Short-term mortality from HIV-infected persons diagnosed from 2012 to 2016

Abstract

We investigated the temporal trends of short-term mortality (death within 1 year of diagnosis) and cause-specific deaths in human immunodeficiency virus (HIV)-infected persons by stage of HIV infection at diagnosis. We also assessed the impact of late diagnosis (LD) on short-term mortality. Epidemiological records of HIV-infected Singapore residents from the National HIV Registry were linked to death records from the Registry of Births and Deaths for observational analyses. Newly-diagnosed HIV cases with available cluster of differentiation 4 count at time of diagnosis in a 5-year period from 2012 to 2016 were included in the study. Hazard ratios (HRs) and 95% confidence interval (CI) of LD for all deaths excluding suicides and self-inflicted or accidental injuries, and HIV/ acquired immunodeficiency syndrome (AIDS)-related deaths occurring within 1 year post-diagnosis were calculated using Cox proportional hazards regression models with adjustment for age at HIV/AIDS diagnosis. Population attributable risk proportions (PARPs) were then calculated using the adjusted HRs. Of the 1990 newly-diagnosed HIV cases included in the study, 7.2% had died by end of 2017, giving an overall mortality rate of 2.16 per 100 person-years (PY) (95% CI 1.82–2.54). The mortality rate was 3.81 per 100 PY (95% CI 3.15–4.56) in HIV cases with LD, compared with 0.71 (95% CI 0.46–1.05) in non-LD (nLD) cases. Short-term mortality was significantly higher in LD (9.1%) than nLD cases (1.1%). Of the 143 deaths reported between 2012 and 2017, 58.0% were HIV/AIDS-related (nLD 28.0% vs LD 64.4%). HIV/AIDS-related causes represented 70.4% of all deaths which occurred during the first year of diagnosis (nLD 36.4% vs LD 74.7%). The PARP of short-term mortality due to LD was 77.8% for all deaths by natural causes, and 87.8% for HIV/AIDS-related deaths. The mortality rate of HIV-infected persons with LD was higher than nLD, especially within 1 year of diagnosis, and HIV/AIDS-related causes constituted majority of these deaths. To reduce short-term mortality, persons at high risk of late-stage HIV infection should be targeted in outreach efforts to promote health screening and remove barriers to HIV testing and treatment.

Estimating the risk of mortality attributable to recent late HIV diagnosis following admission to the intensive care unit: A single‐centre observational cohort study

“…A 10‐year study using data collected between 1999 and 2008 from a national cohort of people with HIV in England and Wales estimated that 60% of all‐cause mortality was attributable to late diagnosis [ 38 ]. Another study in Singapore that used data collected between 2012 and 2016 from a cohort of their population of people with HIV estimated that 78% of short‐term mortality was attributable to late diagnosis [ 23 ]. These previous studies on general populations of people with HIV are informative and our findings are consistent with these studies in relation to late diagnosis generally being associated with an increased risk of mortality and resulting in potentially avoidable excess deaths.…”

“…Pneumocystis jirovecii pneumonia (PCP)] or other infections (13%; e.g. septic shock), the median (IQR) APACHE II score was moderately high at 19 (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), and the number of admissions was highest in 2016-2019 (n = 59). For HIV-specific characteristics measured at ICU admission, the median (IQR) time since HIV diagnosis was 6 (0-14) years, two-thirds had advanced HIV (67%), 45% had an undetectable VL (≤ 50 copies/mL), the median (IQR) CD4 count was low at 122 (29-297) cells/μL, and 74% were receiving cART (or 53% overall had data available on cART start date) (Table 1).…”

“…These data may be used to inform public health efforts aimed at earlier HIV diagnosis in all healthcare services, including ICUs [ 16 ]. Previous studies have analysed in‐hospital and/or in‐ICU mortality outcomes among people with HIV [ 17 , 18 , 19 , 20 ] and have estimated the attributable risk of mortality to late diagnosis in general populations of people with HIV [ 21 , 22 , 23 , 24 , 25 ]. However, there are no studies that have quantified the population attributable fraction (PAF) of in‐ICU mortality to late diagnosis.…”

Sex-based epidemiological and immunovirological characteristics of people living with HIV in current follow-up at a tertiary hospital: a comparative retrospective study, Catalonia, Spain, 1982 to 2020

“…Having a late diagnosis is associated with high morbidity and short-term mortality [18,19]. According to the 2020 data from the ECDC, 51% of those with a new infection were diagnosed with HIV while having a CD4 + cell count of less than 350 cells/mm 3 .…”

Factors Associated with HIV Testing Among People Who Inject Drugs: Findings from a Multistate Study at the Start of the COVID-19 Pandemic

“…Despite this recommendation, existing literature demonstrates that PWID experience substantial barriers to HIV testing, such as: missed opportunities for testing during healthcare encounters, not knowing where to get tested, concern persons may be identified as PWID at the testing site, and stigma [5,23,24]. Barriers to routine HIV testing among PWID may result in delayed diagnosis, and by extension, lead to suboptimal health outcomes [25][26][27][28]. Existing research that examines HIV testing among PWID is informative, but primarily reflect studies conducted preceding the COVID-19 pandemic.…”