Non-AIDS defining cancers in the D:A:D Study - time trends and predictors of survival : A cohort study

Background: Non-AIDS defining cancers (NADC) are an important cause of morbidity and mortality in HIV-positive individuals. Using data from a large international cohort of HIV-positive individuals, we described the incidence of NADC from 2004-2010, and described subsequent mortality and predictors of these.Methods: Individuals were followed from 1st January 2004/enrolment in study, until the earliest of a new NADC, 1st February 2010, death or six months after the patient's last visit. Incidence rates were estimated for each year of follow-up, overall and stratified by gender, age and mode of HIV acquisition. Cumulative risk of mortality following NADC diagnosis was summarised using Kaplan-Meier methods, with follow-up for these analyses from the date of NADC diagnosis until the patient's death, 1st February 2010 or 6 months after the patient's last visit. Factors associated with mortality following NADC diagnosis were identified using multivariable Cox proportional hazards regression.Results: Over 176,775 person-years (PY), 880 (2.1%) patients developed a new NADC (incidence: 4.98/1000PY [95% confidence interval 4.65, 5.31]). Over a third of these patients (327, 37.2%) had died by 1st February 2010. Time trends for lung cancer, anal cancer and Hodgkin's lymphoma were broadly consistent. Kaplan-Meier cumulative mortality estimates at 1, 3 and 5 years after NADC diagnosis were 28.2% [95% CI 25.1-31.2], 42.0% [38.2-45.8] and 47.3% [42.4-52.2], respectively. Significant predictors of poorer survival after diagnosis of NADC were lung cancer (compared to other cancer types), male gender, non-white ethnicity, and smoking status. Later year of diagnosis and higher CD4 count at NADC diagnosis were associated with improved survival. The incidence of NADC remained stable over the period 2004-2010 in this large observational cohort.Conclusions: The prognosis after diagnosis of NADC, in particular lung cancer and disseminated cancer, is poor but has improved somewhat over time. Modifiable risk factors, such as smoking and low CD4 counts, were associated with mortality following a diagnosis of NADC. © 2013 Worm et al.; licensee BioMed Central Ltd

Relationship between land-use in the agro-forestry system of les Landes, nitrogen loading to and risk of macro-algal blooming in the Bassin d`Arcachon coastal lagoon (SW France)

[Departement_IRSTEA]GT [Departement_IRSTEA]MA [TR1_IRSTEA]RURAMEN / CERES [TR2_IRSTEA]QSA / DYNAQInternational audienceNitrogen loading to the Bassin d`Arcachon coastal lagoon (SW France) was evaluated by studying land-use and nitrogen output in its 3001 km2 catchment. At present, the catchment is dominated by forestry (79%), while intensive agriculture occupies 9% of the surface. The N-output of two hydrological subunits, i.e. the Tagon subunit dominated by pine forestry and the Arriou II subunit comprising both forestry and intensive agriculture, were monitored for a seven year period (1996-2002). From these observations it was calculated that forestry contributes on average 1.6 kg total N ha-1 yr-1, which is dominated by organic nitrogen (DONCPON are 70% of N). On an areal basis, intensive agriculture contributes 26 times more than forestry, i.e. 41.6 kg total N ha-1 yr-1, which is mainly in the form of nitrate (65% of N). These data were upscaled to the catchment and the upscaling was validated by comparison to gauged nitrogen throughputs for the catchment of the Leyre river that is the major tributary to the system. Taking into account the other known N sources and the interannual variability in the catchment it was estimated that nitrogen loading to the lagoon was on average 90 kg ha-1 yr-1 (range from 54 to 126 kg ha-1 yr-1). The sandy soils of the catchment have a clear potential for denitrification, but anoxic conditions (waterlogged) and input of organic matter to fuel this process are required. Currently, agricultural practices and spatial planning do not make use of this potential. Nitrogen loading in the Bassin d`Arcachon is reflected by 10-40 µM nitrate concentrations in winter, which became depleted during spring as a result of uptake by vegetation. Short-term uptake experiments showed that the macroalga Monostroma obscurum is well adapted to temperatures between 10 to 20°C and competitive with respect to the seagrass Zostera noltii when the nitrate concentrations are above 10 µM. Spring conditions with high nitrate and high insolation are therefore favourable for M. obscurum and this species presents a high risk for algal blooming. In contrast, the macroalga Enteromorpha clathrata well adapted to summertime temperatures around 25°C, forms occasionally blooms in the lagoon. This phenomenon is limited due to the low DIN concentrations in summer

