Abstract
BackgroundWe 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.MethodsMortality 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).ResultsThere 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).ConclusionsPersons 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.
Highlights
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
Characteristics of the HIV-infected subjects who died On 1 January 1999, there were 879 individuals aged 2059 years in follow-up in Navarre who had been diagnosed with HIV infection, and 266 new cases were added by the end of 2006
68% were men, 63% had a history of intravenous drug use, and 35% had a previous diagnosis of AIDS or were diagnosed with AIDS during follow-up
Summary
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. Many studies evaluating the effect of combined antiretroviral treatments on mortality in HIV-infected persons have been done in cohorts of patients during clinical follow-up [11], or who were being followed up regularly in HIV clinics [3,4,12,13], or who were beginning to receive combined antiretroviral treatment [14,15] Such studies may under-represent persons who died before the beginning medical follow-up, do not have regular check-ups, are difficult to recruit, or died from causes unrelated to HIV infection.
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