Trends in Specific Causes of Death, AIDS-Related Deaths, and Early Mortality in People with HIV in Mexico: Annual Cross-Sectional Analysis of National Death Registries (2004-2015)

Abstract

Background: In Mexico, mortality in people with HIV (PWHIV) remained constant after the expansion of ART access. Information regarding specific causes of deaths and whether related or not to AIDS may provide further comprehension on the roots of this pattern. We estimated the unadjusted and adjusted frequencies of specific causes of deaths in people with HIV occurring in Mexico early after their diagnosis and describe specific causes of death over a 10-year period. Methods: Using National Death Registry data, we identified all deaths among PWHIV during 2004-2015. We defined late mortality (LM) as deaths occurring after one year of HIV-diagnosis, early mortality (EM) as deaths occurring within the first year, and very early mortality (VEM) as those occurring within the first month after HIV-diagnosis. We describe the frequency of specific causes of death, of AIDS-related deaths, and of EM and VEM by calendar-year and explore factors associated to AIDS-related deaths. Findings: There were 59,650 deaths in PWHIV: 48,797 (82%) in men; 47% of deaths were AIDS-related, 56% were EM, and 18% VEM. The probability of AIDS-related deaths decreased from 57% in 2004 to 48% in 2010, but remained constant afterwards. Over time, deaths due to unspecified pneumonia, infectious diseases not definitory of AIDS proportionally increased. Early (EM) and VEM deaths were more likely to be AIDS-related, when compared to LM. Interpretation: Persistent EM, increasing VEM, and constant frequency of AIDS-related deaths strongly suggest that persistence of late HIV-diagnosis in Mexico substantially contributes to lower than expected reductions in AIDS-related mortality. Non-AIDS associated deaths are a small proportion, with modest increases recently in cerebral/myocardial vascular events, renal disorders, and non-AIDS-defining neoplasias. These results indicate that policy efforts should be directed to expand HIV-diagnosis and early linkage to care. Funding Statement: This work was partially supported by the NIH-funded Caribbean, Central and South America network for HIV epidemiology (CCASAnet), a member of the International Epidemiologic Databases to Evaluate AIDS (leDEA) (U01AI069923). Declaration of Interests: Yanink Caro-Vega, Pablo F Belaunzaran-Zamudio, Brenda Crabtree-Ramirez, Jesus Alegre-Diaz, Raul Ramirez-Reyes, Pablo Kuri- Morales, Malaquias Lopez-Cervantes have no conflicts to declare. Juan. Sierra- Madero reports personal fees and non-financial support from Gilead, non-financial support from MSD, grants from BMS, grants from Pfizer, personal fees from Jansen all outside the submitted work. Ethical Approval Statement: Not required.