Trends in Cause-Specific Mortality among Veterans with HIV: A 35-Year (1982–2016) Analysis of the HIV Atlanta VA Cohort Study

• Authors: Kartavya J Vyas, Emory University; Vincent Marconi, Emory University; Abeer Moanna, Emory University; David Rimland, Emory University; Jodie L. Guest, Emory University
• Journal Title: Journal of Acquired Immune Deficiency Syndromes
• Volume: Volume 92, Number 1
• Publisher: Wolters Kluwer Health, Inc. | 2023-01-01, Pages 17-26
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/QAI.0000000000003107
• Subjects: Health Sciences, Epidemiology; Health Sciences, General
• Keywords: HIV; Veterans; cause-specific mortality; antiretroviral therapy; epidemiology

Abstract

Background: Causes of death and their trends among Veterans with HIV (VWH) are different than those in the general population with HIV, but this has not been fully described. The objective was to understand the trends in, and risk factors for, all-cause and cause-specific mortality across eras of combination antiretroviral therapy (cART) among VWH. Setting: The HIV Atlanta VA Cohort Study (HAVACS) includes all VWH who ever sought care at the Atlanta VA Medical Center. Methods: Age-adjusted all-cause and cause-specific mortality rates were calculated annually and compared between pre- (1982–1996), early- (1997–2006), and late-cART (2007–2016) eras. Trends were assessed using Kaplan-Meier curves, cumulative incidence functions, and join-point regression models. Risk factors were identified by Cox proportional hazards models. Results: Of the 4,674 VWH in HAVACS, 1,752 died; of whom, 1,399 (79.9%), 301 (17.2%), and 52 (3.0%) were diagnosed with HIV in the pre-, early-, and late-cART eras, respectively. Significant increases were observed in rates of all-cause, AIDS-related, and non-AIDS-related mortality in the pre-cART era, followed by declines in the early- and late-cART eras. All-cause, AIDS-related, and non-AIDS-related mortality rates plummeted by 65%, 81%, and 45%, respectively, from the pre- to late-cART eras. However, VWH continue to die at higher rates due to AIDS-related infections, non-AIDS-related malignancies, respiratory disease, cardiovascular disease, and renal failure than those in the general population with HIV. Conclusions: In older populations with HIV, it is important that providers not only monitor for and treat diseases associated with aging, but also intervene and address lifestyle risk factors.