 95% CI 18.01-67.90) and HIV RNA 10 001 or
more (hazard ratio 4.21; 95% CI 2.07-8.55).

There was some indication of a lower risk of non-AIDS mortality in Asian
high-income, and possibly low-income, countries compared to Australia .

Conclusion: Immune deficiency is associated with an increased risk of AIDS and
non-AIDS mortality. Older age predicts non-AIDS mortality in the cART era.

Less conclusive was the association between country-income level and
cause-specific mortality because of the relatively high proportion of unknown
causes of death in low-income settings.