Changes in the cause of death among HIV positive subjects across Europe: results from the EuroSIDA study

• Published in: AIDS (London) Vol. 16; no. 12; pp. 1663 - 1671
• Main Authors: MOCROFT, A, BRETTLE, R, KIRK, O, BLAXHULT, A, PARKIN, J. M, ANTUNES, F, FRANCIOLI, P, D'ARMINIO MONFORTE, A, FOX, Z, LUNDGREN, J. D
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 16.08.2002
• Subjects: AIDS/HIV; Biological and medical sciences; Cause of Death; Europe - epidemiology; Female; HIV Infections - complications; HIV Infections - mortality; Human viral diseases; Humans; Incidence; Infectious diseases; Male; Medical sciences; Medicin och hälsovetenskap; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Europe; Infection; Human; Immunopathology; Prognosis; Pathogenesis; Viral disease; Mortality; Risk factor; AIDS; Immune deficiency
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/00002030-200208160-00012

The causes of death among HIV-positive patients may have changed since the introduction of highly active antiretroviral therapy (HAART). We investigated these changes, patients who died without an AIDS diagnosis and factors relating to pre-AIDS deaths. Analyses of 1826 deaths among EuroSIDA patients, an observational study of 8556 patients. Incidence rates of pre-AIDS deaths were compared to overall rates. Factors relating to pre-AIDS deaths were identified using Cox regression. Death rates declined from 15.6 to 2.7 per 100 person-years of follow-up (PYFU) between 1994 and 2001. Pre-AIDS incidence declined from 2.4 to 1.1 per 100 PYFU. The ratio of overall to pre-AIDS deaths peaked in 1996 at 8.4 and dropped to < 3 after 1998. The adjusted odds of dying following one AIDS defining event (ADE) increased yearly (odds ratio, 1.53; P < 0.001), conversely the odds of dying following three or more ADE decreased yearly (odds ratio, 0.79; P < 0.001). The proportion of deaths that followed an HIV-related disease decreased by 23% annually; in contrast there was a 32% yearly increase in the proportion of deaths due to known causes other than HIV-related or suicides. Injecting drug users (IDU) were significantly more likely to die before an ADE than homosexuals (relative hazard, 2.97; P < 0.0001) and patients from northern/eastern Europe (relative hazard, 2.01; P < 0.0001) were more likely to die pre-AIDS than southern patients. The proportion of pre-AIDS deaths increased from 1994 to 2001; however, the incidence of pre-AIDS deaths and deaths overall declined. IDU and subjects from northern/eastern Europe had an increased risk of pre-AIDS death. HIV-positive patients live longer therefore it is essential to continue to monitor all causes of mortality to identify changes.