A tale of two countries: all-cause mortality among people living with HIV and receiving combination antiretroviral therapy in the UK and Canada

the Canadian Observational Cohort (CANOC) - UK Collaborative HIV Cohort (UK CHIC) Collaboration

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2 Citations (Scopus)

Abstract

Objectives: We sought to compare all-cause mortality of people living with HIV and accessing care in Canada and the UK. Methods: Individuals from the Canadian Observational Cohort (CANOC) collaboration and UK Collaborative HIV Cohort (UK CHIC) study who were aged ≥ 18 years, had initiated antiretroviral therapy (ART) for the first time between 2000 and 2012 and who had acquired HIV through sexual transmission were included in the analysis. Cox regression was used to investigate the difference in mortality risk between the two cohort collaborations, accounting for loss to follow-up as a competing risk. Results: A total of 19 960 participants were included in the analysis (CANOC, 4137; UK CHIC, 15 823). CANOC participants were more likely to be older [median age 39 years (interquartile range (IQR): 33, 46 years) vs. 36 years (IQR: 31, 43 years) for UK CHIC participants], to be male (86 vs. 73%, respectively), and to report men who have sex with men (MSM) sexual transmission risk (72 vs. 56%, respectively) (all P < 0.001). Overall, 762 deaths occurred during 98 798 person-years (PY) of follow-up, giving a crude mortality rate of 7.7 per 1000 PY [95% confidence interval (CI): 7.1, 8.3 per 1000 PY]. The crude mortality rates were 8.6 (95% CI: 7.4, 10.0) and 7.5 (95% CI: 6.9, 8.1) per 1000 PY among CANOC and UK CHIC study participants, respectively. No statistically significant difference in mortality risk was observed between the cohort collaborations in Cox regression accounting for loss to follow-up as a competing risk (adjusted hazard ratio 0.86; 95% CI: 0.72–1.03). Conclusions: Despite differences in national HIV care provision and treatment guidelines, mortality risk did not differ between CANOC and UK CHIC study participants who acquired HIV through sexual transmission.

Original languageEnglish
Pages (from-to)655-666
Number of pages12
JournalHIV Medicine
Volume18
Issue number9
DOIs
Publication statusPublished - Oct 2017

Bibliographical note

Funding Information:
We would like to thank all study participants in the CANOC-UK CHIC collaboration, and the physicians, nurses, social workers and volunteers who support them. We would also like to thank Keith Chan for his work on an early version of this analysis Funding: CANOC is funded by the Canadian Institutes of Health Research (CIHR) through a Centres Grant [Centres for HIV/AIDS Population Health and Health Services Research (CIHR 711314)] and two Operating Grants (HIV/AIDS Priority Announcement (CIHR 711310); Population and Public Health (CIHR 711319)], and is also supported by the CIHR Canadian HIV Trials Network (CTN 242). The UK CHIC study is funded by the Medical Research Council (MRC) UK (grant numbers G0000199, G0600337, G0900274 and M004236). The views expressed in this paper are those of the researchers and not necessarily those of the MRC. ANB is supported by a CIHR New Investigator Award. AC is supported by a Canadian Medical Hall of Fame (CMHF) Award for Medical Students. CC is supported through an Applied HIV Research Chair from the OHTN. RSH is supported by a University Professorship at Simon Fraser University. MBK is supported by a Chercheur-National Career Award from the Fonds de recherche Sant?-Qu?bec (FRQ-S). MRL receives salary support from CIHR. JSGM is supported by the British Columbia Ministry of Health and through an Avant-Garde Award (DP1-DA026182) from the National Institute of Drug Abuse (NIDA), at the US National Institutes of Health (NIH). He has also received financial support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institutes of Health Research?Office of AIDS Research, National Institute of Allergy & Infectious Diseases, The United States President's Emergency Plan for AIDS Relief (PEPfAR), UNICEF, the University of British Columbia, Simon Fraser University, Providence Health Care and Vancouver Coastal Health Authority. SP is supported by a Study Abroad Studentship from the Leverhulme Trust. JR is supported through an OHTN Chair in Biostatistics. HS is supported by a Michael Smith Foundation Postdoctoral Fellowship Award. SJ is supported through an MRC UK grant and has received speaker's fees from Gilead Sciences.

Publisher Copyright:
© 2017 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.

Keywords

  • AIDS
  • Canada
  • HIV
  • UK
  • antiretroviral therapy
  • mortality

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