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The profile of AIDS deaths has changed since HIV-infected patients began to receive highly active antiretroviral therapy (HAART) in 1996. While fewer people are now dying overall, more are dying from non-AIDS-related diseases.
Research from the Centers for Disease Control and Prevention and other sources is showing an increase in non-AIDS-defining illnesses. One CDC study presented at the 9th Conference on Retroviruses and Opportunistic Infections, held Feb. 24-28, 2002, in Seattle, showed that while there have been declines in the proportions of deaths from some AIDS-related causes, there is an increase in deaths from non-AIDS-related causes, including liver and kidney disease and possibly ischemic heart disease.1
"I think this increase in proportion in deaths due to liver and kidney disease could be due to aging, meaning patients have more time to experience lifestyle-related illnesses or age-related illnesses," says Mitchell I. Wolfe, MD, MPH, medical epidemiologist with the CDC’s Division of HIV/ AIDS Prevention Surveillance Branch.
Another possible reason for the change in causes of death among AIDS patients could be related to adverse effects of antiretroviral therapy, Wolfe says. "I think this means clinicians and researchers need to be aware that people could be dying from these other causes."
Wolfe was a chief investigator in a cohort study involving more than 100 clinics in 10 cities that followed 54,000 HIV-infected people since 1990 and observed close to 7,200 deaths. There were 11 cities from 1992 to 2000, but one city was not included in the current analysis, Wolfe says.
Other studies presented at the retroviruses conference that also concerned AIDS deaths included the following:
• French investigators concluded that half of the deaths among HIV-infected patients in 2000 were not related to AIDS. These deaths were quite diversified, with the most frequent non-AIDS-related causes being hepatitis C infection, non-AIDS-defining cancer, and cardiovascular disease.2
• A California study found that less than half of deaths among HIV-positive patients in one urban AIDS clinic were due to AIDS. The non-AIDS-related deaths were associated with older age and a history of injection drug use. The non-AIDS-related deaths were among people who had less advanced HIV disease and who were more likely to be off antiretroviral therapy in the year before they died.3
• A cohort of HIV-infected patients in Ohio had a significant decrease in the proportion of deaths (of 299 total deaths) directly related to AIDS since HAART became widespread. The study found that cancer became a prominent cause of mortality, but the findings did not confirm an increase in deaths due to liver disease.4
• One Atlanta study had the opposite findings: Among 207 patients in a larger inner-city clinic, the causes of death had not changed since the use of HAART became widespread.5
1. Wolfe MI, Hanson DL, Selik R, Swerdlow DL. Deaths from non-AIDS-related diseases have increased as a proportion of deaths of HIV-infected persons since the advent of HAART. Presented at the 9th Conference on Retroviruses and Opportunistic Infections. Seattle; Feb. 24-28, 2002. Abstract 14.
2. Lewden C, Heripret L, Bonnet F, et al. Causes of death in HIV-infected adults in the era of highly active antiretroviral therapy (HAART), the French survey "Mortalite 2000." Presented at the 9th Conference on Retroviruses and Opportunistic Infections. Seattle; Feb. 24-28, 2002. Poster 753-W.
3. Jacobson S, Shade SB, Borkert C, et al. Causes and predictors of death among people with HIV in primary care. Presented at the 9th Conference on Retroviruses and Opportunistic Infections. Seattle; Feb. 24-28, 2002. Poster 752-W.
4. Rodriguez B, Valdez H, Salata R, et al. Changes in the causes of death in a cohort of HIV-infected individuals: analysis of the last 6 years. Presented at the 9th Conference on Retroviruses and Opportunistic Infections. Seattle; Feb. 24-28, 2002. Poster 755-W.
5. Folch E, Hernandez I, Vetter T, et al. AIDS-Related mortality: improved survival with HAART but causes of death unchanged. Presented at the 9th Conference on Retroviruses and Opportunistic Infections. Seattle; Feb. 24-28, 2002. Poster 756-W.