Mortality rates for people entering HIV care compared to the general US population

https://doi.org/10.7326/M21-0065

Commentary

This study examined differences in mortality rates among HIV-infected and uninfected adults, as well as differences in mortality rates when people with HIV enter care in an observational cohort study.

Participants were matched by calendar time, age, gender, race/ethnicity, and county using a subset of the U.S. population, U.S. mortality and population data compiled by the National Center for Health Statistics, with 82,766 adults who participated in HIV clinical care from 1999-2017.

The resulting 5-year mortality rate for patients treated for HIV was 10.6 percent, and the mortality rate for the U.S. population matching this number was 2.9 percent, a difference of 7.7 (95% CI, 7.4 to 7.9) percentage points. This difference was found to have decreased over time from 11.1 percentage points for those who started treatment between 1999 and 2004 to 2.7 percentage points for those who started treatment between 2011 and 2017.

However, the covariate matching that was available may not have accounted for the difference in mortality due to sociodemographic factors rather than as a result of HIV infection or other modifiable factors.

These results indicate that the mortality rate of people on HIV treatment tends to decrease dramatically, but that the risk of death is somewhat higher in the first few years of treatment compared to those who are unaffected.