OBJECTIVES: Efficacious treatments prevent the immunodeficiency and opportunist infection in PLHIV. However, PLHIV have more frequent other chronic conditions such as cardiovascular diseases, cancer, due to the infection itself or to side effects of antiviral treatments. Moreover, some patients remain untreated because of unknown reasons. The objectives of this study were to estimate the over-mortality of PLHIV and the impact of other conditions on the over-mortality.

METHODS: A French cohort of PLHIV and age and gender matched controls was extracted from the SNDS French claim and hospitalization database between. PLHIV were identified between 2006 and 2019 and followed up until 2019. The incidence of deaths was estimated and compared between both groups. Comorbidities were identified through classical algorithms used in this database (ICD-10 codes, specific drugs or procedures etc.). A cox model was used to estimate the increased risk of deaths. Impact of comorbidities was estimated by adjusting on them.

RESULTS: 173,712 PLHIV and controls were followed up 8 years on average. Mean age at inception was 42 years and 66% were males. Significant increase of death rates was found in PLHIV with a HR of 2.1 (CI95%=[2.0;2.2]). This HR was 1.961 (CI95%=[1.898;2.027]) for men and 2.966 (CI95%=[2.767;3.180]) for women. The HR was higher in young PLHIV: 3.5 [18-30[ years old subjects, 3.7 [30-40[, 2.9 [40-50[, 1.7 [50-60[, 1.5 [60-70[, 1.4 [70-80[. Infectious diseases had the higher impact on the over-mortality: the HR decreased from 2.1 to 1.6 after adjusting on infectious diseases, hence a attributable risk (AR) of 50%). The other conditions were: hepatitis C (AR=30%), psychiatric diseases (AR=16%), hepatitis B (AR=6%), coronary diseases (4%), and phlebitis/pulmonary embolism (4%). Other studied diseases had ARs below 3%.

CONCLUSIONS: HIV infection doubles the risk of deaths and infections explains half of this over-mortality. The over-mortality is higher among women and young patients.