Background Mortality among adults with human immunodeficiency virus (HIV) remains elevated over those 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 those for 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), the 5-year mortality among adults with HIV was 7.9% (95% confidence interval [CI]: 7.6%–8.2%) higher than expected 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% (95% CI: 2.0%–3.3%) under observed treatment patterns and 2.1% (.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.

中文翻译：

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接受人类免疫缺陷病毒治疗的成人在普遍早期治疗下的五年死亡率与美国普通人群的比较

背景 感染人类免疫缺陷病毒 (HIV) 的成年人的死亡率仍然高于美国普通人群，即使在进入艾滋病毒治疗后的几年内也是如此。我们探讨如果所有感染艾滋病毒的成年人在进入治疗后 3 个月内开始抗逆转录病毒治疗，5 年死亡率是否会持续上升。方法 在美国北美艾滋病队列合作临床中心接受 HIV 护理的 82 766 名成年人中，我们根据观察到的治疗模式计算了自进入 HIV 护理以来 5 年内的死亡率。然后，我们使用逆概率权重来估计普遍早期治疗下的死亡率。为了将死亡率与一般人群中类似个体的死亡率进行比较，我们使用国家卫生统计中心的数据构建了一个队列，代表与研究参与者的关键特征相匹配的美国人口子集。结果 在整个研究期间（1999-2017），艾滋病毒感染者的 5 年死亡率比基于美国普通人群的预期高出 7.9%（95% 置信区间 [CI]：7.6%-8.2%）。在普遍的早期治疗下，艾滋病毒感染者的死亡率将上升 7.2%（95% CI：5.8%–8.6%）。在最近检查的日历期间（2011-2017），在观察到的治疗模式下，艾滋病毒感染者的死亡率上升了 2.6%（95% CI：2.0%-3.3%），而在观察到的治疗模式下，艾滋病毒感染者的死亡率上升了 2.1%（95% CI：2.0%-4.2%）。在普遍的早期治疗下。结论 扩大早期治疗可能会适度降低但不能消除艾滋病毒感染者死亡率的升高。