Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy

Abstract

PURPOSE-To examine changes in the causes of death and mortality in women with human immunodeficiency virus (HIV) infection in the era of combination antiretroviral therapy.METHODS-Among women with, or at risk of, HIV infection, who were enrolled in a national study from 1994 to 1995, we used an algorithm that classified cause of death as due to acquired immunodeficiency syndrome (AIDS) or non-AIDS causes based on data from death certificates and the CD4 count. Poisson regression models were used to estimate death rates and to determine the risk factors for AIDS and non-AIDS deaths.RESULTS-Of 2059 HIV-infected women and 569 who were at risk of HIV infection, 468 (18%) had died by April 2000 (451 HIV-infected and 17 not infected). Causes of death were available for 428 participants (414 HIV-infected and 14 not infected). Among HIV-infected women, deaths were classified as AIDS (n = 294), non-AIDS (n = 91), or indeterminate (n = 29). The non-AIDS causes included liver failure (n = 19), drug overdose (n = 16), non-AIDS malignancies (n = 12), cardiac disease (n = 10), and murder, suicide, or accident (n = 10). Allcause mortality declined an average of 26% per year (P = 0.03) and AIDS-related mortality declined by 39% per year (P = 0.01), whereas non-AIDS-related mortality remained stable (10% average annual decrease, P = 0.73). Factors that were independently associated with non-AIDSrelated mortality included depression, history of injection drug use with hepatitis C infection, cigarette smoking, and age.CONCLUSION-A substantial minority (20%) of deaths among women with HIV was due to causes other than AIDS. Our data suggest that to decrease mortality further among HIV-infected women, attention must be paid to treatable conditions, such as hepatitis C, depression, and drug and tobacco use.With the advent of combination antiretroviral therapy, mortality for persons with acquired immunodeficiency disease syndrome (AIDS) in the United States has declined markedly (1-3). For women with AIDS, these declines have been delayed and smaller in magnitude than those seen in men (1,4), perhaps due to racial and sex differences in access to antiretroviral ©2002 by Excerpta Medica, Inc. Although most studies have not found sex-related differences in HIV disease progression (9,10), some have noted a worse prognosis for women, especially those who inject drugs (11,12). Causes of death were not examined in these studies. Assessing causes of death may clarify the effects of other medical problems on mortality of women with HIV infection.The purpose of this investigation was to evaluate cause-specific mortality of participants in the Women's Interagency HIV Study, the largest U.S. longitudinal study of women with HIV infection. We examined non-HIV-related causes of death, compared the changes in mortality between those who died of AIDS and those who died of non-AIDS causes, and compared risk factors for AIDS and non-AIDS mortality in the era of combination antiretroviral therapy. METHODS SampleThe Women's Interagency HIV Study...

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