Association between Modifiable and Non-modifiable Risk Factors and Specific Causes of Death in the HAART Era: The Data Collection on Adverse Events of Anti-HIV Drugs Study
Colette Smith and D:A:D Study Group
Univ Coll London Med Sch, UK
mortality remains for HIV+ individuals compared to the general
population. Identifying modifiable risk factors associated with specific causes
of death could guide interventions.
were followed from date of entry into the D:A:D study until death or last
follow-up (through October 1, 2007). Cause of death was ascertained using the
CoDe system. Adjusted rate ratios (RR) for the association between potential
modifiable risk factors (hepatitis C and B virus [HCV, HBV], body mass index,
smoking, hypertension [systolic BP≥140 or diastolic BP≥90 or anti-hypertensive
use], diabetes, ART use, current CD4 count, current HIV RNA [current variables
lagged by 3 months]) and death were obtained with Poisson regression, adjusted
for other potential confounders (sex, race, risk for HIV infection,
calendar year, age, prior cardiovascular disease (CVD) or AIDS).
were 2192 deaths in 33,347 people followed for 158,959 person-years (rate = 1.4/100
person-years). Underlying causes were AIDS (32%), liver-related (14%), non-AIDS
cancers (12%), CVD (11%), and other (31%). Risk factors for overall death were smoking,
low body mass index (<18 kg/m2), hypertension, diabetes, HBV/HCV-co-infection,
low current CD4, and higher HIV RNA (table; for comparison, results for the 2
main demographic variables are also shown) although the strength of
associations of the modifiable risk factors with the cause-specific death rates
varied substantially. Smoking was associated with CVD and
non-AIDS cancers, HBV and HCV co-infection with liver-related deaths, and hypertension
with liver-related and CVD deaths. Diabetes was a risk factor for all specific
causes of death except non-AIDS cancers, and higher current HIV RNA for
AIDS-related and liver-related deaths. Lower CD4 counts were associated with a
higher risk of death from all specific causes of death.
Multiple potentially modifiable risk factors for deaths in HIV-infected
persons were identified. These factors must be addressed to further reduce
mortality. Maintaining higher CD4 cell counts is likely to have the broadest
effect on decrease in deaths.