Clinical research studyEstimating the proportion of patients infected with HIV who will die of comorbid diseases
Section snippets
Methods
We simulated cohorts of 10 000 antiretroviral-naïve patients who were newly diagnosed with chronic HIV infections. For the vast majority of analyses, each hypothetical cohort consisted of identical patients who were initially equivalent with respect to a particular combination of baseline characteristics (age, CD4 count, and viral load). For the particular analysis in which we estimated causes of non-HIV-related deaths, we simulated a hypothetical cohort with characteristics similar to those of
Calibration and validation of simulation
The computer simulation closely replicated Kaplan-Meier curves depicting the duration of combination therapy for antiretroviral-naïve patients in a large cohort of HIV-infected patients, demonstrating that the simulation was well calibrated (Figure 2, A–C). It was also able to approximate the survival curve for this cohort (Figure 2, D).
When 3-year mortality estimates for each of 20 possible combinations of baseline age, CD4 count, and viral load strata were compared with corresponding data
Discussion
HIV is increasingly a disease that people die with rather than a disease that people die from. The results of our simulation suggest that a substantial proportion of deaths among HIV-infected patients in the current treatment era will not be directly attributable to HIV. Indeed, for many of the groups examined, the simulation estimates that a majority of deaths will be from nonattributable causes. If the age, CD4 count, and viral load distributions of antiretroviral-naïve patients entering the
Acknowledgment
The authors thank Andrea Casas for editing, proofreading, and preparing the manuscript.
References (42)
- et al.
Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy
Am J Med
(2002) - et al.
Prognosis of HIV-1-infected patients starting highly active antiretroviral therapya collaborative analysis of prospective studies
Lancet
(2002) - et al.
Clinical progression and virological failure on highly active antiretroviral therapy in HIV-1 patients: a prospective cohort study. Swiss HIV Cohort Study
Lancet
(1999) - et al.
Specialty training and specialization among physicians who treat HIV/AIDS in the United States
J Gen Intern Med
(2002) - et al.
Optimizing care for persons with HIV infection
Ann Intern Med
(1999) - et al.
Primary care for patients infected with human immunodeficiency virusa randomized controlled trial
J Gen Intern Med
(2001) - et al.
Relation of physician specialty and HIV/AIDS experience to choice of guideline-recommended antiretroviral therapy
J Gen Intern Med
(2001) - et al.
Physician experience in the care of HIV-infected persons is associated with earlier adoption of new antiretroviral therapy
J Acquir Immune Defic Syndr
(2000) - et al.
Combining specialist and primary health care teams for HIV positive patientsretrospective and prospective studies
BMJ
(1996) - et al.
Ability of primary care physicians to recognize physical findings associated with HIV infection
JAMA
(1995)
Physicians’ ability to provide initial primary care to an HIV-infected patient
Arch Intern Med
Long-term HIV/AIDS survival estimation in the Highly-Active Antiretroviral Therapy era
Med Decis Making
Cost-effectiveness implications of the timing of antiretroviral therapy in HIV-infected adults
Arch Intern Med
Cost-effectiveness of earlier initiation of antiretroviral therapy for uninsured HIV-infected adults
Am J Public Health
Use of genotypic resistance testing to guide HIV therapyclinical impact and cost-effectiveness
Ann Intern Med
Treatment for primary HIV infectionprojecting outcomes of immediate, interrupted, or delayed therapy
J Acquir Immune Defic Syndr
The cost-effectiveness of preventing AIDS-related opportunistic infections
JAMA
The cost effectiveness of combination antiretroviral therapy for HIV disease
N Engl J Med
Durability of HIV-1 viral suppression over 3.3 years with multi-drug antiretroviral therapy in previously drug-naive individuals
AIDS
Incidence and predictors of virologic failure of antiretroviral triple-drug therapy in a community-based cohort
AIDS Res Hum Retroviruses
Adherence to protease inhibitor therapy and outcomes in patients with HIV infection
Ann Intern Med
Cited by (0)
This work was funded by National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health grants #1 K23 AA14483-01 and #UO1 AA13566-01, and National Library of Medicine grant #T15-LM07092-09.