Population Health Sciences, University of Bristol, Bristol, UK.
Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, Connecticut, USA.
J Int AIDS Soc. 2024 Nov;27(11):e26384. doi: 10.1002/jia2.26384.
Identifying strategies to further reduce AIDS-related mortality requires accurate estimates of the extent to which mortality among people living with HIV (PLHIV) is due to AIDS-related or non-AIDS-related causes. Existing approaches to estimating AIDS-related mortality have quantified AIDS-related mortality as total mortality among PLHIV in excess of age- and sex-matched mortality in populations without HIV. However, recent evidence suggests that, with high antiretroviral therapy (ART) coverage, a growing proportion of excess mortality among PLHIV is non-AIDS-related.
We searched Embase on 22/09/2023 for English language studies that contained data on AIDS-related mortality rates among adult PLHIV and age-matched comparator all-cause mortality rates among people without HIV. We extracted data on the number and rates of all-cause and AIDS-related deaths, demographics, ART use and AIDS-related mortality definitions. We calculated the proportion of excess mortality among PLHIV that is AIDS-related. The proportion of excess mortality due to AIDS was pooled using random-effects meta-analysis.
Of 4485 studies identified by the initial search, eight were eligible, all from high-income settings: five from Europe, one from Canada, one from Japan and one from South Korea. No studies reported on mortality among only untreated PLHIV. One study included only PLHIV on ART. In all studies, most PLHIV were on ART by the end of follow-up. Overall, 1,331,742 person-years and 17,471 deaths were included from PLHIV, a mortality rate of 13.1 per 1000 person-years. Of these deaths, 7721 (44%) were AIDS-related, an overall AIDS-related mortality rate of 5.8 per 1000 person-years. The mean overall mortality rate among the general population was 2.8 (95% CI: 1.8-4.0) per 1000 person-years. The meta-analysed percentage of excess mortality that was AIDS-related was 53% (95% CI: 45-61%); 52% (43-60%) in Western and Central Europe and North America, and 71% (69-74%) in the Asia-Pacific region.
Although we searched all regions, we only found eligible studies from high-income countries, mostly European, so, the generalizability of these results to other regions and epidemic settings is unknown.
Around half of the excess mortality among PLHIV in high-income regions was non-AIDS-related. An emphasis on preventing and treating comorbidities linked to non-AIDS mortality among PLHIV is required.
为了进一步降低艾滋病相关死亡率，需要准确估计艾滋病毒感染者（PLHIV）死亡率中有多少是由艾滋病相关或非艾滋病相关原因造成的。现有方法通过计算 PLHIV 中超出年龄和性别匹配的 HIV 阴性人群死亡率的总死亡率来量化艾滋病相关死亡率。然而，最近的证据表明，随着高效抗逆转录病毒治疗（ART）的广泛应用，PLHIV 中死亡人数的增长越来越多是与艾滋病无关的原因。
我们于 2023 年 9 月 22 日在 Embase 上搜索了有关成人 PLHIV 的艾滋病相关死亡率和 HIV 阴性人群中年龄匹配的全因死亡率的英文文献。我们提取了全因和艾滋病相关死亡人数、人口统计学、ART 使用和艾滋病相关死亡率定义的数据。我们计算了 PLHIV 中与艾滋病相关的超额死亡人数的比例。使用随机效应荟萃分析对 AIDS 导致的超额死亡率比例进行了汇总。
通过初步搜索共确定了 4485 项研究，其中 8 项符合条件，均来自高收入地区：欧洲 5 项、加拿大 1 项、日本 1 项、韩国 1 项。没有研究报告仅针对未经治疗的 PLHIV 的死亡率。一项研究仅包括接受 ART 治疗的 PLHIV。在所有研究中，大多数 PLHIV 在随访结束时都在接受 ART 治疗。总的来说，PLHIV 有 1331742 人年和 17471 人死亡，死亡率为每 1000 人年 13.1 人。这些死亡中有 7721 人（44%）与艾滋病相关，总艾滋病相关死亡率为每 1000 人年 5.8 人。一般人群的平均总死亡率为每 1000 人年 2.8 人（95%CI：1.8-4.0）。荟萃分析的 AIDS 相关超额死亡率百分比为 53%（95%CI：45-61%）；西欧和中欧以及北美为 52%（43-60%），亚太地区为 71%（69-74%）。
尽管我们搜索了所有地区，但仅在高收入国家（主要是欧洲）找到了符合条件的研究，因此，这些结果在其他地区和流行环境中的普遍性尚不清楚。
在高收入地区，PLHIV 中约一半的超额死亡率与艾滋病无关。需要强调预防和治疗与非艾滋病相关死亡率相关的合并症。
