(P6) Survival of people living with HIV in Central Denmark Region during the pre-, early- and late HAART era
Niels A. Jespersen1, Anne G. Ording2, Flemming Axelsen3, Jens Dollerup4, Mette Nørgaard2, Carsten S. Larsen1
1Dept. of Infectious Diseases, Aarhus University Hospital, 2Dept. of Clinical Epidemiology, Aarhus University, 3Gilead Sciences Denmark, 4DMC Medical
Highly active antiretroviral therapy (HAART) has transformed HIV infection into a chronical medical condition. Still, people living with HIV (PLHIV) have a reduced life expectancy. The aim of this study was to evaluate the improvement in survival after introduction of HAART by estimating mortality in the pre- (1985-1995), early- (1996-2005) and late (2006-2017) HAART era.
The study population consisted of all HIV infected residents of the Central Denmark Region during 1985-2017, who were at least 18 years old at time of diagnosis and had at least one contact with one of the two HIV-centers in the region. Using the Danish Civil Registration System (DCS), each HIV patient was matched by age, sex and municipality of residence with ten random comparisons from the background population. Information about vital status and Charlson comorbidity index (CCI) were obtained from the DCS and the Danish National Patient Registry (DNPR), respectively. The Kaplan-Meier method was used to construct survival curves for HIV patients and their matched comparators. To compare survival between PLHIV and their population comparisons, we computed hazard ratios for death within up to 10 years of follow-up.
The study included 1,062 PLHIV and 10,620 matched comparisons. 30.8%, 30.9% and 38.3% were diagnosed in the period 1985-1996, 1996-2005 and 2006-2017, respectively. The median age of HIV-patients was 36.6 years (IQR 29.4-45.4) and 19.7% were over 50 years old at HIV-diagnosis, with no major changes over time. Of the PLHIV- and their comparisons 4.7% and 3.5% had a CCI score of one, respectively, and 4.0% and 2.3% had a CCI score of two or more, respectively. In general, HIV patients had a shorter education, lower income and more were unemployed. Overall 10-year survival was 76% for HIV-patients versus 97 % for the background population, but considerable improved over time (Fig 1 a-c). In the pre-, early- and late HAART era survival after the first year after diagnosis was 77.1%, 94.5% and 98.3% and 52.3%, 85.1% and 93.9% after 10 years follow-up (Fig 1 a-c, Table 1). For PLHIV with a CCI score = 2+, the 10-year survival was 63% versus 75% for comparisons, whereas for those with no comorbidity, similar proportions were 77% versus 98% respectively.
The survival of PLHIV have increased dramatically from the pre- to the late HAART era. However, PLHIV still have an increased risk of death compared with the general population. At the time of diagnosis, PLHIV had almost 50% higher prevalence of comorbid diseases according to the CCI score. Not surprisingly, comorbidity was associated with an increased mortality.