Pre-AIDS mortality in HIV-infected individuals in England, Wales and Northern Ireland, 1982–1996

Laurichesse, H.; Mortimer, Janet; Evans, Barry; Farrington, C. P.

doi:10.1097/00002030-199806000-00015

Cited by 22 publications

(8 citation statements)

References 39 publications

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“…Goedert et al retrospectively studied mortality in drug users in Italy and found that trauma, overdose, bacterial infections, hepatitis, and cirrhosis were increased in those who were HIV infected (21). One British study, which took place before combination antiretroviral therapy, found that 5% of deaths among HIV-infected persons were due to non-AIDS causes, especially among those who were older or used injection drugs (22). Another study emphasized the importance of smoking as a risk factor for lung cancer in HIV-infected persons (23).…”

Section: Discussionmentioning

confidence: 99%

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

Cohen

French

Benning

et al. 2002

The American Journal of Medicine

140

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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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Section: Discussionmentioning

confidence: 99%

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

Cohen

French

Benning

et al. 2002

The American Journal of Medicine

140

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“…In a study about the pre‐AIDS mortality in HIV‐infected patients conducted in the UK between 1982 and 1996, Laurichesse et al . have already shown that severe bacterial infections are frequent non AIDS‐related events accounting for up to one‐third of the total of such conditions in HIV‐infected patients [9]. Bacterial pneumonia has been recognized as more frequent in HIV‐infected patients than in the general population, particularly among patients with a CD4 count of fewer than 0.2 cells/μL and in intravenous drug users [10,11].…”

Section: Discussionmentioning

confidence: 99%

Causes of death among HIV‐infected patients in the era of highly active antiretroviral therapy, Bordeaux, France, 1998–1999

et al. 2002

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ObjectivesTo describe the causes of death in HIV-infected patients in the era of highly active antiretroviral therapy (HAART). MethodA retrospective survey conducted in Bordeaux, France. Medical records of all deaths that had occurred in 1998 and 1999 amongst patients followed within the Aquitaine cohort were reviewed by the same physician. Immediate and underlying causes of death were described, taking into account the morbidity at the time of death. ResultsSixty-six deaths occurred in 1998, and 41 in 1999. Sixty-seven per cent of deceased patients were male. Median age at time of death was 43 years (range 25±71), median CD4 was 162 cells/mL (0±957); 28% of patients had a CD4 count > 200 cells/mL and 7% plasma viral load < 500 HIV-RNA copies/mL. Amongst morbidity present at the time of death, there were 23 bacterial infections, 16 non-Hodgkin's lymphomas, 16 cirrhoses, 15 non HIV-related malignancies, 13 central nervous system diseases and 10 myocardiopathies. The main immediate causes of death were: multiple organ failure (21%), coma (18%), septic shock (15%) and acute respiratory failure (14%). Underlying causes of death were AIDS-de®ning events (48%), non AIDS HIV-related infection (3%), hepatitis B-or C-associated cirrhosis (14%), non HIV-related malignancies (11%), cardiovascular events (10%), suicide and overdose (6%), treatment-related fatalities (4%), injury (2%) and unknown (2%). Patients dying from AIDS-related events were more often female, had a lower CD4 count, a higher level of HIV-RNA, a shorter history of HIV infection and were less often coinfected with hepatitis B and C viruses than those dying from other underlying causes.Conclusions AIDS-related events are no longer the major causes of death of HIV-infected patients in the era of HAART. This evolving mortality pattern justi®es an adaptation of both the epidemiological surveillance and the clinical monitoring of HIV-infected patients.

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“…If it is borne in mind that bacterial infection remains the leading cause of death at the pre-acquired immune deficiency syndrome stage [138] and the most frequent terminal event in human immunodeficiency virus-infected patients [100], it is clear that their prevention remains a major goal. Thus, pneumococcal vaccination might be given to the patient on highly active antiretroviral therapy with a CD4 cell count reaching 200 cells?mm -3 .…”

Section: The Way Forwardmentioning

confidence: 99%

Pyogenic bacterial lower respiratory tract infection in human immunodeficiency virus-infected patients

Mayaud

Parrot²,

Cadranel³

2002

European Respiratory Journal

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Pre-AIDS mortality in HIV-infected individuals in England, Wales and Northern Ireland, 1982–1996

Abstract: Pre-AIDS mortality represents a substantial proportion of HIV mortality, particularly where injecting drug use is a frequent route of HIV transmission.

Cited by 22 publications

References 39 publications

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

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

Causes of death among HIV‐infected patients in the era of highly active antiretroviral therapy, Bordeaux, France, 1998–1999

Pyogenic bacterial lower respiratory tract infection in human immunodeficiency virus-infected patients

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