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Advent of HAART Associated With Shift in Causes of Death in HIV-Infected Individuals

Advent of HAART Associated With Shift in Causes of Death in HIV-Infected Individuals

SEATTLE—The proportions of deaths in HIV-infected individuals caused by
non-AIDS-related diseases have increased since the advent of highly active
antiretroviral therapy (HAART), according to a study presented at the 9th
Conference on Retroviruses and Opportunistic Infections (abstract 14). Mitchell
I. Wolfe, MD, MPH, medical epidemiologist, Division of HIV/AIDS Prevention,
Centers for Disease Control and Prevention (CDC), presented the data.

Dr. Wolfe and his colleagues compared proportions of death from various causes for 4,870 HIV-infected individuals dying in the pre-HAART era
(1992-1995) and 2,318 HIV-infected individuals dying in the HAART era
(1996-2000). The data were obtained from an ongoing national cohort study that
has followed more than 54,000 HIV-infected individuals since 1990. The deaths
are based on causes of death from the death certificate or significant
diagnoses at death based on medical record review.

After the advent of HAART, there was a significant decrease in the
proportion of deaths caused by tuberculosis (-59%), nontuberculosis
mycobacterial disease (-30%), Pneumocystis carinii pneumonia (-30%), and toxoplasmosis (-30%).

In contrast, there was a significant increase in the proportion of deaths
caused by liver disease (70%), non-Hodgkin’s lymphoma (43%), cachexia/wasting
(22%), kidney disease (27%), and sepsis (10%). There was also a nonsignificant
80% increase in the proportion of deaths caused by ischemic heart disease.

The observed decrease in proportion of deaths from AIDS-related causes is
consistent with published reports and national data from death certificates. In
1995, there were over 45,000 reported deaths with HIV infection listed,
compared with just over 15,000 such deaths in 1999. "This decrease is
largely attributable to decreases in deaths due to HIV-related causes,"
Dr. Wolfe said.

The observed increase in proportion of deaths from non-AIDS-related causes
did not, in most cases, reflect an increase in the absolute incidence of death
from these causes, Dr. Wolfe cautioned.

Nonetheless, the data support closer scrutiny of two factors that may now
have a relatively greater influence on the survival of HIV-infected patients:
adverse effects of antiretroviral drugs and prolongation of life, which opens
the window for other causes of death.

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