All-cause mortality in HIV-positive adults starting combination antiretroviral therapy: Correcting for loss to follow-up

Nanina Anderegg, Leigh F. Johnson, Elizabeth Zaniewski, Keri N. Althoff, Eric Balestre, Matthew Law, Denis Nash, Bryan E. Shepherd, Constantin T. Yiannoutsos, Matthias Egger

Research output: Research - peer-reviewArticle

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Abstract

Objective: To estimate mortality in HIV-positive patients starting combination antiretroviral therapy (ART) and to discuss different approaches to calculating correction factors to account for loss to follow-up. Methods: A total of 222 096 adult HIV-positive patients who started ART 2009-2014 in clinics participating in the International epidemiology Databases to Evaluate AIDS collaboration in 43 countries in sub-Saharan Africa, Asia Pacific, Latin America, and North America were included. To allow for underascertainment of deaths due to loss to follow-up, two correction factors (one for the period 0-6 months on ART and one for later periods) or 168 correction factors (combinations of two sexes, three time periods after ART initiation, four age groups, and seven CD4 + groups) based on tracing patients lost in Kenya and data linkages in South Africa were applied. Corrected mortality rates were compared with a worst case scenario assuming all patients lost to follow-up had died. Results: Loss to follow-up differed between regions; rates were lowest in central Africa and highest in east Africa. Compared with using two correction factors (1.64 for the initial ART period and 2.19 for later), applying 168 correction factors (range 1.03-4.75) more often resulted in implausible mortality rates that exceeded the worst case scenario. Corrected mortality rates varied widely, ranging from 0.2 per 100 person-years to 54 per 100 person-years depending on region and covariates. Conclusion: Implausible rates were less common with the simpler approach based on two correction factors. The corrected mortality rates will be useful to international agencies, national programmes, and modellers.

LanguageEnglish (US)
PagesS31-S40
JournalAIDS
Volume31
DOIs
StatePublished - Apr 1 2017

Fingerprint

HIV
Mortality
Therapeutics
International Agencies
Central Africa
Eastern Africa
Latin America
Africa South of the Sahara
Information Storage and Retrieval
Kenya
Lost to Follow-Up
North America
South Africa
Acquired Immunodeficiency Syndrome
Epidemiology
Age Groups
Databases

Keywords

  • antiretroviral therapy
  • Asia Pacific
  • bias
  • HIV infection
  • Latin America
  • loss to follow-up
  • mortality
  • North America
  • Spectrum projection software
  • sub-Saharan Africa

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Anderegg, N., Johnson, L. F., Zaniewski, E., Althoff, K. N., Balestre, E., Law, M., ... Egger, M. (2017). All-cause mortality in HIV-positive adults starting combination antiretroviral therapy: Correcting for loss to follow-up. AIDS, 31, S31-S40. DOI: 10.1097/QAD.0000000000001321

All-cause mortality in HIV-positive adults starting combination antiretroviral therapy : Correcting for loss to follow-up. / Anderegg, Nanina; Johnson, Leigh F.; Zaniewski, Elizabeth; Althoff, Keri N.; Balestre, Eric; Law, Matthew; Nash, Denis; Shepherd, Bryan E.; Yiannoutsos, Constantin T.; Egger, Matthias.

In: AIDS, Vol. 31, 01.04.2017, p. S31-S40.

Research output: Research - peer-reviewArticle

Anderegg, N, Johnson, LF, Zaniewski, E, Althoff, KN, Balestre, E, Law, M, Nash, D, Shepherd, BE, Yiannoutsos, CT & Egger, M 2017, 'All-cause mortality in HIV-positive adults starting combination antiretroviral therapy: Correcting for loss to follow-up' AIDS, vol 31, pp. S31-S40. DOI: 10.1097/QAD.0000000000001321
Anderegg N, Johnson LF, Zaniewski E, Althoff KN, Balestre E, Law M et al. All-cause mortality in HIV-positive adults starting combination antiretroviral therapy: Correcting for loss to follow-up. AIDS. 2017 Apr 1;31:S31-S40. Available from, DOI: 10.1097/QAD.0000000000001321
Anderegg, Nanina ; Johnson, Leigh F. ; Zaniewski, Elizabeth ; Althoff, Keri N. ; Balestre, Eric ; Law, Matthew ; Nash, Denis ; Shepherd, Bryan E. ; Yiannoutsos, Constantin T. ; Egger, Matthias. / All-cause mortality in HIV-positive adults starting combination antiretroviral therapy : Correcting for loss to follow-up. In: AIDS. 2017 ; Vol. 31. pp. S31-S40
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