Mortality among Participants in the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study

Abstract

Many studies that have reported decreases in human immunodeficiency virus (HIV)-related mortality since the advent of highly active antiretroviral therapy (HAART) have also reported steady increases in non-HIV-related mortality over the same time periods. We examined temporal trends and risk factors for accident- and injury-related mortality among HIV-infected and -uninfected participants in the Women's Interagency HIV Study (WIHS) and the Multicenter AIDS Cohort Study (MACS). Information on causes of death was recorded for all participants in the MACS and WIHS cohort studies who died, and causes of death were categorized as accident- or injury-related deaths or not. Mortality rates were calculated by time periods, prior to the widespread use of HAART (before 1997) and after (1997-2002), and risk factors. Cause of death information was available for 619 women in the WIHS who died (during the period 1994-2002) and 1830 men in the MACS who died (during the period 1984-2002). The death rates were higher for accident- or injury-related mortality in the WIHS (2.96 deaths per 1000 person-years for the HIV-infected group and 2.96 per 1000 person-years for the HIV-uninfected group), compared with the participants in MACS (0.79 deaths per 1000 person-years for the HIV-infected group and 0.63 per 1000 person-years for the HIV-uninfected group). In the final multivariate analysis, the following factors were associated with significantly higher risk in men: higher education, depressive symptoms, and a greater number of sex partners. Among women, the significant risk factors for death were decreased CD4+ T cell count, unemployment, higher alcohol use, and injection drug use. The characteristics of the men in the MACS who died and women in the WIHS who died differ, as do the risk factors for mortality. These results characterize important target groups for interventions to reduce accident- and injury-related deaths.