Trends in Mortality in People With HIV From 1999 through 2020: A Multicohort Collaboration: A Multicohort Collaboration

Background: Mortality among people with human immunodeficiency virus (HIV) declined with the introduction of combination antiretroviral therapy. We investigated trends in mortality in people with HIV from 1999 through 2020. Methods: Data were collected from the Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) cohort between January 1999 through January 2015 and the International Cohort Consortium of Infectious Disease (RESPOND) from October 2017 through December 2020. Age-standardized all-cause and cause-specific mortality rates, classified using Coding Causes of Death in HIV, were calculated. Poisson models were used to assess mortality over time. Results: Among 55 716 participants followed for median 6 years (interquartile range, 3-11), 5263 died (mortality rate [MR], 13.7/1000 person-years of follow-up [PYFU]; 95% confidence interval [CI], 13.4-14.1). Changing mortality was observed: AIDS mortality was most common between 1999-2009 (n = 952; MR, 4.2/1000 PYFU; 95% CI, 4.0-4.5) and non-AIDS-defining malignancy (NADM) between 2010-2020 (n = 444; MR, 2.8/1000 PYFU; 95% CI, 2.5-3.1). In multivariable analysis, all-cause mortality declined (adjusted mortality rate ratio [aMRR], 0.97 per year; 95% CI,. 96-.98), mostly 1999-2010 (aMRR, 0.96 per year; 95% CI,. 95-.97) but was stable 2011-2020 (aMRR, 1.00 per year; 95% CI,. 96-1.05). Mortality due to all known causes except NADM also declined. Conclusions: Mortality among people with HIV in the D:A:D and/or RESPOND cohorts declined between 1999-2009 and was stable over the period 2010-2020. This decline in mortality was not fully explained by improvements in immunologic-virologic status or other risk factors

Trends in Mortality in People With HIV From 1999 through 2020: A Multicohort Collaboration

Background: Mortality among people with human immunodeficiency virus (HIV) declined with the introduction of combination antiretroviral therapy. We investigated trends in mortality in people with HIV from 1999 through 2020. Methods: Data were collected from the Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) cohort between January 1999 through January 2015 and the International Cohort Consortium of Infectious Disease (RESPOND) from October 2017 through December 2020. Age-standardized all-cause and cause-specific mortality rates, classified using Coding Causes of Death in HIV, were calculated. Poisson models were used to assess mortality over time. Results: Among 55 716 participants followed for median 6 years (interquartile range, 3-11), 5263 died (mortality rate [MR], 13.7/1000 person-years of follow-up [PYFU]; 95% confidence interval [CI], 13.4-14.1). Changing mortality was observed: AIDS mortality was most common between 1999-2009 (n = 952; MR, 4.2/1000 PYFU; 95% CI, 4.0-4.5) and non-AIDS-defining malignancy (NADM) between 2010-2020 (n = 444; MR, 2.8/1000 PYFU; 95% CI, 2.5-3.1). In multivariable analysis, all-cause mortality declined (adjusted mortality rate ratio [aMRR], 0.97 per year; 95% CI,. 96-.98), mostly 1999-2010 (aMRR, 0.96 per year; 95% CI,. 95-.97) but was stable 2011-2020 (aMRR, 1.00 per year; 95% CI,. 96-1.05). Mortality due to all known causes except NADM also declined. Conclusions: Mortality among people with HIV in the D:A:D and/or RESPOND cohorts declined between 1999-2009 and was stable over the period 2010-2020. This decline in mortality was not fully explained by improvements in immunologic-virologic status or other risk factors