HIV Care and Viral Suppression During the Last Year of Life: A Comparison of HIV-Infected Persons Who Died of HIV-Attributable Causes With Persons Who Died of Other Causes in 2012 in 13 US Jurisdictions.

William K Adih,Xiuchan Guo,Richard M Selik,H Irene Hall

doi:10.2196/publichealth.6206

Abstract

BackgroundLittle information is available about care before death among human immunodeficiency virus (HIV)–infected persons who die of HIV infection, compared with those who die of other causes.ObjectiveThe objective of our study was to compare HIV care and outcome before death among persons with HIV who died of HIV-attributable versus other causes.MethodsWe used National HIV Surveillance System data on CD4 T-lymphocyte counts and viral loads within 12 months before death in 2012, as well as on underlying cause of death. Deaths were classified as “HIV-attributable” if the reported underlying cause was HIV infection, an AIDS-defining disease, or immunodeficiency and as attributable to “other causes” if the cause was anything else. Persons were classified as “in continuous care” if they had ≥2 CD4 or viral load test results ≥3 months apart in those 12 months and as having “viral suppression” if their last viral load was <200 copies/mL.ResultsAmong persons dying of HIV-attributable or other causes, respectively, 65.28% (2104/3223) and 30.88% (1041/3371) met AIDS criteria within 12 months before death, and 33.76% (1088/3223) and 50.96% (1718/3371) had viral suppression. The percentage of persons who received ≥2 tests ≥3 months apart did not differ by cause of death. Prevalence of viral suppression for persons who ever had AIDS was lower among those who died of HIV but did not differ by cause for those who never had AIDS.ConclusionsThe lower prevalence of viral suppression among persons who died of HIV than among those who died of other causes implies a need to improve viral suppression strategies to reduce mortality due to HIV infection.

Highlights

As human immunodeficiency virus (HIV)–infected persons are surviving to older ages, the spectrum of causes of death among them is changing—the proportion of deaths in which HIV infection was the underlying cause has decreased, while the proportion of deaths due to causes not clearly attributable to HIV has increased [1,2,3]
The percentage of persons with late-stage disease in the 12 months before death was more than twice as great among persons who died of HIV-attributable causes (65.28%, 2104/3223; Table 1) as among persons who died of non–HIV-attributable causes (30.88%, 1041/3371; Table 2)
The percentages with ≥1 CD4 or viral load test was ≥74% for most demographic groups and transmission categories but somewhat lower for persons who never had stage 3 disease (AIDS; 69.0%, 191/277 and 64.7%, 522/807 among persons who died of HIV-attributable and non–HIV-attributable causes, respectively) and persons whose diagnosis of HIV infection was ≤12 months before their death due to non–HIV-attributable causes (67.8%, 124/183).The percentage of persons with viral suppression was lower in most demographic and behavioral groups of persons who died of HIV-attributable causes than in their counterparts of persons who died of other causes

Summary

Introduction

As human immunodeficiency virus (HIV)–infected persons are surviving to older ages, the spectrum of causes of death among them is changing—the proportion of deaths in which HIV infection was the underlying cause has decreased, while the proportion of deaths due to causes not clearly attributable to HIV has increased [1,2,3]. Little information is available about care and outcomes before death among http://publichealth.jmir.org/2017/1/e3/ XSLFO RenderX. Assessment of predeath care by cause of death can inform opportunities for intervention. We expanded the investigation to compare HIV-infected persons who died of an HIV-attributable underlying cause with those who died of another underlying cause with respect to (1) disease stage within 12 months before death and (2) measures of care in terms of frequency of CD4 T-lymphocyte counts or viral load measurements and viral suppression. Little information is available about care before death among human immunodeficiency virus (HIV)–infected persons who die of HIV infection, compared with those who die of other causes

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Discussion

Conclusion