Changes in mortality rates and causes of death in a population-based cohort of persons living with and without HIV from 1996 to 2012

Abstract

BackgroundNon-HIV/AIDS-related diseases are gaining prominence as important causes of morbidity and mortality among people living with HIV. The purpose of this study was to characterize and compare changes over time in mortality rates and causes of death among a population-based cohort of persons living with and without HIV in British Columbia (BC), Canada.MethodsWe analysed data from the Comparative Outcomes And Service Utilization Trends (COAST) study; a retrospective population-based study created via linkage between the BC Centre for Excellence in HIV/AIDS and Population Data BC, and containing data for HIV-infected individuals and the general population of BC, respectively. Our analysis included all known HIV-infected adults (≥ 20 years) in BC and a random 10% sample of uninfected BC adults followed from 1996 to 2012. Deaths were identified through Population Data BC – which contains information on all registered deaths in BC (BC Vital Statistics Agency dataset) and classified into cause of death categories using International Classification of Diseases (ICD) 9/10 codes. Age-standardized mortality rates (ASMR) and mortality rate ratios were calculated. Trend test were performed.Results3401 (25%), and 47,647 (9%) individuals died during the 5,620,150 person-years of follow-up among 13,729 HIV-infected and 510,313 uninfected individuals, respectively. All-cause and cause-specific mortality rates were consistently higher among HIV-infected compared to HIV-negative individuals, except for neurological disorders. All-cause ASMR decreased from 126.75 (95% CI: 84.92-168.57) per 1000 population in 1996 to 21.29 (95% CI: 17.79-24.79) in 2011-2012 (83% decline; p < 0.001 for trend), compared to a change from 7.97 (95% CI: 7.61-8.33) to 6.87 (95% CI: 6.70-7.04) among uninfected individuals (14% decline; p < 0.001). Mortality rates from HIV/AIDS-related causes decreased by 94% from 103.85 per 1000 population in 1996 to 6.72 by the 2011–2012 era (p < 0.001). Significant ASMR reductions were also observed for hepatic/liver disease and drug abuse/overdose deaths. ASMRs for neurological disorders increased significantly over time. Non-AIDS-defining cancers are currently the leading non-HIV/AIDS-related cause of death in both HIV-infected and uninfected individuals.ConclusionsDespite the significant mortality rate reductions observed among HIV-infected individuals from 1996 to 2012, they still have excess mortality risk compared to uninfected individuals. Additional efforts are needed to promote effective risk factor management and appropriate screening measures among people living with HIV.

Prevalence and Risk Factors of Mortality among Adult HIV Patients Initiating ART in Rural Setting of HIV Care and Treatment Services in North Western Tanzania: A Retrospective Cohort Study

“…For instance, in European and American studies, HIV patients tend to be diagnosed and initiated on ART much earlier with potential less mortality on ART receipt. However, even with the present differences in mortality rate, the clinical message remains significantly similar that, despite the use of ART, the mortality among HIV-positive patients is comparatively higher than the general population in both developed and developing countries with comparable timing of these deaths in most series [21, 22]. For instance, in one study from Ethiopia, where 10.0% of patients on ART died in 6 years of follow-up, it was found that 62.9% of the reported deaths occurred in the first year of ART [23], while in a study by Johannessen et al from Manyara, Tanzania, it was indicated that 72.7% of the reported deaths occurred within the first 12 months of ART initiation [20].…”

The influence of age‐associated comorbidities on responses to combination antiretroviral therapy in older people living with HIV

“…Combination antiretroviral therapy (cART) has dramatically improved the survival and quality of life for people living with HIV . A growing proportion of patients are over the age of 50 years, and by the end of 2013, over four million individuals older than 50 years were living with HIV infection worldwide .…”

Cause-specific mortality among HIV-infected people in Ontario, 1995–2014: a population-based retrospective cohort study

“…Similar findings have been reported in high-income countries where cART has been available for the past 2 decades. 4,5,7,9 Such studies also show that death is increasingly attributed to non-AIDSrelated causes, including non-AIDS-defining malignant disease, 5,6 cardiovascular disease 6 and liver disease, 4,6 even as rates of death from these causes decline. 7,8 In the current study, in 1995-1999, age differences in HIV/AIDS-associated mortality were modest, likely because cART was not yet in widespread use.…”

“…Research chronic liver disease (in particular due to hepatitis B and C), cardiovascular disease and suicide were also observed, 7,8 which represents new trends in the primary causes of death in people with HIV infection.…”