Non-HIV-related deaths rises to 26% in NYC
Non-HIV-related deaths rises to 26% in NYC
IDUs had highest mortality rate
New research hammers home the point that HIV providers need to attend to their patients’ overall health needs and not just to HIV-related morbidity.
"They need to have more of a primary care model in mind that manages all aspects of people’s health," says Judith Sackoff, PhD, director of HIV/AIDS surveillance for the New York City Department of Health and Mental Hygiene.
Sackoff co-authored a study that found mortality among New York City residents, ages 13 and older, who were diagnosed with AIDS, rose to 26% of all deaths among this population in 2003. By comparison, only 7% of all deaths among persons living with AIDS were for non-HIV causes in 1995.1
About 75% of non-HIV-related deaths among persons living with AIDS in New York City were related to cardiovascular disease, cancer, and substance abuse. Also, injection drug users were significantly more likely to die from non-HIV-related causes.1
"Even though we found that, in general, people with AIDS in New York were dying of non-related HIV conditions, including cardiovascular disease, diabetes, etc., substance use was a significant cause," Sackoff explains. "Substance use is not a leading cause of death among all New Yorkers, but it accounted for more than one-third of the non-HIV-related causes of AIDS, and it was consistent across groups of men, women, blacks, Hispanics, and whites."
The study analyzed data between 1999 and 2003, the period when highly active antiretroviral therapy (HAART) was widely adopted. Here are some of the findings for persons living with AIDS during that period of time1:
- the number of people age 50 or older increased from 2,904 to 16,900, almost sixfold;
- the AIDS population has a high rate of smoking and substance use;
- substance use (7.3%) was the leading cause of non-HIV-related deaths;
- major cardiovascular diseases accounted for 5.4% of all non-HIV-related deaths;
- malignant neoplasms accounted for 4.7% of all non-HIV-related deaths.
The population of people living with AIDS in 2003 included 70% men, 45% blacks, 33% Hispanics, and the median age was 45 years, Sackoff reports. "As people live longer due to antiretroviral therapy, they are at more risk for the kinds of things [those getting older] are at risk for," she notes. "So it’s the graying of the population of people living with AIDS."
Investigators gathered data from death certificates that indicated that lung cancer was the leading cause related to cancers, followed by breast cancer in women and liver cancer in men, Sackoff notes. "What we reported is the underlying cause of death. Every death certificate has multiple causes."
Trained specialists sorted through the multiple causes and following a set of guidelines identified the underlying cause of death, Sackoff adds.
"It’s an exceedingly complex process, and we’ve learned an awful lot from this," she says.
The study was limited in what conclusions could be drawn from cause of death and treatment, Sackoff notes. "We wish we could take a look at cardiovascular disease related to antiretroviral therapy, but we can’t look at that because we have no information on the treatment people were on before they died," she says. "And the way deaths are coded on certificates is not subtle enough to pick up cardiovascular disease related to HIV treatment, so we were unable to address that question."
However, investigators were able to classify a large number of conditions as substance use-related, including liver disease, hepatitis C, and overdoses, Sackoff says.
Likewise, researchers knew that other lifestyle habits among people living with AIDS had contributed to the non-HIV-related causes of death.
"We know there are very high rates of cigarette smoking among people with AIDS," Sackoff says. "About 50% of people with AIDS in New York City are smokers, compared with 22% overall; and there are high rates of alcohol use and substance use. These are the things that have become important causes of death to people with AIDS."
While AIDS continues to kill people, those living with the disease are going to have to face the fact that their own behaviors also are going to kill them, Sackoff says.
The study also found that while suicide is only ranked seventh in the causes of non-HIV-related deaths overall, it was the second leading non-HIV-related cause of death among men who have sex with men, Sackoff points out.
"That was something we had not seen reported before, and it’s something that is obviously very much of concern," she says. "I think mental health issues in general are very important for people living with AIDS because they won’t kill directly, but perhaps suicide and substance use are indirect manifestations of the disease."
One last important point made by the study is that people still are dying from AIDS, despite the huge advances made in treatment, Sackoff notes.
Reference
- Hanna DB, Pfeiffer MR, Torian LV, Sackoff JE. Predictors of non-HIV-related deaths among PWA in New York City, 1999-2003. Presented at the 12th Conference on Retroviruses and Opportunistic Infections, Abstract:V-151; Poster 955. Boston; February 2005.
AIDS Alert Update: 21st Century Prevention Work
(Editor’s note: AIDS Alert provides the second part in the series of stories based on how HIV prevention funding and interventions are focusing on evidence-based programs. In this issue are stories about the challenges in adaptation and the trials and tribulations of investigators working on adapting two different, evidence-based interventions.)
New research hammers home the point that HIV providers need to attend to their patients overall health needs and not just to HIV-related morbidity.Subscribe Now for Access
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