Rimke BijkerSasisopin KiertiburanakulNagalingeswaran KumarasamySanjay PujariLy P. SunOon T. NgMan P. LeeJun Y. ChoiKinh V. NguyenYu J. ChanTuti P. MeratiDo D. CuongJeremy RossAwachana JiamsakulVHS Medical Centre IndiaBach Mai HospitalUniversitas UdayanaThe Kirby InstituteYonsei University College of MedicineFaculty of Medicine Ramathibodi Hospital, Mahidol UniversityQueen Elizabeth Hospital Hong KongVeterans General Hospital-TaipeiTan Tock Seng HospitalUniversity of Health SciencesNational Hospital for Tropical DiseasesamfAR - The Foundation for AIDS ResearchInstitute of Infectious Diseases2022-08-042022-08-042021-01-01Antiviral Therapy. Vol.25, No.3 (2021), 131-14220402058135965352-s2.0-85098463524https://repository.li.mahidol.ac.th/handle/20.500.14594/78868Background: This study investigated survival in people living with HIV being followed-up from 5 and 10 years after antiretroviral therapy (ART) initiation in a multi-country Asian cohort. Methods: We included patients in follow-up >5 years after ART initiation. Factors associated with mortality beyond 5 and 10 years on ART were analysed using competing risk regression with time-updated variables. Results: Of 13,495 patients retained after 5 years on ART, 279 subsequently died (0.56/100 person-years). Increased mortality was associated with age >50 years (sub-hazard ratio [sHR] 2.24, 95% CI 1.58, 3.15, compared with ≤40 years), HIV exposure through injecting drug use (sHR 2.17, 95% CI 1.32, 3.56), HIV viral load ≥1,000 copies/ml: sHR 1.52, 95% CI 1.05, 2.21, compared with <400), regimen (second-line regimen: sHR 2.11, 95% CI 1.52, 2.94, and third-line regimen: sHR 2.82, 95% CI 2.00, 3.98, compared with first-line regimen), HBV coinfection (sHR 2.23, 95% CI 1.49, 3.33), fasting plasma glucose ≥126 mg/dl (sHR 1.98, 95% CI 1.22, 3.21, compared with <100 mg/dl) and estimated glomerular filtration rate <60 ml/min/1.73 m2 (sHR 2.57, 95% CI 1.56, 4.22). Decreased mortality was associated with transmission through male-to-male sexual contact (sHR 0.44, 95% CI 0.22, 0.88, compared with heterosexual transmission) and higher CD4+ T-cell count (200-349 cells/µl: sHR 0.27, 95% CI 0.20, 0.38, 350-499 cells/µl: sHR 0.10, 95% CI 0.07, 0.16 and ≥500 cells/µl: sHR 0.09, 95% CI 0.06, 0.13, compared with <200 cells/µl). Results after 10 years were similar, but most associations were weaker due to limited power. Conclusions: Next to preventing ART failure, HIV programmes should carefully monitor and treat comorbidities, including hepatitis, kidney disease and diabetes, to optimize survival after long-term ART exposure.Mahidol UniversityMedicinePharmacology, Toxicology and PharmaceuticsArticleSCOPUS10.3851/IMP3358