Comparisons of Causes of Death and Mortality Rates Among HIV-Infected Persons: Analysis of the Pre-, Early, and Late HAART (Highly Active Antiretroviral Therapy) Eras

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 41; no. 2; pp. 194 - 200
• Main Authors: Crum, Nancy F, Riffenburgh, Robert H, Wegner, Scott, Agan, Brian K, Tasker, Sybil A, Spooner, Katherine M, Armstrong, Adam W, Fraser, Susan, Wallace, Mark R
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-02-2006; Lippincott Williams & Wilkins; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Adult; AIDS/HIV; Anti-HIV Agents - therapeutic use; Antiretroviral Therapy, Highly Active; Biological and medical sciences; Cause of Death; Cohort Studies; Comparative analysis; Deaths; Drug therapy; Female; Fundamental and applied biological sciences. Psychology; HIV; HIV Infections - drug therapy; HIV Infections - mortality; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Male; Medical sciences; Microbiology; Miscellaneous; Mortality; Survival Rate; United States; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Virology; United States; Human; Immunopathology; Microbiology; survival; Retroviridae; AIDS; cause of death; Immune deficiency; Lentivirus; Virology; Infection; Virus; HIV; Viral disease; mortality; Antiviral; Human immunodeficiency virus
• ISSN: 1525-4135; 1944-7884
• DOI: 10.1097/01.qai.0000179459.31562.16

METHODS:Comparisons of death-related variables during the 3 eras were performed.
RESULTS:The number of deaths declined over the study period, with 987 deaths in the pre-HAART era, 159 deaths in the early HAART era (1997-1999), and 78 deaths in the late HAART era (2000-2003) (P < 0.01). The annual death rate peaked in 1995 (10.3 per 100 patients) and then declined to <2 deaths per 100 persons in the late HAART era (P < 0.01). The proportion of deaths attributable to infection decreased, but infection remained the leading cause of death in our cohort, followed by cancer. Of those who died, there was an increasing proportion of non-HIV-related deaths (32% vs. 9%; P < 0.01), including cardiac disease (22% vs. 8%; P < 0.01) and trauma (8% vs. 2%; P = 0.01) in the post-HAART versus pre-HAART era. Despite the absence of intravenous drug use and the low prevalence of hepatitis C coinfection in our cohort, an increasing proportion of deaths in the HAART era were attributable to liver disease, although the numbers are small.
CONCLUSIONS:Despite increasing concerns regarding antiretroviral resistance, the death rate among HIV-infected persons in our cohort continues to decline. Our data show a lower death rate than that reported among many other US HIV-infected populations; this may be the result of open access to health care. A shift in the causes of death toward non-HIV-related causes suggests that a more comprehensive health care approach may be needed for optimal life expectancy; this may include enhanced screening for malignancy and heart disease as well as preventive measures for liver disease and accidents.