Eyawo, Oghenowede - Changes in Causes of Death, the Impact on Life Expectancy, and the Risk of Myocardial Infarction Amo...

This thesis has been approved for inclusion in the SFU Library.
Publication of this thesis has been postponed at the author's request until 2018-10-16.
Term: 
Fall 2017
Degree: 
Ph.D.
Degree type: 
Thesis
Department: 
Faculty of Health Sciences
Faculty: 
Health Sciences
Senior supervisor: 
Robert Hogg
Publishing Documentation
Postponement release date: 
Tue, 2018-10-16
Thesis title: 
Changes in Causes of Death, the Impact on Life Expectancy, and the Risk of Myocardial Infarction Among People Living with and without HIV
Given Names: 
Oghenowede
Surname: 
Eyawo
Abstract: 
Background: Within the context of aging with HIV in the combination antiretroviral therapy (ART) era, the set of four papers that make up this dissertation aimed to: summarize the existing evidence on the risk of myocardial infarction (MI) among people living HIV (PLHIV) (Chapter 2); characterize changes over time in rates and causes of death among HIV-positive and HIV-negative individuals (Chapter 3); assess the impact of the changing causes of death on life expectancy and potential gains in life expectancy over time (Chapter 4); estimate the incidence of MI and its association with HIV infection, ART, and other explanatory variables, among HIV-positive and HIV-negative individuals (Chapter 5). Methods: A systematic review and meta-analysis of MI risk among PLHIV was initially performed. Next, data from the COAST studya linked population-based, retrospective cohort study containing longitudinal data on over half a million HIV-positive and HIV-negative adults in British Columbia (BC)were assessed to investigate several issues pertinent to aging with HIV. With the hope of producing evidence to inform relevant programmatic and clinical guidelines/policies among aging HIV-positive individuals, a series of analyses were performed to examine mortality changes over time, cause-deleted life expectancy, and the risk of MI among HIV-positive compared to HIV-negative individuals. Results: We observed significant declines in mortality and dramatic shifts in the causes of death between 1996 and 2012 among HIV-positive compared to HIV-negative individuals. Although HIV/AIDS continues to account for the greatest burden of mortality among PLHIV, other non-AIDS-defining conditions have become increasingly relevant. Consequently, our results suggest that managing cardiovascular diseases and non-AIDS-defining cancers among PLHIV has the same effect on life expectancy in this population as in HIV-negative individuals. Increasing age, male sex, and HIV infection (including exposure to some ART regimens) were found to be associated with a higher risk of MI. Conclusion: Taken together, our findings highlight the increasing need to concurrently consider multiple factors, including HIV infection itself, other emerging non-HIV-related conditions, exposure to ART, and demographic and clinical risk factors, as part of the effort to address and improve the care of aging HIV-positive individuals.
Keywords: 
HIV infection; Aging with HIV; Combination antiretroviral therapy; Cause-deleted life expectancy and potential gains in life expectancy; Myocardial infarction; Systematic review and meta-analysis
Total pages: 
181