Mortality for adults entering HIV care under universal early treatment compared to the general US population

Abstract

Abstract Background Mortality among adults with HIV remains elevated over mortality in the US general population even in the years after entry into HIV care. We explore whether the elevation in 5-year mortality would have persisted if all adults with HIV had initiated antiretroviral therapy within 3 months of entering care. Methods Among 82,766 adults entering HIV care at North American AIDS Cohort Collaboration clinical sites in the United States, we computed mortality over 5 years since entry into HIV care under observed treatment patterns. We then used inverse probability weights to estimate mortality under universal early treatment. To compare mortality with similar individuals in the general population, we used National Center for Health Statistics data to construct a cohort representing the subset of the US population matched to study participants on key characteristics. Results For the entire study period (1999 – 2017), 5-year mortality among adults with HIV was 7.9 percentage points (95% confidence interval (CI): 7.6, 8.2) higher than the expected mortality based on the US general population. Under universal early treatment, the elevation in mortality for people with HIV would have been 7.2% (95% CI: 5.8, 8.6). In the most recent calendar period examined (2011-2017), the elevation in mortality for people with HIV was 2.6 percentage points (95% CI: 2.0, 3.3) under observed treatment patterns and 2.1 percentage points (95% CI: 0.0, 4.2) under universal early treatment. Conclusions Expanding early treatment may modestly reduce, but not eliminate, the elevation in mortality for people with HIV.