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Existing approaches to estimating AIDS\u2010related mortality have quantified AIDS\u2010related mortality as total mortality among PLHIV in excess of age\u2010 and sex\u2010matched mortality in populations without HIV. However, recent evidence suggests that, with high antiretroviral therapy (ART) coverage, a growing proportion of excess mortality among PLHIV is non\u2010AIDS\u2010related.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched Embase on 22\/09\/2023 for English language studies that contained data on AIDS\u2010related mortality rates among adult PLHIV and age\u2010matched comparator all\u2010cause mortality rates among people without HIV. We extracted data on the number and rates of all\u2010cause and AIDS\u2010related deaths, demographics, ART use and AIDS\u2010related mortality definitions. We calculated the proportion of excess mortality among PLHIV that is AIDS\u2010related. The proportion of excess mortality due to AIDS was pooled using random\u2010effects meta\u2010analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 4485 studies identified by the initial search, eight were eligible, all from high\u2010income settings: five from Europe, one from Canada, one from Japan and one from South Korea. No studies reported on mortality among only untreated PLHIV. One study included only PLHIV on ART. In all studies, most PLHIV were on ART by the end of follow\u2010up. Overall, 1,331,742 person\u2010years and 17,471 deaths were included from PLHIV, a mortality rate of 13.1 per 1000 person\u2010years. Of these deaths, 7721 (44%) were AIDS\u2010related, an overall AIDS\u2010related mortality rate of 5.8 per 1000 person\u2010years. The mean overall mortality rate among the general population was 2.8 (95% CI: 1.8\u20134.0) per 1000 person\u2010years. The meta\u2010analysed percentage of excess mortality that was AIDS\u2010related was 53% (95% CI: 45\u201361%); 52% (43\u201360%) in Western and Central Europe and North America, and 71% (69\u201374%) in the Asia\u2010Pacific region.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Although we searched all regions, we only found eligible studies from high\u2010income countries, mostly European, so, the generalizability of these results to other regions and epidemic settings is unknown.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Around half of the excess mortality among PLHIV in high\u2010income regions was non\u2010AIDS\u2010related. An emphasis on preventing and treating comorbidities linked to non\u2010AIDS mortality among PLHIV is required.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26384","type":"journal-article","created":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T02:29:04Z","timestamp":1730773744000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Excess mortality attributable to AIDS among people living with HIV in high\u2010income countries: a systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3462-2898","authenticated-orcid":false,"given":"Adam","family":"Trickey","sequence":"first","affiliation":[{"name":"Population Health Sciences University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Ambia","sequence":"additional","affiliation":[{"name":"Population Health Sciences University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4936-0264","authenticated-orcid":false,"given":"Robert","family":"Glaubius","sequence":"additional","affiliation":[{"name":"Center for Modeling, Planning and Policy Analysis Avenir Health  Glastonbury Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cari","family":"van Schalkwyk","sequence":"additional","affiliation":[{"name":"The South African Centre for Epidemiological Modelling and Analysis University of Stellenbosch  Stellenbosch South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7728-728X","authenticated-orcid":false,"given":"Jeffrey W.","family":"Imai\u2010Eaton","sequence":"additional","affiliation":[{"name":"Center for Communicable Disease Dynamics Department of Epidemiology Harvard T.H. 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