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<datestamp>2017-12-21</datestamp>
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<title lang=en>Heterogeneity in outcomes of treated HIV-positive patients in Europe and North America: relation with patient and cohort characteristics.</title>
<creator>May, Margaret T</creator>
<creator>Hogg, Robert S</creator>
<creator>Justice, Amy C</creator>
<creator>Shepherd, Bryan E</creator>
<creator>Costagliola, Dominique</creator>
<creator>Ledergerber, Bruno</creator>
<creator>Thiébaut, Rodolphe</creator>
<creator>Gill, M John</creator>
<creator>Kirk, Ole</creator>
<creator>Van Sighem, Ard</creator>
<creator>Saag, Michael S</creator>
<creator>Navarro, Gemma</creator>
<creator>Sobrino-Vegas, Paz</creator>
<creator>Lampe, Fiona</creator>
<creator>Ingle, Suzanne</creator>
<creator>Guest, Jodie L</creator>
<creator>Crane, Heidi M</creator>
<creator>D'Arminio Monforte, Antonella</creator>
<creator>Vehreschild, Jörg J</creator>
<creator>Sterne, Jonathan A C</creator>
<creator>Michelet, Christian</creator>
<contributor>Epidémiologie, stratégies thérapeutiques et virologie cliniques dans l'infection à VIH ; Université Pierre et Marie Curie - Paris 6 (UPMC) - Institut National de la Santé et de la Recherche Médicale (INSERM)</contributor>
<contributor>Epidémiologie et Biostatistique [Bordeaux] ; Université Bordeaux Segalen - Bordeaux 2 - Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED) - Institut National de la Santé et de la Recherche Médicale (INSERM)</contributor>
<contributor>Population Sciences ; University College of London [London] (UCL)</contributor>
<contributor>Institut de recherche, santé, environnement et travail [Rennes] (Irset) ; Université d'Angers (UA) - Université des Antilles et de la Guyane (UAG) - Université de Rennes 1 (UR1) - École des Hautes Études en Santé Publique [EHESP] (EHESP) - Institut National de la Santé et de la Recherche Médicale (INSERM) - Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )</contributor>
<description>International audience</description>
<source>ISSN: 0300-5771</source>
<source>EISSN: 1464-3685</source>
<source>International Journal of Epidemiology</source>
<publisher>Oxford University Press (OUP)</publisher>
<identifier>hal-00875138</identifier>
<identifier>https://hal.archives-ouvertes.fr/hal-00875138</identifier>
<source>https://hal.archives-ouvertes.fr/hal-00875138</source>
<source>International Journal of Epidemiology, Oxford University Press (OUP), 2012, 41 (6), pp.1807-20. 〈10.1093/ije/dys164〉</source>
<identifier>DOI : 10.1093/ije/dys164</identifier>
<relation>info:eu-repo/semantics/altIdentifier/doi/10.1093/ije/dys164</relation>
<identifier>PUBMED : 23148105</identifier>
<relation>info:eu-repo/semantics/altIdentifier/pmid/23148105</relation>
<language>en</language>
<subject lang=en>HIV</subject>
<subject lang=en>AIDS</subject>
<subject lang=en>antiretroviral therapy</subject>
<subject lang=en>mortality</subject>
<subject lang=en>cohort</subject>
<subject lang=en>heterogeneity</subject>
<subject lang=en>prognostic model</subject>
<subject lang=en>socio-economic status</subject>
<subject>[SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases</subject>
<type>info:eu-repo/semantics/article</type>
<type>Journal articles</type>
<description lang=en>BACKGROUND: HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. METHODS: We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. RESULTS: During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. CONCLUSIONS: Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk.</description>
<contributor>Antiretroviral Therapy Cohort Collaboration (ART-CC)</contributor>
<date>2012-12</date>
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