Mortality by causes in HIV-infected adults: comparison with the general population

Abstract

BackgroundWe compared mortality by cause of death in HIV-infected adults in the era of combined antiretroviral therapy with mortality in the general population in the same age and sex groups.MethodsMortality by cause of death was analyzed for the period 1999-2006 in the cohort of persons aged 20-59 years diagnosed with HIV infection and residing in Navarre (Spain). This was compared with mortality from the same causes in the general population of the same age and sex using standardized mortality ratios (SMR).ResultsThere were 210 deaths among 1145 persons diagnosed with HIV (29.5 per 1000 person-years). About 50% of these deaths were from AIDS. Persons diagnosed with HIV infection had exceeded all-cause mortality (SMR 14.0, 95% CI 12.2 to 16.1) and non-AIDS mortality (SMR 6.9, 5.7 to 8.5). The analysis showed excess mortality from hepatic disease (SMR 69.0, 48.1 to 78.6), drug overdose or addiction (SMR 46.0, 29.2 to 69.0), suicide (SMR 9.6, 3.8 to 19.7), cancer (SMR 3.2, 1.8 to 5.1) and cardiovascular disease (SMR 3.1, 1.3 to 6.1). Mortality in HIV-infected intravenous drug users did not change significantly between the periods 1999-2002 and 2003-2006, but it declined by 56% in non-injecting drug users (P = 0.007).ConclusionsPersons with HIV infection continue to have considerable excess mortality despite the availability of effective antiretroviral treatments. However, excess mortality in the HIV patients has declined since these treatments were introduced, especially in persons without a history of intravenous drug use.

Trends in non-AIDS-related causes of death among adults with HIV/AIDS, Brazil, 1999 to 2010

“…These results agree with findings by other authors showing an increase in deaths from cardiovascular diseases in persons with HIV/AIDS since the introduction of HAART 13,16,17 .…”

“…The trends in mortality curves from non-AIDS-related malignant neoplasms also differ between the two groups; as demonstrated 13,16 , the increase is greater in the HIV group. Although the incidence of AIDS-related neoplasms has decreased since the introduction of HAART, it is known that non-AIDS-related malignant neoplasms are currently important causes of mortality in persons with HIV/AIDS in the developed countries 13,14 .…”

Suicide mortality among people accessing highly active antiretroviral therapy for HIV/AIDS in British Columbia: a retrospective analysis

“…Third, the lack of accepted methodology within this field of research, suicidality in HIV-positive populations, limits the comparability and generalizability of results across studies. 1,9,11,41,42 Fourth, suicides may be underestimated as those that occur as a result of selfadministered withdrawal of care or similar indirect ways often cannot be distinguished as such; however, given the definition of suicide used in this study includes accidental poisoning it may also be possible that the number of suicides was overestimated and that some instances of overdose death are, in fact, not suicides. Fifth, our sample size, information on certain variables such as injection drug use and sex distribution is limited; in addition, we had no access to clinical information regarding previous psychiatric history, particularly depression, or any mental health-related treatments.…”

Lethality among Patients with HIV/AIDS Monitored in the Clinic of Infectious Diseases in St George University Hospital, Plovdiv, 2010–2014

“…[1][2][3][4][5] The introduction of cART resulted in increase of life expectancy of HIV+, but in some groups of patients lethality remains unacceptably high. [6][7][8] HIV infection prevalence is rather low in Bulgaria and yet the number of HIV-infected (HIV+) individuals in the country continues to grow. [1][2][3] Contemporary therapeutic regimens are accessible for HIV+ patients in Bulgaria 2 , but there are some factors as late diagnosis 'late presenters, with ad-vanced immunodefi ciency' late treatment, respectively, and poor adherence to treatment that worsen the prognosis of the disease.…”