Survival among people with HIV and their families in Denmark 1995-2021: a nationwide population-based cohort study

Caroline Eves; Lars Haukali Omland; Jan Gerstoft; Gitte Kronborg; Isik Somuncu Johansen; Carsten Schade Larsen; Anders Porskrog; Michael Dalager-Pedersen; Suzanne Lunding; Steffen Leth; Lars Nørregaard Nielsen; Malte Mose Tetens; Niels Obel

doi:10.1016/j.lanepe.2024.100956

Survival among people with HIV and their families in Denmark 1995-2021: a nationwide population-based cohort study

Lancet Reg Health Eur. 2024 Jun 12:43:100956. doi: 10.1016/j.lanepe.2024.100956. eCollection 2024 Aug.

Authors

Caroline Eves¹, Lars Haukali Omland², Jan Gerstoft², Gitte Kronborg³, Isik Somuncu Johansen^{4

5}, Carsten Schade Larsen⁶, Anders Porskrog⁷, Michael Dalager-Pedersen^{8

9}, Suzanne Lunding¹⁰, Steffen Leth^{11

12}, Lars Nørregaard Nielsen¹³, Malte Mose Tetens², Niels Obel^{2

14}

Affiliations

¹ Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen, Denmark.
² Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Esther Møllers Vej 7, 2100, Copenhagen, Denmark.
³ Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre Hospital, Kettegård Allé 30, 2650, Hvidovre, Denmark.
⁴ Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark.
⁵ Research Center of Infectious Diseases, Department of Clinical Research, University of Southern Denmark, Sønder Boulevard 29, 5000, Odense, Denmark.
⁶ Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
⁷ Department of Infectious Diseases, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark.
⁸ Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000, Aalborg, Denmark.
⁹ Department of Clinical Medicine, Aalborg University, Mølleparkvej 4, 9000, Aalborg, Denmark.
¹⁰ Department of Internal Medicine, Herlev University Hospital, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
¹¹ Department of Infectious Diseases & Internal Medicine, Gødstrup Hospital, Hospitalsparken 15, 7400, Herning, Denmark.
¹² Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
¹³ Department of Infectious Diseases, Copenhagen University Hospital, North Zealand Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark.
¹⁴ Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark.

Abstract

Background: Survival among people with HIV (PWH) has vastly improved globally over the last few decades but remains lower than among the general population. We aimed to estimate time trends of survival among PWH and their families from 1995 to 2021.

Methods: We conducted a registry-based, nationwide, population-based, matched cohort study. We included all Danish-born PWH from 1995 to 2021 who had been on antiretroviral therapy for 90 days, did not report intravenous drug use, and were not co-infected with hepatitis C (n = 4168). We matched population controls from the general population 10:1 to PWH by date of birth and sex (n = 41,680). For family cohorts, we identified siblings, mothers, and fathers of PWH and population controls. From Kaplan-Meier tables with age as time scale, we estimated survival from age 25. We compared PWH with population controls and families of PWH with families of population controls to calculate mortality rate ratios adjusted for sex, age, comorbidities, and education (aMRR).

Findings: The median age of death among PWH increased from 27.5 years in 1995-1997 to 73.9 years (2010-2014), but thereafter survival increased only marginally. From 2015 to 2021, mortality was increased among PWH (aMRR 1.87 (95% CI: 1.65-2.11)) and siblings (aMRR: 1.25 (95% CI: 1.07-1.47)), mothers (aMRR: 1.30 (95% CI: 1.17-1.43)), and fathers (aMRR: 1.15 (95% CI: 1.03-1.29)) of PWH compared to their respective control cohorts. Mortality among siblings of PWH who reported heterosexual route of HIV transmission (aMRR: 1.51 (95% CI: 1.16-1.96)) was higher than for siblings of PWH who reported men who have sex with men as route of HIV transmission (aMRR 1.19 (95% CI: 0.98-1.46)).

Interpretation: Survival among PWH improved substantially until 2010, after which it increased only marginally. This may partly be due to social and behavioural factors as PWH families also had higher mortality.

Funding: Preben and Anna Simonsen's Foundation and Independent Research Fund Denmark.

Keywords: Cohort studies; Denmark; HIV; Survival analysis.