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

Centro de Salud de San Juan, Servicio Navarro de Salud, Avda Barañain 26, 31008 Pamplona, Spain.
BMC Public Health (Impact Factor: 2.26). 05/2011; 11(1):300. DOI: 10.1186/1471-2458-11-300
Source: PubMed


We 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.
Mortality 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).
There 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).
Persons 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.

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Available from: Jesús Castilla,
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    • "As the HIV/AIDS pandemic has evolved, reliable assignment of cause of death for people who have lived with the infection has been a persistent difficulty. Although there is no doubt about increased mortality risks associated with HIV infection (1), in settings where people frequently die outside the scope of effective medical services, or where the disease continues to carry some stigma, there may be inadequate information or unwillingness to document HIV/AIDS as a cause of death (2). The situation is further complicated by the interactions between HIV infection and other diseases, whereby clear manifestations of AIDS may not be major features of final illnesses among HIV-positive people, particularly among those receiving treatment (3). "
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    • "The introduction of highly active antiretroviral therapy (HAART) has led to dramatic improvement in survival for persons living with human immunodeficiency virus (HIV), turning a fatal disease into a manageable chronic condition (1-3). In HIV infected patients without other risk factors on a successful HAART, the probability of survival is approaching closer to that in the general population of a similar age (4-9). Along with increased survival, the causes of death among HIV-infected patients also have gradually changed. "
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    • "In interpreting these findings, the composition of the cohort, the background HCV prevalence and the mortality rates of the general population have to be taken into account. Lower SMRs have been reported in large international cohorts made up of heterogeneous populations, whereas higher SMRs are derived from smaller cohorts with larger proportions of injecting drug users [3] [4]. Regarding excess mortality, our rate of 1.0 per 100 p-y, is slightly higher than the 0.6 per 100 py for 2004-2006 reported by the CASCADE Collaboration [8]; overall HCV prevalence in that study was lower than ours, and it was composed exclusively of seroconverters with longer periods of disease-free follow-up. "
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